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Background: Growing data indicates that thiamine deficiency occurs during acute illness in the absence of alcohol use disorder. Our primary objective was to measure clinical factors associated with thiamine deficiency in patients with sepsis, diabetic ketoacidosis, and oncologic emergencies.Methods: This was an analysis of pooled data from cross-sectional studies that enrolled adult emergency department (ED) patients at a single academic center with suspected sepsis, diabetic ketoacidosis, and oncologic emergencies. We excluded patients who had known alcohol use disorder or who had received ED thiamine treatment prior to enrollment. Investigators collected whole blood thiamine levels in addition to demographics, clinical characteristics, and available biomarkers. We defined thiamine deficiency as a whole blood thiamine level below the normal reference range and modeled the adjusted association between this outcome and age.Results: There were 269 patients, of whom the average age was 57 years; 46% were female, and 80% were Black. Fifty-five (20.5%) patients had thiamine deficiency. In univariate analysis, age >60 years (odds ratio [OR] 2.5, 95% confidence interval [CI], 1.3–4.5), female gender (OR 1.9, 95% CI 1.0–3.4), leukopenia (OR 4.9, 95% CI 2.3–10.3), moderate anemia (OR 2.8, 95% CI 1.5–5.3), and hypoalbuminemia (OR 2.2, 95% CI 1.2–4.1) were associated with thiamine deficiency. In adjusted analysis, thiamine deficiency was significantly higher in females (OR 2.1, 95% CI 1.1–4.1), patients >60 years (OR 2.0, 95% CI 1.0–3.8), and patients with leukopenia (OR 5.1, 95% CI 2.3–11.3).Conclusion: In this analysis, thiamine deficiency was common and was associated with advanced age, female gender, and leukopenia.

Abstract Background The COVID-19 pandemic prompted significant shifts to teleworking, raising questions about potential impacts on employee wellbeing. This study examined the association between self-reported changes to teleworking frequency (relative to before the pandemic) and two indicators of occupational burnout: emotional exhaustion and professionally diagnosed burnout. Methods Data were derived from two samples from a digital cohort study based in Geneva, Switzerland: one population-based, and one from a sample of workers who were likely mobilized in the early stages of the COVID-19 pandemic. Emotional exhaustion was measured using the Maslach Burnout Inventory (EE-MBI), while self-reported diagnosed burnout was assessed by asking participants if they had received a professional diagnosis of occupational burnout within the previous 12 months. Participants were categorized based on self-reported telework frequency changes: “no change,” “increase,” “decrease,” “never telework,” and “not possible to telework.” Adjusted regression models for each of the study samples were used to estimate associations between telework changes and burnout outcomes, accounting for sociodemographic, household, and work-related factors. Results In the population-based sample of salaried employees (n = 1,332), the median EE-MBI score was 14 (interquartile range: 6–24), and 7.3% reported diagnosed burnout. Compared to those reporting no change in telework frequency (19% of the sample), those reporting a decrease (4%) and those reporting that teleworking was not possible (28.7%) had significantly higher emotional exhaustion scores (adjusted beta (aβ) 5.26 [95% confidence interval: 1.47, 9.04] and aβ 3.51 [0.44, 6.59], respectively) and additionally reported higher odds of diagnosed burnout (adjusted odds ratio (aOR) 10.59 [3.24, 34.57] and aOR 3.42 [1.22, 9.65], respectively). “Increased” (28.9%) and “never” (19.4%) telework statuses were not significantly associated with burnout outcomes. These trends were mirrored in the “mobilized-workers” sample, with the exception that those reporting that teleworking was not possible did not report significantly higher odds of diagnosed burnout compared to those reporting no change in telework frequency. Conclusions Decreased teleworking frequency and not having the possibility of telework were associated with higher emotional exhaustion and diagnosed burnout. As organizations reconsider their telework policies in a post-pandemic era, they should consider the impact of such organizational changes on employee wellbeing.

Abstract Objective Surgical sterilization, including vasectomy in males and tubal ligation in females, is a highly effective but underutilized contraception method. Adoption rates vary globally mostly due to misconceptions by both the general public and practicing physicians. Our survey aims to explore physicians’ knowledge, attitudes and beliefs about surgical sterilization techniques in Lebanon. Study design A web-based survey was sent to residents and attending physicians of different specialties in Lebanon between April 2022 and April 2023. The survey included 21 multiple-choice questions divided in four parts (demographics, knowledge, attitudes and beliefs) and required around 8 min to complete. Data was analyzed using IBM SPSS Statistics. A descriptive analysis was performed using the chi-square test for categorical variables and ANOVA for continuous variables. Results One hundred eighty-three physicians specialized in Urology, OB/GYN, Family medicine and Internal medicine filled the survey. The majority were resident physicians (79%), male (57%), single (72%) and did not receive training in family planning (73%). Knowledge assessment showed an average score of 5/7. After setting this as a passing score, 60.7% of participants passed the assessment with higher likelihood of passing among attending physicians (84.6%), OB/GYN physicians (94.4%), married participants (80.8%), and physicians who received training in family planning (91.8%). Lower likelihood of passing was among Family Medicine (60%), and Internal Medicine (72.5%) physicians. Recommendations varied among specialties. Most physicians perceived the general public preferring tubal ligation as a sterilization method (98%). Conclusion Lebanese primary care physicians have a lower level of knowledge of surgical sterilization procedures compared to specialists. This, coupled with low levels of family planning training and negative perception of patient beliefs may impact attitudes and recommendations. Ongoing education and family planning training is needed to increase awareness among physicians, especially primary care physicians, to allow them to provide more adequate counseling to patients.

The complexities of Internet sources have caused more challenges to school students, leading them in many cases to copy-paste ideas into their written assignments. Facing these challenges requires adopting and implementing evidence-based practices. This article builds on a mixed-methods, quasi-experimental study which investigated the effect of Internet Reciprocal Model (IRT) to lessen occurrences of copy-paste trend in the writing pieces of Grade 8 ESL students (n = 172) in three private schools in Saida, Lebanon. Eight teachers were randomly assigned to experimental and control conditions along with their respective classes. The researchers collected pre and post-data on online research and comprehension assessment tool. Supported with current research and informed by the principles of the social-cognitive, socio-cultural, and the new literacies theories, regression analyses revealed a strong positive degree of association at post-test between the intervention and the subscale that measured copy-paste trend, indicating that teaching online research skills through one comprehensive model would decrease the copy-paste behavior. Theoretical and pedagogical implications were discussed. Recommendations for school policies and further research were provided.

The pupil, iris, vitreous, and retina are parts of the eye, where any defect due to physical damage or chronic diseases to these parts of the eye can lead to partial vision loss or complete blindness. Changes in retinal structure due to diabetes or high blood pressure lead to diabetic retinopathy (DR). The early diagnosis of DR using computer-aided automated tools is possible due to tremendous advancements in machine and deep learning models in the last decade. Devising and implementing innovative deep learning models for retinal structural analysis is crucial to the early diagnosis of DR and other eye diseases. In this work, we have developed a new approach, which involves the development of a lightweight convolutional neural network (CNN)-based model for segmentation of retinal vessels and a mobile application for DR grading. This paper covers the development process of an Android application that leverages the power of CNN-based deep learning model to detect DR regardless of its stage. To achieve this, two models have been created and compared, the best one having an accuracy of 96.72 %. An Android application has then been developed, that makes calls to this model and then displays the results on screen with a simple-to-understand interface developed using the Kivy framework.

ABSTRACT: An experiment was conducted to determine the effects of supplementing rumen-protected arginine (RPA) on productive performance in dairy cows. One-hundred and two cows were blocked by parity and then by ECM yield. Within block, cows were randomly assigned to control (CON) that received 200 g/d of a mixture of hydrogenated soybean oil and heat-treated soybean meal to supply 30 g of MP, or 200 g/d of a product containing 30 g of metabolizable arginine (RPA), which increased the dietary arginine from 5.7% to 7.5% of the MP from 250 d of gestation to 21 d postpartum. After 21 d postpartum, cows were fed the same diet and data were collected until 84 d postpartum. Cows fed RPA produced an additional 2.5 kg of colostrum (5.3 vs. 7.8 ± 1.0 kg; LSM ± SEM) and 220 g more IgG (526 vs. 746 ± 93 g) than CON cows. Supplementing RPA increased the yields of milk (32.8 vs. 34.9 ± 1.0 kg/d), ECM (37.8 vs. 40.9 ± 1.2 kg/d), and milk total solids (4.48 vs. 4.86 ± 0.14 kg/d) in the first 21 DIM. The benefits of RPA extended beyond the period of supplementation, with a 6.4% increase in yield of ECM per kilogram of DM consumed in all cows (1.88 vs. 2.00 ± 0.05 kg/kg) and an increase in ECM yield, but only in parous cows (44.2 vs. 48.5 ± 1.5 kg/d). Feeding RPA increased the concentrations of urea N in plasma pre- (12.5 vs. 13.9 ± 0.4 mg/dL) and postpartum (11.6 vs. 13.2 ± 0.4 mg/dL), and in milk during the first 21 d postpartum (11.0 vs. 12.0 ± 0.3 mg/dL). Treatment did not affect the concentrations of AA in plasma prepartum, but feeding RPA tended to increase citrulline (72.5 vs. 77.5 ± 2.7 μM), whereas RPA either tended to decrease isoleucine (129.5 vs. 120.9 ± 5.7 μM) or decreased the concentrations of leucine (181.3 vs. 170.2 ± 6.4 μM) and valine (293.2 vs. 276.7 ± 10.4 μM) postpartum. Feeding RPA increased the relative expression of transcripts involved in AA transport (SLC38A4), urea cycle (ARG1), and gluconeogenesis (PC, PEPCK, and G6PC) in hepatic tissue. Feeding diets to supply additional arginine as RPA during the transition period benefited productive performance in dairy cows that extended beyond the period of supplementation despite minor changes in plasma AA concentrations.

Objectives This study aims (1) to assess the prevalence of severe fatigue among the general population of Geneva, 2 years into the COVID-19 pandemic and (2) to identify pandemic and non-pandemic factors associated with severe fatigue.Design Cross-sectional population-based survey conducted in Spring 2022.Setting General adult population of Geneva, Switzerland.Participants 6870 adult participants, randomly selected from the general population, included in the Specchio-COVID-19 cohort study, were invited to answer an online health survey.Outcome and cofactor measure Prevalence of severe fatigue was measured by the Chalder Fatigue Questionnaire with a cut-off score≥4 out of 11. We assessed prevalence ratios of severe fatigue considering sociodemographic factors, health and behavioural characteristics (body mass index, depression, recent diagnosis of chronic disease or allergy, acute health event, smoking status, physical activity and sleep quality) and recent self-reported COVID-19 infections.Results A total of 4040 individuals participated (participation rate 59%, 58% were women, mean age 53.2 (SD=14.1 years)). Overall prevalence of severe fatigue was 30.7% (95% CI=29.2%–32.1%). After adjusting for age, sex, educational level and pre-existing comorbidities, the following characteristics were associated with severe fatigue: individuals aged 18–24 years (adjusted prevalence ratio (aPR)=1.39 (1.10–1.76)) and 25–34 years (aPR=1.23 (1.05–1.45)), female sex (aPR=1.28 (1.16–1.41)), depression (aPR=2.78 (2.56–3.01)), occurrence of health events unrelated to COVID-19 (aPR=1.51 (1.38–1.65)) and self-reported COVID-19 infection in the past 12 months (aPR=1.41 (1.28–1.56)). After further adjustment for depression, previous associations were maintained except for young age.Conclusions About one-third of the adult general population of Geneva experienced severe fatigue, 2 years into the COVID-19 pandemic. Heightened fatigue among young adults is partly explained by depressive symptoms. Recent COVID-19 infection is substantially associated with severe fatigue, regardless of infection severity or co-occurrence of depressive disorder.Trial registration number CCER project ID 2020-00881.

Aim: To describe the incidence, characteristics, success rates, and outcomes of out-of-hospital cardiac arrest (OHCA) patients receiving cricothyroidotomy. Methods: Over an 18-year period, we retrospectively analysed patient care records and cardiac arrest registry data for cricothyroidotomy cases. Multivariable logistic regression analysis was used to examine associations between study characteristics and cricothyroidotomy success. Results: We identified 80 cricothyroidotomies, 56 of which occurred in OHCA. The incidence of cricothyroidotomy in OHCA was 1.1 per 1,000 attempted resuscitations and increased over the study period (incidence rate ratio [IRR] = 1.13, 95 % confidence interval [CI]: 1.02–1.25, p = 0.023). The overall success rate was 68.8 % (n = 55/80), with lower success in cardiac arrest (n = 33/56, 58.9 %) than non-cardiac arrest patients (n = 22/24, 91.7 %). In OHCA, success rates were higher for surgical compared to needle techniques (88.2 % vs. 54.6 %, p = 0.003). Cardiac arrest (odds ratio [OR] 0.09, 95 % CI 0.16–0.51) and needle techniques (OR 0.11, 95 % CI 0.02–0.56) were independently associated with lower odds of procedural success, while male sex (OR 10.06, 95 % CI 2.00–50.62) was associated with higher odds. Return of spontaneous circulation occurred in 44.6 % (n = 22/56), with 35.7 % (n = 20/56) surviving to hospital and 7.1 % (n = 4/56) surviving to hospital discharge. Procedural complications included cardiac arrest (n = 6/56, 10.7 %), minor bleeding (n = 5/56, 8.9 %), surgical emphysema (n = 3/56, 5.4 %), and major bleeding (n = 2/56, 3.6 %). Conclusion: We found cricothyroidotomy in OHCA to be associated with low rates of procedural success and high mortality rates. Further studies are required to assess the role and potential benefits of cricothyroidotomy in cardiac arrest.

Introducción: La luxación de la hemiartroplastia tras una fractura de cadera es una complicación difícil de tratar debido la comorbilidad asociada en este tipo de pacientes, la pobre calidad del hueso y las partes blandas. Materiales y Métodos: Se evaluaron 28 casos de luxación tras una hemiartroplastia. Se comparó la mortalidad con la de 56 controles, en un seguimiento mínimo de un año. En todos los casos, se intentó una reducción cerrada bajo anestesia general, que fue exitosa en 26 pacientes. Se analizaron los episodios de recurrencia de la luxación, considerando los diferentes factores que pueden influir en ella. Resultados: La tasa de mortalidad global de los 28 pacientes con luxación fue del 42% en los primeros 12 meses frente al 21% en el grupo de control (p

ABSTRACT: The objectives of this study were to determine the effects of 2 dietary microbial additives on productive performance and feed efficiency when supplemented to diets of Holstein cows. One hundred seventeen Holstein cows were enrolled at 61 d (31–87 d) postpartum in a randomized complete block design experiment. Cows were blocked by parity group, as nulliparous or multiparous cows and, within parity, by pretreatment ECM yield. Within block, cows were randomly assigned to one of 3 treatments administered as top-dress for 140 d. Treatments consisted of either 100 g of corn meal containing no microbial additive (CON; 15 primiparous and 25 multiparous), 100 g of corn meal containing 5 g of a mixture of Clostridium beijerinckii and Pichia kudriavzevii (G1; 4 × 107 cfu of C. beijerinckii and 1 × 109 cfu of P. kudriavzevii; 14 primiparous and 24 multiparous), or 100 g of corn meal containing 5 g of a mixture of C. beijerinckii, P. kudriavzevii, Butyrivibrio fibrisolvens, and Ruminococcus bovis (G2; 4 × 107 cfu of C. beijerinckii, 1 × 109 cfu of P. kudriavzevii, 1 × 108 cfu of B. fibrisolvens, and 1 × 108 cfu of R. bovis; 15 primiparous and 24 multiparous). Intake of DM, milk yield, and BW were measured daily, whereas milk composition was analyzed at each milking 2 d a week, and body condition was scored twice weekly. Milk samples were collected on d 60 and 62 in the experiment and analyzed for individual fatty acids. The data were analyzed with mixed-effects models with orthogonal contrast to determine the effect of microbial additive (MA; CON vs. 1/2 G1 + 1/2 G2) and type of microbial additive (TMA; G1 vs. G2). Results are described in sequence as CON, G1, and G2. Intake of DM (22.2 vs. 22.4 vs. 22.4 kg/d), BW (685 vs. 685 vs. 685 kg) and the daily BW change (0.40 vs. 0.39 vs. 0.39 kg/d) did not differ among treatments; however, feeding MA tended to increase BCS (3.28 vs. 3.33 vs. 3.36). Supplementing MA increased yields of milk (39.9 vs. 41.3 vs. 41.5 kg/d), ECM (37.9 vs. 39.3 vs. 39.9 kg/d), fat (1.31 vs. 1.37 vs. 1.40 kg/d), TS (4.59 vs. 4.75 vs. 4.79 kg/d), and ECM per kg of DMI (1.72 vs. 1.76 vs. 1.80 kg/kg). Furthermore, cows fed MA increased yields of preformed fatty acids in milk fat (>16C; 435 vs. 463 vs. 488 g/d), particularly UFA (367 vs. 387 vs. 410 g/d), such as linoleic (C18:2 cis-9,cis-12; 30.9 vs. 33.5 vs. 35.4 g/d) and α-linolenic acids (C18:3 cis-9,cis-12,cis-15; 2.46 vs. 2.68 vs. 2.82 g/d) on d 60 and 62 in the experiment. Collectively, supplementing G1 and G2 improved productive performance of cows with no differences between the 2 MA.

This paper proposes four principles for managers and higher education educators who are designing units and programmes so as to be dual mode ready. `Dual mode' design and delivery enables students to equitably complete their studies fully online, while also offering on-campus experiences where possible. The four principles are: (1) All learning outcomes can be met irrespective of participation mode; (2) Teaching-learning activities are equitable across participation modes; (3) All students have equivalent opportunity to demonstrate achievement of learning outcomes; and (4) 'Online ready' design. Being dual mode ready will likely remain important as on-campus delivery may not be possible for all students. Further, universities may need to pivot rapidly to fully online delivery for a range of reasons, including pandemic-related circumstances. The four principles provide guidance on how best to ensure equity and fairness for students and teachers in a dual mode context.

Obesity, the fifth leading cause of death globally and linked to chronic low-grade inflammation and development of numerous severe pathologies, is a major public health problem. Fermented foods, probiotics, and postbiotics emerge as promising avenues for combating obesity and inflammation. The aim of our study was to develop and characterize phyto-postbiotics corresponding to prebiotic compounds fermented by gut bacteria, which could act on obesity and related-inflammation. Chicory extract fermented by Akkermansia muciniphila (C-Akm) was selected as the most antioxidant of 20 fermented extracts. The identification of metabolites derived from C-Akm extract has enabled us to detect mostly amino acids, acids, and some polyphenols (daidzein and genistein). The anti-inflammatory and anti-obesity activities of C-Akm extract were studied by testing the extract (50 μg/mL) on the polarization of THP-1 into macrophages, the secretion of pro-inflammatory cytokines in LPS-stimulated PBMCs, and the secretion of leptin and adiponectin in adipospheroids derived from human adipose stem cells. Finally, the extract was examined in 3D co-culture model mimicking inflamed obese adipose tissue. We found that C-Akm extract decreased ROS generation, TNF-α and Il-6 gene expression in polarized macrophages, INFγ and IL-17A secretion in LPS-stimulated PBMCs stimulated with LPS. It also decreased leptin expression while increasing adiponectin and HSL expression levels in both adipocytes and co-cultures. In addition, C-Akm extract stimulated adiponectin secretion in the co-culture model. Finally, our in vitro investigations demonstrated the potential benefits of C-Akm extract in the prevention and treatment of obesity-related inflammation.

IntroductionThe COVID-19 pandemic, starting in 2020, raised concerns about potential long-term health impacts, including its effects on cardiovascular health and related biomarkers. This study part of the Bus Santé in Geneva, Switzerland, compared cardiovascular and metabolic profiles pre- (2016–2019) and post-pandemic (2023–2024) among individuals aged 30–75.MethodsParticipants completed questionnaires and underwent a clinical visit, including a physical examination and fasting blood test to assess lipid and glycemic profiles. Linear regression was used to estimate results including mean systolic and diastolic blood pressure, cholesterol, and glycemic profiles, after adjusting for age, sex, smoking, and socioeconomic status. Quantile regression models were used to estimate median values.ResultsA total of 4,558 participants were included. The study observed modest declines in mean glucose, cholesterol, HDL, and LDL levels post-pandemic, with stable blood pressure. The prevalence and treatment rates of diabetes, hypertension, and dyslipidemia remained consistent. Unawareness of these conditions was stable.ConclusionDespite initial fears of a pandemic-induced health debt, results indicate healthy cardiovascular profiles post-pandemic, likely driven by improved lifestyle behaviors. This study highlights the importance of monitoring of cardiovascular health and suggests that lifestyle improvements may offset potential adverse pandemic effects in developed nations like Switzerland.

Future time perspectives (FTP) and future-related concerns in adolescence remain underexplored. We aimed to identify factors associated with limited FTP and describe future-related concerns. Data were drawn from a population-based sample of adolescents aged 14–17 participating in the SEROCoV-KIDS cohort study, in Geneva, Switzerland (October 2022). Of 329 adolescents, 56/329 (17%) reported limited FTP; determinants included prior low mental well-being, limited social support, sexual minority identity, academic difficulties and excessive screen time. Adolescents’ main future-oriented concerns encompassed failure, education and climate change. These results underscore the need to address future perspectives/concerns among young people and implement interventions that strengthen adolescent resilience.

OBJECTIVES:. We sought to describe the indications for vasoactive medication administration, hemodynamic treatment targets, and specific agents used by various international emergency medical service (EMS) providers. DESIGN AND SETTING:. In March 2022, we sent an online survey comprising of 20 questions to Medical Directors of EMSs across Australia, the Asia Pacific region, and North America. PATIENTS:. A total of 108 EMS directors were emailed an invitation to participate. INTERVENTIONS:. None. MEASUREMENTS AND MAIN RESULTS:. Twenty-five EMS medical directors responded. Local site guidelines for vasoactive agent administration were available to 77.3% of providers. Epinephrine was commonly used as first-line vasoactive agent in 52% of questionnaire respondents, followed by norepinephrine (22%), dopamine (18%), and metaraminol (4%). Epinephrine was the most commonly used vasoactive agent across all forms of shock, with a higher proportion of utilization in cases of cardiogenic shock (58%) and patients suffering shock following cardiac arrest (56%). CONCLUSIONS:. International EMS vasoactive use in the management of shock is heterogeneous. Future randomized controlled trials should aim to elucidate optimal prehospital treatment strategies for shock, including the initiation, choice of agent, and monitoring of vasoactive medication.

Adoptive transfer of tumor-infiltrating lymphocytes (TIL) has shown remarkable results in melanoma, but only modest clinical benefits in other cancers, even after TIL have been genetically modified to improve their tumor homing, cytotoxic potential or overcome cell exhaustion. The required ex vivo TIL expansion process may induce changes in the T cell clonal composition, which could likely compromise the tumor reactivity of TIL preparations and ultimately the success of TIL therapy. A promising approach based on the production of bispecific T cell-engagers (TCE) by engineered T cells (STAb-T therapy) improves the efficacy of current T cell redirection strategies against tumor-associated antigens in hematological tumors. We studied the TCRβ repertoire in non-small cell lung cancer (NSCLC) tumors and in ex vivo expanded TIL from two unrelated patients. We generated TIL secreting anti-epidermal growth factor receptor (EGFR) × anti-CD3 TCE (TILSTAb) and tested their antitumor efficacy in vitro and in vivo using a NSCLC patient-derived xenograft (PDX) model in which tumor fragments and TIL from the same patient were transplanted into hIL-2 NOG mice. We confirmed that the standard TIL expansion protocol promotes the loss of tumor-dominant T cell clones and the overgrowth of virus-reactive TCR clonotypes that were marginally detectable in primary tumors. We demonstrated the antitumor activity of TILSTAb both in vitro and in vivo when administered intratumorally and systemically in an autologous immune-humanized PDX EGFR+ NSCLC mouse model, where tumor regression was mediated by TCE-redirected CD4+ TIL bearing non-tumor dominant clonotypes.