Management Research Articles

Is physical fitness associated with leucocyte telomere length in youth with type 1 diabetes?

In type 1 diabetes, telomere length (TL) may predict complications and could be influenced by glycaemic control and physical activity, but its relationship with physical fitness in youths remains unexplored. The aim of the study was to assess the association between physical fitness and TL in youth with type 1 diabetes, both at baseline and one year later. Eighty-three children and adolescents (aged 6-18 years; 44.6% girls) with type 1 diabetes from the Diactive-1 Cohort Study were involved in this study. Physical fitness was assessed using spirometry on a cycloergometer (i.e., peak oxygen consumption), dynamometry, and maximal isometric strength (one-repetition maximum [1RM]), and muscle power. Leucocyte TL was assessed using multiplex monochrome real-time quantitative polymerase chain reaction. Positive cross-sectional associations were identified between 1RM (unstandardized beta coefficient [B]= 0.042, 95% bias corrected and accelerated [BCa] confidence interval [CI] 0.012-0.069), muscle power (B = 0.056, 95% BCa CI 0.02-0.250), and overall physical fitness (B = 0.043, 95% BCa CI 0.015-0.071) with TL independent of maturation, glycated haemoglobin, and diabetes duration. However, no associations were observed one year later. Higher levels of fitness, particularly musclestrength, may play a role in telomere dynamics in youth with type 1 diabetes, suggesting that strength training exercise could be beneficial. This is the first study to examine cross-sectional and longitudinal perspectives on the correlation among muscle strength, peak oxygen consumption [VO2peak] and telomere length in youths with type 1 diabetes. Higher physicalfitness levels, as assessed by measures such as one-repetition maximum, muscle power, and overall physical fitness, are positively associated with telomere length in youths with type 1 diabetes. Understanding this link could improve management strategies, prioritizing muscle strength training for better long-term health in type 1 diabetes.

GLIOMA-RELATED EPILEPSY

Diffuse low-grade gliomas (LGGs), originating from glial tissue, have a propensity to progress to higher-grade tumors over time, presenting a complex challenge in clinical management. Glioma-associated epilepsy is a significant clinical indicator influencing both treatment strategies and prognostication. This study aims to assess the impact of glioma-related epilepsy on treatment outcomes and explore the current management guidelines. Material and Methods A retrospective analysis was conducted on 38 patients diagnosed with LGGs (WHO grades 2 and 3) treated in our neurosurgical department from 2013 to 2023. The focus was on glioma-related epileptic seizures, with outcomes evaluated using the Engel classification six months post-surgery. Additionally, anti-seizure medication (ASM) regimens were reviewed, and current National Institute for Health and Care Excellence (NICE) guidelines on low-grade gliomas were synthesized. Results Of the 38 patients, 30 had diffuse astrocytoma and 8 had oligodendroglioma. Among those with glioma-related epilepsy (n=25), management strategies included biopsy only (8%), gross total resection (GTR) (40%), subtotal resection (StR) (32%), and partial resection (PaR) (20%). No significant correlation was found between seizures and tumor volume, growth rate, or histological findings. However, a positive correlation between the extent of surgical resection and improved Engel outcomes was observed. Discussion Existing research suggests that early seizures may be a favorable prognostic indicator for malignant progression-free and overall survival. Epilepsy significantly impacts the quality of life for glioma patients. Exploring targeted epilepsy surgery for glioma-related seizures could potentially enhance patient outcomes and quality of life posttreatment. Conclusion Advancing approaches in epilepsy surgery for glioma-related seizures holds promise for improving patient quality of life and treatment efficacy. Further investigation into these strategies is warranted.

Impact of empirical treatment in patients with extrapulmonary tuberculosis and their outcome

Abstract Background Tuberculosis (TB), primarily caused by mycobacterium tuberculosis (Mtb), remains a significant public health concern globally, particularly in low-resource settings. Extrapulmonary tuberculosis (EPTB), which affects organs beyond the lungs, presents diagnostic and treatment challenges, necessitating improved clinical management strategies. This work was aimed to assess the impact of empirical anti-TB treatment on the outcomes of patients with extrapulmonary tuberculosis and to analyze the demographic and risk factors associated with EPTB. Methods A retrospective cohort study was conducted over three years (2020–2023) at PSG Hospitals, Coimbatore. Ninety-two subjects, all with negative microbiological results but symptoms indicative of EPTB, were carefully selected. Results A total of 92 patients were included in the study, all of whom had negative microbiological diagnosis with symptoms suggestive of EPTB. The mean age of patients was 58.14 years, with a male predominance (59.78%). Pleural effusion was the most common EPTB site, with many patients having no co-morbidities. Occupational factors, such as cotton millwork, and lifestyle factors, including alcohol use and malnutrition, were prominent risk factors. Clinical manifestations varied, with fever being the most common symptom. Treatment completion was 65.22%, falling below National Tuberculosis Elimination Program (NTEP) guidelines, with notable loss to follow-up and mortality rates. Conclusion Empirical treatment for EPTB showed notable improvement in the patient's symptoms and overall health. However, challenges persist in treatment completion, especially among socioeconomically disadvantaged populations. Early detection, prompt treatment initiation, and comprehensive management are essential to address the multifaceted challenges posed by EPTB effectively.

Sex differences in overweight and obese patients undergoing high-power short-duration pulmonary vein isolation for atrial fibrillation: an observational cohort study.

Atrial fibrillation (AF) is the most common heart rhythm disorder worldwide. As treatment methods evolve, optimizing personalized therapy based on patient characteristics, such as sex, becomes crucial. This study investigates sex differences in high-power short-duration (HPSD) pulmonary vein isolation (PVI) in overweight and obese patients. We analyzed data from 189 overweight and obese patients who underwent HPSD PVI for AF, comparing demographic information, procedural details, outcomes, and complications between male and female patients. Our analysis revealed fewer women underwent PVI compared to men, with women typically older and showing more pronounced changes in the left atrial substrate. Despite these differences, the safety and efficacy of PVI were comparable between sexes, including in the BMI ≥ 30kg/m2 subgroup and after age adjustment. The findings emphasize the need for early AF screening in women to prevent treatment delays and show that considering sex-specific differences in fat distribution can improve procedural outcomes. These insights support the need for tailored management strategies for AF in overweight and obese populations, addressing sex-specific risks and anatomical variations.

Septic shock in the prehospital setting: a scoping review.

Septic shock (SS) is a potential life-threatening condition in which an early identification and immediate therapy stand out as the main cornerstones to improve survival chance; in this context, emergency medical services (EMS) become key to reduce the time between diagnosis and management in the ICU or emergency department. However, guidelines for the prehospital management of SS patients remains unclear, and literature around this topic is scant. Our scoping review was conducted following the PICO framework and a search strategy related to septic shock management and diagnosis in prehospital settings was executed in PubMed, Scopus and Virtual Health Library; articles in English and Spanish from 2015, onwards, were screened by the authors and selected by mutual consensus. Our aim is to analyze the prehospital management strategies of SS reported in the literature, and to showcase and summarize the screening tools, demographic factors, clinical manifestations and prognostic factors of SS in the prehospital setting.

The Management of Symptomatic Moyamoya Disease in Pediatric Patients: A Systematic Review and Meta-Analysis

BACKGROUND AND OBJECTIVES: The optimal management strategy for pediatric patients with symptomatic moyamoya disease (MMD) is not well established. This systematic review and meta-analysis compares surgical vs conservative management and direct/combined bypass (DB/CB) vs indirect bypass (IB) for pediatric patients with symptomatic MMD. METHODS: MEDLINE and PubMed were searched from inception to March 17, 2024. For analysis of surgical vs conservative treatment, the primary and secondary outcomes were follow-up ischemic stroke and intracranial hemorrhagic events, respectively. For analysis of DB/CB vs IB, the primary outcome was follow-up ischemic stroke, and secondary outcomes included follow-up transient ischemic attack, new or worsened seizures, symptomatic improvement, modified Rankin Scale score ≤2, and Matsushima grade A at the last follow-up. RESULTS: Twenty-two included studies yielded 1091 patients, with a median follow-up duration of 35.7 months. Regarding surgical vs conservative management, 428 patients were analyzed. Surgical treatment was associated with lower odds of ischemic stroke (odds ratios [OR] = 0.33 [95% CI, 0.11-0.97], P = .04), and intracranial hemorrhagic events tended to be lower with surgery (OR = 0.25 [0.06-1.03], P = .05). Regarding DB/CB techniques vs IB, 875 patients were analyzed. The groups had similar rates of ischemic stroke (OR = 0.79 [0.31-1.97], P = .61), transient ischemic attack (OR = 1.27[0.46-3.55], P = .64), new or worsened seizures (OR = 1.05[0.3-3.65], P = .93), symptomatic improvement (OR = 2.45[0.71-8.45], P = .16), and follow-up modified Rankin Scale ≤2 (OR = 1.21 [0.16-8.85], P = .85). CB was associated with higher Matsushima grade A relative to IB (OR = 3.44 [1.32-9.97], P = .01). CONCLUSION: Surgical revascularization yielded more favorable clinical outcomes than conservative management in this meta-analysis. Clinical outcomes were similar between DB/CB vs IB techniques. Surgical flow augmentation, either by DB/CB or IB, seems to benefit pediatric patients with symptomatic MMD.

The Unique Challenge of Coronary Artery Disease in Adult Patients with Congenital Heart Disease

Advances in medical and surgical interventions have resulted in a steady increase in the number of patients with congenital heart disease (CHD) reaching adult age. Unfortunately, this ever-growing population faces an added challenge: an increased risk of acquiring coronary artery disease. This review provides insight into the complex interactions between coronary artery disease and CHD in adults. We describe the peculiar features of cardiac anatomy in these patients, the possible role cardiac sequelae may play in an increased risk of myocardial ischemia, and the diagnostic challenges in this patient group. Furthermore, this review outlines the risk factors and potential mechanisms of accelerated atherosclerosis in adults with CHD by pointing out areas where current knowledge is incomplete and highlighting areas for further research. The review concludes by examining potential management strategies for this particular population, emphasizing the necessity for a multidisciplinary approach. Understanding the unique coronary risks that adults with CHD experience can enhance patient care and improve long-term results.

Waste-to-energy: exploring the roadmap for energy generation from commercial waste in South Africa

Purpose This study aims to investigate the adoption of waste-to-energy (WtE) technologies in South Africa (SA), focusing on identifying the key drivers, barriers and potential solutions for commercial uptake. The ultimate aim is to propose an implementation framework that promotes renewable energy while reducing landfill reliance. Design/methodology/approach A systematic literature review (SLR) of papers published between 2020 and 2023 was conducted to identify factors impacting WtE adoption in SA. The conceptual model developed from the SLR was tested using a qualitative case study approach. Data was collected through 15 semi-structured interviews with commercial entities and WtE experts from four regions of SA. Findings Anaerobic digestion and pyrolysis are identified as the most suitable waste-to-energy technologies in the South African context. Among the financial challenges of WtE in SA, the availability of cheap coal, low landfill tariffs, high capital costs, funding constraints and regressive economic incentives are critical. The lack of government support, insufficient incentives, regulatory burdens, weak policies and limited innovation capacity are considerable non-financial barriers hindering WtE technologies’ growth. The successful adoption of renewable energy also requires adequate infrastructure, increased sustainability awareness and technical expertise. Research limitations/implications Although the sample size is diverse and consists of a range of organisations, it may not capture the thoughts and experiences of other SA businesses in their entirety. It is important to note that the lack of existing research on the implementation, benefits and impacts of WtE technologies limits the authors’ ability to interpret and benchmark the findings of this study. Yet, this study contributes by developing an implementation framework to encourage WtE adoption, recommending policy actions such as regressive taxation on fossil fuels and landfills and promoting renewable energy through subsidies, awareness and energy credits. Practical implications This study provides a practical framework for businesses and policymakers to adopt WtE technologies by addressing key barriers. The research suggests that businesses could reduce waste management costs and generate new revenue streams by adopting anaerobic digestion and pyrolysis. Policymakers are encouraged to disincentivize landfills and promote WtE through financial incentives such as subsidies and energy credits. The implementation framework offers clear recommendations for integrating WtE into SA’s energy and waste management strategies, supporting both sustainability and economic goals. Social implications The main social contribution is the potential for WtE adoption to improve waste management practices and generate new job opportunities within the renewable energy and waste sectors. Originality/value This study provides a novel contribution by developing an implementation framework tailored to SA’s unique regulatory, economic and social contexts. The research highlights the importance of aligning WtE adoption with sustainability goals, reducing reliance on fossil fuels and promoting renewable energy. The framework serves as a practical guide for policymakers, businesses and industry leaders seeking to implement sustainable waste management solutions in SA.

Strategies for Strengthening Network Capacity in the Implementation of Food Security Policies at the Local Level in Indonesia

This study aims to analyze network management strategies in the interactive governance perspective in the implementation of food security policies in North Luwu Regency, Indonesia. The complexity of food security issues requires effective collaboration and interaction among various actors in the policy network. Using a qualitative approach with an explanatory case study design, this research examines seven indicators of network management strategies: network (de-)activating, constitutional reform, (de)coupling games, changing incentives, changing internal structure and position of actors, changing relations, and management by chaos. Data were collected through in-depth interviews, participatory observation, and document analysis, involving relevant stakeholders from government agencies, farmer organizations, and private sector partners. The findings reveal that the application of network management strategies facilitates interaction among network actors and contributes to the success of interactive governance in implementing food security policies. Network (de-)activating involves the engagement of new coalitions and resource mobilization to strengthen cooperation and interaction. Constitutional reform through changes in rules and resources helps develop coordination mechanisms and strengthen policy integration. (De) coupling games demonstrate the separation of strategies carried out by various actors to support a holistic approach in achieving food security. Changing incentives through incentive interventions can increase motivation and active participation of actors in realizing food security. Changing relations indicate changes in cooperative relationships and actor roles to enhance effective collaboration. Management by chaos through the application of principles of flexibility, adaptability, and the ability to manage uncertainty can strengthen interactive governance in facing complex and dynamic challenges. This study recommends strengthening cross-sectoral collaboration, developing a structured incentive system, enhancing the capacity of farmer organizations, and optimizing the use of information technology to improve the success of interactive governance in food security policy implementation.

Real world application of the 2023 ACR/EULAR antiphospholipid antibody syndrome classification criteria in a pharmacist directed anticoagulation clinic.

To determine the number of patients that met classification for antiphospholipid antibody syndrome (APS) after applying the 2023 American College of Rheumatology and the European Alliance for Associations of Rheumatology (ACR/EULAR) classification criteria, to identify reasons patients did not meet the new criteria, and determine the number of patients who were single, double, or triple positive based on laboratory criteria. A single center, retrospective chart review of patients with APS on anticoagulation managed by ambulatory care clinical pharmacists. Data collected included patient demographics, type of anticoagulation, and clinical and laboratory criteria for APS as defined by the 2023 ACR/EULAR criteria. Data is presented using descriptive statistics. A total of 51 patients previously diagnosed with APS were included. There were 42 patients on warfarin (82.3%), 4 patients on direct oral anticoagulants (19%), 3 patients on low molecular weight heparin (5.8%), and 2 patients on fondaparinux (3.9%). Of the 51 patients, 12 (23.5%) met classification criteria, 33 (64.7%) did not meet classification criteria and 6 (11.7%) had insufficient data. Of the 27 patients that did not meet criteria, 13 patients did not meet the laboratory criteria (39.4%), 6 patients did not meet the clinical criteria (18.2%) and 14 patients did not meet both laboratory and clinical criteria (42.4%). Of the 12 patients that met classification criteria, 2 patients were triple positive (16.7%), 3 were double positive (25%), and 7 were single positive (58.3%). Results from this study indicate that APS continues to be a complex disease state with challenges in diagnosis and classification. Since only a small number of patients in our clinic continued to meet the classification criteria, opportunities for patient re-evaluation of management strategies at our institution could be considered.

Repeatable patterns in the distribution of freshwater biodiversity indicators across contrasting landscapes

Abstract Context Freshwater biodiversity is declining at unparalleled rates, but fundamental questions remain over how it is distributed at the spatial scales most relevant for conservation management. Objectives Here, we test the hypothesis that freshwater biodiversity is distributed across standing waterbody types in a pattern that is reproducible across disparate biota and contrasting landscapes, such that conservation efforts can be aligned across landscapes and taxa. Methods We analysed the richness, composition and distribution of macrophytes, molluscs, beetles and odonates from 199 standing waterbodies (lakes, ponds, ditches and canals) nested within UK landscapes with contrasting dominant land use (agricultural, upland and suburban). Results We found a common pattern in the distribution of our biodiversity indicators across waterbody types in all landscapes that was largely repeated across biota; lakes consistently had the highest or equal alpha diversity and supported a greater proportion of the sampled species pool in each landscape (mean = 86%) in comparison to ponds (74%). Landscape-specific waterbody types (ditches and canals) also contributed significantly to the regional species pool (69 and 33% respectively). Each waterbody type contributed uniquely to landscape biodiversity and usually species of conservation concern, rather than simply supporting a subset of ubiquitous species found in lakes. Conclusions Landscape-wide management strategies that encompass multiple habitats and biota should prove advantageous and generalisable. However, our study landscapes suggest that long-term biodiversity conservation should also recognise lakes as a priority for nature recovery, both to minimise further losses and to maintain the largest reservoir of biodiversity.

EGS SO33 - Management Strategies and Outcomes of Non-Malignant Oesophageal Perforation at a Tertiary Care Hospital

Abstract Background Oesophageal perforation is a life-threatening emergency that requires prompt and effective management. This study aims to evaluate the outcomes of different management strategies—conservative, surgical, and endoscopic washout with stent insertion—for non-malignant oesophageal perforations at a specialist Upper GI unit in a tertiary care hospital. Method This is a retrospective study conducted over a 10-year period from 2012 at a specialist Upper GI Unit in a tertiary care hospital. All patients aged 18 and above who were referred to or admitted with oesophageal perforation were included, with exclusion of those with underlying oesophageal cancer. Data were collected from hospital records. Variables studied included age, gender, Charlson Comorbidity Index (CCI), WHO performance status, site and size of oesophageal perforation, treatment modality (Conservative, Surgery, or Stent), type and size of stent used, length of hospital stay, and mortality. Data analysis was performed using SPSS v.25. Results Over 10 years, 72 cases of non-malignant oesophageal perforation were managed (M:F, 37:35, median age 62.5 years (range 20-86), median CCI 3). The causes of perforation were spontaneous (n=45, 62.5%), iatrogenic (n=22,30.6%), foreign body (n=4,5.6%), and post-corrosive intake (n=1,1.4%). Most perforations occurred in the distal oesophagus (n=52, 72.2%) with an average size of perforation of 3 ± 1.38cm. Management included surgery (n=43,59.7%), conservative treatment (n=22,30.6%), and stent insertion (n=7,9.7%). Overall, in-hospital mortality was 20.8% (n=15). Survival rates varied: 90.9% for conservative treatment, 79.1% for surgical management, and 57.1% for stenting; however, the differences were not statistically significant (p=0.134). Conclusion Oesophageal perforation is a life-threatening condition. This 10-year observational study assessing conservative, surgical, and stent treatments for non-malignant perforations confirms that survival rates varied among the different treatment groups. However, there was no statistically significant survival advantage observed. This underscores the importance of developing individualized management plans based on patient factors to improve outcomes.

Freshwater salinisation: unravelling causes, adaptive mechanisms, ecological impacts, and management strategies.

Freshwater salinisation is a growing problem worldwide, affecting surface and groundwater resources. Compared with other global environmental issues, freshwater salinisation has been studied extensively in North America, Australia, and Europe but less so in South America, Asia, and Africa. Both the natural and anthropogenic sources can contribute for freshwater salinisation, through the concentration of dissolved salts in water rising above its normal levels. This review provides a comprehensive assessment of the causes of freshwater salinisation, the impacts on freshwater communities and ecosystem functions, the adaptive mechanisms for survival in an increasingly saline environment, and the management strategies available to control freshwater salinisation. Many human activities contribute to freshwater salinisation, including road salt use, agricultural practices, resource extraction, reservoir construction, and climate change. Aquatic organisms have evolved mechanisms to survive in increasingly saline environments, but excessive salinity can lead to mortality and non-lethal effects. Such effects can have cascading impacts on the structure and function of aquatic communities and ecosystem services. Therefore, monitoring programmes and chemical fingerprinting are needed to identify highly salinised areas, determine how various human activities contribute to freshwater salinisation, and implement management strategies. Furthermore, current research on freshwater salinisation has been limited to a few regions of the world. It is essential to expand the research further into exploring the impacts of salinisation on freshwater resources in unexplored geographic areas of the world that are mainly impacted by climate change scenarios.

EGS SO20 - Management & outcomes from oesophageal perforations at a tertiary centre

Abstract Background Oesophageal perforations, whilst rare, are a challenging surgical emergency. Traditionally associated with high morbidity and mortality, outcomes have progressively improved over the past 25 years, likely due to advances in medical care and specialised management in high volume tertiary centres. This study examines the management strategies and outcomes from oesophageal perforations at our tertiary unit. Method A retrospective cohort analysis was conducted on consecutive emergency cases of thoracic and junctional oesophageal perforations from January 2019 to June 2024. Data on patient demographics, baseline characteristics, management strategies and clinical outcomes were extracted from the patient’s electronic records. Kaplan-Meier survival curves were generated using the management approach and the extent of perforation as the predictive variables. Results 51 patients (mean age 47 years, 66% male) were treated for oesophageal perforations. The predominant aetiology was spontaneous (80%, n=41). Contained perforations were identified in 57% (n=29) of patients based on imaging, endoscopic, or operative findings. Conservative management was applied in 57% (n=29) of cases. Among those requiring intervention, 11 (58%) underwent surgery, while the remainder underwent endoscopical via vacuum therapy (32%, n=6) or stenting (11%, n=2). The mean in-hospital stay was 11 days (IQR 7-29). The 30-day mortality rate was 18% (n=9). Survival analysis revealed improved survival probabilities with contained perforations and non-surgical management strategies (p=0.023 and 0.001 respectively). Conclusion Our results demonstrate that the outcomes from oesophageal perforations continue to improve, reflecting ongoing advancements in therapeutic management. Furthermore, whilst surgery was once the mainstay, there appears to be a safe, increasing shift towards more conservative and endoscopic management.

Droplet Digital PCR: A New Molecular Method to Detect G1105S/V Mutations in Plasmopara viticola CesA3 Gene

Plasmopara viticola is the causal agent of Grapevine Downy Mildew (GDM), which is a devastating disease of grapevines in humid temperate regions. The most employed method for protecting grapevines against GDM is the application of chemical fungicides. In Spain, Carboxylic Acid Amides (CAAs) are a fungicide group currently utilized in GDM control. In P. viticola, resistance to CAAs is conferred by G1105S and G1105V mutations in the CesA3 gene. Droplet digital polymerase chain reaction (ddPCR) is an innovative technique that combines PCR and droplet microfluidics to disperse the sample into thousands of water-in-oil droplets in which an amplification reaction is individually performed. In this study, we set up a ddPCR protocol to quantify S1105 and V1105 mutations conferring resistance to CAAs in P. viticola. The optimal PCR conditions were established, and the sensitivity and precision of the protocol were assessed. Four P. viticola populations coming from commercial vineyards in northern Spain were analyzed, and different allele frequencies were found in the analyzed samples corresponding to the different fungicide management strategies, ranging from 7.72% to 100%. Knowing the level of mutated alleles allows for designing resistance management strategies suited for each location. This suggests that similar ddPCR assays could be developed for studying mutations implicated in fungicide resistance in other fungicide groups and plant pathogens.

The screening and management of skin diseases in remote African regions: a narrative review.

Skin diseases in remote African regions are often exacerbated due to a lack of resources and expertise with little current research addressing the challenges that patients and healthcare systems experience. Although skin diseases in remote African regions are prevalent and pose a substantial health burden, they remain neglected and understudied. This review aims to explore current challenges in the diagnosis and management of skin diseases in African regions and focus on the need for enhanced understanding and improved healthcare strategies. We reviewed papers that were retrieved from PubMed, Google Scholar, and other relevant academic search sites to analyze the prevalence, screening techniques, as well as management strategies and obstacles associated with dermatological diseases in remote African regions. Current literature suggests there is indeed a high prevalence of skin diseases where other infections are predominant. Further, different factors, such as socioeconomic status and environmental conditions, make it challenging for optimal screening and treatment of skin diseases in remote African regions. Common screening methods for skin diseases involve clinical examination and laboratory tests, while management includes pharmacotherapy, surgery, and counseling approaches. Overall, access to medications and adequate healthcare services remains limited. Early diagnosis and management of skin diseases in remote African regions have significant challenges, including a lack of funding for dermatology, education, and research. Future promising strategies such as teledermatology, point-of-care diagnostic technologies, and task shifting show promise in improving access to care. However, there is a need for sustained efforts to address the underlying socioeconomic factors and improve healthcare delivery in remote African regions.

Sustainable Nitrogen Management in Rice Farming: Spatial Patterns of Nitrogen Availability and Implications for Community-Level Practices

Sustainable nitrogen management is crucial for long-term food security and environmental protection in rice farming systems. However, the spatial patterns of nitrogen availability at the community level remain poorly understood, hindering the development of effective sustainable management strategies. This study introduces a novel application of spatial autoregressive analysis to investigate available nitrogen distribution in paddy soils across a rice farming community in Kyoto, Japan. Soil samples from 61 plots, including organically farmed ones, were analyzed for available nitrogen and various physicochemical properties. Contrary to the hypothesis of high variability between adjacent plots, significant positive spatial autocorrelation in available nitrogen was observed, revealing previously unrecognized community-level patterns. The spatial Durbin model outperformed traditional regression approaches and revealed complex spatial interactions in soil properties. Water-soluble organic carbon and humus content showed strong but opposing effects, with a positive direct impact but negative spatial interaction, suggesting topography-driven accumulation processes. Water-soluble nitrogen exhibited reverse patterns with negative direct effects but positive spatial interaction, indicating potential nutrient transport through water movement. These findings highlight the importance of considering both direct and indirect spatial effects in understanding soil fertility patterns, challenging the conventional plot-by-plot management approach. This methodological advancement provides new perspectives for more effective, community-scale soil management strategies in rice farming systems. Moreover, it demonstrates an innovative approach to maximizing the value of outsourced soil analysis data, providing a model for more comprehensive utilization of such data in agricultural research. By enabling more targeted and efficient nitrogen management practices that consider both plot-level processes and landscape-scale interactions, this study potentially contributes to the development of more sustainable and resilient rice production systems.

Linalool and 1,8-Cineole as Constitutive Disease-Resistant Factors of Norway Spruce Against Necrotrophic Pathogen Heterobasidion Parviporum.

Norway spruce is an important coniferous species in boreal forests. Root and stem rot diseases caused by the necrotrophic pathogen Heterobasidion parviporum threaten the wood production of Norway spruce which necessitates the search for durable control and management strategies. Breeding for resistant traits is considered a viable long-term strategy. However, identification of potential resistant traits and markers remains a major challenge. In this study, short-term disease resistance screening was conducted using 218 Norway spruce clones from 17 families. Disease resistance was evaluated based on the size of necrosis lesion length following infection with the pathogen. A subset of needles/branches from clones with small (partial resistant) or large (susceptible) lesions were used for terpene analysis and transcriptomic profiling. The results revealed that the content of monoterpene linalool and 1,8-cineole and their respective encoded genes were significantly more abundant and highly expressed in the partial resistant group. Furthermore, linalool and 1,8-cineole were demonstrated to have inhibitory effect on the growth of the pathogen H. parviporum, with morphological distortion of the hyphae. RNAseq analysis revealed that transcript of pathogen genes involved in the regulation of carbohydrate metabolism and stress responses were significantly decreased in presence of the terpenes. The results suggest the relevance of monoterpenes together with jasmonic acid precursor and some genes involved in phenylpropanoid biosynthesis, as constitutive tolerance factors for Norway spruce tolerance against necrotrophic pathogen. The high level of necrosis related cell death gene expression might be factors critical for host susceptibility and disease development.

In vivo reflectance confocal microscopy role for early to advanced lentigo maligna melanoma spectrum: A systematic review and pooled analysis.

Lentigo maligna (LM) is a growing problem worldwide and the main type of melanoma insitu in some Caucasian populations. It presents as a spectrum from atypical intraepidermal melanocytic proliferation (AIMP) to invasive lentigo maligna melanoma (LMM). Accurate diagnosis and staging are crucial for determining appropriate management strategies. To assess the role of invivo reflectance confocal microscopy (RCM) in differentiating early and advanced stages of lentigo maligna. A systematic search was conducted on Medline, PubMed, Scopus, Web of Science, Proquest Central, Embase, Cochrane and Google Scholar. References of included and excluded studies were reviewed for additional sources. Studies involving RCM for AIMP, LM and LMM diagnosis published until 1 December 2023, were selected for analysis. Publications on other non-invasive imaging techniques, other skin diseases or those addressing only RCM surgical margins and therapeutic response without reporting RCM features were excluded. Each article was reviewed by two experts, with disagreements resolved by a third expert. Data for each RCM feature were pooled, and odds ratios (ORs) and 95% confidence intervals (CIs) were calculated. Features were stratified for architecture, cellular morphology and distribution. Twenty-seven articles involving 303 lesions were included. Features favouring LM over AIMP included (1) Architecture: the presence of non-edged papillae (OR 4.50, 95% CI 1.92-10.52) and (2) Cellular distribution: widespread pagetoid cells and junctional atypical cells (OR 25.06, 95% CI 4.19-148.45) and junctional nests (OR 18.06, 95% CI 3.04-106.32). Features favouring LMM over LM included (1) Architecture: epidermal disarray (OR 5.03, 95% CI 1.90-13.22), junctional disarray (OR 4.19, 95% CI 1.54-11.33) and destroyed collagen fibres (OR 3.91, 95% CI 1.80-8.44) and (2) cellular distribution: widespread pagetoid and junctional atypical cells (OR 2.71, 95% CI 1.27-5.75) and junctional nests (OR 4.48, 95% CI 2.12-9.43). This study identifies the RCM features associated with the LM/LMM spectrum.

Gut Microbiome Characterisation of Chrysomya megacephala: Isolation, Identification, Antibiotic Profiling, and Initial Documentation of Leclercia adecarboxylata from the Fly

Chrysomya megacephala, known for its vector potential, harbors a diverse microbiota crucial in understanding disease transmission dynamics. Herein, we report the first documentation of Leclercia adecarboxylata isolated from C. megacephala. L. adecarboxylata is an Enterobacteriaceae, gram-negative bacillus that cause infections in human and animals. Additionally, we have reported the presence of Pseudomonas aeruginosa and Enterococcus faecalis from C. megacepahala. The study carried out the antibiotic profiling and hemolytic assays, which revealed distinct resistance patterns and virulence characteristics, shedding light on potential public health implications. L. adecarboxylata, Pseudomonas aeruginosa and Enterococcus faecalis showed positive result for hemolysis and in terms of antibiotic resistance P. aeruginosa strains showed resistance to Amoxicillin, Ampicillin and Tetracycline while, E. faecalis showed resistance towards Streptomycin and Tetracycline. However, L. adecarboxylata showed sensitivity to all antibiotics. This study was conducted from Kozhikode, Kerala, India, and this is the first of its kind of study from the region to analyse the vector potential of C. megacephala. These findings underscore the significance of comprehensive microbiological investigations in vector-borne disease surveillance and management strategies.