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Uun Sumardi,1,&ast; Bima Valentino,1 Dimmy Prasetya,1 Josephine Debora,1 Adhi Kristianto Sugianli2,&ast; 1Department of Internal Medicine, Hasan Sadikin General Hospital, Faculty of Medicine Universitas Padjadjaran, Bandung, Indonesia; 2Department of Clinical Pathology, Hasan Sadikin General Hospital, Faculty of Medicine Universitas Padjadjaran, Bandung, Indonesia&ast;These authors contributed equally to this workCorrespondence: Adhi Kristianto Sugianli, Department of Clinical Pathology, Hasan Sadikin General Hospital, Faculty of Medicine Universitas Padjadjaran, Jl. Pasteur No. 38, Bandung, West Java, 40161, Indonesia, Tel +62-22-2033307, Email adhi.kristianto@unpad.ac.idPurpose: Coronavirus disease 2019 (COVID-19) is a new respiratory tract infection caused by severe acute respiratory syndrome coronavirus-2. The presence of secondary pulmonary bacterial infection (SPBI) made COVID-19 difficult to treat. Neutrophil-lymphocyte count ratio (NLR) is a systemic inflammatory marker used in the diagnosis and prognosis of viral or bacterial infection. At the first 3– 5 days after hyperinflammation, it occurs in relation to clinical outcome. Therefore, this study aimed to evaluate the diagnostic value of NLR based on leukocyte kinetics upon admission and after 72 hours among COVID-19 patients with or without SPBI.Patients and Methods: This retrospective cross-sectional study analyzed medical records data of admitted patients with COVID-19 according to the International Classification of Disease 10th Revision (ICD-10) between January and December 2021. The list of patients was extracted and followed by a hand search to identify the inclusion or exclusion criteria and stratified into proven and non-proven SPBI based on clinical data. The study distinguished between SPBI by means of a cut-off value (COV) on the first (D1) and third day (D3), assessed using receiver operating characteristics (ROC), as well as determined the magnitude of sensitivity, specificity, and prevalence ratio.Results: A screening process was conducted on 2902 COVID-19 patients, of which 236 were included, accounting for 8.1%. Among these patients, 87 (36.9%) were found to have proven SPBI. A considerable difference in NLR value between proven and non-proven SPBI was observed on both D1 (11.1 vs 4.2) and D3 (15.3 vs 5.2), with optimal COV of NLR on D1, D3 was found to be 5.29, 9.47, respectively (p < 0.001).Conclusion: NLR on the D1 and D3 distinguished the occurrence of SPBI among COVID-19 patients. The application of NLR assisted in the early determination of bacterial infection and helped in controlling the empirical use of antibiotics.Keywords: COVID-19, neutrophil–lymphocyte ratio, NLR, secondary pulmonary bacterial infection

Prayudi Santoso,1 Martina Sung,1 Yovita Hartantri,1 Basti Andriyoko,2 Adhi K Sugianli,2 Bachti Alisjahbana,1 Jeanne Sian Lie Tjiam,3 Josephine Debora,1 Dewi Kusumawati,3 Arto Yuwono Soeroto1 1Internal Medicine Department, Hasan Sadikin General Hospital, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia; 2Clinical Pathology Department, Hasan Sadikin General Hospital, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia; 3Santo Borromeus Hospital, Bandung, IndonesiaCorrespondence: Prayudi Santoso, Internal Medicine Department, Hasan Sadikin General Hospital, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia, Tel +62-22-2038986, Email prayudi@unpad.ac.idPurpose: The coronavirus disease (COVID-19) outbreak has created a global health crisis. Secondary pulmonary bacterial infection is a COVID-19 complication, increasing morbidity and mortality. This study aimed to determine the pathogens, antibiotic susceptibility patterns, and risk factors for mortality in hospitalized COVID-19 patients.Patients and Methods: This retrospective study used secondary data from patients’ electronic medical records at Hasan Sadikin General Hospital and Santo Borromeus Hospital between March 2020 and March 2021. Overall, 2230 hospitalized COVID-19 patients were screened, and 182 of them who were hospitalized ≥ 48 hours with a procalcitonin level of ≥ 0.25 ng/mL were enrolled. Culture examination was performed on sputum samples to determine pathogen and antibiotic susceptibilities. Univariate and multivariate analyses were used to determine mortality-related risk factors in hospitalized COVID-19 patients.Results: The prevalence of secondary pulmonary bacterial infections in COVID-19 patients was 8.2%, with 161/182 pathogen growth from sputum samples. Mainly gram-negative bacteria (64.8%) were present, including Acinetobacter baumannii (31.9%), Klebsiella pneumoniae (19.8%), and Pseudomonas aeruginosa (8.8%). High rate of multidrug-resistant (MDR) pathogens was found among isolate (45.9%), ie carbapenem-resistance A.baumannii (CR-Ab) was 84.2%, extended-spectrum β-lactamase (ESBL) among K. pneumoniae was 61.1%. Secondary infection of MDR pathogens was associated with a higher risk of mortality (AOR 5.63, p = 0.001). Other associated factors were age ≥ 60 years, ventilator use, and female gender.Conclusion: Gram-negative bacteria are the predominant pathogens causing secondary pulmonary bacterial infection in COVID-19 patients, implying nosocomial infection. High resistance to first-line antimicrobial drugs was observed in Gram-negative bacteria and Gram-positive bacteria. High rate of MDR pathogens was found among isolate and was associated with a significant risk of mortality.Keywords: COVID-19, secondary pulmonary bacterial infection, antibiotic susceptibility, MDR pathogens, West Java, Indonesia

Bachti Alisjahbana,1,2 Josephine Debora,1 Evan Susandi,1 Guntur Darmawan3 1Internal Medicine Department, Hasan Sadikin Hospital, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia; 2Research Center for Care and Control of Infectious Diseases, Universitas Padjadjaran, Bandung, Indonesia; 3Department of Internal Medicine, Faculty of Medicine, Krida Wacana Christian University, Jakarta, IndonesiaCorrespondence: Bachti AlisjahbanaResearch Center for Care and Control of Infectious Diseases, Universitas Padjadjaran, Education Hospital Building, Jl. Prof Eijkman No. 38, Bandung, IndonesiaTel +62 823 9841 5612Fax +62 22 204 4128Email b.alisjahbana@gmail.comAbstract: Chromobacterium violaceum is a common environmental bacterium that rarely causes disease in humans but has a high fatality rate if it does. Due to the rarity of the cases, clinicians are often unaware of the rapid progression of C. violaceum infection and its unexpected antibiotic resistance pattern, which contribute to the failure of patient management. Our review provides the clinical characteristics, possible sources of exposure, and comorbidities and determines factors associated with survival. We gathered information on 132 cases of C. violaceum causing disease in humans published between 1953 and 2020. Patients were predominantly male with a median age of 17.5, interquartile range (IQR) of 5.0– 40.0 years, and a third of them were known to have immune deficiencies or comorbidities. Portals of entry were mainly through a wound in the leg and feet (28.0%), the torso (8.5%), or hands and arms (6.8%). It is not uncommon to acquire infection through unintended contact with contaminated water or dust through the mouth or inhalation. The median incubation period is 4.0 days (IQR 2.0– 8.0 days) with a duration of clinical course of 17.5 days (IQR 8.0– 30.8 days). The high rate of positive blood cultures (56.1%) and abscesses in internal organs (36.4%) shows the significant severity of this disease. Sepsis and Bacteremia were related to mortality with a risk ratio (RR) of 5.20 (95% CI, 0.831– 32.58) and 2.14 (95% CI, 1.05– 4.36), respectively. Appropriate antibiotic use prevented death at a RR 0.33 (95% CI, 0.21– 0.52). Most patients who recovered and survived were treated with aminoglycosides, fluoroquinolones and carbapenems. This review shows the malignant nature of C. violaceum infection and the need for clinicians to be aware and provide prompt source management for patients. Appropriate empiric and targeted antibiotic regiment guided by susceptibility test results is of vital importance.Keywords: bacteremia, antibiotic, sepsis, mortality

Context: India accounts for 17% of the population, contributes to about 19% of maternal deaths, and 21% of childhood deaths of the world. Antenatal and postnatal services were one of the most important works done by ASHA workers. Aims: The objective of this study was to assess the services provided by ASHA workers in a district of western Utter Pradesh to her beneficiaries regarding antenatal and postnatal care. Settings and Design: A cross-sectional study was done in four randomly selected blocks of the district with the help of simple random sampling technique. Subjects and Methods: A total of 384 study participants (mother having child up to 2 years of age) who availed services from the ASHA of their village. Statistical Analysis: Data were analyzed using SPSS-24.0, IBM Corp., Chicago, USA. Differences between the groups were compared using the Chi-square test and Fisher's exact test. P value 55%) escorted less than four times for ANC, whereas only 0.5% of beneficiaries received the correct number i.e., 180 or > 180 IFA tablet from the ASHA workers. Only 57.2% of beneficiaries replied ≥6 times the post natal care home visit done by ASHA. Conclusion: Services provided by ASHA workers regarding ANC and PNC were not adequate.

It has been postulated that glyphosate (G) or its commercial formulation Roundup (R) might lead to male fertility impairment. In this study, we investigated the possible effects of G or R treatment of juvenile male rats on blood-testis barrier function and on adult male sperm production. Pups were randomly assigned to the following groups: control group (C), receiving water; G2 and G50 groups, receiving 2 and 50 mg/kg/day G respectively; and R2 and R50 groups receiving 2 and 50 mg/kg/day R respectively. Treatments were performed orally from postnatal day (PND) 14 to 30, period of life that is essential to complete a functional blood-testis barrier. Evaluation was done on PND 31. No differences in body and testis weight were observed between groups. Testis histological analysis showed disorganized seminiferous epithelium, with apparent low cellular adhesion in treated animals. Blood-testis barrier permeability to a biotin tracer was examined. A significant increase in permeable tubules was observed in treated groups. To evaluate possible mechanisms that could explain the effects on blood-testis barrier permeability, intratesticular testosterone levels, androgen receptor expression, thiobarbituric acid reactive substances (TBARS) and the expression of intercellular junction proteins (claudin11, occludin, ZO-1, connexin43, 46, and 50 which are components of the blood-testis barrier) were examined. No modifications in the above-mentioned parameters were detected. To evaluate whether juvenile exposure to G and R could have consequences during adulthood, a set of animals of the R50 group was allowed to grow up until PND 90. Histological analysis showed that control and R50 groups had normal cellular associations and complete spermatogenesis. Also, blood-testis barrier function was recovered and testicular weight, daily sperm production, and epididymal sperm motility and morphology did not seem to be modified by juvenile treatment. In conclusion, the results presented herein show that continuous exposure to low doses of G or R alters blood-testis barrier permeability in juvenile rats. However, considering that adult animals treated during the juvenile stage showed no differences in daily sperm production compared with control animals, it is feasible to think that blood-testis barrier impairment is a reversible phenomenon. More studies are needed to determine possible damage in the reproductive function of human juvenile populations exposed to low doses of G or R.

Quilting is an area of creative work rich in tradition that demonstrates how ideas and inspiration flow between quilters as they share with each other, move to new parts of the country, and develop their own designs. While commercial patterns have been copyrighted, quilting has generally existed under the radar of copyright law, primarily because quilts are most often exchanged within a gift economy. However, as quilting becomes big business and patterns and pattern books are more centrally located in quilting culture, issues associated with copyright protection emerge. This article investigates the relationship between copyright law, innovation, and sharing as it is understood by quilters who responded to an online questionnaire. Survey participants feel that quilting is a creative activity in which copyright plays a very small role, except when it restricts the actions of quilters. The survey suggests that respondents see quilting as creating a connection between themselves, their families, and their communities. Their creative work, in other words, is a gift they want to share, not a product they want to sell.

As Training and Education in Professional Psychology (TEPP's) outgoing editorial team ends their term, the authors reflect on the journal's contributions to health service psychology (HSP) and suggest potential priorities and opportunities as both the journal and the science of education and training continue to mature. TEPP's aim is to serve as a forum for thoughtful and rigorous conceptual and empirical investigation of current issues in HSP education and training, and for candid self-reflection about strengths, shortcomings, and growth opportunities in HSP education. The authors review the journal's contributions to this aim through three primary goals established at the beginning of their editorial term: (a) engage the broad training community in sharing its best conceptual and empirical work relevant to education and training across training levels, settings, and focus areas; (b) advance the science of education and training through strong empirical research; and (c) expand emphasis on the sociocultural context in which education and training occurs (Bell et al., 2019). The authors conclude with recommendations to the incoming TEPP editorial team and prospective authors for next steps in advancing HSP education and training. Public Significance Statement: Training and Education in Professional Psychology outgoing editorial team reflects on progress toward their goals for the journal's contributions to education and training in health service psychology. These goals include advancing education that is evidence-based, responsive to the sociocultural context, and that prepares the next generations of health service psychologists to address societal mental health needs. The authors conclude with recommendations for next steps in supporting innovative and effective education and training. [ABSTRACT FROM AUTHOR]

This study elaborated on associations between youth's trauma-related emotional numbing across multiple affective domains (e.g., fear, sadness, happiness, anger) and delinquent behaviors. The study also examined whether the effects of posttrauma emotional numbing varied by the occurrence of posttrauma arousal symptoms. Participants were 123 middle school boys and girls from working-class, urban communities. Emotional numbing, particularly diminished fear, was related to both home and community violence exposure. Numbing of fearful emotions was associated with all types of delinquent behaviors examined. In addition, numbing of sadness was associated with aggression. Interactions between numbing of fear and hyperarousal suggested a complex pattern of emotional processing following exposure to traumatic events in which numbing related to delinquent behavior only in the context of high posttrauma arousal. These patterns may coalesce to place youth at risk for early involvement in delinquent behaviors. (Contains 6 tables.)

Two studies examined shared and unique relations of social information processing (SIP) to youth's anxious and depressive symptoms. Whether SIP added unique variance over and above trait affect in predicting internalizing symptoms was also examined. In Study 1, 215 youth (ages 8-13) completed symptom measures of anxiety and depression and a vignette-based interview measure of SIP. Anxiety and depression were each related to a more negative information-processing style. Only depression was uniquely related to a less positive information processing style. In Study 2, 127 youth (ages 10-13) completed measures of anxiety, depression, SIP, and trait affect. SIP's relations to internalizing symptoms were replicated. Over and above negative affect, negative SIP predicted both anxiety and depression. Low positive SIP added variance over and above positive affect in predicting only depression. Finally, SIP functioning partially mediated the relations of affect to internalizing symptoms. (Contains 1 footnote, 2 tables and 1 figure.)

Brazil, a crucial player in global climate change mitigation, faces challenges in reducing its carbon emissions, of which nearly half are from land use changes. Despite potential reductions that can be achieved through halting deforestation and fostering forest restoration, setbacks in environmental governance have heightened emissions. This article assesses challenges and proposes solutions for conserving and restoring Brazilian biomes in line with the Sustainable Development Goals (SDGs) and the Paris Agreement by 2030. Notably, net carbon emissions from land-use change and forestry increased twofold from 2017 to 2022 due to deforestation in the Amazon and Cerrado. Native vegetation clearing peaked at 2.8 Mha in 2022, the largest area since 2008. The deficit of native vegetation within Legal Reserves and Permanent Protection Areas must be addressed through restoration. Achieving SDGs by 2030 demands urgent action against illegal deforestation, reinforced legislation for secondary forest protection, large-scale restoration programs, and economic incentives for forest conservation through payment for ecosystem services to rural landowners.

Abstract To acquire the ability to fertilize the egg, mammalian spermatozoa must undergo a series of changes occurring within the highly synchronized and specialized environment of the female reproductive tract, collectively known as capacitation. In an attempt to replicate this process in vitro, various culture media for mouse sperm were formulated over the past decades, sharing a similar overall composition but differing mainly in ion concentrations and metabolic substrates. The widespread use of the different media to study the mechanisms of capacitation might hinder a comprehensive understanding of this process, as the medium could become a confounding variable in the analysis. In this context, the present side-by-side study compares the influence of four commonly used culture media (FD, HTF and two TYH versions) on mouse sperm capacitation. We evaluated the induction of protein kinase A phosphorylation pathway, motility, hyperactivation and acrosome reaction. Additionally, in vitro fertilization and embryo development were also assessed. By analyzing these outcomes in two mouse colonies with different reproductive performance, our study provides critical insights to improve the global understanding of sperm function. The results obtained highlight the importance of considering variations in medium composition, and their potential implications for the future interpretation of results.

Background: Caffeine, the only licit psychoactive drug available to minors, may have a harmful impact on students' health and adjustment, yet little is known about its use or effects on students, especially from a developmental perspective. Caffeine use in 5th- and 10th-grade students was examined in a cross-sectional design, and relations and potential mediators of caffeine use to depression and anxiety symptoms were investigated. Methods: Children (n = 135) and adolescents (n = 79) completed a measure of naturalistic use of caffeinated and noncaffeinated beverages. Furthermore, daily availability, perceived benefits, and stimulating, psychological, and withdrawal effects of caffeinated and noncaffeinated beverages were assessed. Measures of depression and anxiety were also administered. Results: Fifth and 10th graders used caffeine frequently. Depression was positively related to caffeine use for both cohorts, though mediated by caffeine withdrawal effects. Surprisingly, anxiety was unrelated to use. Fifth graders reported less daily access to caffeine, but more psychological and stimulating effects of caffeine than 10th graders. Conclusions: Although both children and adolescents experience negative caffeine-related outcomes, intake is seemingly not greatly limited in either cohort. In particular, youth appear vulnerable to increased depressive symptoms with increasing caffeine consumption. Implications for school policy regarding students' caffeine use are discussed. (Contains 4 tables.)

Two studies describe the development of a comprehensive, vignette-based measure of social information processing (SIP) particularly relevant for children with internalizing problems. Study 1 (N = 219 3rd-6th graders) describes the creation of the Children's Evaluation of Everyday Social Encounters Questionnaire (ChEESE-Q) and evidence for its reliability and validity, including internal structure and relation of SIP variables to depressive and anxious symptoms. Study 2 (N = 127 5th-6th graders) replicated the factor structure and validity evidence found in Study 1 and provided support for the reliability of alternate forms of the ChEESE-Q. Overall, results supported ChEESE-Q scores' moderate temporal stability and internal consistency in assessing SIP. Results also supported the presence of positive- and negative-valenced SIP patterns. Child internalizing symptoms were strongly related to a negative SIP style across both depression and anxiety, whereas only depressive symptoms were negatively associated with positive aspects of SIP. (Contains 3 tables, 1 figure and 1 footnote.)

This study examined the possible mediational roles of posttraumatic stress disorder (PTSD) symptoms and acceptance of violence cognitions in the association between violence exposure and youth violent behaviors. This study also examined whether the strength of the relations between exposure and behavior varied across context of exposure and across sex. Participants were 123 early adolescents from the Midwest. Findings indicate a strong positive association between violence exposure at home and in the community. Regardless of context, violence exposure was significantly related to PTSD symptoms, acceptance of violence cognitions, and violent behaviors in youth. PTSD symptoms and acceptance of violence cognitions were both significant mediators in the exposure--behavior relationship but the associations differed for girls and boys and varied across context of exposure. (Contains 6 tables.)

The authors examined the mediating role of posttraumatic stress symptoms in the relationship between traumatic event exposure and attention problems in a sample of 791 Sarajevan children exposed to the Bosnian war. They hypothesized that because of similarities in the arousal symptoms of posttraumatic stress disorder (PTSD) and the hyperactive--inattentive symptoms of attention-deficit/hyperactivity disorder (ADHD), PTSD symptoms would mediate the relationship between trauma exposure and attention problems. The findings support the hypothesis. The findings also show evidence of a reporter effect, whereby the relationship between trauma symptoms and attention problems was strongest when both types of symptoms were reported by school officials. Given the potentially spurious relationship between trauma exposure and attention problems, careful consideration must be given to the diagnosis of traumatized youth who present with ADHD symptoms. In accordance with practice guidelines, a multi-informant, multi-measure approach in the assessment of attention problems is strongly recommended. (Contains 4 tables and 3 figures.)