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To address the problem of dense crowd face detection in complex environments, this paper proposes a face detection model named Deep and Compact Face Detection (DCFD), which adopts an improved lightweight EfficientNetV2 network to replace the backbone network of RetinaFace. A large kernel attention mechanism is introduced to address the face detection task more accurately. The backbone network, an improved efficient channel attention (ECA) mechanism, is added to further improve the algorithm performance. The feature fusion module is an improved neural architecture search feature pyramid network (NAS-FPN) that significantly improves the face detection accuracy in different scenes. To balance the training process of positive and negative samples, we use the focus loss function to replace the traditional cross-entropy loss function. In different environments, the DCFD algorithm has shown efficient face detection performance. This algorithm provides not only a feasible and effective solution for solving the problem of face detection in dense groups but also an important basis for improving the accuracy of face detection models in practical applications.

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Introduction: The integration of self-attention mechanisms into Spiking Neural Networks (SNNs) has garnered considerable interest in the realm of advanced deep learning, primarily due to their biological properties. Recent advancements in SNN architecture, such as Spikformer, have demonstrated promising outcomes. However, we observe that Spikformer may exhibit excessive energy consumption, potentially attributable to redundant channels and blocks. Methods: To mitigate this issue, we propose a one-shot Spiking Transformer Architecture Search method, namely Auto-Spikformer. Auto-Spikformer extends the search space to include both transformer architecture and SNN inner parameters. We train and search the supernet based on weight entanglement, evolutionary search, and the proposed Discrete Spiking Parameters Search (DSPS) methods. Benefiting from these methods, the performance of subnets with weights inherited from the supernet without even retraining is comparable to the original Spikformer. Moreover, we propose a new fitness function aiming to find a Pareto optimal combination balancing energy consumption and accuracy. Results and discussion: Our experimental results demonstrate the effectiveness of Auto-Spikformer, which outperforms the original Spikformer and most CNN or ViT models with even fewer parameters and lower energy consumption.

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Investigating U-Net model robustness in medical image synthesis against adversarial perturbations, this study introduces RobMedNAS, a neural architecture search strategy for identifying resilient U-Net configurations. Through retrospective analysis of synthesized CT from MRI data, employing Dice coefficient and mean absolute error metrics across critical anatomical areas, the study evaluates traditional U-Net models and RobMedNAS-optimized models under adversarial attacks. Findings demonstrate RobMedNAS's efficacy in enhancing U-Net resilience without compromising on accuracy, proposing a novel pathway for robust medical image processing.

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OBJECTIVE: To improve neonatal outcomes through the implementation of an eat, sleep, console (ESC) assessment and change in hospital policy regarding the monitoring requirements for pharmacologic treatment of neonates with neonatal abstinence syndrome (NAS). DESIGN: Retrospective chart review and descriptive survey design. SETTING/LOCAL PROBLEM: A hospital in Northwestern Ontario, where an evidence-based practice change was undertaken to improve care for neonates with NAS. PARTICIPANTS: Neonates being screened for NAS during the Modified Finnegan Neonatal Abstinence Syndrome Scoring System (MFNASSS) protocol (n = 75) and ESC protocol (n = 40). Nurses working in the departments after the implementation of ESC were surveyed. MEASUREMENTS: Length of stay (LOS) and morphine administration by intervention status using unadjusted hazard and risk ratios, respectively. Descriptive statistics are also presented. A one-sample t test was completed for the nurses' perspectives survey questions. RESULTS: Reduced rate of LOS (HR = 1.66, 95% confidence interval [1.1, 2.51]) was observed for participants receiving the ESC intervention (4.53, SD = 1.94), compared to the MFNASSS control (7.45, SD = 6.35). Although the ESC group appeared to have a greater proportion of neonates administered morphine (42.5% ESC vs. 26.7% MFNASSS), the relative risk was not statistically significant (RR = 1.28, 95% confidence interval [0.95, 1.72]). Morphine doses per day were reduced in the ESC group (0.37, SD = 1.50) compared to the MFNASSS group (5.16, SD = 1.02). Overall, the nurses had a positive perspective on the policy change. CONCLUSION: ESC was successfully implemented in a Northwestern Ontario hospital. The overall LOS of neonates with NAS decreased. Nurses found the policy change to be safe and attainable.

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The classic melatonin biosynthesis pathway (Mel; N-acetyl-5-methoxytryptamine) involves two consecutive enzymatic steps that are decisive in hormone production: conversion of serotonin (5-hydroxytryptamine; 5-HT) to N-acetylserotonin (NAS) and the methylation of the last compound to Mel. This pathway requires the activity of the enzymes: the first is of the category of N-acetyltransferases (AANAT, SNAT, or NAT) and the second is N-acetylserotonin O-methyltransferase (ASMT; also known as HIOMT). However, quite recently, new information has been provided on the possibility of an alternative Mel synthesis pathway; it would include a two-step action by these enzymes, but in reverse order, where ASMT (or ASMTL, the enzyme related to ASMT) methylates 5-HT to 5-methoxytryptamine (5-MT), and then the last compound is acetylated by an enzyme of the category of N-acetyltransferases to Mel. In our study on the activity of enzymes in the Mel biosynthesis pathway in flounder skin, we have found an increase in 5-MT level, as a result of the increase in 5-HT concentration, which is followed by a growing concentration of Mel. However, we have not found any increase in Mel concentration, despite an increase in NAS in the samples. Our data strongly suggest an alternative way of Mel production in flounder skin in which 5-HT is first methylated to 5-MT, which is then acetylated to Mel.

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Dental age estimation is extensively employed in forensic medicine practice. However, the accuracy of conventional methods fails to satisfy the need for precision, particularly when estimating the age of adults. Herein, we propose an approach for age estimation utilizing orthopantomograms (OPGs). We propose a new dental dataset comprising OPGs of 27,957 individuals (16,383 females and 11,574 males), covering an age range from newborn to 93 years. The age annotations were meticulously verified using ID card details. Considering the distinct nature of dental data, we analyzed various neural network components to accurately estimate age, such as optimal network depth, convolution kernel size, multi-branch architecture, and early layer feature reuse. Building upon the exploration of distinctive characteristics, we further employed the widely recognized method to identify models for dental age prediction. Consequently, we discovered two sets of models: one exhibiting superior performance, and the other being lightweight. The proposed approaches, namely AGENet and AGE-SPOS, demonstrated remarkable superiority and effectiveness in our experimental results. The proposed models, AGENet and AGE-SPOS, showed exceptional effectiveness in our experiments. AGENet outperformed other CNN models significantly by achieving outstanding results. Compared to Inception-v4, with the mean absolute error (MAE) of 1.70 and 20.46 B FLOPs, our AGENet reduced the FLOPs by 2.7×. The lightweight model, AGE-SPOS, achieved an MAE of 1.80 years with only 0.95 B FLOPs, surpassing MobileNetV2 by 0.18 years while utilizing fewer computational operations. In summary, we employed an effective DNN searching method for forensic age estimation, and our methodology and findings hold significant implications for age estimation with oral imaging.

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BACKGROUND AND AIM: Among low viral load (DNA of hepatitis B virus (HBV) was < 2000 IU/mL), the factor of the loss of hepatitis B surface antigen (HBsAg) remained elusive. METHODS: The retrospective study recruited patients with chronic hepatitis B (CHB) who were negative low for hepatitis B e-antigen (HBeAg), had a low viral load, and experienced HBsAg loss during follow-up. CHB patients with low-viral load but without consequent HBsAg loss were also enrolled at the ratio of 1:4. The factors contributing to HBsAg loss were analyzed. RESULTS: A total of 80 patients were recruited for the current study, with a mean age of 63.9 years and 61.3% being male. Among them, 62.5% patients (50/80) were treated with potent nucleoside/nucleotide analogues (NAs) during the follow-up period. Additionally, 12.5% patients (10/80) had a prior history of NAs treatment before enrolment. During the follow-up, HBsAg loss occurred in 17 patients (21.3%). Compared with patients without HBsAg loss, those with HBsAg loss were younger (57.9 years vs 65.5 years; P = 0.01), had lower HBV DNA levels (1.3 log10 IU/mL vs 2.3 log10 IU/mL; P = 0.003), and higher proportion of prior NAs-treated history. Logistic regression analysis revealed that the factors associated with factors associated with HBsAg loss were age < 60 years (OR/CI: 3.95/1.15-13.60, P = 0.03), prior NAs-treated history (OR/CI: 7.59/1.42-40.51, P = 0.01) and current NAs-treated (OR/CI: 0.19/0.05-0.71, P = 0.01). CONCLUSIONS: In the study, older age and prior NAs were positively associated with HBsAg loss, and current NAs was negatively associated with HBsAg loss. Additionally, some patients experienced HBsAg loss during the NAs therapy.

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Abstract Objective This study aimed to describe the methodological process for developing a questionnaire to identify the prevalence and risk factors for chronic occupational low back pain in healthcare professionals working at hospitals. Method An exploratory crossectional survey study was carried out in Belo Horizonte, MG, Brazil, and its metropolitan region, in two stages. Initially, the authors prepared a questionnaire based on the Roland Morris disability questionnaire and sent it to a committee of low back pain specialists for validation using the Delphi technique. The second stage consisted of sending the final questionnaire to health professionals working in a hospital environment for at least 2 years and presenting chronic low back pain for at least 3 months. Results Validation occurred in two rounds of questionnaire adjustments by a panel consisting of physical therapists and physician experts in the field (orthopedists with more than 3 years of experience). Both rounds had 13 participants. The questionnaire initially consisted of 27 items, and, after validation, it had 19 items. The study included 65 subjects, with an average age of 40.91 years old and an average time working at a hospital of 40 hours per week. The total sample had 76.9% of physicians, 10.8% of physical therapists, and 12.3% of nurses or nursing technicians. Most (52.3%) subjects reported staying in uncomfortable positions affecting the lower back for 5 to 10 hours per day. Conclusion We developed and validated, using the Delphi technique, a questionnaire on the prevalence and risk factors associated with chronic occupational low back pain among healthcare professionals working at hospitals. This unprecedented tool can benefit the population studied since the questionnaires currently used to evaluate chronic low back pain are not specific for investigating the occupational cause of this condition.

Resumo Objetivo Este estudo pretende descrever o processo metodológico para a elaboração de um questionário para identificar a prevalência e os fatores de risco associados à dor lombar ocupacional crônica nos profissionais da área da saúde que atuam em nível hospitalar. Método Foi realizado um estudo transversal exploratório do tipo questionário. O estudo foi realizado na cidade de Belo Horizonte e região metropolitana, em duas etapas. Inicialmente foi elaborado pelos autores um questionário baseado no questionário de deficiências Roland Morris e enviado a um comitê de especialistas em lombalgia para validação do mesmo através da técnica Delphi. A segunda etapa consistiu em enviar o questionário final a profissionais de saúde que atuam em ambiente hospitalar há pelo menos 2 anos e que tenham lombalgia crônica há pelo menos 3 meses. Resultados A validação foi realizada em duas rodadas de adequações do questionário, com painel composto por fisioterapeutas e médicos especialistas na área (ortopedistas com mais de 3 anos de atuação). Ambas as rodadas contaram com 13 participantes. O questionário foi composto inicialmente por 27 itens e, após validação, 19 itens. O estudo incluiu 65 indivíduos, com idade média de 40,91 anos e tempo médio de atuação em nível hospitalar semanal de 40 horas. A amostra total possuía 76,9% médicos, 10,8% fisioterapeutas e 12,3% enfermeiros ou técnicos de enfermagem. A maioria (52,3%) dos indivíduos relatou manter-se em posições desconfortáveis que afetam a região lombar por 5 a 10 horas por dia. Conclusão Foi desenvolvido e validado, pela técnica Delphi, um questionário sobre a prevalência e fatores de risco associados a dor lombar ocupacional crônica entre profissionais da área da saúde que atuam em nível hospitalar. Este instrumento inédito pode trazer benefícios para a população estudada, visto que os questionários utilizados atualmente para a avaliação de dor lombar crônica não são específicos para a investigação da causa ocupacional de tal condição.

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BACKGROUND/AIMS: Bariatric intervention has been reported to be an effective way to improve metabolic dysfunction-associated steatotic liver disease (MASLD) in obese individuals. The current systemic review aimed to assess the changes in MRI-determined hepatic proton density fat fraction (MRI-PDFF) and nonalcoholic fatty liver disease activity score (NAS) after bariatric surgery or intragastric balloon/gastric banding in MASLD patients with obesity. METHODS: We searched various databases including PubMed, OVID Medline, EMBASE, and Cochrane Library. Primary outcomes were the changes in intrahepatic fat on MRI-PDFF and histologic features of metabolic dysfunction-associated steatohepatitis (MASH). RESULTS: Thirty studies with a total of 3,134 patients were selected for meta-analysis. Bariatric intervention significantly reduced BMI (ratio of means, 0.79) and showed 72% reduction of intrahepatic fat on MRI-PDFF at 6 months after bariatric intervention (ratio of means, 0.28). Eight studies revealed that NAS was reduced by 60% at 3-6 months compared to baseline, 40% at 12-24 months, and 50% at 36-60 months. Nineteen studies revealed that the proportion of patients with steatosis decreased by 44% at 3-6 months, 37% at 12-24 months, and 29% at 36-60 months; lobular inflammation by 36% at 12-24 months and 51% at 36-60 months; ballooning degeneration by 38% at 12-24 months; significant fibrosis (≥F2) by 18% at 12-24 months and by 17% at 36-60 months after intervention. CONCLUSION: Bariatric intervention significantly improved MRI-PDFF and histologic features of MASH in patients with obesity. Bariatric intervention might be the effective alternative treatment option for patients with MASLD who do not respond to lifestyle modification or medical treatment.

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Introducción: promover autonomía significa transitar desde un modelo paternalista hacia uno que posi-cione en un rol activo a las personas durante el encuentro clínico, con participación en la toma de deci-siones relativas al cuidado de su salud. Este artículo describe la percepción de usuarios que viven con multimorbilidad respecto del ejercicio de su autonomía durante la atención clínica. Método: estudio de caso cualitativo en usuarios con multimorbilidad atendidos en un centro de salud familiar de Santiago (Chile).Se realizó análisis de contenido según Krippendorf. Resultados: la muestra quedó conformada por 19 participantes adultos con un promedio de 2.7 condiciones crónicas de salud. Del análisis de contenido de las entrevistas emergieron tres categorías: a) significado atribuido por los usuarios a la autonomía en la atención de salud, b) elementos que debe considerar una atención en salud que respete la autonomía del usuario y c) participación durante la atención clínica. Conclusiones: frente al aumento de las condicio-nes crónicas de salud es imperativo repensar la forma de brindar atención de salud, relevando el valor de la participación usuaria a través de la toma de decisiones compartida como expresión de respeto de su autonomía y una forma de fomentar el cuidado centrado en las personas

Aim: Promoting autonomy means changing from a paternalistic model to one in which individuals play an active role in their healthcare, which their participation in medical decision-making will reflect. This issue needs to be sufficiently explored in Chile, so this article aims to describe the perception of users liv-ing with multimorbidity regarding their ability to exercise autonomy in clinical care. Method: Qualitative case study conducted in a sample of patients with multimorbility from a family health center in Santiago de Chile. Content analysis was performed according to the Krippendorf method. Results: The sample com-prised 19 adult participants with an average of 2.7 chronic health conditions. Three categories emerged from the content analysis of the interviews: (a) Meaning attributed by users to autonomy in health care, (b) Elements that health care respecting user autonomy should consider, and (c) Participation during clinical care. Conclusions: Considering the sustained increase in chronic health conditions, it is impera-tive to rethink how health care is provided, highlighting the value of user participation through shared decision-making as an expression of respect for individuals' autonomy and the promotion of patient-cen-tered care

Objetivo: promover a autonomia significa passar de um modelo paternalista para um que posicione as pessoas num papel ativo durante o encontro clínico, com participação na tomada de decisões relaciona-das com os seus cuidados de saúde. Este manuscrito descreve a percepção de usuários que convivem com multimorbidade quanto ao exercício de sua autonomia durante o atendimento clínico. Método: estudo de caso qualitativo em usuários com multimorbidade atendidos em um Centro de Saúde da Família de Santiago, no Chile. A análise de conteúdo foi realizada segundo Krippendorf. Resultados: a amostra foi composta por 19 participantes adultos com média de 2.7 condições crônicas de saúde. Da análise de conteúdo das entrevistas emergem três categorias: a) Significado atribuído pelos usuários à autonomia no cuidado em saúde, b) Elementos que um cuidado de saúde que respeite a autonomia do usuário deve considerar, e c) Participação durante o atendimento clínico. Conclusões: face ao aumento das condições crónicas de saúde, é imperativo repensar a forma de prestar cuidados de saúde, destacando o valor da participação dos pacientes através da tomada de decisão partilhada como expressão de respeito pela sua autonomia e forma de promover o cuidado centrado nas pessoas

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Non-aureus staphylococci (NAS) are an essential group of bacteria causing antimicrobial resistant intramammary infections in livestock, particularly dairy cows. Therefore, bacteriophages emerge as a potent bactericidal agent for NAS mastitis. This study aimed to obtain NAS-specific bacteriophages using bacterial strains isolated from cows with mastitis, subsequently evaluating their morphological, genomic, and lytic characteristics. Four distinct NAS bacteriophages were recovered from sewage or the environment of Chinese dairy farms; PT1-1, PT94, and PT1-9 were isolated using Staphylococcus chromogenes and PT1-4 using Staphylococcus gallinarum. Both PT1-1 (24/54, 44 %) and PT94 (28/54, 52 %) had broader lysis than PT1-4 (3/54, 6 %) and PT1-9 (10/54, 19 %), but PT1-4 and PT1-9 achieved cross-species lysis. All bacteriophages had a short latency period and good environmental tolerance, including surviving at pH=4-10 and at 30-60℃. Except for PT1-9, all bacteriophages had excellent bactericidal efficacy within 5 h of co-culture with host bacteria in vitro at various multiplicity of infection (MOIs). Based on whole genome sequencing, average nucleotide identity (ANI) analysis of PT1-1 and PT94 can be classified as the same species, consistent with whole-genome synteny analysis. Although motifs shared by the 4 bacteriophages differed little from those of other bacteriophages, a phylogenetic tree based on functional proteins indicated their novelty. Moreover, based on whole genome comparisons, we inferred that cross-species lysis of bacteriophage may be related to the presence of "phage tail fiber." In conclusion 4 novel NAS bacteriophages were isolated; they had good biological properties and unique genomes, with potential for NAS mastitis therapy.

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The FDA has approved many nucleic acid (NA)-based products. The presence of charges and biological barriers however affect stability and restrict widespread use. The electrostatic complexation of peptide with polyethylene glycol-nucleic acids (PEG-NAs) via nonreducible and reducible agents lead to three parts at one platform.. The reducible linkage made detachment of siRNA from PEG easy compared with a nonreducible linkage. A peptide spider produces a small hydrodynamic particle size, which can improve drug release and pharmacokinetics. Several examples of peptide spiders that enhance stability, protection and transfection efficiency are discussed. Moreover, this review also covers the challenges, future perspectives and unmet needs of peptide-PEG-NAs conjugates for NAs delivery.

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In this study, a flexible, free-standing Fe-doped CoP nanoarrays electrode for superior lithium-ion storage has been successfully fabricated. The electrode combines the advantages of a Fe-doping and a flexible carbon cloth (CC) support, resulting in a high specific capacity (1356 mAh/g at 0.2 A/g) and excellent cycling stability (1138 mAh/g after 100 cycles). The cyclic voltammetry (CV) curves at different scan rates investigate the outstanding lithium storage behavior of Fe-CoP-NAs/CC which indicates a combined influence of diffusion behavior and capacitance behavior on the electrochemical process. The galvanostatic intermittent titration technique (GITT) analyzes the diffusion kinetics of Li+ which indicates the fast diffusion kinetics in the Fe-CoP/NAs/CC anode. The assembled Fe-CoP-NAs/CC//LiFePO4 battery exhibits a remarkable capacity of 325.2 mAh/g even at 5 A/g. And the battery also has good cycle stability, and still provides 498.1 mAh/g specific capacity after 200 cycles. Moreover, the Fe-CoP-NAs/CC//LiFePO4 soft-pack battery can continuously power the LEDs when it is bent at various angles which demonstrates its potential for use in wearable devices.

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Background: The severity of neonatal abstinence syndrome (NAS) may be assessed with the Finnegan score (FS). Since the FS is laborious and subjective, alternative ways of assessment may improve quality of care. Objective: In this pilot study, we examined associations between the FS and routine monitoring data obtained from the electronic health record system. Methods: The study included 205 neonates with NAS after intrauterine (n=23) or postnatal opioid exposure (n=182). Routine monitoring data were analyzed at 60±10 minutes (t-1) and 120±10 minutes (t-2) before each FS assessment. Within each time period, the mean for each variable was calculated. Readings were also normalized to individual baseline data for each patient and parameter. Mixed effects models were used to assess the effect of different variables. Results: Plots of vital parameters against the FS showed heavily scattered data. When controlling for several variables, the best-performing mixed effects model displayed significant effects of individual baseline-controlled mean heart rate (estimate 0.04, 95% CI 0.02-0.07) and arterial blood pressure (estimate 0.05, 95% CI 0.01-0.08) at t-1 with a goodness of fit (R2m) of 0.11. Conclusions: Routine electronic data can be extracted and analyzed for their correlation with FS data. Mixed effects models show small but significant effects after normalizing vital parameters to individual baselines.

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Neural Architecture Search (NAS) has been widely applied to automate medical image diagnostics. However, traditional NAS methods require significant computational resources and time for performance evaluation. To address this, we introduce the GrMoNAS framework, designed to balance diagnostic accuracy and efficiency using proxy datasets for granularity transformation and multi-objective optimization algorithms. The approach initiates with a coarse granularity phase, wherein diverse candidate neural architectures undergo evaluation utilizing a reduced proxy dataset. This initial phase facilitates the swift and effective identification of architectures exhibiting promise. Subsequently, in the fine granularity phase, a comprehensive validation and optimization process is undertaken for these identified architectures. Concurrently, employing multi-objective optimization and Pareto frontier sorting aims to enhance both accuracy and computational efficiency simultaneously. Importantly, the GrMoNAS framework is particularly suitable for hospitals with limited computational resources. We evaluated GrMoNAS in a range of medical scenarios, such as COVID-19, Skin cancer, Lung, Colon, and Acute Lymphoblastic Leukemia diseases, comparing it against traditional models like VGG16, VGG19, and recent NAS approaches including GA-CNN, EBNAS, NEXception, and CovNAS. The results show that GrMoNAS achieves comparable or superior diagnostic precision, significantly enhancing diagnostic efficiency. Moreover, GrMoNAS effectively avoids local optima, indicating its significant potential for precision medical diagnosis.

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Sulfurized polyacrylonitrile (PAN@S) is a promising cathode material for room-temperature Na/S batteries but suffers from low conductivity and insufficient electrochemical activity, resulting in unsatisfactory actual capacity and rate performance. Herein, Ti3C2Tx MXene nanosheets are used as a conductive and catalytic binder to establish the PAN@S electrode, wherein MXene constructs a highly conductive framework for fast charge transport and provides high catalytic effect to improve the active material utilization and accelerate the redox kinetics significantly. Therefore, the PAN@S electrode bonded by MXene shows an electronic conductivity of 5.05 S cm-1, 4 orders of magnitude higher than the conventional electrodes bonded by the insulative polymer binders, and much decreased activation energy barrier and resistance. Consequently, the PAN@S electrode displays superior performance in terms of high capacity (697.3 mAh g-1 at 200 mA g-1), unparalleled rate capability (189.0 mAh g-1 at 20 A g-1), and excellent high-rate cycling performance (a capacity decay rate of ∼0.04% per cycle during 1000 cycles at 5 A g-1). This work provides a high-performance electrode for room-temperature Na/S batteries and shows the promising potential of conductive and catalytic MXene binders in boosting the performance of active materials.

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Neonatal abstinence syndrome (NAS) presents with a varying severity of withdrawal signs and length of treatment (LOT). We examined the course and relevance of each of the NAS withdrawal signs during treatment in a sample of 182 infants with any prenatal opioid exposure, gestational age ≥ 35 weeks, without other medical conditions, and meeting the criteria for pharmacological treatment. Infants were monitored using the Finnegan Neonatal Abstinence Scoring Tool. Daily mean Finnegan scores were estimated using linear mixed models with random subject effects to account for repeated withdrawal scores from the same subject. Daily item prevalence was estimated using generalized estimating equations with a within-subject exchangeable correlation structure. The median LOT was 12.86 days. The prevalence of withdrawal signs decreased from day one to day three of treatment. However, certain central nervous system (CNS) and gastrointestinal (GI) signs showed sporadic increases in prevalence notable around two weeks of treatment, accounting for increases in Finnegan scores that guided pharmacotherapy. We question whether the resurgence of signs with a prolonged LOT is mainly a consequence of opioid tolerance or withdrawal. Monitoring CNS and GI signs throughout treatment is crucial. Future studies directed to better understand this clinical phenomenon may lead to the refining of NAS pharmacotherapy and perhaps the discovery of treatment alternatives.

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The practical application of the room-temperature sodium-sulfur (RT Na-S) batteries is currently limited by low reversible capacity and serious capacity decay due to the sluggish reaction kinetics and shuttle effect. It is necessary to design a suitable sulfur host integrated with electrocatalysts to realize effective chemisorption and catalysis of sodium polysulfides (NaPSs). Herein, under the guidance of theoretical calculation, the Mott-Schottky heterojunction with a built-in electric field composed of iron (Fe) and iron disulfide (FeS2) components anchored on a porous carbon matrix (Fe/FeS2-PC) is designed and prepared. The enhanced chemisorption effect of Fe, the fast electrocatalytic effect of FeS2, and the fast transfer effect of the built-in electric field within the Fe/FeS2 heterojunction in the cathode of RT Na-S batteries work together to effectively improve the electrochemical performance. As a result, the Fe/FeS2-PC@S cathode exhibits high reversible capacity (815 mAh g-1 after 150 cycles at 0.2 A g-1) and excellent stability (516 mAh g-1 after 600 cycles at 5 A g-1, with only 0.07% decay per cycle). The design of the Fe/FeS2 heterojunction electrocatalyst provides a new strategy for the development of highly stable RT Na-S batteries.

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Proteinaceous brain inclusions, neuroinflammation, and vascular dysfunction are common pathologies in Alzheimer's disease (AD). Vascular deficits include a compromised blood-brain barrier, which can lead to extravasation of blood proteins like fibrinogen into the brain. Fibrinogen's interaction with the amyloid-beta (Aß) peptide is known to worsen thrombotic and cerebrovascular pathways in AD. Lecanemab, an FDA-approved antibody therapy for AD, shows promising results in facilitating reduction of Aß from the brain and slowing cognitive decline. Here we show that lecanemab blocks fibrinogen's binding to Aß protofibrils, normalizing Aß/fibrinogen-mediated delayed fibrinolysis and clot abnormalities in vitro and in human plasma. Additionally, we show that lecanemab dissociates the Aß/fibrinogen complex and prevents fibrinogen from exacerbating Aß-induced synaptotoxicity in mouse organotypic hippocampal cultures. These findings reveal a possible protective mechanism by which lecanemab may slow disease progression in AD.

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BACKGROUND: COVID-19 is associated with increased nursing workload, therefore a high nurse-to-patient ratio would be required. AIM: To analyse difference in nursing workload, as expressed with the Nursing Activities Score (NAS), between COVID-19 patients versus control patients without COVID-19 disease (NCOVID-19 group) in an Italian Extracorporeal Membrane Oxygenation (ECMO) centre. STUDY DESIGN: Retrospective analysis of prospectively collected data, enrolling consecutive patients admitted to a general Intensive Care Unit, between 1st May 2019 and 28th February 2021. A multivariate analysis was then performed to assess if COVID-19 disease was an independent predictor of higher NAS and to assess which other factors and procedures are independently associated with increased workload. RESULTS: We enrolled 574 patients, of which 135 (24%) were in the COVID-19 group and 439 (76%) in the NCOVID-19 group. The average NAS was higher in the COVID-19 group (79 ± 11 vs. 65 ± 15, T = -10.026; p < 0.001). Prone positioning, continuous renal replacement therapy (CRRT) and ECMO were used more frequently in the COVID-19 group. A higher fraction of patients in the COVID group showed colonization from multidrug resistant bacteria. COVID-19 group had a higher duration of mechanical ventilation and longer ICU stay. The COVID-19 diagnosis was independently associated with a higher NAS. Other independent predictors of higher NAS were the use of prone positioning and continuous renal replacement therapy (CRRT). Colonization from multidrug resistant bacteria and ECMO support were not independently associated with higher NAS. CONCLUSIONS: The higher nursing workload in COVID-19 patients is mainly due to specific procedures required to treat the most hypoxemic patients, such as prone positioning. Colonization with multidrug resistant bacteria and ECMO support were not independently associated with a higher NAS. RELEVANCE TO CLINICAL PRACTICE: Higher workload in COVID-19 patients was due to specific interventions, such as prone positioning and CRRT, with the related nursing activities, as continuous presence at patient's bed, mobilization, positioning and complex hygienic procedures.

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