Metabolomic and gut-microbial responses of earthworms exposed to microcystins and nano zero-valent iron in soil.

The earthworm-based vermiremediation facilitated with benign chemicals such as nano zero-valent iron (nZVI) is a promising approach for the remediation of a variety of soil contaminants including cyanotoxins. As the most toxic cyanotoxin, microcystin-LR (MC-LR) enter soil via runoff, irrigated surface water and sewage, and the application of cyanobacterial biofertilizers as part of the sustainable agricultural practice. Earthworms in such remediation systems must sustain the potential risk from both nZVI and MC-LR. In the present study, earthworms (Eisenia fetida) were exposed up to 14 days to MC-LR and nZVI (individually and in mixture), and the toxicity was investigated at both the organismal and metabolic levels, including growth, tissue damage, oxidative stress, metabolic response and gut microbiota. Results showed that co-exposure of MC-LR and nZVI is less potent to earthworms than that of separate exposure. Histological observations in the co-exposure group revealed only minor epidermal brokenness, and KEGG enrichment analysis showed that co-exposure induced earthworms to regulate glutathione biosynthesis for detoxification and reduced adverse effects from MC-LR. The combined use of nZVI promoted the growth and reproduction of soil and earthworm gut bacteria (e.g., Sphingobacterium and Acinetobacter) responsible for the degradation of MC-LR, which might explain the observed antagonism between nZVI and MC-LR in earthworm microcosm. Our study suggests the beneficial use of nZVI to detoxify pollutants in earthworm-based vermiremediation systems where freshwater containing cyanobacterial blooms is frequently used to irrigate soil and supply water for the growth and metabolism of earthworms.

Constructing MXene-based mixed-dimensional structure with multiple interfaces to optimize dielectric-magnetic synergistic effect for effective electromagnetic wave absorption.

Exploring efficient microwave absorbing materials (MAMs) which could convert electromagnetic (EM) energy into thermal energy represents an approbatory vision to reducing EM radiation and interference. Designing of mixed-dimensional structure with multiple interfaces represents the available target to investigate an ideal MAMs, which maximizes the superiority of mixed-dimensional structure in electromagnetic wave absorption (EMWA). Herein, we take full advantage of multiple interfaces engineering of MXene for optimizing the impedance matching to improve EMWA, MXene-based mixed-dimensional structure was designed by incorporating three-dimensional Fe3C@Carbon layers coated zero-dimensional Fe3O4 nanoparticles (NPs) supported two-dimensional MXene nanosheets (MXene/Fe3O4@Fe3C@Carbon, MFC). The Fe3O4@Fe3C@C with Core@shell structure arrests the essentially self-restacked of MXene and provides various attenuation mechanisms for the incident electromagnetic waves (EMWs). By regulating the carbonization temperature, the MFC exhibits enhanced EMWA property which is attributed to the characteristic structure and optimized dielectric-magnetic synergy effect. The minimum reflection loss (RLmin) value of MFC can reach to -64.3 dB with a matching thickness of 1.73 mm. Otherwise, the maximum effective absorption bandwidth (EAB) (RLmin < -10 dB) reaches 6.42 GHz at only 1.5 mm. Thus, our study refers a novel-fire enlighten to develop excellent mixed-dimensional microwave absorbent based on MXene.

Self-assembly of mixed-linkage glucan hydrogels formed following EG16 digestion.

Mixed-linkage glucans are major components of grassy cell-walls and cereal endosperm. Recently identified plant endo-ß-glucanase from the EG16 family cleaves MLGs with strong specificity towards regions with at least four sequential ß(1,4)-linked glucose residues. This activity yields a low molecular-weight MLG with a repeating structure of ß(1,3)-linked cellotriose that gels rapidly at concentrations as low as 1.0 % w/v. To understand the gelation mechanism, we investigated the structure and behavior using rheology, microscopy, X-ray scattering, and molecular dynamics simulations. Upon digestion, the material's rheological behavior changes from typical polymeric material to a fibrillar network behavior seen for e.g. cellulose nanofibrils. Scanning electron microscopy and confocal microscopy verifies these changes in micro- and nanostructure. Small-angle X-ray scattering shows in-solution self-assembly of MLG through ~10 nm elemental structures. Wide-angle X-ray scattering data indicate that the polymer association is similar to cellulose II, with dominant scattering at d-spacing of 0.43 nm. Simulations of two interacting glucan chains show that ß(1,3)-linkages prevent the formation of tight helices that form between ß(1,4)-linked d-glucan chains, leading to weaker interactions and less ordered inter-chain assembly. Overall, these data indicate that digestion drives gelation not by enhancement of interactions driving self-assembly, but by elimination of unproductive interactions hindering self-assembly.

Health risks of rare earth elements exposure: Impact on mitochondrial DNA copy number and micronucleus frequency.

Toxic effects in terms of mitochondria and hereditary substances have been characterized in vitro for individual rare earth elements, while, the joint effects of mixed elements exposure in the population remain ambiguous. Based on the Occupational Chromate Exposure Dynamic Cohort of China, this study investigated the relationship between 15 blood rare earth elements (cerium, dysprosium, erbium, europium, gadolinium, holmium, lanthanum, lutetium, neodymium, praseodymium, samarium, terbium, thulium, yttrium, and ytterbium) and mitochondrial DNA copy number (MtDNACN) as well as peripheral blood lymphocyte micronucleus frequency (MNF). The elastic net was used to select elements highly correlated with effect indicators, whose dose-response relationships were further illustrated by restricted cubic splines. Bayesian kernel regression was employed to explore the combined effects of elements and the contributions of single element. The results showed that most rare earth elements were positively correlated with effect indicators, with yttrium showing the strongest association (ß (95% CI): 0.139 (0.1089 - 0.189) for MtDNACN, 0.937 (0.345 - 1.684) for MNF). In the mixed exposure model, with the exposure level fixed at the 50th percentile as the reference, the effect estimates on MtDNACN and MNF increased by 0.228 and 0.598 units, respectively, at the 75th percentile. The single effect analysis implied that yttrium, lanthanum and terbium contributed the most to the elevation of MtDNACN, while yttrium posed the highest risk for genetic damage, accordingly, we provided recommendations to prioritize these elements of concern. In addition, we observed a chief mediating effect of MtDNACN on the elevation of MNF caused by lanthanum, whereas further mechanistic exploration is required to confirm this finding.

Bamboo-like MnO2⋠Co3O4: High-performance catalysts for the oxidative removal of toluene.

The manganese-cobalt mixed oxide nanorods were fabricated using a hydrothermal method with different metal precursors (KMnO4 and MnSO4·H2O for MnOx and Co(NO3)2⋅6H2O and CoCl2⋅6H2O for Co3O4). Bamboo-like MnO2⋅Co3O4 (B-MnO2⋅Co3O4 (S)) was derived from repeated hydrothermal treatments with Co3O4@MnO2 and MnSO4⋅H2O, whereas Co3O4@MnO2 nanorods were derived from hydrothermal treatment with Co3O4 nanorods and KMnO4. The study shows that manganese oxide was tetragonal, while the cobalt oxide was found to be cubic in the crystalline arrangement. Mn surface ions were present in multiple oxidation states (e.g., Mn4+ and Mn3+) and surface oxygen deficiencies. The content of adsorbed oxygen species and reducibility at low temperature declined in the sequence of B-MnO2⋅Co3O4 (S) > Co3O4@MnO2 > MnO2 > Co3O4, matching the changing trend in activity. Among all the samples, B-MnO2⋅Co3O4 (S) showed the preeminent catalytic performance for the oxidation of toluene (T10% = 187°C, T50% = 276°C, and T90% = 339°C). In addition, the B-MnO2⋅Co3O4 (S) sample also exhibited good H2O-, CO2-, and SO2-resistant performance. The good catalytic performance of B-MnO2⋅Co3O4 (S) is due to the high concentration of adsorbed oxygen species and good reducibility at low temperature. Toluene oxidation over B-MnO2⋅Co3O4 (S) proceeds through the adsorption of O2 and toluene to form O*, OH*, and H2C(C6H5)* species, which then react to produce benzyl alcohol, benzoic acid, and benzaldehyde, ultimately converting to CO2 and H2O. The findings suggest that B-MnO2⋅Co3O4 (S) has promising potential for use as an effective catalyst in practical applications.

Partition coefficient screening - An effective approach for finding the best conditions for byproduct removal as demonstrated by a bispecific antibody purification case.

In recombinant protein purification, differences in isoelectric point (pI)/surface charge and hydrophobicity between the product and byproducts generally form the basis for separation. For bispecific antibodies (bsAbs), in many cases the physicochemical difference between product and byproducts is subtle, making byproduct removal considerably challenging. In a previous report, with a bsAb case study, we showed that partition coefficient (Kp) screening for the product and byproducts under various conditions facilitated finding conditions under which effective separation of two difficult-to-remove byproducts was achieved by anion exchange (AEX) chromatography. In the current work, as a follow-up study, we demonstrated that the same approach enabled identification of conditions allowing equally good byproduct removal by mixed-mode chromatography with remarkably improved yield. Results from the current and previous studies proved that separation factor determination based on Kp screening for product and byproduct is an effective approach for finding conditions enabling efficient and maximum byproduct removal, especially in challenging cases.

Interspecific association between two primatespecies in an urban park / Associação interespecífica entre duas espécies de primatas em um parque urbano

As with Amazonian primates, mixed associations between species in the Atlantic Forest are also influenced by ecological factors. However, Atlantic Forest primates may face additional challenges, such as isolation pressures and fragmentation of forest habitats, which may increase the frequency of these arrangements. The main of this work is to report a sympatry with possible interaction between individuals of two species of primates of the Pitheciidae and Callitrichidae families: Callicebus nigrifrons (Spix 1823) and Callithrix aurita (É. Geoffroy Saint-Hilaire 1812) in an urban park in the south of the state of Minas Gerais. Individuals were observed interacting during foraging and displacement. The association of individuals of the two species can be explained by the low quality of the forest fragment, as it can increases the chances of obtaining food resources and configures a dilution strategy against predator attacks.

Assim como ocorre com os primatas amazônicos, as associações mistas entre espécies na Mata Atlântica também são influenciadas por fatores ecológicos. No entanto, os primatas da Mata Atlântica podem enfrentar desafios adicionais, como pressões de isolamento e fragmentação de habitats florestais, que podem aumentar a frequência desses arranjos. O objetivo deste trabalho é apresentar um relato de simpatia com possível interação entre indivíduos de duas espécies de primatas das famílias Pitheciidae e Callitrichidae: Callicebus nigrifrons (Spix 1823) e Callithrix Resumo aurita (É. Geoffroy Saint-Hilaire 1812) em um parque urbano no sul do estado de Minas Gerais. Foram observados indivíduos interagindo durante o forrageio e deslocamento. A associação de indivíduos das duas espécies pode ser explicada devido à baixa qualidade do fragmento florestal, pois pode aumentar as chances de obter recursos alimentares e configura uma estratégia de diluição de contra-ataques de predadores.

HIV disease progression among heterosexually-infected individuals before the introduction of universal ART in China: A linear mixed-effects model.

In 2016, China introduced universal antiretroviral therapy (ART) for all HIV-infected individuals regardless of CD4 cell count. However, the natural history and rate of CD4 count decline among heterosexually-infected individuals remain uncharacterized. Analyzing national surveillance data can address this gap and shed light on the pathogenesis of HIV in this population. We used a linear mixed-effects model to assess CD4 trajectory over time before ART initiation and estimated the median time from HIV seroconversion to reaching CD4 thresholds of < 500, < 350, and < 200 cell/mm3. From the Chinese HIV/AIDS Comprehensive Response Information Management System, 59,085 eligible individuals were identified, with 113 having data to estimate the date of HIV seroconversion. The linear mixed-effects models estimated an intercept of 23.64 (95% confidence interval [CI]: 22.41 to 24.87) and a slope of -1.32 (95% CI: -1.34 to -1.30) for males, and an intercept of 22.70 (95% CI: 21.00 to 24.40) and a slope of -1.29 (95% CI: -1.31 to -1.27) for females. The estimated median times from HIV seroconversion to reaching CD4 count thresholds of < 500, < 350, < 200 cells/mm3 were 0.97, 3.74, and 7.20 years for males, and 0.26, 3.09, and 6.48 years for females, respectively. Males consistently took longer to reach these CD4 count thresholds compared to females of the same age group. Older individuals (≥ 40 years) reached CD4 thresholds faster than younger individuals (15-29 years), indicating more rapid disease progression in older people living with HIV.

Enhancing Academic Success: A mixed Study on the Influencing Factors among Pharmacy Students in Syrian Universities.

Background: Academic achievement is the result of both effort and perseverance exerted by the students. This mixed-methods study aims to investigate the factors affecting the academic achievement of pharmacy students in Syrian universities. Methods: A convergent parallel mixed-methods study was utilized. In the quantitative phase, a cross-sectional study was conducted on 1008 students (773 females and 235 males) from 23 Syrian universities. A questionnaire consisting of 48 items was designed to be completed by pharmacy students using a 5-point Likert scale.In the qualitative phase, twelve questions were developed to interview thirty pharmacy students from five Syrian universities to obtain in-depth insights into the factors influencing their academic achievement. Results: A significant number of students lacked effective time management skills, identified as a weakness among students. The majority of students faced challenges in maintaining a consistent study routine, averaging a score of (2.0).Motivation towards learning emerged as a crucial factor in enhancing academic performance. Lecturers in the pharmacy faculty employed traditional teaching methods (2.01), and the pharmacy curriculum was perceived as lacking modernity (1.92).Quantitative findings demonstrated that pharmacy students experienced exam-related anxiety (2.05), identified as a weakness in the qualitative phase.Factors associated with the Syrian crisis, like unreliable electricity (1.87) and transportation issues (1.83), could have an impact on academic achievement. Economic conditions were identified as challenging to students' academic performance, negatively affecting the learning process (1.98). Conclusion: The results of the study demonstrate that personal factors, lecturers, educational environment, exams, and the Syrian crisis influence the academic achievement of pharmacy students in Syrian universities.

Institutional influence on length of stay in German forensic hospitals: a multilevel analysis of patients with schizophrenia spectrum disorders.

Introduction: Scientific studies have focused on patient-related characteristics as predictors of length of stay in forensic psychiatry. However, little attention has been paid to the specificities of forensic psychiatric settings. This study aims to test whether differences in forensic admissions transcend individual factors by comparing length of stay between different psychiatric units, controlling for hospital characteristics and patient characteristics. Methods: The dataset was derived from a forensic documentation system containing a wide range of information on forensic psychiatric patients. N = 594 patients with schizophrenia spectrum disorders discharged from 6 forensic hospitals in southern Germany were included in a linear mixed regression model. Linear mixed models were calculated, allowing for the simultaneous estimation of variance between patients and hospitals. Results: The final regression model explained 49% of the total variance. The only statistically significant patient-related predictors were age at admission, education and severity of the index offence. Hospital differences explained 41% (ICC) of the variance in length of stay without finding a significant hospital effect in the data. Discussion: Previous research has primarily analyzed predictors of length of stay in terms of individual patient characteristics. This work suggests that variables other than patient-related factors need to be considered when assessing the length of stay in forensic units. Further multi-center studies are needed to gain a better understanding of how forensic psychiatric hospitals and other institutional influences affect length of stay.

Occupational stress and body composition of hospital workers: a follow-up study.

This study sought to analyze the influence of occupational stress on the body composition of hospital workers after one year of follow-up. This prospective cohort study included 218 workers from one of the leading private hospitals in the municipality of Santo Antônio de Jesus, Recôncavo da Bahia region, Northeast Brazil. Body composition was analyzed by proxy (Body Mass Index and Waist Circumference) and Bioelectrical Impedance Analysis. The primary exposure adopted in the present study was the perception of occupational stress, assessed with the adapted and reduced version of the Job Content Questionnaire evaluating demand and control dimensions. The covariates were work characteristics; biological characteristics; sociodemographic characteristics and lifestyle. Statistical analyses were performed using descriptive, bivariate and multivariate analysis. At the first stage of the study, we identified that 55.96% (n = 122) of workers had high work demand and 25.22% (n = 55) had low control. Among those who had high demand and low control at the beginning of the study, the majority were women, non-white, with low educational and income levels, sleeping less than 7 h/day. After 12 months of follow-up, the median value for demand continued as 13 (IQR: 5-25) and for control, it increased to 16 (IQR: 9-23). In this second moment of the study, 62.38% (n = 136) of workers showed high demand and 45.87% (n = 100) low control. The characteristics of workers with high demand and low control were similar to those of the first moment. The results indicate that high demand and low control at work are risk factors for changes in body mass index, fat mass and fat-free mass in hospital workers. This study shows the importance and need for clinical and epidemiological assessments regarding the body composition of professionals working in hospitals, since high rates of overweight and obesity are triggers of chronic health problems such as dyslipidemia, diabetes mellitus and cardiovascular diseases, among others. Therefore, managers must promote adequate working conditions and understand the need for periodic body composition assessments.

Long-term coastal dynamics: The evolution of a mixed sediment mega-nourishment consisting of colliery spoil.

Mega-nourishments, where large volumes of sediment are deposited on coastlines, are increasingly employed to manage shoreline erosion, yet our understanding of their long-term behaviour is limited by the fact that most current schemes are less than 15 years old. However, on the County Durham coast, 39 million m3 of coal spoil was tipped onto beaches between the late 1800s and 1993, acting as a de facto mixed sediment mega-nourishment. Our findings reveal key insights into the long-term dynamics of mega-nourishment schemes, including evidence of effective sediment dispersal around headlands into normally disconnected units of coast. Following cessation of tipping, shorelines retreated up to 12 m yr-1, with 150 m overall retreat in 12 years. Subsequently, retreat slowed but the present-day shoreline remains seaward of its 1860 position and is subject to ongoing coastal recession. We document significant fining of the deposited material in the years post deposition through abrasion and chemical breakdown. Furthermore, we show that the highest erosion rates now occur downdrift from the initial dump site, indicating that nourishment impacts migrate through time. These findings highlight the need for holistic and adaptive management approaches to mega-nourishment schemes, showing the behaviour of the nourishment to continually change in both location and magnitude as the system evolves. We demonstrate that mixed sediment mega-nourishments can be a cost-effective and durable solution to mitigate erosive losses, even in the absence of a planned approach to the location or composition of deposited sediment. Our results suggest that lessons from this historical intervention can inform the design and management of future mega-nourishment schemes, particularly in mixed sediment environments.

From theoretical aspects to practical food Pickering emulsions: Formation, stabilization, and complexities linked to the use of colloidal food particles.

We noticed that in literature, the term Pickering emulsion (PE) is used as soon as ingredients contain particles, and in this review, we ask ourselves if that is done rightfully so. The basic behavior taking place in particle-stabilized emulsions leads to the conclusion that the desorption energy of particles is generally high making particles highly suited to physically stabilize emulsions. Exceptions are particles with extreme contact angles or systems with very low interfacial tension. Particles used in food and biobased applications are soft, can deform when adsorbed, and most probably have molecules extending into both phases thus increasing desorption energy. Besides, surface-active components will be present either in the ingredients or generated by the emulsification process used, which will reduce the energy of desorption, either by reduced interfacial tension, or changes in the contact angle. In this paper, we describe the relative relevance of these aspects, and how to distinguish them in practice. Practical food emulsions may derive part of their stability from the presence of particles, but most likely have mixed interfaces, and are thus not PEs. Especially when small particles are used to stabilize (sub)micrometer droplets, emulsions may become unstable upon receiving a heat treatment. Stability can be enhanced by connecting the particles or creating network that spans the product, albeit this goes beyond classical Pickering stabilization. Through the architecture of PEs, special functionalities can be created, such as reduction of lipid oxidation, and controlled release features.

Perceived stress and betel quid dependence associated with reasons for betel quid chewing among male chewers: a mixed methods study.

AIMS: Social culture concerns and betel quid (BQ) dependence may be the potential reasons for BQ chewing. This study's purpose was to identify the correlates of reasons for male BQ chewing. METHODS: We adopted a mixed-methods design. The study was conducted between October 2021 and August 2023 at a medical center of northern Taiwan. The Reasons for Betel-Quid Chewing Scale, Numeric Rating Scale, and Betel Quid Dependence Scale were used to quantitatively assess reasons for BQ chewing, stress, and BQ dependence, respectively. Semi-structured questions were used to interview for qualitative data. RESULTS: Among 150 BQ users, the most common reasons for BQ chewing were stimulation, reinforcement, and social/cultural factors. Chewers who reported more pressure to chew were more likely to be younger, have less educational level, be employed, have greater stress, and have more BQ dependence. Content analysis of qualitative data showed three themes: physical and psychological demands, peer pressure, and perceived greater effectiveness. CONCLUSION: Employment was the factor most commonly associated with reasons for BQ chewing and with each construct. Study findings can help healthcare professionals understand reasons for BQ chewing, thereby helping them educate chewers to cope with withdrawal symptoms and successfully quit.

Low carbohydrate diets, glycaemic control, enablers, and barriers in the management of type 1 diabetes: a mixed methods systematic review.

BACKGROUND: Medical nutrition therapy is fundamental for diabetes management, however there is a lack of evidence supporting an ideal recommended carbohydrate intake for maintaining optimal glycaemia in individuals living with type 1 diabetes (T1D). Adults with T1D are increasingly drawn to very low carbohydrate (≤ 50 g/day or < 10% total energy intake) and low carbohydrate diets (< 130 g/day or < 26% total energy intake) because of the reported positive impact on both physical health and psychological well-being. Current evidence regarding the effectiveness on glycaemia and the lived experience by adults with T1D when using these diets is limited. This mixed methods systematic review was undertaken to examine the effectiveness of very low and low carbohydrate diets on HbA1c and explore the lived experience of adults with T1D who have followed these dietary regimens. METHODS: Seven databases (MEDLINE, Embase, CINAHL, Cochrane CENTRAL, Informit Health Collection, Web of Science, and PsycInfo) were searched from inception to 1 October 2023. Quality assessment of the included studies was undertaken using the JBI's critical appraisal checklists. Separate quantitative and qualitative synthesis was performed, and findings were integrated for the purpose of comparison and complementarity. RESULTS: Seventeen studies of varying methodologies were included. Findings from quantitative research were inconclusive in determining the effectiveness of very low and low carbohydrate diets on HbA1c levels. Qualitative data synthesis identified four themes [1) Motivation to follow the diet, 2) Health benefits of the diet, 3) Challenges of the diet, and 4) Limited information (participants knowledge, information sources) about the diet] that influenced adherence to very low and low carbohydrate diets. Through the integration of results from selected studies, it was evident that there were conflicting outcomes between quantitative and qualitative studies. CONCLUSIONS: There is little evidence to indicate that very low and low carbohydrate diets improve HbA1c in adults with T1D. However, this goes against the reported lived experiences of participants. This review highlights the insufficiency of robust evidence on this topic. Future research involving larger participant samples over longer durations are needed to provide more definitive evidence in relation to the efficacy of these diets and into the enablers and barriers experienced when using a very low or low carbohydrate diet in order to provide support to adults with T1D. Systematic review registration PROSPERO CRD42023482800.

Using the Recommended Summary Plan for Emergency Care and Treatment in Primary Care: a mixed methods study.

Background: Emergency care treatment plans provide recommendations about treatment, including cardiopulmonary resuscitation, to be considered in emergency medical situations. In 2016, the Resuscitation Council United Kingdom developed a standardised emergency care treatment plan, the recommended summary plan for emergency care and treatment, known as ReSPECT. There are advantages and potential difficulties in initiating the ReSPECT process in primary care. Hospital doctors and general practitioners may use the process differently and recommendations do not always translate between settings. There are no large studies of the use of ReSPECT in the community. Study aim: To evaluate how, when and why ReSPECT is used in primary care and what effect it has on patient treatment and care. Design: A mixed-methods approach using interviews, focus groups, surveys and evaluation of ReSPECT forms within an analytical framework of normalisation process theory. Setting: A total of 13 general practices and 13 care homes across 3 areas of England. Participants: General practitioners, senior primary care nurses, senior care home staff, patients and their relatives, community and emergency department clinicians and home care workers, people with learning disability and their carers. National surveys of (1) the public and (2) general practitioners. Results: Members of the public are supportive of emergency care treatment plans. Respondents recognised benefits of plans but also potential risks if the recommendations become out of date. The ReSPECT plans were used by 345/842 (41%) of general practitioner survey respondents. Those who used ReSPECT were more likely to be comfortable having emergency care treatment conversations than respondents who used standalone 'do not attempt cardiopulmonary resuscitation' forms. The recommended summary plan for emergency care and treatment was conceptualised by all participants as person centred, enabling patients to have some say over future treatment decisions. Including families in the discussion is seen as important so they know the patient's wishes, which facilitates decision-making in an emergency. Writing recommendations is challenging because of uncertainty around future clinical events and treatment options. Care home staff described conflict over treatment decisions with clinicians attending in an emergency, with treatment decisions not always reflecting recommendations. People with a ReSPECT plan and their relatives trusted that recommendations would be followed in an emergency, but carers of people with a learning disability had less confidence that this would be the case. The ReSPECT form evaluation showed 87% (122/141) recorded free-text treatment recommendations other than cardiopulmonary resuscitation. Patient preferences were recorded in 57% (81/141). Where a patient lacked capacity the presence of a relative or lasting power of attorney was recorded in two-thirds of forms. Limitations: Recruitment for patient/relative interviews was less than anticipated so caution is required in interpreting these data. Minority ethnic groups were under-represented across our studies. Conclusions: The aims of ReSPECT are supported by health and social care professionals, patients, and the public. Uncertainty around illness trajectory and treatment options for a patient in a community setting cannot be easily translated into specific recommendations. This can lead to conflict and variation in how recommendations are interpreted. Future work: Future research should explore how best to integrate patient values into treatment decision-making in an emergency. Study registration: This study is registered as NCT05046197. Funding: This award was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme (NIHR award ref: NIHR131316) and is published in full in Health and Social Care Delivery Research; Vol. 12, No. 42. See the NIHR Funding and Awards website for further award information.

How, when and why ReSPECT plans are made and used outside hospital and how they affect patient care. We listened to general practitioners, patients and their families, and examined ReSPECT plans in patient records. We listened to staff in care homes, homecare workers and other healthcare professionals. We surveyed general practitioners and the public. We worked with people with a learning disability to find out what support they needed to complete a ReSPECT plan. People thought that ReSPECT plans could be a good way to record a person's wishes about medical treatment. They thought that the plan should be made with a healthcare professional they knew and trusted. These conversations need time and preparation, especially for someone with a learning disability. Most people thought family involvement was important. General practitioners told us that it could be difficult to know what kind of emergencies and treatments to discuss and put in the plan. Most plans we looked at had recommendations about cardiopulmonary resuscitation and many plans had recommendations about other treatments. About half of plans recorded the patient's wishes. It was not always clear who the plan had been discussed with to find out their wishes. Care home staff told us that they were often frustrated when healthcare professionals in an emergency did not always follow the plan. Further research is needed on how to improve ReSPECT conversations so that plans clearly reflect what is important to the individual, and how to help health professionals use ReSPECT when an emergency happens.

Retrospective Evaluation of Peri-Implant Marginal Bone Level of Reduced Diameter Implants by Mixed Model Analysis.

PURPOSE: The goal of successful implant placement is to maintain a long-term stable marginal peri-implant bone level (MBL). This retrospective study investigated the MBL of reduceddiameter implants (RDI). The implants were analyzed in different indication in the context of various surgical and prosthetic treatment strategies using heterogeneous data from a private practice. Mixed model analysis was used to process the heterogeneous data structure. This method has not been a standard method of data analysis in implantology, and it shows considerable advantages over conventional variance analyses regarding data integration from outpatient practices. METHOD: 123 patients were treated with 326 implants. 247 implants were diameter-reduced, the remaining 79 implants were standard implants (SDI) as patient related controls. The mean observation time was 24.4 months, and the maximum observation time 76.0 months. The peri-implant bone level of the implants was evaluated, while considering the diameter, as well as the time of implant placement, time of loading, extent of augmentation and localization of the implants. The data were evaluated after restructuring using mixed model analysis. RESULT: No significant difference was found between the use of RDI or SDI in the analyzed indication. Furthermore, no significant difference was found for the implant placement time, loading time, and the use of two-stage augmentations regarding the stability of the peri-implant bone level. CONCLUSION: Narrow-diameter implants are a sufficient treatment option in horizontally deficient bone conditions. The use of diameterreduced implants in the posterior region shows promising results; 3.5mm diameter implants may be indicated considering the individual patient situation. The use of mixed model analysis for the evaluation of heterogeneous practice data can lead to a significant increase in the number of retrospective studies and data integration from practices, forming a sound basis for evidence-based dentistry.

Analysis of data from a national micronutrient survey with a linear mixed model: estimates, predictions and lessons for future surveys.

Background: Because micronutrient deficiencies affect public health, countries monitor population status by national-scale, multi-stage, micronutrient surveys (MNS). In design-based surveys, inclusion probabilities are specified for sample units and the corresponding sample weights allow design-unbiased estimates to be made of population parameters. Corrections may be possible on departures from the design; an alternative is to use linear mixed models (LMM), with an estimated covariance structure reflecting the sampling design, to obtain model-based estimates. Design: The Ethiopia National Micronutrient Survey (2016) specified inclusion probabilities at enumeration area (EA) and household (HH) levels, and sample weights are provided. However, the design was not followed as it would have resulted in insufficient sampling from women of reproductive age. Results: Having found no evidence that sample weights were informative for target serum micronutrient concentrations (Zn), we estimated LMM parameters, with Regions as fixed effects, and the variation of individuals nested within households, households within EA, and EA within regions, random effects. We obtained LMM standard errors, Best Linear Unbiased Estimates (BLUEs) of regional means, and empirical Best Linear Unbiased Predictions for sampled/unsampled EA and HH. The probability that each true regional mean exceeded the sufficiency threshold ( 65 µ g dL - 1 ) was evaluated. The variances of BLUEs of regional means, under alternative sampling designs, were bootstrapped from LMM variance components. Conclusions: We demonstrate use of LMM to obtain model-unbiased estimates and predictions when surveys deviate from the original design; and the use of LMM variance components to evaluate alternative designs for further sampling, or for sampling comparable populations.

Exploring the acceptance of mixed reality technology innovation among mining industry workers.

Mixed Reality (MR) technology is an innovative technology that has the capability to transform and boost productivity in the mining industry. At the same time, the scarcity of guidelines and research in examining the acceptance of MR technology innovation in the mining sector could make the adoption of MR technology innovation unpredictable. Therefore, in order to support the successful adoption of MR technology innovation in the mining sector, this manuscript is designed to better understand the factors influencing its acceptance among workers. Based on the literature review, five factors are hypothesized to influence the acceptance of mining industry workers regarding MR technology innovation. The factors underwent testing on a sample of 253 mining industry workers, which was obtained via an office-intercept survey and processed using SmartPLS software. The model has proven to be highly robust, as indicated by its outstanding scores in validity, reliability, multicollinearity, and goodness of fit. The results from the analysis indicate that attitude, perceived usefulness, and perceived compatibility are significant factors influencing the acceptance of MR technology innovation. While perceived novelty is an important factor affecting attitude, it does not significantly impact the acceptance of MR technology innovation. Moreover, perceived ease of use was not found to be a significant factor in influencing the attitude and intention to adopt MR technology innovation. This research offers both theoretical and managerial implications for its findings.

Midwives' readiness for midwife-led care: a mixed-methods study.

BACKGROUND/PROBLEM: To integrate midwife-led care in Belgian maternity services, understanding whether midwives are primed of executing the change is needed. AIM: To explore Belgian midwives' readiness for midwife-led care and understand the underlying processes. METHODS: A mixed-methods sequential study: 1) A survey including 414 practising midwives and 2) individual interviews with 12 (student) midwives. General linear model analysis was used to examine the trend between knowledge, self-efficacy and performance mean scores - indicators of midwife-led care readiness - proposed in a 27-item questionnaire. The Readiness Assessment Framework served as a template for qualitative thematic analysis. FINDINGS: Template analysis illustrated the underlying mechanisms of midwifery-led care readiness: Governmental and institutional steering and rule-making functions, regulation and reimbursement, awareness of midwife-led care among stakeholders, capacity to extend primary care postpartum services to antenatal and intrapartum care and healthcare professionals' lack of awareness of available data of women's experiences and midwife-led care efficacy in Belgium. These qualitative findings contribute to the understanding of the significant trend with decreasing function for knowledge, self-efficacy and performance mean scores of 25 midwife-led care readiness indicators, and the two non-significant indicators referring to a physiological postpartum period. DISCUSSION/CONCLUSION: In determining midwife readiness for midwife-led care, we observed adequate knowledge mean scores, associated with low self-efficacy and even lower midwife-led care performance mean scores. Our findings suggest limited readiness for MLC in antenatal and intrapartum care. Belgian midwives are the domain experts of postpartum services but face challenges in extending midwife-led care to antenatal and intrapartum services.