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Teamwork in graduate medical education (GME) is often hindered in clinical learning environments where discontinuity among residents, supervisors, and other health care professionals is typical. Teaming is a conceptual approach to teamwork in dynamic environments with constantly changing team members and goals. Teaming is built on principles of project management and team leadership, which together provide an attractive strategy for addressing teamwork challenges in GME. Indeed, teaming is now a requirement of the Accreditation Council for Graduate Medical Education Clinical Learning Environment Review program. However, many clinician-educators and leaders may be unfamiliar with teaming and how to integrate it into their GME programs. In this article, the teaming framework is described with a specific example of how it can be applied to improve hospital ward rounds, a common setting of teamwork breakdown. The goal of this article is to educate and encourage GME leaders as they learn new ways to implement teaming to improve patient care and education in their programs.

Surface water change is a very important indicator for environmental, climatic, and anthropogenic activities. The sediment brought by the stream into the reservoir starts settling down and gets deposited on the bed of the reservoir at all levels. The finer particles are carried in suspension and settle down on the reservoir floor while some of these are passed over the spillway towards the downstream of a dam. If the concentration is high, density current occurs along the floor of the reservoir. The purpose of this study is to assess the sedimentation of the Poondi Reservoir using Satellite Remote-Sensing (SRS). This helps in providing full utilization capacity of reservoir by providing more storage and supply of fresh water to the catchment area. The sedimentation assessment was carried out using satellite data and reservoir water level data from 2000 to 2020. Water spread area was analyzed from satellite data. The NDWI has been used to delineate open water features and to enhance the presence of water surface and linear interpolation/extrapolation technique has been applied for water spread area at different elevation. Further, these areas were used to compute live storage capacity of reservoir between two elevations by Prismoidal formula.

Objective: To explore dietary salt-related knowledge, attitudes, and behaviors of New Zealand (NZ) adults aged 18-65 years and assess differences by demographic subgroups., Design: Cross-sectional online survey conducted between June 1, 2018 and August 31, 2018., Setting: Participants were recruited in shopping malls, via social media, and a market research panel., Participants: English-speaking adults residing in NZ., Variables Measured: An amended version of The Pan American and World Health Organization Knowledge, Attitudes, and Behaviors standardized survey tool was used. Demographic data (age, sex, ethnicity, and educational attainment) were also collected., Analysis: Descriptive statistics reported. Chi-square test for independence to assess differences by demographics., Results: The survey was completed by 1,131 adults (mean age 36 ± 15 years; n = 876 [78%] female; n = 661 [78%] NZ European/other; n = 210 [19%] Asian; n =164 [15%] Māori). In addition, 865 participants (83%) knew the primary dietary source of salt; 406 (40%) knew the recommended salt intake; 946 (95%) believed food manufacturers are responsible for sodium reduction; 563 (55%) supported government regulations; and 259 (26%) used food labels. Females and NZ European/other participants reported more favorable salt-reducing behaviors, such as avoiding fast-food and packaged, ready-to-eat foods (P < 0.001)., Conclusions and Implications: Improving salt-related knowledge, attitudes, and behaviors in NZ is particularly important for men, underserved populations, and adults aged 45-65 years. A multicomponent, national NZ salt reduction program based on research addressing engagement and effectiveness for at-risk groups is warranted., Competing Interests: CONFLICT OF INTEREST DISCLOSURE The authors have not stated any conflicts of interest., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)

Electrospun nanofiber scaffolds have become vital in biomedical applications due to their high surface area and tunable properties. Chitosan (CS) is widely used, but its rapid degradation limits its effectiveness. This study addresses this limitation by blending CS with polycaprolactone (PCL) and applying genipin cross-linking to enhance its stability and mechanical properties. Scanning electron microscopy indicated a uniform morphology of the electrospun fibers, and further, the crystallinity of the scaffolds before and after cross-linking is verified. Fourier-transform infrared spectroscopy is used to analyze the chemical structure, identifying the presence of trifluoroacetic acid residues in the as-spun fibers. These residues are successfully eliminated through neutralization and cross-linking, which are critical for enhancing stability and cell viability in in-vitro studies. Mechanical testing revealed that cross-linked CS+PCL scaffolds exhibit a 350% increase in tensile strength compared to pure CS, and zeta potential reaches the favorable for cell development -26.27 mV. The cytotoxicity assay results with murine NIH 3T3 fibroblast cells indicate the suitability of CS+PCL scaffolds for targeted tissue engineering and wound healing. This work establishes the potential for fine-tuning scaffold properties to create stable, functional, and biocompatible substrates for extended biomedical use., (© 2024 The Author(s). Macromolecular Rapid Communications published by Wiley‐VCH GmbH.)

Objective: DBP is associated with atherosclerosis and cardiovascular disease, independent of SBP. However, prior evaluation of the association of DBP with coronary artery calcium (CAC) has not included South Asian adults, a population that is at excess risk of atherosclerotic cardiovascular disease., Methods: In the Mediators of Atherosclerosis in South Asians Living in America (MASALA) Study, we evaluated the association of sex-specific DBP tertiles and CAC score at least 100 with robust Poisson regression adjusted for age, sex, SBP, BP medication use, and other cardiovascular risk factors. We examined these associations stratified by antihypertensive medication use, and secondarily the association of baseline DBP tertile with incident CAC at least 100 over median 4.7 years of follow-up., Results: Among 1155 participants (48% women, mean age 57 years), mean (standard deviation) DBP was 74 (10) mmHg, 33% were on antihypertensive medications, and 22% had CAC at least 100. Relative to DBP in tertile 1, DBP in tertiles 2 and 3 was associated with a significantly higher prevalence of CAC at least 100 [adjusted prevalence ratio 1.30 [95% confidence interval (CI) 1.03-1.65] and 1.47 (1.12-1.93), respectively]. These significant associations were primarily observed in participants who were not on antihypertensive medications. Baseline DBP tertile was not associated with incident CAC at least 100., Conclusion: Among South Asian adults in MASALA, DBP in the second or third tertiles vs. tertile 1 were associated with a higher prevalence of CAC at least 100 after adjustment for covariates including SBP. DBP may be an important clinical ASCVD risk factor among South Asian adults., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

Background and Aim: The COVID-19 pandemic necessitated the transition to online medical education. This study evaluated the efficacy of online case-based tutorials using a serious game tutorial [PlayMed™ (PM)], as compared to a traditional slideshow tutorial (TT)., Methods: We performed a prospective, mixed-methods, randomised controlled trial on undergraduate medical students during the COVID-19 pandemic, from May 2020 to January 2021. Students were block randomised into the PM or TT groups. Tutors conducted online teaching on bronchiolitis and gastroenteritis cases using PM or TT to facilitate the presentation. Educational experience was assessed using a continuous interval scale (0-100; with pre-defined categories) and free text responses. Immediate and long-term knowledge acquisition was assessed using 6 multiple-choice questions (MCQ) for each case (total of 12 MCQ). A modified intention-to-treat mixed methods and a sensitivity per-protocol analysis were performed to compare outcomes between PM and TT groups., Results: In total, 80 PM and 73 TT participants attended at least one tutorial. Sixty-five (81%) PM and 52 (71%) TT participants completed at least one survey and were included for analysis. PlayMed™ students had an increased likelihood of completing the surveys, which included the MCQ [odds ratio (95% CI) of 2.4 (1.6-3.8), p  < 0.00006]. Regarding the immediate reactions post bronchiolitis and gastroenteritis cases, several responses were significantly more positive in the PM group compared to the TT group; e.g. 'The learning activity was engaging' [medium effect size: d (95% CI) = 0.58 (0.32-0.85), p  < 0.0001]. Higher proportions of participants in the PM group reported feeling safe in the gastroenteritis and bronchiolitis tutorials (96 and 89%), compared to the TT group (76 and 74%). PlayMed™ participants significantly outperformed TT participants on the bronchiolitis MCQs done immediately post tutorial, 4.1 (1.0) vs. 3.5 (1.0), respectively, p  = 0.004 [medium effect size: d (95% CI) = 0.54 (0.16-0.91)]., Conclusion: This study demonstrates the utility of a serious game (PlayMed™) as an online teaching tool for medical education. Students exposed to PM demonstrated superior engagement and feelings of safety. Utilisation of serious games may also facilitate knowledge acquisition, at least in the short term., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. The author(s) declared that they were an editorial board member of Frontiers, at the time of submission. This had no impact on the peer review process and the final decision., (Copyright © 2024 Tan, Coffey, Blazek, Sitaram, Dobrescu, Motta, Chuang and Ooi.)

Electrical motor cortex stimulation can produce corticospinal system plasticity and enhance motor function after injury. We investigate molecular mechanisms of structural and physiological plasticity following electrical neuromodulation, focusing on identifying molecular predictors, or biomarkers, for durable plasticity. We used two neuromodulation protocols, repetitive multipulse stimulation (rMPS) and patterned intermittent theta burst stimulation (iTBS), incorporating different stimulation durations and follow-up periods. We compared neuromodulation efficacy in promoting corticospinal tract (CST) sprouting, motor cortex muscle evoked potential (MEP) LTP-like plasticity, and their associated molecular underpinnings. Only iTBS produced CST sprouting after short-term neuromodulation (1 d of stimulation; 9-d survival for sprouting expression); both iTBS and rMPS produced sprouting with long-term (10-d) neuromodulation. Significant mTOR signaling activation and phosphatase and tensin homolog (PTEN) protein deactivation predicted axon growth across all neuromodulation conditions that produced significant sprouting. Both neuromodulation protocols, regardless of duration, were effective in producing MEP enhancement. However, persistent LTP-like enhancement of MEPs at 30 d was only produced by long-term iTBS. Statistical modeling suggests that Stat3 signaling is the key mediator of MEP enhancement. Cervical spinal cord injury (SCI) alone did not affect baseline molecular signaling. Whereas iTBS and rMPS after SCI produced strong mTOR activation and PTEN deactivation, only iTBS produced Stat3 activation. Our findings support differential molecular biomarkers for neuromodulation-dependent structural and physiological plasticity and show that motor cortex epidural neuromodulation produces molecular changes in neurons that support axonal growth after SCI. iTBS may be more suitable for repair after SCI because it promotes molecular signaling for both CST growth and MEP plasticity., Competing Interests: Competing interests statement:The authors declare no competing interest.

Background: People experiencing homelessness (PEH) are underrepresented in public health and clinical research. Study methods that can improve participation by this group are needed., Methods: In late 2022, the Centers for Disease Control and Prevention conducted an mpox serological survey using venipuncture among PEH in San Francisco, California. Blood collection by a minimally invasive device was offered if venipuncture was not possible or preferred. Participants who had a successful blood draw using the device were asked about device acceptability., Results: Of the 209 successful blood collections, 137 (66%) were among participants who underwent venipuncture and 72 (34%) were among participants who used the device. Use of the device increased overall blood collection participation by 53%. Participants reported high acceptability and preference for the device over venipuncture., Conclusions: Minimally invasive blood collection devices may increase participation and representation of PEH in serosurveys., (Published by Oxford University Press on behalf of Association for Diagnostics & Laboratory Medicine 2024.)

Background: While Pegaspargase is an essential component of the treatment of acute lymphoid leukemia (ALL) in children, it causes adverse events (AEs) that sometimes make full use impossible., Objective: The objective was to investigate the safety of Pegaspargase biosimilar in pediatric ALL patients undergoing treatment according to ICiCLe ALL-14 protocol., Method and Materials: A prospective study was carried out in a university teaching hospital located in the state of Maharashtra, India. Data on clinical factors and adverse reaction characteristics were gathered from hospital medical records. Suspected AEs were classified according to causality and severity., Results: During the study period, 72 children had 52 suspicions of AEs during treatment with biosimilar Pegaspargase. The odds ratio of 1.11 (95%CI, 0.41-2.98) suggested that males and females were both equally likely to experience adverse drug events, despite the fact that the frequency of suspected AEs was higher in boys (66%) than in girls (33%). None of the patients experienced allergic reactions. The high-risk category had the highest number of suspected AEs (56%), followed by intermediate risk (20%) and standard risk (20%). These patients showed a high frequency of suspected AEs during the induction phase (43%) followed by the consolidation phase (26%). Sixty percent of the reactions were classified as grade 1 or 2. ALL cell type ( p  = 0.02), risk category ( p  = 0.04) and length of hospitalization ( p  = 0.003) were significantly correlated with suspected AEs., Conclusion: Bio-similar Pegaspargase in combination with chemotherapy was safe and tolerable in the pediatric ALL patients treated according to ICiCLe ALL-14 protocol. Suspected AEs ranged from mild to moderate and hepatic failure and hyperglycemia being severe., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Bacteria use the second messenger cyclic dimeric guanosine monophosphate (c-di-GMP) to control biofilm formation and other key phenotypes in response to environmental signals. Changes in oxygen levels can alter c-di-GMP signaling through a family of proteins termed globin coupled sensors (GCS) that contain diguanylate cyclase domains. Previous studies have found that GCS diguanylate cyclase activity is controlled by ligand binding to the heme within the globin domain, with oxygen binding resulting in the greatest increase in catalytic activity. Herein, we present evidence that heme-edge residues control O 2 -dependent signaling in PccGCS, a GCS protein from Pectobacterium carotovorum, by modulating heme distortion. Using enzyme kinetics, resonance Raman spectroscopy, small angle X-ray scattering, and multi-wavelength analytical ultracentrifugation, we have developed an integrated model of the full-length PccGCS tetramer and have identified conformational changes associated with ligand binding, heme conformation, and cyclase activity. Taken together, these studies provide new insights into the mechanism by which O 2 binding modulates activity of diguanylate cyclase-containing GCS proteins., Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests. Emily Weinert reports financial support was provided by National Science Foundation. Emily Weinert reports financial support was provided by Herman Frasch Foundation for Chemical Research. Yilin Liu reports financial support was provided by National Science Foundation. If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Thioredoxin reductases (TrxR) activate thioredoxins (Trx) that regulate the activity of diverse target proteins essential to prokaryotic and eukaryotic life. However, very little is understood of TrxR/Trx systems and redox control in methanogenic microbes from the domain Archaea (methanogens), for which genomes are abundant with annotations for ferredoxin:thioredoxin reductases [Fdx/thioredoxin reductase (FTR)] from group 4 of the widespread FTR-like family. Only two from the FTR-like family are characterized: the plant-type FTR from group 1 and FDR from group 6. Herein, the group 4 archetype (AFTR) from Methanosarcina acetivorans was characterized to advance understanding of the family and TrxR/Trx systems in methanogens. The modeled structure of AFTR, together with EPR and Mössbauer spectroscopies, supports a catalytic mechanism similar to plant-type FTR and FDR, albeit with important exceptions. EPR spectroscopy of reduced AFTR identified a transient [4Fe-4S] 1+ cluster exhibiting a mixture of S = 7/2 and typical S = 1/2 signals, although rare for proteins containing [4Fe-4S] clusters, it is most likely the on-pathway intermediate in the disulfide reduction. Furthermore, an active site histidine equivalent to residues essential for the activity of plant-type FTR and FDR was found dispensable for AFTR. Finally, a unique thioredoxin system was reconstituted from AFTR, ferredoxin, and Trx2 from M. acetivorans , for which specialized target proteins were identified that are essential for growth and other diverse metabolisms.

Background: Managing medications for Alzheimer's disease and related dementias is challenging for caregivers. Information about caregivers' strategies to manage these challenges is needed to inform intervention development., Objective: This study aimed to understand caregivers' medication management experiences by analyzing online community discussions., Methods: Posts were extracted from the ALZConnected ® Forum using keywords "medication" and "drug" via web scraping. The researchers applied thematic analysis., Results: Four major themes emerged: (1) role transition of medication management responsibilities, (2) caregivers' uncertainty about medication purpose and values, (3) conflicts between the care recipients and caregivers, and (4) difficulty accessing and affording medications., Conclusions: The experiences shared on a non-moderated, unstructured online forum indicate that medication management is challenging and overwhelming for caregivers of people living with Alzheimer's disease and related dementias. Since this is a progressive disease with various stages and changing needs, caregivers' strategies vary and are often limited by available resources and support. Health care providers should offer training and support for caregivers to navigate the transfer of medication management responsibilities and changing care needs as the disease progresses., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Introduction: Oncoplastic breast surgery includes volume replacement as well as volume displacement. Autologous tissue is the preferred approach for volume replacement and includes chest wall perforator flaps (CWPF). Although described more than a decade ago, CWPFs have not been adopted widely in clinical practice till recently. We report the largest single-centre institutional data on CWPFs., Patients and Methods: The study includes all patients who underwent breast conservation surgery (BCS) using CWPFs from January 2015 to December 2022. Data were retrieved from the institutional electronic record and Redcap database. The analysis was done using SPSS 23 and STATA 14., Results: 150 patients were included in the study. The mean age was 48.8 years (SD 10.4), and the body mass index was (26.6 kg/m 2 , SD 4.3). >50% of patients had breasts with small cup sizes (A&B) and mild ptosis (Non-ptotic and Grade 1 ptosis). 44.7% of patients underwent lateral intercostal artery perforator flap (LICAP), anterior intercostal artery perforator flap in 31.3%, lateral thoracic perforator flap (LTAP) in 12%, LICAP + LTAP in 11.3% and thoracodorsal artery perforator flap in 1%. Post-operatively, haematoma was seen in 1.3%, complete flap necrosis in 1.3%, seroma in 7%, wound dehiscence in 12%, and positive margin in 6.7%. 92 patients responded to the satisfaction assessment, of which >90% were happy with the surgical scars, comfortable going out in a public place, satisfied with the symmetry of the breast, and no one chose mastectomy in hindsight. The 5-year predicted disease free survival and overall survival were 86.4% and 94.7%, respectively., Conclusion: BCS with CWPF is an excellent option for reconstruction in small to medium-sized breasts. It is associated with minimal morbidity and comparable patient-reported cosmetic and survival outcomes., Competing Interests: The authors declare no conflict of interest for this study., (© the authors; licensee ecancermedicalscience.)

Objective: The main objective was to pilot the culturally adapted "Educate, Nurture, Advise, Before Life Ends" for Singapore (ENABLE-SG) model to evaluate its feasibility and potential effectiveness., Methods: A single-arm pilot trial of ENABLE-SG among patients with advanced solid tumors and caregivers of these patients was conducted in the outpatient oncology clinic setting. Enrolled participants participated in individual ENABLE-SG psychoeducational sessions weekly. Patients had 6 sessions on the topics of maintaining positivity, self-care, coping with stress, managing symptoms, exploring what matters most and life review. Caregivers had 4 sessions on the topics of maintaining positivity, self-care, coping with stress and managing symptoms. At baseline, 4, 8, and 12 months after enrolment, patient's quality of life was measured using the Functional Assessment of Chronic Illness Therapy - Palliative Care, patient's mood was measured using the Center for Epidemiologic Studies - Depression scale, and caregiver quality of life was measured using the Singapore Caregiver Quality of Life Scale., Results: We enrolled 43 patients and 15 caregivers over a 10-month period from August 2021 to June 2022. Although there was a low approach-to-participation rate, most of those who enrolled completed all ENABLE-SG sessions - 72% for patients and 94% for caregivers. Caregivers had better quality of life over time, specifically in the subscales of mental well-being and experience-meaning., Significance of Results: Based on findings from this study, we are planning a randomized waitlist-controlled trial of ENABLE-SG for patients with advanced cancer and their caregivers.

Background: Adverse childhood experiences (ACE) are linked to an increased risk of psychological disorders and lower psychosocial functioning throughout life. This study aims to evaluate the FACE self-help app, designed to promote resilience and well-being in emerging adults with a history of ACE. The app is based on cognitive-behavioural principles and consists of two thematic components: (1) self- and emotion regulation (SER) and (2) social skills and biases in social information processing (SSIP)., Methods: The efficacy of the app will be tested through a single-centre, two-arm randomized controlled trial, comparing an active intervention group against a waiting list control group. The active group is divided into two subgroups, in which the two components are delivered in a different order to investigate differential effects in a crossover design. Up to 250 emerging adults aged 18 to 25 years with a history of ACE from a general population cohort study will be recruited. The primary objective is to test the efficacy of the app in improving resilience (primary outcome) and well-being (co-primary outcome) compared to a waiting list control group and to examine the stability of these effects. The secondary objectives include testing the efficacy of the app in improving the secondary outcomes, i.e., self-efficacy in managing emotions, problem solving, fear of evaluation, social avoidance, and self-esteem; examining the differential effects of the two components; and assessing the effect of the app on real-life data on resilience, affective states, distress in social interactions and coping strategies. Furthermore, the study will investigate potential moderators (e.g. ACE severity) and mediators of intervention outcomes (e.g. self-efficacy in managing emotions)., Discussion: The results will provide insights into the efficacy of the self-help intervention as well as mediators and moderators of outcomes. Furthermore, results will extend the existing knowledge by testing the differential effects of the SER and SSIP component on the outcomes. Findings can inform improvements to the FACE app and the development of other interventions for this target group and assess its potential as a scalable, low-threshold intervention to support emerging adults with a history of ACE in their transition to adulthood., Trial Registration Number: NCT05824182., (© 2024. The Author(s).)

Teamwork in graduate medical education (GME) is often hindered in clinical learning environments where discontinuity among residents, supervisors, and other health care professionals is typical. Teaming is a conceptual approach to teamwork in dynamic environments with constantly changing team members and goals. Teaming is built on principles of project management and team leadership, which together provide an attractive strategy for addressing teamwork challenges in GME. Indeed, teaming is now a requirement of the Accreditation Council for Graduate Medical Education Clinical Learning Environment Review program. However, many clinician-educators and leaders may be unfamiliar with teaming and how to integrate it into their GME programs. In this article, the teaming framework is described with a specific example of how it can be applied to improve hospital ward rounds, a common setting of teamwork breakdown. The goal of this article is to educate and encourage GME leaders as they learn new ways to implement teaming to improve patient care and education in their programs., Competing Interests: The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© The Author(s) 2024.)

The biotechnological potential of Rieske Oxygenases (ROs) and their cognate reductases remains unmet, in part because these systems can be functionally short-lived. Here, we describe a set of experiments aimed at identifying both the functional and structural stability limitations of ROs, using terephthalate (TPA) dioxygenase (from Comamonas strain E6) as a model system. Successful expression and purification of a cofactor-complete, histidine-tagged TPA dioxygenase and reductase protein system requires induction with the Escherichia coli host at stationary phase as well as a chaperone inducing cold-shock and supplementation with additional iron, sulfur, and flavin. The relative stability of the Rieske cluster and mononuclear iron center can then be assessed using spectroscopic and functional measurements following dialysis in an iron chelating buffer. These experiments involve measurements of the overall lifetime of the system via total turnover number using both UV-Visible absorbance and HPLC analyses, as well specific activity as a function of temperature. Important methods for assessing the stability of these multi-cofactor, multi-protein dependent systems at multiple levels of structure (secondary to quaternary) include differential scanning calorimetry, circular dichroism, and metallospectroscopy. Results can be rationalized in terms of three-dimensional structures and bioinformatics. The experiments described here provide a roadmap to a detailed characterization of the limitations of ROs. With a few notable exceptions, these issues are not widely addressed in current literature., (Copyright © 2024. Published by Elsevier Inc.)

Background: Work-related disability is caused commonly due to musculoskeletal disorders (MSD) in dentistry. Prolonged static awkward and repetitive postures cause MSD in dentists. The study was executed to confirm the development of MSD in various body regions as they have to work in a small oral cavity to perform crucial dental procedures with precision and concentration., Objective: To assess the occurrence of the MSD in several body regions of dentists and to carry out postural study thereby helping them improve posture., Methods: Dentists were assessed for their current working postures with various MSD symptoms and its effects. The questionnaire was devised to get musculoskeletal health data from dentists. The postural load was investigated using Rapid Upper Limb Assessment (RULA). Various risk factors contributing to MSD symptoms were identified after data were statistically analysed using IBM SPSS version 27., Results: According to the current study neck, shoulder, lower back, upper back, wrist hand, elbow, hip, thigh, knee, and ankle were the most affected anatomical regions. Average RULA score for the current study was found to be 6.75 which indicated a need of change of posture while performing dental procedures. There is statistical correlation between gender, Body Mass Index (BMI), uncomfortable positions, stretching, use of ergonomic saddle chair, hand dominance and MSD. There is no statistical correlation between years of experience and MSD., Conclusion: Current workstation (Dental Chair) requires immediate improvements as evident from the postural load analysis, thus immediate implementation of intervention program is required.

Competing Interests: The authors declare that they have no conflict of interest.

Background: COVID-19 screening testing (ST) can detect asymptomatic or pre-symptomatic cases, allowing for prompt identification of cases and close contacts. This study examined parents' and school staffs' knowledge and attitudes toward to a pilot school-based ST program in a school district in southern Arizona., Methods: In May 2021, online surveys to parents and school staff were administered to examine attitudes toward ST and impacts of the COVID-19 pandemic. Unweighted percent estimates were calculated, and bivariate differences were examined by demographics. Associations were assessed using chi-square tests and logistic regression., Results: The survey had response rates of 10% (606/6085) and 22% (187/849) among parents and staff, respectively. Approximately one-third of responding parents (35%) would or already allow their child to participate in school-based ST, 37% would not participate; 28% were unsure. Among responding staff, 46% would or already participate in ST, 33% would not; 21% were unsure. The top concern (38%) among responding staff was taking job-related leave if testing positive., Conclusion: Schools work to balance the needs of students, families, and staff by implementing supportive and flexible policies and practices founded on buy-in and acceptance from their communities., (© 2023 American School Health Association. This article has been contributed to by U.S. Government employees and their work is in the public domain in the USA.)

Background: Type 2 diabetes (T2D) is a strong risk factor for cardiovascular (CV) disease. CV outcomes in T2D have generally been improving over time but recent data from the US suggest attenuation of trends in older adults with reversal of trends in younger adults. However, published data are only reported through 2015., Objectives: To quantify trends over time in CV outcomes from 2001 to 2018, and describe changes over time in health care costs in T2D., Methods: This retrospective cohort study incorporated data from a regional health insurance plan. Study outcomes included acute myocardial infarction (AMI), ischemic stroke, hemorrhagic stroke, heart failure hospitalization (HFH), percutaneous coronary intervention, coronary artery bypass surgery, and all-cause mortality. Poisson regression estimated rate ratios across the entire 17-year study period (RR 17 )., Results: Among 79,392 T2D members tracked on average 4.1 years, overall trends in AMI (RR 17  = 0.69; 95% CI: 0.64, 0.74), HFH (RR 17  = 0.82; 0.79, 0.86), and all-cause mortality (RR 17  = 0.87; 0.84, 0.91) improved while ischemic stroke (RR 17  = 2.36; 2.16, 2.57) worsened. For AMI, HFH, and all-cause mortality, trends in older age groups were significantly better than in younger age groups (interaction P-values < .001). Health care costs related to pharmaceuticals (+15%/year) and emergency department (ED) visits (>15%/year) increased at faster rates than other utilization metrics (+10%/year)., Conclusions: In T2D, overall trends in most CV outcomes improved but smaller improvements or worsening trends were observed in younger patients. Health care costs accelerated at faster rates for medications and ED visits., Competing Interests: Disclosures Novo Nordisk was an active participant in all phases of this study and Novo Nordisk employees are listed as co-authors. JR and YMP are employees of Novo Nordisk. NK is a former employee of Novo Nordisk. JPB is on the speakers’ bureau of Novo Nordisk. The remaining authors have nothing to disclose., (Copyright © 2023 Elsevier Inc. All rights reserved.)

Reactive oxygen species are frequently associated with various cancers including pancreatic ductal adenocarcinomas (PDACs). Superoxide dismutase 2 (SOD2) is an enzyme that plays an important role in reactive oxygen species (ROS) signaling. Investigating the molecular function and biological functions of SOD2 can help us develop new therapeutic options and uncover new biomarkers for PDAC diagnosis and prognosis. Here, we show that nimbolide (NB), a triterpene limonoid, effectively blocks the growth and metastasis of PDACs by suppressing the expression and activity of SOD2. To identify the role of SOD2 in NB-induced anticancer activity, we used RNA interference to silence and plasmid transfection to overexpress it. Silencing SOD2 significantly reduced the growth and metastatic characteristics like epithelial-to-mesenchymal transition, invasion, migration, and colony-forming capabilities of PDACs, and NB treatment further reduced these characteristics. Conversely, the overexpression of SOD2 enhanced these metastatic characteristics. ROS signaling has a strong feedback mechanism with the PI3K/Akt signaling pathway, which could be mediated through SOD2. Finally, NB treatment to SOD2-overexpressing PDAC xenografts resulted in significant inhibition of tumor growth and metastasis. Overall, this work suggests that NB, a natural and safe phytochemical that silences SOD2 to induce high levels of ROS generation, results in increased apoptosis and reduced growth and progression of PDACs. The role of SOD2 in regulating NB-induced ROS generation presents itself as a therapeutic option for PDACs.

Mpox has affected many communities in the United States (U.S.), including people experiencing homelessness (PEH). Mpox vaccination has been an important tool to disrupt transmission and protect communities at risk of infection. To better understand mpox vaccine knowledge and attitudes, we surveyed 273 PEH and people accessing homeless service sites in San Francisco. Among 64 participants previously offered mpox vaccination, 38 (59 %) had received the vaccine. Among 209 participants not previously offered mpox vaccination, 108 (52 %) reported they would receive the vaccine. Vaccine acceptance was higher among transgender female participants and among male participants who reported male sex partner preference (MSM). Half of participants who declined vaccination identified that perception of personal risk and vaccine education may increase their likelihood of receiving an mpox vaccine. Leveraging trusted information sources to provide risk communication and vaccine education may increase vaccine uptake among PEH., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Published by Elsevier Ltd.)

Competing Interests: The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Background: The Combination Antibiotic Therapy for Methicillin-Resistant Staphylococcus aureus (CAMERA2) trial ceased recruitment in July 2018, noting that a higher proportion of patients in the intervention arm (combination therapy) developed acute kidney injury (AKI) compared to the standard therapy (monotherapy) arm. We analyzed the long-term outcomes of participants in CAMERA2 to understand the impact of combination antibiotic therapy and AKI., Methods: Trial sites obtained additional follow-up data. The primary outcome was all-cause mortality, censored at death or the date of last known follow-up. Secondary outcomes included kidney failure or a reduction in kidney function (a 40% reduction in estimated glomerular filtration rate to <60 mL/minute/1.73 m 2 ). To determine independent predictors of mortality in this cohort, adjusted hazard ratios were calculated using a Cox proportional hazards regression model., Results: This post hoc analysis included extended follow-up data for 260 patients. Overall, 123 of 260 (47%) of participants died, with a median population survival estimate of 3.4 years (235 deaths per 1000 person-years). Fifty-five patients died within 90 days after CAMERA2 trial randomization; another 68 deaths occurred after day 90. Using univariable Cox proportional hazards regression, mortality was not associated with either the assigned treatment arm in CAMERA2 (hazard ratio [HR], 0.84 [95% confidence interval [CI], .59-1.19]; P = .33) or experiencing an AKI (HR at 1 year, 1.04 [95% CI, .64-1.68]; P = .88)., Conclusions: In this cohort of patients hospitalized with methicillin-resistant S aureus bacteremia, we found no association between either treatment arm of the CAMERA2 trial or AKI (using CAMERA2 trial definition) and longer-term mortality., Competing Interests: Potential conflicts of interest. The authors: No reported conflicts of interest., (© The Author(s) 2023. Published by Oxford University Press on behalf of Infectious Diseases Society of America.)

The prospect of electroencephalography (EEG) and functional near-infrared spectroscopy (fNIRS) in the presence of topological information of participants is often left unexplored in most of the brain-computer interface (BCI) systems. Additionally, the usage of these modalities together in the field of multimodality analysis to support multiple brain signals toward improving BCI performance is not fully examined. This study first presents a multimodal data fusion framework to exploit and decode the complementary synergistic properties in multimodal neural signals. Moreover, the relations among different subjects and their observations also play critical roles in classifying unknown subjects. We developed a context-aware graph neural network (GNN) model utilizing the pairwise relationship among participants to investigate the performance on an auditory task classification. We explored standard and deviant auditory EEG and fNIRS data where each subject was asked to perform an auditory oddball task and has multiple trials regarded as context-aware nodes in our graph construction. In experiments, our multimodal data fusion strategy showed an improvement up to 8.40% via SVM and 2.02% via GNN, compared to the single-modal EEG or fNIRS. In addition, our context-aware GNN achieved 5.3%, 4.07% and 4.53% higher accuracy for EEG, fNIRS and multimodal data based experiments, compared to the baseline models.

Background: The lack of health education resources specific to people with disabilities contributes to disparities in outcomes. Developing user-centered materials with representative images tailored to people with disabilities could help improve knowledge and outcomes., Objective: As a first step in developing an online sexual health resource for adolescents with physical disabilities, we sought end-user feedback to create illustrated characters for use in educational materials., Methods: Two styles of characters were developed by the research team, which included a professional disability artist. Verbal and online survey feedback was obtained at the Spina Bifida Association's Clinical Care Conference. A new image was created incorporating initial feedback. The new image and favored image from the first round were then tested through an online survey advertised on the Spina Bifida Association's Instagram story feed. Open-ended comments were organized by categories and overlapping themes., Results: Feedback was obtained from 139 audience members and 25 survey respondents from the conference and 156 Instagram survey respondents. Themes included depiction of disability, nondisability diversity, other physical appearance, emotional response, and design style. Most frequently, participants suggested the inclusion of characters with a range of accurately depicted mobility aids and of characters without mobility aids. Participants also wanted a larger, more diverse group of happy, strong people of all ages., Conclusions: This work culminated in the codevelopment of an illustration that represents how people impacted by spina bifida view themselves and their community. We anticipate that using these images in educational materials will improve their acceptance and effectiveness., (Copyright © 2023 Elsevier Inc. All rights reserved.)

Whether individuals in real-world settings are able to lose weight and improve cardiometabolic risk factors over time is unclear. We aimed to determine the management of and degree of body weight change over 2 years among individuals with overweight or obesity, and to assess associated changes in cardiometabolic risk factors and clinical outcomes. Using data from 11 large health systems within the Patient-Centered Outcomes Research Network in the U.S., we collected the following data on adults with a recorded BMI ≥25 kg/m 2 between January 1, 2016 and December 31, 2016: body-mass index (BMI), systolic blood pressure (SBP), diastolic blood pressure (DBP), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDLC), triglycerides and glycated hemoglobin (HbA1c). We found that among 882,712 individuals with BMI ≥25 kg/m 2 (median age 59 years; 56% female), 52% maintained stable weight over 2 years and 1.3% utilized weight loss pharmacotherapy. Weight loss of 10% was associated with small but significant lowering of mean SBP (-2.69 mmHg [95% CI -2.88, -2.50]), DBP (-1.26 mmHg [95% CI -1.35, -1.18]), LDL-C (-2.60 mg/dL [95% CI -3.14, -2.05]), and HbA1c (-0.27% [95% CI -0.35, -0.19]) in the same 12 months. However, these changes were not sustained over the following year. In this study of adults with BMI ≥25 kg/m 2 , the majority had stable weight over 2 years, pharmacotherapies for weight loss were under-used, and small changes in cardiometabolic risk factors with weight loss were not sustained, possibly due to failure to maintain weight loss., Competing Interests: Declaration of Competing Interest NJP: Research grants from: Amgen, Inc.; AstraZeneca; Boehringer Ingelheim; Duke Clinical Research Institute; Eli Lilly & Company; Novartis Pharmaceuticals, Novo Nordisk Pharmaceutical Company; Verily Sciences Research Company. Consulting fees from AstraZeneca; Boehringer Ingelheim; CRISPR Therapeutics; Eli Lilly & Company, Merck, Novo Nordisk Pharmaceutical Company, Novartis. HM: none. KC: none. ZL: none. WSJ: Research Grants from Boehringer Ingelheim, Bristol-Myers Squibb, Doris Duke Charitable Foundation, Merck, National Institutes of Health, Patient-Centered Outcomes Research Institute; Honoraria/Advisory Committees from Bayer, Bristol-Myers Squibb, Janssen Pharmaceuticals. SM: Consultant for Novo Nordisk, Rhythm pharmaceuticals. Site principal investigator for clinical trials from Novo Nordisk, Eli Lilly, Boehringer Ingelheim. RW: none. MMC: none. FW: Employee of sponsor (Novo Nordisk). NK: Employee at Janssen Pharmaceuticals, Inc. AR: Employee of sponsor (Novo Nordisk), shareholder of stock in sponsor. GS: Employee of sponsor (Novo Nordisk), shareholder of stock in sponsor. EDP: Research support from Amgen, Janssen, BMS, Esperion; Consulting for Janssen, Boehringer Ingelheim, and Cerner. EO: none., (Copyright © 2023 Elsevier Inc. All rights reserved.)

The emergence of antimicrobial resistance (AMR) in lactic acid bacteria (LAB) raises questions on qualified presumptive safety status and poses challenge of AMR transmission in food milieu. This study focuses on isolation, identification and characterization of AMR in LAB prevalent in traditional fermented Indian food products. The analysis of 16SrRNA based phylogenetic tree showed placements of isolates among four different genera Lactobacillus , Enterococcus , Weissella and Leuconostoc . In E-strip gradient test of susceptibility to 14 different antibiotics, over 50% of isolates showed resistance to ampicillin, chloramphenicol, ciprofloxacin, erythromycin, kanamycin, linezolid, streptomycin, trimethoprim and vancomycin. A multivariate principal component analysis, an antibiogram and multiple antibiotic resistance index-values (> 0.2) indicated presence of multidrug-resistance among the isolates. This study reports prevalence of an alarmingly high rate of AMR LAB strains in traditional fermented foods and is important to regulators and public health authorities for developing strategies to control transmission in food systems., Supplementary Information: The online version contains supplementary material available at 10.1007/s10068-023-01305-1., Competing Interests: Conflicts of interestThere is no declared conflict of interest., (© The Korean Society of Food Science and Technology 2023. Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.)

Monkeypox (mpox) is a disease caused by an Orthopoxvirus. The 2022 multinational outbreak, which began in May 2022, has spread primarily by close skin-to-skin contact, including through sexual contact. Persons experiencing homelessness have been disproportionately affected by severe mpox (1). However, mpox prevalence and transmission pathways among persons experiencing homelessness are not known, and persons experiencing homelessness have not been specifically recommended to receive mpox vaccine during the 2022 outbreak (2,3). During October 25-November 3, 2022, a CDC field team conducted an orthopoxvirus seroprevalence survey among persons accessing homeless services or staying in encampments, shelters, or permanent supportive housing in San Francisco, California that had noted at least one case of mpox or served populations at risk. During field team visits to 16 unique sites, 209 participants completed a 15-minute survey and provided a blood specimen. Among 80 participants aged <50 years who did not report smallpox or mpox vaccination or previous mpox infection, two (2.5%) had detectable antiorthopoxvirus immunoglobulin (Ig) G antibody. Among 73 participants who did not report mpox vaccination or previous mpox infection and who were tested for IgM, one (1.4%) had detectable antiorthopoxvirus IgM. Together, these results suggest that three possible undetected mpox infections occurred among a sample of persons experiencing homelessness, highlighting the need to ensure that community outreach and prevention interventions, such as vaccination, are accessible to this population., Competing Interests: All authors have completed and submitted the International Committee of Medical Journal Editors form for disclosure of potential conflicts of interest. No potential conflicts of interest were disclosed.

Competing Interests: The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Background: Hepatitis A virus (HAV) and hepatitis E virus (HEV) have enteric modes of transmission and are common causes of acute hepatitis in low- and middle-income countries. HEV is also characterised as a zoonotic infection and is prevalent in high-income countries. Data on HAV and HEV prevalence in Suriname, a middle-income country in South America, are scarce., Methods: Serum samples of 944 and 949 randomly selected patients attending the Emergency Department at the Academic Hospital of Paramaribo, the capital of Suriname, were analysed for anti-HAV antibodies (anti-HAV) and anti-HEV antibodies (anti-HEV), respectively. Determinants of anti-HAV and anti-HEV positive serology were evaluated using multivariable logistic regression., Results: Anti-HAV prevalence was 58.3% (95% CI 55.4 to 61.4%) and higher prevalence was independently associated with belonging to the Tribal or Indigenous population and older age. Anti-HEV prevalence was 3.7% (95% CI 2.6 to 5.0%) and higher prevalence was associated with Tribal and Creole ethnicity and older age., Conclusions: In Suriname, exposure to HAV is consistent with a very low endemic country and exposure to HEV was rare. Both viruses were more prevalent in specific ethnic groups. As anti-HAVantibodies were less frequently found in younger individuals, they could be susceptible to potential HAV outbreaks and might require HAV vaccination., (© The Author(s) 2022. Published by Oxford University Press on behalf of Royal Society of Tropical Medicine and Hygiene.)

Objectives: Joyuus is a culturally diverse, comprehensive online tool designed to address the self-care needs of underserved postpartum women. The tool provides actionable self-care information, knowledge, and skills to improve postpartum health and identifies red flags for when self-care shifts to seeking care., Methods: We employed a mixed-methods multiphase design to evaluate the Joyuus prototype, including a pre-post evaluation (N = 87) to assess behavioral health outcomes before and after using the tool for a one-month period. 91% completed the post-test (N = 79). The analysis focused on estimation of treatment effect (via 95% confidence intervals) and fitness of instruments in this population., Results: Participants were between 6 months pregnant and one year postpartum, a mean age of 30 years, 100% female, 99% Black, with nearly equal distribution of married (55%) and not married (44%), and above (47%) and below (46%) annual income of $60 K. Key measures saw significant improvement from pre- (mean = 26.44, SD = 5.39) to post (mean = 28.29, SD = 5.26) on the Connor-Davidson Resilience Scale (p < 0.001) Trends toward improvement (not statistically significant) were noted for Depression (EPDS) (p = 0.624) and Anxiety (STAI) (p = 0.286), and no meaningful change on MOS Social Support or COVID-19 Mental Health Impacts Measures., Conclusions for Practice: This pilot study demonstrates that a self-care mobile tool has the potential to address significant health outcomes related to maternal morbidity and mortality. By providing a continuously available companion addressing physical, mental, and real-life questions, it creates value during postpartum for mothers who can often feel overwhelmed or isolated., (© 2023. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Background The treatment of keloidal scars with radiotherapy has been practiced for more than a century. Radiotherapy post-surgery has been deemed necessary and effective in preventing recurrence but still, no clear guidelines exist as to the best modality of radiotherapy, the ideal dose, and the time it should be given for keloidal scars. The purpose of this study is to confirm the effectiveness of this treatment and address these issues. Methods  Since 2004, 120 patients presenting with keloidal scars were seen by the author. Out of them, 50 were managed with surgery followed by HDR brachytherapy/electron beam radiotherapy delivering 2000 rads to the scar within 24 hours of surgery. Patients were followed up for at least 18 months to assess the scar status and the recurrence of keloids. Recurrence was defined as the appearance of a nodule or an obvious return of the keloid within 1 year of treatment. Results  Three patients developed a nodule in the scar, which was deemed a recurrence, making an incidence of 6%. There was no major problem after immediate postoperative radiotherapy. Five patients had delayed healing at 2 weeks and a hypertrophic scar was noted in five patients at 4 weeks that settled with conservative measures. Conclusion  Treating the vexing problem of keloids with surgery and immediate postoperative radiotherapy is safe and effective. We recommend that this be adopted as the standard treatment in keloid management., Competing Interests: Conflict of Interest None declared., (Association of Plastic Surgeons of India. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. ( https://creativecommons.org/licenses/by-nc-nd/4.0/ ).)

Pectin-based edible film plasticized with glycerol has been developed, and the effect of pectin and glycerol concentration was optimized using response surface methodology for better mechanical properties and transparency. The upper and lower concentration of pectin (3-5 g) and glycerol (15%-25%) concentration ranges were considered in this study based on the preliminary experiment. The responses of the edible film determined were tensile strength, elongation at break and elastic modulus and opacity. The interaction effects of glycerol and pectin concentrations on edible film properties significantly affected the film properties. Tensile strength and opacity were positively affected by pectin concentrations; however, elastic modulus and elongation at break were negatively affected. Glycerol concentration negatively affected the edible film's tensile strength and elastic modulus. The decrease in the opacity of the biofilm was observed as the pectin concentration increased; however, glycerol had not shown a significant influence on opacity. The numerical optimization provided 4 g of pectin, and 20% of glycerol showed a strong and transparent edible film. The TGA curve showed that the maximum weight loss occurred between the temperatures 250-400 °C due to the loss of polysaccharides. From FTIR analysis, observed peaks around 1037 cm -1 represented the C-O-C stretching vibrations of the saccharide found in pectin and glycerol., Competing Interests: The authors declare no competing interests., (© 2023 The Authors.)

Salt stress is a severe type of environmental stress. It adversely affects agricultural production worldwide. The overproduction of reactive oxygen species (ROS) is the most frequent phenomenon during salt stress. ROS are extremely reactive and, in high amounts, noxious, leading to destructive processes and causing cellular damage. However, at lower concentrations, ROS function as secondary messengers, playing a critical role as signaling molecules, ensuring regulation of growth and adjustment to multifactorial stresses. Plants contain several enzymatic and non-enzymatic antioxidants that can detoxify ROS. The production of ROS and their scavenging are important aspects of the plant's normal response to adverse conditions. Recently, this field has attracted immense attention from plant scientists; however, ROS-induced signaling pathways during salt stress remain largely unknown. In this review, we will discuss the critical role of different antioxidants in salt stress tolerance. We also summarize the recent advances on the detrimental effects of ROS, on the antioxidant machinery scavenging ROS under salt stress, and on the crosstalk between ROS and other various signaling molecules, including nitric oxide, hydrogen sulfide, calcium, and phytohormones. Moreover, the utilization of "-omic" approaches to improve the ROS-regulating antioxidant system during the adaptation process to salt stress is also described.

Background: The vast majority of devices cleared by the Food and Drug Administration (FDA) are through the 510(k) process, which allows medical devices to be quickly introduced into the market. The FDA 510(k) process is designed to minimize the burden and expense of bringing new devices to market; however, as a result, the FDA may be limited in its ability to establish the safety of these devices., Methods: The FDA 510(k) online archives were searched for devices cleared from 2013 to 2014. One thousand devices were randomly selected. PubMed was searched for each device to identify publications about the devices. The primary outcome was the percentage of devices cleared through the 510(k) process with no published research. Secondary outcomes included: conflict of interest (COI) of authors and outcomes of published studies on the devices., Results: A total of 6152 devices were cleared through the 510(k) process in 2013-2014. Of the 1000 randomly selected devices, 17.8% had published research. There were 375 manuscripts, of which 47 (12.5%) were randomized controlled trials. One-fourth (25.1%) of studies had a clearly identifiable COI, while COI was unclear for half (49.9%)., Conclusion and Relevance: There is limited evidence examining the safety and effectiveness of devices cleared via the 510(k) process. Thousands of devices are cleared through the FDA's 510(k) process each year with limited or no evidence publicly available. This has led to the market being introduced to potentially costly, nonbeneficial, or harmful devices. Devices, like prescription drugs, should undergo a more rigorous clearance process., (Copyright © 2022 Elsevier Inc. All rights reserved.)

Abstract This study investigated the clinical and economic impact of anti-obesity medications (AOMs; orlistat, liraglutide, phentermine/topiramate extended-release [ER], naltrexone ER/bupropion ER) among United States Veterans with obesity participating in Motivating Overweight/Obese Veterans Everywhere! (MOVE!), a government-initiated weight management program. The study population was identified from electronic medical records of the Veterans Health Administration (2010-2020). Clinical indices of obesity and health care resource utilization and costs were evaluated at 6, 12, and 24 months after the initial dispensing of an AOM in the AOM+MOVE! cohort ( N  = 3732, mean age 57 years, 79% male) or on the corresponding date of an inpatient or outpatient encounter in the MOVE! cohort ( N  = 7883, mean age 58 years, 81% male). At 6 months postindex, the AOM+MOVE! cohort had better cardiometabolic indices (eg, systolic blood pressure, diastolic blood pressure, total cholesterol, low-density lipoprotein cholesterol, hemoglobin A1c) than the MOVE! cohort, with the trends persisting at 12 and 24 months. The AOM+MOVE! cohort was significantly more likely than the MOVE! cohort to have weight decreases of 5%-10%, 10%-15%, and >15% and lower body mass index at 6, 12, and 24 months. The AOM+MOVE! cohort also had fewer inpatient and emergency department visits than the MOVE! cohort, which was associated with lower mean total medical costs including inpatient costs. These results suggest that combining AOM treatment with the MOVE! program could yield long-term cost savings for the Veterans Affairs network and meaningful clinical improvements for Veterans with obesity.

The non-biodegradable synthetic plastic is one of the greatest challenges facing the food packaging business since it seriously harms the environment. To solve this problem, non-biodegradable plastic may be disposed of more affordably and with less harm on the environment by using edible starch-based biodegradable film. Therefore, the present study was focused on the development and optimization of tef starch based edible films based on mechanical properties. In this study response surface methodology was employed by considering 3-5g of tef starch, 0.3-0.5% of agar and 0.3-0.5% of glycerol. The prepared film showed the tensile strength of 17.97-24.25 Mpa, elongation break of 1.21-2.03%, elastic modulus of 17.58-108.69 MPa, puncture force of 2.55-15.02 N, puncture formation of 9.59-14.95 mm. The findings showed that as glycerol concentrations in the film-forming solution increased, the prepared tef starch edible films' tensile strength, elastic modulus, and puncture force declined while their elongation at break and puncture deformation increased. Tef starch edible films' mechanical characteristics, including as tensile strength, elastic modulus, and puncture force, were increased by the increase of agar concentration. The optimized (from 5 gm tef starch, 0.4 g agar and 0.3% glycerol) tef starch edible film exhibited higher tensile strength, elastic modulus, and puncture force while lower elongation at break and puncture deformation. The composite edible film based tef starch with agar exhibited good mechanical properties and can be suggested for application in food industry as food packaging., Competing Interests: The authors declare no competing interests., (© 2023 The Authors.)