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Examining non-sport-related cognitive tasks of attention and executive control in skilled athletes may provide insight into the acquisition of highly specific skills developed in experts as well as help identify successful performance in sport. Through a cross-sectional design, this study examined performance on aspects of attention and executive control among varsity athletes playing soccer (strategic sport) or track & field (static sport) using a computerized test of attention and executive control. Ninety-seven university athletes participating in soccer ( n = 50) or track and field ( n = 47) were included in the study. Domains of attention and executive control were examined using the Attention Network Test-Interactions (ANT-I). Mean reaction time (RT) and intra-individual variability (IIV) were compared between groups as measures of performance speed and performance stability respectively. Soccer players demonstrated overall faster RTs ( p = 0.0499; ηp2 = .04) and higher response accuracy ( p = .021, d = .48) on the ANT-I compared to track and field athletes. Faster RTs were observed for soccer players when presented with an alerting tone ( p = .029, d = .45), valid orienting cue ( p = .019, d = .49) and incongruent flanker ( p = .031, d = .45). No significant group differences were observed in IIV ( p = .083, d = .36). Athletes engaging in strategic sports (i.e., soccer) demonstrated faster performance under test conditions that required higher vigilance and conflict resolution. These findings suggest that engagement in strategic sports is associated with enhanced performance on non-sport-related cognitive tasks of attention and executive control.

Objectives To assess diagnostic accuracy of screening tests for pre-diabetes and efficacy of interventions (lifestyle or metformin) in preventing onset of type 2 diabetes in people with pre-diabetes.Design Systematic review and meta-analysis.Data sources and method Medline, PreMedline, and Embase. Study protocols and seminal papers were citation-tracked in Google Scholar to identify definitive trials and additional publications. Data on study design, methods, and findings were extracted onto Excel spreadsheets; a 20% sample was checked by a second researcher. Data extracted for screening tests included diagnostic accuracy and population prevalence. Two meta-analyses were performed, one summarising accuracy of screening tests (with the oral glucose tolerance test as the standard) for identification of pre-diabetes, and the other assessing relative risk of progression to type 2 diabetes after either lifestyle intervention or treatment with metformin.Eligibility criteria Empirical studies evaluating accuracy of tests for identification of pre-diabetes. Interventions (randomised trials and interventional studies) with a control group in people identified through screening. No language restrictions.Results 2874 titles were scanned and 148 papers (covering 138 studies) reviewed in full. The final analysis included 49 studies of screening tests (five of which were prevalence studies) and 50 intervention trials. HbA1c had a mean sensitivity of 0.49 (95% confidence interval 0.40 to 0.58) and specificity of 0.79 (0.73 to 0.84), for identification of pre-diabetes, though different studies used different cut-off values. Fasting plasma glucose had a mean sensitivity of 0.25 (0.19 to 0.32) and specificity of 0.94 (0.92 to 0.96). Different measures of glycaemic abnormality identified different subpopulations (for example, 47%of people with abnormal HbA1c had no other glycaemic abnormality). Lifestyle interventions were associated with a 36% (28% to 43%) reduction in relative risk of type 2 diabetes over six months to six years, attenuating to 20% (8% to 31%) at follow-up in the period after the trails.Conclusions HbA1c is neither sensitive nor specific for detecting pre-diabetes; fasting glucose is specific but not sensitive. Interventions in people classified through screening as having pre-diabetes have some efficacy in preventing or delaying onset of type 2 diabetes in trial populations. As screening is inaccurate, many people will receives an incorrect diagnosis and be referred on for interventions while others will be falsely reassured and not offered the intervention. These findings suggest that “screen and treat” policies alone are unlikely to have substantial impact on the worsening epidemic of type 2 diabetes.Registration PROSPERO (No CRD42016042920).

The ratio of in-plane stiffness to out-of-plane bending stiffness of graphene is shown to be similar to that of a piece of paper, which allows ideas from kirigami (a variation of origami that allows cutting) to be applied to micrometre-scale graphene sheets to build mechanically stretchable yet robust electrodes, springs and hinges. Graphene structures make the cut The paper arts of origami and kirigami (which allows cutting as well as folding) are scalable, and increasingly used by scientists and engineers to create structures from the macro- to the microscale. Melina Blees and colleagues now show that graphene is well suited for kirigami: its relative stiffness against in-plane stretching as opposed to out-of-plane bending is similar to that of a piece of paper, owing to the presence of ripples that stiffen the graphene sheets and dramatically increase their bending stiffness over the predicted atomic-scale value. Ideas from kirigami can thus be applied quite readily to micrometre-sized graphene sheets, and used to build mechanically stretchable yet robust electrodes, springs and hinges that could find use in atomically thin membrane devices for sensing, manipulation, and possibly even robotics applications. For centuries, practitioners of origami (‘ori’, fold; ‘kami’, paper) and kirigami (‘kiru’, cut) have fashioned sheets of paper into beautiful and complex three-dimensional structures. Both techniques are scalable, and scientists and engineers are adapting them to different two-dimensional starting materials to create structures from the macro- to the microscale 1 , 2 . Here we show that graphene 3 , 4 , 5 , 6 is well suited for kirigami, allowing us to build robust microscale structures with tunable mechanical properties. The material parameter crucial for kirigami is the Föppl–von Kármán number 7 , 8 γ : an indication of the ratio between in-plane stiffness and out-of-plane bending stiffness, with high numbers corresponding to membranes that more easily bend and crumple than they stretch and shear. To determine γ , we measure the bending stiffness of graphene monolayers that are 10–100 micrometres in size and obtain a value that is thousands of times higher than the predicted atomic-scale bending stiffness. Interferometric imaging attributes this finding to ripples in the membrane 9 , 10 , 11 , 12 , 13 that stiffen the graphene sheets considerably, to the extent that γ is comparable to that of a standard piece of paper. We may therefore apply ideas from kirigami to graphene sheets to build mechanical metamaterials such as stretchable electrodes, springs, and hinges. These results establish graphene kirigami as a simple yet powerful and customizable approach for fashioning one-atom-thick graphene sheets into resilient and movable parts with microscale dimensions.

Energy transferred via thermal radiation between two surfaces separated by nanometer distances can be much larger than the blackbody limit. However, realizing a scalable platform that utilizes this near-field energy exchange mechanism to generate electricity remains a challenge. Here, we present a fully integrated, reconfigurable and scalable platform operating in the near-field regime that performs controlled heat extraction and energy recycling. Our platform relies on an integrated nano-electromechanical system that enables precise positioning of a thermal emitter within nanometer distances from a room-temperature germanium photodetector to form a thermo-photovoltaic cell. We demonstrate over an order of magnitude enhancement of power generation ( P gen  ~ 1.25 μWcm −2 ) in our thermo-photovoltaic cell by actively tuning the gap between a hot-emitter ( T E  ~ 880 K) and the cold photodetector ( T D  ~ 300 K) from ~ 500 nm down to ~ 100 nm. Our nano-electromechanical system consumes negligible tuning power ( P gen / P NEMS ~ 10 4 ) and relies on scalable silicon-based process technologies. Designing a scalable platform to generate electricity from the energy exchange mechanism between two surfaces separated by nanometer distances remains a challenge. Here, the authors demonstrate reconfigurable, scalable and fully integrated near-field thermo-photovoltaics for on-demand heat recycling.

The use of nanophotonics to rapidly and precisely reconfigure light beams for the optical stimulation of neurons in vivo has remained elusive. Here we report the design and fabrication of an implantable silicon-based probe that can switch and route multiple optical beams to stimulate identified sets of neurons across cortical layers and simultaneously record the produced spike patterns. Each switch in the device consists of a silicon nitride waveguide structure that can be rapidly (<20 μs) reconfigured by electrically tuning the phase of light. By using an eight-beam probe, we show in anaesthetized mice that small groups of single neurons can be independently stimulated to produce multineuron spike patterns at sub-millisecond precision. We also show that a probe integrating co-fabricated electrical recording sites can simultaneously optically stimulate and electrically measure deep-brain neural activity. The technology is scalable, and it allows for beam focusing and steering and for structured illumination via beam shaping. The high-bandwidth optical-stimulation capacity of the device might facilitate the probing of the spatiotemporal neural codes underlying behaviour. A reconfigurable nanophotonic silicon probe, implanted in anaesthetized mice, that switches multiple optical beams in less than 20 μs enables the optical stimulation of multineuron spike patterns in the brain at sub-millisecond precision.

Clinical trials are constantly evolving in the context of increasingly complex research questions and potentially limited resources. In this review article, we discuss the emergence of “adaptive” clinical trials that allow for the preplanned modification of an ongoing clinical trial based on the accumulating evidence with application across translational research. These modifications may include terminating a trial before completion due to futility or efficacy, re-estimating the needed sample size to ensure adequate power, enriching the target population enrolled in the study, selecting across multiple treatment arms, revising allocation ratios used for randomization, or selecting the most appropriate endpoint. Emerging topics related to borrowing information from historic or supplemental data sources, sequential multiple assignment randomized trials (SMART), master protocol and seamless designs, and phase I dose-finding studies are also presented. Each design element includes a brief overview with an accompanying case study to illustrate the design method in practice. We close with brief discussions relating to the statistical considerations for these contemporary designs.

Background National guidance on preventing type 2 diabetes mellitus (T2DM) in the UK recommends low-intensity lifestyle interventions for individuals with intermediate categories of hyperglycaemia defined in terms of impaired fasting glucose (IFG) or ‘at-risk’ levels of HbA1c. In a recent systematic review of economic evaluations of such interventions, most studies had evaluated intensive trial-based lifestyle programmes in participants with impaired glucose tolerance (IGT). This study examines the costs and effects of different intensity lifestyle programmes and metformin in participants with different categories of intermediate hyperglycaemia. Methods We developed a decision tree and Markov model (50-year horizon) to compare four approaches, namely (1) a low-intensity lifestyle programme based on current NICE guidance, (2) a high-intensity lifestyle programme based on the US Diabetes Prevention Program, (3) metformin, and (4) no intervention, modelled for three different types of intermediate hyperglycaemia (IFG, IGT and HbA1c). A health system perspective was adopted and incremental analysis undertaken at an individual and population-wide level, taking England as a case study. Results Low-intensity lifestyle programmes were the most cost-effective (£44/QALY, £195/QALY and £186/QALY compared to no intervention in IGT, IFG and HbA1c, respectively). Intensive lifestyle interventions were also cost-effective compared to no intervention (£2775/QALY, £6820/QALY and £7376/QALY, respectively, in IGT, IFG and HbA1c). Metformin was cost-effective relative to no intervention (£5224/QALY, £6842/QALY and £372/QALY in IGT, IFG and HbA1c, respectively), but was only cost-effective relative to other treatments in participants identified with HbA1c. At a willingness-to-pay threshold of £20,000/QALY, low- and high-intensity lifestyle programmes were cost-effective 98%, 99% and 98% and 81%, 81% and 71% of the time in IGT, IFG and HbA1c, respectively. An England-wide programme for 50–59 year olds could reduce T2DM incidence by < 3.5% over 50 years and would cost 0.2–5.2% of the current diabetes budget for 2–9 years. Discussion This analysis suggests that current English national policy of low-intensity lifestyle programmes in participants with IFG or HbA1c will be cost-effective and have the most favourable budget impact, but will prevent only a fraction of cases of T2DM. Additional approaches to prevention need to be investigated urgently.

COVID-19 patients have experienced worry, altered provider-patient interactions, and options to use novel treatments, initially with neutralizing monoclonal antibodies (mAbs). Limited research has been performed on these aspects of the COVID-19 outpatient experience. This study aimed to evaluate the experiences of outpatients recently diagnosed with COVID-19, who were eligible for use of mAbs, during the diagnosis and treatment process based on sociodemographic and clinical factors. This was a self-reported cohort study performed via telephone surveys. Participants included COVID-19 outpatients who met at least one emergency use criterion for mAbs during the first 120 days after a SARS-CoV-2 positive test. We analyzed survey results using multivariable logistic regression for non-scale outcomes and adjusted proportional odds logistic regression for scaled outcomes. Greater worry about their COVID-19 diagnosis was reported by younger, female, and Hispanic patients and those with Medicaid insurance, two or more comorbid conditions, BMI > 25, and at least 2 COVID-19 vaccinations. Greater provider trust was reported by patients with ≥ 2 years of college education, one or more comorbid conditions, and one or more COVID-19 vaccinations; whereas less provider trust was reported by patients ages 45-64 years, with usual place of care in a walk-in clinic, and those without Commercial, Medicare, or Medicaid insurance. In patients who did not receive mAbs, patients with Medicaid and those without Commercial/Medicare insurance were among the factors that were less likely be offered mAbs by a provider. This report describes factors associated with multiple aspects of outpatients' experience of COVID-19. This study demonstrated that there are important differences in the experience of outpatient COVID-19 patients based on sociodemographic factors and clinical factors, as well as where additional strategies are needed to improve this experience and associated outcomes.

Neutralizing monoclonal antibody (mAb) treatment for COVID-19 prevents hospitalization and death but is underused, especially in racial/ethnic minority and rural populations. Reasons for underuse and inequity may include community member lack of awareness or healthcare access barriers, among others. This study assessed mAbs community awareness and opportunities for improving equitable mAb access. A concurrent mixed methods study including surveys and focus groups with adults with high-risk conditions or their proxy decision-makers. Surveys and focus group guides addressed diffusion of innovation theory factors. Descriptive statistics and Fisher's exact method was used to report and compare survey findings by race and ethnicity. Rapid qualitative methods were used for focus group analysis. Surveys from 515 individuals (460 English, 54 Spanish, 1 Amharic), and 8 focus groups (6 English, 2 Spanish) with 69 participants, completed June 2021 to January 2022. Most survey respondents (75%) had heard little or nothing about mAbs, but 95% would consider getting mAb treatment. Hispanic/Latino and Non-Hispanic People of Color (POC) reported less awareness, greater concern about intravenous infusions, and less trust in mAb safety and effectiveness than White, Non-Hispanic respondents. Focus group themes included little awareness but high interest in mAb treatment and concerns about cost and access barriers such as lacking established sources of care and travel from rural communities. Focus groups revealed preferences for broad-reaching but tailored messaging strategies using multiple media and trusted community leaders. Despite unfamiliarity with mAb treatment, most respondents were open to receiving mAbs or recommending mAbs to others. While mAb messaging should have broad reach \"to everyone everywhere,\" racial and geographic disparities in awareness and trust about mAbs underscore need for tailored messaging to promote equitable access. Care processes should address patient-level barriers like transportation, insurance, or primary care access. COVID-19 treatment dissemination strategies should promote health equity.