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Norovirus (NoV) is an enteric non-enveloped virus which is the leading cause of gastroenteritis across all age groups. It is responsible for around 200,000 deaths annually and outbreaks are common in small communities such as educational and care facilities. 40% of all NoV outbreaks occur in long-term and acute-care facilities, forming the majority of outbreaks. Nosocomial settings set ideal environments for ease of transmission, especially due to the presence of immunocompromised groups. It is estimated to cost global economies around £48 billion a year, making it a global issue. NoV is transmitted via the faecal-oral route and infection with it results in asymptomatic cases or gastrointestinal disease. It has high mutational rates and this allows for new variants to emerge and be more resistant. The classification system available divides NoV into 10 genogroups and 49 genotypes based on whole amino acid sequencing of VP1 capsid protein and partial sequencing of RdRp, respectively. The most predominant genotypes which cause gastroenteritis in humans include GI.1 and GII.4, where GII.4 is responsible for more extreme clinical implications such as hospitalisation. In addition, GII.4 has been responsible for 6 pandemic strains, the last of which is the GII.4 Sydney (2012) variant. In recent years, the successful cultivation of HuNoV was reported in stem cell-derived human intestinal enteroids (HIEs), which promises to assist in giving a deeper understanding of its underlying mechanisms of infection and the development of more personalized control measures. There are no specific control measures against NoV, therefore common practices are used against it such as hand washing. No vaccine is available, but the HIL-214 candidate passed clinical phase 2b and shows promise.

Impaired depolarizing-to-hyperpolarizing (D/H) switch of gamma-aminobutyric acid (GABA) is reported during brain development in rodent valproate-model of autism spectrum disorder (VPA-ASD). We hypothesize that this impairment triggers NADPH oxidases (NOXs)-induced reactive oxygen species (ROS) overproduction. Here, we followed the impact of prenatal exposure to VPA on the synaptic protein expression of potassium chloride cotransporter 2 (KCC2), sodium potassium chloride cotransporter 1 (NKCC1) and, in brains of male and female Wistar rats during infantile (P15), juvenile (P30) and adult (P60) stages. We also assessed alterations in synaptic NOX isoforms 2 and 4 (NOX2 and NOX4) activities and expressions in developing rat brains. Our findings revealed a significant reduction in KCC2 expression and a concomitant increase in NOX activity and NOX4 expression in synaptosomes of VPA-exposed rats, particularly at P15 and P30. Prenatal exposure to shikonin, (10 mg/kg/day, intraperitoneal (i.p.) into pregnant dam, daily from G12.5 until birth), ameliorated these effects by reducing synaptic protein expression of NOX4, generally quenched synaptic NOX activity and enhanced synaptic protein expression of KCC2. Indeed, shikonin reversed VPA-induced sociability deficits in ASD rats. These results suggest that targeting the NOX-ROS pathway may be a potential therapeutic strategy for ASD.

Retaliatory killings caused by human-wildlife conflict have a significant impact on the survival of leopards. This study explores the reasons for retaliatory killings of leopards by interviewing community members in a small village in South Africa that experienced high incidences of human–leopard conflict. The semi-structured interviews focused on the reasons why retaliatory leopard killings occurred and how to best mitigate the situational factors that triggered these killings. Respondents cited four main problems that fueled these killings: the government’s response to human–leopard conflict was slow and unwilling; this response involved inefficient methods; there were inadequate resources to respond to these killings; and there was a clear lack of laws or their application. Local stakeholders provided a range of innovative strategies to reduce human-leopard conflict and retaliatory killings. While all parties expressed different reasons why these solutions were or were not effective, their conclusions were often similar. The distrust that existed between the parties prevented them from recognizing or accepting their common ground. Based on existing human–wildlife conflict mitigation techniques and solutions identified by local stakeholders, this article explores how criminological techniques, including situational crime prevention, can help identify and frame effective interventions to reduce the number of illegal leopard killings driven by human-wildlife conflict.

Background: Studies across the extant literature suggest that less-experienced healthcare workers are more likely to experience adverse outcomes such as burnout, sick leaves, or intend to leave the profession. Thus, one’s readiness to practice is an important element that requires more attention. While extensive research exists on the readiness of certain professions like nurses, a notable gap remains concerning other healthcare workers. Purpose: This study sought to explore studies examining readiness to practice among various underrepresented healthcare workers. Methods: We conducted a scoping review to determine the available research related to clinical and nonclinical areas related to the readiness to practice of healthcare workers, excluding physicians and nurses. We examined three databases, MEDLINE, CINAHL, and PsycINFO, from 1 January 2000 to 31 December 2023. Our search focused on readiness to practice among various healthcare professions, whether clinically focused or broadly related to professionalism. Results: Our search identified 41 articles meeting the inclusion criteria from several professions, including but not limited to physiotherapists and occupational therapists, pharmacists, osteopaths/chiropractors, and social workers. Overall, studies differed in assessing readiness to practice with a broad range of identified clinical competencies that varied between professions and regions. Nonclinical skills, such as communication, conflict management, and cultural competence, were common barriers across professions. Conclusion: Despite the heterogeneity in job roles, work settings, and geographical reasons, there is evidence to suggest that new healthcare professionals may be clinically adept but may be lacking in other nonclinical skills that could affect their work and well-being. With early-career healthcare workers particularly vulnerable to adverse outcomes in the workplace, future research should standardize core competencies, including nonclinical skills and well-being-related activities, as a prevention method across various health groups.

In regions with limited potable water availability, membrane desalination is being employed to filter water using a pressure-driven approach. Because of the high energy consumption required to produce the pressure differential needed for this method, researchers have been trying different geometric designs of spacer filaments to enhance the amount of permeate flux in terms of energy utilization. The purpose of spacer filaments is to support membranes structurally and induce turbulent mixing in spiral wound membrane desalination. In this paper, the improvement of mass transfer in desalination driven by reverse osmosis has been studied using Computational Fluid Dynamics (CFD) with the introduction of spiral wound membranes that are lined with spacer filaments in a zig-zag formation having alternating diameters for strands. The fluid flow characteristics for a 2-dimensional geometric model were resolved using the open-source program OpenFOAM by changing the Reynolds number to just before the inception of instabilities. Ratios of alternate strand diameters were also varied between one and two. Based on a detailed analysis of velocity contours, pressure distribution, wall shear stresses, and steady-state vortex systems, the research findings offer guidance for employing alternating strand design in zig-zag formation for optimum mass transfer and minimal pressure drop when accounting for concentration polarization.

PurposeLimited data are available on venovenous extracorporeal membrane oxygenation (ECMO) in patients with severe hypoxemic respiratory failure from coronavirus disease 2019 (COVID-19).MethodsWe examined the clinical features and outcomes of 190 patients treated with ECMO within 14 days of ICU admission, using data from a multicenter cohort study of 5122 critically ill adults with COVID-19 admitted to 68 hospitals across the United States. To estimate the effect of ECMO on mortality, we emulated a target trial of ECMO receipt versus no ECMO receipt within 7 days of ICU admission among mechanically ventilated patients with severe hypoxemia (PaO2/FiO2 < 100). Patients were followed until hospital discharge, death, or a minimum of 60 days. We adjusted for confounding using a multivariable Cox model.ResultsAmong the 190 patients treated with ECMO, the median age was 49 years (IQR 41–58), 137 (72.1%) were men, and the median PaO2/FiO2 prior to ECMO initiation was 72 (IQR 61–90). At 60 days, 63 patients (33.2%) had died, 94 (49.5%) were discharged, and 33 (17.4%) remained hospitalized. Among the 1297 patients eligible for the target trial emulation, 45 of the 130 (34.6%) who received ECMO died, and 553 of the 1167 (47.4%) who did not receive ECMO died. In the primary analysis, patients who received ECMO had lower mortality than those who did not (HR 0.55; 95% CI 0.41–0.74). Results were similar in a secondary analysis limited to patients with PaO2/FiO2 < 80 (HR 0.55; 95% CI 0.40–0.77).ConclusionIn select patients with severe respiratory failure from COVID-19, ECMO may reduce mortality.

The supercapacitor energy storage system has achieved a great attention, in future perspective, as compared to ordinary dielectric capacitors and batteries. The nature and type of electrode material employed in supercapacitor applications is critical to the electrochemical performance of a supercapacitor. Herein, co-precipitation derived Mn 3 O 4 nanoparticles were mixed with graphite in a simple way and obtained uniformly mixed composite of exfoliated graphene with these nanoparticles. The electrochemical study of these composites revealed promising results for supercapacitor applications. X-ray diffraction study revealed the formation of single-phase Mn 3 O 4 nanoparticles. The composite was probed for microstructural examination, by scanning electron microscopy, which revealed that Mn 3 O 4 was uniformly embedded in exfoliated graphene sheets, aimed specifically for better electrochemical performance. The elemental composition was studied by energy dispersive X-rays spectroscopy and electrochemical performance of the composite deposited on Nickel foam for electrode using polyvinyl alcohol (PVA, 10%) as a binder has been examined by cyclic voltammetry, galvanostatic charge-discharge, and electrochemical impedance spectroscopy in 1M K 2 SO 4 electrolyte. In addition, different ratios of Mn 3 O 4 /graphene were prepared to investigate composition dependent performance of these composites. The highest value of specific capacitance achieved for composition (1:2) was 334 F/g at scan rate of 5 mVs −1 .

IntroductionMalnutrition results in prolonged inpatient stay, high readmission rates and poor clinical outcome.1–3 Malnutrition in cirrhosis is a poor prognostic factor.4 Assessing nutritional status is problematic as traditional methods of assessment are inaccurate.5Decompensated cirrhosis (DC) patients often require nutritional support but optimal timing of intervention and outcomes are unclear.6 7 A regional audit assessing the prevalence of malnutrition in DC, nutritional management, impact on length of stay, readmission and mortality was conducted.MethodAll adults admitted with DC from 1–30 November 2019 to four acute xxxx hospital Trusts were retrospectively identified from coding. Malnutrition was assessed by MUST and Royal Free Hospital–Nutritional Prioritisation Tool (RFH-NPT) screening tools.8 Results47 patients were identified. Patient demographics, liver disease aetiology, baseline biochemical, disease severity, nutritional assessment and mortality were collected (table 1). Prevalence of malnutrition was 76.6% (CI 62–87.6%) which was independent of age or aetiology of liver disease but was associated with disease severity. There were higher rates of screening on gastroenterology wards (p=0.012) compared to other wards. Nutritional supplementation was prescribed in 27 (60%) patients, 78% of which was oral supplementation. Median length of hospitalisation was 9 (2–62) days. This was longer in those prescribed nutritional supplements (median 11:7 days). Those prescribed supplements were more likely to have more severe liver disease (MELD 20:15; p=0.006). Readmission rates at 1 month were similar in those prescribed nutritional supplements than those not (35% vs 36%). Mortality was higher in malnourished patients (p=0.03) and in the group of patients prescribed nutritional supplements versus not at 1, 3 and 6 months.Abstract P047 Table 1Patient demographics, liver disease aetiology, baseline biochemical data, disease severity, nutritional assessment and patient mortality (n=47) Parameter Male:female n (%) 26:21 (55:45) Age in years (median (range)) 62 (16–86) Liver disease aetiology n (%) Alcohol related liver disease (ARLD) 22 (47) Non-alcoholic fatty liver disease (NAFLD) 12 (26) Viral 8 (17) Autoimmune 3 (6) Other 2 (4) Disease severity: Child Pugh n (%) A – 4 (8), B – 22 (47), C – 21 (45) MELD (median (range)) 20 (6–32) Patient management Patients admitted to Gastroenterology ward n (%) 36 (77) Nutritional assessment Malnourished by MUST n (%) 26 (55) Malnourished by RFH-NPA n (%) 36 (77) Malnourished n (%) by Child Pugh A – 2 (50), B – 16 (72), C – 18 (86) Patients screened for malnutrition (Gastro ward) n (%) 30 (83) Patients screened for malnutrition (Non-Gastro ward) n (%) 5 (45) Time to nutritional/dietetic assessment (median (range)) 4 (1–14) Patients receiving dietician review (Gastro ward) n (%) 19 (52) Patients receiving dietician review (Non-Gastro ward) n (%) 4 (45) Patient mortality No nutritional supplements prescribed at 1,3 and 6 months n (%) 3 (18), 4 (24), 6 (35) Nutritional supplements prescribed at 1,3 and 6 months n (%) 10 (33), 14 (47), 14 (47) ConclusionsMalnutrition is widespread in DC being present in 76.6% of this cohort as compared to 30% in hospitalised patients. Malnutrition was independently associated with early readmission and mortality. The RFH-NPT was significantly more sensitive for detecting malnutrition in cirrhosis compared to MUST. Though screening was better on Gastroenterology wards, it is of concern that this was incomplete for many patients nor was a dietician review accomplished in all malnourished patients. Our results indicate that initial in-patient nutritional interventions do not appear to impact on early readmission or early mortality. A larger multi-centre audit would be required to evaluate the impact of specific nutritional interventions on longer-term outcomes. We propose early management of malnutrition at all possible clinical interactions with specialty dietician involvement. Both primary and secondary care guidance could be adapted to achieve this.ReferencesKyle UG, Genton L, Pichard C. Hospital length of stay and nutritional status. Curr Opin Clin Nutr Metab Care 2005;8(4):397–402.Lim SL, Ong KCB, Chan YH, et al. Malnutrition and its impact on cost of hospitalization, length of stay, readmission and 3-year mortality. Clin Nutr 2012;31(3):345–350.Charlton K, Nichols C, Bowden S, et al. Poor nutritional status of older subacute patients predicts clinical outcomes and mortality at 18 months of follow-up. Eur J Clin Nutr 2012;66(11):1224.McFarlane M, Hammond C, Roper T, et al. Comparing assessment tools for detecting undernutrition in patients with liver cirrhosis. Clin Nutr ESPEN 2018;23:156–161.Cheung K, Lee SS, Raman M. Prevalence and mechanisms of malnutrition in patients with advanced liver disease, and nutrition management strategies. Clin Gastroenterol Hepatol 2012;10(2):117–125.European Association for the Study of the Liver. EASL Clinical Practice Guidelines on nutrition in chronic liver disease. J Hepatol 2019;70(1):172–193.Plauth M, Bernal W, Dasarathy S, et al. ESPEN guideline on clinical nutrition in liver disease. Clin Nutr 2019;38(2):485–521.Arora S, Mattina C, Catherine M, et al. PMO-040 the development and validation of a nutritional prioritising tool for use in patients with chronic liver disease. Gut 2012;61:A90.

Rehabilitation therapists (RTs) have developed substantial mental health problems since the pandemic. Our study aimed to understand the experience of COVID-19 on occupational therapists and physiotherapists practicing in Canada, how the pandemic may have affected care delivery, and to identify new learnings articulated by RTs. A qualitative descriptive study design guided data collection through one-on-one interviews, dyadic interviews, and focus groups. We recruited active RTs across Canada, advertising on professional practice networks and social media platforms and using snowball sampling. Forty-nine RTs representing seven Canadian provinces participated. The four overarching themes developed using thematic analysis were (1) navigating uncertainty along with ever-changing practices, policies, and attitudes, (2) morphing roles within a constrained system, (3) witnessing patients suffering and experiencing moral distress, and (4) recognizing the personal toll of the pandemic on self and others, as well as lessons learned. Our study demonstrated that many RTs suffered moral distress, poor mental health, and some from challenging financial situations, especially those in the private sector. They also expressed a resilient attitude in response to these stressors. Implications in the future include identifying promising communication strategies that could act as protective factors, addressing workforce constraints and diminishing resources through innovative models of care.