This paper reports an independently tunable graphene-based metamaterial absorber (GMA) designed by etching two cascaded resonators with dissimilar sizes in the unit cell. Two perfect absorption peaks were obtained at 6.94 and 10.68 μm with simple single-layer metal-graphene metamaterials; the peaks show absorption values higher than 99%. The mechanism of absorption was analyzed theoretically. The independent tunability of the metamaterial absorber (MA) was realized by varying the Fermi level of graphene under a set of resonators. Furthermore, multi-band and wide-band absorption were observed by the proposed structure upon increasing the number of resonators and resizing them in the unit cell. The obtained results demonstrate the multipurpose performance of this type of absorber and indicate its potential application in diverse applications, such as solar energy harvesting and thermal absorbing. Metamaterials are a type of artificially engineered electromagnetic material composed of periodically arranged sub-wavelength elements. They exhibit excellent properties and applications such as negative refractive index , opticalIn this paper, an independently tunable multipurpose single-layer GMA is proposed at mid-infrared frequencies. Two perfect absorption peaks are obtained; each resonant frequency can be independently tuned with a high absorption rate of 99% by varying the Fermi level of graphene under a set of resonators. The absorber remains effective over a wide range of angles under oblique incidence. In addition, multi-band and broadband absorption are observed when appropriately sized resonators are etched in the unit cell. All these results indicate that the proposed structure can be widely used in solar ray harvesting and thermal absorbing.d = 0.2 μm. Gate voltages Vg1 and Vg2 are applied to the two sets of graphene ribbons, and their Fermi levels are fE1 and fE2, respectively. The lengths of the resonator strips are l1 = 2.4 μm and l2 = 3.5 μm, and their widths are w1 = 0.48 μm and w2 = 0.7 μm. The periods of the unit cell are xP = 7.5 μm along the x direction and yP = 3.75 μm along the y direction. The dielectric layer has a thickness of 0.33 μm and comprises polytetrafluoroethylene with a relative permittivity of 2. The thickness of the ground plane is 0.3 μm, which is greater than its skin depth, ensuring that the transmission of electromagnetic waves can be completely suppressed. The relative permittivity of gold is defined as [A schematic diagram of the proposed GMA is illustrated in fined as :(1)εAu=1p = 1.37 × 1016 s−1 is the bulk plasmon frequency and γ0 = 4.08 × 1013 s−1 is the collision frequency.Here, ωσg, can be determined by the Kubo formula [fE > ħω/2), and the intraband contribution dominates the surface conductivity of graphene, while the interband transitions are negligible owing to Pauli blocking [The surface conductivity of graphene,  formula ,26; it cblocking . Conseque is the elementary charge, Bk is the Boltzmann constant, T = 300 K is the Kelvin temperature, ћ = h/2π is the reduced Planck’s constant, and ω is the applied angular frequency. Γ is the carrier scattering rate, which is kept constant at 2.4 THz for this study. cμ is the chemical potential, which is equal to the Fermi level of graphene when cµ > Bk.Here, σg as the Fermi level changes from 0.2 to 0.6 eV. It is evident that σg can be dynamically tuned by changing the Fermi level, which is highly convenient for designing tunable absorbers working within a specific frequency range. According to the Maxwell equations, Re (σg) is proportional to Im (εg), which represents the absorption losses in graphene [σg) when fE is changed. In addition, the spectral tuning can be measured by ∆Im (σg), which is explained in detail below.graphene . Thus, tAccording to the theory of multiple reflection and interference of the incident electromagnetic field, the absorption A (λ) can be obtained by A (λ) = 1 − R (λ) − T(λ), where R (λ) is the reflection and T (λ) is the transmission . Since tmin and λmax are the value of minimum and maximum wavelengths, respectively. Within the wavelength range from 4.5 to 13 μm, the value of E is 28.99% for the dual-band absorption structure. A larger value of absorption efficiency can be achieved via further reducing the wavelength range; the calculated E is 41.03% when the absorber works in the range of 6.5 to 11.5 μm. It should be noted that this range includes a large proportion of the atmospheric window which is the wave band with relatively high transmittance. The calculation means that nearly half of the incident light within the considered range could be absorbed. Therefore, the absorbers proposed in our research could acquire more of the incident energy, which will benefit the applications for light harvesting and thermal absorbing.Theoretical research on the proposed GMA was carried out using the finite elements solver COMSOL Multiphysics. When an s-polarized plane electromagnetic wave was incident on the double cross resonators, the absorption spectrum depicted by the solid curve in nversion . Here, λTo further demonstrate the absorption mechanism, a single-band absorber with one cross-shaped gold resonator was studied, as shown in x-axis direction, and those on the bottom flow in the opposite direction because of the reversed electric dipole moments. Consequently, a magnetic polariton (or “magnetic atom”) [y-axis. For both cases of wave incidence, the excited electromagnetic resonances confine and dissipate the electromagnetic energy in the absorber, resulting in perfect absorption close to 100%.In c atom”) ,31 is exc atom”) . For s-pfE1 increases from 0 to 0.6 eV, and the second peak with fE2 = 0 remains unchanged, as expected. fE1 and different fE2 values. Similar to the trend in the previous case, a blue shift evidently occurs for the second peak.The two absorption bands of the proposed GMA can be tuned as a whole or separately by different gate voltage loading methods on the two independent sets of graphene ribbons. As shown in fE1 and fE2 have the same increase from 0.4 to 0.6 eV, the absorption peak at the shorter wavelength shifts from 6.86 to 6.81 μm and that at the longer wavelength shifts from 10.37 to 10.22 μm. Assuming that the relative change in the resonant wavelengths is defined as δλ = 100 ×  denotes the graphene conductivity, W0 represents the stored electromagnetic energy in an uncovered metamaterial resonator. Thus, the spectral shift in the resonant frequency Re (∆ω) is related to Im (σg(ω)), and the corresponding amplitude modulation of absorption, Im (∆ω), is determined by Re (σg(ω)). The spectral shift is dominant over the amplitude modulation as Im (σg(ω)) > Re (σg(ω)), which is valid in the mid-infrared region [g(ω)) increases with wavelength for the same change in fE, as shown in It is important to note that the tuning efficiencies for the two resonance peaks are significantly different under the same variation in the applied gate voltages loaded on graphene; the second resonant peak exhibits a better response. For instance, when +λR2)/2 , the spe+λR2)/2 :(3)Δω=. The periods along the x and y directions are xP = 11.25 μm and yP = 3.75 μm, respectively. The other geometric parameters remain unchanged. In effε and effµ are the effective permittivity and permeability of the bulk multi-layer metamaterial. To satisfy the condition of matched impedances, the condition of effε = effµ is achieved by manipulating the spectral positions and strengths of the electric and magnetic resonances of the electromagnetic MAs [effε and effµ. The absorption peaks decrease slightly at 6.95 and 10.66 μm due to the mismatch between the dimensions of polytetrafluorethylene and the corresponding two resonators, resulting in an impedance mismatch between the structure and its surrounding [σg) at longer wavelengths for the same ∆fE.A triple-band absorber with three resonators of varied dimensions in the unit cell was designed, as shown in f vacuum ,36, wheretic MAs . The trirounding . Howeverl1 = 3.4 μm, l2 = 3.45 μm, and l3 = 3.5 μm, and their widths are wi = 0.2 × li . As depicted in Furthermore, a broadband absorber was designed using similarly sized resonators in the unit cell. As shown in In summary, an independently tunable multipurpose absorber with a single layer of metal-graphene metamaterials is proposed at mid-infrared frequencies. Compared with the previous work, the proposed dual-band absorber achieves independent tuning of two absorption peaks through reasonably designing the shape and arrangement of graphene and provides a flexible model for multi-band and broadband absorbers. The values of the absorption peaks are higher than 99%, and the structure does not hinder the wide-angle nature of MAs. The absorption spectrum is blue shifted when the Fermi level of graphene increases, and each resonance peak can be tuned independently. Triple-band and broadband absorbers were further achieved by appropriate design. The results of this study suggest that the proposed multipurpose structure can be widely used in light harvesting and thermal absorbing.


Tag questions are imperative, declarative, exclamative or interrogative statements that have been modified to include a question . Tag questions have been characterized as elderspeak because it suggests an expected response from the person with dementia, thus limiting his/her ability to make a decision independently. However, tag questions serve multiple functions in conversation. There is limited research on the multidimensional nature of tag questions in conversations between formal caregivers and their clients with dementia. Accordingly, the purpose of this study was to investigate the functions of tag questions used by formal caregivers in utterances coded as person-centered. Conversations (N= 87) between formal caregivers and a simulated person with dementia were video-recorded during a 5-minute care interaction involving morning care. Caregivers’ utterances were coded for the use of the following types of person-centered communication: recognition, negotiation, facilitation, and validation. During secondary data analysis, the person-centered utterances were analyzed for the use and function of tag questions. Conversational analyses revealed two broad functions of tag questions: gather information and facilitate a desired action. Tag questions used to gather information included the following specific functions: acknowledge response, establish common ground, state fact or opinion, initiate topic, conversational joking, state what is being done and questions. Tag questions that facilitated a desired reaction included the following specific functions: offers, advice and suggestions and requests and commands. Findings from the current study reveal that tag questions are not exclusively elderspeak and can be used to illicit conversation.


Although several reports indicate that the morphologic and electronic properties of the coating, as well as its surface features , play a key role in the biological interaction, these kinds of interactions have not been fully understood yet. In this review, we report and classify the cellular interaction mechanisms observed in graphene and hexagonal boron nitride (hBN) coatings. Graphene and hBN were chosen as study materials to gauge the effect of two atomic-thick coatings with analogous lattice structure yet dissimilar electrical properties upon contact with living matter, allowing to discern among the observed effects and link them to specific material properties. In our analysis, we also considered the influence of crystallinity and surface roughness, detailing the mechanisms of interaction that make specific coatings of these 2DMs either hostile toward bacterial cells or innocuous for mammalian cells. In doing this, we discriminate among the material and surface properties, which are often strictly connected to the 2DM production technique, coating deposition and post-processing method. Building on this knowledge, the selection of 2DM coatings based on their specific characteristics will allow to engineer desired functionalities and devices. Antibacterial coatings to prevent biofouling, biocompatible platforms suitable for biomedical applications  could be realized in the next future. Overall, a clear understanding on how the 2DM coating’s properties may modulate a specific bacterial or cellular response is crucial for any future innovation in the field.Two-dimensional material (2DM) coatings exhibit complex and controversial interactions with biological matter, having shown in different contexts to induce bacterial cell death and contribute to mammalian cell growth and proliferation  Other than being present in most of the Earth’s habitats, bacteria live in symbiotic and parasitic relationships with plants and animals. Bacteria are ubiquitous in mammals, and while they are necessary for the development of a balanced immune system, the disruption of microbiomes can negatively affect the health of an individual. Nowadays, bacterial pathogenic agents represent a major public health issue . The useAnother concern regarding bacteria is their adhesion to surfaces, and the consequent issue of biofouling. Biofouling refers to the formation of a biofilm consisting of a complex community of one or several microbial species on the surface of an object, which can impair its functionality, e.g., by promoting corrosion. Biofouling and related issues can cause damage to objects, equipment and structures, and often lead to significant financial loss . In the in vivo conditions. Suitable substrate materials should be able to guide cell growth and modulation, bioactive molecule delivery, physicochemical cue generation, while having similar mechanical properties to the native tissue  are a class of atomic-thick materials that are the subject of intense research efforts, motivated by a wide range of useful properties of high interest in several technological fields . In the 2-bonded carbon atoms arranged in a hexagonal lattice  are archetypal 2DMs that have drawn the attention of researchers . Graphen lattice   supports for monitoring and modulating excitable cell activity  new systems capable of inducing tissue regeneration or restoring cell-to-cell communication; (ii) specific diagnostic tools for the activity . Graphenactivity . Howeveraterials .Graphene and hBN have been recently found to induce specific cellular responses in different contexts. Taking into consideration the issues related to bacterial infection and the relevance of degenerative diseases, the different biological interactions of these materials can be exploited toward the following aims: (1) inducing bacterial cell death, e.g., to design medical instruments and mitigate the spreading of infections in hospital environment, and to produce anti-biofouling coatings ; (2) stiIn this paper, we reviewed the literature describing the various kinds of interactions that pristine graphene and hBN coatings respectively show with different bacterial species and different types of mammalian cells. Following this “Introduction,” the section “2DM coatings and cellular interaction” will report and comment on the main interaction mechanisms taking place when graphene and hBN coatings are used to interface bacterial and mammalian cells. The section “Coating applications” will then build on this by detailing the current and prospective applications for such coatings in the biomedical field. In the “Conclusion,” the main results and perspectives on the topic will be summarized.In this section, we report on the studied interactions between GBM coatings and bacteria, correlating them to the structural and electrical characteristics of the various coatings. Current literature on the antimicrobial mechanisms in GBMs such as GO and rGO, initially reported in 2010 , has beeIn the case of atomically smooth, CVD-grown graphene coatings, the main antibacterial mechanism is determined by its electronic conductivity  Lu et a. RegardiStaphylococcus aureus and Gram- (G-) (Escherichia coli) were used to investigate the antibacterial properties of monolayer graphene film on Cu, semiconductor Ge and insulator SiO2. The study showed that while graphene on Cu and Ge could inhibit the proliferation of both bacteria types, the same did not occur on SiO2 , where the bacterial cells will not be in contact with exposed flake edges, the antibacterial effects have been shown to arise from electronic conductivity of the basal plane, which induces cell oxidation without reactive oxygen species (ROS) production . This ef on SiO2 . On the ell wall . The conell wall . CVD-graell wall . Prolifereported . Usuallyreported .2 presented a wrinkled surface as a result from the differential thermal expansion on Cu. This situation, coupled with bilayer regions, and micrometric damages resultant from the transfer process, exposed the underlying SiO2 and contribute to the overall roughness of the material. They have observed that the coatings impact surface energy and electrostatic interactions with bacteria, decreasing bacterial adhesion through reduction of the expression levels of genes related to adhesion in Halomonas spp. CAM2, a typical biofilm producing species. In graphene coated SiO2, the substrate has a significant surface state density just below the conduction band, which donates electrons to graphene to balance the chemical potential at the interface. This leads to a n-type graphene coating, repelling negatively charged bacteria in solution, and to an observable decrease in wettability  have more consistently shown to induce the formation of pores in the cell membrane that lead to osmotic imbalance and death. However, the two types of cells attached to the control surfaces remained viable, contrarily to the two other types of fabricated graphene surfaces – rough (GN-R) and smooth (GN-S). The differences in bactericidal activity in the two surfaces can be accounted for by taking into consideration three parameters: exposed edge length (LGN), graphene orientation (θGN), and edge length density (dedge). GN-R exhibits a higher number of viable S. aureus cells due to its decreased edge density. S. aureus are smaller than P. aeruginosa, making it possible for them to colonize the free space between edges  physical insertion of the sharp edges in the membrane and subsequent extraction of phospholipids ; (2) proen edges .S. aureus biofilm formation was observed in samples with the smaller flake size (obtained with the longest sonication times)  . Besidesn times) . By fullin vitro (cell lines and primary cultures) and in vivo (rodent) models, the majority of them focused on the functionalized forms of graphene: GO and rGO , respectively  before neuronal seeding has been used by A controversial aspect, which is necessary to mention, concerns the common practice of pre-coating graphene-based substrates. The practice of pre-coating graphene with poly-Beyond the possible application in neurological diseases/disorders, graphene also represents an attractive material for non-neuronal tissue engineering. The possibility to use graphene as a platform that supports and promotes cell adhesion, proliferation, and maturation, pushed the researchers to investigate its interaction with non-excitable cells. Aiming at an extended knowledge about the interaction of graphene with mammalian cells, it is also useful to study how graphene can interact with cancer cells. In a way similar to its interaction with bacteria, graphene shows toxic effects when put in contact with tumor derived cells. Despite the need for further investigation in this field, in recent years some preliminary studies suggest the possibility to use graphene as anti-neoplastic agent. in vivo studies investigating the toxicology, distribution and clearance of graphene is gradually increasing. Nonetheless, the vast majority concerns the functionalized form of graphene, in particular GO, given its capability to better interact with the biological matter . Authors treated intravenously mice with graphene nanosheets at 20 mg/kg for 3 months and demonstrated that the material localized preferentially at the level of the reticuloendothelial system (RES), liver and spleen. Interestingly, graphene nanosheets were gradually cleared by both renal and fecal excretion. No significant toxicity was detected by blood analysis and histological examinations, leading authors to encourage further studies in this field  rats treated with control ambient air; (ii) rats treated with a low concentration of graphene (0.68 mg/m3); and (iii) rats treated with high concentration of graphene (3.86 mg/m3). No significant alterations were detected in animal and organ weight and in the levels of protein expression . Despite alveolar macrophage ingestion of graphene was observed in both material-treated groups, no severe toxic effect was detected at the concentration and time points used  and, in accordance with in vitro (HEK cells) and in vivo (zebrafish) toxicity of graphene and GO of three different sizes . Authors demonstrated that in vitro both the small and the large size of graphene and GO increased DNA damage, ROS formation and the expression of associated critical genetic markers. Injection of both graphene and GO in zebrafish induced ROS generation and developmental alterations. In general, a significant higher toxicity was reported for smaller size graphene (in particular for GO) that showed a stronger ability to decrease the survival rate and induce the acute toxicity , including other BN structures. m growth . Studiesm growth   bacteria. The results showed significant antibacterial activity  have dominated the vast majority of publications, leaving contrasting results, and unanswered questions . In recein vitro on a mouse hippocampal cell line (mHippo E14). Authors treated cells with hBN and its degradation product (BA), fixing the range of exposure at 4.4–440 μm/mL (for 24 and 72 h). No cytotoxic effects, no changes in cell cycle, ROS production and DNA damage were detected for hBN concentration lower than 22 μm/mL. In addition, both hBN and BA favored the cell survival after exposure to doxorubicin (an anti-neoplastic agent), by reducing oxidative stress (e stress  (Taskin e stress .® CRL 2120TM) and Madin-Darby canine kidney cells. At the highest concentration of 0.4 mg/mL, the hBN NPs caused mild cytotoxic effect on CRL-2120 cells  had higher uptake capacity when compared to human dermal fibroblasts, explaining the different proliferation effect of hBN in these cell lines. Nevertheless, improvement of proliferation and migration in both types of cells was observed. Angiogenesis ability of HUVECs treated with hBN showed promising results. Additionally, it was found that hBN might also improve the wound healing process by lowering ROS due to its antioxidant capacity, similarly to BA; it was found that hBN can rescue cells from apoptosis, and that at low concentrations, it did not depolarize the mitochondria nor disrupt F-actin formation .in vivo in Wistar albino rat subjects. Biochemical, hematologic and histopathology parameters were examined for 24 h after intravenous injection of different doses of hBN NPs. Hematological and biochemical parameters showed no changes except in the 1600 and 3200 μg/kg dose groups. Histological detections on these groups indicated the hBN NP treatment induced significant damage in the liver, kidney, heart, spleen, and pancreas. The results also indicated that hBN NPs with diameter of 121 nm could hold promise in biomedical applications, where low doses between 50 and 800 μg/kg are not toxic (+). Cell viability tests confirmed that hBNs do not exhibit neurotoxic effects. Flow cytometry analysis determined that hBN significantly decreased apoptotic cells in the experimental PD model  formed separated islands. In addition, MSCs seeded onto graphene showed a spindle-shape morphology, allowing a higher proliferation with a possible differentiation toward osteoblast lineage. On the contrary, MSCs plated onto SiO2 presented a more polygonal cell shape, typical of non-differentiated cells. Author also tested the cell adherence and concluded that cells plated onto graphene showed a weaker and smaller contact with the support, corresponding to an active state of the cells  showed rounded and irregular morphology, probably due to the poor adhesion. By adding in the maintaining medium a protein cocktail to favor osteogenic differentiation, the cells plated onto the graphene uncoated supports did not express protein markers of differentiation after 15 days of treatment; on the contrary MSCs plated onto graphene coated substrates remarkably differentiated into osteoblasts at a comparable rate to the differentiation with the bone morphogenic protein-2 (BMP-2) (in vivo effects of a CVD-grown monolayer graphene-coated Ti disks implanted in the back subcutaneous area of nude mice. Authors incubated in vitro human adipose-derived stem cells (hASCs) and human bone marrow mesenchymal stem cells (hBMMSCs) on the top of their support before implanting them into the mice. No evident in vivo toxicity was reported; in addition, they demonstrated that CVD graphene favored cell adhesion, proliferation and differentiation toward an osteogenic faith, in accordance with in vivo osteogenesis and the molecular mechanisms at the base of this process. Authors generated MSC-impregned graphene scaffolds and implanted them into immunocompromised (SCID) mice at 28 days of life. Without the addition of any osteogenic inducers, graphene scaffolds were able to promote osteogenic differentiation of MSC by increasing the expression of bone-related markers (RUNX2 and OPN)  analyses and histological observations were performed. Authors demonstrated that microstructure parameters  and the new bone formation were significantly enhanced in animals implanted with the graphene-coated Ti6-Al4-V (he cells . Nayak e (BMP-2) . In addi (BMP-2) . Liu et and OPN) . Li K. ei6-Al4-V .Due to its biocompatibility and electrical properties, graphene has been regarded as an advanced and viable interface for enhancing neuronal activity or improving the record of electrical cell signal. Li et al. demonstrated that CVD graphene is able to promote neurite sprouting and outgrowth (associated with a significant increase of GAP-43 protein expression), concluding that the graphene-coated substrate could have a prominent impact on the cell early developing stages . In accoThrough a theoretical approach, they speculated that monolayer graphene effects on neurons might be maximized when graphene is deposited in an electrically insulation support , compared to a suspended condition. Authors concluded that the alteration in the spontaneous synaptic transmission could be justify by the different ratio between cells with adaptive/tonic phenotypes. Notably, authors did not exclude a potential contribution of astrocytes in the surface ion concentration alterations, since astrocytes are able to regulate the extracellular medium between neurons and the substrate .per se is not sufficient to promote the electrical activity of neuronal networks, suggesting that other material features  have to be taken into account in the design of future graphene-based implants . The hippocampal neuron cells exhibited healthy morphology and spontaneous electrical activity after 19–21 days in culture. The electrical measurements did not harm the cells. The performance of the GFETs degrades slightly with time , by creating a suitable microenvironment for the stem cells. When interfacing neuronal stem cells, a graphene coating is able per se to boost neurite sprouting and maturation and, when interaction with mesenchymal stem cells, drive their maturation specifically toward osteoblast or cardiomyogenic lineage in both in vitro and in vivo systems. Besides its ability to favor stem cell maturation, when interfacing excitable cells, monolayer graphene films revealed also to enhance synaptic transmission by increasing spontaneous intracellular Ca2+ spikes and neuronal firing by altering extracellular K+ concentration. Traditionally, authors attributed these phenomena to the high electrical conductivity graphene. However, this feature alone is not enough to promote the electrical activity of neuronal networks, and hence other characteristics of the coating  must be considered when designing graphene-based interfaces and implants. As a final and crucial remark, the in vivo biocompatibility of graphene is still debated. Few works reported in the last decade alert about the possible in vivo toxicity of graphene and its derivatives. A peculiar aspect that troubles the scientific community regards the possibility of graphene to permanently deposits in the organs , causing chronic inflammatory processes. Nonetheless, the long-term persistence of graphene in the organisms has not been clearly demonstrated and in most of the cases the toxicity reduces over time; in addition, phenomena of graphene clearance through feces has been reported. On the other hand, the possibility to use 2D graphene as an in vivo therapeutical tool is still an open question. Graphene-coated prosthesis has been successfully employed to favor bone tissue regeneration; in addition, cancer cell aggregations seem permeable to graphene sheets and capable to retain them. This interesting phenomenon leads researcher to investigate the possibility to use graphene in the antineoplastic therapies.With regards to mammalian cells, CVD graphene coatings produced revealed to be highly suitable for cell interfacing. Nonetheless, no universal consensus exists yet on the physio-chemical mechanism underlying the favorable interaction between cells and graphene, despite some authors attributed the excellent biocompatibility to the absence of ROSs formation or to the capability of graphene of directly interacting with specific molecules in the mammalian cell membrane . Overall, the absence of an evident As a partial conclusion about the mechanisms of interaction with the two kinds of cells, we underline that although a graphene coating in certain conditions can induce bacterial cell death, the mammalian cells seem to be generally unharmed by it. Based on these interactions, applications for graphene have surfaced. CVD graphene coatings have shown to be able to hinder bacterial adherence and coating due to electrostatic interactions at the surface. Additionally, its lattice size allows it to be impermeable to Cu and Ni ions, blocking the bacteria at the surface to metabolize the substrate. CVD graphene has also been used for sensing applications in neuroscience and medicine in the form of sensors, wearable devices and scaffolding due to its softness, electrical conductivity, and biocompatibility.Due to the limited availability of literature regarding hBN coatings and their interaction with bacteria and cells, we have reviewed not only cases where this material was deposited on a substrate, but also those investigating its behavior in liquid solutions and in nanocomposites, in order to provide a more comprehensive overview. In the case of 2D hBN coatings, studies conducted experimentally with LPE samples and via simulations showed antibacterial effects related to the exposed flake edges (as shown for graphene), which promoted cellular membrane disruption and temperature-dependent lipid extraction. However, studies conducted in atomically smooth hBN coatings  have revealed no antibacterial activity of the basal plane, further highlighting the role of a sufficiently high electrical conductivity in bacterial death. Electrostatic interactions seemed to contribute toward an inhibition of bacterial adhesion. Despite their markedly different electrical conductivity, both graphene and hBN coatings have shown to be effective against biocorrosion of metal substrates by reducing the number of adhered bacteria, with the reduced cellular adhesion being consequence of the atomic smoothness of the coatings. In both cases, the small lattice size in graphene and hBN allows them to act as impermeable barriers, blocking the migration of aggressive metabolites and avoiding biocorrosion of the underlying metallic substrate.With regards to mammalian cells, hBN has shown to be cytotoxic in liquid solution above certain concentrations and in a shape-dependent manner. Cytotoxicity studies conducted with hBN in liquid solution for different nanoflake sizes show that when the size is small enough it becomes possible for mammalian cells to internalize them and cause an increase in ROS production. Overall, 2D hBN materials have shown promise in bone tissue scaffolding, wound healing, and treatment of neurodegenerative diseases such as Parkinson’s. For further understanding the potential of this kind of materials, the cytotoxicity will need to be ascertained to address some of the inconsistencies present in literature.In conclusion, the current scenario suggests that, notwithstanding the substantial amount of studies in the field, further investigation is still needed before two-dimensional materials such as graphene and hBN can fulfill their potential in advanced biomedical applications. This is particularly true in the case of hBN, where most interactions with living matter still needs to be understood and detailed.JS and MM: data acquisition and writing original draft. JR: data revision and support on writing. PA: data interpretation and evaluation. AC: conceptualization, coordination, writing, and funding acquisition. All authors: final writing.The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.


Since 2016, the European Region has experienced large-scale measles outbreaks. Several measles outbreaks in England during 2017/18 specifically affected Romanian and Romanian Roma communities. In this qualitative interview study, we looked at the effectiveness of outbreak responses and efforts to promote vaccination uptake amongst these underserved communities in three English cities: Birmingham, Leeds and Liverpool. Semi-structured in-depth interviews were conducted with 33 providers involved in vaccination delivery and outbreak management in these cities. Interviews were analysed thematically and factors that influenced the effectiveness of responses were categorised into five themes: (1) the ability to identify the communities, (2) provider knowledge and understanding of the communities, (3) the co-ordination of response efforts and partnership working, (4) links to communities and approaches to community engagement and (5) resource constraints. We found that effective partnership working and community engagement were key to the prevention and management of vaccine-preventable disease outbreaks in the communities. Effective engagement was found to be compromised by cuts to public health spending and services for underserved communities. To increase uptake in under-vaccinated communities, local knowledge and engagement are vital to build trust and relationships. Local partners must work proactively to identify, understand and build connections with communities. Measles is a highly infectious and potentially fatal viral infection which can be prevented by immunisation with the two-dose measles, mumps and rubella (MMR) vaccine . InsuffiSince 2016, the European Region has been affected by large-scale measles outbreaks. There were 83 540 measles cases and 74 measles-related deaths in the World Health Organisation (WHO) European Region in 2018, compared to 5273 measles cases and 13 measles-related deaths in 2016  so much confusion at the start…about whether we were talking about Roma communities or Romanian nationals. They are clearly not the same groups. They have very distinct cultural behaviours. Language issues. Religious influence. Cultural behaviours; and that all drives their engagement in the healthcare system…. there are [also] sub-groups within the populations.’ (Provider#11)At the start of the outbreaks, providers believed that the preferred language of community members would be Romanian. In some instances, this was this case, but many Romanian Roma do not speak Romanian as their first language  and literacy may also be a barrier.Within each city, several providers reported that as the outbreaks unfolded, they knew very little about the Roma and Romanian communities affected. In many instances, providers had not made a distinction between Roma and Romanian and the terms were sometimes used interchangeably.Views from several providers inferred negative attitudes towards the communities. Some interviewees did not comprehend why community members may be distrustful of healthcare professionals and have different beliefs around health. Without having context to the history of discrimination and persecution towards Roma, healthcare professionals instead became frustrated in trying to reach the communities.‘It made a big difference to who was round the table because it meant then that when I started phoning around to get people to come to the outbreak meeting, we got the right people. So, we got the manager of the Children's Centre where the Roma population [go]. We got one of the practice managers from one of the local practices. We got somebody from the local school that's 65% Roma, so we got the right people there.’ (Provider#28)Poor understanding of communities and factors affecting vaccination impeded effective strategies to manage the outbreaks. Understanding the communities was crucial to effective outbreak management.‘Perhaps we need to think about [an integrated] model of working with our local authority partners…. Rather than, “That's your job. That's your job,” Where there's overlap no one's really doing it, no one's coordinating it, and then it becomes very much, “You didn't do this. Why didn't you do that?” rather than, “How can we make this happen?”’ (Provider#16)In a few instances, communication difficulties were reported between PHE teams and frontline healthcare professionals. PHE teams had little power to enforce some of the recommendations as part of the outbreak (e.g. such as requesting busy GPs to support contact tracing for patients sitting in the surgery). In one city, PHE communication with hospitals was difficult due to large numbers of cases being reported, admitted and requiring extensive contact tracing.‘….in hospitals there were issues with communication, certainly, because they weren't notifying us. We ended up with a system where we would contact them every day to ask them, “Do you have anybody who's been tested for measles?” Whereas, it should have been the other way around.’ (Provider#16)Trying to mobilise responses, considering competing pressures on services, was also problematic.‘…. Who's paying for it all? That was our main beef with the GPs. We, as an organisation, would tell them, “We need this Public Health action to happen,” but the GPs would come back and say, “I haven't got the time, I haven't got the staff or resources, …”’ (Provider#15)In one city, efforts between partners were easier to define and co-ordinate the following lesson learnt in a past outbreak, in the same population and postcode area.‘….we were lucky in Leeds actually because we'd done a lot of work last year around roles and responsibilities in response to an outbreak, so actually we had a lot of shared understanding about right, well the CCG's role is this, the PHE's role is this, the local authority role is this. It made life a lot easier’ (Provider#1)In some instances, providers reported that there were challenges in identifying responder roles and responsibilities and promptly co-ordinating efforts.To prevent further outbreak spread, HPTs worked to trace the contacts of measles cases. HPTs in each city communicated with cases over the phone to ascertain the number of contacts, number of children in the household, travel history and length of stay in the country. However, interviewees reported that getting this information was problematic, particularly over the phone, given language barriers and a lack of community member trust in healthcare providers.‘We had minimal [engagement] because the outbreak started around November and as coincidence would have it, the Roma outreach support service that the local authority commissioned from the Red Cross; that ceased in November. I don't think it was a link, but it was just unfortunate timing, so it meant we had no real outreach apart from the [City Council] education team outreach that they do.’ (Provider#11)Providers reported outreach approaches, such as door-to-door knocking, using mobile vaccination vans and offering vaccinations in community centres, as effective in increasing vaccination uptake. Key to the effectiveness of out-reach strategies was being able to take advantage of pre-existing links and established trust with the communities.Though two of the cities reported good links with communities, providers in one city noted some difficulties. In addition, the lack of formal outreach mechanisms impeded the response.part of the community not the establishment’.‘we put on a community meal in the evening in the Children's Centre. Now [the Children's Centre manager] does that regularly so she feeds these kids in school holidays because if they don't get a school dinner, they go short. So that's not unusual…. We just blitzed the area with flyers, that our Romanian Consultant translated… we immunised 80 children on the Monday night in about two-and-a-half hours.’ (Provider#28)Other approaches used by providers, which may well have worked with other communities, such as putting on additional clinics in GP and incentivising GPs to vaccinate, were less successful. This was largely linked to the lack of community engagement with GP.Vaccination in the community centre in Liverpool was particularly effective as the centre was considered ‘In Birmingham, providers had looked to outbreak responses used in Liverpool and Leeds but felt that vaccination through children's centres would not work for their communities, as Romanian and Roma families were reportedly not accessing them.‘…. The biggest problem we think exist is if you send them pre-booked appointments, so if you get them to book an appointment that just does not work; they don't live like that. …. even if they've booked them themselves, it doesn't work, they did not attend (DNA) rates are very high.’ (Provider#12)Some providers discussed using points of engagement with community members for vaccination to also promote registration with GP. This approach was more straightforward in Liverpool when the centre used for vaccination was within easy proximity of a GP.‘…. The evening we did the meal and immunising, we were also literally taking people by the hand to register at the GP practice while we had them.’ (Provider#28)Overall, the most effective approaches to outbreak management were multi-faceted and relied on insight into the communities.‘…. that triple-pronged approach, so doing the schools, the GP practices, and the community at the same time helped sort of bring it all together in some way so you're targeting different parts of the population.’ (Provider#1)It was evident, in speaking with frontline healthcare providers, that in each city there were real attempts being made to engage with Romanian communities, e.g. employing Romanian speaking receptionists, sending letters and SMS messages in Romanian, holding additional clinics and trying outreach approaches. Providers in the three cities highlighted that encouraging communities to access GP was particularly difficult, and that the system of booking future appointments was often ineffective.Face-to-face communication was seen as key to successful engagement. However, participants reported difficulties in sourcing and funding translators and interpreters. Finding Romani speakers was nearly impossible, given the absence of professional Romani interpreters, and prompt access to Romanian speakers could prove difficult. In one of the cities, leaflets had been developed in Romanian but the interpreters stated that the wrong dialect was used in these.don't have time to get an interpreter’, or using Google translate during consultations. This raised concerns that messages would be lost in translation, even with the use of telephone interpreters through LanguageLine.‘…. You sometimes wonder what the Language Line is actually saying, because you're trusting their interpretation. Sometimes the patient looks totally confused with the Language Line.’ (Provider#14)In several instances, participants had appealed to the help of charitable and community organisations and relied on their goodwill to provide translators and interpreters, or ‘fallen lucky’ in having Romanian speakers within their teams.In community and GP settings, several participants discussed using hand gestures to communicate when they ‘Participants working in PHE HPTs also struggled with language barriers, particularly as their work was reliant on over-the-phone communication with people diagnosed with measles and they needed to ask personal questions.‘…. The system is so biased in or towards practices in nice leafy-green areas with English [speaking] people because, you know, that our nice or well-off end but we hit 90 percent vaccination with no trouble at all. We don't have to do anything. Whereas there we spend a huge amount of effort and money and time and we hit about 77 percent.’ (Provider#12)Trying to improve vaccination uptake with underserved communities was considered resource intensive . The focus of the immunisation target payment system on outcome, rather than process, meant that providers felt penalised for not reaching targets even when they ‘work so hard for immunisations’. Providers also felt that this could lead to reduced vaccination call-recall efforts.GPs receive financial payments for administering childhood vaccinations, based on achievement against a 70% or 90% uptake target for children at 2 and 5 years. Practices achieving the 90% target secure the highest financial payment. GPs that served populations with greater barriers to health service found it difficult to achieve the higher immunisation target.‘…a few years back [we] had community link workers and their job was to engage with communities and provide them with help and support so that trust develops. So, over the years when the economic crunch happened, they were the first ones, unfortunately, to get their jobs cut. So, when the outbreak happened there were no link workers as such. So, we were stuck, because the local authority had no contact, or very minimal contact with these communities’ (Provider#17)With the cuts, there were frustrations about lost opportunities to discuss and administer vaccinations.‘….we used to run our baby clinic and we used to have health visitors or school nurses in alongside us and that worked well and we got people who just came for weighing who we could then immunise. But they've since moved all of those people out, they say they've not got enough resource to have these people in here. So yet again….the changes and the cuts in the system are actually having the impact’ (Provider#4)Several participants reported cuts to community link services  as a major factor affecting the ability to engage with the communities during the outbreak. This was considered short-sighted and not cost-effective in the long run.We found that improving MMR vaccination uptake and effectively managing measles outbreaks relied on (1) being able to identify and understand undervaccinated communities, (2) having links with undervaccinated communities and using appropriate approaches for community engagement, and (3) working with local partners to co-ordinate efforts. These three factors were found in turn to be largely dependent on available funding and resources, and efficient and creative partnership working. The research has highlighted the importance of having clear financing and working arrangements in place to respond to outbreaks.One of the first challenges that providers faced was being able to identify under-vaccinated communities, particularly those not accessing GP or the school system. In 2017/18, 48.5% of Gypsy/Roma children in England were persistently absent from school . The onlOne resource that could be used by providers to bring a range of existing datasets together to identify under-vaccinated communities is the Strategic Health Asset Planning and Evaluation (SHAPE) Atlas . SHAPE aOnce at-risk communities are identified, it is important that providers use appropriate engagement approaches to promote vaccination . KnowingOutreach approaches appeared to be needed, at least in the short-term, to develop trust and links with communities which can be used to promote access to GP and to other vaccinations. It was noted by providers that although their efforts during the measles outbreaks were focused on improving MMR vaccination rates, there were also concerns about sub-optimal coverage for other vaccinations.We found that providers were severely limited by resource-constraints, including access to translators and interpreters, community link workers and community organisations. Resource constraints can be linked to changes introduced under the Health and Social Care Act 2012 when public health responsibilities shifted from national to local government . Public In general practice, providers felt that their ability to engage with and improve uptake in underserved communities were exacerbated by an immunisation target payment system focused solely on outcomes and not process. Immunisation target payments for GP are currently under review by NHS England, with a focus on trying to reduce inequalities in vaccination , 46. OveChallenges were voiced by general practice providers in tailoring culturally appropriate approaches to an increasingly ethnic diverse population. One recommendation that emerged from the interviews was to try and share more resources, such as translators and interpreters. It was also highlighted that more opportunistic vaccination or reminding about vaccination should take place, e.g. flexibility in giving vaccinations when a child presents in general practice for another reason.Cuts to health visiting and school nursing teams also appear to have had an impact on maintaining links with underserved communities and the capacity to promote access to GP and vaccination. Short-sighted cuts to services have negative economic, societal impacts and public health impacts , and alsThere is a limited evidence base on interventions to improve vaccination amongst potentially underserved groups, including Roma  and migrMaking measles history together – contains a set of prompts to action focused on reaching undervaccinated communities by drawing on existing third sector and local authority resources [The measles outbreaks in 2017/18 served as a wake-up call to reach undervaccinated communities. The GP contract now includes a check of MMR status for 10- and 11-year olds , and lesesources . The resesources . DevelopFindings from our study may be applicable to other underserved communities, particularly those not accessing general practiceor the school system, who may be unfamiliar with vaccination delivery in the UK and experience language and literacy barriers.The quality of the study was enhanced through the use of interviews with providers across three different outbreak settings to corroborate findings and develop a greater understanding of effective approaches to identifying and engaging with underserved communities. However, there were some limitations. Although we recruited a range of providers in each city, the range varied between cities. The study also did not focus on how the outbreak responses were funded. Future research should look at which partners fund activities and how funding decisions are made.Interviews for this study were limited to providers; however, in preceding studies, we have included Romanian and Roma community members to explore factors affecting vaccination uptake , 30.Our study identified partnership working and community engagement as key to the prevention and management of the 2017/18 measles outbreaks that specifically affected Romanian and Roma communities. Without prior understanding and linkage with Romanian and Roma communities, it was difficult for providers to identify and access communities, who may not trust providers. Cuts to public health spending and the provision of services for underserved communities, including under-vaccinated Romanian and Roma communities, have far-reaching implications for reducing inequalities in vaccination.To increase uptake in under-vaccinated communities, such as the Romanian and Roma communities in this research, local knowledge and engagement are vital to build trust and relationships. Local partners must work proactively to identify, understand and build connections with communities. Approaches that appeared to work best in reaching the Romanian and Roma communities in the outbreaks were multi-faceted, involving GP practices, schools and most importantly community representatives.


Several methodologies have been proposed to determine turn switches in alpine skiing. A recent study using inertial measurement units (IMU) was able to accurately detect turn switch points in controlled lab conditions. However, this method has yet to be validated during actual skiing in the field. The aim of this study was to further develop and validate this methodology to accurately detect turns in the field, where factors such as slope conditions, velocity, turn length, and turn style can influence the recorded data. A secondary aim was to identify runs. Different turn styles were performed  and the performance of the turn detection algorithm was assessed using the ratio, precision, and recall. Short carved turns showed values of 0.996 and 0.996, carving long 1.007 and 0.993, drifted 0.833 and 1.000 and snowplow 0.538 and 0.839 for ratio and precision, respectively. The results indicated that the improved system was valid and accurate for detecting runs and carved turns. However, for drifted turns, while all the turns detected were real, some real turns were missing. Further development needs to be done to include snowplow skiing. Turn detection in alpine skiing has been a topic of growing interest over the last 15 years. Turns are the basic unit required for detailed analysis or interpretation of skiing data such as edge angle, symmetry, or turn phases  sensor technology has been proposed as a promising alternative approach  to further develop and validate the algorithm of Martínez et al.  in fieldFor the validation and development of the turn detection algorithm, an experiment was designed where an IMU was attached to each ski boot  volunteered for the study. All participants were expert skiers, with experience as ski racers or ski instructors. Before the measurements were conducted, they were informed in detail about the testing procedure, as well as possible benefits and risks of the investigation prior to signing the consent form approved by the local Ethics Committee (EK-GZ: 11/2018). The experiment was conducted in accordance with the Declaration of Helsinki.An IMU  was placed in the back of the upper cuff of each boot . The X axis of the IMU was aligned with the vertical axis of the boot (yaw) pointing superiorly, the Y with the lateral axis (pitch) pointing to the left, and the Z with the anterior-posterior axis (roll) pointing posteriorly . The IMUIn order to define reference turn switch points and determine the proper detection of turns , all runs were recorded with a camera  with a sampling rate of 25 Hz. The camera was placed on the skiers' chests using an adjustable chest harness, and positioned such that the field of view included both skis, boots and the surrounding area.Video data was analyzed by experienced raters, labeling relevant events or context, such as turn switch point, turn direction, or jump. Turn switch points in the video analysis were defined as the frames where the surfaces of the skis were flat on the ground. Video and sensor data were synchronized using a jump event at the beginning and end of each trial. The jumps were detected in the vertical axis of the accelerometer and synchronized with the frame at landing. For validation, the actual turns obtained by the video analysis and the number of detected turns were used. The detected turns were computed by applying the turn detection algorithm  ratio, (2) turn count precision, and (3) recall (see below). All steps of evaluation  were conducted in a blinded procedure.Ratio: the quotient between the number of turns detected by the algorithm and the number of turns labeled in the video data (see data see . If the Turn count precision (P): the proportion of turns detected by the algorithm that are actual turns (see Equation 1).Recall (R): the proportion of actual turns detected by the turn detection algorithm (see Equation 2).In all metrics a value of 1 means a perfect performance.To calculate the turn count precision and recall values, the following metric were determined :True positives are determined by a detected turn that was an actual turn (based on video). A correct detection is characterized by the correct turn direction (either left or right turn) and by the difference in time between the detected and the actual timestamp. If the time difference is smaller than half the mean duration of actual turns (for a run), it is a true positive.False positives reflect the number of detected turns that are not actual turns.False negatives are the number of actual turns that are not detected by the turn detection algorithm.Where P is the turn count precision, TP the true positives, FP the false positives, R the recall and FN the false negatives.The purpose of the following algorithm was to determinate turn switches and sequences of parallel skiing turns. To keep the algorithm simple, it was assumed that a turn switch is a single point in time where both skis change from the uphill to downhill set of edges simultaneously. The performance metrics and video recordings were used to evaluate the performance of the current algorithm iteration  and detect weaknesses.roll smooths unilateral rotations. In the next step, a fourth-order zero-lag 0.5 Hz low-pass Butterworth (BW)  that describes the rotation rate in the roll axis . The left graph shows a sequence of nine carving turns , the right graph a sequence of 16 short turns (turn duration 1.04 ± 0.41 s). The minus before ωroll flips the positive direction to anterior in agreement with the movement direction. The extrema indicate possible turn switches, whereby the sign of a value in ωds determines the turn direction. As Switch: This kind of local extrema indicates actual turn switches from left to right or right to left.Noise: Local extrema that happen within a turn are called noise. If a skier performs turns with longer duration , the decision signal ωds shows some artifacts as saddle points or small counter oscillations , opposite sign and a time distance >0.3 s and smaller than 5.0 s then label both as switch.Noise: Look at each sequence of four consecutive local extrema: If both outer extrema fulfill rule 1 and both inner local extrema not and if the rotation rates in abs(ωds) of the inner are smaller than the outer then label both inner as noise.Eliminated:switch or noise and if the rotation rate is smaller than a threshold then label as eliminated.Look at each local extrema: If it is not labeled as switch, noise or eliminated and if it has the same sign in ωds as its predecessor then label as eliminated.Look at each local extrema: If it is not labeled as switch, noise, or eliminated apply a decision tree (see below) to label it as eliminated or not.Look at each local extrema: If it is not labeled as switch, noise or eliminated and if the predecessor and successor are eliminated then label as eliminated.Look at each local extrema: If it is not labeled as switch, noise, or eliminated then label as switch.Remaining: Look at each local extrema: If it is not labeled as Decision tree (3c): the goal of the machine learning task was to obtain a simple rule that removes all remaining local extrema outside a turn sequence because these local extrema should have the label eliminated. If we do not have such a rule, rule 4 cannot be applied. A decision tree was trained by means of machine learning. The intent of the decision tree was to discriminate for each local extrema between the classes within a turn sequence or not-eliminated and outside a turn sequence or eliminated. Data were labeled by manually defining the time ranges of the turn sequences, and a cross-validation was used to avoid overfitting the decision tree. Obvious features as roll, ωds, ωds , its absolute values abs(ωds) and t were used to search the most expressive features. The result was the decision tree: abs(ωds) ≤ θ1 ∧ t ≤ θ2 → eliminated. That means that the absolute value ωds and the t  were identified by the machine learning task as most expressive. The variables θ1 and θ2 are the modeling parameters of the machine learning model thresholds.TSds,n, ln))n∈ℕ. Next, the algorithm derives the turns  from the sequence TSds,n. The timestamps tstart and tend are the start and the end of a turn (turn switch points), the value d ∈ {left, right} indicates turn direction and s∈ ℕ is the number of the turn sequence to which the turn belongs )m∈ℕ (m < n), the algorithm iterates through the sequence and merges consecutive extrema with label switch to a turn if and only if they are no interruptions from local extrema with label eliminated. This rule produces a continuous turn sequence with tend,i−1 = tstart,i. Local extrema with label noise (per definition “within turn”) were ignored because they do not interrupt a turn. Eliminated local extrema (per definition “outside turn”) indicate an interruption of a consecutive turn sequence and causes tend,i−1 ≠ tstart,i and si = si−1 + 1. The previous heuristic rules ensure that in a turn sequence each switch is followed by a switch with opposite sign, even in case were local extrema with label noise are between. A strict alternation of the sign is necessary because otherwise there is no alternation of left and right turns, which is not obvious.The result of the previous step is a turn sequence (TS) of labeled local extrema  belongs . The valsi−1 + 1 . The stafc = 3.0 Hz is a proper cut-off frequency to perform such a “fine tuning.” Therefore, a new fine tuning signal is defined by ωft = BW3.0(−ωroll) , li) the global maximum or minimum in ωft in a time window (an asymmetric ε neighborhood) around the turn switch timestamp ti. The algorithm “fine tunes” only local extrema labeled as switch and defines the global maximum or minimum p ∈  defines the size of the asymmetric ε neighborhood (ti − p(ti − ti−1), ti + p(ti+1 − ti)].The decision signal is a strongly smoothed signal. The rotation rates represent the general rotation behavior of  turning during skiing. The degree of smoothing between raw and decision signal can be observed in (−ωroll) . Then thhborhood : [ti − pp = 0.6. Finally, the fine tuned turn switches, turns and turn sequences are based on the sequence t in Tds,m with t′.For the succeeding evaluation we use 60% for the ε neighborhood, thus The results of the turn detection evaluation for each skiing style  are shown in Investigating the turn precision measures of the algorithm for carved turns, almost all detected turns were correctly detected (turn precision was higher than 0.993 for both turn sequences). The recall measures were also high with values >0.990, which indicates that almost all actual turns were detected by the algorithm.The purpose of this study was to develop and validate a turn detection algorithm for parallel alpine skiing turns in the field. The assumption that a turn switch is a single point in time where the edge changes simultaneously for both skis is not too critical if the turns have seamless transitions, and the skier performs parallel styles. Conversely, the algorithm is not able to count all turn styles accurately. For example, snowplow and drifted turns with low dynamics or straight piste crossings cause problems. However, the proposed methodology was aimed at continuous turn sequences of parallel style turns, as carved turns are usually the main subject of interest.For validation, tests were performed by several subjects with diverse techniques, turn lengths, and snow conditions. The instructions for the different turn lengths aimed to define different types of turns  while allowing the participants to perform slightly different turns. We believe that not having an exact turn length adds an extra variability that is beneficial to develop a more robust algorithm. The natural variation in snow conditions across the 4 days of testing provided an additional layer of variability, adding to the robustness of the algorithm. The results of 374 carved turns  prove the validity and robustness of this turn detection algorithm for this particular turning technique. Misdetections during carved turns were only observed at the beginning of the turn sequences; however, they were mostly counted correctly. The three different options observed for the initial turn detected in a turn sequence are shown in Ratio and recall for drifted turns  were lower than for carved turns. The turn detection algorithm worked properly for all participants but four. For those participants, the missing turns were not isolated but consecutive . All those turns had some common characteristics. They were longer slow turns, which produced a less dynamic movement, and consequently were more affected by the snow conditions, in those cases, bumpy surfaces. The algorithm is prepared to recognize and cancel some noise see ; howeverAlthough the algorithm was developed for parallel turns, the performance during snowplow steering was also evaluated. While the turn count precision was acceptable, ratio and recall were unacceptably low . As expected, most of the detected turns were actual turns, but many real turns were not detected. The snowplow turning style is completely different than drifted or carved turns. The legs do not have synchronized rotation rates in roll axis. The main movement does not rotate around the anterior-posterior axis, but around the vertical axis. Consequently, an algorithm that only takes into consideration the anterior-posterior axis might not be the most effective approach. However, snowplow turns are usually turns during learning and they are not used very often in everyday skiing. Thus, the focus on parallel turns is obvious, at least from a practical perspective. Further development, probably including a combination of more than one axis or a turn style detection system, would be needed for the automatic detection of snowplow turns.Over the different iterations of the development process, modifications were included in the algorithm. These modifications were needed in order to cope with signal features that differed between in-lab  in alpine skiing with an accuracy of 95.3%. For carving turns, the algorithm is able to accurately detect 99.7% of actual carving turns. The algorithm is based only on a single axis of gyroscope data. Simple IMUs, securely mounted on both ski boots, provide sufficient data for the segmentation of time series signals into both turn sequences and single turns. Both are very convenient data structures for further analysis tasks. The approach is applicable for in-field studies because the devices do not disturb skiing and the algorithm is fully automated. Further research is needed to assess the performance of the system for skiers with different skill levels, or to include the detection of other turn styles, such as snowplow turns.The datasets generated for this study are available on request to the corresponding author.The studies involving human participants were reviewed and approved by Ethics Committee of the University of Salzburg. The participants provided their written informed consent to participate in this study.TS, RJ, and RB: conceptualization and investigation. TS, RJ, RB, MB, and AM: methodology. RB and MB: software. AM, VV, CT, and CS: validation. RB, MB, VV, and AM: formal analysis. TS and RB: resources. RJ, RB, and VV: data curation. AM, RB, and VV: writing-original draft preparation and visualization. CS, RJ, MB, TS, VV, and RB: writing-review and editing. TS: supervision, project administration, and funding acquisition.The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.


In this study, we show the synthesis of reduced graphene oxide/hydroxyapatite (rGO/HA) composites using a hydrothermal autoclave with argon-15% hydrogen gas injection. This both increases the hydrothermal pressure and uses hydrogen as a reductive agent in the process. The synthesized powders were then consolidated with spark plasma sintering method. The analysis of the consolidated samples included Vickers Indentation technique and cell viability. The results showed that injected gases in the autoclave produced powders with a higher crystallinity compared to synthesis without the gases. Also, hydrogen gas led to increased reduction of GO. The microscopic analysis confirmed existing graphene sheets with folding and wrinkling in the powders and indicated that various preferential directions played a role in the growth of hydroxyapatite crystals. The results showed that in general, graphene sheets increased the mechanical properties of HA. In the samples synthesized with injected gases, this increase was more significant. Interface analysis results indicate that reduced graphene oxide (rGO)/HA interface is likely coherent. These nanocomposites were biocompatible and showed some hydrophobicity compared to pure HA. The unique properties of HA include excellent bioactivity, osteoconductivity, and biocompatibility. The chemical formula of this ceramic is Ca10(PO4)6(OH)2, in which the ratio of calcium to phosphate is 1.67, and the crystalline structure of HA is similar to the inorganic part of the human skeletal system. HA has a variety of uses other than orthopedic applications5. In recent years, additional researches have been done on calcium phosphates, which indicate the specific value of these ceramic structures9. Despite the excellent biomaterial properties the poor mechanical behavior of HA has limited its application scope. These mechanical properties include brittleness, fracture toughness, and wear resistance, which are important in applications as implants12.Hydroxyapatite (HA), a member of the calcium phosphate family, is one of the most valuable biomaterials used in orthopedics15. But this improvement is not enough for applications as implants, and the mechanical properties of HA still need to be increased by adding a reinforcement phase17. Of all the materials used, carbon nanomaterials such as nanotubes19 and graphene20 have recently received much attention and among the carbon materials, graphene and its derivatives have gained more research because of their unique properties. Graphene has a honeycomb-like structure. Graphene sheets are as thick as a carbon atom. The atoms in the graphene structure are combined with the sp2 hybrid23. The mechanical properties of graphene are very interesting, which include the elastic modulus of 1 TPa and the fracture strength of 130 GPa25. The high reinforcing properties of graphene are due to the two-dimensional structure with high specific surface area of 2630 m2g−1 26. Graphene, having good biological properties, has been extensively studied in biological applications, including drug delivery27, biosensing28, tissue engineering29, and bioimaging30.With the advent of nanotechnology and advanced synthesis methods, the mechanical properties of HA have improved somewhat by decreasing their particles size and morphologies such as nanorods and nanotubes34. Graphene-HA composites are fabricated in various methods. Some of these methods include hydrothermal process35, electrochemical deposition technique37, sonochemical treatments38, biomineralization39, and self-assembly40. Some methods are more suitable for coating. In some methods, such as hydrothermal, the hybrid powders are first synthesized and subsequently consolidated by spark plasma sintering (SPS)43 or hot pressing method44. Among these methods, the hydrothermal process is very convenient for easier control and the ability to synthesize hybrid powders by in situ method46. When other solvents are used beside water, this process is called solvothermal method47. Graphene oxide is mainly used in this method. Due to the presence of functional agents on the surface of graphene oxide, nucleation and growth of HA crystals are easily accomplished. In the hydrothermal method, high temperature and process time cause the graphene oxide to reduce. This also causes the HA particles to form nanorods on the graphene oxide surface49. With the reduction of graphene oxide, its mechanical properties improve. Different methods are used to increase the reduction rate including adding chemicals such as ethylene glycol33, and injecting hydrogen or nitrogen gas into a hydrothermal autoclave53. Increasing hydrothermal pressure increases the crystallinity of HA54 and increases the rate of graphene oxide reduction45.Several researches have been published on the use of graphene to improve the mechanical and biological properties of HA and the results of these studies have shown that graphene has greatly enhanced the properties of HA2 mixed gases injection condition. Pure HA was previously synthesized under this condition, and increased pressure by injecting this mixture of gases increased the mechanical properties of HA54. The presence of hydrogen gas in this mixture is now exploited to increase the rate of graphene oxide reduction. After the powders were synthesized and characterized , spark plasma sintering (SPS) was performed and the samples were subjected to mechanical and biological assays. It is expected that the combination of the above methods will make the final nano-structured composite suitable for orthopedic applications.In this study, a hydrothermal method was used to synthesize reduced graphene oxide- HA nanocomposite powders under the Ar-15% H+2  was added dropwise to a 20 mL stirred suspension of GO (HA/1.5% rGO) with stirring continued for 1 h. The solution containing phosphate ions (1.56 grams of diammonium hydrogenphosphate in 80 mL of S1) was dropwise added to the solution. The pH of the solutions was adjusted to >10 with ammonium solution. The resulting solution was poured into the Teflon (PTFE) vessel and transferred to the autoclave. The hydrothermal process was carried out for 8 h at 180 °C by injection of nitrogen gas at 0, 5, and 10 bar (The volume of the PTFE container was 340 mL). The powders were dried at oven for 12 h at 60 °C. The resulting powders were sintered after drying and ball milling 49.The primary chemicals used in this study, along with their specifications, are presented in Table 54.Figure 54, at a temperature of 950 °C. Exactly similar to the previous report, the biocompatibility assays were performed54.The powders were consolidated via SPS, as previously reported54.To calculate the relative density of sintered samples the Archimedes method was used. In this method, wet weight, dry weight and immersed weight with a precision of 0.0001 were measured and the Archimedes ratio was used for relative density calculations (ASTM C373-88)55. The modified Antis method was used to evaluate the fracture toughness (K1C) of the samples . λ is a dimensionless constant is close to 0.0498 for Vickers tip. C is the average crack length and P is the applied force. The use of experimental parameters is the major advantage of this method; it is easy to calculate when using instrumented indentation.Instrumented microindentation experiments (Grindosonic tester with a Vickers tip) were conducted on the polished surfaces of samples at a maximum load of 2 N and ramp dwell time of 10 s. Nine tests were performed at different locations of each sample. Elastic modulus and hardness were calculated from the load-displacement curves Fig.  using OlDifferent evaluation methods have been used in this research, some of which are described below. The other instruments used to characterize the samples include inductively coupled plasma (ICP) , X-ray photoelectron spectroscopy , FESEM , and TEM . ImageJ 1.52d and Diamond 3.2 softwares were used in this study.57.(112/300) and I300 are the intensity of the hollow between diffraction peaks of HA in the planes (300) and (112) and the intensity of the peak of HA in the plane (300), respectively. Equation 58.X-ray diffraction  was used to determine the phase constituents of the samples, contained a detector Cu Kα radiation  and 2 theta from 10° up to 80° in steps of 0.02°. Equation }}}_{112/00}}{{{\rIn this equation, d, θ, and λ are grain size, Bragg diffraction angle, and wave length of used X-ray (Cu), respectively. β and ε are full width at half height (FWHM), and crystalline lattice strain, respectively.Field emission scanning electron microscope  and a portable scanning electron microscope  were used to observe the morphology of samples (mounted in an adhesive carbon film and Au coated by sputtering for its observation).−1, spectral region from 400 to 4000 cm−1 using 2 cm−1 steps, scan number of 8). The samples were prepared and mixed with potassium bromide (1 mg powdered samples and 300 mg KBr). The mixture was pressed into discs by applying 200 MPa pressures (1 mm thickness). The spectra were collected at room conditions 49.Fourier transform infrared spectroscopy  was used to identify the functional groups of the samples , which had been excited from an argon ion laser. The samples were subjected on Al foil in order to remove the fluorescence background49.Raman spectroscopy (Renishaw inVia spectrometer) was used in the range of 300–3500 cm48.High-resolution transmission electron microscopy  was used to observe atomic structure of the samples and spatially resolved elemental analysis, with a spatial resolution higher than 2 nm . High angle annular dark field detector (HAADF) was used to obtain STEM images . To study the atomic structure, fast fourier transform (FFT) and inverse fast fourier transform (IFFT) analysis were used54. Accordingly, the HA has a high purity hexagonal structure. In other words, the XRD pattern of the rGO-HA powders is quite similar to pure HA. According to studies, graphene oxide has a peak in the range of 2theta = 1048. After reduction of graphene oxide, this peak is removed and a new one appears around 2theta = 26. This peak is much weaker and wider than the HA (002) peak due to the amorphous structure of rGO. Therefore, the rGO peak is covered by the HA (002) peak which is highly intensified due to its high crystallinity. Table 49.Figure 49.Figure 54.Figure 48.Schematic −1 and 1730 cm−1 are shifted upwards, indicating reduction of GO, since these two peaks are characteristic of GO. As shown in the diagrams, the presence of hydrogen gas in the mixture of gases has led to more reduction. Also, the quality of the peaks obtained for the powders which is synthesized under the gas injection conditions is more accurate and uniform than the other, indicating a better bonds quality49.Figure (GO) ≈ 0.73, ID/IG(P10) ≈ 0.91) which shows the chemical and thermal reduction that has caused structural disorder in the graphene network. It is also clear that the presence of injected gas has led to more reduction of GO49.The Raman spectroscopy has been done to confirm the presence of rGO. Table Density calculations from the Archimedes method showed that the sample synthesized by the classical method (P0) reached to relative density of 96.66% and the samples that were synthesized in the presence of injected gas  reached to relative density of 95.91% and 96.9%, respectively. The temperature of 950 °C has been chosen to reduce the probability of decomposition of HA crystals and degradation of graphene sheets.48.Figure 54.Figure According to Eq. oC. As a result of these findings, HA has retained its composition after high temperature consolidation and has not been decomposed. According to Fig. 48.Figure 54. The only difference is the morphology of the cells that are globular. The presence of rGO sheets, which has become hydrophobic by the loss of its surface agents, may have caused this change. It can be concluded that the leached obtained over a 7-days period showed no significant toxicity to the culture of the osteoblasts.Figure The findings showed that the interface between the two phases in the nanocomposite was coherent and the elements were homogenously distributed. The powders synthesized under the injected gas conditions had higher crystallinity and crystallite size. Also, the presence of hydrogen gas further reduced the graphene oxide. These conditions resulted in higher elastic modulus, hardness and fracture toughness of the nanocomposites synthesized by this method. These composites were biocompatible and showed some hydrophobicity compared to pure HA. These findings will be useful for biomedicine applications of these nanocomposites.


The synthesis of promising nanocomposite materials can always be tricky and depends a lot on the method of synthesis itself. Developing such synthesis routes, which are not only simple but also can effectively catch up the synergy of the compositing material, is definitely a worthy contribution towards nanomaterial science. Carbon-based materials, such as graphene oxide, and conjugative polymers, such as conductive polyaniline, are considered materials of the 21st century. This study involves a simple one pot synthesis route for obtaining a nanocomposite of polyaniline and graphene oxide with synergistic effects. The study was carried out in a systematic way by gradually changing the composition of the ingredients in the reaction bath until the formation of nanocomposite took place at some particular reaction parameters. These nanocomposites were then utilized for the fabrication of electrodes for aqueous symmetric supercapacitor devices utilizing gold or copper as current collectors. The device manifested a good capacitance value of 264 F/g at 1 A/g, magnificent rate performance, and capacitance retention of 84.09% at a high current density (10 A/g) when gold sheet electrodes were used as the current collectors. It also showed a capacitance retention of 79.83% and columbic efficiency of 99.83% after 2000 cycles. Generally, energy storage materials are classified into electrical double layer (EDL) and pseudocapacitive materials . This cl2-hybridized single layer of carbon atoms. This problem has been solved through oxidation of graphite to graphene oxide (GO), which is composed of graphene sheets with large quantities of oxygen containing functional groups, and is synthesized through the oxidation of graphite . T. T71]. TThe synthesis protocol is very important for defining different properties of materials. When properly designed and optimized, materials with valuable properties can be tailored. This is true in the case of the present study as when we optimized the reaction parameters for in situ chemical oxidative synthesis of PANI–GO composites, nanocomposites were obtained in particular conditions. These nanocomposites showed enhanced capacitive and electrochemical properties, an excellent rate capability, and a lower ESR value. EIS analysis showed low Rct, ESR, to, and Rs. A phase angle value close to 90° was observed in certain conditions, which is very close to an ideal capacitor. These nanocomposite materials were active as an electrode material when utilized in the fabrication of symmetric supercapacitor devices with gold or copper as the current collectors, thus indicating their multifunctional abilities.


The purpose of this investigation was to describe the lived experience of aging in communities of faith, more specifically how older adults experienced social support. Semi-structured interviews were conducted with 15 older adults ranging in age from 63 to 84 years of age. Grounded Theory coding techniques were applied to identify themes. Findings include people feeling supported by community, connections, and beliefs, but also failed regarding opportunities for elder ministry or other types of worship. Participants expressed wanting more intentional opportunities for engagement. Many participants described the desire for an “expert” in their communities of faith. We consider the culture of support and how communities of faith may need to reconsider traditional ways of meeting the needs of people as they age. Furthermore, we explore the creation of educational tools that may allow for the emergence of an aging specialist in communities of faith.


Aging is an inevitable and complex natural phenomenon due to the increase in age. Cellular senescence means a non-proliferative but viable cellular physiological state. It is the basis of aging, and it exists in the body at any time point. Idiopathic pulmonary fibrosis (IPF) is an interstitial fibrous lung disease with unknown etiology, characterized by irreversible destruction of lung structure and function. Aging is one of the most critical risk factors for IPF, and extensive epidemiological data confirms IPF as an aging-related disease. Senescent fibroblasts in IPF show abnormal activation, telomere shortening, metabolic reprogramming, mitochondrial dysfunction, apoptosis resistance, autophagy deficiency, and senescence-associated secretory phenotypes (SASP). These characteristics of senescent fibroblasts establish a close link between cellular senescence and IPF. The treatment of senescence-related molecules and pathways is continually emerging, and using senolytics eliminating senescent fibroblasts is also actively tried as a new therapy for IPF. In this review, we discuss the roles of aging and cellular senescence in IPF. In particular, we summarize the signaling pathways through which senescent fibroblasts influence the occurrence and development of IPF. On this basis, we further talk about the current treatment ideas, hoping this paper can be used as a helpful reference for future researches. Idiopathic pulmonary fibrosis (IPF) is an interstitial lung disease of unknown etiology, characterized by massive deposition of extracellular matrix (ECM) in the lung interstitium, leading to the irreversible and slowly progressive destruction of lung structure and function . Most paThe risk of interstitial lung disease increases with age. The risk of IPF illness in the elderly over 70 is 6.9 times higher than in the people aged over 40 . With thResearchers have been trying to figure out how the connections between IPF and aging were established. For one thing, the respiratory system itself shows signs of aging with years. Significant increases in peribronchial collagen and progressive fibrosis are observed in the lungs of natural aging mice . In asymWhen compared with the age-matched control group, the primary fibroblasts isolated from the lung of IPF patients showed more senescent characteristics, which indicates that cellular senescence is persistent and intense in IPF patients . Under nUnlike lung epithelial cells, which are more like the sensor to external injury and stimulation, pulmonary fibroblasts act as the fibrosis process’s direct executor during the disease. Senescent fibroblasts in IPF are abnormally activated, accompanied by telomere shortening, metabolic reprogramming, mitochondrial dysfunction, apoptosis resistance, insufficient autophagy, and senescence-associated secretory phenotypes (SASP) . Most ofin vitro, demonstrating the declined proliferation capacity , telomerase synergistic protein 1 (hTP1), and telomerase reverse transcriptase (hTRT). Telomerase can make catalytic reverse transcription and provide the needed RNA template. Both functions are essential guarantees of normal telomere length. Multiple mutations of hTRT and hTR gene have been found in IPF patients, and they all lead the way to telomere shortening . Among tIn primary lung fibroblasts obtained from aged mice, glucose transporter protein 1 (GLUT1) dependent glycolysis is activated. By down-regulating the activity of the AMP-activated protein kinase (AMPK), this glycolytic pathway promotes the protein expression of α-SMA in cells . And in The increased glycolysis is also the result of multiple signal transduction and interaction within the senescent fibroblasts. Hypoxia resulted from the progress of IPF disease will lead to the disorder of cell energy metabolism, but on the other hand, hypoxia also up-regulates the expression of hypoxia-inducible factor-1α (HIF-1α) protein and mRNA. HIF-1α mediates the overexpression of pyruvate dehydrogenase kinase 1 (PDK1) gene, which in turn activated glycolysis and increased the activation of lung fibroblasts . ConsistApart from glycolysis, metabolic heterogeneity in IPF fibroblasts also includes changes in bile acid, heme, amino acid, and lipid metabolism . TGF-β1 The mitochondrial dysfunction triggers include transmembrane potential loss in the mitochondrial inner membrane, down-regulation of electron transport chain (ETC) function, and reduction of key metabolites entering mitochondria from the cytoplasm . These aMitophagy, which occurs in normal cells to maintain mitochondrial homeostasis, is down-regulated in senescent fibroblasts, leading to decreased PTEN-induced putative kinase 1 (PINK1) . InhibitIn addition, signal transduction and transcriptional activator factor 3 (STAT3) is necessary for the ETC of mitochondrial complexes I and II to remain activation and is involved in coordinating intracellular homeostasis . The eleApoptosis is an autonomously ordered death controlled by genes and can maintain homeostasis. In the restoration process of lung injury, the activated fibroblasts show changes corresponding to apoptosis and gradually disappear at the end . ApoptosReduced pro-apoptotic proteins Bak and Bax and increased anti-apoptotic protein Bcl-2 family proteins are found in IPF senescent fibroblasts . The accAlso, senescent IPF lung fibroblasts are found to be highly resistant to Fas ligand-induced (FasL) and TNF-associated apoptotic ligand-induced (TRAIL) apoptosis. FasL, TRAIL, and Caveolin-1 (Cav-1) protein abundance is decreased, and AKT activity is increased in these cells . TGF-β1 Autophagy is responsible for the retrieval of various components by degrading organelles and macromolecules to provide the raw material for reconstructing cellular structures, carefully maintaining the usual fate of fibroblasts . The cysAutophagy-related biomarkers in lung fibroblasts consist of apoptotic effector protein Beclin1, LC3, p62, and the autophagosome number . All of Autophagy is also involved in the regulation of ECM formation. Studies have shown that increasing the autophagy clearance rate to type 1 collagen by lung fibroblasts could reduce the aggressiveness of IPF fibroblasts . In IPF,Senescent cells typically secrete a complex set of factors known as senescence-associated secretory phenotype (SASP), a unique cellular senescence feature. Elevated transcription levels of these factors can be synchronously detected in the cells . SASP inThe SASP activated in senescent cells is a self-amplified secretory network . In IPF Senescent fibroblasts also influence the local microenvironment and the senescence of adjacent cells through SASP in a paracrine manner and finally aggravate IPF disease . When thFibroblast senescence is an important therapeutic target of IPF . In the Given that fibroblast senescence in IPF cannot be entirely attributed to a single cause, these targeted drugs are probably incapable of achieving satisfactory results due to their limited effectiveness. Concomitant administration of several drugs is likely to fall into the dilemma between the chaos caused by drug interactions and the inability to cover every discovered signal pathways. Thus, researchers turn to drugs with multiple effects. Pirfenidone is a pleiotropic molecule approved to be one of the antifibrotic drugs to IPF. It inhibits the MUC1 phosphorylation and β-catenin activation induced by TGF-β1 and prevents SMAD binding elements from forming or activating, thereby combating the fibroblast senescence in IPF . NintedaIn addition to these drugs mentioned above, there are also other treatments for senescent fibroblasts in IPF. Stem cell therapy is one of them. The exocrine body derived from human amniotic epithelial cells contains many soluble factors that can regulate inflammation and fibrosis pathways and is considered a potential treatment for IPF. These isolated stem-cell-derived extracellular vesicles reduce lung inflammation and fibrosis in mice by nasal drip . Gene thCellular senescence is characterized by cell cycle arrest, macromolecular damage, metabolic disorders, and SASP, which are important aging pathways. IPF is an aging-related interstitial lung disease of unknown etiology. The pathogenesis of IPF itself is difficult to be directly and clearly summarized with several abnormalities. Otherwise, it cannot be called “idiopathic.” Although the source of the disease is the key to solve the problem, for IPF patients, intervention in the process of their onset or progression may be a better choice, at least at this stage. We must be clear about the role of cellular senescence in IPF. The related experiments in IPF patients have the problem that the control group is not suitable, while the IPF mice model induced by bleomycin also has the problem of heterogeneity and self-remission. There is no better way to solve the experimental control group’s problems, but the improvement in animal model construction can provide more opportunities for senescence-related research in IPF.Just as cellular senescence is implicitly multifaceted in IPF, how senescent fibroblasts function is also multifaceted. Senescent fibroblasts exhibit abnormal activation, telomere shortening, metabolic reprogramming, mitochondrial dysfunction, apoptosis resistance, autophagy deficiency, and SASP secretion, involving a variety of molecular signaling pathways. However, we have not yet found a sufficiently unique and universal biomarker for cellular senescence. The signaling pathways in senescent fibroblasts are like a dense web, which tightly controls the IPF disease’s severity. It may not be enough only to untie a knot on the web.Under these conditions, the idea of using drugs that precisely clear senescent cells are gaining ground. In the selection of senolytics, compounds from nature undoubtedly perform better for their pleiotropic effects as well as security. When we attempt to discover new senolytics from a vast array of natural and human-made compounds, it is also a beneficial idea in our opinion to find appropriate answers from drugs already on the market or in clinical trials. As the old saying goes, the best way to discover a new drug is to start with an old one. Do drugs that can act on multiple senescence-related pathways at the same time also hide anti-aging properties? In the future, more cell experiments and animal experiments will give us the answer. In addition, just as new pathways are constantly confirmed in IPF, the signaling network in senescent fibroblasts we map will also be enriched. We believe that cellular senescence and senolytics will become new lights in the treatment of IPF.Both authors read and approved the manuscript for publication.The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.