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Older adults are generally amongst the most vulnerable to heat and cold. While temperature-related health impacts are projected to increase with global warming, the influence of population aging on these trends remains unclear. Here we show that at 1.5 °C, 2 °C, and 3 °C of global warming, heat-related mortality in 800 locations across 50 countries/areas will increase by 0.5%, 1.0%, and 2.5%, respectively; among which 1 in 5 to 1 in 4 heat-related deaths can be attributed to population aging. Despite a projected decrease in cold-related mortality due to progressive warming alone, population aging will mostly counteract this trend, leading to a net increase in cold-related mortality by 0.1%–0.4% at 1.5–3 °C global warming. Our findings indicate that population aging constitutes a crucial driver for future heat- and cold-related deaths, with increasing mortality burden for both heat and cold due to the aging population. This study reveals that population aging intensifies heat- and cold-related deaths, more so than climate change, in 50 countries. At 1.53 °C global warming, aging contributes to rising heat-related deaths, offsetting declines in cold related death. [ABSTRACT FROM AUTHOR]

Background: Malaria remains an enduring public health concern in Indonesia, exacerbated by its equatorial climate that fosters the proliferation of Anopheles mosquitoes. This study seeks to assess the performance of the malaria elimination programme comprehensively. Methods: Between May and August 2022, a qualitative study was conducted in Muara Enim Regency, South Sumatra Province, involving 22 healthcare professionals from diverse backgrounds. These informants were strategically chosen for their pivotal roles in providing profound insights into various facets of the malaria elimination programme. This encompasses inputs such as human resources, budgetary allocation, and infrastructural support; processes like case identification and management, capacity enhancement, epidemiological surveillance, prevention measures, outbreak control, and enhanced communication and educational initiatives; and, notably, the programme's outcomes. Data were collected through 3-h Focus Group Discussions (FGDs) divided into two groups, each with 12 participants: healthcare professionals and programme managers. Additionally, in-depth interviews (IDIs) were conducted with ten informants. Employing the Input-Process-Output (IPO) model, this study meticulously analysed the healthcare system dynamics and the interventions' efficacy. Results: The study unveiled many challenges during the input phase, including the absence of entomologists and a shortage of diagnostic tools. Despite these obstacles, it documented remarkable accomplishments in the output domain, marked by significant advancements in the distribution of mosquito nets and the successful implementation of the Early Warning System (EWS). Despite the adversities, the programme has made substantial strides towards malaria elimination. Conclusions: Urgent action is imperative to bolster the effectiveness of the malaria elimination programme. Key measures encompass augmenting the entomologist workforce, optimizing resource allocation, and ensuring stringent adherence to regional regulations. Addressing these concerns will enhance programme efficacy, yielding enduring public health benefits. This research substantially contributes to Indonesia's ongoing malaria elimination endeavours, furnishing actionable insights for programme enhancement. Consequently, this research holds significant importance for the malaria elimination drive. [ABSTRACT FROM AUTHOR]

Background: It was hypothesized that glucose-6-phosphate dehydrogenase (G6PD) deficiency confers a protective effect against malaria infection, however, safety concerns have been raised regarding haemolytic toxicity caused by radical cure with 8-aminoquinolines in G6PD-deficient individuals. Malaria elimination and control are also complicated by the high prevalence of G6PD deficiency in malaria-endemic areas. Hence, accurate identification of G6PD deficiency is required to identify those who are eligible for malaria treatment using 8-aminoquinolines. Methods: The prevalence of G6PD deficiency among 408 Thai participants diagnosed with malaria by microscopy (71), and malaria-negative controls (337), was assessed using a phenotypic test based on water-soluble tetrazolium salts. High-resolution melting (HRM) curve analysis was developed from a previous study to enable the detection of 15 common missense, synonymous and intronic G6PD mutations in Asian populations. The identified mutations were subjected to biochemical and structural characterisation to understand the molecular mechanisms underlying enzyme deficiency. Results: Based on phenotypic testing, the prevalence of G6PD deficiency (< 30% activity) was 6.13% (25/408) and intermediate deficiency (30–70% activity) was found in 15.20% (62/408) of participants. Several G6PD genotypes with newly discovered double missense variants were identified by HRM assays, including G6PD Gaohe + Viangchan, G6PD Valladolid + Viangchan and G6PD Canton + Viangchan. A significantly high frequency of synonymous (c.1311C>T) and intronic (c.1365-13T>C and c.486-34delT) mutations was detected with intermediate to normal enzyme activity. The double missense mutations were less catalytically active than their corresponding single missense mutations, resulting in severe enzyme deficiency. While the mutations had a minor effect on binding affinity, structural instability was a key contributor to the enzyme deficiency observed in G6PD-deficient individuals. Conclusions: With varying degrees of enzyme deficiency, G6PD genotyping can be used as a complement to phenotypic screening to identify those who are eligible for 8-aminoquinolines. The information gained from this study could be useful for management and treatment of malaria, as well as for the prevention of unanticipated reactions to certain medications and foods in the studied population. [ABSTRACT FROM AUTHOR]

The efficient detection of crew overboard behavior has become an important element in enhancing the ability to respond to marine disasters. It remains challenging due to (1) the lack of effective features making feature extraction difficult and recognition accuracy low and (2) the insufficient computing power resulting in the poor real-time performance of existing algorithms. In this paper, we propose a Channel-Time Dense Residual Network (CTDR-Net) for detecting crew overboard behavior, including a Dense Residual Network (DR-Net) and a Channel-Time Attention Mechanism (CTAM). The DR-Net is proposed to extract features, which employs the convolutional splitting method to improve the extraction ability of sparse features and reduce the number of network parameters. The CTAM is used to enhance the expression ability of channel feature information, and can increase the accuracy of behavior detection more effectively. We use the LeakyReLU activation function to improve the nonlinear modeling ability of the network, which can further enhance the network's generalization ability. The experiments show that our method has an accuracy of 96.9%, striking a good balance between accuracy and real-time performance. [ABSTRACT FROM AUTHOR]

Background: Malaria, a disease transmitted by Anopheles mosquitoes, is a major public health problem causing millions of deaths worldwide, mostly among children under the age of 5 years. Biotechnological interventions targeting parasite-vector interactions have shown that the microsporidian symbiont Microsporidia MB has the potential to disrupt and block Plasmodium transmission. Methods: A prospective cross-sectional survey was conducted in Zinder City (Zinder), Niger, from August to September 2022, using the CDC light trap technique to collect adult mosquitoes belonging to the Anopheles gambiae complex. The survey focused on collecting mosquitoes from three neighborhoods of Zinder (Birni, Kangna and Garin Malan, located in communes I, II and IV, respectively). Collected mosquitoes were sorted and preserved in 70% ethanol. PCR was used to identify host species and detect the presence of Microsporidia MB and Plasmodium falciparum infection. Results: Of the 257 Anopheles mosquitoes collected and identified by PCR, Anopheles coluzzii was the most prevalent species, accounting for 97.7% of the total. Microsporidia MB was exclusively detected in A. coluzzii, with a prevalence of 6.8% (17/251) among the samples. No significant difference in prevalence was found among the three neighborhoods. Only one An. coluzzii mosquito tested PCR-positive for P. falciparum. Conclusions: The results confirm the presence of Microsporidia MB in Anopheles mosquitoes in Zinder, Niger, indicating its potential use as a biotechnological intervention against malaria transmission. However, further studies are needed to determine the efficacy of Microsporidia MB to disrupt Plasmodium transmission as well as its impact on vector fitness. [ABSTRACT FROM AUTHOR]

Introduction: In the absence of evidence on the effect of mammographic screening on overall mortality, comparing the number of deaths avoided with the number of deaths caused by screening would be ideal, but the only existing models of this type adopt a very narrow definition of harms. The objective of the present study was to estimate the number of deaths prevented and induced by various mammography screening protocols in Brazil. Methods: A simulation study of cohorts of Brazilian women screened, considering various age groups and screening interval protocols, was performed based on life tables. The number of deaths avoided and caused by screening was estimated, as was the absolute risk reduction, the number needed to invite for screening—NNS, the net benefit of screening, and the ratio of "lives saved" to "lives lost". Nine possible combinations of balances between benefits and harms were performed for each protocol, in addition to other sensitivity analyses. Results and conclusions: The most efficient protocol was biennial screening from 60 to 69 years of age, with almost three times more deaths avoided than biennial screening from 50 to 59 years of age, with a similar number of deaths avoided by biennial screening from 50 to 69 years of age and with the greatest net benefit. Compared with the best scenario of annual screening from 40 to 49 years of age, the NNS of the protocol with biennial screening from 60 to 69 years of age was three-fold lower. Even in its best scenario, the addition of annual screening from 40 to 49 years of age to biennial screening from 50 to 69 years of age results in a decreased net benefit. However, even in the 50–69 year age group, the estimated reduction in breast cancer mortality for Brazil was half that estimated for the United Kingdom. [ABSTRACT FROM AUTHOR]

Background Owing to the increased cases of malaria in older children, the World Health Organization has recently recommended extending seasonal malaria chemoprevention (SMC) to children >5 years of age and using other effective drugs for malaria. In this study, we report the safety and efficacy of dihydroartemisinin-piperaquine (DHA-PQ) for SMC in school-aged children in Mali. Method This randomized, controlled trial included 345 participants aged 6–15 years randomized to receive DHA-PQ, sulfadoxine-pyrimethamine plus amodiaquine (SP-AQ), or no chemoprevention (albendazole) at a 1:1:1 ratio. Four rounds of SMC were conducted from September to December 2021. The participants were assessed 7 days after each round for safety and efficacy of the interventions. Results Abdominal pain (11.8% vs 29.2%), headache (11.2% vs 19.2%), and vomiting (5.7% vs 15.2%) were frequently reported in the DHA-PQ and SP-AQ arms. On Day 120 of follow up, the incidence of clinical malaria was 0.01 episodes/person-month in the DHA-PQ and SP-AQ arms and 0.17 episodes/person-month in the control arm (P <.0001). Gametocytes were detected in 37 participants in all arms. Conclusions Children in DHA-PQ arm reported less adverse events compared to the SP-AQ arm. Both drugs were effective against clinical malaria and infection. [ABSTRACT FROM AUTHOR]

Background: The revision knee complexity classification (RKCC) stratifies knee revision operations depending on their level of complexity from simple revisions (R1) to highly complex cases (R3). Current financial codes used for calculation of reimbursement for knee revision services provided at the Trust, rely on patients' comorbidities. However, previous research has demonstrated that this approach may not yield an accurate financial account of knee revision arthroplasty cost. This is a single centre study from a secondary and tertiary revision unit, with work previously presented by the authors demonstrating that the majority of complex revision knee replacement within the region, take place in this unit. The aims of this study were to illustrate the current cost profile and renumeration service currently in place for revision knee and show the differences in cost based on complexity of the operation. Methods: In this retrospective study, 90 cases who underwent revision knee operations in 2019 were analysed. Data was obtained from a tertiary referral centre where the episodes had occurred. Mean cost, tariff, and subsequent deficit were calculated for the R1, R2 and R3 episodes. Results: R2 and R3 episodes were significantly more expensive than R1 episodes. The increase in cost between R3 and R2 episodes was not significant. The total cost of the revision operations was £1,162,343. Tariffs received for R2 and R3 revision operations were significantly more expensive than R1 operations. However, the increase in tariffs received for R3 operations was not significant in relation to R2 operations. The total amount of tariffs received by the Trust was £ 770,996 generating a net deficit of - £ 391,347. Conclusion: Current financial coding for revision knee does not accurately predict costs associated with revision knee surgery. Net deficit varies depending on the RKCC grade of the knee revision episode with more complex operations resulting in a higher mean net deficit. Implementation of the RKCC could prove to be a useful tool in generating an accurate prediction of the cost associated with knee revision surgery. [ABSTRACT FROM AUTHOR]

Background: Long-lasting insecticidal nets (LLINs) may have different impacts on distinct mosquito vector species. We assessed the efficacy of pyrethroid-pyriproxyfen and pyrethroid-chlorfenapyr LLINs on the density of Anopheles gambiae s.s. and An. coluzzii compared to pyrethroid-only nets in a three-arm cluster randomised control trial in Benin. Methods: Indoor and outdoor collections of adult mosquitoes took place in 60 clusters using human landing catches at baseline and every 3 months for 2 years. After morphological identification, around 15% of randomly selected samples of An. gambiae s.l. were dissected to determine parity, species (using PCR). Results: Overall, a total of 46,613 mosquito specimens were collected at baseline and 259,250 in the eight quarterly collections post-net distribution. Post-net distribution, approximately 70% of the specimens of An. gambiae s.l. speciated were An. coluzzii, while the rest were mostly composed of An. gambiae s.s. with a small proportion (< 1%) of hybrids (An. gambiae/coluzzii). There was no evidence of a significant reduction in vector density indoors in either primary vector species [An. coluzzii: DR (density ratio) = 0.62 (95% CI 0.21–1.77), p = 0.3683 for the pyrethroid-pyriproxyfen LLIN and DR = 0.56 (95% CI 0.19–1.62), p = 0.2866 for the pyrethroid-chlorfenapyr LLIN, An. gambiae s.s.: DR = 0.52 (95% CI 0.18–1.46), p = 0.2192 for the pyrethroid-pyriproxyfen LLIN and DR = 0.53 (95% CI 0.19–1.46), p = 0.2222 for the pyrethroid-chlorfenapyr]. The same trend was observed outdoors. Parity rates of An. gambiae s.l. were also similar across study arms. Conclusions: Compared with pyrethroid-only LLINs, pyrethroid-chlorfenapyr LLINs and pyrethroid-pyriproxyfen LLINs performed similarly against the two primary mosquito species An. gambiae s.s. and An. coluzzii in Benin. [ABSTRACT FROM AUTHOR]

Seasonal vaccination with the RTS,S/AS01 E vaccine combined with seasonal malaria chemoprevention (SMC) prevented malaria in young children more effectively than either intervention given alone over a 3 year period. The objective of this study was to establish whether the added protection provided by the combination could be sustained for a further 2 years. This was a double-blind, individually randomised, controlled, non-inferiority and superiority, phase 3 trial done at two sites: the Bougouni district and neighbouring areas in Mali and Houndé district, Burkina Faso. Children who had been enrolled in the initial 3-year trial when aged 5–17 months were initially randomly assigned individually to receive SMC with sulphadoxine-pyrimethamine and amodiaquine plus control vaccines, RTS,S/AS01 E plus placebo SMC, or SMC plus RTS,S/AS01 E. They continued to receive the same interventions until the age of 5 years. The primary trial endpoint was the incidence of clinical malaria over the 5-year trial period in both the modified intention-to-treat and per-protocol populations. Over the 5-year period, non-inferiority was defined as a 20% increase in clinical malaria in the RTS,S/AS01 E -alone group compared with the SMC alone group. Superiority was defined as a 12% difference in the incidence of clinical malaria between the combined and single intervention groups. The study is registered with ClinicalTrials.gov , NCT04319380 , and is complete. In April, 2020, of 6861 children originally recruited, 5098 (94%) of the 5433 children who completed the initial 3-year follow-up were re-enrolled in the extension study. Over 5 years, the incidence of clinical malaria per 1000 person-years at risk was 313 in the SMC alone group, 320 in the RTS,S/AS01 E -alone group, and 133 in the combined group. The combination of RTS,S/AS01 E and SMC was superior to SMC (protective efficacy 57·7%, 95% CI 53·3 to 61·7) and to RTS,S/AS01 E (protective efficacy 59·0%, 54·7 to 62·8) in preventing clinical malaria. RTS,S/AS01 E was non-inferior to SMC (hazard ratio 1·03 [95% CI 0·95 to 1·12]). The protective efficacy of the combination versus SMC over the 5-year period of the study was very similar to that seen in the first 3 years with the protective efficacy of the combination versus SMC being 57·7% (53·3 to 61·7) and versus RTS/AS01 E -alone being 59·0% (54·7 to 62·8). The comparable figures for the first 3 years of the study were 62·8% (58·4 to 66·8) and 59·6% (54·7 to 64·0%), respectively. Hospital admissions for WHO-defined severe malaria were reduced by 66·8% (95% CI 40·3 to 81·5), for malarial anaemia by 65·9% (34·1 to 82·4), for blood transfusion by 68·1% (32·6 to 84·9), for all-cause deaths by 44·5% (2·8 to 68·3), for deaths excluding external causes or surgery by 41·1% (−9·2 to 68·3), and for deaths from malaria by 66·8% (−2·7 to 89·3) in the combined group compared with the SMC alone group. No safety signals were detected. Substantial protection against malaria was sustained over 5 years by combining seasonal malaria vaccination with seasonal chemoprevention, offering a potential new approach to malaria control in areas with seasonal malaria transmission. UK Joint Global Health Trials and PATH's Malaria Vaccine Initiative (through a grant from the Bill & Melinda Gates Foundation). For the French translation of the abstract see Supplementary Materials section. [ABSTRACT FROM AUTHOR]

Gastrointestinal (GI) endoscopy is among the highest waste generator in healthcare facilities. The major reasons include production of large‐volume non‐renewable waste, use of single‐use devices, and reprocessing or decontamination processes. Single‐use endoscopic accessories have gradually replaced reusable devices over last two decades contributing to the rising impact of GI endoscopy on ecosystem. Several reports of infection outbreaks with reusable duodenoscopes raised concerns regarding the efficacy and adherence to standard disinfection protocols. Even the enhanced reprocessing techniques like double high‐level disinfection have not been found to be the perfect ways for decontamination of duodenoscopes and therefore, paved the way for the development of single‐use duodenoscopes. However, the use of single‐use endoscopes is likely to amplify the net waste generated and carbon footprint of any endoscopy unit. Moreover, single‐use devices challenge one of the major pillars of sustainability, that is, "reuse." In the era of climate change, a balanced approach is required taking into consideration patient safety as well as financial and environmental implications. The possible solutions to provide optimum care while addressing the impact on climate include selective use of disposable duodenoscopes and careful selection of accessories during a case. Other options include use of disposable endcaps and development of effective high‐level disinfection techniques. The collaboration between the healthcare professionals and the manufacturers is paramount for the development of environmental friendly devices with low carbon footprint. [ABSTRACT FROM AUTHOR]

In Sub‑Saharan African (SSA) countries the main channels of morbidity and mortality are preventable and treatable diseases. Yet, SSA countries invest little in preventive healthcare. Literature has shown that providing health information can have an impact on health behaviors. The arrival of optic fiber submarine cables in 2010 brought broadband connectivity to Senegal, allowing access to healthcare information online. Using the Demographic and Health Surveys datasets combined with the Afterfibre database, and a difference‑in‑differences methodology, this study aims to assess the impact of the arrival of broadband internet on preventive health behaviors in Senegal. Broadband access is found to be positively associated with the use of bed‑ net, mixed results are found regarding the use of antenatal care and child immunization. If the positive impacts of internet access are confirmed, the expansion of broadband internet could be important to improve health. [ABSTRACT FROM AUTHOR]

After adopting the Paris Agreement, many countries (including developing countries) have started to develop targets aimed at achieving net-zero emissions to realize a "decarbonized society" in response to the 1.5 °C target. Effective plans and actions need to be urgently developed on how to achieve the ambitious targets associated with these targets, but not many countries have developed long-term strategies to achieve net zero emissions. The Asia–Pacific Integrated Model (AIM) team has been working with researchers and policymakers in Japan and other Asian countries to develop a long-term strategy toward a decarbonized society. Asia is a region with diverse countries, and there are many different pathways to achieve decarbonized societies. This paper presents the process of developing a long-term strategy for several Asian countries based on our experiences to date and discusses challenges and solutions, including how to use the AIM models in the policy-making process. [ABSTRACT FROM AUTHOR]

Introduction: Malaria is one of the most prevalent infectious diseases in subSaharan Africa, with 247 million cases reported worldwide in 2021 according to the World Health Organization. Optical microscopy remains the gold standard technique for malaria diagnosis, however, it requires expertise, is time-consuming and difficult to reproduce. Therefore, new diagnostic techniques based on digital image analysis using artificial intelligence tools can improve diagnosis and help automate it. Methods: In this study, a dataset of 2571 labeled thick blood smear images were created. YOLOv5x, Faster R-CNN, SSD, and RetinaNet object detection neural networks were trained on the same dataset to evaluate their performance in Plasmodium parasite detection. Attention modules were applied and compared with YOLOv5x results. To automate the entire diagnostic process, a prototype of 3D-printed pieces was designed for the robotization of conventional optical microscopy, capable of auto-focusing the sample and tracking the entire slide. Results: Comparative analysis yielded a performance for YOLOv5x on a test set of 92.10% precision, 93.50% recall, 92.79% F-score, and 94.40% mAP0.5 for leukocyte, early and mature Plasmodium trophozoites overall detection. F-score values of each category were 99.0% for leukocytes, 88.6% for early trophozoites and 87.3% for mature trophozoites detection. Attention modules performance show non-significant statistical differences when compared to YOLOv5x original trained model. The predictive models were integrated into a smartphone-computer application for the purpose of image-based diagnostics in the laboratory. The system can perform a fully automated diagnosis by the auto-focus and X-Y movements of the robotized microscope, the CNN models trained for digital image analysis, and the smartphone device. The new prototype would determine whether a Giemsa-stained thick blood smear sample is positive/negative for Plasmodium infection and its parasite levels. The whole system was integrated into the iMAGING smartphone application. Conclusion: The coalescence of the fully-automated system via auto-focus and slide movements and the autonomous detection of Plasmodium parasites in digital images with a smartphone software and AI algorithms confers the prototype the optimal features to join the global effort against malaria, neglected tropical diseases and other infectious diseases. [ABSTRACT FROM AUTHOR]

Background: HIV and malaria are serious public health concerns, particularly in Tanzania. HIV-infected individuals are more likely to get malaria and its complications. However, data on the interaction of the two diseases in Tanzania are limited. This cross-sectional study aimed to determine the prevalence of malaria infection and associated factors among HIV-infected adults attending HIV care and treatment clinic at Kitete regional referral hospital in Tabora region, Tanzania. Methodology: The cross-sectional study was carried out between March and May 2022 at Kitete regional referral hospital in Tanzania. A total of 246 HIV-infected adults were selected by systematic random sampling. Malaria was diagnosed using both malaria rapid diagnostic test (mRDT) and malaria microscopy. Social demographic data were collected using a structured questionnaire, while clinical history and laboratory parameters were extracted from patients' files. Data were analyzed using STATA version 15.1, and a p value < 0.05 was considered statistically significant. The study included consenting HIV+ adults and excluded pregnant women and recent antimalarial users. Results: Twenty-six out of 242 participants 10.7% (95% CI 6.9–15.6%) tested positive for malaria using mRDT, while 20 out of 242 participants 8.3% (95% CI 4.9–13.1%) tested positive for malaria using blood smear for malaria microscopy. Independent factors associated with malaria infection were living in rural areas (aOR = 2.81, 95% CI = 1.06–7.45, p = 0.038), poor adherence to anti-retroviral therapy (aOR = 3.66, 95% CI = 1.04–12.7, p = 0.043), HIV viral load of ≥ 1000 copies/mL (aOR = 3.2, 95% CI = 1.00–10.5, p = 0.02, CD4 count ≤ 350 cells/µL (aOR = 2.8, 95% CI = 1.10–7.30, p = 0.03), while using mosquito nets (aOR = 0.27, 95% CI = 0.08–0.90, p = 0.033) and receiving health education (aOR = 0.26, 95% CI = 0.09–0.71, p = 0.009) were protective factors. Conclusions: The study reveals a concerning prevalence of malaria infection among adult HIV patients at Kitete regional referral hospital. Risk factors identified include a high HIV viral load, low CD4 count, lack of health education, rural residence, and non-use of mosquito nets. The results emphasize the necessity for focused health education, enhanced access to preventive measures, and consistent adherence to ART to reduce the risk of malaria in this vulnerable population. [ABSTRACT FROM AUTHOR]

Mobile phone interviews are becoming an increasingly appealing mode of data collection in low- and middle-income countries. Therefore, we used data from 36 countries to examine mobile phone coverage of adults aged 15–49 years. We paid special attention to the (1) coverage rate (percentage of individuals who own at least one mobile phone) versus penetration rate (mobile phone subscriptions per 100 inhabitants), and (2) proxy-covered population (i.e. persons who do not own mobile phones but are potentially accessible through devices owned by other household members). Study findings suggest that (1) penetration rates notably overestimate mobile phone coverage of the population; (2) mobile phone coverage structure varies substantially; (3) mobile phone owners are more likely to be males, urban residents, literate, married, and relatively wealthy; and (4) proxy-covered adults are distinct with regard to demographic characteristics and survey outcomes in comparison to directly covered and not-covered adults. This study informs practitioners about the current coverage structure in several low- and middle-income countries and promotes proper procedures for studying coverage structure before implementing mobile phone interviews in those countries. Finally, this study introduces the term proxy-coverage and advocates for approaching the proxy-covered population to reduce noncoverage bias, especially in settings where mobile phone sharing among family members is common. [ABSTRACT FROM AUTHOR]

Concerns about climate change and energy security are driving a global shift towards renewable energy sources and green technologies such as electric vehicles (EVs), energy storage and wind turbines. This commentary analyses the policy challenges raised by the growing demand for critical metals needed for this green transition to net zero. It is crucial that the UK's strategy looks beyond merely increasing primary supply or new mining, towards strategies to ensure better stewardship of secondary mineral resources already contained in a range of products. Furthermore, creating an enabling regulatory environment for procuring key technology metals will be key to addressing future supply threats for the UK, especially post-Brexit, and that failure to do so will put the UK at significant risk of falling behind in the global race to secure supplies. [ABSTRACT FROM AUTHOR]

Background: Indoor residual spraying (IRS) and long-lasting insecticidal nets (LLINs) are two core interventions for control and prevention of malaria infection. This descriptive cross-sectional study aimed to determine the knowledge and practices of women regarding malaria and its preventive measures in a malarious area in the Jask County, southeast of Iran. Methods: Data was collected from 400 households through a two-stage random cluster sampling method in six villages. Pre-tested structured questionnaire was used to collect data. During the survey, visual observations were also made by the interviewers to check use of LLINs and IRS. The data were analyzed by SPSS software version 21. Results: The majority of households had a high level of knowledge about symptoms (98%, n=392) and transmission (74.5%, n=298) of malaria. The main preventive measures against malaria were: LLINS (39.5%, n=158), IRS (32%, n=128), and screens on doors/windows (16.7%, n=67). In addition, participants with primary or higher educational level reported that they practice more malaria preventive measures, compared to those who were illiterate (OR=3.3, 95% CI= 1.6–6.6, p=0.0001, Table 6). In spite of positive perceptions about IRS and LLINs, only 35.5% (n=142) and 17% (n=68) of households used IRS and LLINs, respectively. Conclusion: According to the results of this study, despite a high level of knowledge about malaria and its preventive measures, a small number of participants use LLINs and IRS for malaria prevention. Therefore, implementation of effective educational interventions is recommended to improve preventive practices against malaria in the study area. [ABSTRACT FROM AUTHOR]

Purpose: Anaemia remains a serious concern among pregnant women, and thus, it is closely monitored from the onset of pregnancy through to delivery to help prevent adverse maternal and neonatal outcomes. In malaria-endemic settings, continuous low-level carriage of P.falciparum parasites is common and its contribution to maternal anaemia should not be underestimated. In this study, we evaluated the impact of adherence to malaria control measures [number of antenatal clinics (ANC) attended, supervised intake of sulphadoxine pyrimethamine (SP), and use of insecticide treated bed nets (ITNs)] on asymptomatic malaria and anaemia outcomes among pregnant women on ANC in hospitals in the Central region of Ghana. Methods: The study was conducted during two seasons; October–November 2020 (dry season, n = 124) and May–June 2021 (rainy season, n = 145). Among the women, there was a high adherence to the control measures for both seasons (ANC ≥ 3 visits; ~ 82.0%, intake of SP; ~ 80.0% and ITNs use; ~ 75.0%). Results: Asymptomatic P. falciparum carriage was high for both seasons (44.4% for the dry season; 46.9% for the rainy season). Correspondingly, the occurrence of anaemia was high for both seasons (57.3% for the dry season; 68.3% for the rainy season) and was strongly predicted by carriage of P. falciparum parasites. Despite the high adherence to ANC protocols, asymptomatic P. falciparum infection was common and contributed to the high burden of maternal anaemia. Conclusions: Our findings emphasize the need for improved control measures that can clear asymptomatic/sub-microscopic P. falciparum infection and protect against malaria-induced anaemia among pregnant women attending ANC in malaria endemic-settings. [ABSTRACT FROM AUTHOR]

Childhood poverty is the most widespread and important modifiable risk factor for the development of a range of health outcomes, including childhood-onset mental health problems.1 In the United States, 30 million children are growing up impoverished, which ranks among the highest per capita rates of child poverty among high-income countries.2 As a nation, the United States does less to support its poor children and their families than any other wealthy country, despite scientific evidence that growing up in poverty significantly increases lifetime risk of physical and mental health problems, reduces likelihood of academic and vocational success, and leads to poorer social outcomes for children.1 Meanwhile, 2 decades of research in low- and middle-income countries has demonstrated that directly providing poor families with financial support (commonly referred to as cash transfer programs)—delivered as one-time lump sum or smaller payments over time—produces reliably positive effects on a range of outcomes, including improved parental mental health, food security, housing security, educational and vocational attainment, female empowerment within families, as well as family savings and ownership of durable goods.3-6 Critics of cash transfer programs, who argue that poor families will exhibit temptation spending patterns (ie, alcohol, entertainment, etc), are increasingly being proven wrong by this literature, as studies have shown that recipient families tend to invest in the supports their children need to thrive.7 [ABSTRACT FROM AUTHOR]

Background World Health Organization recommend the use of malaria vaccine, Mosquirix, as a malaria prevention strategy. However, Mosquirix has failed to reduce the global burden of malaria because of its inefficacy. The Mosquirix vaccine's modest effectiveness against malaria, 36% among kids aged 5 to 17 months who need at least four doses, fails to aid malaria eradication. Therefore, highly effective and efficacious malaria vaccines are required. The well-characterized P. falciparum circumsporozoite surface protein can be used to discover adjuvants that can increase the efficacy of Mosquirix. Therefore, the study sought to undertake an in-silico discovery of Plasmodium falciparum circumsporozoite surface protein inhibitors with pharmacological properties on Mosquirix using hierarchical virtual screening and molecular dynamics simulation. Results Monoclonal antibody L9, an anti-Plasmodium falciparum circumsporozoite surface protein molecule, was used to identify Plasmodium falciparum circumsporozoite surface protein inhibitors with pharmacological properties on Mosquirix during a virtual screening process in ZINCPHARMER that yielded 23 hits. After drug-likeness and absorption, distribution, metabolism, excretion, and toxicity property analysis in the SwissADME web server, only 9 of the 23 hits satisfied the requirements. The 9 compounds were docked with Plasmodium falciparum circumsporozoite surface protein using the PyRx software to understand their interactions. ZINC25374360 (-8.1 kcal/mol), ZINC40144754 (-8.3 kcal/mol), and ZINC71996727 (-8.9 kcal/mol) bound strongly to Plasmodium falciparum circumsporozoite surface protein with binding affinities of less than -8.0 kcal/mol. The stability of these molecularly docked Plasmodium falciparum circumsporozoite surface protein-inhibitor complexes were assessed through molecular dynamics simulation using GROMACS 2022. ZINC25374360 and ZINC71996727 formed stable complexes with Plasmodium falciparum circumsporozoite surface protein. They were subjected to in vitro validation for their inhibitory potential. The IC50 values ranging between 250 and 350 ng/ml suggest inhibition of parasite development. Conclusion Therefore, the two Plasmodium falciparum circumsporozoite surface protein inhibitors can be used as vaccine adjuvants to increase the efficacy of the existing Mosquirix vaccine. Nevertheless, additional in vivo tests, structural optimization studies, and homogenization analysis are essential to determine the anti-plasmodial action of these adjuvants in humans. [ABSTRACT FROM AUTHOR]

Background: Neuroendocrine tumors (NETs) early diagnosis is a clinical challenge that require a deep understanding of molecular and genetic features of this heterogeneous group of neoplasms. However, few biomarkers exist to aid diagnosis and to predict prognosis and treatment response. In the oncological field, tumor-educated platelets (TEPs) have been implicated as central players in the systemic and local responses to tumor growth, thereby altering tumor specific RNA profile. Although TEPs have been found to be enriched in RNAs, few studies have investigated the potential of a type of RNA, circular RNAs (circRNA), as platelet-derived biomarkers for cancer. In this proof-of-concept study, we aim to demonstrate whether the circRNAs signature of tumor educated platelets can be used as a liquid biopsy biomarker for the detection of gastroenteropancreatic (GEP)-NETs and the prediction of the early response to treatment. Methods: We performed a 24-months, prospective proof-of-concept study in men and women with histologically proven well-differentiated G1-G2 GEP-NET, aged 18–80 years, naïve to treatment. We performed a RNAseq analysis of circRNAs obtained from TEPs samples of 10 GEP-NETs patients at baseline and after 3 months from therapy (somatostatin analogs or surgery) and from 5 patients affected by non-malignant endocrinological diseases enrolled as a control group. Results: Statistical analysis based on p < 0.05 resulted in the identification of 252 circRNAs differentially expressed between GEP-NET and controls of which 109 were up-regulated and 143 were down-regulated in NET patients. Further analysis based on an FDR value ≤ 0.05 resulted in the selection of 5 circRNAs all highly significant downregulated. The same analysis on GEP-NETs at baseline and after therapy in 5 patients revealed an average of 4983 remarkably differentially expressed circRNAs between follow-up and baseline samples of which 2648 up-regulated and 2334 down-regulated, respectively. Applying p ≤ 0.05 and FDR ≤ 0.05 filters, only 3/5 comparisons gave statistically significant results. Conclusions: Our findings identified for the first time a circRNAs signature from TEPs as potential diagnostic and predictive biomarkers for GEP-NETs. [ABSTRACT FROM AUTHOR]

Background: Pyrethroid-PBO nets have demonstrated improved impact against clinical malaria transmitted by pyrethroid resistant mosquito vectors and are being scaled up across Africa. However very little is known about their physical and insecticidal durability under operational conditions. This study will investigate the attrition, fabric integrity, insecticide content and bioefficacy of DuraNet® Plus, a new WHO prequalified alphacypermethrin and PBO incorporated net developed by Shobikaa Impex Private Limited over 3 years of field use in communities in Benin, Cameroon and Tanzania. Methods: The study will be conducted in parallel in selected villages in Zakpota District in Benin, Mbalmayo, District in Cameroon and Muheza District in Tanzania. In each country, ~ 1800 households will be recruited and randomised to receive DuraNet® Plus or DuraNet® (a WHO prequalified alphacypermethrin-only ITN). Follow up surveys will be performed at 1 month post distribution to investigate adverse events and subsequently every 6–12 months to assess ITN attrition and fabric integrity following standard WHO procedures. A second cohort of nets will be withdrawn every 6–12 months and assessed for alpha-cypermethrin and PBO content and for entomological activity in laboratory bioassays (cone bioassays and tunnel tests). Alpha-cypermethrin bioefficacy will be monitored using the susceptible Anopheles gambiae Kisumu strain in cone bioassays while PBO bioefficacy will be monitored using pyrethroid resistant strains with overexpressed P450 enzymes in tunnel tests to determine the proportion of efficacious nets (≥ 95% knockdown, ≥ 80% mortality or ≥ 90% blood feeding inhibition in tunnels) at each time point. Nets withdrawn at 12, 24 and 36 months from each country will also be tested in experimental hut trials against wild free-flying pyrethroid resistant Anopheles gambiae sl in Côvè Benin to investigate the superiority of DuraNet® Plus over DuraNet® at each time point under semi field conditions. Conclusion: This large-scale multi country trial will provide useful information on the durability of a pyrethroid-PBO net (DuraNet® Plus) in 3 different regions in sub-Saharan Africa. The methods proposed for bioefficacy testing could also contribute towards the development of new standardised guidelines for monitoring the insecticidal efficacy of pyrethroid-PBO nets under operational conditions. [ABSTRACT FROM AUTHOR]

Background: The overlap in the epidemiology of malaria and helminths has been identified as a potential area to exploit for the development of an integrated control strategy that may help to achieve elimination of malaria and helminths. A randomized, controlled, observer-blind trial was conducted to assess the feasibility and safety of combining mass drug administration (MDA) for schistosomiasis and soil transmitted helminths (STH) with seasonal malaria chemoprevention (SMC) among children living in Senegal. Methods: Female and male children aged 1–14 years were randomized 1:1:1, to receive Vitamin A and Zinc on Day 0, followed by SMC drugs (sulfadoxine-pyrimethamine and amodiaquine) on Days 1–3 (control group); or praziquantel and Vitamin A on Day 0, followed by SMC drugs on Days 1–3 (treatment group 1); or albendazole and praziquantel on Day 0, followed by SMC drugs on Days 1–3 (treatment group 2). Safety assessment was performed by collecting adverse events from all children for six subsequent days following administration of the study drugs. Pre- and post-intervention, blood samples were collected for determination of haemoglobin concentration, malaria microscopy, and PCR assays. Stool samples were analyzed using Kato-Katz, Merthiolate-iodine-formalin and PCR methods. Urine filtration, PCR and circulating cathodic antigen tests were also performed. Results: From 9 to 22 June 2022, 627 children aged 1–14 years were randomized into the three groups described above. Mild, transient vomiting was observed in 12.6% (26/206) of children in treatment group 2, in 10.6% (22/207) in group 1, and in 4.2% (9/214) in the control group (p = 0.005). Pre-intervention, the geometric mean value of Plasmodium falciparum parasite density was highest among children who received albendazole, praziquantel with SMC drugs. Post-intervention, the parasite density was highest among children who received SMC drugs only. Children who received praziquantel and SMC drugs had a lower risk of developing severe anaemia than their counterparts who received SMC drugs alone (OR = 0.81, 95% CI 0.13–5.00, p = 0.63). Conclusions: Integration of MDA for helminths with SMC drugs was safe and feasible among Senegalese children. These findings support further evaluation of the integrated control model. Trial registration: The study is registered at Clinical Trial.gov NCT05354258. [ABSTRACT FROM AUTHOR]

The wealth-health relationship is not unambiguous and constant. Greater wealth affects individual and population health in opposite ways. Increased risk factors especially raise the probability of noncommunicable diseases (NCDs) impacting a population. Conversely, better healthcare and awareness reduce the chances of developing these diseases or increase the likelihood of treatment and cure. Therefore, this paper aims to assess and quantify the hard-to-grasp overall impact of prosperity on mortality from selected NCDs, allowing us to capture the relevant differences between European regions. In particular, we attempt to estimate the net effect of affluence and the health economic threshold of the GDP-mortality relationship, by developing a dedicated analytical tool based on joinpoint regression and forecasting methods. Our results show that in the case of most investigated diseases in more impoverished regions, a clear pattern reflects mortality rising with prosperity. After crossing the health economic threshold of around 20 thousand euros per capita, the trend changes by stabilising or reversing. The research we present shows that health policy should be more diversified locally to enable health convergence at the national and European regional levels. Moreover, health policy should evolve to prioritise mental and neurological disorders, by improving the resource allocation and increasing public awareness. [ABSTRACT FROM AUTHOR]

Temperate forest soils are net sources of carbon dioxide (CO2) and net sinks for methane (CH4), the two greenhouse gases most responsible for contemporary global climate change. Both soil carbon fluxes are sensitive to their local tree communities due to the direct effects of tree traits as well as indirect effects of associated soil properties. We asked how tree species identity and diversity predicts the flux of CO2 and CH4 from soils, how the two net fluxes are related, and what tree and soil characteristics predict their magnitudes. In a mixed temperate forest in central Massachusetts, we established 49 plots containing either a single tree species or a combination of those species and measured growing season soil CO2 and CH4 fluxes for two years. We found generally greater soil CO2 and CH4 fluxes associated with deciduous tree species. CH4 uptake rates were more sensitive to tree species than were CO2 fluxes. Tree species mixtures lead to predictable intermediate fluxes of CO2, but mixtures resulted in lower than predicted CH4 uptake. Soil CO2 emission and CH4 uptake were both positively related to total litter inputs. Soil CO2 emission was additionally associated with warmer temperatures and a lower ratio of soil carbon to nitrogen; in contrast, CH4 uptake was associated with lower soil moisture and a shallower organic horizon. Thus, tree species community composition may prove useful for predicting soil carbon fluxes, but much remains to be discovered about the mechanisms linking tree species to associated microbial and biogeochemical processes. [ABSTRACT FROM AUTHOR]

Background/Aims: Although gastric neuroendocrine tumors (NETs) are uncommon neoplasms, their prevalence is increasing. The clinical importance of the World Health Organization (WHO) classification of gastric NETs, compared with NETs in other organs, has been underestimated. This study aimed to systematically evaluate the clinical and pathologic characteristics of gastric NETs based on the 2019 WHO classification and to assess the survival outcomes of patients from a single-center with a long-term follow-up. Methods: The medical records of 427 patients with gastric NETs who underwent endoscopic or surgical resection between January 2000 and March 2020 were retrospectively reviewed. All specimens were reclassified according to the 2019 WHO classification. The clinicopathologic characteristics, treatment, and oncologic outcomes of 139 gastric NETs were analyzed. Results: The patients’ median age was 53.0 years (interquartile range [IQR], 46.0 to 63.0 years). The median follow-up period was 36.0 months (IQR, 15.0 to 63.0 months). Of the patients, 92, 44, and 3 had grades 1, 2, and 3 NETs, respectively. The mean tumor size significantly increased as the tumor grade increased (p=0.025). Patients with grades 2 and 3 gastric NETs more frequently had lymphovascular invasion (29.8% vs 10.9%, p=0.005) and deeper tissue invasion (8.5% vs 0%, p=0.012) than those with grade 1 tumors. The overall disease-specific survival rate was 100%. Two patients with grades 2-3 gastric NETs experienced extragastric recurrence. Conclusions: Although gastric NETs have an excellent prognosis, grade 2 or grade 3 gastric NETs are associated with a larger size, deeper invasion, and extragastric recurrence, which require active treatment. [ABSTRACT FROM AUTHOR]

The dengue viruses (of which there are four strains) are the causes of three illnesses of increasing severity; dengue fever (DF), dengue hemorrhagic fever (DHF) and dengue shock syndrome (DSS). Recently, dengue fever has reached epidemic proportion in several countries. Strategies or preventative methods have to be developed to combat these epidemics. This can be done by development of vaccines or by preventing the transmission of the virus. The latter approach could involve the use of mosquito nets or insecticide spraying. To determine which strategy would work, we test the strategy using mathematical modeling to simulate the effects of the strategy on the dynamics of the transmission. We have chosen the Susceptible-Exposed-Infected-Recovered (SEIR) model and the Susceptible-Exposed-Infected (SEI) model to describe the human and mosquito populations, repectively. We use the Pontryagin's maximum principle to find the optimal control conditions. A sensitivity analysis revealed that the transmission rate (γhγv), the birth rate of human population (Uh), the constant recruitment rate of the vector population (Nh) and the total human population (Hh) are the most influential factors affecting the disease transmission. Numerical simulations show that the optimal controlled infective responses, when implemented, cause the convergence to zero to be faster than that in uncontrolled cases. [ABSTRACT FROM AUTHOR]

Background: Malaria infection during pregnancy is an important cause of maternal and infant mortality and morbidity with the greatest effect being concentrated in sub-Saharan Africa. In areas of moderate to high malaria transmission, the World Health Organization (WHO) recommends the administration of intermittent preventive treatment of malaria in pregnancy (IPTp) using sulfadoxine-pyrimethamine (SP) to be given to all pregnant women at each scheduled antenatal care visit at monthly intervals. However, there is concern that increased resistance has compromised its effectiveness. This has led to a need for evaluation of alternatives to SP for IPTp with dihydroartemisinin-piperaquine (DP) emerging as a very promising candidate. Thus, this systematic review and aggregated data meta-analysis was conducted to establish the safety and tolerability of repeated doses with DP in IPTp. Methods: A systematic review and aggregated data meta-analysis of randomized controlled trials (RCTs) was performed by searching electronic databases of PubMed, Science Direct, ClinicalTrials.gov and Google Scholar. RCTs comparing IPTp DP versus recommended standard treatment for IPTp with these outcome measures were analyzed; change in QTc interval, serious adverse events (SAE), grade 3 or 4 adverse events possibly related to study drug and vomiting within 30 min after study drug administration. The search was performed up to 24th June 2023. Data was extracted from eligible studies and an aggregated data meta-analysis was carried out with data pooled as risk ratio (RR) with a 95% confidence interval (CI), using RevMan software (5.4). This study is registered with PROSPERO, CRD42022310041. Results: Six RCTs involving 7969 participants were included in this systematic review and aggregated data meta-analysis. The pooled analysis showed that DP was associated with a change from baseline of the QTc interval although this change was not associated with cardiotoxicity. There was no statistically significant difference in the risk of occurrence of SAEs among participants in both treatment groups (RR = 0.80, 95% CI [0.52–1.24], P = 0.32). However, significant difference was observed in grade 3 or 4 AEs possibly related to study drug where analysis showed that subjects on IPT DP were statistically significantly more likely to experience an AE possibly related to study drug than subjects on IPT SP (RR = 6.65, 95% CI [1.18–37.54], P = 0.03) and in vomiting within 30 min after study drug administration where analysis showed that the risk of vomiting is statistically significantly higher in subjects receiving IPT DP than in subjects receiving IPT SP (RR = 1.77, 95% CI [1.02–3.07], P = 0.04). Conclusion: DP was associated with a higher risk of grade 3 or 4 AEs possibly related to study drug and a higher risk of vomiting within 30 min after study drug administration. However, these were experienced in a very small percentage of women and did not affect adherence to study drugs. DP was also better tolerated in these studies as compared to most alternatives that have been proposed to replace SP which have proved to be too poorly tolerated in IPTp use. [ABSTRACT FROM AUTHOR]

Background: Uganda implemented its third mass campaign to distribute long-lasting insecticidal nets (LLINs) in 2020 during the COVID-19 pandemic. This context necessitated modification of implementation guidelines. The mass campaign's objective was to ensure that at least 85% of the targeted population had access to LLINs. Methods: Revised implementation guidelines were followed while conducting the LLIN distribution campaign. Lessons learned were captured from documented activities and reports. Results: A total of 27,789,044 mosquito nets were distributed in 11,287,392 households, with an average of 5.1 persons per household. Household coverage of the LLIN distribution was 94.1%. The 2020/2021 campaign design was modified to follow COVID-19 Standard Operating Procedures (SOPs). These included using Personal Protective Equipment (PPE), e-platforms for training and briefing meetings, electronic data management systems and door-to-door household registration and distribution of LLINs. Conclusions: Campaign modifications due to the COVID-19 pandemic were effective in implementing mass distribution of LLINs despite the disruptions and restrictions. The campaign's net coverage far exceeded its objective. Electronic data management was critical in monitoring and reporting distribution activities. [ABSTRACT FROM AUTHOR]

Background: Plasmodium vivax malaria is considered a major threat to malaria eradication. The radical cure for P. vivax malaria normally requires a 14-day administration of primaquine (PQ) to clear hypnozoites. However, maintaining adherence to PQ treatment is a significant challenge, particularly in malaria-endemic rural areas. Hence, this study aimed to formulate interventions for promoting patients' commitment to PQ treatment in a highly malaria-endemic township in Myanmar. Methods: A qualitative study was conducted in Waingmaw Township in northern Myanmar, where P. vivax malaria is highly endemic. Key stakeholders including public health officers and community members participated in focus group discussions (FGDs) and in-depth interviews (IDIs) in September 2022. Data were collected using validated guidelines, translated into English, and visualized through thematic analysis. Results: Responsible individuals from different levels of the Myanmar National Malaria Control Programme participated in the IDIs. Most of them reported being aware of the markedly increasing trend of P. vivax and the possibility of relapse cases, especially among migrants who are lost to follow-up. Workload was a key concern surrounding intervention implementation. The respondents discussed possible interventions, such as implementing directly observed treatment (DOT) by family members, piloting a shorter PQ regimen, expanding the community's malaria volunteer network, and strengthening health education activities using local languages to promote reasonable drug adherence. FGDs among community members revealed that although people were knowledgeable about malaria symptoms, places to seek treatment, and the use of bed nets to prevent mosquito bites, most of them still preferred to be treated by quack doctors and rarely used insecticide-treated nets at worksites. Many often stopped taking the prescribed drugs once the symptoms disappeared. Nevertheless, some respondents requested more bed nets to be distributed and health promotion activities to be conducted. Conclusion: In rural areas where human resources are limited, interventions such as implementing family member DOT or shortening PQ regimens should be introduced to enhance the radical cure for the P. vivax infection. Disseminating information about the importance of taking the entire treatment course and emphasizing the burden of relapse is also essential. [ABSTRACT FROM AUTHOR]

Background: The commercial sector plays a vital role in mosquito net ownership and access in Tanzania. The National Malaria Strategic Plan (NMSP) includes long-lasting insecticidal nets (LLIN) delivery through the commercial sector as a complementary mechanism. The NMSP aims to increase LLIN sales while decreasing untreated mosquito net sales. This survey aimed to track quantities, market share of different net categories, prices, and origins of mosquito nets in retail markets and to engage stakeholders to analyse market trends. Methods: This mixed-method mosquito net retail outlet survey was conducted in mid-2021 in six and in mid-2022 in eight regions. Field teams identified net-selling outlets in major urban and peri-urban markets and used snowball sampling to identify additional outlets. A structured questionnaire was used, and photos of available mosquito net products were taken. Key informant interviews were conducted with wholesalers and retailers. The relative market share of a product was calculated by using the mean of each sales category as frequency weights. Qualitative data analysis was undertaken by summarizing common themes and observations based on the research question. Results: A total of 394 and 1139 outlets were surveyed in 2021 and 2022, respectively. More than 96% of distributed brands in both years were untreated nets. The market share for untreated mosquito nets was 99.2% in 2021 and 88.3% in 2022. Bed net sales were seasonal, peaking in the rainy season and at the start of the school year. Leaked LLINs from the public sector comprised 0.3% of the market share in 2021 and 8.3% in 2022. Kigoma markets had the most significant frequency of leaked LLIN products. Legitimate LLINs were rare in 2021 (n = 2) and not found in 2022, despite the presence of a local LLIN manufacturer. A small number (n = 3) of untreated nets fabricated in China claiming to be LLINs were observed in 2022. Conclusions: Despite NMCP's strategic approach to increasing retail market share for legitimate LLINs, significant challenges remain. Efforts are needed to change the current situation given the context of large-scale public sector distributions of LLINs, the higher consumer cost of LLINs, the lack of bed net varieties. Improvement of registration process is recommended. [ABSTRACT FROM AUTHOR]

This paper explores why salmon harvesters in rural Alaska choose to sell their transferable permits. Household survey data from 10 remote Alaskan villages is combined with data on individual landings. Drift permit holders are more likely to sell their permits when average permit prices are low due to volatility in salmon runs or competition from aquaculture. These participants in the capital-intensive sector of the fishery are more likely to be in debt and liquidate assets under financial duress. Conversely, set net permit holders are more likely to liquidate their assets following life events such as the birth of a child or a divorce. For both types of permit holders, covariate shocks to salmon runs and prices are more important predictors of sale than individual productivity within the fishery. These results demonstrate that in the context of highly variable salmon runs, the transferability of property rights may undermine the economic sustainability of coastal communities. [ABSTRACT FROM AUTHOR]

Key Features Recently updated and expanded, the World Health Organization (WHO) Health Inequality Data Repository is a large repository for datasets of disaggregated data, covering a diversity of topics, dimensions of inequality and populations. To our knowledge, it is the largest global data repository of disaggregated health data and provides access to disaggregated data for all SDG indicators, where these data are available. Additional searching and consultation were undertaken to identify other sources of data, focusing first on global datasets (containing data from any/all countries), and then on regional and continental datasets (containing data from multiple countries). Data resource basics Disaggregated health data are a central requirement for health inequality monitoring, which is the process of quantifying and assessing health inequalities in a defined population. [Extracted from the article]

Background: Primary graft dysfunction (PGD), a significant complication that can affect patients' prognosis and quality of life, develops within 72 h post lung transplantation (LTx). Early detection and prevention of PGD should be given special consideration. The purpose of this study was to create a clinical prediction model to forecast the occurrence of PGD. Methods: We collected information on 622 LTx patients from Wuxi People's Hospital from 2016 to 2020 and used the data to construct the prediction model. Information on 224 patients from 2021 to June 2022 was used for external validation. We used LASSO regression for variable screening. A nomogram was developed for model presentation. Distinctness, fit, and calibration were used to evaluate the performance of the model. Results: Subjects with respiratory failure, who received fresh frozen plasma, donor age, donor gender, donor mechanism of death, donor smoking, donor ventilator use time, and donor PaO 2/FiO 2 ratio were independent predictor variables for the occurrence of PGD. The area under the curve of the nomogram was.779. The Hosmer‐Lemeshow test showed a good model fit (P =.158). The calibration curve of the nomogram is fairly close to the ideal diagonal. Moreover, the decision curve analysis revealed a positive net benefit of the model. External validation also confirmed the reliability of the model. Conclusions: The nomogram of PGD based on clinical risk factors in postoperative LTx patients was established with high reliability. It provides clinicians and nurses with a new and effective tool for early prediction of PGD and early intervention. [ABSTRACT FROM AUTHOR]

Size‐based indicators are appropriate for monitoring status and guiding management of multi‐species, multi‐gear fisheries, such as coral reef fisheries. From May 2018 to April 2019, size distribution and composition of coral reef fish catches were monitored through a participatory landing survey in southwestern Madagascar. Fishers targeted a large diversity of fish taxa (75 families) and range of sizes (1.6–86 cm). Five predominant gears accounted for most of the catch (1360 [±39] t), including mosquito net trawl (27.7%), beach seine (26.8%), speargun (7.2%), gillnet (30.6%), and handline (7.1%). Due to widespread use of gears made from mosquito nets, 75% of fishes smaller than 9 cm and 47% of juvenile fishes were represented in the total catch number. Large‐size taxa (Scaridae, Lethrinidae, Siganidae, Acanthuridae, Synodontidae, Mullidae, and Labridae) were mostly harvested as juveniles. Catches varied by 8%–70% throughout the year. Size of coral reef fish, annual catches, and catch rates all declined since the 1990s. [ABSTRACT FROM AUTHOR]

Neutrophil and neutrophil extracellular traps (NETs) were reported to be associated with tumor development, but the exact role and concrete mechanisms are still poorly understood, especially in triple negative breast cancer (TNBC). In this study, our results exhibited that NETs formation in TNBC tissues was higher than that in non-TNBC tissues, and NETs formation was distinctly correlated with tumor size, ki67 level and lymph node metastasis in TNBC patients. Subsequent in vivo experiments demonstrated that NETs inhibition could suppress TNBC tumor growth and lung metastasis. Further in vitro experiments uncovered that oncogenic function of NETs on TNBC cells were possibly dependent on TLR9 expression. We also found that neutrophils from peripheral blood of TNBC patients with postoperative fever were prone to form NETs and could enhance the proliferation and invasion of TNBC cells. Mechanistically, we revealed that NETs could interact with TLR9 to decrease Merlin phosphorylation which contributed to TNBC cell ferroptosis resistance. Our work provides a novel insight into the mechanism of NETs promoting TNBC progression and blocking the key modulator of NETs might be a promising therapeutic strategy in TNBC. [ABSTRACT FROM AUTHOR]

The article discusses the intersection of medical statistics and artificial intelligence (AI), highlighting the challenges faced in applying AI to biomedical data analysis and the need for a balance between learning from data and ensuring accuracy, robustness, and reproducibility of data-driven conclusions in medical research. It emphasizes the unique features of AI that make it powerful yet statistically vulnerable and explores challenges related to population inference.

Drugs targeting multiple stages of the Plasmodium vivax life cycle are needed to reduce the health and economic burdens caused by malaria worldwide. N-myristoyltransferase (NMT) is an essential eukaryotic enzyme and a validated drug target for combating malaria. However, previous PvNMT inhibitors have failed due to their low selectivity over human NMTs. Herein, we apply a structure-guided hybridization approach combining chemical moieties of previously reported NMT inhibitors to develop the next generation of PvNMT inhibitors. A high-resolution crystal structure of PvNMT bound to a representative selective hybrid compound reveals a unique binding site architecture that includes a selective conformation of a key tyrosine residue. The hybridized compounds significantly decrease P. falciparum blood-stage parasite load and consistently exhibit dose-dependent inhibition of P. vivax liver stage schizonts and hypnozoites. Our data demonstrate that hybridized NMT inhibitors can be multistage antimalarials, targeting dormant and developing forms of liver and blood stage. Developing selective N-myristoyltransferase (NMT) inhibitors has been challenging. Here, the authors describe selective NMT inhibitors that can be used as multistage antimalarials, targeting dormant and developing forms of liver and blood stage. [ABSTRACT FROM AUTHOR]

Background: The recent monsoon flood in Pakistan triggered a surge in various diseases, particularly affecting Sindh. This study was conducted to assess the prevalence of malaria in the Khairpur district during the flood pandemic. Methods: A cross-sectional study was carried out in the Khairpur district on the rural population during the flood pandemic of 2022, spanning from August to September. Due to the flood, numerous patients exhibited fever and malaria-related symptoms. Using convenient purposive sampling, all symptomatic patients underwent malaria testing through the ICT (immunochromatographic test) method. Results: Throughout the study period, 2383 individuals presented with malaria-like symptoms. Among them, 1932 individuals tested positive for malaria, resulting in a prevalence of 81.1%. Among the malaria-positive cases, Plasmodium vivax was detected in 1431 (74%) cases, while Plasmodium falciparum was identified in 501 (26%) individuals. Notably, 85% of males, 67% of non-pregnant females, 36% of pregnant females, 65% of children up to 8 years old, and 95% of children aged 9-18 were afflicted with malaria. Conclusion: The prevalence of malaria in flood-affected areas is alarmingly high. While the elevated prevalence of Plasmodium vivax poses a substantial health risk, the presence of Plasmodium falciparum may lead to severe complications. [ABSTRACT FROM AUTHOR]

Anemia is a common problem when patients present with cancer, and it can worsen during treatment. Anemia can directly impact the cognitive and physical quality of life and may impair fitness for oncological therapy. The most common cause of anemia is iron deficiency. Newer intravenous (IV) iron formulations offer a safe and rapidly effective treatment option. We performed a systematic mapping review of randomized controlled trials (RCTs) evaluating intravenous iron therapy in patients with cancer and anemia and their outcomes. A total of 23 RCTs were identified. The median number of patients enrolled was 104 (IQR: 60–134). A total of 5 were focused on surgical outcomes (4 preoperative, 1 postoperative), and 15 were in adjuvant therapies for a variety of tumor types (breast, colorectal, lung, gynecological, myeloid, and lymphomas), 10 of which were in combination with erythropoietin-stimulating agents (ESAs) therapy, 2 in radiotherapy, and 1 in palliative care. Overall, the studies reported that the use of IV iron increased hemoglobin concentration and decreased transfusion rates during different cancer treatment regimes. IV iron can be administered safely throughout the cancer treatment pathway from primary surgery to the palliative setting. More studies are needed to demonstrate net clinical outcomes. [ABSTRACT FROM AUTHOR]

Objectives: A chargemaster is a database of all of the billable items offered by a hospital with their base price listings. A 2018 executive order required all American hospitals to publish their chargemasters to increase price transparency and reduce healthcare expenditures. Chargemaster listings, however, demonstrate marked variability and inconsistency and have not been associated with consumer benefit. The objective of this study was to analyze chargemasters for commonly billed interventional cardiology procedures across five diverse states to explore relationships between price listings and hospital characteristics, ownership, location, and hospital quality. Methods: Chargemasterswere downloaded fromhospitals in five states selected to represent the nation's healthcare diversity. Price listings for five interventional cardiology procedures (percutaneous coronary angiography, coronary angiography, single-vessel angioplasty, single-vessel stent, and percutaneous coronary intervention of acute myocardial infarction) were extracted. Statistical analyses such as the Kruskal-Wallis test were performed to explore relationships between mean chargemaster price listings for each procedure and hospital characteristics, ownership, location, and quality ratings. Results: The median mean chargemaster price of four of the five interventional cardiology procedures significantly differed across all states. Price listings were significantly higher in urban versus rural areas and in general acute care hospitals and state government-owned facilities. The highest prices were found with the highest hospital quality rating. Conclusions: Chargemaster price listings for common interventional cardiology procedures varied significantly across these five states. Urban and metropolitan hospital location, hospital type, and hospital ownership could be factors driving increased chargemaster procedure prices. Prices were highest at hospitals with the highest quality rating. [ABSTRACT FROM AUTHOR]

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Background: Zanzibar has made substantial progress in malaria control with vector control, improved diagnosis, and artemisinin-based combination therapy. Parasite prevalence in the population has remained around 1% but imported infections from mainland Tanzania contribute to sustained local transmission. Understanding travel patterns between mainland Tanzania and Zanzibar, and the risk of malaria infection, may help to control malaria importation to Zanzibar. Methods: A rolling cross-sectional survey linked to routine reactive case detection of malaria was carried out in Zanzibar between May 2017 and October 2018. Households of patients diagnosed with malaria at health facilities were surveyed and household members were tested for malaria using rapid diagnostic tests and a sub-sample by quantitative PCR (qPCR). Interviews elicited a detailed travel history of all household members who had travelled within the past two months, including trips within and outside of Zanzibar. We estimated the association of malaria infection with travel destinations in pre-defined malaria endemicity categories, trip duration, and other co-variates using logistic regression. Results: Of 17,891 survey participants, 1177 (7%) reported a recent trip, of which 769 (65%) visited mainland Tanzania. Among travellers to mainland Tanzania with travel destination details and a qPCR result available, 241/378 (64%) reported traveling to districts with a 'high' malaria endemicity and for 12% the highest endemicity category was 'moderate'. Travelers to the mainland were more likely to be infected with malaria parasites (29%, 108/378) than those traveling within Zanzibar (8%, 16/206) or to other countries (6%, 2/17). Among travellers to mainland Tanzania, those visiting highly endemic districts had a higher odds of being qPCR-positive than those who travelled only to districts where malaria-endemicity was classified as low or very low (adjusted odd ratio = 7.0, 95% confidence interval: 1.9–25.5). Among travellers to the mainland, 110/378 (29%) never or only sometimes used a mosquito net during their travel. Conclusions: Strategies to reduce malaria importation to Zanzibar may benefit from identifying population groups traveling to highly endemic areas in mainland Tanzania. Targeted interventions to prevent and clear infections in these groups may be more feasible than attempting to screen and treat all travellers upon arrival in Zanzibar. [ABSTRACT FROM AUTHOR]