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This qualitative study was conducted in Uttar Pradesh state, India to explore how interrelated socio-economic position and spatial characteristics of four diverse villages may have influenced equity in coverage of community-based maternal and newborn health (MNH) services. We conducted social mapping and three focus group discussions in each village, among women of lower and higher socio-economic position who recently gave birth, and with community health workers (n = 134). Data were analysed in NVivo 11.0 using thematic framework analysis. The extent of socio-economic hierarchies and spatial disparateness within the village, combined with distance to larger centers, together shaped villages’ level of socio-spatial remoteness. Disadvantaged socio-economic groups expressed being more often spatially isolated, with less access to infrastructure, resources or services, which was heightened if the village was physically distant from larger centers. In more socio-spatially remote villages, inequities in coverage of MNH services that disadvantaged lower socio-economic position groups were compounded as these groups more often experienced ASHA vacancies, as well as greater distance to and poorer perceived quality of health services nearest the village. The results inform a conceptual framework of ‘socio-spatial remoteness’ that can guide public health research and programmes to more comprehensively address health inequities within India and beyond.

In this case study, a Business Model Canvas (BMC) was used as a technique for problem identification and scoping for the introduction of a new technology or methodology for water quality assessment. Therefore, information about the Brazilian water supply sector was used for the application of a BMC based on technological innovations for coliform analysis. The innovations proposed in the study include faster results, internet connection, and portability. To populate the model, data regarding the drinking water quality from Brazil were used from public data banks and reports. Also, a group of accountable representatives from diverse water supply systems and water quality laboratories reported their experience with the new coliform analysis and their perception of its technological improvement. The major gaps identified in this study were simplicity and faster results. These may be associated with technological improvements such as portability and internet connection. It was possible to conclude that the segment is diverse, and the BMC highlighted that value might differ for different niches. The results emphasized that the application of a BMC may be more than a business tool. It can also be used by developers or scientists to understand and improve both technology concepts and applications. HIGHLIGHTS A Business Model was applied to structure coliform analysis in drinking water.; Characteristics of water supply systems influence value proposition priorities.; Legal demands have influences in different levels and applications.; Technological innovation and advantages alone may not fit customer needs.; Information gathered reveals a technological gap in coliform analysis.;

Abstract The classic work on the morphology of limestone calcite cements done in the 1960s is extended here by utilising growth zones to reconstruct the growth of cement crystals. Only cement composed of fitted polyhedral monocrystals that form by passive crystallisation of calcite on the walls of liquid‐filled, static pores and fissures is considered. Cement can either be initiated by (1) nucleation, when new crystals start but are not attached to their substrate, or (2) seeding, when new crystals are seamlessly connected to and influenced by substrate crystals. After seeding, epitaxial cement growth starts with many sub‐crystals that coalesce distally, followed by layered mantle growth. Junctions between three intercrystalline boundaries in cement aggregates with one interfacial angel = 180° are of two types: the first, enfacial junctions are caused by a pause in the growth of one crystal and the second is caused by movement of all boundaries due to dissolution of adjacent calcite. Growth zone offsetting at some intercrystalline boundaries is caused by dissolution of calcite at boundaries when permeability values are low. The same width to height ratio of mature aggregate crystals is predicted from the shape of the crystal's growth surfaces; dogtooth calcite forms columnar and nail‐head calcite forms tabular‐shaped crystals. Seeding on different sized crystals causes variations in epitaxial growth rate with faster growth on large crystals resulting in a disorganised cement fabric; the variation in epitaxial growth rate is perpetuated into mantle growth. Echinoderm syntaxial crystals dominate many pore cements due to the large size of their seed ossicles, at the same time, syntaxial crystals form on relatively tiny seeds. Texturally mature crystal aggregates with isopachous fabric are initiated from three different substrate to cement arrangements. Calcite cement zones preserve their original positions allowing the investigation of cement's growth and chemical history.

Abstract Sequential analyses of δ13C, δ18O and Δ47 values of calcite and dolomite deposited in millimetre‐sized cavities are reported from the Ronaldsway Member packstones, Isle of Man. The Ronaldsway brachiopods have δ13C values of ca +2.3‰ and δ18O values of ca −7.2‰; carbon is like predicted Carboniferous values, while oxygen values are more negative. The brachiopods show preserved microstructure but have marginal alteration and a streaky cathodoluminescence pattern. Crinoid ossicles have δ13C values of ca +2.3‰ and one with a δ18O value of ca −3.1‰, compatible with Carboniferous marine precipitates; three samples have δ18O values of ca −6.5‰ and are 18O‐depleted. Calcite stages 1 and 2 have δ13C values ca +3.2‰ and δ18O values ca −2.5‰, compatible with Carboniferous sea water. Stage 1 and 2 have non‐luminescent to orange CL zones. Stage 1 and early stage 2 contain red luminescent dolomite micro crystals generated during Mg calcite stabilisation. The Δ47 values for stage 1 and 2 cements indicate temperatures of 86 and 105°C that occurred after the stabilisation of Mg calcite. Stage 3–8 zoned cements preserve their original growth surfaces and their δ13C and δ18O values suggest precipitation during burial and exhumation. The Δ47 values of the brachiopods and crinoids indicate temperatures between 85 and 140°C indicating they were either recrystallised at high temperatures or affected by solid state reordering. To evaluate these alternatives two quantitative models, water–rock reaction and reordering models are performed. The allochems and cements are progressively altered by porewater towards the fluid‐buffered behaviour. The quantitative evaluation of calcite and dolomite solid‐state reordering suggests the elevated clumped isotopic temperatures are produced by interaction with hydrothermal fluids. This study improves understanding by applying previously untried techniques; further Δ47 data and quantifying elemental variations would help further interpretation but the poorly documented post‐depositional history is a drawback.

Giardia spp. is an intestinal parasite responsible for worldwide disease outbreaks. Guiding researchers and practitioners to choose among current methods for microscopy detection of the infectious forms may be directly beneficial to public health and the environment. This study provides an overall comparison of brightfield (BF), fluorescence and darkfield (DF) microscopies for detecting Giardia duodenalis and Giardia muris cysts, by illustrating micrographs of such protocols applied to purified samples, as well as discussing advantages and constraints based on secondary information and collected data. BF analysis included Lugol's iodine staining. In fluorescence microscopy, samples were processed by immunofluorescence assay (IFA) with DAPI and by standalone DAPI dye. Cyst suspensions were also analysed by DF microscopy using a recently developed low-cost system. The three techniques enabled detecting Giardia spp. cysts, although they did not provide species identification by morphology. The overview of each method points out some relevant aspects to consider when selecting common optical microscopy techniques, and includes challenges and advantages regarding each of them. HIGHLIGHTS Comparisons of BF, DF, standalone DAPI and IFA-combined are provided.; BF and DF may be alternatives for low-cost detection of Giardia cysts.; Combinations of at least two diagnostic methods are recommended to minimise inherent errors.;

Aeromonas hydrophila is a common emerging pathogenic bacterium in natural waters that affects the quality of drinking water. This becomes a challenge for the development and innovation of alternative technologies that provide safe water to families in rural communities. The present study evaluated the ability to inactivate natural A. hydrophila from surface waters using a drinking water treatment system at the point of use (POU). It is based on 2 thermofused polypropylene filters followed by a UV disinfection lamp, and it was installed in houses in two rural communities in Colombia. Experimental results showed that the POU systems removed A. hydrophila with a log reduction value (LRV) of 3.60 ± 0.02 in the synthetic waters, and removal values greater than 2 LRV in tests performed with natural surface waters with detected naturally occurring Aeromonas and quantified in these communities with LRV of 3.1 ± 0.6 and 2.2 ± 0.6, respectively, with a detection limit of 1 CFU/100mL. The concentrations of E. coli and total coliforms (TC) were also monitored in 54 homes all equipped with the above-described POU systems for 12 months. Given the efficacy found in this study and the availability, accessibility, and affordability of the elements used to design and manufacture the POU systems, it is feasible to propose their use to provide safe water to vulnerable families living in rural communities that lack water treatment systems.

Abstract This paper presents a novel computationally efficient Closed Loop Dual‐Mode Nonlinear Model Predictive Control scheme that uses closed loop models for condensing‐based multiple‐shooting frameworks which result in numerically robust optimisations. The proposed approach uses Time‐Varying gains obtained from solving the Time‐Varying Discrete Algebraic Ricatti Equation to embed feedback around the multiple‐shooting trajectory, and proves the equivalence of the solution with the standard approach, thus resulting in the exact same stability, recursive feasibility and convergence properties. Moreover, the paper proposes an efficient algorithm based on an extension of the well‐known O(Np2)$O(N_p^2)$ condensing algorithm, which can be used within the so‐called Real‐Time Iteration Scheme to achieve real‐time performance. Simulations of a nonlinear ball‐plate system, as well as of an inverted pendulum, and its extension ‐ the triple inverted pendulum, are presented along the paper to demonstrate the advantages along with some disadvantages, focusing on the numerical conditioning, the disturbance rejection properties, and the computational performance.

Transactional data from point-of-sales systems may not consider customer behavior before purchasing decisions are finalized. A smart shelf system would be able to provide additional data for retail analytics. In previous works, the conventional approach has involved customers standing directly in front of products on a shelf. Data from instances where customers deviated from this convention, referred to as “cross-location”, were typically omitted. However, recognizing instances of cross-location is crucial when contextualizing multi-person and multi-product tracking for real-world scenarios. The monitoring of product association with customer keypoints through RANSAC modeling and particle filtering (PACK-RMPF) is a system that addresses cross-location, consisting of twelve load cell pairs for product tracking and a single camera for customer tracking. In this study, the time series vision data underwent further processing with R-CNN and StrongSORT. An NTP server enabled the synchronization of timestamps between the weight and vision subsystems. Multiple particle filtering predicted the trajectory of each customer’s centroid and wrist keypoints relative to the location of each product. RANSAC modeling was implemented on the particles to associate a customer with each event. Comparing system-generated customer–product interaction history with the shopping lists given to each participant, the system had a general average recall rate of 76.33% and 79% for cross-location instances over five runs.

Since the beginning of the COVID-19 pandemic, there has been a significant need to develop antivirals and vaccines to combat the disease. In this work, we developed llama-derived nanobodies (Nbs) directed against the receptor binding domain (RBD) and other domains of the Spike (S) protein of SARS-CoV-2. Most of the Nbs with neutralizing properties were directed to RBD and were able to block S-2P/ACE2 interaction. Three neutralizing Nbs recognized the N-terminal domain (NTD) of the S-2P protein. Intranasal administration of Nbs induced protection ranging from 40% to 80% after challenge with the WA1/2020 strain in k18-hACE2 transgenic mice. Interestingly, protection was associated with a significant reduction in virus replication in nasal turbinates and a reduction in virus load in the brain. Employing pseudovirus neutralization assays, we identified Nbs with neutralizing capacity against the Alpha, Beta, Delta, and Omicron variants, including a Nb capable of neutralizing all variants tested. Furthermore, cocktails of different Nbs performed better than individual Nbs at neutralizing two Omicron variants (B.1.529 and BA.2). Altogether, the data suggest the potential of SARS-CoV-2 specific Nbs for intranasal treatment of COVID-19 encephalitis.

Abstract Conspicuous female signals have recently received substantial scientific attention, but it remains unclear if their evolution is the result of selection acting on females independently of males or if mutual selection facilitates female change. Species that express female, but not male, phenotypic variation among populations represents a useful opportunity to address this knowledge gap. White‐shouldered fairywrens (Malurus alboscapulatus) are tropical songbirds with a well‐resolved phylogeny where female, but not male, coloration varies allopatrically across subspecies. We explored how four distinct signaling modalities, each putatively associated with increased social selection, are expressed in two populations that vary in competitive pressure on females. Females in a derived subspecies (M. a. moretoni) have evolved more ornamented plumage and have shorter tails (a signal of social dominance) relative to an ancestral subspecies (M. a. lorentzi) with drab females. In response to simulated territorial intrusions broadcasting female song, both sexes of M. a. moretoni are more aggressive and more coordinated with their mates in both movement and vocalizations. Finally, M. a. moretoni songs are more complex than M. a. lorentzi, but song complexity does not vary between sexes in either population. These results suggest that correlated phenotypic shifts in coloration and tail morphology in females as well as song complexity and aggression in both sexes may have occurred in response to changes in the intensity of social selection pressures. This highlights increased competitive pressures in both sexes can facilitate the evolution of complex multimodal signals.

Abstract Historically, bird song complexity was thought to evolve primarily through sexual selection on males; yet, in many species, both sexes sing and selection pressure on both sexes may be broader. Previous research suggests competition for mates and resources during short, synchronous breeding seasons leads to more elaborate male songs at high, temperate latitudes. Furthermore, we expect male–female song structure and elaboration to be more similar at lower, tropical latitudes, where longer breeding seasons and year‐round territoriality yield similar social selection pressures in both sexes. However, studies seldom take both types of selective pressures and sexes into account. We examined song in both sexes in 15 populations of nine‐fairy‐wren species (Maluridae), a Southern Hemisphere clade with female song. We compared song elaboration (in both sexes) and sexual song dimorphism to latitude and life‐history variables tied to sexual and social selection pressures and sex roles. Our results suggest that song elaboration evolved in part due to sexual competition in males: male songs were longer than female songs in populations with low male survival and less male provisioning. Also, female songs evolved independently of male songs: female songs were slower paced than male songs, although only in less synchronously breeding populations. We also found male and female songs were more similar when parental care was more equal and when male survival was high, which provides strong evidence that sex role similarity correlates with male–female song similarity. Contrary to Northern Hemisphere latitudinal patterns, male and female songs were more similar at higher, temperate latitudes. These results suggest that selection on song can be sex specific, with male song elaboration favored in contexts with stronger sexual selection. At the same time, selection pressures associated with sex role similarity appear to favor sex role similarity in song structure.

Abstract Background Timely and skilled care is key to reducing maternal and neonatal mortality. Birth preparedness involves preparation for safe childbirth during the antenatal period to reach the appropriate health facility for ensuring safe delivery. Hence, understanding the factors associated with birth preparedness and its significance for safe delivery is essential. This paper aims to assess the levels of birth preparedness, its determinants and association with institutional deliveries in High Priority Districts of Uttar Pradesh, India. Methods A community-based cross-sectional survey was conducted between June–October 2018 in the rural areas of 25 high priority districts of Uttar Pradesh, India. Simple random sampling was used to select 40 blocks among 294 blocks in 25 districts and 2646 primary sampling units within the selected blocks. The survey interviewed 9458 women who had a delivery 2 months prior to the survey. Descriptive statistics were included to characterize the study population. Multivariable logistic regression analyses were performed to identify the determinants of birth preparedness and to examine the association of birth preparedness with institutional delivery. Results Among the 9458 respondents, 61.8% had birth preparedness (both facility and transportation identified) and 79.1% delivered in a health facility. Women in other caste category (aOR = 1.24, CI 1.06–1.45) and those with 10 or more years of education (aOR = 1.68, CI 1.46–1.92) were more likely to have birth preparedness. Antenatal care (ANC) service uptake related factors like early registration for ANC (aOR = 1.14, CI 1.04–1.25) and three or more front line worker contacts (aOR = 1.61, CI 1.46–1.79) were also found to be significantly associated with birth preparedness. The adjusted multivariate model showed that those who identified both facility and transport were seven times more likely to undergo delivery in a health facility (aOR = 7.00, CI 6.07–8.08). Conclusion The results indicate the need for focussing on marginalized groups for improving birth preparedness. Increasing ANC registration in the first trimester of pregnancy, improving frontline worker contact, and optimum utilization of antenatal care check-ups for effective counselling on birth preparedness along with system level improvements could improve birth preparedness and consequently institutional delivery rates in Uttar Pradesh, India.

The occurrence of potentially pathogenic free-living amoebae (FLA) in natural hot springs is considered a public health concern. FLAs are known to cause serious health outcomes to a wide spectrum of mammalian hosts. The present study aimed to provide the distribution of isolated cases of FLAs in hot springs through a systematic review process of available published articles online. Relevant studies are published between January 2010 and January 2020 involving the isolation of Naegleria spp., Acanthamoeba spp., Balamuthia spp., Sappinia spp., and Vermamoeba spp. in natural hot springs in the United States, South America, North America, Europe, Asia, and Africa. Articles were identified through a search of PubMed and Google Scholar databases. Out of 94 articles screened, a total of 20 articles are included in the study with consideration of established inclusion and exclusion criteria. The most common FLAs isolated in hot springs are Acanthamoeba spp. (134; 48.5%) and Naegleria spp. (127; 46.0%). Other FLAs isolated in hot springs include Balamuthia spp. (2; 0.7%) and Vermamoeba spp. (13; 4.7%). FLA in hot springs used for recreational and medical purposes is a potential source of infection. It is recommended that strict surveillance and maintenance of hot springs be implemented to prevent potential future infection. HIGHLIGHTS First review on the distribution of potentially pathogenic FLA in hot springs.; Potential risk factors on FLA occurrence in hot springs.; Occurrence of Balamuthia mandrillaris in hot springs.; Occurrence of Vermamoeba vermiformis in hot springs.;

Thomas Aquinas emerges as a remarkable figure whose significant literary contributions have had a profound impact on our understanding of religion. Drawing inspiration from both the Greco-Roman philosophical and legal traditions, particularly the influential works of Cicero and the rich Christian tradition, notably Augustine, Aquinas presents a comprehensive and nuanced approach to the multifaceted concept of ‘religion’. While his analysis often situates ‘religion’ within the moral framework of justice, highlighting its inherent concern with the relationship between humanity and the divine, Aquinas goes beyond mere moral principles in his exploration. His aim is to establish a universal understanding of ‘religion’, offering a well-defined definition and presenting a philosophical and theological doctrine. In this paper, we shall first delve into the foundations and underlying principles that shaped Aquinas’s interpretation of religion. Next, we will undertake a thorough examination of religion as a virtue, highlighting Aquinas’s emphasis on its intrinsic connection to justice rather than confining it to the realm of religious sentiment, piety, or devotion. Finally, our research will explore the specific terminologies employed by Aquinas to elucidate the concept of religion, providing a comprehensive and nuanced approach to the ongoing discourse on this topic. Aquinas’s contribution rests in his defence of religion’s inherent public nature, grounded in its anthropological foundation and its virtuous essence.

Introduction: This study aimed to describe the level of preparedness of the healthcare facilities and the healthcare professionals concerning the four components (Health, Psychosocial and Mental Health, Nutrition on Emergencies, and Water Sanitation and Hygiene) of the Health Emergency Management System (HEMS) in the province of Biliran. Methods: The researchers used a sequential explanatory research design and utilized two sets of research instruments for the purpose of data gathering. The participants were healthcare workers from Rural Health Units (RHUs) and representatives from the Local Government Units (LGUs) in Biliran province in the Philippines. For the analysis of the quantitative data, a qualified statistician analyzed the raw data transcribed using the SPSS IMB 21 tool. The qualitative data was analyzed and processed using Mayring and Miles-Huberman’s technique. Results: The study found that the respondents were suitable to provide reliable data and to credibly assess the condition of the RHUs. They were also knowledgeable enough to determine the gaps confronting the RHUs, including their corresponding solutions. The healthcare facilities of the province were only rated to be average. Their capacity to provide post-traumatic counselling was poor, although their referral systems were rated excellent. Conclusion: The study concludes that the healthcare workers of Biliran Province and the HEMS of the eight RHUs in the province are not prepared to manage health emergencies during disasters. The low capacity of the HEMS is due to the low utilization of the budget, resulting in insufficient supplies and equipment which is necessary when addressing people’s immediate needs during disasters and health emergencies. The study recommends a thorough deliberation of the system to plug the gaps and provide rapid equitable health services during emergencies.

Abstract Background Timely initiation of breastfeeding, also known as early initiation of breastfeeding, is a well-recognized life-saving intervention to reduce neonatal mortality. However, only one quarter of newborns in Uttar Pradesh, India were breastfed in the first hour of life. This paper aims to understand the association of community-based prenatal counselling and postnatal support at place of delivery with early initiation of breastfeeding in Uttar Pradesh, India. Methods Data from a cross-sectional survey of 9124 eligible women (who had a live birth in 59 days preceding the survey) conducted in 25 districts of Uttar Pradesh, India, in 2018, were used. Simple random sampling was used to randomly select 40 Community Development Blocks (sub district administrative units) in 25 districts. The Primary Sampling Units (PSUs), health service delivery unit for frontline workers, were selected randomly from a linelisting of PSUs in each selected Community Development Block. Bivariate and multivariate logistic regression analyses were performed to assess the association of prenatal counselling and postnatal support on early initiation of breastfeeding in public, private and home deliveries. Results Overall 48.1% of mothers initiated breastfeeding within an hour, with major variation by place of delivery (61.2% public, 23.6% private and 32.6% home). The adjusted odds ratio (aOR) of early initiation of breastfeeding was highest among mothers who received both counselling and support (aOR 2.67; 95% CI 2.30, 3.11), followed by those who received only support (aOR 1.99; 95% CI 1.73, 2.28), and only counselling (aOR 1.40; 95% CI 1.18, 1.67) compared to mothers who received none. The odds of early initiation of breastfeeding was highest among mothers who received both prenatal counselling and postnatal support irrespective of delivery at public health facilities (aOR 2.49; 95% CI 2.07, 3.01), private health facilities (aOR 3.50; 95% CI 2.25, 5.44), or home (aOR 2.84; 95% CI 2.02, 3.98). Conclusions A significant association of prenatal counselling and postnatal support immediately after birth on improving early initiation of breastfeeding, irrespective of place of delivery, indicates the importance of enhancing coverage of both the interventions through community and facility-based programs in Uttar Pradesh.

Fruit ripening on a perennial tree or vine is typically asynchronous and rarely investigated. In commerce, this is problematic as it impairs sampling to meet commercial maturity and quality standards at harvest. For grapevines, understanding within-grapevine variability in berry maturity will benefit precision management and harvest planning. It is accepted that variation in maturity is approximately equally allocated at the within- and between-vine scale. However, the mechanistic and ecological factors that cause functional variance are poorly understood and rarely documented. This study aimed to identify structural and spatial within-vine attributes associated with berry composition at harvest related to available resources from the whole grapevine. Vegetative and reproductive biomass attributes within- and between-vines were analysed for cv. Cabernet-Sauvignon trained as a cordon, spur-pruned system using a Smart-Dyson trellis in a ‘New World’ industrial-scale vineyard. The vines were located in northern Margaret River, Western Australia. Variability in soluble solids, anthocyanins and phenolics were analysed for clusters and corresponding canopy characteristics. Berry size was the best predictor of variance in maturity among sugar, anthocyanins and phenolics composition within individual vines. Smaller stems or fruit had greater variation in maturity than larger stems or fruit. However, the relationship between whole plant biomass and fruit maturity interacted at different scales; the first report for grapevines. Including different vine-biomass scales helped explain the heteroscedasticity observed when the individual vine effect was excluded from the analysis. These findings suggest that high vigour grapevines could benefit from differential management, regardless of harvest index. Furthermore, these findings may help explain the diversity of response to treatment effects such as cluster or leaf thinning reported previously for perennial fruit.

Abstract: In this paper we examine translation arising in court cases involving reputational damage. A diachronic and tightly focused cross-jurisdictional selection of examples from case law is used to highlight the range of ways in which translation can be employed, blamed, or relied upon by the parties and by the courts, and we glimpse how translations can be a source of libel, a defence against libel, or a gateway to libellous material, how crucial translation can be in protecting or damaging reputations, and how significantly it can affect a case’s outcome. We apply Engberg’s lens for communication in legal contexts, distinguishing micro, meso and macro occurrences of translation at publisher/business/individual, judicial, and State levels. Recurring translation-related topics either mooted by courts or arising in our analysis are then outlined, including: competing translations; translation techniques; translator identification; online translation; how the acceptance of jurisdiction may be influenced by translation requirements; and how judges approach decision-making when foreign language documents and translation are involved.

Abstract Background Despite substantial reductions in perinatal deaths (stillbirths and early neonatal deaths), India’s perinatal mortality rates remain high, both nationally and in individual states. Rates are highest among disadvantaged socio-economic groups. To address this, India’s National Health Mission has trained community health workers called Accredited Social Health Activists (ASHAs) to counsel and support women by visiting them at home before and after childbirth. We conducted a qualitative study to explore the roles of ASHAs’ home visits in improving equity in perinatal health between socio-economic position groups in rural Uttar Pradesh (UP), India. Methods We conducted social mapping in four villages of two districts in UP, followed by three focus group discussions in each village (12 in total) with ASHAs and women who had recently given birth belonging to ‘higher’ and ‘lower’ socio-economic position groups (n = 134 participants). We analysed the data in NVivo and Dedoose using a thematic framework approach. Results Home visits enabled ASHAs to build trusting relationships with women, offer information about health services, schemes and preventive care, and provide practical support for accessing maternity care. This helped many women and families prepare for birth and motivated them to deliver in health facilities. In particular, ASHAs encouraged women who were poorer, less educated or from lower caste groups to give birth in public Community Health Centres (CHCs). However, women who gave birth at CHCs often experienced insufficient emergency obstetric care, mistreatment from staff, indirect costs, lack of medicines, and referrals to higher-level facilities when complications occurred. Referrals often led to delays and higher fees that placed the greatest burden on families who were considered of lower socio-economic position or living in remote areas, and increased their risk of experiencing perinatal loss. Conclusions The study found that ASHAs built relationships, counselled and supported many pregnant women of lower socio-economic positions. Ongoing inequities in health facility births and perinatal mortality were perpetuated by overlapping contextual issues beyond the ASHAs’ purview. Supporting ASHAs’ integration with community organisations and health system strategies more broadly is needed to address these issues and optimise pathways between equity in intervention coverage, processes and perinatal health outcomes.

Cancer is one of the significant causes of mortality worldwide. Studies on antineoplastic drugs focused on natural products have revealed several mechanisms to inhibit cancer cells. Bugnay (Antidesma bunius) leaves showed potentials due to its activity observed against brine shrimp and breast cancer cells. However, there is still limited knowledge about its activity against other human cancer cells. This study focused on determining the phytochemical compounds in A. bunius leaves extract, the free radical scavenging activity of the extract using the Diphenylpicrylhydrazyl (DPPH) method, and in vitro cytotoxic activity against two cancer cell lines, namely HCT-116 human colorectal and A549 human lung adenocarcinoma cancer cell lines by using 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) assay. The phytochemicals identified were unsaturated lactones, flavonoids, phenolics, diterpenes, saponins, tannins, carbohydrates, and reducing sugars. The extract showed significant free radical scavenging activity and a direct correlation of activity with concentration levels. It also exhibited cytotoxic activity against HCT-116 human colorectal and A549 human lung adenocarcinoma. Hence, A. bunius leaves have the potential to be a source of antioxidant and antineoplastic compounds. This warrant further isolation of the compounds for chemotherapeutic purposes. Keywords: Antidesma bunius, Bugnay, Cancer, Cytotoxicity, Radical

Abstract Aims This study aims to compare the clinical course of peripartum cardiomyopathy (PPCM) cohorts from Germany (G‐PPCM) and South Africa (SA‐PPCM) with fibrosis‐related markers to get insights into novel pathomechanisms of PPCM. Methods and results G‐PPCM (n = 79) and SA‐PPCM (n = 72) patients and healthy pregnancy‐matched women from Germany (n = 56) and South Africa (n = 40) were enrolled. Circulating levels of procollagen type‐I (PINP) and type‐III (PIIINP) N‐terminal propeptides, soluble ST2, galectin‐3, and full‐length and cleaved osteopontin (OPN) were measured at diagnosis (baseline) and 6 months of follow‐up. Both cohorts received standard heart failure therapy while anticoagulation therapy was applied in 100% of G‐PPCM but only in 7% of SA‐PPCM patients. In G‐PPCM patients, baseline left ventricular ejection fraction (LVEF) was lower, and outcome was better (baseline LVEF, 24 ± 8%, full recovery: 52%, mortality: 0%) compared with SA‐PPCM patients (baseline LVEF: 30 ± 9%, full recovery: 32%, mortality: 11%; P < 0.05). At baseline, PINP/PIIINP ratio was lower in SA‐PPCM and higher in G‐PPCM compared with respective controls, whereas total OPN was elevated in both collectives. Cleaved OPN, which increases PIIINP levels, is generated by thrombin and was reduced in patients receiving anticoagulation therapy. High baseline galectin‐3, soluble ST2, and OPN levels were associated with poor outcome in all PPCM patients. Conclusions SA‐PPCM patients displayed a more profibrotic biomarker profile, which was associated with a less favourable outcome despite better cardiac function at baseline, compared with G‐PPCM patients. Use of bromocriptine and anticoagulation therapy in G‐PPCM may counteract fibrosis and may in part be responsible for their better outcome.

Objectives: The PartneRships in cOngeniTal hEart disease (PROTEA) project aims to establish a densely phenotyped and genotyped Congenital Heart Disease (CHD) cohort for southern Africa. This will facilitate research into the epidemiology and genetic determinants of CHD in the region. This paper introduces the PROTEA project, characterizes its initial cohort, from the Western Cape Province of South Africa, and compares the proportion or “cohort-prevalences” of CHD-subtypes with international findings.Methods: PROTEA is a prospective multicenter CHD registry and biorepository. The initial cohort was recruited from seven hospitals in the Western Cape Province of South Africa from 1 April 2017 to 31 March 2019. All patients with structural CHD were eligible for inclusion. Descriptive data for the preliminary cohort are presented. In addition, cohort-prevalences (i.e., the proportion of patients within the cohort with a specific CHD-subtype) of 26 CHD-subtypes in PROTEA's pediatric cohort were compared with the cohort-prevalences of CHD-subtypes in two global birth-prevalence studies.Results: The study enrolled 1,473 participants over 2 years, median age was 1.9 (IQR 0.4–7.1) years. Predominant subtypes included ventricular septal defect (VSD) (339, 20%), atrial septal defect (ASD) (174, 11%), patent ductus arteriosus (185, 11%), atrioventricular septal defect (AVSD) (124, 7%), and tetralogy of Fallot (121, 7%). VSDs were 1.8 (95% CI, 1.6–2.0) times and ASDs 1.4 (95% CI, 1.2–1.6) times more common in global prevalence estimates than in PROTEA's pediatric cohort. AVSDs were 2.1 (95% CI, 1.7–2.5) times more common in PROTEA and pulmonary stenosis and double outlet right ventricle were also significantly more common compared to global estimates. Median maternal age at delivery was 28 (IQR 23–34) years. Eighty-two percent (347/425) of mothers used no pre-conception supplementation and 42% (105/250) used no first trimester supplements.Conclusions: The cohort-prevalence of certain mild CHD subtypes is lower than for international estimates and the cohort-prevalence of certain severe subtypes is higher. PROTEA is not a prevalence study, and these inconsistencies are unlikely the result of true differences in prevalence. However, these findings may indicate under-diagnosis of mild to moderate CHD and differences in CHD management and outcomes. This reemphasizes the need for robust CHD epidemiological research in the region.

Background: It remains unknown what students from medical schools in the Philippines, such as the School of Medicine at Saint Louis University in the Cordilleras, know and feel about climate change, an important issue in this ecological region of the country. Objective: To determine the knowledge and attitudes of future physicians towards climate change. Methods: Pre-pandemic, we conducted a paper survey among first and second year medical students, adapting questionnaires from previous studies: (1) Americans’ Knowledge of Climate Change by the Yale Project on Climate Change Communication; and (2) Attitudes about Global Warming based on the 4th Assessment Report of the United Nations Intergovernmental Panel on Climate Change. A pretest was done to ensure respondents’ understanding of the questions. Sample size was computed at 176, and random sampling was done. Results: We obtained a 100% response rate. The respondents were mostly females, 0.05). Conclusion: The respondents generally showed favorable attitudes towards climate change, although their knowledge on the topic could still be improved. Our study may serve as a basis for developing strategies towards a socially responsive medical education within the Philippines.

In recent years, the human gut microbiome has been recognised to play a pivotal role in the health of the host. Intestinal homeostasis relies on this intricate and complex relationship between the gut microbiota and the human host. While much effort and attention has been placed on the characterization of the organisms that inhabit the gut microbiome, the complex molecular cross-talk between the microbiota could also exert an effect on gastrointestinal conditions. Blastocystis is a single-cell eukaryotic parasite of emerging interest, as its beneficial or pathogenic role in the microbiota has been a subject of contention even to-date. In this study, we assessed the function of the Blastocystis tryptophanase gene (BhTnaA), which was acquired by horizontal gene transfer and likely to be of bacterial origin within Blastocystis. Bioinformatic analysis and phylogenetic reconstruction revealed distinct divergence of BhTnaA versus known bacterial homologs. Despite sharing high homology with the E. coli tryptophanase gene, we show that Blastocystis does not readily convert tryptophan into indole. Instead, BhTnaA preferentially catalyzes the conversion of indole to tryptophan. We also show a direct link between E. coli and Blastocystis tryptophan metabolism: In the presence of E. coli, Blastocystis ST7 is less able to metabolise indole to tryptophan. This study examines the potential for functional variation in horizontally-acquired genes relative to their canonical counterparts, and identifies Blastocystis as a possible producer of tryptophan within the gut.

Abstract Background An increasing number of studies have investigated the clinical epidemiology and outcomes of ventilator-associated pneumonia (VAP) in intensive care units. However, these findings have not been clearly defined in broad subgroups of mechanically ventilated adults. Hence, this protocol for a systematic review and meta-analysis is designed to better understand the clinical and epidemiological features of VAP in these patient populations by establishing its overall prognosis of and risk factors for morbidity and mortality and to determine the differences in clinical and economic outcomes between VAP and non-VAP patients. Methods This present review will systematically search available full-text articles without date and language restrictions and indexed in PubMed, CENTRAL, CINAHL, Web of Science, and EMBASE databases. In addition, reference lists and citations of retrieved articles and relevant medical and nursing journals will be manually reviewed. Supplementary search in other databases involving trials, reviews, and grey literatures, including conference proceedings, theses, and dissertations, will be performed. Study investigators will be contacted to clarify missing or unpublished data. All prognostic studies meeting the pre-defined eligibility criteria will be included. The study selection, risk of bias assessment, data extraction, and grading of the quality of evidence will be carried out in duplicate, involving independent evaluation by two investigators with consensus or a third-party adjudication. The degree of inter-rater agreement will be calculated using the kappa statistic. For meta-analysis, dichotomous and continuous outcome measures will be pooled using odds ratios and standardized mean differences with 95% confidence intervals, respectively. The Mantel-Haenszel or inverse variance methods with random effects model will be used as a guide for analysis. The heterogeneity of each outcome measure will be assessed using both X 2 and I 2 statistics. In addition, sensitivity and subgroup analyses will be performed to ensure consistency of pooled results. The review protocol described herein is in accordance with the PRISMA-P standards. Discussion The investigation of the epidemiological profiles, prognostic factors, and outcomes associated with VAP is critical for the identification of high-risk groups of mechanically ventilated patients and evaluation of possible clinical endpoints. This may provide substantial links for improved VAP prevention practices targeting modifiable risk factors. Implications for future research directions are discussed. Systematic review registration PROSPERO CRD42017048158

Abstract Background Blastocystis is a common gut eukaryote detected in humans and animals. It has been associated with gastrointestinal disease in the past although recent metagenomic studies also suggest that it is a member of normal microbiota. This study investigates interactions between pathogenic human isolates belonging to Blastocystis subtype 7 (ST7) and bacterial representatives of the gut microbiota. Results Generally, Blastocystis ST7 exerts a positive effect on the viability of representative gut bacteria except on Bifidobacterium longum. Gene expression analysis and flow cytometry indicate that the bacterium may be undergoing oxidative stress in the presence of Blastocystis. In vitro assays demonstrate that Blastocystis-induced host responses are able to decrease Bifidobacterium counts. Mice infected with Blastocystis also reveal a decrease in beneficial bacteria Bifidobacterium and Lactobacillus. Conclusions This study shows that particular isolates of Blastocystis ST7 cause changes in microbiota populations and potentially lead to an imbalance of the gut microbiota. This study suggests that certain isolates of Blastocystis exert their pathogenic effects through disruption of the gut microbiota and provides a counterpoint to the increasing reports indicating the commensal nature of this ubiquitous parasite.

Introduction India’s National Health Mission has trained community health workers called Accredited Social Health Activists (ASHAs) to visit and counsel women before and after birth. Little is known about the extent to which exposure to ASHAs’ home visits has reduced perinatal health inequalities as intended. This study aimed to examine whether ASHAs’ third trimester home visits may have contributed to equitable improvements in institutional delivery and reductions in perinatal mortality rates (PMRs) between women with varying education levels in Uttar Pradesh (UP) state, India.Methods Cross-sectional survey data were collected from a representative sample of 52 615 women who gave birth in the preceding 2 months in rural areas of 25 districts of UP in 2014–2015. We analysed the data using generalised linear modelling to examine the associations between exposure to home visits and education-based inequalities in institutional delivery and PMRs.Results Third trimester home visits were associated with higher institutional delivery rates, in particular public facility delivery rates (adjusted risk ratio (aRR) 1.32, 95% CI 1.30 to 1.34), and to a lesser extent private facility delivery rates (aRR 1.09, 95% CI 1.04 to 1.13), after adjusting for confounders. Associations were stronger among women with lower education levels. Having no compared with any third trimester home visits was associated with higher perinatal mortality (aRR 1.18, 95% CI 1.09 to 1.28). Having any versus no visits was more highly associated with lower perinatal mortality among women with lower education levels than those with the most education, and most notably among public facility births.Conclusions The results suggest that ASHAs’ home visits in the third trimester contributed to equitable improvements in institutional deliveries and lower PMRs, particularly within the public sector. Broader strategies must reinforce the role of ASHAs’ home visits in reaching the sustainable development goals of improving maternal and newborn health and leaving no one behind.

Predictive Functional Control is a simple alternative to the traditional PID controller which has the capability to handle process constraints more systematically. Nevertheless, the most basic form of PFC has suffered from ill-posed prediction due to its simplicity in formulation and assumption of constant future input dynamics. Although some constraints can be satisfied, nevertheless the performance may be very conservative due to this issue. The main objective of this paper is to improve the constrained performance of a PFC controller with a minimum modification of the existing formulation. Specifically, a novel constraint handling approach for PFC is proposed based on an implied closed-loop prediction. Instead of assuming a constant input as deployed in the conventional open-loop prediction, the implied closed-loop input dynamics are utilised to detect future constraint violations. In addition, a future perturbation is introduced into the prediction structure as an extra degree of freedom for satisfying the constraints. Two simulation results confirm that the proposed approach gives far less conservative constraint handling and thus better control performance compared to the nominal PFC. Furthermore, this novel implementation also alleviates the well-known tuning difficulties and prediction inconsistency issues that are associated with conventional PFC when handling constraints. ABSTRAK: Kawalan Kefungsian Ramalan adalah alternatif mudah kepada kawalan tradisional PID yang mempunyai kekangan keupayaan bagi mengawal proses secara lebih tersusun. Namun, keadaan paling asas pada kesan PFC adalah daripada ramalan tak teraju-rapi yang disebabkan oleh formula ringkas dan anggapan dinamik input yang sama bagi masa depan. Walau kekangan ini dapat diatasi, namun prestasi akan berubah secara konservatif disebabkan oleh isu ini. Objektif utama kajian ini adalah bagi membaiki kekangan prestasi kawalan PFC dengan modifikasi minimum formula yang ada. Secara spesifik, pendekatan nobel kawalan PFC dicadangkan berdasarkan ramalan lingkaran-tertutup. Selain anggapan input tetap seperti yang dilakukan pada ramalan lingkaran-terbuka yang konservatif, dinamik input yang dibuat pada lingkaran-tertutup telah digunakan bagi mengesan kekangan masa depan yang bertentangan. Tambahan, gangguan yang bakal berlaku pada masa depan telah diperkenalkan ke dalam struktur ramalan sebagai tambahan darjah pada kebebasan bagi mengatasi kekangan. Dua dapatan simulasi kajian menyetujui pendekatan yang dicadangkan dan menyebabkan sangat kurang kekangan pengendalian pada sistem konservatif, oleh itu kawalan yang lebih bagus pada prestasi berbanding pada PFC nominal. Selain itu, pendekatan nobel ini juga menghilangkan kesukaran pelarasan yang dikenali ramai dan ramalan isu tidak konsisten yang terdapat pada PFC konvensional apabila mengendali kekangan.

Sri Lanka is a leprosy endemic country with one of the highest incidences of the disease globally. Low levels of leprosy awareness were identified as one of the reasons for high prevalence. In order to address this low awareness, inter-faith communities were mobilized by trained church leaders to work together to increase leprosy awareness, reduce stigma, and support people affected by leprosy, building strong relationships across inter-religious divides in the process. The efforts were highly successful with over 30,000 people involved in leprosy awareness events. This indicates that faith communities can be an important partner for development agencies and governments; churches can make an impact in improving health outcomes, even where the members are a persecuted minority, as well as contribute to inter-communal peacebuilding efforts.

Abstract Beagles are less susceptible to Rhipicephalus sanguineus sensu lato tick due to the production of the allomones benzaldehyde and 2-hexanone. Our previous published work showed that these compounds can reduce tick burden on susceptible dogs. Here we tested the hypothesis that an increase in repellent dose and release rate could increase repellent efficacy and persistence. Slow-release formulations of these compounds, with higher doses and release rates, were tested on artificially-infested dogs. Ten dogs were randomly assigned to two groups with five dogs each. The treated group received collars with slow-release formulations of the compounds attached, while the control group received collars with clean formulations attached. Five environmental infestations were performed, with the number of ticks (at all stages) on the dogs being counted once a day for 40 days. No significant increase in repellent efficacy was observed with the higher doses and release rates, whereas a greater persistence in repellent activity was observed. Treatment with the formulations resulted in a two-to-three-fold reduction in the number of immature stage ticks for up to three weeks. However, the number of adults was similar in both groups. Loss of repellent activity after the third week of testing coincided with a marked change in the relative release rates for the two compounds. It is hypothesized that relative amounts, rather than absolute amounts, of repellent release from slow-release formulations are important for repellent activity. We also hypothesize that the avoidance of less-preferred hosts by ticks relies on olfactory-mediated perception of specific blends of volatile cues from less preferred hosts.

Abstract Background Program Science is an iterative, multi-phase research and program framework where programs drive the scientific inquiry, and both program and science are aligned towards a collective goal of improving population health. Discussion To achieve this, Program Science involves the systematic application of theoretical and empirical knowledge to optimize the scale, quality and impact of public health programs. Program Science tools and approaches developed for strategic planning, program implementation, and program management and evaluation have been incorporated into HIV and sexually transmitted infection prevention programs in Kenya, Nigeria, India, and the United States. Conclusion In this paper, we highlight key scientific contributions that emerged from the growing application of Program Science in the field of HIV and STI prevention, and conclude by proposing future directions for Program Science.