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Objective: The study objective was to determine the relationship between lung resection and the development of postoperative hiatal hernia. Methods: Preoperative and postoperative computed tomography imaging from 373 patients from the International Early Lung Cancer Action Program and the Initiative for Early Lung Cancer Research on Treatment were compared at a median of 31.1 months of follow-up after resection of clinical early-stage non–small cell lung cancer. Incidence of new hiatal hernia or changes to preexisting hernias were recorded and evaluated by patient demographics, surgical approach, extent of resection, and resection site. Results: New hiatal hernias were seen in 9.6% of patients after lung resection (5.6% after wedge or segmentectomy and 12.4% after lobectomy; P = .047). The median size of new hernias was 21 mm, and the most commonly associated resection site was the left lower lobe (24.2%; P = .04). In patients with preexisting hernias, 53.5% demonstrated a small but significant increase in size from 21 to 22 mm (P

Topic modeling, or identifying the set of topics that occur in a collection of articles, is one of the primary objectives of text mining. One of the big challenges in topic modeling is determining the correct number of topics: underestimating the number of topics results in a loss of information, i.e., omission of topics, underfitting, while overestimating leads to noisy and unexplainable topics and overfitting. In this paper, we consider a semantic-assisted non-negative matrix factorization (NMF) topics model, which we call SeNMFk, based on Kullback-Leibler(KL) divergence and integrated with a method for determining the number of latent topics. SeNMFk involves (i) creating a random ensemble of pairs of matrices whose mean is equal to the initial words-by-documents matrix representing the text corpus and the Shifted Positive Pointwise Mutual Information (SPPMI) matrix, which encodes the context information, respectively, and (ii) jointly factorizing each of these pairs with different number of topics to acquire sets of latent topics that are stable to noise. We demonstrate the performance of our method by identifying the number of topics in several benchmark text corpora, when compared to other state-of-the-art techniques. We also show that the number of document classes in the input text corpus may differ from the number of the extracted latent topics, but these classes can be retrieved by clustering the column-vectors of one of the factor matrices. Additionally, we introduce a software called pyDNMFk to estimate the number of topics. We demonstrate that our unsupervised method, SeNMFk, not only determines the correct number of topics, but also extracts topics with a high coherence and accurately classifies the documents of the corpus.

COVID-19 dramatically influenced students' and staff's learning and teaching experiences and approaches to learning. While many papers examined individual experiences in the context of higher education, synthesising these papers to determine enabling and hindering influences of digital adaptation was needed to guide the next phase of online learning reforms. This study explored the main dimensions of digital technology adaptation in higher education during the COVID-19 pandemic. The consequences for student and staff experiences and what aspects should be sustained and developed were discussed in this review. A total of 90 articles (published between 1st January 2020 and 30th June 2021) were identified and analysed based on the preferred reporting items for systematic reviews and meta-analyses framework. Four dimensions (with associated sub-factors) were found to influence student and staff experiences: techno-economic; personal and psychological; teaching, learning and assessment; and social. The findings highlighted that an integrated approach, across institutional, technical platforms, and individuals would be required to sustain digital learning initiatives during the crisis time.

Imbalances in the sex ratio at birth in Southeast and East Asia increased especially after the mid-1980s. We study how ultrasonic technology affected sex ratios at birth in South Korea, a country with a strong son preference. Between 1985 and 1995 fetal screenings and abortion services were widely available, though not available in the years before, and prohibited in the years after. Using the 1985, 1995, and 2005 Census microdata, we examine changes in sex ratios of newborns by birth year. We then study periodic effects on the fertility stopping rule, using the 2006 Korean Longitudinal Study of Aging, which provides birth years for all children. Between 1985 and 1995 there was a large increase in the fraction of boy babies at birth orders of three or more. Despite these fractions falling in the subsequent time period when fetal screening became illegal, they remained above plausible biological levels. Supporting earlier findings in the literature, the increase in sex ratios was especially large when prior sibling composition was entirely female. We also find that having only daughters significantly increases the probability of parents having another child, and this effect is greater for parents with any child born after 1985 than the parents with all children born before 1985. There exist significant period effects, suggesting that sex ratios at birth became imbalanced when ultrasound technology became available. The availability of ultrasound technology also influenced parents’ fertility decisions, seen especially in parents with only daughters deciding to have another child. Our study provides new evidence for how the availability of ultrasound technology influenced sex ratios at birth and influenced fertility behaviors in Korea. Keywords: Prenatal sex screening, Sex ratio at birth, Sex ratio imbalance, Fertility, South Korea

Abstract Avida-ED is a model system that lets students explore evolution and the nature of science by observing and manipulating the evolutionary dynamics of digital organisms. Over 5 years, we ran eight 2.5-day in-person professional development workshops for 105 primarily college biology instructors to introduce them to Avida-ED and digital evolution and to help them to plan implementations. In this paper, based upon 60-min interviews with 46 of the attendees, we describe what they found to be of value in the workshop itself and the implementations of Avida-ED that they subsequently carried out. The Active LENS workshops were universally valued by the interviewees as a professional development experience; they valued the overall experience of the workshops, their organization and content, and the instructor support materials. Of the 46 teachers that we interviewed, 41 implemented Avida-ED in their classrooms, in 66 separate implementations. We characterized these with respect to the nature of the implementation and its duration, and examined the data in relation to course type, course level, and stated learning goals of the instructors. The most common use was to have students learn evolutionary concepts by observing them in action. A smaller fraction used it to provide a complete research experience.

Abstract Background In the Northern Territory (NT) of Australia, there are significant evidence gaps about illicit drug use and harms, despite having established monitoring and reporting systems. This paper reports on illicit drug use, associated harms, contributing factors, service needs and priorities in the NT from the perspective and experiences of key stakeholders engaged in providing services for, or advocating on behalf of, people who use illicit drugs in the NT. Methods Face-to-face and online qualitative interviews were conducted with stakeholders across urban and remote locations in the NT. Key stakeholders were service providers, including acute and primary care clinicians, representatives of Aboriginal community controlled health organisations, lived experience advocates, peak body representatives and public health executives. Qualitative data were analysed thematically. Results Four researchers interviewed 21 participants across urban (62%), and remote areas (38%) of the NT. Themes identified were: (1) Illicit drug use and harms are diverse and distinct; (2) Client support needs are complex and influenced by co-morbidities, socio-demographic and cultural factors; (3) Priority population sub-groups need targeted strategies; (4) Local service strengths can be further developed and enhanced; (5) Local services need better resourcing; (6) Invest in progressive legislative and policy reforms; and (7) Improve routine monitoring and evaluation. Conclusions Key stakeholders described illicit drug use, harms and contributing factors, which provided insights into the local challenges. Participants emphasised that clients have complex care needs, and further investment into targeted strategies are required to improve service engagement with priority groups. Service needs included greater understanding the role of dual diagnosis and its implementation and enhancing integrated and collaborative care in both primary health and acute care contexts. The voices of people with lived experience captured in this paper must inform local strategy and policy development relating to illicit drug use, in alignment with national strategy.

Objective: Carbapenem-resistant Acinetobacter baumannii (CRAB) is a global concern as effective treatments are very limited. We previously used a modified susceptibility testing approach to predict growth suppression in carbapenem-resistant Enterobacterales, but there are uncertainties about the generalizability of the model. The objective of this study is to verify if a similar approach can be extended to CRAB. Method: A clinical isolate of CRAB resistant to ceftazidime/avibactam (CAZ/AVI, MIC = 32/4 mg/L) was examined. CAZ susceptibility was determined using increasing concentrations of AVI (0–64 mg/L), and MIC reduction was characterized with a sigmoid inhibitory maximum effect (Emax) model. The effectiveness of CAZ/AVI was validated in a hollow fibre infection model (HFIM) over 72 hours, using simulated unbound serum / epithelial lining fluid (ELF) exposures of 2.5 g over 2 hours every 8 hours. Baseline inocula of approximately 5.5 log CFU/mL were examined. Results: An AVI concentration-dependent reduction in CAZ MIC was observed (r2 = 0.99). CAZ MIC was dramatically reduced from 512 mg/L (no AVI) to 32 mg/L (AVI = 4 mg/L), and further to 8 mg/L (AVI = 16 mg/L). Pharmacokinetic simulations were satisfactory in the HFIM (r2 > 0.96). Bacterial suppression was observed >24 hours with the serum exposure, but not that from the ELF. Conclusion: Using multiple AVI concentrations within the clinically relevant range, our susceptibility testing approach could have better insights of treatment outcome for infections caused by CRAB. This could potentially lead to effective intervention(s) overlooked by conventional susceptibility testing method. This case highlights the importance of site-specific drug exposures on determining treatment outcome.

The purpose of this comparative case study research project was to identify the characteristics and practices utilized by the senior leadership teams (SLTs) at two CCCU institutions that had been highly rated in terms of confidence levels from the faculty/staff based on data gathered in ModernThink's "Great Colleges to Work For" annual survey, as published in "The Chronicle of Higher Education". Because the COVID-19 crisis was current and impacting all institutions of higher education, these SLTs were selected to address the research question "What have been the characteristics and practices of highly rated senior leadership teams as they guided their institutions in navigating the COVID-19 crisis?" During one campus visit to each of two locations, a research team of three gathered data through 36 face-to-face interviews, direct observations, and document review. Study findings add to the literature by addressing gaps related to SLTs in the field of higher education, as identified by Kezar et al. This research project is the first "test" of the model of Kezar and colleagues, applying it to a study of two teams to assess which of the eight key elements of SLTs were most prominently identified among the perceptions and experiences of team members. Four unique primary themes emerged from the process of data analysis: (a) designing teams to develop significant levels of trust, (b) prioritizing shared team mission and institutional vision, (c) affirming strong presidential leadership that authentically empowers others, and (d) emphasizing clarity throughout crisis. This study extends the research on higher education SLTs and presents several implications and opportunities for further research.

Background Despite disproportionate rates of mental ill-health compared with non-Indigenous populations, few programs have been tailored to the unique health, social, and cultural needs and preferences of young Aboriginal and Torres Strait Islander males. This paper describes the process of culturally adapting the US-based Young Black Men, Masculinities, and Mental Health (YBMen) Project to suit the needs, preferences, culture, and circumstances of Aboriginal and Torres Strait Islander males aged 16–25 years in the Northern Territory, Australia. YBMen is an evidence-based social media-based education and support program designed to promote mental health, expand understandings of gender and cultural identities, and enhance social support in college-aged Black men. Methods Our adaptation followed an Extended Stages of Cultural Adaptation model. First, we established a rationale for adaptation that included assessing the appropriateness of YBMen’s core components for the target population. We then investigated important and appropriate models to underpin the adapted program and conducted a non-linear, iterative process of gathering information from key sources, including young Aboriginal and Torres Strait Islander males, to inform program curriculum and delivery. Results To maintain program fidelity, we retained the core curriculum components of mental health, healthy masculinities, and social connection and kept the small cohort, private social media group delivery but developed two models: ‘online only’ (the original online delivery format) and ‘hybrid in-person/online’ (combining online delivery with weekly in-person group sessions). Adaptations made included using an overarching Aboriginal and Torres Strait Islander social and emotional wellbeing framework and socio-cultural strengths-based approach; inclusion of modules on health and wellbeing, positive Indigenous masculinities, and respectful relationships; use of Indigenous designs and colours; and prominent placement of images of Aboriginal and Torres Strait Islander male sportspeople, musicians, activists, and local role models. Conclusions This process resulted in a culturally responsive mental health, masculinities, and social support health promotion program for young Aboriginal and Torres Strait Islander males. Next steps will involve pilot testing to investigate the adapted program’s acceptability and feasibility and inform further refinement. Keywords: Aboriginal, Torres Strait Islander, Indigenous, Australia, male, cultural adaptation, social media, mental health, masculinities, social support.

Abstract Background Forests are significant terrestrial biomes for carbon storage, and annual carbon accumulation of forest biomass contributes offsets affecting net greenhouse gases in the atmosphere. The immediate loss of stored carbon through fire on forest lands reduces the annual offsets provided by forests. As such, the United States reporting includes annual estimates of direct fire emissions in conjunction with the overall forest stock and change estimates as a part of national greenhouse gas inventories within the United Nations Framework Convention on Climate Change. Forest fire emissions reported for the United States, such as the 129 Tg CO2 reported for 2022, are based on the Wildland Fire Emissions Inventory System (WFEIS). Current WFEIS estimates are included in the Inventory of U.S. Greenhouse Gas Emissions and Sinks: 1990–2022 published in 2024 by the United States Environmental Protection Agency. Here, we describe WFEIS the fire emissions inventory system we used to address current information needs, and an analysis to confirm compatibility of carbon mass between estimated forest fire emissions and carbon in forest stocks. Results The summaries of emissions from forests are consistent with previous reports that show rates and interannual variability in emissions and forest land area burned are generally greater in recent years relative to the 1990s. Both emissions and interannual variability are greater in the western United States. The years with the highest CO2 emissions from forest fires on the 48 conterminous states plus Alaska were 2004, 2005, and 2015. In some years, Alaska emissions exceed those of the 48 conterminous states, such as in 2022, for example. Comparison of forest fire emission to forest carbon stocks indicate there is unlikely any serious disconnect between inventory and fire emissions estimates. Conclusions The WFEIS system is a user-driven approach made available via a web browser. Model results are compatible with the scope and reporting needs of the annual national greenhouse gas inventories.

Abstract As climate change continues to modify temperature and rainfall patterns, risks from pests and diseases may vary as shifting temperature and moisture conditions affect the life history, activity, and distribution of invertebrates and diseases. The potential consequences of changing climate on pest management strategies must be understood for control measures to adapt to new environmental conditions. The redlegged earth mite (RLEM; Halotydeus destructor [Tucker]) is a major economic pest that attacks pastures and grain crops across southern Australia and is typically controlled by pesticides. TIMERITE® is a management strategy that relies on estimating the optimal timing (the TIMERITE® date) for effective chemical control of RLEM populations in spring. In this study, we assessed the efficacy of control at the TIMERITE® date from 1990 to 2020 across southern Australia using a simulation approach that incorporates historical climatic data and field experimental data on life history, seasonal abundance, and population level pesticide responses. We demonstrate that moisture and temperature conditions affect the life history of RLEM and that changes in the past three decades have gradually diminished the efficacy of the TIMERITE® strategy. Furthermore, we show that by incorporating improved climatic data into predictions and shifting the timing of control to earlier in the year, control outcomes can be improved and are more stable across changing climates. This research emphasises the importance of accounting for dynamic environmental responses when developing and implementing pest management strategies to ensure their long-term effectiveness. Suggested modifications to estimating the TIMERITE® date will help farmers maintain RLEM control outcomes amidst increasingly variable climatic conditions.

Selective internal radiation therapy (SIRT) is a novel intervention for both primary and metastatic malignant liver lesions. Adrenocortical carcinoma (ACC) is rare with limited treatment options; evidence for SIRT in ACC liver metastases consists of case reports only. Selective internal radiation therapy (SIRT) was employed to treat recurrent liver metastases in a 49-year-old gentleman with ACC, who previously underwent a left-sided hepatectomy. The patient opted for SIRT after reviewing the literature regarding mitotane chemotherapy and its toxicities. Selective internal radiation therapy (SIRT) provided several months of progression-free survival (PFS), with no toxicity and an excellent radiological response. The patient re-presented 12 years after the initial diagnosis with skeletal metastases and sadly died in September 2022. Substantial unmet need exists for effective treatments in ACC, with 75% of patients presenting with incurable disease. Developing widespread disease, SIRT offered 2 years’ PFS in our patient; this was well tolerated with minimal residual liver impairment. Its use in ACC liver-limited disease warrants investigation.Selective internal radiation therapy (SIRT) is a novel intervention for both primary and metastatic malignant liver lesions. Adrenocortical carcinoma (ACC) is rare with limited treatment options; evidence for SIRT in ACC liver metastases consists of case reports only. Selective internal radiation therapy (SIRT) was employed to treat recurrent liver metastases in a 49-year-old gentleman with ACC, who previously underwent a left-sided hepatectomy. The patient opted for SIRT after reviewing the literature regarding mitotane chemotherapy and its toxicities. Selective internal radiation therapy (SIRT) provided several months of progression-free survival (PFS), with no toxicity and an excellent radiological response. The patient re-presented 12 years after the initial diagnosis with skeletal metastases and sadly died in September 2022. Substantial unmet need exists for effective treatments in ACC, with 75% of patients presenting with incurable disease. Developing widespread disease, SIRT offered 2 years’ PFS in our patient; this was well tolerated with minimal residual liver impairment. Its use in ACC liver-limited disease warrants investigation.

ABSTRACT Objective Previous research has tended to consider impulsive, inattentive, and loss of control eating (LOC) tendencies as symptoms of greater pathologies in treatment‐seeking samples. However, inattentive and impulsive tendencies and LOC often co‐occur. Although LOC is an important diagnostic component of disordered eating (ED), it has recently been argued to be a dysregulated eating behavior in its own right. The purpose of the current self‐report study was, therefore, to investigate the association between impulsive and inattentive tendencies and LOC in adults after accounting for ED. Method A community sample of 516 adults was surveyed online about their inattentive and impulsive tendencies, LOC, and ED behaviors. Results A hierarchical multiple linear regression revealed ED, inattentive, and impulsive symptoms to be independent, significant, positive predictors of LOC. Discussion These findings suggest that the levels of inattentive and, to a lesser extent, impulsive tendencies are significantly associated with LOC in adults, even after ED is accounted for. Moreover, inattentive tendencies were found to be more significantly associated with LOC than impulsive tendencies. These are novel and important findings that can be used to inform both clinicians and individuals with inattentive and impulsive tendencies alike of this association. Considering the well‐documented adverse health and wellbeing outcomes associated with LOC, future feasibility trials are needed aimed at treating this co‐occurrence.

The FAM83 (Family with sequence similarity 83) family is highly conserved in vertebrates, but little is known of the functions of these proteins beyond their association with oncogenesis. Of the family, FAM83F is of particular interest because it is the only membrane-targeted FAM83 protein. When overexpressed, FAM83F activates the canonical Wnt signalling pathway and binds to and stabilizes p53; it therefore interacts with two pathways often dysregulated in disease. Insights into gene function can often be gained by studying the roles they play during development, and here we report the generation of fam83f knock-out (KO) zebrafish, which we have used to study the role of Fam83f in vivo. We show that endogenous fam83f is most strongly expressed in the hatching gland of developing zebrafish embryos, and that fam83f KO embryos hatch earlier than their wild-type (WT) counterparts, despite developing at a comparable rate. We also demonstrate that fam83f KO embryos are more sensitive to ionizing radiation than WT embryos—an unexpected finding, bearing in mind the previously reported ability of FAM83F to stabilize p53. Transcriptomic analysis shows that loss of fam83f leads to downregulation of phosphatidylinositol-3-phosphate (PI(3)P) binding proteins and impairment of cellular degradation pathways, particularly autophagy, a crucial component of the DNA damage response. Finally, we show that Fam83f protein is itself targeted to the lysosome when overexpressed in HEK293T cells, and that this localization is dependent upon a C’ terminal signal sequence. The zebrafish lines we have generated suggest that Fam83f plays an important role in autophagic/lysosomal processes, resulting in dysregulated hatching and increased sensitivity to genotoxic stress in vivo.

Abstract Heparin-induced thrombocytopenia (HIT) is an adverse reaction to heparin leading to a reduction in circulating platelets with an increased risk of thrombosis. It is precipitated by polymerized immune complexes consisting of pathogenic antibodies that recognize a small chemokine platelet factor 4 (PF4) bound to heparin. Characterization of these immune complexes is extremely challenging due to the enormous structural heterogeneity of such macromolecular assemblies and their constituents. Native mass spectrometry demonstrates that up to three PF4 tetramers can be assembled on a heparin chain, consistent with the molecular modeling studies showing facile polyanion wrapping along the polycationic belt on the PF4 surface. Although these assemblies can accommodate a maximum of only two antibodies, the resulting immune complexes are capable of platelet activation despite their modest size. Taken together, these studies provide further insight into molecular mechanisms of HIT and other immune disorders where anti-PF4 antibodies play a central role.

Objective To identify the availability of results for trials registered on the European Union Clinical Trials Register (EUCTR) compared with other dissemination routes to understand its value as a results repository.Design Cross sectional audit study.Setting EUCTR protocols and results sections, data extracted 1-3 December 2020.Population Random sample of 500 trials registered on EUCTR with a completion date of more than two years from the beginning of searches (ie, 1 December 2018).Main outcome measures Proportion of trials with results across the examined dissemination routes (EUCTR, ClinicalTrials.gov, ISRCTN registry, and journal publications), and for each dissemination route individually. Prespecified secondary outcomes were number and proportion of unique results, and the timing of results, for each dissemination route.Results In the sample of 500 trials, availability of results on EUCTR (53.2%, 95% confidence interval 48.8% to 57.6%) was similar to the peer reviewed literature (58.6%, 54.3% to 62.9%) and exceeded the proportion of results available on other registries with matched records. Among the 383 trials with any results, 55 (14.4%, 10.9% to 17.9%) were only available on EUCTR. Also, after the launch of the EUCTR results database, median time to results was fastest on EUCTR (1142 days, 95% confidence interval 812 to 1492), comparable with journal publications (1226 days, 1074 to 1551), and exceeding ClinicalTrials.gov (3321 days, 1653 to undefined). For 117 trials (23.4%, 19.7% to 27.1%), however, results were published elsewhere but not submitted to the EUCTR registry, and no results were located in any dissemination route for 117 trials (23.4%, 19.7% to 27.1).Conclusions EUCTR should be considered in results searches for systematic reviews and can help researchers and the public to access the results of clinical trials, unavailable elsewhere, in a timely way. Reporting requirements, such as the EU's, can help in avoiding research waste by ensuring results are reported. The registry's true value, however, is unrealised because of inadequate compliance with EU guidelines, and problems with data quality that complicate the routine use of the registry. As the EU transitions to a new registry, continuing to emphasise the importance of EUCTR and the provision of timely and complete data is critical. For the future, EUCTR will still hold important information from the past two decades of clinical research in Europe. With increased efforts from sponsors and regulators, the registry can continue to grow as a source of results of clinical trials, many of which might be unavailable from other dissemination routes.

There are many surgical techniques for reconstruction of the divided or incompetent central slip. Most rely upon postoperative immobilisation to protect the repair. We present our experience using a distally based flexor digitorum superficialis slip to reconstruct the central slip and allow early mobilisation in five patients with intact preoperative intrinsic function. Post-treatment, a mean recovery of 65 degrees of active extension was achieved, albeit at the cost of a mean 22-degree loss of active flexion. We suggest this relatively easy technique provides a useful surgical option in the management of this difficult problem.

Abstract External cycling regenerating nitrogen oxides (NOx ≡ NO + NO2) from their oxidative reservoir, NOz, is proposed to reshape the temporal–spatial distribution of NOx and consequently hydroxyl radical (OH), the most important oxidant in the atmosphere. Here we verify the in situ external cycling of NOx in various environments with nitrous acid (HONO) as an intermediate based on synthesized field evidence collected onboard aircraft platform at daytime. External cycling helps to reconcile stubborn underestimation on observed ratios of HONO/NO2 and NO2/NOz by current chemical model schemes and rationalize atypical diurnal concentration profiles of HONO and NO2 lacking noontime valleys specially observed in low-NOx atmospheres. Perturbation on the budget of HONO and NOx by external cycling is also found to increase as NOx concentration decreases. Consequently, model underestimation of OH observations by up to 41% in low NOx atmospheres is attributed to the omission of external cycling in models.

Background The European Union Medical Device Regulation (MDR) requires manufacturers to undertake post-market clinical follow-up (PMCF) to assess the safety and performance of their devices following approval and Conformité Européenne (CE) marking. The quality and reliability of device registries for this Regulation have not been reported. As part of the Coordinating Research and Evidence for Medical Devices (CORE-MD) project, we identified and reviewed European cardiovascular and orthopaedic registries to assess their structures, methods, and suitability as data sources for regulatory purposes.Methods Regional, national and multi-country European cardiovascular (coronary stents and valve repair/replacement) and orthopaedic (hip/knee prostheses) registries were identified using a systematic literature search. Annual reports, peer-reviewed publications, and websites were reviewed to extract publicly available information for 33 items related to structure and methodology in six domains and also for reported outcomes.Results Of the 20 cardiovascular and 26 orthopaedic registries fulfilling eligibility criteria, a median of 33% (IQR: 14%-71%) items for cardiovascular and 60% (IQR: 28%-100%) items for orthopaedic registries were reported, with large variation across domains. For instance, no cardiovascular and 16 (62%) orthopaedic registries reported patient/procedure-level completeness. No cardiovascular and 5 (19%) orthopaedic registries reported outlier performances of devices, but each with a different outlier definition. There was large heterogeneity in reporting on items, outcomes, definitions of outcomes, and follow-up durations.Conclusion European cardiovascular and orthopaedic device registries could improve their potential as data sources for regulatory purposes by reaching consensus on standardised reporting of structural and methodological characteristics to judge the quality of the evidence as well as outcomes.

Combinations of metal disinfectants (i.e., silver and copper) with chlorine in doses that meet the World Health Organization guidelines for drinking water operate synergistically to provide superior drinking water disinfection across a wide range of pathogens. Moreover, the combination of disinfectants allows for lower chlorine levels and a less objectionable taste and odor to the treated water (some people can taste or smell chlorine at concentrations as low as 300 μg/L). Towards chlorine-releasing materials for combination with silver- or copper-releasing materials in point-of-use water disinfection, N-chloramine containing polymer gels were developed and their potential for E. coli bacteria inactivation was assessed in deionized water that contained salts to simulate groundwater. Following the chlorination of gels containing chloramine precursors, these gels capably inactivated E. coli, achieving log10 reductions—depending on the gel mass—ranging from 1.1 to 4.5. While chlorine released from the gels was not spectroscopically detected, free chlorine solutions inactivated E. coli in a concentration-dependent way, with 5 and 20 μg/L Cl2 yielding log10 reductions of 0.43 and 1.69, respectively, suggesting that low levels of chlorine, below both the limit of detection of spectroscopic assays (ca. 40 μg/L Cl2) and levels known to create adverse taste and smell, are sufficient to inactivate bacteria. Unchlorinated gels or chlorinated control styrene gels (without chloramine precursor) did not inactivate bacteria, suggesting that disinfection did not come from the precursor or from chlorine trapped in the gels after chlorination. In addition, these gels were evaluated together with the MadiDrop (MD, a commercial silver-ceramic tablet) and a copper screen that release silver and copper disinfectants, respectively. Combinations of the gel and MD produced E. coli inactivation close to 2-log10 reduction, with the combination, gels alone, and MD alone achieving 1.86-, 1.10-, and 0.69-log10 reduction, respectively. When the gels were combined with the copper screen, however, neither an increase nor a decrease in bacterial reduction was observed compared to that achieved with the gels alone. The laboratory results in this study are promising and suggest the potential for chloramine-functionalized gels to serve as an alternative to existing commercial chlorine-based POU technologies and in combination with silver-based POU technologies.

Gender-responsive healthcare is critical to advancing men’s health given that masculinities intersect with other social determinants to impact help-seeking, engagement with primary healthcare, and patient outcomes. A scoping review was undertaken with the aim to synthesize gender-responsive approaches used by healthcare providers (HCPs) to engage men with primary healthcare. MEDLINE, PubMed, CINAHL, and PsycINFO databases were searched for articles published between 2000 and February 2024. Titles and abstracts for 15,659 citations were reviewed, and 97 articles met the inclusion criteria. Data were extracted and analyzed thematically. Thirty-three approaches were synthesized from across counseling/psychology, general practice, social work, nursing, psychiatry, pharmacy, and unspecified primary healthcare settings. These were organized into three interrelated themes: (a) tailoring communication to reach men; (b) purposefully structuring treatment to meet men’s health needs, and (c) centering the therapeutic alliance to retain men in care. Strength-based and asset-building approaches focused on reading and responding to a diversity of masculinities was reinforced across the three findings. While these approaches are recommended for the judicious integration into health practitioner education and practice, this review highlighted that the evidence remains underdeveloped, particularly for men who experience health inequities. Critical priorities for further research include intersectional considerations and operationalizing gender-responsive healthcare approaches for men and its outcomes, particularly at first point-of-contact encounters.

Despite its importance to everyday functioning, reasoning is underexplored in developmental dyslexia. The current study investigated verbal deductive reasoning on the Wason selection task, not previously used in dyslexia research despite its well-established pedigree. Reasoning rule was manipulated, with the conditional rules varying in the logical values presented. The word frequency and imageability of the word terms was also manipulated. Twenty-six adults with dyslexia and 31 adults without dyslexia completed Wason selection task problems. No group difference in reasoning accuracy or completion time was found. However, the participants were most accurate when reasoning with the rule type “If p, then not q” and least accurate with the rule type “If p then q”. More trials were also answered correctly when the word terms were highly imageable but of average word frequency. These findings are in line with the general reasoning literature. Dyslexia status did not interact with either rule type or word term type. The study expands upon previous research by testing verbal deductive reasoning in dyslexia, highlighting the role of imageability in facilitating reasoning performance for all, regardless of the presence or absence of dyslexia. Implications for the design of educational materials are considered.

Forest inventory data are useful for determining forest stand structure, growth, and change. Among the information collected on forest inventory plots by the USDA Forest Service Forest Inventory and Analysis Program, attributes characterizing various types of disturbance provide researchers a means of selecting plots specifically affected by disturbances, such as fire. We determine the performance of three of these attributes as indicators of recent fires on forest inventory plots of the United States by comparing them to independent records of wildland fire occurrence. The indicators are plot-level observations of fire effects on (1) general site appearance, (2) tree mortality, and (3) damage to live trees. Independent spatial layers of wildland fire perimeters provide an approach to test indicator performance and identify characteristics of fires that may affect detection. The sensitivities of indicators are generally higher in the West relative to the East. Detection rates exceed 90 percent for the Pacific Coast forests but seldom reach 80 percent in the East. Among the individual indicators, site appearance has higher identification rates than tree indicators for fires in the Pacific Coast, Great Plains, North, and South regions. Tree mortality is the most important single indicator for identifying Rocky Mountain fires. Tree damage is more important than tree mortality in the South; otherwise, the tree damage indicator is of relatively lower importance, particularly where high-severity fires are common, and tree survival is low. The rate of detection by the indicators is affected by the severity of the fire or the recency of the fire. The joint effect of severity and recency influence all three indicators for the Pacific Coast and Rocky Mountain fires, as well as the site appearance indicator in the South. Only a small proportion of fires are clearly missed by all three of the indicators.

Ultra-high-molecular-weight polyethylene (UHMWPE) components for orthopedic implants have historically been integrated into metal backings by direct-compression molding (DCM). However, metal backings are costly, stiffer than cortical bone, and may be associated with medical imaging distortion and metal release. Hybrid-manufactured DCM UHMWPE overmolded additively manufactured polyetheretherketone (PEEK) structural components could offer an alternative solution, but are yet to be explored. In this study, five different porous topologies (grid, triangular, honeycomb, octahedral, and gyroid) and three surface feature sizes (low, medium, and high) were implemented into the top surface of digital cylindrical specimens prior to being 3D printed in PEEK and then overmolded with UHMWPE. Separation forces were recorded as 1.97–3.86 kN, therefore matching and bettering the historical industry values (2–3 kN) recorded for DCM UHMWPE metal components. Infill topology affected failure mechanism (Type 1 or 2) and obtained separation forces, with shapes having greater sidewall numbers (honeycomb-60%) and interconnectivity (gyroid-30%) through their builds, tolerating higher transmitted forces. Surface feature size also had an impact on applied load, whereby those with low infill-%s generally recorded lower levels of performance vs. medium and high infill strategies. These preliminary findings suggest that hybrid-manufactured structural composites could replace metal backings and produce orthopedic implants with high-performing polymer–polymer interfaces.

Abstract Introduction Modafinil and methylphenidate are used off‐prescription for cognitive enhancement in healthy individuals. Such use is often reported in online surveys but it is unclear whether drug use for cognitive enhancement is motivated by perceived poor cognitive performance or a desire to improve good cognitive performance. The current study investigated whether off‐prescription users of modafinil and methylphenidate differed in their self‐perceived cognitive performance from people who do not take these drugs. Method An online survey targeting forum sites assessed self‐perceived cognitive function via the Adult Attention Deficit/Hyperactivity Disorder Self‐Report Scale, the Cognitive Failures Questionnaire, and the General Procrastination Scale. Results There were 249 respondents, of whom 43% reported no use of modafinil and methylphenidate (the control group) and 58% reported use of one or both drugs without a prescription for cognitive enhancement. This created an independent samples design with three groups. On both the Adult Attention Deficit/ Hyperactivity Disorder Self‐Report Scale and General Procrastination Scale, modafinil and methylphenidate users reported higher scores than the control group, indicating higher levels of perceived inattention and procrastination. Scores on the Cognitive Failures Questionnaire indicated that modafinil and methylphenidate users rated themselves as having fewer cognitive failures than controls. Conclusion These findings suggest that at least some reported off‐prescription users of modafinil and methylphenidate may be seeking to reduce the impact of self‐perceived poorer performance, particularly in forms of cognition that are likely to impact on self‐directed or self‐motivated work.

Online mental health interventions have received attention for their potential to bypass barriers that stop men from seeking mental health help from a health professional. However, emerging data suggest that men's use of online mental health interventions is low, and when used, early attrition is common. In this commentary, we hypothesise that men's common lack of engagement with online mental health interventions may reflect limited attention being paid to the needs and preferences of potential users during their development. We outline a series of considerations that we believe are important to advance the development of acceptable, effective online mental health interventions for men: (1) men's diverse and intersecting characteristics, circumstances, and needs; (2) centring positive, progressive masculinities; and (3) listening to, learning from, and working in partnership with men to develop interventions. We also examine how existing online mental health interventions targeting men have engaged with these considerations. Keywords: men, male, mental health, e-mental health, digital health, online interventions.

Summary: Perlecan (HSPG2), a heparan sulfate proteoglycan similar to agrin, is key for extracellular matrix (ECM) maturation and stabilization. Although crucial for cardiac development, its role remains elusive. We show that perlecan expression increases as cardiomyocytes mature in vivo and during human pluripotent stem cell differentiation to cardiomyocytes (hPSC-CMs). Perlecan-haploinsuffient hPSCs (HSPG2+/−) differentiate efficiently, but late-stage CMs have structural, contractile, metabolic, and ECM gene dysregulation. In keeping with this, late-stage HSPG2+/− hPSC-CMs have immature features, including reduced ⍺-actinin expression and increased glycolytic metabolism and proliferation. Moreover, perlecan-haploinsuffient engineered heart tissues have reduced tissue thickness and force generation. Conversely, hPSC-CMs grown on a perlecan-peptide substrate are enlarged and display increased nucleation, typical of hypertrophic growth. Together, perlecan appears to play the opposite role of agrin, promoting cellular maturation rather than hyperplasia and proliferation. Perlecan signaling is likely mediated via its binding to the dystroglycan complex. Targeting perlecan-dependent signaling may help reverse the phenotypic switch common to heart failure.

Importance The study summarises the selection prescreen criteria currently used in the UK for a uterus transplant and highlights the number of women who are suitable to proceed.Objectives To assess the demographics, motivations, reasons and suitability among women with absolute uterine factor infertility (AUFI) to undergo uterine transplantation (UTx).Design A cross-sectional survey.Setting An electronic questionnaire was sent via email to women with AUFI who had previously been referred to the UTx research team or approached the Womb Transplant UK Charity. The questions assessed suitability to undergo UTx based on demographic information, perceptions to adoption and surrogacy and reasons why UTx was preferable. Responses were assessed against the study selection criteria.Participants Women with AUFI.Results 210 women completed the questionnaire. The most common aetiology of AUFI in our cohort was Mayer-Rokitansky-Küster-Hauser (68%; n=143) whereas 29% (n=62) had previously undergone hysterectomy. 63% (n=132) of the cohort had previously considered adoption, 5% (n=11) had attempted it and 2 (1%) had successfully adopted. The most common reason cited to undergo UTx over adoption was to experience gestation (n=63; 53%), while 37% (n=44) wanted a biologically related child. 76% (n=160) of participants had previously considered surrogacy, 22 (10%) had attempted it and 2 (1%) had successfully become mothers using a surrogate. The most common reason to undergo UTx over surrogacy was to experience gestation (n=77; 54%). 15% (n=21) were concerned about the legal implications, 14% (n=20) identified the financial cost as a barrier and 8% (n=12) could not consider it due to religious reasons. On adhering to the selection criteria, 65 (31%) women were suitable to proceed with the trial.Conclusion The study demonstrates that implementing commonly used selection criteria for a UTx led to an attrition rate of more than two-thirds of women who requested to initially undergo the process. As more studies present outcomes following UTx, critical assessment of the selection criteria currently used is warranted to ensure potential recipients are not being unnecessarily excluded.Trial registration number NCT02388802.

Background: This study addresses optimising fleet size in a system with a heterogeneous truck fleet, aiming to minimise transportation costs in interfacility material transfer operations. Methods: The material transfer process is modelled using a closed queueing network (CQN) that considers heterogeneous nodes and customised service times tailored to the unique characteristics of various truck types and their transported materials. The optimisation problem is formulated as a mixed-integer nonlinear programming (MINLP), falling into the NP-Hard, making exact solution computation challenging. A numerical approximation method, a modified sequential quadratic programming (SQP) method coupled with a mean value analysis (MVA) algorithm, is employed to overcome this challenge. Validation is conducted using a discrete event simulation (DES) model. Results: The proposed analytical model tested within a steel manufacturing plant’s material transfer process. The results showed that the analytical model achieved comparable optimisation of the heterogeneous truck fleet size with significantly reduced response times compared to the simulation method. Furthermore, evaluating performance metrics, encompassing response time, utilisation rate, and cycle time, revealed minimal discrepancies between the analytical and the simulation results, approximately ±8%, ±8%, and ±7%, respectively. Conclusions: These findings affirm the presented analytical approach’s robustness in optimising interfacility material transfer operations with heterogeneous truck fleets, demonstrating real-world applications.

Bumble bees are important pollinators for a great diversity of wild and cultivated plants, and in many parts of the world certain species have been found to be in decline, gone locally extinct, or even globally extinct. A large number of symbionts live on, in, or with these social bees. We give an overview of what is known about bumble bee ecto-symbionts and parasitoids. We provide information on assessment of risks posed by select bumble bee symbionts and methods for their detection, quantification, and control. In addition, we assess honey bee hive products such as pollen and wax that are used in commercial bumble bee production, and highlight key risks and knowledge gaps. Knowledge of these potential threats to native pollinators is important and they need to be managed in the context of national and international commercial trade in bumble bees to prevent pest introduction and pathogen spillover that can threaten native bees.

Platelet-rich plasma is an autologous plasma containing platelets prepared from fresh whole blood drawn from a peripheral vein. Through processing, it can be prepared to contain supraphysiologic levels of platelets at three to five times greater than the level of normal plasma. PRP has been explored both in vivo and ex vivo in the human endometrium model in its ability to harness the intrinsic regenerative capacity of the endometrium. Intrauterine autologous PRP infusions have been shown to increase endometrial thickness and reduce the rate of intrauterine adhesions. In the setting of recurrent implantation failure, intrauterine infusion of PRP has been shown to increase clinical pregnancy rate. PRP also appears to hold a potential role in select patients with premature ovarian insufficiency, poor ovarian responders and in improving outcomes following frozen–thawed transplantation of autologous ovarian tissue. Further studies are required to explore the potential role of PRP in reproductive medicine further, to help standardise PRP protocols and evaluate which routes of administration are most effective.

Exploratory field expeditions to the Chocó forests in the northwestern slopes of the Ecuadorian and Colombian Andes resulted in the discovery of two new species of Columnea (Gesneriaceae). Columnea fluidifolia J.L.Clark & F.Tobar, sp. nov., is described as a narrow endemic from Bosque Protector Mashpi and surrounding areas in the province of Pichincha in northern Ecuador. Columnea pendens F.Tobar, J.L.Clark & J.F.Sm., sp. nov., is described from recently discovered populations in the provinces of Carchi and Santo Domingo de los Tsáchilas (Ecuador) and the departments of Cauca and Nariño in southwestern Colombia. The two new species are pendent epiphytes with elongate shoots and shallowly bilabiate to nearly tubular corollas. Descriptions, complete specimen citations, and a distribution map are provided. Based on IUCN guidelines, a preliminary conservation status of Critically Endangered (CR) is provided for C. fluidifolia and Endangered (EN) is provided for C. pendens.

Pancreatic ductal adenocarcinoma (PDAC) has a very poor survival. The intra-tumoural microbiome can influence pancreatic tumourigenesis and chemoresistance and, therefore, patient survival. The role played by bile microbiota in PDAC is unknown. We aimed to define bile microbiome signatures that can effectively distinguish malignant from benign tumours in patients presenting with obstructive jaundice caused by benign and malignant pancreaticobiliary disease. Prospective bile samples were obtained from 31 patients who underwent either Endoscopic Retrograde Cholangiopancreatography (ERCP) or Percutaneous Transhepatic Cholangiogram (PTC). Variable regions (V3–V4) of the 16S rRNA genes of microorganisms present in the samples were amplified by Polymerase Chain Reaction (PCR) and sequenced. The cohort consisted of 12 PDAC, 10 choledocholithiasis, seven gallstone pancreatitis and two primary sclerosing cholangitis patients. Using the 16S rRNA method, we identified a total of 135 genera from 29 individuals (12 PDAC and 17 benign). The bile microbial beta diversity significantly differed between patients with PDAC vs. benign disease (Permanova p = 0.0173). The separation of PDAC from benign samples is clearly seen through unsupervised clustering of Aitchison distance. We found three genera to be of significantly lower abundance among PDAC samples vs. benign, adjusting for false discovery rate (FDR). These were Escherichia (FDR = 0.002) and two unclassified genera, one from Proteobacteria (FDR = 0.002) and one from Enterobacteriaceae (FDR = 0.011). In the same samples, the genus Streptococcus (FDR = 0.033) was found to be of increased abundance in the PDAC group. We show that patients with obstructive jaundice caused by PDAC have an altered microbiome composition in the bile compared to those with benign disease. These bile-based microbes could be developed into potential diagnostic and prognostic biomarkers for PDAC and warrant further investigation.