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Abstract Cryptococcal meningitis is a high-mortality infection. Adding 5-fluorocytosine (5-FC) to its treatment improves outcomes, but resistance to 5-FC presents a significant challenge. We conducted whole-genome sequencing on seven C. neoformans isolates with varying 5-FC susceptibility, along with proteomic and in silico analyses. Our findings indicate that mutations in genes of the pyrimidine salvage pathway are responsible for 5-FC resistance. Specifically, we identified an E64G missense mutation in the FUR1 gene, a large deletion in the FCY1 gene, and a point mutation in FCY1 leading to a truncated protein. The proteomic data indicated that these mutations resulted in the absence or reduction of crucial enzymes in resistant isolates. Genetic transformations confirmed the association between these mutations and 5-FC resistance. Resistance to 5-FC can develop during treatment and is closely tied to mutations in key metabolic enzymes. Understanding in vivo resistance development is crucial for combating resistance and enhancing patient outcomes.

During the Covid-19 pandemic, contact-tracing apps have offered effective help to bend the contagion curve. Thus, it is of critical importance to understand the factors that influence contact-tracing apps’ adoption among citizens. In particular, the successful adoption and usage of contact-tracing apps strongly relies on individual motives. There-fore, this study draws on the theory of altruistic and egoistic motivation for prosocial behaviours to analyse the underlying motives through which citizens engage in voluntary behaviours aimed at using and promoting the use of contact-tracing apps. The study also examines the mediating role of users’ trust in the app. Data from 221 users of Ireland’s Covid Tracker app was analysed. Structural equation modelling with PLS was used to test the research model. Findings show differences between egoistic and altruistic motivation in promoting app use and sharing. Ego-istic motivation significantly promotes voluntary behaviours among citizens and users’ trust in the app mediates this influence. Yet, contrary to predictions, in the context of the pandemic, altruistic motivation does not play a significant role in engaging citizens in these voluntary behaviours, either directly or indirectly. The findings of this study are important for policy makers and may inform future policy decisions regarding the implementation of contact-tracing apps in the case of new pandemics or for other contexts requiring cooperative daily check-in.

Anna Ramírez-Morros,1– 3,* Anna Berenguera,4,* Laura Millaruelo,3 Pilar Buil-Cosiales,3,5– 7 Carmen Gomez Garcia,3,8 Xavier Cos,3,9,10 Luis Ávila Lachica,3,8 Sara Artola,3,11 Jose Manuel Millaruelo,3,12 Didac Mauricio,1,9,13– 15 Josep Franch-Nadal1,3,9,16 1DAP-Cat Group, Unitat de Suport a la Recerca de la Catalunya Central, Institut Universitari d’Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Sant Fruitós de Bages, Spain; 2Gerència Territorial de la Catalunya Central, Institut Català de la Salut, Sant Fruitós de Bages, Spain; 3red GDPS Foundation, Sabadell, Spain; 4Institut Universitari d’Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Barcelona, Spain; 5Centro de Investigación Biomédica en Red Fisiopatología de la Obesidad y la Nutrición (CIBEROBN), Instituto de Salud Carlos III, Madrid, Spain; 6Atención Primaria, Servicio Navarro de Salud, Navarra, Spain; 7IdiSNA, Instituto de Investigación Sanitaria de Navarra, Navarra, Spain; 8Unidad de Gestión Clínica Vélez Norte, Vélez-Málaga, Servicio Andaluz de Salud, Vélez-Málaga, Spain; 9Center for Biomedical Research on Diabetes and Associated Metabolic Diseases (CIBERDEM), Instituto de Salud Carlos III, Barcelona, Spain; 10EAP Sant Martí, Institut Catalá de la Salut, Barcelona, Spain; 11Centro de Salud José Marvá, Madrid, Spain; 12Centro de Salud Torrero La Paz, Zaragoza, Spain; 13Institut de Recerca Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; 14Department of Endocrinology and Nutrition, Hospital Universitari de la Santa Creu i Sant Pau, Barcelona, Spain; 15Department of Medicine, University of Vic – Central University of Catalonia, Vic, Spain; 16Equip d’Atenció Primària (EAP) Raval Sud-Gerencia Territorial Barcelona, Institut Català de la Salut, Barcelona, Spain*These authors contributed equally to this workCorrespondence: Anna Ramírez-Morros, Unitat de Suport a la Recerca de la Catalunya Central, Gerència Territorial de la Catalunya Central, Institut Català de la Salut, Sant Fruitós de Bages, 08272, Spain, Tel +34 936 930 040, Email amramirez.cc.ics@gencat.cat Josep Franch-Nadal, Unitat de Suport a la Recerca de Barcelona, Barcelona, 08025, Spain, Tel +34 932 073 760, Email Josep.franch@gmail.comPurpose: This study aims to identify gender disparities in knowledge, attitudes and behaviors related to self-management and control of Type 2 diabetes Mellitus (T2DM) among primary care patients. The research was conducted across multiple Spanish cities.Patients and Methods: The study involved 8 Primary Care Centres located in four distinct regions of Spain: East (Barcelona), Centre (Madrid), North (Pamplona and Zumaia) and South (Vélez-Málaga and Málaga). A total of 111 individuals diagnosed with T2DM, comprising 52 women and 59 men, participated in 12 group discussions at these primary healthcare centers from February to June 2015. Participation was voluntary, and all participants provided informed consent by signing the consent form. A qualitative hermeneutic phenomenological study with a maximum variation sample was done. Participant profiles were defined based on gender, age, place of residence, type of treatment, years living with T2DM and the presence or absence of a cardiovascular event. Thematic analysis was used to analyze the data.Results: Participants were aware that diabetes is a chronic condition, with varied levels of concern regarding the diagnosis. Participants’ locus of control influenced their perception of the disease’s cause, with women attributing it to stress and emotional situations, while men linked it to risky behaviors. Self-management strategies were shaped by beliefs about diabetes, with both genders facing challenges in implementing recommended practices. Gender differences were also evident in caregiving roles, with men receiving more family support for diet adherence, while women prioritized family needs over their self-care. Participants expressed satisfaction with professional-patient interactions but highlighted the need for more accessible information and specialist care, suggesting support groups for women and clear health guidelines for men.Conclusion: Gender differences significantly influence how patients perceive and manage type 2 diabetes, with women experiencing greater concern and care burden compared to men. Effective diabetes management requires tailored support that addresses these gender-specific challenges. Enhancing healthcare services with clear guidelines and support groups can improve self-management outcomes in both men and women.Keywords: gender, type 2 diabetes mellitus, self-care, personal experience

This paper reports a mixed-method study on the factors shaping language learning through didactic audiovisual translation. The aim is to analyse the determinants influencing the effective implementation of an integrative project, revealing the strengths and weaknesses of the learning process. Data from 172 students were gathered through initial and final questionnaires, which offered insights into their perceptions of didactic audiovisual translation. The results demonstrate a noticeable shift in learners’ attitudes towards audiovisual translation as a language learning tool during the tasks. This transformation led to the recognition of potential benefits, not only in conventional modes like subtitling and dubbing but also in less recognised modes such as audio-description and subtitling for the deaf and hard of hearing.

Abstract Mental disorders are leading causes of disability and premature death worldwide, partly due to high comorbidity with cardiometabolic disorders. Reasons for this comorbidity are still poorly understood. We leverage nation-wide health records and near-complete genealogies of Denmark and Sweden (n = 17 million) to reveal the genetic and environmental contributions underlying the observed comorbidity between six mental disorders and 15 cardiometabolic disorders. Genetic factors contributed about 50% to the comorbidity of schizophrenia, affective disorders, and autism spectrum disorder with cardiometabolic disorders, whereas the comorbidity of attention-deficit/hyperactivity disorder and anorexia with cardiometabolic disorders was mainly or fully driven by environmental factors. In this work we provide causal insight to guide clinical and scientific initiatives directed at achieving mechanistic understanding as well as preventing and alleviating the consequences of these disorders.

IntroductionAdolescence is a dynamic developmental phase in which contact with peers is crucial for socio-emotional development and wellbeing. Depression and social anxiety show patterns of high onset during this period, and more for girls than boys. Here we examine this development among Dutch adolescents, as well as how desire for more peer contact as a result of social distancing measures during the COVID-19 pandemic contributed to this increase.MethodsWe used a longitudinal three-wave design to examine 406 typically developing Dutch adolescents across two consecutive cohorts; Cohort 1: 2016–2019 (N = 138, 53.6% girls, age at T0 M = 13.00, SD = 0.42), Cohort 2: 2017–2020 (N = 268, 63.1% girls, age at T0 M = 13.05, SD = 0.39), final wave during spring 2020 during the first COVID-19 lockdown. Self-report questionnaires were used to measure depression and social anxiety symptoms, desire for change in the amount of peer contact during lockdowns, and emotion regulation. Parallel process dual latent growth models and autoregressive cross-lagged models were used to test the hypotheses.ResultsResults showed that symptoms of both depression and social anxiety increase during adolescence. Gender analysis reveal a higher initial level and increase in depression symptoms for girls, while levels for boys decreased. Adolescents exposed to the pandemic showed a steeper increase in depression but not in social anxiety. Desire for more peer contact was related to an increase in depression and social anxiety, though only in girls. No evidence was found for moderation of emotion regulation skills concerning COVID evoked emotions on the association between desire for peer contact and anxiety and depression symptom development.DiscussionSymptoms of social anxiety increased during adolescence in boys and girls. Symptoms of depression increased for girls, but decreased for boys. The increase in depression was greater in a cohort who experienced the COVID-19 pandemic. For girls, a desire for more peer contact was associated with an increase of depression and social anxiety symptoms in times of social restrictions.

The Sustainable Development Goals (SDGs) are at the heart of the management of public and private enterprises. Organizations have incorporated the SDGs into their business strategy by developing actions that they disseminate in their reports. In the last decade, academic research has paid special attention to this development, publishing a growing number of studies on the subject with the emergence of a specific line of research in the area of sustainability: sustainability reporting. In this context, this paper aims to show a methodology that serves as a tool to analyze the disclosure of SDGs in the sustainability reports. This methodology has three stages. First, a lexicographic analysis of sustainability reports has been carried out, second, a correspondence analysis, and third, outlining through “guided questions” how the information obtained can be useful to analyze SDG communication strategy. For further illustration the methodology has been applied to a company in the Spanish agri-food sector: Ebro Foods. This work has both academic and professional implications by providing a guideline for SDG dissemination analysis in sustainability reports and, on the other hand, by providing the business world with an analysis tool that serves to improve communication strategies in the field of sustainability.

Abstract Background A growing body of literature indicates that adolescent girls who talk with close friends about interpersonal problems or worries in an excessive, speculative way, and with an intense focus on distress (i.e., co-rumination) are at heightened risk for developing internalizing symptoms and disorders as well as reduced friendship quality. However, to date, there are no prevention programs available that target high levels of co-rumination between adolescent girls. As such, we developed the blended school-based mindfulness prevention program Happy Friends, Positive Minds (HFPM) that targets co-rumination at the dyadic level, i.e., between two close female friends. The aim of this trial is to evaluate the effectiveness of HFPM to reduce co-rumination and internalizing problems and to enhance wellbeing and social-emotional behavior in Dutch adolescent girls. Methods A cluster Randomized Controlled Trial (cRCT) will be conducted to evaluate HFPM effectiveness. We will recruit 160 female friendship dyads (n = 320 girls) aged 13 to 15 years who will be characterized by high levels of self-reported co-rumination. The cRCT has two arms: (1) an intervention condition in which 160 girls (80 friendship dyads) will receive the 14-week HFPM program in two consecutive cohorts (cohort 1 in academic year 2023/2024 and cohort 2 in academic year 2024/2025, and (2) a control condition in which 160 girls (80 dyads) will receive care-as-usual (CAU) in two consecutive cohorts (cohort 1 in academic year 2023/2024 and cohort 2 in academic year 2024/2025). Data will be collected at baseline (T0), during the program (T1;T2; T3), immediately after the program (T4), and at 1-year follow-up (T5). Participant-level self-reported risk for (early onset) depression and anxiety, self-reported and observed co-rumination, self- and friend-reported friendship quality, self-reported positive and negative affect, self-reported interpersonal responses to positive affect, and self-reported anhedonia symptoms will be the outcome variables. Discussion This study will provide insights into the short-term and long-term effects of the HFPM program on girls’ internalizing problems, wellbeing, and social-emotional behavior. Trial registration International Standard Randomized Controlled Trials, identifier: ISRCTN54246670. Registered on 27 February 2023.

BRAFV600‐mutated melanoma brain metastases (MBMs) are responsive to BRAF inhibitors, but responses are generally less durable than those of extracranial metastases. We tested the hypothesis that the drug efflux transporters P‐glycoprotein (P‐gp; ABCB1) and breast cancer resistance protein (BCRP; ABCG2) expressed at the blood–brain barrier (BBB) offer MBMs protection from therapy. We intracranially implanted A375 melanoma cells in wild‐type (WT) and Abcb1a/b;Abcg2−/− mice, characterized the tumor BBB, analyzed drug levels in plasma and brain lesions after oral vemurafenib administration, and determined the efficacy against brain metastases and subcutaneous lesions. Although contrast‐enhanced MRI demonstrated that the integrity of the BBB is disrupted in A375 MBMs, vemurafenib achieved greater antitumor efficacy against MBMs in Abcb1a/b;Abcg2−/− mice compared with WT mice. Concordantly, P‐gp and BCRP are expressed in MBM‐associated brain endothelium both in patients and in A375 xenografts and expression of these transporters limited vemurafenib penetration into A375 MBMs. Although initially responsive, A375 MBMs rapidly developed therapy resistance, even in Abcb1a/b;Abcg2−/− mice, and this was unrelated to pharmacokinetic or target inhibition issues. Taken together, we demonstrate that both intrinsic and acquired resistance can play a role in MBMs.

Abstract Forecasting weather has become commonplace, but as society faces novel and uncertain environmental conditions there is a critical need to forecast ecology. Forewarning of ecosystem conditions during climate extremes can support proactive decision-making, yet applications of ecological forecasts are still limited. We showcase the capacity for existing marine management tools to transition to a forecasting configuration and provide skilful ecological forecasts up to 12 months in advance. The management tools use ocean temperature anomalies to help mitigate whale entanglements and sea turtle bycatch, and we show that forecasts can forewarn of human-wildlife interactions caused by unprecedented climate extremes. We further show that regionally downscaled forecasts are not a necessity for ecological forecasting and can be less skilful than global forecasts if they have fewer ensemble members. Our results highlight capacity for ecological forecasts to be explored for regions without the infrastructure or capacity to regionally downscale, ultimately helping to improve marine resource management and climate adaptation globally.

Abstract Given the importance of coastal upwelling systems to ocean productivity, fisheries, and biogeochemical cycles, their response to climate change is of great interest. However, there is no consensus on future productivity changes in these systems, which may be controlled by multiple drivers including wind‐driven and geostrophic transport, stratification, and source water properties. Here we use an ensemble of regional ocean projections and recently developed upwelling indices for the California Current System to disentangle these sometimes‐competing influences. Some changes are consistent among models (e.g., decreased mixed layer depth), while for others there is a lack of agreement even on the direction of future change (e.g., nitrate concentration in upwelled waters). Despite models' diverging projections of productivity changes, they agree that those changes are predominantly driven by subsurface nitrate concentrations, not by upwelling strength. Our results highlight the need for more attention to processes governing subsurface nutrient changes, not just upwelling strength.

Abstract In the California Current System (CCS), changes in the phenology (i.e., seasonal timing) of coastal upwelling alter the functioning of this productive marine ecosystem. Recently developed coastal upwelling indices that account for upwelling strength and nutrient flux to the surface provide a more complete understanding of bottom‐up forcing in the region. Using these indices, we describe CCS upwelling phenological variability in vertical transport and nutrient flux. Physical and biogeochemical spring transitions generally co‐occur in winter or spring, followed by increased upwelling and nutrient flux. In the latter half of the year, upwelling continues but nutrient flux wanes as declining source nutrient concentrations limit the biological efficacy of coastal upwelling. Earlier spring transitions and higher season‐integrated upwelling intensity occur during strong La Niña events at all latitudes, driven largely by stronger alongshore wind stress. Understanding phenological changes in coastal upwelling is critical, as they could have significant ecosystem consequences.

This dataset offers images of mouse brains impacted by photothrombotic stroke in the sensorimotor cortex published by Weber et al. NeuroImage (2024). Data is gathered using two primary techniques: (1) whole-brain ex-vivo magnetic resonance imaging (MRI) and (2) 40 µm thick coronal histological sections that undergo immunofluorescence staining with NeuroTrace. Infarct areas and volumes are assessed through MRI at two distinct time frames—three days (acute) and 28 days (chronic) following photothrombotic stroke induction. Subsequently, the brains are sectioned into 40 µm thick coronal slices, stained with NeuroTrace, and imaged as whole sections. The dataset holds considerable value for reuse, particularly for researchers focused on stroke volume estimation methods as well as those interested in comparing the efficacy of MRI and histological techniques.

Abstract Background For decades, the basic treatment strategies of necrotizing soft tissue infections (NSTI) have remained unchanged, primarily relying on aggressive surgical removal of infected tissue, broad-spectrum antibiotics, and supportive intensive care. One treatment strategy that has been proposed as an adjunctive measure to improve patient outcomes is hyperbaric oxygen (HBO2) treatment. HBO2 treatment has been linked to several immune modulatory effects; however, investigating these effects is complicated due to the disease's acute life-threatening nature, metabolic and cell homeostasis dependent variability in treatment effects, and heterogeneity with respect to both patient characteristics and involved pathogens. To embrace this complexity, we aimed to explore the underlying biological mechanisms of HBO2 treatment in patients with NSTI on the gene expression level. Methods We conducted an observational cohort study on prospective collected data, including 85 patients admitted to the intensive care unit (ICU) for NSTI. All patients were treated with one or two HBO2 treatments and had one blood sample taken before and after the intervention. Total RNAs from blood samples were extracted and mRNA purified with rRNA depletion, followed by whole-transcriptome RNA sequencing with a targeted sequencing depth of 20 million reads. A model for differentially expressed genes (DEGs) was fitted, and the functional aspects of the obtained set of genes was predicted with GO (Gene Ontology) and KEGG (Kyoto Encyclopedia of genes and Genomes) enrichment analyses. All analyses were corrected for multiple testing with FDR. Results After sequential steps of quality control, a final of 160 biological replicates were included in the present study. We found 394 protein coding genes that were significantly DEGs between the two conditions with FDR

The aim of our cross-sectional and longitudinal study is to assess the relationship between daytime and night-time sleep duration and health-related quality of life (HRQoL) in adults with metabolic syndrome after a 1-year healthy lifestyle intervention. Analysis of the data from 2119 Spanish adults aged 55–75 years from the PREDIMED-Plus study was performed. Sleep duration was assessed using a wrist-worn accelerometer. HRQoL was measured using the SF-36 questionnaire. Linear regression models adjusted for socioeconomic and lifestyle factors and morbidity were developed. In cross-sectional analyses, participants with extreme night-time sleep duration categories showed lower physical component summary scores in Models 1 and 2 [β-coefficient (95% confidence interval) p = 0.002. >9 h vs. 7–9 h: −1.1 (−2.0 to −0.3); p = 0.01]. Participants who sleep less than 7 h a night and take a nap are associated with higher mental component summary scores [β-coefficient (95% confidence interval) 6.3 (1.3 to 11.3); p = 0.01]. No differences between night-time sleep categories and 12-month changes in HRQoL were observed. In conclusion, in cross-sectional analyses, extremes in nocturnal sleep duration are related to lower physical component summary scores and napping is associated with higher mental component summary scores in older adults who sleep less than 7 h a night.

Abstract It is well known that police recorded crime data is susceptible to substantial measurement error. However, despite its limitations, police data is widely used in regression models exploring the causes and effects of crime, which can lead to different types of bias. Here, we introduce a new R package (‘rcme’: Recounting Crime with Measurement Error) that can be used to facilitate sensitivity assessments of the impact of measurement error in analyses using police recorded crime rates across a wide range of settings. To demonstrate the potential of such sensitivity analysis, we explore the robustness of the effect of collective efficacy on criminal damage across Greater London’s neighbourhoods. We show how the crime reduction effect attributed to collective efficacy appears robust, even when most criminal damage incidents are not recorded by the police, and if we accept that under-recording rates are moderately affected by collective efficacy.

Abstract Introduction The prevalence of psychiatric disorders has not shifted widely through the COVID pandemic, except for some specific groups such as young people or women. Our objective is to examine prospectively the evolution of children and adolescents who consulted in a psychiatric emergency service during the COVID-19 confinements. Method We collected prospective clinical information about 296 young people under 18 who visited a tertiary hospital for psychiatric reasons during the confinement periods in Spain. Clinical diagnoses, suicide attempts, hospital admissions, and pharmacological prescriptions were extracted from electronic health records through 2020, 2021, and 2022. Features of those who maintained psychiatric care and those who did not were compared. Results Three out of four children and adolescents who visited the psychiatric emergency department during the confinements continued psychiatric care at the end of 2022. Those who did not showed better premorbid adjustment at baseline. During follow-up, diagnoses of neurodevelopmental disorders and eating disorders, as well as the dosage of psychotropic drug prescriptions, increased. The diagnoses of major depressive disorder and eating disorder at baseline were associated with attempting suicide during follow-up. Patients with internalizing symptoms were admitted earlier than those with externalizing symptoms but no differences were found in terms of suicide attempts. Conclusions The continuity of psychiatric care after an initial emergency visit during the confinements implied greater clinical severity, as reflected by changes in clinical diagnoses and pharmacological regimens. Emergent symptoms of depression or eating disorders after social distancing or isolation could predict subsequent suicidal behavior in young populations.

Stroke volume is a key determinant of infarct severity and an important metric for evaluating treatments. However, accurate estimation of stroke volume can be challenging, due to the often confined 2-dimensional nature of available data. Here, we introduce a comprehensive semi-automated toolkit to reliably estimate stroke volumes based on (1) whole brains ex-vivo magnetic resonance imaging (MRI) and (2) brain sections that underwent immunofluorescence staining. We located and quantified infarct areas from MRI three days (acute) and 28 days (chronic) after photothrombotic stroke induction in whole mouse brains. MRI results were compared with measures obtained from immunofluorescent histologic sections of the same brains. We found that infarct volume determined by post-mortem MRI was highly correlated with a deviation of only 6.6 % (acute) and 4.9 % (chronic) to the measurements as determined in the histological brain sections indicating that both methods are capable of accurately assessing brain tissue damage (Pearson r > 0.9, p 0.8) between MRI-delineated regions of interest (ROIs) and ROIs obtained from histologic sections at four to six pre-defined landmarks, with histology-based delineation demonstrating higher inter-operator similarity compared to MR images. We further investigated stroke-related scarring and post-ischemic angiogenesis in cortical peri‑infarct regions and described a negative correlation between GFAP+fluorescence intensity and MRI-obtained lesion size.

The behavioural variant of Frontotemporal Dementia (bvFTD) is a neurodegenerative condition characterized by behavioural and cognitive symptoms. Mood disturbances, including manic-like episodes, can occur in bvFTD, posing diagnostic and therapeutic challenges. This case report presents a 62-year-old male with bvFTD exhibiting weekly mood fluctuations alternating between manic and depressive-like states. While initial treatment with quetiapine and trazodone showed partial improvement, the periodicity of mood fluctuations persisted. Subsequently, lithium was introduced, resulting in a notable reduction in symptom severity for both manic and depressive episodes. This report highlights the potential use of lithium as a mood stabilizer in bvFTD patients with periodic mood fluctuations, refractory to standard treatments. Further research is needed to elucidate the mechanisms underlying lithium’s efficacy in bvFTD and to establish treatment guidelines.

Abstract Biases in global Earth System Models (ESMs) are an important source of errors when used to obtain boundary conditions for regional models. Here we examine historical and future conditions in the California Current System (CCS) using three different methods to force the regional model: (a) interpolation of ESM output to the regional grid with no bias correction; (b) a “seasonally‐varying” delta method that obtains a season‐dependent mean climate change signal from the ESM for a 30‐year future period; and (c) a “time‐varying” delta method that includes the interannual variability of the ESM over the 1980–2100 period. To compare these methods, we use a high‐resolution (0.1°) physical‐biogeochemical regional model to dynamically downscale an ESM projection under the RCP8.5 emission scenario. Using different downscaling methods, the sign of future changes agrees for most of the physical and ecosystem variables, but the spatial patterns and magnitudes of these changes differ, with the seasonal‐ and time‐varying delta simulations showing more similar changes. Not correcting the ESM forcing leads to amplification of biases in some ecosystem variables as well as misrepresentation of the California Undercurrent and CCS source waters. In the non‐bias corrected and time‐varying delta simulations, most of the ecosystem variables inherit trends and decadal variability from the ESM, while in the seasonally‐varying delta simulation the future variability reflects the observed historical variability (1980–2010). Our results demonstrate that bias correcting the forcing prior to downscaling improves historical simulations, and that the bias correction method may impact the spatial and temporal variability of the future projections.

Abstract Background Iron deficiency anaemia is a worldwide health problem in which environmental, physiologic and genetic factors play important roles. The associations between iron status biomarkers and single nucleotide polymorphisms (SNPs) known to be related to iron metabolism were studied in menstruating women. Methods A group of 270 Caucasian menstruating women, a population group at risk of iron deficiency anaemia, participated in the study. Haematological and biochemical parameters were analysed and 10 selected SNPs were genotyped by minisequencing assay. The associations between genetic and biochemical data were analysed by Bayesian Model Averaging (BMA) test and decision trees. Dietary intake of a representative subgroup of these volunteers (n = 141) was assessed, and the relationship between nutrients and iron biomarkers was also determined by linear regression. Results Four variants, two in the transferrin gene (rs3811647, rs1799852) and two in the HFE gene (C282Y, H63D), explain 35% of the genetic variation or heritability of serum transferrin in menstruating women. The minor allele of rs3811647 was associated with higher serum transferrin levels and lower transferrin saturation, while the minor alleles of rs1799852 and the C282Y and H63D mutations of HFE were associated with lower serum transferrin levels. No association between nutrient intake and iron biomarkers was found. Conclusions In contrast to dietary intake, these four SNPs are strongly associated with serum transferrin. Carriers of the minor allele of rs3811647 present a reduction in iron transport to tissues, which might indicate higher iron deficiency anaemia risk, although the simultaneous presence of the minor allele of rs1799852 and HFE mutations appear to have compensatory effects. Therefore, it is suggested that these genetic variants might potentially be used as markers of iron deficiency anaemia risk.

This study analyses how gamification motivates users of gamified mobile exercise apps and enhances their health.Data from 276 Fitbit users were analysed using structural equation modelling. The findings showed that feelings of competence and autonomy arise when exercise apps include achievement and progression-oriented affordances, and that feelings of relatedness arise with social, immersion and achievement and progression-oriented affordances. They also revealed that exercise apps should satisfy the needs for competence and relatedness to develop individuals’ intrinsic motivation, which in turn leads to greater physical, mental and social health. These findings offer insights for managers in this industry.

Abstract Anthropogenic carbon emissions and associated climate change are driving rapid warming, acidification, and deoxygenation in the ocean, which increasingly stress marine ecosystems. On top of long‐term trends, short term variability of marine stressors can have major implications for marine ecosystems and their management. As such, there is a growing need for predictions of marine ecosystem stressors on monthly, seasonal, and multi‐month timescales. Previous studies have demonstrated the ability to make reliable predictions of the surface ocean physical and biogeochemical state months to years in advance, but few studies have investigated forecast skill of multiple stressors simultaneously or assessed the forecast skill below the surface. Here, we use the Community Earth System Model (CESM) Seasonal to Multiyear Large Ensemble (SMYLE) along with novel observation‐based biogeochemical and physical products to quantify the predictive skill of dissolved inorganic carbon (DIC), dissolved oxygen, and temperature in the surface and subsurface ocean. CESM SMYLE demonstrates high physical and biogeochemical predictive skill multiple months in advance in key oceanic regions and frequently outperforms persistence forecasts. We find up to 10 months of skillful forecasts, with particularly high skill in the Northeast Pacific (Gulf of Alaska and California Current Large Marine Ecosystems) for temperature, surface DIC, and subsurface oxygen. Our findings suggest that dynamical marine ecosystem prediction could support actionable advice for decision making.

Summary: Background: Pseudomonas aeruginosa healthcare-associated infections are one of the top antimicrobial resistance threats world-wide. In order to analyze the current trends, we performed a Spanish nation-wide high-resolution analysis of the susceptibility profiles, the genomic epidemiology and the resistome of P. aeruginosa over a five-year time lapse. Methods: A total of 3.180 nonduplicated P. aeruginosa clinical isolates from two Spanish nation-wide surveys performed in October 2017 and 2022 were analyzed. MICs of 13 antipseudomonals were determined by ISO-EUCAST. Multidrug resistance (MDR)/extensively drug resistance (XDR)/difficult to treat resistance (DTR)/pandrug resistance (PDR) profiles were defined following established criteria. All XDR/DTR isolates were subjected to whole genome sequencing (WGS). Findings: A decrease in resistance to all tested antibiotics, including older and newer antimicrobials, was observed in 2022 vs 2017. Likewise, a major reduction of XDR (15.2% vs 5.9%) and DTR (4.2 vs 2.1%) profiles was evidenced, and even more patent among ICU isolates [XDR (26.0% vs 6.0%) and DTR (8.9% vs 2.6%)] (p

The occurrences of summer hypoxia in coastal California Current can significantly affect the benthic and pelagic habitat and lead to complex ecosystem changes. Model-simulated hypoxia in this region is strongly spatially heterogeneous, and its future changes show uncertainties depending on the model used. Here, we used an ensemble of the new generation Earth system models to examine the present-day and future changes of summer hypoxia in this region. We applied model-specific thresholds combined with empirical bias adjustments of the dissolved oxygen variance to identify hypoxia. We found that, although simulated dissolved oxygen in the subsurface varies across the models both in mean state and variability, after necessary bias adjustments, the ensemble shows reasonable hypoxia frequency compared with a hindcast in terms of spatial distribution and average frequency in the coastal region. The models project increases in hypoxia frequency under warming, which is in agreement with deoxygenation projected consistently across the models for the coastal California Current. This work demonstrated a practical approach of using the multi-model ensemble for regional studies while presenting methodology limitations and gaps in observations and models to improve these limitations.

ABSTRACT Fungal rhinosinusitis (FRS) is a common problem worldwide, with an increasing burden in arid climate regions. Aspergillus species are the most common causative agents involved. In the present study, we investigated the prevalence, molecular characterization, and antifungal susceptibility of opportunists causing FRS in Sudan on the basis of strains collected over a period of 5 years. β-Tubulin and calmodulin sequencing were used for species identification, and antifungal susceptibility profiles were evaluated by the protocol of the European Committee on Antimicrobial Susceptibility Testing (EUCAST). Predominant species belonged to the Aspergillus flavus complex (n = 244), A. terreus complex (n = 16), A. fumigatus complex (n = 7), and other fungi (n = 17). Molecular identification of 94 strains of Aspergillus revealed the following species: A. flavus (n = 88), A. terreus (n = 1), A. citrinoterreus (n = 2), A. fumigatus (n = 1), A. caespitosus (n = 1), and A. sydowii (n = 1). Several A. flavus and an A. fumigatus isolates showed reduced susceptibility to azoles (minimum inhibitory concentrations above the clinical breakpoints or epidemiological cutoff values). Despite several mutations revealed in cyp51A of these isolates, none could be directly linked to azole resistance. Molecular identification of fungi causing FRS is useful to identify cryptic species and for epidemiologic studies. IMPORTANCE Fungal rhinosinusitis (FRS) is a significant clinical problem in arid regions. This study provides new insights into the prevalence, etiology, and antifungal susceptibility of FRS pathogens in Sudan, where the disease burden is high. Aspergillus species, particularly the A. flavus complex, were identified as the primary FRS pathogens in the region, with some evidence of antifungal resistance. The molecular identification of fungal species causing FRS is useful for detecting antifungal resistance, identifying cryptic species, and characterizing the epidemiology of the disease. The emergence of Azole resistance Aspergilli in Sudan highlights the need for continued surveillance and appropriate use of antifungal agents. These findings have important implications for clinical management, public health policy, and future research on FRS. Publishing this study in Microbiology Spectrum would enable other researchers and clinicians to build on these findings, ultimately improving the diagnosis, treatment, and prevention of FRS.

Book Review

Purpose: The objective of this work is to determine whether the effort of business schools in terms of sustainability policies improves student satisfaction through boosting the internationalization of the institution and its notoriety. Design/methodology/approach: The sample considered in this study consisted of 272 Spanish business school graduates. The data was collected via online survey during the first quarter of 2020. To validate the hypotheses and the model, structural equations modelling was performed using robust method. Findings: A commitment of the business schools to sustainability not only has an ethical component but also improves their positioning, leading to greater competitiveness. Practical implications: The results obtained point to sustainability practices facilitating entry processes involving joint agreements among business schools and leading to clear accreditations and/or sustainability policies. Originality/value: The present research focuses on those variables included in the scarcely investigated external factors that should be considered to maintain high satisfaction among business school students.

An analysis of phasing and imputation performances using iPSYCH consortium data across multiple methods and data integration protocols provides a useful framework in designing workflows to construct next-generation biobanks or conduct biobank-scale analyses.

Abstract Cognitive functions of individuals with psychiatric disorders differ from that of the general population. Such cognitive differences often manifest early in life as differential school performance and have a strong genetic basis. Here we measured genetic predictors of school performance in 30,982 individuals in English, Danish and mathematics via a genome-wide association study (GWAS) and studied their relationship with risk for six major psychiatric disorders. When decomposing the school performance into math and language-specific performances, we observed phenotypically and genetically a strong negative correlation between math performance and risk for most psychiatric disorders. But language performance correlated positively with risk for certain disorders, especially schizophrenia, which we replicate in an independent sample (n = 4547). We also found that the genetic variants relating to increased risk for schizophrenia and better language performance are overrepresented in individuals involved in creative professions (n = 2953) compared to the general population (n = 164,622). The findings together suggest that language ability, creativity and psychopathology might stem from overlapping genetic roots.

Studies on parent-of-origin effects have been limited in terms of sample size due to lack of parental genomes or known genealogies. Here, the authors develop a method to infer the parent-of-origin of an individual alleles in biobank-scale datasets, without requiring parental genomes or prior knowledge of genealogy, allowing discovery of parent-of-origin effects with an unprecedented sample size.

The present work aimed to establish the influence of self-reported trait anxiety on computerized and self-reported measures of executive control, and speed of processing in young adults using latent variable modeling. One hundred and six participants completed the State-trait anxiety questionnaire (STAI-t), the Attentional Control Scale (ACS), and a set of computerized tasks of executive control, tapping into the updating, inhibition, and shifting components. Higher scores in the latent variable of trait anxiety were negatively associated with the self-reported latent variable of attentional control. Notably, self-reported and performance-based indicators of executive control showed no associations at the latent level. Contrary to our hypotheses, higher trait anxiety did not affect any performance-based executive component but was associated with an increase in response times. We show that self-reported trait anxiety is related to a lower self-perceived sense of attentional control and does not affect executive functioning in non-clinical samples. In turn, trait anxiety is mainly associated with a slowed speed of processing. In conclusion, the tendency to experience a negative mood is related with cognitive processing by reducing its speed even in the absence of threatening stimuli.

ABSTRACT The detection and accurate identification of bacterial species in clinical samples are crucial for diagnosis and appropriate antibiotic treatment. To date, sequencing of the 16S rRNA gene has been widely used as a complementary molecular approach when identification by culture fails. The accuracy and sensitivity of this method are highly affected by the selection of the 16S rRNA gene region targeted. In this study, we assessed the clinical utility of 16S rRNA reverse complement PCR (16S RC-PCR), a novel method based on next-generation sequencing (NGS), for the identification of bacterial species. We investigated the performance of 16S RC-PCR on 11 bacterial isolates, 2 polymicrobial community samples, and 59 clinical samples from patients suspected of having a bacterial infection. The results were compared to culture results, if available, and to the results of Sanger sequencing of the 16S rRNA gene (16S Sanger sequencing). By 16S RC-PCR, all bacterial isolates were accurately identified to the species level. Furthermore, in culture-negative clinical samples, the rate of identification increased from 17.1% (7/41) to 46.3% (19/41) when comparing 16S Sanger sequencing to 16S RC-PCR. We conclude that the use of 16S RC-PCR in the clinical setting leads to an increased sensitivity of detection of bacterial pathogens, resulting in a higher number of diagnosed bacterial infections, and thereby can improve patient care. IMPORTANCE The identification of the causative infectious pathogen in patients suspected of having a bacterial infection is essential for diagnosis and the start of appropriate treatment. Over the past 2 decades, molecular diagnostics have improved the ability to detect and identify bacteria. However, novel techniques that can accurately detect and identify bacteria in clinical samples and that can be implemented in clinical diagnostics are needed. Here, we demonstrate the clinical utility of bacterial identification in clinical samples by a novel method called 16S RC-PCR. Using 16S RC-PCR, we reveal a significant increase in the number of clinical samples in which a potentially clinically relevant pathogen is identified compared to the commonly used 16S Sanger method. Moreover, RC-PCR allows automation and is well suited for implementation in a diagnostic laboratory. In conclusion, the implementation of this method as a diagnostic tool is expected to result in an increased number of diagnosed bacterial infections, and in combination with adequate treatment, this could improve clinical outcomes for patients.

Chimeric antigen receptor (CAR-) T cell therapy is a relatively new form of immunotherapy for hematological malignancies. Although patients are at increased risk of infection following CAR-T cell therapy, reports of fungal infections are scarce. We report a case of Scedosporium apiospermum infection causing bursitis of the elbow in a lymphoma patient after treatment with CAR-T cells. The fungal bursitis relapsed under posaconazole treatment, but was cured after surgical extirpation of the bursa.

The increase in microbial sequenced genomes from pure cultures and metagenomic samples reflects the current attainability of whole-genome and shotgun sequencing methods. However, software for genome visualization still lacks automation, integration of different analyses, and customizable options for non-experienced users. In this study, we introduce GenoVi, a Python command-line tool able to create custom circular genome representations for the analysis and visualization of microbial genomes and sequence elements. It is designed to work with complete or draft genomes, featuring customizable options including 25 different built-in color palettes (including 5 color-blind safe palettes), text formatting options, and automatic scaling for complete genomes or sequence elements with more than one replicon/sequence. Using a Genbank format file as the input file or multiple files within a directory, GenoVi (i) visualizes genomic features from the GenBank annotation file, (ii) integrates a Cluster of Orthologs Group (COG) categories analysis using DeepNOG, (iii) automatically scales the visualization of each replicon of complete genomes or multiple sequence elements, (iv) and generates COG histograms, COG frequency heatmaps and output tables including general stats of each replicon or contig processed. GenoVi's potential was assessed by analyzing single and multiple genomes of Bacteria and Archaea. Paraburkholderia genomes were analyzed to obtain a fast classification of replicons in large multipartite genomes. GenoVi works as an easy-to-use command-line tool and provides customizable options to automatically generate genomic maps for scientific publications, educational resources, and outreach activities. GenoVi is freely available and can be downloaded from https://github.com/robotoD/GenoVi.

Context: The antagonistic capacity of Trichoderma harzianum Rifai against fungal pathogen Sclerotium oryzae (Catt.) strain A-34, and the action mechanisms against the fungal pathogen of Sclerotium oryzae (Catt.), which caused crop losses. Aim: To evaluate the antagonistic capacity of Trichoderma harzianum Rifai against the fungal pathogen Sclerotium oryzae (Catt.). Methods: The concentration of spores/ml-1, the viability and mycelia growth inhibition of the pathogen, and the antagonistic capacity of Trichoderma harzianum, through the action mechanisms. The results were processed using SPSS, version 22.0, for Windows, and Tukey’s test results had a 0.05% probability. A completely randomized experimental design was used for each pathogenic fungus. Results: No antibiosis was observed at 24 hours because the antagonistic did not inhibit pathogen growth; at 72 hours, there was hyphal interaction between S. oryzae and T. harzianum, and there was no mycoparasitism by the antagonist. S. oryzae grew more than the antagonistic at 96 hours, and at 120 hours, the antagonistic grew more than S. oryzae; therefore, no antagonistic or hyper-parasitic activity were observed in the pathogen. Conclusions: The antagonist did not affect the mycelial growth of S. oryzae during the dual challenge. Likewise, T. harzianum (strain A-34) showed no antagonistic activity against Sclerotium oryzae, with a negative inhibition percent of Radial Growth, seen through antibiosis and the action mechanisms.

Contexto: En el país se desconoce la capacidad antagónica de Trichoderma harzianum Rifai cepa A-34 y la acción de los mecanismos frente al fitopatógeno fúngico del arroz Sclerotium oryzae (Catt.) donde ocasionó pérdidas en el cultivo. Objetivo: Evaluar la capacidad antagónica de Trichoderma harzianum Rifai cepa A-34 frente al fitopatógeno fúngico del arroz Sclerotium oryzae (Catt.). Métodos: Se midió concentración de esporas/ ml-1, viabilidad e inhibición del crecimiento micelial del patógeno y la capacidad antagónica de Trichoderma harzianum mediante los mecanismos de acción. Los resultados se procesaron en el paquete estadístico SPSS versión 22,0 para Windows, realizando el Test de Tukey con el 0,05% de probabilidad. Se utilizó un diseño completamente aleatorizado para cada hongo fitopatógeno. Resultados: Se evidencia que no hubo antibiosis a las 24 horas debido a que el antagonista no inhibió el crecimiento del patógeno; a las 72 horas se observó interacción hifal entre S. oryzae y T. harzianum donde no existió micoparasitismo por el antagonista ya que S. oryzae creció más que este a las 96 horas y no fue hasta las 120 horas que el antagonista creció sobre S. oryzae, por tanto, no hubo actividad antagónica ni hiperparasítica sobre el patógeno. Conclusiones: El antagonista no afectó el crecimiento micelial del agente fitopatógeno S. oryzae en el enfrentamiento dual; así mismo T. harzianum (cepa A-34) no manifestó capacidad antagónica, frente a Sclerotium oryzae donde se obtuvo un Porciento de Inhibición del Crecimiento Radial (PICR) negativo, evidenciado a través de la antibiosis y los mecanismos de acción.

Context: The antagonistic capacity of Trichoderma harzianum Rifai against fungal pathogen Sclerotium oryzae (Catt.) strain A-34, and the action mechanisms against the fungal pathogen of Sclerotium oryzae (Catt.), which caused crop losses. Aim: To evaluate the antagonistic capacity of Trichoderma harzianum Rifai against the fungal pathogen Sclerotium oryzae (Catt.). Methods: The concentration of spores/ml-1, the viability and mycelia growth inhibition of the pathogen, and the antagonistic capacity of Trichoderma harzianum, through the action mechanisms. The results were processed using SPSS, version 22.0, for Windows, and Tukey’s test results had a 0.05% probability. A completely randomized experimental design was used for each pathogenic fungus. Results: No antibiosis was observed at 24 hours because the antagonistic did not inhibit pathogen growth; at 72 hours, there was hyphal interaction between S. oryzae and T. harzianum, and there was no mycoparasitism by the antagonist. S. oryzae grew more than the antagonistic at 96 hours, and at 120 hours, the antagonistic grew more than S. oryzae; therefore, no antagonistic or hyper-parasitic activity were observed in the pathogen. Conclusions: The antagonist did not affect the mycelial growth of S. oryzae during the dual challenge. Likewise, T. harzianum (strain A-34) showed no antagonistic activity against Sclerotium oryzae, with a negative inhibition percent of Radial Growth, seen through antibiosis and the action mechanisms.

Contexto: En el país se desconoce la capacidad antagónica de Trichoderma harzianum Rifai cepa A-34 y la acción de los mecanismos frente al fitopatógeno fúngico del arroz Sclerotium oryzae (Catt.) donde ocasionó pérdidas en el cultivo. Objetivo: Evaluar la capacidad antagónica de Trichoderma harzianum Rifai cepa A-34 frente al fitopatógeno fúngico del arroz Sclerotium oryzae (Catt.). Métodos: Se midió concentración de esporas/ ml-1, viabilidad e inhibición del crecimiento micelial del patógeno y la capacidad antagónica de Trichoderma harzianum mediante los mecanismos de acción. Los resultados se procesaron en el paquete estadístico SPSS versión 22,0 para Windows, realizando el Test de Tukey con el 0,05% de probabilidad. Se utilizó un diseño completamente aleatorizado para cada hongo fitopatógeno. Resultados: Se evidencia que no hubo antibiosis a las 24 horas debido a que el antagonista no inhibió el crecimiento del patógeno; a las 72 horas se observó interacción hifal entre S. oryzae y T. harzianum donde no existió micoparasitismo por el antagonista ya que S. oryzae creció más que este a las 96 horas y no fue hasta las 120 horas que el antagonista creció sobre S. oryzae, por tanto, no hubo actividad antagónica ni hiperparasítica sobre el patógeno. Conclusiones: El antagonista no afectó el crecimiento micelial del agente fitopatógeno S. oryzae en el enfrentamiento dual; así mismo T. harzianum (cepa A-34) no manifestó capacidad antagónica, frente a Sclerotium oryzae donde se obtuvo un Porciento de Inhibición del Crecimiento Radial (PICR) negativo, evidenciado a través de la antibiosis y los mecanismos de acción.

Background/Aims: Posthepatectomy liver failure (PHLF) is a major complication that increases mortality in patients with hepatocellular carcinoma after surgical resection. The aim of this retrospective study was to evaluate the utility of magnetic resonance elastography-assessed liver stiffness (MRE-LS) for the prediction of PHLF and to develop an MRE-LS-based risk prediction model. Methods: A total of 160 hepatocellular carcinoma patients who underwent surgical resection with available preoperative MRE-LS data were enrolled. Clinical and laboratory parameters were collected from medical records. Logistic regression analyses were conducted to identify the risk factors for PHLF and develop a risk prediction model. Results: PHLF was present in 24 patients (15%). In the multivariate logistic analysis, high MRE-LS (kPa; odds ratio [OR] 1.49, 95% confidence interval [CI] 1.12 to 1.98, p=0.006), low serum albumin (≤3.8 g/dL; OR 15.89, 95% CI 2.41 to 104.82, p=0.004), major hepatic resection (OR 4.16, 95% CI 1.40 to 12.38, p=0.014), higher albumin-bilirubin score (>–0.55; OR 3.72, 95% CI 1.15 to 12.04, p=0.028), and higher serum α-fetoprotein (>100 ng/mL; OR 3.53, 95% CI 1.20 to 10.40, p=0.022) were identified as independent risk factors for PHLF. A risk prediction model for PHLF was established using the multivariate logistic regression equation. The area under the receiver operating characteristic curve (AUC) of the risk prediction model was 0.877 for predicting PHLF and 0.923 for predicting grade B and C PHLF. In leave-one-out cross-validation, the risk model showed good performance, with AUCs of 0.807 for all-grade PHLF and 0. 871 for grade B and C PHLF. Conclusions: Our novel MRE-LS-based risk model had excellent performance in predicting PHLF, especially grade B and C PHLF.

We studied the developmental course of the spreading of phonological activation in individuals with and without dyslexia by means of a phonological version of the Deese/Roediger-McDermott false memory task. The false memory effect is assumed to reflect the spreading of activation from the presented stimuli to similar words in the lexicon. We assessed 35 volunteers with dyslexia and a group of matched controls with ages ranging from 6 to 58 years. They were first presented with six lists of ten two-syllable words each, all of which shared one syllable with a reference unpresented word. Then, they answered a recognition questionnaire including 24 presented words, 18 phonologically related unpresented words, and 12 unrelated unpresented words. False recognition of phonologically related words increased with age in the control group but stayed at very low levels in the dyslexia group. Our study indicates the existence of a deficit in the spreading of phonological activation in individuals with dyslexia throughout life.

BackgroundThe COVID-19 pandemic has affected the implementation of most ongoing clinical trials worldwide including the PREDIMED-Plus study. The PREDIMED-Plus is an ongoing, multicenter, controlled intervention trial, aimed at weight-loss and cardiovascular disease prevention, in which participants were randomized (1:1 ratio) to an intervention group (energy-reduced Mediterranean diet, promotion of physical activity, and behavioral support) or to a control group (Mediterranean diet with usual care advice). When the pandemic began, the trial was in the midst of the planned intervention. The objective of this report was to examine the effects of the pandemic on the delivery of the intervention and to describe the strategies established to mitigate the possible adverse effects of the pandemic lockdown on data collection and adiposity.MethodsWe assessed the integrity of the PREDIMED-Plus trial during 5 identified periods of the COVID-19 pandemic determined according to restrictions dictated by the Spanish government authorities. A standardized questionnaire was delivered to each of the 23 PREDIMED-Plus recruiting centers to collected data regarding the trial integrity. The effect of the restrictions on intervention components (diet, physical activity) was evaluated with data obtained in the three identified lockdown phases: pre lockdown, lockdown proper, and post lockdown.ResultsDuring the lockdown (March/2020-June/2021), 4,612 participants (48% women, mean age 65y) attended pre-specified yearly follow-up visits to receive lifestyle recommendations and obtain adiposity measures. The overall mean (SD) of the proportions reported by each center showed that 40.4% (25.4) participants had in-person visits, 39.8% (18.2) participants were contacted by telephone and 35% (26.3) by electronic means. Participants’ follow-up and data collection rates increased across lockdown periods (from ≈10% at onset to ≈80% at the end). Compared to pre-lockdown, waist circumference increased during (0.75 cm [95% CI: 0.60–0.91]) and after (0.72 cm [95% CI: 0.56–0.89]) lockdown. Body weight did not change during lockdown (0.01 kg [95% CI: –0.10 to 0.13) and decreased after lockdown (-0.17 kg [95% CI: –0.30 to –0.04]).ConclusionMitigating strategies to enforce the intervention and patient’s follow-up during lockdown have been successful in preserving the integrity of the trial and ensuring its continuation, with minor effects on adiposity.Clinical trial registrationhttps://doi.org/10.1186/ISRCTN89898870, identifier ISRCTN89898870.