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Tim Mercer,1 Alice C Chang,2 Lydia Fischer,3 Adrian Gardner,4–6 Immaculate Kerubo,7,8 Dan N Tran,7,9 Jeremiah Laktabai,10 Sonak Pastakia7,9 1Department of Population Health, The University of Texas at Austin Dell Medical School, Austin, TX 78712, USA; 2Genentech Inc., San Francisco, CA, USA; 3Department of Child Psychiatry, Indiana University School of Medicine, Indianapolis, IN 46202, USA; 4Department of Medicine, Indiana University School of Medicine, Indianapolis, IN 46202, USA; 5Department of Medicine, Moi University School of Medicine, Eldoret, Kenya; 6Indiana Institute for Global Health, Indianapolis, IN 46202, USA; 7Department of Pharmacology and Toxicology, Moi University School of Medicine, Eldoret, Kenya; 8National Spinal Injury Referral Hospital, Nairobi, Kenya; 9Department of Pharmacy Practice, Purdue University College of Pharmacy, Purdue Kenya Partnership P.O. Box 5760, Eldoret 30100, Kenya; 10Department of Family Medicine, Moi University School of Medicine, Eldoret, KenyaCorrespondence: Sonak PastakiaDepartment of Pharmacy Practice, Purdue Kenya Partnership, Purdue University College of Pharmacy, P.O. Box 5760, Eldoret 30100, KenyaEmail spastaki@gmail.comAbstract: Diabetes is a chronic non-communicable disease (NCD) presenting growing health and economic burdens in sub-Saharan Africa (SSA). Diabetes is unique due to its cross-cutting nature, impacting multiple organ systems and increasing the risk for other communicable and non-communicable diseases. Unfortunately, the quality of care for diabetes in SSA is poor, largely due to a weak disease management framework and fragmented health systems in most sub-Saharan African countries. We argue that by synergizing disease-specific vertical programs with system-specific horizontal programs through an integrated disease-system diagonal approach, we can improve access, quality, and safety of diabetes care programs while also supporting other chronic diseases. We recommend utilizing the six World Health Organization (WHO) health system building blocks – 1) leadership and governance, 2) financing, 3) health workforce, 4) health information systems, 5) supply chains, and 6) service delivery – as a framework to design a diagonal approach with a focus on health system strengthening and integration to implement and scale quality diabetes care. We discuss the successes and challenges of this approach, outline opportunities for future care programming and research, and highlight how this approach can lead to the improvement in the quality of care for diabetes and other chronic diseases across SSA.Keywords: diabetes, sub-Saharan African, integrated diagonal health systems approach, health system building blocks, health system strengthening, health system integration

Geoffrey W Siegel,1 J Sybil Biermann,1 Rashmi Chugh,2 Jon A Jacobson,3 David Lucas,4 Mary Feng,5 Andrew C Chang,6 Sean R Smith,7 Sandra Wong,6 Jill L Hasen1 1Department of Orthopedics, 2Department of Medical Oncology, 3Department of Radiology, 4Department of Pathology, 5Department of Radiation, 6Department of Surgery, 7Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI, USA Abstract: The rarity of bone and soft tissue sarcoma, the difficulty in interpretation of imaging and histology, the plethora of treatment modalities, and the complexity and intensity of the treatment contribute to the need for systematic multidisciplinary team management of patients with these diseases. An integrated multidisciplinary clinic and team with a structured sarcoma tumor board facilitate team coordination and communication. This paper reviews the rationale for multidisciplinary management of sarcoma and details the operational structure of the Multidisciplinary Sarcoma Clinic and Sarcoma Tumor Board. The structured Multidisciplinary Sarcoma Tumor Board provides opportunity for improvement in logistics, teaching, quality, and enrollment in clinical trials. Keywords: sarcoma, sarcoma care, sarcoma tumor board, collaborative approach

This study presents a comprehensive examination of the physiological adaptations of white shrimp (Penaeus vannamei) to low-salinity conditions and evaluates the effects of supplementing dietary glucose on disease resistance. Compared to the control group, shrimp cultured at a salinity of 4 psu exhibit significantly elevated expression levels of adenosine 5'-monophosphate-activated protein kinase (AMPK) in the hepatopancreas, which leads to increased energy expenditure and a corresponding reduction in resistance to infection by Vibrio alginolyticus. The suppression of AMPK via dsAMPK treatment markedly enhances disease resistance. Moreover, shrimp raised in low salinity conditions exhibit downregulation of mTOR-associated molecules, including Lipin-1 and hypoxia-inducible factor 1-α (HIF-1α), both of which are essential for immune regulation. Metabolic assessments revealed reduced ATP levels and disrupted ATP/AMP and ATP/ADP ratios, indicating energy imbalance under low salinity stress. Notably, supplementing the diet with 1 % glucose significantly increased glycogen reserves and ATP content, stabilized hemolymph glucose levels, and upregulated glycolysis-related genes, thereby optimizing energy metabolism and enhancing resilience to stress. This study underscores that AMPK activation in response to low salinity conditions leads to increased energy expenditure, which in turn lowers disease resistance. Furthermore, it underscores the critical role of strategic dietary management in maintaining energy homeostasis and improving disease resistance in white shrimp under stressful environmental conditions associated with climate change, offering valuable insights for aquaculture nutrition strategies., Competing Interests: Declaration of competing interest The authors declare that they have no conflicts of interest., (Copyright © 2025 Elsevier Inc. All rights reserved.)

The creation of anisotropic nanoparticles (NPs) by polymerization and/or self-assembly (SA) has significantly promoted the applications of polymer nanomaterials in many fields. However, polymer nanorods are not easily accessible via conventional polymerization or SA. Here we report a one-step route to synthesize single-domain smectic liquid crystalline (LC) nanorods utilizing oriented attachment (OA) that was usually found in the synthesis of inorganic NPs, synchronized with polymerization and SA. The synchronization was achieved by developing a novel stabilizer derived from a thermo-responsive polyelectrolyte system. Mechanistic studies reveal that controlling the thermo-responsive behavior and the distribution of stabilizers on NPs enabled OA. The LC nanorods can further form hierarchical colloidal LCs, which show much larger light transmittance than that of non-LC nanorods. Moreover, we demonstrate that this LC system can be manipulated by an external magnetic field, thus providing a candidate material for magnetic-responsive display., (© 2024 Wiley-VCH GmbH.)

The phase behavior of symmetric diblock copolymers under three-dimensional (3D) soft confinement is investigated using self-consistent field theory. Soft confinement is realized in binary blends composed of AB diblock copolymers and C homopolymers, where the copolymers self-assemble to form a droplet embedded in a homopolymer matrix. The phase behavior of the confined block copolymers is regulated by the degree of confinement and the selectivity of the homopolymers, resulting in a rich variety of novel structures. When the C homopolymers are neutral to the A- and B-blocks, stacked lamellae (SL) are formed where the number of layers increases with the droplet volume, resulting in a morphological transition sequence from Janus particles to square SL. When the C homopolymers are strongly selective for the B-blocks, a series of non-lamellar morphologies, including onion-, hamburger-, cross-, ring-, and cookie-like structures, are observed. A detailed free energy analysis reveals a first-order reversible transformation between SL and onion-like (OL) structures when the selectivity of the homopolymers is changed. Our results provide a comprehensive understanding of how various factors, such as the copolymer concentration, homopolymer chain length, degree of confinement, and homopolymer selectivity, affect the self-assembled structures of diblock copolymers under soft 3D confinement.

This study explores the impact of SYNLAC Prime probiotics on the growth performance, health status, and metabolic profile of white shrimp, Penaeus vannamei. Shrimp fed with the experimental diets, including the control diet without probiotic supplementation, and the diets supplemented with SYNLAC Prime probiotics at concentrations of 10 5  CFU (g diet) -1 (P5) and 10 6  CFU (g diet) -1 (P6) for 56 days. Results indicated a significant enhancement in growth performance in probiotic-treated shrimp relative to the control group, attributed to structural improvements in the digestive tract, particularly the increased abundances of B cells in the hepatopancreas. The administration of dietary probiotics markedly reduced the severity of Enterocytozoon hepatopenaei (EHP) infection and decreased cumulative mortalities following Vibrio alginolyticus challenge. Shrimp in the P6 group exhibited significant elevations in phenoloxidase activity, respiratory burst, lysozyme activity and phagocytic activity compared to control group. Furthermore, there was an upregulation of several immune-related genes in hepatopancreas, including serine protease (SP), prophenoloxidase (proPO) I, proPO II, and penaeidin 3a. Additionally, the expression of β-1, 3-glucan binding protein and SP mRNA was significantly increased in hemocytes. Untargeted metabolomics analysis using LC-MS/MS revealed significant changes in the hepatopancreas metabolic profile, highlighting alterations in energy metabolisms pathways, such as citrate cycle and nicotinate and nicotinamide metabolism, as well as amino acid metabolisms pathways including arginine and proline metabolism, taurine and hypotaurine metabolism, and histidine metabolism. These findings underscore the potential of SYNLAC Prime probiotics in enhancing shrimp growth, immune function, and metabolic pathways, offering valuable insights for advancing health management strategies in shrimp aquaculture., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Eco-friendly aquaculture technology has become a major global trend in recent years. This study's investigation and analysis revealed that eco-friendly aquaculture management technologies increased the production per unit area of the grouper and the fourfinger threadfin. From an economic perspective, it was estimated that the application of eco-friendly aquaculture management technology might increase grouper production by 18.6 metric tons/ha and the output value by US$7,106.9/ha per year, as well as decrease electricity consumption by 1,510.45 kWh/ha/month. It was estimated that for fourfinger threadfin, the use of eco-friendly aquaculture management technologies might increase the production by 10.1 tons/ha and the output value by US$5,031.8/ha each year, as well as reduce the electricity consumption by 257.18 kWh/ha/month. As such, eco-friendly aquaculture management technologies may increase the output value while reducing energy consumption and costs. Furthermore, regression analysis with dummy variables showed that factors affecting grouper production per unit area included applying eco-friendly aquaculture management technology, stocking density, and harvest specifications. However, no significant relationship was identified between breeding time and production per unit area, and the correlation coefficient was negative. The main factors positively affecting the production per unit area of the fourfinger threadfin were stocking density, the application of eco-friendly aquaculture management technology, and harvest specifications. However, a longer breeding time did not result in better production per unit area. This study showed that eco-friendly aquaculture management technology increased the production per unit area and reduced water consumption, electricity consumption, and operating costs to promote sustainable use of water and land resources and sustainable industrial operation and development., 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 Elsevier Ltd. All rights reserved.)

Bladder cancer (BC) is a common malignancy and its most prevalent type is urothelial carcinoma, which accounts for ~90% of all cases of BC. The current treatment options for BC are limited, which necessitates the development of alternative treatment strategies. Hyperthermia (HT), as an adjuvant cancer therapy, is known to improve the efficacy of chemotherapy or radiotherapy. The present study aimed to investigate the anti‑tumor effects of HT on cell survival, invasiveness, chemoresistance and immune evasion in human BC cell lines (5637, T24 and UMUC3). Calcein AM staining was performed to analyze the cytotoxicity of natural killer (NK) cells against human BC cells following HT treatment. Cell migration and invasion affected by HT were analyzed using Transwell migration and invasion assays. It was found that HT inhibited the proliferation of BC cells by downregulating the phosphorylation of protein kinase B. Moreover, HT effectively enhanced the sensitivity of BC cells to the chemotherapy drug cisplatin (DDP) and reduced the chemoresistance of DDP‑resistant cells by downregulating the expression of cadherin‑11. It was further demonstrated that HT inhibited the migration and invasion of BC cells and enhanced the cytotoxic effects of NK cells. In summary, the antineoplastic effects of HT were mediated through three main mechanisms: Enhancement of the chemosensitivity of BC cells and mitigation of DDP‑induced chemoresistance, suppression of the invasive potential of BC cells and reinforcement of the anticancer response of NK cells. Thus, HT appears to be a promising adjunctive therapy for human BC.

Aim: This study aimed to explore anesthesia nurses' (ANs) perceptions of roles, competencies, and attitudes towards patient safety culture, along with predictive factors for patient safety culture., Introduction: The 2021 guidelines from the International Council of Nurses aim to ensure global access to safe surgical and anesthesia care by 2030. However, in Taiwan, the roles and competencies of ANs are still evolving. Many have a limited understanding, posing potential risks to patient safety., Methods: A cross-sectional study was conducted, involving ANs from five hospitals within a healthcare foundation. ANs' self-perceived roles and competencies were assessed using a structured questionnaire based on the CanMEDS framework from the International Federation of Nurse Anesthetists. Additionally, data were collected using the Chinese version of the Safety Attitudes Questionnaire. Reporting followed the STROBE guideline., Results: Among 200 ANs, a consensus emerged favored all roles and competencies, with positive attitudes toward patient safety culture. Remarkably, self-perceived competencies, working in regional hospitals, and working in medical centers significantly predicted ANs' attitude toward patient safety culture., Discussion: The study results can assist ANs in gaining a deeper understanding of their roles and competencies. Considering predictive factors, strengthening ANs' competencies may contribute to enhancing patient safety culture., Conclusion and Implication for Nursing and Health Policy: Our results informed nursing leaders and policymakers in Taiwan and other countries regarding ANs' perceptions of roles and competencies. Nurse managers could consider the specific factors influencing ANs' attitudes toward patient safety culture and make great efforts to develop strategies aimed at enhancing their competencies., (© 2024 International Council of Nurses.)

Breast cancer affects 1/8 of women throughout their lifetimes, with 90% of cancer deaths being caused by metastasis. However, metastasis poses unique challenges to research, as complex changes in the microenvironment in different metastatic sites and difficulty obtaining tissue for study hinder the ability to examine in depth the changes that occur during metastasis. Rapid autopsy programs thus fill a unique need in advancing metastasis research. Here, we describe our protocol and processes for establishing and improving the US-based Hope for OTHERS (Our Tissue Helping Enhance Research and Science) program for organ donation in metastatic breast cancer. Our results reveal key logistical and protocol improvements that are uniquely beneficial to certain programs based on identifiable features, such as working closely with patient advocates, methods to rescue RNA quality in cases where tissue quality may degrade due to time delays, as well as guidelines and future expansions of our program with new research and novel research findings in patient outcomes, metastatic phylogeny, living model development and more., Competing Interests: Conflict of Interest Statement The authors have no conflicts of interest related to this work. Author RB is a former consultant for GE Health (now ended), and current Speaker’s Bureau member for AstraZeneca. Author AB is a current consultant for AstraZeneca, Pfizer, Novartis, Lilly, Genentech/Roche, Daiichi Sankyo, Merck, Agendia, Sanofi, Puma, Myriad, Gilead, Bria-Cell, and receives research support from Agendia and AstraZeneca.