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Abstract Goal-directed memory reactivation involves retrieving the most relevant information for the current behavioral goal. Previous research has linked this process to activations in the fronto-parietal network, but the underlying neurocognitive mechanism remains poorly understood. The current electroencephalogram (EEG) study explores attentional selection as a possible mechanism supporting goal-directed retrieval. We designed a long-term memory experiment containing three phases. First, participants learned associations between objects and two screen locations. In a following phase, we changed the relevance of some locations (selective cue condition) to simulate goal-directed retrieval. We also introduced a control condition, in which the original associations remained unchanged (neutral cue condition). Behavior performance measured during the final retrieval phase revealed faster and more confident responses in the selective vs. neutral condition. At the EEG level, we found significant differences in decoding accuracy, with above-chance effects in the selective cue condition but not in the neutral cue condition. Additionally, we observed a stronger posterior contralateral negativity and lateralized alpha power in the selective cue condition. Overall, these results suggest that attentional selection enhances task-relevant information accessibility, emphasizing its role in goal-directed memory retrieval.

Abstract Background Human Immunodeficiency Virus (HIV) is a global health concern, causing over 35 million deaths, with 97% occurring in developing nations, particularly impacting Sub-Saharan Africa. While HIV testing is crucial for early treatment and prevention, existing research often focuses on specific groups, neglecting general adult testing rates. This study aims to identify predictors of HIV testing uptake among adults in Sub-Saharan Africa. Method Data were obtained from the official Demographic and Health Survey program database, which used a multistage cluster sampling technique to collect the survey data. In this study, a weighted sample of 283,936 adults was included from thirteen Sub-Saharan African countries. Multilevel multivariable logistic regression analysis was employed to identify predictors of HIV testing uptake. Akaike’s information criteria guided model selection. Adjusted odds ratios and corresponding 95% confidence intervals determined significant predictor variables. Result Among adults in Sub-Saharan African countries, the prevalence of HIV testing uptake was 65.01% [95% CI (64.84%, 65.17%)]. Influential factors included male sex [AOR: 0.51, 95% CI (0.49,0.53)], varying odds ratios across age groups (20–24 [AOR: 3.3, 95% CI (3.21, 3.46) ], 25–29 [AOR: 4.4, 95% CI (4.23, 4.65)], 30–34 [AOR: 4.6, 95%CI (4.40, 4.87)], 35–39 [AOR: 4.0, 95%CI (3.82, 4.24)], 40–44 [AOR: 3.7, 95%CI (3.50, 3.91)], 45–49 [AOR: 2.7, 95%CI (2.55, 2.87)], 50+ [AOR: 2.7, 95%CI (2.50, 2.92)]), marital status (married [AOR: 3.3, 95%CI (3.16, 3.46)], cohabiting [AOR: 3.1, 95% CI (2.91, 3.28)], widowed/separated/divorced [AOR: 3.4, 95%CI (3.22, 3.63)]), female household headship (AOR: 1.28, 95%CI (1.24, 1.33)), education levels (primary [AOR: 3.9, 95%CI (3.72, 4.07)], secondary [AOR: 5.4, 95%CI (5.16, 5.74)], higher [AOR: 8.0, 95%CI (7.27, 8.71)]), media exposure (AOR: 1.4, 95%CI (1.32, 1.43)), wealth index (middle [AOR: 1.20, 95%CI (1.17, 1.27)], richer [AOR: 1.50, 95%CI (1.45, 1.62)]), Having discriminatory attitudes towards PLWHIV [AOR: 0.4; 95% CI (0.33, 0.37)], had multiple sexual partners [AOR: 1.2; 95% CI (1.11, 1.28)], had comprehensive knowledge about HIV [AOR: 1.6; 95% CI (1.55, 1.67)], rural residence (AOR: 1.4, 95%CI (1.28, 1.45)), and lower community illiteracy (AOR: 1.4, 95%CI (1.31, 1.50)) significantly influenced HIV testing uptake in the region. Conclusion This study highlights the need for tailored interventions to address disparities in HIV testing uptake among adults in Sub-Saharan Africa and progress towards the achievement of 95-95-95 targets by 2030. Thus, tailored interventions addressing key factors are crucial for enhancing testing accessibility and emphasizing awareness campaigns, easy service access, and targeted education efforts to improve early diagnosis, treatment, and HIV prevention in the region.

Abstract Background The environmental determinants of health (EDH) have a significant impact on people’s physical, mental, and social wellbeing. Everyone needs access to environmental resources of all types, including food, materials, and energy, to survive. Currently, no valid and reliable instrument exists for evaluating individuals’ perceived levels of EDH. Hence, the purpose of this study was to develop and validate the environmental determinants of health questionnaire (EDH-Q) among undergraduate students in Nigeria. Method We conducted a cross-sectional survey among undergraduate students in Nigeria to assess the psychometric properties of the newly developed Environmental Determinants of Health Questionnaire (EDH-Q). Respondents were selected using a convenience sampling approach to evaluate their perceptions of environmental determinants of health. The Content Validity Index (CVI) and Face Validity Index (FVI) were calculated to ascertain the scale’s content validity and response process validity, respectively. Additionally, exploratory factor analysis (EFA), confirmatory factor analysis (CFA), composite reliability (CR), average variance extracted (AVE), Cronbach’s alpha, and intraclass correlation coefficient (ICC) were computed to assess the scale’s construct validity. Results The study involved 300 respondents in the EFA (males 55.7%, females 44.3%) and 430 respondents in the CFA (males 54.0%, females 46.0%). In the EFA, two constructs were identified (the natural environment and the built environment). The EFA model was able to explain 63.57% of the total cumulative variance, and the factor correlation was 0.671. The whole scale Cronbach’s alpha value was 0.947, while the two constructs’ Cronbach’s alpha values were 0.918 (natural environment) and 0.935 (built environment). In the CFA, six pairs of error covariances were included between items within the same construct to improve the fit indices of the initial proposed measurement model. The final re-specified measurement model showed that the EDH-Q, which has two constructs and 18 items, has adequate construct validity (CFI = 0.948, TLI = 0.938, SRMR = 0.046, RMSEA = 0.052, and RMSEA p-value = 0.344). The CRs were 0.845 (natural environment) and 0.854 (built environment). The ICCs were 0.976 (natural environment) and 0.970 (built environment). Conclusion The results show that the newly created EDH-Q has sufficient construct validity and may be utilized to assess participants’ perceptions of their level of EDH. Researchers should examine this instrument in populations with different age ranges and other demographic characteristics, as the present study only applied it to undergraduate students who may share similar characteristics.

Abstract The present study examines the mediating effect of psychological factors in the structural relationships between social and physical environmental factors and the amount of physical activity among undergraduate students at Universiti Sains Malaysia. The sample consisted of 422 students with a mean age of 20.2 years (SD = 1.27). The majority of the students were female (69.7%) and Malay (81.3%). Standardized scales were used to measure the total amount of physical activity and all the study variables. The final SEM had a good fit to the data: CFI = 0.968, TLI = 0.948, SRMR = 0.036, RMSEA (90%CI) = 0.046 (0.025, 0.065), RMSEA p-value = 0.609 with 11 paths relationships. Family support had a significant effect on perceived benefits and perceived barriers. The effect of friend support on physical activity was significantly mediated by perceived benefits, self-efficacy, and psychological needs satisfaction. The effect of the availability of exercise facilities on physical activity was significantly mediated by perceived benefits and psychological needs satisfaction. Furthermore, psychological needs satisfaction mediated the effect of perceived benefits, perceived barriers, and self-efficacy on physical activity. The study findings illustrated that the application of the social-ecological model and psychological factors is important in order to understand and promote positive physical activity behaviour.

Abstract Background Breastfeeding offers numerous benefits for infants, mothers, and the community, making it the best intervention for reducing infant mortality and morbidity. The World Health Organization (WHO) recommends initiating breastfeeding within one hour after birth and exclusively breastfeeding for the first six months. This study investigated the trend, spatio-temporal variation, and determinants of spatial clustering of early initiation of breastfeeding (EIBF) and exclusive breastfeeding (EBF) in Ethiopia from 2011 to 2019. Methods Data from the Ethiopian Demographic and Health Survey (EDHS), which was conducted in 2011, 2016, and 2019, were analyzed utilizing a weighted sample of 10,616 children aged 0–23 years for EIBF and 2,881 children aged 0–5 months for EBF. Spatial autocorrelation analysis was used to measure whether EIBF and EBF were dispersed, clustered, or randomly distributed and Kriging interpolation was employed to predict the outcome variables in the unmeasured areas. Spatial scan statistics were used to identify spatial clusters with a high prevalence of cases. Both global and local regression modeling techniques were employed to examine the spatial relationships between the explanatory variables and the dependent variables. Results The trend analysis revealed a notable increase in the prevalence of EIBF from 51.8% in 2011 to 71.9% in 2019. Similarly, the prevalence of EBF increased from 52.7% in 2011 to 58.9% in 2019. Spatial analysis demonstrated significant spatial variation in both EIBF and EBF throughout the country. Cold spots or clusters with a low prevalence of EIBF were observed consistently in the Tigray and Amhara regions, and significant cold spot areas of EBF were observed consistently in the Afar and Somali regions. Multiscale geographically weighted regression analysis revealed significant predictors of spatial variations in EIBF, including the religious affiliation of being a follower of the orthodox religion, parity of 1–2, absence of antenatal care visits, and delivery via cesarean section. Conclusions Despite the increase in both EIBF and EBF rates over time in Ethiopia, these rates still fall below the national target. To address this issue, the government should prioritize public health programs aimed at improving maternal healthcare service utilization and maternal education. It is essential to integrate facility-level services with community-level services to achieve optimal breastfeeding practices. Specifically, efforts should be made to promote breastfeeding among mothers who have delivered via cesarean section. Additionally, there should be a focus on encouraging antenatal care service utilization and adapting maternal healthcare services to accommodate the mobile lifestyle of pastoralist communities. These steps will contribute to enhancing breastfeeding practices and achieving better outcomes for maternal and child health.

Abstract Background Adult muscle-resident myogenic stem cells, satellite cells (SCs), that play non-redundant role in muscle regeneration, are intrinsically impaired in Duchenne muscular dystrophy (DMD). Previously we revealed that dystrophic SCs express low level of anti-inflammatory and anti-oxidative heme oxygenase-1 (HO-1, HMOX1). Here we assess whether targeted induction of HMOX1 affect SC function and alleviates hallmark symptoms of DMD. Methods We generated double-transgenic mouse model (mdx;HMOX1 Pax7Ind) that allows tamoxifen (TX)-inducible HMOX1 expression in Pax7 positive cells of dystrophic muscles. Mdx;HMOX1 Pax7Ind and control mdx mice were subjected to 5-day TX injections (75 mg/kg b.w.) followed by acute exercise protocol with high-speed treadmill (12 m/min, 45 min) and downhill running to worsen skeletal muscle phenotype and reveal immediate effects of HO-1 on muscle pathology and SC function. Results HMOX1 induction caused a drop in SC pool in mdx;HMOX1 Pax7Ind mice (vs. mdx counterparts), while not exaggerating the effect of physical exercise. Upon physical exercise, the proliferation of SCs and activated CD34− SC subpopulation, was impaired in mdx mice, an effect that was reversed in mdx;HMOX1 Pax7Ind mice, however, both in vehicle- and TX-treated animals. This corresponded to the pattern of HO-1 expression in skeletal muscles. At the tissue level, necrotic events of selective skeletal muscles of mdx mice and associated increase in circulating levels of muscle damage markers were blunted in HO-1 transgenic animals which showed also anti-inflammatory cytokine profile (vs. mdx). Conclusions Targeted expression of HMOX1 plays protective role in DMD and alleviates dystrophic muscle pathology.

Abstract Background Rates of self-harm and suicide are rising for young people globally and many implicate social media in this problem. To address this concern and to increase the confidence of adults to communicate safely about suicide and social media with young people, the #chatsafe Guide for Parents and Carers was developed in Australia. With significant uptake of the resource among Australian adults, the aim of the current study was to update and contextualise the #chatsafe Guide for Parents and Carers for audiences in 15 countries globally. To improve the relevance of this resource for parents and carers in these countries, the present study sought to understand the concerns held by parents, carers and suicide prevention professionals around the world about these topics and to explore the extent to which a resource such as #chatsafe would be helpful within their communities. Methods Seven focus groups were conducted via Zoom with parents, carers and suicide prevention professionals (n = 40) from 15 countries. Transcribed data were coded and thematically analysed using both inductive and deductive processes. Results Six themes are reported: (1) Two scary ‘S’ words; (2) Country and culture impact who talks (or is silent) about self-harm and suicide; (3) The need for a protective social ecosystem; (4) #chatsafe is a tool that can help parents, carers and young people worldwide; (5) #chatsafe should consider local context and end users to improve its relevance for parents and carers worldwide; and (6) A range of marketing and dissemination strategies are needed to reach adults with #chatsafe information. Findings of this study informed the update and contextualisation of the #chatsafe Guide for Parents and Carers for adult audiences in 15 countries. Conclusions The findings from this study underscore a universal need for psychoeducation initiatives that provide adults with the skills and knowledge to support the mental health of young people, both online and offline, and that resources like #chastafe can play an important role in providing reliable information about these topics to adults across a range of cultures and contexts.

Social media is a potent drive in the modern landscape of organizational dynamics, influencing cultural norms and communication styles. The purpose of this study is to investigate the complex effects of social media on organizational culture and communication. The paper explores how social media platforms have changed communication channels, interaction dynamics, and organizational culture, drawing on a mixture of previous research and pragmatic studies. A quantitative research paradigm was employed and a sample of 140 sample respondents was selected using simple random sampling. The sample respondents were employees at a selected South African Social Security Agency branch in South Africa. The results revealed that Facebook was the most used platform and that employees use social media for both work and non-work related purposes. The study concluded a positive and significant relationship between social media usage and social media enhancing the organizational culture (r = 0.227; p < 0.05). Moreover, the study found no relationship between social media usage influencing employee behavior and social media restrictions impacting employee morale negatively (r = 0.036; p > 0.05). The findings highlight valuable insights on the role of social media and its effect on organizational culture and communication. It is also evident from the results that social media usage presents opportunities and challenges for organizations. Hence, the paper concludes that organizations can use social media to create a communicative, flexible, and resilient organizational culture in digital time by recognizing the dynamics at work and taking proactive measures.

Abstract Barrier islands are landscape features that protect coastlines by reducing wave energy and erosion. Quantifying vegetation-topographic interactions between adjacent habitats are essential for predicting long-term island response and resilience to sea-level rise and disturbance. To understand the effects of dune dynamics on adjacent interior island ecosystem processes, we quantified how sediment availability and previous disturbance regime interact with vegetation to influence dune building and ease of seawater and sediment movement into the island interior on two US mid-Atlantic coast barrier islands. We conducted field surveys of sediment accretion, vegetative cover, and soil characteristics in dune and swale habitats. Digital elevation models provided assessment of water flow resistance from the mean high water mark into the island interior. We found that geographic location impacted sediment accretion rates and Panicum amarum (a species increasing in abundance over time in the Virginia barrier islands) accreted sediment at a significantly lower rate compared to other dune grasses. Dune elevation impacted the ease of seawater flow into the island interior, altering soil chlorides, annual net primary productivity, and soil carbon and nitrogen. Our work demonstrates the importance of incorporating biological processes and cross-island connectivity into future scenario modeling and predictions of rising sea-levels and increased disturbance.

Abstract Climate change and atmospheric deposition of nitrogen (N) and sulfur (S) impact the health and productivity of forests. Here, we explored the potential impacts of these environmental stressors on ecosystem services provided by future forests in the contiguous U.S. We found that all stand-level services benefitted (+ 2.6 to 8.1%) from reductions in N+S deposition, largely attributable to positive responses to reduced S that offset the net negative effects of lower N levels. Sawtimber responded positively (+ 0.5 to 0.6%) to some climate change, but negatively (− 2.4 to − 3.8%) to the most extreme scenarios. Aboveground carbon (C) sequestration and forest diversity were negatively impacted by all modelled changes in climate. Notably, the most extreme climate scenario eliminated gains in all three services achieved through reduced deposition. As individual tree species responded differently to climate change and atmospheric deposition, associated services unique to each species increased or decreased under future scenarios. Our results suggest that climate change should be considered when evaluating the benefits of N and S air pollution policies on the services provided by U.S. forests.

Abstract Mutations in human isocitrate dehydrogenase 1 (IDH1) drive tumor formation in a variety of cancers by replacing its conventional activity with a neomorphic activity that generates an oncometabolite. Little is understood of the mechanistic differences among tumor-driving IDH1 mutants. We previously reported that the R132Q mutant unusually preserves conventional activity while catalyzing robust oncometabolite production, allowing an opportunity to compare these reaction mechanisms within a single active site. Here, we employ static and dynamic structural methods and observe that, compared to R132H, the R132Q active site adopts a conformation primed for catalysis with optimized substrate binding and hydride transfer to drive improved conventional and neomorphic activity over R132H. This active site remodeling reveals a possible mechanism of resistance to selective mutant IDH1 therapeutic inhibitors. This work enhances our understanding of fundamental IDH1 mechanisms while pinpointing regions for improving inhibitor selectivity.

BackgroundPilot data suggest that off-label, unmonitored antiepileptic drug prescribing for behavioral and psychological symptoms of dementia is increasing, replacing other psychotropic medications targeted by purposeful reduction efforts. This trend accelerated during the COVID-19 pandemic. Although adverse outcomes related to this trend remain unknown, preliminary results hint that harms may be increasing and concentrated in vulnerable populations. ObjectiveUsing a mixed methods approach including both a retrospective secondary data analysis and a national clinician survey, this study aims to describe appropriate and potentially inappropriate antiepileptic and other psychoactive drug prescribing in US nursing homes (NHs), characteristics and patient-oriented outcomes associated with this prescribing, and how these phenomena may be changing under the combined stressors of the COVID-19 pandemic and the pressure of reduction initiatives. MethodsTo accomplish the objective, resident-level, mixed-effects regression models and interrupted time-series analyses will draw on cohort elements linked at an individual level from the Centers for Medicare and Medicaid Services’ (CMS) Minimum Data Set, Medicare Part D, Medicare Provider Analysis and Review, and Outpatient and Public Use Files. Quarterly cohorts of NH residents (2009-2021) will incorporate individual-level data, including demographics; health status; disease variables; psychotropic medication claims; comprehensive NH health outcomes; hospital and emergency department adverse events; and NH details, including staffing resources and COVID-19 statistics. To help explain and validate findings, we will conduct a national qualitative survey of NH prescribers regarding their knowledge and beliefs surrounding changing approaches to dementia care and associated outcomes. ResultsFunding was obtained in September 2022. Institutional review board exemption approval was obtained in January 2023. The CMS Data Use Agreement was submitted in May 2023 and signed in March 2024. Data access was obtained in June 2024. Cohort creation is anticipated by January 2025, with crosswalks finalized by July 2025. The first survey was fielded in October 2023 and published in July 2024. The second survey was fielded in March 2024. The results are in review as of July 2024. Iterative survey cycles will continue biannually until December 2026. Multidisciplinary dissemination of survey analysis results began in July 2023, and dissemination of secondary data findings is anticipated to begin January 2025. These processes are ongoing, with investigation to wrap up by June 2027. ConclusionsThis study will detail appropriate and inappropriate antiepileptic drug use and related outcomes in NHs and describe disparities in long-stay subpopulations treated or not treated with psychotropics. It will delineate the impact of the pandemic in combination with national policies on dementia management and outcomes. We believe this mixed methods approach, including processes that link multiple CMS data sets at an individual level and survey-relevant stakeholders, can be replicated and applied to evaluate a variety of patient-oriented questions in diverse clinical populations. International Registered Report Identifier (IRRID)DERR1-10.2196/64446

IntroductionAntenatal care (ANC) services play a crucial role in safeguarding the health of pregnant women during their reproductive years. This study aimed to evaluate the primary factors influencing the utilization of ANC among women of childbearing age in Isari town, Jigawa State.MethodsWe conducted a cross-sectional study among 400 mothers of childbearing age, selecting them using a simple random sampling method. Data were collected using interviewer-administered questionnaires. The statistical analyses performed were descriptive analysis, Pearson’s chi-square test, and binary logistic regression analysis.ResultsThe majority of respondents (92.5%) indicated awareness of ANC, with a significant proportion expressing the necessity of ANC services (85.7%). 57.8% of the respondents indicated attending ANC services at least four times during pregnancy. Furthermore, the number of visits has a significant relationship with age (P < 0.001), educational level (P = 0.003), occupation (P = 0.043), mother’s knowledge of pregnancy danger signs (P = 0.001), and husband’s support for ANC (P < 0.001).ConclusionEnhancing ANC utilization will necessitate focusing on women residing in rural areas and those with limited educational attainment.

Abstract Excess nutrient pollution contributes to the formation of harmful algal blooms (HABs) that compromise fisheries and recreation and that can directly endanger human and animal health via cyanotoxins. Efforts to quantify the occurrence, drivers, and severity of HABs across large areas is difficult due to the resource intensive nature of field monitoring of lake nutrient and chlorophyll‐a concentrations. To better characterize how nutrients interact with other environmental factors to produce algal blooms in freshwater systems, we used spatially explicit and temporally matched climate, landscape, in‐lake characteristic, and nutrient inventory data sets to predict nutrients and chlorophyll‐a across the conterminous US (CONUS). Using a nested modeling approach, three random forest (RF) models were trained to explain the spatiotemporal variation in total nitrogen (TN), total phosphorus (TP), and chlorophyll‐a concentrations across US EPA's National Lakes Assessment (n = 2,062). Concentrations of TN and TP were the most important predictors and, with other variables, the RF model accounted for 68% of variation in chlorophyll‐a. We then used these RF models to extrapolate lake TN and TP predictions to lakes without nutrient observations and predict chlorophyll‐a for ∼112,000 lakes across the CONUS. Risk for high chlorophyll‐a concentrations is highest in the agriculturally dominated Midwest, but other areas of risk emerge in nutrient pollution hot spots across the country. These catchment and lake‐specific results can help managers identify potential nutrient pollution and chlorophyll‐a hot spots that may fuel blooms, prioritize at‐risk lakes for additional monitoring, and optimize management to protect human health and other environmental end goals.

Soil contamination with heavy metals threatens ecosystems and human health. The objective of this paper is to evaluate the remediation of heavy metals (Pb, Cr, Cd, and Zn) contaminated soil using biochar-modified kaolin for the stabilization of Pb, Cr, Cd, and Zn in soils. Scanning electron microscope (SEM) X-ray diffraction (XRD) were used to analyze surface morphologies and phase compositions of remediation materials. Stock solutions of different metals were spiked onto the pre-weighed soil with 1mg/kg Pb, 2mg/kg Cr, 1.5mg/kg Zn, and 1mg/kg Cd concentrations above standards, respectively. This was then allowed for 1month aging period for acclimatization. After the aging period, the spiked soil was then treated with kaolin, biochar and biochar-modified kaolin in a 45 mL polypropvlene centrifuge tube and left for a week period for the remediation process. The toxicity characteristics leachability procedure (TCLP) test was used to assess the leachability tendency of residual metals in the treated soil. Amongst the biochar-modified kaolin, the 7:3 (kaolin:biochar ratio in grams) was the most effective compared to raw kaolin and biochar alone in stabilizing the target metals in the treated soil. To optimize the whole process, pretesting of the composites was conducted under constant temperature, dosage, contact time and pH. The residual concentrations of the target metals after TCLP were 2.321%, 10.846%, 0.091%, 0.295% and 3.796%, 22.133%, 0.136%, 0.561% after 30 minutes and 1-hour extraction for Pb, Cr, Cd, and Zn, respectively. The research findings demonstrate that biochar modification enhances kaolin's ability to firmly adsorb the target metals. Thus, the research presents a promising approach for the cost-effective and sustainable remediation of heavy metals in contaminated soils.

Introduction: Unhealthy alcohol use increases the risk for and exacerbation of chronic health conditions. As such, screening, prevention, and management of unhealthy alcohol use is especially critical to improving health outcomes for patients with multiple chronic health conditions. It is unclear to what extent multiple chronic condition status is a barrier to screening for unhealthy alcohol use in the primary care setting. The authors hypothesized that patients with multiple chronic conditions would be at lower odds of being screened for unhealthy alcohol use than patients without multiple chronic conditions. Methods: The authors performed a secondary analysis of electronic health record data for patients from 67 primary care practices in Virginia (2020–2023). Using the Center for Medicare and Medicaid Services’ chronic disease framework, they classified patients by multiple chronic condition status: no multiple chronic conditions, physical multiple chronic conditions, mental health multiple chronic conditions, and physical and mental health multiple chronic conditions. They used multiple logistic regressions with an added practice-level random effect to analyze the relationship between multiple chronic condition status and the odds of receiving an alcohol-related assessment, of being screened for unhealthy alcohol use with a U.S. Preventive Services Task Force–recommended instrument, and of screening positive for unhealthy alcohol use within the past 2 years. Results: Within a final cohort of n=11,789, a total of 6,796 patients (58%) had multiple chronic conditions (29% physical multiple chronic conditions, 4% mental health multiple chronic conditions, and 25% physical and mental health multiple chronic conditions). In all, 69% of patients were screened for unhealthy alcohol use, whereas 16% were screened with a U.S. Preventive Services Task Force–recommended instrument, and 7% screened positive for unhealthy alcohol use. Patients with physical and mental health multiple chronic conditions had 0.9 times lower odds of receiving any screening for unhealthy alcohol use than those with no multiple chronic conditions (95% CI=0.8, 1.0; p=0.0240), whereas patients with only physical multiple chronic conditions or only mental health multiple chronic conditions had similar odds. There was no difference in the odds of being screened with a U.S. Preventive Services Task Force–recommended instrument on the basis of multiple chronic condition status. Patients with mental health multiple chronic conditions and physical and mental health multiple chronic conditions had 1.8 and 1.5 times greater odds of screening positive for unhealthy alcohol use, respectively (95% CI=1.3, 2.7; p=0.0014 and 95% CI=1.2, 1.8; p=0.0003). Conclusions: Although patients with chronic mental health conditions were more likely to screen positive for unhealthy alcohol use than patients without multiple chronic conditions, Virginia primary care patients with physical and mental health multiple chronic conditions were less likely to receive an alcohol-related assessment during the past 2 years. Given the overall modest rate of screening with a U.S. Preventive Services Task Force–recommended instrument, further efforts are needed to create the conditions for high-quality alcohol-related preventive service delivery in primary care, particularly for patients with high complexity and/or mental health conditions.

Background Due to the worldwide reach of the COVID-19 pandemic, authorities across the globe deemed it essential to enforce exceptional containment measures. Maintaining physical activity (PA) during this time was only feasible through engaging in activities at home. Therefore, this study focused on elucidating the levels of PA and well-being among Somali students in the aftermath of the lockdown measures implemented by governments at the onset of the COVID-19 pandemic. Methods This study was conducted in Somalia among undergraduate students studying at Somali International University. A total of 1266 students were included in the present study. An online survey was utilized to measure participant PA behavior. The assessment of PA was conducted in the aftermath of the COVID-19 pandemic, utilizing the Godin Leisure questionnaire. The study showed that 85.8% of the study participants (n = 1086) were between the ages of 17 and 22. More than half of the participants (58.7%, n = 743) were female and had no other employment (57.3%, n = 743). Results Jogging was the most frequently reported PA (57.3%, n = 726), and PA level was on average 59.7 minutes per day (SD = 25.9). Also, most of the study participants were in their last year (82.1%). In the regression analysis, age, gender, academic year, and work status were significant predictors of being physically active after the COVID-19 pandemic. Conclusion Factors affecting PA after the COVID-19 pandemic include age, gender, academic year, and work status. Males, younger individuals, and those who engage in outdoor exercise are more likely to be physically active. Once the COVID-19 restrictions were relaxed, undergraduate students in Somalia were physically active. A high level of PA appears to be advantageous for public health. Universities in Somalia should uphold school policies that promote an active lifestyle among students, aiming to maintain or enhance the existing level of PA.

Abstract The human respiratory syncytial virus (hRSV) and the human metapneumovirus (hMPV) are important human respiratory pathogens from the Pneumoviridae family. Both are responsible for severe respiratory tract infections in infants, young children, elderly individuals, adults with chronic medical conditions, and immunocompromised patients. Despite their large impact on human health, vaccines for hRSV were only recently introduced, and only limited treatment options exist. Here we show that Ginkgolic acid (GA), a natural compound from the extract of Ginkgo biloba, with known antiviral properties for several viruses, efficiently inhibits these viruses’ infectivity and spread in cultures in a dose-dependent manner. We demonstrate that the drug specifically affects the entry step during the early stages on the viruses’ life cycle with no effect on post-entry and late stage events, including viral gene transcription, genome replication, assembly and particles release. We provide evidence that GA acts as an efficient antiviral for members of the Pneumoviridae family and has the potential to be used to treat acute infections.

The goal of this study was to investigate the bacterial community associated with biogas production from food waste and rumen content. Anaerobic mono-digestion and co-digestion were performed using mixture design within Design Expert, resulting in 100 experimental runs. Parameters such as food waste and rumen content, water content, temperature, pH, number of digester agitation per day and retention time were varied during the anaerobic digestion processes. Classical microbiological techniques were used to isolate and identify strict anaerobic and facultative anaerobic bacteria from the food waste and rumen content before and after anaerobic digestion. Sixteen bacterial species belonging to 12 different generae were isolated and identified from the food waste, rumen content and composite digestates obtained from the 100 bio-digesters. These generae included Acetobacterium, Bacteroides, Clostridium, Enterobacter, Escherichia, Lactobacillus, Pseudomonas, Ruminococcus, Staphylococcus, Streptococcus, Syntrophomonas and Syntrophobacter. With the exception of Escherichia coli and Pseudomonas sp., all other bacterial species identified in the substrates were also found in samples of the composite digestates, suggesting that they may have played important roles in the anaerobic digestion process inside the 100 bio-digesters. Overall, this study provides valuable insights into the microbial community structure and function during biogas production from food waste and rumen content. The results could contribute to the development of more efficient and sustainable biogas production processes.

IntroductionLassa fever is a zoonotic infectious disease endemic in West Africa with a high case-fatality rate and reported stigmatization of surviving patients. This study examines discrimination among survivors of Lassa fever (LF) complicated by hearing loss (HL).MethodsThis cross-sectional qualitative study used an in-depth interview guide to collect information from patients with HL about their experience of stigma. Interviews were conducted by a trained team of interviewers at the Jos University Teaching Hospital between January and April 2022 in Hausa language after informed consent was obtained. Recordings of the interviews were transcribed and translated from Hausa to English. Data analysis was conducted using NVivo software using a thematic framework approach.ResultsMost (73%) respondents were male (n = 11); 27% were female (n = 4). The median age was 35 years (interquartile range, 16.5). Some Lassa fever patients experienced stigma and discrimination (53%) including isolation and withdrawal of family and community support during and after illness. HL increased stigma, as some patients were labeled “deaf” by other community members, increasing perceived stigma and devaluation. HL affected the socio-economic wellbeing of some who could not communicate well with their families and customers and constrained social interactions, evoking pain and apathy. Some survivors of LF and victims of its sequelae of HL experienced double stigmatization. While they were ill with LF, a third of respondents reported avoidance and isolation by family and community members who withdrew care and support both to them and their close family members. These forms of stigmatization strained their relationships.ConclusionThere is a need to address stigma in LF survivors who develop HL through concerted community-owned awareness to improve their quality of life along with a robust social support system to aid prevention.

In the field of biodiversity conservation, there is a growing need for research to translate to real-world impacts. Currently there exists a gap between research outcomes and on the ground action, commonly referred to as the knowledge-action gap. Previous research has focused on identifying the causes of the gap, but less research has focused on how to bridge it. We conducted an online survey with conservation researchers and practitioners to identify barriers in the science-to application pipeline and to understand how potential solutions would need to account for their information needs and workflows. Through a qualitative analysis of the open-ended survey responses, we found that information about tools and approaches to address conservation challenges is needed, but decision makers also need information to help them account for context specific barriers and opportunities. Solution-specific information alone, however, is often insufficient for practitioners, who also require the resource capacity and capable personnel to work with that information. Word of mouth and scholarly databases are the most common ways of learning about new tools and techniques, but lack of time, funding and personnel are barriers to implementing them. In addition, respondents identified a need for increased engagement with the conservation social sciences. We argue that a user-centered design approach should underpin any proposed solution to the gap and suggest that an online tool could be one effective solution.

Tumor vasculature plays a crucial role in tumor progression, affecting nutrition and oxygen transportation as well as the efficiency of drug delivery. While targeting pro-angiogenic growth factors has been a significant focus for treating tumor angiogenesis, recent studies indicate that metabolism also plays a role in regulating endothelial cell behavior. Like cancer cells, tumor endothelial cells undergo metabolic changes that regulate rearrangement for tip cell position during angiogenesis. Our previous studies have shown that altered mechanical properties of the collagen matrix regulate angiogenesis and can promote a tumor vasculature phenotype. Here, we examine the effect of collagen density on endothelial cell tip–stalk cell rearrangement and cellular energetics during angiogenic sprouting. We find that increased collagen density leads to an elevated energy state and an increased rate of tip–stalk cell switching, which is correlated with the energy state of the cells. Tip cells exhibit higher glucose uptake than stalk cells, and inhibition of glucose uptake revealed that invading sprouts rely on glucose to meet elevated energy requirements for invasion in dense matrices. This work helps to elucidate the complex interplay between the mechanical microenvironment and the endothelial cell metabolic status during angiogenesis, which could have important implications for developing new anti-cancer therapies.

The Centers for Medicare & Medicaid Services (CMS) grades nursing home performance in antipsychotic prescribing quarterly, publishing findings as a quality measure. While scores have improved since 2011, marked performance variation between facilities persists. To assess quality gap changes between best- and worst-performing deciles, we compared quarterly prescribing changes between these groups pre-pandemic (April 2011 to March 2020) and during the pandemic (April 2020 to March 2022). Antipsychotic quality measure scores, improving pre-pandemic, deteriorated during the pandemic. The pre-pandemic quality gap between the best- and worst-performing deciles narrowed as the worst-performing decile improved faster than the best-performing decile. During the pandemic, the quality gap widened as the worst-performing decile relapsed more than the best-performing decile ( p

BackgroundDespite various interventions to combat child malnutrition in sub-Saharan Africa, wasting remains a critical public health concern for children aged 6–59 months. Wasting is a significant predictor of child survival and development, with a heightened risk of mortality among children. However, there is a lack of recent comprehensive data on the prevalence, severity level, and factors contributing to wasting in this age group.ObjectiveTo identify the severity levels of wasting and its individual and community-level factors contributing to wasting among children aged 6–59 months in Sub-Saharan African countries.MethodsThis research utilized Demographic and Health Survey data from 34 Sub-Saharan African countries, spanning the period from 2007 to 2022. The study included a weighted sample of 180,317 6–59-month-old children. We employed a multilevel proportional odds model to identify factors predicting the severity of wasting. Adjusted odds ratios and 95% confidence intervals were reported to demonstrate significant relationships (p

Epidemiological models—which help us understand and forecast the spread of infectious disease—can be valuable tools for public health. However, barriers exist that can make it difficult to employ epidemiological models routinely within the repertoire of public health planning. These barriers include technical challenges associated with constructing the models, challenges in obtaining appropriate data for model parameterization, and problems with clear communication of modeling outputs and uncertainty. To learn about the unique barriers and opportunities within the state of Arizona, we gathered a diverse set of 48 public health stakeholders for a day-and-a-half forum. Our research group was motivated specifically by our work building software for public health-relevant modeling and by our earnest desire to collaborate closely with stakeholders to ensure that our software tools are practical and useful in the face of evolving public health needs. Here we outline the planning and structure of the forum, and we highlight as a case study some of the lessons learned from breakout discussions. While unique barriers exist for implementing modeling for public health, there is also keen interest in doing so across diverse sectors of State and Local government, although issues of equal and fair access to modeling knowledge and technologies remain key issues for future development. We found this forum to be useful for building relationships and informing our software development, and we plan to continue such meetings annually to create a continual feedback loop between academic molders and public health practitioners.

Rabies remains a burden in Africa, disproportionately affecting the most vulnerable despite the availability of effective vaccines. Nigeria, the most populous African country, needs rapid disease control actions and commitments to achieve the goal of eliminating dog-mediated rabies by 2030. Surveillance is an essential element of effective disease control strategies. This study examined the current state of operationality of the rabies surveillance system for early case detection and management in Gombe state, Nigeria, through a One Health lens. It further examined the barriers impeding the effectiveness of the surveillance based on the perception of surveillance workers. Qualitative and quantitative methods were used to assess the structure of the system and its functioning. Data on dog bite and rabid cases obtained from the veterinary services in Gombe state were analysed descriptively. A total of 13 key informants were interviewed using a semi-structured interview guide. Qualitative data were analysed using thematic analysis to explore in depth the factors that influenced the operationality of the system. A total of 157 potential human exposures to rabies were identified in this study, out of which two people reportedly died at the health facility after showing symptoms highly suggestive of rabies. In terms of rabies surveillance and control, cross-sectoral collaboration was found between the human health and veterinary sectors for risk assessment of potential rabies exposures and its management. Some identified factors affecting the operations of the surveillance were inadequate funding, lack of infrastructure, lack of feedback from higher authorities and insufficient knowledge of rabies prevention and management. To improve the capacity for case detection and management within the state, the appropriate authorities may focus on increasing awareness about the disease to the populace to increase the number of cases identified by the system, employ more workers and strengthen the surveillance capability of existing workers.

Trellis decoders are a general decoding technique first applied to qubit-based quantum error correction codes by Ollivier and Tillich in 2006. Here, we improve the scalability and practicality of their theory, show that it has strong structure, extend the results using classical coding theory as a guide, and demonstrate a canonical form from which the structural properties of the decoding graph may be computed. The resulting formalism is valid for any prime-dimensional quantum system. The modified decoder works for any stabilizer code $S$ and separates into two parts: 1) a one-time offline computation that builds a compact graphical representation of the normalizer of the code, $\mathcal {S}^{\perp}$ and 2) a quick, parallel, online query of the resulting vertices using the Viterbi algorithm. We show the utility of trellis decoding by applying it to four high-density length-20 stabilizer codes for depolarizing noise and the well-studied Steane, rotated surface, and 4.8.8/6.6.6 color codes for $Z$ only noise. Numerical simulations demonstrate a 20% improvement in the code-capacity threshold for color codes with boundaries by avoiding the mapping from color codes to surface codes. We identify trellis edge number as a key metric of difficulty of decoding, allowing us to quantify the advantage of single-axis ($X$ or $Z$) decoding for Calderbank–Steane–Shor codes and block decoding for concatenated codes.

Abstract There is a need to define regions of gene activation or repression that control human kidney cells in states of health, injury, and repair to understand the molecular pathogenesis of kidney disease and design therapeutic strategies. Comprehensive integration of gene expression with epigenetic features that define regulatory elements remains a significant challenge. We measure dual single nucleus RNA expression and chromatin accessibility, DNA methylation, and H3K27ac, H3K4me1, H3K4me3, and H3K27me3 histone modifications to decipher the chromatin landscape and gene regulation of the kidney in reference and adaptive injury states. We establish a spatially-anchored epigenomic atlas to define the kidney’s active, silent, and regulatory accessible chromatin regions across the genome. Using this atlas, we note distinct control of adaptive injury in different epithelial cell types. A proximal tubule cell transcription factor network of ELF3, KLF6, and KLF10 regulates the transition between health and injury, while in thick ascending limb cells this transition is regulated by NR2F1. Further, combined perturbation of ELF3, KLF6, and KLF10 distinguishes two adaptive proximal tubular cell subtypes, one of which manifested a repair trajectory after knockout. This atlas will serve as a foundation to facilitate targeted cell-specific therapeutics by reprogramming gene regulatory networks.

Introduction: The development of immune checkpoint inhibitors is considered one of the most important advances in cancer treatment. Pembrolizumab is an immune checkpoint inhibitor against programmed death-1 (PD-1) receptors that has demonstrated antineoplastic activity against various malignancies, including non-small cell lung cancer, melanoma, and triple-negative breast cancer. Pembrolizumab is associated with numerous adverse reactions including mucosal and cutaneous reactions referred to as immune-related adverse events. These events can impact patient quality of life and lead to dose reduction or discontinuation of the medication. A comprehensive understanding of pembrolizumab’s toxicities is crucial for the initiation of treatment. Case Presentation: We present the case of a 27-year-old man with stage IVB thymic carcinoma with a bulky anterior mediastinal mass, bilateral jugular, bilateral peritracheal, and bilateral cardiophrenic lymphadenopathies, and a small pericardial effusion. He received pembrolizumab IV every 3 weeks for 53 cycles over 39 months. The patient developed bleeding oral lesions approximately 38 months after treatment with pembrolizumab. Conclusion: The patient’s pembrolizumab treatment was not interrupted and the perioral rash ultimately improved after treatment with steroids.

Generalized joint hypermobility (GJH) often leads clinicians to suspect a diagnosis of Ehlers Danlos Syndrome (EDS), but it can be difficult to objectively assess. Video-based goniometry has been proposed to objectively estimate joint range of motion in hyperextended joints. As part of an exam of joint hypermobility at a specialized EDS clinic, a mobile phone was used to record short videos of 97 adults (89 female, 35.0 ± 9.9 years old) undergoing assessment of the elbows, knees, shoulders, ankles, and fifth fingers. Five body keypoint pose-estimation libraries (AlphaPose, Detectron, MediaPipe-Body, MoveNet – Thunder, OpenPose) and two hand keypoint pose-estimation libraries (AlphaPose, MediaPipe-Hands) were used to geometrically calculate the maximum angle of hyperextension or hyperflexion of each joint. A custom domain-specific model with a MobileNet-v2 backbone finetuned on data collected as part of this study was also evaluated for the fifth finger movement. Spearman’s correlation was used to analyze the angles calculated from the tracked joint positions, the angles calculated from manually annotated keypoints, and the angles measured using a goniometer. Moderate correlations between the angles estimated using pose-tracked keypoints and the goniometer measurements were identified for the elbow (rho =.722; Detectron), knee (rho =.608; MoveNet – Thunder), shoulder (rho =.632; MoveNet – Thunder), and fifth finger (rho =.786; custom model) movements. The angles estimated from keypoints predicted by open-source libraries at the ankles were not significantly correlated with the goniometer measurements. Manually annotated angles at the elbows, knees, shoulders, and fifth fingers were moderately to strongly correlated to goniometer measurements but were weakly correlated for the ankles. There was not one pose-estimation library which performed best across all joints, so the library of choice must be selected separately for each joint of interest. This work evaluates several pose-estimation models as part of a vision-based system for estimating joint angles in individuals with suspected joint hypermobility. Future applications of the proposed system could facilitate objective assessment and screening of individuals referred to specialized EDS clinics.

Background and Objectives: The threshold for ineffective esophageal motility (IEM) diagnosis was changed in Chicago v4.0. Our aim was to determine IEM prevalence using the new criteria and the differences between patients with definite IEM versus “inconclusive diagnosis”. Materials and Methods: We retrospectively selected IEM and fragmented peristalsis (FP) patients from the high-resolution esophageal manometries (HREMs) database. Clinical, demographic data and manometric parameters were recorded. Results: Of 348 HREMs analyzed using Chicago v3.0, 12.3% of patients had IEM and 0.86% had FP. Using Chicago v4.0, 8.9% of patients had IEM (IEM-4 group). We compared them with the remaining 16 with an inconclusive diagnosis of IEM (borderline group). Dysphagia (77% vs. 44%, Z-test = 2.3, p = 0.02) and weight loss were more commonly observed in IEM-4 compared to the borderline group. The reflux symptoms were more prevalent in the borderline group (87.5% vs. 70.9%, p = 0.2). Type 2 or 3 esophagogastric junction morphology was more prevalent in the borderline group (81.2%) vs. 64.5% in IEM-4 (p = 0.23). Distal contractile integral (DCI) was lower in IEM-4 vs. the borderline group, and resting lower esophageal sphincter (LES) pressure and mean integrated relaxation pressure (IRP) were similar. The number of ineffective swallows and failed swallows was higher in IEM-4 compared to the borderline group. Conclusions: Using Chicago v4.0, less than 10% of patients had a definite diagnosis of IEM. The dominant symptom was dysphagia. Only DCI and the number of failed and inefficient swallows were different between definite IEM patients and borderline cases.