Keratoconus is a bilateral ocular condition characterized by irregularities and the thinning of the cornea. Decreased central corneal thickness is a hallmark of the condition, and numerous genes have played a role in altering corneal thickness and the subsequent development of keratoconus. Variants in the structural and regulatory genes of the extracellular matrix have been highly associated with keratoconus, as well as with pectus excavatum, a chest wall deformity commonly seen in connective tissue disorders. This report describes a patient with a c.1720-11T>A intronic variant in the collagen-encoding gene, COL5A1, who was diagnosed with early-onset keratoconus and demonstrated a significant pectus excavatum. This report associates a COL5A1 variant with these seemingly unrelated phenotypic associations, further advancing the literature on the topic. Full article

(1) Introduction: Cancer diagnosis has been related to depression, anxiety, and distress, as well as to post-traumatic growth (PTG). One of the mediating variables for emotional response is thought style (rumination, cognitive avoidance, and cognitive engagement). (2) Aim: To identify the relationship between thought style and emotional responses to cancer. A secondary aim was to identify the relationship between emotional responses and inflammatory immunological biomarkers. (3) Method: A total of 115 patients with cancer were included in the study. Before initiating cancer treatment, patients were assessed using the Hospital Anxiety and Depression Scale (HADS), distress thermometer, and Post-Traumatic Growth Inventory (PTGI). Patients provided their most recent blood biometry. (4) Results: Rumination correlated with anxiety, depression, and distress. Cognitive avoidance correlated with PTG (−0.240) and distress (−0.209). Cognitive engagement correlated with PTG (0.393). Regarding thought style and biomarkers, a negative correlation was observed for absolute neutrophils with cognitive avoidance (−0.271) and rumination (0.305). Regarding biomarkers and emotional responses, there was a negative correlation between PTG and absolute lymphocytes (−0.291). There was also a correlation between PTG and neutrophils (0.357) and neutrophil-to-lymphocyte ratio (NLR) (0.295). (5) Conclusions: Thought style is related to the emotional response to a cancer diagnosis; rumination is related to depression, distress, and anxiety; and cognitive engagement is related to PTG. PTG is related to inflammation and immunological biomarkers. Full article

As vaccinations against the SARS-CoV-2 virus have become a crucial tool in controlling the spread of the disease, reports of rare health complications have emerged, including new-onset antineutrophil cytoplasmic autoantibodies (ANCA)-associated vasculitis (AAV). We systematically reviewed new-onset AAV following COVID-19 vaccination case reports and case series published in three databases before January 2024 following PRISMA guidelines to understand the characteristics of possible causal relationships or coincidences. In total, 404 articles were screened respectively by title, abstracts, and full-texts. Thirty-four papers fulfilled the inclusion criteria and have been analyzed, covering 44 patients with new-onset AAV after COVID-19 vaccination with no prior history of COVID-19 infection. Data regarding patients’ metrics, comorbidities, vaccination characteristics, symptoms, diagnostics, treatment, and outcomes were investigated and summarized. The cohort consisted predominantly of females. AAV diagnosis was confirmed via biopsy, with renal dysfunction as a prevailing manifestation. In most cases, the first symptoms of AAV developed after the second dose; moreover, Pfizer-BioNTech was the most frequently administered vaccine among the analyzed cohort. Primary treatment involved glucocorticoid therapy, with a mostly favourable response. This systematic review aims to raise awareness among clinicians in the field regarding this rare but possible complication, to promote the prompt recognition and diagnosis of de novo ANCA-positive small-vessel vasculitis in timely association with SARS-CoV-2 vaccination. Full article

This work is the first one that provides not only evidence for the existence of free volumes in the human stratum corneum but also focuses on comparing these experimental data, obtained through the unique positron annihilation lifetime spectroscopy (PALS) method, with theoretical values published in earlier works. The mean free volume of 0.269 nm was slightly lower than the theoretical value of 0.4 nm. The lifetime τ₃ (1.83 ns with a coefficient of variation CV of 3.21%) is dependent on the size of open sites in the skin. This information was used to calculate the free volume radius R (0.269 nm with CV 2.14%), free volume size Vf (0.081 nm³ with CV 4.69%), and the intensity I₃ (9.01% with CV 10.94%) to estimate the relative fractional free volume f_v (1.32 a.u. with CV 13.68%) in human skin ex vivo. The relation between the lifetime of o-Ps (τ₃) and the radius of free volume (R) was formulated using the Tao–Eldrup model, which assumes spherical voids and applies to sites with radii smaller than 1 nm. The results indicate that PALS is a powerful tool for confirming the existence of free volumes and determining their size. The studies also focused on describing the probable locations of these nanospaces in SC lipid bilayers. According to the theory, these play an essential role in dynamic processes in biological systems, including the diffusion of low-molecular-weight hydrophobic and moderately hydrophilic molecules. The mechanism of their formation has been determined by the molecular dynamics of the lipid chains. Full article

Barley is rich in phenolic compounds, providing health benefits and making it a valuable addition to a balanced diet. However, most studies focus on these compounds at barley’s final maturity, neglecting their synthesis during grain development and its impact on barley quality for food applications. This study investigates phenolic profiles during grain development in four hull-less barley genotypes with different grain colors, specifically bred for food applications. The objectives were to determine the phenolic profile and identify the optimal maturity stage for maximum phenolic content and antioxidant capacity. Using UPLC-MS/MS and in vitro antioxidant capacity assays, results show that total phenolic compounds decrease as grain matures due to increased synthesis of reserve components. Flavan-3-ols, phenolic acids, and flavone glycosides peaked at immature stages, while anthocyanins peaked at physiological maturity. The harvest stage had the lowest phenolic content, with a gradient from black to yellow, purple, and blue genotypes. Antioxidant capacity fluctuated during maturation, correlating positively with phenolic compounds, specially bound phenolic acids and anthocyanins. These findings suggest that early harvesting of immature grain can help retain bioactive compounds, promoting the use of immature barley grains in foods. To support this market, incentives should offset costs associated with decreased grain weight. Full article

Ubiquitin-specific protease 5 (USP5) belongs to the ubiquitin-specific protease (USP) family, which uniquely recognizes unanchored polyubiquitin chains to maintain the homeostasis of monoubiquitin chains. USP5 participates in a wide range of cellular processes by specifically cleaving isopeptide bonds between ubiquitin and substrate proteins or ubiquitin itself. In the process of immune regulation, USP5 affects important cellular signaling pathways, such as NF-κB, Wnt/β-catenin, and IFN, by regulating ubiquitin-dependent protein degradation. These pathways play important roles in immune regulation and inflammatory responses. In addition, USP5 regulates the activity and function of immunomodulatory signaling pathways via the deubiquitination of key proteins, thereby affecting the activity of immune cells and the regulation of immune responses. In the present review, the structure and function of USP5, its role in immune regulation, and the mechanism by which USP5 affects the development of diseases by regulating immune signaling pathways are comprehensively overviewed. In addition, we also introduce the latest research progress of targeting USP5 in the treatment of related diseases, calling for an interdisciplinary approach to explore the therapeutic potential of targeting USP5 in immune regulation. Full article

Alzheimer’s disease (AD), the leading cause of dementia worldwide, remains a challenge due to its complex origin and degenerative character. The need for accurate biomarkers and treatment targets hinders early identification and intervention. To fill this gap, we used a novel longitudinal proteome methodology to examine the temporal development of molecular alterations in the cortex of an intracerebroventricular streptozotocin (ICV-STZ)-induced AD mouse model for disease initiation and progression at one, three-, and six-weeks post-treatment. Week 1 revealed metabolic protein downregulation, such as Aldoa and Pgk1. Week 3 showed increased Synapsin-1, and week 6 showed cytoskeletal protein alterations like Vimentin. The biological pathways, upstream regulators, and functional effects of proteome alterations were dissected using advanced bioinformatics methods, including Ingenuity Pathway Analysis (IPA) and machine learning algorithms. We identified Mitochondrial Dysfunction, Synaptic Vesicle Pathway, and Neuroinflammation Signaling as disease-causing pathways. Huntington’s Disease Signaling and Synaptogenesis Signaling were stimulated while Glutamate Receptor and Calcium Signaling were repressed. IPA also found molecular connections between PPARGC1B and AGT, which are involved in myelination and possible neoplastic processes, and MTOR and AR, which imply mechanistic involvements beyond neurodegeneration. These results help us comprehend AD’s molecular foundation and demonstrate the promise of focused proteomic techniques to uncover new biomarkers and therapeutic targets for AD, enabling personalized medicine. Full article

Cochlear implantation is the therapy used for patients with severe to profound sensorineural hearing loss. For the success of the surgery, it is important that each surgical step is performed with meticulous precision, starting from the correct patient position on the operating table. In elderly or obese patients, this can be difficult to achieve due to cervical rigidity. With this technical note, we want to describe a new position from orthopedic surgery to perform a posterior tympanotomy accurately, ensuring a safe procedure and avoiding unpleasant complications. Full article

The genomes of positive-sense (+) single-stranded RNA (ssRNA) viruses are believed to be subjected to a wide range of RNA modifications. In this study, we focused on the chikungunya virus (CHIKV) as a model (+) ssRNA virus to study the landscape of viral RNA modification in infected human cells. Among the 32 distinct RNA modifications analysed by mass spectrometry, inosine was found enriched in the genomic CHIKV RNA. However, orthogonal validation by Illumina RNA-seq analyses did not identify any inosine modification along the CHIKV RNA genome. Moreover, CHIKV infection did not alter the expression of ADAR1 isoforms, the enzymes that catalyse the adenosine to inosine conversion. Together, this study highlights the importance of a multidisciplinary approach to assess the presence of RNA modifications in viral RNA genomes. Full article

Climate change might benefit water-stress-adapted weeds, further impairing their management. To evaluate the impact of soil moisture regimes on the growth and reproductive behaviour of ACCase-resistant and ACCase-susceptible phenotypes of sterile oat (Avena sterilis subsp. ludoviciana (Durieu) Nyman), a greenhouse experiment was carried out in 2020 and 2021. The factors were soil moisture regimes (100% field capacity (FC) as well-watered, 75% FC, 50% FC, and 25% FC) and ACCase-resistant and ACCase-susceptible phenotypes of sterile oat. Increased drought stress conditions reduced the number of tillers per plant by 34, 55, and 83% and the number of seeds per plant by 36, 61, and 89% in the 75% FC, 50% FC, and 25% FC conditions, respectively, compared to the well-watered treatment. Notably, both phenotypes reacted similarly to water stress, with no interactions between the two factors. Regardless of water stress, the resistant phenotypes produced fewer seeds per plant, indicating fitness costs. However, due to their high plasticity, both phenotypes will still produce seeds even when facing severe water stress conditions. Thus, sterile oat is expected to continue infesting crop fields in the near future, but with ACCase-resistant phenotypes being less successful than susceptible ones in the absence of herbicide application. Full article

Potentiometric titration in a fast and simultaneously high-resolution modality was proposed for the identification and quantification of protolytic groups of variable strength at the surface of primary soil particles. The method is implemented by titrimetric data processing as multicomponent spectra (pK_a spectrotitrimetry). Due to the high resolution, the error of acidity-constant assessment (3–5%) is lower, compared to existing approaches; due to the fast titration, the effect of soil hydrolysis is minimized. The soil profiles for acidic Retisols (podzolic soils)—under a spruce crown and in the intercrown space—were studied. These soils, which have similar bulk properties and genesis but developed under different plant covers, were distinguished by pK_a spectral features at 4–5; 5.5–6.5; 6.5–8.5; 7.5–8.5; and 9–10, as well as total group concentrations. Differences in acidic and basic-group distribution (carboxyl groups, amorphous aluminosilicates, carbonate species, amino groups, soluble (poly)phenolic compounds, phospholipids) and Al and Fe complex compounds within the same soil profiles and between two Retisols were found and quantified. The acidity constants and group concentrations found by pK_a spectrotitrimetry were compared with conventional soil-composition indicators (total organic carbon, oxalate-soluble Fe and Al, and phosphorus), using principal component analysis. The main correlations are between the concentrations of oxalate-soluble Al and groups with pK_a values of 5.0–6.5 and 8.5; oxalate-soluble Fe and pK_a values of 9.0–10.0; and P₂O₅ and pK_a values of 4.0–6.0 and 6.5–8.5. The method provides a set of major acidity values without a priori information on a soil sample and can be used for screening and identifying similar soils. Full article

Cystic fibrosis (CF) is a disease characterized by long-term and troublesome symptoms that affect the patient’s life. This study aimed to assess and compare the health-related quality of life (HRQoL) of Polish CF patients and identify factors influencing it. The study group consisted of 79 patients (6 to 42 years old), who filled in an age-appropriate Cystic Fibrosis Questionnaire-Revised. Medical data were collected from each patient’s medical records. The domains with the highest HRQoL median were eating problems (88.89), digestive symptoms (77.78) and physical functioning (75.00). The lowest-rated domain was social functioning (61.90). Age negatively correlated with eight domains, and most strongly with treatment burden (rho = −0.474). Physical functioning positively correlated with all spirometry parameters, and most strongly with FEV1% (rho = 0.588). Treatment burden, body image and respiratory symptoms were positively correlated with all spirometry parameters except PEF%. Present exacerbations reduced scores in almost all domains, and in the MANCOVA model they were a significant factor differentiating patients’ HRQoL. The univariate analysis of MANCOVA showed the significant effects of both health condition (F = 8.32, p = 0.005) and the COVID-19 pandemic (F = 5.89, p = 0.018) on social functioning domain, and of the place of residence on body image (F = 5.60, p = 0.21). A decreasing HRQoL with increasing age and during exacerbations indicates that it is important to focus on these aspects of patients’ lives and ensure they received the necessary support from their healthcare providers. Full article

The management of large medical files poses a critical challenge in the health sector, with conventional systems facing deficiencies in security, scalability, and efficiency. Blockchain ensures the immutability and traceability of medical records, while the cloud allows scalable and efficient storage. Together, they can transform the data management of electronic health record applications. The method used was the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) methodology to choose and select the relevant studies that contribute to this research, with special emphasis set on maintaining the integrity and security of the blockchain while tackling the potential and efficiency of cloud infrastructures. The study’s focus is to provide a comprehensive and insightful examination of the modern landscape concerning the integration of blockchain and cloud advances, highlighting the current challenges and building a solid foundation for future development. Furthermore, it is very important to increase the integration of blockchain security with the dynamic potential of cloud computing while guaranteeing information integrity and security remain uncompromised. In conclusion, this paper serves as an important resource for analysts, specialists, and partners looking to delve into and develop the integration of blockchain and cloud innovations. Full article

Future thermoacoustic cryocoolers employing hydrogen as a working fluid can reduce reliance on helium and improve hydrogen liquefaction processes. Traditional thermoacoustic modeling methods often assume ideal-gas thermophysical properties and neglect finite-amplitude effects. However, these assumptions are no longer valid for hydrogen near saturated states. In this study, a comparison between the results of computational fluid dynamics simulations using actual hydrogen properties and a low-amplitude, ideal-gas thermoacoustic theory was carried out in a canonical plate-based stack configuration at a mean pressure of 5 bar. It was found that the simplified analytical theory significantly underpredicts the cooling power of hydrogen-filled thermoacoustic setups, especially at lower temperatures in high-amplitude, traveling-wave arrangements. In addition, a thermoacoustic prime mover was modeled at higher temperatures, demonstrating very close agreement with the ideal-gas-based theory. The CFD approach is recommended for the design of future hydrogen-based cryocoolers at temperatures below 80 K. Full article

This research assesses the environmental uses of Haleakalā Crater, and adjoining east Maui areas, by native Hawaiians during recent centuries, and evaluates the modern utilization of this volcanic depression. The study methods examine, and focus on, numerous historical and modern accounts and reports. Three historical periods were identified as follows: (1). A phase, from the ~1400s until contact with foreigners in 1778, characterized by the development of settlements, population expansion, the intensification of traditional agriculture, and the political consolidation of Maui. The construction of the Kiha-a-Pi‘i-lani trail across the crater enhanced travel between distant island areas. (2). Following the collapse of Maui’s human populations during the late 1700s, and until the 20th century, came a period distinguished by scientific exploration of the crater, and intentional or accidental introductions of animals, including goats, horses, cattle, and wild dogs. (3). After Haleakalā became a National Park in 1916, efforts to eradicate introduced animals and to encourage the reproduction of silverswords and other plants were initiated. Unfortunately, in retrospect, construction of a modern paved road, improvement of hiking trails, and building of facilities allowed swift access to the Park and substantially increased tourist numbers, up to ~2 million yearly visitors. Faced with such crowds, the long-term planning of Park resources appears to be a formidable task. Full article

We used a replicative lifespan (RLS) experiment of K6001 yeast to screen for anti-aging compounds within lavender extract (Lavandula angustifolia Mill.), leading to the discovery of β-cyclocitral (CYC) as a potential anti-aging compound. Concurrently, the chronological lifespan (CLS) of YOM36 yeast and mammalian cells confirmed the anti-aging effect of CYC. This molecule extended the yeast lifespan and inhibited etoposide (ETO)-induced cell senescence. To understand the mechanism of CYC, we analyzed its effects on telomeres, oxidative stress, and autophagy. CYC administration resulted in notable increases in the telomerase content, telomere length, and the expression of the telomeric shelterin protein components telomeric-repeat binding factor 2 (TRF2) and repressor activator protein 1 (RAP1). More interestingly, CYC reversed H₂O₂-induced telomere damage and exhibited strong antioxidant capacity. Moreover, CYC improved the survival rate of BY4741 yeast under oxidative stress induced by 6.2 mM H₂O₂, increasing the antioxidant enzyme activity while reducing the reactive oxygen species (ROS), reactive nitrogen species (RNS), and malondialdehyde (MDA) levels. Additionally, CYC enhanced autophagic flux and free green fluorescent protein (GFP) expression in the YOM38-GFP-ATG8 yeast strain. However, CYC did not extend the RLS of K6001 yeast mutants, such as Δsod1, Δsod2, Δcat, Δgpx, Δatg2, and Δatg32, which lack antioxidant enzymes or autophagy-related genes. These findings reveal that CYC acts as an anti-aging agent by modifying telomeres, oxidative stress, and autophagy. It is a promising compound with potential anti-aging effects and warrants further study. Full article

Introduction: To promote optimal healthcare delivery, safeguarding older adults from the risks associated with inappropriate medication use is paramount. Objective: This study aims to evaluate the effectiveness of implementing the Qatar Tool for Reducing Inappropriate Medication (QTRIM) in ambulatory older adults to enhance medication safety. Method: The QTRIM was developed by an expert consensus panel using the Beers Criteria and contained a list of potentially inappropriate medications (PIMs) based on the local formulary. Using quality improvement methodology, it was piloted and implemented in two outpatient pharmacy settings serving geriatric medicine and dermatology clinics at Rumailah Hospital, Qatar. Key performance indicators (KPIs) using implementation documentation as a process measure and the percentage reduction in PIM prescriptions as an outcome measure were assessed before and after QTRIM implementation. This study was conducted between July 2022 and September 2023. Results: In the outpatient department (OPD) geriatric pharmacy, the prescription rate of PIMs was reduced from an average of 1.2 ± 0.7 PIMs per 1000 orders in 2022 to an average of 0.8 ± 0.2 PIMs per 1000 orders in 2023. In the OPD geriatric pharmacy, the results showed a 66.6% reduction in tricyclic antidepressants (TCAs) (from 30 to 10), a reduction in first-generation antihistamines by 51.7% (29 to 14), and muscle relaxants by 33.3% (36 to 24). While in dermatology, the older adult prescription rate of PIMs was reduced from an average of 8 ± 3 PIMs per 1000 orders in 2022 to a rate of 5 ± 3 PIMs per 1000 orders in 2023; the most PIM reductions were (49.4%) in antihistamines (from 89 to 45), while muscle relaxants and TCAs showed a minimal reduction. Conclusions: Implementing QTRIM with pharmacy documentation monitoring markedly reduced the PIMs dispensed from two specialized outpatient pharmacies serving older adults. It may be a promising effective strategy to enhance medication safety in outpatient pharmacy settings. Full article

Enantioseparation of nineteen liquid crystalline racemic mixtures obtained based on (R,S)-2-octanol was studied in reversed-phase mode on an amylose tris(3-chloro-5-methylphenylcarbamate) (ReproSil Chiral-MIG) and a cellulose tris(3,5-dichlorophenylcarbamate) (ReproSil Chiral-MIC). These polysaccharide-based chiral stationary phase (CSP) columns for High-Performance Liquid Chromatography (HPLC) were highly effective in recognizing isomers of minor structural differences. The mobile phase (MP), which consists of acetonitrile (ACN)/water (H₂O) at different volume ratios, was used. The mobile phases were pumped at a flow rate of 0.3, 0.5, or 1 mL·min⁻¹ with a column temperature of 25 °C, using a UV detector at 254 nm. The order of the elution was also determined. The chromatographic parameters, such as resolution (R_s), selectivity (α), and the number of theoretical plates, i.e., column efficiency (N), were determined. The polysaccharide-based CSP columns have unique advantages in separation technology, and this study has shown the potential usefulness of the CSP columns in separating liquid crystalline racemic mixtures belonging to the same homologous series. Full article

Skeletal muscle (SKM), despite comprising ~40% of body mass, rarely manifests cancer. This review explores the mechanisms that help to explain this rarity, including unique SKM architecture and function, which prohibits the development of new cancer as well as negates potential metastasis to SKM. SKM also presents a unique immune environment that may magnify the anti-tumorigenic effect. Moreover, the SKM microenvironment manifests characteristics such as decreased extracellular matrix stiffness and altered lactic acid, pH, and oxygen levels that may interfere with tumor development. SKM also secretes anti-tumorigenic myokines and other molecules. Collectively, these mechanisms help account for the rarity of SKM cancer. Full article

The article deals with the way in which the “theological” as the question of the Biblical G-d’s involvement in the world, as in the Talmuds, and in light of Heidegger’s thought about forgetting and forgetfulness (Verborgenheit and Vergessenheit), becomes a political question about the attitude of the Jew and Israel toward the Heimat. In Heidegger, forgetting is about beings hiding from the view rather than about a psychological or “subjective” process to which forgetting has been reduced in modernity. The Heimat hides from the persons’ life, no matter how strongly the persons strive for their Heimat “subjectively” or politically, Heidegger argues. The essay further detects a residual modernity and subjectivism in Heidegger’s concession to forgetting as only a secondary operation, a loss, in comparison to the primary, “authentic” relationship to the Heimat, which, for him, one can and should hope for. That residual modern subjectivity in Heidegger enables and necessitates a comparison with the roles forgetting plays in relationships between G-d, Israel, and the Land in the two Talmuds as, similarly to Heidegger, dealing with and working against forgetting, if not Being, then the Law of the mutual obligations between G-d and Israel. The resulting analysis distills a conundrum in the Palestinian rabbis. Delivery on Israel’s obligations towards G-d conditions Israel’s arrival to the Land, that is to say Israel’s fully successful exodus from Egypt. Yet, any clear memory of, and delivery on, these obligations, i.e., any humanly delivered testament to the law of G-d, constitutes an acute danger of forgetting masked as a would-be-certitude in the “memory” of the would-be-original law. Regaining the status of a full-fledged, never-tamed primordial power in relationships between G-d and Israel, forgetting, in the Palestinian rabbinic thought, undermines the deployment of logos as a way to formulate the Law fully. Letting the G-d in the world, logos however proves prone to reducing G-d to (a) theos, thus drawing the G-d into disappearance and forgetting. Such a counter-current to the copulation of theos with logos, the primordial power of forgetting operates even before any memory captured in words and images becomes possible. Arriving from antiquity to modernity, this counter-current continues to operate despite the currently prevalent demotion of forgetting to a subjective political act of a person or nation. Full article

Family caregivers can be overwhelmed by the care they provide within the family without external support. The development of self-management skills and the associated ability to actively and responsibly manage one’s own health or illness situation therefore plays a vital role in the home care of people living with dementia. As part of an individualized intervention for family caregivers of people of Turkish origin with dementia, existing self-management skills were examined through qualitative interviews to gain insight into health literacy and empowerment in caregiving and in interviewees’ own practices to maintain their health. Ten caregivers of Turkish origin who were responsible for family members living with dementia were interviewed using problem-centered interviews. We found that the target group has very heterogeneous self-management competencies, which are based, on the one hand, on existing supportive resources and, on the other hand, on diverse care-specific, psychosocial and life-world challenges in intrafamily care that have not been overcome. Self-management skills in family caregivers are influenced by a complex interplay of both available resources that support these skills and challenging caregiving situations. This dynamic combination of resources and challenges results in varying levels of self-management ability among family caregivers. Strengthening resources can help caregivers to meet the challenges resulting from caregiving and to expand their self-management competencies. There is great need for action in promoting self-management skills among Turkish caregivers of people living with dementia in home care. Interventions to promote self-management skills must take into account the individual resources of those affected as well as their social and cultural diversity. Full article

Robust engineering of two-dimensional (2D) materials via covalent grafting of organic molecules has been a great strategy for permanently tuningtheir physicochemical behaviors toward electrochemical energy applications. Herein, we demonstrated that a covalent functionalization approach of graphitic surfaces including graphene by a graftable porphyrin (g-Por) derivative, abbreviated as g-Por/HOPG or g-Por/G, is realizable. The efficiency of this approach is determined at both the molecular and global scales by using a state-of-the-art toolbox including cyclic voltammetry (CV), X-ray photoelectron spectroscopy (XPS), Raman spectroscopy, atomic force microscopy (AFM), and scanning tunneling microscopy (STM). Consequently, g-Por molecules were proven to covalently graft on graphitic surfaces via C-C bonds, resulting in the formation of a robust novel hybrid 2D material visualized by AFM and STM imaging. Interestingly, the resulting robust molecular material was elucidated as a novel bifunctional catalyst for both the oxygen evolution (OER) and the hydrogen evolution reactions (HER) in acidic medium with highly catalytic stability and examined at the molecular level. These findings contribute to an in-depth understanding at the molecular level ofthe contribution of the synergetic effects of molecular structures toward the water-splitting process. Full article