The challenges of balancing industrial development, environmental and human health, and economic growth in China and elsewhere in the world are drivers for recent resource use and low-carbon ...development strategies that include the application of the circular economy (CE) concept. A central theme of the CE concept is the valuation of materials within a closed-looped system with the aim to allow for natural resource use while reducing pollution or avoiding resource constraints and sustaining economic growth. The objectives of this study are (1) to review the history of the CE concept to provide a context for (2) a critical examination of how it is applied currently. Thematic categories are used to organize the literature review results including policy instruments and approaches; value chains, material flows, and products; and technology, organizational, and social innovation. The literature review illustrates the variability in CE project success and failure over time and by region. CE successes, key challenges, and research gaps are identified. The literature review results provide useful information for researchers as well as multi-stakeholder groups who seek to define the CE concept in practical terms, and to consider potential challenges and opportunities it presents when implemented.
Kendall et al discuss the epidemiological importance of subclinical tuberculosis (TB). The World Health Organization has adopted ambitious targets to end the TB epidemic, including a 90% reduction in ...incidence from 2015 to 2035. The corresponding End TB Strategy focuses on the early diagnosis and treatment of individuals with recognizable symptoms and treatment of latent TB infection in people at high risk. However, these targets may not be achievable without increased attention to averting transmission from the millions of people who have subclinical TB. Historically, TB has been conceptualized by some as consisting of latent infection (asymptomatic and noninfectious) and active disease (symptomatic and infectious).
The durability of immune memory after severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) messenger RNA (mRNA) vaccination remains unclear. In this study, we longitudinally profiled vaccine ...responses in SARS-CoV-2–naïve and –recovered individuals for 6 months after vaccination. Antibodies declined from peak levels but remained detectable in most subjects at 6 months. By contrast, mRNA vaccines generated functional memory B cells that increased from 3 to 6 months postvaccination, with the majority of these cells cross-binding the Alpha, Beta, and Delta variants. mRNA vaccination further induced antigen-specific CD4
and CD8
T cells, and early CD4
T cell responses correlated with long-term humoral immunity. Recall responses to vaccination in individuals with preexisting immunity primarily increased antibody levels without substantially altering antibody decay rates. Together, these findings demonstrate robust cellular immune memory to SARS-CoV-2 and its variants for at least 6 months after mRNA vaccination.
The study of what has come to be known as family language policy has evolved and expanded significantly over the last hundred years, from its early beginnings in the diary studies of Ronjat and ...Leopold, to the interdisciplinary and transnational research found in this thematic issue of the Journal of Multilingual and Multicultural Development on 'Multilingual Encounters in Transcultural Families', edited by Elizabeth Lanza and Li Wei. This concluding discussion analyses the ways in which the five papers in this special issue illustrate current, cutting-edge of work in the field, but also showcase the methodological breadth that has long characterised family language policy. Furthermore, as argued here, the papers suggest the ways the field has evolved over time in step with the significant changes in the field of applied linguistics and language policy in particular, as well as reckoned with the intensified forces of globalization evident in recent decades.
OBJECTIVES:We describe the importance of interprofessional care in modern critical care medicine. This review highlights the essential roles played by specific members of the interprofessional care ...team, including patients and family members, and discusses quality improvement initiatives that require interprofessional collaboration for success.
DATA SOURCES:Studies were identified through MEDLINE search using a variety of search phrases related to interprofessional care, critical care provider types, and quality improvement initiatives. Additional articles were identified through a review of the reference lists of identified articles.
STUDY SELECTION:Original articles, review articles, and systematic reviews were considered.
DATA EXTRACTION:Manuscripts were selected for inclusion based on expert opinion of well-designed or key studies and review articles.
DATA SYNTHESIS:“Interprofessional care” refers to care provided by a team of healthcare professionals with overlapping expertise and an appreciation for the unique contribution of other team members as partners in achieving a common goal. A robust body of data supports improvement in patient-level outcomes when care is provided by an interprofessional team. Critical care nurses, advanced practice providers, pharmacists, respiratory care practitioners, rehabilitation specialists, dieticians, social workers, case managers, spiritual care providers, intensivists, and nonintensivist physicians each provide unique expertise and perspectives to patient care, and therefore play an important role in a team that must address the diverse needs of patients and families in the ICU. Engaging patients and families as partners in their healthcare is also critical. Many important ICU quality improvement initiatives require an interprofessional approach, including Awakening and Breathing Coordination, Delirium, Early Exercise/Mobility, and Family Empowerment bundle implementation, interprofessional rounding practices, unit-based quality improvement initiatives, Patient and Family Advisory Councils, end-of-life care, coordinated sedation awakening and spontaneous breathing trials, intrahospital transport, and transitions of care.
CONCLUSIONS:A robust body of evidence supports an interprofessional approach as a key component in the provision of high-quality critical care to patients of increasing complexity and with increasingly diverse needs.
Little is known about how health insurance payer types differ between transgender and gender diverse (TGD) people and cisgender people. Much of what is known about insurance coverage among TGD adults ...has been based on research from claims and electronic health record data, which excludes individuals who have not accessed gender-affirming care. Research designed to understand how TGD populations pay for health care to best inform care interventions and public insurance policies is lacking.
The objective of this study was to examine differences in the prevalence of public and private health insurance between transgender and cisgender adults.
Using data from the Behavioral Risk Factor Surveillance System, this study estimated prevalence of health insurance coverage among TGD and cisgender adults residing in 22 states that administered the Sexual Orientation and Gender Identity module and the Healthcare Access module from 2014 to 2019. This study estimated the odds of health insurance coverage (no insurance, private insurance, public insurance) among cisgender adults compared with TGD adults.
TGD people had greater odds of being uninsured compared with cisgender women. Among nondisabled, nonelderly respondents, TGD adults had lower odds of having private insurance and higher odds of public insurance compared with cisgender men. Among respondents who were likely Medicaid-eligible, TGD respondents had lower odds of having public insurance and higher odds of being uninsured compared with cisgender women.
These findings provide foundational information about the payer mix among TGD people and provide insight into barriers to health insurance that TGD adults may face.
Objective
Neuroimaging and other biomarker assays suggest that the pathological processes of Alzheimer's disease (AD) begin years prior to clinical dementia onset. However, some 30 to 50% of older ...individuals who harbor AD pathology do not become symptomatic in their lifetime. It is hypothesized that such individuals exhibit cognitive resilience that protects against AD dementia. We hypothesized that in cases with AD pathology, structural changes in dendritic spines would distinguish individuals who had or did not have clinical dementia.
Methods
We compared dendritic spines within layer II and III pyramidal neuron dendrites in Brodmann area 46 dorsolateral prefrontal cortex using the Golgi–Cox technique in 12 age‐matched pathology‐free controls, 8 controls with AD pathology (CAD), and 21 AD cases. We used highly optimized methods to trace impregnated dendrites from bright‐field microscopy images that enabled accurate 3‐dimensional digital reconstruction of dendritic structure for morphologic analyses.
Results
Spine density was similar among control and CAD cases but was reduced significantly in AD. Thin and mushroom spines were reduced significantly in AD compared to CAD brains, whereas stubby spine density was decreased significantly in CAD and AD compared to controls. Increased spine extent distinguished CAD cases from controls and AD. Linear regression analysis of all cases indicated that spine density was not associated with neuritic plaque score but did display negative correlation with Braak staging.
Interpretation
These observations provide cellular evidence to support the hypothesis that dendritic spine plasticity is a mechanism of cognitive resilience that protects older individuals with AD pathology from developing dementia. Ann Neurol 2017;82:602–614
We examined antibody and memory B cell responses longitudinally for ∼9–10 months after primary 2-dose SARS-CoV-2 mRNA vaccination and 3 months after a 3rd dose. Antibody decay stabilized between 6 ...and 9 months, and antibody quality continued to improve for at least 9 months after 2-dose vaccination. Spike- and RBD-specific memory B cells remained durable over time, and 40%–50% of RBD-specific memory B cells simultaneously bound the Alpha, Beta, Delta, and Omicron variants. Omicron-binding memory B cells were efficiently reactivated by a 3rd dose of wild-type vaccine and correlated with the corresponding increase in neutralizing antibody titers. In contrast, pre-3rd dose antibody titers inversely correlated with the fold-change of antibody boosting, suggesting that high levels of circulating antibodies may limit the added protection afforded by repeat short interval boosting. These data provide insight into the quantity and quality of mRNA-vaccine-induced immunity over time through 3 or more antigen exposures.
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•Neutralizing antibody titers stabilize ∼6 months after primary vaccination•Memory B cells are stable for >9 months postvaccination and >50% cross-bind Omicron•Omicron-reactive memory B cells are reactivated by a 3rd dose of wild-type vaccine•Low preboost antibody levels correlate with a greater fold increase after boosting
Immunization with 2 doses of mRNA vaccine encoding the ancestral SARS-CoV-2 spike protein induces a population of durable memory B cells with broad reactivity to viral variants including Omicron. Boosting with a 3rd dose of ancestral vaccine increases variant-neutralizing antibody levels, highlighting the significance of vaccine-induced B cell memory.
Biosensors are being developed to provide rapid, quantitative, diagnostic information to clinicians in order to help guide patient treatment, without the need for centralised laboratory assays. The ...success of glucose monitoring is a key example of where technology innovation has met a clinical need at multiple levels - from the pathology laboratory all the way to the patient's home. However, few other biosensor devices are currently in routine use. Here we review the challenges and opportunities regarding the integration of biosensor techniques into body fluid sampling approaches, with emphasis on the point-of-care setting.
This review describes the challenges, opportunities and recent advances in developing clinically applicable biosensors for integrated body fluid analysis.
Culturally appropriate social support predicts better psychological outcomes. Motivation for providing social support may vary cross-culturally, with more independent cultures valuing self-esteem and ...more interdependent cultures valuing closeness. Participants in the U.S. (N = 85) and Singapore (N = 78) reported on emotions and social support receipt using the Day Reconstruction Method. We examined cultural differences in stress and affection, and tested country as a moderator of the associations between both social support receipt and social support motivation, and next-episode emotions. Multilevel modeling analyses showed that not only did the emotional correlates of social support receipt vary by country, but that recipient perceptions of esteem-building and closeness-fostering SS also differentially correlated with subsequent emotion. For example, esteem-building SS predicted greater next-episode stress for Singaporean participants, but less stress in the U.S. Esteem-building SS predicted more next-episode affection only in the U.S. Culturally appropriate social support predicts positive psychological outcomes. This research highlights the importance of considering culture when examining the dynamic emotional correlates of social support receipt.
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