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This study examined the social networks of 26 postsecondary students with mobility and sensory disabilities regarding their perceptions of career preparation and career choice confidence. Social networks have been shown to contribute to postsecondary students' academic success and establishing a successful career for those with and without disabilities. This study examined the social capital resulting from social networks consisting of parents, family, friends, acquaintances (e.g., teachers, counselors, advisors), and interest groups or hobbies. Participants rated their perceptions of career preparation and career choice confidence twice during the study: once in the early weeks of a summer employment internship and after a career-focused presentation and internship completion. Measures of career preparation included self-rated abilities in (a) finding a job, (b) interviewing successfully, (c) keeping a job, and (d) resolving career accommodation challenges. Results showed that social capital contributed significantly to perceptions of career preparation. Career choice confidence remained stable suggesting satisfaction with their choice. A path analysis examined both career variables in conjunction with demographic factors, finding that social capital increased with age. Analyses suggested a number of other relationships between social capital, career perceptions, and demographic variables indicating complexities that warrant additional research.

This study explored online mentoring dialogues of first-year science teachers (FYSTs) to construct a model that was informed by metaphors in teaching dilemmas. Nine teachers' yearlong threaded dialogues were archived and first analyzed by Windschitl's (2002) four dilemma categories, and later by Lakoff and Johnson's (2003) conceptual metaphor theory. Particularly, we charted conceptual metaphor systems and schematic elements of FYSTs' teaching practices in conceptual, pedagogical, cultural, and political dilemma categories using computer-mediated discourse analysis. Findings indicated that the FYSTs' mentoring dialogues were predominantly pedagogical dilemmas (64.34%), mostly related to mastering the art of facilitation. The conceptual metaphors and schematic elements include (a) "Teaching is a trip" within a path schema, (b) "Teaching is a race" within an up-down and more-less visual field schema, (c) "Teaching is policing" within a sanctioned land schema, and (d) "Teaching is building a house" within a construction site schema. This study contributes to the understanding of challenging factors that FYSTs encounter and also illustrates the functionality of the conceptual metaphors for teacher effectiveness.

Knowing how science teachers develop their professional knowledge has been a challenge. One potential way to determine the professional knowledge of teachers is through videos. In the study described here, the authors recruited 60 elementary and secondary science teachers, showed them one of two 10-min videos, and recorded and analyzed their comments when watching the videos. The coding focused on their noticing of student learning, teacher's teaching, types of teaching practices, and the use of interpretative frames. The noticing data were collected and analyzed to determine the differences between groups of teachers. The findings from the analysis indicated that most science teachers noticed the instruction of teachers rather than the learning of students, and these noticing events were often focused on general instructional practices as opposed to the science practices emphasized in the "Next Generation Science Standards" (National Research Council, 2013). The only difference between the teachers was in the area of evaluating the videos. Secondary science teachers and experienced elementary teachers were more likely to evaluate the videos than were novice elementary teachers. This may be a result of the knowledge base of the teachers. These results suggest a need for explicit reform-based instruction and a revision of this research process.

Abstract Background Healthcare fragmentation and lack of care coordination are longstanding problems in cancer care. This study’s goal was to provide in-depth understanding of how the organization and fragmentation of healthcare impacts the experiences of patients with advanced cancer and their families, especially near the end-of-life. Methods This mixed-methods quality improvement study took place at a large multi-specialty healthcare organization in Northern California. Electronic health record data was used to identify patients with advanced cancer and their characteristics. Data were collected 10/2019-05/2022 through periodic patient surveys and in-depth interviews with sampled family members, including open-ended questions about overall healthcare experiences. Data were analyzed using inductive thematic analysis. Results Overall, 281/482 (58.3%) patients with advanced cancer completed surveys. Surveyed patients’ mean age was 68 (SD: 12.8) years, 53% were male, 73% White, 14.2% Asian, 1.4% Black, 3.9% Other; 8.9% Hispanic, and 19.2% were deceased within 12 months. Twenty-four family members completed in-depth interviews: 17/24 (70.8%) were spouses, 62.5% were female and 50% were interviewed after the patient’s death. Respondents were generally positive about health care team interactions, but consistently brought up the negative impacts of the organization of healthcare, “It is not the fault of the health care team - it is the way the system works.” Three major challenges were identified. (1) Systemic healthcare care fragmentation, including difficulties navigating care across providers and institutions, “It seems like everything is like an isolated incident… there’s no overall, big picture viewpoint.” (2) Administrative burdens, “In the end I gave up [scheduling care] because I was tired of calling.” (3) Financial burdens, “This oncologist wanted to put him on a drug…but it was $4000 a month.” Respondents described these challenges leading to worse quality of care, health, and quality of life, and loss of trust in the national healthcare system. Conclusions These findings illustrate how care fragmentation and administrative and financial burdens lead to worse quality care and distrust of healthcare. Better coordination of patient-centered care, and a fundamental restructuring of a highly fragmented national healthcare system are required to meet the needs of patients with complex conditions like advanced cancer and their families.

Flow is a state of optimal or peak experience, commonly associated with expert and creative performance. Musicians often experience flow during playing, yet the neural mechanisms underlying this elusive state have remained underexplored due to challenges posed by substantial artefacts in the neural data. Here, we bypassed these issues by focusing on the resting-state immediately following a flow experience. Musicians performed pieces expected to reliably induce a flow state, and, as a control, non-flow-inducing musical pieces. Following the flow state, we observed higher spectral power in the upper alpha (10-12 Hz) and beta (15-30 Hz) bands, primarily in the frontal brain regions. Connectivity analysis, using the phase slope index, showed a right frontal cluster influencing activities in the left temporal and parietal areas at the theta (5 Hz) band, particularly pronounced in musicians reporting high dispositional flow. Theta band connectivity within the frontoparietal control network facilitates cognitive control and goal-directed attention, potentially crucial for achieving the flow state. These results reveal large-scale oscillatory correlates associated with the immediate post-flow state in musicians. Importantly, this framework holds promise for exploring the neural basis of flow-related states in a laboratory setting while preserving ecological and content validity.

Chance favors the prepared mind, said Louis Pasteur. Sometimes, significant breakthroughs occur when we creatively integrate new information, leading to a creative insight or an Aha! moment, while at other times when we fail to use a clue, we remain stuck in our habitual thinking patterns. In this study, we hypothesized that the brain's transient oscillatory states would characterize its receptivity or preparedness for such insights. We conducted a real-time brain-state-dependent cognitive stimulation experiment during insightful problem-solving. We showed that participants were more successful in utilizing clues and experienced more Aha responses when these clues were presented at the spontaneously up-regulated state of right temporal alpha oscillation, as opposed to the down-regulated state. Furthermore, we observed an inverse correlation between the coupling of alpha oscillation phase and gamma oscillation power and the frequency of insight. These results shed light on the neural mechanism underpinning the brain's receptivity to integrate upcoming semantic information, emphasizing the pivotal role of dynamical brain oscillations in the Aha! experience.

BACKGROUND: We hypothesized that treatment delays might be an effect modifier regarding risks and benefits of intravenous thrombolysis (IVT) before mechanical thrombectomy (MT). METHODS: We used the dataset of the SWIFT-DIRECT trial, which randomized 408 patients to IVT+MT or MT alone. Potential interactions between assignment to IVT+MT and expected time from onset-to-needle (OTN) as well as expected time from door-to-needle (DTN) were included in regression models. The primary outcome was functional independence (modified Rankin Scale (mRS) 0-2) at 3 months. Secondary outcomes included mRS shift, mortality, recanalization rates, and (symptomatic) intracranial hemorrhage at 24 hours. RESULTS: We included 408 patients (IVT+MT 207, MT 201, median age 72 years (IQR 64-81), 209 (51.2%) female). The expected median OTN and DTN were 142 min and 54 min in the IVT+MT group and 129 min and 51 min in the MT alone group. Overall, there was no significant interaction between OTN and bridging IVT assignment regarding either the functional (adjusted OR (aOR) 0.76, 95% CI 0.45 to 1.30) and safety outcomes or the recanalization rates. Analysis of in-hospital delays showed no significant interaction between DTN and bridging IVT assignment regarding the dichotomized functional outcome (aOR 0.48, 95% CI 0.14 to 1.62), but the shift and mortality analyses suggested a greater benefit of IVT when in-hospital delays were short. CONCLUSIONS: We found no evidence that the effect of bridging IVT on functional independence is modified by overall or in-hospital treatment delays. Considering its low power, this subgroup analysis could have missed a clinically important effect, and exploratory analysis of secondary clinical outcomes indicated a potentially favorable effect of IVT with shorter in-hospital delays. Heterogeneity of the IVT effect size before MT should be further analyzed in individual patient meta-analysis of comparable trials. TRIAL REGISTRATION NUMBER: URL: https://www. CLINICALTRIALS: gov ; Unique identifier: NCT03192332.

Additive Manufacturing (AM) has become indispensable in the context of digitalization and Industry 4.0 and is said to be a mega trend of the 21st century. The technology offers immense opportunities to revolutionize the production of parts and components in all industries. Despite of the outstanding technical possibilities, the industry-wide adaptation rate is low. The current approach of looking at AM from a mostly technological view is a major reason for this. The challenge is to efficiently integrate 3D printing and other additive processes into existing manufacturing processes and systems. AM must be perceived as a multidimensional topic and viewed from different perspectives, two of which are the AM technology and the planning and management of production systems. These two perspectives have to be addressed simultaneously and cross-linked. In order to use AM to tackle some of the most challenging problems in modern manufacturing systems like increasing variant diversity, shorter product lifecycles, the demand for digitized processes and cyber-physical systems, it is necessary to develop interdisciplinary approaches and solutions, because none of the disciplines can reach the necessary performance and cost-efficiency alone.

Abstract Aesthetic preference is intricately linked to learning and creativity. Previous studies have largely examined the perception of novelty in terms of pleasantness and the generation of novelty via creativity separately. The current study examines the connection between perception and generation of novelty in music; specifically, we investigated how pleasantness judgements and brain responses to musical notes of varying probability (estimated by a computational model of auditory expectation) are linked to learning and creativity. To facilitate learning de novo, 40 non-musicians were trained on an unfamiliar artificial music grammar. After learning, participants evaluated the pleasantness of the final notes of melodies, which varied in probability, while their EEG was recorded. They also composed their own musical pieces using the learned grammar which were subsequently assessed by experts. As expected, there was an inverted U-shaped relationship between liking and probability: participants were more likely to rate the notes with intermediate probabilities as pleasant. Further, intermediate probability notes elicited larger N100 and P200 at posterior and frontal sites, respectively, associated with prediction error processing. Crucially, individuals who produced less creative compositions preferred higher probability notes, whereas individuals who composed more creative pieces preferred notes with intermediate probability. Finally, evoked brain responses to note probability were relatively independent of learning and creativity, suggesting that these higher-level processes are not mediated by brain responses related to performance monitoring. Overall, our findings shed light on the relationship between perception and generation of novelty, offering new insights into aesthetic preference and its neural correlates.

Abstract Neuromuscular control of bionic arms has constantly improved over the past years, however, restoration of sensation remains elusive. Previous approaches to reestablish sensory feedback include tactile, electrical, and peripheral nerve stimulation, however, they cannot recreate natural, intuitive sensations. Here, we establish an experimental biological sensorimotor interface and demonstrate its potential use in neuroprosthetics. We transfer a mixed nerve to a skeletal muscle combined with glabrous dermal skin transplantation, thus forming a bi-directional communication unit in a rat model. Morphological analyses indicate reinnervation of the skin, mechanoreceptors, NMJs, and muscle spindles. Furthermore, sequential retrograde labeling reveals specific sensory reinnervation at the level of the dorsal root ganglia. Electrophysiological recordings show reproducible afferent signals upon tactile stimulation and tendon manipulation. The results demonstrate the possibility of surgically creating an interface for both decoding efferent motor control, as well as encoding afferent tactile and proprioceptive feedback, and may indicate the way forward regarding clinical translation of biological communication pathways for neuroprosthetic applications.

When Charlotte Brochu, Ashley Rasizzi, and Courtney Tanner taught deaf and hard of hearing students in public schools to complete their course assignments at Kent State University, they wanted to incorporate transformative strategies and their state's standards into their instruction. To become transformative teachers, Brochu, Rasizzi, and Tanner needed to incorporate best practices, target their students' academic needs, and foster their students' self-determination (i.e., ability to make their own life choices) within their instructional practice. This article describes how their coursework and practicum helped them do this.

Background Chimeric antigen receptor (CAR) T-cell therapy has demonstrated significant benefits in the treatment of relapsed/refractory multiple myeloma (RRMM). However, these outcomes can be compromised by severe complications, including cytokine release syndrome, immune effector cell-associated neurotoxicity syndrome (ICANS) and immune effector cell-associated hematotoxicity (ICAHT), predisposing for life-threatening infections.Methods This retrospective observational study examined a total of 129 patients with RRMM who had received idecabtagene vicleucel (ide-cel) at two major myeloma centers in Germany and one center in the USA to assess the Endothelial Activation and Stress Index (EASIX) as a risk marker for an unfavorable clinical course and outcome after CAR T-cell therapy. EASIX is calculated by lactate dehydrogenase (U/L) × creatinine (mg/dL) / platelets (109 cells/L) and was determined before lymphodepletion (baseline) and at the day of CAR T-cell infusion (day 0). The analysis was extended to EASIX derivatives and the CAR-HEMATOTOX score.Results An elevated baseline EASIX (>median) was identified as a risk marker for severe late ICAHT, manifesting with an impaired hematopoietic reconstitution and pronounced cytopenias during the late post-CAR-T period. Patients with high EASIX levels (>upper quartile) were particularly at risk, as evidenced by an increased rate of an aplastic phenotype of neutrophil recovery, severe late-onset infections and ICANS. Finally, we found associations between baseline EASIX and an inferior progression-free and overall survival. Moreover, the EASIX at day 0 also demonstrated potential to serve as a risk marker for post-CAR-T complications and adverse outcomes.Conclusions In conclusion, EASIX aids in risk stratification at clinically relevant time points prior to CAR T-cell therapy with ide-cel. Increased EASIX levels might help clinicians to identify vulnerable patients to adapt peri-CAR-T management at an early stage.

ABSTRACT Lyme disease, caused by spirochetes in the Borrelia burgdorferi sensu lato clade within the Borrelia genus, is transmitted by Ixodes ticks and is currently the most prevalent and rapidly expanding tick-borne disease in Europe and North America. We report complete genome sequences of 47 isolates that encompass all established species in this clade while highlighting the diversity of the widespread human pathogenic species B. burgdorferi. A similar set of plasmids has been maintained throughout Borrelia divergence, indicating that they are a key adaptive feature of this genus. Phylogenetic reconstruction of all sequenced Borrelia genomes revealed the original divergence of Eurasian and North American lineages and subsequent dispersals that introduced B. garinii, B. bavariensis, B. lusitaniae, B. valaisiana, and B. afzelii from East Asia to Europe and B. burgdorferi and B. finlandensis from North America to Europe. Molecular phylogenies of the universally present core replicons (chromosome and cp26 and lp54 plasmids) are highly consistent, revealing a strong clonal structure. Nonetheless, numerous inconsistencies between the genome and gene phylogenies indicate species dispersal, genetic exchanges, and rapid sequence evolution at plasmid-borne loci, including key host-interacting lipoprotein genes. While localized recombination occurs uniformly on the main chromosome at a rate comparable to mutation, lipoprotein-encoding loci are recombination hotspots on the plasmids, suggesting adaptive maintenance of recombinant alleles at loci directly interacting with the host. We conclude that within- and between-species recombination facilitates adaptive sequence evolution of host-interacting lipoprotein loci and contributes to human virulence despite a genome-wide clonal structure of its natural populations.IMPORTANCELyme disease (also called Lyme borreliosis in Europe), a condition caused by spirochete bacteria of the genus Borrelia, transmitted by hard-bodied Ixodes ticks, is currently the most prevalent and rapidly expanding tick-borne disease in the United States and Europe. Borrelia interspecies and intraspecies genome comparisons of Lyme disease-related bacteria are essential to reconstruct their evolutionary origins, track epidemiological spread, identify molecular mechanisms of human pathogenicity, and design molecular and ecological approaches to disease prevention, diagnosis, and treatment. These Lyme disease-associated bacteria harbor complex genomes that encode many genes that do not have homologs in other organisms and are distributed across multiple linear and circular plasmids. The functional significance of most of the plasmid-borne genes and the multipartite genome organization itself remains unknown. Here we sequenced, assembled, and analyzed whole genomes of 47 Borrelia isolates from around the world, including multiple isolates of the human pathogenic species. Our analysis elucidates the evolutionary origins, historical migration, and sources of genomic variability of these clinically important pathogens. We have developed web-based software tools (BorreliaBase.org) to facilitate dissemination and continued comparative analysis of Borrelia genomes to identify determinants of human pathogenicity.

Background Accumulating evidence suggests that cardiac findings after stroke are an important, yet understudied, manifestation of brain–heart interactions. Our aim was to investigate and compare cardiac findings after different cerebrovascular events (acute ischemic stroke, transient ischemic attack, and hemorrhagic stroke). Methods and Results There were 7113 patients screened who were treated between December 2013 and December 2020 at the University Hospital Zurich for ischemic stroke, transient ischemic attack, and hemorrhagic stroke. Seven hundred twenty‐one patients without evidence of previous cardiac disease or presumed cardioembolic origin of their cerebrovascular disease and with at least 1 cardiac checkup were included. Clinical reports from the year following disease onset were screened for new cardiac findings, which were categorized as arrhythmia/electrocardiographic changes, myocardial alterations, valvular abnormalities, and coronary perfusion insufficiency. Differences in proportions of findings among groups were analyzed using the Pearson χ2 test or Fisher exact test. ECG changes were observed in 81.7% (n=474) of patients with ischemic stroke, 71.4% (n=70) of patients with transient ischemic attack, and 55.8% (n=24) of patients with hemorrhagic stroke (P

Abstract Implantable collamer lens implantation (ICL) represents a safe and effective treatment for myopia and myopic astigmatism. To compare the outcomes of a bilateral one-stage same day approach to a two-stage approach, the databases of the University Eye Hospital Munich, Ludwig Maximilians-University and Smile Eyes Linz, Austria were screened for eyes that had undergone ICL implantation. Two-stage surgery was performed at an interval of 1 day (17 patients), 2 days (19 patients) and 1 week (2 patients). Variables analyzed were preoperative, 1-day and last follow-up uncorrected distance (UDVA) and corrected distance visual acuity (CDVA), manifest refraction, refractive spherical equivalent (SEQ), astigmatism, age, endothelial cell count (ECD), intraocular pressure (IOP) and ICL vaulting. In total, 178 eyes (100 eyes one-stage, 78 eyes two-stage) of 89 patients were included in this study. Mean follow-up was 1.1 ± 0.8 and 1.3 ± 0.5 years. Mean preoperative SEQ was − 7.9 ± 2.6 diopters (D) in the one-stage and − 8.0 ± 1.7 D in the two-stage group (p = 0.63) and improved to 0.00 ± 0.40 and − 0.20 ± 0.40 D at end of follow-up, showing slightly better stability in the one-stage group (p = 0.004). There was no difference in the efficacy (1.1 vs. 1.2, p = 0.06) and the safety index (1.2 vs. 1.2, p = 0.60) between the two groups. No eye (0%) in either group lost 2 lines or more of UDVA (p > 0.99). Refraction within ± 0.50 D and ± 1.00 D around target was achieved comparably often (89 vs. 86%, p = 0.65; 99 vs. 99%, p > 0.99). Endothelial cell loss was slightly higher in the two-stage group (1.3 vs. 4.3%). Vaulting at the final follow up was higher in the one-stage group (373.8 ± 205.4 µm vs. 260.3 ± 153.5 µm, p = 0.00007). There were no serious intraoperative complications in either group. In conclusion, this study demonstrates that both the one- and two-stage approaches are equally effective, predictable and safe. Regarding endothelial cell loss, vaulting and SEQ stability, the one-stage group showed slightly better outcomes, but these results are clinically questionable because they are so small. Larger studies are needed to quantitatively evaluate a potential benefit.

Universal screening is a critical component of school-based prevention systems. Screening data enable educators to target students for supplemental intervention, align resources to meet needs, and identify students who may be at risk for learning disabilities. One major requirement of the screening process is that all students are included to gain an accurate picture of school performance. It is therefore surprising that few evaluations of screening systems have focused on English language measures and their use with English learners. In this article, we aim to evaluate common screening thresholds, 54 across Grades k-3, to determine the extent to which they may differ between English learners and English proficient students. Results indicate that many thresholds are consistent between groups with some exceptions in kindergarten. We discuss implications for screening assessment and decision making but suggest that similar cut scores across groups do not imply similar intervention strategies.

O presente estudo destaca a relevância do patrimônio geológico para o contexto histórico-cultural do município de Torres, considerando sua ocupação deste os povos originários no Litoral Norte do Rio Grande do Sul. No entanto, a crescente ocupação urbana ressalta a necessidade de equilibrar o desenvolvimento com a conservação ambiental. O trabalho visa divulgar a história, cultura e diversidade geológica da região, além de apresentar o desenvolvimento do território de Torres considerando o contexto do Geoparque Mundial da Unesco, Caminhos dos Cânions do Sul.

Resumo As recentes transformações no modelo de avaliação empregado pela Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) presumem, entre outros sentidos, a ponderação sobre a necessidade de novas formas avaliativas que contemplem um envolvimento mais ativo da comunidade acadêmica. Desse modo, a partir de 2018, a autoavaliação passou a compor a estrutura fundamental dentro desse modelo. Nessa seara, este artigo objetiva compreender a inserção da Política de Autoavaliação no Sistema de Avaliação da CAPES, refletindo acerca das possíveis interlocuções e significados que emergem nesse cenário. Trata-se de um artigo teórico-empírico, de abordagem qualitativa, que recorre à pesquisa documental e entrevistas com especialistas que atuaram no Grupo de Trabalho (GT) de Autoavaliação da CAPES. Os resultados possibilitam apreender sobre antecedentes, aspectos conceituais e motivacionais da implantação dessa prática, bem como depreender outras possíveis articulações, como aprendizagem e inovação e elementos que configuram um contexto emergente. A pesquisa promove contribuições, ainda que introdutórias, para as discussões sobre essa prática no contexto da pós-graduação brasileira, constatando um campo fértil para estimular outras pesquisas.

IntroductionStroke-induced upper limb disabilities can be characterized by both motor impairments and activity limitations, commonly assessed using Fugl-Meyer Motor Assessment for Upper Extremity (FMMA-UE) and Action Research Arm Test (ARAT), respectively. The relationship between the two assessments during recovery is largely unstudied. Expectedly they diverge over time when recovery of impairment (restitution) plateaus, but compensation-driven improvements still occur. The objective of this study is to evaluate the alignment between FMMA-UE and ARAT in defining upper limb functional recovery categories by ARAT scores. We aimed to establish cut-off scores for both measures from the acute/early subacute, subacute and chronic stages of stroke recovery.MethodsSecondary analysis of four prospective cohort studies (acute/early subacute: n = 133, subacute: n = 113, chronic: n = 92) stages post-stroke. Receiver operating characteristic curves calculated the area under the curve (AUC) to establish optimal FMMA-UE cut-offs based on predefined ARAT thresholds distinguishing five activity levels from no activity to full activity. Weighted kappa was used to determine agreement between the two assessments. We used minimally clinically important difference (MCID) and minimal detectable change (MDC95) for comparison.ResultsFMMA-UE and ARAT scores showed no relevant divergence across all recovery stages. Results indicated similar cut-off scores in all recovery stages with variability below MCID and MDC95 levels. Cut-off scores demonstrated robust AUC values from 0.77 to 0.86 at every recovery stage. Only in highly functional patients at the chronic stage, we found a reduced specificity of 0.55. At all other times sensitivity ranged between 0.68 and 0.99 and specificity between 0.71 and 0.99. Weighted kappa at the acute/early subacute, subacute and chronic stages was 0.76, 0.83, and 0.81, respectively.DiscussionOur research shows a strong alignment between FMMA-UE and ARAT cut-off scores throughout stroke recovery, except among the subgroup of highly recovered patients at the chronic stage. Discrepancies in specificity potentially stem from fine motor deficits affecting dexterity outcomes that are not captured by FMMA-UE. Additionally, the high congruence of both measures suggests they are not suited to distinguish between restitution and compensation. Calling for more comprehensive assessment methods to better understand upper limb functionality in rehabilitation.

BackgroundStroke is a leading cause for long-term disability, requiring both inpatient and outpatient rehabilitation and self-training in the home environment. Technology-based tools are gradually gaining acceptance as additional and suitable options for extending the rehabilitation process. While the experiences of persons living with stroke, therapists, and informal caregivers with respect to technology use have already been investigated in other countries, this topic is underexplored in the Swiss context. ObjectiveWe aimed to explore the experiences and needs of persons living with stroke, informal caregivers, and therapists in using technology-based tools in a home environment for stroke rehabilitation in Switzerland. MethodsThis study followed a qualitative descriptive methodology, including semistructured interviews and focus group discussions. We applied a deductive template analysis alongside the accessibility, adaptability, accountability, and engagement framework to analyze the qualitative data sets for technology-assisted solutions for poststroke rehabilitation. ResultsWe collected the experiences and needs of persons living with stroke (7/23, 30%), informal caregivers (4/23, 17%), and therapists (occupational and physical therapists; 12/23, 52%). The 4 categories we used to organize the analysis and results were accessibility to quality rehabilitation, adaptability to patient differences, accountability or compliance with rehabilitation, and engagement with rehabilitation. Persons living with stroke stated that they use various tools within their rehabilitation process depending on their specific needs. They felt that there is a plethora of tools available but sometimes felt overwhelmed with the selection process. Informal caregivers indicated that they generally felt underserved and insufficiently informed throughout the rehabilitation process. They reported that they use technology-based tools to support their relatives affected by stroke in becoming more independent. Therapists appreciate the numerous possible applications of technology-based tools in rehabilitation. At the same time, however, they express dissatisfaction with the lack of clarity in Switzerland regarding cost coverage, recommendations, and training opportunities. ConclusionsPersons living with stroke, informal caregivers, and therapists in Switzerland reported varied and unique experiences and needs with the use of technology-based tools in outpatient stroke rehabilitation. Written recommendations, the assumption of financial costs, and the provision of information and education could foster increased confidence in the use of technology-based tools for patients and therapists.

Abstract Background and Aims High tissue sodium accumulation and intermuscular adipose tissue (IMAT) are associated with aging, type 2 diabetes, and chronic kidney disease. In this study, we aim to investigate whether high lower‐extremity tissue sodium accumulation relates to IMAT quantity and whether systemic inflammatory mediators and adipocytokines contribute to such association. Methods Tissue sodium content and IMAT accumulation (percentage of IMAT area to muscle area) were measured in 83 healthy individuals using sodium imaging (23Na‐MRI) and proton (1H‐MRI) imaging of the calf. Insulin sensitivity was assessed by glucose disposal rate (GDR) measured with the hyperinsulinemic‐euglycemic clamp. Results Median (interquartile range) muscle and skin sodium contents were 16.6 (14.9, 19.0) and 12.6 (10.9, 16.7) mmol/L, respectively. Median IMAT was 3.69 (2.80, 5.37) %. In models adjusted for age, sex, BMI, GDR, adiponectin, and high‐sensitivity C‐reactive protein, increasing tissue sodium content was significantly associated with higher IMAT quantity (p = 0.018 and 0.032 for muscle and skin tissue sodium, respectively). In subgroup analysis stratified by sex, skin sodium was significantly associated with IMAT only among men. In interaction analysis, the association between skin sodium and IMAT was greater with increasing levels of high‐sensitivity C‐reactive protein and interleukin‐6 (p for interaction = 0.022 and 0.006, respectively). Conclusions Leg muscle and skin sodium are associated with IMAT quantity among healthy individuals. The relationship between skin sodium and IMAT may be mediated by systemic inflammation.

Brazilian biodiversity is considered a source of bioactive substances, and one of the species found is Solanum viarum Dunal, which is mainly composed of pyrrolizidine alkaloids. The purpose of this study was to evaluate two non-conventional extraction techniques — microwave hydrodiffusion and gravity (MHG) and pressurized-liquid extraction (PLE) — in obtaining bioactive compounds from S. viarum. Different parameters were assessed that directly influenced the yield and chemical composition of extracts. For PLE, the percentage of ethanol and temperature were evaluated on yield and composition. For MHG, temperature and pressure were evaluated on the same responses. PLE presented the highest extract yield (26.11 wt.%) and bioactive compounds concentration, while the highest extract yield of MHG was 1.68 wt.%. Both techniques indicated efficiency in extracting integerrimine, senecionine, and quinic acid. Knowing the compounds present in plants, using different extractive methods, enables the development of research that addresses their possible potential in the future.

PurposeEctasia screening in candidates for laser refractive surgery is mandatory during preoperative evaluation. Despite the availability of modern imaging techniques, refractive surgeons often face borderline decisions when patients present with suspicious tomographic findings. This case series presents refractive candidates with suspicious tomographic findings and demonstrates how to interpret them using Scheimpflug imaging and additional anterior segment optical coherence tomography (AS-OCT).SettingDepartment of Ophthalmology, University Hospital, LMU Munich.Case seriesThis case series examines six potential candidates for refractive surgery with a mean age of 29.2 ± 3.9 years, whose corneal assessments using Scheimpflug imaging raised suspicion for ectasia. Each candidate was additionally examined with AS-OCT and reevaluated. The mean manifest subjective spherical equivalent was -3.67 ± 1.8 diopters. The total corneal thickness measured 537 µm ± 30 µm at its thinnest point. None of the candidates had any reported underlying corneal or ophthalmic diseases, and slit lamp examinations revealed no abnormal morphological findings.ConclusionsBoth Scheimpflug imaging and AS-OCT are appropriate tools for screening refractive candidates for ectasia. While topographic and elevation analyses yielded comparable results regarding corneal structure, the epithelial mapping provided by AS-OCT played a critical role in decision-making for cases with borderline tomographic findings. Establishing a global consensus on the use of epithelial mapping in ectasia screening is necessary.

Purpose: To assess the IOL power calculation accuracy in post-SMILE eyes using ray tracing and a range of total keratometry based IOL calculation formulae. Observations: Ray tracing showed excellent predictability in IOL power calculation after SMILE and its accuracy was clinically comparable with the Barrett TK Universal II and Haigis TK formula. Conclusions and importance: Incorporating posterior corneal curvature measurements into IOL power calculation after SMILE seems prudent. The ray tracing method as well as selected TK-based formulae yielded excellent accuracy and should be favored in post-SMILE eyes.