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The Educational Doctorate (EdD) is designed to meet the needs of current practitioners who aim to expand their professional expertise by leveraging deep knowledge and research methods to address specific and contextualized problems of practice. This approach centers on developing scholarly practitioners that are equipped with the skills necessary to bridge the knowledge-to-doing gap and contribute meaningfully to school improvement (CPED, 2020; Donovan, 2013; Hochbein & Perry, 2013; Jackson & Sun, 2022; Lewis et al., 2020; Perry, Zambo, & Crow, 2020). To achieve this goal, program faculty and their respective thinking must be concerned with and oriented to the scholarly practitioner and their unique positionality. This paper explores two considerations related to centering scholarly practitioners and their impact to illustrate the possibilities inherent within EdD programs.

Long single-stranded DNA (ssDNA) is a versatile molecular reagent with applications including RNA-guided genome engineering and DNA nanotechnology, yet its production is typically resource-intensive. We introduce a novel method utilizing an engineered Escherichia coli 'helper' strain and phagemid system that simplifies long ssDNA generation to a straightforward transformation and purification procedure. Our method obviates the need for helper plasmids and their associated contamination by integrating M13mp18 genes directly into the E. coli chromosome. We achieved ssDNA lengths ranging from 504 to 20 724 nt with titers up to 250 μg/l following alkaline lysis purification. The efficacy of our system was confirmed through its application in primary T-cell genome modifications and DNA origami folding. The reliability, scalability and ease of our approach promise to unlock new experimental applications requiring large quantities of long ssDNA.

Abstract The Human Silencing Hub (HuSH) complex silences retrotransposable elements in vertebrates. Here, we identify a second HuSH complex, designated HuSH2, which is centered around TASOR2, a paralog of the core TASOR protein in HuSH. Our findings reveal that HuSH and HuSH2 localize to distinct and non-overlapping genomic loci. Specifically, HuSH localizes to and represses LINE-1 retrotransposons, whereas HuSH2 targets and represses KRAB-ZNFs and interferon signaling and response genes. We use in silico protein structure predictions to simulate MPP8 interactions with TASOR paralogs, guiding amino acid substitutions that disrupted binding to HuSH complexes. These MPP8 transgenes and other constructs reveal the importance of HuSH complex quantities in regulating LINE-1 activity. Furthermore, our results suggest that dynamic changes in TASOR and TASOR2 expression enable cells to finely tune HuSH-mediated silencing. This study offers insights into the interplay of HuSH complexes, highlighting their vital role in retrotransposon regulation.

The World Health Organization Global Hearts initiative (HEARTS) and technical package aim to improve the primary health care management of hypertension and other risk factors for cardiovascular disease at the population level. This study describes the first HEARTS implementation pilot project in Guatemala’s Ministry of Health (MOH) primary health care system. This pilot began in April 2022 in six primary health care facilities in three rural indigenous municipalities. The project consisted of HEARTS-aligned strategies adapted to enhance program sustainability in Guatemala. Outcomes were defined using the Reach, Effectiveness, Adoption, Implementation, Maintenance (RE-AIM) framework. The primary reach outcome was treatment count, defined as the absolute number of patients per month receiving medication treatment for hypertension. The primary effectiveness outcomes were mean systolic blood pressure (BP), mean diastolic BP, and proportion of patients with BP control (

Abstract Alternative splicing (AS) is a crucial mechanism contributing to proteomic diversity, which is highly regulated in tissue- and development-specific patterns. Retinal tissue exhibits one of the highest levels of AS. In particular, photoreceptors have a distinctive AS pattern involving the inclusion of microexons not found in other cell types. PROM1 whose encoded protein Prominin-1 is located in photoreceptor outer segments (OSs), undergoes exon 4 inclusion from the 12th post-conception week of human development through adulthood. Exon 4 skipping in PROM1 is associated with late-onset mild maculopathy, however its role in photoreceptor maturation and function is unknown. In this study retinal organoids, a valuable model system, were employed in combination with phosphorodiamidate morpholino oligos (PMOs) to assess the role of exon 4 AS in the development of human retina. Retinal organoids were treated with the PMOs for four weeks after which RT-PCR, western blotting and immunofluorescence analysis were performed to assess exon 4 exclusion and its impact on photoreceptors. The transcriptome of treated ROs was studied by bulk RNA-Seq. Our data demonstrate that 55% skipping of PROM1 exon 4 resulted in decreased Prominin-1 expression by 40%, abnormal accumulation of cones in the basal side of the retinal organoids as well as detectable cone photoreceptor cilium defects. Transcriptomic and western blot analyses revealed decreased expression of cone, inner segment and connecting cilium basal body markers, increased expression of genes associated with stress response and the ubiquitin-proteasome system, and downregulation of autophagy. Importantly, the use of retinal organoids provides a valuable platform to study AS and unravel disease mechanisms in a more physiologically relevant context, opening avenues for further research and potential therapeutic interventions. Together our data indicate that cones may be more sensitive to PROM1 exon 4 skipping and/or reduced Prominin-1 expression, corroborating the pathogenesis of late-onset mild maculopathy.

Objective: The present study aimed to determine correlates of adherence to COVID-19 health precautions among college students. Drawing from the literature, the following constructs were considered: self-efficacy, conscientiousness, social support, collectivism, empathy, and fear of COVID. Participants: Undergraduate students (N = 92) recruited from psychology classes and social media, living on and off-campus, served as participants during fall 2020. Methods: Participants completed a short self-report survey, delivered online, measuring adherence to COVID-19 health precautions and its possible correlates. Results: After preliminary comparisons showing no differences in adherence between students living on and off-campus, linear regression analyses of the complete sample revealed that the significant predictors of adherence were conscientiousness, collectivism, empathy, and fear of COVID. Conclusions: College student adherence was largely driven by interpersonal motivators coupled with a modest level of fear, rather than more general constructs. These findings offer implications for considering targets in public health campaigns delivered to college students.

In the last two decades, there has been a global movement towards pedagogies that create more inclusive school environments in order to meet the needs of diverse learners. One such approach is Universal Design for Learning (UDL), which foregrounds the design of flexible and accessible learning experiences for all, regardless of learner characteristics. Technology is a key enabler in this. To date, much of the research on UDL has focused on its impact in higher education, with less evidence available on the use of UDL within second-level education. This systematic literature review of n = 15 empirical studies selected from a wide-ranging search that returned an initial result of n = 1253 explores how the affordances of digital technology have been harnessed for UDL enactment at second level. The findings show that, to date, empirical research at second level has focused mostly on the easy wins within the UDL principle of Representation, where educators offer choice about how learners access content. However, there is a clear gap in UDL research on the use of technologies to support the Engagement and Action & Expression principles of UDL, supporting student self-regulation and self-assessment, and on technology-mediated communication and collaboration. The paper highlights the potential for future cross-pollination of research in educational technology with UDL.

Higher education and student affairs graduate programs have attempted to prepare aspiring administrators to answer the call for increased multicultural competency through diversity courses, yet research suggests that new professionals feel ill-prepared to enact social justice work. Current instructional methods foster awareness but fail to cultivate reflective, culturally responsive practitioners. This qualitative case study explores how HESA graduate students' conceptions of critical consciousness evolve during a diversity course and the pedagogical practices that foster consciousness-raising.

Abstract The fine tuning of biological electrical signaling is mediated by variations in the rates of opening and closing of gates that control ion flux through different ion channels. Human ether-a-go-go related gene (HERG) potassium channels have uniquely rapid inactivation kinetics which are critical to the role they play in regulating cardiac electrical activity. Here, we exploit the K+ sensitivity of HERG inactivation to determine structures of both a conductive and non-conductive selectivity filter structure of HERG. The conductive state has a canonical cylindrical shaped selectivity filter. The non-conductive state is characterized by flipping of the selectivity filter valine backbone carbonyls to point away from the central axis. The side chain of S620 on the pore helix plays a central role in this process, by coordinating distinct sets of interactions in the conductive, non-conductive, and transition states. Our model represents a distinct mechanism by which ion channels fine tune their activity and could explain the uniquely rapid inactivation kinetics of HERG.

Sharon Lee,1,2 Janelle Gifford,2,3 Victoria Flood1,2,4 1Western Sydney Local Health District, Research and Education Network, Westmead, 2145, Australia; 2Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Camperdown NSW, Australia; 3Sport and Physical Activity Research and Teaching Network (SPARTAN), The University of Sydney, Camperdown NSW, Australia; 4University Centre for Rural Health, Faculty of Medicine and Health, University of Sydney, Lismore, 2480, AustraliaCorrespondence: Professor Victoria Flood, Westmead Hospital, Research & Education Network, Corner Hawkesbury & Darcy Road, Westmead, NSW, 2145, Australia, Tel + 61288905772, Fax +61288908627, Email Vicki.flood@sydney.edu.auBackground: In response to the increasing involvement of nursing, allied health and medical professionals in research within clinical service roles, understanding the varying research capacities across public health institutions and professions is crucial. This study aims to explore the lived experiences of conducting research among nursing, allied health and medical health professionals within a tertiary public hospital setting in New South Wales (NSW). The focus is on identifying barriers and enablers to research engagement.Methods: Research active health professionals across nursing, allied health and medical professions were invited to participate in a semi-structured interview to discuss enablers and barriers experienced whilst conducting research. All interviews were transcribed verbatim, conceptual and thematic analysis of the interviews was conducted.Results: Nine allied health professionals, eight nurses/midwives and thirteen medical officers were interviewed. Key themes were categorised as barriers or enablers. The ethics regulatory process was identified as a strong barrier in all professions, other commonly identified barriers were lack of time to conduct research and lack of funding. Researchers reported difficulties knowing where to obtain assistance and support when required. Mentorship was the most common enabler identified by all three professions. In addition, a positive research culture and organisational support and assistance within the organisation were seen as strong enablers.Conclusion: This research provides insight into the barriers and enablers for active clinician researchers across three professional groups. We have identified priority areas to increase research capacity within our health care organisation and will focus on training in the ethics regulatory process and mentorship along with infrastructure support to strengthen the positive research culture across all professions.Plain Language Summary: Research by healthcare professionals employed in publicly funded health services is encouraged across nursing/midwifery, allied health and medical professionals. This study sought to identify barriers and enablers to undertaking research for these healthcare professionals. Interviews were conducted with representatives from each of the professions. Barriers identified across all professional groups were inconsistencies and difficulties with the ethical regulatory process. Enablers such as a positive research culture within the institutions were found meaningful by the professional groups. This study will allow health organisations to tailor training and infrastructure support to all researchers.Keywords: research capacity, allied health, nursing, medical, research culture

Emuella Flood,1 Susan McCutcheon,2 Kathleen Beusterien,3 deMauri S Mackie,3 Stella Mokiou,1 Xavier Guillaume,3 Emily Mulvihill3 1Patient Centered Science, AstraZeneca, Gaithersburg, MD, USA; 2Global Medical Affairs, AstraZeneca, Cambridge, UK; 3Health Division, Cerner Enviza, an Oracle Company, Kansas City, MO, USACorrespondence: Emily Mulvihill, Health Division, Cerner Enviza, an Oracle Company, 2800 Rock Creek Parkway, Kansas, MO, USA, Tel +1 314-724-9386, Email emily.mulvihill@cernerenviza.comPurpose: Patients with early breast cancer (eBC) are increasingly provided with different options, which may involve a sequence of different treatments and treatment modalities, and eligibility for certain adjuvant treatments depending upon pre-surgical and surgical outcomes. This study examined patient preferences around aspects of treatment decision-making in eBC.Patients and Methods: A total of 452 patients with self-reported eBC in Germany (n=151), Italy (n=151), and Japan (n=150) completed an online survey about physician interactions and treatment side effects. The survey included best-worst scaling (BWS) to assess prioritization of 13 statements reflecting aspects of treatment decision-making. In a series of choice tasks, participants chose their most and least preferred options among subsets of 4 statements. Hierarchical Bayesian modeling was used to estimate BWS preference scores for each statement. BWS scores were based on the number of times a statement was chosen as most versus least preferred; scores total 100 for each patient.Results: The most preferred aspects of treatment decision-making were “treatment aggressiveness matches personal risk” (mean BWS score = 13.49), “being told about what is coming” (13.18), deciding based on “own surgical outcome” (11.90), “avoiding unnecessary treatment” (10.35), and “involving in treatment decisions” (9.44). The least preferred aspects were “not being asked about treatment decisions along the way” (3.27) and “receiving the same treatment as other patients” (3.41). Patients in Japan preferred “being told about what is coming”, “deciding based on own surgical outcome”, “avoiding unnecessary treatment”, and being “involved in decisions” more than patients in Italy and Germany. Patients in Germany were more satisfied with their physician interactions and care, although their outcomes were not always better than those in Italy and Japan.Conclusion: Patients value individualized treatment tailored to their risk of recurrence and tolerance of side effects, highlighting the need for focused patient education about options, to encourage their engagement.Plain Language Summary: New treatment pathways based on promising biomarkers are being studied in early breast cancer. This study aimed to understand the importance that patients may place on different features describing how decisions are made along potential treatment pathways for early breast cancer. Participants in Italy, Germany, and Japan were asked to compare various aspects of treatment decision-making and choose those that were most and least important to them. Among the aspects tested, the top 4 were similar across countries: the desire to receive treatment with a level of aggressiveness that matches their individual prognosis, the need to receive adequate and timely information about their upcoming treatment, the need to tailor treatment decisions based on their individual surgery outcomes, and a desire to avoid overtreatment. Not being involved in treatment decisions was the least preferred of the aspects. Patients in Germany and Italy most valued the ability to tailor the aggressiveness of their treatment based on their individual risk of recurrence, whereas patients in Japan prioritized being knowledgeable and prepared for their treatment journey. The results from this study emphasize patients’ desire to be adequately informed about available treatment choices for early breast cancer, to avoid unnecessary treatments, and to be involved in treatment decisions. Keywords: breast cancer, patient perspective, patient priorities, shared decision-making, patient satisfaction

Abstract Objective The objective of this study is to investigate the prevalence of diabetes in a clinical population of primarily Indigenous women in Guatemala. Results In a retrospective chart review of a clinical program serving 13,643 primarily Indigenous women in Guatemala, crude diabetes prevalence was 8.3% (95% Confidence Interval [CI]: 7.8 to 8.7) and age-adjusted diabetes prevalence was 7.9% (95% CI: 7.3 to 8.5). Among those with diabetes, 37.9% (95% CI: 35.1 to 40.8) of women were undiagnosed. Diabetes prevalence rose significantly with increasing age and was significantly higher among women with obesity (risk ratio: 1.4 [95% CI: 1.1 to 1.8]) and among women least likely to be in poverty (risk ratio: 2.0 [95% CI: 1.5 to 2.6]). Diabetes prevalence was significantly lower among Indigenous women (risk ratio: 0.7 [95% CI: 0.6 to 0.9]) and among women who spoke Mayan languages rather than Spanish (risk ratio: 0.7 [95% CI: 0.6 to 0.9]). There was no significant difference in diabetes prevalence between women who lived in rural settings and women who lived in urban settings.

Abstract Background Staff shortages limit access to health services. The bidirectional benefits of allied health clinical placements are understood in the domains of student learning, health service delivery, and future workforce development. Still, the benefits to current workforce outcomes remain unknown. This review provides insights into the effects of allied health student placements in acute and primary care settings, particularly on healthcare staff's knowledge and procedural skills. Methods This search was based on the integrative review process established by Whittemore and Knafl in 2005. In October 2023, the first author (MH) searched five major electronic databases: Medline-EBSCO, PubMed, CINAHL, Embase, and Scopus. The CLUSTER model was used to track additional references. The first three authors (MH, SM, and SC) were involved in screening, quality appraisal, and synthesis of the studies. Data were thematically synthesised and analysed. Results MeSH headings and keywords were used in key search areas: health education, health professional training, clinical placements, and allied health professions. The systematic search yielded 12 papers on allied health student placements across various healthcare settings in rural and metropolitan areas, with no high-quality methodologies measuring student placements' impact on staff knowledge and skills. Four main themes were identified from the analysis: meaningful student integration in service delivery, targeted educational support to healthcare staff, development of staff procedural skills and confidence, and the mechanisms of why student placements work in this aspect. Conclusions This review suggests that offering allied health student placement could be a promising approach to supporting rural healthcare staff in performing patient assessments and treatments proficiently and collaboratively. However, this requires further investigation to confirm.

ObjectiveType II diabetes is a recognized risk factor of declining cognitive function in high-income countries. However, there is limited research on this association across low- and middle-income countries. We aimed to examine and compare the relationship between type II diabetes and cognition amongst adults aged 60 years and older for two of the largest LMICs: India and China.MethodsCross-sectional data was analyzed from population-based Harmonized Cognitive Assessment Protocols studies in India (n = 4,062) and China (n = 9,741). Multivariable-adjusted linear regression models examined the relationship between diabetes (self-reported or biomarker HbA1c ≥6.5%) and general cognition. Interaction testing assessed effect modification based on urban versus rural residence and educational attainment.ResultsType II diabetes was not associated with general cognitive scores in India or China in fully adjusted models. Interaction testing revealed a positive association in rural but not urban residences in India, however this was not seen in China. Both countries showed effect modification by education attainment. In India, diabetes was associated with higher average cognitive scores among those with none or early childhood education, while the relationship was null among those with at least an upper secondary education. In China, diabetes was inversely related to average cognitive scores among those with less than lower secondary education, while the relationship was null among the remainder of the study sample.ConclusionThe type II diabetes and cognitive function association in India and China differs from that observed in high-income countries. These findings suggest epidemiologic and nutrition transition variations. In India, health care access, urbanization and social differences between urban and rural areas may influence this relationship. In both countries, epidemiologic and nutrition patterns may adversely impact individuals from socially and financially vulnerable populations with less than lower secondary education. Longitudinal research using harmonized cognitive scores is encouraged to further investigate these findings.

Introduction The use and value of artificial intelligence (AI)-driven tools and techniques are under investigation in detecting coronary artery disease (CAD). EchoGo Pro is a patented AI-driven stress echocardiography analysis system produced by Ultromics Ltd. (henceforth Ultromics) to support clinicians in detecting cardiac ischaemia and potential CAD. This manuscript presents the research protocol for a field study to independently evaluate the accuracy, acceptability, implementation barriers, users’ experience and willingness to pay, cost-effectiveness and value of EchoGo Pro.Methods and analysis The ‘Evaluating AI-driven stress echocardiography analysis system’ (EASE) study is a mixed-method evaluation, which will be conducted in five work packages (WPs). In WP1, we will examine the diagnostic accuracy by comparing test reports generated by EchoGo Pro and three manual raters. In WP2, we will focus on interviewing clinicians, innovation/transformation staff, and patients within the National Health Service (NHS), and staff within Ultromics, to assess the acceptability of this technology. In this WP, we will determine convergence and divergence between EchoGo Pro recommendations and cardiologists’ interpretations and will assess what profile of cases is linked with convergence and divergence between EchoGo Pro recommendations and cardiologists’ interpretations and how these link to outcomes. In WP4, we will conduct a quantitative cross-sectional survey of trust in AI tools applied to cardiac care settings among clinicians, healthcare commissioners and the general public. Lastly, in WP5, we will estimate the cost of deploying the EchoGo Pro technology, cost-effectiveness and willingness to pay cardiologists, healthcare commissioners and the general public. The results of this evaluation will support evidence-informed decision-making around the widespread adoption of EchoGo Pro and similar technologies in the NHS and other health systems.Ethics approval and dissemination This research has been approved by the NHS Health Research Authority (IRAS No: 315284) and the London South Bank University Ethics Panel (ETH2223-0164). Alongside journal publications, we will disseminate study methods and findings in conferences, seminars and social media. We will produce additional outputs in appropriate forms, for example, research summaries and policy briefs, for diverse audiences in NHS.

OBJECTIVES: The purpose of this abstract is to describe how the use of phage therapy can be used to effectively target oral bacteria such as Streptococcus mutans, Aggregatibacter actinomycetemcomitans, and Enterococcus faecalis with minimal side effects to patients. These particular bacteria are important components in the process of caries formation, periodontal disease, and failed endodontic treatment. METHODS: A search of Pubmed was conducted for peer-reviewed randomized control trials, clinical trials, and studies that were less than five years old. The keywords used to find relevant articles were: bacteria, oral bacteria, phage therapy, bacteriophage therapy, pathogenic bacteria, and dental bacteria. RESULTS: The studies that were reviewed demonstrated phage therapy to be effective in reducing oral bacteria commonly responsible for dental caries, periodontal disease, and failed endodontic treatment. The first study showed the isolated phage, SMHBZ8, targeted S. mutans and reduced both biofilm formation and demineralization of enamel. The second study demonstrated the ability of a lysogenic bacteriophage, S1249, to be induced into the lytic cycle in human serum and effectively eliminate A. actinomycetemcomitans, a bacteria implicated in aggressive periodontal disease and known to be resistant to serum. The third study found a phage, PEf771, targeting E. faecalis in endodontically treated teeth with refractory periapical periodontitis was found to have greater substantivity and antibiotic properties than traditional medicaments used in root canal treatment. CONCLUSIONS: These studies prove the viability of phage therapy as a treatment modality in targeting pathogens that contribute to major oral diseases. Benefits of phage therapy include low toxicity, high specificity, biofilm penetrating capabilities, and the ability to continuously replicate in the presence of target bacteria. IMPLICATIONS: With more research to include human trials, phage therapy could prove to be a cost-effective alternative to conventional treatments in dentistry with fewer side effects to patients. Current treatment options for these oral diseases carry risks such as antibiotic resistance, staining, and toxicity. The ability of bacteriophage to target caries-causing bacteria such as S. mutans while sparing commensal bacteria is promising for preventive dentistry while the specificity and replicating abilities are desirable for eliminating periodontal and endodontic pathogens. The use of bacteriophage in dentistry could be adapted for delivery as a rinse, dentifrice, varnish, or targeted delivery system.

Background: To facilitate the shift from risk-factor management to primordial prevention of cardiovascular disease, the American Heart Association developed guidelines to score and track cardiovascular health (CVH). How the prevalence and trajectories of a high level of CVH across the life course compare among high- and lower-income countries is unknown. Methods: Nationally representative survey data with CVH variables (physical activity, cigarette smoking, body mass index, blood pressure, blood glucose, and total cholesterol levels) were identified in Ethiopia, Bangladesh, Brazil, England, and the US for adults (aged 18–69 years and not pregnant). Data were harmonized, and CVH metrics were scored using the American Heart Association guidelines, as high (2), moderate (1), or low (0), with the prevalence of high scores (better CVH) across the life course compared across countries. Results: Among 28,092 adults (Ethiopia n = 7686, 55.2% male; Bangladesh n = 6731, 48.4% male; Brazil n = 7241, 47.9% male; England n = 2691, 49.5% male, and the US n = 3743, 50.3% male), the prevalence of high CVH scores decreased as country income level increased. Declining CVH with age was universal across countries, but differences were already observable in those aged 18 years. Excess body weight appeared to be the main driver of poor CVH in higher-income countries, and the prevalence of current smoking was highest in Bangladesh. Conclusions: Our findings suggest that CVH decline with age may be universal. Interventions to promote and preserve CVH throughout the life course are needed in all populations, tailored to country-specific time courses of the decline. In countries where the level of CVH remains relatively high, protection of whole societies from risk-factor epidemics may still be feasible. Résumé: Contexte: Afin de faciliter la transition de la prise en charge des facteurs de risque vers la prévention primordiale des maladies cardiovasculaires, l’American Heart Association a élaboré des lignes directrices en vue de mesurer la santé cardiovasculaire (SCV) et d’en faire le suivi. On ignore dans quelle mesure la prévalence et la trajectoire d’un niveau élevé de SCV au cours d’une vie se comparent entre les pays à revenu élevé et les pays à plus faible revenu. Méthodologie: Des résultats de sondages représentatifs des pays concernant les variables de la SCV (activité physique, tabagisme, indice de masse corporelle, pression artérielle, glycémie et taux de cholestérol total) ont été obtenus de l’Éthiopie, du Bangladesh, du Brésil, de l’Angleterre et des États-Unis, pour des adultes âgés de 18 à 69 ans, excluant les femmes enceintes. Les données ont été harmonisées, et la SCV a été mesurée conformément aux lignes directrices de l’American Heart Association, et notée en fonction des scores suivants : élevée (2), modérée (1) ou faible (0). La prévalence de scores élevés, soit une meilleure SCV tout au long de la vie, a été comparée entre les pays. Résultats: Parmi 28 092 adultes (Éthiopie, n = 7 686, 55,2 % de sexe masculin; Bangladesh, n = 6 731, 48,4 % de sexe masculin; Brésil, n = 7 241, 47,9 % de sexe masculin; Angleterre, n = 2 691, 49,5 % de sexe masculin, et États-Unis, n = 3 743, 50,3 % de sexe masculin), la prévalence de scores correspondant à une SCV élevée diminuait à mesure que le niveau de revenu du pays augmentait. La diminution de la SCV avec l’âge était universelle dans tous les pays, mais des différences étaient déjà observables chez les personnes âgées de 18 ans. Un surplus de poids corporel semblait être le principal facteur d’une faible SCV dans les pays à revenu plus élevé; la prévalence d’un tabagisme actuel était la plus élevée au Bangladesh. Conclusions: Nos observations laissent croire que le déclin de la SCV avec l’âge pourrait être universel. Il est nécessaire de mener des interventions adaptées à la progression du déclin dans chacun des pays en vue de favoriser et de préserver la SCV tout au long de la vie, et ce, dans toutes les populations. Dans les pays où le niveau de SCV demeure relativement élevé, il pourrait être encore possible de protéger des sociétés entières contre des épidémies liées aux facteurs de risque.

Background: Clinical evidence suggests that anemia exacerbates traumatic bleeding and worsens outcomes. Objectives: To study the influence of iron deficiency anemia on traumatic bleeding, coagulopathy, and mortality. Methods: C57BL/6J mice received an iron-deficient diet (8 weeks; ±1 mg intraperitoneal iron dextran 2 weeks before trauma). Control mice received a normal diet. Iron deficiency anemia was confirmed by hematocrit, red cell indices, and liver iron. Mice received saline or tranexamic acid (TXA; 10 mg/kg) just before liver laceration. Blood loss, coagulopathy (activated partial thromboplastin time, factor [F]II, FV, FVIII, FX, and fibrinogen), D-dimer, thrombin-antithrombin complexes, and plasmin-alpha-2-antiplasmin complexes were analyzed at 15 and 60 minutes, and a cytokine panel was performed at 60 minutes and 6 hours after trauma. Survival was monitored for 7 days. Results: Compared with nonanemic mice, anemic mice had lower hematocrit and hepatic iron content. Anemic mice experienced higher blood loss compared with nonanemic mice, which was reduced by TXA. Both groups developed traumatic coagulopathy characterized by activated partial thromboplastin time prolongation, thrombin-antithrombin complex formation, and depletion of FV, FVIII, and fibrinogen. TXA corrected the coagulopathy. However, plasmin-alpha-2-antiplasmin complex formation and D-dimers, markers of fibrinolysis, were higher in anemic mice and were not corrected by TXA. Seven-day survival was low in anemic mice, and rescued by TXA, but high in nonanemic mice without additional improvement by TXA. Among cytokines, only interleukin-6 increased, which was prevented by TXA most notably in anemic mice. Conclusion: These observations provide first and critical proof-of-principle evidence that anemia accelerates traumatic bleeding and increases mortality, which could be rescued by anemia correction (parenteral iron) or periprocedural TXA.

Objectives To investigate the physiological and perceptual responses to wearing a dryrobe for rewarming after passive cold-water immersion (CWI).Methods 15 unhabituated healthy Caucasian men (age: 28.9 (5.4) years) attended the laboratory on three occasions and performed passive CWI (14°C) for 30 min followed by 15 min of rewarming wearing either a dryrobe, towel or foil blanket while positioned in front of fans replicating a 10 mph wind. Physiological (deep body temperature, skin temperature and heart rate) and perceptual (thermal sensation and thermal comfort) variables were measured.Results At 15 min post-immersion, deep body temperature was higher in the dryrobe condition (mean: 37.09 (SD: 0.49)°C) compared with the foil blanket (36.98 (0.64)°C) and towel (36.99 (0.49)°C) (p

Abstract Introduction There is currently limited guidance for researchers on Patient and Public Involvement (PPI) for preclinical spinal cord research, leading to uncertainty about design and implementation. This study aimed to develop evidence‐informed principles to support preclinical spinal cord researchers to incorporate PPI into their research. Methods This study used a modified Delphi method with the aim of establishing consensus on a set of principles for PPI in spinal cord research. Thirty‐eight stakeholders including researchers, clinicians and people living with spinal cord injury took part in the expert panel. Participants were asked to rate their agreement with a series of statements relating to PPI in preclinical spinal cord research over two rounds. As part of Round 2, they were also asked to rate statements as essential or desirable. Results Thirty‐eight statements were included in Round 1, after which five statements were amended and two additional statements were added. After Round 2, consensus (> 75% agreement) was reached for a total of 27 principles, with 13 rated as essential and 14 rated as desirable. The principles with highest agreement related to diversity in representation among PPI contributors, clarity of the purpose of PPI and effective communication. Conclusion This research developed a previously unavailable set of evidence‐informed principles to inform PPI in preclinical spinal cord research. These principles provide guidance for researchers seeking to conduct PPI in preclinical spinal cord research and may also inform PPI in other preclinical disciplines. Patient and Public Involvement Statement This study was conducted as part of a project aiming to develop PPI in preclinical spinal cord injury research associated with an ongoing research collaboration funded by the Irish Rugby Football Union Charitable Trust (IRFU CT) and the Science Foundation Ireland Centre for Advanced Materials and BioEngineering Research (SFI AMBER), with research conducted by the Tissue Engineering Research Group (TERG) at the RCSI University of Medicine and Health Sciences. The project aims to develop an advanced biomaterials platform for spinal cord repair and includes a PPI Advisory Panel comprising researchers, clinicians and seriously injured rugby players to oversee the work of the project. PPI is included in this study through the involvement of members of the PPI Advisory Panel in the conceptualisation of this research, review of findings, identification of key points for discussion and preparation of the study manuscript as co‐authors.

The global SARS-CoV-2 monitoring effort has been extensive, resulting in many states and countries establishing wastewater-based epidemiology programs to address the spread of the virus during the pandemic. Challenges for programs include concurrently optimizing methods, training new laboratories, and implementing successful surveillance programs that can rapidly translate results for public health, and policy making. Surveillance in Michigan early in the pandemic in 2020 highlights the importance of quality-controlled data and explores correlations with wastewater and clinical case data aggregated at the state level. The lessons learned and potential measures to improve public utilization of results are discussed.The Michigan Network for Environmental Health and Technology (MiNET) established a network of laboratories that partnered with local health departments, universities, wastewater treatment plants (WWTPs) and other stakeholders to monitor SARS-CoV-2 in wastewater at 214 sites in Michigan. MiNET consisted of nineteen laboratories, twenty-nine local health departments, 6 Native American tribes, and 60 WWTPs monitoring sites representing 45 % of Michigan's population from April 6 and December 29, 2020. Three result datasets were created based on quality control criteria. Wastewater results that met all quality assurance criteria (Dataset Mp) produced strongest correlations with reported clinical cases at 16 days lag (rho = 0.866, p < 0.05).The project demonstrated the ability to successfully track SARS-CoV-2 on a large, state-wide scale, particularly data that met the outlined quality criteria and provided an early warning of increasing COVID-19 cases. MiNET is currently poised to leverage its competency to complement public health surveillance networks through environmental monitoring for new and emerging pathogens of concern and provides a valuable resource to state and federal agencies to support future responses.

Abstract Background Total knee arthroplasty is a common surgery for end-stage knee osteoarthritis. Partial knee arthroplasty is also a treatment option for patients with arthritis present in only one or two knee compartments. Partial knee arthroplasty can preserve the natural knee biomechanics, but these replacements may not last as long as total knee replacements. Robotic-assisted orthopedic techniques can help facilitate partial knee replacements, increasing accuracy and precision. This trial will investigate the feasibility and assess clinical outcomes for a larger definitive trial. Methods This is a protocol for an ongoing parallel randomized pilot trial of 64 patients with uni- or bicompartmental knee arthritis. Patients are randomized to either receive robot-assisted partial knee arthroplasty or manual total knee arthroplasty. The primary outcome of this pilot is investigating the feasibility of a larger trial. Secondary (clinical) outcomes include joint awareness, return to activities, knee function, patient global impression of change, persistent post-surgical pain, re-operations, resource utilization and cost-effectiveness, health-related quality of life, radiographic alignment, knee kinematics during walking gait, and complications up to 24 months post-surgery. Discussion The RoboKnees pilot study is the first step in determining the outcome of robot-assisted partial knee replacements. Conclusions from this study will be used to design future large-scale trials. This study will inform surgeons about the potential benefits of robot-assisted partial knee replacements. Trial registration This study was prospectively registered on clinicaltrials.gov (identifier: NCT04378049) on 4 May 2020, before the first patient was randomized.

This study evaluates tropospheric columns of methane, carbon monoxide, and ozone in the Arctic simulated by 11 models. The Arctic is warming at nearly 4 times the global average rate, and with changing emissions in and near the region, it is important to understand Arctic atmospheric composition and how it is changing. Both measurements and modelling of air pollution in the Arctic are difficult, making model validation with local measurements valuable. Evaluations are performed using data from five high-latitude ground-based Fourier transform infrared (FTIR) spectrometers in the Network for the Detection of Atmospheric Composition Change (NDACC). The models were selected as part of the 2021 Arctic Monitoring and Assessment Programme (AMAP) report on short-lived climate forcers. This work augments the model–measurement comparisons presented in that report by including a new data source: column-integrated FTIR measurements, whose spatial and temporal footprint is more representative of the free troposphere than in situ and satellite measurements. Mixing ratios of trace gases are modelled at 3-hourly intervals by CESM, CMAM, DEHM, EMEP MSC-W, GEM-MACH, GEOS-Chem, MATCH, MATCH-SALSA, MRI-ESM2, UKESM1, and WRF-Chem for the years 2008, 2009, 2014, and 2015. The comparisons focus on the troposphere (0–7 km partial columns) at Eureka, Canada; Thule, Greenland; Ny Ålesund, Norway; Kiruna, Sweden; and Harestua, Norway. Overall, the models are biased low in the tropospheric column, on average by −9.7 % for CH4, −21 % for CO, and −18 % for O3. Results for CH4 are relatively consistent across the 4 years, whereas CO has a maximum negative bias in the spring and minimum in the summer and O3 has a maximum difference centered around the summer. The average differences for the models are within the FTIR uncertainties for approximately 15 % of the model–location comparisons.

Abstract Background The HEARTS technical package was developed by the World Health Organization to address the implementation gap in cardiovascular disease prevention in low- and middle-income countries. Guatemala is a middle-income country that is currently implementing HEARTS. National authorities in Guatemala are interested in exploring how hypertension and diabetes management can be integrated in HEARTS implementation. The objective of this study is to conduct a feasibility and acceptability pilot trial of integrated hypertension and diabetes management based on HEARTS in the publicly funded primary care system in Guatemala. Methods A single-arm pilot trial for 6 months will be carried out in 11 Ministry of Health primary care facilities starting in September 2023. A planned sample of 100 adult patients diagnosed with diabetes (n = 45), hypertension (n = 45), or both (n = 10) will be enrolled. The intervention will consist of HEARTS-aligned components: Training health workers on healthy-lifestyle counseling and evidence-based treatment protocols, strengthening access to medications and diagnostics, training on risk-based cardiovascular disease management, team-based care and task sharing, and systems monitoring and feedback, including implementation of a facility-based electronic monitoring tool at the individual level. Co-primary outcomes of feasibility and acceptability will be assessed using an explanatory sequential mixed-methods design. Secondary outcomes include clinical effectiveness (treatment with medication, glycemic control, and blood pressure control), key implementation outcomes (adoption, fidelity, usability, and sustainability), and patient-reported outcome measures (diabetes distress, disability, and treatment burden). Using an implementation mapping approach, a Technical Advisory Committee will develop implementation strategies for subsequent scale-up planning. Discussion This trial will produce evidence on implementing HEARTS-aligned hypertension and diabetes care in the MOH primary care system in Guatemala. Results also will inform future HEARTS projects in Guatemala and other low- and middle-income countries. Trial registration ClinicalTrials.gov ID NCT06080451. The trial was prospectively registered on October 12, 2023.