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Highly microporous carbons with BET surface areas of up to ca. 3300 m 2  g -1 and pore volumes of up to 1.6 cm 3  g -1 have been successfully synthesized from pistachio shells, a waste whose generation is growing on account of the nutritive value of pistachios and the resilience of this crop to climate change. Such a high pore development has been achieved by a simple and benign CO 2 physical activation process assisted by a custom pre-treatment of the biomass. Different approaches have been explored in this work for the transformation of pistachio shells into carbon materials with diverse microstructures, mineral matter content and particle size/morphology, tuning thereby their reactivities towards CO 2 and diffusion kinetics and, in this way, pore development. In particular, the most efficient route for the production of highly microporous carbons from pistachio shells involves a hydrothermal carbonization process which increases the degree of aromatization and effectively removes the mineral matter, enhancing thereby the efficiency of both carbon production and porosity generation. By increasing the activation temperature, substantial shortening of the operation time can be achieved without compromising pore development. This work provides new integral strategies towards the production of biomass-based, CO 2 -activated carbons with a focus on optimizing pore structure, minimizing energy consumption and maximizing product yield., (© 2024 The Authors. ChemSusChem published by Wiley-VCH GmbH.)

With the rapidly increasing demand for lithium ion batteries (LIBs), recycling the metals found in spent cathodes is mandatory to both alleviate shortages resulting from the mining of natural metal ores and manage the disposal of spent LIBs. The use of deep eutectic solvents (DESs) for metals recovery from spent cathodes of LIBs (e. g., LCO and NMC types) offers a sustainable yet efficient alternative to conventional hydrometallurgical processes. Nonetheless, g efforts are required to use milder temperatures and higher mass loadings, thus ensuring cost-effectiveness. In this latter regard, addressing the reutilization of DESs in subsequent stages of metal extraction, and streamlining or eliminating the chemical procedures employed for metal separation, is even more crucial to guarantee the economic feasibility of the recycling process. Herein, we have prepared a DES that provides extraction efficiencies of ca. 100 % for every metal of NMC cathodes even at mild experimental conditions (e. g., 60 °C) and for loadings as high as 70 mg NMC /g DES . Moreover, we have pioneered the direct use of leachates containing DESs and metals as electrolytes for supercapacitors. This approach enables the reintroduction of DESs and the recovered metals into the value chain with a minimal economic and environmental impact., (© 2024 The Authors. ChemSusChem published by Wiley-VCH GmbH.)

Atomically precise graphene nanoribbons (GNRs) have a wide range of electronic properties that depend sensitively on their chemical structure. Several types of GNRs have been synthesized on metal surfaces through selective surface-catalyzed reactions. The resulting GNRs are adsorbed on the metal surface, which may lead to hybridization between the GNR orbitals and those of the substrate. This makes investigation of the intrinsic electronic properties of GNRs more difficult and also rules out capacitive gating. Here, we demonstrate the formation of a dielectric gold chloride adlayer that can intercalate underneath GNRs on the Au(111) surface. The intercalated gold chloride adlayer electronically decouples the GNRs from the metal and leads to a substantial hole-doping of the GNRs. Our results introduce an easily accessible tool in the in situ characterization of GNRs grown on Au(111) that allows for exploration of their electronic properties in a heavily hole-doped regime.

Filariasis, a neglected tropical disease caused by roundworms, is a significant public health concern in many tropical countries. Microscopic examination of blood samples can detect and differentiate parasite species, but it is time consuming and requires expert microscopists, a resource that is not always available. In this context, artificial intelligence (AI) can assist in the diagnosis of this disease by automatically detecting and differentiating microfilariae. In line with the target product profile for lymphatic filariasis as defined by the World Health Organization, we developed an edge AI system running on a smartphone whose camera is aligned with the ocular of an optical microscope that detects and differentiates filarias species in real time without the internet connection. Our object detection algorithm that uses the Single-Shot Detection (SSD) MobileNet V2 detection model was developed with 115 cases, 85 cases with 1903 fields of view and 3342 labels for model training, and 30 cases with 484 fields of view and 873 labels for model validation before clinical validation, is able to detect microfilariae at 10x magnification and distinguishes four species of them at 40x magnification: Loa loa, Mansonella perstans, Wuchereria bancrofti, and Brugia malayi. We validated our augmented microscopy system in the clinical environment by replicating the diagnostic workflow encompassed examinations at 10x and 40x with the assistance of the AI models analyzing 18 samples with the AI running on a middle range smartphone. It achieved an overall precision of 94.14%, recall of 91.90% and F1 score of 93.01% for the screening algorithm and 95.46%, 97.81% and 96.62% for the species differentiation algorithm respectively. This innovative solution has the potential to support filariasis diagnosis and monitoring, particularly in resource-limited settings where access to expert technicians and laboratory equipment is scarce., Competing Interests: I have read the journal’s policy and the authors of this manuscript have the following competing interests: LL, ED, ND, DB-P, CCab, DC, OD, JG-V, AB, MP, ER-J, AS, MJL-C and MLO work for Spotlab and/or hold shares of Spotlab., (Copyright: © 2024 Lin 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.)

Electrodes with nanostructured surface have emerged as promising low-impedance neural interfaces that can avoid the charge-injection restrictions typically associated to microelectrodes. In this work, we propose a novel approximation, based on a two-step template assisted electrodeposition technique, to obtain flexible nanostructured electrodes coated with core-shell Ni-Au vertical nanowires. These nanowires benefit from biocompatibility of the Au shell exposed to the environment and the mechanical properties of Ni that allow for nanowires longer and more homogeneous in length than their only-Au counterparts. The nanostructured electrodes show impedance values, measured by electrochemical impedance spectroscopy (EIS), at least 9 times lower than those of flat reference electrodes. This ratio is in good accordance with the increased effective surface area determined both from SEM images and cyclic voltammetry measurements, evidencing that only Au is exposed to the medium. The observed EIS profile evolution of Ni-Au electrodes over 7 days were very close to those of Au electrodes and differently from Ni ones. Finally, the morphology, viability and neuronal differentiation of rat embryonic cortical cells cultured on Ni-Au NW electrodes were found to be similar to those on control (glass) substrates and Au NW electrodes, accompanied by a lower glial cell differentiation. This positive in-vitro neural cell behavior encourages further investigation to explore the tissue responses that the implantation of these nanostructured electrodes might elicit in healthy (damaged) neural tissues in vivo, with special emphasis on eventual tissue encapsulation., (© 2024. The Author(s).)

Objective: Medical education should enhance empathy. We examined, using self-assessment instruments and standardized patients (SPs), the impact on empathy, of a multi-year intervention (years 4-6 of medical training) that uses reflective learning approaches., Methods: 241 final-year medical students participated; 110 from the 2018 graduation class (non-intervention group) and 131 from the 2019 graduation class (intervention group). Participants completed two self-reported empathy questionnaires - the Jefferson Scale of Empathy-Students (JSE-S) and the Interpersonal Reactivity Index (IRI) - and a personality questionnaire, the NEO Five-Factor Inventory. Additionally, SPs in a simulated station assessed participants' empathy with two patient-reported instruments: the Consultation and Relational Empathy (CARE) scale and the Jefferson Scale of Patient Perceptions of Physician Empathy (JSPPPE)., Results: Empathy scores were significantly higher in the intervention group compared to the non-intervention group when assessed by the SP (p < 0.001). No differences were found in self-reported questionnaires between the two groups., Conclusion: A longitudinal, multi-year reflection-based intervention enhanced empathy amongst medical students as assessed by SPs, but not when assessed by student self-reported measures., Practice Implications: Multi-year reflective learning interventions during clinical training nurture empathy in medical students. Assessments completed by SPs or patients may enhance the evaluation of empathy., 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 B.V. All rights reserved.)

Low dimensional carbon-based materials can show intrinsic magnetism associated to p-electrons in open-shell π-conjugated systems. Chemical design provides atomically precise control of the π-electron cloud, which makes them promising for nanoscale magnetic devices. However, direct verification of their spatially resolved spin-moment remains elusive. Here, we report the spin-polarization of chiral graphene nanoribbons (one-dimensional strips of graphene with alternating zig-zag and arm-chair boundaries), obtained by means of spin-polarized scanning tunnelling microscopy. We extract the energy-dependent spin-moment distribution of spatially extended edge states with π-orbital character, thus beyond localized magnetic moments at radical or defective carbon sites. Guided by mean-field Hubbard calculations, we demonstrate that electron correlations are responsible for the spin-splitting of the electronic structure. Our versatile platform utilizes a ferromagnetic substrate that stabilizes the organic magnetic moments against thermal and quantum fluctuations, while being fully compatible with on-surface synthesis of the rapidly growing class of nanographenes., (© 2023. Springer Nature Limited.)

Low-income countries carry approximately 90% of the global burden of visual impairment, and up to 80% of this could be prevented or cured. However, there are only a few studies on the prevalence of retinal disease in these countries. Easier access to retinal information would allow differential diagnosis and promote strategies to improve eye health, which are currently scarce. This pilot study aims to evaluate the functionality and usability of a tele-retinography system for the detection of retinal pathology, based on a low-cost portable retinal scanner, manufactured with 3D printing and controlled by a mobile phone with an application designed ad hoc. The study was conducted at the Manhiça Rural Hospital in Mozambique. General practitioners, with no specific knowledge of ophthalmology or previous use of retinography, performed digital retinographies on 104 hospitalized patients. The retinographies were acquired in video format, uploaded to a web platform, and reviewed centrally by two ophthalmologists, analyzing the image quality and the presence of retinal lesions. In our sample there was a high proportion of exudates and hemorrhages-8% and 4%, respectively. In addition, the presence of lesions was studied in patients with known underlying risk factors for retinal disease, such as HIV, diabetes, and/or hypertension. Our tele-retinography system based on a smartphone coupled with a simple and low-cost 3D printed device is easy to use by healthcare personnel without specialized ophthalmological knowledge and could be applied for the screening and initial diagnosis of retinal pathology.

S-doped carbon sheets have been easily prepared by deconstructing the 3D cellular structure of a fully sustainable and renewable biomass material such as cork through a mild ball-milling process. S-doping of the material (>14 wt % S) has been achieved by using sulfur as an earth-abundant, cost-effective, and environmentally benign S-dopant. Such synthesized materials provide large Na storage capacities in the range of 300-550 mAh g -1 at 0.1 A g -1 and can handle large current densities of 10 A g -1 , providing 55-140 mAh g -1 . Their increased packing density compared to the 3D pristine structure allows them to also provide good volumetric capacities in the range of 285-522 mAh cm -3 at 0.1 A g -1 and 53-133 mAh cm -3 at 10 A g -1 . In addition, highly porous carbon sheets ( S BET > 2700 m 2 g -1 ) have been produced from the same carbon precursor by rationally designing the chemical activation approach. These materials are able to provide good anion storage capacities/capacitances of up to 100-114 mAh g -1 /163-196 F g -1 . A sodium-ion capacitor assembled with the optimized S-doped carbon sheets and the highly porous carbon sheets with mass matching ratios provided the best energy/power characteristics (90 Wh kg -1 at 29 kW kg -1 ) in combination with robust cycling stability over 10,000 cycles, with a capacity fade of only 0.0018% per cycle., Competing Interests: The authors declare no competing financial interest., (© 2023 The Authors. Published by American Chemical Society.)

Introduction: The acquisition of laparoscopic technique skills in an operating room is conditioned by the expertise of the tutor and the number of training interventions by the trainee. For students and surgeons to use a laparoscopic simulator to train their skills, it must be validated beforehand., Methods: A laparoscopic simulator box was designed, along with 6 interchangeable training games. The simulator was validated by a group of 19 experts, physicians with an experience from at least 100 laparoscopic surgeries, and 20 students of 4 th to 6 th grades of medical school (non-experts). To evaluate its construct validity, time-to-completion and the number of successfully completed games were assessed. We used 11 and 9-item questionnaires to gather information on content and face validity respectively. In both questionnaires, answers were collected through Likert-type scales, scored from 1 to 5., Results: The group of experts required less time and successfully completed more games than the group of non-experts (p < 0.01). The group of non-experts gave a score ≥ 4 points on each of the questions regarding the content validity of the tool, however, the experts rated with a significant lower mean score the need for the simulator to learn the surgical technique (3.68 points; p < 0.01). Regarding the face validity, all items were graded with a score ≥ 4 points except for the question relating to the spatial realism (3.82 points)., Conclusion: The laparoscopy simulation box and the games were valid means for training surgeons and medical students to develop the skills required for the laparoscopic technique., (Copyright © 2022. Published by Elsevier España, S.L.U.)

Background and Purpose: This study examined whether the 786 NOS3 polymorphism is associated with the risk of hemorrhagic transformation (HT) in stroke patients with anterior large vessel occlusion (ALVO) treated using endovascular thrombectomy (EVT)., Methods: We performed an observational cohort study that included 118 patients with ALVO who underwent EVT. HT was assessed in follow-up CT and MRI. HT and non-HT patients were compared in terms of the 786 NOS3 polymorphism, flow mediated dilation (FMD) values within 3 days after the stroke, and collateral status based on three grading scales. Demographics, vascular risk factors, additional radiological data including ASPECT score, thrombus length and infarct size, and EVT procedure and outcome variables were also included., Results: Radiological HT occurred in 55 (46.6%) patients and the 786T/T NOS3 polymorphism was associated with HT (unadjusted OR of 2.33, 95%CI: 1.05-5.20, adjusted OR of 3.14, 95%CI: 1.16-8.54). Collateral status and systemic endothelial function assessed by FMD were not mediators of this relationship as no differences were seen in the median FMD percentage values or collateral status between NOS3 genotypes., Conclusions: Our results suggest that genetic variations affecting the NO pathway, such as the 786 NOS3 polymorphism, may contribute to individual variability in the occurrence of HT and these results support involvement of this pathway in the pathogenesis of ischemia-reperfusion injury after EVT., (Copyright © 2022 Elsevier Inc. All rights reserved.)

An eco-friendly and sustainable salt-templating approach was proposed for the production of anode materials with a 3D sponge-like structure for sodium-ion capacitors using gluconic acid as carbon precursor and sodium carbonate as water-removable template. The optimized carbon material combined porous thin walls that provided short diffusional paths, a highly disordered microstructure with dilated interlayer spacing, and a large oxygen content, all of which facilitated Na ion transport and provided plenty of active sites for Na adsorption. This material provided a capacity of 314 mAh g -1 at 0.1 A g -1 and 130 mAh g -1 at 10 A g -1 . When combined with a 3D highly porous carbon cathode (S BET ≈2300 m 2  g -1 ) synthesized from the same precursor, the Na-ion capacitor showed high specific energy/power, that is 110 Wh kg -1 at low power and still 71 Wh kg -1 at approximately 26 kW kg -1 , and a good capacity retention of 70 % over 10000 cycles., (© 2022 The Authors. ChemSusChem published by Wiley-VCH GmbH.)

Introduction: The COVID19 pandemic collapsed intensive care units (ICUs) all around the world, conditioning systems of care (SOC) for other critical conditions such as severe ischemic stroke requiring endovascular treatment (EVT). Our aim was to evaluate the impact of an adaptive Stroke Unit (SU) based SOC on functional outcomes, with the goal of avoiding both general anesthesia (GA) and ICU admission in stroke patients treated with EVT., Material and Methods: We performed an observational study comparing data from our traditional ICU-GA based SOC and the adaptive SU-Conscious Sedation (CS) based SOC (consecutive patients undergoing EVT 1 year prior and after onset of the pandemic). Primary outcome was 90-days modified Rankin Scale (mRS), and secondary outcomes included, among others, in-hospital complications, and hospital length of stay (LOS)., Results: A total of 210 EVT were performed during the study period (107 under the traditional-SOC and 103 under the adaptive-SOC). A significantly greater proportion of patient was treated under CS (15.9% vs 57.3%; p  < 0.001) and admitted for post-procedural care at SU (15% vs 66%; p  < 0.001) in the adaptive SOC. Rates of in-hospital complications were similar in both periods, with reduced hospital LOS in the adaptive SOC (10 (7-15) vs 8 (6-12); p  = 0.005). The adaptive SOC was associated with higher odds for 90 days favorable outcome (mRS 0-2) (aOR 3.15 (1.34-7.39); p  = 0.008)., Conclusion: In our case, an adaptive SOC that combined both preference for CS and postprocedural care in SU was associated with better functional outcomes and reduced healthcare resource use for patients undergoing EVT., Competing Interests: Declaration of conflicting interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© European Stroke Organisation 2022.)

Background and Objectives: Empathy is considered a prerequisite for a successful physician-patient relationship. The Jefferson Scale of Patient Perceptions of Physician Empathy (JSPPPE) is a regularly-used, patient-rated measure of physician empathy. The aim of this study is to translate and analyze the reliability and validity of the JSPPPE Spanish (Spain) version (Sp-JSPPPE) in primary care in order to use it with medical trainees., Methods: After translation and back translation of the JSPPPE, 369 patients from 21 primary care physicians in Pamplona (Navarre, Spain) completed the Sp-JSPPPE, a sociodemographic questionnaire, the Spanish (Spain) Consultation and Relational Empathy Measure (Sp-CARE), and a question about overall satisfaction. We studied internal reliability (Cronbach's α and ordinal α), homogeneity (corrected item-total correlations), construct validity (confirmatory factor analysis [CFA]) and concurrent validity (Spearman's correlation) of Sp-JSPPPE., Results: Cronbach's α and ordinal α were 0.870 and 0.919, respectively, for the Sp-JSPPPE, and all corrected item-total correlations exceeded the accepted cutoff of 0.30, demonstrating high internal reliability and homogeneity. CFA corroborated the one-factor structure proposed in the original version. The total score for the Sp-JSPPPE was significantly correlated with sp-CARE (Spearman's ϱ 0.651, P&lt;.001) and with overall patient satisfaction (Spearman's ϱ 0.504, P&lt;.001)., Conclusions: The results support the reliability and validity of the Sp-JSPPPE in primary care. Sp-JSPPPE could be useful in empathy assessment of medical trainees, both graduate and postgraduate, in the Spanish context.

Introduction: The acquisition of laparoscopic technique skills in an operating room is conditioned by the expertise of the tutor and the number of training interventions by the trainee. For students and surgeons to use a laparoscopic simulator to train their skills, it must be validated beforehand., Methods: A laparoscopic simulator box was designed, along with 6 interchangeable training games. The simulator was validated by a group of 19 experts, physicians with an experience from at least 100 laparoscopic surgeries, and 20 students of 4th to 6th grades of medical school (non-experts). To evaluate its construct validity, time-to-completion and the number of successfully completed games were assessed. We used 11 and 9-item questionnaires to gather information on content and face validity respectively. In both questionnaires, answers were collected through Likert-type scales, scored from 1 to 5., Results: The group of experts required less time and successfully completed more games than the group of non-experts (p < 0.01). The group of non-experts gave a score ≥4 points on each of the questions regarding the content validity of the tool, however, the experts rated with a significant lower mean score the need for the simulator to learn the surgical technique (3.68 points; p < 0.01). Regarding the face validity, all items were graded with a score ≥4 points except for the question relating to the spatial realism (3.82 points)., Conclusion: The laparoscopy simulation box and the games were valid means for training surgeons and medical students to develop the skills required for the laparoscopic technique., (Copyright © 2022. Published by Elsevier España, S.L.U.)

Background: Understanding the factors related to workload, could help hospital at home (HaH) managers to make decisions on the most appropriate and efficient use of the HaH services. Published studies on this topic are scarce, so we have conducted a systematic review to identify such factors according to published evidence., Methods: Due to the heterogeneity of HaH models, HaH was defined as a care that provides a set of medical and nursing care and attention of hospital rank to patients at home, when they no longer require hospital infrastructure but still need active monitoring and complex care. The electronic data base literature search was conducted in MEDLINE (Ovid), EMBASE (Ovid), and Cinahl (EBSCOhost) from inception to December 2021, including grey literature. Search terms related to `hospital at home´, `workload´ and `care time´ were used. There was no restriction on language, type of study or year of publication. Quality of included studies was assessed using the Critical Appraisal Skills Programme (CASP) checklist and certainty in the body of evidence was assessed using the GRADE Pro Tool. Results were summarised in a tabulated format., Results: Eighteen studies with 56,706 patients were included. Workload was measured as time, number of visits or both. The predictive factors of the workload included variables related to patient characteristics and other valid and reliable patient classification systems, as well as characteristics of the institutions where the studies were conducted. The factors associated with higher workloads were: being older, male, living in a rural environment, presenting a higher number of diagnoses, having worse functional status and being unable to assume self-care., Conclusions: The identified predictors of workload are mostly associated with home nursing care. The results could be useful and applicable to different organisational models of HaH health systems. More studies that include physicians and proxy measures of workload are needed., (© 2022. The Author(s).)