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The scientific literature is lacking in published agricultural noise assessments for employees of swine confinement facilities that have included dosimeter data, octave band analysis, or specific task exposure assessments. This study reports on the former three types of noise assessments in the farrowing stage of swine. Dosimeter data on workers revealed all assessments to be greater than 90 decibels measured on the A-scale (dBA), which exceeds the 85 dBA National Institute for Occupational Safety and Health (NIOSH) Recommended Exposure Limit (REL). RELs were exceeded for all of the employees monitored in the swine facility, as well as the part-time employees who power-washed the farrowing rooms. The recorded time-weighted values were actually underestimated slightly because the dosimeters were set to record only noise at 85 dBA and higher. [ABSTRACT FROM AUTHOR]

During the past 40 years, health education has taken significant steps toward improving quality assurance in professional preparation through individual certification and program approval and accreditation. Although the profession has begun to embrace individual certification, program accreditation in health education has been neither uniformly available nor universally accepted by institutions of higher education. To further strengthen professional preparation in health education, the Society for Public Health Education (SOPHE) and the American Association for Health Education (AAHE) established the National Task Force on Accreditation in Health Education in 2001. The 3-year Task Force was charged with developing a detailed plan for a coordinated accreditation system for undergraduate and graduate programs in health education. This article summarizes the Task Force's findings and recommendations, which have been approved by the SOPHE and AAHE boards, and, if implemented, promise to lay the foundation for the highest quality professional preparation and practice in health education. [ABSTRACT FROM AUTHOR]

Alternative and complementary therapeutic approaches, such as the use of a wide array of herbal, nutritional, and physical manipulations, are becoming popular for relieving symptoms of osteoarthritis (OA). The present study evaluated the efficacy of soy protein (SP) supplementation in relieving the pain and discomfort associated with OA. One hundred and thirty-five free-living individuals (64 men and 71 women) with diagnosed OA or with self-reported chronic knee joint pain not attributed to injury or rheumatoid arthritis were recruited for this double-blind, placebo-controlled, parallel design study. Study participants were assigned randomly to consume 40 g of either supplemental SP or milk-based protein (MP) daily for 3 months. Pain, knee range of motion, and overall physical activity were evaluated prior to the start of treatment and monthly thereafter. Serum levels of glycoprotein 39 (YKL-40), a marker of cartilage degradation, and insulin-like growth factor-I (IGF-I), a growth factor associated with cartilage synthesis, were assessed at baseline and at the end of the study. Overall, SP improved OA-associated symptoms such as range of motion and several factors associated with pain and quality of life in comparison to MP. However, these beneficial effects were mainly due to the effect of SP in men rather than women. Biochemical markers of cartilage metabolism further support the efficacy of SP in men as indicated by a significant increase in serum level of IGF-I and a significant decrease in serum level of YKL-40 compared to MP. This study is the first to provide evidence of possible beneficial effects of SP in the management of OA. Examining and verifying the long-term effects of SP on improving symptoms of OA, particularly in men, is warranted. [ABSTRACT FROM AUTHOR]

Objective: To determine the effect of daily consumption of 100 g of dried plum (Prunus domestica L.) on the bowel habits of postmenopausal women.Method: Fifty-eight postmenopausal women not on hormone replacement therapy and free of any gastrointestinal problems or eating disorders were randomly assigned to receive either 100 g of dried plum or 75 g of dried apples daily for 3 months. During the first week of treatment and each month thereafter, the participants were asked to fill out a validated questionnaire regarding their weekly bowel habits. The parameters used to assess bowel habits included stool frequency, estimated fecal bulk, consistency of stool, strain and pain during bowel movement, and feeling of constipation.Results: In both treatment regimens, there were no significant differences between the 4 different time points for any of the parameters used to assess bowel function. Conclusion: Many postmenopausal women can take advantage of all the health benefits that accompany prune consumption, such as improving blood lipid profile and reducing bone loss, without negative gastrointestinal side effects. [ABSTRACT FROM AUTHOR]

The most recent compilation of DEC Recommended Practices in Early Intervention/Early Childhood Special Education ( S. Sandall, M. E. McLean, & B. J. Smith, 2000) contains 240 recommended practices across 7 strands. The recommended practices evolved from a process involving input from literature reviews, scientific experts, 9 stakeholder focus groups, and field validation of the synthesized practices ( Sandall, McLean, & Smith, 2000). One of the 7 strands addresses recommended practices in interdisciplinary models. The 19 practices in this strand emphasize teamwork, loose boundaries between disciplines, functional intervention, and support to caregivers. The article briefly describes the process used to identify these 19 recommended practices and focuses on the literature base of 30 articles that supports the interdisciplinary models strand. An analysis of the literature was undertaken to better understand the types of research (eg, qualitative or quantitative) and the elements (eg, study setting, study participants) used to support this group of practices as well as gaps currently existing in the research and literature base lending support to these practices. The article suggests the importance of using these recommended practices as the foundation by which practitioners in early intervention/early childhood special education go about their daily routines and practices. By examining the empirical base in the published literature, it is possible to suggest modifications that could help a team move toward meeting recommended practices and suggest future research endeavors to strengthen the empirical support available in this field. [ABSTRACT FROM AUTHOR]

Objective: To investigate the impact of a simple written prescription for physical activity given by a general practitioner and the effect of supplementing this with mailed information materials about physical activity.Methods: A controlled trial was conducted in 27 general practices in New South Wales, Australia. Subjects were sequential routine care patients between 25 and 65 years old. Controls (n = 386) were recruited first, and intervention subjects two weeks later. Intervention subjects were randomised to receive a prescription only (n = 380) or a prescription plus a mailed booklet (n = 376). Self reported physical activity levels were measured by interview at baseline, 6-10 weeks, and seven to eight months.Results: By intention to treat, the average changes in minutes of total physical activity did not differ significantly between the groups. Inactive people in the prescription plus supplementary booklet group were significantly more likely than controls to report an increase in their physical activity by at least 60 min/week after 6-10 weeks (odds ratio 1.58, 95% confidence interval 1.06 to 2.35). No significant short term improvements in self reported activity were shown in the prescription only group. In the supplemented group, the proportion reporting an increase in physical activity to 3,344 kJ/week at 6-10 weeks was not significant, and neither intervention group showed significant increases in any of the outcome measures at seven to eight months by intention to treat. Treatment received analysis showed greater improvements in intervention groups, especially the prescription plus booklet group, in which the odds of inactive people in this group reporting increased activity became significant at seven to eight months.Conclusions: A prescription for physical activity from a general practitioner, supplemented by additional written materials, can lead to modest short term improvements in self reported physical activity levels among inactive patients. A prescription alone was found not to be effective. [ABSTRACT FROM AUTHOR]

Ticks obtain a blood meal by lacerating small blood vessels and ingesting the blood that flows to the feeding site, which triggers various host responses. However, ticks face the challenge of wound healing, a process involving hemostasis, inflammation, cell proliferation and migration, and remodeling, hindering blood acquisition. To overcome these obstacles, tick salivary glands produce an array of bioactive molecules. Here, we characterize ixochymostatin, an Ixodes scapularis protein belonging to the trypsin inhibitor-like (TIL) family. It is expressed in multiple developmental stages and in tick salivary glands and acts as a slow and tight-binding inhibitor of chymase, cathepsin G, and chymotrypsin. Predictions for the tertiary structure complex between ixochymostatin and chymase suggest a direct interaction between the inhibitor reactive site loop and protease active sites. In vitro, ixochymostatin protects the endothelial cell barrier against chymase degrading action, decreasing cell permeability. In vivo, it reduces vascular permeability induced by chymase and compound 48/80, a mast cell degranulator agonist, in a mouse model. Additionally, ixochymostatin inhibits the chymase-dependent generation of vasoconstrictor peptides. Antibodies against ixochymostatin neutralize its inhibitory properties, with epitope mapping identifying potential neutralization regions. Ixochymostatin emerges as a novel tick protein modulating host responses against tick feeding, facilitating blood acquisition., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024. Published by Elsevier B.V.)

Background: Respiratory care departments are experiencing an increased need to demonstrate value in the care they deliver. Value efficiency is a concept that incorporates the value of individual treatments into the normal operations of a department. The purpose of this study was to describe respiratory care leaders' attitudes about the value of services provided by respiratory care departments., Methods: An electronic survey was distributed via social media, professional networks, and a manager work group. The survey was targeted to directors, managers, and supervisors of respiratory care departments. We asked questions related to value, services, and barriers to implementation of value efficiency. Data analysis was descriptive., Results: We received 116 responses; 86% were from managers or directors. The 5 most valuable services delivered were invasive mechanical ventilation (82%), noninvasive ventilation or CPAP (71%), protocol-driven care (47%), code team (44%), and rapid response team (41%). The 5 least valuable services delivered by respiratory care departments were electrocardiograms (63%), stress testing (44%), lung expansion therapies (41%), sleep studies staffed by the respiratory care department (36%), and smoking cessation education (36%). The primary barrier to value efficiency was physician prescribing practices (68%). There was general agreement that physicians support respiratory therapy protocols (71%), value should be considered when evaluating respiratory care services (95%), and directing resources to more valuable services if possible (73%). Respondents did not agree that hospital administrators understand respiratory therapy workflow and full-time equivalent needs (35%) nor that hospital administrators would be supportive if we reduced services (18%)., Conclusions: In a small sample of respiratory therapy leaders, there was limited consensus on what respiratory care services are the most and least valuable. Lack of consensus on high- and low-value services and physician prescribing practice were the primary barriers to value efficiency. Nearly all respondents felt value should be considered when evaluating respiratory care services., (Copyright © 2024 by Daedalus Enterprises.)

Introduction: Young people with chronic health conditions are among the most at risk of having poor social connections, however, little is known about their experiences of loneliness and social isolation. We aimed to describe the perspectives and experiences of loneliness and social isolation among young people with chronic physical conditions., Methods: We searched MEDLINE, Embase, PsycINFO, CINAHL, and CENTRAL from inception to May 2023 for qualitative studies that described the perspectives of loneliness and social isolation in young people aged 10-24 years with chronic physical conditions. Findings from the included studies were analyzed using thematic synthesis., Results: We included 35 studies across 12 countries involving 723 participants (56% female). Most studies (63%) were conducted in young people with cancer. Four major themes were identified: suffering from repercussions of disease (struggling with body image and physical changes, intensified disconnection while hospitalized); hindering relationships with peers and friends (missing out on formative experiences, feeling stuck behind, restrictive parental attitudes); grappling with social exclusion (facing concerns alone, bullying and ostracism); seeking social support and self-help (reliance on family, kindness and empathy from friends, developing rapport with healthcare professionals, discovering self in adversity)., Conclusions: Symptoms, treatments, and hospitalizations limited young people's social participation and ability to maintain friendships, and this was compounded by social exclusion and bullying. Supportive friends, family, and healthcare professionals helped mitigate feelings of isolation. Interventions and strategies are needed to improve social support and foster meaningful connections. This can be achieved through education and awareness initiatives that promote inclusion in schools and the community, as well as efforts to enhance social support and continuity of care in hospitals., (© 2024 Foundation for Professionals in Services to Adolescents.)

The most recent Sudan virus (SUDV) outbreak in Uganda was first detected in September 2022 and resulted in 164 laboratory-confirmed cases and 77 deaths. There are no approved vaccines against SUDV. Here, we investigated the protective efficacy of ChAdOx1-biEBOV in cynomolgus macaques using a prime or a prime-boost regimen. ChAdOx1-biEBOV is a replication-deficient simian adenovirus vector encoding SUDV and Ebola virus (EBOV) glycoproteins (GPs). Intramuscular vaccination induced SUDV and EBOV GP-specific immunoglobulin G responses and neutralizing antibodies. Upon challenge with SUDV, vaccinated animals showed signs of disease like those observed in control animals, and no differences in survival outcomes were measured among all 3 groups. Viral load in blood samples and in tissue samples obtained after necropsy were not significantly different between groups. Overall, this study highlights the importance of evaluating vaccines in multiple animal models and demonstrates the importance of understanding protective efficacy in both animal models and human hosts., Competing Interests: Potential conflicts of interest. T. L. reports consulting fees from Vaccitech on an unrelated project, has received honorarium from Seqirus on an unrelated project, and is named as an inventor on a patent application for a vaccine against SARS-CoV-2. All other authors report no potential conflicts. All authors have submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Conflicts that the editors consider relevant to the content of the manuscript have been disclosed., (Published by Oxford University Press on behalf of Infectious Diseases Society of America 2024.)

Exclusive enteral nutrition (EEN) is a first-line therapy for pediatric Crohn's disease (CD), but protective mechanisms remain unknown. We established a prospective pediatric cohort to characterize the function of fecal microbiota and metabolite changes of treatment-naive CD patients in response to EEN (German Clinical Trials DRKS00013306). Integrated multi-omics analysis identified network clusters from individually variable microbiome profiles, with Lachnospiraceae and medium-chain fatty acids as protective features. Bioorthogonal non-canonical amino acid tagging selectively identified bacterial species in response to medium-chain fatty acids. Metagenomic analysis identified high strain-level dynamics in response to EEN. Functional changes in diet-exposed fecal microbiota were further validated using gut chemostat cultures and microbiota transfer into germ-free Il10-deficient mice. Dietary model conditions induced individual patient-specific strain signatures to prevent or cause inflammatory bowel disease (IBD)-like inflammation in gnotobiotic mice. Hence, we provide evidence that EEN therapy operates through explicit functional changes of temporally and individually variable microbiome profiles., Competing Interests: Declaration of interests D. Haller served on the Microbiome Expert Panel from Reckitt Benckiser Health Limited. T.S. received lecture honoraria from Nutricia and MSD and travel support from Abbvie and Ferring outside the submitted work., (Copyright © 2024 The Author(s). Published by Elsevier Inc. All rights reserved.)

Objective: This work describes the demographics and practice characteristics of physician assistants/associates (PAs) practicing in rheumatology., Methods: We examined 2022 cross-sectional data from the National Commission on Certification of PAs (NCCPA). The investigation included demographics and practice characteristics of PAs working in rheumatology compared to those working in all other specialties. We analyzed data using descriptive and bivariate statistics comparing the two groups., Results: In 2022, 430 PAs self-reported practicing in rheumatology. The median age of these PAs was 39 years, and 84.7% self-identified as female. They primarily (78.8%) worked in office-based private practices and were more likely to engage in telemedicine services (62.5%) than their colleagues in all other specialties. PAs in rheumatology typically worked similar hours as their peers in other medical disciplines but saw a higher proportion of patients in the 61-80 range. At the same time, PAs in rheumatology reported slightly higher job satisfaction and lower burnout symptom rates compared to PAs practicing in other disciplines., Conclusions: Understanding PAs' characteristics and employment settings in rheumatology is crucial to estimating the health workforce supply and demand in this discipline. Further research should explore the economics of PAs in rheumatology, including aspects of teamwork, scope of practice, patient outcomes, and satisfaction., (This article is protected by copyright. All rights reserved.)

Background: Patients with metastatic pancreatic ductal adenocarcinoma (PDAC) have poor 5-year survival. Pharmacological ascorbate (P-AscH - , high dose, intravenous, vitamin C) has shown promise as an adjunct to chemotherapy. We hypothesized adding P-AscH - to gemcitabine and nab-paclitaxel would increase survival in patients with metastatic PDAC., Methods: Patients diagnosed with stage IV pancreatic cancer randomized 1:1 to gemcitabine and nab-paclitaxel only (SOC, control) or to SOC with concomitant P-AscH - , 75 g three times weekly (ASC, investigational). The primary outcome was overall survival with secondary objectives of determining progression-free survival and adverse event incidence. Quality of life and patient reported outcomes for common oncologic symptoms were captured as an exploratory objective. Thirty-six participants were randomized; of this 34 received their assigned study treatment. All analyses were based on data frozen on December 11, 2023., Results: Intravenous P-AscH - increased serum ascorbate levels from micromolar to millimolar levels. P-AscH - added to the gemcitabine + nab-paclitaxel (ASC) increased overall survival to 16 months compared to 8.3 months with gemcitabine + nab-paclitaxel (SOC) (HR = 0.46; 90 % CI 0.23, 0.92; p = 0.030). Median progression free survival was 6.2 (ASC) vs. 3.9 months (SOC) (HR = 0.43; 90 % CI 0.20, 0.92; p = 0.029). Adding P-AscH - did not negatively impact quality of life or increase the frequency or severity of adverse events., Conclusions: P-AscH - infusions of 75 g three times weekly in patients with metastatic pancreatic cancer prolongs overall and progression free survival without detriment to quality of life or added toxicity (ClinicalTrials.gov number NCT02905578)., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier B.V. All rights reserved.)

This study investigated the real-world incidence rate of serotonin syndrome in patients receiving tedizolid and concomitant serotonergic agents. A retrospective cohort of 479 adult patients was assessed between January 2015 and July 2023. Overall, a rare rate of 0.4% (2/479) of possible serotonin syndrome with tedizolid was identified. Given that concomitant serotonergic agents were commonly used, further study is warranted to determine causality., Competing Interests: The authors declare no conflict of interest.

Cardiovascular diseases (CVDs) are complex, encompassing many types of heart pathophysiologies and associated etiologies. Radiotherapy studies have shown that fractionated radiation exposure at high doses (3-17 Gy) to the heart increases the incidence of CVD. However, the effects of low doses of radiation on the cardiovascular system or the effects from space travel, where radiation and microgravity are important contributors to damage, are not clearly understood. Herein, the adverse outcome pathway (AOP) framework was applied to develop an AOP to abnormal vascular remodeling from the deposition of energy. Following the creation of a preliminary pathway with the guidance of field experts and authoritative reviews, a scoping review was conducted that informed final key event (KE) selection and evaluation of the Bradford Hill criteria for the KE relationships (KERs). The AOP begins with a molecular initiating event of deposition of energy; ionization events increase oxidative stress, which when persistent concurrently causes the release of pro-inflammatory mediators, suppresses anti-inflammatory mechanisms and alters stress response signaling pathways. These KEs alter nitric oxide levels leading to endothelial dysfunction, and subsequent abnormal vascular remodeling (the adverse outcome). The work identifies evidence needed to strengthen understanding of the causal associations for the KERs, emphasizing where there are knowledge gaps and uncertainties in both qualitative and quantitative understanding. The AOP is anticipated to direct future research to better understand the effects of space on the human body and potentially develop countermeasures to better protect future space travelers., (© 2024 The Author(s). Environmental and Molecular Mutagenesis published by Wiley Periodicals LLC on behalf of Environmental Mutagenesis and Genomics Society.)