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Monkeypox, a zoonotic infection caused by an orthopoxvirus, is endemic in parts of Africa. On August 4, 2022, the U.S. Department of Health and Human Services declared the U.S. monkeypox outbreak, which began on May 17, to be a public health emergency (1,2). After detection of the first U.S. monkeypox case), CDC and health departments implemented enhanced monkeypox case detection and reporting. Among 2,891 cases reported in the United States through July 22 by 43 states, Puerto Rico, and the District of Columbia (DC), CDC received case report forms for 1,195 (41%) cases by July 27. Among these, 99% of cases were among men; among men with available information, 94% reported male-to-male sexual or close intimate contact during the 3 weeks before symptom onset. Among the 88% of cases with available data, 41% were among non-Hispanic White (White) persons, 28% among Hispanic or Latino (Hispanic) persons, and 26% among non-Hispanic Black or African American (Black) persons. Forty-two percent of persons with monkeypox with available data did not report the typical prodrome as their first symptom, and 46% reported one or more genital lesions during their illness; 41% had HIV infection. Data suggest that widespread community transmission of monkeypox has disproportionately affected gay, bisexual, and other men who have sex with men and racial and ethnic minority groups. Compared with historical reports of monkeypox in areas with endemic disease, currently reported outbreak-associated cases are less likely to have a prodrome and more likely to have genital involvement. CDC and other federal, state, and local agencies have implemented response efforts to expand testing, treatment, and vaccination. Public health efforts should prioritize gay, bisexual, and other men who have sex with men, who are currently disproportionately affected, for prevention and testing, while addressing equity, minimizing stigma, and maintaining vigilance for transmission in other populations. Clinicians should test patients with rash consistent with monkeypox

Background Emergency department (ED) visits for migraine are burdensome to patients and to the larger healthcare system and society. Thus, it is important to determine strategies used to prevent ED visits and the common communication patterns between headache specialists and the ED team. Objective We sought to understand: (1) Whether headache specialists use headache management protocols. (2) The strategies they use to try and reduce the number of ED visits for headache. (3) Whether protocols are used in the EDs with which they are affiliated. (4) The level of satisfaction with the coordination of care between headache physicians and the ED. Methods We surveyed via SurveyMonkey members of the American Headache Society Emergency Department/Refractory/Inpatient (EDRI) Section to understand their practice regarding patients who call their office to be seen urgently, and to understand their communication with their local EDs. Results There were 96 eligible AHS members, 50 of whom responded to questionnaires either by email or in person (52%). Of these, 59% of respondents reported giving rescue treatment to their patients to manage acute attacks. Fifty-four percent reported using standard protocols for outpatients not responding to usual acute treatments. In the event of a request for urgent care, 12% of specialists reported bringing patients into the office most or all of the time, and 20% reported sending patients to the ED some or most of the time for headache management. Thirty-six percent reported prescribing a new medicine and 30% reported providing telephone counseling some/most/all of the time. Sixty percent reported that their ED has a protocol for migraine management. Overall, 38% were usually or very satisfied with the headache care in the ED. Conclusions A substantial number of headache specialists are dissatisfied with the care their patients receive in the ED. More standardized protocols for ED visits by patients with known headache disorders, and clear guidelines for communication between ED providers and treating physicians, along with better methods for follow-up following discharge from the ED, might appear to improve this issue.

Objective Scalable nonpharmacologic treatment options are needed for chronic pain conditions. Migraine is an ideal condition to test smartphone-based mind-body interventions (MBIs) because it is a very prevalent, costly, disabling condition. Progressive muscle relaxation (PMR) is a standardized, evidence-based MBI previously adapted for smartphone applications for other conditions. We sought to examine the usability of the RELAXaHEAD application (app), which has a headache diary and PMR capability. Methods Using the "Think Aloud" approach, we iteratively beta-tested RELAXaHEAD in people with migraine. Individual interviews were conducted, audio-recorded, and transcribed. Using Grounded Theory, we conducted thematic analysis. Participants also were asked Likert scale questions about satisfaction with the app and the PMR. Results Twelve subjects participated in the study. The mean duration of the interviews (SD, range) was 36 (11, 19-53) minutes. From the interviews, four main themes emerged. People were most interested in app utility/practicality, user interface, app functionality, and the potential utility of the PMR. Participants reported that the daily diary was easy to use (75%), was relevant for tracking headaches (75%), maintained their interest and attention (75%), and was easy to understand (83%). Ninety-two percent of the participants would be happy to use the app again. Participants reported that PMR maintained their interest and attention (75%) and improved their stress and low mood (75%). Conclusions The RELAXaHEAD app may be acceptable and useful to migraine participants. Future studies will examine the use of the RELAXaHEAD app to deliver PMR to people with migraine in a low-cost, scalable manner.

In this work, the effectiveness of electric fields to clean two ZrO2 TiO2 ultrafiltration (UF) membranes fouled with three types of whey model solutions was investigated. Membranes tested had different molecular weight cut-offs (MWCOs) (15 and 50 kDa). Whey model solutions consisted of aqueous solutions of bovine serum albumin (BSA) at 10 g/L, a mixture of BSA (10 g/L) and CaCl2 (1.65 g/L) and whey protein concentrate (WPC) (total protein content 45%) solutions at different concentrations (22.2, 33.3 and 150.0 g/L). The hydraulic cleaning efficiency (HCE) achieved by means of the application of the electric fields was evaluated as a function of the membrane MWCO and the operating conditions of the cleaning technique (applied potential, temperature of the cleaning solution and concentration of NaCl). The results demonstrated that the presence of NaCl favoured the removal of protein deposits on the membrane layer. On the other hand, the higher the temperature of the cleaning solution and the applied potential were, the higher HCE was achieved. Regarding the membrane MWCO, the permselective properties of the 15 kDa membrane were completely recovered after the cleaning procedure by electric field for all the feed fouling solutions tested, whereas this technique could not completely remove the protein deposits on the 50 kDa membrane when BSA solutions were used as feed., The authors of this work wish to gratefully acknowledge the financial support from the Spanish Ministry of Science and Innovation through the project CTM2010-20186 and the company MAGNETO Special Anodes B.V. for supplying the Ti-Ir electrode.

[EN] he internal resistance of a PEM fuel cell depends on the operation conditions and on the current delivered by the cell. This work's goal is to obtain a semiempirical model able to reproduce the effect of the operation current on the internal resistance of an individual cell of a commercial PEM fuel cell stack; and to perform a statistical analysis in order to study the effect of the operation temperature and the inlet humidities on the parameters of the model. First, the internal resistance of the individual fuel cell operating in different operation conditions was experimentally measured for different DC currents, using the high frequency intercept of the impedance spectra. Then, a semiempirical model based on Springer and co-workers¿ model was proposed. This model is able to successfully reproduce the experimental trends. Subsequently, the curves of resistance versus DC current obtained for different operation conditions were fitted to the semiempirical model, and an analysis of variance (ANOVA) was performed in order to determine which factors have a statistically significant effect on each model parameter. Finally, a response surface method was applied in order to obtain a regression model., The authors are very grateful to the Generalitat Valenciana for its economic support in form of Valid grant (Ref:. ACIF-2013-268)

Background Progressive muscle relaxation (PMR) has level A evidence in preventing migraine and tension-type headaches. However, there is limited research on behavioral therapy for post-traumatic headache (PTH) let alone delivered via a smartphone application. Aims/objective To gain preliminary evidence as to whether smartphone based PMR is feasible for subjects with PTH. Method(s) We performed a single-arm study of prospective patients calling our Concussion Center between June 2017 and May 2018. Subjects met ICHD-3 criteria for persistent headache secondary to mTBI, were age 18–85 and 3–12 months post injury, with no prior behavioral treatments for headache in the past year. We assessed prior and current headache and neuropsychologic histories. Using the RELAXaHEAD smartphone application, subjects were instructed to record headache symptoms daily and practice 20 minutes of PMR daily. There was a 1-month follow-up assessment. Results In our ongoing study, 21 subjects are currently enrolled, 13 female (62%) with mean age 41.4 (SD 13.1, range 20–65). Nine (43%) subjects had pre-existing headaches. Subjects' injuries were on average 6 months prior to enrollment (SD 2.6, range 4–12). Three (14%) were sports-related. In the month prior to enrollment, subjects reported 19.3 headache days (SD 8.76, median 20, range 5–30). 17 (81%) subjects reported memory problems and 18 (86%) reported impaired concentration. Of 17 subjects enrolled for at least 1 month, 9 (53%) imputed data for 20 or more days within the first month (mean 17 days, SD 12.2, median 20, range 0–31). 4 (24%) practiced PMR 2 + times/wk (mean 8.4 days, SD 8.6, median 6, range 0–31). Conclusion PTH subjects' obstacles regarding adherence to mHealth technology should be further assessed before PMR efficacy can be assessed. Notably, many subjects concurrently reported difficulties with memory and concentration, which may be contributing to poor adherence. Future work will attempt to assess for differences among users vs non-users.