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BACKGROUND: Although studies have documented higher rates of chronic pain among women Veterans compared to men Veterans, there remains a lack of comprehensive information about potential contributors to these disparities. MATERIALS AND METHODS: This study examined gender differences in chronic pain and its contributors among 419 men and 392 women Veterans, enrolled in a mindfulness trial for chronic pain. We conducted descriptive analyses summarizing distributions of baseline measures, obtained by survey and through the electronic health record. Comparisons between genders were conducted using chi-square tests for categorical variables and t-tests for continuous measures. RESULTS: Compared to men, women Veterans were more likely to have chronic overlapping pain conditions and had higher levels of pain interference and intensity. Women had higher prevalence of psychiatric and sleep disorder diagnoses, greater levels of depression, anxiety, post-traumatic stress disorder, fatigue, sleep disturbance, stress and pain catastrophizing, and lower levels of pain self-efficacy and participation in social roles and activities. However, women were less likely to smoke or have a substance abuse disorder and used more nonpharmacological pain treatment modalities. CONCLUSION: Among Veterans seeking treatment for chronic pain, women differed from men in their type of pain, had greater pain intensity and interference, and had greater prevalence and higher levels of many known biopsychosocial contributors to pain. Results point to the need for pain treatment that addresses the comprehensive needs of women Veterans. UNLABELLED: Clinical Trial Registration Number: NCT04526158. Patient enrollment began on December 4, 2020.

Abstract The evolution of morphinan alkaloid biosynthesis in plants of the genus Papaver includes permutation of several processes including gene duplication, fusion, neofunctionalization, and deletion resulting in the present chemotaxonomy. A critical gene fusion event resulting in the key bifunctional enzyme reticuline epimerase (REPI), which catalyzes the stereochemical inversion of (S)-reticuline, was suggested to precede neofunctionalization of downstream enzymes leading to morphine biosynthesis in opium poppy (Papaver somniferum). The ancestrally related aldo-keto reductases 1,2-dehydroreticuline reductase (DRR), which occurs in some species as a component of REPI, and codeinone reductase (COR) catalyze the second and penultimate steps, respectively, in the pathway converting (S)-reticuline to morphine. Orthologs for each enzyme isolated from the transcriptomes of 12 Papaver species were shown to catalyze their respective reactions in species that capture states of the metabolic pathway prior to key evolutionary events, including the gene fusion event leading to REPI, thus suggesting a patchwork model for pathway evolution. Analysis of the structure and substrate preferences of DRR orthologs in comparison with COR orthologs revealed structure-function relationships underpinning the functional latency of DRR and COR orthologs in the genus Papaver, thus providing insights into the molecular events leading to the evolution of the pathway.

Abstract Moiré superlattices in van der Waals heterostructures represent a highly tunable quantum system, attracting substantial interest in both many-body physics and device applications. However, the influence of the moiré potential on light-matter interactions at room temperature has remained largely unexplored. In our study, we demonstrate that the moiré potential in MoS2/WSe2 heterobilayers facilitates the localization of interlayer exciton (IX) at room temperature. By performing reflection contrast spectroscopy, we demonstrate the importance of atomic reconstruction in modifying intralayer excitons, supported by the atomic force microscopy experiment. When decreasing the twist angle, we observe that the IX lifetime becomes longer and light emission gets enhanced, indicating that non-radiative decay channels such as defects are suppressed by the moiré potential. Moreover, through the integration of moiré superlattices with silicon single-mode cavities, we find that the devices employing moiré-trapped IXs exhibit a significantly lower threshold, one order of magnitude smaller compared to the device utilizing delocalized IXs. These findings not only encourage the exploration of many-body physics in moiré superlattices at elevated temperatures but also pave the way for leveraging these artificial quantum materials in photonic and optoelectronic applications.

Graphical Abstract

Abstract Intervalley excitons with electron and hole wavefunctions residing in different valleys determine the long-range transport and dynamics observed in many semiconductors. However, these excitons with vanishing oscillator strength do not directly couple to light and, hence, remain largely unstudied. Here, we develop a simple nanomechanical technique to control the energy hierarchy of valleys via their contrasting response to mechanical strain. We use our technique to discover previously inaccessible intervalley excitons associated with K, Γ, or Q valleys in prototypical 2D semiconductors WSe2 and WS2. We also demonstrate a new brightening mechanism, rendering an otherwise “dark” intervalley exciton visible via strain-controlled hybridization with an intravalley exciton. Moreover, we classify various localized excitons from their distinct strain response and achieve large tuning of their energy. Overall, our valley engineering approach establishes a new way to identify intervalley excitons and control their interactions in a diverse class of 2D systems.

Abstract Background Recruitment for clinical trials and large-scale studies is challenging, especially for patients with complex conditions like chronic pain. Email recruitment has the potential to increase efficiency, to reduce costs, and to improve access for underrepresented patient populations. The objective of this study was to examine the effectiveness, efficiency, and equitability of email versus postal mail recruitment for the Learning to Apply Mindfulness to Pain (LAMP) study, a three-site clinical trial of mindfulness-based interventions for chronic pain. Methods Patients with chronic pain diagnoses were recruited from three United States Department of Veterans Affairs (VA) facilities using the VA electronic health record (EHR). Recruitment materials were sent using either postal mail (n = 7986) or email (n = 19,333). Patients in the email recruitment group were also mailed introductory postcards before any emails. Mailing addresses and email addresses were obtained from the EHR. Effectiveness was measured by the response rate of patients who logged into the secure LAMP study website. Efficiency was measured by the number of days from when the recruitment materials were sent to when patients logged into the LAMP portal as well as the estimated costs of each recruitment approach. To assess equitability, we examined whether email recruitment was less effective for underrepresented populations, based on demographic information from the EHR. Results Effectiveness—unadjusted response rates were greater for email versus postal-mail recruitment (18.9% versus 6.3%), and adjusted response rates were over three times greater for email recruitment (RR = 3.5, 95% CI 3.1–3.8) based on a multivariable analysis controlling for age, gender, race, ethnicity, rurality, and site. Efficiency—email recruitment had a significantly lower mean response time (1 day versus 8 days) and a lower cost. Equity—email recruitment led to higher response rates for all subpopulations, including older, non-White, Hispanic, rural, and female Veterans. Conclusions Email recruitment is an effective, efficient, and equitable way to recruit VA patients to large-scale, chronic pain clinical trials. Trial registration Clinical Trial Registration Number: NCT04526158. Patient enrollment began on December 4, 2020.

Abstract Background An important component in fostering the responsible use of antibiotics is training of new and future prescribers in this interdisciplinary topic. Because podcasts are playing an increasing role in medical education, we aimed to develop and evaluate a podcast format with practice and guideline-oriented learning content on antibiotic therapy for medical students and young medical professionals. Methods We developed the concept for the podcast with the direct involvement of medical students and medical experts with teaching experience. We used video conferencing when recording the episodes in order to have quick, easy, and nationwide access to the experts involved. We released an episode every 2 to 4 weeks on the popular podcast platforms. The podcast was promoted through mailing lists, social and print media, and at conferences. The evaluation of episodes was based on user data provided by the platforms and an anonymous feedback questionnaire linked to each episode in the podcast notes. Results Between December 2021 and December 2022 19 episodes of InfectEd: der Antibiotika-Podcast were released. The mean duration of an episode was 91 min. By March 9, 2023, a total of 38,829 downloads and streams had been recorded. The majority of users listened to the podcast on a mobile device. The average playing time per episode was 65%. The feedback questionnaire was completed 135 times. 60.7% of respondents were female, 38.5% male. The majority of respondents were in their twenties and thirties (66.7%). 31.1% were medical students, 25.9% were residents, and 25.2% were specialists. Listeners were asked to rate episodes on a scale from 1 to 6, where 1 was “very good” and 6 was “insufficient.” Ratings did not differ significantly between female and male respondents or between medical students and others. 118 respondents (87.4%) reported an increase in knowledge. Free-text feedback frequently emphasized clinical and also exam relevance. Conclusion Our podcast format, developed with a user-centered approach, was broadly distributed and has been well accepted by both medical students and physicians alike. It provides a large number of learners with low-threshold access to current, guideline-orientated content and could be a useful supplement to conventional teaching formats.

Locally sourced agricultural residues are a promising feedstock for the production of reinforcement fibers for wastepaper-based packaging papers. An eco-friendly high yield process to generate fibers from wheat straw using high pressure steam and sodium carbonate is presented. The wheat straw was impregnated with up to 16% of sodium carbonate and steam treated for 10 min at temperatures from 148 °C to 203 °C. The pulps were characterized concerning their chemical composition and test sheets with 100% straw fibers and with 15% and 30% straw fibers blended with recycled pulp were prepared. Fiber yields ranged from 70% to 45%, wherein more severe treatment conditions contributed to increased paper strength but lower yields. At comparable fiber yields, treatments featuring a higher chemical input, coupled with lower treatment temperatures, resulted in improved paper strength. By blending recycled pulp with up to 30% of straw fibers with a beating degree of roughly 45 °SR, the burst, compression and tensile strength was enhanced by up to 66%, 74% and 59%, respectively. As the enhancement effect decreases with a high steam treatment intensity and a high proportion of wheat straw, a moderate treatment and limited use of wheat straw may be the best choice.

SYNE2 mutations have been associated with skeletal and cardiac muscle diseases, including Emery-Dreifuss muscular dystrophy (EDMD). Here, we present a 70-year-old male patient with muscle pain and elevated serum creatine kinase levels in whom whole-exome sequencing revealed a novel heterozygous SYNE2 splice site mutation (NM_182914.3:c.15306+2T>G). This mutation is likely to result in the loss of the donor splice site in intron 82. While a diagnostic muscle biopsy showed unspecific myopathological findings, immunofluorescence analyses of skeletal muscle and dermal cells derived from the patient showed nuclear shape alterations when compared to control cells. In addition, a significantly reduced nesprin-2 giant protein localisation to the nuclear envelope was observed in patient-derived dermal fibroblasts. Our findings imply that the novel heterozygous SYNE2 mutation results in a monoallelic splicing defect of nesprin-2, thereby leading to a rare cause of myalgia and hyperCKemia.

Introduction Ice hockey is a popular global sport with growing participation for boys and girls yet remains a high-risk sport for injury. While the evidence for some risk factors, such as bodychecking policy is well established, other risk factors such as player sex have been understudied. The objectives of this study were to examine factors associated with rates of game-related injury, game-related injury resulting in >7 days of time-loss, and practice-related injury in youth ice hockey.Materials and methods Safe2Play was a five-year prospective cohort study (2013–2018). All injuries were identified using validated injury surveillance methodology. Multilevel Poisson regression (adjusting for cluster by team and including multiple imputation of missing covariates) was used to estimate incidence rate ratios (IRRs) for player sex, age group, bodychecking policy, year of play, level of play, weight, previous injury within last 12 months, previous lifetime concussion history, and position.Results A total of 4418 male and female ice hockey players (representing 6584 player-seasons) participating in under-13 (ages 11–12), under-15 (ages 13–14) and under-18 (ages 15–17) age groups were recruited. There were 1184 game-related and 182 practice-related injuries. Factors associated with game-related injury included female sex (IRR = 1.57; 95% CI: 1.18–2.08), previous injury (IRR = 1.46; 95% CI: 1.26–1.70) and lifetime concussion history (IRR = 1.41; 95% CI: 1.23–1.62). Goaltenders had a lower rate of injury (IRR = 0.54; 95% CI: 0.40–0.72) relative to forwards, as did players exposed to policy disallowing bodychecking in games (IRR = 0.44; 95% CI: 0.35–0.55). Female sex (IRR = 1.90; 95% CI: 1.10–3.28) and lifetime concussion history were also significantly associated with practice-related injury (IRR = 1.53; 95% CI: 1.08–2.18).Conclusions Based on data from a large 5-year Canadian youth ice hockey longitudinal cohort, several factors associated with injury were identified. Future injury prevention strategies should consider age, sex, previous concussion and injury history, and body checking leagues. Future research in female youth ice hockey including female-only leagues should be a priority to inform prevention strategies in this understudied population.

Despite Canada’s strengths and widespread acknowledgment of the importance of children and youth, this country recently ranked 30th among 38 high-income countries on indicators of their well-being (UNICEF Innocenti 2020). While there are limited data readily available for monitoring within and across jurisdictions, Alberta compares worse than Canadian averages on indicators of early development vulnerability and child abuse (PHAC 2023a). The Alberta government convened a Child and Youth Well-being Review (GOA 2021) and Action Plan (GOA 2022a) to understand and address the pandemic’s adverse impacts. Indigenous and racialized children and youth, children in low-income families and children with disabilities were highlighted as being disproportionately impacted. In addition, the review found significant gaps in mental health, education, social data and evidence along with fragmentation of data within ministries and service systems (GOA 2021). Influences on child and youth health, well-being and health inequity have social, environmental and economic origins that extend beyond health policy boundaries (Lopez et al. 2021; Vargas-Barón, Diehl and Small 2022; Clark et al. 2020; Patton et al. 2016). Yet, public policy can be a powerful intermediary between children’s conditions and outcomes (UNICEF 2020). Cross-sectoral, whole-of-society approaches are required to improve child and youth health and well-being and government ministries have important roles to play (Akseer et al. 2020; De Montigny, Desjardins and Bouchard 2019; Leppo et al. 2013). Meaningful and accessible measurement and monitoring information is required to support co-ordinated, cross-sectoral decision-making and policy strategies to improve health outcomes and reduce health inequities (OECD 2021). Information is required about child and youth material living standards, physical and mental health, social lives and learning and education (OECD 2021). While definitions of child and youth well-being vary depending on diverse perspectives and cultural, social and local contexts, many established indicators and frameworks can be tailored to local community needs and priorities (OECD 2021).

Introduction: In March 2020, the Ontario-based Centre for Effective Practice (CEP) launched an online portal that would become the CEP COVID-19 Resource Centre (CRC), one of Ontario’s most well-known and best-used sources for primary care clinical and practice guidance during the COVID-19 pandemic. Description: Authors will describe how key principles of librarianship drove the development and evolution of the CRC, discuss their approach to literature searching and appraisal in a time of great uncertainty and scant evidence, and outline successes and challenges. Outcomes: With over 170,500 visitors since 2020, the CRC became an invaluable tool for primary care providers in Ontario, across Canada and internationally. 89% of site visitors reported that the CRC enhanced their knowledge of COVID-19 evidence, recommendations and policies. 87% of visitors reported that the Vaccine resource directly informed their practice. Discussion: Authors discuss challenges of the rapid-response format and skills formed by the demands of the pandemic.

This paper presents an empirical study and related activity system analysis regarding the implementation and use of Moodle specifically, and learning management systems in general, in problem-based learning. The research involved an exploration of the characteristics that defined use of Moodle at a Danish university, the reasons why Moodle was or was not used in specific contexts and the way in which Moodle use was perceived by students. Some of the obstacles and challenges identified through this study highlighted the need for a deeper analysis of the elements that characterised the activity system(s) and their contradictions in this contextual setting, leading to a consideration of possible implications for change processes. The investigation consisted of a literature review, a survey of 345 students regarding their experiences with Moodle in conjunction with a nomination for the best Moodle course, an analysis of the 178 nominated courses and interviews with four university teachers about their use of Moodle. This examination revealed that many existing Moodle activities at Aalborg University focus more on sharing information and teaching materials and less on the students' problem-based learning activities and projects. This finding is intriguing, as use of Moodle does not reflect that problem-based learning comprises the pedagogical foundation of Aalborg University's academic programme. The investigation uncovered several reasons for the lack of focus on problem-based learning in Moodle structures and content and explored them through the contradictions identified within the activity systems and between the double contextual frame surrounding the interacting activity system.

Background: Although studies have documented higher rates of chronic pain among women Veterans compared to men Veterans, there remains a lack of comprehensive information about potential contributors to these disparities. Materials and Methods: This study examined gender differences in chronic pain and its contributors among 419 men and 392 women Veterans, enrolled in a mindfulness trial for chronic pain. We conducted descriptive analyses summarizing distributions of baseline measures, obtained by survey and through the electronic health record. Comparisons between genders were conducted using chi-square tests for categorical variables and t-tests for continuous measures. Results: Compared to men, women Veterans were more likely to have chronic overlapping pain conditions and had higher levels of pain interference and intensity. Women had higher prevalence of psychiatric and sleep disorder diagnoses, greater levels of depression, anxiety, post-traumatic stress disorder, fatigue, sleep disturbance, stress and pain catastrophizing, and lower levels of pain self-efficacy and participation in social roles and activities. However, women were less likely to smoke or have a substance abuse disorder and used more nonpharmacological pain treatment modalities. Conclusion: Among Veterans seeking treatment for chronic pain, women differed from men in their type of pain, had greater pain intensity and interference, and had greater prevalence and higher levels of many known biopsychosocial contributors to pain. Results point to the need for pain treatment that addresses the comprehensive needs of women Veterans. Clinical Trial Registration Number: NCT04526158. Patient enrollment began on December 4, 2020.