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Objectives Performance evaluation of routine laboratory methods to determine the susceptibility of Enterobacterales urinary isolates to fosfomycin (oral administration) and mecillinam. Methods We collected 347 Enterobacterales isolates from monomicrobial midstream urine samples from women with significant bacteriuria and leukocyturia. Mostly non- Escherichia coli isolates (i.e. Klebsiella spp. Citrobacter koseri , Enterobacter cloacae complex and Proteus mirabilis) were included (n  = 298). Performance of VITEK®2, ETEST®, and disc diffusion to determine fosfomycin and mecillinam susceptibility was evaluated following International Organization for Standardization (ISO) 20776-2:2021 (or 20776-2:2007 for disc diffusion) in comparison with the agar dilution reference method. Results For fosfomycin testing, VITEK®2 and ETEST® were close to reaching ISO requirements (essential agreement  ≥ 90%; bias  ±30%) for C. koseri , E. coli and P. mirabilis. Categorical agreement (CA) and major error rates were acceptable for disc diffusion. Fosfomycin displayed lower activity against E. cloacae complex and Klebsiella spp. with MIC50 (minimum inhibitory concentration required to inhibit the growth of 50% of tested isolates) equal to the E. coli EUCAST breakpoint (8 mg/L). For these species, the three alternative techniques overestimated MICs and resistance, and did not meet performance criteria. For mecillinam testing of Enterobacterales isolates, apart from P. mirabilis , ETEST® nearly fulfilled ISO requirements, and CA rates were acceptable for disc diffusion. ISO criteria were reached for C. koseri and E. coli testing with VITEK®2, apart from too high rates of very major errors. For P. mirabilis, performances were unacceptable, whatever the routine method used. Conclusions Commercially available tests may serve as alternatives to agar dilution to assess fosfomycin (oral) and mecillinam susceptibility of Enterobacterales urinary isolates, with important interspecies variabilities. Additional studies comprising more fosfomycin- and mecillinam-resistant isolates are needed to strengthen our conclusions. [ABSTRACT FROM AUTHOR]

Les recherches en psychologie positive suggèrent que certaines pratiques en psychothérapie engendrent des bénéfices cliniques importants, mais il n'est pas toujours clair pour les cliniciens quelles pratiques prioriser ou bien encore comment les intégrer en psychothérapie. Cette recherche vise à identifier et expliquer, pour les cliniciens, certaines pratiques cliniques à intégrer dans la pratique psychothérapeutique. Huit professionnels (incluant : professeurs-chercheurs, psychologues et étudiants au doctorat) se sont réunis durant six rencontres de deux heures afin d'identifier, classifier et décrire comment les résultats de recherches récentes pourraient informer les interventions auprès des clients. Ces conclusions ont subséquemment été spécifiées et bonifiées via une comparaison plus approfondie avec la littérature. Nous décrivons huit pratiques : (1) Évaluer également ce qui va bien chez les clients (2) Favoriser leur motivation autodéterminée ; (3) Mettre en valeur leurs forces et compétences ; (4) Mettre en lumière leur résilience ; (5) Favoriser l'autocompassion et la bienveillance ; (6) Favoriser le soutien et la cohésion sociale, notamment par la gratitude et la compassion ; (7) Favoriser le développement d'une mentalité de croissance ; et (8) Intégrer soi-même les principes qui favorisent le bien-être psychologique. Les cliniciens et leurs clients gagneraient à favoriser ces pratiques en psychothérapie. Research in positive psychology suggests that certain psychotherapy practices yield substantial clinical benefits, but it is not always clear to clinicians which practices to prioritize or how to integrate them into psychotherapy. This research aims to identify and explain, for clinicians, certain clinical practices to be integrated into psychotherapeutic practice. Eight professionals (including: professor-researchers, psychologists, and doctoral students) gathered during six two-hour meetings to identify, classify, and describe how the results of recent research could inform interventions with clients. These conclusions were subsequently specified and developed via a more in-depth comparison with the literature. We describe eight practices: (1) Also assess what is going well with clients (2) Foster their self-determined motivation; (3) Highlight their strengths and skills; (4) Highlight their resilience; (5) Promote self-compassion and loving-kindness; (6) Foster support and social cohesion through gratitude and compassion; (7) Foster the development of a growth mindset; and (8) Integrate, as a therapist, those same principles that promote psychological well-being. Clinicians and their clients would benefit from promoting these practices in psychotherapy. [ABSTRACT FROM AUTHOR]

Virtual recovery after surgery (VRAS) has the potential to reduce hospitalization through remote monitoring and improve patient experience. Our objective was to assess outcomes and satisfaction with VRAS for gynecology and gynecology oncology surgery. Retrospective Cohort Study. Jul/2022-Dec/2023 at the Ottawa Hospital. Adult patients undergoing benign and malignant gynecologic surgery. Patients enrolled in the VRAS program were provided with equipment for seven days of home vital monitoring, remote nursing assessment and health questionnaires. Data for surgical procedures, 30-day outcomes, and patient satisfaction were collected. 662 patients were enrolled in VRAS during the study period. Of these, 480 (72.5%) were benign gynecologic patients, while182 (27.5%) were gynecology oncology patients. Laparoscopic, abdominal, vaginal and other procedures were assessed. Hospital length of stay was 1.89 ± 2.14 days [mean, SD]; 1.60 ± 1.94 days for benign gynecology patients and 2.63 ± 2.41 days for gynecology oncology patients. 67/662 (10.1%) of patients required a post-op ED visit, where 52/480 (10.3%) were benign and 15/182 (8.2%) were oncologic patients. 17/662 (2.4%) of patients required readmission; 9/480 (1.8%) for benign gynecology and 8/182 (4.4%) for gynecology oncology patients. The readmission length of stay was 4.06 ± 3.77 days; 3.44 ± 4.07 days for benign gynecology patients and 4.75 ± 3.54 days for gynecology oncology patients. 322/662 (48.6%) participants responded to the patient experience survey. On a scale of 10, the helpfulness of the VRAS program was assigned a score of 9.48 ± 1.02 [mean, SD]. 245/252 (97%) reported they would recommend the VRAS program. Our study demonstrates the feasibility of virtual recovery with benign gynecology and gynecologic oncology patients. We demonstrate that VRAS is associated with excellent patient satisfaction and holds promise as a strategy for reducing hospitalization and readmission rates. [ABSTRACT FROM AUTHOR]

Trophoblast cell-surface antigen 2 (TROP2), a transmembrane receptor expressed in many carcinomas, is a target for novel antibody-drug conjugates such as sacituzumab govitecan. TROP2-targeted therapy is used for unresectable locally advanced or metastatic triple-negative and hormone receptor-positive, HER2-negative breast cancers. The role of TROP2 as a predictive marker is yet unclear. Standardized interpretation criteria for TROP2 immunohistochemistry (IHC) are lacking. Here, we compared three antibody clones and two methods for semi-quantitative assessment, aiming to establish reproducible evaluation criteria. First, TROP2 IHC was performed on normal tissues and nine breast cancers, using the BSB-148, EPR20043 and SP293 clones. EPR20043 was selected for subsequent evaluation in 69 breast cancers without pathological complete response to neoadjuvant chemotherapy (NAC). Four pathologists applied the ASCO/CAP guidelines for HER2 IHC testing (designated as the 'membrane score') and the H-score. All H-scores were categorized as low (0-100), intermediate (101-200) and high (201-300). Although the membrane scores strongly correlated with the categorized H-scores, the latter showed higher interobserver variability. Next, TROP2 IHC was performed on 94 breast cancer metastases and evaluated by six pathologists, confirming the strong correlation between the membrane scores and H-scores. In metastases, the interobserver variability was similar for both methods. Our observations support the application of the HER2 ASCO/CAP guidelines for semi-quantitative evaluation of membranous TROP2 protein expression, as this method strongly correlates with the H-score and is less prone to interobserver variability in post-NAC breast resections. Future studies should investigate the association between the TROP2 membrane score and response to TROP2-targeted therapy., Competing Interests: Declaration of Competing Interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Mieke R. Van Bockstal reports financial support was provided by Saint-Luc Foundation. Mieke R. Van Bockstal reports financial support was provided by Foundation Against Cancer. Christine Galant reports financial support was provided by Saint-Luc Foundation. Francois Duhoux reports financial support was provided by Foundation Against Cancer. If there are other authors, they 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 Elsevier GmbH. All rights reserved.)

Clinical decision support systems are software tools that help clinicians to make medical decisions. However, their acceptance by clinicians is usually rather low. A known problem is that they often require clinicians to manually enter a lot of patient data, which is long and tedious. Existing solutions, such as the automatic data extraction from electronic health record, are not fully satisfying, because of low data quality and availability. In practice, many systems still include long questionnaire for data entry. In this paper, we propose an original solution to simplify patient data entry, using an adaptive questionnaire, i.e. a questionnaire that evolves during user interaction, showing or hiding questions dynamically. Considering a rule-based decision support systems, we designed methods for determining the relationships between rules and translating the system's clinical rules into display rules that determine the items to show in the questionnaire, and methods for determining the optimal order of priority among the items in the questionnaire. We applied this approach to a decision support system implementing STOPP/START v2, a guideline for managing polypharmacy. We show that it permits reducing by about two thirds the number of clinical conditions displayed in the questionnaire, both on clinical cases and real patient data. Presented to clinicians during focus group sessions, the adaptive questionnaire was found "pretty easy to use". In the future, this approach could be applied to other guidelines, and adapted for data entry by patients., (© 2024. The Author(s).)

Introduction: To date, surveillance of vaping among Canadians (using vaping products with or without nicotine) has largely been examined with respect to age and smoking status. However, a nationally representative examination of a broad set of characteristics is lacking. This study characterized Canadians aged 15 years and older who vape, stratified by smoking status., Methods: Data from the 2020 Canadian Community Health Survey (unweighted analytical sample size: 28 413 respondents) were used to examine past-30-day vaping stratified by smoking status (current smoking, former smoking, and never/nonsmoking). A Sexand Gender-Based Analysis Plus approach was used to select individual-level characteristics for analysis. Descriptive statistics were used to examine outcomes by each characteristic and multivariable logistic regression models were constructed to identify significant factors associated with each past-30-day vaping by smoking status category, using weighted data., Results: In 2020, 2.0% (605 000) of Canadians aged 15 years and older reported vaping and current smoking (dual use), 1.2% (372 000) reported vaping and former smoking and 1.1% (352 000) reported vaping and never/nonsmoking. Within each past-30-day vaping by smoking status category, certain subgroups presented higher risks: youth and young adults, men, and those having a mood and/or anxiety disorder had higher odds of dual use. Vaping and former smoking was associated with self-identification as a man, having a mood and/or anxiety disorder and provincial region. Youth and young adults, men and those identifying as not a visible minority had higher odds of vaping and never/nonsmoking., Conclusion: This analysis of Canadians who vape, stratified by smoking status, identifies high-prevalence subpopulations and informs us of the composition of vaping populations by select characteristics, deepening our understanding of Canadians who engage in vaping behaviours., Competing Interests: None to declare.

Purpose: Virtual reality (VR) and augmented reality (AR) have led to significant advancements in cardiac preoperative planning, shaping the world in profound ways. A noticeable gap exists in the availability of a comprehensive multi-user, multi-device mixed reality application that can be used in a multidisciplinary team meeting., Approach: A multi-user, multi-device mixed reality application was developed, supporting AR and VR implementations. Technical validation involved a standardized testing protocol and comparison of AR and VR measurements regarding absolute error and time. Preclinical validation engaged experts in interventional cardiology, evaluating the clinical applicability prior to clinical validation. Clinical validation included patient-specific measurements for five patients in VR compared with standard computed tomography (CT) for preoperative planning. Questionnaires were used at all stages for subjective evaluation., Results: Technical validation, including 106 size measurements, demonstrated an absolute median error of 0.69 mm (0.25 to 1.18 mm) compared with ground truth. The time to complete the entire task was 892 ± 407    s on average, with VR measurements being faster than AR ( 804 ± 483 versus 957 ± 257    s , P = 0.045 ). On clinical validation of five preoperative patients, there was no statistically significant difference between paired CT and VR measurements (0.58 [95% CI, - 1.58 to 2.74], P = 0.586 ). Questionnaires showcased unanimous agreement on the user-friendly nature, effectiveness, and clinical value., Conclusions: The mixed reality application, validated through technical, preclinical, and clinical assessments, demonstrates precision and user-friendliness. Further research of our application is needed to validate the generalizability and impact on patient outcomes., (© 2024 Society of Photo-Optical Instrumentation Engineers (SPIE).)

Metal chalcogenide nanoparticles have been attracting extensive attention in diverse fields. Traditionally these nanoparticles are stabilized by organic ligands such as thiols and amines involving nonconjugated core-ligand interfacial interactions. In the present study, a facile wet-chemistry method is described for the synthesis of palladium disulfide (PdS 2 ) nanoparticles capped with acetylene derivatives. Spectroscopic and electrochemical measurements suggest that conjugated Pd-C≡ linkages are formed at the core-ligand interface and facilitate electronic coupling and hence manipulation of the nanoparticle optical and electronic properties. The unique interfacial linkages also allow further functionalization of the nanoparticles by metathesis reaction with olefin derivatives, as manifested in the reaction with vinylferrocene. This research opens new avenues for the structural engineering and functionalization of metal chalcogenide nanoparticles.

Unspecific bone uptake (UBU) related to [ 18 F]PSMA-1007 PET/CT imaging represents a clinical challenge. We aimed to assess whether a combination of clinical, biochemical, and imaging parameters could predict skeletal metastases in patients with [ 18 F]PSMA-1007 bone focal uptake, aiding in result interpretation. Methods: We retrospectively analyzed [ 18 F]PSMA-1007 PET/CT performed in hormone-sensitive prostate cancer (PCa) patients at 3 tertiary-level cancer centers. A fourth center was involved in performing an external validation. For each, a volume of interest was drawn using a threshold method to extract SUV max , SUV mean , PSMA tumor volume, and total lesion PSMA. The same volume of interest was applied to CT images to calculate the mean Hounsfield units (HU mean ) and maximum Hounsfield units. Clinical and laboratory data were collected from electronic medical records. A composite reference standard, including follow-up histopathology, biochemistry, and imaging data, was used to distinguish between PCa bone metastases and UBU. PET readers with less ( n = 2) or more ( n = 2) experience, masked to the reference standard, were asked to visually rate a subset of focal bone uptake ( n = 178) as PCa metastases or not. Results: In total, 448 bone [ 18 F]PSMA-1007 focal uptake specimens were identified in 267 PCa patients. Of the 448 uptake samples, 188 (41.9%) corresponded to PCa metastases. Ongoing androgen deprivation therapy at PET/CT ( P < 0.001) with determination of SUV max ( P < 0.001) and HU mean ( P < 0.001) independently predicted bone metastases. A composite prediction score, the bone uptake metastatic probability (BUMP) score, achieving an area under the receiver-operating-characteristic curve (AUC) of 0.87, was validated through a 10-fold internal and external validation ( n = 89 bone uptake, 51% metastatic; AUC, 0.92). The BUMP score's AUC was significantly higher than that of HU mean (AUC, 0.62) and remained high among lesions with HU mean in the first tertile (AUC, 0.80). A decision-curve analysis showed a higher net benefit with the score. Compared with the visual assessment, the BUMP score provided added value in terms of specificity in less-experienced PET readers (88% vs. 54%, P < 0.001). Conclusion: The BUMP score accurately distinguished UBU from bone metastases in PCa patients with [ 18 F]PSMA-1007 focal bone uptake at PET imaging, offering additional value compared with the simple assessment of the osteoblastic CT correlate. Its use could help clinicians interpret imaging results, particularly those with less experience, potentially reducing the risk of patient overstaging., (© 2024 by the Society of Nuclear Medicine and Molecular Imaging.)

Purpose: To evaluate the impact of the 2022 infant formula shortage on self-reported anxiety and depression., Background: The US national infant formula shortage of 2022 originated from supply chain disruptions triggered by the COVID-19 pandemic, and the shortage was further compounded by a recall of tainted formula products., Methods: We used survey-weighted data from the Household Pulse Survey (HPS) to measure self-reported anxiety and depression among individuals with formula-fed infants less than 1 year of age. We evaluated the association between 2 formula disruption variables (being impacted by the infant formula shortage or having difficulty obtaining formula in the last 7 days) with 2 mental health outcomes (anxiety and depression) using multivariable logistic regressions., Results: We found increased odds of self-reported anxiety (aOR: 3.13; P < .001) and depression (aOR: 3.05; P = .005) for respondents affected by the infant formula shortage. There were no adjusted associations between having difficulty obtaining formula in the last 7 days and anxiety and depression., Conclusions: Individuals affected by the infant formula shortage had increased odds of both anxiety and depression. Continued efforts to improve food security for low-income infants is critical for ensuring equitable nutritional and health outcomes across infant populations., Implications for Practice and Research: Continued efforts to reduce food insecurity for low-income infants are critically needed, as infant nutrition impacts caregiver mental health and infant health. Efforts to improve lactation support and breastfeeding initiation are needed in addition to improvements in access to formula., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

This review article examines the extant literature on animism and anthropomorphism in infants and young children. A substantial body of work indicates that both infants and young children have a broad concept of what constitutes a sentient agent and react to inanimate objects as they do to people in the same context. The literature has also revealed a developmental pattern in which anthropomorphism decreases with age, but social robots appear to be an exception to this pattern. Additionally, the review shows that children attribute psychological properties to social robots less so than people but still anthropomorphize them. Importantly, some research suggests that anthropomorphism of social robots is dependent upon their morphology and human-like behaviors. The extent to which children anthropomorphize robots is dependent on their exposure to them and the presence of human-like features. Based on the existing literature, we conclude that in infancy, a large range of inanimate objects (e.g., boxes, geometric figures) that display animate motion patterns trigger the same behaviors observed in child-adult interactions, suggesting some implicit form of anthropomorphism. The review concludes that additional research is needed to understand what infants and children judge as social agents and how the perception of inanimate agents changes over the lifespan. As exposure to robots and virtual assistants increases, future research must focus on better understanding the full impact that regular interactions with such partners will have on children's anthropomorphizing. This article is categorized under: Psychology > Learning Cognitive Biology > Cognitive Development Computer Science and Robotics > Robotics., (© 2024 Wiley Periodicals LLC.)

Background: Bacterial infections (BIs) are widespread in ICUs. The aims of this study were to assess compliance with antibiotic recommendations and factors associated with non-compliance., Methods: We conducted an observational study in eight French Paediatric and Neonatal ICUs with an antimicrobial stewardship programme (ASP) organised once a week for the most part. All children receiving antibiotics for a suspected or proven BI were evaluated. Newborns < 72 h old, neonates < 37 weeks, age ≥ 18 years and children under surgical antimicrobial prophylaxis were excluded., Results: 139 suspected (or proven) BI episodes in 134 children were prospectively included during six separate time-periods over one year. The final diagnosis was 26.6% with no BI, 40.3% presumed (i.e., not documented) BI and 35.3% documented BI. Non-compliance with antibiotic recommendations occurred in 51.1%. The main reasons for non-compliance were inappropriate choice of antimicrobials (27.3%), duration of one or more antimicrobials (26.3%) and length of antibiotic therapy (18.0%). In multivariate analyses, the main independent risk factors for non-compliance were prescribing ≥ 2 antibiotics (OR 4.06, 95%CI 1.69-9.74, p = 0.0017), duration of broad-spectrum antibiotic therapy ≥ 4 days (OR 2.59, 95%CI 1.16-5.78, p = 0.0199), neurologic compromise at ICU admission (OR 3.41, 95%CI 1.04-11.20, p = 0.0431), suspected catheter-related bacteraemia (ORs 3.70 and 5.42, 95%CIs 1.32 to 15.07, p < 0.02), a BI site classified as "other" (ORs 3.29 and 15.88, 95%CIs 1.16 to 104.76, p < 0.03), sepsis with ≥ 2 organ dysfunctions (OR 4.21, 95%CI 1.42-12.55, p = 0.0098), late-onset ventilator-associated pneumonia (OR 6.30, 95%CI 1.15-34.44, p = 0.0338) and ≥ 1 risk factor for extended-spectrum β-lactamase-producing Enterobacteriaceae (OR 2.56, 95%CI 1.07-6.14, p = 0.0353). Main independent factors for compliance were using antibiotic therapy protocols (OR 0.42, 95%CI 0.19-0.92, p = 0.0313), respiratory failure at ICU admission (OR 0.36, 95%CI 0.14-0.90, p = 0.0281) and aspiration pneumonia (OR 0.37, 95%CI 0.14-0.99, p = 0.0486)., Conclusions: Half of antibiotic prescriptions remain non-compliant with guidelines. Intensivists should reassess on a day-to-day basis the benefit of using several antimicrobials or any broad-spectrum antibiotics and stop antibiotics that are no longer indicated. Developing consensus about treating specific illnesses and using department protocols seem necessary to reduce non-compliance. A daily ASP could also improve compliance in these situations., Trial Registration: ClinicalTrials.gov: number NCT04642560. The date of first trial registration was 24/11/2020., (© 2024. The Author(s).)

Efficient and robust analytical methods are needed to improve the identification and subsequent regulation of new psychoactive substances (NPS). NMR spectroscopy is a unique method able to determine the structure of small molecules such as NPS even in mixtures. However, high-field NMR analysis is associated with expensive purchase and maintenance costs. For more than a decade, compact NMR spectrometers have changed this paradigm. It was recently shown that a dedicated analytical workflow combining compact NMR and databases could identify the molecular structure of NPS, in spite of the lower spectral dispersion and sensitivity of compact spectrometers. This approach relies on 1 H- 13 C HSQC to both recognize NPS and elucidate the structure of unknown substances. Still, its performance is limited by the need to compromise between resolution and experiment time. Here, we show that this strategy can be significantly improved by implementing non-uniform sampling (NUS) to improve spectral resolution in the 13 C dimension of HSQC at no cost in terms of experiment time. Gains in the range of 3 to 4 in resolution are achieved for pure NPS and for a mixture. Finally, 2D HSQC with NUS was applied to improve the identification of NPS with the assistance of databases. The resulting method appears as a useful tool for the characterization of NPS in mixtures, which is essential for forensic laboratories., (© 2023 The Authors. Magnetic Resonance in Chemistry published by John Wiley & Sons Ltd.)

Background: Although peer-assisted learning is known to be effective for reciprocal learning in medical education, it has been understudied in simulation. We aimed to assess the effectiveness of peer-led compared to instructor-led debriefing for non-technical skill development in simulated crisis scenarios., Methods: Sixty-one undergraduate medical students were randomized into the control group (instructor-led debriefing) or an intervention group (peer debriefer or peer debriefee group). After the pre-test simulation, the participants underwent two more simulation scenarios, each followed by a debriefing session. After the second debriefing session, the participants underwent an immediate post-test simulation on the same day and a retention post-test simulation two months later. Non-technical skills for the pre-test, immediate post-test, and retention tests were assessed by two blinded raters using the Ottawa Global Rating Scale (OGRS)., Results: The participants' non-technical skill performance significantly improved in all groups from the pre-test to the immediate post-test, with changes in the OGRS scores of 15.0 (95% CI [11.4, 18.7]) in the instructor-led group, 15.3 (11.5, 19.0) in the peer-debriefer group, and 17.6 (13.9, 21.4) in the peer-debriefee group. No significant differences in performance were found, after adjusting for the year of medical school training, among debriefing modalities (P = 0.147) or between the immediate post-test and retention test (P = 0.358)., Conclusions: Peer-led debriefing was as effective as instructor-led debriefing at improving undergraduate medical students' non-technical skill performance in simulated crisis situations. Peer debriefers also improved their simulated clinical skills. The peer debriefing model is a feasible alternative to the traditional, costlier instructor model.

Background: Necrotizing pneumonia (NP) is a serious and rare disease in children. Pediatric data on NP are limited and the impact of the 13-valent pneumococcal conjugate vaccine has been very poorly evaluated., Patients and Methods: We conducted a retrospective study at Toulouse University Hospital between 2008 and 2018. Children who presented with thin-walled cavities in the areas of parenchymal consolidation on imaging were included in the study., Results: The incidence of NP did not decrease during this period. Bacterial identification occurred in 56% of cases (14/25) and included six cases of Streptococcus pneumoniae, five of Staphylococcus aureus, two of Streptococcus pyogenes, and one of Streptococcus viridans. Streptococcus pneumoniae NP are more frequently associated with empyema/parapneumonic effusion compared to S. aureus NP (p = 0.02). Patients with S. pyogenes NP more often required volume expansion than did S. pneumoniae cases (p = 0.03). When comparing children born before and after implementation of the 13-valent pneumococcal conjugate vaccine, we identified a relative modification of the bacterial epidemiology, with an increase in the proportion of S. pyogenes NP and S. aureus NP and a decrease in the proportion of NP caused by S. pneumoniae., Conclusion: Future studies are needed to assess the epidemiology of NP in children. Continued surveillance of identified pneumococcal serotypes is essential to document epidemiological changes in the coming years., Competing Interests: Declaration of competing interest none for M. Cathalau, M. Michelet, A. Rancé, G. Martin-Blondel, O. Abbo, D. Dubois, G. Labouret, E. Grouteau, I. Claudet, L. Ricco, L. Roditis, JM. Mansuy, S. Simon, and C. Bréhin, (Copyright © 2024 French Society of Pediatrics. Published by Elsevier Masson SAS. All rights reserved.)

Postgraduate medical education is an essential societal enterprise that prepares highly skilled physicians for the health workforce. In recent years, PGME systems have been criticized worldwide for problems with variable graduate abilities, concerns about patient safety, and issues with teaching and assessment methods. In response, competency based medical education approaches, with an emphasis on graduate outcomes, have been proposed as the direction for 21st century health profession education. However, there are few published models of large-scale implementation of these approaches. We describe the rationale and design for a national, time-variable competency-based multi-specialty system for postgraduate medical education called Competence by Design. Fourteen innovations were bundled to create this new system, using the Van Melle Core Components of competency based medical education as the basis for the transformation. The successful execution of this transformational training system shows competency based medical education can be implemented at scale. The lessons learned in the early implementation of Competence by Design can inform competency based medical education innovation efforts across professions worldwide., Competing Interests: JRF, JK, LSS, FB, VN, ST, JF, KH, RST were employees of the Royal College.JS, AA, AO, AKH, LC, SD, DR, WJC, RBC, TD, BT, LF, WG, ND, BW, RS, RA, DD, AB, MG, and EVM performed contract work for the Royal College., (Copyright: © 2024 The Author(s).)

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.

Competence committees (CCs) are a recent innovation to improve assessment decision-making in health professions education. CCs enable a group of trained, dedicated educators to review a portfolio of observations about a learner's progress toward competence and make systematic assessment decisions. CCs are aligned with competency based medical education (CBME) and programmatic assessment. While there is an emerging literature on CCs, little has been published on their system-wide implementation. National-scale implementation of CCs is complex, owing to the culture change that underlies this shift in assessment paradigm and the logistics and skills needed to enable it. We present the Royal College of Physicians and Surgeons of Canada's experience implementing a national CC model, the challenges the Royal College faced, and some strategies to address them. With large scale CC implementation, managing the tension between standardization and flexibility is a fundamental issue that needs to be anticipated and addressed, with careful consideration of individual program needs, resources, and engagement of invested groups. If implementation is to take place in a wide variety of contexts, an approach that uses multiple engagement and communication strategies to allow for local adaptations is needed. Large-scale implementation of CCs, like any transformative initiative, does not occur at a single point but is an evolutionary process requiring both upfront resources and ongoing support. As such, it is important to consider embedding a plan for program evaluation at the outset. We hope these shared lessons will be of value to other educators who are considering a large-scale CBME CC implementation., Competing Interests: Some individual authors received funding from the Royal College either as staff (LS, JK, JRF) or as consultants (AO, DD, RA, AKH, WJC)., (Copyright: © 2024 The Author(s).)

Objectives: Patients with HER2-positive invasive breast cancer that is node-positive and/or larger than 3 cm are generally treated with neoadjuvant chemotherapy (NAC). We aimed to identify predictive markers for pathological complete response (pCR) after NAC in HER2-positive breast carcinoma., Methods: Hematoxylin/eosin-stained slides of 43 HER2-positive breast carcinoma biopsies were histopathologically reviewed. Immunohistochemistry (IHC) was performed on pre-NAC biopsies, comprising HER2, estrogen receptor (ER), progesterone receptor (PR), Ki-67, epidermal growth factor receptor (EGFR), mucin-4 (MUC4), p53 and p63. Dual-probe HER2 in situ hybridization (ISH) was performed to study the mean HER2 and CEP17 copy numbers. ISH and IHC data were retrospectively collected for a validation cohort, comprising 33 patients., Results: Younger age at diagnosis, 3+ HER2 IHC scores, high mean HER2 copy numbers and high mean HER2/CEP17 ratios were significantly associated with an increased chance of achieving a pCR, and the latter two associations were confirmed in the validation cohort. No other immunohistochemical or histopathological markers were associated with pCR., Conclusions: This retrospective study of two community-based NAC-treated HER2-positive breast cancer patient cohorts identified high mean HER2 copy numbers as a strong predictor for pCR. Further studies on larger cohorts are required to determine a precise cut-point for this predictive marker., (©The Author(s) 2024. Open Access. This article is licensed under a Creative Commons CC-BY International License.)

How young children learn from different informants has been widely studied. However, most studies investigate how children learn verbally conveyed information. Furthermore, most studies investigate how children learn from humans. This study sought to investigate how 3-year-old children learn from, and come to trust, a competent robot versus an incompetent human when competency is established using a pointing paradigm. During an induction phase, a robot informant pointed at a toy inside a transparent box, whereas a human pointed at an empty box. During the test phase, both agents pointed at opaque boxes. We found that young children asked the robot for help to locate a hidden toy more than the human (ask questions) and correctly identified the robot to be accurate (judgment questions). However, children equally endorsed the locations pointed at by both the robot and the human (endorse questions). This suggests that 3-year-olds are sensitive to the epistemic characteristics of the informant even when its displayed social properties are minimal., (Copyright © 2023 Elsevier Inc. All rights reserved.)

Metal chalcogenide nanoparticles play a vital role in a wide range of applications and are typically stabilized by organic derivatives containing thiol, amine, or carboxyl moieties, where the nonconjugated particle-ligand interfaces limit the electronic interactions between the inorganic cores and organic ligands. Herein, a wet-chemistry method is developed for the facile preparation of stable platinum chalcogenide (S, Se) nanoparticles capped with acetylene derivatives (e.g., 4-ethylphenylacetylene, EPA). The formation of Pt-C≡ conjugated bonds at the nanoparticle interfaces, which is confirmed by optical and X-ray spectroscopic measurements, leads to markedly enhanced electronic interactions between the d electrons of the nanoparticle cores and π electrons of the acetylene moiety, in stark contrast to the mercapto-capped counterparts with only nonconjugated Pt-S- interfacial bonds, as manifested in spectroscopic measurements and density functional theory calculations. This study underscores the significance of conjugated anchoring linkages in the stabilization and functionalization of metal chalcogenides, a unique strategy for diverse applications.

The present study examined the links between haptic word processing speed, vocabulary, and inhibitory control among bilingual children. Three main hypotheses were tested: faster haptic processing speed, measured by the Computerized Comprehension Task at age 1;11, would be associated with larger concurrent vocabulary and greater longitudinal vocabulary growth. Second, early vocabulary size would be associated with greater vocabulary growth at 3;0 and 5;0. Finally, faster haptic processing speed would be associated with greater concurrent inhibitory control, as measured by the Shape Stroop Task. The results revealed that haptic processing speed was associated with concurrent vocabulary, but not predictive of later language skills. Also, early decontextualized vocabulary was predictive of vocabulary at 3;0. Finally, haptic processing speed measured in the non-dominant language was associated with inhibitory control. These results provide insight on the mechanisms of lexical retrieval in young bilinguals and expand previous research on haptic word processing and vocabulary development.