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IntroductionThe issue of the impact of religion and spirituality on mental health is a phenomenon which has recently become increasingly more accentuated. Despite the attention given to the topic, many questions still remain as to whether and how religion and spirituality affect a person’s mental wellbeing. In the text below, we have focused on examining the relationship between religion and spirituality and mental health among young adults in the Czech Republic. Research also explored the idea that forgiveness can be viewed as a component of religion or spirituality.Materials and methodsThe research project was executed in close cooperation with STEM/MARK, a renowned data collection agency. The methodological framework was constructed with a dual focus: leveraging standardized questionnaires to ensure data reliability and comparability while also incorporating tailored questions that delve into the participants’ socioeconomic status (SES) and background details. The study unfolded across four online sessions, a format chosen for its convenience and effectiveness in facilitating participant engagement while accommodating our respondents’ diverse schedules. The total sample approached comprised of 270 young adults that expressed certain form of religiosity.ResultsForgiveness and the depth of one’s personal religious or spiritual history emerged as the most influential factors. Forgiveness was significantly associated with an increase in self-blame (positively), and decrease in refocusing, planning (both negatively), and putting things into perspective (negatively) (Beta = 0.25, Beta = −0.06, and Beta = −0.16, respectively). In contrast, a deeper personal religious history was positively associated with self-blame, rumination, and refocusing (Beta = 0.22, Beta = 0.13, and Beta = 0.15, respectively).ConclusionThe finding that forgiveness may be a risk factor associated with regularly elevated depressive symptoms, stress, and maladaptive coping strategies such as self-blame and ruminating over problems, while negatively affecting physical, psychological, and environmental quality of life, clearly points to the need to examine the inner aspects of individual religions and spiritualities. These findings suggest that religious and spiritual beliefs may play a key role in how people experience and manage the emotional burdens and difficulties of life.

Sleep hygiene is essential for the prevention of somatic and mental disorders, including the prevention of sleep disorders. However, it does not typically address individual differences. The aim of this review is threefold: first, to outline the empirical evidence for particular components of sleep hygiene rules; second, to indicate the importance of individualized sleep hygiene application with regard to the varying degree of validity of sleep hygiene rules in the population; third, to highlight a new field of sleep hygiene, namely light hygiene. PubMed and Google Scholar were used to identify studies that were published between 2007 and 2022. A search was conducted for studies related to sleeping rules topics: sleep regularity, regular exercise, alcohol, caffeine, napping, relaxation and meditation, food intake and light exposure. In applying these sleep hygiene principles, it is essential to pay attention to individual variables such as age, genetic predisposition, health status, and substance (caffeine, alcohol) possible dependence.

Electroconvulsive therapy (ECT) is an important treatment modality in psychiatry, considered to be the most effective option for pharmaco-resistant affective and psychotic disorders. Despite its great efficacy, it still remains a rather controversial method, which hinders its full potential. It is feasible to say that in part, this controversy is caused by a largely negative image of ECT displayed through media. The depiction of ECT in movies has been studied and well documented in the past. The aim of our study was to provide an overview of how ECT is represented in video games - a form of media where ECT representation has been overlooked in scientific literature so far. As with movies, most of these portrayals are negative, depicting ECT as an obsolete, aggressive or torturous treatment method.

Introduction: Young adulthood is a transitional period between adolescence and adulthood. Due to the unique pressures of taking on a new social role and associated uncertainties, young adults are at heightened risk for drug and alcohol use. Furthermore, adverse childhood experiences (ACEs) increases the likelihood of using maladaptive coping strategies such as using substances to avoid or soothe negative emotions. The current review aimed to summarize the associations between exposure to ACEs before the age of 18 years and subsequent drug or alcohol use between the ages of 18 and 25 years. Methods: The review was performed in accordance with the 2020 Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The literature search of the Web of Science, PubMed, and PsycINFO databases was conducted in February 2022. Results: The initial search yielded 7178 articles, with 777 duplicates. Consequently, 6401 titles were inspected for relevance. After reading the full text, 88 articles were included in the review. Conclusion: This review provides clear evidence that exposure to multiple ACEs is a robust risk factor for the use of alcohol, cannabis and other drugs by young adults. Poor self-regulation and maladaptive coping strategies were identified as mechanisms explaining this link; however, further detailed research is needed.

The bacterial origin of mitochondria has been a widely accepted as an event that occurred about 1.45 billion years ago and endowed cells with internal energy producing organelle. Thus, mitochondria have traditionally been viewed as subcellular organelle as any other – fully functionally dependent on the cell it is a part of. However, recent studies have given us evidence that mitochondria are more functionally independent than other organelles, as they can function outside the cells, engage in complex “social” interactions, and communicate with each other as well as other cellular components, bacteria and viruses. Furthermore, mitochondria move, assemble and organize upon sensing different environmental cues, using a process akin to bacterial quorum sensing. Therefore, taking all these lines of evidence into account we hypothesize that mitochondria need to be viewed and studied from a perspective of a more functionally independent entity. This view of mitochondria may lead to new insights into their biological function, and inform new strategies for treatment of disease associated with mitochondrial dysfunction.

IntroductionBurnout syndrome is a state of long-term work exhaustion that manifests on three levels: cognitive, physical and emotional. Research regarding burnout syndrome has spiked in recent years. Despite burnout syndrome not being a clinical diagnosis, it has been recognized as a significant reason for work absence or, in some cases, even work leave. This study examines trends in burnout in the Czech population. The main aim of this research was to fill in the burnout literature gap and document the burnout trend over the years. Our secondary aim was to see if there is awareness regarding burnout syndrome and whether, over the years, we will see an increasing or a decreasing trend in burnout prevalence.MethodsData collection took place in three waves using the computer assisted web interviewing (CAWI) method. In 2014 n = 1,027, in 2017 n = 1,024, and in 2020 n = 1,000. Respondents were selected from the European National Panel. Because the target group was adults (18–65 years), an online survey was chosen. Internet penetration in this target population is sufficient, and it was not necessary to use a combination of methodologies.ResultsThe results suggest a decreasing tendency for burnout syndrome in the Czech Republic. Knowledge about burnout syndrome is increasing, suggesting that people are paying more attention to their mental health and the possible factors that might affect the severity of burnout syndrome.ConclusionOverall, burnout threatens the general population, not only medical employees. It is a positive finding that over the years, there has been an increasing trend in awareness about burnout. It further shows that people have adopted certain precautions and steps to avoid burnout syndrome as the perceived threat from it gradually decreases.

Celiac disease is a chronic autoimmune gastroenterological disorder in which the digestion of gluten leads to damage and constant inflammation in the small intestine. Moreover, there are associated physical and mental health problems related to celiac disease, i.e., a lower health-related quality of life and increased depression and anxiety symptoms. The only effective treatment for celiac disease is lifelong adherence to a gluten-free diet. However, researchers suggest that strict adherence to a gluten-free diet ranges from 42 to 80%, depending on the definition and method of assessment that was utilized. This review examines interventions designed for those who need to adhere to life-long dietary measures and their success in terms of increasing gluten-free dietary adherence and improving their health-related quality of life. In April 2022, the Scopus, Web of Science, PubMed and ProQuest databases were searched using the following terms: “coeliac disease” OR “celiac disease” AND “gluten free diet” AND “intervention” AND “health related quality of life” AND “diabetes.” Eight studies were suitable for this review. The studies were used to analyze different intervention techniques and their impact on gluten-free dietary adherence, quality of life, and the reasons for dietary nonadherence. The studies revealed statistically significant improvements in the knowledge base regarding celiac disease and the gluten-free diet, dietary adherence and quality-of-life satisfaction immediately after the intervention and at a three-month follow-up. Some studies were also focused on behavioral and cognitive aspects of nonadherence to dietary measures.

In this paper, we monitored the accuracy of non-navigated application of repetitive Transcranial Magnetic Stimulation (rTMS) in 10 patients suffering from orofacial pain by using functional magnetic resonance (fMRI), computer modeling and numerical simulation. Through a unique process, each fMRI scan was used to define a Region of Interest (ROI) where the source of the orofacial pain was located, which was to be stimulated using rTMS. For each patient, MRI scans with a spatial resolution of 0.7 mm were converted into an anatomically accurate head model. The head model including the ROI was then co-registered with a model of the stimulation coil in an electromagnetic field numerical simulator. The accuracy of rTMS application was evaluated based on the calculations of electric field intensity distribution in the ROI. The research has yielded unique insight into ROIs (with average volume 904 mm3) in patients with orofacial pain and has also extended further possibilities of human head MRI image semi-automatic segmentation. According to the calculations performed, the average ROI volume that was stimulated by an electric field with an intensity of over 80 V/m was only 4.4%, with the maximum ROI volume being 20.5%. Furthermore, a numerical study of the impact of coil rotation and translation was performed. It demonstrated a) the optimal placement of the stimulation coil can significantly increase the volume of the stimulated ROI up to 60% and b) patients with orofacial pain would need precise coil positioning with a navigation error lower than 10 mm. Due to an acceptable proccessing time of up to 6 hours, described numerical simulation opens up new options for precise rTMS treatment planning. This planning platform together with patient-specific navigated rTMS, could lead to significant increase of treatment outcomes in patients suffering from orofacial pain.

Mitochondria are complex endosymbionts that evolved from primordial purple nonsulfur bacteria. The incorporation of bacteria-derived mitochondria facilitates a more efficient and effective production of energy than what could be achieved based on previous processes alone. In this case, endosymbiosis has resulted in the seamless coupling of cytochrome c oxidase and F-ATPase to maximize energy production. However, this mechanism also results in the generation of reactive oxygen species (ROS), a phenomenon that can have both positive and negative ramifications on the host. Recent studies have revealed that neuropsychiatric disorders have a pro-inflammatory component in which ROS is capable of initiating damage and cognitive malfunction. Our current understanding of cognition suggests that it is the product of a neuronal network that consumes a substantial amount of energy. Thus, alterations or perturbations of mitochondrial function may alter not only brain energy supply and metabolite generation, but also thought processes and behavior. Mitochondrial abnormalities and oxidative stress have been implicated in several well-known psychiatric disorders, including schizophrenia (SCZ) and bipolar disorder (BPD). As cognition is highly energy-dependent, we propose that the neuronal pathways underlying maladaptive cognitive processing and psychiatric symptoms are most likely dependent on mitochondrial function, and thus involve brain energy translocation and the accumulation of the byproducts of oxidative stress. We also hypothesize that neuropsychiatric symptoms (e.g., disrupted emotional processing) may represent the vestiges of an ancient masked evolutionary response that can be used by both hosts and pathogens to promote self-repair and proliferation via parasitic and/or symbiotic pathways.

BackgroundAdolescents are most at risk of engaging in violent interaction. Targeting violence risk and protective factors is essential for correctly understanding and assessing their role in potential violence. We aimed to use the Structured Assessment of Violence Risk in Youth (SAVRY) tool within the sample of adolescents to capture violence risk and protective factors and personality variables related to risk and protective factors. We further aimed to identify which violence risk and protective factors were positively or negatively related to violence within personal history and if any personality traits are typical for violent and non-violent adolescents. Identifying broader or underlying constructs within the SAVRY tool factor analysis can enable appropriate therapeutic targeting.MethodsWe used the Czech standardized version of the SAVRY tool. The study sample comprised 175 men and 226 women aged 12–18 years divided into two categories according to the presence or absence of violence in their personal history. Mann-Whitney U test was used to compare numerical variables between the two groups. SAVRY factor analysis with varimax rotation was used to determine the item factors. We administered the High School Personality Questionnaire (HSPQ) to capture adolescents’ personality characteristics.ResultsIn our sample, there were 151 participants with violence in their personal histories and 250 non-violent participants. Non-violent adolescents had higher values for all six SAVRY protective factors. The strongest protective factor was P3, Strong attachment and bonds across gender or a history of violence. Using factor analysis, we identified three SAVRY internal factors: social conduct, assimilation, and maladaptation. The SAVRY protective factors were significantly positively related to several factors in the HSPQ questionnaire.ConclusionThe results highlight the significance of protective factors and their relationship with violence prevalence. HSPQ diagnostics could be helpful in clinically targeting personality-based violence risks and protective factors. The therapeutic focus should be on tension, peer rejection, and anxiety. It is also essential to foster positive attitudes toward authority, prosocial behavior, and attitudes toward school. These strategies can help strengthen protective factors of the SAVRY.

IntroductionTinnitus is an intrusive and chronic illness affecting a significant portion of the population, decreasing affected individuals’ quality of life and socioeconomic functioning. Transcranial Direct Current Stimulation (tDCS) is a non-invasive neuromodulatory method utilizing weak electrical currents to elicit short and long-term central nervous system changes. Several studies have proven its effect on tinnitus. We aimed to broaden the knowledge and provide data on the effect and its retention.MethodsIn the randomized, double-blinded, sham-controlled trial, 39 patients (active n = 19, sham n = 20) underwent bifrontal tDCS (anode over right dorsolateral prefrontal cortex (DLPFC), cathode left DLPFC, current of 1.5 mA, 20 min, 6 sessions in 2 weeks). Tinnitus Functional Index (TFI), Iowa Tinnitus Handicap Questionnaire (ITHQ), Beck Anxiety Inventory (BAI), Zung Self-Rating Depression Scale (SDS), and WHO-Quality of Life-BREF were employed in 4 evaluation points, including the follow-ups of 6 weeks and 6 months.ResultsWe reached a delayed, significant long-term improvement (p < 0.05) in auditory difficulties associated with tinnitus and noticed it even after 6 months compared to placebo. We also reached a short-term, negative effect in the psychological domain of WHO-Quality of Life-BREF (p < 0.05). Not all subdomains of TFI and ITHQ reached statistical significance during the data analysis, even though specific positive trends were noticed.ConclusionWe proved partial, positive, long-term effects of tDCS on tinnitus and short-term, negative, transient effect on a specific aspect of the general quality of life. We expanded upon the results of previous trials and provided data concerning the longevity and the precise effect of multiple sessions, bifrontal DLPFC tDCS. Our sample size (n = 39) was limited, which might have contributed to the lesser statistical power of the analyzed items.Clinical trial registration[www.ClinicalTrials.gov], identifier [NCT05437185].

Artificial Intelligence (AI), which is the general term used to describe technology that simulates human cognition [...]

Video games represent a rapidly growing media form that is a daily activity for many youths. So far, only a little attention has been paid to the portrayal of mental illnesses and psychiatric intervention within them. In our research, we explored the best-selling video games released between 2002–2021 in order to analyse these representations. We came to the conclusion that approximately 1 out of 10 popular games attempts to portray symptoms of mental illness – with a majority of 75% of them in a negative and stereotypical way. Despite the majority of mental illness depiction in popular video games being negative, there are mounting reports that certain representations have a positive impact on their player bases. Further studies are required, as to how much videogames influence the player's attitude toward this topic.

ObjectiveThe study aim was to assess the psychometric properties of the ASRS in the Czech Republic. Although this screening tool is now frequently used, its validity has not been assessed among the general Czech population.MethodsThe ASRS and WURS were administered online to the general Czech population (N = 1,518). We performed confirmatory and exploratory factor analyses.ResultsFor the ASRS, confirmatory factor analysis showed good fit for the screening part (SRMR = 0.03, RMSEA = 0.06, CFI = 0.98). For the symptom list, the fit was good according to the SRMR, acceptable according to the RMSEA, and slightly below acceptable according to the CFI. For the WURS, the results showed SRMR = 0.06, RMSEA = 0.07, and CFI = 0.92.ConclusionThe Czech translation of the ASRS is appropriate and has acceptable psychometric properties. However, we strongly recommend only using this tool together with clinical judgment.

Background: Anorexia nervosa (AN) is a life-threatening illness with poor treatment outcomes. Although transcranial direct current stimulation (tDCS) is a promising non-invasive brain stimulation method, its effect in patients with AN remains unclear.Objective: This study investigated changes in maladaptive eating behavior, body mass index (BMI), and depression after 10 sessions of anodal tDCS over the left dorsolateral prefrontal cortex (DLPFC).Methods: In this double-blind, randomized controlled trial, 43 inpatients with AN were divided to receive either active (n = 22) or sham (n = 21) tDCS over the left DLPFC (anode F3/cathode Fp2, 2 mA for 30 min). All patients filled the Eating Disorder Examination Questionnaire (EDE-Q) and Zung Self-Rating Depression Scale (ZUNG), and their BMI was measured. These values were obtained repeatedly in four stages: (1) before tDCS treatment, (2) after tDCS treatment, (3) in the follow-up after 2 weeks, and (4) in the follow-up after 4 weeks.Results: Primary outcomes (EDE-Q) based on the ANOVA results do not show any between-group differences either after the active part of the study or in the follow-up. Secondary analysis reveals a reduction in some items of EDE-Q. Compared with sham tDCS, active tDCS significantly improved self-evaluation based on body shape (p < 0.05) and significantly decreased the need of excessive control over calorie intake (p < 0.05) in the 4-week follow-up. However, the results do not survive multiple comparison correction. In both sham and active groups, the BMI values improved, albeit not significantly.Conclusion: We did not observe a significant effect of tDCS over the left DLPFC on complex psychopathology and weight recovery in patients with AN. tDCS reduced the need to follow specific dietary rules and improved body image evaluation in patients with AN. Tests with a larger sample and different positions of electrodes are needed.Clinical Trial Registration:www.ClinicalTrials.gov, identifier: NCT03273205.

The safety and efficacy of electroconvulsive therapy (ECT) in patients with a brain tumor have been debated in the past without a clear conclusion. In the last large review published by Maltbie et al. in 1980, it was concluded that the presence of an intracranial mass should be considered an absolute contraindication to ECT. In our updated review, we investigated a total of 33 published and indexed case reports, case report series, and reviews of 75 individual patients who underwent ECT in the presence of a brain tumor over the last 80 years. Mounting case reports after the original Maltbie et al. review show that it is feasible to apply this method safely in patients with benign or otherwise clinically insignificant lesions. Certain precautionary measures, such as dexamethasone or phenytoin application before ECT, could lead to a further minimalization or even absence of adverse effects, particularly in higher risk individuals.

IntroductionAttention deficit hyperactivity disorder (ADHD) is one of the most common neurodevelopmental disorders, affecting individuals in all stages of their lives and leading to a variety of negative quality of life outcomes. The disorder is associated with marked differences related to time perception and time perspectives, and this area of research is currently becoming more prominent and gaining ground in showing new aspects of ADHD that were considered secondary (i.e., time perception differences, affective differences). In this study, we looked at ADHD symptoms in adults, correlated lifestyles, and time perspectives as defined by the Zimbardo Time Perspective Inventory (ZTPI). The ZTPI is a useful standardized scale to measure one’s time perspective anchoring in the categories of past positive, past negative, present fatalistic, present hedonistic, and future oriented. This is the first study on adult ADHD and time perspectives conducted in the Czechia.MethodologyA national representative sample of Czech adults aged 18–65 was recruited by the STEM/MARK Agency. The individuals were assessed for ADHD symptoms with the Adult ADHD Self-Report Scale (ASRS v.1.1). Furthermore, a demographic and lifestyle questionnaire was administered along with the ZTPI to assess time perspectives. Statistical calculations were conducted to find correlations between ADHD symptoms as assessed by the ASRS and the various categories of the ZTPI.ResultsADHD symptoms were found to be positively correlated with the present hedonistic perspective along with the past negative perspective. Gender was a strong factor in both ADHD symptoms, with males being more likely to show symptoms and to have a present hedonistic perspective. In females, the past negative perspective was most prominent. Education and age were negatively correlated with ADHD symptomatology and the present hedonistic perspective also decreased with age unlike the past negative perspective. Other time perspectives such as future orientation was seen in individuals with lower ADHD symptoms and higher levels of educational achievement.ConclusionResearching ADHD symptoms and their connection to time perspectives can increase knowledge of both the disorder and how time perspectives tie into it. We wish to also raise awareness of the possible utility of the ZTPI scale when working with individuals with ADHD.

The relationship between tDCS (transcranial direct current stimulation) and its influence on glycemia has been the aim of limited research efforts. Usually, the focus has been set on lowering the blood sugar level or interference with insulin resistance, but also the treatment of diabetic polyneuropathy and pain management. In this case report, we outline the development of hyperglycemia and the following onset of type I diabetes during a series of tDCS in a 24-year old Caucasian female patient treated with our research protocol (10 sessions; 2 mA; 30 min; the anode over F3; the cathode over Fp2) for anorexia nervosa.

This study examined the psychometric properties of the Czech translation of the Vanderbilt ADHD Diagnostic Parent Rating Scale (VADPRS), a tool used to assess ADHD symptoms. Data was collected online from parents of school-aged children and included questions related to their child's diagnosis or treatment. The results showed that while relying on professional judgment improved specificity and positive predictive value, it decreased negative predictive value. These findings indicate that the VADPRS scale is more accurate in identifying individuals with ADHD when professionals provide the diagnosis, but fewer true negatives are found. This is the first study attempting to describe the psychometric properties of this tool in the Czech Republic and assess its use as an additional tool for ADHD diagnosis. It is recommended that structured clinical interviews be used to increase the accuracy of ADHD diagnosis.

Litter decomposition is an important factor affecting local and global C cycles. It is known that decomposition through soil microbial activity in ecosystems is mainly influenced by soil type and climatic conditions. However, for agroecosystems, there remains a need for a better understanding of how management practices influence litter decomposition. This study examined the effect of different management practices on decomposition at 29 sites with long-term (mean duration of 38 years) field experiments (LTEs) using the Tea Bag Index (TBI) protocol with standard litter (rooibos and green tea) developed by Keuskamp et al. (2013). The objective was to determine if the TBI decomposition rate (k) and stabilization factor (S) are sensitive enough to detect differences in litter decomposition between management practices as well as how they interact with edaphic factors, crop type and local climatic conditions. Tea bags were buried and collected after ∼90 d at 16 Austrian and 13 Swedish sites. The treatments in the Austrian LTEs focused on mineral and organic fertilizer application, tillage systems and crop residue management, whereas those in Sweden addressed cropping systems, mineral fertilizer application and tillage systems. The results for Austria showed that the incorporation of crop residue and high-N fertilizer application increased k , compared with crop residue removal and low or no N application, respectively. Minimum tillage had significantly higher k compared with reduced and conventional tillage. In Sweden, fertilized plots showed higher S than non-fertilized plots and high-N fertilizer had the highest k. Growing spring cereal led to higher k than forage crops. Random forest regressions for Austria and Sweden jointly showed that k and S were mainly governed by climatic conditions, which explained more than 70 % of their variation. However, under similar climatic conditions, management practices strongly influenced decomposition dynamics. It would be appropriate to apply the TBI approach to a more large-scale network using LTEs for agroecosystems, in order to improve the index's usefulness as an indicator of the effect of management practices on litter decomposition dynamics, particularly linking it with the potential for C storage. [ABSTRACT FROM AUTHOR]

In this study, a solar dryer incorporating a flat plate heat exchanger to recover heat from exhaust air was investigated to explore the usability of different types of collectors in the system. Their usability was further evaluated through economic and environmental analyses. Moreover, the thermodynamic performance of the solar dryers was evaluated under two weather conditions in Nepal. Apple drying experiments were conducted for 8 h from 09:00 to 17:00 from February to April 2023 on solar dryers and with open sun drying (OSD) in Dhulikhel, Nepal. The results showed that the low emissivity (low-e) coated aluminum collector was more efficient in terms of collector efficiency and drying rate than collectors with flat or v-corrugated GI absorbers. The average collector efficiency and drying rate were found to be 89 % and 107 g/(h × m2) using the low-e coated aluminum collectors, while the values were 50 % and 84 g/(h × m2) for the GI sheet collector. The results indicated a slight improvement in the performance of v-corrugated collectors, with values of 53 % and 89 g/(h × m2). The drying rate for OSD was found to be 78 g/(h × m2), which was lower than for the dryers with all collectors used in this study. In terms of economic analysis, the dryer equipped with the low-e coated collector was found to be superior, with a payback time of 1.61 years compared to the dryers with flat or v-corrugated GI collectors. Reducing the thermal losses due to radiation by using the low-e coated absorber was shown to be more important than increasing the absorber area using v-corrugated GI sheets.

The successful economic performance of Pacific Asia is often held as a source of inspiration for aspiring catching-up countries. Notwithstanding, recent literature suggests that a key to the understanding of successful long-term economic performance lies not only in the ability to generate economic growth, but in limiting incidences of economic shrinking. Such analyses to explain the Asian economic miracle are however in short supply. This study highlights the significance of economic shrinking in Asia in a comparative perspective to demonstrate how and why resilience to economic shrinking was a significant aspect of the successful development of the region. To approach the question of why some countries became more resilient than others we propose a social capability framework and apply it to a sample of 26 developing countries between 1964 and 2018. We construct a social capability index on which we develop a set of simple OLS regressions to estimate the impact of social capabilities on shrinking patterns. We demonstrate that poorly endowed countries do not lack the ability to generate growth, but their limited resilience prevents them from catching up.

An immunosuppressive tumor microenvironment promotes tumor growth and is one of the main factors limiting the response to cancer immunotherapy. We have previously reported that inhibition of vacuolar protein sorting 34 (VPS34), a crucial lipid kinase in the autophagy/endosomal trafficking pathway, decreases tumor growth in several cancer models, increases infiltration of immune cells and sensitizes tumors to anti‐programmed cell death protein 1/programmed cell death 1 ligand 1 therapy by upregulation of C‐C motif chemokine 5 (CCL5) and C‐X‐C motif chemokine 10 (CXCL10) chemokines. The purpose of this study was to investigate the signaling mechanism leading to the VPS34‐dependent chemokine increase. NanoString gene expression analysis was applied to tumors from mice treated with the VPS34 inhibitor SB02024 to identify key pathways involved in the anti‐tumor response. We showed that VPS34 inhibitors increased the secretion of T‐cell‐recruitment chemokines in a cyclic GMP‐AMP synthase (cGAS)/stimulator of interferon genes protein (STING)‐dependent manner in cancer cells. Both pharmacological and small interfering RNA (siRNA)‐mediated VPS34 inhibition increased cGAS/STING‐mediated expression and secretion of CCL5 and CXCL10. The combination of VPS34 inhibitor and STING agonist further induced cytokine release in both human and murine cancer cells as well as monocytic or dendritic innate immune cells. Finally, the VPS34 inhibitor SB02024 sensitized B16‐F10 tumor‐bearing mice to STING agonist treatment and significantly improved mice survival. These results show that VPS34 inhibition augments the cGAS/STING pathway, leading to greater tumor control through immune‐mediated mechanisms. We propose that pharmacological VPS34 inhibition may synergize with emerging therapies targeting the cGAS/STING pathway.

Most of the district heating systems today use higher operating temperatures than those in new-built systems, possibly limiting compatibility with solar energy. This study evaluates the cost-effectiveness in terms of unit heat cost of integrating solar heating into an existing district heating system compared to not using solar energy, under changing economic boundary conditions such as collector and fuel cost, in addition to discount rate. This is investigated for both a scenario where the solar heating and a boiler replacement is done concurrently, as well as a scenario where solar heating is added to an existing system without replacing the boiler. A theoretical district heating supply of 3 MW is modelled and simulated based on a real system and load profile. The heat supply is varied to include storage with or without solar heating. Results for a 3 % discount rate indicate that; Replacing a 3 MW boiler with a slightly smaller boiler of 2.5 MW and adding a storage is cost effective and yields a unit heat cost of 58.0 EUR/MWh (16.1 EUR/TJ) which is a reduction of about 6 %. Installing solar heating together with the boiler replacement yields a unit heat cost as low as 55.7 EUR/MWh (15.4 EUR/GJ) which is a reduction of about 8 %. When replacing the boiler, all system configurations have similar unit heat costs compared to a boiler-only system, so factors such as emission reductions due to solar heating are relevant when considering alternatives. Furthermore, adding solar flat plate collectors corresponding to a 13 % solar fraction without replacing the boiler can reduce the unit heat cost as low as 34.8 EUR/MWh (9.7 EUR/TJ), which is 32 % lower than without solar. Evacuated tube collectors can increase this solar fraction to 17 % with similar system size, although at a higher cost. At a discount rate of 5 % solar heating is cost-competitive when fuel cost is above 26 EUR/MWh (7.2 EUR/TJ) and at 7 % competitive when fuel cost is above 32 EUR/MWh (8.9 EUR/TJ). Increasing solar heating system size reduces the backup-boiler fuel use during summer maintenance and makes fuel type less relevant for the overall unit heat cost.

Abstract Introduction There is increasing pressure to use environmentally friendly dry powder inhalers (DPI) instead of pressurized metered-dose inhalers (pMDI). However, correct inhalation technique is needed for effective inhaler therapy, and there is persistent concern whether patients with chronic obstructive pulmonary disease (COPD) can generate sufficient inspiratory effort to use DPIs successfully. The aims of this study were to find clinical predictors for peak inspiratory flow rate (PIF) and to assess whether patients with COPD had difficulties in generating sufficient PIF with a high resistance DPI. Methods Pooled data of 246 patients with COPD from previous clinical trials was analyzed to find possible predictors of PIF via the DPI Easyhaler (PIFEH) and to assess the proportion of patients able to achieve an inhalation flow rate of 30 l/min, which is needed to use the Easyhaler successfully. Results The mean PIF was 56.9 l/min and 99% (243/246) of the study patients achieved a PIF ≥ 30 l/min. A low PIF was associated with female gender and lower forced expiratory volume in 1 s (FEV1), but the association was weak and a statistical model including both only accounted for 18% of the variation seen in PIFEH. Conclusions Based on our results, impaired expiratory lung function or patient characteristics do not predict patients’ ability to use DPIs in COPD; 99% of the patients generated sufficient PIFEH for successful dose delivery. Considering the targets for sustainability in health care, this should be addressed as DPIs are a potential option for most patients when choosing the right inhaler for the patient. Trial Registration Two of three included trials were registered under numbers NCT04147572 and NCT01424137. Third trial preceded registration platforms and therefore, was not registered.