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Anti-racism approaches require an honest examination of cause, impact, and committed action to change, despite discomfort and without experiential avoidance. While contextual behavioral science (CBS) and third wave cognitive-behavioral modalities demonstrate efficacy among samples composed of primarily White individuals, data regarding their efficacy with people of color, and Black Americans in particular, is lacking. It is important to consider the possible effects of racial stress and trauma on Black clients, and to tailor approaches and techniques grounded in CBS accordingly. We describe how CBS has not done enough to address the needs of Black American communities, using Acceptance and Commitment Therapy (ACT) and Functional Analytic Psychotherapy (FAP) as examples. We also provide examples at the level of research representation, organizational practices, and personal experiences to illuminate covert racist policy tools that maintain inequities. Towards eradicating existing racism in the field, we conclude with suggestions for researchers and leadership in professional psychological organizations.

Abstract Background There are progressively alarming rates of non-medical use, addiction and possible dependence on tramadol in low-middle-income countries. Tramadol is known to heighten negative consequences on social interactions, physical and cognitive abilities among adolescents, students and youth, particularly those with polysubstance use. However, literature on the use of tramadol in low-middle-income countries, especially among undergraduate university students in Ghana remains inadequate. Thus, this study sought to determine the prevalence and factors associated with tramadol use among undergraduate students in Ghana. Methods An institutional-based cross-sectional study and a quota sampling technique were employed to gather data from January to March 2023 on 600 undergraduate students from the University for Development Studies, Tamale, Ghana and analyzed with SPSS (version 26.0). Multiple logistic regression model was used to identify factors associated with the use of tramadol (p-value ≤ 0.05). Results The lifetime prevalence of tramadol use was 17.8%. Among those who used tramadol in their lifetime, 14.95% used tramadol alone whereas 85.05% used at least one substance alongside tramadol. The study recorded more females (67.8%) than males. Students aged 20–24 years (20.5%), those single/never married (18.7%), those renting/living alone (19.7%) and first year students (17.4%) accounted for the majority of groups at high risk of lifetime tramadol use. To improve academic performance was the primary reason for initiating tramadol use. Male sex (adjusted odds ratio [AOR] 2.673; 95% confidence interval [CI] 1.590—4.493; p

Abstract Background Iron-Folate Acid Supplementation (IFAS) interventions have been recognized globally as key in reducing the burden of anemia among pregnant women. However, adherence to and determinants of IFAS remain indistinct, as it is the main constraint with supplementation therapy, particularly among minority populations. Hence, this study sought to determine the adherence to and predictors of IFAS among nomadic Fulani pregnant women in the West Gonja Municipality of Ghana. Methods A community-based cross-sectional design was employed to involve 130 respondents between February to July, 2022 in the West Gonja Municipality of Ghana. Fulani pregnant women aged 15–49 years, possessing maternal and child health record book and were given iron-folate supplements within 16 weeks and resided within the study area ≥ 6 months before/during the data collection period were included in the study. Multivariable logistic regression was used to determine independent predictors of IFAS using SPSS version 25.0 (p ≤ 0.05 deemed statistically significant across all models). ResultsUptake of and adherence to IFAS was 47.7% and 35.5% respectively. Major barriers to IFAS uptake were forgetfulness (25.7%) and unavailability (20.0%). About 65.4% of the respondents revealed poor knowledge of IFAS. Spousal occupation (AOR = 0.17, p = 0.010), spousal income (AOR = 4.125, p = 0.050) and knowledge on IFAS (AOR = 0.259, p = 0.039) were predictors of IFAS. Conclusions Poor adherence to and knowledge on IFAS were noted in the study and highlighted as a grave public health concern. Thus, nutrition and antenatal educational programs should give necessary attention to adherence to IFAS during pregnancy, particularly among nomadic and other vulnerable and minority populations to limit the burden of illnesses.

Abstract Background Including structural determinants (e.g. criminalisation, stigma, inequitable gender norms) in dynamic HIV transmission models is important to help quantify their population-level impacts and guide implementation of effective interventions that reduce the burden of HIV and inequalities thereof. However, evidence-based modelling of structural determinants is challenging partly due to a limited understanding of their causal pathways and few empirical estimates of their effects on HIV acquisition and transmission. Methods We conducted a scoping review of dynamic HIV transmission modelling studies that evaluated the impacts of structural determinants, published up to August 28, 2023, using Ovid Embase and Medline online databases. We appraised studies on how models represented exposure to structural determinants and causal pathways. Building on this, we developed a new methodological framework and recommendations to support the incorporation of structural determinants in transmission dynamics models and their analyses. We discuss the data and analyses that could strengthen the evidence used to inform these models. Results We identified 17 HIV modelling studies that represented structural determinants and/or interventions, including incarceration of people who inject drugs (number of studies [n] = 5), violence against women (n = 3), HIV stigma (n = 1), and housing instability (n = 1), among others (n = 7). Most studies (n = 10) modelled exposures dynamically. Almost half (8/17 studies) represented multiple exposure histories (e.g. current, recent, non-recent exposure). Structural determinants were often assumed to influence HIV indirectly by influencing mediators such as contact patterns, condom use, and antiretroviral therapy use. However, causal pathways’ assumptions were sometimes simple, with few mediators explicitly represented in the model, and largely based on cross-sectional associations. Although most studies calibrated models using HIV epidemiological data, less than half (7/17) also fitted or cross-validated to data on the prevalence, frequency, or effects of exposure to structural determinants. Conclusions Mathematical models can play a crucial role in elucidating the population-level impacts of structural determinants and interventions on HIV. We recommend the next generation of models reflect exposure to structural determinants dynamically and mechanistically, and reproduce the key causal pathways, based on longitudinal evidence of links between structural determinants, mediators, and HIV. This would improve the validity and usefulness of predictions of the impacts of structural determinants and interventions.

Abstract Background The use of herbal medicine and/or its products is common throughout the world. In Tamale Metropolis, pregnant women frequently use local oxytocin to induce labour, as shown by the fact that 90% of midwives reported managing patients who used kaligutim (local oxytocin) to speed up labour. Early career midwives are also aware of this and have personally observed it being used by their clients. The purpose of the study was to assess midwives’ opinions on pregnant women’s use of the well-known kaligutim (local oxytocin) for labour induction in the Tamale Metropolis. Methods A facility-based, quantitative, cross-sectional research design was used for the study. A total of 214 working midwives from Tamale’s three main public hospitals participated. Data for the study were gathered through a standardized questionnaire. For the analysis and presentation of the data, descriptive and analytical statistics, such as basic frequencies, percentages, Fisher’s exact test, chi square test and multivariate analysis, were employed. Results According to the findings of this study, the safety, dosages, and contraindications of kaligutim during pregnancy and labour are unknown. The cessation of contractions was reported by 44 (22.4%) of the respondents whose clients used local oxytocin. The study also revealed that women in Tamale metropolis use “walgu”, a spiritual form of oxytocin, to induce and augment labour. Respondents who responded, “yes” to baby admission to the new-born care unit were 25% more likely to use kaligutim (local oxytocin) than were those who responded, “no” to baby admission to the new-born care unit (AOR = 0.25 95% CI (0.01, 0.53), P = 0.021). Conclusions It can be concluded that using kaligutim to start labour has negative effects on both the mother and the foetus. Additional research is required to evaluate the efficacy, effectiveness, biochemical makeup, and safety of these herbal medicines, particularly during pregnancy and delivery, as well as the spiritual significance of kaligutim (Walgu) and its forms.

Introduction/Objectives: Patients returning to the community from incarceration (ie, reentry) are at heightened risk of experiencing trauma when interacting with the healthcare system. Healthcare professionals may not recognize patients’ trauma reactions or know how to effectively respond. This paper describes the development and pilot evaluation of a single-session training to prepare primary care teams to deliver trauma-informed care (TIC) to patients experiencing reentry. Methods: A multidisciplinary team including community members with lived experience engaged in a multiphase human-centered design process that incorporated interviews, discussions, and a participatory process to design and evaluate a single-session interactive pilot training targeting providers’ attitudes toward formerly incarcerated patients and confidence to deliver TIC. Results: Both pre- and post-training surveys were completed by 12 TIC training attendees, which included primary care providers and staff. Trainees reported significant increases in confidence to reduce potentially re-traumatizing practices and improved attitudes toward formerly incarcerated individuals. They also expressed interest in receiving additional TIC training and learning how best to care for and meet the needs of persons with a history of incarceration. Trainees described the panel of community members with lived experience as one of the most rewarding aspects of the training. Conclusion: Centering people with lived experience in the training design and delivery produced a single-session TIC training that was both well-received and effective. Our TIC training helped primary care providers and staff move from being merely informed on trauma to having the self-efficacy to prevent and respond to trauma reactions during encounters with all patients, particularly those with a history of incarceration.

IntroductionRecurrent uveitis (RU), an autoimmune disease, is a leading cause of ocular detriment in humans and horses. Equine and human RU share many similarities including spontaneous disease and aberrant cytokine signaling. Reduced levels of SOCS1, a critical regulator of cytokine signaling, is associated with several autoimmune diseases. Topical administration of SOCS1-KIR, a peptide mimic of SOCS1, was previously correlated to reduced ocular pathologies within ERU patients.MethodsTo further assess the translational potential of a SOCS1 mimetic to treat RU, we assessed peptide-mediated modulation of immune functions in vitro, using equine peripheral blood mononuclear cells (PBMC), and in vivo through topical administration of SOCS1-KIR into the eyes of experimental (non-uveitic) horses. Equine PBMCs from non-uveitic control and ERU horses were cultured with or without SOCS1-KIR pretreatment, followed by 72 hours of mitogen stimulation. Proliferation was assessed using MTT, and cytokine production within cell supernatants was assessed by Luminex. SOCS1-KIR or carrier eye-drops were topically applied to experimental horse eyes twice daily for 21 days, followed by enucleation and isolation of ocular aqueous and vitreous humor. Histology was used to assess peptide treatment safety and localization within treated equine eyes. Cytokine secretion within aqueous humor and vitreous, isolated from experimental equine eyes, was measured by Luminex.ResultsFollowing SOCS1-KIR pretreatment, cell proliferation significantly decreased in control, but not ERU-derived PBMCs. Despite differential regulation of cellular proliferation, SOCS1-KIR significantly reduced TNFα and IL-10 secretion in PHA-stimulated control and ERU equine PBMC. SOCS1-KIR increased PBMC secretion of IL-8. Topically administered SOCS1-KIR was well tolerated. Although SOCS1-KIR was undetectable within the eye, topically treated equine eyes had significant reductions in TNFα and IL-10. Interestingly, we found that while SOCS1-KIR treatment reduced TNFα and IL-10 production in healthy and ERU PBMC, SOCS1-KIR differentially modulated proliferation, IP-10 production, and RANTES within these two groups suggesting possible differences in cell types or activation status.DiscussionTopical administration of a SOCS1 peptide mimic is safe to the equine eye and reduces ERU associated cytokines IL-10 and TNFα serving as potential biomarkers of drug efficacy in a future clinical trial.

IntroductionRecovery community centers (RCCs) offer various support services to people in addiction recovery, such as hosting mutual help meetings and sober social activities and providing employment support and recovery coaching. To date, very little is known about RCCs and their relationship with recovery outcomes, as well as how RCCs may vary in helpfulness from visit to visit. This study used a daily diary approach to assess the intraindividual variation of daily RCC helpfulness, and whether RCC helpfulness predicted the holistic recovery indices of daily meaningfulness and recovery identity.Methods and materialsRCC attendees (analytical N = 88) from RCCs in Pennsylvania completed daily diary assessments using a smartphone application, for 10 consecutive days. If participants reported that they had spent time at the RCC that day, they then reported the perceived helpfulness of the RCC visit using 7 items. Participants also reported their daily meaningfulness and recovery identity. Ultimately, participants visited their RCC on 247/799 (30.9%) of all reported study days. Multilevel models were used to assess the hypotheses.ResultsParticipants generally reported that their RCC visits were very helpful (M = 87.13 [scale of 0–100], SD = 13.26). Nearly half of the variation in RCC helpfulness was attributable to intraindividual variation (ICC = 0.51). Multilevel models revealed that both interindividual and intraindividual RCC experiences predicted increased holistic recovery outcomes, over the prior day. Individuals’ mean levels of perceived RCC helpfulness, as well as person-mean-centered RCC daily helpfulness, positively predicted daily meaningfulness and recovery identity.ConclusionRCCs predict the holistic recovery outcomes of meaningfulness and recovery identity outcomes on the particular days that the RCCs are visited, and for the individuals who find RCCs more helpful overall. This study offers preliminary evidence to suggest that RCCs are appropriate recipients of public funding intended to support recovery in US communities.

Category: Hindfoot; Other Introduction/Purpose: Total knee arthroplasty (TKA), ankle arthrodesis/arthroplasty, and hindfoot arthrodesis are effective procedures in treating end-stage osteoarthritis and deformity of the knee and hindfoot, respectively. Risk of reoperation remains a significant complication associated with these major lower extremity surgeries. Our study aimed to evaluate revision/reoperation rates and etiologies in patients undergoing staged ipsilateral TKA and hindfoot reconstruction (HFR). Methods: A retrospective review identified 162 patients undergoing ipsilateral TKA and HFR procedures between 2000 and 2022. Groups were stratified according to their index surgery: TKA first (n=81) versus HFR first (n=81). Reoperations rates, complications, and indications were compared via descriptive statistics. Mean follow-up was 4 years from the second surgery. Results: For the TKA first cohort, the overall rate of any reoperation was 28% (23/81), including a significantly higher rate of HFR than TKA reoperations (22% vs. 7%, respectively, p< 0.01). The most common etiology for HFR reoperation was arthrodesis nonunion (8/18, 44%) whereas for reoperation indication for TKA was evenly divided between instability, aseptic loosening, and patellar dysfunction. For the HFR first cohort, the overall rate of any reoperation was 16% (13/81), including similar rates of HFR and TKA reoperations (9% and 10%, respectively, p=0.4). The most common etiologies of HFR and TKA reoperations after F&A surgery first were adjacent joint disease (6/7, 86%) and patellar-related complications (4/8, 50%), respectively. Conclusion: Reoperation after a HFR appears to be higher when an ipsilateral TKA is performed first, primarily due to arthrodesis nonunion. Our series represents a first report of the temporal relationship between TKA and ankle/hindfoot reconstruction.

Objectives We sought to determine the optimal time to pre-activation for trauma team activation that resulted in maximum team efficiency, measured by the time to complete critical actions (TCCAs) during resuscitation. We hypothesized that there exists a time window for trauma team pre-activation that minimizes TCCA.Methods This is an exploratory retrospective analysis of video-reviewed traumas at a level 1 trauma center from January 1, 2018 to 28 February, 2022 that received the highest trauma team activation and had a pre-arrival notification. A total of 11 TCCA categories were calculated using video timestamps. To compare TCCAs from different categories, normalized TCCAs (nTCCAs) were calculated by dividing each TCCA by the median time of its category. Pre-activation times were categorized into three groups: long pre-activation (≥8 min), mid pre-activation (≥4 and ≤7 min), and short pre-activation (≥0 and ≤4).Results There were 466 video-recorded level 1 trauma activations, which resulted in 2334 TCCAs. Of the 466 activations, 152 occured on the patient’s arrival (0 min pre-activation). The majority (425) of patients had a pre-activation time of

Since the introduction of oral pre-exposure prophylaxis (PrEP) in 2016, countries have successfully scaled-up PrEP to populations at risk of HIV acquisition, including key populations, serodiscordant couples and pregnant women. Between 2016 and 2023, there were over 5.6 million oral PrEP initiations globally. Of these, over 1.2 million occurred in South Africa, with nearly 700,000 implemented through USAID/South Africa's PEPFAR program. This case study uses WHO's Building Blocks for Health Systems Strengthening to describe USAID's oral PrEP program in South Africa, reporting experiences and lessons learned in 14 districts across 7 provinces. Key lessons include: (i) Substantial donor financial investment was critical for expanding oral PrEP in South Africa, but sustained leadership and investment from government stakeholders, such as the Department of Health and the National Treasury, have been essential for sustainability. Despite fluctuations in USAID funding, annual PrEP initiations have continued to increase in USAID-supported districts largely due to local leadership. (ii) Health information and supply chain systems required agility to monitor oral PrEP introduction and scale-up. When systems lacked agility, temporary solutions like the development of interim reporting tools were necessary. (iii) Integrating community-based and facility-based service delivery supported client-centered care. Nurses and lay health workers contributed to over 80% of the full-time equivalents supporting PrEP under USAID's human resources for health portfolio. (iv) Integrating sexual and reproductive health services with oral PrEP service delivery provided clients with comprehensive, client-centered care. (v) Other client-centered care included differentiated service delivery options, such as mobile and gazebo modalities, and expanded PrEP choice through implementation science activities for new PrEP products. (vi) USAID-supported PrEP initiations have been highest among females of reproductive age in the general population and men who have sex with men among key populations, priority populations in South Africa. As done in this case study, sharing best practices and lessons learned from USAID/South Africa's oral PrEP program can strengthen the implementation evidence base and inform more efficient PrEP service delivery, particularly as new PrEP products become available.

In this study, pedestrians’ violation rate at signalised crosswalks and the associated risk factors were investigated. The data for the study were obtained through roadside pedestrian observational surveys at 10 selected crosswalks within Accra Metropolis, Ghana. The associated risk factors for the red-light violations were determined using mixed-effect logistic regression model. The descriptive statistics revealed that the red-light violation rate in the Accra metropolis was approximately 62%. Most (63.5%) of the violations occurred during the evening and on weekends (73.6%). Over 98% of pedestrians demonstrated safety consciousness by way of crossing behaviour before and during crossing by observing oncoming traffic. From the mixed-effect logistics regression model, six independent variables being age, signal cycle length, number of pedestrians crossing at a time, day of the week and pedestrian light observation significantly influenced the risk of red-light violation by pedestrians. Effective law enforcement, education campaigns and engineering measures could be used to reduce the tendency of red-light violations by pedestrians and improve pedestrian safety at signalised crosswalks in the Accra metropolis.

Abstract Background Lassa fever (LF) presents significant public health challenges in Sierra Leone, particularly in the Lower Bambara Chiefdom. This study aims to deeply understand how knowledge and attitudes towards LF correlate with community-driven prevention and control measures. Methods A descriptive cross-sectional quantitative approach was used to conduct the research. Data from 2167 participants were collected using an Android-based survey from 1st February 2022 to 14th February 2022. Respondents' knowledge of LF causes, risk factors, transmission modes, and preventive measures were evaluated through a multiple-choice questionnaire, and attitudes toward prevention and control were measured on a 5-point Likert scale. Quantitative data were analyzed using SPSS version 26.0 and frequencies were presented in count, percentage, and table. Chi-square statistics were used to test for associations. Results Among the 2167 participants, over half were males (1184, 54.60%), farmers (1406, 64.90%), married (monogamous) (1428, 65.90%), and had never attended school (1336, 61.70%). Respondents demonstrated high knowledge levels of LF across socio-demographic groups (33% to 100%) and shared a positive attitude towards prevention and control (mean score of 26.77 on a 5–40 scale). Educational level, religious beliefs, and occupational status significantly influenced LF knowledge (p

Ovarian fibrosarcomas account for less than 1% of all ovarian malignancies. Clinical diagnosis is extremely difficult. A 20-year-old, illiterate, married nulliparous woman presented to our Outpatient Department Clinic (OPD) with chronic abdominal distension. Ultrasound and CT scan revealed a very large intra-abdominal mass, 23.8x27.8x35.7cm. She underwent a laparotomy and left salpingo-oophorectomy with her uterus and right adenexum conserved. After surgery, the mass weighed 11.1kg and measured 43x38x35cm. Histological findings were in line with a giant primary ovarian fibrosarcoma. To date, as far as we are aware, this is the largest ever recorded primary ovarian fibrosarcoma.

IntroductionX-linked retinoschisis (XLRS) is a vitreoretinal dystrophy caused by RS1 gene mutations which disrupt retinoschisin-1 (RS1) function. Vital for retinal architecture, the absence of functional RS1 leads to the development of intraretinal cysts. Intravitreal injection of a gene therapy for treating XLRS caused ocular inflammation in high dose groups in a phase I/II clinical trial. This study investigates a low dose subretinal gene therapy in Rs1 knockout (Rs1-KO) mice compared to injection of buffer alone. Observation of an unexpected therapeutic effect following the subretinal injection of the hypertonic buffer led to novel findings in XLRS.MethodsRs1-KO mice were subretinally injected with an AAV2/4 vector (n = 10) containing the RS1 gene driven by an Ef1α promoter, a hypertonic buffer (n = 15) (180 mM NaCl 0.001% F68/PBS (pH 7.4)), or isotonic buffer (n = 7) (155.2 mM NaCl 0.001% F68/PBS, pH 7.0). A sham puncture group was also included (n = 6). Endpoints included electroretinogram (ERG), optical coherence tomography (OCT), a visually guided swim assay (VGSA), and immunohistochemistry.ResultsUnexpectedly, hypertonic buffer-injected eyes had reduced cyst severity at 1-month post-injection (MPI) (p

Objectives It has been shown that record linkage methods can induce bias in resulting datasets since the linkage quality may differ between ethno-racial groups. In this project, we used publicly available voter databases to investigate whether ethno-racial attributes can influence the similarities calculated using approximate string comparison functions on voters' names. Approach We used 11 annual snapshots of a publicly available US voter database between 2011 and 2021 with uniquely identifiable voter data. We extracted pairs of the same voter’s first and last name values from two consecutive snapshots where these values differ. We calculated string similarities and created similarity histograms for each of the available ethno-racial categories, and other sociodemographics variables such as gender and age. We characterized common patterns of name disagreements by ethno-racial groups and compared the shapes of these histograms using cumulative density distributions. Preliminary Results Across the 10 snapshot pairs, eligible voters with non-missing first and last names are included (N2011/2012 = 6,193,001, N2020/2021 = 7,852,763), describing 124,009 first name changes and 485,807 last name changes. Results will be presented as a series of density plots. Using Jaro-Winkler similarity scores of 0.7, 0.8 and 0.9 as threshold, we examined whether match rates differ by ethno-racial categories. Conclusions and Implications Using the same string similarity function on names of individuals of different ethno-racial groups may lead to different distributions of the resulting similarity values. Understanding the patterns of ethno-racial-based name changes in your particular dataset is crucial on selecting linkage parameters that would minimise ethno-racial bias.

Objectives Administrative databases such as voter registries contain a wealth of information about a large proportion of a population. This is especially true when longitudinal information about individuals is available, such as changes in their names, addresses, or self-reported ethnic attributes. Apparent changes in ethnic attributes might be due to perceptions of majority evaluations of ethnic groups. In this project, we analysed snapshots of a publicly available US voter database from 2015 to 2022, exploring if and how recent presidential elections impacted changes in voters' self-reported ethnic attributes. Approach Using bi-monthly snapshots of a publicly available US voter database from 2015 to 2022, we generated cohorts by linking active voters during seven twelve-month periods (2015/16 to 2021/22). These seven time periods included one mid-term and two presidential elections, and four control time spans before, between, and after these elections. We compared changes in self-reported ethnic attributes of voters during the times of elections versus the control time periods. Results Preliminary results reveal a substantial change to self-reported ethnic attributes during the periods leading to an election. A majority of such changes are by individuals from a specific ethnic group choosing not to report an ethnicity, an indication of their preference to not disclose ethnicity-related sensitive information. Conclusions We have shown how a publicly available voter database can be used to explore how self-reported ethnic attributes are modified by individual voters over time, and how the prevalence of such changes is influenced by political events such as presidential elections.

We aimed to develop a framework for generating synthetic identifier datasets to support development and evaluation of data linkage methods. We evaluated whether replicating associations between attributes and identifiers improved the utility of the synthetic data for assessing linkage error. We determined the steps required to generate synthetic identifiers that replicate the properties of real-world data collection. We generated synthetic versions of a large United Kingdom cohort study (the Avon Longitudinal Study of Parents and Children), according to the quality and completeness of identifiers recorded over several waves of the cohort. We evaluated the utility of the synthetic identifier data in terms of assessing linkage quality (false matches and missed matches). Comparing data from two collection points in ALSPAC, we found within-person disagreement in identifiers (differences in recording due to both natural change and non-valid entries) in 18% of surnames and 12% of forenames. Rates of disagreement varied by maternal age and ethnic group. Synthetic data provided accurate estimates of linkage quality metrics compared with the original data (within 0.13-0.55% for missed matches and 0.00-0.04% for false matches). Incorporating associations between identifier errors and maternal age/ethnicity improved synthetic data utility. Replicating dependencies between attribute values (e.g. ethnicity), values of identifiers (e.g. name), identifier disagreements (e.g. missing values, errors or changes over time), and their patterns and distribution structure enables generation of realistic synthetic data that can be used for robust evaluation of linkage methods. Our framework provides a novel and generalisable mechanism for developing and benchmarking record linkage algorithms.

Abstract Nasopharyngeal (NP) swab is one of the most effective sampling devices for clinical specimens. However, commercial NP swabs often release samples through diluents, lowering analyte concentration and causing inaccurate detections. Here, we developed 3D-printed open-cell microlattice NP swabs with user-friendly high-efficiency controlled sample release (CR) mode. Compared with traditional NP swabs, our microlattice NP swabs show higher (~7–11 times) flexibility, larger (~2.3 times) and customizable release volume, higher (dozens to thousands of times) release concentration, high recovery efficiency (~100%), and the ability to quantify analyte levels. Our microlattice NP swabs have been thus demonstrated to improve the sensitivity and accuracy of antibody detection experiments using rapid detection kits. This study offers a promising approach to enhance sensitivity and accuracy in clinical specimen detections, and is beneficial to inspire the design of a wider range of biomedical devices based on 3D-printed microlattice metamaterials.

Objective: Randomized evidence suggests a high risk of pacemaker implantation for patients undergoing mitral valve (MV) surgery with concomitant tricuspid valve repair (cTVR). We investigated the impact of cTVR on outcomes in the Mini-Mitral International Registry. Methods: From 2015 to 2021, 7513 patients underwent minimally invasive MV with or without cTVR in 17 international centers (MV: n = 5609, cTVR: n = 1113). Propensity matching generated 1110 well-balanced pairs. Multivariable analysis was applied. Results: Patients with cTVR were older and had more comorbidities. Propensity matching eliminated most differences except for more TR in patients who underwent cTVR (77.2% vs 22.1% MV, P

Objective: Isolated tricuspid valve surgery is uncommon and associated with high perioperative morbidity and mortality. We aimed to study the overall outcomes of patients who underwent minimally invasive right thoracotomy tricuspid valve surgery (Mini-TVS), consisting of either tricuspid valve repair (TVre) or replacement (TVR). Methods: We performed a retrospective analysis of all Mini-TVS procedures (2017-2022), through which we identified isolated tricuspid valve surgeries. We examined in-hospital outcomes, survival analysis over a 4-year period, and competing risk analysis for reoperative surgery. Results: Among a total of 51 patients, the average age was 60 ± 16 years, and 67% (n = 34) were female. Severe tricuspid regurgitation was present in all cases. Infective endocarditis was noted in 7.8% (n = 4), and 24% (n = 12) had preexisting pacemakers. Mini-TVS included TVre in 18 patients (35%) and TVR in 33 patients (65%). The in-hospital and 30-day mortality rates were 4% (n = 2) and 6% (n = 3), respectively. At 4 years, the overall TVS survival was 76% (confidence interval, 62-93%), with no significant difference between TVre and TVR (91% vs 69%, P = .16). At follow-up, 3 patients required repeat surgery for recurrent regurgitation after 2.6, 3.3, and 11 months, with a reoperation rate of 7.3% (confidence interval, 2.4-22%) at 2 years. Factors associated with worse overall survival included nonelective surgery, right ventricular dysfunction, serum creatinine >2 g/dL, and concomitant left-sided valve disease. Conclusions: A nonsternotomy minimally invasive approach is a feasible option for high-risk patients. Midterm outcomes were similar in repair or replacement. Patients with right ventricular dysfunction and left-sided disease had worse outcomes.

Abstract Blastic plasmacytoid dendritic cell neoplasm (BPDCN) predominantly occurs in adults ≥60 years old; 10–20% of cases are pediatric or adolescent/young adult (AYA) patients. Tagraxofusp (TAG, Elzonris®) is the only approved treatment for BPDCN; in the United States it is approved for patients aged ≥2 years. Data on treating pediatric and AYA BPDCN patients are limited. We present a case series of pediatric and AYA patients with BPDCN treated with TAG. Eight patients (five newly diagnosed; three relapsed/refractory [R/R]), aged 2–21 years, received 12 mcg/kg TAG. Seven patients were female; most had skin (n = 6) and/or bone marrow (n = 4) involvement. No new safety signals were identified. Grade 3 adverse events were headache (n = 1) and transaminitis (n = 2). Three patients with newly diagnosed BPDCN achieved complete response, one achieved partial response, and one had stable disease (SD). One patient with R/R BPDCN achieved a minor response; one had SD. Seven patients (88%) were bridged to stem cell transplant: 80% of newly diagnosed patients and 100% of R/R patients. Five patients remained alive at last follow‐up. These cases highlight the efficacy and safety of TAG in pediatric and AYA patients for whom there is no other approved BPDCN therapy.

Abstract Background Consultations for sexually transmitted infection (STI) provide an opportunity to offer HIV testing to both patients and their partners. This study describes the organisation of HIV self-testing (HIVST) distribution during STI consultations in Abidjan (Côte d’Ivoire) and analyse the perceived barriers and facilitators associated with the use and redistribution of HIVST kits by STI patients. Materials and methods A qualitative study was conducted between March and August 2021 to investigate three services providing HIVST: an antenatal care clinic (ANC), a general health centre that also provided STI consultations, and a dedicated STI clinic. Data were collected through observations of medical consultations with STI patients (N = 98) and interviews with both health professionals involved in HIVST distribution (N = 18) and STI patients who received HIVST kits for their partners (N = 20). Results In the ANC clinic, HIV testing was routinely offered during the first prenatal visit. HIVST was commonly offered to women who had been diagnosed with an STI for their partner’s use (27/29 observations). In the general health centre, two parallel pathways coexisted: before the consultation, a risk assessment tool was used to offer HIV testing to eligible patients and, after the consultation, patients who had been diagnosed with an STI were referred to a care assistant for HIVST. Due to this HIV testing patient flow, few offers of HIV testing and HIVST were made in this setting (3/16). At the dedicated STI clinic, an HIVST video was played in the waiting room. According to the health professionals interviewed, this video helped reduce the time required to offer HIVST after the consultation. Task-shifting was implemented there: patients were referred to a nurse for HIV testing, and HIVST was commonly offered to STI patients for their partners’ use (28/53). When an HIVST was offered, it was generally accepted (54/58). Both health professionals and patients perceived HIVST positively despite experiencing a few difficulties with respect to offering HIVST to partners and structural barriers associated with the organisation of services. Conclusion The organisation of patient flow and task-shifting influenced HIV testing and offers of HIVST kits. Proposing HIVST is more systematic when HIV testing is routinely offered to all patients. Successful integration requires improving the organisation of services, including task-shifting.

Abstract Structural domains and domain walls, inherent in single crystalline perovskite oxides, can significantly influence the properties of the material and therefore must be considered as a vital part of the design of the epitaxial oxide thin films. We employ 4D-STEM combined with machine learning (ML) to comprehensively characterize domain structures at both high spatial resolution and over a significant spatial extent. Using orthorhombic LaFeO3 as a model system, we explore the application of unsupervised and supervised ML in domain mapping, which demonstrates robustness against experiment uncertainties. The results reveal the consequential formation of multiple domains due to the structural degeneracy when LaFeO3 film is grown on cubic SrTiO3. In situ annealing of the film shows the mechanism of domain coarsening that potentially links to phase transition of LaFeO3 at high temperatures. Moreover, synthesis of LaFeO3 on DyScO3 illustrates that a less symmetric orthorhombic substrate inhibits the formation of domain walls, thereby contributing to the mitigation of structural degeneracy. High fidelity of our approach also highlights the potential for the domain mapping of other complicated materials and thin films.

This paper reports a comparative analysis of energy transition policies in Hong Kong, London, and Melbourne, highlighting their approaches to achieving carbon neutrality. Utilizing a qualitative research approach, the study combines desktop research and policy analysis to examine secondary data from academic literature and policy reports. A structured policy analysis was developed to compare the strategies of each city, focusing on legislative tools, regulatory mechanisms, and decarbonization goals. The findings reveal that, while all three cities aim to reduce greenhouse gas emissions through energy transition policies, they adopt different strategies shaped by their socio-economic contexts. Hong Kong emphasizes regulatory measures like the Buildings Energy Efficiency Ordinance, London uses market-based instruments such as carbon pricing, and Melbourne prioritizes community engagement and renewable energy integration. Despite progress, challenges remain, including compliance with standards, funding, and public awareness. Recommendations include developing benchmarking strategies, fostering public–private partnerships, and investing in education. This analysis provides actionable insights for future policy development, emphasizing adaptability and innovation in combating climate change and fostering sustainable urban environments.

ABSTRACT Introduction HIV self‐testing (HIVST) is a promising strategy to improve diagnosis coverage among key populations (KP). The ATLAS (Auto Test VIH, Libre d'Accéder à la connaissance de son Statut) programme implemented HIVST in three West African countries, distributing over 380,000 kits up between 2019 and 2021, focussing on community‐led distribution by KP to their peers and subsequent secondary distribution to their partners and clients. We aim to evaluate the cost‐effectiveness of community‐led HIVST in Côte d'Ivoire, Mali and Senegal. Methods An HIV transmission dynamics model was adapted and calibrated to country‐specific epidemiological data and used to predict the impact of HIVST. We considered the distribution of HIVST among two KP—female sex workers (FSW), and men who have sex with men (MSM)—and their sexual partners and clients. We compared the cost‐effectiveness of two scenarios against a counterfactual without HIVST over a 20‐year horizon (2019–2039). The ATLAS‐only scenario mimicked the 2‐year implemented ATLAS programme, whereas the ATLAS‐scale‐up scenario achieved 95% coverage of HIVST distribution among FSW and MSM by 2025 onwards. The primary outcome is the number of disability‐adjusted life‐years (DALY) averted. Scenarios were compared using incremental cost‐effectiveness ratios (ICERs). Costing was performed using a healthcare provider's perspective. Costs were discounted at 4%, converted to $USD 2022 and estimated using a cost‐function to accommodate economies of scale. Results The ATLAS‐only scenario was highly cost‐effective over 20 years, even at low willingness‐to‐pay thresholds. The median ICERs were $126 ($88–$210) per DALY averted in Côte d'Ivoire, $92 ($88–$210) in Mali and 27$ ($88–$210) in Senegal. Scaling‐up the ATLAS programme would also be cost‐effective, and substantial epidemiological impacts would be achieved. The ICERs for the scale‐up scenario were $199 ($122–$338) per DALY averted in Côte d'Ivoire, $224 ($118–$415) in Mali and $61 ($18–$128) in Senegal. Conclusions Both the implemented and the potential scale‐up of community‐led HIVST programmes in West Africa, where KP are important to overall transmission dynamics, have the potential to be highly cost‐effective, as compared to a scenario without HIVST. These findings support the scale‐up of community‐led HIVST to reach populations that otherwise may not access conventional testing services.

Background: Inappropriate antibiotic prescribing contributes to antimicrobial resistance, a global health threat. Prior studies have used ICD-9-CM codes to estimate inappropriate prescribing rates in ambulatory settings, including emergency departments (EDs), though the last national estimates date back to 2010-2015 (Hersh et al, CID 2021). Using the most recent publicly available data, we estimated inappropriate antibiotic prescribing rates in EDs across all conditions. For further characterization, we estimated rates of inappropriate antibiotic prescribing with and without codes that could be plausible indications for which antibiotics are prescribed. Methods: We analyzed 2016-2021 data from the National Hospital Ambulatory Medical Care Survey, a nationally representative survey of EDs, subsetting to visits with ≥1 oral antibiotic prescription. Using ICD-10-CM codes (Chua et al, BMJ 2019), we calculated proportions of visits with inappropriate antibiotic prescribing; inappropriate antibiotic prescribing and ≥1 plausible antibiotic-inappropriate indication (e.g., viral infection); and inappropriate prescribing without plausible antibiotic-inappropriate indications. Among visits with plausible antibiotic-inappropriate indications, we subcategorized these further (e.g. viral infection, ophthalmologic conditions). Among visits without plausible antibiotic-inappropriate indications, we determined the most common diagnosis codes. We conducted analyses overall and separately among children (0-17 years), adults (18-64 years), and older adults (≥65 years). Results: Demographic characteristics by age group are shown in Table 1. Antibiotic prescription rates overall and for children, adults, and older adults were 18.6%, 17.8%, 19.1%, and 18.0%, respectively. Inappropriate prescription rates were 27.6%, 23.7%, 29.8%, and 24.6%, respectively. Inappropriate antibiotic prescription rates with plausible indications were 14.9%, 16.7%, 15.0%, and 12.6%, while inappropriate antibiotic prescription rates without plausible indications were 12.7%, 7.0%, 14.9%, and 12.0%, respectively (Figure 1). Rates of subcategories of inappropriate prescribing with plausible antibiotic indications overall and by age group are shown in Figure 2, with the most common diagnoses for potential signs and symptoms of infection in Table 2. The most common diagnoses for inappropriate prescribing without plausible indications are in Table 3. Conclusions: Inappropriate antibiotic prescriptions in EDs are common with a substantial proportion without plausible conditions. Most inappropriate prescriptions with plausible antibiotic-inappropriate indications are associated with potential signs and symptoms of infection without a more definitive diagnosis code, suggesting either diagnostic uncertainty or poor coding quality. Future work should distinguish between these two possibilities to determine whether stewardship efforts should focus on educational strategies to avoid unnecessary empiric antibiotic prescribing in the setting of diagnostic uncertainty, improving coding quality, or both.

Summary: Oxygen is the most used drug in anaesthesia. Despite such widespread use, optimal perioperative oxygen administration remains highly controversial because of concerns about the competing harms of both hyperoxia and hypoxia.Notwithstanding a Cochrane review concluding that routinely administering a fractional inspired oxygen concentration (FiO2) >0.6 intraoperatively might increase postoperative morbidity and mortality, the World Health Organization (WHO) currently recommends all anaesthetised patients receive 0.8 FiO2 during and immediately after surgery to reduce surgical site infections. Results from the largest trial available at the time of these two reviews (suggesting long-term survival may be worse with high FiO2, particularly in patients with malignant disease) were considered ‘biologically implausible’ by the WHO's Guideline Development Group. In addition, the integrity of some perioperative oxygen studies has been challenged. Resolving these controversies is of fundamental importance to all perioperative clinicians.This narrative review is based on the inaugural BJA William Mapleson lecture delivered by the senior author (AC) at the 2023 annual meeting of the Royal College of Anaesthetists in Birmingham. We present the current evidence for perioperative oxygen administration and contrast this with how oxygen therapy is targeted in other specialties (e.g. intensive care medicine). We will explore whether anaesthetists follow the WHO recommendations and consider how oxygen administration affects the stress response to surgery. We reason that novel clinical trial designs in combination with targeted experimental medicine studies will be required to improve our understanding of how best to optimise individualised perioperative oxygenation—a cornerstone of anaesthesia.

Abstract Background The ethnicity data gap pertains to 3 major challenges to address ethnic health inequality: 1) Under-representation of ethnic minorities in research; 2) Poor data quality on ethnicity; 3) Ethnicity data not being meaningfully analysed. These challenges are especially relevant for research involving under-served migrant populations in the UK. We aimed to review how ethnicity is captured, reported, analysed and theorised within policy-relevant research on ethnic health inequities. Methods We reviewed a selection of the 1% most highly cited population health papers that reported UK data on ethnicity, and extracted how ethnicity was recorded and analysed in relation to health outcomes. We focused on how ethnicity was obtained (i.e. self reported or not), how ethnic groups were categorised, whether justification was provided for any categorisation, and how ethnicity was theorised to be related to health. We held three 1-h-long guided focus groups with 10 young people from Nigeria, Turkistan, Syria, Yemen and Iran. This engagement helped us shape and interpret our findings, and reflect on. 1) How should ethnicity be asked inclusively, and better recorded? 2) Does self-defined ethnicity change over time or context? If so, why? Results Of the 44 included papers, most (19; 43%) used self-reported ethnicity, categorised in a variety of ways. Of the 27 papers that aggregated ethnicity, 13 (48%) provided justification. Only 8 of 33 papers explicitly theorised how ethnicity related to health. The focus groups agreed that 1) Ethnicity should not be prescribed by others; individuals could be asked to describe their ethnicity in free-text which researchers could synthesise to extract relevant dimensions of ethnicity for their research; 2) Ethnicity changes over time and context according to personal experience, social pressure, and nationality change; 3) Migrants and non-migrants’ lived experience of ethnicity is not fully inter-changeable, even if they share the same ethnic category. Conclusions Ethnicity is a multi-dimensional construct, but this is not currently reflected in UK health research studies, where ethnicity is often aggregated and analysed without justification. Researchers should communicate clearly how ethnicity is operationalised for their study, with appropriate justification for clustering and analysis that is meaningfully theorised. We can only start to tackle ethnic health inequity by treating ethnicity as rigorously as any other variables in our research.

Objective: Few studies have assessed the outcomes of mitral valve surgery in patients with obesity. We sought to study factors that determine the in-hospital outcomes of this population to help clinicians provide optimal care. Methods: A retrospective analysis of adult patients with obesity who underwent open mitral valve replacement or repair between January 1, 2012, and December 31, 2020, was conducted using the National Inpatient Sample. Weighted logistic regression and random forest analyses were performed to assess factors associated with mortality and the interaction of each variable. Results: Of the 48,775 patients with obesity, 34% had morbid obesity (body mass index ≥40), 55% were women, 66% underwent elective surgery, and 55% received isolated open mitral valve replacement or repair. In-hospital mortality was 5.0% (n = 2430). After adjusting for important covariates, a greater risk of mortality was associated with older patients (adjusted odds ratio [aOR], 1.24; 95% CI, 1.08-1.43), higher Elixhauser comorbidity score (aOR, 2.10; 95% CI, 1.87-2.36), prior valve surgery (aOR, 1.63; 95% CI, 1.01-2.63), and more than 2 concomitant procedures (aOR, 2.83; 95% CI, 2.07-3.85). Lower mortality was associated with elective admissions (aOR, 0.70; 95% CI, 0.56-0.87) and valve repair (aOR, 0.58; 95% CI, 0.46-0.73). Machine learning identified several interactions associated with early mortality, such as Elixhauser score, female sex, body mass index ≥40, and kidney failure. Conclusions: The complexity of presentation, comorbidities in older and female patients, and morbid obesity are independently associated with an increased risk of mortality in patients undergoing open mitral valve replacement or repair. Morbid obesity and sex disparity should be recognized in this population, and physicians should consider older patients and females with multiple comorbidities for earlier and more opportune treatment windows.

Abstract Background Coverage of HIV testing remains sub-optimal in West Africa. Between 2019 and 2022, the ATLAS program distributed ~400 000 oral HIV self-tests (HIVST) in Côte d’Ivoire, Mali, and Senegal, prioritising female sex workers (FSW) and men having sex with men (MSM), and relying on secondary redistribution of HIVST to partners, peers and clients to reach individuals not tested through conventional testing. This study assesses the proportion of first-time testers among HIVST users and the associated factors. Methods A phone-based survey was implemented among HIVST users recruited using dedicated leaflets inviting them to anonymously call a free phone number. We collected socio-demographics, sexual behaviours, HIV testing history, HIVST use, and satisfaction with HIVST. We reported the proportion of first-time testers and computed associated factors using logistic regression. Results Between March and June 2021, 2 615 participants were recruited for 50 940 distributed HIVST (participation rate: 5.1%). Among participants, 30% received their HIVST kit through secondary distribution (from a friend, sexual partner, family member, or colleague). The proportion who had never tested for HIV before HIVST (first-time testers) was 41%. The main factors associated with being a first-time tester were sex, age group, education level, condom use, and secondary distribution. A higher proportion was observed among those aged 24 years or less (55% vs 32% for 25–34, aOR: 0.37 [95%CI: 0.30–0.44], and 26% for 35 years or more, aOR: 0.28 [0.21–0.37]); those less educated (48% for none/primary education vs 45% for secondary education, aOR: 0.60 [0.47–0.77], and 29% for higher education, aOR: 0.33 [0.25–0.44]). A lower proportion was observed among women (37% vs 43%, aOR: 0.49 [0.40–0.60]); those reporting always using a condom over the last year (36% vs 51% for those reporting never using them, aOR: 2.02 [1.59–2.56]); and those who received their HISVST kit through primary distribution (39% vs 46% for secondary distribution, aOR: 1.32 [1.08–1.60]). Conclusion ATLAS HIVST strategy, including secondary distribution, successfully reached a significant proportion of first-time testers. HIVST has the potential to reach underserved populations and contribute to the expansion of HIV testing services in West Africa.

Abstract Introduction Complex intervention development has been described as the ‘Cinderella’ black box in health services research. Greater transparency in the intervention development process is urgently needed to help reduce research waste. Methods We applied a new consensus‐based framework for complex intervention development to our programme of research, in which we developed an intervention to improve the safety and experience of care transitions for older people. Through this process, we aimed to reflect on the framework's utility for intervention development and identify any important gaps within it to support its continued development. Findings The framework was a useful tool for transparent reporting of the process of complex intervention development. We identified potential ‘action’ gaps in the framework including ‘consolidation of evidence’ and ‘development of principles’ that could bracket and steer decision‐making in the process. Conclusions We consider that the level of transparency demonstrated in this report, aided through use of the framework, is essential in the quest for reducing research waste. Patient or Public Contribution We have involved our dedicated patient and public involvement group in all work packages of this programme of research. Specifically, they attended and contributed to co‐design workshops and contributed to finalizing the intervention for the pilot evaluation. Staff also participated by attending co‐design workshops, helping us to prioritize content ideas for the intervention and supporting the development of intervention components outside of the workshops.

Abstract Introduction The HIV and hepatitis B virus (HBV) epidemics are interconnected with shared routes of transmission and specific antiviral drugs that are effective against both viruses. Nearly, 300 million people around the world live with chronic HBV, many of whom are from priority populations who could benefit from HIV prevention services. Oral pre‐exposure prophylaxis (PrEP) for HIV has implications in the prevention and treatment of HBV infection, but many people at increased risk of HIV acquisition may instead prefer long‐acting formulations of PrEP, which are currently not active against HBV. Discussion People at increased risk for HIV acquisition may also be at risk for or already be living with HBV infection. Oral PrEP with tenofovir is effective in preventing both HIV and HBV, and tenofovir is also the recommended treatment for chronic HBV infection. Although implementation of oral PrEP has been challenging in sub‐Saharan Africa, investments in its scale‐up could secondarily reduce the clinical impact of HBV. Long‐acting PrEP, including injectable medicines and implantable rings, may overcome some of the implementation challenges associated with oral PrEP, such as daily pill burden, adherence challenges and stigma; however, current formulations of long‐acting PrEP do not have activity against HBV replication. Ideally, PrEP programmes would offer both oral and long‐acting formulations with HBV screening to optimize HIV prevention services and HBV prevention and care, when appropriate. People who are not immune to HBV would benefit from being vaccinated against HBV before initiating long‐acting PrEP. People who remain non‐immune to HBV despite vaccination may benefit from being offered oral, tenofovir‐based PrEP given its potential for HBV PrEP. People using PrEP and living with HBV who are not linked to dedicated HBV care would also benefit from laboratory monitoring at PrEP sites to ensure safety when using and after stopping tenofovir. PrEP programmes are ideal venues to offer HBV screening, HBV vaccination for people who are non‐immune and treatment with tenofovir‐based PrEP for people with indications for HBV therapy. Conclusions Long‐acting PrEP holds promise for reducing HIV incidence, but its implications for the HBV epidemic, particularly in sub‐Saharan Africa, should not be overlooked.

BackgroundFacilitated by the inability to vaccinate, and an immature immune system, COVID-19 remains a leading cause of death among children. Vaccinated lactating mothers produce specific SARS-CoV-2 antibodies in their milk, capable of neutralizing the virus in vitro. Our objective for this study is to assess the effect of COVID-19 booster dose on SARS-CoV-2 antibody concentration and viral neutralization in milk, plasma, and infant stool.MethodsThirty-nine mothers and 25 infants were enrolled from December 2020 to May 2022. Milk, maternal plasma, and infants' stool were collected at various time-points up to 12 months following mRNA COVID-19 vaccination. A subgroup of 14 mothers received a booster dose. SARS-CoV-2 antibody levels and their neutralization capacities were assessed.ResultsBooster vaccination led to significantly higher IgG levels within human milk and breastfed infants' stool. In vitro neutralization of VSV-gfp-SARS-CoV-2-S-gp, a laboratory safe SARS-CoV-2 like pseudovirus, improved following the booster, with a 90% increase in plasma neutralization and a 60% increase in milk neutralization. We found that post-booster neutralization by human milk was highly correlated to SARS-CoV-2 IgG level. In support of our correlation result, Protein G column depletion of IgG in milk yielded a significant reduction in viral neutralization (p = 0.04).DiscussionThe substantial increase in neutralizing IgG levels in milk and breastfed infants' stool post-booster, coupled with the decrease in milk neutralization capabilities upon IgG depletion, underscores the efficacy of booster doses in augmenting the immune response against SARS-CoV-2 in human milk.

Following the abolition of the transatlantic trade in African captives, slave traders from France, Spain and Cuba devised strategies of concealment to perpetuate and even expand their enterprise. A close reading of the unexpurgated logbooks and business correspondence of the Jeune Louis , a French ship that transported more than three hundred captives from the Bight of Biafra to Havana in 1825, identifies three decisive innovations in the Franco-Cuban branch of the illegal slave trade. Transnational business structure, risk management through honour-based marine insurance policies, and redacted record keeping transformed the wider Atlantic slave-trading sector into one capable of eluding attempts at international suppression. The clandestine techniques that this transnational slaving network developed to skirt the law also distorted the archival record of that traffic. Accounting for the resulting distortions and disappearances will enable future researchers to better navigate them. [ABSTRACT FROM AUTHOR]

Abstract Background The current biodiversity crisis underscores the urgent need for sustainable management of the human uses of nature. In the context of sustainability management, adopting the ecosystem service (ES) concept, i.e., the benefits humans obtain from nature, can support decisions aimed at benefiting both nature and people. However, marine ecosystems in particular endure numerous direct drivers of change (i.e., habitat loss and degradation, overexploitation, pollution, climate change, and introduction of non-indigenous species) all of which threaten ecosystem structure, functioning, and the provision of ES. Marine ecosystems have received less attention than terrestrial ecosystems in ES literature, and knowledge on marine ES is hindered by the highly heterogeneous scientific literature with regard to the different types of marine ecosystem, ES, and their correlates. Here, we constructed a systematic map of the existing literature to highlight knowledge clusters and knowledge gaps on how changes in marine ecosystems influence the provision of marine ES. Method We searched for all evidence documenting how changes in structure and functioning of marine ecosystems affect the delivery of ES in academic and grey literature sources. In addition to Scopus, Web of Science, and Google Scholar, we searched 6 online databases from intergovernmental agencies, supranational or national organizations, and NGOs. We screened English-language documents using predefined inclusion criteria on titles, abstracts, and then full texts, without any geographic or temporal limitations. All qualifying literature was coded and metadata were extracted. No formal validity appraisal was undertaken. We identified knowledge clusters and gaps in terms of which ecosystem types, biodiversity components, or ES types have been studied and how these categories are linked. Review findings Our searches identified 41 884 articles published since 1968 of which 12 140 were duplicates; 25 747 articles were excluded at the title-screening stage, then 2774 at the abstract stage. After full-text screening, a total of 653 articles—having met the eligibility criteria—were included in the final database, spanning from 1977 to July 2021. The number of studies was unevenly distributed across geographic boundaries, ecosystem types, ES, and types of pressure. The most studied ecosystems were pelagic ecosystems on continental shelves and intertidal ecosystems, and deep-sea habitats and ice-associated ecosystems were the least studied. Food provision was the major focus of ES articles across all types of marine ecosystem (67%), followed by climate regulation (28%), and recreation (14%). Biophysical values were assessed in 91% of the analysed articles, 30% assessed economic values, but only 3% assessed socio-cultural values. Regarding the type of impact on ecosystems, management effects were the most studied, followed by overexploitation and climate change (with increase in seawater temperature being the most commonly assessed climate change pressure). Lastly, the introduction of non-indigenous species and deoxygenation were the least studied. Conclusions This systematic map provides, in addition to a database, knowledge gaps and clusters on how marine ecosystem changes impact ES provision. The current lack of knowledge is a threat to the sustainability of human actions and knowledge-based nature conservation. The knowledge gaps and clusters highlighted here could guide future research and impact the beneficial development of policy and management practices.

Abstract Introduction HIV epidemics in Western and Central Africa (WCA) remain concentrated among key populations, who are often unaware of their status. HIV self-testing (HIVST) and its secondary distribution among key populations, and their partners and relatives, could reduce gaps in diagnosis coverage. We aimed to document and understand secondary HIVST distribution practices by men who have sex with men (MSM), female sex workers (FSW), people who use drugs (PWUD); and the use of HIVST by their networks in Côte d’Ivoire, Mali, and Senegal. Methods A qualitative study was conducted in 2021 involving (a) face-to-face interviews with MSM, FSW, and PWUD who received HIVST kits from peer educators (primary users) and (b) telephone interviews with people who received kits from primary contacts (secondary users). These individual interviews were audio-recorded, transcribed, and coded using Dedoose software. Thematic analysis was performed. Results A total of 89 participants, including 65 primary users and 24 secondary users were interviewed. Results showed that HIVST were effectively redistributed through peers and key populations networks. The main reported motivations for HIVST distribution included allowing others to access testing and protecting oneself by verifying the status of partners/clients. The main barrier to distribution was the fear of sexual partners’ reactions. Findings suggest that members of key populations raised awareness of HIVST and referred those in need of HIVST to peer educators. One FSW reported physical abuse. Secondary users generally completed HIVST within two days of receiving the kit. The test was used half the times in the physical presence of another person, partly for psychological support need. Users who reported a reactive test sought confirmatory testing and were linked to care. Some participants mentioned difficulties in collecting the biological sample (2 participants) and interpreting the result (4 participants). Conclusion The redistribution of HIVST was common among key populations, with minor negative attitudes. Users encountered few difficulties using the kits. Reactive test cases were generally confirmed. These secondary distribution practices support the deployment of HIVST to key populations, their partners, and other relatives. In similar WCA countries, members of key populations can assist in the distribution of HIVST, contributing to closing HIV diagnosis gaps.

Introduction: Prostate cancer carries a high morbidity and mortality especially when not diagnosed early. Patients in resource limited countries tend to be diagnosed late and hence delayed surgery for benign prostate hypertrophy (BPH). Method: This was a retrospective study, from 1st January 2019 to 31st December 2020, on patients who underwent prostatectomy. Demographic and clinical data were extracted from their medical records. Results: This study involved 101 patients who had had simple open prostatectomy. Ages ranged from 49 to 98 years, mean 68 +/- 8.98 years. The largest group (37.6%) was aged 71- 80 years, p=0.001. Two thirds (66%), presented with urinary retention, p=0.03. Histopathological examination showed that 49.5% had BPH. Prostate cancer was found in 28.8%, p=0.082. Almost half (49.5%) were diagnosed histopathologically as having BPH. Prostate cancer made up 28.8% with most patients in the age range 61-80 years, p= 0.456. Conclusion: The prevalence of prostate cancer remains high among patients undergoing prostatectomy for suspected BPH. A national awareness campaign coupled with targeted screening of patients above 40 years could increase early detection of prostate cancer and reduce morbidity and mortality.

This article proposes Irish radio broadcasting as an unexplored context for new directions in Flann O’Brien studies. Brian O’Nolan’s involvement in Irish radio spans at least two decades, from the early 1930s into the 1950s, yet the contributions of O’Nolan and his literary circle to Radio Éireann and the BBC remain an under-researched area of Flann O’Brien scholarship. Scholars are faced with the absence of a sound archive to refer to; but this article argues that such absences are part of the ephemeral nature of radio as a medium, and that we must view O’Nolan’s work in radio as an emerging, amateur practice within a wider, sustained artistic project. Though we cannot resurrect the live performances themselves, the article draws on new archival evidence to offer a short history of O’Nolan’s radio appearances. It attempts to fill the gaps produced by lost media with original radio schedules, reviews, letters, and typescript drafts, and by contextualising O’Nolan’s portrayals of radio within a wider social and technological milieu, via the radio-related activity of his circle (Niall Sheridan, Donagh MacDonagh, Niall Montgomery). This context helps us to see how radio aesthetics influenced O’Nolan’s metafictional writing, as demonstrated through close readings of how the modernist ‘radio’ mode informed ‘!CEÓL!’ (1932), Blather (1934), and At Swim-Two-Birds (1939).

The 2013-2016 Ebola Virus Disease (EVD) epidemic in West Africa was the deadliest in history, with over 28,000 cases. Numerous physical and mental health symptoms have been reported in EVD survivors, although there is limited prior research on how the health of survivors compares to the general population. We conducted a survey of EVD survivors in Kenema District, Sierra Leone and a population-based sample of community members who lived in EVD-affected areas but were not diagnosed with EVD, and compared resulting data about self-reported symptoms, duration, and severity between EVD survivors and community members through multivariate regression models. This study found that more than six years after the epidemic, survivors were significantly more likely to experience both physical and mental health symptoms than community members, with respective adjusted incidence rate ratios (IRRs) of 2.65 (95% CI, 2.28-3.09), p < 0.001, and 11.95 (95% CI, 6.58-21.71), p < 0.001. The most highly reported physical health symptoms experienced by EVD survivors were joint pain (75.5%), headaches (67.3%), and vision problems (44.5%), and the most prevalent psychological symptoms were spells of terror and panic (25.5%) and difficulty falling asleep or staying asleep (20.0%). EVD survivors were significantly more likely than community members to report the symptoms as lasting for a longer period, a median of 6.0 (3.0-7.0) years, and with higher severity. The results indicated that six years after the epidemic, EVD survivors in Kenema District, Sierra Leone are experiencing worse physical and mental health than their peers. These findings of the long-term, debilitating health issues following EVD infection should be considered when designing and implementing future epidemic responses.

While breast cancer is the most common cancer globally, not all women have access to quality care. Long considered a disease of high-income countries, low- and middle-income countries are now facing a major public health issue regarding cancer. This is the case in sub-Saharan Africa, where access to quality breast cancer treatment is often lacking. This context leads some women to travel abroad, particularly to France, hoping to save their lives. This article aims to examine the experiences, the social cost and the perceptions associated with therapeutic mobility for breast cancer in France. To this end, this study uses a qualitative method based on nineteen biographical interviews with women from sub-Saharan Africa with breast cancer who have migrated to France seeking for treatment. It shows that these women often face significant difficulties throughout their care and life paths in France. Main issues lay in accessing care, housing insecurity, loneliness, and administrative instability. This reflects how the double biographical disruption, caused by cancer and migration, impact entire disease trajectories, from entry to care to post-breast cancer period. With this research, we suggest extending the concept of social death to the issue of women who have undergone therapeutic mobility for their breast cancer in France. Highlighting the experiences of women who remain almost invisible in the public arena, this article analyses poorly heard realities and shows how social inequalities in health can be found even in reconstructing oneself after breast cancer.

Category: Hindfoot; Ankle Arthritis Introduction/Purpose: Subtalar arthrodesis (STA) is a common procedure used to correct rigid, arthritic hindfoot deformity. The deformity is often able to be corrected through the subtalar arthrodesis-site, however in severe deformity, calcaneal osteotomy (CO) may also be required to realign the hindfoot. CO may predispose the patient to additional risk of wound complication due to the proximity of sinus tarsi and open lateral calcaneal osteotomy incisions. Despite the relatively common nature of hindfoot deformity, there is no study to date assessing the complication profile and outcomes of combined STA and CO when compared STA alone. The purpose of this study was to compare STA alone versus STA and CO to examine union rates and complications for a procedure with known nonunion risk. Methods: A retrospective review of all STA performed two institutions between January 2011 and August 2021 was performed. All STA performed during that time period were identified using a CPT code search and chart review. 22 patients were identified with combined STA and CO as part of a simultaneous procedure. We then performed a matched pair analysis for STA only as a control group identifying 22 patients with STA only. Complications including delayed union or nonunion, removal of hardware, wound complications, and the need for revision surgery were recorded. The two groups were matched for age, gender, presence of diabetes, and smoking status. Differences were analyzed using a two-tailed Fisher’s exact test. Results: There were 22 patients in the STA and CO group with 22 included matched pairs as our control group . There were no significant statistical differences between the two groups when comparing for age and comorbidities. The STA group had 4 recorded complications, while the STA and CO group had 1 recorded complication in the follow-up period. There was no significant difference in complications between the STA and the combined STA and CO group (p= 0.6361). Radiographic union was identified with CT scan. All but 1 patient achieved union in the STA and CO group (nonunion ST only and not CO). 0 nonunions were identified in the STA control group. Post hoc power analysis demonstrates 81% power regarding union compared to historical controls. Conclusion: There was no statistically significant increase in complications when a calcaneal osteotomy was performed in addition to a subtalar arthrodesis, with no specific concern for wound complication. This data supports that performing a calcaneal osteotomy in combination with a subtalar arthrodesis may be utilized to prevent undercorrection of hindfoot deformity without additional wound complication risk. This study is limited by small study groups due to the severity of deformity required to have an additional calcaneus osteotomy. However it also highlights the importance of deformity correction as no additional risk of revision surgery was added.

BackgroundIn the burgeoning area of clinical digital phenotyping research, there is a dearth of literature that details methodology, including the key challenges and dilemmas in developing and implementing a successful architecture for technological infrastructure, patient engagement, longitudinal study participation, and successful reporting and analysis of diverse passive and active digital data streams. ObjectiveThis article provides a narrative rationale for our study design in the context of the current evidence base and best practices, with an emphasis on our initial lessons learned from the implementation challenges and successes of this digital phenotyping study. MethodsWe describe the design and implementation approach for a digital phenotyping pilot feasibility study with attention to synthesizing key literature and the reasoning for pragmatic adaptations in implementing a multisite study encompassing distinct geographic and population settings. This methodology was used to recruit patients as study participants with a clinician-validated diagnostic history of unipolar depression, bipolar I disorder, or bipolar II disorder, or healthy controls in 2 geographically distinct health care systems for a longitudinal digital phenotyping study of mood disorders. ResultsWe describe the feasibility of a multisite digital phenotyping pilot study for patients with mood disorders in terms of passively and actively collected phenotyping data quality and enrollment of patients. Overall data quality (assessed as the amount of sensor data obtained vs expected) was high compared to that in related studies. Results were reported on the relevant demographic features of study participants, revealing recruitment properties of age (mean subgroup age ranged from 31 years in the healthy control subgroup to 38 years in the bipolar I disorder subgroup), sex (predominance of female participants, with 7/11, 64% females in the bipolar II disorder subgroup), and smartphone operating system (iOS vs Android; iOS ranged from 7/11, 64% in the bipolar II disorder subgroup to 29/32, 91% in the healthy control subgroup). We also described implementation considerations around digital phenotyping research for mood disorders and other psychiatric conditions. ConclusionsDigital phenotyping in affective disorders is feasible on both Android and iOS smartphones, and the resulting data quality using an open-source platform is higher than that in comparable studies. While the digital phenotyping data quality was independent of gender and race, the reported demographic features of study participants revealed important information on possible selection biases that may result from naturalistic research in this domain. We believe that the methodology described will be readily reproducible and generalizable to other study settings and patient populations given our data on deployment at 2 unique sites.

IntroductionB-cell acute lymphoblastic leukemia (B-ALL) is the most common malignancy in children. The current conventional chemotherapy regimens have high overall survival but with significant short- and long-term toxicities, sometimes requiring delay and termination of chemotherapy. Bispecific T-cell engager antibody blinatumomab has been successful in achieving bone marrow remission and acting as bridging therapy in minimal residual disease (MRD)-positive relapsed adult and pediatric B-ALL patients. Its role as upfront therapy is being explored. Here, we report the first case to our knowledge showing the feasibility, tolerability, and sustained remission using blinatumomab upfront as consolidation and maintenance therapy for 2 years in a pediatric patient with high-risk B-ALL who had significant toxicities with conventional chemotherapy.'Case presentationAn 11-year-old Hispanic girl presented with complaints of fever, abdominal pain, and fatigue. On further evaluation, she had tachycardia, pallor, cervical lymphadenopathy, and pancytopenia. Bone marrow studies confirmed high-risk B-ALL. The patient was started on induction chemotherapy per AALL1131. Her induction course was complicated by syncope, febrile neutropenia, and invasive cryptococcal fungal infection. End-of-induction bone marrow results were MRD negative. Further chemotherapy was withheld due to cardiopulmonary and renal failure, along with ventricular arrhythmias requiring intensive care. The patient received two cycles of blinatumomab as consolidation therapy and then transitioned back to conventional consolidation therapy; however, it was terminated mid-consolidation due to Pseudomonas and Aspergillus sepsis. She was then given blinatumomab maintenance therapy for 2 years and tolerated it well without any irreversible toxicity. She had an episode of Staphylococcus epidermidis sepsis and pneumonia treated by antibiotics and a single episode of a seizure while on blinatumomab therapy. At the time of publication, she is 25 months off treatment and in sustained remission without any further transplant or chemotherapy. She received monthly intravenous immunoglobulin G during the blinatumomab maintenance.ConclusionBlinatumomab given upfront as consolidation and maintenance therapy for 2 years in a pediatric high-risk B-ALL patient with significant toxicities to conventional chemotherapy was feasible and very well tolerated without any irreversible toxicity and led to sustained remission without any bridging transplant or further chemotherapy.

Accurate measurement of angular positions on the sky requires a well-defined system of reference, something that in practice is realized by the International Celestial Reference Frame (ICRF) with observations of distant (typical redshift $\sim$1) Active Galactic Nuclei (AGN). At such great distances a subset of these objects exhibit as little as 10$-$50 $\mu$as/year observed parallax or proper motion, thus giving the frame excellent spatial and temporal stability. Until fairly recently the majority of AGN centered imaging was accomplished in the S (2.3 GHz) and X (8.4 GHz) radio frequency bands, however S-band observations for reasons such as sensitivity “plateauing”, increased source structure (jets), and radio frequency interference (RFI) have become less productive. Following spacecraft telemetry moves to higher frequencies and a desire to strengthen JPL's leadership in defining the next-generation of celestial reference frames has motivated the development of a “Quad-band” prototype receiver that operates in X, Ku, K, and Ka band in both right hand (RCP) and left hand (LCP) circular polarization. The goal of this receiver is to achieve less than a 20 % increase in noise over the Jansky Very Large Array (JVLA, NRAO) performance specification, which in such a wide bandwidth represents a revolutionary capability. To evaluate the various technical developments of the 8 GHz$-$40 GHz receiver the feedhorn optical beam was designed to interface to the US based Very Long Baseline Array (VLBA). The receiver's intermediate frequency (IF) spans 4 GHz$-$8 GHz, giving rise to up to eight 4 GHz IF channels for a fully populated instrument. This paper outlines the technical development of a 2$^{1}$/$_{2}$ octave wide (8 GHz$-$40 GHz) X-Ka band prototype receiver, fulfilling a need for super broadband technology within the VLBI network. An important additional benefit of the wideband receiver approach is its simplicity and low cost of operation.

Beginning in March 2020, to reduce COVID-19 transmission, the US President’s Emergency Plan for AIDS Relief supporting voluntary medical male circumcision (VMMC) services was delayed in 15 sub-Saharan African countries. We reviewed performance indicators to compare the number of VMMCs performed in 2020 with those performed in previous years. In all countries, the annual number of VMMCs performed decreased 32.5% (from 3,898,960 in 2019 to 2,631,951 in 2020). That reduction is largely attributed to national and local COVID-19 mitigation measures instituted by ministries of health. Overall, 66.7% of the VMMC global annual target was met in 2020, compared with 102.0% in 2019. Countries were not uniformly affected; South Africa achieved only 30.7% of its annual target in 2020, but Rwanda achieved 123.0%. Continued disruption to the VMMC program may lead to reduced circumcision coverage and potentially increased HIV-susceptible populations. Strategies for modifying VMMC services provide lessons for adapting healthcare systems during a global pandemic.

Abstract Background Climate change and the current phase-out of fossil fuel-fired power generation are currently expanding the market of renewable energy and more especially photovoltaic (PV) panels. Contrary to other types of renewable energies, such as wind and hydroelectricity, evidence on the effects of PV panels on biodiversity has been building up only fairly recently. PV panels have been linked to substantial impacts on species and ecosystems, the first and most obvious one being the degradation of natural habitats but they may also lead to mortality of individuals and displacements of populations. Hence, we propose a systematic map aiming to draw a comprehensive panorama of the available knowledge on the effects of photovoltaic and solar thermal (PVST) installations, whatever their scales (i.e. cells, panels, arrays, utility-scale facilities), on terrestrial and semi-aquatic species and natural/semi-natural habitats and ecosystems. This work aims at providing decision-makers with a better understanding of the effects of PVST installations and, therefore, help them further protect biodiversity while also mitigating anthropogenic climate change. Methods We will follow the collaboration for environmental evidence guidelines and search for relevant peer-reviewed and grey literature in English or French. The search string will combine population (all wild terrestrial and semi-aquatic species—e.g. animals, plants, fungi, microorganisms—as well as natural/semi-natural terrestrial habitats and ecosystems) and exposure/intervention (all technologies of PVST panels at all scales of installations and therefore excluding concentrated solar power) terms. A pre-built test list of relevant articles will be used to assess the comprehensiveness of the search string. Extracted citations will be screened at title and full-text stages thanks to pre-defined inclusion/exclusion criteria. Accepted citations will then be split into studies and observations, from which relevant metadata (e.g. taxon, exposure/intervention, outcome) will be extracted and their internal validity assessed through a critical appraisal. The database will be accessible alongside a map report which will draw a landscape of eligible studies. By describing studied populations, exposures/interventions, outcomes and internal study validity results, the report will identify potential knowledge clusters and gaps regarding the effects of PVST installations on biodiversity and ecosystems.

Habitat loss and degradation due to global agriculture land use is a major threat to biodiversity. Identifying agricultural management practices that mitigate these impacts is urgently needed. Thousands of experiments have been conducted worldwide in the last decades to compare the impacts of various agricultural management practices on biodiversity. The magnitudes of difference in biodiversity responses between pairs of agricultural practices, i.e. effect sizes, have now been synthesised in a growing number of meta-analyses. Yet, each meta-analysis generally focuses on a specific type of farming practice and on specific taxonomic groups, or a single region. Meta-analyses could furthermore yield different or sometimes opposite results for the similar research questions. Gathering all the effect sizes in one single dataset helps to critically assess and weigh the available evidence across all studied practices, taxonomic groups and geographical areas, and provide stakeholders a solid base to better inform their decisions. Here, we present a comprehensive dataset of 200 published meta-analyses gathering 1885 effect sizes based on more than 14 000 primary studies. We detail the effect of 8 main individual field practices (e.g. pest and disease management, amendment and fertilisation), 3 agricultural systems (e.g. organic farming, conservation agriculture) and 2 landscape level interventions (i.e. landscape complexity, land-use change). Our dataset covers numerous taxonomic groups over 14 phyla, including animals (e.g. birds, insects), microorganisms (e.g. fungi, bacteria), plants (e.g. trees, weeds). The dataset presented provides a resource to support decision-makers, farmers, and conservation ecologists alike for managing agricultural land for biodiversity.