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Abstract Neuromorphic computing shows promise for advancing computing efficiency and capabilities of AI applications using brain-inspired principles. However, the neuromorphic research field currently lacks standardized benchmarks, making it difficult to accurately measure technological advancements, compare performance with conventional methods, and identify promising future research directions. This article presents NeuroBench, a benchmark framework for neuromorphic algorithms and systems, which is collaboratively designed from an open community of researchers across industry and academia. NeuroBench introduces a common set of tools and systematic methodology for inclusive benchmark measurement, delivering an objective reference framework for quantifying neuromorphic approaches in both hardware-independent and hardware-dependent settings. For latest project updates, visit the project website ( neurobench.ai ).

The ultra-cold neutron (UCN) source being commissioned at North Carolina State University’s PULSTAR reactor is uniquely optimized for UCN production in the former graphite-filled thermal column outside of the reactor pool. The source utilizes a remote moderation design, which is particularly well suited to the PULSTAR reactor because of its high thermal and epithermal neutron leakage from the core face. This large non-equilibrium flux from the core is efficiently transported to the UCN source through the specially designed beam port in order to optimize UCN production at any given reactor power. The increased distance to the source from the core also greatly limits the heat load on the cryogenic system. A MCNP (Monte Carlo N-Particle) model of this system was developed and is in good agreement with gold foil activation measurements using a test configuration as well as with the real UCN source’s heavy water moderator. These results established a firm baseline for estimates of the cold neutron flux available for UCN production and prove that remote moderation in a thermal column port is a valuable option for future designs of cryogenic UCN sources.

Density wave oscillation (DWO) is an important safety concern for boiling water reactors (BWR) due to their high void fraction in the core. Power extensions to existing reactors such as the Maximum Extended Load Line Limit Analysis Plus (MELLLA+) lead to increase susceptibility of DWO-type instability following an anticipated transient without scram (ATWS). Experiments performed at the Karlstein Thermal Hydraulic Test Facility (KATHY) have reproduced the reactivity feedback mechanism in BWRs under ATWS conditions. Using a neutronics module simulator, the KATHY facility was able to provide data on the effect of different neutronic parameters on DWO onset. This paper serves to assess the capability of the thermal-hydraulics code TRACE V5P7 for simulating DWO onset and development under natural circulation with neutronic feedback. A model of the KATHY natural circulation facility is created in TRACE and a reactivity feedback mechanism is implemented using a manual control scheme to simulate the parametric effects provided by the tests. This comparison allows for an assessment of the TRACE code as well as a better understanding of the instability mechanisms and behavior under the given conditions.

ABSTRACT: The continued efficient use of whey as a fermentable substrate to produce alcoholic beverages will benefit from improving the measurement of key components relevant to the fermentability of whey. One component of fermentation that is not well studied in whey is the concentration of fermentable nitrogen, either as free amino nitrogen (FAN) or yeast-assimilable nitrogen (YAN). Fermentable nitrogen in media is essential for yeast cells to replicate. Insufficient concentrations of FAN or YAN to support the growing yeast population can result in sluggish or “stuck” fermentations. We evaluated 3 common methods of fermentable nitrogen determination and compared them for use in whey fermentation systems, based on ninhydrin, nitrogen by o-phthalaldehyde (NOPA), and formaldehyde pH (Sørensen titration) values. Each measurement method was evaluated independently using standard addition curves and compared for overall accuracy using paired t-tests (α = 0.05). Although the formaldehyde pH method showed high precision, it did not measure nitrogen accurately, as it overestimated YAN in whey by up to 6 times relative to other tests. The ninhydrin and NOPA methods both showed accuracy for fermentable nitrogen determination in whey based on analysis of standardized nitrogen sources. We concluded that either the ninhydrin FAN or NOPA YAN method may be used to determine the fermentable nitrogen content in whey. This is expected to improve the ability of producers to use whey as a fermentation medium.

Land Use and Land Cover changes (LULC) exert a substantial influence on human life and environmental well-being. This research utilized the Intensity Analysis (IA) method to assess LULC change intensities spanning from 2000 to 2021 in the Muthurajawela coastal wetland (MW) and its 5km buffer zone (MB) along the west coast of Sri Lanka. The research employed Landsat Thematic Mapper (TM) and Optical Land Imager (OLI) Remote Sensing Images. The supervised classification was used to accurately identify waterbodies, thick vegetation, other vegetation, settlements, and open areas with an average of 86% accuracy. The study revealed that the MW experienced a fast Interval level intensity shift during 2000-2010, followed by a slower pace during 2010-2021. Conversely, the MB displayed a consistently fast Interval level intensity throughout both time intervals. Notably, waterbodies in MW decreased by 19.6%, while settlements witnessed a gain of 19.1% over the entire period. Transition Level (TL) analyses underscored the transformation of water bodies to open areas (6.75% in 2000-2010) and open areas to settlements (5.38%). In MB, other vegetation saw a significant decrease of 33.7%, with settlements registering a notable increase of 39.4% over the entire period. The study emphasizes urgent action for sustainable land use development in the face of rapid urbanization within the study area.

Antimicrobial resistance (AMR) evolution and onward transmission of resistance genes is impacted by interrelated biological and social drivers, with evidence and impacts observed across human, animal and environmental One Health domains. Systems-based research examining how food production impacts on AMR in complex agrifood systems is lacking, with little written on management approaches in the UK that might prevent and respond to this challenge. One approach is the creation of a transdisciplinary network to enhance capacity, capability and collaboration between agrifood-focused disciplines and stakeholders. This co-creation platform for network-wide systems-based activities would reduce inefficiencies in AMR-related activities around agrifood, providing a cross-cutting, cohesive community to deliver transformational guidance on relevant, practical agrifood solutions that add value by reducing AMR, antimicrobial usage and associated costs, and decreasing resultant environmental contamination by prioritising challenges, sharing knowledge and best practice, and co-creating practical solutions with key stakeholders. An online survey determined prospective network focus, structure and priorities, with responses analysed using mixed methods.Survey results suggested respondents have interests in synthesising data using systems-approaches and using certain disciplines such as ‘social sciences’ within network activities. There were disconnects in how and whom to work with on this, with generalised use of ‘social science/scientists’ but lack of disciplinary understanding (e.g., anthropology, sociology) suggesting disciplinary differences awareness-training is useful. A similar generalisation is seen for mathematics/statistics. There are strong interests in working with food system practitioners (e.g., farmers/vets), providing opportunities for farm/field visits/knowledge exchange, and human health, reflecting the need for farm-to-fork understanding of impacts. There were notable mentions of policy/governance, emphasising translational research desires to create meaningful change. Disciplines/fields did not always align with identified interests e.g., systems and implementation science, suggesting the utility of network activity around introducing these disciplines e.g., methodology-focused rather than subject-focused conferences exploring lateral thinking about subjects. We suggest starting by developing understanding of the most important research questions by working with stakeholders, then working back to how we would achieve desirable project outcomes and who else is needed for this.

Pediatric diffuse midline gliomas (pDMG) are an aggressive type of childhood cancer with a fatal outcome. Their major epigenetic determinism has become clear, notably with the identification of K27M mutations in histone H3. However, the synergistic oncogenic mechanisms that induce and maintain tumor cell phenotype have yet to be deciphered. In 20 to 30% of cases, these tumors have an altered BMP signaling pathway with an oncogenic mutation on the BMP type I receptor ALK2, encoded by ACVR1. However, the potential impact of the BMP pathway in tumors non-mutated for ACVR1 is less clear. By integrating bulk, single-cell, and spatial transcriptomic data, we show here that the BMP signaling pathway is activated at similar levels between ACVR1 wild-type and mutant tumors and identify BMP2 and BMP7 as putative activators of the pathway in a specific subpopulation of cells. By using both pediatric isogenic glioma lines genetically modified to overexpress H3.3K27M and patients-derived DIPG cell lines, we demonstrate that BMP2/7 synergizes with H3.3K27M to induce a transcriptomic rewiring associated with a quiescent but invasive cell state. These data suggest a generic oncogenic role for the BMP pathway in gliomagenesis of pDMG and pave the way for specific targeting of downstream effectors mediating the K27M/BMP crosstalk.

In the most iconic image of the 1930s American Dust Bowl—Dorothea Lange’s Migrant Mother—one figure is conspicuously absent: the father, the male figure in the family unit. The same can be said for our historical understanding of the Great Plains Dust Bowl, whereby an analysis of the role of manhood and masculinity, of the representation of men during an anthropogenic environmental disaster is largely lacking. In this paper I examine how men and patterns of gender at large were represented during the Dust Bowl through analysing the photographs of the federal Farm Security Administration (FSA).

Wetlands are confronting significant threats arising from human activities, particularly anthropogenic influences. The alteration of land use and land cover in and around wetlands serves as a clear indicator of the escalating human pressure on these ecosystems. This study employs Geographical Information System (GIS) and Remote Sensing to conduct a spatiotemporal analysis, comparing land use changes in both an urban wetland (Muthurajawela) and a peri-urban wetland (Anawilundawa) and their respective buffer areas in Sri Lanka. The study reveals noteworthy transformations in the extent of water bodies, thick vegetation, other vegetation, settlements, and open areas during the period from 2000 to 2021. The observed changes are particularly profound in the urban wetland. In the Muthurajawela wetland, the core habitat characterized by open water experienced significant conversions into settlements and infrastructure, resulting in an 81% reduction from 2000 to 2010 and a 30% reduction from 2010 to 2021. Similarly, water bodies in the Anawilundawa wetland reduced in size by 12% from 2000 to 2010 and 16% from 2010 to 2021. The results highlight the urban wetland's more substantial transformation from natural areas to anthropogenic areas, necessitating immediate remedial and restoration action. Given this context, it is imperative to delve further into the trajectories, causes, and drivers of land use changes. This deeper investigation is crucial for developing effective wetland management strategies that support sustainability, environmental stability, and the continued functioning of ecosystems.

Shifting baselines, whereby people’s perceptions of what was the “natural” state of the environment changes with each generation, hinders conservation, restoration, and management. Formal and informal historical animal records can be used to inform past biological, ecological, and environmental patterns and processes. Trophy specimens are cultural and social objects but also are examples of informal historical records that may supply biological tissue and supplement formal natural history collections. The use of social media to gather information from citizen scientists has great potential for data collection of such specimens. The aim of this study was to evaluate the potential utility of Facebook and traditional media to collect data on taxidermal Murray cod (Maccullochella peelii), a large, long-lived freshwater fish endemic to the Murray-Darling Basin, Australia. A Facebook group, “Cod Spot,” was established as the location for information dissemination to potential citizen scientists, and where data on Murray cod mounts could be uploaded. This was complemented with social and mainstream media promotion, a research website, and an e-survey. Cod Spot received >7,000 interactions and approximately 400 participants. A total of 189 verified locations of Murray cod head and whole mounts were found. The e-survey provided verification of the potential to turn these cultural and social objects into ones with scientific value. Participants included interested persons, collectors, taxidermists, stewards, or owners of mounts. Most participants were males aged 35+, although women comprised almost a third of website users. This research has shown that low-cost marketing, combined with a widely dispersed, relatively common and well-known object of interest, can be effective at gaining participation in citizen science collaborations.

With less than half of the worldʼs urban population having safely managed sanitation due to the high cost and difficulty of building sewers and treatment plants, many rely on off-grid options like pit latrines and septic tanks, which are hard to empty and often lead to illegal waste dumping; this research focuses on container-based sanitation (CBS) as an emerging off-grid solution. Off-grid sanitation refers to waste management systems that operate independently of centralized infrastructure and CBS is a service providing toilets that collect human waste in sealable containers, which are regularly emptied and safely disposed of. These data relate to a project investigating CBS in Kenya, Peru, and South Africa, focusing on how different user groups access and utilize sanitation – contrasting CBS with other types. Participants, acting as citizen scientists, collected confidential data through a dedicated smartphone app designed by the authors and external contractors. This project aimed to explore the effective scaling, management, and regulation of off-grid sanitation systems, relevant to academics in urban planning, water and sanitation services, institutional capability, policy and governance, and those addressing inequality and poverty reduction.The 12-month data collection period offered participants small incentives for weekly engagement, in a micro payment for micro tasks approach. Participants were randomly selected, attended a training workshop, and (where needed) were given a smartphone which they could keep at the end of the project. We conducted weekly smartphone surveys in over 300 households across informal settlements. These surveys aimed to understand human-environment interactions by capturing daily life, wellbeing, income, infrastructural service use, and socioeconomic variables at a weekly resolution, contributing to more informed analyses and decision-making.The smartphone-based approach offers efficient, cost-effective, and flexible data collection, enabling extensive geographical coverage, broad subject areas, and frequent engagement. The Open Data Kit (ODK) tools were used to support data collection in the resource-constrained environment with limited or intermittent connectivity.

Abstract Introduction Menstrual health in humanitarian contexts is a neglected topic. Its taboo nature presents difficulties for participants in menstrual health projects in these particularly challenging settings. Namely, their experiences may be concealed or overlooked in projects that are typically outcome focused. Realist Evaluation is a useful method to unearth and explore the hidden mechanisms and their causes, which lead to positive or negative participant experiences. The authors have applied this approach to a robust humanitarian menstrual health project to explore how to centre the emotional wellbeing of participants at all stages: prior to, during, and post-participation. Study setting The project studied was led by the International Federation of Red Cross and Red Crescent Societies who piloted their adaptable manual for menstruator–friendly water, sanitation and hygiene (WaSH) facility design in humanitarian contexts. It was conducted by the Lebanese Red Cross in an informal tented settlement hosting Syrian refugees in Qaa, Lebanon. Methods The authors collected interview and focus group data on the contextual factors and processes within the project from nine project staff and 16 settlement inhabitants. They used a realist process of theory development, testing, and consolidation to understand how and under what circumstances the project inputs affected participants’ wellbeing. Results The contextual factors and causal mechanisms promoting participant experience comprised individual (choices influencing and experience during participation), interpersonal (group dynamics and the role of non-menstruators), and organisational (expertise and knowledge, relationship to participants and cultural differences) factors. Implications The research uses a case study from a renowned humanitarian organisation who provided a well-delivered project in a conducive environment to explore the mechanisms and contexts that can promote wider learning and refine understanding and programming in this under-researched and -theorised space. Specifically, it informs which contextual factors and project inputs must be present within a menstrual health project to ensure participant satisfaction whilst efficiently delivering well-designed menstruator-friendly WaSH facilities.

The Sendai Framework highlights the need for an all-of-society effort to reduce the societal burden of flooding, with a focus on those being disproportionately affected. In this context, community-based organizations shall contribute to and support public awareness, a culture of prevention and education on disaster risk. Participatory theatre could be a promising means to that end, but quantitative evaluations are currently lacking. We provide a systematic literature review on participatory theatre in the context of natural hazards and disaster risk reduction. Moreover, we quantitatively evaluate to what extent community-based theatre implemented by the Women's Union in Central Vietnam could contribute to public awareness and foster societal engagement. 10 theatre performances in five coastal communes were evaluated using pre- and post-performance surveys among 635 visitors, mainly women. We find that community-based theatre enhanced risk perceptions, perceived flood knowledge, self-efficacy, and the importance of social participation. No significant effect was found on intentions to engage in (collective) risk reducing behavior. We conclude that participatory theatre is an effective risk-communication tool for community-based organizations, which should be embedded in broader activities addressing societal resilience against flooding. Future research should explore the sustainability of the observed increases and the long-term dynamics of behavioral changes.

Abstract Background Malaria is endemic throughout Mozambique, contributing significantly to the country’s burden of disease. Prompt and effective treatment for fevers in children can limit the mortality and morbidity impacts of the disease but many children in the country are not taken for formal care when ill. Using an ideational model of behaviour, this study assesses the magnitude of the relationships for potential drivers of care-seeking, including interpersonal communication, malaria messaging, and knowledge and attitudes about malaria, with actual care-seeking behaviours for under-five children with fever in Magoé district, Mozambique. Methods Data on the care-seeking behaviours for fever come from a 2019 household malaria survey in Magoé district. Households were randomly selected for interview from among those with at least one child under age five and one net for every two household members. From 1621 mother-child dyads, the analytical sample consists of 300 children under age five with a fever in the 2 weeks prior to the survey. Multilevel random effects logistic regression models are estimated to test for associations between care-seeking behaviours and hypothesized behavioural determinants, including interpersonal communication (IPC), malaria messaging, ideational factors (e.g., norms, attitudes, beliefs, risk perceptions), and community characteristics. Results Overall, 18.5% of children under age five (N = 300) were reported to have fever in the previous 2 weeks and, of these, 68.5% were taken to a formal sector health care provider. Multivariate models highlight significant roles for interpersonal communication; care-seeking was highest among mothers who spoke only with friends/community members about malaria (94.0%, p

Sustainable Development Goal 6 (SDG6) is grounded in human rights and derives from international policies refined over decades. We argue that much of this agenda setting and monitoring reflects or gives way to neo-colonialism and neo-liberalism. We implement an online version of the Nominal Group Technique to explore its efficacy for more equitable global agenda setting. We apply the technique to a group of 19 graduate WaSH students – from diverse professional backgrounds and originating from and having worked in all global regions – to gain their insights on future WaSH issues to be included in global targets. This was preceded by preparatory exercises on WaSH progress and influential contextual factors. We thus demonstrate a novel and systematic application of the NGT and discuss its potential to be used in challenging neo-colonial and neo-liberal agenda setting. The results also provide an early assessment of future priorities that could inform post-SDG target setting including: inclusivity among populations and settings, hygiene, menstrual health, sustainability, circular economy, climate resilience, preventing infectious disease transmission, and universal ‘safely managed services’. These are compared with themes highlighted in Joint Monitoring Programme reports, SDG6 indicators and General Comment 15: The Human Right to Water. HIGHLIGHTS The use of an adapted virtual nominal group technique to reflect on priority WaSH issues post-2030.; The potential for a virtual NGT to challenge neo-colonial and neo-liberal agenda setting.; Novel priorities: sustainability, climate resilience, water conservation, circular economy of WaSH systems, broadening the scope of hygiene, menstrual health, inclusion of vulnerable groups, and preventing infectious disease transmission;

Low-energy extraction wells fitted with filtration sleeves were numerically modeled to assess their capability to extract narrow contaminant plumes in a hypothetical unconfined aquifer beneath a lined landfill. After 2,000 days, the source was shut off and remediation simulations commenced. A sleeved submersible pump extracting 0.4 m3/day in a well near the downgradient edge of the plume, coupled with an upgradient well injecting the same rate, effectively contained and removed the plume. Adding non-pumped filtration wells upgradient of the extraction well marginally improved containment and remediation timeframe. At some sites, low-energy, sleeved extraction wells may be useful for extracting narrow plumes emerging from contemporary landfills.

Abstract Background A high proportion of patients diagnosed with schizophrenia-spectrum disorders will at some point in their lives be assessed as not having the capacity to make their own decisions about pharmacological treatment or inpatient care (‘capacity’). Few will be helped to regain it before these interventions proceed. This is partly because effective and safe methods to do so are lacking. Our aim is to accelerate their development by testing, for the first time in mental healthcare, the feasibility, acceptability and safety of running an ‘Umbrella’ trial. This involves running, concurrently and under one multi-site infrastructure, multiple assessor-blind randomised controlled trials, each of which is designed to examine the effect on capacity of improving a single psychological mechanism (‘mechanism’). Our primary objectives are to demonstrate feasibility of (i) recruitment and (ii) data retention on the MacArthur Competence Assessment Tool-Treatment (MacCAT-T; planned primary outcome for a future trial) at end-of-treatment. We selected three mechanisms to test: ‘self-stigma’, low self-esteem and the ‘jumping to conclusions’ bias. Each is highly prevalent in psychosis, responsive to psychological intervention, and hypothesised to contribute to impaired capacity. Methods Sixty participants with schizophrenia-spectrum diagnoses, impaired capacity and one or more mechanism(s) will be recruited from outpatient and inpatient mental health services in three UK sites (Lothian, Scotland; Lancashire and Pennine; North West England). Those lacking capacity to consent to research could take part if the key criteria were met, including either proxy consent (Scotland) or favourable Consultee advice (England). They will be allocated to one of three randomised controlled trials, depending on which mechanism(s) they have. They will then be randomised to receive, over an 8-week period and in addition to treatment as usual (TAU), 6 sessions of either a psychological intervention which targets the mechanism, or 6 sessions of assessment of the causes of their incapacity (control condition). Participants are assessed at 0 (baseline), 8 (end-of-treatment) and 24 (follow-up) weeks post-randomisation using measures of capacity (MacCAT-T), mechanism, adverse events, psychotic symptoms, subjective recovery, quality of life, service use, anxiety, core schemata and depression. Two nested qualitative studies will be conducted; one to understand participant and clinician experiences and one to investigate the validity of MacCAT-T appreciation ratings. Discussion This will be the first Umbrella trial in mental healthcare. It will produce the first 3 single-blind randomised controlled trials of psychological interventions to support treatment decision-making in schizophrenia-spectrum disorder. Demonstrating feasibility will have significant implications not only for those seeking to support capacity in psychosis, but also for those who wish to accelerate the development of psychological interventions for other conditions. Trial registration ClinicalTrials.gov NCT04309435 . Pre-registered on 16 March 2020.

The majority of patients requiring heart valve replacement in low- to middle-income countries (LMICs) need it for rheumatic heart disease (RHD). While the young age of such patients largely prescribes replacement with mechanical prostheses, reliable anticoagulation management is often unattainable under the prevailing socioeconomic circumstances. Cases of patients with clotted valves presenting for emergency surgery as a consequence of poor adherence to anticoagulation control are frequent. The operative mortality rates of reoperations for thrombosed mechanical valves are several times higher than those for tissue valves, and long-term results are also disappointing. Under-anticoagulation prevails in these regions that has clearly been linked to poor international normalised ratio (INR) monitoring. In industrialised countries, safe anticoagulation is defined as >60%–70% of the time in the therapeutic range (TTR). In LMICs, the TTR has been found to be in the range of twenty to forty percent. In this study, we analysed >20,000 INR test results of 552 consecutive patients receiving a mechanical valve for RHD. Only 27% of these test results were in the therapeutic range, with the vast majority (61%) being sub-therapeutic. Interestingly, the post-operative frequency of INR tests of one every 3–4 weeks in year 1 had dropped to less than 1 per year by year 7. LMICs need to use clinical judgement and assess the probability of insufficient INR monitoring prior to uncritically applying Western guidelines predominantly based on chronological age. The process of identification of high-risk subgroups in terms of non-adherence to anticoagulation control should take into account both the adherence history of >50% of patients with RHD who were in chronic atrial fibrillation prior to surgery as well as geographic and socioeconomic circumstances.

Coastal dunes, formed and shaped by aeolian sediment transport, play a crucial role in ecosystem services and act as natural flood and coastal erosion defenses. This paper delves into theoretical equations and numerical models predicting sediment transport. Numerical models like cellular automata, XBeach-DUNA, the coastal dune model, and others are analyzed for their ability to simulate dune morphology, erosion processes, and vegetation impacts accurately. Evaluated are field observation and measurement techniques, such as sand traps, impact sensors, and optical sensors, for their precision in quantifying aeolian dynamics. Further examined is the effectiveness of vegetation and fencing in dune stabilization, noting species-specific responses and the influence of fence design on sediment accumulation. These tools offer insights into optimizing aeolian sediment management for coastal protection. By conducting a systematic review and connecting theoretical, empirical, and modeling findings, this study highlights the complex challenge of measuring and managing aeolian sediment transport and proposes integrated strategies for enhancing coastal dune resilience against the backdrop of climate change and erosion. This study’s objectives to bridge gaps in current understanding are met, highlighting the need for a multidisciplinary approach to coastal dune management and conservation, especially combining wind- and wave-driven processes.

Abstract Background Insecticide treated bed nets (ITN) are considered a core malaria vector control tool by the WHO and are the main contributor to the large decline in malaria burden in sub-Saharan Africa over the past 20 years, but they are less effective if they are not broadly and regularly used. ITN use may depend on factors including temperature, relative humidity, mosquito density, seasonality, as well as ideational or psychosocial factors including perceptions of nets and perceptions of net use behaviours. Methods A cross–sectional household survey was conducted as part of a planned randomized controlled trial in Magoe District, Mozambique. Interviewers captured data on general malaria and ITN perceptions including ideational factors related to perceived ITN response efficacy, self-efficacy to use an ITN, and community norms around ITN using a standardized questionnaire. Only households with sufficient ITNs present for all children to sleep under (at least one ITN for every two children under the age of five years) were eligible for inclusion in the study. Additional questions were added about seasonality and frequency of ITN use. Results One-thousand six hundred sixteen mother–child dyads were interviewed. Responses indicated gaps in use of existing nets and net use was largely independent of ideational factors related to ITNs. Self-reported ITN use varied little by season nor meaningfully when different methods were used to solicit responses on net use behaviour. Mothers’ perceived response efficacy of ITNS was negatively associated with net use (high perceived response efficacy reduced the log-odds of net use by 0.27 (95% CI − 0.04 to − 0.51), implying that stronger beliefs in the effectiveness of ITNs might result in reduced net use among their children. Conclusions In this context, ITN use among children was not clearly related to mothers’ ideational factors measured in the study. Scales used in solicitation of ideation around ITN use and beliefs need careful design and testing across a broader range of populations in order to identify ideational factors related to ITN use among those with access.

In pancreatic ductal adenocarcinoma cells and patient tissue, SMAD2/3 is shown to mediate oncogenic effects of TGF-β in the absence of SMAD4.

Measurement(s) land cover Technology Type(s) visual interpretation of satellite imagery Sample Characteristic - Location Indonesia

Designing processors for implantable closed-loop neuromodulation systems presents a formidable challenge owing to the constrained operational environment, which requires low latency and high energy efficacy. Previous benchmarks have provided limited insights into power consumption and latency. However, this study introduces algorithmic metrics that capture the potential and limitations of neural decoders for closed-loop intra-cortical brain–computer interfaces in the context of energy and hardware constraints. This study benchmarks common decoding methods for predicting a primate’s finger kinematics from the motor cortex and explores their suitability for low latency and high energy efficient neural decoding. The study found that ANN-based decoders provide superior decoding accuracy, requiring high latency and many operations to effectively decode neural signals. Spiking neural networks (SNNs) have emerged as a solution, bridging this gap by achieving competitive decoding performance within sub-10 ms while utilizing a fraction of computational resources. These distinctive advantages of neuromorphic SNNs make them highly suitable for the challenging closed-loop neural modulation environment. Their capacity to balance decoding accuracy and operational efficiency offers immense potential in reshaping the landscape of neural decoders, fostering greater understanding, and opening new frontiers in closed-loop intra-cortical human-machine interaction.

Abstract Agriculture around the world needs to become more environmentally sustainable to limit further environmental degradation and impacts of climate change. Many governments try to achieve this through enrolling farmers in agri‐environment schemes (AES) that encourage them to undertake conservation activities. Studies show that AES can suffer from low uptake, meaning their environmental objectives remain unattained. To succeed for people and nature, policy‐makers are increasingly adopting multi‐actor approaches in the ‘co‐design’ of AES to make them more attractive and inclusive of a full range of stakeholders, including ‘harder to reach’ farmers. To address why some land managers (principally farmers) may be harder to reach in the context of co‐designing England's new Environmental Land Management (ELM) approach, we undertook a quick scoping review of the literature, conducted 23 first‐round and 24 s‐round interviews with key informants, and held a workshop with 11 practitioners. We outline why farming stakeholders may be harder to reach and how policy‐makers can adjust the engagement process to make co‐design more inclusive. Based on the results, we make recommendations that could help policy‐makers to design better, more inclusive AES that would attract greater uptake and increase their chances of success. Read the free Plain Language Summary for this article on the Journal blog.

Abstract Background The mixing step after medication addition to the infusion bag is frequently omitted during the preparation of drug infusions. However, the importance of mixing when preparing antibiotic infusions is still unknown. Methods The primary aim of this study was to assess the importance of the mixing step by comparing the concentrations of unmixed antibiotic infusions (cefuroxime, flucloxacillin, meropenem, and vancomycin) with the declared concentration at regular intervals during infusion. The secondary aim was to compare concentrations between preparation sites (hospital pharmacy versus clinical ward). Infusion bags were run through electronic infusion pumps. For cefuroxime, flucloxacillin, and meropenem, samples were collected 1, 15, and 20 min after starting the administration (infusion duration: 30 min). For vancomycin, samples were collected after 1, 60, and 110 min (infusion duration: 120 min). Vancomycin concentrations were measured using the Architect c4000 analyser and other concentrations using a validated UPC2-MS–MS multimethod. Results The median concentrations of the four antibiotics were comparable to the declared concentration at all three time points. No significant differences were found between preparation sites. Conclusions Spontaneous mixing occurred in the examined antibiotic solutions during normal handling.

Background and ObjectivesThe Western Cape public pediatric cardiac service is under-resourced. COVID-19 regulations are likely to have long-term effects on patient care but may provide insight into service capacity requirements. As such, we aimed to quantify the impact of COVID-19 regulations on this service.MethodsAn uncontrolled retrospective pre-post study of all presenting patients over two, one-year periods; the pre-COVID-19 period (01/03/2019–29/02/2020) and the peri-COVID-19 period (01/03/2020–28/02/2021).ResultsAdmissions decreased by 39% (624 to 378) and cardiac surgeries decreased by 29% (293 to 208) in the peri-COVID-19 period, with an increase in urgent cases (PR:5.99, 95%CI:3.58–10.02, p

IntroductionCognition impairments often occur after a traumatic brain injury and occur at higher rates in military members. Cognitive symptoms impair daily function, including balance and life quality, years after the TBI. Current treatments to regain cognitive function after TBI, including medications and cognitive rehabilitation, have shown limited effectiveness. Transcranial direct current stimulation (tDCS) is a low-cost, non-invasive brain stimulation intervention that improves cognitive function in healthy adults and people with neuropsychologic diagnoses beyond current interventions. Despite the available evidence of the effectiveness of tDCS in improving cognition generally, only two small TBI trials have been conducted based on the most recent systematic review of tDCS effectiveness for cognition following neurological impairment. We found no tDCS studies that addressed TBI-related balance impairments.MethodsA scoping review using a peer-reviewed search of eight databases was completed in July 2022. Two assessors completed a multi-step review and completed data extraction on included studies using a priori items recommended in tDCS and TBI research guidelines.ResultsA total of 399 results were reviewed for inclusion and 12 met the criteria and had data extracted from them by two assessors using Google Forms. Consensus on combined data results included a third assessor when needed. No studies using tDCS for cognition-related balance were found.DiscussionGuidelines and technology measures increase the identification of brain differences that alter tDCS effects on cognition. People with mild-severe and acute-chronic TBI tolerated and benefited from tDCS. TBI-related cognition is understudied, and systematic research that incorporates recommended data elements is needed to advance tDCS interventions to improve cognition after TBI weeks to years after injury.

The rapid pace of digitalization forces new ventures to cope with external changes they cannot foresee. Improvisation is a crucial way for companies to respond effectively to sudden changes. However, the mechanisms underlying the improvisation–performance link are not fully understood. This paper focuses on how improvisation affects a firm's performance. We identify two mediators for this relationship: entrepreneurial learning and routines. Our sample includes 243 new ventures in China. The results of structural equation modelling show that learning from improvisation in start-ups contributes to establishing new routines that serve as drivers of firm performance. We discuss the implications for practice and future research.

IntroductionNumerous psychological factors are believed to play a pivotal role in the development and maintenance of persistent somatic symptoms (PSS) in all fields of medicine. However, very few of these factors have been empirically investigated in relation to PSS. The aim of this study is firstly to propose a framework and define search terms for systematic reviews on the empirical evidence and diagnostic value of psychological risk factors for PSS and PSS-related outcomes (PSY-PSS). Secondly, the application of the framework is illustrated using the example of a systematic review on the relevance of psychological factors in somatic symptom disorders (SSD; DSM-5) and bodily distress disorders (BDD; ICD-11).MethodsFollowing a narrative review approach, two comprehensive lists of search terms to identify studies in (1) relevant patient groups with PSS and (2) relevant psychological factors were generated by reviewing the current literature and employing an iterative process of internal revision and external expert feedback.ResultsWe identified 83 relevant symptoms, syndromes and disorders for which we defined a total of 322 search terms (list 1). We further comprised 120 psychological factors into 42 subcategories and 7 main categories (list 2). The introduced lists can be combined to conduct systematic reviews on one or more specific psychological factors in combination with any symptom, syndrome or disorder of interest. A protocol of the application of this framework in a systematic review and meta-analysis on psychological etiological factors of SSD and BDD is presented following the PRISMA guidelines.DiscussionThis framework will help to gather systematic evidence on psychological factors in order to improve the understanding of the etiology of PSS, to refine future diagnostic conceptualizations of PPS, and to develop optimized mechanism-based interventions for individuals with PPS and related syndromes and disorders.

Across Europe there is an increasing behavioural turn in flood risk management, focussing on individual behaviour and responsibilities. For example, a greater focus on implementing property-level resilience measures. A conclusion from this trend is that there are additional burdens being placed on the residents of flood-prone areas, in the hope of reducing their overall burden; therefore, we must understand the burden that is being created as we can unintentionally create new patterns of inequality in terms of who is and is not protected if certain individuals can be judged to be overburdened. This is particularly relevant in the aftermath of disaster events when there is a push to build resilience. One concept for measuring this aspect of the burden generated is affordability, which seeks to define and measure what a suitable burden on an actor is, and then can be targeted for additional assistance, for example, loans, vouchers, or subsidies to eliminate the burden. The concept of affordability can be used to identify how to best spend resources after a disaster event to support a process of ‘building back better’; however, the way this burden can be defined and addressed can also be influenced by different social justice considerations and definitions. This research explores the implications of different social justice concepts for defining what is a reasonable burden that can be placed on the individuals expected to adapt to and limit flood impacts and on the policy strategies and outcomes.

IntroductionIn order to obtain FDA Marketing Authorization for aid in the diagnosis of concussion, an eye tracking study in an intended use population was conducted.MethodsPotentially concussed subjects recruited in emergency department and concussion clinic settings prospectively underwent eye tracking and a subset of the Sport Concussion Assessment Tool 3 at 6 sites. The results of an eye tracking-based classifier model were then validated against a pre-specified algorithm with a cutoff for concussed vs. non-concussed. The sensitivity and specificity of eye tracking were calculated after plotting of the receiver operating characteristic curve and calculation of the AUC (area under curve).ResultsWhen concussion is defined by SCAT3 subsets, the sensitivity and specificity of an eye tracking algorithm was 80.4 and 66.1%, The AUC was 0.718. The misclassification rate (n = 282) was 31.6%.ConclusionA pre-specified algorithm and cutoff for diagnosis of concussion vs. non-concussion has a sensitivity and specificity that is useful as a baseline-free aid in diagnosis of concussion. Eye tracking has potential to serve as an objective “gold-standard” for detection of neurophysiologic disruption due to brain injury.

Background: Back pain has a high global prevalence and carries a substantial risk for chronification. Biopsychosocial factors are assumed to be critical in the transition from acute to chronic back pain. Digital interventions are a promising tool to educate patients about their complaints. Thus, providing patients with an explanatory model regarding their individual risk factors in the early stage of their complaints via the internet might thus be a valuable approach in treatment. Objectives: The objectives of the present online study are to investigate the influence of a personalized psychoeducational intervention on self-efficacy and functioning and to examine biopsychosocial risk factors for symptom chronification. The intervention is based on a current model summarizing the empirical knowledge on relevant factors for persistent somatic symptoms, which has not been studied in back pain patients yet. Methods: An observational cohort of patients with acute and subacute back pain (N = 564) will be asked about biopsychosocial risk factors via online survey at baseline, 4-week, and 12-week follow-up. Within this cohort, a randomly selected group of 132 participants (intervention group) with psychological burden (MCS-12 score of the SF-12 ≤ 50) and relevant somatic symptom intensity and interference (mean sum score of two numeric rating scales ≥5) and no prior psychotherapeutic treatment will be offered a personalized explanatory model in the form of an animated psychoeducational video. The video will be personalized in terms of participants' individual symptom profile and will be made accessible to watch online for 7 days. Participants will be compared to a control group receiving no treatment regarding change in pain-specific self-efficacy after 1 month as primary outcome, and change in functioning after 1 and 3 months, respectively, as secondary outcomes. Acceptance and usefulness of the intervention will be evaluated using the number of video views and a numeric rating scale. Discussion: This is the first investigation of a personalized, video-animated online psychoeducation based on patients' individual risk factors for the chronification of back pain and the first systematic evaluation of the risk factors included in a comprehensive aetiological model on persistent somatic symptoms in back pain patients. This way, this study contributes to the understanding of cross-disorder psychopathological factors and a stronger consideration of biopsychosocial factors in the treatment of persistent somatic symptoms. If proven effective, the internet-based intervention will make an important contribution to the early treatment of back pain. Ethical approval: The study was approved by the Local Psychological Ethics Committee (LPEK) at the Center for Psychosocial Medicine of the University Medical Center Hamburg-Eppendorf. Trial registration: The study was registered at the German Clinical Trials Register in December 2021 (registration trial number: DRKS00025445).

Gills reportedly play a crucial role in induction of an antiviral immune response in fish. We investigated the expression of innate response genes in the rainbow trout gill epithelial cell line RTgill-W1 36 h after pretreatment with ultraviolet-inactivated viral hemorrhagic septicemia virus (UV-VHSV), flagellin C protein from Edwardsiella tarda (FliC), VHSV and SVCV using an Agilent 4 × 44k cGRASP salmonid microarray. RTgill-W1 cells pretreated with UV-VHSV, triggered an independent gene expression profile from those treated with a recombinant flagellin C protein from Edwardsiella tarda. In addition, exposure of RTgill-W1 cells to live viruses spring viremia of carp virus and viral hemorrhagic septicemia virus induced a less robust transcriptional change of 24 and 22 gene probes, respectively, when compared to 123 genes for UV-VHSV. Further the pretreatment of RTgill-W1 cells with (UV-VHSV) significantly reduced VHSV genome copy number at 6 d post infection (dpi) relative to the FliC-treated and untreated control. A quantitative PCR was used to study the transcriptional modulation of a set of 25 innate immune-related genes highlighted by the microarray data and a panel of 7 established antiviral genes in the protected cells. Notably, the expression of ifn1, ifn2, mx1 and mx3 were expressed more in untreated cells than in UV-VHSV-treated cells where virus replication was inhibited. The results from this study shed light on the mechanisms and pathways used by teleost gill epithelium innate immunity in combating viral and bacterial infection.

Abstract Despite the increased salience of infectious disease risk due to the COVID‐19 pandemic, two recent surveys of the business and scientific communities have found a continued belief in the prominence of environmental risks. In particular, failure to take action on climate change was seen as a highly likely risk whose impacts would become locked‐in barring an immediate global response. These expert opinions are consistent with a growing body of evidence and give us insight into the priorities of global thought leaders who study and respond to risk. Given this alignment in priorities, we argue for the importance of integrating climate and environmental action into responses to emerging threats.

Abstract Background Socioeconomic inequalities could mitigate the impact of social and behavior change (SBC) interventions aimed at improving positive ideation towards the practice of exclusive breastfeeding. This study explores the empirical evidence of inequalities in the practice of exclusive breastfeeding (EBF) and associated ideational dimensions and domains of the theory of Strategic Communication and Behavior Change in three north-western Nigeria states. Methods We used cross-sectional data from 3007 randomly selected women with under-two-year-old children; the convenient regression method was applied to estimate the concentration indexes (CIxs) of exclusive breastfeeding behavior, ranked by household wealth index. Inequality was decomposed to associated ideational factors and sociodemographic determinants. Avoidable inequalities and the proportion of linear redistribution to achieve zero inequality were estimated. Results Women from wealthier households were more likely to practice exclusive breastfeeding CIx = 0.1236, p-value = 0.00). Attendance of at least four antenatal clinic visits (ANC 4+) was the most significant contributor to the inequality, contributing CIx = 0.0307 (p-value = 0.00) to the estimated inequality in exclusive breastfeeding practice. The elasticity of exclusive breastfeeding behavior with respect to partners influencing decision to breastfeed and ANC4+, were 0.1484 (p-value = 0.00) and 0.0825 (p-value = 0.00) respectively. Inequality in the regular attendance at community meetings (CIx = 0.1887, p-value =0.00); ANC 4+) (CIx = 0.3722, p-value = 0.00); and maternal age (CIx = 0.0161, p-value = 0.00) were pro-rich. A 10.7% redistribution of exclusive breastfeeding behavior from the wealthier half to the poorer half of the population could eliminate the inequality (line of zero inequality). Inequalities were mainly in the cognitive and social norms dimension and were all pro-poor. Conclusion Socioeconomic inequalities exist in exclusive breastfeeding behaviors and in associated ideation factors in the three states but are mostly avoidable. A 10.7% redistribution from wealthier to the poorer half of the population will achieve elimination. Messaging for SBC communication interventions to improve breastfeeding practices could be more effective by targeting the mitigation of these inequalities.

Abstract In bone regeneration induced by the combination of mesenchymal stromal cells (MSCs) and calcium-phosphate (CaP) materials, osteoclasts emerge as a pivotal cell linking inflammation and bone formation. Favorable outcomes are observed despite short-term engraftments of implanted MSCs, highlighting their major paracrine function and the possible implication of cell death in modulating their secretions. In this work, we focused on the communication from MSCs towards osteoclasts-like cells in vitro. MSCs seeded on a CaP biomaterial or undergoing induced apoptosis produced a conditioned media favoring the development of osteoclasts from human CD14+ monocytes. On the contrary, MSCs’ apoptotic secretion inhibited the development of inflammatory multinucleated giant cells formed after IL-4 stimulation. Components of MSCs’ secretome before and after apoptotic stress were compared using mass spectrometry-based quantitative proteomics and a complementary immunoassay for major cytokines. CXCR-1 and CXCR-2 ligands, primarily IL-8/CXCL-8 but also the growth-regulated proteins CXCL-1, -2 or -3, were suggested as the major players of MSCs’ pro-osteoclastic effect. These findings support the hypothesis that osteoclasts are key players in bone regeneration and suggest that apoptosis plays an important role in MSCs’ effectiveness.

Abstract As indocyanine green (ICG) with near-infrared (NIR) endoscopy enhances real-time intraoperative tissue microperfusion appreciation, it may also dynamically reveal neoplasia distinctively from normal tissue especially with video software fluorescence analysis. Colorectal tumours of patients were imaged mucosally following ICG administration (0.25 mg/kg i.v.) using an endo-laparoscopic NIR system (PINPOINT Endoscopic Fluorescence System, Stryker) including immediate, continuous in situ visualization of rectal lesions transanally for up to 20 min. Spot and dynamic temporal fluorescence intensities (FI) were quantified using ImageJ (including videos at one frame/second, fps) and by a bespoke MATLAB® application that provided digitalized video tracking and signal logging at 30fps (Fluorescence Tracker App downloadable via MATLAB® file exchange). Statistical analysis of FI-time plots compared tumours (benign and malignant) against control during FI curve rise, peak and decline from apex. Early kinetic FI signal measurement delineated discriminative temporal signatures from tumours (n = 20, 9 cancers) offering rich data for analysis versus delayed spot measurement (n = 10 cancers). Malignant lesion dynamic curves peaked significantly later with a shallower gradient than normal tissue while benign lesions showed significantly greater and faster intensity drop from apex versus cancer. Automated tracker quantification efficiently expanded manual results and provided algorithmic KNN clustering. Photobleaching appeared clinically irrelevant. Analysis of a continuous stream of intraoperatively acquired early ICG fluorescence data can act as an in situ tumour-identifier with greater detail than later snapshot observation alone. Software quantification of such kinetic signatures may distinguish invasive from non-invasive neoplasia with potential for real-time in silico diagnosis.

Introduction: Flow diverters such as the pipeline embolization device (PED) cause hemodynamic changes of the treated vessel segment. In posterior communicating artery (PcomA), aneurysms’ unique anatomic consideration have to be taken in account due to the connection between the anterior and posterior circulation. We hypothesize that in conjunction with PcomA remodeling, there will also be remodeling of the ipsilateral P1 segment of the posterior cerebral artery (PCA) after PED treatment for PcomA aneurysms. Methods: We retrospectively collected radiological as well as clinical data of PcomA aneurysm patients treated with PED including PcomA and P1 vessel diameters before and after treatment as well as patient and aneurysm characteristics. Results: Overall, 14 PcomA aneurysm patients were included for analysis and PED treatment was performed without complications in all patients. In 10 out of 14 patients (71%), a decrease in PcomA diameter was observed and there was a significant mean decrease of 0.78 mm in PcomA diameter on angiographic last follow-up (LFU) (p = 0.003). In the same patient population (10 out of 14 patients), there was meanwhile a significant mean increase of 0.43 mm in the ipsilateral P1 segment diameter observed (p = 0.015). These vessel remodeling effects were in direct correlation with aneurysm occlusion since all of these patients showed aneurysm occlusion at LFU while 29% showed only partial occlusion without vessel remodeling effects. A decrease in PcomA diameter was directly associated with aneurysm occlusion (p = 0.042). There were no neurologic complications on LFU. Conclusion: In the treatment of PcomA aneurysms with PED, the P1 segment of the PCA increases in diameter while the PcomA diameter decreases. Our results suggest that this remodeling effect is associated with aneurysm occlusion and decrease of PcomA is hemodynamically compensated for by an increase in the ipsilateral P1 diameter.

O presente artigo tem como objeto a verificação da contribuição americana ao processo de uniformização do Direito Internacional Privado a partir do estudo dos antecessores das Convenções Especializadas Interamericanas sobre Direito Internacional Privado – CIDIPs. Para tal fim, o artigo fará um recorte histórico, partindo das iniciativas de Simón Bolívar, com a conformação política regional do século XIX, descrevendo o envolvimento dos Estados Americanos na construção do Direito Privado no continente americano, traçando o contexto que permitiu o surgimento das Conferências Especializadas Interamericanas sobre Direito Internacional Privado e a influência desse histórico na elaboração das convenções americanas, destacando as características decisivas no desenvolvimento das codificações, bem como seus principais objetos de Direito Privado. Abordar-se-á o fenômeno da uniformização no Direito Americano, apresentando a recepção e a aplicação do Tratado de Lima de 1878, dos Tratados de Montevidéu de 1888/1889 e sua revisão em 1939/1940, bem como do Código de Bustamante, de 1928. Traçar-se-á um breve comparativo dos principais marcos dos citados Tratados e do Código de Bustamante, expondo as inovações para a integração regional, com foco na cooperação dos temas codificados ao processo de uniformização americana. A metodologia utilizada será a dedução, utilizando-se da investigação legislativa e doutrinária sobre o tema.

Abstract In recent years, German cities were heavily impacted by pluvial flooding and related damage is projected to increase due to climate change and urbanisation. It is important to ask how to improve urban pluvial flood risk management. To understand the current state of property level adaptation, a survey was conducted in four municipalities that had recently been impacted by pluvial flooding. A hybrid framework based on the Protection Motivation Theory (PMT) and the Protection Action Decision Model (PADM) was used to investigate drivers of adaptive behaviour through both descriptive and regression analyses. Descriptive statistics revealed that participants tended to instal more low‐ and medium‐cost measures than high‐cost measures. Regression analyses showed that coping appraisal increased protection motivation, but that the adaptive behaviour also depends on framing factors, particularly homeownership. We further found that, while threat appraisal solely affects protection motivation and responsibility appraisal affects solely maladaptive thinking, coping appraisal affects both. Our results indicate that PMT is a solid starting point to study adaptive behaviours in the context of pluvial flooding, but we need to go beyond that by, for instance, considering factors of the PADM, such as responsibility, ownership, or respondent age, to fully understand this complex decision‐making process.

Flood risk management in Germany follows an integrative approach in which both private households and businesses can make an important contribution to reducing flood damage by implementing property-level adaptation measures. While the flood adaptation behavior of private households has already been widely researched, comparatively less attention has been paid to the adaptation strategies of businesses. However, their ability to cope with flood risk plays an important role in the social and economic development of a flood-prone region. Therefore, using quantitative survey data, this study aims to identify different strategies and adaptation drivers of 557 businesses damaged by a riverine flood in 2013 and 104 businesses damaged by pluvial or flash floods between 2014 and 2017. Our results indicate that a low perceived self-efficacy may be an important factor that can reduce the motivation of businesses to adapt to flood risk. Furthermore, property-owners tended to act more proactively than tenants. In addition, high experience with previous flood events and low perceived response costs could strengthen proactive adaptation behavior. These findings should be considered in business-tailored risk communication.

Context: COVID-19 is especially dangerous to older adults living in residential care.Objective: To evaluate the usefulness of a nurse-led Enhanced Care Home Team (ECHT) SARS-CoV-2 testing strategy to identify resident cases early, identify typical illness presentation residents, and correctly attribute cause of death in care home settings in Norfolk, UK.Method: Residents and staff received nose and throat swab tests (7 April to 29 June 2020). Resident test results were linked with symptoms on days 0–14 after test and mortality to 13 July 2020. The data collected were used to evaluate service performance.Findings: Residents (n = 521) and staff (estimated n = 340) in 44 care homes were tested in the ECHT service. SARS-CoV-2 positivity was identified in 103 residents in 14 homes and 49 staff in 7 homes. Of 103 SARS-CoV-2+ residents, just 37 had what were understood to be typical COVID-19 symptom(s). Among 51 residents without symptoms when initially tested, 13 (25%) developed symptoms within 14 days. Many SARS-CoV-2+ residents lacked typical symptoms but presented rather as ‘generally unwell’ (n = 16). Of 39 resident deaths during the monitoring period, 20 (51%) were initially attributed to SARS-CoV-2, all of whom tested SARS-CoV-2+. One deceased person not initially attributed to SARS-CoV-2 tested positive through a different monitoring programme. Of all staff tests, 9% were positive.Implications: A locally designed and integrated joint nursing and social care team approach successfully identified asymptomatic and pre-symptomatic SARS-CoV-2+ residents and staff. Being ‘generally unwell’ was common amongst symptomatic residents and indicated SARS-CoV-2 infection in older people in the absence of more ‘typical’ symptoms. The service supported correct attribution of cause of death.

Abstract Background In 2015, an outbreak of Zika virus spread across Latin America and the Caribbean (LAC). Public health programs promoted vector control behaviors, including covering water storage containers with lids. Such approaches disrupt Zika transmission by eliminating the habitats of the Aedes aegypti mosquito, which breeds in stagnant water. Methods A quantitative household survey and observation checklist with trained enumerators were undertaken between August and October 2018 in selected urban/peri-urban USAID implementation communities in El Salvador, Guatemala, and Honduras. The survey included questions regarding knowledge, attitudes, and practices related to Zika virus. An accompanying checklist was implemented to observe water storage containers, including for short-term and long-term water use. The characteristics of these containers were tabulated, including the presence of a lid. The lids were examined for key features to determine their potential effectiveness to prevent mosquito breeding: fully covering and sealing the container, not having holes, and not having water on them (potentially creating a secondary breeding site). Multivariate logistic regression was used to estimate the effectiveness of lid types and characteristics on the presence of larvae. Results Overall, in adjusted models, using an effective lid versus no lid was associated with a 94% decrease in odds of larval presence in long-term water storage containers (odds ratio = 0.06; 95% confidence interval [0.029, 0.152]); however, similar impacts were not observed for washbasins in the adjusted models. Models adjusted for household wealth, receiving a visit from a vector control technician, scrubbing the container in the last 7 days, and perception of more mosquitoes around. Conclusions Effective lids, if made available and coupled with complementary behavioral messaging, may reduce transmission of Zika and other Aedes mosquito-borne diseases in the LAC region.

Container-based sanitation (CBS) is increasingly used to provide safely managed sanitation in low-income urban settlements. However, questions remain around the viability of scaling up the technology, partly because it relies on regular emptying and servicing of containers by a CBS provider. This paper investigates mechanisms by which this process can be achieved efficiently. Three separate collection strategies are evaluated for their routing efficiencies as CBS goes to scale. An open-source route optimisation solver determines the constituent driving and walking distances necessary for each strategy and has been applied in areas of Cape Town, Cap-Haïtien, Lima and Nairobi. The results indicate that with fewer users (e.g. 50) transfer station models offer the shortest driving routes. However, these do require users to carry their containers (e.g. up to 170 m when stations are 100 m apart). As the number of users increases (e.g. to 5,000), visiting individual houses from a neighbourhood depot offers increasingly efficient driving distances. Overall, however, the results suggest that economies in collection distances for scaled CBS will be largely conditional on greater vehicle capacity (rather than any particular provision strategy). This highlights the importance of road access throughout low-income urban settlements in providing a viable CBS service at scale. HIGHLIGHTS Container-based sanitation is a form of road-based faecal sludge management.; Efficient routing of collection vehicles is critical for enabling scaled CBS.; This modelling evaluates three existing provision strategies using Google-OR tools.; Transfer stations and depots within neighbourhoods can reduce the required driving.; However, enlarged vehicle capacity offers greatest reductions in collection routing.;

Ordinary differential equations models have a wide variety of applications in the fields of mathematics, statistics, and the sciences. Though they are widely used, these models are sometimes viewed as inflexible with respect to the incorporation of time delays. The Generalized Linear Chain Trick (GLCT) serves as a way for modelers to incorporate much more flexible delay or dwell time distribution assumptions than the usual exponential and Erlang distributions. In this paper we demonstrate how the GLCT can be used to generate new ODE models by generalizing or approximating existing models to yield much more general ODEs with phase-type distributed delays or dwell times.

Study Design A retrospective observational study. Purpose Establish a quantifiable and reproducible measure of sarcopenia in patients undergoing lumbar spine surgery based on morphometric measurements from readily available preoperative computed tomography (CT) imaging. Overview of Literature Sarcopenia—the loss of skeletal muscle mass—has been linked with poor outcomes in several surgical disciplines; however, a reliable and quantifiable measure of sarcopenia for future assessment of outcomes in spinal surgery patients has not been established. Methods A cohort of 90 lumbar spine fusion patients were compared with 295 young, healthy patients obtained from a trauma da¬tabase. Cross-sectional vertebral body (VB) area, as well as the areas of the psoas and paravertebral muscles at mid-point of pedicles at L3 and L4 for both cohorts, was measured using axial CT imaging. Total muscle area-to-VB area ratio was calculated along with intraclass correlation coefficients for interobserver and intraobserver reliability. Finally, T-scores were calculated to help identify those patients with considerably diminished muscle-to-VB area ratios. Results Both muscle mass and VB areas were considerably larger in males compared with those in females, and the ratio of these two measures was not enough to account for large differences. Thus, a gender-based comparison was made between spine patients and healthy control patients to establish T-scores that would help identify those patients with sarcopenia. The ratio for paravertebral muscle area-to-VB area at the L4 level was the only measure with good interobserver reliability, whereas the other three of the four ratios were moderate. All measurements had excellent correlations for intraobserver reliability. Conclusions We postulate that a patient with a T-score