Nemeth et al. have sought to collect and collate the current knowledge generated on IPF disease development and progression through a review on the cellular heterogeneity during the progression and development of fibrotic lung disease and how these single cell studies provide insight toward identifying novel therapeutics for the treatment of IPF.This Research Topic titled “From Development to Senescence, Bridging the GAP in Pulmonary Fibrosis” sought to clearly define the role of developmental and senescence pathways that are abnormally regulated during the progression of interstitial lung diseases (ILDs). In contrast to the progress made in reducing the mortality in several other diseases including cancers, ILD mortality rates have remained constant over the last decade. ILDs are characterized by the loss of normal lung regions that are replaced by fibrotic tissue that replace normal alveoli leading to progressive respiratory failure and potentially death. The term ILDs is associated with several lung diseases including cystic fibrosis, scleroderma, sarcoidosis, and one of the most common forms of ILD, Idiopathic Pulmonary Fibrosis (IPF) . IPF is Gokey et al. One of the major pathways identified through genetic studies in mice has been the transforming growth factor-beta (TGFb) pathway. Al-Mudares et al. have sought to clarify the potential role of a TGFb pathway member growth differentiation factor 15 (GDF15), a protein that is ubiquitously expressed, that appears to play a role across the lifespan, as it has been implicated in early life diseases such as bronchopulmonary dysplasia to diseases associated with increased age such as COPD and IPF. The potential role of GDF15 in senescence points to another established risk factor of pulmonary fibrosis, increased age. The link between aging, exposure to injury, and senescence is further explored as a driving factor in onset of pulmonary fibrosis, which is increasingly critical as the world's population ages. Venosa defines the loss of normal cellular “fitness” through the progression of cellular senescence and discusses how as the patient ages, a major indicator of pulmonary fibrosis prognosis, the threshold of injury required to generate an irreversible phenotype is lowered, thereby increasing the potential for abnormal lung regeneration and onset of fibrosis. The link to chronic injury, and potential to treat the source of certain injuries is further explored by Duckworth et al., who collated current data on the role of herpes viral injury in the development of IPF and seek to clarify discrepancies as to whether herpes virus injury is a contributing factor. The potential mechanisms by which herpes virus induces fibrotic progression and whether treatment of viral injury may be beneficial in delaying fibrotic progression are discussed. In the current global environment, the potential role of viral infections leading to onset of pulmonary fibrosis is of eminent concern. The role of lung injury driven by Severe Acute Respiratory Syndrome coronavirus 2 that causes COVID-19, that leads to fibrotic remodeling in some patients is further explored by Kiener et al. The authors explore the various potential models available to study lung fibrosis in-vitro in human samples including the use of precision cut lung slices and organoids to study alveolar regeneration.Several pathways have been implicated in driving development and progression of pulmonary fibrosis. Single cell sequencing has identified that the Hippo/YAP pathway is aberrantly activated in IPF. The recently identified role for YAP during normal alveolar development and repair, as well as aberrant activation leading to abnormal repair that induces atypical cell phenotypes associated with pulmonary fibrosis. Open questions surrounding the function of Hippo/YAP signaling in both normal and pathologic alveolar repair and fibroblast activation have been summarized by Lopez-Rodriguez et al. have generated a novel study by which enhanced repair is capable in the bleomycin induced lung injury model. Instillation of primary AT2 cells into the lung 7 days post injury enhanced lung physiology compared to animals that did not receive AT2 cells when assessed at 14 days post injury.Understanding the mechanisms regulating alveolar repair, and determining ways to enhance alveolar regeneration, are beneficial approaches to identify potential efficacious treatments to delay or resolve pulmonary fibrosis. The most utilized model of pulmonary fibrosis is the use of bleomycin injury in mammalian models. Collectively these manuscripts collate and clarify the current literature in the field that defines the role of developmental and senescence pathways in the onset and progression of pulmonary fibrosis. This collection of timely and insightful reviews greatly assists the field in quickly organizing the current literature and providing novel insights that facilitates the advancement of the understanding of pathways and tools that may provide efficacious targets for delaying, preventing, or resolving pulmonary fibrosis and provide hope for patients diagnosed with this disease and its bleak prognosis.The author confirms being the sole contributor of this work and has approved it for publication.This work was made possible by the Pulmonary Fibrosis Foundation, by an independent grant from Boehringer Ingelheim Pharmaceuticals, Inc. who provided the financial support. The author meets criteria for authorship as recommended by the International Committee of Medical Journal Editors (ICMJE) and was fully responsible for all aspects of the trial and publication development.The author declares that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.


Aging is the major risk factor for many diseases but the mechanisms are poorly understood. The risk of developing hepatic steatosis increases with age and the health impact of this disease is negative and high. When challenged with high fat diets, long living Ames mice withstand the detrimental metabolic effects that occur in normal mice. We examined transcriptomic and epigenomic profiles of Ames and wild type hepatocytes in the presence or absence of fat to demonstrate that the epigenomic profile drives transcription factor and downstream gene expression resulting in susceptibility or resistance to fatty liver disease. We found that markers of steatosis are related to gene expression in wild type and Ames mice, and dwarf mice retain fewer lipid droplets compared to wild type mice. These studies will provide data to guide our understanding of mechanisms leading to hepatic disease and define factors that provide protection from age-related metabolic disorders.


Modern bioinformatics requires the use of many field-specific file formats. Two of the most prevalent formats for representing biological sequences are FASTA  and FASTfqfa is a pure Python package that aims to fill the needs of bioinformatics and computational biology researchers who want a simple and efficient solution for working with files in FASTA and FASTQ formats. It has no dependencies outside of the Python standard library (with the exception of backported dataclasses  for PythAlthough fqfa is written in pure Python, its performance is comparable to modules using C extensions like pyfastx  for taskfqfa is released under the BSD 3-Clause License and is available from GitHub and PyPI.


In their prospective multicentre study Stumpf et al. report on the humoral and cellular immunity to SARS-CoV-2 vaccination in the so far largest cohort of dialysis patients However, when looking in detail at the quantity of the antibody titre their humoral response is significantly lower than in health care workers or non-dialysis patients . More thIn addition to this apparent diminished antibody response in dialysis patients, concerns also remain about faster waning of antibody levels after vaccination in this group, as is described after natural infection Sandra Hasmann and Ulf Schönermarck designed the letter; all authors contributed significantly to the content of the letter and have accepted the final version.This article is based on previously conducted studies and does not contain any new studies with human participants or animals performed by any of the authors.The authors have nothing to disclose.


Mexican immigrants make up an increasing proportion of the US population 65 and older. Estimating outcomes for this population is complicated by return migration. Due to data limitations, theoretical frameworks and empirical evidence fail to provide clear indication of the economic selection mechanism of return migration, especially at older ages making it difficult to estimate economic determinants of return. Here two waves of data from the US based Health and Retirement Study and the Mexican Health and Aging Study are combined to create a novel dataset that enables a comparison of assets at older ages for those who stay in the US, those who return before age 50 and those who return at 50 and older. Unadjusted results show no difference in total net wealth at older ages between the three groups, with higher business assets among returnees and higher concentration of wealth in home equity among stayers. With evidence of higher inequality among stayers, lower median wealth in Mexico, and asset advantages operating through citizenship, older age return can be interpreted as a means to acquire a higher standard of living in retirement for non-citizen immigrants. Comparing assets between 2000 and 2012 reveal the vulnerability of stayers during the US housing crisis. These findings are novel because they point to return migration as a retirement strategy and expose a source of vulnerability among those Mexican immigrants who remain in the US into older ages.


The concern relates to the provenance of this article as brought to our attention by Faisal Alhawaj, who denies authorship of this article and others published in Cureus. These articles were submitted and subsequently published purportedly as an effort coordinated by Imam Abdulrahman Bin Faisal University to ensure all medical interns publish at least one peer-reviewed article in order to qualify for enrollment in a postgraduate residency program as stipulated by The Saudi Commission for Health Specialties (SCFHS).The journal has not been presented with enough evidence to warrant the formal retraction of these articles as both Imam Abdulrahman Bin Faisal University and The Saudi Commission for Health Specialties have failed to respond to numerous communications requesting additional information regarding these allegations. While we acknowledge that the provenance of these articles is very much in question, we cannot act until these claims have been investigated by the appropriate institutions with the results of said investigation communicated to Cureus.The concern and this note will remain appended to the above-mentioned article until Cureus is provided with official confirmation from Imam Abdulrahman Bin Faisal University or The Saudi Commission for Health Specialties.


Aboriginal people face challenges on several fronts when it comes to the health and wellbeing of their community, compared to the rest of the Australian population. This is no different in urban areas such as Australia’s largest urban Aboriginal community located in Blacktown, NSW, where sexually transmitted infections (STIs) remain an issue of concern. Across Australia, rates of infectious syphilis, human immunodeficiency virus (HIV), and hepatitis C infection have increased by 400, 260, and 15% respectively while gonorrhoea decreased 12% in the 5-year period from 2013 to 2017. This study explores how to address the barriers that prevent young Aboriginal people under 30 years of age from accessing STI treatment through Government Sexual Health Services.This qualitative study will use purposeful sampling to recruit 20 male and 20 female health consumers, 10 Aboriginal elders and 10 sexual health clinicians. This recruitment will be undertaken with the assistance of the local Government Health Services and local Aboriginal organisations. One-on-one semi-structured interviews will be undertaken by someone of the same gender in order to address cultural preferences. Data will be entered into NVivo and thematically analysed.This study will seek to add to the literature that explores why young Aboriginal people do not access sexual health services. This study seeks to understand the experience of clinicians, Aboriginal elders and Aboriginal young people to provide practical policy and clinical redesign evidence that can be used to improve the experience and cultural safety of sexual health services in urban areas of Australia. The results of the qualitative research will be disseminated with the assistance of participating local Aboriginal organisations, and the findings will be published through peer-reviewed scientific journals and conference presentations.The study is approved by the Western Sydney Local Health District Human Research Ethics Committee (HREC/16/WMEAD/449) and the New South Wales Aboriginal Health and Medical Research Council’s Human Research Ethics Committee (1220/16). The Closing the Gap report delivered the Australian Parliament a stark picture of the health of Australia’s first people [In 2008, t people . The scat people . Over tht people . Of partt people . The medt people . There iNSW STI Strategy 2016–2020 also identifies Aboriginal people as a priority population in the strategy and in particular focuses upon young people [Whilst the Aboriginal population across Australia represents 3% of the total population, incidence rates of STIs can range anywhere from 3 to 30 times higher than that of the non-Aboriginal population . AccordiAboriginal people in urban communities are often not the focus of research because the funding priorities of the Commonwealth Government tend to direct significant funding towards remote communities and leave state and territory governments to address health needs in urban areas . AborigiOne of the barriers to accessing sexual health services appears to be shame and stigma –10. The There is a significant gap in the published literature in terms of studies that seek to understand the issues that prevent Aboriginal people participating in sexual health care through the collection of directly obtained evidence. Many of the studies reviewed, including those undertaken by Bailie et al., Nattabi et al., Buhrer-Skinner et al. and Richmond et al., rely on the response of clinicians in quality improvement processes to guide the conclusions of their research –14. ThesThe status of sexual health amongst young Aboriginal people in Western Sydney is an area that has not been explored in any great depth within the published literature. The study undertaken by Biggs et al. provides a cross-sectional view of Aboriginal people attending public sexual health services in Western Sydney through an incentive-based program called ‘The Deadly Liver Mob’ . The DeaThis study will seek to add to the literature by exploring why young Aboriginal people do not access sexual health services. This study seeks to understand the experience of clinicians, Aboriginal elders and Aboriginal young people to provide practical policy and clinical redesign evidence that can be used to improve the experience and cultural safety of sexual health services in urban areas of Australia.This qualitative study will utilise content analysis design and undertake semi-structured one-on-one interviews with up to 40 health consumers , 10 clinicians and 10 community elders or until a saturation point is reached. Inclusion criteria for health consumers will be that they need to be between 18 and 29 years of age at the time of enrolment into the study. The semi-structured interview guide was developed with feedback from Aboriginal staff and Clinical Staff with specialist knowledge of sexual health. Wherever possible, we will be using Aboriginal interviewers to create culturally safe spaces for study participants to respond to questions. All cohort groups will be interviewed using a semi-structured interviewer-assisted questionnaire with the aim of answering the following questions:What prevents Aboriginal people in Western Sydney from accessing government sexual health services?What would enable Aboriginal people in Western Sydney to access mainstream services?Would changes in service modality make services more accessible?What do participants see as the most important things that could be implemented to improve sexual health services in Western Sydney?A target number was purely set to ensure gender equity amongst study participants, and data collection will cease once saturation has been reached. The study investigators have adequate qualifications and experience to undertake a qualitative study in the area of sexual health and have significant expertise in community engagement and co-design. The questionnaire is worded in plain English to ensure that potential participants with low literacy can also participate. Interviews will be audio recorded, and results of this study will be analysed using the software program, NVivo , so that major themes can be identified and thematically analysed.This data will create translational research that will assist service delivery models in publicly funded Sexual Health services in Western Sydney and perhaps more widely.Study participants will be free to withdraw from the study at any point up to where audio files are destroyed, post the transcription process. Participants will not be able to withdraw after this point because individual transcripts will only be coded with the participant’s interview cohort, gender and a sequential number; therefore, any individual submission will not be able to be identified for withdrawal.This study will be conducted in a manner that safeguards the anonymity of participants by ensuring that interview responses do not contain any identifying marks apart from an indication of age and sex. This will assist in protecting the privacy of Aboriginal people who choose to participate in the study. The value of Aboriginal interpretation is integral to this project’s success, and this will be achieved through the engagement of Aboriginal research assistants, consultation about the study design and through the engagement of Aboriginal people in the analysis of data and the final conclusions of the study. Involvement in the governance of the study is also of paramount importance, and every effort will be made to ensure participation.NSW Children and Young Persons (Care and Protection) Act 1998, the matter will be immediately reported to the NSW Department of Families and Communities, and referrals would be offered to relevant support services [The investigators anticipate that some risks may be posed by participants disclosing sensitive information particularly around the conduct of illegal activities, a history of sexual or physical abuse or need to have sexual health conditions treated. Should a disclosure of illegal activity be made, the interview would be immediately terminated in order to ensure that the participant did not further incriminate themselves. If the disclosure relates to any form of abuse that falls under the definitions of Section 27 of the services . In ordeThe results of this study will be disseminated through several different media including meetings with study participants, local elders and Aboriginal groups, peer-reviewed publications, presentation of results at conferences, and through summaries presented via social media.The contribution of local Aboriginal people will be acknowledged in all publications to reflect the unique contribution that they provide, and co-authorship of academic papers will be offered, consistent with University of Sydney policy on the matter. The research will be conducted in accordance with the National Health and Medical Research Council (NHMRC) guidelines for ethical research with Aboriginal people . Plain EThis study will provide benefits to Aboriginal people by enabling local health services to better understand and allocate resources to meet the needs of young Aboriginal people through the acquisition of more robust study data concerning how Sexual Health Services may best be delivered.The results of this study will be significant in informing urban health services on the needs of young Aboriginal people in terms of how they prefer to access public sexual health services and the barriers that currently exist that may prevent them from using existing services. Much of the research based both in remote areas and urban areas relies on the experiences of clinicians rather than the lived experience of young Aboriginal people themselves and may miss important aspects of interpretation that only occur when Aboriginal people share their insights. These insights will be deepened in this study by involving local Aboriginal people in the interpretation of the de-identified results of the study.This engagement project will provide a set of documents that will be informed by the local community and provide policy makers with practical measures that can be implemented to improve the cultural appropriateness and clinical care of young Aboriginal people. This study will also address important policy questions and directly inform on the delivery of healthcare to young Aboriginal people in urban settings.


We read with great interest the study by Poncette et al  on the dThe paper  illuminaA survey found high levels of satisfaction among students participating in the elective module. Confidence levels, as well as the acquisition of knowledge and skills in digital health, were reported to be high. However, this analysis is subjective as it is based on the student’s own opinion of their knowledge. In order to obtain more objective results, we recommend the assessment of individual skills by a standardized exam before and after participating in the module. Supplementing the opinion-based survey with exam performance may shed light on the actual perceived level of student competence while reducing selection bias. This would highlight the effectiveness of the course and give medical departments and universities more confidence to adopt digital health competencies in their curricula.We commend Poncette et al  not onlyThe introduction of digital health competencies into the medical curricula remains key to the success of future physicians as shown by Poncette et al . Therefo


Cavernomas are rare cerebrovascular malformations that usually occur in sporadic forms with solitary lesions located most often in the hemispheric white matter, but also in the infratentorial or spinal region. Multiple lesions at different CNS levels are considered a hallmark for the familial form of the disease. The diagnostic modality of choice for cerebral cavernous malformations (CCMs) is magnetic resonance imaging (MRI). We present an intriguing case of a 65-year-old male admitted to our hospital with tetraparesis and cognitive impairment where highly sensitive MRI sequences identified many cerebral cavernous lesions at the supra-, infratentorial and cervical–thoracic spine levels, some of them with recent signs of bleeding in a patient with oral anticoagulant therapy due to atrial fibrillation. The mechanism of cognitive impairment in this patient is most probably the interruption of strategic white matter tracts, as it is known to happen in other subcortical vascular pathologies. MRI can be helpful not only in mapping the anatomical distribution of lesions, but also in weighing the risks and making decisions regarding whether or not to continue oral anticoagulant therapy.


Younger Onset Dementia (YOD) and Mild Cognitive Impairment (MCI) are relatively prevalent conditions globally which can affect the job performance of individuals in their working lives. This presentation considers the existing research documenting actual, stated or intended approaches taken by employers to managing and supporting employees with these conditions. Nine relevant research projects were identified based on an extensive exploration of the peer reviewed literature. These show that employers have some knowledge of dementia, but do not recognise this as a possible explanation when performance changes occur in the workplace. Employees typically leave or are removed from the workplace before a formal diagnosis or soon after. The literature shows both supportive and unsupportive behaviours toward employees. Drawing from this literature recommendations for increasing the quality of support provided to employees are offered: awareness training to foster earlier detection, clarification of these conditions as a disability, and application of methods to support employees to continue to contribute to the workplace while this is feasible and desirable from both the employer and the employee’s perspective.


Population aging will inevitably bring an increasing burden of poor cognitive function. The risk factors for cognitive decline have been widely studied. Even though environmental hazards have the greatest adverse impacts on older adults and the existing evidence has shown that green space, air pollution, and weather have an impact on cognitive function, most of the studies were conducted in developed countries and limited to cross-sectional analyses. China has the largest aging population in the world so the research evidence from it can offer an insight to the study in other developing countries facing similar issues and inform future public health policy and disease control. Using the data from a nationally representative sample of adults aged 45 years and older from the three waves of China Health and Retirement Longitudinal Study (CHARLS 2011-2015) and China City Statistical Yearbook, this study estimated multilevel growth curve models for the effects of green space coverage, air pollution, and weather conditions on cognitive function and cognitive decline. It showed that after controlling for sociodemographic characteristics, built area green coverage rate was positively associated with cognition score at baseline, and higher annual minimum temperature was associated with faster decline in cognitive function. These effects did not substantially change after weekly total hours of physical activities and levels of social engagement were added and the interaction effects were examined between environmental conditions with them, respectively. More research on the mechanisms of the effects of environmental factors on cognition is needed such as the subgroup analyses.


Lycopene is a C40 tetraterpene that is composed of eight isoprene units joined by regular head to tail bindings, except in the middle of the molecule, where tail to tail binding forms an asymmetric structure  . Its abThis work was supported by the Incheon National University Research Concentration Professors Grant in 2021.The authors declare no conflict of interest.


Adherence to Cumbria Northumberland Tyne and Wear NHS Foundation (CNTW) Trust physical health monitoring guidelines for a caseload of community forensic psychiatry patients residing at Westbridge supported accommodation was audited to identify areas for improvement in practice. It was also our aim to highlight the delay in obtaining non-urgent investigations due to the need to minimize COVID infection transmission risks.Data were collected from mental health and acute trust electronic records (Rio and ICE) of all patients taking antipsychotic medications currently care coordinated by the Westbridge Forensic Community Mental Health Team (FCMHT) between January 2020 and January 2021 (8 patients). Analysis of compliance with standards set by Trust guidelines was made.In the chosen audit period, compliance with physical health monitoring standards was below target of 100% . Reasons for non-compliance were unexpected restrictions in service availability  and one omission of sending a prolactin levels request.The need for practice adaptation and advance planning by team in anticipation of potential delays was identified. Request for routine bloods and ECGs will now be made two months before the annual due dates to compensate for delays in the new process with plan to continue re-audit yearly.


This study targeted junior high school kendo club members who have practice experience with elderly kendo practitioners and examined the image of the elderly and the related factors that intergenerational exchange through kendo brings to the junior high school members. Kendo is one of the traditional Japanese martial arts. The subjects in this research were 193 players who practiced with the elderly kendo practitioners in Osaka prefecture. As a result of factor analysis to clarify the structure of the image, the "evaluation" factor and the "activity / competence" factor were extracted as in the previous research, and it was suggested that the junior high school players generally had positive image regarding the elderly practitioners. As a result of logistic regression analysis to clarify the factors related to the high/ low scores in the image of elderly kendo practitioners, "evaluation" factor showed a significant relationship between "intimacy with elderly practitioners" and "empathic interest", and "activity / competence" factor indicated a significant relationship between "gender" and "intimacy with elderly kendo practitioners." Although it is pointed out that the traditional style of kendo and the image of elderly kendo practitioners have a negative impact on children, it may be possible to control these factors through an appropriate guidance and approach depending on the children's stage of growth .


Stigma towards psychiatry feels rife within medical school and this extends from university life into clinical placements. Mental health remains an unattractive area of medicine and is frequently regarded as subpar by other specialists. Against existing literature, this study compares the authors first hand experiences over the last five years within medical school to evaluate how representative their experiences of stigma in psychiatry are for the wider community and published literature. The study aims to inform the wider discussion on this topic and offer areas where intervention may yield a better perception and hence uptake of this specialism.Literature review relating to the topic was completed. Studies pertaining to medical students and/or educators views and experiences of psychiatric medical education and clinical placement were included for discussion. A reflection on the first author's specific experiences to date of psychiatry and his intent to pursue psychiatric career was conducted, with careful reference to existing literature. This allowed validating personal experiences in light of shared experience within the medical community in various national and international settings.Arguably, some non-psychiatric clinicians do inadvertently set the scene early in medical school for the stigma that is to be thrust upon students. This builds upon prospective students ranking psychiatry low for satisfaction, prestige and stating it to be a ‘pseudoscience’ or words to that effect. The lack of understanding from junior medical students of the role of the psychiatrist sees them associating psychosocial education as equivalent to psychiatry. This reinforces the idea of psychiatry being grounded in sciences other than anatomy, biochemistry, physiology and pharmacology. On clinical placement, there is little cross-speciality support for those students who want to be psychiatrists and sometimes even lost opportunities for those publically aspiring towards psychiatry. Placements in psychiatry give students a better understanding of psychiatry but this does not seem to significantly change their career aspirations and this is rather defined from the admission stages.After comparing experience with literature, stigma towards psychiatry appears to be universal. It may be important to consider the types of students who are being attracted to medical school as currently students seem to have an intrinsic disinterest in psychiatry despite later becoming better informed through psychiatric placement. Culture is notoriously hard to change, particularly within medicine. This stigma exists both in the lay and medical communities with early potentially inaccurate lay views of psychiatry being validated and reinforced throughout medical school.


The tendency of caregiving alone is increasing, and these solo caregivers often perceive caregiving responsibilities as a burden. Still, literature on positive aspects of caregiving shows that not all caregivers experience severe distress. Little is known on which factors make a difference in experiencing caregiving distress among solo caregivers. We focused on the empirical findings on the negative impact of social isolation on caregiver’s mental health, examining if and how the intersection of solo caregiving and social isolation is related to severe caregiving stress among caregivers of older adults in Korea. We analyzed 501 family caregivers of older adults in Korea using survey data from the Care Work and the Economy research project (2018). We conducted ordinal logistic regression analysis. The findings show that solo caregivers with a lack of social time fall under the most at-risk group of caregivers in terms of experiencing severe stress  whereas solo caregivers with enough social time did not show significantly higher stress compared to the reference group . Being socially isolated caregivers still had high levels of stress despite the division of care , implying the need to provide caregivers more time for social interaction with others. The current public long-term care insurance in Korea provides limited hours of in-home care aide services to enable aging in place of older adults. To reduce the social isolation of caregivers, it is necessary to extend the service hours and provide support, such as creating online caregiver networks.


The 8th International Cancer Metastasis Congress through the Lymphovascular System: Biology & Treatment, was held from October 25–27, 2019 in San Francisco, California. This international conference was inaugurated in 2005 and has been successfully held biennially with several publications summarizing the biology and treatment of cancer metastasis. The last conference in 2017 was summarized in a special issue by Clinical and Experimental Metastasis , 4 with Cancer heterogeneity is discussed in the context of Breast Cancer Disparities in Outcomes; Unmasking Biological Determinates Associated with Racial and Genetic Diversity  and CancThe diversity of cancer biomarkers further validate that cancer is heterogeneous as represented by several review articles on Detection of Cancer Metastasis: Past, Present and Future ; SentineBased on the heterogeneous array of biomarkers, personalized cancer therapy is developed against specific biomarkers for more accurate targeted therapy as represented by the two review articles on Precision Oncology for Breast Cancer through Clinical Trials  and BrinThe role of cancer microenvironment exerts a selective force akin to Darwin’s natural selection –18 in thCancer clones may escape the primary site and spread initially to the sentinel lymph node as summarized in the Donald L. Morton’s Memorial Lecture: The Legacy of Donald Morton: Past, Present and Future  to suggeThe molecular mechanism of cancer metastasis through the lymphatic versus blood vessels is still not well understood. An attempt has been made to summarize what we know to date relating to the mechanisms of cancer metastasis in the following review articles on Mechanisms of Breast Cancer Metastasis ; The LymThe role of lymph node dissection and systemic treatment for a positive sentinel lymph node biopsy are discussed in depth using the model of melanoma, entitled Current Management of Melanoma Patients with Nodal Metastases . In-tranAdditional novel imaging of cancer is illustrated by Emerging Photoacoustic and Thermoacoustic Imaging Techniques for Detecting Primary and Metastatic Cancer and Guiding Therapy . Novel rFurther, innovations in radiotherapy are described in Innovations in Radiotherapy and Advances in Immunotherapy for the Treatment of Brain Metastases . Check pSecondary Lymphedema Related to Cancer Treatment by Surgery or Radiotherapy is an important topic relating to the treatment complication of cancer .The biological events of cancer development with mutation and cancer evolution as well as the molecular mechanisms of cancer metastasis may be more accurately correlated and defined by the adoption of artificial intelligence as summarized in the review article on Empowering Study of Breast Cancer Data with Application of Artificial Intelligence Technology: Promises, Challenges, and Use Cases .This Special Issue: Novel Frontiers in Cancer Metastasis emphasizes that cancer is a heterogeneous disease resulting from genetic mutations or epigenetic changes . Such he


The Eastern and Western Mediterranean are separated by an elevated plateau that regulates water exchange between these two basins. The Maltese archipelago, situated atop this topographic high, offers a unique window into the evolution of this plateau in the lead up to the Messinian Salinity Crisis. The Upper Coralline Limestone Formation was deposited between the late Tortonian and the early Messinian and was probably terminated by palaeoceanographic events related to the Messinian Salinity Crisis. It represents the youngest Miocene sedimentary deposits outcropping in the Maltese archipelago. This shallow‐water carbonate unit can be used to trace palaeoenvironmental changes atop the sill between the Eastern and Western Mediterranean and to explain the possible water flow restrictions to the Eastern Mediterranean that could have preceded the Messinian Salinity Crisis. Here field surveys, and analysis of the depositional environment within the Upper Coralline Limestone in Malta, are combined with recently acquired multichannel seismic reflection profiles between Malta and Gozo, to reconstruct the depositional sequence in the Malta Plateau during the late Miocene. The Upper Coralline Limestone consists of multiple coralline and larger benthic foraminifera dominated facies, extending from subtidal to intertidal environments. These accumulated in two depositional cycles observed in both outcrop and seismic reflection data. Each cycle exhibits an early aggradation–progradation phase followed by a progradation phase and a final aggradation phase. These manifest themselves in the outcrops as shallowing and deepening upwards phases. These were deposited above a deep water unit and are indicative of a preceding uplift phase followed by filling of the accommodation space through the deposition of the Upper Coralline Limestone Formation in shallow marine depths. The presence of this highly elevated sill during the late Miocene could have restricted circulation to the eastern basin. The Upper Coralline Limestone formation in Malta offers a unique look at the gateway between the West and East Mediterranean in the period before the Messinian Salinity Crisis (MSC). Here we revisit this unit using both field bases sedimentological analysis and seismic imaging to document the evolution of this sequence. The findings illustrate the ongoing uplift of the barrier between the basins before the MSC. This mineral assemblage suggests that material had been recrystallised at some point post‐deposition. The absence of dolomite suggests an open system that allowed removal of the Mg. The implication of this would be that any geochemical analysis would inform of the diagenetic rather than the primary conditions , and the known eustatic sea‐level patterns (Miller et al., The emplacement of two cycles of shallow‐water deposits in the UCL formation, terminating near sea level, indicates that accommodation space was available for the establishment of two depositional cycles and topography fill by a carbonate factory. The fact that a C‐type factory is dominant in Malta at this time, while in other regions of the Mediterranean T‐type factories are still dominant Follows, , does su6Over the late Miocene, the area around the Maltese Archipelago has experienced a significant uplift. The uplift raised the Maltese Islands to a water depth that allowed the emplacement of a shallow‐water carbonate unit in the form of the UCL Formation. This unit was deposited during two depositional cycles, with both cycles characterised by a strong tendency towards filling the available accommodation space typical of C‐type carbonate factories. The mode of emplacement and overall geometry suggests a very shallow position of the Malta Plateau, conforming to an existing tectonic structure already present in the late Miocene. This uplift appears to have played a role in restricting connectivity of the water masses between the east and the west Mediterranean prior to the onset of the MSC and could have played an important role in triggering halite deposition in the larger Eastern Basin prior to salt deposition in the Western Basin. This uplift would have restricted flow to the Eastern Basin at a time when the Western Basin was still relatively well‐connected to the Atlantic Ocean and probably played a pivotal role in the observed differences in deposits between the two basins during the MSC.Figure S1Figure S2Figure S3Click here for additional data file.


Gratitude is foundational to well-being throughout the life course, and an emerging body of work suggests that older adults may be more inclined to attribute gratitude to a non-human target (God). Drawing on life course theory and Erikson’s lifespan development framework, we use data from a national sample of Christian older adults from the United States  to examine whether gratitude towards God buffers the noxious health effects of the death of a loved one or personal illness. Results suggest that gratitude towards God tends to predict better age-comparative and global self-rated physical health in the aftermath of stress, a moderation effect which is partially mediated by stronger beliefs in God-mediated control . We conclude by proposing some interventions for clinicians and counselors centered around gratitude and religiosity that may assist older adults in coping with major life stressors.


From December 2020 – February 2021 we conducted 32 semi-structured interviews with Veterans who responded to our initial and follow-up surveys and agreed to discuss their cannabis use. We coded and themed the interviews using inductive thematic analysis. We found that many Veterans are using cannabis in place of other medications such as opioids and benzodiazepines and often do so to avoid the negative side effects. However, barriers such as Veterans Administration policies and cost of medical cannabis affect Veterans ability to obtain medical cannabis. Our results inform clinicians and policy makers on the use of cannabis as an alternative to prescription medications for treating chronic pain and other conditions in older Veterans.


We discuss a stepwise approach using properties of the conduction system to diagnose the patient’s tachycardia. The presenting ECG is shown in Figure 2The ECG in Figure The most challenging part of interpreting a WCT is determining whether the mechanism is due to aberrant conduction versus VT, especially in light of a history of prior myocardial infarction. While there are numerous algorithms to help differentiate between the two,Shortly after the ECG in Figure The authors have nothing to disclose.


The importance of Public Involvement (PI) is increasingly being recognized in the field of dementia research. In 2012, Alzheimer Europe set up the European Working Group of People with Dementia (EWGPWD) which provides advice and input for all activities of the organization including several large European-funded research projects. The German Center for Neurodegenerative Diseases (DZNE) created a research advisory patient board in 2020 with the intention of supporting the board in strategic research decisions. Both groups are composed of people with dementia and act independently. With the aim of finding out whether PI in research is mutually rewarding and beneficial, members of both groups were asked about their motivation to be involved in PI research activities and the value this had for them. This was collected either through narrative interviews or during meetings. People with dementia described several reasons for being involved in PI activities in dementia research.


The concern relates to the provenance of this article as brought to our attention by Faisal Alhawaj, who denies authorship of this article and others published in Cureus. These articles were submitted and subsequently published purportedly as an effort coordinated by Imam Abdulrahman Bin Faisal University to ensure all medical interns publish at least one peer-reviewed article in order to qualify for enrollment in a postgraduate residency program as stipulated by The Saudi Commission for Health Specialties (SCFHS).The journal has not been presented with enough evidence to warrant the formal retraction of these articles as both Imam Abdulrahman Bin Faisal University and The Saudi Commission for Health Specialties have failed to respond to numerous communications requesting additional information regarding these allegations. While we acknowledge that the provenance of these articles is very much in question, we cannot act until these claims have been investigated by the appropriate institutions with the results of said investigation communicated to Cureus.The concern and this note will remain appended to the above-mentioned article until Cureus is provided with official confirmation from Imam Abdulrahman Bin Faisal University or The Saudi Commission for Health Specialties.


I am delighted to announce this new Methods X Article Collection on Groundwater on the occasion of the World Water Day 2022 dedicated this year to highlight the importance of this water resource.Groundwater constitutes about 30% of the world's freshwater resources. From the other 70% nearly 69% is captured in the ice caps and mountain snow and glaciers and only 1% is located in rivers and lakes. The thing is that according to these figures, groundwater is one of the keys to sustainability of world water resources and there is an urgent need to apply better management practices. Groundwater is extensively used worldwide for domestic, industrial, and agricultural purposes. In this sense both urban and rural areas rely on groundwater resources to meet their water demands. Over-exploitation of groundwater resources reduces water availability and results in negative impacts on groundwater-dependent ecosystems, such as springs and wetlands. In short, the main negative impacts to groundwater quality are caused by saline intrusion, the entrance of chemicals by diffuse sources, i.e., agricultural practices, by point sources such as the leaking of city sewage pipelines and lastly by inefficient waste management practices originated in landfills and other industrial activities like mining.-Conceptual model to include a broad range of emerging contaminants groundwater monitoring programs-Advances in mass spectrometric instrumentation to determine emerging organic contaminants and arsenic in groundwaters-Health risk assessment of nitrate leachates from agriculture and its impact on groundwater resources in mountainous catchments and as a source for drinking water-Hazard assessment models to predict and manage the impact of different types of landfills in groundwater resources-Water quantity and hydrological investigations using numerical and mechanistic models to investigate the groundwater potential zone of the aquifers-River and groundwater model algorithms for simulating the response of river water temperature to urban greeningBased on everything has been said groundwater quality and quantity issues are the major challenges identified and are discussed in the twelve papers selected in this article collection. These papers were published in the last few years in Methods X and evaluate practical aspects and state of the art methodologies such as:Examples reported here describe many different aspects related to groundwater research challenges. The first example discusses the need to develop a conceptual model that integrates various monitoring programs covering a broad range of organic wastewater contaminants like pesticides, pharmaceuticals and personal care products among others. The following two papers report mass spectrometric (MS) methods such as the use of liquid chromatography-MS coupled to solid phase extraction for the analysis of ubiquitous pesticides like atrazine and metolachlor or the application of inductively coupled plasma-MS for the determination of arsenic species. Nitrate contamination of groundwaters is a global problem not only in catchment level but also for drinking water purposes and it also part of this article collection. A drinking water quality index that includes nitrates and other anions and cations has been proposed in one of the papers selected. The impact of landfill leachate plumes on ground water has been in the environmental agenda for quite some time. Examples reported here include industrial and municipal waste and sanitary landfills as well as models for landfills selection sites according to a comprehensive list of criteria such as land use, protected area, surface water and groundwater resources in the potential landfill location. The last examples reported in this collection are related to water quantity and hydrological investigations. Needless to say that stochastic and mechanical models are generally used to predict groundwater availability considering aquifer recharge and evapotranspiration among other variables. Location of groundwater potential zones is of great importance in order to unequivocally identify the quantity of ground water resources in certain geographical area. A river and groundwater model algorithm that captures the warming and cooling impact of urban development and restoration through a water and energy budget is described in the last paper of this article collection.That being said I would like to thank all authors of these twelve contributions to Methods X in compiling such a timely article collection. Needless to say that this groundwater collection papers will be of help to environmental scientists, specially hydrologists as well as newcomers, PhD students and those senior researchers who consider groundwater as one of the world resources that needs protection.Ultimately I have the pleasure to announce a Virtual Special Issue on Groundwater to celebrate this World Water Day 2022. This will allow authors who had not the opportunity to be part of this VSI that is now released as well as to previous authors who contributed to this Methods X article collection to update and publish their recent methods. Submission window will be open from March 20 till October 31st 2022.As always, thanks for reading and stay safe and healthy!


Sexual dysfunction should be enquired about as a symptom of mental health disorders and as side effects of commonly used psychotropic drugs. We audited against NICE guidelines the record of sexual dysfunction discussion at initial assessment and follow-up by the community mental health recovery service (CMHRS).Research reports that sexual dysfunction occurs more often in individuals with serious mental illnesses including depression and schizophrenia. Sexual dysfunction is also a reported side effect of antidepressant and antipsychotic medications. NICE guidelines recommend assessment of biological symptoms of mental health disorders and discussion of potential side effects of treatments being considered prior to initiation and at follow-up.Our sample consisted of 71 patients, all new patient assessments from referrals made to CMHRS between January 1st and March 31st 2019.We reviewed all initial assessment and follow-up electronic notes and any correspondence generated from these meetings.Our results showed that no record was made of sexual dysfunction as present or absent by health care professionals (HCPs) completing initial assessment or follow-up.We surveyed the HCPs from the team and observed a high level of confidence in discussing sexual dysfunction and high self report of this discussion being conducted.Our audit results show no records of the discussion of sexual dysfunction, we held to the principal that in absence of record the discussion did not take place. Our survey results suggested that HCPs were confident they do assess for sexual dysfunction. We wondered, therefore, if HCPs would be less likely to make record in the event that symptoms are denied, recognizing that the list of potential symptoms and side effects is extensive and documentation of all negative results would be time consuming.Our audit results may show then, that sexual dysfunction is not present in any of the sample; however this would contrast to research findings of higher than average rates of sexual dysfunction in groups with serious mental illness and those using antidepressants or antipsychotics.We propose further assessment is needed for the disparity between our and recognised rates of sexual dysfunction.We propose the standard that recording ‘absence of biological symptoms’ of mental health disorders or recorded supply of medicine information leaflets are adequate record. We also made suggestions for training and recording to assist HCPs initial assessment.


Ottawa Charter for Health Promotion provided a template that has fundamentally re-shaped public health practice in the past 35 years . WHO’s priorities include achieving Universal Health Coverage (UHC): responding successfully to global health emergencies (including COVID-19); and creating healthier populations .Shanghai Declaration by exploring law and urban governance through the paper by Burris and Lin; and the future evolution of health literacy by Sørensen and colleagues    as a worThe paper by Hancock and colleagues examines a further key challenge emerging from the task of positioning health promotion methods and strategies at the heart of actions required to achieve the UN SDGs by advancing planetary health promotion through local-level actions (Finally, we have two papers that explore emerging issues in health promotion examining evolving concepts in health and wellbeing by Corbin and colleagues; and Digital Health Promotion by Lim and colleagues (et al. examines the potential benefits and challenges of digital technology for current and future health promotion strategies. The benefits include expanding access to health information and health-promoting services, as well as lowering the cost of scaling up activities to reach larger populations. It also highlights key challenges including the growth of misinformation and disinformation through digital media; and ensuring widespread accessibility and affordability to digital technology in ways that minimize social inequities.The paper by Lim Taken together this set of papers provides an overview of several key transformations facing the global community and suggests pathways for the application of health promotion methods and strategies to meet these challenges. This collection of papers reflects the evolving local and global contexts and emerging priorities for health promotion. Insofar as promoting health is one of the three strategic priorities for the WHO’s 13th General Programme of Work, the papers point to the evolution of our paradigm about health—i.e., shifting from disease to risk factors to determinants, and from individual, through social to planetary health and wellbeing. Research, policy and practice in health promotion will need to similarly evolve to keep up with these emerging health challenges and changing contexts.The authors alone are responsible for the views expressed in this article and they do not necessarily represent the views, decisions or policies of the institutions with which they are affiliated.


I am reading the paper of Sanoglioni et al. aiming to to identify to evaluate the usefulness of left atrial (LA) reservoir strain for risk stratification of asymptomatic patients with moderate aortic stenosis . In rece


Many studies show that cultural perspective is an important factor in caring for elderly tribal adults. To understand the level of attention that the Cultural Health Station of Indigenous People attaches to culture during its operation, this study selected Taitung County as the region of study. A qualitative focus group research method and quantitative questionnaire, we try to understand “What are the demands of elderly tribal adults?” “Do services provided by the Tribal Cultural Health Station satisfy the demands of elderly tribal adults?” and “What are the gaps between the service demands and provided to elderly tribal adults?” The results showed that service providers believe that culture is markedly important to elderly tribal adults, that culture-based care designs offered by the Tribal Cultural Health Station is currently insufficient, and that to enhance the capacity of the multiethnic Tribal Cultural Health Station, the cognition and understanding of policy makers and enforcers must be elevated.


The number of people in the United States with dementia is increasing, with nearly six million people living with Alzheimer’s disease and related dementias. It is the fifth leading cause of death for those aged ≥65 years. Over 95% of people with dementia have another comorbid chronic condition. The Healthy Brain Initiative’s State and Local Public Health Partnerships to Address Dementia: The 2018-2023 Road Map notes that public health agencies should raise awareness of the link between brain health and physical health, and specifically calls out tobacco prevention and control, cardiovascular health management diabetes prevention and management, obesity prevention and control, and injury prevention as intervention points. The National Association of Chronic Disease Directors developed brain health messages targeted to reduce risk for cognitive decline through the prevention and control of comorbid chronic conditions. These messages can be leveraged for public health action by integrating them into existing chronic disease programs.


The aim of this study was to explore experiences of consultations with non-specialist health professionals in a group of young people with ASD and their parents and what they considered would help to improve these interactions.Research has shown that general awareness around autism is poor among the general medical community and this can result in poor communication during medical consultations.An opportunistic group of 4 young people with ASD and 8 parents from a local support group in Exeter were interviewed in an informal environment about their experiences of healthcare consultations after seeking verbal consent.Among the 8 parents interviewed the themes emerging were a deep lack of understanding and awareness among medical staff of the challenges faced by individuals with autism, the importance of the doctor-patient relationship to allow children to open up to healthcare professionals, and the need for all children to be respected as individuals.Among the 4 young people (13 to 19 years) with ASD interviewed they identified significant anxiety around waiting for appointments and expressed a desire for a distractor to relieve stress, questions posed by clinicians were often vague and should be clearer, 3D models/mannequins could be useful to support understanding of anatomy and physiology, patience and a calm demeanour were vital with a quiet clinical environment to avoid distraction, time for mental preparation is important and efforts should be made to avoid delays or cancellation of appointments where possible.An interactive website was generated in the light of feedback from the client group and their parents, aiming to educate clinicians regarding the challenges faced by this client group and provide a guide suggesting how to facilitate effective consultation through the use of simple techniques to promote engagement/reduce anxiety in the clinical environment.Simple changes to the approach to consultation with clients with ASD - a quiet consultation space, no delays and better communication - could reduce stress and promote positive interactions with a beneficial effect on healthcare delivery for this client group.


The number of older adults with intellectual and developmental disabilities (IDD) in the U.S. is expected to double and potentially triple by 2030. Despite this demographic urgency, there continues to be a lack of research directly addressing aging of people with IDD. Individuals with IDD have on average twice as many health problems than others without IDD, experience earlier age-related declines in health and function than the general population and are more likely to develop secondary conditions as they age. The increase in the number of people aging with IDD and the challenges experienced by this population have demanded new directions for research, practice and policy that promote social justice and improve this population’s health and well-being. This symposium brings together research that critically examines and calls for a “new normal” of supports for healthy aging provided to the population aging with IDD. The first presentation consists of a systematic review of healthy aging interventions for adults with IDD. The authors conclude that such interventions for adults with IDD remain scarce, incipient and sporadic. The second presentation critically reviews an interprofessional education model aimed to address the complex and unique needs of older adults with IDD and dementia. The authors provide recommendations for the future development of interprofessional education in this field. In the third and final presentation the authors offer further transformation toward a new normal as they outline future directions for research on aging with IDD that is informed by positive psychology and disability studies theory.


During the recovery, investing in gender equality is essential: it will lead directly to higher GDP and indirectly to increase human capital and promote a sustainable society.Or Women as economic agents may themselves have an impact on policies: the changing role of women in families and societies and their greater representation in decision making positions contribute to focusing and redirecting the policy agenda toward items that ultimately reduce gender gaps.


The psychodynamic approach views human behavior from the standpoint of unconscious motives that influence personality functioning. In contrast with a nosological approach, the emphasis is on tracing behavior to its origins, fostering a deeper understanding of what is “behind” the overt signs and symptoms of disorder (Vaillant, The impact of a dynamic approach in psychotherapy is largely documented (Midgley et al., The health emergency we are experiencing due to COVID-19 has strongly influenced not only physical health but also the mental health of the general population as well as collective behavior (Gray et al., Due to uncertainty surrounding COVID-19, collective distress and individual suffering, the psychodynamic approach may be able to consistently identify and manage stressful life-event dynamics (Afari et al., In this opinion article the relevance of the implementing psychodynamic approach in the prevention of individuals' mental health during the ongoing COVID-19 crisis has been highlighted. In accordance with Marčinko et al. , the incad hoc effective interventions. The systematic assessment of unconscious psychological aspects of personality should be promoted for the early detection of vulnerable individuals and for improving research and clinical practice toward a personalized therapeutic approach (Lingiardi and McWilliams, Understanding how the ongoing pandemic is influencing human reactions to such a stressful event is essential for developing The author confirms being the sole contributor to this work and approves it for publication.The author declares that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.


Stress distribution pattern around dental implants is an important determinant for rate of bone resorption around them. During planning the treatment for most prosthetic rehabilitations, the surgeon uses a software to virtually plan the dimension, position and angulation of the implants considering only the quantity of available bone in the area of interest but does not usually consider the strain generated around the implants after prosthetically loading them. We hence hypothesise that dental implants not be subjected to abnormal strain they should be positioned and angulated not only based on volume of bone available but also based on the vector of occlusal load. The virtual FEA model to analyse the stress distribution would hence require alveolar bone with future tooth/ teeth in centric relation to be modelled. This paper proposes a simple innovative technique to develop a 3D FE model of occlusal loading surface by using a radio-opaque malleable lead foil to generate a patient specific FE model. This would greatly minimise modelling errors and also help determine the best position of the dental implant based on both the volume of bone in the CT scan and the results of FE analyses.  Specifications table*Method detailsThe dental implants are often positioned in the jaws using 3D printed implant positioning surgical guides. The surgeon uses the software to plan the angulation and position of the implants considering only the quantity of available bone in the area of interest but not the strain which would be generated around the positioned dental implants, a vital factor for long-term success of the treatment executed.During the replacement of a single missing tooth, loading vectors are usually along the long axis of the implant Hence, we hypothesise that dental implants not be subjected to abnormal strain, it should be positioned and angulated not only based on volume of bone available but also based on the vector of occlusal load.The problem though is to relate the loading vector to the strain generated around the implants. The only logical way is to relate the position of teeth (loading point) and the available bone for implant placement. When there is a single tooth or multiple teeth missing, it is not possible to model load application point. It requires a patient specific FEA analyses of a virtual model of the alveolar bone with future tooth/ teeth in centric relation, which is a customised position of teeth in the patient's upper and lower jaw at rest.This paper proposes a simple innovative technique to develop a 3D FE model by delineating the occlusal loading points using a radio-opaque malleable lead foil and then generate a patient specific FE model to determine the best position of the dental implant based on both the volume of bone in the CT scan and the results of FE analyses.The proposed process is executed after an informed consent from the patients requiring functional rehabilitation. Practical clinical prosthetic problems for functional rehabilitations of jaws are of two kinds. One rehabilitating a single missing tooth and other multiple missing teeth/completely edentulous patient. This novel method of generating FE model using this lead foil is a versatile technique and is applicable to both scenarios. The current proposed procedure has been clinically applied in 4 patients requiring single tooth replacements in the four quadrants of the mouth  and one patient requiring full maxillary arch rehabilitation. The material properties assigned during creation of FE model is given in The entire concept behind the generation of this technique is to reduce the modelling errors as much as possible. It mimics the reality by incorporating the real material properties and as much architectural features as possible so that results achieved after FE analyses would mimic real-time biomechanical scenario and hence highly reliable. The masticatory apparatus of every human is unique and hence it generates anatomically specific loads of varying magnitude and direction. Every point load on the facial skeleton be it on the maxilla, mandible or surface of teeth, generate unique stress pattern, based on which rehabilitation is to be planned.The precision with which the FE models are generated by this method is very much appreciable. The occlusal surface models depict accurate anatomy mimicking reality. Hence it gives an opportunity for the researcher to customise load application points to individual teeth cuspal levels so that loading conditions can also be modified by altering the design of cusps of individual teeth in case of increased strain noted around the dental implants on loading on specific occlusal points. The technique is inexpensive, does not require high skill or training. It is reproducible under various scenarios with similar clinical problems, requiring biomechanical 3D FE model generation for customised load application points.A possible disadvantage of this current proposed procedure is the requirement of 2 CBCT examinations during the complete treatment. An improvisation of the current proposed protocol would be to take a CBCT using the existing removable prosthesis for generation the FEA model of the occlusal loading points using the lead foil crown delineation technique along with assessment of bone volume and custom fabricate surgical stent to position the implants in accordance to the FEA results. This would hence reduce the requirement from 2 CBCT to a single CBCT as proposed in the current protocol.The success of any functional rehabilitation is measured in terms of its precision, longevity and efficacy. Surgeon planning for rehabilitation, should be aware of the biomechanical perspectives of treatment planning. The biomechanical engineer should understand the bone biomechanics from macro and micro perspectives so that rehabilitation withstands multidimensional load. The proposed patient specific FE model generation of occlusal load application points using lead foil crown delineation technique is a precise, inexpensive, versatile and simple solution in scenarios requiring complex virtual simulations of varied loading points to mimic reality. Thus, the accuracy of finite element analyses would increase with customised patient specific model generation.Even though the proposed technique aims to optimise loading around dental implants based on FE analyses to minimise bone loss during function, a study is required to compare the results of the proposed procedure to conventional implant based on volume of bone alone.Additional material:Biomechanical considerations in functional treatment planning using dental implantsFor a patient requiring maxillofacial functional rehabilitation with dental implants, its architectural complexity should be seen from both the surgeon's and bioengineer's perspective. Such multidisciplinary approach would provide a customised comprehensive rehabilitative solution. Precision, efficacy and longevity of functional rehabilitation of jaws are dependent on both primary mechanical stability of a dental implant and osseointergration. The position and angulation of a dental implant determines the stress distribution pattern for a given load around it which over a period of time determines the pattern of bone resorption around it and hence the stability of an implant The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.


The African Immigrant Dementia Education project is a community-university partnership with the goal of developing a culturally tailored dementia education program with African immigrants in Minnesota. In collaboration with our community partner , a project advisory board that features professionals and family members from the African immigrant community was assembled and its first meeting was held in February 2021. Preliminary discussions about content, mode of delivery and cultural considerations of an eventual dementia education intervention have begun. This presentation will offer details on the process of working with an advisory board and community partner to identify and culturally tailor an evidenced-based dementia education curriculum for a unique cultural group. Also, we will present challenges encountered during this process and offer suggestions and strategies to promote successful researcher-community partnerships.


The parasacral TENS has been used to treat OAB in children however, the periodicity with which it should be carried out has not been yet standardized. This is a randomized clinical trial designed to compare two and three times weekly TENS (20 sessions of 20 min each at 10 Hz.) in children with OAB. The study included children of at least four years of age with a diagnosis of pure OAB based on ICCS definition (Sixteen children were included in the twice-weekly group and eighteen in the three times weekly group . There wBoth groups experienced an improvement in symptoms of urgency and urge incontinence. Evaluation of the bladder diary showed no difference in mean urinary frequency, mean urine volume voided or maximum urine volume voided between the two groups.Based on the results, the study suggested that it is possible to administer parasacral TENS twice a week, since there was a significant reduction in lower urinary tract symptoms in both groups.Parasacral TENS has emerged as an effective non invasive treatment for OAB in view of its success rates in improving lower urinary tract symptoms without direct side effects. However, periodicity and comparison between applications conducted at home or an outpatient basis have not been yet defined. Considering that issues of cost effectiveness and adherence must be considered and put on the table in light of the evidence, more randomized clinical trials with a larger number of patients are necessary for better standardization of the technique.


The link between the migration of cancer cells and the spread of cancers has been established for many years. Tumour invasion and metastasis was labelled as one of the original Hallmarks of Cancer in the seminal paper written by Hanahan and Weinberg at the turn of the century . The defThe tumour microenvironment (TME) is made up of complex mixture of tumour cells and stromal derived cells but also containing a modified extracellular matrix (ECM). The ECM is the major structural component of the body comprised of proteins, glycoproteins, glycosaminoglycans and other polysaccharide in a network which would be able to host tumour cells (seed and soil theory) and control whether the tumour will be able to grow and metastases or not be able to move freely through a tissue ,4. ModulModulation of the ECM can also initiate the release of cytokines and growth factors that can stimulate pathways that allow for cells to migrate whether in single cells or as sheets . Growth n = 279 where 172 have a tumour of the oral cavity and most likely to be oral squamous carcinoma) indicates several signalling pathways such as Akt/PI3K that are up-regulated in these patients [Growth factors and ECM can both modulate cell signalling pathways. Analysis of genomes from Head and Neck Cancer patients  and how this translates into the clinical environment. We are also interested in research involving the studies of novel therapies or novel therapeutic approaches which may block cell migration and leading to possible new treatments.


The international health community has set ambitious goals for health: eliminating or reducing communicable and noncommunicable diseases, ensuring appropriate use of antibiotics, increasing the uptake of vaccines and other preventive measures, and responding appropriately to epidemics, among others. Behavioural science can help in achieving these goals;The global health community should adopt multidisciplinary approaches to changing behaviours and integrating behavioural and social science into public health. Behavioural science is one of several disciplines that can help us understand and address behaviours that affect health – together with social sciences, anthropology, social psychology, behavioural economics, systems thinking, social marketing, human-centred design and implementation science. Each one of these disciplines is uniquely equipped to contribute to this understanding – and action – while sharing the goal of developing and implementing policies and programmes designed around people’s needs and life experiences.Bulletin of the World Health Organization focuses on behavioural science and its application to understand individual and community behaviours through the analysis of cognitive, social and environmental drivers and barriers. Traditionally, public health efforts addressing risk behaviours have often focused on knowledge and awareness. Behavioural science analyses influencing factors within the environments around individuals and how insights can be used to design and make discrete changes in the environment to impact behaviours.This theme issue of the The systematic use of behavioural science to address longstanding and emerging public health challenges can provide an opportunity to improve the impact of programmes and policies, but behavioural science is still underutilized in public health. Ineffective behaviour change techniques continue to be used, while effective ones are not used or are difficult to replicate because both practitioners and researchers often do not capture, describe or understand their mechanisms of action.,Such underutilization may also arise because systematically adopting behavioural science can be challenging for practitioners and policy-makers.Bulletin explores some of these practical and theoretical challenges with the objective of advancing the use of behavioural science within public health. We hope to do so by raising the profile of the debate on these issues and including public health experts in this discussion. Only when these practical and theoretical challenges get beyond discussions held exclusively or mostly among behavioural and social scientists will there be meaningful progress towards the systematic inclusion of behavioural science into public health.This theme issue of the This theme issue targets the global community of public health experts, providing examples of the benefits of incorporating behavioural science in our work. The articles show how behavioural science has been used successfully around the world in support of programmes addressing a variety of risk behaviours and health issues, from iron deficiency


While hypertension is an important predictor of cardiovascular disease (CVD),In an earlier analysis of the Systolic Blood Pressure Intervention Trial (SPRINT)Journal provides several new insights into the relationship of two VVV parameters (the variability independent of the mean [VIM] and the difference of maximum minus minimum [MMD]) with all‐cause mortality in the 7996 hypertensives from SPRINT.The paper by Cheng and coworkersThe first key finding is that VVV SBP was an independent predictor of all‐cause mortality after adjustment of conventional risk factors or FRS.The second key finding was that VVV SBP and FRS were both significant risk factors for all‐cause mortality, and that higher VVV SBP combined with higher FRS conferred an increased risk for all‐cause mortality..Wide oscillations in BP have been considered to increase the extent of oscillatory shear stress in the macrovascular system,While VVV was shown to be associated with artery remodeling in a cross‐sectional analysis,It is not completely clear whether the increased VVV is a cause or simply an index of increased arterial stiffness. One major determinant of BP variability is the sensitivity of baroreceptor function.A recently proposed novel disease entity, systemic hemodynamic atherothrombotic syndrome (SHATS),Until now, there have been few reports assessing the relationship between VVV and unfavorable outcome according to the severity of FRS. The data presented in the manuscript reported by Cheng and coworkersK. Kario has received research grants from Omron Healthcare and A&D Co. outside the submitted work. The other author declare no conflict of interest.


The concern relates to the provenance of this article as brought to our attention by Faisal Alhawaj, who denies authorship of this article and others published in Cureus. These articles were submitted and subsequently published purportedly as an effort coordinated by Imam Abdulrahman Bin Faisal University to ensure all medical interns publish at least one peer-reviewed article in order to qualify for enrollment in a postgraduate residency program as stipulated by The Saudi Commission for Health Specialties (SCFHS).The journal has not been presented with enough evidence to warrant the formal retraction of these articles as both Imam Abdulrahman Bin Faisal University and The Saudi Commission for Health Specialties have failed to respond to numerous communications requesting additional information regarding these allegations. While we acknowledge that the provenance of these articles is very much in question, we cannot act until these claims have been investigated by the appropriate institutions with the results of said investigation communicated to Cureus.The concern and this note will remain appended to the above-mentioned article until Cureus is provided with official confirmation from Imam Abdulrahman Bin Faisal University or The Saudi Commission for Health Specialties.


Prior research has suggested that poor neighborhood and housing conditions can lead to worse psychological wellbeing. Most studies examine either neighborhood or housing conditions, but not both. Since neighborhood and housing conditions may be correlated it raises the question of whether one is a proxy for the other. We use data from the 2006 and 2008 waves of the Health and Retirement Study to examine associations between perceived neighborhood and housing conditions in 2006 and depressive symptoms (CES-D 8) score in 2008. We find that worse housing conditions and neighborhood safety are associated with more depressive symptoms two years later, even when controlling for prior depressive symptoms. Furthermore, housing and neighborhood conditions are independently related to increased depression symptoms over time. Our research contributes to a deeper understanding of the relationship between home and neighborhood environments and psychological wellbeing in older adults.


The use of medical cannabis  to treat chronic pain is increasing globally, although such use is not approved by any national regulatory authority such as the US Food and Drug Administration and is not supported by replicated, high-quality controlled clinical trials. The absence of data generated by the standard drug development process leaves clinicians with a substantial knowledge gap regarding appropriate dosing regimens. The article by Bhaskar et al.  attempts


A 2009 independent review commissioned by the UK government to review the use of antipsychotic medication in patients diagnosed with dementia produced the Time for Action report, often referred to as the Banerjee Report. It highlighted the common practise of using antipsychotics in the treatment of Behavioural and Psychological Symptoms of Dementia (BPSD) and the clinical issues this could raise especially when these medications were not being regularly reviewed. The audti was therefore carried out to determine whether patinets with BPSD in a Community Mental Health Team for Older adults (CMHTOA) in Mid Surrey, who had been diagnosed with BPSD, were being adequately assessed and managed in line with the current guidelines.Patients with a diagnosis of dementia open to one of three teams in the CMHTOA during the months of October and November 2019 were identified, those being prescribed antipsychotic medication were selected and data from their electronic records collected and analysed to determine if clinicians: a) identified and documented the target behaviours, b) carried out a structured assessment using an ABC chart before commencing medication, c) reviewed the antipsychotic medication 6 weeks after it was commenced.Of the 87 patients with a diagnosis of Dementia from October to November 2019, 18 were on antipsychotic medication. 100% of these had target behaviours identified and clearly documented, a sixth had a structured assessment prior to starting medication and 61% had been reviewed after the first 6 weeks of starting antipsychotics.The findings showed that a good proprotion of patients did not have the required structured assessment before commencement of treatment and that more needed to be done by way of improving regular reviews after antipsychotic treatment is commenced.


The aims of this quality improvement project were to determine if Nicotine Replacement Therapy was being prescribed correctly in Shannon Clinic in Northern Ireland and also to improve the rates of correct prescribing of Nicotine Replacement Therapy in the aforementioned unit.There are several different types of Nicotine Replacement Therapy currently available. Shannon Clinic is a smoke-free clinical environment therefore patients who smoke are offered Nicotine Replacement Therapy on admission. When I was working at Shannon Clinic I became aware that there was no clear guidance available to medical staff on the wards regarding prescribing Nicotine Replacement Therapy and therefore I decided to carry out this quality improvement project.An audit of drug charts was done on the patients who were under the care of the consultant that I worked with. In total nine drug charts were included in the audit. After the audit was complete, I produced a poster to show how to correctly prescribe Nicotine Replacement Therapy. A copy of this poster was placed on each ward in Shannon Clinic. After a period of time the drug charts were re-audited to see if there had been an improvement in the rates of correct prescribing of Nicotine Replacement Therapy.In total, 22% of the drug charts which were included in the audit had Nicotine Replacement Therapy prescribed incorrectly on them. After the inclusion of a poster outlining how to prescribe Nicotine correctly on each ward in Shannon Clinic, 0% of drug charts had Nicotine Replacement Therapy prescribed incorrectly on them. This was an improvement of 22%.This quality improvement project was successful at reducing the rates of incorrect Nicotine Replacement Therapy in Shannon Clinic. In the future it is my hope that this quality improvement project should lead to the correct prescribing of Nicotine Replacement Therapy for all patients in Shannon Clinic. It should also lead to an increased awareness regarding the different types of Nicotine Replacement Therapy for medical staff working in this clinical unit.


The pandemic exposes policymakers to fundamental uncertainties about future economic scenarios. While policymakers have to act forcefully to mitigate the impact on the economy, these conditions call for policy strategies that are also robust to uncertainty. This article compares two concepts of robust strategies: robust control and robust satisficing. It argues that a robust satisficing strategy is preferred and shows that the crisis responses of governments and central banks in Europe share features of robust satisficing in several dimensions.


The association between socioeconomic position (SEP) and dementia is well studied. However, scant attention has been given to the relationship with mild cognitive impairment (MCI), often considered a transient state between normal cognition and dementia. The purpose of this study was to determine the role of various SEP markers such as education and wealth on transitioning to MCI and dementia over a four-year period using data from the English Longitudinal Study of Ageing, a national representative sample of the English population aged 50+. We ascertained MCI and dementia over four years, using a validated algorithm based on physician diagnosis and lower cognitive performance (1 standard deviation below the mean) on multiple standardised tests adjusted for age and education. A Multistate Markov survival model was utilised to investigate whether different SEP markers increased the risk of specific transitions between normal cognitive performance and MCI or dementia, with the latter being considered an absorbing state. During the study period, a quarter of participants progressed to MCI from the normal state. Being in the lowest quintile of wealth was associated with a lower probability of transitioning back to a normal cognitive state from MCI, compared with those in the highest quintile. Greater wealth was weakly associated with a lower risk of transitioning from normal cognitive state to MCI and from MCI to dementia. The overall results imply that socioeconomic advantage might be protective against rapid progression from mild to more severe neurocognitive disorders such as dementia in later life.


The session will focus on new and existing innovative ways that Community Colleges are effectively addressing workforce needs resulting from a rapidly aging population; the ever-expanding career pathways available to students in the field of gerontology; as well as the continuing higher education needs of students transferring to bachelor’s and graduate-level gerontology programs. A panel of Community College and University gerontology professionals, representing both the GSA Community College and Aging Workforce Interest Groups, will share the innovative ways that they are working to address the three focus areas of this symposium. We will also include opportunities for discussion with participants about their experiences with and ideas for addressing these issues.


The adulteration of plant based products is a global problem and one that cannot be addressed without combined efforts from industry, academia and regulators. This research topic focused on the problems of quality in the broadest sense as well as looking at specific established and new techniques to help improve the detection of sub-standard products. The issues investigated included species authentication, adulteration and contamination, value chains, agricultural practices and sustainability. Authors and reviewers contributed from Asia, the Americas and Europe, with a high percentage of published papers coming from Chinese institutions.Ichim and Booker in their review assessed the scale of the problem globally and found that 37 countries had significant adulteration problems. An opinion piece provided by Palhares et al., the authors described the situation in Brazil and particularly in relation to sustainability and the protection of minority groups and their traditional knowledge. Luo et al. looked specifically at the on-going and increasing problem of heavy metal contamination in Chinese herbal products, something that is often affected by increased industrial pollution of the land and rivers as well as being due to cultivation or collection in areas where they are naturally occurring e.g., in cinnabar containing rock, risking mercury contamination in crops.Of the fourteen papers that were accepted for publication, three papers focussed on documenting and highlighting the scale of the problem. Kum et al. used Salvia miltiorrhiza as an example of how incorrect species might enter the supply chain and how different processing and storage techniques can affect the end quality of products. Whereas Bi et al. investigated the value chains of Astragalus membranaceus var. mongholicus and assessed the quality in relation to the geographical origin of the material and the effects of using different systems of production and suggested sustainable cultivation as a workable alternative to wild Research Topic. Cultivation may be a viable sustainable option to uncontrolled wild collection, however start up costs and lack of infrastructure can inhibit this process and more governmental and industrial support is needed for these practices to be established long-term.There were several papers that explored the value chains of medicinal plants and Woodley et al. conducted a review of chemical methods and described how mitochondrial activity could be used as a new measure for assessing the biological potency of herbal products and gave detailed methodology on how this could be achieved. Ichim and De Boer described the variation in Ginseng quality and how there were other problems apart from incorrect species, including the wrong part of the plant used and incorrect age of the plant at the time of harvesting (ginseng should be at least 5 years old prior to harvesting in order to obtain the desired amounts of metabolites). There were three papers on shotgun metabarcoding and Yu et al. presented this as a powerful tool for the molecular identification of biological ingredients. This was endorsed by Liu et al. who described how adulterating fungi could be detected in complex herbal mixtures using this technique. Xie et al. showed how shotgun metabarcoding could overcome biased PCR amplification and be used to authenticate herbal mixtures with distinct variation of dosages of individual ingredients. Similarly Yu et al. described specific mini- DNA barcode techniques for use with highly processed herbal products.Other researchers provided new ways to assess the quality of herbal products. Yu et al. described how a method was developed for the analysis of Ophiopogon japonicus that incorporated quantitative microscopy. This allowed for the differentiation of quality within the same species and highlighted the concept of da di  herbs in the Chinese herbal supply chain. Ichim et al. also looked at how microscopy could be used as a cost-effective and rapid method to identify impurities within mixtures although with the caveat that it was difficult to use with highly processed materials e.g., extracts. Zhao et al. described vector control quantitative analysis as a new method for analysing complex formulations. A PCR strategy was explained that rapidly generated the integrated DNA fragments needed from multiple targeted species. A technique with much potential for future use within the industry.Some of the new techniques (or known techniques repurposed) focussed on single plants and It is clear that there are global initiatives in place to improve the detection of poor quality and adulterated material in herbal medicines and there has been advances in many analytical techniques in an effort to overcome the difficulties encountered in analysing complex mixtures of medicinal plants. There appears to be growing emphasis on investigating quality problems along the length of the value chain as opposed to focussing on the finished products and with this comes an increased awareness of good collection and cultivation practices and a greater resolve to tackle issues of sustainability. Overall the papers emphasise the need for effective quality management along the length of the supply chain and the continued application of well known and new techniques to improve herbal quality and safety.