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Abstract Background Intensive lifestyle interventions were effective to reduce the risk of type 2 diabetes mellitus (T2DM) for women with gestational diabetes mellitus (GDM) history. However, reaching these mothers and maintaining participation in lifestyle interventions is suboptimal in real-world settings. Effective, feasible and sustainable new lifestyle interventions are needed. The objectives of this three-arm trial are to (1) compare diabetes risk outcomes of an evidence-based intensive lifestyle modification (ILSM) intervention, a camp-style lifestyle modification program (CAMP) intervention, and usual care among women with GDM history; and (2) evaluate the comparative efficacy of the CAMP versus ILSM intervention on implementation outcomes. Methods A three-arm cluster randomized clinical trial (RCT) using a hybrid type 2 implementation design will be conducted in two counties in Hunan province in China. Six towns from each county will be randomly selected and assigned to CAMP, ILSM, and the usual care group (25 women from each of 12 towns, 100 women in each arm). The ILSM includes six biweekly in-person sessions and 3-month telephone health consultations, while the CAMP consists of a 2-day camp-based session and 3-month health consultations via a popular social media platform. Both interventions share the same session content, including six lifestyle skills. Efficacy (T2DM risk score and behavioral, anthropometric, psychosocial, and glycemic variables) and implementation outcomes (recruitment, acceptability, feasibility, fidelity, and cost-effectiveness) will be collected at baseline, 6-month, and 12-month. Pre-planned ANOVA F-test and generalized estimating equations will be included to test time-by-arm interactions. Discussion The CAMP intervention is expected to have better reach, better attendance, and comparable effectiveness in reducing the risk of T2DM, thus improving postpartum care for GDM in China. The delivery of a concentrated format supplemented with technology-based support may provide an efficient and effective delivery model for implementing maternal health promotion programs in primary care settings. Trial registration Registered in the Chinese Clinical Trial Registry (ChiCTR2200058150) on 31st March 2022.

ABSTRACT Coordinated responses to threats are important for predator evasion in many species. This study examines the effect of developmental social experience on antipredator behavior and group cohesion in a highly gregarious catfish that communicates via tactile interaction, Corydoras aeneus. We reared fish either in a mixed‐age group of age‐matched peers and adult C. aeneus (mixed‐age condition, or MAC), or with age‐matched peers only (same‐age condition, or SAC). A startle test was conducted with small groups of subadults from either social rearing condition. Prior to any startle events, SAC subadults had increased tactile communication compared to MAC subadults, but SAC individuals were overall less active. SAC fish exhibited a stronger antipredator response to startles, and were more likely to freeze or take refuge in cover in response to a startle than MAC fish. MAC fish tended to respond to startle events by maintaining or decreasing their cohesion, whereas SAC fish tended to maintain or increase their cohesion. These behavioral differences are attributed to MAC fish developing with group protection as a result of shoaling with adults, resulting in reduced antipredator responses when reared with adults. This study underscores how social context during development can be critical in shaping how individuals perceive and respond to potential threats in their environment.

NRAS belongs to the RAS family of GTPases. In colorectal cancer (CRC), NRAS mutations are rare compared to KRAS, but may lead to worse outcomes. We report the functional characterization of the novel NRAS mutants—G48C, Q43K, and E37K—identified in Filipino young-onset CRC patients. Unlike previously characterized NRAS mutants with no apparent effects on cell proliferation, these mutants enhanced proliferation of both HCT116 and NIH3T3 cells. This was confirmed in 3D spheroid assays to mimic the spatial organization of cells. G48C and E37K showed apoptosis resistance in both cell lines, and Q43K showed resistance in HCT116 cells. All three showed no effect on cellular migration in NIH3T3, but G48C enhanced the migration rate of HCT116 cells. Actin staining of NIH3T3 cells expressing the mutants showed a shrunken cytoplasm and transient structures associated with motility and invasiveness. Docking simulations show that GDP is only able to bind fully within the binding pocket of wild-type NRAS, but not in the mutants. Further, G48C, Q43K, and E37K all have less negative ΔG values, indicating a weaker GDP-binding affinity compared to wild-type NRAS. Taken together, the results suggest that oncogenic readouts of NRAS mutants are codon- and mutation-specific, with potential repercussions on the aggressiveness, resistance, and therapeutic response.

Abstract The COVID lockdown presented an interesting opportunity to study the anthropogenic emissions from different sectors under relatively cleaner conditions in India. The complex interplays of power production, industry, and transport could be dissected due to the significantly reduced influence of the latter two emission sources. Here, based on measurements of cloud condensation nuclei (CCN) activity and chemical composition of atmospheric aerosols during the lockdown, we report an episodic event resulting from distinct meteorological conditions. This event was marked by rapid growth and high hygroscopicity of new aerosol particles formed in the SO2 plume from a large coal-fired power plant in Southern India. These sulfate-rich particles had high CCN activity and number concentration, indicating high cloud-forming potential. Examining the sensitivity of CCN properties under relatively clean conditions provides important new clues to delineate the contributions of different anthropogenic emission sectors and further to understand their perturbations of past and future climate forcing.

Abstract Background Venous thromboembolism (VTE) including Deep Venous Thrombosis (DVT) and Pulmonary Embolism (PE), is a serious cause of patient morbidity and mortality in hospitals. Neurosurgical hospitalized patients have higher rates of immobility and bed rest, thus increasing their risk of developing VTE. This highlights the need for their thromboprophylaxis regimens. Patients’ awareness of VTE is essential for promoting strategies such as early ambulation and encouraging self-assessment and self-reporting of VTE signs and symptoms. This study evaluated neurosurgical hospitalized patients’ awareness of VTE and explored the influencing factors to provide a theoretical basis for nursing intervention. Methods We selected one tertiary level hospital in Hunan Province and randomly sampled eligible patients from each five neurosurgical units. We conducted a cross-sectional survey of the hospitalized patients of neurosurgery using the self-designed and validated VTE knowledge questionnaire, and the influencing factors were analyzed using SPSS 26.0. Results A total of 386 neurosurgical hospitalized patients completed the survey. The score of VTE knowledge in neurosurgical hospitalized patients was 13.22 (SD = 11.52). 36.0% and 21.2% of participants reported they had heard of DVT and PE, respectively. 38.9% of participants were unable to correctly identify any symptoms of VTE. The most frequently identified risk factor was ‘immobility or bed rest for more than three days’ (50.0% of participants), and 38.1% of patients agreed that PE could cause death. 29.5% of participants were unable to identify any prophylactic measures of VTE. The results of Negative Binomial Regression showed that the influencing factors of VTE knowledge in neurosurgical hospitalized patients were education level (P

Abstract Background Many lifestyle interventions have demonstrated efficacy up to one-year follow-up, yet maintaining improvements at longer-term follow-up is a well-recognized worldwide challenge, especially in underserved areas. The purpose of this study is to compare the 18-month efficacy of an Intensive LifeStyle Modification Program to usual care in reducing the risk for type 2 diabetes (T2D) among women with a history of gestational diabetes mellitus (GDM). Methods We conducted a two-arm, cluster randomized controlled trial among women with a history of GDM in China. A total of 16 towns (clusters) in two distinct rural areas in south-central China were randomly selected (8 towns per area) and assigned (1:1) to the intervention (Intensive LifeStyle Modification Program) or control (usual care) group with stratification in the two rural areas. The strategies for maintaining intervention effects were used (including setting recursive goals and providing a supportive environment, etc.) under the guidance of social cognitive theory. The primary outcome was a change in T2D risk; secondary outcomes included glycemic, weight-related, behavioral, and psychological variables. All outcomes were collected at baseline, 6, and 18 months. All participants entered the intention-to-treat analysis. Data were analyzed via generalized estimation equation models (accounting for clusters) at the individual level, with subgroup analysis included in the model. Results The sample included 320 women from 16 clusters (20 women per cluster). At 18 months, the intervention group demonstrated a significant improvement in T2D risk score, fasting blood glucose, body mass index (BMI), waist circumference, intention to eat low glycemic index food, perceived stress, quality of life in psychological and environmental domains, and social support over time (p

Abstract Background Social distancing measures have been effective in mitigating the spread of COVID-19; however, they have imposed a significant burden on population mental health and well-being. This study aimed to identify factors associated with loneliness during the COVID-19 pandemic, and to describe the relationship between loneliness and the risk of worsening health outcomes and behaviours. Methods Data for 8,960 adults were drawn from a national cross-sectional survey undertaken in Wales between January and June 2021. Participants self-reported changes to health and behaviour since the start of the pandemic. Logistic regression was used to identify factors associated with loneliness, and the impact of loneliness on self-reported changes in physical health, physical fitness, mental health, weight, alcohol consumption and social relations in comparison with pre-pandemic experiences. Results Groups most at risk of loneliness were those aged

Abstract Background Gender differences have been found to be associated with individuals’ pleasure. Cognitive flexibility and emotional expressivity might play an important role between gender differences and pleasure. This current study is to explore the mediating role of cognitive flexibility and emotional expressivity in the relationship between gender differences and pleasure. Method In this cross-sectional study, a sample of 1107 full-time university students from five colleges in Tianjin, Chinese mainland was investigated by questionnaire. All participants completed the Temporal Experience of Pleasure Scale (TEPs), the Cognitive Flexibility Inventory (CFI), and the Berkeley Expressivity Questionnaire (BEQ). Results The results of independent T-test suggested that females reported better emotional expressivity, anticipatory pleasure and consummatory pleasure than males, whereas males had better cognitive flexibility than females. Using bootstrapping approach revealed that the partially mediation effects of cognitive flexibility on gender differences in anticipatory and consummatory pleasure, and that of emotional expressivity on gender differences in anticipatory and consummatory pleasure. Results of this present study stated that cognitive flexibility and emotional expressivity play a partial mediating role in explaining gender differences in anticipatory and consummatory pleasure. Conclusion Females had higher anticipatory and consummatory pleasure because they tend to use emotional regulation strategy to express their emotion.

BackgroundThroughout Wales and the world, health inequality remains a problem that is interconnected with a wider and complex social, economic and environmental dynamic. Subsequently, action to tackle inequality in health needs to take place at a structural level, acknowledging the constraints affecting an individual's (or community's) capability and opportunity to enable change. While the ‘social determinants of health' is an established concept, fully understanding the composition of the health gap is dependent on capturing the relative contributions of a myriad of social, economic and environmental factors within a quantitative analysis.MethodThe decomposition analysis sought to explain the differences in the prevalence of these outcomes in groups stratified by their ability to save at least £10 a month, whether they were in material deprivation, and the presence of a limiting long-standing illness, disability of infirmity. Responses to over 4,200 questions within the National Survey for Wales (n = 46,189; 2016–17 to 2019–20) were considered for analysis. Variables were included based on (1) their alignment to a World Health Organization (WHO) health equity framework (“Health Equity Status Report initiative”) and (2) their ability to allow for stratification of the survey sample into distinct groups where considerable gaps in health outcomes existed. A pooled Blinder-Oaxaca model was used to analyse inequalities in self-reported health (fair/poor health, low mental well-being and low life satisfaction) and were stratified by the variables relating to financial security, material deprivation and disability status.ResultsThe prevalence of fair/poor health was 75% higher in those who were financially insecure and 95% higher in those who are materially deprived. Decomposition of the outcome revealed that just under half of the health gap was “explained” i.e., 45.5% when stratifying by the respondent's ability to save and 46% when stratifying by material deprivation status. Further analysis of the explained component showed that “Social/Human Capital” and “Income Security/Social Protection” determinants accounted the most for disparities observed; it also showed that “Health Services” determinants accounted the least. These findings were consistent across the majority of scenarios modeled.ConclusionThe analysis not only quantified the significant health gaps that existed in the years leading up to the COVID-19 pandemic but it has also shown what determinants of health were most influential. Understanding the factors most closely associated with disparities in health is key in identifying policy levers to reduce health inequalities and improve the health and well-being across populations.

BackgroundForty years from the seminal work of Welsh GP Julian Tudor Hart on the Inverse Care Law, inequalities in health and healthcare remain deeply embedded in Wales. There is a wider gap (over 17 years) in healthy life expectancy between people living in the most and least deprived neighborhoods in Wales. This health inequality is reflected in additional healthcare use. In this study we estimate the cost of inequality associated with this additional healthcare use to the publicly funded National Health Service (NHS) in Wales.MethodsWe retrieved administrative data on all NHS inpatient admissions, outpatient and accident and emergency attendances in Wales between April 2018 and March 2019 from Digital Health and Care Wales (DHCW). Hospital service use data were translated to costs using Healthcare Resource Group (HRG) and health service specific unit cost data and linked with area level mid-year population and deprivation indices in order to calculate the healthcare costs associated with socioeconomics deprivation.ResultsInequality in healthcare use between people from more and less deprived neighborhoods was associated with an additional cost of £322 million per year to the NHS in Wales, accounting for 8.7% of total NHS hospital expenditure in the country. Emergency inpatient admissions made up by far the largest component of this additional cost contributing £247.4 million, 77% of the total. There are also substantial costs of inequality for A&E attendances and outpatient visits, though not maternity services. Elective admissions overall have a negative cost of inequality, since among men aged 50–75 and women aged 60–70, elective utilization is actually negatively associated with deprivation.ConclusionThere are wide inequalities in health and healthcare use between people living in more deprived neighborhoods and those living in less deprived neighborhoods in Wales. Tackling health inequality through a combination of health promotion and early intervention policies targeted toward deprived communities could yield substantial improvement in health and wellbeing, as well as savings for the Welsh NHS through reduced use of emergency hospital care.

Abstract Background Visual art training is a student-led approach using Western art pieces as the main teaching resources. It has been developed and applied in nursing and medical education in the United States. This study aimed to adapt visual art training to Chinese cultural context, then to compare the efficacy of the culturally-tailored visual art training versus traditional education on observational and diagnostic skills at 3-month follow-up among Chinese nursing students in master program. Methods This study included Phase 1 (cultural adaptation) and Phase 2 (3-month efficacy evaluation). It was conducted from June to September, 2019. In Phase 1, cultural barriers were identified and cultural adaptation strategy were made based on two focus group interviews. Phase 2 was a randomized controlled trial in a local museum. A total of 106 first-year nursing students in master program were randomized to the intervention group or the control group. Both groups received traditional education. In addition, intervention group received a visual art training (including a field-guided museum visit with observation and debriefing of Chinese oil paintings and clinical images, four teaching hours). Data were collected for both groups at baseline and 3-month follow-up on the observational and diagnostic skills measured by clinical image tests. Learning satisfaction with the visual art training was investigated among 53 intervention students and teaching satisfaction was done in 10 staff members by self-administered questionnaires. Results In phase 1, we adapted a culturally-tailored visual art training for nursing students in China. Observational skills of the intervention group increased significantly compared with the control group 3 months after the training (p .05). In general, all participants and staff were satisfied with the visual art training, especially the selected Chinese oil paintings and the student-led teaching process, but 34% (n = 18) were not satisfied with the long distance from the museum. Conclusions A culturally-tailored visual art training with great acceptability and feasibility was implemented in China. It had a sustained positive effect on improving the observational skills of Chinese nursing students. This study can be used for a reference to introduce visual art training to nursing students or nurses from other cultures. Trial registration Retrospectively registered in Chinese Clinical Trial Registry ( ChiCTR2000037956 ) on 4th September, 2020.

This report describes how multiple community constituents came together with university researchers to develop a shared agenda for studying young indigenous people in five international circumpolar communities. The paper focuses on the setup and process of an initial face-to-face methodological planning workshop involving youth and adult community members and academics. Members of Yup’ik, Inupiat, Eveny, Inuit, and Sámi communities from Siberia to Norway participated in the workshop and engaged in negotiations to arrive at shared research interests. This was essential since the ultimate goal of the research is translational and transformative, spurring social action in communities. Describing the beginning stage of this project and the underlying participatory methodology offers insight into how the approach engaged community members with varying degrees of sustained interest and practical success. It, therefore, articulates a methodological approach for international community-based participatory research.

Poultry litter is a valuable crude protein feedstuff for ruminants, but it must be treated to kill pathogens before feeding. Composting effectively kills pathogens, but it risks losing ammonia to volatilization or leaching during degradation of uric acid and urea. Hops bitter acids also exert antimicrobial activity against certain pathogenic and nitrogen-degrading microbes. Consequently, the present studies were conducted to test if adding bitter acid-rich hop preparations to simulated poultry litter composts may improve nitrogen retention while simultaneously improving pathogen killing. Results from an initial study, testing doses of Chinook or Galena hops preparations designed to each deliver 79 ppm hops β-acid, revealed that, after nine days simulated composting of wood chip litter, ammonia concentrations were 14% lower (p < 0.05) in Chinook-treated composts than untreated composts (13.4 ± 1.06 µmol/g). Conversely, urea concentrations were 55% lower (p < 0.05) in Galena-treated than untreated composts (6.2 ± 1.72 µmol/g). Uric acid accumulations were unaffected by hops treatments in this study but were higher (p < 0.05) after three days than after zero, six, or nine days of composting. In follow-up studies, Chinook or Galena hops treatments (delivering 2042 or 6126 ppm of β-acid, respectively) for simulated composts (14 days) of wood chip litter alone or mixed 3:1 with ground Bluestem hay (Andropogon gerardii) revealed that these higher dosages had little effect on ammonia, urea, or uric acid accumulations when compared to untreated composts. Volatile fatty acid accumulations measured in these later studies were affected by the hops treatments, with butyrate accumulations being lower after 14 days in hops-treated composts than in untreated compost. In all studies, beneficial effects of Galena or Chinook hops treatments were not observed on the antimicrobial activity of the simulated composts, with composting by itself decreasing (p < 0.05) counts of select microbial populations by more than 2.5 log10 colony forming units/g compost dry matter. Thus, while hops treatments had little effect on pathogen control or nitrogen retention within the composted litter, they did lessen accumulations of butyrate, which may prevent adverse effects of this fatty acid on palatability of litter fed to ruminants.

Skeletal muscle stem cells, known as satellite cells (SCs), are quiescent in normal adult limb muscles. Injury stimulates SC proliferation, differentiation, and fusion to regenerate muscle structure. In pharyngeal muscles, which are critical for swallowing foods and liquids, SCs proliferate and fuse in the absence of injury. It is unknown what factors drive increased basal activity of pharyngeal SCs. Here, we determined how niche factors influence the status of pharyngeal versus limb SCs. In vivo, a subset of pharyngeal SCs present features of activated SCs, including large cell size and increased mitochondrial content. In this study, we discovered that the pharyngeal muscle contains high levels of active hepatocyte growth factor (HGF), which is known to activate SCs in mice and humans. We found that fibroadipogenic progenitors (FAPs) are the major cell type providing HGF and are thus responsible for basal proliferation of SCs in pharyngeal muscles. Lastly, we confirmed the critical role of FAPs for pharyngeal muscle function and maintenance. This study gives new insights to explain the distinctive SC activity of pharyngeal muscles.

Coronaviruses use a broad range of host receptors for binding and cell entry, essential steps in establishing viral infections. This pilot study evaluated the overall distribution of angiotensin-converting enzyme 2 (ACE2), aminopeptidase N (APN), carcinoembryonic antigen-related cell adhesion molecule 1 (CEACAM1), and dipeptidyl peptidase 4 (DPP4) receptors in the pig respiratory and intestinal tract. All the receptors evaluated in this study were expressed and differentially distributed through the respiratory and intestinal tract. The presence and expression levels of these receptors could determine susceptibility to coronavirus infections. This study may have important implications for the development of research models and the assessment of the potential risk and introduction of novel coronaviruses into the swine population.

The Snowden revelations in 2013 redrew the lines of debate surrounding surveillance, exposing the extent of state surveillance across multiple nations and triggering legislative reform in many. In the UK, this was in the form of the Investigatory Powers Act (2016). As a contribution to understanding resistance to expanding state surveillance activities, this article reveals the intertwining of diverse interests and voices which speak in opposition to UK state surveillance. Through a computational topic modelling-based mixed methods analysis of the submissions made to the draft Investigatory Powers Bill consultation, the article demonstrates the diversity and intersection of discourses within different actor groups, including civil society and the technology industry. We demonstrate that encryption is a key issue for these groups, and is additionally conflated with a human rights discourse. This serves to unite seemingly disparate interests by imbuing encryption with a responsibility for the protection of human rights, but also threatens to legitimate corporate interests and distract from their own data-driven activities of surveillance capitalism.

Abstract Despite years of concerted research efforts, an industrial-scale technology has yet to emerge for production and conversion of algal biomass into biofuels and bioproducts. The objective of this review is to explore the ways of possible integration of biology, ecology and engineering for sustainable large algal cultivation and biofuel production systems. Beside the costs of nutrients, such as nitrogen and phosphorous, and fresh water, upstream technologies which are not ready for commercialization both impede economic feasibility and conflict with the ecological benefits in the sector. Focusing mainly on the engineering side of chemical conversion of algae to biodiesel has also become obstacle. However, to reduce the costs, one potential strategy has been progressing steadily to synergistically link algal aquaculture to the governmentally mandated reduction of nitrogen and phosphorous concentrations in municipal wastewater. Recent research also supports the suppositions of scalability and cost reduction. Noticeably, less is known of the economic impact of conversion of the whole algae-based biorefinery sector with additional biochemical and thermochemical processes and integration with ecological constraints. This review finds that a biorefinery approach with integrated biology, ecology, and engineering could lead to a feasible algal-based technology for variety of biofuels and bioproducts.

Salmonella Heidelberg (SH) on contaminated poultry causes economic and health risks to producers and consumers. We hypothesized that sodium bisulfate (SBS) would decrease SH biofilm on polyvinyl chloride (PVC) coupons and decrease the horizontal transfer of SH in broilers. Experiment 1: Salmonella Heidelberg biofilm was cultured with PVC coupons, which were treated with SBS at a pH of 3.5 for 10 min, 8 h, and 24 h. Experiment 2: Nine replicate pens per treatment were divided between two rooms. A seeder contact model was used to mimic a natural infection environment. Treatments consisted of tap water or sodium bisulfate in water at a pH of 3.5. Salmonella Heidelberg incidence and enumeration were measured in crops and ceca. Sodium bisulfate significantly reduced biofilm by 2.16 and 1.04 logs when treated for 8 and 24 h, respectively. Crop colonization was significantly decreased in trials 1 and 2 by 0.29 and 0.23 logs, respectively. Crop pH was significantly decreased in trial 2. Ceca colonization was significantly decreased in trial 1 by 0.39 logs. The results from the present study suggest that SBS may be administered to drinking water to decrease SH gut colonization and to reduce biofilm.

This study led to the development of a parametric design method for mass-customised head/face products. A systematic review of different approaches for mass customization was conducted, identifying advantages and limitations for their application to new product development. A parametric modelling algorithm of a 3D human face was developed using selected scanned 3D head models. The algorithm was developed from a set of measurable and adjustable parameter points related to the facial geometry. These parameters were defined using planimetry. Using the assigned parameter values as input, the parametric model generated 3D models of a human face that served as a reference for the design of customized eyewear. The current challenges and opportunities of mass customized head/face products are described, along with the possibilities for new parametric product design approaches to enable rapid manufacturing and mass customization. This study also explored whether a new parametric design framework for mass customization could be effectively implemented as an early-stage new product development strategy for head/face products.

Rice (Oryza sativa L.) is highly susceptible to the rhizosphere salinity than other cereals. High sensitivity has been observed, mainly at vegetative and reproductive stages in rice. It is the duty of plant physiologists to comprehend the growth, development, and physiological processes of rice plants under stress. This paper includes the overview of rice growth and developmental processes influenced by salt stress and the regulation pathways involved in these processes. It also includes the promising salt tolerance strategies, i.e., genetic modification techniques, agronomic practices to improve rice growth, yield, and role of phytohormones and their management, especially inhibition of ethylene biosynthesis by using inhibitors 1-methylcyclopropene (1-MCP). Rice cultivation may be a first choice for improvement of salt tolerance through plant growth regulators and improved cultivation techniques. This study will significantly improve the understanding toward low rice grain yield and poor rice resistance under salt stress and will also stream scientific knowledge for effective utilization of salt affected soils by using different regulating ways.

Abstract Breaking Continuous Flash Suppression (bCFS) has been adopted as an appealing means to study human visual awareness, but the literature is beclouded by inconsistent and contradictory results. Although previous reviews have focused chiefly on design pitfalls and instances of false reasoning, we show in this study that the choice of analysis pathway can have severe effects on the statistical output when applied to bCFS data. Using a representative dataset designed to address a specific controversy in the realm of language processing under bCFS, namely whether psycholinguistic variables affect access to awareness, we present a range of analysis methods based on real instances in the published literature, and indicate how each approach affects the perceived outcome. We provide a summary of published bCFS studies indicating the use of data transformation and trimming, and highlight that more compelling analysis methods are sparsely used in this field. We discuss potential interpretations based on both classical and more complex analyses, to highlight how these differ. We conclude that an adherence to openly available data and analysis pathways could provide a great benefit to this field, so that conclusions can be tested against multiple analyses as standard practices are updated.

The WaveCat is a moored Wave Energy Converter design which uses wave overtopping discharge into a variable v-shaped hull, to generate electricity through low head turbines. Physical model tests of WaveCat WEC were carried out to determine the device reflection, transmission, absorption and capture coefficients based on selected wave conditions. The model scale was 1:30, with hulls of 3 m in length, 0.4 m in height and a freeboard of 0.2 m. Wave gauges monitored the surface elevation at discrete points around the experimental area, and level sensors and flowmeters recorded the amount of water captured and released by the model. Random waves of significant wave height between 0.03 m and 0.12 m and peak wave periods of 0.91 s to 2.37 s at model scale were tested. The wedge angle of the device was set to 60°. A reflection analysis was carried out using a revised three probe method and spectral analysis of the surface elevation to determine the incident, reflected and transmitted energy. The results show that the reflection coefficient is highest (0.79) at low significant wave height and low peak wave period, the transmission coefficient is highest (0.98) at low significant wave height and high peak wave period, and absorption coefficient is highest (0.78) when significant wave height is high and peak wave period is low. The model also shows the highest Capture Width Ratio (0.015) at wavelengths on the order of model length. The results have particular implications for wave energy conversion prediction potential using this design of device.

Health Information Systems (HIS) are becoming crucial for health providers, not only for keeping Electronic Health Records (EHR) but also because of the features they provide that can be lifesaving, thanks to the advances in Information Technology (IT). These advancements have led to increasing demands for additional features to these systems to improve their intelligence, reliability, and availability. All these features may be provisioned through the use of cloud computing in HIS. This study arrives at three dimensions pertinent to adoption of cloud computing in HIS through extensive interviews with experts, professional expertise and knowledge of one of the authors working in this area, and review of academic and practitioner literature. These dimensions are financial performance and cost; IT operational excellence and DevOps; and security, governance, and compliance. Challenges and drivers in each of these dimensions are detailed and operationalized to arrive at a model for HIS adoption. This proposed model detailed in this study can be employed by executive management of health organizations, especially senior clinical management positions like Chief Technology Officers (CTOs), Chief Information Officers (CIOs), and IT managers to make an informed decision on adoption of cloud computing for HIS. Use of cloud computing to support operational and financial excellence of healthcare organizations has already made some headway in the industry, and its use in HIS would be a natural next step. However, due to the mission′s critical nature and sensitivity of information stored in HIS, the move may need to be evaluated in a holistic fashion that can be aided by the proposed dimensions and the model. The study also identifies some issues and directions for future research for cloud computing adoption in the context of HIS.

Suicide and alcohol use disorders are significant Alaska Native health disparities, yet there is limited understanding of protection and no studies about social network factors in protection in this or other populations. The Qungasvik intervention enhances protective factors from suicide and alcohol use disorders through activities grounded in Yupik cultural practices and values. Identification of social network factors associated with protection within the cultural context of these tight, close knit, and high density rural Yupik Alaska Native communities in southwest Alaska can help identify effective prevention strategies for suicide and alcohol use disorder risk. Using data from ego-centered social network and protective factors from suicide and alcohol use disorders surveys with 50 Yupik adolescents, we provide descriptive data on structural and network composition variables, identify key network variables that explain major proportions of the variance in a four principal component structure of these network variables, and demonstrate the utility of these key network variables as predictors of family and community protective factors from suicide and alcohol use disorder risk. Connections to adults and connections to elders, but not peer connections, emerged as predictors of family and community level protection, suggesting these network factors as important intervention targets for intervention.

In an era where digital and media literacy is as fundamental as reading, writing, and arithmetic, the role of school librarians transcends traditional boundaries. They are the perfect teachers to nurture digital citizenship among learners, an increasingly vital role. This article delves into how these unsung heroes and digital leaders use their digital superpowers to guide young minds toward safe, savvy, and socially responsible digital interactions. These superpowers are also directly aligned with the American Association of School Librarians Standards for Learners (2018) shared foundations: inquire, include, collaborate, curate, explore, and engage, which are easily crosswalked with the International Society for Technology in Education Standards for Students (BrooksYoung 2016).

Catatonia is a psychomotor syndrome which has historically been associated with schizophrenia. Many clinicians have thought that the prevalence of this condition has been decreasing over the past few decades. This review reminds clinicians that catatonia is not exclusively associated with schizophrenia, and is still common in clinical practice. Many cases are related to affective disorders or are of an idiopathic nature. The illusion of reduced prevalence has been due to evolving diagnostic systems that failed to capture catatonic syndromes. This systemic error has remained unchallenged, and potentiated by the failure to perform adequate neurological evaluations and catatonia screening exams on psychiatric patients. We find that current data supports catatonic syndromes are still common, often severe and of modern clinical importance. Effective treatment is relatively easy and can greatly reduce organ failure associated with prolonged psychomotor symptoms. Prompt identification and treatment can produce a robust improvement in most cases. The ongoing prevalence of this syndrome requires that psychiatrists recognize catatonia and its presentations, the range of associated etiologies, and the import of timely treatment.

This work considers the problem of reducing the cost of electricity to a grid-connected commercial building that integrates on-site solar energy generation, while at the same time reducing the impact of the building loads on the grid. This is achieved through local management of the building’s energy generation-load balance in an effort to increase the feasibility of wide-scale deployment and integration of solar power generation into commercial buildings. To realize this goal, a simulated building model that accounts for on-site solar energy generation, battery storage, electrical vehicle (EV) charging, controllable lighting, and air conditioning is considered, and a supervisory model predictive control (MPC) system is developed to coordinate the building’s generation, loads and storage systems. The main aim of this optimization-based approach is to find a reasonable solution that minimizes the economic cost to the electricity user, while at the same time reducing the impact of the building loads on the grid. To assess this goal, three objective functions are selected, including the peak building load, the net building energy use, and a weighted sum of both the peak load and net energy use. Based on these objective functions, three MPC systems are implemented on the simulated building under scenarios with varying degrees of weather forecasting accuracy. The peak demand, energy cost, and electricity cost are compared for various forecast scenarios for each MPC system formulation, and evaluated in relation to a rules-based control scheme. The MPC systems tested the rules-based scheme based on simulations of a month-long electricity consumption. The performance differences between the individual MPC system formulations are discussed in the context of weather forecasting accuracy, operational costs, and how these impact the potential of on-site solar generation and potential wide-spread solar penetration.

INTRODUCTION: Gastrointestinal endoscopy is an important modality for diagnosis and treatment of gastrointestinal disease, but there are limited data regarding the diagnostic yield of endoscopy in Cameroon and changes in the prevalence of endoscopic findings over time. Our aims were to describe the diagnostic utility of esophagogastroduodenoscopy (EGD) and colonoscopy, the impact of periodic on-site mentorship on cecal intubation rate and changes in the prevalence of common upper gastrointestinal findings when compared to a similar report from our region published in 1990.

This article provides four responses from senior psychotherapists and supervisors to Erskine’s articleRelational Healing of Early Affect-Confusion. The authors approach the third part of case study trilogy from their particular perspective and provide both challenge and respect for the author’s work.

Background. The native people of Alaska have experienced historical trauma and rapid changes in culture and lifestyle patterns. As a consequence, these populations shoulder a disproportionately high burden of psychological stress. The Yup’ik Experiences of Stress and Coping project originated from rural Yup’ik communities’ concerns about stress and its effects on health. It aimed to understand the stressful experiences that affect Yup’ik communities, to identify coping strategies used to deal with these stressors and to inform culturally responsive interventions. Objectives. Here, we examine the process of moving from research (gaining understanding) to disseminating project findings to translation into intervention priorities. We highlight the importance of community participation and discuss challenges encountered, strategies to address these challenges and ethical considerations for responsible intervention research with indigenous communities that reflect their unique historical and current socio-cultural realities. Design. Community-wide presentations and discussions of research findings on stress and coping were followed by smaller Community Planning Group meetings. During these meetings, community members contextualized project findings and discussed implications for interventions. This process placed priority on community expertise in interpreting findings and translating results and community priorities into grant applications focused on intervention development and evaluation. Results. Challenges included translation between English and Yup’ik, funding limitations and uncertainties, and the long timelines involved in moving from formative research to intervention in the face of urgent and evolving community needs. The lack of congruence between institutional and community worldviews in the intervention research enterprise highlights the need for “principled cultural sensitivity”. Conclusions. Cultural sensitivity requires sharing results that have practical value, communicating openly, planning for sustainability and incorporating indigenous knowledge and expertise through a community-guided process. Our research findings will inform continued work within our partnership as we co-develop culturally based strategies for multilevel community interventions to address stress.

This article provides four responses from senior psychotherapists and supervisors to Erskine’s articleBalancing on the “Borderline” of Early Affect-Confusion. The authors approach the second part of case study trilogy from their particular perspective and provide both challenge and respect for the author’s work.

This article provides four responses from senior psychotherapists and supervisors to Erskine’s article Early Affect-Confusion: The “Borderline” Between Despair and Rage. The authors approach the first part of case study trilogy from their particular perspective and provide both challenge and respect for the author’s work.

Objectives. To report on a participatory research process in southwest Alaska focusing on youth involvement as a means to facilitate health promotion. We propose youth-guided community-based participatory research (CBPR) as way to involve young people in health promotion and prevention strategizing as part of translational science practice at the community-level. Study design. We utilized a CBPR approach that allowed youth to contribute at all stages. Methods. Implementation of the CBPR approach involved the advancement of three key strategies including: (a) the local steering committee made up of youth, tribal leaders, and elders, (b) youth-researcher partnerships, and (c) youth action-groups to translate findings. Results. The addition of a local youth-action and translation group to the CBPR process in the southwest Alaska site represents an innovative strategy for disseminating findings to youth from a research project that focuses on youth resilience and wellbeing. This strategy drew from two community-based action activities: (a) being useful by helping elders and (b) being proud of our village. Conclusions. In our study, youth informed the research process at every stage, but most significantly youth guided the translation and application of the research findings at the community level. Findings from the research project were translated by youth into serviceable action in the community where they live. The research created an experience for youth to spend time engaged in activities that, from their perspectives, are important and contribute to their wellbeing and healthy living. Youth-guided CBPR meant involving youth in the process of not only understanding the research process but living through it as well.

Com opções virtuais os ativos subjacentes são informação e as regras que governam o exercício são baseadas nas realidades do reino da informação (infosphere). As opções virtuais podem ser modeladas como opções para comprar alguma informação pagando o custo das operações da informação envolvida. As opções virtuais surgem em diversos estágios da criação do valor. O estágio inicial envolve a observação de fenômenos físicos, com acompanhamento da captação de dados. O refinamento seguinte deve organizar os dados, em bases de dados estruturadas. A informação é selecionada, a partir do armazenamento e sintetizada em um produto da informação (tal como um relatório, um artigo, ou desenho de especificações do produto a ser fabricado no mundo físico). O produto da informação é apresentado, então, ao usuário por meio de uma relação eficiente que não requeira que o usuário seja um perito do campo. As opções virtuais são similares em conceito às opções reais mas, substancialmente, diferentes em seus detalhes, porque as opções reais têm objetos físicos, enquanto os ativos subjacentes e as regras que governam o exercício são baseados nas realidades do mundo físico. Também, quando se exercita uma opção financeira mata-se, tipicamente, a opção, as opções virtuais podem incluir o exercício múltiplo. As opções virtuais podem envolver a volatilidade elevada ou saltar processos e, também, adicionar além, realçando seu valor. A aplicação da teoria de preço das opçãos às opções reais criou ferramentas de análise de valor para tomada de decisão disciplinada, e o potencial e, também, é grande para os instrumentos de apoio para análise de valor de decisão baseada em opções virtuais. Este artigo trata diversas aplicações reais e importantes análises de opções no mundo da informação, incluindo modelos de processo do jump e os modelos para avaliar opções e sintetizar alguns itens n da informação em m resultados físicos de produtos .

Tarsal coalitions are relatively rare diagnoses affecting adolescent patients that typically present with progressive foot pain. Cuboid-navicular coalition, a type of tarsal coalition, is extremely rare with less than 10 reported cases to date. Most prevailing theories reported have described this specific type of coalition as asymptomatic except at specific moments of stress and exercise. The purpose in presenting this case is to demonstrate that cuboid-navicular coalition can be associated with chronic unremitting pain, as in our patient. We present a case of cuboid-navicular fibrocartilaginous coalition in an adolescent patient presenting with chronic foot pain. Furthermore, from an imaging standpoint, radiographic findings are often subtle and radiologists cannot rely on indirect signs such as talar beak in clinching the diagnosis of cuboid-navicular coalition. Instead, abnormal articulation between the cuboid and navicular must be sought.

In a continuous-time setting, Fill (2012) proved, for a large class of probabilistic sources, that the number of symbol comparisons used by $\texttt{QuickSort}$, when centered by subtracting the mean and scaled by dividing by time, has a limiting distribution, but proved little about that limiting random variable $Y$—not even that it is nondegenerate. We establish the nondegeneracy of $Y$. The proof is perhaps surprisingly difficult.

Using a recursive approach, we obtain a simple exact expression for the $L^2$-distance from the limit in the classical limit theorem of Régnier (1989) for the number of key comparisons required by $\texttt{QuickSort}$. A previous study by Fill and Janson (2002) using a similar approach found that the $d_2$-distance is of order between $n^{-1} \log{n}$ and $n^{-1/2}$, and another by Neininger and Ruschendorf (2002) found that the Zolotarev $\zeta _3$-distance is of exact order $n^{-1} \log{n}$. Our expression reveals that the $L^2$-distance is asymptotically equivalent to $(2 n^{-1} \ln{n})^{1/2}$.

The name Jane Addams is typically associated with the Settlement House Movement. As a founder of Hull House, the first settlement house in the United States, Addams worked tirelessly on behalf of the poor and oppressed. Less widely known is the depth of her concern about peace and her efforts as a peace builder. A more careful review, however, of Addams’ words and works reveals her passionate commitment to the abolition of war and the restoration of peace. This biographical sketch highlights the breadth and depth of Addams’ work both as an advocate for the poor and as an advocate for peace.