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BackgroundCutaneous and mucocutaneous leishmaniasis (CL/ML) cause significant morbidity globally and are vulnerable to changes from environmental events and conflict. In this ecological study, we aim to measure the associations between annual CL/ML cases, conflict intensity, and environmental factors between 2005 and 2022 globally.MethodsWe pulled annual case data from the WHO for 52 nations that had conflict intensity scores (ranging from 1-10) from the Bertelsmann Transformation Index. Using Earth observation tools, we gathered temperature, precipitation, vegetation, and humidity data, in addition to data on annual estimates of population, internal displacement, and GDP. We fit a negative binomial generalized additive model with a random nation-level intercept.ResultsConflict was positively associated with increased CL/ML across the studied nations (IRR: 1.09, 95% CI: 1.01-1.16, p = 0.02). Given this, intense conflict (a score of ten) was associated with over double the risk of CL/ML compared to the lowest conflict levels (score of one). We also identified a curvilinear relationship between mean temperature and cases, as well as between vegetation level and cases. Each had small pockets of significant increased and decreased risk, respectively. Larger mean humidity ranges were negatively associated with cases. Importantly, the relationship between conflict intensity and cases was mediated by displacement.DiscussionConflict is significantly associated with increased CL/ML cases. This is especially true at higher conflict levels, marking when conflict turns violent. The destruction of critical infrastructure (e.g., that related to healthcare, water, and sanitation) often seen during conflict could drive this association. Such environments can be hospitable to sandflies and can heighten individuals' vulnerability through increased malnutrition, poverty, and displacement. Understanding this relationship is crucial for public health preparedness and response, especially as conflicts become increasingly violent and protracted.

Sensory Over-Responsivity (SOR) is an increasingly recognized challenge among children with neurodevelopmental concerns (NDC). To investigate, we characterized the incidence of auditory and tactile over-responsivity (AOR, TOR) among 82 children with NDC. We found that 70% of caregivers reported concern for their child's sensory reactions. Direct assessment further revealed that 54% of the NDC population expressed AOR, TOR, or both -- which persisted regardless of autism spectrum disorder (ASD) diagnosis. These findings support the high prevalence of SOR as well as its lack of specificity to ASD. Additionally, AOR is revealed to be over twice as prevalent as TOR. These conclusions present several avenues for further exploration, including deeper analysis of the neural mechanisms and genetic contributors to sensory processing challenges.

BackgroundYemen continues to endure cholera outbreaks during ongoing conflict and destructive environmental events. Air raids have been used throughout the conflict to target military and civilian infrastructure. We aimed to assess the association between air raids and cholera incidence while taking into account geographical, environmental, economic, and demographic factors that drive outbreaks.MethodsIn this ecological modelling study, we used data from Sept 12, 2016, to Dec 29, 2019, for the number of air raids, vegetation coverage, surface water, precipitation, temperature, economic variables, and cholera case and population data to model the association between conflict and the weekly incidence of cholera (per 100 000 people) in Yemen. Data were transformed into weekly intervals and governorates were categorised according to air raid severity (the number of raids in the previous 3 months). We used a negative binomial generalised additive model that accounted for geographical location and environmental, temporal, economic, and demographic variables to estimate incidence rate ratios for the association between air raid severity and cases of cholera.FindingsDuring the study period, 2 107 912 cases of cholera were reported in Yemen, and a minimum of 11 366 air raids were recorded. After controlling for relevant factors, compared with no air raids, all other levels of air raid severity were significantly associated with cholera incidence. The largest effect was noted in governorates with severe air raid levels (ie, ≥76 during the previous 3 months), which had an incidence rate ratio of 2·06 (95% CI 1·59-2·69; p

The earthquakes in Türkiye and Syria in February, 2023, have caused further devastation in northwest Syria-an area already affected by protracted armed conflict, mass forced displacement, and inadequate health and humanitarian provision. The earthquake damaged infrastructure supporting water, sanitation, and hygiene, and health-care facilities. The disruptions to epidemiological surveillance and ongoing disease control measures resulting from the earthquake will accelerate and expand ongoing and new outbreaks of many communicable diseases including measles, cholera, tuberculosis, and leishmaniasis. Investing in existing early warning and response network activities in the area is essential. Antimicrobial resistance, which had already been an increasing concern in Syria before the earthquake, will also be exacerbated given the high number of traumatic injuries and breakdown of antimicrobial stewardship, and the collapse of infection prevention and control measures. Tackling communicable diseases in this setting requires multisectoral collaboration at the human-animal-environment nexus given the effect of the earthquakes on all these sectors. Without this collaboration, communicable disease outbreaks will further strain the already overburdened health system and cause further harm to the population.

There are Software Test problems that may not be solved with traditional software engineering techniques.Nevertheless, such problems may be modeled mathematically in order to be solved with mathematical optimization, specially with the use of metaheuristics. In this context, a new research field called Search based Software Engineering (SBSE), which deals with solving software engineering problems by means of optimization techniques, has emerged. Given the significance of the Software Testing phase, a specific subarea called Search Based Software Testing (SBST) has become increasingly important. This paper presents the current state of the area and summarizes its future potential. Initially, we describe the main metaheuristics techniques used in the area. We follow with the presentation of the state of the art of SBST through the description of the main problems that have already been modeled and the results achieved. From the results, we can realize the promise of this field.

Health care among forcibly displaced persons is frequently driven by siloed approaches. Aspects of the built environment, social factors, and the bidirectional relationship between the changing ecosystem and residents are often ignored in health policy design and implementation. While recognizing factors that create a preference for siloed approaches and appreciating the work of humanitarian agencies, we argue for a new data-driven and holistic approach to understand the health of the forcibly displaced. It should be rooted in the realities of the emergence of new diseases, dynamic demographics, and degrading environments around the displaced communities. Such an approach envisions refugee and internally displaced camps as dynamic, complex ecosystems that alter, and are altered by, spatial and temporal factors. At the root of this approach is the necessity to work across disciplines, to think holistically, to go beyond treating single ailments, and to develop ethical approaches that provide dignity to those who are forcibly displaced.

Introduction: The scarcity of available organs for kidney transplantation has resulted in a substantial waiting time for patients with end-stage kidney disease. This prolonged wait contributes to an increased risk of cardiovascular mortality. Calcification of large arteries is a high-risk factor in the development of cardiovascular diseases, and it is common among candidates for kidney transplant. The aim of this study was to correlate abdominal arterial calcification (AAC) score value with mortality on the waitlist. Methods: We modified the coronary calcium score and used it to quantitate the AAC. We conducted a retrospective clinical study of all adult patients who were listed for kidney transplant, between 2005 and 2015, and had abdominal computed tomography scan. Patients were divided into two groups: those who died on the waiting list group and those who survived on the waiting list group. Results: Each 1,000 increase in the AAC score value of the sum score of the abdominal aorta, bilateral common iliac, bilateral external iliac, and bilateral internal iliac was associated with increased risk of death (HR 1.034, 95% CI: 1.013, 1.055) (p = 0.001). This association remained significant even after adjusting for various patient characteristics, including age, tobacco use, diabetes, coronary artery disease, and dialysis status. Conclusion: The study highlights the potential value of the AAC score as a noninvasive imaging biomarker for kidney transplant waitlist patients. Incorporating the AAC scoring system into routine imaging reports could facilitate improved risk assessment and personalized care for kidney transplant candidates.

Background: One in six children worldwide lives in a region exposed to armed conflict. In conflicts, children are among the most vulnerable, and at risk of adverse health outcomes. We sought to describe trends in child and adolescent morbidity in northwest Syria (NWS) and understand how forced displacement affects clinical utilisation during the Syrian conflict. Methods: Retrospective data between January 2018 and December 2022 were obtained from the Syrian American Medical Society (SAMS), a non-governmental organisation that operates health facilities in NWS. After initial descriptive analyses were completed, we performed a seasonal-trend decomposition to estimate the seasonality of clinical presentations. We subsequently employed a multivariate regression model incorporating age, gender, residency status, season, and a random district-level intercept to measure the association between the odds of clinical consultation and forced displacement. Findings: Across 51 reporting SAMS facilities, 2,687,807 clinical consultations were studied over a five-year period. Seasonality was demonstrated for every clinical consultation category. Higher levels of forced displacement were associated with increased odds of consultations for nutrition, trauma, NCDs and mental health and decreased odds of consultation for communicable diseases. Aside from traumatic injury, internally displaced persons (IDPs) had higher AORs of clinical consultations compared to host populations. Interpretation: Forced displacement differentially impacts clinical utilisation among children in northwest Syria, and the effects of displacement persist for at least six months. Clinical needs vary by host/IDP status, sex, age, and season. This study can assist policymakers in forecasting the health needs of children in northwest Syria.

Building a research-practice partnership that spans two or more organizations can be challenging. University researchers, for instance, may find themselves in schools or departments where the incentives and culture favor more individualistic, single-discipline research projects. Practitioners and policy makers may not see the value of investing in research and evaluation, or they may hesitate to prioritize this work above more pressing operational and strategic aims. In this article, Maia Connors, Debra M. Pacchiano, Amanda G. Stein, and Mallary I. Swartz show how an "embedded partnership" between the program implementation and research teams within a single nonprofit organization (Start Early, formerly the Ounce of Prevention Fund) can help overcome such challenges and build important capacities that research-practice partnerships need in order to be effective: an organizational culture that values research evidence, sound measurement, and continuous learning; interdisciplinary expertise; and sustainable infrastructure, including administrative support, technology, and financial resources.

Sensory Over-Responsivity (SOR) is an increasingly recognized challenge among children with neurodevelopmental concerns (NDC). To investigate, we characterized the incidence of auditory and tactile over-responsivity (AOR, TOR) among 82 children with NDC. We found that 70% of caregivers reported concern for their child's sensory reactions. Direct assessment further revealed that 54% of the NDC population expressed AOR, TOR, or both - which persisted regardless of autism spectrum disorder (ASD) diagnosis. These findings support the high prevalence of SOR as well as its lack of specificity to ASD. Additionally, AOR is revealed to be over twice as prevalent as TOR. These conclusions present several avenues for further exploration, including deeper analysis of the neural mechanisms and genetic contributors to sensory processing challenges.

ObjectiveNorthern Syria faces a large burden of influenza-like illness (ILI) and severe acute respiratory illness (SARI). This study aimed to investigate the trends of Early Warning and Response Network (EWARN) reported ILI and SARI in northern Syria between 2016 and 2021 and the potential impact of SARS-CoV-2.MethodsWe extracted weekly EWARN data on ILI/ SARI and aggregated cases and consultations into 4-week intervals to calculate case positivity. We conducted a seasonal-trend decomposition to assess case trends in the presence of seasonal fluctuations.ResultsIt was observed that 4-week aggregates of ILI cases (n = 5,942,012), SARI cases (n = 114,939), ILI case positivity, and SARI case positivity exhibited seasonal fluctuations with peaks in the winter months. ILI and SARI cases in individuals aged ≥5 years surpassed those in individuals aged

Abstract Background Sensory processing dysfunction (SPD) is linked to altered white matter (WM) microstructure in school-age children. Sensory over-responsivity (SOR), a form of SPD, affects at least 2.5% of all children and has substantial deleterious impact on learning and mental health. However, SOR has not been well studied using microstructural imaging such as diffusion MRI (dMRI). Since SOR involves hypersensitivity to external stimuli, we test the hypothesis that children with SOR require compensatory neuroplasticity in the form of superior WM microstructural integrity to protect against internalizing behavior, leaving those with impaired WM microstructure vulnerable to somatization and depression. Methods Children ages 8–12 years old with neurodevelopmental concerns were assessed for SOR using a comprehensive structured clinical evaluation, the Sensory Processing 3 Dimensions Assessment, and underwent 3 Tesla MRI with multishell multiband dMRI. Tract-based spatial statistics was used to measure diffusion tensor imaging (DTI) and neurite orientation dispersion and density imaging (NODDI) metrics from global WM and nineteen selected WM tracts. Correlations of DTI and NODDI measures with measures of somatization and emotional disturbance from the Behavioral Assessment System for Children, 3rd edition (BASC-3), were computed in the SOR group and in matched children with neurodevelopmental concerns but not SOR. Results Global WM fractional anisotropy (FA) is negatively correlated with somatization and with emotional disturbance in the SOR group but not the non-SOR group. Also observed in children with SOR are positive correlations of radial diffusivity (RD) and free water fraction (FISO) with somatization and, in most cases, emotional disturbance. These effects are significant in boys with SOR, whereas the study is underpowered for girls. The most affected white matter are medial lemniscus and internal capsule sensory tracts, although effects of SOR are observed in many cerebral, cerebellar, and brainstem tracts. Conclusion White matter microstructure is related to affective behavior in children with SOR.

Widespread destruction from the Yemeni Civil War (2014-present) triggered the world's largest cholera outbreak. We compiled a comprehensive health dataset and created dynamic maps to demonstrate spatiotemporal changes in cholera infections and war conflicts. We aligned and merged daily, weekly, and monthly epidemiological bulletins of confirmed cholera infections and daily conflict events and fatality records to create a dataset of weekly time series for Yemen at the governorate level (subnational regions administered by governors) from 4 January 2016 through 29 December 2019. We demonstrated the use of dynamic mapping for tracing the onset and spread of infection and manmade factors that amplify the outbreak. We report curated data and visualization techniques to further uncover associations between infectious disease outbreaks and risk factors and to better coordinate humanitarian aid and relief efforts during complex emergencies.

Background On September 10, 2022, a cholera outbreak was declared in Syria for the first time in over a decade of protracted conflict. As of May 20, 2023, 132,782 suspected cases had been reported, primarily in northwest and northeast Syria. We aim to provide a detailed description of water sources and clinical status of a patient cohort seen at a cholera treatment center (CTC) in northwest Syria.

Critical temporal changes such as weekly fluctuations in surveillance systems often reflect changes in laboratory testing capacity, access to testing or healthcare facilities, or testing preferences. Many studies have noted but few have described day-of-the-week (DoW) effects in SARS-CoV-2 surveillance over the major waves of the novel coronavirus 2019 pandemic (COVID-19). We examined DoW effects by non-pharmaceutical intervention phases adjusting for wave-specific signatures using the John Hopkins University's (JHU's) Center for Systems Science and Engineering (CSSE) COVID-19 data repository from 2 March 2020 through 7 November 2021 in Middlesex County, Massachusetts, USA. We cross-referenced JHU's data with Massachusetts Department of Public Health (MDPH) COVID-19 records to reconcile inconsistent reporting. We created a calendar of statewide non-pharmaceutical intervention phases and defined the critical periods and timepoints of outbreak signatures for reported tests, cases, and deaths using Kolmogorov-Zurbenko adaptive filters. We determined that daily death counts had no DoW effects; tests were twice as likely to be reported on weekdays than weekends with decreasing effect sizes across intervention phases. Cases were also twice as likely to be reported on Tuesdays-Fridays (RR = 1.90-2.69 [95%CI: 1.38-4.08]) in the most stringent phases and half as likely to be reported on Mondays and Tuesdays (RR = 0.51-0.93 [0.44, 0.97]) in less stringent phases compared to Sundays; indicating temporal changes in laboratory testing practices and use of healthcare facilities. Understanding the DoW effects in daily surveillance records is valuable to better anticipate fluctuations in SARS-CoV-2 testing and manage appropriate workflow. We encourage health authorities to establish standardized reporting protocols.

The Global Task Force on Cholera Control (GTFCC) created a strategy for early outbreak detection, hotspot identification, and resource mobilization coordination in response to the Yemeni cholera epidemic. This strategy requires a systematic approach for defining and classifying outbreak signatures, or the profile of an epidemic curve and its features. We used publicly available data to quantify outbreak features of the ongoing cholera epidemic in Yemen and clustered governorates using an adaptive time series methodology. We characterized outbreak signatures and identified clusters using a weekly time series of cholera rates in 20 Yemeni governorates and nationally from 4 September 2016 through 29 December 2019 as reported by the World Health Organization (WHO). We quantified critical points and periods using Kolmogorov-Zurbenko adaptive filter methodology. We assigned governorates into six clusters sharing similar outbreak signatures, according to similarities in critical points, critical periods, and the magnitude of peak rates. We identified four national outbreak waves beginning on 12 September 2016, 6 March 2017, 28 May 2018, and 28 January 2019. Among six identified clusters, we classified a core regional hotspot in Sana'a, Sana'a City, and Al-Hudaydah-the expected origin of the national outbreak. The five additional clusters differed in Wave 2 and Wave 3 peak frequency, timing, magnitude, and geographic location. As of 29 December 2019, no governorates had returned to pre-Wave 1 levels. The detected similarity in outbreak signatures suggests potentially shared environmental and human-made drivers of infection; the heterogeneity in outbreak signatures implies the potential traveling waves outwards from the core regional hotspot that could be governed by factors that deserve further investigation.

In September 2022, the Syrian Ministry of Health declared a cholera outbreak after a surge of acute watery diarrhea cases. Since then, cases have been reported across Syria, particularly in the northwest. This ongoing outbreak reflects a pattern of politicizing water, humanitarian response, and health throughout the country's protracted conflict. Interference with water, sanitation, and hygiene (WASH) infrastructure has been a key component of this politicization, impeding detection, prevention, case management, and control. Droughts and floods have exacerbated the WASH situation, as have the early 2023 Türkiye-Syria earthquakes. The humanitarian response after the earthquakes has also faced politicization, leading to increased risk of surges in cases of cholera and other waterborne diseases. This has all occurred in a conflict where health care has been weaponized, attacks on health care and related infrastructure are the norm, and syndromic surveillance and outbreak response have been influenced and restricted by politics. Cholera outbreaks are entirely preventable; what we see in Syria is cholera reflecting the myriad ways in which the right to health has been brought under fire in the Syrian conflict. The recent earthquakes are additional assaults, which raise urgent concerns that a surge of cholera cases, particularly in northwest Syria, may now become uncontrolled.

Military field hospitals typically provide essential medical care in combat zones. In recent years, the United States (US) Army has deployed these facilities to assist domestic humanitarian emergency and natural disaster response efforts. As part of the nation's whole-of-government approach to the coronavirus disease (COVID-19) pandemic, directed by the Federal Emergency Management Agency and the Department of Health and Human Services, during New York City's (NYC) initial surge of COVID-19, from 26 March to 1 May 2020, the US Army erected the Javits New York Medical Station (JNYMS) field hospital to support the city's overwhelmed healthcare system. The JNYMS tasked a nutrition operations team (NuOp) to provide patient meals and clinical nutrition evaluations to convalescent COVID-19 patients. However, few guidelines were available for conducting emergency nutrition and dietary response efforts prior to the field hospital's opening. In this case study, we summarize the experiences of the NuOp at the JNYMS field hospital, to disseminate the best practices for future field hospital deployments. We then explain the challenges in service performance, due to information, personnel, supply, and equipment shortages. We conclude by describing the nutrition service protocols that have been implemented to overcome these challenges, including creating a standardized recordkeeping system for patient nutrition information, developing a meal tracking system to forecast meal requirements with food service contractors, and establishing a training and staffing model for military-to-civilian command transition. We highlight the need for a standardized humanitarian emergency nutrition service response framework and propose a Nutrition Response Toolkit for Humanitarian Crises, which offers low-cost, easily adaptable operational protocols for implementation in future field hospital deployments.

ObjectivesThe protracted and violent conflict in Syria has resulted in large-scale displacement of people and destruction of health and sanitation infrastructure. The aim of this study was to examine epidemiological trends in vector-borne disease (VBD) outbreaks before and following the onset of the Syrian conflict (2011).MethodsProMED, a digital disease surveillance tool, was queried for VBD outbreak reports affecting humans and animals in Syria and select bordering countries between 2003 and 2018. Data were normalized by dividing the number of unique VBD events by the total number of unique outbreak events reported by ProMED for each year. Suspected and confirmed case counts and deaths were manually extracted.ResultsReports on VBDs increased from a mean of 2.9/year pre-2011 to 12.8/year post-2011, a 343.5% (p < 0.05) increase. After normalization, reports increased by 485.5% (p < 0.05) over the time periods. Post-2011, the most commonly reported VBDs were leishmaniasis, Crimean-Congo hemorrhagic fever, and lumpy skin disease. Reported numbers of suspected and confirmed cases and deaths increased during the conflict period.ConclusionsVBD outbreak events in ProMED increased in Syria and select bordering countries after the onset of the Syrian conflict in 2011. Enhanced disease surveillance is critical to detect and manage outbreaks in conflict settings.

IntroductionSensory Processing Dysfunction (SPD) is common yet understudied, affecting up to one in six children with 40% experiencing co-occurring challenges with attention. The neural architecture of SPD with Attention Deficit and Hyperactivity Disorder (ADHD) (SPD+ADHD) versus SPD without ADHD (SPD-ADHD) has yet to be explored in diffusion tensor imaging (DTI) and Neurite Orientation Dispersion and Density Imaging (NODDI) has yet to be examined.MethodsThe present study computed DTI and NODDI biophysical model parameter maps of one hundred children with SPD. Global, regional and voxel-level white matter tract measures were analyzed and compared between SPD+ADHD and SPD-ADHD groups.ResultsSPD+ADHD children had global WM Fractional Anisotropy (FA) and Neurite Density Index (NDI) that trended lower than SPD-ADHD children, primarily in boys only. Data-driven voxelwise and WM tract-based analysis revealed statistically significant decreases of NDI in boys with SPD+ADHD compared to those with SPD-ADHD, primarily in projection tracts of the internal capsule and commissural fibers of the splenium of the corpus callosum.ConclusionWe conclude that WM microstructure is more delayed/disrupted in boys with SPD+ADHD compared to SPD-ADHD, with NODDI showing a larger effect than DTI. This may represent the combined WM pathology of SPD and ADHD, or it may result from a greater degree of SPD WM pathology causing the development of ADHD.

Biographical features like social and economic status, ethnicity, sexuality, care roles, and gender unfairly disadvantage individuals within academia. Authorship patterns should reflect the social dimension behind the publishing process and co-authorship dynamics. To detect potential gender biases in the authorship of papers and examine the extent of women's contribution in terms of the substantial volume of scientific production in Ecology, we surveyed papers from the top-ranked journal Ecology from 1999 to 2021. We developed a Women's Contribution Index (WCI) to measure gender-based individual contributions. Considering gender, allocation in the author list, and the total number of authors, the WCI calculates the sum of each woman's contribution per paper. We compared the WCI with women's expected contributions in a non-gender-biased scenario. Overall, women account for 30% of authors of Ecology, yet their contribution to papers is higher than expected by chance (i.e., over-contribution). Additionally, by comparing the WCI with an equivalent Men's Contribution Index, we found that women consistently have higher contributions compared to men. We also observed a temporal trend of increasing women's authorship and mixed-gender papers. This suggests some progress in addressing gender bias in the field of ecology. However, we emphasize the need for a better understanding of the pattern of over-contribution, which may partially stem from the phenomenon of over-compensation. In this context, women might need to outperform men to be perceived and evaluated as equals. The WCI provides a valuable tool for quantifying individual contributions and understanding gender biases in academic publishing. Moreover, the index could be customized to suit the specific question of interest. It serves to uncover a previously non-quantified type of bias (over-contribution) that, we argue, is the response to the inequitable structure of the scientific system, leading to differences in the roles of individuals within a scientific publishing team. [ABSTRACT FROM AUTHOR]

The rat lungworm Angiostrongylus cantonensis is a zoonotic parasite and the main cause of eosinophilic meningitis in the world. Its main source of nutrients originates from the degradation of host hemoglobin in blood-feeding helminths, such as A. cantonensis. The purpose of this study was to analyze the ultrastructure of the intestinal cells by using of transmission electron microscopy (TEM). A. cantonensis worms obtained from Rattus norvegicus (norway rats) from endemic area were used for TEM. The ultrastructural analysis was performed using fragments cut from the middle part of the worms, and the TEM study revealed the cells with microvilli and nuclei containing areas of loose and condensed chromatin and the presence of macrovesicles and microvesicles of digestion and it was observed in this study that intestinal epithelium is look like a syncytium. The ultrastructural aspects of the intestinal cells surface of A. Cantonensis the indicate that the intestinal epithelium is a multinucleate mosaic or syncytium.