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Background: The diagnosis of Clostridioides difficile infection (CDI) is challenging. Despite guideline-directed, multistep testing algorithms and diagnostic stewardship, the treatment of C. difficile colonization persists. The testing algorithm at our system utilizes an initial real-time PCR test (PCR) for Toxin B gene, which if positive, reflexes to an enzyme immunoassay (EIA) for detecting Toxins A and B. Discordant results (PCR +/EIA -) are suggestive of colonization, but the majority of patients with discordant results are treated for CDI. Correlation of C. difficile EIA B polymerase chain reaction (PCR) cycle thresholds (Ct) with the presence of free EIA and disease severity has been observed, but the ability to use Ct in the decision to treat patients with discordant results is unclear. Our study assesses if Ct values and other clinical characteristics favor treatment in select patients with discordant Methods: A retrospective chart review was performed of adult patients (≥ 18-year-old) with positive C. difficile PCR results that were admitted to our health system between June 01 and August 31, 2023. C. difficile PCR and Ct results were obtained by Cepheid GeneXpert and Toxin A and B EIA results were obtained by Meridian Bioscience Immunocard. Patients with discordant (PCR+/EIA) and true positive (PCR+/EIA+) results were compared. We assessed demographics, past medical history, clinical characteristics, severity of illness, PCR Ct values, treatment, and clinical outcomes including: 30-day all-cause mortality and re-admission, and 60-day CDI repeat testing and treatment. Results Of the 122 patients identified, 89 patients had discordant results and 43 had true positive Results: Severity of illness and other clinical and laboratory characteristics were similar between both groups. Mean Ct values were significantly lower for true positive results compared to discordant results, 24.28 vs 29.27, respectively (p26 (p=.08). Of the patients with discordant results, 73 completed treatment for CDI and no difference in clinical outcomes was observed compared to patients with discordant results that were not treated. Conclusion Ct values were lower among patients with true positive results compared to patients with discordant Conclusion: There were no statistically significant different rates of severe or fulminant CDI among patients with discordant results and Ct values < 26, although this finding may be limited by sample size and Ct may be helpful in deciding which discordant patients to treat.

Background: Directing COVID-19 diagnostic testing to healthcare workers (HCWs) who are likely to be infected has potential to reduce staffing shortages and decrease opportunity for in-hospital transmission; however, HCWs with COVID-19 may exhibit a range of symptoms. We assessed the burden of symptoms in relation to cycle threshold (Ct) values as a surrogate for viral shedding in vaccinated healthcare workers. Methods: We retrospectively reviewed employee health records of COVID-19–vaccinated employees who tested positive for SARS-CoV-2 between December 2020 and January 2022 at 2 academic hospital systems. We reviewed demographic data, reasons for testing including symptoms, exposure history, medical history, vaccination dates, Ct values, and genotypes when available. We compared mean Ct values between symptomatic and minimally symptomatic cases using independent sample t tests. Patients were defined as minimally symptomatic if they had no symptoms or a single symptom that is not cough, fever, or anosmia at the time of testing. Patients were defined as more symptomatic if they reported >1 symptom or cough, fever, or anosmia. Results: In total, 298 HCWs tested positive for COVID-19. Most positive cases were female (73%), white (78%), and had patient-facing roles (77%). Genotypic testing (n = 109) revealed that most genotypes belonged to the SARS-CoV-2 delta variant (AY lineages, B1.617.2). More cases were minimally symptomatic (62%) than were more symptomatic (38%). None required hospitalization during the study period. Mean Ct values (n = 141) showed no significant difference between more symptomatic and minimally symptomatic cases (19.8 vs 20.6; P = .40) (Fig. 1). Also, there was no significant difference in mean Ct value, comparing those with vaccination 90 days prior to positive (20.52 vs 19.88; P = .537). Conclusions: Our study shows no significant difference in cycle threshold values between minimally symptomatic and more symptomatic infections in vaccinated HCWs. In addition, HCWs exhibit high viral load even when infected within 90 days after vaccination. When considering whether to attend work, HCWs should be aware that mild symptoms and recent vaccination do not necessarily reflect low transmissibility and that they should follow CDC guidance regarding when to return to work.

This study aimed to examine the beliefs of students in a public university about the benefits of problem-based learning (PBL) projects in developing 21st-century skills in the EFL classroom. A mixed methodology was applied to a sample of 62 A2 level students in a public university who worked on small PBL projects during the semester, with the teacher as a facilitator. The study aimed to analyze the effects of PBL on students’ process and learning outcomes, specifically in terms of attitudes towards collaborative and critical learning in problem-solving. Data was collected through direct observations, surveys, open-ended questionnaires, and semi-structured personal interviews. The study concluded that PBL projects have a positive impact on the process and learning outcomes of students.

Often unable to fulfill theoretical production potentials and to obtain the maximum yields set by wine quality labels, many vineyards and cellars need to solve the issue of so-called grapevine yield gaps in order to assure their durability. These yield gaps particularly occur in Mediterranean wine regions, where extreme events have intensified because of climate change. Yield gaps at the regional level have been widely studied in arable crops using big datasets, but much less so in perennial crops, such as grapevine. Understanding the environmental factors involved in yield gaps, such as those linked to climate and soil, is the first step in grapevine yield gap analysis. At a regional scale, there are numerous studies on ‘terroir’ linked to wine typicity and quality; however, none have classified spatial zones based on environmental factors identified as being involved in grapevine yield. In the present study, we aggregated into one big dataset information obtained from producers at the municipality level in the wine region Languedoc-Roussillon (South of France) between 2010 and 2018. We used a backward stepwise model selection process using linear mixed-effect models to discriminate and select the statistically significant indicators capable of estimating grapevine yield at the municipality level. We then determined spatial zones by using the selected indicators to create clusters of municipalities with similar soil and climate characteristics. Finally, we analysed the indicators of each zone related to the grapevine yield gap, as well as the variations among the grapevine varieties in the zones. Our selection process evidenced 6 factors that could explain annual grapevine yield annually (R2 = 0.112) and average yield for the whole period (R2 = 0.546): Soil Available Water Capacity (SAWC), soil pH, Huglin Index, the Climate Dryness Index, the number of Very Hot Days and Days of Frost. The clustering results show seven different zones with two marked yield gap levels, although all the zones had municipalities with no or high yield gaps. On each zone, grapevine yield was found to be driven by a combination of climate and soil factors, rather than by a single environmental factor. The white wine varieties showed larger yield gaps than the red and rosé wine varieties. Environmental factors at this scale largely explained yield variability across the municipalities, but they were not performant in terms of annual yield prediction. Further research is required on the interactions between environmental variables and plant material and farming practices, as well as on vineyard strategies, which also play an important role in grapevine yield gaps at vineyard and regional scale.

Practitioners consider the role of the legs in the game of tennis as fundamental to achieve high performance. But, the exact link between leg actions and high-speed and accurate serves still lacks understanding. Here, we investigate the correlation between force-time curve variables during serve leg drive and serve performance indicators. Thirty-six competitive players performed fast serves, on 2 force plates, to measure ground reaction forces (GRF). Correlation coefficients describe the relationships between maximal racket head velocity, impact height, and force-time curve variables. Among all the variables tested, the elapsed time between the instants of maximal vertical and maximal anteroposterior GRF (r = -0.519, p < 0.001) and the elapsed time between the instant of maximal ante-roposterior GRF and ball impact (r = -0.522, p < 0.001) are the best predictors of maximal racket velocity. Maximal racket head velocity did not significantly correlate with the mean or maximal vertical GRF or with the mean or maximum rate of vertical force development. The best predictor for impact height is the relative net vertical impulse during the concentric phase (r = 0.772, p < 0.001). This work contributes to a better understanding of the mechanical demands of tennis serve motion and gives guidelines to improve players preparation and performance. Trainers should encourage their players to better synchronize their upward and forward pushing action during the serve to increase maximal racket head velocity. Players should also aim to improve their relative net vertical impulse to increase impact height through strength training and technical instructions. [ABSTRACT FROM AUTHOR]

IntroductionScaling the equipment of young athletes is justified by the constraints-led approach introduced in motor learning. The aim of the present study is to analyze the effect of racket scaling on the serve biomechanics and performance parameters for young tennis players (between 8 and 11 years-old).MethodsNine young intermediate competitive tennis players (age: 9.9 ± 1.0 years) performed maximal effort flat serves with three different rackets (scaled 23 inches, scaled 25 inches and full-size 27 inches) in a randomized order. A radar measured ball speed while shoulder and elbow kinetics and upper and lower limb kinematics were calculated with a 20-camera optical motion capture system. Repeated measures ANOVAs were used to analyze the effect of the three rackets on ball speed, percentage of serve in, serve kinematics and kinetics.ResultsNo significant differences in ball speed, maximal racket head velocity and percentage of serve in were observed between the three rackets. The lowest maximal upper limb kinetics and the highest upper limb maximal angular velocities were obtained with the scaled 23 inches racket.DiscussionUsing scaled rackets has the advantage to decrease shoulder and elbow loadings without reducing serve performance. Consequently, the present results incite tennis coaches and parents to not upgrade too soon the size of the racket in young intermediate tennis players to avoid overuse injury risks in the long term. Our results showed that the full-size 27 inches racket induced higher lower limb kinematics. As a consequence, occasionally serving with a fullsize racket can be a sparingly interesting intervention to help young tennis players to intuitively and immediately increase their leg drive action, allowing a more functional representation of the elite junior serve.

Intracellular accumulation of tau protein is a hallmark of Alzheimer's Disease and Progressive Supranuclear Palsy, as well as other neurodegenerative disorders collectively known as tauopathies. Despite our increasing understanding of the mechanisms leading to the initiation and progression of tau pathology, the field still lacks appropriate disease models to facilitate drug discovery. Here, we established a novel and modulatable seeding-based neuronal model of full-length 4R tau accumulation using humanized mouse cortical neurons and seeds from P301S human tau transgenic animals. The model shows specific and consistent formation of intraneuronal insoluble full-length 4R tau inclusions, which are positive for known markers of tau pathology (AT8, PHF-1, MC-1), and creates seeding competent tau. The formation of new inclusions can be prevented by treatment with tau siRNA, providing a robust internal control for use in qualifying the assessment of potential therapeutic candidates aimed at reducing the intracellular pool of tau. In addition, the experimental set up and data analysis techniques used provide consistent results in larger-scale designs that required multiple rounds of independent experiments, making this is a versatile and valuable cellular model for fundamental and early pre-clinical research of tau-targeted therapies.

New winegrower and resource datasets appear to be a great opportunity to understand which are the environmental factors involved in grapevine yield spatially. Such analysis can help regional label managers and winegrowers for the conception of local adaptation strategies to climate change, reducing yield gaps. In the present study, we aggregated yield a big dataset obtained from Pays d’Oc winegrowers (n = 96677) between 2010 and 2018 at the municipality level (n = 606), located in the Languedoc-Roussillon region, in the South of France. We used a backward stepwise model selection process using linear mixed-effect models to discriminate and select significant indicators capable of estimating grapevine yield at the municipality level, these include: Soil Available Water Capacity (SAWC), soil pH, Huglin Index, the Climate Dryness Index, the number of Very Hot Days and Days of Frost. We then determined spatial zones by creating clusters of municipalities with similar soil and climate characteristics. The seven zones presented two marked yield levels. Yet, all zones had municipalities with both high yield and high yield gaps. On each zone, grapevine yield was found to be driven by a combination of climate and soil factors, rather than just by a single environmental factor. Environmental factors at this scale largely explained yield variability across the municipalities, but they were not performant in terms of annual yield prediction. Further research is required on the interactions between environmental factors, plant material and farming practices.

Background: The Achilles tendon rupture is a pathology of growing incidence due to the increase in the intensity of amateur sports practices and the continuation of this practice with the rise in age. The rupture follows a degradation of the tendon’s structure, known as degenerative tendinopathy, which is symptomatic only in rare cases. In the absence of prior pain, iterative rupture is the complication to be feared and prevented. Unfortunately, after orthopedic or surgical treatment, there is no consensus concerning criteria for returning to sports. Such criteria would aim to prevent the risk of recurrence and the appearance of other sports injuries. Methods: A current literature review using the PubMed database in June 2021. Results: The literature doesn’t show any validated criteria for returning to sport. Conclusion: Consequently, this work seeks to propose objective criteria for validating the return to sport in connection with the physical and psychological qualities of the subject, abrogating temporal criteria, too formal and remote from the clinical view. Thus, the physiotherapist is advised to take an interest in the ankle's range of motion and the stiffness of the tendon, strength and endurance of the calf muscle, the quality of the proprioceptive and postural functions on a more functional plan, based on the quality of the jumps and then on the subject's running pattern. Finally, a psychological assessment completes the battery of tests that will validate the return to sport.

The accuracy of logical operations on quantum bits (qubits) must be improved for quantum computers to outperform classical ones in useful tasks. One method to achieve this is quantum error correction (QEC), which prevents noise in the underlying system from causing logical errors. This approach derives from the reasonable assumption that noise is local, that is, it does not act in a coordinated way on different parts of the physical system. Therefore, if a logical qubit is encoded non-locally, we can--for a limited time--detect and correct noise-induced evolution before it corrupts the encoded information.sup.1. In 2001, Gottesman, Kitaev and Preskill (GKP) proposed a hardware-efficient instance of such a non-local qubit: a superposition of position eigenstates that forms grid states of a single oscillator.sup.2. However, the implementation of measurements that reveal this noise-induced evolution of the oscillator while preserving the encoded information.sup.3-7 has proved to be experimentally challenging, and the only realization reported so far relied on post-selection.sup.8,9, which is incompatible with QEC. Here we experimentally prepare square and hexagonal GKP code states through a feedback protocol that incorporates non-destructive measurements that are implemented with a superconducting microwave cavity having the role of the oscillator. We demonstrate QEC of an encoded qubit with suppression of all logical errors, in quantitative agreement with a theoretical estimate based on the measured imperfections of the experiment. Our protocol is applicable to other continuous-variable systems and, in contrast to previous implementations of QEC.sup.10-14, can mitigate all logical errors generated by a wide variety of noise processes and facilitate fault-tolerant quantum computation. Quantum error correction of Gottesman-Kitaev-Preskill code states is realized experimentally in a superconducting quantum device., Author(s): P. Campagne-Ibarcq [sup.1] , A. Eickbusch [sup.1] , S. Touzard [sup.1] , E. Zalys-Geller [sup.1] , N. E. Frattini [sup.1] , V. V. Sivak [sup.1] , P. Reinhold [sup.1] [...]

Quantum superpositions of macroscopically distinct classical states--so-called Schrödinger cat states--are a resource for quantum metrology, quantum communication and quantum computation. In particular, the superpositions of two opposite-phase coherent states in an oscillator encode a qubit protected against phase-flip errors.sup.1,2. However, several challenges have to be overcome for this concept to become a practical way to encode and manipulate error-protected quantum information. The protection must be maintained by stabilizing these highly excited states and, at the same time, the system has to be compatible with fast gates on the encoded qubit and a quantum non-demolition readout of the encoded information. Here we experimentally demonstrate a method for the generation and stabilization of Schrödinger cat states based on the interplay between Kerr nonlinearity and single-mode squeezing.sup.1,3 in a superconducting microwave resonator.sup.4. We show an increase in the transverse relaxation time of the stabilized, error-protected qubit of more than one order of magnitude compared with the single-photon Fock-state encoding. We perform all single-qubit gate operations on timescales more than sixty times faster than the shortest coherence time and demonstrate single-shot readout of the protected qubit under stabilization. Our results showcase the combination of fast quantum control and robustness against errors, which is intrinsic to stabilized macroscopic states, as well as the potential of of these states as resources in quantum information processing.sup.5-8. A qubit generated and stabilized in a superconducting microwave resonator by encoding it into Schrödinger cat states produced by Kerr nonlinearity and single-mode squeezing shows intrinsic robustness to phase-flip errors., Author(s): A. Grimm [sup.1] [sup.4] , N. E. Frattini [sup.1] , S. Puri [sup.2] , S. O. Mundhada [sup.1] , S. Touzard [sup.1] , M. Mirrahimi [sup.3] , S. M. [...]

Aim: To assess the efficacy and safety of hydroxychloroquine with or without azithromycin) in hospitalized adult patients with COVID-19. Methods: We utilized a hospital based prospective data registry. The primary end point was to assess the impact of hydroxychloroquine with or without azithromycin, on outcome, length of hospitalization, and time to clinical improvement. We utilized treatment effects with inverse-probability-weighting and Cox proportional hazards models. All analyses accounted for age, gender, race, severity on admission, days from symptoms onset and chronic comorbidities. Results: 36 patients received hydroxychloroquine and were age- and sex-matched to 72 patients with COVID-19 who received supportive care. Compared to supportive care, the use of HCQ did not shorten the time to clinical improvement (+0.23 days; 95% CI: −1.8–2.3 days) nor did it shorten the duration of hospital stay (+0.91 days; 95% CI: −1.1–2.9 days). Additionally, HCQ did not decrease the risk of COVID-19 in-hospital death (aHR 1.67; 95% CI: 0.29–9.36). Finally, we observed a slight QTc prolongation from a baseline of 444 ± 26 ms to 464 ± 32 ms (mean±SD) among patients receiving hydroxychloroquine with or without azithromycin. Conclusion: This study did not yield benefits from hydroxychloroquine use in patients with COVID-19 and monitoring for adverse events is warranted. Nevertheless, the treatment was safely studied under the guidance of an antimicrobial stewardship program.

Questions: We assessed interactions between climate change, bedrock types and snow cover duration on the trajectories of taxonomic and functional composition of subalpine plant communities. We predict (i) an increase in species richness on siliceous bedrock due to a reduced competition and a decrease in richness on calcareous bedrock due to increasing drought stress; (ii) decreasing snow cover duration should induce a higher shrub encroachment in hollows as compared to ridges; and (iii) increasing growing season temperature should induce taller sizes and more conservative growth traits, in particular in hollows. Location: Subalpine belt of the Grandes Rousses mountain range, southwestern Alps (France). Methods: 189 vegetation plots were sampled in 1997 and 2017–2018. The duration of snow cover was assessed during two years in 1995–1997 and five functional traits were measured on 108 species in 2021. We performed multivariate analyses, quantified community‐weighted means (CWM) of traits and used ANOVAs to detect responses to local‐scale factors and changes in snow cover, temperature and precipitation since 1997 according to a nearby meteorological station. Results: Overall, taxonomic composition weakly changed and changes were more dependent on the position of communities along the snow cover duration gradient than on their bedrock type. The abundance of drought‐tolerant species increased at the border of hollows and there was, over all communities, a slight increase in the abundance of dwarf shrubs and tall herbaceous species, a strong decrease in short herbaceous species and, thus, an overall decrease in species richness. There were important overall changes in CWM of size traits, in particular leaf area which increased the most in hollows irrespective of bedrock types. Conclusion: In this subalpine site the effects of decreasing snow cover duration overwhelmed the effects of bedrocks, which may explain the overall increase in competitive species and decrease in species richness. [ABSTRACT FROM AUTHOR]

Introduction: Hallux valgus is the most common condition found in the foot, caused by a progressive failure of the first ray stabilization means. The hallux is deviated into valgus, the first metatarsal into varus, and their association leads to a subluxation of the metatarsophalangeal joint of the first ray. Surgery is a treatment frequently used to correct this condition. So, is the static postural balance altered after corrective surgery? Materials and Method: 23 subjects participated in the study, all women, divided into two groups: control and hallux valgus. The hallux valgus group was evaluated three months post-operatively. Bipodal tests were carried out on a stabilometry platform, one with eyes open and one with eyes closed. The pressure center parameters were recorded and analyzed, such as the length or the area of the pressure center. Results: The results obtained showed significant differences between the two groups and were statistically significant, with a p-value of 0,05. The pressure center values are higher in the hallux valgus group. Conclusion: Some results found in the literature agree with the results of the present study. There are significant deficits in the static postural balance three months after corrective surgery. Other studies with a larger sample may be performed to confirm or not the results of this study.

Background: the deformation of the hallux into a valgus constitutes the most frequent deformation of the forefoot and one of the most performed corrective surgeries in the region. This deformation is the cause of many biomechanical disorders and causes gait disturbances. This review aims to analyze the restoration of space-time and kinematic parameters of walking in the aftermath of corrective surgery for hallux valgus. Methods: four studies were analyzed according to the main criteria of walking speed, support time, step length and kinematics of the ankle and foot before and after the intervention. Results: If some of the results obtained in the analyzed works show an improvement of these criteria in post-operative, the subjects having benefited from hallux valgus surgery seem to present some persistent issues in the spatiotemporal and kinematic parameters. Conclusion: This work does not demonstrate the superiority of one surgical technique over another in the recovery of gait. This recovery does not seem absolute, but this review highlights above all the lack of literature on this subject.

Quantum computing offers a powerful new paradigm of information processing that has the potential to transform a wide range of industries. In the pursuit of the tantalizing promises of a universal quantum computer, a multitude of new knowledge and expertise has been developed, enabling the construction of novel quantum algorithms as well as increasingly robust quantum hardware. In particular, we have witnessed rapid progress in the circuit quantum electrodynamics (cQED) technology, which has emerged as one of the most promising physical systems that is capable of addressing the key challenges in realizing full-stack quantum computing on a large scale. In this Tutorial, we present some of the most crucial building blocks developed by the cQED community in recent years and a précis of the latest achievements towards robust universal quantum computation. More importantly, we aim to provide a synoptic outline of the core techniques that underlie most cQED experiments and offer a practical guide for a novice experimentalist to design, construct, and characterize their first quantum device.