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BACKGROUND: Young adults 18-24 years old have the highest prevalence of cigarillo use, exposing young adults to comparable or higher nicotine levels and many of the same toxicants as combustible cigarettes. Identifying individual and product characteristics that increase the potential for persistent use is warranted. We sought to examine the interacting effects of depression symptoms and sweet flavoring on the rewarding and reinforcing value of cigarillo use. METHODS: 86 young adults (18-24 years old, 73.3 % male, 38.4 % White, 33.7 % Black, and 27.9 % Other) completed three laboratory visits assessing the subjective rewarding value (exposure paradigm), relative reinforcing value (computerized choice task), and absolute reinforcing value (ad libitum cigarillo smoking session) of sweet-flavored versus non-flavored cigarillos. Depression symptoms were measured with the 20-item Center for Epidemiologic Studies of Depression Scale and treated as a continuous variable. RESULTS: General linear models with the appropriate family link tested differences in depressive symptomology for each outcome. Irrespective of flavor, greater cigarillo subjective reward was reported across increasing depressive symptomology (B=.0.03 [95%CI=0.00, 0.05], p=.017). Across symptom levels, no significant differences were observed in the subjective reward and relative and absolute reinforcing values of sweet-flavored versus non-flavored cigarillos (ps >.05). CONCLUSIONS: Young adults with elevated depression find cigarillos more rewarding but not more reinforcing. They are not more vulnerable than young adults with lower symptom levels to sweet cigarillo flavoring. Public health prevention campaigns and tobacco product regulations aimed at preventing the initiation and escalation of young adult cigarillo use may impact young adults broadly.

Abstract The paralogs 9–13 Hox genes in mouse HoxA and HoxD clusters are critical for limb development. When both HoxA and HoxD clusters are deleted in mice, significant limb truncation is observed compared to the phenotypes of single and compound mutants of Hox9-13 genes in these clusters. In zebrafish, mutations in hox13 genes in HoxA- and HoxD-related clusters result in abnormal morphology of pectoral fins, homologous to forelimbs. However, the effect of the simultaneous deletions of entire HoxA- and HoxD-related clusters on pectoral fin development remains unknown. Here, we generated mutants with several combinations of hoxaa, hoxab, and hoxda cluster deletions and analyzed the pectoral fin development. In hoxaa −/− ;hoxab −/− ;hoxda −/− larvae, the endoskeletal disc and the fin-fold are significantly shortened in developing pectoral fins. In addition, we show that this anomaly is due to defects in the pectoral fin growth after the fin bud formation. Furthermore, in the surviving adult mutants, micro-CT scanning reveals defects in the posterior portion of the pectoral fin which is thought to represent latent regions of the limb. Our results further support that the functional role of HoxA and HoxD clusters is conserved in the paired appendage formation in bony fishes.

Oral health and general health are closely linked and dependent in humans. The total disappearance of teeth leads to the loss of proprioceptive control systems, the modification of the entire tissue system and therefore great psychological fragility. Pre-prosthetic surgery consists of restoring the osteo-mucosal tissues to allow the installation of a prosthesis. The objective: was to assess the need for pre-surgical prosthetic preparation for the totally edentulous at the CHU-CNOS of Bamako. Method and materials: This was a prospective, descriptive study extending over a period of 8 months (from January 1 to August 31, 2021). Patients seen at the removable prosthesis service for a consultation in whom a diagnosis of edentulism was made constituted the study population. We carried out an exhaustive recruitment of totally edentulous people received at the service for the completed removable prosthesis who agreed to participate in the study. The data were collected using an individual survey form and analyzed with SPSS version 20.0 software. Result: A total of 50 patients were registered, including 14 men or 28% and 36 women or 72%. The sex ratio was 0.38 in favor of women. The 60 to 69 age group was the most represented with 19% and the average age was 56 years. The demand for prosthetic restoration for aesthetic and functional purposes represented the reasons for consultation in 46%, 44% of cases and pain in 10% of cases the most expressed concern by patients. Oral hygiene was average 64%, good at 20% and poor at 16%. Tooth extraction represented 70% of cases, without surgery 20% of cases and osteotomy 10% of cases as pre-surgical prosthetic treatment. The ridge was poorly resorbed at 40%, moderately resorbed at 30%, very resorbed at 20% and the ridge was negative at 10%, 50% of patients did not wear a prosthesis, 34% of patients wore partial removable prostheses and 16% wore removable total prostheses. Among our patients 66% had normal frenulums, 22% had short frenulums and 12% had wide frenulums. Conclusion: This study made it possible to highlight the real needs in pre-surgical prosthetic preparation. Among these needs, multiple tooth extraction remains the most common pre-prosthetic surgical procedure.

The management of the aesthetic parameter represents an important factor in the integration of removable prostheses. The current major social interest in beauty has made patients more and more demanding with regard to their appearance. [1] The main objective of this study was to assess the aesthetic expectations of patients with removable prostheses at the CHU-CNOS in Bamako. Our prospective and descriptive study having collected 78 patients was carried out over a period from March 2, 2019 to March 9, 2020 at the removable prosthesis department of the CHU-CNOS in Bamako. The female sex represented 55.1% with a sex ratio of 0.65. Removable prosthetic rehabilitation mainly concerned young adults aged 21-41 (41%) Aesthetics was the main reason for rehabilitation most represented with 60.3% of cases. The white tooth was the most requested dental shade with 70.5% of cases Bonded teeth were the most represented in our patients with 71.79% of cases. Pink gum was the shade most requested by our patients with 43.6% of cases. Obtaining a personalized prosthesis in harmony with the facial framework, giving the illusion of naturalness and restoring the smile to patients is the objective to be achieved.

The management of the aesthetic parameter represents an important factor in the integration of removable prostheses. The current major social interest in beauty has made patients more and more demanding with regard to their appearance. [1] The main objective of this study was to assess the aesthetic expectations of patients with removable prostheses at the CHU-CNOS in Bamako. Our prospective and descriptive study having collected 78 patients was carried out over a period from March 2, 2019 to March 9, 2020 at the removable prosthesis department of the CHU-CNOS in Bamako. The female sex represented 55.1% with a sex ratio of 0.65. Removable prosthetic rehabilitation mainly concerned young adults aged 21-41 (41%) Aesthetics was the main reason for rehabilitation most represented with 60.3% of cases. The white tooth was the most requested dental shade with 70.5% of cases Bonded teeth were the most represented in our patients with 71.79% of cases. Pink gum was the shade most requested by our patients with 43.6% of cases. Obtaining a personalized prosthesis in harmony with the facial framework, giving the illusion of naturalness and restoring the smile to patients is the objective to be achieved

BACKGROUND: Research examining the connections between individual adverse childhood experiences (ACEs) and how groupings of interrelated adversities are linked with subsequent health is scarce, limiting our understanding of risk during a period of rapid expansion of ACE screening in clinical practice. The study objective was to conduct a psychometric analysis to derive latent domains of ACEs and related life events and assess the association between each domain and health outcome. METHODS: Participants (3 months-11 years) were recruited from the University of California San Francisco Benioffs Children Hospital Oakland Primary Care Clinic. Children were screened with the Pediatric ACEs and Related Life Events Screener (PEARLS) (n = 340), which assessed 17 total ACEs and related life events, including forms of abuse, household challenges, and social risks. Domains were constructed using confirmatory factor analysis and associations between the three identified domains and 14 health outcomes were assessed using multivariable linear and logistic regression models. RESULTS: Three PEARLS domains were identified: Maltreatment (ω = 0.73, ɑ=0.87), Household Challenges (ω = 0.70, ɑ=0.82), and Social Context (ω = 0.55, ɑ=0.70). Measurement invariance was supported across both gender and screening format. All domains were associated with poorer general and behavioral health and stomachaches. Maltreatment and Social Context were additionally associated with eczema while only Social Context was associated with increased odds of reporting headaches and somatic symptoms. CONCLUSION: In an underserved, urban west-coast pediatric population, the PEARLS found three adversity domains of Maltreatment, Household Challenges, and Social Context that all had an independent statistically significant association with poorer child health. The results provide a timely and more nuanced representation of risk that can inform clinical practice and policy using more targeted resources and interventions.

ObjectiveThis study aimed to examine relationships between adverse childhood experiences (ACEs) and related life events and allostatic load (AL)-"wear and tear" from chronic stress-in a pediatric population.MethodsChildren were screened with the PEdiatric ACEs and Related Life Event Screener (PEARLS) tool, a 17-item questionnaire capturing experiences of abuse, neglect, household challenges, and related life events. Biological data were available for 207 participants, and AL was operationalized using clinical or empirical cutoff points across 4 physiological systems (i.e., cardiac, metabolic, inflammatory, neurologic). Covariate-adjusted multivariable regression models were used to examine associations between AL with adversity and health.ResultsChildren (mean age = 6.5 years, range = 1-11 years) had an average AL score of 1.9 (standard deviation = 1.7), and a U-shaped relationship was observed with child's age. Continuous PEARLS and original ACE scores were not associated with AL. However, children with a reported PEARLS score of 1 to 2 or original ACEs score of 1 to 3 had 1.5 (incidence rate ratio [IRR] = 1.50, 95% confidence interval [CI] = 1.09-2.08) and 1.4 (IRR = 1.41, 95% CI = 1.08-1.84) times greater AL, respectively, compared with participants with none reported. In secondary analyses, caregiver mental illness was associated with higher child AL (adjusted IRR = 1.27, 95% CI = 1.01-1.58). AL was also associated with poorer perceived child general health (adjusted β = -0.87, 95% CI = -1.58 to -0.15) and greater odds of child obesity (adjusted odds ratio = 1.51, 95% CI = 1.23-1.89).ConclusionsMeasuring AL in a pediatric population requires careful consideration of age. Higher AL was associated with a greater number of reported adversities and worse child health.

Abstract: This study set out to explore the process writing approach as a more viable method of teaching essay-writing to English as a Foreign Language (EFL) second year students at FLSL. This research used the mixed methods approach. In the qualitative part, an interview was used. The interview participants provided an understanding of FLSL English second year students’ essay-writing problems, the causes of their lack of proficiency and their areas of difficulty. Different major themes emerged from the interview data that explained respondents’ perceptions about the students’ writing difficulties. The quantitative part of the study used the quasi-experimental design. The researchers used essay tests to collect quantitative data. Again, the researchers did the intervention. Data revealed that the EFL second year students’ writing problems included Grammar, Reading and vocabulary. The analysis of the students’ essay written scripts revealed that the students made great improvement in their essay-writing as a result of their exposure to process writing approach. It was found that the use of the process approach can help EFL students in Mali enhance their writing performance. In the post-test students produce better written texts than they did in the pre-test. In fact, the results of the post-test also showed that the students made good progress in terms of grammar, vocabulary, spelling, and organization of ideas. Based on the findings of the study, it was finally recommended that the process approach be used as a dominant method of instruction in essay writing classes. Keywords: EFL Writing, Effectiveness, Essay, Performance, Process Approach.

Background: Young adults 18–24 years old have the highest prevalence of cigarillo use, exposing young adults to comparable or higher nicotine levels and many of the same toxicants as combustible cigarettes. Identifying individual and product characteristics that increase the potential for persistent use is warranted. We sought to examine the interacting effects of depression symptoms and sweet flavoring on the rewarding and reinforcing value of cigarillo use. Methods: 86 young adults (18–24 years old, 73.3 % male, 38.4 % White, 33.7 % Black, and 27.9 % Other) completed three laboratory visits assessing the subjective rewarding value (exposure paradigm), relative reinforcing value (computerized choice task), and absolute reinforcing value (ad libitum cigarillo smoking session) of sweet-flavored versus non-flavored cigarillos. Depression symptoms were measured with the 20-item Center for Epidemiologic Studies of Depression Scale and treated as a continuous variable. Results: General linear models with the appropriate family link tested differences in depressive symptomology for each outcome. Irrespective of flavor, greater cigarillo subjective reward was reported across increasing depressive symptomology (B=.0.03 [95%CI=0.00, 0.05], p=.017). Across symptom levels, no significant differences were observed in the subjective reward and relative and absolute reinforcing values of sweet-flavored versus non-flavored cigarillos (p’s >.05). Conclusions: Young adults with elevated depression find cigarillos more rewarding but not more reinforcing. They are not more vulnerable than young adults with lower symptom levels to sweet cigarillo flavoring. Public health prevention campaigns and tobacco product regulations aimed at preventing the initiation and escalation of young adult cigarillo use may impact young adults broadly.

IntroductionPrimary care-based interventions that promote nurturing caregiving relationships and early relational health may help mitigate toxic stress and promote resilience in children. This pilot study aims to: (1) describe a novel group-based, psychoeducational primary care intervention for children experiencing adverse childhood experiences (ACEs) ("The Resiliency Clinic"), (2) assess program feasibility and acceptability, and (3) explore effects on child/caregiver behavioral health.MethodsIntervention design centered on promoting supportive caregiving, caregiver/child self-regulation and co-regulation and teaching evidence-based stress management tools. Program feasibility and acceptability were assessed through attendance data and caregiver focus groups. Behavioral health measures were obtained at baseline and 8-month follow-up.ResultsOf 101 eligible families, 38 (37.6%) enrolled and attended a median of 3.00 (mean = 2.95, sd = 1.75) out of 6 sessions. Caregivers reported high satisfaction and benefits including stress management tools and connection with staff and other parents. There were modest, statistically non-significant improvements in caregiver stress (d = 0.23) and child executive functioning (d = 0.27).DiscussionIn conclusion, a group intervention teaching supportive caregiving and stress mitigation is feasible and acceptable for many families in an urban federally qualified health center (FQHC) with a signal for modest improvements in behavioral health. Future program iterations will seek to address participation barriers and expand the intervention's capacity to promote early relational health.

Objectives: The association between thrombocytopenia and parasite density or disease severity is described in numerous studies. In recent years, several studies described the protective role of platelets in directly killing Plasmodium parasites, mediated by platelet factor 4 (PF4) binding to Duffy antigen. This study aimed to evaluate the protective role of platelets in young children who are Duffy antigen-negative, such as those in sub-Saharan Africa. Methods: A zero-inflated negative binomial model was used to relate platelet count and parasite density data collected in a longitudinal birth cohort. Platelet factors were measured by enzyme-linked immunosorbent assay in samples collected from malaria-infected children who participated in a cross-sectional study. Results: We described that an increase of 10,000 platelets/μl was associated with a 2.76% reduction in parasite count. Increasing levels of PF4 and CXCL7 levels were also significantly associated with a reduction in parasite count. Conclusions: Platelets play a protective role in reducing parasite burden in Duffy-negative children, possibly mediated through activation of the innate immune system.

Abstract Background The uptake of Intermittent Preventive Treatment of malaria in pregnancy using Sulfadoxine-Pyrimethamine (IPTp-SP) remains unacceptably low, with more than two-thirds of pregnant women in sub-Saharan Africa still not accessing the three or more doses recommended by the World Health Organisation (WHO). In contrast, the coverage of Seasonal Malaria Chemoprevention (SMC), a more recent strategy recommended by the WHO for malaria prevention in children under five years living in Sahelian countries with seasonal transmission, including Mali and Burkina-Faso, is high (up to 90%). We hypothesized that IPTp-SP delivery to pregnant women through SMC alongside antenatal care (ANC) will increase IPTp-SP coverage, boost ANC attendance, and increase public health impact. This protocol describes the approach to assess acceptability, feasibility, effectiveness, and cost-effectiveness of the integrated strategy. Methods and analysis This is a multicentre, cluster-randomized, implementation trial of IPTp-SP delivery through ANC + SMC vs ANC alone in 40 health facilities and their catchment populations (20 clusters per arm). The intervention will consist of monthly administration of IPTp-SP through four monthly rounds of SMC during the malaria transmission season (July to October), for two consecutive years. Effectiveness of the strategy to increase coverage of three or more doses of IPTp-SP (IPTp3 +) will be assessed using household surveys and ANC exit interviews. Statistical analysis of IPT3 + and four or more ANC uptake will use a generalized linear mixed model. Feasibility and acceptability will be assessed through in-depth interviews and focus group discussions with health workers, pregnant women, and women with a child

To clarify the mechanism of liberation in the comminution process of electronic scrap (e-scrap), we attempted to express the degree of liberation by first-order kinetic equation related to impact energy. Breakage energy measurements, comminution experiments, and discrete element method (DEM) simulations were conducted on two types of e-scrap with relatively simple structures. The mechanism of the liberation was estimated from the observation of the fractions in the comminution experiments. The results of the breakage energy measurements and DEM simulations supported the mechanism in terms of impact energy. The results of fitting first-order kinetic equations based on the cumulative specific impact energy from the DEM simulations and the degree of liberation in the experiments showed a high correlation. The fitting parameters of the firstorder kinetic equations were compared confirmed to be consistent with the mechanism of liberation and the breakage energy measurements, suggesting the numerical validity of the equations. In conclusion, it was shown that for e-scrap with relatively simple structures, the first-order kinetic equations of the cumulative specific impact energy calculated by DEM simulations can be used to evaluate the degree of liberation.

The dental prosthesis is defined as an artificial device intended to replace the missing tooth or teeth and the related tissues. Clinical reality places us in front of an infinite dental edentation situation. For the rehabilitation of missing teeth, it is often necessary to manage simultaneously the use of all prosthetic techniques: partial and total prosthesis, fixed prosthesis and implantology.The aim of this investigation is to evaluate dental prosthesis needs in the University Hospital of Odonto-Stomatology of Bamako (CHUOS).A survey was conducted at Bamako University Hospital over a period of one month. The study included 400 patients who consulted for making dental prosthesis. Patients with 1-4 teeth to replace in the maxillar represented 30, 1% of cases and 30,7% in the mandible. The results showed the highest rate concerning partial removable denture prosthesis preference (83%) in comparison with fixed prosthesis which represented only 8, 75% of cases. Also, the partial removable prosthesis was diagnosed in 52,25% of cases. Edentation can be the cause of several problems in the oral cavity, hence the need to sensitize the population of the importance of oral health and the importance of wearing the prosthesis in case of losing teeth.

Introduction: Uncompensated dental losses are the cause of functional and aesthetic disorders that require prosthetic treatment. The objective of this work was to assess the dental prosthetic rehabilitation needs of adult patients admitted for consultation in the odontostomatology service of the CSREF of Commune I of the district of Bamako. Materials and methods: our study was descriptive and cross-sectional involving 170 subjects admitted to consultations in the odontostomatology service of the CSREF in commune I of the district of Bamako, of both sexes, of adult age. The principle consisted in carrying out an oral and in particular prosthetic examination of each subject in the cabinet. Statistical analysis used SPSS version 21 software. Results: in the sample, the female sex was in the majority with 57.6% and a sex ratio of 0.73 in favor of men. The most represented missing tooth interval was 1 to 3 teeth with 69.7% of the sample in the maxilla and 71.2% in the mandible. Prosthesis wearers were 38.7% in the maxilla and 15.2% in the mandible. The prostheses worn were suitable in 76.5% of cases. The prevalence of the diagnosed therapeutic need was 62.4% PCP in the maxilla and 67.4% PCP in the mandible. But when the patient is asked to formulate a hypothesis of choice; 67.4% will choose the provisional resin PAP in the maxilla and 68.1% will choose the same type prosthesis in the mandible. The reasons may be due to financial constraints and limited access to oral health services for the poor. Conclusion: a better organization of the socio-health care system could facilitate the accessibility of underprivileged populations to prosthetic rehabilitation.

Cervical cancer (CC) is the second most common cancer in Western Africa, accounting for 12,000 cases and 6000 deaths annually. While vaccination against human papilloma virus (HPV) and CC screenings reduce the incidence and mortality of CC in many developed countries, 90% of CC deaths are in low-income countries. Lack of knowledge about the connection between HPV and CC, lack of access to vaccines and screenings, weak healthcare infrastructure, and stigma related to sexually transmitted diseases are among the factors that contribute to this disparity. Previously, we evaluated the knowledge of HPV and CC in Bamako, Mali, showing that knowledge of the link between HPV and CC was very low (less than 8% of participants) and that less than 3% of women were screened for CC. Subsequent implementation of a community-based education program and support for local clinics resulted in a five-fold increase in CC screening at the five participating clinics in 2015. In this study, we paired CC screenings of mothers with HPV vaccination of their daughters to target out-of-school (OOS) girls whom school-based vaccination campaigns would not reach. Our campaign resulted in a 10.7% increase in HPV vaccination.

BackgroundWhile there is growing support for screening for Adverse Childhood Experiences (ACEs), rigorous evidence on the efficacy and preference of screening methods is needed.ObjectiveTo examine caregiver: (1) rates of disclosure of their child's exposure to ACEs using item-level response (each item can be endorsed) versus aggregate-level response (only total score reported) screening format, (2) associations between family demographic factors and disclosure by screening format, and (3) emotional reaction and experience of screening formats in a diverse, low-income pediatric population.MethodsCaregiver participants (n = 367) were randomized to complete the Pediatric ACEs and Related Life Events Screener (PEARLS) tool, in an aggregate-level response vs item-level response format from 2016-2019. Select caregivers (n = 182) participated in debriefing interviews. T-test and chi-square analyses in 2019 compared PEARLS disclosure rates and reactions between the screening modalities. Regression models explored interactions with child characteristics. Thematic analysis of interview notes captured caregiver screening experience.ResultsPEARLS disclosure rates were significantly higher in the aggregate-level response compared to the item-level response screening arm (p

The Taoudéni Basin, spanning 20% of Burkina Faso, holds vital aquifers for the Sahel’s water security and development. However, limited understanding of these aquifers’ hydrodynamics, including the flow patterns, mineralization processes, and renewal rates, hinders sustainable management practices in this arid region. Therefore, this study aims to investigate the aquifer hydrodynamics, mineralization processes and groundwater renewal in the transboundary Taoudéni Basin. Through a combination of hydrogeochemical and isotopic analyses, alongside existing data, this study examines 347 physicochemical samples, 149 stable isotope samples, and 71 tritium samples collected from 2013 to 2022. The findings reveal mineralization and stable isotopes (δ18O, δ2H) spatially aligned with the groundwater flow direction, validating this and indicating potentially multiple independent aquifers. The predominant mineralization mechanisms involve silicate hydrolysis and carbonate dissolution, supplemented by minor processes like evaporitic dissolution and cation exchange. The anthropogenic influence suggests potential groundwater recharge with potential pollution in the “SAC1”, “SAC2”, “GFR”, “GGQ”, and “GKS” geological formations. The stable isotopes (δ18O, δ2H) indicate recharge occurred over 4.5 kyr B.P., while tritium (3H) analysis confirms the presence of old, mixed waters, indicating slow renewal. Overall, this study highlights the minimal recent recharge and limited renewal rates, questions tritium’s efficacy for old water detection, and emphasizes the need for sustainable management.

Abstract Background Research examining the connections between individual adverse childhood experiences (ACEs) and how groupings of interrelated adversities are linked with subsequent health is scarce, limiting our understanding of risk during a period of rapid expansion of ACE screening in clinical practice. The study objective was to conduct a psychometric analysis to derive latent domains of ACEs and related life events and assess the association between each domain and health outcome. Methods Participants (3 months-11 years) were recruited from the University of California San Francisco Benioff’s Children Hospital Oakland Primary Care Clinic. Children were screened with the Pediatric ACEs and Related Life Events Screener (PEARLS) (n = 340), which assessed 17 total ACEs and related life events, including forms of abuse, household challenges, and social risks. Domains were constructed using confirmatory factor analysis and associations between the three identified domains and 14 health outcomes were assessed using multivariable linear and logistic regression models. Results Three PEARLS domains were identified: Maltreatment (ω = 0.73, ɑ=0.87), Household Challenges (ω = 0.70, ɑ=0.82), and Social Context (ω = 0.55, ɑ=0.70). Measurement invariance was supported across both gender and screening format. All domains were associated with poorer general and behavioral health and stomachaches. Maltreatment and Social Context were additionally associated with eczema while only Social Context was associated with increased odds of reporting headaches and somatic symptoms. Conclusion In an underserved, urban west-coast pediatric population, the PEARLS found three adversity domains of Maltreatment, Household Challenges, and Social Context that all had an independent statistically significant association with poorer child health. The results provide a timely and more nuanced representation of risk that can inform clinical practice and policy using more targeted resources and interventions.

In Burkina Faso, human activities around water points in rural areas affect groundwater resources, which become unfit for consumption. Nearly 33.5% of boreholes are subject to point source pollution. The assessment of the evolution of such pollution should be monitored to assess groundwater quality. In addition, withdrawals for irrigation alone are estimated at 85%, i.e. 46% of the water demand, heightening the deterioration in quality while creating depression zones further leading to an increase in recharge. It is therefore critical to understand the evolution and fate of the transfer of pollutants in such environments. In this study, we aimed to model the transfer of pollutant and predict the future state of pollution using the MT3D-USGS Groundwater Solute Transport Simulator code through the Groundwater Modelling Software (GMS) over the period 2012–2062 (50 years). A mathematical model is further developed through inferential statistics and used as a surrogate model for comparison. The results showed that deterioration in water quality was more attributable to withdrawals, especially for Cyanide (Cn) and Arsenic (As). A rather slow degradation is reported for Lead (Pb), which extends over 22 km, and Fluoride (F), which extends from 4 to 10 km due to localized recharge. A faster degradation for Cn over a distance of 2–16 km and as from 3 to 11 km is also observed because of the geological setting of the subsoil. These results might assist decision-makers for the quantitative and qualitative management of groundwater resources, and the management of the basement aquifer in the area through the establishment of protection zones.

Introduction: People with mental illness (MI) are more likely to smoke cigarettes and less likely to receive treatment for tobacco use than the general population. Understanding factors associated with improved staff treatment of tobacco use in community mental health settings has received limited study. Methods: We used data from a completed cluster-randomized clinical trial that tested two interventions designed to increase treatment for tobacco use in mental health clinics. Among 222 clinic staff, we examined demographic and employment characteristics, changes in perceived skills, knowledge, and beliefs using the S-KAP (i.e., perceptions of staff responsibility to treat tobacco use; client quit motivation; client outcomes; and barriers) as predictors of change in clinician reported delivery of tobacco use treatment following training. Results: Clinician reported treatment of client tobacco use significantly increased from baseline to week 52 across both study arms (p

Immunity of human populations against viruses of the genus Orthopoxvirus, to which monkeypox virus (MPXV), variola virus, and vaccinia virus belong, has been questioned recently because of the emergence of [...]

Background Early infant diagnosis (EID) for HIV-exposed infants is essential due to high mortality during the first months of their lives. In Conakry (Guinea), timely EID is difficult as traffic congestion prevents the rapid transport of blood samples to the central laboratory. We investigated the cost-effectiveness of transporting EID blood samples by unmanned aerial vehicles (UAV), also known as drones.Methods and findings Using Monte Carlo simulations, we conducted a cost-effectiveness comparative analysis between EID blood samples transportation by on-demand UAV transportation versus the baseline scenario (ie, van with irregular collection schedules) and compared with a hypothetic on-demand motorcycle transportation system. Incremental cost-effectiveness ratio (ICER) per life-year gained was computed. Simulation models included parameters such as consultation timing (eg, time of arrival), motorcycle and UAV characteristics, weather and traffic conditions. Over the 5-year period programme, the UAV and motorcycle strategies were able to save a cumulative additional 834.8 life-years (585.1–1084.5) and 794.7 life-years (550.3–1039.0), respectively, compared with the baseline scenario. The ICER per life-year gained found were US$535 for the UAV strategy versus baseline scenario, US$504 for the motorcycle strategy versus baseline scenario and US$1137 per additional life-year gained for the UAV versus motorcycle strategy. Respectively, those ICERs represented 44.8%, 42.2% and 95.2% of the national gross domestic product (GDP) per capita in Guinea—that is, US$1194.Conclusion Compared with the baseline strategy, both transportation of EID blood samples by UAVs or motorcycles had a cost per additional life-year gained below half of the national GDP per capita and could be seen as cost-effective in Conakry. A UAV strategy can save more lives than a motorcycle one although the cost needed per additional life-year gained might need to consider alongside budget impact and feasibility considerations.

BackgroundAdverse Childhood Experiences (ACEs) are associated with behavioral, mental, and clinical outcomes in children. Tools that are easy to incorporate into pediatric practice, effectively screen for adversities, and identify children at high risk for poor outcomes are lacking.ObjectiveTo examine the relationship between caregiver-reported child ACEs and related life events with health outcomes.Participants and settingParticipants (0-11 years) were recruited from the University of California San Francisco Benioff's Children Hospital Oakland Primary Care Clinic. There were 367 participants randomized.MethodsParticipants were randomized 1:1:1 to item-level (item response), aggregate-level (total number of exposures), or no screening for ACEs (control arm) with the PEdiatric ACEs and Related Life Event Screener (PEARLS). We assessed 10 ACE categories capturing abuse, neglect, and household challenges, as well as 7 additional categories. Multivariable regression models were conducted.ResultsParticipants reported a median of 2 (IQR 1-5) adversities with 76 % (n = 279) reporting at least one adversity; participants in the aggregate-level screening arm, on average, disclosed 1 additional adversity compared to item-level screening (p = 0.01). Higher PEARLS scores were associated with poorer perceived child general health (adjusted B = -0.94, 95 %CI: -1.26, -0.62) and Global Executive Functioning (adjusted B = 1.99, 95 %CI: 1.51, 2.46), and greater odds of stomachaches (aOR 1.14; 95 %CI: 1.04-1.25) and asthma (aOR 1.08; 95 %CI 1.00, 1.17). Associations did not differ by screening arm.ConclusionIn a high-risk pediatric population, ACEs and other childhood adversities remain an independent predictor of poor health. Increased efforts to screen and address early-life adversity are necessary.

Abstract Background Diarrhoeal disease remains a significant cause of morbidity and mortality among the under-fives in many low- and middle-income countries. Changes to food safety practices and feeding methods around the weaning period, alongside improved nutrition, may significantly reduce the risk of disease and improve development for infants. We describe a protocol for a cluster randomised trial to evaluate the effectiveness of a multi-faceted community-based educational intervention that aims to improve food safety and hygiene behaviours and enhance child nutrition. Methods We describe a mixed-methods, parallel group, two-arm, superiority cluster randomised controlled trial with baseline measures. One hundred twenty clusters comprising small urban and rural communities will be recruited in equal numbers and randomly allocated in a 1:1 ratio to either treatment or control arms. The community intervention will be focussed around an ideal mother concept involving all community members during campaign days with dramatic arts and pledging, and follow-up home visits. Participants will be mother–child dyads (27 per cluster period) with children aged 6 to 36 months. Data collection will comprise a day of observation and interviews with each participating mother–child pair and will take place at baseline and 4 and 15 months post-intervention. The primary analysis will estimate the effectiveness of the intervention on changes to complementary-food safety and preparation behaviours, food and water contamination, and diarrhoea. Secondary outcomes include maternal autonomy, enteric infection, nutrition, child anthropometry, and development scores. A additional structural equation analysis will be conducted to examine the causal relationships between the different outcomes. Qualitative and health economic analyses including process evaluation will be done. Conclusions The trial will provide evidence on the effectiveness of community-based behavioural change interventions designed to reduce the burden of diarrhoeal disease in the under-fives and how effectiveness varies across different contexts. Trial registration ISRCTN14390796. Registration date December 13, 2021