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Radiolabeled peptides play a key role in nuclear medicine to selectively deliver radionuclides to malignancies for diagnosis (imaging) and therapy. Yet, their efficiency is often compromised by low metabolic stability. The use of 1,4‐disubstituted 1,2,3‐triazoles (1,4‐Tzs) as stable amide bond bioisosteres can increase the half‐life of peptides in vivo while maintaining their biological properties. Previously, the amide‐to‐triazole substitution strategy was used for the stabilization of the pansomatostatin radioligand [111In]In‐AT2S, resulting in the mono‐triazolo‐peptidomimetic [111In]In‐XG1, a radiotracer with moderately enhanced stability in vivo and retained ability to bind multiple somatostatin receptor (SSTR) subtypes. However, inclusion of additional 1,4‐Tz led to a loss of affinity towards SST2R, the receptor overexpressed by most SSTR‐positive cancers. To enhance further the stability of [111In]In‐XG1, alternative modifications at the enzymatically labile position Thr10‐Phe11 were employed. Three novel 1,4,7,10‐tetraazacyclododecane‐1,4,7,10‐tetraacetic acid (DOTA)‐peptide conjugates were synthesized with a 1,4‐Tz (Asn5‐Ψ[Tz]‐Phe6) and either a β‐amino acid (β‐Phe11), reduced amide bond (Thr10‐Ψ[NH]‐Phe11), or N‐methylated amino acid (N‐Me‐Phe11). Two of the new peptidomimetics were more stable in blood plasma in vitro than [111In]In‐XG1. Yet none of them retained high affinity towards SST2R. We demonstrate for the first time the combination of the amide‐to‐triazole substitution strategy with alternative stabilization methods to improve the metabolic stability of tumor‐targeting peptides. [ABSTRACT FROM AUTHOR]

Currently, the world is undergoing the fourth industrial revolution, also referred to as Industry 4.0, which is characterised by a set of new technological advances in the industrial and production sectors. Additive manufacturing (AM) is considered an essential factor in this new era because of its ability to process a wide spectra of materials, produce customised products, promote sustainability and develop intricate components which are unachievable using conventional manufacturing techniques. The field of AM is rapidly evolving and has seen unprecedented uptake in many industries. Different types of AM technologies have been developed over the last three decades to process different materials, such as polymers, composites, metals, ceramics and alloys. Both industry and academia have made a considerable effort to investigate the use of AM technologies to print different types of polymers because of the possibility to reach new markets. This comprehensive review focuses on polymer laser sintering (PLS) and fused deposition modelling (FDM), which are the most commonly employed AM methods for polymers. This review outlines the processes, process parameters, available commercial polymeric materials, benefits, challenges, and applications of the two technologies. PLS and FDM are multifactorial processes that produce final components whose quality is subject to the process parameters. This review, therefore, delves into the different process parameters for the two technologies and their impacts. The article also lists the available commercial polymeric materials, for each of the methods, to assist researchers and industries to select most suitable materials based on their processability and characteristics. A detailed discussion of applications of the two technologies is outlined in this review. The study provides a comprehensive detail of the benefits and challenges of PLS and FDM. Last, the study also outlines the future works for the two techniques. [ABSTRACT FROM AUTHOR]

Electric fences used to create protected areas (PAs) are prone to faults that affect their operation. The conventional method of measuring the voltage of the fence periodically to detect faults and walking along the fence to locate the faults is inefficient and time consuming. This paper presents a low‐cost Raspberry Pi time domain reflectometer (TDR) for fault detection and localisation in electric fences. The system is designed using cheap off‐the‐shelf components. It uses time domain reflectometry to detect hard (open and short circuit) faults in electric fences. Time domain reflectometry is a method of detecting and locating faults in electrical cables. The Raspberry Pi TDR is evaluated and it has successfully detected and located open circuit and short circuit faults in electric fences with a mean absolute error of 1.52 m. The Raspberry Pi TDR offers the potential to remotely monitor electric fences autonomously, hence improving their effectiveness. [ABSTRACT FROM AUTHOR]

Treatment outcomes for acute malnutrition can be improved by integrating treatment into community case management (iCCM). However, little is known about the cost‐effectiveness of this integrated nutrition intervention. The present study investigates the cost‐effectiveness of treating moderate acute malnutrition (MAM) through community health volunteer (CHV) and integrating it with routine iCCM. A cost‐effectiveness model compared the costs and effects of CHV sites plus health facility‐based treatment (intervention) with the routine health facility‐based treatment strategy alone (control). The costing assessments combined both provider and patient costs. The cost per DALY averted was the primary metric for the comparison, on which sensitivity analysis was performed. Additionally, the integrated strategy's relative value for money was evaluated using the most recent country‐specific gross domestic product threshold metrics. The intervention dominated the health facility‐based strategy alone on all computed cost‐effectiveness outcomes. MAM treatment by CHVs plus health facilities was estimated to yield a cost per death and DALY averted of US$ 8743 and US$ 397, respectively, as opposed to US$ 13,846 and US$ 637 in the control group. The findings also showed that the intervention group spent less per child treated and recovered than the control group: US$ 214 versus US$ 270 and US$ 306 versus US$ 485, respectively. Compared with facility‐based treatment, treating MAM by CHVs and health facilities was a cost‐effective intervention. Additional gains could be achieved if more children with MAM are enrolled and treated. Key messages: Treatment of MAM by CHVs and health facilities involved a lower cost compared with the health facility‐based treatment approach alone.Treatment of MAM by CHVs and health facilities was cost‐effective compared with the health facility‐based treatment approach alone.Greater health and economic gains could be realized if more children with MAM are enrolled and treated by CHVs through the integration of acute malnutrition treatment into iCCM. [ABSTRACT FROM AUTHOR]

Poor health conditions of livestock cause sizeable losses for many farmers in the Global South. Veterinary services, including vaccinations, could help but often fail to reach farmers under typical smallholder conditions. Here, we examine how the provision of a vaccine against East Coast Fever (ECF)—a tick‐borne disease affecting cattle in Africa—can be designed to reduce typical adoption barriers. Using data from a choice experiment with dairy farmers in Kenya, we evaluate farmers' preferences and willingness to pay for various institutional innovations in vaccine delivery, such as a stronger role of dairy cooperatives, new payment modalities with a check‐off system, vaccination at farmers' homestead, and bundling vaccinations with discounts for livestock insurance. Our data reveal that farmers' awareness of the ECF vaccine is limited and adoption rates are low, largely due to institutional constraints. Results from mixed logit and latent class models suggest that suitable institutional innovations—tailored to farmers' heterogeneous conditions—could significantly increase adoption. This general finding likely also holds for other veterinary technologies and services in the Global South. [ABSTRACT FROM AUTHOR]

High‐density polyethylene (HDPE) is largely processed using conventional manufacturing techniques. However, there is a need to investigate its processability when fabricated using additive manufacturing (AM) in an effort to use this polymer for high‐end applications, such as the fabrication of human implants. In this regard, the current study investigated the intrinsic and extrinsic properties of HDPE powders (DiaPow HDPE HX R) from Diamond Plastics GmbH, to determine its feasibility of use in powder bed fusion (PBF). Powder characterisation was undertaken using a scanning electron microscope (SEM), melt flow index (MFI) testing, tapped density testing, differential scanning calorimetry (DSC), thermogravimetric analysis (TGA), Fourier‐transform infrared (FTIR) spectroscopy, and hot‐stage microscopy. The analysis revealed that this high‐density polyethylene powder is suitable for processing using PBF based on the particle size distribution (PSD) (65–92 μm), flowability (Hausner ratio = 1.22 ± 0.02), melting point range (125.7–135.2 degrees Celsius), enthalpy of melting (170.51 J/g), and thermal stability (the materials starts to degrade at 350.0 degrees Celsius and completely degrades at 500.0 degrees Celsius). It also showed good coalescence behaviour. However, the narrow sintering window (7.9 degrees Celsius) of the material indicates possible challenges of shrinkage and curling during printing. The material was also found to have poor absorptive properties of infrared radiation at 10.6 μm, which might make sintering using CO2 lasers challenging. [ABSTRACT FROM AUTHOR]

Objective: To rigorously evaluate the impact of the percentage of parenchymal volume preserved (PPVP) and how well the preserved parenchyma recovers from ischaemia (Recischaemia) on functional outcomes after partial nephrectomy (PN) using an accurate and objective software‐based methodology for estimating parenchymal volumes and split renal function (SRF). A secondary objective was to assess potential predictors of the PPVP. Patients and Methods: A total of 894 PN patients with available studies (2011–2014) were evaluated. The PPVP was measured from cross‐sectional imaging at ≤3 months before and 3–12 months after PN using semi‐automated software. Pearson correlation evaluated relationships between continuous variables. Multivariable linear regression evaluated predictors of ipsilateral glomerular filtration rate (GFR) preserved and the PPVP. Relative‐importance analysis was used to evaluate the impact of the PPVP on ipsilateral GFR preserved. Recischaemia was defined as the percentage of ipsilateral GFR preserved normalised by the PPVP. Results: The median tumour size and R.E.N.A.L. nephrometry score were 3.4 cm and 7, respectively. In all, 49 patients (5.5%) had a solitary kidney. In all, 538 (60%)/251 (28%)/104 (12%) patients were managed with warm/cold/zero ischaemia, respectively. The median pre/post ipsilateral GFRs were 40/31 mL/min/1.73 m2, and the median (interquartile range [IQR]) percentage of ipsilateral GFR preserved was 80% (71–88%). The median pre/post ipsilateral parenchymal volumes were 181/149 mL, and the median (IQR) PPVP was 84% (76–92%). In all, 330 patients (37%) had a PPVP of <80%, while only 34 (4%) had a Recischaemia of <80%. The percentage of ipsilateral GFR preserved correlated strongly with the PPVP (r = 0.83, P < 0.01) and loss of parenchymal volume accounted for 80% of the loss of ipsilateral GFR. Multivariable analysis confirmed that the PPVP was the strongest predictor of ipsilateral GFR preserved. Greater tumour size and endophytic and nearness properties of the R.E.N.A.L. nephrometry score were associated with a reduced PPVP (all P ≤ 0.01). Solitary kidney and cold ischaemia were associated with an increased PPVP (all P < 0.05). Conclusions: A reduced PPVP predominates regarding functional decline after PN, although a low Recischaemia can also contribute. Tumour‐related factors strongly influence the PPVP, while surgical efforts can improve the PPVP as observed for patients with solitary kidneys. [ABSTRACT FROM AUTHOR]

Climate change will impact mountain watershed streamflow both directly—with changing precipitation amounts and variability—and indirectly—through temperature shifts altering snowpack, melt, and evapotranspiration. To understand how these complex processes will affect ecosystem functioning and water resources, we need tools to distinguish connections between water sources (rain/snowmelt), groundwater storage, and exit fluxes (streamflow/evapotranspiration), and to determine how these connections change seasonally and as climate shifts. Here, we develop novel watershed‐scale approaches to understand water source, storage, and exit flux connections using a dynamic‐flux particle tracking model (EcoSLIM) applied in California's Cosumnes Watershed, which connects the Sierra Nevada and Central Valley. This work develops new visualizations and applications to provide mechanistic understanding that underpins the interpretation of isotopic field data at watershed scales to distinguish sources, flow paths, residence times, and storage selection. In our simulations, streamflow comes primarily from snow‐derived water while evapotranspiration generally comes from rain. Most streamflow starts above 1,000 m while evapotranspiration is sourced relatively evenly across the watershed and is generally younger than streamflow. Modeled streamflow consists primarily of water sourced from precipitation in the previous 5 years but before the current water year, while ET consists primarily of water from precipitation in the current water year. ET, and to a lesser extent streamflow, are both younger than water in groundwater storage. However, snowmelt‐derived streamflow preferentially discharges older water from snow‐derived storage. Dynamic‐flux particle tracking and new approaches presented here enable novel model‐tracer comparisons in large‐scale watersheds to better understand watershed behavior in a changing climate. Plain Language Summary: Climate change will alter the hydrologic cycle: storms will be more intense and higher temperatures will result in less snow, earlier melt, and more early‐season water use by plants. To understand the combined effect of these changes, we need models to simulate water flows and precisely study the effects of rain, snowmelt, subsurface storage, streamflow, and plant water uptake. These models can show us how water flows between different components of the landscape, and how this flow changes seasonally and in response to climate change. This study develops new modeling tools that simulate the Cosumnes River in the Sierra Nevada (California, USA) and will help interpret field data at watershed scales. The majority of simulated streamflow originates from snow while plants rely on rainfall for evapotranspiration (ET). Most streamflow starts as precipitation above 1,000 m while ET comes from water that falls evenly across the watershed. Water used for ET is generally younger than streamflow: most streamflow is 1–5 years old, while most ET is less than 1 year old. Both ET and streamflow are younger than water stored in the subsurface. These new modeling tools, called dynamic‐flux particle tracking, will help us predict how watersheds will behave as climate changes. Key Points: Dynamic‐flux particle tracking (DFPT) is a novel technique to investigate watershed function and connectionWater source wedge plots illustrate connectivity between source water elevation, precipitation phase, and water exit pathways and locationDFPT shows how source phase and watershed conditions influence age‐ranked storage selection behavior [ABSTRACT FROM AUTHOR]

Objectives: To evaluate the validity of the Golden Proportion, Golden Percentage, and Recurring Esthetic Dental (RED) Proportion among Kenyans of African descent with naturally well‐aligned teeth. Materials and Methods: Standardized frontal photographic images of the smiles of 175 participants aged 18–35 years were obtained, and Adobe Photoshop was used to analyze and measure the frontal widths of the maxillary central and lateral incisors and canines in triplicate. The average teeth widths were calculated to determine the existence of the Golden Proportion, Golden Percentage, and RED Proportion, and their validity using independent sample t‐tests to compare the differences in the mean teeth widths at α < 0.05. Results: The number of male and female participants was 107 (61.1%) and 68 (38.9%), respectively. The Golden Proportion between the maxillary central and lateral incisors was found in 4.0% on the right and 2.8% on the left of all the participants, but between the maxillary lateral incisors and canines was found in only 0.6% on the right of male participants (p < 0.0001). The RED Proportion between the maxillary lateral and central incisors was in the range of 67%–70%, and between the canines and lateral incisors was 82%–84% (p < 0.0001). The proportion of RED was not constant, and gradually increased distally. The Golden Percentage of 15% was observed in the lateral incisors bilaterally; however, in the central incisors and the canines, the Golden Percentage was 22% and 12%, respectively. Conclusion: The Golden and RED Proportions were invalid determinants of anterior teeth proportions. The Golden Percentage existed only in the lateral incisors. The Golden Proportion, RED Proportion, and Golden Percentage theories may not be applicable to all populations when designing smiles. Racial and ethnic backgrounds are important considerations to establish objective quantifiable values of anterior tooth proportions that are beneficial for esthetic restorations. [ABSTRACT FROM AUTHOR]

Aim: Recent unprecedented efforts to digitise and mobilise biodiversity data have resulted in the generation of 'biodiversity big data', enabling ecological research at scales previously not possible. However, gaps, biases and uncertainties in these data influence analytical outcomes and the validity of scientific research and conservation actions. Here, we estimated tree species inventory completeness globally and identified where future surveys should focus to maximise regional inventories. Location: Global. Methods: We analysed spatial patterns in sampling effort of tree species occurrence records from the Global Biodiversity and Information Facility (GBIF) and estimated global tree species inventory completeness for 100 × 100 km grid cells (sampling units) and ecoregions. We also identified forested areas for future botanical exploration, by examining the spatial overlap between inventory completeness, remaining natural habitat and protected areas and degrees of forest modification by anthropogenic pressure (forest integrity). Results: Spatial patterns in sampling effort and tree species inventory completeness were unevenly distributed around the world. Only 35% of ecoregions and 18% of sampling units can be considered well surveyed, most of which were concentrated in the Global North, including Europe, North America and Australia. Large areas in species‐rich tropical regions, especially in Southeast Asia, remained poorly documented. Moreover, our results showed that many areas with low inventory completeness overlapped with ecoregions retaining less than 50% of natural habitat and protected land area, as well as sampling units with low forest integrity. Main Conclusions: Due to limitations in biodiversity data, simply sampling more will not necessarily lead to increasing knowledge. We illustrated how gaps in these data can be used to improve existing knowledge by identifying priority areas for future surveys. With ongoing anthropogenic impacts and escalating rates of biodiversity loss, limited resources should be allocated to strategically survey regions likely to yield new knowledge and improve biodiversity representativeness. [ABSTRACT FROM AUTHOR]

Introduction: Delivery of oral pre‐exposure prophylaxis (PrEP) is being scaled up in Africa, but clinic‐level barriers including lengthy clinic visits may threaten client continuation on PrEP. Methods: Between January 2020 and January 2022, we conducted a quasi‐experimental evaluation of differentiated direct‐to‐pharmacy PrEP refill visits at four public health HIV clinics in Kenya. Two clinics implemented the intervention package, which included direct‐to‐pharmacy for PrEP refill, client HIV self‐testing (HIVST), client navigator, and pharmacist‐led rapid risk assessment and dispensing. Two other clinics with comparable size and client volume served as contemporaneous controls with the usual clinic flow. PrEP continuation was evaluated by visit attendance and pharmacy refill records, and time and motion studies were conducted to determine time spent in the clinics. Dried blood spots were collected to test for tenofovir‐diphosphate (TFV‐DP) at random visits. We used logistic regression to assess the intervention effect on PrEP continuation and the Wilcoxon rank sum test to assess the effect on clinic time. Results: Overall, 746 clients were enrolled, 366 at control clinics (76 during pre‐implementation and 290 during implementation phase), and 380 at direct‐to‐pharmacy clinics (116 during pre‐implementation and 264 during implementation phase). Prior to implementation, the intervention and control clinics were comparable on client characteristics (female: 51% vs. 47%; median age: 33 vs. 33 years) and PrEP continuation (35% vs. 37% at 1 month, and 37% vs. 39% at 3 months). The intervention reduced total time spent at the clinic by 35% (median of 51 minutes at control vs. 33 minutes at intervention clinics; p<0.001), while time spent on HIV testing (20 vs. 20 minutes; p = 0.50) and pharmacy (8 vs. 8 minutes; p = 0.8) was unchanged. PrEP continuation was higher at intervention versus the control clinics: 45% versus 33% at month 1, 34% versus 25% at month 3 and 23% versus 16% at month 6. TFV‐DP was detected in 85% (61/72) of samples, similar by the study group (83% vs. 85%). Conclusions: A client‐centred PrEP delivery approach with direct‐to‐pharmacy PrEP refill visits plus client HIVST significantly reduced clinic visit time by more than one‐third and improved PrEP continuation in public health HIV clinics in Kenya. [ABSTRACT FROM AUTHOR]

Helicobacter pylori (H. pylori) strain is the most genetically diverse pathogenic bacterium and now alarming serious human health concern ranging from chronic gastritis to gastric cancer and human death all over the world. Currently, the majority of commercially available diagnostic assays for H. pylori is a challenging task due to the heterogeneity of virulence factors in various geographical regions. In this concern, designing of universal multi‐epitope immunogenic biomarker targeted for all H. pylori strains would be crucial to successfully immunodiagnosis assay and vaccine development for H. pylori infection. Hence, the present study aimed to explore the potential immunogenic epitopes of PSA D15 and Cag11 proteins of H. pylori, using immunoinformatics web tools in order to design novel immune‐reactive multi‐epitope antigens for enhanced immunodiagnosis in humans. Through an in silico immunoinformatics approach, high‐ranked B‐cell, MHC‐I, and MHC‐II epitopes of PSA D15 and Cag11 proteins were predicted, screened, and selected. Subsequently, a novel multi‐epitope PSA D15 and Cag11 antigens were designed by fused the high‐ranked B‐cell, MHC‐I, and MHC‐II epitopes and 50S ribosomal protein L7/L12 adjuvant using linkers. The antigenicity, solubility, physicochemical properties, secondary and tertiary structures, 3D model refinement, and validations were carried. Furthermore, the designed multi‐epitope antigens were subjected to codon adaptation and in silico cloning, immune response simulation, and molecular docking with receptor molecules. A novel, stable multi‐epitope PSA D15 and Cag11 H. pylori antigens were developed and immune simulation of the designed antigens showed desirable levels of immunological response. Molecular docking of designed antigens with immune receptors (B‐cell, MHC‐I, MHC‐II, and TLR‐2/4) revealed robust interactions and stable binding affinity to the receptors. The codon optimized and in silico cloned showed that the designed antigens were successfully expressed (CAI value of 0.95 for PSA D15 and 1.0 for Cag11) after inserted into pET‐32ba (+) plasmid of the E. coli K12 strain. In conclusion, this study revealed that the designed multi‐epitope antigens have a huge immunological potential candidate biomarker and useful in developing immunodiagnostic assays and vaccines for H. pylori infection. [ABSTRACT FROM AUTHOR]

This study focuses on the fabrication and analysis of the mechanical behaviour of unidirectional (UD) glass fibre-reinforced polymer (GFRP) facesheet and polyvinyl chloride (PVC) foam core sandwich structures fabricated by a vacuum-assisted resin infusion method (VARIM). These sandwich structures are commonly used in marine and wind turbine blade applications. To date, relatively little knowledge about the functional behaviour of UD GFRP compared to composites reinforced with bidirectional mats is available for day-to-day applications. The effects of the facesheet orientation, facesheet thickness, and core thickness on the mechanical behaviour of the specimens were examined. The UD fibres were oriented in cross-ply (0/90), angle-ply (+45/−45), and quasi-isotropic orientations. Various mechanical properties such as tensile, flexural, flatwise compression, and edgewise compression tests were examined. Characterization of the tensile properties of the facesheet showed that the cross-ply orientation had a higher strength than the angle-ply and quasi-isotropic orientations. The flexural load-carrying capacity of the cross-ply facesheet orientation was superior to the other orientations. The increase in the core thickness changed the flexural failure mode from face yield and core shear to core indentation. Flatwise compression (FWC) was tested to determine the core characteristics of the sandwich structure, and the peak loads of 4.90, 1.81, and 3.90 kN were obtained for 10-, 15-, and 20 mm core thicknesses, respectively. Edgewise compression (EWC) exhibited stable end crushing for thinner facesheet, whereas thicker facesheet showed core crushing and buckling. When the facesheet thickness was increased from 1.5 mm to 3 mm in the EWC, the buckling load increase ranged from 2.53% to 44.83% for core thicknesses 10-, 15-, and 20 mm, respectively. [ABSTRACT FROM AUTHOR]

Hepatitis is a common adverse event following gene therapy for haemophilia, often associated with a loss of transgene expression. Investigating the potential causes and implications of this is crucial for the overall success of treatment. Gene therapy trials using adeno‐associated virus (AAV) vectors have demonstrated promising results marked by increases in factor FVIII and FIX levels and reductions in episodes of bleeding. However, hepatocellular injury characterised by elevations in alanine aminotransferases (ALT) has been noted. This liver injury is typically transient and asymptomatic, posing challenges in determining its clinical significance. Proposed causes encompass immune‐mediated responses, notably T cell cytotoxicity in response to the AAV vector, direct liver injury from the viral capsid or transcribed protein via the unfolded protein response and pre‐existing liver conditions. Liver biopsy data conducted years post‐gene therapy infusion has shown sinusoidal infiltration without significant inflammation. The overall safety profile of gene therapy remains favourable with no evidence drug‐induced liver injury (DILI) based on Hy's Law criteria. Essential pre‐therapy monitoring and identifying patients at high risk of liver injury should involve liver function tests and non‐invasive fibroscans, while novel blood‐based biomarkers are under exploration. Further research is required to comprehend the mechanisms underlying transaminitis, loss of transgene expression and long‐term effects on the liver, providing insights for optimising gene therapy for haemophilia. [ABSTRACT FROM AUTHOR]

African science has substantial potential, yet it grapples with significant challenges. Here we describe the establishment of the Biomedical Science Research and Training Centre (BioRTC) in Yobe State, Northeast Nigeria, as a case study of a hub fostering on‐continent research and describe strategies to overcome current barriers. We detail the steps taken to establish BioRTC, emphasising the critical importance of stakeholder engagement, community involvement, resource optimisation and collaborations. With its state‐of‐the‐art facilities and commitment to training African scientists, BioRTC is poised to significantly advance neuroscience research and training in the region. Although we are in the early stages of our journey, our model, emphasizing open access and inclusivity, offers a replicable blueprint for neuroscience research development in similar resource‐limited settings, promising to enrich the global neuroscience community. We invite the support and collaboration of those who share our vision and believe in our potential. [ABSTRACT FROM AUTHOR]

Background: Literature is scarce on the occurrence of bovine mastitis and antimicrobial resistance among dairy animals kept by pastoralists in the Kenya. Objectives: A cross‐sectional study was carried out to investigate the prevalence and risk factors of subclinical mastitis (SCM) and evaluate the antibiotic sensitivity of bacteria isolated from dairy cattle kept by farmers in Kajiado Central sub‐county, Kenya. Methods: A total of 202 lactating cows from 40 farms were sampled. Milk from the cows was screened for SCM using the California mastitis test, and the bacteria present in the milk samples were determined using standard bacteriological methods. The sensitivity of the isolated coagulase‐negative staphylococci (CNS) and Staphylococcus aureus against antibiotics was tested using the Kirby–Bauer disk diffusion method. Results: The prevalence of SCM at quarter‐ and cow‐level was 31.7% and 53%, respectively. The prevalence of SCM was significantly higher (p < 0.05) in exotic breeds of cattle and those kept under an extensive system of production. A total of 19 bacterial species were isolated with the majority being CNS (40.1%), S. aureus (15.8%) and Micrococcus spp. (10.4%). S. aureus isolates showed varied resistance to the tested antibiotics with the highest resistance being against ceftazidime (75%), amoxycillin (50%) and streptomycin (46.9%). Several S. aureus isolates were resistant to oxacillin (34.4%) and cefoxitin (12.5%). CNSs were more resistant against ceftazidime (79.1%), amoxycillin (34.6%) and oxacillin (32.1%). Majority (92%–100%) of the Staphylococcus spp. were highly sensitive to ciprofloxacin a fluoroquinolone and augmentin. Conclusions: The high prevalence of SCM and bacteria resistant to antibiotics shows a need for animal health professionals and farmers to develop strategies for the management of mastitis and antibiotic resistance in dairy cows in the study area. [ABSTRACT FROM AUTHOR]

INTRODUCTION: The pace of innovation has accelerated in virtually every area of tau research in just the past few years. METHODS: In February 2022, leading international tau experts convened to share selected highlights of this work during Tau 2022, the second international tau conference co‐organized and co‐sponsored by the Alzheimer's Association, CurePSP, and the Rainwater Charitable Foundation. RESULTS: Representing academia, industry, and the philanthropic sector, presenters joined more than 1700 registered attendees from 59 countries, spanning six continents, to share recent advances and exciting new directions in tau research. DISCUSSION: The virtual meeting provided an opportunity to foster cross‐sector collaboration and partnerships as well as a forum for updating colleagues on research‐advancing tools and programs that are steadily moving the field forward. [ABSTRACT FROM AUTHOR]

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Earth's vegetation has been increasing over the past decades, altering water and energy cycles by changing evapotranspiration (ET). Greening, caused by climatic and anthropogenic factors, has high rates in High Mountain Asia (HMA). Here we focus on two HMA basins (the Yangtze and the Ganges‐Brahmaputra) to contrast the impacts of climate‐ and human‐induced greening on ET. Though the rate of greening is similar in both basins, anthropogenic influences lead to dissimilar responses in ET. In the Yangtze, climate‐induced greening increases ET, with the increase in moisture being high enough to meet the ET demand. In the Ganges‐Brahmaputra, irrigation‐induced greening does not alter annual ET, only pre‐monsoon ET increases. The dry season declines in water storage due to pumping decrease ET, while laboriously meeting the demand. This study provides a representative example of the contrasting influences of climate induced and anthropogenic driven processes on the seasonality of ET. Plain Language Summary: The significant increases in vegetation occurring on Earth are susceptible to altering the climate by affecting evapotranspiration. However, the responses in evapotranspiration to the changes in vegetation depend on the drivers of greening. Here we use High Mountain Asia as a testbed to contrast the impacts of greening on evapotranspiration. Irrigation‐induced greening leads to an increase in transpiration and evapotranspiration in the pre‐monsoon. However, because irrigation decreases water storage it decreases evapotranspiration in the post‐monsoon. Climate‐induced greening, on the contrary, increases both evapotranspiration and water storage. Key Points: Climate and human induced greening have different effects on evapotranspiration and therefore the land‐atmosphere interactionsThough irrigation‐induced greening rises pre‐monsoon evapotranspiration, the latter decreases in post‐monsoon due to groundwater depletionClimate‐induced greening increases evapotranspiration because the energy demand is easily met [ABSTRACT FROM AUTHOR]

Introduction. Alzheimer's disease (AD) is a neurodegenerative disorder with no conclusive remedy. Yohimbine, found in Rauwolfia vomitoria, may reduce brain inflammation by targeting tumour necrosis factor-alpha (TNFα), implicated in AD pathogenesis. Metoserpate, a synthetic compound, may inhibit TNFα. The study is aimed at assessing the potential utility of repurposing metoserpate for TNFα inhibition to reduce neuronal damage and inflammation in AD. The development of safe and effective treatments for AD is crucial to address the growing burden of the disease, which is projected to double over the next two decades. Methods. Our study repurposed an FDA-approved drug as TNFα inhibitor for AD management using structural similarity studies, molecular docking, and molecular dynamics simulations. Yohimbine was used as a reference compound. Molecular docking used SeeSAR, and molecular dynamics simulation used GROMACS. Results. Metoserpate was selected from 10 compounds similar to yohimbine based on pharmacokinetic properties and FDA approval status. Molecular docking and simulation studies showed a stable interaction between metoserpate and TNFα over 100 ns (100000 ps). This suggests a reliable and robust interaction between the protein and ligand, supporting the potential utility of repurposing metoserpate for TNFα inhibition in AD treatment. Conclusion. Our study has identified metoserpate, a previously FDA-approved antihypertensive agent, as a promising candidate for inhibiting TNFα in the management of AD. [ABSTRACT FROM AUTHOR]

Understanding the spatial dynamics of landscape use by free-ranging herbivores is essential for species management and conservation in its natural environment. We used Ivelv's selection index, binary logistic regression analyses and stepwise regression to understand how environmental factors shape habitat selection by the Grevy's zebra (Equus greyvi). We measured biotic, abiotic and human factors that may influence presence or absence of Grevy's zebra in Samburu-Laikipia landscape and showed: (1) during wet periods, percentage perennial grasses, livestock density and grass quality had the greatest effect on Grevy's zebra presence; but (2) during dry weather periods a different suite of factors determined their landscape distribution, namely, the percentage of tree and bush density, distance to water and overall grass abundance. In addition, different Grevy's zebra demographic and reproductive classes varied in their response to environmental selective forces, thus demonstrating flexibility in their pat-terns of habitat selection. While we recommend more detailed studies on how abiotic and biotic interact to shape habitat selection patterns, our findings underscored the need of maintaining both dry and wet season habitats to ensure essential grazing area refugia. Our findings show that 'soft' development with controlled livestock stocking rates within the landscape will enhance Grevy's zebra conservation. [ABSTRACT FROM AUTHOR]

We assessed the potential effectiveness of human milk banking and lactation support on provision of human milk to neonates admitted in the newborn unit (NBU) at Pumwani Maternity Hospital, Kenya. This pre–post intervention study collected data from mothers/caregivers and their vulnerable neonates or term babies who lacked sufficient mother's milk for several reasons admitted in the NBU. The intervention included establishing a human milk bank and strengthening lactation support. Preintervention data were collected between 5 October 2018 and 11 November 2018, whereas postintervention data were collected between 4 September 2019 and 6 October 2019. Propensity score‐matched analysis was performed to assess the effect of the intervention on exclusive use of human milk, use of human milk as the first feed, feeding intolerance and duration of NBU stay. The surveys included 123 and 116 newborns at preintervention and postintervention, respectively, with 160 newborns (80 in each group) being included in propensity score matched analysis. The proportion of neonates who exclusively used human milk during NBU stay increased from 41.3% preintervention to 63.8% postintervention (adjusted odds ratio [OR]: 2.68; 95% confidence interval [CI]: 1.31, 5.53) and those whose first feed was human milk increased from 55.0% preintervention to 83.3% postintervention (adjusted OR: 5.09; 95% CI: 2.18, 11.88). The mean duration of NBU stay was 27% (95% CI: 5.8%, 44.0%) lower in the postintervention group than in the preintervention group. The intervention did not affect feeding intolerance. Integrating human milk banking and lactation support may improve exclusive use of human milk among vulnerable neonates in a resource limited setting. Key messages: Mother's milk is recommended for feeding preterm and low birthweight neonates.However, when the provision of mother's milk is not feasible, the use of donor human milk—from a human milk bank—is recommended.In this quasi‐experimental study, human milk banking and lactation support intervention increased the exclusive use of human milk during hospital stay and the use of human milk as the first feed among neonates admitted in the newborn unit at Pumwani Maternity Hospital, Kenya.The intervention also reduced the duration of stay in the newborn unit and there was no impact on feeding intolerance.Human milk banking and lactation support may improve the exclusive use of human milk among vulnerable neonates in a resource‐limited setting. [ABSTRACT FROM AUTHOR]

Background: A major contributor to the poor meat safety status in Kenya is low level of slaughter hygiene knowledge and practices among slaughterhouse workers. Introduction: The study determined knowledge, attitude and practices (KAPs) of workers from 7 small and medium slaughterhouses in Kajiado County on slaughter hygiene and meat safety. Methodology: Semi‐structured questionnaires were administered to 78 workers, managers and meat inspectors. Results: Majority (92.3%) of workers lacked slaughter hygiene and meat safety training. Workers had high knowledge with an overall mean score of 19.2 ± 2 out of 24, high personal hygiene scores (9.9 ± 0.8 out of 11), moderate carcass contamination scores (4.2 ± 0.8 out of 6), meat‐borne illness score (3.1 ± 1 out of 4) and temperature intervention scores (2.1 ± 0.6 out of 3). Moderate and high scores were recorded in attitude and practices and differed significantly across slaughterhouses (p < 0.05) with a mean of 33 ± 5 out of 40 and 59.3 ± 3.5 out of 65, respectively. There was no significant difference in KAP scores between trained and untrained workers. Carcass decontamination practices by workers differed from that of the meat inspector. Surface and handheld equipment sanitization practices were observed as poor. Medical testing practice was poor and significantly different across slaughterhouses (p < 0.001) with infection rates of zoonoses and occupational hazards as high as 33% in some slaughterhouses. Conclusion: The study concluded that although high knowledge and neutral attitude were scored by slightly more than half of the workers, poor practices were reported and observed in carcass decontamination, equipment and facility sanitization and worker medical examination. Slaughter facilities in Kajiado County have an opportunity to offer their workers role‐specific training, the provision of personal protective equipment, hygiene and sanitation facilities and strict oversight of worker medical testing. [ABSTRACT FROM AUTHOR]

High‐density polyethylene (HDPE) polymer is one of the largest contributors to plastic wastes causing detrimental effects on various sectors of society, and is not biodegradable in nature. In the first stage, river sand and a recycled HDPE as a binder were used to manufacture eco‐friendly plastic sand bricks with various sand(s):plastic(p) ratios: 60s:40p; 65s:35p; 70s:30p; 75s:25p; 80s:20p; 85s:15p. In the second stage, 1%, 5%, and 10% of Kaolin Clay was added to each ratio of sand:plastic, respectively. Three mechanical tests were conducted: compressive strength, impact, and short beam strength. First, the addition of 5% Kaolin Clay to 75s:25p ratio increased compressive strength significantly from 21.4 to 52.76 MPa. Second, the addition of 10% Kaolin Clay in the ratio of 75s:25p mixture increased the impact strength from 4.8 to 5 J. Finally, the addition of 5% Kaolin Clay in the ratio of 60s:40p mixture increased the short beam strength significantly from 1.84 to 2.27 MPa. SEM analysis showed a well‐compacted interface indicating effective bonding between the HDPE and river sand particles in the 75s:25p ratio. Hence, the results of this study present a potential for the use of recycled HDPE plastic to manufacture plastic sand bricks. Highlights: Addition of Kaolin Clay improved the mechanical properties of the composite material. [ABSTRACT FROM AUTHOR]

Antimicrobial resistance (AMR) is a growing health problem globally. To address this challenge, there is a need to generate baseline data on the prevalence and AMR profile of the main disease-causing bacteria. Here, we interrogated the prevalence of bacteria in the nasal cavity of healthy pastoralists in Kajiado Central Subcounty, Kenya, and the occurrence of AMR in Staphylococcus isolates among the study subjects. Nasal swabs from 176 pastoralists were cultured, and the bacteria isolates identified using standard phenotypic and biochemical bacteriological methods. Among the obtained 195 isolates, the most prevalent isolates were coagulase-negative Staphylococcus (CoNS) (44.9%), followed by Enterococci spp. (43.2%) while Staphylococcus aureus prevalence was 8%. Antimicrobial sensitivity of the Staphylococcus spp. isolates to 14 antibiotics representing six antibiotic groups was undertaken using the Kirby-Bauer disk diffusion method. Among the CoNS, the highest resistance was reported in amoxicillin (78.7%) and ceftazidime (76%), while the most resistance for S. aureus was reported in ceftazidime (100%), amoxicillin (71.4%), and streptomycin (71.4%). From an administered questionnaire looking at gender, animal contact frequency, history of hospital visitation and antibiotic usage, and habitual intake of raw milk, the study showed that male participants had a higher risk of carrying multiple drug resistant (MDR) bacteria than females (p = 0.02 , OR = 1.3). Likewise, habitual intake of raw milk was significantly associated MDR acquisition (p = 0.02 , OR = 1.82). This study reveals a high prevalence of AMR Staphylococcus isolates in the study area laying a foundation for further analysis of molecular characterization of the observed resistance as well as the development of interventions that can reduce the occurrence of AMR in the study area. [ABSTRACT FROM AUTHOR]

In commercial poultry farming, respiratory diseases cause high morbidities and mortalities, begetting colossal economic losses. Without empirical evidence, early observations led to the supposition that birds in general, and poultry in particular, have weak innate and adaptive pulmonary defences and are therefore highly susceptible to injury by pathogens. Recent findings have, however, shown that birds possess notably efficient pulmonary defences that include: (i) a structurally complex three‐tiered airway arrangement with aerodynamically intricate air‐flow dynamics that provide efficient filtration of inhaled air; (ii) a specialised airway mucosal lining that comprises air‐filtering (ciliated) cells and various resident phagocytic cells such as surface and tissue macrophages, dendritic cells and lymphocytes; (iii) an exceptionally efficient mucociliary escalator system that efficiently removes trapped foreign agents; (iv) phagocytotic atrial and infundibular epithelial cells; (v) phagocytically competent surface macrophages that destroy pathogens and injurious particulates; (vi) pulmonary intravascular macrophages that protect the lung from the vascular side; and (vii) proficiently phagocytic pulmonary extravasated erythrocytes. Additionally, the avian respiratory system rapidly translocates phagocytic cells onto the respiratory surface, ostensibly from the subepithelial space and the circulatory system: the mobilised cells complement the surface macrophages in destroying foreign agents. Further studies are needed to determine whether the posited weak defence of the avian respiratory system is a global avian feature or is exclusive to poultry. This review argues that any inadequacies of pulmonary defences in poultry may have derived from exacting genetic manipulation(s) for traits such as rapid weight gain from efficient conversion of food into meat and eggs and the harsh environmental conditions and severe husbandry operations in modern poultry farming. To reduce pulmonary diseases and their severity, greater effort must be directed at establishment of optimal poultry housing conditions and use of more humane husbandry practices. [ABSTRACT FROM AUTHOR]

Summary: In the current genomic era, the search and deployment of new semi‐dwarf alleles have continued to develop better plant types in all cereals. We characterized an agronomically optimal semi‐dwarf mutation in Zea mays L. and a parallel polymorphism in Sorghum bicolor L.We cloned the maize brachytic1 (br1‐Mu) allele by a modified PCR‐based Sequence Amplified Insertion Flanking Fragment (SAIFF) approach. Histology and RNA‐Seq elucidated the mechanism of semi‐dwarfism. GWAS linked a sorghum plant height QTL with the Br1 homolog by resequencing a West African sorghum landraces panel.The semi‐dwarf br1‐Mu allele encodes an MYB transcription factor78 that positively regulates stalk cell elongation by interacting with the polar auxin pathway. Semi‐dwarfism is due to differential splicing and low functional Br1 wild‐type transcript expression. The sorghum ortholog, SbBr1, co‐segregates with the major plant height QTL qHT7.1 and is alternatively spliced. The high frequency of the Sbbr1 allele in African landraces suggests that African smallholder farmers used the semi‐dwarf allele to improve plant height in sorghum long before efforts to introduce Green Revolution‐style varieties in the 1960s.Surprisingly, variants for differential splicing of Brachytic1 were found in both commercial maize and smallholder sorghum, suggesting parallel tuning of plant architecture across these systems. [ABSTRACT FROM AUTHOR]

Studies investigating microplastics, pharmaceuticals, and pesticides as contaminants of emerging concern (CECs) in surface water sources in Kenya are reviewed. Contaminants of emerging concern are chemicals that have recently been discovered that may pose a threat to the environment, aquatic life, and human life. Microplastics in surface waters range from 1.56 to as high as 4520 particles/m3, with high concentrations recorded in coastal waters. The dominant microplastics are fibers, fragments, and films, with foams, granules, and pellets making up only a small percentage. The main source of pharmaceuticals in water sources is not wastewater‐treatment plants but rather raw untreated sewage because high concentrations are found near informal settlements with poor sewage connectivity. Antibiotics are detected in the range of the limit of quantification to 320 μg/L, with sulfamethoxazole, trimethoprim, and ciprofloxacin being the most abundant antibiotics. The high frequency of detection is attributed to the general misuse of antibiotics in the country. A health risk assessment indicated that only ciprofloxacin and acetaminophen posed noncarcinogenic health risks in the Ndarugo River and Mombasa periurban creeks, respectively. Similarly, the detection of antiretroviral drugs, mainly lamivudine, nevirapine, and zidovudine, is associated with human immunodeficiency virus prevalence in Kenya. In the Lake Naivasha, Nairobi River, and Lake Victoria basins, frequently detected organochloride pesticides (OCPs) are methoxychlor, alachlor, endrin, dieldrin, endosulfan, endosulfan sulfate, α‐hexachlorocyclohexane (α‐HCH), γ‐HCH, and dichlorodiphenyltrichloroethane (DDT), some of which occur above permissible concentrations. The presence of DDT in some sites translates to illegal use or historical application. The majority of individual OCPs posed no noncarcinogenic health risk, except dieldrin and aldrin which had a hazard quotient >1 in two sites. Therefore, more surveying and regular monitoring in different regions in Kenya concerning CECs is essential to determine the spatial variability and effective measures to be taken to reduce pollution. Environ Toxicol Chem 2023;42:2105–2118. © 2023 SETAC. [ABSTRACT FROM AUTHOR]

Aim: To explore contextual literature on nursing and midwifery education, regulation and workforce in Kenya to develop an understanding of the current state and inform opportunities to strengthen the nursing and midwifery professions. Introduction: Kenya has yet to achieve the minimum nursing and midwifery workforce threshold, despite the exponential increase in population and epidemiologic disease transitions. Background: There are glaring health gaps and inequities in sub‐Saharan African countries. Health systems are evolving into complex and costly utilities, increasing the demand for nurses and midwives. It is, therefore, necessary to re‐examine systems that educate, deploy and retain the nursing workforce, especially given the ongoing COVID‐19 pandemic and increase in non‐communicable diseases. Methods: This scoping review was guided and reported following the PRISMA‐ScR guidelines. Four electronic databases (PubMed, Scopus, CINAHL and Web of Science) were probed for relevant studies conducted in Kenya between 1963 and 2020. The search was supplemented using Google Scholar. Findings from selected studies were extracted and analysed thematically. Results: Of the 238 retrieved studies, 37 were included in this review: 10 articles on nursing and midwifery education, 11 on regulation and 16 on the workforce. Discussion: There have been changes in regulation and an increase in nursing and midwifery enrolment and graduates. However, maldistribution and shortage of nurses and midwives persist. Conclusions: Kenya's nursing and midwifery professions have undergone significant changes to meet the demand for a skilled workforce. However, the shortage of qualified and specialised nurses and midwives persists. Moreover, this shortage is exacerbated by underinvestment, outmigration and a need for more reforms to expand the nursing and midwifery workforce. Implication for nursing and midwifery policy: Investment in nurse and midwifery education, mentorship and legislation is needed to build the capacity of the profession to provide quality health services. Several nursing and midwifery policy changes utilising a multipronged approach involving stakeholders' collaboration are suggested to address the bottlenecks from education to deployment. [ABSTRACT FROM AUTHOR]

Objective: To assess the impact of a novel flipped‐classroom (FC) otolaryngology resident didactic curriculum on resident learning. Methods: Based on the preferences elicited in a survey of preferred learning styles of residents, a hybrid web‐based and in‐person FC otolaryngology didactic curriculum was implemented over a 6‐month period in 2020–2021. Resident reactions to the new curriculum were assessed via a second survey. Kruskal Wallis tests were used to compare mean stanine scores on the Otolaryngology Training Examination (OTE) exam for topics taught in the new format with topics delivered in the old format. Results: After instituting the curriculum reform, engagement in at least a moderate amount of the pre‐didactic work and synchronous case discussions was reported by 67% and 88% of the residents, respectively. After the curriculum change, residents in years PGY2 and above reported statistically significant increases in self‐reported ability to retain information from didactics, to feel prepared for the OTE, and to feel confident in fund of knowledge (p < 0.001, p = 0.004, and p = 0.004, respectively). Compared to the prior year, mean stanine increased on OTE scores for residents in years PGY2‐PGY5 to a statistically significant degree (5.45 vs. 4.41, p = 0.001) for the topics delivered in the new format compared to topics delivered in the traditional format (5.13 vs. 4.70, p = 0.07). Conclusion: By organizing a didactic curriculum through online modules that incorporate pre‐recorded lectures and external resources, residents reported and demonstrated improved knowledge retention. Level of Evidence: NA Laryngoscope, 133:2129–2134, 2023 [ABSTRACT FROM AUTHOR]

We report on the health care experiences of individuals with Down syndrome (DS) from families who are primarily Spanish‐speaking. Data were collected through three methods: (1) a nationally distributed, 20‐item survey, (2) two focus groups with seven family caregivers of individuals with DS who self‐identified as living in primarily Spanish speaking households, and (3) 20 interviews with primary care providers (PCPs) who care for patients who are underrepresented minorities. Standard summary statistics were used to analyze the quantitative survey results. Focus group and interview transcripts, as well as an open‐ended response question in the survey, were analyzed using qualitative coding methods to identify key themes. Both caregivers and PCPs described how language barriers make giving and receiving quality care difficult. Caregivers additionally described condescending, discriminatory treatment within the medical system and shared feelings of caregiver stress and social isolation. Challenges to care experienced by families of individuals with DS are compounded for Spanish‐speaking families, where the ability to build trust with providers and in the health care system may be compromised by cultural and language differences, systemic issues (lack of time or inability to craft more nuanced schedules so that patients with higher needs are offered more time), mistrust, and sometimes, overt racism. Building this trust is critical to improve access to information, care options, and research opportunities, especially for this community that depends on their clinicians and nonprofit groups as trusted messengers. More study is needed to understand how to better reach out to these communities through primary care clinician networks and nonprofit organizations. [ABSTRACT FROM AUTHOR]

Down syndrome (DS) has a unique medical and psychological profile. To date, few studies have asked individuals with DS about their views of health, and fewer have explored the impact of COVID‐19 on the health of individuals with DS and their families. We used a mixed methods approach including two studies on the health of individuals with DS and their parents conducted during the COVID‐19 pandemic: (1) eight virtual focus groups, comprised of 20 parents and 8 individuals with DS to obtain participants' views of health, and (2) a 20‐item questionnaire on health care experience of patients with DS who are African American or come from primarily Spanish‐speaking homes. Focus group transcripts were coded using a hybrid inductive/deductive framework and thematically analyzed using the Framework Method. This questionnaire included questions regarding the impact of COVID‐19 on caregivers and their loved ones with DS; responses to these questions were summarized using descriptive statistics. Individuals with DS discussed the impact of the COVID‐19 pandemic on their physical and social health including masking, online learning, and online communication with friends and family. Parents of individuals with DS discussed how the COVID‐19 pandemic negatively impacted their child's physical, social, and mental health, as a result of virtual schooling and decreased socialization. There were unexpected positives of the pandemic such as improved hygiene and eased scheduling with telehealth visits. Caregivers noted COVID‐19 impacted their own anxiety, employment, and other domains that have potential ripple effects on the health of their children. The COVID‐19 pandemic had a pervasive impact on the mental health and wellness of caregivers as well as the physical, social, and mental health of individuals with DS. [ABSTRACT FROM AUTHOR]

Introduction: The Uganda Ministry of Health recommends facility‐ and community‐based differentiated antiretroviral therapy (DART) models to support person‐centred care for eligible clients receiving antiretroviral therapy (ART). Healthcare workers assess client eligibility for one of six DART models upon initial enrolment; however, client circumstances evolve, and their preferences are not routinely adjusted. We developed a tool to understand the proportion of clients accessing preferred DART models and compared the outcomes of clients accessing preferred DART models to the outcomes of clients not receiving preferred DART models. Methods: We conducted a cross‐sectional study. A sample of 6376 clients was selected from 113 referrals, general hospitals and health centres purposely selected from 74 districts. Clients receiving ART accessing care from the sampled sites were eligible for inclusion. Healthcare workers interviewed clients (caretakers of clients under 18), over a 2‐week period between January and February 2022 using a client preference tool to elicit whether clients were receiving DART services through their preferred model. Treatment outcomes of viral load test, viral load suppression and missed appointment date were extracted from clients' medical files before or immediately after the interview and de‐identified. The descriptive analysis determined the interaction between client preferences and predefined treatment outcomes by comparing outcomes of clients whose care aligned with their preferences to outcomes of clients whose care misaligned with their preferences. Results: Of 25% (1573/6376) of clients not accessing their preferred DART model, 56% were on facility‐based individual management and 35% preferred fast‐track drug refills model. Viral load coverage was 87% for clients accessing preferred DART models compared to 68% among clients not accessing their preferred model. Viral load suppression was higher among clients who accessed the preferred DART model (85%) compared to (68%) clients who did not access their preferred DART model. Missed appointments were lower at 29% for clients who accessed preferred DART models compared to 40% among clients not enrolled in the DART model of their choice. Conclusions: Clients who accessed their preferred DART model have better clinical outcomes. Preferences should be integrated throughout health systems, improvement interventions, policies and research efforts to ensure client‐centred care and client autonomy. [ABSTRACT FROM AUTHOR]

Coral reefs are facing severe threats and are at risk of accelerated decline due to climate change‐induced changes in their environment. Ongoing efforts to understand the mechanisms of coral response to warming rely on multiple sources of temperature data. Yet, it remains uncertain whether the Sea Surface Temperature (SST) data used for coral reef studies are consistent among different data products, despite potential implications for conservation. A better understanding of the consistency among the different SST data applied to coral reefs may facilitate the fusion of data into a standard product. This will improve monitoring and understanding of the impact of global warming on coral reefs. Four types of SST data across North‐Western and South‐Western Australia are compared to assess their differences and ability to observe high thermal stress during historical coral bleaching events. The four SST data sources included those derived from Global Circulation Models, NOAA CoralTemp SST product, ESA CCI SST product, and coral core derived SST. Coral bleaching risk indicators, Degree Heating Week (DHW), and Degree Heating Month (DHM) were calculated using these sources and compared for consistency. DHW and DHM were inconsistent among data sets and did not accurately reflect high thermal stress metrics during moderate and severe bleaching events. Some reefs did not experience bleaching in spite of high DHWs and DHMs, suggesting a mismatch in data scales, or perhaps other oceanographic factors and coral adaptation. By exploring the differences and similarities among these four data sources, this study highlights the need to compare existing indicators of thermal stress from different data sets. Plain Language Summary: Climate change and warming have resulted in global coral bleaching events, severely compromising our environment's health. Monitoring the changes in ocean temperatures around them is essential to maximizing our efforts to protect them. Different ocean temperature data products exist and are being used without understanding their differences. To highlight these differences, the present study compares historical warming from climate models and remote and in situ sensors and known bleaching events on five reefs across Western Australia. Key Points: Temperature data sources did not provide consistent risk indicators for coral bleachingAcross five reefs, coral bleaching risk indicators differed in their ability to predict the observed coral bleaching eventsTemperature data in daily and monthly temporal resolutions differed in the accuracy of coral bleaching risk indicators [ABSTRACT FROM AUTHOR]

The article focuses on advancing the Nurse Practitioner role in Africa through collaborative scholarship, drawing insights from the historical development of advanced practice nursing across the continent. Topics include the colonial legacy's impact on healthcare, challenges in expanding Advanced Practice Nurse/Nurse Practitioner roles, and the need for meaningful collaborations to address context-specific factors and promote equitable healthcare delivery.

In the coastal regions of the western United States, atmospheric rivers (ARs) are associated with the largest precipitation generating storms and contribute up to half of annual precipitation, but the impact of ARs on the integrated hydrologic cycle, specifically on groundwater storage and hydrodynamics, is largely unknown. To better explore the hydrologic behavior of AR versus non‐AR event precipitation, we present a novel combination of two water tracking methods (one in the atmosphere and one in the subsurface) to explicitly track the full lifecycle of water parcels generated by ARs. Simulations of northern California's Cosumnes River watershed during the record wet 2017 water year are performed via the coupling of a high‐resolution regional climate model and a land surface‐groundwater model accounting for lateral groundwater flow. Despite ARs contributing more precipitation than non‐AR storms, we find less AR water is preferentially stored in aquifers by year end. Fractionally, ARs result in 300% less snow derived groundwater‐recharged compared to non‐AR precipitation. Rain‐on‐snow (RoS) plays an important role in AR‐driven discharge, where over 50% of total discharge from ARs snow is from RoS events. Finally, despite record‐breaking annual precipitation, simulated groundwater depletion occurs by year end due to estimates of groundwater pumping activities. The results from these simulations serve as a partial analogue of future hydrologic conditions where ARs are expected to intensify and provide a greater fraction of annual precipitation due to climate change. Key Points: A coupled hydrologic model is forced by a regional climate model to examine the role of atmospheric rivers (ARs) on groundwater dynamicsTracking of atmospheric features and subsurface Lagrangian particles is used to follow the full lifecycle of water through a record wet yearThe most significant difference in AR‐sourced precipitation is on the groundwater recharge‐snow relationship [ABSTRACT FROM AUTHOR]

Aim: The aim is to illustrate and analyse reflections from graduate nursing students over their experience of discussing racism in healthcare in an educational intervention. Design: A qualitative, descriptive design was adopted. Methods: Data were collected through written reflections and analysed through content analysis. In total, 81 students participated in the intervention; 39 paediatric and 42 public health care nursing students. Of those, 27 participants gave consent to have their written reflections included in the study. Results: Three main categories were developed in the content analysis of student reflections: (a) the implicit embeddedness of racism in healthcare organization; (b) the effect of racism on interactions with patients; and (c) a growing awareness of one's own understanding of racism. This study indicates that student nurses discussed racism as relevant to understanding good clinical practice for the benefit of patients and work‐based wellbeing of staff. This recognition of the organizational nature of racism warrants nursing leaders and managers to include racism as a social determinant of health in the undergraduate and graduate curricula to educate the next generation of nursing about racism. [ABSTRACT FROM AUTHOR]

Bacteriophage therapy targeting the increasingly resistant Vibrio cholerae is highly needed. Hence, studying the phenotypic behavior of potential phages under different conditions is a prerequisite to delivering the phage in an active infective form. The objective of this study was to characterize phage VP4 (vB_vcM_Kuja), an environmental vibriophage isolated from River Kuja in Migori County, Kenya in 2015. The phenotypic characteristics of the phage were determined using a one‐step growth curve, restriction digestion profile, pH, and temperature stability tests. The results revealed that the phage is stable through a wide range of temperatures (20−50°C) and maintains its plaque‐forming ability at pH ranging from 6 to 12. The one‐step growth curve showed a latent period falling between 40 and 60 min, while burst size ranged from 23 to 30 plaque‐forming units/10 µl at the same host strain. The restriction digestion pattern using EcoRI, SalI, HindIII, and XhoI enzymes showed that HindIII could cut the phage genome. The phage DNA could not be restricted by the other three enzymes. The findings of this study can be used in future studies to determine phage−host interactions. [ABSTRACT FROM AUTHOR]

Background: Animal husbandry practices in different livestock production systems and increased livestock–wildlife interactions are thought to be primary drivers of antimicrobial resistance (AMR) in Arid and Semi‐Arid Lands (ASALs). Despite a tenfold increase in the camel population within the last decade, paired with widespread use of camel products, there is a lack of comprehensive information concerning beta‐lactamase‐producing Escherichia coli (E. coli) within these production systems. Objectives: Our study sought to establish an AMR profile and to identify and characterise emerging beta‐lactamase‐producing E. coli isolated from faecal samples obtained from camel herds in Northern Kenya. Methods: The antimicrobial susceptibility profiles of E. coli isolates were established using the disk diffusion method, with beta‐lactamase (bla) gene PCR product sequencing performed for phylogenetic grouping and genetic diversity assessments. Results: Here we show, among the recovered E. coli isolates (n = 123), the highest level of resistance was observed for cefaclor at 28.5% of isolates, followed by cefotaxime at 16.3% and ampicillin at 9.7%. Moreover, extended‐spectrum beta‐lactamase (ESBL)‐producing E. coli harbouring the blaCTX‐M‐15 or blaCTX‐M‐27 genes were detected in 3.3% of total samples, and are associated with phylogenetic groups B1, B2 and D. Multiple variants of non‐ESBL blaTEM genes were detected, the majority of which were the blaTEM‐1 and blaTEM‐116 genes. Conclusions: Findings from this study shed light on the increased occurrence of ESBL‐ and non‐ESBL‐encoding gene variants in E. coli isolates with demonstrated multidrug resistant phenotypes. This study highlights the need for an expanded One Health approach to understanding AMR transmission dynamics, drivers of AMR development, and appropriate practices for antimicrobial stewardship in camel production systems within ASALs. [ABSTRACT FROM AUTHOR]

Background: Bipolar depression accounts for most of the disease duration in type I and type II bipolar disorder (BD), with few treatment options, often poorly tolerated. Many individuals do not respond to first‐line therapeutic options, resulting in treatment‐resistant bipolar depression (B‐TRD). Esketamine, the S‐enantiomer of ketamine, has recently been approved for treatment‐resistant depression (TRD), but no data are available on its use in B‐TRD. Objectives: To compare the efficacy of esketamine in two samples of unipolar and bipolar TRD, providing preliminary indications of its effectiveness in B‐TRD. Secondary outcomes included the evaluation of the safety and tolerability of esketamine in B‐TRD, focusing on the average risk of an affective switch. Methods: Thirty‐five B‐TRD subjects treated with esketamine nasal spray were enrolled and compared with 35 TRD patients. Anamnestic data and psychometric assessments (Montgomery‐Asberg Depression Rating Scale/MADRS, Hamilton‐depression scale/HAM‐D, Hamilton‐anxiety scale/HAM‐A) were collected at baseline (T0), at one month (T1), and three months (T2) follow up. Results: A significant reduction in depressive symptoms was found at T1 and T2 compared to T0, with no significant differences in response or remission rates between subjects with B‐TRD and TRD. Esketamine showed a greater anxiolytic action in subjects with B‐TRD than in those with TRD. Improvement in depressive symptoms was not associated with treatment‐emergent affective switch. Conclusions: Our results supported the effectiveness and tolerability of esketamine in a real‐world population of subjects with B‐TRD. The low risk of manic switch in B‐TRD patients confirmed the safety of this treatment. [ABSTRACT FROM AUTHOR]

This implementation research study sought to examine the impact of the COVID-19 pandemic on maternal and infant nutrition practices, and related aspects of health and food systems in Nairobi and Uasin Gishu Counties, Kenya. The study triangulated in-depth interviews with 16 pregnant women, 31 lactating women (including COVID-19 positive), 10 facility health workers, 10 community health volunteers, 6 focus group discussions (FGDs) with food vendors, 4 FGDs and 15 stakeholder interviews with government and implementing partners. Trends from Kenyan Health Information System indicators (i.e., exclusive breastfeeding and initiation of breastfeeding, antenatal care) were also examined. During the COVID-19 pandemic, a decline in attendance of antenatal care, and maternity facilities was observed, and corroborated by Kenyan Health Information System data. Lack of clarity among health workers on COVID-19 breastfeeding guidance and fear of COVID-19 infection early in the pandemic were key drivers of early infant formula use, mother-child separation following delivery and delayed initiation of breastfeeding. Most women exclusively breastfed due to Government of Kenya restrictions in movement. Unemployment and job loss was linked to food insecurity and worsened by increased food prices and limited social protection measures. In response, pregnant and lactating women resorted to skipping meals and reducing quantity and variety of foods consumed. Efforts to build forward from COVID-19 in Kenya should include facility and community health education to prevent disruptions in breastfeeding and to support maternal dietary intake, and in the provision of targeted social protection measures alongside other multisectoral interventions (i.e., psychosocial support) for Kenyan pregnant and lactating women. [ABSTRACT FROM AUTHOR]

Myiasis is the infestation of living tissues of animals with dipterous larvae. In Africa, Cordylobia species (C. anthropophaga, C. rodhaini, and C. ruandae) and Dermatobia hominis are reported as the principal cause of nonmigratory cutaneous myiasis of domestic animals. None of these have been reported in dogs in Kenya. A cross-sectional study was conducted in eight subcounties of Kitui County, Kenya, from March to August 2021 to estimate the prevalence, risk factors, and etiological agents associated with canine cutaneous myiasis (CCM). A questionnaire was administered to dog owners to collect information on CCM risk factors. A total of 400 dogs were physically examined and larvae collected from myiasis skin lesions and preserved in 70% ethanol, taken to the laboratory, processed and identified using parasitological morphological features. Live larvae were incubated and emerging adults were captured and identified. The overall prevalence of CCM was 45% (180/400) (95% confidence interval: 40.0–50.0%). A total of 434 larvae were collected from 180 dogs infested with cutaneous myiasis. All larvae (100%) were identified as C. anthropophaga and hatched adults were "tumbu" flies. There were no significant differences in the prevalence of CCM at 95% confidence interval among different age and sex groups (p > 0.05), although puppies (<6 months) appeared more affected. The highest prevalence of myiasis was in Kitui Central at 65% (95% confidence interval: 51.6–76.9%), Mwingi North at 52.5% (95% confidence interval: 36.1–68.4%), Kitui South at 48.5% (95% confidence interval: 31.5–63.9%), Kitui Rural at 40% (95% confidence interval: 27.6–53.5%), Mwingi Central at 40% (95% confidence interval: 24.9–56.7%), Mwingi West at 40% (95% confidence interval: 24.9–56.7%), Kitui West at 38.3% (95% confidence interval: 26.1–51.8%), and Kitui East subcounty at 36.7% (95% confidence interval: 24.6–50.1%). Lack of housing, housing structures, and dog living area environmental hygiene were the main risk factors associated with the occurrence of CCM (p < 0.05). The CCM occurrence was significantly different among breeds (p < 0.05). Cordylobia anthropophaga larvae were the etiological agent of CCM in Kitui County. There is a need for improved dog housing and hygiene measures to prevent the occurrence of CCM, and affected dogs should be treated to prevent the spread of CCM among the dogs. [ABSTRACT FROM AUTHOR]

Scant research has explored the healthcare experiences of people with Down syndrome (DS) in the United States who are Black, African American, of African descent, or of mixed race. The purpose of this study was to identify and describe the barriers and facilitators that such patients and their caregivers face when accessing healthcare. We gathered data in three ways: focus groups with caregivers, a national survey completed by caregivers, and in‐depth interviews with primary care providers. Many caregivers and primary care physicians felt that patients with DS who are Black, African American, of African descent, or of mixed race receive a lower quality of medical care than their white counterparts with DS. Caregivers mentioned feeling tired of being reminded by the medical community about their race and wanting acknowledgment that raising a child with DS can be hard at times. Many felt that the medical community's conscious and unconscious racial biases do negatively impact the care of their loved ones with DS. Caregivers desired more race concordant medical providers or, when not possible, medical providers who are willing to learn more about DS and build trusted, longitudinal relationships. Primary care providers discussed the need for funded resources and support services to effectively care for their patients with DS. [ABSTRACT FROM AUTHOR]

Rain‐on‐snow (ROS) over snow‐dominated regions such as High Mountain Asia (HMA) modulates snowmelt and runoff and is key contributor in influencing water availability and hazards (e.g., floods and landslides). We studied the trends in ROS in HMA over the past two decades from 2001 to 2018 using the land surface model Noah‐MP driven by an ensemble precipitation data set. Our results show that changes in precipitation phase and rainfall are altering ROS. Because of the strong physical heterogeneity and atmospheric dynamics of HMA, ROS characteristics and trends are region‐dependent and ROS occurs predominantly over the Indus, Ganges‐Brahmaputra, and northwestern basins. In the Indus, ROS representing ∼5% of the annual precipitation and ∼20% of the annual snowmelt, has an increasing trend. This is contrary to the Ganges‐Brahmaputra characterized by decreasing ROS trends, where it represents ∼11% of the annual precipitation and ∼60% of the annual snowmelt. In the northwestern basins, ROS has bidirectional trends due to elevation patterns and trends in rainfall, and it constitutes ∼5 to ∼10% of the annual precipitation. Increasing trends in ROS over Indus contribute to reducing the snowpack in late summer, with concerns of reduced water availability and increased groundwater exploitation. Similarly, because of its high amount and contribution to snowmelt, the decreasing ROS trends in the Ganges‐Brahmaputra will have consequences of decreased recharge from the headwaters and exacerbated use of groundwater unless increasing trends in rainfall compensate for the decreasing snowmelt. These results provide new insights on ROS‐driven changes in the hydrological cycle over HMA. Key Points: In the Indus, rain‐on‐snow (ROS) represents more than 5% of the annual precipitation and has an increasing trendIn the Ganges‐Brahmaputra, ROS which represents more than 10% of the annual precipitation is decreasingIn the Amu Darya, Syr Darya, and Ili, ROS constitutes 5%–10% of the annual precipitation and has a bidirectional trend [ABSTRACT FROM AUTHOR]

Background: Achievement of ISO15189 accreditation demonstrates competency of a laboratory to conduct testing. Three programmes were developed to facilitate achievement of accreditation in low‐ and middle‐income countries: Strengthening Laboratory Management Towards Accreditation (SLMTA), Stepwise Laboratory Improvement Process Towards Accreditation (SLIPTA) and Laboratory Quality Stepwise Implementation (LQSI). Objective: To determine the level of accreditation and associated barriers and facilitators among medical laboratories in the WHO‐AFRO region by 2020. Methods: A desk review of SLIPTA and SLMTA databases was conducted to identify ISO15189‐accredited medical laboratories between January 2013 and December 2020. Data on access to the LQSI tool were extracted from the WHO database. Facility and country characteristics were collected for analysis as possible enablers of accreditation. The chi‐square test was used to analyse differences with level of significance set at <0.05. Results: A total of 668 laboratories achieved accreditation by 2020 representing a 75% increase from the number in 2013. Accredited laboratories were mainly in South Africa (n = 396; 55%) and Kenya (n = 106; 16%), two countries with national accreditation bodies. About 16.9% (n = 113) of the accredited laboratories were registered for the SLIPTA programme and 26.6% (n = 178) for SLMTA. Approximately 58,217 LQSI users were registered by December 2020. Countries with a higher UHC index for access to HIV care and treatment, higher WHO JEE scores for laboratory networks, a larger number of registered LQSI users, with national laboratory policy/strategic plans and PEPFAR‐priority countries were more likely to have an accredited laboratory. Of the 475 laboratories engaged in the SLIPTA programme, 154 attained ≥4 SLIPTA stars (ready to apply for accreditation) and 113 achieved ISO 15189 accreditation, with 96 enrolled into the SLMTA programme. Lower‐tier laboratories were less likely to achieve accreditation than higher‐tier laboratories (7.7% vs. 30%) (p < 0.001). The probability of achieving ISO 15189 accreditation (19%) was highest during the first 24 months after enrolment into the SLIPTA programme. Conclusion: To sustainably anchor quality improvement initiatives at facility level, national approaches including access to a national accreditation authority, adoption of national quality standards and regulatory frameworks are required. [ABSTRACT FROM AUTHOR]