Search

Esports in Portugal have been growing steadily in recent years. As in many other countries, women are significantly underrepresented in Portuguese esports. New studies with Portuguese students show conservative views towards gender roles and disinterest in prioritising diversity, equity, and inclusion (DEI), which contrasts with the global tendency to incorporate it in the industry. Lately, initiatives promoting DEI have populated the esports landscape. However, the communities’ response, which may impact effectiveness, remains under-examined. This work is part of a larger ethnographic project that aims to understand how the esports communities in Portugal perceive and react to DEI initiatives such as women-only tournaments or harassment awareness campaigns. This paper will discuss findings from the thematic analysis of 10 interviews with Portuguese members of an esports community. The recurring themes were (1) DEI initiatives are imposed; (2) Portugal is too small to care (about DEI); (3) nepotism; (4) self-preservation; and (5) ubiquity of online toxicity.

Background: The clinical frailty scale (CFS) was used as a triage tool for medical decision making during the COVID-19 pandemic. The CFS has been posed as a suitable risk marker for in-hospital mortality in COVID-19 patients. We evaluated whether the CFS is associated with mortality 24 months after hospitalisation for COVID-19. Methods: The COvid MEdicaTion (COMET) study is an international, multicentre, observational cohort study, including adult patients hospitalised for COVID-19 between March 2020–July 2020. Patients’ characteristics, prescribed medication, clinical characteristics, and CFS were collected at admission, survival data were collected 24 months after hospitalisation. Multivariable cox proportional hazard models stratified by age (

Objective Enhanced recovery after surgery (ERAS) guidelines have been successfully applied to children and neonates. There is a need to provide evidence-based consensus recommendations to manage neonatal pain perioperatively to ensure adequate analgesia while minimising harmful side effects.Methods Following a stakeholder needs assessment, an international guideline development committee (GDC) was established. A modified Delphi consensus iteratively defined the scope of patient and procedure inclusion, topic selection and recommendation content regarding the pharmacologic management of neonatal pain. Critical appraisal tools assessed the relevance and quality of full-text studies. Each recommendation underwent a formal Grades of Recommendation, Assessment, Development and Evaluation (GRADE) assessment of the quality of evidence and expert consensus was used to determine the strength of recommendations.Results The GDC included paediatric anaesthesiologists, surgeons, and ERAS methodology experts. The population was defined as neonates at >32 weeks gestational age within 30 days of life undergoing surgery or painful procedures associated with surgery. Topic selection targeted pharmacologic opioid-minimising strategies. A total of 4249 abstracts were screened for non-opioid analgesia and 738 abstracts for the use of locoregional analgesia. Full-text review of 18 and 9 articles, respectively, resulted in two final recommendations with a moderate quality of evidence to use regular acetaminophen and to consider the use of locoregional analgesia. There was inadequate evidence to guide the use of other non-opioid adjuncts in this population.Conclusions Evidence-based, ERAS-driven consensus recommendations were developed to minimise opioid usage in neonates. Further research is required in this population to optimize multimodal strategies for pain control.

Introduction: Ferric derisomaltose is the newest available parenteral iron formulation. Studies have demonstrated a good safety profile with improved tolerability compared to alternative parenteral iron formulations. To date there have been no reported acute, life-threatening cardiac events associated with ferric derisomaltose. Case Report: An 86-year-old male who had previously tolerated routine iron infusions received a first dose of ferric derisomaltose at an outpatient infusion clinic. Six minutes into the infusion the patient became unresponsive with no palpable pulse. Return of spontaneous circulation was achieved after two minutes of chest compressions. Electrocardiogram showed complete heart block requiring transcutaneous pacing and vasopressor administration. The patient was transferred to the emergency department for stabilization and then admitted to the cardiac intensive care unit. During admission, the patient received a dual-chamber, permanent pacemaker without complication and was ultimately discharged. Conclusion: It may be reasonable to consider parenteral iron as a toxicological etiology for patients presenting with complete heart block temporally associated with parenteral iron administration, particularly in patients with underlying conduction abnormalities.

Background Adherence to pharmacotherapy and use of the correct inhaler technique are important basic principles of asthma management. Video- or remote-direct observation of therapy (v-DOT) could be a feasible approach to facilitate monitoring and supervising therapy, supporting the delivery of standard care.Objective To explore the utility and the feasibility of v-DOT to monitor inhaler technique and adherence to treatment in adults attending the asthma outpatient service in a tertiary hospital in Northern Ireland.Method The project evaluated use of the technology with 10 asthma patients. Patient and clinician feedback was obtained, in addition to measures of patient engagement and disease-specific clinical markers to assess the feasibility and utility of v-DOT technology in this group of patients.Results The engagement rate with v-DOT for participating patients averaged 78% (actual video uploads vs expected video uploads) over a median 7 week usage period. Although 50% of patients reported a technical issue at some stage during the usage period, all patients and clinicians reported that the technology was easy to use and that they were satisfied with the outcomes. A range of positive impacts were observed, including optimised inhaler technique and an observed improvement in lung function. An increase in asthma control test scores aligned with clinical aims to promote adherence and alleviate symptoms.Conclusion The v-DOT technology was shown to be a feasible method of assessing inhaler technique and monitoring adherence in this small group of adult asthma patients. A range of positive impacts for participating patients and clinicians were observed. Not all patients invited to join the project agreed to participate or engage with using the technology, highlighting that in this setting, digital modes of delivering care provide only one of the approaches in the necessary “tool kit” for clinicians and patients.

Background: Pharmacist-led medication reviews (MR) are one of the key methods to support medication safety in polypharmacy patients. The aims of this study were to pilot MRs in Eastern European community pharmacies, describe medication use in polypharmacy patients, and evaluate the usability of medication safety assessment tools.Methods: The MR pilot was undertaken in Estonia, Latvia, Poland, Hungary, Romania, and Bulgaria. Patients who used at least five medicines were directed to the service by their GPs. Data on drug-related problems (DRPs) and adherence were collected by pharmacists through structured patient interviews. Databases for identification of potential drug-drug interactions (pDDIs) and adverse drug reactions (ADRs) named Inxbase/Riskbase, as well as an integrated tool comprising potentially inappropriate medicines (PIMs) lists EU(7)-PIM and EURO-FORTA, were applied retroactively to the MR pilot data to investigate possibilities for their use and to describe medication use and potential risks in the study population.Results: A total of 318 patients were included in the study, 250 of them elderly (≥65 years). One hundred and eighty (56.6%) participants had a total of 504 pDDIs based on Inxbase analysis. On average, there were 1.6 pDDIs per participant. Twenty-five (5.0%) of the 504 pDDIs were in a high-risk category. A total of 279 (87.7%) participants had a potential ADR in at least one of 10 Riskbase categories. One hundred and fifty-four (20.8%) of the potential ADRs were in a high-risk category. Twenty-seven pDDIs and 68 ADRs documented as DRPs during the service were not included in the databases. Using the integrated EU(7)-PIM/EURO-FORTA PIM list, a total of 816 PIMs were found in 240 (96%) of the 250 elderly participants (on average 3.4 PIMs per elderly participant). Seventy-one (29.6%) of the participants were using high-risk PIMs. Twenty-one percent of high-risk PIMs and 13.8% of medium-risk PIMs were documented as DRPs by the pharmacists during the pilot.Conclusion: Medication safety assessment tools can be useful in guiding decision-making during MRs; however, these tools cannot replace patient interviews and monitoring. Tools that include a thorough explanation of the potential risks and are easy to use are more beneficial for MRs.

This article presents a comprehensive and multistage approach to the development of the user experience (UX) for an mHealth application targeting older adult patients with chronic diseases, specifically chronic heart failure and chronic obstructive pulmonary disease. The study adopts a mixed methods approach, incorporating both quantitative and qualitative components. The underlying hypothesis posits that baseline medicine adherence knowledge (measured by the MARS questionnaire), beliefs about medicines (measured by the BMQ questionnaire), and level of user experience (measured by the SUS and UEQ questionnaires) act as predictors of adherence change after a period of usage of the mHealth application. However, contrary to our expectations, the results did not demonstrate the anticipated relationship between the variables examined. Nevertheless, the qualitative component of the research revealed that patients, in general, expressed satisfaction with the application. It is important to note that the pilot testing phase revealed a notable prevalence of technical issues, which may have influenced participants’ perception of the overall UX. These findings contribute to the understanding of UX development in the context of mHealth applications for older adults with chronic diseases and emphasise the importance of addressing technical challenges to enhance user satisfaction and engagement.

Abstract Insular epilepsy (IE) is an increasingly recognized cause of drug‐resistant epilepsy amenable to surgery. However, concerns of suboptimal seizure control and permanent neurological morbidity hamper widespread adoption of surgery for IE. We performed a systematic review and individual participant data meta‐analysis to determine the efficacy and safety profile of surgery for IE and identify predictors of outcomes. Of 2483 unique citations, 24 retrospective studies reporting on 312 participants were eligible for inclusion. The median follow‐up duration was 2.58 years (range, 0‐17 years), and 206 (66.7%) patients were seizure‐free at last follow‐up. Younger age at surgery (≤18 years; HR = 1.70, 95% CI = 1.09‐2.66, P = .022) and invasive EEG monitoring (HR = 1.97, 95% CI = 1.04‐3.74, P = .039) were significantly associated with shorter time to seizure recurrence. Performing MR‐guided laser ablation or radiofrequency ablation instead of open resection (OR = 2.05, 95% CI = 1.08‐3.89, P = .028) was independently associated with suboptimal or poor seizure outcome (Engel II‐IV) at last follow‐up. Postoperative neurological complications occurred in 42.5% of patients, most commonly motor deficits (29.9%). Permanent neurological complications occurred in 7.8% of surgeries, including 5% and 1.4% rate of permanent motor deficits and dysphasia, respectively. Resection of the frontal operculum was independently associated with greater odds of motor deficits (OR = 2.75, 95% CI = 1.46‐5.15, P = .002). Dominant‐hemisphere resections were independently associated with dysphasia (OR = 13.09, 95% CI = 2.22‐77.14, P = .005) albeit none of the observed language deficits were permanent. Surgery for IE is associated with a good efficacy/safety profile. Most patients experience seizure freedom, and neurological deficits are predominantly transient. Pediatric patients and those requiring invasive monitoring or undergoing stereotactic ablation procedures experience lower rates of seizure freedom. Transgression of the frontal operculum should be avoided if it is not deemed part of the epileptogenic zone. Well‐selected candidates undergoing dominant‐hemisphere resection are more likely to exhibit transient language deficits; however, the risk of permanent deficit is very low.

Clinical pharmacy as an area of practice, education and research started developing around the 1960s when pharmacists across the globe gradually identified the need to focus more on ensuring the appropriate use of medicines to improve patient outcomes rather than being engaged in manufacturing and supply. Since that time numerous studies have shown the positive impact of clinical pharmacy services (CPS). The need for wider adoption of CPS worldwide becomes urgent, as the global population ages, and the prevalence of polypharmacy as well as shortage of healthcare professionals is rising. At the same time, there is great pressure to provide both high-quality and cost-effective health services. All these challenges urgently require the adoption of a new paradigm of healthcare system architecture. One of the most appropriate answers to these challenges is to increase the utilization of the potential of highly educated and skilled professionals widely available in these countries, i.e., pharmacists, who are well positioned to prevent and manage drug-related problems together with ensuring safe and effective use of medications with further care relating to medication adherence. Unfortunately, CPS are still underdeveloped and underutilized in some parts of Europe, namely, in most of the Central and Eastern European (CEE) countries. This paper reviews current situation of CPS development in CEE countries and the prospects for the future of CPS in that region.

The COVID-19 pandemic raised many challenges for university staff and students, including the need to work from home, which resulted in a greater reliance on technology. We collected questionnaire data from university students (N = 894) in three European countries: Greece, Italy, and the United Kingdom. Data were collected between 7th April 2020 and 19th June 2020, representing a period covering the first lockdown and university closures in these countries and across Europe generally. We tested the hypotheses that technology-related stressors (techno-overload, work-home conflict, techno-ease, techno-reliability, techno-sociality, and pace of change) would be associated with anxiety and depressive symptoms, and that coping styles (problem-focused, emotion-focused, and avoidance) would mediate these relationships. Results showed significant positive associations between techno-overload, work-home conflict and anxiety and depressive symptoms, and significant negative associations between techno-reliability, techno-ease and anxiety and depressive symptoms. A significant negative association was found between techno-sociality and depressive symptoms but not anxiety symptoms. No evidence was found for an association between pace of change and anxiety or depressive symptoms. Multiple mediation analyses revealed significant direct effects of techno-overload, work-home conflict and techno-ease on anxiety symptoms, and of work-home conflict and techno-ease on depressive symptoms. Work-home conflict had significant indirect effects on anxiety and depressive symptoms through avoidance coping. Techno-overload and techno-ease both had significant indirect effects on anxiety symptoms through problem- and emotion-focused coping. Techno-ease also had a significant indirect effect on depressive symptoms through problem-focused coping. The findings add to the body of evidence on technostress amongst university students and provide knowledge on how technostress translates through coping strategies into anxious and depressive symptoms during the disruption caused by the outbreak of a pandemic disease.

Objectives Perioperative nutrition aims to replenish nutritional stores before surgery and reduce postoperative complications. ‘Immunonutrition’ (including omega-3 fatty acids) may modulate the immune system and attenuate the postoperative inflammatory response. Hitherto, immunonutrition has overwhelmingly been administered in the postoperative period—however, this may be too late to provide benefit.Design A systematic literature search using MEDLINE and EMBASE for randomized controlled trials (RCTs).Setting Perioperative major gastrointestinal surgery.Participants Patients undergoing major gastrointestinal surgery.Interventions Omega-3 fatty acid supplementation commenced in the preoperative period, with or without continuation into postoperative period.Main outcome measures The effect of preoperative omega-3 fatty acids on inflammatory response and clinical outcomes.Results 833 studies were identified. After applying inclusion and exclusion criteria, 12 RCTs, involving 1456 randomized patients, were included. Ten articles exclusively enrolled patients with cancer. Seven studies used a combination of EPA (eicosapentaenoic acid) and DHA (docosahexaenoic acid) as the intervention and five studies used EPA alone. Eight out of 12 studies continued preoperative nutritional support into the postoperative period.Of the nine studies reporting mortality, no difference was seen. Duration of hospitalisation ranged from 4.5 to 18 days with intervention and 3.5 to 23.5 days with control. Omega-3 fatty acids had no effect on postoperative C-reactive protein and the effect on cytokines (including tumor necrosis factor-α, interleukin (IL)-6 and IL-10) was inconsistent. Ten of the 12 studies had low risk of bias, with one study having moderate bias from allocation and blinding.Conclusions There is insufficient evidence to support routine preoperative omega-3 fatty acid supplementation for major gastrointestinal surgery, even when this is continued after surgery.PROSPERO registration number CRD42018108333.

The generational cohort now commonly referred to as Generation Z numbers approximately 65 million in the United States. They share a number of traits with their millennial predecessors, such as the aspiration to purchase from, and work for socially conscious companies. They are also the first generation to grow up with instantaneous access to information via digital mobile technology and rely on digital platforms and social media for information. To better understand how this emerging consumer category processes product information and product company information regarding social behaviors, an experimental design and two methods of analysis (Choice-Based Conjoint and Latent Class Cluster) are employed. Results indicate that Gen Z consumers’ purchase preferences may be highly influenced by consumer product companies’ purported social and economic behavior, but other attributes remain highly relevant. Further, three distinctive need-based sub-segments combining certain product attributes and company social behavior, of the Gen Z cohort may exist.

Abstract The translation of laboratory-scale bioprocess protocols and technologies to industrial scales and the application of human induced pluripotent stem cell (hiPSC) derivatives in clinical trials globally presents optimism for the future of stem-cell products to impact healthcare. However, while many promising therapeutic approaches are being tested in pre-clinical studies, hiPSC-derived products currently account for a small fraction of active clinical trials. The complexity and volatility of hiPSCs present several bioprocessing challenges, where the goal is to generate a sufficiently large, high-quality, homogeneous population for downstream differentiation—the derivatives of which must retain functional efficacy and meet regulatory safety criteria in application. It is argued herein that one of the major challenges currently faced in improving the robustness of routine stem-cell biomanufacturing is in utilizing continuous, meaningful assessments of molecular and cellular characteristics from process to application. This includes integrating process data with biological characteristic and functional assessment data to model the interplay between variables in the search for global optimization strategies. Coupling complete datasets with relevant computational methods will contribute significantly to model development and automation in achieving process robustness. This overarching approach is thus crucially important in realizing the potential of hiPSC biomanufacturing for transformation of regenerative medicine and the healthcare industry.

Athletic conditioning can increase the capacity for insulin-stimulated skeletal muscle glucose uptake through increased sarcolemmal expression of GLUT4 and potentially additional novel glucose transporters. We used a canine model that has previously demonstrated conditioning-induced increases in basal, insulin- and contraction-stimulated glucose uptake to identify whether expression of glucose transporters other than GLUT4 was upregulated by athletic conditioning. Skeletal muscle biopsies were obtained from 12 adult Alaskan Husky racing sled dogs before and after a full season of conditioning and racing, and homogenates from those biopsies were assayed for expression of GLUT1, GLUT3, GLUT4, GLUT6, GLUT8, and GLUT12 using western blots. Athletic conditioning resulted in a 1.31 ± 0.70 fold increase in GLUT1 (p

Background Medication adherence, one of the most important aspects in the process of optimal medicines use, is unfortunately still a major challenge in modern healthcare, and further research is required into how adherence can be assessed and optimised. The aim of this study was to use a combined method approach of self-report and dried blood spot (DBS) sampling coupled with population pharmacokinetic (PopPK) modelling, to assess adherence to metformin in adult patients with type 2 diabetes. Further aims were to assess metformin exposure levels in patients, determine factors associated with non-adherence with prescribed metformin, and to explore the relationship between adherence and therapeutic outcomes. Methods A combined method approach was used to evaluate metformin adherence in patients with type 2 diabetes who had been prescribed metformin for a minimum period of 6 months. Patients were recruited from consultant-led diabetic outpatient clinics at three hospitals in Northern Ireland, UK. Data collection involved self-reported questionnaires [Medication Adherence Report Scale (MARS), Beliefs about Medicines Questionnaire and Centre for Epidemiologic Studies Depression Scale], direct measurement of metformin concentration in DBS samples, and researcher-led patient interviews. The DBS sampling approach was coupled with population pharmacokinetic (PopPK) modelling, which took account of patient characteristics, metformin dosage and type of formulation prescribed (immediate or sustained release). Results The proportion of patients considered to be adherent to their prescribed metformin, derived from self-reported MARS scores and metformin concentration in DBS samples, was 61.2% (74 out of 121 patients). The majority (n = 103, 85.1%) of recruited patients had metformin exposure levels that fell within the therapeutic range. However, 17 patients (14.1%) had low exposure to metformin and one patient (0.8%) had undetectable metformin level in their blood sample (non-exposure). Metformin self-administration and use of a purchased adherence pill box significantly increased the probability of a patient being classified as adherent based on logistic regression analysis. Both HbA1c and random glucose levels (representing poor glycaemic control) in the present research were, however, not statistically linked to non-adherence to metformin (P > 0.05). Conclusions A significant proportion of participating patients were not fully adherent with their therapy. DBS sampling together with the use of a published PopPK model was a useful, novel, direct, objective approach to estimate levels of adherence in adult patients with type 2 diabetes (61.2%).

In this article, I discuss reception history, its place within the history of historical critical methods, and social memory theory. I apply a reception historical lens buttressed by social memory theory to 1 Timothy 1:3–4. I show that the historical circumstances of this passage’s reception problematize using early understandings of it to reconstruct the referent behind “myths and endless genealogies”. I first show how the phrase “myths and endless genealogies” is ambiguous in the historical setting of the author. Then, I demonstrate that Irenaeus, Tertullian, Athanasius, and Chrysostom use this phrase against very different groups; however, all of these authors use 1 Timothy 1:4 for a (perceived) problem against their present group.

Management of air transportation of strategic goods is a very complex task with many challenges. This paper describes the method used in documenting the requirements for an IT system intended to support management of air transportation of military and dual-use goods. The work was completed in conjunction with a private logistics company. The project produced a Software Requirements Specification document and a working prototype. The document and prototype are held by the Military University of Land Forces of Poland. Requirements were solicited from numerous sources. A private logistics company, numerous books and personal experience of the team members all contributed to requirements. These requirements were then analyzed and a final set of requirements was produced. Screen mock-ups and a working prototype were developed. Selected screen shots are within the paper. The working prototype was developed by constructing a database and using a code generator to produce a web application.

Stents are a widely-used device to treat a variety of cardiovascular diseases. The purpose of this review is to explore the application of regenerative medicine principles into current and future stent designs. This review will cover regeneration-relevant approaches emerging in the current research landscape of stent technology. Regenerative stent technologies include surface engineering of stents with cell secretomes, cell-capture coatings, mimics of endothelial products, surface topography, endothelial growth factors or cell-adhesive peptides, as well as design of bioresorable materials for temporary stent support. These technologies are comparatively analyzed in terms of their regenerative effects, therapeutic effects and challenges faced; their benefits and risks are weighed up for suggestions about future stent developments. This review highlights two unique regenerative features of stent technologies: selective regeneration, which is to selectively grow endothelial cells on a stent but inhibit the proliferation and migration of smooth muscle cells, and stent-assisted regeneration of ischemic tissue injury.

Soil texture is an important property that controls the mobility of the water and nutrients in soil. This study examined the capability of machine learning (ML) models in estimating soil texture fractions using different combinations of remotely sensed data from Sentinel-1 (S1), Sentinel-2 (S2), and terrain-derived covariates (TDC) across two contrasting agroecological regions in Southwest Germany, Kraichgau and the Swabian Alb. Importantly, we tested the predictive power of three different ML models: the random forest (RF), the support vector machine (SVM), and extreme gradient boosting (XGB) coupled with the remote sensing data covariates. As expected, ML model performance was not consistent regarding the input covariates, soil texture fractions, and study regions. For example, in the Swabian Alb, the SVM model performed the best for the sand content with S2 + TDC (RMSE = 3.63%, R2 = 0.42), and XGB best predicted the clay content with S1 + S2 + TDC (RMSE = 6.84%, R2 = 0.64). In Kraichgau, the best models for sand (RMSE = 7.54%, R2 = 0.79) and clay contents (RMSE = 6.14%, R2 = 0.48) were obtained using XGB and SVM, respectively. Moreover, the results indicated that TDC were critical in estimating soil texture fractions, especially in Kraichgau, which indicated that topography plays an important role in defining the spatial distribution of soil properties. In contrast, the contribution of remote sensing data better predicted the silt and clay content in the Swabian Alb. The transferability of a region-specific model to the other region was low as indicated by poor predictive performance. The resulting soil-texture-fraction maps could be a significant source of information for efficient land resource management and environmental monitoring. Nonetheless, further research to evaluate the added value of the Sentinel imagery and to better analyze the spatial transferability of machine learning models is highly recommended.

Maize lethal necrosis (MLN), resulting from co-infection by maize chlorotic mottle virus (MCMV) and sugarcane mosaic virus (SCMV) can cause up to 100% yield losses in maize in Africa under serious disease conditions. Maize improvement through conventional backcross (BC) takes many generations but can significantly be shortened when molecular tools are utilized in the breeding process. We used a donor parent (KS23-6) to transfer quantitative trait loci (QTL) for resistance to MLN into nine adapted but MLN susceptible lines. Nurseries were established in Kiboko, Kenya during 2015–2017 seasons and BC3F2 progeny were developed using marker assisted backcrossing (MABC) approach. Six single nucleotide polymorphism (SNP) markers linked to QTL for resistance to MLN were used to genotype 2,400 BC3F2 lines using Kompetitive Allele Specific PCR (KASP) platform. We detected that two of the six QTL had major effects for resistance to MLN under artificial inoculation field conditions in 56 candidate BC3F2 lines. To confirm whether these two QTL are reproducible under different field conditions, the 56 BC3F2 lines including their parents were evaluated in replicated trials for two seasons under artificial MLN inoculations in Naivasha, Kenya in 2018. Strong association of genotype with phenotype was detected. Consequently, 19 superior BC3F2 lines with favorable alleles and showing improved levels of resistance to MLN under artificial field inoculation were identified. These elite lines represent superior genetic resources for improvement of maize hybrids for resistance to MLN. However, 20 BC3F2 lines were fixed for both KASP markers but were susceptible to MLN under field conditions, which could suggest weak linkage between the KASP markers and target genes. The validated two major QTL can be utilized to speed up the breeding process but additional loci need to be identified between the KASP markers and the resistance genes to strengthen the linkage.

Background The radial forearm flap (RFF) is a versatile flap that can be used for soft-tissue coverage or as a source of vascularized bone during reconstruction. A problem that can arise after RFF harvest is tendon exposure in the donor site, which may lead to tendon injury and restriction of the hand and wrist’s range of motion. Many different methods for providing adequate tendon coverage in the donor site after RFF harvest have been reported. We present a novel technique for coverage of exposed tendon in the volar forearm with an epimysial transposition flap and a split-thickness skin graft (STSG). Methods Retrospective review of two cases: one salvage case with exposed tendon after harvesting an RFF and another with exposed volar forearm tendon after traumatic injuries. Variables of interest were post-operative STSG integration and hand/wrist range of motion. Results Both cases demonstrated 100% graft take at 5-week follow-up. No decrease in hand/wrist range of motion in the patient that could undergo testing. Conclusion We introduce two cases for coverage of exposed flexor tendon in the volar forearm with an epimysial transposition flap. This can be used as a salvage operation for coverage of exposed tendon or as an acute method of tendon coverage prior to skin grafting. In both cases, the skin graft had excellent incorporation.

Most contemporary accounts of the nature of faith explicitly defend what we call ‘the positivity theory of faith’ – the theory that faith must be accompanied by a favourable evaluative belief, or a desire towards the object of faith. This paper examines the different varieties of the positivity theory and the arguments used to support it. Whilst initially plausible, we find that the theory faces numerous problematic counterexamples, and show that weaker versions of the positivity theory are ultimately implausible. We discuss a distinct property of faith that we call ‘true grit’, such that faith requires one to be resilient toward the evidential, practical, and psychological challenges that it faces. We show how true grit is necessary for faith, and provides a simpler and less problematic explanation of the evidence used to support the positivity theory.

Summary: Objective: There is a high risk of developing osteoarthritis (OA) following traumatic injury to the knee. Severe ligament injuries can disrupt the integrity of the multicomponent knee at both biological and biomechanical levels. We hypothesize changes in cartilages stresses could lead to tissue damage and development of OA. Design: The in-vivo gait kinematics of the stifle (knee) joint of four adult female ovine subjects were recorded prior to and at ten-and-twenty weeks following partial ACL-MCL transection. The subjects were sacrificed and the experimental joint from each subject was mounted on a parallel robotic system programmed with the kinematic findings. Ten custom-built Fibre Bragg Grating optic sensors were arranged to measure contact stresses on the surface of the tibial plateau articular cartilage. These sensors provide the first accurate stress measurements in a joint during gait replication using the previously recorded in-vivo kinematics. The relationship between the results obtained and observed focal damage was assessed. Results: The locations on the tibial plateaus that experienced the greatest change in contact stresses corresponded with the locations of focal damage development. No direct link was detected between individual animal differences in kinematics and variations in stress magnitudes or the development of focal cartilage damage. Conclusions: The findings highlight the importance of mechanical stress determinants in the integrated set point for the knee (with individual variation), and how injury-related stress changes correlate with development of PTOA.

Schistosomiasis is a debilitating parasitic disease infecting hundreds of millions of people. Schistosomes use aquatic snails as intermediate hosts. A promising avenue for disease control involves leveraging innate host mechanisms to reduce snail vectorial capacity. In a genome-wide association study of Biomphalaria glabrata snails, we identify genomic region PTC2 which exhibits the largest known correlation with susceptibility to parasite infection (>15 fold effect). Using new genome assemblies with substantially higher contiguity than the Biomphalaria reference genome, we show that PTC2 haplotypes are exceptionally divergent in structure and sequence. This variation includes multi-kilobase indels containing entire genes, and orthologs for which most amino acid residues are polymorphic. RNA-Seq annotation reveals that most of these genes encode single-pass transmembrane proteins, as seen in another resistance region in the same species. Such groups of hyperdiverse snail proteins may mediate host-parasite interaction at the cell surface, offering promising targets for blocking the transmission of schistosomiasis.

Despite anecdotal reports of the astonishing homing abilities in dogs, their homing strategies are not fully understood. We equipped 27 hunting dogs with GPS collars and action cams, let them freely roam in forested areas, and analyzed components of homing in over 600 trials. When returning to the owner (homewards), dogs either followed their outbound track (‘tracking’) or used a novel route (‘scouting’). The inbound track during scouting started mostly with a short (about 20 m) run along the north-south geomagnetic axis, irrespective of the actual direction homewards. Performing such a ‘compass run’ significantly increased homing efficiency. We propose that this run is instrumental for bringing the mental map into register with the magnetic compass and to establish the heading of the animal.

Summary: Background: Surgical, anaesthetic, and obstetric (SAO) health-care system strengthening is needed to address the emergency and essential surgical care that approximately 5 billion individuals lack globally. To our knowledge, a complete, non-modelled national situational analysis based on the Lancet Commission on Global Surgery surgical indicators has not been done. We aimed to undertake a complete situation analysis of SAO system preparedness, service delivery, and financial risk protection using the core surgical indicators proposed by the Commission in Colombia, an upper-middle-income country. Methods: Data to inform the six core surgical system indicators were abstracted from the Colombian national health information system and the most recent national health survey done in 2007. Geographical access to a Bellwether hospital (defined as a hospital capable of providing essential and emergency surgery) within 2 h was assessed by determining 2 h drive time boundaries around Bellwether facilities and the population within and outside these boundaries. Physical 2 h access to a Bellwether was determined by the presence of a motor vehicle suitable for individual transportation. The Department Administrativo Nacional de Estadística population projection for 2016 and 2018 was used to calculate the SAO provider density. Total operative volume was calculated for 2016 and expressed nationally per 100 000 population. The total number of postoperative deaths that occurred within 30 days of a procedure was divided by the total operative volume to calculate the all-cause, non-risk-adjusted postoperative mortality. The proportion of the population subject to impoverishing costs was calculated by subtracting the baseline number of impoverished individuals from those who fell below the poverty line once out-of-pocket payments were accounted for. Individuals who incurred out-of-pocket payments that were more than 10% of their annual household income were considered to have experienced catastrophic expenditure. Using GIS mapping, SAO system preparedness, service delivery, and cost protection were also contextualised by socioeconomic status. Findings: In 2016, at least 7·1 million people (15·1% of the population) in Colombia did not have geographical access to SAO services within a 2 h driving distance. SAO provider density falls short of the Commission's minimum target of 20 providers per 100 000 population, at an estimated density of 13·7 essential SAO health-care providers per 100 000 population in 2018. Lower socioeconomic status of a municipality, as indicated by proportion of people enrolled in the subsidised insurance regime, was associated with a smaller proportion of the population in the municipality being within 2 h of a Bellwether facility, and the most socioeconomically disadvantaged municipalities often had no SAO providers. Furthermore, Colombian providers appear to be working at or beyond capacity, doing 2690–3090 procedures per 100 000 population annually, but they have maintained a relatively low median postoperative mortality of 0·74% (IQR 0·48–0·84). Finally, out-of-pocket expenses for indirect health-care costs were a key barrier to accessing surgical care, prompting 3·1 million (6·4% of the population) individuals to become impoverished and 9·5 million (19·4% of the population) individuals to incur catastrophic expenditures in 2007. Interpretation: We did a non-modelled, indicator-based situation analysis of the Colombian SAO system, finding that it has not yet met, but is working towards achieving, the targets set by the Lancet Commission on Global Surgery. The observed interdependence of these indicators and correlation with socioeconomic status are consistent with well recognised factors and outcomes of social, health, and health-care inequity. The internal consistency observed in Colombia's situation analysis validates the use of the indicators and has now informed development of an early national SAO plan in Colombia, to set a data-informed stage for implementation and evaluation of timely, safe, and affordable SAO health care, within the National Public Health Decennial Plan, which is due in 2022. Funding: Zoll Medical.

This quasi-experimental study investigated the effect of an antibiotic cycling policy based on time-series analysis of epidemiologic data, which identified antimicrobial drugs and time periods for restriction. Cyclical restrictions of amoxicillin/clavulanic acid, piperacillin/tazobactam, and clarithromycin were undertaken over a 2-year period in the intervention hospital. We used segmented regression analysis to compare the effect on the incidence of healthcare-associated Clostridioides difficile infection (HA-CDI), healthcare-associated methicillin-resistant Staphylococcus aureus (HA-MRSA), and new extended-spectrum β-lactamase (ESBL) isolates and on changes in resistance patterns of the HA-MRSA and ESBL organisms between the intervention and control hospitals. HA-CDI incidence did not change. HA-MRSA incidence increased significantly in the intervention hospital. The resistance of new ESBL isolates to amoxicillin/clavulanic acid and piperacillin/tazobactam decreased significantly in the intervention hospital; however, resistance to piperacillin/tazobactam increased after a return to the standard policy. The results question the value of antibiotic cycling to antibiotic stewardship.

Abstract Background To assess antimicrobial prescribing in a Northern Ireland hospital (Antrim Area Hospital (AAH)) and compare them with those of a hospital in Jordan (Specialty Hospital). Methods Using the Global-PPS approach, the present study surveyed patients admitted to the hospital in 2015, the prescribed antibiotics, and a set of quality control indicators related to antibiotics. Results Ultimately, 444 and 112 inpatients in the AAH and the Specialty Hospital, respectively, were surveyed. For the medical group, 165 inpatients were prescribed 239 antibiotics in the AAH, while 44 patients in the Specialty Hospital were prescribed 65 antibiotics. In relation to the surgical group, 34 inpatients treated for infection were prescribed 66 antibiotics in the AAH, while 41 patients in the Specialty Hospital treated for infection were prescribed 56 antibiotics. For the medical patients, the most frequently prescribed antibiotics in the AAH were a combination of penicillins (18.8%) and penicillins with extended spectrum (18.8%). For the surgical patients, the most frequently prescribed antibiotics in the AAH were imidazole derivatives (24.2%). For the medical and surgical patients in the Specialty Hospital, the most frequently prescribed antibiotics were third-generation cephalosporins (26.2 and 37.5%, respectively). In medical patients, compliance to guidelines was 92.2% in the Specialty Hospital compared to 72.0% in the AAH (p

A description and analysis is given of three Neogene odontocete caudal vertebrae that were bitten by the extinct megatooth sharks Carcharocles megalodon or Carcharocles chubutensis. The peduncular caudal vertebrae show bilateral gouge marks consistent with having been actively bitten and wedged between adjacent teeth of C. megalodon or C. chubutensis. None of the vertebrae show signs of healing. The occurrence of bite marks on distal caudals suggests active predation (vs. scavenging) in order to immobilize even relatively small prey prior to consumption.

How are lyrical emotions expressed in music? This paper explores the correlation between affect-carrying lyrics and musical features such as beat strength, duration, pitch height, consonance, and mode. Using computer-aided musicology software music21 and the NRC emotion lexicon, we conduct a corpus study on 1,895 folk and popular song lead-sheets encoded as MusicXML. The study reveals that metrical strength and note lengths are highly correlated with affects, while correlations of pitch height, consonance, and mode are in general less significant, at times contradicting previous research. Measurements of minor vs. major chordal context and tonal certainty, however, reveal certain previously unknown differences among emotional states. The paper uses a larger dataset of observations and gives greater values of significance than has appeared in symbolic corpus analysis of emotions in the past, and includes general discussions and directions for future work.

Medicines optimisation for those with respiratory conditions can have a significant impact on clinical outcomes and substantial efficiency gains for health care. Consultant pharmacists are experts working at the top of their specialism in four main pillars of practice, namely clinical care, leadership, education and training, and research and development. A consultant respiratory pharmacist has recently been appointed at a large Health and Social Care Trust in Northern Ireland to provide expert care and clinical leadership for the medicines optimisation agenda with regards to respiratory care in Northern Ireland. Alongside clinical practice, leadership, and service development, emphasis will be placed on monitoring and evaluating the work of the consultant respiratory pharmacist with a view to gathering the necessary evidence to support the case for further investment in such consultant pharmacist posts in the region. This short communication article outlines some of the clinical and economic factors associated with the decisions to invest in the consultant pharmacist model of care in Northern Ireland

Abstract Present-day terrestrial analogue sites are crucial ground truth proxies for studying life in geochemical conditions close to those assumed to be present on early Earth or inferred to exist on other celestial bodies (e.g. Mars, Europa). Although hypersaline sapropels are border-of-life habitats with moderate occurrence, their microbiological and physicochemical characterization lags behind. Here, we study the diversity of life under low water activity by describing the prokaryotic communities from two disparate hypersaline sapropels (Transylvanian Basin, Romania) in relation to geochemical milieu and pore water chemistry, while inferring their role in carbon cycling by matching taxa to known taxon-specific biogeochemical functions. The polyphasic approach combined deep coverage SSU rRNA gene amplicon sequencing and bioinformatics with RT-qPCR and physicochemical investigations. We found that sapropels developed an analogous elemental milieu and harbored prokaryotes affiliated with fifty-nine phyla, among which the most abundant were Proteobacteria, Bacteroidetes and Chloroflexi. Containing thirty-two candidate divisions and possibly undocumented prokaryotic lineages, the hypersaline sapropels were found to accommodate one of the most diverse and novel ecosystems reported to date and may contribute to completing the phylogenetic branching of the tree of life.

Human papillomavirus (HPV) infection is associated with the vast majority of cervical cancer cases as well as with other anogenital cancers. PepCan is an investigational HPV therapeutic vaccine for treating cervical high-grade squamous intraepithelial lesions. The present study was performed to test whether the cervical microbiome influences vaccine responses and to explore host factors as determinants of the cervical microbiome composition in women with biopsy-proven high-grade squamous intraepithelial lesions. In a recently completed Phase I clinical trial of PepCan, histological response rate of 45% (14 of 31 patients), a significant increase in circulating T-helper type 1 cells, and a significant decrease in HPV 16 viral load were reported. DNA, extracted from liquid cytology specimens collected before and after vaccinations, were amplified and then hybridized to a G4 PhyloChip assay to characterize the microbiome. We describe trends that certain bacterial taxa in the cervix may be enriched in non-responders in comparison to responders ( P adj = .052 for phylum Caldithrix and P adj = .059 for phylum Nitrospirae ). There was no difference in bacterial diversity between the 2 groups. A permutational analysis of variance performed for various demographic and immune parameters showed significant clustering with microbiome beta diversity for race, HPV 16 status, peripheral T-helper type 1 cells, and HLA-B40 ( P = .001, .014, .037, and .024, respectively). Further analyses showed significant differences at the empirical Operational Taxonomic Unit level for race and HPV 16 status. As these results are from a small Phase I study, further studies are needed to examine the role of cervical microbiome in response to HPV therapeutic vaccines.