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Background Paediatric sepsis remains a significant contributor to morbidity and mortality, particularly in low- and middle-income countries (LMICs), where healthcare resources are often limited. Paediatric sepsis bundles, which include prompt administration of antibiotics, fluid resuscitation and continuous organ function monitoring, are crucial for improving outcomes, especially when initiated within the first ‘golden hour’ of sepsis recognition. These bundles, adapted from adult sepsis care protocols through the Surviving Sepsis Campaign, are increasingly emphasised in global sepsis management guidelines. However, the implementation of these protocols in LMICs is challenged by resource limitations and systemic barriers.Methods This situational analysis, conducted at two hospitals in Ghana—a tertiary facility and a district (secondary) facility—maps the availability of critical resources for paediatric sepsis care through a structured environmental scan using survey methodology. We assess staffing levels, access to medications, airway support and diagnostic capabilities. Methods were conceptualised through inner and outer settings of the Consolidated Framework for Implementation Research (CFIR) and reported through the Donabedian model for healthcare quality.Results This study compared paediatric care at a tertiary hospital (Komfo Anokye Teaching Hosptial (KATH)) and a district hospital (Presbyterian Hospital, Agogo (PreHA)) in Ghana, highlighting KATH’s emergency and intensive care unit (ICU) services, specialised staff and broader respiratory support. PreHA, although without a paediatric-specific ICU, leveraged research funding to enhance clinical care capacity. Both hospitals experienced regular power outages but had reliable generators, and while they offered basic medications and treatments, resource limitations, including out-of-pocket costs for families, impacted access to essential medications and laboratory tests.Conclusion Concerns around resource availability, compounded by structural determinants such as financial barriers and historical underfunding hypothesised to be rooted in colonialism, highlight the need for context-sensitive adaptations of paediatric sepsis bundles. Our findings underscore the importance of a participatory approach to guideline adaptation and resource distribution, incorporating local expertise and addressing structural inequities to improve paediatric sepsis outcomes in Ghana. Future qualitative research will explore pre- and peri-hospital barriers to care and inform more effective, contextually appropriate interventions.

People with cystic fibrosis (PwCF), families, and clinicians, partner to co-produce care, navigate access barriers, address mental health and social factors, follow specific infection prevention and control practices, and share decision-making regarding treatments and daily care. Standard patient satisfaction and experience of care surveys are not tailored to return relevant, actionable data for specific populations. To improve the care experience, the U.S. CF Foundation committed to fielding a national survey in 2015. In 2020, the onset of the COVID-19 pandemic prompted revisions to capture virtual care experiences, a mode of care delivery not previously offered to PwCF. Leveraging this opportunity, the CF Foundation also reorganized how stakeholders are engaged in survey design, implementation, and improving the care experience. These changes resulted in a focused survey instrument as well as equitable and transparent data reports available to all stakeholders.

Aim and Scope: Increasing physical activity level is important for public health. This study aims to investigate the relationship between regular physical activity level, body composition and perceived health levels of university students. Methods: Participants of this study were consisted of 331 university students including 158 females and 173 males. The mean ages were 21.85 years for females and 22.94 years for males, respectively. The Exercise Behavior Stages of Change Questionnaire was used to determine the physical activity level. Mann Whitney U test was used to compare two genders while Spearman rank order correlation was performed to test the relationship among variables. Findings: Results of our study showed that there are significant differences between males and females in all variables except age and exercise behavior stages. While the exercise behavior stages and perceived health level of those who exercise in females are significantly different from those of sedentary, height and exercise behavior level in males are more statistically significant in favor of those who exercise. While the health level in females is positively related to the age variable and negatively related to the BMI, there was no significant difference between the health and exercise level and other variables in males. Conclusion: As a result, it can be concluded that male and female university students do not engage in regular physical activity at a level that will affect their perceived health levels.

IntroductionTo achieve and maintain adequate weight, people with cystic fibrosis (CF) May often consume energy-dense, nutrient-poor foods high in added sugars and refined carbohydrates; however, little is known about the glycemic and metabolic effects of dietary composition in this patient population. The objective of this pilot study was to investigate the safety and tolerability of a low glycemic load (LGL) diet in adults with CF and abnormal glucose tolerance (AGT).MethodsTen adults with CF and AGT completed this prospective, open-label pilot study. Mean age was 27.0 ± 2.1 years, 64% were female, and all had pancreatic insufficiency. Each participant followed his/her typical diet for 2 weeks, then transitioned to a LGL diet via meal delivery service for 8 weeks. The primary outcome was change in weight from baseline to study completion, with safety established if no significant decline was noted. Other key safety outcomes included change in hypoglycemia measured by patient report and continuous glucose monitoring (CGM). Exploratory outcomes included changes in other CGM measures, body composition by dual energy X-ray absorptiometry (DXA), and patient reported outcomes.ResultsThere were no significant changes in weight or in subjectively-reported or objectively-measured hypoglycemia. Favorable non-significant changes were noted in CGM measures of hyperglycemia and glycemic variability, DXA measures of fat mass, and gastrointestinal symptom surveys.DiscussionA LGL dietary intervention was safe and well tolerated in adults with CF and AGT. These results lay the groundwork for future trials investigating the impact of low-glycemic dietary interventions on metabolic outcomes in the CF population.

Background Coproduction is defined as patients and clinicians collaborating equally and reciprocally in healthcare and is a crucial concept for quality improvement (QI) of health services. Learning Health Networks (LHNs) provide insights to integrate coproduction with QI efforts from programmes from various health systems.Objective We describe interventions to develop and maintain patient and family partner (PFP) coproduction, measured by PFP-reported and programme-reported scales. We aim to increase percentage of programmes with PFPs reporting active QI work within their programme, while maintaining satisfaction in PFP-clinician relationships.Methods Conducted in the Cystic Fibrosis Learning Network (CFLN), an LHN comprising over 30 cystic fibrosis (CF) programmes, people with CF, caregivers and clinicians cocreated interventions in readiness awareness, inclusive PFP recruitment, onboarding process, partnership development and leadership opportunities. Interventions were adapted by CFLN programmes and summarised in a change package for existing programmes and the orientation of new ones. We collected monthly assessments for PFP and programme perceptions of coproduction and PFP self-rated competency of QI skills and satisfaction with programme QI efforts. We used control charts to analyse coproduction scales and run charts for PFP self-ratings.Results Between 2018 and 2022, the CFLN expanded to 34 programmes with 52% having ≥1 PFP reporting active QI participation. Clinicians from 76% of programmes reported PFPs were actively participating or leading QI efforts. PFPs reported increased QI skills competency (17%–32%) and consistently high satisfaction and feeling valued in their work.Conclusions Implementing system-level programmatic strategies to engage and sustain partnerships between clinicians and patients and families with CF improved perceptions of coproduction to conduct QI work. Key adaptable strategies for programmes included onboarding and QI training, supporting multiple PFPs simultaneously and developing financial recognition processes. Interventions may be applicable in other health conditions beyond CF seeking to foster the practice of coproduction.

This study analyzes the involvement of external actors in Ethiopia's civil war between 2020 and 2022, categorizing their behaviors and discourses based on the dominance of instrumental and affective motives. It argues that the convergence of objectives between instrumental motive-dominant actors, who seek to protect the stability and survival of the Ethiopian government, and affective motive-dominant actors, who address humanitarian crises, reached a point of overlap and consent which led the war to end in relatively short duration.

Bu çalışma, Afrika Boynuzu’nda yer alan Eritre devletinin bağımsızlığı konusunun uluslararası alanda gündeme geldiği iki tarih olan 1950 ve 1990’ların başlarını odağa alarak, 1950’lerde onaylanmayan bağımsızlığın 1990’larda onaylanmış olmasını sorun edinmektedir. Bu açıdan, çalışmanın ilgi alanını bağımsızlık gündemine taraf devlet ve örgütlerin faaliyetleri oluşturur. Eritre’nin bağımsızlığı meselesinin kırk yıl ara ile farklı kararlarla sonuçlanmasının, bölgede çıkarları bulunan uluslararası aktörlerin tutumları, Birleşmiş Milletler’in rolü ve kararları ve bölge ülkelerinin iç dinamikleriyle doğrudan ilintili olduğu öne sürülmektedir. Bu bağlamda, Etiyopya ve Eritre’nin tarihsel birlikteliği ve ayrımına odaklanarak, bu iki coğrafyanın ilişkisinin Eritre’nin bağımsızlığı özelinde üstünde durulan bir unsur olduğu gözler önüne serilmektedir. Bu iki ülkenin bir aradalığını ön gören ve görmeyen argüman ve tarihsel gelişmeler ele alınarak, Eritre’nin ikinci bağımsızlık gündeminde, ilkinde olmayan karşılıklı uzlaşı ve Eritre’nin ulusal niteliğinin üzerinde durulmuştur. İkinci olarak, self-determinasyon ve ayrılma konusunda dünyada yaşanan gelişmelerin Eritre’nin bağımsızlığına nasıl etki ettiği analiz edilmektedir. Bu noktada uluslararası örgütler tarafından alınan kararlar ve değişen normlar incelenmektedir. Son olarak Soğuk Savaş’ın tırmanma ve sönümlenme evrelerini merkeze alarak, ülkenin geleceğinde dış aktörlerin bölgesel ve küresel politikalarının nasıl belirleyici olduğu sorgulanmıştır. Özellikle ilk bağımsızlık gündeminin Soğuk Savaş politikaları gereği desteklenemeyecek ve Etiyopya’nın toprak bütünlüğünü savunacak bir konjonktürde, ikincisinin ise blok politikalarının çözüldüğü ve küresel dönüşümün başladığı yeni bir geçiş evresine denk geldiği için dış aktörlerce olumlu karşılandığı ve mümkün hale geldiği ileri sürülmüştür.

Abstract Cystic fibrosis transmembrane conductance regulator modulators have revolutionized cystic fibrosis (CF) care in the past decade. This study explores the CF-related mortality trends in the US from 1999 to 2020. We extracted CF-related mortality data from the CDC WONDER database. CF age-standardized mortality rates (ASMRs) were identified by ICD-10 code E84 and were stratified by demographic and geographical variables. Temporal trends were analyzed using Joinpoint modeling. CF-related ASMRs decreased from 1.9 to 1.04 per million population (p = 0.013), with a greater reduction in recent years. This trend was replicated in both sexes. The median age of death increased from 24 to 37 years. CF mortality rates decreased across sex, white race, non-Hispanic ethnicity, census regions, and urbanization status. Incongruent trends were reported in non-white races and Hispanic ethnicity. A lower median age of death was observed in women, non-white races, and Hispanic ethnicity. SARS-CoV-2 infection was the primary cause of death in 1.7% of CF decedents in 2020. The national CF-related mortality rates declined and the median age of death among CF decedents increased significantly indicating better survival in the recent years. The changes were relatively slow during the earlier period of the study, followed by a greater decline lately. We observed patterns of sex, ethnic, racial, and geographical disparities associated with the worsening of the gap between ethnicities, narrowing of the gap between races and rural vs. urban counties, and closing of the gap between sexes over the study period.

IntroductionsCystic fibrosis-related diabetes (CFRD) is associated with pulmonary decline, compromised nutritional status, and earlier mortality. Onset is often insidious, so screening for early detection of glycemic abnormalities is important. Continuous glucose monitoring (CGM) has been validated in people with CF and has been shown to detect early glycemic variability otherwise missed on 2-hour oral glucose tolerance testing (OGTT). We previously reported that CGM measures of hyperglycemia and glycemic variability are superior to hemoglobin A1c (HbA1c) in distinguishing those with and without CFRD. However, little is known about the long-term predictive value of CGM measures of glycemia for both the development of CFRD and their effect on key clinical outcomes such as weight maintenance and pulmonary function. In addition, there have been no studies investigating advanced glycation endproducts (AGE) assessed by skin autofluorescence in people with CF.MethodsIn this prospective observational study, CGM and HbA1c were measured at 2 to 3 time points 3 months apart in 77 adults with CF. Participants who did not have CFRD at the time of enrollment underwent OGTT at the baseline visit, and all participants had AGE readings at baseline. Follow up data including anthropometric measures, pulmonary function and CFRD status were collected by review of medical records 1- and 2-years after the baseline visits. We applied multivariable linear regression models correlating glycemic measures to change in key clinical outcomes (weight, BMI, FEV1) accounting for age, gender and elexacaftor/tezacaftor/ivacaftor (ETI) use. We also conducted logistic regression analyses comparing baseline glycemic data to development of CFRD during the 2-year follow up period.ResultsOf the 77 participants, 25 had pre-existing CFRD at the time of enrollment, and six participants were diagnosed with CFRD by the OGTT performed at the baseline visit. When adjusting for age, gender, and ETI use, multiple CGM measures correlated with weight and BMI decline after one year but not after two years. CGM and HbA1c at baseline did not predict decline in FEV1 (p>0.05 for all). In the 46 participants without a diagnosis of CFRD at baseline, two participants were diagnosed with CFRD over the following two years, but CGM measures at baseline did not predict progression to CFRD. Baseline AGE values were higher in individuals with CFRD and correlated with multiple measures of dysglycemia (HbA1c, AG, SD, CV, TIR, % time >140, >180, >250) as well as weight. AGE values also correlated with FEV1 decline at year 1 and weight decline at year 1 and year 2ConclusionsSeveral key CGM measures of hyperglycemia and glycemic variability were predictive of future decline in weight and BMI over one year in this population of adults with CF with and without CFRD. None of the baseline glycemic variables predicted progression to CFRD over 2 years. To our knowledge, this is the first report correlating AGE levels with key clinical and glycemic measures in CF. Limitations of these analyses include the small number of participants who developed CFRD (n=2) during the follow up period and the initiation of ETI by many participants, affecting their trajectory in weight and pulmonary function. These results provide additional data supporting the potential role for CGM in identifying clinically significant dysglycemia in CF. Future studies are needed to investigate CGM as a diagnostic and screening tool for CFRD and to understand the implications of AGE measures in this patient population.

Background Changes in tissue oxygen saturation determined by near-infrared spectroscopy (NIRS) may help predict and determine the success of a lateral infraclavicular (LIC) block. We investigated whether evaluation of tissue oxygen saturation determined by NIRS could be an indicator of LIC block success. Methods Forty patients scheduled for hand or forearm surgery under LIC block were studied. NIRS sensors were placed on the ventral aspect of both mid-forearms, and the contralateral hand was used as the control group. NIRS values were recorded before the block and at regular intervals during the following 30 min. Results NIRS values were significantly higher in the successfully blocked patients when compared to the complete failure, partial failure, and contralateral hand groups at the 10th min. In the successfully blocked patients, NIRS values (mean ± SD [change in %]) increased by 11.09 ± 4.86 (16.03%), 15.00 ± 4.53 (21.76%), 16.35 ± 5.14 (23.77%), 16.38 ± 4.88 (23.85%), 16.67 ± 5.04 (24.29%), and 16.96 ± 5.71 (24.78%), respectively, from baseline to 5, 10, 15, 20, 25, and 30 min. ΔTs values were significantly higher in the successfully blocked patients than in the complete failure patients and contralateral hand at the 30th min. However, there was no statistically significant difference when comparing ΔTs values of successful block and partial failure block patients at the 30th min. Conclusions We conclude that measurement of tissue oxygen saturation by NIRS within the scope of evaluation of the lateral infraclavicular block is a rapid, effective, and applicable technique.

Background Renoprotective effects of vitamin D analogues have been shown in several experimental and clinical studies, the exact mechanism of the therapeutic effectiveness of these analogues in Nephrotic syndrome remains unclear, and these are relatively few studies on potential treatment roles for vitamin D analogues in nephrotic-range proteinuria. ?ndicate similar efficacy of the vitamin D analogues calcitriol and paricalcitol in time-limited amelioration of proteinuria in nephrotic syndrome, yet suggest the likelihood of mechanisms other than direct upregulation of nephrin and podocin in podocytes underlie the renoprotective effects of vitamin D analogues. Objective To investigate the effect of vitamin D (Vit D) analogues calcitriol and paricalcitol on urinary protein/creatinine ratio (UPCR) and renal podocin and nephrin expression in a rat model of puromycin aminonucleoside (PAN)-induced nephrotic syndrome (NS). Methods A total of 28 male Wistar Albino rats were separated into 4 groups (n=7 for each) including CON [control; intraperitoneal (IP) saline injection], PAN (NS + IP saline injection), PAN-C (NS + IP 0.4 µg/kg/day calcitriol injection), and PAN-P (NS + IP 240 ng/kg/day paricalcitol injection). Nephrotic syndrome was induced via intravenous (IV) administration of 10mg/100gr PAN. The UPCR as well as histopathological, immuno-histochemical, and real time PCR analyses of kidney tissue specimens were recorded and analyzed among the 4 groups. Results Median UPCR (Day 4) was significantly lower in both the PAN-C [1.45 (range 1.20-1.80)] and PAN-P [1.40 (range 1.10-1.80)] groups than in the PAN group [2.15 (range 2.00-2.40)] (P

Abstract Background Keel flowers are bilaterally symmetrical, pentamerous flowers with three different petal types and reproductive organs enclosed by keel petals; generally there is also connation of floral parts such as stamens and keel petals. In this study, the evolution of keel flowers within the order Fabales is explored to investigate whether the establishment of this flower type within one of the species-rich families, the Fabaceae (Leguminosae), preceded and could have influenced the evolution of keel flowers in the Polygalaceae. We conducted molecular dating, and ancestral area and ancestral state analyses for a phylogeny constructed for 678 taxa using published matK, rbcL and trnL plastid gene regions. Results We reveal the temporal and spatial origins of keel flowers and traits associated with pollinators, specifically floral symmetry, the presence or absence of a pentamerous corolla and three distinct petal types, the presence or absence of enclosed reproductive organs, androecium types, inflorescence types, inflorescence size, flower size, plant height and habit. Ancestral area reconstructions show that at the time keel flowers appeared in the Polygaleae, subfamily Papilionoideae of the Fabaceae was already distributed almost globally; at least eight clades of the Papilionoideae had keel flowers with a functional morphology broadly similar to the morphology of the first evolving Polygaleae flowers. Conclusions The multiple origins of keel flowers within angiosperms likely represent convergence due to bee specialization, and therefore pollinator pressure. In the case of the Fabales, the first evolving keel flowers of Polygaleae have a functional morphology that corresponds with keel flowers of species of the Papilionoideae already present in the environment. These findings are consistent with the keel-flowered Polygaleae exploiting pollinators of keel-flowered Papilionoideae. The current study is the first to use ancestral reconstructions of traits associated with pollination to demonstrate that the multiple evolutionary origins of the keel flower pollinator syndrome in Fabales are consistent with, though do not prove, mimicry.

Tribe Lithospermeae (Boraginaceae) consists of ca. 26 genera and 470 species, in which Onosma constitutes approximately one third of the species (~150). Although the tribe is strongly supported as monophyletic, both generic and species boundaries remain ambiguous. Among them, not only the phylogenetic position of Eastern Asian Onosma species, but also the taxonomic limits of the genus remain unclear. Whether Eastern Asian Onosma is monophyletic, or the genus should be widened to include Maharanga, and maybe Cystostemon, are still open questions. For these reasons, I performed 16 phylogenetic analyses with different taxon coverages, alignments, gene regions and outgroups, with up to 746 taxa of tribe Lithospermeae and with five DNA regions, using data from GenBank. The results, with the widest taxon coverage to date, show that while genus Onosma is not monophyletic in any of the analyses, the phylogenetic relationships among Onosma s.s., Eastern Asian Onosma, Maharanga and Cystostemon differ among analyses. However, the approximately unbiased (AU) test showed that the topology (((Eastern Asian Onosma+Maharanga) Cystostemon) Onosma s.s.) is overwhelmingly supported. Therefore, the current study highlights the importance of taxon, gene and outgroup sampling in Onosma phylogenetics.

BackgroundVocal biomarker–based machine learning approaches have shown promising results in the detection of various health conditions, including respiratory diseases, such as asthma. ObjectiveThis study aimed to determine whether a respiratory-responsive vocal biomarker (RRVB) model platform initially trained on an asthma and healthy volunteer (HV) data set can differentiate patients with active COVID-19 infection from asymptomatic HVs by assessing its sensitivity, specificity, and odds ratio (OR). MethodsA logistic regression model using a weighted sum of voice acoustic features was previously trained and validated on a data set of approximately 1700 patients with a confirmed asthma diagnosis and a similar number of healthy controls. The same model has shown generalizability to patients with chronic obstructive pulmonary disease, interstitial lung disease, and cough. In this study, 497 participants (female: n=268, 53.9%;