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OBJECTIVE: Bacterial resistance is known to diminish the effectiveness of antibiotics for treatment of urinary tract infections. Review of recent healthcare and antibiotic exposures, as well as prior culture results is recommended to aid in selection of empirical treatment. However, the optimal approach for assessing these data is unclear. We utilized data from the Veterans Health Administration to evaluate relationships between culture and treatment history and the subsequent probability of antibiotic-resistant bacteria identified in urine cultures to further guide clinicians in understanding these risk factors. METHODS: Using the XGBoost algorithm, a retrospective cohort of outpatients with urine culture results and antibiotic prescriptions from 2017 to 2022 was used to develop models for predicting antibiotic resistance for three classes of antibiotics: cephalosporins, fluoroquinolones, and trimethoprim/sulfamethoxazole (TMP/SMX) obtained from urine cultures. Model performance was assessed using Area Under the Receiver Operating Characteristic curve (AUC) and Precision-Recall AUC (PRAUC). RESULTS: There were 392,647 prior urine cultures identified in 214,656 patients. A history of bacterial resistance to the specific treatment was the most important predictor of subsequent resistance for positive cultures, followed by a history of specific antibiotic exposure. The models performed better than previously established risk factors alone, especially for fluoroquinolone resistance, with an AUC of .84 and PRAUC of .70. Notably, the models performance improved markedly (AUC = .90, PRAUC = .87) when applied to cultures from patients with a known history of resistance to any of the antibiotic classes. CONCLUSION: These predictive models demonstrate potential in guiding antibiotic prescription and improving infection management.

Abstract Background Hepatitis C virus (HCV) reinfection following successful treatment threatens the achievement of HCV elimination. The primary aim of this study is to assess reinfection rate three years after sustained virologic response (SVR) in people who inject drugs (PWID) that are on opioid agonist treatment (OAT) who underwent anti-HCV treatment with interferon-free regimens. Methods Observational, non-interventional, prospective, descriptive study carried out in Spanish tertiary public hospitals between 2017 and 2022. Participants comprised 186 adult HCV infected individuals, 85.5% males with a mean age (Standard Deviation, SD) of 50.1 (5.9). All were enrolled in an OAT program at baseline and had attained SVR 12 weeks after therapy completion with an interferon-free treatment. Baseline data were abstracted from medical chart information collected through the routine clinical practice. Results The overall rate of HCV reinfection three years after SVR12 among PWID was 1.2 new cases per 100 person-years of follow-up at a median of 15.9 months. In the subgroup analyses, those with injection drug practice and without a stable housing had higher reinfection rates. Conclusion Although PWID in OAT present a low rate of reinfection by HCV after successful treatment, a closer monitoring in the first year and strengthening inter-consultations with services responsible for monitoring addiction in these patients will be crucial to reduce risky behaviors avoiding HCV reinfection.

Abstract Background Periodontal disease (PD) is an infectious and inflammatory condition that affects the tissues surrounding and supporting the teeth. It has been suggested that PD may be associated with cardiovascular disease (CVD), one of the leading causes of mortality worldwide. Our study aimed to investigate the association between PD and CVD through an umbrella review. Methods A comprehensive search was conducted until April 2024 across various electronic databases, including PubMed, Cochrane Library, Scopus, SciELO, Web of Science, Google Scholar, ProQuest Dissertations and Theses, and OpenGrey. Systematic reviews with or without meta-analysis were considered for inclusion, without any limitations on time or language, provided they examined primary studies linking PD with CVD. The AMSTAR-2 tool was employed to assess the quality and overall confidence of the included studies. Results After the initial search, a total of 516 articles were identified. Following the application of selection criteria, 41 articles remained for further consideration. All these studies indicated an association between PD and CVD, with odds ratios and risk ratios ranging from 1.22 to 4.42 and 1.14 to 2.88, respectively. Conclusions Systematic reviews with high overall confidence support the association between PD, tooth loss, and cardiovascular diseases. However, it is crucial to interpret these results with caution due to methodological limitations. The potential public health relevance justifies preventive and corrective oral health strategies. Additionally, the need for rigorous future research is highlighted to strengthen the evidence and guide effective public health strategies.

Abstract In this article, a regional ocean surface waves dataset from Sentinel‐1 A and B Synthetic Aperture Radar (SAR) satellites has been described. The ocean wave data have been extracted from the Sentinel‐1 level‐2 OCN (ocean) product as provided by the European Space Agency and downloadable for this region from the Copernicus Australasia regional data hub. The source OCN data have been produced by evolving versions of Sentinel‐1 Instrument Processing Facility (IPF). The structure of the source OCN NetCDF files changes over time and presents a challenge in performing long duration, time series analyses, including the examination of potential inconsistencies in OCN wave data, due to employment of different IPF versions over the duration of the satellite missions. Here, the input OCN wave data have been homogenized to a single, easily usable standard format after applying a quality assurance and control procedure that removes various inconsistencies in variables, coordinates, dimensions and land flag, and through the addition of new auxiliary variables. The new format has the desirable properties of being compact in size, consistent in structure, and scalable in temporal and spatial coverage. It is also convenient to use and offers opportunities to perform fast, multi‐year regional processing and analysis for calibration and validation studies and scientific applications. No re‐processing of Sentinel‐1 level‐1 data has been carried out in this work.

Acceptability of a sexual violence (SV) risk reduction program called "RealConsent" designed for first-year female college students was conducted as part of a larger, randomized controlled trial. "RealConsent" uses web-based and mobile technology to deliver four 45-minute theoretically and empirically derived modules designed to increase knowledge, affect attitudes and normative beliefs, increase bystander and other protective behaviors, and reduce alcohol misuse. Educational entertainment is used throughout the program to achieve these aims. A total of 444 first-year female college students recruited from three Southeastern universities who were eligible and provided informed consent were randomized to "RealConsent." Acceptability was ascertained both quantitatively and qualitatively through a survey administered following the completion of each of four modules. Results suggest that overall, "RealConsent" was viewed as relatable, realistic, and relevant. Most participants rated modules as good/excellent in quality, in organization, and in the conveying of a high degree of knowledge regarding alcohol misuse, consent for sex, sexual communication, defense strategies, protective strategies, and intervening to prevent SV. Suggestions to improve "RealConsent" centered on having more content inclusive of sexual and gender-minoritized students. Results suggest that "RealConsent" is an acceptable SV risk reduction program among first-year female college students and may have advantages for dissemination over in-person programs due to its web-based and mobile technology.

Correction to: Molecular Psychiatry, published online 2 May 2023 In this article Honami Arai, Irene Bollettini, Rosa Calvo Escalona, Ana Coelho, Federica Colombo, Leila Darwich, Martine Fontaine, Toshikazu Ikuta, Jonathan C. Ipser, Asier Juaneda-Seguí, Hitomi Kitagawa, Gerd Kvale, Mafalda Machado-Sousa, Astrid Morer, Takashi Nakamae, Jin Narumoto, Joseph O’Neill, Sho Okawa, Eva Real, Veit Roessner, Joao R. Sato, Cinto Segalàs, Roseli G. Shavitt, Dick J. Veltman, Kei Yamada were missing from the author list indexed under the ENIGMA-OCD Working Group. Additionally, there was an error regarding Tokiko Yoshida’s name, where the first name and last name were written in the wrong order. The original article has been corrected.

Current knowledge about functional connectivity in obsessive-compulsive disorder (OCD) is based on small-scale studies, limiting the generalizability of results. Moreover, the majority of studies have focused only on predefined regions or functional networks rather than connectivity throughout the entire brain. Here, we investigated differences in resting-state functional connectivity between OCD patients and healthy controls (HC) using mega-analysis of data from 1024 OCD patients and 1028 HC from 28 independent samples of the ENIGMA-OCD consortium. We assessed group differences in whole-brain functional connectivity at both the regional and network level, and investigated whether functional connectivity could serve as biomarker to identify patient status at the individual level using machine learning analysis. The mega-analyses revealed widespread abnormalities in functional connectivity in OCD, with global hypo-connectivity (Cohens d: -0.27 to -0.13) and few hyper-connections, mainly with the thalamus (Cohens d: 0.19 to 0.22). Most hypo-connections were located within the sensorimotor network and no fronto-striatal abnormalities were found. Overall, classification performances were poor, with area-under-the-receiver-operating-characteristic curve (AUC) scores ranging between 0.567 and 0.673, with better classification for medicated (AUC = 0.702) than unmedicated (AUC = 0.608) patients versus healthy controls. These findings provide partial support for existing pathophysiological models of OCD and highlight the important role of the sensorimotor network in OCD. However, resting-state connectivity does not so far provide an accurate biomarker for identifying patients at the individual level.

Abstract The NEXT-White detector, a high-pressure gaseous xenon time projection chamber, demonstrated the excellence of this technology for future neutrinoless double beta decay searches using photomultiplier tubes (PMTs) to measure energy and silicon photomultipliers (SiPMs) to extract topology information. This analysis uses 83m Kr data from the NEXT-White detector to measure and understand the energy resolution that can be obtained with the SiPMs, rather than with PMTs. The energy resolution obtained of (10.9 ± 0.6)%, full-width half-maximum, is slightly larger than predicted based on the photon statistics resulting from very low light detection coverage of the SiPM plane in the NEXT-White detector. The difference in the predicted and measured resolution is attributed to poor corrections, which are expected to be improved with larger statistics. Furthermore, the noise of the SiPMs is shown to not be a dominant factor in the energy resolution and may be negligible when noise subtraction is applied appropriately, for high-energy events or larger SiPM coverage detectors. These results, which are extrapolated to estimate the response of large coverage SiPM planes, are promising for the development of future, SiPM-only, readout planes that can offer imaging and achieve similar energy resolution to that previously demonstrated with PMTs.

Abstract Nonrelativistic Quantum Chromodynamics (NRQCD) breaks down in the region of low transverse momentum, where the transverse momentum of the produced quarkonium state is sensitive to multiple scattering with the incoming hadron and to soft gluon radiation. In this kinematic regime, the transverse-momentum-dependent (TMD) factorization framework is required, promoting the long-distance matrix elements (LDMEs) of NRQCD to the so-called TMD shape functions (TMDShFs), which encode both the soft gluon radiation and the formation of the heavy-quark bound state. In this work, we apply an effective-field theory approach (combining NRQCD and SCET) to the photon-gluon fusion process in inclusive J/ψ leptoproduction. We derive a factorization theorem for the cross section in terms of TMDShFs, compute these quantities at next-to-leading order, establish their evolution, and study their matching onto the corresponding LDMEs in the high-transverse-momentum region. Our results are particularly relevant to the Electron-Ion Collider, where J/ψ leptoproduction can be used to probe gluon transverse-momentum-dependent parton distribution functions (gluon TMDPDFs).

Abstract Background Nirmatrelvir/ritonavir (NM/r) is a safe and effective oral antiviral therapeutic used for treatment of mild-to-moderate COVID-19. Case reports described a clinical rebound syndrome whereby individuals experience a relapse of symptoms shortly after completing successful treatment. There is a lack of information on frequency of COVID-19 rebound after NM/r in routine clinical care, contributing factors, and clinical outcomes. Methods We reviewed electronic medical records to verify COVID-19 diagnosis, symptoms, and treatment with NM/r from January-June 2022. We defined COVID-19 clinical rebound as clear improvement in symptoms followed by recurrence or worsening of symptoms within 30 days of a five-day course of NM/r. Results We studied 268 adults with median age 57 (IQR 47, 68), 80% White race, 85% non-Hispanic ethnicity, 55% female, 80% vaccinated and boosted against SARS-CoV-2, and 68% with any co-morbidity. Sixteen (6.0%) of studied patients were determined to have COVID-19 clinical rebound. The median time from starting NM/r to rebound was 11 days (IQR 9, 13). Notable demographic and clinical factors with higher proportion (not statistically significant) among COVID-19 rebound patients were female sex (75% rebound vs. 54.5% no rebound), Black race (12.5% rebound vs. 4.9% no rebound), presence of at least one co-morbidity (81.3% rebound vs. 67.5% no rebound), and lack of prior SARS-CoV-2 infection (100% rebound vs. 92.9% no rebound). Only one patient (6.25%) was hospitalized after COVID-19 rebound. Conclusions COVID-19 clinical rebound after treatment with NM/r is mild with favorable outcomes and more common than previously reported from real-world clinical care studies.

Background and Objectives: Juvenile autoimmune hepatitis (AIH) is an inflammatory, immune-mediated liver disease that affects individuals from infancy to adolescence. The clinical presentation of AIH can mimic other hepatic disorders, such as viral hepatitis, toxic hepatitis, and Wilson's disease, often manifesting with symptoms like fatigue, nausea, vomiting, jaundice, fever, and pruritus.Case Presentation: A 16-year-old male with a history of congenital ichthyosis, xerosis cutis, mild intermittent asthma, and environmental allergic rhinitis presented to the clinic with upper respiratory symptoms. Upon examination, the patient was found to be jaundiced, prompting an urgent referral for further evaluation. This led to a diagnosis of autoimmune hepatitis and inflammatory bowel disease.Discussion: Juvenile autoimmune hepatitis is a rare but serious inflammatory liver disorder that primarily affects infants and adolescents. Due to its similarities with various other liver diseases, differential diagnosis can be quite challenging. Overall, the prognosis for our patient appears to be positive.

Purpose: The aim of this paper is to analyse comparatively, at regional level, the current state of a wide range of indicators of Vocational Education and Training (VET) in Spain. This will make it possible to characterise and better understand the existence of a variety of regional VET systems, including the Initial VET and Continuous VET subsystems within Spain, doing so under a multidimensional approach examining VET supply and demand. Methods: Systemic analysis of Spanish VET indicators leads to a selection of 54 indicators, which are then compared at regional level using k-means clustering. This approach identifies similarities and differences (clusters) across all of Spain's 17 autonomous communities (Spanish regions). The correlation between the variables is then analysed to examine the interaction between the VET system's supply and demand dimensions. Findings: The results show that 19 indicators explain the main differences between autonomous communities, which form two distinct clusters. Both VET supply and VET environment and demand influence cluster formation and intercluster differences. In the set of indicators that differentiate the two clusters of autonomous communities, close interaction is detected between certain indicators of VET supply and demand, especially those referring to the STEM occupational group, which confirms the correlation between these dimensions, albeit to a limited extent. Conclusions: While it is necessary to analyse the differences between clusters in greater depth, the results suggest that Spain's regions are split into two distinct groups (clusters) in which the respective VET systems are developing and advancing differently. Moreover, there is evidence of a small number of significant interrelations between indicators of VET supply and demand, which point to both the VET system's specialisation and its inclusive nature.

ABSTRACTThe anti-corrosive effect of the extract in ethanol of Justicia brandegeeana (Acanthaceae) against carbon steel AISI 1020 in sulfuric acid medium 1 mol L−1 was investigated. In addition to the effect of seasonality, several techniques were used to investigate the anti-corrosive activity, such as electrochemical impedance spectroscopy (EIS), potentiodynamic polarization (PP), linear polarization resistance (LPR), and weight loss. The chelating effect was analyzed by UV-Vis spectrophotometry and the surface was analyzed by scanning electron microscopy (SEM). The results showed that the inhibition efficiency is dependent on the concentration of the extract, reaching its maximum at 1500 ppm and despite having good thermal stability (82.41% inhibition at 70°C), it decreases with increasing temperature, indicating a physisorption behavior. The extract obeyed the Langmuir isotherm and the Tafel curves characterized it as a mixed inhibitor, with a tendency to cathodic region. It also presented a 52% chelating effect against Fe+2 ions, and the SEM analysis indicated a protection with the presence of plant extract, thus minimizing surface roughness. These results indicated the J. brangeeana ethanol extract as a green anti-corrosive agent.

AbstractThe aim of this study is to determine factors associated with cannabis discontinuation, to assess the impact of mental health and addiction interventions on cannabis discontinuation during pregnancy and to investigate the neonatal impact of cannabis discontinuation. This is a 10-year cohort study in a tertiary hospital in Barcelona, Spain, including women with self-reported cannabis use during pregnancy. Main outcome was cannabis discontinuation based on biological sample testing. Secondary outcomes were neonatal intensive care unit (NICU) admission, preterm birth, birth weight and bottle-feeding. When cannabis use was detected during pregnancy, 32 out of 81 (38.3%) discontinued cannabis during pregnancy vs. four out of 61 (6.6%) when detected at birth (p

Objective: To investigate the association of nighttime awakenings at 12 months with the duration and efficiency of nighttime sleep at 6 years of age. Methods: Data from two population-based prospective studies (The Pelotas 2004 and The Pelotas 2015 Birth Cohorts) were used. Information on nighttime awakenings was provided by mothers during the 12-month follow-up interview. Infants who awakened >3 times after sleep onset at 12 months were considered frequent wakeners. Sleep duration and sleep efficiency were obtained by actigraphy at the 6-year follow-up. Children wore the device at the wrist of the non-dominant arm continuously for 3–7 days, including at least one weekend day. Unadjusted and adjusted beta coefficients were obtained by linear regression for each cohort separately. Results: 2500 children from the 2004 and 2793 from the 2015 cohort had full information on nighttime awakenings at 12 months and actigraphy at 6 years and were analyzed. Prevalence of frequent wakeners was 6.3 % and 5.9 % in the 2004 and 2015 cohort, respectively. Mean bedtime and wake-up time at 6 years were, respectively, 23:23 and 08:41 h in the 2004 cohort, and 00:10 and 09:00 h int the 2015 cohort. Nighttime sleep lasted on average 7.54 and 7.24 h respectively in the 2004 and the 2015 cohort, and the sleep efficiency was 81.1 and 82.5 % respectively. In adjusted analyses, no associations were found between awakening at 12 months and sleep duration or sleep efficiency at 6 years of age. Conclusion: In both cohorts sleep duration and efficiency were below the recommendation for school-age children (respectively 9–11 h and 85 %). There was no relationship between the number of nighttime awakenings at 12 months and sleep duration or efficiency at 6 years.

BackgroundVirtual wards (VWs) are being introduced within the National Health Service (NHS) in England as a new way of delivering care to patients who would otherwise be hospitalized. Using digital technologies, patients can receive acute care, remote monitoring, and treatment in their homes. Integrated care system commissioners are employees involved in the planning of, agreeing to, and monitoring of services within NHS England and have an important role in the adoption and implementation of VWs in clinical practice. ObjectiveThis study aims to develop an understanding of the acceptability and feasibility of adopting and implementing VWs in England from integrated care system commissioners’ perspectives, including the identification of barriers and facilitators to implementation. MethodsQualitative semistructured interviews were conducted with 20 commissioners employed by NHS England (NHSE) in various geographic regions of England. Thematic analysis was conducted, structured using the framework approach, and informed by the Consolidated Framework for Implementation Research. The COREQ (Consolidated Criteria for Reporting Qualitative Research) guidelines were followed. ResultsFour overarching themes were identified reflecting the acceptability and feasibility of key adoption and implementation processes: (1) assessing the need for VWs, (2) coordinating a system approach, (3) agreeing to Program Outcomes: NHSE Versus Organizational Goals, and (4) planning and adapting services. Commissioners expressed the need for system-level change in care provision within the NHS, with VWs perceived as a promising model that could reform patient-centered care. However, there was uncertainty over the financial sustainability of VWs, with questions raised as to whether they would be funded by the closure of hospital beds. There was also uncertainty over the extent to which VWs should be technology-enabled, and the specific ways technology may enhance condition-specific pathways. Differing interpretations of the NHSE instructions between different health care sectors and a lack of clarity in definitions, as well as use of hospital-centric language within national guidance, were considered hindrances to convening a system approach. Furthermore, narrow parameters of success measures in terms of goals and outcomes of VWs, unrealistic timescales for planning and delivery, lack of interoperability of technology and time-consuming procurement procedures, liability concerns, and patient suitability for technology-enabled home-based care were identified as barriers to implementation. Motivated and passionate clinical leads were considered key to successful implementation. ConclusionsVWs have the potential to reform patient-centered care in England and were considered a promising approach by commissioners in this study. However, there should be greater clarity over definitions and specifications for technology enablement and evidence provided about how technology can enhance patient care. The use of less hospital-centric language, a greater focus on patient-centered measures of success, and more time allowance to ensure the development of technology-enabled VW services that meet the needs of patients and staff could enhance adoption and implementation.

Margalefidinium polykrikoides is a mixotrophic dinoflagellate harmful algal bloom (HAB) species that blooms annually in the lower Chesapeake Bay. M. polykrikoides undertakes a diel vertical migration (DVM) which may give it a competitive advantage over purely phototrophic organisms who cannot access deeper nutrient pools and allow it to form large toxic blooms. Laboratory-based estimates of M. polykrikoides’ DVM rates suggest that it is one of the fastest known dinoflagellate swimmers and understanding this behavior is likely important for modeling and predicting M. polykrikoides blooms. However, to date, no field-derived estimates of M. polykrikoides’ DVM rates have been made in the Chesapeake Bay. In this study, we conducted four targeted field experiments to investigate the DVM of M. polykrikoides in the Lafayette River, a sub-tributary of the Chesapeake Bay. Vertical profiles of chlorophyll a fluorescence collected at least every 2 h over diel periods were used to track the DVM of M. polykrikoides during blooms. The maximum observed DVM rate for M. polykrikoides was 2.5 m h−1, with mean DVM rates around 1.3 m h−1 for both ascents and descents. As in studies from other regions, our results show that M. polykrikoides’ ascent to/descent from the surface initiates before sunrise/sunset, suggesting phototaxis is not the primary trigger of their DVM. However, unlike in other studies where M. polykrikoides was observed to modulate its DVM to avoid excessively warm temperatures (≥30°C), we do not observe active thermotaxic avoidance, despite ambient temperatures exceeding their optimal threshold.

Summary: Background: Symptom fluctuations within and between individuals with long COVID are widely reported, but the extent to which severity varies following different types of activity and levels of exertion, and the timing of symptoms and recovery, have not previously been quantified. We aimed to characterise timing, severity, and nature of symptom fluctuations in response to effortful physical, social and cognitive activities, using Ecological Momentary Assessments. Methods: We recorded activity, effort, and severity of 8 core symptoms every 3 h for up to 24 days, in cohorts from both clinic and community settings. Symptom severities were jointly modelled using autoregressive and moving average processes. Findings: Consent was received from 376 participants providing ≥1 week's measurements (273 clinic-based, 103 community-based). Severity of all symptoms was elevated 30 min after all categories of activity. Increased effort was associated with increased symptom severity. Fatigue severity scores increased by 1.8/10 (95% CI: 1.6–1.9) following the highest physical exertions and by 1.5 (1.4–1.7) following cognitive efforts. There was evidence of only mild delayed fatigue 3 h (0.3, 0.2–0.5) or one day later (0.2, 0.0– 0.5). Fatigue severity increased as the day progressed (1.4, 1.0–1.7), and cognitive dysfunction was 0.2 lower at weekends (0.1–0.3). Interpretation: Cognitive, social, self-care and physical activities all triggered increased severity across every symptom, consistent with associated common pathways as potential therapeutic targets. Clear patterns of symptom fluctuations emerged that support more targeted self-management. Funding: National Institute for Health and Care Research.

The two-week Home Base Intensive Clinical Program (ICP) provides treatment to veterans and active duty service members suffering from primary diagnoses of posttraumatic stress disorder (PTSD), traumatic brain injury (TBI), anxiety, or depression. First launched in 2015, this paper provides a programmatic update, including new treatment components implemented since inception, and examines outcomes for all participants who entered the program from September 2015 to July 2024 (n = 2561). The Home Base ICP provides a massed care approach through daily individual Prolonged Exposure, Cognitive Processing Therapy, Unified Protocol, or cognitive rehabilitation, along with groups targeting coping skills. Participants entering the program are provided with core group programming, as well as individualized therapy sessions tailored to their unique needs and symptom presentation. Supplemental dual recovery support is also available for all participants with co-occurring substance use or behavioral addiction concerns. Participants' support people receive education, support, and case management services. Participants have a multidisciplinary team comprising therapists, psychopharmacology providers, case managers, nurses, and wellness providers. Results demonstrate that program participants exhibited statistically significant reductions in PTSD symptoms (Cohen's d = 0.80), depression (d = 0.68), post-concussion symptoms (d = 0.71), and increased satisfaction in social roles (d = -0.65). Completion rate was 94.60% (n = 2422), suggesting that the Home Base ICP is a well-received and effective model of care for veterans and service members.