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Higher education opens doors to job enhancement and economic benefits to adult learners. Despite facing multiple barriers such as life-work-school time conflicts and financial constraints, adult learners continue to seek higher education and certifications. Rural employers also benefit from supporting degree completion or job-specific certifications because it allows them to attract and retain highly skilled employees. The goal of the current study was to qualitatively analyze data gathered from focus group interviews of senior managers. The results provide insights into how rural employers in the United States use employee education programs to reduce barriers to adult learner success. The importance of a bilateral relationship between institutions of higher education and employers to support adult learners is discussed.

BACKGROUND: Patient-reported outcome measures (PROMs) have been adopted as a way to measure patient self-rated physical function and health status for patients with anterior cruciate ligament (ACL) injuries. Although multiple PROMs exist and have been translated into various languages, the cross-cultural adaptation and validity of these PROMs for Spanish-speaking patients is unknown. PURPOSE: To evaluate the adaptation quality and psychometric properties of Spanish-language adaptations of PROMs for patients with ACL injuries. STUDY DESIGN: Scoping review; Level of evidence, 3. METHODS: Under PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, we reviewed published studies related to adaptation quality and psychometric properties of Spanish PROMs in patients with ACL injuries. The methodological quality of the included studies was assessed using the Guidelines for the Process of Cross-Cultural Adaptation of Self-Reported Measures, the Quality Criteria for Psychometric Properties of Health Status Questionnaires, and the Consensus-based Standards for the selection of health Measurement INstruments (COSMIN) checklist. The level of evidence for each PROM was determined based on the number of studies, methodological quality, consistency of results, and sample size. RESULTS: The initial search strategy identified 5687 articles. After removal of duplicates, 1882 titles were screened, and 114 articles were assessed for eligibility. Six articles were selected for final review, comprising 4 PROMs: the Lysholm knee score, the Anterior Cruciate Ligament-Return to Sport After Injury (ACL-RSI), the Lower Extremity Functional Scale, and the Lower Limb Functional Index. Three studies followed all 6 processes for cross-cultural adaptation. None of the studies demonstrated all 14 domains required for cross-cultural validity (eg, description of translator expertise). The ACL-RSI achieved the highest level of evidence, with 3 of 9 domains demonstrating moderate evidence. CONCLUSION: This review identified 4 instruments that have been translated for Spanish-speaking patients with ACL injuries, none of which demonstrated appropriate adaptation or robust psychometric properties. The study highlights the need for improvement in PROMs for Spanish-speaking patients and the potential for mismeasurement and inappropriate application of PROM results in patients with ACL injuries.

BACKGROUND: Anterior cruciate ligament (ACL) injuries are one of the most common knee injuries in pediatric patients in the United States. The patients primary spoken language may affect outcomes after ACL reconstruction (ACLR). PURPOSE/HYPOTHESIS: The purpose of this study was to identify differences in ACLR outcomes between patients whose primary, preferred spoken language was either English or Spanish. It was hypothesized that there would be a difference in retear rates between patients preferring English versus Spanish. STUDY DESIGN: Cohort study; Level of evidence, 3. METHODS: A retrospective cohort study was performed on pediatric and adolescent patients who underwent ACLR at a single institution. Patients were divided into 2 cohorts based on their preferred spoken language: English or Spanish. All patients underwent either hamstring tendon or bone-patellar tendon-bone autograft ACLR performed by the same surgeon with the same postoperative rehabilitation protocols. Linear regression, chi-square tests, and multivariate logistic regression were used to determine if outcomes, graft tear, revision surgery, and contralateral injury differed between groups. RESULTS: A total of 68 patients were identified: 33 patients whose preferred language was English and 35 patients whose preferred language was Spanish. The overall mean age of the patients was 16.4 ± 1.4 years (range, 13.2-20.5 years), and the mean follow-up time was 3.26 ± 1.98 years (range, 0.53-8.13 years). Patients who preferred Spanish were more likely than those who preferred English to experience graft tears requiring revision surgery after ACLR (P = .02; odds ratio [OR] = 5.81; adjusted OR = 1.94), at a tear rate of 14.3%. CONCLUSION: Patients who preferred to speak Spanish experienced higher graft tear rates when compared with patients who preferred speaking English, even after adjusting for sex, sport played, graft type, type of insurance, and time to surgery.

The management of chronic extensor mechanism injuries represents a significant challenge for orthopaedic surgeons, with numerous options for graft choice and fixation construct, but no clear consensus on which technique achieves optimal outcomes. Although there is little published data regarding outcomes of different fixation methods, small case series have demonstrated modest success using Achilles tendon bone block allografts and transverse patellar screw fixation. In this technical note, we describe a surgical technique for the treatment of a chronic inferior pole patella fracture, with extensor mechanism reconstruction using an Achilles tendon allograft with suture tape augmentation. Our technique describes the use of vertical cannulated screws in the patella for passing tape augmentation sutures, increased construct security by suturing of the Achilles graft directly to the quadriceps tendon, and the use of a post screw in the proximal tibia for suture tape augmentation.

Defect engineering is foundational to classical electronic device development and for emerging quantum devices. Here, we report on defect engineering of silicon with ion pulses from a laser accelerator in the laser intensity range of 1019 W cm−2 and ion flux levels of up to 1022 ions cm−2 s−1, about five orders of magnitude higher than conventional ion implanters. Low energy ions from plasma expansion of the laser-foil target are implanted near the surface and then diffuse into silicon samples locally pre-heated by high energy ions from the same laser-ion pulse. Silicon crystals exfoliate in the areas of highest energy deposition. Color centers, predominantly W and G-centers, form directly in response to ion pulses without a subsequent annealing step. We find that the linewidth of G-centers increases with high ion flux faster than the linewidth of W-centers, consistent with density functional theory calculations of their electronic structure. Intense ion pulses from a laser-accelerator drive materials far from equilibrium and enable direct local defect engineering and high flux doping of semiconductors.

Abstract Nuclear metabolism and DNA damage response are intertwined processes, but the precise molecular links remain elusive. Here, we explore this crosstalk using triple-negative breast cancer (TNBC) as a model, a subtype often prone to DNA damage accumulation. We show that the de novo purine synthesis enzyme IMPDH2 is enriched on chromatin in TNBC compared to other subtypes. IMPDH2 chromatin localization is DNA damage dependent, and IMPDH2 repression leads to DNA damage accumulation. On chromatin, IMPDH2 interacts with and modulates PARP1 activity by controlling the nuclear availability of NAD+ to fine-tune the DNA damage response. However, when IMPDH2 is restricted to the nucleus, it depletes nuclear NAD+, leading to PARP1 cleavage and cell death. Our study identifies a non-canonical nuclear role for IMPDH2, acting as a convergence point of nuclear metabolism and DNA damage response.

Hamstring tendons are a very commonly used autograft for anterior cruciate ligament (ACL) reconstruction. Given that larger hamstring graft diameter has been shown to positively affect outcomes after ACL reconstruction, several techniques have been developed to optimize this variable. In this technical note, we describe the operative technique for generation of a 5-strand hamstring autograft via tripling of the semitendinosus tendon and doubling of the gracilis tendon, which can serve to maximize graft diameter, especially in patient populations with undersized hamstring tendons at baseline.

Abstract Many cellular processes are governed by protein–protein interactions that require tight spatial and temporal regulation. Accordingly, it is necessary to understand the dynamics of these interactions to fully comprehend and elucidate cellular processes and pathological disease states. To map de novo protein–protein interactions with time resolution at an organelle-wide scale, we developed a quantitative mass spectrometry method, time-resolved interactome profiling (TRIP). We apply TRIP to elucidate aberrant protein interaction dynamics that lead to the protein misfolding disease congenital hypothyroidism. We deconvolute altered temporal interactions of the thyroid hormone precursor thyroglobulin with pathways implicated in hypothyroidism pathophysiology, such as Hsp70-/90-assisted folding, disulfide/redox processing, and N-glycosylation. Functional siRNA screening identified VCP and TEX264 as key protein degradation components whose inhibition selectively rescues mutant prohormone secretion. Ultimately, our results provide novel insight into the temporal coordination of protein homeostasis, and our TRIP method should find broad applications in investigating protein-folding diseases and cellular processes.

Abstract Multiple-choice test generation is one of the most complex NLP problems, especially in languages other than English, where there is a lack of prior research. After a review of the literature, it has been verified that some methods like the usage of rule-based systems or primitive neural networks have led to the application of a recent architecture, the Transformer architecture, in the tasks of Answer Extraction (AE) and Question Generation (QG). Thereby, this study is centred in searching and developing better models for the AE and QG tasks in Spanish, using an answer-aware methodology. For this purpose, three multilingual models (mT5-base, mT0-base and BLOOMZ-560 M) have been fine-tuned using three different datasets: a translation to Spanish of the SQuAD dataset; SQAC, which is a dataset in Spanish; and their union (SQuAD + SQAC), which shows slightly better results. Regarding the models, the performance of mT5-base has been compared with that found in two newer models, mT0-base and BLOOMZ-560 M. These models were fine-tuned for multiple tasks in literature, including AE and QG, but, in general, the best results are obtained from the mT5 models trained in our study with the SQuAD + SQAC dataset. Nonetheless, some other good results are obtained from mT5 models trained only with the SQAC dataset. For their evaluation, the widely used BLEU1-4, METEOR and ROUGE-L metrics have been obtained, where mT5 outperforms some similar research works. Besides, CIDEr, SARI, GLEU, WER and the cosine similarity metrics have been calculated to present a benchmark within the AE and QG problems for future work.

The biotransformation of poultry (PSW) and swine (SSW) slaughterhouse waste might provide protein feedstuffs, ensuring efficient ruminant systems while safeguarding the environment. The present study aimed to evaluate the potential of PSW and SSW as alternative protein feed for ruminant animals. A total of 24 lambs [25.4 ± 3.13 kg of body weight (BW), mean ± SD] were randomly allocated to one of three groups (n = 8): a control diet formulated with typical protein ingredients (CTRL) and two diets formulated with PSW or SSW meal as a protein source. Dietary inclusion of PSW or SSW did not alter (p = 0.05) dry matter intake or final BW. However, animals fed SSW showed the highest average daily gain (ADG, p = 0.04). In addition, substituting PSW and SSW improved the feed conversation ratio (FCR, p = 0.05). There were no diet effects (p = 0.05) on N intake, while fecal N excretion increased (p = 0.03) with SSW feeding. Compared to CTRL and PSW, ingestion of SSW decreased (p = 0.001) and retained N. The digestibility of crude protein and organic matter remained unchanged (p = 0.05). Additionally, there were no differences (p = 0.05) in potential microbial protein synthesis based on either protein content (SPMp) or energy content (SPMe). Similarly, potential metabolizable protein by protein (PMp) and potential metabolizable energy by protein (PMe) were not affected (p = 0.05). Overall, both PSW and SSW positively influenced the growth performance of ewe lambs. However, further studies are warranted to explore the impact of PWS or SSW feeding on rumen function, nitrogen pollution, and protein escaping the rumen into the intestine in ruminants.

Abstract: Introduction: Psychological treatments are becoming an increasingly important component of medical healthcare, as a growing number of people seek treatment for a wide range of mental health problems. While these treatments are known to be effective, much remains to be understood about their mechanisms and reasons for effectiveness. The study of statistical mediators is crucial in psychological research, as it is fundamental to understanding how psychological factors influence health, well-being, and human behavior, and thus to designing effective psychological interventions. Aim: This study investigates the role of resilience as a treatment mediator in PROCARE+, a brief transdiagnostic, personalized protocol for the selective prevention of emotional disorders in adolescents. This approach has proven effective for young people at risk of developing emotional issues. Method: We used simple mediation models in a sample of 153 adolescents to assess the impact of interventions on resilience. Outcome variables included self-reported and parent-reported emotional risk, mood, anxiety symptoms, and quality of life. Discussion: The results of this study provide valuable information on how PROCARE+ works and how to improve its effectiveness, pointing to resilience as a key mediator in reducing the risk of developing emotional disorders and improving quality of life.

Business financial risk-taking usually occurs under conditions of stress. Biologically, the stress response has two components: one linked to the hypothalamic-pituitary-adrenal (HPA) axis and the other to the autonomic nervous system (ANS). The existing literature on financial risk-taking has primarily focused on the effects of cortisol, related to the HPA axis. This article, however, examines the influence of the ANS, as measured by vagally mediated heart rate variability at rest (VMHRV). A total of 121 participants (60 female) were divided based on whether their VMHRV was below the median. Participants were then randomly assigned to either a stress test group (tsst) or a control group. Financial risk preferences were assessed using an incentive-compatible 50-50% Eckel and Grossman task. Participants in the tsst with high VMHRV had a higher probability of choosing riskier lotteries compared to the other participants (P = 0,0189). This finding suggests that greater parasympathetic modulation enables individuals to make riskier financial decisions when under stress. Thus, the article contributes to the literature by demonstrating that individuals with a higher physiological capacity to cope with external stressors are less risk-averse in financial decisions under social stress conditions.

Summary: Infection is a commonplace, usually self-limiting, condition but can lead to sepsis, a severe life-threatening dysregulated host response. We investigate the individual phenotypic predisposition to developing uncomplicated infection or sepsis in a large cohort of non-infected patients undergoing major elective surgery. Whole-blood RNA sequencing analysis was performed on preoperative samples from 267 patients. These patients developed postoperative infection with (n = 77) or without (n = 49) sepsis, developed non-infectious systemic inflammatory response (n = 31), or had an uncomplicated postoperative course (n = 110). Machine learning classification models built on preoperative transcriptomic signatures predict postoperative outcomes including sepsis with an area under the curve of up to 0.910 (mean 0.855) and sensitivity/specificity up to 0.767/0.804 (mean 0.746/0.769). Our models, confirmed by quantitative reverse-transcription PCR (RT-qPCR), potentially offer a risk prediction tool for the development of postoperative sepsis with implications for patient management. They identify an individual predisposition to developing sepsis that warrants further exploration to better understand the underlying pathophysiology.

Familial Dysautonomia (FD) is an autosomal recessive disorder caused by a splice site mutation in the gene ELP1, which disproportionally affects neurons. While classically characterized by deficits in sensory and autonomic neurons, neuronal defects in the central nervous system have also been described. Although ELP1 expression remains high in the normal developing and adult cerebellum, its role in cerebellar development is unknown. To explore the role of Elp1 in the cerebellum, we knocked out Elp1 in cerebellar granule cell progenitors (GCPs) and examined the outcome on animal behavior and cellular composition. We found that GCP-specific conditional knockout of Elp1 (Elp1cKO) resulted in ataxia by 8 weeks of age. Cellular characterization showed that the animals had smaller cerebella with fewer granule cells. This defect was already apparent as early as 7 days after birth, when Elp1cKO animals also had fewer mitotic GCPs and shorter Purkinje dendrites. Through molecular characterization, we found that loss of Elp1 was associated with an increase in apoptotic cell death and cell stress pathways in GCPs. Our study demonstrates the importance of ELP1 in the developing cerebellum, and suggests that loss of Elp1 in the GC lineage may also play a role in the progressive ataxia phenotypes of FD patients.

As of March 31, 2023, more than 30,000 monkeypox (mpox) cases had been reported in the United States in an outbreak that has disproportionately affected gay, bisexual, and other men who have sex with men (MSM) and transgender persons (1). JYNNEOS vaccine (Modified Vaccinia Ankara vaccine, Bavarian Nordic) was approved by the Food and Drug Administration (FDA) in 2019 for the prevention of smallpox and mpox via subcutaneous injection as a 2-dose series (0.5 mL per dose, administered 4 weeks apart) (2). To expand vaccine access, an Emergency Use Authorization was issued by FDA on August 9, 2022, for dose-sparing intradermal injection of JYNNEOS as a 2-dose series (0.1 mL per dose, administered 4 weeks apart) (3). Vaccination was available to persons with known or presumed exposure to a person with mpox (postexposure prophylaxis [PEP]), as well as persons at increased risk for mpox or who might benefit from vaccination (preexposure mpox prophylaxis [PrEP]) (4). Because information on JYNNEOS vaccine effectiveness (VE) is limited, a matched case-control study was conducted in 12 U.S. jurisdictions,† including nine Emerging Infections Program sites and three Epidemiology and Laboratory Capacity sites,§ to evaluate VE against mpox among MSM and transgender adults aged 18-49 years. During August 19, 2022-March 31, 2023, a total of 309 case-patients were matched to 608 control patients. Adjusted VE was 75.2% (95% CI = 61.2% to 84.2%) for partial vaccination (1 dose) and 85.9% (95% CI = 73.8% to 92.4%) for full vaccination (2 doses). Adjusted VE for full vaccination by subcutaneous, intradermal, and heterologous routes of administration was 88.9% (95% CI = 56.0% to 97.2%), 80.3% (95% CI = 22.9% to 95.0%), and 86.9% (95% CI = 69.1% to 94.5%), respectively. Adjusted VE for full vaccination among immunocompromised participants was 70.2% (95% CI = -37.9% to 93.6%) and among immunocompetent participants was 87.8% (95% CI = 57.5% to 96.5%). JYNNEOS is effective at reducing the risk for mpox. Because duration of protection of 1 versus 2 doses remains unknown, persons at increased risk for mpox exposure should receive the 2-dose series as recommended by the Advisory Committee on Immunization Practices (ACIP),¶ regardless of administration route or immunocompromise status.

BackgroundDue to the slower dissipation of the osmotic gradient, icodextrin-based solutions, compared to glucose-based solutions, can improve water removal. We investigated scenarios where one icodextrin-based long dwell (Extraneal) replaced two glucose-based exchanges.MethodsThe three-pore model with icodextrin hydrolysis was used for numerical simulations of a single exchange to investigate the impact of different peritoneal dialysis schedules on fluid and solute removal in patients with different peritoneal solute transfer rates (PSTRs). We evaluated water removal (ultrafiltration, UF), absorbed mass of glucose (AbsGluc) and carbohydrates (AbsCHO, for glucose and glucose polymers), ultrafiltration efficiency (UFE = UF/AbsCHO) per exchange, and specified dwell time, and removed solute mass for sodium (ReNa), urea (ReU), and creatinine (ReCr) for a single peritoneal exchange with 7.5% icodextrin (Extraneal®) and glucose-based solutions (1.36% and 2.27%) and various dwell durations in patients with fast and average PSTRs.ResultsIntroducing 7.5% icodextrin for the long dwell to replace one of three or four glucose-based exchanges per day leads to increased fluid and solute removal and higher UF efficiency for studied transport groups. Replacing two glucose-based exchanges with one icodextrin exchange provides higher or similar water removal and higher daily sodium removal but slightly lower daily removal of urea and creatinine, irrespective of the transport type present in the case of reference prescription with three and four daily exchanges.ConclusionOne 7.5% icodextrin can replace two glucose solutions. Unlike glucose-based solutions, it resulted only in minor differences between PSTR groups in terms of water and solute removal with UFE remaining stable up to 16 h.

IntroductionOlive cultivation, like other evergreen fruit crops worldwide, is limited by the occurrence of frost episodes in different times of the year, mainly in winter or early spring. Some contradictory results are reported about cultivars’ response to frost, which depends on the physiological stage of the tissues (acclimated or not acclimated) when the cold or frost episode occurs. This work aimed to implement a user-friendly and reliable lab method for discerning frost tolerance.MethodsOur methodology considered both detached leaves and potted plantlets. The optimal temperature at which damage differentiated between cultivars was evaluated, as well as the time of exposure to cold and the recovery time for the correct evaluation of the symptoms. Furthermore, a comparative analysis of damage on both young and mature leaves was conducted. To validate the efficacy of the methodology, assessments were conducted on the cultivars ‘Arbequina’ (tolerant), ‘Picual’ (moderately tolerant), and ‘Frantoio’ (susceptible) under acclimated and non-acclimated conditions.Results and discussionThe results indicated that, when detached leaves were used for frost evaluation, a temperature of -10°C ± 1°C for 30 min and a recovery time at 26°C for 24–48 h after exposure to cold are enough to induce damages on the leaves and discriminate between cultivar susceptibility. Under these conditions, a precise assessment of symptoms can be made, facilitating the categorization of frost tolerance level in various olive cultivars. Notably, no significant differences were observed between young and mature leaves during the evaluation process. On the other hand, the critical temperature to assess damages on potted plantlets was determined to be -7°C ± 1°C. In addition, it was observed that acclimated plants exhibited fewer symptoms compared to non-acclimated ones, with ‘Frantoio’ being the most affected alongside ‘Picual’ and ‘Arbequina’.ConclusionThe implemented methodology will allow the assessment of frost tolerance in several olive cultivars within a short timeframe, and it is proven to be user-friendly and reliable.

The digital competences of university students are developed using a digital learning ecosystem that integrates: 1) virtual learning environments; 2) digital learning tools; and 3) learning methodologies. This research followed the methodology of systematic literature mapping and review, searching the WoS and Scopus databases and obtaining a total of 5,652 articles between 2001 and 2023. Inclusion and exclusion criteria were then applied to reduce the number of selected articles and carry out a systematic literature mapping and review. Among the relevant results of the literature mapping and systematic review, the geographic distribution of scientific publications, the educational areas in which they have been worked on, and the universities were identified. Educational methodologies, technological tools, and virtual learning environments used to develop university students’ digital competences holistically were also determined. This study is useful as it provides a comprehensive, general, and detailed overview of scientific production and its main contributions regarding the methodologies, tools, and environments that contribute to developing students’ the digital competences in higher education.

The SKY130 Process Design Kit (PDK) offers limited options for Static Random-Access Memory (SRAM) configurations, providing only three predefined memory sizes: $8\times 1024$ , $32\times 256$ , and $32\times 512$ , this poses a challenge for designers who require memories with different characteristics, as they must either design an entire memory architecture from scratch or resort to interleaving techniques with the available memory configurations. To address this issue, we present a novel framework that automates the generation of multiple memory arrays with custom floorplans, leveraging the concept of interleaving memory. Our framework enables designers to create various sizes and configurations memories by combining and interleaving the existing SKY130 PDK memories, additionally, the framework allows designers to easily specify their desired memory size, word length, floorplan, and other essential parameters. The framework then automatically generates multiple memory arrays that meet the specified requirements. Furthermore, it provides the files required by OpenLane, facilitating the seamless integration of these memories into the Register Transfer Level (RTL) to Graphic Data System II (GDSII) flow. The key advantage of our framework lies in its ability to streamline the creation of custom memories by automating the interleaving process and offering flexibility in floorplan design. This significantly reduces design time and effort, empowering designers to efficiently create memories with specific characteristics while adhering to the limitations of the SKY130 PDK. The framework thus serves as a valuable tool for memory design in the context of the SKY130 PDK, opening doors for more efficient and optimized chip designs.

In recent years, transformer language models have made a significant impact on automatic text generation. This study focuses on the task of distractor generation in Spanish using a fine-tuned multilingual text-to-text model, namely mT5. Our method outperformed established baselines based on LSTM networks, confirming the effectiveness of Transformer architectures in such NLP tasks. While comparisons with other Transformer-based solutions yielded diverse outcomes based on the metric of choice, our method notably achieved superior results on the ROUGE metric compared to the GPT-2 approach. Although traditional evaluation metrics such as BLEU and ROUGE are commonly used, this paper argues for more context-sensitive metrics given the inherent variability in acceptable distractor generation results. Among the contributions of this research is a comprehensive comparison with other methods, an examination of the potential drawbacks of multilingual models, and the introduction of alternative evaluation metrics. Future research directions, derived from our findings and a review of related works are also suggested, with a particular emphasis on leveraging other language models and Transformer architectures.

Within the field of nanomedicine, which is revolutionizing cancer treatment, solid lipid nanoparticles (SLNs) have shown advantages over conventional chemotherapy when tested on cancer cells in preclinical studies. SLNs have proven to be an innovative strategy for the treatment of triple-negative breast cancer cells, providing greater efficiency than existing treatments in various studies. The encapsulation of antineoplastic drugs in SLNs has facilitated a sustained, controlled, and targeted release, which enhances therapeutic efficiency and reduces adverse effects. Moreover, the surface of SLNs can be modified to increase efficiency. For instance, the coating of these particles with polyethylene glycol (PEG) decreases their opsonization, resulting in a longer life in the circulatory system. The creation of positively charged cationic SLNs (cSLNs), achieved by the utilization of surfactants or ionic lipids with positively charged structural groups, increases their affinity for cell membranes and plasma proteins. Hyaluronic acid has been added to SLNs so that the distinct pH of tumor cells would stimulate the release of the drug and/or genetic material. The current review summarizes the recent research on SLNs, focusing on the encapsulation and transport of therapeutic agents with a cytotoxic effect on triple-negative breast cancer.