A polymicrobial biofilm model of Komagataeibacter hansenii and Pseudomonas aeruginosa was developed to understand whether a pre-existing matrix affects the ability of another species to build a biofilm. P. aeruginosa was inoculated onto the preformed K. hansenii biofilm consisting of a cellulose matrix. P. aeruginosa PAO1 colonized and infiltrated the K. hansenii bacterial cellulose biofilm (BC), as indicated by the presence of cells at 19 μm depth in the translucent hydrogel matrix. Bacterial cell density increased along the imaged depth of the biofilm (17-19 μm). On day 5, the average bacterial count across sections was 67 ± 4 % P. aeruginosa PAO1 and 33 ± 6 % K. hansenii. Biophysical characterization of the biofilm indicated that colonization by P. aeruginosa modified the biophysical properties of the BC matrix, which inlcuded increased density, heterogeneity, degradation temperature and thermal stability, and reduced crystallinity, swelling ability and moisture content. This further indicates colonization of the biofilm by P. aeruginosa. While eDNA fibres - a key viscoelastic component of P. aeruginosa biofilm - were present on the surface of the co-cultured biofilm on day 1, their abundance decreased over time, and by day 5, no eDNA was observed, either on the surface or within the matrix. P. aeruginosa-colonized biofilm devoid of eDNA retained its mechanical properties. The observations demonstrate that a pre-existing biofilm scaffold of K. hansenii inhibits P. aeruginosa PAO1 eDNA production and suggest that eDNA production is a response by P. aeruginosa to the viscoelastic properties of its environment.

UNASSIGNED: The International Consortium on Manual Therapies (ICMT) is a grassroots interprofessional association open to any formally trained practitioner of manual therapy (MT) and basic scientists promoting research related to the practice of MT. Currently, MT research is impeded by professions\' lack of communication with other MT professions, biases, and vernacular. Current ICMT goals are to minimize these barriers, compare MT techniques, and establish an interprofessional MT glossary.
UNASSIGNED: Practitioners from all professions with training in manual therapies were encouraged by e-mail and website to participate (www.ICMTConferene.org). Video conferences were conducted at least bimonthly for 2.5 years by profession-specific and interprofessional focus groups (FGs). Members summarized scopes of practice, technique descriptions, associated mechanisms of action (MOA), and glossary terms. Each profession presented their work to the interprofessional FG to promote dialogue, understanding and consensus. Outcomes were reported and refined at numerous public events.
UNASSIGNED: Focus groups with representatives from 5 MT professions, chiropractic, massage therapy, osteopathic, physical therapy and structural integration identified 17 targeting osseous structures and 49 targeting nonosseous structures. Thirty-two techniques appeared distinct to a specific profession, and 13 were used by more than 1. Comparing descriptions identified additional commonalities. All professions agreed on 4 MOA categories for MT. A glossary of 280 terms and definitions was consolidated, representing key concepts in MT. Twenty-one terms were used by all MT professions and basic scientists. Five terms were used by MT professions exclusive of basic scientists.
UNASSIGNED: Outcomes suggested a third to a half of techniques used in MT are similar across professions. Additional research is needed to better define the extent of similarity and how to consistently identify those approaches. Ongoing expansion and refinement of the glossary is necessary to promote descriptive clarity and facilitate communication between practitioners and basic scientists.

OBJECTIVE: Assess changes in cross-sector collaboration between Nurse-Family Partnership (NFP) nurse home visitors and community providers in the United States.
METHODS: We collected primary data via internet-based surveys of all NFP nursing supervisors in the United States in 2018, 2020, and 2021.
METHODS: We conducted a panel survey to measure changes in cross-sector collaboration between NFP nurses and 10 provider types in healthcare and social services. We assessed relational coordination using the validated seven item Relational Coordination Scale and structural integration using four items adapted from the Interagency Collaboration Activities Scale. Responses over time were compared using one-way analysis of variances (ANOVAs) and pairwise t-tests. We used the Kruskal-Wallis rank test to assess differences in collaboration by implementing agency type.
METHODS: All nursing supervisors from NFP implementing agencies in the United States were eligible for the study. Survey implementation was conducted using Qualtrics and administered to all eligible participants (N = 370 [2018], 383 [2020], 414 [2021]). Email reminders were sent every 7-10 days, followed by a final telephone outreach.
RESULTS: The response rate was 71% in 2018, 83% in 2020, and 74% in 2021. Relational coordination scores were calculated as a mean of the seven items and ranged from 1 to 5 (not at all to completely); integration scores were calculated as a sum of the four items and ranged from 4 to 20, where higher scores indicated greater sharing of resources. Coordination with women\'s care increased from 2018 to 2020 (M = 3.39 vs. 3.57; p < 0.01); while coordination (M = 3.23 vs. 3.01; p < 0.05) and integration (M = 6.50 vs. 5.28 vs. 5.43; p < 0.01) with parenting programs decreased.
CONCLUSIONS: Changes to cross-sector collaboration varied by provider type, likely due to the delivery of NFP and other services via telehealth during the COVID-19 pandemic. There is an opportunity to improve cross-sector collaboration in home visiting to better address family needs.

OBJECTIVE: The study aims to analyze the relationship between care integration and care quality, and to examine if the relationship varies by patient risk.
METHODS: The key independent variables used validated measures derived from a provider survey of functional (i.e., administrative and clinical systems) and social (i.e., patient integration, professional cooperation, professional coordination) integration. Survey responses represented data from a stratified sample of 59 practice sites from 17 health systems. Dependent variables included three quality measures constructed from patient-level Medicare data: colorectal cancer screening among patients at risk, patient-level 30-day readmission, and a practice-level Healthcare Effectiveness Data and Information Set (HEDIS) composite measure of publicly reported, individual measures of ambulatory clinical quality performance.
METHODS: We obtained quality- and beneficiary-level covariate data for the 41,966 Medicare beneficiaries served by the 59 practices in our survey sample.
METHODS: We estimated hierarchical linear models to examine the association between care integration and care quality and the moderating effect of patients\' clinical risk score. We graphically visualized the moderating effects at ±1 standard deviation of our z-standardized independent and moderating variables and performed simple slope tests.
RESULTS: Our analyses uncovered a strong positive relationship between social integration, specifically patient integration, and the quality of care a patient receives (e.g., a 1-point increase in a practice\'s patient integration was associated with 0.31-point higher HEDIS composite score, p < 0.01). Further, we documented positive and significant associations between aspects of social and functional integration on quality of care based on patient risk.
CONCLUSIONS: The findings suggest social integration matters for improving the quality of care and that the relationship of integration to quality is not uniform for all patients. Policymakers and practitioners considering structural integrations of health systems should direct attention beyond structure to consider the potential for social integration to impact outcomes and how that might be achieved.

Understanding the structure-function relationship in the intervertebral disk (IVD) is crucial for the development of novel tissue engineering strategies to regenerate IVD and the establishment of accurate computational models for low back pain research. A large number of studies have improved our knowledge of the mechanical and structural properties of the nucleus pulposus (NP) and annulus fibrosus (AF), two of the main regions in the IVD. However, few studies have focused on the AF-NP interface (transition zone; TZ). Therefore, the current study aims to, for the first time, characterize the cyclic and failure mechanical properties of the TZ region under physiological loading (1, 3, and 5%s-1 strain rates) and investigate the structural integration mechanisms between the NP, TZ, and AF regions. The results of the current study reveal significant effects of region (NP, TZ, and AF) and strain rates (1, 3, and 5%s-1) on stiffness (p < 0.001). In addition, energy absorption is significantly higher for the AF compared to the TZ and NP (p <0.001) as well as between the TZ and NP (p <0.001). The current research finds adaptation, direct penetration, and entanglement between TZ and AF fibers as three common mechanisms for structural integration between the TZ and AF regions. STATEMENT OF SIGNIFICANCE: Despite a large number of studies that have mechanically, structurally, and biologically characterized the nucleus pulposus (NP) and annulus fibrosus (AF) regions, few studies have focused on the NP-AF interface region (known as Transition Zone; TZ) in the IVD; hence, our understanding of the TZ structure-function relationship is still incomplete. Of particular importance, the cyclic mechanical properties of the TZ, compared to the adjacent regions (NP and AF), are yet to be explored and the precise nature of the structural integration between the NP and AF via the TZ region is not yet known. The current study explores both the mechanical and structural properties of the TZ region to ultimately identify the mechanism of integration between the NP and AF.

Background: Recent work has investigated significant force transmission between the components of myofascial chains. Misalignments in the body due to fascial thickening and shortening can therefore lead to complex compensatory patterns. For the treatment of such nonlinear cause−effect pathology, comprehensive neuromusculoskeletal therapy such as the Rolf Method of Structural Integration (SI) could be targeted. Methods: A total of 727 subjects were retrospectively screened from the medical records of an SI practice over a 23-year period. A total of 383 subjects who had completed 10 basic SI sessions met eligibility criteria and were assessed for active range of motion (AROM) of the shoulder and hip before and after SI treatment. Results: Shoulder flexion, external and internal rotation, and hip flexion improved significantly (all p < 0.0001) after 10 SI sessions. Left shoulder flexion and external rotation of both shoulders increased more in men than in women (p < 0.0001) but were not affected by age. Conclusions: An SI intervention could produce multiple changes in the components of myofascial chains that could help maintain upright posture in humans and reduce inadequate compensatory patterns. SI may also affect differently the outcome of some AROM parameters in women and men.

BACKGROUND: Personality functioning, also referred to as structural integration, describes basic emotion-related perception and regulation capacities directed towards the self and others. Patients with impairments of personality functioning experience difficulties in self-regulation and interpersonal relations. Although personality functioning has become increasingly important in psychotherapeutic and psychiatric diagnoses and treatment planning, there is little systematic evidence on the role of personality functioning in patients with chronic and somatic diseases. This article reviews empirical studies using standardized assessments of personality functioning in patients with chronic and somatic diseases and discusses the role of personality structure in psychosomatic medicine.
RESULTS: Currently, there are only a limited number of studies using standardized assessments of personality functioning in patients with chronic or somatic diseases. The available evidence points to correlations of personality functioning with pain perception and the development of chronic pain. In addition, patients with lower levels of personality functioning may have difficulties in managing chronic conditions that require enduring changes in health behavior, such as in diabetes or posttransplantation therapy.
CONCLUSIONS: The review suggests a systematic link between personality functioning and health behavior in patients with chronic diseases that relate to self-regulation and coping strategies. These findings underline the importance of assessing personality functioning for diagnostics and treatment planning in psychosomatic medicine. Finally, an assessment of personality functioning could be helpful in choosing specific psychotherapeutic treatment strategies; however, more empirical studies are needed to comprehensively prove these assumptions.

BACKGROUND: Ventricular assist devices (VADs) are considered an effective treatment for patients with advanced heart failure, while complications associated with blood damage remain a burden. Structure design innovation has the potential to reduce hemolysis and improve hemocompatibility.
METHODS: In this research, a novel mixed-flow blood pump that integrates structural features of the axial and centrifugal VADs was proposed. The pump consists of an inducer, a mixed impeller supported by two ceramic pivot bearings, and a volute. The flow field and laminar viscous shear stress were analyzed by the in silico simulation. The hydraulic and hemolytic performance were evaluated in vitro by using a 3D printed pump.
RESULTS: The flow field distribution showed that streamlines in the connection area were smoothly transitioned through structural integration and no irregular flow occurred in the entire flow channel. The axial blades work as a fluid accelerator (generating 18.56% of the energy), and the centrifugal blades provide the main pressure head. The proportion of fluid inside the pump exposed to low laminar viscous shear stress (<50 Pa) and high laminar viscous shear stress (>150 Pa) was 99.02% and 0.03%, respectively. The in vitro hemolysis test results showed that the NIH (Normalized Index of Hemolysis) value of the mixed pump is 0.0079 ± 0.0039 g/100 L (n = 6).
CONCLUSIONS: It can be concluded that the mixed flow structure is effective at improving hydraulic performance, eliminating flow disturbance, and minimizing shear stresses. This novel pump design is expected to provide a new direction for the development of next-generation VADs.

The broad range of adverse health outcomes following child maltreatment (child maltreatment) underscores the need to investigate shared trajectories that contribute to associated physical and mental health problems. Previous research focused on different mechanisms, such as emotion regulation or attachment. In the present study, we propose personality functioning, comprising self- and interpersonal regulation and perception, to mediate between child maltreatment and mental and physical health.
In a German representative sample (N = 2,508), we assessed remembered child maltreatment, levels of personality functioning, and different health outcomes in adulthood, namely somatic symptoms, general mental distress, and body dysmorphic concern. We conducted path analyses to investigate mediation effects in the total sample as well as in female and male subsamples.
Child maltreatment significantly predicted the assessed health outcomes and showed significant associations with lower levels of personality functioning. Personality functioning partially mediated all health outcomes assessed by significant indirect effects and lowered direct effects of child maltreatment on health outcomes. An exploratory analysis of different facets of personality functioning revealed a pronounced impact of identity perception and self-reflective capacities in mediating between child maltreatment and physical and mental health. Comparable results were found in female and male participants.
Major limitations of the study are the reliance on cross-sectional data and the use of a screening measure to assess experienced child maltreatment.
Personality functioning may represent a transdiagnostic link to different somatic and psychological symptoms in the aftermath of child maltreatment.

The integration of immigrant minorities is a major concern for diverse societies-with major implications for the well-being of those affected, social cohesion and group relations, and economic and social progress. In this paper, we give a comprehensive description of long-term migrant integration in Western Europe to investigate theories of migrant assimilation and integration. We take a multidimensional approach, looking at 10 indicators measuring social, structural, political, civic and cultural integration. We take an innovative approach to measuring minority background by using two complementary measures: generational status, distinguishing first and second-generation migrants from the third and higher up \'natives,\' and self-reported ancestry, separating those with autochthonous-only ancestry from those with various kinds of allochthonous ancestry. Using interaction effects between these measures, we can test whether generational change is faster or slower for some ethnic groups than for others, i.e. whether different groups integrate at differing speeds. Using the pooled samples of all Western European countries included in the European Social Survey rounds 7 and 8, we run multivariate regression analyses to estimate the effects of migrant background on the 10 indicators of integration. Compared to migrants with autochthonous ancestry, respondents of Middle Eastern, North African & Central Asian as well as Sub-Saharan African ancestry are less integrated on all dimensions of integration except the political and civic ones. The South & South-East Asian group is also substantially less assimilated socially and culturally, but not so much structurally. They are closely followed by the South East and East European groups, following the same pattern except that the latter are less integrated politically as well. We only find substantial interaction effects between ethnic group and migrant generation for two integration indicators, namely citizenship and homophobia, for which speed of integration thus appears to differ across ethnic groups. For all other indicators, integration speed does not appear to differ across ethnic groups, supporting straight line assimilation theory, with social integration in terms of interethnic friendship potentially rather following a \'bumpy-line\' pattern.