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ObjectivesNo study has explored whether availability of endoscopic retrograde cholangiopancreatography (ERCP) is adequate and equitable across US children's hospitals. We hypothesized that ERCP availability and utilization differs by geography and patient factors.MethodsHealthcare encounter data from 2009 to 2019 on children with pancreatic and biliary diseases from the Pediatric Health Information System were analyzed. ERCP availability was defined as treatment at a hospital that performed pediatric ERCP during the year of service.ResultsFrom 2009 to 2019, 37,946 children (88,420 encounters) had a potential pancreatic or biliary indication for ERCP; 7066 ERCPs were performed. The commonest pancreatic diagnoses leading to ERCP were chronic (47.2%) and acute pancreatitis (43.2%); biliary diagnoses were calculus (68.3%) and obstruction (14.8%). No ERCP was available for 25.0% of pancreatic encounters and 8.1% of biliary encounters. In multivariable analysis, children with public insurance, rural residence, or of Black race were less likely to have pancreatic ERCP availability; those with rural residence or Asian race were less likely to have biliary ERCP availability. Black children or those with public insurance were less likely to undergo pancreatic ERCP where available. Among encounters for calculus or obstruction, those of Black race or admitted to hospitals in the West were less likely to undergo ERCP when available.ConclusionsOne-in-four children with pancreatic disorders and one-in-12 with biliary disorders may have limited access to ERCP. We identified racial and geographic disparities in availability and utilization of ERCP. Further studies are needed to understand these differences to ensure equitable care.

Background There has been a resurgence of research into the potential therapeutic benefits of psychedelics for neuropsychiatric disorders. Classic psychedelics, such as psilocybin, exert complex effects on higher cognitive functions such as perception and awareness, but their impact on motor function remains unexplored. Moreover, there is a theoretical rationale for using psychedelics to promote motor retraining in certain neuropsychiatric conditions associated with motor dysfunction. This protocol paper outlines the first study to investigate the feasibility and safety of performing movement tasks during the acute effects of psilocybin in healthy participants. The findings from this study will further our understanding of the impact of psychedelics on motor function, and inform future studies that combine classic psychedelics with motor retraining in clinical populations. Methods 12 healthy participants will each receive three doses of psilocybin (between 5 and 20 mg) in a randomized order, with each dose administered at least 1 week apart. Participants, the trial physiotherapists, and statisticians will remain blinded to the psilocybin dose. A battery of measures assessing motor function will be completed during the acute drug effects. In addition, measures of safety, pre‐ and post‐dose resting‐state brain activity via functional magnetic resonance imaging, and participants' subjective experience will be assessed.

Abstract The interplay between facial age and facial identity is evident from several scenarios experienced in daily life, such as when recognising a face several decades after the last exposure. However, the link between age and identity processing, and how age perception abilities might diverge in individuals with different face processing abilities, has scarcely been considered. Furthermore, the approach used to test age perception ability may also influence outcome, but the effect of different paradigms on performance is not yet known. Across three studies, we compare super-recognisers (SRs), people with developmental prosopagnosia (DPs), and a group of neurotypical controls, on three age perception paradigms. There were no differences on the numeric age estimation task (i.e. providing precise age estimates for a series of faces; Study 1), and numeric age estimation task with added noise-distortion to stimuli (Study 2). However, SRs were more accurate when instructed to classify ambient faces as either over- or under- the age of 18 compared to both DPs and controls (Study 3). Thus, there may be nuanced differences in age processing which can be tapped into using separate paradigms; however, given that the difference is only with SRs it remains unclear to what extent these are linked to facial identity processing.

Abstract Prostate cancer treatment resistance is a significant challenge facing the field. Genomic and transcriptomic profiling have partially elucidated the mechanisms through which cancer cells escape treatment, but their relation toward the tumor microenvironment (TME) remains elusive. Here we present a comprehensive transcriptomic landscape of the prostate TME at multiple points in the standard treatment timeline employing single-cell RNA-sequencing and spatial transcriptomics data from 120 patients. We identify club-like cells as a key epithelial cell subtype that acts as an interface between the prostate and the immune system. Tissue areas enriched with club-like cells have depleted androgen signaling and upregulated expression of luminal progenitor cell markers. Club-like cells display a senescence-associated secretory phenotype and their presence is linked to increased polymorphonuclear myeloid-derived suppressor cell (PMN-MDSC) activity. Our results indicate that club-like cells are associated with myeloid inflammation previously linked to androgen deprivation therapy resistance, providing a rationale for their therapeutic targeting.

The nickel-based superalloy is a critical material in aero-engines, where enhanced durability and resistance to stress relaxation are essential. This study evaluates the effectiveness of a high-energy composite modification technique, applied through dual surface friction methods, to induce residual stress and examines the stability of this stress under medium-temperature aging conditions. GH4169 was selected and a foundational study was conducted to quantify residual stress relaxation under medium-temperature aging treatment. The surface strengthening method used was a high-energy composite modification known for its significant post-treatment effects. The specific temperatures for medium-temperature aging treatment were 425 °C and 650 °C. The test results of the residual stress field confirmed the phenomenon of residual stress relaxation under the influence of temperature. Correspondingly, the different degrees of stress relaxation caused by varying aging treatment conditions are closely related to the microstructural changes within the material. Areas with a higher number of annealing twins exhibited a more pronounced degree of residual stress relaxation. By elucidating the link between stress relaxation and microstructural changes, this research offers a theoretical foundation for optimizing surface-strengthening processes and setting optimal operational temperatures for advanced structural materials.

Background: People with aphasia are vulnerable recipients of healthcare. The nature of the communicative environment and the communication disability can adversely impact access to timely and quality healthcare. Student healthcare professionals are often underprepared to interact successfully with people with aphasia and may benefit from communication partner training (CPT). Aims: To investigate the potential effectiveness and acceptability of a brief, two-part introductory Supported Conversation for Adults with Aphasia (SCA[superscript TM])-based CPT package, delivered to a sample of students across a diverse range of healthcare disciplines. Methods & Procedures: A pre-post-within group experimental design was used to investigate the potential effectiveness and acceptability of an online CPT package (50 minute module + 1 hour workshop) for healthcare students. The Aphasia Attitudes, Strategies and Knowledge (AASK) survey measured participants' knowledge of aphasia, facilitative communication strategies and attitudes towards people with aphasia. Data were collected pre-training, following the training module and following the workshop, and 6 weeks post-training. Statistical analysis was conducted on the AASK data. In addition, participant feedback (ratings and open text responses) was collected after the workshop. Ratings were analysed descriptively, and thematic content analysis was used for open text responses. Outcomes & Results: 236 participants completed the pre-training AASK and 106 completed the AASK at subsequent time points. Statistically significant gains were demonstrated from pre- to post-module completion. Between the end of the module and the end of the workshop, some gains were maintained and others showed further statistically significantly improvements. While all gains were not maintained at the 6-week follow-up, statistically significantly improvements from pre-training scores remained evident. Student feedback was predominantly positive, with suggested improvements for training content and length. Conclusions & Implications: The results provide preliminary evidence that a brief, online CPT package can support student healthcare professionals' knowledge and attitudes towards aphasia and communicating with people with aphasia. Online training was acceptable to students and feasible as an embedded or optional component of curriculum. Ongoing training (e.g., in the form of refresher sessions) and inclusion of a skills-based component are recommended to maximize communication skill development.

Abstract Ascomycetes, basidiomycetes and deuteromycetes can degrade wood, but less attention has been paid to basidiomycetes involved in Esca, a major Grapevine Trunk Disease. Using a wood sawdust microcosm system, we compared the wood degradation of three grapevine cultivars inoculated with Fomitiporia mediterranea M. Fisch, a basidiomycete responsible for white-rot development and involved in Esca disease. The grapevine cultivar Ugni blanc was more susceptible to wood degradation caused by F. mediterranea than the cultivars Cabernet Sauvignon and Merlot. Solid-state Nuclear Magnetic Resonance (NMR) spectroscopy showed that F. mediterranea preferentially degrades lignin and hemicellulose over cellulose (preferential, successive or sequential white-rot). In addition, co-inoculation of sawdust with two cellulolytic and xylanolytic bacterial strains of Paenibacillus (Nakamura) Ash ( Paenibacillus sp. (S231-2) and P. amylolyticus (S293)), enhanced F. mediterranea ability to degrade Ugni blanc. The NMR data further showed that the increase in Ugni blanc sawdust degradation products was greater when bacteria and fungi were inoculated together. We also demonstrated that these two bacterial strains could degrade the wood components of Ugni blanc sawdust. Genome analysis of these bacterial strains revealed numerous genes predicted to be involved in cellulose, hemicellulose, and lignin degradation, as well as several other genes related to bacteria-fungi interactions and endophytism inside the plant. The occurrence of this type of bacteria-fungus interaction could explain, at least in part, why necrosis develops extensively in certain grapevine varieties such as Ugni blanc.

BackgroundProstate cancer (PCa) is a clinically heterogeneous disease. The creation of an expression-based subtyping model based on prostate-specific biological processes was sought.MethodsUnsupervised machine learning of gene expression profiles from prospectively collected primary prostate tumors (training, n = 32,000; evaluation, n = 68,547) was used to create a prostate subtyping classifier (PSC) based on basal versus luminal cell expression patterns and other gene signatures relevant to PCa biology. Subtype molecular pathways and clinical characteristics were explored in five other clinical cohorts.ResultsClustering derived four subtypes: luminal differentiated (LD), luminal proliferating (LP), basal immune (BI), and basal neuroendocrine (BN). LP and LD tumors both had higher androgen receptor activity. LP tumors also had a higher expression of cell proliferation genes, MYC activity, and characteristics of homologous recombination deficiency. BI tumors possessed significant interferon γactivity and immune infiltration on immunohistochemistry. BN tumors were characterized by lower androgen receptor activity expression, lower immune infiltration, and enrichment with neuroendocrine expression patterns. Patients with LD tumors had less aggressive tumor characteristics and the longest time to metastasis after surgery. Only patients with BI tumors derived benefit from radiotherapy after surgery in terms of time to metastasis (hazard ratio [HR], 0.09; 95% CI, 0.01-0.71; n = 855). In a phase 3 trial that randomized patients with metastatic PCa to androgen deprivation with or without docetaxel (n = 108), only patients with LP tumors derived survival benefit from docetaxel (HR, 0.21; 95% CI, 0.09-0.51).ConclusionsWith the use of expression profiles from over 100,000 tumors, a PSC was developed that identified four subtypes with distinct biological and clinical features.Plain language summaryProstate cancer can behave in an indolent or aggressive manner and vary in how it responds to certain treatments. To differentiate prostate cancer on the basis of biological features, we developed a novel RNA signature by using data from over 100,000 prostate tumors-the largest data set of its kind. This signature can inform patients and physicians on tumor aggressiveness and susceptibilities to treatments to help personalize cancer management.

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The advancement of self-driving technologies facilitates the emergence of autonomous minibuses (ABs) in public transportation, which could provide flexible, reliable, and safe mobility services. This study develops an AB routing and scheduling model considering each passenger’s arrival reliability and travel risk. Firstly, to guarantee each passenger’s arrival on time, the arrival reliability (a predetermined threshold of on-time arrival probability of α ​= ​0.9) is included in the constraints. Secondly, three objectives, including system costs, greenhouse gas (GHG) emissions, and travel risk, are optimized in the model. To assess the travel risk of ABs, an enhanced method based on kernel density estimation (KDE) is proposed. Thirdly, an advanced multi-objective adaptive large neighborhood search algorithm (MOALNS) is designed to find the Pareto optimal set. Finally, experiments are conducted in Shanghai to validate model performance. Results show that it can decrease GHG emissions (−2.12%) and risk (−9.47%), while only increasing costs by 2.02%. Furthermore, the proposed arrival reliability constraint can improve an average of 14.70% of passengers to meet their arrival reliability requirement (α ​= ​0.9).

Pistachios, a delicacy food product produced mostly in Sicily, generate significant amounts of skins during processing. This by-product has been incorporated in growing/finishing rabbit diet formulations. Hence, the aim of this study was to investigate the effects of a 6% pistachio skin inclusion in rabbit grower/finisher diets on the meat characteristics. One hundred and fifty healthy Martini rabbits (male and female) were weaned at 30 d of age and body weight (IBW) of 0.82±0.05 kg. The animals were assigned to one of the two treatment groups to be homogeneous for weight and sex. Diets were as follows: (1) a treatment diet (TRMT) with a 6% incorporation of pistachio skin meal, and (2) a control diet (CTRL) without the integration of pistachio skin meal. During the experimental period (from 30 to 63 d of age), rabbits were weighed individually on day 30, day 42 and day 63 of the trial. Weight gain, daily feed intake and feed conversion ratio were calculated. The loin and hind leg were carefully deboned and the Biceps femoris (BF) and Longissimus lumborum (LL) muscles were minced and homogenised. The treatment group fed a diet with 6% pistachio skins showed no adverse effects on the growth performance or carcass characteristics and did not trigger any physiological or clinical changes or show deleterious effects on the rabbits. Overall, while the total fat quantity did not register as significant in any of the muscles from either diet, significance was recorded with regard to the quality of the fatty acids profile between the two diets and between both muscles. The analysis of the BF and LL muscles of the TRMT group showed a significant increase in monounsaturated fatty acids (3.2, and 3.0%, P=0.008 and 0.041, respectively) and in the polyunsaturated fatty acids groups (4.8 and 3.8%, P=0.032 and 0.023, respectively), and a decrease in the saturated fatty acids group (–7.2 and –6.1%, P=0.014 and 0.020, respectively) compared with the CTRL group. In particular, both linoleic and α linolenic fatty acids registered a significant increase in the BF muscle, while only the linoleic acid registered a significant increase in the LL muscle of TRMT compared with the CTRL group (P

This study aimed to analyse trends in rabbit meat consumption amongst consumers in selected Maltese rural communities. To the best of the authors’ knowledge, this is the first study that attempts to assess and report on Maltese consumer perceptions and behaviours related to rabbit meat. Data was collected using a survey conducted through random telephone calls. Results indicate that only 19 of the 250 interviewees did not consume rabbit meat. This meat source is perceived as being lean and low in cholesterol, healthier and tastier than other meats, and price does not seem to be an issue. However, this meat is consumed in moderation. Nonetheless, it is an esteemed food item that is generally the main dish on special occasions (fenkata), including the Sunday meal. Thighs are the most preferred part of the carcass and frying/braising is the most frequent method of cooking. An element of mistrust in the supply chain exists, so much so that consumers prefer to source from family and friends that rear rabbits mainly for their own consumption. While rabbit meat consumption is still popular among Maltese consumers, the retail sector marketing rabbit meat needs to be aware of the fact that there is a strong consumer tendency towards lack of trust in the supply chain.

Lymphoedema is a swelling in part of the body due to an obstructed flow of lymphatic fluid. Extant literature mainly targets coping strategies in females having breast cancer related lymphoedema. This research aims to explore the coping strategies of males living with lymphoedema, secondary to cancer treatment. Semi-structured, in-depth interviews were conducted with 13 males aged between 50 to 85 years. Five themes emerged namely: adjusting attire, changing lifestyle activity, distracting the mind, leaning onto available support and immersing in spirituality. Males described wearing loose, easy-to-wear clothing over swollen body parts. Changes in lifestyle included pacing of activities, avoiding/modifying activities to avoid injury and incorporating treatment in their daily routine. Distraction was enabled though immersion in work, engaging in hobbies and humorous banter. Participants also coped by expressing gratitude, living in the present moment, accepting situations over which they lacked control, connecting with nature, and turning to their religious beliefs. There is a need for health professionals to explore the illness narratives and coping strategies of males living with lymphoedema as this impacts their overall well-being. Interventions targeting coping strategies for males with lymphoedema should address the physical, emotional, psychological and spiritual domains of well-being.

Layered stainless steel samples were manufactured using Plasma Wire Arc Additive Manufacturing by depositing alternating layers of two dissimilar stainless steels onto an AISI 316L substrate. The selected materials were the M430 ferritic and M316L austenitic stainless steels. Comprehensive microstructural characterization in different areas, including interfaces between the two different materials, was achieved through optical microscopy and electron backscatter diffraction. Results revealed good weldability among the two-layered steels and on the substrate. Also, a gradient duplex structure was observed mainly at the layer interfaces, suggesting a nuanced blending of properties in the deposited zone. To establish a direct correlation with mechanical properties in the observed structures, macro and micro-hardness tests were conducted along the cross-section. These tests evidenced the presence of a harder phase along the interface compared to the individual materials. The microstructural analysis corroborated the presence of mixing between phases in conjunction with some areas of delta ferrite.

Abstract Shipping is a highly cyclical, volatile, and unpredictable industry. In recent history, economic shocks like the COVID-19 pandemic have heavily disrupted supply chains and tested the resilience and adaptability of shipping lines from both operational and financial perspectives. Therefore, the commercial success of shipping lines is increasingly determined by an optimal balance between reliable logistics operations and financial performance. Given this, chartering strategies of shipping lines are pivotal in achieving fleet optimisation and financial sustainability. Using a Mann–Whitney U test and a data envelopment analysis (DEA), this study provides a view on chartering strategies and efficiency levels of shipping lines in response to the COVID-19 pandemic. The findings reveal that chartering strategies have changed considerably since 2020 and that most shipping lines have pursued a peculiar strategy with a different mix in terms of chartered vessels’ size, age, and period of charter. Shipping lines which showed the most marked differences in chartering strategies also yielded higher efficiency scores under DEA, whereas those that did not sustain large changes scored lower in terms of efficiency. This study provides significant insights on and managerial guidance for understanding and benchmarking chartering strategies and their impact on efficiency gains.

Abstract Functional trade-offs can affect patterns of morphological and ecological evolution as well as the magnitude of morphological changes through evolutionary time. Using morpho-functional landscape modelling on the cranium of 132 carnivore species, we focused on the macroevolutionary effects of the trade-off between bite force and bite velocity. Here, we show that rates of evolution in form (morphology) are decoupled from rates of evolution in function. Further, we found theoretical morphologies optimising for velocity to be more diverse, while a much smaller phenotypic space was occupied by shapes optimising force. This pattern of differential representation of different functions in theoretical morphological space was highly correlated with patterns of actual morphological disparity. We hypothesise that many-to-one mapping of cranium shape on function may prevent the detection of direct relationships between form and function. As comparatively only few morphologies optimise bite force, species optimising this function may be less abundant because they are less likely to evolve. This, in turn, may explain why certain clades are less variable than others. Given the ubiquity of functional trade-offs in biological systems, these patterns may be general and may help to explain the unevenness of morphological and functional diversity across the tree of life.

Due to large losses of seagrass meadows worldwide, restoration is proposed as a key strategy for increasing coastal resilience and recovery. The emergence of a seagrass meadow is expected to substantially amplify biodiversity and enhance benthic metabolism by increasing primary productivity and respiration. Nevertheless, open questions remain regarding the metabolic balance of aging seagrass meadows and the roles benthic communities within the seagrass ecosystem play in overall metabolism. To address these questions, we investigated a chronosequence of bare sediments and adjacent Zostera marina meadows of 3 and 7 years since restoration alongside a natural meadow located within a high-temperate marine embayment in Gåsö, Sweden. We combined continuous measurements of O2 fluxes using underwater eddy covariance with dissolved inorganic carbon (DIC) and O2 fluxes from benthic chambers during the productive season (July). Based on the ratio between O2 and DIC, we derived site-specific photosynthetic and respiratory quotients, enabling the conversion of eddy covariance fluxes to DIC. We assessed benthic diversity parameters as potential drivers of metabolic flux variability. We observed high rates of gross primary productivity (GPP) spanning −18 to −82 mmolDICm-2d-1, which increased progressively with meadow age. Community respiration (CR) mirrored the GPP trend, and all meadows were net heterotrophic (GPP < CR), with net community productivity (NCP) ranging from 16 to 28 mmolDICm-2d-1. While autotrophic biomass did not increase with meadow age, macrophyte diversity did, elucidating potential effects of niche complementarity among macrophytes on community metabolism. These findings provide valuable insights into how community composition and meadow development relate to ecosystem functioning, highlighting potential tradeoffs between carbon uptake and biodiversity.

ABSTRACT Introduction Co‐design in health research involves patient and public involvement and engagement (PPIE) in intervention or service design. Traditionally, co‐design is undertaken in‐person; however, exploring online delivery is warranted. PPIE in co‐design must be considered carefully, and assumptions that in‐person approaches will transition automatically to an online environment should be avoided. Currently, there are a lack of evidence‐informed approaches to facilitating co‐design online. This study aimed to develop and evaluate a framework for authentically adapting health research co‐design into an online environment. Materials and Methods The initial framework was developed through a literature review, synthesis of in‐person co‐design principles, and alignment of online strategies. The framework was then applied to a co‐design project with 10 participants across relevant PPIE groups (end‐users [n = 4], clinicians [n = 2], coaches [n = 2] and clinician−researchers [n = 2]). Participants' experiences of the online co‐design process were evaluated via a mixed‐methods design using surveys and semi‐structured interviews. Evaluation data were analysed using descriptive statistics and reflexive thematic analysis to inform a revised framework. Results The developed framework, Partnership‐focussed Principles‐driven Online co‐Design (P‐POD) was used to design eight 90 min online co‐design workshops. Evaluation data involved 46 survey responses, and eight participants were interviewed on project completion. Survey data indicated that the process was satisfying, engaging and adhered to the P‐POD framework. Themes derived from interview data describe a respectful and collaborative online culture, valuing of diverse perspectives and space for healthy debate, how power was perceived as being shared but not equal and multiple definitions of success within and beyond the process. A final, refined P‐POD framework is presented. Conclusion With evaluation of the initial P‐POD framework showing evidence of adherence to co‐design principles, positive participant experiences and goal achievement for both the project and the participants, the refined P‐POD framework may be used and evaluated within future intervention or service design. Patient or Public Contribution This study involved the participants (end‐users, clinicians and service providers) in the co‐design process described, interpretation of the results through member‐checking interview responses, assisting in development of the final framework and as co‐authors for this manuscript.