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Abstract Background Pyrethroid-based indoor residual spraying (IRS) and long-lasting insecticidal nets (LLINs) have been employed as key vector control measures against malaria in Namibia. However, pyrethroid resistance in Anopheles mosquitoes may compromise the efficacy of these interventions. To address this challenge, the World Health Organization (WHO) recommends the use of piperonyl butoxide (PBO) LLINs in areas where pyrethroid resistance is confirmed to be mediated by mixed function oxidase (MFO). Methods This study assessed the susceptibility of Anopheles gambiae sensu lato (s.l.) mosquitoes to WHO tube bioassays with 4% DDT and 0.05% deltamethrin insecticides. Additionally, the study explored the effect of piperonyl butoxide (PBO) synergist by sequentially exposing mosquitoes to deltamethrin (0.05%) alone, PBO (4%) + deltamethrin (0.05%), and PBO alone. The Anopheles mosquitoes were further identified morphologically and molecularly. Results The findings revealed that An. gambiae sensu stricto (s.s.) (62%) was more prevalent than Anopheles arabiensis (38%). The WHO tube bioassays confirmed resistance to deltamethrin 0.05% in the Oshikoto, Kunene, and Kavango West regions, with mortality rates of 79, 86, and 67%, respectively. In contrast, An. arabiensis displayed resistance to deltamethrin 0.05% in Oshikoto (82% mortality) and reduced susceptibility in Kavango West (96% mortality). Notably, there was reduced susceptibility to DDT 4% in both An. gambiae s.s. and An. arabiensis from the Kavango West region. Subsequently, a subsample from PBO synergist assays in 2020 demonstrated a high proportion of An. arabiensis in Oshana (84.4%) and Oshikoto (73.6%), and 0.42% of Anopheles quadriannulatus in Oshana. Non-amplifiers were also present (15.2% in Oshana; 26.4% in Oshikoto). Deltamethrin resistance with less than 95% mortality, was consistently observed in An. gambiae s.l. populations across all sites in both 2020 and 2021. Following pre-exposure to the PBO synergist, susceptibility to deltamethrin was fully restored with 100.0% mortality at all sites in 2020 and 2021. Conclusions Pyrethroid resistance has been identified in An. gambiae s.s. and An. arabiensis in the Kavango West, Kunene, and Oshikoto regions, indicating potential challenges for pyrethroid-based IRS and LLINs. Consequently, the data highlights the promise of pyrethroid-PBO LLINs in addressing resistance issues in the region.

ObjectiveAlthough empathy is known to be a strength, recent studies suggest that empathy can be a risk factor for psychopathology under certain conditions in children. This study examines parental mental illness as such a condition. Further, it aims to investigate whether maladaptive emotion regulation (ER) mediates the relationship between empathy and psychopathological symptoms of children.MethodsParticipants were 100 children of parents with a mental illness (55% female) and 87 children of parents without a mental illness (50% female) aged 6 - 16 years and their parents.ResultsGreater cognitive empathy was related to more psychopathological symptoms in COPMI, but not in COPWMI. In addition, in COPMI maladaptive ER mediated this relationship. In contrast, greater affective empathy was associated with more psychopathological symptoms regardless of whether parents had a mental illness.ConclusionOur findings highlight the importance of implementing preventive programs for COPMI that specifically target the reduction of maladaptive ER.

ObjectiveChildren of parents with a mental illness are at heightened risk to develop a mental illness themselves due to genetics and environmental factors. Although parenting stress (PS) is known to be associated with increased psychopathology in parents and children, there is no study investigating PS multimodally in a sample of parents with a mental illness. This study aims to compare PS of parents with and without a mental illness and further to examine the relationship between PS and psychopathology of children.MethodsParticipants were parents with a mental illness and parents without a mental illness and their children aged four to sixteen years. We assessed PS multimodally using a questionnaire, parents’ evaluation of children’s behavior (relational schemas) and psychophysiological arousal of parents during free speech task.ResultsSelf-reported PS was increased, and evaluation of children’s behavior was more negative and less positive in parents with a mental illness compared to parents without a mental illness. Children’s psychopathology was associated with self-reported PS and relational schemas of parents. Regarding psychophysiological arousal, parents with a mental illness showed reduced reactivity in heart rate from baseline to free speech task in comparison to parents without a mental illness.ConclusionsOur findings highlight the importance of implementing intervention programs to reduce PS for parents and children. In particular, parents with a mental illness might benefit from specific intervention programs in order to interrupt the transgenerational transmission of mental disorders.

Abstract Background Namibia’s focus on the elimination of malaria requires an evidence-based strategy directed at understanding and targeting the entomological drivers of malaria transmission. In 2018 and 2019, the Namibia National Vector-borne Diseases Control Program (NVDCP) implemented baseline entomological surveillance based on a question-based approach outlined in the Entomological Surveillance Planning Tool (ESPT). In the present study, we report on the findings of the ESPT-based NVDCP on baseline vector species composition and bionomic traits in malaria endemic regions in northern Namibia, which has the aim of generating an evidence base for programmatic decision-making. Methods Nine representative sentinel sites were included in the 2018 entomological surveillance program (Kunene, Omusati, Oshana, Ohangwena, Oshikoto, Otjozondjupa, Kavango West, Kavango East and Zambezi); the number was reduced to four sites in 2019 due to limited funding (Ohangwena, Kavango West, Kavango East, and Zambezi). In the 2018 baseline collections, multiple sampling methods (human landing catches, pyrethroid spray catches, U.S. Centers for Disease Control and Prevention light traps [CDC-LTs], resting boxes [RBs] and larval sampling) were utilized to evaluate indoor/outdoor human biting rates, resting behaviors and insecticide resistance (IR). CDC-LTs and RBs were not used in 2019 due to low and non-representative sampling efficacies. Results Overall, molecular evidence demonstrated the presence of three primary mosquito vectors, namely Anopheles arabiensis, rediscovered Anopheles gambiae sensu stricto and Anopheles funestus sensu stricto, alongside Anopheles squamosus and members of the Anopheles coustani complex. Vectors were found to bite throughout the night (1800 hours 0600 hours) both indoors and outdoors, with An. arabiensis having the highest biting rates outdoors. Low numbers of indoor resting Anopheles point to possible low indoor residual spraying (IRS) efficacy—with An. arabiensis found to be the major vector species resting indoors. The IR tests demonstrated varying country-wide resistance levels to the insecticide deltamethrin, with the resistance levels confirmed to have increased in 2019, evidence that impacts national programmatic decision-making. Vectors demonstrated susceptibility to the insecticides dichlorodiphenyltrichloroethane, bendiocarb and Actellic 300CS in 2018, with mosquitoes from only one site (Kavango West) demonstrating possible resistance to DDT. Targeted and question-based entomological surveillance enabled a rapid and focused evidence base to be built, showing where and when humans were being bitten and providing entomological data on long-lasting insecticidal nets, IRS efficacy and insecticide resistance, which the Ministry of Health and Social Services-Namibia can use to further build a monitoring and evaluation framework for understanding the drivers of transmission. Conclusion Identification and characterization of species-specific bionomic traits allows for an understanding of where and when vector human contact may occur as well as the potential impact of interventions. Low indoor resting rates as well as the presence of insecticide resistance (and the increase in its frequency) point to the need for mosquito-behavior-directed and appropriate interventions as well as the requirement for a resistance mitigation strategy. The ESPT-based question- and minimal essential indicator-based operational research strategy provides programs with directed and focused data for facilitating decision-making while requiring limited funding and capacity. Graphical Abstract

Michael Stark,1 Ospan Mynbaev,1 Antonio Malvasi,1,2 Andrea Tinelli1,3 1The New European Surgical Academy, Berlin, Germany; 2Department of Obstetrics and Gynecology, Santa Maria Hospital G.V.M. Care & Research, Bari, Italy; 3Department of Obstetrics and Gynecology and CERICSAL (CEntro di RIcerca Clinico SALentino), Veris delli Ponti Hospital, Scorrano, Lecce, ItalyCorrespondence: Michael Stark, Email mstark@nesacademy.orgAbstract: Throughout history, the upright position was the norm for most deliveries. However, due to cultural reasons, this practice was changed in the 17th century, and since then, the majority of deliveries have been conducted with the parturient lying on her back. The aim of this review article is to challenge the nowadays recumbent birth position and to emphasize the added value of gravity to the childbirth. Physiologically there is a strong argument for delivering in an upright position due to the significant role of gravity. The baby’s presenting part does not move back between contractions as happens in today’s recumbent position when due to the anatomy of the pelvis, the presenting part moves uphill. In this position, the second stage is shorter, and the signal for active pushing occurs spontaneously. It is recommended that any parturient should be informed about the risks and benefits of each birthing option to decide the birthing position that suits her.Keywords: labor position, birth, upright birth, delivery

Tahar Benhidjeb,1,2,&ast; Isabel Benhidjeb,3,&ast; Michael Stark,2 Stefan Kreisel,4 Martin Krüger,5 Jesco Pfitzenmaier,3,&ast; Jan Schulte am Esch1,&ast; 1Department of General and Visceral Surgery, Center for General, Vascular, Thoracic and Visceral Surgery, Protestant Hospital of Bethel Foundation, University Hospital OWL, Campus Bielefeld Bethel, University of Bielefeld, Bielefeld, Germany; 2The New European Surgical Academy (NESA), Berlin, Germany; 3Department of Urology, Center for Computer-Assisted and Robotic Urology, Protestant Hospital of Bethel Foundation, University Hospital OWL, Campus Bielefeld Bethel, University of Bielefeld, Bielefeld, Germany; 4Department of Psychiatry and Psychotherapy, Section Gerontopsychiatry, Protestant Hospital of Bethel Foundation, University Hospital OWL, Campus Bielefeld Bethel, University of Bielefeld, Bielefeld, Germany; 5Department of Internal Medicine and Gastroenterology, Protestant Hospital of Bethel Foundation, University Hospital OWL, Campus Bielefeld Bethel, University of Bielefeld, Bielefeld, Germany&ast;These authors contributed equally to this workCorrespondence: Tahar Benhidjeb, Department of General and Visceral Surgery, Center for General, Vascular, Thoracic and Visceral Surgery, Protestant Hospital of Bethel Foundation, University Hospital OWL, Campus Bielefeld Bethel, University of Bielefeld, Schildescher Str. 99, Bielefeld, 33611, Germany, Email tahar.benhidjeb@yahoo.de; tahar.benhidjeb@evkb.deIntroduction: Despite that NOTES produces at least matchable clinical long-term results when compared to laparoscopy, still a restraint within the medical community and among patients is evident. Consequently, it might be meaningful to evaluate factors of patient’s NOTES perception to promote its acceptance. NOTES is still quite novel and questionnaires regarding its perception by the public is still lacking even so in the Middle East. Aim of our survey is to investigate the viewpoint of female healthcare staff on NOTES.Materials and Methods: A total of 350 questionnaires along with written information about Minimally Invasive Surgery and NOTES were distributed among the female staff in a Tertiary-care Hospital in Abu Dhabi, 257 were returned completely anonymously and voluntarily and entered into a database with a response rate of 73%. We surveyed factors like religion, medical background, age as well as history of previous laparoscopy, endoscopy, birth and other aspects that may impact a woman’s perception of both transgastric and transvaginal NOTES for cholecystectomy and ovariectomy, respectively.Results: Univariate analyses revealed the majority of Muslim women to be more receptive to NOTES as a choice of surgical technique for cholecystectomy and for ovariectomy, respectively, when compared to Christians and Hindus. However, when compared to Muslims, Christian and Hindu groups had a larger share of medical professions. Women with a medical background would opt significantly less for NOTES. Among younger women, NOTES cholecystectomy was refused due to anxiety concerning future pregnancies and sexual dysfunction. Multinomial logistic regression analysis determined medical background and with independent predictive value for the overall choice of interventional technique (p< 0.001). Marital status played a significant role only in the comparison of laparoscopy vs transgastric NOTES when performing cholecystectomy and ovariectomy (p< 0.01).Conclusion: In this first study emanating from the Middle East, medical education and partly life stage rather than cross-cultural differences seem to influence NOTES perception in women.Keywords: natural orifice translumenal endoscopic surgery, perception, Arab female

Abstract Background Although the Republic of Namibia has significantly reduced malaria transmission, regular outbreaks and persistent transmission impede progress towards elimination. Towards an understanding of the protective efficacy, as well as gaps in protection, associated with long-lasting insecticidal nets (LLINs), human and Anopheles behaviors were evaluated in parallel in three malaria endemic regions, Kavango East, Ohangwena and Zambezi, using the Entomological Surveillance Planning Tool to answer the question: where and when are humans being exposed to bites of Anopheles mosquitoes? Methods Surveillance activities were conducted during the malaria transmission season in March 2018 for eight consecutive nights. Four sentinel structures per site were selected, and human landing catches and human behavior observations were consented to for a total of 32 collection nights per site. The selected structures were representative of local constructions (with respect to building materials and size) and were at least 100 m from each other. For each house where human landing catches were undertaken, a two-person team collected mosquitoes from 1800 to 0600 hours. Results Surveillance revealed the presence of the primary vectors Anopheles arabiensis, Anopheles gambiae sensu stricto (s.s.) and Anopheles funestus s.s., along with secondary vectors (Anopheles coustani sensu lato and Anopheles squamosus), with both indoor and outdoor biting behaviors based on the site. Site-specific human behaviors considerably increased human exposure to vector biting. The interaction between local human behaviors (spatial and temporal presence alongside LLIN use) and vector behaviors (spatial and temporal host seeking), and also species composition, dictated where and when exposure to infectious bites occurred, and showed that exposure was primarily indoors in Kavango East (78.6%) and outdoors in Ohangwena (66.7%) and Zambezi (81.4%). Human behavior-adjusted exposure was significantly different from raw vector biting rate. Conclusions Increased LLIN use may significantly increase protection and reduce exposure to malaria, but may not be enough to eliminate the disease, as gaps in protection will remain both indoors (when people are awake and not using LLINs) and outdoors. Alternative interventions are required to address these exposure gaps. Focused and question-based operational entomological surveillance together with human behavioral observations may considerably improve our understanding of transmission dynamics as well as intervention efficacy and gaps in protection. Graphical Abstract

This study evaluated the hydraulic conductivity (K) of lighter bentonitepolymer (B-P) geosynthetic clay liners (GCLs) subjected to wet-dry cycles which simulated seasonal conditions on a GCL installed in a landfill cover system. Lighter bentonite-polymer composite (B-P) GCLs are manufactured with a lower mass per unit area of sodium bentonite (Na-B) (approximately 2.9 kg/m2) than conventional Na-B GCLs (approximately ≥ 3.6 kg/m2) which can reduce the transportation and installation costs compared to conventional Na-B GCLs. Hydraulic conductivity tests on lighter B-P GCL and Na-B GCL were conducted with a synthetic soil porewater leachate to represent wet season conditions on a landfill cover. Between hydraulic conductivity tests, GCL samples were placed in sealed chambers with a relative humidity of 75% until the water content of the specimens decreased to 55%, which represented dry season conditions of a GCL under a geomembrane in a cover system. Slight increases of the hydraulic conductivity were measured for both the Na-B and lighter B-P GCLs. After 5 wet-dry cycles K of the Na-B GCL increased from 3.1 x 10-12 m/s to 8.3 x 10-12 m/s, and K of the lighter B-P GCL increased from 1.6 x 10-12 m/s to 8.3 x 10-12 m/s.

In this paper we describe the development of a streamlined framework for large-scale ATLAS pMSSM reinterpretations of LHC Run-2 analyses using containerised computational workflows. The project is looking to assess the global coverage of BSM physics and requires running O(5k) computational workflows representing pMSSM model points. Following ATLAS Analysis Preservation policies, many analyses have been preserved as containerised Yadage workflows, and after validation were added to a curated selection for the pMSSM study. To run the workflows at scale, we utilised the REANA reusable analysis platform. We describe how the REANA platform was enhanced to ensure the best concurrent throughput by internal service scheduling changes. We discuss the scalability of the approach on Kubernetes clusters from 500 to 5000 cores. Finally, we demonstrate a possibility of using additional ad-hoc public cloud infrastructure resources by running the same workflows on the Google Cloud Platform.

Data from the LHC detectors are not easily represented using regular data structures. These detectors are comprised of several species of subdetectors and therefore produce heterogeneous data. LHC detectors are highly granular by design so that nearby particles may be distinguished. As a consequence, LHC data are sparse, in that many detector channels are not active during a given collision event. Graphs offer a flexible and efficient alternative to rectilinear data structures for representing LHC data. Accordingly, graph-based machine learning algorithms are becoming increasingly popular for a large number of LHC physics tasks [1, 2]. This popularity, and the corresponding potential for substantial increase in physics output, are illustrated on the cover of a recent issue [3] of the CERN Courier magazine. The graphs used in almost all practical applications at the LHC so far are homogeneous, i.e. each node is assigned the same features, and each edge is assigned the same features. In other words, the power of graphs to represent sparse data has been exploited in applications for the LHC, but the potential of graphs to represent heterogeneous data has not. The pink graph on the cover of the CERN Courier [3] can be seen as an illustration of this limitation: all nodes are pink, regardless of their position in the detector. We present novel fully-heterogeneous GNN designs and apply them to simulated data from a tracking detector that resembles the trackers that will be used at the HL-LHC. It contains a pixel subsystem that provides 3D hits and a strip subsystem that provides 2D hits. We present a new design which solves the degraded performance observed in the strip detector in the first GNNbased tracking studies presented by the ATLAS Collaboration [4].

Particle tracking is vital for the ATLAS physics programs. To cope with the increased number of particles in the High Luminosity LHC, ATLAS is building a new all-silicon Inner Tracker (ITk), consisting of a Pixel and a Strip subdetector. At the same time, ATLAS is developing new track reconstruction algorithms that can operate in the HL-LHC dense environment. A track reconstruction algorithm needs to solve two problems: track finding for building track candidates and track fitting for obtaining track parameters of those track candidates. Previously, we developed GNN4ITk, a track-finding algorithm based on a Graph Neural Network (GNN), and achieved good track-finding performance under realistic HL-LHC conditions. Our GNN pipeline relied only on the 3D spacepoint positions. This work introduces heterogeneous GNN models to fully exploit the subdetector-dependent features of ITk data, improving the performance of our GNN4ITk pipeline. In addition, we interfaced our pipeline to the standard ATLAS track-fitting algorithm and data model. With that, the GNN4ITk pipeline produces full-fledged track candidates that can be used for any downstream analyses and compared with the other track reconstruction algorithms.

Abstract Neurofibromatosis Type 1 (NF1) has been reported to be associated with a variety of spinal abnormalities. The purpose of this study was to quantify the prevalence of spinal abnormalities in a collective of NF1 patients that is representative for the general NF1 population, to associate the co-appearance of spinal abnormalities with both NF1 and clinical symptoms and to investigate if different mutations of the NF1 gene affect the prevalence of these abnormalities. Retrospectively, 275 patients with NF1 and an age- and sex-matched collective of 262 patients were analyzed. The prevalence of spinal abnormalities was recorded. Mutational analysis of the NF1 gene was obtained in 235 NF1 patients. Associations between spinal abnormalities, clinical symptoms and genotype were investigated by binary logistic regression analysis. Prevalence of all spinal abnormalities was higher in NF1 patients than in the control group. Six characteristics of spinal abnormalities were significantly associated with NF1 (all p