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A scoping review to examine health care professionals’ experiences as family caregivers

Background Health and social care systems must confront the challenge of supporting a growing elderly population and their caregivers. Family caregivers who are healthcare professionals are part of this context, but their caregiving experiences remain unclear. Objective This scoping review explored the experiences of healthcare professionals who are also family caregivers for older adults. Methodology A scoping review methodology identified and summarized pertinent studies. Searches were conducted in Medline, Embase, PsycINFO, CINAHL, and AgeLine. We sought articles published from each journals’ inception to October 19, 2023. Inclusion criteria were English-language studies about healthcare professionals caring for older adult family members. Diverse research designs were included. Data were extracted and synthesized according to key themes. Results The review included 19 studies, highlighting four themes. Studies were published between 1994 and 2019, with most studies published before 2017. The overarching theme was "Expectations," where healthcare professional family caregivers faced multifaceted expectations from themselves, their families, and the healthcare system. Expectations also highlights the dual role of participants as both caregivers and healthcare professionals This complex interplay led to a theme related to personal consequences, including stress, guilt, and potential burnout, but also positive aspects of the dual roles. Studies described how dual roles could enhance the quality-of-care healthcare professional caregivers provided to their family members. Finally, support needs were identified, emphasizing the importance of workplace accommodations and support from the healthcare system and peers. Conclusions The experiences of healthcare professional family caregivers are shaped by unique expectations, resulting in both positive and negative consequences. The support needs of this group are multifaceted, requiring workplace accommodations and tailored support within the healthcare system. Further research is needed to delve deeper into the nuances of their experiences and develop targeted interventions to alleviate the stress and challenges they face in their dual roles. Understanding the evolving needs of healthcare professional family caregivers over time can inform support strategies along the caregiving trajectory.

Real-world clinical multi-omics analyses reveal bifurcation of ER-independent and ER-dependent drug resistance to CDK4/6 inhibitors

Prevalence of mortality caused by injuries at Livingstone University Hospital, Zambia. A retrospective cross-sectional study

Background Trauma is a major global public health issue, with an annual death toll of approximately 5 million, disproportionately affecting low- and middle-income countries. Zambia bears a significant burden of trauma-related mortalities, contributing to 7% of all annual deaths and 1 in 5 premature deaths in the country. Despite the significant burden of trauma in our country, few studies have been conducted, with most focusing on high-population centers, and there is a lack of epidemiological data on trauma-related deaths in our region. Therefore, our aim was to estimate the proportion of deaths caused by injuries at Livingstone University Teaching Hospital, a tertiary hospital located in Zambia’s southern province. Methods We conducted a retrospective cross-sectional study from June 22, 2020, to June 22, 2021, among 956 individuals from 1 month old (29 days of age) to 100 years. Demographic and clinical data were collected from patient’s records from Accident and Emergency department. Data analysis included descriptive statistics, chi square, mann-whitney test and multivariable logistic using forward stepwise generalized linear model equations (GLM) to identified factors associated with mortality, with a significance level set at p < 0.05. Data were analyzed using STATA version 15. Results Among the study participants, the median age was 26 years (interquartile range (IQR) 15, 37) and the majority were males (74.2%, n = 709). Prevalence of mortality was 1.0% (n = 10). The deaths were caused by burns (60%, n = 6), violence (30%, n = 3), and traffic accidents (10%, n = 1). Among those who died, the majority of the trauma occurred at home (90%, n = 9), followed by road (10%, n = 1) and were as a result of burns (60%, n = 6) and community violence (30%, n = 3). Survivors had significantly higher treatment costs (ZMK 9,837 vs. ZMK 6,037, p<0.005). Having burns (AOR: 1.06, 95% CI: 1.05, 1.09, p< 0.001) and hospital stay of one day (AOR: 1.04, 95% CI: 1.02, 1.05, p< 0.001) was positively associated with mortality, while hospital stay of more than five days (AOR: 0.98, 95% CI: 0.96, 0.99, p = 0.002) was negatively associated with mortality. Conclusion The prevalence of death due to trauma was relatively low, with the majority experiencing multiple traumas. Burns were the most common cause and were associated with death, occurring within a day of hospitalization. The findings underscore the need for targeted preventive measures, improved access to quality emergency trauma care, and rehabilitation services, especially among patients with burns.

Telomerase RNA structural heterogeneity in living human cells detected by DMS-MaPseq

Abstract Biogenesis of human telomerase requires its RNA subunit (hTR) to fold into a multi-domain architecture that includes the template-pseudoknot (t/PK) and the three-way junction (CR4/5). These hTR domains bind the telomerase reverse transcriptase (hTERT) protein and are essential for telomerase activity. Here, we probe hTR structure in living cells using dimethyl sulfate mutational profiling with sequencing (DMS-MaPseq) and ensemble deconvolution analysis. Approximately 15% of the steady state population of hTR has a CR4/5 conformation lacking features required for hTERT binding. The proportion of hTR CR4/5 folded into the primary functional conformation is independent of hTERT expression levels. Mutations that stabilize the alternative CR4/5 conformation are detrimental to telomerase assembly and activity. Moreover, the alternative CR4/5 conformation is not found in purified telomerase RNP complexes, supporting the hypothesis that only the primary CR4/5 conformer is active. We propose that this misfolded portion of the cellular hTR pool is either slowly refolded or degraded, suggesting that kinetic RNA folding traps studied in vitro may also hinder ribonucleoprotein assembly in vivo.

Protect or prevent? A practicable framework for the dilemmas of COVID-19 vaccine prioritization

Determining COVID-19 vaccination strategies presents many challenges in light of limited vaccination capacity and the heterogeneity of affected communities. Who should be prioritized for early vaccination when different groups manifest different levels of risks and contact rates? Answering such questions often becomes computationally intractable given that network size can exceed millions. We obtain a framework to compute the optimal vaccination strategy within seconds to minutes from among all strategies, including highly dynamic ones that adjust vaccine allocation as often as required, and even with modest computation resources. We then determine the optimal strategy for a large range of parameter values representative of various US states, countries, and case studies including retirement homes and prisons. The optimal is almost always one of a few candidate strategies, and, even when not, the suboptimality of the best among these candidates is minimal. Further, we find that many commonly deployed vaccination strategies, such as vaccinating the high risk group first, or administering second doses without delay, can often incur higher death rates, hospitalizations, and symptomatic infection counts. Our framework can be easily adapted to future variants or pandemics through appropriate choice of the compartments of the disease and parameters.

Coordinated conformational changes in P450 decarboxylases enable hydrocarbons production from renewable feedstocks

A linear tessellation model for the identification of “food desert”: A case study of Shanghai, China

The "food desert" problem has been treated under a national strategy in the United States and other countries. At present, there is little research on the phenomenon of "food desert" in China. This study takes Shanghai as the research area and proposes a multiscale analysis method using a linear tessellation model that splits the street network into homogeneous linear units. Firstly, the network kernel density estimation using a linear tessellation model is used to measure the travel-mode-based food accessibility. Considering the actual travel constraints, the GPS trajectory data of four travel modes (walking, bicycle, metro and taxi) are applied to calculate the speed of each linear unit. Secondly, the “food desert” phenomenon in Shanghai are identified combing with the results of the network K-function. Finally, the resident income conditions in different modes are fitted based on the housing price data and the spatial distribution of four "food desert" patterns are detected by the overlay analysis of food accessibility and resident income conditions. The experimental results show that fifty percent of Shanghai is characterized by low food accessibility, and half of these areas are disadvantaged and low-income areas in suburbs, which are the locations experiencing the “food desert” phenomenon. Comparing the results of the proposed method and that of the traditional planar method, the identification results for all modes based on the traditional planar method underestimate the severity of the “food desert”, especially for the bicycle and taxi modes. This study also provides corresponding decision-making reference for the alleviation and resolution of “food desert” issues. Moreover, the proposed method provides a new research perspective for urban research under the street network space.

PRMT1-methylated MSX1 phase separates to control palate development

Impact of high body mass index on hepatocellular carcinoma risk in chronic liver disease: A population-based prospective cohort study

Background and aims We investigated associations between body mass index (BMI) and hepatocellular carcinoma (HCC) in patients with hepatitis B (HBV) C (HCV) virus infection, alcoholic liver disease (ALD), non-alcoholic fatty liver disease (NAFLD), and liver cirrhosis (LC). Methods We followed 350,608 Korean patients with liver disease who underwent routine health examinations from 2003–2006 until December 2018 via national hospital discharge records. Multivariable adjusted hazard ratios (HRs) per 5-kg/m2 BMI increase (BMI ≥25 kg/m2) for HCC risk were calculated using Cox models. HCC developed in 17,752 patients. Results The HRs (95% CI) were 1.17 (1.06–1.28), 1.08 (0.87–1.34), 1.34 (1.14–1.58), 1.51 (1.17–1.94), and 1.11 (1.00–1.23) for HBV, HCV, ALD, NAFLD, and LC, respectively. The HRs for HBV were 1.45 (1.23–1.70) and 1.06 (0.95–1.19) in women and men, respectively; the corresponding HRs for LC were 1.27 (1.07–1.50) and 1.02 (0.90–1.16), respectively. In patients <65 years old with HBV, HCV, and NAFLD, the HRs were 1.17 (1.07–1.29), 1.33 (1.03–1.73), and 1.20 (0.87–1.64), respectively; the corresponding HRs were 1.05 (0.70–1.59), 0.74 (0.50–1.10), and 2.40 (1.62–3.54), respectively, in patients ≥65 years old. A BMI of 27.5–29.9 kg/m2 showed significantly higher HCC risks in patients with HBV, ALD, NAFLD, and LC. Conclusions Higher BMIs were associated with increased HCC risks in patients with HBV, ALD, NAFLD, and LC. Overweight status increased HCC risk. Women with HBV and LC had stronger BMI-HCC associations than men. The effect of high BMI was stronger in older patients with NAFLD and younger patients with viral hepatitis.

Metal-oxide phase transition of platinum nanocatalyst below fuel cell open-circuit voltage

Abstract The long-term stability of Pt-based catalysts is critical to the reliability of proton exchange membrane fuel cells (PEMFCs), and receives constant attention. However, the current knowledge of Pt oxidation is restricted to unrealistic PEMFC cathode environment or operation, which questions its practical relevance. Herein, Pt oxidation is investigated directly in a PEMFC with stroboscopic operando high energy X-ray scattering. The onset potential for phase transition of the nanoparticles surface from metallic to amorphous electrochemical oxide is observed far below previously reported values, and most importantly, below the open-circuit potential of PEMFC cathode. Such phase transition is shown to impact PEMFC performance and its role on Pt transient dissolution is verified by electrochemical on-line inductively coupled plasma mass spectrometry. By further demonstrating and resolving the limitations of currently employed accelerated stress test protocols in the light of metal-oxide phase transitions kinetics, this picture of Pt oxidation enables new mitigation strategies against PEMFC degradation.

Effects of clinical stage, behavioral and psychological symptoms of dementia, and living arrangement on social distance towards people with dementia

Background Dementia presents significant challenges, including social exclusion, which can be exacerbated by public stigma. This study aimed to clarify how social distances, a common measure of public stigma, towards people living with dementia and its associated factors vary with clinical stage, presence of behavioral and psychological symptoms of dementia (BPSD), and living arrangements. Methods The study involved 2,589 Japanese participants aged 40 to 90 years. They were exposed to one of four vignettes depicting an 80-year-old woman progressing from normal ageing to mild, moderate, and severe dementia: Vignette A (living with husband, without BPSD); Vignette B (living with husband, with BPSD); Vignette C (living alone, without BPSD); and Vignette D (living alone, with BPSD). Results Social distance showed no significant differences in the normal aging and mild stage of dementia across all vignettes. At the moderate stage, social distance was higher for individuals exhibiting BPSD, regardless of living arrangement. At the severe stage, the lowest social distance was observed towards individuals living with their family without BPSD, whereas the highest was towards those living alone, exhibiting BPSD. For Vignette A, possession of social capital (p<0.001) and having experience of social contact with people living with dementia (PLWD) (p = 0.001–0.007) were independently associated with lower social distance across all dementia stages. In addition, in the mild stage of dementia, high perceived social support (p = 0.005) and having knowledge about dementia (p = 0.036) were associated with lower social distance, but not in the moderate or severe stage of dementia. For Vignette D, possession of social capital (p≤0.001) and having experience of social contact with PLWD (p<0.001 to p = 0.006) were independently associated with lower social distance across all dementia stages. In mild dementia, female sex (p = 0.004) and knowledge about dementia (p = 0.026) were associated with lower social distance. Furthermore, in mild and moderate dementia, living in rural area (p = 0.003–0.048) was associated with lower social distance. Conclusions Social distance is higher toward PLWD who live alone and exhibit BPSD than toward those who live with family and/or do not show BPSD, indicating a higher risk of exclusion for the former. Moreover, factors affecting social distance towards PLWD vary across different clinical stages of dementia. While greater knowledge about dementia is associated with lower social distance toward PLWD, this effect appears to be most pronounced in the mild stage. In contrast, opportunities for social contact with PLWD are crucial for achieving lower social distance across all stages of dementia. The findings underscore the need for stage-specific interventions to address stigma, with a focus on education and opportunities for social contact. Targeted efforts are especially important for promoting the inclusion of PLWD who live alone and exhibit BPSD.

Klebsiella pneumoniae employs a type VI secretion system to overcome microbiota-mediated colonization resistance

Detectability constraints on meso-scale structure in complex networks

Community, core-periphery, disassortative and other node partitions allow us to understand the organisation and function of large networks. In this work we study common meso-scale structures using the idea of block modularity. We find that the configuration model imposes strong restrictions on core-periphery and related structures in directed and undirected networks. We derive inequalities expressing when such structures can be detected under the configuration model which are closely related to the resolution limit. Nestedness is closely related to core-periphery and is similarly restricted to only be detectable under certain conditions. We then derive a general equivalence between optimising block modularity and maximum likelihood estimation of the parameters of the degree corrected Stochastic Block Model. This allows us to contrast the two approaches, how they formalise the structure detection problem and understand these constraints in inferential versus descriptive approaches to meso-scale structure detection.

Metabolic interactions underpinning high methane fluxes across terrestrial freshwater wetlands

High diversity of fungal ecological groups from ice-free pristine and disturbed areas in the Fildes Peninsula, King George Island, Antarctica

Ice-free areas are habitats for most of Antarctica’s terrestrial biodiversity. Although fungal communities are an important element of these habitats, knowledge of their assemblages and ecological functions is still limited. Herein, we investigated the diversity, composition, and ecological functionality of fungal communities inhabiting sediments from ice-free areas across pristine and anthropogenically impacted sites in the Fildes Peninsula on King George Island, Antarctica. Samples were collected from both pristine and disturbed areas. We used the internal transcribed spacer (ITS1) region via Illumina sequencing of 34 sediment samples for fungal identification. The Ascomycota (14.6%) and Chytridiomycota (11.8%) were the most dominant phyla, followed by Basidiomycota (8.1%), Rozellomycota (7.0%), Mucoromycota (4.0%), while 34.9% of the fungal diversity remained unidentified. From a total of 1073 OTUs, 532 OTUs corresponded to 114 fungal taxa at the genus level, and 541 OTUs remained unassigned taxonomically. The highest diversity, with 18 genera, was detected at site A-3. At the genus level, there was no preference for either pristine or disturbed sites. The most widely distributed genera were Betamyces (Chytridiomycota), occurring in 29 of the 34 sites, and Thelebolus (Ascomycota), detected in 8 pristine sites and 7 disturbed sites. The Glomeraceae gen. incertae sedis was more common in disturbed sites. A total of 23 different ecological guilds were recorded, with the most abundant guilds being undefined saprotrophs, plant pathogens, plant saprotrophs, pollen saprotrophs, and endophytes. The fungal communities did not show significant differences between pristine and disturbed sites, suggesting that the anthropogenic impact is either not too intense or prolonged, that the spatial distance between the sampled sites is small, and/or that the environmental factors are similar. Although our study revealed a high fungal diversity with various ecological specializations within these communities, nearly one-third of the diversity could not be assigned to any specific taxonomic category. These findings highlight the need for further taxonomic research on fungal species inhabiting ice-free areas. Without identifying the species present, it is difficult to assess potential biodiversity loss due to environmental changes and/or human activities.

Exploring the Vibrational Coherences in the Ultrafast Electronic Relaxation of Pyrimidine Nucleobases and Nucleosides

Modular access to saturated bioisosteres of anilines via photoelectrochemical decarboxylative C(sp3)–N coupling

Comparative safety and effectiveness of oral anticoagulants in key subgroups of patients with non-valvular atrial fibrillation and at high risk of gastrointestinal bleeding: A cohort study based on the French National Health Data System (SNDS)

Background Risk factors and comorbidities can complicate management of non-valvular atrial fibrillation. We describe and compare real-world safety and effectiveness of direct oral anticoagulants (DOACs; apixaban, rivaroxaban, dabigatran) and vitamin K antagonists (VKAs) in subgroups of patients with non-valvular atrial fibrillation at high risk for gastrointestinal (GI) bleeding, utilizing data from a national quasi-exhaustive French database. Methods Anticoagulant-naïve adults with non-valvular atrial fibrillation with ≥1 gastrointestinal bleeding risk factor, initiating anticoagulant treatment January 2016–December 2019, and covered by the French national health data system were eligible. The following subgroups were evaluated: patients age ≥75 years, receiving concomitant medications, HAS-BLED score ≥3, and chronic kidney disease stage 3–4. Outcomes included major bleeding and stroke/systemic embolism. Patient characteristics were balanced using propensity score matching. Results A total of 314,184 patients were identified; characteristics were similar for propensity score-matched subgroups in VKA/DOAC and DOAC/DOAC comparisons. DOACs showed lower risk of major bleeding versus VKAs in all subgroups evaluated (p<0.0001 for all). Apixaban showed lower risk of major bleeding and gastrointestinal bleeding versus rivaroxaban in all subgroups (p≤0.05 for all) and versus dabigatran in elderly patients, patients with HAS-BLED score ≥3, and those receiving concomitant medications (p<0.05 for all). Stroke/systemic embolism risk was lower with apixaban versus rivaroxaban in elderly patients, those with HAS-BLED ≥3, and those receiving concomitant medications; risks were similar for other comparisons. Conclusions DOACs were associated with improved safety and effectiveness when compared to VKAs among subgroups of non-valvular atrial fibrillation patients at high risk of gastrointestinal bleeding. Apixaban was associated with lower risks of major bleeding, gastrointestinal bleeding, and stroke/systemic embolism versus rivaroxaban as well as lower risk of major bleeding, gastrointestinal bleeding bleed and similar risk of stroke/systemic embolism versus dabigatran among several of these patient subgroups.

Pretargeted Multimodal Tumor Imaging by Enzymatic Self-Immobilization Labeling and Bioorthogonal Reaction

Effects of a 6-month rowing training program in breast cancer survivors

The purpose of this longitudinal study was to determine the effects of a rowing training program on physical fitness and body composition in female breast cancer survivors (56.78 ± 6.38 years). Over six months, the participants (n = 40) performed two training sessions per week for an average of 75 minutes, combining resistance and muscle strength exercises with rowing. To evaluate the impact of the program, physical fitness tests and anthropometric measurements were carried out before and after the training protocol. The results show statistically significant improvements in measures such as weight (-1.84 kg), BMI (-0.7 kg/m2), hip (-3.24 cm) and waist circumference (-2.45 cm). In addition, variables associated with physical fitness also improved including leg strength (3.04 cm), dominant handgrip strength (4.24 kgf), non-dominant handgrip strength (3.49 kgf), aerobic endurance (78.35 m) and muscle flexibility (3.96 cm). We can therefore conclude that a rowing-based exercise program is an effective strategy to improve physical fitness in this type of population, yielding improvements in both anthropometric measurements and basic physical capacity variables, essential factors for better health and quality of life.