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Abstract Shape-morphing capabilities are crucial for enabling multifunctionality in both biological and artificial systems. Various strategies for shape morphing have been proposed for applications in metamaterials and robotics. However, few of these approaches have achieved the ability to seamlessly transform into a multitude of volumetric shapes post-fabrication using a relatively simple actuation and control mechanism. Taking inspiration from thick origami and hierarchies in nature, we present a hierarchical construction method based on polyhedrons to create an extensive library of compact origami metastructures. We show that a single hierarchical origami structure can autonomously adapt to over 103 versatile architectural configurations, achieved with the utilization of fewer than 3 actuation degrees of freedom and employing simple transition kinematics. We uncover the fundamental principles governing theses shape transformation through theoretical models. Furthermore, we also demonstrate the wide-ranging potential applications of these transformable hierarchical structures. These include their uses as untethered and autonomous robotic transformers capable of various gait-shifting and multidirectional locomotion, as well as rapidly self-deployable and self-reconfigurable architecture, exemplifying its scalability up to the meter scale. Lastly, we introduce the concept of multitask reconfigurable and deployable space robots and habitats, showcasing the adaptability and versatility of these metastructures.

Gamified Flipped Learning (GFL), a pedagogical approach that combines the methodology of flipped learning with gamification techniques, has gained increasing attention in recent years, particularly within the context of higher education. This systematic literature review aims to provide educators and researchers with a comprehensive understanding of how GFL has been implemented and with what results. Following the PRISMA guidelines, 26 studies were selected and analysed. The findings indicate that this research field is still evolving and exhibits a high degree of diversity, both in terms of implementation approaches and research methods. This high level of variability is indicative of the flexibility of the approach, but it also presents a challenge for educators wishing to implement it. In light of the aforementioned findings, a set of design principles derived from the analysis is proposed to guide effective GFL practice and assist educators in successfully adopting GFL strategies.

Fluid‐driven artificial muscles exhibit a behavior similar to biological muscles which makes them attractive as soft actuators for wearable assistive robots. However, state‐of‐the‐art fluidic systems typically face challenges to meet the multifaceted needs of soft wearable robots. First, soft robots are usually constrained to tethered pressure sources or bulky configurations based on flow control valves for delivery and control of high assistive forces. Second, although some soft robots exhibit untethered operation, they are significantly limited to low force capabilities. Herein, an electrohydraulic actuation system that enables both untethered and high‐force soft wearable robots is presented. This solution is achieved through a twofold design approach. First, a simplified direct‐drive actuation paradigm composed of motor, gear‐pump, and hydraulic artificial muscle (HAM) is proposed, which allows for a compact and lightweight (1.6 kg) valveless design. Second, a fluidic engine composed of a high‐torque motor with a custom‐designed gear pump is created, which is capable of generating high pressure (up to 0.75 MPa) to drive the HAM in delivering high forces (580 N). Experimental results show that the developed fluidic engine significantly outperforms state‐of‐the‐art systems in mechanical efficiency and suggest opportunities for effective deployment in soft wearable robots for human assistance.

The global dissemination of multi-drug resistant (MDR) pathogenic bacteria requires the rapid research and development of alternative therapies that can support or replace conventional antibiotics. Among MDR pathogens, carbapenem-resistant Klebsiella pneumoniae (CR-Kp) are of particular concern due to their extensive resistance profiles, global dissemination in hospital environments, and their major role in some life-threatening infections. Phages, or some of their components, are recognized as one of the potential alternatives that might be helpful to treat bacterial infections. In this study, we have isolated and characterized four lytic bacteriophages targeting K. pneumoniae strains of Sequence Type (ST) 307 or ST147, two predominant high-risk clones of CR-Kp. Phages, designated vB_KpS_GP-1, vB_KpP_GP-2, vB_KpP_GP-4, and vB_KpP_GP-5, were isolated from sewage wastewater samples. The vB_KpS_GP-1 phage was a siphovirus unable to establish lysogeny with its host, while the other three were podoviruses. While 85.7% of K. pneumoniae strains of ST307 were selectively lysed by the phages vB_KpS_GP-1 or vB_KpP_GP-5, the other two phages were able to lyse all the tested strains of ST147 (n = 12). Phages were stable over a broad pH and temperature range and were characterized by burst sizes of 10–100 plaque forming units and latency periods of 10–50 minutes. Genome sequencing confirmed the absence of antibiotic resistance genes, virulence factors or toxins and revealed that two phages were likely members of new genera. Given their strictly lytic nature and high selectivity towards two of the major high-risk clones of K. pneumoniae, cocktails of these phages could represent promising candidates for further evaluation in in vivo experimental models of K. pneumoniae infection.

Mycobacterium abscessus (Mab) is an opportunistic nontuberculous mycobacterium responsible of difficult-to-treat pulmonary infections in vulnerable patients, such as those suffering from Cystic Fibrosis (CF), where it represents a major cause of morbidity and mortality. Additionally, due to the intrinsic extensive antimicrobial resistance spectrum displayed by this species and the side effects reported for some available antibiotics, the therapeutic management of such infections remains extremely difficult. In the present study, we show that phosphatidylserine liposomes (PS-L) enhance intracellular mycobacterial killing of Mab infected human macrophages with functional or pharmacologically inhibited cystic fibrosis conductance regulator (CFTR), by a mechanism involving phagosome acidification and reactive oxygen species (ROS) production. Additionally, PS-L significantly reduce proinflammatory response of Mab infected macrophages in terms of NF-kB activation and TNF-α production, irrespective of CFTR inhibition. Altogether, these results represent the proof of concept for a possible future development of PS-L as a therapeutic strategy against difficult-to-treat Mab infection.

Fluid‐driven artificial muscles exhibit a behavior similar to biological muscles which makes them attractive as soft actuators for wearable assistive robots. However, state‐of‐the‐art fluidic systems typically face challenges to meet the multifaceted needs of soft wearable robots. First, soft robots are usually constrained to tethered pressure sources or bulky configurations based on flow control valves for delivery and control of high assistive forces. Second, although some soft robots exhibit untethered operation, they are significantly limited to low force capabilities. Herein, an electrohydraulic actuation system that enables both untethered and high‐force soft wearable robots is presented. This solution is achieved through a twofold design approach. First, a simplified direct‐drive actuation paradigm composed of motor, gear‐pump, and hydraulic artificial muscle (HAM) is proposed, which allows for a compact and lightweight (1.6 kg) valveless design. Second, a fluidic engine composed of a high‐torque motor with a custom‐designed gear pump is created, which is capable of generating high pressure (up to 0.75 MPa) to drive the HAM in delivering high forces (580 N). Experimental results show that the developed fluidic engine significantly outperforms state‐of‐the‐art systems in mechanical efficiency and suggest opportunities for effective deployment in soft wearable robots for human assistance. [ABSTRACT FROM AUTHOR]

The global dissemination of multi-drug resistant (MDR) pathogenic bacteria requires the rapid research and development of alternative therapies that can support or replace conventional antibiotics. Among MDR pathogens, carbapenem-resistant Klebsiella pneumoniae (CR-Kp) are of particular concern due to their extensive resistance profiles, global dissemination in hospital environments, and their major role in some life-threatening infections. Phages, or some of their components, are recognized as one of the potential alternatives that might be helpful to treat bacterial infections. In this study, we have isolated and characterized four lytic bacteriophages targeting K. pneumoniae strains of Sequence Type (ST) 307 or ST147, two predominant high-risk clones of CR-Kp. Phages, designated vB_KpS_GP-1, vB_KpP_GP-2, vB_KpP_GP-4, and vB_KpP_GP-5, were isolated from sewage wastewater samples. The vB_KpS_GP-1 phage was a siphovirus unable to establish lysogeny with its host, while the other three were podoviruses. While 85.7% of K. pneumoniae strains of ST307 were selectively lysed by the phages vB_KpS_GP-1 or vB_KpP_GP-5, the other two phages were able to lyse all the tested strains of ST147 (n = 12). Phages were stable over a broad pH and temperature range and were characterized by burst sizes of 10-100 plaque forming units and latency periods of 10-50 minutes. Genome sequencing confirmed the absence of antibiotic resistance genes, virulence factors or toxins and revealed that two phages were likely members of new genera. Given their strictly lytic nature and high selectivity towards two of the major high-risk clones of K. pneumoniae, cocktails of these phages could represent promising candidates for further evaluation in in vivo experimental models of K. pneumoniae infection. [ABSTRACT FROM AUTHOR]

Talking Circles are safe spaces where relationships are built, nurtured, reinforced, and sometimes healed; where norms and values are established; and where people connect intellectually, spiritually, and emotionally with other members of the Circle. The Circle can also be an evaluation method that increases voice, decreases invisibility, and does not privilege one worldview or version of reality over another. The purpose of this article is to describe how the Circle can be a culturally responsive evaluation practice for those evaluators wishing to build relationships, share power, elicit stakeholder voice, solve problems, and increase participants' capacity for program design, implementation, and evaluation. Circles can be used by both Indigenous and non-Indigenous evaluators. By offering the global evaluation community this concrete, practical, and culturally responsive approach, we open the door so that others can build on this work and offer additional insights as this practice is used, refined, and documented.

Powered knee exoskeletons have shown potential for mobility restoration and power augmentation. However, the benefits of exoskeletons are partially offset by some design challenges that still limit their positive effects on people. Among them, joint misalignment is a critical aspect mostly because the human knee joint movement is not a fixed-axis rotation. In addition, remarkable mass and stiffness are also limitations. Aiming to minimize joint misalignment, this paper proposes a bio-inspired knee exoskeleton with a joint design that mimics the human knee joint. Moreover, to accomplish a lightweight and high compliance design, a high stiffness cable-tension amplification mechanism is leveraged. Simulation results indicate our design can reduce 49.3 and 71.9% maximum total misalignment for walking and deep squatting activities, respectively. Experiments indicate that the exoskeleton has high compliance (0.4 and 0.1 Nm backdrive torque under unpowered and zero-torque modes, respectively), high control bandwidth (44 Hz), and high control accuracy (1.1 Nm root mean square tracking error, corresponding to 7.3% of the peak torque). This work demonstrates performance improvement compared with state-of-the-art exoskeletons.

BackgroundOur research groups have developed a number of parental knowledge translation (KT) tools to help families understand common childhood illnesses and make informed decisions regarding when to seek urgent care. We have developed a series of videos to help parents understand how to manage common acute childhood illnesses at home and when to contact emergency health care services. It is unclear whether the videos in their current form and language are useful for a wider range of populations, including Indigenous groups. ObjectiveThe purpose of this study was to explore whether and understand how our KT tools could be adapted for use with Indigenous communities. MethodsHealth care providers (HCPs) serving Indigenous families in Alberta, Canada, were asked to review 2 of our KT tools (one on croup and one on acute otitis media), complete a demographic survey, and participate in a one-on-one semistructured interview. HCPs were asked to reflect on the usability of the KT tools within their practice and what cultural adaptation considerations they felt would be needed to develop KT tools that meet the needs of Indigenous clients. Audio recordings from the interviews were transcribed verbatim and analyzed for relevant themes using thematic analysis. ResultsA total of 18 HCPs (n=15, 83% women and n=3, 17% men) from various health professions (eg, physician, registered nurse, and licensed practical nurse) were interviewed. Of these 18 HCPs, 7 (39%) self-identified as Indigenous. Four overarching themes were identified as important when considering how to adapt KT tools for use by Indigenous communities: accessibility, relatability, KT design, and relationship building. Access to tangible resources and personal and professional connections were considered important. Accessibility affects the types of KT tools that can be obtained or used by various individuals and communities and the extent to which they can implement recommendations given in those KT tools. In addition, the extent to which users relate to the depictions and content within KT tools must be considered. The environments, portrayals of characters, and cultural norms and values presented within KT tools should be relevant to users to increase the relatability and uptake of recommendations. Most importantly, fostering genuine and sustainable relationships with users and communities is a vital consideration for KT tool developers. ConclusionsThese findings serve to cultivate a greater understanding of the various components that HCPs consider important when developing or culturally adapting KT tools for use by Indigenous families. This information will help support the effective adaptation and distribution of KT tools for use by a broad audience. Careful consideration of the themes identified in this study highlights the importance of working together with the knowledge users (health care consumers) when developing KT tools.

Sherri Di Lallo,1 Keren Schoenberger,2 Laura Graham,2 Ashley Drobot,2 Mubashir Aslam Arain3 1Stollery Awasisak Indigenous Health, Alberta Health Services, Edmonton, Alberta, Canada; 2Health Systems Evaluation and Evidence, Alberta Health Services, Edmonton, Alberta, Canada; 3Health Systems Evaluation and Evidence, Alberta Health Services, Calgary, Alberta, CanadaCorrespondence: Mubashir Aslam ArainHealth Systems Evaluation and Evidence, Alberta Health Services, 10301 Southport Lane SW, Calgary, Alberta, T2W 1S7, CanadaTel +1 403-943-0783Fax +1 403-943-2875Email mubashiraslam.arain@ahs.caObjective: The Stollery Children’s Hospital in Edmonton, Alberta, introduced the Stollery Awasisak team to provide targeted support to Indigenous families and their children. Talking Circles were conducted across northern communities from 2017 to 2019 to better understand how Indigenous people perceive the current state of healthcare services delivered by the Stollery Hospital.Methods: The 2019 Talking Circles were held in six cities: Grande Prairie, Slave Lake, High Level, Fort McMurray, Edmonton, and Cold Lake, which were the biggest circles held to date with an attendance of 160 participants. Participants included members of Treaties 6 and 8, and Metis Nations of Alberta, as well as healthcare professionals in those regions.Results: Talking Circles identified challenges Indigenous (First Nation, Inuit and Metis) pediatric patients and their families experienced from accessing care to transitioning home to exploring their positive experiences with the Stollery Hospital and other frontline collaborates. Through these circles guided by Elders in ceremonies, priorities and recommendations were made to help support pediatric patients and their families.Conclusion: Multiple perspectives provided rich data on how best to adhere to the Truth Reconciliation of Canada 19th mandate and ensure equitable healthcare access to all Indigenous children. Together, leaders, healthcare providers, service providers and community members reflected on the lessons of the Medicine Wheel quadrants and the Seven Sacred Teachings, and brought forward four priorities; capacity building, continuity of care, culturally responsive care and increased communication.Keywords: discharge planning, Indigenous Health, Talking Circles, cultural safety

Mycobacterium abscessus (Mab) is an opportunistic nontuberculous mycobacterium responsible of difficult-to-treat pulmonary infections in vulnerable patients, such as those suffering from Cystic Fibrosis (CF), where it represents a major cause of morbidity and mortality. Additionally, due to the intrinsic extensive antimicrobial resistance spectrum displayed by this species and the side effects reported for some available antibiotics, the therapeutic management of such infections remains extremely difficult. In the present study, we show that phosphatidylserine liposomes (PS-L) enhance intracellular mycobacterial killing of Mab infected human macrophages with functional or pharmacologically inhibited cystic fibrosis conductance regulator (CFTR), by a mechanism involving phagosome acidification and reactive oxygen species (ROS) production. Additionally, PS-L significantly reduce proinflammatory response of Mab infected macrophages in terms of NF-kB activation and TNF-α production, irrespective of CFTR inhibition. Altogether, these results represent the proof of concept for a possible future development of PS-L as a therapeutic strategy against difficult-to-treat Mab infection. [ABSTRACT FROM AUTHOR]

Abstract Background Breast cancer (BC) presents important physical and psychological challenges that should be appropriately addressed through continuous, integrated and individualized rehabilitation programs after treatment. In this study, we aimed to collect more information on the rehabilitation patterns and utilization of healthcare services by women with BC. Methods We retrospectively analyzed data from two archives of the Lazio Regional Health System Database to assess rehabilitation patterns in women diagnosed with BC in the Lazio region (Italy) in 2008. Results A total of 5538 women diagnosed with BC were considered in the present study. Most patients (81.7%) received outpatient rehabilitative care, consisting mainly of pathology-related interventions and, more rarely, disability-related interventions (mainly motor rehabilitation and rarely cognitive or psychological therapy). Few patients followed an inpatient (1.3%) or an intensive outpatient rehabilitation program (1.0%). Conclusion Most patients do not receive adequate rehabilitation care during the first year after diagnosis. More information and better rehabilitation services should be provided to help patients with BC access rehabilitation programs. The study also suggests the importance of psychosocial and cognitive interventions, which is a major unmet need in women with BC.

Abstract Background Italy was the first country in Europe affected by COVID-19: the emergency started on February 20, 2020, culminating with national lockdown on March 11, which terminated on May 4, 2020. We describe how the pandemic affected Emergency Department (ED) accesses in a tertiary children’s hospital, composed by two different pediatric centers, one located in Rome’s city center and the second, Palidoro (regional COVID-19 center), in its surrounding metropolitan area, both in the Lazio region, analyzing the profile of admitted patients during the pandemic period in terms of their general characteristics (at presentation in the ED’s) and urgent hospitalizations compared to prepandemic period. Methods The study compare the period between the 21st of February and the 30th of April 2020, covering the three phases of the national responses (this period will be referred to as the pandemic period) with the same period of 2019 (prepandemic period). The study analyzes the number of ED visits and urgent hospitalizations and their distribution according to selected characteristics. Results The reduction of ED visits was 56 and 62%, respectively in Rome and Palidoro centers. The higher relative decline was encountered for Diseases of Respiratory System, and for Diseases of the Nervous System and Sense Organs. A doubling of the relative frequency of hospitalizations was observed, going from 14.2 to 24.4% in Rome and from 6.4 to 10.3% in Palidoro. In terms of absolute daily numbers the decrease of urgent hospitalizations was less sharp than ED visits. For pathologies such as peritonitis, tumors or other possible life-treathening conditions we did not observe a significative increase due to delayed access. Conclusions In the pandemic period there was a general reduction in the number of children referred to ED, such reduction was greater in low-acuity levels. The reduction for respiratory tract infections and other communicable diseases during school closure and the national lockdown must make us reflect on the possible impact that these conditions may have on the health system, in particular the ED, at the reopening of schools. The major problem remains the fear for possible diagnostic delays in life-threatening or crippling diseases; our study doesn’t demonstrate an increase in number or significant delay in some serious conditions such as tumors, peritonitis, diabetic ketoacidosis, ileo-colic intussusception and testis/ovary torsion. A continuous, deep re-organizational process step by step of the ED is nececessary in the present and upcoming pandemic situation.

Objectives: The aim of this study is to characterize a new bacteriophage able to infect Enterococcus faecalis, and to evaluate its ability to disrupt biofilm. Methods: The vB_EfaH_EF1TV (EF1TV) host-range was determined by spot test and efficiency of plating using a collection of 15E. faecalis clinical strains. The phage genome was sequenced with a next generation sequencing approach. Anti-biofilm activity was tested by crystal violet method and confocal laser scanning microscopy. Phage-resistant mutants were selected and sequenced to investigate receptors exploited by phage for infection. Results: EF1TV is a newly discoveredE. faecalis phage which belongs to the Herelleviridae family. EF1TV, whose genome is 98% identical to φEF24C, is characterized by a linear dsDNA genome of 143,507 bp with direct terminal repeats of 1,911 bp. The phage is able to infect E. faecalis and shows also the ability to degrade biofilm produced by strains of this species. The results were confirmed by confocal laser scanning microscopy analyzing the biofilm reduction in the same optical field before and after phage infection. Conclusions: The EF1TV phage shows promising features such as an obligatory lytic nature, an anti-biofilm activity and the absence of integration-related proteins, antibiotic resistance determinants and virulence factors, and therefore could be a promising tool for therapeutic applications.

Human activities impact greenhouse gas emissions through changes in land cover, land use, and land management. Conservation, restoration, and improved land use and land management are increasingly recognized as mitigation solutions. Policy instruments are crucial for addressing environmental challenges and supporting governance actors in enhancing carbon sequestration and reducing emissions in the land sector. The aim of this study was to evaluate the existing spatial decision support systems (SDSSs) for assessing land-based mitigation options and to help policymakers choose the best way to use and manage land. In order to search for tools, a systematic literature review was conducted, where 187 articles suitable for the specified criteria were found, from which 68 tools were selected. Additionally, following the application of the exclusion criteria, 18 tools were chosen for the final analysis. The tools were classified and analyzed based on various features such as type of land-use management, land use, country of application, information on carbon pools, and the number of published articles associated with each tool. Five SDSSs were found to be most suitable for policymakers seeking to implement the most effective land use and land management in order to enhance carbon sequestration. [ABSTRACT FROM AUTHOR]

The Land-Use, Land-Use Change and Forestry sector (LULUCF) role is of critical importance in contributing to the ambitious targets set by the European Union (EU) to reduce by 55% net greenhouse gas (GHG) emissions by 2030, compared to 1990 levels, and to become carbon neutral by 2050. The EU LULUCF regulation, approved in 2023, sets out binding targets for each individual Member State to be achieved by 2030, totaling 310 MtCO2e of net removals for the whole EU. However, it remains poorly understood to what extent the EU LULUCF climate target matches with the Member States' strategies. The alignment between the EU governance and its Member States' visions for the long-term will determine the achievement of the climate targets. The objective of this study is to understand the LULUCF expected contribution to the EU's 2030 and 2050 climate goals. In doing so, we explored the European and country-level visions of LULUCF with respect to climate change mitigation and adaptation, as expressed in their Long-Term Strategies (LTSs) and national projections; we evaluated whether national level projections for LULUCF are aligned with the EU short and long term targets. We found that most countries' LTSs envisage policies and measures in the LULUCF sector, however they are, often general and not comprehensive. Furthermore, the majority of countries' quantitative future projections of GHG emissions and removals from LULUCF differ from the pathway set in EU targets; thus, countries may need to either update existing policies or conceive and plan new policies and actions. European Union (EU) Member States are required to design and carefully implement LULUCF policies to comply with the ambitious EU targets. EU countries describe in their Long-Term Strategies LULUCF policies and measures that are potentially effective, but not comprehensive, transparent and accurate. Ideally Long-Term Strategies for LULUCF are aligned with other policy instruments, e.g. Nationally Determined Contributions and National Energy and Climate Plans. Many EU countries may grapple with the adoption and fulfilment of the currently proposed European Union targets on LULUCF. [ABSTRACT FROM AUTHOR]