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OBJECTIVE: To determine the efficacy of fluoroscopically guided corticosteroid injection for hip osteoarthritis (OA) in a randomized, double-blind, placebo-controlled trial. METHODS: Fifty-two patients with symptomatic hip OA were randomly allocated to receive placebo (10 mg bipuvicaine, 2 ml saline) (n = 21) or corticosteroid treatment (10 mg bipuvicaine, 40 mg triamcinolone hexacetonide) (n = 31). Patients were followed up for 1, 2, 3, and 6 months. The primary outcome measure was the pain improvement response, defined as a 20% decrease in the Western Ontario and McMaster Universities OA Index (WOMAC) pain score (on 5 100-mm visual analog scales [VAS]) (WOMAC20) from baseline to 2 months postinjection. Secondary outcomes were a 50% decrease in the WOMAC pain score (WOMAC50), changes in other WOMAC subscale scores, patient's global assessment of health (on a 100-mm VAS), and Short Form 36 (SF-36) quality of life indices. Analyses were based on the intent-to-treat principle. RESULTS: The mean WOMAC pain score fell 49.2% (decreasing from 310.1 mm to 157.4 mm) at 2 months postinjection in patients receiving corticosteroid, compared with a decrease of 2.5% (from 314.3 mm to 306.5 mm) in the placebo group (P < 0.0001). The proportion of WOMAC20 responders at 2 months' followup was significantly higher in the corticosteroid group (67.7%) compared with the placebo group (23.8%) (P = 0.004); similar proportions of WOMAC50 responders were observed between groups (61.3% in the corticosteroid group versus 14.3% in the placebo group; P = 0.001). Response differences were maintained at 3 months' followup (58.1% responders in the corticosteroid group versus 9.5% responders in the placebo group; P = 0.004). Significant differences in the WOMAC stiffness and physical function scores (P < 0.0001), patient's global health scores (P = 0.005), and SF-36 physical component scores (P = 0.04) were observed, with patients in the corticosteroid group showing greater improvements. There were no differences in the frequency of adverse events between groups. CONCLUSION: This placebo-controlled trial confirms that corticosteroid injection can be an effective treatment of pain in hip OA, with benefits lasting up to 3 months in many cases. Future studies should address questions related to the benefits of repeated steroid injection and the effects of this treatment on disease modification. [ABSTRACT FROM AUTHOR]

Introduction: An estimated 78% of the total deaths attributable to smoking tobacco use occurred in low- and middle-income countries (LMICs) in 2019. In addition, smokeless tobacco increases the risk of all-cause mortality, all cancers including upper aero-digestive tract cancer, stomach cancer, ischaemic heart disease (IHD) and stroke; with 88% of the mortality burden being borne by the South-East Asian region. Evidence-based interventions from high income countries (HICs) are not easily transferable to LMICs, as patterns of tobacco use, health beliefs associated with tobacco use, and awareness of specific health risks vary substantially., Methods: We synthesised the effectiveness of behavioural interventions for tobacco cessation in LMICs through a systematic review and meta-analysis. Interventional studies which delivered individual behavioural intervention and assessed abstinence from tobacco use were included. We examined the pooled intervention effect at six months post-intervention follow up., Results: For continuous abstinence at six months, the intervention was superior to active comparator (RR 2.32; 95% CI 1.78-3.02), and usual care (RR 4.39; 95% CI 2.38-8.11). For point prevalence abstinence at six months, the intervention was superior to active comparator (RR 1.76; 95% CI 1.28-2.44), and usual care (RR 2.37; 95% CI 1.47-3.81). The statistical heterogeneity was substantial to considerable for all comparisons. Only six studies had an overall low risk of bias. Publication bias was observed for all comparisons, except for 6-month continuous outcomes., Conclusion: Implementation research is needed to understand factors for programme sustainability and equity of impact of behavioural interventions in reducing tobacco use in LMICs., Implications: Our review is an important step towards the understanding of effectiveness of behaviour interventions for tobacco cessation suited for low- and middle-income countries and which are responsive to the contextual needs of such countries., (© The Author(s) 2024. Published by Oxford University Press on behalf of the Society for Research on Nicotine and Tobacco.)

Although classical molecular biology assays can provide a measure of cellular response to chemical challenges, they rely on a single biological phenomenon to infer a broader measure of cellular metabolic response. These methods do not always afford the necessary sensitivity to answer questions of subcytotoxic effects, nor do they work for all cell types. Likewise, boutique assays such as cardiomyocyte beat rate may indirectly measure cellular metabolic response, but they too, are limited to measuring a specific biological phenomenon and are often limited to a single cell type. For these reasons, toxicological researchers need new approaches to determine metabolic changes across various doses in differing cell types, especially within the low-dose regime. The data collected herein demonstrate that LC-MS/MS-based untargeted metabolomics with a feature-agnostic view of the data, combined with a suite of statistical methods including an adapted environmental threshold analysis, provides a versatile, robust, and holistic approach to directly monitoring the overall cellular metabolomic response to pesticides. When employing this method in investigating two different cell types, human cardiomyocytes and neurons, this approach revealed separate subcytotoxic metabolomic responses at doses of 0.1 and 1 µM of chlorpyrifos and carbaryl. These findings suggest that this agnostic approach to untargeted metabolomics can provide a new tool for determining effective dose by metabolomics of chemical challenges, such as pesticides, in a direct measurement of metabolomic response that is not cell type-specific or observable using traditional assays., (Published by Oxford University Press on behalf of the Society of Toxicology 2024.)

Earthworm, P. excavatus, is an ideal model organism for studying regeneration. Due to its prodigious regeneration capability, the amputated head part of the earthworm can regenerate completely within 22 days. MicroRNAs (miRNAs) regulate specific genes and are involved in essential biological processes, including regeneration. In this study, we conducted a comprehensive analysis of miRNA profiling of the earthworm, P. excavatus, during the process of anterior regeneration. Our investigation involved in the identification of 55 miRNAs from 30 distinct miRNA families that exhibit significant relevance to wound healing and regeneration. Notably, we have identified 50 novel miRNAs and predicted their pre-miRNA secondary structures using MIREAP. Both Known and Novel miRNAs are validated using qPCR. In addition, we employed the miRanda algorithm to predict the interactions between these miRNAs and their target mRNA transcripts. Based on the miRanda target prediction results, we identified the target genes such as Wnt, Myc, MAPK, SoxB, IHH, Hox, and Notch. These findings indicate that the potential targets of these miRNAs might play crucial roles in various functions related to wound healing, tissue restoration, and regeneration. Furthermore, the acquisition of these findings provides a unique perspective on understanding the molecular mechanisms driving epimorphosis regeneration in connection with miRNAs for the development of miRNA-based therapeutics., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Background: Blastomycosis is an environmentally acquired fungal infection that can result in severe pulmonary illness and high hospitalization rates. In 2023, a blastomycosis outbreak was detected among workers at a paper mill in Delta County, Michigan., Methods: We included patients with clinical and laboratory evidence of blastomycosis who had spent ≥40 hours in Delta County since September 1, 2022 and had illness onset December 1, 2022-July 1, 2023. We assessed epidemiological and clinical features of patients and evaluated factors associated with hospitalization. We performed whole-genome sequencing to characterize genetic relatedness of clinical isolates from eight patients., Results: In total, 131 patients were identified; all had worked at or visited the mill. Sixteen patients (12%) were hospitalized; one died. Compared with non-hospitalized patients, more hospitalized patients had diabetes (p=0.03) and urine antigen titers above the lower limit of quantification (p<0.001). Hospitalized patients were also more likely to have had ≥1 healthcare visits before receiving a blastomycosis diagnostic test (p=0.02) and to have been treated with antibiotics prior to antifungal prescription (p=0.001). All sequenced isolates were identified as Blastomyces gilchristii and clustered into a distinct outbreak cluster., Conclusions: This was the largest documented blastomycosis outbreak in the United States. Epidemiologic evidence indicated exposures occurred at or near the mill, and genomic findings suggested a common exposure source. Patients with diabetes may have increased risk for hospitalization, and elevated urine antigen titers could indicate greater disease severity. Early suspicion of blastomycosis may prompt earlier diagnosis and treatment, potentially reducing unnecessary antibiotic prescriptions and improving patient outcomes., (Published by Oxford University Press on behalf of Infectious Diseases Society of America 2024.)

Omics-based measurements enable the study of biomolecules in a high-throughput fashion, leading to the characterization and quantification of biological systems. Multi-omics methods aim to incorporate several omics measurements for a more holistic approach, which is crucial for advancing our understanding of the diversity and redundancy of biological systems. Current multi-omics sample preparation methods have achieved proteomics, lipidomics, and metabolomics from individual samples; however, the bioinformatic tools currently available for interpreting data generated from these omics are limited. Alternately, transcriptomics has a wide arsenal of available bioinformatic tools offering intensive sample characterization but has yet to be incorporated into a unified, multi-omics sample preparation technique. Herein we describe the modified bead-enabled accelerated monophasic multi-omics (mBAMM) method, which incorporates RNA extraction for transcriptomics analysis. mBAMM was shown to enable RNA-seq without compromising the isolation of biomolecules for proteomics, lipidomics, and metabolomics. This methodology greatly improves sample characterization and represents a major innovation toward cohesive insights into biological systems.

Perionyx excavatus, an indigenous earthworm possesses exceptional regeneration capacity. Their anterior regeneration features wound closure, regeneration induction and morphogenesis of damaged organs. This study involved a complete analysis of their transcriptomic dataset, with an emphasis on identifying the genes expressed during regeneration and predicting their implications in the process of regeneration and morphogenesis. Control (first ten segments) and test (5 th day blastema) RNA samples of biological replicates were isolated and sequenced on NovaSeq. 6000 using PE150 read length. An average of 98.64% of high-quality data was retained with assembly showing better continuity with the average transcript length with 823 bp and N50 value of 1,858 bp. This is the first report on the comparative transcriptome of P. excavatus during anterior regeneration and this study will shed light on the complexity of annelid regeneration., (© 2024. The Author(s).)

Background: Fewer minoritized patients with end-stage kidney disease (ESKD) receive kidney transplantation (KT); efforts to mitigate disparities have thus far failed. Pinpointing the specific stage(s) within the transplant care continuum (being informed of KT options, joining the waiting list, to receiving KT) where disparities emerge among each minoritized population is pivotal for achieving equity. We therefore quantified racial and ethnic disparities across the KT care continuum., Methods: We conducted a retrospective cohort study (2015-2020), with follow-up through 12/10/2021. Patients with incident dialysis were identified using the US national registry data. The exposure was race and ethnicity (Asian, Black, Hispanic, and White). We used adjusted modified Poisson regression to quantify the adjusted prevalence ratio (aPR) of being informed of KT, and cause-specific hazards models to calculate adjusted hazard ratios (aHR) of listing, and transplantation after listing., Findings: Among 637,951 adults initiating dialysis, the mean age (SD) was 63.8 (14.6), 41.8% were female, 5.4% were Asian, 26.3% were Black, 16.6% were Hispanic, and 51.7% were White (median follow-up in years [IQR]:1.92 [0.97-3.39]). Black and Hispanic patients were modestly more likely to be informed of KT (Black: aPR = 1.02, 95% confidence interval [CI]:1.01-1.02; Hispanic: aPR = 1.03, 95% CI: 1.02-1.03) relative to White patients. Asian patients were more likely to be listed (aHR = 1.18, 95% CI: 1.15-1.21) but less likely to receive KT (aHR = 0.56, 95% CI: 0.54-0.58). Both Black and Hispanic patients were less likely to be listed (Black: aHR = 0.87, 95% CI: 0.85-0.88; Hispanic: aHR = 0.85, 95% CI: 0.85-0.88) and receive KT (Black: aHR = 0.61, 95% CI: 0.60-0.63; Hispanic: aHR = 0.64, 95% CI: 0.63-0.66)., Interpretation: Improved characterization of the barriers in KT access specific to each racial and ethnic group, and the interventions to address these distinct challenges throughout the KT care continuum are needed; our findings identify specific stages most in need of mitigation., Funding: National Institutes of Health., Competing Interests: DL Segev receives consulting fees from AstraZeneca, CareDx, Moderna Therapeutics, Novavax, Regeneron, and Springer Publishing. DL Segev also receives honoraria from AstraZeneca, CareDx, Houston Methodist, Northwell Health, Optum Health Education, Sanofi, and WebMd. DL Segev also receives payment from Springer. BJ Orandi is the associate editor for Clinical Transplanation and Obesity. MN Clark-Cutaia participates in the THRIVE advisory board, and is the chapter president of Sigma Theta Tau Xi (Nursing Honor Society). The remaining authors have no competing interests to declare., (© 2024 The Author(s).)

Background: Melioidosis is a potentially fatal tropical infection. Little is known about mediastinal involvement in melioidosis. This study aimed to (a) describe the prevalence and demographics of various morphologies of mediastinal melioidosis, (b) propose a classification for radiological morphologies of mediastinal melioidosis., Methods: A retrospective cohort study was performed. Case records of consecutive patients with culture-positive melioidosis who underwent computed tomography (CT) thorax from January 1, 2018-February 28, 2022, were reviewed., Results: 486 culture-positive melioidosis patients were identified, of which 70 underwent CT thorax. 41 patients demonstrating mediastinal involvement were included in the final analysis, of which four were mediastinal collections, while the rest were classified into those with necrotic or matted appearances, and subcentimeter and larger than 1 cm. Culture-positivity was proven from blood in 83 % of patients (n = 34), with the remaining from chest wall pus, neck abscess pus, sputum, liver abscess, seminal vesicle, pleural, pericardial and peritoneal fluid. The most commonly associated pulmonary manifestations were consolidation and pleural effusion. Half had diabetes; a quarter had chronic kidney disease, while one had syphilis. Exposure to soil was present in six patients: quarry (n = 1), construction (n = 2), farmer (n = 1), living environment (n = 2). Seven patients succumbed before the end of 6-week intensive phase antibiotic treatment., Conclusion: Mediastinal melioidosis is a spectrum with multiple overlapping features consisting of necrosis, matted lymph nodes, multiseptated and non-septated collections. Further studies will elucidate the prognostic implications of mediastinal melioidosis., Competing Interests: Declaration of competing interest There is no conflict of interest., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

To study the relationship between domain characteristics of pufferfish saxitoxin and tetrodotoxin binding protein (PSTBP) proteoforms and their thermal stability, a comparative biochemical characterization of PSTBPs from the plasma of four Takifugu species (T. flavipterus, T. pardalis, T. alboplumbeus and T. rubripes) was conducted by Western blot analysis. The heat-tolerance tetrodotoxin (TTX)-binding ability of PSTBP proteoforms in T. rubripes plasma was verified by ultrafiltration and liquid chromatography tandem mass spectrometry (LC-MS/MS). These results suggest that the heat-stable PSTBP proteoforms, composed of three and two tandemly repeated lipocalin domains, are genetically conserved and ubiquitous in the genus Takifugu. This study builds on our knowledge of the structural and functional properties of PSTBP proteoforms, which is vital for understanding how toxins are transmitted and accumulate in organisms and is essential for evaluating the potential risks of toxins in seafood., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Background: Cemented total knee arthroplasty (TKA) is the gold standard treatment for osteoarthritis, but uncemented TKA offers benefits like improved osseointegration and reduced complications from cement debris. This study aimed to investigate (1) if there has been a rise in uncemented TKA from 2017 to 2021 and (2) if there are differences in early complications between cemented and uncemented TKA., Methods: A retrospective data review was performed on the Michigan Arthroplasty Registry Collaborative Quality Initiative database of TKA patients from 2017 to 2021 at 6 hospitals. Patients with revision or partial knee arthroplasty were excluded. Patients were divided into 2 groups: uncemented and cemented. Hybrid and reverse hybrid fixation data were collected for incidence, but not for demographics or complications. All patient demographics and 90-day postoperative events were collected and analyzed., Results: A retrospective study of 18,749 primary TKAs found that 89.7% were cemented, 9.7% uncemented, and 0.7% hybrid or reverse hybrid. Uncemented patients were younger, men, heavier, current smokers, and diabetics than cemented patients ( P < .0001, P  = .03). They also had a shorter length of stay ( P ≤ .0001) and were on fewer preoperative medications: anticoagulants ( P  = .0059), antiplatelets ( P ≤ .0001), opioids ( P  = .0091), and steroids ( P  = .0039). The rate of uncemented TKA increased from 3.3% to 17.1%, while the rate of cemented TKA fell from 96.2% to 81.9% ( P  = .0048). The readmission rate was higher in cemented TKAs (4.0%) than in uncemented TKAs (2.6%) ( P  = .0048)., Conclusions: The use of uncemented TKA increased from 3.3% in 2017 to 17.1% in 2021, while cemented fixation decreased from 96.7% to 81.9%. There were no significant differences in short-term complications between groups. Uncemented patients were younger, men, took fewer medications, had a shorter length of stay, and were less likely to be readmitted. However, they were more likely to have comorbidities than the cemented group., (© 2024 The Authors.)

Tissue-level and organism-level biological processes often involve the coordinated action of multiple distinct cell types. The recent application of single-cell assays to many individuals should enable the study of how donor-level variation in one cell type is linked to that in other cell types. Here we introduce a computational approach called single-cell interpretable tensor decomposition (scITD) to identify common axes of interindividual variation by considering joint expression variation across multiple cell types. scITD combines expression matrices from each cell type into a higher-order matrix and factorizes the result using the Tucker tensor decomposition. Applying scITD to single-cell RNA-sequencing data on 115 persons with lupus and 83 persons with coronavirus disease 2019, we identify patterns of coordinated cellular activity linked to disease severity and specific phenotypes, such as lupus nephritis. scITD results also implicate specific signaling pathways likely mediating coordination between cell types. Overall, scITD offers a tool for understanding the covariation of cell states across individuals, which can yield insights into the complex processes that define and stratify disease., (© 2024. The Author(s), under exclusive licence to Springer Nature America, Inc.)

Objective: Hoarding disorder is a chronic and progressive psychiatric disorder that often begins in adolescence and early adulthood. The purpose of this study was to investigate the impact of hoarding severity on college students' psychosocial functioning and possible methods of early intervention. Participants: Undergraduate students ( N  = 363) at a large public university in the United States. Methods: Participants completed a self-report battery that included their parental history of clutter, perceptions about possible interventions for clutter, and standardized measures of hoarding severity, psychiatric symptoms, and psychosocial functioning. Results: Hoarding symptom severity predicted significant unique variance in emotional support and companionship, even when controlling for comorbid psychiatric symptoms. The main reasons endorsed by participants for disorganization of their objects despite adequate storage space were "lack of time" (37%), "easily distracted" (26%), and "procrastination" (34%). Conclusions: Emerging adults may benefit from early intervention focused on time management, attentional control, and consistent motivation.

As part of the response to the highly pathogenic avian influenza A(H5N1) virus outbreak in U.S. cattle and poultry and the associated human cases, CDC and partners are monitoring influenza A virus levels and detection of the H5 subtype in wastewater. Among 48 states and the District of Columbia that performed influenza A testing of wastewater during May 12-July 13, 2024, a weekly average of 309 sites in 38 states had sufficient data for analysis, and 11 sites in four states reported high levels of influenza A virus. H5 subtype testing was conducted at 203 sites in 41 states, with H5 detections at 24 sites in nine states. For each detection or high level, CDC and state and local health departments evaluated data from other influenza surveillance systems and partnered with wastewater utilities and agriculture departments to investigate potential sources. Among the four states with high influenza A virus levels detected in wastewater, three states had corresponding evidence of human influenza activity from other influenza surveillance systems. Among the 24 sites with H5 detections, 15 identified animal sources within the sewershed or adjacent county, including eight milk-processing inputs. Data from these early investigations can help health officials optimize the use of wastewater surveillance during the upcoming respiratory illness season., Competing Interests: All authors have completed and submitted the International Committee of Medical Journal Editors form for disclosure of potential conflicts of interest. John Anderson reports support from the Council of State and Territorial Epidemiologists (CSTE) for travel to the 2023 Advanced Molecular Detection Days and the 2024 Advanced Molecular Detection Academy. Alexandria B. Boehm reports institutional support from the Sergey Brin Family Foundation and grant support from the U.S. National Science Foundation for research coordination network for wastewater-based epidemiology and from the Sloan Foundation for public health partnerships and wastewater-based epidemiology, and membership on the state of California wastewater-based epidemiology committee of the State Water Board. Ruth Lynfield reports support from the Infectious Diseases Society of America, CSTE, the National Foundation for Infectious Diseases, and the American Academy of Pediatrics to attend state epidemiology meetings, ID Week, CSTE Board meetings and CSTE annual conference, National Foundation for Infectious Diseases meeting, and the Committee on Infectious Diseases meeting. Marlene K. Wolfe reports a subaward gift to Stanford University, a grant from the Rockefeller Foundation for implementation of wastewater-based epidemiology in Bangladesh and Ghana and a subaward from Ceres Nanosciences (subaward from National Institutes of Health funding) for wastewater monitoring research, and support from the American Society of Microbiology for an invited talk at a conference. No other potential conflicts of interest were disclosed.

This case report details a unique presentation of trigeminal herpes zoster with mucosal involvement in a 72-year-old female undergoing prophylactic valacyclovir treatment for suspected herpes labialis. The patient initially presented for a routine skin examination. Despite the absence of clinical evidence of herpes labialis, she was prescribed prophylactic valacyclovir. Three days later, the patient developed a unilateral rash, gingival darkening, and severe ipsilateral tooth pain. An examination revealed a crusted erythematous rash along the mandibular division of the left trigeminal nerve and a darkening of the gums. Diagnosed with trigeminal herpes zoster, she was treated with valacyclovir and a prednisone taper. A follow-up showed the resolution of the skin and gingival lesions, though herpetic neuralgia persisted. This case underscores the complexity and potential atypical presentations of herpes zoster, even under prophylactic antiviral therapy. It highlights the importance of considering herpes zoster in differential diagnoses, especially in patients presenting with unilateral dermatological and mucosal symptoms., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Coleman et al.)

Background: Primary carers, school teachers, and administrators are key influencers in promoting active lifestyle among children with disabilities (CWD). Guided by the Capability, Opportunity, Motivation, Behavior Model, the Promoting Active Lifestyle among CWD (PALS) Questionnaire aims to determine these influencers' perceptions, capabilities, opportunities, and motivations in active healthy lifestyle promotion. This study evaluated the content validity and feasibility of the PALS Questionnaire in Filipino and English., Methods: Six experts rated the relevance of the items in the Filipino and English versions of the PALS Questionnaire. Item and scale content validity indices and agreement among raters (modified kappa k*) were computed. The questionnaires were revised and pilot tested among 11 participants comprising primary carers, and special education teachers and administrators using 3 methods of administration: online survey, phone interview, and pen-and-paper survey., Results: Scale-level content validity index indicated excellent content validity (0.96-0.97). Item-level content validity index ranged between 0.67 and 1.00. Interrater agreement on the relevance of all items was excellent (k* = .82-1.00), except for the item on teaching assistants (k* = .56). Most participants found the items easy to understand. The average time needed to complete a questionnaire was 30 minutes. The online version of the questionnaire was identified as the most feasible mode of administration., Conclusion: The PALS Questionnaire is a useful instrument for understanding Filipino primary carers' and educators' perceptions on promoting CWD's active healthy lifestyle. Information from the PALS Questionnaire could inform initiatives toward better CWD health and quality of life.

Purpose: To evaluate the use of shoulder arthroscopic simulation in orthopaedic surgery trainees., Methods: A literature search was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, using PubMed, Medline (Ovid), and EMBASE library databases. Inclusion criteria were experimental studies reporting pre- and post-test results of shoulder arthroscopic simulation in orthopaedic trainees (studies reporting results of comparison between groups not within the groups were excluded). Participant demographics, type of simulator training, simulator tasks assessed, and performance outcome measures were systematically reviewed. Each performance outcome measure was graphically represented in a Forest plot with point estimates of the incidence of performance outcomes with corresponding 95% confidence intervals and I 2 ., Results: Fifteen studies met inclusion criteria with a total of 353 participants. The most common procedures simulated were diagnostic shoulder arthroscopy (n = 9 [60%]), arthroscopic Bankart repairs (n = 3 [20%]), and rotator cuff repairs (n = 2 [13%]). Simulations primarily used virtual reality (60%) and benchtop models (40%). The primary outcomes measured were time to task completion and Arthroscopic Surgical Skill Evaluation Tool scores. Time to task completion improved significantly with training (range 13-439 seconds pretest to 8-253.29 seconds post-test), with substantial heterogeneity across studies (I 2  = 87%). ASSET scores improved in 60% of the studies (ranging from 14-20.9 pretest to 17.9-28.5 post-test), with low heterogeneity (I 2  = 20%). In addition, both camera and probe distances decreased after simulation use, whereas the 14-point anatomic checklist showed no pre- to post-test differences., Conclusions: Arthroscopic simulation training benefits technical skills in shoulder arthroscopy, but the quality, assessment, and validity of these protocols vary. The translation of simulation training into the operating room has yet to be conclusively demonstrated., Level of Evidence: Level IV, systematic review of Level I-IV studies., Competing Interests: Disclosures The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: J.M.W. reports consulting or advisory and equity or stocks with Ignite Orthopedics; equity or stocks with Catalyst OrthoScience; board membership, consulting or advisory, and speaking and lecture fees with DePuy Synthes; board membership with American Shoulder and Elbow Surgeons; and consulting or advisory with Limacorporate Spa. All other authors (M.G.D., M.T.P., J.G., O.O., B.P., K.F.D.) declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Author(s). Published by Elsevier Inc. All rights reserved.)

High-definition transcranial direct current stimulation (HD-tDCS) is a non-invasive brain stimulation technique that has been shown to be safe and effective in modulating neuronal activity. The present study investigates the effect of anodal HD-tDCS on haptic object perception and memory through stimulation of the lateral occipital complex (LOC), a structure that has been shown to be involved in both visual and haptic object recognition. In this single-blind, sham-controlled, between-subjects study, blindfolded healthy, sighted participants used their right (dominant) hand to perform haptic discrimination and recognition tasks with 3D-printed, novel objects called "Greebles" while receiving 20 min of 2 milliamp (mA) anodal stimulation (or sham) to the left or right LOC. Compared to sham, those who received left LOC stimulation (contralateral to the hand used) showed an improvement in haptic object recognition but not discrimination-a finding that was evident from the start of the behavioral tasks. A second experiment showed that this effect was not observed with right LOC stimulation (ipsilateral to the hand used). These results suggest that HD-tDCS to the left LOC can improve recognition of objects perceived via touch. Overall, this work sheds light on the LOC as a multimodal structure that plays a key role in object recognition in both the visual and haptic modalities., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Introduction: Hepatopancreatobiliary (HPB) cancers encompassing malignancies of the liver, pancreas, gall bladder, and bile ducts pose a significant health burden in Africa. While the association of certain occupational carcinogens in cancer is well established globally, their potential role in HPB cancers remains understudied, especially in an African context., Aim: This systematic review delves into the association between occupational carcinogens and HPB cancer in Africa. It examines the current state of research on occupational carcinogens and HPB cancers in Africa, identifying key challenges and knowledge gaps., Methods: This systematic review examined publications (published between 01 January 2012 and 31 May 2023) that highlight occupational carcinogens and HBP cancers in Africa. The search was conducted on electronic databases namely PubMed, Web of Science, and Africa Wide Information., Result: Due to the lack of information on the association between occupational carcinogens and HPB cancers in Africa, as a result of the paucity of published studies, only four articles were included in this study. Hepatocellular carcinoma (HCC) was the predominant cancer associated with the occupational carcinogen, aflatoxin. Agricultural workers, especially those involved in the production and processing of maize and peanuts, appear to be the most exposed to aflatoxin., Conclusion: Despite the sample size limitations due to the paucity of research studies on occupational carcinogens and HPB cancers in Africa, this study provides a reasonable tool for subsequent epidemiological studies. There is a need for more research on the association of occupational carcinogens and HPB cancers in Africa, especially with the growing industrialization., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024. Published by Elsevier Inc.)

Asthma is a widespread pediatric chronic disease, but there is limited understanding of its impact on participation (other than physical activity) and the conceptualization of participation. We conducted a scoping review to explore the evidence on the relationship between pediatric asthma and participation in several domains of occupation outlined in the Occupational Therapy Practice Framework 4th Edition. A structured literature search was implemented in PubMed/MEDLINE, Elsevier EMBASE, CINAHL, SCOPUS, Clarivate Web of Science Core Collection, and APA PsycINFO. Data were extracted by occupational domain and analyzed using a stoplight categorization. Of the 3444 identified articles, 10 met inclusion criteria, five of which were categorized as green (addressing specific occupational activities). No article explicitly defined participation. Asthma's influence on nonphysical activity occupations remains unclear. Future research must clarify both the meaning and measures that best capture participation, and further explore the relationship between asthma and participation., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Lipid nanoparticle (LNP)-mRNA complexes are transforming medicine. However, the medical applications of LNPs are limited by their low endosomal disruption rates, high toxicity and long tissue persistence times. LNPs that rapidly hydrolyse in endosomes (RD-LNPs) could solve the problems limiting LNP-based therapeutics and dramatically expand their applications but have been challenging to synthesize. Here we present an acid-degradable linker termed 'azido-acetal' that hydrolyses in endosomes within minutes and enables the production of RD-LNPs. Acid-degradable lipids composed of polyethylene glycol lipids, anionic lipids and cationic lipids were synthesized with the azido-acetal linker and used to generate RD-LNPs, which significantly improved the performance of LNP-mRNA complexes in vitro and in vivo. Collectively, RD-LNPs delivered mRNA more efficiently to the liver, lung, spleen and brains of mice and to haematopoietic stem and progenitor cells in vitro than conventional LNPs. These experiments demonstrate that engineering LNP hydrolysis rates in vivo has great potential for expanding the medical applications of LNPs., (© 2024. The Author(s), under exclusive licence to Springer Nature Limited.)

Background: Spatial repellents (SRs) have been widely used for the prevention of mosquito bites, and preliminary findings suggest efficacy against both malaria (1) and Aedes-borne viruses (2) but their effectiveness in reducing mosquito-borne diseases under operational use has never been evaluated. SRs have the potential of being critical tools in the prevention of mosquito-borne diseases in contexts where typical vector control strategies, such as insecticide-treated nets (ITNs) and indoor residual spraying, are inaccessible or underutilized such as among displaced persons or in emergency relief settings., Methods: Children will be enrolled in 3 separate cohorts to establish the effectiveness of SRs in reducing malaria infection in different distribution channels. One cohort will estimate the direct effect of the SR distributed through a reference channel (study personnel distribution). The two remaining cohorts will estimate the protection of the SR distributed through a voucher channel and the Village Health Team channel. Cohorts will be followed twice a month (approximately every 15 days): during the first scheduled household visit in the month, a blood sample will be taken for malaria rapid diagnostic test (Monthly Visit #1); and, during the second scheduled household visit, a blood sample will only be taken if the participant has a recent history of fever (Monthly Visit #2). The incidence of malaria in each cohort will be estimated and compared to the reference cohort to determine the benefit of using a SR in an area with high, year-round transmission of malaria., Discussion: This study will address the knowledge gap of whether or not SRs are effective in reducing human malaria disease in humanitarian assistance and emergency response settings in sub-Saharan Africa where underlying transmission rates are historically high and ITNs may or may not be widely deployed. This research will inform policy makers on whether to recommend SRs as a means to further reduce malaria transmission for such operational programs., Trial Registration: ClinicalTrials.gov NCT06122142. Registered on November 8, 2023., (© 2024. The Author(s).)

Nanoscale dislocation loops formed by irradiation can significantly contribute to both irradiation hardening and embrittlement of materials when subjected to extreme nuclear reactor environments. This study explores the application of weak-beam dark-field (WBDF) scanning transmission electron microscopy (STEM) methods for quantitative irradiation-induced defect analysis in crystalline materials, with a specific focus on dislocation loop imaging and analysis. A high-purity Fe-5 wt% Cr model alloy was irradiated with 8 MeV Fe2+ ions at 450°C to a fluence of 8.8 × 1019 m-2, inducing dislocation loops for analysis. While transmission electron microscopy (TEM) has traditionally been the primary tool for dislocation imaging, recent advancements in STEM technology have reignited interest in using STEM for defect imaging. This study introduces and compares three WBDF STEM methods, demonstrating their effectiveness in suppressing background contrasts, isolating defect information for dislocation loop type classification, providing finer dislocation line images for small loop analysis, and presenting inside-outside contrast for identifying loop nature. Experimental findings indicate that WBDF STEM methods surpass traditional TEM approaches, yielding clearer and more detailed images of dislocation loops. The study concludes by discussing the potential applications of WBDF STEM techniques in defect analysis, emphasizing their adaptability across various material systems beyond nuclear materials., Competing Interests: Conflict of Interest: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Published by Oxford University Press on behalf of the Microscopy Society of America 2024.)

The most prevalent cause of dementia is Alzheimer's disease. Cognitive decline and accelerating memory loss characterize it. Alzheimer's disease advances sequentially, starting with preclinical stages, followed by mild cognitive and/or behavioral impairment, and ultimately leading to Alzheimer's disease dementia. In recent years, healthcare providers have been advised to make an earlier diagnosis of Alzheimer's, prior to individuals developing Alzheimer's disease dementia. Regrettably, the identification of early-stage Alzheimer's disease in clinical settings can be arduous due to the tendency of patients and healthcare providers to disregard symptoms as typical signs of aging. Therefore, accurate and prompt diagnosis of Alzheimer's disease is essential in order to facilitate the development of disease-modifying and secondary preventive therapies prior to the onset of symptoms. There has been a notable shift in the goal of the diagnosis process, transitioning from merely confirming the presence of symptomatic AD to recognizing the illness in its early, asymptomatic phases. Understanding the evolution of disease-modifying therapies and putting effective diagnostic and therapeutic management into practice requires an understanding of this concept. The outcomes of this study will enhance in-depth knowledge of the current status of Alzheimer's disease's diagnosis and treatment, justifying the necessity for the quest for potential novel biomarkers that can contribute to determining the stage of the disease, particularly in its earliest stages. Interestingly, latest clinical trial status on pharmacological agents, the nonpharmacological treatments such as behavior modification, exercise, and cognitive training as well as alternative approach on phytochemicals as neuroprotective agents have been covered in detailed., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Abdul Manap, Almadodi, Sultana, Sebastian, Kavani, Lyenouq and Shankar.)

IL-23 inhibitors are a class of injectable biologics consisting of risankizumab, tildrakizumab, and guselkumab utilized for treatment of moderate-to-severe psoriasis. This retrospective review sought to determine the value of IL-23 inhibitor intraclass switching among psoriasis patients after experiencing loss of efficacy to any IL-23 inhibitor. We conducted a retrospective chart review, including 43 patients who underwent any of six potential iterations of IL-23 intraclass switch between 11/2017-11/2023. Most commonly, patients switched from guselkumab or tildrakizumab to risankizumab (83.7%). Patients failed 2.3 ± 1.3 biologic treatments prior to switch. Post-switching, 81.4% of patients achieved BSA <1% after 248.8 ± 126.5 days. BSA immediately prior to intraclass switch was 13.1 ± 8.9 [95% CI: 10.4, 15.8] and at most recent follow-up was 2.9 ± 5.2 [2.3, 5.5]. This research adds to a growing body of literature demonstrating the potential of IL-23 intraclass switching in treatment of moderate-to-severe plaque psoriasis., (© The Author(s) 2024. Published by Oxford University Press on behalf of British Association of Dermatologists. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com.)

This paper studies the potential link between the biological evolution of populations and present-day economic interactions by estimating the correlation of shared ancestry among populations with cross-border capital and human flows. To this end, we employ the new concept of genetic distance, based on (dis)similarity of neutral gene alleles, to quantify shared ancestry. We then incorporate the genetic distance measure into an augmented gravity model, traditionally used to analyze the effect of geographical distance on bilateral exchange. Our analysis focuses on bilateral foreign direct investment (FDI) and migration across 135 countries and we use both linear regression techniques as well as the Poisson Pseudo-Maximum Likelihood Estimator to account for any non-linearities in the model. Our results show that a 1% increase in genetic distance reduces FDI flows by 0.08% while controlling for other distance constructs and factors associated with global capital and human movement. Genetic distance also has a negative effect on migration, where a 1% increase in genetic distance reduces migration flows by 0.22%, with all other things remaining constant. Our study, therefore, links shared ancestry with economic behavior, showing how historical connections are associated with current economic exchanges among nations. Additionally, recognizing that ancestral ties are outside human control, we examine policy measures that help nations overcome such distance barriers. Our findings show that strengthening a nation's institutional quality and adherence to the rule of law can effectively mitigate any negative correlation of distance constructs with economic exchanges. These insights suggest that prudent policies to foster a stable business environment are essential for any nation to attract FDI and human capital, even from geographically or genetically distant nations., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Introduction: India is the second largest consumer of tobacco in the world and accounts for 70% of global deaths due to smokeless tobacco (SLT) use., Aim: The aim of this study is to understand the perspectives of tobacco users (smokers and SLT users) and practitioners in India to inform cessation interventions., Method: Semi-structured in-depth interviews with tobacco users (smoked and smokeless; n=23), and healthcare practitioners (n=13). Perspectives were triangulated using thematic analysis to examine convergence, divergence and complementarity of findings., Results: We present the results in a socio-ecological framework to highlight reasons for initiation and continuation of tobacco and motives to quit at the individual, interpersonal, occupational, societal and policy levels. SLT is seen as culturally acceptable compared to smoked forms of tobacco. Emotionally framed messages highlighting negative effects of tobacco on loved ones were perceived to be a better motivator than other types of cessation messages., Discussion: Nuanced differences exist between smokers and SLT user perspectives which have implications for cessation programs. Our findings supplement similar studies with other South Asian populations., Implications for Practice: Our study provides useful insights to tailor cessation interventions to the type of tobacco consumed in order to enhance their acceptability and effectiveness., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. This work was funded by the Department of Health and Social Care (DHSC), the Foreign, Commonwealth and Development Office (FCDO), the Medical Research Council (MRC), and Wellcome, UK (Grant number MR/R018456/1)., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)

Population-scale single-cell genomics is a transformative approach for unraveling the intricate links between genetic and cellular variation. This approach is facilitated by cutting-edge experimental methodologies, including the development of high-throughput single-cell multiomics and advances in multiplexed environmental and genetic perturbations. Examining the effects of natural or synthetic genetic variants across cellular contexts provides insights into the mutual influence of genetics and the environment in shaping cellular heterogeneity. The development of computational methodologies further enables detailed quantitative analysis of molecular variation, offering an opportunity to examine the respective roles of stochastic, intercellular, and interindividual variation. Future opportunities lie in leveraging long-read sequencing, refining disease-relevant cellular models, and embracing predictive and generative machine learning models. These advancements hold the potential for a deeper understanding of the genetic architecture of human molecular traits, which in turn has important implications for understanding the genetic causes of human disease.

Purpose: To firstly identify tools for assessing the impact of chronic pain on emotional functioning in children and young people with cerebral palsy (CP), and secondly identify suggestions to improve their relevance, comprehensiveness, comprehensibility and feasibility for the CP population. Improving assessment of the impact of pain on emotional functioning can enhance quality of life by improving access to interventions for pain-related physical disability, anxiety and depression., Methods: Ethics approval was granted through the Women's and Children's Health Network Human Research Ethics Committee (2022/HRE00154). A mixed methods study with people with lived experience and clinicians, and guided by the Consensus-based Standards for Measurement Instruments (COSMIN), was undertaken. An online survey identified the highest rated tools for validation and/or modification for young people with CP and chronic pain. Focus groups and interviews investigated content validity and feasibility of the tools identified as highest rated., Results: The Fear of Pain Questionnaire for Children-SF (FOPQ-C-SF) and Modified Brief Pain Inventory (mBPI) were the highest rated for pain coping and multidimensional assessment (respectively) from the online survey (n = 61) of eight tools presented. Focus group and interview data (n = 30), including 58 unique modification suggestions, were coded to six categories: accessibility, comprehensibility, feasibility, relevance, presentation and comprehensiveness., Conclusion: Potential modifications have been identified to improve the appropriateness and feasibility of the FOPQ-C-SF and mBPI for children and young people with CP. Future research should implement and test these modifications, prioritising the involvement of people with lived experience to ensure their needs are met alongside clinicians., (© 2024. Crown.)

Competing Interests: All authors have completed and submitted the International Committee of Medical Journal Editors form for disclosure of potential conflicts of interest. Natasha Bagdasarian reports travel or meeting support from the Council of State and Territorial Epidemiologists (CSTE), the Association of State and Territorial Health Officials (ASTHO), and Bloomberg; participation on data safety monitoring boards or advisory boards for ASTHO (including the Advisory Council for the Elimination of Tuberculosis and the Infectious Disease Policy Committee), the Center for Emerging and Infectious Diseases, the Center for Emerging and Infectious Diseases Advisory Board at Wayne State University, the Child Lead Exposure Elimination Commission (chair), the Clinical Competency Committee, the Council for Outbreak Response: Healthcare-Associated Infections and Antimicrobial-resistant Pathogens Committee (co-chair), iMPROve Health Board, the Metropolitan Affairs Coalition Healthcare Task Force, the Michigan Department of Health and Human Services (MDHHS) Institutional Review Board, the Michigan Health and Hospital Association Public Health Taskforce, MDHHS Michigan State Health Improvement Plan Steering Committee, the National Kidney Foundation of Michigan Morris Hood III Advisory Committee, the Physicians Health Plan Advisory Board, Preventative Medicine Residency Program Evaluation Committee, the Public Health Advisory Council (chair), the School Safety Commission, the Society for Healthcare Epidemiology of America External Affairs Committee, and the Technical Advisory Group, National Academy of State Health Policy. Fatema Mamou reports travel support from CSTE. Sarah Lyon-Callo reports travel support from CSTE and ASTHO to attend meetings and service as president of CSTE’s executive board and as the MDHHS’s representative on the Michigan Public Health Institute’s Board of Directors. No other potential conflicts of interest were disclosed.

Objective: This study's purpose is to better understand pediatric intensive care nursing perspectives on sedative management as a precursor to improving aspects of sedation assessment, titration, and communication. Methods/Design: We queried nurses in the pediatric intensive care unit at a 40+ bed quaternary care using an electronic survey about their experiences with sedation management. Data was collected using REDCap and statistical analyses were performed to assess for differences between experience levels in areas. Results: Seventy nurses responded with 42% response rate. More than 95% were comfortable calculating sedation and delirium scores. Those with less than 5 years' experience were significantly more likely to consider sedation scores helpful ( P  = .04) and also significant more likely to agree that delirium scores are used effectively ( P  = .01). Eighty-eight percent of respondents were comfortable raising concerns about sedation to the multidisciplinary team, but those with less than 5 years' experience were significantly less likely to express concerns to attending ( P  = .001). Conclusion: Newer nurses are more inclined to support use of standardized scoring systems for sedation and delirium, but less comfortable approaching attending clinicians with their concerns. Intensive care teams should pay careful attention to team dynamics, particularly as they apply to sedative management and work to improve communication, collaboration, and educational interventions to improve patient care. Further work understanding nursing perspectives and further attempts to improve interprofessional communication seems a wise investment and could obviate barriers that may exist., Competing Interests: Declaration of Conflicting InterestsThe authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Background: The purpose of this study was to assess if subcutaneous fat (SCF) or BMI is a predictor of surgical complications and patient reported outcomes in patients undergoing robotic-assisted total hip arthroplasty (THA)., Methods: Patients who underwent robotic-assisted primary THAs at one institution between 2018 and 2020 were included in this retrospective cohort study. Prior to surgery, computed tomography (CT) was used to measure SCF in the posterolateral quadrant of the hip. SCF was measured 3 centimeters (cm) proximal to the greater trochanter (PGT) and 3 cm inferior to the distal tip of the greater trochanter (DGT).Measurements were normalized to the size of the patient's bony anatomy by dividing the subcutaneous fat area measurement by the transverse diameter of the femur 10 cm inferior to the tip of the greater trochanter. Patients were divided into quintiles determined by SCF distribution around the mean (groups 1-5) and BMI (BMI<25, BMI 25-29.9, BMI 30-34.9, BMI 35-39.9, and >40). Ninety day outcomes and PROMIS (Patient Reported Outcome Measures Information System) scores were acquired from the Michigan Arthroplasty Registry Collaborative Quality Initiative (MARCQI) database preoperatively, at 14-112 days post-operative and at the latest follow up., Results: There were 175 patients identified with a mean age of 63.83 years (range 27-89) and a mean BMI of 30.73kg/m2 (range 18.2-48.4). Interclass correlation coefficient was greater than 0.9 in all PGT, DGT, and GT measurements. Analysis of Variance (ANOVA) found there was a significantly shorter time from incision to closure in quintiles 1 and 3 when compared to the SCF quintile 5 (p<0.05) and that there was a significantly shorter time from incision to closure in BMI categories 1, 2, and 3 when compared to BMI category 5 (BMI > 40). There were no differences between SCF and BMI as predictive of length of stay, transfusion status, infection, or PROMIS scores., Conclusion: It can be concluded that hip SCF on axial CT images can reliably measure SCF and is predictive of time from incision to closure, but it does not show a significant difference in predicting the length of stay, infection, or PROMIS scores when compared to BMI., (© 2024 Professor P K Surendran Memorial Education Foundation. Published by Elsevier B.V. All rights are reserved, including those for text and data mining, AI training, and similar technologies.)

The Philippines is a source of labor for many countries. Roughly 10 million overseas Filipinos are working and living outside of the Philippines. This paper examines the association between sociodemographic characteristics (sex, age, educational level, and income) and self-rated physical and mental health, access to healthcare, and health habits among immigrant Filipinos living in Santa Cruz de Tenerife, Spain. Through convenience sampling, Filipino migrants (n = 103) aged 18 years and above participated in the online survey between October 2022 and March 2023. The data were analyzed using descriptive statistical analysis and chi-square. Almost all respondents self-rated their health as excellent and very good. Female respondents are more affected by mental health. Most are enrolled in the Universal Health System of Spain (public insurance). There is more utilization of private health insurance among respondents aged 60 years and above and high-wage earners. Cigarette smoking and alcohol drinking are associated with males. More than half of the respondents perform weekly exercise occasionally or never. These findings suggest a potential need for targeted interventions with an emphasis on the practice of preventive health and the promotion of healthy lifestyles, especially among financially disadvantaged migrants with lesser health access.

Introduction: There is a significant shortage of observational studies on neurotoxic snakebite envenomation in the Philippines. This lack of data, especially concerning treatment using Purified Cobra Antivenom (PCAV), has prompted the initiation of this foundational study., Methods: The target population included snakebite patients admitted to the Eastern Visayas Medical Center and treated with PCAV between 2016 and 2020. A retrospective chart review was conducted for data collection. The investigation analyzed the hospital stay and patient features of individuals who were administered either lower or higher doses of PCAV., Results: Eighty-two patients were identified during the study. Of these, 27 (33%) were under 20 years of age and 50 (61%) were male. Most patients, totalling 75 (92%) were hailed from rural areas. Of the 82 patients, 59 (72%) received one or two ampoules of PCAV during the course. However, patients who received more than two ampoules had a longer median hospital stay than those who received less than three ampoules [96 h (interquartile range, IQR 66-122) vs. 125 h (IQR 96-218), P  = 0.038]. The study reported five in-hospital mortalities (6.1%)., Conclusions: The individuals who needed a high dosage of PCAV tended to have more extended hospital stays, yet over 70% of the patient population required a lower dosage. To gain a clearer understanding of the burden of neurotoxic snakebites and determine the optimal PCAV dosage based on disease severity in the area, a more comprehensive, prospective study is recommended., (© The Author(s) 2024. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.)

Due to the anthropogenic increase of atmospheric CO 2 emissions, humanity is facing the negative effects of rapid global climate change. Both active emission reduction and carbon dioxide removal (CDR) technologies are needed to meet the Paris Agreement and limit global warming to 1.5 °C by 2050. One promising CDR approach is coastal enhanced weathering (CEW), which involves the placement of sand composed of (ultra)mafic minerals like olivine in coastal zones. Although the large-scale placement of olivine sand could beneficially impact the planet through the consumption of atmospheric CO 2 and reduction in ocean acidification, it may also have physical and geochemical impacts on benthic communities. The dissolution of olivine can release dissolved constituents such as trace metals that may affect marine organisms. Here we tested acute and chronic responses of marine invertebrates to olivine sand exposure, as well as examined metal accumulation in invertebrate tissue resulting from olivine dissolution. Two different ecotoxicological experiments were performed on a range of benthic marine invertebrates (amphipod, polychaete, bivalve). The first experiment included acute and chronic survival and growth tests (10 and 20 days, respectively) of olivine exposure while the second had longer (28 day) exposures to measure chronic survival and bioaccumulation of trace metals (e.g. Ni, Cr, Co) released during olivine sand dissolution. Across all fauna we observed no negative effects on acute survival or chronic growth resulting solely from olivine exposure. However, over 28 days of exposure, the bent-nosed clam Macoma nasuta experienced reduced burrowing and accumulated 4.2 ± 0.7 μg g ww -1 of Ni while the polychaete Alitta virens accumulated 3.5 ± 0.9 μg g ww -1 of Ni. No significant accumulation of any other metals was observed. Future work should include longer-term laboratory studies as well as CEW field studies to validate these findings under real-world scenarios., Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Emilia Jankowska, Francesc Montserrat, Stephen J. Romaniello, Nathan G. Walworth, Grace M. Andrews reports financial support was provided by Cisco Foundation Global Impact Grant. Emilia Jankowska, Francesc Montserrat, Stephen J. Romaniello, Nathan G. Walworth, Grace M. Andrews reports financial support was provided by Grantham Foundation for the Protection of the Environment. Emilia Jankowska, Francesc Montserrat, Stephen J. Romaniello, Nathan G. Walworth, Grace M. Andrews reports financial support was provided by Treadright Foundation. If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Introduction: In low resource settings (LRS), utilization of Computed Tomography scan (CTS) for mild traumatic brain injuries (mTBIs) presents unique challenges and considerations given the limited infrastructure, financial resources, and trained personnel. The Theoretical Domains Framework (TDF) offers a comprehensive theoretical lens to explore factors influencing the decision-making to order CTS for mTBI by imaging referrers (IRs)., Objectives: The primary objective was to explore IRs' beliefs about factors influencing CT utilization in mTBIs using TDF in Uganda.Differences in the factors influencing CTS ordering behavior across specialties, levels of experience, and hospital category were also explored., Materials and Methods: In-depth semi-structured interviews guided by TDF were conducted among purposively selected IRs from 6 tertiary public and private hospitals with functional CTS services. A thematic analysis was performed with codes and emerging themes developed based on the TDF., Results: Eleven IRs including medical officers, non-neurosurgeon specialists and neurosurgeons aged on average 42 years (SD+/-12.3 years) participated.Identified factors within skills domain involved IRs' clinical assessment and decision-making abilities, while beliefs about capabilities and consequences encompassed their confidence in diagnostic abilities and perceptions of CTS risks and benefits. The environmental context and resources domain addressed the availability of CT scanners and financial constraints. The knowledge domain elicited IRs' understanding of clinical guidelines and evidence-based practices while social influences considered peer influence and institutional culture. For memory, attention & decision processes domain, IRs adherence to guidelines and intentions to order CT scans were cited., Conclusion: Using TDF, IRs identified several factors believed to influence decision making to order CTS in mTBI in a LRS. The findings can inform stakeholders to develop targeted strategies and evidence-based interventions to optimize CT utilization in mTBI such as; educational programs, workflow modifications, decision support tools, and infrastructure improvements, among others., Competing Interests: All authors declared no conflicts of interest, (© 2024 The Authors. Published by Elsevier B.V. on behalf of African Federation for Emergency Medicine.)

Biologics and Janus kinase (JAK) inhibitors are immunomodulating and immunosuppressing medications utilized to treat atopic dermatitis (AD), psoriasis (PSO), psoriatic arthritis (PsA), and alopecia areata (AA). Special recommendations must be considered when prescribing vaccinations in this population, as the pneumococcal and herpes zoster vaccine are recommended to patients ≥ 19-years-old (rather than ≥ 65-years-old and ≥ 50-years-old as in the general population, respectively), along with a yearly influenza and up to date COVID-19 vaccination. Additionally, TNF-α and JAK-inhibitors may increase the risk of latent Hepatitis B virus (HBV) reactivation among high-risk patients. Prior to prescribing these medications, a quantitative HepB Surface Antibody (HepB SA) test is performed to determine immunity. This study utilized the SlicerDicer function on EPIC Medical Records to search for any patient ≥ 19-years-old prescribed a biologic or JAK inhibitor for AD, PSO, PsA, or AA between 10/2003 and 10/2023 at a large tertiary institution. Vaccination rates among patients on biologics and JAK inhibitors were low, with rates being significantly lower in patients 19-64 years-old, compared to those ≥ 65 years-old for most disease states (p < 0.01). Among AD, PSO/PsA, and AA patients, on average, 9.39% were vaccinated for influenza, 6.76% for herpes zoster, 16.56% for pneumococcal pneumonia, and 63.98% for COVID-19. Only 3.16% of patients were adequately vaccinated for HepB after an abnormal HepB SA test. Here, extremely low rates of vaccination among patients on biologics and JAK inhibitors at our institution were highlighted, emphasizing the imperative need for ensuring vaccination in this group., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Background: The purpose of this study was to evaluate pre- and post-fracture medical management of osteoporosis among patients who underwent surgical fixation of femoral neck fractures (FNF) and vertebral compression fractures (VCF), and to investigate if there is a difference in treatment, management, and subsequent fractures between FNF and VCF patients., Methods: Patients who underwent surgical fixation of FNF or VCF were retrospectively reviewed at a minimum 1 year follow up. Patients were excluded if their fracture was caused by high energy trauma or malignancy, <50 years-old, deceased, or lost to follow up. Patient demographics such as age, sex, BMI, American Society of Anesthesiology Physical Status Classification System and Charleston Comorbidity index were recorded. Management of osteoporosis, including medication regimen and dual-energy X-ray absorptiometry (DEXA) scans were assessed preoperatively and at minimum one year follow up. Subsequent fractures were also recorded., Results: In the analysis of 370 patients (74.7% FNF, 25.2% VCF), demographics showed a predominantly female population (mean age 78.1). Preoperatively, 21.6% were diagnosed with osteoporosis, consistent between FNF and VCF. Postoperatively, there were no significant differences in new osteoporosis diagnoses, bisphosphonate use, or subsequent fractures. VCF patients, however, were more likely to receive denosumab and post-operative DEXA scans (p < 0.05). Within a year, 6.2% experienced subsequent fractures, with no significant FNF-VCF difference. Only 12.7% received appropriate post-operative osteoporosis treatment, 27.1% had DEXA scans, and 25% had a recorded osteoporosis diagnosis. Multivariable analysis highlighted pre-fracture osteoporosis diagnosis as the sole predictor for post-operative DEXA scans and anti-osteoporotic medication (p < 0.001)., Conclusions: This study suggests that factors beyond the type of fragility fracture may influence subsequent fracture risk and anti-osteoporotic medication administration in elderly patients. These findings underscore the importance of a comprehensive approach to fracture risk assessment and treatment decisions in this population., Level of Evidence: III., (© 2024 The Authors.)

At the energy-chemistry nexus, key molecules include carbon dioxide (CO 2 ), hydrogen (H 2 ), methane (CH 4 ), and ammonia (NH 3 ). The position of these four molecules and that of the more general family of synthetic macromolecular polymer blends (found in plastics) were cross-analyzed with the planetary boundary framework, and as part of five scientific policy roadmaps for the energy transition. According to the scenarios considered, the use of some of these molecular substances will be drastically modified in the coming years. Ammonia, which is currently almost exclusively synthesized as feedstock for the fertilizer industry, is envisioned as a future carbon-free energy vector. "Green hydrogen" is central to many projected decarbonized chemical processes. Carbon dioxide is forecast to shift from an unavoidable byproduct to a valuable feedstock for the production of carbon-based compounds. In this context, we believe that interdisciplinary elements from history, economics and anthropology are relevant to any attempted cross-analysis. Distinctive and crucial insights drawn from elements of humanities and social sciences have led us to formulate or re-raise open questions and possible blind-spots in main roadmaps, which were developed to guide, inter alia , chemical research toward the energy transition. We consider that these open questions are not sufficiently addressed in the academic arena around chemical research. Nevertheless, they are relevant to our understanding of the current planetary crisis, and to our capacity to properly assess the potential and limitations of chemical research addressing it. This academic perspective was written to share this understanding with the broader academic community. This work is intended not only as a call for a larger interdisciplinary method, to develop a sounder scientific approach to broader scenarios, but also - and perhaps mostly - as a call for the development of radically transdisciplinary routes of research. As scientists with different backgrounds, specialized in different disciplines and actively involved in contributing to shape solutions by means of our research, we bear ethical responsibility for the consequences of our acts, which often lead to consequences well beyond our discipline. Do our research and the knowledge it produces respond, perpetuate or even aggravate the problems encountered by society?, Competing Interests: We have no conflict of interests to declare. In spirit of transparency, we wish to mention here that VA contributed to the Sunergy technological roadmap discussed in Section 3., (This journal is © The Royal Society of Chemistry.)

One of the greatest threats facing the planet is the continued increase in excess greenhouse gasses, with CO 2 being the primary driver due to its rapid increase in only a century. Excess CO 2 is exacerbating known climate tipping points that will have cascading local and global effects including loss of biodiversity, global warming, and climate migration. However, global reduction of CO 2 emissions is not enough. Carbon dioxide removal (CDR) will also be needed to avoid the catastrophic effects of global warming. Although the drawdown and storage of CO 2 occur naturally via the coupling of the silicate and carbonate cycles, they operate over geological timescales (thousands of years). Here, we suggest that microbes can be used to accelerate this process, perhaps by orders of magnitude, while simultaneously producing potentially valuable by-products. This could provide both a sustainable pathway for global drawdown of CO 2 and an environmentally benign biosynthesis of materials. We discuss several different approaches, all of which involve enhancing the rate of silicate weathering. We use the silicate mineral olivine as a case study because of its favorable weathering properties, global abundance, and growing interest in CDR applications. Extensive research is needed to determine both the upper limit of the rate of silicate dissolution and its potential to economically scale to draw down significant amounts (Mt/Gt) of CO 2 Other industrial processes have successfully cultivated microbial consortia to provide valuable services at scale (e.g., wastewater treatment, anaerobic digestion, fermentation), and we argue that similar economies of scale could be achieved from this research., (Copyright © 2024 Cold Spring Harbor Laboratory Press; all rights reserved.)

Background: Endometriosis, a chronic noncancerous gynecologic condition commonly characterized by disruptive physical and psychosocial symptoms, can be disabling. Individuals in the United States with endometriosis who are unable to work before retirement age can apply for Social Security Disability Insurance (SSDI) and/or Supplemental Security Income (SSI). Given the multi-step process of disability review, it is important to better understand how disability decisions are made. This study aimed to examine approaches and rationales of U.S. federal appeals courts reviewing SSDI and/or SSI claims involving endometriosis-related issues of appeal., Methods: We searched Westlaw and Nexis Uni records, available as of January 2021, for federal appeals of SSDI and SSI claims including endometriosis as an impairment. Two independent reviewers screened full-text cases and extracted data. Framework Analysis was applied to courts' rationales regarding endometriosis-related issues of appeal., Results: Eighty-seven appeals addressed an endometriosis-related issue. Three themes-evidence, treatment, and time-were identified across the decisions. The courts' discussions across themes exposed rationales and evidentiary requirements that posed challenges for claimants with endometriosis. The courts found subjective reports of symptoms insufficient evidence of impairment and positive responses to treatments to indicate cures or prevent claimants from demonstrating the necessary continuous 12 months of impairment. Some courts expected claimants to use treatments such as contraception or hysterectomy without addressing the risks of such treatments or the fact that they might have been counter to claimants' needs and preferences., Conclusions: Individuals with endometriosis face evidentiary obstacles and common misconceptions about disease, diagnosis, and treatment in disability claims. SSDI and SSI endometriosis claims are systematically disadvantaged, particularly among those without access to care. The health care, policy, and legal systems can leverage the findings in this study to create a more equitable disability application and review system for those with chronic pain conditions such as endometriosis., (Copyright © 2023 Jacobs Institute of Women's Health, George Washington University. Published by Elsevier Inc. All rights reserved.)

Objective: To explore the experiences of healthcare professionals (HCPs) and parents of urine collection methods, to identify barriers to successful sampling and what could improve the process., Design: Qualitative research, using individual semistructured interviews with HCPs and parents. The interviews were audiorecorded, transcribed and thematically analysed., Setting: UK-based HCPs from primary and secondary care settings and parents with experience with urine collection in primary and/or secondary care settings., Participants: HCPs who were involved in aiding, supervising or ordering urine samples. Parents who had experience with urine collection in at least one precontinent child., Results: 13 HCPs and 16 parents were interviewed. 2 participating HCPs were general practitioners (GPs), 11 worked in paediatric secondary care settings (8 were nurses and 3 were doctors). Two parents had children with underlying conditions where frequent urine collection was required to rule out infections.HCPs and parents reported that there were no straightforward methods of urine collection for precontinent children. Each method-'clean catch', urine bag and urine pad-had limitations and problems with usage. 'Clean catch', regarded as the gold standard by HCPs with a lower risk of contamination, often proved difficult for parents to achieve. Other methods had elevated risk of contamination but were more acceptable to parents because they were less challenging. Many of the parents expressed the need for more information about urine collection., Conclusions: Current methods of urine collection are challenging to use and may be prone to contamination. A new device is required to assist with urine collection in precontinent children, to simplify and reduce the stress of the situation for those involved. Parents are key partners in the process of urine collection with young children. Meeting their expressed need for more information could be an important way to achieve better-quality samples while awaiting a new device., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY. Published by BMJ.)