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Food insecurity is linked with poor physical and mental health outcomes, including anxiety, depression and stress. Rural residents in particular face unique challenges obtaining healthy food; the COVID-19 pandemic exacerbated the relationship between food insecurity and mental health outcomes. This study examines the relationship between food insecurity and stress, and the moderating influence of household characteristics, neighborhood social environment and food environment on this relationship, using a sample of 630 rural South Carolina (SC) residents during COVID-19. Two measures of stress were used in this study: current levels of stress and changes in stress since COVID-19. Results showed a gradient pattern between food insecurity and stress: rural residents with high food insecurity were 6.1 times more likely and those with moderate food insecurity were 3.4 times more likely to report higher level of general stress than those with low food insecurity; rural residents with high food insecurity were 3.3 times more likely and those with moderate food insecurity were 2.0 times more likely to report greater increase in stress after COVID-19 than those with low food insecurity. Neighborhood social environment and food environment provided a buffering effect on the relationship between food insecurity and stress. A stronger social environment after COVID-19 and higher levels of easiness in food access mitigated the negative impacts of food insecurity on stress. Efforts to ameliorate food insecurity should address these broader contextual variables, involving community-level factors.

During the COVID-19 pandemic, healthcare workers (HCW) were categorized as “essential” and “non-essential”, creating a division where some were “locked-in” a system with little ability to prepare for or control the oncoming crisis. Others were “locked-out” regardless of whether their skills might be useful. The purpose of this study was to systematically gather data over the course of the COVID-19 pandemic from HCW through an interprofessional lens to examine experiences of locked-out HCW. This convergent parallel mixed-methods study captured perspectives representing nearly two dozen professions through a survey, administered via social media, and video blogs. Analysis included logistic regression models of differences in outcome measures by professional category and Rapid Identification of Themes from Audio recordings (RITA) of video blogs. We collected 1299 baseline responses from 15 April 2020 to 16 March 2021. Of those responses, 12.1% reported no signs of burnout, while 21.9% reported four or more signs. Qualitative analysis identified four themes: (1) professional identity, (2) intrinsic stressors, (3) extrinsic factors, and (4) coping strategies. There are some differences in the experiences of locked-in and locked-out HCW. This did not always lead to differing reports of moral distress and burnout, and both groups struggled to cope with the realities of the pandemic.

JointRep is a bioadhesive hydrogel arthroscopically injected to facilitate cartilage regeneration. The cost-effectiveness of JointRep with microfracture surgery compared to microfracture alone was evaluated from the Australian healthcare system perspective, in patients with symptomatic focal chondral defects (Outerbridge Grade 3 or 4) of the knee who had failed conservative treatment and were indicated for surgery.A de novo Markov model comprising two health states- 'Alive' and 'Dead' was developed. Model transition probability was based on the general population mortality rates. Clinical outcomes were assessed using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores, a validated patient-reported tool measuring pain, stiffness, and physical function. The utility was derived by mapping WOMAC scores to EQ-5D scores using a published algorithm. Cost inputs were based on published Australian costs from AR-DRGs, Medicare Benefits Schedule, and Prostheses List. Model outcomes included costs, Quality-adjusted life years (QALYs), and incremental cost-effectiveness ratio (ICER). Base-case analysis was conducted for a time horizon of 3 years and a cycle length of 1 year. Cost and health outcomes were discounted at 5% per annum. Sensitivity and scenario analyses were also conducted.Total QALYs were estimated to be higher for JointRep with microfracture surgery (2.61) compared to microfracture surgery alone (1.66), an incremental gain of 0.95 QALY. JointRep with microfracture surgery was associated with an incremental cost of $6,022 compared to microfracture surgery alone, thus leading to an ICER of $6,328. Results were substantially robust to varying parameters in the sensitivity analyses conducted, alternative model settings and assumptions in scenario analyses.The clinical inputs used in the model were based on data from short duration, non-randomized, post-market clinical trial.JointRep with microfracture surgery is a cost-effective treatment option compared to microfracture alone from the Australian health care system perspective.

BackgroundSelf-rated health status, a subjective measure, is used broadly to describe an individual’s overall health status. Our long-term goal is to create a more objective, comprehensive, and accurate measure of individual health status. We selected 29 health indicators and prioritized them by conducting online surveys. Thirteen of these 29 indicators received relatively more consistent ratings across 3 samples.ObjectivesTo explore the main and interaction effects of 4 demographic factors as independent variables (age, gender, professional group, and educational level) in the importance ratings of the 13 health indicators.MethodsWe conducted a 4-way multivariate analysis of variance (MANOVA) with post-hoc testing to examine the effects of independent variables on all 13 dependent variables. Descriptive statistics and bivariate correlation analysis were also conducted.DesignCross-sectional study.SettingAn online survey (≥ 18 years).Participants791 participants in the USA.Results13 health indicators were significantly correlated with each other. Age correlated with most of the health indicators (8 of 13). The MANOVA modeling results indicated that gender, age, and education levels significantly affected the combination of the 13 health indicators. There was a significant interaction effect by age and professional group on 5 health indicators.ConclusionsAge is critical in rating the 13 health indicators. Among all the statistically significant main effects of demographic factors, the effect sizes descend regarding age, gender, educational level, and interaction between age and professional group. These results can provide a foundation for further studies to explore behavioral interventions for individual subgroups.Article SummaryStrengths and limitations of this studyThe work establishes the interactions and effects between demographic data (age, gender, education, and professional group) and the perceived importance of 13 health indicators via MANOVA analysisThe interactions and effects of demographic data on the importance ratings of the 13 health indicatorscan guide future study designs for behavioral interventionsDeep analysis of the demographic variables and their effects on and interactions with the rating results are helpful for thoroughly understanding the perspectivesThe study is an observational study despite with relatively large sample size and a robust analysisThe data are not racially representative

This exploratory study examines how a community experiencing food insecurity while navigating multiple crises can be a model to inform resources, processes, and systems supporting communities facing similar circumstances. Data for this study were collected from residents of a community in Oconee County, a rural county in the northwest corner of South Carolina experiencing pervasive food insecurity. The community was severely impacted by the onset of COVID-19 and further devastated by a tornado in mid-April. The area of the county that sustained the greatest damage from the tornado was the Utica Mill Hill community, home to the county’s most vulnerable population. This cascading series of events constituted a crisis-within-a-crisis for the community. In this study, we sought to learn more about community members’ experiences and the effects of the crises on com­munity members’ access to food. We conducted in-depth interviews with 14 residents living in the Utica Mill Hill community. The results provided insight into community members’ experiences of the crises and the nature of community-level response and recovery efforts. We learned about participants’ experiences with food insecurity, new food policy developments, and gained unexpected insight into community members’ experiences with mental health challenges related to the crises.

To evaluate acute stress disorder (ASD) symptoms and their predictors in Neonatal Intensive Care Unit (NICU) mothers.In this cross-sectional study, 119 mothers (~72% Medicaid) completed surveys during the first month of their infants' hospitalizations. Correlations and structural equation models (SEMs) evaluated relations among mothers' childhood trauma history, infant health appraisals, objective infant health, and ASD.ASD symptoms (~55%) and childhood trauma (~33%) were prevalent. ASD was correlated with childhood trauma, infant health, and infant health appraisals. All SEMs had good fit, indicating that (a) infant health appraisals partially mediated relations between childhood trauma and ASD, and (b) infant health appraisals fully mediated relations between objective infant health and ASD.ASD symptoms are prevalent among NICU mothers regardless of infant health severity. Recognition of childhood trauma history and appraisals of infant health is critical for trauma-informed care.

Aims The purpose of this study was to (1) characterise the procedure of phlebotomy, deconstruct it into its constituent parts and develop a performance metric for the purpose of training healthcare professionals in a large teaching hospital and to (2) evaluate the construct validity of the phlebotomy metric and establish a proficiency benchmark. Method By engaging with a multidisciplinary team with a wide range of experience of preanalytical errors in phlebotomy and observing video recordings of the procedure performed in the actual working environment, we defined a performance metric. This was brought to a modified Delphi meeting, where consensus was reached by an expert panel. To demonstrate construct validity, we used the metric to objectively assess the performance of novices and expert practitioners. Results A phlebotomy metric consisting of 11 phases and 77 steps was developed. The mean inter-rater reliability was 0.91 (min 0.83, max 0.95). The expert group completed more steps of the procedure (72 vs 69), made fewer errors (19 vs 13, p=0.014) and fewer critical errors (1 Vs 4, p=0.002) than the novice group. Conclusions The metrics demonstrated construct validity and the proficiency benchmark was established with a minimum observation of 69 steps, with no critical errors and no more than 13 errors in total.

The impact of several land surface models (LSMs) and microphysics (MP), planetary boundary layer (PBL), and surface layer schemes on the accuracy of simulated brightness temperatures (BTs) from water vapor (WV) sensitive bands was examined via comparison with observations from the GOES-16 Advanced Baseline Imager. Nine parameterization configurations were evaluated. Analysis revealed that, compared to the Thompson MP scheme, the National Severe Storms Laboratory MP scheme produced lower simulated WV BTs in the upper troposphere but higher WV BTs in the middle and lower troposphere. The configuration with the Geophysical Fluid Dynamics Laboratory MP and hybrid eddy-diffusivity mass-flux (EDMF) PBL instead of Mellor–Yamada–Nakanishi–Niino (MYNN) PBL produced higher BTs. Yet, changing the PBL from MYNN to Shin–Hong or EDMF reduced the simulated WV BTs. Changing the LSM from Noah to RUC also resulted in lower simulated WV BTs, which were further enhanced with the MYNN surface layer instead of the GFS. The location and orientation of upper-level jet streams and troughs was assessed using the location of WV gradient objects. Every configuration had an increased translation speed compared to the observations, as forecast WV gradient objects were west of the observation objects early in the forecast and then east later in the forecast.

Background: Blood sampling errors including ‘wrong blood in tube’ (WBIT) may have adverse effects on clinical outcomes. WBIT errors occur when the blood sample in the tube is not that of the patient identified on the label. This study aims to determine the effect of proficiency-based progression (PBP) training in phlebotomy on the rate of blood sampling errors (including WBIT). Methods: A non-randomised controlled trial compared the blood sampling error rate of 43 historical controls who had not undergone PBP training in 2016 to 44 PBP trained interventional groups in 2017. In 2018, the PBP training programme was implemented and the blood sampling error rate of 46 interns was compared to the 43 historical controls in 2016. Data analysis was performed using logistic regression analysis adjusting for sample timing. Results: In 2016, 43 interns had a total blood sample error rate of 2.4%, compared to 44 interns in 2017, who had error rate of 1.2% (adjusted OR=0.50, 95% CI 0.36-0.70; Conclusions: The study demonstrates that PBP training in phlebotomy has the potential to reduce blood sampling errors. Trial registration number: NCT03577561

Background: Blood sampling errors including ‘wrong blood in tube’ (WBIT) may have adverse effects on clinical outcomes. WBIT errors occur when the blood sample in the tube is not that of the patient identified on the label. This study aims to determine the effect of proficiency-based progression (PBP) training in phlebotomy on the rate of blood sampling errors (including WBIT). Methods: A non-randomised controlled trial compared the blood sampling error rate of 43 historical controls who had not undergone PBP training in 2016 to 44 PBP trained interventional groups in 2017. In 2018, the PBP training programme was implemented and the blood sampling error rate of 46 interns was compared to the 43 historical controls in 2016. Data analysis was performed using logistic regression analysis adjusting for sample timing. Results: In 2016, 43 interns had a total blood sample error rate of 2.4%, compared to 44 interns in 2017, who had error rate of 1.2% (adjusted OR=0.50, 95% CI 0.36-0.70; Conclusions: The study demonstrates that PBP training in phlebotomy has the potential to reduce blood sampling errors. Trial registration number: NCT03577561

The San Zeno Wheel of Verona is an exceptional, virtually unstudied fifteenth-century horological device, the only one of its type to have survived. Yet certain features of the Wheel correspond to contemporary manuscript volvelles and to the liturgical calendars of larger horological devices. The interpretation of the object presented here has two main objectives: first, to elucidate the Wheel itself; and second, to consider its role in relation to the ecclesiastical routines of the San Zeno complex. By investigating the relationship of the Wheel to fourteenthand fifteenth-century time-reckoning instruments, notably astronomical clocks, the article shows that it is the oldest liturgical calendar disk to survive and, therefore, an invaluable testament to the original appearance of the earliest astronomical clocks. This is followed by a reconstruction of the way in which the Wheel was used in its original setting. An interpretation of its content in relation to the other horologia at San Zeno suggests that it was made to complement another time-reckoning device in the basilica. San Zeno therefore provides a unique case study regarding the ways in which multiple time systems were synchronised in the reckoning of the liturgy following the invention of the mechanical clock. The analysis of the Wheel has potentially far-reaching implications for our understanding of the ways in which the dispensation of mechanical horologia in monastic settings affected the perception of time. Such an analysis is, therefore, significant not only for the study of historical horology, but of medieval temporality more generally.

The translation industry, as well as Higher Education Institutions (HEIs) and translator training, have undergone numerous changes in the last two decades. These changes might explain why there is often a gap between translator training and professional translation practice. In this paper, we argue that situated learning through the development of a community of practice (CoP) ensures cohesion in individual, group and larger professional contexts. We further argue that reflection elements integrated within the CoP provide a way to narrow the gap between translator training and professional translation practice. Unlike previous studies, in this paper we explore how reflection can be embedded during participation and learning throughout the translation postgraduate curriculum to create a CoP. We detail a case-study of the MA in Translation Studies (MATS) at the University of Portsmouth, UK. On the MATS, reflection – for all participants involved – influences all aspects of the course, thereby developing an adaptable CoP that sets both learners and trainers up with the tools for successful adaptation for their professional life.

The Fano interference phenomenon between localized surface plasmon resonances (LSPRs) of individual silver nanocubes is investigated using dark-field optical microscopy and electron-energy loss spectroscopy (EELS) in a scanning transmission electron microscope (STEM). By computing the polarization induced by the electron beam, we show that the hybridized modes responsible for this Fano interference are the same as those present in the resonance-Rayleigh scattering spectrum of an individual nanocube on a substrate.

Osteoporosis is a chronic condition characterized by progressive loss of both bone mass and density. It is the most common bone disease, affecting 70% of women over the age of 80 years, and renders bones brittle and vulnerable to fracture. One in every two women and one in every five men sustain an osteoporosis-related fracture within their lifetime. Most of these fractures occur before a formal diagnosis of osteoporosis has been made; thus there is a clear role for primary prevention in preosteoporotic patients. There are numerous established risk factors for the development of osteoporosis, ranging from age, ethnicity and gender to specific medical conditions, medications, family history and lifestyle. Considering these as part of a primary care assessment allows patients at risk to be identified. Appropriate interventions can then be offered with the view to delaying, or ideally preventing, the onset of osteoporosis and its symptoms.

Driven by the desire to understand energy transfer between plasmonic and catalytic metals for applications such as plasmon-mediated catalysis, we examine the spatially resolved electron energy-loss spectra (EELS) of both pure Au nanoprisms and Pt-decorated Au nanoprisms. The EEL spectra and the resulting surface-plasmon mode maps reveal detailed near-field information on the coupling and energy transfer in these systems, thereby elucidating the underlying mechanism of plasmon-driven chemical catalysis in mixed-metal nanostructures. Through a combination of experiment and theory we demonstrate that although the location of the Pt decoration greatly influences the plasmons of the nanoprism, simple spatial proximity is not enough to induce significant energy transfer from the Au to the Pt. What matters more is the spectral overlap between the intrinsic plasmon resonances of the Au nanoprism and Pt decoration, which can be tuned by changing the composition or morphology of either component.

Disseminated aspergillosis in dogs has been associated with Aspergillus terreus or A. deflectus infection. We report a case of disseminated A. versicolor infection presenting as diskospondylitis, osteomyelitis, and pyelonephritis. The diagnosis was made based on clinical, radiographic, and pathological findings. The etiologic agent was identified by fungal culture and internal transcribed spacer (ITS) ribosomal DNA (rDNA) sequencing. This is the first description of canine aspergillosis caused by A. versicolor .

This is a visually scintillating exploration of medieval visual culture through the lens (and layers) of the Shrine Madonna, an extraordinary type of sculpture of the Virgin and Child (c. 1270–1500...

Episomal Escherichia coli-mycobacterial shuttle vectors containing the pAL5000-derived mycobacterial replicon are most widely utilized in developing recombinant mycobacterial vaccines. However, these vectors can be unstable when utilized to express non-bacterial antigens, leading to poor recombinant antigen expression. Variation in stability and expression is typically attributed to properties of the recombinant gene and promoter elements, while the contribution of the mycobacterial replicon has been largely ignored. Three potential targets were identified for modification of a common mycobacterial replicon to improve stability and recombinant antigen expression: (1) incorporation of a high copy number mutation within repA, (2) inclusion of the entire rap gene and its putative transcription terminator and (3) introduction of an hsp60 transcription terminator following repB. The green fluorescent protein (GFP) was utilized as a model recombinant protein. A significant increase in copy number was achieved by including the high copy number mutation and the entire rap gene. In addition, expression of GFP increased as a result of the rap gene modification as well as incorporation of the hsp60 transcription terminator. Interestingly, results suggested a possible correlation between increased GFP expression levels and reduced stability. If in vitro instability could be overcome through use of a regulatable promoter to control expression, the modifications which increased expression levels, may have widespread application in mycobacterial vaccines.

Background: Argatroban is a direct thrombin inhibitor approved for the prophylaxis or treatment of thrombosis in patients with heparininduced thrombocytopenia (HIT). The product monograph does not guide clinicians beyond specifying the initial dose of 2 µg/kg per minute (or 0.5 µg/kg per minute for patients with hepatic impairment). Some authors have suggested that in the intensive care unit (ICU) and for patients with acute cardiac disease and those with renal or hepatic dysfunction, this dose may result in a supratherapeutic activated partial thromboplastin time (aPTT). Objectives: To evaluate the efficacy and safety of argatroban in adult patients with suspected HIT in a large teaching hospital, and to review dosing for patients in the ICU, patients with acute cardiac disease, and patients with renal or hepatic dysfunction. Methods: Charts of patients with suspected HIT who had received argatroban for at least 24 h between October 1, 2005, and October 1, 2007, at the Foothills Medical Centre, Calgary, Alberta, were examined retrospectively. Results: Thirty patients met the inclusion criteria, with charts available for review. Of these, 21 (70%) patients had an initial argatroban dose of 2 µg/kg per minute and 4 (13%) had an initial dose of 0.5 µg/kg per minute. The median duration of therapy was 6 days, and the mean dose was 2.14 µg/kg per minute. There were 122 dosage adjustments, the most common change being 0.5 µg/kg per minute, followed by adjust ments of 1 and 0.1 µg/kg per minute. Six patients had supratherapeutic aPTT values (above 100 s), and none experienced major bleeding. Conclusions: The results of this study suggest that an initial argatroban dose of 2 µg/kg per minute is appropriate for patients with no hepatic dysfunction. Patients with acute cardiac disease and critically ill patients may require lower doses of argatroban; however no dosage adjustments are required for patients with renal dysfunction.