Exploring the Pathways of Diabetes Foot Complications Treatment and Investigating Experiences From Frontline Health Care Professionals: Protocol for a Mixed Methods Study.

BACKGROUND: Diabetes affects more than 4.3 million individuals in the United Kingdom, with 19% to 34% developing diabetes-related foot ulceration (DFU) during their lifespan, which can lead to an amputation. In the United Kingdom, every week, approximately 169 people have an amputation due to diabetes. Preventing first-ever ulcers is the most effective strategy to reduce the occurrence of diabetes-related amputations, but research in this space is lacking. OBJECTIVE: This protocol seeks to document the experiences and perspectives of frontline health care professionals who work with people who have diabetes and diabetes-related foot problems. Special attention is given to their perceptions of barriers to effective care, their views about barriers to effective and inclusive engagement with people with diabetes, and their experience with the first-ever DFU. Another aspect of the study is the focus on whether clinical management is affected by data sharing, data availability, and interoperability issues. METHODS: This is a mixed methods explanatory protocol, which is sequential, and its purpose is to use the qualitative data to explain the initial quantitative data collected through a survey of frontline health care professionals. Data analysis of quantitative data will be completed first and then synthesized with the qualitative data analysis. Qualitative data will be analyzed using the framework method. This study will use joint displays to integrate the data. Ethical approval has been granted by the ethics committee of Staffordshire University. RESULTS: The quantitative data collection started in March 2023 and will close in May 2024. The qualitative interviews commenced in November 2023 with volunteer participants who initially completed the survey. CONCLUSIONS: This study's survey focuses on data interoperability and the interviews focus more on the perspectives and experiences of clinicians and their perceived barriers for the effective management of diabetes foot ulcers. Including a geographically relevant and diverse cohort of health care professionals that spans a wide range of roles and care settings involved in diabetes-related foot care is very important for the successful application of this protocol. Special care is given to advertise and promote participation as widely as possible. The qualitative part of this protocol is also limited to 30-40 interview participants, as it is not realistic to interview higher numbers, due to time and resource constraints. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/54852.

CURE on yeast genes of unknown function increases students' bioinformatics proficiency and research confidence.

Course-based undergraduate research experiences (CUREs) can reduce barriers to research opportunities while increasing student knowledge and confidence. However, the number of widely adopted, easily transferable CUREs is relatively small. Here, we describe a CURE aimed at determining the function of poorly characterized Saccharomyces cerevisiae genes. More than 20 years after sequencing of the yeast genome, nearly 10% of open reading frames (ORFs) still have at least one uncharacterized Gene Ontology (GO) term. We refer to these genes as "ORFans" and formed a consortium aimed at assigning functions to them. Specifically, over 70 faculty members attended summer workshops to learn the bioinformatics workflow and basic laboratory techniques described herein. Ultimately, this CURE was adapted for implementation at 34 institutions, resulting in over 1,300 students conducting course-based research on ORFans. Pre-/post-tests confirmed that students gained both (i) an understanding of gene ontology and (ii) knowledge regarding the use of bioinformatics to assign gene function. After using these data to craft their own hypotheses, then testing their predictions by constructing and phenotyping deletion strains, students self-reported significant gains in several areas, including computer modeling and exposure to a project where no one knows the outcome. Interestingly, most net gains self-reported by ORFan Gene Project participants were greater than published findings for CUREs assessed with the same survey instrument. The surprisingly strong impact of this CURE may be due to the incoming lack of experience of ORFan Project participants and/or the independent thought required to develop testable hypotheses from complex data sets.

Cortical parenchyma wall width regulates root metabolic cost and maize performance under suboptimal water availability.

We describe how increased root cortical parenchyma wall width (CPW) can improve tolerance to drought stress in maize by reducing the metabolic costs of soil exploration. Significant variation (1.0 to 5.0 µm) for CPW was observed in maize germplasm. The functional-structural model RootSlice predicts that increasing CPW from 2 to 4 µm is associated with ca. 15% reduction in root cortical cytoplasmic volume, respiration rate, and nitrogen content. Analysis of genotypes with contrasting CPW grown with and without water stress in the field confirms that increased CPW is correlated with ca. 32 to 42% decrease in root respiration. Under water stress in the field, increased CPW is correlated with 125% increased stomatal conductance, 325% increased leaf CO2 assimilation rate, 73 to 78% increased shoot biomass, and 92 to 108% increased yield. CPW was correlated with leaf mesophyll midrib parenchyma wall width, indicating pleiotropy. GWAS analysis identified candidate genes underlying CPW. OpenSimRoot modeling predicts that a reduction in root respiration due to increased CPW would also benefit maize growth under suboptimal nitrogen, which requires empirical testing. We propose CPW as a new phene that has utility under edaphic stress meriting further investigation.

Developmental differences in children and adults' enforcement of explore versus exploit search strategies in the United States and Turkey.

Across development, as children acquire a deeper understanding of their environment, they explore less and take advantage, or "exploit," what they already know. Here, we test whether children also enforce exploration-oriented search behaviors onto others. Specifically, we ask whether children are more likely to encourage a search agent to explore versus exploit their environment, and whether this pattern varies across childhood (between 3 and 6 years). We also ask whether this pattern differs between children and adults, and generalizes across two different sociocultural contexts-Turkey and the United States-that differ on dimensions that might relate to children's decisions about exploration (e.g., curiosity-focused educational practices, attitudes toward uncertainty avoidance). Participants (N = 358) watched an agent search for rewards and were asked at various points whether the agent should "stay" (exploit) in their current location, or "go" (explore) to a new location. At all points in the experiment, children enforced exploration significantly more often than adults. Early in the agent's search, children in the US enforced exploration more often than children in Turkey; later in the search, younger children (from both sociocultural contexts) were more likely to continue enforcing exploration compared to older children. These findings highlight that children are not only highly exploratory themselves, but also enforce exploration onto others-underscoring the central role that exploration plays in driving early cognitive development across diverse sociocultural contexts. RESEARCH HIGHLIGHTS: The current study examined developmental and cross-cultural differences in children and adults' enforcement of explore-exploit search strategies. Children in the US and Turkey enforced exploration more than adults, who enforced exploitation more often; results were generally consistent across cultures with small differences. Mirroring developmental changes in children's own search behavior; the tendency to enforce exploration decreased between 3- to 6-years of age. Findings underscore the central role of an "exploration mindset" in children's early decision-making-even when exploration has no direct benefits to the child themselves.

Bayesian Reinforcement Learning With Limited Cognitive Load.

All biological and artificial agents must act given limits on their ability to acquire and process information. As such, a general theory of adaptive behavior should be able to account for the complex interactions between an agent's learning history, decisions, and capacity constraints. Recent work in computer science has begun to clarify the principles that shape these dynamics by bridging ideas from reinforcement learning, Bayesian decision-making, and rate-distortion theory. This body of work provides an account of capacity-limited Bayesian reinforcement learning, a unifying normative framework for modeling the effect of processing constraints on learning and action selection. Here, we provide an accessible review of recent algorithms and theoretical results in this setting, paying special attention to how these ideas can be applied to studying questions in the cognitive and behavioral sciences.

Clinical application of indocyanine green fluorescence navigation technique in laparoscopic common bile duct exploration for complex hepatolithiasis.

BACKGROUND: This study investigated the clinical application of the indocyanine green (ICG) fluorescence navigation technique in bile duct identification during laparoscopic common bile duct exploration (LCBDE) for complex hepatolithiasis. METHODS: Eighty patients with complex hepatolithiasis were admitted to our department between January 2022 and June 2023 and randomly divided into control and observation groups. The control group underwent conventional LCBDE, while the observation group underwent LCBDE guided by ICG fluorescence. RESULTS: Intraoperatively, the observation group had shorter operation and search times for the common bile duct (CBD), as well as reduced intraoperative blood loss and fewer complications, such as conversion to laparotomy and various injuries (gastroduodenal, colon, pancreatic, and vascular) than the control group, with statistical significance (P < 0.05). Postoperatively, the observation group had lower rates of postoperative bile leakage, abdominal infection, postoperative hemorrhage, and residual stone than the control group. Additionally, the observation group demonstrated significantly shorter times for resuming flatus, removal of the abdominal drainage tube, and hospitalization than the control group, with statistical significance (P < 0.05). CONCLUSION: ICG fluorescence navigation technology effectively visualizes the bile duct, improves its identification rate, shortens the operation time, prevents biliary tract injury, and reduces the occurrence of complications.

Interactive network visualization of opioid crisis research: a tool for reinforcing data linkage skills for public health policy researchers.

Background: Public health policy researchers face a persistent challenge in identifying and integrating relevant data, particularly in the context of the U.S. opioid crisis, where a comprehensive approach is crucial. Purpose: To meet this new workforce demand health policy and health economics programs are increasingly introducing data analysis and data visualization skills. Such skills facilitate data integration and discovery by linking multiple resources. Common linking strategies include individual or aggregate level linking (e.g., patient identifiers) in primary clinical data and conceptual linking (e.g., healthcare workforce, state funding, burnout rates) in secondary data. Often, the combination of primary and secondary datasets is sought, requiring additional skills, for example, understanding metadata and constructing interlinkages. Methods: To help improve those skills, we developed a 2-step process using a scoping method to discover data and network visualization to interlink metadata. Results: We show how these new skills enable the discovery of relationships among data sources pertinent to public policy research related to the opioid overdose crisis and facilitate inquiry across heterogeneous data resources. In addition, our interactive network visualization introduces (1) a conceptual approach, drawing from recent systematic review studies and linked by the publications, and (2) an aggregate approach, constructed using publicly available datasets and linked through crosswalks. Conclusions: These novel metadata visualization techniques can be used as a teaching tool or a discovery method and can also be extended to other public policy domains.

Shimmering emerging adulthood: in search of the invariant IDEA model for collectivistic countries.

Emerging adulthood is the youth trajectory characterized by self-focus, identity exploration, feeling between adolescence and adulthood, instability, and experimentation. This trajectory was first identified in industrialized individualistic countries with gender equality and technological progress. To measure transition to adulthood, the Inventory of the Dimensions of Emerging Adulthood (IDEA) was created. Although emerging adulthood is considered universal, adaptations of the questionnaire across the 12 countries show different patterns, and its cross-cultural invariance has been underinvestigated. This study tests IDEA in three collectivistic countries - Armenia, China, and Russia. The sample consisted of 868 students (total male - 152, total female - 716) aged 18 to 29 years old. We tested the questionnaire separately in the three countries to check that this model fits, but we failed to prove it. After that we used a factor-analytic approach to find a common version for the three countries. We got a five-factor correlated model in accordance with the theory, but it was reduced from 31 items to 21, and three items moved to other factors. Finally, we provided measurement invariance and reached configural level. To test the narrower facets of factors we used multi-group alignment and found that variances in six parameters differ, mainly in Instability. Despite the difference in the questionnaire items, we proposed a common model for three countries that we called questionnaire IDEA-collectivistic countries (IDEA-CC).

AOP report: Development of an adverse outcome pathway for deposition of energy leading to cataracts.

Cataracts are one of the leading causes of blindness, with an estimated 95 million people affected worldwide. A hallmark of cataract development is lens opacification, typically associated not only with aging but also radiation exposure as encountered by interventional radiologists and astronauts during the long-term space mission. To better understand radiation-induced cataracts, the adverse outcome pathway (AOP) framework was used to structure and evaluate knowledge across biological levels of organization (e.g., macromolecular, cell, tissue, organ, organism and population). AOPs identify a sequence of key events (KEs) causally connected by key event relationships (KERs) beginning with a molecular initiating event to an adverse outcome (AO) of relevance to regulatory decision-making. To construct the cataract AO and retrieve evidence to support it, a scoping review methodology was used to filter, screen, and review studies based on the modified Bradford Hill criteria. Eight KEs were identified that were moderately supported by empirical evidence (e.g., dose-, time-, incidence-concordance) across the adjacent (directly linked) relationships using well-established endpoints. Over half of the evidence to justify the KER linkages was derived from the evidence stream of biological plausibility. Early KEs of oxidative stress and protein modifications had strong linkages to downstream KEs and could be the focus of countermeasure development. Several identified knowledge gaps and inconsistencies related to the quantitative understanding of KERs which could be the basis of future research, most notably directed to experiments in the range of low or moderate doses and dose-rates, relevant to radiation workers and other occupational exposures.

Possible Effects of Volcanic Eruptions on the Modern Atmosphere of Venus.

This work reviews possible signatures and potential detectability of present-day volcanically emitted material in the atmosphere of Venus. We first discuss the expected composition of volcanic gases at present time, addressing how this is related to mantle composition and atmospheric pressure. Sulfur dioxide, often used as a marker of volcanic activity in Earth's atmosphere, has been observed since late 1970s to exhibit variability at the Venus' cloud tops at time scales from hours to decades; however, this variability may be associated with solely atmospheric processes. Water vapor is identified as a particularly valuable tracer for volcanic plumes because it can be mapped from orbit at three different tropospheric altitude ranges, and because of its apparent low background variability. We note that volcanic gas plumes could be either enhanced or depleted in water vapor compared to the background atmosphere, depending on magmatic volatile composition. Non-gaseous components of volcanic plumes, such as ash grains and/or cloud aerosol particles, are another investigation target of orbital and in situ measurements. We discuss expectations of in situ and remote measurements of volcanic plumes in the atmosphere with particular focus on the upcoming DAVINCI, EnVision and VERITAS missions, as well as possible future missions.

Simulation and analysis of chest loads on crews during Lunar-Earth re-entry returns.

The safety of crews is the primary concern in the manned lunar landing project, particularly during re-entry as the manned spacecraft returns from a direct Lunar-Earth trajectory. This paper analyzed the crew's chest biomechanical response to assess potential injuries caused by acceleration loads during the re-entry phase. Initially, a sophisticated finite element model of the chest was constructed, whose effectiveness was verified by experiments involving vertebral range of motion, rib lateral rupture, and chest frontal impact. The model was then subjected to the return re-entry loads simulating the Apollo and Chang'e 5 T1 (CE-5T1) test returner to specifically analyze the correlation between the acceleration load and the injury of the crew's chest tissues and organs. The results indicate that the biomechanical response of crew chest bone tissue under the two return missions is within the threshold value and will not directly cause damage. Compared to the Apollo mission, the CE-5T1 mission's load poses a higher risk to internal organs. These findings can enhance the crew's safety and provide reliable assurance for future space exploration.

Fournier's gangrene in a female: A case report.

Fournier's gangrene is characterized by an acute necrotic infection. The infection can occur in all parts of the body including the scrotum, penis, or perineum, and is a rare condition that is primarily reported in men and seldom in women. Existing literature suggests that it might be underreported, possibly leading to overlooked cases. Risk factors include diabetes, chronic illness, and trauma. This case involves a 52-year-old female with a 10-year medical history of diabetes mellitus, multiple healed skin lesions all over the body, and dermatitis. The presentation was a perianal swelling, which progressed into an extensive necrotizing soft tissue infection of the perineum, making a diagnosis of Fournier's gangrene. She underwent wide local debridement and was managed with antibiotics in a timely manner. The patient's clinical course and subsequent follow-up were uneventful. Uncontrolled diabetes and dermatitis significantly increase the risk of Fournier's gangrene; therefore, it should be suspected in women with such comorbid conditions. This case highlights the need for increased awareness and vigilance regarding this condition among women.

Space wandering in the rodent default mode network.

The default mode network (DMN) is a large-scale brain network known to be suppressed during a wide range of cognitive tasks. However, our comprehension of its role in naturalistic and unconstrained behaviors has remained elusive because most research on the DMN has been conducted within the restrictive confines of MRI scanners. Here, we use multisite GCaMP (a genetically encoded calcium indicator) fiber photometry with simultaneous videography to probe DMN function in awake, freely exploring rats. We examined neural dynamics in three core DMN nodes-the retrosplenial cortex, cingulate cortex, and prelimbic cortex-as well as the anterior insula node of the salience network, and their association with the rats' spatial exploration behaviors. We found that DMN nodes displayed a hierarchical functional organization during spatial exploration, characterized by stronger coupling with each other than with the anterior insula. Crucially, these DMN nodes encoded the kinematics of spatial exploration, including linear and angular velocity. Additionally, we identified latent brain states that encoded distinct patterns of time-varying exploration behaviors and found that higher linear velocity was associated with enhanced DMN activity, heightened synchronization among DMN nodes, and increased anticorrelation between the DMN and anterior insula. Our findings highlight the involvement of the DMN in collectively and dynamically encoding spatial exploration in a real-world setting. Our findings challenge the notion that the DMN is primarily a "task-negative" network disengaged from the external world. By illuminating the DMN's role in naturalistic behaviors, our study underscores the importance of investigating brain network function in ecologically valid contexts.

How to solve novel problems: the role of associative learning in problem-solving performance in wild great tits Parus major.

Although problem-solving tasks are frequently used to assess innovative ability, the extent to which problem-solving performance reflects variation in cognitive skills has been rarely formally investigated. Using wild breeding great tits facing a new non-food motivated problem-solving task, we investigated the role of associative learning in finding the solution, compared to multiple other non-cognitive factors. We first examined the role of accuracy (the proportion of contacts made with the opening part of a string-pulling task), neophobia, exploration, activity, age, sex, body condition and participation time on the ability to solve the task. To highlight the effect of associative learning, we then compared accuracy between solvers and non-solvers, before and after the first cue to the solution (i.e., the first time they pulled the string opening the door). We finally compared accuracy over consecutive entrances for solvers. Using 884 observations from 788 great tits tested from 2010 to 2015, we showed that, prior to initial successful entrance, solvers were more accurate and more explorative than non-solvers, and that females were more likely to solve the task than males. The accuracy of solvers, but not of non-solvers, increased significantly after they had the opportunity to associate string pulling with the movement of the door, giving them a first cue to the task solution. The accuracy of solvers also increased over successive entrances. Our results demonstrate that variations in problem-solving performance primarily reflect inherent individual differences in associative learning, and are also to a lesser extent shaped by sex and exploratory behaviour.

Flare: An FPGA-Based Full Precision Low Power CNN Accelerator with Reconfigurable Structure.

Convolutional neural networks (CNNs) have significantly advanced various fields; however, their computational demands and power consumption have escalated, posing challenges for deployment in low-power scenarios. To address this issue and facilitate the application of CNNs in power constrained environments, the development of dedicated CNN accelerators is crucial. Prior research has predominantly concentrated on developing low precision CNN accelerators using code generated from high-level synthesis (HLS) tools. Unfortunately, these approaches often fail to efficiently utilize the computational resources of field-programmable gate arrays (FPGAs) and do not extend well to full precision scenarios. To overcome these limitations, we integrate vector dot products to unify the convolution and fully connected layers. By treating the row vector of input feature maps as the fundamental processing unit, we balance processing latency and resource consumption while eliminating data rearrangement time. Furthermore, an accurate design space exploration (DSE) model is established to identify the optimal design points for each CNN layer, and dynamic partial reconfiguration is employed to maximize each layer's access to computational resources. Our approach is validated through the implementation of AlexNet and VGG16 on 7A100T and ZU15EG platforms, respectively. We achieve an average convolutional layer throughput of 28.985 GOP/s and 246.711 GOP/s for full precision. Notably, the proposed accelerator demonstrates remarkable power efficiency, with a maximum improvement of 23.989 and 15.376 times compared to current state-of-the-art FPGA implementations.

Ingested Australasian Snapper (Chrysophrys auratus) Bone Migration to C5 Vertebral Body.

Fishbone ingestion has been reported multiple times previously as a cause of oesophageal perforation. This is a surgical emergency that needs to be identified early to ensure immediate medical attention. This report presents the case of a 70-year-old patient with laryngeal perforation and the migration of a Chrysophrys auratus (Australasian snapper) fishbone to the C5 vertebral body. It is hypothesized that the fishbone migrated from the larynx to the visceral fascia and prevertebral fascia before lodging in between the intramuscular substance of the longus coli muscle. Multiple imaging modalities were used to identify and locate the foreign body, including flexible nasopharyngoscopy, esophagogastroduodenoscopy, and a computed tomography (CT) scan of the neck. The exploration of the neck was done by the ENT team and the orthopaedic spine team via the left anterior cervical approach at the level of the C5 and C6 vertebral bodies. The foreign body was identified (15 mm fishbone) at the left lateral of the C5 body, lodged between the intramuscular substance of the longus coli muscle, and was successfully removed.

Gastric mucocele after conversion of open butterfly gastroplasty to Roux-En-Y gastric bypass - A case report with a review of the literature.

INTRODUCTION: There has been a significant increase in the prevalence of morbid obesity across the globe. Various non-surgical weight loss options have shown limited long-term efficacy, leading to the popularity of surgical treatment alternatives with long-term efficacy. PRESENTATION OF CASE: This case report describes the development of a gastric mucocele in a 51-year-old female patient. The patient initially underwent open butterfly gastroplasty in August 2016. Seven years later, she presented with severe symptoms of gastroesophageal reflux disease (GERD). After further diagnostic evaluations, laparoscopic Roux-en-Y bypass surgery was performed. However, the patient experienced complications including fever, abdominal pain, and fluid collection around the stomach. Conservative management initially helped, but persistent symptoms led to laparoscopic exploration, which revealed a distended remnant stomach forming a gastric mucocele. Severe adhesions hindered attempts to remove the remnant stomach, resulting in the need for gastro-gastric anastomosis. Following the surgery, the patient had no symptoms, could eat solid food, and was discharged in good condition. DISCUSSION: Although various non-surgical weight loss options such as diet modifications, lifestyle changes, and drug therapy have been used for weight loss, they have demonstrated limited long-term efficacy. Surgical treatment has demonstrated long-term efficacy in such patient groups. In recent years, there has been an increased popularity of Roux-en-Y gastric bypass (RYGBP) due to long-term weight loss. However, in some cases, complications have also been reported. CONCLUSION: This case emphasizes the challenges in managing complications from open butterfly gastroplasty and Roux-en-Y gastric bypass. Surgeons should be aware of the possibility of gastric mucocele development and consider appropriate management strategies.

A Biohybrid Self-Dispersing Miniature Machine Using Wild Oat Fruit Awns for Reforestation and Precision Agriculture.

Advances in bioinspired and biohybrid robotics are enabling the creation of multifunctional systems able to explore complex unstructured environments. Inspired by Avena fruits, a biohybrid miniaturized autonomous machine (HybriBot) composed of a biomimetic biodegradable capsule as cargo delivery system and natural humidity-driven sister awns as biological motors is reported. Microcomputed tomography, molding via two-photon polymerization and casting of natural awns into biodegradable materials is employed to fabricate multiple HybriBots capable of exploring various soil and navigating soil irregularities, such as holes and cracks. These machines replicate the dispersal movements and biomechanical performances of natural fruits, achieving comparable capsule drag forces up to ≈0.38 N and awns torque up to ≈100 mN mm-1. They are functionalized with fertilizer and are successfully utilized to germinate selected diaspores. HybriBots function as self-dispersed systems with applications in reforestation and precision agriculture.

An investigation into accidents in laboratories in universities in China caused by human error: A study based on improved CREAM and SPAR-H.

Although considerable research has been devoted to improving safety in university laboratories, accidents, in that environment, have still occurred frequently at the cost of serious injury or even death of laboratory personnel. Currently, few Human Reliability Analyses (HRA) have been conducted with respect to a university laboratory. The aim of the research was to conduct a reliability study relating to human behaviour in a university laboratory to explore quantitatively the causes and influencing factors relating to the frequency of laboratory accidents. Improved Cognitive Reliability and Error Analysis Method (CREAM) and improved Standardized Plant Analysis Risk HRA (SPAR-H) were employed to assess Human Error Probability (HEP) of 23 subjects. The HEP calculated through improved CREAM proved more accurate than results obtained through improved SPAR-H. Unexpectedly, the results demonstrated that under similar environmental conditions, the HEP of subjects did not decrease with an increase in educational background, including additional experimental time and experience. Moreover, environmental conditions exerted greater impact on personnel reliability than Human Inherent Factors (HIFs) in laboratories. It is anticipated that the study would provide valuable insights, in respect of research methods, and to serve as a practical basis for lowering the accident rate in university laboratories.