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Increasing milk quality in smallholder dairy farms will result in a greater quantity of milk being delivered to milk collection centers, an increased milk price for farmers and consequently an improved farmers’ livelihood. However, little research on milk quality has been performed on smallholder farms in Southeast Asia. The objective of this study was to identify risk factors associated with somatic cell count (SCC) and total plate count (TPC) in Indonesian smallholder dairy farms. One dairy cooperative in West Java, Indonesia was selected based on its willingness to participate. All 119 member farmers in the cooperative, clustered in six groups, were interviewed and a bulk milk sample from all farms was collected in April 2022. Risk factors associated with dairy farms’ SCC and TPC were investigated using multivariable population-averaged generalized estimating equations (GEE) models. The mean geometric SCC and TPC from these farms were 529,665 cells/mL of milk and 474,492 cfu/mL of milk, respectively. Five risk factors including manure removal frequency, receiving mastitis treatment training, washing the udder using soap, number of workers, and ownership of the pasture area were associated with SCC. Two risk factors, manure removal frequency and dairy income contribution, were associated with TPC. These findings can therefore be used as a starting point to improve udder health and milk quality in Indonesia and other countries where smallholder farmers play a significant role in milk production.

White dwarfs (WDs) polluted by exoplanetary material provide the unprecedented opportunity to directly observe the interiors of exoplanets. However, spectroscopic surveys are often limited by brightness constraints, and WDs tend to be very faint, making detections of large populations of polluted WDs difficult. In this paper, we aim to increase considerably the number of WDs with multiple metals in their atmospheres. Using 96,134 WDs with Gaia DR3 BP/RP (XP) spectra, we constructed a 2D map using an unsupervised machine-learning technique called Uniform Manifold Approximation and Projection (UMAP) to organize the WDs into identifiable spectral regions. The polluted WDs are among the distinct spectral groups identified in our map. We have shown that this selection method could potentially increase the number of known WDs with five or more metal species in their atmospheres by an order of magnitude. Such systems are essential for characterizing exoplanet diversity and geology.

Accurate models of cooling white dwarfs must treat the energy released as their cores crystallize. This phase transition slows the cooling by releasing latent heat and also gravitational energy, which results from phase separation: liquid C is released from the solid C/O core, driving an outward carbon flux. The Gaia color–magnitude diagram provides striking confirmation of this theory by revealing a mass-dependent overdensity of white dwarfs, indicating slowed cooling at the expected location. However, the observed overdensity is enhanced relative to the models. Additionally, it is associated with increased magnetism, suggesting a link between crystallization and magnetic field generation. Recent works aimed at explaining an enhanced cooling delay and magnetic field generation employ a uniform mixing prescription that assumes large-scale turbulent motions; we show here that these calculations are not self-consistent. We also show that thermohaline mixing is most likely efficient enough to provide the required chemical redistribution during C/O phase separation, and that the resulting velocities and mixing lengths are much smaller than previous estimates. These reduced fluid motions cannot generate measurable magnetic fields, suggesting any link with crystallization needs to invoke a separate mechanism. Finally, this mixing alters the chemical profiles, which in turn affects the frequencies of the pulsation modes.

IntroductionPatients with a low cardiorespiratory fitness (CRF) undergoing colorectal cancer surgery have a high risk for postoperative complications. Cardiopulmonary exercise testing (CPET) to assess CRF is the gold standard for preoperative risk assessment. To aid interpretation of raw breath-by-breath data, different methods of data-averaging can be applied. This study aimed to investigate the influence of different data-averaging intervals on CPET variables used for preoperative risk assessment, as well as to evaluate whether different data-averaging intervals influence preoperative risk assessment.MethodsA total of 21 preoperative CPETs were interpreted by two exercise physiologists using stationary time-based data-averaging intervals of 10, 20, and 30 seconds and rolling average intervals of 3 and 7 breaths. Mean values of CPET variables between different data averaging intervals were compared using repeated measures ANOVA. The variables of interest were oxygen uptake at peak exercise (VO2peak), oxygen uptake at the ventilatory anaerobic threshold (VO2VAT), oxygen uptake efficiency slope (OUES), the ventilatory equivalent for carbon dioxide at the ventilatory anaerobic threshold (VE/VCO2VAT), and the slope of the relationship between the minute ventilation and carbon dioxide production (VE/VCO2-slope).ResultsBetween data-averaging intervals, no statistically significant differences were found in the mean values of CPET variables except for the ventilatory equivalent for carbon dioxide at the ventilatory anaerobic threshold (P = 0.001). No statistically significant differences were found in the proportion of patients classified as high or low risk regardless of the used data-averaging interval.ConclusionThere appears to be no significant or clinically relevant influence of the evaluated data-averaging intervals on the mean values of CPET outcomes used for preoperative risk assessment. Clinicians may choose a data-averaging interval that is appropriate for optimal interpretation and data visualization of the preoperative CPET. Nevertheless, caution should be taken as the chosen data-averaging interval might lead to substantial within-patient variation for individual patients.Clinical trial registrationProspectively registered at ClinicalTrials.gov (NCT05353127).

Aims: Large-diameter metal-on-metal (MoM) total hip arthroplasty (THA) has demonstrated unexpected high failure rates and pseudotumour formation. The purpose of this prospective cohort study is to report ten-year results in order to establish revision rate, prevalence of pseudotumour formation, and relation with whole blood cobalt levels. Methods: All patients were recalled according to the guidelines of the Dutch Orthopaedic Association. They underwent clinical and radiographical assessments (radiograph and CT scan) of the hip prosthesis and whole blood cobalt ion measurements. Overall, 94 patients (95 hips) fulfilled our requirements for a minimum ten-year follow-up. Results: Mean follow-up was 10.9 years (10 to 12), with a cumulative survival rate of 82.4%. Reason for revision was predominantly pseudotumour formation (68%), apart from loosening, pain, infection, and osteolysis. The prevalence of pseudotumour formation around the prostheses was 41%, while our previous report of this cohort (with a mean follow-up of 3.6 years) revealed a 39% prevalence. The ten-year revision-free survival with pseudotumour was 66.7% and without pseudotumour 92.4% (p < 0.05). There was poor discriminatory ability for cobalt for pseudotumour formation. Conclusion: This prospective study reports a minimum ten-year follow-up of large-head MoM THA. Revision rates are high, with the main reason being the sequelae of pseudotumour formation, which were rarely observed after five years of implantation. Blood ion measurements show limited discriminatory capacity in diagnosing pseudotumour formation. Our results evidence that an early comprehensive follow-up strategy is essential for MoM THA to promptly identify and manage early complications and revise on time. After ten years follow-up, we do not recommend continuing routine CT scanning or whole cobalt blood measurements, but instead enrolling these patients in routine follow-up protocols for THA. Cite this article: Bone Jt Open 2022;3(1):61–67.

This paper investigates whether encouraging children to become more physically active in their everyday life affects their primary school performance. We use data from a field quasi-experiment called the Active Living Program, which aimed to increase active modes of transportation to school and active play among 8- to 12-year-olds living in low socioeconomic status (SES) areas in the Netherlands. Difference-in-differences estimations reveal that while the interventions increase time spent on physical activity during school hours, they negatively affect school performance, especially among the worst-performing students. Further analyses reveal that increased restlessness during instruction time is a potential mechanism for this negative effect. Our results suggest that the commonly found positive effects of exercising or participating in sports on educational outcomes may not be generalizable to physical activity in everyday life. Policymakers and educators who seek to increase physical activity in everyday life need to weigh the health and well-being benefits against the probability of increasing inequality in school performance.

To improve local control, neoadjuvant radiotherapy (nRT) followed by surgery is the standard of care in myxofibrosarcoma (MFS) because of its infiltrative growth pattern. Nevertheless, local recurrence rates are high. Data on prognostic factors for poor clinical outcomes are lacking. This retrospective study thus investigates the prognostic relevance of magnetic resonance imaging (MRI) characteristics before and after nRT in 40 MFS patients, as well as their association with disease-free survival (DFS) and overall survival (OS). A vascular pedicle, defined as extra-tumoral vessels at the tumor periphery, was observed in 12 patients (30.0%) pre-nRT and remained present post-nRT in all cases. Patients with a vascular pedicle had worse DFS (HR 5.85; 95% CI 1.56–21.90; p = 0.009) and OS (HR 9.58; 95% CI 1.91–48.00; p = 0.006). An infiltrative growth pattern, referred to as a tail sign, was observed in 22 patients (55.0%) pre-nRT and in 19 patients (47.5%) post-nRT, and was associated with worse DFS post-nRT (HR 6.99; 95% CI 1.39–35.35; p = 0.019). The percentage of tumor necrosis estimated by MRI was increased post-nRT, but was not associated with survival outcomes. The presence of a tail sign or vascular pedicle on MRI could support the identification of patients at risk for poor clinical outcomes after nRT.

Abstract Background While the nexus of migration and health outcomes is well acknowledged, the effect of rural–urban migration on the use of sexual and reproductive health (SRH) services has received less attention. We assessed the effect of rural–urban migration on the use of SRH services, while controlling for confounding, and whether there is a difference in the use of SRH services among migrant and non-migrant street children and young adults. Methods Data were collected from 513 street children and young adults aged 12–24 years, using venue-based time-space sampling (VBTS). We performed multivariate logistic regression analysis using Stata 16.0 to identify factors associated with SRH services use, with rural–urban migration status as the main predictor. Participants were further classified as new migrants (≤ 2 years of stay in city), established migrants (> 2 years of stay in city) or non-migrants (lifelong native street children) with no rural–urban migration history. Results Overall, 18.13% of the street children and young adults had used contraception/family planning, 58.67% had tested for human immunodeficiency virus (HIV) and knew their status and 34.70% had been screened for sexually transmitted infections (STIs). Non-migrants were 2.70 times more likely to use SRH services (HIV testing, STI screening and family planning) compared to the migrants (aOR = 2.70, 95% CI 1.23–5.97). Other factors associated with SRH services use among street children and young adults include age (aOR = 4.70, 95% CI 2.87–7.68), schooling status (aOR = 0.33, 95% CI 0.15–0.76), knowledge of place of care (aOR = 2.71, 95% CI 1.64–4.46) and access to SRH information (aOR = 3.23, 95% CI 2.00–5.24). Conclusions SRH services utilisation among migrant street children and young adults is low compared to their non-migrant counterparts and is independently associated with migration status, age, schooling status, knowledge of place of care and access to SRH information. Our findings call for the need to design and implement multi-dimensional interventions to increase the use of SRH services among street children and young adults, while taking into consideration their migration patterns.

We present a compact, flat-panel phased-array antenna design that beam steers using only mechanical in-plane rotations. We explain the steering mechanism and characterize the beam analytically and numerically. Measurements of two prototype antennas for different frequencies validate the concept and modeling. The prototype designs are described in detail and feature added phase-offset control of the array elements in the aperture layout. Potential applications include low-cost and low-power flat-panel user terminals for the next generation of aerial and space communication systems.

Abstract Accurate and low-cost sleep measurement tools are needed in both clinical and epidemiological research. To this end, wearable accelerometers are widely used as they are both low in price and provide reasonably accurate estimates of movement. Techniques to classify sleep from the high-resolution accelerometer data primarily rely on heuristic algorithms. In this paper, we explore the potential of detecting sleep using Random forests. Models were trained using data from three different studies where 134 adult participants (70 with sleep disorder and 64 good healthy sleepers) wore an accelerometer on their wrist during a one-night polysomnography recording in the clinic. The Random forests were able to distinguish sleep-wake states with an F1 score of 73.93% on a previously unseen test set of 24 participants. Detecting when the accelerometer is not worn was also successful using machine learning ( $$\hbox {F1-score} > 93.31\%$$ F1-score > 93.31 % ), and when combined with our sleep detection models on day-time data provide a sleep estimate that is correlated with self-reported habitual nap behaviour ( $$\hbox {r}=.60$$ r = . 60 ). These Random forest models have been made open-source to aid further research. In line with literature, sleep stage classification turned out to be difficult using only accelerometer data.

Diffuse-type tenosynovial giant cell tumors’ (D-TGCTs) intra- and extra-articular expansion about the knee often necessitates an anterior and posterior surgical approach to facilitate an extensive synovectomy. There is no consensus on whether two-sided synovectomies should be performed in one or two stages. This retrospective study included 191 D-TGCT patients from nine sarcoma centers worldwide to compare the postoperative short-term outcomes between both treatments. Secondary outcomes were rates of radiological progression and subsequent treatments. Between 2000 and 2020, 117 patients underwent one-stage and 74 patients underwent two-stage synovectomies. The maximum range of motion achieved within one year postoperatively was similar (flexion 123–120°, p = 0.109; extension 0°, p = 0.093). Patients undergoing two-stage synovectomies stayed longer in the hospital (6 vs. 4 days, p < 0.0001). Complications occurred more often after two-stage synovectomies, although this was not statistically different (36% vs. 24%, p = 0.095). Patients treated with two-stage synovectomies exhibited more radiological progression and required subsequent treatments more often than patients treated with one-stage synovectomies (52% vs. 37%, p = 0.036) (54% vs. 34%, p = 0.007). In conclusion, D-TGCT of the knee requiring two-side synovectomies should be treated by one-stage synovectomies if feasible, since patients achieve a similar range of motion, do not have more complications, but stay for a shorter time in the hospital.

While research on the nexus of migration and wellbeing of individuals has gained recognition in recent years, far less attention has been devoted to intra-urban mobility especially among the urban poor young populations. We assess the drivers of intra-urban mobility using a random sample of 412 migrant street children and youth in Kampala city, Uganda. This paper draws from a larger cross-sectional survey of circular migration and sexual and reproductive health choices among street children in Kampala, Uganda. We define 'migrants' as street children and youth with a rural-urban migration experience and 'intra-urban mobility' as the number of places stayed in or moved since migrating to the city, measured on a continuous scale. More than half (54.37%) of the migrant street children and youth had lived in two or more places since migrating to the city. Multivariate negative binomial regression analysis reveals migrant street children and youth's intra-urban mobility to be associated with gender (aIRR = 0.71, 95%CI 0.53-0.96), sex work (aIRR = 1.38, 95%CI 1.01-1.88), a daily income of one USD or more (aIRR = 1.57, 95%CI 1.16-2.13) and duration of stay in the city (aIRR = 1.54, 95%CI 1.17-2.01). Other drivers of intra-urban mobility included availability of causal work, personal safety and affordability of rental costs. Our findings suggest the need for urban housing and health policies to take into account street children and youth's intra-urban mobility and its drivers. Future research on all drivers of street children and youth's intra-urban mobility and its linkage with their health outcomes is recommended.

In this study, we investigate whether Conscientiousness, Emotional Stability and Risk Preference relate to student performance in higher education. We employ anchoring vignettes to correct for heterogeneous scale use in these non-cognitive skills. Our data are gathered among first-year students at a Dutch university. The results show that Conscientiousness is positively related to student performance, but the estimates are strongly biased upward if we use the uncorrected variables. We do not find significant relationships for Emotional Stability but find that the point estimates are larger when using the uncorrected variables. Measured Risk Preference is negatively related to student performance, yet this is fully explained by heterogeneous scale use. These results indicate the importance of using more objective measurements of personality traits.

Previous research shows that countries with opt-out consent systems for organ donation conduct significantly more deceased-donor organ transplantations than those with opt-in systems. This paper investigates whether the higher transplantation rates in opt-out systems translate into equally lower death rates among organ patients registered on a waiting list (i.e., organ-patient mortality rates). We show that the difference between consent systems regarding kidney- and liver-patient mortality rates is significantly smaller than the difference in deceased-donor transplantation rates. This is likely due to different incentives between the consent systems. We find empirical evidence that opt-out systems reduce incentives for living donations, which explains our findings for kidneys. The results imply that focusing on deceased-donor transplantation rates alone paints an incomplete picture of opt-out systems' benefits, and that there are important differences between organs in this respect.

White dwarfs are stellar embers depleted of nuclear energy sources that cool over billions of years.sup.1. These stars, which are supported by electron degeneracy pressure, reach densities of 10.sup.7 grams per cubic centimetre in their cores.sup.2. It has been predicted that a first-order phase transition occurs during white-dwarf cooling, leading to the crystallization of the non-degenerate carbon and oxygen ions in the core, which releases a considerable amount of latent heat and delays the cooling process by about one billion years.sup.3. However, no direct observational evidence of this effect has been reported so far. Here we report the presence of a pile-up in the cooling sequence of evolving white dwarfs within 100 parsecs of the Sun, determined using photometry and parallax data from the Gaia satellite.sup.4. Using modelling, we infer that this pile-up arises from the release of latent heat as the cores of the white dwarfs crystallize. In addition to the release of latent heat, we find strong evidence that cooling is further slowed by the liberation of gravitational energy from element sedimentation in the crystallizing cores.sup.5-7. Our results describe the energy released by crystallization in strongly coupled Coulomb plasmas.sup.8,9, and the measured cooling delays could help to improve the accuracy of methods used to determine the age of stellar populations from white dwarfs.sup.10.Photometry and parallax data from the Gaia satellite provide direct observational evidence of a theoretically predicted pile-up in the cooling sequence of white dwarfs, which is associated with core crystallization., Author(s): Pier-Emmanuel Tremblay [sup.1] , Gilles Fontaine [sup.2] , Nicola Pietro Gentile Fusillo [sup.1] , Bart H. Dunlap [sup.3] , Boris T. Gänsicke [sup.1] , Mark A. Hollands [sup.1] , [...]

IntroductionSarcomas are rare tumours. Early diagnosis is challenging, but important for local control and potentially survival and quality of life(QoL). We investigated (1)the route to diagnosis (RtD) experienced by sarcoma patients, including factors contributing to the length of the RtD from patients' perspective; (2)the impact of the RtD on QoL and care satisfaction; and (3)differences in aims 1-2 between English and Dutch patients.MethodsFifteen sarcoma patients from The Royal Marsden Hospital, United Kingdom, and Radboud University Medical Centre, The Netherlands, were interviewed, exploring RtD experiences. Interviews were analysed according to qualitative content analysis.ResultsThe main themes were: patient interval, diagnostic interval, reflection on the RtD and recommendations for improvement. Patient interval was long if symptoms were attributed as benign, did not interfere with daily life or were expected to cease. An incorrect working diagnosis, ineffective process of additional investigations, long referral times and lack of a lead clinician lengthened the diagnostic interval. Long waiting times, false reassurance and inadequate information provision led to dissatisfaction and a high emotional burden. Factors for improvement included increasing awareness of patients and healthcare providers, empowering patients, and having a lead clinician.ConclusionThe RtD of sarcoma patients is complex. Increasing awareness of patients and healthcare providers may contribute to shorten the RtD.