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Abstract To determine the diagnostic yield of cone beam computed tomography (CBCT) compared with 3 T magnetic resonance imaging (MRI) for the evaluation of subchondral insufficiency fractures of the knee. Consecutive patients with subchondral insufficiency fractures of the knee examined by 3 T MRI and CBCT of the femoral condyles were reviewed. Two experienced raters graded the lesion severity on 3 T MRI and CBCT images: grade 1: no signs of a subchondral bone lesion; grade 2: subchondral trabecular fracture or cystic changes, but without infraction of the subchondral bone plate; grade 3: collapse of the subchondral bone plate. Ratings were repeated after six weeks to determine reliability. In addition, the bone lesion size was measured as elliptical area (mm2) and compared between CBCT and T1-weighted MRI sequences. Among 30 patients included (43.3% women; mean age: 60.9 ± 12.8 years; body mass index (BMI) 29.0 ± 12.8 kg/m2), the medial femoral condyle was affected in 21/30 patients (70%). The grading of subchondral lesions between MRI and CBCT did not match in 12 cases (40%). Based on MRI images, an underestimation (i.e., undergrading) compared with CBCT was observed in nine cases (30%), whereas overgrading occurred in three cases (10%). Compared to CBCT, routine T1-weighted 3 T sequences significantly overestimated osseus defect zones in sagittal (84.7 ± 68.9 mm2 vs. 35.9 ± 38.2 mm2, p

The study aimed at exploring the teachers’ self-efficacy belief for teaching critical thinking skills and practices of strategies in reading classroom. It also pursued if there is any significant relationship between the two variables. A descriptive survey study used sequential explanatory mixed-methods approach to collect data. The study involved 40 EFL teachers. The survey contained 19 items using five-point Likert scale. Qualitative data were collected via classroom observations. The results of quantitative data showed(m=3.3) that the participants implemented the strategies moderately. The findings of qualitative data revealed that most of critical thinking strategies were practiced rarely while participants were instructing reading lessons. However, the responsive strategy of teachers to their students’ responses was implemented better than others. Statistical analysis also disclosed a positive high significant correlation between the teachers’ self-efficacy belief for teaching CT and its implementation strategies during teaching reading lessons (r=0.99, p

BackgroundDespite the prevalence of vaping nicotine, most nicotine cessation research remains focused on smoking cigarettes. However, the lived experience of quitting smoking is different from quitting vaping. As a result, research examining the unique experiences of those quitting vaping can better inform quitting resources and cessation programs specific to e-cigarette use. Examining Reddit forums (ie, subreddits) dedicated to the topics of quitting vaping nicotine can provide insight into the discussion around experiences on quitting vaping. Prior literature examining limited discussions around quitting vaping on Reddit has identified the sharing of barriers and facilitators for quitting, but more research is needed to investigate the content comprehensively across all subreddits. ObjectiveThe objective of this study is to examine content across quit vaping subreddits since their inception to better understand quitting vaping within the context of the expanding nicotine market. MethodsAll posts from January 2015 to October 2021 were scraped from all quit vaping subreddits: r/QuittingJuul, r/QuitVaping, r/quit_vaping, and r/stopvaping (N=7110). Rolling weekly average post volume was calculated. A codebook informed by a latent Dirichlet allocation topic model was developed to characterize themes in a subsample of 695 randomly selected posts. Frequencies and percentages of posts containing each coded theme were assessed along with the number of upvotes and comments. ResultsPost volume increased across all subreddits over time, spiking from August – September of 2019 when vaping lung injury emerged. Just over 52% of posts discussed seeking social support and 16.83% discussed providing social support. Posts providing support received the most positive engagements (i.e. upvotes) of all coded categories. Posts also discussed physical and psychological symptoms of withdrawal (30.65% and 18.85%, respectively), strategies for quitting including: quitting cold turkey (38.33%), using alternative nicotine products (17%), and tapering down nicotine content (10.50%). Most posts shared a personal narrative (92.37%) and some discussed quit motivation (28.20%) and relapse (14.99%). ConclusionsThis work identifies a desire for peer-to-peer support for quitting vaping, which reinforces existing literature and highlights characteristics of quitting vaping specific to a changing nicotine product environment. Given that posts providing social support were the most upvoted, this suggests that subreddit contributors are seeking support from their peers when discussing quitting vaping. Additionally, this analysis shows the sharing of barriers and facilitators for quitting, supporting findings from prior exploration of quit vaping subreddits. Finally, quitting vaping in an ever-growing nicotine market has led to the evolution of vaping-specific quit methods such as tapering down nicotine content. These findings have direct implications for quit vaping product implementation and development.

Bone is a dynamic tissue that is constantly remodeled throughout adult life. Recently, it has been shown that bone turnover decreases shortly after food consumption. This process has been linked to the fermentation of non-digestible food ingredients such as inulin by gut microbes, which results in the production of the short-chain fatty acids (SCFAs) acetate, propionate and butyrate. SCFAs exert various metabolic functions, which in part can be explained by activation of G protein-coupled receptors (Gpr) 41 and 43. However, the potential relevance of a SCFA-Gpr41/43 signaling axis for bone metabolism has not been established. The aim of our study is to investigate the role of Gpr41/43 in bone metabolism and osteogenic differentiation of mesenchymal stem cells. For this purpose, we analyzed the skeletal phenotype of wild type controls (WT) and Gpr41/43 double knockout (Gpr41/43 dKO) mice fed either a chow or an inulin-enriched diet. In addition, we isolated bone marrow derived mesenchymal stem cells from WT and Gpr41/43 dKO mice and differentiated them into osteoblasts in the absence or presence of acetate. MicroCT scanning of femoral bones of Gpr41/43 dKO mice revealed a significant increase of trabecular bone volume and trabecular compared to WT controls. Treatment of WT bone marrow-derived osteoblasts with acetate resulted in decreased mineralization and substantial downregulation of bone formation markers such as Phex, Ptgs2 and Col1a1. Notably, this effect was strongly attenuated in differentiated osteoblasts lacking Gpr41/43. Inversely, acetate supplementation resulted in higher levels of adipocyte marker genes including Pparg, Lpl and Adipoq in bone marrow-derived cells from WT mice, an effect blunted in differentiated cells isolated from Gpr41/43 dKO mice. Overall, these data indicate that acetate regulates bone architecture via SCFA-Gpr41/43 signaling by modulating the osteogenic versus adipogenic differentiation of mesenchymal stem cells.

Introduction: Globally, there is rising concern over the growing reliance on breast milk substitutes (BMSs). However, limited studies have been conducted to explore this issue in Ethiopia. Objective: To assess infant formula feeding and associated factors among mothers of infants aged 0–6 months in Debre Berhan City, 2023. Methods and materials: This cross-sectional study used a multistage sampling technique to select 656 mothers residing in Debre Berhan city. The data was collected through face-to-face interviews using a semi-structured questionnaire. Bivariable and multivariable logistic regression models were employed to identify the factors associated with infant formula feeding. The findings are then presented as frequencies, percentages, and odds ratios. Results: The prevalence of infant formula feeding in Debre Berhan city was 39.7 %. In addition, having a female child [AOR = 1.75, 95 % CI: 1.08–2.86], receiving a college education or higher [AOR = 5.79, 95 % CI: 2.38–14.08], being in the age category of 25–34 [AOR = 2.38, 95 % CI: 1.10–5.15] or 35–45 [AOR = 3.43, 95 % CI: 1.35–8.69], being a prime mother [AOR = 1.81, 95 % CI: 1.12–2.94], receiving breastfeeding advice [AOR = 4.64, 95 % CI: 2.78–7.75], delivering via a C-section [AOR = 5.39, 95 % CI: 2.54–11.42], initiating breastfeeding late [AOR = 2.26, (95 % CI: 1.41–3.64)], or being unaware of the risks associated with infant formula feeding [AOR = 5.48, 95 % CI: 3.20–9.39] were the factors that drove mothers towards infant formula feeding. Conclusion: In Debre Berhan city, the prevalence of infant formula feeding was high. Fortunately, with appropriate interventions, most of the factors that led to infant formula feeding could be effectively addressed.

Abstract Objective The importance of research cannot be overemphasized. Research findings serve as a guide for the enactment of development policies and legislation. However, not all members of the target population willingly participate in a study. The current study explored the reasons why some individuals refused to partake in inclusive education research in a developing country, Ghana. The journaling helped to capture the voices of 87 participants who refused to take part in a larger inclusive education survey study. Results The study found that the participants did not take part in the research because of reasons such as lack of financial gain, bad experience with previous research, lack of direct benefit, and lack of time. The findings of the study and its implication for policymaking in Ghana and research studies in sub-Saharan Africa are discussed.

This paper reports on a study that explored the roles of district and community-based education structures (DCES) in preparing, implementing, and communicating education policy initiatives at the district and school levels. A descriptive multiple-case survey design involving three purposefully selected districts was employed. The study used a multi-stage sampling technique involving simple random and purposive sampling to select 257 DCES members from 27 schools in 9 circuits within the districts. Quantitative and qualitative data were collected and analysed in response to three research questions. The results revealed that DCES members implemented several policy initiatives at the local level, including school feeding, capitation grants, free uniforms and furniture. The study also found that DCES members played critical roles in supporting the design and execution of education policy initiatives and employing various avenues to communicate these policy initiatives to the larger community. However, DCES members seemed to only focus on traditional means of preparing, implementing, and communicating policy initiatives. The study therefore recommends that DCES members should be empowered to employ innovative ways to support the preparation, implementation, and communication of education policy initiatives.

Background Poststroke cognitive impairment is prevalent worldwide, with no satisfactory preventative therapeutic strategies. We report on the effect of a cardiovascular polypill on cognitive performance among recent stroke survivors. Methods and Results The SMAART (Stroke Minimization through Additive Anti‐atherosclerotic Agents in Routine Treatment) trial was a phase II randomized trial primarily assessing the polypill versus usual care for secondary prevention after a recent ischemic stroke. Participants allocated to the experimental arm were provided 2 Polycaps taken orally once a day for 12 months. A capsule of Polycap contained aspirin 100 mg, simvastatin 20 mg, hydrochlorothiazide 12.5 mg, ramipril 5 mg, and atenolol 50 mg. Participants in the usual care arm received standard secondary prevention therapy. We compared slopes of the trajectory of raw scores in the executive, language, memory, and visuospatial cognitive domains and aggregated cognitive scores over 12 months via a linear mixed‐effects model. We enrolled 148 eligible participants (n=74 in each arm) and 59 versus 64 participants in the polypill and usual care arms, respectively, at month 12. Compared with the usual care arm, the slopes of cognitive performance over 12 months in the polypill arm were steeper by 2.02 units (95% CI, 0.52–3.53), P=0.009 in executive domain, 1.88 units (95% CI, 0.42–3.34), P=0.012 in language domain, 2.60 (0.03–5.17), P=0.049 in memory domain, 0.55 (−0.80 to 1.91), P=0.42 in the visuospatial domain, and global cognitive performance 6.87 units (95% CI, 1.44–12.30), P=0.013. Conclusions The cardiovascular polypill is associated with a signal of better cognitive performance over 12 months among stroke survivors. Further definitive trials are warranted. Registration URL: https://www.clinicaltrials.gov; Unique Identifier: NCT03329599.

BackgroundElectronic fetal heart rate monitoring (EFM) has been widely used in obstetric practice for over 40 years to improve perinatal outcomes. Its popularity is growing in Ethiopia and other sub-Saharan African countries to reduce high perinatal morbidity and mortality rates. However, its impact on delivery mode and perinatal outcomes in low-risk pregnancies remains controversial. This study aimed to assess the effect of continuous EFM on delivery mode and neonatal outcomes among low-risk laboring mothers at Debre Markos Comprehensive Specialized Hospital, Northwest Ethiopia.MethodsA prospective follow-up study was conducted from November 20, 2023, to January 10, 2024. All low-risk laboring mothers meeting the inclusion criteria were included. Data were collected via pretested structured questionnaires and observation, then analyzed using Epi-data 4.6 and SPSS. The incidences of cesarean delivery and continuous EFM were compared using the chi-squared test and Fisher's exact test.ResultsThe study found higher rates of instrumental-assisted vaginal delivery (7% vs. 2.4%) and cesarean sections (16% vs. 2%) due to unsettling fetal heart rate patterns in the continuous EFM group compared to the intermittent auscultation group. However, there were no differences in immediate neonatal outcomes between the groups.ConclusionWhen compared to intermittent auscultation with a Pinard fetoscope, the routine use of continuous EFM among low-risk laboring mothers was associated with an increased risk of cesarean sections and instrumental vaginal deliveries, without significantly improving immediate newborn outcomes. However, it is important to note that our study faced significant logistical constraints due to the limited availability of EFM devices, which influenced our ability to use EFM comprehensively. Given these limitations, we recommend avoiding the routine use of continuous EFM for low-risk laboring mothers to help reduce the rising number of operative deliveries, particularly cesarean sections. Our findings should be interpreted with caution, and further research with adequate resources is needed to draw definitive conclusions.

This study investigated the recycling of solid waste residues from rock asphalt extraction via 5-h calcination at 900 °C and indirect carbon mineralization. The calcined powder was first dissolved at 60 °C in 2 M CH3COOH, carbonized in NH4HCO3, and agitated at 1200 rpm in 2 M NaOH for 30 minutes at 30–60 °C and pH 12. The precipitated calcium carbonate (PCC) results are calcite (24.4–56.3 wt%) and vaterite (75.6–3.7 wt%), as confirmed by XRD analysis, carbonate FTIR spectra, and SEM images of prismatic calcite and spherical vaterite. This high-value PCC product has potential industrial applications, such as paper and plastics.

Abstract Piezo proteins are mechanically activated ion channels, which are required for mechanosensing functions in a variety of cell types. While we and others have previously demonstrated that the expression of Piezo1 in osteoblast lineage cells is essential for bone-anabolic processes, there was only suggestive evidence indicating a role of Piezo1 and/or Piezo2 in cartilage. Here we addressed the question if and how chondrocyte expression of the mechanosensitive proteins Piezo1 or Piezo2 controls physiological endochondral ossification and pathological osteoarthritis (OA) development. Mice with chondrocyte-specific inactivation of Piezo1 (Piezo1 Col2a1Cre ), but not of Piezo2, developed a near absence of trabecular bone below the chondrogenic growth plate postnatally. Moreover, all Piezo1 Col2a1Cre animals displayed multiple fractures of rib bones at 7 days of age, which were located close to the growth plates. While skeletal growth was only mildly affected in these mice, OA pathologies were markedly less pronounced compared to littermate controls at 60 weeks of age. Likewise, when OA was induced by anterior cruciate ligament transection, only the chondrocyte inactivation of Piezo1, not of Piezo2, resulted in attenuated articular cartilage degeneration. Importantly, osteophyte formation and maturation were also reduced in Piezo1 Col2a1Cre mice. We further observed increased Piezo1 protein abundance in cartilaginous zones of human osteophytes. Finally, we identified Ptgs2 and Ccn2 as potentially relevant Piezo1 downstream genes in chondrocytes. Collectively, our data do not only demonstrate that Piezo1 is a critical regulator of physiological and pathological endochondral ossification processes, but also suggest that Piezo1 antagonists may be established as a novel approach to limit osteophyte formation in OA.

Abstract Lung cancer is the leading cause of cancer deaths in the United States and worldwide. While influenza illness is known to be particularly dangerous for frail and elderly patients, the relationship between influenza illness and outcomes in patients with cancer remains largely unknown. The Surveillance, Epidemiology, and End Results (SEER) database was queried to identify patients with non-small cell lung cancer (NSCLC) diagnosed between 2009 and 2015. Influenza-like illness (ILI) activity, provided by the Outpatient Influenza-like Illness Surveillance Network of the Center of Disease for Control and Prevention, was merged with the SEER dataset on the state-month level. Regional monthly mortality rates were compared during low versus high flu months in this ecological cohort study. 202,485 patients with NSCLC from 13 SEER-reporting states were included in the analysis. 53 of 1049 state-months (5.1%) had high flu activity. Monthly mortality rates during low and high flu months were 0.041 (95% CI 0.041–0.042) and 0.051 (95% CI 0.050–0.053), respectively (RR 1.24 [95% CI 1.21–1.27]). The association between ILI activity and mortality was observed at the individual state level and in all clinical and regional subgroups. Increased regional influenza activity is associated with higher mortality rates for patients with NSCLC. Vaccine-directed initiatives and increased awareness amongst providers will be necessary to address the growing but potentially preventable burden of influenza-related lung cancer deaths in the U.S.

Objectives:This study investigates gender and sex disparities in COVID-19 epidemiology in the Canton of Vaud, Switzerland, focusing on the interplay with socioeconomic position (SEP) and age.Methods:We analyzed COVID-19 surveillance data from March 2020 to June 2021, using an intersectional approach. Negative binomial regression models assessed disparities between women and men, across SEP quintiles and age groups, in testing, positivity, hospitalizations, ICU admissions, and mortality (Incidence Rate Ratios [IRR], with 95% Confidence Intervals [CI]).Results:Women had higher testing and positivity rates than men, while men experienced more hospitalizations, ICU admissions, and deaths. The higher positivity in women under 50 was mitigated when accounting for their higher testing rates. Within SEP quintiles, gender/sex differences in testing and positivity were not significant. In the lowest quintile, women’s mortality risk was 68% lower (Q1: IRR 0.32, CI 0.20–0.52), with decreasing disparities with increasing SEP quintiles (Q5: IRR 0.66, CI 0.41–1.06).Conclusion:Our findings underscore the complex epidemiological patterns of COVID-19, shaped by the interactions of gender/sex, SEP, and age, highlighting the need for intersectional perspectives in both epidemiological research and public health strategy development.

Inclusive education involves creating effective learning environments that welcome and meet the diverse needs of all students. Differentiated instruction (DI) has been identified as a key instructional approach to addressing the diverse needs of all students in regular classrooms. While there is a large body of literature on DI, that relating to the non-Western context is sparse. Using comprehensive model of DI as a conceptual framework, this study examined teacher educators’ perceived usage of DI practices in teacher training institutions in Ghana. It used a questionnaire design based on the tenets of model for data collection. A total of 1,002 participants (199 teacher educators and 883 pre-service teachers) were recruited from four teacher training institutions in Ghana. The data were analyzed using confirmatory factor analysis, t-tests, and Hayes’s model for performing moderation analysis. The results show differences between pre-service teachers and teacher educators, with the former rating the latter lower on the perceived usage of DI. The study concludes with a discussion on the training needs of teacher educators in the usage of DI and enabling them to effectively model appropriate differentiated teaching experiences to beginning teachers.

Introduction Type 2 diabetes is multifactorial and influenced by the intersection of gender-related variables and other determinants of health. The aim of this study was to highlight the intersectional social position of the participants and disentangle its role from administrative sex in predicting the development of type 2 diabetes.Methods Using CoLaus|PsyCoLaus study, a Swiss single-centre prospective cohort initiated in 2003 and including 6733 participants (age 35–75 years; 54% women) at baseline, we conducted latent class analyses using gender-related variables (eg, risk-taking behaviours, gender roles represented by employment status, etc) and socioeconomic determinants at baseline (2003–2006) to construct intersectional classes and we tested their association with the development of type 2 diabetes at follow-up (2018–2021).Results Of the 6733 participants enrolled at baseline, 3409 were included in our analyses (50.6%). Over a median follow-up time of 14.5 years, 255 (7.5%) participants developed type 2 diabetes, of which 158 men (62.0%). We identified seven latent classes highlighting different intersectional social position groups (ie, young, fit, educated men (N=413), non-White physically inactive men and women (N=170), highly qualified men, former or current smokers (N=557), working women living alone (N=914), low qualified working men with overweight (N=445), women with obesity, low education and low qualified job or housewives (N=329), low educated retired participants (N=581)). Using the class labelled as ‘young, fit, educated men’ as reference, the risk of incident type 2 diabetes was higher in all other classes (adjusted OR values between 4.22 and 13.47). Classes mostly feminine had a more unfavourable intersectional social position than that of the predominantly masculine classes. The corresponding OR increased in sex-adjusted regressions analyses.Conclusions We observe cumulative intersectional effects across behavioural and socioeconomic profiles with different risks of developing type 2 diabetes emphasising the deleterious effect of a feminine gender profile. These patterns are only partly captured by traditional sex-stratified analyses.

A 54-year-old African-American male presented to the colorectal surgery clinic with the chief complaint of a painful anal swelling that had been ongoing for several weeks. An adequate rectal examination was not possible due to severe pain. Therefore, he was taken to the operating room for an exam under anesthesia where a presacral mass was identified. A transgluteal core needle biopsy was performed which was consistent with gastrointestinal stromal tumor. Computed tomography imaging identified a 16 cm ×10 cm ×9 cmrectal gastrointestinal stromal tumor. Given the size and location, the patient began treatment with neoadjuvant Imatinib. His progress was followed with serial computed tomography scans and clinic visits. A 3D model was created the tumor and surrounding structures to aide in pre- and intraoperative planning. The model was utilized during patient education and found to valuable in describing the potential for levator invasion and framing potential post-operative outcomes. The patient was able to undergo rectal preservation via a robotic low anterior resection with a transanal total mesorectal excision, coloanal anastomosis, and diverting ileostomy.

Abstract Background There is a critical need for effective treatment of the core symptoms of autism spectrum disorder (ASD). The purinergic antagonist suramin may improve core symptoms through restoration of normal mitochondrial function and reduction of neuro-inflammation via its known antagonism of P2X and P2Y receptors. Nonclinical studies in fragile X knockout mice and the maternal immune activation model support these hypotheses. Methods We conducted a 14 week, randomized, double-blind, placebo-controlled proof -of-concept study (N = 52) to test the efficacy and safety of suramin intravenous infusions in boys aged 4–15 years with moderate to severe ASD. The study had 3 treatment arms: 10 mg/kg suramin, 20 mg/kg suramin, and placebo given at baseline, week 4, and week 8. The Aberrant Behavior Checklist of Core Symptoms (ABC-Core) (subscales 2, 3, and 5) was the primary endpoint and the Clinical Global Impressions—Improvement (CGI-I) was a secondary endpoint. Results Forty-four subjects completed the study. The 10 mg/kg suramin group showed a greater, but statistically non-significant, numeric improvement (− 12.5 ± 3.18 [mean ± SE]) vs. placebo (− 8.9 ± 2.86) in ABC-Core at Week 14. The 20 mg/kg suramin group did not show improvement over placebo. In exploratory analyses, the 10 mg/kg arm showed greater ABC Core differences from placebo in younger subjects and among those with less severe symptoms. In CGI-I, the 10 mg/kg arm showed a statistically significant improvement from baseline (2.8 ± 0.30 [mean ± SE]) compared to placebo (1.7 ± 0.27) (p = 0.016). The 20 mg/kg arm had a 2.0 ± 0.28 improvement in CGI-I, which was not statistically significant compared to placebo (p = 0.65). Conclusion Suramin was generally safe and well tolerated over 14 weeks; most adverse events were mild to moderate in severity. Trial Registration Registered with the South African Health Authority, registration number DOH-27–0419-6116. ClinicalTrials.Gov registration ID is NCT06058962, last update posted 2023–09-28.

Abstract Background Intellectual disability (ID) involves impairment of general mental abilities, restricting the participation of individuals in conceptual, social and practical activities. Consequently, rehabilitation services are critical in efforts towards promoting the social and educational inclusion of persons with ID. However, the preparedness of health professionals in performing such a role depends on their perceptions of individuals with ID. Ajzen’s theory of planned behaviour was used as theoretical framework to understand the relationship between the perceived attitude and self-efficacy of healthcare students towards persons with ID. Method A cross-sectional survey was conducted among healthcare students (N = 328) in a Ghanaian university. The Community Living Attitude Scale for ID(CLAS-ID) and General Self-efficacy (GSE) Scale were employed to assess their attitudes and self-efficacy towards people with ID respectively. The data were analysed using SPSS and AMOS and were subjected to a t-test, ANOVA, correlation and regression. Result The healthcare students were ambivalent about both self-efficacy and attitudes towards persons with ID, and there was correlation between attitudes and self-efficacy. Attitudes and self-efficacy also varied across the demographic characteristics of the respondents including age, having a relative with ID, level of study, religion, and programme of study. Conclusion The study underscores the necessity for healthcare curriculum reform and provides corresponding recommendations. The study emphasizes the importance of enhancing healthcare students' understanding of ID, changing their attitudes, and bolstering their self-efficacy. This is crucial to foster positive attitudes, confidence in providing support to individuals with ID, and raising awareness within the broader community. To achieve this, health educators are encouraged to incorporate exposure to individuals with ID into healthcare students' training, along with more structured field experiences designed to increase their contact and interaction with individuals with ID. Such initiatives would enable students to better understand the uniqueness and requirements of individuals with ID.

Abstract Mechanosensory ion channels are proteins that are sensitive to mechanical forces. They are found in tissues throughout the body and play an important role in bone remodeling by sensing changes in mechanical stress and transmitting signals to bone-forming cells. Orthodontic tooth movement (OTM) is a prime example of mechanically induced bone remodeling. However, the cell-specific role of the ion channels Piezo1 and Piezo2 in OTM has not been investigated yet. Here we first identify the expression of PIEZO1/2 in the dentoalveolar hard tissues. Results showed that PIEZO1 was expressed in odontoblasts, osteoblasts, and osteocytes, while PIEZO2 was localized in odontoblasts and cementoblasts. We therefore used a Piezo1 floxed/floxed mouse model in combination with Dmp1 cre to inactivate Piezo1 in mature osteoblasts/cementoblasts, osteocytes/cementocytes, and odontoblasts. Inactivation of Piezo1 in these cells did not affect the overall morphology of the skull but caused significant bone loss in the craniofacial skeleton. Histological analysis revealed a significantly increased number of osteoclasts in Piezo1 floxed/floxed ;Dmp1 cre mice, while osteoblasts were not affected. Despite this increased number of osteoclasts, orthodontic tooth movement was not altered in these mice. Our results suggest that despite Piezo1 being crucial for osteoclast function, it may be dispensable for mechanical sensing of bone remodeling.

Abstract In the present work, we used daily diary methodology to investigate the influence of awe on stress, somatic health (e.g., pain symptoms), and well-being during the COVID-19 pandemic in 2020. We recruited a sample of community adults (N = 269) and a sample of healthcare professionals (N = 145) in the United States. Across both samples, we found that awe and well-being increased, and stress and somatic health symptoms decreased over the 22-day diary period. In daily level analyses, we found that the more daily awe people experienced, the less stress, less somatic health symptoms, and greater well-being they felt. Daily experiences of awe can benefit individuals during times of acute and chronic stress—such as the COVID-19 pandemic.

Introduction: Inspissated bile syndrome (IBS) is a rare cause of neonatal jaundice. Although it is mostly described in children with RH incompatibilities, some medications such as cefotaxime and ceftriaxone have also been implicated. Case presentation: We present a case of a 14-day-old male who developed pale stools after three days of being treated with intravenous cefotaxime for sepsis and neonatal jaundice. The liver function test (LFT) showed conjugated hyperbilirubinemia (Total bilirubin = 268umol/L; conjugated bilirubin = 124μmol/L). On the third day of treatment, the child developed pale stools. An ultrasound scan showed biliary sludge with a differential of biliary atresia. A laparotomy was performed with findings consistent with IBS (viscous sludge). A single-stage irrigation of the biliary tree using saline was performed. The patient was discharged on post-operative day seven after the jaundice cleared with an unremarkable post-operative period. The patient was lost to follow-up care. He presented later at 11 months of life with a normal liver function test but had developed mixed cerebral palsy. Conclusion: The use of cefotaxime in the setting of sepsis can precipitate IBS. Laparotomy with single-stage irrigation of the biliary tree is a viable option for resolution of the syndrome in low-resource settings.

Foods fermented by lactic acid bacteria (LAB) are considered safer and healthier due to LAB’s ability to inhibit pathogen growth and produce bioactive compounds. The study aimed to evaluate the antimicrobial potential of lactic acid bacteria (LAB) in ice-kenkey, a chilled Ghanaian fermented maize beverage, against common foodborne pathogenic bacteria and to determine the duration of inhibition during ambient storage, all in the interest of promoting public health and safety. Samples of ice-kenkey obtained from a small-scale producer and ice-kenkey produced in the laboratory were inoculated with overnight pure cultures of Escherichia coli, Bacillus cereus, Staphylococcus aureus, Vibrio parahaemolyticus, and Salmonella spp. in nutrient broth at concentrations of about 108–109 CFU/ml during storage at room temperature (≈27°C). The population of the different pathogens in both samples of ice-kenkey was enumerated at different storage periods to assess their survival in the ice-kenkey, hence the antimicrobial activity of the ice-kenkey. The pH of both types of ice-kenkey was below 5.0 throughout the storage period of up to 140 h. The commercial ice-kenkey had higher LAB and yeast counts. For both types of ice-kenkey, there was a steady increase in the population of LAB and yeasts from the 0 h to 72 h period, followed by a steady decline from the 96 h to the 120 h period. There were variations in the survival of the different enteric pathogens in the ice-kenkey samples. Vibrio cholera and Salmonella spp. were not detected in both types of ice-kenkey within 8–24 h of storage at room temperature. However, for Escherichia coli, Bacillus cereus, and Staphylococcus aureus, there were no significant reductions in their population within the first 8 h of the storage of both the laboratory and commercial ice-kenkey samples. This work demonstrated that the LAB in the ice-kenkey has remarkable inhibitory potential against both Gram-positive and Gram-negative pathogenic strains. In spite of this, producers need to minimise the risk of food-borne diseases through improved food safety and hygienic practices to prevent and inhibit the growth of microbial pathogens during retailing and storage.

Introduction: Technical advances and the increasing role of interdisciplinary decision-making may warrant formal definitions of expertise in surgical neuro-oncology. Research question: The EANS Neuro-oncology Section felt that a survey detailing the European neurosurgical perspective on the concept of expertise in surgical neuro-oncology might be helpful. Material and methods: The EANS Neuro-oncology Section panel developed an online survey asking questions regarding criteria for expertise in neuro-oncological surgery and sent it to all individual EANS members. Results: Our questionnaire was completed by 251 respondents (consultants: 80.1%) from 42 countries. 67.7% would accept a lifetime caseload of >200 cases and 86.7% an annual caseload of >50 as evidence of neuro-oncological surgical expertise. A majority felt that surgeons who do not treat children (56.2%), do not have experience with spinal fusion (78.1%) or peripheral nerve tumors (71.7%) may still be considered experts. Majorities believed that expertise requires the use of skull-base approaches (85.8%), intraoperative monitoring (83.4%), awake craniotomies (77.3%), and neuro-endoscopy (75.5%) as well as continuing education of at least 1/year (100.0%), a research background (80.0%) and teaching activities (78.7%), and formal interdisciplinary collaborations (e.g., tumor board: 93.0%). Academic vs. non-academic affiliation, career position, years of neurosurgical experience, country of practice, and primary clinical interest had a minor influence on the respondents’ opinions. Discussion and conclusion: Opinions among neurosurgeons regarding the characteristics and features of expertise in neuro-oncology vary surprisingly little. Large majorities favoring certain thresholds and qualitative criteria suggest a consensus definition might be possible.

BackgroundFemale genital schistosomiasis (FGS) is a gynaecological complication of urinary schistosomiasis (US) with an estimated burden of 20-120 million cases in endemic areas. A neglected sexual and reproductive health disease in sub-Saharan Africa, FGS increases susceptibility to sexually transmitted infections including cervical cancer and infertility among other morbidities. However, there appears to be limited FGS knowledge among practicing and pre-service health providers with implications for control. We assessed FGS awareness among final-year midwifery students who would soon be delivering primary maternal and reproductive health care.MethodsA cross-sectional study was conducted among 193 randomly selected final-year students from all three midwifery training institutions in the Volta region of Ghana in August/September, 2022. Data on participants' demographics and knowledge of the transmission, signs and symptoms, complications, treatment and prevention of both FGS and US were collected using structured questionnaires. Summary statistics were presented as frequencies, proportions and percentages.ResultsOnly 23.3% (44/189) of participants had heard about FGS compared to 64% (123/192) for US. Of the former, 42 (95%), 40 (91%) and 36 (81.8%) respectively identified genital itching/burning sensation, bloody vaginal discharge and pelvic pain/pain during intercourse as part of the symptoms of FGS. Less than a third (13/44) and about half (25/44) of those who indicated hearing about FGS knew it can be a risk for ectopic pregnancies and infertility respectively. Majority of these participants, 40 (91%), wrongly selected antibiotics as treatment for FGS while 9 indicated it is prevented by sleeping in insecticide-treated nets.ConclusionAwareness of FGS was limited among the study participants. The high prevalence of knowledge of some FGS symptoms related to the genitalia needs cautious interpretation. Health care training institutions must make deliberate efforts to highlight FGS in the training of midwives as the condition has diagnostic and management implications for some sexual and reproductive health conditions.

Differences in sex development (DSD) are congenital conditions in which the development of chromosomal, gonadal, or anatomical sex is atypical. Ovotesticular DSD is the rarest variant of DSD where both ovarian and testicular tissues co-exist in an individual. Ambiguous genitalia may be a glaring indicator of DSD, but multiple genital anomalies should also raise a suspicion of DSD. This is a case report of a 15-year-6-month-old boy who presented during infancy with multiple genital anomalies requiring surgery. The diagnosis of ovotesticular DSD was missed until later in adolescence when he presented with progressive bilateral breast enlargement. Work-up revealed a 46, XX karyotype and dysgenetic testes, but functional ovarian tissue. The patient wanted to consider switching to a female gender but was constrained by psychosocial factors. Maintenance of a masculine phenotype was done using testosterone injections due to the relatively high cost of testosterone patches. Conclusion. Multiple genital anomalies should raise the suspicion of DSD, and prompt referral to an endocrinologist should be done before urogenital surgery and gender assignment are carried out.

Background: Patellar tendon ruptures presenting in a chronic setting are rare events that impose technical surgical challenges due to proximal retraction of the patella, quadriceps muscle atrophy and contracture, and peripatellar adhesions. Various reconstruction techniques have been described using different grafts and fixation methods; however, there is a paucity of reported outcomes and there is no consensus on standard of care. Indications: The patient is a 36-year-old man who presented with a failed patellar tendon reconstruction 14 months after his initial surgery (performed 1 year after the initial injury) with functional weakness and loss of extension. The patient was indicated for a revision patellar tendon reconstruction due to persistent functional limitations. Technique Description: The revision patellar tendon reconstruction was performed with gracilis and semitendinosus tendon autografts harvested from the ipsilateral limb. Hardware was removed from the initial graft tunnels in the tibial tubercle and patella. Patellar height was estimated using fluoroscopic measurement of the contralateral patellar tendon length. The graft is first passed through the patellar tunnel, and the individual limbs of the graft are then both placed through the tibial tubercle tunnel. A sternal wire in a figure-of-eight configuration was used to progressively distalize the patella to match the native patellar height, and the graft was then tensioned and secured together. Results: The patient regained full range of motion at 2-year follow-up and was able to return to work and activities without functional limitations. Recent case series also using ipsilateral hamstring tendon autograft for chronic patellar tendon reconstruction report improved patient outcome scores, normal Insall-Salvati index, improved quadriceps strength, and high levels of patient satisfaction. Discussion/Conclusion: Chronic patellar tendon ruptures are technically challenging to treat, especially in the context of revision of a failed reconstruction. The technique presented in this video may aid orthopaedic surgeons in treating this rare but debilitating injury. Given the lack of high-quality evidence, future studies are needed to explore graft choices, graft fixation techniques, and postoperative protocols. Patient Consent Disclosure Statement: The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.

There have been 35 presidential extensions across 24 countries in Africa from 1960 to 2022, done through four categories of extension mechanisms. Most extensions occur in francophone countries, where heads-of-state govern for up to four decades and beyond, propped up by French foreign policy pacts or bilateral defense agreements which station French bases that ward of insurrections against perennial presidents. This has gestated political discontent and festered conflicts in francophone territory, to the point of being conflict-prone and terrorist enclaves. In the process, francophone Africa has attracted US drone bases for supposed counterterrorism, while Wagner mercenaries have taken up roles in countries where French Legions failed and departed. As a result, African countries have become willing or unwilling actors in the foreign policy agendas of the French, Americans, and Russians whose legions they host. Meanwhile, the African Union has the institutional frameworks to address the phenomenon of presidential extensions, but the political will is not forthcoming because the AU Assembly itself consists of several incorrigible presidents who are governing in extensions and do not want change.

AbstractThe role that corporate governance (CG) plays in contributing to firm performance enhancements has been widely acknowledged. However, the conduit through which CG is able to affect firm performance is an emergent theme. This paper re-examines the relationship between corporate governance (CG) and firm performance via means of causal mediation analysis using financial reporting quality (FRQ) as a mediator. The study samples 104 companies listed on the respective stock markets of nine sub-Saharan African countries, and collects annual reports data spanning over a period of 2007 to 2019 for analysis using causal mediation. The study finds that a causal relationship exists between CG and firm performance, albeit through the transmission mechanism of FRQ. Again, the study finds that CG positively affects firm performance both directly and indirectly through the mediation of FRQ. The study is useful in highlighting for mangers and CG practitioners attention, an important channel through which CG would favourably affect firm performance, being FRQ. The current study is unique, in that it is the first panel multi-cross-country investigation within Africa to introduce FRQ in the study of the relationship between CG and firm performance. It therefore extends the agency theory by employing FRQ as a mediating variable in the CG—firm performance nexus within the African context.

AbstractDigital technologies are essential tools that Service-based firms can integrate into their business to transform their operations. However, in the emerging countries’ perspective, research on the application of digital orientation among Service-based firms is less researched. This poses questions to scholars why the adoption of digital orientation is quite low among developing economies. The purpose of this article is to examine the impediments to digital orientation among Service-based firms in emerging and developing countries. Inspired by a resource-based view, a survey using a structured questionnaire was administered to 466 respondents (management and employees) of Service-based firms via a convenience sampling method in Ghana. Findings revealed that the knowledge gap, cost burden, and upgrading of technology positively and significantly create the gap in digital orientation among Service-based firms. The authors admonished that Service-based firms should 'be orient' on the use of digital technologies through appropriate training programs to enhance its adoption. The study again recommends practitioners of Service-based firms cultivate the habit of investing in human and technical capacities to optimize the benefits of the evolution of digital technologies. Limitations and future research directions are discussed.

Abstract Across species, the skeletal system shares mutual functions, including the protection of inner organs, structural basis for locomotion, and acting as an endocrine organ, thus being of pivotal importance for survival. However, insights into skeletal characteristics of marine mammals are limited, especially in the growing skeleton. Harbor seals (Phoca vitulina) are common marine mammals in the North and Baltic Seas and are suitable indicators of the condition of their ecosystem. Here, we analyzed whole-body areal bone mineral density (aBMD) by dual-energy X-ray absorptiometry (DXA) and lumbar vertebrae by high-resolution peripheral quantitative computed tomography (HR-pQCT) in neonate, juvenile, and adult harbor seals. Along skeletal growth, an increase in two-dimensional aBMD by DXA was paralleled by three-dimensional volumetric BMD by HR-pQCT, which could be attributed to an increasing trabecular thickness while trabecular number remained constant. Strong associations were observed between body dimensions (weight and length) and aBMD and trabecular microarchitecture (R2 = 0.71–0.92, all p

Abstract Background The Getah virus (GETV) is a mosquito-borne Alphavirus (family Togaviridae) that is of significant importance in veterinary medicine. It has been associated with major polyarthritis outbreaks in animals, but there are insufficient data on its clinical symptoms in humans. Serological evidence of GETV exposure and the risk of zoonotic transmission makes GETV a potentially medically relevant arbovirus. However, minimal emphasis has been placed on investigating GETV vector transmission, which limits current knowledge of the factors facilitating the spread and outbreaks of GETV. Methods To examine the range of the mosquito hosts of GETV, we selected medically important mosquitoes, assessed them in vitro and in vivo and determined their relative competence in virus transmission. The susceptibility and growth kinetics of GETVs in various mosquito-derived cell lines were also determined and quantified using plaque assays. Vector competency assays were also conducted, and quantitative reverse transcription-PCR and plaque assays were used to determine the susceptibility and transmission capacity of each mosquito species evaluated in this study. Results GETV infection in all of the investigated mosquito cell lines resulted in detectable cytopathic effects. GETV reproduced the fastest in Culex tritaeniorhynchus- and Aedes albopictus-derived cell lines, as evidenced by the highest exponential titers we observed. Regarding viral RNA copy numbers, mosquito susceptibility to infection, spread, and transmission varied significantly between species. The highest vector competency indices for infection, dissemination and transmission were obtained for Cx. tritaeniorhynchus. This is the first study to investigate the ability of Ae. albopictus and Anopheles stephensi to transmit GETV, and the results emphasize the role and capacity of other mosquito species to transmit GETV upon exposure to GETV, in addition to the perceived vectors from which GETV has been isolated in nature. Conclusions This study highlights the importance of GETV vector competency studies to determine all possible transmission vectors, especially in endemic regions. Graphical Abstract

Intimal sarcoma is a grouping of uncommon pleomorphic sarcomas most commonly arising from the intimal layer of large named arteries. The venous system is rarely affected. Albeit, no specific societal guidelines exist, treatment follows the guidelines of soft tissue sarcoma and includes 1 cm margins with radiation therapy for resectable disease. Unfortunately, surveillance of patients is limited, given the high mortality. We present a 65-year-old male with a one-month history of a left neck mass. CT scan demonstrated a 3.7 cm homogenous neck mass. FNA was nondiagnostic, which was followed by an excisional biopsy. Intraoperatively, a solid firm well-circumscribed lesion emanating from the left external jugular vein (EJV) was resected en bloc. Pathology showed locally aggressive angiocentric neoplasm with epithelioid to spindle morphology infiltrating through the vessel wall consistent with intimal sarcoma.

Background: This study assessed the potential cost-effectiveness of high (80–100%) vs low (21–35%) fraction of inspired oxygen (FiO2) at preventing surgical site infections (SSIs) after abdominal surgery in Nigeria, India, and South Africa. Methods: Decision-analytic models were constructed using best available evidence sourced from unbundled data of an ongoing pilot trial assessing the effectiveness of high FiO2, published literature, and a cost survey in Nigeria, India, and South Africa. Effectiveness was measured as percentage of SSIs at 30 days after surgery, a healthcare perspective was adopted, and costs were reported in US dollars ($). Results: High FiO2 may be cost-effective (cheaper and effective). In Nigeria, the average cost for high FiO2 was $216 compared with $222 for low FiO2 leading to a −$6 (95% confidence interval [CI]: −$13 to −$1) difference in costs. In India, the average cost for high FiO2 was $184 compared with $195 for low FiO2 leading to a −$11 (95% CI: −$15 to −$6) difference in costs. In South Africa, the average cost for high FiO2 was $1164 compared with $1257 for low FiO2 leading to a −$93 (95% CI: −$132 to −$65) difference in costs. The high FiO2 arm had few SSIs, 7.33% compared with 8.38% for low FiO2, leading to a −1.05 (95% CI: −1.14 to −0.90) percentage point reduction in SSIs. Conclusion: High FiO2 could be cost-effective at preventing SSIs in the three countries but further data from large clinical trials are required to confirm this.

The study examined the critical factors influencing the sustainability of the Pra river basin in Ghana, with a focus on water pollution incidents caused by illegal mining (galamsey) activities. The study followed a quantitative research approach using data collected from 156 respondents in the Amansie Central district of Ghana. Generally, Strengths-Weaknesses-Opportunities-Threats (SWOT), Analytical Hierarchy Process (AHP) as a multi-criteria technique in two stages of discrete and continuous sustainability analysis and descriptive statistics were the methods of analysis. The study revealed that licensing procedures that do not address environmental impacts, government ban on illegal mining (galamsey) activities as well as poor capacity and financial constraints greatly influence the sustainability of the Pra river basin. Also, self-cleansing capacity of the river basin as well as protection of the ecological status of water in the basin were respondents’ lowest priority. The results revealed that all criteria are currently within a sustainable range with a maximum score indicating a weak sustainability level of the basin due to the pollution incidents. Building on this empirical understanding calls for defensive strategies to be employed. The study therefore recommends amongst other things that revisiting the ban on illegal mining (galamsey) activities, and at this time, within the buffer zones of the basin area is critical for implementation. This, however, calls for a strong collaboration between government, civil society organizations and local communities towards addressing the environmental, economic and human aspects of water security, sustainability and management for the basin.

Currently, explainability represents a major barrier that Artificial Intelligence (AI) is facing in regard to its practical implementation in various application domains. To combat the lack of understanding of AI-based systems, Explainable AI (XAI) aims to make black-box AI models more transparent and comprehensible for humans. Fortunately, plenty of XAI methods have been introduced to tackle the explainability problem from different perspectives. However, due to the vast search space, it is challenging for ML practitioners and data scientists to start with the development of XAI software and to optimally select the most suitable XAI methods. To tackle this challenge, we introduce XAIR, a novel systematic metareview of the most promising XAI methods and tools. XAIR differentiates itself from existing reviews by aligning its results to the five steps of the software development process, including requirement analysis, design, implementation, evaluation, and deployment. Through this mapping, we aim to create a better understanding of the individual steps of developing XAI software and to foster the creation of real-world AI applications that incorporate explainability. Finally, we conclude with highlighting new directions for future research.

Abstract Primary sclerosing cholangitis (PSC) is an idiopathic cholestatic liver disease characterized by chronic inflammation and progressive fibrosis of intra- and extrahepatic bile ducts. Osteoporosis is a frequent comorbidity in PSC, and we could previously demonstrate that IL17-dependent activation of bone resorption is the predominant driver of bone loss in PSC. Since we additionally observed an unexpected heterogeneity of bone mineral density in our cohort of 238 PSC patients, the present study focused on a comparative analysis of affected individuals with diagnosed osteoporosis (PSCOPO, n = 10) or high bone mass (PSCHBM, n = 7). The two groups were not distinguishable by various baseline characteristics, including liver fibrosis or serum parameters for hepatic function. In contrast, quantification of serum bile acid concentrations identified significant increases in the PSCOPO group, including glycoursodeoxycholic acid (GUDCA), an exogenous bile acid administered to both patient groups. Although cell culture experiments did not support the hypothesis that an increase in circulating bile levels is a primary cause of PSC-associated osteoporosis, the remarkable differences of endogenous bile acids and GUDCA in the serum of PSCOPO patients strongly suggest a yet unknown impairment of biliary metabolism and/or hepatic bile acid clearance in this patient subgroup, which is independent of liver fibrosis.

Abstract Background It is well known that skeletal integrity is influenced by the musculature. Poor muscle strength (i.e. sarcopenia) is considered a major predictor of fragility fractures. While this observation appears particularly relevant for older women with increased risk of osteoporosis, there has been no comprehensive investigation to determine the influence of muscle performance on compartment‐specific bone microarchitecture in multiple body regions. Methods We retrospectively analysed data from different muscle performance and bone microarchitecture assessments in 230 women (aged 21 to 87 years) at high risk of osteoporosis. Muscle performance tests included grip strength and chair rising test (CRT) combined with mechanography. Balance was determined by Romberg posturography. Areal bone mineral density (BMD) was measured by dual‐energy X‐ray absorptiometry (DXA) at the hip and lumbar spine. Compartment‐specific volumetric BMD, microarchitecture, and geometry were assessed by second‐generation high‐resolution peripheral quantitative computed tomography (HR‐pQCT) at multiple skeletal sites (distal radius, tibia, and fibula). Regression models were applied to test for interactions between muscle and bone parameters. Subgroups were defined to compare women with osteoporosis and osteosarcopenia regarding BMD and microarchitecture. Results While osteoporosis was diagnosed in 115/230 (50.0%) women, sarcopenia was detected in 38/230 (16.5%). Positive associations of both grip strength and CRT maximum force with cortical geometric and microarchitectural parameters were detected at all measured sites, with the strongest effect applying to CRT maximum force and tibial parameters (e.g. tibial cortical area R2 = 0.36, P

Abstract Introduction Various studies have identified different factors that affect adolescent contraceptive uptake in different parts of Ethiopia. However, varying results were reported across primary studies and those results need to be systematically collated to inform policies. Therefore, this systematic review aimed to synthesize the findings of those primary studies to obtain more robust and representative evidence about adolescent contraceptive uptake in Ethiopia. Methods Five databases (MEDLINE via PubMed, Google Scholar, Scopus, Science Direct and CINAHL) were searched for papers published from January 2000 up to June 2021 in English. We limited our search to start on January 2000 as the health of adolescents have been given more attention after this period and to avoid time-lapsed biases. Seven studies were included in this systematic review. We used the Newcastle-Ottawa Scale and the Mixed Methods Appraisal Tool for quality assessment of the selected studies. Results Determinants of adolescent contraceptive utilization were focused on four levels: individual, socio-cultural, healthcare service and knowledge related factors. Individual-related factors that influence adolescents’ contraceptive uptake include; being in the age group of 10–15 years, not currently enrolled in school and being from low-income families, while socio-cultural factors include: lack of discussion with family members, arranged marriage, pressure from a partner, harmful traditional practices, discussion with peer groups and sexual partners. Healthcare service-related factors include; lack of information about contraceptives during health facility visits, lack of privacy during service provision and inconvenient service hours at health facilities, and not visiting health facilities, whereas, knowledge related factors include; having knowledge of contraceptive methods and being heard about contraceptives from media. Also, the proportion of adolescent contraceptive uptake ranged from 12 to 79%. Conclusions In this systematic, individual, socio-cultural, health-care-related, and knowledge-related characteristics have all been identified as influencing adolescents’ contraceptive uptake in Ethiopia. Hence, integrated interventions aimed at overcoming barriers to adolescent contraceptive uptake would be beneficial to improving adolescent contraceptive utilization in Ethiopia.

Abstract Pregnancy‐ and lactation‐associated osteoporosis (PLO) is a rare but clinically highly relevant condition, characterized by reduced bone mineral density (BMD) and acute onset of severe pain due to symptomatic bone marrow edema of the hip or vertebral and/or insufficiency fractures, among others. Previous reports showed a high frequency of hereditary bone disorders unmasked by PLO, predisposing for more severe forms. To date, no data on the risk for additional fractures during subsequent pregnancy in women with PLO and genetic bone disorder have been available. To address this question, we retrospectively analyzed the clinical, biochemical, and densitometric course of three women with a history of PLO and detected variants in WNT1 or LRP5 and subsequent pregnancies. Calcium homeostasis and bone turnover were optimized by basic treatment, and timely initiation of weaning was recommended. Teriparatide treatment for 12 months under strict contraception was initiated in one woman after the diagnosis of PLO. In none of the women did additional fractures or symptomatic bone marrow edemas occur, and BMD by dual‐energy X‐ray absorptiometry as bone microarchitecture by high‐resolution peripheral quantitative computed tomography remained stable. In conclusion, this report expands the understanding of this rare but severe condition and helps to improve clinical counseling and management. © 2023 The Authors. JBMR Plus published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research.

In Ghana, illegal mining (galamsey) activities have polluted most of the river bodies. For example, water bodies in Ghana that are polluted amounts to 60% with most of them in deteriorating condition. However, to live a sustainable life, there is the need to follow rules of environmental management, where pollution control and advanced treatment technologies are imperative. The adoption of control strategies and advanced technologies in galamsey-affected-water basins in Ghana will help provide real-time revitalization for supply of quality water. The control strategies for water pollution management and advanced technologies would particularly help utility companies in ensuring that all Ghanaians continue to get potable, reliable, and sustainable water supplies for the current and future generations. The paper covers three key control strategies for water pollution management, vis-à-vis six major aspects of advanced technologies and the use of artificial intelligence (AI). AI based decision-making tools help optimize the use of various treatment technologies, such as adsorption, ion exchanges, electrokinetic processes, chemical precipitation, phytobial remediation, and membrane technology to effectively remove pollutants from affected water bodies. The paper also focuses on advantages and disadvantages of several advanced technologies, challenges on leveraging the technologies while identifying gaps, and possible technology roadmap. The review contributes to water quality issues in Ghana's Pra river basin by embracing AI and other cutting-edge technologies to address the current water pollution crisis and also ensure sustainable and secure water supply for future generations. This contribution is in line with the United Nations' Agenda 2030 Sustainable Development Goals' (SDGs) goal 6 (clean water and sanitation) and goal 3 (good health and well-being).

Management and monitoring of vulnerable coastal marshes rely on accurate ground height estimates. However, marsh surface characteristics such as vegetation and water presence complicate aerial remote sensing of the ground. Towards developing an improved understanding and techniques for these remote sensing efforts, this study established relationships among data collection flight altitude, surface characteristics, and ground height estimate accuracy within Juncus roemerianus Scheele-dominated marshes. Uncrewed Aerial System (UAS) Light Detection and Ranging (LiDAR) sampling was conducted at five altitudes for five marsh sites and one local control site. Survey-grade topographic measurements and marsh surface characteristics were recorded at each site for comparison. Root Mean Square Error (RMSE) and linear mixed-effects modeling were used to quantify relationships among vertical error, altitude, and surface characteristics. For low (24–72 m) and high (96–120 m) altitudes Above Ground Level (AGL), the RMSE values were 49 cm and 17 cm, respectively. Despite this appreciable improvement in accuracy with increasing flight altitude, point density values of these datasets limit applications. Linear mixed-effects modeling further emphasized the complex relationships between sensor footprint size, surface characteristics, and ground height estimates. These findings have direct implications for elevation modeling and monitoring efforts of frequently inundated, coastal marshes.

Abstract Background The first world conference on sexual and reproductive health (SRH) in 1994 helped create the awareness that reproductive health is a human right. Over the years, attempts have been made to extend services to all persons; however, lapses persist in service provision for all in need. Recently, countries have been encouraged to target minority groups in their reproductive health service provision. However, studies have rarely attempted to develop deeper insights into the experiences of deaf men and women regarding their knowledge of SRH. The purpose of this study was to develop an in-depth understanding of the knowledge of deaf persons regarding services such as knowledge of contraceptive methods, pregnancy and safe abortion practices. Methods A sequential explanatory mixed-methods approach was adopted for this study. In the first quantitative phase, 288 deaf persons recruited from three out of the 16 regions in Ghana participated in this study. They completed a 31-item questionnaire on the main issues (knowledge of contraceptive methods, pregnancy and safe abortion practices) addressed in this study. In the second phase, a semi-structured interview guide was used to collect data from 60 participants who took part in the first phase. The key trend emerging in the first phase underpinned the interview guide used for the data collection. While the quantitative data were subjected to the computation of means, t-tests, analyses of variance, correlations and linear regressions to understand the predictors, the in-depth interviews were analysed using the thematic method of analysis. Results The results showed a convergence between the quantitative and qualitative data. For instance, the interview material supported the initial findings that deaf women had little knowledge of contraceptive methods. The participants offered reasons explaining their inability to access services and the role of religion in their understanding of SRH. Conclusion The study concludes by calling on policymakers to consider the needs of deaf persons in future SRH policies. The study limitations and other implications for future policymaking are discussed.

The function of RNA binding proteins within innate lymphoid cells (ILC) has been partially characterised. Here the authors show that RBM3 functions to limit the type 2 immunity promoting activity of ILC2 partially through cysteinyl leukotriene 1 receptor.

Background: Superior labrum anterior-posterior tears (SLAP) can be a career-altering injury for Major League Baseball (MLB) pitchers. Surgery and postoperative rehabilitation keep pitchers on the injured list (IL) for extended time, which results in a significant cost to a team. To date, no analyses have focused on the financial cost of SLAP repairs in MLB pitchers. Methods: A retrospective review of MLB pitchers with SLAP repair from 2004 to 2019 was conducted utilizing IL and financial contract data from the MLB website. Cost of injury was calculated from salary of the player. Performance metrics including earned run average, walks + hits per innings pitched, and innings pitched (IP) were averaged for one and all seasons played before and after injury. Return to play and return to prior performance rates were calculated and reported. Results: Of the 55 players identified, 22 players (40%) returned to play and 18 of these 22 players (82%) returned to prior performance. Annual cost increased over the study period (R2 = 0.288) averaging $3.5 million, and a stable average of 172 days was spent on the IL (R2 = 0.001). Performance was negligible except IP (106.95 vs. 50.85; P

Most commercial entities depend on the availability, and reliability of electricity supply for their business ventures. Poor energy security, unreliability, and high cost of electricity characterize the utility grid of Ghana, forcing most of these facilities to resort to using diesel generators to supplement their energy needs. This study, therefore, proposes the development of a Microgrid (MG) to provide electricity to the Zipline facility in Sefwi-Wiawso, Ghana. The optimally designed MG is achieved using the HOMER software and consists of 94.8 kW Sunpower solar panels, 231 kWh Samsung M8068 Li-ion batteries, 56.31 kW ABB MGS inverter, 158 kW CAT-C7 diesel generator, and an infinite distribution grid. The proposed design with a lifespan of 25 years has an initial capital cost of US$ 45,929.17 and a nominal discounted payback period of 2.11yrs making a total savings of US$ 322,563.21.

Background and aim: African trypanosomiasis poses serious health and economic concerns to humans and livestock in several sub-Saharan African countries. The aim of the present study was to identify the antitrypanosomal compounds from B. pilosa (whole plant) through a bioactivity-guided isolation and investigate the in vitro effects and mechanisms of action against Trypanosoma brucei (T. brucei). Experimental procedure: Crude extracts and fractions were prepared from air-dried pulverized plant material of B. pilosa using the modified Kupchan method of solvent partitioning. The antitrypanosomal activities of the fractions were determined through cell viability analysis. Effects of fractions on cell death and cell cycle of T. brucei were determined using flow cytometry, while fluorescence microscopy was used to investigate alterations in cell morphology and distribution. Results and conclusion: The solvent partitioning dichloromethane (BPFD) and methanol (BPFM) fractions of B. pilosa exhibited significant activities against T. brucei with respective half-maximal inhibitory concentrations (IC50s) of 3.29 μg/ml and 5.86 μg/ml and resulted in the formation of clumpy subpopulation of T. brucei cells. Butyl (compound 1) and propyl (compound 2) esters of tryptophan were identified as the major antitrypanosomal compounds of B. pilosa. Compounds 1 and 2 exhibited significant antitrypanosomal effects with respective IC50 values of 0.66 and 1.46 μg/ml. At the IC50 values, both compounds significantly inhibited the cell cycle of T. brucei at the G0-G1 phase while causing an increase in G2-M phase. The results suggest that tryptophan esters may possess useful chemotherapeutic properties for the control of African trypanosomiasis.