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Abstract Background People with disabilities frequently experience barriers in seeking healthcare that lead to poorer health outcomes compared to people without disabilities. To overcome this, it is important to assess the accessibility of primary health facilities – broadly defined to include a disability-inclusive service provision – so as to document present status and identify areas for improvement. We aimed to identify, adapt and pilot test an appropriate tool to assess the accessibility of primary health facilities in Luuka District, Uganda. Methods We conducted a rapid literature review to identify appropriate tools, selecting the Disability Awareness Checklist (DAC) on account of its relative brevity and development as a sensitization and action tool. We undertook three rounds of adaptation, working together with youth researchers (aged 18–35) with disabilities who then underwent 2 days of training as DAC facilitators. The adapted tool comprised 71 indicators across four domains and 12 sub-domains. We also developed a structured feedback form for facilitators to complete with healthcare workers. We calculated median accessibility scores overall, per domain and per sub-domain, and categorised feedback form suggestions by type and presumed investment level. We pilot-tested the adapted tool in 5 primary health facilities in one sub-district of Luuka, nested within a pilot healthcare worker training on disability. Results The median overall facility accessibility score was 17.8% (range 12.3–28.8). Facility scores were highest in the universal design and accessibility domain (25.8%, 22.6–41.9), followed by reasonable accommodation (20.0%, 6.7–33.3). Median scores for capacity of facility staff (6.67%, 6.7–20.0), and linkages to other services were lower (0.0%, 0–25.0). Within the feedback forms, there were a median of 21 suggestions (range 14–26) per facility. Most commonly, these were categorised as minor structural changes (20% of suggestions), with a third categorised as no (2%) or low (33%) cost, and the majority (40%) medium cost. Conclusions Overall accessibility scores were low, with many opportunities for low-cost improvement at the facility level. We did not identify any issues with the implementation of the tool, suggesting few further adaptations are required for its future use in this setting.

ABSTRACT: Omitting or shortening the dry period may result in a fairly constant ration throughout the transition period of dairy cows, reducing the need for adaptation of cow metabolism and rumen function to a new lactation. The objective of this study was to determine the effect of dry period length (DP) on rumen adaptation and cow metabolic state during the transition period. Twelve pregnant, rumen-cannulated Holstein Friesian dairy cows at the end of their first lactation were assigned to 1 of 3 treatments: a conventional (60 d), short (30 d), or no dry period (0 d). At dry-off, cows received a dry-cow ration until calving. Lactating cows received a lactation ration. Cows were monitored from 8 wk before calving until 8 wk after calving for milk yield and DMI. Rumen biopsies were taken from 3 locations in the rumen at 60, 40, and 10 d before calving and 3, 7, 14, 28, and 56 d after calving to assess papillae dimensions. Blood was sampled weekly from 3 wk before until 8 wk after calving, and liver biopsies were taken at wk −2, 2, and 4 relative to calving. Prepartum, DMI, and milk yield were greater for cows with a short or no dry period, compared with cows with a conventional dry period. Postpartum, DMI was greater for cows with a short dry period compared with cows with a conventional dry period. Plasma glucose concentration was greater for cows without a dry period, compared with the other DP postpartum. Plasma concentrations of nonesterified fatty acids and BHB, and liver triglyceride content, did not differ among dry period. Rumen papillae differed in size based on biopsy location, but there was no interaction between biopsy location and the effect of DP. Rumen papillae surface area for cows managed for a 30- or 60-d dry period decreased toward calving. At 40 d prepartum, papillae surface area was greater for short and no dry period treatment compared with a conventional dry period. At 10 d prepartum, papillae surface area was greater for the no dry period treatment compared with both other treatments, and this difference was still present 3 d postpartum. Cows managed for a short dry period showed faster increase in papillae dimensions after calving compared with cows managed for a conventional dry period. From d 28 onwards, no differences in papillae surface area were observed. The faster rumen adaptation postpartum may be related to the increased DMI during the first weeks postpartum for cows managed for a short dry period. However, this did not result in improved metabolic status or milk yield. The results from the present study demonstrate that the dietary changes related to a conventional DP affected rumen papillae development, not only prepartum but also early postpartum. Further optimization of DP as well as dietary composition throughout the transition period may support cows in their adaptation to a new lactation.

ABSTRACT: The objectives were to investigate the effect of feeding and visiting behavior of dairy cattle on CH4 and H2 production measured with voluntary visits to the GreenFeed system (GF) and to determine whether these effects depended on basal diet (BD) and 3-nitrooxypropanol (3-NOP) supplementation. The experiment involved 64 lactating dairy cattle (146 ± 45 DIM at the start of trial; mean ± SD) in 2 overlapping crossover trials, each consisting of 2 measurement periods. Cows within block were randomly allocated to 1 of 3 types of BD: a grass silage-based diet consisting of 30% concentrates and 70% grass silage (DM basis); a grass silage and corn silage mixed diet consisting of 30% concentrates, 42% grass silage, and 28% corn silage (DM basis); or a corn silage-based diet consisting of 30% concentrates, 14% grass silage, and 56% corn silage (DM basis). Each type of BD was subsequently supplemented with 0 and 60 mg 3-NOP/kg of DM in one crossover or 0 and 80 mg 3-NOP/kg of DM in the other crossover. Diets were provided in feed bins that automatically recorded feed intake and feeding behavior, with additional concentrate fed in the GF. All visits to the GF that resulted in a spot measurement of both CH4 and H2 emission were analyzed in relation to feeding behavior (e.g., meal size and time interval to preceding meal) as well as GF visiting behavior (e.g., duration of visit). Feeding and GF visiting behavior were related to CH4 and H2 production measured with the GF, in particular the meal size before a GF measurement and the time interval between a GF measurement and the preceding meal. Relationships between gas production and both feeding and GF visiting behavior were affected by type of BD as well as 3-NOP supplementation. With an increase of the time interval between a GF measurement and the preceding meal, CH4 production decreased with 0 mg 3-NOP/kg of DM but increased with 60 and 80 mg 3-NOP/kg of DM, whereas type of BD did not affect these relationships. In contrast, CH4 production increased with 0 mg 3-NOP/kg of DM but decreased with 60 and 80 mg 3-NOP/kg of DM upon an increase in the size of the meal preceding a GF measurement. With an increase of the time interval between a GF measurement and the preceding meal, or with a decrease of the size of the meal preceding a GF measurement, H2 production decreased for all treatments, although the effect was generally somewhat stronger for 60 and 80 mg 3-NOP/kg of DM than for 0 mg 3-NOP/kg of DM. Hence, the timing of GF measurements next to feeding and GF visiting behavior are essential when assessing the effect of dietary treatment on the production of CH4 and H2 in a setting where a spot-sampling device such as a GF is used and where the measurements depend on voluntary visits from the cows.

Since March 2020, Uganda has confirmed cases of COVID-19 and implemented a response to curb the spread, which included over 12 months of school closure for most children. In this study we investigated parents' perspectives of the impact of the COVID-19 response on education of children with disabilities enrolled in primary schools in Central Uganda during the first 12 months of the outbreak. We conducted four rounds of interviews with 27 parents of children with disabilities, which were analysed thematically. Parents described a lack of financial resources, food, learning materials, and teaching skills necessary to provide meaningful home education. Parents were concerned about the long-term impact school closure may have on their child's development, behaviour, and social life. Although parents were happy about the phased school re-opening, they expressed concerns about the financial costs involved in sending children back to school, and wondered how children would cope with prevention measures. School closure has greatly impacted the education of children with disabilities in Uganda. There is a need to consider inequality, poverty, and culture when studying children with disabilities during the COVID-19 outbreak, and prioritise and include this group in designing COVID-19 responses, prolonged home learning and school reopening plans.

Methane (CH4) emissions from ruminants are of a significant environmental concern, necessitating accurate prediction for emission inventories. Existing models rely solely on dietary and host animal-related data, ignoring the predicting power of rumen microbiota, the source of CH4. To address this limitation, we developed novel CH4 prediction models incorporating rumen microbes as predictors, alongside animal- and feed-related predictors using four statistical/machine learning (ML) methods. These include random forest combined with boosting (RF-B), least absolute shrinkage and selection operator (LASSO), generalized linear mixed model with LASSO (glmmLasso), and smoothly clipped absolute deviation (SCAD) implemented on linear mixed models. With a sheep dataset (218 observations) of both animal data and rumen microbiota data (relative sequence abundance of 330 genera of rumen bacteria, archaea, protozoa, and fungi), we developed linear mixed models to predict CH4 production (g CH4/animal·d, ANIM-B models) and CH4 yield (g CH4/kg of dry matter intake, DMI-B models). We also developed models solely based on animal-related data. Prediction performance was evaluated 200 times with random data splits, while fitting performance was assessed without data splitting. The inclusion of microbial predictors improved the models, as indicated by decreased root mean square prediction error (RMSPE) and mean absolute error (MAE), and increased Lins concordance correlation coefficient (CCC). Both glmmLasso and SCAD reduced the Akaike information criterion (AIC) and Bayesian information criterion (BIC) for both the ANIM-B and the DMI-B models, while the other two ML methods had mixed outcomes. By balancing prediction performance and fitting performance, we obtained one ANIM-B model (containing 10 genera of bacteria and 3 animal data) fitted using glmmLasso and one DMI-B model (5 genera of bacteria and 1 animal datum) fitted using SCAD. This study highlights the importance of incorporating rumen microbiota data in CH4 prediction models to enhance accuracy and robustness. Additionally, ML methods facilitate the selection of microbial predictors from high-dimensional metataxonomic data of the rumen microbiota without overfitting. Moreover, the identified microbial predictors can serve as biomarkers of CH4 emissions from sheep, providing valuable insights for future research and mitigation strategies.

ABSTRACT: Automated measurements of the ratio of concentrations of methane and carbon dioxide, [CH4]:[CO2], in breath from individual animals (the so-called “sniffer technique”) and estimated CO2 production can be used to estimate CH4 production, provided that CO2 production can be reliably calculated. This would allow CH4 production from individual cows to be estimated in large cohorts of cows, whereby ranking of cows according to their CH4 production might become possible and their values could be used for breeding of low CH4-emitting animals. Estimates of CO2 production are typically based on predictions of heat production, which can be calculated from body weight (BW), energy-corrected milk yield, and days of pregnancy. The objectives of the present study were to develop predictions of CO2 production directly from milk production, dietary, and animal variables, and furthermore to develop different models to be used for different scenarios, depending on available data. An international dataset with 2,244 records from individual lactating cows including CO2 production and associated traits, as dry matter intake (DMI), diet composition, BW, milk production and composition, days in milk, and days pregnant, was compiled to constitute the training dataset. Research location and experiment nested within research location were included as random intercepts. The method of CO2 production measurement (respiration chamber [RC] or GreenFeed [GF]) was confounded with research location, and therefore excluded from the model. In total, 3 models were developed based on the current training dataset: model 1 (“best model”), where all significant traits were included; model 2 (“on-farm model”), where DMI was excluded; and model 3 (“reduced on-farm model”), where both DMI and BW were excluded. Evaluation on test dat sets with either RC data (n = 103), GF data without additives (n = 478), or GF data only including observations where nitrate, 3-nitrooxypropanol (3-NOP), or a combination of nitrate and 3-NOP were fed to the cows (GF+: n = 295), showed good precision of the 3 models, illustrated by low slope bias both in absolute values (−0.22 to 0.097) and in percentage (0.049 to 4.89) of mean square error (MSE). However, the mean bias (MB) indicated systematic overprediction and underprediction of CO2 production when the models were evaluated on the GF and the RC test datasets, respectively. To address this bias, the 3 models were evaluated on a modified test dataset, where the CO2 production (g/d) was adjusted by subtracting (where measurements were obtained by RC) or adding absolute MB (where measurements were obtained by GF) from evaluation of the specific model on RC, GF, and GF+ test datasets. With this modification, the absolute values of MB and MB as percentage of MSE became negligible. In conclusion, the 3 models were precise in predicting CO2 production from lactating dairy cows.

Abstract Background There are 1.3 billion people with disabilities globally, and they frequently face barriers to accessing healthcare, contributing to their worse health and higher mortality. However, little research has explored patient-reported approaches to improve healthcare for persons with disabilities. Consequently, this study aimed to explore possible solutions and recommendations to address the existing barriers to access to healthcare for persons with disabilities in rural Uganda. Methods We conducted 27 semi-structured interviews with individuals with various disabilities in rural Luuka district, Eastern Uganda, between September and November 2022. The participants included individuals with visual impairment (n = 5), physical impairment (n = 5), hearing impairment (n = 6), multiple impairments (n = 5), intellectual/cognitive impairment (n = 5), and albinism (n = 1). Interviews were recorded, transcribed verbatim, and thematically analysed. We categorized the solutions using the Missing Billion disability-inclusive health systems framework. Results Our findings, framed within the health systems framework, revealed several critical themes. On the demand side, suggested solutions emphasized advocacy and sensitization for persons with disabilities, their communities, and caregivers about healthcare needs. Socio-economic empowerment and community-based health services were also highlighted as essential. On the supply side, participants stressed the importance of training healthcare workers on disability, facilitating dialogue and experience-sharing sessions, and employing health workers with disabilities. Additional recommendations included improving accessibility and reasonable accommodation, organizing inclusive services like special clinic days and outreaches, ensuring representation in health facility management, and establishing comprehensive rehabilitation services with affordable assistive devices. Conclusion The multifaceted solutions proposed by persons with disabilities highlight the complex challenges they face in accessing healthcare services and highlight the necessity for comprehensive, sustainable interventions. The call to action for policymakers and healthcare providers is to prioritise the incorporation of disability-inclusive practices and explore multi-dimensional approaches that foster a more inclusive healthcare environment that adequately meets the needs of persons with disabilities.

Background: Spina bifida is a congenital neural tube defect, where there is incomplete formation of the spinal cord and vertebrae, resulting in abnormal development of the neural tube. This affects bladder function and urinary incontinence. Clean Intermittent Catheterization (CIC) is used to manage bladder and bowel management. Objectives: This study aims to scope evidence on the facilitators and barriers to usage and practice of CIC in children with spina bifida in low-income countries. Method: We searched databases including PUBMED, Web of Science and SCOPUS, and screened articles for inclusion following the PRISMA-ScR guidelines. The search terms included ‘Spina Bifida ([continence management] AND [clean intermittent catheterisation]) AND ([barriers to Clean Intermittent Catheterisation] OR [Low Income Countries]) OR (myelomeningocele)’. Full-text assessment for eligibility excluded 202 articles. Twenty-two articles were reviewed and twelve full-text articles were excluded because of limited content. Ten articles published in English between 2004 and 2023 were selected for review. Results: Barriers in practicing CIC include pain and discomfort in catheter insertion, stigma and fears; inaccessibility of public toilets, unavailability of appropriate catheters, difficulty in positioning, limited quality of teaching and challenges with accessing supplies. Facilitators include starting CIC in infancy, follow-up by healthcare providers, support from family and community members, quality of training, continuous practice of CIC, utilisation of lubricants, reuse of catheters and other low-cost materials. Conclusion: Our review summarises facilitators and barriers to CIC and provides recommendations for further research, which includes the involvement of family members and community-based rehabilitation workers. Contribution: This article contributes to a better understanding of CIC use in low-income countries.

Gaucher disease (GD) is a lysosomal storage disorder (LSD) resulting from inherited glucocerebrosidase (GBA1) deficiency. GD diagnosis relies on GBA1 activity assays, typically employing 4-methylumbelliferyl-β-D-glucopyranoside (4MU-β-Glc) as fluorogenic substrate. However, these assays suffer from background 4MU release by the non-lysosomal GBA2 and cytosolic GBA3 enzymes. Here we developed GBA1-selective fluorogenic substrates by synthesizing a series of 6-O-acyl-4MU-β-Glc substrates with diverse fatty acid tails. Because of the chemical and enzymatic instability of the ester bonds, analogs of 6-O-palmitoyl-4MU-β-Glc (3) with different chemical linkages were synthesized. 6-O-alkyl-4MU-β-Glc 9, featuring an ether linkage, emerged as the most optimal GBA1 substrate, exhibiting both a low Km and compared to substrate 3 a high Vmax. Importantly, substrate 9 is not hydrolyzed by GBA2 and GBA3 and therefore acts as a superior substrate for GD diagnosis. Plants contain glycosyl phytosterols (campesterol, β-sitosterol, and sigmasterol) that may also be acylated at C-6. LC-MS/MS analysis revealed that 6-O-acylated and regular glycosylcholesterol (HexChol) tend to be increased in spleens of patients with GD. Moreover, significant increases in 6-O-acyl-glycosyl-phytosterols were detected in GD spleens. Our findings suggest uptake of (6-O-acyl)-glycosyl-phytosterols from plant food and subsequent lysosomal processing by GBA1, and comprise the first example of accumulation of an exogenous class of glycolipids in GD. Excessive exposure of rodents to glycosylated phytosterols has been reported to induce manifestations of Parkinson’s disease (PD). Further investigation is warranted to determine whether (6-O-acyl)-glycosyl-phytosterols could contribute to the enigmatic link between inherited defects in GBA1 and the risk for PD.

Objective The aim of the research was to explore the barriers to healthcare access for persons with various disabilities in rural Luuka district of Uganda. The findings will assist in appreciating the challenges persons with disabilities face in accessing Healthcare in a rural setting. These insights will contribute to the development of an intervention to improve healthcare access that is affordable, timely and acceptable.Design and participants This qualitative study formed the exploratory formative phase of the ‘Missing Billion’ project. A total of 27 participants with disabilities—visual impairment (n=5), physical impairment (n=5), multiple impairments (n=6) and intellectual/ cognitive impairment (n=5) were purposively selected to participate in in-depth interviews conducted by two experienced researchers. Participants were identified through contact lists provided by the district disability focal person and local disability associations, with additional participants identified through snowball sampling. Interviews with persons with hearing impairment (n=6) were conducted by a researcher with hearing impairment. The interviews were audio/video recorded and transcribed to facilitate thematic data analysis. We used the disability-inclusive health ‘Missing Billion’ framework to map and inform the barriers.Setting The study was conducted between September and November 2022 in rural communities in Luuka district, Eastern Uganda.Findings On the demand side, challenges revolved around autonomy and awareness, limited access to health information, lack of financial capacity and dependence on caregivers for healthcare choices left persons with disabilities feeling disempowered. On the supply side, discrimination and negative attitudes from healthcare workers were reported as prevalent. Absence of healthcare workers and service delivery delays impacted on healthcare access, resulting in poor care. Inaccessible healthcare facilities compounded issues, as they had limited accessibility features.Conclusions Complex and interconnected barriers underscore the pressing need for systemic changes to ensure equitable healthcare access for persons with disabilities in rural Uganda.

Background and Purpose: Radiotherapy for paediatric posterior fossa tumours may cause complications in the brainstem and upper spinal cord due to high doses. With proton therapy (PT) this risk may increase due to higher relative biological effectiveness (RBE) from elevated linear energy transfer (LET). This study assesses variations in LET in the brainstem and spinal cord in proton treatment plans from European centres. Materials and Methods: Ten European PT centres using spot-scanning PT planned two paediatric posterior fossa cases: One overlapping partly with the brainstem and upper spinal cord, prescribed 54 Gy(RBE), and the second wrapping around these organs, prescribed 59.4 Gy(RBE). Dose-averaged LET distributions were assessed in volumes of the brainstem and spinal cord irradiated to over 50 Gy(RBE = 1.1). The maximum hinge angle effect on near-maximum RBE-weighted doses using the Unkelbach RBE model was also investigated. Results: In the first case, the mean LET in brainstem volumes receiving more than 50 Gy(RBE = 1.1) ranged from 2.8 keV/µm to 3.6 keV/µm across centres (median: 3.3 keV/µm). In the second case, treatment plans showed a narrower range of mean LET in the brainstem, from 2.5 keV/µm to 2.8 keV/µm (median: 2.7 keV/µm). There was no statistically significant impact of the maximum hinge angle. Conclusions: LET distributions vary across centres due to different techniques but are also influenced significantly by factors like shape and position of the target volume.

Background: Disability inclusive youth research, involving youth with disabilities in the design, implementation and dissemination of study data, is still limited in Africa. Objectives: To describe and reflect on the experiences of involving youth with disabilities in an exploratory research study, focused on disability-inclusive education and employment in 7 African countries. Method: 12 youths with different impairments, aged 18 to 35, were employed as researchers in Ethiopia, Ghana, Kenya, Nigeria, Rwanda, Senegal and Uganda. Youth researchers contributed to the data collection and analysis of interviews with 210 youth with disabilities. 24 youth advisors with disabilities formed two youth advisory groups (YAG) of 12 advisors each in the regional hub countries Ghana and Uganda. The YAGs met 4 times during the project and contributed to the study design, data collection, data analysis and dissemination activities. In addition, 4 workshops were held with the Ugandan YAG to develop a participatory film. Results: Together with the youth participants, we reflected on the experiences of involving youth with disabilities and conducting research with, by and on youth with disabilities. We highlighted ethics and safeguarding, recruitment and representation, exploring experiences and data quality, participatory dissemination, accessibility, capacity building and networking as key areas of consideration and benefit in this project. Conclusion: Participatory research with youth with disabilities is feasible, enriching, and key to inclusive research that informs education and employment policy and practices. Contribution: Lessons learned from youth involvement in a disability inclusive research programme, focused on education and employment in 7 African countries.

Abstract Background Approximately 1.3 billion people worldwide face barriers in accessing inclusive healthcare due to disabilities, leading to worse health outcomes, particularly in low and middle-income countries (LMIC). However, there is a lack of training of healthcare workers about disability, both globally and in Uganda. Objectives To use mixed research methods to develop a comprehensive training program with standardisedelements for healthcare workers in Uganda, focusing on improving their knowledge, attitudes, and skills inproviding care for people with disabilities. Methods The Medical Research Council (MRC) approach was employed to guide the development of the training intervention. We conducted an umbrella review to gather relevant literature on disability training for healthcare workers. Interviews were conducted with international experts to gain insights and perspectives on the topic. Additionally, interviews were undertaken with people with disabilities and healthcare workers in Uganda to understand their experiences and needs. A participatory workshop was organised involving key stakeholders, to collaboratively design the training material based on the findings from these data sources. Results Eight review articles examined training programs for healthcare workers on disability. Training settings ranged from specialised clinical settings to non-clinical settings, and the duration and evaluation methods of the training varied widely. Lectures and didactic methods were commonly used, often combined with other approaches such as case studies and simulations. The impact of the training was assessed through healthcare worker reports on attitudes, knowledge, and self-efficacy. Interviews emphasised the importance of involving people with disabilities in the training and improving communication and understanding between healthcare providers and people with disabilities. Five themes for a training on disability for healthcare workers were generated through the workshop, including responsibilities and rights, communication, informed consent, accommodation, and referral and connection, which were used to guide the development of the curriculum, training materials and training approach. Conclusion This study presents a novel approach to develop a training program that aims to enhance healthcare services for people with disabilities in Uganda. The findings offer practical insights for the development of similar programs in LMICs. The effectiveness of the training program will be evaluated through a pilot test, and policy support is crucial for its successful implementation at scale.

Ruminants, particularly dairy and beef cattle, contribute to climate change through mostly enteric methane emissions. Several mitigating options have been proposed, including the feed additive 3-nitrooxypropanol (3-NOP). The objectives of this study were to explain the variability in the mitigating effect of 3-NOP and to investigate the interaction between diet composition and 3-NOP dose, using meta-analytical approaches. Data from 13 articles (14 experiments) met the selection criteria for inclusion in the meta-analysis, and 48 treatment means were used for the analysis. Mean differences were calculated as 3-NOP treatment mean minus control treatment mean and then expressed as a percentage of the control mean. Three types of models were developed: (1) one including 3-NOP dose, overall mean, and individual covariate; (2) a combination of neutral detergent fiber (NDF), 3-NOP dose, and overall mean; and (3) one selected model from all combinations of up to 5 covariates, which were compared using a leave-one-out cross validation method. Models including only 3-NOP dose resulted in a significant reduction of 32.7%, 30.9%, and 32.6% for CH4 production (g/d), yield (g/kg dry matter intake), and intensity (g/kg energy-corrected milk), respectively, at an average 3-NOP dose of 70.5 mg/kg dry matter (DM). The greater the NDF content in the diet, the lower the reduction efficiency for a given 3-NOP dose. For 10 g/kg DM increase in NDF content from its mean (329 g of NDF/kg of DM) the 3-NOP effect on CH4 production was impaired by 0.633%, the 3-NOP effect on CH4 yield by 0.647%, and the 3-NOP effect on CH4 intensity by 0.723%. The analysis based on leave-one-out cross validation showed an increase in NDF and crude fat content reduces efficacy of 3-NOP and an increase in 3-NOP dose increases efficacy. A 1% (10 g/kg) DM decrease in dietary NDF content from its mean may increase the efficacy of 3-NOP in reducing CH4 production by 0.915%. A 1% (10 g/kg DM) decrease in dietary crude fat content from its mean enhances the efficacy of 3-NOP on CH4 production by 3.080% at a given dose and NDF level. For CH4 yield, next to 3-NOP dose, dietary NDF content and dietary crude fat content were included in the selected model, but also dietary starch content with an opposite direction to NDF and crude fat. The effect of 3-NOP dose on CH4 intensity was similar to its effect on CH4 production, whereas the effect of dietary NDF content was slightly lower. Expanding the previously published models with the newly available data published from trials since then improved model performance, hence demonstrating the value of regularly updating meta-analyses if a wider range of data becomes available.

In 2020-2021 the COVID-19 pandemic led to multiple and diverse global public health response strategies globally and in Uganda to slow the spread of the virus by promoting wearing face coverings in public, frequent hand washing, physical distancing, restricting travel, and imposing home lockdowns. We conducted 146 interviews over four rounds of phone-follow up calls over 15 months with 125 young female sex workers coinciding in time with four different government-imposed lockdown periods in Kampala, Uganda, to assess the impact of these measures on young sex workers, their families and their communities as well as to gauge their resilience. Our findings revealed how COVID-19 fears and public health restrictions over time pushed an already marginalized population to the brink and how that pressure drove some participants into a new way of life.

To meet the 1.5 °C target, methane (CH4) from ruminants must be reduced by 11 to 30% by 2030 and 24 to 47% by 2050 compared to 2010 levels. A meta-analysis identified strategies to decrease product-based (PB; CH4 per unit meat or milk) and absolute (ABS) enteric CH4 emissions while maintaining or increasing animal productivity (AP; weight gain or milk yield). Next, the potential of different adoption rates of one PB or one ABS strategy to contribute to the 1.5 °C target was estimated. The database included findings from 430 peer-reviewed studies, which reported 98 mitigation strategies that can be classified into three categories: animal and feed management, diet formulation, and rumen manipulation. A random-effects meta-analysis weighted by inverse variance was carried out. Three PB strategies—namely, increasing feeding level, decreasing grass maturity, and decreasing dietary forage-to-concentrate ratio—decreased CH4 per unit meat or milk by on average 12% and increased AP by a median of 17%. Five ABS strategies—namely CH4 inhibitors, tanniferous forages, electron sinks, oils and fats, and oilseeds—decreased daily methane by on average 21%. Globally, only 100% adoption of the most effective PB and ABS strategies can meet the 1.5 °C target by 2030 but not 2050, because mitigation effects are offset by projected increases in CH4 due to increasing milk and meat demand. Notably, by 2030 and 2050, low- and middle-income countries may not meet their contribution to the 1.5 °C target for this same reason, whereas high-income countries could meet their contributions due to only a minor projected increase in enteric CH4 emissions.

Abstract Methane (CH4) emissions from ruminants are of a significant environmental concern, necessitating accurate prediction for emission inventories. Existing models rely solely on dietary and host animal-related data, ignoring the predicting power of rumen microbiota, the source of CH4. To address this limitation, we developed novel CH4 prediction models incorporating rumen microbes as predictors, alongside animal- and feed-related predictors using four statistical/machine learning (ML) methods. These include random forest combined with boosting (RF-B), least absolute shrinkage and selection operator (LASSO), generalized linear mixed model with LASSO (glmmLasso), and smoothly clipped absolute deviation (SCAD) implemented on linear mixed models. With a sheep dataset (218 observations) of both animal data and rumen microbiota data (relative sequence abundance of 330 genera of rumen bacteria, archaea, protozoa, and fungi), we developed linear mixed models to predict CH4 production (g CH4/animal·d, ANIM-B models) and CH4 yield (g CH4/kg of dry matter intake, DMI-B models). We also developed models solely based on animal-related data. Prediction performance was evaluated 200 times with random data splits, while fitting performance was assessed without data splitting. The inclusion of microbial predictors improved the models, as indicated by decreased root mean square prediction error (RMSPE) and mean absolute error (MAE), and increased Lin’s concordance correlation coefficient (CCC). Both glmmLasso and SCAD reduced the Akaike information criterion (AIC) and Bayesian information criterion (BIC) for both the ANIM-B and the DMI-B models, while the other two ML methods had mixed outcomes. By balancing prediction performance and fitting performance, we obtained one ANIM-B model (containing 10 genera of bacteria and 3 animal data) fitted using glmmLasso and one DMI-B model (5 genera of bacteria and 1 animal datum) fitted using SCAD. This study highlights the importance of incorporating rumen microbiota data in CH4 prediction models to enhance accuracy and robustness. Additionally, ML methods facilitate the selection of microbial predictors from high-dimensional metataxonomic data of the rumen microbiota without overfitting. Moreover, the identified microbial predictors can serve as biomarkers of CH4 emissions from sheep, providing valuable insights for future research and mitigation strategies.

ABSTRACT: Estimating daily enteric hydrogen (H2) and methane (CH4) emitted from dairy cattle using spot sampling techniques requires accurate sampling schemes. These sampling schemes determine the number of daily samplings and their intervals. This simulation study assessed the accuracy of daily H2 and CH4 emissions from dairy cattle using various sampling schemes for gas collection. Gas emission data were available from a crossover experiment with 28 cows fed twice daily at 80% to 95% of the ad libitum intake, and an experiment that used a repeated randomized block design with 16 cows twice daily fed ad libitum. Gases were sampled every 12 to 15 min for 3 consecutive days in climate respiration chambers. Feed was fed in 2 equal portions per day in both experiments. Per individual cow-period combination, generalized additive models were fitted to all diurnal H2 and CH4 emission profiles. Per profile, the models were fitted using the generalized cross-validation, REML, REML while assuming correlated residuals, and REML while assuming heteroscedastic residuals. The areas under the curve (AUC) of these 4 fits were numerically integrated over 24 h to compute the daily production and compared with the mean of all data points, which was considered the reference. Next, the best of the 4 fits was used to evaluate 9 different sampling schemes. This evaluation determined the average predicted values sampled at 0.5, 1, and 2 h intervals starting at 0 h from morning feeding, at 1 and 2 h intervals starting at 0.5 h from morning feeding, at 6 and 8 h intervals starting at 2 h from morning feeding, and at 2 unequally spaced intervals with 2 or 3 samples per day. Sampling every 0.5 h was needed to obtain daily H2 productions not different from the selected AUC for the restricted feeding experiment, whereas less frequent sampling had predictions varying from 47% to 233% of the AUC. For the ad libitum feeding experiment, sampling schemes had H2 productions from 85% to 155% of the corresponding AUC. For the restricted feeding experiment, daily CH4 production needed samplings every 2 h or shorter, or 1 h or shorter, depending on sampling time after feeding, whereas sampling scheme did not affect CH4 production for the twice daily ad libitum feeding experiment. In conclusion, sampling scheme had a major impact on predicted daily H2 production, particularly with restricted feeding, whereas daily CH4 production was less severely affected by sampling scheme.

ABSTRACT: This study aimed to evaluate trade-offs between enteric and manure CH4 emissions, and the size of synergistic effects for CH4 and nitrogenous emissions (NH3 and N2O). Sixty-four Holstein-Friesian cows were blocked in groups of 4 based on parity, lactation stage, and milk yield. Cows within a block were randomly allocated to a dietary sequence in a crossover design with a grass silage-based diet (GS) and a corn silage-based diet (CS). The GS diet consisted of 50% grass silage and 50% concentrate, and CS consisted of 10% grass silage, 40% corn silage, and 50% concentrate (dry matter basis). The composition of the concentrate was identical for both diets. Cows were housed in groups of 16 animals, in 4 mechanically ventilated barn units for independent emission measurement. Treatment periods were composed of a 2-wk adaptation period followed by a 5-wk measurement period, 1 wk of which was without cows to allow separation of enteric and manure emissions. In each barn unit, ventilation rates and concentrations of CH4, CO2, NH3, and N2O in incoming and outgoing air were measured. Cow excretion of organic matter was higher for CS compared with GS. Enteric CH4 and cow-associated NH3 and N2O emissions (i.e., manure emissions excluded) were lower for CS compared with GS (−11, −40, and −45%, respectively). The CH4 and N2O emissions from stored manure (i.e., in absence of cows) were not affected by diet, whereas that of NH3 emission tended to be lower for CS compared with GS. In conclusion, there was no trade-off between enteric and manure CH4 emissions, and there were synergistic effects for CH4 and nitrogenous emissions when grass silage was exchanged for corn silage, without balancing the diets for crude protein content, in this short-term study.

Background. The Dutch guideline Eating Disorders defines admission criteria for children with anorexia nervosa (AN) in need for medical stabilization and advices close monitoring to detect refeeding syndrome (RFS) in an early stage. Methods . Admission criteria, recommendations at admission, and during first week of hospitalization were evaluated in accordance to the guideline. RFS was defined as decreased electrolyte concentrations and/or clinical features. Results. 22 patients were included with a total of 50 admissions. We observed that 62% of the admitted patients met one of the admission criteria, 190/300 (63%) recommended admission examinations were performed. During admission adherence decreased, in particular daily weighing and physical examination (12% and 6%, respectively). The guideline was not fully followed in any of the patients. None of the hospitalized patients met the RFS criteria. Conclusion . Guideline adherence was moderate and can be improved by a few adaptations, which may limit unnecessary laboratory testing.

BackgroundHIV status awareness is critical for HIV prevention and care but HIV testing rates remain low in Uganda, especially among men. One suggested approach to increase access and utilisation of HIV testing services is HIV self-testing. We explored perceptions of pregnant and lactating women and their male partners who attended antenatal care, and health care providers in a government hospital in Kampala, Uganda, about HIV self-testing for initial or repeat testing for women and their partners during pregnancy and postpartum We draw implications for scaling-up this new testing approach in Uganda.MethodsThis was a qualitative study conducted at Mulago National Referral Hospital, Kampala, Uganda, between April and December 2017. We conducted in-depth interviews with five pregnant or lactating women and their five male partners; five focus group discussions (two with women, two with health workers and one with male partners of women attending antenatal care) and five key informant interviews with health workers providing prevention of mother-to-child HIV transmission (PMTCT) services. Data were analysed using content thematic approach.ResultsThere was limited awareness about HIV self-testing especially among pregnant or lactating women and their male partners. Study participants mentioned that HIV self-testing would enable people to know their HIV status faster, they thought the approach would be cost- and time-saving compared to health facility-based HIV testing, improve confidentiality and reduce stigma for those who test HIV positive. They expressed however, a general fear that HIV self-testing would lead to harm to self and others in case one tested HIV positive, including suicide, violence among couples, intentional transmission of HIV, and limited linkage to care due to lack of counselling. The likely misinterpretation of HIV test results especially among those with no or limited education, and possible coercion exerted by male partners on their wives were other potential concerns raised about the use of HIV self-testing.ConclusionsThere was limited knowledge about HIV self-testing among pregnant and lactating women, their partners and health workers. While the self-testing modality was perceived to be critical for helping people, especially those in casual and distant relationships, to know their HIV status and that of their partners, most study participants believed that HIV self-testing could potentially result in a multitude of negative outcomes in the absence of pre- and post-test counselling. Successful scale-up and integration of self-testing in HIV programs requires community education, provision of information materials and making self-test kits accessible and affordable, especially in rural areas.

In this article we investigate data from digital interactions between native speaker (NS) and non-native speaker (NNS) dyads of English during synchronous computer mediated communication. As opposed to most studies into the NS-NNS interface, we reversed the expert-learner participant roles: during the task performance, the NS was the (cultural) learner and the NNS the expert. Our aim was to observe the influence of these reversed participant categories on participant behavior and task performance, i.e., to see if NNS behavior as described in earlier studies also applies to the NSs in a similar apprentice position during a cross-cultural exchange, and vice versa. We found that, in both video calls and written chats, the NSs and NNSs behave in a similar manner when cast in both apprentice and learner roles. We conclude that, in task design and telecollaboration practice, the situated identities of the participants should be taken into account.

It has previously been shown that fermentation may contribute substantially to small intestinal carbohydrate disappearance. The fact that the energetic efficiency of starch fermentation is considerably less than that of enzymatic digestion of starch, makes it of nutritional importance to quantify the level of postruminal starch fermentation for dairy cows. Hence, we subjected six rumen-fistulated Holstein-Friesian dairy cows (48 ± 17 days in milk) to 5 d of continuous abomasal infusions of 0.0, 2.5, and 5.0 mol NH4Cl/d, with and without 3 kg ground maize/d, followed by 2 d of rest in a 6 × 6 Latin square design. A total mixed ration (TMR) consisting of (DM basis) 70% grass silage and 30% concentrate was fed at 95% of ad libitum intake. Separation of postruminal starch disappearance into enzymatically digested starch and fermented starch was based on the measurement of natural 13C enrichment of the TMR, abomasally infused ground maize, and resulting 13C enrichment of faeces. Within each cow, 0.0, 2.5, and 5.0 mol NH4Cl/d without ground maize served as control for the same levels of NH4Cl with 3 kg ground maize/d. Abomasal infusion of ground maize was associated with increased total DM and starch intake, faecal starch excretion, and digestibility of starch, and with decreased digestibility of DM and N. The increased faecal volatile fatty acid (VFA) output and 13C enrichment of the individual VFA indicate increased starch fermentation with abomasally infused ground maize. On average, 1 311 g starch/d was postruminally fermented, representing 60.8% of total starch intake. Overall, postruminal starch fermentation of early-lactation dairy cows abomasally infused with 3 kg ground maize/d is considerable and may result in substantial amounts of VFA rather than glucose production.

BACKGROUND: The Primary HIV Prevention among Pregnant and Lactating Ugandan Women (PRIMAL) randomized controlled trial aimed to assess an enhanced counseling strategy linked to extended postpartum repeat HIV testing and enhanced counseling among 820 HIV-negative pregnant and lactating women aged 18-49 years and 410 of their male partners to address the first pillar of the WHO Global Strategy for the Prevention of Mother-to-Child HIV transmission (PMTCT). This paper presents findings of qualitative studies aimed at evaluating participants and service providers perceptions on the acceptability and feasibility of the intervention and at understanding the effects of the intervention on risk reduction, couple communication, and emotional support from womens partners. METHODS: PRIMAL Study participants were enrolled from two antenatal care clinics and randomized 1:1 to an intervention or control arm. Both arms received repeat sexually transmitted infections (STI) and HIV testing at enrolment, labor and delivery, and at 3, 6, 12, 18 and 24 months postpartum. The intervention consisted of enhanced quarterly counseling on HIV risk reduction, couple communication, family planning and nutrition delivered by study counselors through up to 24 months post-partum. Control participants received repeat standard post-test counseling. Qualitative data were collected from intervention women participants, counsellors and midwives at baseline, midline and end of the study through 18 focus group discussions and 44 key informant interviews. Data analysis followed a thematic approach using framework analysis and a matrix-based system for organizing, reducing, and synthesizing data. RESULTS: At baseline, FGD participants mentioned multiple sexual partners and lack of condom use as the main risks for pregnant and lactating women to acquire HIV. The main reasons for having multiple sexual partners were 1) the cultural practice not to have sex in the late pre-natal and early post-natal period; 2) increased sexual desire during pregnancy; 3) alcohol abuse; 4) poverty; and 5) conflict in couples. Consistent condom use at baseline was limited due to lack of knowledge and low acceptance of condom use in couples. The majority of intervention participants enrolled as couples felt enhanced counselling improved understanding, faithfulness, mutual support and appreciation within their couple. Another benefit mentioned by participants was improvement of couple communication and negotiation, as well as daily decision-making around sexual needs, family planning and condom use. Participants stressed the importance of providing counselling services to all couples. CONCLUSION: This study shows that enhanced individual and couple counselling linked to extended repeat HIV and STI testing and focusing on HIV prevention, couple communication, family planning and nutrition is a feasible and acceptable intervention that could enhance risk reduction programs among pregnant and lactating women. TRIAL REGISTRATION: ClinicalTrials.gov registration number NCT01882998, date of registration 21st June 2013.