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BackgroundPerivascular spaces (PVS) on brain MRI are surrogates for small parenchymal blood vessels and their perivascular compartment, and may relate to brain health. However, it is unknown whether PVS can predict dementia risk and brain atrophy trajectories in participants without dementia, as longitudinal studies on PVS are scarce and current methods for PVS assessment lack robustness and inter-scanner reproducibility.MethodsWe developed a robust algorithm to automatically assess PVS count and size on clinical MRI, and investigated 1) their relationship with dementia risk and brain atrophy in participants without dementia, 2) their longitudinal evolution, and 3) their potential use as a screening tool in simulated clinical trials. We analysed 46,478 clinical measurements of cognitive functioning and 20,845 brain MRI scans from 10,004 participants (71.1 ± 9.7 years-old, 56.6% women) from three publicly available observational studies on ageing and dementia (the Alzheimer's Disease Neuroimaging Initiative, the National Alzheimer's Coordinating Centre database, and the Open Access Series of Imaging Studies). Clinical and MRI data collected between 2004 and 2022 were analysed with consistent methods, controlling for confounding factors, and combined using mixed-effects models.FindingsOur fully-automated method for PVS assessment showed excellent inter-scanner reproducibility (intraclass correlation coefficients >0.8). Fewer PVS and larger PVS diameter at baseline predicted higher dementia risk and accelerated brain atrophy. Longitudinal trajectories of PVS markers differed significantly in participants without dementia who converted to dementia compared with non-converters. In simulated placebo-controlled trials for treatments targeting cognitive decline, screening out participants at low risk of dementia based on our PVS markers enhanced the power of the trial independently of Alzheimer's disease biomarkers.InterpretationThese robust cerebrovascular markers predict dementia risk and brain atrophy and may improve risk-stratification of patients, potentially reducing cost and increasing throughput of clinical trials to combat dementia.FundingUS National Institutes of Health.

Abstract Age-related muscle wasting, sarcopenia is an extensive loss of muscle mass and strength with age and a major cause of disability and accidents in the elderly. Mechanisms purported to be involved in muscle ageing and sarcopenia are numerous but poorly understood, necessitating deeper study. Hence, we employed high-throughput RNA sequencing to survey the global changes in protein-coding gene expression occurring in skeletal muscle with age. Caloric restriction (CR) is a known prophylactic intervention against sarcopenia. Therefore, total RNA was isolated from the muscle tissue of both rats fed ad libitum and CR rats. RNA-seq data were subjected to Gene Ontology, pathway, co-expression, and interaction network analyses. This revealed the functional pathways most activated by both ageing and CR, as well as the key “hub” proteins involved in their activation. RNA-seq revealed 442 protein-coding genes to be upregulated and 377 to be downregulated in aged muscle, compared to young muscle. Upregulated genes were commonly involved in protein folding and immune responses; meanwhile, downregulated genes were often related to developmental biology. CR was found to suppress 69.7% and rescue 57.8% of the genes found to be upregulated and downregulated in aged muscle, respectively. In addition, CR uniquely upregulated 291 and downregulated 304 protein-coding genes. Hub genes implicated in both ageing and CR included Gc, Plg, Irf7, Ifit3, Usp18, Rsad2, Blm and RT1-A2, whilst those exclusively implicated in CR responses included Alb, Apoa1, Ambp, F2, Apoh, Orm1, Mx1, Oasl2 and Rtp4. Hub genes involved in ageing but unaffected by CR included Fgg, Fga, Fgb and Serpinc1. In conclusion, this comprehensive RNA sequencing study highlights gene expression patterns, hub genes and signalling pathways most affected by ageing in skeletal muscle. This data may provide the initial evidence for several targets for potential future therapeutic interventions against sarcopenia.

Abstract The architectural style found in Wa and Tamale is renowned for its distinctive use of earthen construction, which features square buildings with flat roofs and circular compounds with conical thatch roofs. Recently, there has been a growing inclination towards the use of alternative construction techniques in which nontraditional materials such as cement, bitumen, and used car engine oil are utilised to render wall surfaces. These structures show how the materials and design in northern Ghana have substantially evolved. However, what forces drive the changes in cob construction in this region? Furthermore, how might these changes impact the preservation of cultural heritage in Ghana? To explore the factors that contribute to the departure from traditional earthen building methods that rely on local materials, this study employs a constructivist research approach. Participants in a survey that informed this study revealed that they struggled to access building materials to construct their houses. While most of the people who responded to the survey have resided in buildings constructed with a mixture of beini and dawadawa, they hesitate to use plant-based biostabilisers in new constructions. Factors that hinder the ongoing construction and preservation of earthen buildings include shifting cultural and social norms, environmental changes, difficulties accessing local building resources, flood risks, regular maintenance requirements, and societal influences. Thus, this study concludes that if communities are empowered to take ownership and recognise the value of their cultural heritage, they are likely to be increasingly aware and appreciative of their architectural heritage. Thus, their local heritage will be preserved.

Periparturient dairy cows experience metabolic adaptations to prepare for increased nutrient requirements of the fetus and the onset of lactation. Adaptations include increased peripheral tissue insulin resistance, which can be evaluated experimentally using intravenous glucose tolerance tests (IVGTT). The objective of this study was to determine if prepartum skeletal muscle reserves and supplementation of branched-chain volatile fatty acids (BCVFA) in the prepartum period affected blood glucose, β-hydroxybutyrate (BHB), and insulin concentrations 2 wk prepartum and 1 wk postpartum utilizing an IVGTT. At 42 d before expected calving (BEC), the longissimus dorsi muscle depth was measured from an ultrasound image, and based on muscle depth, cows were assigned to either the high muscle (HM; >4.6 cm, n = 17) or low muscle (LM; ≤4.6 cm, n = 17) group. Cows were randomly assigned to either the branched-chain volatile fatty acid (BCVFA) treatment (fed as 39.1 g/d isobutyrate product; 19.4 g/d isovalerate product; 19.6 g/d 2-methylbutyrate product, all on a DM basis) or control (73.0 g/d soyhull pellets on a DM basis) treatment, which were top-dressed daily. Assignment to muscle group and treatment resulted in a 2 × 2 factorial design and the following 4 combinations: HM-CON (n = 7), HM-BCVFA (n = 10), LM-CON (n = 9), and LM-BCVFA (n = 8). On 14 d BEC and 7 DIM an IVGTT was performed following a 1 h fasting period. Baseline blood samples were taken −15 and −5 min before dextrose administration (250 mg/kg BW); blood was then collected at 12 time points over a 3-h time period. Skeletal muscle reserves had no impact on glucose or insulin response across the IVGTT period, whereas BCVFA supplementation increased glucose area under the curve (AUC) in the prepartum period but had no effect in the postpartum period. Prepartum glucose and insulin AUC were higher than the postpartum glucose and insulin AUC. Findings indicate that muscle reserves in the prepartum period do not affect insulin and glucose clearance in periparturient dairy cows, reflecting no differences in insulin sensitivity in response to IVGTT. Changes observed in glucose and insulin AUC between pre- and postpartum IVGTT reflect normal metabolic adaptations to increased energetic requirements of dairy cows between late gestation and early lactation.

Abstract Background Despite high disease burden and heightened suicide risk associated with psychosis, psychosis education is lacking in healthcare curricula, potentially hindering students’ willingness, and confidence to provide psychosis care as future healthcare professionals. This study aimed to co-design and content validate psychosis care assessment material for medical, pharmacy, nursing, and occupational therapy curricula. Methods A nominal group technique (NGT) meeting was conducted to generate and rank ideas among people with lived/living experience of mental illness. Prioritised ideas were used to create simulated role-play scenarios for each discipline, by discipline experts. The developed scenarios underwent content validation by content experts, whereby the content validity index was computed for relevance and clarity. Results The four highest ranked ideas based on rank scores and accumulated rank score sums were selected during the NGT meeting and used to guide the development of four role-play scenarios focusing on antipsychotic medication side effects, suicide risk, paranoia and delusions, and visual hallucinations. Discipline experts created scenario outlines and rubrics for each selected idea. Content validity indices of all items were deemed satisfactory, ranging from 0.8 to 1. Written feedback for each role-play scenario was considered and scenarios/rubrics were modified accordingly. Conclusion Overall, this study provides a framework for partnering with mental health stakeholders to co-design and validate psychosis care assessment material for healthcare curricula. Through the integral contribution of people with lived/living experience and clinicians, authentic scenarios which reflect real-life practice have been developed. Future research is required to evaluate the newly developed materials in educational setting.

ABSTRACT Bacterial pathogens remain poorly characterized in bats, especially in North America. We describe novel (and in some cases panmictic) hemoplasmas (10.1% positivity) and bartonellae (25.6% positivity) across three colonies of Mexican free-tailed bats (Tadarida brasiliensis), a partially migratory species that can seasonally travel hundreds of kilometers. Molecular analyses identified three novel Candidatus hemoplasma species most similar to another novel Candidatus species in Neotropical molossid bats. We also detected novel hemoplasmas in sympatric cave myotis (Myotis velifer) and pallid bats (Antrozous pallidus), with sequences in the latter 96.5% related to Candidatus Mycoplasma haematohominis. We identified nine Bartonella genogroups, including those in cave myotis with 96.1% similarity to Candidatus Bartonella mayotimonensis. We also detected Bartonella rochalimae in migratory Mexican free-tailed bats, representing the first report of this human pathogen in the Chiroptera. Monthly sampling of migratory Mexican free-tailed bats during their North American occupancy period also revealed significant seasonality in infection for both bacterial pathogens, with prevalence increasing following spring migration, peaking in the maternity season, and declining into fall migration. The substantial diversity and seasonality of hemoplasmas and bartonellae observed here suggest that additional longitudinal, genomic, and immunological studies in bats are warranted to inform One Health approaches.IMPORTANCEBats have been intensively sampled for viruses but remain mostly understudied for bacterial pathogens. However, bacterial pathogens can have significant impacts on both human health and bat morbidity and even mortality. Hemoplasmas and bartonellae are facultative intracellular bacteria of special interest in bats, given their high prevalence and substantial genetic diversity. Surveys have also supported plausible zoonotic transmission of these bacteria from bats to humans, including Candidatus Mycoplasma haematohominis and Candidatus Bartonella mayotimonensis. Greater characterization of these bacteria across global bat diversity (over 1,480 species) is therefore warranted to inform infection risks for both bats and humans, although little surveillance has thus far been conducted in North American bats. We here describe novel (and in some cases panmictic) hemoplasmas and bartonellae across three colonies of Mexican free-tailed bats and sympatric bat species. We find high genetic diversity and seasonality of these pathogens, including lineages closely related to human pathogens, such as Bartonella rochalimae.

Summary: Background: Perivascular spaces (PVS) on brain MRI are surrogates for small parenchymal blood vessels and their perivascular compartment, and may relate to brain health. However, it is unknown whether PVS can predict dementia risk and brain atrophy trajectories in participants without dementia, as longitudinal studies on PVS are scarce and current methods for PVS assessment lack robustness and inter-scanner reproducibility. Methods: We developed a robust algorithm to automatically assess PVS count and size on clinical MRI, and investigated 1) their relationship with dementia risk and brain atrophy in participants without dementia, 2) their longitudinal evolution, and 3) their potential use as a screening tool in simulated clinical trials. We analysed 46,478 clinical measurements of cognitive functioning and 20,845 brain MRI scans from 10,004 participants (71.1 ± 9.7 years-old, 56.6% women) from three publicly available observational studies on ageing and dementia (the Alzheimer’s Disease Neuroimaging Initiative, the National Alzheimer’s Coordinating Centre database, and the Open Access Series of Imaging Studies). Clinical and MRI data collected between 2004 and 2022 were analysed with consistent methods, controlling for confounding factors, and combined using mixed-effects models. Findings: Our fully-automated method for PVS assessment showed excellent inter-scanner reproducibility (intraclass correlation coefficients >0.8). Fewer PVS and larger PVS diameter at baseline predicted higher dementia risk and accelerated brain atrophy. Longitudinal trajectories of PVS markers differed significantly in participants without dementia who converted to dementia compared with non-converters. In simulated placebo-controlled trials for treatments targeting cognitive decline, screening out participants at low risk of dementia based on our PVS markers enhanced the power of the trial independently of Alzheimer’s disease biomarkers. Interpretation: These robust cerebrovascular markers predict dementia risk and brain atrophy and may improve risk-stratification of patients, potentially reducing cost and increasing throughput of clinical trials to combat dementia. Funding: US National Institutes of Health.

Summary: Background: People with diabetes are at increased risk of hospitalisation, morbidity, and mortality following SARS-CoV-2 infection. Long-term outcomes for people with diabetes previously hospitalised with COVID-19 are, however, unknown. This study aimed to determine the longer-term physical and mental health effects of COVID-19 in people with and without diabetes. Methods: The PHOSP-COVID study is a multicentre, long-term follow-up study of adults discharged from hospital between 1 February 2020 and 31 March 2021 in the UK following COVID-19, involving detailed assessment at 5 and 12 months after discharge. The association between diabetes status and outcomes were explored using multivariable linear and logistic regressions. Findings: People with diabetes who survived hospital admission with COVID-19 display worse physical outcomes compared to those without diabetes at 5- and 12-month follow-up. People with diabetes displayed higher fatigue (only at 5 months), frailty, lower physical performance, and health-related quality of life and poorer cognitive function. Differences in outcomes between diabetes status groups were largely consistent from 5 to 12-months. In regression models, differences at 5 and 12 months were attenuated after adjustment for BMI and presence of other long-term conditions. Interpretation: People with diabetes reported worse physical outcomes up to 12 months after hospital discharge with COVID-19 compared to those without diabetes. These data support the need to reduce inequalities in long-term physical and mental health effects of SARS-CoV-2 infection in people with diabetes. Funding: UK Research and Innovation and National Institute for Health Research. The study was approved by the Leeds West Research Ethics Committee (20/YH/0225) and is registered on the ISRCTN Registry (ISRCTN10980107).

IntroductionContemporary data and knowledge management and exploration are challenging due to regular releases, updates, and different types and formats. In the food and nutrition domain, solutions for integrating such data and knowledge with respect to the FAIR (Findability, Accessibility, Interoperability, and Reusability) principles are still lacking.MethodsTo address this issue, we have developed a data and knowledge management system called NutriBase, which supports the compilation of a food composition database and its integration with evidence-based knowledge. This research is a novel contribution because it allows for the interconnection and complementation of food composition data with knowledge and takes what has been done in the past a step further by enabling the integration of knowledge. NutriBase focuses on two important challenges; data (semantic) harmonization by using the existing ontologies, and reducing missing data by semi-automatic data imputation made from conflating with existing databases.Results and discussionThe developed web-based tool is highly modifiable and can be further customized to meet national or international requirements. It can help create and maintain the quality management system needed to assure data quality. Newly generated data and knowledge can continuously be added, as interoperability with other systems is enabled. The tool is intended for use by domain experts, food compilers, and researchers who can add and edit food-relevant data and knowledge. However, the tool is also accessible to food manufacturers, who can regularly update information about their products and thus give consumers access to current data. Moreover, the traceability of the data and knowledge provenance allows the compilation of a trustworthy management system. The system is designed to allow easy integration of data from different sources, which enables data borrowing and reduction of missing data. In this paper, the feasibility of NutriBase is demonstrated on Slovenian food-related data and knowledge, which is further linked with international resources. Outputs such as matched food components and food classifications have been integrated into semantic resources that are currently under development in various international projects.

Background: The period following childbirth is marked by dynamic changes in maternal physiology and the growth trajectory of the newborn. We aimed to elucidate the changes and associations in body composition of infants and their mothers during the first year postpartum. Methods: This pilot study assessed infant body composition using the PEA POD air displacement plethysmography (ADP) system (birth–6 months) and deuterium dilution (9–12 months). Maternal body composition was assessed using the BOD POD ADP system at 12 months postpartum. Mothers were grouped by prepregnancy body mass index (BMI) 2 (lean) or ≥25 kg/m2 (overweight/obese: OW/OB), and data were analysed using linear regression. Results: Twenty-nine infant–mother pairs were assessed. Infant percent fat mass (%FM) increased from birth to 6 months (9.3% vs. 24.2%; p < 0.001) and then gradually declined. At birth and 3 months, %FM was significantly higher in infants born to OW/OB mothers compared to their lean counterparts. A significant positive association (β = 0.3; p = 0.040) was observed between maternal %FM and infant %FM at 1 year post-delivery after controlling for the mother’s prepregnancy BMI. Conclusions: Infants born to OW/OB mothers have increased %FM at birth and 3 months, which may have consequences for their health throughout childhood and into adulthood. Moreover, maternal prepregnancy BMI is a significant predictor of maternal postpartum weight status and body composition and impacts the relationship between maternal and infant body composition at 12 months postpartum. While the findings of our pilot study underscore the importance of encouraging women of childbearing age to maintain a healthy BMI before conception, further research is needed to substantiate these results.

Context Low fruit and vegetable intakes are major modifiable determinants of disease. One hundred percent juice may facilitate intake and deliver essential nutrients and bioactive compounds. However, the position of 100% juice in healthy eating guidelines remains controversial due to its lower dietary fiber and higher free-sugar contents compared with whole fruits and vegetables. Objective To conduct an umbrella review of systematic literature reviews with meta-analyses (MAs) to summarize the health benefits of drinking 100% fruit and/or vegetable juice. Data Sources Four databases (Medline, The Cochrane Library, EMBASE, and CINAHL) were systematically searched for MAs of 100% juice and any health outcomes. Data Analysis Screening, quality, risk of bias, and content overlap tools were applied, and extracted data were narratively synthesized. No eligible studies for vegetable juice were found. Fifteen systematic literature reviews (51 primary MAs, 6 dose–response, and 87 subanalyses; 50–1200 mL/day; hours to years of duration) were included. Ten MAs (19.6%) reported health benefits (4 for blood pressure, 2 for vascular function, 3 for inflammation, 1 for stroke mortality), 3 MAs (5.9%) reported adverse risks (1 each for cardiovascular disease mortality, prostate cancer, type 2 diabetes risk), while most (74.5%) reported no effect (blood lipids, body composition, liver function, metabolic health, cancers, and inflammation). Risks were limited to cohort studies and benefits were found in both cohort and intervention studies. Conclusion The findings collate evidence showing some potential health benefits associated with 100% juice consumption, with fewer potential risks. The balance of evidence does not support the exclusion of 100% juice from food-based guides to healthy eating, although caution may be warranted in certain groups or individuals, and the body of evidence is not yet conclusive. Systematic Review Registration PROSPERO registration no. CRD42022380588. [ABSTRACT FROM AUTHOR]

Sleep alterations have been described in several neurodegenerative diseases yet are currently poorly characterized in amyotrophic lateral sclerosis (ALS). This study investigates sleep macroarchitecture and related hypothalamic signaling disruptions in ALS. Using polysomnography, we found that both patients with ALS as well as asymptomatic C9ORF72 and SOD1 mutation carriers exhibited increased wakefulness and reduced non–rapid eye movement sleep. Increased wakefulness correlated with diminished cognitive performance in both clinical cohorts. Similar changes in sleep macroarchitecture were observed in three ALS mouse models (Sod1G86R, FusΔNLS/+, and TDP43Q331K). A single oral administration of a dual-orexin receptor antagonist or intracerebroventricular delivery of melanin-concentrating hormone (MCH) through an osmotic pump over 15 days partially normalized sleep patterns in mouse models. MCH treatment did not extend the survival of Sod1G86R mice but did decrease the loss of lumbar motor neurons. These findings suggest MCH and orexin signaling as potential targets to treat sleep alterations that arise in early stages of the disease. Editor's summary: Patients with amyotrophic lateral sclerosis (ALS) often experience poor sleep, but whether these disturbances are caused by alterations in sleep regulating brain circuits or triggered by motor symptoms remains unclear. Guillot et al. found that patients with ALS and presymptomatic carriers of ALS risk genes show increased wakefulness and reduced non–rapid eye movement sleep. Disruptions in sleep architecture were also found in three mouse models of ALS and partially normalized by intraventricular injection of melanin-concentrating hormone or oral administration of an orexin antagonist. These results suggest that sleep disturbances occur before symptom onset and can be ameliorated by targeting neuropeptides involved in sleep/wake regulation. —Daniela Neuhofer [ABSTRACT FROM AUTHOR]

Borealis is a recently discovered submerged mud volcano in the Polar North Atlantic, differing from the numerous methane seepages previously identified in the region. Here we show in situ observations from a remotely operated vehicle (ROV), capturing the release of warm (11.5 °C) Neogene sediments and methane-rich fluids from a gryphon at Borealis. The surrounding seafloor within the mud volcano features extensive carbonate deposits, indicating prolonged diffuse methane migration. Sampling and imagery reveal that Borealis supports unique habitats adapted to low-oxygen conditions near methane seeps. Additionally, the irregularly shaped carbonate structures serve as a natural shelter from bottom trawling and a substratum for sessile fauna and may function as nursery grounds for threatened fish species. This discovery underscores the ecological significance of cold seep ecosystems in the Polar North Atlantic, highlighting their role in biodiversity by serving as refuges for marine species and emphasizing the need for their conservation. Borealis, a newly discovered mud volcano in the Polar North Atlantic, expels warm Neogene sediments and methane fluids. It hosts unique habitats, with carbonate structures offering refuge and nursery grounds for marine life, highlighting conservation importance. [ABSTRACT FROM AUTHOR]

Age-related muscle wasting, sarcopenia is an extensive loss of muscle mass and strength with age and a major cause of disability and accidents in the elderly. Mechanisms purported to be involved in muscle ageing and sarcopenia are numerous but poorly understood, necessitating deeper study. Hence, we employed high-throughput RNA sequencing to survey the global changes in protein-coding gene expression occurring in skeletal muscle with age. Caloric restriction (CR) is a known prophylactic intervention against sarcopenia. Therefore, total RNA was isolated from the muscle tissue of both rats fed ad libitum and CR rats. RNA-seq data were subjected to Gene Ontology, pathway, co-expression, and interaction network analyses. This revealed the functional pathways most activated by both ageing and CR, as well as the key "hub" proteins involved in their activation. RNA-seq revealed 442 protein-coding genes to be upregulated and 377 to be downregulated in aged muscle, compared to young muscle. Upregulated genes were commonly involved in protein folding and immune responses; meanwhile, downregulated genes were often related to developmental biology. CR was found to suppress 69.7% and rescue 57.8% of the genes found to be upregulated and downregulated in aged muscle, respectively. In addition, CR uniquely upregulated 291 and downregulated 304 protein-coding genes. Hub genes implicated in both ageing and CR included Gc, Plg, Irf7, Ifit3, Usp18, Rsad2, Blm and RT1-A2, whilst those exclusively implicated in CR responses included Alb, Apoa1, Ambp, F2, Apoh, Orm1, Mx1, Oasl2 and Rtp4. Hub genes involved in ageing but unaffected by CR included Fgg, Fga, Fgb and Serpinc1. In conclusion, this comprehensive RNA sequencing study highlights gene expression patterns, hub genes and signalling pathways most affected by ageing in skeletal muscle. This data may provide the initial evidence for several targets for potential future therapeutic interventions against sarcopenia. [ABSTRACT FROM AUTHOR]

Background: Despite high disease burden and heightened suicide risk associated with psychosis, psychosis education is lacking in healthcare curricula, potentially hindering students' willingness, and confidence to provide psychosis care as future healthcare professionals. This study aimed to co-design and content validate psychosis care assessment material for medical, pharmacy, nursing, and occupational therapy curricula. Methods: A nominal group technique (NGT) meeting was conducted to generate and rank ideas among people with lived/living experience of mental illness. Prioritised ideas were used to create simulated role-play scenarios for each discipline, by discipline experts. The developed scenarios underwent content validation by content experts, whereby the content validity index was computed for relevance and clarity. Results: The four highest ranked ideas based on rank scores and accumulated rank score sums were selected during the NGT meeting and used to guide the development of four role-play scenarios focusing on antipsychotic medication side effects, suicide risk, paranoia and delusions, and visual hallucinations. Discipline experts created scenario outlines and rubrics for each selected idea. Content validity indices of all items were deemed satisfactory, ranging from 0.8 to 1. Written feedback for each role-play scenario was considered and scenarios/rubrics were modified accordingly. Conclusion: Overall, this study provides a framework for partnering with mental health stakeholders to co-design and validate psychosis care assessment material for healthcare curricula. Through the integral contribution of people with lived/living experience and clinicians, authentic scenarios which reflect real-life practice have been developed. Future research is required to evaluate the newly developed materials in educational setting. [ABSTRACT FROM AUTHOR]

Objective: Rib fractures lead to altered breathing mechanics, impaired gas exchange, and in some patients to respiratory failure. Multimodal analgesia has become one of the pillars of management; however, barriers toward widespread adoption remain. We reviewed the trends in multimodal pain management strategies and their drivers over a 10-year period at a lead trauma hospital in Canada. Methods: This is a cross-sectional study in which demographic, injury, pharmacological, as well as outcome data were collected for all adult patients admitted with rib fractures. Data were collected retrospectively and the study period was divided into three eras (2011–2014; 2015–2018; 2019–2022). Multimodal pain management was defined as either patient-controlled (PCA) or regional analgesia (epidural or continuous plane block) in combination with acetaminophen or non-steroidal anti-inflammatory drugs (NSAIDs). All patients received pro re nata (PRN) narcotics. Data were stratified based on rib fracture severity, age, and intubation on arrival. Results: We identified 2586 patients with rib fractures (mild non-flail 32.6%; moderate non-flail 50.2%; flail 17.2%). The use of standing acetaminophen and NSAIDs increased over time for all groups. Regional analgesia use increased while PCA use reduced, particularly in the flail group. Only 7% of flail patients intubated on arrival received regional analgesia. Among those not intubated on arrival, only 35% of flail and 23% of non-flail patients received multimodal pain management. Over time, multimodal pain management decreased in the non-flail group due to a reduction in PCA use without an equal rise in regional anesthesia. Those without multimodal pain management were older and the mechanism of injury was more likely a fall. Among those with a flail, who were non-intubated at presentation, only 31% of those aged >65 received multimodal pain regimens compared to 45% in those ≤65y. Conclusions: Although multimodal pain management strategies have improved over time, a large proportion of patients, even among those with flail chest, still do not receive multimodal pain management. Elderly patients, at highest risk of adverse outcomes, were less likely to receive multimodal pain management strategies and should be the target of performance improvement initiatives. [ABSTRACT FROM AUTHOR]

Zanzibar, a low‐resource semiautonomous region of Tanzania, has an estimated prevalence of hepatitis B virus (HBV) infections of 3.6%. To assess the feasibility of care and treatment, a 5‐year hepatitis B demonstration project was implemented in Zanzibar during January 2017–December 2021, following the 2015 WHO HBV care and treatment guidelines. Participants included adults (aged ≥ 18 years) who tested positive for HBV surface antigen and tested negative for HIV and hepatitis C antibody. Participants were examined for clinical signs of liver disease and testing was conducted at baseline to assess treatment eligibility and every 6–12 months thereafter. Tenofovir disoproxil fumarate (TDF) was provided at no cost to treatment‐eligible participants. Clinical and laboratory data were analysed to assess improvement in proximal disease outcomes. Among 596 participants enrolled, the median age was 32 years (IQR 26–39) and 365 (61%) were male. Of those enrolled, 268 (45%) returned for ≥ 1 follow‐up visit, with a median of 511 days of follow‐up. Overall, 58 patients initiated treatment: 15 met treatment criteria based on liver cirrhosis alone; 13 by APRI > 1.5; among those with HBV DNA results, six met criteria based on HBV DNA levels and ALT activity; 24 met ≥ 2 criteria. Significant decreases in ALT activities, APRI scores and HBV DNA levels were observed among those treated. This hepatitis B care and treatment programme was demonstrated to be feasible in a low‐resource setting. Despite challenges, testing and linkage to care is critical to decrease the global burden of hepatitis B. [ABSTRACT FROM AUTHOR]

The World Health Organization's World Mental Health Report: Transforming mental health for all emphasized the need for social workers to adopt a biopsychosocial approach in mental health services. This article explores how we have got to this point, tracing psychiatry's historical development and exploring the increasing hegemony of the Medical Model within this history. We examine the trajectory of psychiatric treatment, from antipsychotics to its current challenges. The discussion extends these issues to social work, emphasizing advocacy for the biopsychosocial model, its integration in education, and prioritizing the voices of those with lived experiences. [ABSTRACT FROM AUTHOR]

The architectural style found in Wa and Tamale is renowned for its distinctive use of earthen construction, which features square buildings with flat roofs and circular compounds with conical thatch roofs. Recently, there has been a growing inclination towards the use of alternative construction techniques in which nontraditional materials such as cement, bitumen, and used car engine oil are utilised to render wall surfaces. These structures show how the materials and design in northern Ghana have substantially evolved. However, what forces drive the changes in cob construction in this region? Furthermore, how might these changes impact the preservation of cultural heritage in Ghana? To explore the factors that contribute to the departure from traditional earthen building methods that rely on local materials, this study employs a constructivist research approach. Participants in a survey that informed this study revealed that they struggled to access building materials to construct their houses. While most of the people who responded to the survey have resided in buildings constructed with a mixture of beini and dawadawa, they hesitate to use plant-based biostabilisers in new constructions. Factors that hinder the ongoing construction and preservation of earthen buildings include shifting cultural and social norms, environmental changes, difficulties accessing local building resources, flood risks, regular maintenance requirements, and societal influences. Thus, this study concludes that if communities are empowered to take ownership and recognise the value of their cultural heritage, they are likely to be increasingly aware and appreciative of their architectural heritage. Thus, their local heritage will be preserved. [ABSTRACT FROM AUTHOR]

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Background: The period following childbirth is marked by dynamic changes in maternal physiology and the growth trajectory of the newborn. We aimed to elucidate the changes and associations in body composition of infants and their mothers during the first year postpartum. Methods: This pilot study assessed infant body composition using the PEA POD air displacement plethysmography (ADP) system (birth–6 months) and deuterium dilution (9–12 months). Maternal body composition was assessed using the BOD POD ADP system at 12 months postpartum. Mothers were grouped by prepregnancy body mass index (BMI) <25 kg/m2 (lean) or ≥25 kg/m2 (overweight/obese: OW/OB), and data were analysed using linear regression. Results: Twenty-nine infant–mother pairs were assessed. Infant percent fat mass (%FM) increased from birth to 6 months (9.3% vs. 24.2%; p < 0.001) and then gradually declined. At birth and 3 months, %FM was significantly higher in infants born to OW/OB mothers compared to their lean counterparts. A significant positive association (β = 0.3; p = 0.040) was observed between maternal %FM and infant %FM at 1 year post-delivery after controlling for the mother's prepregnancy BMI. Conclusions: Infants born to OW/OB mothers have increased %FM at birth and 3 months, which may have consequences for their health throughout childhood and into adulthood. Moreover, maternal prepregnancy BMI is a significant predictor of maternal postpartum weight status and body composition and impacts the relationship between maternal and infant body composition at 12 months postpartum. While the findings of our pilot study underscore the importance of encouraging women of childbearing age to maintain a healthy BMI before conception, further research is needed to substantiate these results. [ABSTRACT FROM AUTHOR]