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Ceftobiprole versus ceftriaxone ± linezolid in Community-Acquired Bacterial Pneumonia (CABP): Re-analysis of a randomized, phase 3 study using 2020 FDA guidance

Background Ceftobiprole is an advanced-generation cephalosporin with activity against methicillin-resistant Staphylococcus aureus, resistant pneumococci, and Enterobacterales. In a Phase 3 study in community-acquired bacterial pneumonia (CABP) performed prior to the current US Food and Drug Administration (FDA) guidance, clinical cure at the test-of-cure visit (TOC) was the primary endpoint. We present a re-analysis using early clinical success as the primary endpoint per the 2020 FDA CABP Guidance. Methods In this multicenter, double-blind study, patients with CABP requiring hospitalization were randomized to intravenous ceftobiprole (500 mg q8h) or ceftriaxone (2000 mg q24h) ± linezolid (600 mg q12h) for 3–14 days. The primary endpoint was clinical success at Day 3 (improvement in ≥2 symptoms of chest pain, cough, productive sputum, difficulty breathing). A 12.5% non-inferiority margin was used. Results Of the original 638 patients, 618 (97%) had ≥ 2 symptoms and were included in the Day 3 Intent-to-Treat (ITT) population for the re-analysis. The Day 3 modified ITT population consisted of 187 patients (29%) meeting additional FDA Guidance including Patient Outcomes Research Team (PORT) classification ≥III. Ceftobiprole was non-inferior to ceftriaxone for clinical success for Day 3 ITT (71.0% vs 71.1%) and Day 3 modified ITT (71.1% vs 66.7%) populations. The 28-day all-cause mortality was 1.6% (ceftobiprole) vs 2.6% (ceftriaxone) in the Day 3 ITT population and 2.1% vs 7.8% in the Day 3 modified ITT population. Conclusion Ceftobiprole was non-inferior to ceftriaxone ± linezolid for clinical success at Day 3 according to the current 2020 FDA CABP Guidance.

Household cooking frequency and diet quality are mediated by food shopping behaviors among U.S. African-American adults: A NHANES analysis

Among U.S. adults who self-identified as African-American, frequent household cooking is related to better dietary quality and adherence to U.S. dietary guidelines, as measured by the Healthy Eating Index. However, African-Americans often reside in commercially disinvested areas with limited access to major food retailers. This study examined whether food shopping behaviors—travel time to grocery store and frequency of major food shopping—affect the relationship between cooking frequency and diet quality, potentially influencing community nutrition education outcomes. Using data from 2,434 non-Hispanic Black adults (≥ 18 years) from the 2007–2010 NHANES cycles, we performed linear regression analysis with Complex Sample General Linear Models (CSGLM). The Healthy Eating Index 2010 measured daily and dinner dietary quality. Mediation analysis was conducted to evaluate if food shopping behaviors are involved in potential causal pathways. Results showed that major food shopping frequency, but not travel time to a grocery store, was significantly associated with daily diet quality and cooking frequency (p < 0.001). Mediation analysis revealed that food shopping frequency significantly mediated the relationship between cooking frequency and dinner quality (52.44% mediating effect). When stratified by food security status, shopping frequency was only a significant mediator of cooking frequency and diet quality for those with full or marginal food security (64.89% mediating effect). For food-insecure individuals, major food shopping did not mediate the cooking-diet quality relationship. These findings suggest that food shopping frequency is a critical factor when assessing the link between cooking frequency and diet quality, and may inform factors to optimize food shopping behaviors within community nutrition education programs among those experiencing food-insecurity in the U.S.

Fossil fuel methane emissions likely underestimated in a model based on atmospheric δ ¹³ C trends

Selection for florfenicol resistance at sub-MIC concentrations in Pasteurella multocida

Antimicrobial resistance is a global threat to both human and animal health, and transfer of resistance between these spheres is recognised as a key concern for all species. Selection for resistance at sub-inhibitory antimicrobial concentrations has been characterised for some bacteria-antimicrobial combinations but there is little data from non-laboratory strains, and veterinary antimicrobials and bacterial species. Here, we demonstrate a minimum selective concentration of 0.06 mg/L (1/6 xMIC) for florfenicol in wild-type Pasteurella multocida, through competition experiments between a susceptible strain and a floR-resistant mutant. We also show that sub-inhibitory concentrations of florfenicol do not appear to significantly select for de novo resistance in P. multocida and present the challenges with adapting experimental protocols between bacterial species. These results have important implications for antimicrobial resistance selection at sub-inhibitory concentrations, method development for within-species differentiation in novel bacterial species, and application to policy regarding antimicrobial contamination in animal-feed.

Design, development and pilot of a realistic virtual reality application to analyse quick directional change in sport: Avatar cutting scenario with alterable parameters

Injuries during quick directional change (cutting) are common, particularly to the anterior cruciate ligament of the knee. Cutting is subsequently a focus in research and clinical practices. However, it is usually assessed in situations with low ecological validity. As a solution, virtual reality (VR) has been used to replicate sporting scenarios. The current paper details the design, development, and piloting of a VR application based on an unanticipated-cutting scenario using an avatar-opponent blocking manoeuvre. The VR environment is highly realistic, avatar approach is instigated by the movement of the headset user, and simple input alters the avatar’s movements and spatiotemporal demands of the cutting task. Piloting occurred in two stages: the first involved three participants and focused on initial system testing and parameter optimisation, the second focused on a pilot case study with a female participant of typical population. The case study evaluated the effects of using different visual cutting cues on frontal plane knee kinematics and kinetics linked to injury risk. Twenty-five successful, unanticipated, 90⁰ cutting manoeuvres to the left were analysed in three conditions: 1) physical world with arrows, 2) VR environment emulation with VR arrows, 3) VR environment emulation with VR avatar opponent. Mean knee angle during the arrow conditions, both physical and VR, presented abduction angles (−8.82° ± 1.44; −2.66° ± 0.90), yet cutting around the avatar opponent presented knee adduction angles (9.78° ± 0.44). During the 50 ms prior to heel strike, pelvis velocity was lowest and cutting foot velocity highest in the avatar condition compared to arrow conditions. This indicated the VR environment acts as a suitable control and that cutting strategy was adapted approaching the avatar, displaying more caution on approach. The avatar-based application has the potential to improve the ecological validity of cutting assessment and make a VR application more accessible to researchers and clinicians, with further development.

The association between community solidarity and adoption of public health preventive measures during the COVID-19 pandemic in a cross-sectional, multi-national sample

Background Few studies have examined the association between community solidarity and health-related behaviors. This study investigates solidarity in navigating challenges during the COVID-19 pandemic. Methods We used cross-sectional data from a multi-national survey of 1,346 respondents to examine (1) factors relating to feelings of solidarity, and (2) associations between solidarity and public health preventive behaviors. Results More than half (53.1%) of participants expressed feelings of solidarity; they were more likely to be aged 30 years or over, employed full-time, and residing in Eastern economies. We found a statistically significant association between positive feelings of solidarity and three of five COVID-19 prevention behaviors (social distancing, skipping an event, and masking in public). Those who reported previous influenza vaccination were also more likely to adopt these behaviors. Discussion The findings underscore the potential of fostering community solidarity to enhance prosocial actions amid widespread emergencies.

A flow pattern recognition method for gas-liquid two-phase flow based on dilated convolutional channel attention mechanism

Addressing the issue of insufficient key feature extraction leading to low recognition rates in existing deep learning-based flow pattern identification methods, this paper proposes a novel flow pattern image recognition model, Enhanced DenseNet with transfer learning (ED-DenseNet). The model enhances the deep feature extraction capability by introducing a multi-branch structure, incorporating an ECA attention mechanism into Dense Blocks and dilated convolutions into Transition Layers to achieve multi-scale feature extraction and refined channel information processing. Considering the limited scale of the experimental dataset, pretrained DenseNet121 weights on ImageNet were transferred to ED-DenseNet using transfer learning. On a gas-liquid two-phase flow image dataset containing Annular, Bubbly, Churn, Dispersed, and Slug flow patterns, ED-DenseNet achieved an overall recognition accuracy of 97.82%, outperforming state-of-the-art models such as Flow-Hilbert–CNN, especially in complex and transitional flow scenarios. Additionally, the model’s generalization and robustness were further validated on a nitrogen condensation two-phase flow dataset, demonstrating superior adaptability compared to other methods.

Effect of technology-aided training on physiological and psychological sports performance: Moderation analysis of sport involvement

This study investigates the impact of technology-assisted sports training on the physiological and psychological performance of recreational exercisers (non-athletes), with particular attention to the moderating role of sport involvement (SI). A quasi-experimental design was employed, with 48 participants randomly assigned to either an experimental group (technology-assisted training) or a control group (traditional coaching) for an eight-week training program. Performance measures included exercise self-efficacy (ESE) and squat speed (SS). Data were analyzed using ANCOVA and linear mixed models. The results showed that technology-assisted training significantly improved SS (p = 0.026), but had no significant effect on ESE (p = 0.905). Furthermore, SI moderated the relationship between training method and ESE: participants with low SI demonstrated significant improvements in ESE under traditional coaching (p = 0.006), whereas those with high SI showed no significant differences between training methods. These findings suggest that while sports technology can enhance physical performance, it does not necessarily improve exercise self-efficacy. For individuals with low sport involvement, traditional coaching remains essential, highlighting the importance of combining technology with interpersonal interaction. Future training strategies should be customized according to participants’ levels of sport involvement to optimize both performance and psychological motivation, thereby promoting broader health engagement and exercise participation.

Correction for Liu et al., Transparency by Chinese cities reduces pollution violations and improves air quality

Identification of key genes associated with anthracnose resistance in Camellia sinensis

Anthracnose, a prevalent fungal disease in tea plantations, cause substantial economic losses in tea production. Identifying resistance-associated genes in tea plants is crucial for developing anthracnose-resistant cultivars. This study used eight tea samples with differential anthracnose resistance for phenotypic evaluation, weighted gene co-expression network analysis (WGCNA) of RNA-seq data, WGCNA- QTL co-localization to identify resistance gene, and qRT-PCR validation of candidate genes. in vitro pathogen inoculation assay revealed that the lesion diameters of the eight samples ranged from 1.45 mm to 4.5 mm (ANOVA p = 4.4×10−10). Using the ‘Longjing 43’ reference genome, transcriptome assembly achieved 93.9% gene detection rate (31,509/33,557 genes). WGCNA categorized expressed genes into 30 modules with the purple module (containing 907 genes) showing positive trait correlation and the yellow-green module (containing 781 genes) exhibiting negative correlation. Integration of WGCNA and QTL mapping identified two high-confidence candidate genes within LG08 QTL intervals. Both genes exhibited significant upregulation (t-test p < 0.01) in tea plant leaves following Colletotrichum spore inoculation. These findings provide actionable genetic targets for marker-assisted breeding of anthracnose-resistant tea cultivars.

Rockburst grade evaluation and parameter sensitivity analysis based on SSA-PNN framework: Considering rock mass strength

The occurrence of rockburst is closely related to the strength and stress conditions of rock mass. The Lalin Railway tunnel in China was taken as an example, the strength and stress parameters of rock mass at 22 rockburst locations were obtained by using the results of indoor and outdoor tests, including maximum in-situ stress, maximum tangential stress, uniaxial compressive strength of rock and uniaxial compressive strength of rock mass. These four parameters were then selected to form a rockburst grade evaluation index system. Furthermore, SSA (Sparrow search algorithm) and probabilistic neural network (PNN) were used to construct a rockburst grade evaluation network, and the sensitivity of rockburst grade evaluation parameters was therefore analyzed. It shows that SSA could determine the smoothness factor of PNN efficiently, and it is reasonable to use SSA-PNN framework to evaluate the rockburst grade; maximum tangential stress and uniaxial compressive strength of rock mass have the greatest influence on the accuracy of rockburst grade evaluation, followed by maximum in-situ stress, and uniaxial compressive strength of rock has the least influence on the accuracy of rockburst grade evaluation; integrated maximum in-situ stress, maximum tangential stress, uniaxial compressive strength of rock and uniaxial compressive strength of rock mass, the rockburst grade evaluation results are highly reliable. The results presented herein may provide important reference value for the rockburst grade evaluation and the selection of rockburst grade evaluation parameters.

Direct agglutination test: Evolution and significance as a simple and safe alternative to tissue aspiration procedures in the diagnosis of visceral leishmaniasis

Although tissue aspiration procedures (TAPs) are considered the gold standard for visceral leishmaniasis (VL) diagnosis, they often fail to detect disease progression before the amastigote-demonstrable phase. To overcome this limitation, a primary direct agglutination test (DAT) was developed using intact Leishmania donovani promastigotes initially treated with trypsin as the antigen. To enhance the exposure of specific epitopes on the promastigote surface and antibody-binding sites, alternative proteolytic agents were evaluated and incorporated into antigen processing and test execution. This approach led to significant or complete inhibition of agglutination in most known cross-reacting disorders. The LQ-DAT consistently demonstrated highly reproducible results across diverse geographical regions, regardless of the L. donovani sub-species or strain. To facilitate routine implementation and local production, the LQ-DAT processing know-how was disseminated to all major VL-endemic areas. Sensitivities comparable to TAP outcomes were demonstrated in 2,224 of 2,697 VL cases successfully diagnosed and treated over 35 years of routine, epidemic, and outbreak evaluations. Notably, 473 (17.5%) of these cases were symptomatic, with TAP-negative but LQ-DAT-positive results, and responded favorably (98.0%−100%) to specific treatment. Given the lower sensitivity also demonstrated by LQ-DAT, TAP does not meet the criteria for classification as the gold-standard VL diagnostic. Consequently, a positive response to specific anti-leishmanial treatment is recommended as a benchmark for diagnostic reliability. Beyond its advantage in detecting VL at earlier stages compared to TAP, the improved LQ-DAT described here also exhibited feasibility and stability required for local production in low-resource settings.

Vibrio cholerae O1 El Tor A1552 encodes two functional ornithine lipid synthases and induces ornithine lipid formation under low phosphate and under low salinity growth conditions

Ornithine lipids (OLs) are phosphorus-free membrane lipids that can be formed by a wide range of bacteria. The presence of OLs is frequently related to the resistance to abiotic stress conditions, and their synthesis is often induced as part of various stress responses. Two different pathways for synthesizing OLs are currently known: the OlsBA pathway, first described in Sinorhizobium meliloti, and the OlsF pathway, first described in Serratia proteamaculans. We identified in the genome of Vibrio cholerae O1 El Tor A1552 two genes encoding OlsF homologs, VC0489 is located on chromosome 1, whereas VCA0646 is located on chromosome 2. Both synthases, when expressed in Escherichia coli, caused the synthesis of OLs. Single mutants deficient in each of the OL synthases, double mutants deficient in both OL synthases, and mutants deficient in the transcriptional regulator PhoB were constructed and characterized. We corroborated that VC0489 is solely responsible for the synthesis of OLs under phosphate limitation. The deletion of VC0489 reduced the growth velocity compared to the wildtype under phosphate-limiting conditions but not under phosphate-replete conditions. The expression of VCA0646 is favored under low salt growth conditions, and its deletion abrogates OL synthesis at low salinities. The absence of VCA0646 and, therefore, the lack of OLs under low salt conditions makes the respective mutant more susceptible to polymyxin than OL-forming strains under these conditions. None of the mutants was affected in biofilm formation, swimming, or virulence assays using standardized survival assays with Caenorhabditis elegans or Galleria mellonella. Here, we describe two functional OL synthases present in a single bacterium for the first time, and we show evidence that OLs have an important function during the V. cholerae lifecycle.

Ability to control forehand groundstroke of skilled tennis players

In tennis, the ability to hit groundstrokes accurately to a target area on the court is important. It is a common belief in tennis coaching that greater concentration leads to more accurate targeting. The purpose of this study was to test this belief by evaluating the variability of the ball-landing position when hitting toward target areas of different sizes and locations. Ten male top-level college tennis players performed forehand strokes and aimed at four target areas: 1) a short area (Short) between the service line and baselines, and 2) a deep area (Deep) just inside the baseline, both with an identical target size (2*2 m); and 3) a large area (Big, 2*4 m), and 4) a small area (Small, 1*1m), both centered in the same location. The average ball-landing position, standard deviation (SD), and bivariate variable error (BVE) were calculated. SD and BVE were normalized relative to the distance between the player and center of the target area. SD in the depth direction (net-baseline direction) was significantly smaller in Short than Deep, but the normalized SDs showed no difference. SD in Big was not significantly different from that in Small, suggesting that it is inherently difficult even for advanced tennis players to intentionally control the distribution of their ball-landing positions.

Editorial Note: Fertility return after hormonal contraceptive discontinuation and associated factors among women attended Family Guidance Association of Ethiopia Dessie model clinic, Northeast Ethiopia: A cross-sectional study

“We have to amplify what we saw at EBOVAC” – Assessing participant perceptions, attitudes, and acceptability of an ancillary care policy in an Ebola vaccine trial in the Democratic Republic of the Congo: A mixed methods study

Introduction In a vaccine trial conducted between 2019 and 2022 in Boende, a remote, resource-constrained area of the Democratic Republic of the Congo, our research team developed an ancillary care (AC) policy to provide adequate care and follow-up for concomitant adverse events (AE), whether study-related or not. The trial aimed to assess the safety and immunogenicity of an Ebola vaccine regimen among approximately 700 healthcare providers and frontliners to strengthen outbreak preparedness in this Ebola-endemic region, where access to healthcare is severely limited by poverty, weak infrastructure, and an overstretched health system. Methods A mixed-methods approach was used to assess participants’ acceptability of the AC policy. First, participants with AE completed a questionnaire (1-–5 scale; 6 questions on AC policy support, 4 on the consequences of no support, and an open comment field). Second, a telephone survey (1-–3 scale; 3 questions evaluating the AC policy, 1 on unsupported AE and an open comment field) was conducted with participants, both with and without AE. Descriptive statistics were used for quantitative data analysis, while open comments were coded qualitatively. Third, semi-structured interviews were conducted with participants who experienced a (serious) AE and either benefited from or did not benefit from the policy. Participants were selected using purposive and convenience sampling, and thematic analysis was performed. Results Of 185 individuals with AE, 290 surveys were collected, with 93.5% expressing (very) strong appreciation for the AC policy. In the telephone survey, all 311 respondents supported the AC policy and emphasized its importance, 88.1% indicated it addressed their medical needs, and 35.7% reported experiencing an AE not covered by the policy. The 17 interviews revealed three major themes: 1) Experiences with AE management and AC support; 2) Financial impact of (non-) support; 3) Expectations of AC support. Participants who received AC reported personal, medical, and financial benefits, but noted limitations, such as the scope and duration of support, variations in local healthcare practices, and administrative hurdles. Conclusion Both quantitative and qualitative findings show high endorsement for the AC policy support, regardless of participants’ personal use. This acceptability study highlights the importance of AC in clinical trials and comprehensive participant care in research.

Development and validation of a clinical prediction model for in-hospital heart failure risk following PCI in patients with coronary artery disease

Objective Patients with acute coronary syndrome (ACS) are at increased risk of in-hospital heart failure (HF) following percutaneous coronary intervention (PCI), yet understanding of the associated risk factors is limited. This study aims to identify predictors of in-hospital HF after PCI and to develop and validate a clinical prediction model for the early identification of high-risk patients. Methods We retrospectively analyzed data from the patients hospitalized for ACS who underwent PCI at Henan Provincial Hospital of Traditional Chinese Medicine from 01/01/2019–01/10/2023. Patients were classified into non-HF and HF groups based on the occurrence of heart failure after PCI. LASSO regression and logistic regression were employed to identify potential predictors. The model’s diagnostic efficacy was assessed using receiver operating characteristic curves and calibration curves, while decision curve analysis and clinical impact curve were utilized to evaluate clinical benefits. Results A total of 309 patients were included in this study, of whom 79.93% were male, with a mean age of 57.84. Key predictors included New York Heart Association (NYHA) classification, smoking status, right coronary artery occlusion after PCI, left ejection fraction (LVEF), and N-terminal fragment of brain natriuretic peptides. The area under the curve (AUC) was 0.910 (95% CI: 0.868–0.953), indicating strong predictive ability. Decision curve analysis and clinical impact curve demonstrated good clinical applicability of the nomogram. Conclusion The identified predictors and the prediction model can be used in identifying high-risk individuals who develop HF hospital admission after PCI, or as a basis for further guiding personalized prevention and treatment.

QnAs with Anne K. Churchland

The impact of IRT and IDT on metaverse adoption in tourism: The moderating role of personal innovativeness among China’s generation Z

This study examines the Metaverse—a virtual world that merges entertainment, work, and social interactions—in terms of leisure tourism, using the frameworks of innovation resistance and diffusion theories. It explores the factors that drive and hinder Chinese Gen Z tourists’ resistance to Metaverse technology, including the moderating role of personal innovativeness. An analysis of data from 400 Chinese Gen Z tourists revealed that, in addition to risk barriers, factors such as value, usage, image, and traditional barriers significantly impact innovation resistance. Conversely, this resistance is mitigated by compatibility, trialability, and relative advantage, as outlined in the Innovation Diffusion Theory (IDT). Additionally, Innovation resistance significantly and negatively affects usage intentions, while personal innovativeness influences innovation barriers and diffusion within the Metaverse. This study not only fills gaps in existing studies but also provides valuable insights for providers and developers of Metaverse tourism services.

Assessing the effects of design modifications on the use of wildlife exits designed for endangered Texas ocelots

Roadside exclusionary fencing is commonly used on highways to prevent wildlife-vehicle collisions. Although it can mitigate wildlife road mortality by limiting their access to the road, it can also create a barrier for wildlife stranded within the right-of-way. On State Highway 100 in Texas, the Texas Department of Transportation installed 10 wildlife exits (WEs) to allow endangered ocelots and other wildlife to escape the fenced roadway and minimize wildlife-vehicle collisions. Our study compared three types of WE designs within the same area from 2019 to 2024 to assess their effectiveness. The first design (Design A) was without a door and berm, and the second design (Design B) had a raised berm (10 WE sites) with a door (six WE sites) and no door (four WE sites). Lastly, a third design (Design C) had all the structural features of Design B, except for the raised berm removed from all ten WE sites. We used the approaches of four meso-carnivore target species (coyote, bobcat, northern raccoon, and striped skunk) as a metric and binomial generalized linear model as a statistical method to evaluate the effectiveness between three designs. The statistical analysis showed that the raised berm in Design B was the major cause for a decline in the approaches of meso-carnivore communities toward the WE sites. With the berm removal in Design C, the approaches of target species from road to habitat increased significantly in the sites without a door. Our study indicates that the WE door design might be another structural cause for limiting its effectiveness, where significantly lower approaches were recorded for meso-carnivores in the sites with a door compared to those without a door in Design C.