Transcatheter Arterialization of Deep Veins in Chronic Limb-Threatening Ischemia.

BACKGROUND: Approximately 20% of patients with chronic limb-threatening ischemia have no revascularization options, leading to above-ankle amputation. Transcatheter arterialization of the deep veins is a percutaneous approach that creates an artery-to-vein connection for delivery of oxygenated blood by means of the venous system to the ischemic foot to prevent amputation. METHODS: We conducted a prospective, single-group, multicenter study to evaluate the effect of transcatheter arterialization of the deep veins in patients with nonhealing ulcers and no surgical or endovascular revascularization treatment options. The composite primary end point was amputation-free survival (defined as freedom from above-ankle amputation or death from any cause) at 6 months, as compared with a performance goal of 54%. Secondary end points included limb salvage, wound healing, and technical success of the procedure. RESULTS: We enrolled 105 patients who had chronic limb-threatening ischemia and were of a median age of 70 years (interquartile range, 38 to 89). Of the patients enrolled, 33 (31.4%) were women and 45 (42.8%) were Black, Hispanic, or Latino. Transcatheter arterialization of the deep veins was performed successfully in 104 patients (99.0%). At 6 months, 66.1% of the patients had amputation-free survival. According to Bayesian analysis, the posterior probability that amputation-free survival at 6 months exceeded a performance goal of 54% was 0.993, which exceeded the prespecified threshold of 0.977. Limb salvage (avoidance of above-ankle amputation) was attained in 67 patients (76.0% by Kaplan-Meier analysis). Wounds were completely healed in 16 of 63 patients (25%) and were in the process of healing in 32 of 63 patients (51%). No unanticipated device-related adverse events were reported. CONCLUSIONS: We found that transcatheter arterialization of the deep veins was safe and could be performed successfully in patients with chronic limb-threatening ischemia and no conventional surgical or endovascular revascularization treatment options. (Funded by LimFlow; PROMISE II study ClinicalTrials.gov number, NCT03970538.).

Preclinical targeting of liver fibrosis with a 89Zr-labeled Fibrobody® directed against platelet derived growth factor receptor-ß.

PURPOSE: Hepatic fibrosis develops as a response to chronic liver injury, resulting in the formation of fibrous scars. This process is initiated and driven by collagen-producing activated myofibroblasts which reportedly express high levels of platelet derived growth factor receptor-ß (PDGFRß). We therefore regard PDGFRß as an anchor for diagnosis and therapy. The Fibrobody® SP02SP26-ABD is a biparatopic VHH-construct targeting PDGFRß. Here, we explore its potential as a theranostic vector for liver fibrosis. METHODS: Specificity, cross-species binding, and cellular uptake of SP02SP26-ABD was assessed using human, mouse and rat PDGFRß ectodomains and PDGFRß-expressing cells. Cellular uptake by PDGFRß-expressing cells was also evaluated by equipping the Fibrobody® with auristatinF and reading out in vitro cytotoxicity. The validity of PDGFRß as a marker for active fibrosis was confirmed in human liver samples and 3 mouse models of liver fibrosis (DDC, CCl4, CDA-HFD) through immunohistochemistry and RT-PCR. After radiolabeling of DFO*-SP02SP26-ABD with 89Zr, its in vivo targeting ability was assessed in healthy mice and mice with liver fibrosis by PET-CT imaging, ex vivo biodistribution and autoradiography. RESULTS: SP02SP26-ABD shows similar nanomolar affinity for human, mouse and rat PDGFRß. Cellular uptake and hence subnanomolar cytotoxic potency of auristatinF-conjugated SP02SP26-ABD was observed in PDGFRß-expressing cell lines. Immunohistochemistry of mouse and human fibrotic livers confirmed co-localization of PDGFRß with markers of active fibrosis. In all three liver fibrosis models, PET-CT imaging and biodistribution analysis of [89Zr]Zr-SP02SP26-ABD revealed increased PDGFRß-specific uptake in fibrotic livers. In the DDC model, liver uptake was 12.15 ± 0.45, 15.07 ± 0.90, 20.23 ± 1.34, and 20.93 ± 4.35%ID/g after 1,2,3 and 4 weeks of fibrogenesis, respectively, compared to 7.56 ± 0.85%ID/g in healthy mice. Autoradiography revealed preferential uptake in the fibrotic (PDGFRß-expressing) periportal areas. CONCLUSION: The anti-PDGFRß Fibrobody® SP02SP26-ABD shows selective and high-degree targeting of activated myofibroblasts in liver fibrosis, and qualifies as a vector for diagnostic and therapeutic purposes.

Closing the gap between existing large-area imaging research and marine conservation needs.

Emerging technology has immense potential to increase the scale and efficiency of marine conservation. One such technology is large-area imaging (LAI), which relies on structure-from-motion photogrammetry to create composite products, including 3-dimensional (3-D) environmental models, that are larger in spatial extent than the individual images used to create them. Use of LAI has become widespread in certain fields of marine science, primarily to measure the 3D structure of benthic ecosystems and track change over time. However, the use of LAI in the field of marine conservation appears limited. We conducted a review of the coral reef literature on the use of LAI to identify research themes and regional trends in applications of this technology. We also surveyed 135 coral reef scientists and conservation practitioners to determine community familiarity with LAI, evaluate barriers practitioners face in using LAI, and identify applications of LAI believed to be most exciting or relevant to coral conservation. Adoption of LAI was limited primarily to researchers at institutions based in advanced economies and was applied infrequently to conservation, although conservation practitioners and survey respondents from emerging economies indicated they expect to use LAI in the future. Our results revealed disconnect between current LAI research topics and conservation priorities identified by practitioners, highlighting the need for more diverse, conservation-relevant research using LAI. We provide recommendations for how early adopters of LAI (typically Global North scientists from well-resourced institutions) can facilitate access to this conservation technology. These recommendations include developing training resources, creating partnerships for data storage and analysis, publishing standard operating procedures for LAI workflows, standardizing methods, developing tools for efficient data extraction from LAI products, and conducting conservation-relevant research using LAI.

Reducción de la brecha entre la investigación actual de imágenes de gran superficie y las necesidades de la conservación marina Resumen Las nuevas tecnologías tienen un enorme potencial para aumentar la escala y la eficiencia de la conservación marina. Una de ellas son las imágenes de gran superficie (IGS), que se basan en la fotogrametría de estructura a partir del movimiento para crear productos compuestos, incluidos modelos ambientales tridimensionales (3D), cuya extensión espacial es mayor que la de las imágenes individuales utilizadas para crearlos. El uso de las IGS se ha generalizado en determinados campos de las ciencias marinas, principalmente para medir la estructura tridimensional de los ecosistemas bentónicos y realizar un seguimiento de los cambios a lo largo del tiempo. Sin embargo, el uso de las IGS en el campo de la conservación marina parece limitado. Realizamos una revisión de la bibliografía sobre el uso de las IGS en los arrecifes de coral para identificar temas de investigación y tendencias regionales en las aplicaciones de esta tecnología. También encuestamos a 135 científicos de arrecifes de coral y profesionales de la conservación para determinar la familiaridad de la comunidad con las IGS, evaluar las barreras a las que se enfrentan los profesionales en el uso de las IGS e identificar sus aplicaciones consideradas como las más interesantes o relevantes para la conservación del coral. La adopción de las IGS se limitó principalmente a los investigadores de las instituciones con sede en las economías avanzadas y se aplicó con poca frecuencia a la conservación, aunque los profesionales de la conservación y los encuestados de las economías emergentes indicaron que esperan utilizar las IGS en el futuro. Nuestros resultados revelaron una desconexión entre los actuales temas de investigación de las IGS y las prioridades de conservación identificadas por los profesionales, lo que subraya la necesidad de una investigación más diversa y relevante para la conservación mediante el uso de las IGS.

Optimization of Recombinant Protein Production in Synechococcus elongatus PCC 7942: Utilizing Native Promoters and Magnetic Fields.

The cyanobacterium Synechococcus elongatus PCC 7942 holds significant potential as a biofactory for recombinant protein (RP) production due to its capacity to harness light energy and utilize CO2. This study aimed to enhance RP production by integration of native promoters and magnetic field application (MF) in S. elongatus PCC 7942. The psbA2 promoter, which responds to stress conditions, was chosen for the integration of the ZsGreen1 gene. Results indicated successful gene integration, affirming prior studies that showed no growth alterations in transgenic strains. Interestingly, exposure to 30 mT (MF30) demonstrated a increase in ZsGreen1 transcription under the psbA2 promoter, revealing the influence of MF on cyanobacterial photosynthetic machinery. This enhancement is likely attributed to stress-induced shifts in gene expression and enzyme activity. MF30 positively impacted photosystem II (PSII) without disrupting the electron transport chain, aligning with the "quantum-mechanical mechanism" theory. Notably, fluorescence levels and gene expression with application of 30 mT were significantly different from control conditions. This study showcases the efficacy of utilizing native promoters and MF for enhancing RP production in S. elongatus PCC 7942. Native promoters eliminate the need for costly exogenous inducers and potential cell stress. Moreover, the study expands the scope of optimizing RP production in photoautotrophic microorganisms, providing valuable insights for biotechnological applications.

Optimizing evapotranspiration and crop irrigation requirements of tropical forages cropping systems in Southern Brazil.

Crop irrigation requirements are usually estimated based on crop evapotranspiration (ETc) as determined by the reference evapotranspiration (ETo) and crop coefficient (Kc). There is a lack of knowledge on the irrigation requirements of tropical forage crops in Brazil, contrasting with the increasing use of irrigation in pastures. The effort of this study was to investigate what would be the water needs of tropical forages in Southern Brazil, based on a robust experimental database. The study was carried out in São Paulo State-Brazil using different forages species and their combinations [Guinea grass (GG); Guinea grass + black oat + ryegrass (GOR); Bermuda grass (BG), and Bermuda + black oat + ryegrass (BOR)]. The experimental fields were fully irrigated, and the Kc values were derived from ETc measurements on lysimeters; ETo was estimated using daily data from a nearby weather station and the standard FAO56 parameterization. Mean daily ETc values for GG, GOR, BG and BOR were 4.1, 2.9, 3.6, and 3.4 mm, respectively, and respective mean Kc values were 0.99, 0.90, 1.0, and 0.94. Average Kc values for all plots decreased as ETo increased, producing a negative Kc-ETo relationship, mainly when ETo reached values greater than 5 mm d-1. This was most likely due to internal plant stomatal resistance to vapor release from the leaves diffusing to the atmosphere at high ETo. So, the time-based Kc curves described by FAO 56 manual should be adjusted for the analyzed crops considering different ranges of ETo to improve the required irrigation depth.

False-positive HIV screening test in a healthcare student.

This case report describes a 22-year-old female Ambulance Technician student who displayed human immunodeficiency virus (HIV) false positivity following a recent hepatitis B vaccination. Occupational health clinicians who work in a healthcare setting (with healthcare staff and/or students) should be aware of the possibility of false-positive HIV screening test results, and where a false positive is suspected, they should consider what the underlying cause could be and should consider whether further medical investigation is required.

Two-Dimensional Silver-Chalcogenolate-Based Cluster-Assembled Material: A p-type Semiconductor.

We have synthesized and characterized a new two-dimensional honeycomb architecture resembling a single-layer of atomically precise silver cluster-assembled material (CAM), [Ag12(StBu)6(CF3COO)6(4,4'-azopyridine)3] (Ag12-azo-bpy). The interlayer noncovalent van der Waals interactions within the single-crystals were successfully disrupted, leading to the creation of this unique structure. The optimized Ag12-azo-bpy CAM demonstrates a valence band that is localized on the Ag12 cluster node situated near the Fermi energy level. This localization induces electron injection from the linker to the cluster node, facilitating efficient charge transportation along the plane. Exploiting this single-layer structure as a distinctive platform for p-type channel material, it was employed in a field-effect transistor configuration. Remarkably, the transistor exhibits a high hole mobility of 1.215 cm2 V-1 s-1 and an impressive ON/OFF current ratio of ∼4500 at room-temperature.

Plasma pTau-217 and N-terminal tau (NTA) enhance sensitivity to identify tau PET positivity in amyloid-ß positive individuals.

INTRODUCTION: We set out to identify tau PET-positive (A+T+) individuals among amyloid-beta (Aß) positive participants using plasma biomarkers. METHODS: In this cross-sectional study we assessed 234 participants across the AD continuum who were evaluated by amyloid PET with [18 F]AZD4694 and tau-PET with [18 F]MK6240 and measured plasma levels of total tau, pTau-181, pTau-217, pTau-231, and N-terminal tau (NTA-tau). We evaluated the performances of plasma biomarkers to predict tau positivity in Aß+ individuals. RESULTS: Highest associations with tau positivity in Aß+ individuals were found for plasma pTau-217 (AUC [CI95% ] = 0.89 [0.82, 0.96]) and NTA-tau (AUC [CI95% ] = 0.88 [0.91, 0.95]). Combining pTau-217 and NTA-tau resulted in the strongest agreement (Cohen's Kappa = 0.74, CI95%  = 0.57/0.90, sensitivity = 92%, specificity = 81%) with PET for classifying tau positivity. DISCUSSION: The potential for identifying tau accumulation in later Braak stages will be useful for patient stratification and prognostication in treatment trials and in clinical practice. HIGHLIGHTS: We found that in a cohort without pre-selection pTau-181, pTau-217, and NTA-tau showed the highest association with tau PET positivity. We found that in Aß+ individuals pTau-217 and NTA-tau showed the highest association with tau PET positivity. Combining pTau-217 and NTA-tau resulted in the strongest agreement with the tau PET-based classification.

Prevalence of orofacial pain in individuals with mild cognitive impairment or dementia: A systematic review and meta-analysis.

BACKGROUND: This systematic review investigated the prevalence of orofacial pain in patients with mild cognitive impairment (MCI) or dementia. MATERIALS AND METHODS: The search was conducted in five databases (Medline (Ovid), Embase (Ovid), CINAHL, Scopus and LILACS), in three grey literature sources and in included articles' reference lists. Three independent reviewers performed study selection, quality appraisal and data extraction. The risk of bias was assessed with the National Institutes of Health tool. Prevalence was calculated using the random-effects model. Subgroup analysis and meta-regression were used to explore the heterogeneity of results. RESULTS: The database and grey literature search led to 12 246 results, from which nine studies were included; a further four were selected through citation searching. The total sample comprised 6115 patients with dementia and 84 with MCI. All studies had high risk of bias. The overall estimated pooled prevalence of orofacial pain among dementia participants was 19.0% (95% CI, 11.0%-27.0%; I2 , 97.1%, P < .001). Only one study included MCI participants, among which the prevalence of orofacial pain was 20.5%. Subgroup analysis demonstrated that the different sources of diagnosis might explain the heterogeneity. A higher prevalence of orofacial pain was observed in dementia participants aged over 80 years or living in nursing homes. Meta-regression analysis showed a nonlinear relationship between age and the prevalence of orofacial pain. CONCLUSIONS: The pooled data from the primary studies revealed that 2 out of 10 patients with dementia have orofacial pain. Further research is needed to clarify the magnitude in individuals with MCI.

Modulation of Singlet-Triplet Gap in Atomically Precise Silver Cluster-Assembled Material.

Silver cluster-based solids have garnered considerable attention owing to their tunable luminescence behavior. While surface modification has enabled the construction of stable silver clusters, controlling interactions among clusters at the molecular level has been challenging due to their tendency to aggregate. Judicious choice of stabilizing ligands becomes pivotal in crafting a desired assembly. However, detailed photophysical behavior as a function of their cluster packing remained unexplored. Here, we modulate the packing pattern of Ag12 clusters by varying the nitrogen-based ligand. CAM-1 formed through coordination of the tritopic linker molecule and NC-1 with monodentate pyridine ligand; established via non-covalent interactions. Both the assemblies show ligand-to-metal-metal charge transfer (LMMCT) based cluster-centered emission band(s). Temperature-dependent photoluminescence spectra exhibit blue shifts at higher temperatures, which is attributed to the extent of the thermal reverse population of the S1 state from the closely spaced T1 state. The difference in the energy gap (ΔEST ) dictated by their assemblies played a pivotal role in the way that Ag12 cluster assembly in CAM-1 manifests a wider ΔEST and thus requires higher temperatures for reverse intersystem crossing (RISC) than assembly of NC-1. Such assembly-defined photoluminescence properties underscore the potential toolkit to design new cluster- assemblies with tailored optoelectronic properties.

Natural Assembly of Electroactive Metallopolymers on the Electrode Surface: Enhanced Electrocatalytic Production of Hydrogen by [2Fe-2S] Metallopolymers in Neutral Water.

A molecular catalyst attached to an electrode surface can offer the advantages of both homogeneous and heterogeneous catalysis. Unfortunately, some molecular catalysts constrained to a surface lose much or all of their solution performance. In contrast, we found that when a small molecule [2Fe-2S] catalyst is incorporated into metallopolymers of the form PDMAEMA-g-[2Fe-2S] (PDMAEMA = poly(2-dimethylamino)ethyl methacrylate) and adsorbed to the surface, the observed rate of hydrogen production increases to kobs > 105 s-1 per active site with lower overpotential, increased lifetime, and tolerance to oxygen. Herein, the electrocatalytic performances of these metallopolymers with different length polymer chains are compared to reveal the factors that lead to this high performance. It was anticipated that smaller metallopolymers would have faster rates due to faster electron and proton transfers to more accessible active sites, but the experiments show that the rates of catalysis per active site are independent of the polymer size. Molecular dynamics modeling reveals that the high performance is a consequence of adsorption of these metallopolymers on the surface with natural assembly that brings the [2Fe-2S] catalytic sites into close contact with the electrode surface while maintaining exposure of the sites to protons in solution. The assembly is conducive to fast electron transfer, fast proton transfer, and a high rate of catalysis regardless of the polymer size. These results offer a guide to enhancing the performance of other electrocatalysts with incorporation into a polymer that provides an optimal interaction of the catalyst with the electrode and solution.

Unusually High-Spin Fe12C12- Metallo-Carbohedrene Clusters.

Ferromagnets constructed from nanometals of atomic precision are important for innovative advances in information storage, energy conversion, and spintronic microdevices. Considerable success has been achieved in designing molecular magnets, which, however, are challenging in preparation and may suffer from drawbacks on the incompatibility of high stability and strong ferromagnetism. Utilizing a state-of-the-art self-developed mass spectrometer and a homemade laser vaporization source, we have achieved a highly efficient preparation of pure iron clusters, and here, we report the finding of a strongly ferromagnetic metal-carbon cluster, Fe12C12-, simply by reacting the Fen- clusters with acetylene in proper conditions. The unique stability of this ferromagnetic Fe12C12- cluster is rooted in a plumb-bob structure pertaining to Jahn-Teller distortion. We classify Fe12C12- as a new member of metallo-carbohedrenes and elucidate its structural stability mechanism as well as its soft-landing deposition and magnetization measurements, providing promise for the exploration of potential applications.

Dependence of cognitive ability on synchronous neural interactions determined by magnetoencephalography.

Previous studies have shown that synchronous neural interactions (SNIs) underlying healthy brain function can be readily distinguished from neural anomalies associated with diseases including dementia; however, it is imperative to identify biomarkers that facilitate early identification of individuals at risk for cognitive decline before the onset of clinical symptoms. Here, we evaluated whether variation in brain function, controlling for age, corresponds with subtle decrements in cognitive performance in cognitively healthy women. A total of 251 women (age range 24-102 yr) who performed above established cutoffs on the Montreal cognitive assessment (MoCA) also underwent a task-free magnetoencephalography scan from which SNIs were computed. The results demonstrated that increased SNI was significantly associated with decreased cognitive performance (r2 = 0.923, P = 0.009), controlling for age. Compared with the lowest performers with normal cognition (MoCA = 26), SNI of the highest performers (MoCA = 30) was associated with decorrelation primarily in the right anterior temporal cortex region, with additional (weaker) foci in left anterior temporal cortex, right posterior temporal cortex, and cerebellum. The findings highlight the relevance of neural network decorrelation on cognitive functioning and suggest that subtle increases in SNI may presage future cognitive impairment.NEW & NOTEWORTHY This study in cognitively healthy women showed that decreased cognitive performance is associated with increased neural network correlations, particularly involving the temporal cortices. As healthy brain function relies on dynamic neural network communication, these findings suggest that subtle increases in correlated neural network activity may be a useful early indicator of decrements in cognitive function.

14-3-3 [Formula: see text]-reported early synaptic injury in Alzheimer's disease is independently mediated by sTREM2.

INTRODUCTION: Synaptic loss is closely associated with tau aggregation and microglia activation in later stages of Alzheimer's disease (AD). However, synaptic damage happens early in AD at the very early stages of tau accumulation. It remains unclear whether microglia activation independently causes synaptic cleavage before tau aggregation appears. METHODS: We investigated 104 participants across the AD continuum by measuring 14-3-3 zeta/delta ([Formula: see text]) as a cerebrospinal fluid biomarker for synaptic degradation, and fluid and imaging biomarkers of tau, amyloidosis, astrogliosis, neurodegeneration, and inflammation. We performed correlation analyses in cognitively unimpaired and impaired participants and used structural equation models to estimate the impact of microglia activation on synaptic injury in different disease stages. RESULTS: 14-3-3 [Formula: see text] was increased in participants with amyloid pathology at the early stages of tau aggregation before hippocampal volume loss was detectable. 14-3-3 [Formula: see text] correlated with amyloidosis and tau load in all participants but only with biomarkers of neurodegeneration and memory deficits in cognitively unimpaired participants. This early synaptic damage was independently mediated by sTREM2. At later disease stages, tau and astrogliosis additionally mediated synaptic loss. CONCLUSIONS: Our results advertise that sTREM2 is mediating synaptic injury at the early stages of tau accumulation, underlining the importance of microglia activation for AD disease propagation.

Impact of case-mix adjustment on observed variation in the healing of diabetic foot ulcers at 12 weeks using data from the National Diabetes Foot Care Audit of England and Wales: A cohort study.

AIM: This cohort study investigates the extent to which variation in ulcer healing between services can be explained by demographic and clinical characteristics. METHODS: The National Diabetes Foot Care Audit collated data on people with diabetic foot ulcers presenting to specialist services in England and Wales between July 2014 and March 2018. Logistic regression models were created to describe associations between risk factors and a person being alive and ulcer-free 12 weeks from presentation, and to investigate whether variation between 120 participating services persisted after risk factor adjustment. RESULTS: Of 27,030 people with valid outcome data, 12,925 (47.8%) were alive and ulcer-free at 12 weeks, 13,745 (50.9%) had an unhealed ulcer and 360 had died (1.3%). Factors associated with worse outcome were male sex, more severe ulcers, history of cardiac or renal disease and a longer time between first presentation to a non-specialist healthcare professional and first expert assessment. After adjustment for these factors, four services (3.3%) were more than 3SD above and seven services (5.8%) were more than 3SD below the national mean for proportions that were alive and ulcer-free at follow-up. CONCLUSIONS/INTERPRETATIONS: Variation in the healing of diabetic foot ulcers between specialist services in England and Wales persisted after adjusting for demographic characteristics, ulcer severity, smoking, body mass index and co-morbidities. We conclude that other factors contribute to variation in healing of diabetic foot ulcers and include the time to specialist assessment.

Medication self-management in predominantly African American and Caribbean American people with epilepsy: The role of medication beliefs and epilepsy knowledge.

INTRODUCTION: Suboptimal medication adherence is common in people with epilepsy (PWE) and disproportionally prevalent among racially/ethnically diverse patients. Understanding reasons and risks of suboptimal adherence is critical to developing interventions that reduce negative health outcomes. This cross-sectional study characterized common barriers to medication self-management, prevalence of negative medication beliefs, and gaps in epilepsy knowledge among predominantly African American and Caribbean American PWE and examined their interrelationships. MATERIALS AND METHODS: Sixty-three PWE (Age = 42.1 ± 13.2; 60% female; 79% Black; 19% Hispanic/Latino) completed validated self-report questionnaires about medication self-management, medication beliefs, and epilepsy knowledge. Correlations and t-tests examined interrelationships. RESULTS: Four barriers to medication self-management were common, including not taking antiseizure medications at the same time every day, forgetting doses, not planning refills before running out, and spreading out doses when running low. More than half the sample believed medications were overused by prescribers. Nearly one-third believed medications were harmful, and nearly a quarter believed their antiseizure medications were minimally necessary with almost half reporting elevated concerns about negative consequences of antiseizure medications. Poorer medication self-management was associated with stronger beliefs that medications in general are harmful/overused by prescribers. Individuals who were "accepting" of their antiseizure medications (i.e., high perceived necessity, low concerns) were less likely to spread out time between doses when running low compared to non-accepting counterparts. Knowledge gaps related to the cause of seizures/epilepsy, chronicity of epilepsy treatment, and seizure semiology/diagnosis were common. Nevertheless, epilepsy knowledge was unrelated to medication self-management and medication beliefs. CONCLUSIONS: In these PWE, the most prevalent reasons for suboptimal medication self-management were behaviorally mediated and potentially modifiable. Negative medication beliefs and misconceptions about epilepsy and its treatment were common. Results further suggest that interventions addressing negative medication beliefs will be more effective than knowledge-based psychoeducation alone to improve medication self-management in this patient population.

Prevalence of QT prolongation and its risk factors in patients with type 2 diabetes.

BACKGROUND: QT prolongation increases cardiovascular mortality in diabetes. The risk factors for QT prolongation vary across different studies. There is no data on the QT prolongation in patients with diabetes from the Arab region, where diabetes is highly prevalent. Here we aimed to assess the prevalence of QT prolongation and its associated risk factors in patients with type 2 diabetes from Saudi Arabia. METHOD: This was a retrospective, cross-sectional, hospital-based file review study. Data were collected from the medical records of patients with type 2 diabetes aged above 14 years and underwent ECG examination, and laboratory investigations were done within one month of ECG. RESULTS: The study included 782 patients with a prevalence of QTc prolongation of 13%. Patients with prolonged QTc interval were characterized by older age, higher BMI, longer diabetes duration, lower total cholesterol and LDL-C, and more diabetic nephropathy, hypertension, and CVD cases. They were also more in insulin treatment, antihypertensive medications, loop diuretics, and potassium-sparring diuretics. Logistic regression analysis revealed the odds of prolonged QTc interval increased significantly with CVD (OR = 1.761, 95% CI:1.021-3.036, p = 0.042), and usage of loop diuretics (OR = 2.245, 95% CI:1.023-4.923, p = 0.044) after adjusting for age, gender, and duration of diabetes. CONCLUSION: The risk factors associated with QTc prolongation in patients with type 2 diabetes are CVD, and loop diuretics. Age, BMI, and diabetes duration were more in people with QTc prolongation, whereas total cholesterol and LDL-C levels were lower. More patients had diabetic nephropathy, hypertension, and CVD with prolonged QTc.

Periodic Trends in the Infrared and Optical Absorption Spectra of Metal Chalcogenide Clusters.

We have investigated the optical absorption, infrared spectra, binding energies, and other cluster properties to investigate whether periodic trends can be observed in the electronic structure of transition metal chalcogenide clusters ligated with CO ligands. Our studies demonstrate the existence of several periodic trends in the properties of pure and mixed octahedral metal chalcogenide clusters, TM6Se8(CO)6 (TM = W-Pt). We find that octahedral metal chalcogenide clusters with 96, 100, and 114 valence electrons have larger excitation energies, consistent with these clusters having closed electronic shells. Periodic trends were observed in the infrared spectra, with the CO bond stretch having the highest energy at 100 and 114 valence electrons due to the closed electronic shell minimizing back-bonding with the CO molecule. A periodic trend in the antisymmetric TM-C stretch was also observed, with the vibrational energy increasing as the valence electron count increased. This is due to decrease in the TM-C bond length, resulting in a larger force constant. These results reveal that periodic trends seen earlier in simple or noble-metal clusters can be observed in symmetric transition metal chalcogenide clusters, showing that the superatom concept in metal chalcogenide clusters goes beyond electronic excitations, and can be seen in other observable properties.

Educational Psychology Is Evolving to Accommodate Technology, Multiple Disciplines, and Twenty-First-Century Skills.

This article covers recent research activities in educational psychology that have an interdisciplinary emphasis and that accommodate twenty-first-century skills in addition to the traditional foundations of literacy, numeracy, science, reasoning (problem-solving), and academic subject matter. We emphasize digital technologies because they are capable of tracking learning data in rich detail and reliably delivering interventions that are tailored to individual learners in particular sociocultural contexts. This is a departure from inflexible pedagogical approaches that previously have been routinely adopted in most classrooms and other contexts of instruction with no precise record of learning and instructional activities. A good design of educational technology embraces the principles of learning science, identifies the basic types of learning that are needed, implements relevant technological affordances, and accommodates feedback from different stakeholders. This article covers research in literacy, collaborative problem-solving, motivation, emotion, and science, technology, engineering, and mathematics (STEM) areas.

Coronavirus hemagglutinin-esterase and spike proteins coevolve for functional balance and optimal virion avidity.

Human coronaviruses OC43 and HKU1 are respiratory pathogens of zoonotic origin that have gained worldwide distribution. OC43 apparently emerged from a bovine coronavirus (BCoV) spillover. All three viruses attach to 9-O-acetylated sialoglycans via spike protein S with hemagglutinin-esterase (HE) acting as a receptor-destroying enzyme. In BCoV, an HE lectin domain promotes esterase activity toward clustered substrates. OC43 and HKU1, however, lost HE lectin function as an adaptation to humans. Replaying OC43 evolution, we knocked out BCoV HE lectin function and performed forced evolution-population dynamics analysis. Loss of HE receptor binding selected for second-site mutations in S, decreasing S binding affinity by orders of magnitude. Irreversible HE mutations led to cooperativity in virus swarms with low-affinity S minority variants sustaining propagation of high-affinity majority phenotypes. Salvageable HE mutations induced successive second-site substitutions in both S and HE. Apparently, S and HE are functionally interdependent and coevolve to optimize the balance between attachment and release. This mechanism of glycan-based receptor usage, entailing a concerted, fine-tuned activity of two envelope protein species, is unique among CoVs, but reminiscent of that of influenza A viruses. Apparently, general principles fundamental to virion-sialoglycan interactions prompted convergent evolution of two important groups of human and animal pathogens.