Sarcoidosis has been a well-recognised risk factor for pulmonary hypertension (PH) for a long time, but still, the knowledge about this concatenation is incomplete. Sarcoidosis-associated PH (SAPH) is an uncommon but serious complication associated with increased morbidity and mortality among sarcoidosis patients. The real epidemiology of SAPH remains unknown, and its pathomechanisms are not fully explained. Sarcoidosis is a heterogeneous and dynamic condition, and SAPH pathogenesis is believed to be multifactorial. The main roles in SAPH development play: parenchymal lung disease with the destruction of pulmonary vessels, the extrinsic compression of pulmonary vessels by conglomerate masses, lymphadenopathy or fibrosing mediastinitis, pulmonary vasculopathy, LV dysfunction, and portal hypertension. Recently, it has been recommended to individually tailor SAPH management according to the predominant pathomechanism, i.e., SAPH phenotype. Unfortunately, SAPH phenotyping is not a straightforward process. First, there are gaps in our understanding of undergoing processes. Second, the assessment of such a pivotal element as pulmonary vasculature on a microscopic level is non-feasible in SAPH patients antemortem. Finally, SAPH is a dynamic condition, multiple phenotypes usually coexist, and patients can switch between phenotypes during the course of sarcoidosis. In this article, we summarise the basic knowledge of SAPH, describe SAPH phenotypes, and highlight some practical problems related to SAPH phenotyping. Pulmonary hypertension (PH) is a haemodynamic state of elevated blood pressure in the pulmonary artery shared by many conditions, and right heart catheterisation (RHC) remains the gold standard for its diagnosis . For decAnother commonly used PH classification is the World Health Organisation’s (WHO) clinical classification. It consists of five main PH groups in which clinical conditions associated with PH are categorised on the basis of similar PH pathophysiological mechanisms, clinical presentation, haemodynamic characteristics, and management .Sarcoidosis has been long recognised as a risk factor for PH. First, sarcoidosis-associated pulmonary hypertension (SAPH) was simply considered to be secondary to lung disease , but latSarcoidosis is a rare disease, and its incidence and prevalence vary broadly depending on geographic region, race, age, and sex. The highest rates are reported in Northern Europe and in African American individuals, and the lowest in Asia. The estimated incidence in Europe ranges between 1 and 19 cases per 100,000 persons/year ,17. RestIt remains unknown why some patients develop PH and some do not, despite the same demographic and sarcoidosis-related characteristics . The rolSAPH is an independent risk factor for mortality in sarcoidosis and carries up to a 10-fold increase in the risk of death ,26,27,28There are no strong recommendations for SAPH treatment, as evidence from randomised clinical trials (RCT) is limited ,10. GiveUnfortunately, SAPH phenotyping is not a straightforward process. It requires sophisticated diagnostic modalities, and the assessment of some elements, such as vascular remodelling, pulmonary angiitis, or microangiopathy, remains beyond the capability of non-invasive tools. Mathijssen et al. have shared the outcome of their attempt to assess the prevalence of different SAPH phenotypes in a single-centre cohort of 40 patients .Sarcoidosis affects the lungs and thoracic lymph nodes in more than 90% of patients . In the Pulmonary involvement increases the risk of PH almost five times compared to non-pulmonary sarcoidosis. In the population from the Nationwide Inpatient Sample 2016–2018, the prevalence of PH was 19% in cases with pulmonary sarcoidosis and 3.5% with non-pulmonary sarcoidosis; however, there was no information on pulmonary sarcoidosis staging . In publ18F-fluorodeoxyglucose (18F-FDG) uptake was found on positron emission tomography (PET) in the pulmonary artery wall in 19% of 175 sarcoidosis patients, and these patients had higher PAP and PVR compared to patients without the uptake [The ablation, compression, and distortion of pulmonary vessels, together with hypoxic pulmonary vasoconstriction (HPV), are believed to be the first elements of the pre-capillary PH development pathway in the parenchymal phenotype of SAPH by analogy to other chronic lung diseases ,37. HPV e uptake . The meae uptake .The distinctive features of sarcoid inflammation and fibrosis, including a specific lymphangitic fashion of distribution, can be responsible for differences observed between SAPH and PH due to other interstitial lung diseases (ILDs). For example, the same degree of fibrosis is associated with higher PAP in sarcoidosis than in idiopathic pulmonary fibrosis (IPF) and other ILDs ,49. The 1) ≤ 60%pred) or restrictive disease  ≤ 70%pred). They found the parenchymal phenotype in 73% of the patients from their SAPH cohort. Interestingly, not all stage 4 patients with pre-capillary PH were classified as the parenchymal phenotype despite the used definition; 17% of them were assigned to a compression phenotype, and one was diagnosed with chronic thromboembolic PH. Patients with stage 2 pulmonary sarcoidosis also fulfilled the criteria of the parenchymal phenotype. Additionally, one patient with stage 2 disease was categorised as having a parenchymal phenotype despite not fulfilling the criteria, but it was decided that this category was the best fit [A clear definition of a parenchymal SAPH phenotype is lacking. Mathijssen et al. adopted the recommendations regarding PH associated with chronic lung diseases from the latest World Symposium on PH to define the criteria of a parenchymal SAPH. These criteria include pre-capillary PH and moderate to severe pulmonary parenchymal disease; the latter was defined as stage 3 or 4 pulmonary sarcoidosis or severe obstructive  .18F-FDG-PET as a tool predicting response to the treatment is limited and shows not satisfying accuracy [Immunosuppressive treatment was reported to be beneficial in some patients with extrinsic pulmonary vessel compression but ineffective in others ,96,98,99accuracy ,8,96. Puaccuracy ,98; howeaccuracy ,97. It iaccuracy .Mathijssen et al. defined a vasculopathy phenotype as a pre-capillary PH with PVR > 3 Wu, no or mild pulmonary disease, and excluded other causes of PH. Based on that, they classified only 1 patient of the group of 40 as a suspected vasculopathy phenotype . Yet, thImmunosuppressive agents are suggested as the first-line treatment when sarcoidosis vasculopathy is suspected, with the option of the pulmonary vasodilators used in some patients . In patiIt is believed that post-capillary SAPH results from cardiac involvement in the course of sarcoidosis that causes LV function impairment. This hypothetical cause-and-effect relationship has not been validated practically, though no studies addressing this topic can be found. Cardiac involvement has been observed in up to 27% of Caucasian and African American sarcoidosis patients and even up to 80% of Japanese patients; in the majority of them, it was clinically silent ,108,109.In post-capillary SAPH due to cardiac sarcoidosis, glucocorticoids and other immunosuppressive agents are recommended. In addition, the standard treatment for cardiac failure should be applied as appropriate ,10,51. TThe liver involvement can be found in 50–75% of sarcoidosis patients, but symptomatic disease occurs in only 5–15% ,111. PorGlucocorticoids and other immunosuppressive agents are recommended for PH caused by sarcoid liver disease . PulmonaThe true prevalence of SAPH and the prevalence of its phenotypes based on predominant cause remain unknown. In the era of precise and personalised medicine, such phenotyping is recommended to lead the management. However, SAPH phenotyping is not a straightforward process. Apart from lacking criteria and gaps in knowledge, multiple phenotypes usually coexist and patients can switch between phenotypes during the course of sarcoidosis. Sarcoid pulmonary vasculopathy is probably the most under-recognised pathophysiological factor of SAPH development, and post-capillary phenotype seems the least studied. Whether genotypes play a role in SAPH development or SAPH phenotype needs further studies ,112,113.18F-FDG-PET seems to be the most helpful tool to achieve this goal; however, it has not been validated and standardised in this indication. There is a large need for well-planned research projects to properly characterise the epidemiology and phenotypes of SAPH and to establish an evidence-based management for this condition. It is also very important to take sarcoidosis into the differential workup of PH, remembering that it may cause PH without visible involvement of the lungs or thoracic lymph nodes.A transthoracic echocardiogram (TTE) should be performed as an initial assessment in all sarcoidosis patients presenting features indicative of PH ,114,115.


Beyond the acute illness caused by SARS-CoV-2, about one-fifth of infections unpredictably result in long-term persistence of symptoms despite the apparent clearance of infection. Insights into the mechanisms that underlie post-acute sequelae of COVID-19 (PASC) will be critical for the prevention and clinical management of long-term complications of COVID-19. Several hypotheses have been proposed that may account for the development of PASC, including persistence of virus or the dysregulation of immunity. Among the immunological changes noted in PASC, alterations in humoral immunity have been observed in some patient subsets.To begin to determine whether SARS-CoV-2 or other pathogen specific humoral immune responses evolve uniquely in PASC, we performed comprehensive antibody profiling against SARS-CoV-2, a panel of endemic pathogens, and a panel of routine vaccine antigens using Systems Serology in two independent cohorts of patients with pre-existing systemic autoimmune rheumatic disease (SARD) who either developed or did not develop PASC.A distinct qualitative shift observed in Fcγ receptor binding was observed in individuals with PASC. Specifically, individuals with PASC harbored weaker Fcγ receptor binding anti-SARS-CoV-2 antibodies and a significantly stronger Fcγ receptor binding antibody response against endemic Coronavirus OC43. Individuals with PASC, further, generated more avid IgM responses and developed an OC43 S2-specific antibody response with stronger Fcγ-receptor binding, linked to cross reactivity across SARS-CoV-2 and common coronaviruses.These findings from two independent cohorts implicate previous common Coronavirus imprinting as a marker for the development of PASC in individuals with SARDs.Douglas A. Lauffenburger, PhD, Sanofi: Board Member|Sanofi: Honoraria|Sanofi: Honoraria Zachary Wallace, MD, MSc, Bristol-Myers Squibb: Grant/Research Support|Horizon: Advisor/Consultant|MedPace: Advisor/Consultant|Principia/Sanofi: Grant/Research Support|Sanofi: Advisor/Consultant|Shionogi: Advisor/Consultant|Viela Bio: Advisor/Consultant|Zenas BioPharma: Advisor/Consultant Jeffrey Sparks, MD, AbbVie: Advisor/Consultant|Amgen: Advisor/Consultant|Boehringer Ingelheim: Advisor/Consultant|Bristol Myers Squibb: Advisor/Consultant|Bristol Myers Squibb: Grant/Research Support|Gilead: Advisor/Consultant|Inova Diagnostics: Advisor/Consultant|Janssen: Advisor/Consultant|Optum: Advisor/Consultant|Pfizer: Advisor/Consultant Galit Alter, PhD, Leyden Labs: Ownership Interest|Moderna Therapeutics: Employee|Seromyx Systems: Ownership Interest


Previous studies in conversational pragmatics have showed that the information people share with others heavily depends on the confidence they have in the correctness of a candidate answer. At the same time, different social contexts prompt different incentive structures, which set a higher or lower confidence criterion to determine which potential answer to report. In this study, we investigated how the different incentive structures of several types of social contexts and how different levels of knowledge affect the amount of information we are willing to share. Participants answered easy, intermediate, and difficult general-knowledge questions and decided whether they would report or withhold their selected answer in different social contexts: formal vs. informal, that could be either constrained (a context that promotes providing only responses we are certain about) or loose (with an incentive structure that maximizes providing any type of answer). Overall, our results confirmed that social contexts are associated with different incentive structures which affects memory reporting strategies. We also found that the difficulty of the questions is an important factor in conversational pragmatics. Our results highlight the relevance of studying different incentive structures of social contexts to understand the underlying processes of conversational pragmatics, and stress the importance of considering metamemory theories of memory reporting. This measure, along with the respective experimental procedures, was introduced by Notably, there is an experimental measure that combines both report choices and their confidence, and thus allows objective quantitative study of the thresholds that individuals use to base their decisions on: the so-caleld Report-Criterion Probability , showing that they were willing to report information even though they had low confidence in it. Thus, reporting some information  is perceived as more relevant than the accuracy of the retrieved memory. In these contexts, the answering strategy is better described as “loose” and the incentive structure would favor informativeness, even though the overall context is still very formal.As mentioned, previous research studied the reporting strategies in formal and informal contexts , Exp. 3.A parallel case can be made for informal contexts. For instance, a “first date” situation is an example of an informal context likely prompting a constrained answering strategy, because there are no explicit rules and people probably want to only share what they are confident in. In turn, an informal context with a loose answering strategy may be the situation of chatting with friends. Based on these definitions, it is possible to draw some similarities between the incentive structure at a job interview and at a date despite one context being formal and the other informal. In both cases, people would not report a lot of information unless they are reasonably certain about its correctness, that is, they favor accuracy. Likewise, there are similarities between the incentives when testifying in a trial and chatting with friends. In both loose contexts the incentive would be to report maximum information, that is, they both favor informativeness, even though they differ in formality. To verify this suggestion, the present research tested the different patterns of reporting derived from the different incentive structure of each context.Another issue, which has been treated differently in studies on conversational pragmatics, is the difficulty of the material. In some studies, participants had access to the information during the main task  or the iIn the present experiment, we studied the effects of the incentive structure prompted by different social contexts. We manipulated both the formality of the context  and the answering strategy the context elicits  in communicating individual responses to easy, intermediate, and difficult questions. We particularly focused on the decision to report or withhold information in a conversational exchange as a window onto the information the speaker wants to provide. In line with the previous research  recruited on social media took part in the experiment for a small monetary compensation. Most of the participants were in the process of completing their university studies and the rest had completed high-school education. All were native Russian speakers. It is worth to mention that in Russia it is compulsory to pass the Unified State Exam for obtaining the high-school diploma. This guarantees that all of our participants have a similar basic general-knowledge. The sample size was decided on the basis of previous research on the topic (n = 24). Although such sample could in principle be considered limited with respect to the statistical power, the homogeneity of the sample  and the high number of items from different topics (see below) and varying levels of difficulty lead to smaller inter-participant variability than inter-trial variability. In that case, the large number of items used in the experiment increases power  were used in the experiment. Four hundred questions were used in the main experiment and two were used for practice. The questions were selected from a previously normed and validated database of questions . The GKQThe experiment was programmed using Experiment Builder 2.3.38 , and consisted of one practice session with two questions and eight experimental blocks with 50 questions each. The order of the questions in the experimental blocks, the placement of the alternatives on the screen, and the social context for each question were fully counterbalanced. No more than two questions were placed in the same context in a row. All participants had the same practice questions, which were not used in the main experiment.rcP (Report-Criterion Probability) analyses  and Cohen’s avd as measures of effect size. Question difficulty was manipulated a posteriori. Each participant answered 100 questions for each context. To ensure a similar amount of questions per difficulty level, we chose the cut-off points of 0.40 and 0.70. These limits divided all questions in each of the contexts in three levels with approximately one third of the questions per level.Unless otherwise mentioned, we report 2 formality  × 2 answering strategy  × 3 question difficulty  analysis of variance (ANOVA), and pairwise comparisons using the Student’s Our main hypotheses pertained to the proportion of reported answers. However, differences in accuracy and confidence could affect the decision to report or withhold an answer. Thus, we first conducted analyses to check whether accuracy and confidence were similar between conditions. A full report of these analyses is presented in the ez package  with the three variables, formality, answering strategy, and difficulty, using the  package  in R CorIn addition, entering confidence as a covariate also changed the meaning of our measure. As confidence was equated across all conditions, this measure is better interpreted as showing whether participants were conservative or liberal with respect to their own confidence level. Thus, the absolute values of the reporting rates adjusted by the covariate, reported in M = 0.70, SD = 0.15) than in the formal contexts , F = 18.56, p < 0.001, ηp2 = 0.44, and no differences by answering strategy, F = 2.40, p = 0.135, ηp2 = 0.09, or by question difficulty, F = 0.17, p = 0.844, ηp2 = 0.01. This latter result indicates that any effect of question difficulty on actual reporting rates was due to differences in confidence. Descriptive statistics of proportions adjusted by the covariate as well as unadjusted values are presented in F = 3.33, p = 0.044, ηp2 = 0.12, and answering strategy x difficulty, F = 3.95, p = 0.026, ηp2 = 0.14, were both significant.The 3 × 2 × 2 ANCOVA showed a more liberal reporting strategy in the informal  than in the formal context , t(71.9) = 2.98, p = 0.003, avd = 0.18, and also in the loose  than in the constrained context , t(71) = 2.97, p = 0.004, avd = 0.21. For the intermediate questions, participants also applied a more liberal policy in the informal  than in the formal context , t(71.9) = 3.93, p < 0.001, avd = 0.23, and there were no differences for easy questions.To ensure that pairwise comparisons were made over the response means adjusted by the confidence covariate and not over the raw, unadjusted, means, we used the  package  in R CorF = 4.90, p = 0.037, ηp2 = 0.17 and F = 7.11, p = 0.014, ηp2 = 0.23, respectively. Consistent with the more liberal criterion found in the analyses with the covariate, participants reported more answers in informal  than in formal contexts  and in loose  than in constrained contexts . For intermediate questions, participants also reported more answers in the informal  than in the formal context , F = 7.54, p = 0.011, ηp2 = 0.24. For easy questions, none of the main effects were significant, but the interaction was, F = 12.16, p = 0.002, ηp2 = 0.34. The interaction showed that participants reported more answers in the formal loose context than in the formal constrained, t(24) = 3.47, p = 0.002, avd = 0.35, but that they also reported more answers in the informal constrained than in the informal loose context, t(24) = 2.12, p = 0.044, avd = 0.30 . As in the previous analyses, a higher rcP value means that fewer answers are reported and a more conservative strategy is employed, that is, the focus is on accuracy; the opposite is true for lower rcP. We computed rcP for each participant on each of the four social contexts. For completeness, we report rcP for each context and difficulty level in rcP value for the four contexts. When the effect of social context is stronger for a given difficulty level, then there should be more responses falling between the highest and lowest rcP.Using the classical approach to data analysis, the above results showed that the incentives structure of social contexts only affected reporting strategy for intermediate and difficult items. To further verify statistically this conclusion that participants decided whether a response should be reported or withheld based on the confidence threshold, we employed the rcP per participant and difficulty level and entered the results into a one-way ANOVA within-participants, using difficulty as a factor. The results showed significant differences, F = 24.72, p < 0.001, η2 = 0.51. Pairwise comparisons showed that the number of responses between the minimum and maximum rcP was higher for the difficult  and intermediate  questions than for the easy ones , t(24) = 4.49, p < 0.001, avd = 0.95 and t(24) = 6.34, p < 0.001, avd = 1.14, respectively, without differences between difficult and intermediate questions, t(24) = 1.54, p = 0.137, avd = 0.15. In sum, this analysis confirmed that the incentives structure of social contexts has a stronger effect in reporting strategies when answering intermediate and difficult questions than when answering easy questions.Following that logic, we computed the number of responses rated with confidence between the minimum and maximum In this study, we examined context-dependent conversational pragmatics from the perspective of the speaker. In particular, we investigated the effect of the incentive structure subjacent to different social contexts and levels of question difficulty on the amount of information the speakers share. Participants answered general-knowledge questions covering all levels of difficulty  and decided whether to report or withhold their answers in a particular social context. The main results showed that the incentive structure of social contexts, categorized as formal or informal or as constrained or loose, affected reporting rates and thus the amount of information speakers shared in these contexts. That is, the results confirmed our hypotheses regarding the influence of the formality of the context and, crucially, on the strategy that the context elicits. In particular, we expected that in the informal social contexts and those that elicit a loose pattern of answers, participants would favor informativeness and consequently report more information than in the other conditions. This shows that social context influences reporting strategies, thus confirming suggestions made by previous studies of conversational pragmatics .rcP as well as the unadjusted analyses. That is, we analyzed participants’ reported answers separately from confidence in the unadjusted analyses and jointly in the adjusted ANOVA and rc,. PrcP was purposely designed to assess changes in the criterion of memory reporting based on the confidence ratings and thus allows to study threshold changes. Thus, rcP provides stronger evidence than the adjusted ANOVA on the relationship of the reporting strategies implement by participants, confirming the role of confidence in these decisions. In general, the results are highly consistent with the framework of the strategic regulation of memory reporting by The results also showed that the influence of social context vanishes as the certainty regarding the answers’ correctness increases, in particular with easy questions. This supports our third hypothesis regarding the relationship between the level of difficulty of the questions and the incentives structure of social context. We hypothesized that if the question difficulty is more relevant than the social context’s incentives structure, then no differences in memory reporting across social contexts should be found. However, we did find differences for intermediate and difficult answers, supporting the idea that the incentives structure of the social contexts plays a bigger role in memory reporting for these more difficult questions as opposed to answering easy ones. These differences were found in all three types of analyses conducted: the adjusted ANOVA and This research expands and better characterizes the influence of social contexts on memory reporting. Previous research manipulated only one context dimension, formal vs. informal . The resThis research also showed that the strategic regulation of the informativeness-accuracy trade-off can be investigated with general-knowledge questions of all difficulties. Previous research in conversational pragmatics and memory reporting was conducted with difficult questions only  for easy questions social context did not affect reporting, whereas (2) for intermediate questions only formality affected reporting, and, finally, (3) for difficult questions both types of context influenced reporting. These results show that the effect of social context on memory reporting is more complex than previously suggested. When questions are intermediate or difficult, threats to our self-image and the way people present themselves may be more evident, which could increase the perceived strength of the rewards and penalties for focusing on accuracy or informativeness in a given situation. However, for easy questions participants are more prone to ignore the context and its incentive structure, maybe because the chances of a mistake are low and the perceived consequences to self-image are also minimal.We expected that social context may not affect reporting strategies for easy questions because most of them would be rated with high confidence and will thus be reported. However, a similar argument could be made for answers to difficult questions. If they are rated with low confidence, then they should be mostly withheld. From this perspective, only the condition with intermediate questions should be sensitive enough to show the effect of social context. However, this idea was not supported because the results showed an effect of both contexts for difficult questions. One explanation for this is that, as mentioned, the incentives and penalties for focusing on accuracy or informativeness may be perceived as being stronger when questions are difficult. Another explanation is that difficult questions were not difficult enough. Indeed, confidence for difficult questions was near 50%, which suggests that participants did not perceive questions as that much difficult. Arguing for the contrary, however, accuracy for difficult questions was only around 0.25, which is the baseline/chance level in a four-alternative test. If participants were in fact overconfident and considered difficult questions as intermediate, that could explain the effect of social context for these questions. Future research should try to test both of these alternatives to further advance our understanding of the effect of perceived incentives of social situations on memory reporting strategies.Finally, another novel aspect of the present research is the use of multiple-choice task instead of cued-recall or free-recall questions. In previous studies, cued-recall questions were used as a proxy to what a conversation is, that is, a sequence of comments or questions and answers. This notwithstanding, when we are involved in a conversation, sometimes we also provide options along with our questions. Recognition tests are known to be easier than cued-recall tests because they are affected by familiarity , and at While showing novel findings, this study also has some limitations. First, the computerized administration of the questions is not particularly representative of how a natural conversation or interview unfolds. Previous research used different methods to try to mimic conversational exchanges. For example, In line with these limitations, a more naturalistic procedure could have allowed to collect other conversational markers such as silences, hesitations, etc. These markers convey a large amount of valuable information that may help further understand participant’s conversational behavior. Future research on memory reporting would be greatly improved by the inclusion of such conversational markers in the context of a more naturalistic conversation.The aforementioned limitations stem from the selection of a method with a restricted ecological validity. Yet, this particular paradigm and procedure were chosen to be able to isolate the influence of the specific experimental variables. This is particularly important in research lines that are not widely developed and for which it is necessary to set the grounds to build up knowledge.Another important factor to consider is that each individual may react and behave in a particular social context in a rather varied way. Reactions can vary depending on the incentive structure. However, we did not directly manipulate incentives, which was instead done by proxy through the modeled social situations. One possibility to directly manipulate the incentive structure could have been to introduce monetary incentives, but that manipulation would have made the experimental set-up even further removed from a typical conversation situation. In addition, reactions can vary even depending on the emotional, psychological, or cognitive state of the same person. The present research was not intended to study such individual differences and that is why we framed the social contexts with the most prototypical and representative situations. Participants’ responses to prototypical situations inform us about what they perceive to be the incentive structure in these situations and what they think is the most appropriate reporting strategy. Thus, the results presented in this research are informative about general patterns of memory reporting, the perceived expectations in a given social context, and what the usual behavior in response to social challenges could be, and should not be interpreted as indicative of individual responses in particular situations. In line with this, further studies could also use this approach to study communicative behavior of different social and professional groups.Finally, we want to stress that these results were found in a within-participant design; to the best of our knowledge, this procedure has not yet been tested in a between-participant design. There are metamemory phenomena that depend on this important feature. For example, font size only affects judgments of learning in within-participants designs . Thus, iThis study showed the importance of the incentives structure of a given social context for deciding on the best reporting strategy, the one focused on accuracy and reporting fewer answers or the one focused on informativeness and hence reporting more answers. In addition, this research also showed that the difficulty of the materials is relevant for understanding reporting strategies, with easy questions being seemingly less sensitive to variations in social context. This helps advance our understanding of how social situations shape and affect communication flow, in particular how much information people are willing to share. Future research should study other ways people can use to modify their discourse behavior to further reveal the underlying principles guiding human communication.The raw data supporting the conclusions of this article will be made available by the authors, without undue reservation.The studies involving human participants were reviewed and approved by ethics committee of the National Research University Higher School of Economics, Moscow. The patients/participants provided their written informed consent to participate in this study.BML and YS acquired funding for research. BML conducted the data collection and completed the initial writing. BML and KL analyzed the data collection. All authors conducted the conceptualization of the research study, and revised and contributed to the final version.This article is an output of a research project implemented as part of the Basic Research Program at the National Research University Higher School of Economics (HSE University) and was carried out using HSE Automated system of non-invasive brain stimulation with the possibility of synchronous registration of brain activity and registration of eye movements.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.All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.https://www.frontiersin.org/articles/10.3389/fpsyg.2023.1004524/full#supplementary-materialThe Supplementary material for this article can be found online at: Click here for additional data file.


Background: Pediatric obesity is prevalent and challenging to treat. Although family-centered behavioral management is the gold standard, many families face structural inequities to its access and efficacy. Identifying ways to manage pediatric obesity within primary care is needed. Methods: This feasibility study included three sequential trials of peer-led group sessions occurring biweekly or monthly between 3/2016 and 2/2017. Parent–child dyads were recruited from a large academic primary care clinic via mailed invitations, prioritizing patients living in local zip codes of historical disinvestment. Eligible patients were 6 to 12 years with a body mass index ≥85th percentile, with parent and child interest in making healthy lifestyle changes, and English speaking. Results: 27 dyads participated, 77% were non-Hispanic Black. Retention and attendance rates were highest in the initial four-session biweekly pilot , high in the full six-session biweekly cohort , and moderate in the monthly cohort . Families reported high satisfaction with the sessions (4.75/5). Qualitative comments suggested social connections had motivated behavior change in some families. Conclusion: Parent-led group sessions for pediatric weight management show promise in engaging families. A future large trial is needed to assess behavior change and anthropometric outcomes. Obesity is a highly prevalent condition of childhood  with significant racial/ethnic disparities  . Childreth percentile associated with a decrease in cardiometabolic risk  34.6 to 49.9). Baseline child BMI was 24.2 (SD 21.7 to 28.8) with a baseline BMI z-score of 1.97 ± 0.44.Baseline parent BMI of those who completed the biweekly and monthly cohorts , high in biweekly cohort  and moderate in the monthly cohort , however they also wanted a “content expert” to co-lead. One focus group participant suggested that we rotate the parent lead; this suggestion was incorporated into the pilot and feasibility trial.Participants in the monthly and biweekly group sessions reported high overall satisfaction (4.75 out of 5) with the group sessions. They rated the nutritional information to be useful (4.72 out of 5). Participants also enjoyed having the group sessions led by a peer (4.64 out of 5) and felt connected to the other parents (4.63 out of 5).At each session, participants’ data on steps and habits such as fruit/vegetable consumption and screen time were compiled and shared back with them. Results for parents and children would be compiled separately. Below are a few examples of the data shared with dyads .n = 14, 7 via phone and 7 in-person), families reported more engagement in their primary care home after completion of the STEP IN study. A few families mentioned it seemed the primary care clinic “truly cared about them” to offer this program. Most participants said they enjoyed the interaction. Several who did not know each other before became friends and have spent time together outside of the sessions. Many families were receptive to follow up in primary care or a weight-management clinic.In exit interviews . Parents and children had fun competing over step counts and servings of fruits and vegetables  were more likely to change over the course of six months compared to the three months required for the biweekly sessions. We also found that six months allowed for more chances of life stressors, such as an illness or death in the family, to change families’ priorities. While we found better attendance with biweekly sessions, one confounding factor is the biweekly cohort had many sessions over summer break from school. Sessions appear to be poorly attended at the end of school semesters (May and December) and in the winter months (December and January) due to snow and cold. An additional confounder was session five for the monthly cohort had to be rescheduled due to weather, yielding 50% attendance. Overall, attendance rates compare very favorably with the clinic appointment no-show rate of 25% for all visit types, and no-show rates as high as 67–75% for weight follow up and nutrition-only visits. The high attendance rate is also crucial given the participants in the full six session cohorts were not previously engaged with an intensive behavior and lifestyle program. Our study visits’ high attendance rates and the high level of engagement of participants at the sessions speak to the value participants see in these sessions for gaining knowledge, feeling supported, and improving their child’s health and their own health. The recent clinical practice guidelines from the American Academy of Pediatrics for the treatment of children with obesity recommend intensive behavior and lifestyle treatment as a key intervention for children six years and older, with a minimum of 26 contact hours recommended . The preThis feasibility study has a few important limitations and challenges. First, recruitment was best achieved by letters mailed directly to families (as compared to fliers in the clinic), however there was a low response rate even to letters (about 1%). Optimization of the recruitment strategy will be needed for a larger trial. Finding engaging activities for the children was sometimes challenging and dependent upon the childcare provider’s engagement with the material. An additional challenge was the unpredictable attendance by siblings of a wide age range. Obtaining catering for the shared meal that was healthy, within budget, and enjoyed by the participants was a challenge. While the exact content of STEP IN may need to be customized to other neighborhood or populations, the structure of the peer led sessions could be applied to other groups facing structural disadvantages and high rates of pediatric obesity. We also found that parents with low literacy were not able to participate fully in these sessions, limiting the generalizability of this format of intervention. Finally, the size of the study was not powered to assess the impact of the intervention on objectively measured behavior change or BMI. We did not find a statistically significant change in dyads’ BMI.Since the study was initially conducted, we have explored models for providing this type of engagement intervention to clinic patients who are in a pre-contemplative or contemplative readiness to change mindset. Because Medicaid does not reimburse for group-level or peer-level counseling in Ohio, and because the program relies on having a full-time program manager to run, we have paused additional study of this intervention. If others are considering group pediatric weight management sessions, we recommend avoiding scheduling the sessions during the end of the academic semester (December and May). Future research should also look for ways to involve children in the learning and sharing their learning while still separating parents and children for part of the session as parents valued this time to connect with one another. Parents noted they would like if their children received their own certificate of completion. We would also consider adding an additional session to discuss sleep hygiene, based on many participants indicating they struggle with healthy sleep habits for themselves and their children.This feasibility study of peer-led group sessions showed strong promise and a larger study should be conducted to assess whether the intervention can improve diet and physical activity habits of families who are predominantly low-income and identify as non-Hispanic Black. More frequent sessions (every other week) were found to be better attended than less frequent (monthly). The opportunity for peer support and connection was one key to the success of this low-intensity, family-focused intervention for pediatric weight management based in the primary medical home.


Water pollution due to heavy metal ions has become a persistent and increasing problem globally. To combat this, carbonaceous materials have been explored as possible adsorbents of these metal ions from solution. The problem with using these materials on their own is that their lifespan and, therefore, usability is reduced. Hence the need to mask them and an interest in using polymers to do so is picked. This introduces an improvement into other properties as well and opens the way for more applications. This work gives a detailed review of the major carbonaceous materials, graphene and graphene oxide, outlining their origin as well as morphological studies. It also outlines the findings on their effectiveness in removing heavy metal ions from water, as well as their water absorption properties. The section further reports on graphene/polymer and graphene oxide/polymer composites previously studied and their morphological as well as thermal properties. Then the work done in the absorption and adsorption capabilities of these composites is explored, thereby contrasting the two materials. This enables us to choose the optimal material for the desired outcome of advancing further in the utilization of carbonaceous material-based polymer composites to remove heavy metal ions from water. Having access to a clean water supply is a basic need in South Africa, as well as the rest of the world. Water is one of the most crucial elements in the sustenance of life on Earth, and as such, its preservation is important. There is a growing concern regarding the availability of usable water in South Africa, as well as on a global scale. In 2007, the World Health Organisation (WHO) issued a report stating that around 1.1 billion people did not have access to a supply of clean water globally . All theThe main reasons for water scarcity in South Africa are climate change, an increasing population, irresponsible water usage, and poor wastewater treatment methods. Climate change causes global warming, which in turn results in delayed rainfall that brings about draught and a deficit in the water supply . Then wh3 and more [Amongst the different contaminants found in water are heavy metals. By definition, these are metals that have a specific density of 5 g/cmand more . Exampleand more .One heavy metal of particular interest is lead, which is a greyish material that naturally occurs on the earth’s crust in very small amounts. Although lead occurs naturally in the environment, industrial activities such as manufacturing, acid metal plating, ammunition development, paints and dyes formations, ceramic and glass forming, as well as fossil fuel burning increase lead concentrations deposited on the earth’s surface. The residues from these industries contain lead ions which eventually make their way into drinking water through transporting agents such as water, wind, and gravity. Research shows that adults consume 35 to 50% of lead through drinking water, and the consumption rate of children may be over 50%. Moreover, lead is not biodegradable, and this means that it would accumulate on living cells and cause fatal damage to the liver, kidneys, reproductive system, and brain, upon consuming water that has it ,11. The Throughout the years, a variety of procedures have been formulated to remove heavy metals and, specifically lead from solution. Amongst others, these methods include coagulation and precipitation, membrane filtration, ion exchange, and absorption. However, most of these methods have financial implications, and/or their execution fails for various reasons and, as such, they have not been accepted for commercial usage ,13,14. IAdsorption refers to a process whereby gasses or liquids accumulate on a substrate surface that is in solid or liquid form . The phaBy definition, carbonaceous materials or carbon-based materials refer to solid materials that have carbon as a main component . These mGraphene (GN), or fully hydrogenated graphene, is a form of carbon that has a single layer of atoms having a two-dimensional honeycomb lattice arrangement in its nanostructure. The derivation of its name is from graphite, and the suffix -ene alludes to the fact that it has numerous double bonds. Graphene possesses useful properties such as heat conduction, electricity conduction, high tensile strength, and its ability to absorb light in all wavelengths. In material science, it gained popular usage and attraction due to its high specific area, which causes ease of processability and allows for tailoring of its properties into what is required ,43. FiguMorphology is the study of form via structure, size, and shape. It gives an indication of the physical and chemical properties of nanostructured materials, making it very crucial in material studies . MorpholIn AFM analyses, it was established that the hexagonal growths are visible on the surface of the substrate. The thickness of the surface increased as the vegetable oils were allowed to interact with the substrate and form graphene. This brought about the assumption that graphene will almost always form hexagonal growths on the surface of the substrate, and this would influence the arrangement of its particles. −1 and a D peak at 1360 cm−1. These peaks represented the presence of more than ten layers of graphene structures and a depiction of the disordered nature of these layers, respectively. The ultra-sonicated graphene showed a second-order peak at 960 cm−1, whereas pristine graphene did not have this peak. This implied, according to the authors, that pristine graphene has thicker layers as compared to ultra-sonicated graphene. From this, it was concluded that the process of ultra-sonication in preparing graphene results in thinner layers of product, which might disperse easily in a polymer matrix.Other morphology studies of graphene have utilized X-ray diffraction (XRD), Transmission electron microscopy (TEM), and Raman spectroscopy together with SEM characterization techniques. Monti et al. , in theiIn terms of thermal properties, there really have not been studies that focus on the thermal stability and melting and crystallization of graphene. The current focus has been on the thermal conductivity of graphene. This might be because graphene consists only of carbon in its structure, so it might be simple to deduce its thermal stability, melting, and crystallization properties.Graphene has been proven to have very poor water intake abilities. This surely is because of its structure, which consists mainly of carbon and no other functional groups that may aid absorption. There really is not much to look at in the way graphene is used in water absorption studies. The consensus here is that the introduction of graphene to any material will lower the water intake properties ,49. ThisIt has already been established that graphene does not possess good water intake properties. As such, researchers shy away from using it as an adsorptive material for heavy metals in aqueous solutions. The already reviewed structure of graphene, which shows it to consist of only carbon, also contributes to its inability to adsorb heavy metals from water. Due to these already established parameters, it would only make sense that there is no progressive and tangible work so far attributed to the removal of heavy metals from water by graphene. There are some reviews and little work done in this regard on the feasibility of graphene being used as a selective adsorbent of heavy metals in water ,51,52. MThe current work on graphene on its own has been remarkable and progressive; most researchers have contributed profusely to the general understanding of the structure of graphene. With more understanding, it becomes eminent that the water uptake and metal ion intake properties are very weak for graphene. On top of this, it is considerably costly to purchase or manufacture. Hence not many researchers have opted to utilize it. All research points towards graphene oxide in this regard, as it seems to be a promising substitute.The functionalization and exfoliation of graphite and graphene forms graphene oxide (GO). This is a carbonaceous carbon allotrope consisting of a single graphite oxide layer. The synthesis of GO is done by chemically treating graphite in an oxidation reaction while continuously exfoliating or dispersing it in a solvent. To this day, the precise structure of GO has not been described conclusively. However, a series of models have surfaced that aim to describe its structure. The common aspect of all these proposed models is that they all suggest that GO consists of oxygen-containing functional groups of variety, with specific areas of attachment on the structure ,54,55. ISeveral morphology studies have been conducted on GO in order to verify its structure and/or synthesis. Shang et al.  looked i−1, C-O-C (ester) at 1226 cm−1, and C=O in carboxylic acid and carbonyl moieties (carbonyl) at 1719 cm−1. There were also bands observed at 3330 and 1396 cm−1, which were attributed to the O-H stretching mode and deformation vibration of intercalated water, respectively. The authors stated that GO was successfully synthesized in light of these observations. Furthermore, they pointed out that the observed FTIR and XPS results implied that GO is amphiphilic, has a hydrophobic basal plane, and is hydrophilic at the edges. In another study by Ghosh et al. [−1 which was attributed to the stretching of the O-H bond and portrayed the presence of a number of OH groups on the surface of GO. A band occurred at 1760 cm−1, indicating the C=O stretching, and another at 1403 cm−1, which represented the presence of carboxy groups in GO. The Raman spectroscopy and XRD results also validated the successful synthesis of GO. In Raman analysis, a spectrum was obtained with two main features: The G band and the D band. The G band was said to represent the first-order scattering of phonons by sp2 carbon atoms, while the D band was representative of the breathing mode of photons. The G band was found at 1591 cm−1 and was a broader band compared to the D band, which was found at 1341 cm−1 and was more apparent. The extensive oxidation of graphite to graphene oxide caused a distraction of the sp2 character and formed defects in the GO sheets, thereby resulting in the said shifts in bands. Then, their XRD results showed a diffraction peak at 11.41°, with a calculated interlayer spacing of 0.741 nm. This, according to the authors, was indicative of the intercalation of water molecules into the graphite layers and the formation of oxygen-containing functional groups between the layers of graphite. Several other authors arrived at similar findings when analyzing the morphology of GO [From the results above, the AFM images showed the average lateral sizes or thickness of GO sheets to be 1 µm and a height of 0.919 nm. This was indicative of the monolayer structure of the GO sheets, according to the authors. The XPS analysis resulted in a C1 spectrum having four different peaks. These were: C=C (284.3 eV), C-O (286.3 eV), C=O (287.6 eV), and COOH (289.0 eV). The peaks were a portrayal of the existence of oxygen-containing functional groups in the structure of GO. Then in FTIR analysis, a spectrum was obtained with the following peaks and their functional groups: C-O  at 1045 cmh et al. , the morh et al. , where tgy of GO ,62,63. AThermal properties refer to the physical properties of a material that are related to heat conductivity. Briefly put, these are properties that a material exhibits when put under a fluctuating heat cycle. Four major components of thermal analysis have been established, namely: heat capacity, thermal expansion, thermal conductivity, and thermal stress . A very The area of study that looks at the water intake properties of GO, according to my knowledge, is still very novel, and as such, there have been minimal outputs in this field ,68. As aAlthough there has not been much work published ,70 that Following this, the authors discovered that adsorption had proceeded by chemisorption for the most part of the experiment. Chemisorption is a type of adsorption occurring on a chemical basis, with a possibility of an irreversible reaction between the adsorbent and the adsorbate. Then they did kinetic modeling to illustrate the mechanism involved in GO adsorbing these heavy metal ions. The Langmuir and Freundlich models were used, and the following −1), KL represents the enthalpy of adsorption (L·mg−1), KF and n are the Freundelich constants related to the adsorption capacity and adsorption intensity, respectively. The qmax values obtained for all the metal ions implied that 1 g of GO could adsorb around 5 mmol of divalent metal ions. This makes GO the highest adsorbing material currently, amongst all the other materials, according to the authors. Moreover, the constants obtained on the Freundlich model were between 1 and 10, and this implied that adsorption was favored under the studied conditions. Upon fitting the isotherms from data derived from the table above, the authors obtained Langmuir and Freundelich plots shown in Where qmax is the maximum amount of metal ions adsorbed per unit mass of GO at high equilibrium ion concentration  (PLA), poly (ε-caprolactone) (PCL), poly (PHBV), and polybutylene succinate (PBS), amongst others. From this, it follows that the recent strides in polymeric composites of GN and GO are reviewed.Graphene/polymer composites have attracted quite a substantial amount of research attention over the past years. The many useful applications of graphene have sparked the interest of researchers to develop new and advanced materials. Most of these composites have been developed and used for improving specific properties in polymer matrices. These include compatibility and miscibility, thermal behavior and materials, and water purification, amongst others. Most researchers have opted to investigate single polymer/graphene composites instead of binary polymer/graphene composites. This implies that the work towards using binary polymer systems is still relatively new and, therefore, quite niche.The morphology of polymer composites with graphene as a filler has been one area of particular interest to researchers. Gao et al.  investigThe study of the morphology of graphene/polymer composites gains more traction each day as more researchers are picking an interest in the field. The current knowledge so far gives an exciting and fruitful incite which paves the way to more advanced applications and advancements in the study of polymers filled with graphene. In time, the structure of graphene will surely be optimized and tailored for specific and useful needs.Thermal analysis is very important in analyzing polymer/GN composites. This is mostly done through differential scanning calorimetry (DSC) and thermogravimetric analyses (TGA). DSC helps in understanding the melting and crystallization behavior, whereas TGA assesses the thermal degradation and stability. Very limited studies have been published that look at the thermal properties of GN/polymer composites.The widely used characterization technique here is DSC. Generally, the literature suggests that the presence of GN in the matrix of a polymer will increase the degree of crystallinity of that polymer ,72. Wu eFrom the table, it is clear that both the neat PLA and the PLA/GN composite exhibited the Tg, which did not differ that much in terms of position. The second transition obtained for both samples was the cold crystallization peak. This transition shifted a bit to a higher temperature for the composite, as the table portrays. The observation was said to imply that the presence of graphene nanosheets reduces chain mobility in PLA and hinders its crystal growth. The melting transition was split into two peaks for both the neat PLA and the PLA/G composite, and its position did not change that much. So, although there were no attributions to the presence of the double melting peak for pure PLA, this could be explained by polymer science principles. That is, even though PLA did not show any crystallization peak upon cooling, it might have crystallized, but the peak was not prominent. The crystals formed from the cooling and the ones formed during cold crystallization would be different types of crystals. These two types of crystals would then melt at slightly different temperatures, thereby resulting in a double melting peak for PLA. In addition, the cold- crystallization of PLA might have resulted in the formation of two types of crystals, namely, the metastable and perfect crystals. These crystals would then melt at different temperatures, which would also result in two melting peaks for PLA. The melting transition of PLA did not change position upon GN addition, which showed that the GN did not have any significant influence on the melting process of PLA. Lastly, the degree of crystallinity of PLA was not influenced by the addition of GN. Perhaps if the analyses were done at increasing GN loadings, then there would be a visible trend in the effect of GN loading on the polymer matrix of PLA. However, on a general basis, carbonaceous materials are known to have significant effects on polymer matrices, even in small quantities. This might be the reason why the study was conducted at 1 wt.% GO content. Then Gao et al.  conducteThe findings in this regard were that firstly, the melting temperature of PCL was not affected by the added graphene, as it remained in the range of 56–60 °C for both composites. Then during cooling, PCL, together with its composites with rGO and CCG, exhibited crystallization transitions. The crystallization temperature of PCL had a significant shift with the addition of graphene for both composites. The neat PCL polymer crystallized at 26 °C, while in the PCL/rGO composite, it crystallized at 39 °C and in the PCL/CCG at 35 °C. These observations were said to indicate that the incorporation of graphene nanosheets into the PCL matrix affects the polymer microstructure by acting as multiple nucleation centers for crystallization. In addition, in our view, graphene nanosheets might have increased the crystallinity of PCL, and the number of crystalline chains increased in the matrix of PCL.These observations work to ascertain the assumption that the presence of graphene in a polymer matrix has a direct effect on only the degree of crystallinity. However, most research has been on one-polymer composites. Perhaps a bi-polymer composite analysis would yield different and more interesting outcomes.Thermal degradation analyses provide insight into the thermal stability of a polymeric material. This information is very important if we wish to deduce the possible applications of that material. It has been generally discovered that the presence of graphene improves the thermal stability in a polymer matrix/matrices. Rodill et al.  made oneThese observations by other researchers could prove useful in the study of using graphene to reinforce polymeric materials. The world needs more materials that can withstand high temperatures, and this research field promises just that.−2) but the lowest average flake thickness (1.6 nm) exhibited the highest maximum water intake (around 1.5%) among the composites. This was attributed to the fact that the high surface area and less thickness in the graphene would make it more permeable and more susceptible to being porous. It is very much clear that the size and surface area of particles has a direct influence on their water intake properties. The fact that the saturation point of intake was reached after a minimal amount of time shows that graphene really does have a low water intake capability. The maximum intake of 15% for the materials used is a very low water intake percentage for both the polymer and graphene. Wang et al. [Some polymers are naturally hydrophilic, and as such, researchers would fill them with graphene to assess the change, if any, in their water intake properties. Prolongo et al.  assessedg et al.  looked aFrom these results, it can clearly be seen that the absorption of pure PVA, taken after 24 h, was 105.2%, with a measured contact angle of 36°. The addition of graphene reduces the water intake and thus improves the barrier properties in the composites. This is seen by the absorption degree dropping to 59.8 and 48.8%, respectively, for 0.5 and 1 wt.% graphene loadings. The contact angle increased with the addition of graphene loading . These observations clearly imply that the introduction of graphene induces and increases hydrophobicity and reduces hydrophilicity in a polymer matrix. These observations are both advantageous and disadvantageous depending on the desired objective. If the intent is to strengthen or rather reinforce the surface properties of a polymer matrix, then graphene is ideal and conducive as a filler. However, if we require to develop materials that can absorb water and probably adsorb heavy metals from solution, then graphene might just not be the go-to filler.Unfortunately, the inefficacy of graphene in removing heavy metal ions from solution has caused a lot of researchers to refrain from exploring its polymer composites in this regard. According to our knowledge, there really is no tangible work so far attributed to the removal of heavy metal ions from solution by graphene/polymer composites. The findings presented by researchers in analysing the water intake properties of graphene-filled polymer composites just show that the inclusion of graphene yields a higher hydrophobicity. As already mentioned, it will all depend on the specific desired outcome of the prepared materials. Particularly, if we require to enhance the metal adsorption properties of polymer composites, we need to investigate fillers that have the desired functional groups, such as oxygen, for example. In light of the above-mentioned views, it becomes important that we review the properties of GO/polymer composites. The contrasts made in this regard, in comparison to graphene and other carbonaceous materials, imply that GO deserves all the attention. The oxygen-containing functional groups on its surface are the primary concern and reason to investigate the feasibility and work done so far in using GO/polymer composites as selective adsorbents of metal ions in water.The reactive sites present in GO make it ideal for structural modification and tailoring, whereby its structure can be manipulated for different purposes. This ease of processability aspect of GO has attracted the need to formulate and analyse GO/polymer composites by researchers. Although little research has been done into biodegradable polymer-based composites with GO, there has been quite a variety of papers reporting on the development and properties of GO/polymer composites in general. This has been for the purposes of adsorption of pollutants, electrical conductivity, and the improvement of materials’ properties. This section focuses on the strides made in the development and characterization of GO/polymer composites ,82,83,84w/w PVA/GO composites. Herein they observed the GO to be dispersed on the surface of the polymer matrix without being embedded deeply into the matrix. This was attributed to the smaller interlayer distances and smaller defects, thereby making it hard for the matrix to be broken down. Their EDS study showed that the carbon composition was 60%, whilst oxygen was 40% in the polymer composites. This makes sense as the GO and PVA consist mainly of carbon. In XRD studies, the peaks became more intense with an increasing GO content for a typical PVA/GO composite. This alluded to the idea that the crystallinity of the composites increased with an increase in GO content, according to the authors. Chen et al. [The limited morphology studies previously conducted on GO/polymer composites utilize SEM and TEM mostly for analysis. Generally, SEM images are not that clear at high magnifications, hence the need to supplement them with TEM, which provides clearer images at higher magnifications. The heat sensitivity of most polymers contributes to this aspect of SEM, meaning these polymers would be thermally unstable at high temperatures and result in blurred images. Pinto et al.  used SEMn et al.  looked iConducting thermal studies on polymer/GO composites is very important. This is done through the differential scanning calorimetry (DSC) and thermogravimetric analysis (TGA). DSC aids in understanding the melting and crystallization behavior, whereas TGA assesses the thermal stability. There has been a limited number of published work that investigates the thermal properties of GO/polymer composites ,80,81.Xu et al.  analyzedFrom the curves in These observations were said to imply that GO caused the molecular chains in PVC to relax with ease. Furthermore, the authors observed that the addition of 0.1 wt.% GO increased the melting enthalpy of PVC from 58.66 J/g for the neat polymer to 62.9 J/g for the composite. This was attributed to the reinforcing effect that GO had on PVC at that loading. Increasing the GO loading, however, resulted in the melting enthalpy of PVC dropping, whereby the lowest enthalpy (29.81 J/g) was when 1 wt.% GO was used. This was attributed to the weak interaction that existed between PVC and GO as the GO loading increased. The authors further stated that the formation of agglomerates of GO might have influenced this behavior. To expand further from known DSC interpretations: at low GO loadings (around 0.1 wt.%), the GO sheets might have completely covered the polymer matrix and dispersed evenly. However, when the content of GO was increased, it might have dispersed and covered all of the available surface area on the polymer matrix, such that it still remained. The remaining GO then formed agglomerates and exhibited particle-to-particle interactions. This could have been the reason for the observed agglomeration and poor dispersion, which in turn affected the melting enthalpy. The melting transition of PVC did not seem to be influenced by the addition of GO. This might imply that the GO did not have that much of an influence on the crystallinity of PVC at the loadings used. In addition, the PVC used could have been mostly amorphous.Xu et al.  investigIt is clear that graphene oxide-based polymer composites are still not that widely explored. Findings from different researchers in this regard are promising and can only be improved from here. GO seems to have a higher affinity towards certain polymers, and this could be very beneficial in helping to develop materials to assist in a number of problems such as pollution, drug administration, and electrical conductivity, amongst others.In analyzing the water intake properties of polymer/GO composites, the generally held opinion is that the oxygen containing functional groups in most polymers and GO influence the water intake properties profusely. These groups have been proven to up the absorption rate in these materials, and as such, the minimally studied GO/polymer composites, so far, are considered very hydrophilic. In one study, Ghosh et al.  investigThe above-presented work clearly shows that the water intake properties of graphene oxide and graphene oxide/polymer composites surpass those of graphene and graphene/polymer composites. The main contributing factor here would be the oxygen containing functional groups present on GO, and the assumption is that these groups would assist a great deal in metal ion adsorption. So as a step further, it would only be fitting to explore strides made in the metal adsorption capabilities of graphene oxide/polymer composites.w/w GO:bipolymercomposition) were used to treat heavy metal contaminated water surfaces. The authors developed the composites and investigated the effect of pH and dosage, ionic strength and associate ions, and contact time on the adsorption of Cr(III), Pb(II), and As(V) ions. In investigating the effect of pH and dosage, a pH range of 2 to 10 was used, and the results were summarised in GO/polymer composites, as adsorbents for heavy metal ions in solution, have had very minimal research outputs ,84 thus 43− ions, Pb(II) removal by increasing the concentrations of Ca2−, K+, and Mg2+, and lastly, the adsorption of As(V) was reduced by the introduction of the anionic species CO32− and PO43−, respectively. The reasons put forth were that the removal of Cr(III) is not affected by any other ionic species but only PO43− due to inner sphere surface complexation at the interface of the adsorbent and metal. The reduction in Pb(II) adsorption is due to the ionic strength and charge of the Ca2+, K+, and Mg2+ ions being close, which might reduce the interaction between Pb(II) and the GO/polymer adsorbent. Lastly, the disturbance in As(V) metal ions by the CO32− and PO43− species was said to be because these ionic species were competing with As (V) for adsorption sites via inner-sphere surface complexation. Concerning the contact time, as expected, metal ion adsorption would increase with an increase in contact time with the adsorbent. Modeling was done in this regard, and the Langmuir isotherm proved more applicable to the scenario, with constants calculated supporting a high adsorption capability. From this, the authors tried to determine the mechanism involved in the adsorption of these heavy metals onto the prepared composites. This was done using FTIR and XPS after the adsorption of heavy metals. It was established that after adsorption, new peaks were formed in FTIR, which portrayed the presence of metal ion and oxygen bonds for all the analyzed heavy metals. This brought about the assumption that adsorption took place on the surface of the adsorbent as the oxygens interacted with the heavy metal ions. Furthermore, the XPS analyses also resulted in newly formed peaks, as well as the shifting of peaks, signifying the presence of newly formed bonds. These bonds were still said to be between the oxygen groups on the adsorbent and the adsorbates . To give it more context, the authors went on to propose that the adsorption process was mostly caused by surface complexation instead of electrostatic contact. The proposed mechanism for the adsorption is shown in Concerning the adsorbent dosage, it was expected that increasing the dosage would result in an increased degree of adsorption. Then in investigating the effect of ionic strength and associated ions, different ionic substances were added to the adsorbent/adsorbate mixture to mimic the natural state with which the water is found if it is contaminated. The findings in this regard were that firstly Cr (III) removal was only deterred by POIt was further established from the modelling that the introduction of a polymer matrix/matrices to a GO-based adsorbent would increase the adsorption capability. This is obviously due to the presence of oxygen containing functional groups on some polymers, which would act as adsorption sites to trap the metal ions. Although there has not been much work done in using these composites for heavy metal removal, the chemistry coupled with recent work really proves that GO-based polymer composites possess excellent metal adsorption properties. In one other study by Peng et al. , the anaThe above report on GO/polymer composites is very minimal, and this is because there has not been much work done on this front, especially where biodegradable polymers are used. So, it would be fitting to identify this area as a knowledge gap and deem it only logical that the gap is explored fully and means to close it are put in place. This would contribute a great deal to the ongoing developments in material science and scientific research in general.This work aimed to review and contrast graphene and graphene oxide and their polymer composites in terms of metal ion adsorption and other properties. Insight into the strides made so far in this field of research has been provided with utmost certainty. In terms of structure and morphology, recent work has established that the main difference between GO and GN is the presence of oxygen-containing functional groups on GO, whereas GN only consists of carbon. Coming to the morphology of the composites, it was established that the layered structures of both GO and GN assist with adhesion and enveloping the polymer matrix/matrices. As such, we can say that both GO and GN have a compatibilizing effect on polymer matrices. From there, the thermal properties were reviewed, starting with melting and crystallization, then thermal stability. The work done on the thermal properties in this regard is also positive and promising. In melting and crystallization, the introduction of GO and GN into a polymer matrix/matrices is said to improve the miscibility of the blend composites and increase the crystallinity. This, of course, can open the way to many uses and applications. The thermal stability is also improved with the introduction of these two fillers, according to thealready-statedd literature. Then we looked at the water absorption capabilities of GN and GO, together with their polymeric composites. Here it was established, through the literature, that the water intake properties of GN are not at all satisfactory, even when used in polymer composites. This is particularly disadvantageous. As such, GO seems to be a suitable stand-in candidate. That is, both GO on its own and in polymer composites have been proven to show great water intake properties. The idea is that the oxygen containing functional groups on GO assist a great deal with this. Then the recent work done in metal ion adsorption shows that GN and its composites are not at all suitable adsorbents of heavy metals in solution. The lack of adsorption sites is the main reason here, and as such, GO would need to step in again. Both neat GO and GO/polymer composites have been shown to have excellent metal ion adsorption capabilities. This is one area that can be further explored, as there are gaps in it. Firstly, as already stated, the GO on its own has a shorter life span, so the gap lies in the need to mask it. Then, the masking that has taken place currently mostly utilizes a single polymer. We need to look into using binary polymer systems to mask GO, and improve other properties. Lastly, a very big gap remains in the type of polymers used. There has not been much research directed to the formulation and usage of completely biodegradable polymer/GO composites for the purposes of removing heavy metal ions from solution. These polymers are important as most of them contain oxygen in their structures, which could aid a great deal in trapping metal ions from water. In addition, as most biodegradable polymers are either too brittle or too rubbery on their own, blending them would assist in remedying this and balancing out the properties to obtain optimal materials. It is very clear now which direction should be taken from here in order to advance further the knowledge already acquired to optimize the usage of GO and its composites.As for the future perspectives regarding the usage of graphene and graphene oxide-based materials for water treatment, it is clear that graphene oxide is the most suited because of the oxygen-containing groups. The limitation with graphene is the absence of these functional groups that would act as adsorption sites and improve the adsorption rate and efficacy. Even if polymers that have these functional groups were used with graphene to form composites, the adsorption rate would surely be lower as compared to materials containing graphene oxide. Therefore, as it stands, there are many countries trying to explore the usage of graphene oxide-based materials in water treatment applications. However limitations arise in the policies. The toxicity of graphene oxide in the human body is a concept that is currently widely debated, although in some countries, it is already allowed to use these materials. This would influence the idea of ulitizing GO-based composites for water treatment, and then focus on developing methods to remove the GO traces in the water. This is already being explored as well, and we believe it could be the optimal remedy, as the absorption capabilities of GO, and its polymeric composites are crucial in water treatment.


RSV is an extremely common respiratory pathogen and a leading cause of infant hospitalisation. An estimated 1 in 7 infants will develop an RSV lower respiratory tract infection (LRTI) requiring medical attention. The majority of infants hospitalised have no comorbidities and were born at term. Nirsevimab is the only preventative option designed to provide protection to all infants from RSV LRTI, from the start of their first RSV season, for the duration of that season.In the HARMONIE trial conducted in the UK, France, and Germany (EudraCT 2022-000099-20), we evaluated the impact of nirsevimab on all cause LRTI hospitalisations, as well as RSV LRTI specifically. Analyses looked at the efficacy of nirsevimab across subgroups that constitute the all infant population, all of whom are vulnerable throughout their first RSV season.Individually randomised infants  received a single intramuscular injection of nirsevimab , or no intervention (standard of care) before or during the RSV season. Following a single physical visit participants were monitored remotely for all cause LRTI hospitalisation . Efficacy was evaluated through the RSV season. Adverse events (AEs) continue to be monitored for 365 days.8058 infants were randomized, 4037 to the nirsevimab group and 4021 to the no intervention group. Efficacy against RSV LRTI was 83.21% (CI 67.77-92.04%) across all countries. Efficacy was consistent across infant subgroups, in those born at term (≥ 37 weeks: 84.41% (CI 64.92-94.10%)) or prematurely (< 37 weeks: 78.31% (CI 33.49-94.69%)) and not impacted by infant weight at randomisation (< 5kg: 82.12% CI 59.14-93.30% and ≥ 5kg 85.16% CI 57.01-96.25%). Efficacy against all cause LRTI hospitalisation was 58.04% (39.693- 71.19).A single dose of nirsevimab given before or during the RSV season demonstrated a significant and sustained impact on RSV LRTI hospitalisations for the entire RSV season. Consistent efficacy was shown across subgroups comprising the all infant population.The potential impact of nirsevimab was reinforced by a reduction in all cause LRTI hospitalisations.Saul N. Faust, FRCPCH PhD, AstraZeneca, Janssen, Pfizer, Moderna, GlaxoSmithKline, Novavax, Sanofi, Seqirus, Medimmune, Merck, MSD, Iliad and Valneva: Advisor/Consultant|AstraZeneca, Janssen, Pfizer, Moderna, GlaxoSmithKline, Novavax, Sanofi, Seqirus, Medimmune, Merck, MSD, Iliad and Valneva: Investigator Katrina Cathie, MBE, FRCPCH, AstraZeneca: Advisor/Consultant|GSK: Advisor/Consultant|Iliad: Advisor/Consultant|Janssen: Advisor/Consultant|MedImmune: Advisor/Consultant|Merck: Advisor/Consultant|Pfizer: Advisor/Consultant|Sanofi: Advisor/Consultant|Valneva: Advisor/Consultant SB Drysdale, FRCPCH, PhD, AstraZeneca: Advisor/Consultant|iLiAD: Advisor/Consultant|Janssen: Advisor/Consultant|Moderna: Advisor/Consultant|MSD: Advisor/Consultant|Pfizer: Advisor/Consultant|Sanofi: Advisor/Consultant|Valneva: Advisor/Consultant S Royal, FRCGP, Sanofi: Advisor/Consultant C Felter, MD, Sanofi: Employee NC Vassilouthis, MD, Sanofi: Employee Mathieu Bangert, PhD, Sanofi: Staff member K Mari, PhD, Sanofi: Employee R Nteene, MD, Sanofi: Employee M Roberts, MD, Sanofi: Employee P Tissieres, MD, Baxter: Advisor/Consultant|PAion: Advisor/Consultant|Sanofi: Advisor/Consultant|Sedana: Advisor/Consultant


Structural stabilities were confirmed for all these heterostructures, indicating their feasibility in fabrication. BP/BP/MoS2 and BlueP/BlueP/MoS2 lowered the bandgaps further, making them suitable for a greater range of applications, with respect to the bilayers BP/MoS2 and BlueP/MoS2, respectively. Their absorption coefficients were remarkably improved in a wide spectrum, suggesting the better performance of photodetectors working in a wide spectrum from mid-wave (short-wave) infrared to violet. In contrast, the bandgaps in BP/graphene/MoS2 and BlueP/graphene/MoS2 were mostly enlarged, with a specific opening of the graphene bandgap in BP/graphene/MoS2, 0.051 eV, which is much larger than usual and beneficial for optoelectronic applications. Accompanying these bandgap increases, BP/graphene/MoS2 and BlueP/graphene/MoS2 exhibit absorption enhancement in the whole infrared, visible to deep ultraviolet or solar blind ultraviolet ranges, implying that these asymmetrically graphene-sandwiched heterostructures are more suitable as graphene-based 2D optoelectronic devices. The proposed 2D trilayer vdW heterostructures are prospective new optoelectronic devices, possessing higher performance than currently available devices.Constructing two-dimensional (2D) van der Waals (vdW) heterostructures is an effective strategy for tuning and improving the characters of 2D-material-based devices. Four trilayer vdW heterostructures, BP/BP/MoS Bilayeronfirmed ,25. Graponfirmed . MoS2/MXoS2/WSe2 , and alloS2/WSe2 , showingoS2/WSe2 . The typ regions . Blue-ph regions . BlueP/G regions . The pho regions  or an el regions . BP/MoS2etectors . Many BP devices . BlueP/M ability . In addiectivity . Graphenectivity . It is a2/MX2/MoS2 exhibit a smaller electron effective mass and a semiconductor-to-metal transition under tensile strain [2/MX2/MoS2 were further calculated, showing that these trilayer heterostructures would be prospective to construct highly sensitive field effect transistors for nano-biomolecules sensing as well as for pH sensing [2 monolayer is encapsulated by two graphitic carbon nitride monolayers, revealing their magnetic metallic characteristics [2/SiC/MoS2 and SiC/MoS2/SiC, and predicted their strain-induced tunable band structure promising for future optoelectronic devices [2-based trilayer heterostructures demonstrated the excellent ability to accelerate the separation of photo-generated electron-hole pairs and the controllable power conversion efficiency indicating great potential for photocatalysis and photovoltaics [2-graphene-based trilayer heterostructures are of unique optoelectronic properties tunable by external electric field and thus of great potential for solar energy harvesting and conversion [2/graphene/graphene and graphene/PtSe2/graphene, revealing their usefulness to guide the design of high-performance field effect transistors [2/graphene/MoS2 p-g-n heterostructure photodetector, which achieved a wide detection wavelength range of 400–2400 nm and a short rise/fall time [2/graphene/SnS2 p–g–n junctions, and achieved extraordinary responsivity as high as 2600 A/W, detectivity as good as 1013 Jones with fast photoresponse in the range of 405–1550 nm [As an extension to the above idea, trilayer vdW heterostructures have recently been attracting more and more attention, since one more layer might open more space for tuning the properties further ,41. Simue strain . Device  sensing . Bafekryeristics  probably devices . Calculavoltaics . BN/grapvoltaics ,48. Xu enversion . Externansistors . In an eall time . Li et a–1550 nm . It is t2, phosphorene and/or graphene are simulated in terms of structural, optical and optoelectronic properties. It is suggested that sophisticated 2D trilayer vdW heterostructures can provide further optimized characters for a new generation of optoelectronic devices. In this work, we attempt to construct and study trilayer vdW heterostructures with asymmetric structures and/or three different types of 2D materials. Four kinds of trilayer heterostructures containing MoS2, BlueP/BlueP/MoS2, BP/graphene/MoS2 and BlueP/graphene/MoS2, which are structurally asymmetric and/or composed of more than two different types of 2D materials. The first-principles calculation was performed using the tool of Vienna ab initio simulation package (VASP) [−5 eV and 0.01 eV/A, respectively. When optimizing the trilayer atomic structures, 1 × 7 × 1, 3 × 3 × 1, 2 × 2 × 1 and 3 × 3 × 1 k-point sets were adopted for BP/BP/MoS2, BlueP/BlueP/MoS2, BP/graphene/MoS2 and BlueP/graphene/MoS2, respectively. When calculating the electronic structures, 5 × 21 × 1, 16 × 16 × 1, 5 × 5 × 1 and 8 × 8 × 1 k-point sets were adopted for the four structures, respectively. When calculating the optical properties, 8 × 21 × 1, 20 × 20 × 1, 10 × 10 × 1 and 13 × 13 × 1 k-point sets were adopted for the four structures, respectively. The above-mentioned k-point sets were actually determined by convergence tests: increasing the k-point set scale until a state in which the calculation results do not change beyond the convergence standard any longer. It reflects that calculations for structural, electronic and optical properties need more and more computational cost and accuracy.In this study, we designed four trilayer vdW heterostructures BP/BP/MoSe (VASP)  within De (VASP) . The gene (VASP) ,55. Due e (VASP)  was adopEb) is calculated using the following equation: Ehts represents the overall energy of the heterostructure and EA, EB, and EC represent the energy of each monolayer in its free state. The work function, used as the key parameter to deduce the band alignment, is described byEvac is the energy of a stationary electron in the vacuum and Ef is the Fermi level.To establish the stability of the proposed vdW heterostructures, we should in principle evaluate their vibrational frequencies to seek real and positive phonon parameters. Nevertheless, most of the first-principles simulations on vdW heterostructures took the binding energy as the figure of merit to characterize the structure stability ,27,30,36ω represents the circular frequency of light. The real part The macroscopic optical response function is usually measured by the complex dielectric function den rule . Based oden rule ,(3)α(ω)2 heterostructure is constructed from a 2 monolayer and a 5 × 1 supercell bilayer-BP, while the BlueP/BlueP/MoS2 heterostructure is formed by stacking a 3 × 3 supercell bilayer-BlueP on a 3 × 3 supercell MoS2 monolayer. After structure optimization calculation, we obtain the rectangular lattice constants a = 22.227 and b = 3.278 Å for BP/BP/MoS2, and the hexagonal lattice constants a = b = 9.642 Å for BlueP/BlueP/MoS2. For BP/graphene/MoS2, bilayer BP/graphene cells are first constructed by matching 3 × 1 BP with 2. For BlueP/graphene/MoS2, a 3 × 3 supercell monolayer BlueP, 4 × 4 supercell graphene, and 3 × 3 supercell monolayer MoS2 are successively stacked. The optimized rectangular lattice constants of BP/graphene/MoS2 are a = 10.256 Å and b = 8.907 Å, and the hexagonal ones of BlueP/graphene/MoS2 are a = b = 9.776 Å. The simulated models of BP/BP/MoS2, BlueP/BlueP/MoS2, BP/graphene/MoS2 and BlueP/graphene/MoS2 are depicted in Due to the surface relaxation and interfacial mismatch, the trilayer vdW heterostructure supercells must be carefully set, for which we here extend monolayer cells individually to satisfy the length matching between different layers. The BP/BP/MoS2 [2 [2 [2 and BlueP/graphene/MoS2 might be easier to be fabricated than BP/BP/MoS2 and BP/graphene/MoS2, although BlueP-related 2D materials seem currently farther away from practical manufacture than BP-related ones.The trilayer vdW heterostructures will have different energies with different layer spacing. 2 , graphen2 [2 , graphen2 [2  bilayer 2 [2 [2  trilayer2 [2 [2 , and the2 [2 [2 ,46. Comb2 and BlueP/BlueP/MoS2 calculated using the PBE method. BP/BP/MoS2 exhibits the conduction band minimum (CBM) located between the Y and G points and mostly contributed by MoS2 (red lines) as well as the valance band maximum (VBM) located at the high-symmetry G point and mostly contributed by BP (blue lines). These are qualitatively consistent with our calculation of the bilayer counterpart BP/MoS2 , which are already lower than the free monolayer ones , whereas the VBM is located at the high-symmetry K point and is mostly contributed by BlueP (blue lines), consistent with the calculated results of the bilayer counterpart BlueP/MoS2 , which are already decreased compared with the corresponding free monolayer ones , suggesP 0.9 eV ). Signifent with ). Simila1.908 eV ). The whdW force . A wholedW force ,61; band2 and BlueP/graphene/MoS2 trilayer vdW heterostructures calculated using the PBE method. What is immediately significant is that the BP/graphene/MoS2 structure opens the bandgap of graphene to 0.051 eV, which is over one order of magnitude larger than the opening by the reported bilayer heterostructures such as graphene/BP (~0.0013 eV) [2 (~0.0007 eV) [2 (~0.0048 eV) [2 opens the bandgap of graphene by 0.0093 eV, similar to many other heterostructures. The effectiveness of the graphene bandgap opening in BP/graphene/MoS2 can hardly be attributed to strain, because the strains of graphene in both structures are close to each other (3.2% and 2.8%) and close to those of the reported structures such as graphene/BP (3%) [2 monolayers and possible built-in electric fields. The remarkable graphene bandgap opening suggests potential applications in temperature-sensitive devices [2 and BlueP/BlueP/MoS2. There seem to be two types of bandgap engineering mechanisms in trilayer vdW heterostructures, providing wider space for novel device design.0013 eV) , graphen0013 eV) , and gra0007 eV) , and rem0048 eV) , graphen0048 eV) , and gra0048 eV) . BlueP/g/BP (3%) . We beli devices . On the  devices  and Blue devices ), which 2 and BlueP/BlueP/MoS2, as shown in 2 and BlueP/graphene/MoS2, where the DOS also increases due to the insertion of a single graphene monolayer with respect to BP/MoS2 and BlueP/MoS2 bilayer heterostructures. It evidences the effectiveness of the proposed trilayer vdW heterostructures in optimizing the performance of 2D material systems.We also calculated the local density of state (LDOS) and total density of states (TDOS) of BP/BP/MoS2 and BlueP/BlueP/MoS2 heterostructures, p-type bilayer-BP(BlueP) (fEcloser to VBM) and n-type MoS2 (fE closer to CBM) form type-II band alignment, as is expected. This band alignment has carrier confinement effects [2 shows a more obvious type-II band alignment with a larger offset on the valence band and will produce a stronger carrier confinement effect compared with BP/MoS2 [2 and BlueP/graphene/MoS2 heterostructures naturally show a type-I quantum-well-like band alignment, providing the potential to construct nano-scaled bipolar transistors, field-effect transistors and photon transistors, which may need three different energy structures. In contrast to the Schottky contact of graphene/MoS2 and graphene/BP(BlueP), here, semiconductor heterojunctions are formed. By applying an electric field across this semiconductor heterojunction, the graphene bandgap can be further flexibly tuned to exhibit different band alignments, which is of significance for the construction of new types of field-effect photodetectors [The band alignment of the vdW heterostructure is important in the design of new 2D-material structures. It is thus necessary to specifically pick up the band alignment data from the proceeding band structures with the help of calculating the work function. In  effects , favorin BP/MoS2 ,40. Withetectors .2 and BlueP/BlueP/MoS2 trilayer heterostructures are shown in 2 is much stronger (reaching 105 cm−1) than that of BlueP/BlueP/MoS2 in the near-infrared range, but the latter displays more significant absorption in the ultraviolet range. They can thus be applied effectively in different scenes. As a whole, these results make up for the shortage of monolayer 2D materials in optical characteristics and are beneficial for optoelectronic devices with the need for light absorption enhancement and absorption range broadening.On the optical absorption properties of 2D materials, many studies have been devoted to monolayer and bilayer vdW heterostructures, but little research has been carried out on trilayer ones, let alone a comparison between the bilayer and trilayer heterostructures . The abs2, and the trilayer heterostructures BP/graphene/MoS2 and BlueP/graphene/MoS2. The inset shows that the two kinds of trilayer heterostructures have stronger light absorption in the range below 0.8 eV than the related bilayer heterostructures, so they are better choices for graphene-based 2D materials to realize photodetectors widely responding to short-, mid- and long-wave infrared light. In the range of 2.2–6 eV, BP/graphene/MoS2 shows remarkably higher light absorption than the related bilayer heterostructures, making it able to realize better graphene-based optoelectronic devices working in a wide range from visible to deep ultraviolet. BlueP/graphene/MoS2 shows better light absorption characteristics than the related bilayer heterostructures in the range of 4–6 eV, so it is more suitable for use as a graphene-based solar-blind ultraviolet photodetector. These asymmetric graphene-sandwiched vdW heterostructrues are thus proved to be effective in tuning and improving the performance of graphene-based 2D materials on the basis of guaranteeing the excellent electronic properties of graphene.2, BlueP/BlueP/MoS2, BP/graphene/MoS2 and BlueP/graphene/MoS2. The atomic structures of these heterostructures are all stable and look feasible to prepare. For BP/BP/MoS2 and BlueP/BlueP/MoS2, all the bandgaps were tuned to be smaller, to effectively compensate for the shortage of corresponding monolayers and to satisfy a wider spectrum of applications with respect to the bilayer structures BP/MoS2 and BlueP/MoS2, respectively. Their higher DOS, much stronger light absorption and more obvious type-II band alignment will realize better performance of optoelectronic devices working in a wide spectrum from mid-wave (short-wave) infrared to violet. In contrast, for BP/graphene/MoS2 and BlueP/graphene/MoS2, most of the bandgaps were enlarged, implying different tuning mechanisms related to vdW interaction. Specifically in BP/graphene/MoS2, the graphene bandgap was well opened to 0.051 eV, more than one order of magnitude larger than usual, indicating more space for graphene tuning in trilayer vdW heterostructures. Accompanying the bandgap increase, both BP/graphene/MoS2 and BlueP/graphene/MoS2 exhibit absorption enhancement in wide spectral ranges, suggesting that these trilayer vdW heterostructures show better prospects as graphene-based 2D material optoelectronic devices with broad responses in the short- to long-wave infrared, visible to deep ultraviolet and solar-blind ultraviolet bands. It is concluded that the proposed 2D trilayer vdW heterostructures are potentially applicable as novel optoelectronic devices.Using the first-principles calculation based on DFT theory, we proposed and simulated trilayer 2D vdW heterostructures: BP/BP/MoS


Pseudomonas is rare. Our objective was to investigate outcomes of patients with Pseudomonas endocarditis by treatment strategy and identify factors associated with treatment failure.Infective endocarditis secondary to Pseudomonas endocarditis at 8 hospitals were identified between July 2010 and December 2022. Unless the cultured valve yielded a Gram-negative pathogen, patients with blood cultures growing Gram-positive bacteria or yeast for >24 hours were excluded. Combination therapy was defined as receipt of ≥2 in vitro active agents for ≥72 hours. Failure was a defined as death or microbiologic failure by day 42; microbiologic failures included escalation of antimicrobial therapy following treatment-emergent resistance, increased vegetation size, or blood cultures positive for ≥14 days.Adult patients with definitive P. aeruginosa was the underlying pathogen in 97% (33/34) of patients. 65% (22/34) and 35% (12/34) received combination and monotherapy, respectively. Patients managed with combination therapy had comparable rates of prosthetic valve endocarditis , a vegetation size > 1cm  and no receipt of cardiac surgical intervention despite an indication  compared to those who received monotherapy. There was no significant difference in 42-day failure rates , 90-day mortality  or median hospital length of stay  between patients who receivedcombination therapy and monotherapy. Patients who experienced 42-day failure were more likely to have multi-drug resistant (MDR) Pseudomonas on initial blood cultures  and were less likely to be initially managed with piperacillin/tazobactam or cefepime  compared to those who experienced clinical cure.34 patients met the inclusion criteria. 32% (11/34) were people who inject drugs and 12% (4/34) were organ transplant recipients. Combination therapy versus monotherapyFactors associated with clinical failurePseudomonas endocarditis to date. We did Not identify a benefit to combination therapy; however, the overall sample size was small. Endocarditis due to MDR P. aeruginosa was associated with a higher risk of clinical failure.To our knowledge, this is the largest study of Ryan K. Shields, PharmD, MS, Allergan: Advisor/Consultant|Cidara: Advisor/Consultant|Entasis: Advisor/Consultant|GSK: Advisor/Consultant|Melinta: Advisor/Consultant|Melinta: Grant/Research Support|Menarini: Advisor/Consultant|Merck: Advisor/Consultant|Merck: Grant/Research Support|Pfizer: Advisor/Consultant|Roche: Grant/Research Support|Shionogi: Advisor/Consultant|Shionogi: Grant/Research Support|Utility: Advisor/Consultant|Venatorx: Advisor/Consultant|Venatorx: Grant/Research Support