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Xiang-Rong Bai,1,* Jing-Rong Cao,2,* Zhi-Zhou Wang,1 Wen-Chao Li,1 Dian-Dian Chen,2 Ran Lou,3 Xin Qu,4 Su-Ying Yan1 1Department of Pharmacy, Xuan Wu Hospital Capital Medical University, National Gerontic Disease Clinical Research Center, Beijing, 100053, People’s Republic of China; 2Department of Clinical Laboratory, Xuan Wu Hospital Capital Medical University, National Gerontic Disease Clinical Research Center, Beijing, 100053, People’s Republic of China; 3Department of Intensive Medicine, Xuan Wu Hospital Capital Medical University, National Gerontic Disease Clinical Research Center, Beijing, 100053, People’s Republic of China; 4Intensive Care Unit, Department of Neurosurgery, Xuan Wu Hospital Capital Medical University, National Gerontic Disease Clinical Research Center, Beijing, 100053, People’s Republic of China*These authors contributed equally to this workCorrespondence: Su-Ying Yan, Department of Pharmacy, Xuan Wu Hospital Capital Medical University, National Gerontic Disease Clinical Research Center, No. 45 Changchun Street, Xi Cheng District, Beijing, 100053, People’s Republic of China, Tel/Fax +86 10-63012837, Email yansuying10@sina.cnPurpose: Tigecycline is an agent for carbapenemase-producing Klebsiella pneumonia (KPC-KP), given its penetration into lung tissues. Our study focused on the molecular and clinical efficacy of tigecycline for hospital-acquired pneumonia (HAP) in the ICU.Patients and Methods: A retrospective cohort study of 52 adult KPC-KP HAP patients by searching hospital medical records from January 2018 to December 2020 was established to investigate the epidemiology of KPC-KP infections for tigecycline treatment and the associated clinical efficacy of tigecycline. The KPC-KP isolates underwent multilocus sequence typing. Molecular typing, antimicrobial resistance, and virulence profiling were also analyzed by whole-genome sequencing of KPC-KP.Results: Among 52 patients with KPC-KP, the ICU mortality rate was 14/52 (27%), and there was no significant statistical difference in mortality between the effective group and failure group (p = 0.754). However, the duration of tigecycline was statistically different between the two groups of patients (14.4 vs 10 days, p=0.046). The total bacterial clearance rate was 6/52 (11.5%). There was no significant statistical difference in both groups (p=0.416). Antibiotic resistance genes (aac3iia) and virulence gene (AREO-iutA, Capsule-wzc) were negatively correlated with clinical efficacy (p = 0.011, OR = 1.237).Conclusions: Blakpc was the main carbapenemase in all K. pneumoniae strains. ST11-KL64 KPC-KP was the most common virulence factors in KPC-KP isolates. This study suggested that antibiotic resistance genes (aac3iia) and virulence gene (AREO-iutA, Capsule-wzc) were independent mortality risk factors for patients with Klebsiella pneumoniae carbapenemase-2 producing K. pneumoniae infections, when during the tigecycline treatment. Molecular analysis of K. pneumoniae may provide an option when choosing the antimicrobial treatment.Keywords: Klebsiella pneumoniae, carbapenemase, virulence factors, resistance genes, hospital-acquired pneumonia

Shu-Chen Dong,1,* Huan-Huan Sha,1,* Xiao-Yue Xu,1 Tian-Mu Hu,2 Rui Lou,1 Huizi Li,1 Jian-Zhong Wu,1 Chen Dan,1 Jifeng Feng1 1Jiangsu Cancer Hospital and Jiangsu Institute of Cancer Research and Nanjing Medical University Affiliated Cancer Hospital, Nanjing 210009, China; 2Department of Biological Science, Purdue University, West Lafayette, IN, USA *These authors contributed equally to this work Abstract: Glutathione S-transferase π (GSTπ) is a Phase II metabolic enzyme that is an important facilitator of cellular detoxification. Traditional dogma asserts that GSTπ functions to catalyze glutathione (GSH)-substrate conjunction to preserve the macromolecule upon exposure to oxidative stress, thus defending cells against various toxic compounds. Over the past 20 years, abnormal GSTπ expression has been linked to the occurrence of tumor resistance to chemotherapy drugs, demonstrating that this enzyme possesses functions beyond metabolism. This revelation reveals exciting possibilities in the realm of drug discovery, as GSTπ inhibitors and its prodrugs offer a feasible strategy in designing anticancer drugs with the primary purpose of reversing tumor resistance. In connection with the authors’ current research, we provide a review on the biological function of GSTπ and current developments in GSTπ-targeting drugs, as well as the prospects of future strategies. Keywords: tumor resistance, glutathione S-transferase pi, drug treatment

BackgroundThere is an urgent need to better understand the factors that predict mental wellbeing in vocationally active adults during globally turbulent times.AimTo explore the relationship between psychological detachment from work (postulated as a key recovery activity from work) in the first national COVID-19 lockdown with health, wellbeing, and life satisfaction of working age-adults one year later, within the context of a global pandemic.MethodsWellbeing of the Workforce (WoW) was a prospective longitudinal cohort study, with two waves of data collection (Time 1, April-June 2020: T1 n = 337; Time 2, March-April 2021: T2 = 169) corresponding with the first and third national COVID-19 lockdowns in the UK. Participants were >18 years, who were employed or self-employed and working in the UK. Descriptive and parametric (t-tests and linear regression) and nonparametric (chi square tests) inferential statistics were employed.ResultsRisk for major depression (T1: 20.0% to T2: 29.0%, p = .002), poor general health (T1: 4.7% to T2: 0%, p = .002) and poor life satisfaction (T1: 15.4% to T2: 25.4%, p = .002) worsened over time, moderate-to-severe anxiety remained stable (T1: 26.1% to T2: 30.2%, p = .15). Low psychological detachment from work was more prevalent in the first wave (T1: 21.4% and T2: 16.0%), with a moderate improvement observed from T1 to T2 (t (129) = -7.09, p < .001). No differences were observed with work status (employed/self-employed), except for self-employed workers being more likely to report poor general health at T1 (16.1%, p = .002). Better psychological wellbeing, lower anxiety and higher life satisfaction at T2 were observed in those who reported better psychological detachment from work at T1 (β = .21, p = .01; β = -.43, p < .001; β = .32, p = .003, respectively), and in those who improved in this recovery activity from T1 to T2 (β = .36, p < .001; β = -.27, p < .001; β = .27, p = .008, respectively), controlling for age, gender and ethnicity.ConclusionThe ability to psychologically detach from work during the first pandemic lockdown, and improvement in this recovery activity over time, predicted better mental wellbeing and quality of life in vocationally active adults after one year of a global crisis, irrespective of work status. Interventions to encourage workers to psychologically detach from work may help to support employee wellbeing at all times, not only in the extreme circumstances of pandemics and economic uncertainty.

Abstract Background People who use illicit drugs cumulate medical and psychosocial vulnerabilities, justifying a rounded health approach. Both caregivers and patients can form barriers to accessing care, leading to inadequate care. This study aimed to identify the needs and expectations of such patients in general practice. Methods Qualitative research was conducted using semi-structured interviews with 23 people with illicit substance use disorder in Brussels in 2020. Multicentric recruitment was conducted to obtain a heterogeneous mix of sociodemographic profiles and care trajectories. Thematic analysis was performed using RQDA package software. Results Participants highlighted several vulnerabilities. These include the presence of significant self-stigmatization and guilt, sometimes to the extent of self-dehumanization, even after years of care, and overdoses masking suicide attempts and early memory disorders. Multiple substance use, smoking in almost all participants, and misuse of benzodiazepines were also noted. The majority of participants expressed the need for an open-minded, non-stigmatizing and empathic GP with a holistic approach that could guide them throughout their life course. The competencies of the GPs in the field of addiction seemed secondary to the participants. Knowledge and good collaboration with the mental health network were assets. Conclusion Participants expressed the need for GPs with good interpersonal skills, including a non-stigmatizing attitude. The care coordinator role of the GP was highlighted as a key element, as it was a holistic approach focusing on global health (including the social determinants of health) and not only on substance use disorders.

Abstract Introduction People with substance use disorder (SUD) deal with stigmatization in various areas of life, including healthcare system. In this study, we investigated the attitudes of final-year medical students towards SUD people and attempted to understand their influence. Methods We conducted a two-stage cluster analysis (hierarchical ascending classification followed by K-means clustering) based on the “beSAAS”. We administrated this 23-item questionnaire to 923 final-year medical students in Belgium (response rate = 71,1%). Sociodemographic characteristics were compared between the clusters. Results Four clusters of students with specific characteristics were identified in this study. The first, “The Inclusives” (including 27,9% of respondents) had the least negative attitudes; they wanted to specialize mainly in psychiatry and gynecology. The second, “The Centrists" (23,6%) consisted mainly of male students. They had many private and professional experiences with substance use and considered themselves less healthy than others did. Most wanted to specialize in pediatrics and general practice. Their attitudes were slightly negative towards people with SUD. The third, “The Moralists” (27,6%), were mainly older, from non-European countries, had the least experience with substance use (or contact mainly in hospitals), had the less high mother’s level of education and reported excellent health. They were heading toward other specialties. They had the most stereotypes and moralism, and less treatment optimism. The fourth, “The Specialist care-oriented” (20,8%), were the most in favor of specialized treatment. This group had a higher proportion of Belgian, females, and students who had specific contact with this population. They especially intended to specialize in internal medicine. Conclusion This study revealed 4 profiles of medical students with different attitudes towards SUD people. “The Moralists”, including more than a quarter of the respondents, were characterized by strong stereotypes and moralism and little treatment optimism. These clusters could contribute to the design of a learner-centered program aimed at addressing stigma within the main curriculum.

Abstract Introduction The misuse of Pregabalin has been the subject of growing concern for several years. The effects sought are multiple and it is rarely taken as a single drug. It is most frequently used together with opioids, which may increase the risk of fatal overdose. In response to this emerging phenomenon, we seek to better understand the situation of misuse in Belgium and identify the people involved in it. Methodology A qualitative study using semi-structured interviews with 20 participants who misuse Pregabalin was conducted throughout the French-speaking region of Belgium between August 2021 and January 2022. Recruitment mostly took place in addictions centers, shelters for migrants and homeless persons and primary care centers. We then conducted a thematic analysis with the help of Nvivo software. Results A profile emerged, of young male users, immigrants, mainly first generation immigrants coming from North Africa. They had in common a challenging or even traumatic migration pathway and precarious living conditions in Belgian territory. Most of them had no stable income. They saw Pregabalin as enabling them to cope with their daily situation. All had psychiatric and/or somatic comorbidities for which they had apparently not recieved adequate medical care. This seemed to lead many of them to use Pregabalin as self-medication, for anxiety-depressive disorders and chronic pain, and it was sometimes initiated in their home country. Pregabalin was never used alone. Conclusion This study has highlighted a rare and insufficient documented profile of Pregabalin misuse: self-medication among a group of first generation immigrants, most of whom have no previous history of opioid-related disorders. Measures should be taken to improve access to health and social care for this population, considering all their biopsychosocial vulnerabilities.

Viral infection can regulate the cell cycle, thereby promoting viral replication. Hijacking and altering the cell cycle are important for the virus to establish and maintain a latent infection. Previously, Spodoptera exigua multiple nucleopolyhedrovirus (SeMNPV)-latently infected P8-Se301-C1 cells, which grew more slowly than Se301 cells and interfered with homologous SeMNNPV superinfection, were established. However, the effects of latent and superinfection with baculoviruses on cell cycle progression remain unknown. In this study, the cell cycle profiles of P8-Se301-C1 cells and SeMNPV or Autographa californica multiple nucleopolyhedrovirus (AcMNPV)-infected P8-Se301-C1 cells were characterized by flow cytometry. The results showed that replication-related genes MCM4, PCNA, and BAF were down-regulated (p < 0.05) in P8-Se301-C1 cells, and the S phase of P8-Se301-C1 cells was longer than that of Se301 cells. P8-Se301-C1 cells infected with SeMNPV did not arrest in the G2/M phase or affect the expression of Cyclin B and cyclin-dependent kinase 1 (CDK1). Furthermore, when P8-Se301-C1 cells were infected with SeMNPV after synchronized treatment with hydroxyurea and nocodazole, light microscopy and qRT-PCR analysis showed that, compared with unsynchronized cells and S and G2/M phase cells, SeMNPV-infected P8-Se301-C1 cells in G1 phase induced G2/M phase arrest, and the amount of virus adsorption and intracellular viral DNA replication were significantly increased (p < 0.05). In addition, budded virus (BV) production and occlusion body (OB)-containing cells were both increased at 120 h post-infection (p < 0.05). The expression of Cyclin B and CDK1 was significantly down-regulated at 48 h post-infection (p < 0.05). Finally, the arrest of SeMNPV-infected G1 phase cells in the G2/M phase increased BV production (p < 0.05) and the number of OB-containing cells. In conclusion, G1 phase infection and G2/M arrest are favorable to SeMNPV proliferation in P8-Se301-C1 cells, thereby alleviating the homologous superinfection exclusion. The results contribute to a better understanding of the relationship between baculoviruses and insect cell cycle progression and regulation.

Tripe-negative breast cancers poorly respond to immune checkpoint inhibition therapy, due to their immune-hostile tumour microenvironment. Authors here show that the oncogene MYC plays a pivotal role in suppressing anti-tumour immunity via directly regulating the transcription of interferon signalling genes.

Pelvic fixation remains one of the main challenging issues in non-ambulatory neuromuscular scoliosis (NMS) patients, between clinical effectiveness and a high complication rate. The objective of this multicenter and retrospective study was to evaluate the outcomes of a technique that was applied to treat 173 NMS patients. The technique is not well-known but promising; it uses the ilio-sacral screw, combined with either the posterior spinal fusion or fusionless bipolar technique, with a minimum follow-up of two years. The mean operative age of the patients was 13 ± 7 years. The mean preoperative main coronal curve was 64° and improved by a mean of −39° postoperatively. The mean preoperative pelvic obliquity was 23°, which improved by a mean of −14° postoperatively. No decrease in the frontal or sagittal correction was observed during the last follow-up. The sitting posture improved in all cases. Twenty-nine patients (17%) had a postoperative infection: twenty-six were treated with local debridement and antibiotics, and three required hardware removal. Fourteen mechanical complications (8%) occurred: screw malposition (n = 6), skin prominence (n = 1), and connector failure (n = 1). This type of surgery is associated with a high risk for infection. Comorbidities, rather than the surgery itself, were the main risk factors that led to complications. The ilio-sacral screw was reliable and effective in correcting pelvic obliquity in NMS patients. The introduction of intraoperative navigation should minimize the risk of screw misplacement and facilitate revision or primary fixation.

Abstract Background People with substance use disorder, and pregnant women especially, are subject to a lot of stigmas, which can prevent optimal accessibility and quality of care. In this survey, we investigated attitudes of final year medical students regarding substance use during pregnancy and identified the factors that influence these attitudes. Method This cross-sectional study was conducted in 2019 and 2020 in Belgium using the short version of the “Substance Abuse Attitude Survey” questionnaire. We focused on two items regarding punishment of substance use during pregnancy. We analysed the concordance between these two, their correlation with other items (e.g. stereotyping, morality, forced withdrawal, low treatment optimism) and the association between respondents’ opinion on punishment and their sociodemographic data. Results The response rate was 65.2% (370/567 online and face-to face questionnaires). 19.2% of respondents were in favour of punishment for alcohol use (n = 353) and 15.1% for drug use (n = 356) during pregnancy. The agreement analysis between the two items showed that 14.3% of students were in favour of punishing both pregnant women who use drugs and those using alcohol. Respondents tended to be more in favour of punishment if they were male students, older, their mothers’ had a lower education level or had no personal or family history of substance use. Attitudes appeared to be more punitive among students with limited contact with people with substance use disorder (i.e. none or limited to hospital). Students intending to specialise in internal medicine were more in favour of punishment of women whereas none of those intending to specialise in psychiatry were in favour. Conclusion Our study shows that about 20% of surveyed medical students favoured punishing substance-using pregnant women. Awareness and training work seems to be necessary to ensure adequate care and support for this already vulnerable population.

Based on the practical problem of fatigue life prediction of landing gear, the fatigue life prediction model of landing gear components with surface treatment was studied. The calculation process of the traditional local stress-strain method was introduced, and the factors that affect the local stress-strain method for fatigue life prediction were systematically explained; The actual engineering research shows that the main factors for predicting the fatigue life of landing gear by using the local stress-strain method are surface treatment and surface roughness. By modifying the strain-life curve, a model for predicting the fatigue life of landing gear components is proposed. The two calculation examples show that the predicted results are in good agreement with the experimental results, and the proposed method for revising the strain-life curves under different surface conditions is reasonable.

Complicated pregnancies are nowadays a major public health concern, with possible lethality or sequelae both for the mother and the fetus. Blood coagulation disorders (including antiphospholipid syndrome, factor V Leiden mutation and antithrombin deficiency) and hypertensive gestational disorders are very well-known contributors of complicated pregnancies with poor fetal outcome, such as intrauterine growth retardation (IUGR) and fetal demise. Less commonly, vascular malformations of the placenta can also potentially lead to serious complications such as IUGR and fetal death. These malformations include hypercoiled umbilical cord, umbilical cord knot, umbilical cord varix, umbilical cord arterial or venous aneurysm, and velamentous insertion of the umbilical cord potentially leading to Benckiser's hemorrhage. Here, we report the case of a 29-year-old Gravida 2 Para 0 mother with previous history of stillbirth and smoking, admitted to the obstetrics department for the absence of fetal movement at 38 weeks of amenorrhea (WA). First-trimester and second-trimester routine ultrasounds were otherwise normal. Ultrasound performed at 38 WA revealed a 83 × 66 × 54 mm cystic heterogenous mass at the umbilical cord insertion. After delivery, fetal and placental pathology as well as maternal blood testing were performed. Fetal pathology was otherwise normal, except for diffuse congestion and meconial overload suggesting acute fetal distress. Fetal karyotype was normal (46 XX). Placental pathology revealed an umbilical artery aneurysm (UAA) at the base of the insertion of the umbilical cord, lined with a CD34+ CD31+ endothelium. After dissection, the aneurysm was filled with hemorrhagic debris, indicating aneurysm thrombosis. Histopathology revealed associated maternal vascular malperfusion (MVM) and increased peri-villous fibrin (IPF). Maternal blood tests revealed heterozygous factor V Leiden mutation, without other associated auto-immune conditions (such as antiphospholipid syndrome). Umbilical artery aneurysms remain extremely rare findings in the placenta, with

Background Several European countries face a shortage of general practitioners (GPs), in part due to GP attrition. Most studies of GP attrition have focussed on why GPs decide to leave. Yet understanding why GPs decide to remain may also elicit potential interventions to reduce attrition. Objectives This study examined GP graduates’ career trajectories and underlying decisions to elucidate the factors influencing GP attrition. Methods We conducted semi-structured interviews of early to mid-career general practice graduates having completed training in Belgian French-speaking universities between 1999 and 2013. We sampled participants from three categories: full-time GPs, part-time GPs, no longer working as GPs. We analysed each participant’s career trajectory and broke it down into major phases. We performed thematic analysis of the factors influencing participants’ trajectories. We compared and contrasted trajectories to develop a typology of career trajectories. Results We identified six types of career trajectories: ‘stable’ (never considered leaving general practice), ‘reaffirmed’ (had considered leaving but made substantial changes whilst remaining), ‘reactional reorientations’ (had left to escape the challenges of general practice), ‘inspired reorientations’ (had left to pursue a different job), ‘reorientations out of loyalty’ (had never wanted to practice as GPs and had remained true to their original professional aspirations) and ‘mobiles’ (valued change and did not want to set-up practice). Conclusion Reasons GPs leave the profession are multiple. The typology that emerged indicates that only some of the career trajectories would benefit from interventions to reduce attrition such as improving working conditions and providing psychological support for GPs.

The landing gear of an aircraft bears a large impact load during landing, which causes the internal shock absorber to withstand high oil pressure and air pressure, and the buffer performance is greatly influenced. Firstly, based on the axial load of the buffer, the pressure formula of each cavity of the buffer is deduced. Then, the differential equation of the landing motion of landing gear is established by using the two mass system. Finally, the landing gear buffer pressure simulation model is built by using MATLAB/Simulink, which is used to analyze the variation of the pressure of each chamber with time and buffer stroke at different landing speeds, and the influence of oil chamber pressure on the cushioning performance with different oil return areas. The results show that, at different landing speeds, the pressure of each cavity presents a certain regularity at a specific moment of the landing process; the positive stroke oil return hole should not be too small, ensuring that the oil fills the oil return cavity, and the reverse stroke oil return hole cannot be too large to ensure that the oil fills the main oil chamber; the oil pressure in the buffer during landing process affects the stability of the plunger.

[Introduction] The paper aims to establish a sparseness approach based sample distribution for LS-SVM models to solve the problem of excessive computation in the application of classical iterative shearing sparseness algorithm for the soft measurement model of the carbon content in flying ash. [Method] On the basis of calculating the feature space distance between the samples, global representative indicator is constructed by mixing together the density and dispersion. The original samples were sorted and pruned and the sparsenseness was realized according to the indicator. The LS-SVM soft measurement model of the carbon content in fly ash was applied to a 1 000 MW coal-fired power plant, the original training sample set was taken from the field operation data of the unit. [Result] The results show that the proposed algorithm can greatly reduce the capacity of the training set with tiny loss of the error performance and it can reduce the training and online prediction calculation work during the LS-SVM soft measurement model of the carbon content in fly ash. [Conclusion] The LS-SVM sparse algorithm proposed in this paper reduces the sample space from 90 to 30, which not only reduces the calculation scale, but also guarantees the calculation accuracy, while guaranteeing that the error is reduced by 0.01%. The algorithm can realize on-line soft measurement of carbon content in fly ash in industrial controllers with limited computing performance such as PLC, and can be extended to other parameters soft measurement systems in power plants.

Perylenediimide (PDI) is one of the most important classes of dyes and is intensively explored in the field of functional organic materials. The functionalization of this electron-deficient aromatic core is well-known to tune the outstanding optoelectronic properties of PDI derivatives. In this respect, the functionalization has been mostly addressed in bay-positions to halogenated derivatives through nucleophilic substitutions or metal-catalyzed coupling reactions. Being aware of the synthetic difficulties of obtaining the key intermediate 1-bromoPDI, we will present as an alternative in this review the potential of 1-nitroPDI: a powerful building block to access a large variety of PDI-based materials.

Comparing the sources of a novel and a biography leads to the paradox that the freedom of fiction can allow a more “realistic” treatment of character than the restriction of biography to documented facts allows. The distinctions and the paradox are asserted to be less poignant and crucial in the light of David Antin’s theory of narrative and Johan Huizinga’s exploration of the play element of culture.

This manuscript summarizes the failure mechanisms found in inorganic fullerene-type tungsten disulfide (IF-WS2) nanoparticles treated with diverse pressure loading methods. The approaches utilized to induce failure included: the use of an ultrasonic horn, the buildup of high pressures inside a shock tube which created a shock wave that propagated and impinged in the sample, and impact with military rounds. After treatment, samples were characterized using electron microscopy, powder X-ray diffraction, energy dispersive X-ray spectroscopy, and surface area analysis. The microstructural changes observed in the IF-WS2 particulates as a consequence of the treatments could be categorized in two distinct fracture modes. The most commonly observed was the formation of a crack at the particles surface followed by a phase transformation from the 3D cage-like structures into the 2D layered polymorphs, with subsequent agglomeration of the plate-like sheets to produce larger particle sizes. The secondary mechanism identified was the incipient delamination of IF-WS2. We encountered evidence that the IF-WS2 structure collapse initiated in all cases at the edges and vertices of the polyhedral particles, which acted as stress concentrators, independent of the load application mode or its duration.

Infection, for example, Helicobacter pylori (H. pylori), has been thought to play a role in the pathogenesis of type 2 diabetes mellitus (T2DM). Our aim was to determine the role of H. pylori infection in glucose metabolism in an American cohort. We examined data from 4,136 non-Hispanic white (NHW), non-Hispanic black (NHB), and Mexican Americans (MA) aged 18 and over from the NHANES 1999-2000 cohort. We calculated the odds ratios for states of glucose tolerance based on the H. pylori status. We calculated and compared homeostatic model assessment insulin resistance (HOMA-IR) and beta cell function (HOMA-B) in subjects without diabetes based on the H. pylori status. The results were adjusted for age, body mass index (BMI), poverty index, education, alcohol consumption, tobacco use, and physical activity. The H. pylori status was not a risk factor for abnormal glucose tolerance. After adjustment for age and BMI and also adjustment for all covariates, no difference was found in either HOMA-IR or HOMA-B in all ethnic and gender groups except for a marginally significant difference in HOMA-IR in NHB females. H. pylori infection was not a risk factor for abnormal glucose tolerance, nor plays a major role in insulin resistance or beta cell dysfunction.

Rice industry in the Philippines is beset with environmental, social, and economic concerns resulting in low farmer incomes, lack of food security and meager competitiveness. This study aimed to develop inclusive interventions on rice trading practices involving smallholder farmers. Primary data were derived from baseline interviews from farmers, traders, millers, wholesalers, and retailers to assess trading practices involved in the chain. Stakeholder consultations were also conducted to validate the findings and identify strategies for the initiatives. Based on the results, the major challenges identified include high production and marketing costs of paddy attributed to high material inputs and labor costs. This leads to a low profit margin for smallholder farmers. This gap relates to poor market linkage that limits the ability of farmers to receive higher prices for their produce. Interventions involving the improvement of marketability through market innovation were prioritized to address the gap. Recommendations concerning reducing institutional barriers towards smallholder farmers was provided to broaden adoption of inclusive trading practices and foster a more equitable and sustainable rice value chain.