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Digital illiteracy has been identified as an important indicator that impacts the quality of life of older adults. This work aims to analyze the impact of three different educational approaches (intergenerational, peer-to-peer and online) on older adults’ digital skills in different European countries (Latvia, Poland, Portugal and the United Kingdom) participating in the Erasmus+ project ICTskills4All.This is a quasi-experimental study. Digital Skills Self-Assessment Questionnaire, which is divided according to the domains of a digital competence framework for citizens (I&DL – information and data literacy; C&C – communication and collaboration; DCC – digital content creation; S – safety), was applied before and after the course. Qualitative evaluation about the pilot courses was also performed.The peer-to-peer and intergenerational (in-person) formats proved to be more effective than the online format in improving I&DL and C&C skills, and the online approach improved the DCC dimension. The results demonstrate that all the educational approaches used in the study are effective possibilities for teaching and learning ICT skills for older adults.

The COVID-19 pandemic has affected the global population, not only in terms of health, but also in the economic, psychosocial, and educational domains. Information and communication technologies (I...

Objective To determine the value of ordering a routine chest CT (CCT) in patients with blunt trauma presenting to the emergency department with a high GCS and low ISS, we retrospectively collected patient data including CT scan results, when physical examination and initial chest X-ray were normal in the trauma bay area. Methods A retrospective data collection of 901 consecutive blunt trauma patients seen in the ED between 2017 and 2019 was analyzed. Data included physical examination, age, gender, current use of anticoagulation therapy, comorbid conditions, as well as the result of radiologic images, hospital length of stay, surgical intervention, and mortality. The patients were divided into two groups: group one (patients with negative physical examination; chest x-ray and CT) and group 2 (negative physical examination, positive or negative chest x-ray, and positive CT). Statistical analysis was performed using student’s t-test and chi-square test. Results Of the 901 patients there were 489 (54%) males and 412 (46%) females with a mean age of 56 years. There were 461 patients who had a physical examination, chest x-ray, abdominal and CCT done. Group one included 442 (96%) patients, with negative physical examination, negative chest X-ray and CT scan. In group 2, 19 (4%) patients who had positive CT and or chest x-ray. Both groups were similar in GCS and ISS. Of the 19 patients, sixteen patients had a positive CCT, and thirteen of those had a positive chest x-ray. In the three patients who had negative physical examination and chest x-ray, the CT findings included one with a nondisplaced 10th rib fracture and two patients with osteoporotic compression fractures of dorsal vertebrae. The rate of both chest x-ray and CCT being positive among a group of screened patients was 16% (3/19) and the rate of a negative chest x-ray but positive CT was 16% (3/19). The odds ratio between the two outcomes was one. Conclusion In blunt trauma patients presenting to the ED with a high GCS and low ISS score, when initial physical examination and chest x-ray are negative, routine CCT is of little value.

BackgroundGenomics-driven discoveries of microbial species have provided extraordinary insights into the biodiversity of human microbiota. In addition, a significant portion of genetic variation between microbiota exists at the subspecies, or strain, level. High-resolution genomics to investigate species- and strain-level diversity and mechanistic studies, however, rely on the availability of individual microbes from a complex microbial consortia. High-throughput approaches are needed to acquire and identify the significant species- and strain-level diversity present in the oral, skin, and gut microbiome. Here, we describe and validate a streamlined workflow for cultivating dominant bacterial species and strains from the skin, oral, and gut microbiota, informed by metagenomic sequencing, mass spectrometry, and strain profiling.ResultsOf total genera discovered by either metagenomic sequencing or culturomics, our cultivation pipeline recovered between 18.1–44.4% of total genera identified. These represented a high proportion of the community composition reconstructed with metagenomic sequencing, ranging from 66.2–95.8% of the relative abundance of the overall community. Fourier-Transform Infrared spectroscopy (FT-IR) was effective in differentiating genetically distinct strains compared with whole-genome sequencing, but was less effective as a proxy for genetic distance.ConclusionsUse of a streamlined set of conditions selected for cultivation of skin, oral, and gut microbiota facilitates recovery of dominant microbes and their strain variants from a relatively large sample set. FT-IR spectroscopy allows rapid differentiation of strain variants, but these differences are limited in recapitulating genetic distance. Our data highlights the strength of our cultivation and characterization pipeline, which is in throughput, comparisons with high-resolution genomic data, and rapid identification of strain variation.

Development of antibody protection during SARS-CoV-2 infection is a pressing question for public health and for vaccine development. We developed highly sensitive SARS-CoV-2-specific antibody and neutralization assays. SARS-CoV-2 Spike protein or Nucleocapsid protein specific IgG antibodies at titers more than 1:100,000 were detectable in all PCR+ subjects (n = 115) and were absent in the negative controls. Other isotype antibodies (IgA, IgG1-4) were also detected. SARS-CoV-2 neutralization was determined in COVID-19 and convalescent plasma at up to 10,000-fold dilution, using Spike protein pseudotyped lentiviruses, which were also blocked by neutralizing antibodies (NAbs). Hospitalized patients had up to 3000-fold higher antibody and neutralization titers compared to outpatients or convalescent plasma donors. Interestingly, some COVID-19 patients also possessed NAbs against SARS-CoV Spike protein pseudovirus. Together these results demonstrate the high specificity and sensitivity of our assays, which may impact understanding the quality or duration of the antibody response during COVID-19 and in determining the effectiveness of potential vaccines., Using SARS-CoV-2-specific antibody- and neutralization assays, Dogan et al find that hospitalized individuals show higher IgG antibody responses and higher neutralization titers compared to outpatient or convalescent plasma donors, providing insights into the host humoral response to SARS CoV-2.

Background. Intubation is a life-saving skill that can be difficult to learn and perform.Objective. The intubation time and user preference of four intubation techniques, performed by novices or experienced individuals, were compared.Methods. Enrolled participants were randomly assigned to one of four simulated intubation groups. Each group first performed intubation on the manikin airway without modifications (‘easy’ airway), followed by the same technique on a manikin with modifications to mimic a ‘difficult’ airway. The primary outcome measure was the time taken to inflate the manikin’s lungs with the bag ventilator, with successful intubation.Results. Ninety-eight participants were recruited and grouped according to experience: 59 novices (10 or fewer live intubations) and 39 experts (more than 10 live intubations). The total time to intubation increased significantly from the easy airway to the difficult airway for both expertise levels, and for all intubation techniques except the novel laryngoscope.Conclusion. Repeated exposure to multiple intubation devices can result in an adequate learning curve for the novice participant. The novel laryngoscope is an uncomplicated intubation tool; in this study, it provided novice users who intubate infrequently with a better chance of successful intubation in manikins.

Development of antibody protection during SARS-CoV-2 (CoV-2) infection is a pressing question for public health and for vaccine development. We developed highly sensitive CoV-2-specific antibody and neutralization assays. CoV-2 Spike protein or Nucleocapsid protein specific IgG antibodies at titers more than 1:100,000 were detectable in all PCR+ subjects (n=87) and were absent in the negative controls. Other isotype antibodies (IgA, IgG1-4) were also detected. CoV-2 neutralization was determined in COVID-19 and convalescent plasma up to 10,000-fold dilution, using Spike protein pseudotyped lentiviruses, which was also blocked by neutralizing antibodies (NAbs). Hospitalized patients had up to 3000-fold higher antibody and neutralization titers compared to outpatients or convalescent plasma donors. Further, subjects who donated plasma further out from the diagnosis of COVID-19 appeared to have lower titers. Interestingly, some COVID-19 patients also contained NAbs against SARS Spike protein pseudovirus. Together these results demonstrate the high specificity and sensitivity of our assays, which may impact understanding the quality or duration of the antibody response during COVID-19 and in determining the effectiveness of potential vaccines.

In the United States, federal law and many state laws differentiate between marijuana and industrial hemp through delta-9-tetrahydrocannabinol (THC) levels, whereby the latter is defined as ≤0.3 percent THC on a dry weight basis. Many traditional cannabis identification methods employed by crime laboratories cannot accurately determine total THC quantities in accordance with federal and state regulations, or do so with increased time, labor, and risks of instrument damage. In order to quickly distinguish positive marijuana samples, a method was developed to identify plant material with a total THC level >1%. This novel, automated dispersive pipette extraction (DPX) method uses tip-based technology and an automated liquid handler to enable fast, hands-free selective isolation of THC and its precursors for downstream gas chromatography-mass spectrometry (GC-MS) analysis. The workflow proceeds with no repetitive manual effort and reduced need for instrument maintenance while enabling crime labs to legally identify marijuana through the detection of total THC above 1%. Recovery of THC using the DPX extraction method was 93% at 30 µg/mL and 78% at 500 µg/mL. Similarly, THCA-A recovery was 100% at 30 µg/mL and 74% at 500 µg/mL. Samples evaluated in a blind study (proficiency, hemp, and nonprobative case samples) were all accurately identified as greater than or less than 1% THC, with samples containing

Introduction Fibrous cephalic plaques (FCP) are a characteristic manifestation of tuberous sclerosis complex (TSC) and occur in one third of cases. Their natural history and long term course is unknown, as is the outcome of long term follow-up of TSC cases in old age. Phenotype and methods We describe an 80 year old with TSC due to a c.2784dupC TSC2 mutation, who was diagnosed in infancy with an FCP and was regularly followed up at the TSC clinic over 8 decades with regular epilepsy treatment and renal monitoring. Results Regular clinical photography and clinical records document the plaque at different ages. The FCP naturally resolved at 74 years. Facial angiofibromas also faded with time in the last decade. His epilepsy and renal abnormalities remained under control with careful surveillance and monitoring. Discussion Natural aging in the eighth decade causes progressive laxity of collagen and leads to natural resolution of FCPs. This novel finding with a unique 80 year follow up yields valuable insights into the aging changes within FCPs and facial angiofibromas as the pathways linking facial angiofibromas and FCP’s through the TGF-β1 pathway are now being elucidated. Conclusion We present a clinical odyssey showing the natural progression and history of FCPs in TSC and comment on the mechanistic pathways allowing potential interventions in this disfiguring condition. TSC cases can be successfully managed and complications – particularly in the brain and kidney, can be avoided over an entire lifetime. This is encouraging for long term prospects for patients with TSC.

Summary Metagenomic inferences of bacterial strain diversity and infectious disease transmission studies largely assume a dominant, within-individual haplotype. We hypothesize that within-individual bacterial population diversity is critical for homeostasis of a healthy microbiome and infection risk. We characterized the evolutionary trajectory and functional distribution of Staphylococcus epidermidis—a keystone skin microbe and opportunistic pathogen. Analyzing 1,482 S. epidermidis genomes from 5 healthy individuals, we found that skin S. epidermidis isolates coalesce into multiple founder lineages rather than a single colonizer. Transmission events, natural selection, and pervasive horizontal gene transfer result in population admixture within skin sites and dissemination of antibiotic resistance genes within-individual. We provide experimental evidence for how admixture can modulate virulence and metabolism. Leveraging data on the contextual microbiome, we assess how interspecies interactions can shape genetic diversity and mobile gene elements. Our study provides insights into how within-individual evolution of human skin microbes shapes their functional diversification.

With the proliferation of neuroscience-related messages in popular media, it is more important than ever to understand their impact on the lay public. Previous research has found that people believed news stories more when irrelevant neuroscientific explanations were added. We sought to reveal whether such information could cause a change in social behavior. Specifically, based on publicized findings of the relationship between social behavior and the neurotransmitter oxytocin, we proposed that participants would accept more strangers into their in-group, or alternatively decrease in-group size, if told that there were oxytocin-based (relative to psychological construct-based) health benefits for doing so. In two tasks, participants were shown faces and written information about stimuli that could match their race, politics, and religion to varying degrees. In spite of evidence that participants processed the primes, and were sensitive to their level of similarity with stimuli, oxytocin-based priming did not alter categorization, or pupil dilation. It did not alter cross-race viewing behavior, as measured by an eye tracker, in consistent ways. Unexpectedly, pupil dilation increased when viewing stimuli of the same religion, an effect entirely related to White liberal Christians viewing other Christians. Overall, these results suggest that neuroscience information may impact some judgments, but lay people will not alter their likelihood of acceptance of strangers simply because they were primed with a neuroscience- (or more specifically, neurotransmitter-) based reason for doing so.

Background Antimicrobial resistance is a growing public health issue influenced by inappropriate prescribing and use. In Australia the prevalence of antibiotic-resistant bacteria in hospital, nursing home and community settings is on the rise. To address this issue, a 5-year program focuses on reducing the prescribing and inappropriate use of antibiotics. In order to inform development of the program, a cross-sectional survey was conducted. Methods The survey was sent to a random sample of 1570 Australian general practitioners (GPs), and data was collected on GP knowledge, attitudes, awareness and self-reported behaviour in relation to antibiotic resistance, medical imaging referrals and antibiotic prescribing. Results 730 GPs participated in the survey (46.5% response rate). While GPs perform very well in many areas, especially in recommending symptomatic management rather than prescribing an antibiotic, there is some possible confusion amongstGPs about the factors that increase antibiotic resistance. The results showed that patient expectation also plays a role in the decision to prescribe antibiotics, with almost 40% of respondents admitting that they would prescribe antibiotics to meet a patient's expectations. Antibiotic resistance is generally not discussed with patients (only half [50%] of respondents would always or often discuss the issue of antibiotic resistance). Conclusion Programs to address the prescribing of antibiotics must be informed by existing knowledge, attitudes, awareness and practice of GPs. There is room for improvement in GPs' knowledge of prescribing behaviours that decrease antibiotic resistance. GPs should be encouraged to discuss the issue of antibiotic resistance with patients and to not provide an antibiotic prescription to be dispensed at a later date or to meet patient expectation.

Genetic testing for the breast and ovarian cancer susceptibility genes BRCA1 and BRCA2 has important implications for the clinical management of people found to carry a mutation. However, genetic testing is expensive and may be associated with adverse psychosocial effects. To provide a cost-efficient and clinically appropriate genetic counselling service, genetic testing should be targeted at those individuals most likely to carry pathogenic mutations. Several algorithms that predict the likelihood of carrying a BRCA1 or a BRCA2 mutation are currently used in clinical practice to identify such individuals.We evaluated the performance of the carrier prediction algorithms BOADICEA, BRCAPRO, IBIS, the Manchester scoring system and Myriad tables, using 1934 families seen in cancer genetics clinics in the UK in whom an index patient had been screened for BRCA1 and/or BRCA2 mutations. The models were evaluated for calibration, discrimination and accuracy of the predictions.Of the five algorithms, only BOADICEA predicted the overall observed number of mutations detected accurately (ie, was well calibrated). BOADICEA also provided the best discrimination, being significantly better (p0.05) than all models except BRCAPRO (area under the receiver operating characteristic curve statistics: BOADICEA = 0.77, BRCAPRO = 0.76, IBIS = 0.74, Manchester = 0.75, Myriad = 0.72). All models underpredicted the number of BRCA1 and BRCA2 mutations in the low estimated risk category.Carrier prediction algorithms provide a rational basis for counselling individuals likely to carry BRCA1 or BRCA2 mutations. Their widespread use would improve equity of access and the cost-effectiveness of genetic testing.

All nonprofit organisations need to give attention to their marketing strategies in order to maximise the funding and support they receive and the numbers using their services. The web offers a new communications medium with which to achieve this. This paper compares suggested best practice approaches to web marketing using the websites of UK environmental charities as a type of nonprofit organisation. Copyright © 2003 Henry Stewart Publications

With digital technology libraries can archive considerable resources of detailed information about their users. This data is generally regarded as confidential between the library and the individual, but it has potential interest for commercial organisations, law enforcement and security agencies, and libraries themselves, to assist in marketing their services. The Privacy in the Digital Library Environment project at Loughborough University, 2000‐2002, investigated the issues this raises. Findings suggested that users had low levels of anxiety about privacy when using libraries, but this was because they expected that libraries would not pass on personal data to other bodies. Librarians, whilst respecting privacy as a professional value in principle, did not give it a high rating against other values. Additionally, a significant minority of libraries was not well prepared for data protection. To assist the professional community, guidelines for privacy policy were drawn up on the basis of suggestions made by survey respondents.

This article presents the case of an adult patient with tuberous sclerosis complex who presented with large right benign and left malignant Leydig cell tumors. The tumors were examined to determine if they showed the classic hallmarks of TSC1/TSC2 involvement.

The paper describes research into charging mechanisms for the delivery of digitized texts to students in the higher education sector. A satisfactory pricing model in this domain is urgently required. The history and background of the use and pricing of digitized texts for students in the higher education sector is examined. Issues of economics in the electronic era are described. The issues involved are outlined in relation to the stakeholders involved, namely academics, authors, the CLA (Copyright Licensing Agency), HERON (Higher Education Resources On-demand) libraries in the HE sector, publishers and students. Past projects and research conducted to date are considered and the results discussed. Particular reference is made to the HERON project, a service provided for the UK higher education community that delivers copyright clearance, digitization and delivery of the text to UK Higher Education Institutions (HEIs). HERON is also building up a national database and resource bank of the texts. Other electronic resource models are considered, in particular library initiatives. International projects are covered in relation to how pricing issues are addressed throughout the world, particularly in the USA. The case is proposed of the benefits to all stakeholders of establishing a mutually acceptable pricing model for the distribution of digitized texts to the HE/FE community. The PELICAN project had the ultimate aim of developing pricing models for the delivery of digitized text to the UK HE community, satisfying all stakeholders as far as possible. The project’s initial research findings are described, including a table of the possible pricing mechanisms and initial conclusions drawn.

A study carried out for the UK Joint Information Systems Committee examined models for the provision of access to material in institutional and subject-based archives and in open access journals. Their relative merits were considered, addressing not only technical concerns but also how e-print provision (by authors) can be achieved – an essential factor for an effective e-print delivery service (for users). A "harvesting" model is recommended, where the metadata of articles deposited in distributed archives are harvested, stored and enhanced by a national service. This model has major advantages over the alternatives of a national centralized service or a completely decentralized one. Options for the implementation of a service based on the harvesting model are presented.

This article presents the case of an 8-year-old boy with a TSC2 1801A>G mutation who has five facial features of tuberous sclerosis complex.