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Increased exercise is a marker of health in fibromyalgia (FM). However, patients frequently avoid physical activity as a way of minimizing the pain they feel. This deprives them of opportunities to obtain positive reinforcement, increasing functional impact.This study examines the mediating role of depressive symptoms between walking (as physical exercise), functional impact, and pain, at different levels of positive affect (PA) among women with fibromyalgia.Cross-sectional correlational study.Mutual aid associations for fibromyalgia in Spain.231 women diagnosed with FM.Moderate mediation analyses were conducted using PROCESS.First, a simple mediation model showed that depression mediated the effect of walking on functional impact, but not on pain. Additionally, the moderated mediated model showed that this effect was significant at medium and high levels of PA, but not when levels of PA were low.Provision of resources focused on positive affect seem to increase the positive effects of walking on functional impact through the reduction of depressive symptoms. Nurses can improve adherence of patients with FM to walking behavior through increasing positive affect.

Despite the availability of effective vaccines against COVID-19, booster vaccinations are needed to maintain vaccine-induced protection against variant strains and breakthrough infections. This study aimed to investigate the efficacy, safety, and immunogenicity of the Ad26.COV2.S vaccine (Janssen) as primary vaccination plus a booster dose.ENSEMBLE2 is a randomised, double-blind, placebo-controlled, phase 3 trial including crossover vaccination after emergency authorisation of COVID-19 vaccines. Adults aged at least 18 years without previous COVID-19 vaccination at public and private medical practices and hospitals in Belgium, Brazil, Colombia, France, Germany, the Philippines, South Africa, Spain, the UK, and the USA were randomly assigned 1:1 via a computer algorithm to receive intramuscularly administered Ad26.COV2.S as a primary dose plus a booster dose at 2 months or two placebo injections 2 months apart. The primary endpoint was vaccine efficacy against the first occurrence of molecularly confirmed moderate to severe-critical COVID-19 with onset at least 14 days after booster vaccination, which was assessed in participants who received two doses of vaccine or placebo, were negative for SARS-CoV-2 by PCR at baseline and on serology at baseline and day 71, had no major protocol deviations, and were at risk of COVID-19 (ie, had no PCR-positive result or discontinued the study before day 71). Safety was assessed in all participants; reactogenicity, in terms of solicited local and systemic adverse events, was assessed as a secondary endpoint in a safety subset (approximately 6000 randomly selected participants). The trial is registered with ClinicalTrials.gov, NCT04614948, and is ongoing.Enrolment began on Nov 16, 2020, and the primary analysis data cutoff was June 25, 2021. From 34 571 participants screened, the double-blind phase enrolled 31 300 participants, 14 492 of whom received two doses (7484 in the Ad26.COV2.S group and 7008 in the placebo group) and 11 639 of whom were eligible for inclusion in the assessment of the primary endpoint (6024 in the Ad26.COV2.S group and 5615 in the placebo group). The median (IQR) follow-up post-booster vaccination was 36·0 (15·0-62·0) days. Vaccine efficacy was 75·2% (adjusted 95% CI 54·6-87·3) against moderate to severe-critical COVID-19 (14 cases in the Ad26.COV2.S group and 52 cases in the placebo group). Most cases were due to the variants alpha (B.1.1.7) and mu (B.1.621); endpoints for the primary analysis accrued from Nov 16, 2020, to June 25, 2021, before the global dominance of delta (B.1.617.2) or omicron (B.1.1.529). The booster vaccine exhibited an acceptable safety profile. The overall frequencies of solicited local and systemic adverse events (evaluated in the safety subset, n=6067) were higher among vaccine recipients than placebo recipients after the primary and booster doses. The frequency of solicited adverse events in the Ad26.COV2.S group were similar following the primary and booster vaccinations (local adverse events, 1676 [55·6%] of 3015 vs 896 [57·5%] of 1559, respectively; systemic adverse events, 1764 [58·5%] of 3015 vs 821 [52·7%] of 1559, respectively). Solicited adverse events were transient and mostly grade 1-2 in severity.A homologous Ad26.COV2.S booster administered 2 months after primary single-dose vaccination in adults had an acceptable safety profile and was efficacious against moderate to severe-critical COVID-19. Studies assessing efficacy against newer variants and with longer follow-up are needed.Janssen ResearchDevelopment.

The explanatory capacity of interpretable fuzzy rule-based classifiers is usually limited to offering explanations for the predicted class only. A lack of potentially useful explanations for non-predicted alternatives can be overcome by designing methods for the so-called counterfactual reasoning. Nevertheless, state-of-the-art methods for counterfactual explanation generation require special attention to human evaluation aspects, as the final decision upon the classification under consideration is left for the end user. In this paper, we first introduce novel methods for qualitative and quantitative counterfactual explanation generation. Then, we carry out a comparative analysis of qualitative explanation generation methods operating on (combinations of) linguistic terms as well as a quantitative method suggesting precise changes in feature values. Then, we propose a new metric for assessing the perceived complexity of the generated explanations. Further, we design and carry out two human evaluation experiments to assess the explanatory power of the aforementioned methods. As a major result, we show that the estimated explanation complexity correlates well with the informativeness, relevance, and readability of explanations perceived by the targeted study participants. This fact opens the door to using the new automatic complexity metric for guiding multi-objective evolutionary explainable fuzzy modeling in the near future Ilia Stepin is an FPI researcher (grant PRE2019-090153). Jose M. Alonso-Moral is a Ramon y Cajal researcher (grant RYC-2016–19802). This work was supported by the Spanish Ministry of Science and Innovation (grants RTI2018-099646-B-I00, PID2021-123152OB-C21, and TED2021-130295B-C33) and the Galician Ministry of Culture, Education, Professional Training and University (grants ED431F2018/02, ED431G2019/04, and ED431C2022/19). All the grants were co-funded by the European Regional Development Fund (ERDF/FEDER program). SI

Tongue base and hypopharynx are the major sites of obstruction in OSA patients with failed palatal surgery. In recent years, several minimally invasive procedures have been developed to address tongue base obstruction. However, the research focus has consistently been on the effectiveness of surgery in reducing obstructive sleep apnoea rather than on postoperative complications. In this systematic review and metanalysis we aim to review the complication rate of minimally invasive base of tongue procedures for OSAS in adults.PubMed (Medline), the Cochrane Library, EMBASE, Scopus, SciELO and Trip Database.Data sources were checked by three authors of the YO-IFOS sleep apnoea study group. Three authors extracted the data. Main outcome was expressed as the complication rate and 95% confidence interval for each surgical technique.20 studies (542 patients) met the inclusion criteria. The mean complication rate is 12.79%; 4.65% for minor complications, 6.42% if they are moderate, and 1.77% if severe. The most reported complication overall is infection, in 1.95% of cases, followed by transient swallowing disorder, occurring in 1.30% of the total sample.The heterogeneity amongst the included studies prevents us from obtaining solid conclusions. The available evidence suggests that minimally invasive base of tongue procedures may present a wide spectrum of complication rates, ranging from 4.4% in tongue base radiofrequency to up to 42.42% in tongue base ablation.

International audience; Le syndrome de Kleine-Levin est un trouble neuropsychiatrique appartenant à la catégorie des hypersomnies d’origine centrale. Sa prévalence est estimée à 1 à 5 cas par million d’habitant. Il débute électivement au moment de la puberté (85 % des cas se déclarent au cours de la deuxième décennie). La clinique se caractérise par la survenue d’épisodes d’hypersomnie récurrents d’une durée de quelques jours à plusieurs semaines, associée à des symptômes neurologiques, psychiatriques ou comportementaux. Ce polymorphisme clinique peut être trompeur en présence de symptômes psychiatriques « bruyants » et retarder le diagnostic et le traitement. La cause du syndrome est encore inconnue : des hypothèses auto-immune, inflammatoire ou génétique ont été avancées. La prise en charge consiste à éviter l’alcool, les infections et le manque de sommeil, à utiliser des corticoïdes en crise et du lithium ou du valproate en prévention. Nous présentons le parcours de soins d’un adolescent de 15 ans, qui illustre l’intrication des symptômes neurologiques et psychiatriques et la nécessité de connaître cette sémiologie aux confins de la neuropsychiatrie qui fera éviter des parcours diagnostiques chaotiques.

This paper presents a high power monocycle generator for Radar Sensor detection in IoT application. The generator was made up of three essential parts-circuits, an avalanche transistor, an Step Recovery Diode (SRD) pulse sharping and an Monocycle Forming Network (MFN). The main idea in this work is to generate a high power monocycle pulse with a minimum of ringing in the output waveform. To overcome this challenge, a useful technique consists of introducing a twice stage of the transistor after the triggering with an overvoltage. The measurement results give an output waveform of 2.3 volts in amplitude with a minimum ringing around 3.6% in overshoot at 1 MHz, which is nearly fourfold of the peak power produced by a single transistor. The generator circuit is completely fabricated using microstrip structure technology characteristics. Good agreements between the measured and theoretical results are achieved which can consider very attractive in many application fields.

Many viruses employ ATP-powered motors for genome packaging. We combined genetic, biochemical, and single-molecule techniques to confirm the predicted Walker-B ATP-binding motif in the phage λ motor and to investigate the roles of the conserved residues. Most changes of the conserved hydrophobic residues resulted in > 107-fold decrease in phage yield, but we identified nine mutants with partial activity. Several were cold-sensitive, suggesting that mobility of the residues is important. Single-molecule measurements showed that the partially active A175L exhibits a small reduction in motor velocity and increase in slipping, consistent with a slowed ATP binding transition, whereas G176S exhibits decreased slipping, consistent with an accelerated transition. All changes to the conserved D178, predicted to coordinate Mg2+•ATP, were lethal except conservative change D178E. Biochemical interrogation of the inactive D178N protein found no folding or assembly defects and near-normal endonuclease activity, but a ∼ 200-fold reduction in steady-state ATPase activity, a lag in the single-turnover ATPase time course, and no DNA packaging, consistent with a critical role in ATP-coupled DNA translocation. Molecular dynamics simulations of related enzymes suggest that the aspartate plays an important role in enhancing the catalytic activity of the motor by bridging the Walker motifs and precisely contributing its charged group to help polarize the bound nucleotide. Supporting this prediction, single-molecule measurements revealed that change D178E reduces motor velocity without increasing slipping, consistent with a slowed hydrolysis step. Our studies thus illuminate the mechanistic roles of Walker-B residues in ATP binding, hydrolysis, and DNA translocation by this powerful motor.

The skull base is a part of the neuro-cranium formed by endochondral ossification. The embryological origin of the skull base is not perfectly known, but there seems to be an anterior region derived from the neural crest and a posterior part derived from the mesoderm. Further studies are needed to define reliable presumptive maps. The origin of the different components of the occipital bone is just as poorly known. Much fundamental work remains to be done to suggest any solution to these problems in humans.

Background and objective Hip dysplasia has been associated with risk factors such as breech presentation, female gender or family history. However, external factors, such as the use of baby carriers, seem to influence the development of the hip in the first months of life. The aim of this study is to evaluate the position of the hips of babies placed in different types of baby carriers by ultrasound image. Method An ultrasound study of the hips of healthy babies between 1.5 and 3.5 months of age was carried out, when the children were carried in three different baby backpacks, which provide different degrees of support for the babies’ thighs. All hips were type I according to the Graf classification. Graf's alpha angle, acetabular coverage and distance to the pubis were assessed at baseline (examination table) and when the children were carried in the three different backpacks. Results In all cases, the babies showed normal values in the three studied parameters, without statistically significant differences between any of the situations. There were also no differences in the ultrasound parameters related to the sex, age or weight of the baby. Conclusions The right hip of the babies shows normal ultrasound parameters when placed in any of the baby carriers studied.

Resumen Antecedentes y objetivo La displasia de cadera se ha asociado con factores de riesgo como la presentacion de nalgas, el sexo femenino o los antecedentes familiares. Sin embargo, factores externos, como los sistemas de porteo, parecen influir en el desarrollo de la cadera en los primeros meses de vida. El objetivo del presente trabajo es valorar por imagen ecografica la posicion de las caderas en bebes colocados en diferentes tipos de mochilas portabebes. Metodo Se ha realizado un estudio ecografico de las caderas de bebes sanos entre 1,5 y 3,5 meses de edad, cuando el nino es porteado en tres diferentes mochilas portabebes que proporcionan diferentes grados de sujecion de los muslos del bebe. Todas las caderas eran tipo I de Graf. Se han valorado tres parametros ecograficos: el angulo alfa de Graf, la cobertura acetabular y la distancia a pubis en situacion basal (mesa de exploracion) y en las tres diferentes mochilas de porteo. Resultados En todos los casos los bebes mostraron valores de normalidad en los tres parametros estudiados, sin diferencias estadisticamente significativas entre ninguna de las situaciones. Tampoco se encontraron diferencias en los parametros ecograficos relacionadas con el sexo, la edad o el peso del bebe. Conclusiones La cadera derecha del bebe mantiene unos parametros ecograficos de normalidad cuando es colocada en cualquiera de los modelos de mochila estudiados.