The high cost of antimicrobials presents critical challenges for healthcare providers managing infections amidst the growing threat of antimicrobial resistance (AMR). High costs hinder access to necessary treatments, disproportionately affecting disadvantaged populations and exacerbating health disparities. High drug prices necessitate the use of less effective or more toxic alternatives, leading to suboptimal outcomes and prolonged hospitalizations. This, in turn, increases healthcare costs and undermines efforts to combat AMR. Equitable policies, national formularies, and cost caps for essential antimicrobials can ensure universal access to life-saving treatments and enable antimicrobial stewardship programs to ensure the best possible outcomes.

There is growing interest in lifestyle interventions as stand-alone and add-on therapies in mental health care due to their potential benefits for both physical and mental health outcomes. We evaluated lifestyle interventions focusing on physical activity, diet, and sleep in adults with severe mental illness (SMI) and the evidence for their effectiveness. To this end, we conducted a meta-review and searched major electronic databases for articles published prior to 09/2022 and updated our search in 03/2024. We identified 89 relevant systematic reviews and assessed their quality using the SIGN checklist. Based on the findings of our meta-review and on clinical expertise of the authors, we formulated seven recommendations. In brief, evidence supports the application of lifestyle interventions that combine behavioural change techniques, dietary modification, and physical activity to reduce weight and improve cardiovascular health parameters in adults with SMI. Furthermore, physical activity should be used as an adjunct treatment to improve mental health in adults with SMI, including psychotic symptoms and cognition in adults with schizophrenia or depressive symptoms in adults with major depression. To ameliorate sleep quality, cognitive behavioural informed interventions can be considered. Additionally, we provide an overview of key gaps in the current literature. Future studies should integrate both mental and physical health outcomes to reflect the multi-faceted benefits of lifestyle interventions. Moreover, our meta-review highlighted a relative dearth of evidence relating to interventions in adults with bipolar disorder and to nutritional and sleep interventions. Future research could help establish lifestyle interventions as a core component of mental health care.

The protection number of a vertex $v$ in a tree is the length of the shortest path from $v$ to any leaf contained in the maximal subtree where $v$ is the root. In this paper, we determine the distribution of the maximum protection number of a vertex in simply generated trees, thereby refining a recent result of Devroye, Goh, and Zhao. Two different cases can be observed: if the given family of trees allows vertices of outdegree $1$, then the maximum protection number is on average logarithmic in the tree size, with a discrete double-exponential limiting distribution. If no such vertices are allowed, the maximum protection number is doubly logarithmic in the tree size and concentrated on at most two values. These results are obtained by studying the singular behaviour of the generating functions of trees with bounded protection number. While a general distributional result by Prodinger and Wagner can be used in the first case, we prove a variant of that result in the second case.

Telerehabilitation and robotics, either traditional rigid or soft, have been extensively studied and used to improve hand functionality after a stroke. However, a limited number of devices combined these two technologies to such a level of maturity that was possible to use them at the patients’ home, unsupervised. Here we present a novel investigation that demonstrates the feasibility of a system that integrates a soft inflatable robotic glove, a cloud-connected software interface, and a telerehabilitation therapy. Ten chronic moderate-to-severe stroke survivors independently used the system at their home for 4 weeks, following a software-led therapy and being in touch with occupational therapists. Data from the therapy, including automatic assessments by the robot, were available to the occupational therapists in real-time, thanks to the cloud-connected capability of the system. The participants used the system intensively (about five times more movements per session than the standard care) for a total of more than 8 hr of therapy on average. We were able to observe improvements in standard clinical metrics (FMA +3.9 ± 4.0, p < .05, COPM-P + 2.5 ± 1.3, p < .05, COPM-S + 2.6 ± 1.9, p < .05, MAL-AOU +6.6 ± 6.5, p < .05) and range of motion (+88%) at the end of the intervention. Despite being small, these improvements sustained at follow-up, 2 weeks after the end of the therapy. These promising results pave the way toward further investigation for the deployment of combined soft robotic/telerehabilitive systems at-home for autonomous usage for stroke rehabilitation.

Mathematical models of polyelectrolyte gels are often simplified by assuming the gel is electrically neutral. The rationale behind this assumption is that the thickness of the electric double layer (EDL) at the free surface of the gel is small compared to the size of the gel. Hence, the thin-EDL limit is taken, in which the thickness of the EDL is set to zero. Despite the widespread use of the thin-EDL limit, the solutions in the EDL are rarely computed and shown to match to the solutions for the electrically neutral bulk. The aims of this paper are to study the structure of the EDL and establish the validity of the thin-EDL limit. The model for the gel accounts for phase separation, which gives rise to diffuse interfaces with a thickness described by the Kuhn length. We show that the solutions in the EDL can only be asymptotically matched to the solutions for an electrically neutral bulk, in general, when the Debye length is much smaller than the Kuhn length. If the Debye length is similar to or larger than the Kuhn length, then phase separation can be initiated in the EDL. This phase separation spreads into the bulk of the gel and gives rise to electrically charged layers with different degrees of swelling. Thus, the thin-EDL limit and the assumption of electroneutrality only generally apply when the Debye length is much smaller than the Kuhn length.

Objective: As health technology assessment (HTA) organizations in Canada and around the world seek to involve the public and patients in their activities, frameworks to guide decisions about whom to involve, through which mechanisms, and at what stages of the HTA process have been lacking. The aim of this study was to describe the development and outputs of a comprehensive framework for involving the public and patients in a government agency's HTA process.

Methods: The framework was informed by a synthesis of international practice and published literature, a dialogue with local, national and international stakeholders, and the deliberations of a government agency's public engagement subcommittee in Ontario, Canada.

Results: The practice and literature synthesis failed to identify a single, optimal approach to involving the public and patients in HTA. Choice of methods should be considered in the context of each HTA stage, goals for incorporating societal and/or patient perspectives into the process, and relevant societal and/or patient values at stake. The resulting framework is structured around four actionable elements: (i) guiding principles and goals for public and patient involvement (PPI) in HTA, (ii) the establishment of a common language to support PPI efforts, (iii) a flexible array of PPI approaches, and (iv) on-going evaluation of PPI to inform adjustments over time.

Conclusions: A public and patient involvement framework has been developed for implementation in a government agency’s HTA process. Core elements of this framework may apply to other organizations responsible for HTA and health system quality improvement.

In wild and domestic animals, gastrointestinal parasites can have significant impacts on host development, condition, health, reproduction and longevity. Improving our understanding of the causes and consequences of individual-level variation in parasite load is therefore of prime interest. Here we investigated the relationship between strongyle fecal egg count (FEC) and body condition in a unique, naturalized population of horses that has never been exposed to anthelmintic drugs (Sable Island, Nova Scotia, Canada). We first quantified variation in FEC and condition for 447 individuals according to intrinsic (sex, age, reproductive status, social status) and extrinsic (group size, location, local density) variables. We then quantified the repeatability of measurements obtained over a field season and tested for covariance between FEC and condition. FECs were high relative to other horse populations (mean eggs per gram ± SD = 1543·28 ± 209·94). FECs generally decreased with age, were higher in lactating vs non-lactating females, and unexpectedly lower in males in some part of the island. FECs and condition were both spatially structured, with patterns depending on age, sex and reproductive status. FECs and condition were both repeatable. Most notably, FECs and condition were negatively correlated, especially in adult females.

The polyphenol quercetin may prevent CVD due to its antihypertensive and vasorelaxant properties. We investigated the effects of quercetin after regular intake on blood pressure (BP) in overweight-to-obese patients with pre-hypertension and stage I hypertension. In addition, the potential mechanisms responsible for the hypothesised effect of quercetin on BP were explored. Subjects (n 70) were randomised to receive 162 mg/d quercetin from onion skin extract powder or placebo in a double-blinded, placebo-controlled cross-over trial with 6-week treatment periods separated by a 6-week washout period. Before and after the intervention, ambulatory blood pressure (ABP) and office BP were measured; urine and blood samples were collected; and endothelial function was measured by EndoPAT technology. In the total group, quercetin did not significantly affect 24 h ABP parameters and office BP. In the subgroup of hypertensives, quercetin decreased 24 h systolic BP by −3·6 mmHg (P=0·022) when compared with placebo (mean treatment difference, −3·9 mmHg; P=0·049). In addition, quercetin significantly decreased day-time and night-time systolic BP in hypertensives, but without a significant effect in inter-group comparison. In the total group and also in the subgroup of hypertensives, vasoactive biomarkers including endothelin-1, soluble endothelial-derived adhesion molecules, asymmetric dimethylarginine, angiotensin-converting enzyme activity, endothelial function, parameters of oxidation, inflammation, lipid and glucose metabolism were not affected by quercetin. In conclusion, supplementation with 162 mg/d quercetin from onion skin extract lowers ABP in patients with hypertension, suggesting a cardioprotective effect of quercetin. The mechanisms responsible for the BP-lowering effect remain unclear.

Amid its human and material tolls, the Vietnam War has given rise to a curious enterprise—the complex process of recovering and repatriating the remains of U.S. service members Missing In Action (MIA) and presumed dead. In this trade, the bones that “count” are American and the aims underwriting the forensic efforts to return them are rooted in an ideology of national belonging.The resultant exchange of both knowledge and physical remains has developed through two historically intertwined ventures: state-sponsored casualty resolution efforts; and the much smaller, informal trafficking of skeletal remains, identification media, and information about American MIAs. This article examines how these sought-after bones tack between roles as objects of recovery, sale, or barter, scientific study, ritual burial, and public commemoration. Through their mutable worth, MIA remains illustrate the dynamic symbolism of war dead that evokes differing sensibilities about familiar or foreign soil, about care and belonging. Like the reliquiae of medieval Christianity, remains of missing service members, even in the most fragmentary form, are replete with the suggestion of power. Their pursuit depends on reciprocity. Indeed, more than just powerful symbols, these bones manifest and confer power itself, as caring for war dead demonstrates authority, and such authority falls to those who control access to the desired object, whether through formal or informal channels. Furthermore, power requires authentication, and the remains of missing American war dead become, in this system of circulation and exchange, a means to demonstrate knowledge, perform certainty, or exploit ambiguity.