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Abstract Background Youth (ages 14–24) in Nigeria have disproportionately high rates of new HIV infection. Pre-exposure prophylaxis could substantially reduce new infections among youth but has not been scaled up. This cross-sectional study aimed to assess Pre-exposure prophylaxis awareness, willingness to use, and prior use of Pre-exposure prophylaxis among youth in Nigeria. Methods This is a secondary analysis of cross-sectional data from a quasi-experimental pilot study (clinical trial NCT04070287). The analysis focused on Pre-exposure prophylaxis awareness, willingness to use, and prior use among 324 youth recruited between September 2019 to March 2020. Descriptive statistics were calculated as frequencies and percentages for categorical variables and means and standard deviations for continuous variables. Results Of the 324 participants, the mean age and standard deviation were 21.17 (± 2.20) years. The majority were 20–24 years old (75.9%) and male (57.7%). Only 30.7% used condoms consistently over three months. Regarding Pre-exposure prophylaxis awareness and willingness, 62.6% had never heard of Pre-exposure prophylaxis, and 158 (50.1%) reported willingness to use Pre-exposure prophylaxis. Only 10 (3.2%) reported having used Pre-exposure prophylaxis. Conclusion Nigerian youth have low awareness of and prior use of Pre-exposure prophylaxis. Given the gap between prior use and willingness to use Pre-exposure prophylaxis, our findings suggest missed opportunities to prevent new HIV infections among youth in Nigeria. Efforts to increase awareness and uptake of Pre-exposure prophylaxis among this population should consider youth-led Pre-exposure prophylaxis outreach efforts and effectively communicate the benefits of Pre-exposure prophylaxis to this population. Trial Registration NCT04070287, the Date of registration of the trial is 20-07-2019.

IntroductionThis double-blind, placebo-controlled, randomized (1:1) clinical trial was conducted at the West China Hospital, Sichuan University, from March to September 2017.MethodsEligible participants included adults aged 18 years and older, living in the community, diagnosed with type 2 Diabetes Mellitus according to ADA guidelines, capable of self-managing their diabetes, and able to visit the study site for follow-up. The intervention group received 25 ml of a probiotic beverage containing with over 10^8 CFU/mL of Lactobacillus, administered four times daily. An equal volume of inactivated Lactobacillus was administered to the control group and the control group was administered the same volume of inactivated Lactobacillus. This study aimed to evaluate the effectiveness of probiotics on glycemic control and other diabetes-related outcomes in patients with type 2 diabetes patients. The primary outcomes were changes in HbA1c and FBG levels post-intervention. Investigators, participants, and study site personnel were blinded to the treatment allocation until the conclusion of the study. This double-blind, randomized, placebo-controlled clinical trial was registered in the Chinese Clinical Trial Registry (ChiCTR-POR-17010850).ResultsOf the 490 participants screened, 213 were randomized to either the probiotics group (n = 103) or the placebo group (n = 110). After 16 weeks of follow-up, the probiotic group showed reductions in HbA1c [-0.44 (-0.66 to -0.22)] and FBG [-0.97 (-1.49 to 0.46)] post-intervention, similar to the placebo group with reductions in HbA1c [-0.33 (-0.52 to -0.15)] and FBG [-0.90 (-1.32 to -0.47)], but these changes were not statistically significant in PP and ITT analyses (P>0.05). Adverse events were similarly distributed among groups, indicating comparable safety profiles.DiscussionOverall, 16-week probiotic supplementation showed no beneficial effects on glycemic control, lipid profiles, or weight.Clinical Trial Registrationhttps://www.chictr.org.cn/showproj.html?proj=18421, identifier ChiCTR-POR-17010850.

Abstract Background The impact of the coexistence of type 2 diabetes mellitus (T2DM) in patients with non-ischemic dilated cardiomyopathy (DCM) on clinical profiles, myocardial fibrosis, and outcomes remain incompletely understood. Method A total of 1152 patients diagnosed with non-ischemic DCM were prospectively enrolled from June 2012 to October 2021 and categorized into T2DM and non-T2DM groups. Clinical characteristics, cardiac function, and myocardial fibrosis evaluated by CMR were compared between the two groups. The primary endpoint included both all-cause mortality and heart transplantation. Cause of mortality was classified into heart failure death, sudden cardiac death, and non-cardiac death. Cox regression analysis and Kaplan-Meier analysis were performed to identify the association between T2DM and clinical outcomes. Propensity score matching (PSM) cohort including 438 patients was analyzed to reduce the bias from confounding covariates. Results Among the 1152 included DCM patients, 155 (13%) patients had T2DM. Patients with T2DM were older (55 ± 12 vs. 47 ± 14 years, P

CO2 emissions from building operations have increased to their highest level, moving away from the Paris Agreement goal of below 2 °C. Zero carbon housing (ZCH) has been identified as a viable solution to realise carbon neutrality. However, ZCHs are barely recognised by the mainstream market due to the misconception of high up-front cost. This research aims to identify affordable solutions for ZCH by synergising building design, mechanical services, and renewable energy, and to balance capital cost and environmental benefits. An integrated framework of energy simulation, sensitivity analysis, and multi-objective optimisation is employed to achieve the goals. A representative house design is selected to demonstrate the proposed methodology, and a national energy rating scheme in Australia, NatHERS, is used for validation. The optimisation identified eight optimal solutions, resulting in a CO2 emission reduction between 1.894 tCO2 to 2.259 tCO2 with increased indoor comfort of 1.3%–2.6%. This research also finds that given the policy incentives, the actual incremental cost is marginal after the government rebate. This research addresses the major barriers of the high up-front cost associated with ZCH through an integrated approach. The research facilitates the paradigm shift in the mainstream market, promoting the development and market expansion of ZCH.

BackgroundSequential embryo transfer has been recognized as a strategy to increase pregnancy rates in women undergoing in vitro fertilization and embryo transfer (IVF-ET). However, its impact on assisted reproductive outcomes remains to be substantiated by robust evidence. This systematic review aims to summarize and analyze the available evidence to investigate the effect of sequential embryo transfer on assisted reproductive outcomes.MethodsA comprehensive literature search was executed across the Pubmed, Cochrane Library, Web of Science, and Scopus databases in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Data were aggregated utilizing a random effects model, and the resultant outcomes were articulated as odds ratios (ORs) along with their 95% confidence intervals (CIs).ResultsThe pooled results revealed a statistically significant enhancement in reproductive outcomes for infertile patients undergoing sequential embryo transfer as evidenced by elevated rates of chemical pregnancy (OR = 1.67, 95% CI = 1.23–2.27), clinical pregnancy (OR = 1.78, 95% CI = 1.43–2.21), and ongoing pregnancy (OR = 1.54, 95% CI = 1.03–2.31). Compared with cleavage-stage embryo transfer, sequential transfer yielded superior outcomes in terms of chemical pregnancy rate (OR = 2.08, 95% CI = 1.35–3.19) and clinical pregnancy rate (OR = 1.78, 95% CI = 1.37–2.31). Furthermore, among the repeated implantation failure (RIF) cohort, sequential embryo transfer surpassed blastocyst-stage transfer, delivering a heightened chemical pregnancy rate (OR = 1.66, 95% CI = 1.19–2.53) and clinical pregnancy rate (OR = 1.65, 95% CI = 1.19–2.27).ConclusionOur meta-analysis indicates that sequential transfer may enhance clinical pregnancy rate in a small subgroup of well-selected women. While promising, further evidence from prospective studies is needed.

Objective Investigate how hypertension during pregnancy (HDP) and depression during pregnancy (DDP) independently and jointly affect infant birth outcomes. Methods This population-based, retrospective cohort study included a sample of 68,052 women who participated in PRAMS 2016–2018 survey. Poisson regression was used for adjusted relative risks (aRRs). Results Compared to women without HDP and DDP, aRRs for PTB and LBW among women with both HDP and DDP are 2.04 (95% CI 1.73, 2.42) and 2.84 (95% CI 2.27, 3.56), respectively, albeit lower than the expected joint effect of risk. Conclusion DDP may modify the association between HDP and PTB, LBW.

Abstract Background Although many behavioral interventions are adapted, little is known about the reasons for adaptations and the process and outcomes influencing adaptations. To address this gap, we explored the adaptations made to promote HIV prevention services, including HIV self-testing (HIVST), among Nigerian youth. Methods The main objective of this qualitative case study design was to document the adaptations made over time using the Framework for Reporting Adaptations and Modifications – Expanded (FRAME). Between 2018 and 2020, we organized four participatory activities as part of the 4 Youth by Youth project to increase the uptake of HIVST services in Nigeria—an open call, a designathon, a capacity-building bootcamp and a pilot feasibility trial. We also began the process of implementing a final intervention using a pragmatic randomized control trial (RCT). The open call solicited creative strategies to promote HIVST among Nigerian youth and then had experts evaluate them. The designathon brought together youth teams to further develop their HIVST service strategies into implementation protocols. Teams determined to be exceptional were invited to a four-week capacity-building bootcamp. The five teams that emerged from the bootcamp were supported to pilot their HIVST service strategies over a 6-month period. The adapted intervention is currently being evaluated in a pragmatic RCT. We transcribed meeting reports and conducted document reviews of study protocols and training manuals. Results Sixteen adaptations were identified and categorized into three domains: (1) modifications to the content of the intervention (i.e. photo verification system and/or Unstructured Supplementary Service Data (USSD) system to verify HIVST); (2) modifications to the delivery the intervention (i.e. implement participatory learning community sessions to provide supportive supervision and technical support); (3) modifications to the evaluation processes (i.e. economic evaluation to estimate the cost of implementing intervention on a larger scale). Frequent reasons for adaptation included increasing intervention reach, modifying interventions to enhance their appropriateness and fit with the recipient, and increasing the intervention’s feasibility and acceptability. Most adaptations were planned and reactive, and the need for modifications was determined by the youths, 4YBY program staff, and advisory group. Conclusions Findings suggest that the nature of adaptations made throughout the implementation process reflects the necessity of evaluating services in context while adjusting to specific challenges as they are identified. Further research is needed to understand the effect of these adaptations on the overall intervention effect as well as the quality of youth engagement.

Abstract CO2 emissions from building operations have increased to their highest level globally, moving away from the Paris Agreement goal of below 2 °C. While geothermal is recognised as a promising renewable source, the lack of an integrated framework guiding investigating ground source heat pumps for building operations, along with the incapability of well-known simulation tools in accurately capturing ground thermal performance, hinders its application. This research aims to unlock ground source heat pumps for building operations through an integrated framework, including an overarching improved U.S. National Renewable Energy Laboratory (NREL) monitoring guideline, a sensor-based monitoring prototype, and a g-function-based simulation approach. This research proposes amendments and improvements to the NREL guideline for monitoring geothermal energy by separating Thermal Energy Net Production from Thermal Energy Gross Production. A state-of-the-art case building located in Melbourne, Australia, housing advanced technologies, including ground source heat pump systems, is used to demonstrate and validate the research framework. A typical winter month in the southern hemisphere, July 2021, is monitored for the ground source heat pump systems designed and used for space heating. The findings reveal that the thermal energy generation during working days in July 2021 is close to the simulation results, with a difference of 2.2% in gross thermal energy production and a difference of 0.92% in inlet temperature. This research develops and validates an integrated approach for evaluating ground source heat pump systems, contributing to the utilisation of geothermal energy for building operations.

This study evaluates two grid-connected solar photovoltaic (PV) systems using five criteria: final energy output, system yield, performance ratio, capacity factor, and system efficiency. The PV systems were installed on the rooftop of the Engineering building, Kyungpook National University, the Republic of Korea. The system was monitored, and necessary environmental data was recorded from January 2021 to December 2021. From the result, the annual electricity exported to the grid by the m-si solar PV was 9521 kWh, and that of the p-si was 8263 kWh. The m-si has a better annual average daily final and array yield of 5.23 h/day and 5.45 h/day than the annual final and array yield of p-si with 4.93 h/day and 5.12 h/day, respectively The composite solar PV saved the environment from 9.7 tons of CO2per year, equivalent to 9.7% of people reducing energy use by 20%. Based on the analysis for this location, the m-si solar cell technology showed a better annual performance than the p-si solar cell when considering the five evaluations, except for the performance ratio where the p-si solar cell outperformed the m-si solar technology. Finally, this study provides insightful information to researchers, PV installers, and PV manufacturing companies on the actual performance of grid-connected solar PV in Korea.

Objective The objectives of this study are to identify patterns of anxiety symptomology over time among patients with systemic lupus erythematosus (SLE) and to assess the longitudinal relationship between SLE disease activity and anxiety symptomology. Methods Longitudinal data from 139 patients with American College of Rheumatology or Systemic Lupus International Collborating Clinic (SLICC)‐classified SLE were analyzed. Anxiety symptomology was assessed using the Patient‐Reported Outcomes Measurement Information System (PROMIS) Emotional Distress: Anxiety Short Form 8a. SLE disease activity was measured using the Systemic Lupus Erythematosus Disease Activity Index (SLEDAI)‐2000 (S2K) and S2K Responder Index 50 (S2K RI‐50). Group‐based trajectory modeling (GBTM) identified longitudinal trajectories of anxiety symptomology. The relationship between disease activity and anxiety over time was assessed using multilevel linear regressions. Results The mean patient age was 40.2 years (standard deviation [SD], 12.7); 90.6% were female, and 56.1% were of Black race. All patients had at least three PROMIS anxiety scores over an average of 30.9 months (SD, 13.0). GBTM identified four trajectories of anxiety symptomology, labeled as the following: low (LA), average (AA), moderate (MA), and high anxiety (HA). Black patients were 2.47 (95% confidence interval: 1.19‐5.12) times as likely as White patients to be classified into the MA or HA groups compared with the LA or AA groups. On multivariable analysis, active SLE disease was not significantly associated with anxiety over time (P = 0.19). Conclusion Anxiety trajectories remained stable over time, and racial differences in anxiety severity were observed. SLE disease activity was not longitudinally associated with anxiety after controlling for depression and other factors. Further understanding of the factors that contribute to the persistence of anxiety among individuals with SLE is necessary.

Men’s pregnancy intention is associated with a host of positive outcomes for families, yet this topic remains understudied. Because unintended pregnancies are more likely to occur at suboptimal parental health, this study aimed to examine the extent to which men improve their preconception health in the context of future fertility planning. This study used pooled data from the 2011–2019 National Survey of Family Growth for a final sample size of 10,223. Latent class analysis (LCA) was used to identify distinct classes of men’s preconception health. Eight preconception health risk factors were used to determine class membership. A classify-analyze approach was used to create the preconception health phenotype ( PhP ) exposure variable. The outcome of interest was men’s fertility intentions. Multinomial regression models were used to examine the association between the exposure and the outcome. Three unique PhPs were identified (lowest risk, substance users, and sexual risk-takers) from the LCA model. Men in the substance users’ group (22.9%) were characterized by high-risk alcohol use and drug use, while sexual risk-takers (8.1%) were characterized by having multiple sexual partners. Belonging in the phenotypes of substance users or sexual risk-takers was associated with increased odds for definite no fertility intention than definite yes intentions (adjusted odds ratio [aOR]: 1.47, 95% confidence interval [CI]: [1.18, 1.84] and aOR: 1.51, 95% CI: [1.13, 2.01], respectively). Results provide new insights on how preconception health can be measured and fills a knowledge gap on its relationship to men’s future fertility planning. Findings can be applied to preconception care intervention frameworks, and guide family planning interventions and contraceptive counseling.

BackgroundGiven the rapid innovation of wearable technology, additional physical indicators can be detected, and blood pressure (BP) has become the focus of many emerging medical-device manufacturers. This study aimed to validate the accuracy of the newly developed HUAWEI WATCH in BP monitoring, according to the American National Standards Institute/Association for the Advancement of Medical Instrumentation/International Organization for Standardization (ANSI/AAMI/ISO 81060-2:2018) guidelines.Materials and methodsThe same arm sequential BP measurement was applied. One validation included four reference BP measurements taken simultaneously by two independent observers using a mercury sphygmomanometer, alternating with three test-watch measurements. Each test-watch measurement was compared against the average of the previous and subsequent reference BP readings. Two criteria were required for validation: (1) a mean BP difference of 5 mm Hg or less, with a standard deviation (SD) of 8 mm Hg or less for systolic blood pressure (SBP) and diastolic blood pressure (DBP) in the 255 pairs of measurements, and (2) an SD for the of 85 averaged BP differences within the threshold defined by the mean test-reference BP difference listed in the ANSI/AAMI/ISO 81060-2:2018 guidelines.ResultsThe mean age of the 85 participants was 48 ± 18 years (range: 21–85), and 53 (62.4%) were male. The mean differences between the test and reference BPs were -0.25 ± 5.62 mm Hg and -1.33 ± 6.81 mm Hg for SBP and DBP, respectively (according to Criterion 1). The mean differences between the test BPs and reference BPs were -0.25 ± 5.00 mm Hg and -1.33 ± 6.31 mm Hg for SBP and DBP, respectively, according to Criterion 2.ConclusionBlood pressure measurement using the HUAWEI WATCH showed excellent consistency with reference BPs, and fulfilled both validation criteria of the guidelines, show its promise as a wearable device for BP self-monitoring.

BackgroundLife course perspectives suggest that optimizing men's health before conception is requisite to equitably improve population health, an area of increasing public health focus. Although scholarship on the social determinants of health (SDOH) suggests that men's health and health behaviors do not occur in a vacuum, preconception health studies have not explicitly examined how these factors influence men's preconception health.ObjectiveTo identify latent classes of men's preconception health and the role of the SDOHs in predicting class membership.MethodsPooled data from the 2011–2019 male file of the National Survey of Family Growth were analyzed (n = 10,223). Latent class analysis (LCA) was used to identify distinct classes of men's preconception health. Eight manifest variables were used to fit latent class models. A classify-analyze approach was subsequently used to create a preconception health phenotype (PhP) outcome variable. SDOHs (exposure variable) were assessed in four domains (rural/urban residence, health access, socioeconomic status, and minority/immigrant status) to predict class membership. Survey-weighted multinomial regression models were fitted to examine the association between the exposure and the outcome.ResultsThree unique PhPs were identified (lowest risk (69%), substance users (22.9%), and sexual risk-takers (8.1%) from the LCA model. Health access, socioeconomic status, and minority/immigrant status were significant predictors of class membership but not rural/urban residence. Sexual risk takers were more likely to be uninsured (aOR: 1.25, 95% CI 1.02, 1.52), college-educated (aOR: 1.94 95% CI: 1.34, 2.79), and non-Hispanic Black (aOR: 1.99 95% CI: 1.55, 2.54) while substance users were more likely to have unstable employment (aOR: 1.23 95% CI:1.04, 1.45) and have a high school degree or higher (aOR 1.48 95% CI: 1.15, 1.90) than men in the lowest risk category.ConclusionSocial determinants may impact men's preconception health in ways that are not conventionally understood. These findings raise important questions about how preconception health interventions should be created, tailored, and/or retooled. Specifically, studies that examine the sociocultural and political contexts underpinning the relationship between social class, masculinity, and men's preconception health are needed to provide nuanced insights on factors that shape these outcomes.

Solar energy is one of the most promising forms of alternative energy because it has no adverse effects on the environment and is entirely free. Converting solar energy into thermal energy is the most common and straightforward method; the efficiency of solar thermal conversion is approximately 70 percent. The intermittent nature of solar energy availability affects the performance of solar water heaters (SWH), which lowers the usefulness of solar energy in residential and commercial settings, particularly for water heating. Even at low temperatures, the performance of a collector can be improved by using low-density polyethylene (LDPE) glazing instead of traditional glass because it is less expensive and lighter than glass. Using a comprehensive experimental-simulative study, the Glass Solar water heater (glass SWH) and the low-density polyethylene solar water heater (LDPE SWH) are analyzed, examined, and compared in this work. These solar water heaters have galvanized iron (GI) as their absorber material. The SWHs were operated in a closed loop at a constant mass flow rate of 0.013 kg/s, and a 4E analysis (which stands for energy, exergy, economics, and efficiency recovery ratio) was carried out. This analysis included a look at the dynamic time, uncertainty, weight reduction, carbon footprint, and series connection. An LDPE SWH has an energy efficiency that is 5.57% and an exergy efficiency that is 3.2% higher than a glass SWH. The weight of the LDPE SWH is 32.56% lower than that of the glass SWH. Compared to the price of a conventional geyser, installing our SWH results in a cost savings of 40.9%, and monthly energy costs are reduced by an average of 25.5%. Compared to October, September has the quickest dynamic time to reach the desired temperature, while October has the most significant dynamic time. The efficiency recovery ratio (ERR) of a glass SWH is 0.0239% lower than that of an LDPE SWH. LDPE SWHs had a carbon credit worth INR 294.44 more than glass SWHs. The findings of these tests demonstrate that the LDPE SWH is a practical replacement for traditional means of heating water, such as SWHs and geysers.

Exposure to daylight significantly affects the psychological well-being of occupants by diminishing headaches, eye tensions, or stress. Daylight penetration is a matter of collaboration between building façade and perimeter zones that can be controlled through façade design features. This study reviews available daylighting systems to block or redirect natural light inside the space and their overall performance. Adaptation found to be the main key feature of daylighting systems to improve their effectiveness in indoor environments. As the main implication of such systems on the visual comfort performance of occupants, a list of quantitative indices is studied based on their mathematical equation to outline their advantages and limitations. Findings revealed a lack of agreement on acceptable indoor illuminance thresholds for most of the indices and the absence of a reliable glare index in presence of sun within the view field of the occupant. Similarly, many green building certifications propose a specific criterion to assess view out but remained a challenge for future studies.

PurposeMaternal depression and neighborhood characteristics are known to be associated both with each other and with adolescent mental health outcomes. These exposures are also subject to change throughout the life of a child. This study sought to identify multi-trajectories of maternal depression (MD) and self-reported neighborhood collective efficacy (NCE) over a 12-year period and determine whether these trajectories are differentially associated with adolescent mental health.MethodsData from the Fragile Families and Child Wellbeing study, a longitudinal cohort study of new parents and their children, were used. Maternal depression (MD) and self-reported NCE when the child was 3, 5, 9, and 15 years of age were the primary exposures of interest. Adolescent depression and anxiety symptomology when the child was 15 years of age were the primary outcomes. Primary analyses were conducted using multi-trajectory modeling and linear regressions.ResultsFive multi-trajectories were identified, two of which were characterized by no MD but either high or low NCE, and three of which were characterized by similarly moderate levels of NCE but either increasing, decreasing, or consistently high MD. Children of mothers with increasing or consistently high depressive symptomology and moderate NCE had significantly higher depression and anxiety scores compared to children of mothers with no depressive symptomology and high NCE.ConclusionAdolescents with consistent and proximal exposure to MD are most likely to suffer from adverse mental health and should be provided with appropriate support systems to mitigate these outcomes.

Background: Ambient fine particulate matter (PM2.5) pollution has been associated with mortality from various diseases, however, its association with under-five mortality rate (U5MR) has remained largely unknown. Methods: Based on the U5MR data across 2851 counties in Mainland China from 1999 to 2012, we employed approximate Bayesian latent Gaussian models to assess the association between ambient PM2.5 and U5MR at the county level for the whole nation and sub-regions. GDP growth rate, normalized difference vegetation index (NDVI), temperature, and night-time light were included as covariates using a smoothing function. We further implemented an empirical dynamic model (EDM) to explore the potential causal relationship between PM2.5 and U5MR. Results: We observed a declining trend in U5MR in most counties throughout the study period. Spatial heterogeneity in U5MR was observed. Nationwide analysis suggested that each 10 µg/m3 increase in annual concentration of PM2.5 was associated with an increase of 1.2 (95% CI: 1.0 – 1.3) per 1000 live births in U5MR. Regional analyses showed that the strongest positive association was located in the Northeastern part of China [1.8 (95% CI: 1.4 – 2.1)]. The EDM showed a significant causal association between PM2.5 and U5MR, with an embedding dimension of 5 and 7, and nonlinear values θ of 4 and 6, respectively. Conclusion: China exhibited a downward trend in U5MR from 1999 to 2012, with spatial heterogeneity observed across the country. Our analysis reveals a positive association between PM2.5 and U5MR, which may support a causal relationship.

Abstract Background China had the second largest proportion of preterm birth (PTB) internationally. However, only 11% of pregnant women in China meet international guidelines for maternal physical activity, a significantly lower proportion than that in Western countries. This study aims to examine the association between outdoor physical exercise during pregnancy and PTB among Chinese women in Wuhan, China. Methods A case-control study was conducted among 6656 pregnant women (2393 cases and 4263 controls) in Wuhan, China from June 2011 to June 2013. Self-reported measures of maternal physical exercise (frequency per week and per day in minutes) were collected. Adjusted odds ratios were estimated using Bayesian hierarchical logistic regression and a generalized additive mixed model (GAMM). Results Compared to women not involved in any physical activity, those who participated in physical exercise 1–2 times, 3–4 times, and over five times per week had 20% (aOR: 0.80, 95% credible interval [95% CI]: 0.68–0.92), 30% (aOR: 0.70, 95% CI: 0.60–0.82), and 32% (aOR: 0.68, 95% CI: 0.59–0.78) lower odds of PTB, respectively. The Bayesian GAMM showed that increasing physical exercise per day was associated with lower risk of PTB when exercise was less than 150 min per day; however, this direction of association is reversed when physical exercise was more than 150 min per day. Conclusion Maternal physical exercise, at a moderate amount and intensity, is associated with lower PTB risk. More data from pregnant women with high participation in physical exercise are needed to confirm the reported U-shape association between the physical exercise and risk of preterm birth.

The diagnosis of a concurrent infection of Avibacterium paragallinarum and fowl adenovirus (FAdV) in an infectious coryza–like outbreak in the outskirt of Beijing is reported. The primary signs of the infection were acute respiratory signs, a drop in egg production, and the presence of hydropericardium–hepatitis syndrome–like gross lesions. Laboratory examination confirmed the presence of A. paragallinarum by bacterial isolation and a species-specific PCR test. In addition, conventional serotyping identified the isolates as Page serovar A. Fowl adenovirus was isolated from chicken liver specimen and identified by hexon gene amplification. In addition, histopathologic analysis and transmission electron microscopy examination further confirmed the presence of the virus. Both hexon gene sequencing and phylogenetic analysis defined the viral isolate as FAdV-4. The pathogenic role of A. paragallinarum and FAdV was evaluated by experimental infection of specific-pathogen-free chickens. The challenge trial showed that combined A. paragallinarum and FAdV infection resulted in more severe clinical signs than that by FAdV infection alone. The concurrent infection caused 50% mortality compared with 40% mortality by FAdV infection alone and zero mortality by A. paragallinarum infection alone. To our knowledge, this is the first report of A. paragallinarum coinfection with FAdV. The case implies that concurrent infections with these 2 agents do occur and more attention should be given to the potential of multiple agents during disease diagnosis and treatment.

Magnetic resonance imaging data are being used in statistical models to predicted brain ageing (PBA) and as biomarkers for neurodegenerative diseases such as Alzheimer’s Disease. Despite their increasing application, the genetic and environmental etiology of global PBA indices is unknown. Likewise, the degree to which genetic influences in PBA are longitudinally stable and how PBA changes over time are also unknown. We analyzed data from 734 men from the Vietnam Era Twin Study of Aging with repeated MRI assessments between the ages 51–72 years. Biometrical genetic analyses “twin models” revealed significant and highly correlated estimates of additive genetic heritability ranging from 59 to 75%. Multivariate longitudinal modeling revealed that covariation between PBA at different timepoints could be explained by a single latent factor with 73% heritability. Our results suggest that genetic influences on PBA are detectable in midlife or earlier, are longitudinally very stable, and are largely explained by common genetic influences.

Zero carbon housing has been forwarded by researchers and policymakers as a way to reduce carbon emissions from the residential sector globally. Although policies promoting zero or low carbon housing have been set in several regions, there has been limited policy development towards this performance outcome in Australia. The research in this paper aims to address this issue through evaluating existing policy and incentives frameworks and proposing adaptations that can be used to promote and increase the delivery of zero carbon housing in the studied region, i.e., Victoria, Australia. The research utilised a systematic qualitative and quantitative research approach across three key phases. In the first phase, a literature review was conducted to provide a depiction of the existing policy framework and incentives in Australia and other representative countries. In the second phase, a workshop with key policymakers and academics was conducted to refine a draft online questionnaire for different stakeholders of zero carbon housing. Additional semi-structured interviews were also conducted with the policy departments of the Department of Environment, Land, Water and Planning (DELWP), Victoria. In the third phase of the research, the online survey was finalised and distributed to randomly sampled key stakeholders. The study reveals that builders lack experience in the construction of zero carbon houses, which was identified as a critical factor hindering the adoption of such houses. Financial incentives of state governments were identified as essential to stimulate the adoption of zero carbon houses in order to overcome any additional capital costs. The analysis informs the development of a proposed policy framework that could shape and scale up the development of policies and financial support to deliver zero carbon housing, not only in Australia but also in other jurisdictions, as the residential sector plays an increasing role in the transition to a low carbon future.

Abstract Background A number of studies have explored the association between depression and ghrelin, leptin, and cortisol; further, postprandial C-peptide levels have a therapeutic effect on type 2 diabetes mellitus (T2DM). However, the relationship between C-peptide and depression in patients with diabetes, remains unclear. The aim of this study was to explore the association between depression and ghrelin, leptin, cortisol, and C-peptide in patients with diabetes. Methods We enrolled 50 adults without T2DM, 77 non-depressed adults with T2DM (free of Axis-I psychiatric disorders as assessed using the Mental Illness Needs Index (MINI), Patient Health Questionnaire (PHQ-9 score ≤ 4)) and 59 patients with T2DM and depression (PHQ-9 ≥ 7 and positive by the Structured Clinical Interview for DSM-5). The age range of the participants was 45–59 years of age. We compared the above three groups and explored the association between ghrelin, leptin, cortisol, C-peptide, and depression in patients with diabetes. A post-hoc power-analysis was finished. Results Compared with the non-depression T2DM group, the depression T2DM group had significantly higher blood glucose fluctuations. Further, compared with the non-depression T2DM and non-diabetic groups, the depression T2DM group had significantly lower levels of post-meal 2-h C-peptide and elevated evening cortisol (p

Prefabricated construction has been well recognized for its benefits, including accelerated construction cycle time and improved sustainability. However, low efficiency in the production of precast concrete components due to component and production complexity has not been sufficiently addressed in previous research. This paper explores the complexity of precast concrete components by establishing complexity indices and evaluating their influence on production efficiency. First, referring to research on product complexity in the machinery manufacturing industry, we define the complexity of precast concrete components in the construction industry. Then, based on a literature review, field studies, and expert interviews, we systematically construct the complexity indices of precast concrete components using the three-stage coding method, Grounded Theory. The overall complexity index system for precast concrete components constructed comprises 16 constituent complexity indices in three dimensions (i.e., structural complexity of the component, production complexity, and management complexity). The relationship between complexity indices and production efficiency is then explored using structural equation model analysis based on the data collected through a questionnaire survey. The results reveal that complexity indices have a significant impact on the production efficiency for precast concrete components, where the number of embedded parts, waiting time in production, operating proficiency of workers, and degree of automation of the production line are found to be the most influential complexity indices. This study provides a foundation upon which production managers improve production efficiency for precast concrete components based on an analysis of their product complexity.

Canine mammary tumors (CMTs) have histopathological, epidemiologic and clinical characteristics similar to those in humans and are known to be one of the best models for human breast cancer (HBC). This research aimed to describe a newly established canine cell line, CMT-1026. Tumor samples were collected from a female dog exhibiting clinical mammary neoplasm, and the adherent cells were cultured. Both the histology and immunohistochemistry (IHC) of tumor samples were estimated. Cell growth, ultrastructural, cytological and immunocytochemistry (ICC) features of CMT-1026 were examined. CMT-1026 cells were inoculated into 10 female BALB/c nude mice to evaluate oncogenicity and metastatic ability. Hematoxylin-eosin (H.E.) staining of the tumors revealed an epithelial morphology. Electron microscopy was used to detect histological and cytological of smears, and ultrathin sections showed that CMT-1026 cells were polygonal and characterized by atypia and high mitotic index in the tumor, with prominent nucleoli and multinucleated cells. IHC characterization of CMT-1026 indicated ER-, PR-, HER-2, p63+, CK5/6+, and α-SMA+ epithelial cells. ICC characterization of CMT-1026 showed high expression of Claudin-1, Delta-catenin, SOX-2, and KI-67. At 2 weeks after inoculation of the CMT-1026 cells, phyma was found in 100% of the mice. The xenograft cancers showed conservation of the original H.E. features of the female dog cancer. In conclusion, CMT-1026 may be a model of canine mammary cancer that can be used in research on the pathogenesis of both CMT and HBC.

Background: AMAZFIT®, a novel wearable electrocardiogram (ECG)-recording system is used for the measurement, acquisition, and storage of single-lead cardiac waveforms for adults. The aim of the study was to evaluate the accuracy of AMAZFIT® for diagnosing arrhythmia in older patients.Methods: From May to December 2019, we recruited 291 elderly individuals with an average age of 78±10 years old, and 41.9% women. All cardiac waveforms were obtained from the AMAZFIT® which included limb and chest leads. Two trained technicians reviewed all ECG data to determine cardiac rhythm using standard diagnostic criteria. We evaluated the accuracy of AMAZFIT® for identifying arrhythmia by comparing the sensitivity, specificity, accuracy, positive predictive value (PPV), negative predictive value (NPV), and positive and negative likelihood ratios with those of a standard 12-lead ECG.Results: Of the 291 participants, 197 older adults had arrhythmias, including AF (n = 119), first-degree AVB (n = 28), PACs (n = 25), and PVCs (n = 28). Three of these participants had arrhythmias of AF and PVCs. Chest lead data from 100% and limb lead data from 4.7% of the participants were analyzed. An evaluation of AMAZFIT® for atrial fibrillation (AF) reported a sensitivity, specificity, PPV, NPV PLR, and negative likelihood ratio (NLR) of 93.28, 95.35, 93.28, 95.35, 20.06, and 0.07%, respectively. AMAZFIT® also demonstrated excellent sensitivity for premature atrial contractions (PACs) (84.00%) and premature ventricular contractions (PVCs) (89.29%). However, the device demonstrated a low sensitivity for first-degree atrioventricular block (32.14%).Conclusions: The AMAZFIT® showed significantly higher sensitivity and specificity for AF, PACs, and PVCs. This portable ECG-recording device based on an algorithm has a potential auxiliary diagnostic value for identifying arrhythmia compared with a standard 12-lead ECG device.

The defect in quality caused by the noncompactness of sleeve grouting has become the main obstacle restricting the further implementation of the prefabricated building in China. Studies have been conducted to explore the influencing factors of inadequate grouting; however, few studies attempt to investigate the complex interrelationship and lack of systematic cognition among these factors. To fill this gap, this study conducted a comprehensive literature review to collect the influencing factors of sleeve grouting and verified the reliability of these factors using the combined methods of brainstorming and semistructured expert discussion. A total of 18 key factors were identified and determined. The structural interpretation model (SIM) and Matrice d’Impacts Croisés Multiplication Appliquée à un Classement (MICMAC) approaches were then used to analyze, depict, and explain the internal relationships between the factors. The results indicate that all factors were classified into six levels, among which poor responsibility of supervisors and weather conditions are the most basic factors, while grouting speed and a loose-sealing rubber plug are the most important factors. Finally, a three-level control strategy was proposed to improve the compactness quality of sleeve grouting. The research findings provide valuable guidelines for managers to eliminate the grouting quality defect and to further the development of prefabricated buildings in China.

Offsite construction (OSC) is attracting increasing attention from both industry and academia due to its benefits, such as improved productivity and quality, as well as reduced waste. However, the current building panelization design in OSC is a time-consuming and experience-based manual process, and the generated panelization design may result in unbalanced manufacturing processes. One reason is that the prefabrication of building components involves a highly variable product mix and there is a lack of a computational framework to evaluate panelization design. The objective of this research is, thus, to propose a BIM-based generative framework that automatically generates the design of production components with the aim of improving production productivity. This framework consists of a building information extraction module, a generative design algorithm, and a simulation-based performance evaluation model. The building information extraction module is designed to extract building component information from a BIM model and classify building components into different production groups in accordance with functionalities and materials. The generative design algorithm is then developed to formulate panelization design alternatives in consideration of the structural, production, and logistics constraints. On this basis, the generated panelization designs are quantitatively assessed by a simulation-based evaluation model in terms of productivity. A case study was used to verify and validate the framework. This research contributes to the body of knowledge by a computational framework of building panelization design, which leverages the generative design algorithm and BIM-simulation integration for optimized panelization design.

In prefabricated construction, building components are manufactured off-site before shipping to the site for installation. Accurate design and planning are essential for smooth on-site execution and improved efficiency, which requires evaluations of various design options. However, due to the design process’s complexity, such evaluations cannot be achieved without automation and optimization. Meanwhile, the recent advancement of digital design technologies (e.g., building information modelling (BIM)) has enabled flexibility in the design process. The integration of BIM with other analytical algorithms also allows optimization of designs, such as the generative design that can parametrize the design. This study proposes a generative design approach that utilizes the optimization of the drywall installation layout to improve overall project efficiency. The framework includes a decision support module that considers environmental, cost, and aesthetic aspects to identify the optimal layout. The framework’s practical applicability has been successfully demonstrated through a case study. After implementation, three “best” design alternatives were found according to the decision aspects. The design improvements achieved were 37.5%, 7%, and 54% for the environmental, cost, and aesthetic factors, respectively. Accordingly, practitioners can make better decisions on planning drywall projects. This approach has proven effective in planning drywall installation and can be applied in similar design scenarios for other prefabricated construction processes.

Off-site construction entails various advantages compared with the traditional construction method; however, the fragmentation of the prefabrication and assembly results in a complex supply chain. Both general contractors and factories often encounter production deviation, making the original component delivery plan nonoptimal. Traditionally, both parties tend to rely on internal resources or third-party resources to manage schedule changes, paying little attention to the optimisation of the component delivery process. The static compensation mechanisms reported in existing literature require factories to manage demand fluctuations but fail to encourage general contractors to control schedule deviations. Therefore, a dynamic compensation mechanism is proposed to achieve just-in-time component delivery, with which a factory shares possible changes for each component’s delivery date to its clients on an inverse Kanban system. First, unfavourable changes for the factory schedule are allocated with surcharges, and the general contractor should compensate the factory if it accepts the date changes; secondly, schedule changes that are beneficial for the factory are assigned as incentives, and the general contractor receives the factory’s incentive upon agreeing to the changes. Based on these two scenarios, genetic algorithm-based optimisation models are developed to achieve optimal delivery planning solutions. General contractors can obtain an optimal component delivery date to reduce the additional cost when they have changed the assembly schedule. General contractors can also optimise their component delivery schedule to trade their duration flexibility for incentives offered by factories. The models can help both parties to reduce component delivery waste when either side has the motivation to change the original component delivery schedules.

Avibacterium paragallinarum, the causative agent of infectious coryza, is known to release outer membrane vesicles (OMVs). In the present study, we investigated the composition, bioactivities, and functional properties of the OMVs of A. paragallinarum. Following extraction and purification, the OMVs were observed to be spherical in shape, with diameters ranging from 20 to 300 nm. The vesicles contained endotoxin as well as genomic DNA. The molecular weights of the OMV-contained protein fragments were mostly concentrated at 65 and 15 kDa. The components of the OMV proteins were mainly various functional enzymes (e.g., ATP-dependent RNA helicase), structural components (e.g., streptomycin B receptor and membrane protein), and some hypothetical proteins with unknown functions. The expression levels of inflammation-related factors, such as interleukin (IL)-2, IL-6, IL-1β, IL-10, and inducible nitric oxide synthase (iNOs), were significantly upregulated in chicken macrophage cells HD11 incubated with OMVs. Serum IgG antibodies were measured after two intramuscular injections of an OMV-based vaccine into specific pathogen-free (SPF) chickens. The vaccinated chickens were then challenged by A. paragallinarum of homologous and heterologous serovars. It was noted that the vaccinated chickens produced immunoglobulin G (IgG) antibodies against A. paragallinarum. The OMVs conferred an acceptable level of protection (70%), defined as an absence of colonization and of clinical signs, against the homologous strain (serovar A), while the cross-protection against heterologous challenge with serovars B and C was much weaker. However, the OMVS did provide significant protection against clinical signs for all three serovars. Overall, this study laid a foundation for further unraveling the functional roles of OMVs released by A. paragallinarum.

Arthritis is a leading cause of disability in the United States, with the most efficacious treatments being physical activity (PA). Arthritis patients are less likely to meet PA recommendations and the neighborhood environment may play a role. This study examines the effect of neighborhood walkability and social cohesion on PA among arthritis patients in a sample of US adults. This cross-sectional study used 2015 National Health Interview Survey data. Eligible participants were age ≥45 years, had arthritis, recent leg-joint pain and complete data. Walkability was based on 6 questions regarding amenities and destinations that promote walking. Social cohesion was based on 4 validated questions. Meeting PA was defined as 150 min/week. Chi-squared testing and logistic regression determined associations between neighborhood environment and PA, including interaction between social cohesion and walkability. The final unweighted sample included 3,826 participants with mean age 64.6 years (SE = 0.26), 61.8% female and 78.1% non-Hispanic White. In adjusted, weighted analysis, not, slightly, and moderately-walkable neighborhoods all had lower odds of meeting PA recommendations verses highly-walkable neighborhood (OR = 0.61[95% CI 0.41–0.92], OR = 0.65[95% CI 0.50–0.85], OR = 0.75[95% CI 0.59–0.97], respectively). Social cohesion was independently associated with decreased odds of meeting PA guidelines (p = 0.003). No interaction with walkability was found (p = 0.405). Less than a highly-walkable neighborhood and lower social cohesion were independently associated with decreased odds of meeting PA recommendations among adults with arthritis and recent joint pain. Since walking is one of the most effective treatments for arthritis, clinicians should be sensitive to barriers patients may perceive to walking.

Objectives: First, we test for differences in various cognitive abilities across trajectories of body mass index (BMI) over the later life course. Second, we examine whether genetic risk factors for unhealthy BMIs—assessed via polygenic risk scores (PRS)—predict cognitive abilities in late-life. Methods: The study used a longitudinal sample of Vietnam veteran males to explore the associations between BMI trajectories, measured across four time points, and later cognitive abilities. The sample of 977 individuals was drawn from the Vietnam Era Twin Study of Aging. Cognitive abilities evaluated included executive function, abstract reasoning, episodic memory, processing speed, verbal fluency, and visual spatial ability. Multilevel linear regression models were used to estimate the associations between BMI trajectories and cognitive abilities. Then, BMI PRS was added to the models to evaluate polygenic associations with cognitive abilities. Results: There were no significant differences in cognitive ability between any of the BMI trajectory groups. There was a significant inverse relationship between BMI-PRS and several cognitive ability measures. Discussion: While no associations emerged for BMI trajectories and cognitive abilities at the phenotypic levels, BMI PRS measures did correlate with key cognitive domains. Our results suggest possible polygenic linkages cutting across key components of the central and peripheral nervous system.

An enormous amount of investment has been spent towards informatization for the construction industrialization engineering, procurement, and construction (EPC) enterprises in China; however, the performance output remains uncertain. This paper aims to evaluate the informatization performance of the construction industrialization enterprises in China based on a proposed evaluation framework. The proposed framework entails a hierarchical input and output structure; the input metrics include 4 first-level and 17 second-level indicators, and the outputs include 6 first-level and 27 second-level indicators as the metrics, respectively. Survey and interview are utilized to collect data, with effective responses from thirty construction industrialization EPC enterprises. The informatization performance of these enterprises is evaluated using an improved D-FCA method, which incorporates the analytic hierarchy process (AHP), data envelopment analysis (DEA), and fuzzy comprehensive evaluation analysis (FCA). The research results indicate that all the surveyed enterprises meet the performance requirement, and 60% of the thirty enterprises show excellent performance, reaching A level, AA level, and AAA level. Furthermore, for those enterprises with DEA scores less than 1, which indicates inefficient use of the resources during the informatization process, strategies are proposed to improve the performance of these enterprises. This study contributes a comprehensive framework to evaluate the informatization performance of construction industrialization enterprises in China. The enterprises studied currently mainly come from some developed areas, and the overall situation for construction industrialization needs to be further studied in future research.

Abstract Introduction Longitudinal testing is necessary to accurately measure cognitive change. However, repeated testing is susceptible to practice effects, which may obscure true cognitive decline and delay detection of mild cognitive impairment (MCI). Methods We retested 995 late‐middle‐aged men in a ∼6‐year follow‐up of the Vietnam Era Twin Study of Aging. In addition, 170 age‐matched replacements were tested for the first time at study wave 2. Group differences were used to calculate practice effects after controlling for attrition effects. MCI diagnoses were generated from practice‐adjusted scores. Results There were significant practice effects on most cognitive domains. Conversion to MCI doubled after correcting for practice effects, from 4.5% to 9%. Importantly, practice effects were present although there were declines in uncorrected scores. Discussion Accounting for practice effects is critical to early detection of MCI. Declines, when lower than expected, can still indicate practice effects. Replacement participants are needed for accurately assessing disease progression.

Innovative mechanical services coupled with renewable energy systems are crucial for achieving a net zero energy goal for houses. Conventional systems tend to be vastly oversized because they lack the means to buffer energy flows and are based on peak loads. This paper presents an approach to achieve a net zero energy goal for houses by using a solar PV system, heat pumps, and thermal and electrical storage batteries, all off-the-shelf. Constraining one part of the system and then showing how to manage energy storage and flow is a paradigm shift in sizing. The design is for a modest-sized house built in Melbourne, Australia. The output of a solar photovoltaic array drives a small-scale heat pump to heat water, buffering its energy in a thermal battery to energise a radiant space heating system. Space cooling is provided by a separate heat pump. Through energy storage in electrical and thermal batteries, it is possible to meet the electricity, heating and cooling needs of the house for the Melbourne climate with a heat pump that draws less than 1 kW. The design methodology is detailed in an appendix and can be applied to similar projects. This paper contributes to similar work worldwide that aims to reinforce innovative renewable energy driven service design.

Geographic variation in the prevalence of chronic kidney disease and incidence of end-stage renal disease has been previously reported. However, the geographic epidemiology of rapid estimated glomerular filtration rate (eGFR) decline has not been examined. Methods: We built a longitudinal cohort of 2,107,570 US veterans to characterize the spatial epidemiology of and examine the associations between US county characteristics and rapid eGFR decline. Results: There were 169,029 (8.02%) with rapid eGFR decline (defined as eGFR slope < –5 ml/min per 1.73 m2/year). The prevalence of rapid eGFR decline adjusted for age, race, gender, diabetes, and hypertension varied by county from 4.10%–6.72% in the lowest prevalence quintile to 8.41%–22.04% in the highest prevalence quintile (P for heterogeneity < 0.001). Examination of adjusted prevalence showed substantial geographic variation in those with and without diabetes and those with and without hypertension (P for heterogeneity < 0.001). Cohort participants had higher odds of rapid eGFR decline when living in counties with unfavorable characteristics in domains including health outcomes (odds ratio [OR] = 1.15; confidence interval [CI] = 1.09–1.22), health behaviors (OR = 1.08; CI = 1.03–1.13), clinical care (OR = 1.11; CI = 1.06–1.16), socioeconomic conditions (OR = 1.15; CI = 1.09–1.22), and physical environment (OR = 1.15; CI = 1.01–1.20); living in counties with high percentage of minorities and immigrants was associated with rapid eGFR decline (OR = 1.25; CI = 1.20–1.31). Spatial analyses suggest the presence of cluster of counties with high prevalence of rapid eGFR decline. Discussion: Our findings show substantial geographic variation in rapid eGFR decline among US veterans; the variation persists in analyses stratified by diabetes and hypertension status; results show associations between US county characteristics in domains capturing health, socioeconomic, environmental, and diversity conditions, and rapid eGFR decline.

Epilepsy is the most common serious childhood neurological disorder. In the low- and middle-income countries (LMICs) of Africa, children with epilepsy suffer increased morbidity and mortality compared to their counterparts in high-income countries, and the majority do not receive treatment - the childhood epilepsy treatment gap. Reports of the childhood epilepsy treatment gap in Africa are likely underestimates; most surveys do not include several common childhood seizure types, including most types of non-convulsive epilepsy. Efforts to scale up childhood epilepsy care services in the LMICs of Africa must contend with a shortage of physicians and diagnostic technology [e.g., electroencephalograms (EEGs)]. One pragmatic solution is to integrate epilepsy care into primary care by task-shifting to community health extension workers. The aims of this project (BRIDGE) are to: 1) train, develop, and pilot task-shifted epilepsy care teams; 2) develop and pilot innovative childhood epilepsy screening and diagnostic paradigms adapted to the local Hausa language/culture in Kano, northern Nigeria; and, 3) quantify and map the childhood epilepsy treatment gap, using geographic information systems (GIS), to target limited resources to areas of greatest need. Task-shifted teams will diagnose and manage childhood epilepsy using an innovative epilepsy screening tools and diagnostic and management paradigms in environments with limited EEG access. If validated and demonstrated efficacious in clinical trials, this project can be taken to scale across broader areas of west Africa's LMICs that share language and culture. BRIDGE has the potential to enhance access to basic childhood epilepsy care and establish the foundation for childhood epilepsy clinical trials in west Africa. Keywords: Childhood epilepsy, Epilepsy treatment gap, Task shifting, Nigeria, Hausa

Prefabricated construction has been widely accepted as an alternative to conventional cast-in-situ construction, given its improved performance. Great efforts have also been made to develop prefabricated construction technologies in China. However, there is a lack of an appropriate pattern for evaluating its comprehensive economic merits, and reasonable mathematical models for providing a comparative analysis of conventional cast-in-situ and prefabricated building projects have yet to be developed. Therefore, the research in this paper aims to comprehensively evaluate the economic benefits of implementing prefabricated construction techniques in order to surpass the economic barrier and promote the development of prefabricated buildings in China. The comprehensive economic evaluation is formulated in terms of resource-use efficiencies, project progress, and incentive policies. An apartment building in Shanghai is selected as a case study. Construction progress is simulated on the BIM platform when the same case study is rationally transformed from the prefabricated to the conventional cast-in-situ construction technique. The results reveal that the comprehensive economic merit can reach ¥739.6/m2 when selecting the prefabricated construction process. The economic benefit brought by shortening the construction period can be regarded as the most significant contributor. Yet, the current incentive policies only contribute 7.1% of the comprehensive economic evaluation. Overall, this research contributes an assessment framework for decision-making in the technique management of building construction. The BIM-based simulation approach can greatly help investors to identify the relevant economic factors and adopt the latest incentive policies.

The purpose of this paper is to examine several real house cases as renewable energy resources are installed. It is an empirical study, based on first principles applied to measured data. In the first case presented, a PV solar system has been installed and a hybrid vehicle purchased. Battery storage is being considered. Smart Meter data (provided in Victoria, Australia) measures the electrical energy flowing to and from the grid in each half hour. Missing is the story about what the house is generating and what its energy requirements are through each half hour interval. We apply actual (on site) solar PV data to this study, resolving the unknown energy flows. Analysing energy flow has revealed that there are five fundamental quantities which determine performance, namely energy load, energy import, energy harvesting, energy export and energy storage. As a function of PV size these quantities depend on four parameters, easily derivable from the Smart Meter data, namely the house load, the night-time house load (no PV generation), the rating of the solar PV system and the tariffs charged. This reveals most of the information for providing advice on PV array size and whether to install a battery. An important discovery is that a battery, no matter what size, needs a PV system large enough to charge it during the winter months. The analysis is extended to two more houses located within 5 km for which detailed solar data is unavailable.

White matter disease in the brain increases with age and cardiovascular disease, emerging in midlife, and these associations may be influenced by both genetic and environmental factors. We examined the frequency, distribution, and heritability of abnormal white matter and its association with hypertension in 395 middle-aged male twins (61.9 ± 2.6 years) from the Vietnam Era Twin Study of Aging, 67% of whom were hypertensive. A multi-channel segmentation approach estimated abnormal regions within the white matter. Using multivariable regression models, we characterized the frequency distribution of abnormal white matter in midlife and investigated associations with hypertension and Apolipoprotein E-ε4 status and the impact of duration and control of hypertension. Then, using the classical twin design, we estimated abnormal white matter heritability and the extent of shared genetic overlap with blood pressure. Abnormal white matter was predominantly located in periventricular and deep parietal and frontal regions; associated with age (t = 1.9, p = 0.05) and hypertension (t = 2.9, p = 0.004), but not Apolipoprotein ε4 status; and was greater in those with uncontrolled hypertension relative to controlled (t = 3.0, p = 0.003) and normotensive (t = 4.0, p = 0.0001) groups, suggesting that abnormal white matter may reflect currently active cerebrovascular effects. Abnormal white matter was highly heritable (a2 = 0.81) and shared some genetic influences with systolic blood pressure (rA = 0.26), although there was evidence for distinct genetic contributions and unique environmental influences. Future longitudinal research will shed light on factors impacting white matter disease presentation, progression, and potential recovery.

Summary: Background: PM2·5 air pollution is associated with increased risk of diabetes; however, a knowledge gap exists to further define and quantify the burden of diabetes attributable to PM2·5 air pollution. Therefore, we aimed to define the relationship between PM2·5 and diabetes. We also aimed to characterise an integrated exposure response function and to provide a quantitative estimate of the global and national burden of diabetes attributable to PM2·5. Methods: We did a longitudinal cohort study of the association of PM2·5 with diabetes. We built a cohort of US veterans with no previous history of diabetes from various databases. Participants were followed up for a median of 8·5 years, we and used survival models to examine the association between PM2·5 and the risk of diabetes. All models were adjusted for sociodemographic and health characteristics. We tested a positive outcome control (ie, risk of all-cause mortality), negative exposure control (ie, ambient air sodium concentrations), and a negative outcome control (ie, risk of lower limb fracture). Data for the models were reported as hazard ratios (HRs) and 95% CIs. Additionally, we reviewed studies of PM2·5 and the risk of diabetes, and used the estimates to build a non-linear integrated exposure response function to characterise the relationship across all concentrations of PM2·5 exposure. We included studies into the building of the integrated exposure response function if they scored at least a four on the Newcastle-Ottawa Quality Assessment Scale and were only included if the outcome was type 2 diabetes or all types of diabetes. Finally, we used the Global Burden of Disease study data and methodologies to estimate the attributable burden of disease (ABD) and disability-adjusted life-years (DALYs) of diabetes attributable to PM2·5 air pollution globally and in 194 countries and territories. Findings: We examined the relationship of PM2·5 and the risk of incident diabetes in a longitudinal cohort of 1 729 108 participants followed up for a median of 8·5 years (IQR 8·1–8·8). In adjusted models, a 10 μg/m3 increase in PM2·5 was associated with increased risk of diabetes (HR 1·15, 95% CI 1·08–1·22). PM2·5 was associated with increased risk of death as the positive outcome control (HR 1·08, 95% CI 1·03–1·13), but not with lower limb fracture as the negative outcome control (1·00, 0·91–1·09). An IQR increase (0·045 μg/m3) in ambient air sodium concentration as the negative exposure control exhibited no significant association with the risk of diabetes (HR 1·00, 95% CI 0·99–1·00). An integrated exposure response function showed that the risk of diabetes increased substantially above 2·4 μg/m3, and then exhibited a more moderate increase at concentrations above 10 μg/m3. Globally, ambient PM2·5 contributed to about 3·2 million (95% uncertainty interval [UI] 2·2–3·8) incident cases of diabetes, about 8·2 million (95% UI 5·8–11·0) DALYs caused by diabetes, and 206 105 (95% UI 153 408–259 119) deaths from diabetes attributable to PM2·5 exposure. The burden varied substantially among geographies and was more heavily skewed towards low-income and lower-to-middle-income countries. Interpretation: The global toll of diabetes attributable to PM2·5 air pollution is significant. Reduction in exposure will yield substantial health benefits. Funding: US Department of Veterans Affairs.

Higher serum phosphorous is associated with cerebral small vessel disease, an important driver of cognitive decline and dementia. Whether serum phosphorous, a potentially modifiable parameter, associates with risk of incident dementia is not known. We aimed to examine the association between serum phosphorous and risk of incident dementia and to determine if the association is modified by age. We used the United States Department of Veterans Affairs national databases to build a longitudinal observational cohort of US veterans without prior history of dementia and with at least one outpatient serum phosphorus between October 2008 and September 2010 and followed them until September 2014. Serum phosphorus was categorized into quintiles: ≤2.9, >2.9 to ≤3.2, >3.2 to ≤3.5, >3.5 to ≤3.9, >3.9 mg/dL. There were 744,235 participants in the overall cohort. Over a median follow-up of 5.07 years (Interquartile range [IQR]: 4.28, 5.63), adjusted Cox models show that compared to quintile 2, the risk of incident dementia was increased in quintile 4 (Hazard Ratio [HR] = 1.05; CI = 1.01-1.10) and quintile 5 (HR = 1.14; CI = 1.09-1.20). In cohort participants ≤60 years old, the risk of incident dementia was increased in quintile 4 (HR = 1.29; CI = 1.12-1.49) and 5 (HR = 1.45; CI = 1.26-1.68). In participants > 60 years old, the risk was not significant in quintile 4, and was attenuated in quintile 5 (HR = 1.10; CI = 1.05-1.16). Formal interaction analyses showed that the association between phosphorous and dementia was more pronounced in those younger than 60, and attenuated in those older than 60 (P for interaction was 0.004 and

Participatory action combined interventionist research approaches can offer possibilities for community-based facilities and institutions attempting to re-engage with their communities and assert their presence. St. Cuthbert’s Church is a heritage-listed property, located on a major landholding, right in the heart of the summer tourist town of Lorne, on Melbourne’s peri-urban ‘sea change’ fringe. Its sloping hillside vantage offers spectacular views to the beach and Bass Strait, beyond. The congregation, however, is aging, while the broader community is increasingly secular. In response to these circumstances, the Church is looking to assert its relevance with the procurement of a community centre to be erected on the property. Using an interventionist research approach, with a professional facilitator in ‘participatory action design’, it was found that while both residents and visitors to Lorne were favourably disposed to the idea of a community centre, it was also clear that the locus of power that needed to realise this objective lay outside the congregation’s control. A conclusion of this research is that community-based organisations may have to pro-actively engage in professional marketing and prepare business plans, as well as engage in substantial political lobbying both within and external to the Church, if the project is to progress and succeed.