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Early UK surveillance data revealed that people living with HIV were overrepresented among cases of monkeypox (mpox). However, it remains unknown whether mpox infection is more severe in people living with well-controlled HIV. All laboratory-confirmed mpox cases presenting between May and December 2022 to one London hospital service were identified via pathology reporting systems. We extracted demographic and clinical data to allow comparison of clinical presentation and severity of mpox among people with and without HIV. We identified 150 people with mpox (median age 36 years, 99.3% male, 92.7% reporting sex with other men). HIV status was available for 144 individuals, 58 (40.3%) of whom were HIV positive (only 3/58 had CD4 cell counts <200 cells/mm 3 and 5/58 had HIV RNA >200 copies/mL). People with HIV had similar clinical presentations to those without HIV, including indicators of more widespread disease, such as extragenital lesions (74.1% vs. 64.0%, p  = .20) and nondermatological symptoms (87.9% vs. 82.6%, p  = .38). People with HIV also experienced a similar time from onset of symptoms to discharge from all inpatient or outpatient clinical follow-up ( p  = .63) and total time under follow-up ( p  = .88) compared with people without HIV. A similar proportion of people with HIV required review in the hospital emergency department (36.2% vs. 25.6%, p  = .17) or admission to hospital (19.0% vs. 9.3%, p  = .09). There were no recorded deaths. In this cohort of people with mpox, there was a high prevalence of HIV coinfection, the majority of which was well-controlled. We find no evidence that people with well-controlled HIV experienced more severe mpox infection.

Magnesium(II) plays catalytic, structural, regulatory, and signaling roles in living organisms. Abnormal levels of this metal have been associated with numerous pathologies, including cardiovascular disease, diabetes, metabolic syndrome, immunodeficiency, cancer, and, most recently, liver pathologies affecting humans. The role of Mg 2+ in the pathophysiology of liver disease, however, has been occluded by concomitant changes in concentration of interfering divalent cations, such as Ca 2+ , which complicates the interpretation of experiments conducted with existing molecular Mg 2+ indicators. Herein, we introduce a new quinoline-based fluorescent sensor, MagZet1, that displays a shift in its excitation and emission wavelengths, affording ratiometric detection of cellular Mg 2+ by both fluorescence microscopy and flow cytometry. The new sensor binds the target metal with a submillimolar dissociation constant─well suited for detection of changes in free Mg 2+ in cells─and displays a 10-fold selectivity against Ca 2+ . Furthermore, the fluorescence ratio is insensitive to changes in pH in the physiological range, providing an overall superior performance over existing indicators. We provide insights into the metal selectivity profile of the new sensor based on computational modeling, and we apply it to shed light on a decrease in cytosolic free Mg 2+ and altered expression of metal transporters in cellular models of drug-induced liver injury caused by acetaminophen overdose.

Background: Identifying female individuals at highest risk of developing life-threatening breast cancers could inform novel stratified early detection and prevention strategies to reduce breast cancer mortality, rather than only considering cancer incidence. We aimed to develop a prognostic model that accurately predicts the 10-year risk of breast cancer mortality in female individuals without breast cancer at baseline., Methods: In this model development and validation study, we used an open cohort study from the QResearch primary care database, which was linked to secondary care and national cancer and mortality registers in England, UK. The data extracted were from female individuals aged 20-90 years without previous breast cancer or ductal carcinoma in situ who entered the cohort between Jan 1, 2000, and Dec 31, 2020. The primary outcome was breast cancer-related death, which was assessed in the full dataset. Cox proportional hazards, competing risks regression, XGBoost, and neural network modelling approaches were used to predict the risk of breast cancer death within 10 years using routinely collected health-care data. Death due to causes other than breast cancer was the competing risk. Internal-external validation was used to evaluate prognostic model performance (using Harrell's C, calibration slope, and calibration in the large), performance heterogeneity, and transportability. Internal-external validation involved dataset partitioning by time period and geographical region. Decision curve analysis was used to assess clinical utility., Findings: We identified data for 11 626 969 female individuals, with 70 095 574 person-years of follow-up. There were 142 712 (1·2%) diagnoses of breast cancer, 24 043 (0·2%) breast cancer-related deaths, and 696 106 (6·0%) deaths from other causes. Meta-analysis pooled estimates of Harrell's C were highest for the competing risks model (0·932, 95% CI 0·917-0·946). The competing risks model was well calibrated overall (slope 1·011, 95% CI 0·978-1·044), and across different ethnic groups. Decision curve analysis suggested favourable clinical utility across all age groups. The XGBoost and neural network models had variable performance across age and ethnic groups., Interpretation: A model that predicts the combined risk of developing and then dying from breast cancer at the population level could inform stratified screening or chemoprevention strategies. Further evaluation of the competing risks model should comprise effect and health economic assessment of model-informed strategies., Funding: Cancer Research UK., Competing Interests: Declaration of interests SL reports institutional funding for clinical trials for which they are the Chief Investigator or Principal Investigator from Cancer Research UK, Boehringer Ingelheim, Piqur Therapeutics, AstraZeneca, Carrick Therapeutics, Sanofi, Merck, Synthon, Roche, and UK National Institute for Health and Care Research (NIHR); consulting fees from Sanofi, GLG Consulting, Rejuversen, Oxford Biodynamics; payment or honoraria for lectures or presentations from Esai, Prosigna, Roche, Pfizer, Novartis and Sanofi; personal support for attending meetings or for travel from Pfizer, Roche, Synthon and Piqur therapeutics; is a co-founder of MitoRx therapeutics; research funding from Cancer Research UK, Against Breast Cancer, Pathios Therapeutics, and NIHR; and participation on a data safety monitoring board or advisory board for Shionogi. JH-C is an unpaid director of QResearch and is a founder and shareholder of ClinRisk and was its medical director until May 31, 2019; and reports other grant support from the Wellcome Trust and the John Fell Fund. All other authors declare no competing interests., (Copyright © 2023 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license. Published by Elsevier Ltd.. All rights reserved.)

This letter explores the societal aspects and healthcare implications that underlie thinking about mpox (formerly known was monkeypox), in the 2022 outbreak, as a sexually transmitted infection (STI). The authors examine what underlies this question, exploring what is an STI, what is sex, and what is the role of stigma in sexual health promotion. The authors argue that, in this specific outbreak, mpox is an STI among men who have sex with men (MSM). The authors highlight the need of critically thinking about how to communicate effectively, the role of homophobia and other inequalities, and the importance of the social sciences., Competing Interests: No competing interests were disclosed., (Copyright: © 2023 Garcia Iglesias J et al.)

Next-generation batteries based on sustainable multivalent working ions, such as Mg 2+ , Ca 2+ , or Zn 2+ , have the potential to improve the performance, safety, and capacity of current battery systems. Development of such multivalent ion batteries is hindered by a lack of understanding of multivalent ionics in solids, which is crucial for many aspects of battery operation. For instance, multivalent ionic transport was assumed to be correlated with electronic transport; however, we have previously shown that Zn 2+ can conduct in electronically insulating ZnPS 3 with a low activation energy of 350 meV, albeit with low ionic conductivity. Here, we show that exposure of ZnPS 3 to environments with water vapor at different relative humidities results in room-temperature conductivity increases of several orders of magnitude, reaching as high as 1.44 mS cm -1 without decomposition or structural changes. We utilize impedance spectroscopy with ion selective electrodes, ionic transference number measurements, and deposition and stripping of Zn metal, to confirm that both Zn 2+ and H + act as mobile ions. The contribution from Zn 2+ to the ionic conductivity in water vapor exposed ZnPS 3 is high, representing superionic Zn 2+ conduction. The present study demonstrates that it is possible to enhance multivalent ion conduction of electronically insulating solids as a result of water adsorption and highlights the importance of ensuring that increased conductivity in water vapor exposed multivalent ion systems is in fact due to mobile multivalent ions and not solely H + .

Communication theory suggests that interactive dialog rather than information transmission is necessary for climate change action, especially for complex systems like agriculture. Climate analogs-locations whose current climate is similar to a target location's future climate-have garnered recent interest as transmitting more relatable information; however, they have unexplored potential in facilitating meaningful dialogs, and whether the way the analogs are developed could make a difference. We developed climate context-specific analogs based on agriculturally-relevant climate metrics for US specialty crop production, and explored their potential for facilitating dialogs on climate adaptation options. Over 80% of US specialty crop counties had acceptable US analogs for the mid-twenty-first century, especially in the West and Northeast which had greater similarities in the crops produced across target-analog pairs. Western counties generally had analogs to the south, and those in other regions had them to the west. A pilot dialog of target-analog pairs showed promise in eliciting actionable adaptation insights, indicating potential value in incorporating analog-driven dialogs more broadly in climate change communication., (© 2023. The Author(s).)

Objective: To develop a clinically useful model that estimates the 10 year risk of breast cancer related mortality in women (self-reported female sex) with breast cancer of any stage, comparing results from regression and machine learning approaches., Design: Population based cohort study., Setting: QResearch primary care database in England, with individual level linkage to the national cancer registry, Hospital Episodes Statistics, and national mortality registers., Participants: 141 765 women aged 20 years and older with a diagnosis of invasive breast cancer between 1 January 2000 and 31 December 2020., Main Outcome Measures: Four model building strategies comprising two regression (Cox proportional hazards and competing risks regression) and two machine learning (XGBoost and an artificial neural network) approaches. Internal-external cross validation was used for model evaluation. Random effects meta-analysis that pooled estimates of discrimination and calibration metrics, calibration plots, and decision curve analysis were used to assess model performance, transportability, and clinical utility., Results: During a median 4.16 years (interquartile range 1.76-8.26) of follow-up, 21 688 breast cancer related deaths and 11 454 deaths from other causes occurred. Restricting to 10 years maximum follow-up from breast cancer diagnosis, 20 367 breast cancer related deaths occurred during a total of 688 564.81 person years. The crude breast cancer mortality rate was 295.79 per 10 000 person years (95% confidence interval 291.75 to 299.88). Predictors varied for each regression model, but both Cox and competing risks models included age at diagnosis, body mass index, smoking status, route to diagnosis, hormone receptor status, cancer stage, and grade of breast cancer. The Cox model's random effects meta-analysis pooled estimate for Harrell's C index was the highest of any model at 0.858 (95% confidence interval 0.853 to 0.864, and 95% prediction interval 0.843 to 0.873). It appeared acceptably calibrated on calibration plots. The competing risks regression model had good discrimination: pooled Harrell's C index 0.849 (0.839 to 0.859, and 0.821 to 0.876, and evidence of systematic miscalibration on summary metrics was lacking. The machine learning models had acceptable discrimination overall (Harrell's C index: XGBoost 0.821 (0.813 to 0.828, and 0.805 to 0.837); neural network 0.847 (0.835 to 0.858, and 0.816 to 0.878)), but had more complex patterns of miscalibration and more variable regional and stage specific performance. Decision curve analysis suggested that the Cox and competing risks regression models tested may have higher clinical utility than the two machine learning approaches., Conclusion: In women with breast cancer of any stage, using the predictors available in this dataset, regression based methods had better and more consistent performance compared with machine learning approaches and may be worthy of further evaluation for potential clinical use, such as for stratified follow-up., Competing Interests: Competing interests: All authors have completed the ICMJE uniform disclosure form at www.icmje.org/disclosure-of-interest/ and declare: JHC is an unpaid director of QResearch (a not-for-profit organisation that is a partnership between the University of Oxford and EMIS Health that supply the QResearch database) and is a founder and shareholder of ClinRisk and was its medical director until 31 May 2019 (ClinRisk produces open and closed source software to implement clinical risk algorithms including two breast cancer risk models implemented in the National Health Service into clinical computer systems., (© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY. No commercial re-use. See rights and permissions. Published by BMJ.)

Magnitude-based PDFF (Proton Density Fat Fraction) and R 2 ∗ mapping with resolved water-fat ambiguity is extended to calculate field inhomogeneity (field map) using the phase images. The estimation is formulated in matrix form, resolving the field map in a least-squares sense. PDFF and R 2 ∗ from magnitude fitting may be updated using the estimated field maps. The limits of quantification of our voxel-independent implementation were assessed. Bland-Altman was used to compare PDFF and field maps from our method against a reference complex-based method on 152 UK Biobank subjects (1.5 T Siemens). A separate acquisition (3 T Siemens) presenting field inhomogeneities was also used. The proposed field mapping was accurate beyond double the complex-based limit range. High agreement was obtained between the proposed method and the reference in UK. Robust field mapping was observed at 3 T, for inhomogeneities over 400 Hz including rapid variation across edges. Field mapping following unambiguous magnitude-based water-fat separation was demonstrated in-vivo and showed potential at 3 T., Competing Interests: Declaration of Competing Interest ATB, DM, CH, AB, MLG, PA, MDR, MB are employees of Perspectum and hold shares and/or share options. DPB declares no potential conflict of interest., (Copyright © 2023 The Authors. Published by Elsevier Inc. All rights reserved.)

Purpose: R2*, a measurement obtained using magnetic resonance imaging (MRI) can be used to estimate liver iron concentration (LIC). 3 T and 1.5 T scanners can be used but conversion of 3 T R2* to LIC is less well validated. In this study the aim was to compare 3 T-R2* LIC and 1.5 T-R2* LIC estimations to assess if they can be used interchangeably., Methods: Thirty participants were scanned at both 1.5 T and 3 T. R2* was measured at both field strengths. 3 T R2* and 1.5 R2* were compared using linear regression and were converted to LIC using different calibration curves. Pearson's rho and Intraclass Correlation Coefficients (ICCs) were used to assess correlation and agreement between 1.5 and 3 T LIC. Bland Altman plots were used to assess bias and limits of agreement., Results: All 1.5 T and 3 T LIC comparisons gave Pearson's rho of 0.99 (p < 0.001). ICC ranged from 0.83 (p = 0.005) to 0.96 (p < 0.001). Biases had magnitude of less than 0.2 mg/g dry weight., Conclusion: Agreement and bias between 3 and 1.5 T-R2* LIC depended on the method used for conversion. There were instances when the agreement was excellent and bias was small, indicating that potentially 3 T-R2* LIC can be used alongside or instead of 1.5 T-R2* LIC but care needs to be taken over the conversion methods selected., Trial Registration Number: Clinicaltrials.gov NCT03743272, 16 November 2018., (© 2022. The Author(s).)

Background: Long COVID is associated with multiple symptoms and impairment in multiple organs. Cross-sectional studies have reported cardiac impairment to varying degrees by varying methodologies. Using cardiac MR (CMR), we investigated a 12-month trajectory of abnormalities in Long COVID., Objectives: To investigate cardiac abnormalities 1-year post-SARS-CoV-2 infection., Methods: 534 individuals with Long COVID underwent CMR (T1/T2 mapping, cardiac mass, volumes, function and strain) and multiorgan MRI at 6 months (IQR 4.3-7.3) since first post-COVID-19 symptoms. 330 were rescanned at 12.6 (IQR 11.4-14.2) months if abnormal baseline findings were reported. Symptoms, questionnaires and blood samples were collected at both time points. CMR abnormalities were defined as ≥1 of low left or right ventricular ejection fraction (LVEF), high left or right ventricular end diastolic volume, low 3D left ventricular global longitudinal strain (GLS), or elevated native T1 in ≥3 cardiac segments. Significant change over time was reported by comparison with 92 healthy controls., Results: Technical success of multiorgan and CMR assessment in non-acute settings was 99.1% and 99.6% at baseline, and 98.3% and 98.8% at follow-up. Of individuals with Long COVID, 102/534 (19%) had CMR abnormalities at baseline; 71/102 had complete paired data at 12 months. Of those, 58% presented with ongoing CMR abnormalities at 12 months. High sensitivity cardiac troponin I and B-type natriuretic peptide were not predictive of CMR findings, symptoms or clinical outcomes. At baseline, low LVEF was associated with persistent CMR abnormality, abnormal GLS associated with low quality of life and abnormal T1 in at least three segments was associated with better clinical outcomes at 12 months., Conclusion: CMR abnormalities (left entricular or right ventricular dysfunction/dilatation and/or abnormal T1mapping), occurred in one in five individuals with Long COVID at 6 months, persisting in over half of those at 12 months. Cardiac-related blood biomarkers could not identify CMR abnormalities in Long COVID., Trial Registration Number: NCT04369807., Competing Interests: Competing interests: AD, AT, VC, ABo, SF, MP, ARF, HTB, MK, MR, MB and RB are employees of Perspectum., (© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY. Published by BMJ.)

Background: High levels of HIV testing in men who have sex with men remain key to reducing the incidence of HIV. We aimed to assess whether the offer of a single, free HIV self-testing kit led to increased HIV diagnoses with linkage to care., Methods: SELPHI was an internet-based, open-label, randomised controlled trial that recruited participants via sexual and social networking sites. Eligibility criteria included being a man or trans woman (although trans women are reported separately); being resident in England or Wales, UK; being aged 16 years or older; having had anal intercourse with a man; not having a positive HIV diagnosis; and being willing to provide name, email address, date of birth, and consent to link to national HIV databases. Participants were randomly allocated (3:2) by computer-generated number sequence to receive a free HIV self-test kit (BT group) or to not receive this free kit (nBT group). Online surveys collected data at baseline, 2 weeks after enrolment (BT group only), 3 months after enrolment, and at the end of the study. The primary outcome was confirmed (linked to care) new HIV diagnosis within 3 months of enrolment, analysed by intention to treat. Those assessing the primary outcome were masked to allocation. This study is registered with the ISRCTN Clinical Trials Register, number ISRCTN20312003., Findings: 10 111 participants (6049 in BT group and 4062 in nBT group) enrolled between Feb 16, 2017, and March 1, 2018. The median age of participants was 33 years (IQR 26-44 years); 9000 (89%) participants were White; 8118 (80%) participants were born in the UK; 81 (1%) participants were transgender men; 4706 (47%) participants were university educated; 1537 (15%) participants had never been tested for HIV; and 389 (4%) participants were taking pre-exposure prophylaxis. At enrolment, 7282 (72%) participants reported condomless anal sex with at least one male partner in the previous 3 months. In the BT group, of the 4511 participants for whom HIV testing information was available, 4263 (95%) reported having used the free HIV self-test kit within 3 months.Within 3 months of enrolment there were 19 confirmed new HIV diagnoses (0·31%) in 6049 participants in the BT group and 15 (0·37%) of 4062 in the nBT group (p=0·64)., Interpretation: The offer of a single, free HIV self-test did not lead to increased rates of new HIV diagnoses, which could reflect decreasing HIV incidence rates in the UK. Nonetheless, the offer of a free HIV self-testing kit resulted in high HIV testing rates, indicating that self-testing is an attractive testing option for a large group of men who have sex with men., Funding: UK National Institute for Health and Care Research., Competing Interests: Declaration of interests MB has received speaker's fees from Gilead and Bristol Myers Squibb. FB and TCW have received consultancy fees from Gilead. All other authors declare no competing interests., (Copyright © 2022 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY-NC-ND 4.0 license. Published by Elsevier Ltd.. All rights reserved.)

Background: Quantitative imaging studies of the pancreas have often targeted the three main anatomical segments, head, body, and tail, using manual region of interest strategies to assess geographic heterogeneity. Existing automated analyses have implemented whole-organ segmentation, providing overall quantification but failing to address spatial heterogeneity., Purpose: To develop and validate an automated method for pancreas segmentation into head, body, and tail subregions in abdominal MRI., Study Type: Retrospective., Subjects: One hundred and fifty nominally healthy subjects from UK Biobank (100 subjects for method development and 50 subjects for validation). A separate 390 UK Biobank triples of subjects including type 2 diabetes mellitus (T2DM) subjects and matched nondiabetics., Field Strength/sequence: A 1.5 T, three-dimensional two-point Dixon sequence (for segmentation and volume assessment) and a two-dimensional axial multiecho gradient-recalled echo sequence., Assessment: Pancreas segments were annotated by four raters on the validation cohort. Intrarater agreement and interrater agreement were reported using Dice overlap (Dice similarity coefficient [DSC]). A segmentation method based on template registration was developed and evaluated against annotations. Results on regional pancreatic fat assessment are also presented, by intersecting the three-dimensional parts segmentation with one available proton density fat fraction (PDFF) image., Statistical Test: Wilcoxon signed rank test and Mann-Whitney U-test for comparisons. DSC and volume differences for evaluation. A P value &lt; 0.05 was considered statistically significant., Results: Good intrarater (DSC mean, head: 0.982, body: 0.940, tail: 0.961) agreement and interrater (DSC mean, head: 0.968, body: 0.905, tail: 0.943) agreement were observed. No differences (DSC, head: P = 0.4358, body: P = 0.0992, tail: P = 0.1080) were observed between the manual annotations and our method's segmentations (DSC mean, head: 0.965, body: 0.893, tail: 0.934). Pancreatic body PDFF was different between T2DM and nondiabetics matched by body mass index., Data Conclusion: The developed segmentation's performance was no different from manual annotations. Application on type 2 diabetes subjects showed potential for assessing pancreatic disease heterogeneity., Level of Evidence: 4 TECHNICAL EFFICACY STAGE: 3., (© 2022 The Authors. Journal of Magnetic Resonance Imaging published by Wiley Periodicals LLC on behalf of International Society for Magnetic Resonance in Medicine.)

Objective: Type 2 diabetes (T2D) is associated with significant end-organ damage and ectopic fat accumulation. Multiparametric magnetic resonance imaging (MRI) can provide a rapid, noninvasive assessment of multiorgan and body composition. The primary objective of this study was to investigate differences in visceral adiposity, ectopic fat accumulation, body composition, and relevant biomarkers between people with and without T2D., Methods: Participant demographics, routine biochemistry, and multiparametric MRI scans of the liver, pancreas, visceral and subcutaneous adipose tissue, and skeletal muscle were analyzed from 266 participants (131 with T2D and 135 without T2D) who were matched for age, gender, and BMI. Wilcoxon and χ 2 tests were performed to calculate differences between groups., Results: Participants with T2D had significantly elevated liver fat (7.4% vs. 5.3%, p = 0.011) and fibroinflammation (as assessed by corrected T1 [cT1]; 730 milliseconds vs. 709 milliseconds, p = 0.019), despite there being no differences in liver biochemistry, serum aspartate aminotransferase (p = 0.35), or alanine transaminase concentration (p = 0.11). Significantly lower measures of skeletal muscle index (45.2 cm 2 /m 2 vs. 50.6 cm 2 /m 2 , p = 0.003) and high-density lipoprotein cholesterol (1.1 mmol/L vs. 1.3 mmol/L, p < 0.0001) were observed in participants with T2D., Conclusions: Multiparametric MRI revealed significantly elevated liver fat and fibroinflammation in participants with T2D, despite normal liver biochemistry. This study corroborates findings of significantly lower measures of skeletal muscle and high-density lipoprotein cholesterol in participants with T2D versus those without T2D., (© 2022 The Authors. Obesity published by Wiley Periodicals LLC on behalf of The Obesity Society (TOS).)

Decision-making is the central element of self-determination, requiring targeted, systematic instruction to learn. In this study, researchers developed a multicomponent intervention, "What ELSE about this job?", to teach job decision-making skills to college students with intellectual and developmental disabilities. The intervention coupled remote audio coaching (RAC) with a mnemonic device, 'ELSE', to guide students to make decisions about whether certain jobs would be a good fit for them. The study aimed to investigate the effectiveness of the intervention and determine whether the skills would maintain once the intervention was removed. All students who received the intervention substantially increased their ability to make job decisions. Additionally, all participants maintained the skills upon removal of the intervention, and showed signs of generalizing their skills to novel job coaches and web-based job search apps. Implications and future research are discussed., Competing Interests: Conflict of InterestThe authors have no conflicts of interest to declare that are relevant to the content of this article., (© The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature 2021.)

Farmers' investment in more efficient irrigation systems represents a primary adaptation strategy when confronting climate change. However, the regional benefits of these investments and their influence on the conflicting demands among different water dependent stakeholders for intensely irrigated regions remains an open question. Using the Pacific Northwest of the United States as an illustrative region of focus, we show that higher irrigation efficiency has diverse effects across stakeholders that are contingent on many local climatic, institutional and infrastructural factors such as the availability of water storage, the location of hydropower generators, and water rights. These complexities limit simple abstractions of irrigation efficiency as broader policy challenge and are central to its inclusion within the class of "wicked problems". Additionally, we argue that the widely used rebound effect concept, which implicitly discourages irrigation efficiency supporting policies, should not be assumed to fully capture the nuances of the complex suite of regional impacts that emerge from irrigation efficiency investments. Consequently, the evaluation of irrigation efficiency investments requires a broader framing across a diversity of perspectives. policies and actions that are pluralistic, context-specific, and closely engage various groups of stakeholders in the policymaking process., (Copyright © 2021. Published by Elsevier Ltd.)

Artificial intelligence (AI) algorithms are used in an increasing range of aspects of our lives. In particular, medical applications of AI are being developed and deployed, including many in image analysis. Deep learning methods, which have recently proved successful in image classification, rely on large volumes of clinical data generated by healthcare institutions. Such data is collected from their served populations. In this opinion article, using digital mammographic screening as an example, we briefly consider the background to AI development and some issues around its deployment. We highlight the importance of high quality clinical data as fundamental to these technologies, and question how the ownership of resultant tools should be defined. Though many of the ethical issues concerning the development and use of medical AI technologies continue to be discussed, the value of the data on which they rely remains a subject that is seldom considered. This potentially controversial issue can and should be addressed in a way which is beneficial to all parties, particularly the population in general and the patients we serve., (© 2021. The Author(s), under exclusive licence to Springer Nature Limited.)

Prospective cardiac gating during MRI is hampered by electromagnetic induction from the rapidly switched imaging gradients into the ECG detection circuit. This is particularly challenging in small animal MRI, as higher heart rates combined with a smaller myocardial mass render routine ECG detection challenging. We have developed an open-hardware system that enables continuously running MRI scans to be performed in conjunction with cardio-respiratory gating such that the relaxation-weighted steady state magnetisation is maintained throughout the scan. This requires that the R-wave must be detected reliably even in the presence of rapidly switching gradients, and that data previously acquired that were corrupted by respiratory motion re-acquired. The accurately maintained steady-state magnetisation leads to an improvement in image quality and removes alterations in intensity that may otherwise occur throughout the cardiac cycle and impact upon automated image analysis. We describe the hardware required to enable this and demonstrate its application and robust performance using prospectively cardio-respiratory gated CINE imaging that is operated at a single, constant TR. Schematics, technical drawings, component listing and assembly instructions are made publicly available., (Copyright © 2021 The Authors. Published by Elsevier Inc. All rights reserved.)

We introduce Region of Interest Contrast Enhancement (RICE) to identify focal densities in mammograms. It aims to help radiologists: 1) enhancing the contrast of mammographic images; and 2) detecting regions of interest (such as focal densities) that are candidate masses potentially masked behind dense parenchyma. Cancer masking is an unsolved issue, particularly in breast density categories BI-RADS C and D. RICE suppresses normal breast parenchyma in order to highlight focal densities. Unlike methods that enhance mammograms by modifying the dynamic range of an image; RICE relies on the actual tissue composition of the breast. It segments Volumetric Breast Density (VBD) maps into smaller regions and then applies a recursive mechanism to estimate the 'neighbourhood' for each segment. The method then subtracts and updates the neighbourhood, or the encompassing tissue, from each piecewise constant component of the breast image. This not only enhances the appearance of a candidate mass but also helps in estimating the mass density. In extensive experiments, RICE enhances focal densities in all breast density types including the most challenging category BI-RADS D. Suitably adapted, RICE can be used as a precursor to any computer-aided diagnostics and detection system., 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 © 2021 Elsevier B.V. All rights reserved.)

Objective: To assess medium-term organ impairment in symptomatic individuals following recovery from acute SARS-CoV-2 infection., Design: Baseline findings from a prospective, observational cohort study., Setting: Community-based individuals from two UK centres between 1 April and 14 September 2020., Participants: Individuals ≥18 years with persistent symptoms following recovery from acute SARS-CoV-2 infection and age-matched healthy controls., Intervention: Assessment of symptoms by standardised questionnaires (EQ-5D-5L, Dyspnoea-12) and organ-specific metrics by biochemical assessment and quantitative MRI., Main Outcome Measures: Severe post-COVID-19 syndrome defined as ongoing respiratory symptoms and/or moderate functional impairment in activities of daily living; single-organ and multiorgan impairment (heart, lungs, kidneys, liver, pancreas, spleen) by consensus definitions at baseline investigation., Results: 201 individuals (mean age 45, range 21-71 years, 71% female, 88% white, 32% healthcare workers) completed the baseline assessment (median of 141 days following SARS-CoV-2 infection, IQR 110-162). The study population was at low risk of COVID-19 mortality (obesity 20%, hypertension 7%, type 2 diabetes 2%, heart disease 5%), with only 19% hospitalised with COVID-19. 42% of individuals had 10 or more symptoms and 60% had severe post-COVID-19 syndrome. Fatigue (98%), muscle aches (87%), breathlessness (88%) and headaches (83%) were most frequently reported. Mild organ impairment was present in the heart (26%), lungs (11%), kidneys (4%), liver (28%), pancreas (40%) and spleen (4%), with single-organ and multiorgan impairment in 70% and 29%, respectively. Hospitalisation was associated with older age (p=0.001), non-white ethnicity (p=0.016), increased liver volume (p<0.0001), pancreatic inflammation (p<0.01), and fat accumulation in the liver (p<0.05) and pancreas (p<0.01). Severe post-COVID-19 syndrome was associated with radiological evidence of cardiac damage (myocarditis) (p<0.05)., Conclusions: In individuals at low risk of COVID-19 mortality with ongoing symptoms, 70% have impairment in one or more organs 4 months after initial COVID-19 symptoms, with implications for healthcare and public health, which have assumed low risk in young people with no comorbidities., Trial Registration Number: NCT04369807; Pre-results., Competing Interests: Competing interests: AD, RB and MB are employees of Perspectum., (© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY. Published by BMJ.)

Adults with intellectual and developmental disabilities (IDD) often have deficits in interpersonal skills due to limited social-communication opportunities. Knowing how to engage in "small talk" or simple social conversational exchanges can be beneficial in postsecondary schooling, employment sites, community environments, and social gatherings. Recently, covert audio coaching (CAC) showed a positive impact on increasing conversational exchanges. As the COVID-19 pandemic increased the need for remote delivery tools, we explored the effectiveness of remote audio coaching (RAC) to teach this skill to college students with IDD. We used a multiple baseline design across participants to examine whether RAC might increase on-topic, small talk conversational exchanges. Results demonstrated that RAC effectively increased small talk skills between participants and a confederate. Upon removal of RAC, all participants still performed above their baselines, with two participants maintaining near mastery levels 2 weeks after the intervention was removed. Limitations and future research are discussed.

There is a distinct need for a research agenda that drives research, practice, and policy for college students with intellectual and developmental disabilities. This paper provides a brief summary of the rapid growth of college programs in the absence of any organized research agenda. A research framework and agenda is proposed, and a brief summary of each of the papers in the special issue is provided.

A new approach for processing satellite-transition magic-angle spinning (STMAS) and multiple-quantum magic-angle spinning (MQMAS) data, based on the two-dimensional one-pulse (TOP) method, which separates the second-rank quadrupolar anisotropy and paramagnetic shift interactions via a double shearing transformation, is described. This method is particularly relevant in paramagnetic systems, where substantial inhomogeneous broadening may broaden the lineshapes. Furthermore, it possesses an advantage over the conventional processing of MQMAS and STMAS spectra because it overcomes the limitation on the spectral width in the indirect dimension imposed by rotor synchronization of the sampling interval. This method was applied experimentally to the 27 Al solid-state nuclear magnetic resonance of a series of yttrium aluminum garnets (YAGs) doped with different lanthanide ions, from which the quadrupolar parameters of paramagnetically shifted and bulk unshifted sites were extracted. These parameters were then compared with density functional theory calculations, which permitted a better understanding of the local structure of Ln substituent ions in the YAG lattice., (© 2020 The Authors. Magnetic Resonance in Chemistry published by John Wiley & Sons Ltd.)

Objective: Childhood cancer metrics are currently primarily focused on survival rates and late effects of therapy. Our objectives were to design and test a metric that reflected overall quality and safety performance, across all cancer types, of an oncology-bone marrow transplant service line and to use the metric to drive improvement., Method: The Cancer Care Index (CCI) aggregates adverse safety events and missed opportunities for best practices into a composite score that reflects overall program performance without regard to cancer type or patient outcome. Fifteen domains were selected in 3 areas as follows: (1) treatment-related quality and safety, (2) provision of a harm-free environment, and (3) psychosocial support. The CCI is the aggregate number of adverse events or missed opportunities to provide quality care in a given time frame. A lower CCI reflects better care and improved overall system performance. Multidisciplinary microsystem-based teams addressed specific aims for each domain. The CCI was widely followed by all team members, particularly frontline providers., Results: The CCI was easy to calculate and deploy and well accepted by the staff. The annual CCI progressively decreased from 278 in 2012 to 160 in 2014, a 42% reduction. Improvements in care were realized across most index domains. Multiple new initiatives were successfully implemented., Conclusions: The CCI is a useful metric to document performance improvement across a broad range of domains, regardless of cancer type. By the use of quality improvement science, progressive reduction in CCI has occurred over a 3-year period.

Irrigated agriculture in snow-dependent regions contributes significantly to global food production. This study quantifies the impacts of climate change on irrigated agriculture in the snow-dependent Yakima River Basin (YRB) in the Pacific Northwest United States. Here we show that increasingly severe droughts and temperature driven reductions in growing season significantly reduces expected annual agricultural productivity. The overall reduction in mean annual productivity also dampens interannual yield variability, limiting yield-driven revenue fluctuations. Our findings show that farmers who adapt to climate change by planting improved crop varieties may potentially increase their expected mean annaul productivity in an altered climate, but remain strongly vulnerable to irrigation water shortages that substantially increase interannual yield variability (i.e., increasing revenue volatility). Our results underscore the importance for crop adaptation strategies to simultaneously capture the biophysical effects of warming as well as the institutional controls on water availability.

Background: Mycobacterium porcinum is a non-tuberculous mycobacterium (NTM) identified in potable water. The identification and clinical impact of M. porcinum in patients with cystic fibrosis (CF) has not been described. In our institution, M. porcinum was isolated exclusively during hospitalization in a cluster of patients with CF., Methods: Patients with CF who were hospitalized between September 2016 and September 2018 and could expectorate sputum were included, and samples were processed per institutional guidelines. Post-hospitalization and one-year clinical outcomes on those who isolated M. porcinum in respiratory cultures were reviewed. Whole genome sequencing was performed on M. porcinum isolates obtained from patients and environmental sources to identify source of acquisition., Results: Review of 14 CF patients with 16 M. porcinum isolates revealed rapid time to culture positivity within 0.8 (0.04-8.0) days after admission. M. porcinum was isolated in teenagers and adults irrespective of baseline pulmonary function, body mass index, or CF genotype. Whole genome sequencing suggested all isolates belong to the same M. porcinum strain and confirmed the source of acquisition to the ice machine. Review of patients' clinical course, including three patients who underwent lung transplantation, suggested a pseudo-outbreak with minimal clinical impact., Conclusions: NTM, including M. porcinum, are ubiquitous in potable water and institutional water reservoirs. Our findings suggest M. porcinum is a transient colonizer rather than a pathogen. Challenges exist in discerning the role of NTM as a contributor of pulmonary morbidity in patients with CF, and adherence to established guidelines regarding NTM related pulmonary disease remains important., Competing Interests: Declaration of Competing Interest None, (Copyright © 2020. Published by Elsevier B.V.)

Purpose: To use a novel segmentation methodology based on dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) to define tumour subregions of liver metastases from colorectal cancer (CRC), to compare these with histology, and to use these to compare extracted pharmacokinetic (PK) parameters between tumour subregions., Materials and Methods: This ethically-approved prospective study recruited patients with CRC and ≥1 hepatic metastases scheduled for hepatic resection. Patients underwent DCE-MRI pre-metastasectomy. Histological sections of resection specimens were spatially matched to DCE-MRI acquisitions and used to define histological subregions of viable and non-viable tumour. A semi-automated voxel-wise image segmentation algorithm based on the DCE-MRI contrast-uptake curves was used to define imaging subregions of viable and non-viable tumour. Overlap of histologically-defined and imaging subregions was compared using the Dice similarity coefficient (DSC). DCE-MRI PK parameters were compared for the whole tumour and histology-defined and imaging-derived subregions., Results: Fourteen patients were included in the analysis. Direct histological comparison with imaging was possible in nine patients. Mean DSC for viable tumour subregions defined by imaging and histology was 0.738 (range 0.540-0.930). There were significant differences between K trans and k ep for viable and non-viable subregions (p < 0.001) and between whole lesions and viable subregions (p < 0.001)., Conclusion: We demonstrate good concordance of viable tumour segmentation based on pre-operative DCE-MRI with a post-operative histological gold-standard. This can be used to extract viable tumour-specific values from quantitative image analysis, and could improve treatment response assessment in clinical practice., (Copyright © 2020 Elsevier B.V. All rights reserved.)

The use of technological devices has proven to be effective and efficient for the delivery of videos aimed at promoting daily living skills (DLS) among individuals with autism spectrum disorder. As technology advances, devices have become more portable and, ultimately, accessible to caregivers. There are relatively few studies that have examined whether parents can be taught to effectively deliver evidence-based practices using portable, mainstream devices. Using a multiple baseline across participants design, we evaluated parent fidelity in the delivery of video prompts on an iPad to their children who were learning DLS. Results indicated that parents were successful in their delivery of the training procedures and their children acquired and maintained the skills.

Purpose: To develop a postprocessing algorithm for multiecho chemical-shift encoded water-fat separation that estimates proton density fat fraction (PDFF) maps over the full dynamic range (0-100%) using multipeak fat modeling and multipoint search optimization. To assess its accuracy, reproducibility, and agreement with state-of-the-art complex-based methods, and to evaluate its robustness to artefacts in abdominal PDFF maps., Methods: We introduce MAGO (MAGnitude-Only), a magnitude-based reconstruction that embodies multipeak liver fat spectral modeling and multipoint optimization, and which is compatible with asymmetric echo acquisitions. MAGO is assessed first for accuracy and reproducibility on publicly available phantom data. Then, MAGO is applied to N = 178 UK Biobank cases, in which its liver PDFF measures are compared using Bland-Altman analysis with those from a version of the hybrid iterative decomposition of water and fat with echo asymmetry and least squares estimation (IDEAL) algorithm, LiverMultiScan IDEAL (LMS IDEAL, Perspectum Diagnostics Ltd, Oxford, UK). Finally, MAGO is tested on a succession of high field challenging cases for which LMS IDEAL generated artefacts in the PDFF maps., Results: Phantom data showed accurate, reproducible MAGO PDFF values across manufacturers, field strengths, and acquisition protocols. Moreover, we report excellent agreement between MAGO and LMS IDEAL for 6-echo, 1.5 tesla human acquisitions (bias = -0.02% PDFF, 95% confidence interval = ±0.13% PDFF). When tested on 12-echo, 3 tesla cases from different manufacturers, MAGO was shown to be more robust to artefacts compared to LMS IDEAL., Conclusion: MAGO resolves the water-fat ambiguity over the entire fat fraction dynamic range without compromising accuracy, therefore enabling robust PDFF estimation where phase data is inaccessible or unreliable and complex-based and hybrid methods fail., (© 2019 International Society for Magnetic Resonance in Medicine.)

Purpose: Cardiac and respiratory motion derived image artefacts are reduced when data are acquired with cardiac and respiratory synchronisation. Where steady state imaging techniques are required in small animals, synchronisation is most commonly performed using retrospective gating techniques but these invoke an inherent time penalty. This paper reports the development of prospective gating techniques for cardiac and respiratory motion desensitised MRI with significantly reduced minimum scan time compared to retrospective gating., Methods: Prospective gating incorporating the automatic reacquisition of data corrupted by motion at the entry to each breath was implemented in short TR 3D spoiled gradient echo imaging. Motion sensitivity was examined over the whole mouse body for scans performed without gating, with respiratory gating, and with cardio-respiratory gating. The gating methods were performed with and without automatic reacquisition of motion corrupted data immediately after completion of the same breath. Prospective cardio-respiratory gating, with acquisition of 64 k-space lines per cardiac R-wave, was used to enable whole body DCE-MRI in the mouse., Results: Prospective cardio-respiratory gating enabled high fidelity steady state imaging of physiologically mobile organs such as the heart and lung. The automatic reacquisition of data corrupted by motion at the entry to each breath minimised respiratory motion artefact and enabled a highly efficient data capture that was adaptive to changes in the inter-breath interval. Prospective cardio-respiratory gating control enabled DCE-MRI to be performed over the whole mouse body with the acquisition of successive image volumes every 12-15 s at 422 μm isotropic resolution., Conclusions: Highly efficient cardio-respiratory motion desensitised steady state MRI can be performed in small animals with prospective synchronisation, centre-out phase-encode ordering, and the automatic reacquisition of data corrupted by motion at the entry to each breath. The method presented is robust against spontaneous changes in the breathing rate. Steady state imaging with prospective cardio-respiratory gating is much more efficient than with retrospective gating, and enables the examination of rapidly changing systems such as those found when using DCE-MRI., (Copyright © 2018 The Authors. Published by Elsevier Inc. All rights reserved.)

Silver metal exposed to the atmosphere corrodes and becomes tarnished as a result of oxidation and precipitation of the metal as an insoluble salt. Tarnish has so poor a reputation that the word itself connotes corruption and disrespectability; however, tarnishing is a facile synthetic approach for preparing thin metal-sulfide films on silver or copper metal that might be exploited to prepare more elaborate materials with desirable optoelectronic properties. In this work, we prepare luminescent semiconducting thin films of mithrene, a metal-organic chalcogenolate assembly, by replacing the tarnish-causing atmospheric sulfur source with diphenyl diselenide. Mithrene, or silver benzeneselenolate [AgSePh] ∞ , is a crystalline solid that contains both an organic supramolecular phase and a two-dimensional inorganic coordination polymer phase. This compound gradually accumulates as the sole product of silver metal corrosion. The chemical reaction is carried out on metallic silver thin films and yields crystalline films with thicknesses ranging from 5 to 100 nm. We use the large-area films (>6 cm 2 ) afforded by this method to measure the optical properties of this compound. The mild-temperature, wafer-scale processing of hybrid chalcogenolate thin films may prove useful in the application of hybrid organic-inorganic materials in semiconductor devices and hierarchical architectures.

We demonstrate the guiding principles behind simple two dimensional self-assembly of MOF nanoparticles (NPs) and oleic acid capped iron oxide (Fe 3 O 4 ) NCs into a uniform two-dimensional bi-layered superstructure. This self-assembly process can be controlled by the energy of ligand-ligand interactions between surface ligands on Fe 3 O 4 NCs and Zr 6 O 4 (OH) 4 (fumarate) 6 MOF NPs. Scanning transmission electron microscopy (TEM)/energy-dispersive X-ray spectroscopy and TEM tomography confirm the hierarchical co-assembly of Fe 3 O 4 NCs with MOF NPs as ligand energies are manipulated to promote facile diffusion of the smaller NCs. First-principles calculations and event-driven molecular dynamics simulations indicate that the observed patterns are dictated by combination of ligand-surface and ligand-ligand interactions. This study opens a new avenue for design and self-assembly of MOFs and NCs into high surface area assemblies, mimicking the structure of supported catalyst architectures, and provides a thorough fundamental understanding of the self-assembly process, which could be a guide for designing functional materials with desired structure., (© 2018 Wiley-VCH Verlag GmbH & Co. KGaA, Weinheim.)

Purpose: Several studies have demonstrated the accuracy, precision, and reproducibility of proton density fat fraction (PDFF) quantification using vendor-specific image acquisition protocols and PDFF estimation methods. The purpose of this work is to validate a confounder-corrected, cross-vendor, cross field-strength, in-house variant LMS IDEAL of the IDEAL method licensed from the University of Wisconsin, which has been developed for routine clinical use., Methods: LMS IDEAL is implemented using a combination of patented and/or published acquisition and some novel model fitting methods required to correct confounds which result from the imaging and estimation processes, including: water-fat ambiguity; T2* relaxation; multi-peak fat modelling; main field inhomogeneity; T1 and noise bias; bipolar readout gradients; and eddy currents. LMS IDEAL has been designed to use image acquisition protocols that can be installed on most MRI scanners and cloud-based image processing to provide fast, standardized clinical results. Publicly available phantom data were used to validate LMS IDEAL PDFF calculations against results from originally published IDEAL methodology. LMS PDFF and T2* measurements were also compared with an independent technique in human volunteer data (n = 179) acquired as part of the UK Biobank study., Results: We demonstrate excellent agreement of LMS IDEAL across vendors, field strengths, and over a wide range of PDFF and T2* values in the phantom study. The performance of LMS IDEAL was then assessed in vivo against widely accepted PDFF and T2* estimation methods (LMS Dixon and LMS T2*, respectively), demonstrating the robustness of LMS IDEAL to potential sources of error., Conclusion: The development and clinical validation of the LMS IDEAL algorithm as a chemical shift-encoded MRI method for PDFF and T2* estimation contributes towards robust, unbiased applications for quantification of hepatic steatosis and iron overload, which are key features of chronic liver disease., Competing Interests: The authors of this manuscript have the following competing interests: Perspectum Diagnostics employees: Chloe Hutton, Michael L. Gyngell, Matteo Milanesi, Alexandre Bagur, Michael Brady; Perspectum Diagnostics stockholders: Chloe Hutton, Michael L. Gyngell, Matteo Milanesi, Alexandre Bagur, Michael Brady. This does not alter our adherence to PLOS ONE policies on sharing data and materials.

Background: Accurate assessment of liver health prior to undertaking resectional liver surgery or chemoembolisation for primary and secondary cancers is essential for patient safety and optimal outcomes. LiverMultiScan™, an MRI-based technology, non-invasively quantifies hepatic fibroinflammatory disease, steatosis and iron content. We hypothesise that LiverMultiScan™can quantify liver health prior to surgery and inform the risk assessment for patients considering liver surgery or chemoembolization and seek to evaluate this technology in an operational environment., Methods/design: HepaT1ca is an observational cohort study in two tertiary-referral liver surgery centres in the United Kingdom. The primary outcome is correlation between the pre-operative liver health assessment score (Hepatica score - calculated by weighting future remnant liver volume by liver inflammation and fibrosis (LIF) score) and the post-operative liver function composite integer-based risk (Hyder-Pawlik) score. With ethical approval and fully-informed consent, individuals considering liver surgery for primary or secondary cancer will undergo clinical assessment, blood sampling, and LiverMultiScan™multiparametric MRI before and after surgical liver resection or TACE. In nested cohorts of individuals undergoing chemotherapy prior to surgery, or those undergoing portal vein embolization (PVE) as an adjunct to surgery, an additional testing session prior to commencement of treatment will occur. Tissue will be examined histologically and by immunohistochemistry. Pre-operative liver health assessment scores and the post-operative risk scores will be correlated to define the ability of LiverMultiScan™to predict the risk of post-operative morbidity and mortality. Because technology performance in this setting is unknown, a pragmatic sample size will be used. For the primary outcome, n = 200 for the main cohort will allow detection of a minimum correlation coefficient of 0.2 with 5% significance and power of 80%., Discussion: This study will refine the technology and clinical application of multiparametric MRI (including LiverMultiScan™), to quantify pre-existing liver health and predict post-intervention outcomes following liver resection. If successful, this study will advance the technology and support the use of multiparametric MRI as part of an enhanced pre-operative assessment to improve patient safety and to personalise operative risk assessment of liver surgery/non-surgical intervention., Trial Registration: This study is registered on ClinicalTrials.gov Identifier: NCT03213314 .

Competing Interests: POTENTIAL CONFLICT OF INTEREST: The author has indicated he has no potential conflicts of interest to disclose.

Many adolescents with developmental disabilities do not learn the safety skills needed to maintain physical well-being in domestic and community environments. Literacy-based behavioral interventions (LBBIs) that combine print, pictures, and behavioral rehearsal are effective for promoting acquisition and maintenance of self-care skills, but have not been investigated as safety skill intervention. Also, LBBIs have primarily been implemented by teachers and other professionals. In this study, a peer partner was taught to deliver an LBBI story to students so they would learn to perform a basic first aid routine: cleaning and dressing a wound. Results showed that students' accuracy with the first aid routine increased after a peer delivered the LBBI instructional package, and maintained after the peer stopped delivering it. This study demonstrates the effectiveness of the LBBI instructional package for teaching first aid safety skills, and extends previous research showing the efficacy of peers in delivering this intervention.

Deformable image registration, a key component of motion correction in medical imaging, needs to be efficient and provides plausible spatial transformations that reliably approximate biological aspects of complex human organ motion. Standard approaches, such as Demons registration, mostly use Gaussian regularization for organ motion, which, though computationally efficient, rule out their application to intrinsically more complex organ motions, such as sliding interfaces. We propose regularization of motion based on supervoxels, which provides an integrated discontinuity preserving prior for motions, such as sliding. More precisely, we replace Gaussian smoothing by fast, structure-preserving, guided filtering to provide efficient, locally adaptive regularization of the estimated displacement field. We illustrate the approach by applying it to estimate sliding motions at lung and liver interfaces on challenging four-dimensional computed tomography (CT) and dynamic contrast-enhanced magnetic resonance imaging datasets. The results show that guided filter-based regularization improves the accuracy of lung and liver motion correction as compared to Gaussian smoothing. Furthermore, our framework achieves state-of-the-art results on a publicly available CT liver dataset.

Background: Regular testing for sexually transmitted infections (STIs) is important to maintain sexual health. Self-sampling kits ordered online and delivered in the post may increase access, convenience, and cost-effectiveness. Sexual health economies may target limited resources more effectively by signposting users toward Web-based or face-to-face services according to clinical need., Objective: The aim of this paper was to investigate the impact of two interventions on testing activity across a whole sexual health economy: (1) the introduction of open access Web-based STI testing services and (2) a clinic policy of triage and signpost online where users without symptoms who attended clinics for STI testing were supported to access the Web-based service instead., Methods: Data on attendances at all specialist public sexual health providers in an inner-London area were collated into a single database. Each record included information on user demographics, service type accessed, and clinical activity provided, including test results. Clinical activity was categorized as a simple STI test (could be done in a clinic or online), a complex visit (requiring face-to-face consultation), or other., Results: Introduction of Web-based services increased total testing activity across the whole sexual health economy by 18.47% (from 36,373 to 43,091 in the same 6-month period-2014-2015 and 2015-2016), suggesting unmet need for testing in the area. Triage and signposting shifted activity out of the clinic onto the Web-based service, with simple STI testing in the clinic decreasing from 16.90% (920/5443) to 12.25% (511/4172) of total activity, P<.001, and complex activity in the clinic increasing from 69.15% (3764/5443) to 74.86% (3123/4172) of total activity, P<.001. This intervention created a new population of online users with different demographic and clinical profiles from those who use Web-based services spontaneously. Some triage and signposted users (29.62%, 375/1266) did not complete the Web-based testing process, suggesting the potential for missed diagnoses., Conclusions: This evaluation shows that users can effectively be transitioned from face-to-face to Web-based services and that this introduces a new population to Web-based service use and changes the focus of clinic-based activity. Further development is underway to optimize the triage and signposting process to support test completion., (©Katy ME Turner, Adam K Zienkiewicz, Jonathan Syred, Katharine J Looker, Joia de Sa, Michael Brady, Caroline Free, Gillian Holdsworth, Paula Baraitser. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 07.03.2018.)

Individuals with autism spectrum disorders (ASD) are increasingly entering institutions of higher education. However, many are not prepared for the academic and social demands of postsecondary environments. Although studies have evaluated academic and social interventions for children and adolescents with ASD, little research exists on the college population. The current study utilized a multiple baseline across participants design to evaluate the effectiveness of a writing learning strategy on the writing performance of three college students with ASD. Results indicated that the quality of writing performance improved following strategy instruction. In addition, participants were able to generalize strategy use to content specific writing tasks.

A novel core/shell porous crystalline structure was prepared using a large pore metal organic framework (MOF, UiO-66-NH 2 , pore size, ∼ 0.6 nm) as core surrounded by a small pore zeolitic imidazolate framework (ZIF, ZIF-8, pore size, ∼ 0.4 nm) through a layer-by-layer deposition method and subsequently used as an engineered filler to construct hybrid polysulfone (PSF) membranes for CO 2 capture. Compared to traditional fillers utilizing only one type of porous material with rigid channels (either large or small), our custom designed core/shell fillers possess clear advantages via pore engineering: the large internal channels of the UiO-66-NH 2 MOFs create molecular highways to accelerate molecular transport through the membrane, while the thin shells with small pores (ZIF-8) or even smaller pores generated at the interface by the imperfect registry between the overlapping pores of ZIF and MOF enhance molecular sieving thus serving to distinguish slightly larger N 2 molecules (kinetic diameter, 0.364 nm) from smaller CO 2 molecules (kinetic diameter, 0.33 nm). The resultant core/shell ZIF@MOF and as-prepared hybrid PSF membranes were characterized by transmission electron microscopy, X-ray diffraction, wide-angle X-ray scattering, scanning electron microscopy, Fourier transform infrared, thermogravimetric analysis, differential scanning calorimetry, and contact angle tests. The dependence of the separation performance of the membranes on the MOF/ZIF ratio was also studied by varying the number of layers of ZIF coatings. The integrated PSF-ZIF@MOF hybrid membrane (40 wt % loading) with optimized ZIF coating cycles showed improved hydrophobicity and excellent CO 2 separation performance by simultaneously increasing CO 2 permeability (CO 2 permeability of 45.2 barrer, 710% higher than PSF membrane) and CO 2 /N 2 selectivity (CO 2 /N 2 selectivity of 39, 50% higher than PSF membrane), which is superior to most reported hybrid PSF membranes. The strategy of using dual-channel molecular sieving core/shell porous crystals in hybrid membranes thus provides a promising means for CO 2 capture from flue gas.

Hydrogen gas is formed when Mg corrodes in water; however, the manner and extent to which the hydrogen may also enter the Mg metal is poorly understood. Such knowledge is critical as stress corrosion cracking (SCC)/embrittlement phenomena limit many otherwise promising structural and functional uses of Mg. Here, we report via D 2 O/D isotopic tracer and H 2 O exposures with characterization by secondary ion mass spectrometry, inelastic neutron scattering vibrational spectrometry, electron microscopy, and atom probe tomography techniques direct evidence that hydrogen rapidly penetrated tens of micrometers into Mg metal after only 4 h of exposure to water at room temperature. Further, technologically important microalloying additions of <1 wt % Zr and Nd used to improve the manufacturability and mechanical properties of Mg significantly increased the extent of hydrogen ingress, whereas Al additions in the 2-3 wt % range did not. Segregation of hydrogen species was observed at regions of high Mg/Zr/Nd nanoprecipitate density and at Mg(Zr) metastable solid solution microstructural features. We also report evidence that this ingressed hydrogen was unexpectedly present in the alloy as nanoconfined, molecular H 2 . These new insights provide a basis for strategies to design Mg alloys to resist SCC in aqueous environments as well as potentially impact functional uses such as hydrogen storage where increased hydrogen uptake is desired.

The objective of this study was to investigate if patients diagnosed in community clinics have higher baseline CD4 cell counts than those diagnosed in Genitourinary medicine (GUM)/HIV clinics. We undertook a retrospective review of baseline CD4 cell counts for patients receiving a reactive HIV test in community-testing clinics. Eleven local HIV clinics were contacted to determine the baseline CD4 cell counts of these patients. Baseline CD4 cell counts of those diagnosed in the community were compared with mean local GUM/HIV clinic and median national baseline CD4 cell count for their year of diagnosis. Clients diagnosed in community settings had a mean baseline CD4 cell count of 481 cells/mm 3 (SD 236 cells/mm 3 ) and median baseline of 483 cells/mm 3 (interquartile range 311-657 cells/mm 3 ). This was significantly higher than those diagnosed in the GUM/HIV clinic local to the community-testing site (mean baseline CD4 397 cells/mm 3 , p = 0.014) and the national median for that year (336 cells/mm 3 , p < 0.001). HIV testing in community settings identifies patients at an earlier stage of infection than testing in clinical settings.

People held in prison are at a high risk of having hepatitis C virus (HCV) and there is a public health drive in the UK to increase HCV testing in prisons and Young Offender Institutions (YOIs), with opt-out testing. There is an oral antibody test for HCV; this project aims to determine its acceptability in an English YOI setting. This project offered HCV oral point-of-care testing (POCT) using the OraQuick® test to 107 male young offenders attending a sexual health service at an English YOI, monitoring HCV positivity and evaluating acceptability. It also investigated young offenders' histories of sexually transmitted infections (STIs) and drug use. Mean age was 19.1 years. A total of 80.4% reported lifetime drug use and 0.9% reported lifetime drug injection. A total of 19.6% reported previous STIs. One patient (0.9%) was positive for HCV on OraQuick® testing. All patients found the POCT acceptable and one stated he would have refused a fingerprick test had it been the only test available for HCV testing. Salivary rapid HCV testing is acceptable among English YOI inmates. It is not as sensitive or specific as standard HCV tests and is more expensive. In our cohort, HCV positivity was low.

We synthesized a two-dimensional (2D) crystalline covalent organic framework (sp 2 c-COF) that was designed to be fully π-conjugated and constructed from all sp 2 carbons by C=C condensation reactions of tetrakis(4-formylphenyl)pyrene and 1,4-phenylenediacetonitrile. The C=C linkages topologically connect pyrene knots at regular intervals into a 2D lattice with π conjugations extended along both x and y directions and develop an eclipsed layer framework rather than the more conventionally obtained disordered structures. The sp 2 c-COF is a semiconductor with a discrete band gap of 1.9 electron volts and can be chemically oxidized to enhance conductivity by 12 orders of magnitude. The generated radicals are confined on the pyrene knots, enabling the formation of a paramagnetic carbon structure with high spin density. The sp 2 carbon framework induces ferromagnetic phase transition to develop spin-spin coherence and align spins unidirectionally across the material., (Copyright © 2017 The Authors, some rights reserved; exclusive licensee American Association for the Advancement of Science. No claim to original U.S. Government Works.)

We report controllable anisotropic light emission of photons originating from vertically aligned transition dipole moments in spun-cast films of CsPbBr 3 nanocubes. By depositing films of nanocrystals on precoated substrates we can control the packing density and resultant radiation pattern of the emitted photons. We develop a technical framework to calculate the average orientation of light emitters, i.e., the angle between the transition dipole moment vector (TDM) and the substrate. This model is applicable to any emissive material with a known refractive index. Theoretical modeling indicates that oriented emission originates from an anisotropic alignment of the valence band and conduction band edge states on the ionic crystal lattice and demonstrates a general path to model the experimentally less accessible internal electric field of a nanosystem from the photoluminescent anisotropy. The uniquely accessible surface of the perovskite nanoparticles allows for perturbation of the normally isotropic emissive transition. The reported sensitive and tunable TDM orientation and control of emitted light will allow for applications of perovskite nanocrystals in a wide range of photonic technologies inaccessible to traditional light emitters.