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Drug Information Centres (DICs) are providing clinicians with evidence-based support for rational drug treatment. However, knowledge gaps in the literature may hinder DICs from offering optimal guidance. This study examined the extent and nature of these knowledge gaps and their impact on clinical pharmacological advice, using real-world query data from a Swedish regional DIC. Data from 2022 at the Sahlgrenska University Hospital were analysed, focusing on queries outside off-label prescriptions and pharmaceutical aspects. A qualitative text content analysis identified phrases indicating a lack of evidence. Responses were categorized by the presence of these signalling phrases and the presence or absence of knowledge gaps. Among 209 responses, the majority were patient-specific (79%), posed by physicians (95%), and often related to adverse effects (37%). The analysis revealed that 23% of the responses had scientific knowledge gaps, and in 18% of the responses, no clinical pharmacological advice could be provided. Knowledge gaps were particularly associated with queries on adverse effects, long-term medication safety, specific patient cases and comorbidities, drug comparisons, or patient populations with limited literature coverage. This analysis highlights the potential of DICs to identify unmet clinical needs in drug treatment and to promote research for evidence-based, patient-centred drug treatment., Competing Interests: Declarations. Competing interests: JN holds a position at CTC Clinical Trial Consultants AB. CTC was not involved in the design, execution, interpretation, or funding of this research. The remaining authors declare no conflict of interest., (© 2024. The Author(s).)

In Ethiopia, the epilepsy knowledge gap among healthcare workers remains high. In this study, we conducted a survey among health care workers in Addis Ababa, Ethiopia, exploring their knowledge, attitudes, beliefs, and perceptions about social inclusion and exclusion regarding epilepsy. Furthermore, we analysed if and how these factors influence the management and quality of care provided. During a training workshop, 50 participants completed the survey. Nurses made up 22% of the participants, midwives comprised 11%, health officers constituted 16%, and medical officers represented 4%. Of the respondents, 69% were male, and 59% had experience in treating patients with epilepsy. This study showed that while 51% of respondents correctly identified epilepsy as being diagnosed after two seizures, many were uncertain about the criteria. Although 90% believed epilepsy is treatable, some were unsure or held misconceptions. Regarding its contagiousness, 82% correctly stated it is not contagious, but some held incorrect beliefs. Treatment options varied, with most recognizing clinical medicines, but some still believed in alternative methods like spiritual or herbal healing. Additionally, understanding of person-centered care was lacking, with several respondents admitting they were unfamiliar with the concept. The factors contributing to the epilepsy treatment gap in Ethiopia were a lack of comprehensive knowledge among healthcare workers about epilepsy, misconceptions such as the belief that epilepsy is contagious, inadequate management practices, challenges in accessing and securing medications due to shortages, and limited community awareness about the condition. Additionally, the study exposed a concerning gap in understanding of person-centered care among some healthcare workers. This study underscores the urgent need for targeted training programs, healthcare policies, and community awareness initiatives to enhance the quality of care for individuals with epilepsy in Ethiopia and similar settings., 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 © 2024 The Author(s). Published by Elsevier Inc. All rights reserved.)

Background: Misconceptions among psoriatic patients often lead to a negative impact on disease outcomes., Objectives: Our main target was knowledge assessment among a sample of psoriatic patients in the Middle East and North Africa (MENA) region where data are scarce., Methods: The present study is a cross-sectional descriptive survey. It consists of an online questionnaire comprising 19 questions designed to assess psoriasis knowledge and five demographic questions. The questionnaire link was posted on the official Facebook page of the Kasr Al Ainy Psoriasis Unit (KAPU)., Results: The questionnaire was taken by 527 participants, but only 396 responses were complete and adequate for analysis. The mean psoriasis knowledge score was higher in females (P = 0.005) and participants with advanced education degrees (P < 0.001). Patients reporting regular follow-ups with dermatologists were more likely to acknowledge joint involvement (P = 0.044) but also incorrectly assume biologics are a final cure (P = 0.038). In addition, they were more likely to assume psoriasis affects pregnancy (P = 0.013). Patients with a family history of psoriasis showed a better mean knowledge score than those without (P = 0.01). Only 54.55% of participants reported knowledge of possible disease exacerbation by drugs. A minority (26.77%) of our patients responded that a diet change could not permanently cure psoriasis., Conclusion: This study reports knowledge gaps in a cohort of Arabic-speaking psoriasis patients, especially regarding areas of extracutaneous involvement, the hereditary nature of the disease, and the effect of psoriasis on pregnancy and fertility. Most participants were unaware that biological therapy and a change in diet do not offer a permanent cure. Dermatologists in our region must reach out to their patients and correct the various misconceptions reported in this study., (© 2024 the International Society of Dermatology.)

Phoxinus minnows are small freshwater fish found throughout Eurasia. The taxonomy of this genus is still under investigation, and new species are regularly described. They are frequently introduced outside their native range due to their use as live bait for angling, and such fish introductions can have diverse impacts on the recipient areas. Before the rise in interest regarding the diversity of this genus in the past 15 years, studies carried out on their biology and ecology reported their findings for the Eurasian minnow Phoxinus phoxinus Linnaeus, 1758, which was then considered ubiquitous. A parasites checklist for Phoxinus minnows has yet to be published, and the recent progress on the taxonomy of this genus has enabled us to propose a reassignment of parasite records to their proper host. The most thoroughly studied potential species were the North European species Phoxinus sp. 7 sensu Palandačić et al. 2017, Phoxinus isetensis, and P. phoxinus. We were able to highlight a gap in knowledge for numerous species that have received little-to-no attention in terms of parasitology. Systematic molecular identification of Phoxinus minnows should be conducted when studying their parasites, as a reliable identification of the host is vital in parasitology research. Future research will certainly reveal a species-specific composition of the parasitofauna occurring in Phoxinus, especially among widespread parasites such as Gyrodactylus and Diplostomum. Such specificities could even become tools for assessing the introduction routes of Phoxinus species., (© 2024 The Author(s). Journal of Fish Biology published by John Wiley & Sons Ltd on behalf of Fisheries Society of the British Isles.)

Freshwater resources remain unequally distributed in time and space around the world. Water resource frameworks should be designed, planned, and overseen in order to fully meet current and future social and economic objectives. The difficulties grow as the system gets bigger and more complex, with varying spatial distribution of water and insufficient resources, making water re-distribution more difficult. The current study fills such gaps by evaluating several factors influencing conjunctive management. In the current study, an effort has been made to compile the best data on water use, agricultural practises, socioeconomic status, and so on through field surveys in order to comprehend the reality on the ground. Additionally, investigations are being conducted into the causes and barriers that are most likely to have slowed the implementation of conjunctive use of available water resources. Two comprehensive socioeconomic surveys were conducted using the quantitative research methodology in a river basin in Southern India, and the results clearly show that stakeholders are unaware of the most effective agricultural water management techniques and the rationale behind modern irrigation systems. Over ninety-five percent of the total respondents were farmers, with only five percent having basic knowledge of watershed development and conjunctive use water management. The identified gaps and the inference made in the study are in the context of conjunctive water management of agricultural water. The current work may provide useful information on the baseline scenarios for upcoming agricultural water management plans, as well as a useful tool for achieving significant milestones in the agricultural sector. Furthermore, the prepared questionnaire and the data gathered for the study may also be helpful to decision-makers., 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., (© 2024 The Authors.)

The invasion of Anopheles stephensi into Africa poses a potential threat to malaria control and elimination on the continent. However, it is not clear if the recent malaria resurgence in Ethiopia has linked to the expansion of An. stephensi . We obtained the clinical malaria case reports and malaria intervention data from the Ethiopian Ministry of Health (MoH) for the period 2001-2022. We analyzed clinical malaria hotspots and investigated the potential role of An. stephensi in the 2022 malaria outbreaks. Clinical malaria cases in Ethiopia decreased by 80%, from 5.2 million cases in 2004 to 1.0 million cases in 2018; however, cases increased steadily to 2.6 million confirmed cases in 2022. Plasmodium vivax cases and proportion have increased significantly in the past 5 years. Clinical malaria hotspots are concentrated along the western Ethiopian border areas and have grown significantly from 2017 to 2022. Major malaria outbreaks in 2022/2023 were detected in multiple sites across Ethiopia, and An. stephensi was the predominant vector in some of these sites, however, it was absence from many of the outbreak sites. The causes of recent upsurge in malaria in Ethiopia may be multi-factorial and it is a subject of further investigation.

Background: Evidence-based guidelines (EBGs) in the nutrition management of advanced liver disease and enhanced recovery after surgery recommendations state that normal diet should recommence 12-24 h following liver transplantation. This study aimed to compare postoperative nutrition practices to guideline recommendations, explore clinician perceptions regarding feeding after transplant surgery, and implement and evaluate strategies to improve postoperative nutrition practices., Methods: A pre-post multimethod implementation study was undertaken, guided by the knowledge-to-action framework. A retrospective chart audit of postoperative dietary practice and semistructured interviews with clinicians were undertaken. Implementation strategies were informed by the Consolidated Framework for Implementation Research-Expert Recommendations for Implementing Change matching tool and then evaluated., Results: An evidence-practice gap was identified, with the median day to initiation of nutrition (free-fluid or full diet) on postoperative day (POD) 2 and only 25% of patients aligning with the EBGs. Clinician interviews identified belief in the importance of nutrition, with variation in surgical practice in relation to early nutrition, competing clinical priorities, and vulnerabilities in communication contributing to delays in returning to feeding. An endorsed postoperative nutrition protocol was implemented along with a suite of theory- and stakeholder-informed intervention strategies. Following implementation, the median time to initiate nutrition reduced to POD1 and alignment with EBGs improved to 60%., Conclusion: This study used implementation frameworks and strategies to understand, implement, and improve early feeding practices in line with EBGs after liver transplant. Ongoing sustainability of practice change as well as the impact on clinical outcomes have yet to be determined., (© 2024 American Society for Parenteral and Enteral Nutrition.)

New anti-diabetic medications, including glucagon-like peptide-1 receptor agonists (GLP-1RA) and sodium-glucose cotransporter 2 (SGLT2) inhibitors are recommended in guidelines to reduce cardio-renal events in type 2 diabetes mellitus (T2DM), independent of glucose control. Yet they might be underused in real world. This study aims to address the knowledge gap, prescription patterns and barriers faced by Chinese doctors. Cardio-Metabolic Survey was a cross-sectional study conducted among doctors managing diabetic patients in clinical practice, via a designated online questionnaire from May 1st, to Dec. 31th, 2022. A total of 358 doctors from 57 hospitals across Beijing participated in this survey, 34.9% from tertiary hospitals. Only 30-40% doctors demonstrated somewhat understanding of the mechanism and clinical applications of GLP-1RA or SGLT2 inhibitors. There is no difference in understanding of these two medications overall (p = 0.336). However, doctors in tertiary hospitals have a higher understanding of GLP-1RA and SGLT2 inhibitors compared to those in non-tertiary hospitals (p = 0.049, and 0.008, respectively). 40.2% doctors have never prescribed GLP-1RA, and 36.6% for SGLT2 inhibitors. The frequency of prescribing SGLT2 inhibitors was significantly higher than prescribing GLP-1RA (p = 0.005). The main barriers on prescription include high cost, poor adherence, side effects concern, and insufficient knowledge about these medications. Chinese doctors currently have limited understanding and low prescription frequency for GLP-1RA and SGLT2 inhibitors. Multifaceted approaches are needed to improve doctors' knowledge and strengthen their ability to manage T2DM effectively., (© 2024. The Author(s).)

Background: The invasion of Anopheles stephensi into Africa poses a potential threat to malaria control and elimination on the continent. However, it is not clear if the recent malaria resurgence in Ethiopia has linked to the expansion of An. stephensi . We aimed to summarize the major achievements and lesson learnt in malaria control in Ethiopia from 2001 to 2022, to assess the new challenges and prospects for the control of An. stephensi ., Methods and Findings: We obtained the clinical malaria case reports, antimalarial drug treatment records, insecticide-treated and long-lasting insecticidal net (ITN/LLIN) distribution and utilization records, and indoor residual spraying (IRS) coverage data from the Ethiopian Ministry of Health (MoH) for the period 2001-2022. We analyzed clinical malaria hotspots using spatially optimized hotspot analysis. We investigated malaria outbreaks in 2022 and examined the potential role of An. stephensi in the outbreaks.Clinical malaria cases in Ethiopia decreased by 80%, from 5.2 million cases (11% confirmed) in 2004 to 1.0 million cases (92% confirmed) in 2018; however, cases increased steadily to 2.6 million confirmed cases (98% confirmed) in 2022. Plasmodium vivax cases and proportion have increased significantly in the past 5 years. Clinical malaria hotspots are concentrated along the western Ethiopian border areas and have grown significantly from 2017 to 2022. Major malaria outbreaks in 2022/23 were detected in multiple sites across Ethiopia, and An. stephensi was the predominant vector in some of these sites, however, it was absence from many of the outbreak sites., Conclusions: The malaria burden has been significantly reduced in Ethiopia in the past two decades, but in recent years it has increased substantially, and the cause of such increase is a subject of further investigation. Major gaps exist in An. stephensi research, including vector ecology, surveillance, and control tools, especially for adult mosquito control., Competing Interests: Competing Interests The authors declare they have no competing interest.

The gap in knowledge and information-seeking between high and low socioeconomic status (SES) has been well documented. This study extends this knowledge gap hypothesis to narrative persuasion in the context of parents' knowledge and information-seeking intention concerning adolescents' COVID-19 vaccination. It specifically tests if the gap is moderated by a message type (narrative vs. non-narrative). An online quasi-experiment, with a 2 (participants' education level: high vs. low) × 3 (message type: narrative vs. non-narrative vs. no-message) between-subject design, showed a main effect of education level (i.e., parents with a higher [vs. lower] education level rated a higher intention to seek information and provided more correct answers on questions about adolescents' COVID-19 vaccination) and an interaction between the two factors. The interaction showed that the gap between high- and low-education groups in information-seeking intention disappeared among those who read the narrative or non-narrative, and the gap in knowledge disappeared among those who read the narrative. Study findings suggest the utility of narratives in narrowing the gap in knowledge and information-seeking to improve parents' decisions on child vaccination., 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.

Salinization, the increase and accumulation of salts in water and soil, impacts productivity of arable crops and is exacerbated by climate change. The Netherlands, like several other deltas and semi-arid regions, faces increasing salinization that negatively impacts agriculture and freshwater availability. Although a lot of salinity expertise exist in the Netherlands, several knowledge gaps on the impact of salinization in the Netherlands, as well as steps to facilitate closing this knowledge gaps to improve saline agriculture in the Netherlands, still exist. This review/opinion article moves beyond existing papers on salinization in bringing together various adaptation measures by thoroughly reviewing the measures through a triple P (People, Planet, Profit) lens. Five main salinity adaptation measures of the crop-soil-water continuum are 1) breeding and selection of salt tolerant varieties, 2) increased cultivation of halophytes, 3) soil management interventions, 4) use of biostimulants, and 5) irrigation techniques. These adaptation measures are described, discussed and analysed for their compliance to the sustainable development elements People, Planet and Profit. All five adaptation measures have potential positive impact on livelihood, contribute to food security and generate revenue but on the other hand, these measures may contribute to unwarranted changes of the ecosystem. The paper ends with a concluding chapter in which the bottlenecks and knowledge gaps that need resolving are identified based on the critical, including triple P, assessment of the discussed adaptation measures. Three key knowledge gaps on breeding, agronomy, environmental sciences and socioeconomics are identified with several approaches that lead to insights elucidated. Thereby informing on future research and action plans to optimize implementation of salinity adaptation measures in the Netherlands., 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 © 2024 The Authors. Published by Elsevier B.V. All rights reserved.)

The production and usage of organophosphate flame retardants (OPFRs) in textiles, plastics, and electronics have surged, with phosphorus-based flame retardants constituting over 30 % of the global consumption of flame retardants. Meanwhile, concerns regarding the potential hazards of OPFRs to ecosystems and human health including disruptions in the endocrine system, inhibition of reproduction, and manifestation of developmental defects have intensified. However, our comprehensive data analysis has unveiled a pronounced and critical knowledge gap, as at present, a majority of studies emphasize the attributes of traditional OPFRs, such as triphenyl phosphate (TPHP), while emerging OPFRs (eOPFRs) remain undeservedly overlooked. We elaborated on the current advancements and challenges regarding eOPFRs research and demonstrated that eOPFRs exhibit considerable diversity in terms of their chemical structures, substantial residue levels, broad sources of occurrence, and limited understanding of their potent (eco)toxicological implications. In light of these attributes, it becomes evident that the environmental and health risks of eOPFRs can be comparable to, if not surpass, those attributed to traditional OPFRs. This compelling observation underscores an imperative need for heightened research focus and extensive research efforts dedicated to the study of eOPFRs, rather than still focusing on the realm of their traditional counterparts. Despite the challenges ahead, the emphasized environmental surveillance and toxicological assessment are imperative to prevent the potential evolution of these compounds into a significant ecological and human health threat., 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 © 2024. Published by Elsevier B.V.)

Introduction: Misconceptions related to terminology used in the diagnosis and treatment of substance use disorders are common among healthcare providers and may contribute to inappropriate management and education of patients. The objective of this study was to evaluate baseline knowledge of addiction, tolerance, and physical dependence in first-year pharmacy students completing a unit on the neurobiological basis of addiction., Methods: Students were asked to define the terms addiction, tolerance, and dependence at the beginning of a didactic unit on nervous system pathophysiology and pharmacology. Handwritten responses were transcribed to a spreadsheet and deidentified by sequential assignment to a single numeric identifier. Data were analyzed by three reviewers through open coding and thematic analysis. Descriptive statistics were used to describe the results., Results: One hundred eighty-seven individual student submitted responses were included in the analysis. Many students were unable to provide a substantive definition for the terms physical dependence (32%) and addiction (27%). The definition of tolerance was partially correct in >80% of student responses, though no students provided a complete description. Approximately 5% of students defined physical dependence as addiction, and > 18% incorrectly attributed withdrawal symptoms to addiction., Conclusions: Significant knowledge gaps or misconceptions regarding terminology related to substance use disorder exists among first-year pharmacy students despite continuing efforts within professional organizations to develop consensus definitions. Developing effective teaching methods to identify and correct misinformation and preconceptions related to care for patients with substance use disorders should continue to be a priority for pharmacy educators., Competing Interests: Declaration of Competing Interest None., (Copyright © 2023. Published by Elsevier Inc.)

Introduction Organ transplantation is a critical intervention for patients with end-stage organ failure, but misconceptions and knowledge gaps often hinder organ donation. This study evaluates the acceptability and effectiveness of an organ donation campaign focusing on addressing knowledge gaps and misconceptions in Riyadh, Saudi Arabia. Methods A two-day awareness campaign was conducted in a shopping mall, featuring four stations providing information on various aspects of organ donation. Participants completed a self-administered, researcher-developed, questionnaire before and after the tour. Results Of the 201 participants, 167 completed the questionnaire (83% response rate). The majority (92.9%) reported learning new information and indicated that the knowledge improved their perspective on organ donation. A high percentage (93.5%) felt the campaign answered their questions, with 90.9% deciding to register as organ donors. Conclusion A knowledge-enhancing campaign can effectively improve public perception and promote awareness of organ donation and transplantation. However, the study is limited by its short timeframe, location, and subjective data. Future research should explore the impact of such campaigns on donor registrations and evaluate their effectiveness in different cultural contexts., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2024, Shaheen et al.)

Introduction: Family physicians are often the first healthcare providers to encounter patients with rheumatoid arthritis (RA) in Nigeria, given the paucity of rheumatology services nationwide. This study aimed to assess and address the knowledge gap regarding RA among family physicians in Nigeria., Methods: A cross-sectional survey involving 609 family physicians from all six geopolitical zones of Nigeria was conducted in October 2022. Pre-intervention questionnaires were administered to assess the participants' knowledge of RA. An investigator-led PowerPoint presentation on RA was then delivered as an intervention, followed by the same participants completing post-intervention questionnaires to evaluate knowledge improvement. Data were analyzed using the Statistical Package for Social Science, version 25., Results: The mean age of participants was 42 ± 15 years, predominantly male (63.9%). The median pre-intervention knowledge score was 3.2 (IQR: 2.0-4.5), with 77.0% scoring <5. After the intervention, the median score significantly improved to 7.1 (IQR: 4.3-8.6) (p = .001), with 62.6% scoring >7. Significant improvements were observed in several knowledge areas where gaps existed pre-intervention, including the understanding that NSAIDs are not the mainstay of management (p < .001), the effectiveness of glucosamine and chondroitin sulfate (p < .001), confidence in diagnosing RA (p = .016), the recognition of joint deformities as a characteristic feature (p < .001), and the understanding that rheumatoid factor is not definitive for diagnosis (p < .001)., Conclusion: This study highlights the importance of interventions in closing the knowledge gap about RA diagnosis and management. We recommend the implementation of a comprehensive approach to rheumatology education and services by policymakers., (© 2023 Asia Pacific League of Associations for Rheumatology and John Wiley & Sons Australia, Ltd.)

Tropical regions contain ecologically and socio-economically important habitats, and are home to about 3.8 billion people, many of which directly depend on tropical coastal waters for their well-being. At the basis of these ecosystems are biogeochemical processes. Climate change is expected to have a greater impact in the tropics compared to temperate regions because of the relatively stable environmental conditions found there. However, it was surprising to find only 660 research articles published focusing on the impact of climate change on the biogeochemistry of coastal tropical waters compared to 4823 for temperate waters. In this perspective, we highlight important topics in need of further research. Specifically, we suggest that in tropical regions compared to temperate counterparts climate change stressors will be experienced differently, that organisms have a lower acclimation capacity, and that long-term baseline biogeochemical datasets useful for quantifying future changes are lacking. The low number of research papers on the impacts of climate change in coastal tropical regions is likely due to a mix of reasons including limited resources for research and limited number of long time series in many developing tropical countries. Finally, we propose some action points that we hope will stimulate more studies in tropical coastal waters., (© 2023 John Wiley & Sons Ltd.)

Background: Monkeypox, as a significant public health concern, warrants a thorough investigation into public knowledge and understanding. Especially in non-endemic areas like China, exploring the factors contributing to knowledge and understanding gaps is crucial for effective disease management and prevention strategies., Objective: This study aims to assess the level of monkeypox knowledge among the Chinese public and to identify the factors that influence this knowledge, particularly focusing on the knowledge gaps between different educational groups., Methods: An online cross-sectional survey was conducted involving 720 participants stratified by age, between July and August 2023. The survey used a modified monkeypox knowledge questionnaire, and hierarchical regression analysis was employed to analyze the data., Results: The study revealed a significant knowledge gap in the understanding of monkeypox among the Chinese public. Key factors influencing this knowledge included educational level, perceived relevance of information, interpersonal communication, and exposure to social media and official health websites. Notably, exposure to social media was found to widen the knowledge gap between different educational groups, with its positive impact more pronounced in individuals with at least a junior high school education., Conclusion: The findings emphasize the need for varied communication strategies to effectively disseminate information about monkeypox and bridge the existing knowledge gaps. Tailoring health communication to different educational levels and utilizing diverse information sources are crucial for improving public understanding and containment of monkeypox., Competing Interests: All authors report no conflicts of interest in this work., (© 2023 Wang et al.)

Health information literacy (HIL), as an essential part of the wellbeing of citizens, is a crucial indicator used to measure a country's primary public health level. The present study collected 1051 samples in southern China to examine the factors predicting HIL. The results showed that males, those less educated, and older adults had lower HIL. Television exposure, unofficial Internet exposure, trust in government and trust in doctors and medical institutions were positively associated with HIL. In contrast, newspapers, radio exposure and trust in web celebrities were negatively associated with HIL. Official Internet media exposure helps to bridge the HIL knowledge gap generated by differences in education level, while trust in celebrities-especially web celebrities-could widen the HIL knowledge gap. This study extends the knowledge gap theory in health communication in the Chinese context and provides pathways for future health interventions., (© The Author(s) 2023. Published by Oxford University Press. All rights reserved. For permissions, please email: journals.permissions@oup.com.)

Gender differences in heart failure (HF), ranging from epidemiological and pathophysiological factors to therapeutic response and prognosis, have been well documented in Western countries, especially in Europe and North America. The above gender differences in HF found in Westerners are rarely investigated in Asians. In this review, we explore the worrying knowledge gap on the gender differences in HF that existed in Asia in contrast with Western populations based on the following four aspects: epidemiology, risk factors, therapy, and prognosis. Finally, we conclude that investigations of gender differences in HF in Asia lag behind those in Europe and North America. Future work is required to establish and better use the high-level, population-based cohorts and develop our own high-quality, convincing clinical trials to deliver robust gender-specific conclusions in Asia., (© 2023 The Authors. ESC Heart Failure published by John Wiley & Sons Ltd on behalf of European Society of Cardiology.)

Background: Tobacco usage has been identified as a leading preventable cause of mortality and is responsible for six million fatalities per year globally. India had enacted COTPA in 2003. Tobacco vendors are one of the key stakeholders for Cigarettes and Other Tobacco Products Act (COTPA) implementation., Objective: To assess the knowledge gap on COTPA and to explore the perceived factors influencing implementation of COTPA among tobacco vendors in Puducherry., Materials and Methods: A mixed-method study was conducted among tobacco vendors from Point of Sale (PoS) around 230 educational institutions (schools and degree colleges) in Puducherry for three months. Simple random sampling was applied to select educational institutions and the tobacco vendors from PoS located around these institutions were included. Data capture was done using a pretested, face-validated questionnaire incorporated in Epicollect software 5 and data analysis by SPSSv24. Purposive sampling was employed to conduct in-depth interviews among tobacco vendors till the point of saturation and manual content analysis performed. Written informed consents were sought. Institutional Ethical Committee approval was obtained., Results: Majority (95.7%) reported that they were aware of tobacco control legislation, but only one person had heard of COTPA. Awareness about the display of signage boards at PoS was observed in 75.7% vendors. Around 41.7% reported that they should not advertise any kind of tobacco products. Three major themes were identified: facilitators, barriers, and suggested measures for COTPA implementation., Conclusion: Tobacco vendors in Puducherry were aware of tobacco control legislations but not familiar with the COTPA and its provisions. It is necessary to put forth efforts to educate these important stakeholders to be more cognizant of COTPA and to effectively include them in anti-tobacco programs., Competing Interests: There are no conflicts of interest., (Copyright: © 2023 Indian Journal of Community Medicine.)

Biodiversity loss is one of the main challenges of our time, 1 , 2 and attempts to address it require a clear understanding of how ecological communities respond to environmental change across time and space. 3 , 4 While the increasing availability of global databases on ecological communities has advanced our knowledge of biodiversity sensitivity to environmental changes, 5 , 6 , 7 vast areas of the tropics remain understudied. 8 , 9 , 10 , 11 In the American tropics, Amazonia stands out as the world's most diverse rainforest and the primary source of Neotropical biodiversity, 12 but it remains among the least known forests in America and is often underrepresented in biodiversity databases. 13 , 14 , 15 To worsen this situation, human-induced modifications 16 , 17 may eliminate pieces of the Amazon's biodiversity puzzle before we can use them to understand how ecological communities are responding. To increase generalization and applicability of biodiversity knowledge, 18 , 19 it is thus crucial to reduce biases in ecological research, particularly in regions projected to face the most pronounced environmental changes. We integrate ecological community metadata of 7,694 sampling sites for multiple organism groups in a machine learning model framework to map the research probability across the Brazilian Amazonia, while identifying the region's vulnerability to environmental change. 15%-18% of the most neglected areas in ecological research are expected to experience severe climate or land use changes by 2050. This means that unless we take immediate action, we will not be able to establish their current status, much less monitor how it is changing and what is being lost., Competing Interests: Declaration of interests The authors declare no competing interests., (Copyright © 2023 The Authors. Published by Elsevier Inc. All rights reserved.)

In 2014 the World Health Organisation recommended providing placental blood to all newborn infants by waiting for at least one minute before clamping the umbilical cord. Mounting evidence supports providing a placental transfusion at the time of birth for all infants. The optimal time before clamping and cutting the umbilical cord is still not yet known, and debate exists around other cord management issues. The newborn's transition phase from intra- to extra-uterine life and the effects of blood volume on the many necessary adaptations are understudied. How best to support these adaptations guides our suggested research questions. Parents' perceptions of enrolling their unborn infant into a study play important parts in the conduct of such trials. This article aims to address these topics and suggest research questions for further studies., Competing Interests: Declaration of Competing Interest HR and JM have both conducted studies on optimal umbilical cord management at birth. They received no extra-mural funding for writing the manuscript., (Copyright © 2023 Elsevier Inc. All rights reserved.)

The right ventricle (RV) has a critical role in hemodynamics and right ventricular failure (RVF) often leads to poor clinical outcome. Despite the clinical importance of RVF, its definition and recognition currently rely on patients' symptoms and signs, rather than on objective parameters from quantifying RV dimensions and function. A key challenge is the geometrical complexity of the RV, which often makes it difficult to assess RV function accurately. There are several assessment modalities currently utilized in the clinical settings. Each diagnostic investigation has both advantages and limitations according to its characteristics. The purpose of this review is to reflect on the current diagnostic tools, consider the potential technological advancements and propose how to improve the assessment of right ventricular failure. Advanced technique such as automatic evaluation with artificial intelligence and 3-dimensional assessment for the complex RV structure has a potential to improve RV assessment by increasing accuracy and reproducibility of the measurements. Further, noninvasive assessments for RV-pulmonary artery coupling and right and left ventricular interaction are also warranted to overcome the load-related limitations for the accurate evaluation of RV contractile function. Future studies to cross-validate the advanced technologies in various populations are required., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (© 2023 Ro, Sato, Ijuin, Sela, Fior, Heinsar, Kim, Chan, Nonaka, Lin, Bassi, Platts, Obonyo, Suen and Fraser.)

Introduction: Invasive meningococcal disease (IMD) is a leading cause of life-threatening bacterial meningitis and septicemia. Evidence points to a knowledge gap among parents, teenagers, and healthcare providers (HCPs) regarding IMD and available vaccines, including those against the highly prevalent serogroup B., Areas Covered: An online survey was conducted between March 27 and 12 April 2019, to gather insights into the knowledge that parents/guardians have about IMD vaccines. The children were aged 2 months to 10 years in Australia, Brazil, Germany, Greece, Italy, and Spain, 5-20 years in the UK, and 16-23 years in the USA. The findings were discussed in the context of the available literature and solutions were proposed to minimize the knowledge gap and the barriers to vaccination against IMD., Expert Opinion: The survey demonstrated that parents have a good understanding of IMD but a limited understanding of the different serogroups and vaccines. The available literature highlighted multiple barriers to IMD vaccine uptake; these may be reduced through education of HCPs, clear recommendations to parents by HCPs, the use of technology, and disease-awareness initiatives that engage parents through physical and digital channels. Further studies are warranted to assess the impact of the COVID-19 pandemic on IMD vaccination.

Invasive Alien Species (IAS), i.e. species introduced by humans outside their natural geographic range, may act as host or vectors of pathogens of both human and animal health relevance. Although it has been recognized that IAS should deserve more attention from a public and animal health perspective, data on the pathogens hosted by these species are not systematically collected and this prevents accurate assessments of IAS-specific risks of disease transmission. To support the future development of disease risk assessments, we systematically reviewed the scientific literature related to the pathogens of the eleven mammal species included in the European list of IAS of concern to gain insight in the amount and quality of data available. Data were analyzed to assess the current knowledge on the pathogens harbored by mammal IAS in natural conditions, through the identification of the main factors associated with research intensity on IAS pathogens and with the IAS observed pathogen species richness, the estimation of the true pathogen species richness for each IAS, and a meta-analysis of prevalence for the pathogens of health relevance. While the review confirmed that mammal IAS harbor pathogens of human and animal health relevance such as rabies virus, West Nile Virus, Borrelia burgdorferi and Mycobacterium bovis, results also highlighted strong information gaps and biases in research on IAS pathogens. In addition, the analyses showed an underestimation of the number of pathogens harbored by these species and the existence of high levels of uncertainty in the prevalence of the pathogens of health significance identified. These results highlight the need towards more efforts in making the available information on IAS pathogens accessible and systematically collected in order to provide data for future investigations and risk assessments, as well as the need of relying on alternative sources of information to assess IAS disease risk, like expert opinions., 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. The authors received no specific funding for this work., (Copyright © 2022 Elsevier B.V. All rights reserved.)

Objective: Continuing medical education (CME) programs are planned to provide medical professionals with the opportunity to stay abreast of new developments in their field. After each program, CME attendees are given the chance to evaluate the success of the activity in meeting its defined learning objectives. Over one-third of intent-to-change statements from CME evaluations do not match the stated learning objectives. We examined unmatched objectives and intent-to-change statements to determine their usefulness for future meeting planning., Methods: This retrospective mixed-method content analysis used quantitative, deductive content analysis to compare intent-to-change statements and learning objectives from American Association of Neurological Surgeons-sponsored CME activities to explore unintended learning themes., Results: We examined 85 CME activities with 424 meeting objectives and 1950 intent-to-change statements. Approximately 37% of intent-to-change statements were unrelated to any meeting objective, and 15% of learning objectives had no associated intent-to-change statements. Among unmatched objectives, those regarding more general subject matter often failed to be met with intent-to-change statements for multiple years, whereas those related to clinical practice were more likely to be unmatched for only 1 year. Some CME learning objectives are repeated for the same meeting for multiple years without change, although 22.6% of unmatched intent-to-change statements led to new learning objectives in subsequent years., Conclusions: An analysis of intent-to-change statements that are unmatched to meeting learning objectives is a potential avenue for understanding outcomes of CME activities. Our observations about general versus specific learning objective language may prove useful for CME planners' future educational event formulation., (Copyright © 2022 Elsevier Inc. All rights reserved.)

Background: Unmet community mobility needs of older adults, published since the announcement of the UN sustainable development goals was synthesised to describe the health equity characteristics of research identifying unmet community mobility needs of older adults., Methods: Searches were conducted in March and April 2020, 2275 articles were screened and 100 identified for data extraction., Results: Findings showed underrepresentation of articles considering rural settings [9%] and originating in the global South [14%]. Gender, disability, education, and transport / driving were identified as key health equity characteristics and only 10 articles provided detail on all four of these. External factors inhibiting community mobility included built environments, service availability, and societal attitudes. Internal factors included finances, fear and apprehension, and functional limitations., Conclusions: The need for standardised reporting of participant characteristics in the community mobility of older adults was highlighted. These characteristics are required by research consumers to judge equity dimensions, and the extent to which findings represent minority or marginalised groups. 15 after the UN pledge to reduce inequalities, peer reviewed primary research does not reflect a global drive to end discrimination, exclusion and reduce the inequalities and vulnerabilities that leave people behind., (© 2022. The Author(s).)

A basic understanding of climate politics is necessary for citizens to assess their government's policies. Media use is supposed to enable learning, while widening knowledge gaps. We analyze whether such a gap opened up in times of intense media coverage during the 2015 climate conference in Paris and explain learning through hierarchical regression analyses, drawing on a 3-month panel survey ( n  = 1121) in Germany. We find a diminishing knowledge gap: people with low previous knowledge catch up on the better informed, but overall knowledge remained low and learning was limited. This suggests a ceiling effect: possibly journalistic media did not provide enough new information for the well-informed. Closing knowledge gaps may also be explained by the media system with public television and regional newspapers reaching broad segments of the population. Higher knowledge was predicted less by media use than by education, concern, and being male.

Introduction: This study describes perceived knowledge gaps of third-year medical students after participating in a virtual surgical didactic rotation (EMLR) and shortened in-person surgery rotation during the COVID-19 Pandemic., Methods: Open-ended and Likert questions were administered at the end of the virtual rotation and inperson-surgical rotation to medical students. Three blinded coders identified themes by semantic analysis., Results: 82 students (51% of all MS3s) participated in the EMLR. Semantic analysis revealed gaps in perioperative management (Post-EMLR:18.4%, Post-Inpatient:26.5%), anatomy (Post-EMLR:8.2%, PostInpatient:26.5%). and surgical skills (Post-EMLR: 43.0%, Post-Inpatient: 44.1%). Students also described gaps related to OR etiquette (Post-EMLR: 12.2%, Post-Inpatient: 8.8%) and team dynamics/the hidden curriculum (Post- Inpatient:26.6%). There was a significant improvement in perceived confidence to perform inpatient tasks after completing the inpatient clinical experience (p ≤ 0.01)., Conclusion: Virtual interactive didactics for cognitive skills development cannot replace a full clinical surgical experience for third-year medical students. Future curricula should address perceived gaps., (Copyright © 2022 Elsevier Inc. All rights reserved.)

In the context of the COVID-19 global pandemic, promoting influenza knowledge and vaccine helps reduce the risk of dual pandemics and relieve the pressure on healthcare systems. Due to the low rate of influenza vaccination in China, we conducted a cross-sectional survey to investigate whether a knowledge gap regarding influenza and influenza vaccine exists between Chinese groups of different socioeconomic statuses and then explore the possible factors influencing knowledge level. A total of 951 valid questionnaires were collected online in this study. Variance analysis shows a knowledge gap regarding influenza and influenza vaccination between different socioeconomic status groups. Correlation analysis shows that internet media, social media, public communication, and interpersonal communication are positively associated with the knowledge level. Multilevel regression analysis shows a significant interaction between internet media and educational level. This study finds that internet media use helps narrow the knowledge gap between groups with different education levels. This article recommends a multi-channel promotion of influenza and vaccine knowledge and better pertinence between contents and readers.

Aim: This study aimed to investigate the confidence levels, knowledge base and learning needs of community-based nurses relating to the care of preterm babies and parents, to explore what education is required and in what format., Design: An online survey methodology was used., Methods: A 32-item questionnaire was distributed via social media platforms to community-based nurses in Australia., Results: Descriptive analysis was undertaken relating to knowledge base, confidence levels, previous training, learning and resource needs and barriers to education. It was deemed vital to expand confidence and knowledge in this area. Gaps in learning resources were identified and a need for more training in topics such as developmental outcomes, feeding, expected milestones, weight gain, growth trajectories and supporting parents. Online resources were the preferred format to teach key knowledge to community-based health professionals, tailored to the specific features of preterm babies and support needs of parents., (© 2021 The Authors. Nursing Open published by John Wiley & Sons Ltd.)

Background: The growing interest for more natural products in food and health industries has led to increasing research on traditional knowledge related to plants. While theoretical knowledge (TK) on the uses of a species informs on the wide spectrum of potential uses of that species, actual uses (AU) highlight their potential being actually used. Distinguishing between the two is important when reporting ethnobotanical studies. However, studies often equated AU and TK, sometimes misleading conclusions, and decision-making. This study assessed TK, AU, and difference between TK and AU of Annona senegalensis and how each is related to factors such as age, sex, sociolinguistic group, and main activity in Benin republic., Methods: Data were collected through semi-structured individual interviews (n = 755) and analyzed using among others, relative frequency of citation (RFC), and use-value (UV)., Results: A total of 168 theoretical uses were recorded but only 92 were "actually" practiced, of which four were food and 88 medicinal uses. TK and AU were positively correlated. As expected, TK was also significantly higher than AU, indicating that some potential uses of the species are still not valued. Sociolinguistic group and main activity, not age and sex, were the main factors influencing TK, AU, and difference between TK and AU. The highest TK was found with Bariba sociolinguistic group and the highest AU with Otamari. Fruits (100%) and flowers (10%) were the most used organs for food, while leaves (40%) and roots (7%) were mostly used for medicinal purposes. The most common food uses were consumption of the ripe fruits (100%), and food seasoning with flowers (10%). The most cited diseases were malaria (28%) and intestinal worms (8%)., Conclusions: The study illustrated the importance of differentiating between TK and AU. It documented  the wide range of the uses of A. senegalensis, while highlighting its most common uses, and the need to better valorize and sustainably manage the species., (© 2022. The Author(s).)

Background: Acquired haemophilia A (AHA) is a rare immune-mediated disorder characterised by the development of autoantibodies against factor VIII. Morbidity and mortality are in general high due to multiple factors including the age of the patient, underlying diseases, toxic effects of available treatments and bleeding itself., Objective: To assess the awareness about AHA among healthcare professionals (HCPs) in Lebanon where patients can present to non-haematologists with life-threatening bleeding disorders., Methods: A cross-sectional survey was conducted in September and October 2017 all over Lebanon among HCPs. The survey covered: (i) the geographic area of practice and specialty; (ii) bleeding disorders encountered within the last 2 years; (iii) assessment of knowledge on AHA; and (iv) importance of increasing awareness on AHA among HCPs., Results: A total of 362 participants completed and returned the questionnaire (response rate 100%). The majority of the HCPs were practicing in Beirut (n=164; 45.3%) and were internists (n=106; 29.3%). 332 (93%) HCPs have encountered patients with bleeding problems within the last 2 years all over Lebanon. 327 (92.1%) HCPs agreed that increasing awareness on AHA among health care professionals is important. HCPs gave an average of 75.9% of correct answers on the survey., Conclusions: Appropriate treatment and diagnosis are essential when dealing with AHA. Knowledge gaps exist in the clinical practice when dealing with patients who have AHA. This study shows the need for increasing awareness about AHA among HCPs in Lebanon regarding the diagnosis and treatment of this disorder.

Rationale & Objective: Education programs are needed for people with advanced chronic kidney disease to understand kidney failure treatment options and participate in shared decision-making (SDM). Little is known about the content and accessibility of current education programs or whether they support SDM., Study Design: Stakeholder-engaged, mixed-methods design incorporating qualitative observations and interviews, and a quantitative content analysis of slide presentations., Setting & Participants: Four sites located in Boston, Chicago, Portland (Maine), and San Diego., Analytical Approach: Thematic analysis based on the Ottawa Framework (observations and interviews) and descriptive statistical analysis (slide presentations)., Results: Data were collected from observations of 9 education sessions, 5 semistructured interviews with educators, and 133 educational slide presentations. Sites offered group classes or one-on-one sessions. Development, quality, and accuracy of educational materials varied widely. Educators emphasized dialysis (often in-center hemodialysis), with little mention of conservative management. Educators reported patients were often referred too late to education sessions and that some patients become overwhelmed if they learn of the implications of kidney failure in a group setting. Commonly, sessions were general and did not provide opportunities for tailored information most supportive of SDM. Few nephrologists were involved in education sessions or aware of the educational content. Content gaps included prognosis, decision support, mental health and cognition, advance care planning, cost, and diet. Slide presentations used did not consistently reflect best practices related to health literacy., Limitations: Findings may not be broadly generalizable., Conclusions: Education sessions focused on kidney failure treatment options do not consistently follow best practices related to health literacy or for supporting SDM. To facilitate SDM, the establishment of expectations for kidney failure treatment options should be clearly defined and integrated into the clinical workflow. Addressing content gaps, health literacy, and communication with nephrologists is necessary to improve patient education in the setting of advanced chronic kidney disease., (Copyright © 2021 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.)

This study aimed to evaluate the general knowledge and attitudes about assisted reproductive technology (ART) and the influence of sociodemographic features on knowledge and attitudes in a large sample of men and women of reproductive age in Hungary. A cross-sectional online survey study was conducted among 1370 men and women between 18 and 50 years of age in Hungary. The questionnaire included questions about self-rated knowledge, an attitude item, and eight questions concerning general knowledge about ART. In addition, participants were asked sociodemographic background questions. The results show that approximately half of the respondents (49.3%) rated themselves as fairly knowledgeable about ART. However, 56% of the respondents answered just three of the eight knowledge questions correctly. Both men and women had limited knowledge about the success rate of ART, the costs of ART and the age limit to access ART. The greatest lack of knowledge about ART was about its risks: the majority of respondents did not know that in-vitro fertilization poses health risks for women and conceived children. Regarding attitudes, the majority of respondents had a very positive attitude towards ART. Only those respondents who were religious were less supportive of ART. These data suggest that men and women of reproductive age overestimate their ART-related knowledge. As most men and women would like to have biological children in Hungary, there is a critical need for public education., (© 2021 The Authors.)

This paper seeks to understand how local emergency managers perceive and define social vulnerability. There has been a significant increase recently in the amount of research on social vulnerability, yet little is known about the extent to which that knowledge is being translated into practice. To address this void, the authors conducted semi-structured interviews with a sample of local emergency managers (N=24), asking them to describe what social vulnerability means to them. The analysis identified four primary perspectives on social vulnerability prevalent in the sample, pertaining to: (i) culture and poverty; (ii) a moral imperative; (iii) a lack of security; and (iv) a lack of knowledge and awareness. Although these practitioner viewpoints may not align perfectly with the definitions of social vulnerability predominant in the hazards and disasters literature, the results of this study do suggest a possible narrowing of the gap between research and practice as it relates to social vulnerability., (© 2019 The Authors Disasters © 2019 Overseas Development Institute.)

This European Heart Rhythm Association (EHRA) Scientific Initiatives Committee, EHRA Young Electrophysiologists, Association of Cardiovascular Nursing and Allied Professionals, and European Society of Cardiology (ESC) Council on Stroke joint survey aimed to assess the interpretation of the CHA2DS2-VASc score components and preferred resources for calculating the score. Of 439 respondents, most were general cardiologists (46.7%) or electrophysiologists (EPs) (42.1%). The overall adherence to the ESC-defined scoring criteria was good. Most variation was observed in the interpretation of the significance of left ventricular ejection fraction and brain natriuretic peptide in the scoring for the 'C' component, as well as the 'one-off high reading of blood pressure' to score on the 'H' component. Greater confidence was expressed in scoring the 'H' component (72.3%) compared with the 'C' (46.2%) and 'V' (45.9%) components. Respondents mainly relied on their recall for the scoring of CHA2DS2-VASc score (64.2%). The three most favoured referencing resources varied among different professionals, with pharmacists and physicians relying mainly on memory or web/mobile app, whereas nurses favoured using a web/mobile app followed by memory or guidelines/protocol. In conclusion, this survey revealed overall good adherence to the correct definition of each component in scoring of the 'C', 'H', and 'V' elements of the CHA2DS2-VASc score, although the variation in their interpretations warrants further clarifications. The preferred referencing resources to calculate the score varied among different healthcare professionals. Guideline education to healthcare professionals and updated and unified online/mobile scoring tools are suggested to improve the accuracy in scoring the CHA2DS2-VASc score., (Published on behalf of the European Society of Cardiology. All rights reserved. © The Author(s) 2020. For permissions, please email: journals.permissions@oup.com.)

Objective: The purpose of the study was to assess knowledge and perceptions related to carbohydrates, including sugars, among Canadian nutrition-major undergraduates compared to those enrolled in elective nutrition courses (i.e., "nutrition-elective students"). Methods: Cross-sectional surveys were distributed during class time at eight Canadian universities, which included 32 questions on demographics, knowledge and perceptions of carbohydrates and sugars. Descriptive analyses were performed. Differences between groups were tested by Chi-squared statistics. Results: A total of 1207 students (60% nutrition-majors) participated in the survey (January 2016-February 2017). Internet-based sources accounted for one-third of the sources where students obtained nutrition information. About 61% of internet-bases sources were "online" or "website" with no qualifiers, and about a quarter was from social media. A higher percentage of nutrition-majors correctly answered knowledge questions of carbohydrates compared with nutrition-elective students ( p  < 0.01); no difference was observed for sugars-related knowledge questions. The perceptions of sugars were generally negative and did not differ between groups. Conclusions: Several knowledge gaps and common perceptions on topics related to carbohydrates and sugars were identified; nutrition-major students performed better than nutrition-elective students on carbohydrate knowledge questions, but not sugars. These results highlight the importance of identifying methods to help students bridge knowledge gaps and develop skills to critically evaluate nutrition information from various resources and challenge personal biases.

The purpose of this scoping review by the American Society for Parenteral and Enteral Nutrition (ASPEN) Coronavirus Disease 2019 (COVID-19) Nutrition Task Force was to examine nutrition research applicable to the COVID-19 pandemic. The rapid pace of emerging scientific information has prompted this activity to discover research/knowledge gaps. This methodology adhered with recommendations from the Joanna Briggs Institute. There were 2301 citations imported. Of these, there were 439 articles fully abstracted, with 23 main topic areas identified across 24 article types and sourced across 61 countries and 51 specialties in 8 settings and among 14 populations. Epidemiological/mechanistic relationships between nutrition and COVID-19 were reviewed and results mapped to the Population, Intervention, Comparator, Outcome, and Time (PICO-T) questions. The aggregated data were analyzed by clinical stage: pre-COVID-19, acute COVID-19, and chronic/post-COVID-19. Research gaps were discovered for all PICO-T questions. Nutrition topics meriting urgent research included food insecurity/societal infrastructure and transcultural factors (pre-COVID-19); cardiometabolic-based chronic disease, pediatrics, nutrition support, and hospital infrastructure (acute COVID-19); registered dietitian nutritionist counseling (chronic/post-COVID-19); and malnutrition and management (all stages). The paucity of randomized controlled trials (RCTs) was particularly glaring. Knowledge gaps were discovered for PICO-T questions on pediatrics, micronutrients, bariatric surgery, and transcultural factors (pre-COVID-19); enteral nutrition, protein-energy requirements, and glycemic control with nutrition (acute COVID-19); and home enteral and parenteral nutrition support (chronic/post-COVID-19). In conclusion, multiple critical areas for urgent nutrition research were identified, particularly using RCT design, to improve nutrition care for patients before, during, and after COVID-19., (© 2020 American Society for Parenteral and Enteral Nutrition.)

Scientific knowledge on autonomous-driving technology is expanding at a faster-than-ever pace. As a result, the likelihood of incurring information overload is particularly notable for researchers, who can struggle to overcome the gap between information processing requirements and information processing capacity. We address this issue by adopting a multi-granulation approach to latent knowledge discovery and synthesis in large-scale research domains. The proposed methodology combines citation-based community detection methods and topic modelling techniques to give a concise but comprehensive overview of how the autonomous vehicle (AV) research field is conceptually structured. Thirteen core thematic areas are extracted and presented by mining the large data-rich environments resulting from 50 years of AV research. The analysis demonstrates that this research field is strongly oriented towards examining the technological developments needed to enable the widespread rollout of AVs, whereas it largely overlooks the wide-ranging sustainability implications of this sociotechnical transition. On account of these findings, we call for a broader engagement of AV researchers with the sustainability concept and we invite them to increase their commitment to conducting systematic investigations into the sustainability of AV deployment. Sustainability research is urgently required to produce an evidence-based understanding of what new sociotechnical arrangements are needed to ensure that the systemic technological change introduced by AV-based transport systems can fulfill societal functions while meeting the urgent need for more sustainable transport solutions., 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., (© 2020 Elsevier Ltd. All rights reserved.)

Research has shown that healthcare providers lack confidence in having the knowledge needed to have conversations about body image with their patients. No research to date has explicitly explored how providers in primary healthcare understand body image, including its definition and how it impacts plans for care. Accordingly, the current study explored how primary healthcare providers define body image and how they see the concept of body image manifest in their practice. A total of 21 participants were interviewed, including 3 registered dietitians, 6 occupational therapists, 4 physiotherapists, 1 registered massage therapist, 1 kinesiologist, 4 family physicians, 1 nurse, and 1 social worker. Using thematic analysis, it was found that gaps in knowledge about body image were quite apparent as participants' understanding of body image was slippery (e.g., they struggled to articulate specifics about the concept within care and recognized body image is not something associated with a clinical guideline that would bring form to the concept). However, healthcare providers believed in the importance of body image in their patients' care in broad and far reaching ways. Future directions for bridging the knowledge gap with respect to body image among primary healthcare providers are discussed., (Copyright © 2020 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Introduction: since December 2019, the world is experiencing, the COVID-19 pandemic caused by the Virus SARS-CoV-2. It is feared that the pandemic maybe more devastating in conflict affected areas in the world. This study assessed the knowledge, attitudes and practices with regard to the COVID-19 in Buea municipality, Cameroon., Methods: this was a cross-sectional study carried out in communities selected from 5 health areas of the Buea Health District. A questionnaire was administered to collect data on the knowledge, attitudes and practices on COVID-19. The knowledge was measured using a 26-points Liker scale on awareness, mode of transmission, clinical manifestation, site of the infection and prevention. The data was analyzed in SPSS version 25., Results: of the 545 particpants who consented, 21.9% had a correct knowledge of COVID-19, 43.8% had intermediate knowledge, 34.4% had poor knowledge and 11.93% had no knowledge. Majority of the participants (73.3%) knew they were at risk of contacting the infection. They were aware that cleaning and disinfecting the environment (78.8%), reducing contact with animals (56.3%) could help prevent the infection. Even though participants knew about the face mask (93.5%) and hand sanitizers (88.8%), only 21.7% and 32.9% had purchased them respectively. Few participants reported that they will go to a man of God (6.0%), native doctor (3.5%) and auto-medication (25.8%) if infected., Conclusion: There is still a knowledge gap in the Buea population with respect to COVID-19. The population is aware of the disease and preventive measures, but few have taken steps to procure essential tools for the prevention. There is need to intensify sensitization to fill the knowledge gap the population has with regards to COVID-19., Competing Interests: The author declares no competing interests., (© Tendongfor Nicholas et al.)

This study compares the scientifically observed spatiotemporal climate variability with farmer perceptions. A survey of 381 farmers and ten focus group discussions (FGDs) were used to collect data from ten coastal subdistricts. We hypothesized that any gap between farmer perceptions and meteorological data could be due to variations in their individual characteristics. An unsupervised clustering algorithm was used to categorise the farmers into good and poor perception clusters to test the hypothesis. The climatic data showed a low (0.45 °C) spatial difference of the mean temperature (1988-2017) among the visited locations. Annual rainfall variations between the western and eastern coastal areas could be more than 100 cm, making the eastern coasts wetter. The FGD outputs were mostly cognate with meteorological data that the recent (2013-2017) average temperature was higher (except early winter) and, in general, rainfall was lower than that of 1998-2002. Compared to the meteorological data, greater imperfect perceptions of farmers were observed in case of rainfall and winter temperature. This resulted in a gap between the meteorological data and farmer perceptions at the household level. Among the sampled farmers, only 30% had meteorologically consistent perceptions of average-, summer- and winter-temperature, and rainfall. The cluster analysis has divided the farmers into good perception (41.2%) and poor perception (58.8%) clusters. Greater proportions of the western coastal farmers were clustered in the good perception group than that of the eastern parts. A higher accuracy of the perceptions was found among the better-off farmers who were characterized by younger age, better education, smaller family size, richer economic status, larger farm size, more affiliation with non-farm jobs, users of more communication media, closer to the marketplaces and more distant from the sea. The worse-off households, in particular, require policy and extension support to update their understanding of climate change to facilitate adaptation strategies., (Copyright © 2019 Elsevier B.V. All rights reserved.)

Rationale, Aims, and Objectives: Osteoporosis is a common health problem in India, which leads to significant morbidity and mortality in elderly individuals. Lack of knowledge and awareness among medical professionals is one of the important barriers in management of these patients. Therefore, this study was conducted to assess knowledge pertaining to diagnosis and treatment of osteoporosis among a group of Indian medical practitioners., Methods: The study participants included 222 allopathic medical professionals, either graduate or postgraduate working in primary or secondary health care levels. They were assessed using a previously validated Fogelman's multiple choice questionnaire. Out of a total of 18 questions, four questions pertained to knowledge of diagnosis, three questions to treatment decisions, one question to assess knowledge regarding recommended dosage of vitamin D and calcium supplementation, five questions concerned medication use, and the rest to assess attitude and practices. The correct answers were converted into scores and expressed as percentages with a maximum of 100., Results: The mean total score among them was 22.5%, which was quite low. Almost all of them had a score of less than 50%. Medical practitioners performed better in diagnosis-related questions, (19.4% answered all options correctly) than in medication knowledge (no correct response regarding side effects and 2% regarding contraindications). In treatment-related decisions, 37.4% answered correctly for duration of treatment, and 59% answered correctly for treatment goal. Only 1.4% of them were able to answer correctly regarding recommended calcium and vitamin D intake. Professional literature, conferences, and Continuing Medical Education (CME's) were regarded as the main sources of information on the subject by 40% of practitioners., Conclusion: This study showed suboptimal knowledge among a group of medical professionals regarding various aspects of diagnosis and management of osteoporosis, and it stipulates the need for escalating the efforts to improve their knowledge regarding various aspects of osteoporosis., (© 2019 John Wiley & Sons, Ltd.)

The sediment characterisation of wetlands belonging to the Northeastern Region of India particularly regarding the assessment of sediment carbon stock is very scanty. The presently available literature on the wetlands cannot be employed as a common model for managing the wetlands of the Northeastern Region of India as wetlands are a sensitive ecosystem with a different origin or endogenous interventions. Thereby, this research was conducted on Deepor Beel for investigating the spatial and seasonal variation of sediment parameters, the relationship between the parameters and pollution status of the wetland. Results revealed that the study area is of an acidic nature with a sandy clay loam type texture. Organic carbon, total nitrogen and available nitrogen were higher in sediments in the monsoon period. The mean stock of the sediment carbon pool of Deepor Beel is estimated to be 2.5 ± 0.7 kg m -2 . The average non-residual fraction percentage (63.2%) of Pb was higher than the residual fraction. Zn content ∼490 mg kg -1 exceeding its effect range medium (ERM) was determined to suggest frequent biological adverse effects. Highest metal enrichment factor (EF) values were shown by Zn and Pb, which ranged between 78 and 255. Risk assessment code (RAC) values of Pb between 21 and 29% indicated its high bio-accessibility risk. Pearson's coefficient matrix revealed a low degree of positive correlation between organic carbon content and metal concentration. Principal component analysis revealed that the first component comprising of EC, basic cations and metals accounted for 62.3% of variance while the second component (OM, OC, TN, AN, AP) and the third component (pH) accounted for 21.8% and 7.0% of the variance, respectively. The present study revealed the adverse impact of human inputs on the Deepor Beel quality status., (Copyright © 2019 Elsevier Ltd. All rights reserved.)

Wetlands are fragile, dynamic systems, transient at larger temporal scales and strongly affected by long-term human activities. Sustaining at least some aspects of human management, particularly traditional grazing, would be especially important as a way of maintaining the "necessary" disturbances for many endangered species. Traditional ecological knowledge represents an important source of information for erstwhile management practices. Our objective was to review historical traditional knowledge on wetland grazing and the resulting vegetation response in order to assess their relevance to biodiversity conservation. We studied the Pannonian biogeographic region and its neighborhood in Central Europe and searched ethnographic, local historical, early botanical, and agrarian sources for historical traditional knowledge in online databases and books. The findings were analyzed and interpreted by scientist, nature conservationist and traditional knowledge holder (herder) co-authors alike. Among the historical sources reviewed, we found 420 records on traditional wetland grazing, mainly from the period 1720-1970. Data showed that wetlands in the region served as basic grazing areas, particularly for cattle and pigs. We found more than 500 mentions of habitat categories and 383 mentions of plants consumed by livestock. The most important reasons for keeping livestock on wetlands were grazing, stock wintering, and surviving forage gap periods in early spring or mid-late summer. Besides grazing, other commonly mentioned effects on vegetation were trampling and uprooting. The important outcomes were vegetation becoming patchy and remaining low in height, tall-growing dominant species being suppressed, litter being removed, and microhabitats being created, such as open surfaces of mud and water. These historical sources lay firm foundations for developing innovative nature conservation management methods. Traditional herders still holding wetland management knowledge could contribute to this process when done in a participatory way, fostering knowledge co-production., (Copyright © 2019. Published by Elsevier B.V.)

Gaps in nurses' knowledge and application related to genomics exist. This project aimed to develop an accessible genomic education program for oncology nurses. Consequently, the flipped classroom strategy was used. This involved the use of prework consisting of an online genetics and genomics module and optional journal articles. In-person class time built on the prework and focused on specific clinical applications. Outcomes demonstrated that learners were highly satisfied with the educational format and that course objectives were met. Improvement in knowledge of basic genomic concepts, clinical applications, and resources was achieved.

Background: Several funding organizations using different agendas support research in general practice. Topic selection and prioritization are often not coordinated, which may lead to duplication and research waste., Objectives: To develop systematically a national research agenda for general practice involving general practitioners, researchers, patients and other relevant stakeholders in healthcare., Methods: We reviewed knowledge gaps from 90 Dutch general practice guidelines and formulated research questions based on these gaps. In addition, we asked 96 healthcare stakeholders to add research questions relevant for general practice. All research questions were prioritized by practising general practitioners in an online survey (n = 232) and by participants of an invitational conference including general practitioners (n = 48) and representatives of other stakeholders in healthcare (n = 16), e.g. patient organizations and medical specialists., Results: We identified 787 research questions. These were categorized in two ways: according to the chapters of the International Classification for Primary Care (ICPC) and in 12 themes such as common conditions, person-centred care and patient education, collaboration and organization of care. The prioritizing procedure resulted in top 10 lists of research questions for each ICPC chapter and each theme., Conclusion: The process resulted in a widely supported National Research Agenda for General Practice. We encourage both researchers and funding organizations to use this agenda to focus their research on the most relevant issues in general practice and to generate new evidence for the next generation of guidelines and the future of general practice.

Climate change and increased anthropogenic activities are expected to elevate the potential of introducing nonindigenous species (NIS) into the Arctic. Yet, the knowledge base needed to identify gaps and priorities for NIS research and management is limited. Here, we reviewed primary introduction events to each ecoregion of the marine Arctic realm to identify temporal and spatial patterns, likely source regions of NIS, and the putative introduction pathways. We included 54 introduction events representing 34 unique NIS. The rate of NIS discovery ranged from zero to four species per year between 1960 and 2015. The Iceland Shelf had the greatest number of introduction events (n = 14), followed by the Barents Sea (n = 11), and the Norwegian Sea (n = 11). Sixteen of the 54 introduction records had no known origins. The majority of those with known source regions were attributed to the Northeast Atlantic and the Northwest Pacific, 19 and 14 records, respectively. Some introduction events were attributed to multiple possible pathways. For these introductions, vessels transferred the greatest number of aquatic NIS (39%) to the Arctic, followed by natural spread (30%) and aquaculture activities (25%). Similar trends were found for introductions attributed to a single pathway. The phyla Arthropoda and Ochrophyta had the highest number of recorded introduction events, with 19 and 12 records, respectively. Recommendations including vector management, horizon scanning, early detection, rapid response, and a pan-Arctic biodiversity inventory are considered in this paper. Our study provides a comprehensive record of primary introductions of NIS for marine environments in the circumpolar Arctic and identifies knowledge gaps and opportunities for NIS research and management. Ecosystems worldwide will face dramatic changes in the coming decades due to global change. Our findings contribute to the knowledge base needed to address two aspects of global change-invasive species and climate change., (© 2018 The Authors. Global Change Biology Published by John Wiley & Sons Ltd.)