Diet and omega-3 and vitamin D supplement use predict five-year fatigue and disability trajectories in people with multiple sclerosis.

BACKGROUND: Fatigue and disability are indicators of disease progression experienced by many people with multiple sclerosis (pwMS). Understanding trajectories of these outcomes, and their predictors, may provide insight to potential interventions for MS management. METHODS: Survey data from 839 pwMS from the Health Outcomes and Lifestyle in pwMS study were analysed. Fatigue was defined as mean Fatigue Severity Scale >5, and severe disability as Patient Determined Disease Steps >5. Group-based trajectory modelling was used to identify fatigue and disability trajectories over five-years. Dietary predictors associated with outcome trajectory group membership were assessed using log-binomial regression. Demographic and clinical characteristics were considered in multivariable models. RESULTS: Distinct trajectories for fatigue and disability were identified. For fatigue, 58 % of pwMS were assigned to low-, and 42 % to high-, fatigue trajectory groups. For disability, 85 % of pwMS were assigned to low-, and 15 % to high-, disability groups. Baseline high-quality diet, and omega-3 and vitamin D supplement use, were associated with reduced risk of being in high-fatigue and high-disability trajectories, while meat and dairy consumption were associated with increased risk. CONCLUSIONS: A high-quality diet, avoiding meat and dairy, and omega-3 and vitamin D supplement use, individually predict better fatigue and disability trajectories. Dietary modifications should be considered in MS management.

Longitudinal association of spirituality with depressive symptom trajectories among older adults in mainland China.

OBJECTIVES: The relationship between spirituality and depressive symptoms among the Chinese elderly is not well known. The current study explores this relationship using longitudinal data and trajectory modeling of depressive symptoms. METHODS: A longitudinal study design was used to measure depressive symptoms repeatedly from 2012 to 2021 using the Geriatric Depression Scale (GDS). Group-based trajectory modeling analysis was conducted to determine the trajectories of depressive symptoms, and multiple logistic regression was used to explore the association between spirituality and depressive symptom trajectories. RESULTS: A total of 2333 participants completed at least two GDS measures, and these were included in the Group-based trajectory modeling analysis. An optimal model of three trajectories was derived: no depressive symptoms group (75.2%), new-onset depressive symptoms group (14.4%), and persistent depressive symptoms group (10.4%). Logistic regression modeling revealed that higher spirituality was associated with a lower risk of both new-onset depressive symptoms (OR = 0.68, 95% CI = 0.49-0.93) and persistent depressive symptoms (OR = 0.32, 95% CI = 0.23-0.45). CONCLUSIONS: Spirituality predicts a lower risk of new-onset depressive symptoms and persistent symptoms among older adults in mainland China.

Efficacy of point source legislation quantified for a 64-year river water quality trajectory of phosphorus loading.

Changes in river water quality often follow typical trajectories characterized by sequential phases of degradation and recovery induced by management measures, typically achieved with combinations of legislative and technological interventions. However, the key question about the effectiveness of the different types of legal interventions - source control, use-related, and end-of-pipe - remains poorly understood. With the case of phosphorus (P), which is a valuable indicator of surface water quality and a widespread target of legislation at various governance levels in order to control eutrophication of water bodies, we quantified the relation between point source loading of P and resulting river water quality for a multidecadal trajectory of the river Ruhr (Germany). In particular, we analysed P-related legislation targeting point source pollution enforced at EU, national, state, and local level and linked their development with measured total phosphorus (TP) concentrations in the river Ruhr (Germany). To this end, we combined archival data with information in the literature and conducted interviews with contemporary witnesses to describe and quantify the efficacy of each legislative approach. Although not specifically targeted at P reduction, end-of-pipe measures (sewer systems and wastewater treatment plants (WWTP)) reduced TP inputs to surface waters already in the 1960s and 1970s, curbing TP inputs to the Ruhr by 38% in 1980. The first targeted source control legislation - the banning of phosphates in textile detergents in 1981 - effectively reduced TP concentrations in WWTP influents by 36% since 1990. In combination with stronger end-of-pipe legislation focusing on P elimination in WWTP since the 1990s, TP concentrations in WWTP effluents were reduced by 86% at the end of the 1990s and by 92% in 2021. Complete and successful source control for textile detergents made use-related legislation redundant. Our study demonstrates that source control measures should be prioritized, because they are the fastest way to curb emissions. These findings provide insights that can inform efficient decision-making regarding water quality in a trajectory perspective of hierarchical governance and technological needs, as well as effective policy-making and management for other pollutants requiring control from point sources.

Trajectories of lifestyle patterns from 2 to 8 years of age and cardiometabolic risk in children: the GUSTO study.

BACKGROUND: Tracking combinations of lifestyle behaviours during childhood ("lifestyle pattern trajectories") can identify subgroups of children that might benefit from lifestyle interventions aiming to improve health outcomes later in life. However, studies on the critical transition period from early to middle childhood are limited. We aimed to describe lifestyle patterns trajectories in children from 2 to 8 years of age and evaluated their associations with cardiometabolic risk markers at age 8 years in a multi-ethnic Asian cohort. METHODS: Twelve lifestyle behaviours related to child's diet, physical activity, screen use, and sleep were ascertained using questionnaires at ages 2, 5, and 8 years. Age-specific lifestyle patterns were derived using principal component analysis and trajectories were determined using group-based multi-trajectory modelling. Child cardiometabolic risk markers were assessed at age 8 years, and associations with trajectories examined using multiple regression, adjusted for confounders. RESULTS: Among 546 children, two lifestyle patterns "healthy" and "unhealthy" were observed at ages 2, 5, and 8 years separately. Three trajectory groups from 2 to 8 years were identified: consistently healthy (11%), consistently unhealthy (18%), and mixed pattern (71%). Children in the consistently unhealthy group (vs. mixed pattern) had increased odds of pre-hypertension (OR = 2.96 [95% CI 1.18-7.41]) and higher levels of diastolic blood pressure (ß = 1.91 [0.27-3.55] mmHg), homeostasis model assessment of insulin resistance (ß = 0.43 [0.13-0.74]), triglycerides (ß = 0.11 [0.00-0.22] mmol/L), and metabolic syndrome score (ß = 0.85 [0.20-1.49]), but not with BMI z-score or any anthropometric measurements. The consistently healthy group showed no differences in cardiometabolic outcomes compared to the mixed pattern group. CONCLUSION: Three distinct lifestyle pattern trajectories were identified from early to middle childhood. Children in the consistently unhealthy lifestyle group did not have a raised BMI but was associated with several elevated cardiometabolic risk markers. These findings suggest the potential benefits of initiating holistic lifestyle interventions to improve children's health and well-being from an early age. TRIAL REGISTRATION: Trial registration number: NCT01174875. Name of registry: ClinicalTrials.gov. URL of registry: https://classic. CLINICALTRIALS: gov/ct2/show/NCT01174875 . Date of registration: August 4, 2010. Date of enrolment of the first participant to the trial: June 2009.

Developmental Trajectory of Depressive Symptoms from Early Childhood through High School in Children and Adolescents with a High Intellectual Potential.

We aimed to explore the developmental trajectory of depressive symptoms in a national sample of French children with a high intellectual potential (HIP) seeking help from gifted organizations. Participants were drawn from a national retrospective survey sent to 1200 families with HIP children (IQ ≥ 130) from primary to high school and they answered a self-report questionnaire of a depression scale (MDI-C). The children's parents completed a self-report questionnaire collected on different stages of the child's school level, perinatality, psychomotor development, health, family's history, behavior, interpersonal relationships and daily activities, school performance, presence of learning disorders and remediation. Four hundred and twenty HIP children were eligible with an IQ ≥ 130 aged from 8 to 17 years-old, 49% with depressive symptoms and 51% with no depressive symptoms. Analysis of 136 variables from anamnestic fields based on the use of Spearman's ρ test (ρ) with a non-parametric correlations showed that "learning disabilities" are significantly related to depressive symptoms in different groups (primary p = 0.001, middle p = 0.02, high school p = 0.001) as well as "difficulties in psychomotor skills" during primary (p = 0.003) and middle school (p = 0.02). Good relationships with family as well as with peers are significantly negatively correlated with depressive symptoms from childhood to primary (p = 0.003) and high school (p = 0.02). Certain details of correlations between the MDI-C scale's subfactors and anamnestic variables were analyzed. The ANOVA test about the MDI-C scale showed provocation as a significant marker at middle school (F (1, 418) = 3.487, p = 0.03) and low self-esteem at high school (F (1, 418) = 3.337, p = 0.03). A holistic developmental approach allowed us to highlight the risk factors of depression with a developmental trajectory origin linked to disorders of social adjustment and psychomotor skills and to the importance of misdiagnosed learning disabilities because of giftedness. Our findings support the interest in an early identification of and intervention in depression risk to improve clinical decision making on the effect of giftedness on mental health outcomes.

Life Course of Asthma.

Asthma is a heterogeneous chronic airway disease that can vary over a lifetime. Although broad categories of asthma by severity and type have been constructed, there remains a tremendous opportunity to discover an approach to managing asthma with additional factors in mind. Many in the field have suggested and are pursuing a novel paradigm shift in how asthma might be better managed, considering the life course of exposures, management priorities, and predicted trajectory of lung function growth. This approach will require a more holistic view of prenatal, postnatal, adolescence, hormonal and gender aspects, and the aging process. In addition, the environment, externally and internally, including in one's genetic code and epigenetic changes, are factors that affect how asthma progresses or becomes more stable in individuals. This chapter focuses on the various influences that may, to differing degrees, affect people with asthma, which can develop at any time in their lives. Shifting the paradigm of thought and strategies for care and advocating for public policies and health delivery that focus on this philosophy is paramount to advance asthma care for all.

Fragmented care trajectories in municipal healthcare: Local sensemaking of digital documentation.

Objective: Since the 1990s, almost all healthcare organisations have had electronic health records (EHR) to organise and manage treatment, care and work routines. This article aims to understand how healthcare professionals (HCPs) make sense of digital documentation practice. Methods: Based on a case study design, field observations and semi-structured interviews were conducted in a Danish municipality. A systematic analysis based on Karl Weick's sensemaking theory was applied to investigate what cues HCPs extract from timetables in the EHR and how institutional logics frame the enactment of documentation practice. Results: The analysis uncovered three themes: making sense of planning, making sense of tasks and making sense of documentation. The themes illustrate that HCPs make sense of the digital documentation practice as a dominant managerial tool designed to control resources and work routines. This sensemaking leads to a task-oriented practice which centres on delivering fragmented tasks according to a timetable. Conclusion: HCPs mitigate fragmentation by responding to a care professional logic, where they document to share information and carry out invisible work outside of timetables and scheduled tasks. However, HCPs are focused on solving specific tasks by the minute with the possible consequence that continuity and their overview of the service user's care and treatment disappear. In conclusion, the EHR system eliminates a holistic view of care trajectories, leaving it up to HCPs to collaborate in an effort to obtain continuity for the service user.

Cancer care patterns in South Korea: Types of hospital where patients receive care and outcomes using national health insurance claims data.

BACKGROUND: Although strengthening coverage has improved cancer care, there are concerns related to medical distortion. Previous studies have only examined whether patients visit a specific hospital, and not the continuum of patients with cancer, resulting in a lack of evidence in South Korea. This study aimed to investigate the patterns in hospital type for cancer care and analyze their association with outcomes. METHODS: The data for this study were obtained from the National Health Insurance Services Sampled Cohort database. This study included patients with four types of cancer (top four cancer incidence in 2020): gastric (3353), colorectal (2915), lung (1351), and thyroid (5158) cancer. The latent class mixed model was used to investigate cancer care patterns, and multiple regression or survival analysis was performed to examine medical cost, length of stay (LOS), and mortality. RESULTS: The patterns in each cancer type were classified into two to four classes, namely, mainly visited clinics or hospitals, mainly visited general hospitals, mainly visited tertiary hospitals (MT), and tertiary to general hospitals through trajectory modeling based on the utilization of cancer care. Compared to the MT pattern, other patterns were generally associated with higher cost, LOS, and mortality. CONCLUSION: The patterns found in this study may be a more realistic way of defining patients with cancer in South Korea compared to previous studies, and its association-related outcomes may be used as a basis to address problems in the healthcare system and prepare alternatives for patients with cancer. Future studies should review cancer care patterns related to other factors such as regional distribution.

Disease Burden of Dysmenorrhea: Impact on Life Course Potential.

Dysmenorrhea is the most common gynecologic condition among the female population and has a significant impact on life course potential. It has a widespread impact on a female's mental and physical well-being, with longstanding impairments on quality of life, personal relationships, and education and career attainment. Furthermore, untreated dysmenorrhea can lead to hyperalgesic priming, which predisposes to chronic pelvic pain. Primary dysmenorrhea is pain in the lower abdomen that occurs before or during menses and in the absence of pelvic pathology. One possible mechanism is endometrial inflammation and increased prostaglandin release, resulting in painful uterine contractions. Dysmenorrhea may also occur secondary to pelvic pathology, such as endometriosis, adenomyosis or due to cyclic exacerbation of non-gynecologic pain conditions. A thorough patient evaluation is essential to differentiate between potential causes and guide management. Treatment must be tailored to individual patient symptoms. Pharmacologic management with non-steroidal anti-inflammatory medications and/or combined hormonal contraceptives is most common. Heat therapy, exercise, vitamins and dietary supplements have limited evidence and can be offered for patients seeking non-pharmacologic adjunctive or alternative options. Greater awareness for both health-care providers and patients allows for early intervention to reduce impact on quality of life and life course potential.

Alcohol intake masked the protective effects of tea consumption against all-cause mortality and blood pressure progression: Findings from CHNS cohort, 1993-2011.

OBJECTIVES: Whether the protective effects of tea consumption interact with the status of alcohol consumption remains unknown. The present study aimed to investigate the relationship between tea consumption and mortality and blood pressure changes between alcohol consumers and non-consumers in a Chinese population. METHODS: This study was conducted with a cohort of 6387 participants from the China Health and Nutrition Survey data between 1993 and 2011. Group-based trajectory modeling was conducted to identify distinct tea consumption trajectories. Kaplan-Meier and Cox regression methods were used to estimate the cumulative rate of all-cause mortality. Restricted cubic spline was performed to determine the nonlinear relationships between mean tea consumption and mortality. Generalized linear mixed-effects models (GLMM) were conducted to assess the blood pressure changes among tea consumption trajectories. RESULTS: We identified three tea consumption trajectories. After a median follow-up of 17.9 y, 580 (9.1%) participants died. The association between tea consumption and death interacted with alcohol drinking status. A lower morality risk for the high tea consumption trajectory was observed only in non-alcohol drinkers (hazard ratio, 0.56; 95% confidence interval, 0.40-0.77). The tea-mortality association was linear in current alcohol drinkers (Plinear = 0.002), demonstrating that mortality increased with increasing tea consumption. The results of GLMM showed that alcohol intake masked the protective effect against blood pressure progression. CONCLUSIONS: The results of this study demonstrated that individuals with a long-term high tea consumption trajectory had a lower risk for all-cause mortality and a slower blood pressure growth rate. The beneficial effects of tea consumption were attenuated by alcohol intake or even harmful to health.

Peri-Conceptional Folic Acid Supplementation and Children's Physical Development: A Birth Cohort Study.

BACKGROUND: Maternal lack of folic acid supplementation during pregnancy may increase the risk of low birth weight and preterm delivery. However, little is known about the relationship between folic acid supplementation during pregnancy and the physical development of offspring in the later stage. OBJECTIVE: This study aimed to explore the association between maternal folic acid supplementation status during pregnancy and the physical development of preschool children. METHODS: A total of 3064 mother-child pairs with data on maternal folic acid supplementation status during pregnancy and children's anthropometric measurements were recruited from the Ma'anshan-Anhui Birth Cohort (MABC) in China. Maternal folic acid supplementation status during pregnancy was the main exposure, and the primary outcomes were children's growth development trajectories. Children's growth development trajectories were fitted using group-based trajectory models. The association between maternal folic acid supplementation status during pregnancy and children's growth trajectories was performed using multiple logistic regression models. RESULTS: After adjusting for potential confounders, we found that the absence of maternal folic acid supplementation before pregnancy and in the first trimester was significantly associated with a "high level" trajectory (trajectory 3) and a "high rising level" trajectory (trajectory 4) of BMI-Z scores in children 0 to 6 years of age (OR = 1.423, 95%CI:1.022-1.982; OR = 1.654, 95%CI: 1.024-2.671). In children aged 4 to 6 years old, a "high level" trajectory (trajectory 3) of body fat ratio was substantially related to maternal no folic acid supplementation before pregnancy and in the first trimester (OR = 1.833, 95%CI:1.037-3.240). No significant additional benefits associated with physical developmental indicators in preschool children have been observed with continued folic acid supplementation after the first trimester of gestation. CONCLUSIONS: Maternal non-supplementation with folic acid during pregnancy is associated with a "high level" BMI trajectory and a "high level" body fat ratio trajectory in preschool-aged children.

ADMS simulation and influencing factors of bioaerosol diffusion from BRT under different aeration modes in six wastewater treatment plants.

Bioaerosols produced by municipal wastewater treatment plants (MWTP) can spread in air, thereby polluting the atmosphere and causing safety hazards to workers and surrounding residents. In this study, the biological reaction tanks (BRTs) of six MWTPs undergoing typical processes in North China, Yangtze River Delta, and the Greater Bay Area were selected to set up sampling points and investigate the production characteristics of bioaerosols. The Atmospheric Dispersion Modelling System method was used to simulate the diffusion of bioaerosols in the MWTPs. The concentrations of bacteria and, specifically, intestinal bacteria in the bioaerosols ranged from 389 CFU/m3 to 1,536 CFU/m3 and 30 CFU/m3 to 152 CFU/m3, respectively, and the proportion of the intestinal bacteria was 8.85%. The concentration of soluble chemicals (SCs) in the bioaerosols was 18.36 µg/m3-82.19 µg/m3, and the main SCs found were Mg2+, Ca2+, and SO42-. The proportion of intestinal bacteria (75.79%) produced via surface aeration by a BRT attached to large-sized bioaerosol particles was higher than that of a BRT undergoing the bottom aeration process (37.28%). The main microorganisms found in the bioaerosols included Moraxellaceae, Escherichia-Shigella, Psychrobacter, and Cyanobacteria. The generation of bioaerosols exhibited regional characteristics. The wastewater treatment scale, wastewater quality, and aeration mode were the main factors influencing bioaerosol production. Model simulation showed that, after 1 h, the diffusion distance of bioaerosol was 292 m-515 m, and the affected area was 42,895 m2-91,708 m2. The diffusion distance and range of the bioaerosols were significantly correlated with the concentration at the bioaerosol source and the aeration mode adopted by the BRTs. Wind speed and direction were two environmental factors that affected the diffusion of bioaerosols. With an increase in the diffusion distance, the concentration of microorganisms, intestinal bacteria, ions, and fine particles in the bioaerosols decreased significantly, resulting in a corresponding reduction in the exposure risk. This study provides new insights to help predict bioaerosol risks at MWTPs and identify safe areas around MWTPs. The study also provides a basis for selecting safe MWTP sites and reducing bioaerosol pollution risks.

Developmental emergence of holistic processing in word recognition.

Holistic processing (HP) of faces refers to the obligatory, simultaneous processing of the parts and their relations, and it emerges over the course of development. HP is manifest in a decrement in the perception of inverted versus upright faces and a reduction in face processing ability when the relations between parts are perturbed. Here, adopting the HP framework for faces, we examined the developmental emergence of HP in another domain for which human adults have expertise, namely, visual word processing. Children, adolescents, and adults performed a lexical decision task and we used two established signatures of HP for faces: the advantage in perception of upright over inverted words and nonwords and the reduced sensitivity to increasing parts (word length). Relative to the other groups, children showed less of an advantage for upright versus inverted trials and lexical decision was more affected by increasing word length. Performance on these HP indices was strongly associated with age and with reading proficiency. Also, the emergence of HP for word perception was not simply a result of improved visual perception over the course of development as no group differences were observed on an object decision task. These results reveal the developmental emergence of HP for orthographic input, and reflect a further instance of experience-dependent tuning of visual perception. These results also add to existing findings on the commonalities of mechanisms of word and face recognition. RESEARCH HIGHLIGHTS: Children showed less of an advantage for upright versus inverted trials compared to adolescents and adults. Relative to the other groups, lexical decision in children was more affected by increasing word length. Performance on holistic processing (HP) indices was strongly associated with age and with reading proficiency. HP emergence for word perception was not due to improved visual perception over development as there were no group differences on an object decision task.

Unresolved early post-operative pain trajectory predicts moderate-to-severe persistent pain after breast cancer surgery-An observational cohort study.

BACKGROUND: Modelling acute post-operative pain trajectories may improve the prediction of persistent pain after breast cancer surgery (PPBCS). This study aimed to investigate the predictive accuracy of early post-operative pain (EPOP) trajectories in the development of PPBCS. MATERIALS & METHODS: This observational study was conducted in a French Comprehensive Cancer Centre and included patients who underwent breast cancer surgery from December 2017 to November 2018. Perioperative and follow-up data were obtained from medical records, and anaesthesia and perioperative charts. EPOP was defined as pain intensity during the first 24 h after surgery, and modelled by a pain trajectory. K-means clustering method was used to identify patient subgroups with similar EPOP trajectories. The prevalence of moderate-to-severe PPBCS (numeric rating scale ≥4) was evaluated until 24 months after surgery. RESULTS: A total of 608 patients were included in the study, of which 18% (n = 108) and 9% (n = 52) reported mild and moderate-to-severe PPBCS, respectively. Based on EPOP trajectories, we were able to identify a low (64%, n = 388), resolved (30%, n = 182), and unresolved (6%, n = 38) pain group. Multivariate analysis identified younger age, axillary lymph node dissection, and unresolved EPOP trajectory as independent risk factors for moderate-to-severe PPBCS development. When compared to patients reporting mild PPBCS, moderate-to-severe PPBCS patients experienced significantly more neuropathic pain features, pain-related interference, and delayed opioid cessation. CONCLUSION: EPOP trajectories can distinguish between resolved and unresolved acute pain after breast cancer surgery, allowing early identification of patients at risk to develop significant PPBCS.

Deep phenotyping and biomarkers of various dairy fat intakes in an 8-week randomized clinical trial and 2-year swine study.

Health effects of dairy fats (DF) are difficult to evaluate, as DF intakes are hard to assess epidemiologically and DF have heterogeneous compositions that influence biological responses. We set out to find biomarkers of DF intake and assess biological response to a summer DF diet (R2), a winter DF diet (R3), and a R3 supplemented with calcium (R4) compared to a plant-fat-based diet (R1) in a randomized clinical trial (n=173) and a 2-year study in mildly metabolically disturbed downsized pigs (n=32). Conventional clinical measures were completed by LC/MS plasma metabolomics/lipidomics. The measured effects were modeled as biological functions to facilitate interpretation. DF intakes in pigs specifically induced a U-shaped metabolic trajectory, reprogramming metabolism to close to its initial status after a one-year turnaround. Twelve lipid species repeatably predicted DF intakes in both pigs and humans (6.6% errors). More broadly, in pigs, quality of DF modulated the time-related biological response (R2: 30 regulated functions, primarily at 6 months; R3: 26 regulated functions, mostly at 6-12 months; R4: 43 regulated functions, mostly at 18 months). Despite this heterogeneity, 9 functions overlapped under all 3 DF diets in both studies, related to a restricted area of amino acids metabolism, cofactors, nucleotides and xenobiotic pathways and the microbiota. In conclusion, over the long-term, DF reprograms metabolism to close to its initial biological status in metabolically-disrupted pigs. Quality of the DF modulates its metabolic influence, although some effects were common to all DF. A resilient signature of DF consumption found in pigs was validated in humans.

Thalamus sends information about arousal but not valence to the amygdala.

RATIONALE: The basolateral amygdala (BLA) and medial geniculate nucleus of the thalamus (MGN) have both been shown to be necessary for the formation of associative learning. While the role that the BLA plays in this process has long been emphasized, the MGN has been less well-studied and surrounded by debate regarding whether the relay of sensory information is active or passive. OBJECTIVES: We seek to understand the role the MGN has within the thalamoamgydala circuit in the formation of associative learning. METHODS: Here, we use optogenetics and in vivo electrophysiological recordings to dissect the MGN-BLA circuit and explore the specific subpopulations for evidence of learning and synthesis of information that could impact downstream BLA encoding. We employ various machine learning techniques to investigate function within neural subpopulations. We introduce a novel method to investigate tonic changes across trial-by-trial structure, which offers an alternative approach to traditional trial-averaging techniques. RESULTS: We find that the MGN appears to encode arousal but not valence, unlike the BLA which encodes for both. We find that the MGN and the BLA appear to react differently to expected and unexpected outcomes; the BLA biased responses toward reward prediction error and the MGN focused on anticipated punishment. We uncover evidence of tonic changes by visualizing changes across trials during inter-trial intervals (baseline epochs) for a subset of cells. CONCLUSION: We conclude that the MGN-BLA projector population acts as both filter and transferer of information by relaying information about the salience of cues to the amygdala, but these signals are not valence-specified.

How do clients with multiple problems and (in)formal caretakers coproduce integrated care and support? A longitudinal study on integrated care trajectories of clients with multiple problems.

INTRODUCTION: Integrated care can create several advantages, such as better quality of care and better outcomes. These advantages apply especially to clients with multiple problems (CWMPs) who have multiple, interconnected needs that span health and social issues and require different health care (e.g., mental health care or addiction care), social care (e.g., social benefits) and welfare services at the same time. Integrated care is most often studied as a phenomenon taking place at the system, organizational, professional and clinical levels. Therefore, in many studies, clients seem to be implicitly conceptualized as passive recipients of care. Less research has been conducted on how clients and (in)formal caretakers coproduce integrated care. METHODS: We performed a longitudinal study to investigate how CWPMs and (in)formal caretakers coproduce integrated care. Data were collected among CWMPs and their (in)formal caretakers in Rotterdam, the Netherlands. CWMPs' care trajectories were followed for 1-1.5 years. CWMPs were interviewed three times at an interval of 6 months (T0, T1, T2). Informal caretakers were interviewed three times (T0, T1, T2), and formal caretakers of 16 clients were interviewed twice (T1, T2). Data in the municipal record systems about participating CWMPs were also included. RESULTS: Our study shows that the CWMPs' multidimensional needs, which should function as the organizing principle of integrated care, are rarely completely assessed at the start (first 6 weeks) of CWMPs' care trajectories. Important drivers behind this shortcoming are the urgent problems CWMPs enter the support trajectory with, their lack of trust in 'the government' and the complexity of their situations. We subsequently found two distinct types of cases. The highest level of integrated care is achieved when formal caretakers initiate an iterative process in which the CWMP's multidimensional needs are constantly further mapped out and interventions are attuned to this new information. CONCLUSIONS: Our study indicates that integrated care is the joint product of formal caretakers and CWMPs. Integrated care however does not come naturally when CWMPs are 'put at the center'. Professionals need to play a leading role in engaging CWMPs to coproduce integrated care. PATIENT CONTRIBUTION: CWMPs and their (in)formal caretakers participated in this study via interviews and contributed with their experiences of the process.

Determining the role and responsibilities of the community epilepsy nurse in the management of epilepsy.

AIMS AND OBJECTIVES: The aim of this study is to enhance the understanding of the core elements and influencing factors on the community-based epilepsy nurse's role and responsibilities. BACKGROUND: Internationally, epilepsy nurse specialists play a key role in providing person-centred care and management of epilepsy but there is a gap in understanding of their role in the community. DESIGN: A national three-stage, mixed-method study was conducted. METHODS: One-on-one, in-depth semi-structured qualitative interviews were conducted online with 12 community-based epilepsy nurses (Stage 1); retrospective analysis of data collected from the National Epilepsy Line, a nurse-led community helpline (Stage 2); and focus group conducted with four epilepsy nurses, to delve further into emerging findings (Stage 3). A thematic analysis was conducted in Stages 1 and 3, and a descriptive statistical analysis of Stage 2 data. Consolidated Criteria for Reporting Qualitative studies checklist was followed for reporting. RESULTS: Three key themes emerged: (1) The epilepsy nurse career trajectory highlighted a lack of standardised qualifications, competencies, and career opportunities. (2) The key components of the epilepsy nurse role explored role diversity, responsibilities, and models of practice in the management of living with epilepsy, and experiences navigating complex fragmented systems and practices. (3) Shifting work practices detailed the adapting work practices, impacted by changing service demands, including COVID-19 pandemic experiences, role boundaries, funding, and resource availability. CONCLUSION: Community epilepsy nurses play a pivotal role in providing holistic, person-centred epilepsy management They contribute to identifying and addressing service gaps through innovating and implementing change in service design and delivery. RELEVANCE TO CLINICAL PRACTICE: Epilepsy nurses' person-centred approach to epilepsy management is influenced by the limited investment in epilepsy-specific integrated care initiatives, and their perceived value is impacted by the lack of national standardisation of their role and scope of practice. NO PATIENT OR PUBLIC CONTRIBUTION: Only epilepsy nurses' perspectives were sought.

Source Area of the Immigrant Population of Beet Webworm (Lepidoptera: Crambidae) in Northern Xinjiang, China.

The beet webworm, Loxostege sticticalis (Linnaeus) (Lepidoptera: Crambidae), is a destructive pest inhabiting the northern temperate zone. In Xinjiang, China, this species has only occasionally infested certain areas, but has been causing severe damage since 2005. Early studies showed that most of the outbreak populations in northern Xinjiang are immigrant populations. However, the specific source area is still unknown. In this study, we determined the source area of the immigrant population of L. sticticalis in northern Xinjiang from 2010 to 2013 using daily monitoring data of L. sticticalis adults; we explained the causation of why an overwintering area of L. sticticalis could build up in Central Asia. Results showed that the direct source area of L. sticticalis in northern Xinjiang was eastern Kazakhstan, and the initial source area could be traced further to Altai Krai, Russia. Both regions were located at the foothills of the westernmost portion of Altai Mountains. The thermal conditions in these regions could not support L. sticticalis development for two generations before 1990. Hence, a few cocoons could be formed in the autumn. Influenced by global warming, L. sticticalis in these regions could complete two whole generations most years after 2001. The increased generation number, combined with sufficient precipitation, and mountainous terrain in the westernmost portion of Altai Mountains have created an overwintering area for L. sticticalis.

Spatio-temporal association mining of intercity PM2.5 pollution: Hubei Province in China as an example.

The complex interaction between emissions, meteorology, and atmospheric chemistry makes accurate predictions of particulate pollution difficult. Advanced data mining techniques can reveal potential laws, providing new possibilities for understanding the evolution and causes of air pollution. Based on the Granger method and block modeling analysis, this paper explored the intercity spillover effects of hourly PM2.5 in Hubei Province, China, to determine the specific role (i.e., overflow, limited overflow, bilateral, inflow, and limited inflow) of each city on regional pollution formation. Furthermore, a dynamic Apriori algorithm considering time-lag effects was used to mine the spatio-temporal associations of extreme PM2.5 pollution events among different cities. Results suggest that the northern and central cities with high-level PM2.5 concentration in Hubei have a significant spillover effect, whereas the eastern and southern cities generally play a role as the sink of pollutants. Based on the association rules of extreme PM2.5 pollution, four main pollutant transport channels were excavated and well matched with the trajectories extracted by the atmospheric model. This paper provides new insights for exploring the interaction of intercity particulate pollution, which is a supplement and cross-validation of the model results.