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Infants are immersed in a world of sounds from the moment their auditory system becomes functional, and experience with the auditory world shapes how their brain processes sounds in their environment. Across cultures, speech and music are two dominant auditory signals in infants' daily lives. Decades of research have repeatedly shown that both quantity and quality of speech input play critical roles in infant language development. Less is known about the music input infants receive in their environment. This study is the first to compare music input to speech input across infancy by analyzing a longitudinal dataset of daylong audio recordings collected in English-learning infants' home environments, at 6, 10, 14, 18, and 24 months of age. Using a crowdsourcing approach, 643 naïve listeners annotated 12,000 short snippets (10 s) randomly sampled from the recordings using Zooniverse, an online citizen-science platform. Results show that infants overall receive significantly more speech input than music input and the gap widens as the infants get older. At every age point, infants were exposed to more music from an electronic device than an in-person source; this pattern was reversed for speech. The percentage of input intended for infants remained the same over time for music while that percentage significantly increased for speech. We propose possible explanations for the limited music input compared to speech input observed in the present (North American) dataset and discuss future directions. We also discuss the opportunities and caveats in using a crowdsourcing approach to analyze large audio datasets. A video abstract of this article can be viewed at https://youtu.be/lFj_sEaBMN4

Sampai dengan 31 Mei 2024, terdapat 9.261 kasus DBD dengan 22 kematian. Case Fatality Rate (CFR) Mei 2024 mencapai 0,24%, walaupun masih tercapai indikator program DBD yakni CFR 1% namun tertinggi dibanding 5 tahun terakhir. Tujuan penelitan adalah menemukan permasalahan belum optimalnya kebijakan Peringatan dini DBD berbasis iklim (DBDKlim) serta menyusun usulan rekomendasi kebijakan di DKI Jakarta. Metodologi yang digunakan dalam proses policy paper ini adalah Analisa SOAR (Strenghts, Opportunity, Aspiration and Result) dan wawancara. Hasil analisis SOAR, maka strategi yang dipilih adalah: 1). Strategi SA: Menggunakan Kekuatan Menjadi Harapan (635), 2). Strategi SR: Menggunakan Kekuatan untuk Mencapai Hasil yang Terukur (565), 3). Strategi OA: Menggunakan Peluang untuk Mencapai Harapan (650), 4). Strategi OR: Menggunakan Peluang untuk Mencapai Hasil yang Terukur (560). Strategi OA merupakan strategi dengan nilai tertinggi, maka konsepsi optimalisasi peran DBDKlim adalah Peluang untuk mencapai Aspirasi/Harapan. Kesimpulan dan rekomendasi yaitu Optimalisasi kebijakan DBDKlim untuk menekan jumlah korban DBD, terutama dalam peningkatan sebaran data level kecamatan, kabupaten hingga level Nasional melalui perubahan instruksi Gubernur dan Peraturan Menteri Kesehatan.

The coronavirus disease 2019 (COVID-19) pandemic that was spread worldwide since 2019 and showed a highly contagious character affecting the lifestyle of people worldwide causing symptoms that are not limited to the respiratory system only but had multi-systemic effects that may progress to severe complications that roughly affect people's health. A newly recognized SARS-CoV-2-associated syndrome called pediatric multisystem inflammatory syndrome has been described worldwide. Initially, it was reported as hyper-inflammatory shock and “Kawasaki-like” symptoms with fever and conjunctivitis, a similar syndrome is also reported in neonates and called Multisystem Inflammatory Syndrome of neonates (MIS-N). In this paper, we presented a case of a newborn baby girl born by caesarian section affected by multisystem inflammatory syndrome of neonates presenting with respiratory distress on her third day of life, then she developed bilateral pneumothorax and pneumomediastinum respectively that required intubation, which highlights that the recognition of pneumothorax and pneumomediastinum as potential presentations of immunoglobulin G (IgG) positive MIS-N in newborns remains crucial.

Abstract Background Adequate diet and lifestyle practices are postulated to improve health and enhance wellbeing of cancer survivors. Despite the heavy cancer burden in Lebanon, little is known about the diet quality of survivors. This cross-sectional study assessed the compliance of survivors in remission with the American Cancer Society/American Institute Research Fund (ACS/AICR) diet and physical activity guidelines. Methods Cancer survivors in remission for at least 3 months and attending oncology clinics in two referral centers in Beirut, Lebanon were recruited. Adherence to the ACS/AICR was assessed by examining the compliance to guidelines promoting fruits, vegetables and whole grain and discouraging elevated alcohol, meat and energy dense foods intake. Dietary data was assessed through food frequency and lifestyle questionnaires administered face to face and through phone interviews. Anthropometrics, food security and sociodemographic data was also collected. Univariate and bivariate descriptive and logistic regressions were used to determine predictors of adherence rates to the ACS/AICR score. Results A total of 268 participants were recruited (mean age = 59 ± 23 years, 83% females, 70% breast cancer). Mean time since remission was 3.2 ± 4 years and the majority (72%) had food insecurity. Low physical activity and overweight/obesity were present in 65% and 67% of the survivors, respectively. Median adherence score with the ACS/AICR score was 9.0 out of 15. The majority of survivors had complete adherence to the moderate meat and alcohol consumption guidelines. However, 98% were noncompliant with the whole grains’ consumption guidelines. Cancer type, site of recruitment and education were the significant predictors of the ACS/AICR diet adherence score. Conclusion This study highlights the elevated rates of overweight/obesity, physical inactivity and the alarmingly low adherence with the whole grains consumption guideline among cancer survivors in remission. Policy makers ought to use study findings to redirect government subsidization and educational interventions in the country and physicians should stress the importance of adherence to a healthy diet during remission through counseling and timely referral.

Abstract Background Young adults face unique vulnerabilities during major life disruptions like the COVID-19 pandemic. The pandemic contributed to increases in mental health challenges and substance use among young adults. This study explores the experiences of young adults who increased their cannabis use during the pandemic. Methods Participants were recruited from the Nicotine Dependence in Teens (NDIT) study, and qualitative data were collected through semi-structured interviews conducted via Zoom. A total of 25 participants (ages 33–34) reporting increased cannabis use during the pandemic were included. Thematic analysis and gender-based analysis was employed to extract key themes. Results Five themes emerged: (1) No disruption in cannabis use; (2) Cannabis use to manage declines in mental health; (3) Cannabis use to break up pandemic boredom; (4) Cannabis use as an expression of freedom; (5) Cannabis use as “another way to chill out.” Conclusions This research provides valuable perspectives on how major life disruptions, like the COVID-19 pandemic, influence cannabis use among young adults. The findings offer guidance for public health initiatives and highlight avenues for further investigation.

Emergent health challenges related to work Work is not only central to population health but is also a significant driver of social inequality in health (1). In a recent Lancet series on work and health, the authors outlined six emergent challenges concerning work: the impact of technology, the intersection of work with sociodemographic health determinants, migrant work, precarious employment, long working hours, and climate change (1). The authors of the Lancet series also presented recommendations for future research, advocating for the utilization of mixed-methods, innovative analytical approaches (eg, causal modeling), realist evaluation, and interdisciplinary collaboration. Although each of these approaches are highly relevant, their integrated application was only vaguely outlined. We believe that each of these work and health challenges show features of complex adaptive systems. They are multifaceted, constantly evolving, and emerge from our complex and disordered real world, which is often characterized by interactions, non-linearity, interference, feedback loops, and adaptation. Consequently, future research on work and health may benefit from adopting a complex systems perspective to obtain a comprehensive understanding of the drivers of these challenges (2–4). We have recently developed an interdisciplinary framework for knowledge production aimed at understanding complex health issues within the domain of public health, rooted in complex systems theory (5). This framework can serve to organize our thinking, formulate research questions, and integrate methodologies related to each of these six work and health challenges. Briefly outlined, the Health Complexity framework relates to three core dimensions in which complex health issues may be conceptualized: patterns, mechanisms, and dynamics (5). Patterns: Looking for specific patterns of disease or risk factors allows us to empirically identify health issues that emerge from the mechanisms and dynamics of the underlying systems, eventually allowing us to discover vulnerable subgroups, and thereby set boundaries for targeted interventions. Mechanisms: Understanding the core mechanisms that give rise to these emergent health patterns and how they are connected across scales through interactions and interference can help us identify potential leverage points for intervention. Dynamics: Building evidence on the dynamics that make patterns and mechanisms change over time will allow us to identify vicious circles associated with particularly high morbidity. Between them, these dimensions cover seven key features of complex systems (emergence, interactions, non-linearity, interference, feedback loops, adaptation, and evolution), which we have highlighted as central to public health. The Health Complexity framework builds upon the ideas of methodological pluralism (6–8) and is intended to be an overarching framework for interdisciplinary and collaborative research on complex health issues, also in the field of work and health. As an illustration, we will outline the elements needed to examine one of these challenges – precarious employment – through a complex systems lens, particularly highlighting how this approach influences the way we phrase research questions on health problems that do justice to the complexity of the real world. Precarious employment viewed through a complex systems lens With globalization and technological advancements, there has been a shift towards a gig economy. This has led to an increase in temporary, part-time, and freelance work, which often lacks stability and benefits. Precarious employment specifically refers to such work characterized by employment insecurity, income inadequacy, and lack of rights and protection (9). The lack of stability and benefits associated with precarious employment combined with poor working conditions have been shown to have negative effects on physical and mental health (10–13). Workers may experience higher levels of stress, depression, and other health problems due to financial insecurity and lack of access to healthcare, which collectively may be an important driver of health inequality and of health decline. In a life course perspective, there may also be important feedback mechanisms exacerbating such inequality, with poor health not only being a consequence of precarious employment, but workers with poor health may be more likely to be excluded from stable work (14). Overall, the increasing prevalence of precarious employment represents a substantial challenge for public health, which can be seen as a sort of byproduct of larger societal trends. We believe that employing a complex systems lens can help us generate relevant scientific knowledge about the fundahttps://www.sjweh.fi/editoi.sjweh.fi/pics/update_u_3.gifmental drivers of this problem. This essentially entails three interlinked steps organized around the three core dimensions of the Health Complexity Framework (figure 1). Patterns: As a first step, we need to zoom out and understand the health effects associated with emergent patterns of precarious employment in their context across time and space, asking questions such as: •How does precarious employment change over time, and how does this changing pattern affect population health? •Are there certain population groups, defined, eg, by socioeconomic status, age, occupation, migrant status, or geographical regions who experience more adverse health effects by precarious employment than others? Systematically evaluating health patterns associated with precariousness can help us define boundaries for targeted prevention. Employing classical epidemiological surveillance methods alongside data science techniques for uncovering patterns within multidimensional large-scale datasets serves as key examples of such pattern identification. Mechanisms: As a second step, we need to understand what mechanisms underlying the health effects of precariousness and how elements of these mechanisms are connected across scales, from cells to society, asking questions such as: •How do mechanisms interact across biological, behavioral, social, and societal scales to create the rising public health problems associated with precarious employment? •Does precarious employment and its associated health problems cluster and spread across social networks and/or across occupational and economic sectors? Systematically evaluating the interconnectedness between mechanisms and individuals across various scales can help us identify leverage points for intervention. Whereas biomedical studies can contribute to uncovering the biological mechanisms linked to precarious employment, such as the embodiment of stress (15), the social sciences may offer profound insights into macro-scale mechanisms involving political, economic, and social structures. Dynamics: As a third step, we need to explore how the health effects of precarious employment change over time due to dynamic processes like adaptation and feedback, asking questions such as: •How do national political and social contexts adapt to historical changes in the labor market including the increase in precarious employment, and what is the impact of this adaptation when it comes to how and to what extent precarious employment can affect the health of individuals and populations? •Is there a reinforcing feedback mechanism between social disadvantage, precarious employment, and health? This mechanism could create a vicious circle—for example, social disadvantage increasing the likelihood of precarious employment, which then leads to health consequences that may further reinforce social disadvantage. Systematically assessing such dynamism can help us intervene on vicious circles that generate excessive burdens of disease in specific population groups. Systems methodology, including formal conceptual model building and computational simulations, are essential in creating such evidence. Integrating interdisciplinary knowledge across these dimensions will provide a systematic and comprehensive understanding of the patterns of precarious employment and health, the underlying connected mechanisms generating these patterns, and the dynamics that makes them change over time. Some dimensions, like the patterns of precarious employment and health, may already be well-researched, while other dimensions such as dynamics require further investigation. We argue that it is essential to systematically explore all these dimensions to comprehensively understand a complex issue. Leaving out one of these core dimensions may leave blind spots that will render our understanding of precarious employment and health incomplete and thereby impact the efficiency of future interventions. In this editorial, we have focused on how to phrase research questions when applying a complex systems lens on precarious employment and health. This clearly needs to be matched by the integration of an interdisciplinary set of methods and data. An overview of such methods and data can be found in Rod et al (5). Are we at the brink of a ‘complexity turn’ in public health? We believe that we are witnessing a shift in public health away from the traditional model of evidence, which primarily focused on empirically testing predefined hypotheses of single exposures and outcomes. Instead, there is a growing recognition of public health issues as complex, involving the complex interactions of biological, social, psychological, economic, and other processes across various levels and time scales (2–5, 16–20). These dynamics may show nonlinearity and adaptability. This paradigm shift is particularly important to our understanding of the relationship between work and health, including the emergent challenges outlined in the Lancet series, where contextual factors and interactions across micro-, meso- and macro-levels emerge as main drivers of dynamic change in employment condition. Formalizing this turn towards complexity in public health requires not only a realignment of our research questions as outlined for precarious employment above, but also necessitates the integration of traditional epidemiological methods with systems methodologies, such as computational simulation modeling (3, 18). Furthermore, it calls for sustained support for interdisciplinary collaboration and substantial investment in a diverse array of data types. These include multi-scale data, spatial data, time-series data, life-course data, network data, and multi-generational data, among others. This shift in our understanding of public health also impacts our approach to evidence synthesis. Traditionally, evidence synthesis has been relatively straightforward, typically summarized in systematic reviews or meta-analyses focusing on single isolated risk factors. However, with a complex systems perspective, we must transition towards a dynamic evidence synthesis framework. This approach involves an ongoing process of data-driven discoveries, hypothesis testing, and theory building. By adopting this dynamic approach, we can effectively synthesize evidence on complex research questions while continuously assessing which dimensions remain unresolved and understudied. These unresolved or understudied aspects should serve as guiding principles for future studies and research programs, also on work and health. Funding NHR acknowledge funding from the European Union (ERC, LAYERS, project no. 101124807). The views and opinions expressed are, however, those of the author(s) only and do not necessarily reflect those of the European Union or the European Research Council. Neither the European Union nor the granting authority can be held responsible for them. References 1. Frank J, Mustard C, Smith P, et al. Work as a social determinant of health in high-income countries: past, present, and future. The Lancet 2023; 402: 1357-67. https://doi.org/10.1016/S0140-6736(23)00871-1 2. Rutter H, Savona N, Glonti K, et al. The need for a complex systems model of evidence for public health. Lancet 2017; 390: 2602-4. https://doi.org/10.1016/S0140-6736(17)31267-9 3. Stronks K, Crielaard L, Rod NH. Systems Approaches to Health Research and Prevention. In: Ahrens W, Pigeot I, eds. Handbook of Epidemiology. New York, NY: Springer, New York, NY, 2024: 1-29. https://doi.org/10.1007/978-1-4614-6625-3_70-1 4. Roux AVD. Complex Systems Thinking and Current Impasses in Health Disparities Research. Am J Public Health 2011; 101: 1627. https://doi.org/10.2105/AJPH.2011.300149 5. Rod NH, Broadbent A, Rod MH, Russo F, Arah OA, Stronks K. Complexity in Epidemiology and Public Health. Addressing Complex Health Problems Through a Mix of Epidemiologic Methods and Data. Epidemiology 2023; 34: 505-14. https://doi.org/10.1097/EDE.0000000000001612 6. Ogilvie D, Bauman A, Foley L, Guell C, Humphreys D, Panter J. Making sense of the evidence in population health intervention research: Building a dry stone wall. BMJ Glob Health 2020; 5. https://doi.org/10.1136/bmjgh-2020-004017 7. Vandenbroucke JP, Broadbent A, Pearce N. Causality and causal inference in epidemiology: the need for a pluralistic approach. Int J Epidemiol 2016; 45: 1776-86. https://doi.org/10.1093/ije/dyv341 8. Illari PM, Russo F. Causality: philosophical theory meets scientific practice. Oxford: Oxford University Press, 2014. 9. Kreshpaj B, Orellana C, Burström B, et al. What is precarious employment? A systematic review of definitions and operationalizations from quantitative and qualitative studies. Scand J Work Environ Health 2020; 46: 235-47. https://doi.org/10.5271/sjweh.3875 10. Matilla-Santander N, Muntaner C, Kreshpaj B, et al. Trajectories of precarious employment and the risk of myocardial infarction and stroke among middle-aged workers in Sweden: A register-based cohort study. The Lancet Regional Health - Europe 2022; 15. https://doi.org/10.1016/j.lanepe.2022.100314 11. Matilla-Santander N, Matthews AA, Gunn V, et al. Causal effect of shifting from precarious to standard employment on all-cause mortality in Sweden: an emulation of a target trial. J Epidemiol Community Health 2023; 77: 736-43. https://doi.org/10.1136/jech-2023-220734 12. Jonsson J, Muntaner C, Bodin T, et al. Low-quality employment trajectories and risk of common mental disorders, substance use disorders and suicide attempt: a longitudinal study of the Swedish workforce. Scand J Work Environ Health 2021; 47: 509. https://doi.org/10.5271/sjweh.3978 13. Rönnblad T, Grönholm E, Jonsson J, et al. Precarious employment and mental health: a systematic review and meta-analysis of longitudinal studies. Scand J Work Environ Health 2019; 45: 429-43. https://doi.org/10.5271/sjweh.3797 14. Junna L, Moustgaard H, Martikainen P. Health-related selection into employment among the unemployed. BMC Public Health 2022; 22: 1-12. https://doi.org/10.1186/s12889-022-13023-0 15. McEwen BS. Neurobiological and Systemic Effects of Chronic Stress. Chronic Stress (Thousand Oaks) 2017; 1. https://doi.org/10.1177/2470547017692328 16. Page SE, Zelner J. Population Health as a Complex Adaptive System of Systems. In: Apostolopoulos Y, Lich KH, Lemke MK, eds. Complex Systems and Population Health, 1st edn. New York: Oxford University Press, 2020: 33-44. https://doi.org/10.1093/oso/9780190880743.003.0003 17. Rod MH, Rod NH, Russo F, Klinker CD, Reis R, Stronks K. Promoting the health of vulnerable populations: Three steps towards a systems-based re-orientation of public health intervention research. Health Place 2023; 80. https://doi.org/10.1016/j.healthplace.2023.102984 18. El-Sayed AM, Galea S. Systems Science and Population Health. New York: Oxford University Press, 2017. https://doi.org/10.1093/acprof:oso/9780190492397.003.0017 19. Luna Pinzon A, Stronks K, Dijkstra C, et al. The ENCOMPASS framework: a practical guide for the evaluation of public health programmes in complex adaptive systems. Int J Behav Nutr Phys Act 2022; 19. https://doi.org/10.1186/s12966-022-01267-3 20. Stronks K, Nicolaou M. Embracing complexity in social epidemiology. Lancet Public Health 2018; 3: e352-3. https://doi.org/10.1016/S2468-2667(18)30137-3

This study focuses on parental use of parentese: the acoustically exaggerated, clear, and higher-pitched speech produced by adults across cultures when they address infants. While previous research shows that parentese enhances language learning and processing, it is still unclear what drives the variability in the amount of parental parentese use. We report on the development of a survey related to parental beliefs, knowledge, and self-awareness of parentese, and the cross-validation of this survey with daylong recordings in which parental parentese was measured through observation. Forty mother-father (18 monolingual English and 22 bilingual Spanish/English) U.S. families with infants between 3 and 24 months of age participated. Scores on the parentese questionnaire showed wide variability, suggesting that many parents were unsure about the effects of parentese on infant language development, and had limited self-awareness of their own parentese use. Almost half of the parents claimed that they talked to their child 'like an adult', and a similar number disagreed with the claim that parentese can support language learning. Our observational assessment of parentese demonstrated that all mothers and all fathers used parentese when talking to their infants; mothers in an average of 81% and fathers in an average of 69% of child-directed segments. Importantly, maternal parentese knowledge/beliefs scores, as well as their self-reported parentese use, were significantly positively correlated with observed parentese use; these relations were not significant for fathers. These results demonstrate that maternal and paternal links between beliefs, self-awareness, and behavior may be distinct, emphasizing the importance of studying all caregivers and using observational methodologies. More broadly, a thorough understanding of the factors that shape infants' language environments contributes to theories of language acquisition and can aid in intervention design.

IntroductionThis study examines the relationships between toddlers' language production, parental language input, media exposure, and parental knowledge of early language development.MethodsWe used a unique collection of daylong recordings of Slovenian toddlers (age: 16–30 months, N = 40, 18 girls) to measure the language environment, toddlers' language production and media exposure. In addition, parental reports of toddlers' media exposure and language ability (using the Slovenian adaptation of the CDI) were collected.ResultsThe results indicate that toddlers' average exposure to electronic media was rather low, with exposure varying widely across the sample. Parental language input was related to various measures of toddlers' language. Parents with a greater knowledge of early language development used more parentese, while their toddlers had less exposure to electronic media. In addition, toddlers' media exposure was related to their age, with older toddlers having more exposure to electronic media, and was marginally related to the number of words spoken by adults and parents' education. No significant relationship was found between toddlers' language ability and media exposure when controlling for toddlers' age.DiscussionThe findings underline the importance of parental knowledge about language development and the characteristics of the language environment for toddlers' language ability.

Background: Acute Flaccid Paralysis (AFP) is a severe clinical symptom that could have a variety of different causes. Acute flaccid paralysis (AFP) is a clinical symptom characterized by the sudden onset of weakness or paralysis and decreased muscle tone (less periodic muscles of the respiratory tract). It occurs in 0.1–1% of infected cases and is the most frequent clinical manifestation of acute poliovirus infection[1]. Methods: A study of cross-sectional descriptive study was carried out in 18 primary healthcare centers located in 2 districts of Najaf city, using the method of simple random sampling technique. The research study includes 210 primary healthcare workers. A questionnaire was used to evaluate the acute flaccid paralysis knowledge of healthcare workers. Data collection from November 1, 2023, to the of February 31, 2024. Results: The study revealed a significant level of moderate knowledge among healthcare workers. Additionally, a statistically significant link was observed between the healthcare workers' levels of education and their knowledge (P < 0.00), Considering years of experience, the findings indicate that a greater proportion of healthcare workers (34%) with

Abstract Introduction Dermatitis herpetiformis is a chronic autoimmune blistering disease characterized by intensely pruritic, symmetrically distributed skin lesions and an association with gluten-sensitive enteropathy. Despite advances in diagnostic methods, delayed diagnosis remains a challenge due to its overlapping features with other dermatoses. Aim of Study This study aims to provide an overview of the diagnostic methods, associated conditions, and differential diagnosis of dermatitis herpetiformis, focusing on recent advancements in serological, histopathological, and immunological testing. Material and methods A comprehensive review of the literature on dermatitis herpetiformis was performed using the PubMed database. Results and Conclusions Direct immunofluorescence remains the gold standard in diagnosing dermatitis herpetiformis, revealing granular IgA deposits in the dermal papillae. Histopathological findings are supportive but nonspecific, with early lesions showing subepidermal vesicles and neutrophilic infiltrates. Serological markers, including anti-TG2 and anti-TG3 antibodies, provide valuable diagnostic support but exhibit variable sensitivity. Associated autoimmune conditions, such as autoimmune thyroid disease and type 1 diabetes, are prevalent, and dermatitis herpetiformis patients face an elevated risk of non-Hodgkin lymphoma within the first five years after diagnosis. The diagnosis of dermatitis herpetiformis relies on a combination of direct immunofluorescence, serological testing, and clinical features. Increased awareness of dermatitis herpetiformis and its associated conditions is critical for timely diagnosis and management. Advances in immunological and genetic testing may further refine diagnostic accuracy, while screening for associated autoimmune disorders and malignancies remains an integral part of patient care.

Background There is a global call for upscaling and optimising the role of community pharmacists (CPs) in the control of non-communicable diseases (NCDs). In the United Arab Emirates (UAE), where NCDs are classified as a public health pandemic, upscaling CPs contributions has become more critical. Several contextual, professional, and educational challenges constrain the role of CPs.Objective To synthesise the perspectives of key stakeholders in the UAE healthcare system and propose a roadmap for advancing the role of CP s in controlling NCDs in the UAE.Methods This research followed a qualitative design using the International Pharmaceutical Federation (FIP) framework for quality assurance of pharmacy profession development. Data were collected using semi-structured interviews with 28 experts and senior leaders, then analysed using the thematic analysis technique with the assistance of NVivo software.Results The analysis yielded three main themes that outlined the prospective roadmap: education, work environment, and policy. Some of the generated subthemes were establishing accredited NCD-specialised programmes, building a national framework for interprofessional education and collaboration, and upscaling the engagement of CPs in public health platforms and initiatives.Conclusion Improving the role of CPs in controlling the NCD pandemic in the UAE requires coherent and well-structured multidisciplinary endeavours from health policymakers, educational institutions, and all groups of healthcare professionals, including the CPs themselves.

Metformin has become the frontline treatment in addressing the significant global health challenge of type 2 diabetes due to its proven effectiveness in lowering blood glucose levels. However, the reality is that many patients struggle to achieve their glycemic targets with the medication and the cause behind this variability has not been investigated thoroughly. While genetic factors account for only about a third of this response variability, the potential influence of metabolomics and the gut microbiome on drug efficacy opens new avenues for investigation. This review explores the different molecular signatures to uncover how the complex interplay between genetics, metabolic profiles, and gut microbiota can shape individual responses to metformin. By highlighting the insights from recent studies and identifying knowledge gaps regarding metformin-microbiota interplay, we aim to highlight the path toward more personalized and effective diabetes management strategies and moving beyond the one-size-fits-all approach.

IntroductionAging is a complex process marked by a gradual decline in physiological function and increased susceptibility to diseases. Telomere length is frequently regarded as one of the primary biomarkers of aging. Metabolic profiles are key features in longevity and have been associated with both age and age-related diseases. We previously reported an increase in the telomere length in healthy female subjects when Ramadan fasting was combined with physical training. This study aims to characterize the metabolic signature differentiating the combined effects of exercise and fasting from exercise alone and explore the correlations with the previously reported telomere length changes.MethodsTwenty-nine young, non-obese, and healthy female subjects were previously randomized into two groups: one group followed a 4-week exercise program, while the other group followed the same 4-week exercise program but also fasted during Ramadan. Metabolic profiles were assessed pre- and post-intervention using untargeted metabolomics.Results and DiscussionOur results showed a significant decrease in many lipid metabolites in the exercise-while-fasting group, particularly ceramides. Our study sheds light on the dynamic changes in lipid metabolism and its potential role in inflammation and age-related diseases, and contributes to the broader understanding of how lifestyle factors can influence cellular aging and metabolic health.

As manifested in Jean Baudrillard’s notoriously provoking claim that “the Gulf War did not take place,” mediatization of war has long been associated with illusion. Today, war images that circulate online are increasingly judged by their proximity to ‘truth,’ eliciting a skepticism towards their ‘evidentiary’ value. By juxtaposing Baudrillard’s reading of the mediatization of the Gulf War with the contemporary image theories of e.g. Cecilia Sjöholm and Matthew Fuller and Eyal Weizman, the article explores how this skepticism is expressed in a contemporary context. Through visual analysis of a YouTube video of a press conference held at the bombed Al-Ahli Baptist Hospital in Gaza, it examines the relationship between the f orm through which the war is perceived (the images) and their cont ent (the ‘realities’ of war). Through a lens oered by Georges Didi-Huberman, the article concludes by suggesting that by expanding what I term the snapshot logic of war images to embrace a scenography of war, the press conference video gives form to the condition of desperation and suering in Gaza.

This paper addresses how strategic spatial planning is considering urban tourism, a phenomenon that has an increasing impact on the development of cities. A research approach interlinking urban tourism and spatial planning is conceptualised based on responsiveness theory and applied to a case study of ten medium-sized Central European cities. Descriptive statistical analysis of the presence of tourism in cities and policy analysis of strategic spatial planning documents enable a comparison analysis of the level of consideration of tourism alongside screening of proposed tourism-related measures. The paper reveals that strategic spatial planning documents are not responsive enough to tourism growth, and there is a lack of strategic measures steering towards sustainable tourism development in cities.

Abstract Methane emission in South Asia is poorly understood due to a lack of observations, despite being a major contributor to methane emissions globally. We present the first results of atmospheric CH4 inversions using air samples collected weekly at Nainital, India (NTL), and Comilla, Bangladesh (CLA), in addition to surface background flask measurements by NOAA, CSIRO and AGAGE using the MIROC4-ACTM. Our simulations span from 2000 to 2020 (considering the fixed “edge” effect), but the main analysis period is 2013–2020, when both the NTL and CLA datasets are available. An additional flux uncertainty reduction of up to 40% was obtained (mainly in the northern part of the Indian subcontinent), which enhanced our confidence in flux estimation and reaffirmed the significance of observations at the NTL and CLA sites. Our estimated regional flux was 64.0 ± 4.7 Tg-CH4 yr−1 in South Asia for the period 2013–2020. We considered two combinations of a priori fluxes that represented different approaches for CH4 emission from rice fields and wetlands. By the inversion, the difference in emissions between these combinations was notably reduced due to the adjustment of the CH4 emission from the agriculture, oil and gas, and waste sectors. At the same time, the discrepancy in wetland emissions, approximately 8 Tg-CH4 yr−1, remained unchanged. In addition to adjusting the annual totals, the inclusion of NTL/CLA observations in the inversion analysis modified the seasonal cycle of total fluxes, possibly due to the agricultural sector. While the a priori fluxes consisted of a single peak in August, the a posteriori values indicated double peaks in May and September. These peaks are highly likely associated with field preparation for summer crops and emissions from rice fields during the heading stage (panicle formation). The newly incorporated sites primarily exhibit sensitivity to the Indo-Gangetic Plain subregion, while coverage in southern India remains limited. Expanding the observation network is necessary, with careful analysis of potential locations using back-trajectory methods for footprint evaluation.

Devising effective national-level climate action plans requires a more detailed understanding of the regional distribution of sources and sinks of greenhouse gases. Due to insufficient observations and modelling capabilities, India's current carbon source–sink estimates are uncertain. This study uses a high-resolution Lagrangian transport model to examine the potential of available CO2 observations over India for inverse estimation of regional carbon fluxes. We use four different sites in India that vary in the measurement technique, frequency and spatial representation. These observations exhibit substantial seasonal (7.5 to 9.2 ppm) and intra-seasonal (2 to 12 ppm) variability. Our modelling framework, a high-resolution Weather Research and Forecasting Model combined with the Stochastic Time-Inverted Lagrangian Transport model (WRF–STILT), performs better in simulating seasonal (R2=0.50 to 0.96) and diurnal (R2=0.96) variability (for the Mohali station) of observed CO2 than the current-generation global models (CarboScope, CarbonTracker and ECMWF EGG4). The seasonal CO2 concentration variability in Mohali, associated with crop residue burning, is largely underestimated by the models. WRF–STILT captures the seasonal biospheric variability over Nainital better than the global models but underestimates the strength of the CO2 uptake by crops. The choice of emission inventory in the modelling framework alone leads to significant biases in simulations (5 to 10 ppm), endorsing the need for accounting for emission fluxes, especially for non-background sites. Our study highlights the possibility of using the CO2 observations from these Indian stations for deducing carbon flux information at regional (Nainital) and suburban to urban (Mohali, Shadnagar and Nagpur) scales with the help of a high-resolution model. On accounting for observed variability in CO2, the global carbon data assimilation system can benefit from the measurements from the Indian subcontinent.

BackgroundMultisystem inflammatory syndrome in children (MIS-C), a hyperinflammatory condition associated with SARS-CoV-2 infection, has emerged as a serious illness in children worldwide. Immunoglobulin or glucocorticoids, or both, are currently recommended treatments.MethodsThe Best Available Treatment Study evaluated immunomodulatory treatments for MIS-C in an international observational cohort. Analysis of the first 614 patients was previously reported. In this propensity-weighted cohort study, clinical and outcome data from children with suspected or proven MIS-C were collected onto a web-based Research Electronic Data Capture database. After excluding neonates and incomplete or duplicate records, inverse probability weighting was used to compare primary treatments with intravenous immunoglobulin, intravenous immunoglobulin plus glucocorticoids, or glucocorticoids alone, using intravenous immunoglobulin as the reference treatment. Primary outcomes were a composite of inotropic or ventilator support from the second day after treatment initiation, or death, and time to improvement on an ordinal clinical severity scale. Secondary outcomes included treatment escalation, clinical deterioration, fever, and coronary artery aneurysm occurrence and resolution. This study is registered with the ISRCTN registry, ISRCTN69546370.FindingsWe enrolled 2101 children (aged 0 months to 19 years) with clinically diagnosed MIS-C from 39 countries between June 14, 2020, and April 25, 2022, and, following exclusions, 2009 patients were included for analysis (median age 8·0 years [IQR 4·2-11·4], 1191 [59·3%] male and 818 [40·7%] female, and 825 [41·1%] White). 680 (33·8%) patients received primary treatment with intravenous immunoglobulin, 698 (34·7%) with intravenous immunoglobulin plus glucocorticoids, 487 (24·2%) with glucocorticoids alone; 59 (2·9%) patients received other combinations, including biologicals, and 85 (4·2%) patients received no immunomodulators. There were no significant differences between treatments for primary outcomes for the 1586 patients with complete baseline and outcome data that were considered for primary analysis. Adjusted odds ratios for ventilation, inotropic support, or death were 1·09 (95% CI 0·75-1·58; corrected p value=1·00) for intravenous immunoglobulin plus glucocorticoids and 0·93 (0·58-1·47; corrected p value=1·00) for glucocorticoids alone, versus intravenous immunoglobulin alone. Adjusted average hazard ratios for time to improvement were 1·04 (95% CI 0·91-1·20; corrected p value=1·00) for intravenous immunoglobulin plus glucocorticoids, and 0·84 (0·70-1·00; corrected p value=0·22) for glucocorticoids alone, versus intravenous immunoglobulin alone. Treatment escalation was less frequent for intravenous immunoglobulin plus glucocorticoids (OR 0·15 [95% CI 0·11-0·20]; p