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In sweet potato and potato, sensory traits are critical for acceptance by consumers, growers, and traders, hence underpinning the success or failure of a new cultivar. A quick analytical method for the sensory traits could expedite the selection process in breeding programs. In this paper, the relationship between sensory panel and instrumental color plus texture features was evaluated. Results have shown a high correlation between the sensory panel and instrumental color in both sweet potato (up to r = 0.84) and potato ( r > 0.78), implying that imaging is a potential alternative to the sensory panel for color scoring. High correlations between sensory panel aroma and flavor with instrumental color were detected (up to r = 0.66), although the validity of these correlations needs to be tested. With instrumental color and texture parameters as predictors, low to moderate accuracy was detected in the machine learning models developed to predict sensory panel traits. Overall, the performance of the eXtreme Gradient Boosting (XGboost) was comparable to the radial-based support vector machine (NL-SVM) algorithm, and these could be used for the initial selection of genotypes for aromas and flavors ( r 2 = 0.64-0.72) and texture attributes like moisture or mealiness ( r 2 > 50). Among the chemical properties screened in sweet potato, only starch showed a moderate correlation with sensory features like mealiness ( r = 0.54) and instrumental color ( r = 0.65). From the results, we can conclude that the instrumental scores of color are equivalent to those scored by the sensory panel, and the former could be adopted for quick analysis. Further investigations may be required to understand the association between color and aroma or flavor., Competing Interests: The authors declare no conflicts of interest., (Copyright © 2024 Judith Ssali Nantongo et al.)

It has been established that near infrared (NIR) spectroscopy has the potential of estimating sensory traits given the direct spectral responses that these properties have in the NIR region. In sweetpotato, sensory and texture traits are key for improving acceptability of the crop for food security and nutrition. Studies have statistically modelled the levels of NIR spectroscopy sensory characteristics using partial least squares (PLS) regression methods. To improve prediction accuracy, there are many advanced techniques, which could enhance modelling of fresh (wet and un-processed) samples or nonlinear dependence relationships. Performance of different quantitative prediction models for sensory traits developed using different machine learning methods were compared. Overall, results show that linear methods; linear support vector machine (L-SVM), principal component regression (PCR) and PLS exhibited higher mean R 2 values than other statistical methods. For all the 27 sensory traits, calibration models using L-SVM and PCR has slightly higher overall R 2 (x¯ = 0.33) compared to PLS (x¯ = 0.32) and radial-based SVM (NL-SVM; x¯= 0.30). The levels of orange color intensity were the best predicted by all the calibration models (R 2  = 0.87 - 0.89). The elastic net linear regression (ENR) and tree-based methods; extreme gradient boost (XGBoost) and random forest (RF) performed worse than would be expected but could possibly be improved with increased sample size. Lower average R 2 values were observed for calibration models of ENR (x¯ = 0.26), XGBoost (x¯ = 0.26) and RF (x¯ = 0.22). The overall RMSE in calibration models was lower in PCR models (X = 0.82) compared to L-SVM (x¯ = 0.86) and PLS (x¯ = 0.90). ENR, XGBoost and RF also had higher RMSE (x¯ = 0.90 - 0.92). Effective wavelengths selection using the interval partial least-squares regression (iPLS), improved the performance of the models but did not perform as good as the PLS. SNV pre-treatment was useful in improving model performance., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024. Published by Elsevier B.V.)

Background: Potato varieties have diverse biophysical characteristics, so it is important for breeders to have the capacity to choose those that meet the preferences of end users, such as mealiness, firmness, and taste, among others. Combining user preferences with descriptive information regarding the sensory characteristics of boiled potatoes can contribute to the improvement of consumer-driven varieties. This study aimed to factor in the preferences of end users to improve the prospects for varietal acceptance, adoption, and discrimination among genotypes in potato breeding., Results: The priority quality traits (traits that play the most significant roles in acceptance and adoption) of the boiled potatoes were determined by evaluating gender and livelihood using the G+ tool. The G+ tool is designed to assess gender impact on roots, tubers and bananas (RTB) traits by serving as a validation check to reflect on important gender-based issues in agricultural food systems in order to reduce harm and promote positive impact. Potato genotypes were differentiated by penetration (textural parameters as measured by standard texture probe) and the procedure was repeatable, as there was no significant difference between the cooking replicates at 40 min of cooking. Instrument-based texture parameters, such as penetration peak force (hardness/firmness) and area (area under the curve, which represents energy needed to penetrate) of boiled potato tubers were significantly associated with sensory attributes such as fracturability and hardness in the mouth. An attempt to differentiate genotypes using near-infrared spectroscopy (NIRS) revealed that the average results observed for the calibration for yellow color (r 2  = 0.70), homogeneity of color (r 2  = 0.48), moisture in mass (r 2  = 0.40), and uniformity of texture (r 2  = 0.56) suggested that these parameters could be used for initial breeding screening purposes., Conclusions: The preferred traits of the boiled potato can be integrated into the potato-breeding program/product profile. Near-infrared spectroscopy shows strong potential to predict potato color and the ability of NIRS models to predict some texture attributes is also promising. © 2023 The Authors. Journal of The Science of Food and Agriculture published by John Wiley & Sons Ltd on behalf of Society of Chemical Industry., (© 2023 The Authors. Journal of The Science of Food and Agriculture published by John Wiley & Sons Ltd on behalf of Society of Chemical Industry.)

Background: Consumer preferences for boiled or fried pieces of roots, tubers and bananas (RTBs) are mainly related to their texture. Different raw and cooked RTBs were physiochemically characterized to determine the effect of biochemical components on their cooking properties., Results: Firmness in boiled sweetpotato increases with sugar and amylose contents but no significant correlation was observed between other physicochemical characteristics and cooking behaviour. Hardness of boiled yam can be predicted by dry matter (DM) and galacturonic acid (GalA) levels. For cassava, no significant correlation was found between textural properties of boiled roots and DM, but amylose and Ca 2+ content were correlated with firmness, negatively and positively, respectively. Water absorption of cassava root pieces boiled in calcium chloride solutions was much lower, providing indirect evidence that pectins are involved in determining cooking quality. A highly positive correlation between textural attributes and DM was observed for fried plantain, but no significant correlation was found with GalA, although frying slightly reduced GalA., Conclusion: The effect of main components on texture after cooking differs for the various RTBs. The effect of global DM and major components (i.e. starch, amylose) is prominent for yam, plantain and sweetpotato. Pectins also play an important role on the texture of boiled yam and play a prominent role for cassava through interaction with Ca 2+ . © 2023 Bill and Melinda Gates Foundation. Journal of The Science of Food and Agriculture published by John Wiley & Sons Ltd on behalf of Society of Chemical Industry., (© 2023 Bill and Melinda Gates Foundation. Journal of The Science of Food and Agriculture published by John Wiley & Sons Ltd on behalf of Society of Chemical Industry.)

Background: The assessment of user acceptability in relation to crop quality traits should be a full part of breeding selection programs. Our methodology is based on a combination of sensory approaches aiming to evaluate the sensory characteristics and user acceptability of root, tuber and banana (RTB) varieties., Results: The four-stepped approach links sensory characteristics to physicochemical properties and end-user acceptance. It starts with the development of key quality traits using qualitative approaches (surveys and ranking) and it applies a range of sensory tests such as Quantitative Descriptive Analysis with a trained panel, Check-All-That-apply, nine-point hedonic scale and Just-About-Right with consumers. Results obtained on the same samples from the consumer acceptance, sensory testing and physicochemical testing are combined to explore correlations and develop acceptability thresholds., Conclusion: A combined qualitative and quantitative approach involving different sensory techniques is necessary to capture sensory acceptance of products from new RTB clones. Some sensory traits can be correlated with physicochemical characteristics and could be evaluated using laboratory instruments (e.g. texture). Other traits (e.g. aroma and mealiness) are more difficult to predict, and the use of a sensory panel is still necessary. For these latter traits, more advanced physicochemical methods that could accelerate the breeding selection through high throughput phenotyping are still to be developed. © 2023 The Authors. Journal of The Science of Food and Agriculture published by John Wiley & Sons Ltd on behalf of Society of Chemical Industry., (© 2023 The Authors. Journal of The Science of Food and Agriculture published by John Wiley & Sons Ltd on behalf of Society of Chemical Industry.)

Background: Previously, a lexicon and protocol for quantitative descriptive analysis (QDA) was established for the Uganda sweetpotato breeding program. The implication of QDA scores for priority sensory attributes on consumer preference should be determined to interpret results efficiently and make decisions effectively. The present study aimed to develop a gender-responsive decision tree to obtain an overall sweetpotato eating quality score to facilitate demand-led targeted breeding selection. It focused on Kamuli and Hoima districts (Uganda) and uses pre-lease advanced clones ('NKB3', 'NKB105', 'NKB135', 'D11' and 'D20'), released varieties ('NASPOT 8' and 'NAROSPOT 1') and landraces ('Muwulu-Aduduma', 'Umbrella')., Results: Including boiled sweetpotato sensory characteristics, namely mealy, sweet taste, sweetpotato smell, firm and not fibrous, in breeding design would benefit end-users, especially women given their role in varietal selection, food preparation and marketing. 'D20', 'NASPOT 8' and 'NAROSPOT 1' were most liked in both districts. 'NKB3' and 'D11' were the least liked in Hoima, whereas 'Muwulu-Aduduma' was the least liked in Kamuli. There was a positive correlation between color and overall liking (r 2  = 0.8) and consumers liked the color (average rating ≥ 6 on a nine-point hedonic scale) of all genotypes. Threshold values (average rating on 11-point scales) for consumer acceptability were identified (sweet taste = 6, sweetpotato aroma and flavor = 6, firmness = 3, and mealiness = 4). A regression decision tree tool was created to calculate an eating quality selection index when screening lines in breeding programs using the values., Conclusion: Decision trees that include consumer needs and gender considerations would facilitate demand-led breeding and make varietal selection in sweetpotato breeding programs more effective. © 2023 The Authors. Journal of The Science of Food and Agriculture published by John Wiley & Sons Ltd on behalf of Society of Chemical Industry., (© 2023 The Authors. Journal of The Science of Food and Agriculture published by John Wiley & Sons Ltd on behalf of Society of Chemical Industry.)

Roots, tubers and bananas (RTBs) contribute immensely to food security and livelihoods in sub-Saharan Africa, Asia and Latin America. The adoption of RTB genotypes in these regions relies on the interplay among agronomic traits, ease of processing and consumer preference. In breeding RTBs, until recently little attention was accorded key textural traits preferred by consumers. Moreover, a lack of standard, discriminant, repeatable protocols that can be used to measure the textural traits deter linkages between breeding better RTB genotypes and end user/consumer preferences. RTB products texture - that is, behaviour of RTB food products under unique deformations, such as disintegration and the flow of a food under force - is a critical component of these preferences. The preferences consumers have for certain product texture can be evaluated from expert sensory panel and consumer surveys, which are useful tools in setting thresholds for textural traits, and inform breeders on what to improve in the quality of RTBs. Textural characterization of RTBs under standard operating procedures (SOPs) is important in ensuring the standardization of texture measurement conditions, predictability of textural quality of RTBs, and ultimately definition of RTB food product profiles. This paper reviews current SOPs for the textural characterization of RTBs, including their various associated methods, parameters, challenges and merits. Case studies of texture characterized during development of SOPs and evaluation of texture of RTB populations are discussed, together with insights into key textural attributes and correlations between instrumental, sensory and consumer assessment of texture unique to various RTB food products. Hardness was considered a universal key textural attribute to discriminate RTBs. The review should provide adequate insight into texture of RTB food products and critical factors in their measurement. It aims to promote inclusion of texture in breeding pipelines by investigating which textural traits are prioritized by consumers, particularly since the inclusion of textural traits has recently gained prominence by breeders in improving RTBs. © 2023 The Authors. Journal of The Science of Food and Agriculture published by John Wiley & Sons Ltd on behalf of Society of Chemical Industry., (© 2023 The Authors. Journal of The Science of Food and Agriculture published by John Wiley & Sons Ltd on behalf of Society of Chemical Industry.)

The 5-year project 'Breeding roots, tubers and banana products for end user preferences' (RTBfoods) focused on collecting consumers' preferences on 12 food products to guide breeding programmes. It involved multidisciplinary teams from Africa, Latin America, and Europe. Diverse data types were generated on preferred qualities of users (farmers, family and entrepreneurial processors, traders or retailers, and consumers). Country-based target product profiles were produced with a comprehensive market analysis, disaggregating gender's role and preferences, providing prioritised lists of traits for the development of new plant varieties. We describe the approach taken to create, in the roots, tubers, and banana breeding databases, a centralised and meaningful open access to sensory information on food products and genotypes. Biochemical, instrumental textural, and sensory analysis data are then directly connected to the specific plant record while user survey data, bearing personal information, were analysed, anonymised, and uploaded in a repository. Names and descriptions of food quality traits were added into the Crop Ontology for labelling data in the databases, along with the various methods of measurement used by the project. The development and application of standard operating procedures, data templates, and adapted trait ontologies improved the data quality and its format, enabling the linking of these to the plant material studied when uploaded in the breeding databases or in repositories. Some modifications to the database model were necessary to accommodate the food sensory traits and sensory panel trials. © 2023 The Authors. Journal of The Science of Food and Agriculture published by John Wiley & Sons Ltd on behalf of Society of Chemical Industry., (© 2023 The Authors. Journal of The Science of Food and Agriculture published by John Wiley & Sons Ltd on behalf of Society of Chemical Industry.)

Background: Health-related quality of life (HRQOL) is a critical issue for patients undergoing surgery for congenital heart disease (CHD) but has never been assessed in a low-income country. We conducted a cross-sectional mixed methods study with age-matched healthy siblings serving as controls at the Uganda Heart Institute., Methods: One-hundred fifteen CHD pediatric and young adult patients and sibling control participants were recruited. Health-related quality of life was assessed using the Pediatric Quality of Life Inventory Version 4.0 in participants ages 5-17 and 36-Item Short Form Survey for young adults aged 18-25. A subset of 27 participants completed face-to-face interviews to supplement quantitative findings., Results: Eighty-six pediatric (age 5-17) sibling and parent pairs completed Peds QOL surveys, and 29 young adult (age 18-25) sibling pairs completed SF-36 surveys. One third of patients had surgery in Uganda. Ventricular septal defects and tetralogy of Fallot were the most common diagnoses. Health-related quality of life scores in patients were lower across all domains compared to control participants in children. Reductions in physical and emotional domains of HRQOL were also statistically significant for young adults. Variables associated with lower HRQOL score on multivariate analysis in pediatric patients were younger age in the physical and emotional domains, greater number of surgeries in the physical domain and surgery outside Uganda in the school domain. The only predictor of lower HRQOL score in young adults was surgery outside Uganda in the social domain. Qualitative interviews identified a number of themes that correlated with survey results including abandonment by family, isolation from peers and community, financial hardship and social stigmatization., Conclusion: Health-related quality of life was lower in Ugandan patients after CHD surgery than siblings. Younger patients and those who had surgery outside of Uganda had lower HRQOL. These data have important implications for patients undergoing CHD surgery in LMIC and have potential to inform interventions., Competing Interests: The authors have no competing interests to declare., (Copyright: © 2024 The Author(s).)

Background: Secondary antibiotic prophylaxis reduces progression of latent rheumatic heart disease (RHD) but not all children benefit. Improved risk stratification could refine recommendations following positive screening. We aimed to evaluate the performance of a previously developed echocardiographic risk score to predict mid-term outcomes among children with latent RHD., Methods: We included children who completed the GOAL, a randomized trial of secondary antibiotic prophylaxis among children with latent RHD in Uganda. Outcomes were determined by a 4-member adjudication panel. We applied the point-based score, consisting of 5 variables (mitral valve (MV) anterior leaflet thickening (3 points), MV excessive leaflet tip motion (3 points), MV regurgitation jet length ≥ 2 cm (6 points), aortic valve focal thickening (4 points) and any aortic regurgitation (5 points)), to panel results. Unfavorable outcome was defined as progression of diagnostic category (borderline to definite, mild definite to moderate/severe definite), worsening valve involvement or remaining with mild definite RHD., Results: 799 patients (625 borderline and 174 definite RHD) were included, with median follow-up of 24 months. At total 116 patients (14.5%) had unfavorable outcome per study criteria, 57.8% not under prophylaxis. The score was strongly associated with unfavorable outcome (HR = 1.26, 95% CI 1.16-1.37, p < 0.001). Unfavorable outcome rates in low (≤6 points), intermediate (7-9 points) and high-risk (≥10 points) children at follow-up were 11.8%, 30.4%, and 42.2%, (p < 0.001) respectively (C-statistic = 0.64 (95% CI 0.59-0.69))., Conclusions: The simple risk score provided an accurate prediction of RHD status at 2-years, showing a good performance in a population with milder RHD phenotypes., Competing Interests: Declaration of Competing Interest The authors of the manuscript have no relevant conflicts of interest to disclose regarding this study., (Copyright © 2023 Elsevier B.V. All rights reserved.)

Purpose: In Uganda, sweetpotato [ Ipomoea batatas (L.) Lam] is typically a "woman's crop," grown, processed, stored and also mainly consumed by smallholder farmers for food and income. Farmers value sweetpotato for its early maturity, resilience to stresses, and minimal input requirements. However, productivity remains low despite the effort of breeding programs to introduce new varieties. Low uptake of new varieties is partly attributed to previous focus by breeders on agronomic traits and much less on quality traits and the diverse preferences of men and women in sweetpotato value chains., Method: To address this gap, breeders, food scientists, and social scientists (including gender specialists) systematically mainstreamed gender into the breeding program. This multidisciplinary approach, grounded in examining gender roles and their relationship with varietal and trait preferences, integrated important traits into product profiles., Results: Building on earlier efforts of participatory plant breeding and participatory varietal selection, new interventions showed subtle but important gender differences in preferences. For instance, in a study for the RTBFoods project, women prioritized mealiness, sweetness, firmness and non-fibrous boiled roots. These were further subjected to a rigorous gender analysis using the G+ product profile query tool. The breeding pipelines then incorporated these gender-responsive priority quality traits, prompting the development of standard operating procedures to phenotype these traits., Conclusion: Following an all-inclusive approach coupled with training of multidisciplinary teams involving food scientists, breeders, biochemists, gender specialists and social scientists, integration into participatory variety selection in Uganda enabled accentuation of women and men's trait preferences, contributing to clearer breeding targets. The research has positioned sweetpotato breeding to better respond to the varying needs and preferences of the users., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Ssali, Mayanja, Nakitto, Mwende, Tinyiro, Bayiyana, Okello, Forsythe, Magala, Yada, Mwanga and Polar.)

Sweetpotato varieties vary greatly in perceived textures and sweetness. This study identified physicochemical factors that influence these attributes in cooked sweetpotatoes. Fifteen genotypes grown on three plots were baked and evaluated by a trained descriptive sensory analysis panel for sweetness and 13 texture attributes. Mechanical parameters were measured by texture profile analysis (TPA); and composition (starch, cell wall material, sugar contents), starch properties (thermal, granule type ratios, granule sizes), and amylase activities were characterized. TPA predicted fracturability and firmness well, whereas starch and sugar contents, B-type starch granule ratio, and amylase activities influenced prediction of mouthfeel textures. Sweetness perception was influenced by perceived particle size and sugar contents; and maltose generation during baking was highly correlated with raw sweetpotato starch content. These relationships between physicochemical sweetpotato properties and baked textures and sweetness could benefit breeders and processors in selecting biochemical traits that result in consumer preferred products., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Objective: Most rheumatic heart disease (RHD) registries are static and centralized, collecting epidemiological and clinical data without providing tools to improve care. We developed a dynamic cloud-based RHD case management application with the goal of improving care for patients with RHD in Uganda., Methods: The Active Community Case Management Tool (ACT) was designed to improve community-based case management for chronic disease, with RHD as the first test case. Global and local partner consultation informed selection of critical data fields and prioritization of application functionality. Multiple stages of review and revision culminated in user testing of the application at the Uganda Heart Institute., Results: Global and local partners provided feedback of the application via survey and interview. The application was well received, and top considerations included avenues to import existing patient data, considering a minimum data entry form, and performing a situation assessment to tailor ACT to the health system setup for each new country. Test users completed a postuse survey. Responses were favorable regarding ease of use, desire to use the application in regular practice, and ability of the application to improve RHD care in Uganda. Concerns included appropriate technical skills and supports and potential disruption of workflow., Conclusion: Creating the ACT application was a dynamic process, incorporating iterative feedback from local and global partners. Results of the user testing will help refine and optimize the application. The ACT application showed potential for utility and integration into existing care models in Uganda., Competing Interests: None declared., (The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).)

The sweetpotato breeding process involves assessing different phenotypic traits, such as the sensory attributes, to decide which varieties to progress to the next stage during the breeding cycle. Sensory attributes like appearance, taste, colour and mealiness are important for consumer acceptability and adoption of new varieties. Therefore, measuring these sensory attributes is critical to inform the selection of varieties during breeding. Current methods using a trained human panel enable screening of different sweetpotato sensory attributes. Despite this, such methods are costly and time-consuming, leading to low throughput, which remains the biggest challenge for breeders. In this paper, we describe an approach to apply machine learning techniques with image-based analysis to predict flesh-colour and mealiness sweetpotato sensory attributes. The developed models can be used as high-throughput methods to augment existing approaches for the evaluation of flesh-colour and mealiness for different sweetpotato varieties. The work involved capturing images of boiled sweetpotato cross-sections using the DigiEye imaging system, data pre-processing for background elimination and feature extraction to develop machine learning models to predict the flesh-colour and mealiness sensory attributes of different sweetpotato varieties. For flesh-colour the trained Linear Regression and Random Forest Regression models attained R 2 values of 0.92 and 0.87, respectively, against the ground truth values given by a human sensory panel. In contrast, the Random Forest Regressor and Gradient Boosting model attained R 2 values of 0.85 and 0.80, respectively, for the prediction of mealiness. The performance of the models matched the desirable R 2 threshold of 0.80 for acceptable comparability to the human sensory panel showing that this approach can be used for the prediction of these attributes with high accuracy. The machine learning models were deployed and tested by the sweetpotato breeding team at the International Potato Center in Uganda. This solution can automate and increase throughput for analysing flesh-colour and mealiness sweetpotato sensory attributes. Using machine learning tools for analysis can inform and quicken the selection of promising varieties that can be progressed for participatory evaluation during breeding cycles and potentially lead to increased chances of adoption of the varieties by consumers., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2023 The Author(s).)

Introduction: Rheumatic heart disease (RHD) remains a significant public health problem in countries with limited health resources. People living with RHD face numerous social challenges and have difficulty navigating ill-equipped health systems. This study sought to understand the impact of RHD on PLWRHD and their households and families in Uganda., Methods: In this qualitative study, we conducted in-depth interviews with 36 people living with RHD sampled purposively from Uganda's national RHD research registry, stratifying the sample by geography and severity of disease. Our interview guides and data analysis used a combination of inductive and deductive methods, with the latter informed by the socio-ecological model. We ran thematic content analysis to identify codes that were then collapsed into themes. Coding was done independently by three analysts, who compared their results and iteratively updated the codebook., Results: The inductive portion of our analysis, which focused on the patient experience, revealed a significant impact of RHD on work and school. Participants often lived in fear of the future, faced limited childbirth choices, experienced domestic conflict, and suffered stigmatization and low self-esteem. The deductive portion of our analysis focused on barriers and enablers to care. Major barriers included the high out-of-pocket cost of medicines and travel to health facilities, as well as poor access to RHD diagnostics and medications. Major enablers included family and social support, financial support within the community, and good relationships with health workers, though this varied considerably by location., Conclusion: Despite several personal and community factors that support resilience, PLWRHD in Uganda experience a range of negative physical, emotional, and social consequences from their condition. Greater investment is needed in primary healthcare systems to support decentralized, patient-centered care for RHD. Implementing evidence-based interventions that prevent RHD at district level could greatly reduce the scale of human suffering. There is need to increase investment in primary prevention and tackling social determinants, to reduce the incidence of RHD in communities where the condition remains endemic., Competing Interests: The authors have no competing interests to declare., (Copyright: © 2023 The Author(s).)

Background: Screening programmes using echocardiography offer opportunity for intervention through identification and treatment of early (latent) rheumatic heart disease (RHD). We aimed to compare two methods for classifying progression or regression of latent RHD: serial review method and blinded, side-by-side review., Methods: A four-member expert panel reviewed 799 enrolment (in 2018) and completion (in 2020) echocardiograms from the GOAL Trial of latent RHD in Uganda to make consensus determination of normal, borderline RHD or definite RHD. Serial interpretations (enrolment and completion echocardiograms read at two different time points, 2 years apart, not beside one another) were compared with blinded side-by-side comparisons (enrolment and completion echocardiograms displayed beside one another in random order on same screen) to determine outcomes according to prespecified definitions of disease progression (worsening), regression (improving) or no change. We calculated inter-rater agreement using Cohen's kappa., Results: There were 799 pairs of echocardiogram assessments included. A higher number, 54 vs 38 (6.8% vs 4.5%), were deemed as progression by serial interpretation compared with side-by-side comparison. There was good inter-rater agreement between the serial interpretation and side-by-side comparison methods (kappa 0.89). Disagreement was most often a result of the difference in classification between borderline RHD and mild definite RHD. Most discrepancies between interpretation methods (46 of 47, 98%) resulted from differences in valvular morphological evaluation, with valves judged to be morphologically similar between enrolment and final echocardiograms when compared side by side but classified differently on serial interpretation., Conclusions: There was good agreement between the methods of serial and side-by-side interpretation of echocardiograms for change over time, using the World Heart Federation criteria. Side-by-side interpretation has higher specificity for change, with fewer differences in the interpretation of valvular morphology, as compared with serial interpretation., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Prioritizing sensory attributes and consumer evaluation early in breeding trials to screen for end-user preferred traits could improve adoption rates of released genotypes. In this study, a lexicon and protocol for descriptive sensory analysis (DSA) was established for sweetpotato and used to validate an instrumental texture method for which critical values for consumer preference were set. The study comprised several phases: lexicon development during a 4-day workshop; 3-day intensive panel training; follow-up virtual training, evaluation of 12 advanced genotypes and 101 additional samples from two trials in 2021 by DSA and instrumental texture analysis using TPA double compression; and DSA, instrumental texture analysis and consumer acceptability tests on 7 genotypes in on-farm trials. The established sweetpotato lexicon comprising 27 sensory attributes enabled characterization and differentiation of genotypes by sensory profiles. Significant correlation was found between sensory firmness by hand and mouth with TPA peak positive force (r = 0.695 and r = 0.648, respectively) and positive area (r = 0.748, r = 0.715, respectively). D20, NAROSPOT 1, NASPOT 8, and Umbrella were the most liked genotypes in on-farm trials (overall liking = 7). An average peak positive force of 3700 gf was proposed as a minimum texture value for screening sweetpotato genotypes, since it corresponded with at least 46 % of consumers perceiving sweetpotatoes as just-about-right in firmness and a minimum overall liking of 6 on average. Combining DSA with instrumental texture analysis facilitates efficient screening of genotypes in sweetpotato breeding programs., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2022 The Author(s).)

Background: Rheumatic heart disease affects more than 40.5 million people worldwide and results in 306,000 deaths annually. Echocardiographic screening detects rheumatic heart disease at an early, latent stage. Whether secondary antibiotic prophylaxis is effective in preventing progression of latent rheumatic heart disease is unknown., Methods: We conducted a randomized, controlled trial of secondary antibiotic prophylaxis in Ugandan children and adolescents 5 to 17 years of age with latent rheumatic heart disease. Participants were randomly assigned to receive either injections of penicillin G benzathine (also known as benzathine benzylpenicillin) every 4 weeks for 2 years or no prophylaxis. All the participants underwent echocardiography at baseline and at 2 years after randomization. Changes from baseline were adjudicated by a panel whose members were unaware of the trial-group assignments. The primary outcome was echocardiographic progression of latent rheumatic heart disease at 2 years., Results: Among 102,200 children and adolescents who had screening echocardiograms, 3327 were initially assessed as having latent rheumatic heart disease, and 926 of the 3327 subsequently received a definitive diagnosis on the basis of confirmatory echocardiography and were determined to be eligible for the trial. Consent or assent for participation was provided for 916 persons, and all underwent randomization; 818 participants were included in the modified intention-to-treat analysis, and 799 (97.7%) completed the trial. A total of 3 participants (0.8%) in the prophylaxis group had echocardiographic progression at 2 years, as compared with 33 (8.2%) in the control group (risk difference, -7.5 percentage points; 95% confidence interval, -10.2 to -4.7; P<0.001). Two participants in the prophylaxis group had serious adverse events that were attributable to receipt of prophylaxis, including one episode of a mild anaphylactic reaction (representing <0.1% of all administered doses of prophylaxis)., Conclusions: Among children and adolescents 5 to 17 years of age with latent rheumatic heart disease, secondary antibiotic prophylaxis reduced the risk of disease progression at 2 years. Further research is needed before the implementation of population-level screening can be recommended. (Funded by the Thrasher Research Fund and others; GOAL ClinicalTrials.gov number, NCT03346525.)., (Copyright © 2021 Massachusetts Medical Society.)

Background: Rheumatic heart disease (RHD) has declined dramatically in wealthier countries in the past three decades, but it remains endemic in many lower-resourced regions and can have significant costs to households. The objective of this study was to quantify the economic burden of RHD among Ugandans affected by RHD. Methods: This was a cross-sectional cost-of-illness study that randomly sampled 87 participants and their households from the Uganda National RHD registry between December 2018 and February 2020. Using a standardized survey instrument, we asked participants and household members about outpatient and inpatient RHD costs and financial coping mechanisms incurred over the past 12 months. We used descriptive statistics to analyze levels and distributions of costs and the frequency of coping strategies. Multivariate Poisson regression models were used to assess relationships between socioeconomic characteristics and utilization of financial coping mechanisms. Results: Most participants were young or women, demonstrating a wide variation in socioeconomic status. Outpatient and inpatient costs were primarily driven by transportation, medications, and laboratory tests, with overall RHD direct and indirect costs of $78 per person-year. Between 20 and 35 percent of households experienced catastrophic healthcare expenditure, with participants in the Northern and Western Regions 5-10 times more likely to experience such hardship and utilize financial coping mechanisms than counterparts in the Central Region, a wealthier area. Increases in total RHD costs were positively correlated with increasing use of coping behaviors. Conclusion: Ugandan households affected by RHD, particularly in lower-income areas, incur out-of-pocket costs that are very high relative to income, exacerbating the poverty trap. Universal health coverage policy reforms in Uganda should include mechanisms to reduce or eliminate out-of-pocket expenditures for RHD and other chronic diseases., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2021 Opara, Du, Kawakatsu, Atala, Beaton, Kansiime, Nakitto, Ndagire, Nalubwama, Okello, Watkins and Su.)

Objectives: We aimed to assess mobility patterns and reasons for high mobility among young women engaged in sex work within a randomised controlled trial to gauge how mobility may hinder access to health services and enhance HIV risk in a highly vulnerable population., Setting: Participants were recruited from a clinic in Kampala, Uganda set up for women at high risk of HIV infection., Participants: Adolescent girls and young women engaged in sex for money and/or commodities are at particular risk in countries with high HIV prevalence and high fertility rates. High mobility increases exposure to HIV risk. Women participants were eligible for the parent study if aged 15-24 years, HIV negative and engaged in sex work. For this substudy, 34 qualitative interviews were held with 14 sex workers (6 HIV positive, 8 HIV negative), 6 health worker/policy makers, 3 peer educators, 5 'queen mothers' and 6 male partners MEASURES: Participants used Google Maps to identify work venues at 12-month and 18-month study visits. We also conducted 34 interviews on mobility with: high-risk women, male partners, health workers and sex-worker managers. Topics included: distance, frequency and reasons for mobility. We used Python software to analyse mapping data., Results: Interviews found in depth narratives describing lack of education and employment opportunities, violence, lack of agency, social, sexual and familial support networks and poverty as a complex web of reasons for high mobility among young sex workers., Conclusions: Young women at high risk are highly mobile. Reasons for mobility impact access and retention to health services and research activities. Strategies to improve retention in care should be cognisant and tailored to suit mobility patterns., Trial Registration Number: NCT03203200., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Using quantitative, qualitative and sensorial data collected from western (Kabale) and central (Rakai) Uganda, this paper identifies and describes gender-responsive traits preferred in varieties for the boiled potato market. These traits are aggregated into a product profile to support breeding programme design and decision-making that will increase probability of variety acceptance. An interdisciplinary and participatory methodology was used to collect data on socio-economic on trait preferences, processing and organoleptics and finally, to develop a lexicon through a sensorial panel. Characteristics that were important to both men and women, such as red skin and yellow flesh, are linked to market preferences. Women-only preferred characteristics such as big size and mealiness are linked to processing efficiency and eating quality. Besides agronomic traits, breeders must consider factors such as gender roles, social norms, and market preferences traits that guide farmers and other food chain actors in their selection of new varieties., Competing Interests: The authors declare that they have no conflict of interest., (© 2020 The Authors. International Journal of Food Science & Technology published by John Wiley & Sons Ltd on behalf of Institute of Food, Science and Technology (IFSTTF).)

This study sought to understand user preferences of raw, boiled and steamed sweetpotato, a staple food in Uganda. A sequential methodology involving state of knowledge review, gendered food mapping, processing diagnosis and consumer testing was used in Lira and Kamwenge districts. Preferred raw sweetpotato characteristics were large roots (≥ 3 cm diameter) with a sweet taste, smooth skin and hard texture, while mealiness, sweet taste and good sweetpotato smell were important attributes for boiled sweetpotato. Processors, mostly women, highlighted ease of peeling and sappiness of raw roots. There were gender differences in quality characteristic preferences and perceived importance. The released variety, NASPOT 8, had the highest overall liking in Kamwenge and was well liked in Lira. Penalty analysis of consumer data showed that sweetness and firmness were key drivers of overall liking. The results will support breeding programmes in meeting specific end-user product profiles, selection criteria and uptake of new varieties., Competing Interests: The authors declare no conflicts of interests., (© 2020 The Authors. International Journal of Food Science & Technology published by John Wiley & Sons Ltd on behalf of Institute of Food, Science and Technology (IFSTTF).)

Background/objectives: This study aimed at evaluating the dietary intakes of Korean adolescents affected by food insecurity, in comparison with those who were food secure., Subjects/methods: The study used one day 24-hour dietary recall data from the 6 th Korea National Health and Nutrition Examination Survey. The study subjects consisted of 1,453 adolescents of whom 695 were middle school-aged and 758 were high school-aged. Food security status was assessed using the 18-item questionnaire. Nutrient intake was evaluated in terms of nutrient density, insufficient intake, and excessive intake for selected nutrients, in addition to meeting the appropriate range for total energy intake and energy intakes from carbohydrate, sugar, protein, fat, and saturated fatty acids. Food intake was evaluated in terms of food group servings and dietary diversity score (DDS)., Results: The percentages of food insecurity were 11.1% for middle school-aged adolescents and 16.8% for high school-aged adolescents. Food insecure middle school-aged adolescents had higher intake of carbohydrate ( P = 0.006) but lower intake of fat ( P = 0.010) and saturated fatty acids ( P = 0.005) than their food secure counterparts although the intake of both groups was in the recommended ranges. Nutrient intake among high school-aged adolescents was generally similar regardless of food security status. Both food secure and insecure adolescents showed insufficient intake of vitamin A, vitamin C, and calcium, and excessive sodium intake. They additionally had low prevalence of meeting appropriate intake ranges for energy, carbohydrate, and sugar. Food intake in terms of food group servings and DDS was also similar regardless of food security status among both age groups, with low intakes of foods from fruit and dairy groups., Conclusions: Except for a few nutrients among the middle school-aged adolescents, dietary intakes among Korean adolescents did not differ by food security status in this study., Competing Interests: CONFLICT OF INTEREST: The authors declare no potential conflicts of interests.

Motorcycles are an important form of transportation in Uganda, and are involved in more road traffic injuries than any other vehicle. The majority of motorcycles in Uganda are used as motorcycle taxis, better known locally as boda bodas. Research shows that a motorcycle helmet is effective at reducing a rider's risk of death and head injury. As part of the Uganda Helmet Vaccine Initiative (UHVI), researchers collected baseline and formative evaluation data on boda boda operators' helmet attitudes, beliefs, and behaviors to inform UHVI activities. Researchers collected data on motorcycle helmet-related attitudes and beliefs through focus group discussions and structured roadside interviews, and researchers conducted roadside observations to collect data on helmet-wearing behaviors. Of the 12,189 motorcycle operators and passengers observed during roadside observations, 30.8% of drivers and <1% of passengers were wearing helmets. The most commonly reported helmet-wearing barriers from the focus group discussions and structured roadside interviews were: (1) 'Helmet is uncomfortable', (2) 'Helmet is too hot', (3) 'Helmet is too expensive', and (4) 'Helmet is of low quality'. Researchers incorporated findings from the formative research into the UHVI campaign to increase motorcycle helmet use. Radio messages addressing helmet comfort and cost were widely aired throughout Kampala, Uganda. In addition, campaign staff held nine boda boda operator workshops, covering approximately 900 operators, in which the facilitator addressed barriers and facilitators to helmet use. Each workshop participant received a high-quality tropical motorcycle helmet. UHVI will continue to use a data-driven approach to future campaign activities.