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Abstract Background Access to affordable and effective menstrual hygiene products (MHP) is critical to the menstrual health of adolescent girls and young women (AGYW). In this mixed-methods analysis, we use data from a programme delivering comprehensive sexual and reproductive health (SRH) services to describe access to MHP and how COVID-19-related closures affected access to MHP; we use qualitative data to understand AGYW’s experience accessing products during the study. Methods Between September 2019-January 2021, we used data routinely collected from ten Yathu Yathu hubs offering community-based, peer-led SRH services to adolescents and young people aged 15–24. Hubs offered free MHP (primarily disposable pads) as a service. To incentivise service access, a “loyalty” card system was embedded within Yathu Yathu, allowing individuals to gain points for services accessed and redeem rewards using these points. Branded pads, tampons and reusable pads were among available rewards. We describe access to service pads and to reward MHP, and use logistic regression to investigate factors associated with accessing pads and reward products before (Sept 2019-March 2020) and after (July 2020-Jan 2021) COVID-19-related closures. Focus group discussions explored accessibility of offering MHP through hubs. Results Between September 2019-January 2021, 6374 AGYW made 34,116 hub visits to access an SRH service and/or redeem a reward. At 30% of these visits, AGYW accessed any MHP. Before COVID19-closures, an average of 17% of monthly visits were for freely-available disposable pads compared to 34% after hubs reopened (p

Background: School-based health centers (SBHCs) have the capability to overcome youth barriers to care. Virtual care programs (VCP) facilitate connection between school nurse and off-site SBHC providers and can increase the reach of SBHCs. This project aimed to examine Denver Public School nurses' perspectives of a pilot VCP. Methods: Thirteen semi-structured qualitative interviews were conducted and coded using an inductive approach to identify key themes. Results: Four major themes emerged: (1) obtaining consent, finding space, and capacity are challenges and nurses have suggestions; (2) nurses enjoy feeling like a valued member of a health care team, and providing additional resources to students; (3) nurses perceive benefits in providing free, efficient, higher level of care; (4) adopting novel technology is a facilitator and challenge; limitations included space and privacy. Conclusions: Key findings can be utilized to further inform practice.

Mission statements have become increasingly important for the accreditation of business universities and colleges. Thus, understanding similarities and differences in the content of business school mission statements is especially timely. The mission statement is also the first component of the strategic management process. It provides the framework or context within which strategies are formulated. This descriptive/informative study aims to present a background that describes and explains institutional mission statements and removes the so-called uncertainty encompassing the foci while preserving exceptional quality--a necessary quality for a compelling mission statement. We question whether all California State University (CSU) and The State University of New York (SUNY) business colleges/schools have developed enduring and inspiring mission statements for their employees and students? While no specific rule regarding length exists, we examined the word count length of these two school system mission statements. Institutions must not make their mission statements too long or too short, or they will risk losing focus and missing essential elements to guide their organization. The mission statement must be long enough to achieve its purpose. Based on our findings, we recommend that all CSU and SUNY campuses embrace a more straightforward, easy-to-understand, hard-hitting, lasting, and inspirational mission statement for their business colleges/schools, one directly relevant to faculty, staff, students, and their families.

Abstract Music is a promising (adjunctive) treatment for both acute and chronic pain, reducing the need for pharmacological analgesics and their side effects. Yet, little is known about the effect of different types of music. Hence, we investigated the efficacy of five music genres (Urban, Electronic, Classical, Rock and Pop) on pain tolerance. In this parallel randomized experimental study, we conducted a cold pressor test in healthy volunteers (n = 548). The primary outcome was pain tolerance, measured in seconds. No objective (tolerance time) or subjective (pain intensity and unpleasantness) differences were found among the five genres. Multinomial logistic regression showed that overall genre preference positively influenced pain tolerance. In contrast, the music genres that participants thought would help for pain relief did not. Our study was the first to investigate pain tolerance at genre level and in the context of genre preference without self-selecting music. In conclusion, this study provides evidence that listening to a favored music genre has a significant positive influence on pain tolerance, irrespective of the kind of genre. Our results emphasize the importance of individual music (genre) preference when looking at the analgesic benefits of music. This should be considered when implementing music in the clinical setting.

Early career teachers (ECTs) are potential resources for educational innovation and development in schools. Innovative professional potential (IPP) emerges in interaction between ECTs and their school ecology. Using semi-structured timeline interviews, we explored 105 IPP experiences of 19 ECTs in the Netherlands, aiming to understand when and how IPP emerges in the school, and to obtain a first grasp of how it can be stimulated. We categorised typification, location and professional interests and explored interaction processes with persons and affordances in the school ecology. Findings showed that ECTs initiate and perform innovative tasks and activities mainly at school or subject department levels. These tasks and activities are mostly social in nature or focused on educational development, while including a wide range of professional interests. Rather than one specific interaction with a person or an affordance, accumulations of restricting and stimulating interactions appear important for how IPP emerges. This paper concludes that it is crucial to consider ECTs capable of exercising the full range of teaching activities from the start of their career, and to share responsibilities among professionals in the school during ECTs' induction. These practices can help to increase educational quality and prevent teacher attrition.

Abstract Isomalto/malto-polysaccharides (IMMPs) are a novel type of soluble dietary fibres with a prebiotic potential promoting growth of beneficial microbes in the gut. However, the mode of action of IMMPs remains unknown. Previous studies on IMMPs showed an increase in total bacteria, especially lactobacilli, and higher production of short chain fatty acids (SCFA) when IMMPs were fed to rats or used during in vitro fermentation. Here we used metatranscriptomics to investigate how IMMPs with different amounts of α − (1 → 6) glycosidic linkages affected microbial function during incubation with human fecal inoculum. We showed that active microbial community dynamics during fermentation varied depending on the type of IMMP used and that the observed changes were reflected in the community gene expression profiles. Based on metatranscriptome analysis, members of Bacteroides, Lactobacillus and Bifidobacterium were the predominant degraders of IMMPs, and the increased gene expression in these bacteria correlated with high amounts of α − (1 → 6) glycosidic linkages. We also noted an increase in relative abundance of these bacteria and an activation of pathways involved in SCFA synthesis. Our findings could provide a baseline for more targeted approaches in designing prebiotics for specific bacteria and to achieve more controlled modulation of microbial activity towards desired health outcomes.

Abstract Background Cancer cachexia is a multifactorial metabolic syndrome characterized by systemic inflammation and ongoing skeletal muscle loss resulting in weakness, poor quality of life, and decreased survival. Whereas lipid accumulation in skeletal muscle is associated with cancer cachexia as well as the prognosis of cancer patients, surprisingly little is known about the nature of the lipids that accumulate in the muscle during cachexia, and whether this is related to inflammation. We aimed to identify the types and distributions of intramyocellular lipids in patients with and without cancer cachexia. Methods Rectus abdominis muscle biopsies were collected during surgery of patients with pancreatic ductal adenocarcinoma (n = 10 without cachexia, n = 20 cachectic without inflammation (CRP

Accelerating electrons to achieve chemical and biological effects is a well-established competence of Fraunhofer FEP. Today, there is a large variety of low-energy electron beam applications with a broad range of absorbed doses, e.g. modification of plastics, plasma-chemical syntheses, pollutant removal in wastewaters and exhaust gases, sterilization of medical products, disinfection of seeds, biocompatible functionalization of implants and stimulation of biotechnological processes. This calls for reliable, sensitive, and flexible methods for dosimetry. Radiochromic films are suitable tools to measure electron dose distributions for the characterization and quality control of Fraunhofer FEP’s irradiation facilities. Risø B3 radiochromic film from DTU Health Tech, the dosimeter of choice at FEP, reliably detects doses in the range of 10–100 kGy. However, with new upcoming applications, doses in the single-digit kGy range and even lower come to the fore. Hence, the palette of dosimeters at FEP must be extended. Gafchromic’s HD-V2 film is a welcome complement and widens the accessible dose range down to 10 Gy. Using a UV-VIS spectrophotometer for read-out of the films and custom analysis algorithms further increase the sensitivity of the dosimetric setup. Additionally, dosimeters based on the optically stimulated luminescence (OSL) of beryllium oxide offer a wide dose range and high sensitivity. They were used to measure doses induced by secondary X-ray components to gain more information about a specific radiation field. The work gives an overview of the dosimetric toolbox at Fraunhofer FEP and the efforts to implement new methods of detection for low-dose applications and X-ray dosimetry.

In recent years, the use of low-energy electrons in various ecological and biotechnological applications has become increasingly relevant. One important application is the treatment of wastewater, wherein highly reactive species produced by water irradiation are used to oxidize pollutants. Low-energy electron irradiation has several advantages, such as minimal demands on radiation protection and electron beam (EB) source dimensions. However, to play into the main advantages of this technology and keep it economically viable, it is necessary to keep the absorbed dose as low as possible. This calls for a liquid dosimeter with sensitivity in the single digit kGy range. An extract from natural Hibiscus sabdariffa (Roselle) has been reported to show a radiochromic effect in this dose range. In the present work, Roselle dosimeter solutions were closely investigated and optimized to characterize a new module for EB wastewater treatment. Upon EB irradiation, the dosimeter solution demonstrated a dose-dependent fading in color, making it useful in the 0.3–7.5 kGy dose range.

Objectives: The primary objective of this study was to explore the interplay of psychological conditions that influenced personal engagement among university students. As a theoretical lens through which to investigate this, the study used the job demands-resources model, the study demands-resources model, and the leader-member exchange theory. This study further aimed to explore outcomes that supported students in becoming lifelong learners (i.e., deep-learning approach). Method: Participants were undergraduate students registered at a South African university. We used a purposive, non-probability sampling strategy and employed a cross-sectional survey research design. This study used Mplus version 8.6 for the statistical analyses. Results: Results showed that the psychological conditions of meaningfulness (study resources), availability (burnout risk), and safety (student-leader-member exchange) influenced student engagement. In addition, the results showed that study demands were positively associated with student engagement, although this association can be regarded as small. Furthermore, study resources and student engagement were associated with a deep approach to learning. Conclusions: Findings from the present study demonstrated that Kahn's theory carried implications beyond the workplace and held true in a student learning environment. Further, an exploration of the psychological conditions that led to engagement showed that the job demands-resources model and the study demands-resources model could be used to operationalise study resources as psychological meaningfulness and burnout risk as availability. Similarly, in the context of exploring the student-lecturer relationship, student leader-member exchange could be operationalised as psychological safety. Implication for Practice: Leaders in higher education are encouraged to focus not only on ensuring that students receive adequate support in terms of structures and physical resources during periods of uncertainty, such as the global COVID-19 pandemic, but to adopt a holistic approach that includes considering all the psychological conditions that encourage and promote students' engagement.

Background Dictyostelia are soil amoebas that aggregate to form fruiting bodies with spores and stalk cells in response to starvation. Where known, species across the dictyostelid phylogeny use secreted cAMP, detected by cAMP receptors (cARs) to induce the differentiation of spores and to organize fruiting body construction. However, recent deletion of the single cAR of Polyspondylium violaceum (Pvio) left both its fruiting bodies and spores intact. Methods To investigate whether Pvio sporulation can occur in the absence of secreted cAMP and to explore alternative inducers in a bioassay, three prespore genes were identified and gene fusions of their promoters with the LacZ reporter gene were transformed into Pvio cells. After assessing the spatial expression pattern of the genes and the stage at which prespore gene expression initiated, the effect of cAMP and other Dictyostelium discoideum (Ddis) signal molecules were tested on prespore gene expression in vitro. Results Pvio genes g4562 (psp1), g2696 (psp2) and g2380 (psp3) were identified as homologs of Ddis spore coat genes. They were first expressed around 4 h of starvation in aggregation centres and later in the posterior 4/5th of emerging sorogens and the spore head of early fruiting bodies. Cells from dissociated 4 h aggregates and shaken in suspension for 6 h increased prespore-LacZ reporter activity 4-fold for psp1 and 6-fold for psp2, but this increase was at least 5-fold higher when cells were plated on solid substratum for 6 h to develop normally. cAMP had no effect on prespore gene induction and neither had the Pvio chemoattractant glorin nor the Ddis chemoattractants and differentiation inducers folate, c-di-GMP, DIF-1, GABA, cGMP and 8Br-cAMP. Conclusions The Pvio lineage uniquely evolved a novel genetic network for synthesis, detection and processing of the signal that triggers its main survival strategy.

Objectives: Pandemic response in low-income countries (LICs) or settings often suffers from scarce epidemic surveillance and constrained mitigation capacity. The drivers of pandemic burden in such settings, and the impact of limited and delayed interventions remain poorly understood. Methods: We analysed COVID-19 seroprevalence and all-cause excess deaths data from the peri-urban district of Kabwe, Zambia between March 2020 and September 2021 with a novel mathematical model. Data encompassed three consecutive waves caused by the wild-type, Beta and Delta variants. Results: Across all three waves, we estimated a high cumulative attack rate, with 78% (95% credible interval [CrI] 71-85) of the population infected, and a high all-cause excess mortality, at 402 (95% CrI 277-473) deaths per 100,000 people. Ambitiously improving health care to a capacity similar to that in high-income settings could have averted up to 46% (95% CrI 41-53) of accrued excess deaths, if implemented from June 2020 onward. An early and accelerated vaccination rollout could have achieved the highest reductions in deaths. Had vaccination started as in some high-income settings in December 2020 and with the same daily capacity (doses per 100 population), up to 68% (95% CrI 64-71) of accrued excess deaths could have been averted. Slower rollouts would have still averted 62% (95% CrI 58-68), 54% (95% CrI 49-61) or 26% (95% CrI 20-38) of excess deaths if matching the average vaccination capacity of upper-middle-, lower-middle- or LICs, respectively. Conclusions: Robust quantitative analyses of pandemic data are of pressing need to inform future global pandemic preparedness commitments.

Natural killer (NK) cell therapy represents an attractive immunotherapy approach against recurrent epithelial ovarian cancer (EOC), as EOC is sensitive to NK cell-mediated cytotoxicity. However, NK cell antitumor activity is dampened by suppressive factors in EOC patient ascites. Here, we integrated functional assays, soluble factor analysis, high-dimensional flow cytometry cellular component data and clinical parameters of advanced EOC patients to study the mechanisms of ascites-induced inhibition of NK cells. Using a suppression assay, we found that ascites from EOC patients strongly inhibits peripheral blood-derived NK cells and CD34+ progenitor-derived NK cells, albeit the latter were more resistant. Interestingly, we found that higher ascites-induced NK cell inhibition correlated with reduced progression-free and overall survival in EOC patients. Furthermore, we identified transforming growth factor (TGF)-β1 to correlate with ascites-induced NK cell dysfunction and reduced patient survival. In functional assays, we showed that proliferation and anti-tumor reactivity of CD34+ progenitor-derived NK cells are significantly affected by TGF-β1 exposure. Moreover, inhibition of TGF-β1 signaling with galunisertib partly restored NK cell functionality in some donors. For the cellular components, we showed that the secretome is associated with a different composition of CD45+ cells between ascites of EOC and benign reference samples with higher proportions of macrophages in the EOC patient samples. Furthermore, we revealed that higher TGF-β1 levels are associated with the presence of M2-like macrophages, B cell populations and T-regulatory cells in EOC patient ascites. These findings reveal that targeting TGF-β1 signaling could increase NK cell immune responses in high-grade EOC patients.

Critical thinking (CT) is widely regarded as an important competence to obtain in education. Students' exposure to problems and collaboration have been proven helpful in promoting CT processes. These elements are present in student-centered instructional environments such as problem-based and project-based learning (P(j)BL). Next to CT, also higher-order thinking (HOT) and critical-analytic thinking (CAT) contain elements that are present in and fostered by P(j)BL. However, HOT, CT, and CAT definitions are often ill-defined and overlap. The present systematic review, therefore, investigated how HOT, CT, and CAT were conceptualized in P(j)BL environments. Another aim of this study was to review the evidence on the effectiveness of P(j)BL environments in fostering HOT, CT, or CAT. Results demonstrated an absence of CAT in P(j)BL research and a stronger focus on CT processes than CT dispositions (i.e., trait-like tendency or willingness to engage in CT). Further, while we found positive effects of P(j)BL on HOT and CT, there was a lack of clarity and consistency in how researchers conceptualized and measured these forms of thinking. Also, essential components of P(j)BL were often overlooked. Finally, we identified various design issues in effect studies, such as the lack of control groups, that bring the reported outcomes of those investigations into question.

Abstract Background The Yathu Yathu (“For Us, By Us”) cluster-randomized trial (CRT) evaluated a peer-led community-based sexual and reproductive health(SRH) intervention implemented to address persistent barriers to SRH service use among adolescents and young people (AYP). We report the impact of the intervention on coverage of key SRH services among AYP. Methods The trial was conducted from Jul 2019-Oct 2021 in two urban communities in Lusaka, Zambia, divided into 20 zones (~ 2350 AYP/zone). Zones were randomly allocated to intervention (N = 10) or control (N = 10) arm. In all zones, a census was conducted and all AYP aged 15-24-years offered participation. The intervention consisted of peer-led community-based hubs providing SRH services; a prevention points card (PPC) system to incentivize and track SRH service use and community engagement. This paper reports on the outcome of coverage (accessing at least one key SRH service), comparing intervention and control arms using PPC data and standard methods of analysis for CRTs. Results Among enumerated AYP, 93.6% (14,872/15,894) consented to participate from intervention zones and 95.1% (14,500/15,255) from control zones. Among those who accepted a PPC, 63.8% (9,493/14,872) accessed at least one key SRH service during the study period in the intervention arm, compared to 5.4% (776/14,500) in the control arm (adjPR 12.3 95%CI 9.3–16.2, p

Abstract Background Tuberculosis (TB) continues to be a major cause of death across sub-Saharan Africa (SSA). In parallel, non-communicable disease and especially cardiovascular disease (CVD) burden has increased substantially in the region. Cardiac manifestations of TB are well-recognised but the extent to which they co-exist with pulmonary TB (PTB) has not been systematically evaluated. The aim of this study is to improve understanding of the burden of cardiac pathology in PTB in those living with and without HIV in a high-burden setting. Methods This is a cross-sectional and natural history study to evaluate the burden and natural history of cardiac pathology in participants with PTB in Lusaka, Zambia, a high burden setting for TB and HIV. Participants with PTB, with and without HIV will be consecutively recruited alongside age- and sex-matched TB-uninfected comparators on a 2:1 basis. Participants will undergo baseline assessments to collect clinical, socio-demographic, functional, laboratory and TB disease impact data followed by point-of-care and standard echocardiography. Participants with PTB will undergo further repeat clinical and functional examination at two- and six months follow-up. Those with cardiac pathology at baseline will undergo repeat echocardiography at six months. Discussion The outcomes of the study are to a) determine the burden of cardiac pathology at TB diagnosis, b) describe its association with patient-defining risk factors and biochemical markers of cardiac injury and stretch and c) describe the natural history of cardiac pathology during the course of TB treatment.