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BackgroundEvidence suggests that a ketogenic diet (KD) may help to alleviate psychiatric symptoms, including depression and anxiety. Positive changes have been reported such as improvements in cognition, concentration, and sleep, a reduction in hunger, and an increase in well-being, energy, confidence, and resilience. This research aims to understand the impact of a non-calorie-restricted KD on depression and aspects of psychological well-being in those with varying degrees of depressive symptoms. Though there are a few studies directly exploring the experiences of those following a KD, this will be the first study to explore the narrative from a mental health and psychological well-being viewpoint.MethodA sample of nine participants who had followed a non-calorie restricted KD intervention of 50 g of carbohydrates or less per day for at least 12 weeks were recruited. Participants were split into ‘healthy adults’ group who had no to low depressive symptoms and ‘depressive symptoms’ group who had mild to moderate depressive symptoms. A reflexive thematic analysis was considered suitable for this study.FindingsFive core themes and 24 subthemes were created. These were, (1) Poor health prior to program; (2) Hunger and cravings-the food and mood connection; (3) Psychological well-being improvements; (4) It becomes a lifestyle; and (5) Implementation difficulties. Participants experienced mental health improvements such as increased self-esteem, confidence, motivation, and achievement. Some experienced more control in life and a greater sense of reward. Those with depressive symptoms who initially reported low self-worth and hopelessness later reported increased self-esteem and renewed meaning and purpose in life. The findings from this study reflect the previous reports that the diet implementation can be difficult initially, but soon becomes easy to follow and turns into a lifestyle.ConclusionIn the literature, there are very few qualitative studies that explore the accounts and lived experiences of those following a KD. From the participants’ accounts in this study, it appears that the benefits and positive outcomes of this diet outweigh any negative side-effects experienced. This is encouraging for those who are looking for adjunctive therapies to address and improve their depressive symptoms and overall mental health.

Introduction Exertional dyspnoea is the primary diagnostic symptom for chronic cardiopulmonary disease populations. Whilst a number of exercise tests are used, there remains no gold standard clinical measure of exertional dyspnoea. The aim of this review was to comprehensively describe and evaluate all types of fixed-intensity exercise tests used to assess exertional dyspnoea in chronic cardiopulmonary populations and, where possible, report the reliability and responsiveness of the tests. Methods A systematic search of five electronic databases identified papers that examined 1) fixed-intensity exercise tests and measured exertional dyspnoea, 2) chronic cardiopulmonary populations, 3) exertional dyspnoea reported at isotime or upon completion of fixed-duration exercise tests, and 4) published in English. Results Searches identified 8785 papers. 123 papers were included, covering exercise tests using a variety of fixed-intensity protocols. Three modes were identified, as follows: 1) cycling (n=87), 2) walking (n=31) and 3) other (step test (n=8) and arm exercise (n=2)). Most studies (98%) were performed on chronic respiratory disease patients. Nearly all studies (88%) used an incremental exercise test. 34% of studies used a fixed duration for the exercise test, with the remaining 66% using an exhaustion protocol recording exertional dyspnoea at isotime. Exertional dyspnoea was measured using the Borg scale (89%). 7% of studies reported reliability. Most studies (72%) examined the change in exertional dyspnoea in response to different interventions. Conclusion Considerable methodological variety of fixed-intensity exercise tests exists to assess exertional dyspnoea and most test protocols require incremental exercise tests. There does not appear to be a simple, universal test for measuring exertional dyspnoea in the clinical setting.

Objective: The study objective was to determine the relationship between lung resection and the development of postoperative hiatal hernia. Methods: Preoperative and postoperative computed tomography imaging from 373 patients from the International Early Lung Cancer Action Program and the Initiative for Early Lung Cancer Research on Treatment were compared at a median of 31.1 months of follow-up after resection of clinical early-stage non–small cell lung cancer. Incidence of new hiatal hernia or changes to preexisting hernias were recorded and evaluated by patient demographics, surgical approach, extent of resection, and resection site. Results: New hiatal hernias were seen in 9.6% of patients after lung resection (5.6% after wedge or segmentectomy and 12.4% after lobectomy; P = .047). The median size of new hernias was 21 mm, and the most commonly associated resection site was the left lower lobe (24.2%; P = .04). In patients with preexisting hernias, 53.5% demonstrated a small but significant increase in size from 21 to 22 mm (P

Real-time and high-intensity teamwork management is complex, as team leaders must ensure good results while also considering the well-being of team members. Given that stress and other factors directly impact team members’ output volume and error rate, these team leaders must be aware of and manage team stress levels in combination with allocating new work. This paper examines methods for visualizing each team member’s status in mixed reality, which, combined with a simulated stress model for virtual team members, allows the team leader to take into account team members’ individual statuses when choosing whom to allocate work. Using simulated Augmented Reality in Virtual Reality, a user study was conducted where participants acted as team leaders, putting simulated team members under stress by allocating several required work tasks while also being able to review the stress and status of each team member. The results showed that providing Augmented Reality feedback on team members’ internal status increases the team’s overall performance, as team leaders can better allocate new work to reduce team members’ stress-related errors while maximizing output. Participants preferred having a graph representation for stress levels despite performing better with a text representation.

Focus-locking improves localization precision in single-molecule microscopy, but fiducials are often deposited at random and provide limited 3D compensation. Here, the authors fabricate 3D optical fiducials with nanometer accuracy by two-photon direct laser writing, and demonstrate isotropic 3D focus locking.

Abstract Background Interstitial lung disease is a debilitating condition associated with significant dyspnoea, fatigue, and poor exercise tolerance. Pulmonary rehabilitation is an effective and key intervention in people with interstitial lung disease. However, despite the best efforts of patients and clinicians, many of those who participate are not achieving clinically meaningful benefits. This assessor-blinded, multi-centre, randomised controlled trial aims to compare the clinical benefits of high intensity interval exercise training versus the standard pulmonary rehabilitation method of continuous training at moderate intensity in people with fibrotic interstitial lung disease. Methods Eligible participants will be randomised to either a standard pulmonary rehabilitation group using moderate intensity continuous exercise training or high intensity interval exercise training. Participants in both groups will undertake an 8-week pulmonary rehabilitation program of twice-weekly supervised exercise training including aerobic (cycling) and strengthening exercises. In addition, participants in both groups will be prescribed a home exercise program. Outcomes will be assessed at baseline, upon completion of the intervention and at six months following the intervention by a blinded assessor. The primary outcome is endurance time on a constant work rate test. Secondary outcomes are functional capacity (6-min walk distance), health-related quality of life (Chronic Respiratory Disease Questionnaire (CRQ), St George’s Respiratory Questionnaire idiopathic pulmonary fibrosis specific version (SGRQ-I), breathlessness (Dyspnoea 12, Modified Medical Research Council Dyspnoea Scale), fatigue (fatigue severity scale), anxiety (Hospital Anxiety and Depression Scale), physical activity level (GeneActiv), skeletal muscle changes (ultrasonography) and completion and adherence to pulmonary rehabilitation. Discussion The standard exercise training strategies used in pulmonary rehabilitation may not provide an optimal exercise training stimulus for people with interstitial lung disease. This study will determine whether high intensity interval training can produce equivalent or even superior changes in exercise performance and symptoms. If high intensity interval training proves effective, it will provide an exercise training strategy that can readily be implemented into clinical practice for people with interstitial lung disease. Trial registration ClinicalTrials.gov Registry (NCT03800914). Registered 11 January 2019, https://clinicaltrials.gov/ct2/show/NCT03800914 Australian New Zealand Clinical Trials Registry ACTRN12619000019101. Registered 9 January 2019, https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=376050&isReview=true

Abstract The interaction between an argon plasma jet excited using microsecond duration voltage pulses and a liquid target was examined using Thomson scattering to quantify the temporal evolution of the electron density and temperature. The electrical resistance between a liquid target and the electrical ground was varied from 1 to $$680\, \text {k}\Omega $$ 680 k Ω to mimic different conductivity liquids while the influence of the varying electrical properties on the electron dynamics within the plasma were examined. It was demonstrated that the interaction between the plasma jet and a liquid target grounded via a high resistance resulted in typical dielectric barrier discharge behaviour, with two discharge events per applied voltage pulse. Under such conditions, the electron density and temperature reached a peak of $$1\cdot 10^{15}\, \text {cm}^{-3}$$ 1 · 10 15 cm - 3 and 3.4 eV, respectively; with both rapidly decaying over several hundreds of nanoseconds. For liquid targets grounded via a low resistance, the jet behaviour transitioned to a DC-like discharge, with a single breakdown event being observed and sustained throughout the duration of each applied voltage pulse. Under such conditions, electron densities of $$2{-}3 \cdot 10^{15}\, \text {cm}^{-3}$$ 2 - 3 · 10 15 cm - 3 were detected for several microseconds. The results demonstrate that the electron dynamics in a pulsed argon plasma jet are extremely sensitive to the electrical characteristics of the target, which in the case of water, can evolve during exposure to the plasma.

We describe the case of a 25 year old male who presented with a bilateral patellar tendon ruptures without any of the identified risk factors for tendon injuries. Our patient is the youngest adult reported to date with confirmed bilateral, unprovoked, patellar tendon ruptures. We accompany our case with an up-to-date literature review on this topic. A degree of clinical suspicion is required for emergency room physicians as well as orthopaedic surgeons assessing such patients to avoid missing bilateral injuries. Point of care ultrasound may be utilised when there is doubt regarding the diagnosis. Prompt surgical management and a specific rehabilitation programme are both required to ensure maximum recovery of these patients.

Data videos are a highly impactful method of communication and are becoming a prevalent medium for communicating information. While the majority of current research focuses on the cinematic aspects of data videos, very little is known about the narrative methodologies involved. This paper presents our insights derived from an initial exploration of this area. We present a taxonomy based on the analysis of 70 existing data videos examining their narrative and visual approaches. We propose that our taxonomy can be used to explain the characteristics or design of data videos. Applying this taxonomy, we present our observations, including the trend of popular technologies applied in current data videos, the under-utilization of promising methods, and highlight research opportunities in the field. Keywords: Narrative visualization, Data videos, Taxonomy, Narrative approaches

Collaborative virtual environments allow people to work together while being distant. At the same time, empathic computing aims to create a deeper shared understanding between people. In this paper, we investigate how to improve the perception of distant collaborative activities in a virtual environment by sharing users’ activity. We first propose several visualization techniques for sharing the activity of multiple users. We selected one of these techniques for a pilot study and evaluated its benefits in a controlled experiment using a virtual reality adaptation of the NASA MATB-II (Multi-Attribute Task Battery). Results show (1) that instantaneous indicators of users’ activity are preferred to indicators that continuously display the progress of a task, and (2) that participants are more confident in their ability to detect users needing help when using activity indicators.

Assuring the safety of muscle foods and seafood is based on prerequisites and specific measures targeted against defined hazards. This concept is augmented by ‘interventions’, which are chemical or physical treatments, not genuinely part of the production process, but rather implemented in the framework of a safety assurance system. The present paper focuses on ‘Cold Atmospheric pressure Plasma’ (CAP) as an emerging non-thermal intervention for microbial decontamination. Over the past decade, a vast number of studies have explored the antimicrobial potential of different CAP systems against a plethora of different foodborne microorganisms. This contribution aims at providing a comprehensive reference and appraisal of the latest literature in the area, with a specific focus on the use of CAP for the treatment of fresh meat, fish and associated products to inactivate microbial pathogens and extend shelf life. Aspects such as changes to organoleptic and nutritional value alongside other matrix effects are considered, so as to provide the reader with a clear insight into the advantages and disadvantages of CAP-based decontamination strategies.

Abstract Background Efficient HIV-1 replication depends on interaction of the viral capsid with the host protein cyclophilin A (CypA). CypA, a peptidylprolyl isomerase, binds to an exposed loop in the viral CA protein via the enzyme’s active site. Recent structural analysis of CypA in complex with CA tubes in conjunction with molecular dynamics simulations identified a secondary CA binding site on CypA that allows a bridging interaction with two hexameric subunits of the assembled CA lattice, leading to capsid stabilization (Liu et al. in Nat Commun 7:10714, 2016). Results We performed mutational analysis of residues that have been proposed to mediate CA binding at the secondary binding site on CypA (A25, K27, P29 and K30) and tested the effects of the amino acid substitutions using interaction assays and HIV-1 infection assays in cells. The binding of recombinant CypA to self-assembled CA tubes or native HIV-1 capsids was measured in vitro using a quantitative fluorescence microscopy binding assay revealing that affinity and stoichiometry of CypA to the CA lattice was not affected by the substitutions. To test for functionality of the CypA secondary CA-binding site in HIV-1 infection, mutant CypA proteins were expressed in cells in which endogenous CypA was deleted, and the effects on HIV-1 infection were assayed. In normal HeLa-P4 cells, infection with HIV-1 bearing the A92E substitution in CA is inhibited by endogenous CypA and was inhibited to the same extent by expression of CypA mutants in CypA-null HeLa-P4 cells. Expression of the mutant CypA proteins in CypA-null Jurkat cells restored their permissiveness to infection by wild type HIV-1. Conclusions The amino acid changes at A25, K27, P29 and K30 did not affect the affinity of CypA for the CA lattice and did not impair CypA function in infection assays suggesting that these residues are not part of a secondary CA binding site on CypA.

Introduction Interstitial lung diseases are characterised by scarring of lung tissue that leads to reduced transfer of oxygen into the blood, decreased exercise capacity and premature death. Ambulatory oxygen therapy may be used to treat exertional oxyhaemoglobin desaturation, but there is little evidence to support its efficacy and there is wide variation in clinical practice. This study aims to compare the clinical efficacy and cost-effectiveness of ambulatory oxygen versus ambulatory air in people with fibrotic interstitial lung disease and exertional desaturation.Methods and analysis A randomised, controlled trial with blinding of participants, clinicians and researchers will be conducted at trial sites in Australia and Sweden. Eligible participants will be randomised 1:1 into two groups. Intervention participants will receive ambulatory oxygen therapy using a portable oxygen concentrator (POC) during daily activities and control participants will use an identical POC modified to deliver air. Outcomes will be assessed at baseline, 3 months and 6 months. The primary outcome is change in physical activity measured by number of steps per day using a physical activity monitor (StepWatch). Secondary outcomes are functional capacity (6-minute walk distance), health-related quality of life (St George Respiratory Questionnaire, EQ-5D-5L and King’s Brief Interstitial Lung Disease Questionnaire), breathlessness (Dyspnoea-12), fatigue (Fatigue Severity Scale), anxiety and depression (Hospital Anxiety and Depression Scale), physical activity level (GENEActive), oxygen saturation in daily life, POC usage, and plasma markers of skeletal muscle metabolism, systematic inflammation and oxidative stress. A cost-effectiveness evaluation will also be undertaken.Ethics and dissemination Ethical approval has been granted in Australia by Alfred Hospital Human Research Ethics Committee (HREC/18/Alfred/42) with governance approval at all Australian sites, and in Sweden (Lund Dnr: 2019-02963). The results will be published in peer-reviewed scientific journals, presented at conferences and disseminated to consumers in publications for lay audiences.Trial registration number ClinicalTrials.gov Registry (NCT03737409).

This article presents our findings from a three-stage research project, which consists of the identification, development, and evaluation of a defect management Augmented Reality (AR) prototype that incorporates Building Information Modelling (BIM) technologies. Within the first stage, we conducted a workshop with four construction-industry representatives to capture their opinions and perceptions of the potentials and barriers associated with the integration of BIM and AR in the construction industry. The workshop findings led us to the second stage, which consisted of the development of an on-site BIM-based AR defect management (BIM-ARDM) system for construction inspections. Finally, a study was conducted to evaluate BIM-ARDM in comparison to the current paper-based defect management inspection approach employed on construction sites. The findings from the study revealed BIM-ARDM significantly outperformed current approaches in terms of usability, workload, performance, completion time, identifying defects, locating building elements, and assisting the user with the inspection task.

The stability of the HIV-1 capsid and the spatiotemporal control of its disassembly, a process called uncoating, need to be finely tuned for infection to proceed. Biochemical methods for measuring capsid lattice disassembly in bulk are unable to resolve intermediates in the uncoating reaction. We have developed a single-particle fluorescence microscopy method to follow the real-time uncoating kinetics of authentic HIV capsids in vitro. The assay utilizes immobilized viral particles that are permeabilized with the a pore-former protein, and is designed to (1) detect the first defect of the capsid by the release of a solution phase marker (GFP) and (2) visualize the disassembly of the capsid over time by “painting” the capsid lattice with labeled cyclophilin A (CypA), a protein that binds weakly to the outside of the capsid. This novel assay allows the study of dynamic interactions of molecules with hundreds of individual capsids as well as to determine their effect on viral capsid stability, which provides a powerful tool for dissecting uncoating mechanisms and for the development of capsid-binding drugs.

Enabling the effective representation of an object’s position and depth in augmented reality (AR) is crucial not just for realism, but also to enable augmented reality’s wider utilization in real world applications. Domains such as architecture and building design cannot leverage AR’s advantages without the effective representation of position. Prior work has examined how the human visual system perceives and interprets such cues in AR. However, it has focused on application systems that only use a single AR modality, i.e., head-mounted display, tablet/handheld, or projection. However, given the respective limitations of each modality regarding shared experience, stereo display, field of view, etc., prior work has ignored the possible benefits of utilizing multiple AR modalities together. By using multiple AR systems together, we can attempt to address the deficiencies of one modality by leveraging the features of other modalities. This work examines methods for representing position in a multi-modal AR system consisting of a stereo head-mounted display and a ceiling mounted projection system. Given that the AR content is now rendered across two separate AR realities, how does the user know which projected object matches the object shown in their head-mounted display? We explore representations to correlate and fuse objects across modalities. In this paper, we review previous work on position and depth in AR, before then describing multiple representations for head-mounted and projector-based AR that can be paired together across modalities. To the authors’ knowledge, this work represents the first step towards utilizing multiple AR modalities in which the AR content is designed directly to compliment deficiencies in the other modality.

Three-dimensional rendering technologies have long been utilized for explanatory purposes in scientific visualization and related areas. Their applications to wider fields, however, have often been limited. In this paper, we explore the use of 3D model and animation techniques, combined with narrative techniques, for recreating event-based information to aid understanding. An empirical experiment was conducted which examined the effectiveness of 3D model images and 3D animation videos compared to reading narratives in textual form. The results indicated that both forms of 3D graphical techniques positively supported users in terms of cognitive load, recall, and engagement over reading text.

Transcatheter angiography and embolization has long been recognized as the gold standard for patients with hemodynamic instability secondary to blunt pelvic trauma. While often the bleeding source can be readily localized based on the distribution of extravasation on preprocedural Computed Tomographic Angiography, one should be cautious in assessment for aberrant anatomy. A variant obturator artery originating from the inferior epigastric branch of the external iliac artery is commonly referred to as the corona mortis. We present a case of blunt pelvic trauma in which a patient demonstrated extravasation in the anterior distributions of both internal iliac arteries. Following embolization of bilateral internal iliac arteries, identification and embolization of bilateral corona mortis branches was crucial to achieving hemodynamic stability in this patient.

We present a new discontinuous ordinary differential equation (ODE) model of the glacial cycles. Model trajectories flip from a glacial to an interglacial state, and vice versa, via a switching mechanism motivated by ice sheet mass balance principles. Filippov’s theory of differential inclusions is used to analyze the system, which can be viewed as a nonsmooth geometric singular perturbation problem. We prove the existence of a unique limit cycle, corresponding to the Earth’s glacial cycles. The diffusive heat transport component of the model is ideally suited for investigating the competing temperature gradient and transport efficiency feedbacks, each associated with ice-albedo feedback. It is the interplay of these feedbacks that determines the maximal extent of the ice sheet. In the nonautonomous setting, model glacial cycles persist when subjected to external forcing brought on by changes in Earth’s orbital parameters over geologic time. The system also exhibits various bifurcation scenarios as key parameters vary.

Uncoating of the metastable HIV-1 capsid is a tightly regulated disassembly process required for release of the viral cDNA prior to nuclear import. To understand the intrinsic capsid disassembly pathway and how it can be modulated, we have developed a single-particle fluorescence microscopy method to follow the real-time uncoating kinetics of authentic HIV capsids in vitro immediately after permeabilizing the viral membrane. Opening of the first defect in the lattice is the rate-limiting step of uncoating, which is followed by rapid, catastrophic collapse. The capsid-binding inhibitor PF74 accelerates capsid opening but stabilizes the remaining lattice. In contrast, binding of a polyanion to a conserved arginine cluster in the lattice strongly delays initiation of uncoating but does not prevent subsequent lattice disassembly. Our observations suggest that different stages of uncoating can be controlled independently with the interplay between different capsid-binding regulators likely to determine the overall uncoating kinetics.

Splenic artery pseudoaneurysms (PSA) are rare entities and far less common than true aneurysms of the splenic artery. The most common etiology is pancreatitis, recurrent either in the setting of chronic pancreatitis or as an episode of acute pancreatitis. Less common causes include trauma, peptic ulcer disease, or iatrogenic causes. Almost all of the trauma-related case reports have been due to blunt trauma. We believe this to be the first reported case of a splenic artery PSA presenting with massive hematemesis at a significant time frame after penetrating trauma. Successful transcatheter treatment was performed and alternative techniques are also discussed.

The 2014–2016 Ebola virus disease epidemic in West Africa highlighted challenges faced by the global response to a large public health emergency. Consequently, the US Centers for Disease Control and Prevention established the Global Rapid Response Team (GRRT) to strengthen emergency response capacity to global health threats, thereby ensuring global health security. Dedicated GRRT staff can be rapidly mobilized for extended missions, improving partner coordination and the continuity of response operations. A large, agencywide roster of surge staff enables rapid mobilization of qualified responders with wide-ranging experience and expertise. Team members are offered emergency response training, technical training, foreign language training, and responder readiness support. Recent response missions illustrate the breadth of support the team provides. GRRT serves as a model for other countries and is committed to strengthening emergency response capacity to respond to outbreaks and emergencies worldwide, thereby enhancing global health security.

Modern fluorescence microscopy requires software-controlled illumination sources with high power across a wide range of wavelengths. Diode lasers meet the power requirements and combining multiple units into a single fiber launch expands their capability across the required spectral range. We present the NicoLase, an open-source diode laser combiner, fiber launch, and software sequence controller for fluorescence microscopy and super-resolution microscopy applications. Two configurations are described, giving four or six output wavelengths and one or two single-mode fiber outputs, with all CAD files, machinist drawings, and controller source code openly available.