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Michael Weekes

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Nick K. Jones1,2*, Lucy Rivett1,2*, Chris Workman3, Mark Ferris3, Ashley Shaw1, Cambridge COVID-19 Collaboration1,4, Paul J. Lehner1,4, Rob Howes5, Giles Wright3, Nicholas J. Matheson1,4,6¶, Michael P. Weekes1,7¶1 Cambridge University NHS Hospitals Foundation Trust, Cambridge, UK2 Clinical Microbiology & Public Health Laboratory, Public Health England, Cambridge, UK3 Occupational Health and Wellbeing, Cambridge Biomedical Campus, Cambridge, UK4 Cambridge Institute of Therapeutic Immunology & Infectious Disease, University of Cambridge, Cambridge, UK5 Cambridge COVID-19 Testing Centre and AstraZeneca, Anne Mclaren Building, Cambridge, UK6 NHS Blood and Transplant, Cambridge, UK7 Cambridge Institute for Medical Research, University of Cambridge, Cambridge, UK*Joint first authorship¶Joint last authorshipCorrespondence: [email protected] UK has initiated mass COVID-19 immunisation, with healthcare workers (HCWs) given early priority because of the potential for workplace exposure and risk of onward transmission to patients. The UK’s Joint Committee on Vaccination and Immunisation has recommended maximising the number of people vaccinated with first doses at the expense of early booster vaccinations, based on single dose efficacy against symptomatic COVID-19 disease.1-3At the time of writing, three COVID-19 vaccines have been granted emergency use authorisation in the UK, including the BNT162b2 mRNA COVID-19 vaccine (Pfizer-BioNTech). A vital outstanding question is whether this vaccine prevents or promotes asymptomatic SARS-CoV-2 infection, rather than symptomatic COVID-19 disease, because sub-clinical infection following vaccination could continue to drive transmission. This is especially important because many UK HCWs have received this vaccine, and nosocomial COVID-19 infection has been a persistent problem.Through the implementation of a 24 h-turnaround PCR-based comprehensive HCW screening programme at Cambridge University Hospitals NHS Foundation Trust (CUHNFT), we previously demonstrated the frequent presence of pauci- and asymptomatic infection amongst HCWs during the UK’s first wave of the COVID-19 pandemic.4 Here, we evaluate the effect of first-dose BNT162b2 vaccination on test positivity rates and cycle threshold (Ct) values in the asymptomatic arm of our programme, which now offers weekly screening to all staff.Vaccination of HCWs at CUHNFT began on 8th December 2020, with mass vaccination from 8th January 2021. Here, we analyse data from the two weeks spanning 18thto 31st January 2021, during which: (a) the prevalence of COVID-19 amongst HCWs remained approximately constant; and (b) we screened comparable numbers of vaccinated and unvaccinated HCWs. Over this period, 4,408 (week 1) and 4,411 (week 2) PCR tests were performed from individuals reporting well to work. We stratified HCWs <12 days or > 12 days post-vaccination because this was the point at which protection against symptomatic infection began to appear in phase III clinical trial.226/3,252 (0·80%) tests from unvaccinated HCWs were positive (Ct<36), compared to 13/3,535 (0·37%) from HCWs <12 days post-vaccination and 4/1,989 (0·20%) tests from HCWs ≥12 days post-vaccination (p=0·023 and p=0·004, respectively; Fisher’s exact test, Figure). This suggests a four-fold decrease in the risk of asymptomatic SARS-CoV-2 infection amongst HCWs ≥12 days post-vaccination, compared to unvaccinated HCWs, with an intermediate effect amongst HCWs <12 days post-vaccination.A marked reduction in infections was also seen when analyses were repeated with: (a) inclusion of HCWs testing positive through both the symptomatic and asymptomatic arms of the programme (56/3,282 (1·71%) unvaccinated vs 8/1,997 (0·40%) ≥12 days post-vaccination, 4·3-fold reduction, p=0·00001); (b) inclusion of PCR tests which were positive at the limit of detection (Ct>36, 42/3,268 (1·29%) vs 15/2,000 (0·75%), 1·7-fold reduction, p=0·075); and (c) extension of the period of analysis to include six weeks from December 28th to February 7th 2021 (113/14,083 (0·80%) vs 5/4,872 (0·10%), 7·8-fold reduction, p=1x10-9). In addition, the median Ct value of positive tests showed a non-significant trend towards increase between unvaccinated HCWs and HCWs > 12 days post-vaccination (23·3 to 30·3, Figure), suggesting that samples from vaccinated individuals had lower viral loads.We therefore provide real-world evidence for a high level of protection against asymptomatic SARS-CoV-2 infection after a single dose of BNT162b2 vaccine, at a time of predominant transmission of the UK COVID-19 variant of concern 202012/01 (lineage B.1.1.7), and amongst a population with a relatively low frequency of prior infection (7.2% antibody positive).5This work was funded by a Wellcome Senior Clinical Research Fellowship to MPW (108070/Z/15/Z), a Wellcome Principal Research Fellowship to PJL (210688/Z/18/Z), and an MRC Clinician Scientist Fellowship (MR/P008801/1) and NHSBT workpackage (WPA15-02) to NJM. Funding was also received from Addenbrooke’s Charitable Trust and the Cambridge Biomedical Research Centre. We also acknowledge contributions from all staff at CUHNFT Occupational Health and Wellbeing and the Cambridge COVID-19 Testing Centre.

Guangming Wang

and 4 more

Tam Hunt

and 1 more

Tam Hunt [1], Jonathan SchoolerUniversity of California Santa Barbara Synchronization, harmonization, vibrations, or simply resonance in its most general sense seems to have an integral relationship with consciousness itself. One of the possible “neural correlates of consciousness” in mammalian brains is a combination of gamma, beta and theta synchrony. More broadly, we see similar kinds of resonance patterns in living and non-living structures of many types. What clues can resonance provide about the nature of consciousness more generally? This paper provides an overview of resonating structures in the fields of neuroscience, biology and physics and attempts to coalesce these data into a solution to what we see as the “easy part” of the Hard Problem, which is generally known as the “combination problem” or the “binding problem.” The combination problem asks: how do micro-conscious entities combine into a higher-level macro-consciousness? The proposed solution in the context of mammalian consciousness suggests that a shared resonance is what allows different parts of the brain to achieve a phase transition in the speed and bandwidth of information flows between the constituent parts. This phase transition allows for richer varieties of consciousness to arise, with the character and content of that consciousness in each moment determined by the particular set of constituent neurons. We also offer more general insights into the ontology of consciousness and suggest that consciousness manifests as a relatively smooth continuum of increasing richness in all physical processes, distinguishing our view from emergentist materialism. We refer to this approach as a (general) resonance theory of consciousness and offer some responses to Chalmers’ questions about the different kinds of “combination problem.”  At the heart of the universe is a steady, insistent beat: the sound of cycles in sync…. [T]hese feats of synchrony occur spontaneously, almost as if nature has an eerie yearning for order. Steven Strogatz, Sync: How Order Emerges From Chaos in the Universe, Nature and Daily Life (2003) If you want to find the secrets of the universe, think in terms of energy, frequency and vibration.Nikola Tesla (1942) I.               Introduction Is there an “easy part” and a “hard part” to the Hard Problem of consciousness? In this paper, we suggest that there is. The harder part is arriving at a philosophical position with respect to the relationship of matter and mind. This paper is about the “easy part” of the Hard Problem but we address the “hard part” briefly in this introduction.  We have both arrived, after much deliberation, at the position of panpsychism or panexperientialism (all matter has at least some associated mind/experience and vice versa). This is the view that all things and processes have both mental and physical aspects. Matter and mind are two sides of the same coin.  Panpsychism is one of many possible approaches that addresses the “hard part” of the Hard Problem. We adopt this position for all the reasons various authors have listed (Chalmers 1996, Griffin 1997, Hunt 2011, Goff 2017). This first step is particularly powerful if we adopt the Whiteheadian version of panpsychism (Whitehead 1929).  Reaching a position on this fundamental question of how mind relates to matter must be based on a “weight of plausibility” approach, rather than on definitive evidence, because establishing definitive evidence with respect to the presence of mind/experience is difficult. We must generally rely on examining various “behavioral correlates of consciousness” in judging whether entities other than ourselves are conscious – even with respect to other humans—since the only consciousness we can know with certainty is our own. Positing that matter and mind are two sides of the same coin explains the problem of consciousness insofar as it avoids the problems of emergence because under this approach consciousness doesn’t emerge. Consciousness is, rather, always present, at some level, even in the simplest of processes, but it “complexifies” as matter complexifies, and vice versa. Consciousness starts very simple and becomes more complex and rich under the right conditions, which in our proposed framework rely on resonance mechanisms. Matter and mind are two sides of the coin. Neither is primary; they are coequal.  We acknowledge the challenges of adopting this perspective, but encourage readers to consider the many compelling reasons to consider it that are reviewed elsewhere (Chalmers 1996, Griffin 1998, Hunt 2011, Goff 2017, Schooler, Schooler, & Hunt, 2011; Schooler, 2015).  Taking a position on the overarching ontology is the first step in addressing the Hard Problem. But this leads to the related questions: at what level of organization does consciousness reside in any particular process? Is a rock conscious? A chair? An ant? A bacterium? Or are only the smaller constituents, such as atoms or molecules, of these entities conscious? And if there is some degree of consciousness even in atoms and molecules, as panpsychism suggests (albeit of a very rudimentary nature, an important point to remember), how do these micro-conscious entities combine into the higher-level and obvious consciousness we witness in entities like humans and other mammals?  This set of questions is known as the “combination problem,” another now-classic problem in the philosophy of mind, and is what we describe here as the “easy part” of the Hard Problem. Our characterization of this part of the problem as “easy”[2] is, of course, more than a little tongue in cheek. The authors have discussed frequently with each other what part of the Hard Problem should be labeled the easier part and which the harder part. Regardless of the labels we choose, however, this paper focuses on our suggested solution to the combination problem.  Various solutions to the combination problem have been proposed but none have gained widespread acceptance. This paper further elaborates a proposed solution to the combination problem that we first described in Hunt 2011 and Schooler, Hunt, and Schooler 2011. The proposed solution rests on the idea of resonance, a shared vibratory frequency, which can also be called synchrony or field coherence. We will generally use resonance and “sync,” short for synchrony, interchangeably in this paper. We describe the approach as a general resonance theory of consciousness or just “general resonance theory” (GRT). GRT is a field theory of consciousness wherein the various specific fields associated with matter and energy are the seat of conscious awareness.  A summary of our approach appears in Appendix 1.  All things in our universe are constantly in motion, in process. Even objects that appear to be stationary are in fact vibrating, oscillating, resonating, at specific frequencies. So all things are actually processes. Resonance is a specific type of motion, characterized by synchronized oscillation between two states.  An interesting phenomenon occurs when different vibrating processes come into proximity: they will often start vibrating together at the same frequency. They “sync up,” sometimes in ways that can seem mysterious, and allow for richer and faster information and energy flows (Figure 1 offers a schematic). Examining this phenomenon leads to potentially deep insights about the nature of consciousness in both the human/mammalian context but also at a deeper ontological level.

Susanne Schilling*^

and 9 more

Jessica mead

and 6 more

The construct of wellbeing has been criticised as a neoliberal construction of western individualism that ignores wider systemic issues including increasing burden of chronic disease, widening inequality, concerns over environmental degradation and anthropogenic climate change. While these criticisms overlook recent developments, there remains a need for biopsychosocial models that extend theoretical grounding beyond individual wellbeing, incorporating overlapping contextual issues relating to community and environment. Our first GENIAL model \cite{Kemp_2017} provided a more expansive view of pathways to longevity in the context of individual health and wellbeing, emphasising bidirectional links to positive social ties and the impact of sociocultural factors. In this paper, we build on these ideas and propose GENIAL 2.0, focusing on intersecting individual-community-environmental contributions to health and wellbeing, and laying an evidence-based, theoretical framework on which future research and innovative therapeutic innovations could be based. We suggest that our transdisciplinary model of wellbeing - focusing on individual, community and environmental contributions to personal wellbeing - will help to move the research field forward. In reconceptualising wellbeing, GENIAL 2.0 bridges the gap between psychological science and population health health systems, and presents opportunities for enhancing the health and wellbeing of people living with chronic conditions. Implications for future generations including the very survival of our species are discussed.  

Mark Ferris

and 14 more

IntroductionConsistent with World Health Organization (WHO) advice [1], UK Infection Protection Control guidance recommends that healthcare workers (HCWs) caring for patients with coronavirus disease 2019 (COVID-19) should use fluid resistant surgical masks type IIR (FRSMs) as respiratory protective equipment (RPE), unless aerosol generating procedures (AGPs) are being undertaken or are likely, when a filtering face piece 3 (FFP3) respirator should be used [2]. In a recent update, an FFP3 respirator is recommended if “an unacceptable risk of transmission remains following rigorous application of the hierarchy of control” [3]. Conversely, guidance from the Centers for Disease Control and Prevention (CDC) recommends that HCWs caring for patients with COVID-19 should use an N95 or higher level respirator [4]. WHO guidance suggests that a respirator, such as FFP3, may be used for HCWs in the absence of AGPs if availability or cost is not an issue [1].A recent systematic review undertaken for PHE concluded that: “patients with SARS-CoV-2 infection who are breathing, talking or coughing generate both respiratory droplets and aerosols, but FRSM (and where required, eye protection) are considered to provide adequate staff protection” [5]. Nevertheless, FFP3 respirators are more effective in preventing aerosol transmission than FRSMs, and observational data suggests that they may improve protection for HCWs [6]. It has therefore been suggested that respirators should be considered as a means of affording the best available protection [7], and some organisations have decided to provide FFP3 (or equivalent) respirators to HCWs caring for COVID-19 patients, despite a lack of mandate from local or national guidelines [8].Data from the HCW testing programme at Cambridge University Hospitals NHS Foundation Trust (CUHNFT) during the first wave of the UK severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic indicated a higher incidence of infection amongst HCWs caring for patients with COVID-19, compared with those who did not [9]. Subsequent studies have confirmed this observation [10, 11]. This disparity persisted at CUHNFT in December 2020, despite control measures consistent with PHE guidance and audits indicating good compliance. The CUHNFT infection control committee therefore implemented a change of RPE for staff on “red” (COVID-19) wards from FRSMs to FFP3 respirators. In this study, we analyse the incidence of SARS-CoV-2 infection in HCWs before and after this transition.

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Andrew Fleming

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Background: Concomitant Wilms tumor (WT) and autosomal dominant polycystic kidney disease (ADPKD) is exceedingly rare, presenting a diagnostic and technical challenge to pediatric surgical oncologists. The simultaneous workup and management of these disease processes is incompletely described. Procedure: We performed a retrospective analysis of patients treated at our institution with concomitant diagnoses of WT and ADPKD. We also review the literature on the underlying biology and management principles of these conditions. Results: We present three diverse cases of concomitant unilateral WT and ADPKD who underwent nephrectomy. One patient had preoperative imaging consistent with ADPKD with confirmatory testing postoperatively, one was found to have contralateral renal cysts intraoperatively with confirmatory imaging post-nephrectomy, and one was diagnosed in childhood post-nephrectomy. All patients are alive at last follow-up, and the patient with longest follow-up has progressed to end-stage kidney failure requiring transplantation and dialysis in adulthood. All patients underwent germline testing and were found to have no cancer predisposition syndrome or pathogenic or likely-pathogenic variants for WT. Conclusion: Concomitant inheritance of ADPKD and development of WT is extremely rare, and manifestations of ADPKD may not present until late childhood or adulthood. ADPKD is not a known predisposing condition for WT. When ADPKD diagnosis is made by family history, imaging, and/or genetic testing before WT diagnosis and treatment, the need for extensive preoperative characterization of cystic kidney lesions in children and increased risk of post-nephrectomy kidney failure warrant further discussion of surgical approach and peri-operative management strategies.

Josje Janna Otten

and 8 more

More than half of CRSwNP patients treated with dupilumab experience olfactory improvement within 28 days To the Editor,Olfactory dysfunction is one of the main complaints of patients suffering from Chronic Rhinosinusitis with Nasal Polyps, significantly affecting their quality of life. Dupilumab has proven to effectively enhance olfactory function within six months of treatment (1-3). However, the speed and efficacy of this effect on olfactory function improvement within the initial weeks of treatment has yet to be determined.The data reported in this letter stem from a prospective observational cohort (PolyREG) aimed to evaluate the therapeutic efficacy of biological therapy in chronic rhinosinusitis with nasal polyps. Eligible patients from this cohort were treated with dupilumab subcutaneously (300mg 1x/2 weeks) for chronic rhinosinusitis with nasal polyps in our tertiary centre. Patients were asked to use the Galenus Health App reporting Visual Analogue Scale (VAS) scores of their complaints in their Health Diary (4, 5). With special regard to olfaction, the question ‘How much does your smell loss bother you today?’ was answered with a VAS score ranging from 0 to 10 (cm) (0 being not bothersome at all, 10 the most bothersome thinkable) with a cut-off of >5.2 for olfactory dysfunction (hyposmia or anosmia) (6). In total, 72 patients filled out a VAS score on olfactory dysfunction at baseline and at least one other day during the first 28 days of dupilumab treatment. Also, the outcomes of the Sniffin’ Sticks-12 Identification test were collected at baseline and after 28 days of treatment.Baseline demographics of these 72 patients were comparable to the complete prospective cohort described by van der Lans et al (1) (data not shown). At baseline, the median Sniffin’ Sticks-12 Identification Test score was 3 (IQR 2) indicating anosmia. After 28 days, the median Sniffin’ Sticks-12 Identification Test score was 6 (IQR 6, Wilcoxon signed-rank test: p<0.001). 93.7% of patients reported a Visual Analogue Scale score on olfaction of >5.2, indicating olfactory dysfunction. Over the subsequent 28 days of treatment, this percentage significantly declined to 44.2% (Figure 1A: Pearson Correlation r=0.924, p<0.001). 50% of the patients scored >6, indicating hyposmia or normosmia (Figure 1B). The mean VAS score in the first week of treatment significantly predicted the outcome of the Sniffin’ Sticks-12 Identification Test after four weeks of treatment (linear regression F(1,97)= 6.7, p=0.012). As such, the data show a rapid olfactory function improvement in more than half of the patients treated with dupilumab, starting after 1-2 injections.Lastly, a retrospective analysis of these 72 patients’ medical records was conducted to see if olfactory function improvement was previously reported during a course of oral corticosteroids prior to the initiation of dupilumab treatment. Subsequently, data was available for 63 of 72 patients. These patients were categorized into either the oral corticosteroid-responsive (n=51) or oral corticosteroid-unresponsive (n=12) group. Stratifying for oral corticosteroid-responsiveness showed enhanced results of dupilumab treatment in the oral corticosteroid-responsive group (Figures 1A and 1B). At best, 70.8% of patients in the oral corticosteroid-responsive group had a VAS score of ≤5.2 compared to 16.7% in the oral corticosteroid-unresponsive group and 55.8% of the total cohort.While acknowledging the limitations of the study, including a relatively small patient group, missing data in the Health Diary, a cut-off corresponding not directly to Sniffin’ Sticks-12 Identification Test and the setting in a tertiary medical center, the implications of our findings are profound. Dupilumab emerges as a fast and efficacious treatment option for improving olfactory function in patients with chronic rhinosinusitis with nasal polyps. Our data also suggest a potential need for stratification of treatment response based on oral corticosteroid responsiveness, as more patients experience olfactory function improvement if they ever had olfactory function improvement upon oral corticosteroids.(600 words)

Shih-Kuei Peng

and 2 more

TITLE PAGE:Title:Letter to the Editor: Human papillomavirus 16 infection in patients with esophageal squamous cell carcinoma undergoing chemoradiotherapyAuthors:Shih-Kuei Peng1James Cheng-Chung Wei2Qi Mei3,4Affiliations:1Department of Anesthesiology, Chung Shan Medical University Hospital, Taichung, Taiwan2Chung Shan Medical University, Taichung, Taiwan3Cancer Center, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, Taiyuan, Shanxi, People’s Republic of China4Department of Oncology,Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Hubei, Wuhan, People’s Republic of China.CorrespondenceShih-Kuei Department of Anesthesiology, Chung Shan Medical University Hospital, 40201 Taichung, Taiwan.Email: [email protected] address of the corresponding author:James Cheng-Chung Wei: [email protected] Mei: [email protected] Penghttps://orcid.org/0009-0002-2038-8594Letter to the Editor: Human papillomavirus 16 infection in patients with esophageal squamous cell carcinoma undergoing chemoradiotherapyDear Editor,We are writing to express our appreciation and to discuss the recent study published in your journal titled ”Survival benefits of human papillomavirus 16 infection in patients with esophageal squamous cell carcinoma undergoing chemoradiotherapy.1” This study provides insightful data into the prognostic impact of HPV 16 on ESCC treated with chemoradiotherapy, emphasizing its potential role in personalized treatment strategies. While the findings are promising, showing that HPV 16-positive patients had significantly longer overall survival, we would like to raise some concerns regarding the study’s limitations which might affect the interpretation of these results.Firstly, the retrospective nature of the study may contribute to inherent biases such as selection and recall bias2-4. Additionally, the study’s single-center design may not reflect a broader demographic, which could limit the generalizability of the findings.Furthermore, it is crucial to consider the external validation of these results to strengthen the study’s conclusions. The impact of HPV 16 on survival seems substantial, but without validation from external cohorts, the findings remain provisional. HPV virus infection can sometimes have local variation on genotypes, serotypes, and clinical phenotypes.Finally, while the study offers valuable insights into the role of HPV 16 in ESCC, further prospective studies with diverse and larger populations are necessary to confirm these findings and to consider them in clinical applications5,6. We appreciate the efforts of the authors and look forward to future research that may expand on these initial findings.CONFLICT OF INTEREST STATEMENTThe authors declare no conflict of interest.Shih-Kuei Peng1James Cheng-Chung Wei2Qi Mei3,41Department of Anesthesiology, Chung Shan Medical University Hospital, Taichung, Taiwan2Chung Shan Medical University, Taichung, Taiwan3Cancer Center, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, Taiyuan, Shanxi, People’s Republic of China4Department of Oncology,Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Hubei, Wuhan, People’s Republic of China.Correspondence: James Cheng-Chung Wei and Qi Mei contribute equallyORCIDShih-Kuei Penghttps://orcid.org/0009-0002-2038-8594REFERENCESQu F, Ji C, Wang Y, et al. Survival benefits of human papillomavirus 16 infection in patients with esophageal squamous cell carcinoma undergoing chemoradiotherapy: A retrospective cohort study. J Med Virol. 2024;96(4): e29592. doi: 10.1002/jmv.29592.Morgan E, Soerjomataram I, Rumgay H, et al. The global landscape of esophageal squamous cell carcinoma and esophageal adenocarcinoma incidence and mortality in 2020 and projections to 2040: new estimates from GLOBOCAN 2020. Gastroenterology. 2022;163(3):649‐658.e2.Sung H, Ferlay J, Siegel RL, et al. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2021;71(3):209‐249.Lagergren J, Smyth E, Cunningham D, Lagergren P. Oesophageal cancer.Lancet. 2017;390(10110):2383‐2396.Spiotto MT, Taniguchi CM, Klopp AH, et al. Biology of the radio‐ and Chemo‐Responsiveness in HPV malignancies. Semin Radiat Oncol.2021;31(4):274‐285.Wang WL, Wang YC, Lee CT, et al. The impact of human papillomavirus infection on the survival and treatment response of patients with esophageal cancers. J Dig Dis. 2015;16(5):256‐263.

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Urbanization modifies ecosystem conditions and evolutionary processes. This includes air pollution, mostly as tropospheric ozone (O3), which contributes to the decline of urban and peri-urban forests. A notable case are fir(Abies religiosa) forests in the peripheral mountains southwest of Mexico City, which have been severely affected by O3 pollution since the 1970s. Interestingly, some young individuals exhibiting minimal O3—related damage have been observed within a zone of significant O3 exposure. Using this setting as a natural experiment, we compared asymptomatic and symptomatic individuals of similar age (≤15 years old; n = 10) using histological, metabolomic and transcriptomic approaches. Plants were sampled during days of high (170 ppb) and moderate (87 ppb) O3 concentration. Given that there have been reforestation efforts in the region, with plants from different source populations, we first confirmed that all analysed individuals clustered within the local genetic group when compared to a species-wide panel (Admixture analysis with ~1.5K SNPs). We observed thicker epidermis and more collapsed cells in the palisade parenchyma of needles from symptomatic individuals than from their asymptomatic counterparts, with differences increasing with needle age. Furthermore, symptomatic individuals exhibited lower concentrations of various terpenes (ß-pinene, ß-caryophylene oxide, α-caryophylene and ß-α-cubebene) than asymptomatic trees, as evidenced through GC-MS. Finally, transcriptomic analyses revealed differential expression for thirteen genes related to carbohydrate metabolism, plant defense, and gene regulation. Our results indicate a rapid and contrasting phenotypic response among trees, likely influenced by standing genetic variation and/or plastic mechanisms. They open the door to future evolutionary studies for understanding how O3 tolerance develops in urban environments, and how this knowledge could contribute to forest restoration.

Mohammad Rowshan

and 4 more

Channel coding plays a pivotal role in ensuring reliable communication over wireless channels. With the growing need for ultra-reliable communication in emerging wireless use cases, the significance of channel coding has amplified. Furthermore, minimizing decoding latency is crucial for critical-mission applications, while optimizing energy efficiency is paramount for mobile and the Internet of Things (IoT) communications. As the fifth generation (5G) of mobile communications is currently in operation and 5G-advanced is on the horizon, the objective of this paper is to assess prominent channel coding schemes in the context of recent advancements and the anticipated requirements for the sixth generation (6G). In this paper, after considering the potential impact of channel coding on key performance indicators (KPIs) of wireless networks, we review the evolution of mobile communication standards and the organizations involved in the standardization, from the first generation (1G) to the current 5G, highlighting the technologies integral to achieving targeted KPIs such as reliability, data rate, latency, energy efficiency, spectral efficiency, connection density, and traffic capacity. Following this, we delve into the anticipated requirements for potential use cases in 6G. The subsequent sections of the paper focus on a comprehensive review of three primary coding schemes utilized in past generations and their recent advancements: lowdensity parity-check (LDPC) codes, turbo codes (including convolutional codes), and polar codes (alongside Reed-Muller codes). Additionally, we examine alternative coding schemes like Fountain codes (also known as rate-less codes), sparse regression codes, among others. Our evaluation includes a comparative analysis of error correction performance and the performance of hardware implementation for these coding schemes, providing insights into their potential and suitability for the upcoming 6G era. Lastly, we will briefly explore considerations such as higher-order modulations and waveform design, examining their contributions to enhancing key performance indicators in conjunction with channel coding schemes.
The involvement of users in the product development process can significantly enhance product quality. The relationship between user experience and knowledge in product design contributes to product efficiency during the development phase. Users often struggle to align their perceptions, leading to extended product usage times and an inability to react to potential performance variations. Product manufacturers also face challenges in identifying suitable features that can positively impact product success and marketability. User experience in product interactions, encompassing both aesthetic and functional aspects, plays a pivotal role in influencing user evaluations and distinguishing characteristics crucial for achieving product success. Determining user knowledge’s influence on product success characteristics can provide valuable insights for the new product development process. This study conducted a survey to gather user experiences and knowledge, aiming to enhance the understanding of how users perceive products. This understanding is crucial for identifying product success characteristics, encompassing aspects such as specifications, sustainability, and recognition, which are instrumental in achieving overall product success. The results of the survey indicate that user knowledge, emotional experiences, and product attribute knowledge can assist product designers and manufacturers in identifying key characteristics for success during the early stages of the new product development process.

Christian Mazimpaka

and 14 more

Background: In Rwanda, Community Health Workers (CHWs) serve a crucial function in providing community-based maternal and neonatal health (CBMNH) services. However, limited access to refresher training contributes to knowledge gaps among CHWs, affecting their confidence and ability to execute their roles effectively. This study aimed to evaluate the impact of eLearning on enhancing and maintaining CHWs’ knowledge of CBMNH. Methods: This prospective cohort study, conducted from April-October 2021 in two Rwandan districts, evaluated knowledge acquisition and retention among 36 Community Health Workers (CHWs) participating in an eLearning course. Knowledge scores were measured using a structured questionnaire administered pre-training, post-training, and at a six-month follow-up. Descriptive analysis and paired t-tests were used to assess mean score differences, exploring the effectiveness of this eLearning approach. Results: This study demonstrated an improvement in Community Health Workers’ (CHWs) performance scores following eLearning training, with an average rise from 86.5% to 98.2%. The improvement was sustained at a six-month follow-up. Statistical significance was found between age category and CHWs’ pre and post-test performance (p=0.01, p=0.04 respectively), and between years of experience and pre-test scores (p=0.02), highlighting demographic influences on training outcomes. Conclusions: The results of this study suggest that eLearning is an effective method for enhancing and retaining CHWs’ knowledge of CBMNH. The findings support the use of eLearning as a valuable strategy for strengthening the capacity of CHWs in Rwanda and other countries with similar contexts.

Dan Bayley

and 4 more

The threat from novel marine species introductions is a global issue. When Non-native marine species are introduced to novel environments and become invasive, they can affect biodiversity, industry, ecosystem function, and both human and wildlife health. Isolated areas with sensitive or highly specialised endemic species can be particularly impacted. The global increase in the scope of tourism activities together with a rapidly changing climate, now put these remote ecosystems under threat. In this context, we analyse invasion pathways into South Georgia & the South Sandwich Islands (SGSSI) for marine non-native species via vessel biofouling. The SGSSI archipelago has high biodiversity and endemism, and has historically been highly isolated from the South American mainland. The islands sit just below the Polar Front temperature boundary, affording some protection against introductions. However, the region is now warming and SGSSI increasingly acts as a gateway port for vessel traffic into the wider Antarctic, amplifying invasion likelihood. We use remote AIS vessel-tracking data over a two-year period to map vessel movement and behaviour around South Georgia, and across the ‘Scotia Sea’, ‘Magellanic’, and northern ‘Continental High Antarctic’ ecoregions. We find multiple vessel types from locations across the globe frequently now enter shallow inshore waters and stop for prolonged periods (weeks/months) at anchor. Vessels are active throughout the year and stop at multiple port hubs, frequently crossing international waters and ecoregions. Management recommendations to reduce marine invasion likelihood within SGSSI include initiating benthic and hull monitoring at the identified activity/dispersion hubs of King Edward Point, Bay of Isles, Gold Harbour, St Andrews Bay and Stromness Bay. More broadly, regional collaboration and coordination is necessary at neighbouring international ports. Here vessels need increased pre- and post-arrival biosecurity assessment following set protocols, and improved monitoring of hulls for biofouling to pre-emptively mitigate this threat.

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