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Natural photosystems couple light harvesting to charge separation using a 'special pair' of chlorophyll molecules that accepts excitation energy from the antenna and initiates an electron-transfer cascade. To investigate the photophysics of special pairs independently of the complexities of native photosynthetic proteins, and as a first step toward creating synthetic photosystems for new energy conversion technologies, we designed C2-symmetric proteins that hold two chlorophyll molecules in closely juxtaposed arrangements. X-ray crystallography confirmed that one designed protein binds two chlorophylls in the same orientation as native special pairs, whereas a second designed protein positions them in a previously unseen geometry. Spectroscopy revealed that the chlorophylls are excitonically coupled, and fluorescence lifetime imaging demonstrated energy transfer. The cryo-electron microscopy structure of a designed 24-chlorophyll octahedral nanocage with a special pair on each edge closely matched the design model. The results suggest that the de novo design of artificial photosynthetic systems is within reach of current computational methods.

Abstract Breath analysis is an area of significant interest in medical research as it allows for non-invasive sampling with exceptional potential for disease monitoring and diagnosis. Volatile organic compounds (VOCs) found in breath can offer critical insight into a person’s lifestyle and/or disease/health state. To this end, the development of a rapid, sensitive, cost-effective and potentially portable method for the detection of key compounds in breath would mark a significant advancement. Herein, we have designed, built and tested a novel reagent-less atmospheric pressure photoionisation (APPI) source, coupled with mass spectrometry (MS), utilising a bespoke bias electrode within a custom 3D printed sampling chamber for direct analysis of VOCs. Optimal APPI-MS conditions were identified, including bias voltage, cone voltage and vaporisation temperature. Calibration curves were produced for ethanol, acetone, 2-butanone, ethyl acetate and eucalyptol, yielding R2 > 0.99 and limits of detection

Background: When it comes to pandemic response, preparation can be the key. Between 2020 and 2024, the fast-paced development of COVID-19—often compounded by pubic policies’ failures to reflect the latest reality and the public’s divergent reactions to the pandemic and the policies—means that society should prepare for exit strategies that can reflect the reality of the pandemic and the interests of the people. Yet oftentimes societies only have one exit strategy with limited scope. This paper investigates the dangers of having only one pandemic exit strategy for pandemics like COVID-19. Methods: Analyses were based on a review of the literature on COVID-19 exit strategies and our own research. The PubMed literature search focused on two concepts—“COVID-19″ and “exit strategy”—and was limited to peer-reviewed papers published between 2020 and 2024 in English. Results: A total of 31 articles were included in the final review. Analyses showed that existing studies on COVID-19 exit strategies often focused on using the modelling method to gauge one exit strategy. Exit strategies were often discussed in the context of implementing, easing, or lifting specific pharmaceutical or non-pharmaceutical interventions. Staged and country-wide coordinated exit strategies were also discussed in the literature, both of which were often deemed as comparatively rigorous options compared to single or stand-alone exit strategies. Drawing on the overall development of COVID-19 and our own research, we presented and discussed the importance of having multiple exit strategies that are considerate of all possible pandemic trajectories, diverse interests of the public, and the communication challenges officials might face in introducing or implementing pandemic policies. Conclusion: This paper underscored the importance of having multiple exit strategies for societies to prepare for pandemics. The insights of this study can help inform health policies so that they can more comprehensively and compassionately protect the needs and wants of the “public” in public health, particularly in grave times like COVID-19.

Positive school climates are associated with numerous benefits for students and school staff. Although there is some evidence that the implementation of school-wide positive behavioral interventions and supports (SWPBIS) impacts features of school climate, such as organizational health, the specific aspects of SWPBIS that contribute to climate have yet to be investigated. In this study, we examined how different components of SWPBIS predicted 490 school staff members' perceptions of school climate. After controlling for race and time in the profession, aspects of staff members' school climate perceptions were positively predicted by the teaching of behavioral expectations and having well-defined corrective consequence systems, and they were negatively predicted by district support for the SWPBIS initiative and having strong school-wide reward systems. These results have implications for which components of SWPBIS schools should prioritize for training and development to have the strongest impact on their staff members' perceptions of school climate.

Children in rural settings are less likely to receive mental health services than their urban and suburban counterparts and even less likely to receive evidence-based care. Rural schools could address the need for mental health interventions by using evidence-based practices within a tiered system of supports such as positive behavioral interventions and supports. However, very few school professionals, with or without mental health training, have received training on evidence-based practices. Rural schools need implementation strategies focused on training to prepare school personnel for the implementation of interventions with fidelity. Little is known about training strategies that are feasible and appropriate for the rural school context. User-centered design is an appropriate framework for the development of training strategies for professionals in rural schools because of its participatory approach and the development of products that fit the context where they are going to be used. The purpose of the study was to develop and assess components of an online training platform and implementation strategy based on the user-centered design. Quantitative and qualitative data from 25 participants from an equal number of schools in rural areas of Pennsylvania were used in the study. A mixed-methods design utilizing complementary descriptive statistics and theme analyses indicated that the training platform and implementation strategy were perceived as highly acceptable, appropriate, feasible and usable by school professionals. The resulting training platform and implementation strategy will fill a void in the training literature in rural schools.

Background Shifting organizational priorities can negatively affect the sustainment of innovations in community settings. Shifting priorities can present barriers to conducting clinical research in schools if a misalignment occurs between school district priorities and the aims of the study. Often this misalignment occurs due to a shift during the period between when the study is submitted for funding and when research activities begin. Participatory research approaches can be employed to restore alignment between study processes and school district priorities. The purpose of the study is to describe data from a shared process with district partners. The shared process resulted in modifications to the main study's implementation processes and strategies in order to restore alignment with evolving school priorities while remaining faithful to the aims of the study. Method Data originated from qualitative interviews conducted with 20 school district and school personnel in a large urban school district. Qualitative themes were organized into categories based on a social-ecological school implementation framework. Data from team meetings, meetings with school district administrators, and emails served to supplement and verify findings from interview analyses. Results Themes included barriers and facilitators at the macro-, school-, individual-, team-, and implementation quality levels. Adaptations were made to address barriers and facilitators and restore alignment with school district priorities. Most adaptations to study processes and implementation strategies focused on re-training and providing more information to school district coaches and school-based staff. New procedures were created, and resources were re-allocated for the larger study. Conclusions Findings were discussed in relation to the implementation literature in schools. Recommendations for sustaining strong collaboration among researchers and school partners are provided.

The 2023 Conference on Magnetism and Magnetic Materials (MMM) was held from October 30–November 3 at the Dallas Hyatt Regency, at the base of the iconic Reunion Tower. There, 703 on-site attendees from 37 different countries discussed cutting-edge research in fundamental and applied magnetism, made new connections, and met old friends and colleagues at one of the first primarily in-person conferences in our field since the major disruptions of the pandemic era. The format of the conference was primarily in-person, with supporting online content that included recordings of the most popular programs and presentations, made available after the conference (including all symposia, the tutorial, and selected other special content). All presenters had the option to contribute online content, as did 96 participants who did not travel to the venue and elected to present virtual posters. Attendees enjoyed a vibrant celebration of the magnetism research community that included a Texas-sized welcome reception, tutorials on machine learning in magnetism, seven symposia, a lively exhibit hall that hosted poster sessions and bierstuben, a full roster of special events, coffee breaks to facilitate active scientific discussions, and of course, excellent technical presentations. These technical presentations, organized into 45 oral sessions, 23 in-person poster sessions, and 17 virtual poster sessions, were selected by a Program Committee of 57 members, capably coordinated by three Program Chairs: Hendrik Ohldag (ALS-LBNL), Karin Leistner (TU Chemnitz), and Takahiro Moriyama (Nagoya University). These three Program Chairs worked seamlessly and tirelessly over many months to make the central mission of MMM a huge success. The Program Committee selected seven symposia from nominations provided by the magnetism community: “Frontier Topics in Antiferromagnetism: Altermagnetism and Topology,” “Rare Earth Spintronics,” “Recent Advances in Cavity Magnonics,” “Emerging Topics in Magnetic Tunnel Junctions: Altermagnetism, Probabilistic Computing and Energy Efficient Switching,” “Orbitronics: From Orbital Currents Created by Charge Currents to Creation by Light or RF Excitation,” “Imaging Magnetic Textures at the Nanoscale,” and finally “Magnetization Dynamics in Two-Dimensional van der Waals Magnets.” These symposia highlighted a wide range of exciting new areas for magnetism, and were part of a total of 101 invited talks, 28% of which were presented by women. The contributed program was selected by the Program Committee from more than 900 submitted abstracts.

Background Aging‐associated left ventricular dysfunction promotes cardiopulmonary fibrogenic remodeling, Group 2 pulmonary hypertension (PH), and right ventricular failure. At the time of diagnosis, cardiac function has declined, and cardiopulmonary fibrosis has often developed. Here, we sought to develop a molecular positron emission tomography (PET)–magnetic resonance imaging (MRI) protocol to detect both cardiopulmonary fibrosis and fibrotic disease activity in a left ventricular dysfunction model. Methods and Results Left ventricular dysfunction was induced by transverse aortic constriction (TAC) in 6‐month‐old senescence‐accelerated prone mice, a subset of mice that received sham surgery. Three weeks after surgery, mice underwent simultaneous PET‐MRI at 4.7 T. Collagen‐targeted PET and fibrogenesis magnetic resonance (MR) probes were intravenously administered. PET signal was computed as myocardium‐ or lung‐to‐muscle ratio. Percent signal intensity increase and Δ lung‐to‐muscle ratio were computed from the pre‐/postinjection magnetic resonance images. Elevated allysine in the heart (P=0.02) and lungs (P=0.17) of TAC mice corresponded to an increase in myocardial magnetic resonance imaging percent signal intensity increase (P

BackgroundIn the Children's Oncology Group ANBL1221 phase 2 trial for patients with first relapse/first declaration of refractory high-risk neuroblastoma, irinotecan and temozolomide (I/T) combined with either temsirolimus (TEMS) or immunotherapy (the anti-GD2 antibody dinutuximab (DIN) and granulocyte macrophage colony stimulating factory (GM-CSF)) was administered. The response rate among patients treated with I/T/DIN/GM-CSF in the initial cohort (n=17) was 53%; additional patients were enrolled to permit further evaluation of this chemoimmunotherapy regimen. Potential associations between immune-related biomarkers and clinical outcomes including response and survival were evaluated.MethodsPatients were evaluated for specific immunogenotypes that influence natural killer (NK) cell activity, including killer immunoglobulin-like receptors (KIRs) and their ligands, Fc gamma receptors, and NCR3. Total white cells and leucocyte subsets were assessed via complete blood counts, and flow cytometry of peripheral blood mononuclear cells was performed to assess the potential association between immune cell subpopulations and surface marker expression and clinical outcomes. Appropriate statistical tests of association were performed. The Bonferroni correction for multiple comparisons was performed where indicated.ResultsOf the immunogenotypes assessed, the presence or absence of certain KIR and their ligands was associated with clinical outcomes in patients treated with chemoimmunotherapy rather than I/T/TEMS. While median values of CD161, CD56, and KIR differed in responders and non-responders, statistical significance was not maintained in logistic regression models. White cell and neutrophil counts were associated with differences in survival outcomes, however, increases in risk of event in patients assigned to chemoimmunotherapy were not clinically significant.ConclusionsThese findings are consistent with those of prior studies showing that KIR/KIR-ligand genotypes are associated with clinical outcomes following anti-GD2 immunotherapy in children with neuroblastoma. The current study confirms the importance of KIR/KIR-ligand genotype in the context of I/T/DIN/GM-CSF chemoimmunotherapy administered to patients with relapsed or refractory disease in a clinical trial. These results are important because this regimen is now widely used for treatment of patients at time of first relapse/first declaration of refractory disease. Efforts to assess the role of NK cells and genes that influence their function in response to immunotherapy are ongoing.Trial registration numberNCT01767194.

Abstract The culling of animals that are infected, or suspected to be infected, with COVID-19 has fuelled outcry. What might have contributed to the ongoing debates and discussions about animal rights protection amid global health crises is the lack of a unified understanding and internationally agreed-upon definition of “One Health”. The term One Health is often utilised to describe the imperative to protect the health of humans, animals, and plants, along with the overarching ecosystem in an increasingly connected and globalized world. However, to date, there is a dearth of research on how to balance public health decisions that could impact all key stakeholders under the umbrella of One Health, particularly in contexts where human suffering has been immense. To shed light on the issue, this paper discusses whether One Health means “human-centred connected health” in a largely human-dominated planet, particularly amid crises like COVID-19. The insights of this study could help policymakers make more informed decisions that could effectively and efficiently protect human health while balancing the health and well-being of the rest of the inhabitants of our shared planet Earth.

Abstract The combination of a geometrically frustrated lattice, and similar energy scales between degrees of freedom endows two-dimensional Kagome metals with a rich array of quantum phases and renders them ideal for studying strong electron correlations and band topology. The Kagome metal, FeGe is a noted example of this, exhibiting A-type collinear antiferromagnetic (AFM) order at T N ≈ 400 K, then establishes a charge density wave (CDW) phase coupled with AFM ordered moment below T CDW ≈ 110 K, and finally forms a c-axis double cone AFM structure around T Canting ≈ 60 K. Here we use neutron scattering to demonstrate the presence of gapless incommensurate spin excitations associated with the double cone AFM structure of FeGe at temperatures well above T Canting and T CDW that merge into gapped commensurate spin waves from the A-type AFM order. Commensurate spin waves follow the Bose factor and fit the Heisenberg Hamiltonian, while the incommensurate spin excitations, emerging below T N where AFM order is commensurate, start to deviate from the Bose factor around T CDW, and peaks at T Canting. This is consistent with a critical scattering of a second order magnetic phase transition with decreasing temperature. By comparing these results with density functional theory calculations, we conclude that the incommensurate magnetic structure arises from the nested Fermi surfaces of itinerant electrons and the formation of a spin density wave order.

Íde O’Shaughnessy,1 Katie Robinson,1 Aoife Whiston,1 Louise Barry,2 Gillian Corey,1 Collette Devlin,1 Deirdre Hartigan,1 Aoife Synnott,3 Aoife McCarthy,4 Eoin Moriarty,5 Bryan Jones,6 Ida Carroll,5 Denys Shchetkovsky,7 Margaret O’Connor,5,8 Fiona Steed,9 Leonora Carey,4 Mairéad Conneely,1 Aoife Leahy,5 Colin Quinn,5 Elaine Shanahan,5 Damien Ryan,7,8 Rose Galvin1 1School of Allied Health, Faculty of Education and Health Sciences, Ageing Research Centre, Health Research Institute, University of Limerick, Limerick, Ireland; 2Department of Nursing and Midwifery, University of Limerick, Limerick, Ireland; 3Department of Physiotherapy, University Hospital Limerick, Limerick, Ireland; 4Department of Occupational Therapy, University Hospital Limerick, Limerick, Ireland; 5Department of Ageing and Therapeutics, University Hospital Limerick, Limerick, Ireland; 6Department of Medical Social Work, University Hospital Limerick, Limerick, Ireland; 7Limerick EM Education Research Training (ALERT), Emergency Department, University Hospital Limerick, Limerick, Ireland; 8School of Medicine, Faculty of Education and Health Sciences, Ageing Research Centre, Health Research Institute, University of Limerick, Limerick, Ireland; 9Department of Health, Government of Ireland, Dublin, IrelandCorrespondence: Íde O’Shaughnessy, School of Allied Health, Faculty of Education and Health Sciences, Ageing Research Centre, Health Research Institute, University of Limerick, Ireland, Tel +35361234149, Email Ide.OShaughnessy@ul.ieBackground: This study aimed to explore the process, clinical, and patient-reported outcomes of older adults who received an interdisciplinary Comprehensive Geriatric Assessment (CGA) in the emergency department (ED) over a six-month period after their initial ED attendance.Patients and Methods: A prospective cohort study recruited older adults aged ≥ 65 years who presented to the ED of a university teaching hospital in Ireland. Baseline assessment data comprising a battery of demographic variables and validated indices were obtained at the index ED attendance. Telephone interviews were completed with participants at 30- and 180-day follow-up. The primary outcome was incidence of hospital admission following the index ED attendance. Secondary outcomes included participant satisfaction, incidence of functional decline, health-related quality of life, incidence of unscheduled ED re-attendance(s), hospital (re)admission(s), nursing home admission, and death.Results: A total of 133 participants (mean age 82.43 years, standard deviation = 6.89 years; 71.4% female) were recruited; 21.8% of the cohort were admitted to hospital following the index ED attendance with a significant decline in function reported at hospital discharge (Z = 2.97, p = 0.003). Incidence of 30- and 180-day unscheduled ED re-attendance was 10.5% and 24.8%, respectively. The outcome at the index ED attendance was a significant predictor of adverse outcomes whereby those who were discharged home had significantly lower odds of multiple adverse process outcomes at 30- and 180-day follow-up, and significantly higher function and health-related quality of life at 30-day follow-up.Conclusion: While this study was observational in nature, findings suggest CGA in the ED may improve outcomes by mitigating against the adverse effects of potentially avoidable hospital admissions and focusing on a longitudinal approach to healthcare delivery at the primary-secondary care interface. Future research should be underpinned by an experimental study design to address key limitations in this study.Keywords: frailty, emergency care, longitudinal study, adverse outcomes, integrated care

This paper presents a systematic bibliometric analysis of the artificial intelligence (AI) domain to explore privacy protection research as AI technologies integrate and data privacy concerns rise. Understanding evolutionary patterns and current trends in this research is crucial. Leveraging bibliometric techniques, the authors analyze 8,322 papers from the Web of Science (WoS) database, spanning 1990 to 2023. The analysis highlights IEEE Transactions on Knowledge and Data Engineering and IEEE Access journals as highly influential, the former being an early contributor and the latter emerging as a pivotal source. The study demonstrates substantial disparities in scientific productivity across countries. Specifically, the top 10 countries collectively accounted for 74.8% of the articles, with China and the USA making up nearly half of the total contribution (46.1%). In contrast, regions in Africa and South America exhibited lower scientific production. The evolution of privacy preservation research is reflected, shifting from an algorithm-oriented approach to a focus on data orientation, and subsequently, to privacy solutions centered around Cloud Computing. In recent years, there has been a shift towards embracing Federated Learning and Differential Privacy. The analysis brings to light emerging themes and identifies research gaps, notably a global disparity in research output and a lag in ethical and legal inquiry. It asserts that enhanced interdisciplinary collaboration is imperative to formulate comprehensive privacy solutions for AI. Specifically, the paper imparts invaluable insights that are pivotal for effectively addressing the evolving privacy concerns in the era of AI and big data.

Treatment foster care (TFC) provides critical mental health supports for youth with emotional, behavioral, and social difficulties who are at risk for adverse long-term outcomes. Existing evidence-based models of TFC are effective, yet resource-intensive, and they have relied primarily on evidence of implementation effectiveness with samples of non-minority parents. Recent research highlights the efficacy of an emerging, socially acceptable model that integrates existing evidence-based practices with usual care. This study applied the new model, Together Facing the Challenge (TFTC), within an urban TFC program. Trained TFC program staff delivered the TFTC training to foster parents in two cohorts. Foster parents reported child problem and prosocial behaviors pre-, mid-, and post-training, as well as 1, 3, and 12 months after the training. Results indicated that foster parents demonstrated an increase in knowledge of TFTC skills following the training and were satisfied with the training. Child problem behaviors significantly decreased over time. There were no significant changes in prosocial behavior over time. Implications of this study include the replication and extension of the use of TFTC, an evidence-based and resource-efficient intervention, to reduce problem behaviors of TFC children in urban settings.

Pulmonary hypertension (PH) pathogenesis is driven by inflammatory and metabolic derangements as well as glycolytic reprogramming. Induction of both interleukin 6 (IL6) and transglutaminase 2 (TG2) expression participates in human and experimental cardiovascular diseases. However, little is known about the role of TG2 in these pathologic processes. The current study aimed to investigate the molecular interactions between TG2 and IL6 in mediation of tissue remodeling in PH. A lung-specific IL6 over-expressing transgenic mouse strain showed elevated right ventricular (RV) systolic pressure as well as increased wet and dry tissue weights and tissue fibrosis in both lungs and RVs compared to age-matched wild-type littermates. In addition, IL6 over-expression induced the glycolytic and fibrogenic markers, hypoxia-inducible factor 1α, pyruvate kinase M2 (PKM2), and TG2. Consistent with these findings, IL6 induced the expression of both glycolytic and pro-fibrogenic markers in cultured lung fibroblasts. IL6 also induced TG2 activation and the accumulation of TG2 in the extracellular matrix. Pharmacologic inhibition of the glycolytic enzyme, PKM2 significantly attenuated IL6-induced TG2 activity and fibrogenesis. Thus, we conclude that IL6-induced TG2 activity and cardiopulmonary remodeling associated with tissue fibrosis are under regulatory control of the glycolytic enzyme, PKM2.

Abstract De novo protein design methods can create proteins with folds not yet seen in nature. These methods largely focus on optimizing the compatibility between the designed sequence and the intended conformation, without explicit consideration of protein folding pathways. Deeply knotted proteins, whose topologies may introduce substantial barriers to folding, thus represent an interesting test case for protein design. Here we report our attempts to design proteins with trefoil (31) and pentafoil (51) knotted topologies. We extended previously described algorithms for tandem repeat protein design in order to construct deeply knotted backbones and matching designed repeat sequences (N = 3 repeats for the trefoil and N = 5 for the pentafoil). We confirmed the intended conformation for the trefoil design by X ray crystallography, and we report here on this protein’s structure, stability, and folding behaviour. The pentafoil design misfolded into an asymmetric structure (despite a 5-fold symmetric sequence); two of the four repeat-repeat units matched the designed backbone while the other two diverged to form local contacts, leading to a trefoil rather than pentafoil knotted topology. Our results also provide insights into the folding of knotted proteins.

Mairéad Conneely,1 Siobhán Leahy,2 Margaret O’Connor,3 Gillian Corey,3 Ahmed Gabr,3 Anastasia Saleh,3 Blessing Okpaje,3 Íde O’ Shaughnessy,1,3 Aoife Synnott,3 Aoife McCarthy,3 Alison Holmes,1 Katie Robinson,1 Lorna Ryan,1 Anne Griffin,1 Louise Barry,4 Dominic Trépel,5 Damian Ryan,6 Rose Galvin1 On behalf of Ageing Research Centre Public and Patient Involvement (PPI) Panel of older adults1School of Allied Health, Faculty of Education and Health Sciences, Ageing Research Centre, Health Research Institute, University of Limerick, Limerick, Ireland; 2Department of Sport, Exercise & Nutrition, School of Science & Computing, Atlantic Technological University, Galway, Ireland; 3Department of Ageing and Therapeutics, University Hospital Limerick, Limerick, Ireland; 4School of Nursing and Midwifery, Faculty of Education and Health Sciences, University of Limerick, Limerick, Ireland; 5Trinity Institute of Neurosciences, School of Medicine, Trinity College Dublin, Dublin, Ireland; 6Limerick EM Education Research Training (ALERT), Emergency Department, University Hospital Limerick, Limerick, IrelandCorrespondence: Mairéad Conneely, Email mairead.c.conneely@ul.ieBackground: Older adults frequently attend the emergency department (ED) and experience high rates of subsequent adverse outcomes including functional decline, ED re-presentation and unplanned hospital admission. The development of effective interventions to prevent such outcomes is a key priority for research and service provision. Our aim was to evaluate the feasibility of a physiotherapy-led integrated care intervention for older adults discharged from the ED (ED PLUS).Patients and Methods: Older adults presenting to the ED of a university teaching hospital with undifferentiated medical complaints and discharged within 72 hours were computer randomised in a ratio of 1:1:1 to deliver usual care, Comprehensive Geriatric Assessment (CGA) in the ED, or ED PLUS. ED PLUS is an evidence-based and stakeholder-informed intervention to bridge the care transition between the ED and community by initiating a CGA in the ED and implementing a six-week, multi-component, self-management programme in the patient’s home. Feasibility and acceptability were assessed quantitatively and qualitatively. All clinical and process outcomes were assessed by a research nurse blinded to group allocation. Data analyses were primarily descriptive.Results: Twenty-nine participants were recruited indicating a 67% recruitment rate. At 6 months, there was 100% retention in the usual care group, 88% in the CGA group and 90% in the ED PLUS group. ED PLUS participants expressed positive feedback, and there was a trend towards improved function and quality of life and less ED revisits and unscheduled hospitalisations in the ED PLUS group.Conclusion: ED PLUS bridges the transition of care between the index visit to the ED and the community and is feasible using systematic recruitment strategies. Despite recruitment challenges in the context of COVID-19, the intervention was successfully delivered and well received by participants. There was a lower incidence of functional decline and improved quality of life in the ED PLUS group.Trial Registration: The trial was registered in Clinical Trials Protocols and Results System as of 21st July 2021, with registration number NCT04983602.Plain Language Summary: Older people need support when they are discharged from the Emergency Department (ED) to their home as a visit to the ED is linked to negative outcomes. This study reports on a trial to reduce negative outcomes in older people discharged from the ED by an assessment in the ED and treatment in the home. Twenty-nine patients attending the ED of University Hospital Limerick were randomly assigned to three groups as follows: One group got the normal care and treatment; Group two received a comprehensive assessment by a dedicated geriatric doctor in the ED and were referred to other health professionals as needed; a third group, called ED PLUS, also received a comprehensive assessment by a dedicated geriatric doctor in the ED and an additional six-week treatment program led by a physiotherapist. The physiotherapist visited the older adult in their own home within twenty-four hours of discharge to start treatment based on what the older adult needed to do to live safely in their own home and again at week four and week six. The same geriatric doctor who saw the older adult in the ED telephoned the older adult in week two to check medications and discussed the case with the physiotherapist. A dietitian and occupational therapist telephoned the older adults to check nutritional intake and if any aids were needed in the home. All older adults in the ED PLUS group had improved quality of their life, improved mobility and did not need to go back to the hospital or ED at six weeks and six months unlike the two other groups. The COVID-19 pandemic affected recruitment, but all ED PLUS patients were extremely satisfied.Keywords: emergencies, recruitment, integrated care, care transitions, public and patient involvement

The structure of the title complex, [Zn2(C2H3O2)4(C11H9N3O)2], is triclinic containing half of the molecule in the asymmetric unit. Each zinc atom is coordinated to a pyridyl and oxime nitrogen from one di-2-pyridyl ketone oxime (dpko) ligand and a third nitrogen from the other dpko pyridyl ring. Additionally, each zinc is coordinated to two acetato anions, one of which is bidentate and the other monodentate. The uncoordinated oxygen of the monodentate acetato group is involved in a hydrogen bond with the oxime hydrogen. The packing in the crystal is assisted by weak C—H...O interactions between acetato groups and neighboring pyridyl rings.

PurposeWe evaluated whether combining a humanized antidisialoganglioside monoclonal antibody (hu14.18K322A) throughout therapy improves early response and outcomes in children with newly diagnosed high-risk neuroblastoma.Patients and methodsWe conducted a prospective, single-arm, three-stage, phase II clinical trial. Six cycles of induction chemotherapy were coadministered with hu14.18K322A, granulocyte-macrophage colony-stimulating factor (GM-CSF), and low-dose interleukin-2 (IL-2). The consolidation regimen included busulfan and melphalan. When available, an additional cycle of parent-derived natural killer cells with hu14.18K322A was administered during consolidation (n = 31). Radiation therapy was administered at the end of consolidation. Postconsolidation treatment included hu14.18K322A, GM-CSF, IL-2, and isotretinoin. Early response was assessed after the first two cycles of induction therapy. End-of-induction response, event-free survival (EFS), and overall survival (OS) were evaluated.ResultsSixty-four patients received hu14.18K322A with induction chemotherapy. This regimen was well tolerated, with continuous infusion narcotics. Partial responses (PRs) or better after the first two chemoimmunotherapy cycles occurred in 42 of 63 evaluable patients (66.7%; 95% CI, 55.0 to 78.3). Primary tumor volume decreased by a median of 75% (range, 100% [complete disappearance]-5% growth). Median peak hu14.18K322A serum levels in cycle one correlated with early response to therapy (P = .0154, one-sided t-test). Sixty of 62 patients (97%) had an end-of-induction partial response or better. No patients experienced progressive disease during induction. The 3-year EFS was 73.7% (95% CI, 60.0 to 83.4), and the OS was 86.0% (95% CI, 73.8 to 92.8), respectively.ConclusionAdding hu14.18K322A to induction chemotherapy improved early objective responses, significantly reduced tumor volumes in most patients, improved end-of-induction response rates, and yielded an encouraging 3-year EFS. These results, if validated in a larger study, may be practice changing.

The Session Rating Scale (SRS) is a widely used clinical tool to measure the client-therapist working alliance. This study investigated the psychometric properties, the cut-off value, and longitudinal invariance of the SRS in a Chinese clinical population. The analyses were conducted separately in a sample of college students in counseling (n = 403) and in a sample of clients in outpatient therapy (n = 246). Participants completed the Outcome Rating Scale (ORS) before each session and the SRS after each session. To test concurrent validity, a subset of participants also completed the Working Alliance Questionnaire at the end of each session. In both samples, the results indicated high internal consistency ([alpha] = .92 ~ 0.97) and adequate test-retest reliability over four sessions (university sample: r = .69 ~ .78; outpatient sample: r = .52 ~ .66). Construct validity was evident in a one-factor structure, and concurrent validity was established based on a strong correlation with the Working Alliance Questionnaire (r = .64 ~ .70). In addition, regression analysis indicated that early alliance ratings (at the third session) on the SRS predicted post-ORS scores. The cut-off value for the SRS in the Chinese context was established as 34. The longitudinal measurement invariance was tested by a longitudinal confirmatory factor analysis. Full scalar invariance of the SRS was supported. This study supported the use of the SRS in China and that a single-factor solution stayed stable over time, providing preliminary evidence for subsequent mean comparisons., Author(s): Zhuang She [sup.1] [sup.2] , Yanwei Shi [sup.3] , Barry L. Duncan [sup.4] , Dong Xie [sup.5] , Juzhe Xi [sup.1] [sup.2] , Qiwu Sun [sup.6] , Weidong Ji [...]