Alcohol-based hand rubs can fulfil efficacy requirements of EN 1500 in 15 seconds.

Aim: Correct hand hygiene is widely regarded as an important measure to prevent healthcare-associated infections. Guidelines on how to perform hand antisepsis are often inspired by laboratory tests that focus on reproducibility rather than ease of use. These cumbersome recommendations can become barriers to hand hygiene, as optimal user acceptance requires a small rub volume and a short application time with an intuitive rubbing technique. Here we modified the EN 1500 to test the efficacy of hand rubs under more user-friendly conditions, using a highly intuitive rubbing technique in 15 seconds. Methods: The efficacy of an ethanolic and a propanolic hand rub in inactivating E. coli on the hands of volunteers was tested according to EN 1500 with modifications in rubbing technique and time. Pre-tests were conducted to find a suitable volume for "responsible application", a procedure without clearly defined steps. Finally, 20 volunteers applied both rubs for 15 seconds using 3 mL and "responsible application" and 5 mL using the WHO 6-step technique. Results: Both hand rubs, ethanolic and propanolic, were non-inferior to an unmodified EN 1500 reference for both application methods, 3 mL with "responsible application" and 5 mL with the WHO 6-step method. Conclusion: Reducing the complexity of hand rub application can have a positive impact on hand hygiene adherence. With our results showing that antimicrobial efficacy comparable to an unmodified EN 1500 can be achieved in 15 seconds using an intuitive rubbing technique, further barriers to more user-friendly hand rub application have been removed.

Seed functional ecology in Brazilian rock outcrop vegetation: an integrative synthesis.

BACKGROUND AND AIMS: Rock outcrop vegetation is distributed worldwide and hosts a diverse and unique flora that evolved under harsh environmental conditions. Unfortunately, seed ecology in such ecosystems has received little attention, especially regarding seed traits, germination responses to abiotic factors and the potential role of phylogenetic relatedness on such features Here, we provide the first quantitative and phylogenetically-informed synthesis of the seed functional ecology of Brazilian rock outcrop vegetation, with a particular focus on quartzitic and ironstone campo rupestre. METHODS: Using a database of functional trait data, we calculated the phylogenetic signal of seven seed traits for 371 taxa and tested whether they varied among growth forms, geographic distribution, and microhabitats. We also conducted meta-analyses that included 4,252 germination records for 102 taxa to assess the effects of light, temperature, and fire-related cues on the germination of campo rupestre species and explored how the aforementioned ecological groups and seed traits modulate germination responses. KEY RESULTS: All traits and germination responses showed a moderate-to-strong phylogenetic signal. Campo rupestre species responded positively to light and had maximum germination between 20-25 ºC. The effect of temperatures beyond this range was moderated by growth form, species geographic distribution, and microhabitat. Seeds exposed to heat shocks above 80 °C lost viability, but smoke accelerated germination. We found a moderating effect of seed mass for in responses to light and heat shocks, with larger, dormant seeds tolerating heat better but less sensitive to light. Species from xeric habitats evolved phenological strategies to synchronise germination during periods of increased soil water availability. CONCLUSIONS: Phylogenetic relatedness plays a major role in shaping seed ecology of Brazilian rock outcrop vegetation. Nevertheless, seed traits and germination responses varied significantly between growth forms, species geographic distribution and microhabitats, providing support to the regeneration niche hypothesis and the role of functional traits in shaping germination in these ecosystems.

The impact of Industry 4.0 on occupational health and safety: A systematic literature review.

INTRODUCTION: Industry 4.0 has brought new paradigms to businesses based on high levels of automation and interconnectivity and the use of technologies. This new context has an impact on the work environment and workers. Nevertheless, these impacts are still inconclusive and controversial, requiring new investigative perspectives. This study aimed to investigate the requirements sought, the risk factors identified, and the adverse effects on workers caused by the characteristics of I4.0. METHOD: The methodology was based on a systematic literature review utilizing the PRISMA protocol, and 30 articles were found eligible. A descriptive and bibliometric analysis of these studies was performed. RESULTS: The results identified the main topics that emerged and have implications for workers' Occupational Health and Safety (OHS) and divided them into categories. The requirements are related mainly to cognitive, organizational, and technological demands. The most significant risk factors generated were associated with the psychosocial ones, but organizational, technological, and occupational factors were also identified. The adverse effects cited were categorized as psychic, cognitive, physical, and organizational; stress was the most cited effect. An explanatory theoretical model of interaction was proposed to represent the pathway of causal relations between the requirements and risk factors for the effects caused by I4.0. CONCLUSIONS AND PRACTICAL APPLICATIONS: This review has found just how complex the relationships between the principles of Industry 4.0 are (e.g., requirements, risk factors, and effects) and the human factors. It also suggests a pathway for how these relationships occur, bridging the gap left by the limited studies focused on connecting these topics. These results can help organizational managers understand the impacts of I4.0 on workers' safety and health.

Radiopharmaceutical small-scale preparation in Europe: will we be able to harmonize the situation?

BACKGROUND: Radiopharmaceuticals have been considered a special group of medicines in Europe since 1989. The use of radiopharmaceuticals that have marketing authorization should always be the first option in clinical use, however due to their special properties the availability of approved radiopharmaceuticals is limited. For this reason, they can be produced on a small scale outside the marketing authorization process. MAIN BODY: The in-house radiopharmaceutical preparations represent an important source of these special medicines for routine nuclear medicine practice. However, a lack of harmonization in Member States' regulations leads to extreme differences in the use and availability of radiopharmaceuticals across Europe. The aim of this work is to provide an overview of the different national regulatory frameworks in which Directive 2001/83/UE is adopted on the preparation of radiopharmaceuticals outside the marketing authorization track in Europe. Nine different national regulations have been studied to describe how unlicensed radiopharmaceuticals are prepared. Special attention is paid to reflect the minimum standards that these preparations should meet as well as the educational requirements to be a radiopharmacist in charge of them. CONCLUSION: The rapid development of new radiopharmaceuticals used in radiometabolic therapy requires a common regulation that allows balance between the use and preparation of licensed and unlicensed radiopharmaceuticals. The absence of a harmonized regulation for the radiopharmaceutical small-scale preparation and the implementation of Good Manufacture Practices, leads to extreme differences in the use, quality assurance and availability of radiopharmaceuticals in Europe.

Critical assessment of furrow openers and operational parameters for optimum performance under conservation tillage.

Conservation Agriculture (CA) is an innovative approach that promotes sustainable farming while enhancing soil health. However, residue management challenges often hinder its adoption, causing farmers to burn crop leftovers in fields. This study aimed to evaluate the effectiveness of various furrow openers under simulated soil bin conditions. Three types of furrow openers were examined: single disk (SD), Inverted T-type furrow opener with a plain rolling coulter (ITRC), and double disc (DD) furrow opener. Tests were conducted at different forward speeds (1.5, 2, and 2.5 km h-1) and with three straw densities (1, 2, and 3 t ha-1) at a consistent working depth of 5 cm. Draft measurements were obtained using load cells connected to an Arduino-based data-logging system. Results indicated that draft requirements increased with forward speed and straw density, while straw-cutting efficiency decreased with these factors. Average draft values for SD, ITRC, and DD were 290.3 N, 420 N, and 368.5 N, respectively, and straw-cutting efficiencies were 53.62%, 59.47%, and 74.89%, respectively. The DD furrow opener showed the highest straw-cutting efficiency (81.36%) at a working speed of 1.5 km h-1 and a straw density of 1 t ha-1, demonstrating optimal performance compared to other furrow openers.

Descriptive study showing the effect of small differences in entry scores on retention and success in six courses in nursing.

BACKGROUND: Undergraduate enrolments and completions in nursing are declining at the same time as requirements for registered nurses in the workforce is increasing. One way to increase enrolments is to lower entry requirements into nursing programs. This study determined the effect of a small lowering of entry scores on the retention and success rates. The study was undertaken at Griffith University, where identical bioscience and clinical courses run at three campuses, one with a lower- than normal-entry score and two with the normal-entry requirements. METHODS: A comparison of the 62-148 students enrolled in the courses at the lower- than normal- (lesser) entry requiring campus with the 197-288 students enrolled in the courses in one normal-entry requiring campuses. For individual courses (4 bioscience and 2 clinical courses) retention rates were measured and compared between campuses/cohorts. For completing students, we measured success as (i) Academic outcomes; overall marks and marks for the exam and coursework and (ii) Failure rates in the examination and coursework. Data analysis was by Student's t-test and Odds ratio. RESULTS: For all courses, there were few significant differences in measures of retention and success between the lower- and normal-entry campuses, and all differences were small. Comparing the campuses; (a) For all courses, progression rates were similar. (b) For completing students, passing rates were similar in the bioscience courses, but higher in the normal- than lower-entry campus for the clinical courses. (c) In the bioscience courses, the overall marks were similar, but in the clinical courses, the overall mark was slightly higher in the normal- than lower-entry campus. (d) The overall failure rates were similar for the biosciences, but higher for the lower- than normal-entry cohort in the clinical courses. (e) The failure rates in exams were similar between cohorts in all courses. CONCLUSIONS: This study shows that small changes in entry requirements for a nursing program had minimal effects on retention. The differences in entry requirements also did not affect the success of students in the bioscience courses. Decreasing entry requirement for nursing programs may be a way to increase nursing graduates.

Predicting habitat suitability of the critically endangered Be'er Sheva fringe-fingered lizard.

Anthropogenic changes, such as land use, are the main drivers causing climate change and biodiversity loss, with hundreds of thousands of species lacking sufficient habitats for their populations to persist and likely to go extinct within decades. Endemic species are more susceptible to habitat changes and are at the forefront of the biodiversity crisis. We used species distribution models to generate a relative habitat suitability map and identified the habitat requirements of the critically endangered and endemic Be'er Sheva fringe-fingered lizard (Acanthodactylus beershebensis). The model showed that the species' suitable habitats are associated with arid loess plains characterized by scattered, low vegetation cover, primarily on north-facing aspects, suggesting that these species-specific habitat requirements limit its distribution. The size of the potentially suitable area within the species' historical range is 1350.73 km2. However, anthropogenic changes decreased the remaining suitable habitat to 995.04 km2. Most of this area is unprotected and at risk of further adverse anthropogenic effects. Only 91.72 km2 of this area is protected by the Israel Nature and Parks Authority, and 587.11 km2 may be considered indirectly protected because it is within military firing zones. Our study is the first attempt to map the remaining suitable habitat of A. beershebensis based on the results of a species distribution model. The results of this model can assist in prioritizing the protection of areas needed for the conservation of this critically endangered and endemic lizard species.

Demystifying XAI: Requirements for Understandable XAI Explanations.

This paper establishes requirements for assessing the usability of Explainable Artificial Intelligence (XAI) methods, focusing on non-AI experts like healthcare professionals. Through a synthesis of literature and empirical findings, it emphasizes achieving optimal cognitive load, task performance, and task time in XAI explanations. Key components include tailoring explanations to user expertise, integrating domain knowledge, and using non-propositional representations for comprehension. The paper highlights the critical role of relevance, accuracy, and truthfulness in fostering user trust. Practical guidelines are provided for designing transparent and user-friendly XAI explanations, especially in high-stakes contexts like healthcare. Overall, the paper's primary contribution lies in delineating clear requirements for effective XAI explanations, facilitating human-AI collaboration across diverse domains.

Implementation of an Atrioventricular Valve Intervention Registry: Comparative Study of REDCap vs. CDR-Based openEHR Registry.

This comparative study examines the transition from isolated registries to a consolidated data-centric approach at University Hospital Schleswig-Holstein, focusing on migrating the Atrioventricular Valve Intervention Registry (AVIR) from REDCap to a Medical Data Integration Center based openEHR registry. Through qualitative analysis, we identify key disparities and strategic decisions guiding this transition. While REDCap has historical utility, its limitations in automated data integration and traceability highlight the advantages of a data-centric approach, which include streamlined data (integration) management at a single-point-of-truth based on e.g., centralized consent management. Our findings lay the groundwork for the AVIR project and a proof-of-concept data-centric registry, reflecting a broader industry trend towards data-centric healthcare initiatives.

A Comparison of Websites Offering Laboratory Test Information Targeted to Citizens.

Laboratory (lab) tests can assist diagnosis, treatment, and monitoring illness and health. Lab results are one of the most commonly accessible types of personal health information, yet they can be difficult for consumers (e.g., patients, laypeople, citizens) to understand. Consequently, many consumers turn to digital educational resources (e.g., websites, mobile applications) to make sense of their tests and results. In this study, we compared the understandability and readability of four different consumer targeted webpages with information about a commonly ordered blood test called the Complete Blood Count (CBC). The webpages varied in terms of understandability, and only one met the threshold. None of the web pages provided any information about how to respond to lab results. Although all four webpages were quite readable, some were much longer than others. The length of webpages may impact users' attention, ability to locate information, and determine what is most important. Future work is warranted to better understand users' information needs and the usability and user experience of these types of websites.

Predictive Energy Equations Inaccurately Estimate Metabolic Demands of Older Adult Trauma Patients.

INTRODUCTION: Suboptimal nutrition promotes unfavorable outcomes in trauma patients, particularly among those aged 60 and over. While many institutions employ predictive energy equations to determine patients' energy requirements, mounting evidence shows these equations inaccurately estimate caloric needs. In this pilot randomized controlled trial, we sought to quantify the discrepancy between predictive equations and indirect calorimetry (IC)-the gold standard for determining energy requirements-in the older adult trauma population. METHODS: This is a nested cohort study within a pilot randomized control trial in which 32 older adult trauma patients were randomized 3:1 to receive IC-guided nutrition delivery versus standard of care. IC requirements of patients in the intervention arm were compared to Mifflin St. Jeor (MSJ), Harris-Benedict (HB), and the American Society for Parenteral and Enteral Nutrition-Society of Critical Care Medicine (ASPEN-SCCM) predictive energy equations. RESULTS: Twenty patients underwent IC to assess measured resting energy expenditure (mREE), yielding a mean (standard deviation) mREE of 23.1 ± 4.8 kcal/kg/d. MSJ and HB gave mean predictive resting energy expenditures of 17.5 ± 2.0 and 18.5 ± 2.0 kcal/kg/d in these patients, demonstrating that IC-derived values were 32.1% and 25.0% higher, respectively. When patients were stratified by body mass index (BMI), MSJ, and HB more severely underestimated caloric requirements in individuals with BMI <30 versus BMI 30-50. While the mean mREE fell within the mean predictive resting energy expenditure range prescribed by ASPEN-SCCM equations (21.4 ± 4.1 to 26.2 ± 4.3 kcal/kg/d), individuals' IC-derived values fell within their personal range in 8 of 20 cases. CONCLUSIONS: The MSJ and HB predictive energy equations consistently and significantly underpredict metabolic demands of older adult trauma patients compared to IC and perform worse in lower BMI individuals. ASPEN-SCCM equations frequently overpredict or underpredict resting energy expenditure. While these findings should be confirmed in a larger randomized control trial, this study suggests that institutions should prioritize IC to accurately identify the metabolic demands of older trauma patients.

Nutritional gap after transfer from the intensive care unit to a general ward - A retrospective quality assurance study.

BACKGROUND: Adequate nutrition is important for recovery after critical illness. Even so, our knowledge of patients' nutritional intake after intensive care unit (ICU) discharge is scarce. OBJECTIVES: We aimed to explore nutritional planning and achieved nutritional intake in ICU patients who transfer from the ICU to general wards. METHODS: A retrospective quality assurance study. INCLUSION CRITERIA: adult ICU patients transferring to a general ward at Copenhagen University Hospital-Herlev from May to August 2021. Primary outcomes were as follows: having a nutritional plan on the day of ICU transfer. A nutritional plan was defined as follows: (i) individual assessment of energy and protein requirement; (ii) intake, documented as achieved percentage of energy and protein requirements; (iii) prescribed type of nutrition. If using enteral or parenteral nutrition; (iv) the prescribed doses; and (v) the prescribed product. Secondary outcomes were as follows: achieved percentage of energy and protein requirements from day -1 before ICU transfer until day +1 and day +3 after ICU transfer. RESULTS: We included 57 patients; the mean age was 64 years (±11.1); 43 (75%) patients were male; the median ICU stay was 6 days (interquartile range: 3-11). One (2%) patient had a full nutritional plan according to listed criteria. Patients' median percentage of requirements met declined significantly from the day before to the day after ICU discharge (energy: from 94% to 30.5%; p = 0.0051; protein: from 73% to 27.5%; p = 0.0117). The decline in percentage of requirements met remained unchanged from day 1 to 3 after ICU transfer. CONCLUSIONS: In conclusion, few patients had a nutritional plan when transferring from the ICU to a general ward. After ICU discharge, percentage of energy and protein requirements met declined significantly and remained insufficient during the first 3 days at the general ward.

Determining amino acid requirements in humans.

Amino acids form the building blocks of body protein. Dietary protein sources provide the amino acids needed, but protein sources vary widely in amio acid composition. To ensure humans can meet body demands for amino acids, amino acid intake recommendations are provided by the Dietary Reference Intakes (DRI) and by Food and Agriculture Organization/World Health Organization/United Nations University (FAO/WHO/UNU). Current amino acid intake recommendations, however, are based on data collected predominantly from young adult males. The development of the minimally invasive indicator amino acid oxidation (IAAO) method has permitted the evaluation of amino acid requirements in various vulnerable populations. The purpose of this review is to discuss recent amino acid requirement studies in school-age children, pregnant females and the elderly determined using the IAAO technique. These requirements will help to inform evidence-based recommendations that will help to guide dietary guidelines.

Mining software insights: uncovering the frequently occurring issues in low-rating software applications.

In today's digital world, app stores have become an essential part of software distribution, providing customers with a wide range of applications and opportunities for software developers to showcase their work. This study elaborates on the importance of end-user feedback for software evolution. However, in the literature, more emphasis has been given to high-rating & popular software apps while ignoring comparatively low-rating apps. Therefore, the proposed approach focuses on end-user reviews collected from 64 low-rated apps representing 14 categories in the Amazon App Store. We critically analyze feedback from low-rating apps and developed a grounded theory to identify various concepts important for software evolution and improving its quality including user interface (UI) and user experience (UX), functionality and features, compatibility and device-specific, performance and stability, customer support and responsiveness and security and privacy issues. Then, using a grounded theory and content analysis approach, a novel research dataset is curated to evaluate the performance of baseline machine learning (ML), and state-of-the-art deep learning (DL) algorithms in automatically classifying end-user feedback into frequently occurring issues. Various natural language processing and feature engineering techniques are utilized for improving and optimizing the performance of ML and DL classifiers. Also, an experimental study comparing various ML and DL algorithms, including multinomial naive Bayes (MNB), logistic regression (LR), random forest (RF), multi-layer perception (MLP), k-nearest neighbors (KNN), AdaBoost, Voting, convolutional neural network (CNN), long short-term memory (LSTM), bidirectional long short term memory (BiLSTM), gated recurrent unit (GRU), bidirectional gated recurrent unit (BiGRU), and recurrent neural network (RNN) classifiers, achieved satisfactory results in classifying end-user feedback to commonly occurring issues. Whereas, MLP, RF, BiGRU, GRU, CNN, LSTM, and Classifiers achieved average accuracies of 94%, 94%, 92%, 91%, 90%, 89%, and 89%, respectively. We employed the SHAP approach to identify the critical features associated with each issue type to enhance the explainability of the classifiers. This research sheds light on areas needing improvement in low-rated apps and opens up new avenues for developers to improve software quality based on user feedback.

Technological aspects and recommendations for applying teledentistry in oral medicine: a scoping review.

BACKGROUND: Teledentistry is applied in oral medicine to help dental practitioners and specialists manage complex oral conditions. This scoping review aims to synthesize the available evidence regarding the technical requirements and the provision of security services, as well as the recommendations on standard oral cavity photography methods for using teledentistry in oral medicine. METHOD: The present scoping review was conducted in 2022 according to the Joanna Briggs Institute (JBI) manual. Four databases were systematically searched, including ISI Web of Science, PubMed, Scopus, and ProQuest, from January 1999 to December 2021. After finalizing the search strategy, all the original articles, reviews, editorials, letters, comments, and book chapters were included. All the dissertations uploaded in English with a full-text electronic file were also included to achieve a comprehensive picture of the available literature. Two types of analysis were applied: the quantitative descriptive analysis applying Excel 2016 and the qualitative thematic analysis using MAXQDA version 10. RESULTS: The included papers were published during 1999-2021. Most of the included articles were from Brazil (n = 9, 21.43%), India (n = 6, 14.28%), the USA (n = 6, 14.28%), and the UK (n = 5, 11.90%). Social media usage as a teledentistry platform increased considerably between 2019 and 2021. Teledentistry platforms have been classified into four categories, including email, telephone, social network applications (WhatsApp, zoom, Google Meeting, Instagram, line Application, Viber, and Messenger), and teledentistry systems (teledentistry systems, which were designed specially to perform a teledentistry project). Teledentistry has been conducted to store and forward (n = 15, 30.71%), real-time (n = 9, 21.43%), or both (n = 12, 35.71%). According to the thematic results, basic technical requirements have been categorized into four, including teledentistry platform, type of interactions, internet connection, and photography tool. Other thematic results demonstrate seven categories of recommendations, including general factors, light, patient position, phone position, setting of a mobile phone camera, photo sending requirements, and photo visualization. CONCLUSION: According to the results, over the past 7 years, especially during the COVID-19 pandemic, social network applications such as WhatsApp and Zoom have been used more frequently. Also, photography recommendations with a mobile phone camera depend on several factors such as general factors, light, patient position, phone position, setting of the mobile phone camera, and photo-sending requirements. Given the increased use of mobile cameras for oral photography, these recommendations can help improve the quality of images and subsequently improve the reliability of clinical decision-making in managing patients' conditions.

Regulatory landscape, risks, and solutions for refurbished medical devices: a comparative analysis in the US, EU, Malaysia, and Ghana.

INTRODUCTION: Refurbished medical devices are previously owned equipment that undergo a process of restoration to ensure they meet quality standards and function effectively. The utilization of refurbished medical devices, coupled with the integration of software, poses intricate challenges in terms of regulatory compliance, risk management, and patient safety. AREAS COVERED: This article explores the regulatory frameworks governing refurbished medical devices in the United States (US), the European Union (EU), Malaysia, and Ghana. Included information from a range of primary and secondary sources. Additionally, it aims to identify and analyze the risks associated with refurbished medical devices, with a specific focus on the implications of software integration, and recommend practical solutions for mitigating these risks. EXPERT OPINION: The landscape of refurbished medical devices presents challenges in terms of regulatory compliance, risk management, and patient safety. Addressing these challenges requires careful consideration and strategies to ensure that refurbished devices meet stringent quality standards. By focusing on these areas, policymakers and healthcare professionals can enhance the safe utilization of refurbished medical devices, thereby improving access to quality healthcare, particularly in underserved regions.

Total energy expenditure measured using doubly labeled water in adults with major chronic diseases: A systematic review.

BACKGROUND: Energy requirement assessment is a cornerstone for nutrition practice. The extent to which total energy expenditure (TEE; indicator of energy requirements) has been measured in adults with chronic diseases has not been explored. OBJECTIVE: This systematic review aimed to: 1) Characterize evidence on TEE among individuals with chronic diseases, and 2) Describe TEE across chronic diseases and compared to controls without a chronic disease. METHODS: A literature search using terms related to doubly labeled water and TEE was conducted in PubMed, MEDLINE, Web of Science, and Embase. Eligible articles included those that measured TEE using doubly labeled water in adults with a major chronic disease. Methodological quality was determined using the Academy of Nutrition and Dietetics Quality Criteria Checklist. Sample size-weighted TEE was calculated in each chronic disease subgroup. RESULTS: Fifty studies were included, of which 15 had a control group. Median sample size was 20 participants, and approximately half of studies were published over 10 years ago. Thirty-five (70%) studies reported resting energy expenditure, and about half (k=26) reported physical activity level. Methodological quality was 'neutral' (k=25) or 'positive' (k=23) for most studies. TEE among individual studies ranged from 934 to 3274 kcal/day. Mean weighted TEE was lowest among gastrointestinal (1786 kcal/day) and neurological (2104 kcal/day) subgroups and highest among cancer (2903 kcal/day), endocrine (2661 kcal/day), and autoimmune (2625 kcal/day) subgroups. Excluding one article in cancer survivors resulted in a low TEE in the cancer subgroup (2112 kcal/day). Most studies with a control group reported no differences in TEE between controls and patients; however, only one study was powered for between-group comparisons. CONCLUSION: Energy requirements vary across chronic diseases, although there is insufficient evidence to suggest that TEE is different than controls. Further research is needed to inform energy requirement recommendations that consider chronic disease.

Structural Quality Indicators in Radiation Oncology: Insights and Implications.

AIMS: Over the past two decades, significant progress has been made in the development of quality indicators (QIs) within the field of radiotherapy (RT). However, most of the literature has predominantly focused on process and outcome-related QIs, with limited attention given to structural QIs. This review aims to address this gap by providing insights into structural QIs in RT and examining the complexities and considerations involved in establishing universal standards for these indicators across RT facilities globally. METHODS: An extensive review of published evidence in each sub-topic was performed using PubMed search strategies, current review papers, national and international guidelines and reports, and personal expertise in the field. RESULTS: Considering their direct impact on treatment outcomes, this article identifies five structural QIs to ensure quality treatment in RT. They are workload, infrastructure, machine downtime, adequacy of training, and access to RT services. CONCLUSIONS: Developing international guidelines for structural QIs in RT can significantly enhance treatment outcomes. The first step toward achieving this goal is to assess the limitations faced by lower and middle-income countries (LMICs) and devise practical solutions to overcome these challenges.

Managing the heat: In-Vessel Components.

The Spherical Tokamak for Energy Production (STEP) programme aims to deliver a first-of-a-kind fusion prototype powerplant (SPP). The SPP plasma places extreme heat, particle and structural loads onto the plasma-facing components (PFCs) of the divertor, limiters and inboard and outboard sections of the first wall. The PFCs must manage the heat and particle loads and wider powerplant requirements relating to safety, net power generation, tritium breeding and plant availability. To enable STEP PFC concepts to be identified that satisfy these wide-ranging requirements, an iterative design ('Decide & Iterate') methodology has been used to synchronize a prioritized set of decisions, within the fast-paced, iterative, whole plant concept design schedule. This paper details the 'Decide and Iterate' methodology and explains how it has enabled the identification of the SPP PFC concepts. These include innovative PFC solutions such as a helium-cooled discrete and panel limiter design to increase tritium breeding while providing sufficient coverage and enabling individual limiter replacement; the integration of the outboard first wall with the breeding zone to enhance fuel self-sufficiency and power generation; and the use of heavy water (D2O) within the inboard first wall and divertor PFCs to increase tritium breeding within the outboard breeding zone. This article is part of the theme issue 'Delivering Fusion Energy - The Spherical Tokamak for Energy Production (STEP)'.

Nutrient requirements shape the preferential habitat of Allorhizobium vitis VAR03-1, a commensal bacterium, in the rhizosphere of Arabidopsis thaliana.

A diverse range of commensal bacteria inhabit the rhizosphere, influencing host plant growth and responses to biotic and abiotic stresses. While root-released nutrients can define soil microbial habitats, the bacterial factors involved in plant-microbe interactions are not well characterized. In this study, we investigated the colonization patterns of two plant disease biocontrol agents, Allorhizobium vitis VAR03-1 and Pseudomonas protegens Cab57, in the rhizosphere of Arabidopsis thaliana using Murashige and Skoog (MS) agar medium. VAR03-1 formed colonies even at a distance from the roots, preferentially in the upper part, while Cab57 colonized only the root surface. The addition of sucrose to the agar medium resulted in excessive proliferation of VAR03-1, similar to its pattern without sucrose, whereas Cab57 formed colonies only near the root surface. Overgrowth of both bacterial strains upon nutrient supplementation inhibited host growth, independent of plant immune responses. This inhibition was reduced in the VAR03-1 ΔrecA mutant, which exhibited increased biofilm formation, suggesting that some activities associated with the free-living lifestyle rather than the sessile lifestyle may be detrimental to host growth. VAR03-1 grew in liquid MS medium with sucrose alone, while Cab57 required both sucrose and organic acids. Supplementation of sugars and organic acids allowed both bacterial strains to grow near and away from Arabidopsis roots in MS agar. These results suggest that nutrient requirements for bacterial growth may determine their growth habitats in the rhizosphere, with nutrients released in root exudates potentially acting as a limiting factor in harnessing microbiota.