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Detecting crustal deformation during transient deformation events at offshore subduction zones remains challenging. The spatiotemporal evolution of slow slip events (SSEs) on the offshore Hikurangi subduction zone, New Zealand, during February–July 2019, is revealed through a time‐dependent inversion of onshore and offshore geodetic data that also accounts for spatially varying elastic crustal properties. Our model is constrained by seafloor pressure time series (as a proxy for vertical seafloor deformation), onshore continuous Global Navigation Satellite System (GNSS) data, and Interferometric Synthetic Aperture Radar displacements. Large GNSS displacements onshore and uplift of the seafloor (10–33 mm) require peak slip during the event of 150 to >200 mm at 6–12 km depth offshore Hawkes Bay and Gisborne, comparable to maximum slip observed during previous seafloor pressure deployments at north Hikurangi. The onshore and offshore data reveal a complex evolution of the SSE, over a period of months. Seafloor pressure data indicates the slow slip may have persisted longer near the trench than suggested by onshore GNSS stations in both the Gisborne and Hawkes Bay regions. Seafloor pressure data also reveal up‐dip migration of SSE slip beneath Hawke Bay occurred over a period of a few weeks. The SSE source region appears to coincide with locations of the March 1947 Mw 7.0–7.1 tsunami earthquake offshore Gisborne and estimated great earthquake rupture sources from paleoseismic investigations offshore Hawkes Bay, suggesting that the shallow megathrust at north and central Hikurangi is capable of both seismic and aseismic rupture. Plain Language Summary: Subduction zones, where one tectonic plate dives beneath another, generate the planet's largest earthquakes. They also host an important mode of fault slip called "slow slip events (SSEs)," which are essentially earthquakes in slow motion. The Hikurangi subduction zone, where the Pacific Plate subducts beneath New Zealand hosts large and frequent SSEs near the trench, where the plate boundary emerges at the seabed, requiring seafloor instrumentation to investigate them. Seafloor pressure measurements can track centimeter‐level up or down movement of the seafloor during slow slip, and reveal offshore displacement during a large 2019 SSE at the Hikurangi subduction zone. The 2019 event involved substantial migration, beginning at ∼15 km depth, and expanding to the trench over a period of several weeks. We also show that the same areas which have ruptured in previous seismic earthquakes (that involved faster slip) can also rupture slowly, in SSEs. This raises the possibility that regions where we currently observe SSEs could also produce seismic events. This result also demands that more work must be done to understand the physical processes that enable the same part of a fault to rupture both fast and slow at different times. Key Points: Central Hikurangi slow slip events (SSEs) propagate up‐dip over a period of weeks to monthsSeafloor geodetic data reveal that shallow SSEs may last longer than onshore Global Navigation Satellite System data suggestThe same portions of a shallow megathrust can host both large seismic and aseismic rupture [ABSTRACT FROM AUTHOR]

Seafloor pressure sensor data is emerging as a promising approach to resolve vertical displacement of the seafloor in the offshore reaches of subduction zones, particularly in response to slow slip events (SSEs), although such signals are challenging to resolve due to sensor drift and oceanographic signals. Constraining offshore SSE slip distribution is of key importance to understanding earthquake and tsunami hazards posed by subduction zones. We processed seafloor pressure data from January to October 2019 acquired at the Hikurangi subduction zone, offshore New Zealand, to estimate vertical displacement associated with a large SSE that occurred beneath the seafloor array. The experiment included three self‐calibrating sensors designed to remove sensor drift, which, together with ocean general circulation models, were essential to the identification and correction of long‐period ocean variability remaining in the data after applying traditional processing techniques. We estimate that long‐period oceanographic signals that were not synchronous between pressure sensors and reference sites influenced our inferred displacements by 0.3–2.6 cm, suggesting that regionally deployed reference sites alone may not provide sufficient ocean noise correction. After incorporating long‐period ocean variability corrections into the processing, we calculate 1.0–3.3 cm of uplift during the SSE offshore Gisborne at northern Hikurangi, and 1.1–2.7 cm of uplift offshore the Hawke's Bay area at central Hikurangi. Some Hawke Bay displacements detected by pressure sensors near the trench were delayed by 6 weeks compared to the timing of slip onset detected by onshore Global Navigation Satellite System sites, suggesting updip migration of the SSE. Plain Language Summary: We use pressure sensors to estimate centimeter‐level vertical motion of the seafloor due to New Zealand slow slip event activity in 2019. These tectonic events have been observed at subduction zones worldwide. They involve a similar amount of slip as fast earthquakes, but the slip occurs over longer periods of time (days to years). Seafloor pressure sensors are important to detecting and determining the location of offshore slow slip events, knowledge that contributes to our understanding of subduction zone processes, and to assessing the risk of future large earthquakes and tsunamis. Variations in ocean circulation can cause high noise levels in the pressure data compared to the tectonic signals of interest, which makes it challenging to calculate seafloor uplift or subsidence. Here we show that the deployment of a self‐calibrating type of pressure sensor, along with knowledge from global models of ocean circulation, can significantly reduce the data noise levels. We estimate up to 3.3 cm of seafloor uplift occurred during a large slow slip event between March and June 2019 offshore New Zealand. Key Points: Seafloor pressure data detected vertical seafloor deformation during 2019 slow slip events at the Hikurangi subduction zoneOcean Global Circulation Models can help with the removal of long‐period (>3 month) oceanographic signals in seafloor pressure recordsSelf‐calibrated pressure sensors and depth‐matched reference sites optimize resolution of seafloor vertical deformation [ABSTRACT FROM AUTHOR]

Background and purpose: Immune system dysfunction and inflammatory dysregulation have been shown in several animal models of fragile X syndrome (FXS). However, the phenotypical implications of this dysregulation have not been systematically evaluated in a large patient cohort. Methods: Five thousand seven hundred thirty‐six FXS patients from a nationwide health insurance database were identified and compared to 573 600 age‐ and sex‐matched controls. The phenome‐wide association studies codes of FXS patients and those without FXS were compared and the false discovery rate was controlled at 0.05 using the Benjamini–Hochberg procedure. Results: In addition to the commonly reported comorbidities of FXS, an over‐representation of infectious diseases, including otitis media, cellulitis and abscess of fingers or toes, viral enteritis, candidiasis and pneumonia, was discovered. In addition, there was an under‐representation of autoimmune disorders in FXS patients. Conclusions: Our systematic comorbidity analyses identified immunologically‐based phenotypes associated with FXS. Our findings align with previous observations of compromised immunity and phagocytic defects in animal models of FXS. These results suggest the importance of immune‐related pathways in FXS patients and their relevance to the FMR1 gene. [ABSTRACT FROM AUTHOR]

ABSTRACT Objectives Cornelia de Lange syndrome (CdLS) is characterized by distinct facial features, growth retardation, upper limb reduction defects, hirsutism, and intellectual disability. NIPBL mutations have been identified in approximately 60% of patients with CdLS diagnosed postnatally. Prenatal ultrasound findings include upper limb reduction defects, intrauterine growth restriction, and micrognathia. CdLS has also been associated with decreased PAPP-A and increased nuchal translucency (NT). We reviewed NIPBL sequence analysis results for 12 prenatal samples in our laboratory to determine the frequency of mutations in our cohort. Methods This retrospective study analyzed data from all 12 prenatal cases with suspected CdLS, which were received by The University of Chicago Genetic Services Laboratories. Diagnostic NIPBL sequencing was performed for all samples. Clinical information was collected from referring physicians. Results NIPBL mutations were identified in 9 out of the 12 cases prenatally (75%). Amongst the NIPBL mutation-positive cases with clinical information available, the most common findings were upper limb malformations and micrognathia. Five patients had NT measurements in the first trimester, of which four were noted to be increased. Conclusion We demonstrate that prenatally-detected phenotypes of CdLS, particularly severe micrognathia and bilateral upper limb defects, are associated with an increased frequency of NIPBL mutations. © 2013 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Objective To document the cost incurred by the Tanzanian government by changing the policy on first-line treatment of malaria, from chloroquine to sulfadoxine–pyrimethamine. Methods Costs were analysed from the perspective of the Ministry of Health and included all sources of funding. Costs external to the public health sector (e.g. private and community costs) were not included. The base case analysis adopted an incremental rather than a full cost approach, assuming that an organizational infrastructure was already in place. However, specific attention was paid to the burden placed on National Malaria Control Program staff. We also costed activities planned but not implemented to estimate the total expense for an ‘ideal’ process. Results Total costs were Tsh 795 million (USD 813 743), with the largest proportion accounted for by training. Costs of the policy change process were equivalent to about 4% of annual government and donor expenditure on malaria and to about 1% of overall public expenditure on health. A number of planned activities were not implemented; including these would bring the total cost to Ts 880 million (USD 896 130). Conclusion On top of extra costs for the drugs themselves, a change in treatment policy requires time, resources and substantial management capacity at national and local level. A better understanding of these issues and the costs involved benefits countries planning and implementing policy change. [ABSTRACT FROM AUTHOR]

Objective To investigate the variation in malaria parasitaemia, reported fever, care seeking, antimalarials obtained and household expenditure by socio-economic status (SES), and to assess the implications for ensuring equitable and appropriate use of antimalarial combination therapy. Methods A total of 2500 households were surveyed in three rural districts in southern Tanzania in mid-2001. Blood samples and data on SES were collected from all households. Half the households completed a detailed questionnaire on care seeking and treatment costs. Households were categorised into SES thirds based on an index of household wealth derived using principal components analysis. Results Of individuals completing the detailed survey, 16% reported a fever episode in the previous 2 weeks. People from the better-off stratum were significantly less likely to be parasitaemic, and significantly more likely to obtain antimalarials than those in the middle or poor stratum. The better treatment obtained by the better off led them to spend two to three times more than the middle and poor third spent. This reflected greater use of non-governmental organisation (NGO) facilities, which were the most expensive source of care, and higher expenditure at NGO facilities and drug stores. Conclusion The coverage of appropriate malaria treatment was low in all SES groups, but the two poorer groups were particularly disadvantaged. As countries switch to antimalarial combination therapy, distribution must be targeted to ensure that the poorest groups fully benefit from these new and highly effective medicines. [ABSTRACT FROM AUTHOR]

Sixteen European badgers () from three statutory removal operations were studied. Samples of tracheal aspirate, pooled lymph nodes and urine were cultured for mycobacteria. Seven of the badgers were infected with and had tuberculous pulmonary lesions which varied in severity from extensive granulomatous consolidation to microgranulomas which were not detectable grossly. Tuberculous lesions were also observed in the upper respiratory airways, intestines, kidneys, spleen, liver, thymus, pleura and lymph nodes. One badger had tuberculous bite wounds. The histopathological characteristics of the tuberculous reactions and the associated tissue damage in various organs, together with the gross pathology, indicate that both mildly and severely infected badgers have the potential to excrete by several routes. [ABSTRACT FROM PUBLISHER]

Western and dot blotting techniques were compared with complement fixation tests (CFT), indirect enzyme-linked immunosorbent assays (ELISA), mycoplasma culture and gross lung pathology to detect subspecies sc, the cause of contagious bovine pleuropneumonia (CBPP), in two groups of Italian cattle. None of the animals showed any clinical signs before slaughter. In group A, seven of the 20 cattle had characteristic lung lesions of acute and chronic CBPP but only six were positive by CFT. Western blotting detected antibody in eight of the animals, of which six had lesions and significant CFT titres (>50 per cent fixation at a serum dilution of 1/10) and two had neither. In group B, seven of the 17 cattle had lesions characteristic of CBPP, and 12 were seropositive by CFT. Western blotting detected antibody in 13 of the animals including one which had a negative CFT titre. The ELISA was less sensitive than either CFT or Western blotting, detecting antibody in five animals in group A and nine animals in group B. The dot blotting test correlated well with Western blotting but gave a small number of ambiguous results. The causative organism was isolated from four of the 20 cattle in group A and six of the 17 cattle in group B. [ABSTRACT FROM PUBLISHER]

A letter to the editor is presented regarding incidents of suspected bracken poisoning in pigs.

Background: Depression is common in people with chronic kidney disease, yet little is known about how depression is identified and managed as part of routine kidney care., Objectives: The primary objective was to survey all UK adult kidney centres to understand how depression is identified and managed. A secondary objective was to broadly describe the variability in psychosocial care., Design: Online survey., Methods: The survey comprised of three sections: (1) general kidney care, (2) psychological provision and (3) social work provision., Results: 48/68 (71%) of centres responded to the general survey with 20 and 13 responses from psychological and social work module respectively. Only 31.4% reported having both in centre psychological and social work practitioners. Three centres reported no access to psychosocial provision. Of the 25 centres who reported on pathways, 36.0% reported having internal pathways for the identification and management of depression. Within services with psychological provision, screening for depression varied across modality/group (e.g., 7.1% in mild/moderate chronic kidney disease vs. 62.5% in kidney donors). Cognitive Behavioural Therapy and Acceptance and Commitment Therapy were the most common interventions offered. Most psychosocial services were aware of the National Institute for Health and Care Excellence guidelines for managing depression in long-term conditions (n = 18, 94.7%) yet few fully utilised (n = 6, 33.3%). Limited workforce capacity was evident., Conclusions: There is considerable variability in approaches taken to identify and treat depression across UK kidney services, with few services having specific pathways designed to detect and manage depression. Workforce capacity remains a significant issue., (© 2024 The Authors. Journal of Renal Care published by John Wiley & Sons Ltd on behalf of European Dialysis & Transplant Nurses Association/European Renal Care Association.)

Background: Depression is prevalent across the spectrum of Chronic Kidney Disease and associated with poorer outcomes. There is limited evidence regarding the most effective interventions and care pathways for depression in Chronic Kidney Disease., Objectives: To investigate how depression is identified and managed in adults with Chronic Kidney Disease., Design: Scoping review., Methods: Systematic search of eight databases with pre-defined inclusion criteria. Data relevant to the identification and/or management of depression in adults with Chronic Kidney Disease were extracted., Results: Of 2147 articles identified, 860 were included. Depression was most identified using self-report screening tools (n = 716 studies, 85.3%), with versions of the Beck Depression Inventory (n = 283, 33.7%) being the most common. A total of 123 studies included data on the management of depression, with nonpharmacological interventions being more frequently studied (n = 55, 45%). Cognitive Behavioural Therapy (n = 15) was the most common nonpharmacological intervention, which was found to have a significant effect on depressive symptoms compared to controls (n = 10). However, how such approaches could be implemented as part of routine care was not clear. There was limited evidence for antidepressants use in people with Chronic Kidney Disease albeit in a limited number of studies., Conclusions: Depression is commonly identified using validated screening tools albeit differences exist in reporting practices. Evidence regarding the management of depression is mixed and requires better-quality trials of both pharmacological and nonpharmacological approaches. Understanding which clinical care pathways are used and their evidence, may help facilitate the development of kidney care specific guidelines for the identification and management of depression., (© 2023 The Authors. Journal of Renal Care published by John Wiley & Sons Ltd on behalf of European Dialysis & Transplant Nurses Association/European Renal Care Association.)

Background: Conventional healthcare models struggle to engage those at risk of hepatitis C virus (HCV) infection. This international study evaluated point-of-care (PoC) HCV RNA diagnostic outreach and direct-acting antiviral (DAA) treatment for individuals receiving opioid agonist therapy (OAT) in community pharmacies., Aims: We assessed the effectiveness of a roving nurse-led pathway offering PoC HCV RNA testing to OAT clients in community pharmacies relative to conventional care., Methods: Pharmacies in Scotland, Wales, and Australia were randomised to provide PoC HCV RNA testing or conventional referral. Pharmacists directed OAT clients to on-site nurses (intervention) or local clinics (control). Infected participants were treated with DAAs, alongside OAT. Primary outcome was the number of participants with sustained virologic response at 12 weeks (SVR) and analysed using mixed effects logistic regression in the intention-to-treat (ITT) population., Results: Forty pharmacies were randomised. The ITT population contained 1410 OAT clients. In the conventional arm (n = 648), 62 (10%) agreed to testing, 17 (27%) were tested, 6 (35%) were positive and 5 (83%) initiated treatment. In the intervention arm (n = 762), 148 (19%) agreed to testing, 144 (97%) were tested, 23 (16%) were positive and 22 (96%) initiated treatment. SVR was obtained by 2 (40%; conventional) and 18 (82%; intervention). Intervention arm participants had higher odds of testing, OR 16.95 (7.07-40.64, p < 0.001); treatment, OR 4.29 (1.43-12.92, p = 0.010); and SVR, OR 8.64 (1.82-40.91, p = 0.007)., Conclusions: Nurse-led PoC diagnosis in pharmacies made HCV care more accessible for OAT clients relative to conventional care. However, strategies to improve testing uptake are required., Trial Registration: NCT03935906., (© 2022 The Authors. Alimentary Pharmacology & Therapeutics published by John Wiley & Sons Ltd.)