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Background and aims: This study aimed to investigate healthcare professionals (HCPs) preparedness to continue using telehealth beyond the COVID-19 pandemic, to examine the perceived ability of HCPs to appraise the reliability of online information sources (digital literacy) and, to examine whether a relationship exists between this and preparedness to continue using telehealth. Methods: Single-site cross-sectional survey of HCPs in an outpatient and community therapy setting. The survey was based on a rapid literature review guided by the Theory of Planned Behaviour and Technology Acceptance Model. Descriptive statistics were used to summarise participant demographics, preparedness for telehealth, and digital literacy (based on confidence in appraising online information). Multivariable logistic regression assessed the associations between preparedness to continue using telehealth, the ability to evaluate online information sources, and demographic variables. Results: A total of 783 HCPs were invited, 310 responded, with 287 participants included in the final analysis (37% response rate excluding incomplete surveys). The analysis shows that 54.8% of participants preferred to return to in-person care. Preparedness to continue telehealth varied by profession and clinical activity, with medical professionals and script provision showing the highest readiness for continued telehealth use and allied health professionals the least likely to continue using telehealth (36%). Most (89%) of HCPs felt confident identifying reliable online information sources and there was no relationship between perceived ability to evaluate online information and preparedness to use telehealth. Conclusion: Results suggest hesitancy amongst allied staff toward continued telehealth use post the pandemic, which may be due to the type of care they provide. Future studies on technologies that support HCPs in providing more intensive virtual care would be of benefit.

Childhood physical activity sets the foundation for health. While we know many factors that contribute to physical activity, there are limitations in our knowledge, especially in early childhood. Through our review, we identify gaps in existing datasets to guide future research.

Abstract Aim To explore the effectiveness and acceptability of a pilot mentoring program for alcohol and other drug (AOD) nurse practitioners (also known globally as addiction nurse practitioners). Design Mixed method evaluation. Methods Two‐phase evaluation comprising survey (demographics, pre‐ and post‐program perceived competency and confidence) with 15 participants completing the pre survey and 10 participants completing the post survey, and qualitative interviews after the program with 10 participants. Results The quantitative results indicate statistically significant increases in some domains of perceived competence and confidence in treatment. Qualitative findings indicate that participants valued peer support and mentoring from experienced nurse practitioners. Where formal residency or internship programs for nurse practitioners do not exist, informal mentoring programs may address issues inherent in nurse practitioner transition that may impact retention. We recommend further exploration of mentoring programs with larger sample sizes to determine if self‐reported clinical improvements are noted. Implications for Profession and/or Patient Care Nurse practitioners are a vital part of the healthcare system; their advanced skills and knowledge place them in an ideal position to address prescriber shortages and access to care for populations underserved by healthcare. However, literature indicates that they are often underutilised, and transition to autonomous practice remains a challenge. Our exploration of a pilot mentoring program for nurse practitioners shows that their knowledge and perceived skills are high, yet peer assistance is valued in transitioning from advanced practice registered nurse to autonomous nurse practitioner. We recommend further trialling and evaluation of nurse practitioner mentoring programs to both increase supply of nurse practitioners and provide greater access to quality healthcare for underserved populations. Impact What problem did the study address? The ability of nurse practitioners to offer advanced practice interventions such as diagnosis and medication management potentially provides a solution to healthcare resource shortages. However, current literature indicates that advanced nurses transitioning to nurse practitioner roles suffer transition shock, leading to burnout and poor retention. What were the main findings? Although this pilot mentoring program shows significant improvements in survey responses on confidence and capability, qualitative data shows that neophyte nurse practitioners value peer support and mentoring from more experienced practitioners. Participants described maintaining ongoing connections with both mentors and fellow mentees, which aided transition to the role of autonomous nurse practitioner. Where and on whom will the research have an impact? The results of this pilot mentoring program indicate that there is benefit to these programs for neophyte nurse practitioners in many specialties. This paper indicates that mentoring programs for nurse practitioners may provide a community of practice and may have a positive impact on transition shock. Reporting Method Good Reporting of a Mixed Methods Study (GRAMMS) checklist. Patient or Public Contribution No patient or public contribution.

Background. This study investigated the association between periodontitis and organic erectile dysfunction (ED) in a sub-Saharan population. Methods. This multicenter analytical study lasted from April to September 2021. A total of 114 patients (38 cases and 76 controls) were recruited and matched on age, diabetes, and smoking status. Medical history and ED were recorded, as well as the plaque index, bleeding index, maximum interdental clinical attachment loss (CALmax), maximum probing depth, clinically detectable furcation involv ement, number of teeth in the mouth, number of teeth lost for periodontal reasons, and tooth mobility. The analysis was performed with SPSS 20.0 with a significance threshold set at 5%. Results. The two study groups were comparable regarding sociodemographic characteristics. Periodontitis was present in 76.31% of cases and 75% of controls without a significant difference (P=0.878). Logistic regression showed a significant association between high blood pressure and ED with an OR=4.78 (95% CI: 1.80‒12.70). Periodontitis was not associated with ED (OR=1.52, 95% CI: 0.55‒4.16); however, severe periodontitis was significantly associated with severe ED (OR=1.44, 95% CI: 1.11‒1.85, and OR=1.68, 95% CI: 1.15‒2.44, respectively for CALmax and tooth loss). Conclusion. Within the limits of this study, periodontitis was not associated with organic ED. However, the severity of periodontal disease significantly increased in patients with organic ED.

With a vibrant economic development, Greater Kampala Metropolitan Area (GKMA) would need to boast low-carbon electricity generation, reduce carbon emissions, and re-structure transportation, yet having no energy management plan. The main objective of this study is to develop a comprehensive framework for analyzing energy impacts and macroeconomic effects of low-carbon scenarios and to identify a sustainable pathway towards 2050 for GKMA. The study uses TIMES/CGE hybrid framework to address the knowledge gap in 4 scenarios. Business as usual is the reference case with Kabejja (20% CO2 abatement), Carbon-Tax (100$/ton), and Lutta (95% CO2 abatement) as alternative scenarios. The analysis shows an increase in consumption from 139.6PJ to 469.35PJ and carbon emissions from 4.6mtns to 7mtns in the reference case. However, consumption and carbon emissions decrease in all the alternative scenarios compared to the reference case. The GDP and equivalent variation (EV) in household welfare increase in all alternative scenarios compared to the reference case. Lutta promises a 60.6% reduction in the carbon emissions intensity of GDP to be realistic. Sustainability is achievable when low-carbon electricity becomes the major contributor to the demand by fuel type, optimization of the total primary energy supply, and construction of an electrified Kampala metro. Transportation, Industrial and Residential sectors are the greatest emitters of CO2 by sector in all scenarios and thus need policy interventions to realize deep CO2 emissions reductions. The study recommends that Lutta guarantee a sustainable low-carbon footprint for GKMA.

This research addresses the inefficiencies of manual garbage data management by developing a dual-platform system: a website-based application for Garongan Asri Garbage Bank staff and a mobile application for customers. Utilizing the waterfall method for systematic development, the project involved stages of analysis, design, coding, testing, support, and maintenance. Key technologies used include the Bootstrap framework, Visual Studio Code, Android Studio, and MySQL database. The resulting website application enables staff to efficiently manage garbage data, while the mobile app allows customers to access their disposal history. The effectiveness of these applications was confirmed through black box testing, demonstrating their functionality and suitability for improving garbage data management and customer service.

Background: Age-related macular degeneration (AMD) is a complex eye disorder with an environmental and genetic origin, affecting millions worldwide. The study aims to explore the association between retinal morphology and the polygenic risk score (PRS) for AMD using fundus images and deep learning techniques. Methods: The study used and pre-processed 23,654 fundus images from 332 subjects (235 patients with AMD and 97 controls), ultimately selecting 558 high-quality images for analysis. The fine-tuned DenseNet121 deep learning model was employed to estimate PRS from single fundus images. After training, deep features were extracted, fused, and used in machine learning regression models to estimate PRS for each subject. The Grad-CAM technique was applied to examine the relationship between areas of increased model activity and the retina’s morphological features specific to AMD. Results: Using the hybrid approach improved the results obtained by DenseNet121 in 5-fold cross-validation. The final evaluation metrics for all predictions from the best model from each fold are MAE = 0.74, MSE = 0.85, RMSE = 0.92, R2 = 0.18, MAPE = 2.41. Grad-CAM heatmap evaluation showed that the model decisions rely on lesion area, focusing mostly on the presence of drusen. The proposed approach was also shown to be sensitive to artifacts present in the image. Conclusions: The findings indicate an association between fundus images and AMD PRS, suggesting that deep learning models may effectively estimate genetic risk for AMD from retinal images, potentially aiding in early detection and personalized treatment strategies.

A precursor feeding strategy was used for the first time in agitated microshoot cultures of Aronia × prunifolia. This strategy involved the addition of biogenetic precursors of simple phenolic acids (phenylalanine, cinnamic acid, and benzoic acid) and depsides (caffeic acid) into the culture media, with an assessment of its effect on the production of these bioactive compounds. The in vitro cultures were maintained in Murashige–Skoog medium (1 mg/L BAP and 1 mg/L NAA). Precursors at five concentrations (0.1, 0.5, 1.0, 5.0, and 10.0 mmol/L) were fed into the medium at the time of culture initiation (point “0”) and independently on the 10th day of growth cycles. The contents of 23 compounds were determined in methanolic extracts of biomass collected after 20 days of growth cycles using an HPLC method. All extracts contained the same four depsides (chlorogenic, neochlorogenic, rosmarinic, and cryptochlorogenic acids) and the same four simple phenolic acids (protocatechuic, vanillic, caffeic, and syringic acids). Chlorogenic and neochlorogenic acids were the predominant compounds in all extracts (max. 388.39 and 263.54 mg/100 g d.w.). The maximal total contents of all compounds were confirmed after feeding with cinnamic acid (5 mmol/L, point “0”) and caffeic acid (10 mmol/L, point “0”), which caused a 2.68-fold and 2.49-fold increase in the contents of the estimated compounds vs. control cultures (603.03 and 558.48 mg/100 g d.w., respectively). The obtained results documented the efficacy of the precursor feeding strategy in enhancing the production of bioactive compounds in agitated cultures of A. × prunifolia and suggest a potential practical application value.

Large scale changes in biodiversity and conservation management require long-term goals and planning across multiple sectors in the face of increasing global change. Major trends in land use and management interventions, species additions or losses, and climate are well recognized, but responses are still often short-term and fragmented across agencies and sectors. Scenario-building can be a powerful tool to imagine possible futures, integrating across sectors and disciplines and promoting long-term thinking and planning. As an interdisciplinary team of experts, we developed potential scenarios for a range of future environmental conditions. The scenarios explored: increasing land ownership and stewardship of land by indigenous peoples (Māori); widespread afforestation using native tree species; national-scale eradication of invasive mammalian predators; and increasing frequency of extreme weather events. We explored the implications of these globally-relevant trends at a national scale using Aotearoa New Zealand as our study system. Detailed descriptions of these scenarios were developed by experts using environmental, economic, social science and policy lenses. Across scenarios several common themes were consistently highlighted, including the importance of land use in driving other conservation outcomes. How the value of ecosystem services is recognized and prioritized was also important to a wide range of outcomes. Furthermore, each scenario presented both opportunities and risks to equality, indigenous empowerment and human capital, emphasizing the importance of good policy responses to maximize benefits and minimize unintended harm. These scenarios will be used to stimulate new questions and ideas for biodiversity conservation and management, such as considering the implications of different potential futures for the management of biological invasions. This approach is explicitly designed to be generalisable across different sites or regions and provides a method for considering the implications of potential future changes for a broad range of disciplines or needs.

Background: Age-related macular degeneration (AMD) is a multifactorial disease encompassing a complex interaction between aging, environmental risk factors, and genetic susceptibility. The study aimed to determine whether there is a relationship between the polygenic risk score (PRS) in patients with AMD and the characteristics of the retinal vascular network visualized by optical coherence tomography angiography (OCTA). Methods: 235 patients with AMD and 97 healthy controls were included. We used data from a previous AMD PRS study with the same group. The vascular features from different retina layers were compared between the control group and the patients with AMD. The association between features and PRS was then analyzed using univariate and multivariate approaches. Results: Significant differences between the control group and AMD patients were found in the vessel diameter distribution (variance: p = 0.0193, skewness: p = 0.0457) and fractal dimension distribution (mean: p = 0.0024, variance: p = 0.0123). Both univariate and multivariate analyses showed no direct and significant association between the characteristics of the vascular network and AMD PRS. Conclusions: The vascular features of the retina do not constitute a biomarker of the risk of AMD. We have not identified a genotype–phenotype relationship, and the expression of AMD-related genes is perhaps not associated with the characteristics of the retinal vascular network.

Plant hypocotyl elongation response to light and temperature. Here the authors show that shade combined with warm temperature synergistically enhances the hypocotyl growth response via the PIF7 transcription factor, auxin, and as yet unknown factor.

Abstract PCR-based diagnostics generally require nucleic acid extraction from patient specimens prior to amplification. As highlighted early in the COVID-19 pandemic, extraction steps may be difficult to scale during times of massive demand and limited reagent supply. Forgoing an extraction step, we previously reported that the N1 primer/probe-set of the widespread CDC COVID-19 assay maintains high categorical sensitivity (95%) and specificity (100%) with direct inoculation of viral transport media (VTM) into qRT-PCR reactions. In contrast, the N2 set demonstrated a prominent Ct delay and low sensitivity (33%) without extraction. In the current study, we have improved the performance of this modified CDC assay (in particular the N2 set) by incorporating N1/N2/RNase P multiplexing and dissecting the effects of annealing temperature, VTM interference, and inoculum volume. The latter two factors exerted a more prominent effect on the performance of N2 than N1, although these effects were largely overcome through elevated annealing temperature. This unextracted/multiplex protocol was evaluated with 41 SARS-CoV-2 positive and 43 negative clinical samples, demonstrating a categorical sensitivity of 92.7% and specificity of 100% versus the unmodified CDC methodology. Overall, this work offers a generalizable strategy to maximize testing capabilities for COVID-19 or other emerging pathogens when resources are constrained.

This paper builds upon qualitative research in El Museo del Bucardo – The Bucardo Museum – an exhibition space in the village of Torla, high in the Spanish Pyrenees. The bucardo was declared extinct on 6 January 2000 and rose to international fame three years later when scientists in Zaragoza delivered a bucardo clone; this event is commonly portrayed around the world as ‘the first de-extinction’. Taxidermic remains of the last bucardo were absent from public view for years, yet they finally returned to Torla in 2013 following years of campaigning from local activists, and El Museo del Bucardo was founded. I draw upon interviews and archival material to present an environmental history of the bucardo as told through the lens of the museum, one which sets out to ‘recover memory’ and institutionalize the bucardo’s legacy. In the museum, bucardo afterlives continue to shape understandings of situated Pyrenean wildlife. I examine El Museo del Bucardo’s role in generating meaning in an epoch characterized by mass extinction and the spectacle of technofixes in the form of de-extinction science.

We introduce and discuss the concept of n-ary K-increasing fusion functions and n-ary K-increasing aggregation functions, K being a subset of the index set {1,…,n} indicating in which variables a considered function is increasing. It is also assumed that this function is decreasing in all other variables. We show that each n-ary K-increasing aggregation function is generated by some aggregation function which enables us to introduce and study the properties of n-ary K-increasing aggregation functions related to the properties of their generating aggregation functions. In particular, we also discuss binary K-increasing aggregation functions, including fuzzy implication and complication functions, among others.

Bony stabilization procedures are a reliable solution for recurrent shoulder instability, but have a steep learning curve due to technical difficulties. Meticulous capsular closure is critical and can be augmented with suture anchor constructs. In addition, although fracture or fragmentation of the coracoid graft is relatively uncommon, it is devastating. Here, we describe the use of additional circumferential suture fixation to improve compression across the graft/glenoid interface and help mitigate the risk of fracture bony augmentation procedures

The rapid development associated with Next Generation Tobacco Products (NGTP) has necessitated the development of high throughput methodologies to test their genotoxic potential in vitro when compared to conventional cigarette smoke (CS). An assessment of two Vitrocell® Mammalian 6/48 exposure modules in three independent experiments was made by comparing results from multiple dosimetric techniques applied to aerosol generated from 3R4F Kentucky Reference cigarettes, commercially available electronically heated tobacco product (eHTP) and Electronic Nicotine Delivery System (ENDS) using the Vitrocell® VC10®. Real-time aerosol particle concentration was assessed by means of light scattering photometers and expressed as area under the curve (∑AUC). Nicotine concentrations were determined analytically by LC/MS. Humectant amount and distribution was assessed for eHTP and ENDS by the quantification of free glycerol in a phosphate buffered saline (PBS) trap, whereas total particulate matter (TPM) was assessed in the 3R4F cigarettes by the fluorescence of the particulate at 485 nm in anhydrous dimethyl sulfoxide (DMSO) trap within the exposure. Dose was adjusted by means of the addition of ambient air to dilute the whole smoke/aerosol in L/min and sampled into the system at a rate of 5 mL/min. Dilution of CS ranged from 8.0 to 0.5 L/min and for the eHTP and ENDS ranged from 4 to 0 L/min (undiluted). Dosimetric analysis of the system showed good concordance within replicates (p-values ranged from p = 0.3762 to p = 0.8926) and showed that the Vitrocell® Mammalian 6/48 is a viable means for genotoxic assessment of aerosol generated from both conventional cigarettes and NGTP. Results demonstrate the need to tailor dosimetry approaches to different aerosols due to variations in the physio-chemical composition, with a multi-dosimetry approach recommended.

With steadfast economic development, the Greater Kampala Metropolitan Area (GKMA) faces increasing pressures to raise low-carbon electricity in the energy consumption by fuel type, abate CO2 emissions, and also restructure transportation for sustainability. GKMA is Uganda’s capital with rampant anthropogenic interference that causes climate change. A sustainable energy portfolio is a low-carbon scenario endowed with CO2 emissions abatement strategies for GKMA towards 2050. Using TIMES-VEDA to address the knowledge gap, the study develops and examines a sustainable energy portfolio for GKMA. TIMES-VEDA is an engineering model generator with a bottom-up approach, paying in-depth attention to low-carbon themes while optimizing energy management systems. The analysis shows that sustainability is plausible by optimizing the total primary energy supply, electrical power production from PV-solar & hydropower technologies, and switching 90% of passengers of the road category to the Kampala metro.

A common forgery technique is to use molds to create a suite of objects. This article introduces a new technique to identify objects made with the same mold through the comparison of 3D models created using structured light scanning (SLS). SLS data, when analyzed with CloudCompare or other point cloud processing software, provides quantitative data on the variation between models that can be visualized in scalar fields. Inexpensive, adaptable, and non-destructive, the technique produces a digital signature for a mold that can be used to identify matching examples within a collection and be circulated between institutions. We demonstrate this technique on three forgeries of Zapotec urns from Oaxaca, Mexico, in the collection of the Royal Ontario Museum that were created in the early twentieth century AD.

Greater Kampala Metropolitan Area (GKMA) is Uganda's capital facing increasing pressures to raise electricity generation and also mitigate CO2 emissions. A low-carbon electrification of the GKMA energy policy is proposed for sustainability. But the macroeconomic effects of this policy are unknown. The study uses a multi-sector, single region, static GKMA-CGE model to address the knowledge gap in 4 scenarios. BAU is the baseline against which comparisons with Kabejja (20% CO2 abatement); Carbon-Tax ($100/ton) and Lutta scenarios (95% CO2 abatement) are made. The results indicate GDP increased by Kabejja:0.7%; Carbon-Tax:1.3%; Lutta:1.56% with respect to BAU. Equivalent variation also increased compared to BAU. Energy & CO2 intensities of GDP decreased in all scenarios. The study recommends Lutta for a sustainable 2050.

Purpose: Current developments due to ongoing socioeconomic transformations have increasingly boosted the digitalisation process and thus, have shifted the work domain closer to the internet. This includes the education sector, which results in the rising demand for suitable online learning opportunities. In the university context, students are frequently challenged with test performances based on collaborative work in joint research projects. The paradigm shift also affects the tutor turning him into an e-tutor. In the scope of e-tutoring, tracking and assessment of group-specific or individual-based work performance can be guaranteed by a suitable social analytics solution. Study design/methodology/approach: In this work, the design and implementation of a learning analytics dashboard tool for Online Collaborative Whiteboards, especially Miro, is presented. Findings: The requirements were derived from focus group interviews with key users. Originality/value: The tool features real-time tracking and quantitative evaluation of group and individual user actions.

Abstract Background By 2021, 10 cases of fibrosis, neurodegeneration, and cerebral angiomatosis (FINCA, MIM #618278) syndrome have been reported, and five causative variants in the NHLRC2 gene (*618277) have been identified. First reported patients presented with recurrent respiratory distress, leading to death before the age of 3. In the recent publication by Rapp, Van Dijck, and Laugwitz et al., six more patients were described. The authors underlined the possibility of survival beyond infancy and neurodevelopmental delay occurrence. Methods Our goal is to characterize further neurobehavioral phenotype of patients with the NHLRC2 gene variants. Therefore, we describe three previously unreported patients with FINCA's clinical features who survived into late childhood and reviewed the neurobehavioral phenotype of all known cases. Results We identify the so far unfamiliar neurological features of FINCA syndrome and a novel variant in the NHLRC2: c.977G>T, p.(G326V) detected in one of the patients.

Computational methods play a significant role in reducing energy consumption in cities. Many different sensor networks (e.g., traffic intensity sensors, intelligent cameras, air quality monitoring systems) generate data that can be useful for both efficient management (including planning) and reducing energy usage. Street lighting is one of the most significant contributors to urban power consumption. This paper presents a summary of recent attempts to use computational methods to reduce energy usage by lighting systems, with special focus on graph-based methods. Such algorithms require all the necessary data to be integrated, in order to function properly: this task is not trivial, and is very time-consuming; therefore, the second part of the paper proposes a novel approach to integrating urban datasets and automating the optimisation process. In two practical examples, we show how spatially triggered graph transformations (STGT) can be used to build a model based on the road network map, sensor locations and street lighting data, and to introduce semantic relations between the objects, including utilisation of existing infrastructure, and planning of development to maximise efficiency.

Intrusion Detection System (IDS) is one of the technology to ensure the security of computers. IDS is an early detection system in the event of a computer network attack. The IDS will alert the computer network administrator in the event of a computer network attack. IDS also records all attempts and activities aimed at disrupting computer networks and other computer network attacks. The purpose of this study is to implement IDS on network systems and analyze IDS logs to determine the different types of computer network attacks. Logs on the IDS will be analyzed and will be used as leverage to improve computer network security. The research was carried out using the Network Forensic Investigation Framework proposed by Pilli, Joshi, and Niyogi. The stages of the Network Forensic Investigation Framework are used to perform network simulations, analysis, and investigations to determine the types of computer network attacks. The results show that the Network Forensic Investigation Framework facilitates the investigation process when a network attack occurs. The Network Forensic Investigation Framework is effectively used when the computer network has network security support applications such as IDS or others. IDS is effective in detecting network scanning activities and DOS attacks. IDS gives alerts to administrators because there are activities that violate the rules on the IDS.

The main goal of roadway lighting design is ensuring compliance with mandatory lighting standards and thus increasing safety for all road users. On the other hand, a design process being only a part of a road investment has to be completed in possibly a short time, due to business needs. The commonly used method for reconciling both requirements is using predefined lighting projects (templates) which are matched with similar, real-life lighting situations. This approach works well for a typical roadway lighting design but not necessarily for crosswalk illumination due to different specifics of underlying calculations (they focus on the contrast of a pedestrian against its background rather than roadway illumination). As one deals with pedestrian safety here, we decided to perform extensive tests to find out whether a standard compliant lighting project prepared for a given crosswalk can be safely applied (in terms of preserving standard compliance) to another similar crosswalk. To accomplish that, we investigated nearly 900 million situations obtained as modifications of the reference template. Results proved that even a 5% change of layout sizes (crosswalk width, lamp spacing, pole height etc.) makes 40% of obtained projects violate illumination requirements. The conclusion of this result is that the template-based design approach broadly used for roadway lighting cannot be applied for pedestrian crossings as it may cause serious safety issues.

Four different types of convolutions of aggregation functions (the upper, the lower, the super-, and the sub-convolution) are examined in the setting of both sub- and super-decomposition integrals defined on a finite space. Examples of the results of the paper are provided. As a by-product, the super-additive transformation of sub-decomposition integrals and the sub-additive transformation of super-decomposition integrals are fully characterized. Possible applications are indicated.

Aim: Characterize the logistical challenges faced by healthcare professionals (HCPs), patients and caregivers during the chimeric antigen receptor T-cell (CAR T) treatment process for non-Hodgkin lymphoma patients. Materials & methods: HCPs in the US and UK experienced with CAR T administration participated in interviews and completed a web-based survey. Results: A total of 133 (80 US, 53 UK) HCPs participated. Two or more logistical challenges were identified by ≥60% of respondents across all stages of the CAR T process. Commonly reported challenges were lengthy waiting periods, administrative and payer-related barriers, limited healthcare capacity, caregiver support and (particularly in the US) patient out-of-pocket costs. Conclusion: The CAR T treatment process presents numerous challenges, highlighting an unmet need for more convenient therapies.

Background: Mental disorders are the leading cause of disability for youth worldwide. However, there is a dearth of validated, brief instruments to assess mental health in low- and middle-income countries (LMIC). We aimed to facilitate identification of mental disorders in LMIC contexts by adapting and validating measures of internalizing and externalizing disorders for adolescents in Mozambique, an LMIC in southeastern Africa., Methods: We selected instruments with good support for validity in high-income and other LMIC settings: the Patient Health Questionnaire Adolescent (PHQ-A), Generalized Anxiety Disorders 7 (GAD-7), and Strengths and Difficulties Questionnaire (SDQ). Instruments were adapted by local and international mental health specialists followed by cognitive interviews (n = 48) with Mozambican adolescents. We administered the instruments along with the Miniature International Neuropsychiatric Interview for Children and Adolescents (MINI-KID)to 485 adolescents aged 12-19 years attending two secondary schools in Maputo City, Mozambique. One week later, we re-administered instruments to a randomly selected sample of 49 adolescents., Results: Participants were 66.2% (n = 321) female and the average age was 15.9 (S.D = 1.7).Internal consistency (alpha = 0.80, PHQ-A; 0.84, GAD-7; 0.80, SDQ) and test-retest reliabilty (ICC = 0.74, PHQ-A; 0.70, GAD-7; 0.77, SDQ) were acceptabe for the PHQ-A, GAD-7, and the full SDQ. The SDQ internalizing subscale showed poor test-retest reliability (ICC = 0.63) and the SDQ externalizing subscale showed poor internal consistency (alpha = 0.65). All instruments demonstrated good sensitivity and specificity (> 0.70). Youden's index identified optimal cutoff scores of 8 for the PHQ-A, 5 for the GAD-7, 10 for the SDQ internalizing and 9 for the SDQ externalizing subscales, though a range of scores provided acceptable sensitivity and specificity., Conclusions: Our data supports reliability and validity of the PHQ-A, GAD-7, and SDQ instruments for rapidly assessing mental health problems in Mozambican adolescents. Use of these tools in other contexts with limited specialists may asist with expanding mental health assessment. Specific instrument and cutoff selection should be based on screening goals, treatment resources, and program objectives., (© 2022. The Author(s).)