In the published version of this article , the Y-aThe authors apologize for the error in the published article.


Retraction note:Malaysian Journal ofMedical Sciences has been requested by the administrator of the youthin mind in the UK who is in charge of the SDQ questionnaire becausea translation of the Malay Parent-version Questionnaire into the Malay Children-versionwas done and published without the necessary authorisation via the author of themanuscript, Dr Idayu Badilla Idris and co-authors.The retraction of the manuscript titled above from the Editor-in-ChiefMalaysian Journal of Medical Sciences


We theoretically investigate the optical bistability in the metal nanoparticles-graphene nanodisks-quantum dots hybrid plasmonic system in the infrared regime of the electromagnetic radiation. The quantum dot is considered to be a three-level atomic-like system of  The terahertz (THz) spectral range of the electromagnetic radiation, of the wavelength range between 1 mm to 30 μm has attracted much attention due to its wide potential applications, including sensing , spectroThe unique electronic structure of graphene resulting from the linear dispersion relation near the Dirac points provides an ultrawideband tunability as a result of Pauli blocking ; graphenl nature . Similarl nature . Moreoveplasmons .Recently, giant and controllable self-Kerr nonlinearity has been demonstrated in the metal nanoparticles-graphene nanodisks-quantum dots (MNP-GND-QD) hybrid system at the optical region of the electromagnetic radiation . ConsequIn the present work, we theoretically investigate the THz optical bistability in the MNP-GND-QD hybrid system situated in a unidirectional ring optical cavity. The QD is modeled as a three-level atomic system interacting with probe and control fields. Due to the unique properties of graphene plasmons including tunability via doping levels and long propagation distances, GND is utilized as a resonator of the system. The MNP is used to support the plasmons of GND and provide more options for optical control. Under the boundary conditions of the unidirectional optical ring cavity, we solve the time evolution of the density matrix elements, that describe the dynamics of the confined nonlinear plasmonic system, with the propagation equation of the probe field circulating inside the cavity. The effect of the parameters of both the system setup and the interacting fields are investigated in order to achieve the ultralow threshold of the controllable optical bistability demonstrated by our proposed plasmonic system at the THz regime of the electromagnetic spectrum.We consider the MNP-GND-QD hybrid system embedded in a fused silica substrate as shown in given as : (1)HRWAΔpσ11+Δ2σ−ℏΩp∂Ep∂tL in the steady-state limit [By solving the propagation equation of the probe field with the boundary conditions of a perfect tuned cavity of length te limit :(6a)Ep is derived by using the dipole-dipole interaction Hamiltonian that is sensitive to the distances between the components of the system, we discuss in n in Ref  is obtaiThe impact of the MNP size on the optical bistability behavior is examined in To conclude, compared to the relevant studies of the optical bistability behavior in the THz for simpler systems such as graphene-coated cylindrical core-shell nanoparticles , graphenWe have studied the optical bistability behavior in the MNP-GND-QD hybrid plasmonic system at the THz frequencies. We have found that the width of the hysteresis loop and the thresholds of the optical bistability can be controlled by the system setup in addition to the detuning and strength of both the probe and control fields. The optical bistability of our proposed system shows a high sensitivity to the detuning of the probe field and the center-to-center distances between the components of the system. Moreover, our plasmonic system has demonstrated ultralow optical bistability thresholds, implying that the proposed MNP-GND-QD hybrid plasmonic system can be employed to construct efficient controllable optical bistable devices that are also used as all-optical switches and optical transistors as well as medical biosensors. We hope that our study will stimulate future experimental investigations of the optical bistability in the MNP-GND-QD hybrid system which contributes a better understanding of this novel system and its nonlinear potential applications.


S-left-semimodule monad S. We show that the composition of almost the monad of convex subsets previously introduced by Jacobs: the only difference consists in the absence in Jacobs’s monad of the empty convex set. We provide a handy characterisation of the canonical weak lifting of We describe the canonical weak distributive law


In the age of the coronavirus epidemic, the implementation of urgent surveillance measures is sorely needed due to the lack of treatment for coronaviruses and the risk of transmission during the incubation period.The risk of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) transmission is a current topic of investigation and the extent of transmission from individuals who are asymptomatic or within the incubation period remains to be understood . The impA recent single center report from Italy provided the first epidemiological data on the skin's involvement in 88 hospitalized patients with COVID-19 . EighteeShortly thereafter, in a Chinese series of seven critical COVID-19 patients, acral ischemia presenting as cyanosis of fingers and toes with blisters and gangrene was reported in all subjects and correlated to an hypercoagulative state secondary to viral infection .Presently, an unusual occurrence of acral ischemic lesions is being reported in Italy in a growing number of apparently healthy children, adolescents, and young adults. Whether these lesions could be due to virally induced microvascular thrombosis and endothelial damage remains speculative and is supported by positive viral swabs in two cases and by a suspicious family history in the remaining reports .In our routine clinical practice during the COVID-19 outbreak, we are observing a growing number of post viral cutaneous eruptions in apparently healthy individuals in the second or third decade of life that we feel is remarkable compared to the usual local epidemiology of this season. We observed multiple rounded erythematous-violaceous lesions appearing on the dorsal and palmar aspect of the fingers  of adoleIn the current outbreak, and considering the predicted high rate of asymptomatic cases, we wondered if these cases should be tested for the presence of novel SARS-CoV-2, as the serology to commonly associated viral agents is negative. However, due to a current shortage of diagnostic tests related to an ongoing emergency we could not perform a diagnosis of SARS-CoV-2 infection.It is remarkable to notice that these virally induced immune-mediated skin eruptions apparently occur in patients that have negligible symptoms of a systemic viral disease. These observations hint at the possible role of specific genetic factors that, while a predisposition to the development of skin eruptions, may protect from severely symptomatic presentations of coronavirus infection.In our current cases of atypical skin eruptions, in which a relationship with conventional viral agents has been ruled out by laboratory testing and clinical history, molecular testing with PCR could be performed on pharynx swabs to support the hypothesis of a possible association with the novel coronavirus. Forthcoming rapid and specific serum assays are expected to aid in the identification of asymptomatic carriers, which is key to controlling the spread of disease. In conclusion, highlighting a relationship between SARS-CoV-2 and virus-induced skin conditions may help identify asymptomatic carriers that are a critical source of inter-human transmission.MA conceived the idea. AS designed and drafted the manuscript. All authors contributed to the writing of the final version of the article.The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.


The Emerging Role of the c-MET-HGF Axis in Non-small Lung Cancer Tumor Immunology and Immunotherapy. The correct title is The Emerging Role of the c-MET-HGF Axis in Non-small Cell Lung Cancer Tumor Immunology and Immunotherapy.In the published article the title was incorrectly given as The authors apologize for this error and state that this does not change the scientific conclusions of the article in any way. The original article has been updated.


Psychological sense of community plays an important role in the wellbeing of older adults, especially in cultures that revolve around community involvement and support. In 2017, Hurricane Maria devastated Puerto Rico, deeply altering community structure and social life. This study draws on the Ecological Theory of Aging to test the proposition that older adults’ sense of community is associated with self-assessed quality of life two years later. We conducted face-to-face interviews with a non-probability sample of 154 community-dwelling adults aged 60+ in Puerto Rico. We measured sense of community with the Brief Sense of Community Scale (BSCS)  and quality of life (QOL) with the EUROHIS-QOL 8-item index . We used multiple linear regression to test the association of sense of community and quality of life while controlling for relevant covariates. Higher levels of sense of community were associated with better quality of life , while increased mental health symptoms  and poor self-rated health  were associated with lower quality of life. Findings indicate that sense of community is an important contributor to older adult’s quality of life in Puerto Rico, perhaps in part due to cultural and age-related factors. Moreover, sense of community may serve as a protective factor against adverse outcomes after large scale natural disasters. Researchers should continue to examine this association while advocating for and developing policies and programs that promote older adults' sense of community in post-disaster contexts.


We also summarized recent advance of PEGylated lipid-based siRNA delivery systems and included some successful research works in this field.RNA interference (RNAi) technology has become a powerful tool in application of unraveling the mechanism of disease and may hold the potential to be developed for clinical uses. Small interfering RNA (siRNA) can bind to target mRNA with high specificity and efficacy and thus inhibit the expression of related protein for the purpose of treatment of diseases. The major challenge for RNAi application is how to improve its stability and bioactivity and therefore deliver therapeutic agents to the target sites with high efficiency and accuracy. PEGylated lipid-based delivery system has been widely used for development of various medicines due to its long circulating half-life time, low toxicity, biocompatibility, and easiness to be scaled up. The PEGylated lipid-based delivery system may also provide platform for targeting delivery of nucleic acids, and some of the research works have moved to the phases for clinical trials. In this review, we introduced the mechanism, major challenges, and strategies to overcome technical barriers of PEGylated lipid-based delivery systems for advanced target delivery of siRNA  Since antisense oligonucleotides (ASOs) have proven to be efficient drugs for treatment of certain diseases by complementary base pairing to target mRNA to inhibit protein expression or splicing pre-mRNA to mature mRNA , till noin vivo. In previous work, the PEGylation on the surface of liposome for siRNA was well introduced to illustrate the effects in different kinds of liposomes  into short RNA duplexes as shown in of siRNA .in vivo circulation. It is reported that naked siRNA is subject to degradation and the half-life is no more than 5 min in plasma  formed nanoparticles, which contain a highly condensed DNA core of polycation and then encapsulated DNA/polycation cores with lipids around its surface. This formulation process is shown in Lipid–calcium–phosphate and siRNA complex , which could show higher tumor accumulation and gene silencing efficiency. With the development of this field, the strategy of PEG cleavable could be widely used in the designing of gene delivery system to improve the ability of targeting and endosomal releasing of siRNA  were first developed in 2001 . The strLipid nanoparticles (LNPs) which contain siRNA and ionizable cationic lipids have proven to be effective in delivering gene materials to target sites. Some of them were proven to be effective in clinical trials . The ionLipid-based nanoparticles have the potentials to be further used in clinical treatment. siRNA delivery and variety of lipid-based nanoparticles are developed in recent years. It is reported that mono-disperse precise carriers assemble by using the forming materials which conjugated two oleic acids to cationizable oligominnoamide, and the targeting anchor atherosclerotic plaque-specific peptides can couple to the end of the synthesized T-sharp configuration lipo-oligomers to recognize the targeting cell. Several apoptotic peptides are selected to conjugate to the siRNA by disulfide linkage to enhance apoptosis of the diseased cells . Lipid-bin vivo transfection , 1,2-dioleoyl-sn-glycero-3-phosphoethanolamine (DOPE), and cholesterol forming anionic liposomes could coat these positively charged siRNA/polycation complex core to assembly lipid membrane on the surface. This method could reduce the surface charges to avoid toxicity .via H-bonding and π-π stacking with relative low toxicity, were applied to encapsulate 3′,3″-bis-peptide-siRNA (pp-siRNA) to form nanoparticle. DSPE-PEG-cyclic Arg-Gly-Asp (cRGD) was post-inserted to this nanoparticle to improve the ability of recognize target cells express integrin αvβ3 to accumulate in tumor tissue with high specificity. The result shows that this nano carrier could also help siRNA to escape from lysosome to avoid siRNA degradation  liposome need series of processing with limited loading efficiency . The devradation . By the herapies .Cationic lipids were most used in the formulation of lipid-based nanoparticles in the delivery of siRNA. Most of the nanoparticles are comprised of cationic lipids, neutral lipids, and gene materials in oligonucleotides delivery due to the electrostatic interaction of cationic lipids and oligonucleotides can provide feasibility to encapsulate these nucleic acids. Cationic lipids help the lipid-based nanoparticles loaded with siRNA to be absorbed on the surface of target cells based on the positive charges and to escape from endosomes after being trapped . Howeverin vivo, as mentioned above, most of these lipid-based nanoparticles were administrated systematically, so how to keep these nanoparticles stable to avoid releasing siRNA before reaching the target place and help these nanoparticles to release in the target site are the key factors. The common strategies are the modification of PEG on the surface of nanoparticles and optimization of the sizes and distribution of these nanoparticles to help with long half-life in vivo. For disease cell reorganization, the targeting molecules were selected and modified on the surface of lipid-based nanoparticles to enhance the attachment of the targeting cells.After formulating siRNAs with lipid forming nanoparticles, which should be stable enough before application in vivo. However, the increased proportion of PEG on the surface of the lipid-based nanoparticles may reduce the mechanical stability and induce the dissociation. PEG can form a mushroom conformation or a brush-like conformation with different degree of polymerization (N), monomer size (a), and distance of two grafting sites, which can be described as the radius of the random coil -derived peptide, can also be used in the design of lipid-based nano-vesicles to help with endosome escaping processing . Most ofFor endosome escaping, the degradation should be taken into consideration. It not only affects the releasing of siRNA but also is related to biocompatibility. It is reported that designing of precise enzymatic cleavable smart lipid-based nanoparticles may provide new solution for enhanced target delivery of siRNA with relative low toxicity induced by materials. To reduce the toxicity of amphiphilic molecules accumulated to lysosomes and other intracellular organelles, the carriers forming materials can be synthesized as cationic lipo-oligomers containing amino acids with precise enzymatic cleavage sites which can be degraded to low toxicity fragments by endolysosomal enzymes to facilitate the excretion. This research work provided possibility for incorporating new motifs in rational design lipo-oligomers to achieve safe and efficient siRNA delivery .The toxicity of the lipid-based nanoparticles for delivery of siRNA is critical to turn research work to clinical applications. The toxicity of the lipid-based nanoparticles for siRNA delivery is mainly caused by usage of cationic lipids and also the immune response from siRNA . siRNA cAs discussed above, these factors may affect the targeting delivery efficiency of siRNA after administration. The desired requirements for delivery of siRNA by lipid-based nanoparticle are summarized in From the webpage of Food and Drug Administration (FDA), more than 30 RNA-based therapies are in clinical trials. Although the development of siRNA drugs experienced a hard time, the approved lipid-based RNA drug patisiran is very inspiring . The DliLipid-based nanoparticles are widely used in targeting delivery of nucleic acids and function as a promising platform in the generation of more siRNA drugs. In the last decade, more efforts have been put to the discovery of the mechanisms, delivery pathways, biological barriers and solutions, and methods for evaluating the behavior and performance of the lipid-based nanoparticles. Although great progress has built in lipid-based siRNA delivery system, we still need to put much more effort in turning these research work to practical applications. It is important to learn more about the relationship between “structure—activity” of the lipids to balance the silencing efficiency and biocompatibility and to know more information for potential toxicity and immunity induced by these materials. To realize the clinical applications of siRNA, more efforts should focus on the design of these lipid-based nanoparticles with safe delivery after administration and the ability to get access to various disease cells with high efficiency and specificity. For further applications, we still need to think about how to develop lipid-based siRNA nanoparticles easily. All of these works will be helpful for advancing the siRNA lipid-based nanoparticles to be more suitable.WY conducted the review and XG wrote the draft while BZ and LC revised the manuscript and helped with the figures. All authors contributed to substantial enhancement of the manuscript.This work was financially supported by the National Science Foundation of China .The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.


Session types describe patterns of interaction on communicating channels. Traditional session types include a form of choice whereby servers offer a collection of options, of which each client picks exactly one. This sort of choice constitutes a particular case of separated choice: offering on one side, selecting on the other. We introduce mixed choices in the context of session types and argue that they increase the flexibility of program development at the same time that they reduce the number of synchronisation primitives to exactly one. We present a type system incorporating subtyping and prove preservation and absence of runtime errors for well-typed processes. We further show that classical  sessions can be faithfully and tightly embedded in mixed choices. Finally, we discuss algorithmic type checking and a runtime system built on top of a conventional (choice-less) message-passing architecture.


The majority of self-perceptions of aging (SPA) research uses either a combination of the Age-related Cognition (AgeCog) scales of Ongoing Development and Physical Loss, or the Attitudes Towards Own Aging (ATOA) subscale to assess views on aging. Although these scales are used interchangeably, the valence (positive/negative) and the specificity of the view on aging  being assessed are not consistent. This study investigates how different measures of SPA relate to one another and whether they differentially predict various types of health outcomes . Data from the 2008 and 2014 waves of the German Aging Survey , a population-based representative survey of adults aged 40 to 95, was used to examine the relationship between the AgeCog scales and the ATOA subscale, as well as the differences in the types of health outcomes each predicts. The correlations between the AgeCog scales and the ATOA were higher than the correlation between the AgeCog scales (p < .001). The AgeCog scale of Ongoing Development significantly predicted psychological health outcomes across a six-year period, while the AgeCog scale of Physical Loss and the ATOA subscale predicted both physiological and psychological health outcomes. Evidence supports using the AgeCog scale of Ongoing Development to predict domain-relevant, psychological health outcomes. However, the multidimensionality of SPA is best measured by the ATOA subscale or a combination of the two AgeCog scales. Both forms of measurement were found to maximize the amount of explained variance for psychological and physiological indicators of well-being and ill-being.


Antibiotics Editorial Office has taken the decision to retract the paper with the consent of the authors. The authors assert that the findings, that vanillic acid exerted a significant antibacterial activity against carbapenem-resistant Enterobacter cloacae (CREC), are nevertheless reliable [The authors have been made aware that two figures were published in two papers: Figure 5A in paper  is duplireliable .Antibiotics Editorial Office and authors apologize to the readers of Antibiotics for any inconvenience caused.The Editor-in-Chief has checked the case and communicated with the authors. The decision to retract has been taken in agreement with the authors of the paper . The AntTo ensure the addition of only high-quality scientific works to the field of scholarly publication, this paper  is retra


Transparency Statement is required to ensure full transparency of the previous review process and to prevent any perception of a conflict of interest.Due to the addition of the published article to the Research Topic “Feed-forward and Feed-back Processing in the Cerebral Cortex: Connectivity and Function,” the inclusion of the following This manuscript was published prior to the launch of the Research Topic” Feed-forward and Feed-back Processing in the Cerebral Cortex: Connectivity and Function “for which the handling Editor and the author are co-Editors. The handling Editor and the author confirm the absence of any collaboration during its review process.”“


Increased Appetite Plays a Key Role in Olanzapine-Induced Weight Gain in, the title should be Increased Appetite Plays a Key Role in Olanzapine-Induced Weight Gain in First-Episode Schizophrenia Patients.There is an error in the article title. Instead of The authors apologize for this error and state that this does not change the scientific conclusions of the article in any way. The original article has been updated.


Older adults with comorbid dementia and cancer is an increasing phenomenon with the aging population worldwide. Caregivers of these older adults might have a totally different and unique end-of-life caregiving experience. This is because all physical and behavioral signs and symptoms of dementia and cancer may interact with each other and complicate the caregiving experience. The aims of this study was to understand and examine the end-of-life caregiving experiences for older adults with comorbid dementia and terminal cancer from the perspective of family caregivers. Twenty-one caregivers were invited to participate in a semi-structured interview that examined the end-of-life caregiving experiences, its impact and how they coped with the challenges they faced. The interviews were transcribed and analyzed using interpretative phenomenological analysis. The essential meaning of the phenomenon is understood as “grieving thrice, suffering dually and becoming one”, characterized by how caregivers understood the meaning of togetherness after going through the time of recurring losses from dementia through cancer to death and experiencing ambiguous sufferings dually with their loved one. Ambiguous sufferings were not “there” before the diagnosis of cancer but emerge in the context of comorbid dementia and cancer and in the connection with the caregivers making interpretation and appraisal of their internal and external resources. These important findings fill in the knowledge gap in the literature related to end-of-life caregiving experience for older adults with comorbid dementia and cancer; and may guide the development of appropriate interventions to support the older adults and their caregivers in a holistic approach.


Background: The telehealth approach offers enhanced service delivery for older patients living in rural areas. Purpose: We conducted a pilot study to evaluate the feasibility of using the Zenbo robot to improve the quality of care of elderly individuals with dementia. Methodology: In this study, we developed a digital solution on service robots and smart devices, which can leverage the capacity of the user-friendly interactive interface and digital dialog system. A group of eleven volunteered older adults was selected for this study. To assess the likability and acceptance of the Zenbo, we conducted a one-on-one (robot vs human) pilot study in our long-term care stations. Each participant engaged in conversational interactions for five consecutive days and completed a survey of 12 questions about the experiences they had with the Zenbo, at the beginning and the end of the study respectively. Results: Subjects with lower GDS-15 scores have more positive attitudes toward the robot before the intervention. 27% of older adults had an increase in positive attitudes toward the interaction with the Zenbo robot. With the aid of teleoperated mobile robotic systems at home, the innovative service model can be achieved through telecommunication between primary health professionals or caregivers at remote locations and psychiatrists at the medical center to make the seamless care environment real. Conclusion: The IoT technologies can be used to assist physicians in switching from a hospital-centered model of care to a home-based service for older people with dementia. It merits more future clinical trials and usability tests.


Brazil lacks an Occupational Therapy methodology of action, justifying the cross-cultural adaptation of TAP. Objectives were to adapt TAP reference materials to the Brazilian culture and evaluation of the applicability of the Portuguese version by perceptions of Occupational Therapists (OT) and family caregivers. The methodology used translation, back translation, evaluation of semantic, idiomatic, conceptual and cultural equivalences and pre-test of materials for production in Portuguese. The OT applied the translated version and evaluated its applicability. Caregivers evaluated the social impact of the adapted program. The cross-cultural adaptation process adapted the entire materials program to Portuguese culture. The OT perception is a need to include one session to guide caregivers and to modify the cognitive assessment used. The caregivers pointed out that TAP helps them in understanding and caring for the elderly with dementia. The TAP-BR has been adapted to the Brazilian culture. Part of a symposium sponsored by the Behavioral Interventions for Older Adults Interest Group.


The complete information in the Funding section should have been given as follows (the added information is highlighted in bold):FundingCo-financed by the European Regional Development Fund of the European Union and Greek national funds through the Operational Program Competitiveness, Entrepreneurship and Innovation, under the call RESEARCH - CREATE - INNOVATE (project code: ?1EDK-05479)The present study was funded by the post-graduate programs ‘Toxicology’ and ‘Biotechnology-Quality Assessment in Nutrition and the Environment’ in the Department of Biochemistry and Biotechnology at the University of Thessaly. The authors apologize to the co-funders of this study, and to the readership of the Journal for any inconvenience caused.


A 31-year-old male amateur bodybuilder presented with a 2-year history of chronic pain over the sternum and a clicking sensation in the chest wall on movement. Ultrasound, computed tomography (CT), and magnetic resonance imaging (MRI) showed no cause for his symptoms. Dynamic ultrasound scan performed at a specialist sports center revealed pseudoarthrosis of the manubriosternal joint (MSJ). After a period of conservative management , he failed to improve and underwent debridement and fusion of the MSJ with plates and screws. At follow-up 23 months later, he remains pain-free and has returned to weight lifting and bodybuilding. Motor vehicle crashes and chest seat belt restraints are the most common causes of sternal fracture. Reports of sternal injury among sportsmen and athletes are less common, however, with fracture resulting from non-contact trauma described in only sporadic cases in the literature –5.While surgery for sternal fracture after acute trauma is rare, surgical repair of painful chronic non-union after sternal fracture has been described , as has We describe the management of painful manubriosternal joint (MSJ) disruption in an amateur weight lifter and describe the challenge of diagnosis, pitfalls in imaging, and a technique of repair to render the patient symptom-free and able to resume his hobby.A 31-year-old man, a bodybuilder, presented with a 2-year history of chronic sternal pain and clicking on movement. On examination, he appeared pain-free and had an athletic body with very well-developed muscles of the torso and upper limbs. On the chest wall, a non-tender, bony thickening was palpable at the MSJ. After repeat consultation and a normal thoracic ultrasound scan, computed tomography (CT) and magnetic resonance imaging (MRI) scans were reported to show no abnormality. The patient's symptoms remained, and after 2-years of repeated consultations  and non-locked (2.7 cm) screws to increase stability while permitting initial slight movement with breathing. Autologous bone graft was performed by harvesting cancellous bone from the iliac crest and inserting this into the defect at the MSJ. At the end of the procedure, a stability check was performed with no pathological movement of the MSJ. The patient made an uneventful postoperative recovery and was discharged 7 days later after completion of a course of physical therapy. He was pain-free and without any limitation of movement. He returned to normal activities 2 weeks later. After 1 month, he was regularly lifting weights at preinjury levels. At 23 month follow-up, the patient remains pain-free and has returned to regular exercise and weight lifting.While much has been written about the management of sternal fractures after blunt trauma and non-union after median sternotomy for cardiac surgery, guidance on the management of MSJ pseudoarthrosis remains relatively scarce.The first challenge is in understanding the pathology in the absence of a single traumatic incident:There are two known mechanisms of MSJ dislocation or disruption; both entail the high-energy trauma expected in a motor vehicle crash. The first type of injury results from direct impact with posterior displacement of the body of the sternum. The second and more common injury type follows flexion–compression trauma of the thorax and neck where the neck is forcefully hyperflexed while the chin, clavicles, or ribs displace the manubrium posteriorly.In the absence of a single incidence of major trauma, a careful history of how and when the pain started is important: the mechanism here is repeated low-level trauma or stress on the chest wall. A key feature of the symptoms is clicking of the fibrocartilaginous pseudoarthrosis on movement of the unstable MSJ [also reported by , in a ruThe strength and stability of the MSJ rely on the attachment of the clavicles and first rib to the body of the manubrium and the strong ligamentous attachments of the second ribs to the MSJ. These attachments result in a non-mobile joint. In our patient, years of bodybuilding and weight lifting resulted in these muscles and ligaments stretched repeatedly under considerable force in opposite directions. Cranial stretching involved the attachment of the manubrium to the spine through the first and second ribs and the attachment to the shoulders through the clavicles, the sternal head of the sternocleidomastoid and part of the pectoralis major attached anteriorly to the manubrium and sternum, and the sternohyoid and sternothyroid muscles attached posteriorly to the manubrium. Caudally, stretching in the opposite direction involved the transverse thoracis muscle attached to the posterior surface of the body of the sternum and the strong rectus abdominis attached to the distal part of the sternum . RepetitBilateral first rib fractures and pseudoarthrosis and callus formation at the thoracic inlet were described by Satija et al.  in a 17-Rarer still are reported non-traumatic inflammatory lesions of the manubriosternal synchondrosis reported among athletes complaining of chronic post-exercise pain at the MSJ . While cImaging findings of MSJ dislocation have been described , but pseThe final challenge was in selecting an appropriate operative technique to render the patient pain-free with a fused stable MSJ able to withstand the resumption of sporting activity:While most sternal injuries are managed conservatively, there are three key indications for surgery: (I) the presence of a sternal deformity, (II) loss of sternal continuity for a period of more than 6 weeks, and (III) persistence of chest pain for 2–8 weeks after trauma.Surgical fixation of the dislocated MSJ using plates and screws has yielded demonstrably better results than that achieved with wire fixation . The supTwenty-three months after surgery, the patient reports no further clicking or pain, and, on examination, there is no further evidence of movement at the MSJ.ronitbarh@gmail.com.The datasets presented in this article are not readily available because they are stored in confidential patient medical records. Requests to access the datasets should be directed to Written informed consent was obtained from the individual(s) for the publication of any potentially identifiable images or data included in this article.All authors listed have made a substantial, direct and intellectual contribution to the work, and approved it for publication.The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.


We read with a deep interest Messina et al.’s meta-analysis focusing on goal-directed therapy (GDT) in major visceral/non-cardiac surgery . This reThe 21 studies included in the analysis can be divided into two subgroups: on the one hand those which only protocolized the fluid management and on the other hand those which protocolized a complete hemodynamics bundle of care including fluid management but also vasopressor or inotrope use. The second subgroup of studies (complete bundle of care) appears to have the most beneficial effect on perioperative complications found in the meta-analysis. This subgroup also included five of the only six studies of the meta-analysis which found a significant effect of GDT on perioperative complications by themselves. Moreover, the two studies with the greatest benefit of GDT also included a mean arterial pressure goal and the use of vasopressors and dobutamine in their protocols .In our opinion, the additional benefit of bundle protocols could be explained by the reduction in hypotension episodes occurrence and duration, thanks to a more frequent screening and a more aggressive treatment of these episodes in such protocols. In fact, even if the optimal blood pressure target remains controversial, hypotension is a well-known risk factor for complications in the perioperative period . To corrIn conclusion, all GDT protocols are not equivalent, and complete hemodynamics GDT protocols seem to be more efficient than fluid management only protocols. We suggest exploring the possible benefit of complete hemodynamics GDT protocols on morbidity and mortality in major visceral and non-cardiac surgery.


Working memory (WM) is essential to daily-life activities as it allows maintaining information in the short-term while processing concurrent information , the spatial location (where) and the temporal context of the scene (when). The recall of the spatial or temporal context associated to each element provided a binding score. As compared to a condition without concurrent processing, a verbal concurrent task (memorizing the number of garbage containers) only impaired memory performance of what information and a visuospatial concurrent task  impaired memory performance of what, when, and what-where-when binding information. These results suggest that construction of memory traces rely on verbal and visuospatial maintenance mechanisms and were interpreted as reflecting an involvement of both phonological loop  and the binding of these features. A passive exploration of the environment would allow determining the time-course of the task and controlling temporal parameters and require no control nor planning for traveling. Motor and planning actions required by active traveling can constitute an attentional cost . To enhance ecological validity, events should occur at a non-isochronous pace. Temporal parameters related to to-be-memorized and to-be-processed events  should be fixed and participants' behavior  should be measured. Studies of interdependence between WM processes and other cognitive functions will also benefit from VR paradigms. Long-term memory and semantic representation seem to contribute to refreshing and WM (Loaiza et al., Developing virtual-reality-based paradigms to investigate WM would be useful to identify the neural basis of WM mechanisms in ecological situations. To date, as for behavioral studies, neurophysiological studies of maintenance in WM (Vogel and Machizawa, VR is a powerful experimental tool that allow creating multimodal and naturalistic environments to assess memory for rich and complex information while keeping a strong experimental control. VR will allow testing theoretical assumptions with enhanced ecological validity and interactive fidelity and explore new hypothesis as whether and how traveling affects WM. In addition, VR allows us to examine some of the basic properties of the situated and embodied approach through exact control of methodological factors and go further into the understanding of the role of presence and consciousness in memory. Yet, using VR paradigms in WM studies require to compromise between a strong control of temporal parameters and immersion through active exploring. We recommend fixing temporal parameters of the experiment and to measure behavior, especially response times, as precisely as possible. Future studies will need to determine the minimum immersion and interaction conditions to explore WM with VR to limit the attentional cost of active navigation and facilitate the combined use of VR and neurophysiological measurements. Moreover, some other technical aspects of VR such as the risk of cybersickness, photorealistic level of environment, type of interaction and way of navigation, level and mode of the embodiment need further investigations to test their impact on WM as suggested by some authors in the domain of memory studies Smith, .Future studies should also assess metric properties of VR-based measurements of WM to ensure a good construct validity and reliability. Besides the good equivalence between cognitive performance and physiological responses in the virtual and the real world (Sorita et al., WM is impaired in various populations such as healthy aging, age-related dementia (e.g., Baddeley et al., All authors conceptualized the manuscript. LF wrote the original draft. GP and PP reviewed and edited its intellectual content.The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.


Cryptococcus neoformans , necessitating an extensive work-up.AK contributed to patient care and drafting of this manuscript. All Authors were directly involved in clinical management of the patient and revision of the manuscript. All authors approved the final version of this manuscript.The authors report no declarations of interest.


The COVID-19 pandemic has exerted considerable impact on public mental health globally. With the pandemic rapidly rising in sub-Saharan Africa including Kenya, there is need to provide evidence to guide the mental health response in the region.The objective of this review is (1) to describe the mental health response to the COVID-19 pandemic in Kenya, guided by the Mental Health Preparedness and Action Framework (2) to offer context specific recommendations for improvement of the mental health response in Kenya. Such information could be useful in decision-making in Kenya as well as in the greater sub-Saharan Africa region.This narrative review is based on information obtained from official government documents released from 13th March 2020, the beginning of the pandemic in Kenya, up to 31st July 2020.The COVID-19 response in Kenya has no formal mental health response plan. There is an unmet need for psychological first aid in the community. While guidelines for the management of mental health conditions during the COVID-19 pandemic have been prepared, implementation remains a major challenge due to a poorly resourced mental health system. There is no mental health surveillance system in place limiting ability to design evidence-based interventions.We propose four key strategies for strengthening the mental health response in order to mitigate the harmful impact of COVID-19 on public mental health in Kenya: (1) preparation of a formal mental health response plan specific to the COVID-19 pandemic with allocation of funding for the response (2) training of community health workers and community health volunteers on psychological first aid to enable access to support for those in need during the pandemic (3) scaling up of mobile health to increase access to care (4) conducting systematic and continuous text message surveys on the mental health impact of the COVID-19 pandemic in order to inform decision-making. The ongoing coronavirus disease of 2019 (COVID-19) outbreak which was declared a pandemic in March 2020 . DiseaseThe World Health Organization (WHO) reports that by far, the largest public mental health impact has been in the form of stress and anxiety, and predicts a rise in depression, suicide and substance use in the coming days . AccordiThe recently developed Mental Health Preparedness and Action Framework (MHPAF)  providesThe cases of COVID-19 are rapidly rising in the sub-Saharan Africa with concerns being raised about its capacity to deal with the pandemic . In addiThe Ministry of Health (MOH) through its Division of Mental Health has nonetheless embarked on efforts to deliver mental health care during the pandemic. Unfortunately, the mental health response is occurring against a backdrop of an under-resourced mental health care system characterized by inaccessible services, an acute shortage of mental health workers and limited funding . This, cThe aim of this review is therefore (1) to provide an overview of the mental health response to COVID-19 by the Government of Kenya guided by the MHPAF. A literature search revealed no paper describing the mental health response to COVID-19 in a sub-Saharan Africa country  to offerThe aim of this narrative review is to describe the mental health response to COVID-19 by the Kenyan government. Documents for review were identified following consultation with experts working at the Division of Mental Health at the MOH. We additionally hand-searched the websites of the MOH and other ministries that were listed by the government as being key in the COVID-19 response  for docuAccording to the MHPAF , the menIn order to manage the distress and anxiety often witnessed during pandemics, the MHPAF  recommenLastly, ‘preparation and co-ordination’ entails the setting up of COVID-19 specific mental health services. In Kenya, a number of guidelines have been developed by the Division of Mental Health in partnership with professional bodies such as the Kenya Psychiatric Association to ensure provision of COVID-19 specific mental health services. The ‘Interim guidelines for managing mental health conditions during the COVID-19 pandemic’ [Two other documents that have been prepared by the Division of Mental Health include a guide for health care workers on how to offer mental health and psychosocial support to the public ; and staA major challenge likely to be faced despite the guidelines is that the number of mental health facilities and mental health workers available in Kenya is scarce. For example the psychologist to population ratio is 1:4,600,000. In addition, less than 1% of the public sector health care facilities offer any form of mental health care . Using mThe MHPAF recommends the setting up of a mental health surveillance system during the early phases of the pandemic. This is to ensure systematic and continuous collection of data on mental health in order to assist with planning and designing of appropriate interventions . Data coCurrently in Kenya, research studies seem to be the main strategy for collecting and analyzing information on mental health during the COVID-19 pandemic. The authors are aware of on-going online studies that are being conducted by mental health professionals to investigate the burden of mental health conditions among health care workers.An additional role of the mental health surveillance system is the dissemination of accurate and timely information and to address myths surrounding COVID-19. This has been shown to reduce anxiety and stress during pandemics . AccordiIn Kenya, the Ministry of Information Communication & Technology (ICT) has been tasked with communication functions during the pandemic with focus on dissemination of information on COVID-19, public education and dissemination of health messages . To achiThe MOH has been involved in providing information on COVID-19 to the public. Specifically, the MOH provides daily situation reports on COVID-19 which usually detail the number of cases, deaths, recoveries and offers key public health messages . The MOHDirect funding to the mental health response could not be ascertained. Given the lack of a formal mental health response plan, it is likely that funding for the mental health response is erratic and inadequate.In the post-pandemic period, Kenya should conduct a thorough evaluation of the five components of a mental health response as outlined in the MHPAF. Lessons learnt should be utilized in preparing a well co-ordinated mental health response plan specific for pandemic situations.Preparation of a formal mental health response plan for COVID-19 by the Division of Mental Health with allocation of funding to the response. This ought to be prepared by a team of mental health experts and guided by the five components of the MHPAF.Training of community health workers and community health volunteers on psychological first aid to enable access to psychological support for those in distress during the pandemic particularly at the grassroots level. Such trainings could be administered remotely via video conferencing given the good internet coverage and smart phone penetration rates in Kenya.Scaling up of mobile health to increase access to mental health and psychosocial support for the general public during the pandemic. We propose that the medical doctors manning the 24-hour call centre receive online trainings on mental health and psychological support following which the service is expanded to incorporate delivery of brief psychological interventions to the general public.In order to ensure proper surveillance of the mental health situation during the current pandemic, we propose that systematic and regular surveys are conducted to allow for monitoring of the mental health impact of COVID-19 in Kenya. Major mobile service providers in Kenya have survey platforms that use text messaging. These constitute potential means through which mental health surveillance could be conducted. Given, the existing partnerships between the MOH and local mobile service providers, such an initiative is likely achievable.Kenya has made attempts at instituting a mental health response to the COVID-19 pandemic despite underlying systemic challenges. However, major gaps remain. The country has no formal mental health response plan, there is an unmet need for psychological first aid, access to mental health care and psychosocial support during the pandemic remains a challenge and there is no systematic collection of data on the mental health impact of COVID-19. We therefore propose four key strategies for strengthening the mental health response in Kenya:


This paper presents a novel method for the automated synthesis of probabilistic programs. The starting point is a program sketch representing a finite family of finite-state Markov chains with related but distinct topologies, and a reachability specification. The method builds on a novel inductive oracle that greedily generates counter-examples (CEs) for violating programs and uses them to prune the family. These CEs leverage the semantics of the family in the form of bounds on its best- and worst-case behaviour provided by a deductive oracle using an MDP abstraction. The method further monitors the performance of the synthesis and adaptively switches between inductive and deductive reasoning. Our experiments demonstrate that the novel CE construction provides a significantly faster and more effective pruning strategy leading to an accelerated synthesis process on a wide range of benchmarks. For challenging problems, such as the synthesis of decentralized partially-observable controllers, we reduce the run-time from a day to minutes.


We read with great interest the recent research letter by Thevissen et al. who reported the findings of their international survey regarding the detection of influenza-associated pulmonary aspergillosis (IAPA), with a focus on the use of galactomannan (GM) in broncho-alveolar lavage (BAL) fluid and serum . They no


Point-of-care (POC) diagnostic services are commonly associated with pathology laboratory services. This issue presents a holistic approach to POC diagnostics services from a variety of disciplines including pathology, radiological and information technology as well as mobile technology and artificial intelligence. This highlights the need for transdisciplinary collaboration to ensure the efficient development and implementation of point-of-care diagnostics. The advent of the novel coronavirus 2019 (COVID-19) pandemic has prompted rapid advances in the development of new POC diagnostics. Global private and public sector agencies have significantly increased their investment in the development of POC diagnostics. There is no longer a question about the availability and accessibility of POC diagnostics. The question is “how can POC diagnostic services be integrated into health services in way that is useful and acceptable in the COVID-19 era?”. Point-of-care (POC) refers to the location where healthcare interventions are carried out. These interventions can be carried out in a variety of settings including in the home, in the office, in the community and at a healthcare facility. Disease diagnosis or testing is one of the healthcare interventions that can be carried at POC and referred to as POC diagnostic services or POC testing. POC testing is performed using various POC diagnostics to enable the near-patient detection and monitoring of disease conditions in order to inform prognoses, guide treatment choices and predict treatment responses . The advThe development of new evidence-based POC diagnostics and the replication of these diagnostics to extend their reach is a global health priority. The appropriate integration of new POC diagnostics approaches is crucial for ensuring desirable outcomes. The implementation of POC healthcare interventions such as POC testing ought to be relevant to each specific context and sensitive to local culture. Factors such as infrastructure, resources, values and the characteristics of the participants can influence the implementation, scalability and sustainability of health interventions. A study conducted in Nigeria calls for community education, screening for schistosomiasis, and the enhancement of diagnostic capacity and strengthening of the capability of health workers through point-of-care diagnostics . Our preResearch suggests the need for training healthcare workers to improve POC diagnostic service delivery in resource-limited settings ,10,11. PThe integration of available POC diagnostics into our current healthcare service needs to be prioritized to aid the prevention and management of current pandemics and in preparation for future pandemics. It is clear that the successful implementation of point-of-care diagnostics requires a transdisciplinary approach. Investment in transdisciplinary research platforms for POC diagnostics is recommended. These platforms can also foster improved awareness and recognition of POC diagnostics services as a standalone healthcare service and development of POC diagnostics curricula for the training of a new cadre of healthcare workers, dedicated to POC diagnostic services. The successful implementation of such platforms requires multidisciplinary and multi-sectorial stakeholder involvement including higher education institutions, diagnostics and information and mobile technology developers and providers as well as implementers and users of POC diagnostic services.


In the US few research initiatives actively engage persons living with dementia (PLWD) as partners in the research. The 2017 Summit actively engaged multiple types of stakeholder groups, including one for Persons Living with Dementia (PLWD), and was the first large-scale US research meeting to actively engage PLWD in planning and conduct of the meeting. The PLWD conducted a self-evaluation of their work that yielded best practices, meeting the need for guidelines for engaging with PLWD. The 2020 Summit presented the opportunity to test best practices. Some were implemented by the group conveners, like use of video-enabled meetings. Others were implemented with the PLWD, including decisions about governance structure for the group. The use of learnings from the first Summit in engaging with PLWD in the following Summit supported refinement of some engagement practices, yielding a list of recommendations for future work.


Maternal and neonatal mortality are disproportionally high in low-and middle-income countries. In 2017 the global maternal mortality ratio was estimated to be 211 per 100 000 live births. An estimated 66% of these deaths occurred in sub-Saharan Africa. Training programmes that aim to prepare providers of midwifery care vary considerably across sub-Saharan Africa in terms of length, content and quality. To overcome the shortfalls of pre-service training and support the provision of quality care, in-service training packages for providers of midwifery care have been developed and implemented in many countries in sub-Saharan Africa. We aim to identify what in-service education and training materials have been used for providers of midwifery care between 2000 and 2020 and map their content to the International Confederation of Midwives’ Essential Competencies for Midwifery Practice (ICM Competencies), and the Lancet Midwifery Series Quality Maternal and Newborn Care (QMNC) framework.A search will be conducted for the years 2000–2020 in Cumulative Index of Nursing and Allied Health Literature, PubMed/MEDLINE, Social Sciences Citation Index, African Index Medicus and Google Scholar. A manual search of reference lists from identified studies and a hand search of literature from international partner organisations will be performed. Information retrieved will include study context, providers trained, focus of training and design of training. Original content of identified education and training materials will be obtained and mapped to the ICM Competencies and the Lancet Series QMNC.https://alert.ki.se/) a multi-country study in Benin, Malawi, Tanzania and Uganda.A scoping review is a secondary analysis of published literature and does not require ethical approval. This scoping review will give an overview of the education and training materials used for in-service training for providers of midwifery care in sub-Saharan Africa. Mapping the content of these education and training materials to the ICM Competencies and The Lancet Series QMNC will allow us to assess their appropriateness. Findings from the review will be reflected to stakeholders involved in the design and implementation of such materials. Additionally, findings will be published in a peer-reviewed journal, and used to inform the design and content of an in-service training package for providers of midwifery care as part of the Action Leveraging Evidence to Reduce perinatal morTality and morbidity (ALERT) study, (PACTR202006793783148; Post-results. This scoping review will give a comprehensive overview of the education and training materials used for in-service training for providers of midwifery care in sub-Saharan Africa.To our knowledge, this is the first review that aims to map the content of in-service education and training materials used for providers of midwifery care in sub-Saharan Africa to the ICM Essential Competencies and The Lancet Series Quality Maternal and Newborn Care framework.This scoping review may miss in-service training materials that have not been reported in journals or published in the grey literature.A transformative agenda for maternal and newborn health has been laid out as part of the Sustainable Development Goals (SDGs); ‘to reduce the global maternal mortality ratio (MMR) to less than 70 per 100 000 live births by 2030’ (SDG 3.1) and ‘end preventable deaths of newborns, with all countries aiming to reduce neonatal mortality to at least as low as 12 per 1000 live births’ (SDG 3.2).et alThe workforce providing midwifery care is diverse. A study by Hobbs Box 1Definition of provider of midwifery careProviders of midwifery care are competent maternal and newborn health professionals educated, trained and regulated to national and/or international standards. They provide skilled, evidence-based and compassionate care to women, newborns and families.Providers of midwifery care:Promote and facilitate normal physiological, social and cultural processes throughout the childbearing continuum with a continuity of care philosophy.Seek to prevent and manage maternal and newborn complications.Consult and refer to other health services when required.Respect women’s individual circumstances and views, providing sensitive and dignified care.Substantial heterogeneity exists in the length, content and quality of training that different providers of midwifery care receive to prepare them for the workforce, as well as in their ability to perform obstetric and neonatal functions.17It is imperative that in-service education is evidence based, of high quality and promotes both autonomy and multidisciplinary team working. The International Confederation of Midwives20This review is a component of the Action Leveraging Evidence to Reduce perinatal morTality and morbidity in sub-Saharan Africa (ALERT) project .No patient involvedDue to the nature of the research question a scoping review design was chosen to allow for identification and mapping of existing in-service education and training materials. This scoping review follows the steps as outlined by Arksey and O’Malley.2310.1136/bmjopen-2020-047118.supp1Supplementary data10.1136/bmjopen-2020-047118.supp2Supplementary dataThe objectives of our study are to identify, and map in-service education and training materials designed for providers of midwifery care in sub-Saharan Africa from 2000 to 2020. The scoping review aims to address the following questions:What in-service education and training materials are available and have been used for providers of midwifery care in sub-Saharan Africa from 2000 to 2020?How does the content of these in-service education and training materials align with the International Confederation of Midwives Essential Competencies for Midwifery Practice as well as in relation to the Lancet Midwifery Series QMNC framework?The research questions will be assessed, and studies will be selected specific to the following Population, Concept, Study Design and Context criteria presented in Articles will not be eligible for inclusion in the scoping review if:The country in which the in-service education and training has taken place is not located within sub-Saharan Africa.The health personnel who have undertaken the in-service education and training is not considered to be a provider of midwifery care.The content of the in-service education and training does not relate to the provision of midwifery care.The in-service education and training materials were developed before 2000There are no details provided on the content of the education and training sessions.The search strategy will be conducted for all relevant existing literature, without language restrictions, based on search terms relating to the research questions and restricted to the years 2000–2020 using the following online bibliographic databases: Cumulative Index of Nursing and Allied Health Literature (CINAHL), PubMed/MEDLINE, Social Sciences Citation Index, African Index Medicus and Google Scholar. Grey literature searches will be performed and include organisations known to be active in global health improvement , International Federation of Gynecology and Obstetrics, International Pediatric Association). The reference list of all eligible studies will be hand-searched to identify any additional relevant studies. Examples of the preliminary search terms and strategy to be conducted in CINAHL are outlined in 10.1136/bmjopen-2020-047118.supp3Supplementary dataFollowing the aforementioned comprehensive search strategy, article titles and abstracts will be screened and eligibility for inclusion assessed independently by two reviewers (A-BM and JW). Any disagreements will be resolved by a third reviewer. Screened abstracts identified for inclusion will have their full texts independently screened by A-BM and JW. As the scoping review aims to map the content of in-service training materials we will not assess the quality of the studies reporting on the in-service training. All studies meeting inclusion criteria will therefore be included in the review. Full-text articles that are excluded at the screening stage will have reasons for exclusion documented. The CovidenceA data collection tool will be used to extract required information see . Informa10.1136/bmjopen-2020-047118.supp4Supplementary dataEducation and training materials identified in the scoping review will be sought by the reviewers. If the reviewers are unable to access the materials, they will contact the authors and ask them to share materials. This will allow original content to be mapped to the ICM Essential Competencies for Midwifery Practice10.1136/bmjopen-2020-047118.supp5Supplementary dataScoping reviews collect and examine data from existing literature and therefore do not require prior ethical approval. This scoping review will give a comprehensive overview of the education and training materials used for in-service training for providers of midwifery care in sub-Saharan Africa. To our knowledge, this is the first review that aims to map the content of education and training materials used for providers of midwifery care in sub-Saharan Africa to the ICM Essential Competencies and The Lancet Series QMNC framework. To ensure future in-service education and training materials are of quality and designed to adhere to the ICM Essential Competencies and the Lancet Series QMNC framework, findings from the scoping review will be reflected to stakeholders involved in the design and implementation of such materials and will be used to inform the development of the ALERT in-service midwifery training package. The authors aim to disseminate findings from the scoping review by publication in a peer-reviewed journal.


One of the first neurological symptoms of a COVID-19 infection that has been frequently described is the loss of smell and taste. A large number of neurological problems following the infection have been reported to date  reportedWe describe the case of a 69-year-old female patient with a moderate  COVID-19This symptom seems to be rare; at the time of submission of the manuscript, 105 patients with COVID-19 infection had been treated in our clinic; no patient had previously reported this symptom. However, in more severe courses of the disease, this pathology may have been disregarded. The two cases previously reported  also seeThe authors declare that they have no competing interests.There was no financial support.The patient gave informed consent to the reporting of her case.


We examine how the presence of long-term care insurance (LTCI) spills over to family outcomes, including informal care, co-residence, and labor supply of adult children. We instrument for long-term care insurance with changes in state tax policies to address the endogeneity of LTCI coverage. We find that for tax-filing families in the top third of the income distribution, LTCI coverage leads to a 50 percent reduction the parents’ perceptions of the willingness of people to care for them in the future, including their adult children. We also find that LTCI causes changes in the residential decisions of adult children, with lower co-residence rates and higher likelihood of living within 10 miles of the parent. We also find small decreases in part-time work among adult children. Our findings provide empirical support for the presence of family spillovers of LTCI on the economic behaviors of family members. Part of a symposium sponsored by the Economics of Aging Interest Group.


This article discusses how decision-makers can be supported to strengthen a culture of prevention. This article presents an example of the United Nations Office on Drugs and Crime’s (UNODC) work to engage with decision-makers to create readiness, demand, and capacity for evidence-based prevention programming among them, particularly in low- and middle-income countries. First, we utilized two of the UNODC’s data sources to describe the context where the UNODC’s prevention efforts take place. Analysis of the first dataset on prevention activities implemented globally revealed a gap in translating evidence into practice on a global scale. The second dataset consisted of UNODC policy documents mandating and guiding global action to address substance use. The analysis showed that at the level of political frameworks, prevention is gradually gaining more attention but is still frequently left in the shadow of health- and law enforcement-related issues. In addition, these guiding documents did not reflect fully the current scientific understanding of what constitutes an effective prevention response. Against this background, the feasibility of the UNODC’s efforts to bridge the science–practice gap in the field of prevention was discussed by presenting the results from the UNODC’s regional capacity-building seminars focused on the role of monitoring and evaluation in prevention programming. The results showed potential of this capacity building to affect the attitudes and knowledge of targeted decision-makers. Such efforts to increase decision-makers’ readiness and ultimately their endorsement, adoption, and ongoing support of evidence-based preventive interventions should be continued and intensified.The online version of this article (10.1007/s11121-020-01088-5) contains supplementary material, which is available to authorized users. Increasing efforts to use scientific knowledge to inform policymaking in the fields of health, education, and welfare have been observed in various contexts , inter alia, is to support all its member states, especially low- and middle-income countries (LMICs), in fulfilling their commitment to eliminate or significantly reduce the non-medical use of controlled substances  and adapting and transferring them into real-world settings without losing their efficacy or effectiveness (stage 3). However, the effective scale-up and institutionalization of evidence-based prevention (stage 4) is a less developed research field. This is especially true in regard to the last stage (stage 5) of the translation process, which is geared toward influencing global policies and generating environmental change across multiple cultures and societies. This last stage includes shaping international behavioral health priorities and agendas and supporting large-scale population-level shifts in well-being via evidence-based practices  is the governing body of the UNODC and serves as the policymaking body that formally discusses and agrees upon the global drug policy agenda. The resolutions and decisions made by the member states’ representatives on the CND provide guidance for addressing the issue of drugs to all the member states and the UNODC. While adopted by consensus, these resolutions are not binding but merely guide the member states and provide a normative framework for their actions. In the present article, the work of the UNODC is portrayed against developments in global cooperation on drugs over 2009–2017. The heads of the UNODC member states set goals for this period for countering the world drug problem in the 2009 Political Declaration (CND 2009) calling for greater commitment on drug demand reduction as part of these shared goals. They also adopted a revised annual report questionnaire  legislative and institutional frameworks; (2) comprehensive approaches to drug demand reduction and supply; (3) extent and patterns of drug use; and (4) extent and patterns of trends in drug crop cultivation and drug manufacture and trafficking. The second part of the ARQ requests information on the prevention and early intervention responses implemented in the reporting year by each member state, among other demand, and supply reduction issues. We describe trends in the prevention practices implemented globally by presenting data from this part of the ARQ across its three reporting cycles: 2010–2011 (reported in 2012), 2012–2013 (reported in 2014), and 2014–2015 (reported in 2016).The ARQ section on prevention offers a list of different prevention approaches from which the member states can choose to indicate which of these readily defined types of prevention activities they are implementing. The member states are also asked to provide information on the size of the population they are reaching with these activitiesA composite score was then generated to summarize the information about the actual implementation of a given type of prevention (yes/no) and, if yes, at what level of coverage of the target population . This score for the level of implementation was generated for each of the three strength-of-evidence categories and was normalized between 0 and 1 to enable cross-comparison  provided the ARQ part II data in all three biannual cycles reported in this article, these respondents were mostly from Europe, Asia, and the Americas , with only a few responses from Africa. Thus, the ARQ data do not allow us to draw solid conclusions about the trends in prevention programming, and the data are not necessarily representative of all geographical regions. Additional work remains to be done to further develop this data collection instrument because this tool remains the only source of information depicting the global state of prevention programming and the translation of prevention research into practice.Finally, the data gathered with this instrument also reveal a significant gap in evaluation. The ARQ shows that a majority of the reported prevention activities (55%) were not evaluated at all in 2010–2011, and process evaluation was far more common than outcome evaluation for those activities reported to be evaluated. For example, only 1.9% of the member states implementing life skills education in schools reported evaluating its impacts  knowledge of the key learning goals of the training; (2) attitudes concerning the usefulness of evaluation; and (3) self-efficacy to utilize research for their professional benefit. Data were collected from participants in three of the regional workshops. A total of 55 participants from 25 countries returned both the pre- and the post-questionnaire, and the changes between the pre- and post-measurements were analyzed. The number of answers to each individual question varied because many respondents left some blank answers.p < 0.05; 29.8%; Table The questionnaire first asked the participants to read different examples of evaluation study results and to identify the types of evaluation research that might produce such results . The aim was to assess whether the training had helped the participants comprehend the different applications of evaluations correctly Table . Before The policymakers were also presented with different statements to assess their perceptions of the potential benefits of evaluating prevention and to measure their self-efficacy to conduct and use evaluations in ways benefitting their professional tasks and roles. The participants were asked to indicate to what extent they agreed with each statement , and the results are presented in Table The previous discussions and research point to the need to translate and transfer the knowledge derived from the abundant prevention-related research into the complex environments of real-world policies and programs and to promote readiness for and appreciation of evidence-based prevention globally, particularly in LMICs  should be continued.In the Sustainable Development Goal 3.5, UN member states have committed to strengthen the treatment and prevention of substance use. It has created invaluable momentum to advance prevention practices globally. However, the two indicators used to measure progress in achieving this goal by 2030 focus on the availability of treatment and on the prevalence of harmful alcohol use, and do not reflect the availability or quality of prevention practices UN DESA . This isWork to advocate for rigorous goals and commitments and to promote prevention efforts higher on the global policymaking agenda should be continued and broadened. During the 2019 CND, representatives of the UNODC member states set new goals to address substance use globally. This effort provides important momentum to strengthen the dialog between the scientific and political communities and to capitalize on the latest scientific knowledge about what works best to address substance use prevention. Capacity building is another key component of advancing evidence-based prevention. Various capacity building activities targeting prevention practitioners, coordinators, and decision-makers have been implemented globally, for example in the context of Universal Prevention Curriculum,ESM 1(DOCX 22 kb)


We present a new wave-type model of saltatory conduction in myelinated axons. Poor conductivity in the neuron cytosol limits electrical current signal velocity according to cable theory, to 1–3 m/s, whereas saltatory conduction occurs with a velocity of 100–300 m/s. We propose a wave-type mechanism for saltatory conduction in the form of the kinetics of an ionic plasmon-polariton being the hybrid of the electro-magnetic wave and of the synchronized ionic plasma oscillations in myelinated segments along an axon. The model agrees with observations and allows for description of the regulatory role of myelin. It explains also the mechanism of conduction deficiency in demyelination syndromes such as multiple sclerosis. The recently observed micro-saltatory conduction in ultrathin unmyelinated C fibers with periodic ion gate clusters is also explained.The online version of this article (10.1007/s00249-020-01442-z) contains supplementary material, which is available to authorized users. The input must be however larger than some threshold voltage, otherwise the response of the ion gate block does not occur . Such a behavior is called the all-or-none principle. Various modifications of HH models have been developed to include additional effects like e.g., leakage of ions due to the natural permeability of the membrane to ions beyond the voltage-gated channels, or in more detail, complex geometries of dendrites and axons, thermodynamic  mechanism at nodes of Ranvier with the cable model diffusion at internodal myelinated segments results in the estimation of the AP propagation velocity ,z direction, as illustrated in Fig. T, m is the mass of the ion, C is a constant on the order of unity (to account for the type of scattering of carriers by the system boundary) and a is the radius of a sphere. The first term in the expression for a. According to Eq.  . If this mechanism (as described in the next paragraph) is included the required frequency of plasmon is achieved at the realistic diameter of the axon cord.The bulk plasmon frequency is The insulating, relatively thick myelin coverage creates a periodically broken channel (corrugated conductor-insulator structure) required for plasmon-polariton formation and its wave-type propagation. To reduce the coupling with the surrounding inter-cellular electrolyte and protect against any leakage of plasmon-polaritons, the myelin sheath must be sufficiently thick, much thicker than what is required merely for electrical insulation.Here, we considered an initial model of the dielectric surroundings. In the electrolytic surroundings, plasmon oscillations in separated myelinated segments have strongly red shifted self-frequency due to non-radiative damping of plasmons. The dipole oscillating in a segment induces the oppositely oscillating dipole in the surrounding electrolyte, which dissipates energy into heat eventually. This large effect causes the reducing of the on Jacak . Inclusia) and for small chain separations of k determines the group velocities of the plasmon-polariton modes. The results are presented in Fig. For the resulting plasmon self-frequency in each segment, k as shadowed in the right panel of the figure) which can propagate with the appropriately high velocity. This subset of k determines also the frequency of plasmon-polariton as visualized by shadowing in the left panel in the figure. The mechanism which selects the appropriate k range is the HH mechanism at nodes of Ranvier and the thickness of the myelin sheath. The frequency of the plasmon polariton must be adjusted to the characteristic time of the triggering of the opening of Nak region right-shifts, which causes lowering of the velocity of plasmon-polariton—cf. Fig. k region left-shifts, which also causes lowering of the velocity on the left side of the maximum.From Fig. The regulatory role is played here by the thickness of the myelin layer (as detailed in the next section). The dipole oscillating in a myelinated segment of the axon cord induces in the outer intercellular electrolyte the opposite dipole. Both dipoles coupled across the myelin layer of thickness kd and k domain and thus are unimportant for the considered ionic system. Hence, the quenching of the radiative losses  for the plasmon-polariton modes in the axon model occurs practically throughout the entire Note that for es Jacak  are chares Jacak  with denAlthough the ionic system chain model for a myelinated axon appears to be a crude approximation of the real axon structure, it can serve for the comparison of the energy and time scales of plasmon-polariton propagation implied by the model with the observed kinetic parameters of nerve signals. In the model, the propagation of a plasmon-polariton through the axon chain, excited by an initial AP on the first Ranvier node , sequentially ignites the consecutive Ranvier node blocks of NaThe plasmon-polariton scheme described above for the ignition of AP spike formation in the ordered chain of Ranvier nodes along an axon is thus consistent with the saltatory conduction observed in myelinated axons. The observations that firing of the AP can simultaneously move in two opposite directions if a certain central node of Ranvier of a passive axon is ignited, as well as the observation of the maintenance of the firing traverse despite small breaks in the axon cord or a few damaged Ranvier nodes also agree with the collective wave-type plasmon-polariton model of saltatory conduction in contrast to the lack of satisfactory explanations in models based on the cable theory. The maintenance of the plasmon-polariton kinetics despite discontinuities in the axon cord agrees well with the discrete chain model.In Fig. n in the volume of the spheroid with semiaxes a, b, c, n equals to, a, b, c for a spheroid). The first isotropic term in the expression for z direction. The dipole coupling is independent of the shape of the chain elements. The mutual independence of dipole oscillations with distinct polarization described above follows from the linearity of the dynamics equation (versus the dipole) regardless of the metal or electrolyte conducting elements.To comment on the appropriateness of the chain model for axons, let us note that even though the thin core of the axon is a continuous ion conducting fiber, the surface electromagnetic field can be closely pinned to the linear conductor similarly as to the Goubau line (well-known from microwave technology) Goubau  and if pentclass1pt{minimaBecause the dynamics equation is not affected by the anisotropy, the solutions of the equation for each polarization have the same form as that for the spherical case with the exception of the modification of the related frequency of the dipole oscillations in each direction and the small correction of the orientation dependent contribution of the scattering ratio . Thus, we can independently renormalize the equation for dipole oscillations for each polarization direction, introducing the oscillation self-frequency for each direction q governed by the periodicity. The wave-type propagation has the form of synchronic dipole oscillations of myelinated sectors. These dipole oscillations are equivalent to periodic polarization of Ranvier nodes. The model allows for quantitative estimation of the relevant propagation characteristics and verification of whether plasmon-polariton dynamics fits the observed features of the saltatory conduction in myelinated axons.The periodic structure of a myelinated axon does not form a chain of electrolyte spheres but rather is a thin electrolyte cord with periodically distributed myelinated sectors separated by very short unmyelinated intervals of Ranvier nodes. The periodic corrugated structure of the dielectric isolation allows, however, for collective plasmon wave-type oscillations, The polarization of Ranvier nodes induced by plasmon-polaritons initiates opening of NaPlasmon-polaritons do not interact with external electromagnetic waves or, equivalently, with photons (even at adjusted frequency), which is a consequence of the large difference between the group velocity of plasmon-polaritons and the velocity of photons . The electrical fields induced by dipoles in the near-field zone are, It is known that the thickness of the myelin layer is an essential factor deciding on the proper functioning of myelinated axons. This thickness is greater than that needed for simple isolation because the role of myelin is more specific and not related with electrical isolation. In the case of a plasmon dipole oscillating in the myelinated segment, as part of the plasmon-polariton, the ion oscillations in the axon cord excite the oppositely directed also oscillating dipole of ions in the outer electrolyte, in the cave surrounding the myelinated segment, cf. Fig. For the initial condition suitable for excitation of the considered segment of the axon, i.e., The frequency for a longitudinal plasmon is reduced in a strongly elongated axon rod segment with the aspect ratio trans-myelin beating. Via synchronization with HH cycle ignition time scale, this selected mode of plasmon-polariton is continuously supplemented in energy by HH cycles and simultaneously is able to ignite the HH cycle on consecutive Ranvier nodes along the chain of myelinated segments on arbitrary large distances. This explains why only the myelinated segments oscillate and the frequency of the related plasmon-polariton wave packet is precisely tuned by the myelin thickness, At the Ranvier node, the inner and outer cytosol are separated by the thin bare cell membrane, thus dipole coupling across the thinner barrier is stronger and the corresponding beating quicker. The quick component of this beating is also quenched as not synchronized with the time scale of electrically gated NaThe described mechanism of selection of the low self-frequency of plasmon oscillations of the myelinated fragment allows for accommodation of the frequency of plasmon-polariton . Not alis Figs. , 9.Fig. Recently, it has been discovered that in the thin (ca. 0.1 The AP formation at lipid rafts (similarly as at nodes of Ranvier) is of major importance for the selection of an appropriate mode of plasmon-polariton—that one which is synchronized with HH cycles at consecutive nodes. Only such a mode will be persistent due to energy supplementation at HH cycles. Other, non-synchronized modes are quickly quenched due to strong damping of plasmon-polaritons on short distances. The plasmon-polariton is not a local effect in contrast to the diffusion current described by cable theory. The plasmon-polariton is disjoint with the HH mechanism at nodes but triggers the HH cycles via depolarization of NaThis scenario explains the micro-saltatory conduction in C fibers. The absence of the myelin sheath causes the frequency of the plasmon-polariton in C fibers to be larger than in myelinated axons and mitigated only by the strong damping of surface plasmon oscillations in periodic segments. This damping is caused by the large Ohmic losses in the inner neuron cytosol and by a strong coupling to outer electrolyte across the membrane. The latter is especially large in the absence of myelin as in C fibers. Thus for these fibers we get the self-frequency for plasmons at a single segment, It is thus evident that the cable theory (coupled with HH cycle of AP formation) is helpful only in small short dendrites and unmyelinated axons without any periodic structure of ion gate clusters. Periodicity  of the conduction velocity. This coincidence together with the immunity of plasmon-polaritons to external e-m perturbations or detection support the reliability of the new model proposed for the saltatory conduction in myelinated axons, which is very efficient, quick and energy efficient despite the poor ordinary conductivity of axons.Plasmon-polariton kinetics of the triggering signal along the myelinated axons has the observed velocity and exceeds by 1–2 orders any estimations based on the conventional cable theory. The role of myelin thickness is elucidated as the regulatory factor in a different manner than for diffusion of ions. The plasmon-polariton is a nonlocal effect decoupled from HH cycles at Ranvier nodes, though the latter select the appropriate mode of plasmon polariton via synchronization with triggering of NaA plasmon-polariton model of the saltatory conduction explains also the recently observed micro-saltatory conduction in unmyelinated ultra thin C fibers in the PNS which possess the periodic structure of rafts with clusters of NaIt is worth noting some quantum aspects of plasmon-polaritons, which are synchronized in a wave form simultaneous for plasmon oscillations in all segments of a chain. The plasmon oscillations in a particular segment are, however, of quantum nature (regardless of whether electrons or ions), though seem to be quite ordinary oscillations of charge fluctuations. Plasmons are coherent oscillations of all charges in the subsystem and this coherence can be understood exclusively in quantum terms (e.g., of random phase approximation by Pines, Bohm Pines Supplementary MaterialBelow is the link to the electronic supplementary material.


In our recently published meta-analysis, due to an oversight, we treated urinary As concentration data reported by Tsinovoi et al.  instead We corrected both We also made the required corrections in Lastly, we note that the corrections to the linear and non-linear dose-response models for combined fatal and non-fatal risks of strokes as a function of drinking water arsenic concentration show the same trends as in the original publication and, in particular, over the relatively low concentration range in the scope of the study, there remains no significant association in the data collated between drinking water As concentration and the combined fatal and non-fatal risks of stroke.


We read with interest the recent meta-analysis by Chang et al. who investigated the role of neuromuscular blocking agent (NMBA) use in moderate-to-severe acute respiratory distress syndrome (ARDS) and discuss the potential mechanisms involved in the identified improvements due to the use of NMBA in ARDS . They co


The authors wish to make the following corrections to this paper :The funding information was missing in the original version. The following acknowledgement of funding support should be included: Funding: This work was partially supported by American Cancer Society Internal Research Grant #126771-IRG-14-194-11-IRG.These changes do not affect the scientific results. The manuscript will be updated and the original version will remain online on the article webpage, with a reference to this erratum. The authors would like to apologize for any inconvenience caused to the readers by this change.


Food insecurity is an under-recognized geriatric syndrome that has extensive implications in the overall health and well-being of older adults. Understanding the impact of food insecurity in older adults is a first step in identifying at-risk populations and provides a framework for potential interventions in both hospital and community-based settings. This symposium will provide an overview of current prevalence rates of food insecurity using large population-based datasets. We will present a summary indicator that expands measurement to include the functional and social support limitations , which disproportionately impact older adults, and in turn their rate and experience of food insecurity and inadequate food access. We will illustrate using an example of at-risk seniors the association between sarcopenia, the age-related loss of muscle mass and function, with rates of food security in the United States. The translational aspect of the symposium will then focus on identification of psychosocial and environmental risk factors including food insecurity in older veterans preparing for surgery within the Veterans Affairs Perioperative Optimization of Senior Health clinic. Gaining insights into the importance of food insecurity will lay the foundation for an intervention for food insecurity in the deep south. Our discussant will provide an overview of the implications of these results from a public health standpoint. By highlighting the importance of food insecurity, such data can potentially become a framework to allow policy makers to expand nutritional programs as a line of defense against hunger in this high-risk population.