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Pulau Jawa merupakan salah satu daerah seismik aktif karena terdapat zona subduksi yang disebabkan oleh pergerakan di bagian selatan Laut Pulau Jawa, yaitu Trench Sunda sehingga sering terjadi gempabumi. Keberadaan sesar-sesar yang melintang di daerah Jawa Barat sesar di Pulau Jawa juga termasuk dalam faktor yang menyebabkan gempabumi merusak. Untuk mengidentifikasi jenis gempa, perlu dilakukan analisis berdasarkan besar magnitudo, kedalaman hiposenter, dan mekanisme fokalnya. Dengan menggunakan metode segmen irisan vertikal (vertical cross-section) dapat diketahui arah subduksi lempeng, kedalaman hiposenter, dan jarak hiposenter terhadap titik awal lintasan, serta persebaran gempabumi. Pada penelitian ini, gempa intraslab di Tasikmalaya terjadi dengan kedalaman lebih dari 60 km, yaitu 115 km dengan Mw (moment magnitude) 6,5 dan mekanisme fokal oblique strike-slip.

Abstract Background Sex differences exist in type 2 diabetes (T2D), and androgens have been implicated in the etiology of T2D in a sex-specific manner. We therefore aimed to investigate whether androgens play a role in explaining sex differences in glucose homeostasis and incidence of T2D. Methods We used observational data from the German population-based KORA F4 study (n = 1975, mean age: 54 years, 41% women) and its follow-up examination KORA FF4 (median follow-up 6.5 years, n = 1412). T2D was determined through self-reporting and confirmed by contacting the physicians and/or reviewing the medical charts. Multivariable linear and logistic regression models were employed to explore associations. Mediation analyses were performed to assess direct effects (DE) and indirect effects (IE), and the mediating role of androgens (total testosterone (TT), dehydroepiandrosterone (DHEA), dehydroepiandrosterone-sulfate (DHEAs)) in the association between sex (women vs. men) and glucose- and insulin-related traits (cross-sectional analysis) and incidence of T2D (longitudinal analysis). Results After adjustment for confounders, (model 1: adjusted for age; model 2: model 1 + smoking + alcohol consumption + physical activity), women had lower levels of TT, DHEAs, fasting glucose levels, fasting insulin levels, 2 h-glucose levels and HOMA-IR, compared to men. An inverse association was observed for TT and glucose- and insulin-related traits in men, while a positive association was observed for TT and fasting glucose levels in women. We found a mediatory role of TT on the association of sex with fasting glucose levels (IE: β = 3.08, 95% CI: 2.04, 4.30), fasting insulin levels (IE: β = 0.39, 95% CI:0.30, 0.47), 2 h-glucose levels (IE: β = 12.77, 95% CI: 9.01, 16.03) and HOMA-IR (IE: β = 0.41, 95% CI: 0.33, 0.50). Also, the inconsistent mediatory role of TT was seen on the association of sex with incidence of T2D (DE: 0.12, 95% CI: 0.06, 0.20 and IE: OR = 7.60, 95% CI: 3.43, 24.54). The opposing DE and IE estimates suggest that the association between sex and either glucose homeostasis or the incidence of T2D may differ when TT is considered as a potential mediator, with higher TT levels being beneficial for glucose metabolism or incidence of T2D in men, while in women, detrimental. No mediatory role was observed for either DHEA or DHEAs on glucose homeostasis or the incidence of T2D. Conclusions The dimorphic mediatory role of TT highlights its complex role in metabolic health, contributing differently to the glucose dysregulation and risk of T2D in men and women.

ABSTRACT Sodium‐glucose cotransporter‐2 inhibitors (SGLT2i) have demonstrated a blood pressure (BP) reduction benefit despite other indications for use. We evaluated BP changes and antihypertensive medication use pre‐ and post‐SGLT2i initiation among 12 960 patients with treated hypertension and among subgroups with apparent treatment‐resistant hypertension (aTRH) and/or proteinuria. Post‐SGLT2i initiation, the mean (SD) systolic blood pressure (SBP) was reduced from 133.9 (16.4) to 128.6 (15.5) mmHg and the mean diastolic blood pressure (DBP) was reduced from 70.8 (11.8) to 68.3 (11.3) mmHg among all patients. The mean SBP/DBP reduction was 5.3/2.5, 6.2/2.8, and 6.1/2.9 mmHg among all patients, patients with aTRH, and patients with proteinuria, respectively. Achieved BP < 130/80 mmHg increased by 12.5%, 16.9%, and 11.1% for all patients, patients with aTRH, and patients with proteinuria, respectively. Discontinuation of ≥ 1 antihypertensive medication within 12 months of SGLT2i initiation occurred in 33.4% overall, 47.6% of patients with aTRH, and 38.7% of patients with proteinuria.

Abstract Background Although the number of teledermatology studies is increasing, not all variables have been researched in equal depth, so there remains a lack of robust evidence for some teledermatology initiatives. This review describes the landscape of teledermatology research and identifies knowledge gaps and research needs. This evidence map can be used to inform clinicians about the current knowledge about teledermatology and guide researchers for future studies. Methods Our evidence map was conducted according to the Campbell Collaboration checklist for evidence and gap maps. Eight databases were searched (CINAHL, Embase, PubMed, Scopus, Web of Science, Cochrane Library, JBI Database of Systematic Reviews and Implementation Reports, and OpenGray), and only included systematic reviews of teledermatology involving humans published in English; while excluding non-systematic reviews (i.e., abstracts, conference proceedings, editorials, commentaries, or letters). From 909 records, 14 systematic reviews published between 2004 and 2022 were included. Our analysis focused on the systematic reviews’ characteristics, dermatological conditions studied, rate of overlap and quality assessment of primary studies reviewed, and main findings reported. Results Teledermatology was reportedly comparable with clinic dermatology and generally accepted by patients as a mode of care delivery for dermatological conditions. However, there are concerns about privacy, communication, completeness of information transmitted, familiarity with the technology, and technical problems. Healthcare professionals were generally satisfied with teledermatology but found telemedicine consultations longer than face-to-face consultations, and less confident in asynchronous teledermatology than conventional consultations. Teledermatology was reportedly more cost-effective than clinic dermatology; especially considering the distance traveled by patients, referral volume to teledermatology, and clinic dermatology costs. Although patients and providers are satisfied with teledermatology, face-to-face dermatology has higher diagnostic and management accuracy. Teledermatology was also used for training medical professionals. Regarding the validity and reliability of teledermatology outcome measures, no significant discussions were found. Conclusions COVID-19 spotlighted telemedicine in clinical care, and we must ensure telemedicine continually improves with robust research. Further research is necessary for establishing a standardized outcome set, enhancing accuracy, concordance, cost-effectiveness, and safety, comparing teledermatology with non-dermatologist care, examining its effectiveness in non-Western low and middle-income countries, and incorporating patient involvement for improved study design. Systematic review registration https://www.researchregistry.com/ (Unique Identifying Number: reviewregistry878).

Background and aims: Liver cirrhosis is a complex disease that may result in increased morbidity and mortality following bariatric surgery (BS). This study aimed to explore the outcome of BS in patients with unexpected cirrhosis, focusing on postoperative complications and the progression of liver disease. Methods: A retrospective study of bariatric patients with cirrhosis from four centers in China between 2016 and 2023 was conducted, with follow-up for one year after BS. The primary outcome was the safety of BS in patients with unexpected cirrhosis, while the secondary outcome was the metabolic efficacy of BS in this group postoperatively. Results: A total of 47 patients met the study criteria, including 46 cases of Child-Pugh class A cirrhosis and 1 case of Child-Pugh B. Pathological examination confirmed nodular cirrhosis in 21 patients (44.68%), pseudolobule formation in 1 patient (2.13%), lipedema degeneration with inflammatory cell infiltration in 3 patients (6.38%), and chronic hepatitis in 1 patient (2.13%). The average percentage of total weight loss was 29.73 ± 6.53% at one year postoperatively. During the 30-day postoperative period, the complication rate was 6.38%, which included portal vein thrombosis, gastrointestinal bleeding, and intra-abdominal infection. Moreover, no cases of liver decompensation or mortality were reported during the follow-up period. The remission rates of comorbidities among 41 patients one year after surgery were as follows: dyslipidemia 100%, type 2 diabetes 82.61%, hypertension 84.62%, and obstructive sleep apnea syndrome 85.71%. Conclusions: BS can be safely performed in patients with unexpected cirrhosis in the compensated stage of liver disease, with low postoperative morbidity and no mortality observed during one-year follow-up.

Objective: To assess the factors associated with knowledge, attitude and behavior of contraception use among urban slum population in Chennai. Methods: A cross-sectional study was conducted in the urban slum of Anakaputhur, Chennai. Married couples between ages of 19-49 years and living in slum areas were taken up for the study by simple random sampling. Pregnant women, postnatal and postmenopausal women were excluded from the study. Data collection was done using a pretested structured questionnaire focusing on details regarding contraception knowledge, attitude, and practices. Data analysis was done using IBM SPSS version 22. Analytical test like Chi square and odds ratio (OR) were used to identify association between knowledge, attitude, and behavior of contraception with the associated variables and enter method of logistic regression analysis was done. Results: Out of the 360 respondents, 228 were females, with a mean age of (34±5) years. Approximately 43% demonstrated adequate knowledge of contraception use, and 91% were aware of at least one contraceptive method. Notably, 72% exhibited a positive attitude towards contraceptive use. Nevertheless, 43% (155 individuals) did not utilize any contraceptive method. Among contraceptive users, intrauterine devices were the most commonly adopted, followed by barrier methods and female sterilization. There was significant association between knowledge of contraception and education (aOR 7.29, 95% CI 2.93-18.10, P

Abstract Purpose Researchers have theorized that interactions between appetitive and circadian disruptions result in increased eating disorder (ED) symptoms and insomnia. However, it is unclear how specific insomnia symptoms present among people with EDs and if the latent structure of insomnia in this population is similar to that of people with insomnia disorder. Methods We conducted a secondary analysis of data collected on ED and insomnia symptoms using a subset of students (N = 547; 79.52% female) with probable EDs at a large Midwestern American university. Item response theory (IRT) for polytomous items was performed to identify item difficulty, discrimination, and information parameters for the Insomnia Severity Index (ISI). IRT parameters were compared to those established in a 2011 study of people diagnosed with insomnia disorder by Morin and colleagues. Results Clinically significant insomnia symptoms were common among students with ED pathology and symptom endorsement for each ISI item ranged from 40.77 to 86.65%. ISI items assessing insomnia-related impairment and distress showed better discriminative capacities and had higher item information than items assessing sleep behavior alterations (i.e., difficulties falling asleep, difficulties maintaining sleep, waking too early). Item discrimination was largely similar among the ED sample compared to previous IRT analyses in an insomnia disorder sample. Conclusion Insomnia symptoms are common among university students with probable EDs and similar to those reported by people with insomnia disorder. When considering insomnia assessment, items assessing sleep behaviors alone are likely inadequate to provide information about insomnia severity among people with EDs. Level V Evidence obtained from a cross-sectional descriptive study.

There is accumulating evidence indicating a close crosstalk between key molecular events regulating cell growth and proliferation, which could profoundly impact carcinogenesis and its progression. Here we focus on reviewing observations highlighting the interplay between epigenetic modifications, irreversible cell cycle arrest or senescence, and cellular redox metabolism. Epigenetic alterations, such as DNA methylation and histone modifications, dynamically influence tumour transcriptome, thereby impacting tumour phenotype, survival, growth and spread. Interestingly, the acquisition of senescent phenotype can be triggered by epigenetic changes, acting as a double-edged sword via its ability to suppress tumorigenesis or by facilitating an inflammatory milieu conducive for cancer progression. Concurrently, an aberrant redox metabolism, which is a function of the balance between reactive oxygen species (ROS) generation and intracellular anti-oxidant defences, influences signalling cascades and genomic stability in cancer cells by serving as a critical link between epigenetics and senescence. Recognizing this intricate interconnection offers a nuanced perspective for therapeutic intervention by simultaneously targeting specific epigenetic modifications, modulating senescence dynamics, and restoring redox homeostasis.

Background General practitioners (GPs) form the gateway to healthcare in numerous European countries. Their role in addressing and managing overweight/obesity in children is crucial. In Dutch guidelines, GPs are encouraged to proactively address weight-related issues during patient consultations, regardless of the initial reason of the visit.Objective(s) To examine the frequency, management and follow-up of GP visits of children for overweight/obesity and the identification by GPs of these children presenting with other complaints.Methods A retrospective cohort study. Health records from 2012–2021 in the Rijnmond Primary Care Database (RPCD) of children aged 2–18 with overweight/obesity who visited the GP were analysed. Children were categorised into two groups: those visiting for weight-related issues (group 1) and those visiting for other complaints but identified as overweight or obese by GPs (group 2). Data on patient demographics, reasons for contact, and management strategies were extracted.Results From the 120,991 children, 3035 children with documented overweight or obesity were identified, 208 were excluded. The study population comprised 2827 individuals: 55% belonging to group 1, 45% to group 2. The frequency of first visits remained stable at approximately 0.5% visits per total person-years each year. Group 1 received more referrals (74%) and follow-up consultations (45.5%) than group 2 with 17% referrals and 19.7% follow-up consultations.Conclusion This study highlights a concerning difference in the management of the two groups. Strategies for effective management of overweight in children and the GP’s role, warrant further investigation. Especially when overweight is not the primary reason for visit.

Comprehensive evaluation of cancer screening activities based on individual experiences is urgently needed to address the burden of cancer among Métis people. In this co-designed and co-led study, a cancer screening questionnaire developed for Métis people to evaluate their cancer screening histories and to explore barriers and facilitators to cancer screening was used. Adult Métis Albertans were invited to participate in the anonymous survey through a multi-modal strategy used for community consultations. Descriptive analyses compared responses between regions, age groups and geographic locations. In total, 370 participants who identified as Métis consented and contributed responses between 12 September and 2 December 2022. Female respondents reported higher rates of cervical and breast cancer screening (>94%) and lower rates of colorectal cancer screening (67–78%). Most of the barriers and facilitators were rated as very important, especially access to reliable and accurate information on screening, risks and benefits of cancer screening, explanation of the test results or procedures, trust in their health care provider(s) and health care system and access to a primary health care provider. This study fills a crucial gap that can inform targeted interventions to increase cancer screening awareness and rates among Métis Albertans and reduce their cancer burden.

AbstractEvaluation of maize varieties under multiple environments, including drought and low nitrogen (N) stressed sites is an important breeding approach, to identify well adapted and stable maize varieties. This study was undertaken to identify new quality protein maize (QPM) hybrids that have good agronomic performance and assess the presence of genotype by environment (G × E) interaction and grain yield stability of QPM hybrids under different environment conditions. Forty-five hybrids, including two QPM, two non-QPM and one local check were evaluated across 34 environments under stress and non-stress conditions in Ethiopia, Zimbabwe, Zambia, Mozambique, and Malawi during 2018 to 2020. Additive Main Effects and Multiplicative Interaction (AMMI) and Genotype main effects plus G × E interaction (GGE) bi-plots were used for stability analysis. Environment, genotype and G × E interaction effects were significant for grain yield and other traits in all management conditions. The top yielding hybrids were 44 (QS7646) 12 (CZH15099Q) under optimum; 14 (CZH15142Q), 44 (QS7646) and 23 (CZH17192Q) under random stress; 9 (CZH142237Q) and 10 (CZH142238Q) under managed drought; and 14 (CZH15142Q) and 34 (CZH17203Q) under low N conditions. Among these, 10 (CZH142238Q) and 14 (CZH15142Q) were the most stable hybrids and can be recommended for release in sub-Saharan Africa to improve food and nutritional security of smallholder farmers who depend on maize. Kwekwe (KWE), Bindura (BIN), Chokwe (CHO) and Bako (BK2) were identified as the most discriminating and representative for optimum, random stress, managed drought and low N environments, respectively and help to identify superior hybrids.

Madeleine de Scudéry’s own version of Mariamne in the first volume of The Illustrious Women, or the Heroic Orations (1642) asserts the heroine’s virulent eloquence by legitimizing it. According to Scudéry, Mariamne’s desobedience far from proves the moral faltering of a woman who, overcome by hatred for her husband, forgot her place and gave into her impulses. Instead, her virulence demonstrates the nobility and the reliability or her character. Since Mariamne is the last direct heiress of the Maccabees, her passionate revolt against Herod’s tyranny is her duty as queen, not a sign of her unruliness. My work analyses the rhetoric and stylistic strategies that Scudéry mobilizes to consecrate Mariamne’s relentless denouncing of Herod’s abuses of power. I argue that Scudéry invests irony with an astonishing function. By turning a simple figure of speech into an enunciative modality, Scudéry magnifies the three rhetorical appeals: ethos, logos, and pathos. Scudéry seeks to canonize Mariamne’s “learned disparagement” of Herod. She moves female eloquence away from pure pathos and bases it upon logical reasonings, without sacrificing both Mariamne’s proud ethos and vehement elocutio. Finally, I show how Scudéry restores the heroine’s authority and agency as a sovereign in the midst of a tense policital and intimate context.

Plants provide and possess many elements that help humans and the whole ecosystem strive and function properly. Plant disease affects food production, the economy, and the health and safety of plants and humans who consume the plants. Identifying the type of plant disease might be a good solution in planning preventive measures against the disease. Rice or Oryza Sativa is one of the predominant foods or crops in the world. Due to rice diseases, the rice production has significantly decreased. The purpose of this study is to develop a system that will identify Tungro, Blast, and Blight which are the most common diseases in the Philippines. These diseases have similar symptoms shown on the leaf which are visible spots, damage, and discoloration on the leaf. The hardware consists of a Pi Camera, LCD, and a microcomputer. The captured image of a damaged leaf was processed using a CNN for diagnosis. The website serves as a GUI where the user can see the output and the previous predictions. CNN can detect if the leaf is healthy and predict if the disease is Tungro, Blast, or Blight. Laplacian function was used to check the blurriness of the image. The method used in this study is Densenet201 with 100 x 100 pixels target size and 3 x 3 convolutional layer. The dataset contains 400 images per prediction, with more than 1,600 images. The system can detect and identify healthy, Tungro, Blast, and Blight with 80 % reliability. Based on the Likert scale and Cronbach’s alpha, the respondents consider the system excellent in detecting and identifying healthy and diseased plants.

This study delved into the impact of integrating cognitive and practical skills within the National Certification II (NC II) in Commercial Cookery on student preparedness and assessment outcomes. The objective is to enhance vocational training programs by analyzing the relationships between these variables and identifying areas for improvement. Using an embedded mixed-methods approach, the research combined quantitative and qualitative data for a comprehensive analysis. Surveys were employed to measure cognitive skills, practical skills, preparedness, and assessment performance among NC II students, while qualitative insights were obtained from interviews and focus group discussions with educators and students. Pearson correlation coefficients indicated very high positive correlations between cognitive skills and practical skills (r = 0.929) and between preparedness and assessment outcomes (r = 0.917), with p-values of 0, highlighting the strong interdependence of these variables and their significant impact on educational performance. The study emphasizes the importance of integrating cognitive and practical skills in vocational education, demonstrating that improvements in these areas are closely connected. Additionally, the significant relationship between preparedness and assessment outcomes underscores the need for thorough preparation to achieve better results. Based on these findings, recommendations include developing targeted educational strategies to bolster both cognitive and practical skills and enhancing preparedness efforts. Future research should focus on exploring the longitudinal impacts of these interventions and applying the findings to broader educational contexts to further validate their effectiveness.

Background: Gastrointestinal anastomosis surgery does not have standardized postoperative feeding practices. The majority of surgeons used to believe that early enteral feeding (EEF) after bowel resection and anastomosis could be harmful and cause stress on the anastomosis site, increasing the risk of leakage. This study compared EEF patients whose nutrition started for the first 24 hours with delayed enteral feedings (DEF) during bowel anastomosis surgery Case: This systematic review and meta-analysis used the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. All extracted data was presented in the table, summarized narratively, and analyzed statistically using forest plots through a relative risk (RR) with a fixed effect model test. Results: This research included 444 participants from 6 studies, including 196 in the EEF group and 248 in the DEF group. From the analysis, the incidence of leakage, gastrointestinal symptoms of abdominal distention and vomiting, fever, and surgical site infection (SSI) were lower in the EEF group although not significant, with statistical values in order namely; leakage (RR 0.39, p=0.10); abdominal distention (RR 0.67, p=0.11), vomiting (RR 0.88, p=0.53); fever (RR 0.61, p=0.005) and SSI (RR 0.42; p=0.002). Length of stay (LOS) was found to be statistically significant shortened in the EEF group (Mean Difference 2.23 days; P < 0.00001). Conclusion: The EEF group had a statistically insignificant lower incidence of leakage, gastrointestinal symptoms, fever, and SSI and statistically significant shorter LOS. Twenty-four hours post-operation enteral feeding showed a satisfactory outcome, so we recommend it in either small or large bowel anastomosis surgery.

Abstract Previous work has shown that estimates of climate sensitivity vary over time in response to abrupt CO2 forcing in climate model simulations. The energy fluxes that drive warming in response to increasing CO2 also influence precipitation, which prompts the question: Does the precipitation response therefore also vary over time? We investigate by examining the response of precipitation to warming forced by greenhouse gases—the hydrological sensitivity—in a set of millennial‐length climate simulations with multiple climate models, Long Run Model Intercomparison Project (LongRunMIP). We compare hydrological sensitivity calculated from three different timescales of the simulations: years 1–20, 21–150, and 151–1000. We show that the hydrological sensitivity lacks a consistent dependence on timescale, in contrast to climate sensitivity. Decomposition of the surface energy budget reveals that the relative muting of the multi‐model mean hydrological sensitivity is driven by surface downwelling shortwave flux.

Introduction ISMiHealth is a clinical decision support system, integrated as a software tool in the electronic health record system of primary care, that aims to improve the screening performance on infectious diseases and female genital mutilation (FGM) in migrants. The aim of this study is to assess the health impact of the tool and to perform a process evaluation of its feasibility and acceptability when implemented in primary care in Catalonia (Spain).Methods and analysis This study is a cluster randomised control trial where 35 primary care centres in Catalonia, Spain will be allocated into one of the two groups: intervention and control. The health professionals in the intervention centres will receive prompts, through the ISMiHealth software, with screening recommendations for infectious diseases and FGM targeting the migrant population based on an individualised risk assessment. Health professionals of the control centres will follow the current routine practice.A difference in differences analysis of the diagnostic rates for all aggregated infections and each individual condition between the intervention and control centres will be performed. Mixed-effects logistic regression models will be carried out to identify associations between the screening coverage and predictor factors. In addition, a process evaluation will be carried out using mixed methodology.Ethics and dissemination The study protocol has been approved by the institutional review boards at Hospital Clínic (16 June 2022, HCB/2022/0363), Clinical Research Ethics Committee of the Primary Care Research Institute IDIAPJGol (22 June 2022, 22/113-P) and the Almería Research Ethics Committee (27 July 2022, EMC/apg). The study will follow the tenets of the Declaration of Helsinki and Good Clinical Practice. All researchers and associates signed a collaboration agreement in which they undertake to abide by good clinical practice standards.Findings will be disseminated in peer-reviewed journals and communications to congresses.Trial registration number NCT05868005.

IntroductionPathogen genomics, where whole genome sequencing technologies are used to produce complete genomic sequences of pathogens, is being increasingly used for infectious disease surveillance and outbreak response. Although proof-of-concept studies have highlighted the viability of using pathogen genomics in public health, few studies have investigated how end-users utilize pathogen genomics in public health. We describe a protocol for a study that aims to identify key factors that influence the use of pathogen genomics to inform public health responses against infectious diseases in Australia and New Zealand.MethodsWe will use qualitative comparative analysis (QCA), a case-oriented methodology that systematically compares and analyses multiple cases (or ‘units of analysis’), to identify multiple pathways leading to the use of pathogen genomics results in public health actions. As part of the process, we will develop a rubric to identify and define the use of pathogen genomics and individual factors affecting this process. Simultaneously, we will identify cases where pathogen genomics has been used in public health across Australia and New Zealand. Data for these cases will be collected from document review of publicly available and confidential documents and semi-structured interviews with technicians and end-users and summarized in a case report. These case reports will form the basis for scoring each case on the extent of the use of pathogen genomics data and the presence or absence of specific factors such as the ease of extracting essential information from pathogen genomics reports and perceptions toward pathogen genomics. Using the scores, cases will be analyzed using QCA techniques to identify pathways leading to the use of pathogen genomics data. These pathways will be interpreted alongside the cases to provide rich explanations of the use of pathogen genomics in public health.DiscussionThis study will improve our understanding of the key factors that facilitate or hinder the use of pathogen genomics to inform public health authorities and end-users. These findings may inform ways to enhance the use of pathogen genomics data in public health.

The ecological and evolutionary consequences of ploidy-driven trait variation, particularly for autopolyploids, remain poorly understood. Saxifraga oppositifolia L. (purple saxifrage), is a highly successful arctic-alpine plant species with significant genetic and phenotypic variation potentially related to autopolyploidy. Over the past decade, we have accumulated knowledge of S. oppositifolia through student projects at the University Centre in Svalbard. Building on this knowledge, we initiated the long-term “SO-field study” in 2018 including 768 permanently tagged plants screened for ploidy level, trait variation and environmental associations. Here we summarize main findings from unpublished student projects, consolidating and extending these findings with the available data from the ongoing SO-field study, containing 63% diploids, 16% triploids, and 21% tetraploids. Our results support that Svalbard is a mixed-ploidy contact zone, where ploidy is strongly associated with certain traits, including growth form, leaf mass area, flower investment, seed production and habitat. Autopolyploidy has significantly influenced both ecology and evolution of S. oppositifolia and needs to be accounted for when autopolyploids are used as a study species or evaluated for management purposes. Our findings suggest considerable re-interpretation of former research and pave the way for new inquiries and hypotheses to be tested within this framework.

Abstract Applying science to conservation requires deliberate planning and action infrequently taught in academic settings. To illustrate impactful analysis and science communication, we describe scientific activities targeting the needs of land trusts, NGOs, landowners, and government agencies working to conserve the Florida Wildlife Corridor (“Corridor”). This 7.2 million hectare area is prioritized for habitat connectivity conservation in the US state of Florida. Our activities are built on decades of science guiding Florida land conservation. We quantified threats (e.g., average of over 14,000 ha of development/year from 2001 to 2019) and socio‐ecological benefits of Corridor conservation, prioritized yet‐to‐be‐conserved Corridor areas, produced and shared a new statewide connectivity model, and convened groups to identify campaign science needs. The new connectivity model—the Florida Circuit Model—supported the geography of the Corridor, as designated, and facilitates local (10 km radius, or less) conservation planning. Our efforts have contributed to allocation of over $2 billion for land conservation and the permanent protection of over 82,000 ha within the Corridor by state agencies from June 2021 to March 2024. Targeting science to outreach and policy, planning, and management decisions can motivate public, media, researcher, and government support for land conservation, improve conservation interventions, and attract research funding.

Indonesia is a relatively large market for the cosmetics industry in the hair care category. Teenagers and young adults are among the dominant segments in cosmetic consumption. Hair and scalp problems often experienced are hair loss and unhealthy hair structure. This problem can be overcome with hair serum. This dosage form is attractive because it can be purchased freely and is quite promising due to its high active substance content. Various types of hair serums are available on the market so that they can be adjusted based on user preferences. The high level of public consumption of hair serum needs to be balanced with education regarding hair serum. The education process uses lecture and workshop methods related to identifying hair problems, the nutrition needed by hair, and the types and formulation of hair serum. The workshop was conducted directly by involving participants in producing the hair serum. The educational process was attended by 24 students aged 19-22 years, 21% coming from outside Atma Jaya and 79% from internal Atma Jaya. Gender includes 19% of men and the rest of women. The educational process increased the understanding of 92% of participants, with an average score from 5.9 to 9.75. As many as 96% of participants were very interested and stated that this workshop supported the theory that had been given to make it easier to understand.

Abstract Background Myopia affects 1.4 billion individuals worldwide. Notably, there is increasing evidence that choroidal thickness plays an important role in myopia and risk of developing myopia-related conditions. With the advancements in artificial intelligence (AI), choroidal thickness segmentation can now be automated, offering inherent advantages such as better repeatability, reduced grader variability, and less reliance for manpower. Hence, we aimed to evaluate the agreement between AI-automated and manual segmented measurements of subfoveal choroidal thickness (SFCT) using two swept-source optical coherence tomography (OCT) systems. Methods Subjects aged ≥ 16 years, with myopia of ≥ 0.50 diopters in both eyes, were recruited from the Prospective Myopia Cohort Study in Singapore (PROMYSE). OCT scans were acquired using Triton DRI-OCT and PLEX Elite 9000. OCT images were segmented both automatically with an established SA-Net architecture and manually using a standard technique with adjudication by two independent graders. SFCT was subsequently determined based on the segmentation. The Bland–Altman plot and intraclass correlation coefficient (ICC) were used to evaluate the agreement. Results A total of 229 subjects (456 eyes) with mean [± standard deviation (SD)] age of 34.1 (10.4) years were included. The overall SFCT (mean ± SD) based on manual segmentation was 216.9 ± 82.7 µm with Triton DRI-OCT and 239.3 ± 84.3 µm with PLEX Elite 9000. ICC values demonstrated excellent agreement between AI-automated and manual segmented SFCT measurements (PLEX Elite 9000: ICC = 0.937, 95% CI: 0.922 to 0.949, P

Abstract Background Community health workers (CHWs) had important roles mitigating the impact of the COVID-19 pandemic in vulnerable communities. We described how CHWs supported the dissemination of COVID-19 information and services during the early pandemic response. Methods Online article searches were conducted across five scientific databases, with review article reference lists hand searched to identify grey/unpublished literature. Articles were included if they reported on a program that engaged CHWs and aimed to prevent/control COVID-19. Results Nineteen relevant programs were identified from 18 included articles. CHWs were widely engaged in the pandemic response, especially in low- and middle-income countries and in vulnerable communities. CHWs’ ability to effectively disseminate COVID-19 information/services was enabled by community trust and understanding community needs. CHWs were often underfunded and required to work in difficult conditions. Pre-existing services incorporating CHWs rapidly adapted to the new challenges brought by the pandemic. Conclusions We recommend establishing programs that employ CHWs to disseminate health information and services in communities at-risk of misinformation and poor health outcomes during non-pandemic times. CHWs are well-placed to deliver interventions should an infectious disease outbreak arise. Having pre-existing trusted relationships between CHWs and community members may help protect vulnerable groups, including when outbreaks occur.

Abstract Background Precise evaluation of fungal conidia production may facilitate studies on resistance mechanisms and plant breeding for disease resistance. In this study, hyperspectral imaging (HSI) was used to quantify the sporulation of Magnaporthe oryzae on the leaves of rice cultivars grown under controlled conditions. Three rice genotypes (CO 39, Nipponbare, IR64) differing in susceptibility to blast were inoculated with M. oryzae isolates Guy 11 and Li1497. Spectral information (450–850 nm, 140 wavebands) of typical leaf blast symptoms was recorded before and after induction of sporulation of the pathogen. Results M. oryzae produced more conidia on the highly susceptible genotype than on the moderately susceptible genotype, whereas the resistant genotype resulted in no sporulation. Changes in reflectance spectra recorded before and after induction of sporulation were significantly higher in genotype CO 39 than in Nipponbare. The spectral angle mapper algorithm for supervised classification allowed for the classification of blast symptom subareas and the quantification of lesion areas with M. oryzae sporulation. The correlation between the area under the difference spectrum (viz. spectral difference without and with sporulation) and the number of conidia per lesion and the number of conidia per lesion area was positive and count-based differences in rice - M. oryzae interaction could be reproduced in the spectral data. Conclusions HSI provided a precise and objective method of assessing M. oryzae conidia production on infected rice plants, revealing differences that could not be detected visually.

Abstract Background Multiple chronic conditions (MCC) are defined as the presence of two or more chronic conditions, that significantly impact health status, functional capacity, quality of life, and overall healthcare management. Despite the significant evidence on chronic disease burden, the co-existence of MCC within a household in low- and middle-income countries (LMICs) is less studied. This study therefore estimates the prevalence of MCC and its determinants among adults in the Indian households. Methods Data used in this study were drawn from the fifth round of the National Family Health Survey (NFHS) conducted in 2019–21. Data sets of men (15–54 years) and women (15–49 years) were used for the study. The total sample size of adults for this analysis was N = 239,848. The outcome variable of this study was multiple chronic conditions (MCC) in adults which included a total of nine chronic conditions (hypertension, diabetes, chronic respiratory diseases, chronic kidney disorders, cancer, thyroid disorders, obesity, and heart diseases, consuming alcohol, chewing tobacco, and smoking) documented in NFHS-5. Descriptive statistics and binary logistic regression analysis were used to quantify the results. Results A prevalence of 5.5% of MCC in adults emerged from our study. Logistic regression analysis identified that younger age, males (AOR 0.36 (0.33–0.39)), urban areas (AOR 1.11 (1.02–1.17)) as the place of residence, and participants representing SC (AOR 0.89 (0.81–0.97)), and ST (AOR 1.30 (1.17–1.45)), had a higher risk of MCC irrespective of level of education, type of occupation, marital status, or wealth index, and states from any category of social progress. Conclusion A 5% prevalence of MCC specifically obesity, substance use, and hypertension calls for integrated efforts aiming at behavior change, and regulatory efforts to prevent further increase of MCC among young adults in India.

Abstract Background Pneumonia is a leading cause of childhood morbidity and mortality. Hospital re-admission may signify missed opportunities for care or undiagnosed comorbidities. Methods We conducted a retrospective cohort study including children aged $$\ge$$ ≥ 2 months-14 years hospitalised with severe pneumonia between 2013 and 2021 in a network of 20 primary referral hospitals in Kenya. Severe pneumonia was defined using the 2013 World Health Organization criteria, and re-admission was based on clinical documentation from individual patient case notes. We estimated the prevalence of re-admission, described clinical management practices, and modelled risk factors for re-admission and inpatient mortality. Results Among 20,603 children diagnosed with severe pneumonia, 2,274 (11.0%, 95% CI 10.6–11.5) were readmitted. Re-admission was independently associated with age (12–59 months vs. 2–11 months: adjusted odds ratio (aOR) 1.70, 1.54–1.87; >5 years vs. 2–11 months: aOR 1.85, 1.55–2.22), malnutrition (weight-for-age-z-score (WAZ) -2SD: aOR 2.05, 1.84–2.29); WAZ − 2 to -3 SD vs. WAZ> -2SD: aOR 1.37, 1.20–1.57), wheeze (aOR 1.17, 1.03–1.33) and presence of a concurrent neurological disorder (aOR 4.42, 1.70-11.48). Chest radiography was ordered more frequently among those readmitted (540/2,274 [23.7%] vs. 3,102/18,329 [16.9%], p -2SD: aHR 1.87, 1.71–2.05); WAZ − 2 to -3 SD vs. WAZ >-2SD: aHR 1.46, 1.31–1.63), complete vaccination (aHR 0.74, 0.60–0.91), wheeze (aHR 0.87, 0.78–0.98) and anaemia (aHR 2.14, 1.89–2.43) were independently associated with mortality. Conclusions Children readmitted with severe pneumonia account for a substantial proportion of pneumonia hospitalisations and deaths. Further research is required to develop evidence-based approaches to screening, case management, and follow-up of children with severe pneumonia, prioritising those with underlying risk factors for readmission and mortality.

Yellow Phosphorus (YP) poisoning is an infrequent, yet severe medical condition characterised by multi-systemic toxicity. The ingestion or inhalation of YP can lead to gastrointestinal irritation, hepatic injury, and Acute Liver Failure (ALF). Plasmapheresis, a therapeutic intervention involving the removal and replacement of plasma components, is a potential adjunctive treatment for YP poisoning. This case report aims to explore the mechanistic rationale, clinical efficacy, and safety considerations of plasmapheresis in the management of this toxicological emergency. Here, a 16-year-old female reported to the Emergency Department (ED), having consumed 1-2 g of Ratol poison at two different times of the day. She came to the hospital on day 4 post-consumption. On admission, the patient was jaundiced and Arterial Blood Gas (ABG) analysis was suggestive of respiratory alkalosis with hypokalemia. Treatment focused on fluid therapy, vitamin K therapy, and N-Acetyl Cysteine (NAC). She developed angioedema and urticaria with no airway compromise, in response to intravenous NAC. A diagnosis of acute liver injury secondary to YP poisoning was made. Close monitoring of liver function and coagulation parameters, and bleeding complications was done. Plasmapheresis was considered as NAC reinitiating was not feasible due to potential anaphylaxis. The patient responded well to the treatment and was discharged on day 7 of hospitalisation.

Abstract Background Racism contributes to health disparities and is a serious threat to public health. Teaching physicians about racism, how to address it in medical practice, and developing high quality and sustainable curricula are essential to combating racism. Objective This study aimed to (1) describe the experience of racism and anti-racism teaching in residency programs, and elicit recommendations from key informants, and (2) use these data and formative research to develop recommendations for other residencies creating, implementing, and evaluating anti-racism curricula in their own programs. Methods From May to July 2023, 20 faculty and residents were recruited via convenience sampling for key informant interviews conducted via Microsoft Teams. Interviews were audio recorded, transcribed, and coded. An initial list of themes was developed using theoretical frameworks, and then refined using a grounded-theory approach. A brief online optional anonymous demographic survey was sent to participants in August of 2023. Results Eighty percent (20/25) of participants approached were interviewed. Seventy-five percent (15/20) answered a brief optional demographic survey. Seven themes emerged: (1) Racism in medicine is ubiquitous; (2) Anti-racism teaching in medicine varies widely; (3) Sustainability strategies should be multifaceted and include recruitment, resource allocation, and outcome measures; (4) Resources are widely available and accessible if one knows where to look; (5) Outcomes and metrics of success should include resident- faculty-, patient- community-, and system-focused outcomes; (6) Curricular strategies should be multilayered, longitudinal, and woven into the curriculum; and (7) Self-reflection and discomfort are necessary parts of the process. Conclusions This study is one of the first to qualitatively examine perspectives of key stakeholders invested in anti-racism teaching for residents. The Support - Pipeline - Outcomes - Community (SPOC) Model, that was developed using information collected during this study, can be used in the future as a guide for others working to design and implement sustainable and high quality anti-racism curricula for residents.

Usaha Mikro, Kecil, dan Menengah merupakan satu kekuatan ekonomi melalui kemampuannya untuk menyerap tenaga kerja. Salah satu kategori usaha yang memiliki peluang yang besar adalah jasa kecantikan karena jumlahnya masih sedikit, terutama di Tasikmalaya. Pandemi Covid-19 menjadi kendala utama bagi pelaku usaha yang memasarkan produk/jasanya secara langsung. Talita Care merupakan salah satu usaha bidang kecantikan yang masih melakukan pemasaran secara konvensional dan belum memiliki kompetensi untuk melakukan pemasaran secara digital. Karena itu diberikan program pendampingan kepada Talita Care untuk mengembangkan kemampuan Talita Care terutama dari sisi Pemasaran Digital. Penerapan Pemasaran Digital diangkat sebagai fokus pembahasan karena memiliki peran penting sebagai strategi promosi bagi produk Talita Care untuk semakin dikenal oleh masyarakat, bahkan setelah pandemi berakhir. Mengingat kondisi pandemi, program pendampingan dilakukan secara online dengan menggunakan media Zoom. Program ini berhasil membuka channel pemasaran baru bagi Talita Care, meningkatkan penjualan melalui platform digital serta meningkatkan kompetensi pemilik dan pegawai Talita Care dalam Pemasaran Digital.

Objective: This study aims to comprehensively assess TRT's cardiovascular safety in males with hypogonadism, providing valuable insights for treatment decisions. Material & Methods: Adhering to PRISMA guidelines, we registered our PROSPERO protocol and analyzed relevant English-language randomized clinical trials published from 2008 to 2023. Results: Among 1187 initial papers, 7 studies met inclusion criteria, with 6 in quantitative analysis and all 7 in qualitative assessment. Our findings indicate that TRT does not significantly increase the risk of cardiovascular events compared to placebo. Specifically, the analysis of major adverse cardiac events (MACE) yielded an OR of 0.90 (95% CI: 0.74, 1.10; I² = 26%; p = 0.25), while the evaluation of all cardiovascular adverse events revealed an OR of 1.37 (95% CI: 0.73, 2.55; I² = 75%; p = 0.001). Conclusion: This study offers reassurance for clinical decision-making by suggesting that TRT is not significantly associated with an elevated cardiovascular risk in hypogonadal men, addressing the ongoing debates on this issue. Keywords: Cardiovascular safety, hypogonadism, testosterone replacement therapy.

Background: The Government of Kenya adopted the practice of 7.1% chlorhexidine digluconate (CHX) application for all newborns. However, challenges in implementation have arisen, as some counties in Kenya do not align with the underlying criteria for this recommendation. Therefore, we aimed to evaluate CHX adoption and associated factors in Kiambu County, Kenya. Methods: A cross-sectional survey was conducted among 434 caregivers attending their 6-week well-child clinics using multistage sampling. Descriptive statistics summarized sociodemographic data and CHX cord care uptake, while logistic regression analyzed associations between variables and CHX uptake. Results: The prevalence of use of CHX in Kiambu county was 41.0%. Twenty-two percent (22%) of the mothers were provided CHX post-delivery and 100% used it. Of the 78% who weren't provided CHX post-delivery, 39% were given prescriptions for CHX. The 61% who were not issued a prescription resorted to the use of surgical spirit (34.8%), dry cord care (9.2%) and saliva (3%). In public facilities, being married [AOR 0.19 (0.11–0.33)] and index use of CHX [AOR 0.17 (0.08–0.35)] were associated with non-adherence. Being employed [AOR 2.46 (1.26–4.77)] and delivering in hospital [COR 3.29 (1.69–7.08)] increased the likelihood of using CHX. Conclusion: Weak prescription and adherence to the CHX cord care policy in Kiambu county has led to women turning to alternative substances for cord care. Quality improvement strategies are necessary to enhance adherence to guidelines, such as refining county-specific recommendations for cord care and providing corresponding patient education, or issuing definitive prescriptions for CHX post-delivery.

Summary: Background: Understanding how SARS-CoV-2 breakthrough infections impacts the breadth of immune responses against existing and pre-emergent SARS-CoV-2 strains is needed to develop an evidence-based long-term immunisation strategy. Methods: We performed a randomised, controlled trial to assess the immunogenicity of homologous (BNT162b2) versus heterologous (mRNA-1273) booster vaccination in 100 BNT162b2-vaccinated infection-naïve individuals enrolled from October 2021. Post hoc analysis was performed to assess the impact of SARS-CoV-2 infection on humoral and cellular immune responses against wild-type SARS-CoV-2 and/or Omicron subvariants. Findings: 93 participants completed the study at day 360. 71% (66/93) of participants reported first SARS-CoV-2 Omicron infection by the end of the study with similar proportions of infections between homologous and heterologous booster groups (72.3% [34/47] vs 69.6% [32/46]; p = 0.82). Mean wildtype SARS-CoV-2 anti-S-RBD antibody level was significantly higher in heterologous booster group compared with homologous group at day 180 (14,588 IU/mL; 95% CI, 10,186–20,893 vs 7447 IU/mL; 4646–11,912; p = 0.025). Participants who experienced breakthrough infections during the Omicron BA.1/2 wave had significantly higher anti-S-RBD antibody levels against wildtype SARS-CoV-2 and antibody neutralisation against BA.1 and pre-emergent BA.5 compared with infection-naïve participants. Regardless of hybrid immunity status, wildtype SARS-CoV-2 anti-S-RBD antibody level declined significantly after six months post-booster or post-SARS-CoV-2 infection. Interpretation: Booster vaccination with mRNA-1273 was associated with significantly higher antibody levels compared with BNT162b2. Antibody responses are narrower and decline faster among uninfected, vaccinated individuals. Boosters may be more effective if administered shortly before infection outbreaks and at least six months after last infection or booster. Funding: Singapore NMRC, USFDA, MRC.

Context: Vitamin D acts as an immune modulator, by downregulating the production of inflammatory immune markers and upregulating the production of anti-microbial peptides and anti-inflammatory markers. Hence, vitamin D may be useful in improving the immune response against respiratory tract diseases. Objective: A systematic review (following PRISMA guidelines) and meta-analysis were performed to study the effect of vitamin D supplementation on the immune response to respiratory tract diseases irrespective of population type. Data sources: Electronic search engines Pubmed, Pubmed Central, Google Scholar, Clinicaltrials.gov, Clinical Trial Registry India, ScienceDirect, and Web of Science were searched for relevant articles. Data extraction: Sixteen RCTs were eligible for inclusion. Jadad scale was used to assess the quality of studies. Methods of the selected studies were assessed using the Cochrane Risk of Bias assessment. Using the random-effects model meta-analysis was performed if at least three articles studied similar immune markers. Thus, IL-6, cathelicidin, CRP, TNF alpha, and IFN gamma, were included in the analysis. In all 16 articles were included for qualitative assessment, and 14 articles for meta-analysis. Data analysis: There was a significant decrease in CRP levels after intervention with an overall effect of Z = 3.37 (P

Live attenuated vaccines (LAVs) whose virulence would be controlled at the tissue level could be a crucial tool to effectively fight intracellular bacterial pathogens, because they would optimize the induction of protective immune memory while avoiding the long-term persistence of vaccine strains in the host. Rational development of these new LAVs implies developing an exhaustive map of the bacterial virulence genes according to the host organs implicated. We report here the use of transposon sequencing to compare the bacterial genes involved in the multiplication of Brucella melitensis, a major causative agent of brucellosis, in the lungs and spleens of C57BL/6 infected mice. We found 257 and 135 genes predicted to be essential for B. melitensis multiplication in the spleen and lung, respectively, with 87 genes common to both organs. We selected genes whose deletion is predicted to produce moderate or severe attenuation in the spleen, the main known reservoir of Brucella, and compared deletion mutants for these genes for their ability to protect mice against challenge with a virulent strain of B. melitensis. The protective efficacy of a deletion mutant for the plsC gene, implicated in phospholipid biosynthesis, is similar to that of the reference Rev.1 vaccine but with a shorter persistence in the spleen. Our results demonstrate that B. melitensis faces different selective pressures depending on the organ and underscore the effectiveness of functional genome mapping for the design of new safer LAV candidates.

Background: Compared to other occupational groups, first responders (FR) experience worse mental health outcomes due to duty-related trauma and occupational stressors. Despite their best efforts, they bring this stress home to friends and family. Consequently, FR and their supporters suffer from increased psychosocial difficulties and experience stigma and other barriers to help-seeking. Prior work offers little opportunity for open dialogue and shared understanding of the repercussions of this occupation for all members of the first responder community.In this qualitative study, we aimed to: (i) explore the lived experience of Irish FR and their family members (FM) related to occupational stressors, and (ii) identify opportunities to engage FM with existing organizational supports available for FR. Methods: Using a community based participatory research (CBPR) approach, we conducted six focus groups involving a total of fourteen participants comprising FR, organizational representatives, and FM. All focus groups were audio recorded, transcribed, and analyzed using reflexive thematic analysis. Findings: FR and FM shared their experiences of both joining and learning to live as members of the FR community in Ireland. Through our analysis, we identified a main theme of ‘crossing thresholds’, characterizing their transformative learning experiences. This learning experience includes recognizing the consequences of this new role for them as individuals and for their relationships. Participants also shared how they have learned to cope with the consequences of their roles and what they need to better support each other. Conclusions: FM are often unheard, hidden members of the first responder community in Ireland, highlighting an unmet need for FR organizations to acknowledge FM role in supporting FR and to provide them with the appropriate training and resources required. Training for new recruits needs to move beyond the tokenistic involvement of FM and encourage knowledge sharing among experienced and novice members. Cultural change is required to support help-seeking among FR and foster a sense of peer support and community among families.

Abstract Introduction Identifying the optimal approaches to offering HIV prevention to meet the needs of those at risk is a high priority, particularly given the expanding toolkit of biomedical HIV prevention options. An ongoing study in rural East African communities evaluated the uptake of choices in product, testing mode and location of care delivery through a structured patient‐centred HIV prevention delivery model. In this qualitative study, we sought to understand clients’ experiences of this “dynamic choice prevention model” (DCP) and highlight pathways of action to inform HIV prevention delivery models. Methods In‐depth semi‐structured interviews were conducted from November 2021 through March 2022 with a purposively selected sample of n = 56 participants in DCP trials (across outpatient departments, antenatal clinics and community settings), and n = 21 healthcare providers (total n = 77). A seven‐person multi‐regional team translated and inductively coded transcript data. We used a framework analysis approach to identify emergent themes. Results Individuals taking up HIV pre‐exposure prophylaxis (PrEP) reported feelings of relief, liberation from fears of acquiring HIV and satisfaction with being able to take action despite partners’ behaviours. Couples used a range of approaches afforded by the study to persuade partners to get tested and opt for PrEP. Post‐exposure prophylaxis (PEP) use was less common, although women welcomed it in the event of sexual coercion or assault. Participants discussed switching from PEP to PrEP after familiarizing themselves with usage and ascertaining ongoing risk. Participants felt respected by providers, trusted them and appreciated being able to contact them directly for telephone support. Prevention uptake was hindered by stigma, limited experience with and knowledge of prevention methods, gendered and generational power dynamics within intimate partnerships and families, and negative perceptions of methods due to the products themselves. Participants anticipated long‐acting injectable PrEP could solve their challenges regarding pill size, daily pill burden and the likelihood of unwanted disclosure. Conclusions Diverse preferences and barriers to uptake of prevention require a choice of HIV prevention options, locations and delivery modalities—but in addition, flexible, competent and friendly care provision is crucial to promote uptake. Helping clients feel valued, and addressing their unique needs and challenges, enables their agency to prioritize their health.

Introduction Reducing neonatal deaths in premature infants in low- and middle-income countries is key to reducing global neonatal mortality. International neonatal networks, along with patient registries of premature infants, have contributed to improving the quality of neonatal care; however, the involvement of low-to-middle-income countries was limited. This project aims to form an international collaboration among neonatal networks in Asia (AsianNeo), including low-, middle- and high-income countries (or regions). Specifically, it aims to determine outcomes in sick newborn infants, especially very low birth weight (VLBW) infants or very preterm infants, with a view to improving the quality of care for such infants.Methods and analysis Currently, AsianNeo comprises nine neonatal networks from Indonesia, Japan, Malaysia, Philippines, Singapore, South Korea, Sri Lanka, Taiwan and Thailand. AsianNeo will undertake the following four studies: (1) institutional questionnaire surveys investigating neonatal intensive care unit resources and the clinical management of sick newborn infants, with a focus on VLBW infants (nine countries/regions); (2) a retrospective cohort study to describe and compare the outcomes of VLBW infants among Asian countries and regions (four countries/regions); (3) a prospective cohort study to develop the AsianNeo registry of VLBW infants (six countries/regions); and (4) implementation and evaluation of educational and quality improvement projects in AsianNeo countries and regions (nine countries/regions).Ethics and dissemination The study protocol was approved by the Research Ethics Board of the National Center for Child Health and Development, Tokyo, Japan (reference number 2020–244, 2022–156). The study findings will be disseminated through educational programmes, quality improvement activities, conference presentations and medical journal publications.

Summary: Background: In children with severe acute malnutrition (SAM) tuberculosis is common, challenging to diagnose, and often fatal. We developed tuberculosis treatment decision algorithms (TDAs) for children under the age of 5 years with SAM. Methods: In this prospective diagnostic study, we enrolled and followed up children aged

Background: A doctor's communication and interpersonal skills encompass gathering information to facilitate accurate diagnosis, counsel appropriately, give therapeutic instructions, and establish caring relationships with patients. While face-to-face consultations have been the norm, tele-consultations and enrolment in telemedicine apps have become necessary. Tele-consultations have been on the rise significantly during the COVID-19 lockdown. This study aims to assess the barriers to tele-consultations among doctors in Chennai. Methodology: This study uses a cross-sectional design to assess the barriers to tele-consultations among doctors in Chennai using a convenience sampling technique. Data was entered in Microsoft Excel and analyzed using SPSS software version 23. Results: 81.6% of the participants feel that teleconsultations have reduced face-to-face consultations. Only about 6% of the study participants preferred teleconsultation in the future. About a third of the doctors in the study could not treat/manage chronically ill patients through teleconsultations. About 70% of the doctors could follow up with their patients through telecommunication, but 70% failed to follow up. Conclusion: From this study, we conclude that only about 6% of the study participants would prefer teleconsultation in the future. Treating medical emergencies and assessment of surgical patients were considered as top 2 important barriers in this study with about half of them facing this barrier during their telecommunication.

Abstract Background The cohealth Health Concierge program operated in Melbourne, Australia from July 2020 to 30 June 2022. It provided peer-to-peer support to culturally and linguistically diverse residents of high-rise public housing. During this time, the COVID-19 public health response changed frequently and included movement restriction, testing and vaccination. We conducted a mixed-methods evaluation to determine the Health Concierge program’s impact on residents’ engagement with health services and public health activities. Methods The evaluation, informed by a Project Reference Group, used the RE-AIM framework. We analysed data from 20,901 routinely collected forms describing interactions between Concierges and residents from August 2021 to May 2022. Additional evaluation-specific data were collected between March and May 2022 in four housing estates; we surveyed 301 residents and conducted 32 interviews with residents, Concierges and program stakeholders. Results Concierges promoted COVID-safe behaviours; linked residents with support, testing and vaccination services; and disseminated up-to-date information. Of the 20,901 recorded interactions, 8,872 (42%) included Concierges providing support around COVID-19 vaccination. Most surveyed residents (191/301, 63%) reported speaking with a Concierge in the previous six months. The self-reported two-dose COVID-19 vaccine uptake was 94% (283/301). Some residents described having meaningful, appreciated conversations with Concierges, and some described superficial interactions. While residents initially welcomed the program, many felt it failed to evolve. Poorly defined management and hiring criteria led to variable program implementation. A need for bicultural workers to continue linking residents with services was discussed. Conclusions Concierges’ impact on residents may have contributed to high community uptake of COVID-19 testing and vaccination, and had benefits beyond the COVID-19 remit. We recommend the program be revised and continued to inform further preparedness planning and support service access generally. Program models such as this have potential to inform and reassure high-risk communities during a pandemic. In addition, such programs can help overcome vaccine hesitancy and promote protective health behaviours, regardless of whether a pandemic is currently occurring. Ensuring these programs remain responsive to the changing needs of end-users needs over time is imperative.

Abstract Background Although polygenic risk score (PRS) has emerged as a promising tool for predicting cancer risk from genome-wide association studies (GWAS), the individual-level accuracy of lung cancer PRS and the extent to which its impact on subsequent clinical applications remains largely unexplored. Methods Lung cancer PRSs and confidence/credible interval (CI) were constructed using two statistical approaches for each individual: (1) the weighted sum of 16 GWAS-derived significant SNP loci and the CI through the bootstrapping method (PRS-16-CV) and (2) LDpred2 and the CI through posteriors sampling (PRS-Bayes), among 17,166 lung cancer cases and 12,894 controls with European ancestry from the International Lung Cancer Consortium. Individuals were classified into different genetic risk subgroups based on the relationship between their own PRS mean/PRS CI and the population level threshold. Results Considerable variances in PRS point estimates at the individual level were observed for both methods, with an average standard deviation (s.d.) of 0.12 for PRS-16-CV and a much larger s.d. of 0.88 for PRS-Bayes. Using PRS-16-CV, only 25.0% of individuals with PRS point estimates in the lowest decile of PRS and 16.8% in the highest decile have their entire 95% CI fully contained in the lowest and highest decile, respectively, while PRS-Bayes was unable to find any eligible individuals. Only 19% of the individuals were concordantly identified as having high genetic risk (> 90th percentile) using the two PRS estimators. An increased relative risk of lung cancer comparing the highest PRS percentile to the lowest was observed when taking the CI into account (OR = 2.73, 95% CI: 2.12–3.50, P-value = 4.13 × 10−15) compared to using PRS-16-CV mean (OR = 2.23, 95% CI: 1.99–2.49, P-value = 5.70 × 10−46). Improved risk prediction performance with higher AUC was consistently observed in individuals identified by PRS-16-CV CI, and the best performance was achieved by incorporating age, gender, and detailed smoking pack-years (AUC: 0.73, 95% CI = 0.72–0.74). Conclusions Lung cancer PRS estimates using different methods have modest correlations at the individual level, highlighting the importance of considering individual-level uncertainty when evaluating the practical utility of PRS.

AIM: To assess diabetic macular edema (DME) progression during the early phases of the COVID-19 pandemic, when severe societal restrictions raised the concern of possible deterioration of health in patients with systemic conditions, particularly those requiring frequent office visits. METHODS: This is a multicenter retrospective chart review of 370 patients (724 eyes) with an established diagnosis of DME seen on 3 separate visits between January 2019 and July 2021. Period 1 was January 2019 to February 2020 (considered pre-COVID-19), period 2 was March 2020 to December 2020 (considered the height of the pandemic; highest level of pandemic-related clinical and societal regulations) and period 3 was January 2021 to July 2021 (re-adjustment to the new “pandemic norms”). Main outcome measures included visual acuity, body mass index (BMI), blood pressure (BP), hemoglobin A1c (HbA1c), macular thickness, patient adherence to scheduled ophthalmology visits, and DME treatment(s) received at each visit. To facilitate measurement of macular thickness, each macula was divided into 9 Early Treatment Diabetic Retinopathy Study (ETDRS)-defined macular sectors as measured by OCT imaging. RESULTS: There was no change of BMI, systolic BP, and diastolic BP between any of the time periods. HbA1c showed a very small increase from period 1 (7.6%) to period 2 (7.8%, P=0.015) and decreased back to 7.6% at period 3 (P=0.12). Macular thickness decreased for 100% of macular regions. The central macular thickness decreased across all 3 periods from 329.5 to 316.6 μm (P=0.0045). After analysis of multiple variables including HbA1c, BMI, adherence to scheduled appointments, different clinic centers, and treatment interventions, there was no easily identifiable subgroup of patients that experienced the increase in DME. CONCLUSION: DME doesn't worsen during the COVID-19 pandemic, instead sustaining a very small but statistically significant improvement. While identifying a mechanism behind our findings is beyond the scope of this study, potential explanations may include a delay in retinal changes beyond our study period, an unexpected increase in treatment frequency despite pandemic restrictions, and an unanticipated pandemic-related improvement in some lifestyle factors that may have had a positive impact on DME.

The Space Physics Data Facility (SPDF) is a digital archive of space physics data and is useful for the storage, analysis, and dissemination of data. We discuss the process used to create an amended dataset and store it on the SPDF. The operational software to generate the archival data software uses the open-source Python package pysat, and an end-user module has been added to the pysatNASA module. The result is the addition of data products to the Mars Global Surveyor (MGS) magnetometer (MAG) dataset, its archival location on SPDF, and pysat compatibility. The primary and metadata format increases the convenience and efficiency for users of the MGS MAG data. The storage of planetary and heliophysics data in one location supports the use of data throughout the solar system for comparison, while pysat compatibility enables loading data in an identical format for ease of processing. We encourage the use of the outlined process for past, present, and future space science missions of all sizes and funding levels. This includes balloons to Flagship-class missions.

Background: How have we progressed and where are the gaps of integrated care in Singapore? Social-health care provision in the context of an ageing population is critical in the city-state’s management of the unprecedented demand as the proportion of seniors with multiple complex medical needs have almost doubled in the past decade. Objective: This study measures the maturity level of Singapore’s integrated care, identifies key gaps and discusses their implications using the SCIROCCO Exchange tool, an online self-assessment tool consisting of the 12 dimensions necessary for the provision of integrated care. Methods: A three-step mixed method Delphi study was used to derive expert consensus. Participants across the social-healthcare sector as well as representatives from all three public healthcare delivery networks with at least five years of experience were included. Participants rated each of the twelve dimensions of the SCIROCCO Exchange tool on a six-point ordinal scale and provided justifications for each rating. Criteria from the RAND UCLA appropriateness method and thematic analysis were adopted for the analysis. Results: All participants completed the study. The study found five dimensions in the “Initial” maturity level and five dimensions in the “Progressing” maturity level. There were two dimensions which were “Uncertain” because of split responses, possibly due to their differing vantage points and conceptualisations of integrated care. The overall medians were plotted on a spider diagram. The absence of a systematic approach for integrated care was the most common subtheme across all dimensions. This is foundational for integrated care as this would enable stakeholders across health and social care to identify with a common goal. Implications: The findings emphasise the imperative to reshape social-health care delivery by focusing on foundational dimensions (such as structure, governance and citizen empowerment) to enable progress in other dimensions. Following the conclusion of this study, Singapore initiated a primary care reform with the launch of Healthier SG in July 2023. Future research may wish to explore the impact of Healthier SG on maturity of integrated care in Singapore.

Abstract Extreme precipitation events are projected to increase in frequency across much of the land‐surface as the global climate warms, but such projections have typically relied on coarse‐resolution (100–250 km) general circulation models (GCMs). The ensemble of HighResMIP GCMs presents an opportunity to evaluate how a more finely resolved atmosphere and land‐surface might enhance the fidelity of the simulated contribution of large‐magnitude storms to total precipitation, particularly across topographically complex terrain. Here, the simulation of large‐storm dominance, that is, the number of wettest days to reach half of the total annual precipitation, is quantified across the western United States (WUS) using four GCMs within the HighResMIP ensemble and their coarse resolution counterparts. Historical GCM simulations (1950–2014) are evaluated against a baseline generated from station‐observed daily precipitation (4,803 GHCN‐D stations) and from three gridded, observationally based precipitation data sets that are coarsened to match the resolution of the GCMs. All coarse‐resolution simulations produce less large‐storm dominance than in observations across the WUS. For two of the four GCMs, bias in the median large‐storm dominance is reduced in the HighResMIP simulation, decreasing by as much as 62% in the intermountain west region. However, the other GCMs show little change or even an increase (+28%) in bias of median large‐storm dominance across multiple sub‐regions. The spread in differences with resolution amongst GCMs suggests that, in addition to resolution, model structure and parameterization of precipitation generating processes also contribute to bias in simulated large‐storm dominance.

IntroductionPatients with high-grade gliomas are at risk of developing increased intracranial hypertension (ICHT) in relation to the increase in volume of their tumor. ICP change cannot be measured by invasive method but can be estimated by using routine clinical signs, in combination with a standard imaging method, magnetic resonance imaging (MRI). A non-invasive monitoring of ICP could be of interest in high-grade glioma, in particular after radiotherapy treatment with as major side effect a cerebral oedema.Patients and MethodsThis prospective clinical study aimed to compare the ICP changes (estimated by a non-invasive method based upon distortion product otoacoustic emissions (DPOAE) monitoring) with volume changes observed on MRI in patients with high-grade gliomas treated with radiotherapy. DPOAE measurements were performed one month after the end of radiotherapy and then every 3 months for one year. At each visit, the patient also underwent MRI as well as an evaluation of clinical signs.ResultsThe variation in the estimate of intracranial pressure readout measured at each follow-up visit (in absolute value with respect to the baseline measurements) was significantly associated with the variation of T2/FLAIR volume (n=125; p

BackgroundYouth overweight and obesity is a public health crisis and increases the risk of poor cardiovascular health (CVH) and chronic disease. Health care providers play a key role in weight management, yet few tools exist to support providers in delivering tailored evidence-based behavior change interventions to patients. ObjectiveThe goal of this pilot randomized feasibility study was to determine the feasibility of implementing the Patient-Centered Real-Time Intervention (PREVENT) tool in clinical settings, generate implementation data to inform scale-up, and gather preliminary effectiveness data. MethodsA pilot randomized clinical trial was conducted to examine the feasibility, implementation, and preliminary impact of PREVENT on patient knowledge, motivation, behaviors, and CVH outcomes. The study took place in a multidisciplinary obesity management clinic at a children’s hospital within an academic medical center. A total of 36 patients aged 12 to 18 years were randomized to use PREVENT during their routine visit (n=18, 50%) or usual care control (n=18, 50%). PREVENT is a digital health tool designed for use by providers to engage patients in behavior change education and goal setting and provides resources to support change. Patient electronic health record and self-report behavior data were collected at baseline and 3 months after the intervention. Implementation data were collected via PREVENT, direct observation, surveys, and interviews. We conducted quantitative, qualitative, and mixed methods analyses to evaluate pretest-posttest patient changes and implementation data. ResultsPREVENT was feasible, acceptable, easy to understand, and helpful to patients. Although not statistically significant, only PREVENT patients increased their motivation to change their behaviors as well as their knowledge of ways to improve heart health and of resources. Compared to the control group, PREVENT patients significantly improved their overall CVH and blood pressure (P

BackgroundInterpersonal violence (IPV) is an issue of major public health concern, with 24% of Kenyan women reporting physical violence perpetrated by a current husband or partner. IPV has profound impacts on physical and mental health outcomes, particularly for pregnant women; it has been found to increase the risk of perinatal mortality, low birth weight, and preterm birth. This study aims to identify variables associated with IPV and assess the effects of IPV experience on prenatal and peripartum maternal healthcare in Migori County, Kenya. Findings build on a previous study that investigated a smaller region of Migori County.MethodsResponses to cross-sectional household surveys conducted in six wards of Migori County, Kenya in 2021 from female respondents aged 18 and older were analyzed. The survey contained validated screening tools for interpersonal violence. Group-wise comparisons, and bivariate and multivariate logistic regression analyses were performed to describe community prevalence, factors associated with IPV against women, and the effect of IPV exposure on prenatal and peripartum health care.ResultsThis study finds that 2,306 (36.7%) of the 6,290 respondents had experienced lifetime IPV. IPV experience was associated with the age group 25–49 (adjusted odds ratio (aOR) 1.208; 95%CI: [1.045–1.397]; p = 0.011), monogamous marriage [aOR 2.152; 95%CI: (1.426–3.248); p

Early development is characterized by dynamic transitions in brain maturation, which may be impacted by environmental factors. Here, we sought to determine the effects of social isolation from postweaning and during adolescence on reward behavior and dopaminergic signaling in male rats. Subjects were socially isolated or group housed at postnatal day 21. Three weeks later, extracellular dopamine concentrations were examined in the medial prefrontal cortex (mPFC) and nucleus accumbens shell (NAc) during a feeding bout. Surprisingly, opposing effects were found in which increased mPFC dopamine concentrations were observed in group housed, but not isolated, rats. In stark contrast, increased dopamine levels were found in the NAc of isolated, but not group housed, rats. Moreover, the absence of an effect in the mPFC of the isolated rats could not be reversed by subsequent group housing, demonstrating the remarkable long-term effects on dopamine signaling dynamics. When provided a highly palatable food, the isolated subjects exhibited a dramatic increase in mPFC dopamine levels when the chocolate was novel, but no effects following chronic chocolate consumption. In contrast, the group housed subjects showed significantly increased dopamine levels only with chronic chocolate consumption. The dopamine changes were correlated with differences in behavioral measures. Importantly, the deficit in reward-related behavior during isolation could be reversed by microinjection of either dopamine or cocaine into the mPFC. Together, these data provide evidence that social isolation from postweaning and during adolescence alters reward-induced dopamine levels in a brain region-specific manner, which has important functional implications for reward-related behavior.