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Background: Female genital schistosomiasis (FGS) can occur in S. haematobium infection and is caused by egg deposition in the genital tract. Confirming a diagnosis of FGS is challenging due to the lack of a diagnostic reference standard. A 2010 expert-led consensus meeting proposed visual inspection of the cervicovaginal mucosa as an adequate reference standard for FGS diagnosis. The agreement of expert human reviewers for visual-FGS has not been previously described. Methods: In two Zambian communities, non-menstruating, non-pregnant, sexually-active women aged 18-31 years participating in the HPTN 071 (PopART) Population-Cohort were enrolled in a cross-sectional study. Self-collected genital swabs and a urine specimen were collected at a home visit; trained midwives performed cervicovaginal lavage (CVL) and hand-held colposcopy at a clinic visit. S. haematobium eggs and circulating anodic antigen (CAA) were detected from urine. Two senior physicians served as expert reviewers and independently diagnosed visual-FGS as the presence of sandy patches, rubbery papules or abnormal blood vessels in cervicovaginal images obtained by hand-held colposcopy. PCR-FGS was defined as Schistosoma DNA detected by real-time PCR in any genital specimen (CVL or genital swab). Results: Of 527 women with cervicovaginal colposcopic images, 468/527 (88.8%) were deemed interpretable by Reviewer 1 and 417/527 (79.1%) by Reviewer 2. Visual-FGS was detected in 35.3% (165/468) of participants by expert review of colposcopic images by Reviewer 1 and in 63.6% (265/417) by Reviewer 2. Cohen’s kappa statistic for agreement between the two reviewers was 0.16, corresponding to "slight" agreement. The reviewers made concordant diagnoses in 38.7% (204/527) participants (100 negative, 104 positive) and discordant diagnoses in 31.8% (168/527) participants. Conclusions: The unexpectedly low level of correlation between expert reviewers highlights the imperfect nature of visual diagnosis for FGS based on cervicovaginal images. This finding is a call to action for improved point-of-care diagnostics for female genital schistosomiasis.

Female genital schistosomiasis (FGS) can occur in S. haematobium infection and is caused by parasite egg deposition in the genital tract. Confirming a diagnosis of FGS is challenging due to the lack of a diagnostic reference standard. A 2010 expert-led consensus meeting proposed visual inspection of the cervicovaginal mucosa as an adequate reference standard for FGS diagnosis. The agreement of expert human reviewers for visual-FGS has not been previously described. Methods: In two Zambian communities, non-menstruating, non-pregnant, sexually-active women aged 18-31 years participating in the HPTN 071 (PopART) Population-Cohort were enrolled in a cross-sectional study. Self-collected genital swabs and a urine specimen were collected at a home visit; trained midwives performed CVL and hand-held colposcopy at a clinic visit. S. haematobium eggs and circulating anodic antigen (CAA) were detected from urine. Two expert reviewers independently diagnosed visual-FGS as the presence of sandy patches, rubbery papules or abnormal blood vessels in digital cervicovaginal images obtained by hand-held colposcopy. PCR-FGS was defined as Schistosoma DNA detected by real-time PCR in any genital specimen (CVL or genital swab). Results: Of 527 women with cervicovaginal colposcopic images, 468/527 (88.8%) were deemed interpretable by Reviewer 1 and 417/527 (79.1%) by Reviewer 2. Visual-FGS was detected in 35.3% (165/468) of participants by expert review of colposcopic images by Reviewer 1 and in 63.6% (265/417) by Reviewer 2. Cohen’s kappa statistic for agreement between the two expert reviewers was 0.16, corresponding to "slight" agreement. The reviewers made concordant diagnoses in 38.7% (204/527) participants (100 negative, 104 positive) and discordant diagnoses in 31.8% (168/527) participants. Conclusions: The unexpectedly low level of correlation between expert reviewers highlights the imperfect nature of visual diagnosis for FGS based on cervicovaginal images obtained with a hand-held colposcope. This finding is a call to action for improved point-of-care diagnostics for female genital schistosomiasis

Policy implementation has presented the Nigerian educational system with countless obstacles cum problems. This research explored the principles and problems of policy implementation reconsiderations for effective secondary school administration. The study adopted a descriptive research design. The study population was 286 principals. The study sample was 229 principals drawn through a simple random sampling, representing 80% of the population. An instrument, principles and problems of policy implementation for effective secondary school administration was utilized for data collection. Cronbach alpha established a reliability coefficient of 0.89. Mean and standard deviation were used for data collection, while a t-test was utilized to test the hypotheses at a 0.05 significance level. The researchers found that the principles of policy implementation for effective secondary school administration are founded on ensuring a positive and clear policy statement, flexibility in the policy statement, fact-based policy statement, effectiveness in policy statement communication, openness to review, and properly documented in writing. It was recommended that school principals provide copies of the school policy to all the teachers. The principals should not be subjective in implementing policy for effective school administration. The implication of the study is that principals should adopt effective principles for policy implementation.

Located within the seismically active Pacific Ring of Fire, California's transportation infrastructure, especially in the Bay Area, is susceptible to earthquakes. A review of current research and stakeholder interviews revealed a growing awareness of emergency preparedness among local jurisdictions and transit agencies in recent years. However, many have yet to formalize and publish their recovery plans. This study introduces an agent-based multimodal transportation simulation tool to enhance post-earthquake transportation resilience. Integrating a road network simulator with a metro system simulator, the tool employs an optimized Dijkstra-based algorithm to calculate optimal routes, travel times, and fares. A case study is conducted for the East Bay, using the simulator to gauge the impact of a compromised Bay Area Rapid Transit (BART) system. The results suggested that original BART passengers could face either longer commute times or higher costs during the recovery phase of a major earthquake without appropriate policies. Such outcomes could disproportionately burden low-income riders, affecting their mobility and overall travel time.

Located on the tectonic boundary with multiple active faults, the San Francisco Bay Area is highly vulnerable to earthquakes. The United States Geological Survey (USGS) has estimated a 72% probability of an earthquakewith a magnitude of 6.7 or greater striking the region within the next 30 years. Historical seismic events have demonstrated the profound impact earthquakes can have on transportation systems. During the 1989 Loma Prieta Earthquake, the closure of the San Francisco-Oakland Bay Bridge, a critical transit route for San Francisco commuters, left nearly 400,000 commutersand approximately 245,000 vehicles daily with limitedalternative routes.

Many small, resource-strapped communities located in areas vulnerable to wildfire don’t have resources to conduct dedicated evacuation studies and many do not consider the impact of background traffic (i.e., normal traffic rather than evacuating traffic) on evacuation. In response, we explored the performance of several generalizable evacuation strategies with background traffic for representative communities in Marin County, including the Ross Valley, Woodacre Bowl, Tamalpais Valley, and an area near Highway 101 and Ignacio Boulevard in Novato (hereafter referred to as ‘Novato Neighborhood’). The strategies we explored include vehicle reduction (i.e., evacuees share a vehicle), phased evacuation (i.e., evacuees in different zones have different departure times), and off-street parking (i.e., street parking is prohibited on a high-fire Red Flag Day to increase overall road capacity in the event of an evacuation). We then tested each strategy using a wildfire-traffic simulation framework.

In the event of a wildfire, government agencies need to make quick, well-informed decisions to safely evacuate people. Small communities, such as in Marin County, with a mix of residences and flammable vegetation in Wildland-Urban Interface zones tend to lack resources to conduct evacuation studies. Consequently, this study uses a framework of wildfire and traffic simulations to test the performance of potential evacuation strategies, including reducing the volume of evacuating vehicles through car-pooling, phasing evacuations by staggering evacuation times by zone, and prohibiting street parking in four representative areas of Marin County. Results show that reducing vehicle numbers lowers the average travel time by 20%-70% and average exposure time to wildfire by 27%-60% from the baseline. Phased evacuations with suitable time intervals lower the average travel time by 13.5%-70%, but may expose more vehicles to fire in some situations. Prohibiting street parking yields varying results due to different numbers of exits and evacuees. In some cases, prohibiting street parking reduces the average travel time by over 50%, while in other cases it only reduces the average travel time by 9%, contributing little to evacuation efficiency. Altogether, Marin County may want to consider developing a communication and parking plan to reduce the number of evacuating vehicles in wildfire situations. Phased evacuation is also highly recommended, but the suitable phasing interval depends on the speed of fire spread and number of evacuees. Further, whether to establish street parking prohibition policies for a certain area depends on the number of exits and the number of vehicles on the streets.

OBJECTIVES: Depot medroxyprogesterone acetate-subcutaneous (DMPA-SC) can be prescribed through telemedicine and self-administered, but data about availability, particularly during the COVID-19 pandemic, are limited. This study assessed changes in the availability of DMPA-SC for self-administration during the pandemic. STUDY DESIGN: This study used survey data from a convenience sample of US providers engaged in contraceptive care and participating in a Continuing Medical Education-accredited contraceptive training (April 2020-April 2022; n = 849). Providers were recruited from across 503 clinics, including primary care and family planning clinics, public health departments, college and school-based health centers, independent abortion care clinics, and outpatient clinics in hospital settings. Measures included the availability of DMPA-SC for self-administration before and during the pandemic and the use of telemedicine. We used Poisson regression models and cluster-robust errors by clinic, adjusting for region, time of survey, and clinic size, to assess clinic availability of DMPA-SC for self-administration by practice setting. RESULTS: Compared to the prepandemic period (4%), the availability of DMPA-SC for self-administration increased significantly during the pandemic (14%) (adjusted prevalence ratios [aPR] 3.43, 95% CI [2.43-4.85]). During the pandemic, independent abortion clinics were more likely to offer DMPA-SC for self-administration compared to primary care clinics (aPR 2.44, 95% CI [1.10-5.41]). Clinics receiving Title X funds were also more likely to provide DMPA-SC for self-administration during the pandemic compared to other clinics (aPR 2.32, 95% CI [1.57-3.43]), and more likely to offer DMPA-SC for self-administration through telemedicine (aPR 2.35, 95% CI [1.52-3.63]). Compared to the early pandemic period (April-September 2022), telemedicine access to DMPA-SC for self-administration was highest during the later pandemic time period (October 2021-April 2022) (aPR 2.10, 95% CI [1.06-4.17]). CONCLUSIONS: The availability of DMPA-SC for self-administration significantly increased during the pandemic with differences by practice setting and Title X funding. However, overall method availability remains persistently low. IMPLICATIONS: Despite increased availability of DMPA-SC for self-administration among US contraceptive providers during the COVID-19 pandemic, there remains a need to train providers, educate patients, and remove barriers to ensure broader availability of this method across different practice settings.

The performance history of 277 students in clothing and textile from two tertiary institutions in southern Nigeria was studied by artificial neural networks (ANN) and analysis of variance (ANOVA) in terms of institution, gender, ordinary level (O-level) qualification, marital status, and age. The study was guided by five research questions and five hypotheses tested at the 0.05 level of significance. ANOVA is utilised to identify significant differences in academic performance among groups formed by the aforementioned factors. The most significant factors identified through ANOVA are used as input features for the ANN model. The dataset for the ANN model development was randomly distributed into three groups training (80%), validation (10%), and testing (10%). Hypothesis testing indicates significant differences in students' academic performance between institutions and based on O-level qualifications. Further research can build upon these findings to enhance the quality of education in the field of clothing and textiles.