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Is it safe for women with a history of two cesarean deliveries to undergo a vaginal delivery attempt in comparison to patient with a history of one cesarean delivery?
Introduction Worldwide, numbers of repeat cesarean sections continue to rise. Although there is a multitude of evidence about the safety of a vaginal delivery attempt after one cesarean section, data is scarce regarding the risks of one compared to two prior procedures. This study aims to determine whether vaginal childbirth is less safe and successful for both mother and child in patients with a history of two cesarean sections compared to those with only one. Materials and methods This retrospective cohort study included all patients with a history of one or two prior cesarean deliveries who gave birth at term at Goethe University Frankfurt between 2014 and 2021. Maternal and neonatal morbidity, as well as rates of success for vaginal birth and uterine rupture, were compared between the groups. Results Of the 1967 women studied, 1697 gave birth after one previous cesarean section, while 270 had a history of two prior cesarean sections. There was no significant increase in maternal or fetal morbidity in women with two previous cesarean sections compared to one. However, the success rate of a vaginal delivery was lower in the group with two prior cesareans (27/79, 34.2%) than in the group with one (696/989, 70.3%). The rate of complete uterine rupture was higher in patients with two cesareans who underwent cesarean section after onset of labor (CSAOL-2: 3/89, 3.4%) compared to none in the CSAOL-1 group (0/492, 0.0%; p = 0.004). Maternal and fetal morbidity remained comparable across groups, with NICU admission rates of 11.2% (CSAOL-1) vs. 5.6% (CSAOL-2), and maternal transfusion rates of 0.86% (VBAC-1) vs. 6.45% (VBAC-2). Conclusion In the context of patient autonomy regarding the timing of delivery, offering the patient the choice of different delivery modes after two previous cesareans appears to be safe with respect to maternal and fetal risks. An individualized consultation and thorough counseling are essential, but the opportunity for different delivery options should be respected and supported.
A disproportionality analysis of FDA adverse event reporting system (FAERS) events for methimazole and propylthiouracil
Background Methimazole and propylthiouracil are the most common antithyroid drugs. We assessed the safety signals associated with methimazole and propylthiouracil by data mining the FDA pharmacovigilance database. Methods Data were retrieved from the FAERS database from the 1st quarter of 2004 through the 4th quarter of 2023. A disproportionate analysis of reporting advantage ratios was used to assess potential associations between adverse events and methimazole/propylthiouracil. Results A total of 17,379,609 reports were extracted, of which 5,317 cases of methimazole and 1,761 cases of propylthiouracil were classified as primary suspect reports. After combining the same primary ID, 1586 patients with methimazole and 446 patients with propylthiouracil were retained. We observed 8 categories of SOCs with a reported number ≥ 30 for methimazole and 12 categories of SOCs with a reported number ≥ 10 for propylthiouracil. The median time to adverse events in patients with methimazole was 31 days, with an interquartile range of 31–74 days. The median time to adverse events in patients with propylthiouracil was 90 days, with an interquartile range was 20–388.5 days. Conclusion Our study provided a more in-depth and extensive understanding of adverse events that may be associated with methimazole and propylthiouracil, which will help to reduce the risk of adverse events in the clinical treatment of methimazole and propylthiouracil.
Healthy minds index, Spanish version of core dimensions of wellbeing
Psychological wellbeing is a crucial aspect of human flourishing, yet validated assessment tools are needed across diverse linguistic and cultural contexts. This study aimed to adapt and validate the Healthy Minds Index (HMx) for Spanish-speaking populations (HMx-SV). The HMx-SV assesses four core dimensions of wellbeing: awareness, connection, insight, and purpose. We conducted exploratory and confirmatory factor analyses on data from two independent samples of university students (N = 362 and N = 1,594). The findings confirmed a four-factor structure, with strong internal consistency and convergent validity with established wellbeing measures. The HMx-SV demonstrated robust psychometric properties, making it a reliable and valid tool for assessing wellbeing in Spanish-speaking populations. By expanding access to a culturally adapted instrument, this study contributes to the broader understanding and promotion of psychological wellbeing in diverse communities.
Protocol to establish standards for the elements of infection prevention and control programs and practice and competency standards for infection control professionals in Australian hospitals
Healthcare-associated infections (HAI) are the most frequent hospital-acquired complication, resulting in significant mortality, disability, and system-level costs in Australian hospitals. Many HAIs can be prevented with appropriate infection prevention and control (IPC) measures, including IPC programs led by infection control professionals (ICPs). Despite recent improvements in hospital IPC practices in Australia, such as the introduction of National Safety and Quality Health Service (NSQHS) Standards for hospital accreditation, there are currently no evidence-based minimum standards for the content, composition, and governance of IPC programs, nor the identification of their core elements. Furthermore, there is a similar lack of evidence-based minimum standards guiding the practice requirements, skills, and competencies of hospital ICPs. This protocol outlines a sequential three-phase research design to establish the core requirements for the elements and governance of IPC programs, as well as minimum practice standards for ICPs in Australian hospitals. Phase 1 will involve two integrative reviews to synthesise the elements and governance systems of international IPC programs, and the competencies, education and practice standards for hospital ICPs globally. Phase 2 will use survey and interview methodologies to examine the current content and structure of IPC programs and governance systems in Australian hospitals, as well as the academic and professional content of IPC education and training courses for ICPs in Australia. In Phase 3, a modified electronic Delphi study will be conducted to generate expert consensus on the core requirements of Australian hospital IPC programs and systems of governance, and the professional practice, qualifications and competencies for Australian ICPs. The outcomes of Phase 3 will form the basis for the development of new standards that aim to equip the Australian acute care sector to deliver evidence-based IPC practices, education, resources, and governance.
Unpacking gender discrepancies in academic promotion across STEM fields in Mexico
Gender inequality in the sciences remains a persistent issue. Women are often unable to participate in the scientific process as easily as men. When they do, this is largely constricted to opportunities at the lower rather than higher ranks of academia. This gap not only sets back female scientists but also scientific and social progress, more generally. The objective of this study is to look at a prominent national program for researchers in Mexico – Sistema Nacional de Investigadores (SNI) – to assess additional productivity and promotion heterogeneity by gender across career trajectories and disciplinary boundaries. Tracing productivity and promotion activity for 18,799 researchers active in the SNI program from 1991 to 2011, the analysis uncovers the following: while female researchers are associated with more productivity than males at each stage of the program, they are less likely to attain higher levels of promotion as they progress through their career. Illustratively, our more conservative results indicate women are associated with 1.2 more publications than men the year prior to promotion to Level 2 from Level 1 in SNI. Yet, 13 percent of women are associated with Level 2 promotion compared to 22 percent of men. To contextualize our understanding of these patterns, we interviewed SNI participants and include empirical assessments to unpack what may explain these perplexing results. While significant female representation in the applicant pool is needed to improve the gender gap, only a marginal increase in the gender representation of the reviewer pool is needed to reduce it significantly. This result points to a novel underexplored mechanism to inform future studies and policy – that of evaluative salience . While this does not fully address gender bias in the sciences, a shift in salience from applicants to reviewers may be an important precursor to address more structural ills around gender inequality.
Genetic mutation predicts survival after immunotherapy for ovarian cancer
Delayed motherhood and its determinants among women of reproductive age in five Sub-Saharan African Countries: A multilevel analysis of recent demographic and health surveys (2021–2023)
Introduction In recent years, more women have delayed childbearing until their late twenties or early thirties, a time when reproductive potential declines, thereby making conception more challenging with advancing age. While delayed motherhood is widely reported, there is limited research on its underlying causes in Sub-Saharan Africa. Exploring these factors offers valuable insights for researchers, policymakers, and healthcare providers. Method This study used the most recent Demographic and Health Surveys (2021–2023) across five Sub-Saharan Africa countries. A weighted sample of 47,439 women of reproductive age were analyzed using Stata 14. The determinants of delayed motherhood were determined using a multilevel mixed-effects logistic regression model. Statistical significance was determined at p-values <0.05, and results were reported using adjusted odds ratio (AOR) with 95% confidence interval. Results A total of 47,439 study participants were enrolled in the study. The mean age was 31.9 years (±8.7 SD), with over half (54.54%) aged between 20 and 35 years. The prevalence of delayed motherhood among women of reproductive age in Sub-Saharan Africa was 61.94%. Individual factors such as did not have occupation (AOR = 1.65, 95% CI: 1.57, 1.73), whose husband did not have occupation (AOR = 1.55, 95% CI: 1.51, 1.78), and those with poor wealth status (AOR = 2.62, 95% CI: 1.58, 3.66) were more likely to delay motherhood. Moreover distance to a health facilities (AOR = 1.04, 95% CI: 1.09, 1.39), urban residence (AOR = 2.48, 95% CI: 1.67, 2.09), and high community illiteracy (AOR = 3.24, 95% CI: 1.55, 5.35) were also significant predictors of delayed motherhood. Conclusions This study reveals a significant prevalence of delayed motherhood among women of reproductive age in Sub-Saharan Africa. Major contributing factors include unemployment, poverty, urban residence, limited healthcare access, and community illiteracy. Addressing these disparities requires targeted policies and improved access to education and healthcare services.
Teacher acceptability of physically active learning in UK secondary schools – a mixed methods study
Background Roughly 70% of UK adolescents are insufficiently physically active, while secondary education reform is needed to improve adolescent wellbeing and 21 st -century skill-building. One potential strategy to help address these areas is physically active learning (PAL), where movement is integrated into curricular lessons. In the UK, studies have largely focussed on primary schools; little is known about PAL in UK secondary schools. This study aimed to explore, using mixed-methods, UK secondary school teachers’ acceptability of PAL, and their delivery preferences, perceived implementation barriers and facilitators. Methods Cross-sectional data were collected from UK secondary teachers via online survey (N = 75). In addition to descriptive statistics, Mann-Whitney U tests were conducted to examine differences by gender and school types (urban/rural, state-funded/independent), and Kruskal-Wallis tests for differences by subject. Qualitative data on teachers’ current teaching practice, PAL acceptability, and perceived barriers and facilitators, collected through open survey questions (N = 63), and online teacher interviews (N = 7), were analysed using the framework method. Results Using a scale of 1.0 (strong disagreement) to 5.0 (strong agreement), participants liked the concept of PAL (median 4.0, IQR 4.0,5.0) and would use PAL if it was school policy (median 4.0, IQR 3.5,5.0). Female participants were more certain that PAL should be implemented than male ( U = 361.5, p = 0.04). Languages teachers found PAL appropriate for their subject more than humanities and social science teachers ( U = 6, p = 0.01). Four main themes were generated: (1) ‘It’s time for a change’; (2) ‘PAL seems like common sense’; (3) ‘Is PAL realistic in secondary schools?’ and (4) ‘Recommendations for implementation’, highlighting a collaborative approach. Conclusions UK secondary teachers largely felt that PAL is a logical and enjoyable tool to contribute to education system improvement and can benefit pupils’ wellbeing and learning, if appropriately executed. The findings can inform future research working towards sustainable PAL implementation in UK schools.
Bioorthogonal Non-Canonical Amino Acid Tagging (BONCAT) to detect newly synthesized proteins in cells and their secretome
Background Cells respond to physiological or pathological stimuli by altering the composition of the proteins they produce. This adaptation includes changes to newly translated polypeptides that are destined for intracellular compartments or secretion. The secretome is relevant to cell physiology, as it promotes autocrine, paracrine, and endocrine signaling. These events control cell death, tissue repair, and other regenerative processes. Uncovering the changes in de novo protein synthesis under different growth conditions requires reliable methods to identify and quantify newly synthesized proteins. Bioorthogonal Noncanonical Amino Acid Tagging (BONCAT) can generate this information with high spatiotemporal resolution. Methods We developed a BONCAT-based protocol to characterize proteins synthesized de novo in mammalian cells. Cultured HeLa cells are used as a model system, as their cell physiology is particularly well understood. The current protocol employs L-azidohomoalanine as an L-methionine analog, which is incorporated into newly translated polypeptide chains. After the incubation period, cells and the growth medium, which contains the secretome, are processed separately. Specifically, proteins are alkylated, and L-azidohomoalanine is modified with a biotin affinity tag. Proteins are collected using a rapid precipitation method, which is compatible with the subsequent affinity purification of biotinylated polypeptides. The affinity-purified material can be used for diverse downstream applications, such as Western blotting. Our experiments illustrate the feasibility of different steps of the protocol. Moreover, we discuss potential bottlenecks of the procedure and provide solutions that address these obstacles. Discussion Our work demonstrates the power of a modified BONCAT protocol to study newly produced proteins in growing cells and their secretome. This method will be useful to examine the proteome and secretome changes that are linked to the altered performance of cells, tissues, and organs during aging, disease, or other challenging conditions.
Retraction: Suppression of uPA and uPAR Attenuates Angiogenin Mediated Angiogenesis in Endothelial and Glioblastoma Cell Lines
Omnipresent intercorrelations of metabolic syndrome markers in the general population
Background Besides the usual characterization of metabolic syndrome as a cluster of markers arbitrarily defined by thresholds, it is unclear to which extent these markers as continuous traits are correlated with each other in the general population. The present study aimed to explore these correlations across a wide array of biological, social and behavioral characteristics. Methods The cross-sectional analyses were performed in a large population-based French cohort (CONSTANCES) of 159,476 adults in whom blood glucose, low-density lipoproteins (LDL) and high-density lipoproteins (HDL), triglycerides, body mass index, waist and hip circumferences, systolic and diastolic blood pressures were measured at the time of recruitment between 2012 and 2021. Correlations between each pair of continuous marker distributions were assessed by calculating raw and partial correlation coefficients (r). Results The same pattern of partial correlations is observed with little variation in all groups of sex, age, individual and parental histories of cardiovascular disease, diagnosis of metabolic syndrome, social position, work environment, lifetime unemployment exposure, smoking, non-moderate alcohol consumption, leisure-time physical inactivity and diet quality. This pattern is composed of strong and expected intercorrelations between systolic and diastolic blood pressures (r ranging from 0.62 to 0.74), between body mass index and waist (r from 0.50 to 0.63) and hip (r from 0.58 to 0.70) circumferences and between waist and hip circumferences (r from 0.07 to 0.19). It also includes intercorrelations of systolic blood pressure with waist (r from 0.10 to 0.21) and hip (r from −0.07 to −0.12) circumferences and with blood glucose (r from 0.09 to 0.15), those of triglycerides with blood glucose (r from 0.07 to 0.16), LDL (r from 0.24 to 0.33), HDL (r from −0.20 to −0.29) and waist circumference (r from 0.07 to 0.15), and finally those of waist and hip circumferences with blood glucose (r from 0.09 to 0.17 and from −0.08 to −0.13) and HDL (r from −0.12 to −0.24 and from 0.08 to 0.18). Conclusions These results show that metabolic syndrome markers are correlated with each other whatever the biological, social or behavioral characteristics of individuals. They suggest that it makes sense to systematically consider these markers all together rather than separately in terms of etiology, prevention and treatment of metabolic diseases and cardiovascular risk in the general population.
Challenges and opportunities in monitoring the long-term well-being of people with HIV in Spain
Background Thanks to antiretroviral therapy, people living with HIV have an increased life expectancy, but face multimorbidity challenges while ageing. This study aimed to evaluate the monitoring capabilities of Spain’s subnational and national health information systems in addressing the multimorbidity needs of people with HIV (PHIV). Methods Employing 7 semi-structured focus groups discussions of 20 total participants through purposive sampling of relevant professional profiles recruited by the Spanish Interdisciplinary AIDS Society (SEISIDA), we thematically analysed the discussions using two theoretical frameworks: the World Health Organization health systems building blocks and the DeLone and McLean Information Systems Success Model. Content was validated via participant follow-up and triangulation with publicly available data. Results Participant feedback revealed ongoing challenges and capacities within the Spanish health information system for collecting, reporting, and using multimorbidity information among PHIV, including gaps in systematic monitoring of comorbidities, including mental health, technical and interoperability challenges in health data systems, and the need for improved data collection and coordination strategies. Conclusion Our findings underscore the importance of a comprehensive approach to health monitoring for chronic care management and the critical role of data standardization and systematization towards improved patient care and public health goal-setting.
An assessment of optimizing biofuel yield percentage using K-fold integrated machine learning models for a sustainable future
Accelerating population and modernization has triggered a steady rise in energy demand and a significant rise in household waste, particularly municipal solid waste. In this context, waste-to-energy conversion has emerged as a sustainable solution. This study aims to maximize biofuel production yield using biomass-based banana peel catalyst waste by optimizing process parameters through machine learning models integrated with k-fold cross-validation. The models employed include Polynomial Regression (PR), Decision Tree (DT), Random Forest (RF), and Linear Regression (LR). The three key input variables including reaction temperature (RT), catalyst concentration (CC), and methanol-to-oil molar ratio (MOR) were used to train and test the models, with biodiesel yield as the measured output. Among the models, PR emerged as the best-performing one for predicting biofuel yield, demonstrated by its high R² value of 0.956 and low error metrics (RMSE = 1.54 MSE = 2.39 MAE = 1.43). The best model was determined through balancing bias and variance across k-fold validation iterations, where PR exhibited the highest average R² value of 0.868. Furthermore, the optimized process parameters predicted by PR for maximum biofuel yield were a RT of 59°C, CC of 2.96%, and a MOR of 9.21, resulting in a yield of 95.38%. These findings contribute to advancing large-scale machine learning-driven biofuel optimization, supporting industrial waste-to-energy applications, and fostering sustainable energy development.
Preoptic EP3R neurons constitute a two-way switch for fever and torpor
Amino acid residues 655 and 969 in the spike protein of Omicron subvariant BA.1 control use of TMPRSS2 versus Cathepsin L dependent entry pathways and cell tropism
The spike (S) protein of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is activated by the host cell proteases cathepsin L or TMPRSS2. The ancestral virus circulating in Wuhan in 2020 and early variants mainly use TMPRSS2 for entry into Calu-3 lung cells while the Omicron subvariant BA.1 and most subsequently circulating Omicron subvariants employ both cathepsin L and TMPRSS2 for Calu-3 cell entry. Here, we investigated which amino acid residues in the S protein of the Omicron subvariant BA.1 control protease choice. We show that Y655 promotes S protein cleavage and cathepsin L-dependent entry while H655 jointly with N969 promotes TMPRSS2-dependent entry. These results define molecular signatures of SARS-CoV-2 protease choice and lung cell infection.
Effectiveness of physical therapy for locomotive syndrome: A systematic review and meta-analysis protocol
Locomotive syndrome, characterized by impaired mobility owing to musculoskeletal disorders, poses a significant public health challenge, especially in aging populations. Locomotive syndrome limits physical activity, increases fall risk, leads to dependency, and diminishes quality of life. Effective interventions are urgently required. This systematic review and meta-analysis aims to evaluate the effectiveness of physical therapy in improving the symptoms of locomotive syndrome. A systematic evaluation of its effectiveness compared with other interventions is crucial for informing clinical practice and policy decisions. This systematic review and meta-analysis will follow the PRISMA-P guidelines. Studies involving individuals diagnosed with locomotive syndrome, without restrictions on age, sex, or location, will be included. The reviewed interventions will include exercise programs, manual therapy, neuromuscular stimulation, and balance training, which will be compared with the absence of interventions or alternative therapies. The primary outcomes will include improvements in functional mobility and physical performance, symptom reduction, and the progression of locomotive syndrome. Secondary outcomes will include adherence to therapy, safety, quality of life, and psychological well-being. Randomized controlled and non-randomized controlled trials published in peer-reviewed journals will be searched in PubMed, CENTRAL, CINAHL, PEDro, Ichushi Web, and the Thai-Journal Citation Index Center, without language restrictions. Independent reviewers will perform data extraction and assess the risk of bias. A meta-analysis will be conducted using RevMan 5.4 software, with subgroup analyses to address heterogeneity. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach will be used to evaluate the certainty of evidence. This review aims to provide robust evidence on the effectiveness of physical therapy in managing locomotive syndrome and to potentially guide clinical practice and healthcare policy decisions.
A Multi-load balancing control strategy for a novel low carbon integrated energy system for buildings
With the escalating global energy demand and the pressing need for clean energy, innovations in building energy systems are crucial. This paper proposes a Multi - load Balancing Control Strategy (MLBS) based on the Improved Tuna Swarm Optimization (ITSO) algorithm. By integrating battery and compressed air energy storage, the strategy enhances the building energy system’s flexible dispatch capability.A building complex in Huai’an, Jiangsu is used as a case study. Two cases are compared: one without MLBS and the other with MLBS using a low - carbon economic dispatch model. Results show that MLBS effectively adjusts electric and thermal loads. After applying MLBS and the low - carbon economic dispatch strategy, the quarterly planning cost drops to 110.37 million, the operating cost to 204.28 tons, the carbon trading cost to 8.15 million, and the total carbon emission to 137.27 million, significantly lower than the values without the strategy. Moreover, the TSO - MLBS energy scheduling strategy adopted in this paper has the shortest computation time and lower energy scheduling cost, offering a double improvement in economic efficiency and carbon emission reduction.
The molecular phase diagram of carbon dioxide by molecular simulations of the TraPPE model
The determination of the phase diagram of carbon dioxide by using exclusively experimental techniques has been prevented by the strong metastabilities of solid phases and the hysteresis in some phase transitions. Quantum mechanical methods have played a crucial role in this field helping the characterization of the molecular/non molecular character of the phases. Nowadays, it is well-established that CO2-I, CO2-II, CO2-III (first termed as VII), and CO2-IV phases are molecular phases in contrast with high temperature and high pressure non-molecular phases such as CO2-V and CO2-VI. In this work, we explore the ability of the molecular force field TraPPE to describe the molecular part of the carbon dioxide phase diagram by using classical Monte Carlo and molecular dynamics simulations. As it will be shown, this model predicts very accurately the fluid-I transition line and the stability of phases CO2-I, CO2-II, CO2-III, and CO2-IV in well-defined regions of the phase diagram. The main shortcomings are the small size of the stability regions of CO2-II and CO2-III and the appearance of CO2-II, CO2-III, and CO2-IV phases at too low pressures. In addition, the densities of the solid phases are only well-predicted for CO2-I and at pressures lower than 3 GPa. At higher pressures, the density is underestimated for all the solids. The results clearly indicate that although the TraPPE model does a reasonable job in describing the phase diagram of CO2, there is still room for improvement.
Establishing standardized conditions for clinically available sound-localization tests: A multicenter approach
Sound localization is essential for auditory spatial awareness. The process relies on interaural differences in timing and level, and spectral cues. This study aimed to standardize sound-localization testing conditions across facilities in Japan, analyze the impact of early reflected sounds on localization accuracy, and compare outcomes between individuals with normal hearing and those with unilateral hearing loss. This study included 77 participants with normal hearing and 45 individuals with unilateral hearing loss, at 11 facilities. Sound-localization tests were conducted using nine loudspeakers arranged in a 180° horizontal arc. The stimuli consisted of Comité Consultatif International Téléphonique et Télégraphique (CCITT) and low-pass CCITT noise bursts at randomized levels of 50, 55, and 60 dB SPL. The reflected sound measurements employed time-stretched pulses to analyze early reflections (4–7 ms). The localization accuracy was assessed using the root-mean-square error and mean deviation score. Localization performance was negatively influenced by early reflections, with reflected sound envelope area and peak values within 4–7 ms correlating significantly with reduced accuracy (r = −0.535 to −0.555). Participants with normal hearing achieved a root-mean-square error of 2.0° ± 4.8°, whereas participants with unilateral hearing loss exhibited significantly greater errors (68.4° ± 40.7°, p < .001). Asymmetries in the left–right response accuracy correlated positively with the reflected sound characteristics (r > 0.6). Noise type (normal vs. low-pass CCITT) did not significantly impact performance in either group. Early reflections significantly compromise sound-localization accuracy, particularly in smaller testing environments where reflections overlap with direct sounds. Standardized testing protocols, in which early reflections are controlled, are critical for reliable assessments. The use of sound-absorbing materials can enhance the test precision, particularly in the clinical evaluation of unilateral hearing loss. These findings emphasize the need for optimizing acoustic conditions to improve the reliability and accuracy of sound-localization testing.