Search

The Water Framework Directive (WFD, 2000/60/EC) mandates member states to consider trace element background values when establishing environmental quality standards (EQS) for sediments. This study proposes defining the "background" value as the trace element concentration that is consistently present in the unaltered natural environment, and the "reference" value as an upper limit of variation of naturally occurring concentrations, suggestive of anthropogenic enrichment if exceeded. We argue that background and reference values can be computed as the upper limits of the one-sided 95 % confidence interval for the median and for the 90th percentile, respectively. This proposition has been tested in two European river basins with different historical anthropogenic impacts: the Nalón (impacted by mining activities) and the Esva (mostly unpolluted) basins. For 110 bottom sediment samples collected from both pristine (background) and potentially impacted (non-background) locations, 19 elements were analyzed by ICP-MS/ICP-AES. The proposed background and reference values, calculated using the Bootstrap method, demonstrated consistency despite geological differences between the basins. The methodology proved particularly effective in datasets with a limited sample size and highly skewed data distributions. In the Nalón basin, with higher anthropogenic activity, the percentage of samples exceeding reference values was higher than in the Esva basin (e.g., 29 % vs 7 % for As and 11 % vs 0 % for Pb), suggesting the utility of these values in discerning potential impacts of historic mining activities. In the Esva basin, background and reference values were either near or below generic thresholds for good ecological status (LEL, TEL) unlike the Nalón basin, in which reference values for all elements, except three, exceeded these thresholds., Competing Interests: Declaration of Competing Interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Almudena Ordonez reports financial support was provided by Spanish Ministry of Science and Innovation. If there are other authors, they 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 © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)

Purpose: Endoscopic procedures and surgery are common treatments for early colorectal cancer (CRC). However, only approximately 10% of patients who undergo surgery have lymph node metastases (LNM) detected on postoperative pathology, which often leads to overtreatment. This study aims to comprehensively analyze the risk factors for LNM in early CRC patients, establishing a predictive model to aid in treatment decisions., Methods: This study reviewed the clinicopathologic data of patients with early CRC who underwent surgery from January 2015 to June 2023. Univariate and multivariate logistic regression analyses were employed to identify LNM risk factors. The receiver operating characteristic (ROC) analysis and calibration curves were also constructed to verify the model's discrimination and calibration. A simplified scale was calculated to promote the risk stratification for LNM., Results: The study analyzed medical records of 375 patients. Of these, 37 (9.9%) cases had LNM. Univariate analysis identified age, nerve invasion, depth of submucosal invasion, histologic grade, LVI, and tumor budding as risk factors. The multivariate analysis confirmed histologic grade (OR, 13.403; 95% CI, 1.415-126.979; P = 0.024), LVI (OR, 6.703; 95% CI, 2.600-17.284; P < 0.001), and tumor budding (OR, 3.090; 95% CI, 1.082-8.820; P = 0.035) as independent predictors. The optimal nomogram, incorporating six risk factors, demonstrated strong predictability with an area under the ROC curve (AUC) of 0.837 (95% CI, 0.762-0.912). A simplified risk assessment scale with a total score of 19 points was developed., Conclusion: The study developed a nomogram and a simplified risk assessment scale to predict LNM risk, potentially optimizing the management of early CRC patients., Competing Interests: Declarations. Ethics approval and consent to participate: This research study was conducted retrospectively from data obtained for clinical purposes and was reviewed and approved by the Ethics Committee of the Affiliate Hospital of Qingdao University (Reference Number QYFYWZLL28762). The procedures used in this study adhere to the tenets of the Declaration of Helsinki. The need for written informed consent was waived by the Ethics Committee of the Affiliate Hospital of Qingdao University due to the retrospective nature of the study. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests., (© 2024. The Author(s).)

Background: Language barriers in healthcare lead to miscommunication between professionals and patients, thereby reducing the quality of and equitable access to healthcare. In African countries, the recognition and formal study of these barriers is severely limited despite Africa having more languages than any other continent. Our study investigates language barriers in healthcare facilities in Zomba district in Malawi, where three major local languages are spoken., Methods: We employed a mixed methods approach and conducted a questionnaire-led study. Data were gathered at 22 health facilities, from 79 healthcare professionals and 312 outpatients using a semi-structured questionnaire. Findings were corroborated using document analysis to review legislation and policies, curriculum documents and patient notes., Results: Language discordance emerged as a problem for professionals and patients. Both faced challenges due to vocabulary limitations for medical terms in English and Chichewa. Professionals did not receive training on how to effectively communicate medical concepts in local languages. Most patients did not speak English, which was used for all written records. Patient understanding of the information given to them verbally during consultations or in written health notes was very low, and this diminished their confidence in the diagnosis or treatment they received. Social factors including gender, age or patient experience, as well as patient literacy or perceived low literacy, poor rapport between healthcare professionals and patients, and a lack of privacy during consultations all exacerbated communication issues. Consequences of language barriers included unsatisfactory care experiences and compromised exchanges of health information. Strategies used by professionals to cope with these challenges were flexibility in the choice of language, reliance on physical checks and non-verbal communication indicators and the occasional use of ad-hoc interpretations., Conclusion: Language barriers in healthcare facilities in Malawi have serious implications on the quality of healthcare provided. We propose solutions such as the development of dictionaries with phrases for symptoms and conditions, sensitisation courses that incorporate language considerations for both professionals and patients. Policies such as the provision of interpreters and staff allocation are discussed. We recognise that coordinated efforts at national and international levels are key to securing significant funding for effective interventions., Competing Interests: Declarations Ethics Approval and Consent to participate The research committee of the Zomba District Heath Office has approved all materials and procedures for this study (ZA/DC/ADMIN/15/02/2024) dated 15th February 2024. All procedures were carried out in accordance with the Declaration of Helsinki. All patient participants were given a written and verbal explanation regarding the aim of the study, data protection and privacy of individual data. Consent was obtained verbally. The written consent of healthcare professionals and patients came in the form of completed and returned questionnaires. Consent for publication Not applicable. Competing interest The authors declare no competing interests., (© 2024. The Author(s).)

The Greater Sydney (Australia) region is dissected by eleven major estuaries comprising a wide range of sizes, sediment and contaminant types, while the catchments also vary in size, land use type, populations size and geology/soils. The magnitude and breadth of the current study are rare and offered an unusual opportunity to provide new information on interactions between source, fate and effect relationships of a highly diverse estuarine-catchment environment using sedimentary metals (Co, Cr, Cu, Ni, Pb and Zn). Advanced methodologies used in this study revealed that although metal concentrations were generally high, ecological risk was surprisingly reduced due to the presence of metal-poor coarse sediment. Stormwater was identified as the dominant source of metals to estuaries of Greater Sydney and relates to development of high-density road networks. Industrial sources, frequently identified as a major contributor to estuarine contamination, was significantly reduced due to the decline of industry through decentralisation and gentrification and because waste is discharged to the sewer system, which is released offshore, or tertiary-treated to the Hawkesbury. Groundwater leachate associated with shoreline reclamation and wetland infilling and metals related to boating activities were important sources of metals impacting local bays and coastal lagoons. Temporal monitoring and unique modelling approaches indicated that the concentration of sedimentary metals is generally declining in these estuaries, (especially for Pb), except for areas with rapidly increasing urban populations. Multivariate statistical modelling was able to differentiate the 11 estuaries on a chemical basis by aligning Cu, Pb, Zn vectors with metal-rich estuaries and also identified catchment attributes (percent area, total yield, anthropogenic yield and population density) normalised to catchment areas as having a major influence on estuarine condition. The new knowledge derived from this study should be used to assess the environmental status of estuaries and to prioritise management actions in future investigations., Competing Interests: Declaration of competing interest The authors have no relevant financial, or non-financial interests to disclose., (Copyright © 2024 The Authors. Published by Elsevier B.V. All rights reserved.)

The Perseverance rover landed at Jezero crater, Mars, on 18 February 2021, with a payload of scientific instruments to examine Mars' past habitability, look for signs of past life, and process samples for future return to Earth. The instrument payload includes the Scanning Habitable Environments with Raman and Luminescence for Organics and Chemicals (SHERLOC) deep ultraviolet Raman and fluorescence imaging spectrometer designed to detect, characterize, and map the presence of organics and minerals on the Martian surface. Operation and engineering constraints sometimes result in the acquisition of spectra with features near the detection limit. It is therefore important to separate instrumental (background) spectral components and spectral components inherent to Martian surface materials. For SHERLOC, the instrumental background is assessed by collecting spectra in the stowed-arm configuration where the instrument is pointed at the Martian nighttime sky with no surface sample present in its optical path. These measurements reveal weak Raman and fluorescence background spectral signatures as well as charged-coupled device pixels prone to erroneous intensity spikes separate from cosmic rays. We quantitatively describe these features and provide a subtraction procedure to remove the spectral background from surface spectra. By identifying and accounting for the SHERLOC Raman background features within the median Raman spectra of Martian target scans, we find that the undefined silicate spectral feature interpreted to be either amorphous silicate or plagioclase feldspar is ubiquitously found in every Mars target Raman scan collected through Sol 751., Competing Interests: Declaration of Conflicting InterestsThe authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Metabolic conversion of benzene (Bz) is thought to be required for the hematotoxic effects observed following Bz exposures. Most safe exposure limits set for Bz utilize epidemiology data on the hematotoxic effects of Bz for the dose-response assessments. These hematotoxic effects occurred among workers exposed to elevated Bz levels, thus dose extrapolation is required for assessing relevant risks for populations exposed orders of magnitude lower. Thus, understanding how Bz is metabolized over a wide range of air Bz levels is an important topic for risk assessments for Bz. Here, we analyze biomonitoring data for workers exposed to Bz to make evaluations of how the metabolism of Bz varies across a wide range of exposures. Our analysis indicates that the presence of metabolites derived from exposures to sources other than Bz (nonspecific metabolites of Bz) are significant confounders among biomonitoring studies and this precludes making any assessments of how Bz metabolism differs below approximately 3 ppm air Bz exposures using such nonspecific metabolites.

Purpose: Pancreatic cancer remains a significant public health challenge, with poor long-term outcomes due to the lack of effective treatment options. Repurposing commonly used clinical drugs, such as ACE inhibitors, ARBs, CCBs, and metformin, may enhance the efficacy of chemotherapy and offer a promising therapeutic strategy for improving patient outcomes., Methods: A retrospective analysis of concomitant treatment with ACE-Is, ARBs, CCBs, and metformin alongside gemcitabine chemotherapy in patients with pancreatic cancer was conducted. Treatment responses were evaluated, with overall survival (OS) estimated using the Kaplan-Meier method. Additionally, the Cox proportional hazards model was employed to assess the impact of these specific agents on patient survival., Results: 4628 patients with various stages of pancreatic cancer were identified in the database between 2007 and 2016. The estimated overall survival (OS) in the analyzed group was 6.9 months (95% CI 6.4-7). The use of any of the analyzed drugs was associated with a significant improvement in mOS of 7.5 months (95% CI 6.8-7.8) vs. 6.7 months (95% CI 6.4-7.0) for patients who did not have additional treatment (p < 0.0001). ARBs, ACE-Is, CCBs, and metformin varied in their effectiveness in prolonging mOS among patients. The longest mOS of 8.9 months (95% CI 7.7-11.6) was observed in patients receiving additional therapy with ARBs, while the shortest mOS of 7.7 months (95% CI 6.5-8.9) was achieved by patients receiving metformin. In the adjusted Cox analysis, metformin was associated with a significantly weaker effect on mOS (p = 0.029). A particularly interesting trend in prolonging 5-year survival was demonstrated by ARBs and CCBs with 14.1% (95% CI 9-22%) and 14.8% (95% CI 11.1-19.6%), respectively, compared to patients not taking these drugs, who achieved a 5-year OS of 3.8% (95% CI 3.2-4.4%)., Conclusion: Our results demonstrate a significant positive impact of ARBs, ACE inhibitors, and CCBs on survival in patients with pancreatic cancer treated with gemcitabine. The addition of these inexpensive and relatively safe drugs in patients with additional comorbidities may represent a potential therapeutic option in this indication. However, prospective clinical trials to evaluate the optimal patient population and further studies to determine the potential impact of these agents on chemotherapy are necessary., (© 2024. The Author(s).)

Background and objective The pervasive use of earphones has raised concerns about its potential impact on hearing acuity and the health of the external auditory canal (EAC). This study aimed to investigate these effects in a sample of individuals in Central India to better understand the associated risks. Materials and methods This observational cross-sectional study was conducted in the Department of Otorhinolaryngology, Acharya Vinoba Bhave Rural Hospital, Sawangi Wardha. A total of 130 participants aged 15-35 years were divided into two groups: 65 earphone users and 65 non-earphone users. The data collection involved medical histories, clinical examinations, and audiometric testing, including pure-tone audiometry (PTA), impedance audiometry, and otoacoustic emissions (OAE). Participants completed a questionnaire on earphone usage, and EAC health was assessed via physical examinations and photographic documentation. Statistical analyses included descriptive and inferential statistics, with significance set at p<0.05. Results Among earphone users, 45 (69.23%) exhibited hearing loss compared to 11 (16.92%) in non-users (p<0.00001). Noise-canceling earphones were associated with fewer cases of hearing loss (6/45, 13.33%) than non-noise-canceling types (39/45, 86.67%) (p<0.00001). EAC issues were more prevalent in earphone users, with 39 (60%) showing normal conditions versus 52 (80%) in non-users. Impactions of wax, otomycosis, and otitis externa were observed more frequently among earphone users. Conclusions The study highlights a significant association between earphone use and increased risk of hearing loss and EAC issues. Noise-canceling earphones may offer some protective benefits. These findings underscore the need for raising awareness and implementing preventive measures to mitigate potential risks associated with prolonged earphone use., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Institutional Ethics Committee, Datta Meghe Institute of Higher Education & Research issued approval DMIMS(DU)/IEC/Dec-2022/11. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Ghosh Moulic et al.)

Background Stress is prevalent among college students, impacting their mental health and academic performance. Understanding the distribution and determinants of stress levels in students is crucial for developing effective interventions. This study aims to assess the prevalence of stress and its association with sociodemographic factors among undergraduate students at St. John's College, Agra, India. Materials and methods A descriptive cross-sectional study was conducted between August 1, 2023, and December 31, 2023, involving 160 undergraduate students from B.A., B. Com., and B.Sc. programs. Students were selected using a stratified random sampling technique. Stress levels were measured using the Perceived Stress Scale (PSS), which classifies low, moderate, and high levels. Data were collected through a validated, semi-structured questionnaire administered via Google Forms. Statistical analysis was performed using IBM SPSS Statistics for Windows, Version 29 (Released 2023; IBM Corp., Armonk, New York), with descriptive statistics and chi-square tests used to examine associations between stress levels and sociodemographic variables. Results The study found that 103 (64.4%) of students experienced moderate stress, 34 (21.3%) reported high perceived stress, and 23 (14.4%) had low stress. A significant association was observed between stress levels and gender (p = 0.022), with female students more likely to experience high stress. Additionally, urban students reported higher stress levels than their rural counterparts (p = 0.012). However, no significant differences in stress levels were found across different courses. Conclusion The study reveals a substantial prevalence of moderate to high stress among college students, particularly among females and those from urban areas. These findings suggest the need for targeted stress management interventions to support student well-being. Further research is recommended to explore the underlying causes of stress and develop comprehensive stress reduction strategies in the student population., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. St. Johns College, Agra issued approval SJC/IEC/01/2023-24. This approval has been granted on the assumption that the ethical guidelines for biomedical research on human participants will carry out the proposed work. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Shrivastava et al.)

Minipigs are valued alternatives to dogs and non-human primates in non-clinical safety and toxicity studies, and Göttingen minipigs are bred specifically for experimental purposes. They are bred under barrier conditions and monitored regularly for many pathogens and opportunistic agents, and spontaneous disease is rare when compared to what is seen in production pigs. Knowledge of spontaneous background lesions is important when toxicological pathologists evaluate microscopic findings in pre-clinical toxicity studies to avoid interference with study data interpretation. In this brief communication, intra-abdominal granulomas/abscesses were seen in Göttingen minipigs. The minipigs did not show any clinical signs, but nodules were present in the abdominal peritoneum at necropsy. Microscopic evaluation revealed chronic inflammation, with abscess or granuloma formation. Areas of inflammation, occasionally associated with the presence of the Splendore-Hoeppli material, were surrounded by a fibrotic capsule. Special stains were applied to investigate for the presence of microorganisms., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

The evaluation of the results from a fibre comparison given activity level propositions is well established when considering only a single group of potential primary transfers. However, secondary transfers are less prevalent in the literature despite their potential value, especially in cases where the primary transfers are not sufficiently informative. In particular, one can consider the fibres from frequented environments of the person of interest (POI) identified in a struggle. If the POI did struggle with the complainant, these fibres can potentially be recovered in small quantities on the surface of the complainant as a result of secondary or higher order transfers. Therefore, these fibres may provide useful information that can resolve competing propositions involving struggles, as well as forensic intelligence in the form of linkages or investigative leads. If a non-differentiation is indeed found between recovered fibres and fibres from the frequented environments of the POI, these results need to be properly interpreted. In this paper, a model, based on an object oriented Bayesian network (OOBN), for evaluating such findings along with its implementation is proposed. Using available data from the literature and other sources, the model was then used to assess a few hypothetical scenarios involving secondary transfers. The results provided useful insights into secondary transfer that help to validate the model and demonstrate the potential utility that can be gained by considering transfers beyond the primary order. Moreover, these results can be used to help guide future research by identifying gaps in the literature. Finally, the direct application to a case study was conducted to demonstrate the practical aspects of such a model., Competing Interests: Declaration of Competing Interest None, (Copyright © 2024 The Authors. Published by Elsevier B.V. All rights reserved.)

What is noise? When does a sound form part of the acoustic background and when might it come to our attention as part of the foreground? Our brain seems to filter out irrelevant sounds in a seemingly effortless process, but how this is achieved remains opaque and, to date, unparalleled by any algorithm. In this review, we discuss how noise can be both background and foreground, depending on what a listener/brain is trying to achieve. We do so by addressing questions concerning the brain's potential bias to interpret certain sounds as part of the background, the extent to which the interpretation of sounds depends on the context in which they are heard, as well as their ethological relevance, task-dependence, and a listener's overall mental state. We explore these questions with specific regard to the implicit, or statistical, learning of sounds and the role of feedback loops between cortical and subcortical auditory structures.

The historical control database of a multinational laboratory services provider was queried for all histopathologic findings in New Zealand White rabbits which were used as control animals during a ten-year period (2011-2020). The query included all evaluated tissues, with or without microscopic findings, in studies conducted for safety testing for regulatory approval by the U.S. Food and Drug Agency (FDA) or the U.S. Environmental Protection Agency. A second query included studies conducted in the United Kingdom for control rabbits used in studies compliant with the Healthcare Products Regulatory Agency (MHRA) and/or the European Medicines Agency (EMA), which provide regulatory oversight in the United Kingdom and European Union, respectively. Infiltrates of inflammatory (mixed or mononuclear) cells were commonly noted in various organs including heart, digestive tract, muscle, thyroid, kidney, urinary bladder, eyelid, ocular structures, harderian gland, lacrimal gland, and lung. Mineralization was noted in aorta, kidney, urinary bladder, and ovary. Also noted were degeneration/necrosis in the myocardium, and intramuscular injection sites of the skin, degeneration/regeneration of muscle and diaphragm, ectopic tissue in the pancreas and thyroid, basophilic foci in salivary gland, increased/decreased vacuolation in adrenal gland, increased/decreased lymphocytic cellularity of lymph nodes, intrasinusoidal erythrocytes in lymph nodes, thymic atrophy, increased adipocytes in bone marrow, inflammatory cell foci in the liver and gall bladder, lacrimal gland atrophy, renal tubule basophilia, degeneration/regeneration, and dilatation; oviduct cyst; in the testis, degeneration/atrophy, cellular debris, dilatation, decreased sperm and segmental hypoplasia of seminiferous tubules; and squamous metaplasia of the testis and seminal vesicle., Competing Interests: None of the authors received funding for participation in this project or has a conflict of interest in the generation or publication of this manuscript., (©2024 The Japanese Society of Toxicologic Pathology.)

Background: Libya has experienced decades of violent conflict that have severely disrupted health service delivery. The Government of National Unity is committed to rebuilding a resilient health system built on a platform of strong primary care., Aim: Commissioned by the government, we set out to perform a rapid assessment of the system as it stands and identify areas for improvement., Design and Setting: We used a rapid applied policy explanatory-sequential mixed-methods design, working with Libyan data and Libyan policymakers, with supporting interview data from other primary care policymakers working across the Middle East and North Africa region., Method: We used the Primary Health Care Performance Initiative framework to structure our assessment. Review of policy documents and secondary analysis of WHO and World Bank survey data informed a series of targeted policymaker interviews. We used deductive framework analysis to synthesise our findings., Results: We identified 11 key documents and six key policymakers to interview. Libya has strong policy commitments to providing good quality primary care, and a high number of health staff and facilities. Access to services and trust in providers is high. However, a third of facilities are non-operational; there is a marked skew towards axillary and administrative staff; and structural challenges with financing, logistics, and standards has led to highly variable provision of care., Conclusion: In reforming the primary care system, the government should consolidate leadership, clarify governance structures and systems, and focus on setting national standards for human resources for health, facilities, stocks, and clinical care., (© 2024. The Author(s).)

Background: Spinal surgery is a common procedure associated with significant postoperative pain, and identifying effective interventions to manage this pain is crucial for optimizing patient outcomes. This review assesses the existing literature to determine the overall impact of vitamin C supplementation on spinal postoperative pain. Vitamin C, also known as ascorbic acid, is an essential nutrient that plays a vital role in numerous physiological processes. It functions as a potent antioxidant, neutralizing free radicals and reducing oxidative stress within the body. Furthermore, vitamin C is a cofactor in collagen synthesis, a crucial component of connective tissues, including those found in the spinal structures. Given its antioxidant and collagen-promoting properties, vitamin C has piqued interest as a potential therapeutic option for postoperative spinal pain. Based on the available evidence, vitamin C may have a beneficial effect on postoperative spinal pain, including reducing pain scores, analgesic consumption, and the incidence of complications such as complex regional pain syndrome. However, more research is needed to fully understand the optimal dosage and duration of vitamin C supplementation for postoperative pain management., Conclusion: Vitamin C could be considered a potentially beneficial adjunctive therapy for managing spinal postoperative pain, but its routine use requires further investigation., (© 2024. The Author(s).)

Purpose: Polytrauma is increasingly recognized as a disease beyond anatomical injuries. Due to population growth, centralization, and slow uptake of preventive measures, major trauma presentations in most trauma systems show a slow but steady increase. The proportional contribution of polytrauma patients to this increase is unknown., Methods: A 13-year retrospective analysis ending 31/12/2021 of all major trauma admissions (ISS > 15) to a level-1 trauma center were included. Polytrauma was classified using the Newcastle definition. Linear regression analysis was used to compare the rates of patient presentation over time. Logistic regression was used to measure for change in proportion of polytrauma. Data are presented as median (IQR), with odds ratios and 95% confidence intervals as appropriate., Results: 5897 (age: 49 ± 43 years, sex: 71.3% male, ISS: 20 ± 9, mortality: 10.7%) major trauma presentations were included, 1,616 (27%) were polytrauma (age: 45 ± 37 years, 72.0% male, ISS: 29 ± 14, mortality: 12.7%). Major trauma presentations increased significantly over the study period (+ 8 patients per year (3-14), p < 0.01), aged significantly (0.42 years/year (0.25-0.59, p < 0.001). The number of polytrauma presentations per year did not change significantly (+ 1 patients/year (- 1 to 4, p > 0.2). Overall unadjusted mortality did not change (OR 0.99 (0.97-1.02). Polytrauma mortality fell significantly (OR 0.96 (0.92-0.99)) over the study period., Conclusions: Polytrauma patients represent about 25% of the major trauma admissions, with higher injury severity, static incidence and higher but improving mortality in comparison to all major trauma patients. Separate reporting and focused research on this group are warranted as monitoring the entire major trauma cohort does not identify these specifics of this high acuity subgroup., (© 2022. The Author(s).)

Studying DNA transfer and persistence has become increasingly important over the last decade, due to the impressive sensitivity of modern DNA detection methods in forensic genetics. To improve our understanding of background DNA that could also potentially be transferred, we analyzed the DNA composition on the outside of sleeve cuffs and sampled DNA directly from the hands of four different collaborators upon their arrival at work during 25 working days. Sampling of their hands was repeated after several hours working in our department. The shedder status of the participants, as assumed from previous internal studies, was well re-produced in the study. However, we noticed that the DNA shedding capacity could also change drastically during the day, with one participant showing a more than sixfold increase between hands sampled in the morning and hands sampled in the afternoon. As expected, poor DNA shedders carry more relative amounts of non-self-DNA on their hands than good shedders. Non-self-alleles were detected in 95% of the samples. We also observed potential effects of hand washing and the mode of transport to get to work on the DNA amount. People living with family members occasionally carried their DNA on their hands and more frequently on their sleeve cuffs. Sleeve cuffs, as being close to our hands, have a large potential to transfer DNA from one place to another, yet they have sparsely been studied as DNA transfer intermediates so far. In general, we collected consistently more DNA from the sleeve cuffs than from the hands of the participants, demonstrating their importance as potential transfer vectors. More DNA was recovered from sleeve cuffs made of synthetic fabric than from cuffs made of cotton or leather. In the afternoon, DNA from co-habitant family members could not be detected on the hands anymore and the detection of profiles from colleagues became more frequent. From two out of 100 analyzed sleeve cuffs and two out of 200 sampled hands, we established unknown major DNA profiles that would have been suitable for an entry in the national DNA database. This finding demonstrates the possibility to transfer DNA that has most likely been picked up somewhere in the public space., (© 2023. The Author(s).)

Background: Spain's lockdown measures couldn't prevent the severe impact of the COVID-19 first wave, leading to high infections, deaths, and strain on healthcare workers (HCWs). This study aimed to explore the mental health impact on HCWs in the Balearic Islands during the initial months of the pandemic, the influencing factors, and the experiences of those in a COVID-19 environment., Methods: Using a mixed-methods approach, the study encompassed quantitative and qualitative elements. Cross-sectional survey data from April to June 2020 comprised HCWs who were emailed invitations. The survey covered demographics, work, clinical and COVID-19 variables, along with psychological distress and PTSD symptoms, using validated measures. Additionally, semi-structured interviews with HCWs offered qualitative insights., Results: Three hundred thirty-six HCWs averaging 46.8 years, mainly women (79.2%), primarily nurses in primary care with over 10 years of experience. Anxiety symptoms were reported by 28.8%, 65.1% noted worsened sleep quality, and 27.7% increased psychoactive drug usage. Psychological distress affected 55.2%, while 27.9% exhibited PTSD symptoms. Gender, age, experience, COVID-19 patient contact, and workload correlated with distress, PTSD symptoms, sleep quality, and psychoactive drug usage. Interviews uncovered discomfort sources, such as fear of infection and lack of control, leading to coping strategies like information avoidance and seeking support., Limitations: Static cross-sectional design, non-probabilistic sample, and telephone interviews affecting non-verbal cues, with interviews conducted during early pandemic lockdown., Conclusions: HCWs faced significant psychological distress during the pandemic's first wave, underscoring the necessity for robust support and resources to counteract its impact on mental health., (© 2024. The Author(s).)

Studies on the occurrence and environmental distribution of per- and polyfluoroalkyl substances (PFAS) have clearly demonstrated their ubiquity in surface soil as a result of historic and ongoing emissions from various manufacturing and industrial activities worldwide. Given global efforts to characterize and mitigate risk from point source-impacted sites, there is, thus, an urgent need to quantify nonpoint source threshold concentrations (i.e., background) to support site management decisions particularly for perfluorooctane sulfonate (PFOS) as a top priority. Accordingly, this study evaluated the application of Gaussian mixture models (GMMs) fitted to log-transformed PFOS concentrations using nation-wide metadata consisting of thousands of surface soil samples representative of both background and aqueous film-forming foam (AFFF) impacts with unknown proportion. Multiple GMMs were fitted for a given number of components using different methods to account for bias associated with a marginal non-detect fraction (n = 8%) including exclusion, substitution, and imputation. Careful evaluation of the rate of change among multiple goodness-of-fit measures universally justified fitting a 2-component GMM; thus, discriminating between background and AFFF-impacted samples among the metadata. Background threshold PFOS concentrations were defined as the intersection of the probability density functions and ranged between 1.9 and 13.8 µg/kg within a broader concentration range extending up to ~ 50,000 µg/kg reflecting AFFF impacts. By demonstrating an innovative statistical approach that intelligently incorporates different criteria for model selection, this research makes significant contributions to risk mitigation efforts at point source-impacted sites and lays the groundwork for future targeted regulatory actions., (© 2024. This is a U.S. Government work and not under copyright protection in the US; foreign copyright protection may apply.)

Protein S-acylation is a reversible post-translational modification (PTM). It is present on diverse proteins and has important roles in regulating protein function. Aminolysis with hydroxylamine is widely used in the global identification of the PTM. However, the identification is indirect. Distinct criteria have been used for identification, and the false discovery rate has not been addressed. Here, we report a site-specific method for S-acylation identification based on tagging of S-acylation sites with iodoTMT0. Efforts to improve the performance of the method and confidence of identification are discussed, highlighting the importance of reducing contaminant peptides and keeping the recovery rate consistent between aliquots with or without hydroxylamine treatment. With very stringent criteria, presumptive S-acylation sites of 269, 684, 695, and 780 were identified from HK2 cells, HK11 cells, mouse brain, and mouse liver samples, respectively. Among them, the newly identified protein S-acylation sites are equivalent to 34% of human and 24% of mouse S-acylation sites reported previously. In addition, false-positive rates for S-acylation identification and S-acylation abundances were estimated. Significant differences in S-acylation abundance were found from different samples (from 0.08% in HK2 cells to 0.76% in mouse brain), and the false-positive rates were significantly higher for samples with a low abundance of S-acylation.

Purpose: Botulinum toxin type A (BTA) is an adjuvant tool used in the preoperative optimization of complex hernias before abdominal wall reconstruction (AWR). This study aims to investigate changes in the abdominal cavity and hernia sac dimensions after BTA application., Method: A prospective study with 27 patients with a hernia defect of ≥ 10 cm and loss of domain (LOD) ≥ 20% underwent AWR. Computed tomography (CT) measurements and volumetry before and after the application of BTA were performed. Intraoperative and postoperative outcomes were evaluated., Results: Imaging post-BTA revealed hernia width reduction of 1.9 cm (p = 0.002), lateral abdominal wall muscle elongation of 3.1 cm (p < 0.001), hernia volume reduction (HV) from 2.9 ± 0.9L to 2.4 ± 0.8L (p < 0.001), increase in abdominal cavity volume (ACV) from 9.7 ± 2.5L to 10.3L ± 2.4L (p = 0.003), and a reduction in the HV/ACV ratio from 30.2 ± 5% to 23.4 ± 6% (p < 0.001). Fascial closure was achieved in 92.6% of cases and component separation was required in 78%. The average variation in pulmonary plateau pressure was 3.53 cmH 2 O, and there were no postoperative respiratory failure recorded. At the 90-day follow-up, the wound morbidity rate was 25%, unplanned readmissions were 11%, and hernia recurrence 7.4%., Conclusion: BTA produces measurable volumetric changes in abdominal wall and appears to facilitate fascial closure. Further studies are required to determine the role of BTA in the surgical armamentarium for complex hernia repair., (© 2023. The Author(s), under exclusive licence to Springer-Verlag France SAS, part of Springer Nature.)

Many parents enroll their children in extracurricular music activities. However, cultural differences may contribute to parents' different values that ultimately influence their behaviors and attitudes. This cross-cultural study aimed to compare the value parents have on their children's private music education by examining four cases in Guilin, Guangxi (China) and Tampa, Florida (United States). Two main research questions guided this study: (1) How do parents in Guilin and Tampa perceive and value their children's music learning? (2) Does the value parents hold for their children's extracurricular music activities differ across different cultural contexts? If so, how do parents' values and perceptions of their children's involvement in extracurricular music activities differ between the contexts of Guilin and Tampa? We purposefully selected participants from two regions based on these criteria: (a) the participants included a single-child family and a two-child family in each of the two regions; (b) children's age ranged from 5 to 12 years and lived with their biological parents (c) children were currently taking music lessons after school. We interviewed both children and parents during the data collection. The key findings reveal that parental values transcend two cultural contexts, specifically in (1) motivations for music learning, (2) expectations of music learning, (3) utilizing personal background, and (4) strategies for success. The findings suggest that several factors, such as children's autonomy, musical joy, pursuit of musical career, "beauty development" and achievements, may have contributed to parents' values. The implication for parents, psychologists, and policymakers is to understand the diverse needs and values within different cultural backgrounds, to promote the children's development, to design curricula, and to use effective teaching methods in music education. In conclusion, both Guilin's and Tampa's parents' values varied due to cultural differences, which further influenced their behaviors, attitudes and perceptions toward their children's musical experiences., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Cui and Xie.)

Background: The birth cohort effect has been suggested to influence the rate of breast cancer incidence and the trends of associated reproductive and lifestyle factors. We conducted a cohort study to determine whether a differential pattern of associations exists between certain factors and breast cancer risk based on birth cohorts., Methods: This was a cohort study using pooled data from 12 cohort studies. We analysed associations between reproductive (menarche age, menopause age, parity and age at first delivery) and lifestyle (smoking and alcohol consumption) factors and breast cancer risk. We obtained hazard ratios (HRs) with 95% confidence intervals (CIs) using the Cox proportional hazard regression analysis on the 1920s, 1930s, 1940s and 1950s birth cohorts., Results: Parity was found to lower the risk of breast cancer in the older but not in the younger birth cohort, whereas lifestyle factors showed associations with breast cancer risk only among the participants born in the 1950s. In the younger birth cohort group, the effect size was lower for parous women compared to the other cohort groups (HR [95% CI] 0.86 [0.66-1.13] compared to 0.60 [0.49-0.73], 0.46 [0.38-0.56] and 0.62 [0.51-0.77]). Meanwhile, a higher effect size was found for smoking (1.45 [1.14-1.84] compared to 1.25 [0.99-1.58], 1.06 [0.85-1.32] and 0.86 [0.69-1.08]) and alcohol consumption (1.22 [1.01-1.48] compared to 1.10 [0.90-1.33], 1.15 [0.96-1.38], and 1.07 [0.91-1.26])., Conclusion: We observed different associations of parity, smoking and alcohol consumption with breast cancer risk across various birth cohorts., (© 2024. The Author(s).)

Carbonaceous aerosols (CA) from anthropogenic emissions have been significantly reduced in urban China in recent years. However, the relative contributions of fossil and nonfossil sources to CA in rural and background regions of China remain unclear. In this study, the sources of different carbonaceous fractions in fine aerosols (PM 2.5 ) from five background sites of the China Meteorological Administration Atmosphere Watch Network during the winter of 2019 and 2020 were quantified using radiocarbon ( 14 C) and organic markers. The results showed that nonfossil sources contributed 44-69% to total carbon at these five background sites. Fossil fuel combustion was the predominant source of elemental carbon at all sites (73 ± 12%). Nonfossil sources dominated organic carbon (OC) in these background regions (61 ± 13%), with biomass burning or biogenic-derived secondary organic carbon (SOC) as the most important contributors. However, the relative fossil fuel source to OC in China (39 ± 13%) still exceeds those at other regional/background sites in Asia, Europe, and the USA. SOC dominated the fossil fuel-derived OC, highlighting the impact of regional transport from anthropogenic sources on background aerosol levels. It is therefore imperative to develop and implement aerosol reduction policies and technologies tailored to both the anthropogenic and biogenic emissions to mitigate the environmental and health risks of aerosol pollution across China.

We show that in gamma-ray spectrometric measurements the decision threshold depends on the observed value of the measurand. Since the decision threshold is intended to describe the sensitivity of the measurement, this dependence restricts its application to measurements where the indication is not expressive. To extend the direct applicability of the decision threshold to expressive indications in gamma-ray spectrometric measurements, where mainly the Region-of-Interest method is used to evaluate the isolated peaks, a recalculation of the decision thresholds to the peak widths corresponding to the inexpressive peaks is proposed. For the Least-Squares method, where the dependence of the decision threshold on the value of the measurand originates in the non-zero value of the correlation coefficient between the indication and the background, no recalculation is possible. Instead, we can only make a drastic simplification of the calculation, resulting in underestimated decision thresholds., 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 Elsevier Ltd. All rights reserved.)

Surface-enhanced Raman scattering (SERS) has garnered substantial attention due to its ability to achieve single-molecule sensitivity by utilizing metallic nanostructures to amplify the exceedingly weak Raman scattering process. However, the introduction of metal nanostructures can induce a background continuum which can reduce the ultimate sensitivity of SERS in ways that are not yet well understood. Here, we investigate the impact of laser irradiation on both Raman scattering and backgrounds from self-assembled monolayers within nanoparticle-on-mirror plasmonic nanocavities with variable geometry. We find that laser irradiation can reduce the height of the monolayer by inducing an irreversible change in molecular conformation. The resulting increased plasmon confinement in the nanocavities not only enhances the SERS signal, but also provides momentum conservation in the inelastic light scattering of electrons, contributing to the enhancement of the background continuum. The plasmon confinement can be modified by changing the size and the geometry of nanoparticles, resulting in a nanoparticle geometry-dependent background continuum in SERS. Our work provides new routes for further modifying the geometry of plasmonic nanostructures to improve SERS sensitivity.

Cognitive research points towards cultural differences in the way people perceive and express scenes. Whereas people from Western cultures focus more on focal objects, those from East Asia have been shown to focus on the surrounding context. This paper examines whether these cultural differences are expressed in complex multimodal media such as comics. We compared annotated panels across comics from six countries to examine how backgrounds convey contextual information of scenes in explicit or implicit ways. Compared to Western comics from the United States and Spain, East Asian comics from Japan and China expressed the context of scenes more implicitly. In addition, Nigerian comics moderately emulated American comics in background use, while Russian comics emulated Japanese manga, consistent with their visual styles. The six countries grouped together based on whether they employed more explicit strategies such as detailed, depicted backgrounds, or implicit strategies such as leaving the background empty. These cultural differences in background use can be attributed to both cognitive patterns of attention and comics' graphic styles. Altogether, this study provides support for cultural differences in attention manifesting in visual narratives, and elucidates how spatial relationships are depicted in visual narratives across cultures., Competing Interests: Competing interests: The authors report there are no competing interests to declare., (© 2023 the author(s), published by De Gruyter, Berlin/Boston.)

Background: The noradrenergic innervation of the spleen is implicated in the autonomic control of inflammation and has been the target of neurostimulation therapies for inflammatory diseases. However, there is no real-time marker of its successful activation, which hinders the development of anti-inflammatory neurostimulation therapies and mechanistic studies in anti-inflammatory neural circuits., Methods: In mice, we performed fast-scan cyclic voltammetry (FSCV) in the spleen during intravenous injections of norepinephrine (NE), and during stimulation of the vagus, splanchnic, or splenic nerves. We defined the stimulus-elicited charge generated at the oxidation potential for NE (~ 0.88 V) as the "NE voltammetry signal" and quantified the dependence of the signal on NE dose and intensity of neurostimulation. We correlated the NE voltammetry signal with the anti-inflammatory effect of splenic nerve stimulation (SpNS) in a model of lipopolysaccharide- (LPS) induced endotoxemia, quantified as suppression of TNF release., Results: The NE voltammetry signal is proportional to the estimated peak NE blood concentration, with 0.1 μg/mL detection threshold. In response to SpNS, the signal increases within seconds, returns to baseline minutes later, and is blocked by interventions that deplete NE or inhibit NE release. The signal is elicited by efferent, but not afferent, electrical or optogenetic vagus nerve stimulation, and by splanchnic nerve stimulation. The magnitude of the signal during SpNS is inversely correlated with subsequent TNF suppression in endotoxemia and explains 40% of the variance in TNF measurements., Conclusions: FSCV in the spleen provides a marker for real-time monitoring of anti-inflammatory activation of the splenic innervation during autonomic stimulation., (© 2023. BioMed Central Ltd., part of Springer Nature.)

In this study, soil top layers from the German Environmental Specimen Bank (ESB) covering a period from 2002 to 2018 and 11 sampling sites representing four ecosystem types were analysed for 24 PFAS (11 PFCA, 7 PFSA, and 6 precursors), including the total oxidizable precursor (TOP) assay. Median ΣPFAS levels before and after TOP assay ranged from 0.31 to 19.7 μg/kg dry weight (dw) and 0.32 to 20.4 μg/kg dw, respectively. The most frequently measured PFAS above LOQ were PFOS and PFOA, which were present at concentrations above 0.1 μg/kg dw in each sample. Both accounted, on average, for half to two-thirds of the total identified PFAS load at most sites. The investigated samples from the near-natural and forestry ecosystem types each had significantly higher PFAS levels than those from the urban-industrial ecosystem type, while samples from the agricultural ecosystem type did not differ distinctly from the others. Increases of median ΣPFAS levels after TOP assay ranged up to slightly >20 %, indicating that precursor compounds do not play a major role in the substance spectrum of German ESB soil samples from different ecosystem types. Total organic carbon (TOC) content in analysed samples ranged from about 1 % in sandy soil to >40 % in litter layer and showed a strong positive correlation with PFAS concentrations. It is therefore highly recommended that TOC content is reported along with PFAS levels in soils. PFAS trend analysis for nine sampling sites before and after TOP assay showed that concentration levels at most sites have remained more or less stable for the sampled period of almost two decades. The constant PFAS levels in soil samples indicate that PFOS and PFOA regulations have not yet had a positive effect on the exposure situation in this environmental compartment., 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 The Authors. Published by Elsevier B.V. All rights reserved.)

River nitrate (NO 3 - ) pollution is a global environmental issue. Recently, high NO 3 - levels in some pristine or minimally-disturbed rivers were reported, but their drivers remain unclear. This study integrated river isotopes (δ 18 O/δ 15 N-NO 3 - and δD/ 18 O-H 2 O), 15 N pairing experiments, and qPCR to reveal the processes driving the high NO 3 - levels in a nearly pristine forest river on the Qinghai-Tibet Plateau. The river isotopes suggested that, at the catchment scale, NO 3 - removal was prevalent in summer, but weak in winter. The pristine forest soils contributed more than 90 % of the riverine NO 3 - , indicating the high NO 3 - backgrounds. The release of soil NO 3 - to the river was "transport-limited" in both seasons, i.e., the NO 3 - production/stock in the soils exceeded the capacity of hydrological NO 3 - leaching. In summer, this regime and the NO 3 - -plentiful conditions in the soils associated with the strong NO 3 - nitrification led to the high riverine NO 3 - levels. While the in-soil nitrification was weak in winter, the leaching of legacy NO 3 - resulted in the consistently high NO 3 - levels. This study provides insights into the reasons for high NO 3 - levels in pristine or minimally-disturbed rivers worldwide and highlights the necessity to consider NO 3 - backgrounds when evaluating anthropogenic NO 3 - pollution in rivers., 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 Elsevier B.V. All rights reserved.)

Background: The COVID-19 pandemic provided a unique opportunity to learn about acute health organisations experiences implementing a pandemic response plan in real-time. This study was conducted to explore organisational leader's perspectives and experience activating a COVID-19 pandemic response plan in their health service and the impact of this on service provision, clinicians, and consumers., Methods: This study was conducted at a large metropolitan health service in Australia that provides acute, subacute, and residential aged care services. Semi-structured interviews were conducted with 12 key participants from the COVID-19 leadership team between November-January 2021/2022. A semi-structured interview guide was developed to explore how the health service developed a clinical governance structure, policy and procedures and experience when operationalising each element within the Hierarchy of Controls Framework. Thematic analysis was used to code data and identify themes. A cross-sectional survey of frontline healthcare workers on the impacts and perceptions of infection control practices during the COVID-19 pandemic, was also completed in 2021 with 559 responses., Results: Twelve organisational leaders completed the semi-structured interviews. Key themes that emerged were: (1) Building the plane while flying it, (2) A unified communications strategy, (3) Clinicians fear 'my job is going to kill me', (4) Personal Protective Equipment (PPE) supply and demand, and (5) Maintaining a workforce. When surveyed, front-line healthcare workers responded positively overall about the health services pandemic response, in terms of communication, access to PPE, education, training, and availability of resources to provide a safe environment., Conclusion: Health service organisations were required to respond rapidly to meet service needs, including implementing a pandemic plan, developing a command structure and strategies to communicate and address the workforce needs. This study provides important insights for consideration when health service leaders are responding to future pandemics. Future pandemic plans should include detailed guidance for acute and long-term care providers in relation to organisational responsibilities, supply chain logistics and workforce preparation., (© 2023. BioMed Central Ltd., part of Springer Nature.)

Background: The growth of data science and artificial intelligence offers novel healthcare applications and research possibilities. Patients should be able to make informed choices about using healthcare. Therefore, they must be provided with lay information about new technology. A team consisting of academic researchers, health professionals, and public contributors collaboratively co-designed and co-developed the new resource offering that information. In this paper, we evaluate this novel approach to co-production., Methods: We used participatory evaluation to understand the co-production process. This consisted of creative approaches and reflexivity over three stages. Firstly, everyone had an opportunity to participate in three online training sessions. The first one focused on the aims of evaluation, the second on photovoice (that included practical training on using photos as metaphors), and the third on being reflective (recognising one's biases and perspectives during analysis). During the second stage, using photovoice, everyone took photos that symbolised their experiences of being involved in the project. This included a session with a professional photographer. At the last stage, we met in person and, using data collected from photovoice, built the mandala as a representation of a joint experience of the project. This stage was supported by professional artists who summarised the mandala in the illustration., Results: The mandala is the artistic presentation of the findings from the evaluation. It is a shared journey between everyone involved. We divided it into six related layers. Starting from inside layers present the following experiences (1) public contributors had space to build confidence in a new topic, (2) relationships between individuals and within the project, (3) working remotely during the COVID-19 pandemic, (4) motivation that influenced people to become involved in this particular piece of work, (5) requirements that co-production needs to be inclusive and accessible to everyone, (6) expectations towards data science and artificial intelligence that researchers should follow to establish public support., Conclusions: The participatory evaluation suggests that co-production around data science and artificial intelligence can be a meaningful process that is co-owned by everyone involved., (© 2023. BioMed Central Ltd., part of Springer Nature.)

Objective . Background events are one of the most relevant contributions to image degradation in Compton camera imaging for hadron therapy treatment monitoring. A study of the background and its contribution to image degradation is important to define future strategies to reduce the background in the system. Approach . In this simulation study, the percentage of different kinds of events and their contribution to the reconstructed image in a two-layer Compton camera have been evaluated. To this end, GATE v8.2 simulations of a proton beam impinging on a PMMA phantom have been carried out, for different proton beam energies and at different beam intensities. Main results . For a simulated Compton camera made of Lanthanum (III) Bromide monolithic crystals, coincidences caused by neutrons arriving from the phantom are the most common type of background produced by secondary radiations in the Compton camera, causing between 13% and 33% of the detected coincidences, depending on the beam energy. Results also show that random coincidences are a significant cause of image degradation at high beam intensities, and their influence in the reconstructed images is studied for values of the time coincidence windows from 500 ps to 100 ns. Significance . Results indicate the timing capabilities required to retrieve the fall-off position with good precision. Still, the noise observed in the image when no randoms are considered make us consider further background rejection methods., (Creative Commons Attribution license.)

Objective: Electroencephalogram (EEG) and serum neuron specific enolase (NSE) are frequently used prognosticators after cardiac arrest (CA). This study explored the association between NSE and EEG, considering the role of EEG timing, its background continuity, reactivity, occurrence of epileptiform discharges, and pre-defined malignancy degree., Methods: Retrospective analysis including 445 consecutive adults from a prospective registry, surviving the first 24 hours after CA and undergoing multimodal evaluation. EEG were interpreted blinded to NSE results., Results: Higher NSE was associated with poor EEG prognosticators, such as increasing malignancy, repetitive epileptiform discharges and lack of background reactivity, independently of EEG timing (including sedation and temperature). When stratified for background continuity, NSE was higher with repetitive epileptiform discharges, except in the case of suppressed EEGs. This relationship showed some variation according to the recording time., Conclusions: Neuronal injury after CA, reflected by NSE, correlates with several EEG features: increasing EEG malignancy, lack of background reactivity, and presence of repetitive epileptiform discharges. The correlation between epileptiform discharges and NSE is influenced by underlying EEG background and timing., Significance: This study, describing the complex interplay between serum NSE and epileptiform features, suggests that epileptiform discharges reflect neuronal injury particularly in non-suppressed EEG., (Copyright © 2023 International Federation of Clinical Neurophysiology. Published by Elsevier B.V. All rights reserved.)

Background: Knowing what to eat and realizing the significance of healthful eating habits are among the important steps to promoting eating behavior. The current study aims to assess the nutrition knowledge (NK) among a convenient sample in four different countries, determine the association between different demographic factors and NK, and investigate the need for future interventions on nutrition in the four selected countries., Methods: A cross-sectional multi-national survey study among a convenient sample of 8,191 subjects from Egypt, Syria, Saudi Arabia, and Jordan who undertook surveys between January 2019 and January 2020. A pre-tested interview questionnaire was utilized for data collection from study participants. It included three sections: i) Sociodemographic characteristics:. ii). Section two included twenty-one questions related to NK.. iii). Section three included one question about NK sources., Results: About three-quarters showed inadequate nutrition knowledge (73.1%). Youth (15-24 yrs.) were more dependent on social media, with 87% using it as a primary source of NK, while adults (≥ 25 yrs.) demonstrated that 43% of them used social media. In contrast, TV was more prominent among them, with participants' characteristics such as living with parents, body mass index, and country of residence showing no association with NK. However, female sex, education, and reading nutrition articles are significantly correlated with adequate knowledge (p < 0.001). Significant predictors of satisfactory knowledge were age, sex, education, living with parents, and reading nutrition articles., Conclusion: The study revealed low levels of NK indicating an urgent need to implement educational programs to promote nutrition knowledge. As NK is a modifiable determinant of diet intake and can positively impact the need for developing strategies in counselling and raising awareness among the general population to improve their health status., (© 2023. The Author(s).)

Recent studies demonstrate a short 3-6-month atmospheric lifetime for mercury (Hg). This implies Hg emissions are predominantly deposited within the same hemisphere in which they are emitted, thus placing increasing importance on considering Hg sources, sinks and impacts from a hemispheric perspective. In the absence of comprehensive Hg data from the Southern Hemisphere (SH), estimates and inventories for the SH have been drawn from data collected in the NH, with the assumption that the NH data are broadly applicable. In this paper, we centre the uniqueness of the SH in the context of natural biogeochemical Hg cycling, with focus on the midlatitudes and tropics. Due to its uniqueness, Antarctica warrants an exclusive review of its contribution to the biogeochemical cycling of Hg and is therefore excluded from this review. We identify and describe five key natural differences between the hemispheres that affect the biogeochemical cycling of Hg: biome heterogeneity, vegetation type, ocean area, methylation hotspot zones and occurence of volcanic activities. We review the current state of knowledge of SH Hg cycling within the context of each difference, as well as the key gaps that impede our understanding of natural Hg cycling in the SH. The differences demonstrate the limitations in using NH data to infer Hg processes and emissions in the SH., (© 2023. The Author(s).)

The scintillator detectors such as LaCl 3 (Ce) play an important role in some fields of scientific research, environment, safeguards, medicine, security and industry due to its superior energy resolution and exceptional luminescence properties, etc. However, Cl element in a LaCl 3 crystal produces uncertainty of determining oil saturation in pulsed neutron logging because of the background spectrum caused by secondary gamma ray from the reaction of Cl nuclei with the neutron. In this paper, we employed Monte Carlo method to simulate secondary gamma ray generated LaCl 3 crystal induced by thermal neutron with different borehole and formation conditions and establish a reference spectrum of Cl element. The relations between elemental window or peak areas counts and borehole and formation conditions were also investigated. The background was obtained by combining the reaction rate derived from thermal neutron capture cross section for Cl element and neutron flux with the reference spectrum. The results indicate that the contribution of secondary gamma ray to measuring spectrum decreases with formation porosity, limestone content, borehole diameter, and water salinity increasing. Nevertheless, the relative peak areas of Cl at different energies remain constant, indicating that the logging conditions have less of an effect on the background spectrum shape. As evidenced by the measured spectra in the sandstone and limestone calibration wells processed, the peaks of Si and Ca elements are enhanced while the peaks of Cl element are weakened. After subtracting detector background, the computations of oil saturation based on calibration wells are 38% more accurate than the original method., 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 Elsevier Ltd. All rights reserved.)

This proceeding presents the decomposition of the background spectra of the four screening detectors GeMPI 1 - 4 at the Gran Sasso Underground Laboratory (LNGS) using Monte Carlo simulations in the Geant4-based framework MaGe. A detailed understanding of the composition of the background spectra was achieved, allowing for the proposal of two new shield designs for future GeMPI-like detectors and enabling a reduction of the integrated background count rate to 15 counts/d/kg in the interval [40, 2700] keV., 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 Elsevier Ltd. All rights reserved.)

Adjustment disorder is a disorder characterized by an extreme emotional reaction to a stressor. It is defined diagnostically with either the Diagnostic and Statistical Manual V or ICD-11 definitions. There is currently a diagnostic tool that is still being validated to assist with diagnosing adjustment disorder. The prevalence of this disorder ranges from 0.2% to 40%, depending on the stressful circumstances that the patient experiences. There are several treatments available for adjustment disorder, ranging from psychological interventions, natural therapies to pharmacotherapies., (Copyright © 2022 Elsevier Inc. All rights reserved.)

Smooth pursuit eye movements (SPEM) are essential to guide behaviour in complex visual environments. SPEM accuracy is known to be degraded by the presence of a structured visual background and at higher target velocities. The aim of this preregistered study was to investigate the neural mechanisms of these robust behavioural effects. N = 33 participants performed a SPEM task with two background conditions (present and absent) at two target velocities (0.4 and 0.6 Hz). Eye movement and BOLD data were collected simultaneously. Both the presence of a structured background and faster target velocity decreased pursuit gain and increased catch-up saccade rate. Faster targets additionally increased position error. Higher BOLD response with background was found in extensive clusters in visual, parietal, and frontal areas (including the medial frontal eye fields; FEF) partially overlapping with the known SPEM network. Faster targets were associated with higher BOLD response in visual cortex and left lateral FEF. Task-based functional connectivity analyses (psychophysiological interactions; PPI) largely replicated previous results in the basic SPEM network but did not yield additional information regarding the neural underpinnings of the background and velocity effects. The results show that the presentation of visual background stimuli during SPEM induces activity in a widespread visuo-parieto-frontal network including areas contributing to cognitive aspects of oculomotor control such as medial FEF, whereas the response to higher target velocity involves visual and motor areas such as lateral FEF. Therefore, we were able to propose for the first time different functions of the medial and lateral FEF during SPEM., (© 2022 The Authors. Human Brain Mapping published by Wiley Periodicals LLC.)

The microsurgical anastomosis is integral to the success of autologous-free tissue transfer. Successful performance of this procedure relies strongly on operator dexterity, which can be made more challenging when blood and edematous fluids obscure the field of view. Workflow is impeded by intermittent irrigation and suctioning, necessitating presence of an assistant, with risk of arterial thrombosis, from vessels being drawn into suction drains. To negate these current disadvantages and minimize the barrier of entry to microvascular operations, we designed, manufactured, and patented a novel three-dimensional printed microsurgical background device with microfluidic capabilities that allow continuous suction and irrigation as well as provide platforms that enable multiangle retraction to facilitate operator autonomy. This was validated in an ex vivo model, with the device found to be superior to the current standard. We believe that this will have major applicability to the improvement of microsurgeon., Competing Interests: Conflict of Interest All four authors are stakeholders in a patent (ref P68111GB) filed for the device described in this article., (The Korean Society of Plastic and Reconstructive Surgeons. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. ( https://creativecommons.org/licenses/by-nc-nd/4.0/ ).)

In order to reduce care partner strain and support aging in place for people living with Alzheimer's Disease and Alzheimer's Disease Related Dementias (AD/ADRD), adult day centers (ADCs) must manage behavioral and psychological symptoms of dementia (BPSD). The purpose of this paper is to identify person-centered care strategies used by center staff to manage BPSD. Six focus groups with center staff (n = 31) were conducted. Data were analyzed using directed content analysis guided by Kitwood's conceptual approach to cultivating personhood in dementia care. Themes were identified and organized within Kitwood's framework. The results demonstrate that staff incorporate evidence-based person-centered approaches to AD/ADRD care that align with Kitwood's principles of comfort, attachment, inclusion, and identity. Staff individualize their approach to people with AD/ADRD within a group setting. They monitor, engage, socially stimulate, and, when needed, de-stimulate them. Centers are flexible social environments with underrecognized expertise managing BPSD using person-centered approaches.

The current critical review examines the application of 11 frequently used sedimentary metal indices in their ability to accurately assess the magnitude of human-induced change (enrichment) in the highly vulnerable and intensely developed coastal environment. The plethora and rapidly increasing number of sedimentary metal indices should, if not derived for special purposes, produce a consistent assessment on the basis that they use the same suite of metals and concentrations. Inconsistent numerical results produced by different index formulations should, when combined with their associated classification scheme, produce a common assessment of environmental condition. However, such a consistent outcome is seldom observed. Significant differences in assessment results are partly due to the historical evolution of indices and to the extraordinary diversity of background and reference values and materials being applied to account for pre-anthropogenic metal levels and confounding due to variable sediment characteristics. Size-normalised sample and background metal data used in the mCd and MEQ indices do not require reference values to account for textural variability and provide a quasi-direct measurement of enrichment with minimal computation (simple division). These priority indices should be combined into a single index (Enrichment Quotient, EQ). Results produced by the EF index were strongly correlated to mCd and MEQ and provide a similar classification and is recommended if normalised data are unavailable. Other indices assessed (MPI, PI, mPI, SEF, Igeo, PLI and Cf, original and current) provided a range of results, which either over- or under-estimated enrichment. The confusion concerning the choice and application of background and reference values in the assessment process is reviewed and their use in local and global assessment is clarified. Single- and combined-metal evaluations are recommended to provide detailed, local and more comprehensive assessments, respectively., Competing Interests: Declaration of competing interest The findings of this paper are appropriate for the ‘Science of the Total Environment’. The paper is an original work that has not been published previously and is not currently being considered for publication elsewhere. The work is not funded and the authors have no conflicting interests. This article does not contain any studies with human participants, or animals by any of the authors., (Copyright © 2022 Elsevier B.V. All rights reserved.)

Aim: The current EEG role for prognostication after cardiac arrest (CA) essentially aims at reliably identifying patients with poor prognosis ("highly malignant" patterns, defined by Westhall et al. in 2014). Conversely, "benign EEGs", defined by the absence of elements of "highly malignant" and "malignant" categories, has limited sensitivity in detecting good prognosis. We postulate that a less stringent "benign EEG" definition would improve sensitivity to detect patients with favorable outcomes., Methods: Retrospectively assessing our registry of unconscious adults after CA (1.2018-8.2021), we scored EEGs within 72 h after CA using a modified "benign EEG" classification (allowing discontinuity, low-voltage, or reversed anterio-posterior amplitude development), versus Westhall's "benign EEG" classification (not allowing the former items). We compared predictive performances towards good outcome (Cerebral Performance Category 1-2 at 3 months), using 2x2 tables (and binomial 95% confidence intervals) and proportions comparisons., Results: Among 381 patients (mean age 61.9 ± 15.4 years, 104 (27.2%) females, 240 (62.9%) having cardiac origin), the modified "benign EEG" definition identified a higher number of patients with potential good outcome (252, 66%, vs 163, 43%). Sensitivity of the modified EEG definition was 0.97 (95% CI: 0.92-0.97) vs 0.71 (95% CI: 0.62-0.78) (p < 0.001). Positive predictive values (PPV) were 0.53 (95% CI: 0.46-0.59) versus 0.59 (95% CI: 0.51-0.67; p = 0.17). Similar statistics were observed at definite recording times, and for survivors., Discussion: The modified "benign EEG" classification demonstrated a markedly higher sensitivity towards favorable outcome, with minor impact on PPV. Adaptation of "benign EEG" criteria may improve efficient identification of patients who may reach a good outcome., (Copyright © 2022 The Author(s). Published by Elsevier B.V. All rights reserved.)

The COVID-19 pandemic has changed all areas of human activity as it forced the authorities around the world to enact unprecedented restrictions such as "lockdowns". The low economic activity reduced the anthropogenic impact on the environment, in particular, greenhouse gases and aerosols emissions were decreased. However, the associated change in air quality is difficult to directly observe and quantify, since concentrations of these components in urban areas are affected by many other factors. In this work statistical analysis of atmospheric CO 2 , CH 4 and PM 2.5 , measured in 2017-2020 in the city of Ekaterinburg, Russia, are presented. A detailed focus was made on the lockdown period from March 28 to April 30, 2020. A significant decrease in concentrations and inter-hourly variations of all studied components were observed only in the short "self-isolation" period from April 6 to April 8. The anthropogenic origin of this effect, primarily associated with the reduction in vehicular traffic, was concluded from mean diurnal cycles and air temperature correlations of all components. A decrease in the difference between measured and background CO 2 and CH 4 mole fractions was also found during this period. The difference was 1.3±0.2 ppm for CO 2 and 8±4 ppb for CH 4 , which was many times lower than during any other observed periods, suggesting a short-term effect of lockdown restrictions. Overall, a negative impact on the atmosphere quickly resumed after the recovery of economic activity. The approaches in this study can be used to detect weak fluctuations of atmospheric components in other urban territories., Competing Interests: Conflict of interestThe 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., (© The Author(s) under exclusive licence to Iranian Society of Environmentalists (IRSEN) and Science and Research Branch, Islamic Azad University 2022.)

The characterisation of microplastics is still difficult, and the challenge is even greater for nanoplastics. A possible source of these particles is the scratched surface of a non-stick cooking pot that is mainly coated with Teflon. Herein we employ Raman imaging to scan the surfaces of different non-stick pots and collect spectra as spectrum matrices, akin to a hyperspectral imaging process. We adjust and optimise different algorithms and create a new hybrid algorithm to extract the extremely weak signal of Teflon microplastics and particularly nanoplastics. We use multiple characteristic peaks of Teflon to create several images, and merge them to one, using a logic-based algorithm (i), in order to cross-check them and to increase the signal-noise ratio. To differentiate the varied peak heights towards image merging, an algebra-based algorithm (ii) is developed to process different images with weighting factors. To map the images via the whole set of the spectrum (not just from the individual characteristic peaks), a principal component analysis (PCA)-based algorithm (iii) is employed to orthogonally decode the spectrum matrix to the PCA spectrum and PCA intensity image. To effectively extract the Teflon spectrum information, a new hybrid algorithm is developed to justify the PCA spectra and merge the PCA intensity images with the algebra-based algorithm (PCA/algebra-based algorithm) (iv). Based on these developments and with the help of SEM, we estimate that thousands to millions of Teflon microplastics and nanoplastics might be released during a mimic cooking process. Overall, it is recommended that Raman imaging, along with the signal recognition algorithms, be combined with SEM to characterise and quantify microplastics and nanoplastics., 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 © 2022 Elsevier B.V. All rights reserved.)

The automatic detection of individual pigs can improve the overall management of pig farms. The accuracy of single-image object detection has significantly improved over the years with advancements in deep learning techniques. However, differences in pig sizes and complex structures within pig pen of a commercial pig farm, such as feeding facilities, present challenges to the detection accuracy for pig monitoring. To implement such detection in practice, the differences should be analyzed by video recorded from a static camera. To accurately detect individual pigs that may be different in size or occluded by complex structures, we present a deep-learning-based object detection method utilizing generated background and facility information from image sequences (i.e., video) recorded from a static camera, which contain relevant information. As all images are preprocessed to reduce differences in pig sizes. We then used the extracted background and facility information to create different combinations of gray images. Finally, these images are combined into different combinations of three-channel composite images, which are used as training datasets to improve detection accuracy. Using the proposed method as a component of image processing improved overall accuracy from 84% to 94%. From the study, an accurate facility and background image was able to be generated after updating for a long time that helped detection accuracy. For the further studies, improving detection accuracy on overlapping pigs can also be considered.

Nitrate (NO 3 - pollution in rivers, the role of background NO 3 - pollution in rivers, the role of background NO 3 - in determining NO 3 - loads remains to be studied. In this study, we used dual-isotopes (δ 15 N/δ 18 O-NO 3 - ) and an isotope-mixing model to reveal the natural and anthropogenic processes regulating the NO 3 - loads in a forest river that acts as a headwater source for the China's South to North Water Transfer Project. Even though the basin is sparsely populated, the mean NO 3 loads in rivers could not all be ascribed to direct anthropogenic inputs, and background NO - -N concentration (0.6 ± 0.2 mg/L) was much higher than the median concentration of global rivers (0.3 ± 0.2 mg/L). Meanwhile, the δ 15 pollution of rivers, the background NO 3 - loads. In the low-flow season, the contribution from manure and sewage (c.a. 34%) increases. This study highlights the potentially important role of background NO 3 - concentrations and isotopes indicate that the nitrification of different sources (i.e., soil organic nitrogen, chemical fertilizer, manure, and sewage) dominates the NO 3 - loads. Soil organic nitrogen accounted for c.a. 60% of the riverine NO 3 - in the high-flow season, which alone exceeds China's national standard. This finding clearly shows that high NO 3 - loads in rivers could not all be ascribed to direct anthropogenic inputs, and background NO 3 - could be critical triggers. Therefore, when evaluating the NO 3 - pollution of rivers, the background NO 3 - concentrations must be considered along with the actual NO 3 - loads. In the low-flow season, the contribution from manure and sewage (c.a. 34%) increases. This study highlights the potentially important role of background NO 3 - in regulating riverine NO 3 - loads, providing important implications for understanding high riverine NO 3 - loads worldwide., Competing Interests: Declaration of competing interest We declare that we do not have any commercial or associative interest that represents a conflict of interest in connection with the work submitted., (Copyright © 2022 Elsevier B.V. All rights reserved.)

Long-term exposure to polycyclic aromatic hydrocarbons (PAHs) and their nitrated (NPAHs) and oxygenated (OPAHs) derivatives can cause adverse health effects due to their carcinogenicity, mutagenicity and oxidative potential. The distribution of PAH derivatives in the terrestrial environment has hardly been studied, although several PAH derivatives are ubiquitous in air and long-lived in soil and water. We report the multi-annual variations in the concentrations of NPAHs, OPAHs and PAHs in soils sampled at a semi-urban (Mokrá, Czech Republic) and a regional background site (Košetice, Czech Republic) in central Europe. The concentrations of the Σ 18 NPAHs and the Σ 11+2 OPAHs and O-heterocycles were 0.31 ± 0.23 ng g -1 and 4.03 ± 3.03 ng g -1 , respectively, in Košetice, while slightly higher concentrations of 0.54 ± 0.45 ng g -1 and 5.91 ± 0.45 ng g -1 , respectively, were found in soil from Mokrá. Among the 5 NPAHs found in the soils, 1-nitropyrene and less so 6-nitrobenzo(a)pyrene were most abundant. The OPAHs were more evenly distributed. The ratios of the PAH derivatives to their parent PAHs in Košetice indicate that they were long-range transported to the background site. Our results show that several NPAHs and OPAHs are abundant in soil and that gas-particle partitioning is a major factor influencing the concentration of several semi-volatile NPAHs and OPAHs in the soils. Complete understanding of the long-term variations of NPAH and OPAH concentrations in soil is limited by the lack of kinetic data describing their formation and degradation., (© 2021. The Author(s).)

Generic viewpoints produce images where the visible elements, and their spatial relationships, are largely preserved with small alterations in viewpoint. In contrast, specific viewpoints result from the observer being in a special position relative to the scene, causing spatial alignments between elements that are readily broken with a change in viewpoint. It has been proposed that generic viewpoints are aesthetically more pleasing, due to their lack of suspicious spatial coincidences. We investigated this idea for cartoon foreground and background objects, and found images where foreground and background objects were not suspiciously aligned were judged to be more appealing. A similar, albeit weaker, effect was seen when we digitally manipulated a Monet painting that contained a prominent spatial alignment between a foreground and a background object: the appeal of the painting increased with the magnitude of an introduced spatial offset. A further experiment on an independent observer group found a strong preference for generic viewpoints when tested on a range of cartoon images featuring foregrounds and backgrounds. Our results provide empirical support for the idea that suspicious spatial coincidences between foreground and background objects reduces the aesthetic appeal of images., (Copyright © 2022 Elsevier Ltd. All rights reserved.)