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Qiang Xu,1,2,* Xiangjie Zhang,3,* Maolin Hao,3,* Xitong Dang,3 QianQian Xu,3 Lukas Cyganek,4,5 Ibrahim Akin,2,6 Dan Tang,7 Bin Liao,8 Xiaobo Zhou,2,3,6 Huan Lan3 1School of Basic Medical Science, Southwest Medical University, Luzhou, People’s Republic of China; 2First Department of Medicine, Faculty of Medicine, University Medical Centre Mannheim (UMM), University of Heidelberg, Mannheim, Germany; 3Key Laboratory of Medical Electrophysiology, Ministry of Education & Medical Electrophysiological Key Laboratory of Sichuan Province, Institute of Cardiovascular Research, Department of Cardiology, The Affiliated Hospital, Southwest Medical University, Luzhou, People’s Republic of China; 4Stem Cell Unit, Clinic for Cardiology and Pneumology, University Medical Center Göttingen, Göttingen, Germany; 5DZHK (German Center for Cardiovascular Research), Partner Site, Göttingen, Germany; 6DZHK (German Center for Cardiovascular Research), Partner Site, Heidelberg, Mannheim, Germany; 7The First People’s Hospital of Longquanyi District, Chengdu/West China Longquan Hospital, Sichuan University, Chengdu, People’s Republic of China; 8Department of Cardiac Macrovascular Surgery, Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, People’s Republic of China*These authors contributed equally to this workCorrespondence: Huan Lan, Key Laboratory of Medical Electrophysiology, Ministry of Education & Medical Electrophysiological Key Laboratory of Sichuan Province, Institute of Cardiovascular Research, No. 1 section 1 of Xiang Lin Road, Longmatan District, Luzhou City, Sichuan, People’s Republic of China, Tel +0086-0830-3160619, Email lanhuan@swmu.edu.cn Xiaobo Zhou, First Department of Medicine, Faculty of Medicine, University Medical Centre Mannheim (UMM), University of Heidelberg, Theodor-Kutzer-Ufer 1-3, Mannheim, Baden-Württemberg, Germany, Tel +0049-621-3831448, Email Xiaobo.zhou@medma.uni-heidelberg.deBackground and Purpose: Esophageal cancer-related gene-4 (ECRG4) participate in inflammation process and can interact with the innate immunity complex TLR4-MD2-CD14 on human granulocytes. In addition, ECRG4 participate in modulation of ion channel function and electrical activity of cardiomyocytes. However, the exact mechanism is unknown. This study aimed to test our hypothesis that ECRG4 contributes to inflammation-induced ion channel dysfunctions in cardiomyocytes.Methods: Human-induced pluripotent stem cell-derived cardiomyocytes (hiPSC-CMs) generated from three donors were treated with lipopolysaccharide (LPS) to establish an endotoxin-induced inflammatory model. Immunostaining, real-time PCR, and patch-clamp techniques were used for the study.Results: ECRG4 was detected in hiPSC-CMs at different differentiation time. LPS treatment increased ECRG4 expression in hiPSC-CMs. Knockdown of ECRG4 decreased the expression level of Toll-Like-Receptor 4 (TLR4, a LPS receptor) and its associated genes and inflammatory cytokines. Furthermore, ECRG4 knockdown shortened the action potential duration (APD) and intercepted LPS-induced APD prolongation by enhancing ISK (small conductance calcium-activated K channel current) and attenuating INCX (Na/Ca exchanger current). Overexpression of ECRG4 mimicked LPS effects on ISK and INCX, which could be prevented by NFκB signaling blockers.Conclusion: This study demonstrated that LPS effects on cardiac ion channel function were mediated by the upregulation of ECRG4, which affects NFκB signaling. Our findings support the roles of ECRG4 in inflammatory responses and the ion channel dysfunctions induced by LPS challenge.Keywords: esophageal cancer-related gene-4, arrhythmias, lipopolysaccharide, human-induced pluripotent stem cell-derived cardiomyocytes, inflammation

It has been aimed to compare the level of cell-free nucleic acids (DNA, RNA, and miRNA) concentrations in laryngeal cancer patients with the control group composed of healthy individuals. It has been utilized 46 patients with laryngeal carcinoma who were previously diagnosed and treated were included and 46 healthy individuals were included as a control group. Peripheral blood samples were obtained from all participants. DNA, RNA, and miRNA were fluorometrically measured. We applied Mann Whitney U test to compare both groups and the adjusted general lineal model to identify associations between nucleic acid concentrations and tumor stages. Circulating cell-free microRNA and RNA concentrations in the laryngeal cancer patients were significantly different (p

Background Malaria during pregnancy causes significant maternal and perinatal morbidities and mortality. The World Health Organization recommends intermittent preventive treatment with sulfadoxine-pyrimethamine (SP). The reports of SP resistance have prompted the need for alternatives. Objective This study compared the effects of azithromycin (AZ) and SP on maternal malaria during pregnancy among pregnant women in Owo, Ondo State. Methods and Materials A prospective randomized controlled trial was conducted among 322 pregnant women who presented for antenatal care and delivery at Federal Medical Centre, Owo, Ondo State. 500 mg AZ was administered to 148 participants on three consecutive days at intervals of every four weeks, whereas 143 participants received SP in accordance with the standard regimen. Data were analyzed using descriptive and inferential statistics at a 5% level of significance, and outcomes were compared across groups using Chi-square and Student’s t-test. Results The incidence of asymptomatic parasitaemia was 17.2%. Following the administration of the trial drugs, the rates of maternal parasitaemia did not show any statistically significant difference at antenatal follow-up (9 [6.3%] for SP and 12 [8.1%] for AZ [P = 0.360]) and at delivery in both the groups (7 [4.9%] for SP and 5 [3.4%] for AZ [P = 0.360]). The incidence of adverse events and pregnancy outcomes were also comparable between both groups. AZ compared effectively with SP in reducing the risk of having symptomatic malaria during pregnancy. There was no significant difference in maternal peripheral parasitaemia between the two groups. Conclusion Hence, AZ could be considered an alternative to SP for intermittent preventive treatment of malaria during pregnancy.

Dentin tissue can act as a reservoir for bioactive molecules that create signals for cellular proliferation and differentiation to initiate tissue regeneration. Therefore, the aim of this study is to compare the cell viability, inflammatory response, and antimicrobial activity of bovine dentin grain-added calcium-hydroxide (CH-BDG) with different pulp-capping materials.

This study assessed health insurance uptake, and payment preferences for health insurance enrollment, and identified barriers and facilitators of the utilization of health insurance amongst residents in Lagos State.

Background: Vegetarian diets have grown in popularity partly because they have been linked to numerous health benefits. They are typically high in fiber and antioxidants and low in cholesterol, potentially lowering the risk of chronic diseases. On the other hand, diets established on meat and its products play a significant role in increasing the incidence of non-communicable diseases owing to their increased calorie density and extra saturated fat. Methods: A cross-sectional study was conducted among 121 adults recruited purposively from two Seventh-day Adventist churches in the Ede South Local Government area of Osun State. Results: Most respondents (73.6 %) were non-vegetarian and 26.4% were vegetarian (65.6% semi-vegetarian, 25% lacto-ovo, and 9.4% vegans). Among the non-vegetarians, 4.0% were underweight, 42.0% were of normal weight, 44.0% were overweight, and 10.1 % were obese. Among Vegetarians, 56.3% and 43.7% were of normal weight and overweight, respectively. Conclusion: The prevalence of obesity among non-vegetarians was high, indicating the need for nutritional education intervention on the health benefits of a vegetarian diet.

This essay uses the concepts of chronicity and extreme spectacle to ask how we might think about death as a constitutive force in urban gang life. It explains how death becomes proximate, what that proximity means regarding how we understand urban gang violence, and the social and spatial relationships with the city it produces.

This paper examines the role of export destinations on firm upgrading. I exploit the real effective exchange rate devaluation in Spain during the Great Recession to identify the unusual export performance of manufacturing firms. Using directly observable measures of firm upgrading, I find that increased share of exports to low-income destinations in sales reduced productivity and upgrading efforts of firms. However, real effective exchange rate devaluation did not affect the share of exports to high-income destinations in sales as well as productivity and upgrading efforts. The results are consistent with the quality sorting hypothesis that suggests a positive relationship between firm productivity and product quality. The findings in this paper emphasize that export market destination is an important determinant in analysing the gains from exporting.

ObjectivesTo assess diagnostic mycology capacity and available fungal diagnostic services of microbiology laboratories in eight tertiary hospitals in Nigeria and one in Ghana.MethodsOn-site audits were performed in the microbiology laboratories of nine tertiary hospitals using a structured observation checklist.ResultsA total of nine tertiary hospitals' laboratories in Nigeria and Ghana were assessed between June 2022 and December 2023. The majority of audited laboratories lacked basic infrastructure and materials needed for fungal diagnostic testing, with less than half of the labs having a dedicated mycology bench, space or room, 3/9 (33.3%), appropriate bench workflow 1/9 (11.1%), functional biosafety cabinet type two 2/9 (22.2%), dedicated incubators 3/9 (33.3%), standard operating procedures 1/9 (11.1%), mycology atlases 2/9 (22.2%). Trained laboratory personnel for mycology were also lacking with only one of the laboratories 1/9 (11.1%) observed to have a designated trained personnel for the mycology bench.ConclusionThe audit revealed deficits in basic infrastructure, material resources, dedicated human resources, and laboratory capacity to detect serious fungal infections.

Background: To compare the choroidal thickness (CT) and choroidal vascularity index (CVI) values in ocular rosacea (OR) patients across skin subtypes of the disease and healthy controls. Methods: This prospective study included 90 eyes of 90 mild-moderate OR patients with different skin subtypes (30 phymatous, 30 papulopustular and 30 erythematotelangiectatic) and 30 eyes of 30 age-gender matched healthy volunteers. After obtaining the enhanced depth imaging optical coherence tomography images, the CT was measured at subfoveal, 1500 μm nasal and 1500 μm temporal to the fovea, and the CVI was calculated using Image J software in the subfoveal, nasal and temporal areas. Results: There was no CT significant difference between OR patients and healthy controls in all regions (p > 0.05). CVI values of OR patients were found to be significantly lower in the subfoveal, nasal and temporal regions compared to healthy controls (p = 0.02, p = 0.01, p = 0.01, respectively). No CT difference was detected between the subtypes and healthy controls in all regions (p > 0.05). Subfoveal-CVI was significantly lower in the phymatous subtype than the other subtypes and controls (p < 0.05), while nasal and temporal-CVI were significantly lower in the phymatous and papulopustular subtypes than the erythematotelangiectatic subtype and controls. Conclusion: Our study demonstrated no difference between rosacea skin types and healthy controls in terms of CT. Phymatous and papulopustular subtypes were more likely to be affected by chronic inflammation with having lower CVI in most of the regions. Further studies are needed to investigate the association of inflammatory factors with CVI in OR.

Summary: Background: While many patients seem to recover from SARS-CoV-2 infections, many patients report experiencing SARS-CoV-2 symptoms for weeks or months after their acute COVID-19 ends, even developing new symptoms weeks after infection. These long-term effects are called post-acute sequelae of SARS-CoV-2 (PASC) or, more commonly, Long COVID. The overall prevalence of Long COVID is currently unknown, and tools are needed to help identify patients at risk for developing long COVID. Methods: A working group of the Rapid Acceleration of Diagnostics-radical (RADx-rad) program, comprised of individuals from various NIH institutes and centers, in collaboration with REsearching COVID to Enhance Recovery (RECOVER) developed and organized the Long COVID Computational Challenge (L3C), a community challenge aimed at incentivizing the broader scientific community to develop interpretable and accurate methods for identifying patients at risk of developing Long COVID. From August 2022 to December 2022, participants developed Long COVID risk prediction algorithms using the National COVID Cohort Collaborative (N3C) data enclave, a harmonized data repository from over 75 healthcare institutions from across the United States (U.S.). Findings: Over the course of the challenge, 74 teams designed and built 35 Long COVID prediction models using the N3C data enclave. The top 10 teams all scored above a 0.80 Area Under the Receiver Operator Curve (AUROC) with the highest scoring model achieving a mean AUROC of 0.895. Included in the top submission was a visualization dashboard that built timelines for each patient, updating the risk of a patient developing Long COVID in response to clinical events. Interpretation: As a result of L3C, federal reviewers identified multiple machine learning models that can be used to identify patients at risk for developing Long COVID. Many of the teams used approaches in their submissions which can be applied to future clinical prediction questions. Funding: Research reported in this RADx® Rad publication was supported by the National Institutes of Health. Timothy Bergquist, Johanna Loomba, and Emily Pfaff were supported by Axle Subcontract: NCATS-STSS-P00438.

The inhuman socioeconomic repercussions of corruption and bad governance inherent in successive male-dominated governments have generated agitation for increased women’s participation in governance. Primarily, this agitation is based on the premise that women are less inclined to corruption, which is a major impediment to good governance. Given the notoriety of these two impediments to development, this study aims to investigate the relationship between women’s participation in governance, corruption, and quality of governance in sub-Saharan Africa from 1996 to 2021. This study analyzed annual panel data of four sub-Saharan African countries using the autoregressive distributed lag model and the Granger causality test. Governance quality was proxied by government effectiveness, while women’s participation in governance and corruption were proxied by the number of women in government positions and control of corruption, respectively. Economic development and institutional quality were used as control variables. The findings revealed negative main and interaction effects of women’s participation in governance and corruption on governance quality, unidirectional causality from corruption to women’s participation in governance and from governance quality to women’s participation in governance, and bidirectional causality between corruption and governance quality. Quantitative increases in women’s participation in governance and corruption exacerbates governance quality. Women’s ability to participate in governance is determined by the prevalence of corruption in previous years. Anticorruption campaigns that focused on women’s participation in governance often result in reductions in corruption insufficient for improvement of governance quality. Corruption and bad governance are mutually reinforcing. Governance quality determines women’s participation in governance. To minimize corruption and bad governance, sub-Saharan African countries should shift their focus away from merely increasing the number of women in government positions to building strong institutions capable of creating a meritocratic political and socioeconomic environment in which selfless women and men have equal chances of being elected or appointed to public offices.

Anthony J Kondracki,1 John R Attia,2 Matthew J Valente,3 Kimberly B Roth,1 Marshall Akin,4 Claire A McCarthy,5 Jennifer L Barkin1 1Department of Community Medicine, Mercer University School of Medicine, Savannah and Macon, GA, USA; 2School of Medicine and Public Health, The University of Newcastle, Callaghan, New South Wales, Australia; 3College of Public Health, University of South Florida, Tampa, FL, USA; 4Memorial Health University Medical Center, Savannah, GA, USA; 5School of Medicine, Mercer University, Savannah, GA, USACorrespondence: Anthony J Kondracki, Mercer University School of Medicine, Department of Community Medicine, 1250 East 66th Street, Savannah, GA, 31404, USA, Tel +1 912-721-8227, Fax +1 912-721-8267, Email kondracki_aj@mercer.eduPurpose: To explore a potential interaction between the effect of specific maternal smoking patterns and the presence of antenatal depression, as independent exposures, in causing postpartum depression (PPD).Methods: This case–control study of participants with singleton term births (N = 51220) was based on data from the 2017– 2018 Pregnancy Risk Assessment Monitoring System. Multivariable log-binomial regression models examined the main effects of smoking patterns and self-reported symptoms of antenatal depression on the risk of PPD on the adjusted risk ratio (aRR) scale and tested a two-way interaction adjusting for covariates selected in a directed acyclic graph (DAG). The interaction effects were measured on the additive scale using relative excess risk due to interaction (RERI), the attributable proportion of interaction (AP), and the synergy index (SI). Causal effects were defined in a counterfactual framework. The E-value quantified the potential impact of unobserved/unknown covariates, conditional on observed covariates.Results: Among 6841 women in the sample who self-reported PPD, 35.7% also reported symptoms of antenatal depression. Out of 3921 (7.7%) women who reported smoking during pregnancy, 32.6% smoked at high intensity (≥ 10 cigarettes/day) in all three trimesters and 36.6% had symptoms of antenatal depression. The main effect of PPD was the strongest for women who smoked at high intensity throughout pregnancy (aRR 1.65; 95% CI: 1.63, 1.68). A synergistic interaction was detected, and the effect of all maternal smoking patterns was augmented, particularly in late pregnancy for Increasers and Reducers.Conclusion: Strong associations and interaction effects between maternal smoking patterns and co-occurring antenatal depression support smoking prevention and cessation interventions during pregnancy to lower the likelihood of PPD.Keywords: maternal smoking patterns, antenatal depression, postpartum depression, interaction, directed acyclic graph, DAG

Marielen Reinhardt,1,&ast; Tobias Schupp,1,&ast; Mohammad Abumayyaleh,1 Felix Lau,1,2 Alexander Schmitt,1 Noah Abel,1 Muharrem Akin,2 Jonas Rusnak,3 Ibrahim Akin,1 Michael Behnes1 1Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany; 2Department of Cardiology, Angiology, Hannover Medical School, Hannover, Germany; 3Department of Cardiology, Angiology and Pneumology, University Hospital Heidelberg, Heidelberg, Germany&ast;These authors contributed equally to this workCorrespondence: Tobias Schupp, First Department of Medicine, University Medical Center Mannheim (UMM), Theodor-Kutzer-Ufer 1-3, Mannheim, 68167, Germany, Tel +49 621-383-2204, Email tobias.schupp@umm.deObjective: The study investigates the prognostic impact of body mass index (BMI) in patients hospitalized with heart failure with mildly reduced ejection fraction (HFmrEF).Background: Limited data regarding the prognostic impact of BMI in patients with HFmrEF is available.Methods: Consecutive patients with HFmrEF (ie, left ventricular ejection fraction 41– 49% and signs and/or symptoms of HF) were retrospectively included at one institution from 2016 to 2022. Risk stratification was performed according to WHO-defined BMI groups. The primary endpoint was all-cause mortality at 30 months (median follow-up). Kaplan-Meier, uni- and multivariable Cox proportional regression analyses were applied for statistics.Results: 1832 consecutive patients with HFmrEF were included with a median BMI of 26.7 kg/m2 (IQR 24.0– 30.8 kg/m2). Patients with lowest BMI (ie, 18.5– 24.9 kg/m2) were associated with highest risk of all-cause mortality at 30 months compared to patients with higher BMI values (40.0% vs 29.0% vs 21.4% vs 20.9%; log rank p = 0.001; HR = 0.721; 95% CI 0.656– 0.793; p = 0.001). Even after multivariable adjustment, higher BMI values were associated with improved survival at 30 months (HR = 0.963; 95% CI 0.943– 0.985; p = 0.001). In contrast, the risk of HF- related rehospitalization at 30 months was not affected by BMI (log rank p = 0.064).Conclusion: In patients hospitalized with HFmrEF, lower BMI was associated with increased risk of all-cause mortality at 30 months, suggesting an obesity paradox in HFmrEF.Keywords: heart failure with mildly reduced ejection fraction, HFmrEF, body mass index, BMI, obesity, mortality

Background: This was a cross-sectional community-based survey to study the prevalence of serum antibodies against the severe acute respiratory syndrome coronavirus 1 (SARS-COV-1) and determine possible source of antibodies as to whether from vaccination or from natural infection as well as attempt to compare antibody levels in response to the different four types of vaccines administered in Nigeria. Methods: A cross-sectional community-based study of the prevalence of serum antibodies against all four vaccine types used in Nigeria amongst a representative sample of people aged 18 years and above in the six geopolitical zones of the country using a multistage sampling technique covering 12 states of the country with two states being randomly selected from each geopolitical zone. High-throughput Roche electrochemiluminescence immunoassay system (Elecsys Anti-SARS-COV-1 Cobas) was used for qualitative and quantitative detection of antibodies to SARS-COV-1 in human plasma. Results: There was no statistically significant difference between the proportions with seropositivity for both the vaccinated and the unvaccinated (P = 0.95). The nucleocapsid antibody (anti-Nc) titres were similar in both the vaccinated and the unvaccinated, whereas the Spike protein antibody (anti-S) titres were significantly higher amongst the vaccinated than amongst the unvaccinated. Antibody levels in subjects who received different vaccines were compared to provide information for policy. Conclusion: While only 45.9% of the subjects were reported to have been vaccinated, 98.7% of the subjects had had contact with the SARS-COV-1 as evidenced by the presence of nucleocapsid (NC) antibodies in their plasma. The 1.3% who had not been exposed to the virus, had spike protein antibodies which most likely resulted from vaccination in the absence of NC antibodies. Successive vaccination and booster doses either through heterogeneous or homologous vaccines increased antibody titres, and this stimulation of immune memory may offer greater protection against coronavirus disease 2019.

Summary: Chromatin immunoprecipitation (ChIP) combined with sequencing has revolutionized our understanding of gene regulation; however, its application to frozen adipose tissue presents unique challenges due to the high levels of lipid content. Here, we present a protocol for ChIP of histone modifications in human frozen adipose tissue. We describe steps for tissue preparation, chromatin isolation, sonication, pre-clearing of chromatin, and immunoprecipitation. We then detail procedures for elution, crosslink reversal, chromatin purification, quality control, and library synthesis. : Publisher’s note: Undertaking any experimental protocol requires adherence to local institutional guidelines for laboratory safety and ethics.

Predictive biomarkers are necessary for the identification of immunotherapy-responsive patients. Tumor mutation burden (TMB), as determined by next-generation sequencing (NGS), and PD-L1 expression, as evaluated by Immunohistochemistry (IHC), are the biomarkers most frequently employed in clinical practice. In addition, microsatellite instability (MSI) was the first biomarker to demonstrate immunotherapy efficacy irrespective of the type of tumor and possesses a high predictive value. However, its limited use across most tumor types limits its therapeutic potential. This report describes two cancer patients with positive TMB and PD-L1 expression. The molecular profile of the tumor indicated that the first patient was responsive to Immune checkpoint inhibitors (ICI), while the second patient was resistant. These case studies demonstrate that tumor molecular analysis in combination with immunotherapy predictive biomarkers, such as PD-L1 expression and TMB, can enhance the prediction of response to ICI for specific patients. This methodology enables an individualized and improved approach to the treatment and management of the disease.

Abstract Central nervous system (CNS) metastases can be seen at a rate of 30% in advanced stages for patients with non-small cell lung cancer (NSCLC). Growing evidence indicates the predictive roles of driver gene mutations in the development of brain metastases (BM) in recent years, meaning that oncogene-driven NSCLC have a high incidence of BM at diagnosis. Today, 3rd generation targeted drugs with high intracranial efficacy, which can cross the blood–brain barrier, have made a positive contribution to survival for these patients with an increased propensity to BM. It is important to update the clinical and pathological factors reflected in the survival with real-life data. A multi-center, retrospective database of 306 patients diagnosed with driver mutant NSCLC and initially presented with BM between between November 2008 and September 2022 were analyzed. The median progression-free survival (mPFS) was 12.25 months (95% CI, 10–14.5). While 254 of the patients received tyrosine kinase inhibitor (TKI), 51 patients received chemotherapy as first line treatment. The median intracranial PFS (iPFS) was 18.5 months (95% CI, 14.8–22.2). The median overall survival (OS) was 29 months (95% CI, 25.2–33.0). It was found that having 3 or less BM and absence of extracranial metastases were significantly associated with better mOS and iPFS. The relationship between the size of BM and survival was found to be non-significant. Among patients with advanced NSCLC with de novo BM carrying a driver mutation, long-term progression-free and overall survival can be achieved with the advent of targeted agents with high CNS efficacy with more conservative and localized radiotherapy modalities.

Background Peripheral arterial disease and related lower extremity wounds are prominent causes of amputation. Revascularization may reduce amputation rates or the amputation margin more distally in patients with peripheral arterial disease who have wounds resulting from critical limb ischemia. This study examined the association of risk factors and intervention types with amputation rates in patients with critical lower extremity arterial disease. Methods A total of 211 patients who underwent peripheral intervention because of foot wound were followed up for 12 months after the intervention. All patients had lower extremity wounds resulting from peripheral arterial disease. The effects of treatment approaches were compared in patients who underwent and did not undergo amputation. Results Revascularization of the anterior tibial artery reduced the amputation rate by 6.52 times compared with occlusion. Posterior tibial artery revascularization reduced the amputation rate by 49.95 times. Conclusion In this study of percutaneous intervention methods for prevention of amputation, the most effective option was revascularization of the posterior tibial artery and anterior tibial artery. Considering these results, treatment of critical peripheral arterial disease can be cost-effective and efficient and may shorten procedure time.

The Ukrainian-Russian relationship is examined in this paper amid Ukraineâs identity crisis, focusing on the historical trajectory, promotion of the Ukrainian language, and implications of continuous use of the Russian language in Ukraine. A thorough but careful look at the linguistic contact history reveals crisis sources influenced by Ukraineâs geography and politics. Russian dominance, especially in the Soviet era, eroded Ukrainian language and identity, sparking debates on linguistic, social, and political implications. The impact of Russian on Ukrainian identity raises concerns about cultural preservation. Recent efforts prioritise Ukrainian language promotion to revive identity, addressing tensions from linguistic differences. Language becomes a geopolitical tool, amplifying the identity crisis. The political and social consequences of language choice are creating divisions in Ukrainian society today. This article concludes by emphasising the need to address the identity crisis in Ukraine through fostering linguistic diversity, inclusivity, and respect for both Russian and Ukrainian languages.

5-th generation (5G) has brought mobility robustness and interruption time reduction enhancements to mobility procedures. Advanced beam management procedures were also introduced in 5G, including beam-based mobility. In this paper, we summarize the procedure that fuses beam-based mobility with conventional mobility procedures, namely L1/L2-triggered mobility (LTM). We first provide the Release 18 LTM procedural summary, followed by a detailed explanation of the introduced technical enhancements and an analysis of their expected benefits. Through system-level simulations, we show that having the LTM as the mobility procedure brings two major improvements, namely interruption time reduction and mobility robustness. The lower interruption time is mainly the result of configuring the network and the user equipment (UE) well in advance of the handover, early configuration decoding, early synchronization, and triggering the handover with a lightweight medium access control (MAC) command. The mobility robustness increase is the result of the triggering of the handover based on the layer 1 (L1) measurements, which are more sensitive to channel degradation. This in turn further reduces the interruption time as the radio link failure and reestablishment are avoided. On the other hand, LTM can suffer from excess unnecessary handovers, where the UE is handed over back and forth between two or three cells. Besides, the increased measurement reporting of the L1 measurements can cause additional overhead. Finally, we give a short insight on the on-going Release 19 work that addresses some the known LTM issues.

Abstract There is limited data on the relationship of miRNAs with parameters that may affect surgical management or reflect tumour prognosis. It was aimed to evaluate serum miRNA levels in breast carcinoma cases and reveal the relationship between these levels and prognosis-related factors such as the histological type of the tumour, estrogen receptor, progesterone receptor, Ki-67 index, HER-2neu, E-cadherin, tumour size, CK5/6, CA15.3 levels, number of tumour foci, number of metastatic lymph nodes, and status of receiving neoadjuvant therapy. Thirty-five patients with a histopathologically confirmed breast carcinoma diagnosis in the case group and 35 healthy individuals in the control group were examined. miR-206, miR-17-5p, miR-125a, miR-125b, miR-200a, Let-7a, miR-34a, miR-31, miR-21, miR-155, miR-10b, miR-373, miR-520c, miR-210, miR-145, miR-139-5p, miR-195, miR-99a, miR-497 and miR-205 expression levels in the serum of participants were determined using the Polymerase Chain Reaction method. While serum miR-125b and Let-7a expression levels were significantly higher in breast cancer patients, miR-17-5p, miR-125a, miR-200a, miR-34a, miR-21, miR-99a and miR-497 levels were significantly lower in them. The Let-7a expression level had a statistically significant relationship with breast cancer histological type and HER-2neu parameters, miR-17-5p, miR-125b, Let-7a, miR-34a, miR-21 and miR-99a levels with E-cadherin, miR-34a, miR-99a and miR-497 with CA15.3, miR-125b, miR-200a and miR-34a with the number of metastatic lymph nodes, miR-125a with the number of tumour foci and miR-200a with the status of having the neoadjuvant therapy. Serum miR-17-5p, miR-125a, miR-125b, miR-200a, Let-7a, miR-34a, miR-21, miR-99a and miR-497 expression levels were determined to have predictive and prognostic importance in breast cancer.

PURPOSEProstate cancer disproportionately affects men of African descent, yet their representation in tissue-based studies is limited. This multinational, multicenter pilot study aims to establish the groundwork for collaborative research on prostate cancer in sub-Saharan Africa.METHODSThe Men of African Descent and Carcinoma of the Prostate network formed a pathologist working group representing eight institutions in five African countries. Formalin-fixed paraffin-embedded prostate tissue specimens were collected from Senegal, Nigeria, and Ghana. Histology slides were produced and digitally scanned. A central genitourinary pathologist (P.L.) and eight African general pathologists reviewed anonymized digital whole-slide images for International Society of Urological Pathology grade groups and other pathologic parameters. Discrepancies were re-evaluated, and consensus grading was assigned. A virtual training seminar on prostate cancer grading was followed by a second assessment on a subcohort of the same tissue set.RESULTSOf 134 tissue blocks, 133 had evaluable tissue; 13 lacked cancer evidence, and four were of insufficient quality. Post-training, interobserver agreement for grade groups improved to 56%, with a median Cohen's quadratic weighted kappa of 0.83 (mean, 0.74), compared with an initial 46% agreement and a quadratic weighted kappa of 0.77. Interobserver agreement between African pathologist groups was 40%, with a quadratic weighted kappa of 0.66 (95% CI, 0.51 to 0.76). African pathologists tended to overgrade (36%) more frequently than undergrade (18%) compared with the reference genitourinary pathologist. Interobserver variability tended to worsen with a decrease in tissue quality.CONCLUSIONTissue-based studies on prostate cancer in men of African descent are essential for a better understanding of this common disease. Standardized tissue handling protocols are crucial to ensure good tissue quality and data. The use of digital slide imaging can enhance collaboration among pathologists in multinational, multicenter studies.

The Naples prognostic score (NPS) predicts patient survival in gastroesophageal cancer using parameters related to nutritional and inflammatory status. These parameters include risk factors for coronary endothelial dysfunction except for low total cholesterol. Therefore, we modified the score (mNPS) to include high cholesterol, a risk factor for coronary endothelial dysfunction. We aimed to evaluate the relationship between mNPS and the angiographic epicardial coronary slow flow phenomenon (CSFP). This retrospective study included 301 patients with coronary slow flow who underwent coronary angiography between 2018 and 2022. The mNPS parameters were calculated and the population was divided into three groups based on the calculated parameters. Angiographic findings were classified in the left anterior descending (LAD), circumflex (Cx), right coronary (RCA) arteries, and three coronary arteries together. Statistical analyses were performed to identify mNPS as predictors of a slow flow phenomenon. Participants were divided into mNPS Group 1 (n=63), mNPS Group 2 (n=201), and mNPS Group 3 (n=37). No significant differences were observed in age, gender, or medications among the mNPS groups. The RCA had a statistically significant association with mNPS groups for slow flow phenomenon (p=0.006). Considering all three coronary arteries, the association with mNPS groups was also significant (p=0.005). White blood cell and lymphocyte counts showed significant differences. Compared with group 1, group 3 had 4.11 times more coronary artery slow flow. Our study suggests that the mNPS, integrating nutritional and inflammatory parameters along with high cholesterol, holds promise as a potential predictor for the coronary slow flow phenomenon. This could impact risk stratification and clinical management in this patient group. [Med-Science 2023; 12(4.000): 1227-31]

Abstract Background Multidrug regimens can increase the risk of drug–drug interactions at the level of albumin binding especially for drugs with narrow therapeutic windows such as carbamazepine (CBZ). This risk is particularly heightened for CBZ which is mainly metabolized to the active carbamazepine-10,11-epoxide (CBZE) that has been identified as contributory to both the therapeutic efficacy and severity of toxicity in CBZ-treated individuals. The objective of this study was to investigate the binding affinities of albumin with CBZ and CBZE, and to explore the influence of two competing over-the-counter medicines on the binding characteristics. CBZE was synthesized by epoxidation of CBZ and characterized using IR, NMR and mass spectrometry. The influence of paracetamol and ascorbic acid on the albumin complexes of CBZ and CBZE was investigated using absorption and IR spectrophotometry. Results Protein–ligand complexation produced progressive hyperchromic changes in 278 nm band of bovine serum albumin (BSA) with formation constants of 10.28–10.44 and 12.66–13.02 M−1 for CBZ and CBZE, respectively. Thermodynamic considerations confirmed both binding processes as endothermic, spontaneous and driven by hydrophobic interactions. The presence of ascorbic acid increased the binding constants of both CBZ-BSA and CBZE-BSA complexes by non-competitive interference mechanism. Similarly, paracetamol increased the affinity of CBZ for albumin but then competitively interfered with the CBZE-BSA complex. The ratio of albumin binding affinities of CBZ–CBZE varied from 0.81 in the absence of competing drug to 1.29 and 1.0 with paracetamol and ascorbic acid, respectively. IR study confirmed that both CBZ and CBZE induced a reduction from the 67.34% α-helical content of free BSA to 42.56 and 56.43%, respectively. Competitive binding in the presence of either paracetamol or ascorbic acid induced further reduction in the α-helical content of BSA in the complexes. The most extensive perturbation in the secondary structure of BSA (22.78% α-helical content) which was observed with CBZE-BSA complex in the presence of paracetamol is probably due to the increased interaction of the protein for the analgesic. Conclusion The study has revealed potential interference of paracetamol or ascorbic acid with the albumin binding of carbamazepine and its major metabolite.

Abstract Background Malignant gastric outlet obstruction (GOO) is a debilitating condition that frequently occurs in patients with malignancies of the distal stomach and (peri)ampullary region. The standard palliative treatment for patients with a reasonable life expectancy and adequate performance status is a laparoscopic surgical gastrojejunostomy (SGJ). Recently, endoscopic ultrasound-guided gastroenterostomy (EUS-GE) emerged as a promising alternative to the surgical approach. The present study aims to compare these treatment modalities in terms of efficacy, safety, and costs. Methods The ENDURO-study is a multicentre, open-label, parallel-group randomized controlled trial. In total, ninety-six patients with gastric outlet obstruction caused by an irresectable or metastasized malignancy will be 1:1 randomized to either SGJ or EUS-GE. The primary endpoint is time to tolerate at least soft solids. The co-primary endpoint is the proportion of patients with persisting or recurring symptoms of gastric outlet obstruction for which a reintervention is required. Secondary endpoints are technical and clinical success, quality of life, gastroenterostomy dysfunction, reinterventions, time to reintervention, adverse events, quality of life, time to start chemotherapy, length of hospital stay, readmissions, weight, survival, and costs. Discussion The ENDURO-study assesses whether EUS-GE, as compared to SGJ, results in a faster resumption of solid oral intake and is non-inferior regarding reinterventions for persistent or recurrent obstructive symptoms in patients with malignant GOO. This trial aims to guide future treatment strategies and to improve quality of life in a palliative setting. Trial registration International Clinical Trials Registry Platform (ICTRP): NL9592. Registered on 07 July 2021.

Abstract Objective The standard method of generating disorder‐specific disability scores has lay raters make rankings between pairs of disorders based on brief disorder vignettes. This method introduces bias due to differential rater knowledge of disorders and inability to disentangle the disability due to disorders from the disability due to comorbidities. Methods We propose an alternative, data‐driven, method of generating disorder‐specific disability scores that assesses disorders in a sample of individuals either from population medical registry data or population survey self‐reports and uses Generalized Random Forests (GRF) to predict global (rather than disorder‐specific) disability assessed by clinician ratings or by survey respondent self‐reports. This method also provides a principled basis for studying patterns and predictors of heterogeneity in disorder‐specific disability. We illustrate this method by analyzing data for 16 disorders assessed in the World Mental Health Surveys (n = 53,645). Results Adjustments for comorbidity decreased estimates of disorder‐specific disability substantially. Estimates were generally somewhat higher with GRF than conventional multivariable regression models. Heterogeneity was nonsignificant. Conclusions The results show clearly that the proposed approach is practical, and that adjustment is needed for comorbidities to obtain accurate estimates of disorder‐specific disability. Expansion to a wider range of disorders would likely find more evidence for heterogeneity.

Aim: This study aimed to compare the estimated and measured resting metabolic rates of patients with type 1 and type 2 diabetes mellitus in an outpatient clinical setting. Material and methods: Participants were categorized into three groups that included type 1 diabetes, type 2 diabetes, and individuals without diabetes. Bland–Altman analysis was used to identify the equation that most accurately predicted the measured resting metabolic rates. Multiple regression analysis was used to identify the factors affecting resting metabolic rates. Results: Resting metabolic rates was observed to be higher in subjects with type 2 diabetes compared to that of the other groups. There was a proportional bias between predicted and measured resting metabolic rates. Type 1 diabetes, type 2 diabetes, male sex, body weight, waist circumference, and triglyceride level were factors that positively predicted resting metabolic rates, and age was a factor that negatively predicted it. Conclusions: Although there was a bias between estimated and measured RMR, the most accurate results were achieved with the Mifflin–St Jeor equation for women with type 1 diabetes, with the Owen equation for men with type 1 diabetes, with the Harris Benedict equation for women with type 2 diabetes, and with the Ikeda equation for men with type 2 diabetes as well as for women and men in the control group.

Introduction: Resilience may be central to poststroke recovery. There is a knowledge gap on the predictors of resilience and its impact on mental health of Africans who survive a stroke. We describe the trajectory of psychological resilience and its association with depression and quality of life across the first poststroke year in Nigeria. Methods: Prospective observational study. Resilience was ascertained at 3 time-points prospectively over 12 months using the resilience scale. Depression and quality of life were also assessed at baseline and follow-up, respectively using centre for epidemiologic studies depression scale (CES-D 10) and health related quality of life in stroke patients (HRQOLISP-26). Trajectory was examined using the Greenhouse-Gaiser and Bonferoni corrected Analyses of variance. Associations were investigated using regression models and presented as adjusted odds ratios (aOR) and wald test coefficients within 95% confidence intervals (CI). Results: Of 150 consenting stroke survivors, 132 (88%) could be assessed for resilience. Resilience scores improved across time points of measurement (F-test=23.516, p

Ubuntu has been generalized for Africa without paying attention to the plurality of cultures within the continent. This creates the need to put Ubuntu in dialogue with other African theories of social interactions. This study compares Ubuntu with the principle of Hu Ìwà síi bí Ènìyàn Ẹlẹ́ran-Ara (Act towards the other as one with human flesh), as it applies to relationships and justice. This theory was developed from the observed relationships between Yoruba traditional healthcare providers and their patients. As a theory, it assigns duty and rights to human actors in social interactions. The principle of Hu Ìwà síi bí Ènìyàn Ẹlẹ́ran-Ara is practiced among the Yoruba, and has developed into a moral system in recent researches. It shows multiplicity in African theories of social interaction. The principle was analysed and interpreted to show how it guides behaviour towards ‘the other person’ by the very fact that ‘the other’ is a human being with flesh. Contexts were analysed to establish what ought to be done to the other person as Ènìyàn eléran ara (a Human being with flesh and blood). There is a need to engage other African principles of social interaction to highlight overlaps and possible complementarities with Ubuntu.

A common challenge for most students in intercultural contexts both in their academic studies ‎and future careers is balancing speaking opportunities for talkative and less talkative students. ‎The differences in individuals’ communication styles due to their backgrounds may lead to ‎some concerns about intercultural competencies. In this respect, this study intends to explore the ‎possible relationship between students' confidence in communication levels, their self-‎perception of English proficiency levels, and cultural styles. For this purpose, three ‎questionnaires were carried out by the participation of 106 students at a state university. The ‎obtained data were analyzed by conducting ANOVA tests. The findings indicated that ‎participants have low to medium levels of English proficiency and as their language levels ‎increase, their cultural self-awareness and cross-cultural communication levels increase as well. ‎In addition, there is a significant relationship between their levels of confidence in ‎communication and having outgoing personalities.‎

Mass movements resulting from landslides cause significant losses in terms of lives and property. Periodic observations of these movements using geodetic measurement techniques help to prevent these losses. Network-RTK measurement technique produces real-time location with centimeter accuracy, based on phase observations using a network of reference stations. In this study, the paleo-landslide area in the Işıklar location of Trabzon province, Esiroğlu district, Turkey, was chosen as the application area. This study aims to measure the application area between 2019 and 2021, using the Network-RTK technique to determine the mass movements. Additionally, there is a rock block in an area with a steep slope. The possible movement of this rock block is a threat to infrastructure facilities, residential areas, agricultural areas, and life safety if the mass movement continues. Within this scope, the potential movement scenarios of the block were produced using RocPro3D software and UAV photogrammetry. Scenarios following an ongoing mass movements in the region triggering another mass movement are discussed. In the light of the results obtained, mass movements in the vertical direction of up to 28 cm were detected in the area where the rock block is located in the last 2 years. The periodic continuation of mass movements in the study area, declared a disaster-prone area, confirms the importance of the rock block in the region. In another phase of the study, possible movement scenarios of the rock block were examined using a rockfall analysis. In this context, with the help of an unmanned aerial vehicle, a digital elevation model and orthophoto map of the region where the rock block is likely to move was produced and a base map to be used in rockfall analysis was obtained. As a result of the rockfall analysis, maps showing the speed, energy, spread, possible impacts, and stopping points were produced. With the examination of these maps, it has been determined that residential areas, agricultural areas, and infrastructure facilities in the study area may be significantly damaged.

In this study, the in vitro DNA-binding interactions of the food/drug additive, 5-hydroxymethylfurfural (HMF) and its major degradant, 5, 5'[oxy-bis(methylene)]bis-2-furfural (OBMF) were investigated. OBMF was synthesized and characterized using IR, NMR and mass spectrometry. Photometric titrations revealed OBMF induced more extensive perturbations in the 258 nm band of DNA and exhibited binding constants that were 5–12-folds higher than those of HMF. The greatest net changes in viscosity of DNA induced by HMF and OBMF were 10.5 and 8.9%, respectively which confirmed both compounds as minor groove binders. Docking revealed that OBMF and HMF bound to the guanine–cytosine regions of minor groove of DNA with global binding energies of −36.36 and −26.12 kcal/mol, respectively. DFT calculations revealed the higher electrophilicity of OBMF contributed to its increased interaction with the negatively charged DNA backbone. There is a need for stricter control of permissible levels of OBMF in food and drug products.

Statistical models have been created to understand capital assets’ return and risk. In the empirical studies in which these developed models were tested, it was concluded that the models were valid in some periods and some samples, but not in others. In this study, it is aimed to test whether the developed asset pricing models are valid for the stocks in the Borsa Istanbul (Istanbul Stock Exchange – ISE) Information Technology Index. Model tests were carried out with panel data analysis. The data set consists of the monthly returns of 13 companies traded in the ISE Information Technology Index for the period 2013/January-2019/December. Model tests were performed on both portfolio and stock basis. As a result of the tests, it was concluded that CAPM is valid in firm-based studies in the ISE Information Technology Index, and both CAPM and C4F are valid in portfolio-based studies.

Data on geographically restricted SARS-CoV-2 variants is lacking in some regions. In this nationwide effort including 18 public health labs, the authors used genomic epidemiology and travel data to understand the origin and spread of 2 variants of interest that predominated during the second wave of the pandemic in Nigeria.

An in-depth understanding of the transient operation of devices at cryogenic temperatures remains experimentally elusive. However, the impact of these transients has recently become important in efforts to develop both electronics to support quantum information science as well as cryogenic high-performance computing. In this paper, we discuss a fast time-dependent device characterization technique, capable of examining the charge trapping dynamics of devices operating at cryogenic temperatures. Careful calibrations allow for the acquisition of accurate fast I-V and transconductance transients down to 20 ns for devices operating down to 8 K. The trap charging dynamics was monitored via shifts in both threshold voltage and transconductance. The combination of fast measurements and cold temperatures were used to shift the observable measurement window to reveal charge trapping/de-trapping time dynamics of both fast and slow traps in high-k devices to demonstrate the utility of the fast I-V for cryogenic device characterization.

With an objective to reduce the switching losses in a bidirectional resonant CLLC DC/DC converter for electric vehicle (EV) charging applications, this paper presents an elaborate frequency dependent general harmonic approximation (GHA) based secondary side turnoff current minimization technique by investigating the optimum operating point to achieve synchronous rectification (SR). Formulation of an accurate all-inclusive gain model is presented, specifically focusing on effect of parasitic components on the resultant gain-frequency trend, backed with thorough experimental validation. Further, meticulous modeling of the GHA based state equations is presented to obtain a contour of feasible operational frequencies and corresponding phase shifts to ascertain accurate SR operation with a multi-dimensional optimization technique to ensure reduced switching losses. In addition to that, to precisely characterize the resonant tank equivalent circuit, stressing on its effect on SR phase calculation, a detailed 3D finite element analysis (FEA) based R-L-C modelling of the employed high frequency planar transformer (HFPT) is explained. To validate and benchmark the performance of the proposed gain model while ensuring accurate SR operation, a 1 kW all-GaN based CLLC experimental prototype is developed for a resonant frequency of 500 kHz, with a power density of 106 W/inch3. Experimental waveforms at corner conditions are presented for a wide-gain bidirectional operation, portraying a peak converter efficiency of 98.49%.

The Republic of Mali is a country of the African continent. The country is situated in a landlocked region in West Africa with Bamako as its capital city. It is worthy to note that the contemporary Mali was an integral part of the then great West African empires. These empires namely; the Ghana Empire, the Mali Empire and the Songhai Empire controlled the trans-Saharan trade. Mali has for a long time been under the control of France, especially with the events of the late 19th century scramble for and partitioning of Africa among some European powers. Over the years, there have been varying debates on the presence of France in Mali as compared with other great powers. Although Russia tried to move in the direction of Mali during the era of the Union of Soviet Socialist Republics (USSR), contemporary Russian Federation has been somehow distanced from Mali until Vladimir Putin assumed the leadership role of Russia. Thus, this paper is carried out to dissect the Pacts between Moscow and Bamako and the implications on France interest. Cultural Theory of International Relations was used. The study relied on interpretive design. Primary and secondary data were collected. Data were subjected to content analysis. It is uncovered that Moscow challenged Paris, whose dominance is fast depreciating in Mali. Mali and France enjoyed mutual relationship until the closure of 5000 Berkane mission in Kidal, northern Mali over alleged sympathy for terrorists and economic sabotage. Putin’s Russia therefore capitalized on Mali’s face off with France.

The recent Ebola outbreak in West African is reported to have started in December 2013 in Guinea from where it spread to the neighboring countries of Sierra Leone, Liberia, Mali, Nigeria and Senegal (Abayomi et al., 2016). Consequently, this attracted a great attention from all quarters such as humanitarian NGOs, local and international health organisations, governmental agencies, research and development facilities as well as pharmaceutical companies. During the outbreak, a large number of patients were screened for the Ebola Virus (EBOV) with thousands of biomedical samples generated over a short period of time and in rapid succession. These samples were sent to laboratories including mobile laboratories hastily formed to manage the situation due to the absence of infrastructure to deal with such instance in West Africa. A good number of these samples were destroyed, exported out of the country of origin with the government’s consent and documentation and in other cases without such consent while the remaining samples were stored in facilities without adequate biosafety or biosecurity (Abayomi et al., 2016). Ebola virus along with other pathogens of high consequence requires specialized facilities such as Biosafety Level 3 (BSL3) and Biosafety Level 4 (BSL4) to handle during research and identification for surveillance. Similarly, facilities of such high infrastructure and security are needed to store and secure such samples and their products.

Abstract Background Cervical cancer is the fourth most common cancer in women globally despite being a largely treatable and preventable malignancy. Developing countries account for over 80% of all new cases. Women residing in low-resource settings such as those residing in slums have a higher risk of cervical cancer, and lower uptake of cervical cancer screening. Diverse barriers influence the uptake of cervical cancer screening among women in low-resource settings. Objectives This qualitative study was done prior to the introduction of a cervical cancer screening program in two slum areas in Lagos Nigeria and explored women’s knowledge about cervical cancer, and their perceived barriers and recommendations for the program. Method Four focus group discussions(FGD) were conducted among 35 women between the ages of 21–65 years residing in two urban slums in Lagos, Nigeria from February to April 2019. Each FGD was limited to 8–10 participants of women of similar ages. Voice recordings were transcribed verbatim and thematic analysis was done. Results Most of the women were not aware of cervical cancer and none knew the symptoms or risk factors of cervical cancer. The participants felt that the cervical cancer screening program would be well accepted in the community, however, expressed concerns about the cost of the screening test and the sex of the person performing the test. The recommendations proffered for a successful cervical cancer screening program include; reducing the cost of the test or providing the test free of charge, having people that speak the local language as part of the team, using female health care providers, using a private location within the community or nearby primary health center, and publicizing the program with the use of SMS, phone calls, town crier, and health talks. It was recommended that organizing health education sessions would help improve women’s poorly perceived susceptibility to cervical cancer. Conclusion Interventions to increase uptake of cervical cancer screening among women in low resource settings need to improve knowledge of cervical cancer and address barriers to cervical cancer screening such as cost, distance, and as much as possible, sex of the healthcare provider should be considered.

Abstract Background Taking advantage of the rapidly increasing access to digital technology in low- and middle-income countries, the World Health Organization has launched an electronic version of the mental health Gap Action Programme intervention guide (emhGAP-IG). This is suitable for use on smartphones or tablets by non-specialist primary healthcare providers (PHCWs) to deliver evidence-based intervention for priority mental, neurological and substance use disorders. We assessed the perceptions of PHCWs on the feasibility, acceptability, and benefits of using smartphone-based clinical guidance and the emhGAP-IG in the management of people with mental health conditions in Nigeria. Methods Exploration of the views of PHCWs from 12 rural and urban primary health clinics (PHCs) in South-Western Nigeria were carried out using 34 in-depth key informant qualitative interviews with nurses (n = 10), community health officers (n = 13) and community health extension workers (n = 11). An additional two focus group discussions, each comprising eight participants drawn from across the range of characteristics of PHCWs, were also conducted. Thematic analysis was conducted using a three-staged constant comparison technique to refine and categorise the data. Results Three overall themes were identified around the use of clinical guidance and mobile applications (apps) in PHCs. Apps were deployed for purposes other than clinical consultation and decision making. Although paper-based guidance was the expected practice, its utilization is not fully embedded in routine care. An app-based decision-making tool was preferred to paper by PHCWs. Future usage of the emhGAP-IG would be facilitated by training and supporting of staff, helpful design features, and obtaining patients’ buy-in. Conclusion Our findings suggest that the emhGAP-IG could be a viable way to embed clinical guidance and decision-making tools in the management of people with mental health conditions in Nigerian PHCs.

Background: This study assessed the potential cost-effectiveness of high (80–100%) vs low (21–35%) fraction of inspired oxygen (FiO2) at preventing surgical site infections (SSIs) after abdominal surgery in Nigeria, India, and South Africa. Methods: Decision-analytic models were constructed using best available evidence sourced from unbundled data of an ongoing pilot trial assessing the effectiveness of high FiO2, published literature, and a cost survey in Nigeria, India, and South Africa. Effectiveness was measured as percentage of SSIs at 30 days after surgery, a healthcare perspective was adopted, and costs were reported in US dollars ($). Results: High FiO2 may be cost-effective (cheaper and effective). In Nigeria, the average cost for high FiO2 was $216 compared with $222 for low FiO2 leading to a −$6 (95% confidence interval [CI]: −$13 to −$1) difference in costs. In India, the average cost for high FiO2 was $184 compared with $195 for low FiO2 leading to a −$11 (95% CI: −$15 to −$6) difference in costs. In South Africa, the average cost for high FiO2 was $1164 compared with $1257 for low FiO2 leading to a −$93 (95% CI: −$132 to −$65) difference in costs. The high FiO2 arm had few SSIs, 7.33% compared with 8.38% for low FiO2, leading to a −1.05 (95% CI: −1.14 to −0.90) percentage point reduction in SSIs. Conclusion: High FiO2 could be cost-effective at preventing SSIs in the three countries but further data from large clinical trials are required to confirm this.

IntroductionSmall cell lung cancer (SCLC) is a rapidly growing malignancy with early distant metastases. Up to 70% will develop brain metastases, and the poor prognosis of these patients has not changed considerably. The potential of checkpoint inhibitors (CPI) in treating recurrent (r/r) SCLC and their effect on brain metastases remain unclear.MethodsIn this retrospective multicenter study, we analyzed r/r SCLC patients receiving second or further-line CPI versus chemotherapy between 2010 and 2020. We applied multivariable-adjusted Cox regression analysis to test for differences in 1-year mortality and real-world progression. We then used interaction analysis to evaluate whether brain metastases (BM) and/or cranial radiotherapy (CRT) modified the effect of CPI versus chemotherapy on overall survival.ResultsAmong 285 patients, 99 (35%) received CPI and 186 (65%) patients received chemotherapy. Most patients (93%) in the CPI group received nivolumab/ipilimumab. Chemotherapy patients were entirely CPI-naïve and only one CPI patient had received atezolizumab for first-line treatment. CPI was associated with a lower risk of 1-year mortality (adjusted Hazard Ratio [HRadj] 0.59, 95% CI 0.42 to 0.82, p=0.002). This benefit was modified by BM and CRT, indicating a pronounced effect in patients without BM (with CRT: HRadj 0.34, p=0.003; no CRT: HRadj 0.50, p=0.05), while there was no effect in patients with BM who received CRT (HRadj 0.85, p=0.59).ConclusionCPI was associated with a lower risk of 1-year mortality compared to chemotherapy. However, the effect on OS was significantly modified by intracranial disease and radiotherapy, suggesting the benefit was driven by patients without BM.

Summary: Bone morphogenetic protein (BMP) signaling and fluid shear stress (FSS) mediate complementary functions in vascular homeostasis and disease development. It remains to be shown whether altered chromatin accessibility downstream of BMP and FSS offers a crosstalk level to explain changes in SMAD-dependent transcription. Here, we employed ATAC-seq to analyze arterial endothelial cells stimulated with BMP9 and/or FSS. We found that BMP9-sensitive regions harbor non-palindromic GC-rich SMAD-binding elements (GGCTCC) and 69.7% of these regions become BMP-insensitive in the presence of FSS. While GATA and KLF transcription factor (TF) motifs are unique to BMP9- and FSS-sensitive regions, respectively, SOX motifs are common to both. Finally, we show that both SOX(13/18) and GATA(2/3/6) family members are directly upregulated by SMAD1/5. These findings highlight the mechano-dependency of SMAD-signaling by a sequential mechanism of first elevated pioneer TF expression, allowing subsequent chromatin opening to eventually providing accessibility to novel SMAD binding sites.

Background: Early evidence suggested that the impact of the COVID-19 pandemic was less severe in Africa compared to other parts of the world. However, more recent studies indicate higher SARS-CoV-2 infection and COVID-19 mortality rates on the continent than previously documented. Research is needed to better understand SARS-CoV-2 infection and immunity in Africa. Methods: In early 2021, we studied the immune responses in healthcare workers (HCWs) at Lagos University Teaching Hospital (n = 134) and Oxford-AstraZeneca COVID-19 vaccine recipients from the general population (n = 116) across five local government areas (LGAs) in Lagos State, Nigeria. Western blots were used to simultaneously detect SARS-CoV-2 spike and nucleocapsid (N) antibodies (n = 250), and stimulation of peripheral blood mononuclear cells with N followed by an IFN-γ ELISA was used to examine T cell responses (n = 114). Results: Antibody data demonstrated high SARS-CoV-2 seroprevalence of 72·4% (97/134) in HCWs and 60·3% (70/116) in the general population. Antibodies directed to only SARS-CoV-2 N, suggesting pre-existing coronavirus immunity, were seen in 9·7% (13/134) of HCWs and 15·5% (18/116) of the general population. T cell responses against SARS-CoV-2 N (n = 114) were robust in detecting exposure to the virus, demonstrating 87·5% sensitivity and 92·9% specificity in a subset of control samples tested. T cell responses against SARS-CoV-2 N were also observed in 83.3% of individuals with N-only antibodies, further suggesting that prior non-SARS-CoV-2 coronavirus infection may provide cellular immunity to SARS-CoV-2. Conclusions: These results have important implications for understanding the paradoxically high SARS-CoV-2 infection with low mortality rate in Africa and supports the need to better understand the implications of SARS-CoV-2 cellular immunity.

Electronic medical records (EMRs), as they are more popularly known, are rapidly being accepted globally to ensure timely access to notes and a safer and quicker way to transfer information. It is an efficient way of delivering patient care. However, existing literature needs to be interpreted objectively, keeping in mind its many drawbacks. Different countries have different needs and health-care delivery models. Due to this, EMR systems vary worldwide. With giant strides being made every day in the use of software for various fields, the medical field has had to adapt to changes rapidly. The COVID-19 pandemic has pushed this to even greater levels of adaption. This article extensively reviews the existing literature on its usability and key areas that one needs to pay attention to. Key areas considered in this review include cost-effectiveness, efficiency, quality improvement, and usability. The cost-effectiveness, efficiency, and usability may depend on the design and implementation of the EMR. EMR can improve the quality of documentation. The workflow becomes inefficient when both EMR and paper documentation are simultaneously used. Usability scores improve if end users are involved in the early stages of designing and implementing EMR.

Abstract Background Malaria is a major public health concern among pregnant women in sub‐Saharan Africa. Within the region, Nigeria has the highest malaria cases. This study aimed to determine the prevalence and factors associated with malaria parasitaemia among pregnant women at a booking clinic in Ibadan, Nigeria. Methods A cross‐sectional study was conducted between January and April 2021 at the University College Hospital in Ibadan, Nigeria. A sample of 300 pregnant women participated, and anaemia and malaria were diagnosed using packed cell volume and Giemsa‐stained blood smears, respectively. Data analysis was done using SPSS 25.0. Results The study found that 26 (8.70%) pregnant women tested positive for malaria parasitaemia. Factors such as age, religion, level of education, and occupation were significantly related to the prevalence of malaria parasitaemia among pregnant women with p

Background: Globally traumatic brain injuries (TBIs) are the leading cause of death in people under the age of 45. 2020 saw a series of social lockdowns as a response to the COVID-19 pandemic. We aimed to unveil the impact of the different levels of lockdown on TBI incidence at Tshepong Hospital. Method: A retrospective review of patients with TBIs during the first 30 days of each of the 5 lockdown levels, between 1st of April -20th October 2020 was conducted. Each lockdown level was compared to a control of a similar period in 2019. Results: Level 5 lockdown resulted in a 66% reduction in total incidence of TBI, with a decrease in the daily incidence median value to 0 when compared to its control group median of 1 (P-value 0.004). However, Level 3 and 2 resulted in a significant 133% and 200% increase respectively in TBI incidence for similar period the year before.There was a 0,75% decrease in total trauma during the non-lockdown periods in relation to the lock down periods with a lockdown mean incidence of 53,4 (std Dev. 26.6) and non-lockdown mean of 53 (std Dev 20.8). Conclusion: The cumulative effect of the lockdowns made miniscule changes in the overall TBI incidence but led to significant variation in TBI incidence in the comparative months. A “rebound trauma” phenomena is observed in transitioning from severe social restrictions to milder ones with unemployment and unbanning of alcohol as possible contributary factors. Further studies are needed to investigate these complex interactions.