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The WHO research agenda for antimicrobial resistance (AMR) in human health has identified 40 research priorities to be addressed by the year 2030. These priorities focus on bacterial and fungal pathogens of crucial importance in addressing AMR, including drug-resistant pathogens causing tuberculosis. These research priorities encompass the entire people-centred journey, covering prevention, diagnosis, and treatment of antimicrobial-resistant infections, in addition to addressing the overarching knowledge gaps in AMR epidemiology, burden and drivers, policies and regulations, and awareness and education. The research priorities were identified through a multistage process, starting with a comprehensive scoping review of knowledge gaps, with expert inputs gathered through a survey and open call. The priority setting involved a rigorous modified Child Health and Nutrition Research Initiative approach, ensuring global representation and applicability of the findings. The ultimate goal of this research agenda is to encourage research and investment in the generation of evidence to better understand AMR dynamics and facilitate policy translation for reducing the burden and consequences of AMR.

Increased intracranial pressure (ICP) is encountered in numerous traumatic and non-traumatic medical situations, and it requires immediate recognition and attention. Clinically, ICP typically presents with a headache that is most severe in the morning, aggravated by Valsalva-like maneuvers, and associated with nausea or vomiting. Papilledema is a well-recognized sign of increased ICP; however, emergency physicians often find it difficult to visualize the optic disc using ophthalmoscopy or to accurately interpret digital fundus photographs when using a non-mydriatic retinal camera. Emergency ultrasound can evaluate the optic nerve sheath diameter (ONSD) and optic disc elevation to determine whether increased ICP is present, however, the studies have been small with different definitions and measurements of the ONSD. The ONSD threshold values for increased ICP have been reported anywhere from 4.8 to 6.3 millimeters. Neuroimaging is the next step in the evaluation of patients with papilledema or high clinical suspicion of increased ICP, as it can identify most structural causes or typical radiological patterns of increased ICP. Neuroradiographic signs of increased ICP can be helpful in suggesting idiopathic intracranial hypertension (IIH), especially when papilledema is absent. Patients with papilledema and normal neuroimaging may undergo lumbar puncture as part of their clinical workup. The cerebrospinal fluid (CSF) opening pressure remains one of the most important investigations to establish the diagnosis of IIH. A CSF evaluation is also required to exclude other etiologies of elevated ICP such as infectious, inflammatory, and neoplastic meningitis. Invasive ICP measurement remains the standard to measure and monitor this condition.

BackgroundNon-sputum-based triage tests for tuberculosis are a priority for ending tuberculosis. We aimed to evaluate the diagnostic accuracy of the late-prototype Xpert MTB Host Response (Xpert HR) blood-based assay.MethodsWe conducted a prospective diagnostic accuracy study among outpatients with presumed tuberculosis in outpatient clinics in Viet Nam, India, the Philippines, Uganda, and South Africa. Eligible participants were aged 18 years or older and reported cough lasting at least 2 weeks. We excluded those receiving tuberculosis treatment in the preceding 12 months and those who were unwilling to consent. Xpert HR was performed on capillary or venous blood. Reference standard testing included sputum Xpert MTB/RIF Ultra and mycobacterial culture. We performed receiver operating characteristic (ROC) analysis to identify the optimal cutoff value for the Xpert HR to achieve the target sensitivity of 90% or more while maximising specificity, then calculated diagnostic accuracy using this cutoff value. This study was prospectively registered with ClinicalTrials.gov, NCT04923958.FindingsBetween July 13, 2021, and Aug 15, 2022, 2046 adults with at least 2 weeks of cough were identified, of whom 1499 adults (686 [45·8%] females and 813 [54·2%] males) had valid Xpert HR and reference standard results. 329 (21·9%) had microbiologically confirmed tuberculosis. Xpert HR had an area under the ROC curve of 0·89 (95% CI 0·86-0·91). The optimal cutoff value was less than or equal to -1·25, giving a sensitivity of 90·3% (95% CI 86·5-93·3; 297 of 329) and a specificity of 62·6% (95% CI 59·7-65·3; 732 of 1170). Sensitivity was similar across countries, by sex, and by subgroups, although specificity was lower in people living with HIV (45·1%, 95% CI 37·8-52·6) than in those not living with HIV (65·9%, 62·8-68·8; difference of 20·8%, 95% CI 13·0-28·6; p

This study examines the extent to which local au­thorities in rural North-West Romania adhere to the requirements set forth in Law no. 544 of 2001, which mandates the ex officio public information disclo­sure online. The findings suggest a relatively low level of transparency, with notable discrepancies ob­served across communes. While larger communes exhibited slightly elevated levels of compliance, pop­ulation size exerted a limited influence on transpar­ency. Additionally, the study revealed no statistically significant correlation between the gender of mayors and transparency. This may be attributed to the lim­ited representation of female mayors in the sample. Similarly, while the presence of businesses demon­strated some influence on transparency, it was not a robust predictor. These findings underscore the ne­cessity for more robust enforcement mechanisms, including penalties for non-compliance, to guarantee compliance with transparency laws. Furthermore, the study highlights the necessity of considering a broader array of factors, including local governance practices, institutional capacity, and citizen engage­ment, when evaluating transparency outcomes. It would be beneficial for future research to expand to other regions and consider a longitudinal approach to monitor changes over time. The study under­scores the pivotal role of transparency in cultivating public trust, curbing corruption, and strengthening democratic governance.

Objectives. This study aimed to investigate the toxicity of nicotine and its metabolite cotinine on crustacean D. magna, and evaluate the quantity of compounds accumulated by D. magna. Materials and Methods. The bioassays involved the exposure of D. magna to varying doses of nicotine and cotinine, for 24 h and 48 h. The amount of bioaccumulated nicotine and cotinine was determined by an HPLC-DAD method. Results. The study has revealed that nicotine is more toxic than cotinine on D. magna, as the medium lethal concentration (LC50) values were higher for nicotine compared to cotinine. After 24 hours of exposure, D. magna accumulated comparable amounts of nicotine and cotinine. However, after 48 hours of exposure, the crustacean accumulated significantly lower levels of nicotine, which is consistent with the higher toxicity of nicotine compared to cotinine. Conclusions. These findings demonstrated that nicotine triggers various alterations in aquatic organism, hence jeopardizing the equilibrium of the aquatic ecosystem within a little timeframe.

Increased intracranial pressure (ICP) is encountered in numerous traumatic and non-traumatic medical situations, and it requires immediate recognition and attention. Clinically, ICP typically presents with a headache that is most severe in the morning, aggravated by Valsalva-like maneuvers, and associated with nausea or vomiting. Papilledema is a well-recognized sign of increased ICP; however, emergency physicians often find it difficult to visualize the optic disc using ophthalmoscopy or to accurately interpret digital fundus photographs when using a non-mydriatic retinal camera. Emergency ultrasound can evaluate the optic nerve sheath diameter (ONSD) and optic disc elevation to determine whether increased ICP is present, however, the studies have been small with different definitions and measurements of the ONSD. The ONSD threshold values for increased ICP have been reported anywhere from 4.8 to 6.3 millimeters. Neuroimaging is the next step in the evaluation of patients with papilledema or high clinical suspicion of increased ICP, as it can identify most structural causes or typical radiological patterns of increased ICP. Neuroradiographic signs of increased ICP can be helpful in suggesting idiopathic intracranial hypertension (IIH), especially when papilledema is absent. Patients with papilledema and normal neuroimaging may undergo lumbar puncture as part of their clinical workup. The cerebrospinal fluid (CSF) opening pressure remains one of the most important investigations to establish the diagnosis of IIH. A CSF evaluation is also required to exclude other etiologies of elevated ICP such as infectious, inflammatory, and neoplastic meningitis. Invasive ICP measurement remains the standard to measure and monitor this condition.

Metaheuristics are optimization algorithms that efficiently solve a variety of complex combinatorial problems. In psychological research, metaheuristics have been applied in short-scale construction and model specification search. In the present study, we propose a bee swarm optimization (BSO) algorithm to explore the structure underlying a psychological measurement instrument. The algorithm assigns items to an unknown number of nested factors in a confirmatory bifactor model, while simultaneously selecting items for the final scale. To achieve this, the algorithm follows the biological template of bees' foraging behavior: Scout bees explore new food sources, whereas onlooker bees search in the vicinity of previously explored, promising food sources. Analogously, scout bees in BSO introduce major changes to a model specification (e.g., adding or removing a specific factor), whereas onlooker bees only make minor changes (e.g., adding an item to a factor or swapping items between specific factors). Through this division of labor in an artificial bee colony, the algorithm aims to strike a balance between two opposing strategies diversification (or exploration) versus intensification (or exploitation). We demonstrate the usefulness of the algorithm to find the underlying structure in two empirical data sets (Holzinger-Swineford and short dark triad questionnaire, SDQ3). Furthermore, we illustrate the influence of relevant hyperparameters such as the number of bees in the hive, the percentage of scouts to onlookers, and the number of top solutions to be followed. Finally, useful applications of the new algorithm are discussed, as well as limitations and possible future research opportunities.

Despite the value of sense of purpose during older adulthood, this construct often declines with age. With some older adults reconsidering the relevance of purpose later in life, the measurement of purpose may suffer from variance issues with age. The current study investigated whether sense of purpose functions similarly across ages and evaluated if the predictive power of purpose on mental, physical, cognitive, and financial outcomes changes when accounting for a less age-affected measurement structure. Utilizing data from two nationwide panel studies (Health and Retirement Study: n = 14,481; Midlife in the United States: n = 4,030), the current study conducted local structural equation modeling and found two factors for the positively and negatively valenced purpose items in the Purpose in Life subscale (Ryff, 1989), deemed the purposeful and purposeless factor. These factors become less associated with each other at higher ages. When reproducing past findings with this two-factor structure, the current study found that the purposeful and purposeless factors predicted these outcomes in the same direction as would be suggested by past research, but the magnitude of these effects differed for some outcomes. The discussion focuses on the implications of what this means for our understanding of sense of purpose across the lifespan.

Summary: Background: Clinical severity scores can identify patients at risk of severe disease and death, and improve patient management. The modified early warning score (MEWS), the quick Sequential (Sepsis-Related) Organ Failure Assessment (qSOFA), and the Universal Vital Assessment (UVA) were developed as risk-stratification tools, but they have not been fully validated in low-resource settings where fever and infectious diseases are frequent reasons for health care seeking. We assessed the performance of MEWS, qSOFA, and UVA in predicting mortality among febrile patients in the Lao PDR, Malawi, Mozambique, and Zimbabwe. Methods: We prospectively enrolled in- and outpatients aged ≥ 15 years who presented with fever (≥37.5 °C) from June 2018–March 2021. We collected clinical data to calculate each severity score. The primary outcome was mortality 28 days after enrolment. The predictive performance of each score was determined using area under the receiver operating curve (AUC). Findings: A total of 2797 participants were included in this analysis. The median (IQR) age was 32 (24–43) years, 38% were inpatients, and 60% (1684/2797) were female. By the time of follow-up, 7% (185/2797) had died. The AUC (95% CI) for MEWS, qSOFA and UVA were 0.67 (0.63–0.71), 0.68 (0.64–0.72), and 0.82 (0.79–0.85), respectively. The AUC comparison found UVA outperformed both MEWS (p

Congenitally corrected transposition of the great arteries (ccTGA) is a rare congenital anomaly defined by double discordance – atrioventricular and ventricular-arterial. ccTGA frequently has associated lesions, which influence long-term survival.

The genus Scutellaria L. comprises about 400 - 500 species, some of which are of practical value due to their biological activities. To prevent misidentification and contamination of plant material harvested from species of this genus, knowledge of the morphological and micromorphological characters of the seeds has proved useful. The present paper aims to perform a morphological and micromorphological characterization of seeds belonging to 12 taxa of the genus Scutellaria L., with the idea of completing the literature data and discussing the importance of these characters. The seeds of the analysed taxa showed different colours (yellow, black, brown) and ornamentations (generated by the arrangement and shape of the epidermal papillae). In some taxa, the seeds were glabrous (Scutellaria baicalensis Georgi, S. resinosa Torr., S. suffrutescens S. Watson., S. incana Spreng., S. integrifolia L.), others showed tector hairs concentrated in the apical region of the epidermal papillae (S. altissima L.) or distributed over the entire surface (S. orientalis L., S. supina L., S. orientalis L. var. pinnatifida Rchb.), covering the whole or part (S. pontica K. Koch.) of the seed surface. Sessile glands were observed in S. galericulata L., among the papillae, whereas S. alpina L., presented stellate hairs. Seed sizes also varied between the taxa. The results obtained confirm the taxonomic importance of the analysed features but indicate that the correct identification of Scutellaria species cannot be performed based only on seed characteristics, requiring additional research and observations.

Radial artery occlusion (RAO), Forearm Hematoma (FH), and compartmental syndrome are three well-recognized complications associated with radial artery (RA) access to percutaneous coronary intervention (PCI). There are disparate ways the RA can be damaged, from multiple needling attempts to adverse interactions between the radial sheath, exchange wire, and diagnostic or guiding catheter with the artery.

Cutaneous metastases from clear cell renal carcinoma (ccRC) are uncommon and often indicate a poor prognosis. These metastases typically occur on the scalp, face, and trunk, and they can be difficult to diagnose due to their resemblance to benign dermatological tumors. We report the case of a 56-year-old patient with a history of ccRC (TNM stage 4) who was referred to our dermatology department with two rapidly enlarging, painful lesions on the left jawline and scalp, which had developed one month and one week earlier, respectively. On examination, the lesions appeared as well-defined, round to oval plaques with a central ulceration and a peripheral red rim, suggestive of an inflammatory appearance. Dermoscopic examination revealed a structureless pink to orange pattern, atypical central vessels, and irregular linear vessels in a corona-like arrangement. Despite the patient’s stable oncological treatment for six months, pain management had recently included paracetamol, tramadol, and NSAIDs. The primary presumptive diagnosis was of cutaneous metastasis, considering the patient’s history of metastatic ccRC. However, given the recent initiation of new pharmacological agents, the rapid progression of the cutaneous lesions, and their clinical presentation, alternative differential diagnoses were considered, including drug-induced reactions such as erythema multiforme or fixed drug eruption. A biopsy of the facial lesion revealed immunohistochemical positivity for CD10, CAIX, and PAX8, confirming the diagnosis of metastatic ccRC with sarcomatoid differentiation. Unfortunately, despite continued targeted therapies and palliative care, the patient’s condition deteriorated rapidly, leading to death two months later. This case highlights the potential for extremely rapidly evolving cutaneous metastases from ccRC and their capacity to occasionally mimic atypical drug eruptions. Additionally, it reaffirms the poor prognosis of such metastases, as evidenced by the patient’s death within two months.