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Abstract Background A central challenge to closing the mental health treatment gap in low- and middle-income countries (LMICs) is determining the most effective pathway for delivering evidence-based mental health services. We are conducting a cluster-randomized, Type 2 hybrid implementation-effectiveness trial across 20 districts of Mozambique called the Partnerships in Research to Implement and Disseminate Sustainable and Scalable EBPs (PRIDE) program. Following training of nonspecialized providers in facilitation of evidence-based treatments for mental health and informed by the Consolidated Framework for Implementation Research (CFIR), we identified how PRIDE compares to care as usual and the perceived barriers and facilitators of implementation and modifications needed for widescale service delivery and scale-up. Methods We conducted rapid ethnographic assessment using freelisting among 34 providers, followed by four focus group discussions (n = 29 participants) with a subsample of psychiatric technicians and primary care providers from 14 districts in Nampula Province. We used Thematic Analysis to inductively apply open codes to transcripts and then deductively applied the CFIR domains and constructs to organize open codes. Results The main Outer Setting constructs relevant to implementation were recognition that patient mental health needs were significant. Additionally, numerous community-level characteristics were identified as barriers, including distance between clinics; shortage of providers; and low awareness of mental health problems, stigma, and discrimination among community members towards those with mental health struggles. The PRIDE program was perceived to offer a relative advantage over usual care because of its use of task-sharing and treating mental illness in the community. PRIDE addressed Inner Setting barriers of having available resources and training and provider low self-efficacy and limited knowledge of mental illness. Providers recommended leadership engagement to give support for supervision of other task-shared professionals delivering mental healthcare. Conclusions Primary care providers and psychiatric technicians in Mozambique perceived the relative advantage of the PRIDE program to address mental health treatment access barriers and offered recommendations for successful sustainment and scale up of integrated mental health care.

Abstract Background Malaria is a life-threatening parasitic disease typically transmitted through the bite of an infected Anopheles mosquito. There is ample evidence showing the potential of malaria infection to affect the counts of lymphocyte subpopulations in the peripheral blood, but the extent of alteration might not be consistent in all geographical locations, due to several local factors. Although Ghana is among the malaria-endemic countries, there is currently no available data on the level of alterations that occur in the counts of lymphocyte subpopulations during P. falciparum malaria infection among adults. Aim The study was to determine the immunophenotypic alterations in the level of peripheral blood lymphocytes and their subsets in adults with uncomplicated P. falciparum malaria infection and apparently healthy participants. Methods The study was a cross-sectional comparative study conducted in two municipalities of the Volta region of Ghana. Blood samples were collected from study participants and taken through serology (P. falciparum/Pan Rapid Diagnostic Kits), microscopy (Thick and thin blood films) and Haematological (Flow cytometric and Full blood count) analysis. Results A total of 414 participants, comprising 214 patients with malaria and 200 apparently healthy individuals (controls) were recruited into this study. Parasite density of the malaria patients ranged from 75/µL to 84,364/µL, with a mean of 3,520/µL. It was also observed that the total lymphocytes slightly decreased in the P. falciparum-infected individuals (Mean ± SD: 2.08 ± 4.93 × 109/L) compared to the control group (Mean ± SD: 2.47 ± 0.80 × 109/L). Again, there was a significant moderate positive correlation between parasite density and haematocrit levels (r = 0.321, p

Abstract Research demonstrates the important role of genetic factors in attention-deficit/hyperactivity disorder (ADHD). DNA sequencing of families provides a powerful approach for identifying de novo (spontaneous) variants, leading to the discovery of hundreds of clinically informative risk genes for other childhood neurodevelopmental disorders. This approach has yet to be extensively leveraged in ADHD. We conduct whole-exome DNA sequencing in 152 families, comprising a child with ADHD and both biological parents, and demonstrate a significant enrichment of rare and ultra-rare de novo gene-damaging mutations in ADHD cases compared to unaffected controls. Combining these results with a large independent case-control DNA sequencing cohort (3206 ADHD cases and 5002 controls), we identify lysine demethylase 5B (KDM5B) as a high-confidence risk gene for ADHD and estimate that 1057 genes contribute to ADHD risk. Using our list of genes harboring ultra-rare de novo damaging variants, we show that these genes overlap with previously reported risk genes for other neuropsychiatric conditions and are enriched in several canonical biological pathways, suggesting early neurodevelopmental underpinnings of ADHD. This work provides insight into the biology of ADHD and demonstrates the discovery potential of DNA sequencing in larger parent-child trio cohorts.

Abstract The Philippines are central to understanding the expansion of the Austronesian language family from its homeland in Taiwan. It remains unknown to what extent the distribution of Malayo-Polynesian languages has been shaped by back migrations and language leveling events following the initial Out-of-Taiwan expansion. Other aspects of language history, including the effect of language switching from non-Austronesian languages, also remain poorly understood. Here we apply Bayesian phylogenetic methods to a core-vocabulary dataset of Philippine languages. Our analysis strongly supports a sister group relationship between the Sangiric and Minahasan groups of northern Sulawesi on one hand, and the rest of the Philippine languages on the other, which is incompatible with a simple North-to-South dispersal from Taiwan. We find a pervasive geographical signal in our results, suggesting a dominant role for cultural diffusion in the evolution of Philippine languages. However, we do find some support for a later migration of Gorontalo-Mongondow languages to northern Sulawesi from the Philippines. Subsequent diffusion processes between languages in Sulawesi appear to have led to conflicting data and a highly unstable phylogenetic position for Gorontalo-Mongondow. In the Philippines, language switching to Austronesian in ‘Negrito’ groups appears to have occurred at different time-points throughout the Philippines, and based on our analysis, there is no discernible effect of language switching on the basic vocabulary.

Abstract Background Multiple evidence-based strategies (EBS) for promoting HPV vaccination exist. However, adolescent HPV vaccination rates remain below target levels in communities at high risk for HPV-associated cancers and served by safety-net clinics. Participatory engaged approaches are needed to leverage the expertise of community and clinical partners in selecting EBS relevant to their local context. We engaged concept mapping as a method to inform the adoption and adaptation of EBS that seeks to empower implementation partners to prioritize, select, and ultimately implement context-relevant EBS for HPV vaccination. Methods Using 38 EBS statements generated from qualitative interviews and national HPV vaccine advocacy sources, we conducted a modified concept mapping activity with partners internal to safety-net clinics and external community members in two study sites of a larger implementation study (Greater Los Angeles and New Jersey), to sort EBS into clusters and rate each EBS by importance and feasibility for increasing HPV vaccination within safety-net clinics. Concept mapping findings (EBS statement ratings, ladder graphs and go-zones) were shared with leaders from a large federally qualified health center (FQHC) system (focusing on three clinic sites), to select and implement EBS over 12 months. Results Concept mapping participants (n=23) sorted and rated statements, resulting in an eight-cluster solution: 1) Community education and outreach; 2) Advocacy and policy; 3) Data access/quality improvement monitoring; 4) Provider tracking/audit and feedback; 5) Provider recommendation/communication; 6) Expanding vaccine access; 7) Reducing missed opportunities; and 8) Nurse/staff workflow and training. The FQHC partner then selected to intervene on eight of 17 EBS statements in the “go-zone” for action, with three from “reducing missed opportunities,” two from “nurse/staff workflow and training,” and one each from “provider tracking/audit and feedback,” “provider recommendation/communication,” and “expanding vaccine access,” which the research team addressed through the implementation of three multi-level intervention strategies (e.g., physician communication training, staff training and workflow assessment, audit and feedback of clinic processes). Conclusions Concept mapping provided a powerful participatory approach to identify multilevel EBS for HPV vaccination relevant to the local safety-net clinic context, particularly when several strategies exist, and prioritization is necessary. This study demonstrates how a clinic system benefited directly from the ratings and prioritization of EBS by multilevel clinic and community partners within the broader safety-net clinic context to identify and adapt prioritized solutions needed to advance HPV vaccine equity.

Abstract The applicability of the specific human IgG antibody response to Anopheles gambiae salivary Gland Protein-6 peptide 1 (gSG6-P1 salivary peptide) as a biomarker able to distinguish the level of exposure to mosquito bites according to seasonal variations has not yet been evaluated in Central African regions. The study aimed to provide the first reliable data on the IgG anti-gSG6-P1 response in rural area in Cameroon according to the dry- and rainy-season. Between May and December 2020, dry blood samples were collected from people living in the Bankeng village in the forest area of the Centre region of Cameroon. Malaria infection was determined by thick-blood smear microscopy and multiplex PCR. The level of IgG anti-gSG6-P1 response, was assessed by enzyme-linked immunosorbent assay. Anopheles density and aggressiveness were assessed using human landing catches. The prevalence of malaria infection remains significantly higher in the rainy season than in the dry season (77.57% vs 61.44%; p = 0.0001). The specific anti-gSG6-P1 IgG response could be detected in individuals exposed to few mosquito bites and showed inter-individual heterogeneity even when living in the same exposure area. In both seasons, the level of anti-gSG6-P1 IgG response was not significantly different between Plasmodium infected and non-infected individuals. Mosquito bites were more aggressive in the rainy season compared to the dry season (human biting rate-HBR of 15.05 b/p/n vs 1.5 b/p/n) where mosquito density was very low. Infected mosquitoes were found only during the rainy season (sporozoite rate = 10.63% and entomological inoculation rate-EIR = 1.42 ib/p/n). The level of IgG anti-gSG6-P1 response was significantly higher in the rainy season and correlated with HBR (p ˂ 0.0001). This study highlights the high heterogeneity of individual’s exposure to the Anopheles gambiae s.l vector bites depending on the transmission season in the same area. These findings reinforce the usefulness of the anti-gSG6-P1 IgG response as an accurate immunological biomarker for detecting individual exposure to Anopheles gambiae s.l. bites during the low risk period of malaria transmission in rural areas and for the differentiating the level of exposure to mosquitoes.

Abstract The East African Community (EAC) grapples with many challenges in tackling infectious disease threats and antimicrobial resistance (AMR), underscoring the importance of regional and robust pathogen genomics capacities. However, a significant disparity exists among EAC Partner States in harnessing bacterial pathogen sequencing and data analysis capabilities for effective AMR surveillance and outbreak response. This study assesses the current landscape and challenges associated with pathogen next-generation sequencing (NGS) within EAC, explicitly focusing on World Health Organization (WHO) AMR-priority pathogens. The assessment adopts a comprehensive approach, integrating a questionnaire-based survey amongst National Public Health Laboratories (NPHLs) with an analysis of publicly available metadata on bacterial pathogens isolated in the EAC countries. In addition to the heavy reliance on third-party organizations for bacterial NGS, the findings reveal a significant disparity among EAC member States in leveraging bacterial pathogen sequencing and data analysis. Approximately 97% (n = 4,462) of publicly available high-quality bacterial genome assemblies of samples collected in the EAC were processed and analyzed by external organizations, mainly in Europe and North America. Tanzania led in-country sequencing efforts, followed by Kenya and Uganda. The other EAC countries had no publicly available samples or had all their samples sequenced and analyzed outside the region. Insufficient local NGS sequencing facilities, limited bioinformatics expertise, lack of adequate computing resources, and inadequate data-sharing mechanisms are among the most pressing challenges that hinder the EAC’s NPHLs from effectively leveraging pathogen genomics data. These insights emphasized the need to strengthen microbial pathogen sequencing and data analysis capabilities within the EAC to empower these laboratories to conduct pathogen sequencing and data analysis independently. Substantial investments in equipment, technology, and capacity-building initiatives are crucial for supporting regional preparedness against infectious disease outbreaks and mitigating the impact of AMR burden. In addition, collaborative efforts should be developed to narrow the gap, remedy regional imbalances, and harmonize NGS data standards. Supporting regional collaboration, strengthening in-country genomics capabilities, and investing in long-term training programs will ultimately improve pathogen data generation and foster a robust NGS-driven AMR surveillance and outbreak response in the EAC, thereby supporting global health initiatives.

Liver diseases have gained increasing attention due to their substantial impact on health, independently as well as in association with cardio-metabolic disorders. Studies have suggested that glutathione and adenosine assist in providing protection against oxidative stress and inflammation while glucocorticoid (GC) therapy has been associated with chronic inflammatory disorders, even in pregnancy. The implications of Glucocorticoid exposure on maternal health and fetal growth is a concern, however, the possible role of glutathione and adenosine has not been thoroughly investigated. The study therefore hypothesize that exposure to glucocorticoids leads to depletion of hepatic glutathione and adenosine levels, contributing to oxidative stress and tissue injury. Additionally, we aim to investigate whether the effects of glucocorticoids on hepatic health are pregnancy dependent in female rats. Twelve Pregnant and twelve age-matched non-pregnant rats were used for this study; an exogenous administration of glucocorticoid (Dex: 0.2 mg/kg) or vehicle (po) was administered to six pregnant and six non-pregnant rats from gestational day 14 to 19 or for a period of 6 days respectively. Data obtained showed that GC exposure led to a decrease in hepatic glucose-6-phosphate dehydrogenase, glutathione peroxidase, GSH/GSSG ratio and adenosine content in both pregnant and non-pregnant rats. In addition, increased activities of adenosine deaminase and xanthine oxidase, along with increased production of uric acid and increased levels of lactate dehydrogenase, aspartate aminotransferase, alanine transferase, alkaline phosphatase and gamma-glutamyl transferase were observed. In summary, the study indicates that GC-induced liver damage is underlined by depleted hepatic adenosine and glutathione levels as well as elevated markers of tissue inflammation and/or injury. Furthermore, the findings suggest that the effects of GC exposure on hepatic health are pregnancy independent.

• The efficacy of weekly somatrogon injections was no different from that of daily somatropin injections to treat children who don’t make enough growth hormone to grow adequately. ○ Efficacy refers to how well a drug works in a clinical trial. ○ Children treated with weekly somatrogon had an increased growth rate, similar to that of children treated with daily somatropin . • The safety of weekly somatrogon injections was similar to that of daily somatropin injections. The original scientific article on which this summary is based was published in The Journal of Clinical Endocrinology & Metabolism and can be accessed for free at: https://academic.oup.com/jcem/article/107/7/e2717/6566444 . The details of the original article are as follows: Cheri L. Deal, Joel Steelman, Elpis Vlachopapadopoulou, Renata Stawerska, Lawrence A Silverman, Moshe Phillip, Ho-Seong Kim, CheolWoo Ko, Oleg Malievskiy, Jose F. Cara, Carl L. Roland, Carrie Turich Taylor, Srinivas Rao Valluri, Michael P. Wajnrajch, Aleksandra Pastrak, and Bradley S. Miller. Efficacy and safety of weekly somatrogon vs daily somatropin in children with growth hormone deficiency: a phase 3 study. J Clin Endocrinol Metab 2022; 107(7): e2717–e2728. The purpose of this plain language summary is to help you to understand the findings from recent research. • Somatrogon is used to treat growth hormone deficiency (the condition under study that is discussed in this summary). Approval varies by country; please check with your local healthcare provider for more details. • The results of this study may differ from those of other studies. Physicians/providers should make treatment decisions based on all available evidence and not on the results of a single study.

This study explores the role of librarians in promoting information literacy for inclusive education, entrepreneurship, and national development in today's knowledge-driven society. The researcher conducted a literature review to investigate the responsibilities of librarians in fostering an information-literate society, the impact of such a society on inclusive education, entrepreneurship, and national development, and the challenges faced by librarians in this endeavour. The study concludes that librarians should advocate for the inclusion of knowledge literacy as a course in higher education curricula. It emphasizes the importance of information literacy in promoting inclusiveness, entrepreneurship, and national growth, including the development of individuals with diverse skills who can navigate technology-rich environments for societal benefit. As part of the recommendations, the study suggests that librarians collaborate and submit a position paper to the National University's Commission (NUC) to underscore the necessity of incorporating knowledge literacy into higher education programs, aiming to empower students as independent lifelong learners.

Climate change is responsible for marked increases in the frequency and severity of bush/wildfires, resulting in more people exposed to such events with long-term subclinical psychiatric symptoms. This editorial calls for immediate action to implement comprehensive and novel approaches to treating these conditions and preventing them from developing into more severe disorders.

Orientation: Although talent is a strategic asset for achieving organisational success, most higher education institutions (HEIs) struggle to attract talented academics required to compete. Research purpose: The primary purpose of this study was to examine talent attraction practices that create a competitive advantage for South African HEIs. Motivation for the study: The study was necessary to enhance the competitiveness of HEIs through talent attraction practices such as recruitment and selection, job analysis and employer branding. Research approach/design and method: The concurrent mixed-methods approach was used to analyse the quantitative and qualitative data independently. A sample size of 347 was selected from three South African HEIs. However, the data were collected from only 277 respondents using questionnaires (265) and interviews (12). The quantitative data were analysed using Statistical Package for the Social Sciences (version 27.0) and Analysis of Moment Structures (version 29.0). The qualitative data were analysed using thematic analysis. Main findings: The quantitative results showed a significant positive relationship between recruitment and selection, job analysis, employer branding and competitive advantage. The qualitative findings confirmed that talent attraction strategies created a competitive advantage for HEIs by hiring highly talented employees. Practical/managerial implications: The research findings could be a viable tool to create value for HEIs by adopting different talent attraction strategies to acquire highly talented employees. Contribution/value-add: This study sheds more light on the talent attraction practices that create value for HEIs.

Abstract Background Diabetes‐related foot infections are common and represent a significant clinical challenge. There are scant data about outcomes from large cohorts. The purpose of this study was to report clinical outcomes from a large cohort of people with diabetes‐related foot infections. Methods A tertiary referral hospital limb preservation service database was established in 2018, and all new episodes of foot infections were captured prospectively using an electronic database (REDCap). People with foot infections between January 2018 and May 2023, for whom complete data were available on infection episodes, were included. Infection outcomes were compared between skin and soft tissue infections (SST‐DFI) and osteomyelitis (OM) using chi‐square tests. Results Data extraction identified 647 complete DFI episodes in 397 patients. The data set was divided into two cohorts identifying each infection episode and its severity as either SST‐DFI (N = 326, 50%) or OM (N = 321, 50%). Most infection presentations were classified as being moderate (PEDIS 3 = 327, 51%), with 36% mild (PEDIS 2 = 239) and 13% severe (PEDIS 4 = 81). Infection resolution occurred in 69% (n = 449) of episodes with failure in 31% (n = 198). Infection failures were more common with OM than SST‐DFI (OM = 140, 71% vs. SST‐DFI = 58, 29%, p

BackgroundAlthough surveys and apps are available for women to report urination and bladder symptoms, they do not include their decisions regarding toileting. Real-world factors can interfere with toileting decisions, which may then influence bladder health. This premise lacks data per want of a robust data collection tool. ObjectiveThe Prevention of Lower Urinary Tract Symptoms (PLUS) research consortium engaged a transdisciplinary team to build and test WhereIGo, a mobile data collection app for Android and iOS. The design goal was a comprehensive reporting system for capturing environmental, sociocultural, and physical factors that influence women’s decisions for toileting. Aims include having (1) an innovative feature for reporting physiologic urge sensation when “thinking about my bladder” and shortly before “I just peed,” (2) real-time reporting along with short look-back opportunities, and (3) ease of use anywhere. MethodsThe development team included a plain language specialist, a usability specialist, creative designers, programming experts, and PLUS scientific content experts. Both real-time and ecological momentary assessments were used to comprehensively capture influences on toileting decisions including perceived access to toileting, degree of busyness or stress or focus, beverage intake amount, urge degree, or a leakage event. The restriction on the maximal number of taps for any screen was six. PLUS consortium investigators did pilot-testing. Formal usability testing relied on the recruitment of community-dwelling women at four PLUS research sites. Women used the app for 2 consecutive days. Outcome measures were the system usability scale (SUS; 0-100 range) and the functional Mobile Application Rating Scale (1-5 range). These scales were embedded at the end of the app. The estimated a priori sample size needed, considering the SUS cut point score set at ≥74, was 40 women completing the study. ResultsFunding was provided by the National Institute of Diabetes and Digestive and Kidney Diseases since July 2015. The integrity of the build process was documented through multiple 5-minute videos presented to PLUS Consortium and through WhereIGo screenshots of the final product. Participants included 44 women, with 41 (93%) completing data collection. Participants ranged in age from 21 to 85 years, were predominantly non-Hispanic White (n=25, 57%), college-educated (n=25, 57%), and with incomes below US $75,000 (n=27, 62%). The SUS score was 78.0 (SE 1.7), which was higher than 75% of the 500 products tested by the SUS developers. The mean functional Mobile Application Rating Scale score was 4.4 (SE 0.08). The build and informal acceptability testing were completed in 2019, enrollment for formal usability testing completed by June 2020, and analysis was completed in 2022. ConclusionsWhereIGo is a novel app with good usability for women to report toileting decisions, urination, and fluid intake. Future research using the app could test the influence of real-time factors on bladder health. International Registered Report Identifier (IRRID)RR1-10.2196/54046

Metabolic dysfunction-associated steatotic liver disease (MASLD) is a worldwide health epidemic with a global occurrence of approximately 30%. The pathogenesis of MASLD is a complex, multisystem disorder driven by multiple factors, including genetics, lifestyle, and the environment. Patient heterogeneity presents challenges in developing MASLD therapeutics, creating patient cohorts for clinical trials, and optimizing therapeutic strategies for specific patient cohorts. Implementing pre-clinical experimental models for drug development creates a significant challenge as simple in vitro systems and animal models do not fully recapitulate critical steps in the pathogenesis and the complexity of MASLD progression. To address this, we implemented a precision medicine strategy that couples the use of our liver acinus microphysiology system (LAMPS) constructed with patient-derived primary cells. We investigated the MASLD-associated genetic variant patatin-like phospholipase domain-containing protein 3 (PNPLA3) rs738409 (I148M variant) in primary hepatocytes as it is associated with MASLD progression. We constructed the LAMPS with genotyped wild-type and variant PNPLA3 hepatocytes, together with key non-parenchymal cells, and quantified the reproducibility of the model. We altered media components to mimic blood chemistries, including insulin, glucose, free fatty acids, and immune-activating molecules to reflect normal fasting (NF), early metabolic syndrome (EMS), and late metabolic syndrome (LMS) conditions. Finally, we investigated the response to treatment with resmetirom, an approved drug for metabolic syndrome-associated steatohepatitis (MASH), the progressive form of MASLD. This study, using primary cells, serves as a benchmark for studies using “patient biomimetic twins” constructed with patient induced pluripotent stem cell (iPSC)-derived liver cells using a panel of reproducible metrics. We observed increased steatosis, immune activation, stellate cell activation, and secretion of pro-fibrotic markers in the PNPLA3 GG variant compared to the wild-type CC LAMPS, consistent with the clinical characterization of this variant. We also observed greater resmetirom efficacy in the PNPLA3 wild-type CC LAMPS compared to the GG variant in multiple MASLD metrics, including steatosis, stellate cell activation, and the secretion of pro-fibrotic markers. In conclusion, our study demonstrates the capability of the LAMPS platform for the development of MASLD precision therapeutics, enrichment of patient cohorts for clinical trials, and optimization of therapeutic strategies for patient subgroups with different clinical traits and disease stages.

Three senior figures at the US National Institutes of Health explain why the agency remains committed to supporting basic science and research.

Developing countries, including Ghana, face challenges ensuring access to clean and reliable cooking fuels and technologies. Traditional biomass sources mainly used in most developing countries for cooking contribute to deforestation and indoor air pollution, necessitating a shift towards environmentally friendly alternatives. The study's primary objective is to evaluate the economic viability of using solar PV-based green hydrogen as a sustainable fuel for cooking in Ghana. The study adopted well-established equations to investigate the economic performance of the proposed system. The findings revealed that the levelized cost of hydrogen using the discounted cash flow approach is about 89 %, 155 %, and 190 % more than electricity, liquefied petroleum gas (LPG), and charcoal. This implies that using the hydrogen produced for cooking fuel is not cost-competitive compared to LPG, charcoal, and electricity. However, with sufficient capital subsidies to lower the upfront costs, the analysis suggests solar PV-based hydrogen could become an attractive alternative cooking fuel. In addition, switching from firewood to solar PV-based hydrogen for cooking yields the highest carbon dioxide (CO2) emissions savings across the cities analysed. Likewise, replacing charcoal with hydrogen also offers substantial CO2 emissions savings, though lower than switching from firewood. Correspondingly, switching from LPG to hydrogen produces lower CO2 emissions savings than firewood and charcoal. The study findings could contribute to the growing body of knowledge on sustainable energy solutions, offering practical insights for policymakers, researchers, and industry stakeholders seeking to promote clean cooking adoption in developing economies.

Abstract Background Policymaking is quickly gaining focus in the field of implementation science as a potential opportunity for aligning cross-sector systems and introducing incentives to promote population health, including substance use disorders (SUD) and their prevention in adolescents. Policymakers are seen as holding the necessary levers for realigning service infrastructure to more rapidly and effectively address adolescent behavioral health across the continuum of need (prevention through crisis care, mental health, and SUD) and in multiple locations (schools, primary care, community settings). The difficulty of aligning policy intent, policy design, and successful policy implementation is a well-known challenge in the broader public policy and public administration literature that also affects local behavioral health policymaking. This study will examine a blended approach of coproduction and codesign (i.e., Policy Codesign), iteratively developed over multiple years to address problems in policy formation that often lead to poor implementation outcomes. The current study evaluates this scalable approach using reproducible measures to grow the knowledge base in this field of study. Methods This is a single-arm, longitudinal, staggered implementation study to examine the acceptability and short-term impacts of Policy Codesign in resolving critical challenges in behavioral health policy formation. The aims are to (1) examine the acceptability, feasibility, and reach of Policy Codesign within two geographically distinct counties in Washington state, USA; (2) examine the impact of Policy Codesign on multisector policy development within these counties using social network analysis; and (3) assess the perceived replicability of Policy Codesign among leaders and other staff of policy-oriented state behavioral health intermediary organizations across the USA. Discussion This study will assess the feasibility of a specific approach to collaborative policy development, Policy Codesign, in two diverse regions. Results will inform a subsequent multi-state study measuring the impact and effectiveness of this approach for achieving multi-sector and evidence informed policy development in adolescent SUD prevention and treatment.

Abstract Background Migration-related changes in dietary patterns and other structural and individual factors affect weight-related health practices of individuals migrating from low-and-middle-income to high-income countries. Thus, individuals of ethnically diverse backgrounds may be disproportionately affected by poorer health outcomes, including weight-related health issues. Understanding how this community could be supported to adopt weight-related healthy practices such as optimum dietary and exercise behaviour is an important issue for public health research. Against this backdrop, we explored structural and individual factors that facilitate and constrain the uptake of weight management services among members of minority ethnic communities in Medway, England. Methods Data were collected from audio-recorded interviews with 12 adult community members from minoritised ethnic communities using a semi-structured interview guide. Participants were recruited through a purposive and convenient sampling technique. Generated data were transcribed, coded into NVivo and analysed using the reflexive thematic analytical technique. Results Results showed that social support and health benefits of weight management were the main motivating factors for weight management among the study participants. Conversely, systemic barriers, family commitment and caring responsibilities, changes in dietary patterns post-migration and cultural norms were major factors constraining participants from adopting weight management behaviours. Conclusion The results of this study indicate that structural and person-level factors serve as both facilitators and barriers to weight management among ethnically diverse communities in Medway, England. While our study is exploratory and opens doors for more studies among the population, we conclude that these minoritised communities could benefit from more equitable, tailored weight management programmes to support them in adopting weight-related practices.

Background: Childhood obesity is a significant public health challenge, particularly among children under five. In England, weight management programs aim to address this issue; however, engagement and uptake of these services remain low. Understanding the perceptions of parents and professionals involved in these programs is crucial to enhancing participation and improving health outcomes. This study explores these perceptions to identify barriers and facilitators to effective engagement with weight management services. Method: This qualitative study used purposive sampling to recruit parents and professionals involved in weight management programs across England. Semi-structured interviews were conducted with 15 participants (8 parents and 7 professionals). Data were transcribed, coded, and thematically analyzed using Braun and Clarke's six-phase framework to identify key themes related to engagement, cultural influences, and program effectiveness. Results: The study identified several key themes: parental engagement, the impact of virtual versus face-to-face sessions, motivations for participation, barriers to involvement, and the role of cultural beliefs. Parental involvement was critical for the success of weight management programs, but barriers such as time constraints, cultural beliefs, and socioeconomic factors hindered participation. Professionals highlighted the need for more training and resources to effectively address these challenges. Cultural sensitivities and systemic support were found to be crucial for improving engagement and outcomes. Conclusions: The findings emphasize the need for culturally tailored, accessible, and sustainable weight management interventions. Enhanced professional training, increased community outreach, and policy-level support are essential to improve engagement and ensure long-term success in addressing childhood obesity.

The implementation of Evidence-Based Practice (EBP) in healthcare can significantly improve health outcomes and alleviate poverty, particularly in developing countries like Uganda. Despite its potential, EBP adoption remains limited due to challenges such as resource constraints and inadequate infrastructure. This study explores the barriers and facilitators of EBP implementation among lecturers at Makerere University College of Health Sciences (Mak-CHS) in Uganda, providing insights relevant to resource-limited settings. This qualitative study employed semi-structured interviews with 12 purposively sampled lecturers at Mak-CHS. Interviews were transcribed verbatim and analysed using thematic analysis to identify key themes related to EBP barriers and facilitators. Participants (n = 12) identified EBP as a relatively new concept in Uganda. Key barriers included resistance to change, lack of resources, inadequate organisational support, and insufficient locally generated research. Facilitators included strong organisational support, integration of EBP training into curricula, and the adoption of a ‘train-the-trainers’ approach. These factors are closely tied to the challenges and opportunities typical of resource-limited settings. EBP adoption in Uganda faces significant challenges, particularly within resource-limited environments. However, strong institutional support and targeted training programs, such as integrating EBP into undergraduate curricula and implementing ‘train-the-trainers’ strategies, are critical for overcoming these barriers. Implications for Practice: To enhance EBP adoption, it is essential to incorporate EBP training into healthcare curricula, develop robust ‘train-the-trainers’ programs, and ensure the availability of necessary resources. These strategies are crucial for fostering a culture of evidence-based decision-making in healthcare, particularly in resource-limited settings like Uganda.

AbstractCOVID-19 was declared a global pandemic by the World Health Organisation in March 2022, resulting in over 115,0000 deaths worldwide by October of the same year. Only 25% of adults worldwide undertake the recommended levels of Physical activity (PA) for their respective age ranges, potentially exacerbating the symptoms associated with contraction of COVID-19 and recovery. This review aims to identify specific barriers and facilitators to engagement with PA interventions that were implemented during the pandemic. This quantitative study was undertaken adhering to the Preferred Reporting Items for Systematic Reviews and Meta Analyses. A systematic search was conducted of the following databases: CINAHL, MEDLINE, AMED, Cochrane, SCOPUS and Web of Science. Quality appraisal of selected papers was conducted through the CASP tool, with data extraction by two independent reviewers thereby minimising bias. This was then followed by a meta-analysis of the resulting data; however, no eligible studies were identified. Whilst 258 papers were identified through the database searches, following removal of duplicates (n = 19), the remaining 239 were screened, of these 237 were excluded on title and abstract, with the remaining two subsequently excluded following full read due to failure to meet the inclusion criteria. This review identified research gaps in the study.

AbstractStudies indicated that prior to the COVID-19 pandemic, the majority of adult Black, Asian and Minority Ethnic (BAME) individuals lived a sedentary lifestyle, which exacerbated their physical inactivity behaviours during the COVID-19 subsequent lockdowns. Experiences related to making healthy physical activity (PA) lifestyle choices in adult BAME individuals during the COVID-19 pandemic were mapped onto the capability, opportunity, and motivation model of behaviour (COM-B model). Twelve adult BAME participants were interviewed using one-on-one, semi-structured interviews that lasted 45–60 min, which captured participant perceptions of PA engagement during the pandemic between April and August 2022 via Microsoft Teams. Using thematic analysis, three themes were generated and successfully mapped onto the modified COM-B model. These include the influence of culture on the PA lifestyle, the capability to engage in the PA lifestyle, and the self-reflective determination model. Although existing literature has used both the COM-B and the self-determination models, these have been generalised findings that are not representative of adult BAME individuals’ lived PA participation experiences. This enabled the modification of the COM-B and self-reflective determination models to reflect the experiences of adult BAME individuals with respect to PA participation as well as improving PA culturally related policies.

AbstractThe study sought to explore the barriers and facilitators for making physical activity lifestyle choices among Black Asian Ethnic Minority (BAME) students at Teesside University during the COVID-19 pandemic. A qualitative approach was used to capture the in-depth physical activity experiences of BAME individuals. There is a paucity of primary qualitative studies focusing on BAME individuals’ activity lifestyles prior to and during the COVID-19 lockdowns between April and August 2020. BAME individuals faced exacerbated physical, psychological, social, and institutional barriers which are mapped onto the capability, opportunity, and motivation model of behaviour (COM-B). Twelve BAME participants were interviewed via Microsoft Teams using semi-structured interviews lasting 45 to 60 minutes. Using thematic analysis, we identified seven themes; the two primary ones were barriers and facilitators to being active and were successfully mapped onto the modified COM-B. Although existing literature has used the COM-B, these were primary quantitative findings that did not enable an in-depth exploration of BAME individuals lived experiences of physical activity participation during COVID-19. Thus, the COM-B model was modified to reflect this research’ qualitative approach, through which improved policies and implementation strategies may be applied specifically to BAME individuals.

AbstractPhysical activity (PA) is widely recognised as being integral to physical and mental wellbeing. The World Health Organisation recommends around 150–300 minutes of moderately intense PA per week for adults aged 18–64 years. Physical inactivity costs the UK £7.4 billion per year and is associated with one out of every six deaths that occur in the country. The review aims at exploring the barriers and facilitators to making healthy PA lifestyle choices among UK BAME adults during the COVID-19 pandemic. Database searches were conducted in CINAHL, AMED, Medline, SCOPUS, COCHRANE, EMBASE, and Web of Science. There are 53 records that were identified. After removing three duplicates, the titles and abstracts of 50 papers were screened. Of these, all but 50 studies were excluded after reviewing the title and abstracts, resulting in no studies eligible for inclusion. Data extraction using the JBI-QARI data extraction template was performed, followed by a narrative synthesis of the resulting data; however, no eligible studies were identified. This empty systematic review without meta-analysis, highlighted major research gaps and indicated the state of the evidence between 2019–2021. The review has, through the application of theoretical models (COM-B and TTM), highlighted themes that need to be addressed.

Orientation: Today, industries and academic institutions across different continents, including those in South Africa, compete for the same talent, which presents the most valuable asset of an organisation. The surge in talent rivalry means that employers need to adopt strategies to distinguish themselves from their rivals. Research purpose: The aim of this study was to develop a conceptual model to better understand how talent management (TM) creates value for higher education institutions. Motivation for the study: Talent management research is primarily built around an exclusive approach to TM, yet how it works in practice and is implemented, conceived and developed in higher education, remains unclear. Hence, this study is needed to understand how integrated TM fosters competitive advantage in higher education institutions. Research approach/design and method: A quantitative research method was, by means of a questionnaire. Primary data were collected from 265 academics across three universities in South Africa. The data were analysed using the Statistical Package for the Social Sciences and Analysis of Moment Structures. Main findings: The results revealed that integrated TM practices (i.e. talent attraction, development and retention) positively contributed to sustainable competitive advantage of higher education institutions. Practical/managerial implications: The study provides a better understanding of the role of integrated TM in improving competitive advantage. Also, the study will help shape the policy-making process on TM in higher education institutions. Contribution/value-add: This study adds value to TM literature by designing a conceptual model for higher education institutions to achieve sustainable competitive advantage.

The study focused on the extraction of free erythromycin from commercially manufactured tablets and the use of metal salts to synthesize erythromycin-metal complexes, specifically involving silver (Ag), nickel (Ni), cobalt (Co), and copper (Cu). The synthesis was confirmed through various methods, including elemental analysis, thermogravimetric analysis, Fourier-transform infrared (FTIR), and UV–visible spectroscopy. The microbiological investigation involved Salmonella typhi, Escherichia coli, Staphylococcus aureus, Bacillus cereus, Candida albicans, and Microsporum canis as test organisms. The NCCLS broth microdilution reference method was used to determine the minimum fungicidal concentration and minimum inhibitory concentration of the complexes. The synthesized complexes were highly effective against a variety of fungi and bacteria, with compound Ery-Cu having MIC as low as 1.56 mg/mL, Ery-Cu and Ery-Ni with MBCs of 6.25 mg/mL and Ery-Cu having MFC of 6.25 mg/mL. Dose-dependent inhibitory effects were found upon examination of the antimicrobial susceptibility of specific complexes (Cu, Ni, Co and Ag) at varying concentrations of 100, 50, 25 and 12.5 mm/mL. Antibiotic susceptibility testing revealed efficacy against the tested pathogens. The study suggests that the synthesis of erythromycin-metal complexes, coupled with their antibacterial effectiveness against a diverse spectrum of bacteria and fungi, as they showed promising inhibitory properties when tested against a range of test species (Bacillus cereus, Staphylococcus aureus, Escherichia coli, Salmonella typhi, Candida albicans, and Microsporum canis), could lead to the development of innovative antibacterial agents. Molecular docking simulations were used to examine the interactions between metal complexes with proteins filamentous temperature-sensitive protein Z and lanosterol 14α-demethylase. The study highlights the need for further exploration in pharmaceutical research.

BackgroundPreventing childhood obesity and associated comorbidities is often hampered by disproportionate disparity in healthcare provision in minority ethnic populations. This study contextualized factors influencing childhood obesity and related comorbidity from the perspectives and experiences of parents of ethnic minority populations.MethodsFollowing ethical approval, families (n = 180) from ethnic minority populations in the Northeast of England were contacted through flyers, community social groups and online forum. Of the 180 families contacted, 22 expressed interests, of whom 12 parents were eligible to participate in the study, and one family dropped out due to time constraints. Therefore 11 parents from ethnic minority communities living with at least one child with obesity were interviewed. Each family was separately visited at home and took part in a semi-structured interview based on the study’s qualitative, descriptive phenomenological design. Nine of the families had one child who was diagnosed with an obesity-related comorbidity (non-alcoholic fatty liver disease, musculoskeletal problems or respiratory disorder). Semi-structured interviews were standardized around parents’ perspective and experience on how their children were impacted by obesity and comorbidities, healthcare preventative interventions including lifestyle physical activity and nutrition, and views on tackling obesity impact on their lives. All interviews were analyzed using qualitative thematic analysis.ResultsParents’ perspectives revealed 11 themes centered around experience of living with a child with obesity, risks, and impact of obesity related Non-Communicable Diseases; and access to support, and barriers unique to minority ethnic groups. Parents revealed social disadvantages, fear of victimization by social services, perceptions on their cultural and religious traditions, and racial stigmatization related to their child’s weight. Parents reported closer bonding with their children to protect them from the untoward consequences of overweight, and little awareness of healthcare obesity prevention programs. Work pressure, lack of time, absence of guidance from professionals were seen as barriers to healthy lifestyle, while support from friends and closer family bond in adopting healthy lifestyle behaviors were facilitators. However, there was little awareness or access to current healthcare obesity preventive offerings.ConclusionMinority ethnic communities’ perspective on childhood obesity prevention does not match the healthcare system preventative offerings. Community and family-oriented obesity preventative approaches, especially lifestyle interventions are needed beyond those administered by the primary healthcare system.

Aim: Recent developments in cancer research indicate that cancer is a manifestation of immune system dysfunction. Many natural anticancer agents developed recently possess immune-modulatory properties. In our ongoing pursuit of anticancer alternatives, we evaluated the immune-modulatory potential of oligandrin, an ent-pimarane type diterpenoid from Croton oligatrus. Methods: we assessed on Breast cancer patients’ peripheral blood mononuclear cells (PBMCs) were isolated to assess the effect of oligandrin (0.5, 1, 10, 100, 200 mg/mL) in vitro using the Ficoll-histopaque density centrifugation method. The parameters that were assessed included, PBMC viability and cytokine (IL-6, IL-12, IL-10, EGF, TNF-α, INF-γ) production. In vivo, we chemically induced breast cancer using DMBA (50 mg/kg BW) in Wistar rats, then treated them with oligandrin (1 mg/kg BW) or standards (tamoxifen 3.3 mg/kg; letrozole 1 mg/kg) for 20 weeks. The parameters that were evaluated included, tumor burden, volume, incidence, histopathology, antioxidant, and inflammatory status. Results: Oligandrin (1, 10, 100 and 200 μg/mL) significantly increased (p

In low-resource settings like Nigeria, the rising prevalence of diabetes is accompanied by an excessive burden of microvascular complications from diabetes. This study aimed to determine the prevalence and predictors of microvascular complications among older patients with diabetes mellitus. Therefore, a 2-year retrospective cross-sectional study was carried out among elderly diabetes patients at the Chief Tony Anenih Geriatric Center outpatient diabetes clinic. A total of 148 diabetic patients were included in the study; the mean (± standard deviation) age was 70.89 (±6.99) years, with 71.6% of the studied population being female. Logistic regression analysis was employed to determine the prevalence and predictors of microvascular complications. Results show that the prevalence of microvascular complications in older diabetes patients was 73.9% [95% confidence interval (CI)=66.7-81.6] with peripheral neuropathy (77.1% prevalence, 95% CI=67.9-84.8) being the most common and retinopathy being the least prevalent (95% CI=4.7-16.8). The significant predictors of developing microvascular complications were intake of oral agents only [p=0.013, odds ratio (OR)=2.35, 95% CI=1.15-16.81], number of comorbidities (p=0.041, adjusted OR=5.28, 95% CI=1.09-27.93) and systolic blood pressure (p=0.042, OR=1.02, 95% CI=1.00-1.04). Considering the high prevalence of microvascular complications among aging patients with diabetes mellitus, older patients should comply with oral medications and undergo regular check-ups, and more advocacy should be undertaken to strengthen geriatric healthcare systems to mitigate comorbidities and reduce complications.

ABSTRACT The COVID-19 pandemic has highlighted the critical need for accurate and efficient diagnostic tools for detecting severe acute respiratory coronavirus 2 (SARS-CoV-2) infections. This study presents a comparison of two diagnostic tests: RT-PCR and antigen detection rapid diagnostic tests (Ag-RDTs). This study focused on their performance, variant specificity, and their clinical implications. A simultaneous testing of 268 samples was carried out for SARS-CoV-2 using RT-PCR and Ag-RDTs [flourescence immunoassay (FIA) and lateral flow immunoassay (LFIA)]. Viral load was quantified, and variant identification was performed using a PCR-based assay. The prevalence was found to be 30.2% using reverse transcription PCR (RT-PCR), 26.5% using FIA, and 25% using LFIA. When comparing the FIA and LFIA, the overall diagnostic performance was found to be 80.25% vs 76.54%, 96.79% vs 97.33%, 91.55% vs 90.51%, and 91.88% vs 92.56% for sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV), respectively. Both Ag-RDTs showed a strong agreement with RT-PCR (κ = 0.78–0.80). The overall accuracies of the FIA and LFIA were 92.41% and 92.13%, respectively. The FIA showed higher sensitivity (73.68%) and PPV (92.08%) than the LFIA (65.79% and 90.56%, respectively) in asymptomatic patients. At low Ct values ( 30. The diagnostic sensitivity of FIA compared to LFIA for detecting the Alpha variant was 78.85% vs. 69.23% and 72.22% vs. 83.33% for the Delta variant. Both Ag-RDTs had 100% sensitivity for detecting Omicron. Both Ag-RDTs performed well in patients with high viral loads and Omicron variant infections compared to those infected with Alpha and Delta variants. This study confirms the comparable performance of RT-PCR and Ag-RDTs, specifically FIA and LFIA, for SARS-CoV-2 detection. The FIA showed higher sensitivity and PPV in asymptomatic cases, while both Ag-RDTs exhibited strong agreement with RT-PCR results. Notably, Ag-RDTs, particularly FIA, proved effective in detecting the Omicron variant and cases with high viral loads, highlighting their potential clinical utility in managing the COVID-19 pandemic.IMPORTANCEThis study is of utmost importance in providing effective responses to manage the COVID-19 pandemic. It rigorously compares the diagnostic accuracy, variant specificity, and practical considerations of reverse transcription PCR (RT-PCR) and antigen detection rapid diagnostic tests (Ag-RDTs) for severe acute respiratory coronavirus 2 (SARS-CoV-2), answering critical questions. The results of this study will help healthcare professionals choose the appropriate testing methods, allocate resources effectively, and enhance public health strategies. Given the evolution of the virus, understanding the performance of these diagnostic tools is crucial to adapting to emerging variants. Additionally, the study provides insights into logistical challenges and accessibility issues, which will contribute to refining testing workflows, particularly in resource-limited settings. Ultimately, the study’s impact extends to global healthcare, providing valuable information for policymakers, clinicians, and public health officials as they work together for mitigating the impact of the pandemic.

The nuclear-localized ethylene-insensitive3/ethylene-insensitive3-like (EIN3/EIL) proteins regulate the ethylene signaling pathway for growth and stress responses. This study presents a genome-wide analysis of nine Oryza sativa EIN3/EIL genes, exhibiting three clads in an ML phylogenetic tree. These proteins are conserved in both exon-intron organization and motif architecture aligned with their phylogenetic clustering. The EIN3/EIL proteins harbor the EIN3, EIN3 superfamily, and RDV-p3 conserved domains. OsEIN3/EIL expression profiling revealed consistently high transcript levels of LOC_Os03g20790 and LOC_Os02g36510 in leaf blades across vegetative and reproductive stages and in the endosperm, indicating a potential role in growth and yield enhancement. Additionally, LOC_Os03g20790, LOC_Os02g36510, LOC_Os07g48630, and LOC_Os09g31400 are highly expressed at later stages of root development, showing potential in nutrient signaling for seed-filling. Moreover, elevated expression of LOC_Os04g38400, LOC_Os09g31400, LOC_Os03g20790, LOC_Os08g39830, and LOC_Os07g48630 were detected under mannitol treatment, while LOC_Os04g38400 and LOC_Os08g39830 were highly upregulated in root and leaf tissues under drought stress exposure. The EIN3/EIL genes also intricately interacted with MPK1, MPK5, and MYC genes, underscoring their potential involvement in growth and stress tolerance. Altogether, our findings lay a foundation for improved rice growth and yield enhancement.

Abstract The role of parathyroid hormone (PTH)-related protein (PTHrP) in breast cancer remains controversial, with reports of PTHrP inhibiting or promoting primary tumor growth in preclinical studies. Here, we provide insight into these conflicting findings by assessing the role of specific biological domains of PTHrP in tumor progression through stable expression of PTHrP (-36-139aa) or truncated forms with deletion of the nuclear localization sequence (NLS) alone or in combination with the C-terminus. Although the full-length PTHrP molecule (-36-139aa) did not alter tumorigenesis, PTHrP lacking the NLS alone accelerated primary tumor growth by downregulating p27, while PTHrP lacking the NLS and C-terminus repressed tumor growth through p27 induction driven by the tumor suppressor leukemia inhibitory factor receptor (LIFR). Induction of p27 by PTHrP lacking the NLS and C-terminus persisted in bone disseminated cells, but did not prevent metastatic outgrowth, in contrast to the primary tumor site. These data suggest that the PTHrP NLS functions as a tumor suppressor, while the PTHrP C-terminus may act as an oncogenic switch to promote tumor progression through differential regulation of p27 signaling.

Abstract Introduction The 2021 Canadian Cardiovascular Society (CCS) guidelines recommend intensive low-density lipoprotein cholesterol (LDL-C) reduction for patients with atherosclerotic cardiovascular disease (ASCVD). For patients above LDL-C threshold on maximally tolerated statins, adding ezetimibe and/or a proprotein convertase subtilisin/kexin type 9 inhibitor (PCSK9i) is recommended. This population-based, real-world study examined cardiovascular (CV) events in patients with ASCVD who are on statins and above current guideline threshold LDL-C levels. Methods Using administrative health data in Alberta, Canada, we identified patients with myocardial infarction (MI), ischemic stroke (IS), or peripheral artery disease with LDL-C > 1.8 mmol/L on statins between April 1, 2010 and March 31, 2016. Exploratory subgroups included very high-risk patients with ASCVD shown to derive the most benefit from PCSK9i intensification as identified by the CCS guidelines, including those with acute coronary syndrome (ACS) or recent MI. Frequencies and rates of individual and composite CV events (primary outcome: MI, IS, hospitalization for unstable angina, coronary revascularization, cardiovascular death; secondary outcome: MI, IS, CV death) were calculated over follow-up. Results The study included 32,984 patients with a mean (standard deviation) follow-up of 40.8 (21.0) months. Overall, 17.7% and 15.6% experienced a primary and secondary outcome, respectively, with rates of 5.58 and 4.83 per 100 patient-years, respectively. CV death and MI were the most common events. Subgroups with recurrent MI and comorbid diabetes exhibited higher CV event rates (23.6% and 22.2% had a primary outcome, respectively). Rates of CV events were notably high in patients with ACS or recent MI (49.4% and 54.0% had a primary outcome, respectively). Conclusion This real-world study confirms that statin-treated high-risk patients with ASCVD and above-threshold LDL-C levels have substantial incidence of recurrent CV events. These findings reinforce the opportunity for lipid-lowering therapy intensification in high-risk patients to levels below guideline-recommended threshold in order to reduce CV risk.

The qualities of a teacher are the essential factors that influence learners’ academic performance. Most of these qualities are acquired through retraining programmes. As a result of this, many in-service training programme have been on-going. This study was undertaken to ascertain the impact of SDGs retraining workshop on pedagogical competencies of primary school teachers. It is a descriptive survey design guided by four research questions. The population of the study consisted of 3,115 primary school teachers who participated in SDGs retraining workshops. Multistage sampling technique was used to select 360 teachers. The researchers developed a structured questionnaire titled primary school teachers’ pedagogical competence questionnaire (PSTPCQ, r=0.86). Mean and standard deviation were used to answer the research questions. The results of the data analysis revealed that the SDGs retraining workshops impacted basic science and technology teachers’ pedagogical competencies positively in areas of teaching methods, construction of instructional materials and assessment of learning outcomes but negatively on the out-of-class science teaching strategy. It was recommended among others that all primary school teachers should be given opportunity to attend the SDGs retraining workshop and that adequate fund should be made available for regular and consistent retraining programmes to ensure greater and effective instructional delivery of BST lessons.

Noroviruses (NoVs) are a leading cause of viral gastroenteritis. Despite global clinical relevance, our understanding of how host factors, such as antiviral cytokines interferons (IFNs), modulate NoV population dynamics is limited. Murine NoV (MNoV) is a tractable in vivo model for the study of host regulation of NoV. A persistent strain of MNoV, CR6, establishes a reservoir in intestinal tuft cells for chronic viral shedding in stool. However, the influence of host innate immunity and permissive cell numbers on viral population dynamics is an open question. We generated a pool of 20 different barcoded viruses (CR6BC) by inserting 6-nucleotide barcodes at the 3' position of the NS4 gene and used this pool as our viral inoculum for in vivo infections of different mouse lines. We found that over the course of persistent CR6 infection, shed virus was predominantly colon-derived, and viral barcode richness decreased over time irrespective of host immune status, suggesting that persistent infection involves a series of reinfection events. In mice lacking the IFN-λ receptor, intestinal barcode richness was enhanced, correlating with increased viral intestinal replication. IL-4 treatment, which increases tuft cell numbers, also increased barcode richness, indicating the abundance of permissive tuft cells to be a bottleneck during CR6 infection. In mice lacking type I IFN signaling (Ifnar1-/-) or all IFN signaling (Stat1-/-), barcode diversity at extraintestinal sites was dramatically increased, implicating different IFNs as critical bottlenecks at specific tissue sites. Of interest, extraintestinal barcodes were overlapping but distinct from intestinal barcodes, indicating that disseminated virus represents a distinct viral population than that replicating in the intestine. Barcoded viruses are a valuable tool to explore the influence of host factors on viral diversity in the context of establishment and maintenance of infection as well as dissemination and have provided important insights into how NoV infection proceeds in immunocompetent and immunocompromised hosts.

Background: Cardiac allograft vasculopathy (CAV) accounts for significant long-term morbidity and mortality in heart transplant recipients; limited data exist for donation after circulatory death (DCD). Intravascular ultrasound (IVUS) assessment is a gold standard for early diagnosis of CAV and has strong prognostic power. Methods: We evaluated all consecutive circulatory and brain death heart transplant recipients from January 2020 to March 2022. Patients were followed for need for percutaneous coronary intervention (PCI), development of severe allograft vasculopathy, or death. Among 143 heart transplant recipients, 39 received circulatory death and 104 received brain death hearts. Results: Baseline characteristics were similar between groups: median age (56.3 vs 53.7 years, p = 0.290), female sex (15% vs 26%, p = 0.265), and sirolimus use (69% vs 53%, p = 0.116). At 1 year, there were no significant differences in maximal intimal thickness (0.49 vs 0.46 mm, p = 0.861) or Stanford classification. During a median follow-up of 793 days [interquartile ranges 618, 1003], there was no difference in the unadjusted or adjusted primary composite outcome of death, PCI, or International Society of Heart and Lung Transplantation cardiac allograft vasculopathy maximal intimal thickness ≥0.6 mm (unadjusted hazard ratio (HR) 0.42, 95% confidence interval (CI): 0.05, 3.48, p = 0.42), event rate 9.6% vs 2.6%, p = 0.29, nor was there a difference in death, PCI or severe IVUS disease (HR 1.44, 95% CI 0.81, 2.56, p = 0.21). Conclusion: In DCD heart transplant recipients, circulatory death donors did not have a significantly higher risk for coronary allograft vasculopathy by IVUS or related complications at 1 year following transplantation.

IntroductionDepending on the microenvironment, γδ T cells may assume characteristics similar to those of Th1, Th2, Th17, regulatory T cells or antigen presenting cells. Despite the wide documentation of the effect of Th1/Th2 balance on pregnancy associated malaria and outcomes, there are no reports on the relationship between γδ T cell phenotype change and Placental Malaria (PM) with pregnancy outcomes. This study sought to investigate the involvement of γδ T cells and its subsets in placental Plasmodium falciparum malaria.MethodsIn a case-control study conducted in Yaoundé, Cameroon from March 2022 to May 2023, peripheral, placental and cord blood samples were collected from 50 women at delivery (29 PM negative: PM- and 21 PM positive: PM+; as diagnosed by light microscopy). Hemoglobin levels were measured using hemoglobinometer. PBMCs, IVBMCs and CBMCs were isolated using histopaque-1077 and used to characterize total γδ T cell populations and subsets (Vδ1+, Vδ2+, Vδ1-Vδ2-) by flow cytometry.ResultsPlacental Plasmodium falciparum infection was associated with significant increase in the frequency of total γδ T cells in IVBMC and of the Vδ1+ subset in PBMC and IVBMC, but decreased frequency of the Vδ2+ subset in PBMC and IVBMC. The expression of the activation marker: HLA-DR, and the exhaustion markers (PD1 and TIM3) within total γδ T cells and subsets were significantly up-regulated in PM+ compared to PM- group. The frequency of total γδ T cells in IVBMC, TIM-3 expression within total γδ T cells and subsets in IVBMC, as well as HLA-DR expression within total γδ T cells and Vδ2+ subset in IVBMC were negatively associated with maternal hemoglobin levels. Furthermore, the frequency of total γδ T cells in PBMC and PD1 expression within the Vδ2+ subset in CBMC were negatively associated with birth weight contrary to the frequency of Vδ1-Vδ2- subset in PBMC and HLA-DR expression within the Vδ2+ subset in IVBMC which positively associated with maternal hemoglobin level and birth weight, respectively.ConclusionThe data indicate up-regulation of activated and exhausted γδ T cells in Plasmodium falciparum placental malaria, with effects on pregnancy outcomes including maternal hemoglobin level and birth weight.

Background: : Pangdahai (matured, ripened, and dried seeds of Scaphium affine (Mast.) Pierre) is widely used in managing several diseases in countries like China, Vietnam, Japan, and India. This study evaluated the anti-inflammatory effects of the crude extracts (ethanol and aqueous) and isolated compounds of Pangdahai. Methods: : Xylene-induced ear edema in mice, carrageenan-induced paw edema in rats, and nitric oxide (NO) assay were used to evaluate and screen the crude extracts and isolated compounds from the ethanolic extracts of Pangdahai. TNF-α and IL-1β levels in the tissues of rat foot and ear were determined by ELISA. The cytotoxicity of the isolated compounds was also determined by MTT assay. Molecular docking studies using targets involved in the inflammatory process were also used to further evaluate the compounds. Results: : Both aqueous and ethanol extracts demonstrated significant anti-inflammatory effect and markedly attenuated vascular permeability in mice induced by acetic acid in a dose-independent manner. The ethanol extract also significantly inhibited levels of IL-1β and TNF-α. Four (4) compounds exhibited significant inhibitory effects on NO release without cytotoxicity on RAW 264.7 macrophage. These compounds also showed good binding affinities for COX-2, PLA2, IRAK-4 and NIK. Conclusions: This study validates, provides scientific evidence and justification for the use of the aqueous decoctions of Pangdahai in pharyngitis traditionally. (+) – Pinoresinol, tiliroside, Z-caffeic acid, and 3,4-dihydroxybenzoic acid (protocatechuic acid) isolated from Pangdahai showed anti-inflammatory activities, which might be responsible for the actions of Pangdahai. Tiliroside showed high binding affinity comparable to the native ligands of inflammatory mediators.

In the extensive literature, farmers' credit access in SSA has been examined, albeit with limited evidence derived from health-related shocks (e.g. pandemics). While the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) ''COVID-19″pandemic has exacerbated rural communities' economic downturn and financial challenges, there is still scant evidence on how this lethargy shaped farmers' credit access. Through 105 semi-structured household interviews and 10 key informant interviews in the Kwahu Afram Plains South District of Ghana, this research explores the variations and determinants of agricultural credit access in rural communities before and during the COVID-19 pandemic, using Analysis of Variance ''ANOVA'' and logistic regression. The findings revealed that while marital status, organizational membership and the size of household labour accounted for significant variations in agricultural credit access before the pandemic, variations during the pandemic were explained by income status, gender, and household labour. Furthermore, shifts in the determinants of agricultural credit access during the pandemic were reported as household labour size, marital status, and the interaction of motorbike ownership and organizational membership, which played crucial roles in predicting the likelihood of credit access before the pandemic. Conversely, during the pandemic, gender, savings, household labour size and livestock ownership significantly determined agricultural credit access in rural communities. Based on these empirical insights, the paper advocates that savings should be encouraged and social capital should be strengthened as pandemic resilience mechanisms. At the same time, policies and programs to improve agricultural credit access during health-related shocks should target vulnerable groups. This study contributes to the theoretical debate on rural farmers' credit access determinants, emphasizing the COVID-19 pandemic as a health shock.

BackgroundRates of sleep disturbance among survivors of cancer are more than 3 times higher than the general population. Causes of sleep disturbance among survivors are many and multifaceted, including anxiety and fear related to cancer diagnosis and treatments. Cognitive behavioral therapy for insomnia (CBT-I) is considered a first-line treatment for insomnia; However, a lack of access to trained professionals and limited insurance coverage for CBT-I services has limited patient access to these effective treatments. Evidence supports digital delivery of CBT-I (dCBT-I), but there is only limited evidence to support its use among survivors of cancer. Broad adoption of smartphone technology provides a new channel to deliver dCBT-I, but no prior studies have evaluated mobile dCBT-I interventions for survivors. To address the need for accessible and efficacious CBT-I for survivors of cancer, the Mi Sleep Coach program was developed to adapt CBT-I for delivery to survivors of cancer as a self-directed mobile health app. ObjectiveThis single-arm feasibility study assessed the adherence, attrition, usefulness, and satisfaction of the Mi Sleep Coach app for insomnia. MethodsA 7-week, single-arm study was conducted, enrolling adult survivors of breast, prostate, or colon cancer reporting sleep disturbances. ResultsIn total, 30 participants were enrolled, with 100% completing the study and providing data through week 7. Further, 9 out of 10 app features were found to be useful by 80% (n=24) to 93% (n=28) of the 30 participants. Furthermore, 27 (90%) participants were satisfied with the Mi Sleep Coach app and 28 (93%) would recommend the use of the Mi Sleep Coach app for those with insomnia. The Insomnia Severity Index showed a decrease from baseline (18.5, SD 4.6) to week 7 (10.4, SD 4.2) of 8.1 (P

Aims: This study presents a protocol for the Pharmacy Integrated Community Care (PICC) program, meticulously designed to enhance Hemoglobin A1c (HbA1c) levels and augment knowledge about diabetes mellitus (DM) among individuals diagnosed with Type 2 Diabetes Mellitus (T2DM) in the Sarawak State of Malaysia. Methods: From 1 May to December 31, 2023, a prospective, multicenter, parallel-design randomised controlled trial will be conducted with two groups, each consisting of 47 participants. The intervention group will receive a structured, four-session group-based program guided by experienced pharmacists, focusing on medication adherence and diabetes management. The control group will follow the standard Diabetes Mellitus Adherence Clinic program. The primary outcomes of this study encompass enhancements in knowledge regarding diabetes medication management and adherence, followed by subsequent changes in HbA1c levels. Conclusions: The successful implementation of the PICC program holds promise for enhancing health outcomes in the T2DM population, potentially leading to more effective diabetes management initiatives and better health practices in the community. Trial registration clinicaltrials.gov identifier: NCT05106231.

Background Micronutrient deficiencies result from multiple factors, including inadequate intake of micronutrients (vitamins and minerals) from nutrient-rich diverse diets. Point-of-use fortification with a nutritional supplement powder is recommended to address micronutrient deficiencies and anemia among infants and young children (6-23 months), particularly, in low-income countries. In Ghana, about a quarter of children aged 6-59 months are anemic, or deficient in iron and vitamin A. World Vision Ghana (WVG) implemented the integrated Improved Feeding Practices (IFP) project between 2020 and 2023 in three districts in Ghana to improve diet quality and practices of women of reproductive age, and young children below age two years. One component of the project involved the distribution of a nutritional supplement powder (KOKO Plus). This is the second in a series of four papers that document the implementation and outcomes of the IFP project; the other papers are published in this journal. The current paper assessed the availability, acceptability, and utilization of KOKO Plus to households who participated in the IFP project as well as lessons learned from implementing the intervention. Methods A mixed-methods design was used, triangulating primary and secondary data. Secondary data originated from review of IFP project documents, including project mid-year and annual reports, and implementation plans across the three interdependent components of the IFP project. Primary data were obtained from interviews in six purposively selected communities. Key informants included WVG staff, community volunteers, and local government agency staff from health and agriculture sector agencies, and beneficiaries of the intervention. Interview respondents answered questions on the project’s mechanism for KOKO Plus distribution, participant experiences of purchasing and using KOKO Plus, perceived benefits of using KOKO Plus, and lessons learned about KOKO Plus from the IFP project. Beneficiaries also provided information on their perceptions of KOKO Plus acceptability and adverse outcomes. Results The project distributed KOKO Plus free of charge to almost 14,000 (13,942) children, more than its target (4,900). In addition, Village-Based Entrepreneurs (VBE) sold 192,092 sachets of KOKO Plus in the project communities. The KOKO Plus value chain involved WVG purchasing the KOKO Plus from the Ghanaian manufacturer and supplying it to VBE’s either in their respective communities, or at distribution centers in their respective WVG district office. KOKO Plus promotion and marketing was led by trained VBE’s, VBE supervisors, and Community Based Organizations across multiple settings (homes, child welfare clinics, markets, community durbars, and religious gatherings). There was high acceptability of KOKO Plus. Mothers attributed their acceptance of KOKO Plus to its potential health and nutrition benefits for children. They also attributed increased child weight, and less frequent illness, to feeding meals that included KOKO Plus to their young children. KOKO Plus was added to the diverse local meals fed to young children. Diarrhea was the only mentioned adverse report, albeit rarely. At the end of the IFP project, WVG established a fund to ensure sustainable distribution of KOKO Plus in the project communities. Conclusions The IFP project established a KOKO Plus value chain, increasing availability, accessibility, acceptability, and utilization of KOKO Plus in the project communities. VBE’s successfully distributed KOKO Plus with support from community volunteers, and health care workers. This approach to KOKO Plus distribution is feasible and sustainable and is recommended for similar contexts.

Abstract Background and Aims Improving the sexual and reproductive health of adolescents remains a public health priority. Effective communication between parents and adolescents regarding sexual health and relationships is important and could influence adolescents to adopt safer sexual behaviors. However, several barriers can impede this communication in the UK population. The aim of the review is to explore barriers and facilitators, as well as wider determinants of parent–adolescent communication (PAC) on sexual health and relationships. The review will explore possible interventions aimed at promoting PAC on sexual health and relationships. Methods The review will focus on exploring barriers and facilitators of PAC on sexual health and relationships in the United Kingdom. This study will synthesize qualitative literature to understand the significance of parent–adolescent sexual and reproductive health communication, the challenges and facilitators to effective communication in the United Kingdom. Using a detailed predetermined search strategy, the study will search for relevant studies from CINAHL, MEDLINE, PsycINFO, EMBASE, SCOPUS, Web of Science, and gray literature on Google Scholar. The Critical Appraisal Skills Program checklist will appraise the included studies' methodological quality. A thematic synthesis approach will be used to synthesize data from included studies. Conclusion Findings from the systematic review are expected to give information on the barriers and facilitators of PAC on sexual health and relationships which will further optimize interventions to improve this type of communication and guide future research in understanding this area. Systematic review registration The review has been registered with the International Prospective Register of Systematic Reviews CRD (PROSPERO) (CRD42022351697).

Abstract Background Obtaining information on implementation strategy costs and local budget impacts from multiple perspectives is essential to data-driven decision-making about resource allocation for successful evidence-based intervention delivery. This mixed methods study determines the costs and priorities of deploying Enhanced Replicating Effective Programs (REP) to implement the Michigan Model for Health™, a universal school-based prevention intervention, from key shareholder perspectives. Methods Our study included teachers in 8 high schools across 3 Michigan counties as part of a pilot cluster randomized trial. We used activity-based costing, mapping key Enhanced REP activities across implementation phases. We included multiple perspectives, including state agencies, regional education service agencies, lead organization, and implementers. We also conducted a budget impact analysis (BIA, assessing the potential financial impact of adopting Enhanced REP) and a scenario analysis to estimate replication and account for cost variability. We used an experimental embedded mixed methods approach, conducting semi-structured interviews and collecting field notes during the trial to expand and explain the cost data and the implications of costs across relevant perspectives. Results Based on trial results, we estimate costs for deploying Enhanced REP are $11,903/school, with an estimated range between $8263/school and $15,201/school. We estimate that adding four additional schools, consistent with the pilot, would cost $8659/school. Qualitative results indicated misalignment in school and teacher priorities in some cases. Implementation activities, including training and implementation facilitation with the health coordinator, were sometimes in addition to regular teaching responsibilities. The extent to which this occurred was partly due to leadership priorities (e.g., sticking to the district PD schedule) and organizational priorities (e.g., budget). Conclusions Previous research findings indicate that, from a societal perspective, universal prevention is an excellent return on investment. However, notable misalignment in cost burden and priorities exists across shareholder groups. Our results indicate significant personal time costs by teachers when engaging in implementation strategy activities that impose an opportunity cost. Additional strategies are needed to improve the alignment of costs and benefits to enhance the success and sustainability of implementation. We focus on those perspectives informed by the analysis and discuss opportunities to expand a multi-level focus and create greater alignment across perspectives. Trial registration ClinicalTrials.gov NCT04752189. Registered on 12 February 2021.

Abstract An effective HIV-1 vaccine remains a critical unmet need for ending the AIDS epidemic. Vaccine trials conducted to date have suggested the need to increase the durability and functionality of vaccine-elicited antibodies to improve efficacy. We hypothesized that a conjugate vaccine based on the learned response to immunization with hepatitis B virus could be utilized to expand T cell help and improve antibody production against HIV-1. To test this, we developed an innovative conjugate vaccine regimen that used a modified vaccinia virus Ankara (MVA) co-expressing HIV-1 envelope (Env) and the hepatitis B virus surface antigen (HBsAg) as a prime, followed by two Env–HBsAg conjugate protein boosts. We compared the immunogenicity of this conjugate regimen to matched HIV-1 Env-only vaccines in two groups of 5 juvenile rhesus macaques previously immunized with hepatitis B vaccines in infancy. We found expansion of both HIV-1 and HBsAg-specific circulating T follicular helper cells and elevated serum levels of CXCL13, a marker for germinal center activity, after boosting with HBsAg–Env conjugate antigens in comparison to Env alone. The conjugate vaccine elicited higher levels of antibodies binding to select HIV Env antigens, but we did not observe significant improvement in antibody functionality, durability, maturation, or B cell clonal expansion. These data suggests that conjugate vaccination can engage both HIV-1 Env and HBsAg specific T cell help and modify antibody responses at early time points, but more research is needed to understand how to leverage this strategy to improve the durability and efficacy of next-generation HIV vaccines.

Abstract Background Medication reconciliation is an evidence-based practice that reduces medication-related harm to patients. This study evaluated the effect of educational intervention on medication reconciliation practice of pharmacists among ambulatory diabetes and hypertensive patients. Methods A non-randomized clinical trial on medication reconciliation practice was carried out among 85 and 61 pharmacists at the intervention site and control site, respectively. Medication reconciliation was carried out among 334 (intervention-183; control-151) diabetes and/or hypertensive patients by the principal investigator to indirectly evaluate pharmacists’ baseline medication reconciliation practice at both sites. A general educational intervention was carried out among intervention pharmacists. Medication reconciliation was carried out by the principal investigator among another cohort of 96 (intervention-46; control-50) and 90 (intervention-44; control-46) patients at three and six months postintervention, respectively, to indirectly assess pharmacists’ postintervention medication reconciliation practice. Thereafter, a focused educational intervention was carried out among 15 of the intervention pharmacists. Three experts in clinical pharmacy analysed the medication reconciliation form filled by the 15 pharmacists after carrying out medication reconciliation on another cohort of 140 patients, after the focused intervention. Data was summarized with descriptive (frequency, percentage, mean ± standard deviation) and inferential (Pearson product-moment correlations analysis, independent-samples t-test and one-way ANOVA) statistics with level of significance set at p

Melioidosis, caused by the environmental gram-negative bacterium Burkholderia pseudomallei, usually develops in adults with predisposing conditions and in Australia more commonly occurs during the monsoonal wet season. We report an outbreak of 7 cases of melioidosis in immunocompetent children in Australia. All the children had participated in a single-day sporting event during the dry season in a tropical region of Australia, and all had limited cutaneous disease. All case-patients had an adverse reaction to oral trimethoprim/sulfamethoxazole treatment, necessitating its discontinuation. We describe the clinical features, environmental sampling, genomic epidemiologic investigation, and public health response to the outbreak. Management of this outbreak shows the potential benefits of making melioidosis a notifiable disease. The approach used could also be used as a framework for similar outbreaks in the future.