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We report an experimental-computational study of the optical properties of plasma mirrors (PMs) at the incident laser frequency when irradiated directly at relativistic intensity (1018

Circularly-polarized extreme ultraviolet and X-ray radiation is useful for analysing the structural, electronic and magnetic properties of materials. To date, such radiation has only been available at large-scale X-ray facilities such as synchrotrons. Here, we demonstrate the first bright, phase-matched, extreme ultraviolet circularly-polarized high harmonics source. The harmonics are emitted when bi-chromatic counter-rotating circularly-polarized laser pulses field-ionize a gas in a hollow-core waveguide. We use this new light source for magnetic circular dichroism measurements at the M-shell absorption edges of Co. We show that phase-matching of circularly-polarized harmonics is unique and robust, producing a photon flux comparable to linearly polarized high harmonic sources. This work represents a critical advance towards the development of table-top systems for element-specific imaging and spectroscopy of multiple elements simultaneously in magnetic and other chiral media with very high spatial and temporal resolution.

Background: Allograft tissues can undergo several freeze-thaw cycles between donor tissue recovery and final use by surgeons. However, there are currently no standards indicating the number of reasonable freeze-thaw cycles for allograft bone and it is unclear how much a graft may be degraded with multiple cycles.Questions/purposes: We therefore asked whether (1) the mechanical properties of fibular allograft bone would remain unchanged with increasing numbers of freeze-thaw cycles and (2) histologic alterations from increased numbers of freeze-thaw cycles would correspond to any mechanical changes.Methods: Fibular allograft segments were subjected to two, four, and eight freeze-thaw cycles and compared biomechanically and histologically with a control group (one freeze-thaw cycle). Two freeze-dried treatments, one after being subjected to one freeze-thaw cycle and the other after being subjected to three freeze-thaw cycles, also were compared with the control group.Results: For all segments, the average ultimate stress was 174 MPa, average modulus was 289 MPa, average energy was 2.00 J, and the average stiffness was 1320 N/mm. The material properties of the freeze-thaw treatment groups were similar to those of the control group: ultimate stress and modulus were a maximum of 16% and 70% different, respectively. Both freeze-dried treatments showed increased stiffness (maximum 53% ± 71%) and energy to failure (maximum 117% ± 137%) but did not exhibit morphologic differences. There were no alterations in the histologic appearance of the bone sections in any group.Conclusions: Fibular allograft segments can be refrozen safely up to eight times without affecting the biomechanical or morphologic properties. Freeze-dried treatments require further study to determine whether the detected differences are caused by the processing.Clinical Relevance: Cryopreserved cortical allografts are thawed by surgeons in preparation for procedures and then occasionally discarded when not used. Refreezing allograft tissues can result in a cost savings because of a reduction in wasted graft material. [ABSTRACT FROM AUTHOR]

PURPOSE: To compare areal bone mineral density (aBMD) of female winter sport athletes to healthy controls of similar age and body mass index (BMI). METHODS: Areal BMD (g x cm(-2)) of the whole body, lumbar spine (L2-L4), and right proximal femur were assessed by dual energy x-ray absorptiometry in athletes (N = 40; age: 26.1 +/- 5.7 yr; ht: 165.6 +/- 0.1 cm; wt: 63.0 +/- 6.5 kg; BMI: 23.0 +/- 1.9 kg x m(-2)) involved in speed skating (N = 9), snowboarding (N = 13), freestyle skiing (N = 3), biathlon (N = 8), bobsleigh, skeleton, luge (N = 7), and controls (N = 21; age: 26.0 +/- 5.1 yr; ht: 165.8 +/- 0.1 cm; wt: 62.8 +/- 5.9 kg; BMI: 22.9 +/- 1.3 kg x m(-2)). RESULTS: Using independent t-tests, athletes had lower fat mass, percent body fat, and higher lean mass than controls (P < 0.001). Areal BMD was higher in athletes than controls for all skeletal sites (P

We sought to determine the performance and anthropometric correlates of physical self-concept and self-esteem and to observe whether long-term resistance training would alter these variables in postmenopausal women. Forty-four nonsmoking, community-dwelling, Caucasian women aged 50-75 years participated in the study. Half of the subjects participated in a 9-month regimen of weight-bearing exercises performed 3 times per week which emphasized lower body muscle strength and power development. At baseline, total body fat was negatively associated with physical self-concept and perception of physical appearance but not with self-esteem. Perception of physical appearance improved in both exercisers and controls after the 9-month trial but was most noticeable in exercisers who had low self-esteem at baseline. The only predictor of improvement in perception of physical appearance was a decrease in lower body fat mass. Minimal or nonsignificant change in psychological measures associated with the training may be due to high initial values. [ABSTRACT FROM AUTHOR]

Background: Bone mineral density (BMD) is a primary risk factor for hip fracture. We studied the effect of long-term weighted vest plus jumping exercise on hip BMD in postmenopausal women as a strategy for reducing hip fracture risk.Methods: Eighteen postmenopausal women (age = 64.1 +/- 1.6 years at baseline, 69.9 +/- 1.6 years at post-testing) who had participated in a 9-month exercise intervention volunteered for the long-term trial. Nine of the original group engaged in weighted vest plus jumping exercise three times per week for 32 weeks of the year over a period of 5 years. Nine of the original controls were active but not enrolled in the exercise program. BMD of the proximal femur was assessed by dual energy x-ray absorptiometry at baseline and after 5 years.Results: At baseline, groups were similar for age, weight, height, years past menopause, and BMD of the femoral neck, trochanter, and total hip. At follow-up, differences in BMD at all regions of the hip were higher in exercisers than controls. For exercisers, changes in BMD were + 1.54% +/- 2.37%, -0.24% +/- 1.02%, and -0.82% +/- 1.04% (means + SE) at the femoral neck, trochanter, and total hip, respectively; controls decreased at all sites (-4.43% +/- 0.93%. 3.43% +/- 1.09%, and -3.80% +/- 1.03%, respectively).Conclusions: A 5-year program of weighted vest plus jumping exercise maintains hip BMD by preventing significant bone loss in older postmenopausal women. Furthermore, this particular program appears to promote long-term adherence and compliance, as evidenced by the commitment of the exercisers for more than 5 years. [ABSTRACT FROM AUTHOR]

Background: Blended therapy (BT) combines digital with face-to-face psychological interventions. BT may improve access to treatment, therapy uptake, and adherence. However, research is scarce on the structure of BT models., Objective: We synthesized the literature to describe BT models used for the treatment of psychological disorders in adults. We investigated whether BT structure, content, and ratio affected treatment efficacy, uptake, and adherence. We also conducted meta-analyses to examine treatment efficacy in intervention-control dyads and associations between treatment outcomes versus BT model structure., Methods: PsycINFO, CINAHL, Embase, ProQuest, and MEDLINE databases were searched. Eligibility criteria included articles published in English till March 2023 that described digital and face-to-face elements as part of an intervention plan for treating psychological disorders in adult patients. We developed a coding framework to characterize the BT interventions. A meta-analysis was conducted to calculate effect size (ES; Cohen d and 95% CIs) regarding pre- and posttreatment outcomes in depression and anxiety versus BT structure. The review was registered with PROSPERO and followed the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines., Results: Searches identified 8436 articles, and data were extracted from 29 studies. BT interventions were analyzed and classified according to mode of interaction between digital and face-to-face components (integrated vs sequential), role of the components (core vs supplementary), component delivery (alternate vs case-by-case), and digital materials assignment mode (standardized vs personalized). Most BT interventions (n=24) used a cognitive behavioral therapy approach for anxiety or depression treatment. Mean rates of uptake (91%) and adherence (81%) were reported across individual studies. BT interventions were more effective or noninferior to treatment as usual, with large spread in the data and a moderate to large ES in the treatment of depression (n=9; Cohen d=-1.1, 95% CI -0.6 to -1.6, P<.001, and z score=-4.3). A small, nonsignificant ES was found for anxiety outcomes (n=5; Cohen d=-0.1, 95% CI -0.3 to 0.05, P=.17, and z score=-1.4). Higher ESs were found in blended interventions with supplementary design (depression: n=11, Cohen d=-0.75, 95% CI -0.56 to -0.95; anxiety: n=8, Cohen d=-0.9, 95% CI -0.6 to -1.2); fewer (≤6) face-to-face sessions (depression: n=9, Cohen d=-0.7, 95% CI -0.5 to -0.9; anxiety: n=7, Cohen d=-0.8, 95% CI -0.3 to -1.3); and a lower ratio (≤50%) of face-to-face versus digital sessions (depression: n=5, Cohen d=-0.8, 95% CI -0.6 to -1.1; anxiety: n=4, Cohen d=-0.8, 95% CI 0.006 to -1.6)., Conclusions: This study confirmed integrated BT models as feasible to deliver. We found BT to be effective in depression treatment, but anxiety treatment results were nonsignificant. Future studies assessing outcomes across different psychological disorders and therapeutic approaches are required., Trial Registration: PROSPERO CRD42021258977; https://www.crd.york.ac.uk/prospero/display&#95;record.php?RecordID=258977., (©Kelly Ferrao Nunes-Zlotkowski, Heather L Shepherd, Lisa Beatty, Phyllis Butow, Joanne Margaret Shaw. Originally published in the Interactive Journal of Medical Research (https://www.i-jmr.org/), 29.10.2024.)

Human-wildlife conflict is a global conservation issue, necessitating effective mitigation strategies. Hunting is a common management approach to reduce conflict, but the indirect consequences are often overlooked. Chronic hunting-related disturbance can reduce fitness and redistribute species. In recent decades, goose-agricultural conflict has intensified due to increasing abundance and shifts towards agricultural foraging. On Islay, Scotland, escalating conflict culminated in shooting Greenland barnacle geese Branta leucopsis to reduce damage to agricultural grassland. In this study, we contrast the impact of shooting disturbance on the movement, behavior, energy expenditure and habitat selection of the target species (Greenland barnacle goose) and a vulnerable nontarget species (Greenland white-fronted goose, Anser albifrons flavirostris) using biologging devices (target species: n = 33; nontarget species: n = 94). Both species were displaced by shooting, and greater distances were subsequently traveled by the target species (1.71 km when directly targeted). When disturbed at any distance, total daily movement increased significantly by 1.18 km for the target species but not for the nontarget species. The target species exhibited no accompanying change in diurnal energy expenditure (measured via accelerometery) but foraged in improved grasslands further from roads after shooting disturbance, where disturbance from all sources was likely lower. The significant increases in movement and changes in foraging site selection of the target species could reduce fitness but given the infrequency of shooting disturbances (0.09 per day) there is likely capacity for compensatory feeding to recoup energetic losses. The nontarget species expectedly showed no significant change in energy expenditure, behavior or habitat selection following shooting disturbance, suggesting mitigation strategies have been effective at minimizing fitness impacts. Refuge areas with a 3.5 km diameter (three times the maximum distance from shooting that displacement was detectable) could provide undisturbed foraging for the target species, minimizing compensatory feeding and further agricultural damage. Wildlife managers should, where possible, consider the fitness implications of shooting disturbance, and whether compensatory feeding and redistribution could hamper conflict mitigation. Management strategies should also include species-specific monitoring and mitigation as we have demonstrated differing responses potentially due to imposed mitigation but also differing species ecology and "landscapes of fear.", (© 2024 The Author(s). Ecological Applications published by Wiley Periodicals LLC on behalf of The Ecological Society of America.)

Purpose: Cancer-related fatigue (CRF) is one of the most common symptoms reported by people with primary brain tumour (BT). Previous research predominantly examined CRF using quantitative assessments, failing to capture the rich insight garnered from exploring individuals' lived experiences. We addressed this gap by qualitatively exploring people with BTs' experiences of CRF., Methods: Semi-structured interviews were conducted with people with BT, their caregivers, and healthcare professionals (HCPs) who care for them. Interviews explored the experience, impact, and management of CRF, including types of support provided by HCPs. Data were analysed using reflexive thematic analysis., Results: Forty participants were interviewed (24 people with BT, 5 caregivers, 11 HCPs). Qualitative analysis identified four themes: pervasiveness of CRF; impacts of CRF; advice and support; and self-management strategies. CRF was described as an almost universal symptom with physical, emotional, and cognitive aspects and profound psychosocial and functional impacts. HCPs reported assessing fatigue and providing management support. Yet, people with BT and caregivers reported CRF assessment and support were rarely received. Consequently, people with BT developed their own management strategies. All participants identified a lack of CRF information resources and interventions specific to people with BT., Conclusion: Our findings provide rich insight into the pervasive, debilitating impact of CRF in people with BT and highlight the lack of BT-specific CRF support and information available., Implications for Cancer Survivors: There is a critical need for evidence-based fatigue interventions and information resources tailored to the needs of people with BT., (© 2024. The Author(s).)

Amikacin and piperacillin/tazobactam are frequent antibiotic choices to treat bloodstream infection, which is commonly fatal and most often caused by bacteria from the family Enterobacterales. Here we show that two gene cassettes located side-by-side in and ancestral integron similar to In37 have been "harvested" by insertion sequence IS26 as a transposon that is widely disseminated among the Enterobacterales. This transposon encodes the enzymes AAC(6')-Ib-cr and OXA-1, reported, respectively, as amikacin and piperacillin/tazobactam resistance mechanisms. However, by studying bloodstream infection isolates from 769 patients from three hospitals serving a population of 1.2 million people in South West England, we show that increased enzyme production due to mutation in an IS26/In37-derived hybrid promoter or, more commonly, increased transposon copy number is required to simultaneously remove these two key therapeutic options; in many cases leaving only the last-resort antibiotic, meropenem. These findings may help improve the accuracy of predicting piperacillin/tazobactam treatment failure, allowing stratification of patients to receive meropenem or piperacillin/tazobactam, which may improve outcome and slow the emergence of meropenem resistance., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Dulyayangkul et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Background: Approximately 25% of pregnant people fall, yet the underlying mechanisms of this increased fall-risk remain unclear. Prior studies examining pregnancy and balance have utilized center of pressure analyses and reported mixed results. The purpose of this study was to examine sensory and segmental contributions to postural control throughout pregnancy using accelerometer-based measures of sway., Methods: Thirty pregnant people (first trimester: n = 10, second trimester: n = 10, third trimester: n = 10) and 10 healthy, nonpregnant control people stood quietly for one minute in four conditions: eyes open on a firm surface, eyes closed on a firm surface, eyes open on a foam pad, and eyes closed on foam. Postural sway was quantified using the root mean square accelerations in the anterior-posterior and medial-lateral directions from an inertial sensor at the lumbar region. Sensory sway ratios, segmental coherence and co-phase, were calculated to assess sensory contributions and segmental control, respectively., Findings: Pregnant people did not display greater sway compared to healthy, nonpregnant controls. There were no group differences in vestibular, visual, or somatosensory sway ratios, and no significant differences in balance control strategies between pregnant and nonpregnant participants across sensory conditions., Interpretation: The small effects observed here contrast prior studies and suggest larger, definitive studies are needed to assess the effect of pregnancy on postural control. This study serves as a preliminary exploration of pregnant sensory and segmental postural control and highlights the need for future to hone the role of balance in fall risk during pregnancy., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023. Published by Elsevier Ltd.)

Purpose: Learning is optimised when postgraduate trainees engage in clinical tasks in their zone of proximal development (ZPD). However, workplace learning environments impose additional non-learning goals and additional tasks that may lead to trainees engaging in tasks that do not fall within their ZPD. We do not fully understand how trainees select clinical tasks in the workplace learning environment. If we knew the goals and factors they consider when selecting a task, we could better equip trainees with strategies to select tasks that maximise learning. We explored how postgraduate trainees select clinical tasks using echocardiography interpretation as a model., Methods: Canadian General Cardiology residents and Echocardiography fellows were invited to participate in semi-structured interviews. Aligning with a theory-informed study, two independent researchers used a deductive, directed content analysis approach to identify codes and themes., Results: Eleven trainees from seven Canadian universities participated (PGY4 = 4, PGY5 = 3, PGY6 = 1 and echocardiography fellows = 3). Goals included learning content, fulfilling assessment criteria and contributing to clinical demands. Trainees switched between goals throughout the day, as it was too effortful for them to engage in tasks within their ZPD at all times. When trainees had sufficient mental effort available, they selected higher complexity tasks that could advance learning content. When available mental effort was low, trainees selected less complex tasks that fulfilled numerically based assessment goals or contributed to clinical demands. Trainees predominantly used perceived complexity of the echocardiogram as a factor to select tasks to achieve their desired goals., Conclusion: Postgraduate trainees select tasks within their ZPD that enable them to maximise learning when they perceive to have sufficient mental effort available and workplace affordances are adequate. These findings can inform individual and systemic strategies to maximise learning when selecting tasks., (© 2023 The Authors. Medical Education published by Association for the Study of Medical Education and John Wiley & Sons Ltd.)

The United Kingdom (UK) and Europe have seen successive outbreaks of H5N1 clade 2.3.4.4b high-pathogenicity avian influenza virus (HPAIV) since 2020 peaking in the autumn/winter periods. During the 2021/22 season, a mass die-off event of Svalbard Barnacle Geese ( Branta leucopsis ) was observed on the Solway Firth, a body of water on the west coast border between England and Scotland. This area is used annually by Barnacle Geese to over-winter, before returning to Svalbard to breed. Following initial identification of HPAIV in a Barnacle Goose on 8 November 2021, up to 32% of the total Barnacle Goose population may have succumbed to disease by the end of March 2022, along with other wild bird species in the area. Potential adaptation of the HPAIV to the Barnacle Goose population within this event was evaluated. Whole-genome sequencing of thirty-three HPAIV isolates from wild bird species demonstrated that there had been two distinct incursions of the virus, but the two viruses had remained genetically stable within the population, whilst viruses from infected wild birds were closely related to those from poultry cases occurring in the same region. Analysis of sera from the following year demonstrated that a high percentage (76%) of returning birds had developed antibodies to H5 AIV. This study demonstrates genetic stability of this strain of HPAIV in wild Anseriformes, and that, at the population scale, whilst there is a significant impact on survival, a high proportion of birds recover following infection.

Objectives: Approximately 75% of women weigh more at 1-year postpartum than pre-pregnancy. More than 47% retain >10 lbs at 1-year postpartum, which is associated with adverse health outcomes for mother and child. Disturbed sleep may contribute to risk of postpartum weight retention (PWR) as short sleep duration is associated with increased risk of obesity. Thus, we investigated whether night-time sleep duration is associated with risk for excessive PWR. We also explored night-time sleep duration and change in postpartum waist circumference., Methods: This is an ancillary analysis from a prospective cohort study. Participants were healthy primiparous adults with a singleton birth. Excessive PWR at 1-year postpartum was defined as ≥7% of pre-pregnancy weight. Log-binomial and linear regression assessed associations between night-time sleep duration at 6 months postpartum and PWR at 1-year postpartum. Linear regression assessed the association between night-time sleep duration and change in postpartum waist circumference., Results: Mean age of participants ( N  = 467) was 29.51 (SD ± 4.78) years. Night-time sleep duration by actigraphy or self-report was not associated with risk for excessive PWR (risk ratio 0.96, [95%CI 0.87-1.06]; risk ratio 0.95 [95%CI 0.83-1.07], respectively) or change in waist circumference., Conclusion: Night-time sleep duration at 6 months postpartum was not associated with PWR at 1-year postpartum. Mixed findings among our results and previous research could be due to our focus on night-time sleep, and differences in sleep measurement methods and timeframes across studies. More comprehensively assessing sleep, including multiple sleep dimensions, may help advance our understanding of potential links between sleep and PWR., Trial Registration: The parent study, Motherhood and Pelvic Health (MAP Study), is registered at https://clinicaltrials.gov/ct2/show/NCT02512016, NCT02512016., Competing Interests: C.M.D. reports during the conduct of the study receiving personal fees from Elsevier Inc. All other authors report none., (© The Author(s) 2023. Published by Oxford University Press on behalf of Sleep Research Society.)

Time-resolved ultrafast EUV magnetic scattering was used to test a recent prediction of >10  km/s domain wall speeds by optically exciting a magnetic sample with a nanoscale labyrinthine domain pattern. Ultrafast distortion of the diffraction pattern was observed at markedly different timescales compared to the magnetization quenching. The diffraction pattern distortion shows a threshold dependence with laser fluence, not seen for magnetization quenching, consistent with a picture of domain wall motion with pinning sites. Supported by simulations, we show that a speed of ≈66  km/s for highly curved domain walls can explain the experimental data. While our data agree with the prediction of extreme, nonequilibrium wall speeds locally, it differs from the details of the theory, suggesting that additional mechanisms are required to fully understand these effects.

Imaging using coherent extreme-ultraviolet (EUV) light provides exceptional capabilities for the characterization of the composition and geometry of nanostructures by probing with high spatial resolution and elemental specificity. We present a multi-modal tabletop EUV imaging reflectometer for high-fidelity metrology of nanostructures. The reflectometer is capable of measurements in three distinct modes: intensity reflectometry, scatterometry, and imaging reflectometry, where each mode addresses different nanostructure characterization challenges. We demonstrate the system's unique ability to quantitatively and non-destructively measure the geometry and composition of nanostructures with tens of square microns field of view and sub-nanometer precision. Parameters such as surface and line edge roughness, density, nanostructure linewidth, and profile, as well as depth-resolved composition, can be quantitatively determined. The results highlight the applicability of EUV metrology to address a wide range of semiconductor and materials science challenges., (© 2023 Author(s). Published under an exclusive license by AIP Publishing.)

Purpose: The electronic health record (EHR) is frequently identified as a source of assessment data regarding residents' clinical performance. To better understand how to harness EHR data for education purposes, the authors developed and authenticated a prototype resident report card. This report card used EHR data exclusively and was authenticated with various stakeholders to understand individuals' reactions to and interpretations of EHR data when presented in this way., Methods: Using principles derived from participatory action research and participatory evaluation, this study brought together residents, faculty, a program director, and medical education researchers ( n  = 19) to develop and authenticate a prototype report card for residents. From February to September 2019, participants were invited to take part in a semistructured interview that explored their reactions to the prototype and provided insights about how they interpreted the EHR data., Results: Our results highlighted three themes: data representation, data value, and data literacy. Participants varied in terms of the best way to present the various EHR metrics and felt pertinent contextual information should be included. All participants agreed that the EHR data presented were valuable, but most had concerns about using it for assessment. Finally, participants had difficulties interpreting the data, suggesting that these data could be presented more intuitively and that residents and faculty may require additional training to fully appreciate these EHR data., Conclusions: This work demonstrated how EHR data could be used to assess residents' clinical performance, but it also identified areas that warrant further consideration, especially pertaining to data representation and subsequent interpretation. Providing residents and faculty with EHR data in a resident report card was viewed as most valuable when used to guide feedback and coaching conversations., Competing Interests: The authors declare no potential conflict of interest., (© 2023 Society for Academic Emergency Medicine.)

We evaluated the association between sedentary time and pelvic floor support in primiparas delivered vaginally. The 532 participants (29.2 ± 4.9 years) wore wrist accelerometers 6 months postpartum to assess sedentary time, light physical activity (LPA) and moderate to vigorous physical activity (MVPA). We assessed pelvic floor support 1 year postpartum, considered worse if vaginal walls or apex prolapsed to or beyond the hymen. We used multivariable isotemporal substitution analyses to determine the prevalence of worse support when replacing sedentary time with equal time spent in either LPA or MVPA. In 1 year, 9.4% demonstrated worse pelvic floor support. Decreasing sedentary time by 30 min/day with a concomitant increase in MVPA, controlling for LPA, was associated with increased prevalence of worse support (PR 1.43 (95% CI 1.15, 1.77), P  < 0.01). Decreasing the sedentary time by 30 min/day with a concomitant increase in LPA, controlling for MVPA, was not significant (PR 0.89 (95% CI 0.80, 0.99), P  = 0.04, > pre-set alpha of 0.02). Increasing MVPA while decreasing LPA, controlling for sedentary time, also increased the prevalence of worse support (PR 1.66 (95% CI 1.28, 2.16), P  < 0.001). In conclusion, decreasing sedentary time increased the prevalence of worse pelvic floor support when replaced by MVPA, but not LPA.