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Abstract Objective After liver transplant (LT), many investigations are needed to evaluate abnormal liver function test (LFT), which has poor specificity for graft function and complication. A single center retrospective audit of all adult single organ LT from 1/1/2015 to 31/12/2017 was performed. Demographic, clinical and investigation data from the LT database and electronic medical records and cost data from the hospital’s Business Intelligence Unit were analyzed. Patients were classified into uncomplicated or complicated LFT by 2 independent investigators and the number, type, and cost of investigations in the first 30 post-operative days were analyzed. Investigations prior to liver biopsy was sub-analyzed. Results There was 170 LT with 87 cases of uncomplicated LFT (51.2%) and 83 cases of complicated LFT (48.8%). Most patients with complicated LFT had additional investigations (97.6%), most commonly cholangiogram (55.4%) and liver biopsy (LBx) (50.6%). The additional investigations cost was $1863.3 (95% CI 1289.0–2437.6). Although most LBx (73.8%) showed evidence of rejection, LBx was often not the initial investigation of choice. Current LFT based post-transplant monitoring is inefficient. It remains difficult to determine which patient will benefit from an early invasive procedure like LBx, using LFT alone without further imaging investigations.

ObjectivesTo evaluate primarily the relationship between postoperative complications and hospital costs, and secondarily the relationship between postoperative complications and mortality, following radical cystectomy.MethodsPostoperative complications were retrospectively examined for 147 patients undergoing radical cystectomy at a university hospital between January 2012 and July 2021. Complications were defined and graded using the Clavien-Dindo classification system. In-hospital cost was calculated using an activity-based costing methodology. Regression modelling was used to investigate the relationships among a priori selected perioperative variables, complications, and costs. The effect of complications on postoperative mortality was ascertained using time-dependent coefficients in a Cox proportional hazards regression model.Results135 (92%) patients experienced one or more postoperative complications. The medians of hospital cost for patients who experienced no complications and those who experienced complications were $42,796.3 (29,222.9-53,532.5) and $81,050.1 (49,614.8-122,533.6) respectively, p < 0.001. Hospital costs were strongly associated with complication severity: Clavien-Dindo grade II complications increased costs by 45.2% (p < 0.001, 95% CI 19.1%-76.6%), and Clavien-Dindo grade III to V complications increased costs by 107.5% (p < 0.001, 95% CI 52.4%-181.8%). Each additional count of complication and increase in Clavien-Dindo complication grade increased the risk of mortality 1.28-fold (RR = 1.28, p = 0.006, 95% CI 1.08-1.53) and 2.50-fold (RR = 2.50, p = 0.012 95% CI 1.23-5.07) respectively.ConclusionsThese findings demonstrate a high prevalence of complications following cystectomy and significant associated increases in hospital costs and mortality. Postoperative complications are a key target for cost-containment strategies.Trial registrationTrial Registration: Australian New Zealand Clinical Trials Registry (ACTRN:12622000057785.

BackgroundUnderstanding the financial implications associated with the complications post-distal pancreatectomy (DP) may be beneficial for the future optimisation of postoperative care pathways and improved cost-efficiency. The primary outcome of this retrospective study was the characterisation of the additional cost associated with postoperative complications following DP. The secondary outcome was the estimation of the prevalence, type and severity of complications post-DP and the determination of which complications were associated with higher costs.MethodsPostoperative complications were retrospectively examined for 62 adult patients undergoing distal pancreatectomy at an Australian university hospital between January 2012 and July 2021. Complications were defined and graded using the Clavien–Dindo (CVD) classification system. In-hospital cost of index admission was calculated using an activity-based costing methodology and was reported in US dollars at 2021 rates. Regression modelling was used to investigate the relationships among selected perioperative variables, complications and costs.Results45 patients (72.6%) experienced one or more postoperative complications. The median (IQR) hospital cost in US dollars was 31.6% greater in patients who experienced complications compared to those who experienced no complications ($40,717.8 [27,358.0–59,834.3] vs. $30,946.9 [23,910.8–46,828.1]). Costs for patients with four or more complications were 43.5% higher than for those with three or fewer complications (p = 0.015). Compared to patients with no complications, the median hospital costs increased by 17.1% in patients with minor complications (CVD grade I/II) and by 252% in patients who developed major complication (i.e., CVD grade III/IV) complications.ConclusionPostoperative complications are a key target for cost-containment strategies. Our findings demonstrate a high prevalence of postoperative complications following distal pancreatectomy with number and severity of postoperative complications being associated with increased hospital costs. (Registered in the Australian New Zealand Clinical Trials Registry [No. ACTRN12622000202763]).

Abstract Background In a randomized controlled trial of 628 Chinese patients with type 2 diabetes receiving multidisciplinary care in the Joint Asia Diabetes Evaluation (JADE) Progam, 372 were randomized to receive additional telephone-based peer support (Peer Empowerment And Remote communication Linked by information technology, PEARL) intervention. After 12 months, all-cause hospitalization was reduced by half in the PEARL group especially in those with high Depression Anxiety and Stress Scale (DASS) scores. Methods We used stratified analyses, negative binomial regression, and structural equation modelling (SEM) to examine the inter-relationships between emotions, self-management, cardiometabolic risk factors, and hospitalization. Results Hospitalized patients were older, more likely to have heart or kidney disease, and negative emotions than those without hospitalization. Patients with high DASS score who did not receive peer support had the highest hospitalization rates. After adjustment for confounders, peer support reduced the frequency of hospitalizations by 48% with a relative risk of 0.52 (95% CI 0·35–0·79;p = 0·0018). Using SEM, improvement of negative emotions reduced treatment nonadherence (Est = 0.240, p = 0.034) and hospitalizations (Est=−0.218, p = 0.001). The latter was also reduced by an interactive term of peer support and chronic kidney disease (Est = 0.833, p =

BackgroundPostoperative complications after major gastrointestinal surgery are a major contributor to hospital costs. Thus, reducing postoperative complications is a key target for cost-containment strategies. We aimed to evaluate the relationship between postoperative complications and hospital costs following small bowel resection.MethodsPostoperative complications were recorded for 284 adult patients undergoing major small bowel resection surgery between January 2013 and June 2018. Complications were defined and graded according to the Clavien-Dindo classification system. In-hospital cost of index admission was calculated using an activity-based costing methodology; it was reported in US dollars at 2019 rates. Regression modeling was used to investigate the relationships among a priori selected perioperative variables, complications, and costs.FindingsThe overall complication prevalence was 81.6% (95% CI: 85.7-77.5). Most complications (69%) were minor, but 22.9% of patients developed a severe complication (Clavien-Dindo grades III or IV). The unadjusted median total hospital cost for patients with any complication was 70% higher than patients without complications (median [IQR] USD 19,659.64 [13,545.81-35,407.14] vs. 11,551.88 [8,849.46-15,329.87], P < 0.001). The development of 1, 2, 3, and ≥ 4 complications increased hospital costs by 11%, 41%, 50%, and 195%, respectively. Similarly, more severe complications incurred higher hospital costs (P < 0.001). After adjustments were made (for the Charlson Comorbidity Index, anemia, surgical urgency and technique, intraoperative fluid administration, blood transfusion, and hospital readmissions), a greater number and increased severity of complications were associated with a higher adjusted median hospital cost. Patients who experienced complications had an adjusted additional median cost of USD 4,187.10 (95% CI: 1,264.89-7,109.31, P = 0.005) compared to those without complications.ConclusionsPostoperative complications are a key target for cost-containment strategies. Our findings demonstrate a high prevalence of postoperative complications following small bowel resection surgery and quantify their associated increase in hospital costs.Trial registrationAustralian Clinical Trials Registration number: 12620000322932.

BackgroundTo determine the frequency of chronic kidney disease (CKD) and its associated risk factors in Chinese type 2 diabetic patients, we conducted a cross-sectional study in Nanjing, China, in the period between January 2008 and December 2009.MethodsPatients with type 2 diabetes under the care by Jiangsu Province Official Hospital, Nanjing, China were invited for assessment. CKD was defined as the presence of albuminuria or estimated glomerular filtration rate

Background and aims: The indication for endoscopy to investigate anemia of causes other than iron deficiency is not clear. Increasing numbers of endoscopic procedures for anemia raises concerns about costs to the health system, waiting times, and patient safety. The primary aim of this study was to determine the diagnostic yield of endoscopy in patients referred to undergo investigation for anemia. Secondary aims were to identify additional factors enabling the risk stratification of those likely to benefit from endoscopic investigation, and to undertake a cost analysis of performing endoscopy in this group of patients. Methods: We performed a retrospective review of endoscopy referrals for the investigation of anemia over a 12-month period at a single center. The patients were divided into three groups: those who had true iron deficiency anemia (IDA), tissue iron deficiency without anemia (TIDWA), or anemia of other cause (AOC). Outcome measures included finding a lesion responsible for the anemia and a significant change of management as a result of endoscopy. A costing analysis was performed with an activity-based costing method. Results: We identified 283 patients who underwent endoscopy to investigate anemia. A likely cause of anemia was found in 31 of 150 patients with IDA (21 %) and 0 patients in the other categories (P

Objective. While the low dose short Synacthen® test (LDSST) is considered to be the gold standard to evaluate adrenal function, it is labor-intensive, invasive and inconvenient. The aim of the study is to identify cut-offs for spot serum cortisol for in-patients and morning serum cortisol for out-patients. The study also aims to describe the disease spectrum leading to suspicion of adrenal insufficiency in a Chinese out-patient cohort. Methodology. Adult patients were recruited from a tertiary hospital in Hong Kong. 423 in-patients were included consecutively from July 2013 to December 2013, and 422 out-patients from June 2014 to October 2014. Serum cortisol responses at 0, 20 and 30 minutes were evaluated. Results. For in-patients admitted for acute illness, a spot serum cortisol of ≤92 nmol/L indicated adrenal insufficiency, and a value of ≥494 nmol/L signaled adequate adrenal reserve. The respective morning cortisol values for out-patients who were ambulatory and not under stress were ≤124 nmol/L and ≥428 nmol/L. The percentage of unnecessary LDSST was higher in the in-patient cohort than the out-patient cohort (43% and 37%, respectively). The most common referral for out-patient LDSST was for suspected iatrogenic Cushing’s syndrome (ie: iatrogenic adrenal suppression) from Rheumatology. Conclusions. The LDSST is of little added value in in-patients with spot serum cortisol of ≤92 nmol/L or ≥494 nmol/L and out-patients with morning serum cortisol of ≤124 nmol/L or ≥428 nmol/L. Spot and morning cortisol levels, for in and out-patients respectively, should be incorporated into endocrine protocols preceding the LDSST in the workup of adrenal insufficiency

Abstract Big data can revolutionize research and quality improvement for cardiac ultrasound. Text reports are a critical part of such analyses. Cardiac ultrasound reports include structured and free text and vary across institutions, hampering attempts to mine text for useful insights. Natural language processing (NLP) can help and includes both statistical- and large language model based techniques. We tested whether we could use NLP to map cardiac ultrasound text to a three-level hierarchical ontology. We used statistical machine learning (EchoMap) and zero-shot inference using GPT. We tested eight datasets from 24 different institutions and compared both methods against clinician-scored ground truth. Despite all adhering to clinical guidelines, institutions differed in their structured reporting. EchoMap performed best with validation accuracy of 98% for the first ontology level, 93% for first and second levels, and 79% for all three. EchoMap retained performance across external test datasets and could extrapolate to examples not included in training. EchoMap’s accuracy was comparable to zero-shot GPT at the first level of the ontology and outperformed GPT at second and third levels. We show that statistical machine learning can map text to structured ontology and may be especially useful for small, specialized text datasets.

Abstract Background Aedes aegypti is the primary vector of dengue, chikungunya, and Zika viruses in Colombia. Various insecticides, including pyrethroid, organophosphate, and carbamate insecticides; growth regulators; and biological insecticides, such as Bacillus thuringiensis var. israelensis, have been used to control Ae. aegypti populations. However, organophosphates such as malathion, pirimiphos-methyl, and temephos have been used over the last decade owing to the high resistance to pyrethroids. Methods This study assessed the susceptibility to organophosphates in 14 Ae. aegypti populations from the Córdoba department in northern Colombia. Moreover, possible resistance mechanisms were investigated by determining the activity levels of α-esterases, β-esterases, mixed function oxidases (MFOs), glutathione S-transferases (GSTs), and insensitive acetylcholinesterase (iAChE). Additionally, the Ace-1 gene was sequenced to identify mutations at the target site of action. Results The populations were susceptible to temephos and malathion but resistant to fenitrothion, and in three of them, to pirimiphos-methyl. Alterations in the enzyme activity levels of α-esterases and β-esterases, GST, and iAChE were observed among the populations, with high enzyme activity levels of α and β esterases associated with resistance to fenitrothion. No mutations were identified in the Ace-1 gene. Conclusions These findings are highly relevant for vector control programs in the region, as they allow for adjustments in resistance management strategies and improve the effectiveness of interventions against these arboviruses. Graphical Abstract

Abstract Background Sarcopenia is a prevalent muscle disorder in old people leading to higher fracture rate, mortality, and other adverse clinical outcomes. Evidence indicates that short‐chain fatty acids (SCFAs), which are beneficial gut microbial metabolites, were reduced in old people with sarcopenia. This study aimed to determine whether the use of SCFAs as a supplement can be a therapeutic strategy of sarcopenia in a pre‐clinical model. Methods Seven‐month‐old pre‐sarcopenic senescent accelerated mouse prone 8 (SAMP8) mice received daily SCFAs cocktail (acetate, butyrate, and propionate) for 3 months. Age‐matched senescence accelerated mouse resistant 1 (SAMR1) and SAMP8 mice receiving sodium‐matched drinking water were control groups. The gut microbiota composition analysis of aged mice with or without sarcopenia was conducted by 16S rDNA sequencing. Gut barrier‐related proteins and lipopolysaccharide (LPS) concentration were biomarkers of gut permeability. Colon inflammation levels, circulatory SCFAs concentration, muscle quality, function, and underlying pathways were detected by cell number counting, RT‐qPCR, gas chromatography–mass spectrometry, measurements of muscle wet weight and grip strength, ex vivo functional test, treadmill endurance test, transcriptomic sequencing, morphological and immunofluorescent staining, as well as western blot. To investigate the role of mTOR signalling pathways in SCFAs treatment, C2C12 myotubes were treated with rapamycin. Results Aged SAMP8 mice had different microbiota composition, and lower serum butyric acid compared with SAMR1 mice (P

ABSTRACT: Vitamin D3 is essential for several functions in the human body and the demand is usually covered by natural reactions in skin with UV radiation delivered by the sun. But living beyond a latitude of 35° can lead to a lack of sufficient exposure to the deciding wavelength. Here, many countries fortify their milk prophylactically with artificial vitamin D3. However, the precursor molecule of vitamin D3 (7-deydrocholesterol) is already naturally located in the milk fat globule membrane. Thus, this study deals with the transformation of the naturally occurring 7-dehydrocholesterol into vitamin D3 through UV treatment of the milk—a mechanism that was observed a century ago only indirectly. Different parameters such as temperature (10–50°C), fluid flow regimen (turbulent vs. laminar thin film, i.e., 0.6 mm), and wavelength (254, 280, and 313 nm) were investigated in this study for their efficiencies. The UV dose of each experiment was measured, with chemical actinometry delivering the actual applied dose reaching the milk. Thus, the connection between applied UV dose and generated vitamin D3 content in the milk measured quantitively with liquid chromatography-MS/MS was evaluated here; neither of these measurements were possible a hundred years ago. The experimental results revealed that temperature generally promotes vitamin D3 formation at 254 nm. Furthermore, a turbulent flow is not as efficiently treated as a laminar thin film flow that is as narrow as 0.6 mm. As expected from absorbance spectra of the precursor molecule 7-dehydrocholesterol, 280 nm turned out to be the most efficient wavelength, followed by intermediate success through irradiation with 254 nm and almost no effect by 313 nm. Generally, it was shown that the vitamin D3 concentration of milk was easily increased by UV treatment with today's technologies and that adjustment of certain physical parameters have a distinct effect on the efficiency of the process.

The Pacific Plate is one of the heaviest tectonic plates, hosting multiple Pacific Island countries. Geological research has long provided evidence of volcanic magmatic events, which have frequently caused subsurface activities. The formation of an active ring of fires across the Pacific Ocean is a geological signature of the intense volcanic events occurring over time. The study aims to verify the close correlation between groundwater features and volcanic magmatic events, which is evident in near-surface ground signatures and geothermal systems. Hot water springs and geysers emerge as manifestations of the active molten volcanic processes, releasing intense heat flux, gases, and pressure. Pacific Island countries exhibit common geological features, particularly in terms of parent rock materials, resulting in a unique combination of aquifer characteristics essential for long-term hydrological sustainability. The sustainability of groundwater resources is intricately linked with volcanic events and their associated signatures, which emerge abruptly over time. Furthermore, the study is to access the correlation of the pacific geological features within Fiji and various regions and its usages in terms of implementing water resources upon the identification of the active aquifers in the terrestrial and coastal plains. Fieldwork using various tomography methods from various regional countries executed by the Secretariat of the Pacific Community through the implementation of various programs has provided various supporting evidence that the magmatic activities featured by dikes, basins, and aquifers have water holding capacity which is hydrogeological connected to the main water aquifer.

Background: Hip fractures are one of the most serious forms of fragility fractures. Low-magnitude high-frequency vibration (LMHFV) is a biophysical intervention that provides non-invasive, systemic mechanical stimulation. The objectives of this study were to investigate the efficacy of LMHFV in trochanteric hip fracture elderly patients to (i) accelerate trochanteric fracture healing and (ii) improve clinical and functional outcomes. Methods: A randomized double-blinded, placebo-controlled clinical trial was conducted. Participants were randomly assigned into LMHFV or placebo intervention for 14 days. Primary outcome assessments were fracture healing assessed with CT scan and X-rays. Dual X-ray Absorptiometry (DXA) scan was performed to assess bone mineral density change. Secondary outcome assessments were clinical and functional outcomes with quadriceps muscle strength, balancing ability, handgrip strength, Time Up and Go (TUG) test, quality of life outcomes, pain, falls, and mortality. Results: 237 patients were screened for eligibility by the inclusion and exclusion criteria. 62 patients were recruited and randomly assigned to placebo group (n = 32, mean age: 83.6 ± 7.0 years, women: 71.9 %) or LMHFV group (n = 30, mean age: 81.5 ± 5.7 years, women: 73.3 %). For fracture healing, CT scan at 6 weeks showed improved osseous union for the LMHFV group at 71.5 ± 19.4 % compared to placebo group at 58.8 ± 30.5 %, but no statistical significance detected. X-rays showed fractures healed at 12 months. LMHFV group had significantly higher quadriceps muscle strength compared to placebo group on affected leg using maximum reading (week 26: 8.8 ± 3.6 kg vs. 6.1 ± 4.1 kg; p = 0.011) and average reading (week 26: 8.0 ± 3.7 kg vs. 5.2 ± 3.3 kg; p = 0.008) amongst 3 trials. The balancing ability test could not be performed in most of the subjects at the baseline measurement. However, from week 6 to week 26, LMHFV group had significantly improved balancing compared to placebo group for overall stability index (week 26: 1.6 ± 1.1 vs. 3.4 ± 2.6; p = 0.006), anteroposterior stability index (week 26: 1.1 ± 0.7 vs. 2.1 ± 1.9; p = 0.048) and medial-lateral stability index (week 26: 0.9 ± 0.7 vs. 2.2 ± 2.2; p = 0.008). There was a significant increase in success in performing TUG test in LMHFV group from baseline (13.3 %) to 26 weeks (57.1 %) (p = 0.004). Quality-of-life outcomes by SF-36 showed LMHFV group had a significant improvement at a score of 62.1 ± 18.9 compared to control group at a score of 48.5 ± 18.9 after adjusting for the baseline measurement (p = 0.044). Conclusion: A short duration of LMHFV during in-patient stay can improve clinical outcomes and can potentially be incorporated as a practical measure during the recovery of fragility hip fractures. The translational potential of this article: 14 days of LMHFV treatment is generally within the common in-patient stay period for hip fracture patients and therefore can potentially be incorporated into clinical practice with physiotherapy to facilitate recovery of hip fracture patients. Clinical trial registration number: NCT04063891.

A quantitative approach was adopted for the study. The study population consisted of four hundred retail employees, 200 research instruments were administered and 102 useable ones were retrieved. Analysis was done by using Multiple Regression and Pearson Correlation. It was revealed that the Time of Introduction has a positive effect on the perceived Relevance of New Technology and Fairness of Performance Appraisal (F = 49.647 with a P value of P

Background: Romosozumab is a novel monoclonal antibody that binds to sclerostin, and has dual effects of increasing bone formation and decreasing bone resorption, giving it a unique mechanism of action. The objective of this study was to perform a systematic review and meta-analysis based on existing worldwide data on treatment effects and safety of romosozumab in randomized controlled trials. Methods: A systematic search was carried out on four databases including PubMed, Embase, Web of Science and Cochrane Central Register of Controlled Trials (CENTRAL). The keywords used for search was “(romosozumab) AND (osteoporosis OR safety)”. Randomized controlled trial or post-hoc studies of the included randomized controlled trial which studied the effects and safety of romosozumab were included. The quality of selected studies was assessed with the Cochrane collaboration tool and the PEDro scale. Results: 20 studies were included for qualitative analysis. 14 studies were included for meta-analysis. In total, there were 13,507 (n = 13,507) participants with 637 men and 12,870 women from original cohorts. The overall mean difference was in favor of romosozumab treatment for lumbar spine (10.04 (95 % confidence interval (CI) = 7.51–12.57; p

Summary: Background: Children from racial and ethnic minority groups are at greater risk for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, but it is unclear whether they have increased risk for post-acute sequelae of SARS-CoV-2 (PASC). Our objectives were to assess whether the risk of respiratory and neurologic PASC differs by race/ethnicity and social drivers of health. Methods: We conducted a retrospective cohort study of individuals

Objectives The goal of the current study was to assess the effectiveness of a peer integrated collaborative care intervention for postinjury outcomes.Methods Injury survivors ≥18 years of age were screened for post-traumatic stress disorder (PTSD) symptoms and severe postinjury concerns; screen-positive patients were randomized to the intervention versus enhanced usual care control conditions. The collaborative care intervention included peer support and care management. The intervention also included evidence-based pharmacotherapy and psychotherapeutic elements targeting PTSD. The COVID-19 pandemic interrupted recruitment between March and June 2020; in response to the COVID-19 pandemic, the peer component of the intervention went from in-person to virtual delivery. The primary outcomes were PTSD symptoms assessed with the Diagnostic and Statistical Manual of Mental Disorders fourth edition PTSD checklist, any severe postinjury concerns, and emergency department/inpatient utilization followed over the 12 months postinjury. Secondary outcomes included patient satisfaction with emotional healthcare.Results A total of 450 patients were randomized to the intervention (n=225) and control (n=225) conditions; 124 patients (28%) were recruited and completed all study assessments prior to the onset of the COVID-19 pandemic, while 326 patients (72%) were recruited after and/or had one or more study follow-ups occur postpandemic onset. Mixed model regression revealed no statistically significant comparisons for any of the primary outcomes. In exploratory models that examined the impact of COVID-19, significantly improved PTSD symptoms were present at 3 months pre-COVID-19 relative to post-COVID-19. Intervention patients consistently demonstrated higher satisfaction with emotional aspects of healthcare (F(5,1652)=2.87, p=0.01).Conclusions The intervention demonstrated no significant improvements in primary outcomes in the intent-to-treat sample. The peer integrated collaborative care intervention contributed to higher patient satisfaction with the emotional aspects of healthcare.Level of evidence Level II, randomized clinical trial.Trial registration number NCT03569878.

Background: People with disability are a vulnerable population and are at a high risk of acquiring human immunodeficiency virus (HIV) infection. Objectives: We investigated the association between severity of disability and not having knowledge of any HIV prevention method among adults in Uganda. Method: Between January 2015 and December 2015, data were collected within a general population in Uganda, on six domains of disability based on the Washington Group Short Set on Functioning. In addition, routine data on socio-demographic factors and other HIV-related data were collected among adults aged 16 years and above. A continuum of functioning was developed: without disability, mild, moderate and severe. Bivariate and multivariate associations of disability and not knowing any HIV prevention method were fitted using logistic regression models. Results: A total of 3,331 adults (60.4% female) were included. Of these, 14.5% (n = 482) were classified as having either moderate or severe disability, and this proportion exponentially increased with age (p 0.001). Overall, 4.2% (n = 140) reported not knowing any HIV prevention method, with a slightly higher proportion among females than males (3.1% in males, 4.9% in females). Compared to people with no disability, those with moderate or severe disability were 5 times more unlikely to know any HIV prevention methods (adjusted odds ratio = 5.45, 95% confidence interval = 3.25 -9.13, p 0.001). Additionally, the combined effect of moderate and severe disability and none/incomplete primary education increased the likelihood of not knowing HIV prevention methods over and beyond their separate effects (p 0.001). Conclusion: Effective HIV prevention strategies must integrate best practices that target people with disabilities. Contribution: These findings contribute to the evidence of the lack of HIV prevention knowledge among people with disabilities in general populations.

Introduction Malnutrition contributes to 45% of all childhood deaths globally, but these modelled estimates lack direct measurements in countries with high malnutrition and under-5 mortality rates. We investigated malnutrition’s role in infant and child deaths in the Child Health and Mortality Prevention Surveillance (CHAMPS) network.Methods We analysed CHAMPS data from seven sites (Bangladesh, Ethiopia, Kenya, Mali, Mozambique, Sierra Leone and South Africa) collected between 2016 and 2023. An expert panel assessed each death to determine whether malnutrition was an underlying, antecedent or immediate cause or other significant condition. Malnutrition was further classified based on postmortem anthropometry using WHO growth standards for underweight (z-scores for weight-for-age

In sub-Saharan Africa, the parasitic Alectra vogelii is seriously threatening Bambara groundnuts, farmers to suffer yield losses of up to 100 %. The objective of this study was to determine the effects of phosphorus (P) application and Alectra vogelii inoculation on Bambara groundnut genotypes for growth and reproductive phrase. The experiment was conducted in 2020 at the Henderson Research Station in Mazowe, Zimbabwe in a 2 × 2 × 26 factorial design with 26 genotypes arranged in a completely randomized design (CRD) with four replications, two P rates (0 and 20 kg ha-1) and two levels of inoculation (with and without Alectra vogelii). Half of the perforated black plastic bags were inoculated with Alectra vogelii seeds. The results showed a significant (p

Mango is a popular tropical fruit known worldwide and mango peel is a waste product worthy of valorization. This study explores the stabilizing effect of hydrocolloids extracted from mango peel in dressing-type emulsions (DE). Emulsions stabilized with different ratios of mango (Mangifera indica) peel-derived hydrocolloids (PE) and guar gum (1 % wt. total concentration) were prepared and characterized: DE1 (0.25/075), DE2 (0.5/0.5), DE3 (0.75/0.25) and DE4 (1/0). Particle size distribution, ζ-potential, proximal composition, color, microstructure, and rheological properties were evaluated. All the samples showed similar proximal compositions. However, PE/guar gum ratio influences color parameters. For the microstructural analysis, Sauter's mean droplet size ranged from 6.41 to 11.11 µm. The ζ- potential values ranged from −18.03±0.21 to −16.97 mV. Emulsions exhibited shear thinning responses that can be well described by the Williamson model, and gel-like viscoelastic character with G’ higher than G”. The activation energy values (Eα) deduced from the application of an Arrhenius model to the viscous flow behaviour of the emulsions ranged from 108.46 to 143.44 Kj/mol. From the microstructural analysis and the rheological characterization, it can be inferred that PE favors the flocculation of the emulsion droplet in high concentrations. Overall, this research contributes to the sustainable exploitation of a mango waste material, such as the peel, in food emulsions.

Triticale (× Triticosecale Wittmack), an edible hybrid of rye and wheat, is known for its superior agronomic traits. This study investigates the patterns of 5-n-alk(en)ylresorcinols (AR), phenolic lipids with diverse biological activities, in fresh and dried triticale across developmental stages. Total AR (TAR) content and LC-MS and GC-MS analyses were performed for profiling extracts obtained by solvent-assisted and supercritical fluid extraction methods. All triticale plant parts accumulated ARs, revealing significant distinctions in content and profiles between fresh and dry basis. CO2-extracted dry spikes at late stages and solvent-extracted fresh and dry leaves at the earliest stage exhibited the highest TAR content. Moreover, triticale kernels showcased a broader AR homolog diversity. Semi-quantitative AR levels varied based on plant parts and ontogeny, suggesting constitutive roles during growth. These insights into temporal and spatial distribution offer valuable information for determining optimal harvesting times, quality, and material condition for future breeding studies in triticale.

Bambara groundnuts (Vigna subterranea (L.) Verdc) provide essential proteins for African farmers, but the yield is largely affected by Alectra vogelii infestation, particularly on nutrient-depleted soils. Laboratory and field investigations were conducted to assess the influence of phosphorus rates and Bambara groundnut genotypes on Alectra vogelii infestation. In the laboratory, a 4 × 26 factorial experiment, varying phosphorus rates (0, 20, 30 and 40 kg ha−1) across 26 genotypes, revealed a significant (p

Rainfall variability and low soil fertility are negatively affecting sorghum grain yield in smallholder farming systems. This study investigated the effect of contour-based rainwater harvesting (RWH) systems and cattle manure on grain yield of two sorghum varieties Macia and Sc Sila. A factorial experiment was laid out in a split-split plot design and replicated three times. Rainwater harvesting practice (tied contour, infiltration pits, standard contour) were the main plot factor, sorghum variety (Macia, Sc Sila) sub-plot factor, cattle manure application rates (0; 5; 8; 10; 15; 20) t/ha sub-sub plot factor, and distance from rainwater harvesting practice (0–5 m; 5–10 m; 10–15 m) sub-sub-sub plot factor. Grain yield under tied contour (TC) and infiltration pits (IP) rainwater harvesting systems were compared with the control - standard contour (SC). The results showed that TC and IP improved soil moisture content by 1.83% and 1.71% respectively compared to SC. Sorghum grain yield was significantly higher (p IP (2.10 t/ha) > SC (1.49 t/ha) at cattle manure application rate of 20 t/ha. Sorghum variety Macia had the highest grain yield of 2.01 t/ha at cattle manure application of 20 t/ha. In both sorghum varieties, TC and IP had higher sorghum grain yields than SC at all distances from the RWH practice in both seasons (2016/17 and 2017/18). The findings suggest that the use of TC and SC RWH practices, and cattle manure may increase sorghum grain yields in rain-fed smallholder farming systems.

Abstract Background This study introduced an Augmented Reality (AR) navigation system to address limitations in conventional high tibial osteotomy (HTO). The objective was to enhance precision and efficiency in HTO procedures, overcoming challenges such as inconsistent postoperative alignment and potential neurovascular damage. Methods The AR-MR (Mixed Reality) navigation system, comprising HoloLens, Unity Engine, and Vuforia software, was employed for pre-clinical trials using tibial sawbone models. CT images generated 3D anatomical models, projected via HoloLens, allowing surgeons to interact through intuitive hand gestures. The critical procedure of target tracking, essential for aligning virtual and real objects, was facilitated by Vuforia’s feature detection algorithm. Results In trials, the AR-MR system demonstrated significant reductions in both preoperative planning and intraoperative times compared to conventional navigation and metal 3D-printed surgical guides. The AR system, while exhibiting lower accuracy, exhibited efficiency, making it a promising option for HTO procedures. The preoperative planning time for the AR system was notably shorter (4 min) compared to conventional navigation (30.5 min) and metal guides (75.5 min). Intraoperative time for AR lasted 8.5 min, considerably faster than that of conventional navigation (31.5 min) and metal guides (10.5 min). Conclusions The AR navigation system presents a transformative approach to HTO, offering a trade-off between accuracy and efficiency. Ongoing improvements, such as the incorporation of two-stage registration and pointing devices, could further enhance precision. While the system may be less accurate, its efficiency renders it a potential breakthrough in orthopedic surgery, particularly for reducing unnecessary harm and streamlining surgical procedures.

Abstract Sarcopenia is a complex age-associated syndrome of progressive loss of muscle mass and strength. Although this condition is influenced by many factors, age-related changes in immune function including immune cell dynamics, and chronic inflammation contribute to its progression. The complex interplay between the immune system, gut-muscle axis, and autophagy further underscores their important roles in sarcopenia pathogenesis. Immunomodulation has emerged as a promising strategy to counteract sarcopenia. Traditional management approaches to treat sarcopenia including physical exercise and nutritional supplementation, and the emerging technologies of biophysical stimulation demonstrated the importance of immunomodulation and regulation of macrophages and T cells and reduction of chronic inflammation. Treatments to alleviate low-grade inflammation in older adults by modulating gut microbial composition and diversity further combat sarcopenia. Furthermore, some pharmacological interventions, nano-medicine, and cell therapies targeting muscle, gut microbiota, or autophagy present additional avenues for immunomodulation in sarcopenia. This narrative review explores the immunological underpinnings of sarcopenia, elucidating the relationship between the immune system and muscle during ageing. Additionally, the review discusses new areas such as the gut-muscle axis and autophagy, which bridge immune system function and muscle health. Insights into current and potential approaches for sarcopenia management through modulation of the immune system are provided, along with suggestions for future research directions and therapeutic strategies. We aim to guide further investigation into clinical immunological biomarkers and identify indicators for sarcopenia diagnosis and potential treatment targets to combat this condition. We also aim to draw attention to the importance of considering immunomodulation in the clinical management of sarcopenia.

Abstract We present GPSat; an open-source Python programming library for performing efficient interpolation of non-stationary satellite altimetry data, using scalable Gaussian process techniques. We use GPSat to generate complete maps of daily 50 km-gridded Arctic sea ice radar freeboard, and find that, relative to a previous interpolation scheme, GPSat offers a 504 × computational speedup, with less than 4 mm difference on the derived freeboards on average. We then demonstrate the scalability of GPSat through freeboard interpolation at 5 km resolution, and Sea-Level Anomalies (SLA) at the resolution of the altimeter footprint. Interpolated 5 km radar freeboards show strong agreement with airborne data (linear correlation of 0.66). Footprint-level SLA interpolation also shows improvements in predictive skill over linear regression. In this work, we suggest that GPSat could overcome the computational bottlenecks faced in many altimetry-based interpolation routines, and hence advance critical understanding of ocean and sea ice variability over short spatio-temporal scales.

Background: The interaction between muscle and bone is shown to be clinically important but the underlying mechanisms are largely unknown. The canonical Wnt/β-catenin signaling pathway is reported to be involved in muscle-bone crosstalk, but its detailed function remains unclear. This systematic review aims to investigate and elucidate the role of the Wnt/β-catenin signaling pathways in muscle-bone crosstalk. Methods: We conducted a literature search on the Web of Science, PubMed, EBSCO and Embase with keywords “Wnt*”, “bone*” and “muscle*”. A systematic review was completed according to the guideline of preferred reporting items of systematic reviews and meta-analyses (PRISMA). Data synthesis included species (human, animal or cell type used), treatments involved, outcome measures and key findings with respect to Wnts. Results: Seventeen papers were published from 2007 to 2021 and were extracted from a total of 1529 search results in the databases of Web of Science (468 papers), PubMed (457 papers), EBSCO (371) and Embase (233). 12 Wnt family members were investigated in the papers, including Wnt1, Wnt2, Wnt2b, Wnt3a, Wnt4, Wnt5a, Wnt8a, Wnt8b, Wnt9a, Wnt10a, Wnt10b and Wnt16. Many studies showed that muscles were able to increase or decrease osteogenesis of bone, while bone increased myogenesis of muscle through Wnt/β-catenin signaling pathways. Wnt3a, Wnt4 and Wnt10b were shown to play important roles in the crosstalk between muscle and bone. Conclusions: Wnt3a, Wnt4 and Wnt10b are found to play important mediatory roles in muscle-bone crosstalk. The role of Wnt4 was mostly found to regulate muscle from the bone side. Whilst the role of Wnt10b during muscle ageing was proposed, current evidence is insufficient to clarify the specific role of Wnt/β-catenin signaling in the interplay between sarcopenia and osteoporosis. More future studies are required to investigate the exact regulatory roles of Wnts in muscle-bone crosstalk in musculoskeletal disease models such as sarcopenia and osteoporosis. Translational potential of this article: The systematic review provides an extensive overview to reveal the roles of Wnt/β-catenin signaling pathways in muscle-bone crosstalk. These results provide novel research directions to further understand the underlying mechanism of sarcopenia, osteoporosis, and their crosstalk, finally helping the future development of new therapeutic interventions.

ABSTRACT Background Patient adherence is a key factor in achieving orthodontic treatment success. Despite an evolution in orthodontic healthcare, no recent comprehensive reviews are available on patient adherence in orthodontics. This scoping review provides an evidence-based overview of the literature available on multiple aspects of patient adherence in orthodontics, during both active treatment as well as during the retention phase. Knowledge gaps identified in the literature are listed. Methods The protocol for this scoping review was registered in the Open Science Framework ( https://doi.org/10.17605/OSF.IO/EC6QD ). Electronic databases and reference lists of relevant studies were searched up to 9 February 2023. The inclusion criteria were studies investigating any form of patient adherence in orthodontics published in English from 2006 onwards. The exclusion criteria were studies investigating adherence in the following patients: those with an intellectual or physical disability that could affect their ability to coincide with their therapist’s recommendations and advice, those with oral cleft and craniofacial conditions, and those treated solely for obstructive sleep apnoea. Non-peer-reviewed studies and case reports were also excluded. Results A total of 3284 articles were identified, 60 of which met the criteria for final inclusion. Conclusions There is no conclusive evidence on which factors have a significant impact on patient adherence and how patient adherence can be promoted. The degree of patient adherence is generally not compared to achieved treatment results or stability of treatment results, making it difficult to provide clear statements about the impact of the degree of adherence on desired treatment results or orthodontic stability.

Urinary dysfunction following treatment for rectal adenocarcinoma is a common and complex complication. We present a case of a 69-year-old male who underwent laparoscopic-assisted left hemicolectomy and loop ileostomy after receiving chemotherapy and radiation therapy for rectal adenocarcinoma. Postoperatively, it was incidentally discovered the patient had urinary frequency and urgency. Cystoscopy revealed radiation changes to the bladder walls and a bladder leak was confirmed by cystogram. The patient underwent successful repair of the urinary bladder leak, with challenges posed by prior radiation therapy. Effective prevention and management strategies for urinary dysfunction require a comprehensive preoperative risk assessment, consideration of nerve-preserving surgical techniques, and prompt identification and repair of postoperative complications.

Abstract In a rapidly urbanizing world, heavy air pollution and increasing surface temperature pose significant threats to human health and lives, especially in densely populated cities. In this study, we took an information theory perspective to investigate the causal relationship between diel land surface temperature (LST) and transboundary air pollution (TAP) from 2003 to 2020 in the Bangkok Metropolitan Region (BMR), which includes Bangkok Metropolis and its five adjacent provinces. We found an overall increasing trend of LST over the study region, with the mean daytime LST rising faster than nighttime LST. Evident seasonal variations showed high aerosol optical depth (AOD) loadings during the dry period and low loadings at the beginning of the rainy season. Our study revealed that TAP affected diel surface temperature in Bangkok Metropolis significantly. Causality tests show that air pollutants of two adjacent provinces west of Bangkok, i.e., Nakhon Pathom and Samut Sakhon, have a greater influence on the LST of Bangkok than other provinces. Also, the bidirectional relationship indicates that air pollution has a greater impact on daytime LST than nighttime LST. While LST has an insignificant influence on AOD during the daytime, it influences AOD significantly at night. Our study offers a new approach to understanding the causal impact of TAP and can help policymakers to identify the most relevant locations that cause pollution, leading to appropriate planning and management.

The neuromuscular junction (NMJ) is a specialized chemical synapse that converts neural impulses into muscle action. Age-associated NMJ degeneration, which involves nerve terminal and postsynaptic decline, denervation, and loss of motor units, significantly contributes to muscle weakness and dysfunction. Although physical training has been shown to make substantial modifications in NMJ of both young and aged animals, the results are often influenced by methodological variables in existing studies. Moreover, there is still lack of strong consensus on the specific effects of exercise on improving the morphology and function of the ageing NMJ. Consequently, the purpose of this study was to conduct a systematic review to elucidate the effects of exercise training on NMJ compartments in the elderly.We conducted a systematic review using PubMed, Embase, and Web of Science databases, employing relevant keywords. Two independent reviewers selected studies that detailed NMJ changes during exercise in ageing, written in English, and available in full text.In total, 20 papers were included. We examined the altered adaptation of the NMJ to exercise, focusing on presynaptic and postsynaptic structures and myofibers in older animals or humans. Our findings indicated that aged NMJs exhibited different adaptive responses to physical exercise compared to younger counterparts. Endurance training, compared with resistance and voluntary exercise regimens, was found to have a more pronounced effect on NMJ structural remodeling, particularly in fast twitch muscle fibers. Physical exercise was observed to promote the formation and maintenance of acetylcholine receptor (AChR) clusters by increasing the recombinant docking protein 7 (Dok7) expression and stabilizing Agrin and lipoprotein receptor-related protein 4 (LRP4). These insights suggest that research on exercise-related therapies could potentially attenuate the progression of neuromuscular degeneration.Translational potential of this article: This systematic review provides a detailed overview of the effects of different types of physical exercise on improving NMJ in the elderly, providing scientific support for the timely intervention of muscle degeneration in the elderly by physical exercise, and providing help for the development of new therapeutic interventions in the future.

Abstract In the smallholder farming areas located in semi-arid regions of Zimbabwe, low and unreliable rainfall distribution and poor soil fertility are the major factors limiting crop production. The negative effects of these biophysical factors have been worsened by climate change. However, the major challenges have been the lack of sustainable, low-cost water and nutrient management technologies for these semi-arid regions. The objectives of this study were to evaluate the effects of contour-based rainwater harvesting (RWH) namely tied contours (TC), infiltration pits (IP) which were compared with the standard contour (STDC), and intergrated nutrient management (INM) where cattle manure was used as basal fertiliser and Ammonium Nitrate (AN) as top dressing, on maize yields. Results showed that fields with RWH had higher yields compared to STDC. Average maize yields were 2210 and 1792 kg ha−1 for TC and IP which were 88% and 52% above STDC (1176 kg ha−1) respectively. Increasing nitrogen (N) levels resulted in a further increase in maize yields. Return on investment was negative during drier years and was significantly higher in RWH systems compared with STDC during wet seasons. Farmers need to reduce mineral fertiliser application during dry seasons since little rainwater is captured. We conclude that contour based RWH and INM can be used as sustainable low cost methods of crop production. Higher fertiliser application rates when rainfall is limiting, do not result in increased return on investiment.

Abstract The food and culinary heritage with medicinal uses are a fascinating field that combines history, culture, and health through food. Over the centuries, various cultures have developed knowledge and practices related to the use of specific ingredients and culinary preparations with medicinal properties. In the Pungalá parish in Ecuador, these generational knowledge and traditions form a valuable biocultural heritage that helps us understand the close relationship between food and traditional medicine. Through qualitative and documentary research, interviews and community workshops are conducted to gather information using different techniques. Among the findings regarding the food and culinary heritage of Pungalá are extinct culinary traditions, as well as important culinary techniques and processes that play a role in nutrition and medicine, valuing traditional and ancestral knowledge as part of their culture. The inventory includes 22 plants used in Andean medicine and 38 preparations, including beverages, porridges, stews, soups, and wrapped dishes that become an integral part of everyday routines, dietary habits, and festive traditions. It is concluded that this knowledge constitutes a valuable food and culinary heritage, and its biocultural is based on ancestral knowledge of the healing properties of local plants and foods, contributing to the health and identity of the community. Measures should be taken to preserve and promote this heritage in the face of current challenges.