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The ozone-depleting substances chlorofluorocarbons (CFCs), hydrochlorofluorocarbons (HCFCs) and their major substitutes hydrofluorocarbons (HFCs) are all potent greenhouse gases, and their atmospheric concentrations and emission sources have received international attention. The relevant studies have been carried out at multiple background sites around the world, but there is no report on the southern slope of the Himalayas. For the first time, this study set up the Medog background observation site 30 km away from Medog County on the southern slope of the Himalayas (95.5262ºE, 29.5314ºN, 1298.8 m above sea level) in China. From August 10 to September 19 and November 3 to November 30 in 2021, 114 atmospheric samples were collected instantaneously using evacuated electro-polished stainless-steel canisters and manual pressurization equipment and 1-3 samples were collected per day. Nine substances (CFC-11, 12, 113; HCFC-22, 141b, 142b; HFC-23, 125, 134a) were analyzed using a high-precision measurement system of halogenated gases (ODS5-pro). For each substance, all the atmospheric samples were divided into two categories: background samples and polluted samples. The background samples are those whose concentrations were within the range of the background concentrations (measured at the Ragged Point site at the same latitude in 2021) ± 3σ (instrument precision), and the others were classified as polluted samples. Our results showed that the number of the polluted samples of each substance accounted for about 40%-90%. In addition, we found that the mixing ratios of CFC-113, HFC-23, and HCFC-22 in the polluted samples were 93, 44 and 311 pptv, respectively, with higher mixing ratios (31.6%, 24.5%, and 22.5%) above the background levels than other substances (4.3%~10.2%). Furthermore, CFC-113 and HFC-23 were significantly correlated (R = 0.429, P < 0.01), suggesting that they may have similar sources. Both Backward Trajectory and Potential Source Contribution Function of the polluted samples of CFC-113, HFC-23, and HCFC-22 found that the polluted air masses mainly came from the northeast of India and other regions southwest of the sampling site. In contrast, the background air masses mainly came from the local areas. The concentrations of CFC-113, HFC-23, and HCFC-22 in the polluted samples observed in this study, likely from the northeast of India, were about 20-30% higher than the results of aircraft samples conducted by Say et al. (2019) over Northern and Southern India in 2016. In the future, we will continue to carry out atmospheric observations at the Medog background site and try to use the suitable atmospheric transport model to inverse the emissions in the surrounding areas.

Sulfur hexafluoride (SF6) is the most potent non-CO2 Greenhouse Gas currently incorporated in the Paris Agreement, with a global warming potential of around 25,000 over a 100-year time horizon and lifetime of around 1,000 years. Global mole fractions and emissions of SF6 have increased substantially since the 2000s. The increasing SF6 emissions worldwide are thought to originate from its growing emissions in Kyoto Protocol non-Annex-I countries, where China is a major contributor. Top-down emission estimates provide evaluation of national bottom-up inventories, based on information from atmospheric observations. Previous top-down emissions of SF6 in China were determined by observations made outside of China (e.g., in Korea and Japan), which lack sensitivity to emissions in regions far from the measurement sites (like the western or southern parts of China). In this study, emissions of SF6 in China over 2011-2020 were derived using observations of SF6 from 9 sites within China, coupled with a Lagrangian transport model and a hierarchical Bayesian inference algorithm. Analysis of the sensitivity maps (footprints) of these measurement sites suggest broad sensitivity to the major emission areas in China. The emissions in China show a substantial increase throughout the study period and contribute substantially to the rise in global emissions. The spatial distribution of SF6 emissions in different regions or provinces in China and their changes are further analyzed. Finally, the potential industrial drivers behind the changes in emissions in China, and the necessity of continuous atmospheric observations in some key regions like in the northwest of China are discussed.

Data in the NESTIMATOR project

The Norwegian tender system for biologic drugs used as an instrument for head-to-head comparisons of treatment in inflammatory arthritis

Supplemental material, sj-docx-1-cre-10.1177_02692155231170450 for Efficacy of electrophysical agents in fibromyalgia: A systematic review and network meta-analysis by John Marwa Gikaro, Francis Manyori Bigambo, Victor Mark Minde and Elia Asanterabi Swai in Clinical Rehabilitation

To investigate the distribution of patient-reported outcomes (PROs) in axial spondyloarthritis (axSpA) patients initiating a tumor necrosis factor inhibitor (TNFi), to assess the proportion reaching PRO "remission" across registries and treatment series, and to compare patients registered to fulfill the New York criteria for ankylosing spondylitis (AS) versus non-radiographic axSpA (nr-axSpA) patients.Fifteen European registries contributed PRO scores for pain, fatigue, patient global, Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Bath Ankylosing Spondylitis Functional Index (BASFI) and Health Assessment Questionnaire (HAQ) from 19,498 axSpA patients. Changes in PROs and PRO "remission" rates (definitions: ≤20 mm for pain, fatigue, patient global, BASDAI and BASFI; ≤0.5 for HAQ) were calculated at 6, 12 and 24 months of treatment.Heterogeneity in baseline characteristics and outcomes between registries were observed. In pooled data, six months after start of a 1st TNFi, pain score was reduced by approximately 60% (median at baseline/6/12/24 months: 65/25/20/20 mm) in patients on treatment. Similar patterns were observed for fatigue (68/32/30/25), patient global (66/29/21/20), BASDAI (58/26/21/19), BASFI (46/20/16/16) and HAQ (0.8/0.4/0.2/0.2). Patients with AS, n=3281 had a slightly better response than nr-axSpA patients, n=993. LUNDEX-adjusted "remission" rates at 6 months for pain/fatigue/patient global/BASDAI/BASFI/HAQ were 39%/30%/38%/34%/35%/48% for the AS cohort and 30%/21%/26%/24%/33%/47% for the non-radiographic axSpA cohort. Better PRO responses were seen with a 1st TNFi compared to 2nd and 3rd TNFi.AxSpA patients starting a TNFi achieved high PRO "remission" rates, most pronounced in those fulfilling the modified New York criteria and for the first TNFi.

Accurate prediction of topographical correlation between craniopharyngiomas (CPs) and hypothalamus is important for treatment. This study sought to develop a predicting tool based on preoperative-MRI through radiological–surgical–pathological–outcome analysis. Third ventricle floor (TVF), mammillary bodies and cerebral peduncle were evaluated through preoperative-MRI. An eagle-head-like sign named “eagle sign” was observed. Normal TVF on sagittal-MRI was defined as the baseline. Variants of the sign were analyzed by comparing with the baseline and corresponding correlations of CPs with hypothalamus were verified using intraoperative records, histopathology and outcome evaluation. A total of 146 CPs patients, who undergone endoscopic endonasal procedure were divided into four groups based on the variants of “eagle sign”. Group A: 24 patients with the upward sign; group B: 81 with the downward sign; group C: 21 with the anterior TVF upward sign and group D: 20 with the unidentifiable sign. Surgical–pathological analysis showed significant correlations between 95.8% CPs in group A and 95.2% in group C with tumor topography and tumor adherence to the hypothalamus. These CPs had their origins beneath the hypothalamus. In contrast, groups B and D, with hypothalamic origin, showed hypothalamic infiltration by tumor in 97.5% and 95% of cases in groups B and D, respectively. Outcomes of groups A and C were relatively better than groups B and D. Predictive sensitivity and specificity of “eagle sign” were more than 90%. “Eagle sign” is an accurate tool for predicting topographic correlations between CPs and hypothalamus with high sensitivity and specificity.

Background Home care workers perform physically strenuous tasks, in particular when handling patients with high care demands. Thus, musculoskeletal pain and sick leave is greater in this group than in the general population. To ease these issues, we will implement a Goldilocks Work intervention (GoldiCare), redistributing schedules between workers to achieve a “just right” weekly structure of physical work that can promote health. This protocol paper describes the content, design, implementation and evaluation of the cluster randomized controlled trial of the GoldiCare intervention in home care. Methods The cluster randomized controlled trial is a 16-week workplace organizational intervention implemented through operations managers at the home care units. The operations managers will be introduced to the Goldilocks Work Principle and a GoldiCare tool, to assist the operations managers when composing a “just right” distribution of work schedules throughout the week. The GoldiCare tool provides an overview of the physical strain for each shift, based on the number of patients and their need for care. We expect to include 11 units, which will be randomized to either intervention or control at a 1:1 ratio. Home care workers assigned to the control group will continue to work as normal during the intervention period. Musculoskeletal pain in neck/shoulder and lower back will be the primary outcomes and we will also evaluate the composition of physical behaviors as well as fatigue after work as secondary outcomes. We will collect data using (1) daily questions regarding musculoskeletal pain and fatigue after work, (2) 7 days of objective measurements of physical behavior, (3) questionnaires about the participant’s characteristics, health, and workplace psychosocial stressors and (4) information on the implementation of the GoldiCare tool. In addition, a process evaluation will be conducted using focus group discussions and individual interviews. Discussion Due to the increasing aging population in need of care, measures that can improve the health of home care workers are paramount for the sustainability of this sector. This organizational intervention is based on information available nation-wide, and therefore has the potential to be scaled to all municipalities in Norway if proven effective. Trial registration This clinical trial was registered on 08/05/2022 under NCT05487027.

Background: To study the pathogenesis of steroid-induced femoral head osteonecrosis, an ideal animal model is very important. As experimental animals, mice are beneficial for studying the pathogenesis of disease. However, there are currently few mouse models of steroid-induced femoral head osteonecrosis, and there are many questions that require further exploration and research.Purposes: The purpose of this study was to establish a new model of osteonecrosis in mice using angiotensin II (Ang II) combined with asparaginase (ASP) and dexamethasone (DEX) and to study the effects of this drug combination on femoral head osteonecrosis in mice.Methods: Male BALB/c mice (n = 60) were randomly divided into three groups. Group A (normal control, NC) was treated with physiological saline and given a normal diet. Group B (DEX + ASP, DA) was given free access to food and water (containing 2 mg/L DEX) and subjected to intraperitoneal injection of ASP (1200 IU/kg twice/week for 8 weeks). Group C (DEX + ASP + Ang II, DAA) was treated the same as group B, it was also given free access to food and water (containing 2 mg/L DEX) and subjected to intraperitoneal injection of ASP (1200 IU/kg twice/week for 8 weeks), but in the 4th and 8th weeks, subcutaneous implantation of a capsule osmotic pump (0.28 mg/kg/day Ang II) was performed. The mice were sacrificed in the 4th and 8th weeks, and the model success rate, mouse mortality rate, body weight, blood lipids, coagulation factors, histopathology, and number of local vessels in the femoral head were evaluated.Results: DAA increased the model success rate [4th week, 30% (DA) vs. 40% (DAA) vs. 0% (NC); 8th week, 40% (DA) vs. 70% (DAA) vs. 0% (NC)]. There was no significant difference in mortality rate between the groups [4th week, 0% (DA) vs. 0% (DAA) vs. 0% (NC); 8th week, 5% (DA) vs. 10% (DAA) vs. 0% (NC)]. DAA affected mouse body weight and significantly affected blood lipids and blood coagulation factors. DAA reduces the number of blood vessels in the femoral head and destroys the local blood supply.Conclusion: Angiotensin II combined with asparaginase and dexamethasone can obviously promote the necrosis of femoral head and provide a new idea for the model and treatment of osteonecrosis.

Background The Lancet Commission on Global Surgery recommends a minimum of 20 surgical specialists and 5,000 annual operations per 100,000 population by 2030. In 2012, Sierra Leone was far from reaching these targets. This study aimed to assess the changes in surgical activity, surgical workforce, and surgical productivity between 2012 and 2017. Methods A nationwide, retrospective mapping of surgical activity and workforce in 2012 was repeated in 2017. All 60 facilities performing comprehensive surgery in Sierra Leone in 2017 were identified and data was obtained from surgical records and through structured interviews with facility directors. Annual estimates were calculated and compared with 2012. Results The surgical workforce increased from 164.5 to 312.8 full-time positions. The annual volume of surgeries was enhanced by 15.6% (95% CI: 7.8–23.4%) from 24,152 to 27,928 (26,048–29,808) operations. With simultaneous population growth, this led to a decrease in surgical volume from 400 to 372 procedures per 100,000 population and an unmet operative need of 92.7%. The mean productivity of surgical providers went from 2.8 to 1.7 surgeries per week per full-time position. An increasing number of caesarean deliveries were performed in public institutions, by associate clinicians. Conclusion The unmet need for surgery in Sierra Leone remains very high, despite an increase in the surgical workforce, subsidizing maternal healthcare, and initiation of a surgical task-sharing program. The decline in surgical productivity with simultaneous increases in the surgical workforce calls for further exploration of the barriers to access and delivery of surgical care in Sierra Leone.

Historically controlled study design assessing an innovative postnatal risk assessment on growth and developmental problems in young children.

Genetic counselling (GC) is a process of communicating and educating patients and/or their family members diagnosed with genetic abnormalities. Ideally, GC is offered in-person, physical presence of both the counselee and the counsellor. However, COVID-19 pandemic and new norms of social distancing precluded undertaking GCs. In the wake of this, Genetic Research Centre at ICMR-NIRRH, Mumbai, arranged virtual sessions for GC. Here, we describe our experience of initiating genetic counselling services on virtual platform. This report presents the challenges faced by the genetic counsellors as well as the counselees and suggests a protocol to be followed during tele-genetic counselling. It is based on the retrospective data of 65 cases that were counselled from July 2020 to September 2020 which was the period of lockdown and restriction. Although a few issues emerged during the process of GC, virtual tele-counselling was a preferred option due to social distancing, lack of public transport facilities and COVID-19 specific restrictions. Effective virtual follow ups saved time, energy and finances of providers as well as clients. This article presents providers' experience of the process and some recommendations in Indian scenario.

Funder: Nederlandse Organisatie voor Wetenschappelijk Onderzoek (Netherlands Organisation for Scientific Research); doi: https://doi.org/10.13039/501100003246, Many proteins form dynamic complexes with DNA, RNA, and other proteins, which often involves protein conformational changes that are key to function. Yet, methods to probe these critical dynamics are scarce. Here we combine optical tweezers with fluorescence imaging to simultaneously monitor the conformation of individual proteins and their binding to partner proteins. Central is a protein–DNA coupling strategy, which uses exonuclease digestion and partial re-synthesis to generate DNA overhangs of different lengths, and ligation to oligo-labeled proteins. It provides up to 40 times higher coupling yields than existing protocols and enables new fluorescence-tweezers assays, which require particularly long and strong DNA handles. We demonstrate the approach by detecting the emission of a tethered fluorescent protein and of a molecular chaperone (trigger factor) complexed with its client. We conjecture that our strategy will be an important tool to study conformational dynamics within larger biomolecular complexes.

We present a fully analytic approach to calculate infrared (IR) and Raman spectra of molecules embedded in complex molecular environments modeled using the fragment-based polarizable embedding (PE) model. We provide the theory for the calculation of analytic second-order geometric derivatives of molecular energies and first-order geometric derivatives of electric dipole moments and dipole-dipole polarizabilities within the PE model. The derivatives are implemented using a general open-ended response theory framework, thus allowing for an extension to higher-order derivatives. The embedding-potential parameters used to describe the environment in the PE model are derived through first-principles calculations, thus allowing a wide variety of systems to be modeled, including solvents, proteins, and other large and complex molecular environments. Here, we present proof-of-principle calculations of IR and Raman spectra of acetone in different solvents. This work is an important step toward calculating accurate vibrational spectra of molecules embedded in realistic environments.

This article challenges traditional approaches to inter-state relations and reinforces the actor-specific nature of foreign policy analysis. Using individual decision-making theory based on the personalities of key political actors, this article proposes a case study on the foreign policy decision outcome by Tanzania’s President Jakaya Kikwete, in response to the 2013 diplomatic row with Rwanda. Tanzania’s relations with Rwanda have historically been cordial. However, President Kikwete’s proposal for Rwanda to negotiate with the rebel group Forces Démocratiques pour la Libération du Rwanda (FDLR) at the African Union Summit in Addis Ababa in 2013 was not well received by Rwanda. The FDLR is a Hutu rebel outfit based in Eastern DRC, consisting of surviving Hutus who had fled into DRC, after the 1994 genocide. This article argues that in view of the diplomatic row that ensued, Kikwete’s response supports current theories on the role played by a key political actor’s personality in the foreign policy decision-making process.

Objective To examine the effectiveness of electrophysical agents in fibromyalgia. Data sources CINAHL, Cochrane Library, Embase, Medline, PEDro, and Web of Science were searched from their inceptions to March 27, 2023. Methods This study was registered in PROSPERO (CRD42022354326). Methodological quality of included trials was assessed using PEDro scale, and the quality of evidence was determined according to the Grading of Recommendations Assessment, Development, and Evaluation system. The primary outcomes were pain, functional status, and mood. Results Fifty-four studies involving 3045 patients with fibromyalgia were eligible for qualitative synthesis and 47 (pain), 31 (functional status), and 26 (mood) for network meta-analysis. The network consistency model revealed that, when compared with true control, transcutaneous electrical nerve stimulation and microcurrent improved pain symptoms ( P = 0.006 and P = 0.037, respectively); repetitive transcranial magnetic stimulation improved patient functional status ( P = 0.018); and microcurrent ( P = 0.001), repetitive transcranial magnetic stimulation ( P = 0.022), and no treatment ( P = 0.038) significantly improved mood after intervention. Surface under the cumulative ranking indicated that microcurrent was most likely to be the best for managing pain and mood (surface under the cumulative ranking: 70% and 100%, respectively); low-level laser therapy for pain and mood (80% and 70%, respectively); and repetitive transcranial magnetic stimulation for improving functional status and mood (80% and 70%, respectively). Conclusion This review found low to moderate quality evidence that microcurrent, laser therapy, and repetitive transcranial magnetic stimulation are the most effective electrophysical agents for improving at least one outcome in fibromyalgia.

Background A wide range of success rates following the surgical management of enterococcal periprosthetic joint infection (PJI) with a tendency toward worse outcomes have been reported. However, the role of 1-stage exchange remains under-investigated. Therefore, we aimed to evaluate our results after the 1-stage knee exchange for enterococcal PJI. Methods Forty patients were retrospectively included between 2002 and 2017 with a mean follow-up of survivors of 80 months (range 22-172; standard deviation [SD] = 5). Polymicrobial infections occurred in 45% (18/40) of patients. Patients’ characteristics, joint-related data, and antibiotic therapy were recorded. Rates of enterococcal infection relapse, reinfection with new microorganisms, and re-revision for any reason were determined. Bivariate analysis was conducted to identify risk factors of infection recurrence. Results Revision surgery was required in 22 cases (55%) with a mean time to revision surgery of 27 months (range 1-78; SD = 25). Indications for aseptic revisions (18%) included aseptic loosening (10%), periprosthetic fracture (5%), and patellar instability (3%). The most common cause of re-revision was a subsequent PJI (15/22; 68%) after a mean time of 22 months (range 1-77; SD = 24). Overall infection recurrence rate was 37.5% (15/40), substantially due to entirely non-enterococcal infections (9/15; 60%). Infection relapse with Enterococci occurred in 4 cases (10%) within 16 months postoperatively. Older patients (P = .05) and male gender (P = .05) were associated with a higher risk of infection recurrence. Conclusion Overcoming the Enterococci using the 1-stage exchange for knee PJI is achievable but the rate of reinfection due to new microorganisms is high . However, the overall infection recurrence rate is comparable to other treatment approaches.

Drosophila nicotinic acetylcholine receptors (nAChRs) are ligand-gated ion channels that represent a target for insecticides. Peptide neurotoxins are known to block nAChRs by binding to their target subunits, however, a better understanding of this mechanism is needed for effective insecticide design. To facilitate the analysis of nAChRs we used a CRISPR/Cas9 strategy to generate null alleles for all ten nAChR subunit genes in a common genetic background. We studied interactions of nAChR subunits with peptide neurotoxins by larval injections and styrene maleic acid lipid particles (SMALPs) pull-down assays. For the null alleles, we determined the effects of α-Bungarotoxin (α-Btx) and ω-Hexatoxin-Hv1a (Hv1a) administration, identifying potential receptor subunits implicated in the binding of these toxins. We employed pull-down assays to confirm α-Btx interactions with the Drosophila α5 (Dα5), Dα6, Dα7 subunits. Finally, we report the localisation of fluorescent tagged endogenous Dα6 during Drosophila CNS development. Taken together, this study elucidates native Drosophila nAChR subunit interactions with insecticidal peptide toxins and provides a resource for the in vivo analysis of insect nAChRs., UKRI-BBSRC (BB/P021107/1)

Negative emotionality (NE) was evaluated as a candidate mechanism linking prenatal maternal affective symptoms and offspring internalizing problems during the preschool/early school age period. The participants were 335 mother–infant dyads from the Maternal Adversity, Vulnerability and Neurodevelopment project. A Confirmatory Bifactor Analysis (CFA) based on self-report measures of prenatal depression and pregnancy-specific anxiety generated a general factor representing overlapping symptoms of prenatal maternal psychopathology and four distinct symptom factors representing pregnancy-specific anxiety, negative affect, anhedonia and somatization. NE was rated by the mother at 18 and 36 months. CFA based on measures of father, mother, child-rated measures and a semistructured interview generated a general internalizing factor representing overlapping symptoms of child internalizing psychopathology accounting for the unique contribution of each informant. Path analyses revealed significant relationships among the general maternal affective psychopathology, the pregnancy- specific anxiety, and the child internalizing factors. Child NE mediated only the relationship between pregnancy-specific anxiety and the child internalizing factors. We highlighted the conditions in which prenatal maternal affective symptoms predicts child internalizing problems emerging early in development, including consideration of different mechanistic pathways for different maternal prenatal symptom presentations and child temperament.

Identifying relationships between craniopharyngiomas (CPs) and contiguous structures, and tumor origin are crucial for treatments. This study attempted to explore the relationships and tumor origin.CPs that underwent endoscopic surgeries were enrolled. The interfacial specimens of CPs attaching the hypothalamus, pituitary stalk (PS), pituitary grand (PG), optic chiasma (OC) and brain tissue (BT) were pathologically examined. Boundaries between CPs and these structures were observed during operations. Expression of β-catenin and stem cell markers were analyzed to explore the tumor origin. Outcomes of patients were assessed.A total of 34 CPs were categorized into two groups based on the locations of finger-like protrusions (FP). Group A comprised 18 CPs with FP only present in the specimens attaching to hypothalamus. The surface of these CPs was fused with hypothalamus under endoscopic videos. However, the specimens attaching to the PS, PG, OC, and BT showed no FP. Clear boundaries was observed between these CPs and these structures. Group B comprised 16 CPs with FP only present in the specimens attaching to PS. The tumor surface was fused with PS. Specimens attaching to the hypothalamus, PG, OC and BT showed no FP. Clear boundary was observed among these CPs with these structures. These results implied CPs only invaded a certain part of hypothalamic-pituitary axis. β-catenin and stem cells markers mainly distributed in the FP tissues of both groups. Patients in group B achieved better outcomes than group A.CPs only invade the hypothalamic-pituitary axis with FP and the FP would be the tumor origin.

Isoniazid preventive therapy (IPT) can prevent tuberculosis among people receiving antiretroviral therapy (ART). HIV programmes are now initiating patients on ART with higher average CD4 cell counts and lower tuberculosis risks under test-and-treat guidelines. We aimed to investigate how this change has affected the health impact and cost-effectiveness of IPT.We constructed a tuberculosis-HIV microsimulation model parameterised using data from a large HIV treatment programme in Dar es Salaam, Tanzania. We simulated long-term health and cost outcomes for the 211 748 individuals initiating ART between Jan 1, 2014, and Dec 31, 2020, under three scenarios: no IPT access; observed levels of IPT access (75%) and completion (71%); and full (100%) IPT access and completion. We stratified results by ART initiation year and starting CD4 cell count.Observed levels of IPT access were estimated to have averted 12 800 (95% uncertainty interval 7300 to 21 600) disability-adjusted life-years (DALYs) and saved US$23 000 (-2 268 000 to 1 388 000). Full IPT access would have averted 24 500 (15 100 to 38 300) DALYs and cost $825 000 (-1 594 000 to 4 751 000), equivalent to $23·4 per DALY averted. Lifetime health benefits of IPT were estimated to be greater for more recent ART cohorts, while lifetime costs were stable. In subgroup analyses, a higher CD4 cell count at ART initiation was associated with greater health gains from IPT (15 900 [10 300 to 22 500] DALYs averted by full IPT per 100 000 patients for CD4 count500 cells per μL at ART initiation, versus 7400 [4500 to 11 600] for CD4 count100 cells per μL) and lower incremental lifetime costs.IPT remains highly cost-effective or cost-saving for recent ART cohorts. The health impact and cost-effectiveness of IPT are estimated to improve as patients initiate ART earlier in the course of infection.US National Institutes of Health.

Objectives: The WHO recommends that children and adolescents living with HIV (CALHIV) complete TB symptom screening at every clinical encounter but evidence supporting this recommendation is limited. We evaluated the performance of the recommended TB symptom screening in six high-burden TB/HIV countries. Design: Retrospective longitudinal cohort. Methods: We extracted data from electronic medical records of CALHIV receiving care from clinics in Botswana, Eswatini, Lesotho, Malawi, Tanzania, and Uganda from January 2014 to June 2017. We defined incident TB cases as those prescribed TB treatment within 30 days of TB diagnosis. We analyzed the most recent symptom screen preceding a TB diagnosis. In accordance with WHO guidelines, positive screens were defined as current fever, cough, poor weight gain, or recent TB contact. Odds of TB disease was modeled by screen result and age at which screening was conducted. Results: Twenty thousand seven hundred and six patients collectively had 316 740 clinic visits, of which 240 161 (75.8%) had documented TB symptom screens. There were 35 701 (14.9%) positive TB symptom screens, and 1212 incident TB diagnoses. Sensitivity and specificity of the TB symptom screen to diagnose TB were 61.2% (95% CI 58.4--64.0) and 88.8% (95% CI 88.7--88.9), respectively. Log odds of documented TB for positive or negative screens was statistically different only for screens conducted at ages 7--17. Conclusion: Although specificity was high, the sensitivity of the TB symptom screen to detect TB in CALHIV was low. More accurate screening approaches are needed to optimally identify TB disease in CALHIV.

Advanced techniques for analysis of XRD patterns and optical absorption spectra were employed to derive in-depth physical insights into the structure and properties of quantum nanocrystals of the c...

This study reports mineralogical and physical property changes linked to geo-chemical alterations processes during three ultra-long-term tri-axial tests on outcrop-chalk from Liege (Belgium). The test core plugs were flooded with MgCl2-brines for approximately one and a half, two and three years, mimicking effective reservoir stresses (9.5–12.5 MPa) and temperature (130 °C) of important hydrocarbon deposits at the Norwegian Continental Shelf. The flooded cores were studied using electron microscopy, whole-rock and stable isotope geochemical analyses, and ion chromatography of the effluent water. All tests show altered textures and mineralogy at the flow-inlet side of the approximately 7 cm long cores. With longer duration of flooding, these alterations moved further into the cores, and for the three-year-test, the entire core was altered. When studied at nano-scale, the newly formed crystals were found to be magnesite containing minor calcium impurities, together with clay-minerals. On the outlet side of the alteration-fronts in the two shorter tests, the mineralogy still mainly consists of calcite and primary clay-minerals, together with newly formed magnesite and secondary clay-minerals. Dolomite or low- and high-Mg-calcite are not observed. The textures of larger micro-fossils are often preserved, but the mineralogy of their shells is altered. A sharp, only 4 mm narrow transition zone at the border of the alteration front towards the less altered area for the two shorter tests, shows the highest porosity in the cores. This pattern resembles what is observed in single-crystal experiments, where the alterations are driven by phase dissolution and subsequent precipitation, the progression of high porosity zones and the state of equilibrium at the boundary between the primary and new mineral phase. This is also in line with observations in nature and models for transport driven mineral replacement in porous media, where differences in dissolution and precipitation rates may cause high porosity transitions zones. During the experiments, all cores underwent severe overall compaction between 10.1% and 18.2%. However, in the two- and three-year long test-cores, the permeability, and calculated porosity, started to increase after a primary phase of reduction. As magnesite precipitates at the expense of calcite, the density increase, but the solid volume decrease. As the bulk volume is constant, porosity and permeability are increased. The changes in ion-concentration of effluents, monitored throughout the experiments, balance the changes in mineralogy, compaction and permeability within the cores. Compositional variations of the injection fluid effectively control the amount of chemical reaction in chalk. This allows for control and predicting changes in geo-mechanical parameters induced by mineralogical replacement, which has significant impact on reservoir conditions.

Lablab is a legume with multiple uses as food, feed, and organic fertilizer. However, it is underutilized, and its empirical contribution to farmers' livelihoods is limited. This study examined the Lablab value chain (LVC) relative to smallholder farmers' livelihood assets in Tanzania. Data on Lablab farming, its value chain, and its contribution to the farmers' livelihood assets were collected from four districts of Tanzania known for Lablab production. The results showed that the LVC mapping comprised systems, actors, and interdependent activities, the key systems being input supply, tillage, intercropping, and marketing. Seed supply was through the recycling of the last harvest (48.8%), while intercropping (56.5%) and hand-hoeing (51.6%) were the primary cultivation systems, with farm gates and/or local markets serving as the marketing locations. The grown seeds were mainly black (62.3%) due to external marketability but were rarely eaten. Although farmers were the major chain actors, traders were highly active in the marketing segment, leaving farmers out of the bargain art protocol. Generally, Lablab production generated almost 90% of the farmers' revenue by multiple linear regression. Based on farmers' five asset categories, natural and human assets contributed 70% and 50% respectively, while there was less contribution from social, financial, and physical assets. The study recommends networking exposure to reliable marketplaces with good prices, improved seed availability, and financial services for Lablab farmers in Tanzania. To sustain the smallholder farmers' five livelihood assets from Lablab, researchers and policymakers must pay attention to the three linkages of the LVC.

Objectives Many axial spondylarthritis (axSpA) patients receive a conventional synthetic DMARD (csDMARD) in combination with a TNF inhibitor (TNFi). However, the value of this co-therapy remains unclear. The objectives were to describe the characteristics of axSpA patients initiating a first TNFi as monotherapy compared with co-therapy with csDMARD, to compare one-year TNFi retention and remission rates, and to explore the impact of peripheral arthritis. Methods Data was collected from 13 European registries. One-year outcomes included TNFi retention and hazard ratios (HR) for discontinuation with 95% CIs. Logistic regression was performed with adjusted odds ratios (OR) of achieving remission (Ankylosing Spondylitis Disease Activity Score (ASDAS)-CRP Results Amongst 24 171 axSpA patients, 32% received csDMARD co-therapy (range across countries: 13.5% to 71.2%). The co-therapy group had more baseline peripheral arthritis and higher CRP than the monotherapy group. One-year TNFi-retention rates (95% CI): 79% (78, 79%) for TNFi monotherapy vs 82% (81, 83%) with co-therapy (P Conclusion This large European study of axial SpA patients showed similar one-year treatment outcomes for TNFi monotherapy and csDMARD co-therapy, although considerable heterogeneity across countries limited the identification of certain subgroups (e.g. peripheral arthritis) that may benefit from co-therapy.

Utforsking og utnyttelse er ifølge flere forskere motstridende prosesser. Det er utfordrende for bedrifter å kombinere, balansere og beherske disse kravene. Ambideksteritet kan være en løsning på denne utfordringen, med hensyn til høyere sannsynlighet for overlevelse og bedre markedsposisjon. Oppgaven omhandler mindre sparebanker i bankbransjen, som står ovenfor utfordringer ved innovasjon, endret kundeatferd og skiftende omgivelser. Forskerspørsmålet i oppgaven er: «Hvordan går sparebanker frem for å bli ambidekstrøse?». Oppgaven baserer seg på en enkeltcasestudie av Skagerrak sparebank, som er endel av Eika gruppen. Mindre sparebanker er gjerne ikke ressurssterke nok til å overleve uten en allianse. Eika gruppen leverer tjenester til 53 sparebanker som er deleiere av konsernet. Bankbransjen kjennetegnes for stabile omgivelser, med et strengt regel- og lovverk. Sett bort i fra kravene fra myndighetene er det raske endringer. Digitaliseringen og teknologien det siste tiåret har gått fremover i rekordfart. Dette har vært grobunnen for en tydeligere segmentering og at konkurrensen er skarp. Kundeatferden har endret seg og kravene deres er høye. Ett av oppgavens sentrale funn er at det oppstår ulike tilnærminger. Det kommer frem at Eika gruppen og Skagerrak sparebank er atskilt, og har et leverandørforhold. Flere partnere inngår i et nettverk for å utvikle teknologien, og lokalbanken er der i større grad for å gi rådgivning til kundene. Omgivelsene og myndighetskravene vanskeliggjør utviklingen av ambideksteritet, med hensyn til at disse moderatorene i liten grad kan påvirkes. Oppgaven konkluderer med at det eksisterer flere mekanismer i organisasjonen. Det er likevel en dominerende, hvilket er den strukturelle mekanismen. Skagerrak sparebank utnytter i større grad eksisterende kunnskap og arbeider med kjernevirksomheten. Utforsking av kunnskap skjer gjennom Eika gruppen, og gode løsninger kommer frem i fellesskap.

Context: The purpose of this study was to determine whether the expression of sensory neuropeptides, NK1, 5-HT1A receptors, as well as mast cells in the skin of patients with hereditary neuropathy and sensory and autonomic deficits (HSAN type 5) was elevated. Such increase might reflect an attempt to compensate for nerve loss.

ObjectiveTo investigate the distribution of patient-reported outcomes (PROs) in patients with axial spondyloarthritis (axSpA) initiating a tumor necrosis factor inhibitor (TNFi), to assess the proportion reaching PRO "remission" across registries and treatment series, and to compare patients registered to fulfill the modified New York (mNY) criteria for ankylosing spondylitis (AS) vs patients with nonradiographic axSpA (nr-axSpA).MethodsFifteen European registries contributed PRO scores for pain, fatigue, patient global assessment (PtGA), Bath Ankylosing Spondylitis (AS) Disease Activity Index (BASDAI), Bath AS Functional Index (BASFI), and Health Assessment Questionnaire (HAQ) from 19,498 patients with axSpA. Changes in PROs and PRO remission rates (definitions: ≤ 20 mm for pain, fatigue, PtGA, BASDAI, and BASFI; ≤ 0.5 for HAQ) were calculated at 6, 12, and 24 months of treatment.ResultsHeterogeneity in baseline characteristics and outcomes between registries were observed. In pooled data, 6 months after the start of a first TNFi, pain score was reduced by approximately 60% (median at baseline/ 6/12/24 months: 65/25/20/20 mm) in patients on treatment. Similar patterns were observed for fatigue (68/32/30/25 mm), PtGA (66/29/21/20 mm), BASDAI (58/26/21/19 mm), BASFI (46/20/16/16 mm), and HAQ (0.8/0.4/0.2/0.2). Patients with AS (n = 3281) had a slightly better response than patients with nr-axSpA (n = 993). The Lund Efficacy Index (LUNDEX)-adjusted remission rates at 6 months for pain/fatigue/PtGA/BASDAI/BASFI/HAQ were 39%/30%/38%/34%/35%/48% for the AS cohort and 30%/21%/26%/24%/33%/47% for the nr-axSpA cohort. Better PRO responses were seen with a first TNFi compared to a second and third TNFi.ConclusionPatients with axSpA starting a TNFi achieved high PRO remission rates, most pronounced in those fulfilling the mNY criteria and for the first TNFi.

In recent years, a significant research attention has been given for the protection of the environment with an increase in environmental pollution and a continuous increase in global warming. Due to these issues, renewable energy sources such as solar and wind energy and the latest technologies such as electric vehicles have received an increased research attention. The transport sector accounts for 18% of total energy consumption in India. In the last few years, the Indian Segment of Electric Vehicles has been increased. However, the growth rate has been slow; the support for policy was not enough to fully realize the potential of the electricity market. When compared to internal combustion engine (ICE) vehicles, sales of EVs are still low. Electric vehicles have benefits such as environmental friendly, as they have the advantageous characteristics such as non-polluting, reducing dependency on conventional fuel, and low running cost. High price, charging infrastructure, and limited range are some of the major issues involved with electric vehicles. When renewable energy sources are not available, the development of new technologies in the EV sector creates an additional power source. Industry leaders believe that electric vehicles will be the best option for the Indian public to develop a sustainable future.