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Megacities are major sources of anthropogenic fossil fuel CO2 (FFCO2) emissions. The spatial extents of these large urban systems cover areas of 10 000 km2 or more with complex topography and changing landscapes. We present a high-resolution land-atmosphere modelling system for urban CO2 emissions over the Los Angeles (LA) megacity area. The Weather Research and Forecasting (WRF)-Chem model was coupled to a very high-resolution FFCO2 emission product, Hestia-LA, to simulate atmospheric CO2 concentrations across the LA megacity at spatial resolutions as fine as ∼ 1 km. We evaluated multiple WRF configurations, selecting one that minimized errors in wind speed, wind direction, and boundary layer height as evaluated by its performance against meteorological data collected during the CalNex-LA campaign (May-June 2010). Our results show no significant difference between moderate-resolution (4 km) and high-resolution (1.3 km) simulations when evaluated against surface meteorological data, but the high-resolution configurations better resolved planetary boundary layer heights and vertical gradients in the horizontal mean winds. We coupled our WRF configuration with the Vulcan 2.2 (10 km resolution) and Hestia-LA (1.3 km resolution) fossil fuel CO2 emission products to evaluate the impact of the spatial resolution of the CO2 emission products and the meteorological transport model on the representation of spatiotemporal variability in simulated atmospheric CO2 concentrations. We find that high spatial resolution in the fossil fuel CO2 emissions is more important than in the atmospheric model to capture CO2 concentration variability across the LA megacity. Finally, we present a novel approach that employs simultaneous correlations of the simulated atmospheric CO2 fields to qualitatively evaluate the greenhouse gas measurement network over the LA megacity. Spatial correlations in the atmospheric CO2 fields reflect the coverage of individual measurement sites when a statistically significant number of sites observe emissions from a specific source or location. We conclude that elevated atmospheric CO2 concentrations over the LA megacity are composed of multiple fine-scale plumes rather than a single homogenous urban dome. Furthermore, we conclude that FFCO2 emissions monitoring in the LA megacity requires FFCO2 emissions modelling with ∼ 1 km resolution because coarser-resolution emissions modelling tends to overestimate the observational constraints on the emissions estimates.

This study investigates the effects of polycarboxylate-lignosulfonate superplasticizer (PLS), water, and cement content on mechanical, physical and cementitious paste thickness of pervious concrete (PC) for its further application in urban areas. For this reason, 17 PC mixtures containing different portions of PLS (0.10% to 1.00% of the cement content), water-to-cement ratio (0.30 to 0.40), and cement content (315 to 350 kg/m3) with a constant range aggregate size (4.75 to 9.5 mm) were designed, tested, and analyzed by Design of Expert (DoE). The results showed that increasing the proportion of PLS, water, and cement increased the compressive strength of PC at ages of 7, 11, and 28 days. However, the permeability and porosity would decrease due to formation of a pasty mixture. The effect of water content on changing the compressive strength was more significant than other variables, especially in the range of 0.3 to 0.35. Apart from this, increasing the portion of variables resulted in increasing the average cementitious paste thickness and the number of line segments, which both resulted in an increment of compressive strength. The PC mixture with 1.00% of PLS, W/C ratio of 0.40, and cement content of 350 kg/m3 had the maximum compressive strength of 18.35 MPa with reasonable porosity and permeability. This system is suitable as pavements in urban areas with light-traffic load, green spaces, and sidewalks to mitigate the anthropization impacts.

Although the Flow experience has been researched extensively in music education, there is limited investigation into exploring the link between the Suzuki piano method and Csikszentmihalyi’s flow theory. To address this gap, a quasi-experimental study was conducted to examine how the Suzuki piano method can promote the flow state of adult piano beginners. The study involved 36 participants assigned to either a treatment group or a control group. Both groups underwent an eight-week training program in Suzuki Piano Method and Conventional Group Piano Class respectively. After the program, participants from both groups underwent a post-training performance test and completed a survey, namely Learning and Performing Experience Scale (LPES), modified based on the Short Flow State Scale (S-FFS) by Martin and Jackson to examine their flow experience. The treatment group showed significantly higher flow experience levels than the control group, particularly in dimensions of Concentration, Unambiguous feedback, Timelessness, Loss of self-consciousness, Sense of control, Autotelic experience, and Challenge-skill balance. The findings suggested that the Suzuki piano method may promote flow experiences among adult beginners in piano learning. The implication of the study signified that the collaborative and interactive learning inherent in the method might be beneficial in achieving flow state and could be a consideration in conducting group piano classes.

We investigate the scattering properties of coupled parity-time (PT) symmetric chiral nanospheres with scattering matrix formalism. The exceptional points, i.e., spectral singularities at which the eigenvalues and eigenvectors simultaneously coalesce in the parameter space, of scattering matrix can be tailored by the chirality of the nanospheres. We also calculate the scattering, absorption and extinction cross sections of the PT-symmetric chiral scatter under illumination by monochromatic left- and right-circularly polarized plane waves. We find that the scattering cross section of the nanostructures exhibits an asymmetry when the plane waves are incident from the loss and gain regions, respectively, especially in the broken phase, and the optical cross section exhibits circular dichroism, i.e., differential extinction when the PT-symmetric scatter is endowed with chirality. In particular, under illumination by linearly polarized monochromatic plane waves without intrinsic chirality, the ellipticity of scattered fields in the forward direction, denoting the chirality of light, becomes larger when the scatter is in the PT-symmetry-broken phase. Our findings demonstrate that the gain and loss can control the optical chirality and enhance the chiroptical interactions and pave the way for studying the resonant chiral light–matter interactions in non-Hermitian photonics.

Introduction: Total knee arthroplasty has been adopted to be the most successful treatment for advanced knee osteoarthritis. The adoption of multimodal periarticular analgesic (MPI) has been shown to have satisfactory pain control after surgery. However, there is relatively lack of data investigating whether this mode of pain control is effective in enhancing rehabilitation. Method: This is a prospective randomized control trial from July 2017 to June 2018, including 82 patients, in which 43 of them had MPI injection and 39 of them had no MPI injection. Primary outcome measures included the number of days required to perform straight leg raise, length of hospital stay, and Insall knee score upon discharge. Secondary outcome measures included total dose of patient-controlled analgesia (PCA) consumption postoperatively and visual analog scale (VAS) at rest and on motion during postoperative days 1–4. Result: The MPI group performed significantly better than the femoral nerve block (FNB) group in terms of early functional outcome, namely the number of days required to perform straight leg raising and length of hospital stay. The total postoperative PCA consumption and VAS score on motion during postoperative day 1 were also significantly better for MPI group. There was no difference in Insall knee score upon discharge between these two groups. Conclusion: Compared to FNB, MPI depicts a faster inpatient rehabilitation, accounted by its quadriceps-sparing, and better pain relief especially in the early postoperative period.

This article illustrates the clinical course of a patient diagnosed to have bilateral Charcot hip arthropathy secondary to tabes dorsalis from delayed untreated syphilitic infection. This differential diagnosis of rapid bilateral hip destruction was a near-extinct entity, and a high index of suspicion is needed to prevent untoward sequelae.

Background/Purpose Reverse shoulder arthroplasty (RSA) is an effective treatment for patients who suffer from shoulder pain and dysfunction associated with a variety of shoulder pathologies including severe rotator cuff deficiency with or without glenohumeral arthritis. It has been widely used in European countries and the United States and is now gaining popularity in Asia, including Hong Kong. However, there are only limited size options available for glenoid baseplates, with 25 mm being the smallest size in some commonly used systems. The aim of our study is to perform computerized tomography (CT) measurements of the glenoid dimension in the Chinese population and to see if the current glenoid baseplate component size option is sufficient for our local population. Methods A total of 70 CT scans of shoulder regions were analysed. Measurements included maximum superoinferior height and the anteroposterior height. Results The glenoid dimensions were smaller compared to those from previous studies in Caucasian counterparts. Some 41% of female glenoids had widths measuring < 25 mm (25 mm being the smallest size available in some commonly used RSA systems). Conclusion Although there are only limited size options available for the glenoid baseplate in RSA, from our data, it should be able to cover most patients in our local population. However, surgeons should exercise special care when contemplating performing reverse shoulder replacement for small size females in our local population.

A case with simultaneous tibial tuberosity fracture and patellar tendon avulsion in a 16-year-old boy is presented. Surgery was performed for open reduction, screw fixation and patellar tendon repair, and protected with a wire loop to restore the extensor mechanism. The wire loop was removed at 2 months postoperatively. The fracture healed at 5 months after surgery and the patient regained the full range of movement of the knee at 5 months.

Visibility can be interpreted as the largest distance of an object that can be recognized or detected under a bright environment that can be used as an environmental indicator for weather conditions and air pollution. The accuracy of the classical approach of visibility calculation, in which meteorological laws and image feature extraction from digital images are used, depends on the quality and noise disturbances of the image. Therefore, artificial intelligence (AI) and digital image approaches have been proposed for visibility estimation in the past. Image features for the whole digital image are generated by pre-trained convolutional neural networks, and the Artificial Neural Network (ANN) is designed for correlation between image features and visibilities. Instead of using the information of the whole digital images, past research has been proposed to identify effective subregions from which image features are generated. A generalized regression neural network (GRNN) was designed to correlate the image features with the visibilities. Past research results showed that this method is more accurate than the classical approach of using handcrafted features. However, the selection of effective subregions of digital images is not fully automated and is based on manual selection by expert judgments. In this paper, we proposed an automatic effective subregion selection method using landmark object extraction techniques. Image features are generated from these LMO subregions, and the ANN is designed to approximate the mapping between LMO regions' feature values and visibility values. The experimental results show that this approach can minimize the reductant information for ANN training and improve the accuracy of visibility estimation as compared to the single image approach.

For emergency medicine physicians, being named in a malpractice suit is not an if, it is a when. By the age of 55 years, 68% of emergency physicians have been sued. In the following article, we review the most common factors shared by closed claims in adult and pediatric patients from emergency departments and acute care settings. Our hope is that by identifying shared characteristics, we may improve patient care and reduce litigation risk., Competing Interests: Disclosure The authors have nothing to disclose., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Circuit dysfunction in autism may involve a failure of homeostatic plasticity. To test this, we studied parvalbumin (PV) interneurons which exhibit rapid homeostatic plasticity of intrinsic excitability following whisker deprivation in mouse somatosensory cortex. Brief deprivation reduces PV excitability by increasing Kv1 current to increase PV spike threshold. We found that PV homeostatic plasticity is disrupted in Tsc2 +/- and Fmr1 -/- models of autism. In wildtype mice, deprivation elevates the transcription factor ER81 which drives Kcna1 transcription, increasing Kv1.1 protein in the axon initial segment and soma. These molecular signatures of homeostasis were absent in Tsc2 +/- and Fmr1 -/- . Whisker enrichment increased PV excitability, but not in Tsc2 +/- , indicating that homeostasis is lost bidirectionally. Deprivation reduced feedforward L4-L2/3 inhibition in wildtype but not Tsc2 +/- mice. Thus, two autism models show a convergent loss of PV circuit homeostasis at physiological and molecular levels, potentially contributing to sensory processing impairments.

High spatial or temporal variability in community composition makes it challenging for natural resource managers to predict ecosystem trajectories at scales relevant to management. This is commonly the case in nearshore marine environments, where the frequency and intensity of disturbance events vary at the sub-kilometer to meter scale, creating a patchwork of successional stages within a single ecosystem. The successional stage of a community impacts its stability, recovery potential, and trajectory over time in predictable ways. Here we demonstrate the value of successional theory for interpreting fine-scale community heterogeneity using Hawaiian coral reefs as a case study. We tracked benthic community dynamics on 36 forereefs over a 6-year period (2017-2023) that captures impacts from high surf events, a marine heatwave, and unprecedented shifts in human behavior due to the COVID-19 pandemic. We document high spatial variation in benthic community composition that was only partially explained by island and environmental regime. Through hierarchical clustering, we identify three distinct community types that appear to represent different successional stages of reef development. Reefs belonging to the same community type exhibited similar rates of change in coral cover and structural complexity over time, more so than reefs located on the same island. Importantly, communities that were indicative of early succession (low coral cover reefs dominated by stress-tolerant corals) were most likely to experience an increase in coral cover over time, while later-stage successional communities were more likely to experience coral decline. Our findings highlight the influence of life history and successional stage on community trajectories. Accounting for these factors, not simply overall coral cover, is essential for designing effective management interventions. Site-specific management that accounts for a community's unique composition and history of disturbance is needed to effectively conserve these important ecosystems., (Global Change Biology© 2025 The Author(s). Global Change Biology published by John Wiley & Sons Ltd.)

Background/purpose: Various pulp-covering materials offer advantages in regenerative root canal treatment, but each has limitations, highlighting the need for more effective antibacterial strategies for pulp repair and regeneration. Mesoporous bioactive glasses (MBG) show significant biological activity, making them valuable in tissue/dental repair. Silver-incorporated MBG exhibits promising antibacterial effects against various bacteria; copper ions are crucial in regulating angiogenesis signals. Co-loading copper and silver in bioactive glasses has been explored to address clinical challenges. This study modified the preparation of silver-copper bimetallic mesoporous bioactive glass, analyzing their textural properties and antibacterial activity against Enterococcus faecalis ., Materials and Methods: The silver-copper co-loaded bioactive glass (designated as AgCu/80S) was synthesized using a sol-gel technique with modifications. Textural analyses were carried out via X-ray diffraction, UV-Vis spectroscopy, Brunauer-Emmett-Teller analysis, and transmission electron microscope. The ion-releasing activity determined using inductively coupled plasma-mass spectrometry, and the antibacterial activity against E. faecalis was assessed through disk diffusion and kinetic bacterial growth curve., Results: The modification led to weaker crystallization of calcium silicate, altering ion-releasing and antibacterial activities. Ag3Cu2/80S exhibited the highest released silver ion concentration at 112.6 ppm, with an inhibition zone of 9.09 ± 0.09 mm in disk diffusion assays. However, the inhibition zone of Ag2Cu3/80S was 9.92 ± 0.04 mm, implying that the antibacterial activity may not only be influenced by silver ions., Conclusion: The AgCu/80S showed a potential antibacterial activity against E. faecalis , whereas further research on AgCu/80S glasses is necessary to optimize ion release conditions, assess bioactivities, and explore potential dental applications., Competing Interests: The authors have no conflicts of interest relevant to this article., (© 2024 Association for Dental Sciences of the Republic of China. Publishing services by Elsevier B.Vé.)

Embryonic stem cells possess the remarkable ability to self-organize into blastocyst-like structures upon induction. These stem cell-based embryo models serve as invaluable platforms for studying embryogenesis and therapeutic developments. Nevertheless, the specific intrinsic regulators that govern this potential for blastoid formation remain unknown. Here we demonstrate an intrinsic program that plays a crucial role in both blastoids and blastocysts across multiple species. We first establish metrics for grading the resemblance of blastoids to mouse blastocysts, and identify the differential activation of gene regulons involved in lineage specification among various blastoid grades. Notably, abrogation of nuclear receptor subfamily 1, group H, member 2 (Nr1h2) drastically reduces blastoid formation. Nr1h2 activation alone is sufficient to rewire conventional ESC into a distinct pluripotency state, enabling them to form blastoids with enhanced implantation capacity in the uterus and contribute to both embryonic and extraembryonic lineages in vivo. Through integrative multi-omics analyses, we uncover the broad regulatory role of Nr1h2 in the transcriptome, chromatin accessibility and epigenome, targeting genes associated with embryonic lineage and the transposable element SINE-B1. The Nr1h2-centred intrinsic program governs and drives the development of both blastoids and early embryos., Competing Interests: Competing interests The authors declare no competing interests., (© 2024. The Author(s).)

Purpose: Antibodies to select Epstein-Barr virus proteins can diagnose early-stage nasopharyngeal carcinoma (NPC). We have previously shown that IgA against Epstein-Barr virus nuclear antigen 1 (EBNA1) can predict incident NPC in high- and intermediate-risk cohorts 4 years before diagnosis. Here, we tested EBNA1 variants, with mutants, to define the sequence requirements for an NPC risk assay., Experimental Design: Mammalian-expressed constructs were developed to represent EBNA1 variants 487V and 487A, which can differ by ≥15 amino acids in the N- and C-termini. Denatured lysates were evaluated by a refined IgA and IgG immunoblot assay in a case-control study using prediagnostic NPC sera from two independent cohorts in Singapore and Shanghai, the People's Republic of China., Results: At 95% sensitivity, 487V yielded a 94.9% specificity compared with 86.1% for 487A. EBNA1 deleted for the conserved glycine-alanine repeats (GAr) reduced false positives by 22.8%. NPC sera reacted more strongly to the C-terminus than healthy controls, but the C-terminal construct (a.a. 390-641) showed lower specificity (84.8%) than the EBNA1 GAr-deleted construct (92.4%) at 95% sensitivity., Conclusions: Although EBNA1 IgA was present in healthy sera, most epitopes localized to the immunodominant GAr. We conclude that a refined EBNA1 antigen deleted for the GAr, but with residues consistently detected in Southeast Asian NPC tumors, is optimized for risk prediction with an extended sojourn time of 7.5 years. Furthermore, distinct EBNA1 serologic profiles enhanced the utility of the EBNA1 IgA assay for risk stratification. This illustrates the importance of serologically relevant EBNA1 sequences for NPC risk prediction and early detection., (©2024 American Association for Cancer Research.)

Background Calcific uremic arteriolopathy (CUA) is a rare but debilitating disease affecting patients with kidney disease. Reported risk factors of CUA in the literature include female sex, obesity, diabetes mellitus, and vitamin K antagonists' (VKAs) usage. CUA prevalence in Malaysia is unknown and has not been reported before. Methods A multicenter observational study was conducted in 13 centers all over Malaysia to study the clinical characteristics, treatment, and outcomes of CUA. The data of patients confirmed with CUA between January 1, 2016, and December 31, 2021, was collected from medical records by each center's nephrologists. Results Out of 33 confirmed CUA cases, 69.7% were females, and 66.7% were Malay with a mean age of 47.33 ± 13.80 years old. The mean BMI was 25.66 ± 9.77 kg/m 2 , and 18.2% were classified as obese (BMI > 30). Two-thirds of the patients were on hemodialysis (HD), and the mean dialysis vintage was 6.2 ± 4.11 years. A majority (87.9%) have hypertension, 33.3% are diabetic, and 27.3% have coronary artery disease. Only 15.2% of the patients were on warfarin at the time of diagnosis. A total of 78.8% of patients were taking calcium-based phosphate binders during diagnosis. Investigation results showed calcium, 2.44 ± 0.29 mmol/L; phosphate, 2.18 ± 0.67 mmol/L; CaXPO4 = 5.41 ± 1.90; and parathyroid hormone, 181.14 ± 153.23 pmol/L. About half (54.5%) had skin biopsy confirmation done. Distribution of lesions was 57.6% peripheral and 30.3% central. For treatment of CUA, there were 57.6% usage of non-calcium-based phosphate binders, 48.5% cinacalcet, 30.3% sodium thiosulphate, and 33.3% had parathyroidectomy. Half (54.5%) of our CUA patients died within three months from diagnosis. The mean time from diagnosis to mortality was 4.12 ± 5.59 months. A majority (45.5%) died from septicemia caused by infections. Interestingly, there were a few rare presentations of CUA such as pulmonary calciphylaxis, heart and lung calcifications, liver and spleen calcifications, and genital lesions. One patient had resistant CUA and was given a trial of lipid apheresis for 10 sessions. Conclusion This is the first and largest multicenter study looking into the characteristics, treatment, and outcome of CUA in Malaysia. Majority of patients in Malaysia undergo HD as kidney replacement therapy; hence, our results correlate with this. The incidence of CUA was estimated to be 6.6 per 10,000 dialysis patients in this study and the mortality rate is very high. This is consistent with worldwide data which reported mortality as high as 60%., Competing Interests: Human subjects: Consent for treatment and open access publication was obtained or waived by all participants in this study. University of Malaya Medical Centre Medical Research Ethics Committee issued approval 2021922-10603. This study protocol was reviewed and approved by the University of Malaya Medical Centre Medical Research Ethics Committee, with approval number 2021922-10603. Requirement for informed consent was waived due to the retrospective nature of the study. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Lee et al.)

Key Clinical Message: Lumbar facet fracture-dislocation is rare, often due to hyperflexion with rotational force. Abnormal scoliosis on radiography is a key sign, prompting further imaging. Facetectomy and laminectomy ensure safe reduction, while instrumented fusion is an effective surgical treatment., Abstract: Traumatic lumbar facet dislocation is an uncommon condition, particularly when unilateral lumbar facet dislocation is accompanied by a contralateral facet fracture. The patient had a locked facet joint at the left L4-L5, a fracture of the right superior articular process of L5 and a comminuted fracture at the peritrochanteric region of the right femur following a fall. Emergent operation was conducted, starting with open reduction and fixation for the right proximal femur, followed by posterior open reduction and posterolateral fusion with instrumentation, without interbody fusion, for the lumbar spine injury. The patient exhibited positive outcomes throughout the follow-up. This article highlights the trauma mechanism of lumbar facet dislocation, emphasizing hyperflexion with rotational force. Abnormal local scoliosis is a distinctive imaging sign of facet joint dislocation. Facetectomy and laminectomy are recommended for safe reduction and instrumented fusion is considered a safe and effective surgical treatment for facet joint dislocation injuries., Competing Interests: None of the authors had any conflict of interest in relation to this report., (© 2024 The Author(s). Clinical Case Reports published by John Wiley & Sons Ltd.)

Wearable haptics serve as an enhanced media to connect humans and VR/robots. The inevitable sweating issue in all wearables creates a bottleneck for wearable haptics, as the sweat/moisture accumulated in the skin/device interface can substantially affect feedback accuracy, comfortability, and create hygienic problems. Nowadays, wearable haptics typically gain performance at the cost of sacrificing the breathability, comfort, and biocompatibility. Here, we developed a fully integrated breathable haptic textile (FIBHT) to solve these trade-off issues, where the FIBHT exhibits high-level integration of 128 pixels over the palm, great stretchability of 400%, and superior permeability of over 657 g/m 2 /day (moisture) and 40 mm/s (air). It is a stand-alone haptic system totally composed of stretchable, breathable, and bioadhesive materials, which empowers it with precise, sweating/movement-insensitive and dynamic feedback, and makes FIBHT powerful for virtual touching in broad scenarios.

Background: Metabolic surgery is recognized for its effectiveness in weight loss and improving outcomes for individuals with type 2 diabetes mellitus (T2DM). However, its impact on renal function, especially in multi-ethnic Asian populations, remains underexplored. This study investigates mid- and long-term renal outcomes following metabolic surgery in Asian patients with T2DM., Methods: This retrospective cohort study utilized data from the Asian Diabetes Surgery Study (ADSS), involving T2DM patients aged 20-79 who underwent metabolic surgery from 2008 to 2015. The primary outcome was the change in estimated glomerular filtration rate (eGFR) at 1, 3, and 5 years post-surgery, with adjustments for confounders. Secondary outcomes included changes in chronic kidney disease (CKD) stages and the relationship between weight loss and eGFR changes. Data were analyzed using univariate and multivariable regression analyses, along with the McNemar test., Results: The study included 1513 patients with a mean age of 42.7 years. The results revealed that a significant improvement in eGFR was observed at 1-year post-surgery (112.4 ± 32.0 ml/min/1.73 m², P  < .001), with a shift toward less severe CKD stages. However, this improvement was not sustained at 3 and 5 years. No significant correlation was found between weight loss and eGFR changes at 1-year follow-up., Conclusion: Metabolic surgery significantly improves renal function at 1 year postoperatively in Asian individuals with T2DM, highlighting its potential benefits beyond glycemic control and weight loss. The long-term effects on renal function require further investigation., Competing Interests: None declared., (© The Author(s) 2024. Published by Oxford University Press on behalf of the ERA.)

Objective: Mass Casualty Incidents (MCIs) involving high-speed passenger ferries (HSPFs) may result in the dual-wave phenomenon, in which the emergency department (ED) is overwhelmed by an initial wave of minor injuries, followed by a second wave of more seriously injured victims. This study aimed to characterize the time pattern of ED presentation of victims in such accidents in Hong Kong., Methods: All HSPF MCIs from 2005 to 2015 were reviewed retrospectively, with the time interval from accident to ED registration determined for each victim. Multivariable linear regression was used to identify independent factors associated with the time of ED presentation after the accidents., Results: Eight MCIs involving 492 victims were identified. Victims with an Injury Severity Score (ISS) ≥ 9 had a significantly shorter median time interval compared to those with minor injuries. An ISS ≥ 9 and evacuation by emergency service vessels were associated with a shorter delay in ED arrival, whereas ship sinking, accident at nighttime, and a longer linear distance between the accident and receiving ED were associated with a longer delay., Conclusion: The dual-wave phenomenon was not present in HSPF MCIs. Early communication is the key to ensure early resource mobilisation and a well-timed response.

Given a maze (e.g., in a book of puzzles), you might solve it by drawing out paths with your pencil. But even without a pencil, you might naturally find yourself mentally tracing along various paths. This "mental path tracing" may intuitively seem to depend on your (overt, conscious, voluntary) goal of wanting to get out of the maze, but might it also occur spontaneously-as a result of simply seeing the maze, via a kind of dynamic visual routine? Here, observers simply had to compare the visual properties of two probes presented in a maze. The maze itself was entirely task irrelevant, but we predicted that simply seeing the maze's visual structure would "afford" incidental mental path tracing (à la Gibson). Across four experiments, observers were slower to compare probes that were further from each other along the paths, even when controlling for lower level properties (such as the probes' brute linear separation, ignoring the maze "walls"). These results also generalized beyond mazes to other unfamiliar displays with task-irrelevant circular obstacles. This novel combination of two prominent themes from our field-affordances and visual routines-suggests that at least some visual routines may not require voluntary goals; instead, they may operate in an automatic (incidental, stimulus-driven) fashion, as a part of visual processing itself. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Objective: To evaluate the factors that improve professional and personal well-being amongst women in neonatology (WiN)., Study Design: A 30-question survey of multiple choice, rank order, and open-ended questions focused on professional and personal factors that affect the well-being of WiN members. Quantitative and qualitative methods were used to determine leading factors and themes., Results: Of 326 respondents, 64% felt "well" professionally over half of the time. Professional well-being was most affected by scheduling flexibility, helping patients, administrative and staffing support, feelings of being valued, and clinical workload/acuity. Time for family and self-care, having domestic help, and scheduling flexibility were factors that most positively impacted personal well-being., Conclusion: In this national survey, WiN members identified the factors that can improve their well-being. Strategic planning and targeted interventions are urgently needed to enhance work-life integration and job satisfaction, leading to improved neonatal workforce retention and improved quality of patient care., (© 2024. The Author(s), under exclusive licence to Springer Nature America, Inc.)

Background: Autologous bone dust can be filled in bone defects to promote effective bone healing but typically it is lost when using suction during surgery. The aim of this study was to develop a novel bone collector that can be used to collect bone chips/dust of varying sizes without changing current surgical procedures., Research Design and Methods: This collector was designed to connect to a surgical continuous suction system and comprised a plate filter with a 3 mm hole and featured a taper filter with a mesh size of 0.27 mm for the separation and collection of both coarse and fine bone chips/dust. The bone collector was manufactured using nylon 3D printing and plastic injection with biocompatible materials., Results: The bone collector functional test revealed high bone chip collection efficiency (93%) with automatic size separation function. Low (3.42%) filtration errors showed that most of the water can be drained smoothly from the bone collector. In clinical usability testing, bone collectors can provide functions demonstrated in in vivo spinal fusion and femoral fracture surgeries with different bone grafting size requirements., Conclusions: The novel bone collector has been validated as a viable and effective surgical device, offering surgeons an additional option to enhance patient outcomes.

Tuberculosis-affected lungs with chronic inflammation harbor abundant immunosuppressive immune cells but the nature of such inflammation is unclear. Dysfunction in T cell exhaustion, while implicated in chronic inflammatory diseases, remains unexplored in tuberculosis. Given that immunotherapy targeting exhaustion checkpoints exacerbates tuberculosis, we speculate that T cell exhaustion is dysfunctional in tuberculosis. Using integrated single-cell RNA sequencing and T cell receptor profiling we reported defects in exhaustion responses within inflamed tuberculosis-affected lungs. Tuberculosis lungs demonstrated significantly reduced levels of exhausted CD8+ T cells and exhibited diminished expression of exhaustion-related transcripts among clonally expanded CD4+ and CD8+ T cells. Additionally, clonal expansion of CD4+ and CD8+ T cells bearing T cell receptors specific for CMV was observed. Expanded CD8+ T cells expressed the cytolytic marker GZMK. Hence, inflamed tuberculosis-affected lungs displayed dysfunction in T cell exhaustion. Our findings likely hold implications for understanding the reactivation of tuberculosis observed in patients undergoing immunotherapy targeting the exhaustion checkpoint., 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 © 2024. Published by Elsevier Ltd.)

Genetic variants in Epstein-Barr virus (EBV) have been strongly associated with nasopharyngeal carcinoma (NPC) in South China. However, different results regarding the most significant viral variants, with polymorphisms in EBER2 and BALF2 loci, have been reported in separate studies. In this study, we newly sequenced 100 EBV genomes derived from 61 NPC cases and 39 population controls. Comprehensive genomic analyses of EBV sequences from both NPC patients and healthy carriers in South China were conducted, totaling 279 cases and 227 controls. Meta-analysis of genome-wide association study revealed a 4-bp deletion downstream of EBER2 (coordinates, 7188-7191; EBER-del) as the most significant variant associated with NPC. Furthermore, multiple viral variants were found to be genetically linked to EBER-del forming a risk haplotype, suggesting that multiple viral variants might be associated with NPC pathogenesis. Population structure and phylogenetic analyses further characterized a high risk EBV lineage for NPC revealing a panel of 38 single nucleotide polymorphisms (SNPs), including those in the EBER2 and BALF2 loci. With linkage disequilibrium clumping and feature selection algorithm, the 38 SNPs could be narrowed down to 9 SNPs which can be used to accurately detect the high risk EBV lineage. In summary, our study provides novel insight into the role of EBV genetic variation in NPC pathogenesis by defining a risk haplotype of EBV for downstream functional studies and identifying a single high risk EBV lineage characterized by 9 SNPs for potential application in population screening of NPC., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Wong et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Background: This study aims to evaluate the optimal ratio of synthetic bone graft (SBG) material and platelet rich fibrin (PRF) mixed in a metal 3D-printed implant to enhance bone regeneration., Methods: Specialized titanium hollow implants (5 mm in diameter and 6 mm in height for rabbit; 6 mm in diameter and 5 mm in height for pig) were designed and manufactured using 3D printing technology. The implants were divided into three groups and filled with different bone graft combinations, namely (1) SBG alone; (2) PRF to SBG in 1:1 ratio; (3) PRF to SBG in 2:1 ratio. These three groups were replicated tightly into each bone defect in distal femurs of rabbits (nine implants, n = 3) and femoral shafts of pigs (fifteen implants, n = 5). Animal tissue sections were obtained after euthanasia at the 8th postoperative week. The rabbit specimens were stained with analine blue, while the pig specimens were stained with Masson-Goldner's trichrome stain to perform histologically examination. All titanium hollow implants were well anchored, except in fracture specimens (three in the rabbit and one fracture in the pig)., Result: Rabbit specimens under analine blue staining showed that collagen tissue increased by about 20% and 40% in the 1:1 ratio group and the 2:1 ratio group, respectively. Masson-Goldner's trichrome stain results showed that new bone growth increased by 32% in the 1:1 ratio PRF to SBG, while - 8% in the 2:1 ratio group., Conclusion: This study demonstrated that placing a 1:1 ratio combination of PRF and SBG in a stabilized titanium 3D printed implant resulted in an optimal increase in bone growth., (© 2024. The Author(s).)

This systematic review aims to investigate and determine the effectiveness of interventions on improving mental health (anxiety, depression, stress or mental well-being) and/or reducing burnout of nurses working in hospitals during the COVID-19 pandemic. A search was conducted on studies from conception to December 2022 in databases: PubMed, Embase, Cochrane Central Register of Controlled Trials, CINAHL, PsycINFO, Scopus and Web of Science and in ProQuest Thesis & Dissertations Global Database, Google Scholar and ClinicalTrials.gov. A total of 17 randomised controlled trials that evaluated different interventions were included. The outcomes were anxiety (n = 11), depression (n = 5), stress (n = 13) mental well-being (n = 7) and burnout (n = 7). Not all interventions led to positive outcomes. Grading of Recommendations Assessment, Development and Evaluation (GRADE) appraisal and risk of bias assessment using the Cochrane tool for randomised controlled trials (RoB 2.0) revealed poor quality of currently available literature, with low to very low certainty. Meta-analysis showed high heterogeneity among the five different outcomes, with subgroup analysis showing greater success in interventions conducted on nurses involved in the care of COVID-19 patients. More well-designed trials are necessary to reinforce current evidence to improve the mental health of nurses, to not only protect their quality of life but also to ensure the quality of patient care., (© 2023 John Wiley & Sons Australia, Ltd.)

Nasopharyngeal carcinoma (NPC), a cancer that is etiologically associated with the Epstein-Barr virus (EBV), is endemic in Southern China and Southeast Asia. The scarcity of representative NPC cell lines owing to the frequent loss of EBV episomes following prolonged propagation and compromised authenticity of previous models underscores the critical need for new EBV-positive NPC models. Herein, we describe the establishment of a new EBV-positive NPC cell line, designated NPC268 from a primary non-keratinizing, differentiated NPC tissue. NPC268 can undergo productive lytic reactivation of EBV and is highly tumorigenic in immunodeficient mice. Whole-genome sequencing revealed close similarities with the tissue of origin, including large chromosomal rearrangements, while whole-genome bisulfite sequencing and RNA sequencing demonstrated a hypomethylated genome and enrichment in immune-related pathways, respectively. Drug screening of NPC268 together with six other NPC cell lines using 339 compounds, representing the largest high-throughput drug testing in NPC, revealed biomarkers associated with specific drug classes. NPC268 represents the first and only available EBV-positive non-keratinizing differentiated NPC model, and extensive genomic, methylomic, transcriptomic, and drug response data should facilitate research in EBV and NPC, where current models are limited., Significance: NPC268 is the first and only EBV-positive cell line derived from a primary non-keratinizing, differentiated nasopharyngeal carcinoma, an understudied but important subtype in Southeast Asian countries. This model adds to the limited number of authentic EBV-positive lines globally that will facilitate mechanistic studies and drug development for NPC., (© 2024 The Authors; Published by the American Association for Cancer Research.)

On December 5, 2022, an indirect drive fusion implosion on the National Ignition Facility (NIF) achieved a target gain G&#95;{target} of 1.5. This is the first laboratory demonstration of exceeding "scientific breakeven" (or G&#95;{target}>1) where 2.05 MJ of 351 nm laser light produced 3.1 MJ of total fusion yield, a result which significantly exceeds the Lawson criterion for fusion ignition as reported in a previous NIF implosion [H. Abu-Shawareb et al. (Indirect Drive ICF Collaboration), Phys. Rev. Lett. 129, 075001 (2022)PRLTAO0031-900710.1103/PhysRevLett.129.075001]. This achievement is the culmination of more than five decades of research and gives proof that laboratory fusion, based on fundamental physics principles, is possible. This Letter reports on the target, laser, design, and experimental advancements that led to this result.

Objective To investigate the impact of Pseudomonas aeruginosa (PA) infection on the function of pulmonary vascular endothelial cells,and explore the mechanism of this bacterium in exacerbating lung inflammation in mice. Methods Two hours after human lung microvascular endothelial cell(HULEC-5a) were infected with the PA strain PAO1,the mRNA levels of autophagy-related gene 5(ATG5),6-phosphofructo-2-kinase/fructose-2,6-bisphosphatase 3(PFKFB3),and calcium adhesion protein 5(CDH5) were determined by reverse transcription real-time fluorescent quantitative PCR(RT-qPCR).The protein levels of ATG5,PFKFB3,and vascular endothelial calcium adhesion protein(VE-cadherin) were detected by immunofluorescence.After the expression of ATG5 and PFKFB3 was respectively knocked down by small interfering RNA(siRNA),RT-qPCR was employed to measure the mRNA levels of ATG5,PFKFB3,and CDH5,and immunofluorescence to detect the protein levels of PFKFB3 and VE-cadherin.In addition,the lactate assay kit was used to determine the level of lactate in the cells.After mice were infected with PAO1,lung inflammation was assessed through histopathological section staining.Confocal microscopy was employed to capture and analyze fluorescence-labeled PFKFB3 and VE-cadherin in endothelial cells. Results Compared with the control group,the HULEC-5a cells infected with PAO1 showed up-regulated mRNA and protein levels of PFKFB3(all P <0.05),down-regulated mRNA level of CDH5( P =0.023),disrupted continuity and down-regulated protein level of VE-cadherin( P <0.001),and elevated lactate level( P =0.017).Compared with PAO1-infected HULEC-5a cells,knocking down PFKFB3 led to the up-regulated mRNA level of CDH5( P =0.043),lowered lactate level( P =0.047),and restored continuity of VE-cadherin;knocking down ATG5 led to up-regulated mRNA and protein levels of PFKFB3( P =0.013 and P =0.003),elevated lactate level( P =0.015),and down-regulated mRNA level of CDH5( P =0.020) and protein level of VE-cadherin( P =0.001).The HE staining results showed obvious red blood cell leakage,inflammatory cell infiltration,alveolar septal widening,and partial detachment of vascular endothelial cells in the alveoli of PA-infected mice.Immunofluorescence staining showed up-regulated expression of PFKFB3 and decreased fluorescence signal of VE-cadherin in endothelial cells of infected mice compared with normal mice. Conclusion PA may regulate the PFKFB3 pathway via AGT5 to disrupt the function of pulmonary vascular endothelial cells,thereby exacerbating the inflammation in the lungs of mice.

Background: COVID-19 is continuing to ravage globally and has resulted in a huge health and financial burden. Chinese proprietary medicines, such as Lianhua Qingwen (LHQW) and Huoxiang Zhengqi (HXZQ) capsules, have been recommended for non-high-risk patients with COVID-19 in China. Based on this, we described the baseline information, using status of LHQW and HXZQ capsules and inoculation history of quarantined patients in the second half of 2022 in Macao. Additionally, we analyzed the underlying association among medicines administration, vaccination and COVID-19 indices, in order to explore novel clues for the regular control and prevention of local epidemic situation in the future., Methods: A total of 976 patients in Macao quarantine hotels from June to August 2022 were included in the present study, of which, 857 subjects were followed-up for prognosis evaluation. During quarantine, the baseline demographic information, including sex, age, BMI, occupation and personal habits were collected. Additionally, the inoculation history, medicine employment status and cycle threshold (Ct) values were also reported. We interviewed the patients for collection of their symptoms at the beginning and end of quarantine, as well as prognostic ones. Basic statistical description of baseline information, vaccination history and medication were displayed. Chi-squared test or with continuous correction test was employed for comparison of dichotomous data between two or multiple groups. Binary logistic regression was applied to reveal the correlation between potential risk factors and Ct values or prognosis symptoms. We also used Cox regression model to identify the effect of different types of vaccine products on Ct value altering rate., Results: Patients who were female (52.0%), engaged in service industry (31.8%), from Macao native (65.8%), never took physical exercises (33.6%) and preferred irritated diet (59.5%) enjoyed more dominant proportions. Over 80% of participants were inoculated and 74.6% of them chose inactivated COVID-19 vaccine produced by China National Biotech Group (CNBG). Participants used LHQW capsules accounted for 92.1% and the duration of medicating lasted for one to two weeks. All of the reported symptoms were significantly ameliorated after quarantine and the duration of quarantine was concentrated on 21 days. People with different age, sex, occupation and region had different choices of HXZQ administration and vaccination. Additionally, middle dose (4-5 boxes) of LHQW capsules exhibited evidently negative association with positive Ct values (adjusted, - 0.037 ± 0.19, p = 0.04). Two doses of CNBG and one dose of mRNA vaccine had obvious protective effect on reducing Ct positive rate (p = 0.041). Meanwhile, symptoms after quarantine were significantly positive correlated with those in prognosis (adjusted, 1.38 ± 0.18, p < 0.0001)., Conclusion: Our study found that the administration of LHQW capsules was beneficial for Ct value turning negative, meanwhile, certain mixed inoculation may be the promoting factor to reduce the positive rate of Ct value. These findings provide data basis for the Chinese proprietary medicine treatment and mixed vaccination applying for prevention and control of local COVID-19 epidemic in the future., (© 2024. The Author(s).)

Introduction: Acquired hemophilia A (AHA) is a rare bleeding disorder with destruction of factor VIII by autoantibodies. Comprehensive data for Chinese patients are lacking. Predictors of hospital stay have not been investigated., Methods: A territory-wide review of patients diagnosed with AHA from January 1, 2012, to December 31, 2021 was performed by retrieving patients' information from an electronic database system in Hong Kong., Results: Overall, 165 patients were included in this 10-year study, and the estimated incidence was 2.4 per million/year, which was higher than those reported from Caucasian cohorts. The median age of diagnosis was 80 years old. Patients had a long hospital stay (median: 25 days) and high mortality (55.2 %). The majority of deaths were caused by immunosuppression-related sepsis (49.5 %). Age was an independent predictor of overall survival (Hazard ratio: 1.065, 95 % CI: 1.037-1.093, p < 0.001), complete remission (CR) status (odd ratios (OR): 0.948, 95 % CI: 0.921-0.976, p < 0.001) and time to achieve CR (OR: 1.043, 95 % CI: 1.019-1.067, p < 0.001). Higher hemoglobin level on presentation was associated with shorter time to achieve CR (OR: 0.888, 95 % CI: 0.795-0.993, p = 0.037). Factor VIII level < 1 % normal, high inhibitor titer and intensive immunosuppressive regimen predicted long hospital stay., Conclusion: We presented comprehensive data of Chinese patients with AHA which comprised predominantly frail elderly who required long hospital stay and had high sepsis-related mortality. This posed challenges in managing AHA in such patients. Individualized immunosuppressive therapy is needed to balance the benefits and risk of septic complications., 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 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Since diagnostic laboratories handle large COVID-19 samples, researchers have established laboratory-based assays and developed biosensor prototypes. Both share the same purpose; to ascertain the occurrence of air and surface contaminations by the SARS-CoV-2 virus. However, the biosensors further utilize internet-of-things (IoT) technology to monitor COVID-19 virus contamination, specifically in the diagnostic laboratory setting. The IoT-capable biosensors have great potential to monitor for possible virus contamination. Numerous studies have been done on COVID-19 virus air and surface contamination in the hospital setting. Through reviews, there are abundant reports on the viral transmission of SARS-CoV-2 through droplet infections, person-to-person close contact and fecal-oral transmission. However, studies on environmental conditions need to be better reported. Therefore, this review covers the detection of SARS-CoV-2 in airborne and wastewater samples using biosensors with comprehensive studies in methods and techniques of sampling and sensing (2020 until 2023). Furthermore, the review exposes sensing cases in public health settings. Then, the integration of data management together with biosensors is well explained. Last, the review ended with challenges to having a practical COVID-19 biosensor applied for environmental surveillance samples.

Our experience of time is strikingly plastic: Depending on contextual factors, the same objective duration can seem to fly by or drag on. Perhaps the most direct demonstration of such subjective time dilation is the oddball effect: when seeing identical objects appear one after another, followed by an "oddball" (e.g., a disc that suddenly grows in size, in a sequence of otherwise static discs), observers experience this oddball as having lasted longer than its nonoddball counterparts. Despite extensive work on this phenomenon, a surprisingly foundational question remains unasked: What actually gets dilated? Beyond the oddball, are the objects just before (or just after) the oddball also dilated? As in previous studies, observers viewed sequences of colored discs, one of which could be the oddball-and subsequently reproduced the oddball's duration. Unlike previous studies, however, there were also critical trials in which observers instead reproduced the duration of the disc immediately before or after the oddball. A clear pattern emerged: oddball-induced time dilation extended to the post-oddball disc, but not the pre-oddball disc. Whence this temporal asymmetry? We suggest that an oddball's sudden appearance may induce uncertainty about what will happen next, heightening attention until after the uncertainty is resolved., (© 2023. The Psychonomic Society, Inc.)

Lung inflammation indicated by 18F-labeled fluorodeoxyglucose (FDG) in patients with tuberculosis is associated with disease severity and relapse risk upon treatment completion. We revealed the heterogeneity and intercellular crosstalk in lung tissues with 18F-FDG avidity and adjacent uninvolved tissues from 6 tuberculosis patients by single-cell RNA-sequencing. Tuberculous lungs had an influx of regulatory T cells (Treg), exhausted CD8 T cells, immunosuppressive myeloid cells, conventional DC, plasmacytoid DC, and neutrophils. Immune cells in inflamed lungs showed general up-regulation of ATP synthesis and interferon-mediated signaling. Immunosuppressive myeloid and Treg cells strongly displayed transcriptions of genes related to tuberculosis disease progression. Intensive crosstalk between IL4I1-expressing myeloid cells and Treg cells involving chemokines, costimulatory molecules, and immune checkpoints, some of which are specific in 18F-FDG-avid lungs, were found. Our analysis provides insights into the transcriptomic heterogeneity and cellular crosstalk in pulmonary tuberculosis and guides unveiling cellular and molecular targets for tuberculosis therapy., 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 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Pigmented epithelioid melanocytomas (PEM) are intermediate-grade melanocytic lesions with frequent lymph node involvement and rare metastases that tend to follow an indolent course with a favorable outcome. We report two unique cases of congenital PEM with PRKCA fusion transcripts: a multifocal PEM with an aggressive incompletely resectable scalp tumor and a solitary palmar PEM with newly reported ITGB5-PRKCA fusion. Through these case reports and a summary of previously reported cases, we outline the spectrum of disease of PEM and highlight the key clinical and histopathologic features associated with PEM with PRKCA fusion transcripts. We also discuss the treatment options and suggest that surgical excision without further adjuvant systemic treatment is reasonable first-line therapy given the favorable prognosis.

Background: There is limited understanding of the epidemiology of generalized pustular psoriasis (GPP) internationally, with no population-based estimates of GPP in South East Asia., Objectives: To determine the incidence and prevalence of GPP in the Malaysian population and characterize its flares and trigger factors., Methods: We conducted a population-based cohort study using the Teleprimary Care database between January 2010 and December 2020. We identified 230 dermatologist-confirmed GPP cases using International Classification of Diseases, 10th revision, diagnostic codes. Annual prevalence and incidence rates were stratified by age, sex and ethnicity. We compared data regarding flares and trigger factors for patients with GPP who had associated psoriasis vulgaris (PV) with those who did not have associated PV., Results: The prevalence of GPP was 198 per million (267 women, 127 men) and incidence was 27.2 per million person-years [95% confidence interval (CI) 22.8-31.6]; 35.3 (28.4-42.2) per million person-years for women and 18.3 (13.1-23.5) per million person-years for men. Rates were higher in Chinese individuals [prevalence 271 per million; incidence 41.6 per million person-years (28.9-54.3)] than in the Malay population [prevalence 186; incidence 24.6 (19.4-29.7)] or the Indian ethnic group [prevalence 179; incidence 25.0 (13.8-36.3)]. Annual prevalence was consistently higher in women than in men and highest among the Chinese population, followed by the Indian and Malay populations. Overall, 67% of patients with GPP had associated PV. The prevalence and incidence of GPP without PV were lower than GPP with PV at 66 vs. 132 per million and 19.3 (95% CI 15.6-23.0) vs. 8.0 (95% CI 5.6-10.3) per million person-years, respectively. The mean age at GPP onset was 42.7 years (SD 18.4). A bimodal trend in the age of GPP onset was observed, with first and second peaks at age 20-29 years and age 50-59 years, respectively. Disease onset was significantly earlier in patients with GPP without PV than in those with PV [mean age 37.5 years (SD 20.7) vs. 44.9 years (SD 17.0), P = 0.026]. Flares occurred more frequently in patients without PV than in those with PV [mean number of flares per patient per year was 1.35 (SD 0.77) vs. 1.25 (SD 0.58), P = 0.039]. Common triggers of flares in patients with GPP who did not have PV were infections, pregnancy, menstruation and stress, whereas withdrawal of therapy, particularly systemic corticosteroids, was a more frequent trigger in patients with GPP who also had PV., Conclusions: Our findings contribute to the global mapping of GPP, which will help inform the management of this rare condition., Competing Interests: Conflicts of interest: S.E.C. declares paid activities as advisor, speaker or consultant for AbbVie, Boehringer Ingelheim, Eli Lilly, Janssen, LEO Pharma, MSD, Novartis, Pfizer, Sanofi and UCB. C.E.M.G. has received honoraria and/or research grants from AbbVie, Almirall, Amgen, AnaptysBio, Boehringer Ingelheim, Bristol Myers Squibb, Eli Lilly, Evelo Bioscience, Galderma, GSK, Inmagene, LEO Pharma, Janssen, ONO Pharmaceuticals, Novartis, Pfizer, Sandoz and UCB Pharma. D.M.A. reports research grants from AbbVie, Almirall, Eli Lilly, Janssen, Novartis, UCB, and the LEO Foundation., (© The Author(s) 2023. Published by Oxford University Press on behalf of British Association of Dermatologists.)

Objective: This scoping review aims to map and summarize the direct impact of contracting COVID-19, and the indirect consequences of the pandemic on the health of peri- and postmenopausal women., Methods: Searches for published studies were conducted in CINAHL, Cochrane, EMBASE, PubMed, Scopus, Web of Science, PsycINFO and ProQuest from inception to 26 Oct, 2022. Grey literature and reference lists of included studies were searched. Results are presented as a narrative synthesis and tables., Results: Thirty-eight studies were selected in this review. Overall, a majority of studies (n = 31) suggest that menopausal women were negatively impacted, while lesser studies (n = 21) concluded that they were not and some studies (n = 14) produced both negative and neutral results. Twenty-three studies presented on the direct health impact of COVID-19 infections on menopausal women. Eleven studies focused on the indirect impact of COVID-19 in terms of contact restriction measures on menopausal health during the pandemic compared to before the pandemic. Six studies described the different indirect impact of COVID-19 on health of menopausal women with various characteristics or lifestyles., Conclusion: The direct and indirect impacts of COVID-19 on menopausal women on physical, mental health and social wellbeing are largely negative., Competing Interests: Declaration of Competing Interest The authors declare that they have no competing interests., (Copyright © 2023. Published by Elsevier Inc.)