Relative Humidity Modulates the Physicochemical Processing of Secondary Brown Carbon Formation from Nighttime Oxidation of Furan and Pyrrole.

Light-absorbing secondary organic aerosols (SOAs), also known as secondary brown carbon (BrC), are major components of wildfire smoke that can have a significant impact on the climate system; however, how environmental factors such as relative humidity (RH) influence their formation is not fully understood, especially for heterocyclic precursors. We conducted chamber experiments to investigate secondary BrC formation from the nighttime oxidation of furan and pyrrole, two primary heterocyclic precursors in wildfires, in the presence of pre-existing particles at RH < 20% and ∼ 50%. Our findings revealed that increasing RH significantly affected the size distribution dynamics of both SOAs, with pyrrole SOA showing a stronger potential to generate ultrafine particles via intensive nucleation processes. Higher RH led to increased mass fractions of oxygenated compounds in both SOAs, suggesting enhanced gas-phase and/or multiphase oxidation under humid conditions. Moreover, higher RH reduced the mass absorption coefficients of both BrC, contrasting with those from homocyclic precursors, due to the formation of non-absorbing high-molecular-weight oxygenated compounds and the decreasing mass fractions of molecular chromophores. Overall, our findings demonstrate the unique RH dependence of secondary BrC formation from heterocyclic precursors, which may critically modulate the radiative effects of wildfire smoke on climate change.

Nutrition Education and Nutrition Knowledge Among Obstetrics and Gynecology Residents.

Background: Nutrition in pregnancy is a component of the Council on Resident Education in obstetrics and gynecology core curriculum; however, no studies currently examine adherence to this goal. Objectives: Our objective was to assess obstetrics and gynecology (Ob/Gyn) residents' education and knowledge surrounding nutrition in pregnancy, including (1) amount of dedicated didactic time to and attitudes toward, (2) subjective comfort in counseling patients on, and (3) objective knowledge of pregnancy-related nutrition. Materials and Methods: This is a cross-sectional electronic survey-based study. A 28-item questionnaire was distributed to residents enrolled in Ob/Gyn training programs across the United States in 2022. Results: From 247 Ob/Gyn residency programs, 218 residents across postgraduate years and from geographically diverse locations consented to participation and completed all survey questions. Almost half (48%) of participants reported 0 hours per year of dedicated nutrition-related education, 49% reported 1-2 hours, and 3% reported >2 hours. Most residents (92%) strongly agreed or agreed that education regarding pregnancy-related nutrition guidelines would be useful for clinical practice. However, less than one-third (31%) of residents reported feeling comfortable counseling patients on nutrition in pregnancy. On assessment of residents' objective knowledge of pregnancy-related nutrition, mean percentage of correct responses was 74%. Conclusions: This study identifies a gap in graduate medical education, specifically a disconnect between the recognized impact of nutrition on pregnancy outcomes and residents' ability to confidently and effectively counsel patients on nutrition in pregnancy. Results demonstrate a need to develop curriculum and interventions to educate Ob/Gyn residents about pregnancy-related nutrition.

Universal Fetal Echocardiography for Pregestational Diabetes Mellitus: A Cost-Effectiveness Analysis.

OBJECTIVE: To evaluate the cost effectiveness of universal fetal echocardiogram for patients with pregestational diabetes mellitus by first-trimester hemoglobin A1c (Hb A1c) level. METHODS: We developed a cost-effectiveness model comparing two strategies of screening for critical fetal congenital heart disease among patients with diabetes: universal fetal echocardiogram and fetal echocardiogram only after abnormal findings on detailed anatomy ultrasonogram. We excluded ventricular septal defect, atrial septal defects, and bicuspid aortic valve from the definition of critical fetal congenital heart disease. Probabilities and costs were derived from the literature. We used individual models to evaluate different scenarios: first-trimester Hb A1c lower than 6.5%, Hb A1c 6.5-9.0%, and Hb A1c higher than 9.0%. Primary outcomes included fetal death, neonatal death, and false-positive and false-negative results. A cost-effectiveness threshold was set at $100,000 per quality-adjusted life-year. Univariable sensitivity analyses were performed to investigate the drivers of the model. RESULTS: Universal fetal echocardiogram is not cost effective except for when first-trimester Hb A1c level is higher than 9.0% (incremental cost-effectiveness ratio $638,100, $223,693, and $67,697 for Hb A1c lower than 6.5%, 6.5-9.0%, and higher than 9.0%, respectively). The models are sensitive to changes in the probability of congenital heart disease at a given Hb A1c level, as well as the cost of neonatal transfer to a higher level of care. Universal fetal echocardiogram became both cost saving and more effective when the probability of congenital heart disease reached 14.48% (15.4 times the baseline risk). In the Monte Carlo simulation, universal fetal echocardiogram is cost effective in 22.7%, 48.6%, and 62.3% of scenarios for each of the three models, respectively. CONCLUSION: For pregnant patients with first-trimester Hb A1c levels lower than 6.5%, universal fetal echocardiogram was not cost effective, whereas, for those with first-trimester Hb A1c levels higher than 9.0%, universal fetal echocardiogram was cost effective. For those with intermediate Hb A1c levels, universal fetal echocardiogram was cost effective in about 50% of cases; therefore, clinical judgment based on individual patient values, willingness to pay to detect congenital heart disease, and resource availability needs to be considered.

The perspectives of participants with traumatic brain injury on prospective memory rehabilitation incorporating compensatory and metacognitive skills training.

OBJECTIVE: Patient feedback is rarely gathered systematically in cognitive rehabilitation research. This study examined the perceptions and experiences of people with traumatic brain injury (TBI) who participated in a trial of a 6-session educational program for the rehabilitation of prospective memory (PM) impairment. METHODS: A mixed methods design was used with 47 participants with TBI who completed a compensatory strategy training program (COMP) or COMP plus metacognitive strategy training program (COMP-MST) delivered by an occupational therapist. Data were collected via a participant survey, extracts from progress notes, and audiotaped discussions about learnings from the program during the final session. RESULTS: Participants from both programs were highly satisfied and perceived improvements in everyday PM performance post-intervention. Elements that were highly valued include setting individualised client-centred goals, repetitive training of strategy use, establishing habits and routines, and receiving experiential, verbal, and written feedback.Changes including more therapy sessions were recommended. CONCLUSIONS: Both the COMP and COMP-MST programs were perceived as effective by participants with TBI in improving their PM performance in everyday life using compensatory strategies such as assistive technology. PRACTICE IMPLICATIONS: Routine collection of patient feedback on cognitive rehabilitation can provide valuable information to support person-centred implementation of clinical practice guidelines.

Contribution of Carbonyl Chromophores in Secondary Brown Carbon from Nighttime Oxidation of Unsaturated Heterocyclic Volatile Organic Compounds.

The light absorption properties of brown carbon (BrC), which are linked to molecular chromophores, may play a significant role in the Earth's energy budget. While nitroaromatic compounds have been identified as strong chromophores in wildfire-driven BrC, other types of chromophores remain to be investigated. Given the electron-withdrawing nature of carbonyls ubiquitous in the atmosphere, we characterized carbonyl chromophores in BrC samples from the nighttime oxidation of furan and pyrrole derivatives, which are important but understudied precursors of secondary organic aerosols primarily found in wildfire emissions. Various carbonyl chromophores were characterized and quantified in BrC samples, and their ultraviolet-visible spectra were simulated by using time-dependent density functional theory. Our findings suggest that chromophores with carbonyls bonded to nitrogen (i.e., imides and amides) derived from N-containing heterocyclic precursors substantially contribute to BrC light absorption. The quantified N-containing carbonyl chromophores contributed to over 40% of the total light absorption at wavelengths below 350 nm and above 430 nm in pyrrole BrC. The contributions of chromophores to total light absorption differed significantly by wavelength, highlighting their divergent importance in different wavelength ranges. Overall, our findings highlight the significance of carbonyl chromophores in secondary BrC and underscore the need for further investigation.

Linear Immunoglobulin A (IgA) Bullous Dermatosis Mimicking Stevens-Johnson Syndrome.

Linear IgA bullous dermatosis (LABD) is a rare autoimmune blistering disease characterized by linear IgA deposition along the dermo-epidermal junction on direct immunofluorescence (DIF). LABD appears clinically as erythematous polycyclic lesions in younger patients but can show considerable phenotypic heterogeneity in older patients, often leading to misdiagnoses such as bullous pemphigoid, pemphigus vulgaris, Stevens-Johnson syndrome/toxic epidermal necrolysis (SJS/TEN), or other bullous conditions. Cases of LABD mimicking SJS/TEN require prompt skin biopsies for histopathology and DIF for disease differentiation and medical decision-making. In cases of suspected drug-induced LABD or SJS/TEN, identification and removal of the offending agent are paramount. The preferred treatment for LABD is oral dapsone, while SJS/TEN may respond better to cyclosporine or a combination of intravenous immunoglobulin and systemic corticosteroids. This case highlights the rare occurrence of LABD mimicking SJS/TEN and emphasizes the details that clinicians must know to guide patient management.

Pharmacological mTOR-inhibition facilitates clearance of AD-related tau aggregates in the mouse brain.

In this study we aimed to reduce tau pathology, a hallmark of Alzheimer's Disease (AD), by activating mTOR-dependent autophagy in a transgenic mouse model of tauopathy by long-term dosing of animals with mTOR-inhibitors. Rapamycin treatment reduced the burden of hyperphosphorylated and aggregated pathological tau in the cerebral cortex only when applied to young mice, prior to the emergence of pathology. Conversely, PQR530 which exhibits better brain exposure and superior pharmacokinetic properties, reduced tau pathology even when the treatment started after the onset of pathology. Our results show that dosing animals twice per week with PQR530 resulted in intermittent, rather than sustained target engagement. Nevertheless, this pulse-like mTOR inhibition followed by longer intervals of re-activation was sufficient to reduce tau pathology in the cerebral cortex in P301S tau transgenic mice. This suggests that balanced therapeutic dosing of blood-brain-barrier permeable mTOR-inhibitors can result in a disease-modifying effect in AD and at the same time prevents toxic side effects due to prolonged over activation of autophagy.

Efficacy of Prospective Memory Rehabilitation Plus Metacognitive Skills Training for Adults With Traumatic Brain Injury: A Randomized Controlled Trial.

BACKGROUND: Prospective memory (PM) failure can limit independence and productivity following traumatic brain injury (TBI). Compensatory strategy use may ameliorate the effect of PM impairment on daily life but requires sufficient self-awareness. Metacognitive skills training (MST) can facilitate self-awareness and strategy use and may improve the efficacy of PM rehabilitation. OBJECTIVE: To evaluate the effectiveness of compensatory strategy training (COMP) with an MST component (COMP-MST) for reducing everyday PM failure and improving psychosocial integration in adults with moderate-severe TBI, compared to COMP alone and a control condition. Secondary aims were to evaluate the effect of training on psychometric PM test scores, strategy use, self-awareness, and level of care. METHODS: Assessor and participant-blinded randomized controlled trial with 52 participants (77% male, mean age = 39.0. SD = 13.6) allocated to 3 groups: COMP-MST, COMP, and waitlist control. Interventions were delivered over 6 weekly sessions. Measures were collected pre- and post-intervention and 3-month follow-up. Data were analyzed using unstructured linear mixed-effects modeling for repeated measures and planned contrasts between time-points for each group. RESULTS: The models showed no significant differences between the groups on primary or secondary outcome measures. Significant pre-post intervention improvements were found for significant other's ratings of everyday PM failure for both intervention groups but not the control group, with medium to large effect sizes. Clinically relevant improvements on primary outcomes were found for participants across all 3 groups. CONCLUSIONS: This study found no significant benefits of combining MST with COMP for improving everyday PM and psychosocial integration. CLINICAL TRIAL REGISTRATION: Australian and New Zealand Clinical Trials Registry https://www.anzctr.org.au/ ACTRN12615000996561.

The effect of washing and wearing on sports bra function.

Sports bras provide support by restricting breast motion during exercise, which may prevent damage to breast structures. Laundering affects the mechanical properties of some sports bra materials. Bra function on the wearer after washing is unreported, meaning sports bra durability is unknown. This intervention study compared subjective and objective performance of sports bras that were washed, and worn/washed, to a control. Twenty-two females were assigned three identical sports bras; control, washed and worn/washed (washed after 60-min wear). Pre-intervention: breast position was recorded while standing and running in each bra. Comfort, fit and aesthetics were rated. Intervention: participants undertook their normal exercise in their worn/washed bra. Post-intervention: after 25 washes (n = 19), pre-intervention testing was repeated. Breast volume and control bra motion were consistent pre/post-intervention; however, post-intervention breast motion increased (20% mediolaterally, 16% superioinferiorly) in washed bras and (32% mediolaterally, 25% superioinferiorly) worn/washed bras. Post-intervention washed, and worn/washed bras were perceived as less supportive and washed bras less comfortable than worn/washed bras. Sports bra support reduced after 25 washes; this was compounded by wear. Participants detected reduced support, but comfort was sustained, suggesting replacement may not be considered. Guidelines on sports bra durability are recommended for breast health.

Improving self-awareness of prospective memory function after TBI using experiential feedback on a board game activity: An observational study.

This study investigated whether experiential and video feedback on performance of prospective memory (PM) tasks embedded within a board game activity improved self-awareness of PM function in adults with moderate-severe traumatic brain injury. An observational pre-post study design with 26 participants from a larger trial of a 6-session PM rehabilitation programme. Sessions 3 and 4 included a board game activity with embedded time-, event-, and activity-based PM tasks. Verbal feedback was provided by therapists during the game and video feedback afterwards. Self-ratings of performance were used to divide the sample into under-estimators (n = 7), accurate estimators (n = 9) and over-estimators (n = 10) of actual PM performance. The discrepancy between self- and therapist ratings of PM performance was measured before and after the game, and following video feedback, and compared between timepoints using non-parametric statistics. Post-task self-evaluations were more accurate than pre-task self-evaluations for the under- and over-estimator groups. Under-estimators showed significant improvement in accuracy of ratings for activity-based PM. Over-estimators showed improvement for event-based PM. Further improvements after video feedback were not significant. The board game activity provided a vehicle for experiential feedback and a means of engaging both those with impaired self-awareness and heightened self-awareness of PM in cognitive rehabilitation.

Usability of affordable feedback-based technologies to improve mobility and physical activity in rehabilitation: a mixed methods study.

PURPOSE: To explore physiotherapists' views on the usability of feedback-based technologies used in physical rehabilitation. MATERIALS AND METHODS: A mixed methods study which was nested within a randomised controlled trial to investigate the effectiveness of affordable feedback-based technologies to improve mobility and physical activity within aged care and neurological rehabilitation. Technologies included virtual reality systems, handheld device apps and wearable devices. Physiotherapists (n = 11) who were involved in prescribing technologies during the trial rated the usability of 11 different devices using the System Usability Scale (SUS), then attended a focus group. Descriptive statistics and framework analysis were used for analysis. RESULTS: Fitbit devices (mean 89.8, SD 9.3), Fysiogaming (mean 75.6, SD 15.3) and Xbox Kinect (mean 75.5, SD 11.2) rated in the acceptable range (>70) on the SUS. Three key factors on usability emerged from the focus groups: (1) Key device features relating to practicalities (ease of set up and use, reliability, safety) and therapeutic benefit (customisation, high active practice time, useful feedback) are important for usability; (2) Usability depends on the context of use; and (3) Usability can be enhanced with technical, clinical, environmental and financial support. CONCLUSIONS: Health service managers and clinicians should consider key device features identified, contextual factors of their service, and supports available when selecting technologies for use in clinical practice. Further collaboration between clinicians, researchers and technology developers would benefit future technology development, particularly taking into consideration the identified key device features from this study.IMPLICATIONS FOR REHABILITATIONTechnology selection should be based on key device features relating to both practicalities and therapeutic benefit.Contextual factors and available supports should also be considered when selecting technologies.Key usability features identified in this study such as ease of set up, reliability and customisability should be considered in the design of future feedback-based technologies to optimise usability in physical rehabilitation.

Experiences of therapists using feedback-based technology to improve physical function in rehabilitation settings: a qualitative systematic review.

Purpose: To synthesise therapist experiences of using feedback-based technology for physical rehabilitation through a systematic review of qualitative studies. Methods: Ten electronic databases were searched up to March 2017. Peer reviewed studies that provided qualitative data that met the inclusion criteria were selected. The methodological quality of included studies was assessed using the Critical Appraisal Skills Programme. Relevant text from each study was extracted including quotes and the author's interpretations. Data were imported into NVivo for analysis. Text was coded for content, then categorised using a thematic synthesis approach. Results: The search yielded 50,379 records. Of 340 full text articles assessed for eligibility, 12 publications (10 studies) were included. Themes that emerged relating to therapists' experience of using feedback-based technology in practice were: (1) the benefits of using technology; (2) practicalities of using technology in practice; (3) the need for support; and (4) design to support the use of technology in rehabilitation. Conclusions: Therapists perceive many benefits to using feedback-based technologies in rehabilitation but view it as an addition rather than an alternative to usual therapy. Input from therapists was perceived to be needed for technology to achieve therapeutic benefit. Technology use in practice may be influenced by design limitations or the available support to access and use the technology. Implications for Rehabilitation Therapists perceive technology can be used for benefit as an adjunct to usual therapy with the skilled input of a therapist to assess and monitor patient performance to ensure the "right" quality and quantity of movements for recovery. Technology prescription requires an investment of time and a tailored approach so that its use meets the needs of the individual patient. Support for training, evidence of effectiveness and access to technology is imperative for implementation in practice. Therapists need to work collaboratively with technology developers to improve the design and usability of technologies to better support the rehabilitation process.

Patient and therapist experiences of using affordable feedback-based technology in rehabilitation: a qualitative study nested in a randomized controlled trial.

OBJECTIVE: To explore how technologies are used and experienced in rehabilitation. DESIGN: A qualitative study using a grounded theory approach within a randomized controlled trial investigating the effectiveness of tailored, affordable technologies to improve mobility and physical activity. SETTINGS: Aged care and neurological rehabilitation wards with community follow-up. PARTICIPANTS: Twenty patients undergoing rehabilitation and randomized to the experimental arm of a trial (mean age 64 years (SD 23)) were recruited for interviews, plus 11 physiotherapists involved in technology prescription as part of the trial. METHOD: Two interviews per patient (one in hospital, one post-discharge) and four focus groups with physiotherapists were conducted. Transcribed data were coded and synthesized. Memo-writing and constant comparison methods guided data analysis. RESULTS: A process of patient engagement with technology involving two stages: (1) initial patient engagement and (2) maintaining patient engagement was identified. Therapists used a series of steps and strategies to gain and maintain patient engagement. A positive first experience and continued input into patient programmes was needed. The level of patient engagement was not consistent across the duration of the trial, increasing or decreasing due to changes in the technologies prescribed or setting of use. Two conditions were key to optimizing patient engagement: sufficient support and perceived benefit from using technology. CONCLUSIONS: Patients can engage with technology during rehabilitation when prescription is tailored by a therapist. Perceiving benefit from using technology, in addition to receiving the right support to enable use appears to influence the level of patient engagement.

Wild, free-living rufous hummingbirds do not use geometric cues in a spatial task.

In the laboratory, many species orient themselves using the geometric properties of an enclosure or array and geometric information is often preferred over visual cues. Whether animals use geometric cues when relocating rewarded locations in the wild, however, has rarely been investigated. We presented free-living rufous hummingbirds with a rectangular array of four artificial flowers to investigate learning of rewarded locations using geometric cues. In one treatment, we rewarded two of four flowers at diagonally opposite corners. In a second treatment, we provided a visual cue to the rewarded flower by connecting the flowers with "walls" consisting of four dowels (three white, one blue) laid on the ground connecting each of the flowers. Neither treatment elicited classical geometry results; instead, hummingbirds typically chose one particular flower over all others. When we exchanged that flower with another, hummingbirds tended to visit the original flower. These results suggest that (1) hummingbirds did not use geometric cues, but instead may have used a visually derived cue on the flowers themselves, and (2) using geometric cues may have been more difficult than using visual characteristics. Although hummingbirds typically prefer spatial over visual information, we hypothesize that they will not use geometric cues over stable visual features but that they make use of small, flower-specific visual cues. Such cues may play a more important role in foraging decisions than previously thought.