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Introduction Electronic cigarette (e-cigarette) use has increased globally among adolescents. However, data on its use among adolescents in Saudi Arabia remain limited. Therefore, this study describes the characteristics and factors associated with e-cigarette use in this population. Methods Data from the Saudi Arabia 2022 Global Youth Tobacco Survey targeting students aged 13–15 years were analyzed. This study examined current use and ever use of e-cigarettes as dependent variables, and sociodemographic characteristics, smoking behaviors, and exposure to tobacco-related messages as independent variables. Results Among the adolescents, 14.2% had ever used e-cigarettes, while 5.3% were current users. Older adolescents exhibited a higher prevalence of ever use (12%, 13%, and 19% among those aged 13, 14, and 15 years, respectively). Of those who ever smoked cigarettes, 44% reported ever using e-cigarettes, and 23% were current users. Older adolescents (15 years) were 35% more likely to be ever e-cigarette users (AOR=1.35; 95% CI: 1.32–1.38) and 39% more likely to be current e-cigarette users (AOR=1.39; 95% CI: 1.34–1.43) than those aged 13 years. Exposure to pro-tobacco marketing was associated with twice the odds of ever using e-cigarettes (AOR=2.23; 95% CI: 2.21–2.26) and 2.76 times the odds of becoming current e-cigarette users (AOR=2.64; 95% CI: 2.58–2.69) compared with non-exposed adolescents. Conclusions E-cigarette use is more prevalent among older adolescents, males, and those with higher weekly allowances. Additionally, e-cigarette use is associated with adolescents who use tobacco cigarettes, are exposed to secondhand smoke, or encounter tobacco promotional marketing.

Abstract Pregnancy is a period of profound biological transformation. However, we know remarkably little about pregnancy-related brain changes. To address this gap, we chart longitudinal changes in brain structure during pregnancy and explore potential mechanisms driving these changes. Ten participants (Mean age = 28.97 years) are assessed 1–6 times (median = 3) during their pregnancy. Each visit includes anatomical and diffusion-weighted MRI, and assessments of waking salivary hormones, hair hormones, and inflammatory cytokines. Here we observe a reduction in gray matter volume and an increase in neurite density index (NDI), a proxy of axon density, in white matter tracts across pregnancy. Progesterone levels are associated with reductions in brain volumetric measurements, and both progesterone and estradiol levels are linked to increases in NDI in white matter tracts. This study highlights the profound neurobiological changes experienced by pregnant individuals and provides insights into neuroplasticity in adulthood.

Abstract Background/aim: cognitive flexibility refers to people’s capacity to change or evolve their thinking and strategies when confronted with new information or circumstances These attributes are essential in research environments where complex and dynamic challenges frequently arise. In this study, the aim is to explore and establish whether a correlation exists between cognitive flexibility and research performance, especially in the medical students, in order to fill the deficit, if any, as well as understand the status of research teaching. Methods We conducted an analytical cross-sectional study with medical students from the College of Medicine at King Saud University in Riyadh, Saudi Arabia. We requested the subjects to participate in an online questionnaire consisting of four question sections. They included demographic information, a Cognitive Flexibility Scale, knowledge, attitude, practice, and barriers to performing medical research. Results The survey received responses from 303 medical students. We judged cognitive flexibility highest in the willingness to shift to possible alternatives and lowest in the use of acquired knowledge in practical contexts. The students were aware of and had a positive attitude towards research, although only 19.5% of them had actually published. Some of the barriers included inadequate time and challenges with follow-up care for patients. It was established that there was a weak negative relationship between the scores of perceived barriers and the Cognitive Flexibility score (r = -0.217, P

Abstract Northern elephant seals (Mirounga angustirostris) have been integral to the development and progress of biologging technology and movement data analysis, which continue to improve our understanding of this and other species. Adult female elephant seals at Año Nuevo Reserve and other colonies along the west coast of North America were tracked annually from 2004 to 2020, resulting in a total of 653 instrument deployments. This paper outlines the compilation and curation process of these high-resolution diving and location data, now accessible in two Dryad repositories. The code used for data processing alongside the corresponding workflow is available through GitHub and Zenodo. This data set represents 3,844,927 dives and 596,815 locations collected from 475 individual seals with 178 repeat samplings over 17 years. We anticipate that these data will stimulate further analysis and investigation into elephant seal biology and aid in developing new analytical approaches for large marine predators.

Abstract Background The added benefits of a multi-cancer early detection (MCED) test among individuals with multiple risk factors will help policy decision-makers allocate limited healthcare resources. This study sought to estimate the population health implications of adding an MCED test to standard-of-care (SOC) cancer screening tests among individuals aged 50–79 years with additional cancer risk factors (i.e., tobacco use, family history of cancer, and/or obesity). Methods A mathematical model was developed to assess the potential screening efficiency of an MCED test in addition to current guideline-recommended screenings. Among the US population of 107 million adults aged 50–79 years, the size of, and cancer risk among specific subgroups (i.e., smokers, obese individuals, those with a family history of cancer) as well as the general population were estimated from the literature. Published estimates of screening uptake and/or performance were used to model the number of cancers detected by SOC screening alone, and the number of incremental cancers that could be detected by an MCED test. Screening efficiency outcomes included the true-positive:false-positive (TP:FP) ratio, diagnostic yield (DY), and cancer detection rate (CDR). Sensitivity analyses were conducted by varying the values of key parameters. Results Among all subgroups, the TP:FP ratios were higher with an MCED test than with SOC screening alone, and higher than in the general population, suggesting improved screening efficiency with an MCED test. The estimated TP:FP ratios were 1:43.3 (SOC)/1:1.1 (MCED), 1:40.4/1:0.8, 1:36.9/1:0.5 among former, ever, and current smokers, respectively, 1:38.3/1:0.9 (those with a family history of cancer), and 1:39.3/1:1.1 (obese individuals). Among the general population, the TP:FP ratios were 1:43.5/1:1.1. Across all subpopulations, the DY and CDR increased by up to threefold with an MCED test, when compared to SOC screening alone, with up to 75% of cancers detected with an MCED test lacking a screening paradigm. These results were robust in sensitivity analyses. Conclusions Adding an MCED test could improve screening efficiency among individuals with multiple risk factors, as well as the general population.

Introduction The epidemic of tobacco use poses one of the most severe public health challenges globally, responsible for over 8 million deaths annually according to the World Health Organization (WHO). This study investigates the factors associated with tobacco use among Saudi Arabian youth using the Theory of Planned Behavior (TPB) framework. Methods A cross-sectional study used the 2022 Global Youth Tobacco Survey (GYTS) to assess tobacco use among 5610 Saudi students aged 13–15 years. The structured, anonymous questionnaire collected demographic data and TPB constructs (e.g. attitudes, subjective norms, perceived behavioral control, and intentions) were derived from the validated GYTS questionnaire, with items grouped and scored to represent each construct. One-way ANOVA, t-tests, and logistic regression analyses were conducted, with a significance level set at 0.05. Results Of the surveyed students, 5610 (80.4%) aged 13–15 years met the inclusion criteria. Tobacco use was prevalent, with 31.3% having ever used tobacco and 8.78% currently using it. Negative attitudes toward tobacco were inversely associated with usage (AOR=0.97; 95% CI: 0.970–0.974). Subjective norms, reflecting perceived social pressure, were positively associated with tobacco use (AOR=1.17; 95% CI: 1.170–1.176). Perceived behavioral control, indicating the ease of quitting or avoiding tobacco, was strongly associated with use (AOR=1.87; 95% CI: 1.848–1.888). Stronger behavioral intentions to use tobacco were also associated with a higher likelihood of use (AOR=1.24; 95% CI: 1.226–1.246). Conclusions The high prevalence of tobacco use among Saudi Arabian youth, early initiation, and significant social influences highlight the need for comprehensive public health strategies. Targeted education, reduced tobacco accessibility, and programs to shift social norms and attitudes are essential. Addressing these factors can help prevent initiation and support cessation efforts among young people.

Background: Despite its prevalence, limited research has explored the direct correlation between irritable bowel syndrome (IBS) and endometriosis, particularly in regions like Saudi Arabia. This study aimed to bridge this gap by investigating the prevalence of IBS among endometriosis patients and identifying associated risk factors. Materials and Methods: The study conducted a cross-sectional analysis, it was done at King Abdulaziz University Hospital, Jeddah. From September to December 2023. Women who were diagnosed with endometriosis and aged above 18 years old were included. Results: Our study revealed that 47.8% of endometriosis patients had previously been diagnosed with IBS. Interestingly, Saudi patients exhibited a significantly higher prevalence of IBS compared to non-Saudi individuals. While no substantial link emerged between IBS prevalence and other demographic or endometriosis-related factors, patients with chronic digestive conditions like food intolerance, esophageal reflux, and inflammatory colon diseases showed a higher likelihood of IBS. Conclusions: This study underscores a substantial association between IBS and endometriosis, urging healthcare providers to consider IBS as a potential comorbidity in affected patients. The findings stress the importance of holistic assessments and awareness regarding overlapping symptoms and risk factors. Further research is encouraged to unveil underlying mechanisms and devise optimal management strategies for individuals grappling with both conditions.

Abstract Road traffic is an important source of urban air pollutants. Due to increasingly strict controls of exhaust emissions from road traffic, their contribution to the total emissions has strongly decreased over time in high-income countries. In contrast, non-exhaust emissions from road vehicles are not yet legislated and now make up the major proportion of road traffic emissions in many countries. Brake wear, which occurs due to friction between brake linings and their rotating counterpart, is one of the main non-exhaust sources contributing to particle emissions. Since the focus of brake wear emission has largely been on particulate pollutants, little is currently known about gaseous emissions such as volatile organic compounds from braking and their fate in the atmosphere. This study investigates the oxidative ageing of gaseous brake wear emissions generated with a pin-on-disc tribometer, using an oxidation flow reactor. The results demonstrate, for the first time, that the photooxidation of gaseous brake wear emissions can lead to formation of secondary particulate matter, which could amplify the environmental impact of brake wear emissions.

IntroductionOnline formats provide promising and low-threshold options for mental health coaching. However, research on online mental health interventions compared to traditional face-to-face interventions remains scarce. In the present study, the established prevention tool “Teacher Group-coaching Program” (TGP) was applied in both the original face-to-face setting as well as online. TGP focuses on promoting mental health in teachers by strengthening relational skills using the Balint group technique. This technique roots back to a psychoanalytic approach to explore the emotional aspects of (stress inducing) professional relationships. The current study aimed at comparing the satisfaction with and effectiveness of TGP between both settings.MethodThe sample consisted of 104 teachers who voluntarily chose between face-to-face (n = 51) and online (n = 53) setting. In a pre-posttest design, participants completed questionnaires before and after the intervention. Additionally participant's satisfaction with the program was assessed during and after TGP.ResultsIntervention effects did not differ significantly in terms of mental health, general life satisfaction and emotional distancing between TGP online and face-to-face. In line with previous research, there was a pre-posttest improvement for mental distress and the ability to distance oneself for both groups, which did not differ significantly between face-to-face and online setting. Satisfaction with the program was rated high in both settings, suggesting similar acceptance.DiscussionAlthough, the absence of an effect is not the evidence of equality of the groups, the present study highlights the potential of online admissions of mental health interventions as possible alternatives and additions to traditional face-to-face programs, especially when in-person meetings are not feasible. Specifically, it shows evidence that the Balint group technique can also be applied successfully by trained experts in the online setting.

Background Chronic rhinosinusitis (CRS) and olfactory dysfunction (OD) are prevalent disease complications in people with cystic fibrosis. These understudied comorbidities significantly impact quality of life. The impact of highly effective modulator therapy (HEMT) in young children with cystic fibrosis (YCwCF) on these disease complications is unknown. This proposed study aims to characterise CRS and OD in YCwCF and assess the efficacy of HEMT in improving sinus and olfactory health in this young age group. Methods This six-centre, prospective, observational study will enrol 80 YCwCF aged 2–8 years. Patients are divided into two groups: those receiving HEMT and those not on HEMT based on clinical indication. Both groups undergo sinus magnetic resonance imaging, psychophysical olfactory tests, and complete patient- or parent-reported quality of life surveys over 2 years. Outcomes will be compared before and after initiation of HEMT and between groups. Ethical approval has been obtained for all sites, and this study has been registered on ClinicalTrials.gov (NCT06191640). Results Enrolment began in April 2023. 21 participants have been enrolled as of October 2023 with ongoing enrolment at all sites. Conclusion This investigation is expected to provide critical insights into the potential benefits of early HEMT initiation in managing CRS and OD in YCwCF. It will assist in developing targeted interventions and contribute to the understanding of HEMT's role in altering the disease course in this demographic.

With the increasing utilization of exome and genome sequencing in clinical and research genetics, accurate and automated extraction of human phenotype ontology (HPO) terms from clinical texts has become imperative. Traditional methods for HPO term extraction, such as PhenoTagger, often face limitations in coverage and precision. In this study, we propose a novel approach that leverages large language models (LLMs) to generate synthetic sentences with clinical context, which were semantically encoded into vector embeddings. These embeddings are linked to HPO terms, creating a robust knowledgebase that facilitates precise information retrieval. Our method circumvents the known issue of LLM hallucinations by storing and querying these embeddings within a true database, ensuring accurate context matching without the need for a predictive model. We evaluated the performance of three different embedding models, all of which demonstrated substantial improvements over PhenoTagger. Top recall (sensitivity), precision (positive-predictive value, PPV), and F1 are 0.64, 0.64, and 0.64, respectively, which were 31%, 10%, and 21% better than PhenoTagger. Furthermore, optimal performance was achieved when we combined the best performing embedding model with PhenoTagger (a.k.a. Fused model), resulting in recall (sensitivity), precision (PPV), and F1 values of 0.7, 0.7, and 0.7, respectively, which are 10%, 10%, and 10% better than the best embedding models. Our findings underscore the potential of this integrated approach to enhance the precision and reliability of HPO term extraction, offering a scalable and effective solution for biomedical data annotation.

Abstract Aims This study aimed to investigate whether the response to adding metformin to insulin in young adults with type 1 diabetes (T1D) differs according to weight phenotype and insulin sensitivity index. Methods A prospective pilot study was conducted over 26 weeks in which insulin plus metformin (2 g/day) was administered to 35 individuals, ranging from normal weight (NW) to overweight (OW) to obese (OB) T1D individuals, to correlate insulin sensitivity indices and other clinical variables. Results At the end of the follow-up period, all groups showed an increase in the eGDR (NW: 7.37 vs 8.16, p = 0.002; OW: 7.28 vs 8.24, p

الملخص: أهداف البحث: شهد نظام الرعاية الصحية في المملكة العربية السعودية تحولات كبيرة كجزء من رؤية 2030. وكجزء من هذا التحول، تم تنفيذ نظام الوصفات الطبية الإلكتروني (وصفتي) لتمكين المرضى من تلقي الوصفات الطبية من صيدليات المجتمع. قامت هذه الدراسة بتقييم رضى المرضى عن خدمات صيدليات المجتمع ونظام وصفتي. طرق البحث: استخدمت دراسة رصدية مقطعية بيانات موجودة من برنامج تجربة المرضى التابع لوزارة الصحة السعودية. تم جمع البيانات من مرضى أعمارهم أكبر من 15 سنة، والذين زاروا مراكز الرعاية الأولية الحكومية خلال النصف الأول من عام 2022. وتم إجراء إحصاءات تلخيصية، وتحليلات الانحدار اللوجستي متعدد المتغيرات، لتقييم ومقارنة الرضى بين مجموعات المرضى. النتائج: شملت العينة 66,541 مريضاُ. وكان أكثر من 70% من المرضى راضين عن خدمات صيدليات المجتمع ونظام وصفتي. أظهر التقدم في السن والإناث ارتباطا إيجابيًا بالرضى عن العديد من الخدمات. في حين أظهر المرضى الذين زاروا العيادات الوقائية احتمالات أعلى للرضى عن توافر الأدوية ووقت الانتظار، بينما كان مرضى عيادات الأمراض المزمنة أقل رضى عن توافر الأدوية. كان لدى المرضى السعوديين احتمالات أقل للرضى عن الخدمات المتعددة. الاستنتاجات: قد تشير مستويات الرضى المرتفعة بشكل عام بين المرضى إلى نجاح نظام وصفتي في تلبية احتياجات المرضى وتوقعاتهم. ومع ذلك، لا تزال هناك مجالات للتحسين لزيادة رضى المرضى، مثل معالجة نقص الأدوية وضمان التواصل الواضح بين المريض والصيدلي. تسلط النتائج الضوء على أهمية المراقبة والتقييم المستمرة لدعم تجربة المريض مع خدمات الصيدلة التي قد تحسن تجربة∖رحلة المريض، والالتزام بالدواء، ونتائج الرعاية الصحية الشاملة. Abstract: Introduction: The healthcare system in KSA has been substantially transformed as part of Vision 2030, including implementation of an electronic prescribing system, called Wasfaty, to enable patients to receive their prescriptions from community pharmacies (CPs). This study assessed patient satisfaction with CPs and the Wasfaty system. Methods: This cross-sectional observational study used existing data from the Saudi Ministry of Health's patient experience program. Data were collected from patients (≥15 years of age) visiting governmental primary care clinics in 2022. Summary statistics were determined and multivariable logistic regression analyses were conducted. Results: The sample included 66,541 patients. More than 70% of patients were satisfied with the services of the CPs and the Wasfaty system. Being older and being female consistently showed a positive association with satisfaction across several services. Whereas patients in preventive clinics had higher odds of satisfaction with medication availability (OR: 1.19, 95% CI: 1.03–1.37) and waiting time (OR: 1.23; 95% CI: 1.03–1.47), patients in chronic disease clinics had lower satisfaction with medication availability (OR: 0.92, 95% CI: 0.85–0.99). Saudi patients had lower odds of being satisfied with multiple services. Conclusions: The overall high satisfaction among patients suggested the success of the Wasfaty system in meeting patient needs and expectations. However, areas for improvement exist to increase patient satisfaction, such as addressing medication shortages and ensuring clear patient–pharmacist communication. The results highlight the importance of continued monitoring and evaluation to support the patient experience with pharmacy services, and to improve patients' journeys, medication adherence, and overall healthcare outcomes.

This systematic review and meta-analysis assesses the effectiveness of no or low-dose versus high-dose aspirin on the incidence of coronary artery aneurysms (CAAs), intravenous immunoglobulin (IVIG) resistance, hospital stay length, and fever duration during the acute phase of Kawasaki disease. Our review adheres to the Preferred Reporting Items for Systematic Reviews guidelines. The PubMed and Google Scholar databases were comprehensively searched to identify relevant studies in the literature, including observational studies and randomized controlled trials (RCTs). The primary outcome was the incidence of CAAs. The secondary outcomes were the hospital stay length, fever duration, and IVIG resistance. The risk of bias was assessed using the Newcastle–Ottawa scale for cohort studies and Cochrane’s Risk of Bias Tool for RCTs. The data were analyzed using the Review Manager software. Twelve studies with a total of 68,495 participants met the inclusion criteria. The incidences of CAAs (odds ratio [OR] = 0.93; 95% confidence interval [CI] = 0.64–1.34) and IVIG resistance (OR = 1.46; 95% CI = 1.00–2.12) did not differ significantly between no or low-dose versus high-dose aspirin in treating acute KD. Moreover, the fever durations (mean difference [MD] = 3.55 h; 95% CI = −7.99–15.10) and hospital stay lengths (MD = −0.54 days; 95% CI = −2.50–1.41) were similar in the no and low-dose aspirin group compared to the high-dose aspirin group. Our review indicates that there are no significant differences in the incidences of CAA and IVIG resistance, fever durations, and hospital stay lengths between no or low-dose versus high-dose aspirin in treating the acute phase of KD.

In this essay, we advance a conversation initiated on these pages by the recent special issue on “Flourishing and Health in Critical Perspective: An Invitation to Interdisciplinary Dialogue” (Willen, 2022; Willen, Williamson, and Walsh 2022), followed by a response from VanderWeele and the Human Flourishing Program team (VanderWeele et al., 2023). We were pleased to learn of their agreement with several of the concerns we raised — among them the need for more qualitative inquiry into flourishing; greater attention to sociocultural differences; and additional consideration of the impact of structural conditions, power dynamics, and legacies of injustice on opportunities to flourish. Yet significant disagreements persist. In this rejoinder, we clarify a foundational concern that precipitated our initial call for critical dialogue: the entanglement of normative religious values and empirical methods in HFP’s work. This concern becomes even more evident in VanderWeele and colleagues’ published response and more recent work. This essay highlights the normative theological commitments that inform HFP’s measures and findings, and it foregrounds the risks of introducing theological views into the design and conduct of social scientific research. If religious commitments shape concept formulation and measurement, then those commitments will inevitably influence the findings and policy recommendations that result. Researchers, policymakers, public health professionals, and others interested in engaging with HFP’s instruments, findings, and recommendations need to be aware of the context of their emergence as well as the normative assumptions upon which they rest.

Optical remote sensing (RS) enables the study of the elemental composition of Earth’s surface over broad spatial extents by detecting reflected electromagnetic radiation. Covalent bonds of macromolecular structures often reflect electromagnetic radiation at specific wavelengths, and in some cases relate to bonds of specific elemental identity. In other cases, interfering optical properties greatly impact the ability of RS to measure elements directly, but advances in statistical methods and the theoretical understanding of optical properties expand the capacity to quantify diverse elements in many systems. When applied under the framework of ecological stoichiometry, spatially and temporally explicit measurements of elemental composition permit understanding of the drivers of ecological processes and variation over space and through time. However, the multitude of available technologies and techniques present a large barrier of entry into RS. In this paper we summarize the capabilities and limitations of RS to quantify elements in terrestrial and aquatic systems. We provide a practical guide for researchers interested in using RS to quantify elemental ratios and discuss RS as an emerging tool in ecological stoichiometry. Finally, we pose a set of emerging questions which integrating RS and ecological stoichiometry is uniquely poised to address.

Trait variation in predator populations can influence the outcome of predator-prey dynamics, with consequences for trophic dynamics and ecosystem functioning. However, the influence of prey trait variation on the impacts of predators is not well understood, especially for introduced predators where variation in prey can shape invasion outcomes. In this study, we investigated if intra-specific differences in vertical position of Daphnia influenced the impacts of the invasive zooplankton predator, Bythotrephes cederströmii, on plankton communities. Our results show that vertical position of Daphnia influenced Bythotrephes predation on smaller cladoceran species and impacts on primary production. Larger reductions in small cladoceran density and greater algal biomass were observed in mesocosms with less spatial overlap between Daphnia and Bythotrephes. These results suggest that differences in vertical position of Daphnia can alter the type and magnitude of Bythotrephes impacts in invaded systems.

The turbocharger fails due to high pressure and rotational speed. To examine the stress placed on the turbocharger's turbine blade, the analysis focused specifically on the turbine's relation to a 118 kW engine used in automobiles. The turbine operates at a rotational speed of 10000 r.p.m. In calculating the turbine design, factors such as pressure, quantity, breadth, tangential force, mass flow rate, radial force, and the input and output of the blades were considered. The turbine blade design included twelve blades. SolidWorks software was used to study and model the turbine blade of the turbo-engine, and a suitable finite element model was developed. In this project, the turbocharger turbine wheel, with configurations of 8, 10, and 12 blades, was designed and optimized for material selection. When subjected to the same pressure and speed, the Von Mises stress and deformation data were analyzed, comparing aluminum alloys (2618-T61 and 7075-T6), alloy steel, and copper alloys (manganese bronze). The results showed that the turbine wheel experienced minimal Von Mises stress of 175.8 MPa in aluminum alloy (2618-T61) with 12 blades at a ball velocity of 50 m/s, a minimum equivalent elastic strain of 1.503 in alloy steel with 8 blades, and a minimum total deformation of 6.138×10⁻² mm in alloy steel with 8 blades at a ball velocity of 50 m/s. Therefore, aluminum alloy (2618-T61) with 12 blades was determined to be the most suitable material and configuration for the turbine blade wheel.

Pulsed laser deposition (PLD) has become a widely used technology for fabricating multicomponent thin films. In this research, nanomaterial Alfa-Al2O3 with a particle size of 30 ± 5 nm was deposited on the surface of AL-2618 alloy turbine blades. The microstructure, phase composition and the effects of a coating made from Alfa-Al2O3 nanomaterial were studied. PLD was employed to improve the mechanical performance of the aluminium alloy (AL-2618) used in turbocharger blades, primarily to reduce corrosion and erosion. To ensure high hardness and extended fatigue life, a 10 μm layer of aluminium dioxide was deposited on the surface of the aluminium alloy using PLD. The mechanical properties of the blade improved, as shown by hardness tests conducted on the samples. An energy-dispersive X-ray spectroscopy test was conducted before and after deposition. After depositing a nanolayer of Al2O3, the mechanical properties were enhanced. The hardness of the samples increased from 685 HLD to 781 HLD, and corrosion and erosion were reduced. The atomic percentage of oxygen deposited on the blade surface ranged from 0.6% to 0.8%, and the surface roughness (x) decreased from 49.5 µm to 22.8 µm because of the nanolayer applied via PLD.

Hepatocellular carcinoma (HCC) is among the most common cancers worldwide, and tumor recurrence following liver resection or transplantation is one of the highest contributors to mortality in HCC patients after surgery. Using artificial intelligence (AI), we developed an interdisciplinary model to predict HCC recurrence and patient survival following surgery. We collected whole-slide H&E images, clinical variables, and follow-up data from 300 patients with HCC who underwent transplant and 169 patients who underwent resection at the Cleveland Clinic. A deep learning model was trained to predict recurrence-free survival (RFS) and disease-specific survival (DSS) from the H&E-stained slides. Repeated cross-validation splits were used to compute robust C-index estimates, and the results were compared to those obtained by fitting a Cox proportional hazard model using only clinical variables. While the deep learning model alone was predictive of recurrence and survival among patients in both cohorts, integrating the clinical and histologic models significantly increased the C-index in each cohort. In every subgroup analyzed, we found that a combined clinical and deep learning model better predicted post-surgical outcome in HCC patients compared to either approach independently.

Klebsiella pneumoniae is a Gram-negative bacterium associated with a wide range of community- and hospital-acquired infections. The emergence of clonal hypervirulent strains resistant to last-resort antimicrobial agents has become a global concern. The Kingdom of Saudi Arabia (KSA), with its diverse population and high tourism traffic, serves as a platform where the spread of multidrug-resistant (MDR) strains are facilitated. However, the knowledge of epidemiology and population diversity of MDR K. pneumoniae in KSA is scarce. We conducted a comprehensive genomic survey on 352 MDR K. pneumoniae isolates systematically collected from bloodstream and urinary tract infections in 34 hospitals across 15 major cities in KSA during 2022 and 2023. Whole-genome sequencing on the isolates was performed, followed by genomic epidemiology and phylodynamic analysis. Our study revealed a dynamic population characterized by the rapid expansion of several dominant clones, including, ST2096, ST147, and ST231, which were estimated to have emerged within the past decade. These clones exhibited widespread dissemination across hospitals and were genetically linked to global strains, particularly from the Middle East and South Asia. All major clones harboured plasmid-borne ESBLs and carbapenemase genes, with plasmidome analysis identifying multiple IncH, IncA/C and IncL plasmids underlying the MDR-hypervirulent phenotype. These plasmids were shared between major clones and became acquired on the same time scales as the expansion of the dominant clones. Our results report ST2096 as an emerging MDR-hypervirulent clone, emphasizing the need for monitoring of the circulating clones and their plasmid content in the KSA and broader West Asia.

Abstract Endothelial‐to‐mesenchymal transition (EndoMT) plays an important role in pulmonary hypertension (PH) but the molecular mechanisms regulating EndoMT remain to be defined. We demonstrate that the axis of the transcription factors PPARγ (Peroxisome Proliferator‐Activated Receptor gamma) and ETV2 (ETS variant 2) play important roles in the pathogenesis of PH. Decreased levels of the expression of PPARγ and ETV2 along with reduced endothelial and increased EndoMT markers are consistently observed in lungs and pulmonary artery endothelial cells (PAECs) of idiopathic pulmonary arterial hypertension patients, in hypoxia‐exposed mouse lungs, human PAECs, and in induced‐EndoMT cells. Etv2+/− mice spontaneously developed PH and right ventricular hypertrophy (RVH), associated with increased EndoMT markers and decreased EC markers. Interestingly, chronic hypoxia exacerbated right ventricular systolic pressure and RVH in Etv2+/− mice. PPARγ transcriptionally activates the ETV2 promoter. Consistently, while mice overexpressing endothelial PPARγ increases the expression of ETV2 and endothelial markers with reduced EndoMT markers, endothelial PPARγ KO mice show decreased ETV2 expression and enhanced EndoMT markers. Inducible overexpression of ETV2 under induced‐EndoMT cell model reduces number of cells with mesenchymal morphology and decreases expression of mesenchymal markers with increased EC makers, compared to control. Therefore, our study suggests that PPARγ‐ETV2 signaling regulates PH pathogenesis through EndoMT.

Purpose: The Audiovisual-Assisted Therapeutic Ambience in Radiotherapy (AVATAR) trial was a prospective multicenter study (NCT03991156) examining the combination of video immersion with radiation therapy and was successfully conducted through the collaboration of pediatric radiation oncology teams at 10 institutions independent of any pre-existing consortium. We sought to analyze and report the methodology of trial conception and development, process map, and cost. Methods and Materials: The study enrolled patients aged 3 to 10 years preparing to undergo radiation therapy, integrated the combination of AVATAR-based video immersion with radiation therapy at each institution, and offered AVATAR use as an alternative to anesthesia, with rates of anesthesia use and outcomes of serial standardized anxiety and quality-of-life assessments assessed among the 81 children enrolled. A process map was created based on the trial timeline with the following components: study development time (time from conception of the trial to the accrual of the first patient, including design phase, agreement and approval phase, and site preparation phase), and accrual duration time (time from the first to last accrual). Costs and institutional success rates were calculated. Results: Time from inception of study to last accrual was 3.6 years (1313 days). The study development time was 417 days (31.7%), and accrual duration time was 896 days (68.3%), with the final 50% of accrual occurring in

Facial expressions are critical for non-verbal communication. The Canis genus epitomizes the interplay between behaviour and morphology in the evolution of non-verbal communication. Recent work suggests that the levator anguli oculi medialis (LAOM) muscle is unique to dogs (Canis familiaris) within the Canis genus and evolved due to domestication. The LAOM raises the inner eyebrows, resulting in the ‘puppy dog eyes’ expression. Here, we test whether the LAOM is a derived trait in dogs by (i) examining the facial expression muscles of a closely related and ancestral wild Canis species, the coyote (C. latrans) and (ii) comparing our results with other Canis and canid taxa. We discover that coyotes have a well-developed LAOM like dogs, which differs from the modified/absent LAOM in grey wolves. Our findings challenge the hypothesis that the LAOM developed due to domestication. We suggest that the LAOM is a basal trait that was lost in grey wolves. Additionally, we find inter- and intraspecific variations in the size of the muscles of the outer ear, forehead, lips and rostrum, indicating potential adaptations related to sensory perception, communication and individual-level functional variations within canids. Together, this research expands our knowledge of facial expressions, their evolution and their role in communication.

To better understand adolescent experiences of menstruation, the CODE Red project was initiated to examine period poverty and menstruation stigma. As part of the project, a survey was posted online through Qualtrics, and the link was posted to social media sites. One hundred and eighty-seven individuals completed the open-ended questionnaire between January and August 2022. The individuals are based in the United States, with most coming from northeastern Indiana. Using an iterative analysis, the data were analyzed using the theory of memorable messages. Three themes emerged supporting memorable messages: the negative cycle of self, talk silence breeds silence, and my mom wasn’t there. The study concludes that grin n’ bear it and silence are the predominant types of memorable messages first-time menstruators’ experience. Moreover, first-time menstruators experience self-silencing and other-silencing. Implications include that silence negatively impacts the mother-daughter relationship and that attention should be paid to the importance of communication before menarche.

Leopard seals have traditionally been considered Antarctic predators with a Southern Ocean distribution. Historically, sightings north of the Antarctic Polar Front were considered extralimital. However, recent studies suggest a significant presence of leopard seals in subantarctic regions. Here, we assess the spatial occurrence, residency status, and temporal trends of leopard seals in Chile using historical records, stranding reports, standardized monitoring data, photo-identification (photo ID) catalogs, and sightings from four research expeditions. We also characterize glaciers where sightings are concentrated, identifying glaciological and geomorphic attributes that prolong iceberg residency time, which is linked to high leopard seal concentrations. Based on these attributes, we evaluated other potential suitable glacial habitats in Patagonia. We obtained 438 sighting records of leopard seals from 1927 to 2023. Over the last 15 years, we documented a 4-18% annual increase in stranding events reported to national authorities. Most sightings (75%) were concentrated in two hotspots: National Park San Rafael Lagoon, located in Northern Patagonia, and Parry Fjord in Tierra del Fuego. Using photo ID catalogs, we identified 19 resident leopard seals, including 16 multi-year residents observed between 2010-2023 (10 in San Rafael, 6 in Tierra del Fuego) and 3 potential residents (observed multiple months in the same year in Tierra del Fuego). San Rafael monitoring data showed no inter-annual trend, but seasonal trends were observed. We also provide evidence of breeding in Chile, with records of at least 14 pups born and at least two females giving birth in multiple years. Our habitat characterization suggests that calving flux, fjord sinuosity, and fjord width variation are crucial for prolonging iceberg residency in hotspot areas. Based on these attributes, we identified 13 additional fjords in Patagonia as “very likely” suitable for leopard seals. Our study confirms that Patagonia is part of the species’ breeding distribution, shifting the paradigm that leopard seals are merely visitors north of the Antarctic Polar Front. Given the limited number of suitable glaciers in Chile and the potential impacts of climate change, our assessment highlights glacial retreat as a major threat for the ecosystem of this pagophilic marine apex predator in South America.

Background: The global COVID-19 crisis has underscored the critical role of effective decision-making in healthcare systems. Saudi Arabia has shown resilience by implementing comprehensive testing, tracing, and vaccination measures. Given the unique cultural and religious characteristics of Makkah, specific challenges have prompted efforts to uncover local pandemic responses. This qualitative assessment aims to delineate the challenges faced by decision-makers during COVID-19 in Makkah and identify key interventions implemented by the Makkah healthcare cluster to manage and coordinate care. Method: Utilizing a purposive sampling approach, executive leaders within the Makkah Healthcare Cluster were invited for semi-structured interviews during the COVID-19 period. Thematic analysis was carried out in five steps, ensuring rigor and trustworthiness through multiple checks, and employing a critical and collaborative approach. Result: Throughout the COVID-19 outbreak in Makkah, participants revealed Several factors that have hindered healthcare organizations' ability to effectively manage the pandemic, including testing difficulties, resource shortages, vaccination misconceptions, continuity of care issues, infections among healthcare workers, and the need for consistent protocols. The participant leaders in Makkah's healthcare cluster specified implemented strategies that helped in overcoming the encountered challenges, such as adopting new technologies, enhancing communication, managing supply and demand, and improving workforce adaptability and development. Their experience in managing Hajj and Umrah provided valuable insights for handling the pandemic effectively. Conclusion: The study emphasizes the significance of technology adoption, effective communication, supply management, workforce development, and lessons from managing religious events. Its findings have implications for healthcare systems globally, emphasizing the importance of preparedness, response, and resilience in diverse cultural contexts.

Abstract Smooth pursuit eye movements are considered a well-established and quantifiable biomarker of sensorimotor function in psychosis research. Identifying psychotic syndromes on an individual level based on neurobiological markers is limited by heterogeneity and requires comprehensive external validation to avoid overestimation of prediction models. Here, we studied quantifiable sensorimotor measures derived from smooth pursuit eye movements in a large sample of psychosis probands (N = 674) and healthy controls (N = 305) using multivariate pattern analysis. Balanced accuracies of 64% for the prediction of psychosis status are in line with recent results from other large heterogenous psychiatric samples. They are confirmed by external validation in independent large samples including probands with (1) psychosis (N = 727) versus healthy controls (N = 292), (2) psychotic (N = 49) and non-psychotic bipolar disorder (N = 36), and (3) non-psychotic affective disorders (N = 119) and psychosis (N = 51) yielding accuracies of 65%, 66% and 58%, respectively, albeit slightly different psychosis syndromes. Our findings make a significant contribution to the identification of biologically defined profiles of heterogeneous psychosis syndromes on an individual level underlining the impact of sensorimotor dysfunction in psychosis.

Abstract Background Patients with opioid use disorder (OUD) experience various forms of stigma at the individual, public, and structural levels that can affect how they access and engage with healthcare, particularly with medications for OUD treatment. Telehealth is a relatively new form of care delivery for OUD treatment. As reducing stigma surrounding OUD treatment is critical to address ongoing gaps in care, the aim of this study was to explore how telehealth impacts patient experiences of stigma. Methods In this qualitative study, we interviewed patients with OUD at a single urban academic medical center consisting of multiple primary care and addiction clinics in Oregon, USA. Participants were eligible if they had (1) at least one virtual visit for OUD between March 2020 and December 2021, and (2) a prescription for buprenorphine not exclusively used for chronic pain. We conducted phone interviews between October and December 2022, then recorded, transcribed, dual-coded, and analyzed using reflexive thematic analysis. Results The mean age of participants (n = 30) was 40.5 years (range 20–63); 14 were women, 15 were men, and two were transgender, non-binary, or gender-diverse. Participants were 77% white, and 33% had experienced homelessness in the prior six months. We identified four themes regarding how telehealth for OUD treatment shaped patient perceptions of and experiences with stigma at the individual (1), public (2–3), and structural levels (4): (1) Telehealth offers wanted space and improved control over treatment setting; (2) Public stigma and privacy concerns can impact both telehealth and in-person encounters, depending on clinical and personal circumstances; (3) The social distance of telehealth could mitigate or exacerbate perceptions of clinician stigma, depending on both patient and clinician expectations; (4) The increased flexibility of telehealth translated to perceptions of increased clinician trust and respect. Conclusions The forms of stigma experienced by individuals with OUD are complex and multifaceted, as are the ways in which those experiences interact with telehealth-based care. The mixed results of this study support policies allowing for a more individualized, patient-centered approach to care delivery that allows patients a choice over how they receive OUD treatment services.

Abstract Pneumonia is a common comorbidity in patients with severe traumatic brain injury (TBI), and is associated with increased morbidity and mortality. In this study, we established a model of intratracheal Klebsiella pneumoniae administration in young adult male and female mice, at 4 days following an experimental TBI, to investigate how K. pneumoniae infection influences acute post-TBI outcomes. A dose-response curve determined the optimal dose of K. pneumoniae for inoculation (1 x 10^6 colony forming units), and administration at 4 days post-TBI resulted in transient body weight loss and sickness behaviors (hypoactivity and acute dyspnea). K. pneumoniae infection led to an increase in pro-inflammatory cytokines in serum and bronchoalveolar lavage fluid at 24 h post-infection, in both TBI and sham (uninjured) mice. By 7 days, when myeloperoxidase + neutrophil numbers had returned to baseline in all groups, lung histopathology was observed with an increase in airspace size in TBI + K. pneumoniae mice compared to TBI + vehicle mice. In the brain, increased neuroinflammatory gene expression was observed acutely in response to TBI, with an exacerbated increase in Ccl2 and Hmox1 in TBI + K. pneumoniae mice compared to either TBI or K. pneumoniae alone. However, the presence of neuroinflammatory immune cells in the injured brain, and the extent of damage to cortical and hippocampal brain tissue, was comparable between K. pneumoniae and vehicle-treated mice by 7 days. Examination of the fecal microbiome across a time course did not reveal any pronounced effects of either injury or K. pneumoniae on bacterial diversity or abundance. Together, these findings demonstrate that K. pneumoniae lung infection after TBI induces an acute and transient inflammatory response, primarily localized to the lungs with some systemic effects. However, this infection had minimal impact on secondary injury processes in the brain following TBI. Future studies are needed to evaluate the potential longer-term consequences of this dual-hit insult.

Abstract Using pooled vaginal microbiota data from pregnancy cohorts (N = 683 participants) in the Environmental influences on Child Health Outcomes (ECHO) Program, we analyzed 16S rRNA gene amplicon sequences to identify clinical and demographic host factors that associate with vaginal microbiota structure in pregnancy both within and across diverse cohorts. Using PERMANOVA models, we assessed factors associated with vaginal community structure in pregnancy, examined whether host factors were conserved across populations, and tested the independent and combined effects of host factors on vaginal community state types (CSTs) using multinomial logistic regression models. Demographic and social factors explained a larger amount of variation in the vaginal microbiome in pregnancy than clinical factors. After adjustment, lower education, rather than self-identified race, remained a robust predictor of L. iners dominant (CST III) and diverse (CST IV) (OR = 8.44, 95% CI = 4.06–17.6 and OR = 4.18, 95% CI = 1.88–9.26, respectively). In random forest models, we identified specific taxonomic features of host factors, particularly urogenital pathogens associated with pregnancy complications (Aerococcus christensenii and Gardnerella spp.) among other facultative anaerobes and key markers of community instability (L. iners). Sociodemographic factors were robustly associated with vaginal microbiota structure in pregnancy and should be considered as sources of variation in human microbiome studies.

الملخص: أهداف البحث: تشهد المملكة العربية السعودية تغييرات تحويلية في مجال الرعاية الصحية، مع إعطاء الأولوية لمراكز الرعاية الصحية الأولية لتحسين تجربة المرضى ونظام الرعاية الصحية الشامل. وتهدف هذه الدراسة إلى تقييم مدى الاستعداد للتغيير لدى مديري مراكز الرعاية الصحية الأولية في مكة المكرمة، المملكة العربية السعودية. طرق البحث: استخدمت دراسة مقطعية نموذج استبانة ''أدكار''، التي تتكون من 22 سؤالاً على مقياس ليكرت، لتقييم وعي المديرين ورغبتهم ومعرفتهم وقدراتهم وتعزيزهم واستعدادهم للتغيير بشكل عام. النتائج: وجدت الدراسة وجود ارتباط كبير بين مستويات التعليم العالي وزيادة الوعي، إلى جانب زيادة الرغبة، بين مديري الرعاية الصحية الأولية. بالإضافة إلى ذلك، تم العثور على ارتباط إيجابي بين العمر (أكبر من 41 سنة) والمعرفة بين مديري الرعاية الصحية الأولية. ومع ذلك، أظهر المديرون الذين لديهم 11 عامًا أو أكثر من الخبرة ارتباطا سلبيا بالاستعداد للتغيير. الاستنتاجات: يحدد نموذج ''أدكار'' خمسة أبعاد مفيدة لتحديد مدى استعداد المديرين واستعدادهم للخضوع للتغيير. تعتمد إدارة التغيير الناجحة على انفتاح الأفراد على التغيير، متأثرين بعوامل مثل العمر والتعليم والخبرة. Abstract: Background: KSA is currently undergoing significant changes in its healthcare system, with a particular emphasis on enhancing the role of primary healthcare centers (PHCs) to elevate patient experience and overall healthcare quality. At the forefront of this transformation are head managers in PHCs, who play a crucial role in implementing these changes effectively. The readiness of these managers is paramount to the successful execution of the envisioned transformation and the subsequent improvement of patient experience. Objective: This study aims to assess the readiness to change among head managers of primary healthcare centers in Makkah, KSA. Methodology: Cross-sectional study utilized the ADKAR model questionnaire, consisting of 22 Likert scale questions, to assess PHCs head managers' awareness, desire, knowledge, ability, reinforcement, and overall change readiness. Results: The study found a significant association between higher educational levels and increased awareness (β = 0.214, p = 0.030), along with greater desire (β = 0.207, p = 0.029) among primary healthcare (PHC) managers. Additionally, a positive association was found between age (≥41 years) and knowledge among PHC managers (β = 0.138, p = 0.030). However, managers with 11 or more years of experience showed a negative association with change readiness (β = −0.112, p = 0.001). Conclusion: The ADKAR model outlines five dimensions that are useful for identifying the readiness and willingness of head managers in PHCs in Makkah cluster to undergo change. Assessing change readiness is crucial for organizational transformation, with head managers playing a significant role. Factors such as age, education, and experience influence managers' readiness for change in primary healthcare centers (PHCs) in Makkah.

This study aimed to evaluate the static and dynamic pupil changes, and light sensitivity following a single dose of low-dose atropine at concentrations of 0.01%, 0.025%, and 0.05% over a 24 h period. Healthy young adults (20–22 years; n = 25) participated in this randomized, double-blind study. Each participant received one of three atropine concentrations in a masked fashion. Baseline mesopic and dynamic pupil sizes were measured at various post-instillation intervals (5 min, 30 min, 1 h, 2 h, 4 h, and 24 h). A minimum 48 h washout period was observed between treatments. Subjective light sensitivity was assessed using the Visual Light Sensitivity Questionnaire (VLSQ-8) at 24 h. All atropine concentrations caused significant pupil dilation (p < 0.001), with the 0.05% concentration producing the greatest dilation (peak mesopic size: 7.4 mm, p < 0.001) and the slowest recovery at 24 h (6.4 mm, p < 0.001). The dynamic pupil constriction range was most restricted with 0.05% (1.7 mm, p < 0.05), compared to 0.025% (2.2 mm) and 0.01% (2.6 mm). Subjective symptoms, including light sensitivity and glare, followed a dose-dependent pattern (p < 0.05). In 60% participants, 0.05% caused the most symptoms, while in 70% participants, 0.01% caused the least. Despite significant pupil dilation, the pupil center coordinates did not shift significantly along the horizontal or vertical axes (p > 0.05). Low-dose atropine induced dose-dependent pupil dilation and light sensitivity; 0.05% atropine caused the most pronounced effects. These findings underscore the importance of tailoring the atropine dosage to balance its efficacy and tolerability. Further studies are needed to explore the long-term impact of repeated dosing on pupillary behavior and subjective symptoms.

The defining characteristic of laterality is the dominance of one side of the brain controlling specific functions of paired organs or on one side of the body. Structural and functional asymmetries are ubiquitous in horses and range from anatomical features (e.g., the length of long bones) to the gathering of sensory information (e.g., which eye is used to observe unfamiliar scenes) and motor functions (e.g., left–right differences in locomotion). There is a common tendency to assign observed structural or functional asymmetries to lateralization, which often involves more than a simple left–right difference in observed behavior. This narrative review explores the concept of laterality relative to the structural and functional asymmetries reported in horses. Inconsistent and poorly defined terminology, a widely disparate methodology, and a lack of standardized thresholds make it difficult to assess the presence or degree of laterality. Within this context, there seems to be limited evidence of laterality in horses and much more prevalent and stronger support for structural and functional asymmetries due to a wide range of well-established behavioral, nociceptive, and biomechanical mechanisms. The authors caution against generalizing the idea that all observed structural or functional asymmetries in horses are due to laterality.

Shrimp is one of the most popular and widely consumed seafood products worldwide. It is highly perishable due to its high moisture content. Thus, dehydration is commonly used to extend its shelf life, mostly via air drying, leading to a temperature increase, moisture removal, and matrix shrinkage. In this study, a mathematical model was developed to describe the changes in moisture and temperature distribution in shrimp during hot-air drying. The model considered the heat and mass transfer in an irregular-shaped computational domain and was solved using the finite element method. Convective heat and mass transfer coefficients (57.0–62.9 W/m2∙K and 0.007–0.008 m/s, respectively) and the moisture effective diffusion coefficient (6.5 × 10−10–8.5 × 10−10 m2/s) were determined experimentally and numerically. The shrimp temperature and moisture numerical solution were validated using a cabinet dryer with a forced air circulation at 60 and 70 °C. The model predictions demonstrated close agreement with the experimental data (R2≥ 0.95 for all conditions) and revealed three distinct drying stages: initial warming up, constant drying rate, and falling drying rate at the end. Initially, the shrimp temperature increased from 25 °C to around 46 °C and 53 °C for the process at 60 °C and 70 °C. Thus, it presented a constant drying rate, around 0.04 kg/kg min at 60 °C and 0.05 kg/kg min at 70 °C. During this stage, the process is controlled by the heat transferred from the surroundings. Subsequently, the internal resistance to mass transfer becomes the dominant factor, leading to a decrease in the drying rate and an increase in temperatures. A numerical analysis indicated that considering the irregular shape of the shrimp provides more realistic moisture and temperature profiles compared to the simplified finite cylinder geometry. Furthermore, a sensitivity analysis was performed using the validated model to assess the impact of the mass and heat transfer parameters and relative humidity inside the cavity on the drying process. The proposed model accurately described the drying, allowing the further evaluation of the quality and safety aspects and optimizing the process.

The present study aims to better understand the nature of currently circulating GPV strains and their pathological impact on the immune system during natural outbreaks among different duck breeds in Egypt. For this purpose, 99 ducks (25 flocks) of different breeds, aged 14–75 days, were clinically examined, and 75 tissue pools from the thymus, bursa of Fabricius, and spleen were submitted for virus detection and identification. Clinical and postmortem findings were suggestive of GPV infection. Concerning the immune system organs, atrophy in the thymus (60.6%), bursa (45.5%), and spleen (38.3%) was the most common gross lesion. Microscopically, the pathological impact of the virus was exhibited by a necrotic thymic cortex with Hassall’s corpuscle disintegration, the disappearance of normal bursal histological morphology accompanied by atrophied follicles and lymphocytic depletion, and apoptosis of B-lymphocytes in lymphoid follicles of the spleen. Furthermore, immunohistochemical examination revealed positive signals of the parvovirus detected in thymic lymphocytes in the cortex, bursa-dependent lymphoid follicle of the medulla, and diffuse positive expression of viral antigens in the spleen. GPV was detected in ducks using polymerase chain reaction, with the highest percentage of positive detection in the bursa of Fabricius (76%). Next-generation sequencing and phylogenetic analysis revealed that the detected virus was a variant of GPV, globally named novel GPV (NGPV), and closely related to Chinese NGPV isolates. To our knowledge, the current study is pioneering to address the immunopathological impact of NGPV among naturally infected ducks confirmed with full genome sequencing and immunohistochemical identification worldwide.

This study aimed to utilise response surface methodology (RSM) to determine the optimal conditions for extracting urease from a plant source and evaluate its biochemical properties. Chickpea seeds were selected as the source of urease. Results showed that chickpea seeds had a high enzyme activity (3.99 U/mg protein) under the best extraction conditions of pH 7.99, tris base buffer concentration of 0.2, time of 60 minutes and ratio of 1:13 (g: mL). When a second-order polynomial model was used, the predicted correlation coefficient (pred. R2) was 0.8477, the adjusted correlation coefficient (adj. R2) was 0.9333 and the correlation values (R2) were 0.9665, indicating that the predicted models and experimental values agreed very well. The method has the potential to enhance the cost-effectiveness of enzyme production through large-scale manufacturing and offers an economical alternative to other techniques.

Virtual culinary medicine education interventions have the potential to improve dietary behaviors, nutrition knowledge, cooking skills, and health outcomes for ethnically diverse individuals with type 2 diabetes. The purpose of this study is to describe the adaptation of the Nourishing the Community through Culinary Medicine (NCCM) program for virtual delivery, and the protocol for pilot testing this intervention. The intervention includes five 90-min virtual NCCM sessions streamed live from a Teaching Kitchen. Feasibility outcomes are recruitment, retention, acceptability, and satisfaction. Short-term effectiveness outcomes are measured through self-administered questionnaires, including perceived health, average daily servings of fruits and vegetables, frequency of healthy food consumption, shopping, cooking, and eating behaviors, cooking self-efficacy, diabetes self-management, perceived barriers to healthy eating, and nutrition knowledge. Demographics and biometric outcomes are sourced from the patient’s electronic medical records including glycosylated hemoglobin (HbA1c), Body Mass Index, and blood pressure. We will conduct a single-arm pilot study to test the feasibility and short-term effectiveness of NCCM program with individuals with type 2 diabetes.

Summary: Tumor cells undergo uncontrolled proliferation driven by enhanced anabolic metabolism including glycolysis and glutaminolysis. Targeting these pathways to inhibit cancer growth is a strategy for cancer treatment. Critically, however, tumor-responsive T cells share metabolic features with cancer cells, making them susceptible to these treatments as well. Here, we assess the impact on anti-tumor T cell immunity and T cell exhaustion by genetic ablation of lactate dehydrogenase A (LDHA) and glutaminase1 (GLS1), key enzymes in aerobic glycolysis and glutaminolysis. Loss of LDHA severely impairs expansion of T cells in response to tumors and chronic infection. In contrast, T cells lacking GLS1 can compensate for impaired glutaminolysis by engaging alternative pathways, including upregulation of asparagine synthetase, and thus efficiently respond to tumor challenge and chronic infection as well as immune checkpoint blockade. Targeting GLS1-dependent glutaminolysis, but not aerobic glycolysis, may therefore be a successful strategy in cancer treatment, particularly in combination with immunotherapy.

ABSTRACT The limited temporal completeness and taxonomic accuracy of species lists, made available in a traditional manner in scientific publications, has always represented a problem. These lists are invariably limited to a few taxonomic groups and do not represent up-to-date knowledge of all species and classifications. In this context, the Brazilian megadiverse fauna is no exception, and the Catálogo Taxonômico da Fauna do Brasil (CTFB) (http://fauna.jbrj.gov.br/), made public in 2015, represents a database on biodiversity anchored on a list of valid and expertly recognized scientific names of animals in Brazil. The CTFB is updated in near real time by a team of more than 800 specialists. By January 1, 2024, the CTFB compiled 133,691 nominal species, with 125,138 that were considered valid. Most of the valid species were arthropods (82.3%, with more than 102,000 species) and chordates (7.69%, with over 11,000 species). These taxa were followed by a cluster composed of Mollusca (3,567 species), Platyhelminthes (2,292 species), Annelida (1,833 species), and Nematoda (1,447 species). All remaining groups had less than 1,000 species reported in Brazil, with Cnidaria (831 species), Porifera (628 species), Rotifera (606 species), and Bryozoa (520 species) representing those with more than 500 species. Analysis of the CTFB database can facilitate and direct efforts towards the discovery of new species in Brazil, but it is also fundamental in providing the best available list of valid nominal species to users, including those in science, health, conservation efforts, and any initiative involving animals. The importance of the CTFB is evidenced by the elevated number of citations in the scientific literature in diverse areas of biology, law, anthropology, education, forensic science, and veterinary science, among others.

To determine changes in Bordetella pertussis and B. parapertussis detection rates, we analyzed 1.43 million respiratory multiplex PCR test results from US facilities from 2019 through mid-2023. From mid-2022 through mid-2023, Bordetella spp. detection increased 8.5-fold; 95% of detections were B. parapertussis. While B. parapertussis rates increased, B. pertussis rates decreased.

Abstract Despite the proven efficacy of the disease-modifying therapy (DMT) for multiple sclerosis (MS), the rates of non-adherence are frequently high. We aimed to evaluate the rate of non-adherence to the first DMT in Upper Egypt and identify different contributing factors. Out of 310 patients, ninety-seven adult patients with RRMS were recruited from three MS units located in Upper Egypt and were subjected to the following: complete clinical history, expanded disability status score (EDSS), Eight-item Morisky Medication Adherence Scale (MMAS-8), abbreviated Treatment Satisfaction Questionnaire for Medication-9 (TSQM-9), Hamilton depression scale, Fatigue Severity Scale (FSS) and the Pittsburgh Sleep Quality Index (PSQI). According to MMAS-8 scores, 63 (64.9%) of patients were non-adherent to their first DMT. Non-adherent patients are more likely to have longer disease duration (p = 0.002), longer duration on first DMT (p = 0.030), first DMT-start date before 2019 (p = 0.040), and lower treatment satisfaction scores (p = 0.016). However, there was no significant relation with physical disability, depression, fatigue, or sleep quality. On the regression analysis model, a lower treatment satisfaction score was the only predictor of DMT non-adherence (p = 0.012). Despite expanding DMT options, non-adherence among MS patients in Upper Egypt is high. Treatment satisfaction with DMT is the only predictor of adherence among MS patients of Upper Egypt. Adherence and satisfaction with the prescribed DMT should be assessed carefully to maximize DMT benefits.

Objective: The impact of conduit dimensions and location of esophagogastric anastomosis on long-term quality of life after esophagectomy remains unexplored. We investigated the association of these parameters with surgical outcomes and patient-reported quality of life at least 18 months after esophagectomy. Methods: We identified all patients who underwent esophagectomy for cancer from 2018 to 2020 in our institution. We reviewed each patient's initial postoperative computed tomography scan measuring the gastric conduit's greatest width (centimeters), linear staple line length (centimeters), and relative location of esophagogastric anastomosis (vertebra). Quality of life was ascertained using patient-reported outcome measures. Perioperative complications, length of stay, and mortality were collected. Multivariate regressions were performed. Results: Our study revealed that a more proximal anastomosis was linked to an increased risk of pulmonary complications, a lower recurrence rate, and greater long-term insomnia. Increased maximum intrathoracic conduit width was significantly associated with trouble enjoying meals and reflux long term after esophagectomy. A longer conduit stapled line correlated with fewer issues related to insomnia, improved appetite, less dysphagia, and significantly enhanced “social,” “role,” and “physical'” aspects of the patient's long-term quality of life. Conclusions: The dimensions of the gastric conduit and the height of the anastomosis may be independently associated with outcomes and long-term quality of life after esophagectomy for cancer.

Background: Sleep is important for health, but its relationship to cardiometabolic health in women of childbearing age remains unclear. Furthermore, stress, unmet basic needs, and lack of physical activity may be related to disrupted sleep and poor cardiometabolic health in women of childbearing age and these relationships may differ by ethnicity. The purposes of this study were to investigate the relationship between sleep, markers of cardiometabolic health, stress, unmet basic needs, and physical activity in women of childbearing age with overweight or obesity and identify if these relationships differed between women that identified as Latino/Hispanic and non-Latino/Hispanic ethnicity. Methods: A secondary cross-sectional analysis was conducted using baseline data from a trial that embeds healthy eating and activity into a national home visiting program, Parents as Teachers. The sample was stratified based on self-reported ethnicity (Hispanic/Latino or non-Hispanic/Latino). Pearson's and Spearman's correlations were used to determine bivariate relationships among sleep, cardiometabolic variables, stress, unmet basic needs, and physical activity. Results: Two hundred seventy-six women, 46% of whom identified as Hispanic/Latino, were included in the analysis. Body mass index (BMI) was significantly correlated with sleep disturbance (??=?0.23, p?=?0.01) in women who identify as Hispanic/Latino. Stress was positively related to sleep disturbance, sleep duration, and unmet needs for both groups of women. BMI was correlated with unmet basic needs in women who identified as non-Hispanic/Latino (??=?0.25, p?=?0.01). Conclusions: Our results suggest that sleep, stress, and basic needs are important in understanding cardiometabolic health in women of childbearing age and these relationships differ depending on ethnicity. Clinical Trial Registration Number: NCT03758638.

Background: Radiation is one of the most important stressors related to missions in space beyond Earth’s orbit. Epidemiologic studies of exposed workers have reported elevated rates of Parkinson’s disease. The importance of cognitive dysfunction related to low-dose rate radiation in humans is not defined. A meta-analysis was conducted of six cohorts in the Million Person Study (MPS) of low-dose health effects to learn whether there is consistent evidence that Parkinson’s disease is associated with radiation dose to brain. Materials and methods: The MPS evaluates all causes of death among U.S. radiation workers and veterans, including Parkinson’s disease. Systematic and consistent methods are applied to study all categories of workers including medical radiation workers, industrial radiographers, nuclear power plant workers, atomic veterans, and Manhattan Projects workers at the Los Alamos National Laboratory and at Rocky Flats. Consistent methods for all cohorts are used to estimate organ-specific doses and to obtain vital status and cause of death. Results: The meta-analysis include 6 cohorts within the MPS, consisting of 517,608 workers and 17,219,001 person-years of observation. The mean dose to brain ranged from 6.9 to 47.6 mGy and the maximum dose from 0.76 to 2.7 Gy. Five of the 6 cohorts revealed positive associations with Parkinson’s disease. The overall summary estimate from the meta-analysis was statistically significant based on 1573 deaths due to Parkinson’s disease. The summary excess relative risk at 100 mGy was 0.17 (95% CI: 0.05; 0.29). Conclusions: Parkinson’s disease was positively associated with radiation in the MPS cohorts indicating the need for careful evaluation as to causality in other studies, delineation of possible mechanisms, and assessing possible implications for space travel as well as radiation protection guidance for terrestrial workers.

Abstract Background Gay, bisexual, and other men who have sex with men (GBM) report high rates of problematic alcohol use, anxiety, and depression. This may, in part, be due to stressors related to their sexual identity (i.e., minority stressors). However, few studies have examined both distal and proximal stressors, as well as the specific psychological mechanisms by which these stressors may be related to alcohol use outcomes, in a representative sample of GBM. We explored the relationship between distal and proximal stressors and alcohol use outcomes, as well as the role of anxiety and depression as potential mediators of these relationships. Methods We analyzed the baseline data of 2,449 GBM from Engage, a cohort study of sexually active GBM recruited using respondent-driven sampling (RDS) in Montreal, Toronto, and Vancouver from February 2017 to August 2019. Using structural equation modeling, we examined the associations between distal minority stressors (i.e., experiences of heterosexist harassment, rejection, and discrimination), proximal minority stressors (i.e., internalized homonegativity, concerns about acceptance, concealment, and lack of affirmation), anxiety and depression, and alcohol consumption and alcohol use problems. RDS-adjusted analyses controlled for age, income, sexual orientation, ethnicity, recruitment city, and HIV serostatus. Results There were positive direct associations between distal stress and proximal stress, anxiety, and depression, but not alcohol use outcomes. Proximal stress had a positive direct association with anxiety, depression, and alcohol use problems, but not alcohol consumption. Anxiety was positively associated with alcohol consumption and alcohol use problems. Depression was negatively associated with alcohol consumption but not alcohol use problems. Regarding indirect effects, distal stress was associated with alcohol use outcomes via proximal stress and anxiety, but not via depression. Conclusions We found support for a minority stress model as it relates to alcohol use outcomes among GBM. Findings suggest that proximal minority stress and anxiety differentially impact the problematic alcohol use among GBM who experience heterosexist discrimination. Clinical providers should consider incorporating the treatment of proximal minority stressors and anxiety into existing alcohol interventions for GBM.

Abstract Background Dairy products and their components may impact immune function, although the current evidence base has some research gaps. As part of a larger systematic literature review of dairy products/components (including probiotics, dairy proteins, and dairy fats) and immune function, we identified the available epidemiologic research on the impact of dairy products/components on incidence and natural history of infectious diseases. Methods PubMed and Embase databases were systematically searched through May 2022 to identify eligible studies using pre-defined Population, Intervention, Comparator, Outcomes, and Study design criteria. Herein, we focused on describing the impacts of dairy product/component on infectious disease outcomes, including the effect on leukocyte and cytokine response in humans. Risk of bias assessment was performed using the Academy of Nutrition and Dietetics Quality Criteria Checklist. The Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines were followed. Results Among 9,832 studies identified from the larger literature search, 133 relevant publications from 128 studies reported on dairy product/component and infectious disease outcomes. Few studies are available on the impact of non-fermented milk and traditional yogurt on infectious disease. Evidence was identified to suggest milk and yogurt drinks fermented with Lactobacillus strains reduce the risk and burden of common infectious diseases (CIDs), although the findings are mixed and difficult to reconcile due to heterogenous study populations, bacterial strains, and study methods. Few studies are available on the impact of dairy products/components on the natural history of infection, with the available findings indicating probiotics may both improve gastrointestinal symptoms among HIV-infected persons and help eradicate and alleviate the symptoms of Heliobacter (H.) pylori. The available evidence also suggests lactoferrin may reduce the virological burden of COVID-19 and hepatitis C virus. No consistent changes in leukocytes or cytokine production were observed for any type of dairy product or their components, but probiotics appeared to enhance natural killer cell levels/activity and the phagocytic process. Conclusions Dairy products, particularly those with added probiotics, may represent an easily accessible nutritional intervention to prevent and improve the course of infectious diseases. This review highlights the need for additional research in this potentially impactful area. Prospero registration CRD42022333780.

Abstract 15% of US adults have gallstones, most of which are clinically “silent”. Several studies show that menopausal hormone therapy (MHT) increases symptomatic gallstones and cholecystectomy risk. MHT use may be contraindicated in women with gallstones and population studies may be biased by “confounding by contraindication” while the true association between MHT and gallstones remains underestimated. We sought to examine whether MHT use was associated with asymptomatic gallstones using instrumental variable (IV) analysis to account for confounding by contraindication. We used 2018 postmenopausal women from the Third National Health and Nutrition Examination Survey to estimate associations of MHT use with asymptomatic gallstones. A traditional logistic regression analysis was compared to instrumental variable (IV) analysis to account for confounding by contraindication. 12% of women with asymptomatic gallstones and 25% of women without gallstones were current MHT users (P

Abstract Background Sudden unexpected death in children is a tragic event. Understanding the genetics of sudden death in the young (SDY) enables family counseling and cascade screening. The objective of this study was to characterize genetic variation in an SDY cohort using whole genome sequencing. Methods The SDY Case Registry is a National Institutes of Health/Centers for Disease Control and Prevention surveillance effort to discern the prevalence, causes, and risk factors for SDY. The SDY Case Registry prospectively collected clinical data and DNA biospecimens from SDY cases