Characteristics of lymph node metastasis and short-term outcome of esophageal squamous-cell carcinoma undergoing minimally invasive esophagectomy: a prospective cross-sectional study (with video).

Introduction: Surgery for esophageal squamous-cell carcinoma (ESCC) presents many potential challenges owing to malignant lymph node metastasis, complex procedures and severe postoperative complications. The appropriate lymphadenectomy for ESCC remains controversial. This study aims to evaluate the characteristics of lymph node metastasis and postoperative complications in patients with ESCC undergoing minimally invasive esophagectomy and extended two-field lymph node dissection. Patients and methods: This prospective, single-center, cross-sectional study was conducted from October 2022 to May 2024. All patients with ESCC who underwent minimally invasive esophagectomy and extended two-field lymph node dissection were selected for this study. Postoperative lymph nodes were divided into upper thoracic, middle thoracic, lower thoracic and abdominal lymph node groups. Results: Seventy-four patients with ESCC, including 49 patients who underwent upfront surgery and 25 patients who received preoperative chemoradiotherapy, were selected. The rate of lymph node metastasis in all patients was 39.2%, with 13.6% of patients having upper thoracic metastasis. The factors affecting the rate of lymph node metastasis included preoperative chemoradiotherapy, tumor stage, poor differentiation, lymphovascular/perineural invasion, and tumor size greater than 2 cm, all of which were significantly different (P<0.05). Common postoperative complications included pneumonia (25.7%), recurrent laryngeal nerve (RLN) palsy (10.8%) and anastomotic leak (4.1%). There were no cases required conversion to open surgery, nor any deaths within 90 days postoperatively. Conclusion: Lymph node metastasis in esophageal squamous-cell carcinoma has a high incidence, occurs in the early stages, and is widely distributed in all regions of the mediastinum and abdomen. Minimally invasive esophagectomy and extended two-field lymph node dissection are feasible and safe, with low complication rates.

Rejuvenation of human mesenchymal stem cells using a nonintegrative and conditionally removable Sendai virus vector.

Human mesenchymal stem cells (hMSCs) with extended lifespan and differentiation potential that can recapitulate in vivo characteristics could significantly contribute to basic research, drug development, and cell therapy. Specifically, they could ensure a stable supply of specific cellular resources, and possibly extracellular vesicles. Here, we established a technology for extending the lifespan while maintaining differentiation potential, termed "rejuvenation," of hMSCs (rej-hMSCs) using nonintegrative and conditionally removable temperature-sensitive Sendai virus (SeV) vectors. Various immortalizing factors (i.e., Bmi-1, hTERT, SV40T, and/or HPV E6/E7) were first introduced by the SeV vector into the cells. A combination of three SeVs with Bmi-1, hTERT, or SV40T conferred markedly improved cell proliferation and cloning ability while maintaining differentiation potential and a normal karyotype. An extended lifespan was also demonstrated in other cell types. The rejuvenation of long-passaged or aged hMSCs was also confirmed. SeV vectors were rapidly removed as a function of cell doubling by increasing the temperature from 35 °C to 37 °C or higher, while proliferative ability was maintained. Following FACS sorting, the complete removal of SeV vectors was confirmed by qPCR analyses. Therefore, our cell rejuvenation technology could contribute to research and clinical applications by enabling the supply of modified cells without damaging host chromosomes.

End-extended Conjugation Strategy to Reduce the Efficiency-Stability-Mechanical Robustness Gap in Binary All-Polymer Solar Cells.

Concurrently achieving high efficiency, mechanical robustness and thermal stability is critical for the commercialization of all-polymer solar cells (APSCs). However, APSCs usually demonstrate complicated morphology, primarily attributed to the polymer chain entanglement which has a detrimental effect on their fill factors (FF) and morphology stability. To address these concerns, an end-group extended polymer acceptor, PY-NFT, was synthesized and studied. The morphology analysis showed a tightly ordered molecular packing mode and a favorable phase separation was formed. The PM6:PY-NFT-based device achieved an exceptional PCE of 19.12% (certified as 18.45%), outperforming the control PM6:PY-FT devices (17.14%). This significant improvement highlights the record-high PCE for binary APSCs. The thermal aging study revealed that the PM6:PY-NFT blend exhibited excellent morphological stability, thereby achieving superior device stability, retaining 90% of initial efficiency after enduring thermal stress (65 °C) for 1500 hours. More importantly, the PM6:PY-NFT blend film exhibited outstanding mechanical ductility with a crack onset strain of 24.1%. Overall, rational chemical structure innovation, especially the conjugation extension strategy to trigger appropriate phase separation and stable morphology, is the key to achieving high efficiency, improved thermal stability and robust mechanical stability of APSCs.

Efficacy of medical education combined with extended care on adherence to inhaled glucocorticoids and clinical effects in patients with bronchial asthma.

OBJECTIVE: To observe the clinical efficacy of medical education combined with extended care in patients with bronchial asthma and its effect on adherence to inhaled glucocorticoids. METHODS: Ninety-eight patients with bronchial asthma were divided into the control group and the experimental group, n = 49, by utilizing the random number table method. The control group was given routine education and care as well as routine out-of-hospital instructions, and the experimental group was given medical education and extended care based on the control group. Asthma disease knowledge mastery, asthma control, quality of life, medication adherence and lung function were compared between both groups, and the number of asthma attacks and re-hospitalizations were recorded. RESULTS: The experimental group performed higher scores of health knowledge, asthma control test and quality of life, rate of complete adherence, forced expiratory volume in one second (FEV1), peak expiratory flow rate, and FEV1/forced vital capacity. The number of asthma attacks and the times of re-hospitalizations were lower in the experimental group (all P < 0.05). CONCLUSION: Medical education combined with extended care can improve bronchial asthma patients' mastery of asthma disease knowledge, effectively control patients' conditions, enhance patients' quality of life and lung function, increase patients' adherence to inhaled glucocorticoids, and reduce the recurrence of bronchial asthma patients.

The links between experiential learning and 4E cognition.

In this article, we explore the connections between two distinct approaches: experiential learning (EL) and 4E cognition. EL emphasizes the role of concrete experiences as the building blocks of learning, whereas 4E cognition views cognition as arising from the interactions that an individual has with their physical and social environment. Despite their divergent theoretical frameworks, methodologies, and interests, we argue that both frameworks share a common vision of cognition and that their integration could mutually enhance their respective fields. This article outlines the historical origins and underlying assumptions of both frameworks, highlighting the potential links that can be established between them. Specifically, we explore the significance of embodiment, embeddedness, extended cognition, and enactive processes in learning and cognition. To bridge these frameworks, we propose employing the concept of "concrete experience" as an active engagement of individuals with their physical and social surroundings. By encompassing the essential aspects assigned to concrete experiences in EL, as well as the embodiment, situatedness, extended cognition, and enactive features of 4E cognition, this notion serves as a unifying element. Ultimately, the article suggests that combining the insights from EL and 4E cognition can offer a richer, more holistic understanding of representation.

Adsorption behavior of cationic dyes on starch nanocrystals: Kinetic, isotherm, and thermodynamic insights from single to multi-component systems.

The adsorptive potential of starch nanocrystals (SNCs) was evaluated for the elimination of methylene blue (MB), crystal violet (CV), and malachite green (MG) from aqueous media in single, binary, and ternary dye systems using batch mode experiments. SNCs were extracted using mild acid hydrolysis to remove the amorphous parts of native granular starch, and they were characterized using different physicochemical methods, such as FESEM, XRD, FTIR, BET, TGA, and pHZPC. The results revealed that the optimal pH for dye removal in both single and mixed dye systems was found to be 9.0. The equilibrium time increased from 5 to 20 min when the system was changed from single to binary, and then further increased to 30 min when the system was changed to ternary. The equilibrium data for single-dye systems exhibited a good fit with the Langmuir isotherm model (R2 > 0.98, SEE <3.52 mg g-1), whereas for binary and ternary dye mixtures, the extended Langmuir model provided an accurate representation of the experimental data (R2 > 0.99, SEE <1.33 mg g-1). Among the single, binary, and ternary systems, the highest adsorption capacities were observed for MB, MB in the (MB + MG) binary system, and MB in the (MB + CV + MG) ternary system. The respective adsorption capacities were recorded as 79.55 mg g-1, 61.91 mg g-1, and 43.59 mg g-1. The adsorption of dyes onto the SNCs was inherently spontaneous and endothermic, and adhered to the pseudo-second-order kinetic model in single dye systems as well as mixed dye systems. It can be concluded that the SNCs are capable of being utilized for five consecutive cycles in the adsorption-desorption process for single dye systems and three consecutive cycles for mixed dye systems. This suggests that the SNCs have potential as a sustainable and efficient option for dye removal in mixture systems.

Hazard characterization of antibiotic-resistant Aeromonas spp. isolated from mussel and oyster shellstock available for retail purchase in Canada.

Surveillance and monitoring of foods for the presence of antimicrobial-resistant (AMR) bacteria is required to assess the risks these bacteria pose to human health. Frequently consumed raw or lightly cooked, live bivalve shellfish such as mussels and oysters can be a source of exposure to AMR bacteria. This study sought to determine the prevalence of third generation cephalosporin (3GC) and carbapenem resistant bacteria in live mussel and oyster shellstock available for retail purchase through the course of one calendar year. Just over half of the 180 samples (52%) tested positive for the presence 3GC-resistant bacteria belonging to thirty distinct bacterial species. Speciation of the isolates was carried out using the Bruker MALDI Biotyper. Serratia spp., Aeromonas spp., and Rahnella spp. were the most frequently isolated groups of bacteria. Antibiotic resistance testing confirmed reduced susceptibility for 3GCs and/or carbapenems in 15 of the 29 Aeromonas isolates. Based on AMR patterns, and species identity, a sub-set of ten Aeromonas strains was chosen for further characterization by whole genome sequence analysis. Genomic analysis revealed the presence of multiple antibiotic resistance and virulence genes. A number of mobile genetic elements were also identified indicating the potential for horizontal gene transfer. Differences in gene detection by the bioinformatic tools and databases used (ResFinder. CARD RGI, PlasmidFinder, and MobSuite) are discussed. This study highlights the strengths and limitations of using genomics tools to perform hazard characterization of diverse foodborne bacterial species.

Investigating fractal fractional PDEs, electric circuits, and integral inclusions via (ψ,ϕ)-rational type contractions.

The fixed point theory has been generalized mainly in two directions. One is the extension of the spaces, and the other is relaxing and generalizing the contractions. This paper aims to establish novel fixed point results of rational type generalized ( ψ , ϕ ) -contractions in the context of extended b-metric spaces. This will allow us to analyze generalized rational type contraction in a more relaxed and diversified framework in the light of the characteristics of ( ψ , ϕ ) . Some existing rational-type contractions have been recalled in this direction, and others are defined. New fixed point results have been established by utilizing the properties of ψ and ϕ and applying the iteration technique. Moreover, the established results are employed to investigate the stability of fractal and fractional differential equations and electric circuits. For the reliability of the established results, examples and applications to the system of integral inclusions and system of integral equations are presented.

Extended vs. Traditional Operating Table in C-Arm-Guided Percutaneous Balloon Compression of the Gasserian Ganglion for Trigeminal Neuralgia: A Prospective Study.

BACKGROUND: The degree of cervical extension required during percutaneous balloon compression (PBC) of the Gasserian ganglion for trigeminal neuralgia (TN) varies among patients, but the traditional operating tables often fail to fulfil each patient's individual requirements. OBJECTIVE: This study aimed to compare the clinical efficacy of an extended operating table to that of a traditional operating table in C-arm-guided PBC of the Gasserian ganglion for TN. STUDY DESIGN: This is a consecutively prospective comparative study. SETTING: Fujian Provincial Hospital. METHODS: This study consecutively enrolled patients with TN who were scheduled for PBC of the Gasserian ganglion between February 2020 and February 2023. Some patients who underwent the procedure were placed on an extended operating table, whereas others were placed on a traditional operating table. The primary outcome was the duration of the cervical extension. The secondary outcomes included the duration of patient positioning, operation duration, C-arm radiation exposure, and pressure pain threshold of the bilateral trapezius, levator scapulae, and upper trapezius muscles, as well as the occurrence rate of postoperative complications. RESULTS: A total of 76 patients (mean age of 53.18 ± 2.74 years old, 44 men) were enrolled, with 38 patients using the extended operating table. The baseline characteristics between the extended and traditional operating table groups were comparable (P > 0.05). The duration of the cervical extension was significantly shorter in patients who used an extended operating table than in those who used a traditional operating table (58.77 ± 2.11 vs. 76.49 ± 2.16, P < 0.001). Patients who used an extended operating table exhibited significantly shorter positioning time (3.40 ± 0.45 vs. 10.32 ± 0.66, P < 0.001), operation duration (50.88 ± 2.95 vs. 76.49 ± 2.16, P = 0.020), and C-arm radiation exposure (8.71 ± 1.06 vs. 10.87 ± 1.26, P < 0.001) and significantly higher postoperative 24-hour pressure pain thresholds of the bilateral trapezius muscle (left: 274.39 ± 10.42 vs. 187.05 ± 6.19, P < 0.001; right: 272.89 ± 11.62 vs. 185.42 ± 6.88, P < 0.001), bilateral levator scapulae (left: 357.71 ± 11.37 vs. 245.34 ± 12.87, P < 0.001; right: 353.71 ± 14.14 vs. 245.05 ± 13.20, P < 0.001), and bilateral upper trapezius (left: 253.63 ± 10.91 vs. 163.95 ± 8.44, P < 0.001; right: 255.66 ± 11.99 vs. 165.32 ± 7.93, P < 0.001) compared to those who used a traditional operating table. The occurrence of postoperative adverse events, such as headache, neck pain, back pain, and limb numbness, was significantly lower in the extended operating table group (2.63% vs. 13.79%, P = 0.047) than in the traditional operating table group. LIMITATIONS: This is a single-center study with a small, homogeneous sample, limiting the generalizability of findings; the absence of randomization raises concerns about potential bias; long-term follow-up and recurrence rate measurements were lacking. CONCLUSION: This study found that the extended operating table may be an alternative equipment option for C-arm-guided PBC of the Gasserian ganglion for TN.

Beyond the Learning Curve of Robot-Assisted Navigation Spine Surgery: Refinement of Outcomes With Extended Experience.

Objective This study assessed whether robotic-assisted navigation (RAN) spine surgery outcomes, including operative time and pedicle screw accuracy, continue to improve with extended experience beyond 200 cases. Methods This is a retrospective review of 60 patients who underwent lumbosacral transforaminal interbody fusion using RAN. Patients were segmented into three groups of 20 consecutive cases each. The first group represented a surgical performance baseline leading up to the investigating surgeon's 200th RAN case. The subsequent two groups were selected beyond the 200th case with an average of 15 cases between groups. Pedicle screw accuracy and intraoperative outcomes were assessed. Statistical results were significant if p<0.05. Results Measures of surgical efficiency significantly improved beyond the investigating surgeon's 200th RAN case. As case number increased, the following parameters significantly decreased: registration time (group 1: 16.9±6.5, group 2: 12.9±3.0, group 3: 8.7±1.6 minutes; p<0.05), screw insertion time (group 1: 14.9±3.5, group 2: 10.9±2.0, group 3: 8.4±2.7 minutes; p<0.05), and total operative time significantly decreased from group 1 (175.9±58.2 minutes) to group 2 (135.8±23.9 minutes) (p=0.013) with a non-significant decrease to group 3 (121.5±32.3 minutes). Accuracy (Grade = A) significantly increased across groups (group 1: 87%, group 2: 94%, group 3: 98%; p=0.024). Group 1 had the highest misplacement rate of 3.7% (4/108 screws). The overall misplacement rate was 1.4% (4/290 screws) (Grade C-E). There was a higher rate of lateral screw misplacement compared to medial misplacement. Conclusion Even with a small number of initial cases, RAN spine surgery can consistently be performed with high accuracy and acceptable intraoperative outcomes. However, this study demonstrated refined outcomes with extended robotic experience.

Long Term Visual Outcomes of an Extended Macular Vision IOL in Eyes with Macular Disease and Visually Insignificant Cataract.

Purpose: To determine long-term efficacy and safety of an extended macular vision intraocular lens (IOL) implanted in patients with dry age-related macular degeneration (AMD) and visually insignificant cataracts. Design: Retrospective observational case series. Setting: MicroChirurgia Oculare, Italy. Methods: A retrospective case series of patients with dry AMD and visually insignificant cataracts undergoing phacoemulsification and implantation of an extended macular vision IOL designed to optimize image quality up to 10° from the foveal center (EyeMax Mono, Sharpview Ophthalmology, London, UK). Criteria for implantation were visually insignificant cataract (NC1 according to LOCS III classification) with dry age-related macular degeneration. Hypermetropia was targeted in most eyes to provide magnification when corrected with spectacles. Primary outcome measures were changes in corrected distant and secondary outcome measures included near visual acuity (CDVA and CNVA, respectively) between baseline and latest follow-up and safety outcomes. Results: 113 eyes of 86 patients (mean age 70.3±7.9 years) were included (mean follow-up: 48.3±25.1 months). Mean CDVA improved by 0.22 logMAR (11 ETDRS letters), from 0.53±0.4 to 0.31±0.3 (n=113, p<0.001). Similarly, mean CNVA improved by 0.08 logMAR (4 ETDRS letters), from 0.45±0.2 to 0.37±0.2 (n=77, p<0.001). Eleven eyes had AMD with extensive atrophy, and their mean CDVA improved by 0.32 logMAR (16 ETDRS letters). Three eyes (2.7%) experienced loss of more than one line in logMAR CDVA and four eyes (5.2%) experienced loss of more than one line in logMAR CNVA. No complications or instances of IOL exchange were reported. Conclusion: Visual improvement in eyes with visually insignificant cataract and AMD who underwent phacoemulsification and were implanted with EyeMax Mono IOL appears to be influenced by the IOL optical design. Vision enhancement in eyes with visually insignificant cataracts underscores the IOL's ability to optimize use of healthy retinal areas. Prospective studies with control groups are needed to confirm these findings.

Whole genome-based characterization of extended-spectrum ß-lactamase-producing Enterobacter cloacae from orthopedic patients and environment of a tertiary referral hospital in Tanzania.

Objectives: We investigated the genomic epidemiology of extended-spectrum ß-lactamase-producing Enterobacter cloacae (ESBL-Ec) isolates from patients and hospital environment to better understand their distribution to help devising effective strategies for infection prevention and control. Methods: We screened ESBL-Ec at Bugando Medical Center (BMC) in Mwanza, Tanzania. Rectal swabs from orthopedic patients on admission and swabs from the neighboring inanimate environment were collected. Following microbial culture, DNA was extracted from pure ESBL-Ec, and whole-genome sequencing was done. Sequence typing (ST), plasmid replicons, drug resistance, and virulence genes were deciphered using the Rapid Microbial Analysis Pipeline (rMAP). Results: We obtained 209 ESBL isolates, of which 15 (7.2 %) were ESBL-Ec [8 (53.3 %) from patients and 7 (46.7 %) from the environment]. Seven isolates were novel and eight were diverse, each with a unique ST. All isolates harbored two to five ß-lactamase genes, with the predominance of bla CTX-M-15 (15/15), bla OXA-1 (14/15), bla TEM (14/15) and bla ACT (12/15). The most common non ß-lactam drug resistance genes were aac(3)-IIa (14/15), aac(6')-Ib-cr (14/15), fosA (14/15), and qnrB1 (12/15), aph(3″)-Ib (10/15) and aph(6)-Id (10/15). Eleven different types of plasmid replicons were identified in 14/15 of the isolates, harboring one to five plasmids, with the most common plasmids being IncFII (11/15) and IncFIB (10/15). All isolates harbored the outer membrane protein (ompA), and curli protein (csg) was in 14/15 isolates. Conclusion: Admitted orthopedic patients and the hospital environment act as a reservoir of ESBL-Ec with diverse STs and endowed with drug resistance and arsenals of virulence genes, calling for their routine screening on admission for mitigation of potential subsequent infections.

Prescribed performance dynamic surface control based on dual extended state observer for 2-dof hydraulic cutting arm.

In tunnel section forming operations, the boom-type roadheader tracking target trajectory with high precision is greatly significant in avoiding over and under excavation and improving excavation efficiency. However, there exist complex cutting loads, measurement noise, and model uncertainties, seriously degrading the tracking performance of traditional nominal model-based controllers. Hence, this study first fully analyzes the kinematics of all members of the cutting mechanism and establishes its complete multi-body dynamic model using the Lagrange method. Furthermore, a dual extended state observer is designed to estimate the mechanical system's angular velocity and unmodeled disturbances and actuators' uncertain nonlinearities. In particular, introducing a nonlinear filter replaces the traditional first-order filter in dynamic surface technology, overcoming the "explosion of complexity" while attenuating the conservatism of gains tuning. Then, a dual extended state observer-based prescribed performance dynamic surface controller is developed for roadheaders for the first time. Simultaneously, integrating an improved error transformation function into controller design effectively avoids the online computational burden caused by traditional logarithmic operations. Utilizing Lyapunov theory, the cutting system's prescribed transient response and steady-state performance are guaranteed. Finally, the proposed controller's effectiveness is verified by comparative experiments on the roadheader.

The what, the when and the how: A qualitative study of allied health decision-maker perspectives on factors influencing the development and implementation of advanced and extended scopes of practice in Australia.

BACKGROUND: Health workforce supply is critical to ensuring the delivery of essential healthcare and may be enhanced via mechanisms which alter the scopes of practice of health professions. The aim of this paper is to study the collective perspectives of allied health decision-makers on factors which influence their development and implementation of advanced and extended scope of practice initiatives, and how they contribute to scope of practice change. The reasoning for the selection of each factor will also be examined. METHODS: A grounded-theory, qualitative study of the experiences of allied health directors and senior managers across two Australian State/Territory jurisdictions. RESULTS: Twenty allied health decision-makers participated in the study. Data coding of interview transcripts identified 14 factors specific to scope of practice change, spanning rational (n = 8) and non-rational (n = 6) decision-making approaches. Leadership, Governance, Needs of organisational leaders, Resourcing, Knowledge, skills & experience - clinical, Supporting resources, Knowledge & skills - change and Sustainability were identified as being rational and enabling in and of themselves, with Leadership seen as being most influential. Comparatively, the non-rational factors of Socio-economic & political environment, Perceived patient need, Organisational environment, Change culture & appetite, Perceived professional territorialism and Actual professional territorialism were more varied, and primarily influenced the timing/catalyst and application of decision-making. The complex interplay between these factors was conceptually represented as a decision-making construct. CONCLUSION: Allied health decision-makers hold a complex, systems-level understanding of scope of practice change. Whilst rational decision criteria were predominant and seen to enable scope change, non-rational influences reflected greater variation in decision timing/catalyst and application, thus emphasising the human dimensions of decision-making. Further research is required to better understand how decision-makers integrate and weight these decision-making factors to determine their relative importance and to inform the development of structured decision tools.

Prevalence of Bacteremia and Antimicrobial Resistance Pattern Among Patients in South Lebanon.

BACKGROUND: Bacteremia are a leading cause of morbidity and mortality worldwide. Rising prevalence and antimicrobial resistance (AMR) are critical public health issues. This study aims to determine the prevalence of bacteremia and the antimicrobial resistance pattern among patients in South Lebanon. METHODS: A cross-sectional study analyzed 76 positive blood cultures from Hammoud and Labib Hospitals in South Lebanon between September 2023 and March 2024.The phenotype and antimicrobial susceptibility of gram-positive and gram-negative was determined by using disk diffusion. Genotypically, PCR was used to detect the carbapenemase-resistant Enterobacterales (CRE), extended-spectrum ß-lactamases (ESBL) and Methicillin Resistant Staphylococcus aureus (MRSA) genes. RESULTS: Out of 76 isolates, 38(50%) were gram-positive and 38(50%) were gram-negative. Escherichia coli was the most common among gram-negative (18. 42%), with 10.52% ESBL and 3.94% CRE. Staphylococcus coagulase negative was the most common among gram-positive (40.78%), followed by S. aureus (6.57%), with 3.94% MRSA.The prevalent ESBL gene was CTX-M (100%), and for the CRE, NDM (66.66%). Regarding S. aureus, (66.66%) were mecA. DISCUSSION: The diverse bacteremia isolates and resistance genes in South Lebanon reflect global variability in incidence and resistance profiles. CONCLUSION: High rates of bacteremia and AMR in South Lebanon underscore the need for effective antibiotic stewardship programs.

Effect of a small increase in off-premises trading hours on alcohol sales in Norway: A stepped-wedge cluster-randomized controlled trial.

BACKGROUND AND AIMS: Evidence of the effect of limiting off-premises alcohol trading hours is still scarce. This study tested the effect of a small extension in trading hours on alcohol sales in alcohol monopoly outlets in Norway. DESIGN: The extension of trading hours was implemented within a stepped-wedge cluster-randomized trial design. Eligible state monopoly outlets (n = 229) were clustered into trade districts (n = 62), which were block-randomized to one of three sequences regarding date of implementation: 1 September 2020 (n = 21 districts, 82 outlets), 1 December 2020 (n = 21 districts, 73 outlets) and 1 March 2021 (n = 20 districts, 74 outlets). Outcomes were followed-up for a 1-year period. SETTING AND PARTICIPANTS: Study participants were state monopoly outlets in urban and rural trade districts in all parts of Norway. MEASUREMENTS: Monthly alcohol sales in litres of pure alcohol per trade district and per outlet were measured from March 2020 to March 2022 (primary outcome). We applied a linear mixed-effect model with two-way fixed effects within a difference-in-difference framework. As a robustness check we considered the effects of cross-border trade and effects in subgroups of outlets. Trading hours in monopoly outlets were extended by 1 hour on Saturdays. The extension was permanent. Pre-intervention periods and not-yet-treated units served as control conditions. FINDINGS: We did not find a statistically significant effect of the small extension in trading hours on monthly alcohol sales (i) per trade district [average treatment effect: -185.5 litres, 95% confidence interval (CI) = -1159.9, 788.9] and (ii) per outlet (-35.3 litres, 95% CI = -142.1, 72.0). These findings were consistent across estimation methods and model specifications. CONCLUSION: There is no clear evidence that a small extension in off-premises trading hours affected alcohol sales in monopoly outlets in Norway.

First report of carbapenems encoding multidrug-resistant gram-negative bacteria from a pediatric hospital in Gaza Strip, Palestine.

BACKGROUND: The worldwide prevalence of multi-drug resistance (MDR) in Gram-negative bacteria (GNB), particularly related to extended-spectrum beta-lactamases (ESBLs) and carbapenemases, poses significant global public health and clinical challenges. OBJECTIVES: To characterize ESBL-producing Gram-negative bacilli, within a pediatric hospital in Gaza using whole genome sequencing (WGS). METHODS: A total of 158 clinical isolates of Gram-negative bacilli were collected from Al-Nasser Pediatric Hospital. These isolates were tested for ESBL production using the double disk synergy test. The antibiotic susceptibility profile was determined using the Kirby Bauer method following the Clinical and Laboratory Standard Institute guidelines. Selected 15 phenotypically MDR isolates were whole-genome sequenced and characterized for their genome-based species identity and antibiotic resistance gene profile. RESULTS: Of the 158 isolates, 93 (58.9%) were positive for ESBL production. The frequency of Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa, Acinetobacter baumannii, Proteus mirabilis, and Serratia marcescens was 50%, 22.7%, 22.7%, 1.8%, 1.2%, and 1.2% respectively. The prevalence of ESBL among urine, pus, blood, and sputum was 64%, 44%, 23%, and 63.6%, respectively. Chloramphenicol, Imipenem, and Meropenem were the most effective antibiotics against ESBL producers. In sequenced isolates,  an average of six anti-microbial resistance (AMR) genes were noted per isolate, where one of them carried up to 13 antibiotic resistance genes. Carbapenem resistance genes such as blaKPC-2(6.6%), blaPDC-36/12 (6.6%), and blaPOM-1 (6.6%) were detected. All the sequenced E. coli isolates (n = 8) showed multiple resistance genes, mainly against ß-lactamase (25.0%), aminoglycosides (37.5%), sulfonamides (37.5%), and genes conferring resistance to tetracyclines (25.0). CONCLUSION: Our results showed a high prevalence of ESBL-producing GNB isolated from a pediatric hospital in the Gaza Strip. Various antibiotic resistance genes were identified, including those encoding ESBL and carbapenems. The results highlight the significant challenge posed by MDR in GNB and emphasize the need for effective antibiotic strategies. Given the high endemicity observed in various studies from Palestine, it is important to conduct clinical and molecular epidemiology research to identify risk factors, transmission patterns, and clinical outcomes associated with GNB strains that carry ESBL and carbapenem resistance genes.

Silver Telluride Colloidal Quantum Dot Solid for Fast Extended Shortwave Infrared Photodetector.

Extended shortwave infrared (eSWIR) photodetectors that employ solution-processable semiconductors have attracted attention for use in applications such as ranging, night vision, and gas detection. Colloidal quantum dots (CQDs) are promising materials with facile bandgap tunability across the visible-to-mid-infrared wavelengths. However, toxic elements, such as Hg and Pb, and the slow response time of CQD-based IR photodetectors, limit their commercial viability. This article presents a novel eSWIR photodetector that is fabricated using silver telluride (Ag2Te) CQDs. Effective thiolate ligand exchange enables a lower trap density and improved carrier mobility in CQD solids. Furthermore, a vertical p-n photodiode architecture with a favorable energy-level landscape is utilized to facilitate charge extraction, resulting in a fast, room-temperature-operable, and toxic-element-free CQD photodetector. The best eSWIR Ag2Te CQD photodetector exhibits a fall time of 72 ns, representing the fastest response time among all prior CQD-based eSWIR photodetectors, including those containing toxic elements, such as Pb and Hg.

Provider costs of treating opioid dependence with extended-release buprenorphine in Australia.

INTRODUCTION: The costs of providing medication-assisted treatment for opioid dependence can determine its scale of provision. To provide estimates of the costs of extended-release buprenorphine (BUP-XR), we performed a bottom-up costing analysis of provider operational treatment costs. METHODS: Data were collected in a single-arm open label trial of BUP-XR injections conducted in specialist public drug treatment services and primary care private practices in three Australian states (the CoLAB study). The unit costs of resources used for each activity were combined with quantities used at each participating facility to arrive at the average annual cost per client. RESULTS: One hundred participants across the six health facility sites received monthly subcutaneous BUP-XR injections administered by a health-care practitioner. The average cost of providing 1 year of treatment per participant was $6656 ($6026-$8326). Screening cost (initial assessment and medical history) was $282 while monthly follow-up appointments cost $531 per client. The main cost driver was the monthly treatment costs accounting for 79% of the average annual client cost, with medication costs comprising 95% of this cost. DISCUSSION AND CONCLUSION: With medication costs making up the largest proportion of treatment costs, treatment using BUP-XR has the potential to free up other health system resources, for example, staff time. The costs reported in this study can be used in an economic evaluation to estimate the net benefit or cost-effectiveness of BUP-XR especially when compared to other opioid agonist treatments.