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Background: The implementation of the maternal perinatal death surveillance and response (MPDSR) policy is among the envisaged strategies to reduce the high global burden of maternal and perinatal mortality and morbidity. However, implementation of this policy across various contexts is inconsistent. Theoretically informed approaches to process evaluation can support assessment the implementation of policy interventions such as MPDSR, particularly in understanding what the actors involved actually do. In this article, we reflect on how the normalisation process theory (NPT) was used to explore implementation of the MPDSR policy in Uganda. NPT is a sociological theory concerned with the social organisation of the work (implementation) of making practices routine elements of everyday life (embedding) and of sustaining embedded practices in their social contexts (integration). Methods: This qualitative multiple case study conducted across eight districts in Uganda and among 10 health facilities (cases) representing four out of the seven levels of the Uganda health care system. NPT was utilised in several ways including informing the study design, structuring the data collection tools (semi-structured interview guides), providing an organising framework for analysis, interpreting and reporting of study findings as well as making recommendations. Study participants were purposely selected to reflect the range of actors involved in the policy implementation process. This included direct care providers located at each of the cases, the Ministry of Health and from agencies and professional associations. Data were collected using semi-structured, in-depth interviews and were inductively and deductively analysed using NPT constructs and subconstructs. Results and conclusion: NPT served useful for process evaluation, particularly in identifying factors that contribute to variations in policy implementation. Considering the NPT focus on the agency of people involved in implementation, additional efforts are required to understand how recipients of the policy intervention influence how the intervention becomes embedded within the various contexts. [ABSTRACT FROM AUTHOR]

Purpose: Nivolumab is approved at various doses, including 3 mg/kg, 240 mg and 480 mg flat doses at various dosing intervals. The concept of low-dose immunotherapy is gaining traction in recent years. However, there is a need to better understand the pharmacokinetics and clinical outcomes at lower doses. Methods: Patients were either administered 40 mg flat dose or 3 mg/kg Q2W/Q3W, depending on affordability as per prevailing hospital practice. All patients were hospitalized on day 1 and pharmacokinetic samples were collected at 0, 0.5, 1.0, 6.0, 24.0, 72.0 h and day 14 following administration of the first dose of nivolumab. Plasma nivolumab levels were measured by ELISA. Patients were followed up for response and toxicity. Results: Twenty five patients were included in the study. Fourteen received nivolumab at conventional dose (3 mg/kg), while 11 patients received low-dose (40 mg flat). The geometric means of dose normalized Cmax and AUC0-t were comparable between those who received conventional dose and low-dose of nivolumab (0.28 versus 0.23 µg/mL/mg and 0.0014 versus 0.0011 d/mL respectively). Nineteen patients were evaluable for response. ORR among patients who received conventional dose was 5/11 (45.5%) whereas it was 4/9 (44.4%) in the low-dose cohort. All 14 (100%) patients in conventional dosing group and 7/11 patients (63.64%) in low-dose group had treatment emergent adverse events. Grade ≥ 3 toxicities were observed in 4/14 patients in conventional dose group and none in low-dose group. Conclusion: Low-dose nivolumab leads to lower exposure in patients as compared with conventional dose, but low-dose was better tolerated, while response rates were comparable to conventional dose. [ABSTRACT FROM AUTHOR]

Introduction and Objectives: Although unlimited sessions of conventional transarterial chemoembolization (cTACE) may be performed for liver metastases, there is no data indicating when treatment becomes ineffective. This study aimed to determine the optimal number of repeat cTACE sessions for nonresponding patients before abandoning cTACE in patients with liver metastases. Materials and Methods: In this retrospective, single-institutional analysis, patients with liver metastases from neuroendocrine tumors (NET), colorectal carcinoma (CRC), and lung cancer who underwent consecutive cTACE sessions from 2001 to 2015 were studied. Quantitative European Association for Study of the Liver (qEASL) criteria were utilized for response assessment. The association between the number of cTACE and 2-year, 5-year, and overall survival was evaluated to estimate the optimal number of cTACE for each survival outcome. Results: Eighty-five patients underwent a total of 186 cTACE sessions for 117 liver metastases, of which 30.7 % responded to the first cTACE. For the target lesions that did not respond to the first, second, and third cTACE sessions, response rates after the second, third, and fourth cTACE sessions were 33.3 %, 23 %, and 25 %, respectively. ThefourthcTACEsessionwastheoptimalnumberfor2-yearsurvival (HR0.40;95 %CI:0.16-0.97; p=0.04),5-year survival(HR0.31;95%CI:0.11-0.87;p=0.02), and overall survival (HR0.35;95%CI:0.13-0.89;p=0.02). Conclusions: Repeat cTACE in the management of liver metastases from NET, CRC, and lung cancer was associated with improved patient survival. We recommend at least four cTACE sessions before switching to another treatment for nonresponding metastatic liver lesions. [ABSTRACT FROM AUTHOR]

Background: Although liraglutide has established advantages in treating patients with type 2 diabetes mellitus (T2DM) and metabolic syndrome (MS), there are still some patients with lower responsiveness to liraglutide. The objective of the study was to identify the predictors of response to liraglutide in patients with T2DM and MS. Methods: This retrospective cohort study included patients diagnosed with T2DM and MS who received liraglutide treatment as a part of their diabetes management for a minimum of six months. The participants were stratified into two groups: responders (HbA1c reduction≥1.0% and weight loss≥3%) and nonresponders. The discrepancies in baseline data between the two groups were analyzed, containing comedications, test parameters, and basic profiles. The affecting factors of response to liraglutide by Logistic regression analysis were performed, and the predictive ability of the identified factors was evaluated by plotting a receiver operating characteristic (ROC) curve. Results: A total of 417 patients with T2DM and MS were examined and followed up according to the inclusion criteria, and 206 patients completed the follow-up; 105 (50.97%) were responders and 101 (49.03%) were non-responders to liraglutide. The binary logistic regression analysis identified baseline HbA1c, baseline BMI, and the duration of T2DM as significant predictors of glycemic and weight responses to liraglutide (P <0.05). The area under the curve of the ROC for the three predictors of liraglutide response after 6 months of treatment was 0.851 (95% confidence interval: 0.793 - 0.910). Conclusion: The baseline HbA1c, baseline BMI, and duration of T2DM were shown to be predictive factors of glycemic and weight improvements in patients with T2DM and MS treated with liraglutide, and had good predictive power. [ABSTRACT FROM AUTHOR]

Background: Anthrax is a zoonotic disease caused by Bacillus anthracis that poses a significant threat to both human health and livestock. Effective preparedness and response to anthrax outbreak at the district level is essential to mitigate the devastating impact of the disease to humans and animals. The current diseaae surveillance in animals and humans uses two different infrastructure systems with online platform supported by established diagnostic facilities. The differences in surveillance systems affect timely outbreak response especially for zoonotic diseases like anthrax. We therefore aimed to assess the feasibility of implementing a simulation exercise for a potential anthrax outbreak in a local government setting and to raise the suspicion index of different district stakeholders for a potential anthrax outbreak in Namisindwa District, Uganda. Methods: We conducted a field-based simulation exercise and a health education intervention using quantitative data collection methods. The study participants mainly members of the District Taskforce (DTF) were purposively selected given their role(s) in disease surveillance and response at the sub-national level. We combined 26 variables (all dichotomized) assessing knowledge on anthrax and knowledge on appropriate outbreak response measures into an additive composite index. We then dichotomized overall score based on the 80% blooms cutoff i.e. we considered those scoring at least 80% to have high knowledge, otherwise low. We then assessed the factors associated with knowledge using binary logistic regression with time as a proxy for the intervention effect. Odds ratios (ORs) and 95% Confidence intervals (95%CI) have been reported. Results: The overall district readiness score was 35.0% (24/69) and was deficient in the following domains: coordination and resource mobilization (5/16), surveillance (5/11), laboratory capacity (3/10), case management (4/7), risk communications (4/12), and control measures (4/13). The overall community readiness score was 7 out of 32 (22.0%). We noted poor scores of readiness in all domains except for case management (2/2). The knowledge training did not have an effect on the overall readiness score, but improved specific domains such as control measures. Instead tertiary education was the only independent predictor of higher knowledge on anthrax and how to respond to it (OR = 1.57, 95% CI = 1.07–2.31). Training did not have a significant association with overall knowledge improvement but had an effect on several individual knowledge aspects. Conclusion: We found that the district's preparedness to respond to a potential anthrax outbreak was inadequate, especially in coordination and mobilisation, surveillance, case management, risk communication and control measures. The health education training intervention showed increased knowledge levels compared to the pre-test and post-test an indicator that the health education sessions could increase the index of suspicion. The low preparedness underscores the urgency to strengthen anthrax preparedness in the district and could have implications for other districts. We deduce that trainings of a similar nature conducted regularly and extensively would have better effects. This study's insights are valuable for improving anthrax readiness and safeguarding public and animal health in similar settings. [ABSTRACT FROM AUTHOR]

Background: On 5 November 2021, a fire incident following a tanker explosion occurred in the Wellington PMB Junction east of Freetown, Sierra Leone, injuring and killing people. WHO facilitated the deployment of international emergency medical teams (EMTs) to support the Ministry of Health (MoH) in providing care to the wounded in four hospitals. Objective: In this study, we document Sierra Leone's experience managing the fire incident and the role of EMTs in responding to it. Method: This is a cross-sectional After-Action Review (AAR) debrief of the response and deployment, including focus group discussion with WHO and MoH staff (n = 14) in a virtual workshop and document reviews on the response. The results thematically cover the event and the different agencies' responses and a review of EMTs' responses. Results: At the onset of the emergency, the National Disaster Management Agency (NDMA) instituted a well-coordinated response mechanism in collaboration with the MoH and managed all response actions, such as medical services, informing partners and the public and coordinating all other agencies. WHO facilitated EMT deployments and mobilised medical supplies and equipment, while the MoH provided accommodation, logistics and coordination. The EMTs dispensed their functions with professionalism, adapted to the environment and available resources, and augmented the care the national health workers provided. They offered additional care: reconstructive surgery, pain management, palliative care, wound care, rehabilitation, physiotherapy and psychosocial counselling, which were initially inadequate at the onset of the disaster. 94 out of 157 patients were discharged home at the end. National clinicians acquired additional skills through the capacity-building activities of EMTs. The community appreciated the teams. Conclusion: The government, partners and EMTs were important in the response and worked with speed and political acceptability using the context experience to provide surge support to the country. This experience brought to focus the idea of developing a national EMT in Sierra Leone, which would be useful to help respond even more swiftly. In collaboration with WHO, there is a need to institute further mechanisms to facilitate rapid response and quality-assured deployment of EMTs at regional and sub-regional levels and strengthen to support future responses. [ABSTRACT FROM AUTHOR]

Background: Tumor-induced coagulation is widely observed in cancer patients. Moreover, it is associated with tumorigenesis, tumor progression and metastasis, by creating a proliferative and proangiogenic microenvironment. Therefore, D-dimer, a fibrin degradation product, correlates with tumor prognosis in several cancer types. Objectives: This study aims to investigate whether D-dimer levels can be a predictive and monitoring indicator for chemotherapy response in metastatic breast cancer (MBC) patients. Design: This was a prospective study. Methods: This study included two groups, 76 patients diagnosed with metastatic breast carcinoma and 25 patients with primary breast carcinoma. Plasma D-dimer levels were measured prospectively before chemotherapy initiation, and after the fourth treatment cycle in MBC patients. D-dimer levels before chemotherapy (D0) were analyzed using Receiver Operating Characteristic (ROC) curves to determine the optimal cut-off baseline values of D0, and to evaluate their discriminatory abilities in predicting response to chemotherapy. Results: In the preliminary response evaluation, the mean level of D-dimer significantly decreased by 0.65 μg/ml in patients with partial response patterns, and by 0.5 μg/ml in patients with stable disease. In the disease progression group, a marked increase was seen in D-dimer levels by 1.2 μg/ml. Analysis of ROC curves showed that D-dimer levels at D0 could discriminate the response to chemotherapy, whereas progressive disease rate correlated with higher levels of D-dimer. Conclusion: D-dimer level in plasma is a useful predictive and monitoring marker of response to chemotherapy in metastatic breast cancer. [ABSTRACT FROM AUTHOR]

Simple Summary: Previous studies have demonstrated that the occurrence of immune-related adverse events (irAEs) is significantly associated with favorable efficacy and prognosis in patients with cancers treated with immune checkpoint inhibitors (ICIs), such as anti-programmed cell death protein 1 (PD-1) and anti-cytotoxic T lymphocyte-associated antigen. However, few studies have investigated this association in patients with esophageal squamous cell carcinoma (ESCC). Herein, we evaluated the relationship of irAEs with tumor response and survival in patients with unresectable advanced or recurrent ESCC treated with second- or later-line nivolumab, an anti-PD-1 antibody, monotherapy. We observed that the occurrence of mild (grade 1/2) irAEs during the entire period, as well as within 8 weeks of nivolumab initiation, was significantly associated with tumor response and survival following nivolumab monotherapy. Thus, mild irAEs may serve as predictive markers for the response and prognosis of patients with ESCC treated with ICIs. Background: Patients across various cancers who develop immune-related adverse events (irAEs) post-immune checkpoint inhibitor (ICI) treatment tend to experience better tumor response and survival than those who do not. However, studies regarding this association in patients with esophageal squamous cell carcinoma (ESCC) are limited. Methods: We assessed the relationship of irAEs with tumor response and survival in 82 consecutive patients with unresectable advanced or recurrent ESCC treated with second- or later-line nivolumab, an anti-PD-1 antibody, monotherapy. Results: We observed irAEs in 24 (29.3%) patients, with the overall response and disease control rates in the irAE-positive group being significantly better than those in the irAE-negative group (both p < 0.0001). During the entire period and within 8 weeks of nivolumab initiation, progression-free and overall survivals (PFS and OS, respectively) were significantly better in patients with grade1/2 irAEs than in those without. Univariate and multivariate analyses indicated grade1/2 irAEs during the entire period and within 8 weeks as independent covariates for PFS (entire period: hazard ratio [HR] 0.28, 95% confidence interval [CI] 0.16–0.49, p < 0.001; within 8 weeks: HR 0.46, 95% CI 0.23–0.93, p = 0.03) and OS (entire period: HR 0.24, 95% CI 0.13–0.44, p < 0.001; within 8 weeks: HR 0.41, 95% CI 0.18–0.92, p = 0.03). Conclusions: Grade1/2 irAEs during the entire treatment period and within 8 weeks of nivolumab initiation were significantly associated with improved tumor response and survival in patients with advanced ESCC treated with nivolumab monotherapy. Therefore, mild irAEs may be predictive markers for the response and prognosis of ESCC following ICI treatment. [ABSTRACT FROM AUTHOR]

Numerous studies using oddball tasks have shown that unexpected sounds presented in a predictable or repeated sequence (deviant vs. standard sounds) capture attention and negatively impact ongoing behavioral performance. Here, we examine an aspect of this effect that has gone relatively unnoticed: the impact of deviant sounds is stronger for response repetitions than for response switches. Our approach was two-fold. First, we carried out a simulation to estimate the likelihood that stimuli sequences used in past work may not have used balanced proportions of response repetition and switch trials. More specifically, we sought to determine whether the larger distraction effect for response repetitions may have reflected a rarer, and thereby more surprising, occurrence of such trials. To do so, we simulated 10,000 stimuli sets for a 2-AFC task with a proportion of deviant trial of 0.1 or 0.16. Second, we carried out a 2-AFC oddball task in which participants judged the duration of a tone (short vs. long). We carefully controlled the sequence of stimuli to ensure to balance the proportions of response repetitions and response switches across the standard and deviant conditions. The results of the stimuli simulation showed that, contrary to our concerns, response switches were more likely than response repetitions when left uncontrolled for. This suggests that the larger distraction found for response repetition in past work may in fact have been underestimated. In the tone duration judgment task, the results showed a large impact of the response type on distraction as measured by response times: Deviants sounds significantly delayed response repetitions but notably accelerated switches. These findings suggest that deviant sound hinder response repetition and encourage or bias the cognitive system towards a change of responses. We discuss these findings in relation to the adaptive nature of the involuntary detection of unexpected stimuli and in relation to the notion of partial repetition costs. We argue that results are in line with the binding account as well as with the signaling theory. [ABSTRACT FROM AUTHOR]

Introduction: Livestock are central to pastoral livelihoods. A major constraint in pastoral production is livestock diseases, which is often exacerbated by inadequate surveillance systems. Reporting of disease outbreaks from pastoral communities to animal health workers is one of the challenges that affects effective and timely response to disease outbreaks. This study aimed to understand animal disease reporting and response in pastoral areas of Northern Kenya. Stakeholders, their roles, information flow among them and methods used for both livestock disease reporting and response and their strengths and challenges were identified. Methods: The study was carried out in Marsabit County, a pastoral county in Kenya. Pretested tools were used to guide data collection through Focus Group Discussions, Narrative and Key Informant Interviews with pastoralists, County government Animal Health Workers, agrovets and private animal health workers, Community Disease Reporters, Chiefs, County Public Health Officers and local Non-Governmental Organization staff. Net mapping was further used where participants drew links among the various stakeholders and assigned them perceived influence and power. Output from thematic analysis, notes taken during data collection and net maps were used to produce a network of stakeholders and their links using Gephi software. Centrality measures were generated and recorded. Perceived power and influence scores were used to produce a graph and the reasons for the scores documented. Methods used for livestock disease reporting and response were obtained from thematic analysis. Results: A network of 19 stakeholders with 67 links among them was identified. Major stakeholders were the Animal Owners/Pastoralists, Government Animal Health Workers, County Director of Veterinary Services, the Chief and radio based on network indices of Total degree and Betweenness Centrality, and also based on perceived scores of influence and power. Pastoralists had pivotal roles in both livestock disease reporting and response, Government Animal Health Workers (GAHWs) were mainly involved in disease surveillance and mass interventions including treatment and vaccinations. Non-state actors like NGOs and iNGOs collaborated and supported the County Government with resources to manage outbreaks. Various methods were used for reporting diseases, with use of mobile phones highly mentioned while for response to disease occurrences, the methods included trainings and treatment by both Government and Private AHWs and use of alternative veterinary practices by pastoralists. Various challenges constraining livestock disease response were highlighted, the most frequent challenges centered around low numbers and under resourcing of Animal Health Workers. Conclusion: These findings show that designing an efficient livestock disease surveillance system in pastoral areas requires recognition and utilization of all stakeholders and understanding of their roles. Gaps highlighted in disease response should be prioritized by the government and its development partners for improved animal health service delivery in pastoral areas. These inadequacies in livestock disease response have a direct effect on veterinary practice as mandated by the Government of Kenya Veterinary Surgeons and Para-professionals Act. The results are important for guiding policy formulation to support mitigation of disease impacts in similar areas with limited access to quality veterinary services. [ABSTRACT FROM AUTHOR]

This paper proposes development of optimized heterogeneous ensemble models for prediction of responses based on given sets of input parameters for wire electrical discharge machining (WEDM) processes, which have found immense applications in many of the present-day manufacturing industries because of their ability to generate complicated 2D and 3D profiles on hard-to-machine engineering materials. These ensembles are developed combining predictions of the three base models, i.e. random forest, support vector machine and ridge regression. These three base models are first framed utilizing the training datasets, providing predictions for all the responses under consideration. Based on these predictions, two optimization problems are formulated for each of the responses, while minimizing root mean squared error and mean absolute error, for subsequent development of two optimized ensembles whose predictions are the weighted sum of the predictions of the base models. The prediction performance of all the five models is ascertained through nine statistical metrics, after which a cumulative quality loss-based multi-response signal-to-noise (MRSN) ratio for each model is computed, for each of the responses, where a higher MRSN ratio indicates greater accuracy in prediction. This study is conducted using two experimental datasets of WEDM process. Overall, the optimized ensemble models having higher MRSN ratios than the base models are indicated to deliver better prediction accuracy. [ABSTRACT FROM AUTHOR]

Background: Concurrent chemoradiotherapy (CCRT) is a crucial treatment for non-small cell lung carcinoma (NSCLC). However, the use of deep learning (DL) models for predicting the response to CCRT in NSCLC remains unexplored. Therefore, we constructed a DL model for estimating the response to CCRT in NSCLC and explored the associated biological signaling pathways. Methods: Overall, 229 patients with NSCLC were recruited from six hospitals. Based on contrast-enhanced computed tomography (CT) images, a three-dimensional ResNet50 algorithm was used to develop a model and validate the performance in predicting response and prognosis. An associated analysis was conducted on CT image visualization, RNA sequencing, and single-cell sequencing. Results: The DL model exhibited favorable predictive performance, with an area under the curve of 0.86 (95% confidence interval [CI] 0.79–0·92) in the training cohort and 0.84 (95% CI 0.75–0.94) in the validation cohort. The DL model (low score vs. high score) was an independent predictive factor; it was significantly associated with progression-free survival and overall survival in both the training (hazard ratio [HR] = 0.54 [0.36−0.80], P = 0.002; 0.44 [0.28−0.68], P < 0.001) and validation cohorts (HR = 0.46 [0.24−0.88], P = 0.008; 0.30 [0.14−0.60], P < 0.001). The DL model was also positively related to the cell adhesion molecules, the P53 signaling pathway, and natural killer cell-mediated cytotoxicity. Single-cell analysis revealed that differentially expressed genes were enriched in different immune cells. Conclusion: The DL model demonstrated a strong predictive ability for determining the response in patients with NSCLC undergoing CCRT. Our findings contribute to understanding the potential biological mechanisms underlying treatment responses in these patients. Key message: What is already known on this topic: The relationship between deep learning and biological signaling pathways in the context of concurrent chemoradiotherapy for non-small cell lung carcinoma has not been reported. What this study adds: Based on contrast-enhanced computed tomography images, a three-dimensional ResNet50 algorithm was used to develop a robust model for response. The DL model demonstrated a strong predictive ability for determining the prognosis in patients with NSCLC undergoing CCRT. Positive associations between CAMs, NK cell-mediated cytotoxicity, and prediction models for CCRT were revealed in patients with NSCLC. How this study might affect research, practice or policy: This approach is generalizable to any medical imaging analysis, including concurrent chemoradiotherapy, offering a novel noninvasive method to tailor cancer treatment. [ABSTRACT FROM AUTHOR]

This article offers a theory of action model for grading in first‐year writing classes, as enacted at two public, suburban, Midwestern two‐year colleges. First, it analyzes labor‐based contract grading and specifications grading through this model, examining how these popular grading methods have manifested in unintended negative consequences for historically and multiply marginalized students. Then, it proposes a sociocognitive grading model designed to maximize course‐level success rates for New Majority college students. The sociocognitive model was iteratively built on feminist standpoint theory, intersectional learning sciences, multilingual writing pedagogy, and disability studies. Thus far, student course‐level success has improved, along with their learning in four domains of a robust writing construct: intrapersonal, interpersonal, cognitive, and health. While it does not prescribe specific patterns of response, this model nevertheless establishes an overall referential frame that holds the potential to incorporate empirically based best response practices. [ABSTRACT FROM AUTHOR]

Purpose: Since 2020, atezolizumab plus bevacizumab (Ate/Bev) has been the standard first-line therapy for unresectable hepatocellular carcinoma (HCC), but long-term treatment studies are limited. This study evaluated the clinical characteristics and effects of Ate/Bev for over 1 year. Materials and Methods: This study included patients with unresectable HCC treated with first-line Ate/Bev between May 2020 and April 2022. Those receiving Ate/Bev for 1 year or more were classified as the long-term treatment group. Results: Of 246 patients, 69 (28.0%) were in the long-term treatment group, which comprised more proportions of intrahepatic tumor burden < 25%, Eastern Cooperative Oncology Group 0, and a lower proportion of portal vein tumor thrombosis than the short-term treatment group. The long-term treatment group had a higher incidence of atezolizumab-related thyroid dysfunction (31.9% vs. 10.7%, p < 0.001; median time to onset [mTTO], 2.8 months), dermatologic toxicity (29.0% vs. 14.7%, p=0.017; mTTO, 3.3 months), bevacizumab-related hypertension (44.9% vs. 22.0%, p=0.001; mTTO, 4.2 months), and proteinuria (69.6% vs. 38.4%, p < 0.001; mTTO, 6.8 months), compared to the short-term treatment group. Regarding liver function in the long-term treatment group, patients initially classified as Child-Pugh class A decreased from 87.0% to 75.4%, and albumin-bilirubin grade 1 decreased from 68.1% to 50.7% after 1 year of treatment. Conclusion: The Ate/Bev long-term treatment group had a lower intrahepatic tumor burden, less portal vein tumor thrombosis, and better performance status and liver function at baseline. Atezolizumab-related immunological adverse events emerged relatively early in treatment compared to the bevacizumab-related. Additionally, some patients demonstrated liver function deterioration during long-term Ate/Bev treatment. [ABSTRACT FROM AUTHOR]

Biodiversity metrics are increasingly in demand for informing government, business, and civil society decisions. However, it is not always clear to end users how these metrics differ or for what purpose they are best suited. We seek to answer these questions using a database of 573 biodiversity-related metrics, indicators, indices, and layers, which address aspects of genetic diversity, species, and ecosystems. We provide examples of indicators and their uses within the state–pressure–response–benefits framework that is widely used in conservation science. Considering complementarity across this framework, we recommend a small number of metrics considered most pertinent for use in decision-making by governments and businesses. We conclude by highlighting five future directions: increasing the importance of national metrics, ensuring wider uptake of business metrics, agreeing on a minimum set of metrics for government and business use, automating metric calculation through use of technology, and generating sustainable funding for metric production. [ABSTRACT FROM AUTHOR]

Purpose: Cyclophosphamide, Epirubicin/Doxorubicin, 5-fluorouracil (CEF or CAF) chemotherapy has long been a standard first-line treatment for breast cancer. The genetic variations of enzymes that are responsible for the metabolism of these drugs have been linked to altered treatment response and toxicity. Two drug-metabolizing enzymes ALDH1A1 and NQO1 are critically involved in the pathways of CEF/CAF metabolism. This study aimed to evaluate the effect of ALDH1A1 (rs13959) and NQO1 (rs1800566) polymorphisms on treatment response and toxicities caused by adjuvant (ACT) and neoadjuvant chemotherapy (NACT) where CEF/CAF combination was used to treat Bangladeshi breast cancer patients. Methods: A total of 330 patients were recruited from various hospitals, with 150 receiving neoadjuvant chemotherapy and 180 receiving adjuvant chemotherapy. To extract genomic DNA, a non-enzymatic simple salting out approach was adopted. The polymerase chain reaction-restriction fragment length polymorphism method was used to detect genetic polymorphisms. Unconditional logistic regression was used to derive odds ratios (ORs) with 95% confidence intervals (CIs) to study the association between genetic polymorphisms and clinical outcome and toxicity. Results: A statistically significant association was observed between ALDH1A1 (rs13959) polymorphism and treatment response (TT vs. CC: aOR = 6.40, p = 0.007; recessive model: aOR = 6.38, p = 0.002; allele model: p = 0.032). Patients with the genotypes TT and CT + TT of the NQO1 (rs1800566) polymorphism had a significantly higher risk of toxicities such as anemia (aOR = 0.34, p = 0.006 and aOR = 0.58, p = 0.021), neutropenia (aOR = 0.42, p = 0.044 and aOR = 0.57, p = 0.027), leukopenia (aOR = 0.33, p = 0.010 and aOR = 0.46, p = 0.005), and gastrointestinal toxicity (aOR = 0.30, p = 0.02 and aOR = 0.38, p = 0.006) when compared to the wild CC genotype, while patients with the genotype CT had a significant association with gastrointestinal toxicity (aOR = 0.42, p = 0.02) and leukopenia (aOR = 0.52, p = 0.010). The TT and CT + TT genotypes of rs13959 had a significantly higher risk of anemia (aOR = 2.00, p = 0.037 and aOR = 1.68, p = 0.029). There was no significant association between rs1800566 polymorphism and treatment response. Conclusion: Polymorphisms in ALDH1A1 (rs13959) and NQO1 (rs1800566) may be useful in predicting the probability of treatment response and adverse effects from CEF or CAF-based chemotherapy in breast cancer patients. [ABSTRACT FROM AUTHOR]

Background and purpose: The amplitude, timing, and determinants of improvement with available treatments are uncertain in chronic inflammatory demyelinating polyneuropathy (CIDP). Our primary objective was to quantify categorized outcomes with routine care. Methods: We retrospectively studied treatment response within 36 months from initiation in 112 consecutive subjects with CIDP. Response was classified into a proposed new "CIDP treatment‐response category" (CT‐RC), based on achieved endpoints. Determinants of the CT‐RC, of timing of maximum improvement, and of treatment discontinuation were ascertained. Results: The CT‐RC demonstrated high concurrent validity with current outcome measures. Thirty‐six subjects (32.1%) achieved a "complete response," 37 (33%) a "good partial response," 10 (8.9%) a "moderate partial response," and 15 (13.4%) a "poor partial response." Fourteen subjects (12.5%) were "nonresponsive." The CT‐RC was independently predicted only by age. Mean time to maximum improvement was 12.1 months (range = 1–36) and was not associated with any pretreatment covariate. Treatment discontinuation occurred in 24 of 62 (38.2%) partial responders and was only associated with shorter pretreatment disease duration. Nonresponders were older and received a similar number of treatments compared to responders. Conclusions: CT‐RC classification indicates persistent disability in >60% of treatment responders in CIDP. Timing of maximum improvement is variable, frequently delayed, and unpredictable. Treatment withdrawal without deterioration is achievable in approximately 40% of subjects and may be more likely with prompt treatment. Treatment withdrawal in partial responders and limited escalation in nonresponders suggest implication of physician‐ and patient‐related factors in suboptimal response. More effective treatments/treatment methods and better understanding of other factors influencing response are needed in CIDP. [ABSTRACT FROM AUTHOR]

There is heightened awareness that a whole-of-systems approach to perpetrator responses is key to addressing domestic and family violence (DFV). This paper reports on the findings from a scoping review which mapped the international literature on how health professionals identify and respond to perpetrators of DFV within a hospital setting. A comprehensive scoping review methodology was used. The search, spanning January 2010 to January 2022, yielded 12,380 publications from four databases. Eligibility for inclusion included peer-reviewed literature with any reference to inpatient hospital health professionals identifying or responding to perpetrators of DFV. Fourteen articles were included in the final review. The review presents the literature categorized by levels of prevention, from primary, secondary, through to tertiary preventive interventions. An additional category "other practices" is added to capture practices which did not fit into existing levels. Despite glimpses into how health professionals can identify, and respond to perpetrators of DFV, the current knowledge base is sparse. The review did not identify any mandated or formal procedures for identifying and/screening or responding to perpetration of abuse in hospitals. Rather, responses to perpetrators are inconsistent and rely on the motivation, skill, and self-efficacy of health professionals rather than an embedded practice that is driven and informed by hospital policy or procedures. The literature paints a picture of missed opportunities for meaningful work with perpetrators of DFV in a hospital setting and highlights a disjuncture between policy and practice. [ABSTRACT FROM AUTHOR]

Based on TIMED/SABER temperature observations and the Real‐Time Multivariate Madden‐Julian Oscillation (MJO) Index, for the first time, we discussed the daily resolution non‐migrating DE3 temperature tide response to the MJO phenomenon during MJO phases between ±45° latitude from 2003 to 2012 in the Mesosphere and Lower Thermosphere (MLT) region. We found: (a) The DE3 tide significantly depends on different MJO phases in the four seasons above 100 km altitude. The DE3 tidal phase exhibits varying responses to the different MJO phases. (b) The DE3 tide response to the MJO phenomenon is stronger at the solstices than at the equinoxes, and the response at the June solstices is stronger. (c) The symmetric component of the DE3 response to the MJO phenomenon is stronger than the asymmetric component. In summary, the daily resolved DE3 tide response to the MJO phenomenon, especially the DE3 tidal phase dominates certain seasonal characteristics and symmetry in the MLT region. Plain Language Summary: The MJO phenomenon is one of the dominant modes of intra‐seasonal variability in the troposphere in the tropical regions, and some seasonal atmospheric characteristics of the MLT region thought to be generated from the tropospheric MJO phenomenon. Based on TIMED/SABER temperature observations and the RMM Index of the troposphere, we quantified the daily resolution MLT tide response to the MJO phenomenon for the first time. We discuss the 30‐90‐day period DE3 tide response to the MJO phenomenon during phases 1–8 in different seasons between ±45° latitudes from 2003 to 2012 at the altitude of 70–108 km. We found: (a) The DE3 tide, including its amplitude and phase, shows a significant dependence on the MJO phase in the four seasons above 100 km altitude. (b) The DE3 tide affected by the MJO phenomenon are stronger at the solstices than at the equinoxes, and the June solstices exhibits the strongest MJO response. Moreover, there are some differences between the northern and southern hemispheres. (c) The symmetric component of the DE3 tide response to the MJO phenomenon is stronger than the asymmetric component in the four seasons. In summary, the daily resolved DE3 tide response to the MJO phenomenon, especially during the different MJO phase, dominates certain seasonal characteristics and symmetry in the MLT region. Key Points: The daily resolved DE3 temperature tidal component response to the Madden‐Julian Oscillation (MJO) phenomenon is presented in the Mesosphere and Lower Thermosphere regionThe DE3 tidal component response to the MJO phenomenon during different MJO phases dominates certain seasonal characteristicsThe symmetric component of the DE3 tide response to the MJO phenomenon is stronger than the asymmetric component [ABSTRACT FROM AUTHOR]

Globally, both industrialized and developing nations struggle with the issue of water pollution due to heavy metals. Human life depends on water, and when it is contaminated with dangerous heavy metals like arsenic, people's health suffers. The interactive influence of three independent sorption processes variables such as bio-adsorbent dosage (0.50–3.00 g/L), contact time (40.00–90.00 min), and initial concentration (10.00–30.00 mg/L) on the modeling and optimization of trivalent arsenic removal from wastewater was studied in a batch mode using multivariate experimental design. The quadratic models provided accurate predictions for the response variables with high coefficients of correlation of 0.9984 and 0.9994 for removal and uptake rates, respectively. The developed models were accurate and exhibited a remarkable correlation between the observed and projected data according to the diagnostic test analyses. Through the analysis of variance, all the studied adsorption factors were statistically significant (p-values < 0.0001) with initial concentration and bio-adsorbent dosage producing the main interactive effect on the percentage removal and adsorption capacity with F-values of 146.05 and 264.65, respectively. The optimum operating conditions attained were 90.00 min contact time, 0.50 g/L bio-adsorbent dosage, and an initial concentration of 10.00 mg/L, which gave arsenic maximum removal and uptake efficiencies of 93.14% and 7.04 mg/g, correspondingly with the desirability of 0.844. Confirmative tests were conducted under the optimized conditions to validate the accuracy of the models in which a maximum removal efficacy of 94.33% and adsorption capacity of 7.15 mg/g were achieved. The applicability of the bio-adsorbent in the adsorption of arsenic in textile industrial wastewater was also tested and the bio-adsorbent could competitively decontaminate over 99% of arsenic species from the wastewater. [ABSTRACT FROM AUTHOR]

Repetitive transcranial magnetic stimulation (rTMS) is a rapidly emerging treatment for depression, but outcome prediction is still a challenge. This study aimed to identify predictors of response to rTMS among baseline clinical factors and early symptomatic improvements. This cohort study comprised 136 patients with a unipolar or bipolar depressive episode referred for clinical intermittent theta-burst stimulation or right-sided 1 Hz rTMS at the Uppsala Brain Stimulation Unit. The co-primary outcomes used for logistic regression were response, defined as ≥50 % reduction of Montgomery and Åsberg Depression Rating Scale Self-assessment (MADRS-S) total score, and 1–2 points on the Clinical Global Impression Improvement (CGI-I) scale. Early improvement was defined as ≥20 % reduction in the MADRS-S total score, or ≥ 1 point reduction in each MADRS-S item, after two weeks of treatment. The response rates were 21 % for MADRS-S and 45 % for CGI-I. A depressive episode >24 months had lower odds for MADRS-S response compared to ≤12 months. Early improvement of the MADRS-S total score predicted CGI-I response (95 % CI = 1.35–9.47, p = 0.011), Initiative 6 predicted MADRS-S response (95 % CI = 1.08–9.05, p = 0.035), and Emotional involvement 7 predicted CGI-I response (95 % CI = 1.03–8.66, p = 0.044). No adjustment for concurrent medication. A depressive episode ≤12 months and early improvement in overall depressive symptoms, as well as the individual items, Initiative 6 and Emotional involvement 7 , predicted subsequent rTMS response in a naturalistic sample of depressed patients. This could facilitate the early identification of patients who will benefit from further rTMS sessions. • rTMS response rates are higher when rated by clinicians than patients (45 % vs 21 %). • The duration of a depressive episode is a predictor of patient rated rTMS response. • Early improvement in overall depressive symptoms predicts rTMS response. • Early improvement in initiative predicts patient rated rTMS response. • Early improvement in emotional involvement predicts clinician rated rTMS response. [ABSTRACT FROM AUTHOR]

Droughts and extreme rainfall events are two of the hazards that affect many people in the world and are frequent and complex hazards, the rate of occurrence and magnitude of which are expected to increase in a changing climate. In this context, understanding how different actors perceive changes in climate, drought, and extreme rainfall events and their impacts is relevant in contributing to successfully implementing adaptation strategies to reduce their impacts. This research seeks to explore the main changes the climate has undergone and the impacts of drought and precipitation events, as perceived at local levels by different stakeholders. A multi-method approach was applied, including qualitative methods such as observation, 51 semi-structured interviews, and document reviews in Chañaral and the Aconcagua Valley, Chile. This research shows what the perceived changes in climate are and that drought and extreme rainfall events have affected the well-being of the local people by severely impacting the economy, the environment, social interactions, quality of life, and human health. Additionally, the perception of climate change and its impacts vary depending on the type of hazard and the social, geographical, and environmental contexts in which communities live. This study is useful as it has generated knowledge relevant to inform policy decisions, practice, and theory. [ABSTRACT FROM AUTHOR]

Objective Methods Results Conclusion Childhood maltreatment is associated with less favourable treatment outcomes with pharmacotherapy and psychotherapy for depression. It is unknown whether this increased risk of treatment resistance in maltreated individuals extends to electroconvulsive therapy (ECT).This retrospective cohort study included 501 consecutive adult referrals for an acute course of twice‐weekly ECT for unipolar or bipolar depression at an academic inpatient centre in Ireland between 2016 and 2024. Retrospectively reported physical and sexual childhood maltreatment were assessed on hospital admission. Response was defined as a score of 1 or 2 and remission was defined as a score of 1 on the Clinical Global Impression – Improvement scale 1–3 days after final ECT session. Logistic regression analyses were used to examine the associations between childhood maltreatment and ECT nonresponse and nonremission, adjusting for covariates. Mediation analyses were conducted to explore the role of psychiatric comorbidities, persistent depressive symptoms lasting 2 years or more in the current episode, and baseline depression severity.Compared to the group with no childhood maltreatment, the childhood maltreatment group had similar odds of ECT nonresponse (adjusted odds ratio = 1.47, 95% CI = 0.85–2.53) but significantly elevated odds of ECT nonremission (adjusted odds ratio = 3.75, 95% CI = 1.80–7.81). In a mediation analysis, presence of persistent depressive symptoms mediated 7.4% of the total effect of childhood maltreatment on ECT nonremission.Individuals with exposure to childhood maltreatment may be less likely to achieve full remission following a course of ECT. [ABSTRACT FROM AUTHOR]

Polycrystalline CsPbBr3 perovskite materials exhibit exemplary stability, and desirable optoelectronic characteristics are promising for direct X‐ray detection. In this study, polycrystalline 2D phase of CsPb2Br5 hinged on CsPbBr3 is investigated for X‐ray array detector. The incorporation of CsPb2Br5 will modify the carrier transport environment, acting as an amplification factor that significantly enhances carrier mobility and response sensitivity. Finally, the devices demonstrates excellent performance growth. Carrier mobility of CsPbBr3 is improved by a significant 2 orders of magnitude, leading to the sensitivity increased from 2.64 × 104 to 2.58 × 105 µC Gyair−1 cm−2 at a bias voltage of 25 V mm−1. Even at a low bias voltage of 2 V mm−1, still got the value of 3.075 × 103 µC Gyair−1 cm−2, accompanied by a notable increase in the minimum detection limit of 127.9 nGyair s−1 at 0.5 V. Furthermore, a high modulation transfer function (MTF) of 1.57 lp mm−1 is obtained, and achieved a clear and high contrast X‐ray imaging with 64 × 64 TFT board. The perovskite exhibits outstanding light stability (RH ≈ 70 ± 5%) in the atmosphere following the introduction of 2D phase. This excellent carrier transport effect and good long‐term stability present significant commercial potential. [ABSTRACT FROM AUTHOR]

The present paper deals with the data communication between a computer and a hydroelectric renewable energy system called a Hydroelectric Turbine. The purpose of the communication is to obtain data from the turbine to diagnose how it is operating. In terms of physical data transport, the two points, which are composed of a computer and a turbine, communicate via radio frequency through two transceivers operating at the frequency of 433 MHz. One is on the turbine and the second is on an electronic system with a microcontroller. The microcontroller serves as an interface to transmit information from the computer's USB port to the turbine. The communication protocol is a request-response type, and the length of the data packet transmitted between the turbine and the computer is fixed. This paper outlines the internal communication processes from the software level of the microcontroller and the PC. These methods enable the PC and the turbine to establish half duplex connection for data acquisition. In the last section of the paper, the advantages, and results of using this type of communication are presented. [ABSTRACT FROM AUTHOR]

We determined the value of computed tomography perfusion (CTP) for assessing the response of hepatocellular carcinoma (HCC) to transarterial chemoembolization (TACE). 20 post-TACE HCC patients were re-evaluated with contrast-enhanced computed tomography and CTP. Patients with persistent arterial vascularization [non-response (NR)] or those with no arterial vascularization in the mass, but with signs of new nodules, underwent digital subtraction angiography (DSA), which was used to analyze image characteristics and CTP parameters of TACE-treated HCC. 27 post-TACE HCC masses (mean size 4.21 cm, range 2-6.5 cm) were observed in the 20 patients. The values yielded by CTP were 78.30±40.41 mL/min/100g and 33.67±38.74 mL/min/100g for hepatic arterial blood flow (HABF) and 51.40±17.80% and 25.60±26.53% for hepatic arterial fraction (HAF) in the NR group and complete response group, respectively. The NR group's cutoff value of HABF was =55.95 mL/min/100g, with a sensitivity of 91.7% and specificity of 71.42%, and that of HAF was =32.55%, with a sensitivity of 92.3% and specificity of 83.33%. The CTP and DSA techniques showed high agreement in assessing the post-TACE responses of liver tumors (κ=0.872). The perfusion parameters HABF and HAF have high value for assessing post-TACE responses of HCC. [ABSTRACT FROM AUTHOR]

Background: The rarity of primary central nervous system lymphoma (PCNSL) and treatment heterogeneity contributes to a lack of prognostic models for evaluating posttreatment remission. This study aimed to develop and validate radiomic‐based models to predict the durable response (DR) to high‐dose methotrexate (HD‐MTX)‐based chemotherapy in PCNSL patients. Methods: A total of 159 patients pathologically diagnosed with PCNSL between 2011 and 2021 across two institutions were enrolled. According to the NCCN guidelines, the DR was defined as the remission lasting ≥1 year after receiving HD‐MTX‐based chemotherapy. For each patient, a total of 1218 radiomic features were extracted from prebiopsy T1 contrast‐enhanced MR images. Multiple machine‐learning algorithms were utilized for feature selection and classification to build a radiomic signature. The radiomic‐clinical integrated models were developed using the random forest method. Model performance was externally validated to verify its clinical utility. Results: A total of 105 PCNSL patients were enrolled after excluding 54 cases with ineligibility. The training and validation cohorts comprised 76 and 29 individuals, respectively. Among them, 65 patients achieved DR. The radiomic signature, consisting of 8 selected features, demonstrated strong predictive performance, with area under the curves of 0.994 in training cohort and 0.913 in validation cohort. This signature was independently associated with the DR in both cohorts. Both the radiomic signature and integrated models significantly outperformed the clinical models in two cohorts. Decision curve analysis underscored the clinical utility of the established models. Conclusions: This radiomic signature and integrated models have the potential to accurately predict the DR to HD‐MTX‐based chemotherapy in PCNSL patients, providing valuable therapeutic insights. [ABSTRACT FROM AUTHOR]

Objective: To estimate the change in serum hepcidin levels and its correlation with change in hemoglobin (Hb) level during the initial two weeks of oral iron therapy in children with iron deficiency anemia (IDA). Methods: A prospective observational study was carried out in children aged 2–12 years with IDA. Children with severe anemia (Hb < 7 g/dL), those with fever, infections, history of oral iron intake or blood transfusion within the preceding three months, or intolerant to oral iron were excluded. Serum hepcidin-25 was assessed using ELISA-based kits on day 0 (pre-therapy), after 24 hours and 14 days of starting oral iron therapy. Results: Out of 78 children who were screened, we included 64 children with IDA with a mean (SD) hemoglobin of 8.81 (1.22) g/dL. The baseline mean (SD) serum hepcidin-25 levels [7.81 (4.88) ng/mL] increased significantly to 8.38 (4.96) ng/mL at 24 hours and 9.51 (5.2) ng/mL on day 14 of oral iron therapy (P < 0.001). 63 children showed a good response to oral iron therapy. No significant correlation was observed between baseline hepcidin levels with change in hemoglobin on day 1 (r = −0.10, P = 0.40) or day 14 (r = −0.10, P = 0.43) of therapy. Conclusion: Serum hepcidin levels rise significantly as early as 24 hours after starting oral iron therapy and should be explored to assess response to oral iron therapy in children with anemia. [ABSTRACT FROM AUTHOR]

Dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) can assess tumour vascularity, which depends on the process of angiogenesis and affects tumour response to treatment. Our study explored the associations between DCE-MRI parameters and the expression of plasma angiogenic factors in human papilloma virus (HPV)-negative oropharyngeal cancer, as well as their predictive value for response to concurrent chemoradiotherapy (cCRT). Twenty-five patients with locally advanced HPV-negative oropharyngeal carcinoma were prospectively enrolled in the study. DCE-MRI and blood plasma sampling were conducted before cCRT, after receiving a radiation dose of 20 Gy, and after the completion of cCRT. Perfusion parameters ktrans, kep, Ve, initial area under the curve (iAUC) and plasma expression levels of angiogenic factors (vascular endothelial growth factor [VEGF], connective tissue growth factor [CTGF], platelet-derived growth factor [PDGF]-AB, angiogenin [ANG], endostatin [END] and thrombospondin-1 [THBS1]) were measured at each time-point. Patients were stratified into responders and non-responders based on clinical evaluation. Differences and correlations between measures were used to generate prognostic models for response prediction. Higher perfusion parameter ktrans and higher plasma VEGF levels successfully discriminated responders from non-responders across all measured time-points, whereas higher iAUC and higher plasma PDGF-AB levels were also discriminative at selected time points. Using early intra-treatment measurements of ktrans and VEGF, a predictive model was created with cut-off values of 0.259 min−1 for ktrans and 62.5 pg/mL for plasma VEGF. Early intra-treatment DCE-MRI parameter ktrans and plasma VEGF levels may be valuable early predictors of response to cCRT in HPV-negative oropharyngeal cancer. [ABSTRACT FROM AUTHOR]

This study aimed to assess 68Ga-DOTA-TATE (-TOC) PET/CT quantitative parameters in monitoring and predicting everolimus response in neuroendocrine tumor (NET) patients with hepatic metastases (NELM). This retrospective analysis included 29 patients with 62 target lesions undergoing everolimus treatment and pre-therapy, and follow-up 68Ga-DOTA-TATE (-TOC) PET/CT scans. Response evaluation utilized progression-free survival (PFS) categorized as responders (R; PFS > 6 months) and non-responders (NR; PFS ≤ 6 months). Lesion size and density, along with maximum and median standardize uptake value (SUV) in target lesions, liver, and spleen were assessed. Tumor-to-spleen (T/S) and tumor-to-liver (T/L) ratios were calculated, including the tumor-to-spleen (T/S) ratio and tumor-to-liver (T/L) ratio (using SUVmax/SUVmax, SUVmax/SUVmean, and SUVmean/SUVmean). PET/CT scans were acquired 19 days (interquartile range [IQR] 69 days) pre-treatment and 127 days (IQR 74 days) post-starting everolimus. The overall median PFS was 264 days (95% CI: 134–394 days). R exhibited significant decreases in Tmax/Lmax and Tmean/Lmax ratios compared to NR (p = 0.01). In univariate Cox regression, Tmean/Lmax ratio was the sole prognostic parameter associated with PFS (HR 0.5, 95% CI 0.28–0.92, p = 0.03). Percentage changes in T/L and T/S ratios were significant predictors of PFS, with the highest area under curve (AUC) for the percentage change of Tmean/Lmax (AUC = 0.73). An optimal threshold of < 2.5% identified patients with longer PFS (p = 0.003). No other imaging or clinical parameters were predictive of PFS. This study highlights the potential of quantitative SSTR-PET/CT in predicting and monitoring everolimus response in NET patients. Liver metastasis-to-liver parenchyma ratios outperformed size-based criteria, and Tmean/Lmax ratio may serve as a prognostic marker for PFS, warranting larger cohort investigation. [ABSTRACT FROM AUTHOR]

The general objective of this study was to evaluate response of selected watermelon growth and yield attributes to pig manure in Owerri, South Eastern Nigeria. Specifically, it determined response of watermelon to four rates of pig manure in terms of number of leaves produced per plant, vine length per plant, number of fruits harvested per plant and weight of fruits harvested per plant. The field experiments were conducted in 2020 and 2021 cropping seasons in the Teaching and Research Farm, Agricultural Science Department, Alvan Ikoku Federal University of Education, Owerri, Imo State, Nigeria. The investigation was carried out in a Randomized Complete Block Design with three replications. Treatments were composed of pig manure rates of 0, 5, 10, 15 tons per hectare. Parameters studied were number of leaves per plant, vine length per plant, number of fruits harvested per plant and weight of harvested fruits per plant. Data were subjected to Analysis of Variance (ANOVA) test and significant treatment means were separated using Least Significant Difference (LSD) protocol. Results obtained from the two experiments conducted show plants that received application of pig manure at the rate of 15 tons per hectare were outstanding in terms of vine length at 4weeks after planting (79.96 cm in 2020 and 58.93cm in 2021 ), 6 weeks after planting ( 162.46cm in 2020 and 89.73cm in 2021 ) and 8 weeks after planting (201.36cm in 2020 and 187.06 cm), number of leaves at 4 weeks after planting(25.50 in 2020 and 33.96 in 2021), 6 weeks after planting (28.50 in 2020 and 39.63 in 2021), 8 weeks after planting (31.10 in 2020 and 42.96 in 2021), number of fruits ( 4 fruits/plant in 2020 and 6 fruits/plant) as well as fruit weight(10kg in 2020 and 8kg in 2021) and is therefore to recommended for watermelon cultivation in Owerri, South Eastern Nigeria. [ABSTRACT FROM AUTHOR]

Oropouche virus has recently caused outbreaks in South America and the Caribbean, expanding into areas to which the virus was previously not endemic. This geographic range expansion, in conjunction with the identification of vertical transmission and reports of deaths, has raised concerns about the broader threat this virus represents to the Americas. We review information on Oropouche virus, factors influencing its spread, transmission risk in the United States, and current status of public health response tools. On the basis of available data, the risk for sustained local transmission in the continental United States is considered low because of differences in vector ecology and in human–vector interactions when compared with Oropouche virus–endemic areas. However, more information is needed about the drivers for the current outbreak to clarify the risk for further expansion of this virus. Timely detection and control of this emerging pathogen should be prioritized to mitigate disease burden and stop its spread.

Abstract Background On 5 November 2021, a fire incident following a tanker explosion occurred in the Wellington PMB Junction east of Freetown, Sierra Leone, injuring and killing people. WHO facilitated the deployment of international emergency medical teams (EMTs) to support the Ministry of Health (MoH) in providing care to the wounded in four hospitals. Objective In this study, we document Sierra Leone's experience managing the fire incident and the role of EMTs in responding to it. Method This is a cross-sectional After-Action Review (AAR) debrief of the response and deployment, including focus group discussion with WHO and MoH staff (n = 14) in a virtual workshop and document reviews on the response. The results thematically cover the event and the different agencies' responses and a review of EMTs' responses. Results At the onset of the emergency, the National Disaster Management Agency (NDMA) instituted a well-coordinated response mechanism in collaboration with the MoH and managed all response actions, such as medical services, informing partners and the public and coordinating all other agencies. WHO facilitated EMT deployments and mobilised medical supplies and equipment, while the MoH provided accommodation, logistics and coordination. The EMTs dispensed their functions with professionalism, adapted to the environment and available resources, and augmented the care the national health workers provided. They offered additional care: reconstructive surgery, pain management, palliative care, wound care, rehabilitation, physiotherapy and psychosocial counselling, which were initially inadequate at the onset of the disaster. 94 out of 157 patients were discharged home at the end. National clinicians acquired additional skills through the capacity-building activities of EMTs. The community appreciated the teams. Conclusion The government, partners and EMTs were important in the response and worked with speed and political acceptability using the context experience to provide surge support to the country. This experience brought to focus the idea of developing a national EMT in Sierra Leone, which would be useful to help respond even more swiftly. In collaboration with WHO, there is a need to institute further mechanisms to facilitate rapid response and quality-assured deployment of EMTs at regional and sub-regional levels and strengthen to support future responses.

Abstract Background Anthrax is a zoonotic disease caused by Bacillus anthracis that poses a significant threat to both human health and livestock. Effective preparedness and response to anthrax outbreak at the district level is essential to mitigate the devastating impact of the disease to humans and animals. The current diseaae surveillance in animals and humans uses two different infrastructure systems with online platform supported by established diagnostic facilities. The differences in surveillance systems affect timely outbreak response especially for zoonotic diseases like anthrax. We therefore aimed to assess the feasibility of implementing a simulation exercise for a potential anthrax outbreak in a local government setting and to raise the suspicion index of different district stakeholders for a potential anthrax outbreak in Namisindwa District, Uganda. Methods We conducted a field-based simulation exercise and a health education intervention using quantitative data collection methods. The study participants mainly members of the District Taskforce (DTF) were purposively selected given their role(s) in disease surveillance and response at the sub-national level. We combined 26 variables (all dichotomized) assessing knowledge on anthrax and knowledge on appropriate outbreak response measures into an additive composite index. We then dichotomized overall score based on the 80% blooms cutoff i.e. we considered those scoring at least 80% to have high knowledge, otherwise low. We then assessed the factors associated with knowledge using binary logistic regression with time as a proxy for the intervention effect. Odds ratios (ORs) and 95% Confidence intervals (95%CI) have been reported. Results The overall district readiness score was 35.0% (24/69) and was deficient in the following domains: coordination and resource mobilization (5/16), surveillance (5/11), laboratory capacity (3/10), case management (4/7), risk communications (4/12), and control measures (4/13). The overall community readiness score was 7 out of 32 (22.0%). We noted poor scores of readiness in all domains except for case management (2/2). The knowledge training did not have an effect on the overall readiness score, but improved specific domains such as control measures. Instead tertiary education was the only independent predictor of higher knowledge on anthrax and how to respond to it (OR = 1.57, 95% CI = 1.07–2.31). Training did not have a significant association with overall knowledge improvement but had an effect on several individual knowledge aspects. Conclusion We found that the district’s preparedness to respond to a potential anthrax outbreak was inadequate, especially in coordination and mobilisation, surveillance, case management, risk communication and control measures. The health education training intervention showed increased knowledge levels compared to the pre-test and post-test an indicator that the health education sessions could increase the index of suspicion. The low preparedness underscores the urgency to strengthen anthrax preparedness in the district and could have implications for other districts. We deduce that trainings of a similar nature conducted regularly and extensively would have better effects. This study’s insights are valuable for improving anthrax readiness and safeguarding public and animal health in similar settings.

Abstract This paper proposes development of optimized heterogeneous ensemble models for prediction of responses based on given sets of input parameters for wire electrical discharge machining (WEDM) processes, which have found immense applications in many of the present-day manufacturing industries because of their ability to generate complicated 2D and 3D profiles on hard-to-machine engineering materials. These ensembles are developed combining predictions of the three base models, i.e. random forest, support vector machine and ridge regression. These three base models are first framed utilizing the training datasets, providing predictions for all the responses under consideration. Based on these predictions, two optimization problems are formulated for each of the responses, while minimizing root mean squared error and mean absolute error, for subsequent development of two optimized ensembles whose predictions are the weighted sum of the predictions of the base models. The prediction performance of all the five models is ascertained through nine statistical metrics, after which a cumulative quality loss-based multi-response signal-to-noise (MRSN) ratio for each model is computed, for each of the responses, where a higher MRSN ratio indicates greater accuracy in prediction. This study is conducted using two experimental datasets of WEDM process. Overall, the optimized ensemble models having higher MRSN ratios than the base models are indicated to deliver better prediction accuracy.

Abstract Background Concurrent chemoradiotherapy (CCRT) is a crucial treatment for non-small cell lung carcinoma (NSCLC). However, the use of deep learning (DL) models for predicting the response to CCRT in NSCLC remains unexplored. Therefore, we constructed a DL model for estimating the response to CCRT in NSCLC and explored the associated biological signaling pathways. Methods Overall, 229 patients with NSCLC were recruited from six hospitals. Based on contrast-enhanced computed tomography (CT) images, a three-dimensional ResNet50 algorithm was used to develop a model and validate the performance in predicting response and prognosis. An associated analysis was conducted on CT image visualization, RNA sequencing, and single-cell sequencing. Results The DL model exhibited favorable predictive performance, with an area under the curve of 0.86 (95% confidence interval [CI] 0.79–0·92) in the training cohort and 0.84 (95% CI 0.75–0.94) in the validation cohort. The DL model (low score vs. high score) was an independent predictive factor; it was significantly associated with progression-free survival and overall survival in both the training (hazard ratio [HR] = 0.54 [0.36−0.80], P = 0.002; 0.44 [0.28−0.68], P

Over the last two decades, we have witnessed great advancements in our understanding of the immunological pathways of asthma, leading to the development of targeted therapies, such as biologic drugs, that have radically and definitively changed the clinical outcomes of severe asthma. Despite the numerous therapeutic options available, ~4–10% of all people with asthma have severe or uncontrolled asthma, associated with an increased risk of developing chronic oral corticosteroid use, fixed airflow limitation, exacerbations, hospitalization and, finally, increased healthcare costs. The new concept of disease modification in asthma comes from the evolution of asthma management, which encompasses phenotyping patients with different inflammatory endotypes characterizing the disease, followed by the advent of more effective therapies capable of targeting the proximal factors of airway inflammation. This treat-to-target approach aims to achieve remission of the disease. Because the novel treatment paradigm for severe asthma with the advent of biologic therapies is no longer clinical control but rather clinical remission – a step closer to the concept of cure – a deeper and more accurate understanding of the critical causal mechanisms and endotypes of asthma is necessary to achieve the goal of clinical remission, which has the potential to generate real life-changing benefits for patients. This review aims to frame the evolution of the debated concept of clinical remission and provide clinicians with insights that may be helpful in achieving remission in the greatest number of patients.

Background and objective: The depth of the prostate-specific antigen (PSA) decline after androgen receptor pathway inhibitor (ARPI) treatment combined with androgen deprivation therapy for patients with metastatic hormone-sensitive prostate cancer (mHSPC) may affect prognosis. The primary objective in our study was the correlation between the PSA response at 3 mo and radiologic progression-free survival (rPFS) at 24 mo. Three groups were defined according to the PSA decline: complete response (PSA ≤0.02 ng/ml), partial response (PSA >0.02 and ≤0.2 ng/ml), and incomplete response (PSA >0.2 ng/ml). Secondary objectives were correlation between the PSA response at 3 mo and overall survival, and the development of a model predicting complete PSA response. Methods: We conducted a retrospective multicenter study of patients with mHSPC treated with apalutamide from May 2018 to September 2023 registered in the Real-World Evidence APA registry across 20 centers. Key findings and limitations: We included 633 patients with mHSPC. The median age at diagnosis was 68 yr (interquartile range [IQR] 63–75) and median PSA was 16 ng/ml (IQR 7.5–64). Some 63% of the short had low-volume disease, 51% had de novo disease, 48% had recurrent disease. At 3 mo, 27% had a complete response, 42% a partial response, and 31% an incomplete response, with corresponding rRFS rates at 24 mo of 92%, 86%, and 63%. According to the predictive model, a complete PSA response at 3 mo was associated with the use of next-generation imaging and PSA

Abstract Introduction Lebrikizumab is a novel monoclonal antibody with established efficacy in patients with moderate-to-severe atopic dermatitis (AD) in multiple Phase 3 trials. One of the ultimate treatment goals for patients with moderate-to-severe AD is to achieve stable disease control without concern for planning future life events. Methods In ADvocate1 and ADvocate2, lebrikizumab-treated patients meeting the protocol-defined response criteria at Week 16 were re-randomized 2:2:1 to receive lebrikizumab every 2 weeks (Q2W), lebrikizumab every 4 weeks (Q4W), or placebo Q2W (lebrikizumab withdrawal) for 36 additional weeks. In this post hoc analysis, we evaluated the proportions of patients with no or minimal fluctuations of efficacy during the 36-week maintenance period and plotted individual patient trajectories. We defined no or minimal fluctuations as achieving and maintaining the defined endpoint (≥ 75% improvement in the Eczema Area and Severity Index [EASI 75], ≥ 90% improvement in EASI, Pruritus Numeric Rating Scale [NRS] ≥ 4-point improvement, or Pruritus NRS ≥ 3-point improvement) for ≥ 80% of the study visits. If patients used rescue medication, discontinued treatment, or transferred to the escape arm, data collected at or after the event were imputed as non-response. Results The proportions of lebrikizumab responders who maintained EASI 75 with no or minimal fluctuations were 70.8% (lebrikizumab Q2W), 71.2% (lebrikizumab Q4W), and 60.0% (lebrikizumab withdrawal). Of the patients with baseline Pruritus NRS ≥ 4 and who achieved ≥ 4-point improvement at Week 16, 66.1% (lebrikizumab Q2W), 62.7% (lebrikizumab Q4W), and 55.2% (lebrikizumab withdrawal) maintained ≥ 4-point Pruritus NRS improvement with no or minimal fluctuations. Conclusions Patients who met the response criteria at Week 16 and continued treatment with lebrikizumab Q2W or Q4W demonstrated a stable response with no or minimal fluctuations of efficacy in measures of skin and itch up to Week 52. Clinical Trial Registration NCT04146363 (ADvocate1) and NCT04178967 (ADvocate2).

Abstract Background Stereotactic radiotherapy is the preferred treatment for managing patients with fewer than five brain metastases (BMs). However, some lesions recur after irradiation. The purpose of this study was to identify patients who are at a higher risk of failure, which can help in adjusting treatments and preventing recurrence. Methods In this retrospective multicenter study, we analyzed the predictive significance of a set of interpretable morphological features derived from contrast-enhanced (CE) T1-weighted MR images as imaging biomarkers using Kaplan–Meier analysis. The feature sets studied included the total and necrotic volumes, the surface regularity and the CE rim width. Additionally, we evaluated other nonmorphological variables and performed multivariate Cox analysis. Results A total of 183 lesions in 128 patients were included (median age 61 [31–95], 64 men and 64 women) treated with stereotactic radiotherapy (57% single fraction, 43% fractionated radiotherapy). None of the studied variables measured at diagnosis were found to have prognostic value. However, the total and necrotic volumes and the CE rim width measured at the first follow-up after treatment and the change in volume due to irradiation can be used as imaging biomarkers for recurrence. The optimal classification was achieved by combining the changes in tumor volume before and after treatment with the presence or absence of necrosis (p

Hui Ma,1,2,&ast; Ting Yu,3,&ast; Zhong-Chen Li,1 Lan Zhang,1,2 Rong-Xin Chen,1 Zheng-Gang Ren1 1Liver Cancer Institute, Zhongshan Hospital, Fudan University, Shanghai, People’s Republic of China; 2Department of Hepatic Oncology, Xiamen Branch, Zhongshan Hospital, Fudan University, Xiamen, People’s Republic of China; 3Department of Pathology, Obstetrics and Gynecology Hospital, Fudan University, Shanghai, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Hui Ma, Email mahui_676@163.comPurpose: Oxidative stress plays a critical role in promoting tumor resistance to hypoxia and chemotherapeutic drugs. However, the prognostic role of oxidative stress-related genes (OSRGs) in hepatocellular carcinoma (HCC) treated with transarterial chemoembolization (TACE) has not been fully explored.Methods: We used transcriptome data from the GSE104580 cohort containing patients marked as responders or nonresponders to TACE therapy to identify differentially expressed OSRGs associated with TACE response (TR-OSRGs). We created a TR-OSRG prognostic signature based on TR-OSRGs using least absolute shrinkage and selection operator Cox and stepwise Cox regression analyses in a training cohort of patients with HCC (TCGA-LIHC). We verified this prognostic signature in two external cohorts of patients who received TACE for HCC (GSE14520-TACE and ZS-TACE-37). Finally, we constructed a prognostic nomogram model for predicting survival probability of patients with HCC based on Cox regression analysis.Results: The TR-OSRG prognostic signature was created and shown to be a robust independent prognostic factor for treatment response and outcomes for HCC after TACE therapy. Risk scores based on this signature correlated with tumor stage and grade. Tumor samples from patients with higher risk scores exhibited more infiltration of immune cells and significantly increased expression of immune checkpoint genes. We also developed a nomogram for patients with HCC based on the TR-OSRG prognostic signature and clinical parameters; this nomogram was a useful quantitative analysis tool for predicting patient survival.Conclusion: The TR-OSRGs signature exhibited good performance in predicting treatment response and outcomes in patients with HCC treated with TACE.Keywords: hepatocellular carcinoma, transarterial chemoembolization, oxidative stress, response, prognosis

Jiaoquan Chen, Shanshan Ou, Weihong Wu, Hui Zou, Huaping Li, Huilan Zhu Department of Dermatology, Guangzhou Dermatology Hospital, Guangzhou, Guangdong, 510095, People’s Republic of ChinaCorrespondence: Huilan Zhu, Department of Dermatology, Guangzhou Dermatology Hospital, 56 Hengfu Road, Guangzhou, Guangdong, 510095, People’s Republic of China, Email zhlhuilan@126.comBackground: Although omalizumab has shown success in treating chronic spontaneous urticaria (CSU) patients unresponsive to antihistamines, the exact mechanism of action and predictive markers of response remain unclear.Purpose: The aim of this study was to examine the correlation between baseline levels of biomarkers and clinical parameters with omalizumab response and response rate in patients with CSU.Methods: This retrospective study included 82 adult CSU patients who received omalizumab 300mg every 4 weeks for 16 weeks between January 2022 and December 2023. Treatment response was assessed using UAS7 and DLQI scores at baseline and weeks 4, 8, 12, and 16. Responders were defined as patients achieving UAS7 < 7, with early and late responders categorized based on response within or after 4 weeks, respectively. Baseline clinical features and laboratory biomarkers were compared between responders and non-responders.Results: The overall response rate was 71.95% (59/82), with 23 early responders and 36 late responders. Responders had significantly lower baseline UAS7 (median: 28 vs 35, P < 0.01), DLQI (median: 8 vs 15, P < 0.001), and IL-17 levels (median: 0.53 vs 1.26 pg/mL, P < 0.001) compared to non-responders. Baseline UAS7 > 31, DLQI > 9.5, and IL-17 > 0.775 pg/mL predicted non-response with sensitivities of 78.26%, 100%, and 78.26%, and specificities of 67.8%, 59.32%, and 72.88%, respectively. ASST positivity and comorbid allergic diseases were associated with early response (P < 0.05). Adverse events were reported in 6.09% of patients, including mild injection site reactions and transient urticaria exacerbation, not requiring treatment discontinuation.Conclusion: This study suggests that omalizumab is an effective and safe treatment option for antihistamine-refractory CSU. Baseline UAS7, DLQI, ASST status, serum total IgE levels, and IL-17 may serve as potential predictors of omalizumab response. Notably, ASST positivity and comorbid allergic diseases were associated with an early response to treatment. These findings highlight the importance of considering individual patient characteristics when predicting the likelihood and timing of response to omalizumab in CSU.Keywords: Chronic spontaneous urticaria, omalizumab, response, early responder, late responder

Abstract Objective To investigate the impact of response to induction chemotherapy (IC) on survival outcomes in patients with locally advanced nasopharyngeal carcinoma (LANPC) and evaluate the efficacy of adding nimotuzumab to concurrent chemoradiotherapy (CCRT) based on different responses to IC. Methods We retrospectively included patients with stage III-IVA NPC who underwent IC with and without nimotuzumab during CCRT. Statistical analysis included the chi-square test, propensity score matching, Kaplan-Meier survival analysis, and Cox proportional hazards model. Results Among 383 identified patients, 216 (56.4%) received nimotuzumab during CCRT, while 167 (43.6%) did not. Following IC, 269 (70.2%) patients showed a complete response (CR) or partial response (PR), and 114 (29.8%) had stable disease (SD) or progressive disease (PD). The response to IC independently influenced disease-free survival (DFS) and overall survival (OS). Patients achieving CR/PR demonstrated significantly higher 3-year DFS (80.3% vs. 70.6%, P = 0.031) and OS (90.9% vs. 83.2%, P = 0.038) than those with SD/PD. The addition of nimotuzumab during CCRT significantly improved DFS (P = 0.006) and OS (P = 0.037) for CR/PR patients but not for those with SD/PD. Conclusions This study emphasizes the importance of IC response in LANPC and highlights the potential benefits of nimotuzumab during CCRT for improving survival outcomes in CR/PR patients. Tailored treatment approaches for SD/PD patients warrant further investigation.

Abstract Introduction COVID-19 has demonstrated the importance of competent staff with expertise in public health emergency preparedness and response in the civil aviation system. The civil aviation system is a critical sentinel and checkpoint to prevent imported cases and slow the spread of communicable diseases. Understanding the current competencies of staff to deal with public health emergencies will help government agencies develop targeted training and evidence-based policies to improve their public health preparedness and response capabilities. Methods This cross-sectional pilot study was conducted from November 2022 to October 2023, involving 118 staff members from various positions within China’s civil aviation system. A 59-item questionnaire was translated and developed according to a competency profile. Data were collected using the self-report questionnaire to measure the workforce’s self-perceptions of knowledge and skills associated with public health emergency proficiency, categorized into (1) general competency, (2) preparedness competency, (3) response competency, and (4) recovery competency. KMO & Bartlett test and Cronbach’s α reliability analysis were used to test the reliability and validity of the questionnaire. Descriptive statistics, independent sample T-test, ANOVA, and linear regression models were performed to analyze the competencies. Results A total of 107 staff members from the aviation system were surveyed in this study. The KMO & Bartlett test, (KMO = 0.919, P

The unprecedented introduction and spread of SARS-CoV-2, responsible for the COVID-19 epidemic, had many varied and unanticipated consequences for the United States and other countries. In addition to the direct effects of human infection, multiple industries, commodities, and jobs were impacted. This review describes the impact on an academic institution, with a chronological account of events related to constantly changing perceptions and understanding of the pandemic. Although a personal account, the objective is to document how leadership was able to adjust to circumstances in order to support research activities, student education, and the academic goals of our land grant university. It is hoped that these examples will inspire and better prepare us for a subsequent event and avoid what for the COVID-19 situation might be summarized as a progression from procrastination-pandemic-panic-pandemonium-endemic

Abstract Background Studies have confirmed the rapid antidepressant action of ketamine in depressive episodes. Nevertheless, a standardized procedure for the delivery of ketamine infusion in individuals suffering from treatment-resistant depression, particularly in terms of infusion frequency and total dosage, remains undetermined. In addition, an efficacious ketamine regimen for persistent pain management involved a continuous 10-day infusion period with no notable adverse effects. Consequently, the primary objective of this study was to evaluate the antidepressant capacity of consecutive ketamine infusions spanning over three successive days, the duration of therapeutic response, and the overall safety profile of the treatment. Methods In this randomized controlled trial, participants aged 18–64 with treatment-resistant depression were randomized to receive either intravenous ketamine or midazolam (used as an active placebo) for 40 min daily over three consecutive days. Statistical analysis using repeated measures ANOVA was employed to assess the changes in the total score of the Montgomery–Åsberg Depression Rating Scale (MADRS) and the clinical global impression-Severity from the initial assessment to 10 and 31 days post-infusion. Additionally, the duration of response and remission was evaluated using Kaplan–Meier survival analysis. Results Out of 33 randomized participants, 20 underwent the treatment as planned. By day 10th, the ketamine group had a mean reduction in MADRS score of 12.55 (95% CI = 6.70–18.09), whereas the midazolam group had a decrease of 17.22 (95% CI = 11.09–23.36). This pattern continued to day 31, with ketamine showing a mean score decrease of 13.73 (95% CI = 7.54–19.91) and midazolam a fall of 12.44 (95% CI = 5.61–19.28). Both treatments were well tolerated, with dissociative symptoms in the ketamine group being temporary and ceasing by the end of each infusion. Conclusion Intravenous ketamine given for three consecutive days did not show a notable antidepressant advantage when compared to the active placebo midazolam, highlighting the need for further research into effective treatments schedules for treatment-resistant depression. Trial registration NCT05026203, ClinicalTrials.gov, registered on 24/08/2021.

Ying Zhang,1,&ast; Peijun Chen,1,&ast; Tianzhuo Yu,1 Yuehui Yu,2 Xinyi Yan,2 Jie Chu,1 Gaoyi Yang3 1Department of Ultrasonography, Hangzhou Red Cross Hospital (Zhejiang Tuberculosis Diagnosis and Treatment Center), Hangzhou, Zhejiang, People’s Republic of China; 2Division of Health Sciences, Hangzhou Normal University, Hangzhou, Zhejiang, People’s Republic of China; 3Department of Ultrasonography, Hangzhou First People’s Hospital, Hangzhou, Zhejiang, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Gaoyi Yang, Department of Ultrasonography, Hangzhou First People’s Hospital, Hangzhou, Zhejiang, People’s Republic of China, Email yanggaoyi8@163.comPurpose: To explore the relationship between the initial size and the necrotic rate of lymph nodes evaluated by ultrasound in patients with cervical tuberculous lymphadenitis (CTL) and therapeutic response.Methods: Overall, 55 patients were included in this study. Conventional ultrasound and contrast-enhanced ultrasound examination were performed before anti-tuberculosis chemotherapy. Based on the different therapeutic outcomes, they were divided into responder groups (n = 39) and non-responder groups (n = 16). The relationship between the initial size (maximum area, length diameter, short diameter), rate of necrosis, and therapeutic response were compared and analyzed between two groups.Results: There was a significant difference in maximum area, short diameter and rate of necrosis of lymph nodes between the responder groups and the non-responder groups (P < 0.05). The receiver-operating-characteristic (ROC) curve analysis was used to differentiate the two groups, it showed that the area under the curve was 0.746 for maximum area and 0.721 for short diameter, respectively. The cut-off value for the lymph node maximum area and short diameter based on ROC curve analysis was determined as 3.94cm2 (sensitivity 76.9%, specificity 68.7%) and 1.15cm (sensitivity 59.0%, specificity 93.7%), respectively. A negative correlation was observed between maximum area, short diameter, and therapeutic response.Conclusion: The initial maximum area and short diameter of lymph nodes were found to have a negative correlation with chemotherapy response in patients with CTL. The treatment outcomes are typically unsatisfactory for lymph nodes exhibiting an initial necrosis rate of 50% or higher. These findings may be helpful for evaluating therapeutic response.Plain Language Summary: In this study, we evaluated the relationship between the initial size and the necrotic rate by ultrasound with cervical tuberculous lymphadenitis (CTL) and therapeutic response. We found that the initial maximum area and short diameter of lymph nodes have a negative correlation with chemotherapy response in patients with CTL. The treatment outcomes are typically unsatisfactory for lymph nodes exhibiting an initial necrosis rate of 50% or higher. These findings may be helpful for evaluating therapeutic response in the early stages.Keywords: ultrasound, tuberculous lymphadenitis, cervical, anti-tuberculosis chemotherapy, response

OBJECTIVE: The study aims to explore the perspective of disaster survivors on Islamic-based nurses' competencies in response to disasters, principally in handling psychological, psychosocial, and spiritual conditions. METHODOLOGY: A qualitative study with a descriptive phenomenology design was conducted. The data collection using a focus group discussion with five interview guides for nine disaster survivors was involved in this study. The data was evaluated through thematic analysis using sub-themes and themes, followed by qualitative steps. RESULTS: The study identified three themes related to disaster survivors' perspective: 1) Perception of disaster: tests and punishments, 2) Nurses' competencies: skills and attitude, and 3) Integrating Islamic values: spiritual support and motivation. CONCLUSION: The study indicated that the Islamic-based nurses' disaster response competencies identified an essential role in dealing with psychological, psychosocial, and spiritual problems among disaster survivors from the Islamic perspective

By the end of 2020, the unknown and contagious COVID-19 virus had spread across the globe. Failure to follow health instructions and the ambiguity of the nature of the virus caused it to infect every single citizen in a short period of time and even lead to the death of vulnerable people. Nearly two years of experience in medical research and humanities findings show that in addition to the measures of government institutions, it is the people and civil society who can be very effective in breaking the chain of transmission, and with self-care, social oversight and collective responsibility Manage. However, improper performance of people in observing the necessary health instructions and care can, in addition to the criminal title of threat to public health (subject of Article 688 of the Islamic Penal Code adopted in 1375) and also the Act on the prevention of sexually transmitted diseases and infectious diseases approved in 1320, in some cases lead to death, disability, or benefit of other persons. It also leads to intentional, quasi-intentional or pure error, depending on the case. Government criminal policy by legislative, judicial, and executive methods alone is not effective in counteracting such criminal titles, and the components of participatory (comprehensive) criminal policy need to be expanded. In fact, the purpose of this study, which has been written in an analytical and descriptive way, is to find a significant answer to the question of the effectiveness and ineffectiveness of participatory criminal policy in controlling and combating the virus. Participation as an effective and efficient method in today's difficult campaigns such as Corona. As a rule, the hypothesis of this research that the effectiveness of these components has been proved in the following and can be implemented by taking measures at different levels of government and people. Therefore, the application of this research can be hoped to eliminate the damage of Covid virus 19 and prevent, control and deal with its spread and contagion.