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Background Randomized controlled trials found that twice-yearly mass azithromycin administration (MDA) reduces childhood mortality, presumably by reducing infection burden. World Health Organization (WHO) issued conditional guidelines for mass azithromycin administration in high-mortality settings in sub-Saharan Africa given concerns for antibiotic resistance. While prolonged twice-yearly MDA has been shown to increase antibiotic resistance in small randomized controlled trials, the objective of this study was to determine if macrolide and non-macrolide resistance in the gut increases with the duration of azithromycin MDA in a larger setting. Methods and findings The Macrolide Oraux pour Réduire les Décès avec un Oeil sur la Résistance (MORDOR) study was conducted in Niger from December 2014 to June 2020. It was a cluster-randomized trial of azithromycin (A) versus placebo (P) aimed at evaluating childhood mortality. This is a sub-study in the MORDOR trial to track changes in antibiotic resistance after prolonged azithromycin MDA. A total of 594 communities were eligible. Children 1 to 59 months in 163 randomly chosen communities were eligible to receive treatment and included in resistance monitoring. Participants, staff, and investigators were masked to treatment allocation. At the conclusion of MORDOR Phase I, by design, all communities received an additional year of twice-yearly azithromycin treatments (Phase II). Thus, at the conclusion of Phase II, the treatment history (1 letter per 6-month period) for the participating communities was either (PP-PP-AA) or (AA-AA-AA). In Phase III, participating communities were then re-randomized to receive either another 3 rounds of azithromycin or placebo, thus resulting in 4 treatment histories: Group 1 (AA-AA-AA-AA-A, N = 51), Group 2 (PP-PP-AA-AA-A, N = 40), Group 3 (AA-AA-AA-PP-P, N = 27), and Group 4 (PP-PP-AA-PP-P, N = 32). Rectal swabs from each child (N = 5,340) were obtained 6 months after the last treatment. Each child contributed 1 rectal swab and these were pooled at the community level, processed for DNA-seq, and analyzed for genetic resistance determinants. The primary prespecified outcome was macrolide resistance determinants in the gut. Secondary outcomes were resistance to beta-lactams and other antibiotic classes. Communities recently randomized to azithromycin (groups 1 and 2) had significantly more macrolide resistance determinants than those recently randomized to placebo (groups 3 and 4) (fold change 2.18, 95% CI 1.5 to 3.51, P.sub.unadj < 0.001). However, there was no significant increase in macrolide resistance in communities treated 4.5 years (group 1) compared to just the most recent 2.5 years (group 2) (fold change 0.80, 95% CI 0.50 to 1.00, P.sub.adj = 0.010), or between communities that had been treated for 3 years in the past (group 3) versus just 1 year in the past (group 4) (fold change 1.00, 95% CI 0.78 to 2.35, P.sub.adj = 0.52). We also found no significant differences for beta-lactams or other antibiotic classes. The main limitations of our study were the absence of phenotypic characterization of resistance, no complete placebo arm, and no monitoring outside of Niger limiting generalizability. Conclusions In this study, we observed that mass azithromycin distribution for childhood mortality among preschool children in Niger increased macrolide resistance determinants in the gut but that resistance may plateau after 2 to 3 years of treatment. Co-selection to other classes needs to be monitored. Trial registration NCT02047981 https://classic.clinicaltrials.gov/ct2/show/NCT02047981., Author(s): Ahmed M. Arzika 1, Amza Abdou 1, Ramatou Maliki 1, Nassirou Beido 1, Boubacar Kadri 1, Abdoul N. Harouna 1, Abdoul N. Galo 1, Mankara K. Alio 1, Elodie [...]

Background: Trachoma programs use the indicator trachomatous inflammation-—follicular (TF) to monitor indication for and response to treatment for trachoma at the district level. Alternative indicators, including serologic markers, are increasingly being evaluated for trachoma surveillance. We evaluated seroprevalence of IgG antibodies to the Pgp3 antigen in two districts in Maradi, Niger thought to have low TF prevalence. Methods: Data were collected as part of the baseline assessment of the Azithromycin Reduction to Reach Elimination of Trachoma (ARRET) trial in September 2021. A random sample of 80 communities was selected from Mayahi and Guidan Roumdji districts, both of which had TF prevalence <20% at their most recent trachoma impact survey in 2018. A random sample of 50 children per community was sampled. We collected field grades, conjunctival swabs for processing PCR for ocular Chlamydia trachomatis, and dried blood spots for serologic assessment. Results: Of 3,994 children sampled in 80 communities, 49% were female and median age was 4 years. Overall TF prevalence was 4.6% (95% CI 3.5 to 5.8%) and trachomatous inflammation—intense (TI) prevalence was 0.6% (95% 0.3 to 0.9%). The prevalence of ocular chlamydia was 0.03% (95% CI 0.08%). Seroprevalence for Pgp3 antibodies was 6.3% (95% CI 5.5 to 7.1%) in 1–9-year-olds and 3.7% (95% CI 2.9 to 4.4%) in 1–5-year-olds. TF and Pgp3 seroprevalence were better correlated in 1–5-year-olds (correlation coefficient 0.29) compared to 1–9-year-olds (correlation coefficient 0.09). Conclusions: In this low trachoma prevalence setting in Niger, seroprevalence of antibodies to Pgp3 were consistent with little ongoing transmission of C. trachomatis. Author summary: Trachoma is the leading cause of infectious blindness globally and is caused by the bacteria Chlamydia trachomatis. Trachoma programs use the indicator trachomatous inflammation—follicular (TF) to monitor the progress of trachoma control efforts in endemic regions. However, TF is an imperfect indicator of trachoma transmission, and alternative indicators may be useful for monitoring trachoma. We evaluated the prevalence of TF, C. trachomatis as measured by PCR, and serologic markers of trachoma in an area of Niger with low prevalence of TF. We found little evidence of ongoing transmission of C. trachomatis, as evidenced by low prevalence of C. trachomatis and low seroprevalence of trachoma markers, suggesting that ongoing antibiotic distribution for trachoma may not be required in this region. [ABSTRACT FROM AUTHOR]

Orbital inflammatory disease (OID) is a heterogeneous group of immunologic disorders whose etiology is often non-specific despite routine investigation. In this proof-of-concept study, metagenomic deep sequencing (MDS) is applied to examine host gene expression in two subtypes of OID. Prospectively collected lacrimal gland tissue from patients with OID was processed for MDS. Differential gene expression analysis was performed to evaluate for host transcriptome signatures. Proof-of-concept comparison was made between histologically confirmed samples of idiopathic dacryoadenitis and IgG4-related disease (IgG4-RD). Twelve genes were identified to be differentially expressed between idiopathic dacryoadenitis and IgG4-RD. Differences in innate humoral immunity gene expression were observed. Several additional genes of interests were also found to be upregulated in idiopathic dacryoadenitis. A unique transcriptome signature was found when comparing idiopathic dacryoadenitis to IgG4-RD. This suggests that MDS can identify differentially expressed genes in OID. Such insight could potentially provide a better understanding of host gene expression and the inflammatory pathways involved in OID. [ABSTRACT FROM AUTHOR]

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The Han culture is the Chinese national culture as well as a significant part of the world's costuming heritage. However, Han clothes (Hanfu) are little known outside of China. This research selected Xi'an, a famous historical city, as the case to collect data using the survey questionnaire method. Factor analysis explored the variables involved in the cultural tourism experiences of wearing Hanfu clothing. Two-step clustering was used to prepare a market segmentation of this form of cultural tourism. The experience of wearing Hanfu clothing was influenced by the five factors of entertainment, aesthetics, culture, escape, and cosplay (costume play). Tourists who wore Hanfu clothing while travelling were classified into the four types of immersive cultural, aesthetic experience, culturally refined, and passing tourists. These groups had dissimilar socio-demographic characteristics and experience priorities. This research expands the knowledge on Hanfu clothing and cultural tourism experiences and provides insights for the management of cultural tourism destinations. [ABSTRACT FROM AUTHOR]

Background Infectious conjunctivitis is common in Nepal. Materials and Methods This prospective study recruited 60 patients with presumed acute infectious conjunctivitis from the B.P. Koirala Lions Center for Ophthalmic Studies in Kathmandu, Nepal. Swabs from the conjunctiva and anterior nares were processed for metagenomic RNA deep sequencing (RNA-seq). Results Pathogens were identified in 55% of cases. RNA viruses were the most common pathogen class identified. Severe acute respiratory syndrome coronavirus 2 was the most common RNA virus identified. Conclusions Acute infectious conjunctivitis varies by location. Contrary to expectations, RNA viruses predominated. Repeat surveillance may be useful and RNA-seq allows for detection of the unexpected pathogen including RNA viruses. [ABSTRACT FROM AUTHOR]

Health tourism has received increasing attention from academic researchers from a global perspective. Although mainland China (hereafter referred to as "China") has long been recognized as a health tourism destination, its health tourism development is still in its infancy stage. Hence, to minimize the aforementioned gap, the present study explored the perception of health tourism and effective health tourism promotion methods from the perspective of tourists before and after the coronavirus disease 2019 (COVID‐19) pandemic. The major findings of this study showed that tourists perceived wellness tourism and medical tourism as critical activities/components after the COVID‐19 pandemic. [ABSTRACT FROM AUTHOR]

Construction courses are characterized by a combination of theoretical and practical knowledge; however, the teaching of practical knowledge is often absent due to safety and cost considerations. VR can improve the teaching of practical knowledge by facilitating interactions between teachers and students through virtual means, regardless of location, which is a weakness of current lecture-based teaching, especially in the COVID-19 era. Therefore, this paper aims to evaluate the effect and discuss the prospect of VR in construction teaching, with a comparative study of 50 students who were evenly divided into two groups and taught using traditional teaching and VR teaching, respectively. This experiment shows that VR teaching improves the students' learning enthusiasm and satisfaction, especially in terms of practical knowledge. Additionally, students believe the combination of traditional and VR teachings can be more helpful in construction teaching. The findings of this research strengthened the advantages of VR in delivering practical knowledge in construction teaching. [ABSTRACT FROM AUTHOR]