Fatigue is a prevalent symptom in people with multiple sclerosis (MS), significantly impacting quality of life and daily functioning(1). The Mediterranean diet, with its anti-inflammatory and neuroprotective properties, may help to alleviate fatigue(2). However, existing evidence linking the Mediterranean diet to fatigue in people with MS is primarily cross-sectional, providing limited insights into long-term effects(3). This study aimed to prospectively test associations between the alternate Mediterranean diet score (aMED) and fatigue using data from the United Kingdom (UK) Multiple Sclerosis Register. Dietary intake was measured in 2016 (n = 2,455) and 2022 (n = 3,740) using the EPIC-Norfolk 130-item Food Frequency Questionnaire. A total of 879 participants provided dietary intake data at both timepoints. aMED is a score ranging from 0 to 9, with higher scores indicating greater adherence to a Mediterranean diet (higher consumption of vegetables, fruit, nuts, legumes, whole-grains, fish; greater monounsaturated-to-saturated fat ratio; lower consumption of red meat; moderate consumption of alcohol). Fatigue was measured using the Fatigue Severity Scale (FSS), a 9-item questionnaire that evaluates the extent to which fatigue interferes with daily activities, with scores ranging from 1 to 7. Additionally, fatigue levels were categorised as either ‘high’ (FSS score: ≥ 5) or ‘low’ (FSS score: < 5). The association between aMED and fatigue over six years (from 2016 to 2022) was assessed using generalized mixed-effects models for the continuous FSS score, while mixed-effects logistic regression models were employed to examine the association between aMED and binary FSS categories (high/low). The models were adjusted for age, sex, MS type (benign, relapse-remitting, secondary progressive, primary progressive, unknown), and total energy intake (kcal/day). Analysis was restricted to those participating at both timepoints and who had complete data on diet, covariates, and FSS (n = 379). The study population consisted of 71.5% females, with a mean age of 55.0 years (standard deviation, 9.9). Higher aMED scores (one-unit increase) were significantly associated with lower FSS scores (adjusted β = -0.08; 95% CI: -0.14, -0.03; p = 0.004) and with 17% lower odds of having high fatigue (FSS > 5), with an adjusted odds ratio of 0.83 (95% CI: 0.71, 0.98; p = 0.029). These findings suggest that adherence to a Mediterranean diet may play a protective role in reducing fatigue severity in people with MS over a 6-year period. Further research could explore associations between a Mediterranean diet and other MS related outcomes in this study population.

We read with interest the recent editorial, “The Hennepin Ketamine Study,” by Dr. Samuel Stratton commenting on the research ethics, methodology, and the current public controversy surrounding this study.1 As researchers and investigators of this study, we strongly agree that prospective clinical research in the prehospital environment is necessary to advance the science of Emergency Medical Services (EMS) and emergency medicine. We also agree that accomplishing this is challenging as the prehospital environment often encounters patient populations who cannot provide meaningful informed consent due to their emergent conditions. To ensure that fellow emergency medicine researchers understand the facts of our work so they may plan future studies, and to address some of the questions and concerns in Dr. Stratton’s editorial, the lay press, and in social media,2 we would like to call attention to some inaccuracies in Dr. Stratton’s editorial, and to the lay media stories on which it appears to be based.

Ho JD, Cole JB, Klein LR, Olives TD, Driver BE, Moore JC, Nystrom PC, Arens AM, Simpson NS, Hick JL, Chavez RA, Lynch WL, Miner JR. The Hennepin Ketamine Study investigators’ reply. Prehosp Disaster Med. 2019;34(2):111–113

Atmospheric dust constitutes particles <100 μm, or deposits thereof (continental or marine); dust includes ‘loess,’ defined as continental aeolian silt (4–62.5 μm). Dust is well-known from Earth's near-time (mostly Quaternary) record, and recognized as a high-fidelity archive of climate, but remains under-recognized for deep time. Attributes such as thickness, grain size, magnetism, pedogenesis, and provenance of dust form valuable indicators of paleoclimate to constrain models of atmospheric dustiness. Additionally, dust acts as an agent of climate change via both direct and indirect effects on radiative forcing, and on productivity, and thus the biosphere and carbon cycling. Dust from the late Paleozoic of western equatorial Pangea reflects ultimate derivation from orogens (ancestral Rocky Mountains, Central Pangean Mountains), whereas dust from southwestern Pangea (Bolivia) reflects both proximal volcanism and crustal material. Records of dust conducive to cyclostratigraphic analysis, such as data on dust inputs from carbonate sections, or magnetism in paleo-loess, reveal dust cyclicity at Milankovitch timescales, but resolution is compromised if records are too brief, or irregular in interval or magnitude of the attribute being measured. Climate modeling enables identification of the primary regions of dust sourcing in deep time, and impacts of dust on radiative balance and biogeochemistry. Deep-time modeling remains preliminary, but is achievable, and indicates principal dust sources in the Pangean subtropics, with sources increasing during colder climates. Carbon cycle modeling suggests that glacial-phase dust increases stimulated extreme productivity, potentially increasing algal activity and perturbing ecosystem compositions of the late Paleozoic.

ITN Energy Systems, Inc., (ITN) and Global Solar Energy, Inc., (GSE) have continued the advancement of copper indium gallium diselenide (CIGS) production technology through the development of a number of activities, including fault-tolerant control, in-situ sensors, and process improvements, with the goal of enabling uninterrupted continuous manufacturing of high quality CIGS materials that are very sensitive to processing conditions. In this paper real-time sensor fault detection and diagnosis strategies developed by ITN and GSE to enable fault-tolerant controllers for thin-film CIGS deposition process are presented. The results indicate that these strategies are very effective and they would play a major role in improving system reliability, thereby also improving yield, throughput, and efficiency. Sensing process reconfiguration methodologies that lead to fault-tolerant controllers also are briefly discussed.