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Abstract Background Yoga is increasingly practised by older adults, with growing evidence for its safety and effectiveness across a range of health conditions common to the age group. This process evaluation, embedded within a randomised controlled trial of chair-based yoga for older adults with multimorbidity, qualitatively explored participants’ perceptions and experiences of the chair-based yoga programme. Methods One-to-one interviews and class observations were conducted with a subset of trial participants randomised to receive the 12-week chair-based yoga programme. Interview participants were selectively recruited to represent the demographic breadth of the main trial cohort; one yoga class was observed at each delivery site. Interviews were audio recorded, independently transcribed, and analysed according to longitudinal and thematic analysis. Results Twenty-five yoga participants were interviewed once (N = 10) or twice (N = 15), providing a 40-interview data set. Participants were aged 66–91 years (mean age 74 years), 56% female (N = 14), predominantly White British (N = 22, 88%), with 2–8 long term health conditions (mean 4.5 conditions). Four interlinked and overarching themes predominated: perceptions of healthy ageing, delineating yoga and exercise, yoga as an adaptable multifaceted health tool, and patterns of ongoing yoga practice. Participants equated acute symptom presentation, not multimorbidity, with illness, and mostly viewed their health as good. They distinguished yoga from exercise based on its integration of the breath with physical movements, which provided a mental focus unfound in other physical activities. Impact of the yoga programme ranged from minimal to transformative, dependent on meaningful biopsychosocial improvements. Accordingly, continuation of yoga beyond the trial ranged from none to full integration as a multifaceted health management tool. Conclusions Participant experiences of the yoga programme interlinked views on health, ageing, exercise, and sustainable health management. Yoga presented as a safe, acceptable, and adaptable option for non-pharmacological health management in older adults. Impact on biopsychosocial health was variable, and directly linked to participants’ longer term yoga engagement. Education of health professionals and activity providers regarding ageist stereotypes of health and ageing, together with the evidence base for the safety and effectiveness of yoga, could support and broaden yoga’s reach and engagement among both older adult and multimorbid cohorts. Trial registration ISRCTN ISRCTN13567538. Registered 18 March 2019.

Abstract Background Sport Mental Health Continuum – Short Form (Sport MHC-SF) is an adaptation of the Mental Health Continuum-Short Form for athletes. Although validated in Western contexts, its applicability to the Chinese population remains unexplored. This study aims to validate the Chinese adaptation of the Sport MHC-SF in Chinese university athletes, evaluate its reliability and validity, and confirm its factorial structure. Methods A total of 1,025 Chinese university athletes (65% male, mean age 20 ± 1.54 years) were included in this study. Confirmatory factor analysis (CFA) and multi-group CFA (MGCFA) were conducted using Mplus 8.0 to evaluate the factorial structure and assess measurement invariance across sports levels. Results Both the three-factor and second-order models demonstrated a good fit for the Chinese adaptation of the Sport MHC-SF. Chi-square values were 262.704 (74) and 262.705 (74), respectively, with a comparative fit index (CFI) of 0.968, a Tucker-Lewis index (TLI) of 0.961, a standardized root mean square residual (SRMR) of 0.027, and a root mean square error of approximation (RMSEA) of 0.050 (90% CI: 0.043–0.056). Measurement invariance across ranked and non-ranked athletes was confirmed, with minimal changes in fit indices (ΔCFI ≤ 0.01, ΔTLI ≤ 0.01, ΔRMSEA ≤ 0.015) from configural to strict invariance. Conclusion The Chinese adaptation of the Sport MHC-SF scale has strong construct validity, reliability, and measurement invariance, making it a reliable tool for future research on the well-being of Chinese athletes. This study fills a critical gap in cross-cultural validation, offering a foundation for future research and practical applications in sports psychology among Chinese athletes.

Abstract Background Microbial expansin-related proteins include fungal loosenins, which have been previously shown to disrupt cellulose networks and enhance the enzymatic conversion of cellulosic substrates. Despite showing beneficial impacts to cellulose processing, detailed characterization of cellulosic materials after loosenin treatment is lacking. In this study, small-angle neutron scattering (SANS) was used to investigate the effects of three recombinantly produced loosenins that originate from Phanerochaete carnosa, PcaLOOL7, PcaLOOL9, and PcaLOOL12, on the organization of holocellulose preparations from Eucalyptus and Spruce wood samples. Results Whereas the SANS analysis of Spruce holocellulose revealed an increase in inter-microfibril spacing of neighboring cellulose microfibrils following treatment with PcaLOOL12 and to a lesser extent PcaLOOL7, the analysis of Eucalyptus holocellulose revealed a reduction in the ordered arrangement of microfibrils following treatment with PcaLOOL12 and to a lesser extent PcaLOOL9. Parallel SEC-SAXS characterization of PcaLOOL7, PcaLOOL9, and PcaLOOL12 indicated the proteins likely function as monomers; moreover, all appear to retain a flexible disordered N-terminus and folded C-terminal region. The comparatively high impact of PcaLOOL12 motivated its NMR structural characterization, revealing a double-psi β-barrel (DPBB) domain surrounded by three α-helices—the largest nestled against the DPBB core and the other two part of loops extending from the core. Conclusions The SANS analysis of PcaLOOL action on holocellulose samples confirms their ability to disrupt cellulose fiber networks and suggests a progression from reducing regular order in the microfibril arrangement to increasing inter-microfibril spacing. The most impactful PcaLOOL, PcaLOOL12, was previously observed to be the most highly expressed loosenin in P. carnosa. Its structural characterization herein reveals its stabilization through two disulfide linkages, and an extended N-terminal region distal to a negatively charged and surface accessible polysaccharide binding groove.

Abstract Background Piwi-interacting RNAs (piRNAs) are well established for monitoring and protecting the genome from transposons in germline cells. Recently, numerous studies provided evidence that piRNAs also play important roles in regulating mRNA transcript levels. Despite their significant role in regulating cellular RNA levels, the piRNA targeting rules are not well defined, especially in mammals, which poses obstacles to the elucidation of piRNA function. Results Given the complexity and current limitation in understanding the mammalian piRNA targeting rules, we designed a deep learning model by selecting appropriate deep learning sub-networks based on the targeting patterns of piRNA inferred from previous experiments. Additionally, to alleviate the problem of insufficient data, a transfer learning approach was employed. Our model achieves a good discriminatory power (Accuracy: 98.5%) in predicting an independent test dataset. Finally, this model was utilized to predict the targets of all mouse and human piRNAs available in the piRNA database. Conclusions In this research, we developed a deep learning framework that significantly advances the prediction of piRNA targets, overcoming the limitations posed by insufficient data and current incomplete targeting rules. The piRNA target prediction network and results can be downloaded from https://github.com/SofiaTianjiaoZhang/piRNATarget .

Abstract: Anthracycline-mediated cardiotoxicity is a common concern after lymphoma therapy, particularly in patients with high cardiovascular risk (CVR). In noncancer populations, coronary artery calcium scoring (CACS) effectively identifies individuals who may benefit from aggressive CVR modification to lower the risk of cardiovascular events. Emerging evidence suggests that CACS can also predict cancer therapy-related cardiotoxicity, potentially identifying candidates for cardioprotective strategies. Our study aimed to evaluate whether CACS obtained from pretreatment positron emission tomography (PET)/computed tomography (CT) scans could stratify cardiac event risk in patients with lymphoma receiving anthracycline-based chemotherapy. We enrolled 358 consecutive patients with lymphoma treated between 2012 and 2022, calculating the CACS from their pretreatment PET/CT. We reviewed medical records to identify pre-existing cardiac conditions, CVR, and posttreatment cardiac events, including coronary events, heart failure (HF), and arrhythmias. Logistic and Cox regression models were used to assess associations between CVR, CACS categories (CACS = 0, CACS 1-400, CACS >400), and new cardiac events. At a median follow-up of 27 months (95% confidence interval [CI], 22.3-31.7) in patients without cardiac history, 10% experienced posttreatment cardiac events (HF, 14; arrhythmias, 9; coronary event, 1; combination, 8). Patients with a CACS >0 had more events (21 total, 20% vs 11 total, 5.4% for CACS = 0; P < .001). Elevated CACS was independently associated with HF (CACS 1-400: odds ratio [OR], 3.73; 95% CI, 1.21-11.43; P = .022; CACS >400: OR, 5.43; 95% CI, 1.47-20.03; P = .011) and any cardiac event (CACS 1-400: OR, 2.48; 95% CI, 1.02-6.04; P = .045; CACS >400: OR, 3.28; 95% CI, 0.91-10.68; P = .029). CACS may effectively stratify patients with lymphoma at risk of cardiac complications, thereby identifying a group poised to benefit from targeted preventive strategies.

Polar bears (Ursus maritimus Phipps, 1774) rely on seals as their primary prey, yet predator–prey spatial relationships are poorly understood. We examined the spatial relationship between Davis Strait polar bears and harp seals (Pagophilus groenlandicus Erxleben, 1777), using satellite telemetry for both species. We analyzed sea ice trends using remote sensing (1979–2021) to examine how their environment may be changing using four sea ice seasons (freeze-up, winter, break-up, and summer). Sea ice cover decreased and summer season lengthened over time. Polar bears (n = 18) tracked in 1991–2001 for 7–12 months had a mean 95% minimum convex polygon (MCP) home range size of 108 146 km2 (standard error of the mean (SE) = 18 252 km2) and a mean 95% kernel density home range size (kernel density estimate (KDE)) of 76 863 km2 (SE = 12 260 km2). Harp seals (n = 22) tracked for 5–8 months in 1993–2005 had a mean 95% MCP of 693 403 km2 (SE = 74 384 km2) and a mean 95% KDE of 395 316 km2 (SE = 48 688 km2). During freeze-up, the core-use areas of both species did not overlap, but the broad-use areas did. During break-up, the broad-use areas overlapped more than the core-use areas. The space use of both species was influenced by the sea ice seasons and these seasons have changed over time.

Abstract Background The incidence and mortality of first-ever strokes have risen sharply, especially in the intensive care unit (ICU). Emerging surrogate for insulin resistance, triglyceride-glucose index (TyG), has been linked to stroke prognosis. We aims to explore the relationships between TyG with ICU all-cause mortality and other prognosis, and to develop machine learning (ML) models in predicting ICU all-cause mortality in the first-ever strokes. Methods We included first-ever stroke patients from the eICU Collaborative Research Database in 2014–2015 as the primary analysis cohort (then divided into training and internal validation cohorts) and from local hospital’s ICUs as the external validation cohort. Multivariate Cox proportional hazards models and restricted cubic spline analyses were used to evaluate the association between TyG and ICU/hospital all-cause mortality. Linear regression and correlation analyses were performed to examine the relationships between TyG with length of ICU/hospital stay and Glasgow Coma Score. Results The primary analysis cohort included 3173 first-ever strokes (median age 68.0 [55.0–68.0] years; 63.0% male), while the external validation cohort included 201 first-ever strokes (median age 71.0 [63.0–77.0] years; 62.3% male). Multivariate Cox proportional hazards models revealed that the high TyG group (TyG ≥ 9.265) was associated with higher ICU (HR 1.92, 95% CI 1.38–2.66) and hospital (HR 1.69, 95% CI 1.32–2.16) all-cause mortality, compared with low TyG group (TyG

Abstract Ferroptosis is a form of cell death characterized by a pro‐oxidative cellular milieu and iron‐dependent lipid peroxidation. Ferroptosis has been implicated in various forms of liver injury, in keeping with the major role of the liver in iron metabolism. Limited research has addressed potential differences in ferroptosis mediators with age and sex, especially in an in vivo model. The goal of this investigation was to evaluate hepatic labile iron and mediators of ferroptosis with ageing in both sexes. Because female animals generally display greater antioxidant defences than males, we hypothesized that females would display a phenotype resistant to ferroptosis. Here, we determined iron contents, protein expression of ferroptosis mediators and measures of oxidative injury in liver samples from 12‐ and 24‐month‐old male and female Fischer 344 rats. In comparison to males, the livers of female rats at both ages contained more non‐haem iron, which was associated with greater ferritin heavy chain expression and attenuated expression of transferrin receptor‐1. In female rats, the 24‐month‐old group had higher contents of thiobarbituric acid reactive substances compared with their 12‐month‐old counterparts, yet similar contents of labile iron. These results suggest a disconnect between labile iron contents and oxidative injury with age. Female animals also displayed greater expression of acyl‐CoA synthetase long‐chain family member 4 (ACSL4), a modulator of ferroptosis, and greater abundance of high molecular weight 4‐hydroxnonenal‐modified proteins. These results demonstrate clear differences in iron and ferroptosis mediators between sexes and suggest that female rats of this strain might be more susceptible to ferroptosis.

Artificial intelligence (AI) and machine learning (ML) are driving innovation in biosciences and are already affecting key elements of medical scholarship and clinical care. Many schools of medicine are capitalizing on the promise of these new technologies by establishing academic units to catalyze and grow research and innovation in AI/ML. At Stanford University, we have developed a successful model for an AI/ML research center with support from academic leaders, clinical departments, extramural grants, and industry partners. The Center for Artificial Intelligence in Medicine and Imaging uses the following 4 key tactics to support AI/ML research: project-based learning opportunities that build interdisciplinary collaboration; internal grant programs that catalyze extramural funding; infrastructure that facilitates the rapid creation of large multimodal AI-ready clinical data sets; and educational and open data programs that engage the broader research community. The center is based on the premise that foundational and applied research are not in tension but instead are complementary. Solving important biomedical problems with AI/ML requires high-quality foundational team science that incorporates the knowledge and expertise of clinicians, clinician scientists, computer scientists, and data scientists. As AI/ML becomes an essential component of research and clinical care, multidisciplinary centers of excellence in AI/ML will become a key part of the scholarly portfolio of academic medical centers and will provide a foundation for the responsible, ethical, and fair implementation of AI/ML systems.

This study aimed to quantify the postures and muscle activity while parks and gardens workers operated ride-on mowers during a typical shift. Eight participants operated ride-on mowers in the same park but on different terrains (flat and undulating). Body postures and muscle activity were collected wirelessly and unobtrusively. Participants adopted a forward-flexed seated posture with the predominant movement being head rotation. Oscillatory movements (20–40° from neutral) of the thorax in all three planes of movement were noted in all participants. Low levels (90%) of the recording time. Higher (>50% MVIC) activation levels were interspersed through the data, but these were not sustained. There was no difference in posture or muscle activity between the flat and undulating terrain. The forward-flexed posture combined with vibration can increase the risk of discomfort and injury in the low back while ride-on mowing. The low levels of muscle activity suggest participants did not actively brace for the occupational situation and task. The large inter-participant difference in posture attests to subjective variation to accommodate muscular stress, and this may not be optimal for injury mitigation.

Abstract Background The burden of atrial fibrillation (AF) in the intensive care unit (ICU) remains heavy. Glycaemic control is important in the AF management. Glycaemic variability (GV), an emerging marker of glycaemic control, is associated with unfavourable prognosis, and abnormal GV is prevalent in ICUs. However, the impact of GV on the prognosis of AF patients in the ICU remains uncertain. This study aimed to evaluate the relationship between GV and all-cause mortality after ICU admission at short-, medium-, and long-term intervals in AF patients. Methods Data was obtained from the Medical Information Mart for Intensive Care IV 3.0 database, with admissions (2008–2019) as primary analysis cohort and admissions (2020–2022) as external validation cohort. Multivariate Cox proportional hazards models, and restricted cubic spline analyses were used to assess the associations between GV and mortality outcomes. Subsequently, GV and other clinical features were used to construct machine learning (ML) prediction models for 30-day all-cause mortality after ICU admission. Results The primary analysis cohort included 8989 AF patients (age 76.5 [67.7–84.3] years; 57.8% male), while the external validation cohort included 837 AF patients (age 72.9 [65.3–80.2] years; 67.4% male). Multivariate Cox proportional hazards models revealed that higher GV quartiles were associated with higher risk of 30-day (Q3: HR 1.19, 95%CI 1.04–1.37; Q4: HR 1.33, 95%CI 1.16–1.52), 90-day (Q3: HR 1.25, 95%CI 1.11–1.40; Q4: HR 1.34, 95%CI 1.29–1.50), and 360-day (Q3: HR 1.21, 95%CI 1.09–1.33; Q4: HR 1.33, 95%CI 1.20–1.47) all-cause mortality, compared with lowest GV quartile. Moreover, our data suggests that GV needs to be contained within 20.0%. Among all ML models, light gradient boosting machine had the best performance (internal validation: AUC [0.780], G-mean [0.551], F1-score [0.533]; external validation: AUC [0.788], G-mean [0.578], F1-score [0.568]). Conclusion GV is a significant predictor of ICU short-term, mid-term, and long-term all-cause mortality in patients with AF (the potential risk stratification threshold is 20.0%). ML models incorporating GV demonstrated high efficiency in predicting short-term mortality and GV was ranked anterior in importance. These findings underscore the potential of GV as a valuable biomarker in guiding clinical decisions and improving patient outcomes in this high-risk population.

Abstract The Human Cell Atlas (HCA) is a global partnership “to create comprehensive reference maps of all human cells—the fundamental units of life – as a basis for both understanding human health and diagnosing, monitoring, and treating disease.” ( https://www.humancellatlas.org/ ) The atlas shall characterize cells from diverse individuals across the globe to better understand human biology. HCA proactively considers the priorities of, and benefits accrued to, contributing communities. Here, we lay out principles and action items that have been adopted to affirm HCA’s commitment to equity so that the atlas is beneficial to all of humanity.

BACKGROUND: Bariatric surgery represents an actively developing surgery field. With this, thanks to using modern automated methods of dissecting and suturing the tissues, a significant decrease is observed in the number of postoperative complications. At the same time, the problem of surgical suture incompetence remains topical even at the present times. The traditional methods of intraoperative diagnostics of incompetence are the provocative tests: the methylene blue test and the air leak test. One of the promising methods for intraoperative control during surgery is the use of fluorescent visualization in the near infrared range using the indocyanine green (ICG). AIM: Evaluate the informativity of intraoperative diagnostics of machine suture incompetence during the longitudinal gastric resection using fluorescent visualization with indocyanine green (ICG) by using the pig model to imitate various reasons of incompetence and to control surgical complications using morphological tests. METHODS: The research was carried out with using 20 pigs, each of which underwent the longitudinal gastric resection. The animals were distributed into the following experimental groups: the control group with performing standard longitudinal gastric resection (n=4) and the tests groups with longitudinal gastric resection and modeling of two variants of mechanical reasons of incompetence (n=12), as well as the local ischemia group (n=4). Intraoperationally, the gastric lumen was filled with a solution containing methylene blue and indocyanine green, after which, an evaluation was performed of the developed staining or Indocyanine green fluorescence visualization. Besides, in the ischemia group, ICG was administered intravenously. On Day 7 after surgery, samples were taken for histological examination. RESULTS: In 10 out of 11 experiments with the mechanical factor of modeling used to stimulate the machine suture incompetence, ICG visualization was found, with the ingress of methylene blue found in two cases out of 11, respectively. In 90% of the cases, the transudation of ICG corresponded to significant signs of inflammation, with the ingress of methylene blue being found only in 20% of the cases. CONCLUSION: The method of intraluminal administration of Indocyanine green in “mechanical” models of machine suture incompetence upon longitudinal gastric resection is more informative comparing to the introduction of methylene blue. Data from fluorescent ICG-angiography completely correspond to the location of ischemia modeling area.

Abstract Background Sporting success relies not only on athletes’ physical qualities but also involves psychological, technical, and environmental factors. Given the lack of effective tools to comprehensively measure sporting success in the Chinese context, this study aimed to validate the Chinese version of the Sport Success Scale (SSS-C). Methods A total of 604 adolescent basketball players, comprising 301 (49.8%) males and 303 (50.2%) females aged between 12 and 19 (M = 15.53, SD = 1.42), were recruited from secondary schools across 17 cities in Shandong Province, China, to answer the questionnaire, which measured their views on 29 items through a six-point Likert scale. The SSS was translated into Chinese language (SSS-C) using forward-backward translation techniques. Confirmatory Factor Analysis (CFA) was performed using Mplus 8.0 software to assess the structural validity of SSS-C. The reliability and convergent validity were also evaluated. Results CFA results demonstrated an excellent fit to the hypothesized six-factor model based on the fit indices (CFI = 0.997, TLI = 0.997, RMSEA = 0.016 [90% CI: 0.005, 0.022], SRMR = 0.018). All items displayed significant factor loadings above 0.40, supporting the robustness of the model. The SSS-C exhibited high internal consistency reliability (Cronbach’s α ranged from 0.95 to 0.96; Composite Reliability ranged from 0.95 to 0.96) and strong convergent validity (Average Variance Extracted values > 0.50). Conclusion The SSS-C with 29 items was a valid and reliable instrument for comprehensively assessing sport success among Chinese adolescent athletes. The multidimensional approach of the SSS-C provides a new perspective for understanding the psychological factors contributing to athletes’ success, which can inform the development of targeted interventions.

Abstract Background An ongoing challenge with rare diseases is limited data and, consequently, limited knowledge about the collective prevalence and impact of these conditions on individuals, families, and the health system, particularly in rural and regional areas. Using existing datasets, this project aimed to examine the epidemiology of and hospital activity for Tasmanians with rare diseases. Methods Rare diseases were defined as non-infectious diseases with a prevalence of less than 1 in 2000. An initial resource set of 1028 ICD-10-AM diagnostic codes was used to identify a cohort of Tasmanians with rare diseases in Tasmanian Health datasets (1 January 2007 until 31 December 2020). Validating the resource set using a small group with known rare diseases revealed limitations in ascertainment, and so an expanded set of 1940 ICD-10-AM diagnostic codes was developed by cross-referencing ICD-10-AM codes with Orphanet data. Cohort hospital activity and admission costs were compared to statewide data for the final year of the study, 01 January 2020 to 31 December 2020. Results Using the resource set of 1028 ICD-10-AM diagnostic codes, the period prevalence of rare diseases in Tasmania across all age groups was estimated at 3.5%, with a point prevalence of 1.5% in December 2020. In 2020, 3384 individuals within the Tasmanian rare disease cohort, representing 0.6% of the Tasmanian population, accessed the public hospital system and accounted for 5.6% of all admissions. The mean length of stay for rare disease-related hospital admissions was 5.0 days, compared to 3.3 days for non-rare disease-related admissions. The mean cost per admission for the rare disease cohort was AUD$11,310, compared to AUD$6475 for all admissions statewide. In 2020, using the expanded resource set, the total cost of public hospital admissions in Tasmania was estimated to be AUD$979 million, with rare disease-related hospital admissions accounting for 9.1% of this cost, increasing to 19.0% when the costs for all admissions for the rare disease patients were included. Conclusions Patients with rare diseases had more admissions, longer length of stay, and a higher average cost per admission. Patients with rare diseases have a disproportionate impact on statewide hospital activity and costs in Tasmania.

Summary: Evaluating the effectiveness of different brush types used during the cleaning and reprocessing of flexible endoscopes is challenging. This study compared the yield of microbial growth from endoscopes that had been used clinically before and after cleaning with different brush types (bristle, squeegee, and hybrid). Endoscopes used to perform a total of 91 medical procedures on 82 patients were included. Quantitative bacterial cultures yielded no statistical differences between the different brushes used. Colonoscopes and gastroscopes surveyed after rigorous cleaning steps resulted in a drop in colony counts between pre- and post-cleaning from 1.45E+8 (±5.21E+07) to 2.5 (±0.13) individual colonies suggesting that the overall cleaning process was effective regardless of the brush type used.

Objectives Unlike comparable countries, acute coronary syndrome (ACS) mortality is similar among patients who present to rural and urban hospitals in Aotearoa New Zealand (NZ). The aim of this study was to determine whether differences in ischaemic heart disease (IHD) deaths that occurred without a preceding hospital admission in rural and urban populations explained this finding.Design Retrospective observational study using the National Mortality Collection (MORT) and National Minimum Dataset (NMDS) for hospital discharges datasets.Setting People in NZ who died from IHD were categorised based on their rural–urban status (U1 (major urban), U2 (large urban) and rural) using the Geographic Classification for Health and prioritised ethnicity (Māori—NZ’s Indigenous population and non-Māori).Participants All people 20+ years who died from IHD between July 2011 and December 2018.Primary and secondary outcomes The outcome was the lack of a hospital admission preceding IHD death, identified by linking the NMDS with MORT. This was measured for the 30 days and 1 year prior to death and for all-cause and IHD hospitalisations separately.Results Of the 37 296 deaths, a similar percentage of rural and urban residents died without an all-cause (rural 63.2%, U2 60.8%, U1 62.8%) or IHD (rural 70.9%, U2 69.0%, U1 70.1%) admission in the preceding 30 days, or without an all-cause (rural 32.8%, U2 35.5%, U1 35.5%) or IHD (rural 52.7%, U2 52.6%, U1 51.9%) admission in the preceding year. Exceptions were deaths that occurred without a prior admission for rural non-Māori aged 55–64 (higher odds) and 75+ years (lower odds) compared with U1 non-Māori 55–64 and 75+ years, respectively, across all four outcome measures.Conclusions This study suggests that the lack of difference in ACS mortality for patients who present to NZ rural and urban hospitals is not explained by IHD death that occurred without a recent preceding hospital admission.

Summary: Background: Insulin resistance (IR) is an important risk factor for multiple chronic diseases, increasing mortality and reducing life expectancy. The associations between emerging surrogates for IR, triglyceride-glucose index (TyG) and TyG-related indicators, with all-cause mortality and life expectancy in middle-aged and older patients in primary care are unclear. Methods: This study originated from the Polish primary care cohort LIPIDOGRAM2015, including patients aged ≥45 years. Baseline fasting triglycerides and fasting glucose were used to derive TyG. Other TyG-related indicators included TyG-adjusted body mass index (TyG-BMI), TyG-adjusted waist circumference (TyG-WC), TyG-adjusted waist-to-hip, and TyG-adjusted waist-to-height. In this longitudinal analysis, we assessed associations between TyG-related indicators with total all-cause mortality, premature (age at death ≤75 years) all-cause mortality and years of life lost (YLL). Findings: We included 10,688 patients (mean age 61.8 ± 9.3 years; 63.5% female). Cumulative total and premature all-cause mortality were 7.2% and 4.6%, respectively, during 5.7 years (IQR 5.6–5.7) of follow-up. Lowest (Q1) and highest quartile (Q4) of TyG-BMI and TyG-WC were associated with total all-cause mortality (second quartile [Q2]: reference; TyG-BMI: Q1: aHR 1.33, 95% CI 1.07–1.65, Q4: aHR 1.28, 95% CI 1.03–1.58; TyG-WC: Q1: aHR 1.44, 95% CI 1.14–1.82, Q4: aHR 1.29, 95% CI 1.04–1.59), similar results for premature all-cause mortality. Within age 45–80 years, compared with Q2 and third quartile, YLL were 4.49 and 5.46 years for TyG-BMI Q1 and Q4, respectively, 3.24 and 5.31 years for TyG-WC Q1 and Q4, respectively. Interpretation: TyG-BMI and TyG-WC demonstrated a U-shaped association with total and premature all-cause mortality. Low and high levels of TyG-BMI and TyG-WC were associated with reduced life expectancy. Despite the relatively short follow-up period, significant associations were still observed, but longer follow-up studies are required to further explore these relationships. Funding: Polish Lipid Association, College of Family Physician in Poland, Valeant in Poland.

The Satisfaction With Life Scale (SWLS) is a widely used self-report measure of subjective well-being, but studies of its measurement invariance across a large number of nations remain limited. Here, we utilised the Body Image in Nature (BINS) dataset-with data collected between 2020 and 2022 -to assess measurement invariance of the SWLS across 65 nations, 40 languages, gender identities, and age groups (N = 56,968). All participants completed the SWLS under largely uniform conditions. Multi-group confirmatory factor analysis indicated that configural and metric invariance was upheld across all nations, languages, gender identities, and age groups, suggesting that the unidimensional SWLS model has universal applicability. Full scalar invariance was achieved across gender identities and age groups. Based on alignment optimisation methods, partial scalar invariance was achieved across all but three national groups and across all languages represented in the BINS. There were large differences in latent SWLS means across nations and languages, but negligible-to-small differences across gender identities and age groups. Across nations, greater life satisfaction was significantly associated with greater financial security and being in a committed relationship or married. The results of this study suggest that the SWLS largely assesses a common unidimensional construct of life satisfaction irrespective of respondent characteristics (i.e., national group, gender identities, and age group) or survey presentation (i.e., survey language). This has important implications for the assessment of life satisfaction across nations and provides information that will be useful for practitioners aiming to promote subjective well-being internationally.

Burnout of healthcare workers is of increasing concern as workload pressures mount. Burnout is usually conceptualised as resulting from external pressures rather than internal resilience and although is not a diagnosable condition, it is related to help seeking for its psychological sequelae. To understand how staff support services can intervene with staff heading for burnout, it is important to understand what other intrapsychic factors are related to it. A diary tool was used by staff in a region of England to self-monitor their wellbeing over time. The tool explores many areas of mental health and wellbeing and enabled regression analysis to predict which of the various factors provided the strongest indicators of burnout. Using a multiple linear regression model, burnout was found to be most associated with depression, receptiveness, mental wellbeing, and connectedness (p

The Recovery-Stress Questionnaire for Athletes (RESTQ-Sport-52) is a tool developed to measure the frequency of stress associated through recovery activities with strong theoretical foundations. The study aims to examine the psychometric properties of the Malay version of RESTQ-Sport-52 using confirmatory factor analysis (CFA) and exploratory structural equation modeling (ESEM). A cross-sectional study with purposive sampling method was employed. There were 617 undergraduate university students in Malaysia participated in the study with mean age of 20 years old (SD = 1.5). The majority of the participants were female (66.1 %), Malay (76 %) and participated in at least one sport or exercise. The RESTQ-Sport-52-M consisted of 52 items with two main sections; (1) general stress and recovery scales and (2) sport-specific stress and recovery scales. Mplus 8.3 was used to perform the CFA and ESEM analysis to examine the construct validity and reliability of RESTQ-Sport-52-M. For measurement model assessment using CFA, the final model of general-stress/recovery and sport-specific stress/recovery indicated a fit based on several fit indices. However, in the measurement model assessment using ESEM, the fit indices for model of general-stress/recovery (CFI = 0.935, SRMR = 0.037, RMSEA = 0.045) and sport-stress/recovery (CFI = 0.923, SRMR = 0.036, RMSEA = 0.044) were generally improved. The construct reliability for measurement models of RESTQ-Sport-52-M ranged from 0.76 to 0.89. The ESEM approach yielded a better fit indices compared to the CFA approach for both scales. The RESTQ-Sport-52-M (50 items) were considered a more valid and reliable questionnaire to measure recovery and stress in sports for Malaysian sample.

Abstract Background Skin cancer is the most common form of cancer in Ireland with over 13,000 new cases diagnosed annually. People with inflammatory bowel disease are at higher risk of developing skin cancer. Objectives The aim of this study is to assess inflammatory bowel disease (IBD) patients' awareness around skin cancer risk and photoprotection practices and to identify gaps in patient education regarding skin cancer prevention in IBD patients. Methods IBD patients >18 years old were invited to fill out a questionnaire while waiting for their outpatient appointment. Results A total of 87 patients (52% women) with IBD (Crohn's disease 62.8%, UC 35%,) were included. A total of 38 patients were diagnosed before age 25 (44%). Most patients were on active treatment for their IBD (96.5%, n = 85). Four patients had a personal history, and seven patients had a family history of skin cancer. Nearly half of participants (47.6%) were unaware or unsure of an increased risk of skin cancer associated with IBD and 42.5% were unaware or unsure of an increased risk with some IBD treatments. Behaviours around sun‐cream were generally good, however, other sun protective methods were suboptimal. Conclusions Only half (52.4%) of IBD patients surveyed were aware of a link between skin cancer and IBD. Skin cancer knowledge was generally good, however, photoprotection practices were suboptimal. This underscores the role of healthcare professionals in re‐enforcing sun safety information and skin cancer education in the IBD population.

Abstract Purpose This scoping review aims to understand the extent and attributes of literature evaluating differences between rural and urban populations’ utilization of health services in upper-middle and high-income countries. Method The review was conducted in line with established scoping review methodology guidelines. We used the “Participants, Concept and Context” framework to guide the inclusion criteria and determination of the review’s scope. Studies published over a 15-year period (2008–2022) were identified using Embase, Medine, PubMed, and Scopus databases. Study attributes, areas of focus and findings were reviewed and extracted. Results The search identified 179 studies. The number of studies published looking at rural–urban differences in health service utilization has increased over time. The focus of these studies is relatively evenly split between primary and secondary sectors. The majority of studies observed less service utilization by rural populations than urban—especially so in primary-sector services. When higher rural utilization of secondary services was observed this was frequently attributed to poor access to other services that would have had the potential to mitigate the secondary demand. Studies were not commonly grounded in principles of equity or fairness and rarely offered value judgements on observed differences in utilization. There were limited system-level studies – the vast majority being disease- or service-specific analyses. We consider this a notable gap in the literature. Conclusion This scoping review identifies key parameters of studies on rural–urban variation in health service utilization. The finding that most studies observed rural populations utilized comparatively less services is concerning, in the context of general evidence about high levels of health need in rural communities. Future system-level research considering the combined variations in need and utilization appears a priority.

Abstract Background The influence of social determinants of health (SDH) on sustainable development goals (SDG) has gained attention in recent years. However, there is a scarcity in the availability of valid and reliable instruments to assess the multiple aspects of SDH. Hence, this study was conducted to develop a brief self-reported measure for assessing SDH. Method A cross-sectional survey was conducted among university undergraduate students in Nigeria. The study consisted of 300 participants in the EFA (males 55.7%, females 44.3%) and 430 participants in the CFA (males 54.0%, females 46.0%). Participants were selected using a convenience sampling approach to assess their perceptions regarding SDH. Content Validity Index (CVI), Face Validity Index (FVI), Exploratory Factor Analysis (EFA), Confirmatory Factor Analysis (CFA), Composite Reliability (CR), Average Variance Extracted (AVE), Cronbach’s alpha, and Intraclass Correlation Coefficient (ICC) were computed to determine the psychometric properties of the newly developed SDH scale. Results In the EFA, two factors were extracted (structural determinants of SDH and intermediary determinants of SDH), with all 20 items retained. The total variance explained by the EFA model was 61.8%, and the factor correlation was 0.178. The Cronbach’s alpha values of the two factors were 0.917 and 0.939. In the CFA, the initial model did not fit the data well based on fit indices. After several re-specification of the model, the final re-specified measurement model demonstrated adequate fit factor structure of the SDH scale with two factors and 20 items (CFI = 0.943, TLI = 0.930, SRMR = 0.056, RMSEA = 0.053, RMSEA p-value = 0.220). The CR was 0.797 for structural determinants of SDH and 0.794 for intermediary determinants of SDH. The ICC was 0.938 for structural determinants of SDH and 0.941 for intermediary determinants of SDH. Conclusion The findings indicate that the SDH scale has adequate psychometric properties and can be used to assess the perceived level of SDH. We recommended that this tool be tested in other populations with diverse age groups and other demographic characteristics.

Abstract Mental energy is an important factor in many domains, including athletic performance. The athletic mental energy scale (AMES) is one of the established tools available to measure athletes’ perceived mental energy state. To date, there is no validated questionnaire to assess athletic mental energy for Chinese adolescents. Therefore, purpose of this study was to validate a Chinese version of AMES (C-AMES) among the Chinese adolescents in Lanzhou, Gansu Province, China. We sampled 729 adolescents aged 14 to 18 in five middle schools in Lanzhou City, Gansu Province, China to complete the revised C-AMES. Data were analyzed for factor structure validity by performing CFA. The results showed that the fit index was acceptable (RMSEA = 0.050, CFI = 0.962, TLI = 0.951), and a six-factor model containing 18 C-AMES items had good measurement properties for athletic mental energy. We suggest future study may use C-AMES to examine the relationship between athletes’ mental energy and athletic performance and sporting behavior.

Abstract The utility of spatial omics in leveraging cellular interactions in normal and diseased states for precision medicine is hampered by a lack of strategies for matching disease states with spatial heterogeneity-guided cellular annotations. Here we use a spatial context-dependent approach that matches spatial pattern detection to cell annotation. Using this approach in existing datasets from ulcerative colitis patient colonic biopsies, we identified architectural complexities and associated difficult-to-detect rare cell types in ulcerative colitis germinal-center B cell follicles. Our approach deepens our understanding of health and disease pathogenesis, illustrates a strategy for automating nested architecture detection for highly multiplexed spatial biology data, and informs precision diagnosis and therapeutic strategies.

Abstract Background The environmental determinants of health (EDH) have a significant impact on people’s physical, mental, and social wellbeing. Everyone needs access to environmental resources of all types, including food, materials, and energy, to survive. Currently, no valid and reliable instrument exists for evaluating individuals’ perceived levels of EDH. Hence, the purpose of this study was to develop and validate the environmental determinants of health questionnaire (EDH-Q) among undergraduate students in Nigeria. Method We conducted a cross-sectional survey among undergraduate students in Nigeria to assess the psychometric properties of the newly developed Environmental Determinants of Health Questionnaire (EDH-Q). Respondents were selected using a convenience sampling approach to evaluate their perceptions of environmental determinants of health. The Content Validity Index (CVI) and Face Validity Index (FVI) were calculated to ascertain the scale’s content validity and response process validity, respectively. Additionally, exploratory factor analysis (EFA), confirmatory factor analysis (CFA), composite reliability (CR), average variance extracted (AVE), Cronbach’s alpha, and intraclass correlation coefficient (ICC) were computed to assess the scale’s construct validity. Results The study involved 300 respondents in the EFA (males 55.7%, females 44.3%) and 430 respondents in the CFA (males 54.0%, females 46.0%). In the EFA, two constructs were identified (the natural environment and the built environment). The EFA model was able to explain 63.57% of the total cumulative variance, and the factor correlation was 0.671. The whole scale Cronbach’s alpha value was 0.947, while the two constructs’ Cronbach’s alpha values were 0.918 (natural environment) and 0.935 (built environment). In the CFA, six pairs of error covariances were included between items within the same construct to improve the fit indices of the initial proposed measurement model. The final re-specified measurement model showed that the EDH-Q, which has two constructs and 18 items, has adequate construct validity (CFI = 0.948, TLI = 0.938, SRMR = 0.046, RMSEA = 0.052, and RMSEA p-value = 0.344). The CRs were 0.845 (natural environment) and 0.854 (built environment). The ICCs were 0.976 (natural environment) and 0.970 (built environment). Conclusion The results show that the newly created EDH-Q has sufficient construct validity and may be utilized to assess participants’ perceptions of their level of EDH. Researchers should examine this instrument in populations with different age ranges and other demographic characteristics, as the present study only applied it to undergraduate students who may share similar characteristics.

Abstract Spatial omics technologies decipher functional components of complex organs at cellular and subcellular resolutions. We introduce Spatial Graph Fourier Transform (SpaGFT) and apply graph signal processing to a wide range of spatial omics profiling platforms to generate their interpretable representations. This representation supports spatially variable gene identification and improves gene expression imputation, outperforming existing tools in analyzing human and mouse spatial transcriptomics data. SpaGFT can identify immunological regions for B cell maturation in human lymph nodes Visium data and characterize variations in secondary follicles using in-house human tonsil CODEX data. Furthermore, it can be integrated seamlessly into other machine learning frameworks, enhancing accuracy in spatial domain identification, cell type annotation, and subcellular feature inference by up to 40%. Notably, SpaGFT detects rare subcellular organelles, such as Cajal bodies and Set1/COMPASS complexes, in high-resolution spatial proteomics data. This approach provides an explainable graph representation method for exploring tissue biology and function.

Abstract Rationale & objective Glomerulonephritis (GN) is a leading cause of chronic kidney disease (CKD). Major adverse cardiovascular events (MACE) are prolific in CKD. The risk of MACE in GN cohorts is multifactorial. We investigated the prognostic significance of routine cardiac biomarkers, Troponin I and N-terminal pro-BNP (NT-proBNP) in predicting MACE within 5 years of GN diagnosis. Study Design Retrospective cohort study. Setting & participants Data were obtained from TriNetX, a global federated health research network of electronic health records (EHR). Exposure or predictor Biomarker thresholds: Troponin I: 18 ng/L, NT-proBNP: 400 pg/mL. Outcomes Primary outcome: Incidence of major adverse cardiovascular events (MACE). Secondary outcome: was the risk for each individual component of the composite outcome. Analytical Approach 1:1 propensity score matching using logistic regression. Cox proportional hazard models were used to assess the association of cardiac biomarkers with the primary and secondary outcomes, reported as Hazard Ratio (HR) and 95% confidence intervals (CI). Survival analysis was performed which estimates the probability of an outcome over a 5-year follow-up from the index event. Results Following PSM, 34,974 and 18,218 patients were analysed in the Troponin I and NTproBNP cohorts, respectively. In the Troponin I all cause GN cohort, 3,222 (9%) developed composite MACE outcome HR 1.79; (95% CI, 1.70, 1.88, p

Abstract The present study examines the mediating effect of psychological factors in the structural relationships between social and physical environmental factors and the amount of physical activity among undergraduate students at Universiti Sains Malaysia. The sample consisted of 422 students with a mean age of 20.2 years (SD = 1.27). The majority of the students were female (69.7%) and Malay (81.3%). Standardized scales were used to measure the total amount of physical activity and all the study variables. The final SEM had a good fit to the data: CFI = 0.968, TLI = 0.948, SRMR = 0.036, RMSEA (90%CI) = 0.046 (0.025, 0.065), RMSEA p-value = 0.609 with 11 paths relationships. Family support had a significant effect on perceived benefits and perceived barriers. The effect of friend support on physical activity was significantly mediated by perceived benefits, self-efficacy, and psychological needs satisfaction. The effect of the availability of exercise facilities on physical activity was significantly mediated by perceived benefits and psychological needs satisfaction. Furthermore, psychological needs satisfaction mediated the effect of perceived benefits, perceived barriers, and self-efficacy on physical activity. The study findings illustrated that the application of the social-ecological model and psychological factors is important in order to understand and promote positive physical activity behaviour.

Introduction: Lung cancer remains the most common cause of cancer death in the USA and worldwide despite continued advances in lung cancer screening and treatment. Pericardial effusion (PerF) has been found in up to 50% of postmortem patients with cancer; lung and breast cancers are the most frequent malignancies. Furthermore, it is a sign of poor outcomes with fewer than 5 months of survival. Nevertheless, PErF with or without tamponade as a presentation of lung cancer is uncommon. Case Presentation: We present a 72-year-old male without medical history who presented with 1 month of cough with white sputum and shortness of breath, progressively worsening, associated with weight loss (20 pounds). Further studies demonstrated early cardiac tamponade secondary to malignancy. Conclusion: Cardiac tamponade can arise secondarily from various etiologies and have different presentations depending on the cause. In general, it is a slowly developing and clinically silent disease process. Therefore, malignant PerFs can rarely present with hemodynamic instability and be the initial manifestation of an underlying malignancy. Our case review presents a rare case of metastatic lung adenocarcinoma manifesting as early symptomatic cardiac tamponade and as an emergency. The results might be life-threatening if this presentation is not recognized and managed appropriately. Clinicians must be aware of such atypical presentations of thoracic malignancies to take action adequately.

This article reviews the current and potential trends in ventilation strategies within hospitals’ operating rooms (ORs), with a specific focus on vertical downward ventilation systems meeting cleanroom criteria. It also explores potential innovations, including thermal-guided mobile air supply units and the possibility of localised exhaust systems mounted on operating tables. By evaluating existing ventilation systems and emerging technologies, this review aims to provide valuable insights into optimising surgical environments to ensure improved patient safety and outcomes. Vertical downward ventilation systems, currently widely deployed in modern ORs, adhere to stringent cleanroom criteria, maintaining sterile conditions by efficiently controlling air flow and minimising airborne contaminants. These systems utilise High-Efficiency Particulate Air (HEPA) filters and controlled airflow patterns to create a clean and controlled environment conducive to surgical procedures. While vertical downward ventilation remains the prevailing practice, the potential integration of thermal-guided mobile air supply units represents an exciting innovation. These units offer dynamic airflow control based on real-time temperature gradients within the surgical zone, potentially enhancing contaminant control and settlement rate. Also, the possibility of localised exhaust systems mounted on operating tables presents another avenue for improving ventilation efficiency. By efficiently capturing and removing contaminants generated during surgical procedures, localised exhaust systems have the potential to further reduce the risk of surgical site infections and improve overall cleanliness in the vicinity of the surgical site. This review concludes that combining a mobile air supply unit with thermal control capabilities, in addition to integrating it with a vertical downward ventilation airflow system, appears to be the optimal choice for reducing low concentrations near the patient's vicinity. By synthesising current practices with potential innovations, this review could assist healthcare professionals and facility managers in the evolving landscape of ventilation strategies in ORs. The adoption of advanced ventilation technologies and practices contributes to advancing surgical care and enhancing patient safety in healthcare settings. Future studies could consider integrating the Internet of Things (IoT) for automatic indoor air quality optimisation through ventilation control.

Accurate data on population abundance is needed to monitor trends through time, especially for species that are commercially harvested or vulnerable to climate change related impacts. Hooded seals (Cystophora cristata) in the Northwest Atlantic whelp on drifting sea ice in three areas: Davis Strait, the southern Gulf of St. Lawrence and off of northeastern Newfoundland (“Front”), Canada, with the majority of whelping (>90%) occurring at the Front. They are harvested in Canada and Greenland but have not been assessed since 2005. Aerial surveys for harp seals (Pagophilus groenlandicus) took place at the Front in 2012 and 2017. These surveys also captured the vast majority of hooded seal whelping patches in these years and so were used to estimate hooded seal pup production at the Front. Pup production was estimated from photo (2012 and 2017) and visual (2017 only) line-transect surveys. Staging data from 2004, 2005 and 2017 were used to correct these estimates for the proportion of pups not born on the survey days, resulting in total pup production estimates of 41,129 (SE = 7,374) and 39,021 (SE = 18,334) pups in 2012 and 2017, respectively. This is a large decrease from the previous estimate, being 38% and 36%, respectively, of the pup production estimated on the Front in 2005. Extensive reconnaissance that failed to locate whelping hooded seals in Davis Strait (2024) or outside the traditional whelping area at the Front (2012, 2017), along with low sea-ice coverage in the Gulf of St. Lawrence makes it unlikely that significant whelping was redistributed to other areas. The large decline in pup production after 2005 mirrors a similar decline and continued low level of pup production for hooded seals in the Greenland Sea that occurred between 1997 and 2005/07. Although the cause of the decline in the Northwest Atlantic is unknown, it is possible that negative impacts of ecosystem change on female fecundity and juvenile survival, as has been documented for harp seals in the Northwest Atlantic, are also impacting hooded seals.

Introduction Acute liver failure (ALF) has no effective treatment other than liver transplantation and is commonly caused by paracetamol overdose. New treatments are needed to treat and prevent ALF. Alternatively-activated macrophages (AAMs) can promote resolution of liver necrosis and stimulate hepatocyte proliferation. Using AAMs in unscheduled care requires the use of an allogeneic product. A clinical trial is needed to determine the safety and tolerability of allogeneic AAMs.Methods and analysis A single-centre, open-label, dose-escalation, phase 1 randomised trial to determine whether there is dose-limiting toxicity of AAMs in patients with paracetamol-induced acute liver injury. Randomisation will occur at higher doses. Between 17 and 30 patients will receive treatment, subject to dose-limiting toxicity and an adaptive trial design which aims to reduce the risk of allocation bias through blinding and randomisation.Ethics and dissemination The trial will be conducted according to the ethical principles of the Declaration of Helsinki 2013 and has been approved by North East—York Research Ethics Committee (reference 23/NE/0019), National Health Service Lothian Research and Development department, and the UK Medicines and Healthcare products Regulatory Agency. When the trial concludes, results will be shared by presentation and publication.Trial registration number ISRCTN12637839.

Small cysteine-rich antifungal peptides with multi-site modes of action (MoA) have potential for development as biofungicides. In particular, legumes of the inverted repeat-lacking clade express a large family of nodule-specific cysteine-rich (NCR) peptides that orchestrate differentiation of nitrogen-fixing bacteria into bacteroids. These NCRs can form two or three intramolecular disulfide bonds and a subset of these peptides with high cationicity exhibits antifungal activity. However, the importance of intramolecular disulfide pairing and MoA against fungal pathogens for most of these plant peptides remains to be elucidated. Our study focused on a highly cationic chickpea NCR13, which has a net charge of +8 and contains six cysteines capable of forming three disulfide bonds. NCR13 expression in Pichia pastoris resulted in formation of two peptide folding variants, NCR13_PFV1 and NCR13_PFV2, that differed in the pairing of two out of three disulfide bonds despite having an identical amino acid sequence. The NMR structure of each PFV revealed a unique three-dimensional fold with the PFV1 structure being more compact but less dynamic. Surprisingly, PFV1 and PFV2 differed profoundly in the potency of antifungal activity against several fungal plant pathogens and their multi-faceted MoA. PFV1 showed significantly faster fungal cell-permeabilizing and cell entry capabilities as well as greater stability once inside the fungal cells. Additionally, PFV1 was more effective in binding fungal ribosomal RNA and inhibiting protein translation in vitro. Furthermore, when sprayed on pepper and tomato plants, PFV1 was more effective in reducing disease symptoms caused by Botrytis cinerea, causal agent of gray mold disease in fruits, vegetables, and flowers. In conclusion, our work highlights the significant impact of disulfide pairing on the antifungal activity and MoA of NCR13 and provides a structural framework for design of novel, potent antifungal peptides for agricultural use.

Pyoderma gangrenosum is a rare, autoinflammatory disorder characterized by rapidly progressive painful ulcers that are challenging to diagnose and treat. This qualitative study aimed to explore the experiences of patients living with pyoderma gangrenosum. Using an inductive qualitative approach, semi-structured interviews were completed with a purposive sample of 21 patients with pyoderma gangrenosum recruited from a public dermatology outpatient clinic in Melbourne, Australia. A reflexive thematic analysis was performed, yielding 5 themes: pain, physical challenges, social functioning and relationships, mental health, and treatment. The impact of pyoderma gangrenosum on quality of life was multifaceted and varied throughout disease progression, remission, and recurrence. Experiences of delayed diagnosis and misdiagnosis were common, causing distress and resulting in unnecessary treatments including surgery. Severe pain disrupted sleep and limited daily activities, eroding patients’ sense of self-control and perpetuating depressed mood and anxiety. Management should include early specialist referral, providing information sheets for managing pain and wound care, and communicating disease expectations. In conclusion, this study has deepened understanding and given personal perspectives on what it is like to live with a condition poorly understood by many health professionals. Increased efforts should be made to increase clinician awareness regarding pyoderma gangrenosum to facilitate early diagnosis.

AbstractThe purpose of the study was to examine the determinant factors that influence the intention to revisit retailer omnichannel in Indonesia with Mean-End Chain Approach. The internet economy growth drives the use of the omnichannel strategy in Indonesia retail companies. The past research showed that there was inconsistency in the understanding of omnichannel strategy channel integration. The Means-End Chain Theory believes can help to enlighten this integration by understanding the attribute, consequences, and values of customer omnichannel strategy acceptances. The research is cross-sectional quantitative research with sample of 248 respondents that gathered using convenience sampling. The Disjoint Two-Stage Approach Partial Least Square Structural Equation Model (PLS-SEM) was used to analyse the high order construct model. The finding shows that both customer satisfaction and shopping value were the mediating variables between channel integration and intention to revisit. The integrated order fulfilment, integrated transaction information, integrated customer service, and integrated customer service influenced channel integration were identified as the dominant dimensions to the channel integration. The managerial implication emphasized on the various channel integration optimization and integration during pre and post customer shopping journey. This study enriches the customer behavior studies, especially in the importance of channel integration with Mean-End Chain Theory approach.

There is a rising crisis in respect to teacher wellbeing, with emerging international literature indicating high levels of work-related stress, anxiety and/or depression, cited alongside an increasing exodus of teachers from the workforce. Within this available literature, teacher wellbeing terms are typically collated under frameworks of poor mental health or otherwise ‘deficit-based’ definitions of wellbeing (i.e. teachers showing an excess of difficulties). Arguably, alternative discourses (e.g. a focus on teacher autonomy or positive emotions, do not receive similar attention despite their utility. Worse, and at the crux of this paper is the point that alternative discourses are often not considered alongside or presented in juxtaposition when considering teacher wellbeing (i.e. a ‘partisan approach’ in examining only one perspective at a time), which means there is an otherwise fragmented variety of narrow and/or context-specific concepts promoting alternative discourses to wellbeing, with little consideration as to the potential value of synthesis to holism in approach. Building on extant literature, the current paper examines these current concepts of teacher wellbeing, examining to what extent existing discourses can be synthesised to produce a more comprehensive understanding of what is meant by the term. In doing so, we present an overview of current concepts, examining similarities and distinctiveness. We present a tentative unified model for understanding teacher wellbeing, discussing its suitability as a conceptual frame for future research.

Summary: Background: Patients with atrial fibrillation (AF) frequently experience multimorbidity. Cluster analysis, a machine learning method for classifying patients with similar phenotypes, has not yet been used in South Asian AF patients. Methods: The Kerala Atrial Fibrillation Registry is a prospective multicentre cohort study in Kerala, India, and the largest prospective AF registry in South Asia. Hierarchical clustering was used to identify different phenotypic clusters. Outcomes were all-cause mortality, major adverse cardiovascular events (MACE), and composite bleeding events within one-year follow-up. Findings: 3348 patients were included (median age 65.0 [56.0–74.0] years; 48.8% male; median CHA2DS2-VASc 3.0 [2.0–4.0]). Five clusters were identified. Cluster 1: patients aged ≤65 years with rheumatic conditions; Cluster 2: patients aged >65 years with multi-comorbidities, suggestive of cardiovascular-kidney-metabolic syndrome; Cluster 3: patients aged ≤65 years with fewer comorbidities; Cluster 4: heart failure patients with multiple comorbidities; Cluster 5: male patients with lifestyle-related risk factors. Cluster 1, 2 and 4 had significantly higher MACE risk compared to Cluster 3 (Cluster 1: OR 1.36, 95% CI 1.08–1.71; Cluster 2: OR 1.79, 95% CI 1.42–2.25; Cluster 4: OR 1.76, 95% CI 1.31–2.36). The results for other outcomes were similar. Atrial fibrillation Better Care (ABC) pathway in the whole cohort was low (10.1%), especially in Cluster 4 (1.9%). Overall adherence to the ABC pathway was associated with reduced all-cause mortality (OR 0.26, 95% CI 0.15–0.46) and MACE (OR 0.45, 95% CI 0.31–0.46), similar trends were evident in different clusters. Interpretation: Cluster analysis identified distinct phenotypes with implications for outcomes. There was poor ABC pathway adherence overall, but adherence to such integrated care was associated with improved outcomes. Funding: Kerala Chapter of Cardiological Society of India.

Introduction Non-invasive ventilation (NIV) is a known effective and safe treatment for children and young people with sleep disordered breathing (SDB). Adherence can be challenging and poor adherence risks undertreatment of SDB. While the risk factors for non-adherence have been widely reported, very few interventions have been tested in any capacity to address barriers to adherence.Methods and analysis We will conduct a mixed methods study over three phases. The aim is to identify the components of a toolkit of interventions to address some of the barriers to NIV usage in children and young people who have SDB. We will test these components for their feasibility and acceptability to families. We will also aim to identify health outcomes from NIV use that are important to families. Qualitative data will be managed using NVivo software and analysed using the Framework method. Quantitative data will be analysed using descriptive statistics.Ethics and dissemination The study will run from January 2023 to October 2025. This study has ethics and local site approval. Data will be stored and accessed only by the research team, stored on a secure server. Data will be pseudo-anonymised prior to analysis and presented in a way that no individual can be identified. We will disseminate widely to relevant stakeholders including peer-reviewed journals, presentations to academic and clinical audiences at conferences and meetings and a lay report.Trial registration number ISRCTN56845190.

Background: Patients with metastatic pancreatic ductal adenocarcinoma (PDAC) have poor 5-year survival. Pharmacological ascorbate (P-AscH-, high dose, intravenous, vitamin C) has shown promise as an adjunct to chemotherapy. We hypothesized adding P-AscH- to gemcitabine and nab-paclitaxel would increase survival in patients with metastatic PDAC. Methods: Patients diagnosed with stage IV pancreatic cancer randomized 1:1 to gemcitabine and nab-paclitaxel only (SOC, control) or to SOC with concomitant P-AscH−, 75 g three times weekly (ASC, investigational). The primary outcome was overall survival with secondary objectives of determining progression-free survival and adverse event incidence. Quality of life and patient reported outcomes for common oncologic symptoms were captured as an exploratory objective. Thirty-six participants were randomized; of this 34 received their assigned study treatment. All analyses were based on data frozen on December 11, 2023. Results: Intravenous P-AscH- increased serum ascorbate levels from micromolar to millimolar levels. P-AscH- added to the gemcitabine + nab-paclitaxel (ASC) increased overall survival to 16 months compared to 8.3 months with gemcitabine + nab-paclitaxel (SOC) (HR = 0.46; 90 % CI 0.23, 0.92; p = 0.030). Median progression free survival was 6.2 (ASC) vs. 3.9 months (SOC) (HR = 0.43; 90 % CI 0.20, 0.92; p = 0.029). Adding P-AscH- did not negatively impact quality of life or increase the frequency or severity of adverse events. Conclusions: P-AscH− infusions of 75 g three times weekly in patients with metastatic pancreatic cancer prolongs overall and progression free survival without detriment to quality of life or added toxicity (ClinicalTrials.gov number NCT02905578).

The title compound, C19H15BrN2O, crystallizes with two similar molecules in the asymmetric unit. The extended structure features dimers linked by pairs of N—H...O and C—H...O hydrogen bonds. The HNCNO moiety of the title compound shows delocalization over the N—C—N part, as evidenced by the similar C—N bond distances.

Background: Postoperative ileus (POI) is a common complication after colorectal surgery, leading to increased hospital stay and costs. This study aimed to explore patient comorbidities that contribute to the development of POI in the colorectal surgical population and compare machine learning (ML) model accuracy to existing risk instruments. Study Design: In a retrospective study, data were collected on 316 adult patients who underwent colorectal surgery from January 2020 to December 2021. The study excluded patients undergoing multi-visceral resections, re-operations, or combined primary and metastatic resections. Patients lacking follow-up within 90 days after surgery were also excluded. Eight different ML models were trained and cross-validated using 29 patient comorbidities and four comorbidity risk indices (ASA Status, NSQIP, CCI, and ECI). Results: The study found that 6.33% of patients experienced POI. Age, BMI, gender, kidney disease, anemia, arrhythmia, rheumatoid arthritis, and NSQIP score were identified as significant predictors of POI. The ML models with the greatest accuracy were AdaBoost tuned with grid search (94.2%) and XG Boost tuned with grid search (85.2%). Conclusions: This study suggests that ML models can predict the risk of POI with high accuracy and may offer a new frontier in early detection and intervention for postoperative outcome optimization. ML models can greatly improve the prediction and prevention of POI in colorectal surgery patients, which can lead to improved patient outcomes and reduced healthcare costs. Further research is required to validate and assess the replicability of these results.

Abstract Research indicates that COVID-19 has had adverse effects on the mental health of adolescents, exacerbating their negative psychological states. The purpose of this study is to investigate the impact of Physical Literacy (PL) on Negative Mental State caused by COVID-19 (NMSC) and identify potential factors related to NMSC and PL in Chinese adolescents. This cross-sectional study involved a total of 729 Chinese high school students with an average age of 16.2 ± 1.1 years. Participants’ demographic data, PL data, and NMSC data were collected. PL and NMSC were measured using the self-reported Portuguese Physical Literacy Assessment Questionnaire (PPLA-Q), the Stress and Anxiety to Viral Epidemics-6 (SAVE-6), and the Fear of COVID-19 Scale (FCV-19). Adolescents in the current study demonstrated higher levels of NMSC and lower PL, with average scores of 3.45 and 2.26, respectively (on a scale of 5). Through multiple linear regression analysis, Motivation (MO), Confidence (CO), Emotional Regulation (ER), and Physical Regulation (PR) were identified as factors influencing NMSC in adolescents. The study findings contribute to providing guidance for actions aimed at alleviating NMSC among adolescents.

Abstract Background The CBM13 family comprises carbohydrate-binding modules that occur mainly in enzymes and in several ricin-B lectins. The ricin-B lectin domain resembles the CBM13 module to a large extent. Historically, ricin-B lectins and CBM13 proteins were considered completely distinct, despite their structural and functional similarities. Results In this data mining study, we investigate structural and functional similarities of these intertwined protein groups. Because of the high structural and functional similarities, and differences in nomenclature usage in several databases, confusion can arise. First, we demonstrate how public protein databases use different nomenclature systems to describe CBM13 modules and putative ricin-B lectin domains. We suggest the introduction of a novel CBM13 domain identifier, as well as the extension of CAZy cross-references in UniProt to guard the distinction between CAZy and non-CAZy entries in public databases. Since similar problems may occur with other lectin families and CBM families, we suggest the introduction of novel CBM InterPro domain identifiers to all existing CBM families. Second, we investigated phylogenetic, nomenclatural and structural similarities between putative ricin-B lectin domains and CBM13 modules, making use of sequence similarity networks. We concluded that the ricin-B/CBM13 superfamily may be larger than initially thought and that several putative ricin-B lectin domains may display CAZyme functionalities, although biochemical proof remains to be delivered. Conclusions Ricin-B lectin domains and CBM13 modules are associated groups of proteins whose database semantics are currently biased towards ricin-B lectins. Revision of the CAZy cross-reference in UniProt and introduction of a dedicated CBM13 domain identifier in InterPro may resolve this issue. In addition, our analyses show that several proteins with putative ricin-B lectin domains show very strong structural similarity to CBM13 modules. Therefore ricin-B lectin domains and CBM13 modules could be considered distant members of a larger ricin-B/CBM13 superfamily.

The net return from milk to the producers is defined as the aggregate market income from dairy products, after deducting all processing and marketing costs. The way to distribute this net return is through the payment system, which is usually based on multiple components, mainly with a reward for fat and protein and, in the case of the New Zealand dairy industry, a penalty for milk volume. Traditionally, the value of genetic improvement is evaluated using selection index theory assuming that there is an unlimited market where all dairy products can be sold in unlimited amounts at a fixed price and therefore economic values for fat and protein are assumed to be independent of demand. The objective of this study was to estimate the value of continuous genetic improvement evaluated using a model encompassing all the dairy producers in the industry where prices of the dairy products were determined by product specific supply-demand curves. Over 10 years of genetic improvement, the present value of the benefit (10% discount rate) was estimated to be $123,000 per farm. The corresponding benefit when the markets were assumed to have fixed commodity prices was $183,000 per farm. The model revealed that systematic genetic gains had a finite duration during which incremental benefits progressively declined and would be exhausted eventually.

This narrative review explores the utilization of machine learning (ML) and artificial intelligence (AI) models to enhance perioperative cancer care. ML and AI models offer significant potential to improve perioperative cancer care by predicting outcomes and supporting clinical decision-making. Tailored for perioperative professionals including anesthesiologists, surgeons, critical care physicians, nurse anesthetists, and perioperative nurses, this review provides a comprehensive framework for the integration of ML and AI models to enhance patient care delivery throughout the perioperative continuum.

Abstract This work presents a deep learning approach for rapid and accurate muscle water T2 with subject-specific fat T2 calibration using multi-spin-echo acquisitions. This method addresses the computational limitations of conventional bi-component Extended Phase Graph fitting methods (nonlinear-least-squares and dictionary-based) by leveraging fully connected neural networks for fast processing with minimal computational resources. We validated the approach through in vivo experiments using two different MRI vendors. The results showed strong agreement of our deep learning approach with reference methods, summarized by Lin’s concordance correlation coefficients ranging from 0.89 to 0.97. Further, the deep learning method achieved a significant computational time improvement, processing data 116 and 33 times faster than the nonlinear least squares and dictionary methods, respectively. In conclusion, the proposed approach demonstrated significant time and resource efficiency improvements over conventional methods while maintaining similar accuracy. This methodology makes the processing of water T2 data faster and easier for the user and will facilitate the utilization of the use of a quantitative water T2 map of muscle in clinical and research studies.