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Aim – to develop an applied prognostic calculator for the rate of progression of CKD in elderly patients with type 2 diabetes, which makes it possible to identify a group of high rate of GFR reduction in conditions of routine outpatient admission. Material and methods. 69 clinical indicators were studied, the interrelationships and significance of differences in parameters in the groups identified according to the original diagnostic parameter, the glomerular filtration rate reduction index with a threshold value of 3.83 ml/min/1.73 m2 per year, above which the rate of progression of CKD was considered high. Results. By using regression analysis, significant factors for the prognostic calculator were identified: the duration of diabetes and insulin therapy, concomitant diagnosis of obesity, pulse in the ankle artery, severe stage of polyneuropathy, risk group IV of hypertension, treatment with sulfonylureas, the number of antihypertensive drugs taken. When evaluating the information capacity and predictive ability of the calculator, the area under the AUC ROC curve was 0.89 (0.80; 0.99) p 0.001, which characterizes the quality of the diagnostic technique as high. Conclusion. The presented calculator gives the doctor the opportunity to identify a group of patients with the risk of rapid progression of CKD directly on an outpatient basis.

Swyer syndrome is a rare genetic disorder in which gonadal dysgenesis and karyotype 46, XY are observed. In the postnatal and prepubescent period, this disease has no clinical manifestations and is asymptomatic, which makes diagnosis difficult. The first signs of the syndrome appear in puberty in the form of underdevelopment of secondary sexual characteristics. This review presents the criteria based on which such a diagnosis as Swyer syndrome can be made. The main diagnostic methods are highlighted, the possibilities of both surgical treatment of patients and drug treatment due to hormone replacement therapy are considered. Verification of the syndrome contributes to a more thorough examination, which will allow you to determine management tactics and avoid complications from other organs and systems.

Latar belakang. Setiap unit perawatan intensif anak (UPIA) memiliki karakteristik berbeda dan evaluasi terhadap luaran pasien penting untuk memperbaiki kualitas pelayanan. Data publikasi penelitian terkait UPIA umumnya dikerjakan pada level tersier. Tujuan Mengetahui karakteristik klinis, luaran, serta faktor-faktor yang memengaruhi luaran di UPIA level sekunder pada Rumah Sakit Umum Daerah (RSUD). Metode: Penelitian potong lintang retrospektif menggunakan data rekam medis pasien yang dirawat di UPIA RSUD Balaraja selama tahun 2022. Data yang diambil mencakup data demografis (usia, jenis kelamin, berat badan), ruang asal perawatan, diagnosis utama, komorbiditas, terapi selama perawatan, dan parameter laboratorium. Hasil uji statistik disajikan dalam nilai p serta interval kepercayaan 95%, besarnya hubungan dinyatakan dengan nilai odd ratio (OR). Hasil: Seratus satu pasien masuk dalam penelitian. Sebagian besar berusia di bawah 1 tahun, berasal dari bangsal perawatan, dan memiliki komorbiditas. Sebanyak 87,1% pasien memiliki diagnosis utama medis, pneumonia dan infeksi sistem saraf pusat merupakan diagnosis terbanyak. Terdapat 32 pasien (31,6 %) meninggal dunia, penggunaan ventilator mekanik (OR 36,75; 95% KI 8,014-168,519; p

Abstract Background While osteoarthritis is a significant issue within the hemodialysis population and contributes to reduced quality of life, pain related to osteoarthritis is poorly managed by healthcare professionals (HCPs) in hemodialysis settings due to the absence of clinical guidance applicable to this population. The purpose of this study was to explore the perceptions of HCPs on the barriers and facilitators to using a clinical decision support tool for osteoarthritis pain management in the hemodialysis setting. Methods A qualitative descriptive study was conducted. Purposeful and snowball sampling techniques were used to recruit hemodialysis clinicians from academic and community settings across multiple Canadian provinces. One-to-one interviews were conducted with clinicians using a semi-structured, open ended interview guide informed by the Theoretical Domains Framework, a behavior change framework. A general inductive approach was applied to identify the main themes of barriers and facilitators. Results A total of 11 interviews were completed with 3 nephrologists, 2 nurse practitioners and 6 pharmacists. Findings revealed 6 main barriers and facilitators related to the use of the clinical decision support tool. Alignment of the tool with practice roles emerged as a key barrier and facilitator. Other barriers included challenges related to the dialysis environment, varying levels of clinician comfort with pain medications, and limited applicability of the tool due to patient factors. An important facilitator was the intrinsic motivation among clinicians to use the tool. Conclusions Most participants across the included hemodialysis settings expressed satisfaction with the clinical decision support tool and acknowledged its overall potential for improving osteoarthritis pain management among patients on hemodialysis. Future implementation of the tool may be limited by existing roles and practices at different institutions. Increased collaboration among hemodialysis and primary care teams may promote uptake of the tool.

This research aims to develop a teaching module for the Merdeka Curriculum with nuances of critical reasoning for elementary school students. It does this by outlining the validity level assessed from the teaching module's suitability aspect, language aspects, and empirical validity of the practicality level of the module. This study used the research and development method with the 4D model, which involved definition, design, development, and dissemination. The instruments used in this research included validation sheets, interviews, teacher and student questionnaires, field trials, and trial observation checklists. Data analysis techniques involved qualitative content analysis and descriptive statistics. The findings demonstrated that three of the four stages, define, design, and development, were completed to construct the teaching module. The curriculum analysis, teaching module needs analysis, learning outcomes analysis, and material analysis are completed during the define step. Designing instructional modules that satisfy requirements for viability, correctness, clarity, and attractive presentation is the design stage process. Teaching module products were put through testing, validation procedures, and practicality checks to complete the development stage. The average percentage of the language component and the appropriateness aspect in the validity of the teaching module were 4.87 and 4.81, respectively, with very valid criteria. Based on teacher answer questionnaires (4.6 with very practical criteria) and student response questionnaires (4.2 with very practical criteria), the practicality of the teaching module was determined. Based on these results, the teaching module is valid and practical, so it qualifies as a feasible and quality development product.

This study examines the repurchase intention of imported vegetables in Batam City by analyzing consumer satisfaction, price, and quality as factors influencing repurchase intentions. Path analysis with SmartPLS was used to test the hypothesis. The sample used in this study was 199 respondents. The results showed a positive relationship between customer satisfaction and repurchase intention, there was no relationship between price and repurchase intention and showed that quality was positively related to repurchase intention. The results also show that there is a significant influence between quality on repurchase intentions through customer satisfaction. However, customer satisfaction failed to mediate the relationship between price and repurchase intention.

Abstract Breast cancer (BC) screening plays a major role in the prevention of BC through early detection and timely treatment. This study aims to determine the level of uptake of BC screening and associated factors. A community-based analytical cross-sectional study was conducted in Dodoma City, Tanzania from July to December 2020. The study included women aged 8 years and above without a known history of breast cancer. Multivariable logistic regression was used to determine the socio-demographic factors associated with BC screening. P value

Background. Despite the global trend towards a decrease in mortality from cardiovascular pathology of atherosclerotic genesis, this group of diseases continues to occupy a leading position in the structure of disability and mortality among the population of many countries. Aim. Identification of noninvasive markers of arterial wall lesions associated with the presence of arterial hypertension (AH) and coronary heart disease (CHD) in persons younger than 55 years. Materials and methods. The study included 81 people. Three groups were distinguished from them: 1st (n=31) – a control group of practically healthy individuals, average age – 43 (40; 48) years; 2nd group (n=21) – patients with coronary heart disease without a history of cardiovascular diseases (CVD), average age – 45,5±6,1; group 3 (n=29) – patients with AH without CHD, average age – 47 (35; 50) years. The parameters of a biochemical blood test were determined, volumetric sphygmography and a sample with post-occlusive reactive hyperemia were performed. Results. In groups of patients with CHD and AH, negative changes in the lipid profile and higher glucose levels were recorded compared to healthy individuals. According to the results of volumetric sphygmography, the pulse wave velocity in arteries of predominantly elastic type (R/L-PWV) in group 1 was 10.1±1.7 m/s, in group 2 – 12.9±1.8 m/s, in group 3 – 13.1 (12; 14) m/s (р1–2=0.029; р1–30.001); cardio-ankle vascular index (CAVI) – 6.5±0.7, 7.7 (7; 8.7) and 7.8 (7.3; 8.4), respectively (р1–20.001; р1–30.001). According to the data of the test with post-occlusive reactive hyperemia, a comparably high frequency of pathological values of flow-dependent vasodilation (FDV) and reactivity index (RI) was demonstrated in patients with CHD and AH (р1–20.05; р1–30.05). A multifactorial model of noninvasive diagnosis of CHD in individuals without a history of CVD, including non-high-density lipoprotein cholesterol, R/L-PWV, and FDV, has been developed. For patients with AH, glucose, lipid metabolism, R/L-PWV, pulse wave velocity in muscle-type arteries (B-PWV), augmentation index (AI), biological age, CAVI, FDV, RI were the risk factors for the presence of the disease in the anamnesis. Conclusion. The results obtained confirm the importance of an integrated approach in the screening diagnosis of CVD.

Abstract Background Women are disproportionately impacted by osteoarthritis (OA) but less likely than men to access OA care, particularly racialized women. One way to reduce inequities is through policies that can influence healthcare services. We examined how OA-relevant policies in Canada address equitable, person-centred OA care for women. Methods We used content analysis to extract data from English-language OA-relevant documents referred to as policies or other synonymous terms published in 2000 or later identified by searching governmental and other web sites. We used summary statistics to describe policy characteristics, person-centred care using McCormack’s six-domain framework, and mention of OA prevalence, barriers and strategies to improve equitable access to OA care among women. Results We included 14 policies developed from 2004 to 2021. None comprehensively addressed all person-centred care domains, and few addressed individual domains: enable self-management (50%), share decisions (43%), exchange information (29%), respond to emotions (14%), foster a healing relationship (0%) and manage uncertainty (0%). Even when mentioned, content offered little guidance for how to achieve person-centred OA care. Few policies acknowledged greater prevalence of OA among women (36%), older (29%) or Indigenous persons (29%) and those of lower socioeconomic status (14%); or barriers to OA care among those of lower socioeconomic status (50%), in rural areas (43%), of older age (37%) or ethno-cultural groups (21%), or women (21%). Four (29%) policies recommended strategies for improving access to OA care at the patient (self-management education material in different languages and tailored to cultural norms), clinician (healthcare professional education) and system level (evaluate OA service equity, engage lay health leaders in delivering self-management programs, and offer self-management programs in a variety of formats). Five (36%) policies recommended research on how to improve OA care for equity-seeking groups. Conclusions Canadian OA-relevant policies lack guidance to overcome disparities in access to person-centred OA care for equity-seeking groups including women. This study identified several ways to strengthen policies. Ongoing research must identify the needs and preferences of equity-seeking persons with OA, and evaluate the impact of various models of service delivery, knowledge needed to influence OA-relevant policy.

Se presenta un estudio basado en el diseño y centrado en la intervención de una secuencia de modelización para revelar ideas y representaciones de funciones que surgen de los alumnos en una situación de desarrollo de talento para el canto en un conjunto de personas durante un periodo de tiempo. La experimentación se llevó a cabo con 37 alumnos (de 18 años de edad) de un curso propedéutico previo al ingreso a una licenciatura en Matemáticas, siguiendo la metodología de investigación basada en el diseño, cumpliendo un ciclo con análisis prospectivo, experimentación en el aula y evaluación para el rediseño. Se identificaron categorías emergentes a partir de un análisis inductivo para clasificar las representaciones de los modelos de los estudiantes: lineales, lineales a trozos, suaves, discretas y alternativas. Los resultados muestran que los estudiantes utilizaron su conocimiento previo y el que emergió durante la interacción en el equipo para representar las historias de los personajes y representar el desarrollo de talento a través del tiempo. Adicionalmente, fue notorio que para destacar momentos cruciales de la historia de los personajes, los alumnos exploraron el comportamiento en momentos cercanos a estos.

Hormone-producing ovarian tumors in girls are an actual problem in modern gynecology, which is associated with certain difficulties in managing patients. Firstly, it is worth taking into account the higher anatomical mobility of tumors in girls than in adults, due to the high location of the ovaries, weakness of the ligamentous apparatus and the active lifestyle of the child, which causes a higher incidence of torsion of the volumetric mass in children. Secondly, surgical treatment of hormone-producing ovarian tumors leads to a decrease in ovarian reserve and irreversible consequences in the reproductive health of patients in the future, which is an extremely undesirable complication in childhood. Therefore, methods of fertility preservation should be discussed with girls and their parents. It is also important to note that hormone-producing ovarian tumors have a certain degree of malignancy and a tendency to recur. Thus, the relevance of this topic lies in the complexity of management of pediatric patients with this pathology due to the clinical features of the course and a higher probability of complications. Hormone-producing ovarian masses should also include follicular cysts and corpus luteum cysts, but the above structures are excluded from the discussion in this article.

Abstract Background Dysferlinopathy is a phenotypically heterogeneous group of hereditary diseases caused by mutations in the DYSF gene. Early contractures are considered rare, and rigid spine syndrome in dysferlinopathy has been previously reported only once. Case presentation We describe a 23-year-old patient with Miyoshi myopathy with a rigid spine and multiple contractures, a rare phenotypic variant. The disease first manifested when the patient was 13 years old, with fatigue of the gastrocnemius muscles and the development of pronounced contractures of the Achilles tendons, flexors of the fingers, and extensors of the toes, followed by the involvement of large joints and the spine. Magnetic resonance imaging revealed signs of connective tissue and fatty replacement of the posterior muscles of the thighs and lower legs. Edema was noted in the anterior and medial muscle groups of the thighs, lower legs, and the multifidus muscle of the back. Whole genome sequencing revealed previously described mutations in the DYSF gene in exon 39 (c.4282 C > T) and intron 51 (c.5785-824 C > T). An immunohistochemical analysis and Western blot showed the complete absence of dysferlin protein expression in the muscle fibers. Conclusions This case expands the range of clinical and phenotypic correlations of dysferlinopathy and complements the diagnostic search for spine rigidity.

Abstract Background Married women who experience intimate partner violence (IPV) are less likely to negotiate with their partners on modern family planning (FP) use. This study aimed to determine the influence of intimate partner violence and sociodemographics on modern family planning use. Methods A community-based cross-sectional study was conducted in the Mara region, Tanzania from April to July 2020. A total of 366 married women were interviewed. Data were collected using a structured interviewer-administered questionnaire. Analysis was done using SPSS version 25, and a binary logistic regression model was used to determine the predictors of modern FP use. The significance level was set at a p-value less than 0.05. Results The overall prevalence of IPV was 73% with 54.1% physical, 36.3% psychological, and 25.4%, sexual violence. The prevalence of modern FP use was 62%, and the most (49.1%) common method practiced by married women was injection (Depo Provera). Physical violence (AOR = 0.32, p = 0.0056), and psychological violence (AOR = 0.22, p = 0.0022) had significantly reduced odds of modern FP use. Religion (AOR = 4.6, p = 0.0085), and availability of preferred modern FP methods (AOR = 9.27, p < 0.0001) had significantly increased odds of modern FP use. Conclusion In this study, there is a positive association between the use of modern FP methods and IPV. To prevent IPV and its negative health consequences, it is crucial to involve community leaders and primary healthcare workers. They can help in identifying the best strategies to prevent IPV and promote the use of modern FP methods. It is equally important to involve male partners in reproductive health decisions, including the use of modern FP methods. This approach will help reduce reproductive coercion.

The natural polyphenol resveratrol is a biologically active compound that interacts with DNA and affects the activity of some nuclear enzymes. Its effect on the interaction between nucleosomes and poly(ADP-ribose) polymerase-1 (PARP1) and on the catalytic activity of PARP1 was studied using Western blotting, spectrophotometry, electrophoretic mobility shift assay, and single particle Förster resonance energy transfer microscopy. Resveratrol inhibited PARP1 activity at micro- and sub-micromolar concentrations, but the inhibitory effect decreased at higher concentrations due to the aggregation of the polyphenol. The inhibition of PARP1 by resveratrol was accompanied by its binding to the enzyme catalytic center and a subsequent decrease in PARP1 affinity to nucleosomal DNA. Concurrent binding of talazoparib to the substrate binding pocket of PARP1, which occurs in the presence of resveratrol, restores the interaction of PARP1 with nucleosomes, suggesting that the binding sites of resveratrol and talazoparib overlap. The data suggest that resveratrol can be classified as a natural inhibitor of PARP1.

In systemic hyper-inflammation, as in severe COVID-19 disease, there are pronounced disorders of the hematological and lymphatic systems with prognostically relevant hemophagocytosis of the bone marrow. The current work aimed to address the importance of hemophagocytosis in the lymph nodes of patients with severe COVID-19 disease. From 28 patients who died of severe COVID-19 infection, samples of the vertebral bone marrow and lymph nodes from the cervical, hilar, para-aortic, mesenteric and inguinal locations were morphologically and immunohistologically (CD163, CD68, CD61, CD71, CD3, CD20, CD138) examined for the possible presence of hemophagocytosis. In the single-center study at the University Hospital Jena, a total of 191 hemophagocytes were found in the bone marrow and a total of 780 hemophagocytes in the lymph nodes in a standardized area of 21,924 mm2 per tissue sample. With 370 hemophagocytes, hilar lymph nodes were most frequently affected (370/780; 47.44%; 95%-CI: [43.94, 50.95]), followed by cervical lymph nodes (206/780; 26.41%; 95%-CI: [23.41, 29.59]), para-aortic lymph nodes (125/780; 16.03%; 95%-CI: [13.58, 18.73]) and inguinal/mesenteric lymph nodes (79/780; 10.13%; 95%-CI: [8.155, 12.4]). Based on the standard area (21,924 mm2), the difference in the number of hemophagocytes in the bone marrow and in the hilar lymph nodes was statistically significant (p < 0.05), while this did not apply to the lymph nodes from the other locations. In fatal COVID-19 disease, hemophagocytosis is particularly found in the hilar lymph nodes and is therefore a better indicator of the severity of the disease than hemophagocytosis in the bone marrow. The findings provide some evidence for the concept of compartmentalized human host responses to life-threatening infections.

Background: Although osteoarthritis is common in the hemodialysis population and leads to poor health outcomes, pain management is challenged by the absence of clinical guidance. A treatment algorithm was developed and validated to aid hemodialysis clinicians in managing osteoarthritis pain. Objective: The objective was to develop and validate a treatment algorithm for managing osteoarthritis pain in patients undergoing hemodialysis. Design: A validation study was conducted based on Lynn’s method for content validation. Setting: To develop and validate a treatment algorithm, interviews were conducted virtually by the primary researcher with clinicians from various institutions across the Greater Toronto and Hamilton Area in Ontario. Patients: The treatment algorithm was developed and validated for the management of osteoarthritis pain in patients on hemodialysis. Patients were not involved in the development or validation of the tool. Measurements: The algorithm was measured for content and face validity. Content validity was measured by calculating the content validity index of each component (I-CVI) of the algorithm and the overall scale validity index (S-CVI). Face validity was assessed by calculating the percentage of positive responses to the face validity statements. Methods: A draft algorithm was developed based on literature searches and expert opinion and validated by interviewing nephrology and pain management clinicians. Through consecutive rounds of 1:1 interviews, content and face validity were assessed by asking participants to rate the relevance of each component of the algorithm and indicate their level of agreeability with a series of statements. Following each round, the I-CVI of the algorithm as well as the S-CVI was calculated and the percentage of positive responses to the statements was determined. The research team revised the algorithm in response to the findings. The final algorithm provides a stepwise approach to the non-pharmacologic and pharmacologic management of pain, including topical, oral, and opioid use. Results: A total of 18 clinicians from 7 institutions across the Greater Toronto and Hamilton Area were interviewed (10 pharmacists, 5 nurse practitioners, and 3 physicians). The average S-CVI of the algorithm across all 3 rounds was 0.93. At least 78% of participants provided positive responses to the face validity statements. Limitations: An algorithm was developed based on input from clinicians working in the province of Ontario, limiting the generalizability of the algorithm across provinces. In addition, the algorithm did not include the perspectives of primary care providers or patients/caregivers. Conclusions: An algorithm for the management of osteoarthritis pain in the hemodialysis population was developed and validated through expert review to standardize practices and encourage clinicians to use evidence-based treatments and address the psychosocial symptoms of pain. As the algorithm possesses a high degree of content and face validity, it may improve osteoarthritis pain management among patients undergoing hemodialysis. Future research will assess the implementation of the algorithm across hemodialysis settings.

Introduction Cancer is a multifactorial disease dependent on the influence of genetic and environmental factors. About 10% of cancers are associated with germline mutations, which predispose to a higher risk of developing cancer. Currently, the use of panels that identify susceptibility and/or association genes cancer has been increasingly used, both in clinical practice and in scientific research.

Abstract Cyclic-AMP-response element-binding protein (CREB) is a leucine zipper class transcription factor that is activated through phosphorylation. Ample CREB phosphorylation is required for neurotrophin expression, which is of key importance for preventing and regenerating neurological disorders, including the sequelae of long COVID syndrome. Here we created lipid-peptide nanoassemblies with different liquid crystalline structural organizations (cubosomes, hexosomes, and vesicles) as innovative nanomedicine delivery systems of bioactive PUFA-plasmalogens (vinyl ether phospholipids with polyunsaturated fatty acid chains) and a neurotrophic pituitary adenylate cyclase-activating polypeptide (PACAP). Considering that plasmalogen deficiency is a potentially causative factor for neurodegeneration, we examined the impact of nanoassemblies type and incubation time in an in vitro Parkinson’s disease (PD) model as critical parameters for the induction of CREB phosphorylation. The determined kinetic changes in CREB, AKT, and ERK-protein phosphorylation reveal that non-lamellar PUFA-plasmalogen-loaded liquid crystalline lipid nanoparticles significantly prolong CREB activation in the neurodegeneration model, an effect unattainable with free drugs, and this effect can be further enhanced by the cell-penetrating peptide PACAP. Understanding the sustained CREB activation response to neurotrophic nanoassemblies might lead to more efficient use of nanomedicines in neuroregeneration.

Abstract Objective: To evaluate the application of the Antimicrobial (ATM) treatment time reduction strategy in Intensive Care Units (ICU) in an Antimicrobial Stewardship Program (ASP). Method: This is a descriptive and cross-sectional study, carried out in two ICU of a university hospital in Fortaleza, Brazil, from January/2017 to January/2019. Adult patients were included, accompanied by a pharmacist, and using ATM, in which the treatment time reduction strategy was applied. The evaluation of the strategy was made through the difference between the predicted time established at the beginning of the treatment and the effective days of use of each ATM. Results: Of the 100 patients included, 51.0 % were male and 64.0 % were elderly. The respiratory system was the most frequently affected by the infections (37.4 %) and the most prevalent classes of ATM were carbapenems (23.0 %) and glycopeptides (20.1 %). There was a decrease from 831 unnecessary days of antimicrobial therapy and from an average of 13.7 to 8.9 days of treatment. The greatest reductions in days were observed for meropenem, with 202 days reduced. The study also allowed the identification of associations between the reduction > 8 days of treatment and the variables length of stay > 22 days and patients in exclusive palliative care, and associations between hospital discharge and reductions of up to 7 days of therapy. Conclusions: The data obtained suggest that the presence of an ASP influences the practices of ATM use and its treatment time and emphasize the role of pharmaceutical professionals in these programs.

Abstract Background Women are more likely to develop osteoarthritis (OA), and have greater OA pain and disability compared with men, but are less likely to receive guideline-recommended management, particularly racialized women. OA care of diverse women, and strategies to improve the quality of their OA care is understudied. The purpose of this study was to explore strategies to overcome barriers of access to OA care for diverse women. Methods We conducted qualitative interviews with key informants and used content analysis to identify themes regarding what constitutes person-centred OA care, barriers of OA care, and strategies to support equitable timely access to person-centred OA care. Results We interviewed 27 women who varied by ethno-cultural group (e.g. African or Caribbean Black, Chinese, Filipino, Indian, Pakistani, Caucasian), age, region of Canada, level of education, location of OA and years with OA; and 31 healthcare professionals who varied by profession (e.g. family physician, nurse practitioner, community pharmacist, physio- and occupational therapists, chiropractors, healthcare executives, policy-makers), career stage, region of Canada and type of organization. Participants within and across groups largely agreed on approaches for person-centred OA care across six domains: foster a healing relationship, exchange information, address emotions, manage uncertainty, share decisions and enable self-management. Participants identified 22 barriers of access and 18 strategies to overcome barriers at the patient- (e.g. educational sessions and materials that accommodate cultural norms offered in different languages and formats for persons affected by OA), healthcare professional- (e.g. medical and continuing education on OA and on providing OA care tailored to intersectional factors) and system- (e.g. public health campaigns to raise awareness of OA, and how to prevent and manage it; self-referral to and public funding for therapy, greater number and ethno-cultural diversity of healthcare professionals, healthcare policies that address the needs of diverse women, dedicated inter-professional OA clinics, and a national strategy to coordinate OA care) levels. Conclusions This research contributes to a gap in knowledge of how to optimize OA care for disadvantaged groups including diverse women. Ongoing efforts are needed to examine how best to implement these strategies, which will require multi-sector collaboration and must engage diverse women.

Amino acids with unusual types of chirality and their derivatives have recently attracted attention as precursors in the synthesis of chiral catalysts and peptide analogues with unique properties. In this study, we have synthesized a new nido-carborane-based planar-chiral amino acid, in the molecule of which the amino group is directly bonded to the B(3) atom, and the carboxyl group is attached to the B(9) atom through the CH2S+(Me) fragment. 3-Amino-9-dimethylsulfonio-nido-carborane, prepared in three steps from 3-amino-closo-carborane in a high yield, was a key intermediate in the synthesis of the target planar-chiral amino acid. The carboxymethyl group at the sulfur atom was introduced by the demethylation reaction of the dimethylsulfonio derivative, followed by S-alkylation. The structure of new 3,9-disubstituted nido-carboranes was studied for the first time using NMR spectroscopy. The resonances of all boron atoms in the 11B NMR spectrum of 3-amino-9-dimethylsulfonio-nido-carborane were assigned based on the 2D NMR correlation experiments. The nido-carborane-based planar-chiral amino acid and related compounds are of interest as a basis for peptide-like compounds and chiral ligands.

Clouds and other data artefacts frequently limit the retrieval of key variables from remotely sensed Earth observations. We train a natural language processing (NLP)-inspired algorithm with high-fidelity ocean simulations to accurately reconstruct masked or missing data in sea surface temperature (SST) fields—one of 54 essential climate variables identified by the Global Climate Observing System. We demonstrate that the resulting model, referred to as Enki, repeatedly outperforms previously adopted inpainting techniques by up to an order of magnitude in reconstruction error, while displaying exceptional performance even in circumstances where the majority of pixels are masked. Furthermore, experiments on real infrared sensor data with masked percentages of at least 40% show reconstruction errors of less than the known uncertainty of this sensor (root mean square error (RMSE) ≲0.1 K). We attribute Enki’s success to the attentive nature of NLP combined with realistic SST model outputs—an approach that could be extended to other remotely sensed variables. This study demonstrates that systems built upon Enki—or other advanced systems like it—may therefore yield the optimal solution to mitigating masked pixels in in climate-critical ocean datasets sampling a rapidly changing Earth.

Abstract Introduction Women are disproportionately impacted by osteoarthritis (OA) but less likely than men to access early diagnosis and management, or experience OA care tailored through person-centred approaches to their needs and preferences, particularly racialized women. One way to support clinicians in optimizing OA care is through clinical guidelines. We aimed to examine the content of OA guidelines for guidance on providing equitable, person-centred care to disadvantaged groups including women. Methods We searched indexed databases and websites for English-language OA-relevant guidelines published in 2000 or later by non-profit organizations. We used manifest content analysis to extract data, and summary statistics and text to describe guideline characteristics, person-centred care (PCC) using a six-domain PCC framework, OA prevalence or barriers by intersectional factors, and strategies to improve equitable access to OA care. Results We included 36 OA guidelines published from 2003 to 2021 in 8 regions or countries. Few (39%) development panels included patients. While most (81%) guidelines included at least one PCC domain, guidance was often brief or vague, few addressed exchange information, respond to emotions and manage uncertainty, and none referred to fostering a healing relationship. Few (39%) guidelines acknowledged or described greater prevalence of OA among particular groups; only 3 (8%) noted that socioeconomic status was a barrier to OA care, and only 2 (6%) offered guidance to clinicians on how to improve equitable access to OA care: assess acceptability, availability, accessibility, and affordability of self-management interventions; and employ risk assessment tools to identify patients without means to cope well at home after surgery. Conclusions This study revealed that OA guidelines do not support clinicians in caring for diverse persons with OA who face disadvantages due to intersectional factors that influence access to and quality of care. Developers could strengthen OA guidelines by incorporating guidance for PCC and for equity that could be drawn from existing frameworks and tools, and by including diverse persons with OA on guideline development panels. Future research is needed to identify multi-level (patient, clinician, system) strategies that could be implemented via guidelines or in other ways to improve equitable, person-centred OA care. Patient or public contribution This study was informed by a team of researchers, collaborators, and thirteen diverse women with lived experience, who contributed to planning, and data collection, analysis and interpretation by reviewing study materials and providing verbal (during meetings) and written (via email) feedback.

Penelitian ini bertujuan untuk membuktikan secara empiris pengaruh kepemilikan institusional, komite audit, dan kinerja lingkungan terhadap pengungkapan emisi karbon pada perusahaan manufaktur. Untuk mengukur seluas apa pengungkapan emisi karbon pada tiap perusahaan, digunakan checklist yang telah dikembangkan berdasarkan lembar permintaan informasi yang diberikan oleh proyek pengungkapan emisi karbon (CDP). Jenis penelitian ini digolongkan pada penelitian kuantitatif dengan pengujian hipotesis. Jenis data yang digunakan adalah data kuantitatif dan kualitatif berupa laporan tahunan yang diperoleh dari www.idx.co.id. Populasi dalam penelitian ini adalah perusahaan manufaktur yang terdaftar di BEI selama 4 tahun berturut-turut yakni dari tahun 2017 sampai dengan tahun 2020. Sedangkan sampel penelitian ditentukan dengan metode purposive sampling, total 148 sampel. Hasil penelitian ini menunjukkan bahwa variabel kepemilikan institusional dan komite audit berpengaruh positif terhadap pengungkapan emisi karbon. Variabel kinerja lingkungan berpengaruh negatif terhadap pengungkapan emisi karbon.

Background: Patients on hemodialysis have complex medical diagnoses and medication regimens, requiring access to numerous health services and consultation with various healthcare providers. While interprofessional collaboration can optimize care among hemodialysis patients, these patients commonly experience medication-related problems and frequent hospitalizations resulting from miscommunications and mismanagement of medications. Objectives: This study aims to capture the lived experiences of patients on hemodialysis to reveal their medication management needs as they navigate ongoing care between various outpatient services. Methods: A qualitative methodology was used to explore the perspectives of hemodialysis patients. One-on-one, in-person, semi-structured interviews were conducted at an outpatient hemodialysis clinic located inside an urban teaching hospital. English-speaking adults 18 years and older who have been followed at the clinic for at least three months were selected through random, convenience sampling. Interviews were recorded and transcribed verbatim. Patients were recruited and data were collected iteratively and continued until data saturation was reached. Data was analyzed through the lens of the Picker Principles of Patient Centered Care using a general inductive approach. Results: A total of nine interviews were conducted. Two major themes, medication management and care navigation, were identified. Though patients had a wealth of knowledge about their medications, and they were motivated to self-manage their medications to enhance their well-being, they experienced barriers with medication management. Patients further expressed challenges with navigating care and spoke of the importance of having good rapport with healthcare providers who are attentive to their needs. Conclusions: The results revealed a need for improved support for self-care and interprofessional collaboration to possibly reduce the burden of medications and care fragmentation experienced by patients and improve continuity of care for patients.

Objectives Osteoarthritis (OA) prevalence, severity and related comorbid conditions are greater among women compared with men, but women, particularly racialised women, are less likely than men to access OA care. We aimed to prioritise strategies needed to reduce inequities in OA management.Design Delphi survey of 28 strategies derived from primary research retained if at least 80% of respondents rated 6 or 7 on a 7-point Likert scale.Setting Online.Participants 35 women of diverse ethno-cultural groups and 29 healthcare professionals of various specialties from across Canada.Results Of the 28 initial and 3 newly suggested strategies, 27 achieved consensus to retain: 20 in round 1 and 7 in round 2. Respondents retained 7 patient-level, 7 clinician-level and 13 system-level strategies. Women and professionals agreed on all but one patient-level strategy (eg, consider patients’ cultural needs and economic circumstances) and all clinician-level strategies (eg, inquire about OA management needs and preferences). Some discrepancies emerged for system-level strategies that were more highly rated by women (eg, implement OA-specific clinics). Comments revealed general support among professionals for system-level strategies provided that additional funding or expanded scope of practice was targeted to only formally trained professionals and did not reduce funding for professionals who already managed OA.Conclusions We identified multilevel strategies that could be implemented by healthcare professionals, organisations or systems to mitigate inequities and improve OA care for diverse women.

Abstract Aim We explored midwives' experiences and challenges in providing maternity care during the period of the first surge of the COVID‐19 pandemic in Dodoma. Design Phenomenological study design was used to explore midwives' experiences and challenges in providing maternity care during the COVID‐19 pandemic in Tanzania. Methods We conducted interviews with a total of 23 midwives, using semi‐structured interviews and an audio recorder. Five focus group discussions (FGDs) were conducted. To analyse the data, we used interpretive phenomenological thematic data analysis with NVivo software. To analyse templates, we followed a step‐by‐step process, starting with familiarizing ourselves with the data, followed by preliminary coding, organizing themes, developing an initial coding template, using the initial template, refining the template and finally applying it to the entire dataset. Results It was found that three themes and eight subthemes merged in the current study. The main themes were ① mental health distress, ② work environment challenges and ③ isolation of midwives by different groups. Public Contribution Reducing risk and protecting midwives from infectious diseases will improve the workforce, reduce the number of hospital stays, reduce the cost of hospital services, improve birth outcomes and indirectly improve family, community and national economies. Conclusion Due to the system's failure to provide psychological support, protective environment and isolation rooms for confirmed or suspected cases put midwives at a higher risk of contracting the virus and had to work in a stressful environment. In addition to having the right tools, midwives must also receive emotional and psychological support in order to be at their best. The system must ensure that midwives are ready for uncertain times, such as pandemic infectious disease outbreaks, by providing protective work place environment such as personal protective equipment, psychological support and isolation room for confirmed COVID‐19 cases.

The relevance of the work. The relevance of the study is due to the need to develop agro-industrial production at a new qualitative level, to increase the level of food security in the region by improving the organizational and economic mechanism for the development of investment activities in the agro-industrial complex. Objective. The purpose of this study is the development of scientific and methodological provisions for improving the organizational and economic mechanisms of investment activity in the agro-industrial complex of Siberian regions. Materials and methods. The research methodology is aimed at clarifying the basic principles of the formation of the organizational and economic mechanism for the development of the food and processing industry, taking into account the sectoral features of innovative development. Results. In-depth studies were carried out on the organizations of the agro-industrial complex of the Novosibirsk region. The main part of the article discloses indicators characterizing the development of Russian agriculture in 2017-2020, as well as indicators of innovative activity in agriculture for 2017-2021. Shows the share of investments aimed at the reconstruction and modernization of fixed assets in Russia, as a percentage of the total investment. The mechanism of subsidizing to compensate for the costs incurred for the construction (modernization) of agribusiness facilities is considered. The main directions for improving the organizational and economic mechanism of the investment process in Siberian agriculture have been developed. Conclusion. In conclusion, scientific provisions are formulated to improve the organizational and economic mechanism for the development of investment activities in the agro-industrial complex.

Mathematics actually plays an important role in various aspects of life. There are two influential factors in mathematics learning. This research analyzes internal factors that affect mathematics learning, namely motivation, attitude, and students' self-concept because these factors play a significant role in mathematics. This study aims to describe the motivation, attitude, and self-concept of students towards mathematics in class VA at SD Negeri 40 Pontianak Utara. The method used is qualitative research with a descriptive qualitative approach. The population in this study is class VA students, and a sample of seven students was selected using random sampling technique. Data collection in this study was done through observation and interviews. In the data analysis technique, the researcher observed mathematics learning and then conducted interviews, and the results were processed and analyzed. Based on the research findings, it was found that the majority of students in class VA have a significant motivation in mathematics learning, although some other students do not have an interest in learning mathematics. The attitude of class VA students towards mathematics is also quite positive, and they believe that mathematics can help them develop, although there are still students who do not feel progress and are not interested in learning mathematics. Most of the class VA students have understood their self-concept in relation to mathematics learning.

Introduction: Glucocorticosteroid therapy is the basic therapeutic option for rheumatoid arthritis; however, long-term treatment with low and medium doses is associated with the development of negative side effects. As reported, oxidative stress is crucial in the pathogenesis of rheumatoid arthritis. Therefore, pharmacotherapy that combines application of methylprednisolone pulse therapy and an aqueous molecular hydrogen solution seems to be a reasonable treatment option in these cases. Materials and Methods: The study of the effectiveness of combined pharmacotherapy for rheumatoid arthritis was carried out on mature male rats. Rheumatoid arthritis was simulated by introducing bovine type II collagen into the right knee joint. Animals of the 1st – control – group received placebo; animals of the 2nd group received molecular hydrogen-enriched water intragastrically; animals of the 3rd group received methylprednisolone solution intravenously by catheterization of the tail vein, and animals of the 4th group received water enriched with molecular hydrogenintragastrically and methylprednisolone solution intravenously. After withdrawal of animals from the experiment, microsections of their joint tissues were analysed histologically and biomarkers of the joint inflammation were detected immunohistochemically. Results and Discussion: Morphological analysis of microsections taken from animals of the 4th group evidenced effectiveness of the combined therapy based on quantitative estimation of the inflammatory biomarker expression. Dynamic polarization of M1/M2 macrophage was manifested with high quality in animals of this group. Conclusion: The search for new therapeutic options for rheumatoid arthritis is expanded due to major antioxidant substances that can reduce duration of treatment, while ensuring positive dynamics of the course of the disease.

Introduction. The incidence of healthcare-associated infections is a major public health problem worldwide, affecting all countries regardless of their economic status. The main agents of these infections are pathogens belonging to the ESKAPE group. The aim of the study was to explore the structure, molecular and antigenic characteristics of the ESKAPE pathogens isolated from oral and anal mucosa of patients of the neonatal intensive care unit (NICU), and to assess their etiological significance in occurrence of healthcare-associated infections. Materials and methods. Samples from a total of 49 children were tested, including 40 newborns patients of NICU at the National Hospital of Pediatrics in Hanoi. Collection and processing of biomaterial (oropharyngeal swabs, rectal swabs) and isolation of bacterial cultures were performed using conventional bacteriological methods. Mass spectrometry was used for identification of isolates. Klebsiella pneumoniae strains were analyzed using the whole-genome sequencing method. Results. The group of gram-positive ESKAPE pathogens identified in oral mucosa was represented by isolates Enterococcus faecium and Staphylococcus aureus. The isolates of the family Enterobacteriaceae included K. pneumoniae, Escherichia coli, Enterobacter cloacae; the group of nonfermenting gram-negative bacteria was represented by Pseudomonas aeruginosa, Acinetobacter baumannii. The structure of ESKAPE pathogens persistent in anal mucosa was characterized by dominance of Enterococcus spp., E. coli, K. pneumoniae and P. aeruginosa bacteria. The whole-genome sequencing of K. pneumoniae isolates revealed 7 clusters and 8 sequence types. ST14 and ST1741 prevailed, accounting for 25%, respectively, of the total number of the studied strains. The molecular serotyping showed that by the O antigen, strains belonged mainly to serotypes O1v1, O1/ O2v2, O5; by the presence of the capsular antigen to serotypes KL2, KL104, KL60. Conclusion. The analysis of the structure of the ESKAPE pathogens isolated from the oral and anal mucosa of patients of NICU at the National Hospital of Pediatrics in Hanoi identified etiologically significant agents of bacterial infections: S. aureus, K. pneumoniae, E. coli, E. cloacae, P. aeruginosa, A. baumannii. The molecular and genetic analysis of K. pneumoniae strains co-circulating in mucous membranes of several patients of the unit revealed their homology, thus confirming healthcare-associated contamination of children with nosocomial strains.

Abstract Background Child mortality continue to be a major public health issue in most developing countries; albeit there has been a decline in global under-five deaths. The differences in child mortality can best be explained by socioeconomic and environmental inequalities among countries. In this study, we explore the effect of country-level development indicators on under-five mortality rates. Specifically, we examine potential spatio-temporal heterogeneity in the association between major world development indicators on under-five mortality, as well as, visualize the global differential time trend of under-five mortality rates. Methods The data from 195 countries were curated from the World Bank’s World Development Indicators (WDI) spanning from 2000 to 2017 and national estimates for under-five mortality from the UN Inter-agency Group for Child Mortality Estimation (UN IGME).We built parametric and non-parametric Bayesian space-time interaction models to examine the effect of development indicators on under-five mortality rates. We also used employed Bayesian spatio-temporal varying coefficient models to assess the spatial and temporal variations in the effect of development indicators on under-five mortality rates. Results In both parametric and non-parametric models, the results show indicators of good socioeconomic development were associated with a reduction in under-five mortality rates while poor indicators were associated with an increase in under-five mortality rates. For instance, the parametric model shows that gross domestic product (GDP) (β = − 1.26, [CI − 1.51; − 1.01]), current healthcare expenditure (β = − 0.40, [CI − 0.55; − 0.26]) and access to basic sanitation (β = − 0.03, [CI − 0.05; − 0.01]) were associated with a reduction under-five mortality. An increase in the proportion practising open defecation (β = 0.14, [CI 0.08; 0.20]) an increase under-five mortality rate. The result of the spatial components spatial variation in the effect of the development indicators on under-five mortality rates. The spatial patterns of the effect also change over time for some indicators, such as PM2.5. Conclusion The findings show that the burden of under-five mortality rates was considerably higher among sub-Saharan African countries and some southern Asian countries. The findings also reveal the trend in reduction in the sub-Saharan African region has been slower than the global trend.

High-speed global surface temperature distributions and heat flux measurements on the Initial Concept 3.X vehicle (IC3X) model were investigated at the UTSA Mach 7 wind tunnel, examining angles of attack of 0° and 5° at a freestream unit Reynolds number (Re) ~7 × 106 m−1. A ruthenium-based, fast-responding, temperature-sensitive paint (fast-TSP) prepared in-house was applied to a 7.1% scale model of the vehicle. Static calibration was performed to convert the intensity measurements into surface temperature values. The surface temperatures and derived heat flux fields conformed to the predicted trends, which was corroborated by Schlieren flow visualization. Notably, the average surface temperature variation was identified to range from 6 to 34 K at a 0° angle of attack and from 11 to 44 K at a 5° angle of attack, with the most pronounced gradient detected at the stagnation point. Additional measurements provided a detailed thermal assessment of the model, including estimations of the stagnation point heat flux, the convective heat transfer coefficient, and the modified Stanton number. Statistical and time series analyses of the data collected revealed the absence of prevailing unsteady phenomena, suggesting that the tested design geometry is well suited for hypersonic flight applications. These experimental outcomes not only shed light on the aerothermodynamics experienced during high-speed flight but also underscore the effectiveness of fast-TSP in capturing both quantitative and qualitative thermal data.

Electrocatalytic CO2 reduction to CO and formate can be coupled to gas fermentation with anaerobic microorganisms. In combination with a competing hydrogen evolution reaction in the cathode in aqueous medium, the in situ, electrocatalytic produced syngas components can be converted by an acetogenic bacterium, such as Clostridium ragsdalei, into acetate, ethanol, and 2,3-butanediol. In order to study the simultaneous conversion of CO, CO2, and formate together with H2 with C. ragsdalei, fed-batch processes were conducted with continuous gassing using a fully controlled stirred tank bioreactor. Formate was added continuously, and various initial CO partial pressures (pCO0) were applied. C. ragsdalei utilized CO as the favored substrate for growth and product formation, but below a partial pressure of 30 mbar CO in the bioreactor, a simultaneous CO2/H2 conversion was observed. Formate supplementation enabled 20–50% higher growth rates independent of the partial pressure of CO and improved the acetate and 2,3-butanediol production. Finally, the reaction conditions were identified, allowing the parallel CO, CO2, formate, and H2 consumption with C. ragsdalei at a limiting CO partial pressure below 30 mbar, pH 5.5, n = 1200 min−1, and T = 32 °C. Thus, improved carbon and electron conversion is possible to establish efficient and sustainable processes with acetogenic bacteria, as shown in the example of C. ragsdalei.

This research puts the question of linguistic categorization back into the context of sports terminology by looking at the translation of English crossfit movement terms (Tmvt) by non-specialist French speakers. The study examines three cases involving simple Tmvts (squat, snatch), compound Tmvts (pull-up, deadlift) and polylexical Tmvts (push jerk, split jerk, push press,…). The analysis of translation errors reveals that accessing the signified of the foreign term mobilizes various linguistic skills depending on the case, and the study of translation strategies (such as calque, transposition, literal translation, or description) provides linguistic clues about the conceptual delimitation of each Tmvt in particular and the organization of the knowledge network of the specialized domain of sports exercises in general.

A growing body of evidence suggests that cell division and basement membrane invasion are mutually exclusive cellular behaviors. How cells switch between proliferative and invasive states is not well understood. Here, we investigated this dichotomy in vivo by examining two cell types in the developing Caenorhabditis elegans somatic gonad that derive from equipotent progenitors, but exhibit distinct cell behaviors: the post-mitotic, invasive anchor cell and the neighboring proliferative, non-invasive ventral uterine (VU) cells. We show that the fates of these cells post-specification are more plastic than previously appreciated and that levels of NHR-67 are important for discriminating between invasive and proliferative behavior. Transcription of NHR-67 is downregulated following post-translational degradation of its direct upstream regulator, HLH-2 (E/Daughterless) in VU cells. In the nuclei of VU cells, residual NHR-67 protein is compartmentalized into discrete punctae that are dynamic over the cell cycle and exhibit liquid-like properties. By screening for proteins that colocalize with NHR-67 punctae, we identified new regulators of uterine cell fate maintenance: homologs of the transcriptional co-repressor Groucho (UNC-37 and LSY-22), as well as the TCF/LEF homolog POP-1. We propose a model in which the association of NHR-67 with the Groucho/TCF complex suppresses the default invasive state in non-invasive cells, which complements transcriptional regulation to add robustness to the proliferative-invasive cellular switch in vivo.

The issue of cervicitis and vulvovaginitis is relevant worldwide due to the increasing incidence in women of reproductive age. To date, the significant role of chronic cervicitis in the development of cancer and other diseases of the reproductive system, including cervical cancer, has been proven. In recent years, a number of large studies have been conducted, covering a significant part of the clinical issues, pathogenesis, and epidemiology of cervicitis. However, there is a clear need for further studies of both the etiological factors and the pathogenetic mechanisms of inflammatory cervical disease to support the treatment choice.

IntroductionPhenolic compounds in lettuce can increase by the application of positive stress (eustress) such as moderate saline stress. Phenolic compounds possess antioxidant capacity that is a key factor in the detoxification of excess reactive oxygen species. A double-blinded randomized interventional and placebo- controlled study design was carried out to compare the effect of daily dietary eustress lettuce ingestion in hepatic, lipid, bone, glucose, and iron metabolism.MethodsForty-two healthy volunteers, 19 female and 23 male participants, were divided into two groups. Participants were randomized into a polyphenol-enriched treatment (PET) arm or control arm. Each arm consumed 100 g/day of control or eustress (polyphenols enriched treatment = PET) lettuce for 12 days. Primary study outcomes were serological analysis for assessing hepatic, lipid, bone, iron, and glucose markers at baseline and after 12 days. Secondary outcomes assessed body composition.ResultsSalinity stress reduced plant yield but increased caffeic acid (+467%), chlorogenic acid (+320%), quercetin (+538%), and rutin (+1,095%) concentrations. The intake of PET lettuce reduced PTH, low-density lipoprotein (LDL), cholesterol, alanine transaminase (ALT), and aspartate transaminase (AST) enzyme levels and increased vitamin D and phosphate levels, while iron and glucose metabolism were unaffected.DiscussionSupplementation with eustress lettuce by increasing polyphenols concentration ameliorates hepatic, lipid, and bone homeostasis. Body composition was not affected.Clinical trial registrationhttps://classic.clinicaltrials.gov/ct2/show/NCT06002672, identifier: NCT06002672.

ABSTRACTThere has been an increase in the prevalence of Clostridioides difficile (C. diff) causing significant economic impact on the health care system. Although toxigenic C. diff carriage is recognized in infancy, there is limited data regarding its longitudinal trends, associated epidemiolocal risk factors and intestinal microbiome characteristics. The objectives of our longitudinal cohort study were to investigate temporal changes in the prevalence of toxigenic C.diff colonization in children up to 2 years, associated epidemiological and intestinal microbiome characteristics. Pregnant mothers were enrolled prenatally, and serial stool samples were collected from their children for 2 years. 2608 serial stool samples were collected from 817 children. 411/817 (50%) were males, and 738/817 (90%) were born full term. Toxigenic C.diff was detected in 7/569 (1%) of meconium samples, 116/624 (19%) of 2 m (month), 221/606 (37%) of 6 m, 227/574 (40%) of 12 m and 18/235 (8%) of 24 m samples. Infants receiving any breast milk at 6 m were less likely to be carriers at 2 m, 6 m and 12 m than those not receiving it. (p = 0.002 at 2 m, p

ObjectivesHIV self-testing (HIVST) has been proposed as an innovative strategy to diagnose human immunodeficiency virus (HIV). While HIVST offers the potential to broaden accessibility of early HIV diagnosis and treatment initiation, this testing strategy incurs additional cost and requires confirmatory testing and treatment. We have conducted the first systematic review to summarize the current economic literature for HIVST in low- and middle-income countries (LMICs).DesignA search strategy was developed including key terms for HIV, self-testing and cost-effectiveness and was conducted in Medline and Embase databases. Studies were included that reported costs per outcome and included both cost-effectiveness and cost-utility outcome measures. The search strategy identified publications up until August 15, 2023 were included. Abstract and full text screening was conducted and a standardized data abstraction form was used for included studies. Costs are reported in USD, 2020.ResultsOur search strategy identified 536 total titles from the search strategy, which were screened down to 25 relevant studies that provided both cost and outcome data on HIVST. There was significant heterogeneity in the HIVST intervention, study population, costs and outcomes reported among included studies. Cost per person tested ranged from $1.09–155. Cost per case diagnosed ranged from $20–1,277. Cost-utility estimates ranged from cost-saving to $1846 per DALY averted. Higher cost-effectiveness estimates were associated with more expensive testing algorithms with increased support for linkage to care and post-test counseling.ConclusionAll studies considered HIVST cost-effective although major drivers were identified included underlying HIV prevalence, testing cost and linkage to care. HIVST is likely to be cost-effective in a LMIC context, however policy makers should be aware of the drivers of cost-effectiveness when implementing HIVST programs as these underlying factors can impact the overall cost-effectiveness of HIVST.

ABSTRACT Microbes play a significant role in the degradation of petroleum hydrocarbons in the oceans, yet little is known about the native bacteria that metabolize hydrocarbons before an oil spill. The Faroe-Shetland Channel (FSC) is a deepwater subarctic region of the North Atlantic with prominent oil production and a diverse microbial community associated with the degradation of petroleum. Here, we combine DNA-based stable-isotope probing (DNA-SIP) with metagenomics to elucidate the metabolic underpinnings of native alkane-degrading bacteria from the FSC. From two 13C n-hexadecane SIP experiments using seawater from 5 and 700 m depths in the FSC, we obtained 42 metagenome-assembled genomes (MAGs) belonging to 19 genera, including two previously overlooked hydrocarbon-degrading bacteria, Lentibacter (Alphaproteobacteria) and Dokdonia (Bacteroidetes). Diversity surveys indicated Lentibacter were dominant members of the FSC, constituting up to 17% of these communities. Many of the SIP-enriched MAGs (20/42) encoded a complete alkane oxidation pathway, including alkane monooxygenase (AlkB), rubredoxin reductase (AlkT), and rubredoxin-2 (AlkG). Fourteen Aphaproteobacteria MAGs lacked AlkG for electron transfer. Instead, they encoded novel disulfide isomerases with iron-binding cysteine motifs conserved across rubredoxins. Dokdonia lacked AlkT and AlkG, however, their central alkane-degradation catabolic pathways were complete. We describe previously unrecognized bacteria capable of hydrocarbon degradation, including the dominant genera Lentibacter, which may continuously purge hydrocarbons released from oil exploration activities in the FSC. This advances the understanding of the diversity and physiologies of alkane degradation in the North Atlantic and provides evidence of new mechanisms used to metabolize alkanes. IMPORTANCE Petroleum pollution in the ocean has increased because of rapid population growth and modernization, requiring urgent remediation. Our understanding of the metabolic response of native microbial communities to oil spills is not well understood. Here, we explored the baseline hydrocarbon-degrading communities of a subarctic Atlantic region to uncover the metabolic potential of the bacteria that inhabit the surface and subsurface water. We conducted enrichments with a 13C-labeled hydrocarbon to capture the fraction of the community actively using the hydrocarbon. We then combined this approach with metagenomics to identify the metabolic potential of this hydrocarbon-degrading community. This revealed previously undescribed uncultured bacteria with unique metabolic mechanisms involved in aerobic hydrocarbon degradation, indicating that temperature may be pivotal in structuring hydrocarbon-degrading baseline communities. Our findings highlight gaps in our understanding of the metabolic complexity of hydrocarbon degradation by native marine microbial communities.

Background: Obesity is recognized as a risk factor for adverse outcomes in patients with COVID-19. However, a number of studies, including an analysis of the Federal Registry of Diabetic Patients (Russian Federation), have not identified any significant effect of obesity on mortality in COVID-19. Therefore, the role of obesity, assessed by body mass index (BMI) and waist circumference (WC), as a risk factor for an unfavorable course of coronavirus infection remains disputable. Aim: To assess the impact of obesity on the severity and outcomes of coronavirus infection in the Russian population of hospitalized patients. Materials and methods: This was a single center, retrospective, observational study in 367 patients with the polymerase chain reaction (PCR)-confirmed diagnosis of COVID-19 hospitalized to the in-patient department from April 2020 to November 2021. The first group included 185 patients with obesity (BMI 30.0 kg/m2); the second group consisted of 182 patients without obesity (BMI 30.0 kg/m2). Prevalence of comorbidities, clinical and laboratory parameters, and computed tomography results were assessed in both groups. WC was measured in 100 patients. Results: In this Russian population of hospitalized patients with COVID-19, obesity (BMI 30.0 kg/m2) didn't increase the probability of death both in the general sample (odds ratio (OR) = 1.31; 95% confidence interval (CI) 0.901.92, p = 0.164) and in the patients with type 2 diabetes (OR = 1.0; 95% CI 0.591.7, p = 0.997) or without diabetes (OR = 1.3; 95% CI 0.712.39, p = 0.392). However, obesity was associated with a 1,7-fold increase of the risk of severe COVID-19 (95% CI 1.132.59, p = 0.010). Morbid and abdominal obesity (according to World Health Organization and International Diabetes Federation criteria) had no significant impact on the death rate. WC of 101 cm, regardless of the patients gender, was associated with a 4,9-fold increase of the risk of death (95% CI 1.4516.42, p = 0.012). Conclusion: Obesity didnt show any significant effect on mortality, but increased the chance of severe course of COVID-19 infection. Abdominal obesity (WC 101 cm) was a more significant factor in predicting of a fatal outcome, than BMI.

Aim. To study the vasoprotective effects of atorvastatin depending on the achievement of the target level of low-density lipoprotein cholesterol (LDL-C) in patients with ST-segment elevation myocardial infarction (STEMI) within 48 weeks of follow-up. Materials and methods. Included were 112 STEMI patients who received atorvastatin 204080 mg. On days 79 from the onset of the disease, after 24 and 48 weeks, ultrasound examination of the carotid arteries with RF technology and applanation tonometry were performed, the lipid profile was determined. The patients were divided into groups: group 1 (n=41) of highly effective therapy (HET) who achieved the target LDL-C after 24 and 48 weeks; group 2 (n=29) in relatively effective therapy (RET) achieving target values at 24th or 48th week; group 3 (n=42) insufficiently effective therapy (IET) did not reach the target LDL-C. Results. When examining the carotid arteries in the HET group, the intima-media thickness (IMT) decreased by 10.713.1%, the b index by 14.926.3% after 2448 weeks. In the RET group, the IMT regression was 10.413.3%; b index 23.9% by the 48th week. In the IET group, the b index decreased by the 48th week by 14.3%. According to applanation tonometry in the HET group, the central pressure did not change. In the RET group, systolic pressure in the aorta increased by 1015.7% after 2448 weeks, pulse pressure by 33.9% by the end of observation. With IET, the increase was 8.66.8 and 19.825.9%, respectively. The odds ratio of developing endpoints in the RET group was 4.7 (95% CI 1.226.4; p=0.02), in the IET group 3.9 (95% CI 1.124.8; p=0.03) compared with HET. Conclusion. The most pronounced vasoprotective effect and a decrease in cardiovascular risk are associated with the achievement of the target LDL-C throughout the entire treatment period.

INTRODUCTION. Knee osteoarthrosis (KO) among the adult population often leads to permanent disability, a sharp decrease in the quality of life, and chronic use of analgesics. At the same time, according to the clinical guidelines of the Russian Rheumatology Association for osteoarthrosis treatment, hyaluronic acid medications are included in the list recommended for KO, and they are particularly effective at stages I-II of the disease. AIM. Evaluation of the efficiency of the dietary supplement B-Luron for KO patients within 12 weeks therapy. MATERIAL AND METHODS. A total of 70 patients with stage I-II deforming osteoarthrosis (DOA) were followed up, consecutively included in the study from December 14, 2021 to January 31, 2022, for an average of 90 days (3 months). RESULTS AND DISCUSSION. The efficiency of B-Luron for I-II DOA stages was shown: a statistically significant decrease in the level of pain in knee joints, an improvement in the function of the joint were found compared to the initial state. The analysis of objective data showed a positive trend in ultrasound parameters and MRI features of joint inflammation and a decrease in the need for analgesics within 12 weeks. CONCLUSION. In a prospective randomized clinical trial with 70 knee DOA patients as a part of the combination therapy (12 weeks use) with non-steroidal anti-inflammatory drugs, B-Luron showed its efficiency for stages I-II of the disease; there was a positive trend in ultrasound parameters and MRI signs of inflammation in the joints as well as a decrease in the need for non-steroidal anti-inflammatory drug use.

Abstract Background and aims This consensus statement presents a comprehensive and evidence-based set of guidelines that modify the general European or US guidelines for hypotension management with vasopressors during cesarean delivery. It is tailored to the Southeast Asian context in terms of local human and medical resources, health system capacity, and local values and preferences. Methods and results These guidelines were prepared using a methodological approach. Two principal sources were used to obtain the evidence: scientific evidence and opinion-based evidence. A team of five anesthesia experts from Vietnam, the Philippines, and Thailand came together to define relevant clinical questions; search for literature-based evidence using the MEDLINE, Scopus, Google Scholar, and Cochrane libraries; evaluate existing guidelines; and contextualize recommendations for the Southeast Asian region. Furthermore, a survey was developed and distributed among 183 practitioners in the captioned countries to gather representative opinions of the medical community and identify best practices for the management of hypotension with vasopressors during cesarean section under spinal anesthesia. Conclusions This consensus statement advocates proactive management of maternal hypotension during cesarean section after spinal anesthesia, which can be detrimental for both the mother and fetus, supports the choice of phenylephrine as a first-line vasopressor and offers a perspective on the use of prefilled syringes in the Southeast Asian region, where factors such as healthcare features, availability, patient safety, and cost should be considered.

Abstract Background While microbiomes in industrialized societies are well characterized, indigenous populations with traditional lifestyles have microbiomes that are more akin to those of ancient humans. However, metagenomic data in these populations remains scarce, and the association with soil-transmitted helminth infection status is unclear. Here, we sequenced 650 metagenomes of indigenous Malaysians from five villages with different prevalence of helminth infections. Results Individuals from villages with higher prevalences of helminth infections have more unmapped reads and greater microbial diversity. Microbial community diversity and composition were most strongly associated with different villages and the effects of helminth infection status on the microbiome varies by village. Longitudinal changes in the microbiome in response to albendazole anthelmintic treatment were observed in both helminth infected and uninfected individuals. Inference of bacterial population replication rates from origin of replication analysis identified specific replicating taxa associated with helminth infection. Conclusions Our results indicate that helminth effects on the microbiota were highly dependent on context, and effects of albendazole on the microbiota can be confounding for the interpretation of deworming studies. Furthermore, a substantial quantity of the microbiome remains unannotated, and this large dataset from an indigenous population associated with helminth infections is a valuable resource for future studies. Video Abstract

Latar belakang. Terdapat peningkatan kasus Covid-19 dan angka rawat inap anak selama gelombang pandemi ketiga di Indonesia, Januari sampai April 2022. Banyak hal baru muncul terkait Covid-19 pada anak, tetapi data dan penelitiannya masih terbatas. Tujuan. Mengetahui profil klinis dan luaran pasien anak yang dirawat inap dengan Covid-19 selama gelombang ketiga. Metode. Penelitian observasional deskriptif menggunakan data rekam medis dari pasien anak berusia 0-18 tahun terkonfirmasi Covid-19 dengan tes PCR SARS-CoV-2 di ruang isolasi Covid-19 RSUD Balaraja selama bulan Februari - April 2022. Hasil. Terdapat 23 pasien, terbanyak (43,5%) berusia 1-5 tahun. Gejala tersering adalah demam

After five waves of coronavirus disease 2019 (COVID-19) outbreaks, it has been recognized that a significant portion of the affected individuals developed long-term debilitating symptoms marked by chronic fatigue, cognitive difficulties (“brain fog”), post-exertional malaise, and autonomic dysfunction. The onset, progression, and clinical presentation of this condition, generically named post-COVID-19 syndrome, overlap significantly with another enigmatic condition, referred to as myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS). Several pathobiological mechanisms have been proposed for ME/CFS, including redox imbalance, systemic and central nervous system inflammation, and mitochondrial dysfunction. Chronic inflammation and glial pathological reactivity are common hallmarks of several neurodegenerative and neuropsychiatric disorders and have been consistently associated with reduced central and peripheral levels of plasmalogens, one of the major phospholipid components of cell membranes with several homeostatic functions. Of great interest, recent evidence revealed a significant reduction of plasmalogen contents, biosynthesis, and metabolism in ME/CFS and acute COVID-19, with a strong association to symptom severity and other relevant clinical outcomes. These bioactive lipids have increasingly attracted attention due to their reduced levels representing a common pathophysiological manifestation between several disorders associated with aging and chronic inflammation. However, alterations in plasmalogen levels or their lipidic metabolism have not yet been examined in individuals suffering from post-COVID-19 symptoms. Here, we proposed a pathobiological model for post-COVID-19 and ME/CFS based on their common inflammation and dysfunctional glial reactivity, and highlighted the emerging implications of plasmalogen deficiency in the underlying mechanisms. Along with the promising outcomes of plasmalogen replacement therapy (PRT) for various neurodegenerative/neuropsychiatric disorders, we sought to propose PRT as a simple, effective, and safe strategy for the potential relief of the debilitating symptoms associated with ME/CFS and post-COVID-19 syndrome.

Background: Violence during childbirth indirectly contributes to maternal and neonatal morbidity and mortality. It also causes intrapartum health consequences such as prolonged labor, postpartum hemorrhage, and postpartum psychological problems, including postpartum depression, post-traumatic stress disorder, and other negative feelings that lead to a decreased desire for facility delivery and increase the events of home deliveries which reduce the quality of life. In Tanzania, several efforts have been made to promote respectful maternity care. However, violence during childbirth continues to create a critical barrier for facility-based delivery and is in need of considerable attention throughout the health system. Objectives: This study aimed to assess types of intrapartum violence and its determinants among postnatal women in the Dodoma Region, Tanzania. Design: A cross-sectional study using a questionnaire to interview postnatal women at the exit point after being discharged from the health facility to assess intrapartum violence and its determinants. Methods: This study was conducted in Dodoma Region involving 307 postnatal women from April to June 2022. A simple random method was used to select respondents. The Chi-square and Fisher’s exact tests were used to assess the association between the categorical variables. The predictors of intrapartum violence were determined using binary logistic regression analysis. Statistical analysis was performed using Statistical Package for Social Science version 25.0. P

Introduction. Listeria monocytogenes is an important human pathogen causing various forms of listeriosis, including foodborne infections, meningitis, neonatal sepsis, and abortion. Listeria are common all over the world. The purpose of the study was to conduct microbiological monitoring of L. monocytogenes in water reservoirs near livestock premises in the Vologda district of the Vologda region. Materials and methods. Bacterial cultures were isolated using two methods, titration and filtration, followed by analysis using methods of conventional bacteriology, serotyping, and species identification by instrumental procedures such as whole genome sequencing, and bioinformatic analysis. Results. Three isolates of L. monocytogenes and one isolate of Listeria innocua were isolated from 12 analyzed water samples (wastewater 6, river water 4, and storm water 2 samples). whole genome sequencing of three L. monocytogenes strains attributed them to the evolutionary line II, and to three sequence types and two serogroups ST425(1/2a-3a), ST20(1/2a-3a), ST7 (4a-4c). The strains are shown to belong to multiple drug resistant ones conferring resistance to three functional groups of antibacterials such as tetracyclines, macrolides, and sulfonamides. Antibiotic resistance genes (fox, psp-like, lin,norB,sul), virulence Islands LIPI-1 and LIPI-2, and virulence genes inlABCJ, oatA, ami, gtcA, vip, and lisK in genomes of the strain were identified. Stress tolerance Island SSI-1 was identified in one strain. Conclusions. The data obtained indicate contamination of water sources near the livestock premises with L. monocytogenes strains possessing high pathogenic potentiality for outbreaks of listeriosis in humans. This shows the necessity of careful monitoring of water sources for the presence of the causative agent of listeriosis as well as the implementing of anti-epidemic measures.