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Summary: While neurostimulation technologies are rapidly approaching clinical applications for sensorimotor disorders, the impact of electrical stimulation on network dynamics is still unknown. Given the high degree of shared processing in neural structures, it is critical to understand if neurostimulation affects functions that are related to, but not targeted by, the intervention. Here, we approach this question by studying the effects of electrical stimulation of cutaneous afferents on unrelated processing of proprioceptive inputs. We recorded intraspinal neural activity in four monkeys while generating proprioceptive inputs from the radial nerve. We then applied continuous stimulation to the radial nerve cutaneous branch and quantified the impact of the stimulation on spinal processing of proprioceptive inputs via neural population dynamics. Proprioceptive pulses consistently produce neural trajectories that are disrupted by concurrent cutaneous stimulation. This disruption propagates to the somatosensory cortex, suggesting that electrical stimulation can perturb natural information processing across the neural axis.

Introduction: Boerhaave syndrome is a rare condition associated with high morbidity and mortality. Prompt intervention greatly improves outcomes, with surgery traditionally being the mainstay of management. Recent advances in therapeutic endoscopy have led to increasing interest in endoluminal vacuum therapy (EVT), a minimally invasive technique, allowing wound debridement and drainage, encouraging granulation tissue formation. EVT has been associated with positive clinical outcomes, including lower mortality rates compared to surgery and stenting for the management of anastomotic leaks, and to a lesser extent, oesophageal perforations. EVT has been adopted into practice across Europe; however, only few cases have been reported from the UK. Case Presentations: We report three cases of Boerhaave syndrome, successfully managed with EVT, using the Eso-SPONGE ® (B.Braun Medical Ltd, Sheffield, UK). EVT involves the placement of a polyurethane sponge into the wound cavity. The cavity is initially assessed, then an overtube is introduced through which the sponge is inserted, and then the overtube is removed. Sponge position is confirmed and adjusted if necessary. The sponge is connected via a trans-nasal drain to continuous negative pressure suction and is changed every 3–5 days. Having been deemed surgically unfit, all 3 patients were referred for EVT. All patients made excellent recovery and were discharged home. Conclusion: EVT is an effective management strategy for surgically unfit Boerhaave syndrome patients. Eso-SPONGE use aided drainage of the septic focus and closure of the defect, leading to complete recovery. Our findings support the existing evidence that EVT is a promising solution for Boerhaave syndrome.

This paper challenges the simplified binary division of suppliers of goods and services into market or state categories and identifies the continued relevance of household, community, and third-sector provision in rural areas. We explain the emergence, survival, and development of place-based and collaborative action using a three-fold typology, reflecting differences in the motivations and rationales for providing goods and services in these ways. In a place-based context, some communities have acted collectively using collaborative agency. Many observers of rural community development have suggested that place-based communitarian action may be unable to break free from class-based controls, but this is contested by some compelling examples. Where supported by effective public policy, place-based communitarianism can offer an alternative mode of provision for a wide range of services. Using Scotland as an example, this paper explores the dynamics of interactions between community and policy actors in land acquisition and management, renewable energy, and social care.

Abstract Genetic support for a drug target has been shown to increase the probability of success in drug development, with the potential to reduce attrition in the pharmaceutical industry alongside discovering novel therapeutic targets. It is therefore important to maximise the detection of genetic associations that affect disease susceptibility. Conventional statistical methods such as genome-wide association studies (GWAS) only identify some of the genetic contribution to disease, so novel analytical approaches are required to extract additional insights. C4X Discovery has developed Taxonomy3, a unique method for analysing genetic datasets based on mathematics that is novel in drug discovery. When applied to a previously published rheumatoid arthritis GWAS dataset, Taxonomy3 identified many additional novel genetic signals associated with this autoimmune disease. Follow-up studies using tool compounds support the utility of the method in identifying novel biology and tractable drug targets with genetic support for further investigation.

Introduction: The seemingly inexorable rise of opioid-related overdose deaths despite the reduced number of COVID-19 pandemic deaths demands novel responses and partnerships in our public health system’s response. Addiction medicine is practiced in a broad range of siloed clinical environments that need to be included in addiction medicine training beyond the traditional fellowship programs. Our objective in this project was to implement a knowledge-based, live virtual training program that would provide clinicians and other healthcare professionals with an overview of addiction, substance use disorders (SUD), and clinical diagnosis and management of opioid use disorder (OUD). Methods: The Veterans Health Administration (VHA) Emergency Department Opioid Safety Initiative (ED OSI) offered a four-day course for healthcare professionals interested in gaining knowledge and practical skills to improve VHA-based SUD care. The course topics centered around the diagnosis and treatment of SUD, with a focus on OUD. Additionally, trainees received six months of support to develop addiction medicine treatment programs. Evaluations of the course were performed immediately after completion of the program and again at the six-month mark to assess its effectiveness. Results: A total of 56 clinicians and other healthcare professionals participated in the Addiction Scholars Program (ASP). The participants represented nine Veteran Integrated Service Networks and 21 different VHA medical facilities. Nearly 70% of participants completed the initial post-survey. Thirty-eight respondents (97.4%) felt the ASP series contained practical examples and useful information that could be applied in their work. Thirty-eight respondents (97.4%) felt the workshop series provided new information or insights into the diagnosis and treatment of SUD. Eleven capstone projects based on the information acquired during the ASP were funded (a total of $407,178). Twenty participants (35.7%) completed the six-month follow-up survey. Notably, 90% of respondents reported increased naloxone prescribing and 50% reported increased prescribing of buprenorphine to treat patients with OUD since completing the course. Conclusion: The ASP provided healthcare professionals with insight into managing SUD and equipped them with practical clinical skills. The students translated the information from the course to develop medication for opioid use disorder (M-OUD) programs at their home institutions.

Leptogenys is the most diverse genus of the ant subfamily Ponerinae and is widely distributed across the world’s tropical and subtropical regions. More than 40 species are known from the Oriental realm displaying a wide range of ecologies, although their life history traits remain poorly understood, and new species are frequently discovered. Here, a faunal review of the genus from Hong Kong SAR, southern China is provided. A total of nine species are recorded, with one new species, Leptogenys grohli Hamer, Lee & Guénard, sp. nov. described. Ecological and biogeographic information, including new information on reproductive modes for two species are provided with the ergatoids of L. binghamii Forel, 1900 and L. rufida Zhou et al., 2012 described. Additional records for five of these species within the neighbouring province of Guangdong are also provided. Finally, an illustrated key to species known from Hong Kong is presented, as well as notes on each species’ distribution, ecology, and behaviour. An updated provincial distributional checklist of the Leptogenys species of Mainland China and Taiwan is also supplied.

Abstract Distressing low sexual desire, termed Hypoactive Sexual Desire Disorder (HSDD), affects approximately 10% of women and 8% of men. In women, the ‘top-down’ theory of HSDD describes hyperactivity in higher-level cognitive brain regions, suppressing lower-level emotional/sexual brain areas. However, it is unknown how this neurofunctional disturbance compares to HSDD in men. To investigate this, we employed task-based functional MRI in 32 women and 32 men with HSDD to measure sexual-brain processing during sexual versus non-sexual videos, as well as psychometric questionnaires to assess sexual desire/arousal. We demonstrate that women had greater activation in higher-level and lower-level brain regions, compared to men. Indeed, women who had greater hypothalamic activation in response to sexual videos, reported higher psychometric scores in the evaluative (r = 0.55, P = 0.001), motivational (r = 0.56, P = 0.003), and physiological (r = 0.57, P = 0.0006) domains of sexual desire and arousal after watching the sexual videos in the scanner. By contrast, no similar correlations were observed in men. Taken together, this is the first direct comparison of the neural correlates of distressing low sexual desire between women and men. The data supports the ‘top-down’ theory of HSDD in women, whereas in men HSDD appears to be associated with different neurofunctional processes.

Abstract Objectives Haematopoietic stem cell transplant (HCT) is a cellular therapy that, whilst curative for a child's underlying disease, carries significant risk of mortality, including because of pulmonary complications. The aims of this study were to describe the burden of pulmonary complications post‐HCT in a cohort of Australian children and identify risk factors for the development of these complications. Methods Patients were identified from the HCT databases at two paediatric transplant centres in Australia. Medical records were reviewed, and demographics, HCT characteristics and pulmonary complications documented. Relative risk ratio was used to identify risk factors for developing pulmonary complications prior to first transplant episode, and survival analysis performed to determine hazard ratio. Results In total, 243 children underwent transplant during the study period, and pulmonary complications occurred in 48% (117/243) of children. Infectious complications were more common (55%) than non‐infective complications (18%) and 26% of patients developed both. Risk factors for the development of pulmonary complications included the following: diagnoses of MPAL (RR 2.16, P = 0.02), matched unrelated donor (RR1.34, P = 0.03), peripheral blood (RR 1.36, P = 0.028) or cord blood (RR 1.73, P = 0.012) as the stem cell source and pre‐existing lung disease (RR1.72, P

Abstract Background The ligamentum flavum (LF) degeneration is a critical factor in spinal stenosis, leading to nerve compression and pain. Even with new treatment options becoming available, it is vital to have a better understanding of LF degeneration to ensure the effectiveness of these treatments. Objective This study aimed to provide insight into LF degeneration by examining the connections between various aspects of LF degeneration, including histology, microstructure, chemical composition, and biomechanics. Method We analyzed 30 LF samples from 27 patients with lumbar vertebrae, employing magnetic resonance imaging (MRI) to link lumbar disc degeneration grades with fibrosis levels in the tissue. X‐ray diffraction (XRD) analysis assessed microstructural alterations in the LF matrix component due to degeneration progression. Instrumented nanoindentation combined with Raman spectroscopy explored the spatial microbiomechanical and biochemical characteristics of the LF's ventral and dorsal regions. Results Our outcomes revealed a clear association between the severity of LF fibrosis grades and increasing LF thickness. XRD analysis showed a rise in crystalline components and hydroxyapatite molecules with progressing degeneration. Raman spectroscopy detected changes in the ratio of phosphate, proteoglycan, and proline/hydroxyproline over the amide I band, indicating alterations in the extracellular matrix composition. Biomechanical testing demonstrated that LF tissue becomes stiffer and less extensible with increasing fibrosis. Discussion Notably, the micro‐spatial assessment revealed the dorsal side of the LF experiencing more significant mechanical stress, alongside more pronounced biochemical and biomechanical changes compared to the ventral side. Degeneration of the LF involves complex processes that affect tissue histology, chemical composition, and biomechanics. It is crucial to fully understand these changes to develop new and effective treatments for spinal stenosis. These findings can improve diagnostic accuracy, identify potential biomarkers and treatment targets, guide personalized treatment strategies, advance tissue engineering approaches, help make informed clinical decisions, and educate patients about LF degeneration.

Introduction The WHO estimates a gap of about 30% between the incident (10.6 million) and notified (7.5 million) cases of tuberculosis (TB). Combined with the growing recognition in prevalence surveys of the high proportion of cases identified who are asymptomatic or paucisymptomatic, these data underscore how current symptom screening approaches and use of diagnostic tests with suboptimal performance on sputum miss large numbers of cases. Thus, the development of sputum-free biomarker-based tests for diagnosis is becoming necessary, which the WHO has already identified as a priority for new TB diagnostics.The objective of this study is to evaluate a combination of exhaled breath condensate (EBC) samples and mycobacterial lipoarabinomannan (LAM) as point-of-care (POC) assays to identify TB patients.Methods and analysis This prospective diagnostic accuracy study is conducted at the TB Screening and Treatment Centre of International Center for Diarrhoeal Disease Research, Bangladesh, on a cohort of adults and adolescents >11 years of age. A total of 614 individuals with presumptive pulmonary TB based on TB signs, symptoms and radiography are being recruited from 28 August 2023. Spot sputum is collected for standard reference testing (L-J culture, GeneXpert MTB/Rif, acid-fast Bacilli microscopy) to fine-tune categorisation of TB disease status for each participant, defined as (1) definite TB (at least one positive standard reference test); (2) probable TB (not microbiologically confirmed but under TB treatment); (3) possible TB (no TB treatment but signs, symptoms and radiography suggestive of TB); (4) other respiratory disease (microbiologically not confirmed and no radiography presenting abnormalities compatible with TB); and (5) unknown (no microbiological evidence with normal/no TB abnormalities with radiography). Urine and EBC specimens will be subjected to LAM POC testing and biobanked for further investigation. Statistical analyses will include an assessment of diagnostic accuracy by constructing receiver operating curves and calculating sensitivity and specificity, as well as post-test probabilities.Ethics and dissemination The study protocol was approved by the Research Review Committee as well as the Ethical Review Committee of icddr,b and recorded under a protocol reference number, PR-2301. Results will be submitted to open-access peer-reviewed journals, presented at academic meetings, and shared with national and international policymaking bodies.

Objectives There is no agreed standard assessment of the minimum knowledge and skills that are required to provide healthcare to participants in individual or team sports. This study aims to develop a syllabus for the Faculty of Sport and Exercise Medicine (FSEM) Team Care Diploma examination. This will provide a recognised assessment of the minimum required skills and knowledge for healthcare professionals providing care in an individual and team sport environment.Methods A modified Delphi approach was used. A syllabus was developed by a purposeful selection of members of the FSEM, all of whom have significant team care experience. This was then reviewed by the Delphi expert panel who were team care practitioners with at least 5 years of experience. A two-round Delphi approach was used to develop a consensus.Results The expert panel consisted of 50 individuals, with 46 (92%) completing both rounds. Of the 447 learning objectives (LOs) proposed; 430 (96%) were accepted outright, 17 (4%) were rejected and four new LOs were introduced based on expert panel feedback. The final syllabus contained 434 LOs across 6 modules (clinical governance, safe and effective practice, interdisciplinary teamwork, specific athlete groups, specific health conditions and duties of the medical team).Conclusion This standardised syllabus will be used as the basis for the new FSEM Team Care Diploma examination which will aim to provide world-leading standardised assessment of the minimum skills and knowledge required for healthcare professionals across the multidisciplinary team providing care in individual and team sport.

ABSTRACT Lactococcus garvieae is a fish pathogen that can cause diseases in humans and cows. Two genetically related species, Lactococcus formosensis and Lactococcus petauri, may be misidentified as L. garvieae. It is unclear if these species differ in host specificity and virulence genes. This study analyzed the genomes of 120 L. petauri, 53 L. formosensis, and 39 L. garvieae isolates from various sources. The genetic diversity and virulence gene content of these isolates were compared. The results showed that 77 isolates previously reported as L. garvieae were actually L. formosensis or L. petauri. The distribution of the three species varied across different collection sources, with L. petauri being predominant in human infections, human fecal sources, and rainbow trout, while L. formosensis was more common in bovine isolates. The genetic diversity of isolates within each species was high and similar. Using a genomic clustering method, L. petauri, L. formosensis, and L. garvieae were divided into 45, 22, and 13 clusters, respectively. Most rainbow trout and human isolates of L. petauri belonged to different clusters, while L. formosensis isolates from bovine and human sources were also segregated into separate clusters. In L. garvieae, most human isolates were grouped into three clusters that also included isolates from food or other sources. Non-metric multidimensional scaling ordination revealed the differential association of 15 virulence genes, including 14 adherence genes and a bile salt hydrolase gene, with bacterial species and certain collection sources. In conclusion, this work provides evidence of host specificity among the three species.IMPORTANCELactococcus formosensis and Lactococcus petauri are two newly discovered bacteria, which are closely related to Lactococcus garvieae, a pathogen that affects farmed rainbow trout, as well as causes cow mastitis and human infections. It is unclear whether the three bacteria differ in their host preference and the presence of genes that contribute to the development of disease. This study shows that L. formosensis and L. petauri were commonly misidentified as L. garvieae. The three bacteria showed different distribution patterns across various sources. L. petauri was predominantly found in human infections and rainbow trout, while L. formosensis was more commonly detected in cow mastitis. Fifteen genes displayed a differential distribution among the three bacteria from certain sources, indicating a genetic basis for the observed host preference. This work indicates the importance of differentiating the three bacteria in diagnostic laboratories for surveillance and outbreak investigation purposes.

Summary: Background: Wound dressing is intended to provide a physical barrier from microorganisms. Spray dressing is convenient and can be applied to wounds of various contours. In July 2020, a cluster of four Burkholderia cepacia complex (BCC) exit site infections was identified among peritoneal dialysis patients in a regional hospital in Hong Kong. In response, our hospital infection control team conducted an epidemiologic investigation. Methods: We conducted a retrospective cohort study of peritoneal dialysis patients with culture-confirmed BCC exit site infections from January 2011 to July 2020. Outbreak investigations, including case finding, molecular typing and post-outbreak surveillance, were performed. Discussion: A substantial increase in BCC exit site infections has been observed since 2013, rising from 0.23 in 2012 to 1.09 episodes per 100 patient-year in 2015, with the number of cases in the first half of 2020 already surpassing the total from 2019. The potential source had been traced to a spray dressing introduced to exit site care in December 2012. Burkholderia cepacia complex was isolated from both the unopened and in-use sprays from the same lot. Multilocus sequence typing analysis confirmed their genetic relatedness. The spray dressing was subsequently removed from exit site care. Post-outbreak surveillance over two years showed a marked and sustained decrease in BCC exit site infection. Conclusion: Water-based spray dressing can be a source of BCC causing wound infections. The use of contaminated spray dressing, especially in chronic wounds with proximity to indwelling catheters, may pose an inherent risk to patients.

Camera-based object detection is widely used in safety-critical applications such as advanced driver assistance systems (ADAS) and autonomous vehicle research. Road infrastructure has been designed for human vision, so computer vision, with RGB cameras, is a vital source of semantic information from the environment. Sensors, such as LIDAR and RADAR, are also often utilized for these applications; however, cameras provide a higher spatial resolution and color information. The spatial frequency response (SFR), or sharpness of a camera, utilized in object detection systems must be sufficient to allow a detection algorithm to localize objects in the environment over its lifetime reliably. This study explores the relationship between object detection performance and SFR. Six state-of-the-art object detection models are evaluated with varying levels of lens defocus. A novel raw image dataset is created and utilized, containing pedestrians and cars over a range of distances up to 100-m from the sensor. Object detection performance for each defocused dataset is analyzed over a range of distances to determine the minimum SFR necessary in each case. Results show that the relationship between object detection performance and lens blur is much more complex than previous studies have found due to lens field curvature, chromatic aberration, and astigmatisms. We have found that smaller objects are disproportionately impacted by lens blur, and different object detection models have differing levels of robustness to lens blur.

Introduction/Purpose: Return to play (RTP) assessment and decision-making protocols are among the most discussed topics in sports medicine. Given the lack of validated guidelines, physicians and rehabilitation practitioners often rely on subjective functional evaluation to guide decisions to RTP. Biomechanical assessment using motion capture may be a useful strategy to evaluate an athlete’s post-injury functional status, and to estimate their ability to RTP with reduced risk of re-injury. The purpose of this case-study was to determine the efficacy of using marker-less 3D motion capture to provide an objective functional evaluation to tailor rehabilitation and aid RTP status for a patient who underwent syndesmotic fixation. Methods: In this case-study, a National Collegiate Athletic Association Division I collegiate football offensive lineman (Height: 1.96 m, Weight: 141 kg) performed a movement screen 5 weeks after left ankle syndesmotic fixation for purely ligamentous syndesmotic injury. Testing was performed at the anticipated time of RTP. After a standardized warm-up, the patient performed a series of 14 movements consisting of upper and lower extremity actions in all three planes of motion, including bilateral and unilateral lower extremity actions. Kinematic data was captured using an 8-camera marker-less motion capture system (MLMCS). Left and right joint-specific ranges of motion were compared for symmetry and to normative data produced by the MLMCS manufacturer. Results: The participant successfully performed all 14 movements without limitation. Ankle flexion was symmetrical during bilateral and unilateral squatting actions. However, left ankle (i.e., involved side) flexion was consistently less than right ankle flexion during more dynamic actions (Table 1). Despite the asymmetries, ankle range of motion was within normal ranges for both sides in all movements. From a performance standpoint, left-side jump heights were consistently less than the right-side efforts during the unilateral countermovement jump (left: 34.5 cm versus right: 41.1 cm; -16.0%) and consecutive hops (left: 29.5 cm versus right: 33.0 cm; -10.8%). Results were shared with the athletic trainer to focus rehabilitation efforts. The patient was able to fully RTP at 6 weeks. Conclusion: In this case-study, the patient successfully performed a movement screen without limitation at the time of RTP after left ankle syndesmotic fixation. A MLMCS detected kinematic differences that would be difficult to qualitatively recognize. Specifically, the patient expressed reduced ankle flexion and jumping performance on the operative side. No baseline screening was performed, but the observed asymmetries were consistent with what would be expected from the specific injury. Further research is needed to compare baseline measures to kinematic changes. These findings suggest that a basic movement screen using MLMCS can detect kinematic asymmetries after syndesmotic fixation. Table 1. Kinematic Assessment of Ankle Range of Motion

Summary: Looking at SRHR as an isolated set of elements, as is the current practice, does not do justice to the needs and rights of people and communities and may be one of the reasons why challenges remain in the attainment of SRHR for all. SRHR Infographic snapshots were developed for all 194 WHO Member States and included 120 indicators covering a broad range of policy, health systems and service delivery interventions. The snapshots were created using data less than 10 years old publicly available in data repositories maintained by international and global agencies. Data availability was not consistent across countries with low and lower-middle income countries having higher data availability (71%) compared to high income countries (40%). SRHR data that is easily accessible and consistently reported can improve accountability and opportunities for learning to improve people-centred approaches to accelerate the attainment of SRHR for all.

BackgroundResearch demonstrates sustained return to work (RTW) by individuals on medical leave is influenced by personal and job resources and job demands. Relatively few studies have been conducted in the workers’ compensation context that is known to have longer absence durations for RTW.AimsThis study sought to illuminate workers’ experience as they returned to work following a work injury that was either psychological in nature or involved more than 50 days of disability, with a focus on the co-worker, supervisor, and employer actions that supported their return.MethodsWorkers in Saskatchewan, Canada, with a work-related psychological or musculoskeletal injury, subsequent disability, and who returned to work in the last three years, were invited to complete an online survey comprising of free-text questions. Thematic analysis was used to explore participants’ experiences.ResultsResponses from 93 individuals were analysed. These revealed that persistent pain, emotional distress, and loss of normal abilities were present during and beyond returning to work. Almost two-thirds indicated that the supervisors’ and co-workers’ support was critical to a sustained return to work: their needs were recognized and they received autonomy and support to manage work demands. By contrast, one-third indicated that the support they expected and needed from supervisors and employers was lacking.ConclusionsWorkers returning to work lacked personal resources but co-workers’ and supervisors’ support helped improve confidence in their ability to RTW. Supervisors and employers should acknowledge workers’ experiences and offer support and autonomy. Likewise, workers can expect challenges when returning to work and may benefit from cultivating supportive relationships with co-workers and supervisors.

IntroductionNew diagnostic tools are needed to rapidly assess the efficacy of pulmonary tuberculosis (PTB) treatment. The aim of this study was to evaluate several immune biomarkers in an observational and cross-sectional cohort study conducted in Paraguay.MethodsThirty-two patients with clinically and microbiologically confirmed PTB were evaluated before starting treatment (T0), after 2 months of treatment (T1) and at the end of treatment (T2). At each timepoint plasma levels of IFN-y, 17 pro- and anti-inflammatory cytokines/chemokines and complement factors C1q, C3 and C4 were assessed in unstimulated and Mtb-specific stimulated whole blood samples using QuantiFERON-TB gold plus and recombinant Mycobacterium smegmatis heparin binding hemagglutinin (rmsHBHA) as stimulation antigen. Complete blood counts and liver enzyme assays were also evaluated and correlated with biomarker levels in plasma.ResultsIn unstimulated plasma, C1q (P

OBJECTIVES:. Inhaled volatile anesthetics support management of status asthmaticus (SA), status epilepticus (SE), and difficult sedation (DS). This study aimed to evaluate the effectiveness, safety, and feasibility of using inhaled anesthetics for SA, SE, and DS in adult ICU and PICU patients. DATA SOURCES:. MEDLINE, Cochrane Central Register of Controlled Trials, and Embase. STUDY SELECTION:. Primary literature search that reported the use of inhaled anesthetics in ventilated patients with SA, SE, and DS from 1970 to 2021. DATA EXTRACTION:. Study data points were extracted by two authors independently. Quality assessment was performed using the Joanna Briggs Institute appraisal tool for case studies/series, Newcastle criteria for cohort/case–control studies, and risk-of-bias framework for clinical trials. DATA SYNTHESIS:. Primary outcome was volatile efficacy in improving predefined clinical or physiologic endpoints. Secondary outcomes were adverse events and delivery logistics. From 4281 screened studies, the number of included studies/patients across diagnoses and patient groups were: SA (adult: 38/121, pediatric: 28/142), SE (adult: 18/37, pediatric: 5/10), and DS (adult: 21/355, pediatric: 10/90). Quality of evidence was low, consisting mainly of case reports and series. Clinical and physiologic improvement was seen within 1–2 hours of initiating volatiles, with variable efficacy across diagnoses and patient groups: SA (adult: 89–95%, pediatric: 80–97%), SE (adults: 54–100%, pediatric: 60–100%), and DS (adults: 60–90%, pediatric: 62–90%). Most common adverse events were cardiovascular, that is, hypotension and arrhythmias. Inhaled sedatives were commonly delivered using anesthesia machines for SA/SE and miniature vaporizers for DS. Few (10%) of studies reported required non-ICU personnel, and only 16% had ICU volatile delivery protocol. CONCLUSIONS:. Volatile anesthetics may provide effective treatment in patients with SA, SE, and DS scenarios but the quality of evidence is low. Higher-quality powered prospective studies of the efficacy and safety of using volatile anesthetics to manage SA, SE, and DS patients are required. Education regarding inhaled anesthetics and the protocolization of their use is needed.

The effect of helminthiasis on host immunity is a neglected area of research, particularly in tuberculosis (TB) infection. This study aimed to evaluate the effect of helminthiasis on immunological and haematological parameters in newly diagnosed TB patients in Bobo-Dioulasso. After all biological analyses, we formed three subpopulations: group 1 (n = 82), as control, were participants without helminthic or Mycobacterium tuberculosis complex infection (Mtb−/Helm−), group 2 (n = 73) were TB patients without helminthic infection (Mtb+/Helm−), and group 3 (n = 22) were TB patients with helminthic infection (Mtb+/Helm+). The proportion of helminth coinfection was 23.16% (22/95) in TB patients, and Schistosoma mansoni infection was found in 77.3% (17/22) cases of helminthiasis observed in this study. A low CD4 T cell count and a low CD4:CD8 ratio were significantly associated with concomitant infection with helminths and the Mtb complex (Mtb+/Helm+) compared to the other groups (p < 0.05). However, there was no statistically significant difference in the CD8 median among the three participating groups (p > 0.05). Lymphopenia, monocytosis, thrombocytosis, and hypochromic microcytic anaemia were the haematological defects observed in the Mtb+/Helm+ and Mtb+/Helm− patients. Exploring these types of immune–haematological biomarkers would be a valuable aid in diagnosing and a better follow-up and monitoring of the tuberculosis–helminthiasis coinfection.

The cross-hybridization of American chestnut (Castanea dentata (Marsh.) Borkh.) with Chinese chestnut (Castanea mollissima Bl.) is a promising strategy for restoring a blight-resistant strain of this keystone species to the Appalachian mountains. To assess the ecological impacts of hybridization on invertebrate communities, we conducted a study across chestnut plots with varying degrees of hybridization (75%, 94%, or 100% American chestnut). Our findings indicate American chestnut hybridization impacted invertebrate communities above- and belowground. Aboveground insect community composition, insect herbivory, gall infestation, and belowground invertebrate diversity were all altered. While some of these differences could be explained by different growth habits or environmental differences, stark differences in Asian chestnut gall wasp infestation (Dryocosmus kuriphilus Yasumatsu.) suggest a genetic component. These results suggest that chestnut hybridization, and particularly expanded restoration efforts using chestnut hybrids, could impact invertebrate communities above- and belowground in addition to pest dynamics. Understanding these effects is crucial for successful chestnut restoration and ecosystem management.

In recent years, significant advances have been made in the development of Advanced Driver Assistance Systems (ADAS) and other technology for autonomous vehicles. Automated object detection is a crucial component of autonomous driving; however, there are still known issues that affect its performance. For automotive applications, object detection algorithms are required to perform at a high standard in all lighting conditions; however, a major problem for object detection is poor performance in low-light conditions due to objects being less visible. This study considers the impact of training data composition on object detection performance in low-light conditions. In particular, this study evaluates the effect of different combinations of images of outdoor scenes, from different times of day, on the performance of deep neural networks, and considers the different challenges encountered during the training of a neural network. Through experiments with a widely used public database, as well as a number of commonly used object detection architectures, we show that more robust performance can be obtained with an appropriate balance of classes and illumination levels in the training data. The results also highlight the potential of adding images obtained in dusk and dawn conditions for improving object detection performance in day and night.

The generation of terahertz radiation via laser-induced plasma from two-color femtosecond pulses in air has been extensively studied due to its broad emission spectrum and significant pulse energy. However, precise control over the temporal properties of these ultra-broadband terahertz pulses, as well as the measurement of their polarization state, remain challenging. In this study, we review our latest findings on these topics and present additional results not previously reported in our earlier works. First, we investigate the impact of chirping on the fundamental wave and the effect of manipulating the phase difference between the fundamental wave and the second-harmonic wave on the properties of generated terahertz pulses. We demonstrate that we can tune the time shape of terahertz pulses, causing them to reverse polarity or become bipolar by carefully selecting the correct combination of chirp and phase. Additionally, we introduce a novel technique for polarization characterization, termed terahertz unipolar polarimetry, which utilizes a weak probe beam and avoids the systematic errors associated with traditional methods. This technique is effective for detecting polarization-structured terahertz beams and the longitudinal component of focused terahertz beams. Our findings contribute to the improved control and characterization of terahertz radiation, enhancing its application in fields such as nonlinear optics, spectroscopy, and microscopy.

We present a new analysis of the KELT-24 system, comprising a well-aligned hot Jupiter, KELT-24 b, and a bright ( V = 8.3), nearby ( d = 96.9 pc) F-type host star. KELT-24 b was independently discovered by two groups in 2019, with each reporting best-fit stellar parameters that were notably inconsistent. Here, we present three independent analyses of the KELT-24 system, each incorporating a broad range of photometric and spectroscopic data, including eight sectors of Transiting Exoplanet Survey Satellite (TESS) photometry and more than 200 new radial velocities (RVs) from the MINiature Exoplanet Radial Velocity Array. Two of these analyses use KELT-24's observed spectral energy distribution (SED) through a direct comparison to stellar evolutionary models, while our third analysis assumes an unknown additional body contributing to the observed broadband photometry and excludes the SED. Ultimately, we find that the models that include the SED are a poor fit to the available data, so we adopt the system parameters derived without it. We also highlight a single transit-like event observed by TESS, deemed likely to be an eclipsing binary bound to KELT-24, that will require follow-up observations to confirm. We discuss the potential of these additional bodies in the KELT-24 system as a possible explanation for the discrepancies between the results of the different modeling approaches, and explore the system for longer-period planets that may be weakly evident in the RV observations. The comprehensive investigations that we present not only increase the fidelity of our understanding of the KELT-24 system but also serve as a blueprint for future stellar modeling in global analyses of exoplanet systems.

Multiplanet systems exhibit a diversity of architectures that diverge from the solar system and contribute to the topic of exoplanet demographics. Radial velocity (RV) surveys form a crucial component of exoplanet surveys, as their long observational baselines allow for searches for more distant planetary orbits. This work provides a significantly revised architecture for the multiplanet system HD 134606 using both HARPS and UCLES RVs. We confirm the presence of previously reported planets b, c, and d with periods of ${12.0897}_{-0.0018}^{+0.0019}$ , ${58.947}_{-0.054}^{+0.056}$ , and ${958.7}_{-5.9}^{+6.3}$ days and masses of ${9.14}_{-0.63}^{+0.65}$ , 11.0 ± 1, and 44.5 ± 2.9 Earth masses, respectively, with the planet d orbit significantly revised to over double that originally reported. We report two newly detected super-Earths, e and f, with periods of ${4.31943}_{-0.00068}^{+0.00075}$ and ${26.9}_{-0.017}^{+0.019}$ days and masses of ${2.31}_{-0.35}^{+0.36}$ and ${5.52}_{-0.73}^{+0.74}$ Earth masses, respectively. In addition, we identify a linear trend in the RV time series, and the cause of this acceleration is deemed to be a newly detected massive companion with a very long orbital period. HD 134606 now displays four low-mass planets in a compact region near the star, one gas giant further out in the habitable zone, an additional companion in the outer regime, and a low-mass M dwarf stellar companion at large separation, making it an intriguing target for system formation/evolution studies. The location of planet d in the habitable zone proves to be an exciting candidate for future space-based direct imaging missions, whereas continued RV observations of this system are recommended for understanding the nature of the massive, long-period companion.

We present the discovery of TOI-1994b, a low-mass brown dwarf transiting a hot subgiant star on a moderately eccentric orbit. TOI-1994 has an effective temperature of ${7700}_{-410}^{+720}$ K, V magnitude of 10.51 mag and log( g ) of ${3.982}_{-0.065}^{+0.067}$ . The brown dwarf has a mass of ${22.1}_{-2.5}^{+2.6}$ M _J , a period of 4.034 days, an eccentricity of ${0.341}_{-0.059}^{+0.054}$ , and a radius of ${1.220}_{-0.071}^{+0.082}$ R _J . TOI-1994b is more eccentric than other transiting brown dwarfs with similar masses and periods. The population of low-mass brown dwarfs may have properties similar to planetary systems if they were formed in the same way, but the short orbital period and high eccentricity of TOI-1994b may contrast this theory. An evolved host provides a valuable opportunity to understand the influence stellar evolution has on the substellar companion’s fundamental properties. With precise age, mass, and radius, the global analysis and characterization of TOI-1994b augments the small number of transiting brown dwarfs and allows the testing of substellar evolution models.

Molecular emission from the galactic and extragalactic interstellar medium (ISM) is often used to determine the physical conditions of the dense gas. However, even from spatially resolved regions, the observed molecules do not necessarily arise from a single component. Disentangling multiple gas components is often a degenerate problem in radiative transfer studies. In this paper, we investigate the use of the nonnegative matrix factorization (NMF) approach as a means to recover gas components from a set of blended line intensity maps of molecular transitions that may trace different physical conditions. We run a series of experiments on synthetic data sets designed to replicate conditions in two very different environments: galactic pre-stellar cores and the ISM in high-redshift galaxies. We find that the NMF algorithm often recovers the multiple components resembling those used in the data-generating process, provided that the different components have similar column densities. When NMF fails to recover all the individual components it does however group together the most similarly emitting ones. We further found that initialization and regularisation are key factors in the efficiency of the NMF algorithm.

Abstract Chemotherapy induced ovarian failure and infertility is an important concern in female cancer patients of reproductive age or younger, and non-invasive, pharmacological approaches to maintain ovarian function are urgently needed. Given the role of reduced nicotinamide adenine dinucleotide phosphate (NADPH) as an essential cofactor for drug detoxification, we sought to test whether boosting the NAD(P)+ metabolome could protect ovarian function. We show that pharmacological or transgenic strategies to replenish the NAD+ metabolome ameliorates chemotherapy induced female infertility in mice, as measured by oocyte yield, follicle health, and functional breeding trials. Importantly, treatment of a triple-negative breast cancer mouse model with the NAD+ precursor nicotinamide mononucleotide (NMN) reduced tumour growth and did not impair the efficacy of chemotherapy drugs in vivo or in diverse cancer cell lines. Overall, these findings raise the possibility that NAD+ precursors could be a non-invasive strategy for maintaining ovarian function in cancer patients, with potential benefits in cancer therapy.