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Abstract Progress on surgical system strengthening has been slow due to a disconnect between evidence generation and the information required for effective policymaking. This systematic mapping review sought to assess critical research gaps in the field of global surgery guided by the World Health Organisation Health Systems building block framework, analysis of authorship and funding patterns, and an exploration of emerging research partnership networks. Literature was systematically mapped to identify, screen, and synthesize results of publications in the global surgery field between 2015 and March 2022. We searched four databases and included literature published in seven languages. A social network analysis determined the network attributes of research institutions and their transient relationships in shaping the global surgery research agenda. We identified 2,298 relevant studies out of 92,720 unique articles searched. Research output increased from 453 in 2015-16 to 552 in 2021-22, largely due to literature on Covid-19 impacts on surgery. Sub-Saharan Africa (792/2298) and South Asia (331/2298) were the most studied regions, although high-income countries represented a disproportionate number of first (42%) and last (43%) authors. Service delivery received the most attention, including the surgical burden and quality and safety of services, followed by capacity-building efforts in low- and middle-income countries. Critical research in economics and financing, essential infrastructure and supplies, and surgical leadership necessary to guide policy decisions at the country level were lacking. Global surgical systems remain largely under-researched. Knowledge diffusion requires an emphasis on developing sustainable research partnerships and capacity across low- and middle-income countries. A renewed focus must be given to equipping countries with tools for effective decision-making to enhance investments in high-quality surgical services.

Higher education has been touted as critical to social mobility, even greater longevity; however, these benefits accrue with degree completion, and many students who begin college never earn a degree. Using the most recent Integrated Postsecondary Education Data System (IPEDS), we sought to understand variation in college completion rates and test hypotheses related to a set of institutional factors potentially associated with higher completion rates. Our findings suggest that greater attention to low-resource institutions is paramount if higher education is to fulfill the aspiration of promoting social mobility and equity. Several policy interventions could be used to combat ongoing disparities.

Dispensing antibiotics without prescription is irrational and can hasten the emergence and spread of antibiotic resistance. This study aims at determining the extent of this practice and its determinants in all drug retail outlets of Eritrea. A cross-sectional simulated client method was used to conduct the study. Data was collected between July and August 2019, entered and analyzed using Statistical Package for Social Science version 22. Descriptive analysis was performed using mean (standard deviation), median (interquartile range), frequency, percentage, as appropriate, for independent variables. Logistic regression, at bivariate and multivariate levels, along with odds ratio (95% confidence interval) was used to determine the association between the dispensing of antibiotics without prescription and independent variables. P-values less than 0.05 were considered as statistically significant. The extent of dispensing antibiotics without prescription was found to be 87.6% with the most frequently dispensed antibiotics being ciprofloxacin (47.8%) and co-trimoxazole (37.5%). Furthermore, 12.4% of the drug retail outlet attendants did not dispense antibiotics because they preferred a referral to health facilities (52.6%), were following administrative restrictions not to sell antibiotics (42.1%), or did not have the necessary antibiotics (31.6%). Private community pharmacies (AOR = 7.68, 95% CI: 1.67, 35.37; p = 0.009) and private drug shops (AOR = 10.65, 95% CI: 1.96, 57.93; p = 0.006) were more likely to dispense antibiotics compared to the governmental community pharmacies. Dispensing antibiotics without prescription was more likely to occur in the Maekel (central) region (AOR = 3.76, 95% CI: 1.19, 11.92; p = 0.024) compared to the remaining regions combined. In conclusion, the sales of antibiotics without prescription in the drug retail outlets of Eritrea is alarming which requires immediate attention from policymakers.

Abstract Multiple omics analyzes of Vaccinia virus (VACV) infection have defined molecular characteristics of poxvirus biology. However, little is known about the monkeypox (mpox) virus (MPXV) in humans, which has a different disease manifestation despite its high sequence similarity to VACV. Here, we perform an in-depth multi-omics analysis of the transcriptome, proteome, and phosphoproteome signatures of MPXV-infected primary human fibroblasts to gain insights into the virus-host interplay. In addition to expected perturbations of immune-related pathways, we uncover regulation of the HIPPO and TGF-β pathways. We identify dynamic phosphorylation of both host and viral proteins, which suggests that MAPKs are key regulators of differential phosphorylation in MPXV-infected cells. Among the viral proteins, we find dynamic phosphorylation of H5 that influenced the binding of H5 to dsDNA. Our extensive dataset highlights signaling events and hotspots perturbed by MPXV, extending the current knowledge on poxviruses. We use integrated pathway analysis and drug-target prediction approaches to identify potential drug targets that affect virus growth. Functionally, we exemplify the utility of this approach by identifying inhibitors of MTOR, CHUK/IKBKB, and splicing factor kinases with potent antiviral efficacy against MPXV and VACV.

Abstract Urban forests are crucial providers of ecosystem services, delivering significant benefits to residents and the environment. This study aimed to investigate how residents in Mekelle, Tigray, Ethiopia, perceive the ecosystem services provided by urban forests. Understanding these perceptions is essential, particularly in developing countries and the study area, where little research has been conducted on this topic. To achieve this objective, a questionnaire-based survey was conducted among randomly selected household heads from two sub-cities within Mekelle. The collected data were analyzed using both descriptive and inferential statistics, including Spearman rank correlation and ordinal regression analysis. These analyses helped identify the factors influencing inhabitants’ perceptions of ecosystem services. The findings revealed that residents placed a high value on the regulating ecosystem services provided by urban forests. In contrast, provisioning, supporting, and cultural ecosystem services were perceived at a medium level. Additionally, the analysis indicated that the level of education and age of respondents were significant factors influencing their overall perception of these ecosystem services. Higher educational attainment and older age were associated with a greater appreciation of the ecosystem services offered by urban forests. This study has important implications for urban forest management and policy. It highlights the necessity of incorporating community perceptions of ecosystem services into urban planning and management efforts. Moreover, the study recommends the need for local governments to focus on raising community awareness about the ecosystem services provided by urban forests. This can ensure more effective and inclusive urban forest management strategies that align with community values and needs.

Probabilistic seismic performance assessment method for buildings offers a valuable approach to simulate the broader regional impacts: economic losses, downtime, and casualties. A crucial aspect of this process entails accounting for the spatial correlation of building performances, aiming for an accurate estimation of the probability of extreme regional losses, such as the simultaneous collapse of buildings with similar structural characteristics. In this study, a correlation model based on a Gaussian random field is employed, and several key challenges associated with its application are addressed. In addition, efficiency of five different methods of selecting station records from the same earthquake scenario is compared. The minimum number of earthquake records necessary to achieve a stable correlation result is determined. Additionally, spatial correlations derived from different history earthquake events are compared. By addressing these critical issues, this research contributes to refining the reliability of probabilistic methods for regional resilience assessment.

High quality, safe and sufficient drinking water is essential for public health and well-being. However, the war on Tigrai damaged the water sources of communities and pose people to health problems. Therefore, the aim of the present study was to assess the quality of water of the town of Abyi Adi, Tigrai, Northern Ethiopia using physicochemical and biological parameters and water quality indices. A total of 36 water samples were collected from four major water sources. The physicochemical and biological parameters were determined using standard analytical procedures for water analysis. The mean values of electrical conductivity and pH ranged from 273.63 to 881.27 μS/cm and 6.68 to 7.42, respectively. Moreover, the experimental results of major cations (Na+ = 3.70–14.77 mg/L and Ca2+ = 8.50–15.77 mg/L), and anions (HCO3− = 21.52–40.77 mg/L, Cl− = 13.56–40.29 mg/L, NO3− = 0.14–0.25 mg/L, NO2− = 0.24–0.76 mg/L and PO43− = 0.34–1.32 mg/L) were recorded below the World Health Organization (WHO) permissible limits set for drinking water. The water quality index (WQI) that is determined using a weighted arithmetic water quality index method (WAWQIM) was also found in the range of 5.3–37.2. Subsequently, all groundwater sources except Adibakla are classified as excellent or “A” rating. However, the total coliform of Maylomin and Chiny water sources were found to be 6.33 MPN/100 mL and 3.67 MPN/100 mL, respectively. Both are higher than the WHO permissible limit set for drinking water. Considering the susceptibility of groundwater to pollution and its impact to human health, regular monitoring and supervision should be performed to keep the water safe for drinking. Accordingly, chlorination water treatment process is recommended to provide safe drinking water.

Abstract Lipopolysaccharide (LPS) phase variation is a critical aspect of virulence in many Gram-negative bacteria. It is of particular importance to Coxiella burnetii, the biothreat pathogen that causes Q fever, as in vitro propagation of this organism leads to LPS truncation, which is associated with an attenuated and exempted from select agent status (Nine Mile II, NMII). Here, we demonstrate that NMII was recovered from the spleens of infected guinea pigs. Moreover, these strains exhibit a previously unrecognized form of elongated LPS and display increased virulence in comparison with the initial NMII strain. The reversion of a 3-bp mutation in the gene cbu0533 directly leads to LPS elongation. To address potential safety concerns, we introduce a modified NMII strain unable to produce elongated LPS.

Objective To assess antibiotic prescribing practice and its determinants among outpatient prescriptions dispensed to the elderly population.Design A prescription-based, cross-sectional study.Setting Six community chain pharmacies in Asmara, Eritrea.Participants All outpatient prescriptions dispensed to the elderly population (aged 65 and above) in the six community chain pharmacies in Asmara, Eritrea.Data collection and analysis Data were collected retrospectively, between 16 June 2023 and 16 July 2023. Antibiotic prescribing practice was assessed using the 2023 World Health Organization (WHO) Access, Watch and Reserve (AWaRe) classification system. Descriptive statistics and logistic regression were performed using IBM SPSS (V.26.0). P values less than 0.05 were considered as significant.Results Of the 2680 outpatient prescriptions dispensed to elderly population, 35.8% (95% CI: 34.0, 37.6) contained at least one antibiotic. Moreover, a total of 1061 antibiotics were prescribed to the elderly population. The most commonly prescribed antibiotics were ciprofloxacin (n=322, 30.3%) and amoxicillin/clavulanic acid (n=145, 13.7%). The Access category accounted for the majority of antibiotics (53.7%) with 32.1% from the Watch category. Prescriber qualification (Adjusted Odds Ratio (AOR)= 0.60, 95% CI: 0.44, 0.81) and polypharmacy (AOR= 2.32, 95% CI: 1.26, 4.27) were significant determinants of antibiotic prescribing in the elderly population. Besides, sex (AOR=0.74, 95% CI: 0.56, 0.98), prescriber qualification (AOR=0.49, 95% CI: 0.30 to0.81) and level of health facility (AOR 0.52, 95% CI 0.34 to 0.81) were significant determinants of a Watch antibiotic prescription.Conclusion Antibiotics were prescribed to a considerable number of the elderly population, with more than half of them falling into the Access category. Further efforts by policy-makers are needed to promote the use of Access antibiotics while reducing the use of Watch antibiotics to mitigate risks associated with antimicrobial resistance.

Personal and situational factors contribute to international students' sociocultural adjustment in a host society. Thus this study attempts to determine the roles of self-efficacy, self-esteem, and previous travel experience on sociocultural adjustment. The sample for this study constituted 328 undergraduate and postgraduate international students, studying in three Chinese universities. Participants completed a set of tests measuring their sociocultural adjustment, self-efficacy and self-esteem, as well as answered demographic questions. Hierarchical multiple regression and a PROCESS macro were used to analyze the data. Results revealed that prior travel experience, self-efficacy, and self-esteem significantly predicted sociocultural adaptation. In particular, self-esteem partially mediated the relationship between self-efficacy and sociocultural adaptation. Limitations and future study directions and implications for the findings are discussed.

BACKGROUND: The great advances of nanomaterials have brought out broad important applications, but their possible nanotoxicity and risks have not been fully understood. It is confirmed that exposure of environmental particulate matter (PM), especially ultrafine PM, are responsible for many lung function impairment and exacerbation of pre-existing lung diseases. However, the adverse effect of nanoparticles on allergic asthma is seldom investigated and the mechanism remains undefined. For the first time, this work investigates the relationship between allergic asthma and nanosized silicon dioxide (nano-SiO₂). METHODOLOGY/PRINCIPAL FINDINGS: Ovalbumin (OVA)-treated and saline-treated control rats were daily intratracheally administered 0.1 ml of 0, 40 and 80 µg/ml nano-SiO₂ solutions, respectively for 30 days. Increased nano-SiO₂ exposure results in adverse changes on inspiratory and expiratory resistance (Ri and Re), but shows insignificant effect on rat lung dynamic compliance (Cldyn). Lung histological observation reveals obvious airway remodeling in 80 µg/ml nano-SiO₂-introduced saline and OVA groups, but the latter is worse. Additionally, increased nano-SiO₂ exposure also leads to more severe inflammation. With increasing nano-SiO₂ exposure, IL-4 in lung homogenate increases and IFN-γ shows a reverse but insignificant change. Moreover, at a same nano-SiO₂ exposure concentration, OVA-treated rats exhibit higher (significant) IL-4 and lower (not significant) IFN-γ compared with the saline-treated rats. The percentages of eosinophil display an unexpected result, in which higher exposure results lower eosinophil percentages. CONCLUSIONS/SIGNIFICANCE: This was a preliminary study which for the first time involved the effect of nano-SiO₂ to OVA induced rat asthma model. The results suggested that intratracheal administration of nano-SiO₂ could lead to the airway hyperresponsiveness (AHR) and the airway remolding with or without OVA immunization. This occurrence may be due to the Th1/Th2 cytokine imbalance accelerated by the nano-SiO₂ through increasing the tissue IL-4 production.