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Fact-checking has been changing in recent years from an initial stage in which fact-checkers were more concerned with political discourse to a stage in which combating misinformation becomes the primary purpose. This work examines more closely the standardizing and the customizing aspects of active fact-checking outlets in Portuguese-speaking countries, focusing on the verification methods and organizational models in use.

Este artículo analiza la polarización política en Argentina durante los gobiernos peronistas entre 1946 y 1955. Identificamos los temas que dividieron la opinión pública a partir de referencias documentales y bibliográficas que tratan de las políticas de gobierno y la relación del gobierno con los medios de comunicación. Para ilustrar los temas polarizadores, compilamos tapas del diario Clarín del mismo período. Metodológicamente, para la reconstrucción del contexto político y mediático, trabajamos con la propuesta de “negociación de las escenas mediáticas” (Schuliaquer, 2017, 2020). Para identificar los temas que dividieron la opinión pública, usamos el concepto de “tópicos disparadores” (Baldassarri, Bearman, & Baldassarri, 2016). Las dicotomías que operaron para la polarización política en este momento en Argentina eran agricultura/industria, elite/clase trabajadora y popular, iglesia/estado, capital nacional/capital extranjero y libertad/autoridad estatal.

Background: Girl child, early, and forced marriage (CEFM) persists in South Asia, with long-term effects on well-being. CARE's Tipping Point Initiative (TPI) sought to address the gender norms and inequalities underlying CEFM by engaging participant groups on programmatic topics and supporting community dialogue to build girls' agency, shift power relations, and change norms. We assessed impacts of the CARE TPI on girls' multifaceted agency and risk of CEFM in Nepal. Methods: The quantitative evaluation was a three-arm, cluster-randomized controlled trial (control; Tipping Point Program [TPP]; Tipping Point Plus Program [TPP+] with emphasized social-norms change). Fifty-four clusters of ∼200 households each were selected from two districts (27:27) with probability proportional to size and randomized evenly to study arms. A pre-baseline census identified unmarried girls 12–16 years (1,242) and adults 25 years or older (540). Questionnaires covered marriage; agency; social networks/norms; and discrimination/violence. Baseline participation was 1,140 girls and 540 adults. Retention was 1,124 girls and 531 adults. Regression-based difference-in-difference models assessed program effects on 15 agency-related secondary outcomes. Cox-proportional hazard models assessed program effects on time to marriage. Sensitivity analyses assessed the robustness of findings. Results: At follow-up, marriage was rare for girls (

To reliably predict the distribution of heat and particle fluxes at the target plates of tokamaks, a comprehensive understanding of turbulence throughout the entire Scrape-Off-Layer (SOL) is imperative. This study examines divertor turbulence systematically across a broad parameter range on the TCV tokamak, including variations in magnetic field direction, plasma current $I_{\mathrm{p}} \in [140, 320]$ kA, edge safety factor $q_{95} \in [2.6,4.7]$ and Greenwald fraction $f_{\mathrm{G}}\in [0.18,0.6]$ . The TCV X-point Gas Puff Imaging (GPI) system is used to measure 2D filament properties in the inner and outer divertor region. The fluctuation levels in the divertor are found to strongly increase with density (to 80% over most of the SOL) while remaining insensitive to $I_{\mathrm{p}}$ . The previously identified divertor-localized filaments (DLF), located on the bad curvature side of the outer divertor leg, are found to be a common feature on TCV, while no filaments are observed in the PFR. DLFs are present over most of the parameter space and in both field directions. However, they are absent, or appear only closer to the target, for sufficiently large $\Lambda_{\mathrm{div}}\gtrsim 10$ or $q_{95}\gtrsim3.7$ . Across both $I_{\mathrm{p}}$ and $f_{\mathrm{G}}$ scans, some clear trends with $\Lambda_{\mathrm{div}}$ are found for divertor filament sizes and velocities, and with target fall-off lengths of density and heat flux profiles at the outer target. This study provides important experimental insights to turbulent transport in the divertor also for comparison with self-consistent, turbulence simulations and extrapolation to future reactor conditions.

Tokamak à configuration variable (TCV), recently celebrating 30 years of near-continual operation, continues in its missions to advance outstanding key physics and operational scenario issues for ITER and the design of future power plants such as DEMO. The main machine heating systems and operational changes are first described. Then follow five sections: plasma scenarios. ITER Base-Line (IBL) discharges, triangularity studies together with X3 heating and N2 seeding. Edge localised mode suppression, with a high radiation region near the X-point is reported with N _2 injection with and without divertor baffles in a snowflake configuration. Negative triangularity (NT) discharges attained record, albeit transient, β _N ∼ 3 with lower turbulence, higher low-Z impurity transport, vertical stability and density limits and core transport better than the IBL. Positive triangularity L-Mode linear and saturated ohmic confinement confinement saturation, often-correlated with intrinsic toroidal rotation reversals, was probed for D, H and He working gases. H-mode confinement and pedestal studies were extended to low collisionality with electron cyclotron heating obtaining steady state electron iternal transport barrier with neutral beam heating (NBH), and NBH driven H-mode configurations with off-axis co-electron cyclotron current drive. Fast particle physics. The physics of disruptions, runaway electrons and fast ions (FIs) was developed using near-full current conversion at disruption with recombination thresholds characterised for impurity species (Ne, Ar, Kr). Different flushing gases (D2, H2) and pathways to trigger a benign disruption were explored. The 55 kV NBH II generated a rich Alfvénic spectrum modulating the FI fas ion loss detector signal. NT configurations showed less toroidal Alfvén excitation activity preferentially affecting higher FI pitch angles. Scrape-off layer and edge physics. gas puff imaging systems characterised turbulent plasma ejection for several advanced divertor configurations, including NT. Combined diagnostic array divertor state analysis in detachment conditions was compared to modelling revealing an importance for molecular processes. Divertor physics. Internal gas baffles diversified to include shorter/longer structures on the high and/or low field side to probe compressive efficiency. Divertor studies concentrated upon mitigating target power, facilitating detachment and increasing the radiated power fraction employing alternative divertor geometries, optimised X-point radiator regimes and long-legged configurations. Smaller-than-expected improvements with total flux expansion were better modelled when including parallel flows. Peak outer target heat flux reduction was achieved (>50%) for high flux-expansion geometries, maintaining core performance ( H _98 > 1). A reduction in target heat loads and facilitated detachment access at lower core densities is reported. Real-time control. TCV’s real-time control upgrades employed MIMO gas injector control of stable, robust, partial detachment and plasma β feedback control avoiding neoclassical tearing modes with plasma confinement changes. Machine-learning enhancements include trajectory tracking disruption proximity and avoidance as well as a first-of-its-kind reinforcement learning-based controller for the plasma equilibrium trained entirely on a free-boundary simulator. Finally, a short description of TCV’s immediate future plans will be given.

Within the 9th European Framework programme, since 2021 EUROfusion is operating five tokamaks under the auspices of a single Task Force called ‘Tokamak Exploitation’. The goal is to benefit from the complementary capabilities of each machine in a coordinated way and help in developing a scientific output scalable to future largre machines. The programme of this Task Force ensures that ASDEX Upgrade, MAST-U, TCV, WEST and JET (since 2022) work together to achieve the objectives of Missions 1 and 2 of the EUROfusion Roadmap: i) demonstrate plasma scenarios that increase the success margin of ITER and satisfy the requirements of DEMO and, ii) demonstrate an integrated approach that can handle the large power leaving ITER and DEMO plasmas. The Tokamak Exploitation task force has therefore organized experiments on these two missions with the goal to strengthen the physics and operational basis for the ITER baseline scenario and for exploiting the recent plasma exhaust enhancements in all four devices (PEX: Plasma EXhaust) for exploring the solution for handling heat and particle exhaust in ITER and develop the conceptual solutions for DEMO. The ITER Baseline scenario has been developed in a similar way in ASDEX Upgrade, TCV and JET. Key risks for ITER such as disruptions and run-aways have been also investigated in TCV, ASDEX Upgrade and JET. Experiments have explored successfully different divertor configurations (standard, super-X, snowflakes) in MAST-U and TCV and studied tungsten melting in WEST and ASDEX Upgrade. The input from the smaller devices to JET has also been proven successful to set-up novel control schemes on disruption avoidance and detachment.

The Super-X Divertor (SXD) is an alternative divertor configuration leveraging total flux expansion at the Outer Strike Point (OSP). While the extended 2-Point Model (2PM) predicts facilitated detachment access and control in the SXD configuration, these attractive features are not always retrieved experimentally. These discrepancies are at least partially explained by the effect of parallel flows which, when self-consistently included in the 2PM, reveal the role of total flux expansion on the pressure balance and weaken the total flux expansion effect on detachment access and control, compared to the original predictions. This new model can partially explain the discrepancies between the 2PM and experiments performed on tokamak à configuration variable (TCV), in ohmic L-mode scenarios, which are particularly apparent when scanning the OSP major radius Rt. In core density ramps in lower Single-Null (SN) configuration, the impact of Rt on the CIII emission front movement in the divertor outer leg—used as a proxy for the plasma temperature in the divertor—is substantially weaker than 2PM predictions. Furthermore, in OSP radial sweeps in lower and upper SN configurations, in ohmic L-mode scenarios with a constant core density, the peak parallel particle flux density at the OSP is almost independent of Rt, while the 2PM predicts a linear dependence. Finally, analytical and numerical modeling of parallel flows in the divertor is presented. It is shown that an increase in total flux expansion can favour supersonic flows at the OSP. Parallel flows are also shown to be relevant by analysing SOLPS-ITER simulations of TCV.

The physical mechanisms regulating the power sharing at the outer targets of L-mode double-null (DN) configurations are investigated using nonlinear, flux-driven, three-dimensional two-fluid simulations. Scans of parameters that regulate the turbulent level, such as the plasma resistivity and the magnetic imbalance, reveal that the power asymmetry in DN configurations is determined by the combined effects of diamagnetic drift, turbulence, and geometrical factor. Leveraging these observations, an analytical theory-based scaling law for the power-sharing asymmetry is derived and compared with nonlinear simulations. These comparisons indicate that the scaling law effectively captures the trends observed in simulations. Validation with experimental data from TCV DN discharges demonstrates agreement of the scaling law with the experimental results.

Drought is considered among the most devastating climate hazards impacting civilizations, including human health, throughout history. It causes cumulative damages based on the five generally categorized meteorological, hydrological, agricultural, socioeconomic, and ecological droughts. Reducing damages at the local, regional, and global levels requires a better understanding of human (health) vulnerability to drought. While there are different studies to distinguish and measure vulnerabilities for the five aforementioned conditions, there is minimal effort to identify vulnerabilities to health impacts from drought. Our study aims to develop an analysis of vulnerability for Nebraska based on the established health effects associated with drought. We considered vulnerability as the interaction between exposure to drought and different sensitivity measures for a timespan, including the highest drought levels in the 21st century. To calculate the total sensitivities, we extracted ten initial variables and applied two well-known methods of dimensionality reduction and (Weighted) Additive Overlays of percentile-ranked values. The result showed the inadequacy of the former method for our study. We also grouped the sensitivity variables into socioeconomic, environmental, and water-related intervention categories and developed related intensity maps showing different spatial patterns. We calculated the drought exposure levels by adding the intensity, duration, and frequency of drought over the study period (2012–2016) and developed total vulnerability maps to determine the ten most vulnerable counties, of which nine are rural. The resulting three intervention category maps can help related experts find priority areas within Nebraska, and the final vulnerability maps can help distinguish the areas of concern for general state-wide planning. While the results and some sensitivity variables are unique to Nebraska, the provided framework and the inclusion of two different methods can guide other regions in similar studies.

Spinocerebellar ataxia type 7 (SCA7) is a retinal-cerebellar degenerative disorder caused by CAG-polyglutamine (polyQ) repeat expansions in the ataxin-7 gene. As many SCA7 clinical phenotypes occur in mitochondrial disorders, and magnetic resonance spectroscopy of patients revealed altered energy metabolism, we considered a role for mitochondrial dysfunction. Studies of SCA7 mice uncovered marked impairments in oxygen consumption and respiratory exchange. When we examined cerebellar Purkinje cells in mice, we observed mitochondrial network abnormalities, with enlarged mitochondria upon ultrastructural analysis. We developed stem cell models from patients and created stem cell knockout rescue systems, documenting mitochondrial morphology defects, impaired oxidative metabolism, and reduced expression of nicotinamide adenine dinucleotide (NAD+) production enzymes in SCA7 models. We observed NAD+ reductions in mitochondria of SCA7 patient NPCs using ratiometric fluorescent sensors and documented alterations in tryptophan-kynurenine metabolism in patients. Our results indicate that mitochondrial dysfunction, stemming from decreased NAD+, is a defining feature of SCA7.

Abstract Western flower thrips (Frankliniella occidentalis; Thysanoptera: Thripidae), or WFT, are a global pest of commercial crops, particularly those grown in greenhouses. Current management recommendations often involve judicious use of pesticides to which WFT have evolved multiple resistance phenotypes. Essential oils (EOs) have shown promise as a less toxic alternative for WFT greenhouse management. However, challenges remain in predicting which EOs are most likely to be insecticidal to WFT and ensuring that the efficacy of EOs under bioassay conditions reflect performance in whole-plant application scenarios. To address these challenges, 9 EOs were tested for contact toxicity against WFT in small container assays, then gas chromatography–mass spectroscopy (GC–MS) profiles of each EO were used to quantify concentrations of 22 chemicals shared by at least 5 or more of the plant species. Of these, 13 compounds were positively correlated with thrips mortality. Effective compounds were a mixture of sesquiterpenes, cyclic monoterpenes, and noncyclic monoterpenes. Interestingly, no bicyclic monoterpenes shared among the essential oils tested correlated with thrips mortality. Whole-plant assays of the four best EOs from the container assay showed significant reduction in the number of thrips per plant, although mortality in EO treatments in the whole plant assay was lower than in the container assay. In addition, all four EOs were as efficacious as the conventional insecticide flonicamid. Identifying other EOs with high concentrations of the efficacious compounds that were identified in this study and using container assays to screen these oils for WFT thrip mortality and phytotoxicity could help integrated pest management (IPM) practitioners and greenhouse staff to more rapidly accumulate a suite of EOs as low toxicity alternatives for management of WFT in greenhouse settings. Graphical Abstract

The objective of this study was to assess the use of breakpoints in antibiotic susceptibility testing among veterinary diagnostic laboratories in the United States and Canada. An eight-question survey was conducted via phone and email to determine how often laboratories use breakpoints consistent with published guidelines in wounds, lower urinary tract infections and upper urinary tract infections (pyelonephritis) involving Escherichia coli, both in dogs and cats, for a total of 6 different hypothetical clinical scenarios. Nineteen veterinary diagnostic laboratories that perform antibiotic susceptibility testing on samples from dogs and cats in the United States or Canada and were accredited by the American Association of Veterinary Laboratory Diagnosticians (AAVLD) responded to the survey between January 15th and September 15th, 2022. The overall response rate of laboratories that were not excluded for known lack of dog and cat antibiotic susceptibility testing was 19 of 44 laboratories. Of the 17 respondent laboratories that reported using minimal inhibitory concentration breakpoints, only four laboratories used breakpoints consistent with published guidelines in all six clinical scenarios included in the survey. Our results suggest that there is clinically important variation in what breakpoints laboratories use to determine antibiotic susceptibility, which is of antibiotic stewardship and clinical relevance. Using breakpoints that are too high, too low, or inappropriately reporting “not interpreted” as the interpretive category may result in inappropriate use of antibiotics.

Abstract Background Whole‐brain longitudinal diffusion studies are crucial to examine changes in structural connectivity in neurodegeneration. Here, we investigated the longitudinal alterations in white matter (WM) microstructure across the timecourse of Huntington's disease (HD). Methods We examined changes in WM microstructure from premanifest to early manifest disease, using data from two cohorts with different disease burden. The TrackOn‐HD study included 67 controls, 67 premanifest, and 10 early manifest HD (baseline and 24‐month data); the PADDINGTON study included 33 controls and 49 early manifest HD (baseline and 15‐month data). Longitudinal changes in fractional anisotropy (FA), mean diffusivity (MD), axial diffusivity, and radial diffusivity from baseline to last study visit were investigated for each cohort using tract‐based spatial statistics. An optimized pipeline was employed to generate participant‐specific templates to which diffusion tensor imaging maps were registered and change maps were calculated. We examined longitudinal differences between HD expansion‐carriers and controls, and correlations with clinical scores, including the composite UHDRS (cUHDRS). Results HD expansion‐carriers from TrackOn‐HD, with lower disease burden, showed a significant longitudinal decline in FA in the left superior longitudinal fasciculus and an increase in MD across subcortical WM tracts compared to controls, while in manifest HD participants from PADDINGTON, there were significant widespread longitudinal increases in diffusivity compared to controls. Baseline scores in clinical scales including the cUHDRS predicted WM microstructural change in HD expansion‐carriers. Conclusion The present study showed significant longitudinal changes in WM microstructure across the HD timecourse. Changes were evident in larger WM areas and across more metrics as the disease advanced, suggesting a progressive alteration of WM microstructure with disease evolution.

Summary: TSPEAR variants cause autosomal recessive ectodermal dysplasia (ARED) 14. The function of TSPEAR is unknown. The clinical features, the mutation spectrum, and the underlying mechanisms of ARED14 are poorly understood. Combining data from new and previously published individuals established that ARED14 is primarily characterized by dental anomalies such as conical tooth cusps and hypodontia, like those seen in individuals with WNT10A-related odontoonychodermal dysplasia. AlphaFold-predicted structure-based analysis showed that most of the pathogenic TSPEAR missense variants likely destabilize the β-propeller of the protein. Analysis of 100000 Genomes Project (100KGP) data revealed multiple founder TSPEAR variants across different populations. Mutational and recombination clock analyses demonstrated that non-Finnish European founder variants likely originated around the end of the last ice age, a period of major climatic transition. Analysis of gnomAD data showed that the non-Finnish European population TSPEAR gene-carrier rate is ∼1/140, making it one of the commonest AREDs. Phylogenetic and AlphaFold structural analyses showed that TSPEAR is an ortholog of drosophila Closca, an extracellular matrix-dependent signaling regulator. We, therefore, hypothesized that TSPEAR could have a role in enamel knot, a structure that coordinates patterning of developing tooth cusps. Analysis of mouse single-cell RNA sequencing (scRNA-seq) data revealed highly restricted expression of Tspear in clusters representing enamel knots. A tspeara−/−;tspearb−/− double-knockout zebrafish model recapitulated the clinical features of ARED14 and fin regeneration abnormalities of wnt10a knockout fish, thus suggesting interaction between tspear and wnt10a. In summary, we provide insights into the role of TSPEAR in ectodermal development and the evolutionary history, epidemiology, mechanisms, and consequences of its loss of function variants.

Background: The uterocutaneous fistula is an abnormal connection or passageway between the uterus and the skin. The most common causes include infections, trauma, or surgery, a severe medical condition requiring prompt medical attention and treatment. Case Presentation: Here, we describe the case of a 36-year-old female who developed a uterocutaneous fistula after cesarean delivery. Her post-cesarean recovery was complicated by wound infection, and after healing the wound, she presented with cyclical bloody discharge from a pinpoint opening in the healed wound scar. Management: On ultrasound and MRI, she was diagnosed as having a uterocutaneous fistula. She opted for non-surgical management and underwent successful medical management with GnRH agonists. She remained symptom-free after the resumption of her menstrual cycle. Conclusion: In younger populations hoping to avoid surgery, pharmacological care with GnRH agonist therapy can be a reasonable alternative to surgical resection of the fistulous tract. Healthcare professionals should have a high index of suspicion to diagnose this condition.

During the spring of 2020, K-12 schools were turned upside-down. The COVID-19 pandemic essentially forced all schools across the nation to close their doors and move their learning environments online. The switch to remote learning put a great deal of stress and responsibility on teachers at all levels. The content taught by family and consumer sciences (FCS) teachers presented those teachers with unique challenges that differentiated them from other content teachers in programs such as math, language arts, and social studies. With a sample of 97 teachers from Midwestern states, this study found that FCS teachers reported higher levels of depersonalization and lower feelings of personal accomplishment.

Background: Environmental pollution and exposure to lead (Pb) through household paint continue to be a great concern, especially for low- and middle-income countries (LMICs). Methods: We measured the Pb levels of solvent-based paints commercially available in Karachi, Pakistan. We visited major markets and collected commonly available brands of paint, sampling the yellow, red, and white colors of each. The paint samples’ Pb content was measured using inductively coupled argon plasma atomic emission spectrometry (ICP-AES). Results: Of the 60 analyzed paint samples, 24 (40%) contained Pb levels of >100 ppm (beyond the legal limit in Pakistan), with a maximum of 97,000 ppm (dry weight). Sixteen (76.2%) of the 21 yellow paints (range: 5,100–97,000 ppm, IQR: 36,900 ppm), seven (37.0%) of the 19 red paints (range: 220–1,800 ppm, IQR: 255 ppm), and one (5%) of the 20 white paints (870 ppm) contained Pb levels of >100 ppm. Of the 60 paints, 45 were produced by domestic Pakistani companies (51% exceeding the limit) and 15 by multinational companies (7% exceeding the limit). Conclusions: Although Pakistani regulations have restricted Pb content in paints to

Abstract Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is responsible for the infectious disease COVID-19, which has rapidly become an international pandemic with significant impact on healthcare systems and the global economy. To assist antiviral therapy and vaccine development efforts, we performed a natural history/time course study of SARS-CoV-2 infection in ferrets to characterise and assess the suitability of this animal model. Ten ferrets of each sex were challenged intranasally with 4.64 × 104 TCID50 of SARS-CoV-2 isolate Australia/VIC01/2020 and monitored for clinical disease signs, viral shedding, and tissues collected post-mortem for histopathological and virological assessment at set intervals. We found that SARS-CoV-2 replicated in the upper respiratory tract of ferrets with consistent viral shedding in nasal wash samples and oral swab samples up until day 9. Infectious SARS-CoV-2 was recovered from nasal washes, oral swabs, nasal turbinates, pharynx, and olfactory bulb samples within 3–7 days post-challenge; however, only viral RNA was detected by qRT-PCR in samples collected from the trachea, lung, and parts of the gastrointestinal tract. Viral antigen was seen exclusively in nasal epithelium and associated sloughed cells and draining lymph nodes upon immunohistochemical staining. Due to the absence of clinical signs after viral challenge, our ferret model is appropriate for studying asymptomatic SARS-CoV-2 infections and most suitable for use in vaccine efficacy studies.

Abstract The aim of this work is to evaluate the performance of a novel algorithm that combines dynamic wavefront aberrometry data and descriptors of the retinal image quality from objective autorefractor measurements to predict subjective refraction. We conducted a retrospective study of the prediction accuracy and precision of the novel algorithm compared to standard search-based retinal image quality optimization algorithms. Dynamic measurements from 34 adult patients were taken with a handheld wavefront autorefractor and static data was obtained with a high-end desktop wavefront aberrometer. The search-based algorithms did not significantly improve the results of the desktop system, while the dynamic approach was able to simultaneously reduce the standard deviation (up to a 15% for reduction of spherical equivalent power) and the mean bias error of the predictions (up to 80% reduction of spherical equivalent power) for the handheld aberrometer. These results suggest that dynamic retinal image analysis can substantially improve the accuracy and precision of the portable wavefront autorefractor relative to subjective refraction.

Abstract Background Hereditary spastic paraplegias (HSPs) are progressively debilitating neurodegenerative disorders that follow heterogenous patterns of Mendelian inheritance. Available epidemiological evidence provides limited incidence and prevalence data, especially at the genetic subtype level, preventing a realistic estimation of the true social burden of the disease. The objectives of this study were to (1) review the literature on epidemiology of HSPs; and (2) develop an epidemiological model of the prevalence of HSP, focusing on four common HSP genetic subtypes at the country and region-level. Methods A model was constructed estimating the incidence at birth, survival, and prevalence of four genetic subtypes of HSP based on the most appropriate published literature. The key model parameters were assessed by HSP clinical experts, who provided feedback on the validity of assumptions. A model was then finalized and validated through comparison of outputs against available evidence. The global, regional, and national prevalence and patient pool were calculated per geographic region and per genetic subtype. Results The HSP global prevalence was estimated to be 3.6 per 100,000 for all HSP forms, whilst the estimated global prevalence per genetic subtype was 0.90 (SPG4), 0.22 (SPG7), 0.34 (SPG11), and 0.13 (SPG15), respectively. This equates to an estimated 3365 (SPG4) and 872 (SPG11) symptomatic patients, respectively, in the USA. Conclusions This is the first epidemiological model of HSP prevalence at the genetic subtype-level reported at multiple geographic levels. This study offers additional data to better capture the burden of illness due to mutations in common genes causing HSP, that can inform public health policy and healthcare service planning, especially in regions with higher estimated prevalence of HSP.