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The most common complication in older surgical patients is postoperative delirium (POD). POD is associated with preoperative cognitive impairment and longer durations of intraoperative burst suppression (BSup) – electroencephalography (EEG) with repeated periods of suppression (very low-voltage brain activity). However, BSup has modest sensitivity for predicting POD. We hypothesized that a brain state of lowered EEG power immediately precedes BSup, which we have termed “pre-burst suppression” (preBSup). Further, we hypothesized that even patients without BSup experience these preBSup transient reductions in EEG power, and that preBSup (like BSup) would be associated with preoperative cognitive function and delirium risk. Data included 83 32-channel intraoperative EEG recordings of the first hour of surgery from 2 prospective cohort studies of patients ≥age 60 scheduled for ≥2-h non-cardiac, non-neurologic surgery under general anesthesia (maintained with a potent inhaled anesthetic or a propofol infusion). Among patients with BSup, we defined preBSup as the difference in 3–35 Hz power (dB) during the 1-s preceding BSup relative to the average 3–35 Hz power of their intraoperative EEG recording. We then recorded the percentage of time that each patient spent in preBSup, including those without BSup. Next, we characterized the association between percentage of time in preBSup and (1) percentage of time in BSup, (2) preoperative cognitive function, and (3) POD incidence. The percentage of time in preBSup and BSup were correlated (Spearman’s ρ [95% CI]: 0.52 [0.34, 0.66], p < 0.001). The percentage of time in BSup, preBSup, or their combination were each inversely associated with preoperative cognitive function (β [95% CI]: −0.10 [−0.19, −0.01], p = 0.024; −0.04 [−0.06, −0.01], p = 0.009; −0.04 [−0.06, −0.01], p = 0.003, respectively). Consistent with prior literature, BSup was significantly associated with POD (odds ratio [95% CI]: 1.34 [1.01, 1.78], p = 0.043), though this association did not hold for preBSup (odds ratio [95% CI]: 1.04 [0.95, 1.14], p = 0.421). While all patients had ≥1 preBSup instance, only 20.5% of patients had ≥1 BSup instance. These exploratory findings suggest that future studies are warranted to further study the extent to which preBSup, even in the absence of BSup, can identify patients with impaired preoperative cognition and/or POD risk.

Introduction Streptococcus pneumoniae is a causative agent of pneumonia and acute otitis media (AOM), as well as invasive diseases such as meningitis and bacteremia. PCV15 (V114) is a new 15-valent pneumococcal conjugate vaccine (PCV) approved for use in individuals ≥6 weeks of age for the prevention of pneumonia, AOM, and invasive pneumococcal disease.Areas Covered This review summarizes the V114 Phase 3 development program leading to approval in infants and children, including pivotal studies, interchangeability and catch-up vaccination studies, and studies in at-risk populations. An integrated safety summary is presented in addition to immunogenicity and concomitant use of V114 with other routine pediatric vaccines.Expert Opinion Across the development program, V114 demonstrated a safety profile that is comparable to PCV13 in infants and children. Immunogenicity of V114 is comparable to PCV13 for all shared serotypes except serotype 3, where V114 demonstrated superior immunogenicity. Higher immune responses were demonstrated for V114 serotypes 22F and 33F. Results of the ongoing study to evaluate V114 efficacy against vaccine-type pneumococcal AOM and anticipated real-world evidence studies will support assessment of vaccine effectiveness and impact, with an additional question of whether higher serotype 3 immunogenicity translates to better protection against serotype 3 pneumococcal disease.

Abstract Current understanding of soil carbon dynamics suggests that plant litter quality and soil mineralogy control the formation of mineral-associated soil organic carbon (SOC). Due to more efficient microbial anabolism, high-quality litter may produce more microbial residues for stabilisation on mineral surfaces. To test these fundamental concepts, we manipulate soil mineralogy using pristine minerals, characterise microbial communities and use stable isotopes to measure decomposition of low- and high-quality litter and mineral stabilisation of litter-C. We find that high-quality litter leads to less (not more) efficient formation of mineral-associated SOC due to soil microbial community shifts which lower carbon use efficiency. Low-quality litter enhances loss of pre-existing SOC resulting in no effect of litter quality on total mineral-associated SOC. However, mineral-associated SOC formation is primarily controlled by soil mineralogy. These findings refute the hypothesis that high-quality plant litters form mineral-associated SOC most efficiently and advance our understanding of how mineralogy and litter-microbial interactions regulate SOC formation.

Increasing the human plasma concentration of high-density lipoproteins (HDL) may be part of strategy for control of cardiovascular diseases (CVD). HDL particles vary in their structure, metabolism, and biological activity. The review describes major HDL fractions (subpopulations) and discusses new findings on the antiatherogenic properties of HDL particles. The whole spectrum of HDL fractions, small, dense, protein-rich lipoproteins, has atheroprotective properties that are determined by the presence of specialized groups of proteins and lipids; however, this activity may be decreased in atherogenic lesion. Comprehensive structural and compositional analysis of HDL may provide key information to identify the fractions that have characteristic biological properties and lose their functionality in CVD. These fractions may be also biomarkers for the risk of CVD and hence represent pharmacological targets.

Objective: This study explored medical trainees' understanding of collaborative writing sessions in the Dominican Republic as a strategy to strengthen their technical writing and critical analysis skills in health education and communication. Method: We conducted semi-structured interviews with seven medical trainees who participated in a series of collaborative writing sessions and published their articles in medical journals. Thematic analysis was used to study coded notes and identify salient themes with quotations and a conceptual model. Results: Five perceived individual- and programme-level enabling factors of the collaborative writing sessions were described: (1) detailed agenda, (2) direct mentorship, (3) effective teamwork, (4) personal investment and dedication, and (5) future vision. Conclusion: Study findings highlight that collaborative writing sessions with direct mentorship offers medical trainees a unique opportunity to acquire key written communication and analytical competencies and publish their articles, as part of their professional development. The incorporation of these valuable health education training exercises for health professional students can help develop an academic culture of writing and publishing on emerging global health topics.

The transition toward renewable energy includes a need for equitable outcomes, yet a critical research gap exists in understanding the relationship between renewable energy deployment and energy justice within International Energy Agency (IEA) member nations. This study addresses this gap by thoroughly examining the influence of renewable energy deployment on energy justice across 23 IEA member nations from 1995 to 2020. We employ advanced econometric techniques such as the two-step system generalized method of the moment to investigate the linkage between renewable energy deployment and energy justice. By considering the various dimensions of energy justice, this study provides a holistic assessment of the positive linkage between renewable energy deployment and energy justice within IEA member nations. Significantly, we uncover that a greater share of renewable energy substantially enhances energy justice levels, highlighting the importance of renewable energy policies prioritizing social inclusion and justice. By shedding light on this relationship and addressing a critical research gap, our study contributes to advancing knowledge in renewable energy deployment and energy justice. These insights hold substantial implications for policymakers, providing valuable guidance for formulating policies and strategies that promote equitable and sustainable outcomes during the renewable energy transition.

Several studies have documented the presence of Lp[a] in nonhuman primates. However, data are lacking in great apes such as the chimpanzee. We have studied the quantitative distribution of Lp[a], as well as the frequency of apo[a] phenotypes, in a population of chimpanzees living in Gabon. Monoclonal antibody 14A12, directed against human apo[a], failed to recognize chimpanzee Lp[a]. Therefore, Lp[a] was assayed using an ELISA involving two polyclonal antibodies, an anti-human apo[a] and an anti-human apoB-100. Under these conditions, Lp[a] was detected in each of 28 animals. The plasma level of Lp[a] was found to be highly skewed toward elevated values: the mean Lp[a] level was 0.61 mg/ml (SD 0.45) as compared to 0.18 mg/ml (SD 0.16) in a normal Caucasian population (P < 0.0001). Phenotypes for apo[a] were identified by SDS-agarose-gel electrophoresis, followed by immunoblotting and detection by chemiluminescence. Seventeen different isoforms (ranging from 440 to 920 kDa) were found among all the animals as compared to 19 (540 to 960 kDa) in a human population of equivalent number. However, the distribution of apo[a] phenotypes was distinct between these populations. Thus isoforms of low molecular mass occurred with greater frequency in chimpanzee as compared to humans. In both populations, a strong inverse correlation between Lp[a] levels and apo[a] isoform sizes was found in chimpanzees (r = -0.48; P < 0.01) and in man (r = -0.68; P < 0.0002).(ABSTRACT TRUNCATED AT 250 WORDS)

Abstract Inland fisheries support the livelihoods of millions of people in riparian communities worldwide but are influenced by increasing climate variability and change. Freshwater fishing societies are among the most vulnerable to climate change given their dependence on highly threatened aquatic resources. As climate change intensifies, building adaptive capacity within communities and understanding the efficacy of adaptive strategies for maintaining household stability is essential for coping with ongoing social and environmental change. In this study, we examined household perceptions of climate change, livelihood impacts and responses to socio‐ecological changes in fishing‐dependent households in the Lake Victoria basin in Uganda, East Africa. Through a series of household surveys and focus group discussions in five fish landing sites, we assessed social adaptive capacity (SAC) based on 207 households and identified adaptive strategies that are effective for coping with climatic change. We found that people in fishing households are aware of environmental change but that most households do not have adaptive strategies that are efficacious for securing long‐term income and food security. We also investigated household demographics that contribute to SAC, examined links between SAC and adaptive efficacy and established potential routes towards developing effective adaptive approaches in small‐scale fisheries. This work contributes to a growing foundation of documented community‐based knowledge for building adaptive capacity in inland fisheries and the communities around the world that depend on them. Read the free Plain Language Summary for this article on the Journal blog.

Background : The use of medium-chain triglyceride (MCT) oil has increased due to its potential for therapeutic and ergogenic properties. Although recent evidence has suggested that MCT oil supplementation may lead to an improvement in endurance and substrate utilization, contradicting studies have reported the ergogenic benefits of MCT oil toward exercise performance. Methods : An extensive systematic review was conducted to assess the role of MCT oil as an ergogenic aid in exercise performance. Moreover, this study examined any alterations in substrate utilization and various physiological components while using MCT oil. The databases searched in this review were PubMed, Embase, CINAHL, and the Cochrane Library. Results : Most studies reported that MCT oil did not improve exercise performance and had no effect on respiratory exchange ratio, glucose concentration, fat and carbohydrate oxidation, and lactate concentration. Although ketones were increased when supplementing with MCTs, most studies demonstrated that the body could not utilize the MCT oil-induced ketones as its primary energy source during an acute bout of endurance exercise. Thirty grams of MCTs seems to be the safe maximal dosage to minimize adverse reactions during or after exercise. Conclusion : MCT oil showed very little to no ergogenic effects on exercise performance and substrate utilization in healthy populations. Future research is needed to examine the effects of long-term intake of MCT oil alongside various diets, perhaps a ketogenic diet, on exercise performance within different sports/exercises in a variety of populations.

There is growing interest around the world in more effectively linking public payments to the provision of public goods from agriculture. However, published evidence syntheses suggest mixed, weak or uncertain evidence for many agri-environment scheme options. To inform any future “public money for public goods” based policy, further synthesis work is needed to assess the evidence-base for the full range of interventions currently funded under agri-environment schemes. Further empirical research and trials should then focus on interventions for which there is mixed or limited evidence. Furthermore, to ensure the data collected is comparable and can be synthesised effectively, it is necessary to reach agreement on essential variables and methods that can be prioritised by those conducting research and monitoring. Future policy could then prioritise public money for the public goods that can most reliably be delivered, offering better value for taxpayers and improving the provision of ecosystem services from agricultural landscapes.

Abstract Purpose Combined medial tibiofemoral and symptomatic patellofemoral osteoarthritis is not amenable to unicompartmental knee replacement (UKR). Total knee replacement (TKR) is an invasive option in younger adults with high functional demands. The aim of this study was to compare the clinical outcome of patients who have undergone UKR, bicompartmental knee replacement (BKR) and TKR up to 2 years post-operatively. Materials and methods This prospective study comprised 133 subjects including 30 patients in the medial UKR group, 53 patients in the BKR group (combined medial UKR with patellofemoral joint replacement) and 50 patients in the TKR group. All subjects were evaluated using the Oxford Knee Score (OKS) and the Western Ontario and MacMaster Universities Osteoarthritis Index (WOMAC). Patients in each group were assessed using both scoring systems pre-operatively and 6 months, 1 year and 2 years post-operatively. Results Significant improvement of OKS was found at 6 months compared to baseline for UKR (22.7 to 38.1, p = 0.046), BKR (22.6 to 36.8, p

Surveying engineering education includes several outdoor laboratories that complement and enhance theoretical concepts taught in class. In addition, outdoor laboratories develop student skills with instruments and surveying techniques. These laboratories are often affected by weather, leading to cancelled laboratories, which reduce the time students spend with instruments and disrupt/delay the academic plan. Furthermore, terrain characteristics are important in surveying, as each terrain and project introduce unique surveying challenges. However, training often takes places in one location, thus, limiting student comprehension and experience on how to use the same instrument and techniques in different terrain conditions. Virtual reality constantly gains ground in education, as it overcomes restrictions of physical laboratories and enhances student learning. This study discusses the development of a leveling laboratory in immersive and interactive virtual reality, as well as the challenges encountered. We have replicated a part of the Penn State Wilkes-Barre campus, where students conduct many of their physical laboratories, in virtual reality with geometric and photorealistic fidelity using remote sensing and photogrammetric methods. Dense point clouds derived from terrestrial laser scanning and small unmanned aerial surveys are used for terrain and man-made object modeling. In addition, we have developed software that simulates surveying instruments, their properties, and user/student interaction with the instrument (e.g., moving the tripod, leveling the level instrument and leveling rod, etc.). This paper demonstrates that by utilizing cutting-edge remote sensing and virtual reality technologies, we can create realistic laboratories that can supplement physical outdoor laboratories and improve/enhance undergraduate instruction of surveying students.

Background: Treatment of Mycobacterium abscessus pulmonary disease (PD) is challenging with frequent side effects and uncertain rates of success. Methods: We performed a retrospective review of all patients at our center with at least one respiratory sample positive for M. abscessus between 2014 and 2019. Electronic health records were reviewed to determine factors associated with M. abscessus infection and clinical outcomes. Results: Thirty-seven patients were identified including 24 with cystic fibrosis (CF), 10 with bronchiectasis, two with chronic obstructive PD (COPD), and one with asthma. American Thoracic Society/Infectious Diseases Society of America criteria for nontuberculous mycobacteria PD were met in 21/37 (56.8%) of cases. Evidence of Aspergillus lung disease was noted in 18 (75.0%) CF patients compared with 3 (23.1%) non-CF patients (P = 0.005). Induction therapy for M. abscessus was given to 22/37 (59.5%) patients (18/24 [75%] with CF and 4/13 [30.8%] without CF). Median duration of induction therapy was 6 weeks (range 3–12). Maintenance antibiotic therapy was prescribed to 17/22 (77.3%) of treated patients. Culture conversion was seen in 15/24 (62.5%) of CF patients compared with 3/13 (23.1%) in the non-CF group (P = 0.034). Culture conversion occurred in 10/22 (45.5%) of treated patients compared with 8/15 (53.3%) untreated patients. Three patients (8.1%) died during follow-up: one with CF and two with COPD. Conclusions: Culture conversion following isolation of M. abscessus from respiratory samples not only is more common in CF than in patients without CF but also frequently occurs spontaneously in both groups. Targeted treatment for M. abscessus did not clearly impact rates of culture conversion.

Abstract Background Different multi‐segment foot models have been used to explore the effect of foot orthoses. Previous studies have compared the kinematic output of different multi‐segment foot models, however, no study has explored if different multi‐segment foot models detect similar kinematic changes when wearing a foot orthoses. The aim of this study was to compare the ability of two different multi‐segment foot models to detect kinematic changes at the hindfoot and forefoot during the single and double support phases of gait when wearing a foot orthosis. Methods Foot kinematics were collected during walking from a sample of 32 individuals with and without a foot orthosis with a medial heel bar using an eight‐camera motion capture system. The Oxford Foot Model (OFM) and a multi‐segment foot model using the Calibrated Anatomical System Technique (CAST) were applied simultaneously. Vector field statistical analysis was used to explore the kinematic effects of a medial heel bar using the two models, and the ability of the models to detect any changes in kinematics was compared. Results For the hindfoot, both models showed very good agreement of the effect of the foot orthosis across all three anatomical planes during the single and double support phases. However, for the forefoot, the level of agreement between the models varied with both models showing good agreement of the effect in the coronal plane but poorer agreement in the transverse and sagittal planes. Conclusions This study showed that while consistency exists across both models for the hindfoot and forefoot in the coronal plane, the forefoot in the transverse and sagittal planes showed inconsistent responses to the foot orthoses. This should be considered when interpreting the efficacy of different interventions which aim to change foot biomechanics.

In order to mitigate the effects of climate change, the UK government has set a target of achieving net zero greenhouse gas (GHG) emissions by 2050. Agricultural GHG emissions in 2017 were 45.6 million tonnes of carbon dioxide equivalent (CO2e; 10% of UK total GHG emissions). Farmland hedgerows are a carbon sink, storing carbon in the vegetation and soils beneath them, and thus increasing hedgerow length by 40% has been proposed in the UK to help meet net zero targets. However, the full impact of this expansion on farm biodiversity is yet to be evaluated in a net zero context. This paper critically synthesises the literature on the biodiversity implications of hedgerow planting and management on arable farms in the UK as a rapid review with policy recommendations. Eight peer-reviewed articles were reviewed, with the overall scientific evidence suggesting a positive influence of hedgerow management on farmland biodiversity, particularly coppicing and hedgelaying, although other boundary features, e.g. field margins and green lanes, may be additive to net zero hedgerow policy as they often supported higher abundances and richness of species. Only one paper found hedgerow age effects on biodiversity, with no significant effects found. Key policy implications are that further research is required, particularly on the effect of hedgerow age on biodiversity, as well as mammalian and avian responses to hedgerow planting and management, in order to fully evaluate hedgerow expansion impacts on biodiversity.

The SARS-CoV-2 can lead to severe illness with COVID-19. Outcomes of patients requiring mechanical ventilation are poor. Awake proning in COVID-19 improves oxygenation, but on data clinical outcomes is limited. This single-centre retrospective study aimed to assess whether successful awake proning of patients with COVID-19, requiring respiratory support (continuous positive airways pressure (CPAP) or high-flow nasal oxygen (HFNO)) on a respiratory high-dependency unit (HDU), is associated with improved outcomes. HDU care included awake proning by respiratory physiotherapists. Of 565 patients admitted with COVID-19, 71 (12.6%) were managed on the respiratory HDU, with 48 of these (67.6%) requiring respiratory support. Patients managed with CPAP alone 22/48 (45.8%) were significantly less likely to die than patients who required transfer onto HFNO 26/48 (54.2%): CPAP mortality 36.4%; HFNO mortality 69.2%, (p=0.023); however, multivariate analysis demonstrated that increasing age and the inability to awake prone were the only independent predictors of COVID-19 mortality. The mortality of patients with COVID-19 requiring respiratory support is considerable. Data from our cohort managed on HDU show that CPAP and awake proning are possible in a selected population of COVID-19, and may be useful. Further prospective studies are required.

As a saprophytic insect, the black soldier fly can digest organic waste efficiently in an environmentally friendly way. However, the ability and efficiency of this insect, and the microbial mechanisms involved, in the degradation of antibiotics are largely uncharacterized. To obtain further details during the degradation of OTC (oxytetracycline) by black soldier fly larvae (larvae), the changes in intestinal bacterial communities were examined. Both ARGs (antibiotic resistance genes) and MGEs (mobile genetic elements) were found within the larval guts. At the end of the degradation period, 82.7%, 77.6% and 69.3% of OTC was degraded by larvae when the initial concentrations were 100, 1000 and 2000 mg kg−1 (dry weight), respectively, which was much higher than the degradation efficiencies (19.3–22.2%) without larvae. There was no obvious effect of OTC on the development of the larvae. Although the larval gut microorganisms were affected by OTC, they adapted to the altered environment. Enterococcus, Ignatzschineria, Providencia, Morganella, Paenalcaligenes and Actinomyces in the gut responded strongly to antibiotic exposure. Interestingly, numerous ARGs (specifically, 180 ARGs and 10 MGEs) were discovered, and significantly correlated with those of both integron-integrase gene and transposases in the larval gut. Of all the detected ARGs, tetracycline resistance genes expressed at relatively high levels and accounted for up to 67% of the total ARGs. In particular, Enterococcus, Ignatzschineria, Bordetella, Providencia and Proteus were all hosts of enzymatic modification genes of tetracycline in the guts that enabled effective degradation of OTC. These findings demonstrate that OTC can be degraded effectively and prove that the bioremediation of antibiotic contamination is enhanced by larvae. In addition, the abundance of ARGs and MGEs formed should receive attention and be considered in environmental health risk assessment systems.

Abstract Background Breast cancer (BC) incidence in Australian women aged 45 to 64 years (‘middle-aged’) has tripled in the past 50 years, along with increasing alcohol consumption and obesity in middle-age women. Alcohol and obesity have been individually associated with BC but little is known about how these factors might interact. Chronic psychological stress has been associated with, but not causally linked to, BC. Here, alcohol could represent the ‘missing link’ – reflecting self-medication. Using an exploratory cross-sectional design, we investigated inter-correlations of alcohol intake and overweight/obesity and their association with BC incidence in middle-aged women. We also explored the role of stress and various lifestyle factors in these relationships. Methods We analysed population data on BC incidence, alcohol consumption, overweight/obesity, and psychological stress. A case control study was conducted using an online survey. Cases (n = 80) were diagnosed with BC and controls (n = 235) were women in the same age range with no BC history. Participants reported lifestyle data (including alcohol consumption, weight history) over consecutive 10-year life periods. Data were analysed using a range of bivariate and multivariate techniques including correlation matrices, multivariate binomial regressions and multilevel logistic regression. Results Ecological inter-correlations were found between BC and alcohol consumption and between BC and obesity but not between other variables in the matrix. Strong pairwise correlations were found between stress and alcohol and between stress and obesity. BMI tended to be higher in cases relative to controls across reported life history. Alcohol consumption was not associated with case-control status. Few correlations were found between lifestyle factors and stress, although smoking and alcohol consumption were correlated in some periods. Obesity occurring during the ages of 31 to 40 years emerged as an independent predictor of BC (OR 3.5 95% CI: 1.3–9.4). Conclusions This study provides ecological evidence correlating obesity and alcohol consumption with BC incidence. Case-control findings suggest lifetime BMI may be important with particular risk associated with obesity prior to 40 years of age. Stress was ecologically linked to alcohol and obesity but not to BC incidence and was differentially correlated with alcohol and smoking among cases and controls. Our findings support prevention efforts targeting weight in women below 40 years of age and, potentially, lifelong alcohol consumption to reduce BC risk in middle-aged women.