Low Level Research Articles

Strong isolation by distance and evidence of population microstructure reflect ongoing Plasmodium falciparum transmission in Zanzibar.

The Zanzibar archipelago of Tanzania has become a low-transmission area for Plasmodium falciparum. Despite being considered an area of pre-elimination for years, achieving elimination has been difficult, likely due to a combination of imported infections from mainland Tanzania and continued local transmission. To shed light on these sources of transmission, we applied highly multiplexed genotyping utilizing molecular inversion probes to characterize the genetic relatedness of 282 P. falciparum isolates collected across Zanzibar and in Bagamoyo district on the coastal mainland from 2016 to 2018. Overall, parasite populations on the coastal mainland and Zanzibar archipelago remain highly related. However, parasite isolates from Zanzibar exhibit population microstructure due to the rapid decay of parasite relatedness over very short distances. This, along with highly related pairs within shehias, suggests ongoing low-level local transmission. We also identified highly related parasites across shehias that reflect human mobility on the main island of Unguja and identified a cluster of highly related parasites, suggestive of an outbreak, in the Micheweni district on Pemba island. Parasites in asymptomatic infections demonstrated higher complexity of infection than those in symptomatic infections, but have similar core genomes. Our data support importation as a main source of genetic diversity and contribution to the parasite population in Zanzibar, but they also show local outbreak clusters where targeted interventions are essential to block local transmission. These results highlight the need for preventive measures against imported malaria and enhanced control measures in areas that remain receptive to malaria reemergence due to susceptible hosts and competent vectors. This research was funded by the National Institutes of Health, grants R01AI121558, R01AI137395, R01AI155730, F30AI143172, and K24AI134990. Funding was also contributed from the Swedish Research Council, Erling-Persson Family Foundation, and the Yang Fund. RV acknowledges funding from the MRC Centre for Global Infectious Disease Analysis (reference MR/R015600/1), jointly funded by the UK Medical Research Council (MRC) and the UK Foreign, Commonwealth & Development Office (FCDO), under the MRC/FCDO Concordat agreement and is also part of the EDCTP2 program supported by the European Union. RV also acknowledges funding by Community Jameel.

Cross-Sectional and Longitudinal Association of Clinical and Neurocognitive Factors With Apathy in Patients With Parkinson Disease.

A robust understanding of the natural history of apathy in Parkinson disease (PD) is foundational for developing effective clinical management tools. However, large longitudinal studies are lacking while the literature is inconsistent about even cross-sectional associations. We aimed to determine the longitudinal predictors of apathy development in a large cohort of people with PD and its cross-sectional associations and trajectories over time, using sophisticated Bayesian modeling techniques. People with PD followed up in the longitudinal New Zealand Parkinson's progression project were included. Apathy was defined using the neuropsychiatric inventory subscale ≥4, and analyses were also repeated using a less stringent cutoff of ≥1. Both MoCA and comprehensive neuropsychological testing were used as appropriate to the model. Depression was assessed using the hospital anxiety and depression scale. Cross-sectional Bayesian regressions were conducted, and a multistate predictive model was used to identify factors that predict the initial onset of apathy in nonapathetic PD, while also accounting for the competing risk of death. The relationship between apathy presence and mortality was also investigated. Three hundred forty-six people with PD followed up for up to 14 years across a total of 1,392 sessions were included. Apathy occurrence did not vary significantly across the disease course (disease duration odds ratio [OR] = 0.55, [95% CI 0.28-1.12], affecting approximately 11% or 22% of people at any time depending on the NPI cutoff used. Its presence was associated with a significantly higher risk of death after controlling for all other factors (hazard ratio [HR] = 2.92 [1.50-5.66]). Lower cognition, higher depression levels, and greater motor severity predicted apathy development in those without motivational deficits (HR [cognition] = 0.66 [0.48-0.90], HR [depression] = 1.45 [1.04-2.02], HR [motor severity] = 1.37 [1.01-1.86]). Cognition and depression were also associated with apathy cross-sectionally, along with male sex and possibly lower dopaminergic therapy level, but apathy still occurred across the full spectrum of each variable (OR [cognition] = 0.58 [0.44-0.76], OR [depression] = 1.43 [1.04-1.97], OR [female sex] = 0.45 [0.22-0.92], and OR [levodopa equivalent dose] = 0.78 [0.59-1.04]. Apathy occurs across the PD time course and is associated with higher mortality. Depressive symptoms and cognitive impairment in particular predict its future development in those with normal motivation.

Relationship Between Mental Health Stigma, Perceived Discrimination, and Social Support: Focusing on Racial Groups and COVID-19

ABSTRACT An investigation was conducted into the relationship between stigma, perceived discrimination, and social support among college students. First, levels of these variables were assessed across different racial groups and compared for differences before and after the COVID-19 pandemic. Employing Multivariate Analysis of Variance (MANOVA), we examined racial disparities in these variables and identified variations in the levels of self-stigma, public stigma, perceived discrimination, and social support among diverse racial groups. Notably, Asian/Asian American college students reported a higher level of public stigma compared to their African American/Black, White, and Hispanic/Latinx peers. In addition, our findings indicated that college students exhibited a lower level of self-stigma and a higher level of perceived discrimination following the onset of the pandemic. No interaction effect was observed. We also discussed the implications of these findings for college counseling professionals and administrators.

Neighborhood factors associated with late effects among survivors of adolescent and young adult cancer.

The purpose of this study is to evaluate the associations between neighborhood income, education, and neighborhood racial composition (measured as a low percentage of white residents) and risk of developing cardiovascular diseases (CVD), diabetes (DM), and severe depression among survivors of AYA cancer and matched non-cancer peers. Two-year survivors of AYA cancers diagnosed at age 15-39 yrs at Kaiser Permanente Southern California (diagnosed 2000-2012) and individually matched (1:13) non-cancer subjects were included. The development of CVD, DM, and severe depression was ascertained via electronic health records. Neighborhood characteristics were obtained from census-based geocoded data. Cox regression evaluated associations between neighborhood characteristics and the health outcomes of interest among both the cancer survivors and the non-cancer comparison cohort and effect modification by cancer survivor status on these relationships. Among cancer survivors (n = 6774), living in mostly non-white neighborhoods, was associated with risk of CVD (hazard ratio (HR) = 1.54 (95% CI 1.00-2.36)), while lower education level (HR = 1.41 (95% CI 1.02-1.94)) was associated with risk of severe depression. None of the neighborhood characteristics were associated with risk of DM. Effect modification was found for neighborhood education and risk of DM and severe depression. When jointly considered, cancer survivors who resided in the most disadvantaged neighborhoods were at the highest risk of developing these health outcomes compared to other subgroups. Our findings may inform screening strategy and addressing social determinants of health among AYA cancer survivors.

Artificial intelligence utilization in the healthcare setting: perceptions of the public in the UAE

ABSTRACT Understanding the use of AI in healthcare is essential for the successful implementation of AI-driven healthcare solutions. The aim of this study was to evaluate public perception of AI utilization in healthcare settings. A validated questionnaire assessed general perceptions towards AI utilization, the use of AI by physician , and the use of AI by pharmacists . The study included 770 participants. The median perception score indicated an unfavorable attitude. Participants who had lower education level and those with no employment had a significantly lower perception scores than their counterpart. Participants who reported low income and those who visited the pharmacy five to ten times on average had a higher perception than their counterparts did. The reported negative perception necessitates the implementation of education campaigns to improve AI literacy and dispel any misconceptions and concerns, particularly among individuals with low education, high income, unemployment, and frequent pharmacy visits.

Disability Training and Programme Conduciveness in Counselor Education: A Preliminary Assessment

ABSTRACT Counselors from all speciality areas should be prepared to serve people with disabilities (PWDs). Thus, we examined how counselling students in CACREP accredited programmes evaluate their disability training and their programmes’ disability conduciveness, and how it differs by speciality area. Effects of discrimination, ableism, power, privilege, and oppression on the life of PWDs, disability multicultural counselling competencies, and environmental, attitudinal, and individual barriers for PWDs were the training areas with highest three mean scores, indicating greater student satisfaction. Specific skills for leading a group consists of PWDs, sexual and reproductive concerns of PWDs, and parenting by parents with disabilities had the lowest three mean scores, indicating lower level of satisfaction. Results highlighted the inadequacy in disability training for clinical mental health and school counselling programmes. For disability conduciveness, almost one-fourth of the participants reported their programmes not meeting any of the criteria.

Modulation of Mouse Dendritic Cells In Vitro by Lactobacillus gasseri Postbiotic Proteins.

Different lactobacilli are probiotics for their beneficial effects that confer to the host. Recently, some of these effects were associated with released metabolic products/constituents (postbiotics). In the present study, the potential immunomodulatory capacity of the probiotic Lactobacillus gasseri OLL2809 cell-free supernatant (sup) was investigated in murine bone marrow-derived dendritic cells (DCs). Bacteria induced significantly higher expression of all examined cytokines than those induced by the stimulatory lipopolysaccharide (LPS) itself. On the contrary, sup only induced the anti-inflammatory IL-10 similarly to LPS, whereas IL-12 and IL-6 secretions were stimulated at a lower level. Moreover, sup reduced the surface expression of the analyzed co-stimulatory markers CD40, CD80, and CD86. Treatments of sup with different digestive enzymes indicated the proteinaceous nature of these immunomodulatory metabolites. Western blot and immunoadsorption analyzes revealed cross-reactivity of sup with the surface-layer proteins (SLPs) isolated from OLL2809. Therefore, we directly tested the ability of OLL2809 SLPs to stimulate specifically cytokine expression in iDCs. Interestingly, we found that all tested cytokines were induced by SLPs and in a dose-dependent manner. In conclusion, our results highlighted distinct immune properties between L. gasseri OLL2809 and its metabolites, supporting the concept that bacterial viability is not an essential prerequisite to exert immunomodulatory effects.

Percutaneous distal chevron osteotomy is associated with lower immediate postoperative pain and a greater range of motion than the open technique: A prospective randomized study.

The results of past studies comparing percutaneous techniques with traditional open techniques for hallux valgus are controversial. Therefore, this study aimed to compare the radiologic and clinical outcomes of percutaneous and open distal chevron osteotomies. Seventy-one patients with mild to severe hallux valgus deformity were randomized to undergo percutaneous distal chevron osteotomy (percutaneous group, n = 36) or open distal chevron osteotomy (open group, n = 35) between October 2019 and September 2020. Radiological and clinical outcomes were assessed preoperatively and postoperatively. Outcome measures included the foot and ankle outcome score, foot functional index, visual analogue scale (VAS) scores for pain, range of motion (ROM) of the first metatarsophalangeal (MTP) joint, hallux valgus angle, intermetatarsal angle, and first metatarsal shortening. Additionally, the first metatarsal declination angle was measured to evaluate sagittal malunion. The mean first metatarsal declination angle decreased significantly at 12 months postoperatively in both groups (p = 0.021 and p < 0.001 in the percutaneous and open groups, respectively), and the decrement was significantly greater in the open group (p = 0.033). The mean VAS score for pain on postoperative day one was 4.2 ± 1.9 and 5.3 ± 1.7 in the percutaneous and open groups, respectively (p = 0.019). The mean ROM of the first MTP joint did not change significantly after surgery, from 72.5 ± 7.5 preoperatively to 71.0 ± 9.5 at 12 months postoperatively in the percutaneous group (p = 0.215); however, it decreased significantly from 70.6 ± 7.3 preoperatively to 63.4 ± 10.4 at 12 months postoperatively in the open group (p < 0.001). There were no significant differences between the groups regarding other clinical outcomes. The percutaneous group showed a lower immediate pain level at postoperative day 1 and better ROM of the first MTP joint at 12 months postoperatively.

The leading role of personality in concerns about autonomous vehicles.

Development of autonomous vehicles (AVs) is growing in a rapid rate, however, the most dominant barriers in their adoption seem to be rather psychological than technical. The present online survey study aimed to investigate which demographical and personality dimensions predict attitudes towards AVs on a Hungarian sample (N = 328). Data was collected by convenience and snowball sampling. Three-level hierarchical regression models were applied: in the first level, demographical variables, then general personality traits and third, attitude-like personality factors were entered. We demonstrated that the predictive effect of age, gender and education disappeared when personality dimensions were included into the models. Importantly, more positive general attitudes towards technology and higher optimism regarding innovations predicted eagerness to adopt AVs. On the other hand, individuals with more negative attitudes and higher dependence on technology as well as those with lower level of Sensory Sensation Seeking and higher level of Conscientiousness were more concerned about AVs. Our results suggest that AV acceptance cannot be regarded as a one-dimensional construct and that certain personality traits might be stronger predictors of AV acceptance than demographical factors.

Does virtual reality reduce anxiety and pain in patients undergoing third molar surgery? A systematic review and meta-analysis.

This study aimed to systematically review the literature to evaluate the effectiveness of virtual reality in reducing anxiety and pain in patients undergoing third molar surgeries. Clinical trials evaluating patients who used virtual reality (VR) compared with no VR in the management of pain or anxiety after third molar extractions were included. A literature search was conducted in five electronic databases to identify relevant articles: Medline (PubMed interface), Web of Science, Virtual Health Library, Embase, and Scopus. There were no restrictions on the time or language of publication. The risk of bias was assessed using the Cochrane Risk of Bias Tool for Randomised Trials (RoB 2.0). A total of six studies were included in the qualitative analysis and three in the quantitative analysis. The results of the meta-analyses on anxiety revealed that patients in the intervention group before VR already showed less anxiety compared to those in the control group (-0.28 [-0.44 to -0.13, 95%CI] I²=24.51%. In the post-intervention evaluation, the group that received VR remained with a lower level of anxiety and a slight reduction compared to the pre-intervention. (-0.34 [-0.49 to -0.19, 95%CI] I²=36.61%. Virtual reality can be a clinical resource in dental care because it seems to cause a small reduction in anxiety, and with still uncertain results in the reduction of postoperative pain in extractions of third molars.

Evaluating ChatGPT Responses on Atrial Fibrillation for Patient Education.

Background ChatGPT is a language model that has gained widespread popularity for its fine-tuned conversational abilities. However, a known drawback to the artificial intelligence (AI) chatbot is its tendency to confidently present users with inaccurate information. We evaluated the quality of ChatGPT responses to questions pertaining to atrial fibrillation for patient education. Our analysis included the accuracy and estimated grade level of answers and whether references were provided for the answers. Methodology ChatGPT was prompted four times and 16 frequently asked questions on atrial fibrillation from the American Heart Association were asked. Prompts included Form 1 (no prompt), Form 2 (patient-friendly prompt), Form 3 (physician-level prompt), and Form 4 (prompting for statistics/references). Responses were scored as incorrect, partially correct, or correct with references (perfect). Flesch-Kincaid grade-level unique words and response lengths were recorded for answers. Proportions of the responses at differing scores were compared using the chi-square analysis. The relationship between form and grade level was assessed using the analysis of variance. Results Across all forms, scoring frequencies were one (1.6%) incorrect, five (7.8%) partially correct, 55 (85.9%) correct, and three (4.7%) perfect. Proportions of responses that were at least correct did not differ by form (p = 0.350), but perfect responses did (p = 0.001). Form 2 answers had a lower mean grade level (12.80 ± 3.38) than Forms 1 (14.23 ± 2.34), 3 (16.73 ± 2.65), and 4 (14.85 ± 2.76) (p < 0.05). Across all forms, references were provided in only three (4.7%) answers. Notably, when additionally prompted for sources or references, ChatGPT still only provided sources on three responses out of 16 (18.8%). Conclusions ChatGPT holds significant potential for enhancing patient education through accurate, adaptive responses. Its ability to alter response complexity based on user input, combined with high accuracy rates, supports its use as an informational resource in healthcare settings. Future advancements and continuous monitoring of AI capabilities will be crucial in maximizing the benefits while mitigating the risks associated with AI-driven patient education.

Lower HBV DNA level is associated with more severe liver fibrosis in HBeAg-positive chronic hepatitis B with normal alanine transaminase

BackgroundThe association of hepatitis B virus (HBV) DNA levels and liver fibrosis in chronic hepatitis B (CHB) patients with immune-tolerant phase remains unclear. We explored the association between liver fibrosis and HBV DNA levels in HBeAg-positive CHB patients with normal alanine transaminase (ALT) with relatively high HBV DNA.MethodsSix hundred and twenty-two HBeAg-positive CHB patients with normal ALT were included. Patients were divided into three categories: low (6 log10 IU/mL ≤ HBV DNA < 7 log10 IU/mL), moderate (7 log10 IU/mL ≤ HBV DNA < 8 log10 IU/mL), and high (HBV DNA ≥ 8 log10 IU/mL). APRI, FIB-4, transient elastography, or liver biopsy were used to assess liver fibrosis.ResultsThe median age of patients was 33.0 years and 57.9% patients were male. 18.8%, 52.1%, and 29.1% of patients had low, moderate, and high HBV DNA levels, respectively. The APRI (0.33 vs. 0.26 vs. 0.26, P < 0.001), FIB-4 (1.03 vs. 0.71 vs. 0.68, P < 0.001), and LSM values (7.6 kPa vs. 5.6 kPa vs. 5.5 kPa, P = 0.086) were higher in low HBV DNA group than other two groups. Low HBV DNA group had higher proportions of significant fibrosis (24.8% vs. 9.9% vs. 3.3%, P < 0.001) and cirrhosis (7.7% vs. 2.5% vs. 1.1%, P = 0.004) than moderate and high HBV DNA groups. Moderate (OR 3.095, P = 0.023) and low (OR 4.968, P = 0.003) HBV DNA were independent risk factors of significant fibrosis.ConclusionLower HBV DNA level was associated with more severe liver fibrosis in HBeAg-positive CHB patients with ALT.

An analysis of EV charging and route choice behavior considering the effects of planning ability, risk aversion and confidence in battery in long-distance travel

The increasing demand for long-distance and intercity travel is driven by the progress in regional transportation integration and the establishment of charging infrastructure. This increase suggests that the use of electric vehicles (EVs) for long-distance trips is likely to become more prevalent in the future. Therefore, there is an urgent need for more studies on the travel behavior of EV drivers for long-distance trips. However, there are few studies looking at the travel behavior of EV drivers on long-distance trip and multiple charging during trips. To fill this gap, this study identified EV drivers’ preferences for charging and route choice in long-distance or intercity travel on the basis of a stated preference survey, with the Shandong highway network as the travel scenario. A nested logit (NL)-based hybrid choice model was used to investigate the impacts of personal attitudes, namely planning ability, risk aversion and confidence in battery, on the drivers’ charging times choice behavior. The NL structure consists of two levels, with the upper level focusing on the charging times decision process, and the lower level analyzing the choice behavior of routes with no charging, routes with charging once, and routes with charging twice. The results show that the initial state of charge, and attitudes significantly influence the decision on charging times. In addition, EV drivers who are risk-averse and lack confidence in the battery tend to charge, whereas drivers with strong planning ability prefer to charge once in long-distance travel. Charging and resting simultaneously is the best way to meet the needs of charging and resting, and reduce the time lost while driving. These results provide insights on drivers’ travel planning and charging infrastructures planning for long-distance trips.

Determinants of the haemoglobin level in patients with sickle cell disease living in sub-Saharan Africa: Major impact of the country of residence and independent effects of leucocyte and platelet counts and haemolysis.

The degree of anaemia in sickle cell disease (SCD) is a well-known contributor to morbidity and mortality. We aimed to explore the factors affecting haemoglobin (Hb) level in African SCD patients, considering haemolysis biomarkers (LDH and bilirubin level, and reticulocyte count), leucocyte and platelet counts and socio-demographic characteristics (gender, age group, country of residence and BMI). The research was part of the CADRE multinational cohort and involved 3699 SCD patients living in Mali, Senegal, Ivory Coast, Democratic Republic of Congo, Gabon and Cameroon: 2936 SS/Sβ0, 587 SC and 176 Sβ + patients with median Hb level of 8, 11.3 and 11.2 g/dL respectively (p < 0.001). In multivariate analysis conducted in 1394 SS/Sβ0 patients, living in Cameroon, female gender, lower BMI, higher haemolysis markers (especially LDH) and higher leucocyte and platelet counts were independently associated with lower Hb level (all p < 0.05). In 497 SC and 156 Sβ + patients, female gender (p < 0.001), lower BMI (p < 0.05) and higher platelet counts (p < 0.001) were independently associated with lower Hb level. Anaemia in African SCD patients is not only associated with haemolysis but also with the country of residence, lower BMI and leucocyte or platelet counts which might reflect inflammation related to infectious burden in the region.

Physical Activity in Patients with Advanced Cancer: Sociodemographic, Clinical, and Psychological Correlates.

As cancer progresses, patients may experience physical decline, which can impair their ability to carry out essential daily tasks. The aim of this study was to analyze the levels of physical activity in patients with advanced cancer undergoing systemic treatment and its relationship with sociodemographic, clinical, and psychological factors. A prospective, cross-sectional, multicenter study was carried out in 15 oncology departments in Spain. Patients with locally advanced, unresectable, or metastatic cancer who were candidates for systemic treatment were included. Participants completed demographic information and psychological scales. In total, 508 patients were included in the study, the majority of whom were male, over the age of 65, and diagnosed with bronchopulmonary tumors (36%) and metastatic disease. Based on their physical activity levels, participants were categorized as sedentary (20%, n = 190), engaging in light physical activity (43%, n = 412), or demonstrating moderate physical activity (37%, n = 351). Patients who were over 65 years old; had a worse baseline status (ECOG ≥ 1); lacked a partner; had a lower educational level; or were retired or unemployed were found to have lower levels of physical activity. Those with sedentary physical activity reported higher levels of psychological distress, anxiety, depression, somatization, and physical symptoms, as well as worse functional status, global health status, and well-being. Understanding the complex interplay between physical activity and sociodemographic, clinical, and psychological factors can help neuroscientists develop tailored exercise interventions that address the unique needs of advanced cancer patients.

Anodic Electrolysis Strategy Enabled Fe/FeCl2 Electrode for Scalable Fe/FeCl2-Graphite Molten Salt Battery.

The Fe/FeCl2-Graphite molten salt battery is a promising technology for large-scale energy storage, offering a long lifespan, a low operating temperature (<200 °C), and cost efficiency. However, its practical applications are hindered by the lack of a scalable preparation approach and insufficient redox stability in the Fe/FeCl2 electrode. Our study introduces an electrochemical anodic electrolysis (EAE) strategy, employing the anodic process (Fe → Fe2+) in an Al|AlCl3/NaCl/LiCl|Fe electrolysis system for the Fe/Fe2+ negative electrode in the Fe/FeCl2-Graphite battery. The EAE strategy forms an oxidized film, preventing incipient dissolution in the electrolyte and addressing redox stability issues with FeCl2 as the active substance. The Fe/Fe2+ negative electrode prepared by the EAE strategy exhibits a stabilized capacity of 0.72 mAh/cm2 after 7000 cycles at 5 mA/cm2, with a lower polarization level (∼29 mV) compared to FeCl2 as the active component. The flexibility of the EAE strategy is validated in both galvanostatic and potentiostatic processes, with a discharge capacity of 14 mAh after 1000 cycles, a capacity retention rate of 85%, and a Coulombic efficiency of 98% in the potentiostatic anodic electrolysis Fe/Fe2+ electrode. The scalability and reliability of the EAE strategy are further demonstrated in capacity-expanded Fe/FeCl2-Graphite batteries, reaching a discharge capacity of 155.1 mAh after 1000 cycles at 130 mA, with a capacity retention rate of 94%. For the first time, we showcased an EAE approach capable of producing Fe/Fe2+ electrodes at a rate of about 68.6 m2 per day. Additionally, we successfully assembled an Fe/FeCl2-Graphite battery at about a 0.42 ampere-hour level, paving the way for the scalable application of Fe/FeCl2-Graphite batteries.

Joint Routing and Pricing Control in Bimodal Mixed Autonomy Networks with Elastic Demand and Three-Dimensional Passenger Macroscopic Fundamental Diagram

The interaction between mixed autonomy traffic and public transport vehicles competing for limited road space is a less explored area of research. To evaluate the traffic dynamics in bimodal networks, a three-dimensional (passenger) network fundamental diagram, known as 3D-NFD (3D-pNFD), can be estimated that relates the accumulation of cars (autonomous and human-driven) and buses to the network vehicular (passenger) travel production. In this study, we propose a 3D-pNFD-based congestion pricing scheme considering three vehicle classes of buses, system-optimal (SO) seeking connected and automated vehicles (CAVs), and user-equilibrium (UE) seeking human-driven vehicles (HVs). We develop an iterative tri-level modeling framework for mode choice, pricing, and route choice in a mixed autonomy network. The lower level generates mixed equilibrium traffic flow through an integrated mixed equilibrium simulation-based dynamic traffic assignment model and a transit assignment model. The mid-level finds the optimal toll rates through a 3D-pNFD feedback-based controller. A nested logit-based mode choice model is also applied to capture travelers’ preferences toward three available modes and incorporates elastic demand. To encourage CAVs to follow the SO routing mode, they are provided with a discount on the congestion toll whereas UE-seeking HVs are subject to full price toll. Buses are also entirely exempt from the toll. We explore three scenarios with different discount rates on SO-seeking CAVs to investigate the effect of the incentive plans on the mode choice behaviors of road users in the pricing zone. The performance of the proposed model is evaluated in a large-scale network in Melbourne, Australia.

Reversion to sensitivity explains limited transmission of resistance in a hospital pathogen.

Bacterial pathogens that are successful in hospital environments must survive times of intense antibiotic exposure and times of no antibiotic exposure. When these organisms are closely associated with human hosts, they must also transmit from one patient to another for the resistance to spread. The resulting evolutionary dynamics have, in some settings, led to rising levels of resistance in hospitals. Here, we focus on an important but understudied aspect of this dynamic: the loss of resistance when the resistant organisms evolve in environments where the antibiotic pressure is removed. Based on prior data, we hypothesize that resistance arising in the context of strong selection may carry a high cost and revert to sensitivity quickly once the selective pressure is removed. Conversely, resistant isolates that persist through times of no antibiotic pressure should carry a lower cost and revert less quickly. To test this hypothesis, we utilize a genetically diverse set of patient-derived, daptomycin-resistant Enterococcus faecium isolates that include cases of both de novo emergence of resistance within patients and putatively transmitted resistance. Both of these sets of strains have survived periods of antibiotic exposure, but only putatively transmitted resistant strains have survived extended periods without antibiotic exposure. These strains were then allowed to evolve in antibiotic free laboratory conditions. We find that putatively transmitted resistant strains tended to have lower level resistance but that evolution in antibiotic-free conditions resulted in minimal loss of resistance. In contrast, resistance that arose de novo within patients was higher level but exhibited greater declines in resistance in vitro. Sequencing of the experimentally evolved isolates revealed that reversal of high level resistance resulted from evolutionary pathways that were frequently genetically associated with the unique resistance mutations of that strain. Thus, the rapid reversal of high-level resistance was associated with accessible evolutionary pathways where an increase in fitness is associated with decreased resistance. We describe how this rapid loss of resistance may limit the spread of resistance within the hospital and shape the diversity of resistance phenotypes across patients.

Facilitating most population engagement with the circular economy: Challenges for academics and (as) social media influencers

The lack of consumer engagement with the Circular Economy (CE) hinders the use of recycled materials in products manufactured by the B2B companies (e.g., recycled pet bottles in industrial adhesives). Such an institutional void gives space to the rise of a type of network activity: knowledge brokerage, which is a process of knowledge exchange facilitation.This multiple case study contributes with a practical description of brokerage activities in this context. It investigated how companies could interact with academics through knowledge exchange translated into campaigns to engage most consumers with CE. The network approach, under the knowledge brokerage perspective, was the main theoretical foundation of this work.Findings indicate doubts that prevent companies from developing better green marketing campaigns. Academics could help to fill these gaps. Regarding campaign management, academics could identify the different groups of consumers, the delivery channels, campaign duration, and disclosure days/times that most engage each consumer group.Campaigns require educational materials. Academics could identify the amount of information and the presentation format in printed materials. However, engaging most of the population requires a better use of social media. Academics must investigate the posts that could change each group of people's behaviors (including consumers with a lower educational level and less purchasing power).Companies plan to financially support academics who elucidate these doubts or those who succeed in using social media to induce consumers to review their postures. Such support could increase the research funds for the projects managed by the researchers we have named “academic influencers.”

Evaluation of Soil Quality of Pingliang City Based on Fuzzy Mathematics and Cluster Analysis

Pingliang City has a complex topography and diverse soil types. To realize the improvement of soil according to local conditions and the reasonable and sustainable use of soil resources, an evaluation of soil quality in Pingliang City was carried out, based on the soil distribution situation in Pingliang City, adopting a method combining fuzzy mathematics and cluster analysis of the main evaluation factors, such as soil organic matter, topsoil depth, soil erosion intensity, soil moisture regime, effective soil thickness, soil texture, soil profile structure, soil nutrient status and topographical parts, to carry out a comprehensive evaluation. A comprehensive evaluation of soil quality was conducted in seven counties under the jurisdiction of Pingliang City, and the evaluation results were compared and analyzed against the national standard, “Cultivated land quality grade”, to provide a basis for the selection of scientific soil improvement methods. The results of the arable land quality grades indicate that the quality of farmland in Pingliang City is divided into three to ten grades, and the average quality grade of farmland is 6.83, which is in the middle–lower level, and the overall grade distribution shows the characteristics of low in the middle and high in the east and west. The results of fuzzy mathematics combined with cluster analysis indicated the following trends in soil quality for the 12 soil genera: Chuan black gunny soil &gt; yellow moist soil &gt; sandy soil &gt; silt soil &gt; mulching helilu soil&gt; loessal soil&gt; loamy soil &gt; slope loessal soil &gt; arenosol &gt; tillage leaching gray cinnamon soil &gt; calcareous gray cinnamon soil &gt; red clay soil. The results of the combination of fuzzy mathematics and clustering were significantly correlated with the results of the evaluation of the soil quality of arable land; the correlation coefficient was 0.884. This indicates that the method can accurately and objectively review the advantages and disadvantages of arable land soil and can be effectively applied to the evaluation of the soil quality of agricultural soils in other regions. It is a complement to the existing evaluation of the soil quality of arable land and at the same time provides a reference for the improvement of soil quality in agricultural regions.