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Abstract Background Communication campaigns for health warning labels (HWLs) are an evidence-based strategy to reduce tobacco use. No research has examined campaign messages to support graphic HWLs for little cigars and cigarillos (LCCs). Methods We developed four message types for graphic LCC HWLs: (1) Explanatory (2) Testimonial (3) Inquisitive and (4) Recommendation, depicting colon, lung, and esophageal cancer. Online focus groups with Black and White young adults (18–25 years old) who reported current LCC use were conducted. Participants were shown graphic HWLs on LCCs and then four message types corresponding to the HWLs. Participants discussed persuasive communication features for each message type. Results Thirty-six young adults who use LCCs participated. Four central themes were revealed. (1) Perceived credibility of message and messenger impacted effectiveness. (2) Personally relevant messages were emotionally engaging and made people think about their health, (3) Succinct, factual messages with new information were perceived as believable, and (4) Language perceived to be “Marketing,” was deemed insincere. Conclusions For communication campaigns to support graphic HWLs for LCCs, messages perceived as credible, relatable, and messages that convey new information are more likely to be received positively and may increase campaign effectiveness.

As positive-sense RNA viruses, the genomes of flaviviruses serve as the template for all stages of the viral life cycle, including translation, replication, and infectious particle production. Yet, they encode just 10 proteins, suggesting that the structure and dynamics of the viral RNA itself helps shepherd the viral genome through these stages. Herein, we highlight advances in our understanding of flavivirus RNA structural elements through the lens of their impact on the viral life cycle. We highlight how RNA structures impact translation, the switch from translation to replication, negative- and positive-strand RNA synthesis, and virion assembly. Consequently, we describe three major themes regarding the roles of RNA structure in flavivirus infections: 1) providing a layer of specificity; 2) increasing the functional capacity; and 3) providing a mechanism to support genome compaction. While the interactions described herein are specific to flaviviruses, these themes appear to extend more broadly across RNA viruses.

Background: Multiple sclerosis (MS) is an immune-mediated inflammatory disease that primarily targets the myelin of axons. Extremities are frequently affected, resulting in a negative impact on both activities of daily living (ADL) and quality of life. In recent years, there has been increasing interest in the potential benefits of exercise and blood flow restriction training (BFRT) programs as a therapeutic tool in people with neurological disorders. The aim of the present systematic review was to know the clinical effects of BFRT programs in people with MS. Methods: A systematically comprehensive literature search was conducted and registered in PROSPERO prior to its execution under the reference number CRD42024588963. The following data sources were used: Pubmed, Scopus, Web of Science (WOS) and the Cochrane Library. The following data were extracted from the papers: study design, sample, interventions, dosage, outcome measures and results. To assess the methodological quality of the papers included, the Quality Index of Downs and Black was used. Additionally, the articles were classified according to the levels of evidence and grades of recommendation for diagnosis studies established by the Oxford Center for Evidence-Based Medicine. Also, the Cochrane Handbook for Systematic Reviews of Interventions was used by two independent reviewers to assess risk of bias, assessing the six different domains. Results: Seven articles with a total of 71 participants were included in the review. Of the seven articles, five papers studied the effectiveness of BFRT combined with strengthening exercises and two papers studied the effect of BFRT combined with aerobic exercise. Of the five articles that analyzed BFRT combined with strengthening exercises, only two presented a control group. Both performed a low-load resistance training in combination with BFRT with four series, 30/15/15/15 repetitions and a rest of 1 min between the series and 3 min between the exercises. The control groups to which they were compared performed a high intensity strengthening exercise protocol which had the same exercises, sets, rests and duration of the protocol as the experimental groups. For those two papers which investigated the effects of BFRT combined with aerobic training, exercise was performed in two sessions per week for a period of 8 and 6 weeks, respectively. In both studies, the experimental protocol began with a warm-up phase and ended with a cool-down phase, and there were differences in cuff management. All these investigations found positive effects in the interventions that combined exercise with BFRT. The characteristics, outcome measures, effects of the interventions and the assessment of the methodological quality of the included studies and risk of bias are shown in the tables. Conclusions: BFRT in people with MS appears to be effective and safe for people with MS. BFRT might show positive clinical effects on strength, hypertrophy and balance outcomes. Nevertheless, future research should be conducted with better methodological quality to ensure the potential benefits of BFRT in people with MS since the studies analyzed present a high risk of bias and methodological limitations.

Abstract Background Advance Choice Documents (ACDs) have been recommended for use in England and Wales based on evidence from trials that show that they can reduce involuntary hospitalisation, which disproportionately affects Black African and Caribbean people. Our aim was therefore to develop and test ACD implementation resources and processes for Black people who have previously been involuntarily hospitalised and the people that support them. Methods Resource co-production workshops were held to inform the development of the ACD template and two types of training for all stakeholders, comprising a Recovery College course and simulation training. An ACD facilitator then used the ACD template developed through the workshops to create personalised ACDs with service users and mental health staff over a series of meetings. Interviews were then conducted with service user and staff participants and analysed to document their experience of the process and opinions on ACDs. Other implementation strategies were also employed alongside to support and optimise the creation of ACDs. Results Nine ACDs were completed and were largely reported as appropriate, acceptable, and feasible to service users and staff. Both reported it being an empowering process that encouraged hope for better future treatment and therefore better wellbeing. Uncertainty was also expressed about the confidence people had that ACDs would be adhered to/honoured, primarily due to staff workload. The information provision training and the skills training were generally considered to be informative by trainees. Conclusions The project has developed an ACD creation resource that was reported as agreeable to all stakeholders; however, the generalisability of the findings is limited due to the small sample size. The project also highlights the importance of staff and ACD facilitator capacity and good therapeutic relationships in ACD completion. Further research is needed to determine the adjustments needed for large scale use, including for those under age 18 and those under the care of forensic mental health services; and how to include carers/supporters more in the process.

This article propounds that Jonathan Swift’s Gulliver’s Travels develops a geometrical comedy in the Albertinian fashion. Starting with a specific reference to Momus in Puppet-Show, it will be maintained that Swift refers to an earlier tradition of criticism and transfers it to his prose writing. To explore this point, the article will draw on the Italian Renaissance humanist, satirist, and architect Leon Battista Alberti’s Momus and De Pictura. It will be suggested that there is a corollary between the exilic vision of the picaresque anti-hero and the definitive quality of the centric ray which establishes the centre of meaning in painting in Alberti. In accordance, it will be maintained that Swift adapts Alberti’s critical rendition of the Momus story as a geometrical metaphor for linear perspective. Although Momus does not directly appear as part of the dramatis personae in Gulliver’s Travels, Lemuel Gulliver emerges as an eighteenth-century successor to Alberti’s geometrical designs since Swift adapts the Renaissance humanist’s method of geometrical optics which reveres ocularcentrism. By these standards, it will be propounded that this method informs the comedic programme of Gulliver’s Travels. In accordance, the conclusion draws on the point that Swiftian comedy owes a considerable debt to the mimetic concerns of Renaissance humanism which signals the birth of a posthumanist comedy through a re-mapping of Albertinian perspectivism.

Abstract Cerebral vasospasm (CVS) is an important contributor to delayed cerebral ischemia following aneurysmal subarachnoid hemorrhage (aSAH), leading to high morbidity and long-term disability. While several microRNAs (miRNAs) have been implicated in vasospasm, the underlying mechanisms for CVS remain poorly understood. Our study aims to identify miRNAs that may contribute to the development of CVS. Whole-blood samples were obtained during or outside of vasospasm from aSAH patients whose maximal vasospasm was moderate or severe. MiRNAs were isolated from serial whole-blood samples, and miRNA sequencing was performed. Differentially expressed miRNAs were identified and the expression levels in patients’ samples were verified using real-time qPCR. The biological functions of identified miRNA were evaluated in human brain endothelial cells (HBECs). MiRNA profiling revealed significant upregulation of miR-148b-3p in patients during CVS. We demonstrated that miR-148b-3p directly targeted and decreased the expression of ROCK1, affecting cell proliferation, migration, and invasion of HBECs through the ROCK-LIMK-Cofilin pathway. We propose that the upregulation of miRNA-148b-3p plays a role in the development of CVS by regulating actin cytoskeletal dynamics in HBECs, which is crucial for vascular function. Our study highlights miR-148b-3p as a potential diagnostic marker as well as therapeutic target for CVS following aSAH.

In this paper, a model of a wireless receiver based on macro diversity (MD) technique is considered. The system consists of a macro diversity SC receiver (MD SC) that combines the output signals from two micro diversity (mD SC) receivers with L input branches. This approach is used to simultaneously reduce the effects of Weibull short-term fading, Gamma long-term fading, and co-channel interference (CCI) on system performance. In this paper, closed-form expressions for the outage probability (Pout) of the system for the ratio of the signal-to-interference (SIR) at the outputs of the mD SC and the MD SC receiver, were derived. The system Pout of the ratio the signal-to-interference at the output of the MD SC receiver can further be used to calculate the average fading duration (AFD) of the proposed system configuration. Further, we explore the potential of using Large Language Model (LLM)-based trending ChatGPT service to estimate the degree of the Quality of Service (QoS), considering Pout as one of the input variables. Finally, we have compared the proposed method to traditional Weka-based machine learning algorithm in predicting the QoS.

Epidural steroid injections (ESIs) are often used to treat low back pain (LBP) due to lumbosacral radiculopathy as well as LBP without a clear component of radiculopathy, in some cases. While it is increasingly recognized that psychosocial factors are associated with pain outcomes, few studies have assessed the contribution of these factors to common pain interventions like ESIs. This study aimed to summarize the scope and nature of how psychosocial factors are accounted for in research on ESIs for the treatment of LBP with or without lumbosacral radiculopathy and to identify gaps and recommendations for future research. A scoping review following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis-Scoping Review Extension framework was conducted. Publications dated before September 2023 were searched in PubMed, CINAHL, Scopus, PsycINFO, and Google Scholar. Of the 544 records identified through database searching, a total of 51 studies cumulatively totaling 10,447 participants were included. Sample sizes ranged from 12 to 5,104 participants. Of the 51 included studies, only 10 (20%) analyzed and reported the relationship between at least one psychosocial variable and post-injection pain at any follow-up timepoint. The other 41 (80%) included no analyses examining ESI response as a function of psychosocial variables. Based on the studies that included analysis by psychosocial variables, poor psychosocial functioning appears to be associated with inferior treatments outcomes following ESI for back pain with or without lumbosacral radiculopathy. Relative to the vast body of literature on ESIs for LBP and lumbosacral radiculopathy, minimal attention has been directed to the influence of psychosocial factors on ESI treatment outcomes. Future research evaluating predictors of the effect of ESI on pain relief should include development of more comprehensive models containing modifiable psychosocial variables as predictors of ESI response.

El presente libro se gesta entre los años 2018 y 2021 como el resultado de una investigación en la Facultad de letras de la Universidad del País Vasco, cuyo objetivo es el de incorporar al currículum universitario las diversidades sexo-genéricas desde la perspectiva de la historia del arte. A este respecto, se vuelve fundamental hacerse con las partes olvidadas de la historia del arte, aquellas que evidenciaban la dimensión pública de las diversidades sexo-genéricas. Para lo cual, es necesario un doble movimiento que, por un lado, deconstruya la normatividad invisibilizadora y por otro, recupere y re-edifique espacios en los que poder producir nuevas narrativas capaces de albergar la diversidad de la realidad humana, a nivel sexual, racial, de género, de capacidades, etc.

Annual well visit appointments with personal primary care providers (PCP) are critical for improving population health. However, barriers to healthcare access can hinder routine and preventive screenings and treatment. This study examined the financial, geospatial, and attitudinal barriers to routine PCP visits among rural-residing patients. Data were collected from Amazon Mechanical Turk (MTurk) workers who lived in a rural ZIP code. A logistic regression model was fitted to assess barriers and facilitators associated with receipt of a routine checkup within the past year. The primary predictor of interest was the belief that a personal PCP can improve access to primary and preventive care and therefore improve health (alpha=0.9015). The model also adjusted for age, sex, insurance status, distance to primary care, and typical wait time for a primary care appointment. All analyses were conducted in Stata 17 SE. Increased belief that a personal PCP can improve access to primary and preventive care and therefore improve health was associated with increased likelihood of receiving an annual routine checkup (AOR=1.21, p=0.003). Patients who were insured (AOR=5.16, p=0.003) were significantly more likely to receive an annual routine checkup, while those who travelled farther distances to see a primary care provider were less likely to receive an annual routine checkup (AOR=0.69; p=0.027). Findings suggest that financial, geospatial, and attitudinal barriers may hinder annual routine checkups with PCP. Addressing all three of these potential barriers can have a positive impact on population health by increasing access and utilization of primary care within rural populations.

Background Receiving communication of positivity for metabolic diseases at Expanded Newborn Screening can be extremely stressful for parents, both in case of false positive and true positive cases. However, little is known about the predictors of distress and differential impact on mothers and fathers.Methods In this longitudinal study, 169 fathers and 171 mothers referred to one of the Italian metabolic centres for communication of positivity completed a survey including General Health Questionnaire-12, Emotion Thermometers (measuring stress, anxiety, depression, anger and need for help), Impact of Event Scale–Revised, Multidimensional Scale of Perceived Social Support and Emotion Regulation Questionnaire. Perceived severity and control of the children’s health were also assessed. The survey was completed in person after the first session at metabolic centres and online after 1, 3 and 6 months.Results Nearly 80% of parents reported a clinical level of distress and anxiety after the communication of positivity, one-third of them reported post-traumatic symptoms and more than half of parents reported a need for help. After 6 months, there are still more than 30% of parents with a clinical level of distress and anxiety, 6% with post-traumatic symptoms and more than 20% who continue to express a need for help. No gender difference was reported and no differences emerged between pre-COVID-19 and post-COVID-19 periods for parental distress and post-traumatic symptoms.Social support, perceived severity and control of the child’s health—but not gender or previous parental experience—predicted the post-traumatic symptoms at baseline while at 6 months the only significant predictor was perceived severity.Conclusion Adequate psychological support should be provided from the initial communication for both parents and for true positive, false positive and variants of uncertain significance/heterozygous carrier cases.

Introduction Autism is a lifelong minority neurotype present from birth. There is a dearth of credible evidence to suggest gender variation in Autism prevalence, despite historical under-diagnosis of women. Autistic people Assigned Female At Birth (AFAB) have worse physical and mental health compared with non-Autistic peers. To date, the reproductive health experiences of Autistic AFAB people have been under-investigated.Methods and analysis This study aims to co-develop a quality improvement intervention to improve the reproductive health of Autistic people. The study uses Community Partnered Participatory Research (an approach similar to Community-Based Participatory Research), largely through a Community Council that co-governs the study. To understand reproductive health needs, a longitudinal qualitative investigation using creative methods will be undertaken with 100 Autistic AFAB people with 10 waves of data collection over 5 years (interview n=500–1000). Participants will be purposively selected to include harder-to-reach members of the Autistic community, including those who are non-speaking or semi-speaking, have a learning disability and those from marginalised ethnicities. Data will be analysed thematically with Community Council involvement. Intervention development will be undertaken from 2029 onwards.Ethics and dissemination We are an Autistic-led team that adopts a social model of disability. However, this study raises ethical issues relating to sensitive topics and marginalised populations. Accordingly, we have robust procedures in place to assess capacity to ensure informed consent and to allow participants to take part without opting into data sharing. Ethical approval has been awarded by the Swansea University School of Health and Social Care Research Ethics Committee. We will publish our findings as open access articles in peer-reviewed journals.

Neuropsychiatric symptoms (NPS) such as depression, anxiety, apathy and aggression affect up to 90% of Alzheimer’s disease (AD) patients. These symptoms significantly increase caregiver stress and institutionalization rates, and more importantly they are correlated with faster cognitive decline. However, the neuronal basis of NPS in AD remains largely unknown. Here, we review current understanding of NPS and related pathology in studies of AD patients and AD mouse models. Clinical studies indicate that NPS prevalence and severity vary across different AD stages and types. Neuroimaging and postmortem studies have suggested that pathological changes in the anterior cingulate cortex, hippocampus, prefrontal cortex, and amygdala are linked to NPS, although the precise mechanisms remain unclear. Studies of AD mouse models have indicated that amyloid-beta and tau-related neurodegeneration in the hippocampus, prefrontal cortex, and anterior cingulate cortex are correlated with NPS-like behavioral deficits. A better understanding of the NPS phenotypes and related pathological changes will pave the way for developing a better management strategy for NPS in AD patients.

Blockchain technology has garnered substantial interest due to its capacity to transform numerous industries by amplifying transparency and bolstering security measures. Despite the increasing interest, there is a void in existing literature regarding the alignment of actors with the Diffusion of Innovation (DOI) principles in the context of blockchain adoption. This gap restricts comprehension of the factors influencing adoption. This research addresses this void by investigating how actors align with the DOI principles in making decisions about blockchain adoption. The DOI model is combined with the innovation translation concept derived from Actor-Network Theory (ANT) to explore these complex dynamics in more detail. The results indicate that the decision-making process for blockchain adoption corresponds to the knowledge, persuasion, and decision stages, mirroring the phases found in the innovation translation approach. This research offers theoretical insights and practical knowledge that can be beneficial to individuals and organisations looking to promote the successful implementation of blockchain technology.

Archaeological burial contexts are among particularly attractive topics for both experts – archaeologists, and wider audiences. The reasons behind this are partially the rich, attractive portable finds that are usually associated with these contexts, but also the interpretative potential, i.e., insight into rituals and symbolic values of people in the past. Archaeological finds from burial contexts are very diverse in their nature and function, and may include parts of burial constructions, remains of rituals, objects placed along the deceased and objects placed on the deceased. The interpretation of burial contexts and associated finds are tightly connected and interlinked. These finds were often regarded as a result of a single, short-lived event and were considered as particularly important for the questions of relative and absolute chronology; the contents of burial finds were used as a basis for hypotheses regarding social relations, and, overall, burial finds were used for interpreting the identity of the deceased, reconstructing rituals, etc. Personal ornaments are particularly common in burial contexts, and, at the same time, the richest finds of personal ornaments mainly originate from burial contexts. When it comes to personal ornaments, it is usually assumed that they were owned by the deceased, and they are interpreted through the prism of status, prestige, and/or identity. However, personal ornaments might have had a much wider symbolic meaning. In this paper, we will look at the possibilities in terms of the meanings of personal ornaments from prehistoric contexts – beside markings of identity and status of the deceased, they might also have represented a gift to the deceased, gift to divinities, they might have had an apotropaic and a prophylactic function, for both the deceased and the participants in the burial ritual, and they might also have had an emotional meaning.

Introduction:: Manual segmentation of medical images is labor intensive and especially challenging for images with poor contrast or resolution. The presence of disease exacerbates this further, increasing the need for an automated solution. To this extent, SynthSeg is a robust deep learning model designed for automatic brain segmentation across various contrasts and resolutions. This study validates the SynthSeg robust brain segmentation model on computed tomography (CT), using a multi-center dataset. Methods:: An open access dataset of 260 paired CT and magnetic resonance imaging (MRI) from radiotherapy patients treated in 5 centers was collected. Brain segmentations from CT and MRI were obtained with SynthSeg model, a component of the Freesurfer imaging suite. These segmentations were compared and evaluated using Dice scores and Hausdorff 95 distance (HD95), treating MRI-based segmentations as the ground truth. Brain regions that failed to meet performance criteria were excluded based on automated quality control (QC) scores. Results:: Dice scores indicate a median overlap of 0.76 (IQR: 0.65-0.83). The mean volume difference is 7.79% (CI: 6.41%–9.18%), with CT segmentations typically smaller than MRI-based. The median HD95 is 2.95 mm (IQR: 1.73-5.39). QC score based thresholding improves median dice by 0.1 and median HD95 by 0.05 mm. Morphological differences related to sex and age, as detected by MRI, were also replicated with CT, with an approximate 17% difference between the CT and MRI results for sex and 10% difference between the results for age. Conclusion:: SynthSeg can be utilized for CT-based automatic brain segmentation, but only in applications where precision is not essential. CT performance is lower than MRI based on the integrated QC scores, but low-quality segmentations can be excluded with QC-based thresholding. Additionally, performing CT-based neuroanatomical studies is encouraged, as the results show correlations in sex- and age-based analyses similar to those found with MRI.

Objective: This study created personas using quantitative segmentation and knowledge user enhancement to inform intervention and service design for rural patients to encourage preventive care uptake. Methods: This study comprised a cross-sectional survey of rural unattached patients and a co-design workshop for persona development. Cross-sectional survey data were analyzed for meaningful subgroups based on quartiles of preventive care completion. These quartiles informed “relevant user segments” grouped according to demographics (age, sex), length of unattachment, percentage of up-to-date preventive activities, health care visit frequency, preventive priorities, communication confidence with providers, and chronic health conditions, which were then used in the workshop to build the final personas. Results: 207 responses informed persona user segments, and five health care providers and 13 patients attended the workshop. The resulting four personas, included John (not up-to-date on preventive care activities), Terrance (few up-to-date preventive care activities), George (moderately up-to-date preventive care activities), and Anne (mostly up-to-date preventive care activities). Conclusion: Quantitative persona development with integrated knowledge user co-design/enhancement elevated and enriched final personas that achieved robust profiles for intervention design. Innovation: This project's use of a progressive methodology to build robust personas coupled with participant feedback on the co-design process offers a replicable approach for health researchers.

Background In 2021, an estimated 43% of the world’s population had been diagnosed with a neurological disorder. Early life stress (ELS) is now a well-established risk factor for later-life neurological disorders. However, translation to clinical practice is hindered by oversimplification, lack of standardisation and limited knowledge of the patterns and mechanisms of disease pathogenesis.Methods The current paper reviews existing literature relating to ELS and neurological disorders and provides an overview and clinical perspective of the gaps in knowledge and future directions required to improve clinical care for patients.Results To develop effective preventive or restorative therapies, there will be an increasing need to understand and further define the role of ELS in the subsequent emergence of neurological disorders and to investigate the interaction of ELS with other more widely recognised genetic and environmental factors.Conclusions We propose that additional interdisciplinary studies are needed to develop standardised scales to assess ELS and a new taxonomy and survey of ELS for future interdisciplinary studies. In addition, we suggest that further studies involving clinical cohorts have the potential to contribute to important findings that could help enhance the care of patients.

Background: In March 2023, the lung allocation policy underwent major changes from a tiered structure to a composite allocation score (CAS). The goal was to improve allocation equity for disadvantaged groups by deprioritizing transplant distance. This study examines the effects of CAS on geographic trends and transportation efficiency. Methods: A retrospective cohort study was conducted using the United Network for Organ Sharing database, queried for adult lung transplants from September 1, 2022 to September 1, 2023. Outcomes were nautical distance of transplant, ischemic time, and flight required for transport (estimated as distance >100 miles). Perioperative complications and early survival were analyzed, with propensity matching to account for baseline differences. Results: A total of 1,394 pre-CAS and 1,197 post-CAS patients were included in the study cohort. Post-CAS recipients were less likely to be ABO type O (39.2% vs 47.3%, p

Environmental, social and governance corporate policies (ESG) will remodel the overall economy in the next years, respectively will influence the success of investment. ESG factors will drive change fundamentally in the economy that will raise some risks and opportunities for the financial sector. Therefore, it is crucial that they include responsible investment and ESG criteria in their overall business strategy. ESG policies have passed so from the early stage, in which they represented a specialized product for a restricted group of investors, to the actual stage, in which these actions have transformed into a general framework that influences the strategic thinking of the whole entity. ESG thus has an influence on growing business strategy throughout the transaction life cycle and in their portfolios. This paper explores the impact of the ESG notch on the share performance of the Romanian entities listed on the Bucharest Stock Exchange. In conclusion, incorporation of ESG factors in investment strategy may influence stock performance and attract investors interested in sustainability.

Abstract Vestibular schwannomas (VS) are the most common tumor of the skull base with available treatment options that carry a risk of iatrogenic injury to the facial nerve, which can significantly impact patients’ quality of life. As facial nerve outcomes remain challenging to prognosticate, we endeavored to utilize machine learning to decipher predictive factors relevant to facial nerve outcomes following microsurgical resection of VS. A database of patient-, tumor- and surgery-specific features was constructed via retrospective chart review of 242 consecutive patients who underwent microsurgical resection of VS over a 7-year study period. This database was then used to train non-linear supervised machine learning classifiers to predict facial nerve preservation, defined as House-Brackmann (HB) I vs. facial nerve injury, defined as HB II–VI, as determined at 6-month outpatient follow-up. A random forest algorithm demonstrated 90.5% accuracy, 90% sensitivity and 90% specificity in facial nerve injury prognostication. A random variable (rv) was generated by randomly sampling a Gaussian distribution and used as a benchmark to compare the predictiveness of other features. This analysis revealed age, body mass index (BMI), case length and the tumor dimension representing tumor growth towards the brainstem as prognosticators of facial nerve injury. When validated via prospective assessment of facial nerve injury risk, this model demonstrated 84% accuracy. Here, we describe the development of a machine learning algorithm to predict the likelihood of facial nerve injury following microsurgical resection of VS. In addition to serving as a clinically applicable tool, this highlights the potential of machine learning to reveal non-linear relationships between variables which may have clinical value in prognostication of outcomes for high-risk surgical procedures.

El presente artículo analiza el papel crucial de las estrategias disruptivas en la supervivencia y adaptación de la industria gastronómica durante la pandemia de la COVID-19. Mediante una investigación cualitativa basada en entrevistas en profundidad con empresarios, emprendedores y gerentes gastronómicos, se identificaron tendencias y prácticas comunes que reflejan un enfoque proactivo y adaptable para enfrentar la crisis. Los resultados revelaron una amplia gama de estrategias innovadoras, que van desde la personalización de servicios de entrega hasta la diversificación del producto y la colaboración estratégica con otros establecimientos. La rápida adaptación a las nuevas condiciones del mercado, la gestión eficaz de riesgos y la búsqueda activa de alianzas estratégicas emergieron como elementos clave para la resiliencia empresarial. Además, se destacó la importancia de la transformación digital y la comunicación efectiva con los clientes como factores determinantes para mantener la relevancia y competitividad en un entorno empresarial en constante cambio.

Abstract Enolase, a multifunctional protein with diverse isoforms, has generally been recognized for its primary roles in glycolysis and gluconeogenesis. The shift in isoform expression from α-enolase to neuron-specific γ-enolase extends beyond its enzymatic role. Enolase is essential for neuronal survival, differentiation, and the maturation of neurons and glial cells in the central nervous system. Neuron-specific γ-enolase is a critical biomarker for neurodegenerative pathologies and neurological conditions, not only indicating disease but also participating in nerve cell formation and neuroprotection and exhibiting neurotrophic-like properties. These properties are precisely regulated by cysteine peptidase cathepsin X and scaffold protein γ1-syntrophin. Our findings suggest that γ-enolase, specifically its C-terminal part, may offer neuroprotective benefits against neurotoxicity seen in Alzheimer's and Parkinson's disease. Furthermore, although the therapeutic potential of γ-enolase seems promising, the effectiveness of enolase inhibitors is under debate. This paper reviews the research on the roles of γ-enolase in the central nervous system, especially in pathophysiological events and the regulation of neurodegenerative diseases.

Abstract INTRODUCTION Adults with Down syndrome (DS) have an increased risk of Alzheimer's disease (AD) dementia, often showing neuropathological indicators by age 40. Physical function and activities of daily living (ADLs) are understudied areas of function that may inform dementia risk. We investigated associations among age, physical function (gait/balance, grip strength, and lower extremity strength), ADLs, and dementia risk symptoms in adults with DS. We hypothesized that compromised physical function and lower independence with ADLs would be associated with an informant/caregiver‐reported measure of dementia risk symptoms. METHODS A secondary analysis for this cross‐sectional study was completed using data from two academic research centers with 43 adults with DS (age 30 ± 12 years). We examined the association of dementia risk symptoms, captured through the Dementia Screening Questionnaire for Individuals with Intellectual Disabilities (DSQIID), with physical function (timed up and go [TUG], sit‐to‐stand [STS], grip strength) and ADLs (Waisman Activities of Daily Living Scale). A linear regression model for the continuous dementia risk measure in the DSQIID used a log transformation of (1 + log(Y + 1)) to account for a high zero count. Wilcoxon rank‐sum tests were used to assess differences in the physical function measures, DSQIID questionnaire, and Waisman ADL by dividing mean age categories. RESULTS Higher DSQIID scores were associated with lower independence with ADLs (β = −0.103, p = 0.008), slower gait times (TUG; β = 0.112, p = 0.034), and impaired lower extremity strength (STS; β = 0.112, p = 0.017) and grip strength (β = −0.039, p = 0.034). DSQIID scores differed significantly between the ≥30 and

This article presents a case of spontaneous conception and live birth in a 40-year-old woman who had undergone gonadotoxic chemotherapy and allogenic stem cell transplant for relapsed acute myelogenous leukemia complicated by treatment-refractory graft-versus-host disease. The patient's follicle stimulating hormone level was 44.4 mIU/mL at age 38 and then decreased to 4.1 mIU/mL at age 41, suggesting ovarian recovery. Her graft-versus-host disease subjectively improved during pregnancy. She ultimately delivered a healthy neonate. This case demonstrates the potential for ovarian recovery after stem allogenic cell transplant in a patient of advanced reproductive age and provides insight into the limited knowledge about graft-versus-host disease in pregnancy. As survival after stem cell transplant continues to improve, understanding the downstream consequences of the treatment, including for fertility and pregnancy, is of growing importance.

For several years, the application of versatile Lagrangian puff models like CALPUFF has been widely acknowledged as a standard practice in numerous countries globally for forecasting odour exposure levels in the vicinity of industrial facilities. In this case study, the CALPUFF model was adopted to assess the odour impact related to a rendering plant located in Italy. For the implementation of the emission scenario, data obtained from olfactometric monitoring conducted at the plant were taken into account. The modelling study was divided into two parts. Firstly, the odour impact resulting from the current emission condition of the plant was evaluated, distinguishing between different macro-areas of the plant: production department, cooking vats, and wastewater treatment plant. Secondly, simulations of predictive impact scenarios were conducted, assuming the introduction of odour emission containment systems for the macro-areas identified as the major contributors to impact. In particular, from the simulations, it emerged that the production department contributes negligibly to the odour impacts on the surrounding area. The cooking tanks revealed odour concentrations, at the 98th percentile on an annual basis, near the closest residential areas to the plant, reaching the odour perception threshold (1 ouE/m3). The contribution of the water treatment plant proved to be significant, with concentrations estimated on some sensitive receptors around the odour nuisance threshold (5 ouE/m3). For this reason, it was hypothesized to introduce cooling systems that facilitate the condensation of vapours emitted from the cooking vats before the release into the atmosphere. In this way, based on the simulation results, receptor concentrations lower than 1 ouE/m3 would be achieved. Regarding the wastewater treatment plant, various predictive scenarios were hypothesized, assuming the covering of one or more tanks and the conveyance of air streams to be treated. The results of the different scenarios highlighted that the configuration ensuring the greatest reduction in impacts, among those analyzed, involves covering three tanks. This way, the odour impact could be reduced by approximately 80% compared to the current scenario. However, the solution that appears to be of greater interest seemed to be the closure of only one tank: in this way, by intervening on a single emission source, receptor concentrations could be reduced by an average of 60%.

The present paper intends to discuss recent developments in detection and quantification of odorous compounds in real industrial gaseous emissions. In this work, the chemical characterization of industrial odours is carried out using an Agilent gas chromatograph (mod. 8890) coupled with three different detectors to obtain a more complete chemical characterization: a Mass Spectrometer (Agilent 5977B MSD), a Flame Ionization detector (FID, Agilent) and a Pulsed Flame Photometric Detector (PFPD, OI Analytical mod. 5833). This system (GC-MS/FID/PFPD) offers different significant advantages if compared with the classical analytical techniques currently adopted in the chemical characterisation of industrial odour mixtures. Applied to industrial case studies, it enables the selective detection and quantification of Volatile Organic Sulphur Compounds (VOSCs), even present in traces (ppb level) in complex gaseous mixtures, facilitating the identification of molecules responsible of odour harassment. This instrumentation represents a crucial development in enhancing the understanding of the chemical composition of odorous mixtures, demonstrating cost-effectiveness and time efficiency.

Dynamic olfactometry involves human examiners for quantifying odour. Examiners directly inhale, although diluted, the increasingly concentrated odorous samples and, during the analysis, they are thus exposed to substances potentially dangerous to human health. EN 13725 still does not propose a protocol for assessing the risk related to such activities. In the scientific literature, only few studies have addressed this issue, with discrepant approaches based on a deterministic risk assessment. However, the risk assessment needs the definition of exposure parameters that are strictly linked to their specific working time and the activity of the olfactometric laboratory, in terms of hours worked, number and type of samples analysed. Therefore, a deterministic risk assessment method remains limited to the experience of a single laboratory. Despite the importance of the topic, many aspects of the subject still remain unexplored. This paper aims to highlight the critical aspects of deterministic approaches available in the scientific literature (mainly due to the variability of exposure parameters connected with the specific working activity of every single panellist and each olfactometric laboratory and the necessity of conducting risk assessment within 30 h permitted by EN 13725) and evaluate the possible new solutions to conduct risk assessment for olfactometric workers.

The surge of atmospheric contaminants due to industrial and population expansion has led to increased public concern over olfactory annoyance, particularly in residential areas adjacent to agricultural, industrial, and waste management facilities. Characterizing passive area sources, which lack defined flows, in terms of odor emissions, represents a challenging task, exacerbated by the dual role of wind as both a dispersal agent and driving force for emission. Many sampling devices have been developed over the past decades. In particular, Flux Chambers have a mixed headspace and a non-directional flow, and Wind Tunnels have a directional flow that is predominantly parallel to the inspected surface. Besides the significant differences between the two devices, the issue is further complicated by the variety of designs proposed within the same family. Wind tunnel designs have evolved from large, portable hoods to compact versions to improve portability and fluid dynamic performances. In particular, Low-Speed Wind Tunnels have gained traction due to reduced dilution within the hoods. The aim of this study is to investigate the fluid dynamics and mass transfer of the current Italian regulatory LSWT, mentioned by the Italian legislation, with the purpose of highlighting its strengths and limitations. Fluid dynamic analysis on this device reveals non-homogenous airflow distribution within the hood, indicating the presence of a preferential channel in the central body of the wind tunnel. Mass transfer analysis demonstrates a concentration gradient along the outlet duct’s vertical direction, possibly affecting sample representativeness. Future developments may aim to achieve uniform flow and concentration distribution, ensuring accurate odor emission assessments from passive area sources.

The sampling of odorous emissions is a fundamental step in correctly quantifying odour concentration. Its importance was strongly emphasized in the recent Italian legislation (MASE, 2023), which describes strict constraints for conducting olfactometric sampling. In particular, for point sources, it is necessary to assess the variability of the source to evaluate any spikes in emissivity and then sample consistently with the trend of this emissivity. Therefore, this study aims to conduct a field sampling campaign that meets the criteria mentioned in the Italian recent directive, combining olfactometric sampling with continuous monitoring of the source using portable PID instrumentation. The results obtained during this preliminary monitoring campaign highlight that the variability in VOC emissions is not strictly correlated with potential variability in terms of odour concentration. Indeed, despite the variations observed in continuous measuring at the source, the odour concentration measurements remained stable throughout the monitoring period. Chemical speciation of samples identified high concentrations of propene, varying in accordance with PID reading, while the odour potential was primarily due to lower concentrations of octene and nonene, which remained relatively constant. These results indicate that continuous monitoring emission variability does not necessarily translate into odour concentration variability.

Gaseous emissions which may be of odour impact and interest are not solely derived from industrial processes or agricultural fields, but also from natural sources. Natural odorous gaseous emissions are often present in geothermal areas. In these cases, the inventory and the measurement of the emitted gas flows are not trivial. This work presents the experience of an olfactometric survey conducted in a geothermal-interest area, specifically around Mt. Amiata, Tuscany, Italy. Dynamic olfactometry analyses showed odour concentrations in the order of millions of ouE/m3. While the main constituent of these natural gas emissions was CO2, the very high odour concentration data primarily resulted from the high portion of H2S in these emissions, with detected concentrations ranging from 1,000 to 10,000 ppmv. This not only indicates the presence of odour impact potential but also the high risk for people in the nearby area due to the high concentration of this gas. In parallel with the measurement of representative concentration data of these spot vents, a flexible and innovative approach was established for the measurement of emitted gas flow. The main breakthrough was obtained via the revamping of a balometer, a tool used for the measurement of indoor airflows, in the measurement of the gas flow of large spot vents (i.e. mine gates). Thanks to this stretchy approach, it was possible to estimate the OER of these emissions: the overall OER of all the inventory of the investigated spot vents in the area was impressive, and reached almost 10 million of ouE/s.

An Executive Decree was published in Italy on 28 June 2023 by which the Ministry of the Environment and Energy Security (MASE) adopted the guidelines for the management of odorous emissions from industrial plants and activities. The document provides a framework to be used in the investigation and decision-making procedures of the authorities responsible for environmental authorisations and for the future development of regional and state legislation. The guidelines contain criteria and detailed rules for the application of Article 272 bis of Legislative Decree 152/2006, the Italian Environmental Code. After a brief overview of the concept of channelled emissions, diffuse emissions and technically conveyable emissions, with a particular focus on odorous emissions, this paper aims to analyse, from a technical and legal point of view, the main contents of these guidelines.

Accuracy in the characterisation of odour-emitting sources is particularly significant for the implementation of a truly representative odour impact study. The selection of sampling techniques to measure odour concentrations, along with an accurate method to assess Odour Emission Rate, is closely linked to the type of source under investigation. The distinction between active and passive sources is not always obvious, such as in the case of biological oxidation tanks. This kind of emissive source, commonly classified as a passive source, is characterised by convective flow that is generally not intense. Indeed, the flushing of a known airflow within a dynamic hood, such as a wind tunnel system, necessary to simulate the wind action on the surface of the tank, may not be the driving force of the system. The aim of the present study is to evaluate the emissive contributions of biological oxidation tanks, focusing on the phenomenon of aeration and the effect of wind on the liquid surface of an oxidation basin. Using different sampling methodologies, through different field measurements, the Specific Odour Emission Rates, associated with each contribution, were measured and compared. The results indicate that the stripping phenomenon due to the convective flow generated by aeration can account for up to 96% of the odorous emission contribution.

IntroductionThere is a high incidence of unsafe abortion among women in Nigeria and the DRC. Low knowledge of recommended abortion methods [i.e., surgical and medication abortion (MA) pills] is a barrier for women accessing safe abortions. Women often rely on friends for information about abortion methods. Understanding characteristics of women with knowledge of recommended abortion methods, and MA specifically, and how it is influenced by close female friendships may help identify women most at risk of relying on unsafe abortion.MethodsWe used survey data from Performance Monitoring for Action from 11,106 women of reproductive age in Nigeria (April–May 2018) and 3,697 women in Kinshasa and Kongo Central, DRC, (December 2021–April 2022) to produce representative estimates of knowledge of abortion methods at the national and province levels, respectively. We performed bivariate and multivariate logistic regression to determine which characteristics were independently associated with knowing a recommended abortion method, with knowing of MA pills specifically, and to assess our hypothesis that having at least one female confidante would increase one's odds of knowing about these methods.ResultsA minority (26.9%) of women in Nigeria and the majority in Kinshasa (76.7%) and Kongo Central (58.1%) reported having knowledge of at least one recommended abortion method, while knowledge of MA pills was low in all sites. Having at least one close female confidante was associated with increased odds of knowing a recommend abortion method in Nigeria (aOR = 1.50, 95% CI 1.25–1.79) and in Kongo Central (aOR = 2.66, 95% CI 1.40–5.40), and with increased odds of knowing about MA specifically in Kinshasa (aOR = 1.44, 95% CI 1.08–1.93) and Kongo Central (aOR = 3.61, 95% CI 1.28–10.22), but not Nigeria.DiscussionIn legally restrictive contexts where knowledge of recommended abortion methods (particularly medication abortion) is low, having close female friends is related to increased knowledge of recommended abortion methods.

Background. The number of patients waiting for heart transplant far exceeds the number of hearts available. Donation after circulatory death (DCD) combined with machine perfusion can increase the number of transplantable hearts by as much as 48%. Emerging studies also suggest machine perfusion could enable allograft “reconditioning” to optimize outcomes. However, a detailed understanding of the energetic substrates and metabolic changes during perfusion is lacking. Methods. Metabolites were analyzed using 1-dimensional 1H and 2-dimensional 13C-1H heteronuclear spectrum quantum correlation nuclear magnetic resonance spectroscopy on serial perfusate samples (N = 98) from 32 DCD hearts that were successfully transplanted. Wilcoxon signed-rank and Kruskal-Wallis tests were used to test for significant differences in metabolite resonances during perfusion and network analysis was used to uncover altered metabolic pathways. Results. Metabolite differences were observed comparing baseline perfusate to samples from hearts at time points 1–2, 3–4, and 5–6 h of perfusion and all pairwise combinations. Among the most significant changes observed were a steady decrease in fatty acids and succinate and an increase in amino acids, especially alanine, glutamine, and glycine. This core set of metabolites was also altered in a DCD porcine model perfused with a nonblood-based perfusate. Conclusions. Temporal metabolic changes were identified during ex vivo perfusion of DCD hearts. Fatty acids, which are normally the predominant myocardial energy source, are rapidly depleted, while amino acids such as alanine, glutamine, and glycine increase. We also noted depletion of ketone, β-hydroxybutyric acid, which is known to have cardioprotective properties. Collectively, these results suggest a shift in energy substrates and provide a basis to design optimal preservation techniques during perfusion.

Using the Theory of Planned Behavior, this research aimed to analyze the effect of attitudes, the social environment and perceived control over the law, to understand criminal intentions of young people in Ecuador, a country that has experienced a significant increase in crime. juvenile delinquency in recent years. 202 students between 14 and 17 years old from five public schools in Ecuador participated in the non-experimental cross-sectional study. The results of the Structural Equations Model show a negative relationship between Attitude and intention (-0.367; p

Summary: The subthalamic nucleus (STN) is traditionally thought to restrict movement. Lesion or prolonged STN inhibition increases movement vigor and propensity, while optogenetic excitation has opposing effects. However, STN neurons often exhibit movement-related increases in firing. To address this paradox, STN activity was recorded and manipulated in head-fixed mice at rest and during self-initiated and self-paced treadmill locomotion. We found that (1) most STN neurons (type 1) exhibit locomotion-dependent increases in activity, with half firing preferentially during the propulsive phase of the contralateral locomotor cycle; (2) a minority of STN neurons exhibit dips in activity or are uncorrelated with movement; (3) brief optogenetic inhibition of the lateral STN (where type 1 neurons are concentrated) slows and prematurely terminates locomotion; and (4) in Q175 Huntington’s disease mice, abnormally brief, low-velocity locomotion is associated with type 1 hypoactivity. Together, these data argue that movement-related increases in STN activity contribute to optimal locomotor performance.

Abstract Introduction Although clinical and functional impairments in the lower limbs have been extensively studied in patients with MS, the upper limb (UL) are also frequently affected. Clinical impairment of the UL in patients with MS is very common with muscle strength and hand dexterity as critical factors in maintaining functional activities that are the basis for independence and quality of life in people with MS. Objective To investigate the effects of a training protocol using the Powerball® system in combination with conventional physiotherapy on muscle strength, coordination, fatigue, functionality, and quality of life in persons with MS over an 8-week period. Materials and methods A double-blind randomized controlled trial was conducted. The control group received conventional treatment, while the experimental group received additional UL training using the Powerball® system. Both groups received the same number of sessions and weeks of intervention. The following outcome measures were used: isometric grip and pinch strength, Box and Block Test (BBT), Nine Hole Peg Test (NHPT), Abilhand scale, Fatigue Severity Scale (FSS), Multiple Sclerosis Impact Scale (MSIS-29), and Likert satisfaction questionnaire for the experimental group. All measures were administered at baseline, after the treatment, and during a 3-week follow-up period. Results 25 patients completed the study (12 in the experimental and 13 in the control group). The experimental group showed significant improvements in coordination and manual dexterity of the more affected UL as measured by the BBT comparing pre- to post-treatment (p = 0.048) and pre-treatment to follow-up (p = 0.001), and on the less affected UP comparing pre-treatment to follow-up (p

Abstract DDR1 has been linked to schizophrenia (SCZ) and bipolar disorder (BD) in association studies. DDR1 encodes 58 distinct transcripts, which can be translated into five isoforms (DDR1a-e) and are expressed in the brain. However, the transcripts expressed in each brain cell type, their functions and their involvement in SCZ and BD remain unknown. Here, to infer the processes in which DDR1 transcripts are involved, we used transcriptomic data from the human brain dorsolateral prefrontal cortex of healthy controls (N = 936) and performed weighted gene coexpression network analysis followed by enrichment analyses. Then, to explore the involvement of DDR1 transcripts in SCZ (N = 563) and BD (N = 222), we studied the association of coexpression modules with disease and performed differential expression and transcript significance analyses. Some DDR1 transcripts were distributed across five coexpression modules identified in healthy controls (MHC). MHC1 and MHC2 were enriched in the cell cycle and proliferation of astrocytes and OPCs; MHC3 and MHC4 were enriched in oligodendrocyte differentiation and myelination; and MHC5 was enriched in neurons and synaptic transmission. Most of the DDR1 transcripts associated with SCZ and BD pertained to MHC1 and MHC2. Altogether, our results suggest that DDR1 expression might be altered in SCZ and BD via the proliferation of astrocytes and OPCs, suggesting that these processes are relevant in psychiatric disorders.

Recent crises have significantly amplified cybersecurity challenges. Numerous studies have identified these challenges during major crises; however, empirical investigations using a sociotechnical systems (STS) theoretical perspective remain limited. Against this backdrop, this research study examines and categorizes cybersecurity challenges in the Higher Education and Research Sector (HERS) through the lens of STS theory. Utilizing a qualitative methodology, semi-structured interviews were conducted with cybersecurity experts and top managers. This study proposes an STS cybersecurity framework, classifying challenges into five subsystems: social, technical, political, economic, and environmental. This framework expands on previous literature by incorporating factors often overlooked, such as cybersecurity challenges arising from internal and external environmental conditions, legal and regulatory political factors, and national and global economic factors. This research provides valuable theoretical and practical insights applicable beyond the context of the recent crisis.

The occurrence of anterior abdominal wall ulcer at the site of the peritoneal catheter (PC) is one of the rarest complications of peritoneal dialysis (PD). When present, it is mainly caused by staphylococci which respond well to vancomycin therapy. Despite well-conducted therapy, there is a tendency to relapse and induce peritonitis, which makes it necessary to remove the PC and change the dialysis model of treatment and/or re-insert the catheter at another place to preserve PD as a treatment method. In the present study, we discuss a case of a 53-year-old patient with end-stage kidney disease treated with PD and with decubitus changes at the PC exit site; the change occurred due to migration of the catheter middle part by protruding from the abdominal cavity to the skin, thus allowing ulcer appearance. Although the PC site was treated with antibiotics, as advised by the surgeon, the patient was finally transferred to hemodialysis as the repositioning of the catheter was not performed. This leads to the conclusion that the antibiotic treatment and catheter repositioning are mandatory to preserve peritoneal dialysis as an end-stage kidney disease (ESKD) treatment model.

Background/Objectives: Androgen receptor (AR) expression and signaling are critical for the progression of prostate cancer and have been the therapeutic focus of prostate cancer for over 50 years. While a variety of agents have been developed to target this axis, many of these fail due to the emergent expression of AR RNA splice variants, such as AR-V7, that can signal independently of ligand binding. Other therapies, such as vaccination against prostate-specific antigens, have achieved FDA approvals but have fallen short of being incorporated as standard-of-care therapies for advanced prostate cancer. This may be due to the elevated level of immunosuppression observed in prostate cancer, which remains largely refractory to immune checkpoint blockade. Methods: We developed a vaccine targeting AR-V7, a common isoform associated with treatment resistance, and demonstrated its ability to elicit AR-V7-specific immunity and enable anti-tumor responses against AR-V7+ cancers in subcutaneous tumor models. Results: Our studies also revealed that AR-V7 expression conferred an immune suppressive phenotype that was significant in a non-AR-dependent prostate cancer model. Notably, in this model, we found that vaccination in combination with enzalutamide, an AR antagonist, suppressed these aggressive immune suppressive cancers and resulted in enhanced survival in comparison to control vaccinated and enzalutamide-treated mice. While anti-PD-1 immune checkpoint inhibition (ICI) alone slowed tumor growth, the majority of vaccinated mice that received anti-PD-1 therapy showed complete tumor elimination. Conclusions: Collectively, these results validate the importance of AR signaling in prostate cancer immune suppression and suggest the potential of AR-V7-specific vaccines as therapeutic strategies against prostate cancer, offering significant protective and therapeutic anti-tumor responses, even in the presence of androgen signaling inhibitors.

Background/objectives Stroke damage to the primary visual cortex induces large, homonymous visual field defects that impair daily living. Here, we asked if vision‐related quality of life (VR‐QoL) is impacted by time since stroke. Subjects/methods We conducted a retrospective meta‐analysis of 95 occipital stroke patients (female/male = 26/69, 27–78 years old, 0.5–373.5 months poststroke) in whom VR‐QoL was estimated using the National Eye Institute Visual Functioning Questionnaire (NEI‐VFQ) and its 10‐item neuro‐ophthalmic supplement (Neuro10). Visual deficit severity was represented by the perimetric mean deviation (PMD) calculated from 24‐2 Humphrey visual fields. Data were compared with published cohorts of visually intact controls. The relationship between VR‐QoL and time poststroke was assessed across participants, adjusting for deficit severity and age with a multiple linear regression analysis. Results Occipital stroke patients had significantly lower NEI‐VFQ and Neuro10 composite scores than controls. All subscale scores describing specific aspects of visual ability and functioning were impaired except for ocular pain and general health, which did not differ significantly from controls. Surprisingly, visual deficit severity was not correlated with either composite score, both of which increased with time poststroke, even when adjusting for PMD and age. Conclusions VR‐QoL appears to improve with time postoccipital stroke, irrespective of visual deficit size or patient age at insult. This may reflect the natural development of compensatory strategies and lifestyle adjustments. Thus, future studies examining the impact of rehabilitation on daily living in this patient population should consider the possibility that their VR‐QoL may change gradually over time, even without therapeutic intervention.

Los quistes foliculares son una patología recurrente que afecta al ganado bovino lechero, impactando de manera negativa en los índices reproductivos del rebaño. Esto se traduce en un aumento significativo del intervalo entre partos, ocasionando importantes pérdidas económicas. Por este motivo, el objetivo de este estudio es describir un caso de quistes foliculares en una vaca Holstein en Nicaragua, Centroamérica. Durante una visita técnica a una propiedad ubicada en la comarca Masiguito, perteneciente al municipio de Camoapa, departamento de Boaco, Nicaragua, se identificó una vaca adulta de la raza Holstein, con buena condición corporal (3/5), la cual, según el productor, ha estado en anestro durante varios meses, sin mostrar signos de manifestación de celo. Mediante la inspección clínica y realización de ultrasonografía reproductiva, se diagnosticó la presencia de múltiples quistes foliculares en el ovario izquierdo. Con el fin de tratar esta condición, se implementó un tratamiento hormonal basado en fármacos análogos de hormonas liberadora de gonadotropinas (GnRH) y prostaglandinas (PGF2α). Como resultado, el animal experimentó el retorno del ciclo estral, confirmando mediante examen de imagen la ausencia de los quistes foliculares. Por esta razón, es importante considerar esta condición como un factor diferencial entre las patologías reproductivas que afectan la fertilidad del ganado bovino, y se debe destacar el papel fundamental de la ultrasonografía como herramienta principal para el diagnóstico.

Demand is emerging for personal health records (PHRs), a patient-centric digital tool for engaging in shared decision-making and healthcare data management. This study uses a RE-AIM framework to explore rural patients and providers' perceptions prior to and following implementation of a PHR. Health care providers and their patients were recruited from early-adopter patient medical home clinics and a local patient advisory group. Focus groups were used to explore patient and provider pre-implementation perceptions of PHRs and post-implementation provider perspectives. Patients were invited through participating clinics to use the PHR. An implementation process evaluation was conducted. Multiple methods and data sources were used and included pre-/post-intervention patient surveys, provider interviews, and PHR/EHR administrative data. Both patient and provider focus groups described PHRs as providing a comprehensive health story and enhanced communication. Patients prioritized collection of health promotion data while providers endorsed health-related, clinical data. Both groups expressed the need for managing expectations and setting boundaries on PHR use. The evaluation indicated Reach: 16% of targeted patients participated and an additional 127 patients used the PHR as a tool during the COVID-19 pandemic. Effectiveness: Patient satisfaction with use was neutral, with no significant changes to quality of life, self-efficacy, or patients' activation. Adoption: 44% of eligible clinics participated, primarily those operated publicly versus privately, in smaller communities, and farther from a regional hospital. Implementation: Despite system interoperability expectations, at time of roll out, information exchange standards had not been reached. Additional implementation complications arose from the onset of the pandemic. One clinic on-boarded additional patients resulting in a rapid spike in PHR use. Maintenance: All clinics discontinued PHR within the study period, citing several key barriers to use. RE-AIM offers a valuable process evaluation framework for a comprehensive depiction of impact, and how to drive future success. Interoperability, patient agency and control, and provider training and support are critical obstacles to overcome in PHR implementation.

Objectives(1) To determine stiffness, load at failure, and mode of failure of a novel fixation method with a tension modified-hemicerclage (MH) for tibial tuberosity transposition, and (2) to compare the biomechanical properties of this novel fixation technique to 2 pins (2Pins) and 2 pins and tension band wire fixation (2Pins + TBW).Study designThirty cadaveric stifles from dogs between 5.2 and 13.1 kg were assigned to 3 treatment groups: Group 1: fixation technique with MH; Group 2: 2Pins; Group 3: 2Pins + TBW. Biomechanical testing was performed with the tibia positioned at an angle of 135° relative to vertical position. Tensile force was applied to the patellar ligament until catastrophic failure was observed. The mode of failure, the load at failure, and the stiffness were compared among treatment groups.ResultsThe mean stiffness of the novel fixation (38.1 N/mm ± 7.1) and the 2Pins + TBW (40.2 N/mm ± 9.3) were greater than the 2Pins (26.7 N/mm ± 6.7). There was no significant difference between the novel fixation technique and 2Pins + TBW in stiffness and maximum load to failure. The 2Pins (284.3 N ± 70.5) failed at a significantly lower load than the tension modified-hemicerclage (555.7 N ± 225.9 N) and 2Pins + TBW (715.3 N ± 339.8 N).ConclusionA fixation technique using a modified hemicerclage had the same strength and stiffness as the 2Pins + TBW and was stronger and stiffer than the 2 Pins technique in a cadaveric model.

ObjectivesTo explore the correlation between the vessel density (VD) of the retina and choroid vascular plexuses and the thicknesses of their respective retinal layers and choroid membranes in participants with severe non-proliferative diabetic retinopathy (NPDR).MethodsWe retrospectively analyzed the data of 42 eyes of 42 participants with diabetes mellitus (DM) and severe NPDR. In addition, 41 eyes of 41 healthy controls were evaluated. Measurements were taken for both groups using optical coherence tomography angiography (OCTA), including the area and perimeter of the foveal vascular zone (FAZ) and the vascular density (VD) in the superficial capillary plexus (SCP), deep capillary plexus (DCP), and choroid capillary (CC). These measurements were compared with the retinal thickness (RT) of the inner/intermediate retinal layers and choroidal thickness (CT). The study evaluated the correlation between RT or CT and VD in the respective vascular networks, namely superficial capillary plexus (SCP), deep capillary plexus (DCP), or CC.ResultsThe inner RT and VD in all plexuses were significantly lower in the severe NPDR group than in the healthy controls. Furthermore, the FAZ area and perimeter were larger in the severe NPDR group. Inner RT was correlated with VD in the SCP group (r=0.67 and r=0.71 in the healthy control and severe NPDR groups, respectively; p