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We present the model we developed to reconstruct the CUORE radioactive background based on the analysis of an experimental exposure of 1038.4 kg yr. The data reconstruction relies on a simultaneous Bayesian fit applied to energy spectra over a broad energy range. The high granularity of the CUORE detector, together with the large exposure and extended stable operations, allow for an in-depth exploration of both spatial and time dependence of backgrounds. We achieve high sensitivity to both bulk and surface activities of the materials of the setup, detecting levels as low as 10 nBq kg-1 and 0.1 nBq cm-2, respectively. We compare the contamination levels we extract from the background model with prior radio-assay data, which informs future background risk mitigation strategies. The results of this background model play a crucial role in constructing the background budget for the CUPID experiment as it will exploit the same CUORE infrastructure.

Since the first plasma realized in 2020, a series of key systems on HL-3 (known as HL-2M before) tokamak have been equipped/upgraded, including in-vessel components (the first wall, lower divertor, and toroidal cryogenic/water-cooling/baking/glow discharge systems, etc.), auxiliary heating system of 11 MW, and 28 diagnostic systems (to measure the plasma density electron temperature, radiation, magnetic field, etc.). Magnet field systems were commissioned firstly for divertor plasma discharges. During the 2nd experimental campaign of HL-3 tokamak, several great progresses have been achieved. Firstly, the successful operation with plasma current larger than 1 MA was achieved under a divertor configuration. Secondly, the advanced divertor concept with two distinct snowflake configurations was realized. It is found that the distribution of ion saturation current and heat flux on bottom plate becomes wide due to magnetic surface expansion, demonstrating the advantage of such configuration in the heat flux mitigation. In addition, using the combination of NBI, ECRH and LHCD, the standard sawtoothing high confinement mode of megampere plasma was firstly accessed on the HL-3. The successful commissioning of HL-3 is beneficial for the initial operation of ITER.

Abstract: The flux ratios of gravitationally lensed quasars provide a powerful probe of the nature of dark matter. Importantly, these ratios are sensitive to small-scale structure, irrespective of the presence of baryons. This sensitivity may allow us to study the halo mass function even below the scales where galaxies form observable stars. For accurate measurements, it is essential that the quasar’s light is emitted from a physical region of the quasar with an angular scale of milli-arcseconds or larger; this minimizes microlensing effects by stars within the deflector. The warm dust region of quasars fits this criterion, as it has parsec-size physical scales and dominates the spectral energy distribution of quasars at wavelengths greater than 10μm. The JWST Mid-Infrared Instrument (MIRI) is adept at detecting redshifted light in this wavelength range, offering both the spatial resolution and sensitivity required for accurate gravitational lensing flux ratio measurements. Here, we introduce our survey designed to measure the warm dust flux ratios of 31 lensed quasars. We discuss the flux-ratio measurement technique and present results for the first target, DES J0405-3308. We find that we can measure the quasar warm dust flux ratios with 3 % precision. Our simulations suggest that this precision makes it feasible to detect the presence of 107 M⊙ dark matter halos at cosmological distances. Such halos are expected to be completely dark in Cold Dark Matter models.

PurposeUreteral access sheaths (UAS) pose the risk of severe ureteral injury. Our prior studies revealed forces ≤6 Newtons (N) prevent ureteral injury. Accordingly, we sought to define the force urologists and residents-in-training typically use when placing a UAS.Materials & methodsAmong urologists and urology residents attending two annual urological conferences in 2022, 121 individuals were recruited for the study. Participants inserted 12Fr, 14Fr, and 16Fr ureteral access sheaths into a male genitourinary model containing a concealed force sensor; they also provided demographic information. Analysis was completed using t-tests and Chi-square tests to identify group differences when passing a 16Fr sheath UAS. Participant traits associated with surpassing or remaining below a minimal force threshold were also explored via polychotomous logistic regression.ResultsParticipant force distributions were: ≤4N (29%), >6N (45%), and >8N (32%). More years of practice were significantly associated with exerting >6N relative to forces between 4-6N; results for >8N relative to 4N-8N were similar. Compared to high-volume ureteroscopists (those performing >20 ureteroscopies/month), physicians performing ≤20 ureteroscopies/month were significantly less likely to exert forces ≤4N (p=0.017 and p=0.041). Of those surpassing 6N and 8N, 15% and 18% respectively were high-volume ureteroscopists.ConclusionsDespite years of practice or volume of monthly ureteroscopic cases performed, most urologists failed to pass 16Fr access sheaths within the ideal range of 4N-6N (74% of participants) or within a predefined safe range of 4N-8N (61% of participants).

This corrects the article DOI: 10.1103/PhysRevLett.126.171801.

Heba Ashi,1 Marwah A Afeef,2 Faris M Almutairi,3 Razin H Subahi,4 Emad A Aljohani,5 Zuhair S Natto1 1Department of Dental Public Health, Faculty of Dentistry, King Abdulaziz University, Jeddah, Kingdom of Saudi Arabia; 2Department of Research & Studies, Al-Thagher Hospital, Jeddah, Kingdom of Saudi Arabia; 3Department of Respiratory Therapy, Al-Thagher Hospital, Jeddah, Kingdom of Saudi Arabia; 4Specialty Dental Centre. Al-Thagher Hospital, Jeddah, Kingdom of Saudi Arabia; 5Department of Health Services and Hospital Management, Al-Thagher Hospital, Jeddah, Kingdom of Saudi ArabiaCorrespondence: Marwah A Afeef, Al-Thagher Hospital, Jeddah, Kingdom of Saudi Arabia, Tel +966535732762, Email mafeef@moh.gov.saObjective: In this study, we aim to determine post-pandemic level of secondary traumatic stress and the associated factors among healthcare workers practicing in the Western province of Saudi Arabia.Methods: Healthcare workers practicing at public health sector of the Western province of Saudi Arabia. Received Web-based Self-administered questionnaire, assessing post-pandemic Secondary Traumatic Stress (STS), using Secondary Traumatic Stress Scale (STSS).Results: A total of 380 responses received. Logistic regression analysis identified significant predictors of secondary traumatic stress (STS). Females had a significantly higher likelihood of experiencing STS (OR=2.425, p< 0.001). Doctors were significantly more likely to experience STS compared to other specialties (OR=2.863, p=0.016). Participants sleeping 7 hours were associated with a lower likelihood of STS (OR=0.427, p=0.016), while sleeping 6 hours showed a trend towards lower STS but was not statistically significant (p=0.068). Participants aged 50 and above were significantly less likely to experience STS (OR=0.275, p=0.021). Lastly, Saudi nationals were significantly more likely to experience STS compared to non-Saudis (OR=2.717, p=0.014).Conclusion: Female healthcare workers, doctors, and those younger than 50 years old were all found to be at a significantly higher risk of STS. Interestingly, sleep duration emerged as a potential protective factor, with those sleeping 7 hours exhibiting a lower risk of STS. Finally, the analysis revealed a higher prevalence of STS among Saudi nationals compared to non-Saudis.Keywords: secondary traumatic stress, post-pandemic, healthcare workers, Saudi Arabia, public sector

Hatem A Emara,1,2,&ast; Eman Sobh,3,4,&ast; Raid Homoud Almohammadi,5 Emad Abdullah Alamri,5 Marwan MA Aljohani,1 Ayman Abdullah Alhammad1 1Physical Therapy Department, College of Medical Rehabilitation Sciences, Taibah University, Medina, Saudi Arabia; 2Department of Physical Therapy for Growth and Developmental Disorders in Children and Its Surgery, Faculty of Physical Therapy, Cairo University, Cairo, Egypt; 3Respiratory Therapy Department, College of Medical Rehabilitation Sciences, Taibah University, Medina, Saudi Arabia; 4Chest Diseases Department, Faculty of Medicine for Girls, Al-Azhar University, Cairo, Egypt; 5Department of Physical Therapy, Medical Rehabilitation Hospital, Ministry of Health, Medina, Saudi Arabia&ast;These authors contributed equally to this workCorrespondence: Hatem A Emara, Physical Therapy Department, College of Medical Rehabilitation Sciences, Taibah University, Medina, Saudi Arabia, P.o 344, Medina, 41411, Saudi Arabia, Tel +966564156262, Fax +966148618888, Email drhatem_emara@yahoo.comPurpose: Children with cerebral palsy (CP) have limited postural control and functional ability. TheraTogs was reported to improve postural stability. However, studies involving the functional ability and quality of life are limited. We aimed to investigate the effects of TheraTogs use as an orthotic garment and strapping system on the balance and functional ability of children with spastic diplegic CP and if wearing TheraTogs improves their quality of life.Patients and Methods: A total of 34 children (aged 5– 8 years) with spastic diplegic cerebral palsy participated in this study. The control group received conventional physical therapy (CPT), whereas the study group received CPT in addition to wearing TheraTogs. Balance, lower limb strength, and functional abilities were examined using the Biodex balance system, 30-s chair rise test, and Pediatric Evaluation of Disability Inventory-PEDI).Results: The measured parameters of postural stability significantly improved in both groups post-treatment (p< 0.05). The study group showed significant improvement in balance and lower limb strength compared to the traditional physical therapy group (p < 0.05). Both groups showed significant improvement in functional skill mobility (0.001 and 0.01 for control and study groups respectively) and caregiver assistance mobility scores (p=0.001 and < 0.001 for control and study groups respectively); however, there was no significant improvement in self-care ability with TheraTogs. The 30s sit-to-stand showed increased number of sit to stands in both groups post treatment (p=< 0.001 for both groups) and the study group showed significant improvement compared to the control group (p=0.01).Conclusion: The findings in this study suggest that both conventional physical therapy and TheraTogs are beneficial in improving balance and functional ability. TheraTogs could be utilized as a useful posture orthosis to help improve the balance and functional strength of children with spastic diplegic cerebral, palsy indicating improved quality of life.Keywords: children with cerebral palsy, TheraTogs, functional ability, 30-s Sit-to-Stand Test, pediatric evaluation of disability inventory

Abstract X-Ray micro-computed tomography (XCT) is used to reveal the micro-structural changes of banana pseudostem nanocellulose bioplastic due to a biodegradation process initiated in a formulated composting media that allowed the growth of aerobic microflora. The bioplastic itself was made of nanocellulose, which was isolated from banana pseudostem using the 2,2,6,6-Tetramethyl-1-piperidinyloxy (TEMPO) mediated oxidation method, and polyethylene glycol (PEG) as plasticiser. XCT provided insights into the 3D structural change of the bioplastic identifying the degradation process at two scales. The results showed that the local thickness and roughness of the bioplastic increased after degradation, while the density of the material decreased. Enlarged voids and tunnels were observed in the material after degradation. The formation of these tunnels is attributed to the popping of internal PEG-containing voids because of the generation of gases, which after forming may further accelerate biodegradation by microbial activity.

Kenneth Kenyon,1 Eugene B McLaurin,2 Steven M Silverstein,3 John C Meyer,4 Erik Anderson,5 Ravi H Patel,6 Paul J Gomes,7 Erin Reilly,8 Srilatha Vantipalli,8 Matthew W Cheung,8 Michael H Goldstein8 1Andover Eye Associates, Andover, MA, USA; 2Total Eye Care, P.A., Memphis, TN, USA; 3Silverstein Eye Centers, Kansas City, MO, USA; 4The Eye Care Institute, Louisville, KY, USA; 5Vision Institute, Colorado Springs, CO, USA; 6Eye Associates of Texas, Round Rock, TX, USA; 7Ora, Inc., Andover, MA, USA; 8Ocular Therapeutix, Inc., Bedford, MA, USACorrespondence: Matthew W Cheung, Ocular Therapeutix, Inc., 15 Crosby Drive, Bedford, MA, 01730, USA, Tel +1 516-287-7678, Email mcheung@ocutx.comPurpose: To evaluate the efficacy and safety of a dexamethasone intracanalicular insert (DEX) for treatment of allergic conjunctivitis (AC).Patients and Methods: In this multicenter, randomized, double-masked, placebo-controlled phase 3 study, adults (≥ 18 years) with AC were randomized 1:1 to DEX or placebo insert (PBO) placed bilaterally. Subjects underwent repetitive conjunctival allergen challenges (CAC) across 30 days and were assessed for changes in AC signs and symptoms. The primary endpoint was ocular itching score at 3, 5, and 7 minutes post-CAC at Day 8 (7 days post-insertion). This trial is registered on ClinicalTrials.gov (NCT04050865).Results: Ninety-six subjects were randomized (n=48 DEX, n=48 PBO). Compared to PBO, there were statistically significant treatment differences favoring DEX for the primary endpoint of mean ocular itching score at Day 8 (− 0.86, − 0.98, − 0.96 at 3, 5, and 7 minutes post-CAC respectively; P< 0.0001 for all). Treatment differences favored DEX for all 24 time points across 6 visits and were statistically significant (P< 0.05) except for the first post-insertion (Day 7, 3 minutes). For the 18 time points at which conjunctival redness was assessed, DEX had lower scores than PBO (P< 0.05 for all). The most common ocular adverse events (AEs) in DEX subjects were eye discharge and irritation. No serious AEs, elevated intraocular pressure, dacryocanaliculitis, or use of rescue medications were reported.Conclusion: Results of this study support the potential use of dexamethasone insert as a physician-administered, preservative-free treatment for AC, with significant improvements in ocular itching and conjunctival redness compared with placebo. The dexamethasone insert was generally safe with a favorable safety profile.Keywords: allergy, conjunctivitis, dexamethasone, insert, intracanalicular

Abdullah M Alzahrani,1– 3,&ast; Razan Rambo,1– 3 Fahad Alotain,1– 3 Anjum Naeem,1– 3 Rami M Alzhrani,4 Mohammad A Albaradi,1– 3 Shoeb Althubiani,1– 3 Shahd E Sharaf,1– 3 Ali F Alwadie,1– 3 Mohammad S Alzahrani,5 Noor T AlSebaih,6 Randa H Ainosah,7 Yahya A Alzahrani7,&ast; 1Pharmaceutical Care Department, Ministry of National Guard—Health Affairs, Jeddah, 22384, Saudi Arabia; 2King Abdullah International Medical Research Center, Jeddah, 21423, Saudi Arabia; 3College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, 22384, Saudi Arabia; 4Department of Pharmaceutics and Industrial Pharmacy, College of Pharmacy, Taif University, Taif, 21944, Saudi Arabia; 5Department of Clinical Pharmacy, College of Pharmacy, Taif University, Taif, 21944, Saudi Arabia; 6Pharmaceutical Care Department, King Fahad Armed Forces Hospital, Jeddah, 23311, Saudi Arabia; 7Department of Pharmacy, East Jeddah Hospital, Ministry of Health, Jeddah, 23816, Saudi Arabia&ast;These authors contributed equally to this workCorrespondence: Yahya A Alzahrani, Department of Pharmacy, East Jeddah Hospital, Ministry of Health, Jeddah, 23816, Saudi Arabia, Tel +966557700178, Email yalzahrani5@moh.gov.saPurpose: Patient satisfaction with pharmacy services, particularly in outpatient and discharge pharmacy settings, has become a vital metric for assessing medical quality. However, there’s limited research on patient satisfaction in discharge pharmacy services in the Kingdom of Saudi Arabia (KSA). This study aims to systematically investigate and delineate the various patient-related and non-patient-related factors that significantly impact patient satisfaction in the realm of discharge pharmacy services.Patients and Methods: This cross-sectional study was conducted over three months at King Abdulaziz Medical City in Jeddah (KAMC-J). The sample size was determined using a single population proportion formula, which resulted in a required sample size of 384 patients. A validated questionnaire with a five-point Likert scale evaluated satisfaction from “Strongly Dissatisfied” (1 point) to “Very Satisfied” (5 points) has been used. Data collectors underwent training and obtained written consent from participants, with questionnaire completion taking 5– 10 minutes face to face.Results: The study encompassed 437 participants, primarily male (59%) with a college education (45.3%), residing mostly in Jeddah (67.3%). Notably, 84.4% were not healthcare providers, and most visited the pharmacy every six months (44.6%). The patient satisfaction survey revealed high scores for counseling understanding, pharmacist courtesy, and the way the pharmacist answered questions (4.94± 0.31, 4.94± 0.27, 4.94± 0.32; respectively), but lower for understanding possible side effects (4.30± 1.30) and pharmacy location (4.57± 0.99). In logistic regression, visits lasting 10– 15 minutes, and less than 10 minutes were significantly (p< 0.05) associated with increased odds of patient satisfaction (OR=6.39, OR=9.45; respectively) Moreover, the medium length hospital stay was associated with decreased odds of patient satisfaction (OR=0.31, p=0.026).Conclusion: In conclusion, the study determined a significant proportion of patients are satisfied with discharge pharmacy services at KAMC-J, with the length of consultation and hospital stay being pivotal to their satisfaction. Addressing these factors, alongside optimizing pharmacist-patient communication and pharmacy service efficiency, can substantially elevate the quality of pharmaceutical care and patient experience.Keywords: King Abdulaziz medical city, KAMC-J, Discharge pharmacy, Patient Satisfaction, Counseling Services, Pharmacist-Patient Relationship, Pharmacy Location and Environment

Ziyad F Al Nufaiei,1,2 Reem H Alluhibi,1,2 Mashael B Alsabiti,1,2 Haya Onaybisi,1,2 Lama M Alahmadi,1,2 Shatha A Jabal,1,2 Raid M Al Zhranei1,2 1Respiratory Therapy Department, College of Applied Medical Sciences, King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia; 2King Abdullah International Medical Research Center, Jeddah, Saudi ArabiaCorrespondence: Ziyad F Al Nufaiei, Department of Respiratory Therapy College of Applied Medical Sciences-Jeddah King Saud bin Abdulaziz University for Health Sciences, P.O.Box.9515, Mail Code 6610, Jeddah, 21423, Saudi Arabia, Tel +966551600060 Ext 46125, Email nufaieiz@ksau-hs.edu.saBackground: Obstructive sleep apnea (OSA), if left untreated, can have major negative effects on health, such as an elevated risk of diabetes, heart disease, and stroke. Increasing people’s knowledge of this illness might lessen the stigma associated with sleep problems and motivate them to get treatment if they think they might have OSA.Aim of the Study: This study aims to assess the knowledge and awareness of OSA among patients’ families in Saudi Arabia.Methods: A phenomenological-oriented study with in-depth interviews was used to collect data from 28 participants.Results: Two themes and subthemes emerged from the interviews, revealing significant knowledge gaps, especially regarding the health risks and management of OSA. Only a few participants were aware of the serious health implications of untreated OSA. Furthermore, many did not know about effective management strategies for OSA.Conclusion: The level of awareness and knowledge among participants was poor, with participants’ lifestyles significantly affected by having relatives with OSA. They expressed concerns about challenges with CPAP adherence and recommended various coping techniques to support affected individuals.Keywords: obstructive sleep apnea, lifestyles, knowledge & awareness, qualitative design, snoring, health literacy

Jordan G Kassab, R Hayden Meeks, Werner TW de Riese Department of Urology, Texas Tech University Health Sciences Center, Lubbock, TX, USACorrespondence: Werner TW de Riese, Email werner.deriese@ttuhsc.eduAbstract: Prostate cancer (PCa) currently stands as the most common malignancy and the second most common cause of death in men worldwide. Dr. C. Huggins revolutionized the field of PCa treatment through his work investigating the therapeutic effects of androgen deprivation. These early surgical castration methods were expanded upon by integrating reversible pharmacologic castration via biologic agonists. Following this, intermittent ADT (iADT) became a medical substitute for its continuous counterpart. This data synthesis aims to highlight and assess the pertinent adverse effects of ADT, to compare mortality for PCa treatment plans, and consequently provide direction for clinicians in choosing the suitable systemic ADT approach. We performed a thorough systematic search across the PubMed database to identify prospective randomized clinical trials (RCTs) comparing continuous and intermittent androgen deprivation therapy (cADT and iADT). Our qualitative analysis aimed to evaluate the potential of iADT as an alternative treatment approach, emphasizing recent clinical outcomes. The analysis of randomized control trials in the literature revealed no discernable statistical difference in PCa-specific mortality in comparison of iADT and cADT treatments. Further, in the analysis of mortality due to non-PCa causes, iADT patients fared more favorably compared to cADT. Due to iADT’s characteristics of being more cost-efficient and less likely to cause undesirable side effects, urologic healthcare professionals should be made aware of these findings when counseling patients on the optimal form of ADT and consulting for future treatment guidelines.Keywords: androgen deprivation therapy, prostate cancer, cancer mortality

Pati Aji Achdiat,1 Dini Atiyah,1 Fitri Yulianti,1 Endang Sutedja,1 Srie Prihianti Gondokaryono,1 Hermin Aminah Usman,2 Retno Hesty Maharani1 1Department of Dermatology and Venereology, Faculty of Medicine, Universitas Padjadjaran – Dr. Hasan Sadikin General Hospital, Bandung, Indonesia; 2Department of Pathology Anatomy, Faculty of Medicine, Universitas Padjadjaran - Dr. Hasan Sadikin General Hospital, Bandung, IndonesiaCorrespondence: Pati Aji Achdiat, Department of Dermatology and Venereology, Faculty of Medicine, Universitas Padjadjaran – Dr. Hasan Sadikin General Hospital, Jl. Pasteur No. 38, Bandung, West Java, 40161, Indonesia, Tel/Fax +62222032426 Ext. 3449, Email pati.aji.achdiat@unpad.ac.idIntroduction: Anogenital warts (AGW) are sexually transmitted infections (STIs) caused by the human papillomavirus (HPV), particularly types 6 and 11. The highest incidence of AGW occurs in the age group of 15– 24 years. However, as life expectancy increases, there is a significant rise in the geriatric population worldwide. This demographic shift is directly proportional to the increasing number of STIs cases within the geriatric group.Cases: A case of AGW was reported in a 75-year-old man who had a history of erectile dysfunction medication use and recent sexual contact. During the physical examination, a hyperpigmented plaque with a verrucous surface was observed at the base of the penis. The results of the histopathological examination were consistent with the characteristics of AGW. In addition, HPV genotyping, through polymerase chain reaction (PCR) showed the presence of HPV type 6.Discussion: The aging process leads to a decline in immune function among geriatric individuals, which causes susceptibility to infections, including STIs. Moreover, the geriatric population has a different level of susceptibility to STIs compared to younger individuals. Factors such as physiological changes, decreased sexual function, low awareness of STIs, and having multiple sexual partners further increase the risk of STIs in this age group.Conclusion: Sexual intercourse is an important component of the human life. However, the natural decline in sexual function due to the aging process often occurs with advancing age. As a result, many geriatrics seek various solutions in order to maintain sexual function and activity in old age. Since STIs can occur at any age, early detection and education are essential, particularly for the geriatric population.Keywords: anogenital warts, geriatric, HPV, immunosenescence, sexually transmitted disease

Hsiang-Yu Ma, Nein-Tsu Chiang, Rui-Hsin Kao, Chih-Ying Lee Department of Ocean and Border Management, National Quemoy University, Kinmen, TaiwanCorrespondence: Rui-Hsin Kao, Department of Ocean and Border Management, National Quemoy University, 1 University Road Jinning Township, Kinmen, 892, Taiwan, Email toptop074@yahoo.com.twBackground: Research indicates that a significant number of healthcare workers accounted for all confirmed Coronavirus disease 2019 (COVID-19) cases, and many of the infected healthcare workers were asymptomatic. During the COVID-19 outbreak, a considerable number of people in Taiwan contracted the disease. Therefore, health workers in Taiwan often experienced lack of medical resources, and this problem is worse for outer island areas. In terms of stress and mental health, this study investigated the effect of poor healthcare capacity and high workload on health workers during the COVID-19 pandemic. This study also explored mindfulness-based stress reduction and resilience in health workers.Methods: This study conducted an in-depth interview to investigate stress perceived by health workers in a hospital located on an outer island of Taiwan as well as their mental health and stress relieving strategies.Results: It was found that during the COVID-19 outbreak, some common sources of stress for health workers included exposure to infectious diseases, heavy workloads, facing ethical dilemma in clinical decision-making, and unfamiliar problems from the pandemic. These types of stress cause worries, anxiety, and depression in health workers, which affects their mental and physical health as well as their patient-care performance.Conclusion: This study proposed that mindfulness-based stress reduction and protecting mental health are important for health workers.Keywords: health workers, stress and mental health, mindfulness-based stress reduction and resilience, COVID-19 pandemic

Haemoglobin (Hb) Malay is variant haemoglobin with a β++ thalassemia phenotype. The prevalence of Hb Malay in the Malaysian population was 5.5%. We describe a 58-year-old male who presented with symptomatic anaemia to the Hospital Universiti Sains Malaysia. Further history revealed that the patient had anaemia since the age of 28, and on regular follow-up at other hospital. Physical examination revealed pallor, jaundice and hepatosplenomegaly. The full blood count and peripheral blood smear showed hypochromic microcytic anaemia with anisopoikilocytosis, and many target cells. High-performance liquid chromatography results showed a β thalassemia trait. However, the diagnosis does not alight with the patient’s condition. Bone marrow aspirate was completed and showed reactive changes and erythroid hyperplasia. A molecular test was then performed for β globin gene mutation detection using Multiplex Amplification Refractory Mutation System (M-ARMS) PCR method. This revealed the result as homozygous codon 19 mutation or Hb Malay. Therefore, in this case report we would like to highlight the laboratory approaches, the challenges faced by the usual haematological investigations and the importance role of molecular testing in the diagnosis of severe anaemia.

Ziyad F Al Nufaiei,1,2 Hassan Z Omar,1,2 Raed G Alghamdi,1,2 Saeed D Felemban,1,2 Raid M Al Zhranei,1,2 Maher Alsulami,2,3 Reem H Alluhibi,1,2 Waad A Alsulami,2,4 Majid S Al-Thaqafy,2,4– 6 Emad I Abdelrahman7 1Department of Respiratory Therapy, College of Applied Medical Sciences, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia; 2King Abdullah International Medical Research Center, Jeddah, Saudi Arabia; 3Department of Emergency Medical Service, College of Applied Medical Sciences, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia; 4Research Unit, College of Applied Medical Sciences, King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia; 5Department of Infection Prevention and Control, King Abdulaziz Medical City, Jeddah, Saudi Arabia; 6College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia; 7Albayt Medical General Center, Mecca, Saudi ArabiaCorrespondence: Ziyad F Al Nufaiei, Department of Respiratory Therapy, College of Applied Medical Sciences-Jeddah, King Saud bin Abdulaziz University for Health Sciences, Mail Code 6610, P.O.Box.9515, Jeddah, 21423, Kingdom of Saudi Arabia, Tel +966551600060 Ext 46125, Email nufaieiz@ksau-hs.edu.saIntroduction: The coronavirus disease (COVID-19) is an infectious disease that has rapidly spread on a global scale. The entire world has fought tirelessly to combat this disease, which has had a significant impact on humanity. This study examines the effects of the COVID-19 pandemic on the performance of undergraduate healthcare students during internship, focusing on the leadership, social, and mental aspects.Methodology: A cross-sectional national survey was conducted among Saudi Arabia’s undergraduate health care students. From August to December of 2021, non-probability convenient sampling was employed in the study. Online-questionnaire was used to administer the three survey dimensions—mental health, social life, and leadership—as well as the demographic profiles. Correlation coefficients were utilized to establish a meaningful connection between the independent variables and the study’s domains. Moreover, the Kruskal–Wallis tests were employed to efficiently compare the medians among the independent groups.Results: Two hundred and forty-one undergraduate healthcare students from a variety of backgrounds participated in this study. Mental health issues such as difficulty relaxing and increased irritability were prominent. From a sociological perspective, the majority of participants expressed a strong desire for more social interaction. Lastly, most participants in the leadership domain revealed satisfaction with their professional relationships. However, 50.7% of respondents expressed dissatisfaction with their incentives.Conclusion: The study concludes that addressing problems in the mental, social, and leadership domains is crucial to enhancing the resilience and overall well-being of undergraduate healthcare students during their internships. Anxiety and stress emerged as the most prevalent factors affecting these students. However, the presence of a positive relationship with their supervisors, as well as the support provided by healthcare organizations, played a vital role in helping them overcome these challenges.Keywords: COVID-19, internship, psychological well-being, stress, mental health, social life, leadership

Historical ecology draws on a broad range of information sources and methods to provide insight into ecological and social change, especially over the past ∼12000 yr. While its results are often relevant to conservation and restoration, insights from its diverse disciplines, environments, and geographies have frequently remained siloed or underrepresented, restricting their full potential. Here, scholars and practitioners working in marine, freshwater, and terrestrial environments on 6 continents and various archipelagoes synthesize knowledge from the fields of history, anthropology, paleontology, and ecology with the goal of describing global research priorities for historical ecology to influence conservation. We used a structured decision-making process to identify and address questions in 4 key priority areas: (1) methods and concepts, (2) knowledge co-production and community engagement, (3) policy and management, and (4) climate change impacts. This work highlights the ways that historical ecology has developed and matured in its use of novel information sources, efforts to move beyond extractive research practices and toward knowledge co-production, and application to management challenges including climate change. We demonstrate the ways that this field has brought together researchers across disciplines, connected academics to practitioners, and engaged communities to create and apply knowledge of the past to address the challenges of our shared future.

The great hammerhead shark Sphyrna mokarran and the scalloped hammerhead shark S. lewini are marine top predators with global distributions. However, limited information is available on the trophic ecology of hammerhead sharks in the Indian Ocean. In this study, we measured stable nitrogen and carbon isotopes in the muscle tissues of neonates and juveniles of S. mokarran and S. lewini from the waters of the western Arabian Gulf. In general, values of δ15N were lower in S. mokarran (10.8-18.7‰) than in S. lewini (12.2-18.7‰), indicating a reliance on food sources with low nitrogen values. Isotopic niche similarities were observed between female and male S. mokarran. We further observed considerable ontogenetic changes in the δ15N values of both S. mokarran and S. lewini neonates (a reduction from 19 to 12‰), reflecting the maternal effect. The effects of total length and sex on the nitrogen and stable isotope values were nonsignificant in S. mokarran juveniles. The western Arabian Gulf likely serves as a key feeding ground for both the neonates and the juveniles of S. mokarran. By contrast, S. lewini appears to have a low level of reliance on this region.

INTRODUCTION: Pollen is one of the most common triggers of an allergy or hay fever. It is a fine yellowish powder that fertilizes other plants and is carried by the wind, birds, insects, or other animals. Between 10% and 40% of the Indian population has a pollen allergy which makes it one of the most common outdoor allergies in the country. In Bengaluru, 20% of allergies are caused by pollens – Parthenium, Amaranthus spinosus, Prosopis juliflora, and Ricinus communis. AIMS: The aim was to study the therapeutic management of patients who are allergic to pollen at Bengaluru Allergy Centre and assessment of the quality of life (QOL) of patients. SETTINGS AND DESIGN: It was a prospective, interventional study conducted at Bengaluru Allergy Centre. SUBJECTS AND METHODS: Both male and female patients who have had chronic allergic rhinitis (CH AR) and also CH AR with other comorbidities and who have been taking treatment for more than 6 months are involved. The data were collected from case records of patients in the data collection form. Questionnaires were used to assess the QOL, and counseling was done to the pollen allergy patients. STATISTICAL ANALYSIS: A paired t-test was done using SPSS software for analyzing the P value, simple descriptive graphs, and pie charts, and the percentage was calculated. RESULTS: A total of 60 patients were enrolled in the study where 26 were male and 34 were female. The maximum number of patients was affected with weed pollen. Cynodon dactylon (13.97%) is the major sensitivity seen in patients. Sneezing, running nose, and itchy eyes are commonly seen in patients with AR due to pollens. The classification of AR with other comorbidities is CH AR (78.33%), CH AR + ANB (10%), CH AR + urticaria (6.66%), and CH AR + AD (5%). Patients’ symptoms were persistent at day (5%), night (8.33%), and both day and night (86.66%), whereas symptom severity in Bengaluru amounted to 41.66%, other than Bengaluru 16.66%, and both in and out of Bengaluru 41.66%. In Bengaluru Allergy Centre (BAC), the main treatment given is sublingual immunotherapy, nasal spray, vitamin supplements, pre- and probiotics, and influenza vaccine. Nasal and eye symptoms are commonly seen in patients with AR due to pollen, and QOL factors that significantly impacted were productivity at home/work, mental concentration, reading books or newspapers, outdoor life (e.g., sports and picnics), going out, visiting friends or relatives, sleeping, and tiredness. A decrease in the symptoms and an increase in the QOL were achieved by proper patient counseling and treatment. There is a significant reduction in symptom scores after the intervention. The intervention has a significant effect in reducing the symptom scores (t = 17.99, P < 0.001). CONCLUSIONS: It can be concluded that intervention by clinical pharmacists by way of patient counseling can help improve the reduction of symptoms and QOL of patients.

Zi-Lin Chen,1,2 Xiang Ding,3 Lin Zhuo,3 Rong-Hua Li,4 Hong Zhang1,5 1Teaching and Research Section of Clinical Nursing, Xiangya Hospital, Central South University, Changsha, Hunan, 410008, People’s Republic of China; 2Xiangya School of Nursing, Central South University, Changsha, Hunan, 410008, People’s Republic of China; 3Organ Transplant Center, Xiangya Hospital, Central South University, Changsha, Hunan, 410008, People’s Republic of China; 4Nuclear Medicine Department, Xiangya Hospital, Central South University, Changsha, Hunan, 410008, People’s Republic of China; 5National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, 410008, People’s Republic of ChinaCorrespondence: Hong Zhang, Email Zhong2800@csu.edu.cnBackground: Kidney transplantation is a critical treatment for end-stage renal disease (ESRD), with health-promoting lifestyle (HPL) significantly impacting patient outcomes. HPL involves behaviors like regular exercise, balanced nutrition, stress management, and habit modification. However, few studies have analyzed the HPL of renal transplant recipients, addressing a significant gap in current research.Objective: This study aimed to determine the predictors of HPL in renal transplant recipients using the Chinese Health Promoting Lifestyle Profile (HPLP).Methods: This cross-sectional study enrolled renal transplant recipients completing the revised Chinese HPLP at organ transplant center in a tertiary hospital in Hunan Province of China between May 2022 and July 2022.Results: A total of 450 patients were included, comprising 256 males (56.9%), with a mean age of 44.85 ± 10.57 years. The mean score of self-actualization, health responsibility, interpersonal support, physical activity, stress management, nutrition, and overall HPLP were 15.27 ± 5.03 (possible range: 0– 24), 11.41 ± 4.18 (possible range: 0– 24), 11.61 ± 3.13 (possible range: 0– 18), 7.53 ± 3.79 (possible range: 0– 18), 12.68 ± 3.61 (possible range: 0– 21), 11.17 ± 2.41 (possible range: 0– 15), and 69.66 ± 16.98 (possible range: 0– 120), respectively. Multivariate logistic regression analysis showed that urban residence (OR = 2.061, 95% CI: 1.350– 3.148, P = 0.001), non-smoking after transplantation (OR = 2.010, 95% CI: 1.123– 3.600, P = 0.019) and two post-transplant complications (OR=0.387, 95% CI: 0.218– 0.689, P = 0.001).Conclusion: Although renal transplant recipients exhibit a moderate level of HPL, targeted interventions are essential to improve these behaviors. These interventions should focus especially on individuals from rural households, post-transplant smokers, and those experiencing post-transplant complications, to enhance their quality of life and clinical outcomes.Keywords: health promotion, healthy lifestyle, kidney transplantation, cross-sectional study

Mira Sekar Arumi,1,2 Marina Sulastiana,1 Anissa Lestari Kadiyono,1 Retno Hanggarani Ninin1 1Faculty of Psychology, Universitas Padjadjaran, Bandung, West Java, Indonesia; 2Faculty of Psychology, Universitas Bhayangkara Jakarta Raya, Jakarta, Jakarta, IndonesiaCorrespondence: Marina Sulastiana, Universitas Padjadjaran, Jatinangor, West Java, 45363, Indonesia, Tel +6222-84288828, Email marina.sulastiana@unpad.ac.idBackground: Despite the importance of understanding ethical climates in Indonesian organizations, a standardized scale for measuring this is lacking. Therefore, this study aims to adapt, validate, and ensure the consistency of the Ethical Climate Questionnaire (ECQ) within Indonesia’s cultural context.Methods: Data were collected from 565 Indonesian individuals aged 18 or older, using an online survey and convenience sampling. To ensure accurate measurements, Beaton’s guidelines were followed. Reliability was assessed using Cronbach’s alpha and McDonald’s omega, while validity was examined through various analyses including content validity index and confirmatory factor analysis.Results: The Indonesian version of the ECQ measures egoist, benevolent, and principled ethical climates reliably (Cronbach’s alpha: egoism=0.809, principle=0.920, benevolence=0.910). Validity analyses confirm the questionnaire’s validity. Demographic analysis shows age impacts the principle dimension, while organizational type affects all dimensions.Conclusion: The Indonesian version of the ECQ demonstrates strong psychometric properties and cross-cultural adaptability, making it a valuable tool for assessing ethical climates among Indonesian individuals aged 18 or older.Keywords: ethical climate, Indonesian context, test validation, test adaptation

Transcriptomic and proteomic analysis were performed on 72 h biofilms of the acneic strain Cutibacterium acnes and planktonic cultures in the presence of epinephrine. Epinephrine predominantly downregulated genes associated with various transporter proteins. No correlation was found between proteomic and transcriptomic profiles. In control samples, the expression of 51 proteins differed between planktonic cultures and biofilms. Addition of 5 nM epinephrine reduced this number, and in the presence of 5 µM epinephrine, the difference in proteomic profiles between planktonic cultures and biofilms disappeared. According to the proteomic profiling, epinephrine itself was more effective in the case of C. acnes biofilms and potentially affected the tricarboxylic acid cycle (as well as alpha-ketoglutarate decarboxylase Kgd), biotin synthesis, cell division, and transport of different compounds in C. acnes cells. These findings are consistent with recent research on Micrococcus luteus, suggesting that the effects of epinephrine on actinobacteria may be universal.

Jaime E Dickerson Jr,1,2 Alison E Harvey,1 Reay H Brown1,3 1Sight Sciences, Inc., Menlo Park, CA, USA; 2North Texas Eye Research Institute, University of North Texas Health Science Center, Fort Worth, TX, USA; 3Atlanta Ophthalmology Associates, Atlanta, GA, USACorrespondence: Jaime E Dickerson Jr, Email Jaime.dickerson@unthsc.eduPurpose: To determine if there was an association between severity of glaucoma and intraocular pressure (IOP) and medication (med) outcomes for patients in the ROMEO (Retrospective, Observational, Multicenter Evaluation of OMNI) study.Setting: Eleven ophthalmology practices in 8 US states.Design: Post-hoc analysis of all eyes enrolled and treated with ab interno canaloplasty and trabeculotomy in the retrospective, multicenter ROMEO study.Methods: Eyes were grouped according to visual field mean deviation (MD): mild (MD better than − 6 dB), moderate (MD between − 6 and − 12 dB), advanced (− 12 dB or worse). IOP and med outcomes at 12 months were compared across groups. Least squares regression was used to assess the relationship of MD with month 12 IOP. Outcomes for 1st and last MD deciles were compared as a sensitivity analysis.Results: One hundred and twenty-seven eyes were available for analysis including 79 mild, 42 moderate, 6 advanced. Most eyes had a reduction in IOP at Month 12 (70%) with most at 18 mmHg or less. Percentage IOP reduction was similar across the groups (mild 16.9%, moderate 18.6%, advanced 18.0%) with mean month 12 IOP between 14 and 16 mmHg. Medications were also reduced in all three groups; − 0.8 (mild, P < 0.001), − 0.55 (moderate, P < 0.05), and − 1.0 (advanced, P = 0.139, ns). Regression analysis revealed no relationship between month 12 IOP and MD. Med reductions were observed for all groups with a reduction of 1 or more medications seen in (%, 95% CI) 69%, 59– 79 (mild), 50%, 35– 65 (moderate), and 60%, 21– 99 (advanced). Secondary interventions tended to have greater incidence with worse MD likely reflecting lower desired IOP targets.Conclusion: Analysis of data from the ROMEO study suggests that similar meaningful IOP and med reductions can be expected across the range of disease severity studied.Keywords: MIGS, canaloplasty, primary open-angle glaucoma, trabeculotomy, OMNI

Lisa Nijm,1,2 Cynthia Matossian,3 Michelle K Rhee,4 John D Stephens,5 Maria E Rosselson,6 Parag A Majmudar,6 Subba Rao Gollamudi,7 Ravi H Patel,8 Aditi Bauskar,9 Alyssa Montieth,9 Srilatha Vantipalli,9 Andrea Gibson,9 Jamie Lynne Metzinger,9 Michael H Goldstein,9 Rabia Gurses Ozden9 1Warrenville EyeCare and LASIK, Warrenville, IL, USA; 2University of Illinois Eye and Ear Infirmary, Chicago, IL, USA; 3CM Associates, LLC, New Hope, PA, USA; 4Icahn School of Medicine at Mount Sinai, New York, NY, USA; 5Tyson Eye, Fort Myers, FL, USA; 6Chicago Cornea Consultants, Ltd, Chicago, IL, USA; 7Eye Specialty Group, Memphis, TN, USA; 8Eye Associates of Central Texas, Round Rock, TX, USA; 9Ocular Therapeutix, Inc, Bedford, MA, USACorrespondence: Aditi Bauskar, Ocular Therapeutix, Inc, 15 Crosby Drive, Bedford, MA, 01730, USA, Tel +1 210-452-8029, Email abauskar@ocutx.comPurpose: To evaluate both the early experience of real-world patients treated with dexamethasone ophthalmic insert (0.4 mg; DEXTENZA®), hereafter referred to as DEX, after cataract surgery as well as staff/practice integration of DEX relative to eyedrops.Patients and Methods: This was a cross-sectional survey study of 23 cataract practices in the United States. Respondents were patients and practice staff who had experience with DEX following cataract surgery. Both patients and practice staff completed an online survey. Descriptive statistics summarized the survey responses to portray the experience of the respondents.Results: Surveys were completed by 62 patients and 19 practice staff. Almost all patients (93%) were satisfied or extremely satisfied with DEX. Patients highly preferred DEX (93%) to topical steroid drops (7%) based on past experiences with topical steroid drops. Most practice staff (95%) were satisfied or highly satisfied with DEX, reporting a 45% reduction in time spent educating patients on postoperative drop use and a 46% decrease in time spent addressing calls from pharmacies regarding postoperative medications.Conclusion: Incorporating the DEX insert into clinical practice in cataract surgery practices can improve patient adherence, while potentially providing significant savings to practices in terms of time spent educating patients and responding to patient and pharmacy call-backs.Keywords: intracanalicular dexamethasone insert, phacoemulsification, hands-free therapy, ocular pain, ocular inflammation, sustained-release drug delivery

Michel Kabamba Nzaji,1 Anselme Manyong Kapit,1 Kristen B Stolka,2 Shanice Fezeu Meyou,2 Charlie K Kasendue,3 Melissa Dahlke,4 Robert T Perry,4 Reena H Doshi,4 Brooke Noel Aksnes,4 Richard R Luce,3 Stephane Hans Bateyi Mustafa,5 Crispin Kazadi Mwina-Ngoie,5 Cikomola Mwana Wa Bene Aimé,5 Pia DM MacDonald,1,6 Claire J Standley7,8 1Social, Statistical, & Environmental Sciences, RTI International, Kinshasa, Democratic Republic of the Congo; 2Social, Statistical, & Environmental Sciences, RTI International, Research Triangle Park, NC, United States America; 3Division of Global Health Protection (DGHP), U.S. Centers for Disease Control and Prevention (CDC), Kinshasa, Democratic Republic of the Congo; 4Global Immunization Division (GID), U.S. Centers for Disease Control and Prevention (CDC), Atlanta, GA, United States America; 5Expanded Programme on Immunization (EPI), Ministry of Public Health & Hygiene, Kinshasa, Democratic Republic of the Congo; 6Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, United States America; 7Center for Global Health Science and Security, Georgetown University, Washington, DC, United States America; 8Heidelberg Institute of Global Health, University of Heidelberg, Heidelberg, GermanyCorrespondence: Michel Kabamba Nzaji, RTI International, Social, Statistical, & Environmental Sciences, Kinshasa, Democratic Republic of the Congo, Tel +243978467432, Email michelnzaji@yahoo.frBackground: Low levels of COVID-19 vaccination coverage in many countries prompted the use of rapid assessments to characterize barriers to vaccination and identify corrective measures. The World Health Organization recommended the use of intra-action reviews (IARs) to identify best practices, gaps, and lessons learned to make real-time improvements to the COVID-19 vaccination response.Objective: The Democratic Republic of the Congo (DRC) implemented a national IAR in July 2021 that was poorly attended by the provincial health level, where vaccination activities are planned and implemented. To bridge this gap, we proposed sub-national IARs focused on COVID-19 vaccine program implementation at the provincial level.Methods: Using the WHO methodology, we organized a four-day provincial IAR workshop and invited national, provincial and health zone Ministry of Health (MoH) representatives and private and non-governmental organizations involved in the provincial COVID-19 vaccination response. Participants were divided into six groups based on their expertise, affiliation, and role within the health system to assess and identify lessons learned, challenges and the solutions within each of the six technical areas: (1) coordination, planning and monitoring; (2) service delivery; (3) risk communication and community engagement; (4) adverse effects following immunization (AEFI); (5) logistics; (6) and data management, monitoring and evaluation.Results: The first provincial COVID-19 IAR was conducted in Goma, North Kivu, from January 19– 22, 2022. A total of 56 participants came from provincial and health zone offices, and non-governmental organizations. Through work group discussions, they identified best practices, challenges, and lessons learned, and made recommendations to improve implementation of vaccination activities and reach coverage targets. Activities were proposed to operationalize recommendations and address challenges to improve the provincial response.Conclusion: This provincial IAR was a useful tool for reviewing progress and areas of improvement, while evaluating aspects of the COVID-19 vaccine rollout. It provided a means to share information with vaccination partners on areas of intervention, tailored to the local context.Keywords: COVID-19, intra-action review, COVID-19 vaccination, public health preparedness and response, Democratic Republic of Congo, public health emergency management

We study the effect of magnification in the Dark Energy Survey Year 3 analysis of galaxy clustering and galaxy-galaxy lensing, using two different lens samples: a sample of luminous red galaxies, redMaGiC, and a sample with a redshift-dependent magnitude limit, MagLim. We account for the effect of magnification on both the flux and size selection of galaxies, accounting for systematic effects using the Balrog image simulations. We estimate the impact of magnification on the galaxy clustering and galaxy-galaxy lensing cosmology analysis, finding it to be a significant systematic for the MagLim sample. We show cosmological constraints from the galaxy clustering autocorrelation and galaxy-galaxy lensing signal with different magnifications priors, finding broad consistency in cosmological parameters in ΛCDM and wCDM. However, when magnification bias amplitude is allowed to be free, we find the two-point correlation functions prefer a different amplitude to the fiducial input derived from the image simulations. We validate the magnification analysis by comparing the cross-clustering between lens bins with the prediction from the baseline analysis, which uses only the autocorrelation of the lens bins, indicating that systematics other than magnification may be the cause of the discrepancy. We show that adding the cross-clustering between lens redshift bins to the fit significantly improves the constraints on lens magnification parameters and allows uninformative priors to be used on magnification coefficients, without any loss of constraining power or prior volume concerns.

Reactor neutrino experiments play a crucial role in advancing our knowledge of neutrinos. In this Letter, the evolution of the flux and spectrum as a function of the reactor isotopic content is reported in terms of the inverse-beta-decay yield at Daya Bay with 1958 days of data and improved systematic uncertainties. These measurements are compared with two signature model predictions: the Huber-Mueller model based on the conversion method and the SM2018 model based on the summation method. The measured average flux and spectrum, as well as the flux evolution with the ^{239}Pu isotopic fraction, are inconsistent with the predictions of the Huber-Mueller model. In contrast, the SM2018 model is shown to agree with the average flux and its evolution but fails to describe the energy spectrum. Altering the predicted inverse-beta-decay spectrum from ^{239}Pu fission does not improve the agreement with the measurement for either model. The models can be brought into better agreement with the measurements if either the predicted spectrum due to ^{235}U fission is changed or the predicted ^{235}U, ^{238}U, ^{239}Pu, and ^{241}Pu spectra are changed in equal measure.

We present a new determination of the smallest neutrino mixing angle θ_{13} and the mass-squared difference Δm_{32}^{2} using a final sample of 5.55×10^{6} inverse beta-decay (IBD) candidates with the final-state neutron captured on gadolinium. This sample is selected from the complete dataset obtained by the Daya Bay reactor neutrino experiment in 3158 days of operation. Compared to the previous Daya Bay results, selection of IBD candidates has been optimized, energy calibration refined, and treatment of backgrounds further improved. The resulting oscillation parameters are sin^{2}2θ_{13}=0.0851±0.0024, Δm_{32}^{2}=(2.466±0.060)×10^{-3}  eV^{2} for the normal mass ordering or Δm_{32}^{2}=-(2.571±0.060)×10^{-3}  eV^{2} for the inverted mass ordering.

Study questionsThe primary objective of this study is to determine what parental factors or specific ART may influence the risk for adverse cardiometabolic outcomes among children so conceived and their parents. The secondary objective of this study is to prospectively examine the effects of infertility or ART on the intrauterine environment, obstetric and neonatal outcomes.What is known alreadyPregnancies conceived with ART are at an increased risk of being affected by adverse obstetric and neonatal outcomes when compared to spontaneously conceived (SC) pregnancies among fertile women. Small cohort studies have suggested ART-conceived children may have a higher risk of long-term cardiometabolic disturbances as well. Currently, few studies have compared long-term cardiometabolic outcomes among ART-conceived children and non-IVF treated (NIFT) children, to children conceived spontaneously to parents with infertility (subfertile parents).Study design size durationThe Developmental Epidemiological Study of Children born through Reproductive Technologies (DESCRT) is a prospective cohort study that aims to: establish a biobank and epidemiological cohort of children born to subfertile or infertile parents who either conceived spontaneously (without assistance) or used reproductive technologies to conceive (all offspring were from couples assessed and/or treated in the same institute); prospectively examine the effects of infertility or ART on the intrauterine environment, obstetric and neonatal outcomes; and determine what parental factors or ART may influence the cardiometabolic risk of children so conceived. Pregnancies and resultant children will be compared by mode of conception, namely offspring that were conceived without medical assistance or SC or following NIFT, IVF with fresh embryo transfer or frozen embryo transfer (FET), and by fertilization method (conventional versus ICSI). DESCRT has a Child group evaluating long-term outcomes of children as well as a Pregnancy group that will compare obstetric and neonatal outcomes of children conceived since the commencement of the study. Recruitment started in May of 2017 and is ongoing. When the study began, we estimated that ∼4000 children would be eligible for enrollment.Participants/materials setting methodsEligible participants are first-trimester pregnancies (Pregnancy group) or children (Child group) born to parents who were evaluated at an infertility center in the University of California, San Francisco, CA, USA who were SC or conceived after reproductive treatments (NIFT, IVF ± ICSI, FET). Children in the Child group were conceived at UCSF and born from 2001 onwards. In the Pregnancy group, enrollment began in November of 2017.The primary outcome is the cardiometabolic health of offspring in the Child group, as measured by blood pressure and laboratory data (homeostatic model assessment for insulin resistance (HOMA-IR), oral glucose disposition). There are several secondary outcome measures, including: outcomes from parental survey response (assessing parent/child medical history since delivery-incidence of cardiometabolic adverse events), anthropomorphic measurements (BMI, waist circumference, skinfold thickness), and laboratory data (liver enzymes, lipid panel, metabolomic profiles). In the Pregnancy group, outcomes include laboratory assessments (bhCG, maternal serum analytes, soluble fms-like tyrosine kinase-1 (sFLT-1), and placental growth factor (PlGF)) and placental assessments (placental volume in the second and third trimester and placental weight at delivery). Importantly, aliquots of blood and urine are stored from parents and offspring as part of a biobank. The DESCRT cohort is unique in two ways. First, there is an extensive amount of clinical and laboratory treatment data: parental medical history and physical examination at the time of treatment, along with ovarian reserve and infertility diagnosis; and treatment specifics: for example, fertilization method, culture O2 status, embryo quality linked to each participant. These reproductive data will aid in identifying explanatory variables that may influence the primary cardiometabolic outcomes of the offspring-and their parents. Second, the DESCRT control group includes pregnancies and children SC from parents with subfertility, which may help to assess when infertility, as opposed to reproductive treatments, may be affecting offspring cardiometabolic health.Study funding/competing interestsThis study is funded by the National Institutes of Health NICHD (1R01HD084380-01A1). A.J.A. is a shareholder in Carrot and consultant for Flo Health. The other authors have no conflicts of interest.Trial registration numberNCT03799107.Trial registration date10 January 2019.Date of first patient’s enrollment10 May 2017.

The Dark Energy Spectroscopic Instrument (DESI) is carrying out a five-year survey that aims to measure the redshifts of tens of millions of galaxies and quasars, including 8 million luminous red galaxies (LRGs) in the redshift range 0.4 < z ≲ 1.0. Here we present the selection of the DESI LRG sample and assess its spectroscopic performance using data from Survey Validation (SV) and the first two months of the Main Survey. The DESI LRG sample, selected using g, r, z, and W1 photometry from the DESI Legacy Imaging Surveys, is highly robust against imaging systematics. The sample has a target density of 605 deg−2 and a comoving number density of 5 × 10−4 h3 Mpc−3 in 0.4 < z < 0.8; this is a significantly higher density than previous LRG surveys (such as SDSS, BOSS, and eBOSS) while also extending to z ∼ 1. After applying a bright star veto mask developed for the sample, 98.9% of the observed LRG targets yield confident redshifts (with a catastrophic failure rate of 0.2% in the confident redshifts), and only 0.5% of the LRG targets are stellar contamination. The LRG redshift efficiency varies with source brightness and effective exposure time, and we present a simple model that accurately characterizes this dependence. In the appendices, we describe the extended LRG samples observed during SV.

Pati Aji Achdiat,1 Rita Septharina,1 Rasmia Rowawi,1 Hartati Purbo Dharmadji,1 Diah Puspitosari,1 Hermin Aminah Usman,2 Retno Hesty Maharani1 1Department of Dermatology and Venereology, Faculty of Medicine, Universitas Padjadjaran–Dr. Hasan Sadikin General Hospital, Bandung, West Java, Indonesia; 2Department of Anatomy Pathology, Faculty of Medicine, Universitas Padjadjaran–Dr. Hasan Sadikin General Hospital, Bandung, West Java, IndonesiaCorrespondence: Pati Aji Achdiat, Department of Dermatology and Venereology, Faculty of Medicine, Universitas Padjadjaran–Dr. Hasan Sadikin General Hospital, Jl. Pasteur 38, Bandung, West Java, 40161, Indonesia, Tel +6281322750101, Email pati.aji.achdiat@unpad.ac.idAbstract: Extragenital warts caused by HPV types 6 and 11 are rarely reported. However, major risk factors for anogenital warts (AGW) include men who have sex with men (MSM) and Human Immunodeficiency Virus (HIV) infection. The incidence of extragenital warts among these populations has not been reported. This study presented a case report of a 33-year-old male with high-risk sexual behavior who showed symptoms of flesh-colored and hyperpigmentation papules. Furthermore, verrucous surfaces were observed at genital and extragenital. The patient had a history of using the same razor for pubic and armpit hair, bathing with a mesh scrub, and scratching the anal area. The histopathological result showed koilocytes, while polymerase chain reaction (PCR) examination for both genital and extragenital lesions confirmed HPV type 6 and 11. This represented the first reported case describing the incidence of extragenital and AGW caused by HPV types 6 and 11. The transmission of extragenital warts was facilitated through fomites autoinoculation, particularly in the immunocompromised condition induced by HIV, which was common among MSM. Extragenital warty-like lesions were considered as warts caused by HPV type 6/11, in HIV-infected persons, specifically MSM.Keywords: anogenital warts, extragenital warts, human papillomavirus type 6, human papillomavirus type 11, human immunodeficiency virus

Wedgefishes (Rhinidae) are threatened by unsustainable fishing globally, and especially in the Southwest Indian Ocean (SWIO), due to their high-value fins in the shark trade. The whitespotted wedgefish Rhynchobatus djiddensis and the bottlenose wedgefish R. australiae are both classified as Critically Endangered on the IUCN Red List of Threatened Species, yet a lack of species-specific knowledge and taxonomic uncertainty still exists within this genus. Genetic approaches aid in taxonomic classification and identifying distinct populations for targeted conservation. Morphological specimen identification of samples (n = 189) collected across the SWIO was confirmed based on the cytochrome oxidase c subunit I (COI) and/or nicotinamide adenine dehydrogenase subunit 2 (ND2) gene regions. The genetic diversity and population structure within and between species and sampling locations were investigated using a dual marker approach: (1) 2 concatenated mitochondrial gene regions, namely COI and the control region (n = 117), and (2) 9 nuclear microsatellite markers (n = 146). The overall genetic diversity was moderate, with an indication that different evolutionary forces are at play on a mitochondrial versus nuclear level. The 2 species were delineated based on both marker types, and for R. djiddensis, the sampling locations of South Africa and Mozambique were genetically homogeneous. For R. australiae, significant differentiation was found between sampling locations, with Madagascar and Tanzania being genetically the most similar. This information provides critical insights into the distribution range and population structure of the whitespotted wedgefish species complex that can support the sustainable management of wedgefishes.

Mohammed Almuqbil,1– 3 Fatimah Yaseen Alshaikh,4 Waleed Altwaijri,1– 3 Duaa Baarmah,5 Raid Harb Hommady,2,3 Maryam Yaseen Alshaikh,1 Fares Alammari,6 Meshal Alhussain,7 Reem Almotawa,8 Faris Alqarni,9 Amna Kashgari,1,10 Rayan Alkhodair,1,2,11 Jumanah N Alkhater,1 Lujeen Nasser Alkhater,6 Sawsan A Alharthi,11 Mada Abdulkarim Alsadi,12 Ahmed AlRumayyan1– 3 1College of Medicine, King Saud Bin Abdulaziz University for Health Sciences (KSAU-HS), Riyadh, Saudi Arabia; 2King Abdullah International Medical Research Center (KAIMRC), Ministry of National Guard, Riyadh, Saudi Arabia; 3Division of Pediatric Neurology, Department of Pediatrics, King Abdullah Specialist Children’s Hospital (KASCH), National Guard Health Affairs (NGHA), Riyadh, Saudi Arabia; 4Collage of Medicine, Princess Nora University, Riyadh, Saudi Arabia; 5Department of Pediatrics, King Abdullah Bin Abdulaziz University Hospital, Princess Nourah Bint Abdulrahman University, Riyadh, Saudi Arabia; 6College of Medicine, Almaarefa University, Riyadh, Saudi Arabia; 7College of Medicine, King Khalid University, Abha, Saudi Arabia; 8Royal College of Surgeons, Dublin, Ireland; 9College of Dentistry, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia; 10Department of Radiology, King Abdullah Specialist Children’s Hospital (KASCH), National Guard Health Affairs (NGHA), Riyadh, Saudi Arabia; 11Division of Dermatology, King Abdulaziz Medical City, Riyadh, Saudi Arabia; 12Division of Otolaryngology, Head and Neck Surgery, King Abdulaziz University Hospital, Riyadh, Saudi ArabiaCorrespondence: Mohammed Almuqbil, College of medicine, King Saud bin Abdulaziz University for health Sciences (KSAU-HS), Prince Mutib Ibn Abdullah Ibn Abdulaziz, Ar Rimayah, P.O. Box 22490, MC 1940, Riyadh, 11426, Saudi Arabia, Tel +966-11-8011111 ext 53594, Email muqbilm@ksau-hs.edu.sa; almuqbilmo@ngha.med.saPurpose: The aim of this manuscript was to assess the epidemiology and clinical features of Neurofibromatosis type 1 (NF-1) based on the newly published revised NF-1 diagnostic criteria and to evaluate complications of NF-1 including neurodevelopmental disorders.Patients and methods: A retrospective cross-sectional observational study was conducted in the Ministry of National Guard Health Affairs (MNGHA) healthcare organization branches including four tertiary hospitals and 51 primary health care centers in different regions in Saudi Arabia. This study included all patients diagnosed with NF1 using the revised NIH diagnostic criteria published in 2021 that were registered at the electronic medical records (EMR) from 2015 to 2021.Results: A total of 184 patients fulfilled the diagnostic criteria and were included in this study. The median age at diagnosis was 11 years (IQR: 4.00– 20.25). The most encountered diagnostic criteria in this study were Café-au-lait macules (85.3%), and (42.9%) were found to have two or more neurofibromas with plexiform neurofibroma being the most common subtype (23.36%), approximately (36.4%) of the patient with optic pathway glioma. Nearby (26.6%) of the patients displayed different type of tumors. Iris Lisch nodules were presented in 36.4% of patients at a median age of 12 years (IQR: 9.0– 21.8). Cardiovascular abnormality was encountered in 9.8% of the patients. Around 27.7% of the patients reported headache and 11.4% of the patient suffered from different type of epilepsy. Besides, 10.5% of the patients had intellectual disability, 33.8% suffered from communication disorders, and 4.9% patients had ADHD.Conclusion: The results of this study will enable practitioners to adopt a more holistic approach and prioritize numerous attributes, which they can subsequently incorporate into their therapeutic methodologies. Furthermore, the identification of these attributes will facilitate an expeditious and accurate diagnosis. Hence, the implementation of intervention during its nascent phase may result in a more advantageous consequence.Keywords: neurofibromatosis type 1, café-au-lait macule, glioma, neurofibromas

Daniela Oliveira Werneck Rodrigues,1,2 Roberta Wolp Diniz,2 Leonardo Cunha Dentz,1 Monica de Albuquerque Costa,3 Roberto Heleno Lopes,2 Lucas Fernandes Suassuna,4 Jane Rocha Duarte Cintra,2 Christian Domenge2 1Department of Medicine, Centro Universitário Presidente Antônio Carlos, Juiz de Fora, MG, Brazil; 2Department of Oncohematology, Hospital 9 de Julho/ Instituto Oncológico de Juiz de Fora, Juiz de Fora, MG, Brazil; 3Department of Dematology, Secretaria de Saúde da Prefeitura Municipal de Juiz de Fora, Juiz de Fora, MG, Brazil; 4Department of Medicine, Universidade Federal de Juiz de Fora (UFJF), Juiz de Fora, MG, BrazilCorrespondence: Daniela Oliveira Werneck Rodrigues, Instituto Oncológico de Juiz de Fora, R. Santos Dumont, 56 - Granbery, Juiz de Fora, MG, 36010-510, Brazil, Tel +553232573126, Email danielawerneckhemato@hotmail.comAbstract: Rosai-Dorfman Disease (RDD) is a rare non-Langerhans histiocytosis, usually self-limited and presenting with massive, painless, bilateral cervical lymphadenopathy, with or without constitutional symptoms. Extranodal disease is frequently present, and may happen in the absence of lymph node involvement, symptomatology and differential diagnosis will depend on the site affected and fatal cases may occur. The authors present two cases of Rosai-Dorfman disease (RDD), diagnosed through immunohistochemistry, with different progressions, one with complete remission and one culminating in death, highlighting the variety of presentations and the diagnostic difficulty. RDD is a rare condition with clinical presentations similar to several diseases, and should be considered in the differential diagnosis of lymphadenopathy with extranodal lesions.Keywords: Rosai Dorfman disease, immunohistochemistry, diagnosis, differential diagnosis (MeSH-NCBI)

Pati Aji Achdiat,1,2 Oki Suwarsa,1,2 Yudi Mulyana Hidayat,2,3 Mohamad Nasir Shafiee,4 Reiva Farah Dwiyana,1,2 Reti Hindritiani,1 Endang Sutedja,1 Satiti Retno Pudjiati,5 Dany Hilmanto,2,6 Meita Dhamayanti,2,6 Ida Parwati,2,7 Retno Hesty Maharani,1 Eva Krishna Sutedja,1 Erda Avriyanti,1 Yunitasari1 1Department of Dermatology and Venereology, Faculty of Medicine, Universitas Padjadjaran, Bandung, West Java, Indonesia; 2Doctoral Study Program Faculty of Medicine Universitas Padjadjaran, Bandung, West Java, Indonesia; 3Department of Obstetrics and Gynecology, Faculty of Medicine, Universitas Padjadjaran, Bandung, West Java, Indonesia; 4Department of Obstetrics and Gynecology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia; 5Department of Dermatology and Venereology, Faculty of Medicine Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia; 6Department of Pediatric, Faculty of Medicine, Universitas Padjadjaran, Bandung, West Java, Indonesia; 7Department of Clinical Pathology, Faculty of Medicine, Universitas Padjadjaran, Bandung, West Java, IndonesiaCorrespondence: Pati Aji Achdiat, Email pati.aji.achdiat@unpad.ac.idIntroduction: Various treatments available today for anogenital and cutaneous warts have limitations, including time-consuming, challenging to perform, and the risk of scarring. A new treatment using tuberculin purified protein derivative (PPD) has been developed, which is expected to generate cellular immunity against HPV.Objective: To assess the evidence for the efficacy and safety of PPD treatment for cutaneous and anogenital warts.Materials and methods: A literature search was performed with the keyword-based search on digital libraries, including the National Library of Medicine, Cochrane Controlled Register of Trial, and Google Scholar, using the following terms: anogenital warts, condyloma acuminata, cutaneous warts, human papillomavirus, immunotherapy, and tuberculin purified protein derivative. Original studies on treating cutaneous or anogenital warts with PPD were included. The results were 47 clinical trials and 4 case reports. Most of the research was done in countries with common Mycobacterium tuberculosis infection. The treatment showed good efficacy. Comparative studies showed that the treatment has similar efficacy with other immunotherapies. No significant side effects were reported, with evidence of the safety use on the pregnant population.Conclusion: Based on good efficacy and safety, PPD can be considered an alternative therapy, especially in countries where tuberculosis is frequent.Keywords: anogenital warts, condyloma acuminata, cutaneous warts, human papillomavirus, immunotherapy, tuberculin purified protein derivative

Globally, sawfishes are amongst the most threatened of all sharks and rays, but a paucity of current data on their presence and status has limited conservation action in many countries. Whilst 2 sawfish species, Pristis pristis and P. zijsron, were historically present in the Philippines, a lack of recent reports suggests that they may have become extremely rare. To determine the current status of sawfishes in the Philippines, interviews were conducted with 106 fishers, fish brokers and fisheries officers at 31 sites in 2016. Interviewees confirmed that sawfishes had inhabited Laguna de Bay and the Agusan and Cagayan Rivers in the past, but the majority of interviewees had last seen a sawfish several decades ago. The most recent observations of a sawfish reported during interviews were in 2014, at the estuary of the Tamontaka River, Mindanao, and at Mercedes fish port, Bicol. After the study, photographic evidence of the landing in 2015 of a largetooth sawfish in Zamboanga Peninsula was published on social media. The considerable degradation and modification of freshwater ecosystems, mangrove loss, coastal degradation, fishing pressure and widespread bottom trawling since the 1940s have all likely contributed to sawfish declines. This study confirms that sawfishes, previously abundant in the Philippines, are now extremely rare or locally extinct. Bottlenose wedgefish Rhynchobatus australiae were observed at Mercedes port during the study and interviewees stated that they are landed regularly. Given the Critically Endangered status of this species, this fishery likely needs immediate management.

Laren D Tan,1 Anthony A Hilliard,2 Ricardo L Peverini,3 Robert D Martin,4 Tamara L Thomas,5 Trevor G Wright,6 Lyndon C Edwards,6 Angela M Lalas,6 Helen M Staples-Evans,6 Barbara J Sharp,7 Stella L Ahn-Kim,7 Kent A Hansen,6 Richard H Hart8 1Department of Medicine, Pulmonary, Critical Care, Hyperbaric and Sleep Medicine, Loma Linda University School of Medicine, Loma Linda, CA, USA; 2Department of Medicine, Cardiology, Loma Linda University School of Medicine, Loma Linda, CA, USA; 3Department of Pediatrics, Neonatology, Loma Linda University School of Medicine, Loma Linda, CA, USA; 4Department of Anesthesia, Loma Linda University School of Medicine, Loma Linda, CA, USA; 5Department of Emergency Medicine, Loma Linda University School of Medicine, Loma Linda, CA, USA; 6Loma Linda University Health, Loma Linda, CA, USA; 7Loma Linda University School of Medicine, Loma Linda, CA, USA; 8Department of Preventive Medicine, Loma Linda University School of Medicine, Loma Linda, CA, USACorrespondence: Laren D Tan, Email Latan@llu.eduAbstract: Navigating the healthcare conundrum in the Blue Zone of Loma Linda, California, requires understanding the unique factors that make this region stand out in terms of health and longevity. But more important is understanding the healthcare system sustaining the Blue Zone in Loma Linda, California. In an era marked by soaring healthcare costs and diminishing reimbursement rates, hospitals and physicians face an unprecedented challenge: providing excellent patient care while maintaining financial sustainability. This leadership perspective publication paper delves into the multifaceted struggles encountered by healthcare and hospital leaders, exploring the root causes, implications, and potential solutions for this complex issue. As we examine the evolving healthcare landscape, we aim to shed light on the critical need for innovative approaches to sustain the future of healthcare excellence in one of the five original Blue Zones.Keywords: blue zone, Loma Linda, healthcare cost, leadership healthcare, longevity, California

Hua Zhao,1 Wen-Jing Geng,2 Rui-Hong Wu,3 Zhen-Zhen Li3 1College of Nursing, Shanxi University of Chinese Medicine, Jinzhong, Shanxi, People’s Republic of China; 2Nursing Department, Third Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Taiyuan, Shanxi, People’s Republic of China; 3Department of Hematology, the Second Hospital of Shanxi Medical University, Taiyuan, Shanxi, People’s Republic of ChinaCorrespondence: Hua Zhao, College of Nursing, Shanxi University of Chinese Medicine, Jinzhong, Shanxi, 030619, People’s Republic of China, Tel +86 13903465019, Email zhshun7788@126.comPurpose: A better understanding of the factors that influence engagement is needed to provide a reference for conducting genetic testing in female relatives of patients with hemophilia (PWH). We therefore determined the perceptions and understanding of genetic testing among female relatives of PWH in China.Methods: We carried out a qualitative study using in-depth, semi-structured interviews with 11 female relatives of PWH in Shanxi Province, China. The resulting data were analyzed using thematic analyses.Results: This study extracted four topics: uncertainty about carrier genetic status; limited understanding of genetic testing; coexistence of positive and negative coping; and multi-aspect demands.Conclusion: Healthcare professionals should provide personalized and multidimensional health education and comprehensive decision-making support to female relatives of PWH, to enhance their motivation and willingness to undergo genetic testing. It is also important to actively improve relevant policies, strengthen the genetic testing service system, and promote the popularization of genetic testing in female relatives of PWH.Keywords: hemophilia, female, genetic testing, attitudes, qualitative study

Ralph HB Benedict,1 Pamela Vo,2 Nicholas Adlard,2 Olwyn Grennan,3 Ashley Enstone,4 Daisy Bridge,4 Robin Wyn,4 Stanley L Cohan5 1Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY, USA; 2Novartis Pharma AG, Basel, Switzerland; 3Novartis Ireland, Dublin, Ireland; 4Adelphi Values PROVE, Bollington, UK; 5Providence Brain and Spine Institute, Providence St. Joseph Health, Portland, OR, USACorrespondence: Pamela Vo, Email pamela.vo@novartis.comIntroduction: Cognitive impairment, especially relating to cognitive processing speed, is a major cause of disability in people with multiple sclerosis (MS). Utility values are quantitative estimates of the quality of life experienced in specific health states and are a key component of cost-effectiveness modelling. However, existing health state utility values in MS typically focus on physical ability and are generally derived using generic (not disease-specific) measures of quality of life. The objective of the current study was to generate health state utility values for levels of cognitive impairment. We used a direct utility elicitation approach called the time trade-off (TTO) methodology.Materials and Methods: Health state descriptions were created following interviews with healthcare professionals, patients, and caregivers in the United States (n=35), and with healthcare professionals in the UK (n=5). Three health states (mild, moderate, and severe impairment) were defined based upon a well-established and validated test for cognitive dysfunction called the Symbol Digit Modalities Test (SDMT) and described using qualitative interview findings. Next, interviews with members of the general public in the UK were conducted to estimate utility values for each health state using the TTO methodology. The procedure was based on the established Measurement and Valuation of Health (MVH) protocol, which generates values on a scale from 0.0 to 1.0.Results: Mean health state utility values were 0.77 ± 0.24 in “mild impairment” (SDMT 43-40), 0.57 ± 0.26 in “moderate impairment” (SDMT 39-32), and 0.34 ± 0.28 in “severe impairment” (SDMT ≤ 31).Discussion: Results indicate that the public perceives that health states of cognitive slowing (as observed in MS) are associated with a substantial reduction in affected individuals’ health-related quality of life, quantified using the TTO methodology. Future economic modeling should consider how utility impacts of both cognitive and physical disability can be appropriately incorporated.Keywords: cognitive impairment, processing speed, health state utility, health-related quality of life, multiple sclerosis, time trade-off

Franklin Dexter,1 Richard H Epstein2 1Division of Management Consulting, Department of anesthesia, University of Iowa, Iowa City, IA, USA; 2Department of Anesthesiology, Perioperative Medicine & Pain Management, University of Miami, Miller School of Medicine, Miami, FL, USACorrespondence: Franklin Dexter, Department of Anesthesia, University of Iowa, 6-JCP, 200 Hawkins Dr, Iowa City, IA, 52242, USA, Tel +1 3196216360, Email franklin-dexter@uiowa.edu

Lactic acid recovery and reusability for hydrolysis of cellulose offers an economical method and produces fewer waste streams. Successful lactic acid recovery up to three recycle times efficiently hydrolyzed NCs with rod-shape morphology. However, after four cycles, the nanocrystalline cellulose yield reduced from 72.3 % to 48.2 %, forming large nanocelluloses with high crystalline index. Large-size nanocellulose with high zeta potential and thermal stability were obtained with increasing cycles due to inefficient acid diffusion into the rigid crystalline network compared to amorphous cellulose. This study offers a green pathway for hydrolysis nanocellulose using a less corrosive and low toxicity lactic acid than inorganic acids.

In this contribution we present the achievements of the CUORE experiment so far. It is the first tonne-scale bolometric detector and it is in stable data taking since 2018. We reached to collect about 1800 kg×yr of exposure of which more than 1 ton×year have been analysed. The CUORE detector is meant to search for the neutrinoless double β decay (0νββ) of the 130Te isotope. This is a beyond Standard Model process which could establish the nature of the neutrino to be Dirac or a Majorana particle. It is an alternative mode of the two-neutrinos double β decay, a rare decay which have been precisely measured by CUORE in the 130Te. We found no evidence of the 0νββ and we set a Bayesian lower limit of 2.2 ×1025yr on its half-life. The expertise achieved by CUORE set a milestone for any future bolometric detector, including CUPID, which is the planned next generation experiment searching for 0νββ with scintillating bolometers.

The Cryogenic Underground Observatory for Rare Events (CUORE) is the first cryogenic experiment searching for 0 νββ decay that has been able to reach the one-tonne mass scale. The detector, located at the Laboratori Nazionali del Gran Sasso (LNGS) in Italy, consists of an array of 988 TeO 2 crystals arranged in a compact cylindrical structure of 19 towers. CUORE began its first physics data run in 2017 at a base temperature of about 10 mK and in April 2021 released its 3 rd result of the search for 0 νββ, corresponding to a tonne-year of TeO 2 exposure. This is the largest amount of data ever acquired with a solid state detector and the most sensitive measurement of 0 νββ decay in 130Te ever conducted. We present the current status of CUORE search for 0 νββ with the updated statistics of one tonne-yr. We finally give an update of the CUORE background model and the measurement of the 130Te 2 νββ decay half-life and decay to excited states of 130Xe , studies performed using an exposure of 300.7 kg yr.

The CUORE experiment is a ton-scale array of TeO 2 cryogenic bolometers located at the underground Laboratori Nazionali del Gran Sasso of Istituto Nazionale di Fisica Nucleare (INFN), in Italy. The CUORE detector consists of 988 crystals operated as source and detector at a base temperature of ∼ 10 mK. Such cryogenic temperature is reached and maintained by means of a custom built cryogen-free dilution cryostat, designed with the aim of minimizing the vibrational noise and the environmental radioactivity. The primary goal of CUORE is the search for neutrinoless double beta decay of 130Te , but thanks to its large target mass and ultra-low background it is suitable for the study of other rare processes as well, such as the neutrinoless double beta decay of 128Te. This tellurium isotope is an attractive candidate for the search of this process, due to its high natural isotopic abundance of 31.75%. The transition energy at (866.7 ± 0.7) keV lies in a highly populated region of the energy spectrum, dominated by the contribution of the two-neutrino double beta decay of 130Te. As the first ton-scale infrastructure operating cryogenic TeO 2 bolometers in stable conditions, CUORE is able to achieve a factor > 10 higher sensitivity to the neutrinoless double beta decay of this isotope with respect to past direct experiments.

CUORE Upgrade with Particle IDentification (CUPID) is a foreseen ton-scale array of Li2MoO4 (LMO) cryogenic calorimeters with double readout of heat and light signals. Its scientific goal is to fully explore the inverted hierarchy of neutrino masses in the search for neutrinoless double beta decay of 100Mo. Pile-up of standard double beta decay of the candidate isotope is a relevant background. We generate pile-up heat events via injection of Joule heater pulses with a programmable waveform generator in a small array of LMO crystals operated underground in the Laboratori Nazionali del Gran Sasso, Italy. This allows to label pile-up pulses and control both time difference and underlying amplitudes of individual heat pulses in the data. We present the performance of supervised learning classifiers on data and the attained pile-up rejection efficiency.

The Cryogenic Underground Observatory for Rare Events (CUORE) at Laboratori Nazionali del Gran Sasso of INFN in Italy is an experiment searching for neutrinoless double beta (0νββ) decay. Its main goal is to investigate this decay in ^{130}Te, but its ton-scale mass and low background make CUORE sensitive to other rare processes as well. In this Letter, we present our first results on the search for 0νββ decay of ^{128}Te, the Te isotope with the second highest natural isotopic abundance. We find no evidence for this decay, and using a Bayesian analysis we set a lower limit on the ^{128}Te 0νββ decay half-life of T_{1/2}>3.6×10^{24}  yr (90% CI). This represents the most stringent limit on the half-life of this isotope, improving by over a factor of 30 the previous direct search results, and exceeding those from geochemical experiments for the first time.

We evaluate the consistency between lensing and clustering based on measurements from Baryon Oscillation Spectroscopic Survey combined with galaxy-galaxy lensing from Dark Energy Survey (DES) Year 3, Hyper Suprime-Cam Subaru Strategic Program (HSC) Year 1, and Kilo-Degree Survey (KiDS)-1000. We find good agreement between these lensing data sets. We model the observations using the Dark Emulator and fit the data at two fixed cosmologies: Planck (S8 = 0.83), and a Lensing cosmology (S8 = 0.76). For a joint analysis limited to large scales, we find that both cosmologies provide an acceptable fit to the data. Full utilization of the higher signal-to-noise small-scale measurements is hindered by uncertainty in the impact of baryon feedback and assembly bias, which we account for with a reasoned theoretical error budget. We incorporate a systematic inconsistency parameter for each redshift bin, A, that decouples the lensing and clustering. With a wide range of scales, we find different results for the consistency between the two cosmologies. Limiting the analysis to the bins for which the impact of the lens sample selection is expected to be minimal, for the Lensing cosmology, the measurements are consistent with A = 1; A = 0.91 ± 0.04 (A = 0.97 ± 0.06) using DES+KiDS (HSC). For the Planck case, we find a discrepancy: A = 0.79 ± 0.03 (A = 0.84 ± 0.05) using DES+KiDS (HSC). We demonstrate that a kinematic Sunyaev-Zeldovich-based estimate for baryonic effects alleviates some of the discrepancy in the Planck cosmology. This analysis demonstrates the statistical power of small-scale measurements; however, caution is still warranted given modelling uncertainties and foreground sample selection effects.

Digital Frequency-Domain Multiplexing (DfMux) is a technique that uses MHz superconducting resonators and Superconducting Quantum Interference Device (SQUID) arrays to read out sets of transition edge sensors. DfMux has been used by several Cosmic Microwave Background experiments, including most recently POLARBEAR-2 and SPT-3 G with multiplexing factors as high as 68, and is the baseline readout technology for the planned satellite mission LiteBIRD. Here, we present recent work focused on improving DfMux readout noise, reducing parasitic impedance, and improving sensor operation. We have achieved a substantial reduction in stray impedance by integrating the sensors, resonators, and SQUID array onto a single-carrier board operated at 250 mK. This also drastically simplifies the packaging of the cryogenic components and leads to better-controlled crosstalk. We demonstrate a low readout noise level of 8.6 pA / Hz 1 1 / 2, which was made possible by operating the SQUID array at a reduced temperature and with a low dynamic impedance. This is a factor of two improvement compared to the achieved readout noise level in currently operating Cosmic Microwave Background experiments using DfMux and represents a critical step toward maturation of the technology for the next generation of instruments.

The Cryogenic Underground Observatory for Rare Events (CUORE) is the most sensitive experiment searching for neutrinoless double-beta decay (0νββ) in 130Te. CUORE uses a cryogenic array of 988 TeO2 calorimeters operated at ∼10 mK with a total mass of 741 kg. To further increase the sensitivity, the detector response must be well understood. Here, we present a non-linear thermal model for the CUORE experiment on a detector-by-detector basis. We have examined both equilibrium and dynamic electro-thermal models of detectors by numerically fitting non-linear differential equations to the detector data of a subset of CUORE channels which are well characterized and representative of all channels. We demonstrate that the hot-electron effect and electric-field dependence of resistance in NTD-Ge thermistors alone are inadequate to describe our detectors' energy-dependent pulse shapes. We introduce an empirical second-order correction factor in the exponential temperature dependence of the thermistor, which produces excellent agreement with energy-dependent pulse shape data up to 6 MeV. We also present a noise analysis using the fitted thermal parameters and show that the intrinsic thermal noise is negligible compared to the observed noise for our detectors.