Abstract Diagnostic advances outpace bedside interpretation in tropical medicine. Two forces drive this gap: mimicry—infectious syndromes resembling noninfectious disease, and expansibility—epidemiology transcending geography, age, season, and host. The result is misclassification, mistargeted therapies (e.g., steroid-treated helminth infection), and wasted resources amid climate- and mobility-driven shifts. This correspondence proposes lightweight, locally led evidence circulation through structured case reviews, minimal essential data, and living, site-specific algorithms that integrate mimicry-aware red flags and calibrated pretest probabilities. Such networks transform tacit experience into auditable knowledge, improve day-to-day decision-making, and align technological advances with context, thereby strengthening equitable and sustainable care for tropical diseases.
We operationally uncover aspects of wave/particle duality for the open driven Jaynes-Cummings (JC) model in its strong-coupling limit. We lay special emphasis on the vacuum Rabi resonance, and determine the corresponding normalized intensity-field correlation function via mapping to ordinary resonance fluorescence. We demonstrate that temporal wave-particle fluctuations of light emanating from an established vacuum Rabi resonance are explicitly non-classical, while the limit of vanishing spontaneous emission restores detailed balance. When photon blockade sets in, individual realizations show a rapidly increasing frequency of fluctuations towards the two-photon resonance, arising as a direct consequence of a resolved JC spectrum. About the two-photon resonance peak, spontaneous emissions are more likely to revive a high-frequency quantum beat in the conditioned electromagnetic field amplitude than photons escaping out of the cavity mode. The beat originates from a coherent superposition of the first excited JC couplet states, and sets the background against which nonclassical phase shifts are observed in the conditioned quadrature amplitudes. We also find that the onset of steady-state bimodality reduces the variation of the normalized intensity-field correlation, at the expense of its temporal symmetry.
We offer the first operational interpretation of the α-z relative entropies, a measure of distinguishability between two quantum states introduced by Jakšić et al. and Audenaert and Datta. We show that these relative entropies appear when formulating conditions for large-sample or catalytic relative majorization of pairs of flat states and certain generalizations of them. Indeed, we show that such transformations exist if and only if all the α-z relative entropies of the two pairs are ordered. In this setting, the α and z parameters are truly independent from each other. These results also yield an expression for the optimal rate of converting one flat state pair into another. Our methods use real-algebraic techniques involving preordered semirings and certain monotone homomorphisms and derivations on them.
Athagran Nakham, Christine Bond, Moira Cruickshank
et al.
<b>Background:</b> Anticholinergic burden (ACB) from medications has been associated with adverse outcomes in older adults. <b>Aim:</b> The aim was to conduct a non-randomized feasibility study of an intervention to reduce the anticholinergic burden in older patients (REGENERATE) to inform a subsequent definitive trial. <b>Methods:</b> The development and evaluation of an ACB reduction intervention was guided by the Medical Research Council framework. Findings from preliminary studies, two systematic reviews, and two qualitative studies informed the design of a mixed-method feasibility study. The study was conducted in one UK primary care site. The clinical pharmacist identified and invited potentially eligible patients, reviewed their medications, and made recommendations to reduce the ACB as needed. Patients completed surveys at baseline and 6 and 12 weeks post-intervention. A purposive sample of patients and healthcare professionals was interviewed. <b>Results:</b> There was a response of 16/20; 14/16 attended the pharmacist-led consultation and completed the baseline questionnaire, and 13/14 completed both follow-up questionnaires. The sustainability of deprescribing was confirmed. The results suggest the potential of the intervention to reduce side effects from medications and improve quality of life (EQ-5D-5L). The interviews showed patients were happy with the study processes and the medication changes and were satisfied with the pharmacist’s consultation. <b>Conclusions:</b> This feasibility study demonstrated that a deprescribing/reducing ACB intervention in older adults is feasible in a primary care setting and may benefit patients. Well-designed RCTs and cost-effectiveness studies should be undertaken to confirm the benefits of ACB deprescribing in primary care settings.
In this paper we study the optimal control of an initial-boundary value problem for the classical nonviscous Cahn-Hilliard system with zero Neumann boundary conditions. Phase field systems of this type govern the evolution of diffusive phase transition processes with conserved order parameter. For such systems, optimal control problems have been studied in the past. We focus here on the situation when the cost functional of the optimal control problem contains a sparsity-enhancing nondifferentiable term like the L1-norm. For such cases, we establish first-order necessary and second-order sufficient optimality conditions for locally optimal controls, where in the approach to second-order sufficient conditions we employ a technique introduced by E. Casas, C. Ryll and F. Tröltzsch in the paper [SIAM J. Control Optim. 53 (2015), 2168-2202]. The main novelty of this paper is that this method, which has recently been successfully applied to systems of viscous Cahn-Hilliard type, can be adapted also to the classical nonviscous case. Since in the case without viscosity the solutions to the state and adjoint systems turn out to be considerably less regular than in the viscous case, numerous additional technical difficulties have to be overcome, and additional conditions have to be imposed. In particular, we have to restrict ourselves to the case when the nonlinearity driving the phase separation is regular, while in the presence of a viscosity term also nonlinearities of logarithmic type turn could be admitted. In addition, the implicit function theorem, which was employed to establish the needed differentiability properties of the control-to-state operator in the viscous case, does not apply in our situation and has to be substituted by other arguments.
Aysun Yahşi, Gülsüm İclal Bayhan, Tuğba Erat
et al.
Objective: To investigate the clinical and epidemiological features and outcome of Chryseobacterium and Elizabethkingia spp. infections in children, together with antimicrobial susceptibilities.
Methods: This retrospective study was conducted at a tertiary pediatric hospital in Turkey. All patients infected with Chryseobacterium/Elizabethkingia spp. among those presenting to Ankara City Hospital between March 2014 and March 2022 were included.
Results: A total of 49 cases were included and 29 cases were identified as Elizabethkingia. The median age was 14 (0.2-185.0) months. The majority (89.8%) of these patients had an underlying disease, including malignancy (42.9%). Bacteremia (46.9%) and central line-associated bloodstream infection (28.6%) were the most common infections. The thirty-day all-cause mortality rate was 12.2%. The most commonly used antibiotics were ciprofloxacin and trimethoprim-sulfamethoxazole (TMP-SMX). Forty-five (91.8%) isolates were susceptible to ciprofloxacin, 44 (91.6%) to TMP-SMX, and 21 (87.5%) to levofloxacin.
Conclusions: Chryseobacterium and Elizabethkingia spp. are emergent, nosocomial pathogens and the majority of cases were older than the neonatal period. They were mainly seen in patients with long hospital stays, indwelling devices, and those who have received antibiotics within the last month, especially carbapenems. In addition, they were associated with bloodstream infection and malignancy. The most commonly useful antibiotics according to the resistance patterns were ciprofloxacin and TMP-SMX.
Abstract Background: Conotoxins exhibit great potential as neuropharmacology tools and therapeutic candidates due to their high affinity and specificity for ion channels, neurotransmitter receptors or transporters. The traditional methods to discover new conotoxins are peptide purification from the crude venom or gene amplification from the venom duct. Methods: In this study, a novel O1 superfamily conotoxin Tx6.7 was directly cloned from the genomic DNA of Conus textile using primers corresponding to the conserved intronic sequence and 3’ UTR elements. The mature peptide of Tx6.7 (DCHERWDWCPASLLGVIYCCEGLICFIAFCI) was synthesized by solid-phase chemical synthesis and confirmed by mass spectrometry. Results: Patch clamp experiments on rat DRG neurons showed that Tx6.7 inhibited peak calcium currents by 59.29 ± 2.34% and peak potassium currents by 22.33 ± 7.81%. In addition, patch clamp on the ion channel subtypes showed that 10 μM Tx6.7 inhibited 56.61 ± 3.20% of the hCaV1.2 currents, 24.67 ± 0.91% of the hCaV2.2 currents and 7.30 ± 3.38% of the hNaV1.8 currents. Tx6.7 had no significant toxicity to ND7/23 cells and increased the pain threshold from 0.5 to 4 hours in the mouse hot plate assay. Conclusion: Our results suggested that direct cloning of conotoxin sequences from the genomic DNA of cone snails would be an alternative approach to obtaining novel conotoxins. Tx6.7 could be used as a probe tool for ion channel research or a therapeutic candidate for novel drug development.
Cooperation in human society is sustained by reputation. In general, the reputation of an individual is determined by others who observe his behavior, but this rarely happens in private situations. This may cause people to behave inconsistently, cooperating in public and not cooperating in private. A previous experiment showed that people gave a lower reputation to an individual who cooperated in public but defected in private rather than a consistently uncooperative individual regardless of public and private situations. However, the reason behind this is unclear. Here, we study how cooperation and the reputational mechanism co-evolve on the condition that two types of interaction (public and private) exist. The simulation results show that the evolved social norm is characterized by at least one of the following: preference for consistent or aversion of inconsistent behavior in both interactions when the risk that behaviors in private interactions are observed exceeds a certain threshold. We also find that such social norms promote cooperation in private situations as well as in public ones.
Pongthep Meankaew, Saranath Lawpoolsri, Watcharapong Piyaphanee
et al.
Abstract Background The risk of disease is a key factor that travelers have identified when planning to travel abroad, as many people are concerned about getting sick. Mobile devices can be an effective means for travelers to access information regarding disease prevalence in their planned destinations, potentially reducing the risk of exposure. Methods We developed a mobile app, ThaiEpidemics, using cross-platform technology to provide information about disease prevalence and status for travelers to Thailand. We aimed to assess the app’s usability in terms of engagement, search logs, and effectiveness among target users. The app was developed using the principle of mobile application development life cycle, for both iOS and Android. As its data source, the app used weekly data from national disease-surveillance reports. We conduced our study among visitors to the Travel Clinic in the Hospital for Tropical Diseases, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand. The participants were informed that the app would collect usage and search logs related to their queries. After the second log-in, the app prompted participants to complete an e-survey regarding their opinions and preferences related to their awareness of disease prevalence and status. Results We based our prototype of ThaiEpidemics on a conceptualized framework for visualizing the distribution of 14 major diseases of concern to tourists in Southeast Asia. The app provided users with functions and features to search for and visualize disease prevalence and status in Thailand. The participants could access information for their current location and elsewhere in the country. In all, 83 people installed the app, and 52 responded to the e-survey. Regardless of age, education, and continent of origin, almost all e-survey respondents believed the app had raised their awareness of disease prevalence and status when travelling. Most participants searched for information for all 14 diseases; some searched for information specifically about dengue and malaria. Conclusions ThaiEpidemics is evidently potentially useful for travelers. Should the app be adopted for use by travelers to Thailand, it could have an impact on wider knowledge distribution, which might result in decreased exposure, increased prophylaxis, and therefore a potential decreased burden on the healthcare system. For app developers who are developing/implementing this kind of app, it is important to address standardization of the data source and users’ concerns about the confidentiality and safety of their mobile devices.
Language models (LMs) often generate incoherent outputs: they refer to events and entity states that are incompatible with the state of the world described in their inputs. We introduce SituationSupervision, a family of approaches for improving coherence in LMs by training them to construct and condition on explicit representations of entities and their states. SituationSupervision has two components: an auxiliary situation modeling task that trains models to predict state representations in context, and a latent state inference procedure that imputes these states from partially annotated training data. SituationSupervision can be applied to both fine-tuning (by supervising LMs to encode state variables in their hidden representations) and prompting (by inducing LMs to interleave textual descriptions of entity states with output text). In both cases, SituationSupervision requires only a small number of state annotations to produce major coherence improvements (between 4-11%), showing that standard LMs can be sample-efficiently trained to model not just language but the situations it describes.
David Heath, David Momtaz, Abdullah Ghali, Luis Salazar, Jonathan Bethiel, Boris Christopher, Caitlyn Mooney, Katherine C Bartush UT Health San Antonio, Department of Orthopaedics, San Antonio, TX, 78249, USACorrespondence: Katherine C BartushUT Health San Antonio, Department of Orthopaedics, 7703 Floyd Curl Dr, MC-7774, San Antonio, Tx, 78229-3900, USATel +1-574-514-2499Fax +1-210-567-5125Email bartush@uthscsa.eduBackground: The rate of medial meniscus tear (MMT) in professional soccer players is high. There are no studies on objective performance metrics following medial meniscus repair in these athletes.Purpose: Examine the impact of MMT treated with surgical repair on performance metrics and career longevity in Major League Soccer (MLS) players.Methods: MLS players who sustained an MMT between 1993 and 2019 were identified via publicly available databases. These players were each matched to 2 uninjured controls by debut date, experience, position, race, ethnicity, height, weight, and body mass index (BMI). Demographic data and performance metrics were then collected for both groups. Matches, minutes, goals, assists, shots, shots on target, duels, and duel percentage won are collectively referred to as performance metrics. Statistical analysis compared demographic distributions and performance metrics between the MMT and control groups.Results: Thirty-three MLS players who had undergone medial meniscus repair were identified and matched to 66 controls. All performance metrics decreased in the MMT group when compared to their controls in the first year after injury. This difference remained significant even when the performance metrics were normalized with respect to time, indicating that the injured players both played less and were not as productive. At 2 years after injury, performance metrics returned to pre-injury levels and were equivalent to those of the healthy controls. Career length was found to be significantly different between the two groups at 8.81 ± 3.9 years for the MMT group and 12.63 ± 3.51 years for the control group (P < 0.001).Conclusion: MLS players undergoing medial meniscus repair had decreased performance metrics in the first year after injury but returned to baseline levels of play at the second year after injury. Their careers were also shorter than those of their uninjured controls.Keywords: meniscus tear, soccer, return to play, return to sport
Marjan Abbasi, Sheny Khera, Julia Dabravolskaj
et al.
(1) Background: Integrated models of primary care deliver the comprehensive and preventative approach needed to identify and manage frailty in older people. Seniors’ Community Hub (SCH) was developed to deliver person-centered, evidence-informed, coordinated, and integrated care services to older community dwelling adults living with frailty. This paper aims to describe the SCH model, and to present patient-oriented results of the pilot. (2) Methods: SCH was piloted in an academic clinic with six family physicians. Eligible patients were community dwelling, 65 years of age and older, and considered to be at risk of frailty (eFI > 0.12). Health professionals within the clinic received training in geriatrics and interprofessional teamwork to form the SCH team working with family physicians, patients and caregivers. The SCH intervention consisted of a team-based multi-domain assessment with person-centered care planning and follow-up. Patient-oriented outcomes (EQ-5D-5L and EQ-VAS) and 4-metre gait speed were measured at initial visit and 12 months later. (3) Results: 88 patients were enrolled in the pilot from April 2016–December 2018. No statistically significant differences in EQ-5D-5L/VAS or the 4-metre gait speed were detected in 38 patients completing the 12-month assessment. (4) Conclusions: Future larger scale studies of longer duration are needed to demonstrate impacts of integrated models of primary care on patient-oriented outcomes for older adults living with frailty.
The concept of inertial frame of reference in classical physics and special theory of relativity is analysed. It has been shown that this fundamental concept of physics is not clear enough. A definition of inertial frame of reference is proposed which expresses its key inherent property. The definition is operational and powerful. Many other properties of inertial frames follow from the definition, or it makes them plausible. In particular, the definition shows why physical laws obey space and time symmetries and the principle of relativity, it resolves the problem of clock synchronization and the role of light in it, as well as the problem of the geometry of inertial frames.
Self-adaptive systems continuously adapt to changes in their execution environment. Capturing all possible changes to define suitable behaviour beforehand is unfeasible, or even impossible in the case of unknown changes, hence human intervention may be required. We argue that adapting to unknown situations is the ultimate challenge for self-adaptive systems. Learning-based approaches are used to learn the suitable behaviour to exhibit in the case of unknown situations, to minimize or fully remove human intervention. While such approaches can, to a certain extent, generalize existing adaptations to new situations, there is a number of breakthroughs that need to be achieved before systems can adapt to general unknown and unforeseen situations. We posit the research directions that need to be explored to achieve unanticipated adaptation from the perspective of learning-based self-adaptive systems. At minimum, systems need to define internal representations of previously unseen situations on-the-fly, extrapolate the relationship to the previously encountered situations to evolve existing adaptations, and reason about the feasibility of achieving their intrinsic goals in the new set of conditions. We close discussing whether, even when we can, we should indeed build systems that define their own behaviour and adapt their goals, without involving a human supervisor.
Jin-wen Huang, Qiu-yun Xu, Min Lin, Bo Cheng, Chao Ji Department of Dermatology, The First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian 350005, People’s Republic of ChinaCorrespondence: Chao Ji; Bo ChengDepartment of Dermatology, The First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian 350005, People’s Republic of ChinaEmail surpassing.ji@gmail.com; chengbo_fjmu1@163.comIntroduction: Skin, as the outermost organ, is exposed to a wide range of environmental risk factors including ultraviolet (UV) and all kinds of pollutants. Excessive UV exposure contributes to many disorders, such as photoaging, skin inflammation, and carcinogenesis.Methods: To determine the effects of bamboo extract (BEX) from our local plant, Acidosasa longiligula, on UV-irritated human skin, we conducted a variety of studies, including Western blot, apoptosis assays, reactive oxygen species (ROS) detection, and thioredoxin (TXN) and thioredoxin reductase (TXNRD) activity assays in primary skin keratinocytes.Results: We first determined that BEX protects human skin keratinocytes against UV radiation-induced apoptosis and ROS production. UV radiation can robustly impair TXN and TXNRD activity which can, in turn, be significantly rescued by BEX treatment. Moreover, BEX regulates TXN1 levels in primary skin keratinocytes and TXN1 is proved to be required for the protective function of BEX. Last, we found that the NF-κB/p65 pathway mediates the protective function of BEX against UV.Discussion: Collectively, our work delineates the beneficial role of BEX in UV-induced skin cell damage and provides a novel therapeutic reagent to prevent or alleviate the progress of photoaging and other UV-provoked skin diseases.Keywords: Acidosasa longiligula, bamboo extract, BEX, ultraviolet radiation, UV radiation, thioredoxin, TXN, NF-κB pathway
Walter Ceretti-Junior, Daniel Pagotto Vendrami, Marco Otavio de Matos-Junior
et al.
ABSTRACT This note reports on occurrences of triatomine species in the city of Sao Paulo, Brazil, registered between 1988 and 2017. Records of triatomines captured in Sao Paulo are based on specimens received spontaneously from Health Surveillance Centers, Health Centers and Zoonosis Control Centers in the city as well as from citizens. Species were identified morphologically at the Public Health Entomology Laboratory, Faculty of Public Health, University of Sao Paulo, where the triatomines, which are vectors of Chagas disease, were tested for Trypanosoma cruzi infection. The first reported occurrence of triatomine bugs in urban Sao Paulo was in 1988. The specimen, which was captured in Jardim Sao Luiz district, was from the genus Panstrongylus and was registered as Panstrongylus sp. but was not sexed. Since this first recorded occurrence, the following species have been found in the city: Panstrongylus geniculatus (2 occurrences), P. megistus (15 occurrences), Triatoma infestans (1 occurrence) and T. sordida (3 occurrences). In this paper, the importance of reporting occurrences of triatomine bugs in the city of Sao Paulo, one of the largest metropolis in the world, is discussed with an emphasis on P. megistus. The occurrences discussed here indicate the importance of entomological surveillance for these vectors even in urban centers although the possibility of vector transmission of Chagas disease in these centers is very low.
Arctic medicine. Tropical medicine, Infectious and parasitic diseases
This paper introduces operators, semantics, characterizations, and solution-independent conditions to guarantee temporal logic specifications for hybrid dynamical systems. Hybrid dynamical systems are given in terms of differential inclusions -- capturing the continuous dynamics -- and difference inclusions -- capturing the discrete dynamics or events -- with constraints. State trajectories (or solutions) to such systems are parameterized by a hybrid notion of time. For such broad class of solutions, the operators and semantics needed to reason about temporal logic are introduced. Characterizations of temporal logic formulas in terms of dynamical properties of hybrid systems are presented -- in particular, forward invariance and finite time attractivity. These characterizations are exploited to formulate sufficient conditions assuring the satisfaction of temporal logic formulas -- when possible, these conditions do not involve solution information. Combining the results for formulas with a single operator, ways to certify more complex formulas are pointed out, in particular, via a decomposition using a finite state automaton. Academic examples illustrate the results throughout the paper.