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Understanding forest water limitation during droughts within a warming climate is essential for accurate predictions of forest-climate interactions. In hyperdiverse ecosystems like the Amazon forest, the mechanisms shaping hysteresis patterns in transpiration relative to environmental factors are not well understood. From this perspective, we investigated these dynamics by conducting in situ leaf-level measurements throughout and after the 2015 El Niño-Southern Oscillation (ENSO) drought. Our findings indicate a substantial increase in the hysteresis area (Harea) among transpiration (E), vapor pressure deficit (VPD), and stomatal conductance (gs) at canopy level during the ENSO peak, attributed to both temporal lag and differences in magnitude between gs and VPD peaks. Specifically, the canopy species Pouteria anomala exhibited an increased Harea, due to earlier maximum gs rates leading to a greater temporal lag with VPD compared to the post-drought period. Additionally, leaf water potential (ΨL) and canopy temperature (Tcanopy) showed larger Harea during the ENSO peak compared to post-drought conditions across all studied species, suggesting that stomatal closure, particularly during the afternoon, acts to minimize water loss and may explain the counterclockwise hysteresis observed between ΨL and Tcanopy. The pronounced Harea during the drought points to a potential imbalance between water supply and demand, underlining the role of stomatal behavior of isohydric species in response to drought.

Motor vehicles are among the major sources of pollutants and greenhouse gases in urban areas and a transition to "zero emission vehicles" is underway worldwide. However, emissions associated with brake and tire wear will remain. We show here that previously unrecognized volatile and semi-volatile organic compounds, which have a similarity to biomass burning emissions are emitted during braking. These include greenhouse gases or, these classified as Hazardous Air Pollutants, as well as nitrogen-containing organics, nitrogen oxides and ammonia. The distribution and reactivity of these gaseous emissions are such that they can react in air to form ozone and other secondary pollutants with adverse health and climate consequences. Some of the compounds may prove to be unique markers of brake emissions. At higher temperatures, nucleation and growth of nanoparticles is also observed. Regions with high traffic, which are often disadvantaged communities, as well as commuters can be impacted by these emissions even after combustion-powered vehicles are phased out.

Ever since the Taiwanese government introduced the giant freshwater shrimp (GFS) (Macrobrachium rosenbergii) to Saint Lucia in the 1980s, its production has increased significantly. This production although has contributed significantly to the well-being of local farmers and the gross domestic product of Saint Lucia, its productivity is however threatened by challenges such as scarcity and high cost of live feed (nauplii from Anemia sp.), poor funding, insufficient and substandard hatcheries, poor infrastructures, high mortality rate of postlarvae due to adverse climate, diseases, and knowledge gap between researchers and local farmers (inadequate extension services). Among these challenges, the total reliance on scarce and expensive live feeds (nauplii from Anemia sp.) is the most crucial . Therefore increasing production costs is of the utmost importance and requires urgent attention. Although it would not be possible to completely substitute nauplii, combining it with other inexpensive, readily accessible, and locally sourced feed components is paramount. As evident in postlarvae-producing countries, alternative diets have been compounded and fed in place of nauplii to lower production costs without any negative impact on the general performance of GFS postlarvae being recorded. This could be adopted and replicated in the production of GFS postlarvae in Saint Lucia because most of the ingredients such as powdered fishmeal, duckweed, moringa leaf, freshwater daphnia and rotifers, and microalgae are readily available and accessible within the country. KEY WORDS: Aquaculture, Anemia, Macrobrachium rosenbergii, feed, production, shrimp, INTRODUCTION The growth of aquaculture in the Caribbean has been characterized as slow but steady since the introduction of tilapia culture in the early 1960s (Largo et al. 2020). More [...]

Scovia Nalugo Mbalinda,1,* Mark Kaddumukasa,2,* Josephine Nambi Najjuma,3,* Doreen R Birungi,2,* Martin Ntambi Kaddumukasa,1,4,* Jennifer B Levin,5,* Carolyn Harmon Still,6,* Christopher J Burant,7,* Avani C Modi,8,* Elly T Katabira,2,* Martha Sajatovic5,* 1Department of Nursing, College of Health Sciences, Makerere University, Kampala, Uganda; 2Department of Medicine, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda; 3Department of Nursing, Mbarara University of Science and Technology, Mbarara, Uganda; 4Department of Medicine, Mulago Hospital, Kampala, Uganda; 5Neurological and Behavioral Outcomes Center, University Hospitals Cleveland Medical Center & Case Western Reserve University School of Medicine, Cleveland, OH, 44106, USA; 6Louis Stokes VA Medical Center, Geriatric Research Education, and Clinical Center, Cleveland, OH, 44106, USA; 7Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH, 44106, USA; 8Cincinnati Children, S Hospital Medical Center, Cincinnati, Ohio, USA*These authors contributed equally to this workCorrespondence: Scovia Nalugo Mbalinda, Email snmbalinda@gmail.comBackground: People of all ages are affected by epilepsy, a prevalent chronic brain illness that is primarily found in underdeveloped nations. It is very necessary to implement epilepsy self-management techniques to support individuals with epilepsy in order to impact outcomes related to epilepsy. The purpose of this 2-site randomised controlled experiment is to investigate this further, based on encouraging preliminary evidence.Methods: A total of 188 adult people with epilepsy (PWE) attending the neurology clinics at Mulago and Mbarara hospitals and consent to participate in the study will be recruited. They will be randomised into intervention versus enhanced treatment control (eTAU) study groups. The intervention group will receive 12-week “intensive” educational sessions and a 12-week remotely accessed telephone follow-up stage. The controls will continue in their usual care supplemented by written materials on epilepsy in their preferred language and tailored to the reading level of most patients at the clinic. SMART-U consists of 2 main components: a 12-week “intensive” group format stage and a 12-week remotely accessed telephone follow-up stage. SMART-U will be assessed for acceptability, fidelity, and efficacy compared to eTAU. The primary study outcome is the mean change in cumulative past 24-week seizure frequency (24 weeks prior to the study baseline compared to the 24-week follow-up). Seizure frequency will be via self-report with corroboration by family/support system informants whenever possible. Participants will self-report the seizure frequency (numeric count) that they experienced between baseline and 13 weeks and again between 13 and 24 weeks, and the mean change from baseline to 24 weeks in QOL.Discussion: The curriculum-guided Self-Management intervention for Reducing The epilepsy burden among Ugandans (SMART-U) program is anticipated to reduce the epilepsy burden seizure frequency and improve other health outcomes, including depression, functional status and health resource use.Trial Registration Number (TRN): NCT06139198.Date of registration: November142023.Keywords: self-management, epilepsy, targeted management, intervention

Isaac G Freedman,1,2 Michael R Mercier,3,4 Anoop R Galivanche,3,5 Mani Ratnesh S Sandhu,6 Mark Hocevar,7 Harold Gregory Moore,8 Jonathan N Grauer,3 Lee E Rubin,3 Jinlei Li2 1Department of Anesthesiology, Critical Care & Pain Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA; 2Department of Anesthesiology, Yale School of Medicine, New Haven, CT, USA; 3Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, CT, 06511, USA; 4Division of Orthopaedic Surgery, University of Toronto, Toronto, ON, Canada; 5Department of Orthopaedic Surgery, University of California, San Francisco, CA, USA; 6Department of Neurosurgery, Carver College of Medicine, University of Iowa, Iowa City, IA, USA; 7Warren Alpert School of Medicine, Brown University, Providence, RI, USA; 8Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USACorrespondence: Isaac G Freedman, Department of Anesthesiology, Critical Care & Pain Medicine, Massachusetts General Hospital, Harvard Medical School, 55 Fruit St, Boston, MA, 02114, Email igfreedman@mgh.harvard.eduAim: To compare the efficacy of a postoperative continuous adductor canal block (cACB) with and without a steroid adjuvant to that of epidural analgesia (EA).Methods: Patients who underwent primary total TKA at a single institution between July 2011-November 2017 were included for retrospective analysis. TKA patients were stratified into one of the three analgesia approaches: EA, cACB without steroid adjuvant, and cACB with steroid adjuvant. Hospital length of stay (LOS), discharge disposition, incidence of postoperative adverse events, and total milligram morphine equivalents (MME) requirements were compared between strata. Logistic regressions were performed to assess the independent effect of analgesia approach on prolonged LOS greater than 3 days (pLOS), non-home discharge, and total and daily MME requirements (tMME and dMME) following TKA.Results: Of the 4345 patients undergoing TKA, 1556 (35.83%) received EA, 2087 (48.03%) received cACB without steroids, and 702 (16.13%) cACB with steroids. cACB patients experienced lower rates of pLOS, higher rates of discharge to home than EA patients, and lower tMME and dMME. On multivariable analysis, cACB groups were at a lower odds of experiencing a pLOS compared to EA patients without steroids (OR = 0.64; 95% CI 0.49– 0.84; with steroids: OR = 0.54; 95% CI 0.38– 0.76). cACB groups had lower odds of a non-home discharge when compared to EA patients (without steroids OR = 0.42; 95% CI 0.36– 0.48; with steroids: OR 0.22; 95% CI 0.18– 0.27). On multivariable analysis, cACB groups required less tMME compared to the EA group (without steroids β=− 290 mmE; 95% CI: − 313 to − 268 mmE; with steroids: β=− 261 mmE; 95% CI: − 289 to − 233 mmE) as well as lower dMME (without steroids: β=− 66 mmE/day; 95% CI − 72 to − 60 mmE/day; with steroids: β=− 48 mmE/day; 95% CI − 55 to − 40 mmE/day).Conclusion: cACB was associated with greater discharge to home rates, lower rates of pLOS, and lower tMME and dMME consumption.Level of Evidence: Level IIIPlain Language Summary: Anesthesia practice for TKA in the inpatient setting varies widely. Retrospectively compared outcomes for EA and cACB with or without steroids in TKA. cACB is associated with superior perioperative outcomes vs EA. cACB is associated with reduced opioid analgesia requirements vs EA. cACB with steroids was superior to cACB without steroids.Keywords: adductor canal block, knee arthroplasty, complications, length of stay, pain control, milligram morphine equivalents, dexamethasone, methylprednisolone acetate, steroid, NSQIP, MME

Sabila Moses,1 Ezekiel Mupere,2 Joan Nangendo,1 Fred C Semitala,3 Joan N Kalyango,1 Saul Chemonges,4 Patience A Muwanguzi,5 Achilles Katamba6 1Clinical Epidemiology Unit, Makerere University, Kampala, Uganda; 2Department of Peadiatric and Child Health, Makerere University, Kampala, Uganda; 3Department of Internal Medicine, Makerere University, Kampala, Uganda; 4Department of UQ VETS- Small Animal Hospital, University of Queensland, Brisbane, Australia; 5Department of Nursing, Makerere University, Kampala, Uganda; 6Department of Medicine, Makerere University, Kampala, UgandaCorrespondence: Sabila Moses, Email sabilamoses84@gmail.comBackground: Uganda faces a significant dual challenge with tuberculosis (TB), ranking among these countries most affected by the disease worldwide. The World Health Organization (WHO) recommends isoniazid preventive therapy (IPT) for managing latent TB. However, the adherence to IPT in military settings remains under-explored in Uganda. This study aims to assess IPT adherence and identify its predictors among soldiers undergoing HIV antiretroviral therapy at a General Military Hospital in Uganda.Methodology: We conducted a cross-sectional study involving 300 HIV-positive soldiers receiving antiretroviral therapy (ART) at the General Military Hospital in Uganda. Due to the small sample size, we employed a consecutive sampling method. We utilized descriptive statistics and modified Poisson regression model for prevalence of IPT adherence and associated factors respectively.Results: Among the 300 clients, the prevalence of isoniazid preventive therapy (IPT) was 94.7%, 95% CI: 92.1– 97.2; adherence to IPT was associated with being aged ≥ 50 years, with a prevalence ratio (PR) of 1.061 and 95% CI: 1.01– 1.12; being married, with a PR of 1.438, 95% CI:1.12– 1.84; having social support, with a PR of 1.498, 95% CI:1.17– 1.92; and having social support played a significant role in IPT adherence among married participants, with a PR of 0.817,95% CI:0.72– 0.93.Conclusion: To enhance adherence to isoniazid preventive therapy among young soldiers with HIV, targeted interventions are crucial, as older individuals tend to adhere better. Implementing marital support programs and strengthening community engagement can bolster adherence through social support networks. Educational campaigns should focus on the importance of IPT, while regular follow-ups will ensure effective monitoring and support. Further research is needed to explore how social support can mitigate stigma associated with HIV. The findings highlight the importance of improving IPT adherence among married soldiers and suggest that this approach could be effective in other low-resource settings.Keywords: IPT, adherence, TB, HIV, soldiers, ART

Xiao-Fang Dong,1 Qiang Zhang,2 Jia-Ning Wei,2 Qian-Yu Zhou,3 Fan-Jia-Yi Yang,2 Yan-Jin Liu,4 Yu-Sheng Li,5 Chang-Qing Sun2,3 1Department of Endocrinology and Metabolic Diseases, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, People’s Republic of China; 2School of Nursing and Health, Zhengzhou University, Zhengzhou, Henan, People’s Republic of China; 3Department of Epidemiology and Biostatistics, Zhengzhou University, Zhengzhou, Henan, People’s Republic of China; 4Department of Nursing, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, People’s Republic of China; 5Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, People’s Republic of ChinaCorrespondence: Chang-Qing Sun, School of Nursing and Health, Zhengzhou University, NO. 101 Kexue Road, High-Tech Development Zone of District, Zhengzhou, Henan, People’s Republic of China, Email suncq@zzu.edu.cnObjective: Our research explores how leisure-time sedentary behavior (SB) correlates with stroke risk. Additionally, we utilize the isotemporal substitution model (ISM) to examine how replacing brief durations of leisure-time SB with light physical activity (LPA), moderate physical activity (MPA), vigorous physical activity (VPA), and sleep might influence the risk of stroke.Methods: This investigation tracked 478,198 participants from the UK Biobank. Data regarding individual leisure-time SB and PA were collected through a standardized questionnaire. A Cox proportional hazards model, alongside an isotemporal substitution model (ISM), was utilized.Results: We identified 10,003 cases of incident stroke over 12.7 years. When compared to participants who engaged in leisure-time SB for less than 4 hours per day, the hazard ratios (HRs) for stroke incidence increased with more prolonged leisure-time SB: HRs were 1.06 (95% CI: 1.01 to 1.11) for 4– 6 h/d, 1.16 (95% CI: 1.10 to 1.23) for 6– 8 h/d, and 1.24 (95% CI: 1.15 to 1.33) for over 8 h/d. According to the ISM analysis, substituting leisure-time SB with various forms of PA could markedly reduce stroke risk. For individuals sleeping ≤ 8h/d, replacing one hour of leisure-time SB with an equivalent duration of LPA, VPA, or sleep corresponded to a 3.0%, 7.0%, and 22.0% decrease in stroke risk, respectively. Meanwhile, for those already sleeping more than 8h/d, substituting one hour of leisure-time SB with an equivalent duration of LPA or VPA resulted in a notable decrease in the risk of stroke by 6.0% and 18.0%, respectively.Conclusion: The findings demonstrate that leisure-time SB and unhealthy sleep durations are confirmed risk factors for stroke. For individuals sleeping 8 hours or less per day, and for those who sleep more than 8 hours, substituting SB with an adequate amount of sleep or engaging in VPA, respectively, emerges as an effective strategy for reducing stroke risk.Keywords: stroke, isotemporal substitution model, physical activity, sedentary behavior, sleep

The science of mountainous hydrology spans the atmosphere through the bedrock and inherently crosses physical and disciplinary boundaries: land–atmosphere interactions in complex terrain enhance clouds and precipitation, while watersheds retain and release water over a large range of spatial and temporal scales. Limited observations in complex terrain challenge efforts to improve predictive models of the hydrology in the face of rapid changes. The Upper Colorado River exemplifies these challenges, especially with ongoing mismatches between precipitation, snowpack, and discharge. Consequently, the U.S. Department of Energy’s (DOE) Atmospheric Radiation Measurement (ARM) user facility has deployed an observatory to the East River Watershed near Crested Butte, Colorado, between September 2021 and June 2023 to measure the main atmospheric drivers of water resources, including precipitation, clouds, winds, aerosols, radiation, temperature, and humidity. This effort, called the Surface Atmosphere Integrated Field Laboratory (SAIL), is also working in tandem with DOE-sponsored surface and subsurface hydrologists and other federal, state, and local partners. SAIL data can be benchmarks for model development by producing a wide range of observational information on precipitation and its associated processes, including those processes that impact snowpack sublimation and redistribution, aerosol direct radiative effects in the atmosphere and in the snowpack, aerosol impacts on clouds and precipitation, and processes controlling surface fluxes of energy and mass. Preliminary data from SAIL’s first year showcase the rich information content in SAIL’s many datastreams and support testing hypotheses that will ultimately improve scientific understanding and predictability of Upper Colorado River hydrology in 2023 and beyond.

It is crucial to find ways to employ less expensive conventional materials in fish farming to lower production costs without adversely affecting the general performance of the fish. Consequently, certain neglected plants, such as goat weed leaves that have been reported to have the potential to serve as a partial substitute for maize (energy source) must be considered. Therefore, this research evaluated the effects of partially replacing maize with goat weed leaf meal (Ageratum conyzoides) (GWLM) on the growth, haematology, and serum enzyme indices of Clarias gariepinus. A 56-day feeding trial was conducted with a total of 500 juveniles with an average weight of 13.7 g. After sterilizing the fish in a mixture of potassium permanganate and water to reduce stress, a one-week acclimatisation period was ensured using commercial feed (2 mm). Subsequently, the juveniles were randomly stocked in quadruplets of 25 fish per culture tank measuring 1.2 m x 1.2 m x 0.9 m each (labelled Ai-iv, Bi-iv, Ci-iv, Di-iv, and Ei-iv) based on the number of repetition and the diet to be fed. A total of five (5) different diets with varying levels of dietary inclusion (A: 0%, B: 2%, C: 4%, D: 6%, and E: 8%) of goat weed leaf meal (GWLM) as a partial replacement for maize were formulated to contain a minimum crude protein level of 40%. The test diets were administered twice daily (7:00 hrs. and 18:00 hrs.) and the sampled fish were adequately fed (5% body weight) with proper follow-up to monitor feeding behaviour. The data collected from the research were subjected to a one-way analysis of variance (ANOVA) using the SPSS version 23 analysis package. Furthermore, a Duncan multiple-range test was employed to separate the means. There were notable (p < 0.05) variations in various parameters (proximate composition, digestibility of nutrients, growth performance, haematological and serological profiles, and water quality) observed in all treatments as the inclusion of the test ingredient in the diet increased. However, as the inclusion levels of the test ingredient increased above 4%, a steady decline was observed between treatments. At a 4% dietary inclusion level, the best performance indices (weight gained (36.52g), feed conversion ratio (2.15), specific growth rate (2.31) and survival rate (95%)), and blood profile (haematology and serum enzyme indices) were observed. Therefore, a 4% replacement of maize using goat weed leaf meal (GWLM) in the diet is suitable for an optimum performance of African catfish.

Dong-Xia Wu,1,&ast; Jing-Xian Hu,2,&ast; Jian-Hong Ma,1,&ast; Ke-Yi Chang,1,&ast; Yun Zhang,1 Xiao-Li Quan,1 Jia-Ning Han,1 Hai-Jing Long,1 Chen Chen,1 Wei Zhai,1 Huan-Huan Guo,1 Li-Li Zhang,2 Xiao-Lan Wang2 1Department of Infection and Immunology, Beijing Youan Hospital, Capital Medical University, Beijing, 100069, People’s Republic of China; 2Department of Nursing, Beijing Youan Hospital, Capital Medical University, Beijing, 100069, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Li-Li Zhang; Xiao-Lan Wang, Department of Nursing, Beijing Youan Hospital, Capital Medical University, No. 8 of Xitoutiao, Fengtai District, Beijing, 100069, People’s Republic of China, Tel/Fax +86 010 8399 7143, Email lillizhang3200z@163.comPurpose: To investigate and analyse the status quo of the self-management of patients living with HIV/AIDS (PLWHA) and its influencing factors and to provide the basis for formulating intervention strategies.Methods: In this cross-sectional study, 300 PLWHA who visited the Infection Center of Beijing Youan Hospital, Capital Medical University between September 2021 and December 2021 were enrolled using the convenience sampling method. Demographic characteristics and disease-related data were collected for each participant. The HIV/AIDS Self-Management Scale was used to evaluate the self-management ability of PLWHA.Results: A total of 251 male and 49 female PLWHA were included in this study, with an average age of 39.08 ± 12.09 years and an average disease duration of 9.61 ± 37.04 months. Univariate analysis showed that the PLWHA’s place of residence, educational level, physical condition, family relations, duration of HIV disease, receipt or not of antiviral therapy and knowledge of disease had an influence on the scores of the HIV Self-Management Scale (all p < 0.05). The results of the self-management scores indicated that the total score for self-management was 41.5 ± 6.4 points, with a scoring rate of 69.6%, which was at a medium level. Long-term self-management had the highest scoring rate (12.2 ± 2.5 points), followed by daily health management (22.3 ± 4.3 points), and social support for self-management had the lowest scoring (5.1 ± 0.9 points). Multivariable analysis showed that the self-management ability of PLWHA was related to educational level, duration of disease and family relations (R2 = 0.67, F = 121.7, p < 0.05).Conclusion: The self-management level of patients with AIDS, especially the social support of daily health management and self-management, needs to be further improved. Educational level, duration of disease and family relations are important factors influencing the self-management of PLWHA.Keywords: HIV/AIDS, AIDS, self-management

Anthony C Oganov, Timothy Y Chou, Paris M Hanson, Azin Abazari, Preston Kung, Sarah B Weissbart, Jacqueline N Lenoci, Robert A Honkanen Department of Ophthalmology, Renaissance School of Medicine, Stony Brook University, Stony Brook, NY, 11974, USACorrespondence: Timothy Y Chou, Department of Ophthalmology, Renaissance School of Medicine, Stony Brook University, HSC L2, Rm 152, Stony Brook, NY, 11974, USA, Tel +1 631444-1131, Fax +631444-4089, Email timothy.chou@stonybrookmedicine.eduPurpose: The aim of the research was to evaluate the use of teleophthalmology at a university practice during the COVID-19 pandemic, specifically examining precision, effectiveness, and patient satisfaction.Patients and Methods: Telemedicine visits were offered to new and established patients requesting appointments with the Stony Brook University Department of Ophthalmology between March 30 and June 2, 2020. Records from these visits were reviewed for chief complaint, past medical and ocular history, diagnoses, treatment/management, and providers’ sub-specialty. Precision was determined by comparing agreement between diagnoses of the telemedicine visit with those of the subsequent in-person visit. The decision to follow up in person was made by the physician and patient. Diagnostic precision as well as progression, improvement, or stability of patients’ symptoms were determined by the physician’s assessment at follow-up visits. Post-telemedicine visit satisfaction surveys were sent to all patients.Results: Telemedicine visits were offered to 783 patients, 520 (66.4%) of whom accepted. Of these 520 patients, 409 (78.7%) were established and 105 (20.2%) had in-person, follow-up visits. Overall, the diagnostic precision of the follow-up visits was 89.5%. Precision differed significantly across ophthalmologic subspecialties. Of the patients who had in-person follow-up visits, 56.8% remained stable, 32.4% improved, and 10.8% worsened. Established patients presented with more extensive ocular histories/procedures and experienced a higher percentage of worsening symptoms/disease stage compared to new patients. Oculoplastics/orbit was the most prevalent diagnostic subspecialty that worsened. Surveys were sent to all patients completing telemedicine visits, 15.0% of whom responded. Overall satisfaction was 91.9%, although only 23.0% of respondents preferred telemedicine to an in-office visit.Conclusion: Telehealth provides high levels of precision and patient satisfaction for a wide range of ophthalmologic visits, although most patients still prefer in-office examinations. Employing teleophthalmology for follow-up and emergency care may provide patients with an effective alternative during pandemic situations and beyond.Plain Language Summary: Telemedicine involves integration of modern telecommunications technology into medical practice. Over the years, it has demonstrated greater and more widespread utility for different medical specialties, including ophthalmology.As a response to the recent COVID-19 pandemic, the Stony Brook University Department of Ophthalmology provided an option of telemedicine for patients in lieu of in-person eye examinations. In this paper, Stony Brook ophthalmologists report on their experience with teleophthalmology, particularly regarding its utilization, accuracy, effectiveness, precision, and acceptability. The authors examined the records of 520 patients who had telemedicine encounters between March 30 and June 2, 2020. Precision was determined by comparing the initial and final diagnoses of all patients who had an in-person follow-up appointment following a telemedicine visit. Of 105 patients that followed up, precision was determined to be 89.5%. Precision was compared across ophthalmologic subspecialties and found to be statistically similar (p> 0.05). Approximately a third of patients improved, while nearly 11% worsened. Established and oculoplastics patients were more significantly likely to worsen. Surverys were sent out to study patients to gauge their satisfaction with their telemedicine experience. Although satisfaction was nearly 92%, only 23% of patients preferred telemedicine to an in-person physician encounter. The authors conclude that teleophthalmology provides a high level of diagnostic precision and patient satisfaction; nevertheless, most patients prefer in-person physician encounters. Telemedicine may provide an effective alternative to in-person ophthalmology assessments, especially during a pandemic. There appears to be a lesser but potentially useful role for teleophthalmology in a non-pandemic setting.Keywords: Teleophthalmology, teleglaucoma, teleretina, telehealth, coronavirus

Margarida Ribeiro,1,2,&ast; João Nogueira Freitas,3,&ast; Mário Lima-Fontes,1 Mariana Leuzinger-Dias,1 Marta Inês Silva,1 Joana Araújo,1,4 Sérgio Estrela-Silva,1,4 António Benevides Melo,1,4 João Tavares-Ferreira,1 Flávio Alves,1 João Barbosa-Breda1,4– 6 1Department of Ophthalmology, Unidade Local de Saúde de São João, Porto, Portugal; 2Department of Biomedicine – Unit of Pharmacology and Therapeutics, Faculty of Medicine of the University of Porto, Porto, Portugal; 3Faculty of Medicine of the University of Porto, Porto, Portugal; 4Department of Surgery and Physiology, Faculty of Medicine of the University of Porto, Porto, Portugal; 5UnIC@RISE, Department of Surgery and Physiology, Faculty of Medicine of the University of Porto, Porto, Portugal; 6KULeuven, Research Group Ophthalmology, Department of Neurosciences, Leuven, Belgium&ast;These authors contributed equally to this workCorrespondence: Margarida Ribeiro, Department of Ophthalmology – Unidade Local de Saúde de São João, Alameda Prof. Hernâni Monteiro, Porto, 4200-319, Portugal, Email margarida.ribeiro.guimaraes@gmail.comPurpose: To evaluate the efficacy and safety of transscleral diode cyclophotocoagulation (TSCPC) at 2 years of follow up.Methods: This is a retrospective review of the records of all adult patients who underwent their first TSCPC treatment between 2014 and 2019 at Unidade Local de Saúde de São João, Porto, Portugal. Data regarding intraocular pressure (IOP), best corrected visual acuity, number of IOP-lowering medications, use of oral acetazolamide, retreatments and complications during a 2-year period following TSCPC were registered. The primary outcome was overall success at 2 years, defined as IOP≥ 6 and ≤ 21 mmHg, with at least 20% IOP reduction from baseline, with or without IOP-lowering medications (qualified and complete success, respectively), without the development of phthisis bulbi or loss of light perception due to glaucoma and no further glaucoma procedures except TSCPC retreatment.Results: Ninety-six eyes from 96 patients were included, mean age was 63 (± 14) years. Mean IOP at baseline was 39.1 (± 13.3) mmHg. Mean IOP reduction at 2 years was 18.5 (42.9%) mmHg (± 16.0, min − 16.0, max 56.0) (p < 0.001) and a significant reduction in the number of IOP-lowering medications and use of oral acetazolamide was observed. IOP reduction at 2 years was positively correlated with baseline IOP (r=0.682; p < 0.001). Overall success (including complete and qualified) was achieved in 42 patients (43.8%), with 34 (35.4%) presenting qualified success. Neovascular glaucoma (NVG) was the predominant diagnosis (n = 30, 31.3%), with a higher mean baseline IOP of 46.3 mmHg (± 11.8, min 21.0, max 70.0) and a larger mean IOP reduction at 2 years of 24.7 (51.0%) mmHg (± 16.4, min − 2.0, max 55.0). Thirteen patients (13.5%) developed persistent hypotony, eight of which converted to phthisis bulbi, of which half had NVG.Conclusion: TSCPC can be an effective IOP-lowering procedure, demonstrating a stronger effect when the preoperative IOP is highest. However, there is a wide variability in the effect (specially in eyes with NVG) and some relevant complications, including 8.3% of patients developing phthisis bulbi after 2 years of follow up.Keywords: intraocular pressure, glaucoma, ocular hypotension, transscleral cyclophotocoagulation, neovascular glaucoma, phthisis bulbi

Objective: To rank diagnostic features of childhood pulmonary tuberculosis; and to determine the effect of working in tuberculosis Directly Observed Treatment Short Course (DOTS) facilities on the ranking of these features by medical doctors. Methods: A cross sectional descriptive study, using structured questionnaires to collect data from medical doctors whose daily routine included attending to sick children in 34 selected children outpatient clinics and TB DOTS centers in southeastern Nigeria. Results: Approximately, one quarter (25.3% or 56 of 221) of respondents worked in Directly Observed Treatment Short course (DOTS) clinics, while three quarters (74.7% or 165 of 221) worked in nonDOTSclinics. Majority of the respondents (69.7%) ranked chronic persistent cough (1), 42.5 % ranked weight loss and failure to thrive (2), another 27.7% ranked weight loss and failure to thrive (3), while 17.6% and 21.7% ranked History of contact with adult index case and radiographic abnormalities, (4) and (5), respectively. Conclusions: The study found that the percentage of doctors working in DOTS clinics who ranked weight loss and failure to thrive (2) was statistically and significantly higher than those of non-DOTS respondents. The most important symptoms/signs on which medical doctors based their diagnosis of childhood pulmonary tuberculosis include cough, weight loss and failure to thrive, history of contact with adult with smear positive pulmonary tuberculosis, and r adiogr aphicabnormalities consistent with active tuberculosis. There was statistically significant difference between the ranking of weight loss and failure to thrive by doctors working in DOTS clinics and their counterparts in non DOTS clinics. This study showed a decline in the percentage of ranking in both DOTS and Non DOTS respondents as they moved from the first to the fifth.

Background: Acute exacerbation is a major cause of morbidity in asthmatic children. It can occur even in well controlled asthma. Aim: To determine the prevalence and pattern of acute exacerbation of asthma in children seen at the emergency room of the University of Nigeria Teaching Hospital (UNTH), Enugu.Materials and methods: This was a descriptive, cross sectional study in which consecutive children with acute exacerbation of asthma presenting to the Children Emergency Room (CHER) of UNTH, Enugu were recruited. Information from the history and examination were documented with a structured questionnaire completed by the attending doctor. Severity of their exacerbation was determined using the Global Initiative for Asthma (GINA) guidelines. The children were treated using the written management protocol used in CHER, UNTH, Enugu which was adapted from GINA guidelines. Results: There were a total of 114 presentations (episodes) of acute exacerbation asthma by 104 children within the study period with eight children having multiple episodes. This represented 6.5% of the overall number of emergency cases seen during the period. Nearly an equal number (ratio; 1: 1.04) of males and females were enrolled with the mean age of 7.9 ± 4.7 years. More children with asthma exacerbations were admitted during the rainy season months of May and June, while the dry season months of December and January recorded lower number of episodes. Most (86.0%) cases were mild to moderate exacerbations and 16 (15.3%) were severe.Three of the 22 (13.6%) children on controller medications were among the 16 that had severe exacerbation. No death was recorded during the period. Conclusion: The prevalence of asthma exacerbation is relatively high in our tropical environment and the pattern is similar to those of the developed countries in terms of age and sex distribution, however, the peak period of presentation differ in our environment.

Justine N Huang, Sara Mariam Amini, Christopher Fadumiye Department of Anesthesiology, Medical College of Wisconsin Affiliated Hospitals, Milwaukee, WI, USACorrespondence: Christopher Fadumiye, Department of Anesthesiology, Medical College of Wisconsin Affiliated Hospitals, 9200 W. Wisconsin Ave, Milwaukee, WI, 53226, USA, Tel +414 805-8700, Email Cfadumiye@mcw.eduAbstract: Transfusion-associated circulatory overload (TACO) is a potentially fatal blood transfusion complication that often presents itself within 12 hours of transfusion cessation. We present a case of TACO in an orthopedic surgery patient to highlight the importance of anticipating and managing complications of blood loss and transfusion in an otherwise healthy patient.Keywords: transfusion associated circulatory overload, blood transfusion reaction, massive transfusion protocol

Introdução: As síndromes mielodisplásicas (SMD) são um grupo heterogêneo de doenças mieloides caracterizadas por hematopoiese clonal e insuficiência medular que causam citopenias periféricas, anormalidades citogenéticas recorrentes e um risco variável de progressão para leucemia mieloide aguda (LMA). Dada a heterogeneidade da doença e o comportamento clínico variável em termos de evolução para leucemia, muitas análises citogenéticas e molecular têm surgido como ferramentas para identificar pacientes com características biológicas, clínicas e prognósticas semelhantes. Nesse contexto, a alteração citogenética de del20q isolada denota um bom prognóstico, de acordo com a estratificação de risco vigente (IPSS-R e IPSS-M). Objetivo: Relatar um caso de SMD com del 20q isolada, em seguimento clínico há sete anos, sem progressão de doença. Relato de caso: Paciente masculino, 85 anos, evoluiu com bicitopenia – anemia leve com Hb 11,0 e plaquetopenia grave – 20.000, desde 2017. Na ocasião do diagnóstico, realizou estudo medular que mostrou displasia moderada nas três séries, associada a 20% de sideroblastos em anel e cariótipo com del 20q11.2 em 14 das 20 metáfases analisadas. Na ocasião, estratificado como risco baixo (IPSS-R: 2), no entanto, devido à plaquetopenia importante, optado por tratamento com hipometilante. Recebeu 3 ciclos de Azacitidina, com suspensão por sangramento com hemorragia subaracnóidea e infecções bacterianas graves de repetição. Desde então, manteve apenas seguimento clínico, sempre com plaquetopenia entre 20-30mil. Em Abril/24, quando teve piora da anemia – Hb 7,0, porém mantendo hemograma sem neutropenia e sem piora da plaquetopenia de base, optado por repetir estudo medular. Novo mielograma hipercelular, com displasia das três séries e 1,6% de blastos. Coloração para ferro mostrando 8% de sideroblastos em anel. Citogenética mantendo del 20q11.2 isolada em 19 das 20 metáfases analisadas. Não foi realizado estudo molecular por indisponibilidade pela operadora. Novo IPSS-R: 3 – baixo risco. Optado por iniciar tratamento com Alfapoetina 30.000 unidades semanais. Conclusão: Estudo retrospectivos demonstram que a entidade acima descrita é mais comum em homens, idosos, apresentando plaquetopenia como citopenia mais exuberante no diagnóstico e durante o acompanhamento. O caso do paciente acima vai de acordo ao encontrado na literatura disponível, e o tempo de seguimento do paciente está acima da média para a estratificação inicial, sem indícios atuais de evolução para LMA. Apesar de não termos estudo molecular disponível, a evolução do doente fala contra presença de mutação clonal de risco adicional em associação ao achado citogenético da del20q.

Introdução: A leucemia mieloide aguda (LMA) é a leucemia aguda mais comum, acometendo predominantemente um grupo de pessoas idosas, com uma idade mediana de 67 anos ao diagnóstico, sendo que esses pacientes frequentemente têm reposta insatisfatória ao tratamento quimioterápico convencional. A combinação de agente hipometilante com venetoclax, mostrou-se eficaz e segura neste cenário, sendo atualmente a terapia de escolha em pacientes maiores 60 anos e/ou com comorbidades limitantes. Efeitos adversos dessa terapia ainda estão sendo descobertos. Objetivo: Relatar dois casos de LMA em tratamento com o protocolo VIALE-A que tiveram surgimento de sidero blastos em anel ao curso do tratamento com Viale A. Relato de caso: Caso 1: LAB, sexo masculino, 63 anos, diagnóstico de LMA com TP53mutado, apresentava ao diagnóstico 60% de blastos à avaliação medular, foi submetido a tratamento com o protocolo VIALE-A e, após o 8° ciclo, foi observado medula óssea (MO)hipercelular, com displasia multilinhagem e presença de sidero blastos em anel (73%). Caso 2: AC, sexo masculino, 79 anos, LMA de risco intermediário, com displasia nas três séries analisadas e 18% de blastos no mielograma ao diagnóstico, após o 9° ciclo do protocolo VIALE-A, apresentava uma MO hipocelular, com displasia e presença desideroblastos em anel (59%) ao mielograma. Conclusão: Os pacientes relatados acima, alcançaram remissão morfológica com o protocolo de tratamento utilizado, evoluindo, após vários ciclos de tratamento, com displasia e presença de sidero blastos em anel. O caso 1 foi submetido a transplante de medula óssea após melhora do perfomance status e o segundo caso segue em tratamento com o protocolo VIALE-A. Relatos sobre o surgimento de tal displasia após tratamento nesse perfil de pacientes são escassos em literatura. É incerto se isso pode conferir fator prognóstico ou influenciar na resposta alcançada.

Intestinal duplication is one of the rare congenital abnormalities encountered. Duplications found on the small intestine are more commonly encountered in clinical practice than the large intestine and majority of these occurs in the ileum. We present a three-week old neonate with features of intestinal obstruction a presumptive diagnosis of intususception with presumed sepsis was made. Intraoperative findings revealed caecal duplication causing the intestinal obstruction. Limited excision and ileo-ascending colic anastomosis was carried out. Patient responded well and was discharged on follow-up.

Chronic sinusitis is an inflammatory lesion that involves the paranasal sinuses with symptoms and signs that are beyond 12 weeks in duration. It commonly presents with nasal stuffiness, mouth breathing, purulent nasal discharge, post natal drip, snoring, cough, headache, facial fullness, hyposmia, sore throat and halitosis. Features of ocular and cerebral complications may be present at diagnosis but are uncommon and can thus result in misdiagnosis. A 15 year old male presented with sudden onset ptosis and other symptoms that initially suggested an intracranial SOL or a Cavernous sinus thrombosis. A CT scan of the head and neck structures identified chronic sinusitis as the only likely pathology. We present this case to highlight an unusual ocular complication of chronic sinusitis.

Long-Fei Xia,1 Jing-Bo Li,2 Guo-Sheng Tian,2 Wei-Ran Jiang,3 Yao-Shuang Li,1 Chen-Ying Lin,1 Hui-Na Qiu,2 Fan Wu,4 Jun-Jia Wang,5 Chun-Jun Li,2 Jing-Na Lin2 1Tianjin Union Medical Center, Tianjin Medical University, Tianjin, 300070, People’s Republic of China; 2Department of Endocrinology, Health Management Center, Tianjin Union Medical Center, Nankai University Affiliated Hospital, Tianjin, 300121, People’s Republic of China; 3Eastman Institute for Oral Health, University of Rochester Medical Center, Rochester, NY, USA; 4School of Medicine, Nankai University, Tianjin, 300071, People’s Republic of China; 5Graduate School, Tianjin University of Traditional Chinese Medicine, Tianjin, 301617, People’s Republic of ChinaCorrespondence: Jing-Na Lin; Chun-Jun Li, Email 13207628978@163.com; li_chunjun@126.comObjective: To investigate the impact of sarcopenia on the 10-year risk of atherosclerotic cardiovascular disease (ASCVD) among individuals with type 2 diabetes mellitus (T2DM).Methods: This study included the clinical, laboratory, and body composition data of 1491 patients with T2DM who were admitted to the Department of Endocrinology and Metabolism at Tianjin Union Medical Center from July 2018 to July 2023. The China-PAR model was utilized to evaluate cardiovascular disease risk. Associations between ASCVD risk and various clinical parameters were analyzed, and the relationship between body composition parameters and ASCVD risk was assessed using logistic regression.Results: The analysis revealed that T2DM patients with sarcopenia had a higher 10-year ASCVD risk compared to those without sarcopenia, with reduced muscle mass independently predicting an increased risk of cardiovascular disease. This association was significant among female T2DM patients, while male T2DM patients with sarcopenia showed a marginally higher median ASCVD risk compared to their non-sarcopenic counterparts. ASCVD risk inversely correlated with body muscle parameters and positively correlated with fat content parameters. Specifically, height- and weight-adjusted fat mass (FM, FM%, FMI) were identified as risk factors for ASCVD. Conversely, muscle parameters adjusted for weight and fat (ASM%, SMM%, FFM%, ASM/FM, SMM/FM, FMM/FM) were protective against ASCVD risk. These findings highlight the critical role of sarcopenia in influencing cardiovascular disease risk among Chinese patients with T2DM, as predicted by the China-PAR model.Conclusion: This study highlights the importance of sarcopenia in T2DM patients, not only as an indicator of ASCVD risk, but possibly as an independent risk factor in this demographics.Keywords: atherosclerotic cardiovascular disease, ASCVD, type 2 diabetes, T2DM, sarcopenia, fat content, muscle mass

Scovia Nalugo Mbalinda,1 Mark Kaddumukasa,2 Josephine Nambi Najjuma,3 Martin Kaddumukasa,1,4 Jane Nakibuuka,1,4 Christopher J Burant,5 Shirley Moore,6 Carol Blixen,7 Elly T Katabira,1 Martha Sajatovic7 1Department of Nursing, School of Health Sciences, College of Health Sciences, Makerere University, Kampala, Uganda; 2Department of Medicine, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda; 3Department of Nursing, Mbarara University of Science and Technology, Mbarara, Uganda; 4Department of Medicine, Mulago Hospital, Kampala, Uganda; 5Louis Stokes VA Medical Center, Geriatric Research Education, and Clinical Center, Cleveland, OH, 44106, USA; 6Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH, 44106, USA; 7Neurological and Behavioral Outcomes Center, University Hospitals Cleveland Medical Center & Case Western Reserve University School of Medicine, Cleveland, OH, 44106, USACorrespondence: Scovia Nalugo Mbalinda, Department of Nursing, College of Health Sciences, Makerere University, P.O. Box 7072, Kampala, Uganda, Tel +256782212151, Email snmbalinda@gmail.comPurpose: Evidence supporting secondary stroke in sub-Saharan Africa is scarce. This study describes the incidence of stroke recurrence and associated risk factors in sub-Saharan Africa.Methods and Materials: Scientific databases were systematically searched from January 2000 to December 2022 for population-based observational studies, case-control or cohort studies of recurrent stroke involving adults aged 18 years and above in sub-Saharan Africa (SSA). We assessed the quality of the eligible studies using the Critical Appraisal Skills Program (CASP) checklist for observational studies.Results: Six studies met the inclusion criteria and were included in this study. Stroke recurrence rates in SSA ranged from 9.4% to 25%. Majority of the studies were conducted from Western Africa and showed that stroke recurrence rates are high within sub-Saharan Africa ranging from 2% to 25%. The known stroke risk factors such as hypertension, chronic alcohol consumption, etc., remained the leading causes of stroke recurrence. The studies reported a higher mortality rate ranging from 20.5 − 23% among those with recurrent strokes compared to primary strokes.Conclusion: This systematic review is an update and summary of the available literature on stroke recurrence within sub-Saharan Africa. Further studies are warranted to assess the outcomes and burden of stroke recurrence in SSA.Keywords: stroke recurrence, sub-Saharan Africa, risk factors, secondary prevention, cardiovascular disease

Increasing fire severity and warmer, drier postfire conditions are making forests in the western United States (West) vulnerable to ecological transformation. Yet, the relative importance of and interactions between these drivers of forest change remain unresolved, particularly over upcoming decades. Here, we assess how the interactive impacts of changing climate and wildfire activity influenced conifer regeneration after 334 wildfires, using a dataset of postfire conifer regeneration from 10,230 field plots. Our findings highlight declining regeneration capacity across the West over the past four decades for the eight dominant conifer species studied. Postfire regeneration is sensitive to high-severity fire, which limits seed availability, and postfire climate, which influences seedling establishment. In the near-term, projected differences in recruitment probability between low- and high-severity fire scenarios were larger than projected climate change impacts for most species, suggesting that reductions in fire severity, and resultant impacts on seed availability, could partially offset expected climate-driven declines in postfire regeneration. Across 40 to 42% of the study area, we project postfire conifer regeneration to be likely following low-severity but not high-severity fire under future climate scenarios (2031 to 2050). However, increasingly warm, dry climate conditions are projected to eventually outweigh the influence of fire severity and seed availability. The percent of the study area considered unlikely to experience conifer regeneration, regardless of fire severity, increased from 5% in 1981 to 2000 to 26 to 31% by mid-century, highlighting a limited time window over which management actions that reduce fire severity may effectively support postfire conifer regeneration.

A key component of the Dark Energy Spectroscopic Instrument (DESI) survey validation (SV) is a detailed visual inspection (VI) of the optical spectroscopic data to quantify key survey metrics. In this paper we present results from VI of the quasar survey using deep coadded SV spectra. We show that the majority (≈70%) of the main-survey targets are spectroscopically confirmed as quasars, with ≈16% galaxies, ≈6% stars, and ≈8% low-quality spectra lacking reliable features. A nonnegligible fraction of the quasars are misidentified by the standard spectroscopic pipeline, but we show that the majority can be recovered using post-pipeline “afterburner” quasar-identification approaches. We combine these “afterburners” with our standard pipeline to create a modified pipeline to increase the overall quasar yield. At the depth of the main DESI survey, both pipelines achieve a good-redshift purity (reliable redshifts measured within 3000 km s−1) of ≈99%; however, the modified pipeline recovers ≈94% of the visually inspected quasars, as compared to ≈86% from the standard pipeline. We demonstrate that both pipelines achieve a median redshift precision and accuracy of ≈100 km s−1 and ≈70 km s−1, respectively. We constructed composite spectra to investigate why some quasars are missed by the standard pipeline and find that they are more host-galaxy dominated (i.e., distant analogs of “Seyfert galaxies”) and/or more dust reddened than the standard-pipeline quasars. We also show example spectra to demonstrate the overall diversity of the DESI quasar sample and provide strong-lensing candidates where two targets contribute to a single spectrum.

With an ever-increasing amount of (meta)genomic data being deposited in sequence databases, (meta)genome mining for natural product biosynthetic pathways occupies a critical role in the discovery of novel pharmaceutical drugs, crop protection agents and biomaterials. The genes that encode these pathways are often organised into biosynthetic gene clusters (BGCs). In 2015, we defined the Minimum Information about a Biosynthetic Gene cluster (MIBiG): a standardised data format that describes the minimally required information to uniquely characterise a BGC. We simultaneously constructed an accompanying online database of BGCs, which has since been widely used by the community as a reference dataset for BGCs and was expanded to 2021 entries in 2019 (MIBiG 2.0). Here, we describe MIBiG 3.0, a database update comprising large-scale validation and re-annotation of existing entries and 661 new entries. Particular attention was paid to the annotation of compound structures and biological activities, as well as protein domain selectivities. Together, these new features keep the database up-to-date, and will provide new opportunities for the scientific community to use its freely available data, e.g. for the training of new machine learning models to predict sequence-structure-function relationships for diverse natural products. MIBiG 3.0 is accessible online at https://mibig.secondarymetabolites.org/.

Although fire is a fundamental ecological process in western North American forests, climate warming and accumulating forest fuels due to fire suppression have led to wildfires that burn at high severity across larger fractions of their footprint than were historically typical. These trends have spiked upwards in recent years and are particularly pronounced in the Sierra Nevada–Southern Cascades ecoregion of California, USA, and neighboring states. We assessed annual area burned (AAB) and percentage of area burned at high and low-to-moderate severity for seven major forest types in this region from 1984 to 2020. We compared values for this period against estimates for the pre-Euro-American settlement (EAS) period prior to 1850 and against a previous study of trends from 1984 to 2009. Our results show that the total average AAB remained below pre-EAS levels, but that gap is decreasing (i.e., ~14% of pre-EAS for 1984–2009, but 39% for 2010–2020 [including ~150% in 2020]). Although the average AAB has remained low compared with pre-EAS, both the average annual area burned at high severity (AAHS) and the percentage of wildfire area burned at high severity have increased rapidly. The percentage of area burned at high severity, which was already above pre-EAS average for the 1984–2009 period, has continued to rise for five of seven forest types. Notably, between 2010 and 2020, the average AAHS exceeded the pre-EAS average for the first time on record. By contrast, the percentage of area that burned at low-to-moderate severity decreased, particularly in the lower elevation oak and mixed conifer forest types. These findings underline how forests historically adapted to frequent low-to-moderate severity fire are being reshaped by novel proportions and extents of high-severity burning. The shift toward a high-severity-dominated fire regime is associated with ecological disruptions, including changes in forest structure, species composition, carbon storage, wildlife habitat, ecosystem services, and resilience. Our results underscore the importance of finding a better balance between the current management focus on fire suppression and one that puts greater emphasis on proactive fuel reduction and increased forest resilience to climate change and ecological disturbance.

The perceived risk of transmission of aerosolised viral particles from patients to airway practitioners during the COVID-19 pandemic led to the widespread use of aerosol precautions, including personal protective equipment and modifications to anaesthetic technique. The risk of these aerosol precautions on peri-operative airway complications has not been assessed outside of simulation studies. This prospective, national, multicentre cohort study aimed to quantify this risk. Adult patients undergoing general anaesthesia for elective or emergency procedures over a 96-hour period were included. Data collected included use of aerosol precautions by the airway practitioner, airway complications and potential confounding variables. Mixed-effects logistic regression was used to assess the risk of individual aerosol precautions on overall and specific airway complications. Data from 5905 patients from 70 hospital sites were included. The rate of airway complications was 10.0% (95%CI 9.2-10.8%). Use of filtering facepiece class 2 or class 3 respirators was associated with an increased risk of airway complications (odds ratio 1.38, 95%CI 1.04-1.83), predominantly due to an association with difficult facemask ventilation (odds ratio 1.68, 95%CI 1.09-2.61) and desaturation on pulse oximetry (odds ratio 2.39, 95%CI 1.26-4.54). Use of goggles, powered air-purifying respirators, long-sleeved gowns, double gloves and videolaryngoscopy were not associated with any alteration in the risk of airway complications. Overall, the use of filtering facepiece class 2 or class 3 respirators was associated with an increased risk of airway complications, but most aerosol precautions used during the COVID-19 pandemic were not.

Adolescent screen usage is ubiquitous and influences development and behavior. Longitudinal screen usage data coupled with psychometrically valid constructs of problematic behaviors can provide insights into these relationships. We describe methods by which the screen usage questionnaire was developed in the Adolescent Brain Cognitive Development (ABCD) Study, demonstrate longitudinal changes in screen usage via child report and describe data harmonization baseline-year 2. We further include psychometric analyses of adapted social media and video game addiction scales completed by youth. Nearly 12,000 children ages 9-10 years at baseline and their parents were included in the analyses. The social media addiction questionnaire (SMAQ) showed similar factor structure and item loadings across sex and race/ethnicities, but that item intercepts varied across both sex and race/ethnicity. The videogame addiction questionnaire (VGAQ) demonstrated the same configural, metric and scalar invariance across racial and ethnic groups, however differed across sex. Video gaming and online social activity increased over ages 9/10-11/12 (p's

Mohammed Almuqbil,1– 3 Fatimah Yaseen Alshaikh,4 Waleed Altwaijri,1– 3 Duaa Baarmah,5 Raid Harb Hommady,2,3 Maryam Yaseen Alshaikh,1 Fares Alammari,6 Meshal Alhussain,7 Reem Almotawa,8 Faris Alqarni,9 Amna Kashgari,1,10 Rayan Alkhodair,1,2,11 Jumanah N Alkhater,1 Lujeen Nasser Alkhater,6 Sawsan A Alharthi,11 Mada Abdulkarim Alsadi,12 Ahmed AlRumayyan1– 3 1College of Medicine, King Saud Bin Abdulaziz University for Health Sciences (KSAU-HS), Riyadh, Saudi Arabia; 2King Abdullah International Medical Research Center (KAIMRC), Ministry of National Guard, Riyadh, Saudi Arabia; 3Division of Pediatric Neurology, Department of Pediatrics, King Abdullah Specialist Children’s Hospital (KASCH), National Guard Health Affairs (NGHA), Riyadh, Saudi Arabia; 4Collage of Medicine, Princess Nora University, Riyadh, Saudi Arabia; 5Department of Pediatrics, King Abdullah Bin Abdulaziz University Hospital, Princess Nourah Bint Abdulrahman University, Riyadh, Saudi Arabia; 6College of Medicine, Almaarefa University, Riyadh, Saudi Arabia; 7College of Medicine, King Khalid University, Abha, Saudi Arabia; 8Royal College of Surgeons, Dublin, Ireland; 9College of Dentistry, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia; 10Department of Radiology, King Abdullah Specialist Children’s Hospital (KASCH), National Guard Health Affairs (NGHA), Riyadh, Saudi Arabia; 11Division of Dermatology, King Abdulaziz Medical City, Riyadh, Saudi Arabia; 12Division of Otolaryngology, Head and Neck Surgery, King Abdulaziz University Hospital, Riyadh, Saudi ArabiaCorrespondence: Mohammed Almuqbil, College of medicine, King Saud bin Abdulaziz University for health Sciences (KSAU-HS), Prince Mutib Ibn Abdullah Ibn Abdulaziz, Ar Rimayah, P.O. Box 22490, MC 1940, Riyadh, 11426, Saudi Arabia, Tel +966-11-8011111 ext 53594, Email muqbilm@ksau-hs.edu.sa; almuqbilmo@ngha.med.saPurpose: The aim of this manuscript was to assess the epidemiology and clinical features of Neurofibromatosis type 1 (NF-1) based on the newly published revised NF-1 diagnostic criteria and to evaluate complications of NF-1 including neurodevelopmental disorders.Patients and methods: A retrospective cross-sectional observational study was conducted in the Ministry of National Guard Health Affairs (MNGHA) healthcare organization branches including four tertiary hospitals and 51 primary health care centers in different regions in Saudi Arabia. This study included all patients diagnosed with NF1 using the revised NIH diagnostic criteria published in 2021 that were registered at the electronic medical records (EMR) from 2015 to 2021.Results: A total of 184 patients fulfilled the diagnostic criteria and were included in this study. The median age at diagnosis was 11 years (IQR: 4.00– 20.25). The most encountered diagnostic criteria in this study were Café-au-lait macules (85.3%), and (42.9%) were found to have two or more neurofibromas with plexiform neurofibroma being the most common subtype (23.36%), approximately (36.4%) of the patient with optic pathway glioma. Nearby (26.6%) of the patients displayed different type of tumors. Iris Lisch nodules were presented in 36.4% of patients at a median age of 12 years (IQR: 9.0– 21.8). Cardiovascular abnormality was encountered in 9.8% of the patients. Around 27.7% of the patients reported headache and 11.4% of the patient suffered from different type of epilepsy. Besides, 10.5% of the patients had intellectual disability, 33.8% suffered from communication disorders, and 4.9% patients had ADHD.Conclusion: The results of this study will enable practitioners to adopt a more holistic approach and prioritize numerous attributes, which they can subsequently incorporate into their therapeutic methodologies. Furthermore, the identification of these attributes will facilitate an expeditious and accurate diagnosis. Hence, the implementation of intervention during its nascent phase may result in a more advantageous consequence.Keywords: neurofibromatosis type 1, café-au-lait macule, glioma, neurofibromas

Huan-Huan Shen,1,2,&ast; Jie-Fei Peng,1,3,&ast; Ran-Ran Wang,4,&ast; Ping-Yu Wang,1,5 Jia-Xiang Zhang,1 Hong-Fang Sun,1 Yan Liang,1 Yan-Mei Li,6 Jiang-Nan Xue,7 You-Jie Li,1 Guang-Bin Sun,1,&ast; Shu-Yang Xie1,2,&ast; 1Department of Biochemistry and Molecular Biology, Binzhou Medical University, YanTai, Shandong, 264003, People’s Republic of China; 2Shandong Laboratory of Advanced Materials and Green Manufacturing, Yantai, Shandong, 264000, People’s Republic of China; 3Department of Clinical Laboratory, the Affiliated Taian City Central Hospital of Qingdao University, Taian, 271000, People’s Republic of China; 4Institute of Rehabilitation Medicine, School of Rehabilitation Medicine, Binzhou Medical University, Yantai, Shandong, 264003, People’s Republic of China; 5Department of Epidemiology, Binzhou Medical University, YanTai, ShanDong, 264003, People’s Republic of China; 6Department of Immune Rheumatism, Yantaishan Hospital, Yantai, Shandong, 264000, People’s Republic of China; 7Department of Immunology, Binzhou Medical University, Yantai, Shandong, 264003, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Shu-Yang Xie; Guang-Bin Sun, Department of Biochemistry and Molecular Biology, Binzhou Medical University, YanTai, Shandong, 264003, People’s Republic of China, Tel +86 535 6913010 ; +86 535 6913335, Fax +86 535 6913163, Email xieshuyang@bzmc.edu.cn; bingo@bzmc.edu.cnPurpose: The drug resistance and low response rates of immunotherapy limit its application. This study aimed to construct a new nanoparticle (CaCO3-polydopamine-polyethylenimine, CPP) to effectively deliver interleukin-12 (IL-12) and suppress cancer progress through immunotherapy.Methods: The size distribution of CPP and its zeta potential were measured using a Malvern Zetasizer Nano-ZS90. The morphology and electrophoresis tentative delay of CPP were analyzed using a JEM-1400 transmission electron microscope and an ultraviolet spectrophotometer, respectively. Cell proliferation was analyzed by MTT assay. Proteins were analyzed by Western blot. IL-12 and HMGB1 levels were estimated by ELISA kits. Live/dead staining assay was performed using a Calcein-AM/PI kit. ATP production was detected using an ATP assay kit. The xenografts in vivo were estimated in C57BL/6 mice. The levels of CD80+/CD86+, CD3+/CD4+ and CD3+/CD8+ were analyzed by flow cytometry.Results: CPP could effectively express EGFP or IL-12 and increase ROS levels. Laser treatment promoted CPP-IL-12 induced the number of dead or apoptotic cell. CPP-IL-12 and laser could further enhance CALR levels and extracellular HMGB1 levels and decrease intracellular HMGB1 and ATP levels, indicating that it may induce immunogenic cell death (ICD). The tumors and weights of xenografts in CPP-IL-12 or laser-treated mice were significantly reduced than in controls. The IL-12 expression, the CD80+/CD86+ expression of DC from lymph glands, and the number of CD3+/CD8+T or CD3+/CD4+T cells from the spleen increased in CPP-IL-12-treated or laser-treated xenografts compared with controls. The levels of granzyme B, IFN-γ, and TNF-α in the serum of CPP-IL-12-treated mice increased. Interestingly, CPP-IL-12 treatment in local xenografts in the back of mice could effectively inhibit the growth of the distant untreated tumor.Conclusion: The novel CPP-IL-12 could overexpress IL-12 in melanoma cells and achieve immunotherapy to melanoma through inducing ICD, activating CD4+ T cell, and enhancing the function of tumor-reactive CD8+ T cells.Keywords: cancer immunotherapy, CaCO3 nanoparticle, interleukin-12, immunogenic cell death, tumor therapy

Xiao-Yu Xu,1,&ast; Yang Gao,2,&ast; Chuang-Shi Yue,3,&ast; Yu-Jia Tang,4,&ast; Zhao-Jin Zhang,5 Feng-Jie Xie,6 Hong Zhang,6 Yu-Cheng Zhu,7 Yan Zhang,7 Qi-Qi Lai,4 Xin-Tong Wang,4 Jia-Xi Xu,4 Jia-Ning Zhang,4 Bo-Wen Liu,4 Jian-Nan Zhang,4 Kai Kang4 1Department of Critical Care Medicine, The Second People’s Hospital of Beihai, Beihai, People’s Republic of China; 2Department of Critical Care Medicine, The Sixth Affiliated Hospital of Harbin Medical University, Harbin, People’s Republic of China; 3Department of Critical Care Medicine, Henan Provincial People’s Hospital, Zhengzhou, People’s Republic of China; 4Department of Critical Care Medicine, The First Affiliated Hospital of Harbin Medical University, Harbin, People’s Republic of China; 5Department of Critical Care Medicine, The Yichun Central Hospital, Yichun, People’s Republic of China; 6Department of Critical Care Medicine, The Hongqi Hospital Affiliated to Mudanjiang Medical University, Mudanjiang, People’s Republic of China; 7Department of Critical Care Medicine, The Hongxinglong Hospital of Beidahuang Group, Shuangyashan, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Jian-Nan Zhang; Kai Kang, Department of Critical Care Medicine, The First Affiliated Hospital of Harbin Medical University, 23 Youzheng Street, Nangang District, Harbin, Heilongjiang, 150001, People’s Republic of China, Tel +86-13836119816 ; +86-13904618016, Email zhangjiannan@hrbmu.edu.cn; janekk79@126.comPurpose: In this study, our objective was to investigate the potential utility of lymphocyte-C-reactive protein ratio (LCR) as a predictor of disease progression and a screening tool for intensive care unit (ICU) admission in adult patients with acute pancreatitis (AP).Methods: We included a total of 217 adult patients with AP who were admitted to the First Affiliated Hospital of Harbin Medical University between July 2019 and June 2022. These patients were categorized into three groups: mild AP (MAP), moderately severe AP (MSAP), and severe AP (SAP), based on the presence and duration of organ dysfunction. Various demographic and clinical data were collected and compared among different disease severity groups.Results: Height, diabetes, lymphocyte count (LYMPH), lymphocyte percentage (LYM%), platelet count (PLT), D-Dimer, albumin (ALB), blood urea nitrogen (BUN), serum creatinine (SCr), glucose (GLU), calcium ion (Ca2+), C-reactive protein (CRP), procalcitonin (PCT), hospitalization duration, ICU admission, need for BP, LCR, sequential organ failure assessment (SOFA) score, bedside index for severity in AP (BISAP) score, and modified Marshall score showed significant differences across different disease severity groups upon hospitalization. Notably, there were significant differences in LCR between the MAP group and the MSAP and SAP combined group, and the MAP and MSAP combined group and the SAP group, and adult AP patients with ICU admission and those without ICU admission upon hospitalization.Conclusion: In summary, LCR upon hospitalization can be utilized as a simple and reliable predictor of disease progression and a screening tool for ICU admission in adult patients with AP.Keywords: lymphocyte-C-reactive protein ratio, acute pancreatitis, lymphocyte count, C-reaction protein, disease progression, ICU admission, screening tool

Abstract Overconsumption of energy‐rich foods that disrupt caloric balance is a fundamental cause of overweight, obesity and diabetes. Dysglycemia and the resulting cardiovascular disease cause substantial morbidity and mortality worldwide, as well as high societal cost. The prevalence of obesity in childhood and adolescence is increasing, leading to younger diabetes diagnosis, and higher severity of microvascular and macrovascular complications. An important goal is to identify early life conditions that increase future metabolic risk, toward the goal of preventing diabetes and cardiovascular disease. An ample body of evidence implicates prenatal and postnatal childhood growth trajectories in the programming of adult metabolic disease. Human epidemiological data show that accelerated childhood growth increases risk of type 2 diabetes in adulthood. Type 2 diabetes results from the combination of insulin resistance and pancreatic β‐cell failure, but specific mechanisms by which accelerated postnatal growth impact one or both of these processes remain uncertain. This review explores the metabolic impact of overnutrition during postnatal life in humans and in rodent models, with specific attention to the connection between accelerated childhood growth and future adiposity, insulin resistance, β‐cell mass and β‐cell dysfunction. With improved knowledge in this area, we might one day be able to modulate nutrition and growth in the critical postnatal window to maximize lifelong metabolic health.

Samuel Mbadu Lelo,1,2 François-Pantaléon Musungayi Kajingulu,1,3,4 Jean-Robert Makulo,1,2 Yannick Mayamba Nlandu,1,5 Justine Busanga Bukabau,1,5 Pierre Koso Mbulupasu,1,6 Augustin Luzayadio Longo,1 Jeanine Nina Losa Luse,7 Vieux Momeme Mokoli,1,2 Ernest Kiswaya Sumaili,1 Nazaire Mangani Nseka1 1Hemodialysis Center, Division of Nephrology, Kinshasa University Hospital, Kinshasa, Democratic Republic of the Congo; 2Hemodialysis Center, Ngaliema Medical Center, Kinshasa, Democratic Republic of the Congo; 3Dialysis Center, HJ Hospital, Kinshasa, Democratic Republic of the Congo; 4Department of Internal Medicine, Saint-Joseph Hospital, Kinshasa, Democratic Republic of the Congo; 5Hemodialysis Center, Centre Médical de Kinshasa, Kinshasa, Democratic Republic of the Congo; 6Department of Internal Medicine, Clinique Ngaliema, Kinshasa, Democratic Republic of the Congo; 7Hemodialysis Center, Hôpital Général de Référence de Kinshasa, Kinshasa, Democratic Republic of the CongoCorrespondence: Jean-Robert Makulo, Email jrmakulo2016@gmail.comBackground: Data on 25 [OH] vitamin D and intact parathyroid hormone [iPTH] in hemodialysis patients are very limited in sub-Saharan African countries. The present study aimed to assess the magnitude of hypovitaminosis D, and to evaluate the achievement of iPTH KDIGO 2017 targets among chronic hemodialysis patients followed in Kinshasa.Methods: We conducted a multicenter cross-sectional study in 6 hospitals in Kinshasa. All patients followed on hemodialysis for more than 3 months were included. Hypovitaminosis D was defined as < 30 ng/mL (insufficiency = 20– 29 ng/mL; deficiency if < 20 ng/mL) and the targets for iPTH values were based on the 2017 KDIGO guidelines. The determinants for hypovitaminosis D were evaluated by logistic regression.Results: 251 patients [mean age 56 ± 14 years, 72.5% men, 63% hypertensive, 31% diabetic, 100% supplemented with native 25 [OH] vitamin D + CaCO3 were included. Hypovitaminosis D was found in 79.7% (deficiency 47.4%) and was associated with the male gender aOR 2.7 [1.4– 5.2], p = 0.004, the low-permeability dialyzer 2.2 [1.1– 4.2], p = 0.025 and anemia 3.9 [1.2– 12.7], p = 0.022. Only 40% of patients with 25 [OH] vitamin D deficiency had iPTH according to KDIGO targets vs 6% of patients with severe hyperparathyroidism (iPTH > 600 pg/mL), 45% with levels between 16 and 150 pg/mL and 9% a iPTH ≤ 15 pg/mL.Conclusion: Despite a sunny environment, a large proportion of Congolese hemodialysis patients have hypovitaminosis D, in particular a deficiency. Among them, less than half have target iPTH values. These results show the benefit of regular monitoring of these parameters in order to optimize treatment.Keywords: KDIGO targets, hemodialysis, hypovitaminosis D, iPTH

M Ellen Kuenzig,1,2 Therese A Stukel,3,4 Matthew W Carroll,5 Gilaad G Kaplan,6 Anthony R Otley,7 Harminder Singh,8– 10 Alain Bitton,11 Stephen G Fung,12,13 Sarah Spruin,3,14 Stephanie Coward,6 Yunsong Cui,15 Zoann Nugent,8 Anne M Griffiths,1,2,16 David R Mack,12,13,17 Kevan Jacobson,18 Geoffrey C Nguyen,3,4,19 Laura E Targownik,19 Wael El-Matary,20 Charles N Bernstein,8,9 Trevor J B Dummer,21 Jennifer L Jones,15 Lisa M Lix,22 Sanjay K Murthy,14,23– 25 Juan Nicolás Peña-Sánchez,26 Soheila Nasiri,12,13 Eric I Benchimol1– 4,16 On behalf of the Canadian Gastro-Intestinal Epidemiology Consortium1SickKids Inflammatory Bowel Disease Centre, Division of Gastroenterology, Hepatology and Nutrition, The Hospital for Sick Children (Sickkids), Toronto, Ontario, Canada; 2Child Health Evaluative Sciences, SickKids Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada; 3ICES, Toronto, Ontario, Canada; 4Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada; 5Division of Pediatric Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada; 6Departments of Medicine & Community Health Sciences, University of Calgary, Calgary, Alberta, Canada; 7Department of Pediatrics, Dalhousie University, Halifax, Nova Scotia, Canada; 8Univeristy of Manitoba IBD Clinical and Research Centre, University of Manitoba, Winnipeg, Manitoba, Canada; 9Department of Internal Medicine, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada; 10Research Institute at CancerCare Manitoba, Winnipeg, Manitoba, Canada; 11McGill University Health Centre, Division of Gastroenterology and Hepatology, Montreal, Québec, Canada; 12CHEO Inflammatory Bowel Disease Centre, Division of Gastroenterology, Hepatology and Nutrition, CHEO, Ottawa, Ontario, Canada; 13CHEO Research Institute, Ottawa, Ontario, Canada; 14Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; 15Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada; 16Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada; 17Department of Pediatrics, University of Ottawa, Ottawa, Ontario, Canada; 18Department of Pediatrics, BC Children’s Hospital Research Institute, University of British Columbia, Vancouver, British Columbia, Canada; 19Mount Sinai Hospital Centre for Inflammatory Bowel Disease, Department of Medicine, University of Toronto, Toronto, Ontario, Canada; 20Department of Pediatrics, University of Manitoba, Winnipeg, Manitoba, Canada; 21School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada; 22Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada; 23Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada; 24Division of Gastroenterology, The Ottawa Hospital IBD Centre, Ottawa, Ontario, Canada; 25School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada; 26Department of Community Health & Epidemiology, College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, CanadaCorrespondence: Eric I Benchimol, The Hospital for Sick Children Division of Gastroenterology, Hepatology and Nutrition 555 University Avenue, Toronto, ON, M5G 1X8, Canada, Fax +1-416-813-4972, Email eric.benchimol@sickkids.caPurpose: The incidence of childhood-onset inflammatory bowel disease (IBD) is rising. We described variation in health services utilization and need for surgery among children with IBD between six and 60 months following IBD diagnosis across Canadian pediatric centers and evaluated the associations between care provided at diagnosis at each center and the variation in these outcomes.Patients and Methods: Using population-based deterministically-linked health administrative data from four Canadian provinces (Alberta, Manitoba, Nova Scotia, Ontario) we identified children diagnosed with IBD < 16 years of age using validated algorithms. Children were assigned to a pediatric center of care using a hierarchical approach based on where they received their initial care. Outcomes included IBD-related hospitalizations, emergency department (ED) visits, and IBD-related abdominal surgery occurring between 6 and sixty months after diagnosis. Mixed-effects meta-analysis was used to pool results and examine the association between center-level care provision and outcomes.Results: We identified 3784 incident cases of pediatric IBD, of whom 2937 (77.6%) were treated at pediatric centers. Almost a third (31.4%) of children had ≥ 1 IBD-related hospitalization and there were 0.66 hospitalizations per person during follow-up. More than half (55.8%) of children had ≥ 1 ED visit and there were 1.64 ED visits per person. Between-center heterogeneity was high for both outcomes; centers where more children visited the ED at diagnosis had more IBD-related hospitalizations and more ED visits during follow-up. Between-center heterogeneity was high for intestinal resection in Crohn’s disease but not colectomy in ulcerative colitis.Conclusion: There is variation in health services utilization among children with IBD and risk of undergoing intestinal resection in those with Crohn’s disease, but not colectomy among children with ulcerative colitis, across Canadian pediatric tertiary-care centers. Improvements in clinical care pathways are needed to ensure all children have equitable and timely access to high quality care.Plain Language Summary: Inflammatory bowel disease (IBD) is a chronic health condition of the gastrointestinal system, which is becoming more common in children. They require lifelong treatment and receiving high quality care is important for preventing complications. We determined if outcomes of children with IBD was different across Canada. We also tested if differences in care at diagnosis was related to outcomes. More than three-quarters of children with IBD were treated at pediatric hospitals. Children treated at some hospitals were more likely to be hospitalized and visit the emergency room when compared to children treated at other hospitals. Children with Crohn’s disease (one type of IBD) were more likely to have surgery at some hospitals when compared to children treated at other hospitals. We should improve care to make sure children living with IBD have timely access to high quality specialist care.Keywords: Crohn’s disease, ulcerative colitis, health administrative data, variation in care, health services utilization, surgery

The performance of Colossoma macropomum subjected to a six-month feeding trial using duckweed (Lemna minor) and fish visceral as partial replacements for soybean meal and fishmeal respectively was evaluated in this study. A total of one thousand five hundred (1500) nearly same sizes (average size 45 g) juveniles of C. macropomum were sourced from the nearby research man-made lake and subjected to proper acclimatisation for two weeks prior to the commencement of the feeding trial. One hundred (100) juveniles per experimental pond (EP) were stocked in triplicate with EPi-iii0% (control), EPi-iii25%, EPi-iii50%, EPi-iii75%, and EPi-iii100%. The formulated diets with varying dietary inclusion levels (0%, 25%, 50%, 75%, and 100%) of duckweed as a substitute for soybean meal, and at the same levels, fish visceral meal was used as a substitute for fishmeal. The formulated diets were fed to the experimental fishes on a twice-daily schedule (7 am and 5:30 pm). The control diet contained the conventional protein sources (fishmeal and soybean) while the other diets had fish visceral and duckweed as dietary replacements for fishmeal and soybean, respectively. A biweekly sampling of growth parameters such as body weight was carried out on twenty (20) randomly selected juveniles from each EP and data collected from the feeding trial was subjected to analysis of variance (ANOVA) (SPSS version 26) while Duncan's multiple ranges test distinguished the means at p < 0.05 significant level. The highest value for mean body weight gain at 6 months was observed at a 50% dietary inclusion level of the test ingredients (1411.7 g), while at a 100% inclusion level, the lowest value was recorded (1213.6 g). Water quality parameters sampled were within the acceptable standards indicating no adverse effect of the test ingredients on the culture medium. In general, no adverse effect was recorded across treatments. Conclusively, C. macropomum culture in Nigeria using the test diets at a 50% dietary inclusion level to replace the conventional protein sources is feasible and can help improve fish availability and sustainability through species diversification and reduced production cost since the test ingredients are obtained at minimal cost from fish traders (fish visceral) and fallow earthen ponds (duckweed).

Spinal muscular atrophy (SMA) is an autosomal recessive neuromuscular disease caused by loss-of-function of SMN1. SMA is characterized by degeneration of motor neurons in the spinal cord, leading to progressive muscle weakness and atrophy. One of three currently available treatments is onasemnogene abeparvovec, an AAV9-based gene replacement therapy. Despite its effectiveness in improving motor function in SMA patients, its long-term safety profile remains unclear and adverse events such as liver toxicity are common. This may be caused by high vector dose or supraphysiological levels of SMN, driven by its strong, ubiquitous promoter. In this issue of EMBO Molecular Medicine, Xie et al addressed this by replacing the promoter of a benchmark virus—equivalent to onasemnogene abeparvovec—by an endogenous SMN1 promoter. In a common mouse model of SMA, treatment with this 2nd generation vector restored SMN expression close to physiological levels across tissues, resulting in improved safety and efficacy. This approach holds promise for safer and more efficacious AAV gene therapy for SMA and other diseases.

Frank Ssedyabane,1 Thomas C Randall,2 Deusdedit Tusubira,3 Cesar M Castro,4,5 Josephine Nambi Najjuma,6 Christopher Okeny,1 Doreen Nuwashaba,1 Hope Mudondo,1 Rogers Kajabwangu,7 Joy Muhumuza,7 Alexcer Namuli,7 Joseph Ngonzi7 1Department of Medical Laboratory Science, Mbarara University of Science of Science and Technology, Mbarara, Uganda; 2Department of Global Health and Social Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; 3Department of Biochemistry, Mbarara University of Science of Science and Technology, Mbarara, Uganda; 4Centre for Systems Biology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; 5Cancer Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; 6Department of Nursing, Mbarara University of Science of Science and Technology, Mbarara, Uganda; 7Department of Obstetrics and Gynecology, Mbarara University of Science of Science and Technology, Mbarara, UgandaCorrespondence: Frank Ssedyabane, Email fssedyabane@must.ac.ugPurpose: There is a documented association between cervical cancer and metabolic syndrome. In this study, we determined the association between lipids, insulin-like growth factor binding protein-3 (IGFBP-3) and treatment outcomes for cervical lesions at Mbarara Regional Referral Hospital (MRRH) in south western Uganda.Patients and Methods: In this prospective cohort study, we recruited 94 cases and 94 controls at the cervical cancer clinic of MRRH, and followed them for 12 months. Cases were confirmed with cytology and/or histology. With consent, we collected demographic data and measured lipids and IGFBP-3 both at baseline and after 12 months. The lipid profile was measured using a Cobas 6000 Chemistry Analyzer, whereas IGFBP-3 was measured using a MAGLUMI fully automated chemiluminescence immunoassay analyzer. Abnormal values for lipids were defined using WHO recommended cut-offs. IGFBP-3 concentrations were divided into two categories of low concentration (< 3.29 μg/mL) and raised concentration (≥ 3.29 μg/mL). Statistical analyses were conducted in STATA version 17 using logistic regression analysis. A p-value of < 0.05 was taken to be statistically significant.Results: The average (mean ± SD) age of our participants was 38.7± 8.2 years for controls and 34.5± 7.8 years for cases. The average serum IGFBP-3 concentration was 3.769± 1.098 μg/mL among cases with cleared lesions and 3.505± 0.979 μg/mL among cases whose lesions persisted. A serum IGFBP-3 concentration of less than 3.291 μg/mL was likely to be associated with clearance of cervical lesions (AOR 1.65, p=0.67), although this was not statistically significant. A serum triglyceride concentration of 35– 135 mg/dL was also likely to be associated with clearance of cervical lesions (AOR 2.41, p=0.46), although this was also not statistically significant.Conclusion: Although not statistically significant, reduced serum concentrations of IGFBP-3 and triglyceride may be associated with clearance of cervical lesions. Lipid management may be of benefit in the treatment of cervical lesions.Keywords: cervical intraepithelial neoplasia, cervical lesions, clearance, persistence, IGFBP-3

Aim: In response to DNA damage the serine/threonine-specific protein kinase checkpoint kinase 1 (CHK1) is activated allowing cells to enter S phase (S) and G2 phase (G2) cell-cycle arrest. CHK1 inhibitors are expected to prevent cells from entering such arrest, thereby enhancing DNA damage-induced cytotoxicity. In contrast, normal cells with intact ataxia–telangiectasia mutated (ATM), CHK2 and tumour suppressor protein 53 (P53) signalling are still able to enter cell-cycle arrest using the functioning G1/S checkpoint, thereby being rescued from enhanced cytotoxicity. The main objective of this work is to investigate the in vitro effects of the novel CHK1 inhibitor SRA737 on pairs of non-small cell lung cancer (NSCLC) and colorectal cancer (CRC) cell lines, all with genetic aberrations rendering them susceptible to replication stress but of differing tumour protein 53 (TP53) gene status, focusing on DNA damage induction and the subsequent effects on cell proliferation and viability. Methods: NSCLC cell lines H23 [TP53 mutant (MUT)] and A549 [TP53 wild-type (WT)] and CRC cell lines HT29 (TP53 MUT) and HCT116 (TP53 WT) were incubated with differing micromolar concentrations of SRA737 for 24 h and then analysed using alkaline comet and phosphorylated H2A.X variant histone (γH2AX)-foci assays to assess mostly DNA single strand break and double strand break damage, respectively. Cell-counting/trypan blue staining was also performed to assess cell proliferation/viability. Results: Clear concentration-dependent increases in comet formation and γH2AX-foci/cell were noted for the TP53 MUT cells with no or lower increases being noted in the corresponding TP53 WT cells. Also, greater anti-proliferative and cell killing effects were noted in the TP53 MUT cells than in the TP53 WT cells. Conclusions: This study’s data suggests that P53 status/functioning is a key factor in determining the sensitivity of NSCLC and CRC cancer cells towards CHK1 inhibition, even in circumstances conducive to high replicative stress.

Zhe-Feng Zhao,1,&ast; Bing-Bing Liu,1,&ast; Jian-Nan Zhang,2,&ast; Ni Shi,3,&ast; Ping Zhang,1,&ast; Gang-Zhi Yang,4 Yu-Fu Cao,4 Long-He Tian,4 Cheng-Cai Qiu,5 Yang Gao6,7 1Department of Neurosurgery, The Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, People’s Republic of China; 2Department of Critical Care Medicine, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, People’s Republic of China; 3Department of Critical Care Medicine, The Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, People’s Republic of China; 4Department of Neurosurgery, People’s Hospital of Hegang City, Hegang, Heilongjiang, People’s Republic of China; 5Department of Neurosurgery, Traditional Chinese Medicine Hospital of Jixi City, Jixi, Heilongjiang, People’s Republic of China; 6Department of Critical Care Medicine, The Sixth Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, People’s Republic of China; 7Institute of Critical Care Medicine, The Sino Russian Medical Research Center of Harbin Medical University, Harbin, Heilongjiang, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Zhe-Feng Zhao, Department of Neurosurgery, The Second Affiliated Hospital of Harbin Medical University, Harbin, People’s Republic of China, Email know810512@163.com Yang Gao, Department of Critical Care Medicine, The Sixth Affiliated Hospital of Harbin Medical University, Harbin, People’s Republic of China, Email gaoyang0312@126.comObjective: In this study, we aimed to explore the demographic and clinical factors that could determine short- and long-term complete pain relief (CPR) in adult patients with primary trigeminal neuralgia (PTN) after microvascular decompression (MVD) to guide clinical practice.Methods: This single-center retrospective study included adult patients with PTN who underwent MVD as their initial neurosurgical procedure in the Department of Neurosurgery at the Second Affiliated Hospital of Harbin Medical University from January 2017 to December 2019 and completed a 3-year post-surgery follow-up. Demographic and clinical information was obtained from medical records. Pain relief of adult patients with PTN at various time points after sufficient decompression of trigeminal nerve (TN) during MVD was determined and classified by the patient’s subjective response and medications use. Pain relief of local patients was evaluated by outpatient follow-up at various time points, whereas that of local cases who could not return to outpatient or non-local cases was assessed through telephone or WeChat.Results: In univariate analysis, compression degree of TN and type of conflicting vessels constantly showed significant differences between the two groups at 3 months, 6 months, 1 year, 2 years, and 3 years after MVD. Compression degree of TN and type of conflicting vessels at various time points after MVD were always the related factors to CPR in logistic regression analysis, with the former having the greatest impact. The areas under the receiver operating characteristic (ROC) curve of CPR at various time points after MVD were 0.937, 0.874, 0.879, 0.864, and 0.869, respectively.Conclusion: In summary, compression degree of TN and type of conflicting vessels can determine short- and long-term CPR in adult patients with PTN after MVD.Keywords: compression degree of trigeminal nerve, type of conflicting vessels, microvascular decompression, sufficient decompression of trigeminal nerve, complete pain relief, primary trigeminal neuralgia

James Davis Katumba,1 Bruce Kirenga,2 Anthony Muwagga Mugagga,3 Joan N Kalyango,1 Rebecca Nantanda,2 Charles Karamagi1 1Clinical Epidemiology Unit, College of Health Sciences, Makerere University, Kampala, Uganda; 2Lung Institute, College of Health Sciences, Makerere University, Kampala, Uganda; 3College of Education and External Studies, Makerere University, Kampala, UgandaCorrespondence: James Davis Katumba, Clinical Epidemiology Unit, College of Health Sciences, Makerere University, P O Box 7072, Kampala, Uganda, Tel +256 726119537, Email james.katumba@students.mak.ac.ug; jamesdaviskatumba@gmail.comIntroduction: Poor asthma control in adolescents is partly attributed to inadequate asthma education for self-management. This study is set to determine the effectiveness of the “KmAsthma” self-management app in improving the control of asthma among adolescents in a low-resource setting.Methods: The two-arm 6-month cluster randomized controlled trial, will aim at enrolling 120 day scholars aged 12-19 years in secondary schools with a clinician’s diagnosis and self-reported uncontrolled asthma in Kampala City Uganda. The primary endpoint of asthma control will be measured as a change in mean Asthma Control Test (ACT) scores. Asthma quality of life, adherence to medications, and self-efficacy will also be assessed. The iMprovIng the ContROl of aSthma (MICROS) study will employ the “KmAsthma” app for self-management education. The intervention group will receive the app on their smartphones and training on its eight sections: the profile, asthma history, goals, inspirations, reminders, connect, information about asthma, and emergency support. Participants will navigate these sections to set asthma control goals, schedule medication reminders, log daily symptoms, and receive guidance for attacks. All participants will be encouraged to seek routine care. A study nurse will follow up with each participant via the phone six weeks post-intervention. The MICROS study was approved by the Makerere University School of Medicine Research and Ethics Committee and the Uganda National Council of Science and Technology. This protocol is registered on Clinicaltrials.gov (NCT05850806).Conclusion: The MICROS study will provide comprehensive insights into how effective a mHealth intervention can be an aid for adolescents in a low-resource setting in managing their asthma. The findings of this study will contribute to filling the gap leading to unsatisfactory asthma control in adolescents.Keywords: asthma control, uncontrolled asthma, smartphone app, adolescents, school, low-resource setting, adherence, self-efficacy

Martin Kaddumukasa,1 Alyssa M Edwards,2 Josephine Nambi Najjuma,3 Scovia Nalugo Mbalinda,4 Jane Nakibuuka,1 Christopher J Burant,5 Shirley M Moore,6 Carol Blixen,2 Elly T Katabira,1 Martha Sajatovic,2 Mark Kaddumukasa1 1Department of Internal Medicine, College of Health Sciences, Makerere University, Kampala, Uganda; 2Neurological and Behavioral Outcomes Center, University Hospitals Cleveland Medical Center and Case Western Reserve University School of Medicine, Cleveland, OH, USA; 3Department of Nursing, Mbarara University of Science and Technology, Mbarara, Uganda; 4Department of Nursing, College of Health Sciences, Makerere University, Kampala, Uganda; 5Louis Stokes VA Medical Center, Geriatric Research Education, and Clinical Center, Cleveland, OH, USA; 6Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH, USACorrespondence: Martin Kaddumukasa, Email kaddumart@gmail.comAbstract: The study set out to perform a systematic literature review of evidence-based interventions that target the reduction of secondary stroke risk in Africa. The review analyzed longitudinal intervention studies conducted in Sub-Saharan Africa, focusing on adult participants who had suffered a prior stroke. It encompassed publications and peer-reviewed papers sourced from reputable databases, including PubMed, Ovid, Cochrane, and Web of Science. Three randomized clinical trial (RCT) studies were included with sample sizes ranging from 16 to 400 participants, mean age ranged between 50 and 66 years, with 64.5% male participants. All studies applied multidisciplinary team interventions of enhanced patient follow-up involving care givers, nurse educators, physicians, and social workers. Interventions ranged from comprehensive patient education, tracking of medication adherence and enforcing healthy lifestyle behaviors (regular exercise, regular BP checks, and dietary changes). We found a decrease in Systolic Blood Pressure over time in 2 of 3 treatment groups, an improvement in medical adherence in all treatment groups, and a decrease in cholesterol levels in 1 treatment group. Evidence-based interventions involving multidisciplinary teams and comprehensive patient education were found to demonstrate promising results in reducing secondary stroke risk in Africa, leading to significant improvements in medical adherence and reductions in systolic blood pressure in the majority of treatment groups. However, more research is required to confirm the influence of these interventions on cholesterol levels and to establish their lasting advantages in preventing strokes among African communities.Keywords: secondary stroke risk, risk interventions, Sub-Saharan Africa