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A man in his 40s was referred to our centre with rapidly progressive interstitial lung disease for lung transplant evaluation. Three months prior to his presentation he had developed periorbital oedema and discolouration, papules over the dorsal aspect of his metacarpophalangeal (MCP) joints and mucocutaneous ulcerations over the dorsum and palmar aspects of his MCPs. He had also been experiencing progressive shortness of breath. Based on the characteristic appearance of the cutaneous lesions, lack of muscle weakness on clinical examination, rapid progression of the interstitial lung disease together with presence of melanoma differentiation-associated gene 5 (MDA5) antibodies a diagnosis of anti-MDA5 dermatomyositis was made. Prompt treatment was initiated with aggressive combined immunomodulatory therapy that resulted in significant improvement in symptoms.

Zusammenfassung: Hintergrund: Die in diese Studie involvierte Population betrifft Personen mit Anorexia nervosa (AN). AN ist eine Erkrankung mit teilweise lebensbedrohlichem Untergewicht. Selbstwertproblematik, Ängste und soziale Probleme begleiten Betroffene. AN verläuft oft chronisch. Hospitalisiert nehmen die Betroffenen an Gewicht zu, oft persistiert die zugrundeliegende Essproblematik, was zur Rehospitalisation führt. Untersuchungen zur Selbstwirksamkeitserwartung (SWE) Betroffener fehlen weitgehend. Ziel: Das Ziel dieser Arbeit ist die Untersuchung der SWE bei Betroffenen im poststationären Setting mit Bezug zum Alter, der Anzahl Hospitalisationen und des Krankheitsverlaufs. Methode: Im Rahmen dieser Querschnittstudie wurden Betroffene im poststationären, psychosomatischen Setting anhand eines standardisierten Fragebogens „Allgemeine SWE“ befragt. Die Daten wurden deskriptiv und mittels Inferenzstatistik ausgewertet. Ergebnis: Befragt wurden 85 Jugendliche. Bei der Stichprobe lag der SWE-Score bei durchschnittlich = 28.53 bis und mit drei und bei = 24.68 ab vier Hospitalisationen. Lag der stationäre Aufenthalt erst kürzlich zurück, wies der SWE-Score einen tieferen Wert auf (= 26.08) als bei jenen mit länger zurückliegendem Aufenthalt (= 29.00). Schlussfolgerung: Die Resultate weisen darauf hin, dass die SWE den Krankheitsverlauf von Betroffenen beeinflussen können. Personen mit höheren SWE-Werten zeigen einen günstigeren Krankheitsverlauf mit weniger Rehospitalisationen. Die Stärkung der SWE ist deshalb im stationären und ambulanten Setting durch gezielte Interventionen seitens Fachpersonen von großer Bedeutung.

BACKGROUND & AIMS The use of oral nutritional supplements (ONS) in the hospital setting is important to reach individual protein and energy goals in patients at risk for malnutrition. Compliance with ONS can be challenging but may be improved by prescribing ONS in smaller portions with medication rounds (MEDPass). We compared the likelihood of meeting energy and protein requirements in patients receiving ONS with MEDPass versus conventional ONS administration. METHODS The MEDPass Trial is a randomized, controlled, open-label superiority trial conducted on medical and geriatric wards in a University Hospital in Switzerland. The MEDPass group was allocated to receive 50 ml of ONS four times per day with the medication rounds. The control group received ONS per conventional care between the meals. The primary outcome was the percentage of energy in relation to the individual requirement. Secondary outcomes included the coverage of protein intake in relation to the individual requirement, the amount of daily consumed ONS, the course of handgrip strength (HGS), body weight appetite and nausea. Furthermore, we compared 30-day mortality and hospital length of stay (LOS) was studied in medical patients. RESULTS From November 22nd, 2018 until November 30th, 2021, 204 patients were included in the trial (MEDPass group n = 100, control group n = 104). A total of 203 patients at nutritional risk were analyzed in the intention-to-treat analysis (ITT). Regarding the primary endpoint, there was no difference in the coverage of energy requirement between the MEDPass and control group (82 vs. 85% (Δ -3%, 95%CI -11 to 4%), p = 0.38). Similarly, no differences were found for the secondary outcomes including coverage of protein requirement (101 vs. 104% (Δ -3%, 95% CI -12 -7%), p = 0.57, average daily intake of ONS (170 vs 173 ml (Δ - 3 ml, 95% CI -14 to 8 ml), p = 0.58) and 30-day mortality (3 vs. 8 patients, OR 0.4 (95% CI 0.1-1.4), p = 0.15). The course of HGS, body weight, appetite and nausea did not differ between the groups (p = 0.29, p = 0.14, p = 0.65 and p = 0.94, respectively). The per protocol analysis including 178 patients showed similar results. CONCLUSION Within this controlled trial setting, we found a high compliance for ONS intake and high coverage of protein requirements but no further improvement when ONS was administered using MEDPass compared to conventional care. MEDPass administration may provide an alternative that is easy to integrate into nursing routines, which may lead to lower workload with cost benefits and reduction of food waste. TRIAL REGISTRATION ClinicalTrials.gov: NCT03761680.

Three-dimensional (3D) cell cultures represent the spontaneous state of stem cells with specific gene and protein molecular expression that are more alike the in vivo condition. In vitro two-dimensional (2D) cell adhesion cultures are still commonly employed for various cellular studies such as movement, proliferation and differentiation phenomena; this procedure is standardized and amply used in laboratories, however their representing the original tissue has recently been subject to questioning. Cell cultures in 2D require a support/substrate (flasks, multiwells, etc.) and use of fetal bovine serum as an adjuvant that stimulates adhesion that most likely leads to cellular aging. A 3D environment stimulates cells to grow in suspended aggregates that are defined as "spheroids." In particular, adipose stem cells (ASCs) are traditionally observed in adhesion conditions, but a recent and vast literature offers many strategies that obtain 3D cell spheroids. These cells seem to possess a greater ability in maintaining their stemness and differentiate towards all mesenchymal lineages, as demonstrated in in vitro and in vivo studies compared to adhesion cultures. To date, standardized procedures that form ASC spheroids have not yet been established. This systematic review carries out an in-depth analysis of the 76 articles produced over the past 10 years and discusses the similarities and differences in materials, techniques, and purposes to standardize the methods aimed at obtaining ASC spheroids as already described for 2D cultures.

Fluid shifts have been ascribed to central diabetes insipidus in patients with anorexia nervosa hospitalized for refeeding. Recent data, however, suggest that vasopressin production is not dysregulated in this population. Our objective was to describe the trajectory of fluid imbalances in relationship to kidney function, electrolyte disturbances, and acid/base balance during refeeding.A retrospective review of daily fluid balance and biochemical values was performed in 70 sequential unique patients admitted to University of California at Los Angeles Hospital Medical Stabilization Program for Eating Disorders from December 2018 to November 2020.Participants (2 males/68 females) were between 10 and 24 years of age and with a median body mass index of 16.1 (14.3, 18.1) kg/mChronic energy deprivation alters the physiology of renal fluid and bicarbonate handling in ways that are independent of vasopressin and glomerular filtration. Further studies are warranted to understand the renal adaptations that occur during energy restriction and subsequent refeeding.Massive urinary fluid losses occur in patients with restrictive eating disorders hospitalized for refeeding. In addition, many patients have impaired renal bicarbonate excretion. These findings suggest that chronic energy deprivation impairs the kidney's ability to handle the shifts in fluid and acid/base balance that occur when appropriate oral nutrition is re-introduced.

The female reproductive tract, similar to other mucosal sites, harbors a specific microbiome commonly dominated by Lactobacillus species (spp.), which has an essential role in maintaining health and homeostasis. Increasing evidence shows that genital tract dysbiosis and/or specific bacteria and cytokines might have an active role in the development and/or progression of HPV infection and cervical intra-epithelial neoplasia (CIN) and as a result cervical cancer. Cross-sectional and longitudinal studies reported that Lactobacillus spp. depletion increases with severity of CIN and that this may negatively affect disease regression rates. It is plausible that Lactobacillus deplete microbiome composition may lead to a pro-inflammatory environment that can increase malignant cell proliferation and HPV E6 and E7 oncogene expression. Future longitudinal cohorts and mechanistic experiments on HPV transfected cells models will further permit exploration of the impact of Lactobacillus spp. on HPV infection.

Background: Many studies analysed solutions to simple proportionality problems, but few focused on double and multiple proportionality. Objectives: Analysis of students’ solutions to double and multiple proportionality problems. Design: Quantitative and qualitative analyses of empirical data. Setting and participants: Ninety students in grades 7 to 9 in Recife, Brazil. Data collection and analysis: Participants solved, in writing, double and multiple proportionality problems and orally explained their solutions. The analysis considers performance and solution strategies. Results: Percentage of correct answers per problem and school grade ranged from 67 to 97%, with no significant differences between types of problems or grades. Partipants used scalar, functional, and mixed strategies, with higher frequency of scalar strategies for double and of functional strategies for multiple proportionality problems. Conclusions: Double and multiple proportionality problems were equally accessible. Correct answers associated with the mixed strategy suggests that students considered multiple relationships in problems’ statements.

Secondary organic aerosols (SOA) formed by oxidation of typical precursors largely emitted by biomass burning, such as PAHs and furans, are still poorly characterized in terms of formation yields, physical and light absorption properties, particularly those generated at night following reaction with nitrate radicals (NO3). In the present study, we evaluated and compared the formation yields, effective density (ρeff), absorption Ångström exponent (α), and mass absorption coefficient (MAC) of laboratory-generated SOA from three furan compounds (furan, 2-methylfuran, and 2,5-dimethylfuran) and four PAHs (naphthalene, acenaphthylene, fluorene, and phenanthrene). SOA were generated in an oxidation flow reactor from the reaction between hydroxyl radicals (OH; 0.1–20 equivalent aging days) or NO3 radicals (0.05–6 equivalent aging nights of 14 h) with single furan or PAH. The ρeff, formation yields, α, and MAC of the generated SOA varied depending on the precursor and oxidant considered. The ρeff of SOA formed with OH and NO3 tended to increase with particle size before reaching a “plateau”. This was particularly evident for the nighttime chemistry experiments with NO3 radicals (1.2 to 1.6 on average for particles > 100 nm). Such results highlighted potential differences in the chemical composition of the SOA, as well as probably in their morphology, according to the particle size. Three times lower SOA formation yields were obtained with NO3 compared to OH. The yields of PAH SOA (18 to 76 %) were 5 to 6 times higher than those obtained for furans (3–12 %). While furan SOA showed low or negligible light absorption properties, PAH SOA was found to have a significant impact in the UV-Visible region, implying a significant contribution to atmospheric brown carbon (BrC). No increase in the MAC values was observed from OH to NO3 oxidation processes, probably due to a low formation of nitrogen-containing chromophores through homogeneous gas phase oxidation processes with NO3 only (without NOx). Overall, the results obtained in this work demonstrated that PAHs are significant precursors of SOA emitted by biomass burning, through both, day- and nighttime processes, and have a substantial impact on the aerosol light absorption properties and so probably on climate.

Aromatic hydrocarbons represent a large fraction of anthropogenic volatile organic compounds and significantly contribute to tropospheric ozone and secondary organic aerosol (SOA) formation. Toluene photooxidation experiments were carried out in an oxidation flow reactor (OFR). We identified and quantified the gaseous and particulate reaction products at 280, 285 and 295 K using a proton-transfer reaction time-of-flight mass spectrometer (PTR-ToF-MS) coupled to a CHemical Analysis of aeRosol ONline (CHARON) inlet. The reaction products accounted for both ring-retaining compounds such as cresols, benzaldehyde, nitrophenols, nitrotoluene, bicyclic intermediate compounds, as well as ring-scission products such as dicarbonyls, cyclic anhydrides, small aldehydes and acids. The chemical system exhibited a volatility distribution mostly in the semi-volatile (SVOCs – semi-volatile organic compounds) regime. The saturation concentration (Ci*) values of the identified compounds were mapped onto the two-dimensional volatility basis set (2D-VBS). Temperature decrease caused a shift of Ci* towards lower values while there was no clear relationship between Ci* and oxidation state. The CHARON PTR-ToF-MS instrument identified and quantified approximately 70–80 % of the total organic mass measured by an aerosol mass spectrometer (AMS). The experiments were reproduced by simulating SOA formation with the SSH-aerosol box model. A semi-detailed mechanism for toluene gaseous oxidation was developed. It is based on the MCM and GECKO-A deterministic mechanisms modified following the literature in particular to update cresols and ring-scission chemistry. The new mechanism improved secondary species representation with an increment of the major identified species (+35 % in number). Light compounds formation (i.e. m/z < 100) is enhanced and accumulation of heavy compounds (i.e. m/z ≥ 100) is reduced, especially in the gas phase. Additional tests on (i) partitioning processes such as condensation into aqueous phase, (ii) interactions of organic compounds between themselves and with inorganics and (iii) wall losses were also performed. When all these processes were taken into account the simulated SOA mass concentration showed a much better agreement with the experimental results. Finally, an irreversible partitioning pathway for methylglyoxal was introduced and considerably improved the model results, opening a way to further developments of partitioning in models. Our results underline that the volatility itself is not sufficient to explain the partitioning between gas and particle phase: the organic and the aqueous phases need to be taken into account as well as interactions between compounds in the particle phase.

Local air pollution sources in the Arctic lead to poor air quality in Arctic cities, particularly during the winter months. Fairbanks in central Alaska, is a prime example of such an Arctic city which suffers from acute wintertime pollution episodes. The topography of Fairbanks (situated in a basin), coupled with strong surface-based temperature inversions, contributes to stable meteorological conditions that hinder the dispersion of pollutants and surface temperatures reaching -40 °C. These harsh winter conditions result in enhanced domestic and power plant combustion emissions. Stable meteorological regimes are frequently interspersed with less stable episodes, resulting in vertical mixing between surface and elevated inversion layers. However, there are many uncertainties in our understanding about pollution sources and secondary aerosol formation under cold, dark winter conditions, where photochemistry is limited. These issues were addressed through the collection of comprehensive datasets on atmospheric composition and meteorology in Fairbanks, during the international ALPACA (Alaskan Layered Pollution and Chemical Analysis) field campaign in January and February 2022. Data were collected at the surface and vertical profiles were collected using a tethered balloon (EPFL Helikite).Here, we examine the relative contributions and distributions of power plant emissions, emitted above the surface, and surface emission sources to pollution levels in the Fairbanks region. The FLEXPART-Weather Research and Forecasting (WRF) Lagrangian particle dispersion model, driven by meteorological fields from WRF-Environmental Protection Agency (EPA, Alaska) simulations is deployed. Firstly, model runs are used to evaluate the transport and dispersion of emissions from power plants at several altitudes in and around Fairbanks. Surface-based and elevated temperature inversions, characteristic of the winter boundary layer in Fairbanks, are considered in a parameterisation of power plant plume injection heights, and temporal variations in these emissions is also taken into account. Secondly, the extent to which power plant emissions are contributing to surface pollution is investigated using power plant (point source) and sector-based surface EPA emissions at 1.3km resolution at hourly time resolution during the 2022 campaign period. Model results are evaluated against available vertical profile and ground-based observations from ALPACA 2022. Power plant plumes are simulated aloft at several ALPACA measurement sites, as validated by vertical profile observations. The simulations indicate that power plant emissions are mixed down towards the surface in some cases. These results also provide insights into relative source contributions from each power plant in Fairbanks within the vertical profile of the lower atmospheric boundary layer, which could be used as tool for source apportionment studies.

Mesenchymal stem cells (MSCs) can exert different functions and can be used in several medical fields. In the last years, MSC properties have been attributed to their secreted factors such as soluble proteins, cytokines and growth factors. Moreover, a key role is played by the extracellular vesicles (EVs) which lead a heterogeneous cargo of proteins, lipids and small and long non-coding RNAs that interfere with the pathways of the recipient cells. Due to the safeness and easiness in obtaining the secretome, its use is becoming a turning point for the application in physiological and pathological fields. This review summarizes the most recent studies on the use of MSCs secretome, focusing on some physiological (angiogenesis and osteogenesis) and pathological (cancer, cardiovascular and autoimmune diseases) applications. The secreted analyzed factors are listed in a table. In addition, the different characteristics of the fetal MSCs derived secretome and the differences in the secretome composition of three-dimensionally (3D) cultured cells are discussed. As very innovative aspects, recent studies on some applications of engineered vesicles, embedded or not in three-dimensional structures, are treated and the influence of some epigenetic modifications on cells and EVs is investigated.

Cervical cancer has killed millions of women over the past decade. In 2019 the World Health Organization launched the Cervical Cancer Elimination Strategy, which included ambitious targets for vaccination, screening, and treatment. The COVID-19 pandemic disrupted progress on the strategy, but lessons learned during the pandemic - especially in vaccination, self-administered testing, and coordinated mobilization on a global scale - may help with efforts to achieve its targets. However, we must also learn from the failure of the COVID-19 response to include adequate representation of global voices. Efforts to eliminate cervical cancer will only succeed if those countries most affected are involved from the very start of planning. In this article we summarize innovations and highlight missed opportunities in the COVID response, and make recommendations to leverage the COVID experience to accelerate the elimination of cervical cancer globally.

Human genetic variation has enabled the identification of several key regulators of fetal-to-adult hemoglobin switching, including BCL11A, resulting in therapeutic advances. However, despite the progress made, limited further insights have been obtained to provide a fuller accounting of how genetic variation contributes to the global mechanisms of fetal hemoglobin (HbF) gene regulation. Here, we have conducted a multi-ancestry genome-wide association study of 28,279 individuals from several cohorts spanning 5 continents to define the architecture of human genetic variation impacting HbF. We have identified a total of 178 conditionally independent genome-wide significant or suggestive variants across 14 genomic windows. Importantly, these new data enable us to better define the mechanisms by which HbF switching occurs in vivo. We conduct targeted perturbations to define BACH2 as a new genetically-nominated regulator of hemoglobin switching. We define putative causal variants and underlying mechanisms at the well-studied BCL11A and HBS1L-MYB loci, illuminating the complex variant-driven regulation present at these loci. We additionally show how rare large-effect deletions in the HBB locus can interact with polygenic variation to influence HbF levels. Our study paves the way for the next generation of therapies to more effectively induce HbF in sickle cell disease and β-thalassemia.

Background Age-specific data on anal, and corresponding cervical, human papillomavirus (HPV) infection are needed to inform female anal cancer prevention. Methods We centrally reanalyzed individual-level data from 26 studies reporting HPV prevalence in paired anal and cervical samples by human immunodeficiency virus (HIV) status and age. For women with HIV (WWH) with anal high-grade squamous intraepithelial lesions or worse (HSIL+), we also investigated concurrent cervical cytopathology. Results In HIV-negative women, HPV16 prevalence decreased significantly with age, both at anus (4.3% at 15–24 years to 1.0% at ≥55 years; ptrend = 0.0026) and cervix (7.4% to 1.7%; ptrend < 0.0001). In WWH, HPV16 prevalence decreased with age at cervix (18.3% to 7.2%; ptrend = 0.0035) but not anus (11.5% to 13.9%; ptrend = 0.5412). Given anal HPV16 positivity, concurrent cervical HPV16 positivity also decreased with age, both in HIV-negative women (ptrend = 0.0005) and WWH (ptrend = 0.0166). Among 48 WWH with HPV16-positive anal HSIL+, 27 (56%) were cervical high-risk HPV-positive, including 8 with cervical HPV16, and 5 were cervical HSIL+. Conclusions Age-specific shifts in HPV16 prevalence from cervix to anus suggest that HPV infections in the anus persist longer, or occur later in life, than in the cervix, particularly in WWH. This is an important consideration when assessing the utility of cervical screening results to stratify anal cancer risk.

3D printing of polymeric scaffolds and autologous stem cells is a promising tool for damaged facial cartilage reconstruction surgeries. To this end, suitable bioinks are needed to generate scaffolds with the required morphological and functional features. We formulated hydrogel bioinks using k-Carrageen (kC) and poly(vinyl alcohol) (PVA) in three different weight ratios. The kC gives the systems the ability to undergo rapid sol-to-gel transitions upon cooling from 60 °C and above to body temperature, while the PVA is used as rheology modifier and porogen. The latter is crosslinked after molding or printing by freeze-thaw cycling for 1 day (FT1) or 5 days (FT5). To select the most suitable formulation for 3D printing, the sol-to-gel transition and the physico-chemical, mechanical and morphological properties of obtained hydrogels were studied. Moreover, the absence of cytotoxic effects of the material on SASCs was assessed in both stemness-preserving or chondro-inductive media. Printing trials were performed to identify optimal process parameters and co-printing and post-printing seeding approaches of SASCs were evaluated. Cells were found to be viable after co-printing and also after the FT1 treatment. Viable adherent cells were also found in the FT5 system, where cells were plated after freezing and thawing treatment.

Background & aims The use of oral nutritional supplements (ONS) in the hospital setting is important to reach individual protein and energy goals in patients at risk for malnutrition. Compliance with ONS can be challenging but may be improved by prescribing ONS in smaller portions with medication rounds (MEDPass). We compared the likelihood of meeting energy and protein requirements in patients receiving ONS with MEDPass versus conventional ONS administration. Methods The MEDPass Trial is a randomized, controlled, open-label superiority trial conducted on medical and geriatric wards in a University Hospital in Switzerland. The MEDPass group was allocated to receive 50 ml of ONS four times per day with the medication rounds. The control group received ONS per conventional care between the meals. The primary outcome was the percentage of energy in relation to the individual requirement. Secondary outcomes included the coverage of protein intake in relation to the individual requirement, the amount of daily consumed ONS, the course of handgrip strength (HGS), body weight appetite and nausea. Furthermore, we compared 30-day mortality and hospital length of stay (LOS) was studied in medical patients. Results From November 22nd, 2018 until November 30th, 2021, 204 patients were included in the trial (MEDPass group n = 100, control group n = 104). A total of 203 patients at nutritional risk were analyzed in the intention-to-treat analysis (ITT). Regarding the primary endpoint, there was no difference in the coverage of energy requirement between the MEDPass and control group (82 vs. 85% (Δ −3%, 95%CI -11 to 4%), p = 0.38). Similarly, no differences were found for the secondary outcomes including coverage of protein requirement (101 vs. 104% (Δ −3%, 95% CI -12 -7%), p = 0.57, average daily intake of ONS (170 vs 173 ml (Δ – 3 ml, 95% CI -14 to 8 ml), p = 0.58) and 30-day mortality (3 vs. 8 patients, OR 0.4 (95% CI 0.1–1.4), p = 0.15). The course of HGS, body weight, appetite and nausea did not differ between the groups (p = 0.29, p = 0.14, p = 0.65 and p = 0.94, respectively). The per protocol analysis including 178 patients showed similar results. Conclusion Within this controlled trial setting, we found a high compliance for ONS intake and high coverage of protein requirements but no further improvement when ONS was administered using MEDPass compared to conventional care. MEDPass administration may provide an alternative that is easy to integrate into nursing routines, which may lead to lower workload with cost benefits and reduction of food waste.

In recent decades, astronomy has seen a boom in large-scale stellar surveys of the Galaxy. The detailed information obtained about millions of individual stars in the Milky Way is bringing us a step closer to answering one of the most outstanding questions in astrophysics: how do galaxies form and evolve? The Milky Way is the only galaxy where we can dissect many stars into their high-dimensional chemical composition and complete phase space, which analogously as fossil records can unveil the past history of the genesis of the Galaxy. The processes that lead to large structure formation, such as the Milky Way, are critical for constraining cosmological models; we call this line of study Galactic archaeology or near-field cosmology. At the core of this work, we present a collection of efforts to chemically and dynamically characterise the disks and bulge of our Galaxy. The results we present in this thesis have only been possible thanks to the advent of the Gaia astrometric satellite, which has revolutionised the field of Galactic archaeology by precisely measuring the positions, parallax distances and motions of more than a billion stars. Another, though not less important, breakthrough is the APOGEE survey, which has observed spectra in the near-infrared peering into the dusty regions of the Galaxy, allowing us to determine detailed chemical abundance patterns in hundreds of thousands of stars. To accurately depict the Milky Way structure, we use and develop the Bayesian isochrone fitting tool/code called StarHorse; this software can predict stellar distances, extinctions and ages by combining astrometry, photometry and spectroscopy based on stellar evolutionary models. The StarHorse code is pivotal to calculating distances where Gaia parallaxes alone cannot allow accurate estimates. We show that by combining Gaia, APOGEE, photometric surveys and using StarHorse, we can produce a chemical cartography of the Milky way disks from their outermost to innermost parts. Such a map is unprecedented in the inner Galaxy. It reveals a continuity of the bimodal chemical pattern previously detected in the solar neighbourhood, indicating two populations with distinct formation histories. Furthermore, the data reveals a chemical gradient within the thin disk where the content of 𝛼-process elements and metals is higher towards the centre. Focusing on a sample in the inner MW we confirm the extension of the chemical duality to the innermost regions of the Galaxy. We find stars with bar shape orbits to show both high- and low-𝛼 abundances, suggesting the bar formed by secular evolution trapping stars that already existed. By analysing the chemical orbital space of the inner Galactic regions, we disentangle the multiple populations that inhabit this complex region. We reveal the presence of the thin disk, thick disk, bar, and a counter-rotating population, which resembles the outcome of a perturbed proto-Galactic disk. Our study also finds that the inner Galaxy holds a high quantity of super metal-rich stars up to three times solar suggesting it is a possible repository of old super-metal-rich stars found in the solar neighbourhood. We also enter into the complicated task of deriving individual stellar ages. With StarHorse, we calculate the ages of main-sequence turn-off and sub-giant stars for several public spectroscopic surveys. We validate our results by investigating linear relations between chemical abundances and time since the 𝛼 and neutron capture elements are sensitive to age as a reflection of the different enrichment timescales of these elements. For further study of the disks in the solar neighbourhood, we use an unsupervised machine learning algorithm to delineate a multidimensional separation of chrono-chemical stellar groups revealing the chemical thick disk, the thin disk, and young 𝛼-rich stars. The thick disk is shown to have a small age dispersion indicating its fast formation contrary to the thin disk that spans a wide range of ages. With groundbreaking data, this thesis encloses a detailed chemo-dynamical view of the disk and bulge of our Galaxy. Our findings on the Milky Way can be linked to the evolution of high redshift disk galaxies, helping to solve the conundrum of galaxy formation., In den letzten Jahrzehnten hat die Astronomie mit großen galaktischen Durchmusterungen einen Boom erlebt. Die dadurch gewonnenen detaillierten Informationen über Millionen von Einzelsternen in der Milchstraße bringen uns der Beantwortung einer der wichtigsten Fragen der Astrophysik einen Schritt näher: Wie entstehen und entwickeln sich Galaxien? Die Milchstraße ist die einzige Galaxie, in der wir viele Sterne in ihre hochdimensionale chemische Zusammensetzung und ihren vollständigen Phasenraum zerlegen können, was analog zu fossilen Aufzeichnungen die Entstehungsgeschichte der Galaxie enthüllen kann. Für kosmologische Modelle ist es von entscheidender Bedeutung, die Prozesse zu verstehen, die zur Bildung großer Strukturen wie der Milchstraße führen; wir nennen diese Studienrichtung Galaktische Archäologie oder Nahfeldkosmologie. Im Mittelpunkt dieser Arbeit stehen die Bemühungen, die Scheiben und den Bulge unserer Galaxie chemisch und dynamisch zu charakterisieren. Die Ergebnisse, die wir in dieser Arbeit vorstellen, waren nur dank des starts des astrometrischen Satelliten Gaia möglich, der das Gebiet der galaktischen Archäologie durch die präzise Messung der Positionen, Parallaxenwinkel und Eigenbewegungen von mehr als einer Milliarde Sterne revolutioniert hat. Ein weiterer, aber nicht minder wichtiger Durchbruch ist die APOGEE-Durchmusterung, die Spektren im nahen Infrarot beobachtet hat, was es uns erlaubt, durch die staubigen Regionen der Milchstraße hindurchzublicken und die chemischen Fingerabdrücke von Hunderttausenden von Sternen zu bestimmen. Um die Struktur der Milchstraße genau darzustellen, verwenden und entwickeln wir das Isochrone-fitting-Tool StarHorse; diese Software kann Sternentfernungen, Aussterbezeiten und Alter vorhersagen, indem sie Astrometrie, Photometrie und Spektroskopie auf der Grundlage von Modellen der Sternentwicklung kombiniert. Der Code StarHorse ist von zentraler Bedeutung für die Berechnung von Entfernungen, bei denen Gaia -Parallaxen allein keine Bestimmung ermöglichen. Wir zeigen, dass wir durch die Kombination von Gaia, APOGEE und StarHorse eine chemische Kartographie der Milchstraßenscheiben von ihrem äußersten bis zum innersten Teil erstellen können. Eine solche Karte ist in der inneren Galaxis beispiellos und zeigt ein bimodales chemisches Muster, das auf zwei Populationen mit unterschiedlichen Entstehungsgeschichten hinweist. Darüber hinaus bestätigen die Daten einen chemischen Gradienten innerhalb der dünnen Scheibe, bei dem der Gehalt an Elementen und Metallen aus 𝛼-Prozessen zum Zentrum hin zunimmt ist. Eine Überdichte in der Anzahl der Sterne bestätigt zudem die Signatur eines Balkens in der inneren Galaxie. Modelle der Galaxienentstehung sagen gewöhnlich deren Beginn im galaktischen Zentrum voraus. Wir konzentrieren uns auf eine Stichprobe in der inneren Galaxie und erwarten, dass wir primordiale stellare Populationen finden. Wir bestätigen die chemische Bimodalität der inneren Galaxie und dass der galaktische Balken sowohl aus Sternen mit hohem als auch mit niedrigem 𝛼 besteht, was darauf hindeutet, dass sich der Balken durch säkulare Evolution gebildet hat, bei der bereits existierende Sterne eingefangen wurden. Durch die Analyse des chemischen Orbitalraums der inneren galaktischen Regionen können wir die verschiedenen Populationen, die diese komplexe Region bewohnen, unterscheiden. Wir zeigen das Vorhandensein einer dünnen Scheibe, einer dicken Scheibe, eines Balkens und einer gegenläufig rotierenden Population, die dem Ergebnis einer gestörten proto-galaktischen Scheibe ähnelt. Unsere Studie zeigt auch, dass die innere Galaxie eine große Menge an supermetallreichen Sternen enthält, die bis zum Dreifachen der solaren Metallizität reichen. Möglicherweise handelt es sich bei der Gruppe alter supermetallreicher Sterne, die in der Sonnenumgebung gefunden wurden um Kandidaten für Migranten aus den innersten Regionen. Wir befassen uns auch mit der komplizierten Aufgabe der Bestimmung individueller Sternalter. Mit StarHorse berechnen wir das Alter von Hauptreihenabzweig- und Unterriesensternen für mehrere öffentliche spektroskopische Durchmusterungen. Wir validieren unsere Ergebnisse, indem wir lineare Abhängigkeiten zwischen den chemischen Häufigkeiten und der Zeit untersuchen, da die 𝛼- und Neutroneneinfang-Elemente empfindlich auf das Alter reagieren, was auf die unterschiedlichen Zeitskalen der Anreicherung dieser Elemente zurückzuführen ist. Zur weiteren Untersuchung der Scheiben in der Sonnenumgebung verwenden wir einen nicht überwachten Algorithmus für maschinelles Lernen, um eine mehrdimensionale Trennung der chrono-chemischen Sterngruppen vorzunehmen. Dies macht die chemisch dicke Scheibe, die dünne Scheibe und junge 𝛼 Sterne erkennbar. Es zeigt sich, dass die dicke Scheibe eine geringe Altersstreuung aufweist, was auf ihre schnelle Entstehung hindeutet, während die dünne Scheibe eine große Altersspanne abdeckt. Mit bahnbrechenden Daten liefert diese Arbeit ein detailliertes chemodynamisches Bild der Scheibe und des Bulge der Galaxis. Unsere Erkenntnisse über die Milchstraße können mit der Entwicklung von Scheibengalaxien mit hoher Rotverschiebung in Verbindung gebracht werden und so zur Lösung des Rätsels der Galaxienbildung beitragen.

Purpose Coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) is currently the major threat for immunocompromised individuals. The course of COVID-19 in lung transplant recipients in the Omicron era remains unknown. The aim of the study was to assess outcome and associated factors in lung transplant recipients in a German-wide multicenter approach. Methods All affected individuals from January 1st to March 20th, 2022 from 8 German centers during the Omicron wave were collected. Baseline characteristics and antiviral measures were associated with outcome. Results Of 218 patients with PCR-proven SARS-CoV-2 infection 166 patients (76%) received any early (2 were independent risk factors for a severe or critical COVID-19. Conclusion COVID-19 due to Omicron remains an important threat for lung transplant recipients. In particular, elderly patients and patients with impaired kidney function are at risk for worse outcome. Prophylaxis and therapy in highly immunocompromised individuals need further improvement.

The eighteenth data release of the Sloan Digital Sky Surveys (SDSS) is the first one for SDSS-V, the fifth generation of the survey. SDSS-V comprises three primary scientific programs, or "Mappers": Milky Way Mapper (MWM), Black Hole Mapper (BHM), and Local Volume Mapper (LVM). This data release contains extensive targeting information for the two multi-object spectroscopy programs (MWM and BHM), including input catalogs and selection functions for their numerous scientific objectives. We describe the production of the targeting databases and their calibration- and scientifically-focused components. DR18 also includes ~25,000 new SDSS spectra and supplemental information for X-ray sources identified by eROSITA in its eFEDS field. We present updates to some of the SDSS software pipelines and preview changes anticipated for DR19. We also describe three value-added catalogs (VACs) based on SDSS-IV data that have been published since DR17, and one VAC based on the SDSS-V data in the eFEDS field., Comment: Accepted to ApJS

Extracellular High-mobility group box 1 (HMGB1) contributes to the pathogenesis of inflammatory disorders, including inflammatory bowel diseases (IBD). Poly (ADP-ribose) polymerase 1 (PARP1) has been recently reported to promote HMGB1 acetylation and its secretion outside cells. In this study, the relationship between HMGB1 and PARP1 in controlling intestinal inflammation was explored. C57BL6/J wild type (WT) and PARP1−/− mice were treated with DSS to induce acute colitis, or with the DSS and PARP1 inhibitor, PJ34. Human intestinal organoids, which are originated from ulcerative colitis (UC) patients, were exposed to pro-inflammatory cytokines (INFγ + TNFα) to induce intestinal inflammation, or coexposed to cytokines and PJ34. Results show that PARP1−/− mice develop less severe colitis than WT mice, evidenced by a significant decrease in fecal and serum HMGB1, and, similarly, treating WT mice with PJ34 reduces the secreted HMGB1. The exposure of intestinal organoids to pro-inflammatory cytokines results in PARP1 activation and HMGB1 secretion; nevertheless, the co-exposure to PJ34, significantly reduces the release of HMGB1, improving inflammation and oxidative stress. Finally, HMGB1 release during inflammation is associated with its PARP1-induced PARylation in RAW264.7 cells. These findings offer novel evidence that PARP1 favors HMGB1 secretion in intestinal inflammation and suggest that impairing PARP1 might be a novel approach to manage IBD.

In vorgegangenen Studien wurde bei erwachsenen Patienten mit Angststörungen eine verstärkte Furchtgeneralisierung, eine eingeschränkte Fähigkeit zur Reizdiskrimination sowie eine veränderte Aufmerksamkeitsverteilung nachgewiesen. In einer gesunden Studienpopulation konnte bei Kindern eine stärkere Furchtgeneralisierung nachgewiesen werden als bei Erwachsenen. Ihre Generalisierungsgradienten gleichen denen von Erwachsenen mit Angststörung. Möglicherweise haben gestörte Lernprozesse in der Kindheit somit langfristige Effekte auf die Entwicklung von Angststörungen. Obwohl die Vorgänge des Furchtlernens im Kindesalter entscheidend für das Verständnis von Angststörungen sind, gibt es kaum Studien in dieser Altersgruppe. Die vorliegende Studie untersucht die Zusammenhänge von Furchtgeneralisierung und Aufmerksamkeitsprozessen in einer klinischen Population mit internalisierender Störung im Kindes- und Jugendalter. Hierzu durchliefen Kinder und Jugendliche mit internalisierender Störung (n= 49) sowie gesunde Kontrollen (n=48) im Alter von 9 bis 17 Jahre ein Furcht-generalisierungsparadigma mit Diskriminationstraining sowie einen modifizierten Dotprobe mit integriertem Eyetracking. Die Ängstlichkeit wurde mittels verschiedener Angstfragebögen gemessen. Im Generalisierungsparadigma wurden zwei weibliche Gesichter mit neutralem Gesichtsausdruck als Stimuli verwendet, die entweder mit (CS+) oder ohne (CS-) einem 95dB lauten Schrei sowie einem angsterfüllten Gesichtsausdruck gezeigt wurden. Zur Messung der Furchtreaktion wurden subjektive Ratings für Arousal, Valenz und Kontingenz erfasst, zudem wurde die Hautleitfähigkeit gemessen. Zur Auswertung des Dotprobes wurden die Reaktionszeiten und die Initialsakkade erfasst. Die statistische Analyse des Furchtgeneralisierungsparadigmas sowie des Dotprobe-Paradigmas wurde mittels Multivarianzanalysen mit Messwiederholung durchgeführt, gefolgt von t-Tests zur weiterführenden Analyse. Desweiteren wurden die Aufmerksamkeitsreaktionen von nicht-ängstlichen und ängstlichen Teilnehmern in Kategorien eingeteilt und mittels Chi-Quadrat Analysen verglichen. Zur Analyse des Zusammenhangs zwischen Furchtgeneralisierung und Aufmerksamkeitsprozessen erfolgte eine Regressionsanalyse mit einem GS Mittelwert als abhängiger Variable und der Ängstlichkeit und den Aufmerk-samkeitsprozessen als Prädiktoren. Die Ergebnisse bestätigten eine solide Furchtkonditionierung anhand des „Screaming Lady“-Paradigmas in einer klinischen Population, dies war erkennbar an höheren Ratings für den aversiven Stimulus im Vergleich zum sicheren Stimulus in beiden Gruppen. Grundsätzlich höhere Furchtratings sowie höhere Ratings der Generalisierungsstimuli im Vergleich zum sicheren Stimulus wiesen auf eine stärkere Generalisierung in der Untergruppe mit höherem Angst-Trait innerhalb der internalisierenden Probandengruppe hin. Die Analyse der Dotprobe Daten ergab schnellere Reaktionszeiten sowie häufigere Initialsakkaden gegenüber furchteinflößenden Stimuli bei Patienten mit internalisierender Störung. Des Weiteren zeigten sehr ängstliche Probanden häufiger einen Attentional bias im Chi Quadrat Test als nicht-ängstliche Probanden. Dies wies daraufhin, dass sowohl bei Patienten mit internalisierender Störung als auch bei sehr ängstlichen Probanden ein Attentional bias gegenüber furchtrelevanten Stimuli vorliegt. Vor allem bei Kindern mit internalisierender Störung sagten die Ängstlichkeit und veränderte Aufmerksamkeitsprozesse die Ausprägung der Furchtgeneralisierung voraus. Somit kann ein Zusammenhang von veränderten Aufmerksamkeitsprozessen und Furchtgeneralisierung vermutet werden., Overgeneralization of fear, diminished discrimination skills as well as attentional biases were identified in adult patients with anxiety disorders in preceding studies. In healthy individuals, children display stronger fear generalization than adults. Their generalization gradients resemble those of adults with anxiety disorders. Hence, dysfunctional learning processes during childhood may have long term effects on developing anxiety disorders. Despite the relevance of fear learning in childhood, few studies on the underlying cognitive processes exist. This study investigates the associations of fear generalization with attentional biases in a clinical population of children and adolescents suffering from internalizing disorders. Therefore, children and adolescents with internalizing disorders (n= 49) as well as a healthy control group (n= 48) completed a fear generalization paradigm with discrimination task as well as a modified dot probe task with integrated eye tracking. Trait anxiety was determined by different anxiety questionnaires. The generalization task used two neutral female faces as stimuli which were paired (CS+) or not paired (CS-) with a 95dB loud scream and a fearful facial expression. Fear reactions were measured by subjective ratings of arousal, valence and contingency as well as by skin conductance responses. The dot probe analysis included a comparison of reaction times and initial saccades. Statistical analyses of the fear generalization task and the dot probe were performed by repeated measures ANOVA followed by t-tests for further analysis. Moreover, attentional biases of non-anxious and very anxious participants were classified into categories and compared by Chi square analysis. In order to analyse the associations of fear generalization with attentional biases a regression analysis was conducted with a GS mean value as dependant variable and anxiety scores and attention allocation biases as predictors. Significance levels were set at p=.05. Results showed solid fear conditioning in a clinical population by the “Screaming lady” paradigm with significantly higher ratings for the aversive stimulus compared to the safe stimulus in both groups. Generally higher fear ratings as well as higher ratings of the generalization stimuli compared to the safe stimulus indicated stronger fear generalization in the anxious subgroup among patients with internalizing disorders. In the dot probe analysis, patients with internalizing disorders showed faster reaction times and more initial saccades when confronted with a threatening stimulus. Furthermore, the group of anxious participants displayed a higher frequency of attentional bias in the Chi square analysis compared to the non-anxious subgroup. These results indicate a threat related attentional bias in patients with internalizing disorders as well as in very anxious subjects. Anxiety scores and attentional bias measures predicted the level of generalization in the regression analysis, most notably, in children with internalizing disorders. This indicates combined effects of fear generalization and attentional biases for minor clinical populations.

Der Pflegeberuf steht angesichts des Bevölkerungswachstums und der Alterung der Gesellschaft, aber auch der gesellschaftlichen Veränderungen vor grossen Herausforderungen. Um die Qualität der Pflege erhalten zu können, müssen zwingend mehr Pflegefachkräfte ausgebildet und die Arbeitsbedingungen verbessert werden. Beides waren Forderungen der Schweizer Volksinitiative „Für eine starke Pflege” (siehe: Artikel 117b Bundesverfassung1), die am 28. November 2021 mit einem historischen Abstimmungserfolg an der Urne angenommen wurde.

Self-efficacy expectancy in adolescents with anorexia nervosa in the outpatient setting: A cross-sectional study

As discussões sobre o estado de preservação e possibilidades de impactos a sítios arqueológicos na arqueologia brasileira têm sido um tema recorrente e importante para moldar as ações de instituições de salvaguarda e pesquisadores da área. Especialmente a partir da década de 1960, vários estudos têm sido realizados sobre esse tema na intenção de diagnosticar e, quando possível, agir sobre as questões de conservação. Independentemente do ambiente e tipo de sítios arqueológicos que sejam objeto dessas preocupações, tem se mostrado necessário levar em consideração a ocupação humana recente como um dos principais fatores de interferência sobre os sítios. A partir do levantamento realizado em 100 sítios arqueológicos localizados nos municípios de Manaus e Iranduba, Estado do Amazonas, buscamos contribuir com esta questão. Para tal, partimos do princípio que é imprescindível considerar a relação de comunidades contemporâneas com objetos arqueológicos a partir não só das estratégias de ocupação e uso do espaço que processam sobre áreas com sítios arqueológicos, como também ponderar a influência das lógicas de salvaguarda cultural que se utilizam ao longo da formação de suas identidades culturais e memória social. Discussions about the state of preservation and possibilities of impacts on archeological sites in Brazilian archeology have been a recurrent and important theme to shape the actions of safeguard institutions and researchers in the area. Especially since the 1960s, several studies have been carried out on this topic with the intention of diagnosing and, when possible, acting on conservation issues. Regardless of the environment and type of archaeological sites that are the object of these concerns, it has proved necessary to take into account recent human occupation as one of the main factors interfering with the sites. Based on the survey carried out in 100 archaeological sites located in the cities of Manaus and Iranduba, State of Amazonas, we seek to contribute to this issue. To this end, we assume that it is essential to consider the relationship of contemporary communities with archaeological objects from not only the occupation and use of space strategies that process over areas with archaeological sites, but also to consider the influence of cultural safeguard logics that are they use throughout the formation of their cultural identities and social memory.

Background: Pressure Injuries are not exclusively an adult phenomenon; various risk factors contribute to a high prevalence rate of 43% in the neonatal and pediatric intensive care population. Effective preventive measures in this population are limited. Methods: We performed a pilot study to analyze the distribution and localization of support surface interface pressures in neonates in a pediatric intensive care unit (PICU). The hypothesis was that pressure redistribution by a novel air mattress would reduce pressure peaks in critical neonates. The measurements were conducted in a 27-bed level III PICU between November and December 2020. This included measuring pressure distribution and pressure peaks for five neonates positioned on either a state-of-the-art foam mattress or a new prototype air mattress. Results: We confirmed that the pressure peaks were significantly reduced using the prototype air mattress, compared with the state-of-the-art foam mattress. The reduction of mean pressure values was 9%–29%, while the reduction of the highest 10% of pressure values was 23%–41%. Conclusions: The journey to an effective, optimal, and approved product for severely ill neonates to reduce Pressure Injuries is challenging. However, a crucial step was completed by this pilot study with the first pressure measurements in a real-world setting and the successful realization of a decrease in pressure peaks obtained using a prototype air mattress.

International audience; Marine ecosystems are important drivers of the global climate system. They emit volatile species into the atmosphere, involved in complex reaction cycles that influence the lifetime of greenhouse gases. Sea spray and marine biogenic aerosols affect Earth's climate by scattering solar radiation and controlling cloud microphysical properties. Here we show larger than expected marine biogenic emissions of butenes, three orders of magnitude higher than dimethyl sulfide, produced by the coastal part of the Benguela upwelling system, one of the most productive marine ecosystems in the world. We show that these emissions may contribute to new particle formation in the atmosphere within the marine boundary layer through production of Criegee intermediates that oxidize SO2 to H2SO4. Butene emissions from the marine biota may affect air quality and climate through ozone, secondary organic aerosol, and cloud condensation nuclei formation even in pristine regions of the world. Our results indicate a potentially important role of butene emissions in marine particle formation that requires investigation in other regions.

Aims Current methods to induce tolerance following allotransplantation or in autoimmunity carry significant morbidity, and research is very active in investigating alternative methods which could minimize toxicity. Spheroids from adipose stem cells (SASCs) are increasingly gaining interest, they hold a great proliferative and differentiating potential. An immunomodulatory effect has not been investigated on SASCs yet. In this study, we analysed the immunomodulatory properties of SASCs and compared them to ADSCs. Main methods Adipose stem cells (SASCs and ADSCs) and peripheral blood mononuclear cells (PBMCs) were collected from healthy individuals. We analysed the cytokine production and proliferation of T cells co-cultured with adipose samples or conditioned medium. Key findings SASCs modulated cytokines production and proliferation of heterologous and autologous T cells. In the heterologous assays, we observed a reduction of IFNγ and IL-17 production and an increase of IL-9 in γδ T cells. The soluble factors present in SASCs sovranatants were also able to induce a slight reduction of IFNγ and an increase of IL-9, IL-10 and IL-17 while they could not modulate the proliferative ability of γδ T cells. In the autologous assays, we observed a reduction of the proliferative ability of T cells in co-culture at different ratios with SASCs. Analysis of the SASCs secretome showed an increased IL-5, IL-10, IL-4 and IL-13 production compared to the ADSCs one, demonstrating greater anti-inflammatory properties. Significance Our preliminary results support the idea that SASCs exert more pronounced biological immune modulation compared to the classical adherent ADSCs, especially in heterologous experimental settings.

Background Understanding the natural history of anal high-risk human papillomavirus (hrHPV) infection is key for designing anal cancer prevention programs but has not been systematically characterized. Methods We reanalyzed data from 34 studies including 16 164 individuals in 6 risk groups defined by human immunodeficiency virus (HIV) status, sex, and male sexuality: men who have sex with men (MSM) and people with HIV (MSMWH), HIV-negative MSM, women with HIV (WWH), HIV-negative women, men who have sex with women (MSW) with HIV (MSWWH), and HIV-negative MSW. We used Markov models to estimate incidence and clearance of 13 hrHPV types and their determinants. Results Human papillomavirus (HPV) 16 had the highest incidence-clearance ratio of the hrHPV types. MSMWH had the highest hrHPV incidence (eg, 15.5% newly HPV-16 infected within 2 years), followed by HIV-negative MSM (7.5%), WWH (6.6%), HIV-negative women (2.9%), MSWWH (1.7%), and HIV-negative MSW (0.7%). Determinants of HPV-16 incidence included HIV status and number of sexual partners for MSM, women, and MSW, and anal sex behavior for MSM only. HPV-16 clearance was lower for people with HIV (PWH) and lower for prevalent than incident infection. Among MSM, increasing age was associated with lower clearance of prevalent, but not incident, HPV-16 infection. Conclusions This robust and unifying analysis of anal hrHPV natural history is essential to designing and predicting the impact of HPV vaccination and HPV-based screening programs on anal cancer prevention, particularly in MSM and PWH. Importantly, it demonstrates the higher carcinogenic potential of longstanding anal prevalent hrHPV infection than more recent incident infection.

Although great strides have been made to tackle hospital-acquired pressure ulcers (HAPUs), there is a need for greater recognition of device-related pressure ulcers (DRPUs), including their causes, management and prevention. This consensus statement, an updated second edition, aims to continue raising awareness of these largely preventable injuries and, crucially, to stimulate action. DRPUs are relatively common and account for a growing proportion of HAPUs. Updated information on the incidence of DRPUs is described in chapter 1. Although it is recognised that DRPUs increase the financial burden of healthcare, there is little formal analysis of their economic impact. This needs to be addressed; robust evidence on the burden of DRPUs and the value that can be released by adopting prevention strategies is needed to help drive action. Our understanding of the pathophysiology of DRPUs has improved significantly over the past few years; this is described in chapter 2. One crucial difference between PUs and DRPUs is that body-weight forces are less significant in DRPUs, with the force being exerted from a device that is typically strapped or taped onto the body. Devices and their securement may generate high stress concentrations in tissues, leading to cell and tissue-damage pathways associated with sustained deformation. As more evidence is published on DRPUs, recurring themes are emerging, as outlined in chapter 3: The most vulnerable patients are bearing the brunt of DRPUs; paediatric and neonatal patients, and all those needing critical care are particularly susceptible. During the COVID-19 pandemic, a new high-risk population (people with severe COVID-19 infection) emerged. They are at increased risk of DRPUs because of their need for prolonged ventilatory support, especially when 'proning' Devices associated with DRPUs are often used to perform essential, life-saving functions. They include continuous positive airway pressure (CPAP) masks or endotracheal tubes. Minimising their use is clearly not an option, so practice innovation is needed Although the most common locations for DRPUs are the face, ears, lower legs and heels, any location where a device comes into close contact with the skin can be at risk. In the same vein, any device, whether needed for a medical purpose or not, has the capacity to cause injury if its use is not properly managed. Vigilance is needed for all patients. What can be done? The importance of routine risk assessment is covered in chapter 4. Although use of a validated risk assessment tool is the vital first step, this will not be enough on its own. Several steps can be taken to ensure the safe use of devices. These are described in chapter 5 and include device repositioning, cushioning with prophylactic dressings and moisture control (only where possible and clinically appropriate). Of key importance is the development of an institutional protocol and champions to ensure all necessary steps are adopted. For any of these changes to be put into practice, awareness of DRPUs needs to increase. A number of proposals are outlined in chapter 6. A change of focus among health professionals and policy makers, along with more investment in education and training, are needed. All patients being managed with a medical device must be considered as at high risk. The pandemic introduced the world to the problem of DRPUs in health professionals caused by the extended wear of personal protective equipment. Health professionals also have a right to expect institutional protocols and provision of devices that protect them from DRPUs. Cutting-edge ideas and technologies that may be available in the future are described in chapter 7. When designing new products, manufacturers of medical devices have a duty of care to investigate the risks of DRPUs associated with their products and mitigate them, wherever possible. Our developing understanding of how the design, structure and materials used in medical devices contribute to DRPUs will help us develop new solutions for tomorrow. The first step is for everyone involved to ask themselves, 'what can I do to help?' There is work to be done-your journey to reduce DRPUs starts here!.

We examined reporting agreement of oral, vaginal, and anal sex in adolescents and young adults living with perinatally-acquired HIV and those perinatally HIV-exposed and uninfected in the Pediatric HIV/AIDS Cohort Study Adolescent Master Protocol (AMP) and AMP Up studies. Agreement between fixed constructs (e.g., age at first sex) and prevalence of logical inconsistencies (e.g., reclaimed virginity status) over time were assessed. Internal consistency was also examined using an attention check question and questions regarding condom use in the prior three months. Those who reported having anal sex in adolescence had a higher proportion of inconsistent responses compared to vaginal and oral sex measures. At their most recent survey, 84% of young adults correctly answered an attention check question and 74% agreed within the survey on condom use in the prior three months. In bivariate analyses, HIV status was not associated with responding inconsistently. Increased time between surveys, male sex, and younger age at first survey were associated with multiple measures of inconsistency over time, while lower cognitive scores, having less than a high school diploma, and negatively answering post-survey acceptability questions were associated with incorrectly answering an attention check question.

Deep copper ore mines in Poland have been struggling with seismic hazard since almost fifty years ago when the first rock burst occurred. Increasing exploitation depth and mined-out space make the mining conditions constrained and severe causing the seismic activity to grow substantially. Consequently, rock burst preventive activities have to be incorporated into mining technology to provide work safety. To date, the group winning blasting has posed the most commonly used preventive measure, so its efficiency in seismic energy reduction is of significant importance for the rock burst hazard mitigation. The more energy blasting works provoke to release the safer the work environment gets. The article aimed to assess the efficiency of such an energy reduction, which was approached in two ways. Firstly, the drop of energy and in turn its reduction efficiency was assessed simply using a percentage of provoked tremors’ energy and number. Next, the analysis employed passive seismic tomography results to find if provoked tremors took place in high-velocity zones. The analysis made it possible to verify the assumption that the more provoked energy occurs in such zones the more successful preventive blasting is.

Coral reefs and their associated marine communities are increasingly threatened by anthropogenic climate change. A key step in the management of climate threats is an efficient and accurate end-to-end system of coral monitoring that can be generally applied to shallow water reefs. Here, we used RGB drone-based imagery and a deep learning algorithm to develop a system of classifying bleached and unbleached corals. Imagery was collected five times across one year, between November 2018 and November 2019, to assess coral bleaching and potential recovery around Lord Howe Island, Australia, using object-based image analysis. This training mask was used to develop a large training dataset, and an mRES-uNet architecture was chosen for automated segmentation. Unbleached coral classifications achieved a precision of 0.96, a recall of 0.92, and a Jaccard index of 0.89, while bleached corals achieved 0.28 precision, 0.58 recall, and a 0.23 Jaccard index score. Subsequently, methods were further refined by creating bleached coral objects (>16 pixels total) using the neural network classifications of bleached coral pixels, to minimize pixel error and count bleached coral colonies. This method achieved a prediction precision of 0.76 in imagery regions with >2000 bleached corals present, and 0.58 when run on an entire orthomosaic image. Bleached corals accounted for the largest percentage of the study area in September 2019 (6.98%), and were also significantly present in March (2.21%). Unbleached corals were the least dominant in March (28.24%), but generally accounted for ~50% of imagery across other months. Overall, we demonstrate that drone-based RGB imagery, combined with artificial intelligence, is an effective method of coral reef monitoring, providing accurate and high-resolution information on shallow reef environments in a cost-effective manner.

This paper shows that perceptions of inequality matter for demand for redistribution and investigates how individuals form their perceptions. Using data from the ISSP, we present new evidence on the significant changes of perceptions of inequality for more than 20 countries during the last three decades and how these are not in synch with changes in objective inequality. Rather than indicating misperceptions, these discrepancies reflect a broader view of inequality that for most individuals encompasses poverty, insecurity in the labor markets, availability of public goods in addition to objective income disparities. We then show that these perceptions have much stronger correlation with demand for redistribution than objective inequality, or any of the mentioned contextual variables that mold perceptions. Ideology and self-interest also contribute to demand for redistribution. Much more than those on the left, right-leaning individuals adjust their demand for redistribution in line with their inequality perceptions.

Post-transplant lymphoproliferative disorder is a life-threatening complication of immunosuppression following transplantation mediated by failure of T cells to control Epstein-Barr virus (EBV)-infected and transformed B cells. Typically, a modification or reduction of immunosuppression is recommended, but insufficiently defined thus far. In order to help delineate this, we characterized EBV-antigen-specific T cells and lymphoblastoid cell lines from healthy donors and in patients with a kidney transplant in the absence or presence of the standard immunosuppressants tacrolimus, cyclosporin A, prednisolone, rapamycin, and mycophenolic acid. Phenotypes of lymphoblastoid cell-lines and T cells, T cell-receptor-repertoire diversity, and T-cell reactivity upon co-culture with autologous lymphoblastoid cell lines were analyzed. Rapamycin and mycophenolic acid inhibited lymphoblastoid cell-line proliferation. T cells treated with prednisolone and rapamycin showed nearly normal cytokine production. Proliferation and the viability of T cells were decreased by mycophenolic acid, while tacrolimus and cyclosporin A were strong suppressors of T-cell function including their killing activity. Overall, our study provides a basis for the clinical decision for the modification and reduction of immunosuppression and adds information to the complex balance of maintaining anti-viral immunity while preventing acute rejection. Thus, an immunosuppressive regime based on mTOR inhibition and reduced or withdrawn calcineurin inhibitors could be a promising strategy for patients with increased risk of or manifested EBV-associated post-transplant lymphoproliferative disorder.