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In the Split City area, with an air distance of approximately 18 km, the survey of land surface temperature (LST) and urban heat islands (UHI) was detected. It also shows how local geomorphology, especially the density of urban areas (especially densely built high-rise buildings and urban canyons) and the amount of greenery and water surfaces, affect the UHI of the observed area. The paper uses a known method of classifying local climatic zoning (LCZ) and its coincidence with the zones of the highest urban temperatures. The paper highlights the critical areas and suggests possible solutions to reduce the UHI.

Intro: International travelers may seek care abroad to address health problems that arise during their trip or plan healthcare outside their country of residence as medical tourists. Methods: Data were collected on travelers evaluated at GeoSentinel Network sites who reported healthcare during travel. Both unplanned and planned healthcare were analyzed, including the reason and nature of healthcare sought, characteristics of the treatment provided, and outcomes. Travelers that presented for rabies post-exposure prophylaxis were described elsewhere and were excluded from detailed analysis. Findings: From May 2017 through June 2020, after excluding travelers obtaining rabies post-exposure prophylaxis (n=415), 1,093 travelers reported care for a medical or dental issue that was an unanticipated part of the travelers’ planned itinerary (unplanned healthcare). Travelers who sought unplanned healthcare abroad had frequent diagnoses of acute diarrhea, dengue, falciparum malaria, and unspecified viral syndrome, and obtained care in 131 countries. Thirty-four (3%) reported subsequent deterioration and 230 (21%) reported no change in condition; a third (n=405; 37%) had a pre-travel health encounter. Forty-one travelers had sufficient data on planned healthcare abroad for analysis. The most common destinations were the US, France, Dominican Republic, Belgium, and Mexico. The top reasons for their planned healthcare abroad were unavailability of procedure at home (n=9; 19%), expertise abroad (n=9; 19%), lower cost (n=8; 17%), and convenience (n=7; 15%); a third (n=13; 32%) reported cosmetic or surgical procedures. Early and late complications occurred in 14 (33%) and 4 (10%) travelers, respectively. Four travelers (10%) had a pre-travel health encounter. Conclusion: A substantial number of travelers developed health problems abroad. International travelers encounter health problems during travel that often could be prevented by pre-travel consultation. Travelers obtaining planned healthcare abroad can experience negative health consequences associated with treatments abroad, for which pre-travel consultations could provide advice and potentially help to prevent complications.

Abstract Background Fibromyalgia (FM) is a very prevalent and debilitating chronic pain disorder that is difficult to treat. Mindfulness-based techniques are regarded as a very promising approach for the treatment of chronic pain and in particular FM. The Mindfulness-Oriented Recovery Enhancement (MORE) intervention, a mindfulness-based group intervention, has shown beneficial effects in opioid-treated chronic pain patients, including reduced pain severity, functional interference, and opioid dosing, by restoring neurophysiological and behavioral responses to reward. The first evidence for a hypodopaminergic state and impaired reward processing in FM has been reported. However, little is known about its impact on dopamine (DA) function and in particular with regard to DA responses to monetary reward in FM. The aim of the present study protocol is to evaluate if MORE is able to restore the DA function in FM patients, in particular with regard to the DA responses to reward, and to reduce pain and mood complaints in FM. Methods The present study is a multi-center interventional RCT with 3 time points: before the intervention, after completion of the intervention, and 3 months after completion of the intervention. Sixty-four FM patients will be randomly assigned to either the MORE intervention (N = 32) or a non-intervention control group (N = 32). Additionally, a comparison group of healthy women (N = 20) for PET measures will be enrolled and another group of healthy women (N = 15) will do the ambulatory assessments only. The MORE intervention consists of eight 2-h-long group sessions administered weekly over a period of 8 weeks. Before and after the intervention, FM participants will undergo [18F] DOPA positron emission tomography (PET) and functional MR imaging while performing a reward task. The primary outcome will be endogeneous DA changes measured with [18F] DOPA PET at baseline, after the intervention (after 8 weeks for the non-intervention control group), and at 3 months’ follow-up. Secondary outcomes will be (1) clinical pain measures and FM symptoms using standardized clinical scales; (2) functional brain changes; (3) measures of negative and positive affect, stress, and reward experience in daily life using the ambulatory assessment method (AA); and (4) biological measures of stress including cortisol and alpha-amylase. Discussion If the findings of this study confirm the effectiveness of MORE in restoring DA function, reducing pain, and improving mood symptoms, MORE can be judged to be a promising means to improve the quality of life in FM patients. The findings of this trial may inform health care providers about the potential use of the MORE intervention as a possible non-pharmacological intervention for FM. Trial registration ClinicalTrials.gov NCT 04451564 . Registered on 3 July 2020. The trial was prospectively registered.

Background: Metered dose inhalers (MDIs) are important devices for delivering inhaled medications; however, they have an outsized carbon footprint due to their propellant gas. Many short-acting beta-agonist inhalers contain HFA-134a which has a global warming potential >1000 fold higher than carbon dioxide. We aimed to determine the practices around MDI use and disposal within Australia's major lung function testing laboratories and identify the actions that most influence the carbon footprint of bronchodilator responsiveness (BDR) testing., Methods: Australia's 45 accredited lung function laboratories were invited to participate in an online survey asking about their volume of BDR testing, as well as practices around MDI use such as the number of actuations per BDR test, reuse of MDIs between patients and disposal method. We calculated MDI-associated carbon dioxide equivalent (CO2e) emissions by combining previously published estimates., Results: 39 laboratories completed the survey. Most laboratories used 4 actuations of salbutamol per BDR test for both adults (27/34, 79.4%) and children (17/20, 85%), but this ranged from 2 to 12. Only three (7.7%) laboratories did not routinely reuse MDIs between patients; however, they all sent their used MDIs for high-temperature incineration. Based on different combinations of observed MDI practices in Australia, we identified a potential sixfold difference in CO2e per 100 BDR tests, from as low as 23.3 kg CO2e up to 166 kg CO2e., Conclusions: We identified three key practices to reduce the carbon footprint of BDR testing: disposing of MDIs via high-temperature incineration, reducing the number of actuations per BDR test and reusing MDIs between patients., Competing Interests: Competing interests: NR is a Board director of the Australian and New Zealand Society of Respiratory Scientists (ANZSRS)., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Objectives: Given the complex role of immunity in dengue severity, we aimed to review the clinical course of dengue infection in immunocompromised patients., Methods: We conducted a systematic review of studies reporting outcomes among immunocompromised patients with laboratory-confirmed dengue infection. Meta-analysis using the Mantel-Haenszel method (fixed effects) was performed for studies with control groups. We registered the study with PROSPERO (No. CRD42021258930)., Results: We included 115 studies. Among these, 30 studies compared immunocompromised (cases) and nonimmunocompromised (control) patients, focusing mainly on children (n = 22 studies) with malnutrition (n=18). Immunocompromised patients had a higher likelihood of dengue complications (OR 1.87; 95% CI: 1.04-3.35]) but a lower likelihood of severe dengue (OR 0.83; 95% CI: 0.69-1.00]. No significant difference in mortality was observed. In the 85 studies focused solely on immunocompromised patients, severe dengue and mortality rates were 9% and 4%, respectively, mostly among adult solid organ transplant recipients and those with inflammatory diseases. Immunosuppressive treatment alterations and temporary graft dysfunction were reported., Conclusion: Immunocompromised patients have an increased risk of dengue-related complications. However, definitive conclusions about the comparative severity of dengue across different immunocompromised patient groups are limited by a lack of robust data, highlighting the need for well-designed future studies., Competing Interests: Declarations of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Background: The burden of Aedes aegypti -transmitted viruses such as dengue, chikungunya, and Zika are increasing globally, fueled by urbanization and climate change, with some of the highest current rates of transmission in Asia. Local factors in the built environment have the potential to exacerbate or mitigate transmission., Methods: In 24 informal urban settlements in Makassar, Indonesia and Suva, Fiji, we tested children under 5 years old for evidence of prior infection with dengue, chikungunya, and Zika viruses by IgG serology. We used a catalytic model using seroprevalence and mean age to estimate annual incidence of dengue in each country. We also conducted detailed questionnaires to evaluate environmental risk factors for a positive serology result. Dengue risk factors were evaluated for individual children by univariate and multivariable logistic regression accounting for settlement as a flxed effect. Trash and flooding were additionally evaluated as dengue risk factors at the settlement level by univariate linear regression., Results: In Fiji and Indonesia respectively, 46% and 33% of children under 5 years old were seropositive for dengue, 3% and 3% for chikungunya, and 9% and 2% for Zika. In Indonesia, children living in a household where trash is routinely collected and removed were signiflcantly less likely to be dengue seropositive in both unadjusted and adjusted models [adjusted model: OR 0.3 (95% CI: 0.1-0.8)]. In Indonesia, settlements with a higher proportion of households reporting flooding also had lower dengue rates (slope = 0.44; p-value: <0.05)., Conclusions: Household trash collection and community flood management are important targets for interventions to mitigate the increasing risk of Aedes aegypti -transmitted viruses.

Objectives and importance of study: Australian children frequently travel overseas, but little is known about their travel-related morbidity. We aimed to describe the spectrum of illness and injury in returned travellers presenting to the largest paediatric referral centre in NSW, the Children's Hospital at Westmead (CHW)., Study Type: Observational cohort study., Methods: In the 18 months immediately before the COVID-19 pandemic (2018-2020), we prospectively collected demographic, travel and clinical data from children with travel-acquired illness or injury identified by active surveillance of CHW Emergency Department attendees and referrals to the infectious diseases service., Results: We identified 587 returned child travellers with an illness or injury associated with overseas travel. Most were aged younger than 5 (62.8%) and had travelled within the Asia-Pacific region (84.6%). The main reason for travel, where recorded (50.3%), was visiting friends and relatives (VFR)(65.4%). Most travellers (90.1%) had a common childhood infection, illness or injury coincidentally acquired during travel, including respiratory infection (37.5%), acute diarrhoea (15.7%) and nonspecific febrile illness (13.1%). Exotic/nonendemic infections were uncommon (9.9%, including potential rabies exposure) but were associated with much higher admission rates than 'cosmopolitan' (globally distributed) diseases (74.2% vs 21.9%). Most of these occurred in VFR travellers (86.3%); enteric fever, largely acquired in South Asia, predominated (51.7%). One in five admitted patients had a disease for which specific pretravel vaccination is available. Receipt of pretravel vaccines was infrequently recorded., Conclusions: Returned child travellers in Western Sydney frequently presented with respiratory infections and may be a key population for surveillance of imported respiratory viruses. The burden of exotic disease was small and borne by VFR travellers. Travel-related illness in Western Sydney could be reduced by health education of travellers and targeted pretravel vaccination, especially typhoid vaccination for VFR travellers to South Asia. Universal, systematic screening of emergency department attendees for recent overseas travel would improve surveillance of travel-related illness., Competing Interests: None declared

Objective: To present a series of case studies from our respective countries and disciplines on approaches to implementing the Planetary Health Education Framework in university health professional education programs, and to propose a curriculum implementation and evaluation toolbox for educators to facilitate the adoption of similar initiatives in their programs. We emphasize the importance of applying an Indigenous lens to curriculum needs assessment, development, implementation, and evaluation., Methods: Case studies from Australia and United States were collated using a six-stage design-based educational research framework (Focus, Formulation, Contextualization, Definition, Implementation, Evaluation) for teaching planetary health and methods of curriculum evaluation. These components were then mapped to derive the curriculum implementation toolbox reflecting the six-stage design-based educational research framework., Results: The case studies demonstrated different approaches to successful integration of the Planetary Health Education Framework in medicine, nursing, public health, and allied health disciplines. This integration often involved Indigenous perspectives on environmental stewardship, holistic health, and community well-being into the curriculum. The case studies also highlighted the importance of community engagement, cultural competency, and interdisciplinary collaboration in curriculum development. Findings from case studies were used to propose a curriculum implementation toolbox to assist educators in adapting and integrating planetary health education into their own programs., Discussion: While valuable frameworks for teaching planetary health in health science programs exist, challenges remain in implementing these frameworks in real-world educational environments. The proposed curriculum implementation toolbox offers practical strategies and resources for educators to incorporate these principles into their teaching. Additionally, the case studies reported here contribute to the growing body of literature on planetary health education pertinent to addressing the triple planetary crisis., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Lokmic-Tomkins, Barbour, LeClair, Luebke, McGuinness, Limaye, Pillai, Flynn, Kamp, Leder and Patz.)

In this study, we develop consistent estimators for key parameters that govern the dynamics of tumor cell populations when subjected to pharmacological treatments. While these treatments often lead to an initial reduction in the abundance of drug-sensitive cells, a population of drug-resistant cells frequently emerges over time, resulting in cancer recurrence. Samples from recurrent tumors present as an invaluable data source that can offer crucial insights into the ability of cancer cells to adapt and withstand treatment interventions. To effectively utilize the data obtained from recurrent tumors, we derive several large number limit theorems, specifically focusing on the metrics that quantify the clonal diversity of cancer cell populations at the time of cancer recurrence. These theorems then serve as the foundation for constructing our estimators. A distinguishing feature of our approach is that our estimators only require a single time-point sequencing data from a single tumor, thereby enhancing the practicality of our approach and enabling the understanding of cancer recurrence at the individual level., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Pathogenic and antimicrobial-resistant (AMR) microorganisms are continually transmitted between human, animal, and environmental reservoirs, contributing to the high burden of infectious disease and driving the growing global AMR crisis. The sheer diversity of pathogens, AMR mechanisms, and transmission pathways connecting these reservoirs create the need for comprehensive cross-sectoral surveillance to effectively monitor risks. Current approaches are often siloed by discipline and sector, focusing independently on parts of the whole. Here we advocate that integrated surveillance approaches, developed through transdisciplinary cross-sector collaboration, are key to addressing the dual crises of infectious diseases and AMR. We first review the areas of need, challenges, and benefits of cross-sectoral surveillance, then summarise and evaluate the major detection methods already available to achieve this (culture, quantitative PCR, and metagenomic sequencing). Finally, we outline how cross-sectoral surveillance initiatives can be fostered at multiple scales of action, and present key considerations for implementation and the development of effective systems to manage and integrate this information for the benefit of multiple sectors. While methods and technologies are increasingly available and affordable for comprehensive pathogen and AMR surveillance across different reservoirs, it is imperative that systems are strengthened to effectively manage and integrate this information., Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Rachael Lappan reports financial support was provided by Australian Research Council. Francesca Short reports financial support was provided by Australian Research Council. Dena Lyras reports financial support was provided by Australian Research Council. Trevor Lithgow reports financial support was provided by National Health and Medical Research Council. Chris Greening reports financial support was provided by National Health and Medical Research Council. Multiple authors (RISE Program) reports financial support was provided by Wellcome Trust. Multiple authors (RISE Program) reports financial support was provided by New Zealand Ministry of Foreign Affairs and Trade. Multiple authors (RISE Program) reports financial support was provided by Australian Government Department of Foreign Affairs and Trade. Multiple authors (RISE Program) reports financial support was provided by Government of Fiji. Multiple authors (RISE Program) reports financial support was provided by Asian Development Bank. Steven Chown reports financial support was provided by Australian Research Council. If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

The number, scale and ambition of transdisciplinary research initiatives between the global north and the global south is increasing, yet there is very little theoretical or empirical scholarship on how to lead and manage implementation to promote responsible practice. Within science, technology and innovation (STI) studies and decolonising research frameworks, and utilising collaborative autoethnography, this study codifies experience with implementing the 'Revitalising Informal Settlements and their Environments' (RISE) program (2017-2020). Our specific aim is to explore the leadership and management tensions and challenges of implementing transboundary transdisciplinary research. The findings reaffirm the importance of research leaders and managers carefully operationalising north-south research by critically reflecting on power asymmetries between disciplines, partners and locations, leveraging the potential for transdisciplinary consortia to build research capabilities in the global south, and creating a culture of reflexivity on the historical and social positionality in which research is designed, funded, implemented and evaluated. The findings foreground the role of boundary-spanning 'integrators' and 'pracademics', roles that have received little attention to date but are essential for effective delivery and societal impact beyond scientific advances. A framework for implementing north-south transdisciplinary research is outlined with five domains: (1) collaborative leadership; (2) agile management; (3) flexible consortia; (4) researcher positionality; and (5) co-design and participation. The framework can support efforts for responsibly designing and implementing large, transdisciplinary, cross-country research programs in line with ambitions for decolonising north-south research., Competing Interests: The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Rebekah Brown reports financial support was provided by Wellcome Trust. Karin Leder reports financial support was provided by National Health and Medical Research Council. If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2024 The Authors.)

Circulating tumor DNA assays are promising tools for the prediction of cancer treatment response. Here, we build a framework for the design of ctDNA biomarkers of therapy response that incorporate variations in ctDNA dynamics driven by specific treatment mechanisms. We develop mathematical models of ctDNA kinetics driven by tumor response to several therapy classes, and utilize them to simulate randomized virtual patient cohorts to test candidate biomarkers. Using this approach, we propose specific biomarkers, based on ctDNA longitudinal features, for targeted therapy, chemotherapy and radiation therapy. We evaluate and demonstrate the efficacy of these biomarkers in predicting treatment response within a randomized virtual patient cohort dataset. These biomarkers are based on novel proposals for ctDNA sampling protocols, consisting of frequent sampling within a compact time window surrounding therapy initiation - which we hypothesize to hold valuable prognostic information on longer-term treatment response. This study highlights a need for tailoring ctDNA sampling protocols and interpretation methodology to specific biological mechanisms of therapy response, and it provides a novel modeling and simulation framework for doing so. In addition, it highlights the potential of ctDNA assays for making early, rapid predictions of treatment response within the first days or weeks of treatment, and generates hypotheses for further clinical testing.

Background: Antimicrobial resistance (AMR) is a global health crisis, with Enterobacterales including Escherichia coli and Klebsiella pneumoniae playing significant roles. While international travel to low- and middle-income countries is linked to colonisation with AMR Enterobacterales, the clinical implications, particularly the risk of subsequent infection, remain unclear due to limited data. We aimed to characterise E. coli and K. pneumoniae infections in travellers and the antimicrobial susceptibility profiles of their isolates., Methods: We analysed data on E. coli and K. pneumoniae infections in travellers collected at GeoSentinel sites between 2015 and 2022, focusing on epidemiological, clinical and microbiological characteristics. We defined multi-drug resistance (MDR) as non-susceptibility to agents from at least three drug classes., Results: Over the 8-year period, we included 655 patients (median age 41 years; 74% female) from 57 sites in 27 countries, with 584 E. coli and 72 K. pneumoniae infections. Common travel regions included Sub-Saharan Africa, Southeast Asia, and South-Central Asia. Urinary tract infections predominated. Almost half (45%) were hospitalised. Among infections with antimicrobial susceptibility data across three or more drug classes, 203/544 (37%) E. coli and 19/67 (28%) K. pneumoniae demonstrated MDR. Over one-third of E. coli and K. pneumoniae isolates were non-susceptible to third-generation cephalosporins and cotrimoxazole, with 38% and 28% non-susceptible to fluoroquinolones, respectively. Travellers to South-Central Asia most frequently had isolates non-susceptible to third-generation cephalosporins, fluoroquinolones and carbapenems. We observed increasing frequencies of phenotypic extended spectrum beta-lactamase and carbapenem resistance over time., Conclusions: E. coli and K. pneumoniae infections in travellers, particularly those to Asia, may be challenging to empirically treat. Our analysis highlights the significant health risks these infections pose to travellers and emphasises the escalating global threat of AMR. Enhanced, systematic AMR surveillance in travellers is needed, along with prospective data on infection risk post travel-related AMR organism acquisition., (© The Author(s) 2024. Published by Oxford University Press on behalf of International Society of Travel Medicine.)

Background: Prolonged diarrhoea is common amongst returning travellers and is often caused by intestinal protozoa. However, the epidemiology of travel-associated illness caused by protozoal pathogens is not well described., Methods: We analysed records of returning international travellers with illness caused by Giardia duodenalis, Cryptosporidium spp., Cyclospora cayetanensis or Cystoisospora belli, reported to the GeoSentinel Network during January 2007-December 2019. We excluded records of travellers migrating, with an unascertainable exposure country, or from GeoSentinel sites that were not located in high-income countries., Results: There were 2517 cases, 82.3% giardiasis (n = 2072), 11.4% cryptosporidiosis (n = 287), 6.0% cyclosporiasis (n = 150) and 0.3% cystoisosporiasis (n = 8). Overall, most travellers were tourists (64.4%) on long trips (median durations: 18-30 days). Cryptosporidiosis more frequently affected people < 18 years (13.9%) and cyclosporiasis affected people ≥ 40 years (59.4%). Giardiasis was most frequently acquired in South Central Asia (45.8%) and sub-Saharan Africa (22.6%), cryptosporidiosis in sub-Saharan Africa (24.7%) and South-Central Asia (19.5%), cyclosporiasis in South East Asia (31.3%) and Central America (27.3%), and cystoisosporiasis in sub-Saharan Africa (62.5%). Cyclosporiasis cases were reported from countries of uncertain endemicity (e.g. Cambodia) or in countries with no previous evidence of this parasite (e.g. French Guiana). The time from symptom onset to presentation at a GeoSentinel site was the longest amongst travellers with giardiasis (median: 30 days). Over 14% of travellers with cryptosporidiosis were hospitalized., Conclusions: This analysis provides new insights into the epidemiology and clinical significance of four intestinal protozoa that can cause morbidity in international travellers. These data might help optimize pretravel advice and post-travel management of patients with travel-associated prolonged gastrointestinal illnesses. This analysis reinforces the importance of international travel-related surveillance to identify sentinel cases and areas where protozoal infections might be undetected or underreported., (© The Author(s) 2024. Published by Oxford University Press on behalf of International Society of Travel Medicine. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)