Complex Process Research Articles

Structure, Propagation of the 10–25-Day and 30–60-Day Intraseasonal Oscillations and Their Role in Triggering the South China Sea Summer Monsoon Onset

Abstract The onset of the South China Sea (SCS) summer monsoon (SCSSM) is a complex process that involves multiscale variabilities, including the 10–25-day high-frequency intraseasonal oscillation (HISO) and the 30–60-day low-frequency intraseasonal oscillation (LISO) along with the seasonal variation. Using the reanalysis and satellite data during the period of 1979–2020, this study comprehensively investigates how the HISO and LISO trigger the SCSSM onset, which improves the understanding of the abrupt SCSSM onset from the point of intraseasonal view. It is clearly documented that in most years, the abrupt SCSSM onsets are triggered by the first branch of HISO and/or LISO propagating into the northern SCS along their distinctive pathways. The HISOs (LISO) originating from the northwestern Pacific Ocean (tropical eastern Indian Ocean) propagates westward (northeastward) toward central-to-northern SCS. The diagnosis based on the moist static energy (MSE) budget reveals the different governing mechanisms of HISO and LISO propagations. HISO’s westward propagation is favored by the zonal advection of the anomalous MSE by the mean easterly wind. In contrast, the surface turbulent heating by sea surface temperature (SST) is the dominant term for LISO’s northward propagation, followed by the meridional advection of the anomalous MSE by the mean southerly wind. Significance Statement This study provides the comprehensive intraseasonal view of the SCSSM onset, where the respective roles of 10–20-day HISO and 30–60-day LISO in triggering the SCSSM onset are identified and their propagating mechanisms are revealed. The prevailing easterlies in the northwestern Pacific and SST-induced turbulent heat flux in SCS are confirmed as the respective dominant processes governing their distinct propagations. These results improve the understanding of the SCSSM onset and hence have significant implication to the monitoring, simulation, and prediction of SCSSM.

RNA granules in flux: dynamics to balance physiology and pathology.

The life cycle of an mRNA is a complex process that is tightly regulated by interactions between the mRNA and RNA-binding proteins, forming molecular machines known as RNA granules. Various types of these membrane-less organelles form inside cells, including neurons, and contributecritically to various physiological processes. RNA granules are constantly in flux, change dynamically and adapt to their local environment, depending on their intracellular localization. The discovery that RNA condensates can form by liquid-liquid phase separation expanded our understanding of how compartments may be generated in the cell. Since then, a plethora of new functions have been proposed for distinct condensates in cells that await their validation in vivo. The finding that dysregulation of RNA granules (for example, stress granules) islikely toaffect neurodevelopmental and neurodegenerative diseases further boosted interest in this topic. RNA granules have various physiological functions in neurons and in the brain that we would like to focus on. We outline examples of state-of-the-art experiments including timelapse microscopy in neurons to unravel the precise functions of various types ofRNA granule. Finally, we distinguish physiologically occurring RNA condensation from aberrant aggregation, induced by artificial RNA overexpression, and present visual examples to discriminate both forms in neurons.

Spotting the unthinkable. Tips for detecting incest

Identifying the signs that an infant, child or adolescent is a victim of incest is a complex process. Contradictory psychic mechanisms can interfere with the professional's position: how to think about the unspeakable and the unthinkable in a confused and confusing context? Faced with this sensitive issue, it's important to offer some food for thought on how to tackle it. Children speak to us, with words but above all with their bodies. It's up to us to listen carefully.

Active and Passive Infrared Emittance Tuning Using Optically Transparent Unpatterned ITO Thin Films

Tailoring of thermal emittance has applications in smart radiators, camouflage, infrared (IR) scene generation, stealth, and thermal management. Various studies have explored avenues to achieve both passive and active emittance tuning using methods such as meta-surfaces, phase change materials, composites, nanostructure arrays and multi-layer stacks. Most of these methods often involve complex fabrication processes like multilayer depositions and micro/nano patterning, limiting their scalability for large-scale applications. This study presents a straightforward and scalable approach for passive and active emittance tuning using Indium Tin Oxide (ITO) films deposited on a high emissivity flexible polyethylene terephthalate (PET) substrate. By changing the deposition time, the thickness of the ITO film is controlled which changes the observed emissivity of the ITO/PET composite structure over a wide range (0.2-0.94) while maintaining optical transparency. Using this approach for passive emittance tuning, we demonstrate an IR scene generation application. As the ITO film is conducting, by applying voltage to the ITO/PET sheet, its temperature is changed using which active emittance tuning is also achieved. Compared to existing methods of emittance tuning, the presented approach is simpler, gives flexible films with optical transparency, and has the potential for large-scale integration, enabling cost-effective and scalable manufacturing of emittance-tuned surfaces.

Preparation of magnesium potassium phosphate cement from magnesite tailings under lower calcination temperature

The identification of a more economical source of magnesium, coupled with reduced preparation costs, is essential for enhancing the competitiveness of magnesium potassium phosphate cement (MKPC) production. This study explores the utilization of magnesite tailings, waste materials produced during the mining and ore dressing process of magnesite, as raw materials for the preparation of low-cost dead-burnt magnesium oxide (MgO-T) at comparatively low calcination temperatures. The research demonstrated that impurities, specifically silicon and calcium, formed compounds with MgO during calcination, leading to the encapsulation of certain MgO particles. This encapsulation reduced both the specific surface area and hydration activity of the MgO. Despite the calcination temperature of 1100 °C being significantly lower than that of commercial dead-burnt MgO (MgO-C) at 1700 °C, MgO-T exhibited lower activity compared to MgO-C, which rendered it more suitable for the production of MKPC. Under optimal conditions, characterized by a molar ratio of magnesium to phosphorus (M/P) of 3, a borax retarder content of 15%, and a water-cement ratio of 0.15, the MKPC prepared using MgO-T demonstrated an initial setting time exceeding 60min and achieved a compressive strength of up to 79.6MPa. XRD and microstructural analyses revealed that struvite-K was the primary strength phase; however, the porosity of the specimens had a more pronounced effect on strength. By producing lower activity MgO at reduced calcination temperatures, this method obviates the need for complex purification processes when utilizing magnesite tailings, thereby decreasing the costs associated with MKPC preparation and presenting promising applications for the future.

Electro-capacitive cancer therapy using wearable electric field detector: a review

Electro-capacitive cancer therapy (ECCT), a less invasive and more targeted approach using wearable electric field detectors, is revolutionizing cancer therapy, a complex process involving traditional methods like surgery, chemotherapy, and radiation. The review aims to investigate the safety and efficacy of electric field exposure in vital organs, particularly in cancer therapy, to improve medical advancements. It will investigate the impact on cytokines and insulation integrity, as well as contribute to improving diagnostic techniques and safety measures in medical and engineering fields. Wearable electric field detectors have revolutionized cancer therapy by offering a non-invasive and personalized approach to treatment. These devices, such as smart caps or patches, measure changes in electric fields by detecting capacitance alterations. Their lightweight, comfortable, and easy to-wear nature allows for real-time monitoring, providing valuable data for personalized treatment plans. The portability of wearable detectors allows for long-term surveillance outside clinical settings, increasing therapy efficacy. The ability to collect data over extended periods provides a comprehensive view of electric field dynamics, aiding researchers in understanding tumor growth and progression. Technology advancements in electro-capacitive therapy, including wearable devices, have revolutionized cancer treatment by adjusting electric field intensity in real-time, enhancing personalized medicine, and improving treatment outcomes and patient quality of life.

A research paper on software design patterns

This article affords another exhaustive examination of software design patterns, discussing their importance, the classification system, and the influence on software architecture and design. It looks at how existing practices handle predictable problems, make things more easily serviceable, and increase developer collaboration. The article goes further and explains the use of design patterns and elaborates on real-life examples of design patterns and the difficulties and drawbacks of using them. Further, it expands on future possibilities, such as applying design patterns for cloud-new architectures, AI incorporation, serverless, and Agile/DevOps. From these trends, the article lays down the argument that design patterns are not insulated from change but are continually being adapted to fit into the software development processes of today's complex and sophisticated world and that to be relevant in the designing of today's complex, large and intelligent software-based systems, developers should be familiar with both the recognized and emergent design patterns.

Comparative analysis of human and mouse transcriptomes during skin wound healing

Skin wound healing is a complex process which involves multiple molecular events and the underlying mechanism is not fully understood. We presented a comparative transcriptomic analysis of skin wound healing in humans and mice to identify shared molecular mechanisms across species. We analyzed transcriptomes from three distinct stages of the healing process and constructed protein-protein interaction networks to elucidate commonalities in the healing process. A substantial number of differentially expressed genes (DEGs) were identified in human transcriptomes, particularly upregulated genes before and after wound injury, and enriched in processes related to extracellular matrix organization and leukocyte migration. Similarly, the mouse transcriptome revealed thousands of DEGs, with shared biological processes and enriched KEGG pathways, highlighting a conserved molecular signature in skin wound healing. A total of 21 common DEGs were found across human comparisons, and 591 in mouse comparisons, with four genes (KRT2, MARCKSL1, MMP1, and TNC) consistently differentially expressed in both species, suggesting critical roles in mammalian skin wound healing. The expression trends of these genes were consistent, indicating their potential as therapeutic targets. The molecular network analysis identified five subnetworks associated with collagen synthesis, immunity, cell-cell adhesion, and extracellular matrix, with hub genes such as COL4A1, TLR7, TJP3, MMP13, and HIF1A exhibited significant expression changes before and after wound injury in humans and mice. In conclusion, our study provided a detailed molecular network for understanding the healing process in humans and mice, revealing conserved mechanisms that could help the development of targeted therapies across species.

Newcard telemonitoring system improves survival in comparison both with traditional approaches and other French telemonitoring systems in chronic heart failure

Abstract Background in the NEWTS3 Study, the French National Health Data System (SNDS) was used to comprehensively collect medico economic data for patients between 2017 and 2020. We have shown a decrease in all-cause mortality with the Newcard telemonitoring system (NewTM) in comparison with traditional approaches in Chronic Heart Failure (CHF). This effect seemed to be greater in the group of patients included in the specific year 2020 Purpose The aim of the NEWTS3EXT study is on one hand to confirm those results by adding 2021 and 2022 data to the follow up of the 2020 population. On the other hand, a new evaluation was performed for NewTM patients matched with patients followed by other telemonitoring French systems (TLM). Methods All NewTM patients monitored at least 3 months between 2017 and 2020 were included. For each patient, anonymised data was retrieved from the SNDS. Control Group (CG) was randomly selected from an exhaustive extraction of SNDS of patients with CHF without telemonitoring. This CG was matched in a 1:3 ratio to NewTM patients using a propensity score including baseline characteristics, presence of comorbidities and presence of significative treatments. TLM group was randomly selected from an extraction of SNDS of patients with CHF including a reimbursement of telemonitoring but not followed by Newcard. This TLM group was matched in a 1:1 ratio to NewTM patients using the same propensity score. Binomial negative GEE models were used on matched data sets to assess differences. Results 53.97 % of the patients were included during the 2020 year (571 patients). During 2020, the COVID first year, the prognosis of patients with HF is known as more positive. Despite that, we show a consistent gain in survival rates for the NewTM group (OR 0.707 p=0.0025) (fig 1) For the second arm of the study, 919 NewTM patients were matched to 919 TLM patients. We show also an increase statically significative in survival rates in the NewTM group versus TLM group at 48 months (OR 0.832 p=0.0394) (fig 2) Conclusion In this part of the NEWTS3 program, we confirm the effect on all-cause mortality of the Newcard telemonitoring system in comparison with a control group even on the specific 2020 population which is known to have a better prognostic. On the other hand, it is one of the first comparison between one specific solution and a group of others. Explaining the positive result on all-cause mortality for the NewTM must be a mix of plenty of specificities especially in a complex process like telemonitoring of HF. To help to find the best place for telemonitoring in the care pathway of HF, we can emphasize on the high level of adherence of the NewTM patients (data collected every 1.4 days) and on the precise process to ensure that every alert is followed by a medical response.

Common misconceptions of speciation

Abstract Speciation is a complex process that can unfold in many different ways. Speciation researchers sometimes simplify core principles in their writing in a way that implies misconceptions about the speciation process. While we think that these misconceptions are usually inadvertently implied (and not actively believed) by the researchers, they nonetheless risk warping how external readers understand speciation. Here we highlight six misconceptions of speciation that are especially widespread. First, species implied to be clearly and consistently defined entities in nature, whereas in reality species boundaries are often fuzzy and semi-permeable. Second, speciation is often implied to be ‘good’, which is two-fold problematic because it implies both that evolution has a goal and that speciation universally increases the chances of lineage persistence. Third, species-poor clades with species-rich sister clades are considered ‘primitive’ or ‘basal’, falsely implying a ladder of progress. Fourth, the evolution of species is assumed to be strictly tree-like, but genomic findings show widespread hybridisation more consistent with network-like evolution. Fifth, a lack of association between a trait and elevated speciation rates in macroevolutionary studies is often interpreted as evidence against its relevance in speciation — even if microevolutionary case studies show that it is relevant. Sixth, obvious trait differences between species are sometimes too readily assumed to be i) barriers to reproduction, ii) a stepping-stone to inevitable speciation, or iii) reflective of the species’ whole divergence history. In conclusion, we call for caution, particularly when communicating science, because miscommunication of these ideas provides fertile ground for misconceptions to spread.

Subendocardial ischemic-like state in patients with severe aortic stenosis: insights from myocardial histopathology and ultrastructure

Abstract Background myocardial adaptation to severe aortic stenosis (AS) is a complex process that involves myocardial fibrosis (MF) beyond cardiomyocyte hypertrophy. Perfusion impairment is believed to be involved in myocardial remodeling in chronic pressure overload. Aim to describe morphological and ultrastructural myocardial changes at EMB, possibly reflecting subendocardial ischemia, in a group of patients with severe AS referred to surgical aortic valve replacement (AVR), with no previous history of ischemic cardiomyopathy. Methods one-hundred-fifty-eight patients (73 [68-77] years, 50% women) referred for surgical AVR because of severe symptomatic AS with pre-operative clinical and imaging study and no previous history of ischemic cardiomyopathy. Intra-operative septal EMB was obtained in 129 patients. Tissue sections were stained with Masson ́s Trichrome for MF quantification and periodic acid-Schiff (PAS) staining was performed to assess the presence of intracellular glycogen. Ultrastructure was analyzed through Transmission electron microscopy (TEM). Results MF totalized a median fraction of 11.90% [6.54-19.97%] of EMB, with highly prevalent perivascular involvement (95.3%). None of the samples had histological evidence of myocardial infarction. In 58 patients (45%) we found subendocardial groups of cardiomyocytes with cytoplasmatic enlargement, vacuolization and myofiber derangement, surrounded by extensive interstitial fibrosis. These cardiomyocytes were PAS positive, PAS-diastase resistant and Alcian Blue/PAS indicative of the presence of neutral intracellular glyco-saccharides. At TEM there were signs of cardiomyocyte degeneration with sarcomere disorganization and reduction, organelle rarefaction but no signs of intracellular specific accumulation. Conclusion almost half of the patients with severe AS referred for surgical AVR have histological and ultrastructural signs of subendocardial cardiomyocyte ischemic insult. It might be inferred that local perfusion imbalance contributes to myocardial remodeling and fibrosis in chronic pressure overload.

Vibration Thresholds Using Conventional Audiometry are Clinically Useful Indicators of Postural Instability in Older Adults.

Falls are a major health concern with potentially dramatic consequences for people over 65 years of age. One crucial determinant in the risk of falls in older adults is postural control, a complex process that requires the contribution of different sensory modalities, namely visual, vestibular, auditory, and somatosensory. While there are well-established methods to screen for age-related vision, hearing, tactile, and vestibular impairments, there are very few widely available methods to screen for somatosensory function, but studies indicate that ankle audiometry (vibration thresholds) using a common B-71 bone vibrator can serve that purpose. To date, unfortunately, this technique has received little attention as a tool to measure postural instability in older adults. The objective of the present study was to examine postural control in older adults with and without degradation of the somatosensory functions, as determined with ankle audiometry. This was standard group comparison. In total, 36 healthy elderly aged between 65 and 80 years old were divided into two groups (low vibration threshold [n = 18] and high vibration threshold [n = 18]). Standard audiometry, video head impulse test, vibration thresholds (big toe, ankle, and tibia), and static postural control task using a force platform were performed. Greater postural instability in participants with higher (worse) vibration thresholds as compared with participants with lower (better) vibration thresholds was observed even though both groups were comparable on hearing threshold and vestibular function. The results indicate that performing a simple vibration threshold evaluation, using a clinically available B-71 with a cut-off value of 42 dB hearing loss, could be an effective, fast, and easy-to-use procedure for detecting people at risk of falls.

RGS5 balances macrophage vs vascular smooth muscle cell origin of foam cells in apoE-deficient plaques

Abstract Background G Protein Coupled Receptors and regulators of G-protein signalling (RGS), play a pivotal role in the signalling processes associated with atherosclerosis [1]. RGS5 is highly expressed in aortic tissue [2]. Development of atherosclerotic plaque is a complex process that involves foam cells originating from macrophages (Mϕ) and/or vascular smooth muscle cells (VSMCs). Differentiation of Mϕ and VSMC into various intermediary cells of varying inflammatory potency affects atherosclerotic plaque composition and vulnerability [3]. We hypothesize that RGS5 is involved in signalling of foam cell transition and thus, plaque biology. Purpose To evaluate the role of RGS5 on atherosclerotic plaque complexity and shifts of foam cell origin. Methods ApoE-/-RGS5+/+ and ApoE-/-RGS5-/- mice were fed a high fat Western Diet for 14 weeks. Cryosections bearing aortic valve cusps were used for staining. Lesion size was quantified on hematoxylin and eosin staining. Plaque composition was assessed by CD68, CD45, Oil red O and collagen staining. Triple staining was performed for CD45, CD68 and aSMA. Double immunofluorescent staining for CD45 and pro- and anti-inflammatory markers was carried out. Co-Localisation was analysed by Zeiss Zen. Data were analysed using Mann-Whitney-U test. Results Lesion size was significantly reduced in RGS5-deficient mice in comparison to control (in mm2: 0.398±0.02 vs 0.191±0.09, p=0.0001, n=15). Relative areas positive for Oil Red O and collagen did not differ between genotypes. Area positive for leukocyte marker CD45 increased significantly by 30.8% (p<0.0001, n=15), whereas area positive for CD68 was reduced by 10.3% (p=0.0292, n=15) in RGS5-deficient mice. Absence of RGS5 decreased co-localization of Mϕ-derived foam cells by 23% (p=0.03734, n=4-5) while leading to an 5.8% increase in aSMA-derived foam cells compared to control. Area positive for pro-inflammatory M1 Mϕ marker CD86 and iNOS increased by 36.3% and 36.8% after RGS5 knock-out (p<0.0001, n=15). No difference in M2 Mϕ positive area was observed when RGS5 was lacking. Conclusion RGS5 promotes plaque formation. The number of Mϕ-derived foam cells is increased by RGS5, while it reduces inflammatory M1 Mϕ. Interestingly, there were no differences in numbers of M2 Mϕ, indicating RGS5 inhibits VSMCs transition to M1 Mϕ resulting in an overall decrease of CD68-positive foam cells. Further study is required to determine molecular signalling of RGS5 that modulates the phenotype of Mϕ- and VSMC-derived cells. RGS5 could be useful as therapeutic target to suppress undesirable plaque phenotypes and to reduce acute cardiovascular events.

The role of governance in shaping health system reform: a case study of the design and implementation of new health regions in Ireland, 2018–2023

Abstract Background This study focuses on the development of new regional health structures in Ireland in the period 2018-2023, one part of a broader health system reform programme aimed at greater universalism, in order to scrutinise how aspects of governance impact on the reform process, from policy design through to implementation. Methods This qualitative, multi-method study draws on document analysis of official documents relevant to the reform process, as well as twelve semi-structured interviews with key informants from across the health sector. Interviews were analysed according to thematic analysis methodology. Conceiving governance as comprising five domains (Transparency, Accountability, Participation, Integrity, Capacity) the research uses the TAPIC framework for health governance as a conceptual starting point and as initial, deductive analytic categories for data analysis. Results The analysis reveals important lessons for policymakers across the five TAPIC domains of governance. These include deficiencies in accountability arrangements, poor transparency within the system and vis-à-vis external stakeholders and the public, and periods during which a lack of clarity in terms of roles and responsibilities for various process and key decisions related to the reform were identified. Inadequate resourcing of implementation capacity, competing policy visions and changing decision-making arrangements, among others, were found to have originated in and continuously reproduced a lack of trust between key institutional actors. Conclusions Large scale health system reform is a complex process and its governance presents distinct challenges and opportunities for stakeholders. To understand and be able to address these, and to move beyond formulaic prescriptions, critical analysis of the historical context surrounding the policy reform and the institutional relationships at its core are needed

Governance and health system reform: a case study of new health regions in Ireland, 2018-2023

Abstract Background While the significance of good governance is recognised within health systems research, its role in health system reform is underexplored. This research focuses on the establishment of new decentralised regional health structures in Ireland in the period 2018-2023, examining how aspects of governance impacted the decentralisation reform process, from policy design through to implementation. Methods The research applied a qualitative, multi-method approach involving analysis of official documents relevant to the regional decentralisation process, and 12 semi-structured interviews with key informants from across the health sector. The research applies the TAPIC framework for health governance as its analytic framework and the data is analysed using thematic analysis. Results Deficiencies in accountability arrangements, poor transparency within the system and vis-à-vis external stakeholders, and a lack of clarity of roles and responsibilities for various process and key decisions related to the reform were identified as undermining progress at various stages of Ireland’s decentralisation reform process. An underlying distrust between key institutional actors was identified. These findings are grounded in complex social, cultural, and political and institutional developments in Ireland’s history. Also of note is the interwovenness of the five TAPIC domains and the importance of engaging with the complexity and relationality intrinsic to health system reform processes to achieve the aim(s) of the reform in question. Conclusions Large scale health system reform is a complex process and its governance presents distinct challenges and opportunities for stakeholders. To understand and address these, critical analysis of the historical context surrounding the policy reform and the institutional relationships at its core are needed. Key messages • Governance plays a crucial if overlooked role in health systems reform. Effective governance arrangements are central to the successful design and implementation of reform initiatives. • Ensuring a strong link between policy design and implementation processes is crucial to the success of health systems reform.

Applying a Planetary Health approach in the European urban context: Lessons from Preparing Traditional Lasagna

Abstract Lasagna is a quintessential Italian dish, renowned worldwide. The most traditional version is “alla Bolognese”, which requires a complex preparation process involving careful attention to mixing ingredients and layering to achieve the final delicious result. The images depicting the preparation steps of this typical Italian dish will be used to inspire participants to creatively reflect on how to implement a transdisciplinary approach to address a planetary health issue, such as heatwaves, in a European urban context. The presentation will be structured as follows: 1. Identification of current problems; 2. Stakeholder analysis; 3. Possible solutions; 4. Barriers and limitations. The first phase will focus on selecting quality ingredients, analogous to analyzing the urban map of the city, the presence of green areas, identifying vulnerable residents, mapping transportation, etc. The second phase will identify all relevant stakeholders to be involved in creating transdisciplinary solutions for the city, paralleling the proper mixing of lasagna ingredients. The third phase will propose various solutions to be applied, taking into account the inputs and viewpoints of the involved stakeholders, showcasing best practices already adopted, and comparing them to different variations of lasagna alla Bolognese. The final phase will present barriers and limitations to implementing such an approach in a European urban context (e.g., costs, historical monuments, lack of stakeholder collaboration), drawing parallels to challenges in preparing lasagna, such as ingredient unavailability, oven issues, or overcooking. Through this original modality, participants will learn about the process of implementing a planetary health approach to one of the major climate change issues affecting the European landscape.

Transactivation of the EGF receptor as a novel desensitization mechanism for G protein-coupled receptors, illustrated by dopamine D2-like and β2 adrenergic receptors

Transactivation of epidermal growth factor receptors (EGFR) provides intricate control over multiple regulatory cellular processes that merge the diversity of G protein-coupled receptors (GPCRs) with the robust signaling capacities of receptor tyrosine kinases. Contrary to the typical assertions, our findings demonstrate that EGFR transactivation contributes to the desensitization of GPCRs. Repeated agonist stimulation of certain GPCRs enhanced EGFR transactivation, triggering a series of cellular events associated with GPCR desensitization. This effect was observed in receptors undergoing desensitization (D3R, K149C-D2R, β2AR) but not in those resistant to desensitization (D2R, C147K-D3R, D4R, β2AR mutants lacking GRK2 or GRK6 phosphorylation sites). The EGFR inhibitor AG1478 prevented both desensitization and the associated cellular events. Similarly, these cellular events were also observed when cells were treated with EGF, but only in GPCRs that undergo desensitization. These findings suggest that EGFR transactivation diversifies pathways involved in ERK activation through the EGFR signaling system and also mediates GPCR desensitization. Alongside the widely accepted steric hindrance model, these findings offer new insights into understanding the mechanisms of GPCR desensitization, which occurs through complex cellular processes.

Exploring Type 2 Diabetes Self-Management Practices Among African Americans in Rural Counties: A Qualitative Study.

The purpose of the study was to understand diabetes self-management practices among African American individuals living with type 2 diabetes (T2D) in rural communities. This qualitative descriptive study, undergirded by the theory of integration, purposively sampled African Americans (N = 34) diagnosed with T2D living in rural communities. Thematic analysis employed both a priori and inductive coding to identify salient themes. Participants' mean age was 65.9 (SD 12.3) years, with an average T2D diagnosis duration of 14 (SE 11.2) years. Two major themes emerged: deciphering the cues and body sensing, which the participants used to monitor their glucose level using a personalized feedback loop. Those with longer diabetes duration demonstrated an ability to recognize hypoglycemic or hyperglycemic symptoms (deciphering the cues), informing their decision-making and self-management strategies (body sensing). The decision-making involved in glycemic level management emerges as a complex developmental process influenced by disease trajectory and cultural and environmental factors. These findings may inform a conceptual framework to guide future inquiries and provide insights for primary care clinicians and diabetes educators to better understand the complexities of T2D management among African American individuals in rural settings.

Co-planning as a public health tool: the Milan Health Protection Agencies’s Local Gambling Plan

Abstract Issue/problem Gambling represents a public health, social, and economic problem. Lombardy Region, according with national and regional law, has approved the Regional Plan for the prevention and contrast of Pathological Gambling. The Health Protection Agencies (HPA) of the Metropolitan City of Milan, as the other HPAs, implemented the Local Gambling Plan, based on a context analysis and in synergy with all the actors involved. Description of the problem Since 2019, the Milan HPA’s Local Gambling Plan has been implemented through collaboration with non-profit entities (TSEs), which are involved via public tendering. The implementation of the new Italian ‘Code of the Third Sector’ changed the TSEs engagement modalities. For this reason, a complex co-planning process has been initiated in order to increase the level of active citizenship and to enhance public health, in line with horizontal subsidiarity principle. Results The Co-planning procedure promoted the integration among local health services, non-profit entities and municipalities with the aim of gambling prevention and contrast, ensuring the continuity of prevention programs and the involvement of local stakeholders in addressing a public health issue. During the co-planning, 9 working groups were established to define objectives, project actions, monitoring and evaluation methods, ensuring the common interest of all actors involved. Lessons For the health and social system, the co-planning procedure becomes an opportunity to translate what is foreseen by the regulations into local actions. It allow the active participation of local stakeholders involved into the co-construction and achievement of public health objectives and the promotion of communities’ empowerment. Key messages • Co-planning is both a process and a tool for local welfare. • Co-planning involved multiple actors, among which the public institution that ensures satisfaction of health needs through governance actions.

The changing association between pandemic-related stressors and child and adolescent mental health during the waning phase of the COVID-19 pandemic

This study examined the relation between pandemic-related stressors and mental health among young people (YP) in India during two time points in the waning phase of the pandemic. We use data from two cross-sectional waves of over 20,000 YP aged 5–19 in February 2022, during the peak of the Omicron wave, and October 2022, during a reduction in infections and easing of restrictions. COVID illness/death in the family’s social network, current lockdown stringency, and significant change in household income were examined in relation to adult respondents’ reports of YP internalizing symptoms. Internalizing symptoms declined slightly from February to October 2022. COVID-19 illness/death in the family’s network was generally associated with more internalizing symptoms. Higher lockdown stringency was associated with lower levels of internalizing symptoms. YP in households with increases in income tended to have more internalizing symptoms. Many associations were driven by older adolescents and were stronger during the earlier (Feb-2022) than later (Oct-2022) data collection time-points. The findings illustrate the importance of anchoring results within a study’s specific geographic context, including concurrent events during the study period. Importantly, findings that may initially seem counterintuitive ultimately illuminate the dynamic and complex processes underlying child and adolescent mental health.