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Climate variability, particularly, that of the annual air temperature and precipitation, has received a great deal of attention worldwide. The magnitude of the variability of the factors changes according to the locations. The present study focuses on detecting the trends and variability in the annual temperature and rainfall for the district of Mandi in Himachal Pradesh, India. This study used annual and monsoon time series data for the time period 1981-2010 and modified the Mann-Kendall test and Sen's slope estimator in analyzing the problem. The results of the analysis indicate that the annual maximum temperature (TMX) and annual minimum temperature (TMN) for the period of 30 years have shown an increasing trend, whereas the monsoon’s maximum and minimum temperatures have shown a decreasing trend, although it is statistically not significant. The amount of annual rainfall does not show any significant trend, but the monsoonal rainfall has shown an increasing trend that is also statistically not significant. The resulting Mann-Kendall test statistic (Z) and Sen’s slope estimate (Q) of all the parameters studied indicate that changes are occurring in the magnitude and timing of the precipitation and temperature events at the Mandi station.

Quercus afares, an endemic North African species that combines morphological, physiological and ecological traits ecological traits of both Quercus suber and Quercus canariensis, two distant species is presented. Two Quercus afares populations of both Quercus suber nad Quercus canariensis sampled both within and outside areas where these species overlap with Quercus afares is studied.

Purpose: The aim of this study was to investigate the sustained intraocular pressure (IOP) elevation after repeated anti-VEGF intravitreal injections (IVI) in patients with diabetic macular edema (DME). Methods: A retrospective study included 140 eyes without prior glaucoma, treated with at least three anti-VEGF injections for DME between 2012 and 2016. IOP elevation was defined by an increase above baseline IOP by ≥6 mmHg. Baseline IOP was defined as the mean of IOP values before treatment initiation. Three groups were differentiated: group 1 without IOP elevation, groups 2 and 3 with IOP elevation and IOP <21 mmHg (group 2) and ≥21 mmHg (group 3). Rate and several risk factors of IOP elevation were assessed and compared between the three groups. Results: IOP elevation occurred in ten eyes (7.1%). IOP was <21 mmHg in six eyes and ≥21 mmHg in four eyes. Statistically significant associations were found between IOP elevation and the number of injections, and HbA1c level. Two patients required local hypotonic treatment. Conclusions: In a real-life setting, we confirmed in eyes with center-involved DME without prior glaucoma or IOP elevation that repeated anti-VEGF IVI may increase the risk of sustained IOP elevation in about 7% of eyes. [ABSTRACT FROM AUTHOR]

Objectives We conducted a mortality study of members of the United Food and Commercial Workers International Union who worked in poultry slaughtering/processing plants, and controls. Excess deaths from cancer at 11 different cancer sites including lung cancer were observed in the poultry workers. The study described here is a pilot case-cohort study of lung cancer nested within the cohort to examine if it is possible, in a larger study to be conducted later, to identify specific potentially carcinogenic occupational exposures in poultry workers. Methods Subjects or the next of kin of deceased subjects were interviewed by phone. Logistic regression ORs and Cox proportional HRs were estimated. Results Elevated risks for poultry exposure were recorded for subjects who (1) killed chickens at work (OR 4.2, 95% CI 1.2 to 14.7; HR 1.8, 95% CI 1.0 to 3.3) and (2) ever had direct contact with chicken blood at work (OR 1.9, 95% CI 1.0 to 3.8; HR 1.3, 95% CI 0.9 to 2.0). These activities are associated with high exposure to oncogenic viruses. Conclusion These results may have important public health implications, since the general population is also exposed to these viruses. Elevated risks were observed for non-poultry-related occupational exposures such as working in a stockyard, working in a chemical plant, use of chemicals to kill moulds, and working in plants where plastic products were manufactured. These preliminary findings indicate that full scale epidemiological studies of adequate statistical power are needed to examine the role of occupational exposures in cancer occurrence in poultry workers. [ABSTRACT FROM AUTHOR]

Short term hydrothermal scheduling (STHTS) is a daily planning proposition in power system operation. The main purpose of hydro thermal generation scheduling is to minimize the overall operation cost and to satisfy the given constraints by optimally scheduling the power outputs of all hydro and thermal units under study periods, given electrical load and limited water resource. This paper presents the lambda-gamma iteration method for fixed head hydro-thermal problems. Also, hydro power input-output model with constant head has been developed for Sewa Hydro Electric Power Plant by using the curve fitting techniques by least square method in MATLAB 7.9 version software. From scheduling results, operational decisions can be made for the best performance under changing conditions of load, head, unit availability and other important constraints. Furthermore, these decisions may be used as an effective input to the on-line decision support system for real-time operation of reservoir systems in availability based tariff (ABT) context that results in increased power production and enhanced revenue earnings in the process of planning and management of a water resources project. [ABSTRACT FROM AUTHOR]

Objective:To assess the public support for potential legislation to prohibit weight-based discrimination against obese individuals in the United States, and to examine whether certain message frames about weight discrimination influence public support.Design:Participants were randomly assigned to read one of the four paragraphs that framed the topic of weight discrimination in a distinct way (or a control condition with no paragraph). Participants were then asked to indicate their level of support for six antidiscrimination laws.Subjects:A national sample of 1114 participants (48% women, 52% men), mean age 44.78 years (s.d.=15.93).Results:There was moderate support for several laws to prohibit weight-based discrimination, but gender differences were observed across experimental conditions indicating that some message frames may increase support for certain laws among women, but not men. However, message frames had no effect on support for laws with specific provisions to prohibit weight discrimination in the workplace, suggesting that public support for these particular legal measures is consistent and high (65% of men and 81% of women expressed support) regardless of how the issue of weight discrimination is framed to the public.Conclusion:The present findings provide evidence of current levels of public support for legislation to prohibit weight-based discrimination, and offer potential ways for policy makers and interest groups to communicate messages about weight discrimination in efforts to increase support. [ABSTRACT FROM AUTHOR]

The collection of data for unsteady/non-uniform sediment transport rates in a river below a reservoir, which arrests sediment from upstream, is very difficult. The establishment of a model for the determination of these sediment transport rates is equally difficult but important for the safety of a structure below the reservoirs. An indirect technique based on continuity equation for sediment transport has been used to obtain such data for unsteady/non-uniform flow conditions. Based on these data and dimensional analysis, a relationship for determination of sediment transport rate below high capacity reservoirs under unsteady-non-uniform conditions has been proposed which gave very high efficiency when checked with the available data for such conditions. As a consequence, a relationship for extent of degradation has also been established. [ABSTRACT FROM AUTHOR]

Gene flow is particularly frequent in the genus Quercus (oaks), especially between closely related species. We focus here on Quercus ilex and the cork-producing Quercus suber, which occasionally hybridize although they are phylogenetically markedly separated. Morphological observations were combined with both allozymic and chloroplastic diagnostic markers to characterize hybridization and introgression and to infer their dynamics in two French regions (French Catalonia and Provence), which are separated by several hundred kilometres. Some hybrids were found in both regions, indicating recent hybridization events. As expected from previous studies, most hybrids resulted from ♀ Q. ilex × ♂ Q. suber crosses, but our data showed that the reciprocal cross is also possible. Partial independence between nuclear and chloroplastic introgression was observed in the two species. Nuclear introgression was limited in both species and both regions, with no preferred direction. In Provence, chloroplastic introgression was very rare in both species. Conversely, all Q. suber individuals from French Catalonia were introgressed by Q. ilex chlorotypes. This might be explained by introgression in the Iberian Peninsula antedating the first occurrence of the two species in French Catalonia. We also observed a new chlorotype that was created locally, and was exchanged between the two species. However, the two species still remain genetically differentiated. The dynamics and complexity of exchanges and the factors determining them (including human management of Q. suber) are discussed. [ABSTRACT FROM AUTHOR]

Degradation in a homogeneous alluvial channel due to complete stoppage of sediment downstream of a high capacity reservoir has been studied empirically. Based on dimensional analysis, a method has been established for predicting transient bed profiles in degrading alluvial stream. In addition, prediction procedures for other degradation elements like maximum degradation at any time at upstream section and degradation extent has also been evolved. The prediction procedures when tested against known data gave satisfactory results. [ABSTRACT FROM AUTHOR]

An experimental study was carried out to investigate the CBR behaviour of waste plastic strip reinforced-stone dust/fly ash overlying saturated clay. Three different sizes of waste plastic strips were used in this study. The effect of waste plastic strip content (0.25% to 4%) and length on the CBR and secant modulus of strip reinforced-stone dust/fly ash overlying saturated clay was investigated. The study reveals that addition of waste plastic strip in stone dust/fly ash overlying saturated clay resulted in an appreciable increase in the CBR and the secant modulus. The reinforcement benefit increased with an increase in waste plastic strip content and strip length. The benefit of adding waste plastic strips beyond 2% does not improve the CBR or secant modulus appreciably. Reinforced stone dust is more effective than reinforced fly ash overlying saturated clay in improving the behaviour of the system. The material can be used in base courses in constructing rural roads over saturated clay, thereby leading to safe disposal of these waste materials in an environmentally friendly manner. Further research is recommended to study the cost economics of the use of waste materials in base courses in rural roads. [ABSTRACT FROM AUTHOR]

Hybridisation is a potent force in plant evolution, although there are few reported examples of stabilised species that have been created through homoploid hybridisation. We focus here on Quercus afares, an endemic North African species that combines morphological, physiological and ecological traits of both Q. suber and Q. canariensis, two phylogenetically distant species. These two species are sympatric with Q. afares over most of its distribution. We studied two Q. afares populations (one from Algeria and one from Tunisia), as well as several populations of both Q. suber and Q. canariensis sampled both within and outside areas where these species overlap with Q. afares. A genetic analysis was conducted using both nuclear (allozymes) and chloroplastic markers, which shows that Q. afares originates from a Q. suber × Q. canariensis hybridisation. At most loci, Q. afares predominantly possesses alleles from Q. suber, suggesting that the initial cross between Q. suber and Q. canariensis was followed by backcrossing with Q. suber. Other hypotheses that can account for this result, including genetic drift, gene silencing, gene conversion and selection, are discussed. A single Q. suber chlorotype was detected, and all Q. afares individuals displayed this chlorotype, indicating that Q. suber was the maternal parent. Q. afares is genetically, morphologically and ecologically differentiated from its parental species, and can therefore be considered as a stabilised hybrid species.Heredity (2006) 96, 175–184. doi:10.1038/sj.hdy.6800782; published online 21 December 2005 [ABSTRACT FROM AUTHOR]

Purpose To evaluate the efficacy and safety of ranibizumabin patients with vision loss secondary to diabetic macular edema (DME). Methods Retrospective analysis of a cohort of patients with vision loss (VA) due to DME and treated by ranibizumab. Patients were examined before treatment and during treatment every 4-6 weeks. Ophthalmologic examination included:measure of the best corrected visual acuity ( BCVA) on the ETDRS scale, examination at the slit lamp, fundus, and SD- OCT (Cirrus 5000, Carl Zeiss Meditec). All patients received a loading dose of 3 monthly injections followed by re-treatments on an as-needed basis (PRN regimen) The primary endpoint was the change in visual acuity at 12 months. The other criteria assessed were central retinal thickness (CRT) after loading dose, and at 12 months, and the number of intravitreal injections (IVT) during the first year of follow-up. Results 109 eyes of 79 consecutive patients treateded since November 2012 have been included. At baseline the mean BCVA was 48.77 letters, the CRT was 517 microns. At 12 months the average BCVA was of 60.80 letters (p < 0.05), with an average VA gain of +14.67 letters and 25% of patients had a BCVA> 70 letters. The mean CRT after 3 injections was 344.32 microns (p < 0.05) and 332 microns (p < 0.05) at 12 months, with 57.23% of patients with CRT ≤ 300 microns. At 12 months the average VA in patients with CRT ≤ 300 microns was 63.51 letters (p < 0.05) and the average AV in patients with ERC> 300 .microns was 57.39 letters (p < 0.05). The average number of IVT performed during the first year of follow up was 5.59. No serious adverse event was noted. Conclusions Pivotal studies have clearly shown the benefit of ranibizumab treatment of vision loss due to DME. This study in a 'real life' setting confirms the results obtained in randomized trials. [ABSTRACT FROM AUTHOR]

Purpose This research aimed at exploring and characterizing differences in vivo between healthy and pathology retinas, hereditary macular diseases at the microscopic scale using a compact adaptive optics (AO) retinal camera and high resolution OCT. Methods Seven RP patients, Cone‐rod dystrophies (3), Stargardt diseases (5), Occult macular dystrophies (4) and indeterminate macular dystrophies (4) had undergone en face retinal imaging by AO camera "rtx1" (Imagine Eyes, France). AO images were taken at the eccentricities from 0 deg to 6 deg temporal and nasal from fovea. Each patient was examined using high resolution spectral domain (SD)‐OCT and infrared SLO (Spectralis OCT). Results Cellular‐resolution images could be obtained in most cases. In inherited retinal dystrophies, AO helped to better evaluate losses of cone cells across the retina. Other microstructures, slightly larger in size than cones, were also visible in several pathological retinas. Hereditary macular disease cases showed loss of cone mosaics. Some of these cases, there were patchy areas of increased reflectance. In Cone rod dystrophy and some other cases, the RPE mosaic was visible where cone had disappeared. Conclusion Cellular‐resolution images could be obtained in most cases. In inherited retinal dystrophies, AO helped to better evaluate losses of cone cells across the retina. Other microstructures, slightly larger in size than cones, were also visible in several pathological retinas. Hereditary macular disease cases showed loss of cone mosaics. Some of these cases, there were patchy areas of increased reflectance. In Cone rod dystrophy and some other cases, the RPE mosaic was visible where cone had disappeared. [ABSTRACT FROM AUTHOR]

Introduction: Ureteral polyp causing ureteral intussusception is a rare phenomenon and only 16 cases have been reported in the world literature. We report one case of ureteral polyp causing ureteral intussusception due to fibroepithelial polyp. Subject, Methodology and Results: Fibroepithelial polyp: 40 year old female presented with difficulty of passing urine, mass prolapsing from right ureteric orifice with backpressure changes in the kidney. The biopsy showed fibroepithelial polyp. On exploration about 6 cm ureter was intussuscepted. Segmental ureteric resection with reanastomosis was done. Discussion: Ureteral polyp causing ureteral intussusception is a rare phenomenon possibly due to; 1. Small ratio between the thickness of the ureter and ureteric lumen caliber. 2. Limited range of the ureteral mobility. Following different mechanisms can be proposed; 1. It is an accidental combination. 2. Ureteral invagination is secondary to the presence of a mass in the ureteric lumen (polyp) & the flow of urine. 3. In case of polyp, the invagination develop first and the inflammatory changes cause fibroepithelial polyp. [ABSTRACT FROM AUTHOR]

Introduction: We report a rare case of Pelvic lipomatosis with obstructive uropathy and stone disease. It has been reported that these patients are always associated with cystitis glandularis and cystitis cystica. This is a first reported case of Pelvic lipomatosis with left renal stone and cystitis glandularis. Materials and Methods: 42-year male patient presented to our department with increased urinary frequency, constipation, left loin pain. After investigations in the form of USG, X-ray KUB, IVP, CT Pelvis, Cystoscopy and Histopathology, he was diagnosed to have Pelvic lipomatosis with left renal stone and cystitis glandularis but there was no evidence of malignancy as adenocarcinoma of bladder is known to occur. He underwent antegrade stenting as retrograde approach was not possible and Lithotripsy with pelvic exploration and excision of pelvic fatty tissue. Result: After a follow up of 6 month, patient is free of his symptoms of increase frequency, constipation and renal stone. Disscussion: Pelvis lipomatosis is benign condition associated with deposition of mature uncapsulated fat in retroperitoneal pelvic space. This is the first reported case of Pelvic lipomatosis with left renal stone and cystitis glandularis. [ABSTRACT FROM AUTHOR]

PURPOSE: To test the hypothesis that exposure to poultry oncogenic viruses that widely occurs occupationally in poultry workers and in the general population, may be associated with increased risks of deaths from liver and pancreatic cancers, and to identify new risk factors. METHODS: A pilot case-cohort study of both cancers within a combined cohort of 30,411 highly exposed poultry workers and 16,408 control subjects was conducted, and risk assessed by logistic regression odds ratios (OR) and proportional hazards risk ratios. RESULTS: New occupational findings were recorded respectively for pancreatic/liver cancers, for slaughtering of poultry (OR = 8.9, 95% confidence interval [CI]: 2.7-29.3)/OR = 9.1, 95% CI: 1.9-42.9); catching of live chickens (OR = 3.6, 95% CI: 1.2-10.9)/OR = 1.0, 95% CI: 0.1-8.5); killing other types of animals for food (OR = 4.8, 95% CI: 1.5-16.6)/OR = 2.0, 95% CI: 0.2-18.2), and ever worked on a pig raising farm (OR = 3.0, 95% CI: 1.0-8.2) for pancreatic cancer only. New non-occupational findings for liver cancer were for receiving immunization with yellow fever vaccine (OR = 8.7, 95% CI: 1.0-76.3); and vaccination with typhoid vaccine (OR = 6.3, 95% CI: 1.1-37.4). The study also confirmed previously reported risk factors for both diseases. CONCLUSIONS: This study provides preliminary evidence that exposure to poultry oncogenic viruses may possibly be associated with the occurrence of liver and pancreatic cancers. Case-control studies nested within occupational cohorts of highly exposed subjects of sufficient statistical power may provide an efficient and valid method of investigating/confirming these findings. [ABSTRACT FROM AUTHOR]

Aim: Quantify disparities and identify correlates and predictors of 'wellness' supplement use among nurses during the first year of the pandemic., Design: Longitudinal secondary analysis of Nurses' Health Studies 2 and 3 and Growing Up Today Study data., Methods: Sample included 36,518 total participants, 12,044 of which were nurses, who completed surveys during the first year of the COVID-19 pandemic (April 2020 to April 2021). Analyses were conducted in March 2023. Modified Poisson models were used to estimate disparities in 'wellness' supplement use between nurses and non-healthcare workers and, among nurses only, to quantify associations with workplace-related predictors (occupational discrimination, PPE access, workplace setting) and psychosocial predictors (depression/anxiety, county-level COVID-19 mortality). Models included race/ethnicity, gender identity, age and cohort as covariates., Results: Nurses were significantly more likely to use all types of supplements than non-healthcare workers. Lacking personal protective equipment and experiencing occupational discrimination were significantly associated with new immune supplement use. Depression increased the risk of using weight loss, energy and immune supplements., Conclusion: Nurses' disproportionate use of 'wellness' supplements during the COVID-19 pandemic may be related to workplace and psychosocial stressors. Given well-documented risks of harm from the use of 'wellness' supplements, the use of these products by nurses is of concern., Impact: 'Wellness' supplements promoting weight loss, increased energy, boosted immunity and cleansing of organs are omnipresent in today's health-focused culture, though their use has been associated with harm. This is of added concern among nurses given their risk of COVID-19 infection at work. Our study highlighted the risk factors associated with use of these products (lacking PPE and experiencing occupational discrimination). Findings support prior research suggesting a need for greater public health policy and education around the use of 'wellness' supplements., Reporting Method: STROBE guidelines were followed throughout manuscript., Patient or Public Contribution: No patient or public contribution was involved., (© 2024 John Wiley & Sons Ltd.)

This study examined concordance of family members' perspectives of family functioning and mental health across two years in families with transgender and/or nonbinary youth (TNBY). Participants were 89 family members (30 TNBY, age 13-17 years; 44 cisgender caregivers; 15 cisgender siblings, age 14-24 years) from 30 families from the U.S. New England region. Family members completed an online survey every 6-8 months for 5 waves between December 2015 and Feb 2019. Surveys assessed family functioning (quality of communication, satisfaction with family) and the following mental health-related outcomes: depression and anxiety symptoms, non-suicidal self-injury, suicidality, self-esteem, and resilience. Analyses tested concordance of family functioning and mental health across family members. Reports of family functioning changed over time, and family members were not consistently concordant in their reports of family functioning. Caregivers perceived a higher quality family communication than TNBY at all waves and higher than siblings at some waves. Perceptions of family satisfaction did not show a clear pattern between family member types across waves. The greatest concordance of perceived family functioning was between caregivers and siblings and between TNBY and siblings. Across all waves, TNBY reported more severe depression and anxiety symptoms than their caregivers and siblings, and more non-suicidal self-injury than their siblings. Compared to siblings, TNBY reported higher self-esteem, but less resilience. This study highlights opportunities for intervention in clinical work with TNBY and their families. Providers working with families with TNBY should use family systems approaches to support the mental health of all family members., Competing Interests: Competing interests. Dr. Katz-Wise is a diversity consultant for Paramount Global. The other authors have no conflicts of interest to disclose.

Aim: This observational study investigated the association between remdesivir treatment during hospitalization for COVID-19 and 30-day COVID-19-related and all-cause readmission across different variants time periods. Patients & methods: Hospitalization records for adult patients discharged from a COVID-19 hospitalization between 1 May 2020 to 30 April 2022 were extracted from the US PINC AI Healthcare Database. Likelihood of 30-day readmission was compared among remdesivir-treated and nonremdesivir-treated patients using multivariable logistic regression models adjusted for age, corticosteroid treatment, Charlson comorbidity index and intensive care unit stay during the COVID-19 hospitalization. Analyses were stratified by maximum supplemental oxygen requirement and variant time period (pre-Delta, Delta and Omicron). Results: Of the 440,601 patients discharged alive after a COVID-19 hospitalization, 248,785 (56.5%) patients received remdesivir. Overall, remdesivir patients had a 30-day COVID-19-related readmission rate of 3.0% and all-cause readmission rate of 6.3% compared with 5.4% and 9.1%, respectively, for patients who did not receive remdesivir during their COVID-19 hospitalization. After adjusting for demographics and clinical characteristics, remdesivir treatment was associated with significantly lower odds of 30-day COVID-19-related readmission (odds ratio 0.60 [95% confidence interval: 0.58-0.62]), and all-cause readmission (0.73 [0.72-0.75]). Significantly lower odds of 30-day readmission in remdesivir-treated patients was observed across all variant time periods. Conclusion: Treating patients hospitalized for COVID-19 with remdesivir is associated with a statistically significant reduction in 30-day COVID-19-related and all-cause readmission across variant time periods. These findings indicate that the clinical benefit of remdesivir may extend beyond the COVID-19 hospitalization.

Introduction: Racial and ethnic disparities in patient outcomes following COVID-19 exist, in part, due to factors involving healthcare delivery. The aim of the study was to characterize disparities in the administration of evidence-based COVID-19 treatments among patients hospitalized for COVID-19., Methods: Using a large, US hospital database, initiation of COVID-19 treatments was compared among patients hospitalized for COVID-19 between May 2020 and April 2022 according to patient race and ethnicity. Multivariate logistic regression models were used to examine the effect of race and ethnicity on the likelihood of receiving COVID-19 treatments, stratified by baseline supplemental oxygen requirement., Results: The identified population comprised 317,918 White, 76,715 Black, 9297 Asian, and 50,821 patients of other or unknown race. There were 329,940 non-Hispanic, 74,199 Hispanic, and 50,622 patients of unknown ethnicity. White patients were more likely to receive COVID-19 treatments, and specifically corticosteroids, compared to Black, Asian, and other patients (COVID-19 treatment: 87% vs. 81% vs. 85% vs. 84%, corticosteroids: 85% vs. 79% vs. 82% vs. 82%). After covariate adjustment, White patients were significantly more likely to receive COVID-19 treatments than Black patients across all levels of supplemental oxygen requirement. No clear trend in COVID-19 treatments according to ethnicity (Hispanic vs. non-Hispanic) was observed., Conclusion: There were important racial disparities in inpatient COVID-19 treatment initiation, including the undertreatment of Black patients and overtreatment of White patients. Our new findings reveal the actual magnitude of this issue in routine clinical practice to clinicians, policymakers, and guideline developers. This is crucial to ensuring equitable and appropriate access to evidence-based therapies., (© 2024. The Author(s).)

Purpose: The manual user-operated Arise Standing Wheelchair (SWC) is the end-result of multiple design iterations based on comments from user trials. The Arise SWC provides standing functionality, outdoor mobility, affordability, and customizability. This paper describes a user experience study of the Arise SWC's pre-commercial version., Methods: Thirty participants ( N  = 30, 25 Male, 5 Female) were recruited for the study. All the participants were people with spinal cord injury. The study was conducted over a period of six weeks (five participants per week) within the hospital premises under the supervision of clinical personnel. A 30 min interactive training session involved thirteen activities. During the trial period, the participants were trained to perform twenty-two activities to familiarize themselves with the SWC. The participants were also trained to perform four functional usage activities with the SWC. At the end of the study, participant responses to ten outcome measures were captured using a smiley-based Likert-scale questionnaire., Results: A majority of the participants (93.3%) felt happy when they stood in the SWC. The majority participants (83.3%) preferred the Arise SWC over their current wheelchair. Also, 80% participants anticipated that they could get more work done at home using the standing function of the wheelchair., Conclusions: A one-time fitting and training ensured optimal effort for the SWC operation, correct posture, and comfortable user experience. With proper dissemination and awareness, it is believed that the Arise SWC will benefit eligible users and improve their quality of life.IMPLICATIONS FOR REHABILITATIONThe Arise wheelchair provides standing functionality, outdoor mobility, affordability, and customizability.Study confirms that incorporating standing functionality can improve the quality of life for wheelchair users.The majority of users were happy, felt safe and expected to do more with the standing functionality.Study results support further testing in real world conditions beyond the hospital setting.

The dietary supplements industry disproportionately markets potentially harmful products promising weight loss, cleansing/detoxing, and boosted energy and immunity to women. The COVID-19 pandemic heightened consumer concerns around health and body weight, which may have increased women's risks of using supplements, particularly if they had a higher weight and experienced weight discrimination. This study aimed to estimate inequities in prevalence and change in use of weight-loss, cleanse/detox, immunity, and energy supplements in the first year of the pandemic and to assess the extent to which the relationship between weight and supplement use differs across discrimination experiences. We drew upon longitudinal data from cisgender women in the U.S. COVID-19 Pandemic Substudy of the Nurses' Health Study II and 3 and Growing Up Today Study cohorts, collected over 5 waves from April/May 2020 to April 2021 (N = 51,814). Modified Poisson generalized estimating equation models, adjusted for age, cohort, race/ethnicity, wave, and Census region, estimated the relative excess risk due to interaction (RERI) between weight status and weight discrimination on prevalence of supplement use. Weight status categories were derived from body mass index (BMI), and weight discrimination was assessed using the attributions item of the Everyday Discrimination Scale. Baseline prevalence of supplement use was 2.7% for weight-loss, 3.3% for cleanse/detox, 4.2% for energy, and 22.6% for immune. Respondents with BMIs of 25-29.9 kg/m 2 and 30-34.9 kg/m 2 who experienced weight discrimination had RERI values of 0.89 (95% CI 0.14, 1.65) and 1.00 (95% CI 0.25, 1.75) for weight-loss and 0.57 (95% CI 0.13, 1.02) and 0.60 (95% CI 0.19, 1.01) for energy supplements, respectively, indicating this group had excess risk of use compared to lower BMI respondents who experienced no weight discrimination. The findings demonstrate the disproportionate impact of weight discrimination on use of potentially harmful supplements among cisgender women with higher weights during the pandemic., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 Elsevier Ltd. All rights reserved.)

Purpose: Assistive devices like Standing Wheelchairs (SWC) have remained out of reach of the economically underprivileged even before the pandemic-induced financial downturn, and more so now. This paper describes the mechanical design of a manual user-actuated SWC that is cost-effective (equivalent of USD 210 in India, ex-factory) and has special features that minimise user effort and accommodates varying body weights (50-110 kg) and dimensions (1.52-1.83 m height)., Methods: The design includes a six-bar mechanism and spring balancing to optimise user effort during operation. The optimised gas spring incorporates adjustability to minimise each user's force for sit-stand-sit transitions. The handle shape is ergonomically designed using kinematic analysis to provide convenient gripping positions for actuation. The design has been customised based on parametric studies to suit varying body weights., Results: Overall, the SWC design provides standing functionality with ease of operation, safety locks, customisability, affordability, outdoor mobility and is aesthetically pleasing., Conclusions: Customisability and the low cost of the device would enhance the accessibility of the SWC to a larger group of eligible users.Implications for rehabilitationManual user-operated standing wheelchair design using a six-bar mechanismSpring balancing used to reduce user effort to self-lift to the standing positionKinematic analysis used to determine convenient handle location for user easeCustomisability for wide range of users to ensure correct posture, optimal effortDesign refined through multiple iterations using inputs from users and cliniciansDesign commercialised at an affordable cost, making it accessible to a larger population.

Purpose: Only 1 in 10 people with disabilities can access assistive devices, underlining the critical need for low-cost assistive products. This paper describes the design evolution of a manual user-operated standing wheelchair (SWC), translating from prototype to product., Methods: The SWC design has been refined over 5 years through multiple iterations based on comments from user trials. The SWC product, Arise, provides standing functionality, facile outdoor mobility, affordability, customisability, and is aesthetically pleasing. A one-time fitting and training ensure optimal effort for operation, correct posture, and comfortable user experience. The SWC accommodates users of different sizes and body weights (up to 110 kg) and minimises user effort with the use of a gas spring. Incorporating discrete adjustments enables customisation while retaining the advantages of mass manufacturing, which is necessary for ensuring affordability., Results: The SWC has been field-tested and well received by over 100 wheelchair users, and Arise was launched recently by the industry partner., Conclusions: It should be noted that RESNA cautions on the use of any standing device without medical consultation. Nevertheless, with appropriate dissemination and awareness, it is anticipated that the affordable SWC product, Arise, will immensely benefit the eligible users and make a difference in their quality of life.Implications for RehabilitationProvides standing functionality, outdoor mobility, affordability and customisabilityAccommodates users of different sizes and body weights in a mass-manufacturable designErgonomic design reduces net user effort during sit-to-stand, stand-to-sit activityDesign iterated and refined based on feedback from over 100 user trials.

Introduction: Supplements sold with claims to promote weight loss, cleansing/detoxing, increased energy, or boosted immunity can be dangerous, and consumers experiencing extreme stressors may be especially vulnerable to deceptive claims. The purpose of our study was to investigate associations of financial strain and psychological distress during the COVID-19 pandemic with use of supplements sold for weight loss, cleanse/detox, energy, or immunity., Methods: We used repeated-measures data gathered over five survey waves from April/May 2020-April 2021 from the COVID-19 Substudy ( N = 54,951), within three prospective US national cohorts (Nurses' Health Study 2, Nurses' Health Study 3, and Growing Up Today Study), to investigate longitudinal associations between financial strain and psychological distress and risk of use of potentially dangerous types of supplements. Surveys assessed use of supplements prior to and during the first year of the pandemic, as well as financial precarity, food insecurity, depressive and anxiety symptoms, perceived stress, and daily hassles. We fit sociodemographic-adjusted modified Poisson GEE models to estimate risk ratios (RRs) and 95% confidence intervals (CIs) for associations between baseline or lagged time-varying predictors and prevalent or incident (i.e., new-onset) use of each supplement type., Results: At baseline in April/May 2020, soon after pandemic onset, current use of supplement types was: weight loss 2.7%; cleanse/detox 3.2%; energy 4.4%; immune 22.6%. By the end of the study period, cumulative incidence was: weight loss 3.5%; cleanse/detox 3.7%; energy 4.5%; immune 21.3%. In prevalent-use analyses, financial precarity, food insecurity, and psychological distress were associated with up to 2.4 times the risk of use of these types of supplements across the study period. Similarly, in incident-use analyses, financial precarity and psychological distress were associated with up to 2.1 times the risk of initiating use; whereas, high food insecurity was associated with nearly 1.8 times higher risk of onset of weight-loss supplements use but was not associated with onset of use of other types of supplements., Discussion: We found consistent evidence that during the first year of the pandemic, participants experiencing elevated financial strain and psychological distress were at heightened risk of initiating use of potentially dangerous types of supplements. Our findings raise concerns about deceptive claims about the safety and product effectiveness by manufacturers of these supplements to profit from vulnerable consumers during the pandemic., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Austin, Beccia, Raffoul, Jackson, Sarda, Hart, Chavarro and Rich-Edwards.)

Agriculture is a backbone of global economy and most of the population relies on this sector for their livelihood. Chitosan as a biodegradable material thus can be explored for in various fields in its nano form to replace non-biodegradable and toxic compounds. The chitosan has appealing properties like biocompatibility, non-toxicity, biodegradability, and low allergenic, making it useful in several applications including in agriculture sector. Because of their unique properties, chitosan nanoparticles (ChNPs) are extensively applied as a bioagent in various biological and biomedical processes, including wastewater treatment, plant growth promoter, fungicidal agent, wound healing, and scaffold for tissue engineering. Furthermore, the biocompatibility of chitosan nanoparticles (ChNPs) is reported to have other biological properties such as anti-cancerous, antifungal, antioxidant activities, even induces an immune response in the plant, and helps manage biotic and abiotic stresses. Chitosan can also find its application in wastewater treatment, hydrating agents in cosmetics, the food industry, paper, and the textile industry as adhesive, drug-delivering agent in medical as well as for bioimaging. Since chitosan has low toxicity, the nano-formulation of chitosan can be used for the controlled release of fertilizers, pesticides, and plant growth promoters in agriculture fields. The ChNPs applications in precision farming being a novel approach in recent developments. Here we have comprehensively reviewed the major points in this review are; the synthesis of ChNPs by biological resources, their modification and formulation for increasing its applicability, their modified types, and the different agricultural applications of ChNPs., Competing Interests: The authors declare no conflict of interest., (© 2022 The Authors.)

Objective: Develop and pilot-test the efficacy of an online training in improving comfort, knowledge, and behaviors related to eating disorders (EDs) screening among U.S.-based pediatric primary care providers (PCPs)., Methods: PCPs (N = 84) completed a baseline survey assessing comfort, knowledge, and behaviors regarding ED screening and referral, then watched a 1-h training video followed by a post-video survey. Half of the participants were randomly assigned to complete spaced-education questions in the following 2 months. All participants completed a 2-month follow-up survey. We used McNemar's and McNemar-Bowker tests to assess differences from baseline to post-video and post-video to follow-up, and logistic models to assess differences by spaced-education condition., Results: From baseline to post-video, there were significant improvements in PCPs' knowledge about and comfort in screening and making referrals for EDs (p < .05). There were no differences between spaced-education conditions in knowledge and behaviors from baseline or post-video to follow-up, but spaced-education participants reported significantly greater comfort in screening for BN (p < .01) and BED (p < .01) compared to non-spaced-education participants., Discussion: Findings suggest that a 1-h asynchronous training can improve PCP comfort, knowledge, and behavior in screening for EDs; spaced-education may provide slight additional benefits in PCP comfort., Public Significance: The delivery of an 1-h asynchronous online video training helped to improve PCPs' comfort, knowledge, and behavior in screening and referral for EDs among pediatric populations. This has implications for future evaluations of brief trainings among this provider population, which could ultimately help to improve early identification of EDs and referrals to appropriate treatment., (© 2022 Wiley Periodicals LLC.)

Background: Ovarian cancer with miliary disease spread is an aggressive phenotype lacking targeted management strategies. We sought to determine whether adjuvant intravenous/intraperitoneal (IV/IP) chemotherapy is beneficial in this disease setting., Methods: Patient/tumor characteristics and survival data of patients with stage IIIC epithelial ovarian cancer who underwent optimal primary debulking surgery from 01/2010 to 11/2014 were abstracted from records. Chi-square and Mann-Whitney U tests were used to compare categorical and continuous variables. The Kaplan-Meier method was used to estimate survival curves, and outcomes were compared using log-rank tests. Factors significant on univariate analysis were combined into multivariate logistic regression survival models., Results: Among 90 patients with miliary disease spread, 41 (46%) received IV/IP chemotherapy and 49 (54%) received IV chemotherapy. IV/IP chemotherapy, compared with IV chemotherapy, resulted in improved progression-free survival (PFS; 23.0 versus 12.0 months; p = 0.0002) and overall survival (OS; 52 versus 36 months; p = 0.002) in patients with miliary disease. Among 78 patients with nonmiliary disease spread, 23 (29%) underwent IV/IP chemotherapy and 55 (71%) underwent IV chemotherapy. There was no PFS or OS benefit associated with IV/IP chemotherapy over IV chemotherapy in these patients. On multivariate analysis, IV/IP chemotherapy was associated with improved PFS (HR, 0.28; 95% CI 0.15-0.53) and OS (HR, 0.33; 95% CI 0.18-0.61) in patients with miliary disease compared with those with nonmiliary disease (PFS [HR, 1.53; 95% CI 0.74-3.19]; OS [HR, 1.47; 95% CI 0.70-3.09])., Conclusions: Adjuvant IV/IP chemotherapy was associated with oncologic benefit in miliary disease spread. This survival benefit was not observed in nonmiliary disease., (© 2021. Society of Surgical Oncology.)

Gender minority (GM) youth are more likely to engage in sexual behaviors that increase risk of exposure to sexually transmitted infections, including HIV. However, family functioning may be protective against sexual risk taking. We characterized longitudinal associations between family functioning (family communication and family satisfaction) and sexual risk behaviors across two years in a community sample of 30 GM adolescents, ages 13-17 years. Participants were purposively recruited from community-based venues, through social media, and peer referrals throughout the New England area and completed surveys every 6 months, with measures of family functioning, sexual risk behaviors, risk factors (depressive and anxious symptoms, perceived stress related to parents), and protective factors (social support, gender-related pride, and community connectedness). Results indicated that higher levels of family communication, improved family satisfaction, and increased social support were protective for sexual risk taking, in general, and specifically for condom use for anal/vaginal sex. In contrast, increased depressive symptoms were associated with lower likelihood of anal/vaginal condom use. Associations between family functioning and sexual risk taking were not attenuated by adding risk and protective factors to the model; thus, these factors did not explain the observed associations between family functioning and sexual risk taking. These findings suggest improved family functioning, greater social support, and lower depressive symptoms are associated with reduced sexual risk taking among gender minority youth, thus making these factors an important target for future prevention efforts., (© 2021. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Purpose: Gender minority (GM) adolescents, who have a different gender identity than their sex assigned at birth, may use substances as a coping strategy in response to GM-related stressors. This study examined longitudinal effects of gender minority stressors on substance use in GM adolescents, and related risk factors (internalized transphobia, depressive symptoms, anxious symptoms) and protective factors (resilience, gender-related pride, family functioning, social support, gender-related community connectedness)., Methods: Participants were 30 GM adolescents, ages 13-17 years, from the U.S. community-based longitudinal Trans Teen and Family Narratives Project. Participants completed an online survey every 6 months across 2 years (5 waves; data collected 2015-2019)., Results: Exposure to gender minority stressors was associated with higher odds of alcohol use. Across models, internalized transphobia (risk factor), resilience (protective factor), and gender-related pride (protective factor) were the most significant mediators of associations between gender minority stressors and substance use. Family functioning and social support (protective factors) significantly moderated the association between gender minority stressors and alcohol use, such that family functioning and social support were protective for alcohol use at lower levels of gender minority stress, but not at higher levels., Conclusion: Results suggest that GM adolescents engage in substance use as a coping strategy in response to gender minority stressors. A number of hypothesized risk and protective factors mediated or moderated these associations. Future interventions with GM adolescents should focus efforts on addressing internalized transphobia as a risk factor and strengthening resilience, gender-related pride, and family functioning as protective factors for substance use., Competing Interests: The authors have declared that no competing interests exist.

Objectives: To examine contraceptive methods used by adolescent/young adult women of diverse sexual orientations., Study Design: We collected data from 12,902 females, born 1982-1995, from the longitudinal Growing Up Today Study., Results: Compared to heterosexuals, lesbians were half as likely to use contraceptives; other sexual minority subgroups (e.g., bisexuals) were more likely to use contraceptives, particularly long-acting reversible contraceptives., Conclusions: Many sexual minority women use contraception throughout adolescence/young adulthood, though use is low among lesbians., Implications: With limited contraception use, lesbians miss opportunities for care and need to be brought into the healthcare system in other ways., (Copyright © 2020. Published by Elsevier Inc.)

Problem: To compare inflammatory- and immune-associated peritoneal cytokines of adolescents and adults with and without endometriosis., Methods of Study: In a nested case-control study in multiple university-affiliated scientific centers, ten adolescents and thirteen adults with visually and histologically confirmed endometriosis (cases), thirteen adolescents with visually suspected endometriosis but indeterminate (seven patients) or negative (six patients) histology, and fifteen adults undergoing surgery for non-malignant gynecologic disease without endometriosis (controls) underwent laparoscopic aspiration of peritoneal fluid (PF), from which PF and conditioned medium (CM) cytokine levels were assayed., Results: Compared to adults with endometriosis, MCP-3, IL-12p40, MIP-1β, and IL-15 were significantly higher among adolescents with endometriosis, while TNF-β and CTACK were lower among adolescents. These differences were similar comparing adolescents with endometriosis to adult controls except for MIP-1β, which was not statistically different. MIP-1β was, however, the only cytokine observed to differ between adult cases and controls. There were no significant differences in CM cytokines among the three groups. Results were similar when analyses were restricted to samples collected (a) during menstrual cycle days 1-10, (b) from patients unexposed to exogenous hormones, or (c) from all adolescents despite presence or absence of histologic endometriosis., Conclusion: Biologically relevant and statistically significant differences in six PF cytokines were observed and suggest a more pro-invasion cytokine profile among adolescents with endometriosis. Adolescents with endometriosis have unique peritoneal cytokine profiles and molecular behavior when compared to adults with and without endometriosis., (© 2020 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Purpose: The aim of this study was to assess the effect of intravitreal injections (IVI) of ranibizumab and aflibercept on the choroidal thickness (CT) in patients with treatment-naive diabetic macular edema (DME) before and after monthly IVI. Patients and Methods . Prospective monocenter study. Inclusion criteria were treatment-naive DME eyes without concomitant panretinal photocoagulation, associated with a decrease in best-corrected visual acuity ≤75 letters on the Early Treatment Diabetic Retinopathy Study (ETDRS) scale. DME was defined by a central retinal thickness ≥300  μ m on swept-source OCT (Triton DRI OCT, Topcon Corporation, Itabashi, Japan). Patients received 5 IVI of ranibizumab or aflibercept. The primary endpoint was the change in the central subfield CT (CSCT) between inclusion (M0) and 1 month after the fifth IVI (M5). The secondary endpoint was the CT changes between M0 and M5 in other locations of the macular ETDRS grid., Results: Twenty-four eyes of 24 patients with a mean age of 61.1 years were included. Eleven and 13 patients were, respectively, treated with ranibizumab and aflibercept, and 86.4% had type 2 diabetes. The overall CSCT decreased significantly by -12  μ m between M0 and M5 (231.7  μ m at M0 and 219.7  μ m at M5) ( p =0.03). It decreased by -15.2  μ m ( p =0.02) in the aflibercept group (206.9  μ m at M0 and 191.7  μ m at M5) and by -7.3  μ m ( p =0.4) in the ranibizumab group (267.5  μ m at M0 and 260.2  μ m at M5). The CSCT decreased by -4.9  μ m in noninjected contralateral eyes (242.3  μ m at M0 and 237.4  μ m at M5). CT changes between M0 and M5 in the superior, temporal, inferior, and nasal macular inner ring were significant in the aflibercept group but not in the ranibizumab and control groups., Conclusion: In DME patients, the CSCT decreases after 5 IVI of anti-VEGF, especially after aflibercept treatment., Competing Interests: V. Sarda, P. Eymard, and L. Hrarat have nothing to disclose. F. Fajnkuchen and A. Giocanti-Aurégan are consultants for Allergan, Bayer, and Novartis. The authors declare no conflicts of interest related to the submitted work., (Copyright © 2020 Valérie Sarda et al.)

Background: Adolescents with endometriosis are a particularly underserved population who struggle with chronic pain. Despite widespread use, there are no published trials examining the individual effects of vitamin D and omega-3 (n-3) fatty acid supplementation on endometriosis-associated pain in adolescents., Objectives: We aimed to determine whether supplementation with vitamin D or ω-3 fatty acids remediates pain, changes frequency of pain medication usage, or affects quality of life in young women with endometriosis., Methods: Women (aged 12-25 y) with surgically confirmed endometriosis and pelvic pain enrolled in a double-blind, randomized, placebo-controlled trial. The primary outcome was pain measured by the visual analog scale (VAS). Secondary outcomes were quality of life, pain catastrophizing, and pain medication usage. Participants were randomly assigned to receive 2000 IU vitamin D3, 1000 mg fish oil, or placebo daily for 6 mo., Results: A total of 147 women were screened and 69 were randomly assigned as follows: 27 to vitamin D3; 20 to fish oil; and 22 to placebo. Participants in the vitamin D arm experienced significant improvement in VAS pain [mean (95% CI) worst pain in the past month, from baseline to 6 mo: 7.0 (6.2, 7.8) to 5.5 (4.2, 6.8), P = 0.02]; however, an improvement of nearly identical magnitude was observed in the placebo arm [6.0 (5.1, 6.9) to 4.4 (3.0, 5.8), P = 0.07]. A more modest improvement was observed in the fish oil arm [5.9 (4.8, 7.0) to 5.2 (3.7, 6.8), P = 0.39]. Neither of the intervention arms were statistically different from placebo., Conclusions: In young women with endometriosis, supplementation with vitamin D led to significant changes in pelvic pain; however, these were similar in magnitude to placebo. Supplementation with fish oil resulted in about half of the VAS pain reduction of the other 2 arms. Studies are needed to better define the physiology underlying the observed reduction in pain score in the placebo arm that persisted across 6 mo.This trial was registered at clinicaltrials.gov as NCT02387931., (Copyright © The Author(s) on behalf of the American Society for Nutrition 2020.)

Introduction: Motor vehicle crashes are a leading cause of injury death in the U.S. Restrictive alcohol policies protect against crashes involving alcohol above the legal blood alcohol concentration of 0.08%. Characteristics of motor vehicle crash fatalities involving blood alcohol concentrations below the limit and their relationships to alcohol control policies have not been well characterized., Methods: Motor vehicle crash fatality data and crash and decedent characteristics from 2000 to 2015 came from the Fatality Analysis Reporting System and were analyzed in 2018-2019. Alcohol Policy Scale scores characterized alcohol policy environments by state-year. Generalized estimating equation alternating logistic regression models assessed these scores and the odds that a fatality involved alcohol below the legal threshold., Results: Of 612,030 motor vehicle crash fatalities, 223,471 (37%) died in alcohol-involved crashes, of which 33,965 (15% of alcohol-involved fatalities or 6% of all fatalities) had a blood alcohol concentration <0.08%. A 10 percentage point increase in Alcohol Policy Scale score, approximating the interquartile range among states, was associated with reduced odds of fatalities involving alcohol <0.08% vs 0.00% (AOR=0.91, 95% CI=0.89, 0.93). These findings held across multiple subgroup analyses by decedent and crash characteristics. Similar results were found for odds of alcohol involvement <0.05% vs 0.00% (AOR=0.90, 95% CI=0.88, 0.93), and ≥0.05% but <0.08% vs <0.05% (AOR=0.93, 95% CI=0.89, 0.96)., Conclusions: The number of lower blood alcohol concentration fatalities is substantial. States with more restrictive alcohol policies tend to have reduced odds of lower blood alcohol concentration motor vehicle crashes than states with weaker policies., (Copyright © 2020 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.)