Multiple-long term conditions (MLTCs), also known as multimorbidity, are commonly defined as the presence of two or more long-term medical conditions in one individual(1). More than half of all adults over 60 years are affected by multimorbidity worldwide(2) and its increasing prevalence demands a shift in focus for research and healthcare towards multiple clusters of disease, rather than single conditions(3).

Current epidemiological evidence on diet as preventative lifestyle factor in relation to MLTCs is limited(4). Therefore we reviewed the existing evidence to summarise methods of assessment of diet and multimorbidity measure to identify further research needs in a scoping review.

Medline, Embase, CINAHL, Web of Science and Scopus were searched systematically following the methodological approach for scoping reviews by PRISMA. The protocol was published on Open Science Framework under DOI10.17605/OSF.IO/9FP5D. The search yielded a total of 10,937 results. After de-duplication, title and abstract screening and a final inclusion round of in-text screening by two reviewers, 53 articles met the inclusion criteria. Observational studies were included if they examined the relationship between any dietary factor and the prevalence/or development of MLTCs in community-dwelling adults.

Publication dates of included research papers ranged from 2014 to 2023, with over half of studies published in the last three years. There was high variability between dietary assessment methods used: in the majority of studies (n=21, 39.6%) fruit and vegetable intake was the only diet-related variable reported. A priori diet quality scores were used in n=15 (28.3%) studies and n=6 (11.3%) studies used a posteriori approaches to identify dietary patterns, n=11 used other methods (20.8%). Only n=3 (5.7%) studies also focussed on micronutrients. MLTCs were generally defined as presence of ≥2 chronic conditions by most papers, however the number of qualifying conditions ranged from 2-60 conditions.

Overall, 60.4% (n=32) of studies were cross-sectional with various dietary components and patterns showing either mixed results, (n=10, 31.3%), no association (n=5, 15.6%) or inverse associations (n=12, 37.5%), i.e. higher diet score/adherence/consumption of diet components was associated with lower MLTCs, to positive relationships e.g. individuals with MLTCs consumed higher intakes of fruit and vegetables (n=5, 15.6%). Varying results were also found in longitudinal studies (n= 21, 39.6%). Some studies found inverse associations (n=8, 38.1%) i.e. higher adherence/more healthy food consumption was associated with lower MLTCs. However, other studies showed either no significant association (n=4, 19%), mixed results (n=5, 23.8%) or positive associations (n=4, 19.1%).

The evidence relating MLTCs to dietary intakes is relatively recent with most studies being reported within the last 3 years. Studies showed various outcomes and more detailed information is needed on the effect of dietary patterns and their compounds on the prevalence and development of multimorbidity. Following a standardized method of multimorbidity-quantification is highly important.

Background: Over the past decade, worldwide stroke incidence has been increasing among young adults (≤65years), which has implications during the most dynamic period of their life. There is a dearth of research exploring young adults stroke patients’ experiences, healthy lifestyle habits, preferences, and recommendations for brain care-related initiatives. The study aimed to gain knowledge and a deeper understanding of young adult stroke patients’ experiences, lifestyle habits, and support needs for brain care-related education and interventions. Methods: A descriptive qualitative study was used. Participants who took part in the quantitative phase of a larger mixed methods study (n=103 that expressed an interest in the qualitative phase, were invited to take part in semi-structured focus groups. Simultaneous data collection and analysis are being conducted. Data are being analyzed using inductive thematic analysis outlined by Braun and Clarke (2006). Results: Findings will be available by May 20, 2024. Conclusions: Study findings will be essential to 1) mobilize an understanding of young adult stroke patients’ lived experience; 2) reconceptualize the current model of stroke care and services that is traditionally geared towards older adults; and 3) inform the development of brain care-related education and interventions to meet the unique needs, priorities, and preferences of young adult stroke patients.

Background: Medically refractory pediatric epilepsy is a disorder that can cause significant financial and physical burden. Although multiple treatments exist, cost-effectiveness remains unclear. We conducted a systematic review to assess cost-effectiveness of treatments for medically refractory pediatric epilepsy and to summarize key issues and areas for further inquiry. Methods: We searched MEDLINE and 6 other databases up to July 2022. We included partial and full economic evaluations (EEs) on treatments for medically refractory pediatric epilepsy. Pairs of reviewers independently screened the literature, extracted data, and assessed quality using the 24-item Consolidated Health Economic Evaluation Reporting Standards (CHEERS) checklist. We extracted data on study characteristics, health outcomes, model design, costs, and treatment characteristics. Results: We identified 37 eligible studies for analysis, 19 of which were partial EEs and 18 were full EEs. Study quality, outcomes reported, treatment comparators, and factors included in cost calculations were common influential factors in study results. Vagus nerve stimulation and cannabinoid oil were the most consistently cost-effective, in 6 of 7 and 1 of 2 studies, respectively. Other treatments were inconsistently cost-effective. Conclusions: The cost-effectiveness of treatments for medically refractory pediatric epilepsy was not definitive. Consistency in study design and inputs is necessary for future comparison of epilepsy treatment.

The EU has introduced a Carbon Border Adjustment Mechanism (CBAM), which extends its carbon prices to imported products in some sectors. Increasingly considered by other countries, such border carbon adjustments (BCAs) are facing a global backlash against the lack of consideration of the adverse impacts on developing countries and particularly, least developed countries (LDCs). This article first argues that small overall import volumes support the conclusion that exempting or lessening BCA requirements from LDCs would not undermine developed countries' climate-related objectives in practical terms. An economic analysis of EU and UK trade in relation to a CBAM supports this assertion. However, legally, such an exemption or development-based preferential treatment is difficult under existing multilateral trade rules and jurisprudence, owing to the legal characterization and objectives of BCAs; their interaction with existing special and differential treatment (SDT) provisions; and complexity of available policy options. We thus highlight the gap between normative aims of SDT provisions to support development, and current WTO law and jurisprudence which expose WTO members providing preferential treatment to allegations of discrimination. With increasing unilateral climate action, an inability to integrate SDT more meaningfully into WTO non-discrimination frameworks risks further weakening of international cooperation on climate and trade.

Diets low in vegetables are a main contributor to the health burden experienced by Australians living in rural communities. Given the ubiquity of smartphones and access to the Internet, digital interventions may offer an accessible delivery model for a dietary intervention in rural communities. However, no digital interventions to address low vegetable intake have been co-designed with adults living in rural areas(1). This research aims to describe the co-design of a digital intervention to improve vegetable intake with rural community members and research partners. Active participants in the co-design process were adults ≥18 years living in three rural Australian communities (total n = 57) and research partners (n = 4) representing three local rural governments and one peak non-government health organisation. An iterative co-design process(2) was undertaken to understand the needs (pre-design phase) and ideas (generative phase) of the target population through eight online workshops and a 21-item online community survey between July and December 2021. Prioritisation methods were used to help workshop participants identify the ‘Must-have, Should-have, Could-have, and Won’t-have or will not have right now’ (MoSCoW) features and functions of the digital intervention. Workshops were transcribed and inductively analysed using NVivo. Convergent and divergent themes were identified between the workshops and community survey to identify how to implement the digital intervention in the community. Consensus was reached on a concept for a digital intervention that addressed individual and food environment barriers to vegetable intake, specific to rural communities. Implementation recommendations centred on i) food literacy approaches to improve skills via access to vegetable-rich recipes and healthy eating resources, ii) access to personalisation options and behaviour change support, and iii) improving the community food environment by providing information on and access to local food initiatives. Rural-dwelling adults expressed preferences for personalised intervention features that can enhance food literacy and engagement with community food environments. This co-design process will inform the development of a prototype (evaluation phase) and feasibility testing (post-design phase) of this intervention. The resulting intervention is anticipated to reduce barriers and support enablers, across individual and community levels, to facilitate higher consumption of vegetables among rural Australians. These outcomes have the potential to contribute to improved wellbeing in the short term and reduced chronic disease risk in the long term, decreasing public health inequities.

In this paper, we investigate the attitude manoeuver planning and tracking control of the flexible satellite equipped with a coilable mast. Due to its flexible beamlike structure, the coilable mast experiences bending and torsional modal vibrations in multi-direction. The complex nonlinear coupling and other external disturbances significantly impact the achievement of high-precision attitude control. To overcome these challenges, a robust attitude tracking controller is proposed for easy implementation by the Attitude Determination and Control System (ADCS). The controller consists of a disturbance compensator, feedforward controller and output feedback controller. The compensator, based on a Nonlinear Disturbance Observer (NDO), effectively compensates for the cluster disturbances caused by vibrations, environmental factors and parameter perturbations. The feedforward controller tracks the desired path in the nominal satellite model. Furthermore, the output feedback controller enables large-angle manoeuver control of the satellite and evaluates the suppression effect of the controlled output on the observation error of cluster disturbances used the ${L_2}$-gain. Simulation results demonstrate that the proposed controller successfully achieves high-precision attitude tracking control during large-angle manoeuvering.

Epidemiologic research has increasingly acknowledged the importance of developmental origins of health and disease (DOHaD) and suggests that prior exposures can be transferred across generations. Multigenerational cohorts are crucial to verify the intergenerational inheritance among human subjects. We carried out this scoping review aims to summarize multigenerational cohort studies’ characteristics, issues, and implications and hence provide evidence to the DOHaD and intergenerational inheritance. We adopted a comprehensive search strategy to identify multigenerational cohorts, searching PubMed, EMBASE, and Web of Science databases from the inception of each dataset to June 20th, 2022, to retrieve relevant articles. After screening, 28 unique multigenerational cohort studies were identified. We classified all studies into four types: population-based cohort extended three-generation cohort, birth cohort extended three-generation cohort, three-generation cohort, and integrated birth and three-generation cohort. Most cohorts (n = 15, 53%) were categorized as birth cohort extended three-generation studies. The sample size of included cohorts varied from 41 to 167,729. The study duration ranged from two years to 31 years. Most cohorts had common exposures, including socioeconomic factors, lifestyle, and grandparents’ and parents’ health and risk behaviors over the life course. These studies usually investigated intergenerational inheritance of diseases as the outcomes, most frequently, obesity, child health, and cardiovascular diseases. We also found that most multigenerational studies aim to disentangle genetic, lifestyle, and environmental contributions to the DOHaD across generations. We call for more research on large multigenerational well-characterized cohorts, up to four or even more generations, and more studies from low- and middle-income countries.

This paper proposes a fixed-time anti-saturation (FT-AS) control scheme with a simple control loop for the 6-Degree-of-Freedom tracking (6-DOF) control problem of spacecraft with parameter uncertainties, external disturbances and input saturation. Considering the external disturbance and parameter uncertainties, the dynamical model of the tracking error is established. The traditional methods of handling input saturation usually add anti-saturation subsystems in the control system to suppress the impact of input overshoot. However, this paper directly inputs the input overshoot into the tracking error model, thus constructing a modified lumped disturbance term that includes the influence of input overshoot. Then, a novel fixed-time disturbance observer (FT-DO) is designed to estimate and compensate for this modified lumped disturbance. Therefore, there is no need to add the anti-saturation structures in the control loop, significantly reducing the complexity of the system. Finally, an observer-based fixed-time non-singular terminal sliding mode (FT-NTSM) controller is designed to guarantee the fixed-time stability of the whole system. In this way, the convergence time of the proposed scheme does not depend on the system’s initial conditions. Simulation results illustrate that the proposed method keeps the control input within the limit while achieving high-precision tracking control of attitude and position.

The chemistry of Al transformation has been well documented, though little is known about the mechanisms of structural perturbation of Al precipitates by carbonates at a molecular level. The purpose of the present study was to investigate the structural perturbation of Al precipitates formed under the influence of carbonates. Initial carbonate/Al molar ratios (MRs) used were 0, 0.1, and 0.5 after aging for 32 days, then the samples were analyzed by X-ray absorption near edge structure spectroscopy (XANES), X-ray diffraction (XRD), Fourier-transform infrared absorption spectroscopy (FTIR), and chemical analysis. The XRD data were in accord with the FTIR results, which revealed that as the carbonate/Al MR was increased from 0 to 0.1, carbonate preferentially retarded the formation of gibbsite and had relatively little effect on the formation of bayerite. As the carbonate/Al MR was increased to 0.5, however, the crystallization of both gibbsite and bayerite was completely inhibited. The impact of carbonate on the nature of Al precipitates was also evident in the increase of adsorbed water and inorganic C contents with increasing carbonate/Al MR. The Al K- and L- edge XANES data provide the first evidence illustrating the change in the coordination number of Al from 6-fold to mixed 6- and 4-fold coordination in the structural network of short-range ordered (SRO) Al precipitates formed under the increasing perturbation of carbonate. The fluorescence yield spectra of the O K-edge show that the intensity of the peak at 534.5 eV assigned to σ* transitions of Al-O and O-H bonding decreased with increasing carbonate/Al MR. The XANES data, along with the evidence from XRD, FTIR, and chemical analysis showed clearly that carbonate caused the alteration of the coordination nature of the Al-O bonding through perturbation of the atomic bonding and structural configuration of Al hydroxides by complexation with Al in the SRO network of Al precipitates. The surface reactivity of an Al-O bond is related to its covalency and coordination geometry. The present findings were, therefore, of fundamental significance in understanding the low-temperature geochemistry of Al and its impacts on the transformation, transport, and fate of nutrients and pollutants in the ecosystem.

The formation of siderite and magnetite by Fe(III)-reducing bacteria may play an important role in C and Fe geochemistry in subsurface and ocean sediments. The objective of this study was to identify environmental factors that control the formation of siderite (FeCO3) and magnetite (Fe3O4) by Fe(III)-reducing bacteria. Psychrotolerant (<20°C), mesophilic (20–35°C) and thermophilic (>45°C) Fe(III)-reducing bacteria were used to examine the reduction of a poorly crystalline iron oxide, akaganeite (β-FeOOH), without a soluble electron shuttle, anthraquinone disulfuonate (AQDS), in the presence of N2, N2-CO2(80:20, V:V), H2 and H2-CO2 (80:20, V:V) headspace gases as well as in -buffered medium (30–210 mM) under a N2 atmosphere. Iron biomineralization was also examined under different growth conditions such as salinity, pH, incubation time, incubation temperature and electron donors. Magnetite formation was dominant under a N2 and a H2 atmosphere. Siderite formation was dominant under a H2-CO2 atmosphere. A mixture of magnetite and siderite was formed in the presence of a N2-CO2 headspace. Akaganeite was reduced and transformed to siderite and magnetite in a -buffered medium (>120 mM) with lactate as an electron donor in the presence of a N2 atmosphere. Biogeochemical and environmental factors controlling the phases of the secondary mineral suite include medium pH, salinity, electron donors, atmospheric composition and incubation time. These results indicate that microbial Fe(III) reduction may play an important role in Fe and C biogeochemistry as well as C sequestration in natural environments.

Innovations in horse equipment during the early Middle Ages provided advantages to societies from the steppes, reshaping the social landscape of Eurasia. Comparatively little is known about the precise origin of these crucial advances, although the available evidence points to early adoption in East Asia. The authors present new archaeological discoveries from western and northern Mongolia, dating to the fourth and fifth centuries AD, including a wooden frame saddle with horse hide components from Urd Ulaan Uneet and an iron stirrup from Khukh Nuur. Together, these finds suggest that Mongolian groups were early adopters of stirrups and saddles, facilitating the expansion of nomadic hegemony across Eurasia and shaping the conduct of medieval mounted warfare.

High-intensity vortex beams with tunable topological charges and low coherence are highly demanded in applications such as inertial confinement fusion (ICF) and optical communication. However, traditional optical vortices featuring nonuniform intensity distributions are dramatically restricted in application scenarios that require a high-intensity vortex beam owing to their ineffective amplification resulting from the intensity-dependent nonlinear effect. Here, a low-coherence perfect vortex beam (PVB) with a topological charge as high as 140 is realized based on the super-pixel wavefront-shaping technique. More importantly, a globally adaptive feedback algorithm (GAFA) is proposed to efficiently suppress the original intensity fluctuation and achieve a flat-top PVB with dramatically reduced beam speckle contrast. The GAFA-based flat-top PVB generation method can pave the way for high-intensity vortex beam generation, which is crucial for potential applications in ICF, laser processing, optical communication and optical trapping.

Competition among the two-plasmon decay (TPD) of backscattered light of stimulated Raman scattering (SRS), filamentation of the electron-plasma wave (EPW) and forward side SRS is investigated by two-dimensional particle-in-cell simulations. Our previous work [K. Q. Pan et al., Nucl. Fusion 58, 096035 (2018)] showed that in a plasma with the density near 1/10 of the critical density, the backscattered light would excite the TPD, which results in suppression of the backward SRS. However, this work further shows that when the laser intensity is so high ($>{10}^{16}$ W/cm2) that the backward SRS cannot be totally suppressed, filamentation of the EPW and forward side SRS will be excited. Then the TPD of the backscattered light only occurs in the early stage and is suppressed in the latter stage. Electron distribution functions further show that trapped-particle-modulation instability should be responsible for filamentation of the EPW. This research can promote the understanding of hot-electron generation and SRS saturation in inertial confinement fusion experiments.

Job knowledge characteristics have long been regarded as relatively fixed. However, this may no longer be the case given the dynamic and complex situations faced by employees during the COVID-19 pandemic. On the basis of event system theory and the work design literature, we argue that the onset of COVID-19 created an immediate decrease in job knowledge characteristics, which gradually increased over time in the post-onset period because of employees’ coping with the pandemic. The rate of increase in job knowledge characteristics is higher for those with higher individual task adaptivity than for others. We further argue that changes in job knowledge characteristics produced changes in job stress, and that this effect is weakened by job security. We conducted a 6-month, 6-wave longitudinal survey to gather data from 235 employees in Macau, China covering the pre-onset, onset, and post-onset periods of the COVID-19 outbreak. The results, based on discontinuous growth modeling and latent change score modeling, support our arguments. Our study advances the dynamic view of work design by identifying how a macro event may shape job knowledge characteristics and the implications of a time-to-time change in job knowledge characteristics. Overall, we suggest that there are psychological costs when employees cope at work with the business interruptions caused by COVID-19.

We calculated the attributable cost of several healthcare-associated infections in a community hospital network: central-line–associated bloodstream infections (CLABSIs), catheter-associated urinary tract infections (CAUTIs), hospital-onset Clostridioides difficile infections (CDI-HOs) (43 hospitals); surgical site infections (SSIs) (40 hospitals). From 2016 to 2022, the total cost of CLABSIs, CAUTIs, CDI-HOs, and SSIs was $420,012,025.

The target backsheath field acceleration mechanism is one of the main mechanisms of laser-driven proton acceleration (LDPA) and strongly depends on the comprehensive performance of the ultrashort ultra-intense lasers used as the driving sources. The successful use of the SG-II Peta-watt (SG-II PW) laser facility for LDPA and its applications in radiographic diagnoses have been manifested by the good performance of the SG-II PW facility. Recently, the SG-II PW laser facility has undergone extensive maintenance and a comprehensive technical upgrade in terms of the seed source, laser contrast and terminal focus. LDPA experiments were performed using the maintained SG-II PW laser beam, and the highest cutoff energy of the proton beam was obviously increased. Accordingly, a double-film target structure was used, and the maximum cutoff energy of the proton beam was up to 70 MeV. These results demonstrate that the comprehensive performance of the SG-II PW laser facility was improved significantly.