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The COVID-19 pandemic triggered transformations in academic medicine, rapidly adopting remote teaching and online assessments. Whilst virtual environments show promise in evaluating medical knowledge, their impact on examiner workload is unclear. This study explores examiner’s workload during different European Diploma in Anaesthesiology and Intensive Care Part 2 Structured Oral Examinations formats. We hypothesise that online exams result in lower examiner’s workload than traditional face-to-face methods. We also investigate workload structure and its correlation with examiner characteristics and marking performance. In 2023, examiner’s workload for three examination formats (face-to-face, hybrid, online) using the NASA TLX instrument was prospectively evaluated. The impact of examiner demographics, candidate scoring agreement, and examination scores on workload was analysed. The overall NASA TLX score from 215 workload measurements in 142 examiners was high at 59.61 ± 14.13. The online examination had a statistically higher workload (61.65 ± 12.84) than hybrid but not face-to-face. Primary contributors to workload were mental and temporal demands, and effort. Online exams were associated with elevated frustration. Male examiners and those spending more time on exam preparation experienced a higher workload. Multiple diploma specialties and familiarity with European Diploma in Anaesthesiology and Intensive Care exams were protective against high workload. Perceived workload did not impact marking agreement or examination scores across all formats. Examiners experience high workload. Online exams are not systematically associated with decreased workload, likely due to frustration. Despite workload differences, no impact on examiner’s performance or examination scores was found. The hybrid examination mode, combining face-to-face and online, was associated with a minor but statistically significant workload reduction. This hybrid approach may offer a more balanced and efficient examination process while maintaining integrity, cost savings, and increased accessibility for candidates.

Résumé: A ce jour, le débat sur l’orthographe des langues du Gabon s’est focalisé sur la représentation orthographique des unités phoniques des langues et la mise en place d’un alphabet. Toutefois, la représentation des phénomènes microlinguistiques tels que la longueur vocalique ou la nasalisation vocalique est souvent prise pour acquise malgré les nombreuses divergences que l’on peut observer dans les différentes propositions de graphèmes pour ces langues à tradition orale. Le présent article s’intéresse à la représentation orthographique de la longueur vocalique dans trois langues bantoues du Gabon, à savoir le vili (H12a), le lumbu (B44) et le punu (B43). La longueur vocalique est phonologique dans chacune des trois langues. La question de savoir si elle doit être marquée orthographiquement ne se pose pas. La question est par contre de savoir comment elle doit être orthographiée dans ces langues ou s’il est approprié d’en établir un graphème. Après une esquisse théorique pour poser la problématique de cette étude, cet article passe en revue les différentes propositions d’orthographe pour chacune des trois langues avant de donner des orientations en vue de l’harmonisation de l’orthographe dans ce sous-groupe Merye. Mots-clés : Longueur Vocalique, Graphématisation, Lumbu, Punu, Vili

Abstract Background Adolescence is a critical period for development, with many risk factors resulting in long-term health consequences, particularly regarding mental health. The purpose of this study was to examine the associations between problem technology use, life stress, and self-esteem in a representative sample of adolescents residing in Ontario, Canada. Methods Self-reported data were obtained from a cross-sectional sample of 4,748 students (57.9% females) in grades 9 to 12 (mean age: 15.9 ± 1.3 years) who participated in the 2019 Ontario Student Drug Use and Health Survey. Problem technology use was measured using the 6-item Short Problem Internet Use Test, life stress was assessed using an item from the British Columbia Adolescent Health Survey and self-esteem was assessed using a global measure from the Rosenberg Self-Esteem Scale. Ordinal logistic regression models were adjusted for age, sex, ethnoracial background, subjective socioeconomic status, body mass index z-score, tobacco cigarette smoking, alcohol consumption and cannabis use. Results We found that 18.3% of participants reported symptoms of moderate-to-high problem technology use, although symptoms were more common in females than males (22% vs. 14.7%, respectively). Moderate-to-high problem technology use was associated with 2.04 (95% CI: 1.77–2.35) times higher odds of reporting high life stress and 2.08 (95% CI: 1.76–2.45) times higher odds of reporting low self-esteem compared to all other response options. Conclusions Findings from this study show that problem technology use is strongly associated with higher life stress and lower self-esteem in adolescents. This study supports the importance of developing and implementing effective strategies that help to mitigate the adverse effects of problem technology use on adolescent mental health.

Purpose: This research note argues that investigating the intersections between hospitality and speed dating events can yield practical implications for both industries. Hospitality professionals can gain valuable insights into how to enhance customer experiences by understanding the unique needs and expectations of individuals participating in dating events. Conversely, dating event organizers can draw upon the principles of hospitality to create more engaging and enjoyable experiences for their attendees, ultimately contributing to the success and longevity of such events. Methods: Adopting the User-Centred Design (UCD), which is structured around seven distinct phases including understand, observe, engage, define, ideate, prototype and test, and implement. Results: This study suggests a blueprint for the new concept of speed dating event. It proposes a methodology to develop a research agenda to generate strategies for implementing the “dinner date” concept. Implications: Developing aligning goals between hospitality and dating industries creates a valuable experience for their target audience, where food is presented as a soft management tool facilitating this relationship.

En este artículo se analizan la productividad y la especialización ganadera en dos ciudades ubicadas en la gobernación de Santa Marta, en el Virreinato del Nuevo Reino de Granada: Valledupar y Valencia de Jesús. Desde su fundación —una en 1550 y la otra en 1610—, en la jurisdicción de las mencionadas ciudades prosperó una economía basada en la cría de diversos tipos de ganados. Observamos que, en el siglo XVIII, la demanda de carnes generada por el mercado cartagenero favoreció la producción y cría de ganado vacuno, y esta actividad se convirtió en la principal y casi única en la que participaba un gran número de vecinos. Dicha realidad se observa al consultar varios tipos de documentos que reposan en la Notaría Primera de Valledupar y en el Archivo General de la Nación. Estas fuentes permiten dimensionar la actividad ganadera en perspectiva micro, especialmente a partir del análisis de las transacciones crediticias y la fundación de capellanías respaldadas con ganado vacuno y equino, como también conocer sobre los precios y las calidades de los ganados mayores y menores en testamentos, dotes y tutelas de menores, y cuantificar las existencias de ganado con base en las cifras de diezmos. Al final se demuestra que la actividad ganadera fue muy importante en zonas de frontera, en las cuales un ecosistema particular permitió la cría de ganados, a pesar de la presencia de indígenas hostiles a la colonización.

Antimicrobial resistance (AMR) is a global public health threat. Quality data on AMR are needed to tackle the rise of multidrug-resistant clones. These data are rare in low-income countries, especially in sub-Saharan Africa. In this study, we investigated the rise of extended-spectrum β-lactamase–producing (ESBL) Enterobacteriaceae in Bangui, Central African Republic. We collected 278 fecal samples from 0–5-year-old children admitted to the Pediatric University Hospital Complex in Bangui from July to September 2021. Enterobacteriaceae were isolated and identified, and their susceptibility to 19 antibiotics was tested. We recovered one and two Enterobacteriaceae species from 208 and 29 samples, respectively. One clone of each species from each sample was further characterized, for a total of 266 isolates. Escherichia coli predominated, followed by Klebsiella. AMR was frequent, with 98.5% (262/266) of the isolates resistant to at least one antibiotic. Additionally, 89.5% (238/266) of the isolates were multidrug resistant, with resistance being frequent against all tested antibiotics except carbapenems and tigecycline, for which no resistance was found. Importantly, 71.2% (198/278) of the children carried at least one ESBL species, and 85.3% (227/266) of the isolates displayed this phenotype. This study confirms the rise of ESBL Enterobacteriaceae in Bangui and stresses the need for action to preserve the efficacy of antibiotics, as crucial for the treatment of bacterial infections.

Abstract Background For patients presenting with an aneurysmal subarachnoid hemorrhage (aSAH), delayed cerebral ischemia (DCI) is a significant cause of morbidity and mortality. The REACT study is designed to assess the safety and efficacy of clazosentan in preventing clinical deterioration due to DCI in patients with aSAH. Methods REACT is a prospective, multicenter, randomized phase 3 study that is planned to enroll 400 patients with documented aSAH from a ruptured cerebral aneurysm, randomized 1:1 to 15 mg/hour intravenous clazosentan vs. placebo, in approximately 100 sites and 15 countries. Eligible patients are required to present at hospital admission with CT evidence of significant subarachnoid blood, defined as a thick and diffuse clot that is more than 4 mm in thickness and involves 3 or more basal cisterns. The primary efficacy endpoint is the occurrence of clinical deterioration due to DCI up to 14 days post-study drug initiation. The main secondary endpoint is the occurrence of clinically relevant cerebral infarction at Day 16 post-study drug initiation. Other secondary endpoints include the modified Rankin Scale (mRS) and the Glasgow Outcome Scale-Extended (GOSE) score at Week 12 post-aSAH, dichotomized into poor and good outcome. Radiological results and clinical endpoints are centrally evaluated by independent committees, blinded to treatment allocation. Exploratory efficacy endpoints comprise the assessment of cognition status at 12 weeks and quality of life at 12 and 24 weeks post aSAH. Discussion In the REACT study, clazosentan is evaluated on top of standard of care to determine if it reduces the risk of clinical deterioration due to DCI after aSAH. The selection of patients with thick and diffuse clots is intended to assess the benefit/risk profile of clazosentan in a population at high risk of vasospasm-related ischemic complications post-aSAH. Trial registration (Additional file 1) ClinicalTrials.gov (NCT03585270). EU Clinical Trial Register (EudraCT Number: 2018–000241-39).

The purpose of this paper is to stimulate discussion and debate, and to draw attention to the extent that ‘heritage’ is used as a branding strategy in Caribbean destinations’ logo designs. A visual methodology was used to analyse the logo designs of 21 Destination Management Organisations (DMOs) of the Caribbean Tourism Organisation (CTO) member countries representing the English, French, Spanish and Dutch speaking Caribbean. The branding strategies of each destination were analysed, compared, and contrasted. The analysis found that member countries of the CTO mainly used a neutral branding strategy in their logos. 52% of the DMO logos analysed adopted a neutral position in their branding strategy. 38% of DMOs have based their branding on heritage and 10% on sun-and-sea.

BackgroundDespite increasing evidence that social media use is associated with adolescents’ mental well-being, little is known about the role of various factors in modifying the effect of this association during adolescence. This study examined the association between social media use and psychological distress among adolescents and explored whether sex, age, and parental support moderate this association.MethodsData came from a representative sample of middle and high school students in Ontario, Canada. Cross-sectional analyses included 6,822 students derived from the 2019 Ontario Student Drug Use and Health Survey.ResultsOur results showed that 48% of adolescents used social media for 3 h or more per day, and 43.7% had moderate to severe psychological distress, with a higher prevalence among females (54%) than males (31%). After adjustment for relevant covariates, heavy social media use (≥3 h/day) was associated with increased odds of severe psychological distress [odds ratio (OR): 2.01; 95% confidence interval (CI):1.59–2.55]. The association of social media use with psychological distress was modified by age (p

Massive stars are recognized for their high degree of multiplicity, yet the mass ratio regime below 0.1 remains insufficiently explored. It is therefore unknown whether extremely low-mass (possibly substellar) companions can form and survive in the direct UV-irradiated environment of massive stars. In this paper, we discuss Very Large Telescope/Spectro-Polarimetric High-contrast Exoplanet REsearch integral field spectrograph (0.″15–0.″85) observations of six massive O- and early B-type stars in Sco OB1 and M17 that each have a low-mass candidate companion (CC). Two targets have companions that are brown dwarf candidates. The other four have CCs in the low end of the stellar mass regime (≤0.30 M _⊙ ). For three of these, we have obtained a second epoch observation. At least two sources exhibit similar proper motion to that of their central star. However, given the expected proper motion of background objects, this does not imply certain companionship. We show how future follow-up observations of the brown dwarf CCs in the J , H , and L bands should allow for an unambiguous confirmation of their nature.

BackgroundEvidence examining the longitudinal associations between different types of screen behaviours and mental health among adolescents is limited. The present study examined the association between five types of screen behaviours and symptoms of anxiety and depression one year later. This study also assessed how changes in screen time were associated with changes in anxiety and depressive symptoms and whether the observed relationships were moderated by sex.MethodsLongitudinal data of 17,174 students in grades 9–12 (53.5% females; mean age: 15.1 ± 0.9 years) attending high schools in Canada from two waves (year 6: 2017/18, year 7: 2018/19) of the COMPASS study were analyzed. Leisure screen time and mental health measures were self-reported. To test if the associations between screen time and anxiety, and depression vary by sex, two-way interactions were examined for sex. Analyses accounted for school clustering, race/ethnicity, sex, age, income, body mass index z-score, and previous year anxiety and depression symptoms.ResultsThere were significant longitudinal associations between time spent on each type of screen and subsequent anxiety and depression symptoms. The strength of the associations varied by type of screen behaviour. Interaction analysis indicated a sex difference for television viewing and anxiety and depression symptoms, and internet surfing and anxiety symptoms. A dose-response relationship was observed between phone talking and anxiety symptoms. Beta estimates indicated that an increase in screen duration was associated with a further increase in anxiety and depression symptoms.ConclusionHigher screen time was longitudinally associated with higher anxiety and depression symptoms at one-year follow-up in adolescents. Time-change associations between screen usage and depressive and anxiety symptoms were observed. Also, associations differed based on sex and screen type, whereby greater increases in screen use predicted greater emotional distress. Findings from this prospective analysis suggest that screen time is an important determinant of anxiety and depressive symptoms among adolescents. Future studies are recommended to help inform programs promoting screen time reduction with a goal to enhance adolescents’ mental health.

Purpose: Taking Lourdes as an en example, this paper aims at understanding the relationship amongst the main tourism and events industry stakeholders. Methods: To achieve the objective of the study, data were collected through interviews of key players. The results where then filtered through the ‘Alpha’ framework to theorise the interactions amongst stakeholders. Results: The study also provides a (1) typology of the ultimate alpha syndrome in the context of destination management; (2) typology of the delta syndrome. (3) Finally, the study argues that in destinations where there is an ultimate alpha hallmark event, or an ultimate alpha stakeholder, a situation quite similar to an anti-competitive market can arise. This situation is referred as ‘ultimate alpha tourism monopoly’. Implications: Based on the findings of this study, Destination Marketing Organisations need to ensure that there is a suitable synergy amongst all stakeholders involved in the tourism industry (and related sector), to avoid anti-competitive market ‘ultimate alpha tourism monopoly’ to arise.

Abstract Background Infectious diseases account for the third most common cause of neonatal deaths. Globally, antibiotic resistance (ABR) has been increasingly challenging neonatal sepsis treatment, with 26 to 84% of gram-negative bacteria resistant to third-generation cephalosporins. In sub-Saharan Africa, limited evidence is available regarding the neonatal microbiology and ABR. To our knowledge, no studies have assessed neonatal bacterial infections and ABR in Central-African Republic (CAR). Therefore, this study aimed to describe the pathogens isolated and their specific ABR among patients with suspected antibiotic-resistant neonatal infection admitted in a CAR neonatal unit. Methods This retrospective cohort study included neonates admitted in the neonatal unit in Bangui, CAR, from December 2018 to March 2020, with suspected antibiotic-resistant neonatal infection and subsequent blood culture. We described the frequency of pathogens isolated from blood cultures, their ABR prevalence, and factors associated with fatal outcome. Results Blood cultures were positive in 33 (26.6%) of 124 patients tested (17.9% for early-onset and 46.3% for late-onset infection; p = 0.002). Gram-negative bacteria were isolated in 87.9% of positive samples; with most frequently isolated bacteria being Klebsiella pneumoniae (39.4%), Escherichia coli (21.2%) and Klebsiella oxytoca (18.2%). All tested bacteria were resistant to ampicillin. Resistance to third-generation cephalosporins was observed in 100% of tested Klebsiella pneumoniae, 83.3% of isolated Klebsiella oxytoca and 50.0% of tested Escherichia coli. None of the tested bacteria were resistant to carbapenems. Approximately 85.7 and 77.8% of gram-negative tested bacteria were resistant to first-line (ampicillin-gentamicin) and second-line (third-generation cephalosporins) treatments, respectively. In hospital mortality, adjusted for blood culture result, presence of asphyxia, birth weight and sex was higher among neonates with positive blood culture (adjusted relative risk [aRR] = 2.32; 95% confidence interval [CI] = 1.17–4.60), male sex (aRR = 2.07; 95% CI = 1.01–4.26), asphyxia (aRR = 2.42; 95% CI = 1.07–5.47) and very low birth weight (1000–1499 g) (aRR = 2.74; 95% CI = 1.3–5.79). Conclusion Overall, 77.8% of confirmed gram-negative neonatal infections could no longer effectively be treated without broad-spectrum antibiotics that are not routinely used in sub-Saharan Africa referral hospitals. Carbapenems should be considered an option in hospitals with surveillance and antibiotic stewardship.

Purpose: This study examines the process by which eWOM susceptibility moderates the strength of indirect links between the perceived credibility of eWOM messages and the intention to visit a destination via the destination image and the perceived usefulness of these messages. Methods: The research hypotheses were tested according to structural equations modelling and Hayes procedure, which made it possible to study simultaneously and rigorously the mediating and moderating effects, and to have a clear view on the model fittness. Results: The results indicate that the mediation links of the destination image on the relationship between perceived credibility and intention to visit a destination, are moderated by the susceptibility of the eWOM (the comments generated by Internet users or the sharing of tourists' experiences on Facebook). This study also indicates that the relationship between the perceived credibility of the eWOM and the intentions to visit a destination is mediated by the usefulness of the eWOM messages and the destination image. Implications: Tourism practitioners seeking to attract tourists can use the eWOM as a communication technique for product and/or service recommendations. Given the powerful influence of the eWOM, it should not be ignored or misused, but managed to improve the effectiveness of marketing strategies in hospitality, tourism and travel.

Four cholera outbreaks were reported in the Central African Republic during 1997–2016. We show that the outbreak isolates were Vibrio cholerae O1 serotype Inaba from 3 seventh pandemic El Tor sublineages originating from West Africa (sublineages T7 and T9) or the African Great Lakes Region (T10).

Proper conformational arrangement of the E2 molecules of bovine viral diarrhoea-mucosal disease virus (BVD-MDV) is crucial to obtain an effective recombinant vaccine candidate against the disease. In this study, we characterised a new molecule composed of two distinct sequences of the E2 glycoprotein of BVD-MDV and the Fc fragment of human immunoglobulin (BVDE2Fc).

Purpose – The purpose of this paper is to examine and provide insights into one of the most influential technologies impacting the tourism and hospitality industry over the next five years, i.e. big data and analytics. It reflects on both opportunities and risks that such technological advances create for both consumers and tourism organisations, highlighting the importance of data governance and processes for effective and ethical data management in both tourism and hospitality. Design/methodology/approach – This paper is based on a review of academic and industry literature and access to trends data and information from a series of academic and industry databases and reports to examine how big data and analytics shape the future of the industry and the associated risks and opportunities. Findings – This paper identifies and examines key opportunities and risks posed by the rising technological trend of big data and analytics in tourism and hospitality. While big data is generally regarded as beneficial to tourism and hospitality organisations, there are extensively held ethical, privacy and security concerns about it. Therefore, the paper is making the case for more research on data governance and data ethics in tourism and hospitality and posits that to successfully use data for competitive advantage, tourism and hospitality organisations need to solely expand compliance-based data governance frameworks to frameworks that include more effective privacy and ethics data solutions. Originality/value – This paper provides useful insights into the use of big data and analytics for both researchers and practitioners and offers new perspectives on the debate on data governance and ethical data management in both tourism and hospitality. Because forecasts from the UNWTO indicate a significant increase in international tourist arrivals (1.8 billion tourist arrivals by 2030), the ways tourism and hospitality organisations manage customers’ data become important.

Purpose: This study is addressing the dearth of research regarding children in the tourism industry and cognate sectors, alongside contributing to existing literature on diaspora, and diaspora tourism. Methods: In order to get the most reliable results, triangulation, which is a form of mixed methods, that enables to view a topic from more than one perspective, is used. Results: Post-colonial, post-conflict, and post-disaster destinations are relying heavily on their diaspora not only for the survival of their tourism industry, but more generally speaking for their economic and social sustainability. It is therefore very important for the country of origin to main a strong link with the members of the diaspora, whether they belong to the first or second generation onward of the diaspora. The main challenge is to keep the connection with the younger generation. The results of this study reveal that childhood experience of the country of origin is a transformative tool which can lead to either dediasporisation (if negative), or transnational attachment (if positive). Implications: Destination Marketing Organisations therefore need to put in place suitable events (and activities) which are based on an edutainment and advertainment model, while applying other key principles. If successful, it is expected that children will go through three different stages: young diaspora thinkers, actioners; and transformers.

Abstract Background For optimal health benefits, the Canadian 24-Hour Movement Guidelines for Children and Youth (aged 5–17 years) recommend an achievement of high levels of physical activity (≥60 min of moderate-to-vigorous physical activity), low levels of sedentary behaviour (≤2 h of recreational screen time), and sufficient sleep (9–11 h for children or 8–10 h for adolescents) each day. The objective of this systematic review was to examine how combinations of physical activity, sedentary time, and sleep duration relate to depressive symptoms and other mental health indicators among children and adolescents. Methods Literature was obtained through searching Medline, EMBASE, PsycINFO, and SportDiscus up to September 30, 2019. Peer-reviewed studies published in English or French were included if they met the following criteria: population (apparently healthy children and adolescents with a mean age of 5–17 years), intervention/exposure (combinations of physical activity, sedentary time, and sleep duration), and outcomes (depressive symptoms and other mental health indicators). A risk of bias assessment was completed for all included studies using the methods described in the Cochrane Handbook. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework was used to assess the quality of evidence for each health indicator. Narrative syntheses were employed to describe the results due to high levels of heterogeneity across studies. Results A total of 13 cross-sectional studies comprised in 10 papers met inclusion criteria. Data across studies involved 115,540 children and adolescents from 12 countries. Overall, the findings indicated favourable associations between meeting all 3 recommendations and better mental health indicators among children and adolescents when compared with meeting none of the recommendations. There was evidence of a dose-response gradient between an increasing number of recommendations met and better mental health indicators. Meeting the screen time and sleep duration recommendations appeared to be associated with more mental health benefits than meeting the physical activity recommendation. The quality of evidence reviewed was “very low” according to GRADE. Conclusions The findings indicate favourable associations between meeting all 3 movement behaviour recommendations in the 24-h guidelines and better mental health indicators among children and adolescents. There is a clear need for high-quality studies that use robust measures of all movement behaviours and validated measures of mental health to increase our understanding in this topic area.

Summary Background Spending time outdoor has been identified as an important way to achieve the physical activity required for maintaining and improving health and to lower sedentary time among young children. However, evidence of such relationships in adolescents is particularly limited. This study investigated the relationships between frequency of outdoor physical activity after school, compliance with the physical activity, screen time, and sleep duration recommendations, and overweight/obesity among adolescents. Methods A total of 10 028 middle and high school students (mean age of 15.2 y) self‐reported the number of weekdays they spent physically active outdoors after school. Physical activity, screen time, sleep duration, height, and weight were self‐reported. Logistic regression models for the total sample and stratified by sex were adjusted for important covariates. Results Overall, there was a positive gradient between the number of weekdays spent physically active outdoor after school and compliance with the physical activity (more than or equal to 60 min/day at moderate‐to‐vigorous intensity) and screen time (less than or equal to 2 h/day) recommendations while a negative gradient with overweight/obesity was observed. Significant sex differences were observed in the associations of outdoor physical activity after school with adherence to the sleep duration and physical activity recommendations. For example, outdoor physical activity after school on all 5 days was associated with greater odds of compliance with the sleep duration recommendation among males (OR = 1.53; 95% CI, 1.01‐2.31), but not females (OR = 0.92; 95% CI, 0.65‐1.30). Conclusions Results suggest that outdoor physical activity after school could be a behavioural target to increase compliance with the physical activity and screen time recommendations and to possibly tackle excess weight among adolescents.

BackgroundAdolescence is often considered a period of heightened stress, and healthy active living behaviors may help those experiencing it to better cope with life stressors and increase their self-esteem. The 24-h movement guidelines for children and adolescents recommend ≥60 min per day of moderate-to-vigorous physical activity, ≤ 2-h per day of recreational screen time, and 9–11-h of sleep per night for school-aged children or 8–10-h per night for adolescents. The objective of this study was to examine the association of meeting the 24-h movement guidelines with life stress and self-esteem among students in Ontario, Canada.MethodsSelf-reported data on movement behaviors, life stress and self-esteem were derived from the 2019 cycle of the Ontario Student Drug Use and Health Survey, a cross-sectional and province-wide survey of students in grades 7–12 aged 11 to 20 years (N = 6,932). Multivariable ordered logistic regression analyses were adjusted for the complex sample design of the survey and for important covariates.ResultsOverall, meeting all combinations of movement behavior recommendations were associated with lower life stress and better self-esteem compared with meeting none of the recommendations, except meeting the physical activity only or screen time only recommendations that were not associated with lower life stress. Meeting all 3 recommendations was associated with lower life stress (OR: 0.40; 95 CI: 0.30–0.53) and better self-esteem (OR: 0.29; 95% CI: 0.21–0.40). There was a dose-response gradient between the number of recommendations met (3 > 2 > 1) and lower life stress (p < 0.001) and higher self-esteem (p < 0.001), with meeting all 3 recommendations being the best combination.ConclusionsThese findings suggest that meeting the recommendations of the 24-h movement guidelines is associated with lower life stress and better self-esteem among adolescents.

Abstract In the MITICA (Mother‐to‐Infant TransmIssion of microbiota in Central‐Africa) study, 48 mothers and their 50 infants were followed from delivery to 6 months between December 2017 and June 2019 in Bangui (Central‐African Republic). Blood tests and stool analyses were performed in mothers at delivery, and their offspring at birth, 11 weeks and 25 weeks. Stool cultures were performed in specific growth media for Salmonella, Shigella, E. coli, Campylobacter, Enerobacter, Vibrio cholerae, Citrobacter and Klebsiella, as well as rotavirus, yeasts and parasitological exams. The median vitamin C levels in mothers at delivery were 15.3 μmol/L (inter‐quartile‐range [IQR] 6.2–27.8 μmol/L). In infants, the median vitamin C levels at birth were 35.2 μmol/L (IQR 16.5–63.9 μmol/L). At 11 and 25 weeks, the median vitamin C levels were 41.5 μmol/L (IQR 18.7–71.6 μmol/L) and 18.2 μmol/L (IQR 2.3–46.6 μmol/L), respectively. Hypovitaminosis C was defined as seric vitamin C levels

Background: Alcohol consumption and distress have increased among Canadians since the start of the COVID-19 pandemic.Methods: We examined whether sociodemographic and COVID-19-related worries are associated with various combinations of alcohol consumption and comorbid psychological distress variables among a Canadian sample of adults. Data were derived from a sample of Canadian adults (N = 1,005, 49.6% female) who participated in an online survey in May 2020. Four multivariate ordinal logistic regression models were used to estimate the odds of binge drinking, increased alcohol consumption during the pandemic, and psychological distress. Predictor variables used in the analyses included self-reported sociodemographic characteristics, financial worries, COVID-19 impact on work, and worrying about getting ill.Results: Women were found to have higher odds of increased drinking and anxiety. Also being divorced, separated, or widowed was associated with higher odds of binge drinking and anxiety, and binge drinking and depression. Furthermore, being 60 or older was associated with lower odds of binge drinking and depression and increased drinking and depression, as well as lower odds of increased drinking and depression and increased drinking and anxiety. High income groups were associated with higher odds of binge drinking, increased drinking, and mental distress. Compared to those less worried, being very worried about finances were associated with higher odds of binge drinking and anxiety, increased drinking and anxiety, and increased drinking and depression. Also, being very worried about getting ill with COVID was associated with higher odds of binge drinking and anxiety and increased drinking and anxiety.Conclusion: Our findings identify several demographic and COVID-related worries for increased odds of alcohol intake and co-morbid psychological distress during the COVID-19 pandemic, including identifying as a woman, high income groups, being divorced, separated or widowed, and experiencing financial worries and COVID illness worries. These characteristics should be considered when developing prevention and treatment programs for adults with problematic alcohol use and comorbid anxiety and depression.

Existing literature has explored the impacts of tourism events on destinations and on their residents as a one-way strategy. However, the direction of those impacts may have a reversal in terms of residents’ supportiveness and level of happiness. Happiness and tourism are very topical at the moment and are still under-researched. Based on this notion, the main objective of this study was to investigate the relationship between residents’ level of happiness and their supportiveness/ non-supportiveness for tourism events. Primary data was collected using questionnaire and SPSS was utilised to run few descriptive analyses. The study reveals a different outcome; it is resilience of local residents that enable tourism events to grow and sustain the industry. The findings provide valuable insight on the relationship between residents’ causes of satisfaction/dissatisfaction with tourism events and the impacts on their level of happiness. The information is helpful for Destination Management Organisations (DMOs) and event organisers for development of events that may be profitably marketed along with tourism. Happiness may therefore be used as a metric by DMOs to assess tourism performance.

Este trabajo analiza el ordenamiento político administrativo del territorio en los lugares donde habían surgido sitios de libres de todos los colores. También revisa el papel desempeñado por la vecindad para su integración al orden hispánico. Finalmente, presenta varios casos en que algunos libres, haciendo uso de condición de vecinos, aprovecharon los canales institucionales para acceder a empleos que estaban investidos de autoridad. Fue un proceso lleno de conflictos personales y vecinales que involucraron, en la mayoría de casos, a toda la comunidad.

Abstract Background Past mental disorders predict future disorders, both in the presence and absence of trauma exposure. However, it is not clear whether those with past mental disorders are disproportionately vulnerable to the negative effects of a given level of trauma. Methods The data source was the 2013 Canadian Forces Mental Health Survey (CFMHS), of which 1820 respondents had deployed only once in their military careers—all in support of the mission in Afghanistan. The primary outcomes were past 12-month depression and past 12-month PTSD. Multivariate logistic regression was performed for each outcome variable, looking primarily for differences in the marginal effect of deployment-related trauma in those with and without a pre-deployment history of each disorder. Results A history of each pre-deployment disorder did indeed interact with deployment-related trauma with respect to the corresponding past 12-month disorder. In addition, pre-deployment history of depression and of PTSD interacted with each other, though only for the outcome of past 12-month PTSD. The average marginal effect of deployment-related trauma on past 12-month PTSD was highest in those with a pre-deployment history of depression in the absence of a pre-deployment history of PTSD. This group was twice as vulnerable to post-deployment PTSD relative to those without a pre-deployment history of both disorders and four times as vulnerable to post-deployment PTSD relative to those with a pre-deployment history of both disorders. No significant differences were seen in the marginal effects of trauma on past 12-month depression in the presence or absence of a pre-deployment history of that disorder. Conclusion There is modest differential vulnerability to past 12-month PTSD as a function of deployment-related trauma in those who had a pre-deployment history of PTSD or depression when compared to those who did and did not have a pre-deployment history of one or both disorders.

INTRODUCTION: The spread of enterobacteria producing broad-spectrum beta-lactamases (ESBL) is a global public health-problem. In a study carried in 2003-2005 at the Pasteur Institute in Bangui, 450 enterobacteria were identified in clinical isolates, of which 17 were ESBL (prevalence: 3.78%). The aim of this study was to update this data. METHODS: from May 2018 to April 2019, a total of 941 enterobacteria were isolated and identified under identical conditions of recruitment and with the same techniques used in the previous study: phenotypic identification using Api 20E strips (biomérieux SA, Marcy-l´Etoile, France) and antimicrobial drug susceptibility using the disk diffusion method (Bio-Rad antibiotic discs, Marnes la Coquette, France). Resistance genes were identified by PCR and sequencing. RESULTS: from May 2018 to April 2019, a total of 941 enterobacteria were isolated of which 478 were ESBL, thus amounting to a prevalence of 50.80%. The genetic profiles of the bla CTX-M resistance genes exhibited the emergence of the CTX-M28 variant (CTX-M1 group) and variants of the M2 and M9 groups. There was also a notable increase, from 35 to 64%, in the ESBL with a bla SHV gene. CONCLUSION: this study documents a 13 fold increase in the prevalence of ESBL derived from clinical isolates of the bacteriology laboratory of the Institut Pasteur in Bangui, by comparing its data with that of the publication by Frank et al. 2006. Together with this increase a significant diversification of the circulating CTX-M resistance genes was noticed.

Background: A reduction of admission for MI has been reported in most countries affected by COVID-19. No clear explanation has been provided. Methods: To report the incidence of myocardial infarction (MI) admission during COVID-19 pandemic and in particular during national lockdown in two unequally affected French provinces (10-million inhabitants) with a different media strategy, and to describe the magnitude of MI incidence changes relative to the incidence of COVID-19-related deaths. A longitudinal study to collect all MIs from January 1 until May 17, 2020 (study period) and from the identical time period in 2019 (control period) was conducted in all centers with PCI-facilities in northern “Hauts-de-France” province and western “Pays-de-la-Loire” Province. The incidence of COVID-19 fatalities was also collected. Findings: In “Hauts-de-France”, during lockdown (March 18–May 10), 1500 COVID-19-related deaths were observed. A 23% decrease in MI-IR (IRR=0.77;95%CI:0.71–0.84, p

BackgroundResearch examining the associations between movement behaviours and mental health indicators within a compositional framework are sparse and limited by their cross-sectional study design. This study has three objectives. First, to describe the change in movement behaviour composition over time. Second, to explore the association between change in movement behaviour composition and change in depressive symptoms. Third, to explore how reallocations of time between movement behaviours are associated with changes in depressive symptoms.MethodsLongitudinal data of 14,620 students in grades 9-12 (mean age: 14.9 years) attending secondary schools in Canada (Ontario, British Columbia, Alberta, Quebec) were obtained from two waves (2017/18, 2018/19) of the COMPASS study. Moderate-to-vigorous physical activity (MVPA), recreational screen time, and sleep duration were self-reported. Depressive symptoms were measured using the Center for Epidemiologic Studies Depression Scale (Revised)-10 (CESD-R-10). Compositional data analyses using pivot coordinates and compositional isotemporal substitution for longitudinal data were used to analyse the data. Analyses accounted for school clustering, were stratified by gender and age (< or ≥ 15 years), and were adjusted for race/ethnicity, body mass index z-score, baseline movement behaviour composition, and baseline depressive symptoms.ResultsThere were significant differences in movement behaviour composition over time across all subgroups. For example, the relative contributions of MVPA and sleep duration to the movement behaviour composition decreased over time while screen time increased among younger boys and girls and older girls. Increasing sleep duration relative to the remaining behaviours (i.e. screen time and MVPA) was associated with lower depressive symptoms among all subgroups. Increasing screen time relative to the remaining behaviours (i.e. MVPA and sleep duration) was associated with higher depressive symptoms among all subgroups. Increasing MVPA relative to the remaining behaviours (i.e. screen time and sleep duration) was associated with lower depressive symptoms in older girls only. Isotemporal substitution estimates indicated that decreasing screen time by 60 minutes/day and replacing that time with 60 minutes of additional sleep is associated with the largest change in depressive symptoms across all subgroups.ConclusionsFindings from this prospective analysis suggest that increased sleep duration and reduced screen time are important determinants of lower depressive symptoms among adolescents.

Bacteria of the Burkholderia cepaciai complex cause frequent infections in immunocompromised and hospitalized patients, with a significant mortality rate. Phenotypic identification of those bacteria is difficult and therefore rarely reported from developing countries. This study presents the first ever reported case series of Burkholderia cenocepacia neonatal sepsis in Central African Republic. It demonstrates the superiority of molecular methods to accurately identify B. cenocepacia III A species compared to the phenotypic methods.