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Background Neonatal sepsis (NS) is a global health issue, particularly in Sub-Saharan Africa, where it accounts for a substantial portion of neonatal morbimortality. This multicountry survey aimed to elucidate current practices, challenges and case definitions in managing NS among clinicians in Sub-Saharan Africa.Methods The survey targeted physicians and medical practitioners working in neonatal care who participated in a Self-Administered Web Questionnaire. The main objective was to understand NS and infection case definitions and management from the clinician’s point of view and to identify challenges and opportunities in sepsis management. Participants were queried on demographics, definitions and diagnostic criteria, treatment approaches, and infection prevention and control (IPC) measures. A total of 136 participants from 86 healthcare structures responded, providing valuable insights into NS management practices.Results From May to July 2022 across 25 Sub-Saharan African countries, 136 neonatal clinicians with an average from 86 structures with on average 10-year experience took the survey. NS ranked highest among prevalent neonatal conditions. Diagnostic case definitions between sepsis and infection were attributed to clinical signs, anamnesis, C reactive protein, white blood cll count and blood cultures with no statistically significant differences. Early-onset sepsis was defined within 72 hours by 48%, while late-onset varied. Antibiotics were likely on admission (86.4%) and during the stay (82.2%). Treatment abandonment was reported unlikely. The preferred antibiotic regimen for early-onset sepsis was intravenous amoxicillin (or ampicillin), gentamycin and cefotaxime. Blood culture availability and IPC protocols were reported as limited, particularly concerning patient environment, pharmacy protocols and clean–dirty circuits.Conclusions This NS survey emphasises clinicians’ challenges due to limited access to diagnostic tools and raises concerns about antimicrobial overexposure. IPC also seem limited, according to participants. Addressing these challenges can enhance diagnostic practices, antibiotic stewardship and infection control in the region.

In late 2020, a private volunteer group operating through a Facebook group approached Toronto and Region Conservation Authority (TRCA) with an interest in participating in the Citizen Science Nest Protection and Monitoring Volunteer Program. During the 2021 season, TRCA staff virtually trained volunteers in turtle nest detection, protection, and monitoring due to COVID-19 social constraints, and provided necessary supplies and equipment. In 2021 volunteers and staff detected 181 turtle nests and were able to protect 75 nests with simple predator-exclusion devices, while in 2022, 165 nests were detected, and 155 were protected. The volunteers also collected data, including nesting location, date, and species in addition to the number of successful hatchlings (2021 only). In 2021, the 75 protected nests yielded 81 Midland Painted Turtle and 665 Snapping Turtle hatchlings. Five Midland Painted Turtle’s eggs were also recovered from an injured turtle, and 44 Snapping Turtle eggs were recovered from a partially predated nest, transported to the Ontario Turtle Conservation Centre, incubated, hatched, and overwintered, and then released back into the local wetlands. The partnership with a local community group proved effective, and we would recommend this practice to other conservation organizations interested in turtle nest protection.

Introduction Approximately 4%–5% of mothers develop childbirth-related post-traumatic stress disorder (CB-PTSD) and approximately 12.3% of mothers develop some CB-PTSD symptoms (CB-PTSS). To date, there is a dearth of studies on fathers and other coparents. Parental CB-PTSD and CB-PTSS may have a negative impact not only on the parents but also on the infant. Understanding risk and protective factors of CB-PTSD for both parents and its consequences on the family is key to detecting or anticipating it, to developing interventions aimed at reducing its detrimental effects and to supporting parents.Methods and analysis This study protocol describes an observational, population-based study, consisting of a longitudinal prospective cohort with online surveys at four time points. The population of interest consist of women, in the third trimester of pregnancy or at 6–12 weeks postpartum, and their partner/coparent, who will give birth or gave birth in the French-speaking part of Switzerland. The target sample size is 300–500 women and a proportional number of partners. The primary outcome of this study is the prevalence of CB-PTSD and CB-PTSS. The secondary outcomes focus on: (1) the impact of CB-PTSD and CB-PTSS on the marital and coparental relationships, the bonding with the infant, parental burnout and healthcare seeking behaviours, (2) the role of the childbirth experience in the development of CB-PTSD and CB-PTSS and (3) the social and economic determinants of CB-PTSD and CB-PTSS.Ethics and dissemination Ethical approval was granted by the human research ethics committee of the Canton de Vaud (study number 2022-00284). All study participants signed an informed consent form. Dissemination of results will occur via national and international conferences, in peer-reviewed journals, public conferences and social media.Trial registration number NCT05865704.

Abstract Exotic species are often vilified as “bad” without consideration of the potential they have for contributing to ecological functions in degraded ecosystems. The red-eared slider turtle (RES) has been disparaged as one of the worst invasive species. Based on this review, we suggest that RES contribute some ecosystem functions in urban wetlands comparable to those provided by the native turtles they sometimes dominate or replace. While we do not advocate for releases outside their native range, or into natural environments, in this review, we examine the case for the RES to be considered potentially beneficial in heavily human-altered and degraded ecosystems where native turtles struggle or fail to persist. After reviewing the ecosystem functions RESs are known to provide, we conclude that in many modified environments the RES is a partial ecological analog to native turtles and removing them may obviate the ecological benefits they provide. We also suggest research avenues to better understand the role of RESs in heavily modified wetlands.

Single-measurement-point data collection to assess change has increased with studies assessing the impact of the Covid-19 pandemic and of its containment, despite evidence of its lack of validity. Retrospective change is not equivalent to change in repeated self-reported measures giving raise to questions about the validity of the former. This paper purports to investigate inconsistencies between change measures by confronting retrospective change to information from longitudinally self-reported measures from the C-SURF cohort study. The study sample consists of 2,279 young men who participated in C-SURF between 2020 and 2021, and completed between May and June 2021 a survey covering change in alcohol, cigarette, cannabis and other addictive behaviors related to the pandemic. The aforementioned behaviors were assessed longitudinally at two time points using self-reports, and retrospective change since the onset of the Covid-19 crisis was also assessed at the second measurement time. Information from both prospective and retrospective change measures were confronted to identify inconsistent information for each behavior. Additionally, multiple logistic regressions were performed to assess associations between socioeconomic status, impulsivity, depression, and different indicators of motivation to complete the study and inconsistency between both measures for each behavior of interest. Importantly, inconsistent information in at least one of the investigated behaviors was found in about 90% of the participants. Small associations were found between inconsistency and different factors with a consistent effect of impulsivity. In the absence of evidence of the validity of retrospective change measures, studies relying on retrospective change should be interpreted with caution.

Abstract Background The Older people Quality of Life-7 domains (OQoL-7) is a 28-item multidimensional questionnaire developed to measure community-dwelling older people’s QoL. The OQoL-7 assesses both importance of and satisfaction in seven QoL domains (Material resources; Close entourage; Social and cultural life; Esteem and recognition; Health and mobility; Feeling of safety; and Autonomy). This study aimed to investigate concurrent and construct validity of the OQoL-7. A secondary aim was to compare different methods of weighting participants’ ratings of satisfaction according to their individual ratings of importance, as compared to the OQoL-7 total score (unweighted). Methods Data came from the first and second samples of the Lausanne cohort 65+ study, assessed at the same age of 72–77 years in 2011 (N = 1117) and 2016 (N = 1091), respectively. To assess concurrent validity, the OQoL-7 was compared to other measures of the same concept (single QoL item) or related concepts (self-rated health, SF-12). Construct validity was tested by comparing subscores in the seven QoL domains in the presence and absence of two stressful events during the preceding year (financial difficulties and relationship difficulties). The effect of importance weighting was assessed using moderated regression analysis. Results The OQoL-7 total score was significantly associated with the single QoL item (Spearman’s rho 0.46), self-rated health (Spearman’s rho 0.34), SF-12 physical (Spearman’s rho 0.22) and mental (Spearman’s rho 0.28) component scores. Large differences (Cohen’s d > 0.8) were observed in the presence or absence of stressful events in the expected QoL domains: “Material resources” in the presence or absence of “Financial difficulties” (Cohen’s d 1.34), and “Close entourage” in the presence or absence of “Relationship difficulties” (Cohen’s d 0.84). Importance weighting resulted in a very small improvement in the prediction of the single QoL item (ΔR2 0.018). All results were highly consistent across 2011 and 2016 samples. Conclusions The OQoL-7 showed adequate concurrent and construct validity in two samples of older people. In future studies, the decision to use weighted or unweighted scores will depend on the priority given to either optimizing the prediction of QoL or limiting the burden on respondents and the amount of missing data.

Social media has become a potent vector for the spread of disinformation. Content initially posted by bots, trolls, or malicious actors is often picked up and magnified by ordinary users, greatly extending its influence and reach. In order to combat disinformation online, it is important to understand how users interact with and spread this type of content, unwittingly or not. We studied patterns in the sharing of propaganda and disinformation on social media through political image-based memes. Initially, we began with a selection of 12 memes. In our first survey, we narrowed this down from 12 memes to six based on the responses received with respect to the message it was trying to convey and representation of varying viewpoints along the ideological spectrum. Ultimately, we chose a selection of six memes. Four of them involved climate-change with two considered left-leaning and the other two right-leaning, and the remaining two were focused on particular politicians and also split along ideological lines. Next, we conducted a second survey in order to better understand the behavior of ordinary users as they interact with propaganda and disinformation on social media. Particular attention was paid to differences based on political affiliation and psychological factors, including personality and trait affect. Negative types of affect appear to dominate the level of engagement Republicans and Independents have with memes, while positive types of affect and extraversion do the same for Democrats.

We report on the results of the first mark–recapture survey of freshwater turtles in an isolated urban wetland complex in one of Canada’s fastest growing municipalities. Although we found turtles in every surveyed wetland, the density and assemblage of turtles in smaller wetlands were significantly different than in larger wetland bodies. We also documented two species of turtles that were thought to be absent from this wetland complex, the Northern Map turtle and Eastern Musk turtle. We noted that a wetland that was bisected by a high-traffic road showed a male-skewed sex ratio in the population of Midland Painted turtles but not in the population of Eastern Snapping turtles. As a whole, the sex ratios inside the wetland complex were not skewed. These results reinforce the conclusions of a previous study of a single wetland within this same complex that had found a correlation between road mortality and a male-skewed sex ratio in Midland painted turtles. We discuss population sources and sinks within the complex and the importance of protecting the overland corridors that support the safe turtle movements within this provincially significant wetland complex.

The scientific literature on noma (Cancrum Oris) has clearly increased in recent decades, but there seems to have been limited analysis of issues around the psycho-social impacts of this disease. Even when these issues have been addressed, the focus has tended to be on patient experiences, whereas the community dimension of the disease and the role of healthcare professionals and community leaders in mitigating these impacts remain largely unexplored. A study in the form of semi-directed interviews with 20 noma survivors and 10 healthcare professionals and community leaders was conducted between January and March 2021 in Burkina Faso with the aim of describing the experiences of noma survivors, generating knowledge about living with the burden of the disease and understanding the attitudes of community leaders towards the disease. The results reveal that noma is a disease that affects economically vulnerable populations and leads to extreme household poverty. As far as treatment is concerned, patients tend to turn to practitioners of both traditional and modern medicine. Within communities, noma survivors face discrimination and stigma. The study highlighted a lack of information and knowledge about noma. However, surgical operations lead to patient satisfaction and these remain one of the coping strategies used to tackle the stigma and discrimination. The recommendations set out in this article are aimed firstly at stepping up research into the psycho-social impacts of noma, and secondly at considering these impacts in regional programmes and national plans to combat the disease.

Background: While noma affects hundreds of thousands of children every year, taking their lives, disfiguring them and leaving them permanently disabled, the economic and social costs of the disease have not been previously estimated. An understanding of the nature and levels of these costs is much needed to formulate and implement strategies for the prevention and control of this disease, or to mitigate its burden. The objectives of our study were to develop a model for estimating the economic and social costs of noma and to provide estimates by applying this model to the specific contexts of two countries in the “noma belt”, namely Burkina Faso and Niger. Methods: Three main approaches were used. The estimation of prevalence levels of potential noma cases and of cases that should receive and actually do receive medical care was carried out using a literature review. The documentary approach made it possible to estimate the direct costs of noma by analyzing the database of a non-governmental organization operating in this field and present in both countries. Indirect costs were estimated using the human capital method and the cost component analysis technique. Results: The direct costs of care and management of noma survivors amount to approximately USD 30 million per year in Burkina Faso, compared to approximately USD 31 million in Niger. They mainly include costs for medical treatment, surgery, hospital stays, physiological care, psychological care, social assistance, schooling, vocational training and care abroad. Indirect costs are estimated at around 20 million in lost production costs in Burkina and around 16 million in Niger. Costs related to premature deaths are estimated at more than USD 3.5 billion in Burkina Faso and USD 3 billion in Niger. Finally, the costs to survivors who are unable to marry are around USD 13.4 million in Burkina and around USD 15 million in Niger. Intangible costs were not calculated. Conclusions: The neglect of noma and inaction in terms of prevention and control of the disease have enormous economic and social costs for households, communities and states. Future studies of this kind are necessary and useful to raise awareness and eradicate this disease, which impacts the health and well-being of children and results in lifelong suffering and severe economic and social costs to survivors and their families.

Conservation policy and practice can sometimes run counter to their mutual aims of ensuring species survival. In Kenya, where threatened predators such as lion deplete endangered prey such as Grevy’s zebra, conservation practitioners seek to ensure species success through exclusive strategies of protection, population increase and preservation. We found strong selection for the endangered Grevy’s zebra by both lion and hyena on two small fenced conservancies in Kenya. Despite abundant diversity of available prey, Grevy’s zebra were selected disproportionately more than their availability, while other highly available species such as buffalo were avoided. Lions were therefore not alone in presenting a credible threat to Grevy’s zebra survival. Conservation practitioners must consider interlinked characteristics of prey selection, resource availability and quality, the interplay between carnivore guild members and landscape scale population trends performance in wildlife management decisions.

Wildlife fencing has become more prevalent throughout Africa, although it has come with a price of increased habitat fragmentation and loss of habitat connectivity. In an effort to increase connectivity, managers of fenced conservancies can place strategic gaps along the fences to allow wildlife access to outside habitat, permitting exploration, dispersal and seasonal migration. Wildlife can become accustomed to certain movement pathways and can show fidelity to these routes over many years, even at the path level. Our study site has three dedicated wildlife crossings (fence-gaps) in its 142 km perimeter fence, and we continuously monitor these fence-gaps with camera-traps. We monitored one fence-gap before and after a 1.49 km fence section was completely removed and 6.8 km was reconfigured to leave only a two-strand electric fence meant to exclude elephant and giraffe, all other species being able to cross under the exclusionary fence. The removal and reconfiguration of the fence effectively rendered this fence-gap (which was left in place structurally) as a “ghost” fence-gap, as wildlife now had many options along the 8.29 km shared border to cross into the neighboring habitat. Although we documented some decline in the number of crossing events at the ghost-gap, surprisingly, 19 months after the total removal of the fence, we continued to document the usage of this crossing location by wildlife including by species that had not been previously detected at this location. We discuss potential drivers of this persistent and counterintuitive behavior as well as management implications.

Conservation authorities invest heavily in the restoration and/or creation of wetlands to counteract the destruction of habitat caused by urbanization. Monitoring the colonization of these new wetlands is critical to an adaptive management process. We conducted a turtle mark-recapture survey in a 250 ha artificially created wetland complex in a large North American city (Toronto, Ontario). We found that two of Ontario’s eight native turtle species (Snapping turtle (SN), Chelydra serpentina, and Midland Painted (MP) turtle, Chrysemys picta marginata) were abundant and both were confirmed nesting. The Blanding’s turtle (Emydoidea blandingii) was present but not well established. Species richness and turtle density were not equally distributed throughout the wetland complex. We noted SN almost exclusively populated one water body, while other areas of the wetland had a varying representation of both species. The sex ratios of both SN and MP turtles were 1:1. We tracked the movement of Snapping and Blanding’s turtles and found that most turtles explored at least two water bodies in the park, that females explored more water bodies than males, and that 95% of turtles showed fidelity to individual overwintering wetlands. We performed DNA analysis of two Blanding’s turtles found in the created wetlands and could not assign these turtles to any known profiled populations. The genetic data suggest that the turtles probably belong to a remnant local population. We discuss the implications of our results for connectivity of artificial wetlands and the importance of the whole wetland complex to this turtle assemblage.

OBJECTIVES:In countries with universal health coverage (UHC), national public health insurances cover 70% of health expenditures on average, but health care user fees and out-of-pocket expenditures have been neglected in empirical patient-centered health inequality research. This study is the first to investigate how health care-related factors are associated with health status among middle-aged and elderly people-vulnerable groups for the burden of illness-in countries with UHC. DESIGN:Longitudinal observational cohort study. SETTING:Population-based cohort Survey of Health, Ageing and Retirement in Europe (SHARE) in twelve countries with UHC. PARTICIPANTS:Non-institutionalized people aged 50 and older (n = 29,260). Two subsamples were also used: participants without global activity limitation at baseline (n = 16,879) and participants without depression at baseline (n = 21,178). MAIN OUTCOME MEASURES:Risk of death, risk of global activity limitations, and risk of depression. We used mixed-effects Cox proportional hazards regressions to estimate hazard ratios (HR) for all-cause mortality, physical limitations, and depression. RESULTS:Having a voluntary private insurance to cover health expenses not included in the public health care system (44.1% of the total sample) was a protective factor for all outcomes (HR≤0.91), controlling for a large range of socio-economic variables. On the contrary, having out-of-pocket expenditures (62.4%) was a risk factor (HR≥1.12). CONCLUSIONS:UHC systems are not free from health inequalities: there is a potential effect of lack of voluntary private insurance and out-of-pocket expenditures on mortality and health. Health care-related factors should be at focus in future researches designed to understand and address health inequalities. Reducing out-of-pocket expenditures and developing voluntary private insurance may protect against premature illness and death.

The use of fences to segregate wildlife can change predator and prey behaviour. Predators can learn to incorporate fencing into their hunting strategies and prey can learn to avoid foraging near fences. A twelve-strand electric predator-proof fence surrounds our study site. There are also porous one-strand electric fences used to create exclosures where elephant (and giraffe) cannot enter in order to protect blocs of browse vegetation for two critically endangered species, the black rhinoceros (Diceros bicornis) and the Grevy’s zebra (Equus grevyi). The denser vegetation in these exclosures attracts both browsing prey and ambush predators. In this study we examined if lion predation patterns differed near the perimeter fencing and inside the elephant exclosures by mapping the location of kills. We used a spatial analysis to compare the predation patterns near the perimeter fencing and inside the exclosures to predation in the rest of the conservancy. Predation was not over-represented near the perimeter fence but the pattern of predation near the fence suggests that fences may be a contributing factor to predation success. Overall, we found that predation was over-represented inside and within 50 m of the exclosures. However, by examining individual exclosures in greater detail using a hot spot analysis, we found that only a few exclosures contained lion predation hot spots. Although some exclosures provide good hunting grounds for lions, we concluded that exclosures did not necessarily create prey-traps per se and that managers could continue to use this type of exclusionary fencing to protect stands of dense vegetation.

Protecting an endangered and highly poached species can conflict with providing an open and ecologically connected landscape for coexisting species. In Kenya, about half of the black rhino (Diceros bicornis) live in electrically fenced private conservancies. Purpose-built fence-gaps permit some landscape connectivity for elephant while restricting rhino from escaping. We monitored the usage patterns at these gaps by motion-triggered cameras and found high traffic volumes and predictable patterns of prey movement. The prey-trap hypothesis (PTH) proposes that predators exploit this predictable prey movement. We tested the PTH at two semi-porous reserves using two different methods: a spatial analysis and a temporal analysis. Using spatial analysis, we mapped the location of predation events with GPS and looked for concentration of kill sites near the gaps as well as conducting clustering and hot spot analysis to determine areas of statistically significant predation clustering. Using temporal analysis, we examined the time lapse between the passage of prey and predator and searched for evidence of active prey seeking and/or predator avoidance. We found no support for the PTH and conclude that the design of the fence-gaps is well suited to promoting connectivity in these types of conservancies.

QUESTIONS UNDER STUDY: the main purpose of this longitudinal study was to determine the impact of risky single occasion drinking (RSOD) frequency on alcohol dependence and drinking consequences reported 15 months later. METHODS: As a baseline sample, 5,990 young men were assessed on their drinking habits including the frequency of RSOD. Of them, 5,196 were reassessed at follow-up 15 months later on RSOD frequency, alcohol dependence and alcohol related consequences in thze interceding year. Drop out biases were investigated. RESULTS: Around 45% of the baseline participants reported regular RSOD (every month or more frequently). Despite the fact that RSOD distribution was generally stable during the initial sample, 47.4% reported a variation of their RSOD frequency 15 months later. Around 25% of the sample reported reduced RSOD frequency. Nonetheless, occasional RS drinkers were more likely to become regular (monthly) RSO drinkers at follow up. Daily and weekly RSOD were associated with high proportions of alcohol dependence and detrimental consequences of drinking. Surprisingly, abstainers at baseline were more likely to be at risk of alcohol dependence and consequences at follow up than non-RSO drinkers. CONCLUSIONS: Despite the fact that alcohol abstinence is logically the best way to avoid the detrimental consequences of alcohol drinking, abstainers at baseline reported as many problems due to alcohol use at follow up as occasional or monthly RSO drinkers. The few participants who had become RSO drinkers during the follow up period were indeed likely to engage in detrimental behaviour. Non-RSO drinkers had the fewest problems due to alcohol use. This substantiates the early occurrence of drinking consequences among inexperienced RSO drinkers.

Dendritic ceils (DC) are potent antigen-presenting cells (APC) capable of inducing strong T-cell–mediated immunity. Infusion of lymphoma-specific antigen-loaded autologous DC has been demonstrated to result in the generation of antigen-specific immunity and reduction in tumor burden in B-cell lymphoma patients. Cellular immunotherapy employing antigen-loaded DC could have a potential therapeutic impact in tumors and viral infections, including HIV infection. However, DC in HIV-infected individuals and breast cancer patients are believed to be functionally defective. Therefore, the potential of using allogeneic DC offers significant implications for DC immunotherapy in AIDS and immunocompromised cancer patients. To explore the potential of allogeneic DC therapy in vivo, we tested the ability of allogeneic DC to generate primary peptide-specific CD8 + cytotoxic T-lymphocyte (CTL) responses in vitro. Our results indicate that DC from HLA class I-matched individuals elicit primary immune responses in vitro using viral peptides as naive antigens. A primary peptide-specific immune response could also be detected even when only one HLA allele (HLA-A*0201) was matched between the allogeneic DC and T-lymphocytes. The ability to generate primary peptide-specific responses in vitro is strongly indicative of the in vivo therapeutic potential of allogeneic DC.