BACKGROUND: The global epidemic of diabetes mellitus continues to grow and affects developed and developing countries alike. Intensive glycemic control is thought to modify the risks for vascular complications, hence the risks for diabetes-related death. We investigated the trend of diabetic vascular complication-related deaths between 2000 and 2016 in the global diabetes landscape. METHODS: We collected 17 years of death certificates data from 108 countries in the World Health Organization mortality database between 2000 and 2016, with coding for diabetic complications. Crude and age-standardized proportions and rates were calculated. Trend analysis was done with annual average percentage change (AAPC) of rates computed by joinpoint regression. RESULTS: From 2000 through 2016, 7,108,145 deaths of diabetes were reported in the 108 countries. Among them, 26.8% (1,904,787 cases) were attributed to vascular complications in damaged organs, including the kidneys (1,355,085 cases, 71.1%), peripheral circulatory (515,293 cases, 27.1%), nerves (28,697 cases, 1.5%) and eyes (5751 cases, 0.3%). Overall, the age-standardized proportion of vascular complication-related mortality was 267.8 [95% confidence interval (95% CI), 267.5C268.1] cases per 1000 deaths and the rate was 53.6 (95% CI 53.5C53.7) cases per 100,000 person-years. Throughout the 17-year period, the overall age-standardized proportions of deaths attributable to vascular complications had increased 37.9%, while the overall age-standardized mortality rates related to vascular complications had increased 30.8% (AAPC = 1.9% [1.4C2.4%, p < 0.05]). These increases were predominantly driven by a 159.8% increase in the rate (AAPC = 2.7% [1.2C4.3%, p < 0.05]) from renal complications. Trends in the rates and AAPC of deaths varied by type of diabetes and of complications, as well as by countries, regions and domestic income. CONCLUSION: Diabetic vascular complication-related deaths had increased substantially during 2000C2016, mainly driven by the increased mortality of renal complications.

Cell-free systems are a rapidly expanding platform technology with an important role in the engineering of biological systems. The key advantages that drive their broad adoption are increased efficiency, versatility, and low cost compared to in vivo systems. Traditionally, in vivo platforms have been used to synthesize novel and industrially relevant proteins and serve as a testbed for prototyping numerous biotechnologies such as genetic circuits and biosensors. Although in vivo platforms currently have many applications within biotechnology, they are hindered by time-constraining growth cycles, homeostatic considerations, and limited adaptability in production. Conversely, cell-free platforms are not hindered by constraints for supporting life and are therefore highly adaptable to a broad range of production and testing schemes. The advantages of cell-free platforms are being leveraged more commonly by the biotechnology community, and cell-free applications are expected to grow exponentially in the next decade. In this study, new and emerging applications of cell-free platforms, with a specific focus on cell-free protein synthesis (CFPS), will be examined. The current and near-future role of CFPS within metabolic engineering, prototyping, and biomanufacturing will be investigated as well as how the integration of machine learning is beneficial to these applications.

Background and Objectives: Echinacea angustifolia and purpurea have known immunomodulatory effects which boost viral clearance, including HPV infection. However, evidence regarding the improvement due to Echinacea-based supplements of cervical HPV-related pathologies is still lacking. The aim of this study is to evaluate the efficacy of Echinacea supplementation on the remission of cervical low-grade squamous intraepithelial lesions (L-SIL). Materials and Methods: A single-blind 1:1:1 parallel randomized controlled trial was conducted at the Colposcopy Unit of a tertiary care referral center. Reproductive-aged women were allocated either to (a) an oral supplement based on Echinacea extracts plus vaginal hyaluronic acid-based soft gel capsules, (b) the Echinacea supplement alone, or (c) vaginal hyaluronic acid-based soft gel capsules alone for 3 months. The primary outcome was the regression of cervical intraepithelial neoplasia (CIN)-1 for each treatment arm at 3, 6 and 12 months after the diagnosis. Secondary outcomes included changes in the epithelialization, pap smear, colposcopic parameters, histological reports, and vaginal health indexes (VHI) in the study groups. Results: 153 women (52 for arm A, 50 for arm B and 51 for arm C) completed the follow-up and were included in the analysis. There were no significant differences in both primary and secondary outcomes for the three groups after 3 months. At the 6-month follow-up, the number of persistent CIN-1 diagnoses was significantly lower in arm A (15/51), rather than in arm B (23/48, p = 0.03) and C (27/49, p = 0.03). Similarly, the same effect was seen after 12 months for treatment A (5/51) relative to B (15/48, p = 0.03) and C (14/48, p = 0.03). Colposcopic, histological and vaginal parameters were all significantly improved at 6 and 12 months for arm A relative to B and C, while no beneficial effects were seen after 3 months. Conclusions: Echinacea extracts supplementation in women with L-SIL/CIN-1 significantly boosts HPV lesion clearance, reducing the overall amount of diagnosis, histological, colposcopic and vaginal parameters after 6 and 12 months. However, a limited sample size reduces the quality of evaluated evidence, emphasizing the need for additional studies to validate these findings.

The global effort against the COVID-19 pandemic dictates that routine quantitative detection of SARS-CoV-2 neutralizing antibodies is vital for assessing immunity following periodic revaccination against new viral variants. Here, we report a dual-detection fluorescent immunochromatographic assay (DFIA), with a built-in self-calibration process, that enables rapid quantitative detection of neutralizing antibodies that block binding between the receptor-binding domain (RBD) of the SARS-CoV-2 spike protein and the angiotensin-converting enzyme 2 (ACE2). Thus, this assay is based on the inhibition of binding between ACE2 and the RBD of the SARS-CoV-2 spike protein by neutralizing antibodies, and the affinity of anti-human immunoglobulins for these neutralizing antibodies. Our self-calibrating DFIA shows improved precision and sensitivity with a wider dynamic linear range, due to the incorporation of a ratiometric algorithm of two-reverse linkage signals responding to an analyte. This was evident by the fact that no positive results (0/14) were observed in verified negative samples, while 22 positives were detected in 23 samples from verified convalescent plasma. A comparative analysis of the ability to detect neutralizing antibodies in 266 clinical serum samples including those from vaccine recipients, indicated that the overall percent agreement between DFIA and the commercial ELISA kit was 90.98%. Thus, the proposed DFIA provides a more reliable and accurate rapid test for detecting SARS-CoV-2 infections and vaccinations in the community. Therefore, the DFIA based strategy for detecting biomarkers, which uses a ratiometric algorithm based on affinity and inhibition reactions, may be applied to improve the performance of immunochromatographic assays.

Public library makerspaces intend to contribute to the development of children from marginalized communities through the education of digital technology and creativity and by stimulating young people to experience new social roles and develop their identity. Learning in these informal settings puts demands on the organization of the makerspace, the activities, and the support of the children. The present study investigates how children evaluate their activities and experiences in a public library makerspace both in the after-school programs and during school visits. Furthermore, it examines the effectiveness of the training program for the makerspace coaches. The study covers self-evaluations by children (n = 307), and interviews with children (n = 27) and makerspace coaches (n = 11). Children report a lot of experiences concerning creating (maker skills, creativity) and maker mindset (motivation, persistence, confidence). Experiences with collaboration (helping each other) were mentioned to a lesser extent. Critical features of the training program for makerspace coaches were (i) adaptation to the prior knowledge, skills and needs of makerspace coaches, (ii) input of expert maker educators, (iii) emphasis on learning by doing, (iv) room for self-employed learning, and (v) collaboration with colleagues. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s41979-022-00070-w.

The effects of climate change and global warming are arising a new awareness on the impact of our daily life. Power generation for transportation and mobility as well as in industry is the main responsible for the greenhouse gas emissions. Indeed, currently, 80% of the energy is still produced by combustion of fossil fuels;thus, great efforts need to be spent to make combustion greener and safer than in the past. For this reason, a review of the most recent gas turbines combustion strategy with a focus on fuels, combustion techniques, and burners is presented here. A new generation of fuels for gas turbines are currently under investigation by the academic community, with a specific concern about production and storage. Among them, biofuels represent a trustworthy and valuable solution in the next decades during the transition to zero carbon fuels (e.g., hydrogen and ammonia). Promising combustion techniques explored in the past, and then abandoned due to their technological complexity, are now receiving renewed attention (e.g., MILD, PVC), thanks to their effectiveness in improving the efficiency and reducing emissions of standard gas turbine cycles. Finally, many advances are illustrated in terms of new burners, developed for both aviation and power generation. This overview points out promising solutions for the next generation combustion and opens the way to a fast transition toward zero emissions power generation.

BACKGROUND: As clinical trial protocol designs become more complex and eligible patient populations narrow, it is becoming increasingly difficult to recruit participants and retain them for the duration of the trial. This study surveyed clinical trial participants to learn about the prevalence and impact of new technologies and other supportive solutions designed to improve patient engagement and retention. Patient perceptions of these convenience-enhancing solutions and how they have changed since our last study in 2017 were examined. METHODS: Based on 12,451 responses to a global online survey collected in 2019, we conducted an analysis of respondents who used convenience-enhancing solutions during their participation in a clinical trial. RESULTS: We found that the prevalence of convenience-enhancing solutions is increasing and that their use correlates with high ratings for clinical trial satisfaction, as well as with high ratings for care and attention received during the trial. CONCLUSIONS: A wide range of strategies and tactics are needed to reduce barriers to participation and improve retention. The use of convenience-enhancing solutions can help reduce these barriers. The solutions are also particularly popular among under-represented populations, revealing further potential opportunities to increase patient engagement specifically among these groups.

INTRODUCTION: To explore patient and clinician perspectives on acute ophthalmology presentations during the COVID pandemic. To ascertain whether the pandemic had differentially impacted access to care based on patient demographics and postcodes. METHODS: A single-centre, cross-sectional prospective study in a busy metropolitan eye casualty between AprilCJune 2020 recording patient demographics, distance travelled to access healthcare, diagnosis and outcome compared to the equivalent period in 2019. A further two-part survey was conducted to explore patient and clinician's perceptions around delays in attendances, views on remote consultation and severity of the condition. RESULTS: There was a 68% decrease in April 2020 compared to previous year's ED attendance. The diagnosis tended towards more visually significant pathology. From 2019 to 2020, there was a significant decrease in average distance travelled to the eye emergency department (eye ED). working-age adults (18-59) and white patients travelling from very far pre-pandemic contributed most to this change. 513 Patient responses (12%) out of 4433 attendances during the study period were received, 89% (456/513) of the completed surveys also had matching clinician surveys. 29% (149/513) patients felt COVID-19 stopped them from attending earlier. Clinicians thought a video consultation would have been suitable for 40% (182/456) of patients compared to only 13% (58/456) of patients preferring a video consultation. DISCUSSION: Although our findings were limited by low response rates, COVID-19 may have caused a delay in presentation for emergency eye care. Demographic changes and attitudes towards video consultations have implications for planning of emergency eye care in future pandemics.

Empirical evidence on COVID-19-related psychological distress, moral injury, and sleep disturbances among primary care providers has been scarcely documented in the literature. Using and replicating data from Bain & Company, BMA, Gorini et al. (2020), Sperling (2020), The University of Melbourne, ICF, ICFJ, SEIU, and TCDJ/Columbia University, we performed analyses and made estimates regarding psychological wellness among healthcare workers treating COVID-19 patients. Descriptive statistics of compiled data from the completed surveys were calculated when appropriate.

PURPOSE This Commentary illustrates how innovative clinical and research initiatives highlight the ingenuity and creativity of nursing and midwifery professions thus leveraging the momentum of 2020 which commenced with the Year of the Nurse and Midwife and the Nursing Now Challenge. BACKGROUND Speakers demonstrated through vision, creativity and policy generation how the world is now in a different place due to Covid-19 and how the global crisis will change and shape the future of healthcare delivery. EVALUATION Speakers were invited because of their reputation as international leaders in global health and population. Participants evaluated content and its relevance to research, education and practice in group discussions. KEY ISSUES The current global crisis determines that the capabilities and capacity of nurses and midwives will become more crucial than ever to the delivery of universal health coverage (UHC) and population health by 2030. CONCLUSIONS Global leaders and policy makers must seek the knowledge and skills they need to support their work during a global crisis. IMPLICATIONS FOR NURSING MANAGEMENT Achieving population health and equitable access to health care is dependent on an adequate health workforce.

Mental and substance use disorders have been identified as the leading cause of global disability, and the global burden of mental illness is concentrated among those experiencing disability due to serious mental illness (SMI). Music has been studied as a support for SMIs for decades, with promising results; however, a lack of synthesized evidence has precluded increased uptake of and access to music-based approaches. The purpose of this scoping review was to identify the types and quantity of research at intersections of music and SMIs, document evidentiary gaps and opportunities, and generate recommendations for improving research and practice. Studies were included if they reported on music's utilization in treating or mitigating symptoms related to five SMIs: schizophrenia, bipolar disorder, generalized anxiety disorder, major depressive disorder, or post-traumatic stress disorder. Eight databases were searched; screening resulted in 349 included studies for data extraction. Schizophrenia was the most studied SMI, with bipolar disorder studied the least. Demographics, settings, and activity details were found to be inconsistently and insufficiently reported; however, listening to recorded music emerged as the most common musical activity, and activity details appeared to have been affected by the conditions under study. RCTs were the predominant study design, and 271 unique measures were utilized across 289 primary studies. Over two-thirds of primary studies (68.5%) reported positive results, with 2.8% reporting worse results than the comparator, and 12% producing indeterminate results. A key finding is that evidence synthesis is precluded by insufficient reporting, widely varied outcomes and measures, and intervention complexity; as a result, widespread changes are necessary to reduce heterogeneity (as feasible), increase replicability and transferability, and improve understandings of mechanisms and causal pathways. To that end, five detailed recommendations are offered to support the sharing and development of information across disciplines.

Objective: Extensive combination pharmacotherapy regimens for bipolar disorder have gained increasing use in routine practice in ways that outpace data from evidence-based clinical trials. The present review examined the prevalence of complex pharmacotherapy regimens in bipolar disorder patients and sought to characterize factors that most influence polypharmacy prescribing patterns. Data Sources: The authors independently systematically searched the MEDLINE, PsycINFO, and Embase databases for English-language observational/naturalistic or randomized controlled polypharmacy trials, using the keywords bipolar and polypharmacy or bipolar and combination treatment and pharmacotherapy. Study Selection: From among 3,566 publications, 49 ultimately met study inclusion criteria. Data Extraction: Information was obtained regarding prevalence rates of extensive polypharmacy as well as clinical characteristics and naturalistic outcomes for patients with simple ( 2) or complex ( 3) regimens of psychotropic agents. Results: A weighted mean percentage of 32.7% of bipolar outpatients (4,535/13,863) taking 3 psychotropic medications was identified. Factors associated with complex polypharmacy use include female sex, White race, age > 50 years, history of psychosis, greater burden of depressive illness, subtherapeutic dosing, lower treatment adherence, more extensive psychiatric comorbidity, and a greater history of suicide attempts. Conclusions: Extensive or complex combination pharmacotherapy regimens are common in many patients with bipolar disorder and often reflect greater overall illness severity. Naturalistic studies do not point to better outcomes for patients receiving more complex drug regimens, suggesting likely confounding by indication, high severity, or comorbid conditions. Formal clinical trials are needed to identify optimal drug combinations and durations when using 3 psychotropic medications to treat patients with bipolar disorder.

Levels of type 2 cytokines are elevated in the blood and intestinal tissues of ulcerative colitis (UC) patients in the active phase; this phenomenon indicates the participation of type 2 immune response in UC progression. The beneficial effects of melatonin in dextran sodium sulfate (DSS) and 2,4,6-trinitrobenzene sulfonic acid (TNBS) colitis models have been illustrated, but its role in the oxazolone (Oxa)-induced colitis model (driven by type 2 immune response) remains relatively unknown. We investigated the relationship between melatonin concentration and the severity of UC, revealing a significantly negative correlation. Subsequently, we investigated the effects of melatonin in Oxa-induced colitis mice and the potential underlying mechanisms. Administration of melatonin significantly counteracted body weight loss, colon shortening, and neutrophil infiltration in Oxa-induced colitis mice. Melatonin treatment mitigated Oxa-induced colitis by suppressing type 2 immune response. In addition, melatonin attenuated intestinal permeability by enhancing the expression of ZO-1 and occludin in colitis mice. Interestingly, the protective effect of melatonin was abolished when the mice were co-housed, indicating that the regulation of gut microbiota by melatonin was critical in alleviating Oxa-induced colitis. Subsequently, 16S rRNA sequencing was performed to explore the microbiota composition. Decreased richness and diversity of intestinal microbiota at the operational taxonomic unit (OTU) level resulted from melatonin treatment. Melatonin also elevated the abundance of Bifidobacterium, a well-known probiotic, and reduced proportions of several harmful bacterial genera, such as Desulfovibrio, Peptococcaceae, and Lachnospiraceae. Fecal microbiota transplantation (FMT) was used to explore the role of microbiota in the function of melatonin in Oxa-induced colitis. Microbiota transplantation from melatonin-treated mice alleviated Oxa-induced colitis, suggesting that the microbiome participates in the relief of Oxa-induced colitis by melatonin. Our findings demonstrate that melatonin ameliorates Oxa-induced colitis in a microbiota-dependent manner, suggesting the therapeutic potential of melatonin in treating type 2 immunity-associated UC.

BACKGROUND There are strong links between obstructive sleep apnea (OSA), chronic disease, mental health, job performance, and motor vehicle accidents. Corporate wellness clinics and health monitoring programs present ideal settings to educate and screen employees for OSA. METHODS In January 2020, the Stop-Bang Sleep Apnea Questionnaire was added to the yearly health monitoring program of 571 State of Texas air, water, and hazardous waste workers as part of routine care. Medium- and high-risk (HR) scoring employees were counseled to seek follow-up care from a primary-care provider (PCP). The January 2021 exams provided an opportunity to determine the success of counseling efforts. FINDINGS Of the 479 returning employees in 2021, 24 (49%) of HR and 17 (21.8%) of intermediate risk (IR) had discussed OSA with a PCP. Seven (14.3%) HR and 1 (<1%) IR employee underwent a sleep study and 4 (8.2%) were prescribed continuous positive airway pressure (CPAP). CONCLUSIONS/APPLICATION TO PRACTICE Screening for OSA at the workplace was inexpensive and, when diagnosed and treated, can mitigate associated chronic disease, improve worker productivity, and reduce associated accidents and injuries. The described OSA screening delivered value to the employer and employees. The screening was performed at a very low cost, involved little time on the part of the nurse practitioner and employees, brought signs and symptoms of OSA to the consciousness level of 571 employees, encouraged at-risk participants to discuss OSA with a PCP and led to 4 (8.2%) being prescribed CPAP.

NZNO has also received reports of staff being advised to use hand-made cloth masks;of gloves that were not of an adequate grade;and of paper gowns ripping easily Staff dealing with elderly, confused dementia patients have to contend with saliva and other body fluids Clusters of COVID-19 positive patients in a number of aged-care facilities made it even more important that staff felt safe - another example of the science of IPC meeting the reality of practice

INTRODUCTION: The coronavirus disease 2019 (COVID-19) pandemic recently affected Taiwan, China. This study aimed to calculate the transmissibility of COVID-19 to predict trends and evaluate the effects of interventions. METHODS: The data of reported COVID-19 cases was collected from April 20 to May 26, 2021, which included daily reported data (Scenario I) and reported data after adjustment (Scenario II). A susceptible-exposed-symptomatic-asymptomatic-recovered model was developed to fit the data. The effective reproductive number (R(eff)) was used to estimate the transmissibility of COVID-19. RESULTS: A total of 4,854 cases were collected for the modelling. In Scenario I, the intervention has already taken some effects from May 17 to May 26 (the R(eff) reduced to 2.1). When the R(eff) was set as 0.1, the epidemic was projected to end on July 4, and a total of 1,997 cases and 855 asymptomatic individuals would have been reported. In Scenario II, the interventions were projected as having been effective from May 24 to May 26 (the R(eff) reduced to 0.4). When the R(eff) was set as 0.1, the epidemic was projected to end on July 1, and a total of 1,482 cases and 635 asymptomatic individuals would have been reported. CONCLUSION: The epidemic of COVID-19 was projected to end after at least one month, even if the most effective interventions were applied in Taiwan, China. Although there were some positive effects of intervention in Taiwan, China.

A male patient with severe pneumonia due to coronavirus disease 2019 (COVID-19) had acute respiratory distress syndrome (ARDS) which developed in the second week since the first symptoms and improved without mechanical ventilation. The patient had epilepsy as a comorbid disease and his routinely consumed antiepileptic drugs were likely to cause alterations of the immune system. Ground-glass opacity (GGO), consolidation, and reticular pattern are typical radiological features of COVID-19 pneumonia. Less common findings were septal thickening, bronchiectasis, pleural thickening, and subpleural involvement. These radiological abnormalities evolve throughout the course of the disease. In this case report, a GGO lesion was seen in thin-section CT scans on the 30th and 45th day since the onset of symptoms. The consolidation subsided with time and on the 65th day, minimal GGO was seen in CT scan without pulmonary fibrosis and bronchiectasis.

A high-throughput drug screen identifies potentially promising therapeutics for clinical trials. However, limitations that persist in current disease modeling with limited physiological relevancy of human patients skew drug responses, hamper translation of clinical efficacy, and contribute to high clinical attritions. The emergence of induced pluripotent stem cell (iPSC) technology revolutionizes the paradigm of drug discovery. In particular, iPSC-based three-dimensional (3D) tissue engineering that appears as a promising vehicle of in vitro disease modeling provides more sophisticated tissue architectures and micro-environmental cues than a traditional two-dimensional (2D) culture. Here we discuss 3D based organoids/spheroids that construct the advanced modeling with evolved structural complexity, which propels drug discovery by exhibiting more human specific and diverse pathologies that are not perceived in 2D or animal models. We will then focus on various central nerve system (CNS) disease modeling using human iPSCs, leading to uncovering disease pathogenesis that guides the development of therapeutic strategies. Finally, we will address new opportunities of iPSC-assisted drug discovery with multi-disciplinary approaches from bioengineering to Omics technology. Despite technological challenges, iPSC-derived cytoarchitectures through interactions of diverse cell types mimic patients' CNS and serve as a platform for therapeutic development and personalized precision medicine.

BACKGROUND: Exercised-induced ventricular tachycardia is associated with pre-existing ischemia or structural heart disease. However, exercise-induced ventricular tachycardia in asymptomatic patient without evident of coronary artery disease or structural heart disease needs further investigation. CASE DESCRIPTION: A 53-year-old woman with suspected coronary artery disease underwent an Exercise Stress Test. During recovery phase, the patient developed monomorphic ventricular tachycardia accompanied by drowsiness, which lasted eight minutes before resolving. The patient was tested positive on COVID-19 screening, a mandatory testing before hospital admission. Subsequent evaluation with transthoracic echocardiography and coronary angiography revealed absence of coronary artery stenosis and significant structural heart disease. Twenty-four hours Holter monitoring results were low-grade premature ventricular contractions. DISCUSSION: Exercise-induced ventricular tachycardia in normal coronary artery patient may be associated with an increased risk of sudden cardiac death, thus required careful examinations and establishment of underlying pathology. COVID-19 was reported to be associated with and might trigger episodes of ventricular tachycardia through sympathetic hyperactivity or re-entry in myocarditis. This case is noteworthy due to the absence of typical cause of exercise-induced ventricular tachycardia and the possible relation with COVID-19 infection. However electrocardiogram monitoring should be taken periodically to observe recurrences and to determine prognosis.

Nonsteroidal anti-inflammatory drugs (NSAIDs) have been an important therapy in the treatment of a large number of cutaneous pathologies for more than three decades. Concerns have been raised that NSAIDs may be associated with an increased risk of adverse effects when used in patients with acute viral respiratory infections. Given the current SARS-CoV-2 (COVID-19) pandemic, the availability of reliable information for clinicians and patients is of extreme importance Although accumulating evidence support the existence of a harmful effect of NSAIDs in some infectious settings, no clinical studies demonstrating that such risk applies in case of COVID-19. Pending further research, a pragmatic and cautionary approach would be to avoid regular NSAID use or as first line option in suspicion of COVID19 symptoms.