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This article seeks to address the need for research supporting localization efforts in placement assessment. We argue that as a highly technical communication endeavor, directed self-placement (DSP) and its developers can benefit from research in technical and professional communication (TPC). We synthesize the theoretical relations between DSP and TPC, especially regarding models of localization, and demonstrate how implementing user experience (UX) design can help address placement equity concerns by foregrounding accessibility and usability from the beginning. We follow this discussion of DSP and TPC scholarship with storied examples from our institution, providing a sample range of UX methods that (1) are flexible across contexts, (2) are relatively manageable to implement, and (3) are cognizant of WPA, staff, and students’ time, labor, and compensation concerns. We propose DSP as a form of advocacy, and we demonstrate how UX method/ologies are an excellent choice for DSP localization efforts toward equity and accessibility.

BackgroundEvaluation and interpretation of the literature on obstructive sleep apnea (OSA) allows for consolidation and determination of the key factors important for clinical management of the adult OSA patient. Toward this goal, an international collaborative of multidisciplinary experts in sleep apnea evaluation and treatment have produced the International Consensus statement on Obstructive Sleep Apnea (ICS:OSA).MethodsUsing previously defined methodology, focal topics in OSA were assigned as literature review (LR), evidence-based review (EBR), or evidence-based review with recommendations (EBR-R) formats. Each topic incorporated the available and relevant evidence which was summarized and graded on study quality. Each topic and section underwent iterative review and the ICS:OSA was created and reviewed by all authors for consensus.ResultsThe ICS:OSA addresses OSA syndrome definitions, pathophysiology, epidemiology, risk factors for disease, screening methods, diagnostic testing types, multiple treatment modalities, and effects of OSA treatment on multiple OSA-associated comorbidities. Specific focus on outcomes with positive airway pressure (PAP) and surgical treatments were evaluated.ConclusionThis review of the literature consolidates the available knowledge and identifies the limitations of the current evidence on OSA. This effort aims to create a resource for OSA evidence-based practice and identify future research needs. Knowledge gaps and research opportunities include improving the metrics of OSA disease, determining the optimal OSA screening paradigms, developing strategies for PAP adherence and longitudinal care, enhancing selection of PAP alternatives and surgery, understanding health risk outcomes, and translating evidence into individualized approaches to therapy.

BACKGROUND: Similar to many resource-constrained urban settings, cesarean deliveries in Dar es Salaam, Tanzania, have increased rapidly, from 17% in 2015 to 26% in 2022. Alarmingly, at the population level, the increase was not followed by improvements in perinatal outcomes, suggesting the overuse of cesarean delivery. Prolonged labor is the leading cause of women's first cesarean delivery. Therefore, understanding the management of prolonged labor preceding cesarean delivery is crucial for preventing nonmedically indicated cesarean deliveries across Tanzania and globally. OBJECTIVE: This study aimed to estimate the proportion of cesarean deliveries with a written indication of prolonged labor that was performed in labors with uncomplicated progression. STUDY DESIGN: This study was conducted at 5 urban maternity units in Dar es Salaam, Tanzania, from October 1, 2021, to August 31, 2022. Data were extracted from case files of women who gave birth via cesarean delivery with a written indication of prolonged labor. The timing of cesarean delivery decision was assessed against predefined definitions of prolonged labor at each stage/phase of labor. The proportion of cesarean deliveries performed in cases of uncomplicated progression was calculated. The exclusion criteria included referral to study sites because of prolonged labor or cervical dilatation of >6 cm upon admission, noncephalic presentation, multiple pregnancy, intrauterine fetal death, failed induction of labor, previous cesarean delivery, or other written indications for cesarean delivery. RESULTS: The overall cesarean delivery rate was 32% (2949/9364). Of first-time cesarean delivery cases, 746 of 1517 patients (47.9%) had a written indication of prolonged labor. Finally, 456 of 746 patients (61.1%) met the inclusion criteria, of which 307 of 456 patients (67.3%) were admitted in the latent phase of labor. In 243 of 456 cesarean deliveries (53.3%) with an indication of prolonged labor, labor was not prolonged. This group included (1) women not being given a trial of labor (78/243 [32.1%]), (2) women in the first stage of active labor not crossing the partograph action line (145/243 [59.7%]), and (3) women in the second stage of labor lasting

Pollen and nectar consumed by honey bees contain plant secondary metabolites (PSMs) with vital roles in plant–insect interactions. While PSMs can be toxic to bees, they can also be health-promoting, e.g. by improving pesticide and pathogen tolerances. As xenobiotics, PSMs undergo post-ingestion chemical modifications that can affect their bioactivity and transmission to the brood. Despite the importance of understanding honey bee PSM metabolism and distribution for elucidating bioactivity mechanisms, these aspects remain largely unexplored. In this study, we used HPLC-MS/MS to profile 47 pollen PSMs in honey bees and larvae. Both adult bees and larvae had distinct PSM profiles that differed from their diet. This is likely due to post-ingestion metabolism and compound-dependent variations in PSM transmission to the brood via nurse bee jelly. Phenolic acids and flavonoid aglycones were most abundant in bees and larvae, whereas alkaloids, cyanogenic glycosides and diterpenoids had the lowest abundance despite being consumed in higher concentrations. This study documents larval exposure to a variety of PSMs for the first time, with concentrations increasing from early to late larval instars. Our findings provide novel insights into the post-ingestion fate of PSMs in honey bees, providing a foundation for further exploration of biotransformation pathways and PSM effects on honey bee health.

Introduction: Currently, there are no non-surgical FDA-approved biological approaches to accelerate fracture repair. Injectable therapies designed to stimulate bone healing represent an exciting alternative to surgically implanted biologics, however, the translation of effective osteoinductive therapies remains challenging due to the need for safe and effective drug delivery. Hydrogel-based microparticle platforms may be a clinically relevant solution to create controlled and localized drug delivery to treat bone fractures. Here, we describe poly (ethylene glycol) dimethacrylate (PEGDMA)-based microparticles, in the shape of microrods, loaded with beta nerve growth factor (β-NGF) for the purpose of promoting fracture repair. Methods: Herein, PEGDMA microrods were fabricated through photolithography. PEGDMA microrods were loaded with β-NGF and in vitro release was examined. Subsequently, bioactivity assays were evaluated in vitro using the TF-1 tyrosine receptor kinase A (Trk-A) expressing cell line. Finally, in vivo studies using our well-established murine tibia fracture model were performed and a single injection of the β-NGF loaded PEGDMA microrods, non-loaded PEGDMA microrods, or soluble β-NGF was administered to assess the extent of fracture healing using Micro-computed tomography (µCT) and histomorphometry. Results: In vitro release studies showed there is significant retention of protein within the polymer matrix over 168 hours through physiochemical interactions. Bioactivity of protein post-loading was confirmed with the TF-1 cell line. In vivo studies using our murine tibia fracture model show that PEGDMA microrods injected at the site of fracture remained adjacent to the callus for over 7 days. Importantly, a single injection of β-NGF loaded PEGDMA microrods resulted in improved fracture healing as indicated by a significant increase in the percent bone in the fracture callus, trabecular connective density, and bone mineral density relative to soluble β-NGF control indicating improved drug retention within the tissue. The concomitant decrease in cartilage fraction supports our prior work showing that β-NGF promotes endochondral conversion of cartilage to bone to accelerate healing. Discussion: We demonstrate a novel and translational method wherein β-NGF can be encapsulated within PEGDMA microrods for local delivery and that β-NGF bioactivity is maintained resulting in improved bone fracture repair.

Abstract Background Little is known about factors that influence footwear selection by field hockey players. Methods An online survey was used to collect data on participant demographics and physical characteristics, factors influencing footwear selection, perceptions regarding footwear design features on injury and performance, and experiences regarding usability. Nominal and ordinal data were described as absolute frequencies and relative frequencies. Free text responses were analysed using content analysis. Sex‐related differences in quantitative and qualitative data were explored. Results A total of 401 hockey players completed the survey. Participants reported that fit, comfort, support, and cushioning were the most important factors when selecting hockey footwear. Most hockey players believed that stud design could influence athletic performance (65%) and injury risk (63%) but reported having no preference on outsole design or stud shape. Most participants (63%) used hockey‐specific footwear, but 46% of female hockey players did not, with 40% using trail running footwear instead. Qualitative analysis revealed that hockey players, particularly female participants, encounter difficulties finding properly fitting footwear. They desire more options for wide or narrow feet and face challenges in accessing suitable hockey shoes due to limited choices and availability. Conclusions With over a third of field hockey players not using hockey‐specific footwear, future research should attempt to understand the reasons and assess the impact of different footwear features on comfort, performance, injury risk, and usability.

Abstract Nighttime smartphone use is associated with sleep problems, which in turn have a bidirectional association with overweight. We aim to investigate whether nighttime smartphone use and sleep are related to overweight and metabolic dysfunction in adult populations. We used data from three population samples (aged 16–89) from the SmartSleep Study, which included survey data (N = 29,838), high-resolution tracking data (N = 3446), follow-up data (N = 1768), and cardiometabolic risk markers (N = 242). Frequent self-reported nighttime smartphone use was associated with 51% higher odds (95% CI: 1.32; 1.70) of overweight compared with no use. Tracked nighttime smartphone use was also associated with overweight. Similar results were found for obesity as an outcome. No consistent associations were found between nighttime smartphone use and cardiometabolic risk markers in a small subsample of healthy young women. Poor sleep quality (vs. good sleep quality) was associated with overweight (OR = 1.19, 85% CI: 1.10; 1.28). Overall, frequent nighttime smartphone use was consistently associated with overweight and a higher BMI across diverse population samples. The bidirectional interplay between nighttime smartphone use, sleep, and overweight may create a vicious circle of metabolic dysfunction over time. Therefore, nighttime smartphone use may be a potential target point for public health interventions to reduce overweight at the population level.

Although current stem cell therapies exhibit promising potential, the extended process of employing autologous cells and the necessity for donor–host matching to avert the rejection of transplanted cells significantly limit the widespread applicability of these treatments. It would be highly advantageous to generate a pluripotent universal donor stem cell line that is immune-evasive and, therefore, not restricted by the individual’s immune system, enabling unlimited application within cell replacement therapies. Before such immune-evasive stem cells can be moved forward to clinical trials, in vivo testing via transplantation experiments in immune-competent animals would be a favorable approach preceding preclinical testing. By using human stem cells in immune competent animals, results will be more translatable to a clinical setting, as no parts of the immune system have been altered, although in a xenogeneic setting. In this way, immune evasiveness, cell survival, and unwanted proliferative effects can be assessed before clinical trials in humans. The current study presents the generation and characterization of three human embryonic stem cell lines (hESCs) for xenogeneic transplantation in immune-competent mice. The major histocompatibility complexes I- and II-encoding genes, B2M and CIITA, have been deleted from the hESCs using CRISPR-Cas9-targeted gene replacement strategies and knockout. B2M was knocked out by the insertion of murine CD47. Human-secreted embryonic alkaline phosphatase (hSEAP) was inserted in a safe harbor site to track cells in vivo. The edited hESCs maintained their pluripotency, karyotypic normality, and stable expression of murine CD47 and hSEAP in vitro. In vivo transplantation of hESCs into immune-competent BALB/c mice was successfully monitored by measuring hSEAP in blood samples. Nevertheless, transplantation of immune-evasive hESCs resulted in complete rejection within 11 days, with clear immune infiltration of T-cells on day 8. Our results reveal that knockout of B2M and CIITA together with species-specific expression of CD47 are insufficient to prevent rejection in an immune-competent and xenogeneic context.

Objective: To evaluate a ring wearable’s accuracy in the measurement of oxyhemoglobin saturation measured by pulse oximeter (SpO2) compared to a simultaneous SaO2 obtained from arterial blood gases (ABGs) because oximeters may overestimate oxyhemoglobin saturation in darkly pigmented individuals resulting in occult hypoxemia. Patients and Methods: Circul+ (Bodimetrics), with a form factor of a ring, measures several variables for cardiorespiratory assessment (SpO2, movement, and heart rate). The design ensures that measurements are made on the palmar surface of the digit, where there is generally less pigment. Twenty-four healthy participants (8 Black, 16 non-Black) had catheters inserted into their radial arteries during the timeframe between August 2020 and January 2022. They were administered nitrogen-rich air that made them hypoxic in steps to an SaO2 of 70%. ABGs was sampled at various levels of hypoxia, and simultaneous readings were obtained from the Circul+. We compared SpO2 from Circul with measurement of ABGs by a medical grade blood gas analyzer. Results: There was excellent correlation between SaO2 measured by the ring oximeter and ABGs in both Black (y = 1.0174x − 1.573; R2 = 0.9414) and Non-Black (y = 1.0209x − 2.5607; R2 = 0.9207) participants. No differences were found in comparing the intercept and slopes of the regressions. At ABG of 70% and 100%, the SaO2 measured by the ring was calculated to be 69.6% and 100.2% for the Black participants and 68.9% and 99.5% for the non-Black participants. Bland-Altman analysis found a bias (deviation from the mean) of 0.0 for the Black participants and −0.7% for the non-Black participants. Conclusion: Results from this study confirmed that Circul+ oximetry accuracy seems to be independent of skin tone, perhaps because measurements are made on the palmar surface of the digit, where there is generally less pigment.

Abstract For people who have experienced psychological trauma, distressing experiences like being notified of exposure to an infectious disease, may trigger a trauma response, a natural, often unconscious, emotional reaction. Disease investigation specialists (DIS), including contact tracers and case investigators, may encounter clients who exhibit trauma responses during outreach calls. In this paper, we describe a novel approach to these calls that combines two evidence‐based approaches: trauma‐informed care and health coaching. These two approaches are put into practice using the HEAR technique, which uses the four steps of Hear, Express Gratitude, Ask, and Respond, to engage with emotionally triggered clients. We provide a series of case vignettes and practical examples of how disease investigation specialists can use the HEAR technique to support clients who may be experiencing trauma. Equipped with this approach, DIS can better engage with the public around existing and emerging infectious diseases, thereby improving both individual health outcomes and public health more broadly.

The use of technology in higher education science classrooms rose significantly in the advent of the COVID-19 pandemic. In many universities, academic programs including introductory physics classes were taken online. Some institutions adopted online learning but also maintained face-to-face (F2F) laboratories when COVID-19 restrictions began to ease. Here, the effectiveness of the online learning approach in comparison with F2F learning is explored. The percentage difference in performance for students who took the online introductory physics course, "Physics for Scientists and Engineers," versus that of students simultaneously taking the same course F2F is reported. This is done both across different sections taught by different instructors, and for the same course taught online versus F2F by the same professor. Furthermore, a short survey was conducted to assess the student learning experience and opinion about online and F2F learning. The results show equal or better overall performance for online learning with 4.2% higher performance when comparing results across different sections taught by different instructors. A similar 6.1% performance improvement was seen when comparing results across different sections taught by the same instructor. In contrast with the performance outcomes, the survey results indicate that about 72% of students prefer F2F compared to online learning. The findings provide a useful reference as many institutions and programs transition back to more standard F2F or hybrid learning modes. The benefits and drawbacks of each mode are discussed in the specific context of student preferences and challenges faced in online learning during COVID-19.

Purpose The SmartSleep Study is established to comprehensively assess the impact of night-time smartphone use on sleep patterns and health. An innovative combination of large-scale repeated survey information, high-resolution sensor-driven smartphone data, in-depth clinical examination and registry linkage allows for detailed investigations into multisystem physiological dysregulation and long-term health consequences associated with night-time smartphone use and sleep impairment.Participants The SmartSleep Study consists of three interconnected data samples, which combined include 30 673 individuals with information on smartphone use, sleep and health. Subsamples of the study population also include high-resolution tracking data (n=5927) collected via a customised app and deep clinical phenotypical data (n=245). A total of 7208 participants are followed in nationwide health registries with full data coverage and long-term follow-up.Findings to date We highlight previous findings on the relation between smartphone use and sleep in the SmartSleep Study, and we evaluate the interventional potential of the citizen science approach used in one of the data samples. We also present new results from an analysis in which we use 803 000 data points from the high-resolution tracking data to identify clusters of temporal trajectories of night-time smartphone use that characterise distinct use patterns. Based on these objective tracking data, we characterise four clusters of night-time smartphone use.Future plans The unprecedented size and coverage of the SmartSleep Study allow for a comprehensive documentation of smartphone activity during the entire sleep span. The study has been expanded by linkage to nationwide registers, which allow for further investigations into the long-term health and social consequences of night-time smartphone use. We also plan new rounds of data collection in the coming years.

This article explores how labor-based grading contract (LBGC) systems can be informed by neurodivergence. To date, little research has described how grading contracts impact students of varying neurological abilities. This article addresses this gap by investigating how neurodivergent students experience LBGC systems. Neurodivergent students face increased academic and emotional labor, thus shifting power and ease of access in such contract-grading classrooms to neurotypical students who may be more adept at "performing" academic labor. First, we articulate the ways in which neurodivergence is defined and made invisible, how it manifests in our writing classrooms, and the ways in which our institutions uphold normative conceptions of neurological ability. Second, we illuminate how grading contracts, by altering the activity systems of schooling and writing classrooms, create barriers to accessibility that heighten neurodivergent students' experiences of schooling- and grade-related anxiety. Finally, they offer an ethnographic exploration of ways to unite the socially just aims of LBGC systems with the intersectional lens inherent in a consideration of the neurodivergent student experience. Keywords: neurodivergence, grading contracts, academic labor, assessment theory, disability studies

Abstract Background Understanding common MRI findings may allow clinicians to appreciate the sport-specific effects on the lumbar spine, and to discern clinically significant pathology. Prevalence data regarding radiological abnormalities seen during the surveillance of asymptomatic elite footballers is, therefore, important to help understand injury mechanisms and to prevent associated injuries. The purpose of this study was to evaluate the magnetic resonance imaging (MRI) findings in the lumbar spines of asymptomatic elite male adolescent footballers. Methods A prospective case-series study was carried out. MRI was performed using a 3T Siemens Prisma scanner including a 3D VIBE sequence in 18 asymptomatic male elite adolescent footballers recruited from a professional academy in England (mean age 17.8, range 16.9–18.6 years). The images were independently reported by two consultant musculoskeletal radiologists to achieve consensus opinion. Standardised classification criteria were used to assess and report abnormalities descriptively. Results Fifteen players (15/18, 83%) showed ≥1 abnormalities, included facet degeneration, synovial cysts, disc degeneration, disc herniation, and pars injury. One player (1/18, 6%) had mild (Grade 1) facet joint arthropathy at L4/L5 and 3/18 (16.7%) showing evidence of bilateral facet joint effusions. Three synovial cysts were identified in 2/18 players (11%), 4/18 players (22%) presented asymptomatic pars injuries, with 4 showing a grade 2 subtotal stress fracture and 1 player a grade 4 chronic stress fracture seen on 3D VIBE sequencing. Disc degeneration at one or more levels was demonstrated in 7/18 players (38%). Disc herniation was present in 5/18 players (27%). Conclusion A range of unsuspected findings on MRI of the lumbar spine are common in elite adolescent footballers.

This article explores understandings of professional identity among newly started students at the Public Administration Bachelor-education at a Danish University College and analyzes tensions linked to these. Based on data from focus group interviews and ‘study start tests’ the article focuses on perceived advantages and disadvantages of initiating an education with short history, low public visibility, but also great flexibility in relation to potential career paths. Based on Kåre Heggen's theoretical work, the analysis highlights the distinction between an internal and an external view of the education as crucial for understanding the students’ statements. A key observation is that the students generally consider flexibility in relation to future career paths to be a strength, but at the same time miss the external recognition associated with more established professions. The article thereby shows how many new students, on the one hand, request the legitimacy linked to clear professional images, but on the other hand, highlight their appreciation of the flexibility and open-ended nature of this particular education. It thus points to a central, but also difficult, challenge with relevance across a wide range of University College educations: How to balance a strong collective identity with the needs of individualization and flexibility?

Rui Zhao,1 Jianbo Xue,1 Xueli Zhang,1 Maohuan Peng,1 Jing Li,1 Bing Zhou,1 Long Zhao,1 Thomas Penzel,2 Meir Kryger,3 Xiao Song Dong,1 Zhancheng Gao,1 Fang Han1 1Department of Pulmonary and Critical Care Medicine, Peking University People’s Hospital, Beijing, People’s Republic of China; 2Sleep Medicine Center, Charité-Universitätsmedizin, Berlin, Germany; 3Division of Pulmonary, Critical Care and Sleep Medicine, Yale School of Medicine, New Haven, CT, USACorrespondence: Xiao Song Dong; Zhancheng Gao, Department of Pulmonary and Critical Care Medicine, Peking University People’s Hospital, No. 11 Xizhimen Nandajie, Xicheng District, Beijing, 100044, People’s Republic of China, Email dongxiaosong@pkuph.edu.cn; zcgao@bjmu.edu.cnObjective: A novel ring-worn oximeter (Circul) uses reflective photoplethysmography and automated signal processing to calculate oxygen desaturations. We evaluated the ability of Circul to detect obstructive sleep apnea in Chinese adults.Methods: We recruited 207 Chinese Han subjects: 70% males, mean age 48.2± 14.7 years, mean BMI 27.6± 4.8 kg/m2 and mean AHI 28.6± 25.2 events/h. All participants underwent simultaneous polysomnography (PSG) and Circul testing in a sleep laboratory. Oxygen desaturation index (ODI), mean oxygen saturation (MSpO2), cumulative time at SpO2< 90% (CT90), cumulative percentage of sleep time spent with SpO2< 90% (CT90/TST) were derived and compared for the Circul and the PSG.Results: The ODI was 25.3± 24.5 events/h using PSG and 22.2± 24.5 events/h using Circul (P< 0.0001), with an intraclass correlation coefficient (ICC) of 0.884. CT90 and CT90/TST between the two methods were not different; the MSpO2 level calculated by PSG was slightly lower than Circul, 95.0% (93.0– 96.0%) vs 95.3% (93.9– 96.6%), P< 0.0001. Circul-ODI had a good correlation (r=0.91, p< 0.0001) and close agreement with PSG-AHI (Bland-Altman analysis: Mean Difference 6.4, 95% CI − 14.8 to 27.5 events/h). Using a threshold of AHI ≥ 5 events/h, the Circul had 87% sensitivity, 83% specificity, 5.09 positive likelihood ratio (LR+), 86% accuracy, and 0.929 area under the curve (AUC).Conclusion: Circul ring pulse oximetry can detect OSA with reasonable reliability. The Circul system is a reliable and comfortable choice for OSA assessment.Keywords: obstructive sleep apnea, reflective photoplethysmography, pulse oximetry, polysomnography

Introduction: Currently, there are no non-surgical FDA-approved biological approaches to accelerate fracture repair. Injectable therapies designed to stimulate bone healing represent an exciting alternative to surgically implanted biologics, however, the translation of effective osteoinductive therapies remains challenging due to the need for safe and effective drug delivery. Hydrogel-based microparticle platforms may be a clinically relevant solution to create controlled and localized drug delivery to treat bone fractures. Here, we describe poly (ethylene glycol) dimethacrylate (PEGDMA)-based microparticles, in the shape of microrods, loaded with beta nerve growth factor (β-NGF) for the purpose of promoting fracture repair.Methods: Herein, PEGDMA microrods were fabricated through photolithography. PEGDMA microrods were loaded with β-NGF and in vitro release was examined. Subsequently, bioactivity assays were evaluated in vitro using the TF-1 tyrosine receptor kinase A (Trk-A) expressing cell line. Finally, in vivo studies using our well-established murine tibia fracture model were performed and a single injection of the β-NGF loaded PEGDMA microrods, non-loaded PEGDMA microrods, or soluble β-NGF was administered to assess the extent of fracture healing using Micro-computed tomography (µCT) and histomorphometry.Results:In vitro release studies showed there is significant retention of protein within the polymer matrix over 168 hours through physiochemical interactions. Bioactivity of protein post-loading was confirmed with the TF-1 cell line. In vivo studies using our murine tibia fracture model show that PEGDMA microrods injected at the site of fracture remained adjacent to the callus for over 7 days. Importantly, a single injection of β-NGF loaded PEGDMA microrods resulted in improved fracture healing as indicated by a significant increase in the percent bone in the fracture callus, trabecular connective density, and bone mineral density relative to soluble β-NGF control indicating improved drug retention within the tissue. The concomitant decrease in cartilage fraction supports our prior work showing that β-NGF promotes endochondral conversion of cartilage to bone to accelerate healing.Discussion: We demonstrate a novel and translational method wherein β-NGF can be encapsulated within PEGDMA microrods for local delivery and that β-NGF bioactivity is maintained resulting in improved bone fracture repair.

Abstract Frequent nighttime smartphone use can disturb healthy sleep patterns and may adversely affect mental health and wellbeing. This study aims at investigating whether nighttime smartphone use increases the risk of poor mental health, i.e. loneliness, depressive symptoms, perceived stress, and low life satisfaction among young adults. High-dimensional tracking data from the Copenhagen Network Study was used to objectively measure nighttime smartphone activity. We recorded more than 250,000 smartphone activities during self-reported sleep periods among 815 young adults (university students, mean age: 21.6 years, males: 77%) over 16 weekdays period. Mental health was measured at baseline using validated measures, and again at follow-up four months later. Associations between nighttime smartphone use and mental health were evaluated at baseline and at follow-up using multiple linear regression adjusting for potential confounding. Nighttime smartphone use was associated with a slightly higher level of perceived stress and depressive symptoms at baseline. For example, participants having 1–3 nights with smartphone use (out of 16 observed nights) had on average a 0.25 higher score (95%CI:0.08;0.41) on the Perceived stress scale ranging from 0 to 10. These differences were small and could not be replicated at follow-up. Contrary to the prevailing hypothesis, nighttime smartphone use is not strongly related to poor mental health, potentially because smartphone use is also a social phenomenon with associated benefits for mental health.

Abstract Background Glycemic variability (GV) has only been sparsely studied in patients with community-acquired pneumonia (CAP). This study aimed to quantify in-hospital GV in CAP patients, including determining the impact of type 2 diabetes mellitus (T2DM) and glucocorticoid (GC) treatment on GV. Methods This is a prospective cohort study of CAP patients (N = 40) with or without T2DM and treated or not with GCs. The primary endpoint was GV measured as glucose standard deviation (SD), coefficient of variation (CV), and postprandial glucose excursions (PPGE) based on continuous glucose monitoring (CGM). Analysis of glucose data was split into daytime and nighttime when possible. Results Patients included had a mean age of 74 (range 55 to 91) years. SD (95%CI) increased by a factor of 1.93 (1.40 to 2.66) and 2.29 (1.38 to 3.81) in patients with T2DM and not treated with GCs during the daytime and the nighttime, respectively (both P

Historically Danish preschool has emphasised play and downplayed curricular planning. Over the last 20 years, there has been heightened emphasis on learning and goal orientation. This article explores the consequential framing of play as result of that shift. This is done first by discussing the changes in policy and discourse in Denmark in particular the introduction of a preschool curriculum in 2004 and the accompanying heightened emphasis on 'learning'. Second, by comparing ethnographic studies from 2000 with a recently completed research project 'Appropriate readiness'. This project focused on children aged 5 years old in preschool and how their parents and pedagogues viewed readiness and how they acted to make children ready for school. This ethnographic study identifies increased emphasis on preparation, but a continued focus on 'the social' child. The historical change in the position of play in preschool is analysed with Bernstein's concepts of pedagogic framing, classification alongside visible and invisible pedagogy. In the closing section, we discuss the latest 2018 Danish preschool curriculum revision and consider to what extent this points to a return to a play-based practice.

Polska Marynarka Wojenna podczas II wojny światowej utraciła bezpośredni kontakt z zapleczem demograficznym, co uwidoczniło się szczególnie mocno z chwilą wprowadzania do służby kolejnych jednostek pływających dzierżawionych od the Royal Navy. Braki kadrowe okazały się szczególnie uciążliwe zwłaszcza na przełomie 1941/1942 r., zaś wyszkolenie nowych specjalistów zajmowało sporo czasu. Owe niesprzyjające okoliczności znajdowały wyraz m.in. w meldunkach dowódców okrętów. Prezentowane materiały źródłowe dokumentują zarówno kłopoty z uzupełnieniem stanów osobowych w ogóle, jak również wskazują na inne dylematy przed jakimi stawali dowódcy okrętów w zakresie szkolenia obsad głównych systemów walki.

While facility births are increasing in many low-resource settings, quality of care often does not follow suit; maternal and perinatal mortality and morbidity remain unacceptably high. Therefore, realistic, context-tailored clinical support is crucially needed to assist birth attendants in resource-constrained realities to provide best possible evidence-based and respectful care. Our pilot study in Zanzibar suggested that co-created clinical practice guidelines (CPGs) and low-dose, high-frequency training (PartoMa intervention) were associated with improved childbirth care and survival. We now aim to modify, implement, and evaluate this multi-faceted intervention in five high-volume, urban maternity units in Dar es Salaam, Tanzania (approximately 60,000 births annually). This PartoMa Scale-up Study will include four main steps: I. Mixed-methods situational analysis exploring factors affecting care; II. Co-created contextual modifications to the pilot CPGs and training, based on step I; III. Implementation and evaluation of the modified intervention; IV. Development of a framework for co-creation of context-specific CPGs and training, of relevance in comparable fields. The implementation and evaluation design is a theory-based, stepped-wedged cluster-randomised trial with embedded qualitative and economic assessments. Women in active labour and their offspring will be followed until discharge to assess provided and experienced care, intra-hospital perinatal deaths, Apgar scores, and caesarean sections that could potentially be avoided. Birth attendants’ perceptions, intervention use and possible associated learning will be analysed. Moreover, as further detailed in the accompanying article, a qualitative in-depth investigation will explore behavioural, biomedical, and structural elements that might interact with non-linear and multiplying effects to shape health providers’ clinical practices. Finally, the incremental cost-effectiveness of co-creating and implementing the PartoMa intervention is calculated. Such real-world scale-up of context-tailored CPGs and training within an existing health system may enable a comprehensive understanding of how impact is achieved or not, and how it may be translated between contexts and sustained. Trial registration number: NCT04685668

The article deals with the ecological assessment of the potential road investment, which is the closure of Piotrowo and Berdychowo streets within the campus of the Poznań University of Technology. The research was carried out on a simulation model of the city of Poznań with the use of the PTV software. Research has shown that the closure of these streets has virtually no impact on city wide emissions. However, the emissions deterioration takes place on a local scale, i.e. in the vicinity of the campus of the Poznań University of Technology and on most of the streets leading to it.

HIGHLIGHTS This special issue explores a key question in the energy transition: how are visions, relationships and practices with emerging technologies gendered, and what does this mean for home relations and energy outcomes? Homes are deeply gendered spaces where labour, care, technology management and household responsibilities are unequally distributed. Yet, as the papers in this special issue reveal, policy and industry visions tend to overlook gendered dynamics associated with these technologies, reflecting a perceived technology neutrality. This oversight puts the energy transition at risk. This special issue reveals how understanding the gender impacts of emerging technologies is crucial for realising energy policy, regulatory and building efficiency aspirations. The collection identifies how technology use, energy consumption and everyday practices in homes reflect gendered differences. Studies from diverse empirical and geographical contexts explore questions of gender in relation to emerging technologies such as energy feedback portals, smart home systems, home efficiency improvements, electric vehicles, solar photovoltaic panels and home batteries. Recommendations are provided for policymakers, and house, technology and program designers, to achieve an equitable energy transition. The collection demonstrates the need for concerted policy and industry attention to gendered dynamics in order to ensure inclusive energy policy and technology development.

Smart home technology (SHT) is becoming more widespread, implemented to enhance convenience as well as energy flexibility and efficiency. Smart heating, lighting, security and entertainment systems are affecting social practices and the use of energy in different ways. This paper explores differences in competences, meanings and forms of knowledge involved in the performance of (gendered) household practices based on two Danish qualitative studies of different user groups: SHT frontrunner households ('n' = 15) and less tech-interested households ('n' = 12). The former had incorporated a broad range of smart technologies, 'e.g'. vacuum cleaners, lighting and entertainment systems, while the latter were primarily engaged with smart heating systems. In the frontrunner households, internal differences in competences and meanings between men and women were more apparent than in households with less tech interest. A clear division between traditional and digital housekeeping is apparent that reinforces gender inequality. Evidence shows the variation in how SHT is part of gendered everyday practices; how SHT changes meanings and competences in practices and induces new ways of performing practices that can involve gendered digital inequality. Thus, it is necessary to consider competences and meanings in everyday practices as well as gendered ideas behind the technology. 'Policy relevance' Strategies and policies for a green transition of the energy systems in Denmark and the European Union include a digitalisation of consumption in households. This transition will induce reconfigurations of everyday practices potentially entailing both digital and gendered inequality. The home has often been a contested space, relating to gender roles, inequality and division of household labour. This paper shows that SHT potentially reinforces gender inequality by creating a gendered gap between digital and traditional housekeeping. To avoid potential reinforcement of gender inequality within the home, SHT promotion and development needs to account for gender differences. Actions by industry would include differences of gendered housekeeping, showing an awareness of varying technology competences and meanings in everyday practices as well as the gendered vision of SHT and its users.

BackgroundPhysical activity (PA) during pregnancy is an effective and safe way to improve maternal health in uncomplicated pregnancies. However, compliance with PA recommendations remains low among pregnant women. ObjectiveThe purpose of this study was to evaluate the effects of offering structured supervised exercise training (EXE) or motivational counseling on PA (MOT) during pregnancy on moderate-to-vigorous intensity physical activity (MVPA) level. Additionally, complementary measures of PA using the Pregnancy Physical Activity Questionnaire (PPAQ) and gold standard doubly labeled water (DLW) technique were investigated. The hypotheses were that both EXE and MOT would increase MVPA in pregnancy compared with standard care (CON) and that EXE would be more effective than MOT. In addition, the association between MVPA and the number of sessions attended was explored. MethodsA randomized controlled trial included 220 healthy, inactive pregnant women with a median gestational age of 12.9 (IQR 9.4-13.9) weeks. A total of 219 women were randomized to CON (45/219), EXE (87/219), or MOT (87/219). The primary outcome was MVPA (minutes per week) from randomization to the 29th gestational week obtained by a wrist-worn commercial activity tracker (Vivosport, Garmin International). PA was measured by the activity tracker throughout pregnancy, PPAQ, and DLW. The primary outcome analysis was performed as an analysis of covariance model adjusting for baseline PA. ResultsThe average MVPA (minutes per week) from randomization to the 29th gestational week was 33 (95% CI 18 to 47) in CON, 50 (95% CI 39 to 60) in EXE, and 40 (95% CI 30 to 51) in MOT. When adjusted for baseline MVPA, participants in EXE performed 20 (95% CI 4 to 36) minutes per week more MVPA than participants in CON (P=.02). MOT was not more effective than CON; EXE and MOT also did not differ. MVPA was positively associated with the number of exercise sessions attended in EXE from randomization to delivery (P=.04). Attendance was higher for online (due to COVID-19 restrictions) compared with physical exercise training (P=.03). Adverse events and serious adverse events did not differ between groups. ConclusionsOffering EXE was more effective than CON to increase MVPA among pregnant women, whereas offering MOT was not. MVPA in the intervention groups did not reach the recommended level in pregnancy. Changing the intervention to online due to COVID-19 restrictions did not affect MVPA level but increased exercise participation. Trial RegistrationClinicalTrials.gov NCT03679130; https://clinicaltrials.gov/ct2/show/NCT03679130 International Registered Report Identifier (IRRID)RR2-10.1136/bmjopen-2020-043671

Objective: To provide a step-by-step presentation of the complete primary repair of bladder exstrophy (CPRE). Design: Video presentation. Setting: Children's Hospital of Philadelphia, within the Multi-Institutional Bladder Exstrophy Collaboration Patient(s): A 3-month-old boy with the bladder exstrophy (BE) undergoing a CPRE after the family provided informed consent. Results: A ten-hour procedure, including a bilateral pelvic osteotomy and epidural catheter placement was completed. There was no intraoperative complication. The child was immobilized with a spica cast for 6 weeks. His bladder was cycled via the suprapubic tube until he could tolerate clamping for 24 h with no evidence of upper tract dilation. Conclusions: Through collaboration, we have significantly refined the CPRE technique for BE repair. We believe that for rare congenital anomalies such as bladder exstrophy, collaboration across institutions increases volume exposure, which in turn, correlates with improved outcomes. We continue to carefully follow treated patients for the long-term to observe these outcomes, and measure the burden of BE on families in terms of stigma, quality of life and psychosocial impacts.

Since children spend a large proportion of their time in institutional settings such as schools, health promotion researchers have identified this as an important setting to promote physical activity (PA). Apart from physical education, PA could be integrated into the school curriculum in other ways. Therefore, the aim of this study was to examine whether a school excursion to a museum can increase primary school students' PA and reduce sedentary time. One hundred and ten primary school students aged 12-13, from three Danish schools, wore accelerometers for four consecutive days, of which one consisted of an excursion day to a museum. While an increase in light physical activity and reduction in the amount of sedentary time was observed, students did not spend more time in moderate to vigorous PA (MVPA) during the visit to the museum than on a regular school day. However, over the full excursion day, the students accumulated more MVPA. One school used active transportation to and from the museum, which contributed to significantly more MVPA compared to the other schools. An excursion to a museum significantly reduced sedentary time, but was in itself not sufficient to increase MVPA.