Search

Biomedicine today is experiencing a shift towards decentralized data collection, which promises enhanced reproducibility and collaboration across diverse laboratory environments. This inter-laboratory study evaluates the performance of biocytometry, a method utilizing engineered bioparticles for enumerating cells based on their surface antigen patterns. In centralized and aggregated inter-lab studies, biocytometry demonstrated significant statistical power in discriminating numbers of target cells at varying concentrations as low as 1 cell per 100,000 background cells. User skill levels varied from expert to beginner capturing a range of proficiencies. Measurement was performed in a decentralized environment without any instrument cross-calibration or advanced user training outside of a basic instruction manual. The results affirm biocytometry to be a viable solution for immunophenotyping applications demanding sensitivity as well as scalability and reproducibility and paves the way for decentralized analysis of rare cells in heterogeneous samples.

WhatsApp has billions of users worldwide. Instead of paying a subscription fee, users provide their data for the use allowance. This data is used by Meta – the company behind WhatsApp – to obtain insights into user characteristics and monetize those insights. However, this data business model is among others criticized for fostering a loss of privacy that arises when platforms analyze user data, and for the use of design elements to attract users to the platform when they are not online or to extend their online time. Therefore, an increasing number of scientists are discussing whether other payment models are needed to overcome those disadvantages, like a monetary payment model. However, users would probably only pay for improved social media products. This paper provides an empirical basis for understanding the user perspective and, in particular, whether and how much users are willing to pay for improved social media products. For this, 2924 WhatsApp users’ perspectives on this topic were investigated. They were asked whether and how much they are willing to pay money for a messenger/social media service when its quality would be improved. Variables potentially influencing Willingness to Pay (i.e., personality, sent/received messages) were studied as well.47% of the participants were unwilling to pay for a healthier messenger service, and about a quarter were willing or stayed neutral. Further analysis revealed that more agreeable people were more willing to pay. Further: Higher Extraversion was associated with more sent/received messages, but the number of sent/received messages was not linked to Willingness to Pay. The present study shows that many users still are not willing to pay for social media (here messengers), which indicates that the advantages of paying for social media with money instead of with one's own data might need to be better communicated.

Aims: The present study investigated the potential links between Internet Use Disorder tendencies, well-being and the impact of COVID-19 on Internet usage patterns. Method: A sample of 2498 participants filled out the Compulsive Internet Use Scale (CIUS), the Satisfaction with Life Scale (SWLS; the cognitive facet of well-being) and the Sofalizing Scale which comprises the Online Displacement and Social Compensation dimensions. Participants were also asked to report the extent to which changes in Internet use occurred due to COVID-19 pandemic (i.e., reductions, no changes, increases). The present study comprised a survey study with cross-sectional character. Results: The statistical analyses demonstrated that the aforementioned variables were robustly associated with each other. In a first mediation model, the association between higher levels of Internet Use Disorder and reduced well-being was partially mediated by the two dimensions of the Sofalizing scale called Online Displacement and Social Compensation. The results of the second mediation model showed that the relationship between changes in Internet use due to COVID-19 pandemic and well-being was fully mediated by CIUS scores, suggesting that increased Internet use due to the COVID-19 pandemic increased levels of Internet Use Disorder tendencies, which in turn decreased levels of well-being. Discussion: The findings are discussed in the context of human social needs in a time of crisis, where meeting people in-person was restricted.

This study assessed the effects of environmental and operational hazardous events on the Bushenyi water supply system over the period 2017–2020. Monthly secondary water quality data for the period July 2013–December 2017 were analyzed together with data from field samples collected monthly from January 2018 to November 2020. The parameters analyzed were pH, turbidity, total iron, free chlorine and faecal coliforms. Hazardous events and risks affecting the water supply at the source, treatment and distribution system were identified and assessed during the field visits. Control measures were determined during water safety plan development effective July 2017 and implemented effective August 2018. Quality of water in the distribution system met the national standards for turbidity (93%), total iron (99%), residual free chlorine (90%) and faecal coliforms (96%). pH in the storage and distribution system was below the national standard (annual mean range, 5.5–6.7). Water quality was negatively influenced by extreme seasonal weather variations at the source, source protection gaps, treatment deficiencies related to clarifier, filter and chemical dose management as well as distribution management and maintenance gaps. Improved source protection, treatment and distribution network management and maintenance are recommended for sustainable system and water quality standards. HIGHLIGHTS Water supplied to Bushenyi is abstracted from a wetland.; The water supply system is faced with risks that affect the source, treatment, and distribution.; The study assessed the risks and applied control measures using the water safety plan approach.; Water quality analysis showed that control measures resulted in meeting standards.; The study recommends investment in risk control measures for safe water supply.;

Abstract Neutralization of Omicron subvariants by different bivalent vaccines has not been well evaluated. This study characterizes neutralization against Omicron subvariants in 98 individuals on dialysis or with a kidney transplant receiving the BNT162b2 (BA.4/BA.5) or mRNA-1273 (BA.1) bivalent COVID-19 vaccine. Neutralization against Omicron BA.1, BA.5, BQ.1.1, and XBB.1.5 increased by 8-fold one month following bivalent vaccination. In comparison to wild-type (D614G), neutralizing antibodies against Omicron-specific variants were 7.3-fold lower against BA.1, 8.3-fold lower against BA.5, 45.8-fold lower against BQ.1.1, and 48.2-fold lower against XBB.1.5. Viral neutralization was not significantly different by bivalent vaccine type for wild-type (D614G) (P = 0.48), BA.1 (P = 0.21), BA.5 (P = 0.07), BQ.1.1 (P = 0.10), nor XBB.1.5 (P = 0.10). Hybrid immunity conferred higher neutralizing antibodies against all Omicron subvariants. This study provides evidence that BNT162b2 (BA.4/BA.5) and mRNA-1273 (BA.1) induce similar neutralization against Omicron subvariants, even when antigenically divergent from the circulating variant.

Water treatment and reuse can avail more clean and safe water for human use. In this study, iron oxide waste powder generated from the steel pickling process was used to develop iron oxide nanoparticles (IONPs) using solution gelation synthesis process. The powder and developed IONPs were characterized by X-ray fluorescence and diffraction (XRF, XRD), scanning electron microscopy, Fourier-transform infrared spectroscopy, and Brunauer-Emmett-Teller (BET) analyses. Adsorption experiments were carried out on synthetic water with lead and chromium metal ions. The adsorption data were analysed with Langmuir and Freundlich models. Adsorption kinetics were also analysed with Pseudo-First-Order and Pseudo-Second-Order models using non-linear regression. The synthesized IONPs were porous with active surface functional groups of hydroxyl bonds, with BET specific surface area of 325.02 m2/g. XRD results confirmed the cubic spinel structure of IONPs with particle sizes of 20–30 nm. The nanoparticles at a dosage of 0.35 g in 10 mL for 50 min effectively removed Pb(II) and Cr(VI) metal ions up to 99.9% from both synthetic water and industrial wastewater. The adsorption capacity (qmax) of IONPs was found to be 417 and 326.80 for Pb(II) and Cr(VI) respectively. Freundlich isotherm model data fitted best for the removal of both metal ions. The regression values for kinetic models confirmed that pseudo-second-order best fit the adsorption of both Pb(II) and Cr(VI) confirming chemisorption processes. This study contributes to elucidating alternative application of pickling waste from the steel rolling mills for the benefit of heavy metal removal in industrial wastewater.

The use of coconut fibre (CF) from agricultural waste offers a sustainable solution to environmental challenges by reusing residues from the coconut industry. This approach respects the principles of sustainability and environmental preservation by minimising waste and encouraging the use of renewable resources in construction. A study was carried out to assess the effectiveness of untreated (UT) and treated CFs as reinforcement in high-strength concrete (HSC), targeting an average strength of 60 MPa. The study evaluated the mechanical and durability characteristics of HSC reinforced with raw and processed coconut fibres (CFR-HSC). The CFs underwent physical treatment by boiling and chemical treatment using a 1% sodium hydroxide (NaOH) solution. Different fibre contents were examined, and analyses including scanning electron microscopy (SEM) and energy dispersive X-ray spectroscopy (EDS) were carried out on untreated and treated fibres. The results showed that additional fibre content reduced the workability of the concrete, its fresh density, and its air void content, but that the treated fibres had better workability than the UT fibres. While compressive strength was not significantly improved with CFR-HSC compared to the HSC control mix after 28 days of curing, tensile and flexural strengths were improved with fibre content. Notably, the NaOH-treated (NT) CF showed the greatest increase in tensile strength, while the boiling-treated (BT) CF showed the greatest improvement in flexural strength. An increase in fibre content resulted in a reduction in crack width, and CFR-HSC showed an increase in water absorption but better resistance to sulfuric acid, with NT CF producing the most promising results.

Introduction Informed consent forms (ICFs) for randomised clinical trials (RCTs) can be onerous and lengthy. The process has the potential to overwhelm patients with information, leading them to miss elements of the study that are critical for an informed decision. Specifically, overly long and complicated ICFs have the potential to increase barriers to trial participation for patients with mild cognitive impairment, those who do not speak English as a first language or among those with lower medical literacy. In turn, this can influence trial recruitment, completion and external validity.Methods and analysis SIMPLY-SNAP is a pragmatic, multicentre, open-label, two-arm parallel-group superiority RCT, nested within a larger trial, the Staphylococcus aureus Network Adaptive Platform (SNAP) trial. We will randomise potentially eligible participants of the SNAP trial 1:1 to a full-length ICF or a SIMPlified LaYered (SIMPLY) consent process where basic information is summarised with embedded hyperlinks to supplemental information and videos. The primary outcome is recruitment into the SNAP trial. Secondary outcomes include patient understanding of the clinical trial, patient and research staff satisfaction with the consent process, and time taken for consent. As an exploratory outcome, we will also compare measures of diversity (eg, gender, ethnicity), according to the consent process randomised to. The planned sample size will be 346 participants.Ethics and dissemination The study has been approved by the ethics review board (Sunnybrook Health Sciences Research Ethics Board) at sites in Ontario. We will disseminate study results via the SNAP trial group and other collaborating clinical trial networks.Trial registration number ClinicalTrials.gov Registry (NCT06168474; www.clinicaltrials.gov).

Background: Guidelines suggest that active surveillance (AS) may be considered for select patients with favorable intermediate-risk (fIR) prostate cancer. Objective: To compare the outcomes between fIR prostate cancer patients included by Gleason score (GS) or prostate-specific antigen (PSA). Most patients are classified with fIR disease due to either a 3 + 4 = 7 GS (fIR-GS) or a PSA level of 10–20 ng/ml (fIR-PSA). Previous research suggests that inclusion by GS 7 may be associated with worse outcomes. Design, setting, and participants: We conducted a retrospective cohort study of US veterans diagnosed with fIR prostate cancer from 2001 to 2015. Outcome measurements and statistical analysis: We compared the incidence of metastatic disease, prostate cancer–specific mortality (PCSM), all-cause mortality (ACM), and receipt of definitive treatment between fIR-PSA and fIR-GS patients managed with AS. Outcomes were compared with those of a previously published cohort of patients with unfavorable intermediate-risk disease using cumulative incidence function and Gray’s test for statistical significance. Results and limitations: The cohort included 663 men; 404 had fIR-GS (61%) and 249 fIR-PSA (39%). There was no evidence of difference in the incidence of metastatic disease (8.6% vs 5.8%, p = 0.77), receipt of definitive treatment (77.6% vs 81.5%, p = 0.43), PCSM (5.7% vs 2.5%, p = 0.274), and ACM (16.8% vs 19.1%, p = 0.14) between the fIR-PSA and fIR-GS groups at 10 yr. On multivariate regression, unfavorable intermediate-risk disease was associated with higher rates of metastatic disease, PCSM, and ACM. Limitations included varying surveillance protocols. Conclusions: There is no evidence of difference in oncological and survival outcomes between men with fIR-PSA and fIR-GS prostate cancer undergoing AS. Thus, presence of GS 7 disease alone should not exclude patients from consideration of AS. Shared decision-making should be utilized to optimize management for each patient. Patient summary: In this report, we compared the outcomes of men with favorable intermediate-risk prostate cancer in the Veterans Health Administration. We found no significant difference between survival and oncological outcomes.

Background: Post-acute sequelae of COVID-19, or long COVID, is a condition characterized by persistent COVID-19 symptoms. As long COVID is defined by clinical criteria after an elapsed period, an opportunity for early intervention may aid in future prophylactic approaches; however, at present, the pathobiological mechanisms are multifactorial. By analyzing early virally infected upper respiratory tract tissue prior to eventual clinical diagnosis, it may be possible to identify biomarkers of altered immune response to facilitate future studies and interventions. Methods: This is a sub-group analysis of samples collected from those with confirmed COVID-19. RNA extraction from nasopharyngeal/mid-turbinate samples, sequencing, and bioinformatic analysis were performed to analyze long COVID and non-long COVID cohorts at day 14 post infection. Differences in mean viral load at various timepoints were analyzed as well as serological data. Results: We identified 26 upregulated genes in patients experiencing long COVID. Dysregulated pathways including complement and fibrinolysis pathways and IL-7 upregulation. Additionally, genes involved in neurotransmission were dysregulated, and the long COVID group had a significantly higher viral load and slower viral clearance. Conclusions: Uncovering early gene pathway abnormalities associated with eventual long COVID diagnosis may aid in early identification. We show that, post acute infection, in situ pathogenic deviations in viral response are associated with patients destined to meet consensus long COVID diagnosis that is entirely dependent on clinical factors. These results identify an important biological temporal window in the natural history of COVID-19 infection and long COVID pathogenesis amenable to testing from standard-of-care upper respiratory tract specimens.

Abstract Measles, or rubeola, is a highly contagious acute febrile viral illness. Despite the availability of an effective vaccine since 1963, measles outbreaks continue worldwide. This article seeks to provide emergency physicians with the contemporary knowledge required to rapidly diagnose potential measles cases and bolster public health measures to reduce ongoing transmission.

Although geopolymer cement (GPC) is a substitute for Portland cement, its application is restricted due to the need for high-temperature curing (40–90 °C), which makes it challenging to utilise for onsite applications. To address this issue, the current study examined the potential of substituting fly ash (FA) with teff straw ash (TSA) in geopolymer mortars cured at ambient temperature. The findings revealed that substituting FA with TSA can eliminate the need for high-temperature curing, and the compressive strengths of FA-TSA-based geopolymer mortar mixtures cured for 28 days ranged from 45 to 53 MPa. Further, increasing the TSA content enhanced the mortar's flexural and direct tensile strengths. A teff straw ash level of 10% increased compressive, flexural, and direct tensile strengths by 40%, 59%, and 30% at 28 days, respectively. Furthermore, the mineralogical phases of the mortar after 28 days confirmed the presence of gismondine coexisting with other phases, and microstructural analysis indicates that the inclusion of TSA resulted in a denser structure. These findings suggest that TSA could be a potential substitute for FA in GPC applications to lower energy usage and environmental impact.

Background: People living with chronic kidney disease (CKD) have been disproportionately affected by the coronavirus disease 2019 (COVID-19) pandemic, including higher rates of infection, hospitalization, and death. Data on responsiveness to COVID-19 vaccination strategies and immunogenicity are limited, yet required to inform vaccination strategies in this at-risk population. Objective: The objective of this study is to characterize the longitudinal serologic response to COVID-19 vaccination. Design: This is a prospective observational cohort study. Setting: Participating outpatient kidney programs within Ontario and British Columbia. Patients: Up to 2500 participants with CKD G3b-5D receiving COVID-19 vaccination, including participants receiving dialysis and kidney transplant recipients (CKD G1T-5T). Measurements: The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) IgG antibodies (anti-spike, anti-receptor binding domain, anti-nucleocapsid) will be detected by ELISA (enzyme-linked immunosorbent assay) from serum or dried blood spot testing. In a subset of participants, neutralizing antibodies against novel variants of concern will be evaluated. Peripheral blood mononuclear cells will be collected for exploratory immune profiling of SARS-CoV-2 specific cellular immunity. Methods: Participants will be recruited prior to or following any COVID-19 vaccine dose and have blood sampled for serological testing at multiple timepoints: 1, 3, 6, 9, and 12 months post vaccination. When possible, samples will be collected prior to a dose or booster. Participants will remain in the study for at least 1 year following their last COVID-19 vaccine dose. Strengths and limitations: The adaptive design of this study allows for planned modification based on emerging evidence or rapid changes in public health policy surrounding vaccination. Limitations include incomplete earlier timepoints for blood collection due to rapid vaccination of the population. Conclusions: This large multicenter serologic study of participants living with kidney disease will generate data on the kinetics of SARS-CoV-2 immune response to vaccination across the spectrum of CKD, providing insights into the amplitude and duration of immunity conferred by COVID-19 vaccination and allowing for characterization of factors associated with immune response. The results of this study may be used to inform immunization guidelines and public health recommendations for the 4 million Canadians living with CKD.

In the present era of technology, the design of structural deep concrete beams is highly modernized through the use of computer-aided tools. However, theories for such design are the paramount aspects to be understood particularly when the beam has openings. To improve the mechanical properties of the deep beam with openings, recycled tyre steel fibres are required. To estimate the bond strength of the fibre-concrete interface, the concrete shrinkage strains for fibre lengths 30, 50 and 60 mm with a content of 0.5% were considered. To mitigate the conservativeness of some available shear models and improve the design of deep beams, the simplified shear equation model was developed. The model was established using a simplified compressive stress block, forces in steel reinforcement and shear stress at the fibre-concrete interface. The combined effect of opening height and length was also considered in the model. The results show that incorporating fibres in concrete increase the shear performance of deep concrete beams with openings due to high strains in the shear zone indicating high loads being transferred. For instance, beam BS2 had a strain of 0.0153 in the lower load path compared to 5.6 × 10−5 for beam BC2 There was a good correlation between measured and proposed shear capacities with t-test values of 0.46, 0.996 and 0.003 for beams without fibres, and with fibres and mesh respectively. Results also showed the model shear equation performed better compared to other equations with mean absolute error (MAE) and coefficient of variation (COV) of 9.3 and 18.9%, respectively for the control beams with openings. The model also showed a mean absolute error (MAE) and coefficient of variation (COV) of 11.6 and 7.4%, respectively for the beams with fibres. The COV and MAE for the proposed model were small than those in the database, therefore, the proposed model can provide the precise design of deep concrete beams with openings and fibres.

BackgroundLarge observational studies have demonstrated the real-world effectiveness of nirmatrelvir-ritonavir in preventing severe COVID-19 in higher risk individuals, but have provided limited information on other aspects of nirmatrelvir-ritonavir use. Our objective was to evaluate prescribing outcomes such as the prevalence of drug-drug interactions (DDI), adverse drug events (ADE) and treatment adherence in an outpatient community clinic setting.MethodsWe conducted a single-centre retrospective cohort study of adult outpatients prescribed nirmatrelvir-ritonavir in our community COVID-19 assessment clinic in Toronto, Ontario between March 3 and September 20, 2022. We performed a descriptive analysis of the patient population, DDIs, DDI interventions, treatment adherence, ADEs and clinical outcomes of patients prescribed nirmatrelvir-ritonavir.ResultsThere were 637 individuals prescribed nirmatrelvir-ritonavir during the study period. The median age was 70, the median number of risk factors for severe disease were 2, 45% were immunocompromised and 82% had received 3 or more COVID-19 vaccine doses. 95% (542/572) completed the 5-day course of therapy with 68% (388/572) having complete symptom resolution by 28-day. Eleven percent (60/572) experienced recurrent symptoms following the completion of nirmatrelvir-ritonavir. Over 70% had one or more clinically significant DDIs requiring mitigation and 62% of patients experienced at least one ADE, which was most commonly dysgeusia or gastrointestinal-related. Ninety-five percent (542/572) of patients completed therapy as prescribed. Overall, hospitalization within 28 days was 3.3% with 1.2% attributed to COVID-19 and there were no deaths.InterpretationNirmatrelvir-ritonavir was associated with a high prevalence of clinically significant DDIs, which required mitigation strategies and a high frequency of mild ADEs. Collaborative assessment to address medication alterations resulted in high treatment adherence.

The present study aimed at investigating associations of both ideological attitudes and personal value types with the personality traits derived from the Affective Neuroscience Theory (ANT). For that, data of N = 626 (n = 403 men, n = 220 women, n = 3 identifying as neither a man nor a woman) participants of an online survey in the German language were analyzed. Relations of primary emotional traits derived from the ANT with Right-Wing Authoritarianism (RWA), Social Dominance Orientation (SDO), and personal value types, such as the higher-order value type dimensions "Conservation-Openness to Change" and "Self-Enhancement-Self-Transcendence", were examined by means of correlational analyses and structural equation modeling. Results revealed among others relations between low SEEKING, high ANGER and high RWA. Low CARE and high ANGER were associated with high SDO. Moreover, FEAR was related to the higher-order value type dimension ranging from Conservation to Openness to Change. ANGER was associated with the higher-order value type dimension ranging from Self-Enhancement to Self-Transcendence. The present results do not only expand knowledge on the personality traits associated with ideological attitudes and personal value types. Beyond this, considering the neuroanatomical, functional, and neurochemical correlates of the primary emotional traits SEEKING, ANGER, CARE, and FEAR, the present results may provide a roadmap for forthcoming studies aiming at examining biological correlates of ideological attitudes and personal value types, such as those works in the field of political neuroscience.

Introduction Excessive internet use can lead to problems for some individuals. The WHO has introduced Gaming Disorder in the International Classification of Diseases-11 (ICD-11). Previous research has shown that other internet applications can cause serious mental health problems as well. It is important to provide measures of prevention, early intervention and therapy for internet use disorders (IUDs).Methods and analysis The study ‘Stepped Care Approach for Problematic Internet use Treatment’ is a randomised, two-arm, parallel-group, observer-blind trial. The aim of the study is to investigate if a stepped care approach is effective to reduce symptom severity for IUD. The sample is primarily recruited online with a focus on employees in companies with support of health insurances. After screening, the stepped care approach depends on the success of the previous step—that is, the successful reduction of criteria—and comprise: (1) app-intervention with questionnaires and feedback, (2) two telephone counsellings (duration: 50 min) based on motivational interviewing, (3) online therapy over 17 weeks (15 weekly group sessions, eight individual sessions) based on cognitive–behavioural therapy. A follow-up is conducted after 6 months. A total of 860 participants will be randomised. Hierarchical testing procedure is used to test the coprimary endpoints number of Diagnostic and Statistical Manual of Mental Disorders, fifth edition and ICD-11 criteria. Primary analysis will be performed with a sequential logit model.Ethics and dissemination The study has been approved by the Ethics Committees of the Universities of Lübeck (file number: 21-068), Mainz (file number: 2021-15907) and Berlin (file number: 015.2021). Results will be reported in accordance to the CONSORT statement. If the approach is superior to the control condition, it may serve as part of treatment for IUD.Trial registration number DRKS00025994.

A deep concrete beam is a structural member that transfers heavy loads from the introduced column(s) due to a change of function layout of a particular floor in the building. Due to its high depth, the service utilities are always accommodated by creating a transverse opening rather than at its soffit. However, this practice leads to a reduction of shear resistance and affects the serviceability of the beams. To reinstall this capacity, waste tyre steel fibres were used to assess their effectiveness in improving the shear resistance of the deep concrete beams with openings. Three sets of beams with, without fibres, and with fibre mesh that had openings of 160 × 86, 115 × 120, 86 × 160, and 165 × 170 mm were considered. A total of 16 beams with dimensions 150 × 400 × 1100 mm and a constant shear span-to-depth ratio of 0.8 were cast and tested. The steel fibres used had a diameter of 1.3 mm, a length of 50 mm, a fibre content of 0.5% and a fibre mesh of 110 × 100 mm. The main variables evaluated were the effect of the opening size and its orientation, the effect of stirrups, the random mixing of fibres in the matrix, and the internal strengthening of the fibre mesh in the anticipated strut line of the deep beam. The results showed that an interruption of the strut width affected the shear resistance of the beam. The beam with 160 × 86 mm had a lower capacity of 7.7% compared to 115 × 120 mm with the same opening area. The 160 × 86 mm control beam had a high shear capacity of 2.6% compared to 86 × 160 mm. The inclusion of fibre increased the compressive stiffness of the strut; The beam with fibre and opening size 165 × 170 mm had a shear capacity of 37.8% higher than the beam without fibres. The addition of mesh had a limited increase in shear capacity compared to random fibre mixes; however, the capacity was 21.6% higher than the control mix for a beam with an opening size of 165 × 170mm. Therefore, it is recommended to use recycled waste tyre steel fibres to improve the shear capacity of the deep concrete beam and less application of shear bars.

BackgroundPrevention in psychiatry provides a promising way to address the burden of mental illness. However, established approaches focus on specific diagnoses and do not address the heterogeneity and manifold potential outcomes of help-seeking populations that present at early recognition services. Conceptualizing the psychopathology manifested in help-seeking populations from a network perspective of interacting symptoms allows transdiagnostic investigations beyond binary disease categories. Furthermore, modern technologies such as smartphones facilitate the application of the Experience Sampling Method (ESM). ObjectiveThis study is a combination of ESM with network analyses to provide valid insights beyond the established assessment instruments in a help-seeking population. MethodsWe will examine 75 individuals (aged 18-40 years) of the help-seeking population of the Cologne early recognition center. For a maximally naturalistic sample, only minimal exclusion criteria will be applied. We will collect data for 14 days using a mobile app to assess 10 transdiagnostic symptoms (ie, depressive, anxious, and psychotic symptoms) as well as distress level 5 times a day. With these data, we will generate average group-level symptom networks and personalized symptom networks using a 2-step multilevel vector autoregressive model. Additionally, we will explore associations between symptom networks and sociodemographic, risk, and resilience factors, as well as psychosocial functioning. ResultsThe protocol was designed in February 2020 and approved by the Ethics Committee of the University Hospital Cologne in October 2020. The protocol was reviewed and funded by the Köln Fortune program in September 2020. Data collection began in November 2020 and was completed in November 2021. Of the 258 participants who were screened, 93 (36%) fulfilled the inclusion criteria and were willing to participate in the study. Of these 93 participants, 86 (92%) completed the study. The first results are expected to be published in 2022. ConclusionsThis study will provide insights about the feasibility and utility of the ESM in a help-seeking population of an early recognition center. Providing the first explorative phenotyping of transdiagnostic psychopathology in this population, our study will contribute to the innovation of early recognition in psychiatry. The results will help pave the way for prevention and targeted early intervention in a broader patient group, and thus, enable greater intended effects in alleviating the burden of psychiatric disorders. International Registered Report Identifier (IRRID)DERR1-10.2196/35206

The present data set contains self-report data of German individuals participating in a longitudinal data assessment via online surveys conducted in the year preceeding the general elections in Germany.Data of N = 122 individuals are included in the data set. Those individuals participated in an initial, extensive survey between November 2020 and February 2021 (T1) as well as in a final survey after the general German elections, thus, between the end of September 2021 and October 2021 (T3). Of those individuals, n = 93 additionally participated in an intermediate survey in between the previously mentioned ones between the end of May and the end of June 2021 (T2).Next to the assessment of sociodemographic variables, information on (political) news consumption, such as the frequency of being confronted with counter-attitudinal news, and on political attitudes, for example via current voting intentions for one of the major German parties, were assessed in the initial survey (T1).In the intermediate survey (T2), participants provided information on recent political news consumption habits including the frequency of being confronted with counter-attitudinal news, current voting intentions for one of the major German parties, as well as on extraordinary events that happened recently and impacted their voting intentions.In the final survey (T3), sociodemographic variables and actual voting decisions in the general German elections in 2021 were assessed. Moreover, variables on recent political news consumption habits, including the frequency of being confronted with counter-attitudinal news, and extraordinary events that happened recently and impacted voting decisions were assessed. Finally, a detailed self-report questionnaire retrospectively assessing political news consumption for the time between participation in the initial survey (T1) and the final survey (T3) was completed by participants. Not only did this questionnaire assess which online and offline news channels (e.g., TV, print, news websites) participants used. Besides, the questionnaire included items on how many outlets per channel were used and the frequency of being confronted with counter-attitudinal news within each channel.This data set is provided alongside the present article to be used for further investigations of the stability of voting intentions, thus, political attitudes. Moreover, a content analysis of the open responses on which extraordinary events happened and impacted voting intentions/decisions can provide further knowledge on factors influencing voting intentions and their variability versus stability.

Orgasm-associated urinary incontinence, or climacturia, is a common side effect after radical prostatectomy (RP) that is gaining more attention due to the distress it causes to patients. A range of treatment options have been reported in the literature and are outlined in this review. The goal of our study is to review the pathophysiology and current management options for climacturia following RP. A PubMed search was used to review the current literature relating to the pathophysiology and the treatment of postprostatectomy climacturia. We reviewed the currently available treatment options and their success rates for climacturia. Several techniques were found to subjectively help improve the amount and bother of patients' climacturia. These include pelvic floor muscle training (PFMT), penile variable tension loop, soft silicone occlusion loop, artificial urethral sphincter, male urethral sling, and the Mini-Jupette graft. Success rates ranged from 48% to 100% depending on the modality used. For patients with erectile dysfunction and climacturia, the Mini-Jupette graft could be a valuable option. Given the lack of validated measurement tools and management options, climacturia has become a challenge for urologists. Albeit a condition that has not garnered much attention, there are several management options from conservative to invasive treatments that have shown a hopeful promise for the treatment of climacturia. These options should be discussed with patients to determine the best treatment for each individual. More clinical trials are needed to assess the efficacy and impact of the different treatment options before a definitive recommendation regarding management can be made.

Concrete with various fibres has been in practice over the years now to improve the internal characteristics of concrete. In most of the developing countries, there is a high rate of waste tyres due to the importation of used cars. Waste tyres increase the environmental burden due to their resistance to decomposition in landfills. To have alternative disposal of waste tyres, their components of steel fibres were utilized in concrete to assess their effect on the mechanical and durability performance of high-strength concrete with a target mean strength of 70 MPa. Fibres had a diameter of 1.3 mm and lengths of 30, 50, and 60 mm with fibre contents of 0.3, 0.5, 0.75, and 1.0% in each length. Slump tests were performed on fresh concrete with and without fibres. The mechanical performance variables assessed were compressive strength, splitting tensile strength, flexural strength, flexural toughness, residual strength, static modulus, and Poisson’s ratio. In addition, durability tests such as chloride ion penetration and absorption rate of water were investigated. The results showed that an increase in fibre length to 60 mm and a 1.0% fibre content resulted in the high bond strength in the concrete matrix resulting in a smaller crack width. Moreover, these fibre length and content resulted in improved tensile and flexural strength to 21.5% and 71.1% of control mix, respectively. The increase in fibre length and content affected both the durability properties and the flowability of the concrete, and as for length (60 mm) and 1% content, concrete had a slump of 77.8% lesser compared to the control mix. The compressive strength was improved to 15.2% for concrete with a fibre length of 50 mm and a fibre content of 0.5%. However, further increases in fibre content and length caused an increase in the number of weaker interfacial transition zones at the composite interface that reduces compressive stiffness, resulting in low compressive strength. Furthermore, the reduced fibre content and length (30 mm) improve the static modulus linearly up to 0.75% fibre content; however, concrete with a fibre length of 50 mm and content of 0.3% gives the best results.

Introduction: Virtual reality (VR) technologies have rapidly advanced and offer increasingly higher fidelity visually immersive learning environments. Several studies have shown promise for using VR in medical education. This pilot study evaluates the feasibility of using a novel VR trauma simulator that can function without an instructor, assessing potential challenges with the technology, perceived realism of the simulation, side effects experienced while completing the simulations, and overall perception of training utility from end-users.Methods: This was a single-center prospective cohort study completed at Madigan Army Medical Center Emergency Department. Participants were enrolled using convenience sampling. They completed surveys before and after completing a trauma simulation. Each participant underwent a 10-min simulation orientation and subsequently completed a self-directed trauma simulation involving massive hemorrhage, tension pneumothorax, or airway obstruction case. The simulation utilized a gaming laptop and a Microsoft Mixed Reality© headset and controllers. Survey data was analyzed using descriptive statistics and subgroup analyses.Results: Seventeen participants were enrolled and completed pre-and post-surveys. Study participants were predominantly male and represented all clinical roles in the emergency department (ED). Overall, participants indicated the training environment felt realistic (AV 8.3/10, SD 1.4, 95% CI 7.6, 8.0) and supported further use of this technology in training (AV 9.3/10, SD 0.99, 95% CI 8.8, 9.8). There was a statistically significant correlation between participants who responded, “I would support further use of this technology in my training” (likert greater than 8/10) and several other responses. Individuals who supported further use of VR in training were more likely to have fewer years of clinical experience, have more experience with 2D (desktop) computer training, reported realistic clinical changes within the simulator, indicated the environment was realistic, and supported the addition of VR to mannequin-based training.Conclusion: The results indicate it may be possible to create realistic dynamic VR simulations that function without an instructor, and that medical personnel may be supportive of integrating VR technology into medical education. This seems most likely for younger individuals, with less experience, who have found computer based medical training helpful in the past. Future research could focus on methods to minimize side effects, and how VR technology can best augment current training techniques and curricula.

Aortic pseudoaneurysms can commonly be caused by previous thoracic surgery, trauma, and infection, quickly becoming life-threatening if ruptured. This pathology is typically asymptomatic and incidentally found on imaging; however, few cases have outlined hemoptysis as a presenting symptom for aortic pseudoaneurysms. Traditionally, management of these patients included surgical correction; however, percutaneous approaches have emerged as a safe alternative, helping to reduce the risk of morbidity and mortality associated with surgical correction. This report seeks to describe a case in which hemoptysis was the symptom unveiling the finding of a thoracic ascending aortic pseudoaneurysm and the use of an Amplatzer atrial septal defect (ASD) occlusion device as a viable option to safely resolve the disease process.

BackgroundSocial communication via instant messaging (IM) and social networking (SN) apps makes up a large part of the time that smartphone users spend on their devices. Previous research has indicated that the excessive use of these apps is positively associated with problematic smartphone use behaviors. In particular, image-based SN apps, such as Instagram (Facebook Inc) and Snapchat (Snap Inc), have been shown to exert stronger detrimental effects than those exerted by traditional apps, such as Facebook (Facebook Inc) and Twitter (Twitter Inc). ObjectiveIn this study, we investigated the correlation between individuals’ tendencies toward smartphone use disorder (SmUD) and objective measures of the frequency of smartphone usage. Additionally, we put to test the hypothesis that the pathway linking the frequency of actual smartphone usage to self-reported tendencies toward SmUD was mediated by the increased frequency of IM and SN app usage. MethodsWe recruited a sample of 124 adult smartphone users (females: 78/124, 62.9%; age: mean 23.84 years, SD 8.29 years) and collected objective information about the frequency of smartphone and SN app usage over 1 week. Participants also filled in a self-report measure for assessing the multiple components of tendencies toward SmUD. Bivariate associations were investigated by using Spearman correlation analyses. A parallel mediation analysis was conducted via multiple regression analysis. ResultsThe frequency of smartphone usage, as well as the use of IM apps (Messenger, Telegram, and WhatsApp [Facebook Inc]), Facebook, and image-based apps (Instagram and Snapchat), had significant positive associations with at least 1 component of SmUD, and the cyberspace-oriented relationships factor exhibited the strongest associations overall. We found support for an indirect effect that linked actual smartphone usage to SmUD tendencies via the frequency of the use of image-based SN apps. ConclusionsOur novel results shed light on the factors that promote SmUD tendencies and essentially indicate that image-based SN apps seem to be more strongly associated with problematic smartphone behaviors compared to IM apps and traditional SN apps, such as Facebook.

Artificial intelligence (AI) has been successful at solving numerous problems in machine perception. In radiology, AI systems are rapidly evolving and show progress in guiding treatment decisions, diagnosing, localizing disease on medical images, and improving radiologists' efficiency. A critical component to deploying AI in radiology is to gain confidence in a developed system's efficacy and safety. The current gold standard approach is to conduct an analytical validation of performance on a generalization dataset from one or more institutions, followed by a clinical validation study of the system's efficacy during deployment. Clinical validation studies are time-consuming, and best practices dictate limited re-use of analytical validation data, so it is ideal to know ahead of time if a system is likely to fail analytical or clinical validation. In this paper, we describe a series of sanity tests to identify when a system performs well on development data for the wrong reasons. We illustrate the sanity tests' value by designing a deep learning system to classify pancreatic cancer seen in computed tomography scans.

Case Presentation: We present the case of a young male with high clinical suspicion of a penile fracture found to have dorsal vein rupture by emergency department point-of-care ultrasound. This false form of penile fracture was subsequently confirmed intraoperatively. Discussion: Penile fracture is a rare clinical entity that may be separated into true vs false penile fracture, with only true fracture requiring surgery. The images submitted here add to the sparse literature evidence that point-of-care ultrasound can be used to differentiate between these two clinical entities. Additionally, this case report highlights an opportunity for further research into and application of point-of-care ultrasound to the evaluation of suspected penile fractures.

Introduction: Penile prosthesis implantation is a widely used treatment option for erectile dysfunction. Data is limited with regard to patient satisfaction with a penile prosthesis following radical prostatectomy/cystoprostatectomy vs patients with erectile dysfunction of other etiologies. Aim: To examine patient satisfaction with penile prosthesis implantation and determine if a difference in satisfaction exists in post-prostatectomy/cystoprostatectomy patients vs patients with erectile dysfunction of other etiologies. We hypothesize that etiology does not affect satisfaction. Methods: A total of 164 patients underwent penile prosthesis implantation at our institution between August 2017 and December 2019, with 102 patients completing a validated 14 item questionnaire, Erectile Dysfunction Inventory of Treatment Satisfaction (EDITS), at 6 months postoperation. Demographics, surgical characteristics, and erectile dysfunction etiology were recorded. Patients were assigned to one of 2 groups: postprostatectomy/postcystoprostatectomy erectile dysfunction or other etiologies. The study group was further analyzed between radical prostatectomy or radical cystoprostatectomy. Main Outcome Measures: Satisfaction based on key EDITS questions with postradical prostatectomy/cystoprostatectomy vs patients with erectile dysfunction of other etiologies. Results: Responses to 3 questions were analyzed: overall satisfaction, expectations met in the past 4 weeks, and confidence in the ability to participate in sexual activity. Chi-square analysis was performed to determine the difference in responses. No difference was seen in overall satisfaction (P = .96), expectations (P = .78), or confidence (P = .78) between groups. On subgroup analysis, there was no difference in reported overall satisfaction (P = .47) or confidence (P = .080) between postprostatectomy and postcystoprostatectomy patients. Postprostatectomy and postcystoprostatectomy patients differed in whether the penile prosthesis implantation met expectations (P = .033). Postprostatectomy patients reported a mean score of 3.5/4 compared to postcystoprostatectomy patients, who reported a mean of 3.0/4. Conclusions: Our analysis suggests that key erectile function scores are not significantly different between postprostatectomy/postcystoprostatectomy patients compared to other etiologies. The difference in measures between postprostatectomy and postcystoprostatectomy patients is not significant or of unclear significance.Registration # of clinical trial: HSC-MS-19-0320Howell S, Palasi S, Green T, et al. Comparison of Satisfaction With Penile Prosthesis Implantation in Patients With Radical Prostatectomy or Radical Cystoprostatectomy to the General Population. Sex Med 2021;9:100300.

Robust and sensitive methods for monitoring inorganic and organic As species As(III), As(V), dimethylarsinate (DMA), and monomethylarsonate (MMA) in environmental water are necessary to understand the toxicity and redox processes of As in a specific environment. The method is sufficiently sensitive and selective to ensure accurate and precise quantitation of As(III), As(V), DMA, and MMA in surface water and groundwater samples with As species concentrations from tens of nanograms per liter to 50 µg/L without dilution of the sample. Mean recoveries of the four species spiked into reagent water, surface water and groundwater and measured periodically over three months ranged from 87.2 % to 108.7 % and relative standard deviation of replicates of all analytes ranged from 1.1 % to 9.0 %. • A PRP-X100 column and nitrate/phosphate mobile phase was used to separate As(III), As(V), DMA, and MMA in 0.45 µm filtered surface water and groundwater matrices. • Oxygen was used in the collision cell of the inductively coupled plasma-mass spectrometer with MS/MS mode to shift the measured As mass from 75 to 91. • The analytical performance of the method and figures of merit including detection limits, precision, accuracy, and interferences when applied to surface water and groundwater matrices were investigated.

Disordered gaming has gained increased medical attention and was recently included in the eleventh International Classification of Diseases (ICD-11) by the World Health Organization (WHO) after its earlier inclusion in the Diagnostic and Statistical Manual of Mental Disorders (fifth revision) (DSM-5) as an emerging disorder by the American Psychiatric Association (APA). Although many studies have investigated associations between personality and disordered gaming, no previous research compared the differential associations between personality and disordered gaming with time spent gaming. Due to the novelty of the WHO diagnostic framework for disordered gaming, previous research focused mainly on the associations between personality and disordered gaming in relation to the APA framework. Beyond that, these studies are generally limited by small sample sizes and/or the lack of cross-cultural emphasis due to single-country sampling. To address these limitations, the present study aimed to investigate the associations between personality and gaming behavior in a large and culturally heterogeneous sample (N = 50,925) of individuals from 150 countries. The results obtained suggested that low conscientiousness and high neuroticism were robustly associated with disordered gaming across both the APA and WHO frameworks. Interestingly, personality associations with weekly time spent gaming were smaller. The findings of the present study suggest that personality is of higher importance to predict disordered gaming compared to weekly time spent gaming.

Supervised classification methods often assume the train and test data distributions are the same and that all classes in the test set are present in the training set. However, deployed classifiers often require the ability to recognize inputs from outside the training set as unknowns. This problem has been studied under multiple paradigms including out-of-distribution detection and open set recognition. For convolutional neural networks, there have been two major approaches: 1) inference methods to separate knowns from unknowns and 2) feature space regularization strategies to improve model robustness to novel inputs. Up to this point, there has been little attention to exploring the relationship between the two approaches and directly comparing performance on large-scale datasets that have more than a few dozen categories. Using the ImageNet ILSVRC-2012 large-scale classification dataset, we identify novel combinations of regularization and specialized inference methods that perform best across multiple open set classification problems of increasing difficulty level. We find that input perturbation and temperature scaling yield significantly better performance on large-scale datasets than other inference methods tested, regardless of the feature space regularization strategy. Conversely, we find that improving performance with advanced regularization schemes during training yields better performance when baseline inference techniques are used; however, when advanced inference methods are used to detect open set classes, the utility of these combersome training paradigms is less evident.

We map single energy CT (SECT) scans to synthetic dual-energy CT (synth-DECT) material density iodine (MDI) scans using deep learning (DL) and demonstrate their value for liver segmentation. A 2D pix2pix (P2P) network was trained on 100 abdominal DECT scans to infer synth-DECT MDI scans from SECT scans. The source and target domain were paired with DECT monochromatic 70 keV and MDI scans. The trained P2P algorithm then transformed 140 public SECT scans to synth-DECT scans. We split 131 scans into 60% train, 20% tune, and 20% held-out test to train four existing liver segmentation frameworks. The remaining nine low-dose SECT scans tested system generalization. Segmentation accuracy was measured with the dice coefficient (DSC). The DSC per slice was computed to identify sources of error. With synth-DECT (and SECT) scans, an average DSC score of 0.93±0.06 (0.89±0.01) and 0.89±0.01 (0.81±0.02) was achieved on the held-out and generalization test sets. Synth-DECT-trained systems required less data to perform as well as SECT-trained systems. Low DSC scores were primarily observed around the scan margin or due to non-liver tissue or distortions within ground-truth annotations. In general, training with synth-DECT scans resulted in improved segmentation performance with less data.

Language grounded image understanding tasks have often been proposed as a method for evaluating progress in artificial intelligence. Ideally, these tasks should test a plethora of capabilities that integrate computer vision, reasoning, and natural language understanding. However, the datasets and evaluation procedures used in these tasks are replete with flaws which allows the vision and language (V&L) algorithms to achieve a good performance without a robust understanding of vision and language. We argue for this position based on several recent studies in V&L literature and our own observations of dataset bias, robustness, and spurious correlations. Finally, we propose that several of these challenges can be mitigated by creation of carefully designed benchmarks.

Thrombotic thrombocytopenic purpura (TTP) is a potentially fatal disorder that requires urgent identification and treatment. The association of TTP with systemic lupus erythematosus (SLE) and vasculitis has been reported, however, never simultaneously. A 33-year-old woman with a history of SLE presented with acute abdominal pain, fever, arthralgias, and skin rash. She had acute severe hypertension, diffuse abdominal tenderness, and petechial rash. Diagnostic work-up revealed active urine sediment with proteinuria and hematuria and elevated creatinine, anemia, and thrombocytopenia. She was diagnosed with acute lupus nephritis and early microangiopathic hemolytic anemia in the setting of hypertensive urgency and started on intravenous methylprednisolone 500 mg once a day. Within 48 hours, she developed shock with multiorgan dysfunction and succumbed to her illness. Laboratory tests later showed ADAMTS13 activity less than 10% consistent with TTP and p-antineutrophil cytoplasmic antibody (ANCA) positivity. Autopsy revealed small-vessel vasculitis of the visceral organs. Kidney biopsy demonstrated diffuse proliferative glomerulonephritis. This case illustrates the occurrence of SLE nephritis, p-ANCA vasculitis, and severe TTP with rapidly fatal course, and the importance of having a low threshold for initiating plasma exchange therapy. Here, we discuss the case and provide a literature review on cases of TTP with SLE and vasculitis.

Though a relatively uncommon manifestation of sarcoidosis, some clinicians are tasked with managing osseous involvement of disease, and the optimal treatment approach in this setting is not well established. Previous studies have shown variable efficacy for osseous sarcoidosis utilizing multiple agents alone or in combination, often using imaging follow-up in conjunction with clinical assessment to evaluate response to treatment. We present a case of widespread skeletal involvement of sarcoidosis without evidence of concurrent pulmonary disease demonstrating marked clinical improvement and near-complete resolution of imaging abnormalities on magnetic resonance imaging (MRI) following the use of methotrexate as the primary pharmacologic agent.

The burden of poisoning exposures in Africa is a significant public health concern, yet only ten African countries have poisons information centres. The establishment of poisons centres was subsequently identified as a priority. This article focuses on workshop discussions with international multi-sector stakeholders in Eastern Africa regarding the possibility of a sub-regional poisons centre serving multiple countries. Methods: The project was led by an independent consultant under the guidance of an international steering group. Steering group members provided input at international multi-stakeholder meetings and during monthly teleconferences. Results: Participants of the stakeholder meetings agreed that the establishment of a sub-regional poisons centre in Eastern Africa was necessary and feasible. Virtual collaboration is possible due to recent technological developments, and the overall suggestion was for countries to establish their own poisons centres and to network and coordinate these centres through a network hub. Conclusion: A number of benefits might result from such a poisons centre network hub, including: (1) Improved cooperation between countries on poisoning problems; (2) Harmonisation and strengthening of research and surveillance; (3) Common standards and best practices e.g. regulating chemicals, data management, and staff training; and (4) Greater bargaining power to secure resources. Further investigation is needed to identify the most suitable location for the network hub, the activities it should fulfil, and the availability of specialists in poisons information who could become members of the hub.

Widely available and easily accessible testing for COVID-19 is a cornerstone of pandemic containment strategies. Nasopharyngeal swabs (NPS) are the currently accepted standard for sample collection but are limited by their need for collection devices and sampling by trained healthcare professionals. The aim of this study was to compare the performance of saliva to NPS in an outpatient setting. This was a prospective study conducted at three centers, which compared the performance of saliva and NPS samples collected at the time of assessment center visit. Samples were tested by real-time reverse transcription polymerase chain reaction and sensitivity and overall agreement determined between saliva and NPS. Clinical data was abstracted by chart review for select study participants. Of the 432 paired samples, 46 were positive for SARS-CoV-2, with seven discordant observed between the two sample types (four individuals testing positive only by NPS and three by saliva only). The observed agreement was 98.4% (kappa coefficient 0.91) and a composite reference standard demonstrated sensitivity of 0.91 and 0.93 for saliva and NPS samples, respectively. On average, the Ct values obtained from saliva as compared to NPS were higher by 2.76. This study demonstrates that saliva performs comparably to NPS for the detection of SARS-CoV-2. Saliva was simple to collect, did not require transport media, and could be tested with equipment readily available at most laboratories. The use of saliva as an acceptable alternative to NPS could support the use of widespread surveillance testing for SARS-CoV-2.

Adult aging is associated with difficulties in recognizing negative facial expressions such as fear and anger. However, happiness and disgust recognition is generally found to be less affected. Eye-tracking studies indicate that the diagnostic features of fearful and angry faces are situated in the upper regions of the face (the eyes), and for happy and disgusted faces in the lower regions (nose and mouth). These studies also indicate age-differences in visual scanning behavior, suggesting a role for attention in emotion recognition deficits in older adults. However, because facial features can be processed extrafoveally, and expression recognition occurs rapidly, eye-tracking has been questioned as a measure of attention during emotion recognition. In this study, the Moving Window Technique (MWT) was used as an alternative to the conventional eye-tracking technology. By restricting the visual field to a moveable window, this technique provides a more direct measure of attention. We found a strong bias to explore the mouth across both age groups. Relative to young adults, older adults focused less on the left eye, and marginally more on the mouth and nose. Despite these different exploration patterns, older adults were most impaired in recognition accuracy for disgusted expressions. Correlation analysis revealed that among older adults, more mouth exploration was associated with faster recognition of both disgusted and happy expressions. As a whole, these findings suggest that in aging there are both attentional differences and perceptual deficits contributing to less accurate emotion recognition.

Analogue zeitgebers such as wristwatches and alarm clocks are essential for structuring everyday life. Since the dawn of the digital revolution – particularly since the advent of the smartphone – mobile phones have increasingly replaced analogue zeitgebers as a means of telling time. This functionality may prove problematic, in that it may contribute to the overuse of digital media (e.g. when checking the time turns into extended use of other smartphone utilities, including Internet-based applications). Of N = 3084 participants, 45% reported wearing a wristwatch and 67% used an analogue alarm clock. We observed that participants who reported using analogue zeitgebers used their mobile-/smartphone significantly less. Use of analogue zeitgebers may prove a practical tool for therapeutic and preventative interventions for problematic Internet use in an increasingly digital age.

Many Africans who are on life-saving ART face challenges from a variety of toxicities. After the introduction of a standardized first-line efavirenz-containing ART regimen, reports of gynecomastia appeared in Malawian popular media, however data on the prevalence and risk factors of gynecomastia from Africa are lacking.We conducted a cross-sectional study in males ≥18 years registered on ART at the HIV clinic in Zomba Central Hospital. Men who reported to have ever experienced breast or nipple enlargement received a standard questionnaire and underwent physical examination. Questions included perceptions and concerns about gynecomastia. Clinicians confirmed the presence and severity of gynecomastia. Routinely collected data on current and previous ART regimens, CD4 count, WHO clinical stage, anthropometric measurements and history of tuberculosis were extracted from the electronic database.We enrolled 1,027 men with median age 44 years (IQR: 38-52). The median ART duration was 57 months (IQR: 27-85); 46.7% were in WHO stage III/IV at ART initiation, 88.2% had exposure to efavirenz and 9% were overweight or obese. The prevalence of self-reported gynecomastia was 6.0% (62/1027) (95%-CI: 4.7-7.7%). Of men with gynecomastia 83.6% reported nipple enlargement and 98.4% enlarged breasts (85.5% bilateral). One-third said they had not reported gynecomastia to a health care worker. Over three-quarters mentioned that gynecomastia was an important or very important problem for them, while more than half were embarrassed by it. On examination gynecomastia was present in 90% (confirmed gynecomastia prevalence 5.5%; 95%-CI: 4.2-7.0%) and 51.8% had severity grade III or IV. History of tuberculosis treatment was independently associated with self-reported gynecomastia, adjusted OR 2.10 (95%-CI: 1.04-4.25).The burden of gynecomastia among men on ART in Malawi was higher than previously reported, and was associated with adverse psychological consequences, calling for increased awareness, a proactive diagnostic approach and diligent clinical management.

Introduction: Acute toxic ingestion is a common cause of morbidity and mortality. Emergency physicians (EP) caring for overdose (OD) patients are often required to make critical decisions with incomplete information. Point of care ultrasound (POCUS) may have a role in assisting EPs manage OD patients. We evaluated the impact of different liquid adjuncts used for gastric decontamination on examiners’ ability to identify the presence of tablets using POCUS, and assessed examiners’ ability to quantify the numbers of tablets in a simulated massive OD. Methods: This prospective, blinded, pilot study was performed at an academic emergency department. Study participants were volunteer resident and staff EPs trained in POCUS. Five non-transparent, sealed bags were prepared with the following contents: 1 liter (L) of water, 1 L of water with 50 regular aspirin (ASA) tablets, 1 L of water with 50 enteric-coated aspirin tablets (ECA), 1 L of polyethylene glycol (PEG) with 50 ECA, and 1 L of activated charcoal (AC) with 50 ECA. After performing POCUS on each of the bags using a 10-5 MHz linear array transducer, participants completed a standardized questionnaire composed of the following questions: (1) Were pills present? YES/NO; (2) If tablets were identified, estimate the number (1-10, 11-25, >25). We used a single test on proportions using the binomial distribution to determine if the number of EPs who identified tablets differed from 50% chance. For those tablets identified in the different solutions, another test on proportions was used to determine whether the type of solution made a difference. Since 3 options were available, we used a probability of 33.3%. Results: Thirty-seven EPs completed the study. All (37/37) EP’s correctly identified the absence of tablets in the bag containing only water, and the presence of ECA in the bags containing water and PEG. For Part 2 of the study, most participants - 25/37 (67.5%) using water, 23/37 (62.1%) using PEG, and all 37 (100%) using AC - underestimated the number of ECA pills in solution by at least 50%. Conclusion: There may be a potential role for POCUS in the evaluation of patients suspected of acute, massive ingested OD. EPs accurately identified the presence of ECA in water and PEG, but underestimated the number of tablets in all tested solutions. [West J Emerg Med. 2014;15(2):176–179.]

Electrical mini-grids can provide electrification to rural communities far from the national network. However the benefits of such schemes are disputed. We observed changes in two matched trading-centres in Makueni County, Kenya, neither of which were initially electrified. During the study a solar photovoltaic mini-grid scheme (13.5 kWp) was constructed in one of the trading-centres. After electrification there were relative increases in the number of businesses and business income. Comparing the households in the areas around the trading centres, perceived wealth increased more around the electrified trading centre. Qualitative interviews indicated improvements in service provision by the local school and health centre. The co-operative set up to run the mini-grid was free to set its own kWh tariff and chose to reduce it to a level that covers operating costs and would recover 70% of the initial investment interest-free. However, the tariff finally agreed is higher than the national grid tariff, which would be difficult to achieve if the mini-grid was not owned by and run for the benefit of the local community. Overall, we found that the mini-grid had a positive effect over background development, recovered some of its cost and charged a higher tariff than the national rate.

Virtually everybody would agree that life satisfaction is of immense importance in everyday life. Thus, it is not surprising that a considerable amount of research using many different methodological approaches has investigated what the best predictors of life satisfaction are. In the present study, we have focused on several key potential influences on life satisfaction including bottom-up and top-down models, cross-cultural effects, and demographic variables. In four independent (large scale) surveys with sample sizes ranging from N = 488 to 40,297, we examined the associations between life satisfaction and various related variables. Our findings demonstrate that prediction of overall life satisfaction works best when including information about specific life satisfaction variables. From this perspective, satisfaction with leisure showed the highest impact on overall life satisfaction in our European samples. Personality was also robustly associated with life satisfaction, but only when life satisfaction variables were not included in the regression model. These findings could be replicated in all four independent samples, but it was also demonstrated that the relevance of life satisfaction variables changed under the influence of cross-cultural effects.

Image data from space-borne thermal infrared (IR) sensors are used for a variety of applications, however they are often limited by their temporal resolution (i.e., repeat coverage). To potentially increase the temporal availability of thermal image data, a study was performed to determine the extent to which thermal image data can be simulated from available atmospheric and surface data. The work conducted here explored the use of Modern-Era Retrospective analysis for Research and Applications, Version 2 (MERRA-2) developed by The National Aeronautics and Space Administration (NASA) to predict top-of-atmosphere (TOA) thermal IR radiance globally at time scales finer than available satellite data. For this case study, TOA radiance data was derived for band 31 (10.97 μ m) of the Moderate-Resolution Imaging Spectroradiometer (MODIS) sensor. Two approaches have been followed, namely an atmospheric radiative transfer forward modeling approach and a supervised learning approach. The first approach uses forward modeling to predict TOA radiance from the available surface and atmospheric data. The second approach applied four different supervised learning algorithms to the atmospheric data. The algorithms included a linear least squares regression model, a non-linear support vector regression (SVR) model, a multi-layer perceptron (MLP), and a convolutional neural network (CNN). This research found that the multi-layer perceptron model produced the lowest overall error rates with an root mean square error (RMSE) of 1.36 W/m 2 ·sr· μ m when compared to actual Terra/MODIS band 31 image data. These studies found that for radiances above 6 W/m 2 ·sr· μ m, the forward modeling approach could predict TOA radiance to within 12 percent, and the best supervised learning approach can predict TOA to within 11 percent.

Mammals rely on vision, audition, and olfaction to remotely sense stimuli in their environment. Determining how the mammalian brain uses this sensory information to recognize objects has been one of the major goals of psychology and neuroscience. Likewise, researchers in computer vision, machine audition, and machine olfaction have endeavored to discover good algorithms for stimulus classification. Almost 50 years ago, the neuroscientist Jerzy Konorski proposed a theoretical model in his final monograph in which competing sets of "gnostic" neurons sitting atop sensory processing hierarchies enabled stimuli to be robustly categorized, despite variations in their presentation. Much of what Konorski hypothesized has been remarkably accurate, and neurons with gnostic-like properties have been discovered in visual, aural, and olfactory brain regions. Surprisingly, there have not been any attempts to directly transform his theoretical model into a computational one. Here, I describe the first computational implementation of Konorski's theory. The model is not domain specific, and it surpasses the best machine learning algorithms on challenging image, music, and olfactory classification tasks, while also being simpler. My results suggest that criticisms of exemplar-based models of object recognition as being computationally intractable due to limited neural resources are unfounded.