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Lawrence E Armstrong,1,2 Evan C Johnson,3 William M Adams,4– 7 John F Jardine2 1Human Performance Laboratory, Department of Kinesiology, University of Connecticut, Storrs, CT, USA; 2Korey Stringer Institute, Department of Kinesiology, University of Connecticut, Storrs, CT, USA; 3Division of Kinesiology & Health, University of Wyoming, Laramie, WY, USA; 4Department of Sports Medicine, United States Olympic & Paralympic Committee, Colorado Springs, CO, USA; 5United States Coalition for the Prevention of Illness and Injury in Sport, Colorado Springs, CO, USA; 6Department of Kinesiology, University of North Carolina at Greensboro, Greensboro, NC, USA; 7School of Sport, Exercise and Health Sciences, Loughborough University, National Centre for Sport and Exercise Medicine (NCSEM), Loughborough, UKCorrespondence: Lawrence E Armstrong, University of Connecticut, Department of Kinesiology, Human Performance Laboratory, 2095 Hillside Road, Unit 1110, Storrs, CT, 06269, USA, Email lawrence.armstrong@uconn.eduAbstract: Few previous epidemiological studies, sports medicine position statements, and expert panel consensus reports have evaluated the similarities and differences of hyperthermia and exertional heatstroke (EHS) during endurance running, cycling, open water swimming, and triathlon competitions. Accordingly, we conducted manual online searches of the PubMed and Google Scholar databases using pre-defined inclusion criteria. The initial manual screenings of 1192 article titles and abstracts, and subsequent reviews of full-length pdf versions identified 80 articles that were acceptable for inclusion. These articles indicated that event medical teams recognized hyperthermia and EHS in the majority of running and triathlon field studies (range, 58.8 to 85.7%), whereas few reports of hyperthermia and EHS appeared in cycling and open water swimming field studies (range, 0 to 20%). Sports medicine position statements and consensus reports also exhibited these event-specific differences. Thus, we proposed mechanisms that involved physiological effector responses (sweating, increased skin blood flow) and biophysical heat transfer to the environment (evaporation, convection, radiation, and conduction). We anticipate that the above information will help race directors to distribute pre-race safety advice to athletes and will assist medical directors to better allocate medical resources (eg, staff number and skill sets, medical equipment) and optimize the management of hyperthermia and EHS.Keywords: heat illness, epidemiology, pathophysiology, thermoregulation, athlete

Abstract This study hypothesized that SCFA, acetate impacts positively on hypothalamic pyroptosis and its related abnormalities in experimentally induced PCOS rat model, possibly through NrF2/HIF1-α modulation. Eight-week-old female Wister rats were divided into groups (n = 5), namely control, PCOS, acetate and PCOS + acetate groups. Induction of PCOS was performed by administering 1 mg/kg body weight of letrozole for 21 days. After PCOS confirmation, the animals were treated with 200 mg/kg of acetate for 6 weeks. Rats with PCOS were characterized with insulin resistance, leptin resistance, increased plasma testosterone as well as degenerated ovarian follicles. There was also a significant increase in hypothalamic triglyceride level, triglyceride-glucose index, inflammatory biomarkers (SDF-1 and NF-kB) and caspase-6 as well as plasma LH and triglyceride. A decrease was observed in plasma adiponectin, GnRH, FSH, and hypothalamic GABA with severe inflammasome expression in PCOS rats. These were accompanied by decreased level of NrF2/HIF1-α, and the alterations were reversed when treated with acetate. Collectively, the present results suggest the therapeutic impact of acetate on hypothalamic pyroptosis and its related comorbidity in PCOS, a beneficial effect that is accompanied by modulation of NrF2/HIF1-α.

Abstract Background Tropical oils such as palm and coconut oils are renowned for their high saturated fat content and culinary versatility. However, their consumption has sparked debate regarding their health benefits and production concerns. The purpose of this review was to map existing evidence on the health benefits and challenges associated with the consumption of tropical oils. Method The recommendations for conducting a scoping review by Arksey and O’Malley were followed. PubMed, Dimensions AI, Central, JSTOR Google, Google Scholar, and ProQuest databases were searched for relevant papers. The predetermined keywords used were Consumption” AND “Tropical oil,” as well as “Health benefits” OR “Health challenges” AND “Tropical Countries.” Peer-reviewed and grey literature published in English were eligible for this review. Result Tropical oils, such as palm and coconut oils, provide health benefits including essential vitamins (A and E) that enhance ocular health, boost immunity, and support growth. They are also recognised for their role in managing high blood sugar, obesity, and cholesterol levels, while offering antioxidant and anti-inflammatory properties. These oils have wound-healing abilities and are commonly used in infant nutrition and traditional cooking. Nevertheless, prolonged and repeated use of tropical oils to high temperature can degrade vitamin E, whereas excessive intake may result in overdose. Health concerns include oxidative risks, diabetes, cancer, coronary heart disease, high blood pressure, and acrylamide formation due to production challenges excessive consumption. Additional issues include obesity, suboptimal oil production, misconceptions, regulatory obstacles, and preferences for alternative fats. Conclusion This review suggest that tropical oils provide essential health benefits, including vitamins and antioxidant properties, but pose significant health risks and production challenges, particularly when exposed to high temperatures and through excessive intake. Guidelines on the consumption of tropical oils in the tropical regions are necessary to regulate their consumption.

Nicole Adams,1 Carol A Ott,2 Cody J Mullen,3 Yitong Wang4 1Purdue Regenstrief Center for Healthcare Engineering, West Lafayette, IN, USA; 2Purdue Department of Pharmacy Practice, West Lafayette, IN, USA; 3Purdue Department of Public Health, West Lafayette, IN, USA; 4Purdue School of Nursing, West Lafayette, IN, USACorrespondence: Nicole Adams, Regenstrief Center for Healthcare Engineering, Purdue University, West Lafayette, IN, USA, 47907, Email adams417@purdue.eduAbstract: The opioid crisis in the United States continues to take the lives of tens of thousands of Americans each year. Opioid medications are important components of acute pain management and opioid stewardship is necessary to mitigate opioid misuse while providing adequate pain control for patients with severe medical needs. The definition of opioid stewardship includes the use of evidence-based guidelines, policies, and patient-centered practices to promote appropriate prescribing, use, and deprescribing of opioids to optimize treatment and minimize adverse consequences. There is little concrete guidance about how to achieve these goals or define the role and importance of various healthcare professionals in opioid stewardship programs. An integrative review process was used to evaluate and collate best practices in opioid stewardship from a variety of published papers. The integrative review was chosen to be inclusive of papers outside of quantitative research, allowing for interpretation of qualitative research, position statements, reports, editorials, and opinions. Data extraction included 71 publications that revealed common characteristics that can improve and coalesce opioid stewardship programs. Top characteristics and themes developed include prescribing guidelines, patient and provider education, referral and consultation, prescribing audits, barriers to opioid stewardship, the use of multidisciplinary teams and non-physician healthcare providers, accountability, risk of misuse, access to care, and patient-centeredness. The use of electronic health record tools, decision support tools, patient screening and discharge standards, and opioid tapering were recommended. Open and consistent communication between patients and healthcare providers is deemed essential. Staffing resources were found to be a significant barrier to opioid stewardship. This integrative review of publications related to opioid stewardship seeks to provide a comprehensive list of best practices that can be incorporated into programs to streamline processes and contribute to an organized foundation that can be used in research to illuminate practices that lead to enhanced outcomes.Keywords: opioid, stewardship, multidisciplinary, education, patient-centered, barriers

Abstract Aim Illicitly manufactured fentanyl and its analogs are the primary drivers of opioid overdose deaths in the United States (U.S.). People who use drugs may be exposed to fentanyl or its analogs intentionally or unintentionally. This study sought to identify strategies used by rural people who use drugs to reduce harms associated with unintentional fentanyl exposure. Methods This analysis focused on 349 semi-structured qualitative interviews across 10 states and 58 rural counties in the U.S conducted between 2018 and 2020. Interview guides were collaboratively standardized across sites and included questions about drug use history (including drugs currently used, frequency of use, mode of administration) and questions specific to fentanyl. Deductive coding was used to code all data, then inductive coding of overdose and fentanyl codes was conducted by an interdisciplinary writing team. Results Participants described being concerned that fentanyl had saturated the drug market, in both stimulant and opioid supplies. Participants utilized strategies including: (1) avoiding drugs that were perceived to contain fentanyl, (2) buying drugs from trusted sources, (3) using fentanyl test strips, 4) using small doses and non-injection routes, (5) using with other people, (6) tasting, smelling, and looking at drugs before use, and (7) carrying and using naloxone. Most people who used drugs used a combination of these strategies as there was an overwhelming fear of fatal overdose. Conclusion People who use drugs living in rural areas of the U.S. are aware that fentanyl is in their drug supply and use several strategies to prevent associated harms, including fatal overdose. Increasing access to harm reduction tools (e.g., fentanyl test strips, naloxone) and services (e.g., community drug checking, syringe services programs, overdose prevention centers) should be prioritized to address the polysubstance-involved overdose crisis. These efforts should target persons who use opioids and other drugs that may contain fentanyl.

Abstract As building becomes more leak-tight, air refreshment to improve indoor air quality is needed for healthy living standards. In the quest to ensure comfortable indoor climatic conditions, energy recovery ventilators (ERV) are used to provide air refreshment and thermal comfort. In this study, a fixed plate air-to-air ERV was analysed to determine its effectivity in terms of energy recovery during air refreshment. A customized test bench was built and used to acquire the instantaneous surface temperatures of the heat exchanger plates contained in the ERV during air refreshment. Also, a numerical model of the ERV was developed and validated by comparing its output from simulation with experiment results under the same conditions. The model consisted of a single heat exchanger plate and the air across the plate surface. To capture the effect of heat transfer between the air and the heat exchanger plate in 3D, the model was discretized into numerous cells. From the experiment and simulation results, the air-to-air ERVs were more effective in recovering thermal energy at low flow velocity than at high flow velocity. At lower flow velocity, it will take a longer time duration before any significant impact is made on the thermal conditions of the building, comparatively. The prediction of the model was within acceptable margins and could be used to provide insight on the ERVs performance improvement.

Godfrey L Sambayi,1,* George M Bwire,2,3,* Mary Spicar Kilapilo,3 David T Myemba,4 Idda H Mosha,5 Manase Kilonzi,6 Renatus B Magati,7 Maryam Amour,8 Rogers Mwakalukwa,1 Ally Nassoro Mangara,9 Muhammad Bakari,10 Christopher R Sudfeld,11 Mecky IN Matee,12 Raphael Z Sangeda,3 Lisa V Adams,13 Japhet Killewo14 1Department of Pharmacognosy, School of Pharmacy, Muhimbili University of Health and Allied Sciences, Dar es Salaam, 65013, Tanzania; 2Department of Microbiology, Immunology and Transplantation, Rega Institute for Medical Research Clinical and Epidemiological Virology, Institute for the Future, KU Leuven, Leuven, 3000, Belgium; 3Department of Pharmaceutical Microbiology, School of Pharmacy, Muhimbili University of Health and Allied Sciences, Dar es Salaam, 65013, Tanzania; 4Department of Pharmaceutics and Pharmacy Practice, School of Pharmacy, Muhimbili University of Health and Allied Sciences, Dar es Salaam, 65013, Tanzania; 5Department of Behavioural Sciences, School of Public Health and Social Sciences, Muhimbili University of Health and Allied Sciences, Dar es Salaam, 65015, Tanzania; 6Department of Clinical Pharmacy and Pharmacology, School of Pharmacy, Muhimbili University of Health and Allied Sciences, Dar es Salaam, 65013, Tanzania; 7Department of Clinical Nursing, Catholic University of Health and Allied Sciences, Mwanza, P.O. Box 1464, Tanzania; 8Department of Community Health, School of Public Health and Social Sciences, Muhimbili University of Health and Allied Sciences, Dar es Salaam, 65015, Tanzania; 9Dar Es Salaam Urban Cohort Study, Department of Epidemiology and Biostatistics, School of Public Health and Social Sciences, Dar es Salaam, 65013, Tanzania; 10Department of Internal Medicine, School of Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, P.O. Box 65001, Tanzania; 11Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA; 12Department of Microbiology and Immunology, School of Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, 65013, Tanzania; 13Department of Medicine, Center for Global Health Equity, Geisel School of Medicine at Dartmouth, Hanover, NH, USA; 14Department of Epidemiology and Biostatistics, School of Public Health and Social Sciences, Muhimbili University of Health and Allied Sciences, Dar es Salaam, 65015, Tanzania*These authors contributed equally to this workCorrespondence: Godfrey L Sambayi, Department of Pharmacognosy, Sciences, School of Pharmacy, Muhimbili University of Health and Allied, Dar es Salaam, P. O. Box 65013, Tanzania, Email godfreysambayi08@gmail.comPurpose: To explore the enabling factors, barriers, and strategies to improve retention in HIV care and adherence to antiretroviral therapy (ART) among adults (18 years and above) living with HIV in Dar es Salaam, Tanzania.Methods: We conducted a descriptive qualitative study to better understand and explore enablers, barriers, and strategies to improve retention in HIV care and adherence to antiretroviral therapy (ART) among PLHIV in Dar es Salaam, Tanzania. Focus group discussions (FGD) were conducted with a semi-structured discussion guide between December 2021 and June 2022. A non-random purposive sampling technique was used to select PLHIV and people involved in provision of healthcare and socioeconomic support to PLHIV. Thematic analysis was used to identify and interpret the themes.Results: Three major themes with 10 sub-themes emerged. Participants indicated that family and partner support, peer-support group/adherence clubs, and healthcare provider counselling on medication adherence facilitated retention and adherence to ART. In contrast, stigma and discrimination, financial constraints, disease outbreaks such as the COVID-19 pandemic, myths and misconceptions about HIV, and side effects of antiretrovirals were mentioned as barriers. Strengthening community and patient education about HIV and ART through peer support groups and financial support for poor PLHIV were the proposed mitigation.Conclusion: Addressing the challenges to ART adherence may require a more holistic approach. We recommend the implementation of peer support groups and financial support through small microfinance groups as interventions to increase retention in HIV care and adherence to ART in the study area.Keywords: people living with HIV, peer support group, stigma, SDG 3.3

Orjola Shahaj,1 Anne Meiwald,1 Krishnan Puri Sudhir,1 Rupert Gara-Adams,1 Peter Wark,2 Alexis Cazaux,3 Abelardo Elizondo Rios,4 Sergey N Avdeev,5 Elisabeth J Adams1 1Aquarius Population Health, London, UK; 2Respiratory and Sleep Medicine, John Hunter Hospital, New Castle, Australia; 3Pulmonary and Respiratory Medicine, Universidad Nacional de Cordoba, Cordoba, Argentina; 4Intensive Pneumology, Autonomous University of Nuevo Leon, Monterrey, Nuevo Leon, Mexico; 5Respiratory Medicine, Sechenov First Moscow State Medical University, Moscow, RussiaCorrespondence: Elisabeth J Adams, Aquarius Population Health, Unit 29 Tileyard Studios, London, N7 9AH, UK, Tel +44 207 993 2930, Email elisabeth.adams@aquariusph.comPurpose: Chronic obstructive pulmonary disease (COPD) poses a significant global health burden despite being largely preventable and treatable. Despite the availability of guidelines, COPD care remains suboptimal in many settings, including high-income countries (HICs) and upper-middle-income countries (UMICs), with varied approaches to diagnosis and management. This study aimed to identify common and unique barriers to COPD care across six countries (Australia, Spain, Taiwan, Argentina, Mexico, and Russia) to inform global policy initiatives for improved care.Methods: COPD care pathways were mapped for each country and supplemented with epidemiological, health-economic, and clinical data from a targeted literature review. Semi-structured interviews with 17 respiratory care clinicians were used to further validate the pathways and identify key barriers. Thematic content analysis was used to generate the themes.Results: Six themes were common in most HICs and UMICs: “Challenges in COPD diagnosis”, “Strengthening the role of primary care”, “Fragmented healthcare systems and coordination challenges”, “Inadequate management of COPD exacerbations”, “Limited access to specialized care” and, “Impact of underfinanced and overloaded healthcare systems”. One theme, “Insurance coverage and reimbursement challenges”, was more relevant for UMICs. HICs and UMICs differ in patient and healthcare provider awareness, primary care involvement, spirometry access, and availability of specialized care. Both face issues with healthcare fragmentation, guideline adherence, and COPD exacerbation management. In addition, UMICs also grapple with resource limitations and healthcare infrastructure challenges.Conclusion: Many challenges to COPD care are the same in both HICs and UMICs, underscoring the pervasive nature of these issues. While country-specific issues require customized solutions, there are untapped possibilities for implementing global respiratory strategies that support countries to manage COPD effectively. In addition to healthcare system-level initiatives, there is a crucial need for political prioritization of COPD to allocate the essential resources it requires.Keywords: COPD, barriers, qualitative research, healthcare systems, global policy

Enema is largely used and widely abused in our community for various ailments including fever, constipation; abdominal pains vomiting and even diarrhoea. Objectives: To describe the abuse of enema at home in the Calabar area, and the associated findings among children who received enema. Method: Children admitted to the Children Emergency Unit of the University of Calabar Teaching Hospital with history of enema use at home were recruited into the study. The presenting symptoms, type of enema used and associated findings were documented. Relevant investigations were carried out where necessary. Tables and simple proportions were used to analyze the data. Results: Twenty two children were seen with enema abuse over a six months period. Diarrhoea diseases and fever were the predominant reasons why enema was given. Types of enema given were herbal concoctions in 13(59.1%) plain water enema in 8(36.4%) and salt water enema in one (4.5%) child. Electrolytes derangements were the commonest associated findings. Others were convulsions/coma, intestinal perforation, acute renal failure and severe dehydration from diarrhoea. Conclusion: Enema abuse is a continuing cultural phenomenon in the Calabar area. It is associated with severe consequences including intestinal perforation. Enema abuse should form part of history taking in this environment and child care practitioners should actively search for possible complications. Most importantly, health education to stem this widespread practice

Assessing tree species diversity at Ogbomoso-North Secondary Schools, Nigeria provides essential data for effective environmental management in both rural and urban areas. The study sites were selected through a two-stage selection process. The information obtained was on tree species and abundance which was done by point count usage. Descriptive statistics, Shannon-Weiner diversity Index, Simpson’s Diversity Index and Analysis of variance were used to evaluate the information gotten. A total number of 38 tree species in 22 families were documented in the assessment. The Fabaceae (15.8 %) Apocynaceae (10.5 %), Arecaceae (10.5 %) and Euphorbiaceae (7.9 %) were the most abundant families observed. The tree species diversity was unevenly dispersed, though, the ANOVA result indicated that the tree species profusion was typically spread and uniformed significantly (p > 0.05) among the study sites. The study established that the schools in the study area have a diverse composition of trees and are key supporters of a solid environmental framework. It was suggested that partners ought to develop the establishment and authorization of regulations that will protect the trees, as well as afforestation, which should be done in short-term periods to replace the felled trees in the school compounds in South-West Nigeria.

Abstract Background Efforts to distribute naloxone have equipped more people with the ability to reverse opioid overdoses but people who use drugs are often reluctant to call 911 due to concerns for legal repercussions. Rural communities face unique challenges in reducing overdose deaths compared to urban communities, including limited access to harm reduction services as well as greater concerns about stigma and privacy. Methods The Rural Opioid Initiative was funded in 2017 to better understand the health-related harms associated with the opioid crisis in rural US communities and consists of eight studies spanning ten states and 65 counties. Each study conducted semi-structured qualitative interviews with people who use drugs to understand contextual factors influencing drug use and health behaviors. We analyzed qualitative data from seven studies with data available at the time of analysis to understand peer response to overdose. Results Of the 304 participants interviewed, 55% were men, 70% were white, 80% reported current injection drug use, and 60% reported methamphetamine use. Similar to what has been found in studies focused on urban settings, people who use drugs in rural communities use a range of strategies to reverse overdoses, including non-evidence-based approaches. Several reported that multiple doses of naloxone are needed to reverse overdose. Three themes emerged around the willingness to call 911, including (1) hesitancy to call 911 for fear of legal consequences, (2) negative perceptions or experiences with law enforcement officers, and (3) efforts to obtain medical intervention while avoiding identification/law enforcement involvement. Conclusion People who use drugs employ multiple strategies to attempt overdose reversal, including non-evidence-based approaches. Greater education about the most effective and least harmful strategies is needed. Reluctance to call 911 is rooted in concerns about potential legal consequences as well as perceptions about law enforcement officers, which may be heightened in rural communities where people who use drugs are more easily identified by law enforcement. People who use drugs will go to great strides to connect their peers to needed medical services, suggesting that comprehensive interventions to reduce interactions with law enforcement officers and eliminate legal consequences for reporting overdoses are critical.

Abstract Background Human fishing activities have significantly affect environmental concern for marine ecosystems, conservation of marine mammals, and human health. Coastal cetaceans are highly vulnerable to ingestion of fishing gear, bycatching, or entanglement, all of which can be fatal for these animals. In particular, certain coastal dolphins and porpoises are heavily impacted by fishing gear such as angling gear or stownet, as their food often overlap with the target fish species of human fisheries. Case presentation This study presents a case of an Indo-Pacific finless porpoise (Neophocaena phocaenoides) beached on the coast of Jeju Island, Republic of Korea, with ingestion of fishing gear and severe Anisakis infection. Although this species inhabits waters ranging from the Persian Gulf to Taiwan, several stranded carcasses have been reported on Jeju Island in recent years. Post-mortem computed tomography revealed a bundle of four fishing hooks in the forestomach, along with nylon lines and steel lines with connectors, which were assumed to be angling gear for Jeju hairtail (Trichiurus lepturus). Further necroscopic investigation revealed that the forestomach contained a large number of Anisakis spp. (Nematoda: Anisakidae). Histological examination revealed a thickened forestomach wall with pinpoint and volcanic ulcerations, a thickened layer of stratified squamous epithelium, and infiltrated stroma in the squamous epithelium. conclusions This study emphasizes the urgent need to address the impact of fishing activities on marine mammals, marine litter pollution, and the bycatch problem in Korean seawater. In addition, the occurrence of N. phocaenoides in seawater around Jeju Island should be raised in future geographical ecology or veterinary pathology studies and when its distribution is updated.

Abstract Background On 20 September 2022, Uganda declared its fifth Sudan virus disease (SVD) outbreak, culminating in 142 confirmed and 22 probable cases. The reproductive rate (R) of this outbreak was 1.25. We described persons who were exposed to the virus, became infected, and they led to the infection of an unusually high number of cases during the outbreak. Methods In this descriptive cross-sectional study, we defined a super-spreader person (SSP) as any person with real-time polymerase chain reaction (RT-PCR) confirmed SVD linked to the infection of ≥ 13 other persons (10-fold the outbreak R). We reviewed illness narratives for SSPs collected through interviews. Whole-genome sequencing was used to support epidemiologic linkages between cases. Results Two SSPs (Patient A, a 33-year-old male, and Patient B, a 26-year-old male) were identified, and linked to the infection of one probable and 50 confirmed secondary cases. Both SSPs lived in the same parish and were likely infected by a single ill healthcare worker in early October while receiving healthcare. Both sought treatment at multiple health facilities, but neither was ever isolated at an Ebola Treatment Unit (ETU). In total, 18 secondary cases (17 confirmed, one probable), including three deaths (17%), were linked to Patient A; 33 secondary cases (all confirmed), including 14 (42%) deaths, were linked to Patient B. Secondary cases linked to Patient A included family members, neighbours, and contacts at health facilities, including healthcare workers. Those linked to Patient B included healthcare workers, friends, and family members who interacted with him throughout his illness, prayed over him while he was nearing death, or exhumed his body. Intensive community engagement and awareness-building were initiated based on narratives collected about patients A and B; 49 (96%) of the secondary cases were isolated in an ETU, a median of three days after onset. Only nine tertiary cases were linked to the 51 secondary cases. Sequencing suggested plausible direct transmission from the SSPs to 37 of 39 secondary cases with sequence data. Conclusion Extended time in the community while ill, social interactions, cross-district travel for treatment, and religious practices contributed to SVD super-spreading. Intensive community engagement and awareness may have reduced the number of tertiary infections. Intensive follow-up of contacts of case-patients may help reduce the impact of super-spreading events.

Skye Nandi Adams Department of Speech Pathology and Audiology, School of Human and Community Development, University of the Witwatersrand, Johannesburg, South AfricaCorrespondence: Skye Nandi Adams, Department of Speech Pathology and Audiology, School of Human and Community Development, University of Witwatersrand, 1 Jan Smuts Avenue, Johannesburg, 2193, South Africa, Email skye.adams@wits.ac.zaAbstract: This review is of interest to researchers, policymakers, and healthcare professionals working in the field of autism in Africa. The review aims to describe autism in sub-Saharan Africa, focusing on South Africa and Nigeria regarding prevalence, incidence, identification, treatment, and attitudes towards autistic children. There are several challenges, such as lack of awareness, limited access to professional support and diagnostic tools, and cultural considerations in establishing the autism prevalence in the African region compared to other parts of the world. Additionally, South Africans and Nigerians exhibit diverse perspectives and attitudes that significantly influence the provision of treatment, including stigma and misconceptions held by healthcare professionals themselves. As a result, it is difficult to determine prevalence in South Africa and Nigeria. However, research has indicated that autism prevalence is rising globally, and in these contexts. Rising prevalence highlights the need to increase access to services, rehabilitation, and provide support to families of children with autism. Furthermore, research has emphasized the inequitable support and access available to families living in low-and high-income households and the need to provide contextually relevant and responsive interventions, education and training, research and policy in these countries.Keywords: Africa, autism, Nigeria, South Africa

Suebsarn Ruksakulpiwat,1 Nicholas K Schiltz,2 Elliane Irani,2 Richard A Josephson,3 Jon Adams,4 Carolyn Harmon Still2 1Department of Medical Nursing, Faculty of Nursing, Mahidol University, Bangkok, Thailand; 2Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH, USA; 3School of Medicine, Case Western Reserve University, Cleveland, OH, USA; 4School of Public Health, The University of Technology Sydney, Sydney, AustraliaCorrespondence: Suebsarn Ruksakulpiwat, Department of Medical Nursing, Faculty of Nursing, Mahidol University, Bangkok, Thailand, Email suebsarn25@gmail.comObjective: Hypertension (HTN) significantly increases the risk of stroke and heart disease, which are the leading causes of death and disability globally, particularly among older adults. Antihypertensive medication is a proven treatment for blood pressure control and preventing complications. However, medication adherence rates in older adults with HTN are low. In this review, we systematically identified factors influencing medication adherence in older adults with HTN.Methods: We applied the PRISMA guidelines and conducted systematic searches on PubMed, MEDLINE, and Google Scholar in July 2022 to identify preliminary studies reporting factors influencing medication adherence among older adults with HTN. The convergent integrated analysis framework suggested by the Joanna Briggs Institute for systematic reviews was adopted for data synthesis.Results: Initially, 448 articles were identified, and after title and abstract screening, 16 articles qualified for full-text review. During this phase, three articles were excluded for reporting on irrelevant populations or focusing on issues beyond the review’s aim, leaving thirteen studies in the final review. After data synthesis, fifteen themes were extracted from the key findings of the included studies. The most prevalent themes included the number of medications used (53.9%, n=7 studies), financial status (38.5%, n=5), sex (38.5%, n=5), age (30.1%, n=4), duration of disease (23.1%, n=3), comorbidities (23.1%, n=3), and health compliance (23.1%, n=3). Other themes, such as education, health literacy, health belief, medication belief, perception of illness, patient-physician relationship, self-efficacy, and social support, were also identified.Conclusion: The findings of this review highlight critical areas for developing innovative, evidence-based programs to improve medication adherence in hypertensive older adults. Insights from this review can contribute to improving medication adherence and preventing future health complications.Keywords: hypertension, medication adherence, older adults, systematic review

Abstract Background Drug overdose deaths in the United States exceeded 100,000 in 2021 and 2022. Substance use stigma is a major barrier to treatment and harm reduction utilization and is a priority target in ending the overdose epidemic. However, little is known about the relationship between stigma and overdose, especially in rural areas. We aimed to characterize the association between felt stigma and non-fatal overdose in a multi-state sample of rural-dwelling people who use drugs. Methods Between January 2018 and March 2020, 2,608 people reporting past 30-day opioid use were recruited via modified chain-referral sampling in rural areas across 10 states. Participants completed a computer-assisted survey of substance use and substance-related attitudes, behaviors, and experiences. We used multivariable logistic regression with generalized estimating equations to test the association between felt stigma and recent non-fatal overdose. Results 6.6% of participants (n = 173) reported an overdose in the past 30 days. Recent non-fatal overdose was significantly associated with felt stigma after adjusting for demographic and substance use-related covariates (aOR: 1.47, 95% CI: 1.20–1.81). The association remained significant in sensitivity analyses on component fear of enacted stigma items (aOR: 1.48, 95% CI: 1.20–1.83) and an internalized stigma item (aOR: 1.51, 95% CI: 1.07–2.14). Conclusions Felt stigma related to substance use is associated with higher risk of non-fatal overdose in rural-dwelling people who use drugs. Stigma reduction interventions and tailored services for those experiencing high stigma are underutilized approaches that may mitigate overdose risk.

The productivity of the quarry during the wet season heavily depends on how well the personnel adjusts to the mine's environmental conditions and management plans. The improvement of granite production through workers' impact identification and mining advancement decision-making in Ondo State, Nigeria, has been considered in this study. The rate of granite production and the factors influencing workers’ efficiency were assessed using a well-structured survey and descriptive-analytic technique. To improve the production rate, the Multiple Criteria Decision-Making (MCDM) technique was used to select the most productive pit depending on a number of key labor impact factors. Health and safety in employment, the energy crisis, market conditions and level of competition, on-site accidents, natural disasters, and language barriers were some of the factors identified as external influencer factors affecting mine labor efficiency in granite quarrying. Finally, using the criteria's significance through the inter-criterion (CRITIC) approach, the mine workers’ influence on production was estimated and utilized for the best pit selection. The result of the MCDM revealed that the five pits (Pit 1, Pit 2, Pit 3, Pit 4, and Pit 5) had the following decision performance scores: 0.659, 0.617, 0.5, 0.5, and 0.5, respectively. This made Pit 1 the best production pit to be considered during the rainy season. The optimal solution was validated with the 2021 production report. The report shows that production from Pit 1 had the highest revenue of $16,000 Per annum, the lowest dewatering cost, and the highest production rate compared to the other four pits.

It has been widely documented that good governance reduces income inequality when it creates a conducive environment for quality human capital development. This study investigates the unconditional effects of human capital on income inequality and explores whether institutional quality mechanisms for corruption control and government effectiveness moderate the relationship. Results from the instrumental variable generalised method of moments estimator and data for an unbalanced panel data of 36 African over the period 2010-2020, shows that human capital increases income inequality. However, robust evidence from the interactive analysis reveals that corruption control and government effectiveness mitigate the income inequality-enhancing effect of human capital. This study underscores the need to improve structures and system government effectiveness and corruption control for human capital development to equalise income in Africa.

Mass propagation of Coffea canephora through stem cuttings using various rooting hormones and clonal chambers is an innovative practice to hasten and mass produce planting materials of coffee for commercial production. The study was conducted to determine the rooting and shooting performance of C. canephora cuttings in response to rooting hormone and the clonal chamber using semihardwood stem cuttings. The experiment was laid out in a randomized complete block design (RCBD) with four treatments and replicated four times. The different treatments were: cuttings treated with hormone + propagated off clonal chamber condition), control (cuttings without hormonal treatment + propagated off clonal chamber condition), cuttings treated with hormone + propagated under clonal chamber condition), and cuttings without hormonal treatment + propagated under clonal chamber condition. Data collection started on the 8 th week after propagation and data were collected on leaf number, root number, root length and mortality of cuttings for a period of ten weeks. The study indicated that, the effect of rooting hormone on the number of roots, root length and cutting mortality was significant (p 0.05) with the exception of the number of newly developed leaves. More so, the clonal chamber had a significant effect on the number of leaves, root number and root length as well as mortality (p 0.05). The cuttings treated with rooting hormone propagated under clonal chamber conditions significantly improved the number of roots, root length, number of leaves with the least mortality. However, cuttings propagated off the clonal chamber conditions had the highest mortality, least root number, least root length and least leaf number. Therefore, it is recommended that the ideal treatment for C. canephora cuttings for mass propagation is to treat cuttings with rooting hormone and propagated under clonal chamber condition.

BackgroundStigma is a barrier to treatment and harm reduction seeking in people who use drugs. Most stigma reduction interventions offer psychotherapy or psychoeducation in group-based clinical settings, failing to reach people who are not in treatment. SMS text messaging is an effective and acceptable modality for delivering health information to people who use drugs and may be a suitable conduit for providing information and advice to understand and cope with stigma. ObjectiveThis paper presents the protocol for a study that aims to determine the feasibility, acceptability, and preliminary effectiveness of a 4-week automated SMS text message intervention to increase stigma resistance and reduce self-stigma in people who use drugs. MethodsWe designed a novel automated SMS text message intervention to address the four personal-level constructs of stigma resistance: (1) not believing stigma and catching and challenging stigmatizing thoughts, (2) empowering oneself through learning about substance use and one’s recovery, (3) maintaining one’s recovery and proving stigma wrong, and (4) developing a meaningful identity and purpose apart from one’s substance use. Theory-based messages were developed and pilot-tested in qualitative elicitation interviews with 22 people who use drugs, resulting in a library of 56 messages. In a single-group, within-subjects, community-based pilot trial, we will enroll 30 participants in the Resisting Stigma and Revaluating Your Thoughts (RESTART) intervention. Participants will receive 2 daily SMS text messages for 4 weeks. Implementation feasibility will be assessed through recruitment, enrollment, retention, and message delivery statistics. User feasibility and acceptability will be assessed at follow-up using 23 survey items informed by the Theoretical Framework of Acceptability. Primary effectiveness outcomes are changes in self-stigma (Substance Abuse Self-Stigma Scale) and stigma resistance (Stigma Resistance Scale) from baseline to follow-up measured via a self-administered survey. Secondary outcomes are changes in hope (Adult Dispositional Hope Scale) and self-esteem (Rosenberg Self-Esteem Scale). Feasibility and acceptability will be assessed with descriptive statistics; effectiveness outcomes will be assessed with paired 2-tailed t tests, and group differences will be explored using ANOVA. Overall, 12 participants will also be selected to complete acceptability interviews. ResultsThis pilot study was funded by the National Institute on Drug Abuse in April 2023 and received regulatory approval in January 2024 by the University of North Carolina-Chapel Hill Institutional Review Board. Recruitment and enrollment began in March 2024. Follow-up visits are expected to conclude by May 2024. Results will be disseminated in relevant peer-reviewed journals. ConclusionsTo the best of our knowledge, this is the first study to address substance use stigma via a self-help SMS text messaging program. Results will add to the nascent literature on stigma reduction in people who use drugs. This protocol may interest researchers who are considering text messaging to address psychosocial needs in hard-to-reach populations. Trial RegistrationClinicalTrials.gov NCT06281548; https://clinicaltrials.gov/ct2/show/NCT06281548 International Registered Report Identifier (IRRID)DERR1-10.2196/59224

With the development of serial crystallography at both x-ray free electron laser and synchrotron radiation sources, time-resolved x-ray crystallography is increasingly being applied to study conformational changes in macromolecules. A successful time-resolved serial crystallography study requires the growth of microcrystals, a mechanism for synchronized and homogeneous excitation of the reaction of interest within microcrystals, and tools for structural interpretation. Here, we utilize time-resolved serial femtosecond crystallography data collected from microcrystals of bacteriorhodopsin to compare results from partial occupancy structural refinement and refinement against extrapolated data. We illustrate the domain wherein the amplitude of refined conformational changes is inversely proportional to the activated state occupancy. We illustrate how resampling strategies allow coordinate uncertainty to be estimated and demonstrate that these two approaches to structural refinement agree within coordinate errors. We illustrate how singular value decomposition of a set of difference Fourier electron density maps calculated from resampled data can minimize phase bias in these maps, and we quantify residual densities for transient water molecules by analyzing difference Fourier and Polder omit maps from resampled data. We suggest that these tools may assist others in judging the confidence with which observed electron density differences may be interpreted as functionally important conformational changes.

This study conducts an empirical retrospective examination of the effect of COVID-19 protocols on Health workers' quality of life during the pandemic. Data from a survey respondent of 330 health workers were analyzed through structural equation modeling. Results indicated COVID-19 protocols specifically hand hygiene, personal protective equipments, and physical distancing had a significant effect on the quality of life of health workers during the COVID-19 era. However, the results did not follow the expected literature trend. Analysis indicated a direct significant positive relationship between hand hygiene and quality of life and also highlighted a negative relationship between physical distancing and protective equipments and quality of life. Detailed analysis in an attempt to explain this development highlighted the significant role physical and mental health play in the relationship between COVID-19 safety protocols and quality of life. The findings of the study suggest implications and suggestions for future research.

Maximizing the use of explosives is crucial for optimizing blasting operations, significantly influencing productivity and cost-effectiveness in mining activities. This work explores the incorporation of machine learning methods to predict powder factor, a crucial measure for assessing the effectiveness of explosive deployment, using important rock characteristics. The goal is to enhance the accuracy of powder factor prediction by employing machine learning methods, namely decision tree models and artificial neural networks. The analysis finds key rock factors that have a substantial impact on the powder factor, hence enabling more accurate planning and execution of blasting operations. The analysis uses data from 180 blast rounds carried out at a dolomite mine in south-south Nigeria. It incorporates measures such as root mean square error (RSME), mean absolute error (MAE), R-squared (R2), and variance accounted for (VAF) to determine the best models for predicting powder factor. The results indicate that the decision tree model (MD4) outperforms alternative approaches, such as artificial neural networks and Gaussian Process Regression (GPR). In addition, the research presents an efficient artificial neural network equation (MD2) for estimating the values of optimum powder factor, demonstrating outstanding blasting fragmentation. In conclusion, this research provides significant information for improving the accuracy of powder factor prediction, which is especially advantageous for small-scale blasting operations.