Search

The HEALthy Brain and Child Development (HBCD) Study, a multi-site prospective longitudinal cohort study, will examine human brain, cognitive, behavioral, social, and emotional development beginning prenatally and planned through early childhood. The HBCD study has faced several ethical and legal challenges due to its goal of enrolling pregnant people (including those with substance use disorder) and their newborns. Challenges not fully anticipated at the outset emerged from the rapidly changing legal landscape around reproductive rights in the United States. By embedding scholars in bioethics and law within research teams and engaging them in conversation with each other and other study personnel, we were able to address many challenges proactively and respond promptly to unanticipated challenges. In this paper, we highlight several important ethical and legal challenges that arose from the first phase of funding through the beginning of participant enrollment. We explain the methods used to address these challenges, the ethical and legal tradeoffs that arose, and the resolution of challenges through the design of the study. Based on this experience, we provide recommendations for research teams, sponsors, and reviewers to address legal risks and promote the ethical conduct of studies with pregnant people and caregivers. We highlight the importance of collaboration with bioethics and legal scholars in studies involving complex and evolving legal risks, as well as the necessity of designing robust approaches to informed consent and maintaining participant trust while navigating ethical challenges in research., Competing Interests: Declaration of Competing Interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests. Jenny Kingsley reports financial support was provided by National Institutes of Health. If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024. Published by Elsevier Ltd.)

Different parents grieve differently. However, research directed at understanding the important contextual or individual factors that influence the path each bereaved parent takes is lacking. In this qualitative analysis we seek to understand the array of bereaved parent experiences more completely. By deeply diving into one parent dyad using interpretive phenomenology analysis and situating that story within the conventional content analysis of 13 other bereaved parents of adolescents and young adults (AYAs) who died from advanced cancer, we illustrate the roles of religion/spirituality, maintaining a connection, and fulfilling parental roles as elements of grief processing. Clinicians and investigators should consider similar individualized approaches to understanding and supporting the grief experiences of bereaved parents before and after the death of a child., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Background: The coronavirus disease 2019 (COVID-19) pandemic was characterized by rapid evolution of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) variants, affecting viral transmissibility, virulence, and response to vaccines/therapeutics. EMPATHY (NCT04828161), a phase 2 study, investigated the safety/efficacy of ensovibep, a multispecific designed ankyrin repeat protein (DARPin) with multivariant in vitro activity, in ambulatory patients with mild to moderate COVID-19., Methods: Nonhospitalized, symptomatic patients (N = 407) with COVID-19 were randomized to receive single-dose intravenous ensovibep (75, 225, or 600 mg) or placebo and followed until day 91. The primary endpoint was time-weighted change from baseline in log 10 SARS-CoV-2 viral load through day 8. Secondary endpoints included proportion of patients with COVID-19-related hospitalizations, emergency room (ER) visits, and/or all-cause mortality to day 29; time to sustained clinical recovery to day 29; and safety to day 91., Results: Ensovibep showed superiority versus placebo in reducing log 10 SARS-CoV-2 viral load; treatment differences versus placebo in time-weighted change from baseline were -0.42 ( P = .002), -0.33 ( P = .014), and -0.59 ( P < .001) for 75, 225, and 600 mg, respectively. Ensovibep-treated patients had fewer COVID-19-related hospitalizations, ER visits, and all-cause mortality (relative risk reduction: 78% [95% confidence interval, 16%-95%]) and a shorter median time to sustained clinical recovery than placebo. Treatment-emergent adverse events occurred in 44.3% versus 54.0% of patients in the ensovibep and placebo arms; grade 3 events were consistent with COVID-19 morbidity. Two deaths were reported with placebo and none with ensovibep., Conclusions: All 3 doses of ensovibep showed antiviral efficacy and clinical benefits versus placebo and an acceptable safety profile in nonhospitalized patients with COVID-19., Competing Interests: Potential conflicts of interest. J. K. reports receiving grants or contracts from Pfizer, Regeneron, Lilly, Novavax, Boehringer Ingelheim, GlaxoSmithKline, Merck, Clear Creek, National Institute of Allergy and Infectious Diseases, and Azur. N. K. reports receiving grants or contracts from Hetero Labs, Viatris, Emcure, Johnson & Johnson, National Institutes of Health, Indian Council of Medical Research, and the World Health Organization. L. A. reports payment for expert testimony by individual law firms and insurance companies. M. B. reports receiving grants or contracts from Janssen Vaccines, Novartis, and CureVac; consulting fees from AstraZeneca, Pfizer, Janssen Vaccines, and Novartis; participation on a data and safety monitoring board or advisory board for Sanofi (all payments to University Medical Center Utrecht); and honoraria for lectures by Takeda. E. R. is an employee of Novartis. R. C., D. S. E., S. G., P. K., P. L., A. T., C. G. K., and S. R. are employees at Novartis and hold stock or stock options in the company. P. L., P. S., M. S., and N. S. are employees at Molecular Partners AG and hold stock or stock options in the company. M. T. S. is an employee at Molecular Partners AG, is a member of its executive management, and owns shares in the company. At the time of writing this manuscript, P. F. was an employee at Molecular Partners AG and K. R. was an employee at Novartis. All other authors report no potential conflicts., (© The Author(s) 2024. Published by Oxford University Press on behalf of Infectious Diseases Society of America.)

Acute respiratory failure (ARF) strikes an estimated two million people in the United States each year, with care exceeding US$50 billion. The hallmark of ARF is a heterogeneous injury, with normal tissue intermingled with a large volume of low compliance and collapsed tissue. Mechanical ventilation is necessary to oxygenate and ventilate patients with ARF, but if set inappropriately, it can cause an unintended ventilator-induced lung injury (VILI). The mechanism of VILI is believed to be overdistension of the remaining normal tissue known as the 'baby' lung, causing volutrauma, repetitive collapse and reopening of lung tissue with each breath, causing atelectrauma, and inflammation secondary to this mechanical damage, causing biotrauma. To avoid VILI, extracorporeal membrane oxygenation (ECMO) can temporally replace the pulmonary function of gas exchange without requiring high tidal volumes (V T ) or airway pressures. In theory, the lower V T and airway pressure will minimize all three VILI mechanisms, allowing the lung to 'rest' and heal in the collapsed state. The optimal method of mechanical ventilation for the patient on ECMO is unknown. The ARDSNetwork Acute Respiratory Management Approach (ARMA) is a Rest Lung Approach (RLA) that attempts to reduce the excessive stress and strain on the remaining normal lung tissue and buys time for the lung to heal in the collapsed state. Theoretically, excessive tissue stress and strain can also be avoided if the lung is fully open, as long as the alveolar re-collapse is prevented during expiration, an approach known as the Open Lung Approach (OLA). A third lung-protective strategy is the Stabilize Lung Approach (SLA), in which the lung is initially stabilized and gradually reopened over time. This review will analyze the physiologic efficacy and pathophysiologic potential of the above lung-protective approaches., Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Introduction: The health and well-being of Aboriginal Australians is inextricably linked to culture and Country. Our study challenges deficit approaches to health inequities by seeking to examine how cultural connection, practice and resilience among Aboriginal peoples through participation in 'cultural camps' held on sites of cultural significance promotes health and well-being., Methods and Analysis: The study will be undertaken in close collaboration and under the governance of traditional cultural knowledge holders from Yuwaalaraay, Gamilaraay and Yuin nation groups in New South Wales, Australia. Three cultural camps will be facilitated, where participants (n=105) will engage in activities that foster a connection to culture and cultural landscapes. A survey assessing connection to culture, access to cultural resources, resilience, self-rated health and quality of life will be administered to participants pre-camp and post-camp participation, and to a comparative group of Aboriginal adults who do not attend the camp (n=105). Twenty participants at each camp (n=60) will be invited to participate in a yarning circle to explore cultural health, well-being and resilience. Quantitative analysis will use independent samples' t-tests or χ 2 analyses to compare camp and non-camp groups, and linear regression models to determine the impact of camp attendance. Qualitative analysis will apply inductive coding to data, which will be used to identify connections between coded concepts across the whole data set, and explore phenomenological aspects. Results will be used to collaboratively develop a 'Model of Cultural Health' that will be refined through a Delphi process with experts, stakeholders and policymakers., Ethics and Dissemination: The study has ethics approval from the Aboriginal Health and Medical Research Council (#1851/21). Findings will be disseminated through a combination of peer-reviewed articles, media communication, policy briefs, presentations and summary documents to stakeholders., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Aim: Both an acute bout of resistance exercise (RE) and caffeine consumption can significantly alter hemodynamics, autonomic modulation, and arterial stiffness, which may correlate with adverse cardiovascular events. However, effects of an acute bout of RE and caffeine are unclear in resistance-trained women., Purpose: The purpose of this study was to compare the effects of an acute bout of RE with repetitions to failure on squat and bench press, with or without caffeine, on performance, resting and recovery measures of hemodynamics, autonomic modulation, as well as arterial stiffness in resistance-trained women., Methods: Eleven women participated in a double-blind, placebo controlled cross-over design in which they consumed caffeine (4 mg/kg) or placebo at least 72 h apart. Sixty minutes following ingestion, participants performed two sets of 10 repetitions followed by a third set to failure on squat and bench press. Hemodynamics, autonomic modulation, and arterial stiffness were measured at rest, 60 min post-ingestion, and three minutes and 10 min following RE., Results: Data demonstrated caffeine has no additive effects on performance, hemodynamics, autonomic modulation, or arterial stiffness (p > 0.05) before or following an acute bout of RE in resistance-trained women compared to a placebo., Conclusions: Resistance-trained women may not observe any alteration to RE performance on the squat and bench press in terms of repetitions to failure following caffeine ingestion. In addition, the data from the present study suggests that there may also not be any further negative effects on the cardiovasculature if caffeine is consumed prior to the RE bout., (© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Families and clinicians approaching a child's death in the paediatric intensive care unit (PICU) frequently encounter questions surrounding medical decision-making at the end of life (EOL), including defining what is in the child's best interest, finding an optimal balance of benefit over harm, and sometimes addressing potential futility and moral distress. The best interest standard (BIS) is often marshalled by clinicians to help navigate these dilemmas and focuses on a clinician's primary ethical duty to the paediatric patient. This approach does not consider a clinician's potential duty to the patient's family. This paper argues that when a child is dying in the PICU, the physician has a duty to serve both the patient and the family, and that in some circumstances, the duty to serve the family becomes as important as that owed to the child. We detail the limitations of the BIS in paediatric EOL care and propose the relational potential standard as an additional ethical framework to guide our decisions., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2023. No commercial re-use. See rights and permissions. Published by BMJ.)

To examine the effects of two different volume-matched resistance exercise (RE) recovery protocols (passive and active) on platelet indices and hemodynamic variables. Twelve Healthy participants (mean ± SD; 25 ± 3 yrs) completed a traditional resistance exercise (TRE) protocol that included three sets of six repetitions at 80% one repetition maximum (1RM) with two minutes passive recovery between sets, exercises and an interval resistance exercise (IRE) protocol that included three sets of six repetitions at 60%1RM followed by active recovery including six repetitions of the same exercise at 20%1RM. Blood samples for multiple platelet indices were taken before the protocols, immediately-post (IP), and after 1-hour recovery. Hemodynamic variables were measured before, IP, and every five minutes during recovery. Mean platelet volume and platelet large cell ratio P&#95;LCR decreased from baseline to recovery. Heart rate (HR) and rate pressure product (RPP) were augmented at IP following IRE compared to TRE. HR was significantly elevated for 20 minutes after both RE protocols, and RPP recovered by five minutes. Systolic blood pressure was increased at IP compared to baseline and all recovery time points for both RE protocols. Our research demonstrated that both RE protocols, produced transient increases in platelet indices (MPV, and P&#95;LCR) and hemodynamic variables (SBP, HR, and RPP), all of which returned to baseline within an hour. Notably, the IRE protocol elicited a greater increase in HR and RPP compared to the TRE protocol., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2023 Soltani et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Background: Cannabis use, be it either cannabidiol (CBD) use and/or delta-9-tetrahydrocannabinol (THC) use, shows promise to enhance exercise recovery. The present study aimed to determine if individuals are using CBD and/or THC as a means of recovery from aerobic and/or resistance exercise, as well as additional modalities that might be used to aid in recovery., Methods: Following consent, 111 participants (Mean ± SD: Age: 31 ± 13 years) completed an anonymous survey. All participants were regularly using cannabis (CBD and/or THC) as well as were currently exercising. Questions pertained to level of cannabis use, methods used for consumption of cannabis, exercise habits, exercise recovery strategies, and demographics., Results: Eighty-five percent of participants reported participating in aerobic training. In addition, 85% of participants also reported regular participation in resistance exercise. Seventy-two percent of participants participated in both aerobic and resistance exercise. Ninety-three percent of participants felt that CBD use assisted them with recovery from exercise, while 87% of participants felt the same regarding THC use., Conclusions: Individuals who habitually use cannabis, CBD or THC, and regularly engage in exercise do feel that cannabis assists them with exercise recovery. More data are necessary to understand the role of cannabis in exercise recovery as well as perceived ergogenic benefits of cannabis by individuals who both regularly participate in exercise and habitually use cannabis., (© 2023. Board of Governors of the Colorado State University System, acting by and through Colorado State University-Pueblo.)

Gardening has the potential to enhance health and well-being, through increased physical activity and social connectedness. However, while much is known about the benefits of garden activities, less is known about the potential health implications of more passive forms of engagement with gardens, for example, viewing gardens. In addition, much garden research is undertaken in urban settings, leaving little known about potential health impacts for rural populations. The present study explored these research gaps by gaining an understanding of the experiences and perspectives of members of a gardening appreciation group in rural Australia: The Colac Horticultural and Marvellous Property Appreciation Society (CHAMPAS). A phenomenological, qualitative methodology was applied, using semi-structured interviews for data collection. Eleven participants were selected using purposive and snowball sampling and the data were analysed by applying interpretive, reflexive thematic analysis. Four main themes and supporting sub-themes were generated. The four main themes were: (i) motivations for maintaining participation in CHAMPAS; (ii) social connections and friendships, formed from membership; (iii) sense of community and structure of CHAMPAS and (iv) the perceived health and well-being benefits of continued involvement in this group. This study found that members perceived health and well-being benefits stemmed from CHAMPAS facilitation of social connectedness, function as a community group and a way for members to share a love for home gardening. This study provides insights into the perceived and potential health-promoting effects of garden appreciation groups for rural populations., (© The Author(s) 2023. Published by Oxford University Press. All rights reserved. For permissions, please email: journals.permissions@oup.com.)

Foam rolling (FR) has recently become very popular among athletes and recreational exercisers and is often used during warm up prior to strength training (ST) to induce self-myofascial release. The purpose was to examine the acute effects of ST and FR performed in isolation or in combination on blood pressure (BP) responses during recovery in normotensive women. Sixteen normotensive and strength trained women completed four interventions: 1) rest control (CON), 2) ST only, 3) FR only, and 4) ST immediately followed by FR (ST + FR). ST consisted of three sets of bench press, back squat, front pull-down, and leg press exercises at 80% of 10RM. FR was applied unilaterally in two sets of 120 s to each of the quadriceps, hamstring, and calf regions. Systolic (SBP) and diastolic (DBP) BP were measured before (rest) and every 10 min, for 60 min, following (Post 10-60) each intervention. Cohen's d effect sizes were calculated to indicate the magnitude effect by the formula d = Md/Sd, where Md is the mean difference and Sd is the standard deviation of differences. Cohen's d effect-sizes were defined as small (≥0.2), medium (≥0.5), and large (≥0.8). There were significant reductions in SBP for ST at Post-50 (p < 0.001; d = -2.14) and Post-60 (p < 0.001; d = -4.43), for FR at Post-60 (p = 0.020; d = -2.14), and for ST + FR at Post-50 (p = 0.001; d = -2.03) and Post-60 (p < 0.001; d = -2.38). No change in DBP was observed. The current findings suggest that ST and FR performed in isolation can acutely reduce SBP but without an additive effect. Thus, ST and FR can both be used to acutely reduce SBP and, importantly, FR can be added to a ST regimen without furthering the SBP reduction during recovery., Competing Interests: Declaration of competing interest There were no conflicts of interest., (Copyright © 2023 Elsevier Ltd. All rights reserved.)

Since the concept of death by neurologic criteria (DNC) or "brain death" was articulated by the Harvard Ad Hoc Committee in 1968, efforts to establish and uphold DNC as equivalent to biologic death have been supported through federal and state legislation, professional guidelines, and hospital policies. Despite these endeavors, DNC remains controversial among bioethics scholars and clinicians and is not universally accepted by patient families and the public. In this focused review, we outline the current points of contention surrounding the diagnosis of DNC in pediatric patients. These include physiologic, legal, and philosophical inconsistencies in the definition of DNC, controversy regarding the components of the clinical exam, variability in clinical practice, and ethical concerns regarding justice and role of informed consent. By better understanding these controversies, clinicians may serve families grappling with the diagnosis of DNC more effectively, compassionately, and equitably., Competing Interests: Declaration of Competing Interests The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 Elsevier Inc. All rights reserved.)

Zinc (Zn) is a vital element required by all living creatures for optimal health and ecosystem functioning. Therefore, several researchers have modeled and mapped its occurrence and distribution in soils. Nonetheless, leveraging model predictive performances while coupling information derived from visible near-infrared (Vis-NIR) and soils (i.e. chemical properties) to estimate potential toxic elements (PTEs) like Zn in agricultural soils is largely untapped. This study applies two methods to rapidly monitor Zn concentration in agricultural soil. Firstly, employing Vis-NIR and machine learning algorithms (MLAs) (Context 1) and secondly, applying Vis-NIR, soil chemical properties (SCP), and MLAs (Context 2). For the Vis-NIR information, single and combined pretreatment methods were applied. The following MLAs were used: conditional inference forest (CIF), partial least squares regression (PLSR), M5 tree model (M5), extreme gradient boosting (EGB), and support vector machine regression (SVMR) respectively. For context 1, the results indicated that M5-MSC (M5 tree model-multiplicative scatter correction) with coefficient of determination (R 2 ) = 0.72, root mean square error (RMSE) = 21.08 (mg/kg), median absolute error (MdAE) = 13.69 and ratio of performance to interquartile range (RPIQ) = 1.63 was promising. Regarding context 2, CIF with spectral pretreatment and soil properties [CIF-DWTLOGMSC + SCP (conditional inference forest-discrete wavelet transformation-logarithmic transformation-multiplicative scatter correction-soil chemical properties)] yielded the best performance of R 2  = 0.86, RMSE = 14.52 (mg/kg), MdAE = 6.25 and RPIQ = 1.78. Altogether, for contexts 1 and 2, the CIF-DWTLOGMSC + SCP approach (context 2) was the best Zn model outcome for the agricultural soil. The uncertainty map revealed a low to high error distribution in context 1, and a low to moderate distribution in context 2 for all models except CIF, which had some patches with high uncertainty. We conclude that a multiple optimization approach for modeling Zn levels in agricultural soils is invaluable and may provide fast and reliable information needed for area-specific decision-making., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2022 Elsevier Ltd. All rights reserved.)

Potentially toxic elements in agricultural soils are primarily derived from anthropogenic and geogenic sources. This study aims to predict and map antimony (Sb) concentration in soil using multiple regression kriging in two distinct modeling approaches, namely Sb prediction using data fusion coupled with regression kriging (scenario 1) and Sb prediction using data fusion, terrain attributes, and regression kriging (scenario 2). Cubist regression kriging (cubist&#95;RK), conditional inference forest regression kriging (CIF&#95;RK), extreme gradient boosting regression kriging (EGB&#95;RK) and random forest regression kriging (RF&#95;RK) were the modeling techniques used in the estimation of Sb concentration in agricultural soil. The validation results suggested that in scenario 1, EGB&#95;RK was the optimal modeling approach for Sb prediction in agricultural soil with root mean square error (RMSE) = 1.31 and mean absolute error (MAE) = 0.61, bias = 0.37, and high coefficient of determination R 2  = 0.81. Similarly, the EGB&#95;RK was also the optimal modeling approach in scenario 2, with the highest R 2  = 0.76, RMSE = 0.90, bias = 0.06, and MAE = 0.48 values than the other regression kriging modeling approaches. The cumulative assessment suggested that the EGB&#95;RK in scenario 2 yielded optimal results compared to the respective modeling approach in scenario 1. The uncertainty propagated by the modeling approaches in both scenarios indicated that the degree of uncertainty during the modeling process was distributed across the study area from a low to a moderate uncertainty level. However, cubist&#95;RK in scenario 2 exhibited some elevated spots of uncertainty levels. As a result, the combination of data fusion, terrain attributes, and regression kriging modeling approaches produces optimal results with a high R 2 value, minimal errors as well as bias. Furthermore, combining terrain attributes with data fusion is promising for reducing model error, bias and yielding high-accuracy predictions., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2022 Elsevier Ltd. All rights reserved.)

Based on recently collected material and records in the literature, 14 species of fiddler crabs (Crustacea: Ocypodidae: Gelasiminae) are reported from Vietnam. DNA barcoding analyses using the mitochondrial gene COI (cytochrome c oxidase subunit I) was performed to identify examined materials and their precise distributional range. Thirteen species-level taxa are identified and, with the exception of Galsimus borealis and G. vocans , have minimum interspcific divergences of at least 7.27%. The identified species include seven species of Tubuca Bott, 1973, three of Austruca Bott, 1973 and three of Gelasimus Latreille, 1817, and one Paraleptuca Bott, 1973. Two new records of Vietnam are herein reported: Tubuca rhizophorae and T. dussumieri . The southernmost distribution limits of East Asian G. borealis , T. acuta and T. arcuata are in northern Vietnam, A. lactea in central Vietnam, whereas northernmost limit of Southeast Asian T. rhizophorae and T. forcipata in southern Vietnam. A dichotomous key to identify the 14 Vietnamese species is provided.

Resistance exercise (RE) has been shown to elevate hemodynamics and pulse wave reflection. However, the effects of acute RE with blood flow restriction (BFR) on hemodynamics and pulse wave reflection are unclear. The purpose of this study was to evaluate the differences between upper- and lower-body RE with and without BFR on hemodynamics and pulse wave reflection. Twenty-three young resistance-trained individuals volunteered for the study. Hemodynamics and pulse wave reflection were assessed at rest, 10, 25, 40, and 55 min after either upper- or lower-body with or without BFR. The upper-body RE (URE) consisted of the latissimus dorsi pulldown and chest press; the lower-body RE (LRE) consisted of knee extension and knee flexion. The BFR condition consisted of four sets of 30, 15, 15, and 15 repetitions at 30% 1-repetition maximum (1RM) while the without BFR condition consisted of four sets of 8 repetitions at 70% 1RM. Heart rate, rate pressure product, and subendocardial viability ratio significantly ( p  < 0.05) increased after all exercises. Brachial and aortic systolic blood pressure (BP) significantly ( p  < 0.05) elevated after LRE while brachial and aortic diastolic BP significantly ( p  < 0.05) reduced after URE. Augmentation pressure, augmentation index (AIx), AIx normalized at 75 bpm, and wasted left ventricular pressure energy significantly ( p  < 0.05) increased after URE while transit time of reflected wave significantly ( p  < 0.05) decreased after LRE. URE places greater stress on pulse wave reflection while LRE results in greater responses in BP. Regardless of URE or LRE, the cardiovascular responses between BFR and without BFR are similar. HIGHLIGHTS High-load resistance exercise and low-load resistance exercise with blood flow restriction may produce similar cardiovascular responses.Upper-body resistance exercise generates greater changes on pulse wave reflections while lower-body resistance exercise induces greater elevations in systolic blood pressure.

Competing Interests: The authors have disclosed that they do not have any potential conflicts of interest.

While it has been demonstrated that acute resistance exercise (RE) alters measures of wave reflection and aortic arterial stiffness in young, healthy individuals, limited research has evaluated sex differences. Accordingly, we recruited moderately active, resistance-trained men (Age: 22 ± 3yrs, n=12) and women (23 ± 3yrs, n=10) to perform two randomized conditions consisting of an acute bout of weight machine RE or a quiet control (CON). Measures of aortic wave reflection and aortic stiffness were taken at baseline and 15 minutes following the RE (Recovery). At baseline, women had significantly higher heart rate (p = 0.05) and lower brachial systolic blood pressure (p = 0.009) compared to men. There were no significant three-way interactions for any variable. Significant condition by time interactions were noted for heart rate (Baseline: 65 ± 10bpm, Recovery: 87 ± 13bpm, p = 0.001), brachial systolic blood pressure (Baseline: 116 ± 9mmHg, Recovery: 123 ± 10mmHg, p = 0.014), and the augmentation index (AIx) normalized at 75bpm (Baseline: 7.7 ± 12.8%, Recovery: 15.5 ± 9.5%, p = 0.002) such that Recovery was augmented compared to Baseline following RE but not CON. There was also a significant main effect of time for augmentation pressure (Baseline: 4.1 ± 4.0mmHg, Recovery: 4.0 ± 3.6mmHg, p = 0.04) such that it decreased from Baseline to Recovery following RE but not the CON. There were no significant effects of sex, condition, or time on aortic arterial stiffness. Men and women have similar responses in measures of aortic wave reflection and aortic arterial stiffness following acute RE using weight machines.

Gardening has the potential to improve health and wellbeing, especially during crises. Using an international survey of gardeners (n = 3743), this study aimed to understand everyday gardening experiences, perspectives and attitudes during early stages of the COVID-19 pandemic in 2020. Our qualitative reflexive thematic and sentiment analyses show that during the first months of the COVID-19 pandemic, gardening seemed to create a safe and positive space where people could socially connect, learn and be creative. Participants had more time to garden during the pandemic, which led to enhanced connections with family members and neighbours, and the ability to spend time in a safe outdoor environment. More time gardening allowed for innovative and new gardening practices that provided enjoyment for many participants. However, our research also highlighted barriers to gardening (e.g. lack of access to garden spaces and materials). Our results illustrate the multiple benefits of gardening apparent during COVID-19 through a lens of the social-ecological model of health., (Copyright © 2022 Elsevier Ltd. All rights reserved.)

This study investigates the associations of vigorous-intensity gardening time with cardiometabolic health risk markers. This cross-sectional study (AusDiab) analyzed 2011-2012 data of 3,664 adults (55% women, mean [range], age = 59.3 [34-94] years) in Australia. Multiple linear regression models examined associations of time spent participating in vigorous gardening (0, <150 min/week, ≥150 min/week) with a clustered cardiometabolic risk (CMR) score and its components, for the whole sample and stratified by age and gender. Of participants, 61% did no vigorous gardening, 23% reported <150 min/week, and 16% reported ≥150 min/week. In the whole sample, spending ≥150 min/week in vigorous gardening was associated with lower CMR (lower CMR score, waist circumference, diastolic blood pressure, and triglycerides) compared with no vigorous gardening. Stratified analyses suggested that these associations were almost exclusively observed for older adults and women. These findings suggest the public health potential of vigorous-intensity gardening in reducing CMR.

Australia is experiencing mounting pressures related to processes of urbanisation, biodiversity loss and climate change felt at large in cities. At the same time, it is cities that can take the leading role in pioneering approaches and solutions to respond to those coupling emergencies. In this perspective piece we respond to the following question: What are the required transformations for prioritising, valuing, maintaining and embracing nature in cities in Australia? We adopt the mission framework as an organising framework to present proposed pathways to transform Australian cities as nature-positive places of the future. We propose three interconnected pathways as starting actions to steer urban planning, policy and governance in Australian cities: First, cities need to establish evidence-based planning for nature in cities and mainstream new planning tools that safeguard and foreground urban nature. Second, collaborative planning needs to become a standard practice in cities and inclusive governance for nature in cities needs to prioritise Aboriginal knowledge systems and practices as well as look beyond what local governments can do. Third, for progressing to nature-positive cities, it is paramount to empower communities to innovate with nature across Australian cities. Whilst we focus on Australian cities, the lessons and pathways are broadly applicably globally and can inspire science-policy debates for the post COP15 biodiversity and COP26 climate change implementation processes., (© 2022. The Author(s).)

The purpose of this study was to compare cardiac autonomic responses following bilateral and unilateral upper-body (UB) acute resistance exercise (ARE). In total, 14 individuals were assessed for markers of cardiac autonomic responses via heart rate variability (HRV) and baroreflex sensitivity (BRS) at rest and at 10- and 30-min following ARE. Logarithmically transformed (ln) HRV measures included: total power (ln TP), high-frequency power (ln HF power), low-frequency power (ln LF power), sympathovagal balance (ln LF: HF), and the square root of the mean squared differences of successive R-R intervals (ln RMSSD). BRS was assessed using the sequence method. Two-way repeated measures ANOVAs were used to analyze effects of UB ARE (bilateral, unilateral) across time (Rest, 10, and 30 min). There were no significant (p > 0.05) interactions. However, there were significant (p ≤ 0.05) main effects of time such that ln TP, ln HF power, ln RMSSD, and BRS decreased and did not recover within 30 min compared to Rest for both conditions. Collectively, this study suggests that bilateral and unilateral UB ARE yielded similar reductions, for at least 30 min, in respect to vagal measures of HRV and BRS.

Supramaximal interval exercise alters measures of autonomic modulation, while a cool-down may speed the recovery of vagal modulation. The purpose of this study was to compare the effects of a cool-down (pedaling a cycle ergometer at 50 rpm against a resistance of 45 W) versus passive recovery (no pedaling) after supramaximal interval exercise on autonomic modulation. Sixteen moderately active individuals (Mean ± SD: 23 ± 3 years (men: n = 10; women: n = 6) were assessed for autonomic modulation at Rest, and 15 (R15), 30 (R30), 45 (R45) and 60 (R60) min following supramaximal interval exercise. Linear measures of autonomic modulation included natural log (ln) total power (lnTP), high-frequency power (lnHF), the ratio of low frequency (LF) to HF ln(LF/HF) ratio, root mean square of successive differences between normal heartbeats (lnRMSSD), while non-linear measures included sample entropy (SampEn) and Lempel-Ziv entropy (LZEn). Two-way repeated ANOVAs were used to evaluate the main effects of condition (cool-down, passive recovery) across time (Rest, and R15, R30, R45 and R60). There were significant ( p ≤ 0.05) condition by time interactions for SampEn and LZEn, such that they decreased at 15, 30, 45 and 60 min during passive recovery compared to Rest, with the recovery of SampEn and LZEn by 60 and 45 min, respectively, during cool-down. There were significant ( p ≤ 0.05) main effects of time for lnTP, lnHF and lnRMSSD, such that lnTP, lnHF and lnRMSSD were attenuated, and lnLF/HF ratio was augmented, at all recovery times compared to Rest. These data demonstrate that a cool-down increases the recovery of nonlinear measures of vagal modulation within 45-60 min after supramaximal interval exercise, compared to passive recovery in moderately active individuals.

Introduction: The World Health Organization recommends seeking medical treatment within 24 hours after transmission of malaria to reduce the risk of severe complications and its onwards spread. However, in some parts of Indonesia, including East Nusa Tenggara Province (ENTP), this adherence is not achieved for a range of reasons including delays in visiting health centres. This study aims to determine factors related to the poor understanding of appropriate malaria treatment-seeking behaviour (AMTSB) of rural adults in ENTP. AMTSB was defined as seeking treatment at professional health facilities within 24 hours of the onset of malaria symptoms., Methods: A cross-sectional study was conducted in the East Sumba, Belu, and East Manggarai district of ENTP between October and December 2019. A multi-stage cluster sampling procedure was applied to enrol 1503 participants aged between 18 and 89 years of age. Data were collected through face-to-face interviews. Multivariable logistic regression analyses were used to assess significant factors associated with the poor understanding of AMTSB., Results: Eighty-six percent of participants were found to be familiar with the term malaria. However, poor understanding level of AMTSB in rural adults of ENTP achieved 60.4% with a 95% confidence interval (CI): 56.9-63.8. Poor understanding of AMTSB was significantly higher for adults with no education (adjusted odds ratio (AOR) 3.42, 95% CI: 1.81, 6.48) compared to those with a diploma or above education level; having low SES (AOR: 1.87, 95% CI: 1.19, 2.96) compared to those having high SES; residing at least three kilometres (km) away from the nearest health facilities (AOR: 1.73, 95% CI: 1.2, 2.5) compared to those living within one km from the nearest health service; and working as farmer (AOR: 1.63, 95% CI: 1.01-2.63) compared to those working at government or non-government sector. Whilst, other factors such as ethnicity and family size were not associated with the poor understanding of AMTSB., Conclusion: The proportion of rural adults having a poor understanding of AMTSB was high leading to ineffective implementation of artemisinin-based combination therapies as the method to treat malaria in ENTP. Improving awareness of AMTSB for rural adults having low level education, low SES, working as a farmer, and living at least three km from the nearest health facilities is critical to support the efficacy of malaria treatment in ENTP. This method will support the Indonesian government's objective to achieve malaria elimination by 2030., Competing Interests: The authors have declared that no competing interests exist

The COVID-19 pandemic has severely disrupted social life. Gardens and yards have seemingly risen as a lifeline during the pandemic. Here, we investigated the relationship between people and gardening during the COVID-19 pandemic and what factors influenced the ability of people to garden. We examined survey responses (n = 3,743) from gardeners who reported how the pandemic had affected personal motivations to garden and their use of their gardens, alongside pandemic-related challenges, such as food access during the first wave of COVID-19 (May-Aug 2020). The results show that for the respondents, gardening was overwhelmingly important for nature connection, individual stress release, outdoor physical activity and food provision. The importance of food provision and economic security were also important for those facing greater hardships from the pandemic. While the literature on gardening has long shown the multiple benefits of gardening, we report on these benefits during a global pandemic. More research is needed to capture variations in public sentiment and practice - including those who do little gardening, have less access to land, and reside in low-income communities particularly in the global south. Nevertheless, we argue that gardening can be a public health strategy, readily accessible to boost societal resilience to disturbances., Competing Interests: The authors have no relevant financial or non-financial interests to disclose. The authors have no conflicts of interest or competing interest to declare. The research was carried out with approval by the appropriate ethics committee for research., (© 2022 Elsevier GmbH. All rights reserved.)

Autistic adults have higher health needs compared to most, yet they continue to experience barriers to accessing appropriate healthcare. Presently, no qualitative research exists exploring these barriers which impact overall physical and mental health. We conducted a qualitative analysis in Victoria (Australia) of the perceived experiences of healthcare access for autistic adults ( n = 9) and primary caregivers of autistic adults ( n = 7). Specifically, a three-staged phenomenological approach was applied involving: (i) a communicative checklist, (ii) a health status survey and (iii) face-to-face interviews. Elements such as support, responsibilities and protective factors exhibited by caregivers, may impact healthcare access for autistic adults. Results indicate the need for further research exploring interdependent factors that impact healthcare access by caregivers, so evidence-based interventions can be developed to support caregivers in the future.

Objectives: This study investigated associations between ethnicity and malaria awareness in East Nusa Tenggara Province (ENTP), Indonesia., Methods: A community-based cross-sectional study was conducted upon 1503 adults recruited by multi-stage cluster random sampling. A malaria awareness questionnaire was used to collect data, according to which participants were classified as aware or unaware of malaria. Logistic regression was applied to quantify the strength of associations of factors with malaria awareness., Results: The participation rate in this study was high (99.5%). The participants were distributed relatively evenly among the Manggarai, Atoni, and Sumba ethnicities (33.0, 32.3, and 30.2%, respectively). Malaria awareness was significantly different amongst these groups; it was most common in the Manggarai ethnicity (65.1%; 95% confidence interval [CI], 59.9 to 70.3) and least common in the Sumba ethnicity (35.0%; 95% CI, 27.6 to 42.4). The most prominent factor influencing the malaria awareness in the Sumba and Manggarai ethnicities was education level, whilst it was socioeconomic status (SES) in the Atoni ethnicity. The likelihood of malaria awareness was significantly higher in adults with an education level of diploma or above (adjusted odds ratio [aOR], 21.4; 95% CI, 3.59 to 127.7 for Manggarai; aOR, 6.94; 95% CI, 1.81 to 26.6 for Sumba). Malaria awareness was significantly more common amongst high-SES adults in the Atoni group (aOR, 24.48; 95% CI, 8.79 to 68.21)., Conclusions: Low education levels and low SES were prominent contributors to lower levels of malaria awareness in rural ENTP. Interventions should focus on improving malaria awareness to these groups to support the Indonesian government's national commitment to achieve a malaria elimination zone by 2030.

Introduction: The 2009 Indonesian roadmap to malaria elimination indicated that the nation had been progressing towards achieving malaria elimination by 2030. Currently, most of the districts in the western part of Indonesia have eliminated malaria; however, none of the districts in the East Nusa Tenggara Province (ENTP) have met these set targets. This study aimed to investigate the status of malaria awareness of rural adults in the ENTP., Methods: A community-based cross-sectional study was conducted between October and December 2019 in high, moderate, and low malaria-endemic settings (MESs) in the ENTP. After obtaining informed consent, data were collected using an interviewer-administered structure questionnaire among 1503 participants recruited by a multi-stage cluster sampling method. A malaria awareness index was developed based on ten questions. A binary logistic regression method was applied to investigate the significance of any association between malaria awareness and the different MESs., Results: The participation rate of the study was 99.5%. Of this number, 51.4% were female and 45.5% had completed primary education. The malaria awareness index was significantly low (48.8%, 95% confidence interval [CI]: 45.2-52.4). Malaria awareness of rural adults residing in low endemic settings was two times higher than for those living in high endemic settings (adjusted odds ratio [AOR]: 2.41, 95% CI: 1.81-3.21) and the basic malaria knowledge of participants living in low malaria-endemic settings was almost four times higher than that in high endemic settings (AOR: 3.75, 95% CI: 2.75-5.11). Of the total participants, 81.3% (95% CI: 79.1-83.5) were aware that malaria could be prevented and 75.1% (95% CI: 72.6-77.6) knew at least one prevention measure. Overall, the awareness of fever as the main symptom of malaria, mosquito bites as the transmission mode of malaria, and seeking treatment within 24 hours of suffering from malaria was poor at 37.9% (95% CI: 33.9-41.9), 59.1% (95% CI: 55.9-62.3), and 46.0% (95% CI: 42.3-49.7), respectively. The poor level of awareness was significantly different amongst the three MESs, with the lowest levels of awareness in the high endemic setting., Conclusion: Malaria awareness of rural adults needs to be improved to address Indonesia's national roadmap for malaria elimination. Results indicated that public health programs at a local government level should incorporate the malaria awareness index in their key strategic intervention to address malaria awareness., Competing Interests: The authors have declared that no competing interests exist.

Sarcopenia is defined as the progressive and generalized loss of skeletal muscle mass and strength, which is associated with increased likelihood of adverse outcomes including falls, fractures, physical disability, and mortality. The etiology of sarcopenia has been postulated to be multifactorial with genetics, aging, immobility, nutritional deficiencies, inflammation, stress, and endocrine factors all contributing to the imbalance of muscle anabolism and catabolism. The prevalence of sarcopenia is estimated to range from 13 to 24% in adults over 60 years of age and up to 50% in persons aged 80 and older. As the population continues to age, the prevalence of sarcopenia continues to increase and is expected to affect 500 million people by the year 2050. Sarcopenia impacts the overall health of patients through limitations in functional status, increase in hospital readmissions, poorer hospital outcomes, and increase in overall mortality. Thus, there exists a need to prevent or reduce the occurrence of sarcopenia. Here, we explore the potential mechanisms and current studies regarding angiotensin receptor blockers (ARBs) and angiotensin-converting enzyme (ACE) inhibitors on reducing the development of sarcopenia through the associated changes in cardiovascular function, renal function, muscle fiber composition, inflammation, endothelial dysfunction, metabolic efficiency, and mitochondrial function., (© 2021 The Author(s). Published by Portland Press Limited on behalf of the Biochemical Society.)

Learning is thought to be achieved by the selective, activity dependent, adjustment of synaptic connections. Individual learning can also be very hard and/or slow. Social, supervised, learning from others might amplify individual, possibly mainly unsupervised, learning by individuals, and might underlie the development and evolution of culture. We studied a minimal neural network model of the interaction of individual, unsupervised, and social supervised learning by communicating "agents". Individual agents attempted to learn to track a hidden fluctuating "source", which, linearly mixed with other masking fluctuations, generated observable input vectors. In this model data are generated linearly, facilitating mathematical analysis. Learning was driven either solely by direct observation of input data (unsupervised, Hebbian) or, in addition, by observation of another agent's output (supervised, Delta rule). To make learning more difficult, and to enhance biological realism, the learning rules were made slightly connection-inspecific, so that incorrect individual learning sometimes occurs. We found that social interaction can foster both correct and incorrect learning. Useful social learning therefore presumably involves additional factors some of which we outline., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2021. Published by Elsevier Ltd.)

Issue Addressed: The Anthropocene is a new era in which human activity has been the dominant influence on climate and the environment. The negative impact humans have on the earth's systems pose significant threats to human health. Health promotion is a discipline well placed to respond to planetary health challenges of the Anthropocene. The overarching aim of this paper is to describe the elements of 21st century socio-ecological health and apply them in a revised socio-ecological framework for health promotion., Methods: A qualitative description study design was employed to explore the significance of ecological and cultural determinants of health and review models in contemporary health promotion to inform the development of a revised Mandala of Health. Purposeful sampling was used to recruit ten experts from across Australia including academics and practitioners working at the nexus of health promotion, environmental management and sustainability. Data were analysed thematically, using deductive and inductive methods., Results: A revised Mandala of Health could address existing gaps in health promotion theory and practice. Ecological and cultural determinants of health were considered essential components of health promotion that is often lacking in socio-ecological frameworks. Indigenous Knowledge Systems were considered immensely important when addressing ecological and cultural determinants of health., Conclusions: A revised Mandala of Health could encourage development of contemporary health models, assisting health promotion to evolve with the health and environmental issues of the Anthropocene. This study highlights the need for more theoretical development and empirical research regarding ecological and cultural determinants of health in a health promotion context. SO WHAT?: In the context of the Anthropocene, this study highlights the potential gaps in health promotion theory and practice in terms of the natural environment and health and emphasises the need of a paradigm shift to embed ecological and cultural determinants with other determinants of health., (© 2020 The Authors. Health Promotion Journal of Australia published by John Wiley & Sons Australia, Ltd on behalf of Australian Health Promotion Association.)

Context: With advances in treatments that have resulted in children living longer with serious illness, it is essential to understand how parents adapt to changes during the final stages of their child's life or after their child's death., Objective: To examine the process by which parents adapt to their child's serious illness and death among a group of non-bereaved and bereaved parents of adolescents and young adults (AYAs) with advanced cancer., Methods: Qualitative study exploring the experiences of parents of AYAs who were being treated for recurrent or refractory advanced cancer (nonbereaved parents) or had died from their disease (bereaved parents) at one large academic center. Participants completed demographic surveys and semi-structured interviews to better understand parent adaptation. Data were analyzed using content and thematic approaches., Results: Of the 37 participating parents; 22 (59%) were non-bereaved and 15 (41%) were bereaved. The AYAs predominantly had hematologic malignancies (n = 18/34, 53%). Across both cohorts, parents described the process of adapting to their child's worsening health or death as moments of feeling stuck and moments of gratitude and meaning., Conclusion: Adaptation to a child's serious illness and death likely occurs on a dynamic spectrum and parents may oscillate both cognitively and emotionally. This has important implications for how clinicians and communities support parents. Greater comfort with and normalization of the adaptation process may enable parents to more openly share both the unimaginable hardships and unexpected silver-linings that are part of their parenting experiences during their child's illness and death., (Published by Elsevier Inc.)

Abstract: Fariñas, J, Mayo, X, Giraldez-García, MA, Carballeira, E, Fernandez-Del-Olmo, M, Rial-Vazquez, J, Kingsley, JD, and Iglesias-Soler, E. Set configuration in strength training programs modulates the cross education phenomenon. J Strength Cond Res 35(9): 2414-2420, 2021-This study aimed to compare the strength gains in the nontrained arm after 2 independent unilateral training programs differing in the set configuration. Thirty-five subjects were randomly assigned to 3 groups: traditional training (TT; n = 12), cluster training (CT; n = 11), or control (CON; n = 12). The experimental groups performed a 5-week training program of a unilateral biceps curl exercise with the dominant limb using the 10 repetition maximum (10RM) load. Traditional training performed 5 sets of 6 repetitions and 135 seconds of rest between sets. Cluster training completed 30 repetitions with 18.5 seconds of rest between each repetition. Anthropometry (ANT), muscle thickness (MT), 1RM, the number of repetitions with 10RM (n10RM), and isometric maximal voluntary contraction (MVC) were measured before and after the intervention. Regarding the nontrained arm, TT improved 1RM (7.3%, p < 0.001). No changes were observed in CT. Regarding the trained arm, TT improved 1RM (9.1%, p < 0.001), n10RM (p = 0.005), and MVC (p = 0.011), whereas CT only showed a trend for improvement of 1RM (3.4%, p = 0.052). These results suggest that when total volume and repetition-to-rest ratio are equated, a more fatiguing set configuration causes a higher effect on the non-trained limb., (Copyright © 2019 National Strength and Conditioning Association.)

Aboriginal 'gathering places' have been described as cultural hubs, healing centres, and social meeting places. This article explores a gap in the literature on the health and wellbeing outcomes of gathering places from the perspectives of Aboriginal people who attend them. The aim of this study was to develop a framework to articulate the enablers, principles, and outcomes of 'successful' Aboriginal gathering places. In this study, sixty-nine (n = 69) community members participated in qualitative interviews or focus group discussions across thirteen gathering place sites in Victoria (Australia). The research found that gathering places address social health disparities through the provision of a broad range of health and wellbeing programs that benefit Aboriginal community members accessing them. Gathering places were described by participants as providing connections to place, Aboriginal culture, and healing and mainstream health services that enhanced wellbeing. These findings contribute to a better understanding of how Aboriginal gathering places function and offer strategies for creating culturally safe and welcoming settings for Aboriginal peoples, with potential for consideration in international contexts. This research informed a best-practice framework and outlines different models for developing community empowering and culturally affirming gathering places for improving Aboriginal people's access to culturally appropriate health and support services, while simultaneously reducing health and social inequalities. Key elements of this framework that contribute to a successful gathering place include the people, place (location/facilities), programs and community themselves, whilst the principles that enable these places include elements like self-determination, respect of culture, sustainability and strong governance., (Copyright © 2021 Elsevier Ltd. All rights reserved.)

The rising and continuous pollution of the soil from anthropogenic activities is of great concern. Owing to this concern, the advent of digital soil mapping (DSM) has been a tool that soil scientists use in this era to predict the potentially toxic element (PTE) content in the soil. The purpose of this paper was to conduct a review of articles, summarize and analyse the spatial prediction of potentially toxic elements, determine and compare the models' usage as well as their performance over time. Through Scopus, the Web of Science and Google Scholar, we collected papers between the year 2001 and the first quarter of 2019, which were tailored towards the spatial PTE prediction using DSM approaches. The results indicated that soil pollution emanates from diverse sources. However, it provided reasons why the authors investigate a piece of land or area, highlighting the uncertainties in mapping, number of publications per journal and continental efforts to research as well as published on trending issues regarding DSM. This paper reveals the complementary role machine learning algorithms and the geostatistical models play in DSM. Nevertheless, geostatistical approaches remain the most preferred model compared to machine learning algorithms.

Background: Malaria is a global pandemic that results in approximately 228 million cases globally; 3.5% of these cases are in Southeast Asian countries, including Indonesia. Following the World Health Organization (WHO) initiative, Indonesia is in the process of achieving malaria-free zone status by 2030. However, the eastern part of Indonesia, including the East Nusa Tenggara Province (ENTP), still has a disproportionately high rate of malaria., Objective: The aims of this cross-sectional study are to determine the awareness and knowledge, attitude, and practice toward various aspects of malaria among rural adults and their associated factors, including sociodemographic factors and ethnicities; assess the gap between coverage of, access to, and use of long-lasting insecticide-treated nets (LLINs) among the households; estimate the prevalence of and factors associated with malaria in rural adults; and develop a risk prediction model for malaria., Methods: A multistage cluster sampling procedure with a systematic random sampling procedure at cluster level 4 was applied to recruit 1503 adults aged 18 years or older from the ENTP. Each participant participated in a face-to-face interview to assess their awareness and knowledge, attitude, and practice toward aspects of malaria, practices of sleeping under LLINs, and history of malaria. Information on sociodemographic, environmental, and lifestyle factors was also documented. The proportion of knowledge, attitude, and practice toward aspects of malaria and their variations across different sociodemographic and ethnic groups will be analyzed using descriptive statistics and chi-square tests. Coverage and access to LLINs will be evaluated based on the WHO recommendations. Malaria risk factors will be analyzed using logistic regression. Multilevel logistic regression will be applied to estimate the risk score for malaria., Results: Of the total participants, 99.46% (1495/1503) of rural adults from 49 villages in the ENTP participated in a face-to-face interview from October to December 2019. The study results are expected to be published in peer-reviewed journals., Conclusions: The best malaria risk prediction model will be developed in this study. In this protocol, we developed a methodology to provide new evidence to guide health policy in supporting the ENTP government's expectation to achieve the malaria-free rating by 2030., International Registered Report Identifier (irrid): DERR1-10.2196/23545., (©Robertus Dole Guntur, Jonathan Kingsley, Fakir M Amirul Islam. Originally published in JMIR Research Protocols (http://www.researchprotocols.org), 09.04.2021.)

The purpose of the study was to assess high-intensity battling rope exercise (HI-BRE) on hemodynamics, pulse wave reflection and arterial stiffness during recovery and between sexes. Twenty-three young, healthy resistance-trained individuals (men: n = 13; women: n = 10) were assessed for all measures at Rest, as well as 10-, 30-, and 60-minutes following HI-BRE. A one-way repeated measures ANOVA was used to analyze the effects of HI-BRE across time (Rest, 10, 30, and 60-minutes) on all dependent variables. Significant main effects were analyzed using paired t-tests with a Sidak correction factor. Significance was accepted a priori at p 0.05. There were significant reductions in hemodynamic measures of diastolic blood pressure (BP) in women, but not men following HI-BRE at 30 minutes. Further, measures of pulse wave reflection, specifically those of the augmentation index (AIx) and wasted left ventricular energy (ΔE w ), were significantly increased in both men and women for 60 minutes, but changes were significantly attenuated in women suggesting less ventricular work. There were also significant increases in arterial stiffness in regard to the aorta and common carotid artery that were fully recovered by 30 and 60 minutes, respectively with no differences between men and women. Thus, the primary findings of this study suggest that measures of hemodynamics and pulse wave reflection are collectively altered for at least 60 minutes following HI-BRE, with women having attenuated responses compared to men., (© Journal of Sports Science and Medicine.)

Background and Objectives: Acute resistance exercise (RE) reduces vagal modulation and increases sympathovagal balance, which increases the risk for arrythmias. Few studies have examined sex differences in autonomic modulation after acute RE. The purpose of this investigation was to examine sex-specific responses to acute RE on autonomic modulation. Materials and Methods: Twenty-one resistance-trained individuals (men n = 11, women n = 10) between the ages of 19 and 25 y were analyzed for autonomic modulation in response to acute RE and a control (CON). Measures of autonomic modulation were collected at rest, 15 (R15), and 30 (R30) min following both conditions. Heart rate (HR), log transformed root mean square of successive differences (lnRMSSD), total power (lnTP), low-frequency power (lnLF), high-frequency power (lnHF), sample entropy (SampEn), and Lempel-Ziv entropy (LZEn) were measured at all time points. A three-way repeated analysis of variance (ANOVA) was used to analyze sex (men, women) across condition (RE, CON) and time (Rest, R15, R30). Results: The results are similar for all heart rate variability (HRV) variables at rest for both conditions (RE, CON). SampEn was significantly higher in men compared to women at rest for both conditions ( p = 0.03), with no differences in LZEn ( p > 0.05). There were no significant ( p > 0.05) three-way interactions on any variables. Condition by time interactions demonstrated that both sexes increase in HR ( p = 0.0001) and lnLF/HF ratio ( p = 0.001), but decreases in lnRMSSD ( p = 0.0001), lnTP ( p < 0.0001), lnLF ( p < 0.0001), lnHF ( p = 0.0001), and LZEn ( p = 0.009) at R15 and R30 compared to rest following acute RE and were different from CON. Condition by time interaction ( p = 0.017) demonstrated that SampEn was attenuated at R15 compared to rest, and the CON, but not R30 following acute RE. Conclusion: Although SampEn is more complex at rest in men compared to women, autonomic modulation responses between sexes following acute RE appear to be similar.

Social networking sites are the primary means by which trans and gender diverse people meet, enabling both community contact and information exchange. This study considers the meaning of participation in a secret Facebook group for trans and gender diverse adults in Melbourne (Australia). A peer ethnographic methodology was used to study the Melbourne-based group listed under the pseudonym 'Virtually Trans'. Qualitative semi-structured interviews were conducted with 12 Virtually Trans group members. Interviews were transcribed and thematically analysed. Interview data were supplemented with field notes written throughout online participation over an 8-month period to add richness and provide context to the data. Three major themes were developed from this analysis. First, experiences outside of Virtually Trans, most notably within health care settings, were perceived to be unsafe. Second, practices of care in Virtually Trans conferred a sense of kinship and identity affirmation. Finally, Virtually Trans enabled localized information exchange between peers. Virtually Trans is not a neutral platform of self-performance but a safe(r) environment for expanding the gendered possibilities of who and how people may become. This study highlights the importance of a secret Facebook group in filling care, information and resource gaps experienced by trans and gender diverse people within a major metropolitan setting. The findings have implications for practitioners working with trans and gender diverse adults and peer health navigation., (© The Author(s) 2020. Published by Oxford University Press. All rights reserved. For permissions, please email: journals.permissions@oup.com.)

Introduction: Diabetic ketoacidosis (DKA) is a life-threatening illness which classically presents with polyuria, polydipsia, and polyphagia that can rapidly progress to severe dehydration and altered mental status from cerebral edema. Younger patients may present with subtle or atypical symptoms that are critical to recognize and emergently act upon. Such patients are often cared for by teams in the emergency department (ED) requiring multidisciplinary collaboration., Methods: This simulation case was designed for pediatric emergency medicine fellows and residents. The case was a 14-month-old male who presented to the ED with respiratory distress and dehydration. The team was required to perform an assessment, manage airway, breathing and circulation, and recognize and initiate treatment for DKA including judicious fluid administration and an insulin infusion. The patient developed altered mental status with signs of cerebral edema requiring the initiation of cerebral protection strategies. We created a debriefing guide and a participant evaluation form., Results: Forty-two participants completed this simulation across seven institutions including attendings, residents, fellows, and nurses. The scenario was rated by participants on a 5-point Likert scale and was generally well received ( M = 5.0). Participants rated the simulation case as effective in teaching how to recognize ( M = 4.8) and manage ( M = 4.5) DKA with cerebral edema in a pediatric patient., Discussion: This simulation represents a resource for learners in the pediatric ED in the recognition and management of a toddler with DKA and can be adapted to learners at all levels and tailored to various learning environments., (© 2021 Roberts et al.)

Urbanised estuaries, ports and harbours are often utilised for recreational purposes, notably recreational angling. Yet there has been little quantitative assessment of the footprint and intensity of these activities at scales suitable for spatial management. Urban and industrialised estuaries have previously been considered as having low conservation value, perhaps due to issues with contamination and disturbance. Studies in recent decades have demonstrated that many of these systems are still highly biodiverse and of high value to local residents. As a response, urbanised estuaries are now being considered by coastal spatial management initiatives, where assessments of recreational use in these areas can help avoid 'user-environmental' and 'user-user' conflict. The models of these activities need to be developed at a scale relevant to governments and regulatory authorities, but the few human-use models that do exist integrate fishing intensity to a regional or even continental scale; too large to capture the fine scale variation inherent in complex urban fisheries. Species Distribution Modeling (SDM) is a tool commonly used to assess drivers of species range, but can be applied to models of recreational fishing in complex environments, at a scale relevant to regulatory bodies. Using point-data from 573 visual surveys with recently developed Poisson point process models, we examine the recreational fishery in Australia's busiest estuarine port, Sydney Harbour. We demonstrate the utility of these models for understanding the distribution of boat and shore-based fishers, and the effects of a range of temporally static (geographical) and dynamic (weather) predictors on these distributions., (Copyright © 2020. Published by Elsevier Ltd.)

During the COVID-19 pandemic, many countries experienced something of a boom in interest in gardening. Gardens have long been considered as refuges into which we retreat to escape various struggles and challenges. In this study we examine the characteristics and functions of the garden as a refuge during the period of increased garden interest associated with the COVID-19 pandemic. Analysis of qualitative results about garden experiences from 3,743 survey respondents revealed intertwining garden and emotional geographies. Utilising non-representational and therapeutic landscape theories, we found multifarious and heightened experiences of non-material aspects of gardens; that is, the sensory and emotional aspects. People experienced, for example, a sense of joy, beauty, and reassurance, a greater attunement to the natural world and an increased sense of nature connection than they had at other times: birds felt louder. These heightened sensory and emotional experiences had therapeutic benefits, across age and geographical spectrums, during these difficult times. This research improves our understandings of the positive potential of non-material aspects of gardens in the creation of therapeutic landscapes in and beyond COVID-19., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2021 The Authors.)

The sustenance of humans and livestock depends on the protection of the soil. Consequently, the pollution of the soil with potentially toxic elements (PTEs) is of great concern to humanity. The objective of this study is to investigate the source apportionment, concentration levels and spatial distribution of PTEs in selected soils in Frýdek-Místek District of the Czech Republic. The total number of soil samples was 70 (topsoil 49 and 21 subsoils) and was analysed using a portable XRF machine. Contamination factor and the pollution index load were used for the assessment and interpreting the pollution and distribution of PTEs in the soils. The inverse distance weighting was used for the spatial evaluation of the PTEs. The results of the analysis showed that the area is composed of low-to-high pollution site. PTEs displayed spatial variation patterns. The average PTE concentration decreases in this Fe > Ti > Ba > Zr > Rb > Sr > Cr > Y>Cu > Ni > Th order for the topsoil and also decreases in this Fe > Ti > Zr > Ba > Rb > Sr > Cr > Y > Cu > Ni > and Th order for the subsoil. These PTEs Cr, Ni, Cu, Rb, Y, Zr, Ba, Th, and Fe were far above the baseline European average value and the World average value level, respectively. The source apportionment showed the dominance of Cr, Ni, Rb, Ti, Th, Zr, Cu, Fe in the topsoil, while the subsoil was dominated by all the PTEs (factor 1 to 6) except Ba. The study concludes that indiscriminate human activities have an enormous effect on soil pollution.

Nature-based therapies have a long history in mental health care. Beneficial effects have been documented for nature-based therapies in a variety of other health care settings. The aims of this grounded theory study were to understand the processes of maintaining nature-based therapeutic groups and the value of the activities to patients in a psychiatric inpatient setting. Over a nine-month period, semi-structured surveys of patient responses to nature-based activities were administered to patients in a pilot therapy group assessing the feasibility of a nature-based group program. Findings indicated that the group promoted use of the senses, social interaction, and care of self/others. Perceptions of benefits led to a nuanced understanding of the effects of being in contact with nature. Based on our findings we offer a preliminary theoretical model for patient engagement with nature-based programming in inpatient mental health care.

Background: Parents of adolescents and young adults (AYAs) with serious illness experience enormous stress as they navigate their child's illness. In this study, we aimed to elucidate AYA parental perspectives on the advanced cancer experience, including what parents find challenging and their sources of strength., Methods: Parents of AYAs aged 14 to 24 years old being treated for recurrent or refractory advanced cancer at a large academic center completed demographic surveys and 1:1 semi-structured interviews between December 2017 and July 2018. Conventional content analysis was used by 2 coders to analyze transcriptions, with a third reviewer adjudicating. Thematic networks analysis was then used to extrapolate basic and organizing themes., Results: A total of 22 parents participated. The majority were female, non-Hispanic, and married; 23% ( n = 5) were from racial minority groups. We identified 3 organizing themes related to navigating parents' experiences: (1) what we do to love our child, (2) what challenges us, and (3) how we keep our heart focused on what matters most. Despite substantial uncertainty about their child's future, parents endorsed growth and gratitude as they focused on the ways they showed love for their child during this difficult time., Conclusions: Parents of AYAs with advanced cancer experience many parenting challenges, elucidating some of the vulnerabilities and magnifying the sources of strength among parents of children transitioning to adulthood during serious illness. This research has important implications for how we build programs that support and sustain parents' well-being during their child's serious illness., Competing Interests: POTENTIAL CONFLICT OF INTEREST: The authors have indicated they have no potential conflicts of interest to disclose., (Copyright © 2020 by the American Academy of Pediatrics.)