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ABSTRACTBackground Cardiovascular diseases (CVDs) are on the rise in Sub-Saharan Africa. The management of these CVDs comes at an exorbitant cost to both individuals and health institutions. However, data on the economic impact of the most common CVDs in Ghana are lacking. Our objective was to describe the in-patient cost and outcomes of acute CVD admissions in a leading teaching hospital in Ghana.Methods We retrospectively reviewed hospital admissions, cost of hospitalization, length of stay, and CVD outcomes following admissions between January 2018 and December 2019.Results A total of 1975 patients with a mean age of 62.2 (±16.1) years were admitted over the study period of which 52.6% were males.The top 3 most prevalent CVDs among admitted patients were stroke(48.5%), hypertensive urgencies/emergencies(42.7%), and heart failure(29.4%). The overall case fatality rate (CFR) was 21.5% (95% CI: 19.7%−23.3%). The CFR for stroke, hypertensive urgencies/emergencies, and heart failure were 28.9%, 17.6%, and 14.1%, respectively. Median (IQR) length of stay and cost of treatment across all CVDs was 5(3–9) days and USD $195.29(137.9–288.9), respectively. The highest median cost for admission was for stroke (USD $211.19).Conclusion The average cost of CVD hospitalization is over a hundred times the daily minimum wage of the average Ghanaian. A greater emphasis on primordial and primary prevention is warranted to curtail the economic burden of CVDs in developing economies such as Ghana.

Tuberculosis which is mainly caused by Mycobacterium tuberculosis remains of public health importance due to the resistance of the causative pathogen to the present antibiotics used as treatment options. This resistance has led to the need for the discovery of new treatment options. Herein, the isolation, geometrical optimization, spectroscopic NMR and FT-IR analysis, a study of weak interactions, electronic properties, and the in-silico biological activity of 3,3′-di-O-methyl ellagic acid (DMA) were determined. In addition, the effect of solvent on the kinetic stability, reactivity, and other electronic properties of DMA was determined in three solvents; DMSO, methanol, and water. Also, the biological activity potential and the drug-likeness of DMA were determined using molecular docking protocol and ADMET studies. The studied compound was isolated using column and thin-layer chromatography techniques while characterization was done using spectroscopic techniques. Key vibrations in the compound are C = O vibrations, C = C vibrations, C-H vibrations, –CH3 vibrations, and O-H vibrations. A study of quantum descriptors revealed that DMA is more reactive in water with an energy gap of −3.162 eV and those in three solvents are −3.163, −3.944, and −4.3022 eV in methane, gas, and water respectively. The compound shows great optical potentials with dipole moments of 3.2415D, 5.221D, 5.2015D, and 4.469D in water, DMSO, methanol, and Gas-phase respectively which are greater than that of urea used in the comparison. The QTAIM analysis based on the bond ellipticity

Lymphoma, a type of cancer that affects the lymphatic system—an essential element of the body's immune defense—has captured increased interest from modern researchers. This study, investigate the possible antilymphoma characteristics of benzo bisthiazole using both experimental and theoretical investigations at DFT/B3LYP-GD3BJ/6–311++G(d, p) level of theory. This study aims to provide a comprehensive understanding of the electronic and spectroscopic behavior of benzo[1,2_d:4,5] bisthiazole (BBT), given the diverse range of applications for thiazole derivatives. We investigate the impact of solvation on BBT's molecular structure, spectral characteristics, quantum chemical properties, vibrational modes, electronic features, and its interaction through molecular docking. Our findings reveal intriguing insights into BBT's reactivity, highlighting its enhanced reactivity in benzene with an energy gap of 4.6406 eV, while demonstrating greater stability in water with an energy gap of 4.6490 eV. Notably, the analysis of high-energy transitions reveals prevalent n-π* transitions, while some transitions, though absent in UV spectra due to their low oscillator strength, are also identified. The dominant transitions, constituting around 74.85 to 75.57% contribution, are characterized across various solvents, emphasizing their significance. Impressively, molecular docking underscores BBT's potential bioactivity against lymphoma, with a docking score of -6.3 kcal/mol. Moreover, the interaction analysis with 6TOF-BBT reveals favorable hydrogen bonding with essential amino acids, histidine (HIS: 116), and glycine (GLY:55), along the polypeptide chain A of the receptor. These hydrogen bonds are notably well-structured at bond distances of 2.75 Å and 2.99 Å, respectively, further elucidating BBT's unique interaction mechanisms.

Abstract Background Sub-valvular aortic stenosis is a rare disorder that has a prevalence of 6.5% of all adult congenital heart diseases. The hemodynamic changes that occur in pregnancy with the resultant increase in cardiac output may not well be tolerated by a pregnant woman with sub-valvular aortic stenosis. Case presentation We report the case of a 34-year-old para 7 (6 alive + 1 dead) who has been experiencing intermittent episodes of easy fatigability on moderate exertion since childhood and had survived 6 prior pregnancies. During her last pregnancy, she started experiencing chest pain, palpitations, dyspnea, orthopnea, and pre-syncope at 36 weeks and had a caesarean section at 37 weeks on account of fetal distress. The post-delivery cardiac evaluation showed severe sub-valvular Aortic stenosis and a ventricular septal defect. Conclusion Sub-valvular Aortic stenosis may progress slowly in adults and may be tolerated during pregnancy. Despite the rare presentation and contraindication of pregnancy in such a patient, she extraordinarily survived the pregnancy with a healthy baby. Routine cardiovascular assessment during prenatal, ante-natal and post-natal care is highly advocated particularly so in resource-poor settings.

IntroductionUne collaboration efficace et soutenue entre cliniciens et professionnels en santé publique peut améliorer la santé des individus et la santé de la population. Le concept de santé publique clinique favorise cette collaboration entre médecine clinique et santé publique et permet de relever des défis complexes en matière de santé.Dans ce commentaire, nous décrivons le concept de santé publique clinique, les types de problèmes complexes qui nécessitent une collaboration entre les professionnels responsables de la santé des individus et ceux responsables de la santé de la population, de même que les obstacles à la santé publique clinique et les applications de la santé publique clinique qui ont émergé pendant la pandémie de COVID-19. ArgumentaireIl existe une complémentarité entre la médecine clinique, qui est axée sur la santé des individus, et la santé publique, qui est axée sur la promotion et la protection de la santé des populations. Une collaboration entre ces deux disciplines est nécessaire pour résoudre les problèmes de santé complexes. Pour ce faire, toutefois, il convient de s’attaquer aux obstacles relatifs aux disciplines, ainsi qu’aux obstacles culturels et financiers qui empêchent une collaboration accrue et durable en la matière. Les succès récents, particulièrement durant la pandémie de COVID-19, constituent un modèle de collaboration de ce type entre cliniciens et praticiens en santé publique. ConclusionUne approche en matière de santé publique qui favorise une collaboration permanente entre cliniciens et professionnels en santé publique pour lutter contre des menaces sanitaires complexes aura plus d’impact que la somme de ses parties.

IntroductionEffective, sustained collaboration between clinical and public health professionals can lead to improved individual and population health. The concept of clinical public health promotes collaboration between clinical medicine and public health to address complex, real­world health challenges.In this commentary, we describe the concept of clinical public health, the types of complex problems that require collaboration between individual and population health, and the barriers towards and applications of clinical public health that have become evident during the COVID­19 pandemic. RationaleThe focus of clinical medicine on the health of individuals and the aims of public health to promote and protect the health of populations are complementary. Interdisciplinary collaborations at both levels of health interventions are needed to address complex health problems. However, there is a need to address the disciplinary, cultural and financial barriers to achieving greater and sustained collaboration. Recent successes, particularly during the COVID­19 pandemic, provide a model for such collaboration between clinicians and public health practitioners ConclusionA public health approach that fosters ongoing collaboration between clinical and public health professionals in the face of complex health threats will have greater impact than the sum of the parts.

Inherited mutations in MUTYH have been shown to predispose patients to colorectal cancers. Here, the authors show that MUTYH mutations lead to an increased somatic base substitution mutation rate in normal intestinal epithelial cells, which is the likely cause for the increased cancer risk.

Helmet Mounted Displays (HMDs), such as in Virtual Reality (VR), Augmented Reality (AR), Mixed reality (MR), and Smart Glasses have the potential to revolutionize the way we live our private and professional lives, as in communicating, working, teaching and learning, shopping and getting entertained. Such HMD devices have to satisfy draconian requirements in weight, size, form factor, power, compute, wireless communication and of course display, imaging and sensing performances. We review in this paper the various optical technologies and architectures that have been developed in the past 10 years to provide adequate solutions for the drastic requirements of consumer HMDs, a market that has yet to become mature in the next years, unlike the existing enterprise and defense markets that have already adopted VR and AR headsets as practical tools to improve greatly effectiveness and productivity. We focus specifically our attention on the optical combiner element, a crucial element in Optical See-Through (OST) HMDs that combines the see-through scene with a world locked digital image. As for the technological platform, we chose optical waveguide combiners, although there is also a considerable effort today dedicated to free-space combiners. Flat and thin optics as in micro-optics, holographics, diffractives, metasurfaces and other nanostructured optical elements are key building blocks to achieve the target form factor.

It is unclear whether somatic mutation rates are elevated in Lynch Syndrome (LS), which is the most common cause of hereditary colorectal cancer. Here, the authors use whole-genome sequencing and organoid cultures to show that normal tissues in LS patients are genomically stable, while ancestor cells of neoplastic tissues undergo multiple cycles of clonal evolution.

Parathyroid adenomas weighing more than 3.5 g are reported variously as “atypical”, “large” or “giant” parathyroid adenomas. All such adenomas are rare variants accounting for no more than 1.5% of all parathyroid adenomas. Large parathyroid adenomas are often associated with more severe form of the disease, including osteitis fibrosa cystica (OFC) and share many biochemical, histological, and molecular features of both benign and malignant parathyroid neoplasms, and are considered a distinct clinical entity. However, the pathogenesis of oversized parathyroid adenomas and the often-associated skeletal phenotype remains unclear. We present 5 cases of primary hyperparathyroidism (PHPT) with OFC, an uncommon manifestation of contemporary PHPT, associated with larger parathyroid adenomas, seen in the Bone and Mineral Disorders Clinic of the Henry Ford Health in the last 30 years to illustrate the critical role of vitamin D nutrition in the pathogenesis of both the OFC and adenoma size. The estimated prevalence of OFC was very low 0.2%, 5 of the >3000 surgically confirmed cases of PHPT seen during this time. The mean ± SD values were: age: 36.8 ± 22.1 years (4 of the 5 10 years of follow-up. Because OFC is a very rare in the West, but very common areas of endemic vitamin D deficiency, we also examined the relationship between vitamin D nutrition, as assessed by serum 25-hydroxyvitamin D level, and parathyroid adenoma weight as well as prevalence of OFC in two large secularly diverse cohorts of patients with PHPT (Detroit, USA and Chandigarh, India). Based on this relationship and the relative prevalence of OFC in these two large cohorts, we propose that vitamin D nutrition (and perhaps calcium nutrition) best explains both the adenoma size and prevalence of OFC.

Exotic tephritid incursions are of high concern to Australia’s biosecurity and its horticultural industries. It is vital that Australia remains ready to respond to incursions as they arise, as an incursion of tephritid fruit fly species will result in significant economic losses. In this review, we compared Australian incursion management strategies for fruit flies with global management strategies and identified possible areas where improvements could be made in an Australian context. Overall, Australia has a good understanding of the main tephritid threats, of which Bactrocera species from across the Torres Strait (northern Australia) are of most concern. Effective tools for tephritid detection and early warning surveillance at points of entry are in place at ports and in horticultural areas Australia-wide and provide the basis for initiating biosecurity responses in the event of an incursion. Area-wide control measures used in successful eradication attempts globally are available for use in Australia. However, a specific tephritid emergency response plan identifying suitable response measures and control options for species of concern is not yet available. We have identified that Australia has the policies and management tools available to respond to an exotic tephritid incursion, but the speed at which this could be accomplished would be greatly improved by the development of species-specific emergency response plans.

We are pleased that our paper on clinical public health1 received support from Dr. Shah, who also provides important historical aspects of clinical public health. Dr. Shah was the inaugural director of a newly created residency program (Community Medicine, now known as Public Health and Preventive Medicine) at the University of Toronto in 1976. Although he claims to have failed to “bring clinicians and public health professionals together to define the common elements and synergy needed,”2 we believe he did not fail, because his efforts ignited sparks among his students (including several co-authors of this paper1). Building on his important legacy, subsequent generations of clinicians and public health professionals have made strides towards effective collaboration of clinical medicine and public health.

Nous sommes heureux que notre article sur la santé publique clinique1 ait reçu l’appui du Dr Shah2, qui mentionne également des éléments historiques importants au sujet de la santé publique clinique. Le Dr Shah a été le premier directeur d’un nouveau programme de résidence lancé en 1976 à l’Université de Toronto, soit le programme de résidence en médecine communautaire, qui porte maintenant le nom de programme de résidence en santé publique et en médecine préventive. Même s’il prétend ne pas avoir « su rassembler les cliniciens et les professionnels de la santé publique pour définir les éléments communs et les synergies nécessaires »2, nous sommes d’avis qu’il n’a pas échoué, car ses efforts ont inspiré ses étudiants (dont plusieurs ont corédigé l’article en question1). Tirant parti de son héritage important, les générations suivantes de cliniciens et de professionnels en santé publique ont fait des avancées sur le plan d’une collaboration efficace entre médecine clinique et santé publique.

Abstract Background This study aimed to reduce the total waiting time for high-end health screening processes. Method The subjects of this study were recruited from a health screening center in a tertiary hospital in northern Taiwan from September 2016 to February 2017, where a total of 2342 high-end customers participated. Three policies were adopted for the simulation. Results The first policy presented a predetermined proportion of customer types, in which the total waiting time was increased from 72.29 to 83.04 mins. The second policy was based on increased bottleneck resources, which provided significant improvement, decreasing the total waiting time from 72.29 to 28.39 mins. However, this policy also dramatically increased the cost while lowering the utilization of this health screening center. The third policy was adjusting customer arrival times, which significantly reduced the waiting time—with the total waiting time reduced from 72.29 to 55.02 mins. Although the waiting time of this policy was slightly longer than that of the second policy, the additional cost was much lower. Conclusions Scheduled arrival intervals could help reduce customer waiting time in the health screening department based on the “first in, first out” rule. The simulation model of this study could be utilized, and the parameters could be modified to comply with different health screening centers to improve processes and service quality.

McKitrick et al engineer and characterize a novel lamprey antibody that recognizes terminal sulfated galactose epitopes on mammalian glycoproteins. This provides a new tool for the exploration of glycoprotein sulfation in mammalian cells, which could aid in the understanding of its functional role and potentially lead to identification of disease biomarkers.

BackgroundThe Surveillance Outbreak Response Management and Analysis System (SORMAS) contains a management module to support countries in their epidemic response. It consists of the documentation, linkage, and follow-up of cases, contacts, and events. To allow SORMAS users to visualize data, compute essential surveillance indicators, and estimate epidemiological parameters from such network data in real-time, we developed the SORMAS Statistics (SORMAS-Stats) application. ObjectiveThis study aims to describe the essential visualizations, surveillance indicators, and epidemiological parameters implemented in the SORMAS-Stats application and illustrate the application of SORMAS-Stats in response to the COVID-19 outbreak. MethodsBased on findings from a rapid review and SORMAS user requests, we included the following visualization and estimation of parameters in SORMAS-Stats: transmission network diagram, serial interval (SI), time-varying reproduction number R(t), dispersion parameter k, and additional surveillance indicators presented in graphs and tables. We estimated SI by fitting lognormal, gamma, and Weibull distributions to the observed distribution of the number of days between symptom onset dates of infector-infectee pairs. We estimated k by fitting a negative binomial distribution to the observed number of infectees per infector. Furthermore, we applied the Markov Chain Monte Carlo approach and estimated R(t) using the incidence data and the observed SI computed from the transmission network data. ResultsUsing COVID-19 contact-tracing data of confirmed cases reported between July 31 and October 29, 2021, in the Bourgogne-Franche-Comté region of France, we constructed a network diagram containing 63,570 nodes. The network comprises 1.75% (1115/63,570) events, 19.59% (12,452/63,570) case persons, and 78.66% (50,003/63,570) exposed persons, including 1238 infector-infectee pairs and 3860 transmission chains with 24.69% (953/3860) having events as the index infector. The distribution with the best fit to the observed SI data was a lognormal distribution with a mean of 4.30 (95% CI 4.09-4.51) days. We estimated a dispersion parameter k of 21.11 (95% CI 7.57-34.66) and an effective reproduction number R of 0.9 (95% CI 0.58-0.60). The weekly estimated R(t) values ranged from 0.80 to 1.61. ConclusionsWe provide an application for real-time estimation of epidemiological parameters, which is essential for informing outbreak response strategies. The estimates are commensurate with findings from previous studies. The SORMAS-Stats application could greatly assist public health authorities in the regions using SORMAS or similar tools by providing extensive visualizations and computation of surveillance indicators.

In November 2017, the mobile digital Surveillance Outbreak Response Management and Analysis System was deployed in 30 districts in Nigeria in response to an outbreak of monkeypox. Adaptation and activation of the system took 14 days, and its use improved timeliness, completeness, and overall capacity of the response.

BackgroundGaining oversight into the rapidly growing number of mobile health tools for surveillance or outbreak management in Africa has become a challenge. ObjectiveThe aim of this study is to map the functional portfolio of mobile health tools used for surveillance or outbreak management of communicable diseases in Africa. MethodsWe conducted a scoping review by combining data from a systematic review of the literature and a telephone survey of experts. We applied the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines by searching for articles published between January 2010 and December 2020. In addition, we used the respondent-driven sampling method and conducted a telephone survey from October 2019 to February 2020 among representatives from national public health institutes from all African countries. We combined the findings and used a hierarchical clustering method to group the tools based on their functionalities (attributes). ResultsWe identified 30 tools from 1914 publications and 45 responses from 52% (28/54) of African countries. Approximately 13% of the tools (4/30; Surveillance Outbreak Response Management and Analysis System, Go.Data, CommCare, and District Health Information Software 2) covered 93% (14/15) of the identified attributes. Of the 30 tools, 17 (59%) tools managed health event data, 20 (67%) managed case-based data, and 28 (97%) offered a dashboard. Clustering identified 2 exceptional attributes for outbreak management, namely contact follow-up (offered by 8/30, 27%, of the tools) and transmission network visualization (offered by Surveillance Outbreak Response Management and Analysis System and Go.Data). ConclusionsThere is a large range of tools in use; however, most of them do not offer a comprehensive set of attributes, resulting in the need for public health workers having to use multiple tools in parallel. Only 13% (4/30) of the tools cover most of the attributes, including those most relevant for response to the COVID-19 pandemic, such as laboratory interface, contact follow-up, and transmission network visualization.

Fall risk assessment is very important for the graying societies of developed countries. A major contributor to the fall risk of the elderly is mobility impairment. Timely detection of the fall risk can facilitate early intervention to avoid preventable falls. However, continuous fall risk monitoring requires extensive healthcare and clinical resources. Our objective is to develop a method suitable for remote and long-term health monitoring of the elderly for mobility impairment and fall risk without the need for an expert. We employed time–frequency analysis (TFA) and a stacked autoencoder (SAE), which is a deep neural network (DNN)-based learning algorithm, to assess the mobility and fall risk of the elderly according to the criteria of the timed up and go test (TUG). The time series signal of the triaxial accelerometer can be transformed by TFA to obtain richer image information. On the basis of the TUG criteria, the semi-supervised SAE model was able to achieve high predictive accuracies of 89.1, 93.4, and 94.1% for the vertical, mediolateral and anteroposterior axes, respectively. We believe that deep learning can be used to analyze triaxial acceleration data, and our work demonstrates its applicability to assessing the mobility and fall risk of the elderly.

Introduction: Speech Language Therapy First Point of Contact Clinic (SLT-FPOCC) models can assist assessment of low-risk patient populations referred to ear, nose and throat (ENT) services. To further improve ENT waitlist management and compliance with best-practice care, consideration of other low-risk populations that could be safely managed through this service model is needed. The aims of this paper are to evaluate the clinical and service outcomes of completing vocal cord check (VCC) assessments for patients' pre and post thyroid/parathyroid surgery within an SLT-FPOCC model and examine consumer perceptions. Methods & Procedures: The service followed existing SLT-FPOCC procedures, with ENT triaging referrals, then SLT completing pre- and postoperative VCC assessment (interview, perceptual assessment, flexible nasendoscopy), with assessment data later reviewed by ENT to diagnose laryngeal pathology. Clinical and service outcomes were collected prospectively. Patients completed an anonymous post-service satisfaction survey. Results: Of the first 100 patients referred for preoperative VCCs, SLT assessment identified 42 with dysphonia and 30 reporting dysphagia, while ENT confirmed 9 with significant preoperative anatomical findings. Eighty-three underwent surgery, with 63 (95 nerves at surgical risk) returning for a postoperative VCC. Postoperative VCC identified three temporary neuropraxias (3.2%) and three unilateral vocal fold paresis (3.2%). Patients were highly satisfied with the service. All 163 pre-/postoperative VCCs were completed with no adverse events. Conclusion & Implications: The current data support SLT-FPOCC service expansion to include pre and post thyroid/parathyroid surgery VCC checks, with positive consumer perception. The model supports delivery of best practice management (i.e., pre- and postoperative VCC) for patients receiving surgery for thyroid/parathyroid dysfunction, and associated efficiencies for ENT services.

The relentless growth of wireless applications and data traffic continues to accentuate the long felt need for decentralized, self-managed, and cooperative network architectures. Enlightened by the power of blockchain technology, we propose a blockchain radio access network (B-RAN) architecture and develop decentralized, secure, and efficient mechanisms to manage network access and authentication among inherently trustless network entities. We further identify promising advanced functions made possible by adopting blockchain for open radio access networks. Our test results demonstrate the benefits of the B-RAN architecture. We also present a number of challenges and future research directions.

Charlotte Bernard,1,2 Eric Balestre,1,2 Patrick A Coffie,3–5 Serge Paul Eholie,3,4 Eugène Messou,3–6 Viviane Kwaghe,7 Benson Okwara,8 Adrien Sawadogo,9 Yao Abo,10 François Dabis,1,2 Nathalie de Rekeneire1,2 On behalf of the International Epidemiological Database to evaluate Aids (IeDEA) West Africa Collaboration 1INSERM, Centre INSERM U1219-Epidémiologie-Biostatistique, Bordeaux, France; 2University of Bordeaux, School of Public Health (ISPED), Bordeaux, France; 3Département de Dermatologie et d’Infectiologie, UFR des Sciences Médicales, Université Félix Houphouët Boigny, Abidjan, Côte d’Ivoire; 4Unit of Infectious and Tropical Diseases, Treichville University Teaching Hospital, Abidjan, Côte d’Ivoire; 5Programme PAC-CI, Treichville University Teaching Hospital, Abidjan, Ivory Coast; 6Center of Care, Research and Training (CePReF), Yopougon-Attié Hospital, Abidjan, Ivory Coast; 7University of Abuja Teaching Hospital, Abuja, Nigeria; 8University of Benin City Teaching Hospital, Benin City, Nigeria; 9Institut Supérieur des Sciences de la Santé (INSSA), Bobo-Dioulasso Polytechnic University, Bobo-Dioulasso, Burkina Faso; 10National Blood Transfusion Center (CNTS), Abidjan, Ivory Coast Background: Reporting mortality and lost to follow-up (LTFU) by age is essential as older HIV-positive patients might be at risk of long-term effects of living with HIV and/or taking antiretroviral therapy (ART). As age effects might not be linear and might impact HIV outcomes in the oldest more severely, people living with HIV (PLHIV) aged 50–59 years and PLHIV aged >60 years were considered separately.Setting: Seventeen adult HIV/AIDS clinics spread over nine countries in West Africa.Methods: Data were collected within the International Epidemiological Databases to Evaluate AIDS West Africa Collaboration. ART-naïve PLHIV-1 adults aged >16 years initiating ART and attending ≥2 clinic visits were included (N=73,525). Age was divided into five groups: 16–29/30–39/40–49/50–59/≥60 years. The age effect on mortality and LTFU was evaluated with Kaplan–Meier curves and multivariable Cox proportional hazard regressions.Results: At month 36, 5.9% of the patients had died and 47.3% were LTFU. Patients aged ≥60 (N=1,736) and between 50–59 years old (N=6,792) had an increased risk of death in the first 36 months on ART (adjusted hazard ratio=1.66; 95% CI: 1.36–2.03 and adjusted hazard ratio=1.31; 95% CI: 1.15–1.49, respectively; reference: 50 years old should not be considered as a unique group irrespective of their age. Tailored programs focusing on improving the care services for older PLHIV in Sub-Saharan Africa are clearly needed to improve basic program outcomes. Keywords: HIV, aging, ART, mortality, lost to follow-up, Sub-Saharan Africa

Global markets do not tolerate the presence of fruit fly (Tephritidae) in horticultural produce. A key method of control for tephritidae pests, is the sterile insect technique (SIT). Several countries release a bisex strain, i.e., males and females, however the sterile male is the only sex which contributes to wild population declines when released en masse. In commercial orchards, there are concerns that sterile females released as part of bisex strains, may oviposit, i.e., ‘sting’ and cause damage to fruit, rendering it unmarketable. Australia has released a bisex strain of sterile Queensland fruit fly, Bactrocera tryoni Froggatt, for several decades to suppress wild pest populations, particularly in peri-urban and urban environments. Here, we assessed fruit damage in two commercially grown stone fruit orchards where bisex sterile B. tryoni were released, and in an orchard that did not receive sterile flies. The number of detected stings were higher in only one SIT release orchard, compared with the control; however, there was no difference between SIT and control orchards in the number of larvae detected. We showed that there is no evidence that sterile female B. tryoni released in large numbers caused stings, or damage that led to downgraded or unsaleable fruit. The bisex strain of sterile B. tryoni is recommended for use in commercial stone-fruit orchards, under the conditions in which this trial was conducted.

Larval diets used for artificial rearing can have a significant effect on insect biology. The Queensland fruit fly (aka “Qfly”), Bactrocera tryoni (Froggatt) (Diptera: Tephritidae), is one of the greatest challenges for fruit growers in Australia. The sterile insect technique (SIT) is being developed to manage outbreaks in regions that remain free of Qfly and to reduce populations in regions where this species is endemic. Factory scale rearing is essential for SIT; however, artificial larval diets are known to affect the microbiome of Qfly, which may then affect fly performance. In this study, high-throughput Illumina sequencing was used to assess the Qfly microbiome in colonies reared, for five generations from nature, on two common artificial diets (carrot and gel). At generation five (G5), the microbiome was assessed in larvae, pupae, adult males and adult females and standard fly quality control parameters were assessed together with additional performance measures of mating propensity and survival under nutritional stress. At the genus level, bacterial communities were significantly different between the colonies reared on the two larval diets. However, communities converged at Phyla to family taxonomic levels. Bacterial genera of Morganella, Citrobacter, Providencia, and Burkholderia were highly abundant in all developmental stages of Qfly reared on the gel diet, when compared to the carrot diet. Despite abundance of these genera, a greater percentage of egg hatching, heavier pupal weight and a higher percentage of fliers were found in the Qfly reared on the gel diet. Mating propensity and survival under nutritional stress was similar for adult Qfly that had been reared on the two larval diets. Overall, our findings demonstrate that the artificial larval diet strongly influences the microbiome and quality control measures of Qfly, with likely downstream effects on performance of flies released in SIT programs.

Tephritid fruit flies are among the most destructive horticultural pests posing risks to Australia's multi-billion-dollar horticulture industry. Currently, there are 11 pest fruit fly species of economic concern in Australia. Of these, nine are native to this continent (Bactrocera aquilonis, B. bryoniae, B. halfordiae, B. jarvisi, B. kraussi, B. musae, B. neohumeralis, B. tryoni and Zeugodacus cucumis), while B. frauenfeldi and Ceratitis capitata are introduced. To varying degrees these species are costly to Australia's horticulture through in-farm management, monitoring to demonstrate pest freedom, quarantine and trade restrictions, and crop losses. Here, we used a common species distribution model, Maxent, to assess climate suitability for these 11 species under baseline (1960-1990) and future climate scenarios for Australia. Projections indicate that the Wet Tropics is likely to be vulnerable to all 11 species until at least 2070, with the east coast of Australia also likely to remain vulnerable to multiple species. While the Cape York Peninsula and Northern Territory are projected to have suitable climate for numerous species, extrapolation to novel climates in these areas decreases confidence in model projections. The climate suitability of major horticulture areas currently in eastern Queensland, southern-central New South Wales and southern Victoria to these pests may increase as climate changes. By highlighting areas at risk of pest range expansion in the future our study may guide Australia's horticulture industry in developing effective monitoring and management strategies.

We report a case of infection with New York orthohantavirus in a woman who showed renal impairment and hemorrhage, complicated by hydrocephalus, in Long Island, New York, USA. Phylogenetic analysis showed that this virus was genetically similar to a New York orthohantavirus isolated in the same region during 1993.

The application of corrugated paper to buffer packaging has increased with the rise of the circular economy. The dynamic buffer curve is the key to designing the buffer packaging structure but requires multiple testing by small- and medium-sized enterprises (SMEs) without resources. In this study, we propose drop testing to perform a fractional factorial experiment and establish a regression model of impact strength through experimental data. The analysis results show that static stress, falling height, and buffer material thickness are the key variables of impact strength, and an impact strength prediction model (R2 = 94.1%) was obtained. Model verification using the buffer package design of a personal computer showed that the measured values of impact strength fell within the estimated 95% confidence interval. These results indicate that SMEs can use the proposed analysis procedure to improve the design of corrugated paper using minimal resources.

Introduction: The objective of this study was to investigate whether morbidity in Canada, at the national and provincial levels, is compressing or expanding by tracking trends in life expectancy (LE) and health-adjusted life expectancy (HALE) from 1994 to 2010. "Compression" refers to a decrease in the proportion of life spent in an unhealthy state over time. It happens when HALE increases faster than LE. "Expansion" refers to an increase in the proportion of life spent in an unhealthy state that happens when HALE is stable or increases more slowly than LE. Methods: We estimated LE using mortality and population data from Statistics Canada. We took health-related quality of life (i.e. morbidity) data used to calculate HALE from the National Population Health Survey (1994-1999) and the Canadian Community Health Survey (2000-2010). We built abridged life tables for seven time intervals, covering the period 1994 to 2010 and corresponding to the year of each available survey cycle for females and males and for each of the 10 Canadian provinces. National and provincial trends were assessed at birth, and at ages 20 years and 65 years. Results: We observed an overall average annual increase in HALE that was statistically significant in both Canadian females and males at each of the three ages assessed, with the exception of females at birth. At birth, HALE increased an average of 0.2% (p = .08) and 0.3% (p < .001) annually for females and males respectively over the 1994 to 2010 period. At the national level for all three age groups, we observed a statistically non-significant average annual increase in the proportion of life spent in an unhealthy state, with the exception of men at age 65, who experienced a non-significant decrease. At the provincial level at birth, we observed a significant increase in proportion of life spent in an unhealthy state for Newfoundland and Labrador (NL) and Prince Edward Island (PEI). Conclusion: Our study did not detect a clear overall trend in compression or expansion of morbidity from 1994 to 2010 at the national level in Canada. However, our results suggested an expansion of morbidity in NL and PEI. Our study indicates the importance of continued tracking of the secular trends of life expectancy and HALE in Canada in order to verify the presence of compression or expansion of morbidity. Further study should be undertaken to understand what is driving the observed expansion of morbidity in NL and in PEI.

Introduction : Notre étude visait à examiner s'il y a eu une expansion ou une compression de la morbidité au Canada, à l'échelle tant nationale que provinciale, en suivant l'évolution de l'espérance de vie (EV) et de l'espérance de vie ajustée en fonction de la santé (EVAS) entre 1994 et 2010. Une « compression », qui correspond à une diminution de la proportion de la vie marquée par des problèmes de santé, survient lorsque l'EVAS augmente plus rapidement que l'EV. Inversement, une « expansion », qui désigne une augmentation de la proportion de la vie marquée par des problèmes de santé, survient lorsque l'EVAS est stable ou augmente plus lentement que l'EV. Méthodologie : Nous avons estimé l'EV à l'aide des données de Statistique Canada sur la mortalité et sur la population. Nous avons utilisé les données sur la qualité de vie liée à la santé (c.-à-d. morbidité) de l'Enquête nationale sur la santé de la population (1994-1999) et de l'Enquête sur la santé dans les collectivités canadiennes (2000-2010) pour calculer l'EVAS. Nous avons établi des tables de mortalité abrégées pour sept intervalles de temps correspondant aux cycles d'enquête disponibles durant la période de 1994 à 2010, ainsi que pour les deux sexes et les dix provinces canadiennes. Les tendances nationales et provinciales ont été examinées à la naissance, à 20 ans et à 65 ans. Résultats : Dans l'ensemble, nous avons constaté une hausse annuelle moyenne statistiquement significative de l'EVAS chez les deux sexes aux trois âges évalués, sauf chez les nouveau-nés de sexe féminin. L'EVAS à la naissance a augmenté en moyenne par année, entre 1994 et 2010, de 0,2 % (p = 0,08) chez les sujets de sexe féminin et de 0,3% (p < 0,001) chez ceux de sexe masculin. À l'échelle nationale, les trois groupes d'âge ont présenté une augmentation annuelle moyenne non statistiquement significative de la proportion de la vie marquée par des problèmes de santé, sauf les hommes de 65 ans, qui ont présenté une diminution non significative. À l'échelle provinciale, nous avons observé une augmentation significative de la proportion de la vie marquée par des problèmes de santé à Terre-Neuve-et-Labrador et à l'Île-du-Prince-Édouard. Conclusion : Notre étude n'a fait ressortir aucune tendance générale nette indiquant une compression ou une expansion de la morbidité à l'échelle nationale au Canada entre 1994 et 2010. Nos résultats indiquent qu'il y a eu une expansion de la morbidité à Terre-Neuve-et-Labrador et à l'Île-du-Prince-Édouard. L'étude a mis en évidence l'importance de continuer à suivre les tendances à long terme concernant l'EV et l'EVAS pour vérifier la présence d'une compression ou d'une expansion de la morbidité. D'autres études devraient être entreprises pour éclaircir les causes de l'expansion de la morbidité observée à Terre-Neuve-et-Labrador et à l'Île-du-Prince-Édouard.

BACKGROUND:Studies using health administrative databases (HAD) may lead to biased results since information on potential confounders is often missing. Methods that integrate confounder data from cohort studies, such as multivariate imputation by chained equations (MICE) and two-stage calibration (TSC), aim to reduce confounding bias. We provide new insights into their behavior under different deviations from representativeness of the cohort. METHODS:We conducted an extensive simulation study to assess the performance of these two methods under different deviations from representativeness of the cohort. We illustrate these approaches by studying the association between benzodiazepine use and fractures in the elderly using the general sample of French health insurance beneficiaries (EGB) as main database and two French cohorts (Paquid and 3C) as validation samples. RESULTS:When the cohort was representative from the same population as the HAD, the two methods are unbiased. TSC was more efficient and faster but its variance could be slightly underestimated when confounders were non-Gaussian. If the cohort was a subsample of the HAD (internal validation) with the probability of the subject being included in the cohort depending on both exposure and outcome, MICE was unbiased while TSC was biased. The two methods appeared biased when the inclusion probability in the cohort depended on unobserved confounders. CONCLUSION:When choosing the most appropriate method, epidemiologists should consider the origin of the cohort (internal or external validation) as well as the (anticipated or observed) selection biases of the validation sample.

Graduates of Roosevelt High School remember their experiences, specifically the principals. Bernard Watson introduces the other authors' personal reflections by describing the environment, his relationships with the principals and his fellow students, and the long-term effects of the school on its graduates. Following this introduction, Randall C. Morgan remembers his grandfather, H. Theo Tatum, who everyone knew and respected and who crafted a sense of excellence in the students. The other two principals--Warren Anderson and Robert Eugene Jones--are remembered by their children. Rosemary Davis remembers her father, Anderson, as being energized by teaching, learning, and interacting with teachers and students. He believed in producing well-rounded students, those with both physical as well as intellectual skills. Byron Jones remembers his father, Robert Jones, as also having a passion for teaching and leading. He honored students' achievements and increased the number who graduated with honors. These personal memories support the importance of leadership within an elite African-American school's culture.

The results obtained by medical experts and inertial sensors via clinical tests to determine fall risks are compared. A clinical test is used to perform the whole timed up and go (TUG) test and segment-based TUG (sTUG) tests, considering various cutoff points. In this paper, (a) t-tests are used to verify fall-risk categorization; and (b) a logistic regression with 100 stepwise iterations is used to divide features into training (80%) and testing sets (20%). The features of (a) and (b) are compared, measuring the similarity of each approach’s decisive features to those of the clinical-test results. In (a), the most significant features are the Y and Z axes, regardless of the segmentation, whereas sTUG outperforms TUG in (b). Comparing the results of (a) and (b) based on the overall TUG test, the Z axis multiscale entropy (MSE) features show significance regardless of the approach: expert opinion or logistic prediction. Among various clinical test combinations, the only commonalities between (a) and (b) are the Y-axis MSE features when walking. Thus, machine learning should be based on both expert domain knowledge and a preliminary analysis with objective screening. Finally, the clinical test results are compared with the inertial sensor results, prompting the proposal for multi-oriented data analysis to objectively verify the sensor results.

Evaluation of human postural stability is important to prevent falls. Recent studies have been carried out to develop postural stability evaluation in an attempt to fall prevention. The postural stability index (PSI) was proposed as a measure to evaluate the stability of human postures in performing daily activities. The objective of this study was to use the PSI in developing the stability scales for human daily activities. The current study used two open datasets collected from mobile devices. In addition, we also conducted three experiments to evaluate the effect of age, velocity, step counts, and devices on PSI values. The collected datasets were preprocessed using the ensemble empirical mode decomposition (EEMD), then the complexity index from each intrinsic mode function (IMF) was calculated using the multiscale entropy (MSE). From the evaluation, it can be concluded that the PSI can be applied to do daily monitoring of postural stability for both young and older adults, and the PSI is not affected by age. The revised stability scales developed in this current study can give better suggestions to users than the original one.

The ability to maintain postural stability is essential in our daily lives. Relatedly, hemiparetic stroke patients have a very high risk of falls. This study aimed to improve the traditional rehabilitation treatment for stroke patients with hemiparesis by providing a virtual reality (VR) feedback system with modular interactive tiles (MITs) to enhance their postural stability and thus prevent falls. The data collected included pre-test and post-test Berg Balance Scale (BBS) values, and complexity index (CI) values for center of pressure (COP) data based on multiscale entropy (MSE) and multivariate multiscale entropy (MMSE) at the 12-week exercise program. Higher BBS and CI values indicate better postural stability, and the results showed that the exercise program yielded significant improvements in postural stability. The mean pre-test BBS value of 51.67 ± 3.12 increased to 53.83 ± 2.17 (p < 0.05), and the mean CI of MMSE value increased by 14.8% (p < 0.01). We confirmed that this training program including MITs is beneficial to the rehabilitation of stroke patients. More specifically, the MITs training program positively affected the CI of MMSE values, and the affected result similar to the BBS values of the patients, indicating their improved balance and ability to avoid falls.

To develop an effective fall prevention program, clinicians must first identify the elderly people at risk of falling and then take the most appropriate interventions to reduce or eliminate preventable falls. Employing feature selection to establish effective decision making can thus assist in the identification of a patient’s fall risk from limited data. This work therefore aims to supplement professional timed up and go assessment methods using sensor technology, entropy analysis, and statistical analysis. The results showed the different approach of applying logistic regression analysis to the inertial data on a fall-risk scale to allow medical practitioners to predict for high-risk patients. Logistic regression was also used to automatically select feature values and clinical judgment methods to explore the differences in decision making. We also calculate the area under the receiver-operating characteristic curve (AUC). Results indicated that permutation entropy and statistical features provided the best AUC values (all above 0.9), and false positives were avoided. Additionally, the weighted-permutation entropy/statistical features test has a relatively good agreement rate with the short-form Berg balance scale when classifying patients as being at risk. Therefore, the proposed methodology can provide decision-makers with a more accurate way to classify fall risk in elderly people.

Missing data are common in industrial sensor readings owing to system updates and unequal radio-frequency periods. Existing methods addressing missing data through imputation may not always be appropriate. This study presented a sorted missing percentages technique for filtering attributes when building machine learning classification models using sensor readings with missing data. Signal detection theory was employed to evaluate the distinguishing ability of resulting models. To evaluate its performance, the proposed technique was applied to a publicly available air pressure system dataset, which then was used to build several classifiers. The experimental results indicated that the proposed technique allowed a logistic regression model to achieve the best accuracy score (99.56%) and a better distinguishing ability (response bias of 0.0013, adjusted response bias of 0.0044, and decision criterion of −1.8994) compared with the methods applied to the same dataset and reported in papers published between 2016 and 2019 March on binary classification, wherein attributes with more than 20% of missing data were filtered out. The proposed technique is suitable for industrial sensor data analysis and can be applied to the scenarios dealing with missing data owing to unequal radio-frequency periods or a system being updated with new fields.

The role of human papillomavirus type 16 (HPV16) in oral potentially malignant disorders (OPMD) and oral cavity carcinoma (OC) is still under debate. We investigated HPV16 prevalence in unstimulated saliva, oral rinse samples, oral swabs and tumour biopsies collected from OPMD (n = 83) and OC (n = 106) patients. HPV16 genotype, viral load, physical status (episomal vs. integrated) and tumour p16INK4a expression were determined. Oral HPV16 prevalence was higher in OC than in OPMD, but this difference was not statistically significant (7.5% (8/106) versus 3.6% (3/83), odds ratio (OR): 2.18, 95% confidence interval (CI): 0.56, 8.48, p = 0.26). There was a significant association (p < 0.05) between oral HPV16 infection and heavy tobacco consumption. Real-time PCR results indicated that no integration events occurred in either OPMD or OC cases based on the HPV16 E2/E6 ratio. HPV16 positive OPMD and OC patients had similar HPV16 E2 and E6 viral loads. The inter-rater agreement between tumour p16INK4a expression and oral HPV16 infection was considered as fair (k = 0.361) for OC. Our data suggest that the involvement of HPV16 in oral carcinogenesis is limited.

As people in developed countries live longer, assessing the fall risk becomes more important. A major contributor to the risk of elderly people falling is postural instability. This study aimed to use the multiscale entropy (MSE) analysis to evaluate postural stability during a timed-up-and-go (TUG) test. This test was deemed a promising method for evaluating fall risk among the elderly in a community. The MSE analysis of postural instability can identify the elderly prone to falling, whereupon early medical rehabilitation can prevent falls. Herein, an objective approach is developed for assessing the postural stability of 85 community-dwelling elderly people (aged 76.12 ± 6.99 years) using the short-form Berg balance scale. Signals were collected from the TUG test using a triaxial accelerometer. A segment-based TUG (sTUG) test was designed, which can be obtained according to domain knowledge, including “Sit-to-Walk (STW),” “Walk,” “Turning,” and “Walk-to-Sit (WTS)” segments. Employing the complexity index (CI) of sTUG can reveal information about the physiological dynamics’ signal for postural stability assessment. Logistic regression was used to assess the fall risk based on significant features of CI related to sTUG. MSE curves for subjects at risk of falling (n = 19) exhibited different trends from those not at risk of falling (n = 66). Additionally, the CI values were lower for subjects at risk of falling than those not at risk of falling. Results show that the area under the curve for predicting fall risk among the elderly subjects with complexity index features from the overall TUG test is 0.797, which improves to 0.853 with the sTUG test. For the elderly living in a community, early assessment of the CI for sTUG using MSE can help predict the fall risk.

Alpine, subalpine and boreal tree species, of low genetic diversity and adapted to low optimal temperatures, are vulnerable to the warming effects of global climate change. The accurate prediction of these species’ distributions in response to climate change is critical for effective planning and management. The goal of this research is to predict climate change effects on the distribution of red spruce (Picea rubens Sarg.) in the Great Smoky Mountains National Park (GSMNP), eastern USA. Climate change is, however, conflated with other environmental factors, making its assessment a complex systems problem in which indirect effects are significant in causality. Predictions were made by linking a tree growth simulation model, red spruce growth model (ARIM.SIM), to a GIS spatial model, red spruce habitat model (ARIM.HAB). ARIM.SIM quantifies direct and indirect interactions between red spruce and its growth factors, revealing the latter to be dominant. ARIM.HAB spatially distributes the ARIM.SIM simulations under the assumption that greater growth reflects higher probabilities of presence. ARIM.HAB predicts the future habitat suitability of red spruce based on growth predictions of ARIM.SIM under climate change and three air pollution scenarios: 10% increase, no change and 10% decrease. Results show that suitable habitats shrink most when air pollution increases. Higher temperatures cause losses of most low-elevation habitats. Increased precipitation and air pollution produce acid rain, which causes loss of both low- and high-elevation habitats. The general prediction is that climate change will cause contraction of red spruce habitats at both lower and higher elevations in GSMNP, and the effects will be exacerbated by increased air pollution. These predictions provide valuable information for understanding potential impacts of global climate change on the spatiotemporal distribution of red spruce habitats in GSMNP.

The article explores the contours of multiple identities in contrast to singular identities in situations of social complexity and cultural diversity. Nyamnjoh’s concepts of “incompleteness†and “frontier Africans†imply an alternative approach to identity formation. Although the formation of one’s own, singular identity is a necessary stage in the development of each individual, it has specific limitations. This is especially true in situations of complexity and diversity and where the achievement of social cohesion is an important goal. With reference to existing theories of identity formation, an alternative framework is proposed that is more appropriate for the dynamic, open-ended nature of identity and better suited to encourage the enrichment of identity. The role of imagination, a strategy for crossing borders (with reference to Clingman’s concept of a “grammar of identityâ€), the search for commonality, and the effect of historical memory are discussed. Enriched and multiple identities are not achieved by replacement or exchange, but by widening (existing) singular identities into a more inclusive and diverse understanding of the self.

A key factor for fall prevention involves understanding the pathophysiology of stability. This study proposes the postural stability index (PSI), which is a novel measure to quantify different stability states on healthy subjects. The results of the x-, y-, and z-axes of the acceleration signals were analyzed from 10 healthy young adults and 10 healthy older adults under three conditions as follows: Normal walking, walking with obstacles, and fall-like motions. The ensemble empirical mode decomposition (EEMD) was used to reconstruct the acceleration signal data. Wearable accelerometers were located on the ankles and knees of the subjects. The PSI indicated a decreasing trend of its values from normal walking to the fall-like motions. Free-walking data were used to determine the stability based on the PSI. The segmented free-walking data indicated changes in the stability states that suggested that the PSI is potentially helpful in quantifying gait stability.

To assess the improvement of human body balance, a low cost and portable measuring device of center of pressure (COP), known as center of pressure and complexity monitoring system (CPCMS), has been developed for data logging and analysis. In order to prove that the system can estimate the different magnitude of different sways in comparison with the commercial Advanced Mechanical Technology Incorporation (AMTI) system, four sway tests have been developed (i.e., eyes open, eyes closed, eyes open with water pad, and eyes closed with water pad) to produce different sway displacements. Firstly, static and dynamic tests were conducted to investigate the feasibility of the system. Then, correlation tests of the CPCMS and AMTI systems have been compared with four sway tests. The results are within the acceptable range. Furthermore, multivariate empirical mode decomposition (MEMD) and enhanced multivariate multiscale entropy (MMSE) analysis methods have been used to analyze COP data reported by the CPCMS and compare it with the AMTI system. The improvements of the CPCMS are 35% to 70% (open eyes test) and 60% to 70% (eyes closed test) with and without water pad. The AMTI system has shown an improvement of 40% to 80% (open eyes test) and 65% to 75% (closed eyes test). The results indicate that the CPCMS system can achieve similar results to the commercial product so it can determine the balance.

We describe complimentary imaging technologies in traumatic chorioretinal injury. Color and fundus autofluorescence (FAF) images were obtained with a non-mydriatic retinal camera. Optical coherence tomography (OCT) helped obtain detailed images of retinal structure. Microperimetry was used to evaluate the visual function. A 40-year-old man sustained blunt ocular trauma with a stone. Color fundus image showed a large chorioretinal scar in the macula. Software filters allowed detailed illustration of extensive macular fibrosis. A 58-year-old man presented with blunt force trauma with a tennis ball. Color fundus imaging showed a crescentric area of macular choroidal rupture with fibrosis. FAF imaging delineated an area of hypofluorescence greater on fundus imaging. OCT showed chorioretinal atrophy in the macula. Microperimetry delineated an absolute scotoma with no response to maximal stimuli. Fundus imaging with digital filters and FAF illustrated the full extent of chorioretinal injury, while OCT and microperimetry corroborated the structure and function correlations.

Falls are unpredictable accidents and resulting injuries can be serious to the elderly. A preventative solution can be the use of vibration stimulus of white noise to improve the sense of balance. In this work, a pair of vibration shoes were developed and controlled by a touch-type switch which can generate mechanical vibration noise to stimulate the patient’s feet while wearing the shoes. In order to evaluate the balance stability and treatment effect of vibrating insoles in these shoes, multivariate multiscale entropy (MMSE) algorithm is applied to calculate the relative complexity index of reconstructed center of pressure (COP) signals in antero-posterior and medio-lateral directions by the multivariate empirical mode decomposition (MEMD). The results show that the balance stability of 61.5% elderly subjects is improved after wearing the developed shoes, which is more than 30.8% using multiscale entropy. In conclusion, MEMD-enhanced MMSE is able to distinguish the smaller differences between before and after the use of vibration shoes in both two directions, which is more powerful than the empirical mode decomposition (EMD)-enhanced MSE in each individual direction.

Despite evidence for avian influenza A virus (AIV) transmission between wild and domestic ecosystems, the roles of bird migration and poultry trade in the spread of viruses remain enigmatic. In this study, we integrate ecosystem interactions into a phylogeographic model to assess the contribution of wild and domestic hosts to AIV distribution and persistence. Analysis of globally sampled AIV datasets shows frequent two-way transmission between wild and domestic ecosystems. In general, viral flow from domestic to wild bird populations was restricted to within a geographic region. In contrast, spillover from wild to domestic populations occurred both within and between regions. Wild birds mediated long-distance dispersal at intercontinental scales whereas viral spread among poultry populations was a major driver of regional spread. Viral spread between poultry flocks frequently originated from persistent lineages circulating in regions of intensive poultry production. Our analysis of long-term surveillance data demonstrates that meaningful insights can be inferred from integrating ecosystem into phylogeographic reconstructions that may be consequential for pandemic preparedness and livestock protection.