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Research Findings: Few studies address the contextual conditions for preschool staff in supporting children in preschool, especially in classrooms with high proportions of early second language learners (L2-learners). The aim of the study was to describe preschool staff's support of children's engagement in units with high proportions of L2-learners. In an exploratory mixed-methods approach, eleven interviews (11 units and 27 staff) were conducted, analyzed through content analysis. For the observations, 121 preschool staff (31 units) were added, and 594 children were observed (42 classrooms), analyzed through T-tests to investigate staff's contextual differences in units with high proportions (> 80%) of L2-learners (L2-groups) and child groups with high proportions (> 80%) of L1-learners. Content analysis revealed a main theme of "a commitment to establish relationships with the children while managing cultural values and norms." In interacting with children individually, the staff wanted to be close to the children and acknowledging them. In these aspects, no differences were found between staff between groups. Differences occurred in interaction with children in groups. Staff in L2-groups struggled with routines, mediating values and encouraging children learning from each other. Policy/practice: Staff in L2-groups need further encouragement from the organization to manage the needs of children in L2-groups without straining their commitments.

Sterol lipids are widely present in eukaryotes and play essential roles in signaling and modulating membrane fluidity. Although rare, some bacteria also produce sterols, but their function in bacteria is not known. Moreover, many more species, including pathogens and commensal microbes, acquire or modify sterols from eukaryotic hosts through poorly understood molecular mechanisms. The aerobic methanotroph Methylococcus capsulatus was the first bacterium shown to synthesize sterols, producing a mixture of C-4 methylated sterols that are distinct from those observed in eukaryotes. C-4 methylated sterols are synthesized in the cytosol and localized to the outer membrane, suggesting that a bacterial sterol transport machinery exists. Until now, the identity of such machinery remained a mystery. In this study, we identified three novel proteins that may be the first examples of transporters for bacterial sterol lipids. The proteins, which all belong to well-studied families of bacterial metabolite transporters, are predicted to reside in the inner membrane, periplasm, and outer membrane of M. capsulatus, and may work as a conduit to move modified sterols to the outer membrane. Quantitative analysis of ligand binding revealed their remarkable specificity for 4-methylsterols, and crystallographic structures coupled with docking and molecular dynamics simulations revealed the structural bases for substrate binding by two of the putative transporters. Their striking structural divergence from eukaryotic sterol transporters signals that they form a distinct sterol transport system within the bacterial domain. Finally, bioinformatics revealed the widespread presence of similar transporters in bacterial genomes, including in some pathogens that use host sterol lipids to construct their cell envelopes. The unique folds of these bacterial sterol binding proteins should now guide the discovery of other proteins that handle this essential metabolite.

Abstract Aim The aim of the study was to describe different eHealth literacy domains among parents of children needing paediatric surgery in Sweden, and the correlation between these eHealth literacy domains and parents' socioeconomic factors and demographic characteristics. Design Descriptive correlational design. Method Thirty‐five Swedish‐speaking parents participated as a historical control group within an ongoing Swedish clinical trial developing eHealth solutions for families after hospital care; of these, 30 completed the eHealth Literacy Questionnaire and the socioeconomic and demographic questionnaire. Results Of the seven eHealth literacy domains assessed, parents' strengths lay in those pertaining to their own digital competence, control and safety, while their weakness concerned their motivation to engage with digital services, and their ability to access eHealth platforms that work. Overall, parents presented adequate eHealth literacy. Of the five socioeconomic and demographic variables assessed (i.e. monthly wages, education levels, age, gender and residency), monthly wages correlated the strongest, and positively, with the seven eHealth literacy domains.

The DIII-D tokamak has elucidated crucial physics and developed projectable solutions for ITER and fusion power plants in the key areas of core performance, boundary heat and particle transport, and integrated scenario operation, with closing the core-edge integration knowledge gap being the overarching mission. New experimental validation of high-fidelity, multi-channel, non-linear gyrokinetic turbulent transport models for ITER provides strong confidence it will achieve Q ⩾ 10 operation. Experiments identify options for easing H-mode access in hydrogen, and give new insight into the isotopic dependence of transport and confinement. Analysis of 2,1 islands in unoptimized low-torque IBS demonstration discharges suggests their onset time occurs randomly in the constant β phase, most often triggered by non-linear 3-wave coupling, thus identifying an NTM seeding mechanism to avoid. Pure deuterium SPI for disruption mitigation is shown to provide favorable slow cooling, but poor core assimilation, suggesting paths for improved SPI on ITER. At the boundary, measured neutral density and ionization source fluxes are strongly poloidally asymmetric, implying a 2D treatment is needed to model pedestal fuelling. Detailed measurements of pedestal and SOL quantities and impurity charge state radiation in detached divertors has validated edge fluid modelling and new self-consistent ‘pedestal-to-divertor’ integrated modeling that can be used to optimize reactors. New feedback adaptive ELM control minimizes confinement reduction, and RMP ELM suppression with sustained high core performance was obtained for the first time with the outer strike point in a W-coated, compact and unpumped small-angle slot divertor. Advances have been made in integrated operational scenarios for ITER and power plants. Wide pedestal intrinsically ELM-free QH-modes are produced with more reactor-relevant conditions, Low torque IBS with W-equivalent radiators can exhibit predator-prey oscillations in T _e and radiation which need control. High- β _P scenarios with q _min > 2, q _95 –7.9, β _N > 4, β _T –3.3% and H _98y2 > 1.5 are sustained with high density ( $\bar n$ = 7E19 m ^−3 , f _G –1) for 6 τ _E , improving confidence in steady-state tokamak reactors. Diverted NT plasmas achieve high core performance with a non-ELMing edge, offering a possible highly attractive core-edge integration solution for reactors.

The objectives of NSTX-U research are to reinforce the advantages of STs while addressing the challenges. To extend confinement physics of low- A , high beta plasmas to lower collisionality levels, understanding of the transport mechanisms that set confinement performance and pedestal profiles is being advanced through gyrokinetic simulations, reduced model development, and comparison to NSTX experiment, as well as improved simulation of RF heating. To develop stable non-inductive scenarios needed for steady-state operation, various performance-limiting modes of instability were studied, including MHD, tearing modes, and energetic particle instabilities. Predictive tools were developed, covering disruptions, runaway electrons, equilibrium reconstruction, and control tools. To develop power and particle handling techniques to optimize plasma exhaust in high performance scenarios, innovative lithium-based solutions are being developed to handle the very high heat flux levels that the increased heating power and compact geometry of NSTX-U will produce, and will be seen in future STs. Predictive capabilities accounting for plasma phenomena, like edge harmonic oscillations, ELMs, and blobs, are being tested and improved. In these ways, NSTX-U researchers are advancing the physics understanding of ST plasmas to maximize the benefit that will be gained from further NSTX-U experiments and to increase confidence in projections to future devices.

Since the last IAEA-FEC in 2021, significant progress on the development of long pulse steady state scenario and its related key physics and technologies have been achieved, including the reproducible 403 s long-pulse steady-state H-mode plasma with pure radio frequency (RF) power heating. A thousand-second time scale (∼1056 s) fully non-inductive plasma with high injected energy up to 1.73 GJ has also been achieved. The EAST operational regime of high β _P has been significantly extended ( H _98y2 > 1.3, β _P ∼ 4.0, β _N ∼ 2.4 and n _e / n _GW ∼ 1.0) using RF and neutral beam injection (NBI). The full edge localized mode suppression using the n = 4 resonant magnetic perturbations has been achieved in ITER-like standard type-I ELMy H-mode plasmas with q _95 ≈ 3.1 on EAST, extrapolating favorably to the ITER baseline scenario. The sustained large ELM control and stable partial detachment have been achieved with Ne seeding. The underlying physics of plasma-beta effect for error field penetration, where toroidal effect dominates, is disclosed by comparing the results in cylindrical theory and MARS-Q simulation in EAST. Breakdown and plasma initiation at low toroidal electric fields (

Real-time magnetic control has been developed to deliver precise control of multiple plasma shape parameters for advanced divertor configurations, including double-null, Super-X, X-point target and X-divertor for the first time on the MAST Upgrade (MAST-U) spherical tokamak. Successful real-time magnetic equilibrium control of different plasma shape variables has been accomplished in the 2022–2023 MAST-U experimental campaign for the advanced MAST-U divertor configurations. Application of the MAST-U boundary reconstruction algorithm, LEMUR, is described and compared with off-line equilibrium reconstruction and diagnostic measurements. The process of design and verification of the axisymmetric magnetic control schemes using a suite of control analysis tools (known collectively as TokSys) is also described.

Evidence of a MHD dynamo brought about by intrinsic helical core structures in negative triangularity (NT) and ITER baseline scenario (IBS) plasmas demonstrates paths to operating tokamaks without seeds for deleterious global MHD modes. A stationary sawtooth- and edge localized mode-free state maintains high performance for long durations in a strong NT shape in the DIII-D tokamak. Disparity between minimum safety factor values predicted by magnetic flux diffusion theory and derived from experiment suggests anomalous flux diffusion by an MHD dynamo, driven by flows associated with quasi-interchange modes. Stability calculations with the GATO code find NT and IBS experimental equilibria unstable to quasi-interchange modes, in agreement with observed saturated activity. IBS discharges with similar magnetic winding structure occupy robust helical core states following a transition from sawtooth instabilities. These states agree with prior modeling of helical core bifurcation thresholds with the VMEC equilibrium code.

The cell membranes of many archaea contain characteristic membrane-spanning lipids known as glycerol dibiphytanyl glycerol tetraethers. Here, Zeng et al. identify a protein that participates in a key step of the synthesis of these lipids from diether precursors.

Abstract Background Prevention of child obesity is an international public health priority and believed to be effective when started in early childhood. Caregivers often ask for an early and structured response from health professionals when their child is identified with overweight, yet cost‐effective interventions for children aged 2–6 years and their caregivers in Child Health Services are lacking. Objectives To evaluate the effects and cost‐effectiveness of a child‐centered health dialogue in the Child Health Services in Sweden on 4‐year‐old children with normal weight and overweight. Methods Thirty‐seven Child Health Centers were randomly assigned to deliver intervention or usual care. The primary outcome was zBMI‐change. Results A total of 4598 children with normal weight (zBMI: 0.1 [SD = 0.6] and 490 children with overweight (zBMI: 1.6 [SD = 0.3]) (mean age: 4.1 years [SD = 0.1]; 49% females) were included. At follow‐up, at a mean age of 5.1 years [SD = 0.1], there was no intervention effect on zBMI‐change for children with normal weight. Children with overweight in the control group increased zBMI by 0.01 ± 0.50, while children in the intervention group decreased zBMI by 0.08 ± 0.52. The intervention effect on zBMI‐change for children with overweight was –0.11, with a 95% confidence interval of –0.24 to 0.01 (p = 0.07). The estimated additional costs of the Child‐Centered Health Dialogue for children with overweight were 167 euros per child with overweight and the incremental cost‐effectiveness ratio was 183 euros per 0.1 zBMI unit prevented. Conclusions This low‐intensive multicomponent child‐centered intervention for the primary prevention of child obesity did not show statistical significant effects on zBMI, but is suggested to be cost‐effective with the potential to be implemented universally in the Child Health Services. Future studies should investigate the impact of socio‐economic factors in universally implemented obesity prevention programs.

Abstract Context The current report is part of a prospective, multi-center, two-arm, quasi-randomized field study focusing on the effectiveness in general praxis of evidence-based procedures in the non-surgical treatment of patients with periodontitis. Objective The specific aims were to (i) evaluate patient-reported experience and outcome measures of treatment following a guided approach to periodontal infection control (GPIC) compared to conventional non-surgical therapy (CNST) and to (ii) identify potential predictors of subjective treatment outcomes and patient’s adherence to self-performed infection control, i.e. adequate oral hygiene. Methods The study sample consisted of 494 patients treated per protocol with questionnaire- and clinical data at baseline and 6-months. The GPIC approach (test) comprised patient education for adequate oral hygiene prior to a single session of full-mouth ultra-sonic instrumentation, while the CNST approach (control) comprised education and instrumentation (scaling and root planing) integrated at required number of consecutive appointments. Clinical examinations and treatment were performed by Dental Hygienists, i.e. not blinded. Data were processed with bivariate statistics for comparison between treatment groups and with multiple regression models to identify potential predictors of subjective and clinical outcomes. The primary clinical outcome was gingival bleeding scores. Results No substantial differences were found between the two treatment approaches regarding patient-reported experiences or outcomes of therapy. Patients’ experiences of definitely being involved in therapy decisions was a significant predictor for a desirable subjective and clinical outcome in terms of; (i) that oral health was considered as much improved after therapy compared to how it was before, (ii) that the treatment definitively had been worth the cost and efforts, and (iii) adherence to self-performed periodontal infection control. In addition, to be a current smoker counteracted patients’ satisfaction with oral health outcome, while gingival bleeding scores at baseline predicted clinical outcome in terms of bleeding scores at 6-months. Conclusions The results suggest that there are no differences with regard to patient-reported experiences and outcomes of therapy following a GPIC approach to periodontal infection control versus CNST. Patients’ experiences of being involved in therapy decisions seem to be an important factor for satisfaction with care and for adherence to self-performed periodontal infection control. Registered at: ClinicalTrials.gov (NCT02168621).

Abstract Background The increasing prevalence of carbapenem-resistant Enterobacteriaceae (CRE) is a growing problem globally, particularly in low- to middle-income countries (LMICs). Previous studies have shown high rates of CRE colonisation among patients at hospitals in LMICs, with increased risk of hospital-acquired infections. Methods We isolated carbapenem-resistant Klebsiella pneumoniae (CRKP) from faecal samples collected in 2017 from patients at admission and discharge at a Vietnamese neonatal intensive care unit (NICU). 126 CRKP were whole-genome sequenced. The phylogenetic relationship between the isolates and between clinical CRKP isolates collected in 2012–2018 at the same hospital were investigated. Results NDM-type carbapenemase-(61%) and KPC-2-encoding genes (41%) were the most common carbapenem resistance genes observed among the admission and discharge isolates. Most isolates (56%) belonged to three distinct clonal clusters of ST15, carrying bla KPC-2, bla NDM-1 and bla NDM-4, respectively. Each cluster also comprised clinical isolates from blood collected at the study hospital. The most dominant ST15 clone was shown to be related to isolates collected from the same hospital as far back as in 2012. Conclusions Highly resistant CRKP were found colonising admission and discharge patients at a Vietnamese NICU, emphasising the importance of continued monitoring. Whole-genome sequencing revealed a population of CRKP consisting mostly of ST15 isolates in three clonally related clusters, each related to blood isolates collected from the same hospital. Furthermore, clinical isolates collected from previous years (dating back to 2012) were shown to likely be clonally descended from ST15 isolates in the largest cluster, suggesting a successful hospital strain which can colonise inpatients.

Background Patients with chronic kidney disease (CKD) and atrial fibrillation (AF) on oral anticoagulants (OACs) are at high risk of bleeding. Determinants of major bleeding risk in OAC users with AF and CKD are not well established and available bleeding score systems do not perform well in CKD. This study aims to present risk factors associated with major bleeding in a Swedish cohort of OAC-treated patients with CKD G3–5D. Methods We conducted a Swedish register-based cohort study including patients with AF and CKD G3–5D on warfarin or direct OACs (DOACs) between 2009 and 2018. Data were collected from high-quality registers including the Swedish Renal Registry and Auricula, a register for AF and OACs. Risk factors for major bleeding were investigated with Cox regression analysis. Results Of 2453 included patients, 59% were on warfarin (time in therapeutic range 67%) and 41% on DOACs. Major bleeding rates were 8.9/100 patient-years. Factors associated with increased bleeding risk were glomerular filtration rate category, G5/5D versus G3 {hazard ratio [HR] 1.92 [95% confidence interval (CI) 1.43–2.56]}, previous gastrointestinal bleeding [HR 1.77 (95% CI 1.39–2.25)], previous other bleeding [HR 1.33 (95% CI 1.09–1.62)], congestive heart failure [HR 1.36 (95% CI 1.11–1.68)], male sex [HR 1.28 (95% CI 1.03–1.60)] and vascular disease [HR 1.35 (95% CI 1.01–1.79)]. Conclusion Patients with AF and G3–5D on OACs are at a high risk of bleeding. Previous major bleeding and kidney failure are strongly associated with major bleeding. The present study also shows an association between OAC-associated bleeding and male sex, congestive heart failure and vascular disease. Knowledge about determinants of bleeding in advanced CKD is essential when deciding on when to anticoagulate or not. [ABSTRACT FROM AUTHOR]

Sub-Saharan Africa has fewer medical workers per capita than any region of the world, and that shortage has been highlighted consistently as a critical constraint to improving health outcomes in the region. This paper draws on newly available, systematic, comparable data from 10 countries in the region to explore the dimensions of this shortage. We find wide variation in human resources performance metrics, both within and across countries. Many facilities are barely staffed, and effective staffing levels fall further when adjusted for health worker absences. However, caseloads—while also varying widely within and across countries—are also low in many settings, suggesting that even within countries, deployment rather than shortages, together with barriers to demand, may be the principal challenges. Beyond raw numbers, we observe significant proportions of health workers with very low levels of clinical knowledge on standard maternal and child health conditions. This study highlights that countries may need to invest broadly in health workforce deployment, improvements in capacity and performance of the health workforce, and on addressing demand constraints, rather than focusing narrowly on increases in staffing numbers. [ABSTRACT FROM AUTHOR]

Abstract Superconducting radio-frequency (SRF) resonator cavities provide extremely high quality factors > 1010 at 1–2 GHz and 2 K in large linear accelerators of high-energy particles. The maximum accelerating field of SRF cavities is limited by penetration of vortices into the superconductor. Present state-of-the-art Nb cavities can withstand up to 50 MV/m accelerating gradients and magnetic fields of 200–240 mT which destroy the low-dissipative Meissner state. Achieving higher accelerating gradients requires superconductors with higher thermodynamic critical fields, of which Nb3Sn has emerged as a leading material for the next generation accelerators. To overcome the problem of low vortex penetration field in Nb3Sn, it has been proposed to coat Nb cavities with thin film Nb3Sn multilayers with dielectric interlayers. Here, we report the growth and multi-technique characterization of stoichiometric Nb3Sn/Al2O3 multilayers with good superconducting and RF properties. We developed an adsorption-controlled growth process by co-sputtering Nb and Sn at high temperatures with a high overpressure of Sn. The cross-sectional scanning electron transmission microscope images show no interdiffusion between Al2O3 and Nb3Sn. Low-field RF measurements suggest that our multilayers have quality factor comparable with cavity-grade Nb at 4.2 K. These results provide a materials platform for the development and optimization of high-performance SIS multilayers which could overcome the intrinsic limits of the Nb cavity technology.

Electron affinity (EA) is a key parameter in determining the chemical behavior of the elements, but challenging to measure for unstable atoms. Here the authors succeed in measuring the EA of astatine, the heaviest naturally occurring halogen, and compare it with predictions from relativistic calculations.

This procedure describes the setup and testing protocol for metal-supported solid oxide electrolysis cell (MS-SOEC) button cell performance evaluation. It defines a standard testing protocol, describes materials selection, and identifies common pitfalls for testing MS-SOEC button cells.

Several retrospective studies have identified hospital sinks as reservoirs of Gram-negative bacteria. The aim of this study was to prospectively investigate the bacterial transmission from sinks to patients and if self-disinfecting sinks could reduce this risk. Samples were collected weekly from sinks (self-disinfecting, treated with boiling water, not treated) and patients in the Burn Centre at Linköping University Hospital, Sweden. The antibiotic susceptibility of Gram-negative isolates was tested, and eight randomly chosen patient isolates and their connected sink isolates were subjected to whole genome sequencing (WGS). Of 489 sink samples, 232 (47%) showed growth. The most frequent findings were Stenotrophomonas maltophilia (n = 130), Pseudomonas aeruginosa (n = 128), and Acinetobacter spp. (n = 55). Bacterial growth was observed in 20% of the samplings from the self-disinfecting sinks and in 57% from the sinks treated with boiling water (p = 0.0029). WGS recognized one transmission of Escherichia coli sampled from an untreated sink to a patient admitted to the same room. In conclusion, the results showed that sinks can serve as reservoirs of Gram-negative bacteria and that self-disinfecting sinks can reduce the transmission risk. Installing self-disinfecting sinks in intensive care units is an important measure in preventing nosocomial infection among critically ill patients.

Jarrick S, Lundberg S, Welander A, Fored CM, Ludvigsson JF. Clin Epidemiol. 2017;9:67–73. The authors have advised that the Compliance with ethical standards section on page 69 is incorrect. The text “The current study was approved by the Stockholm Ethics Review Board (Jan 22, 2014; approval number: 2013/2095-31/2)” should read “The current study was approved by the Stockholm Ethics Review Board (March 31, 2010; approval number: 2010/407-31/1)”. The authors apologize for this error. Read the original article

Introduction Migraine is a prevalent condition causing a substantial level of disability worldwide. Despite this, the pathophysiological mechanisms are not fully understood. Migraine often co‐occurs with gastrointestinal disorders, but the direction of a potential causal link is unclear. The aim of this project was to investigate the associations between migraine and several gastrointestinal disorders in the same cohort in order to determine the relative strengths of these associations. Methods This cross‐sectional study examined whether migraine is associated with irritable bowel syndrome (IBS), peptic ulcers, Helicobacter pylori (HP) infections, celiac disease, Crohn's disease and ulcerative colitis. Baseline data covering 489,753 UK Biobank participants (migraine group: n = 14,180) were analyzed using Pearson's chi‐square tests and adjusted binary logistic regression models. Results Migraine was significantly associated with IBS (odds ratio [OR] 2.24, 95% confidence interval [CI] 2.08–2.40, p