Midwestern Research Articles

Global, regional, and national prevalence of HIV-1 drug resistance in treatment-naive and treatment-experienced children and adolescents: a systematic review and meta-analysis

Despite significant reductions in mother-to-child HIV-1 transmission risks due to the advancements and scale-up of antiretroviral therapy (ART), the global burden of HIV-1 drug resistance (HIVDR) in treatment-naive and treatment-experienced children and adolescents remains poorly understood. In this study, we conducted a systematic review and meta-analysis to estimate the prevalence of HIVDR in these populations globally, regionally, and at the country level. We systematically searched PubMed, Embase, and Web of Science for studies reporting HIVDR in treatment-naive and treatment-experienced children and adolescents from inception to June 28, 2024. Eligible studies reported at least ten successfully genotyped cases. We excluded studies where drug resistance was not reported separately for children and adults or for treatment-naive and treatment-experienced populations. The methodological quality of eligible studies was assessed, and random-effect models were used for meta-analysis to determine the pooled overall and regimen-specific prevalence of one or more HIVDR mutations in these populations globally, regionally, or at the country level. This study is registered with PROSPERO under the number CRD42023424483. Of 2282 records identified, 136 studies (28,539 HIV-1-infected children from 52 countries) were included for analysis. The overall prevalence of HIVDR is 26.31% (95% CI, 20.76-32.25) among treatment-naive children and 74.16% (95% CI, 67.74-80.13) among treatment-experienced children (p<0.0001). HIVDR varied widely across subregion with the highest prevalence in Southern Africa (37.80% [95% CI, 26.24-50.08]) and lowest in South America (11.79% [95% CI, 4.91-20.84]) for treatment-naive children while highest in Asia (80.85% [95% CI, 63.76-93.55]) and lowest in Europe (54.39% [95% CI, 28.61-79.03]) for treatment-experienced children. The proportion of viral failure (VF) presented positive correlation with DR prevalence for treatment-experienced children, which increased from 61.23% (95% CI, 47.98-73.72) in proportion of VF<50%-81.17% (95% CI, 71.57-89.28) in proportion of 100%. Meta-regression analysis for both groups showed that only age (naive: p=0.0005; treated: p<0.0001) was the sources of heterogeneity. Non-nucleoside reverse transcriptase inhibitor (NNRTI) resistances were the most seen mutations among the treatment-naive group, with the HIVDR prevalence more than 10% in Southern Africa, Western and Central Africa, Eastern Africa, Asia, and North America. Both nucleoside reverse transcriptase inhibitor (NRTI) and NNRTI resistances were commonly seen among the treatment-experienced group, varying from 36.33% (95% CI, 11.96-64.93) in North America to 77.54% (95% CI, 62.70-89.58) in South America for NRTI and from 39.98% (95% CI, 13.47-69.97) in Europe to 68.86 (95% CI, 43.91-89.17) in Asia for NNRTI, respectively. This study underscores the significant burden of HIVDR among children and adolescents worldwide, particularly pronounced in sub-Saharan Africa and low-income countries. It emphasizes the critical importance of surveillance in all HIV-1-infected children and advocates for the adoption of dolutegravir (DTG) or other optimal formulations as first-line ART in settings where NNRTI resistance exceeds the WHO's 10% threshold. DTG's high resistance barrier, potent antiviral efficacy, and favorable safety profile makes it a superior choice for managing drug-resistant HIV-1, surpassing traditional antiretroviral therapies. This work was supported by the Science and Technology Innovation Committee of Shenzhen Municipality (No. JCYJ20220531102202005) and the Natural Science Foundation of Guangdong Province (No. 2024A1515012118).

Expanded geographic distribution for two Legionella pneumophila sequence types of clinical concern.

Legionella pneumophila serogroup 1 sequence types (ST) 213 and 222, a single-locus variant of ST213, were first detected in the early 1990s in the Midwest United States (U.S.) and the late 1990s in the Northeast U.S. and Canada. Since 1992, these STs have increasingly been implicated in community-acquired sporadic and outbreak-associated Legionnaires' disease (LD) cases. We were interested in understanding the change in LD frequency due to these STs and identifying genetic features that differentiate these STs from one another. For the geographic area examined here (Mountain West to Northeast) and over the study period (1992-2020), ST213/222-associated LD cases identified by the Centers for Disease Control and Prevention increased by 0.15 cases per year, with ST213/222-associated LD cases concentrated in four states: Michigan (26%), New York (18%), Minnesota (16%), and Ohio (10%). Additionally, between 2002 and 2021, ST222 caused at least five LD outbreaks in the U.S.; no known outbreaks due to ST213 occurred in the U.S. during this time. We compared the genomes of 230 ST213/222 isolates and found that the mean of the average nucleotide identity (ANI) within each ST was high (99.92% for ST222 and 99.92% for ST213), with a minimum between ST ANI of 99.50% and a maximum of 99.87%, indicating low genetic diversity within and between these STs. While genomic features were identified (e.g., plasmids and CRISPR-Cas systems), no association explained the increasing geographic distribution and prevalence of ST213 and ST222. Yet, we provide evidence of the expanded geographical distribution of ST213 and ST222 in the U.S.IMPORTANCESince the 1990s, cases of Legionnaires' disease (LD) attributed to a pair of closely related Legionella pneumophila variants, ST213 and ST222, have increased in the U.S. Furthermore, between 2002 and 2021, ST222 caused at least five outbreaks of LD in the U.S., while ST213 has not been linked to any U.S. outbreak. We wanted to understand how the rate of LD cases attributed to these variants has changed over time and compare the genetic features of the two variants. Between 1992 and 2020, we determined an increase of 0.15 LD cases ascribed to ST213/222 per year in the geographic region studied. Our research shows that these STs are spreading within the U.S., yet most of the cases occurred in four states: Michigan, New York, Minnesota, and Ohio. Additionally, we found little genetic diversity within and between these STs nor could specific genetic features explain their geographic spread.

The LTAR Croplands Common Experiment at Upper Mississippi River Basin-Ames.

Agricultural systems evolve from the interactions of climate, crops, soils, management practices (e.g., tillage, cover crops, nutrient management), and economic risks and rewards. Alternatives to the corn (Zea mays L.)-soybean [Glycine max (L.) Merr.] (C-S) cropping systems that dominate in the US Midwest may provide more sustainable use of resources, reduce the documented environmental impacts of current C-S systems, and improve production efficiency and ecosystem services. Innovative management practices are needed to offer producers options to increase farm resilience to variable weather conditions and offset negative environmental impacts. In response to this need, the Upper Mississippi River Basin Long-Term Agroecosystem Research network site at Ames, IA, established a cropland experiment in 2016 to investigate an alternative crop management system that includes reduced tillage, cover crops, and right source, right rate, right time, and right place (4R) nitrogen (N) management. The experimental site is located on the Iowa State University Kelley Research Farm in Boone County, IA. Crop, soil, air, and tile drainage water measurements are made throughout the year using published methods for each agronomic and environmental metric. Our goal is to provide quantitative information to farmers, consultants, agribusiness partners, and state and federal agencies to help guide decisions on the effective use of alternative management practices. Future changes in experimental treatments will adopt a knowledge co-production approach whereby researchers and stakeholders will work collaboratively to identify problems, implement research protocols, and interpret results.

Having a Trusted Adult in School: Concurrent and Predictive Relations With Internalizing Problems Across Development

Internalizing problems are common mental health concerns among children and youth. Identifying malleable risk factors that are associated with internalizing problems, such as not having a trusted adult at school, can lead to positive behavior supports to reduce student risk. The purpose of this study was to evaluate the association between student-reported internalizing problems and having an adult to talk to at school. Students in elementary, middle, and high school ( N = 13,881) in the Midwestern United States provided self-report data about their internalizing symptoms and whether they had an adult to talk to at school if they had a problem. Participants were 51% male and 72% White; 40% qualified for free or reduced lunch and 12% were in special education. A series of growth models revealed that not having a trusted adult at school was a strong risk factor for internalizing symptoms over the school year. Moreover, lack of a trusted adult was associated with worsening internalizing symptoms over time for middle and high school students. The findings have implications for identifying students and planning supports to alleviate this risk.

Delineating the drought vulnerability zones in Bangladesh

The research aims to explore the vulnerability of Bangladesh to drought by considering a comprehensive set of twenty-four factors, classified into four major categories: meteorological, hydrological, agricultural, and socioeconomic vulnerability. To achieve this, the study utilized a knowledge-based multi-criteria method known as the Analytic Hierarchy Process (AHP) to delineate drought vulnerability zones across the country. Weight estimation was accomplished by creating pairwise comparison matrices for factors and different types of droughts, drawing on relevant literature, field experience, and expert opinions. Additionally, online-based interviews and group discussions were conducted with 30 national and foreign professionals, researchers, and academics specializing in drought-related issues in Bangladesh. Results from overall drought vulnerability map shows that the eastern hills region displays a notably high vulnerability rate of 56.85% and an extreme low vulnerability rate of 0.03%. The north central region shows substantial vulnerability at high levels (35.85%), while the north east exhibits a significant proportion (41.68%) classified as low vulnerability. The north west region stands out with a vulnerability rate of 40.39%, emphasizing its importance for drought management strategies. The River and Estuary region displays a modest vulnerability percentage (38.44%), suggesting a balanced susceptibility distribution. The south central and south east regions show significant vulnerabilities (18.99% and 39.60%, respectively), while the south west region exhibits notable vulnerability of 41.06%. The resulting model achieved an acceptable level of performance, as indicated by an area under the curve value of 0.819. Policymakers and administrators equipped with a comprehensive vulnerability map can utilize it to develop and implement effective drought mitigation strategies, thereby minimizing the losses associated with drought.

Variation in species-specific responses to habitat fragmentation and land cover structure in urban small mammal communities

Abstract Urbanization is a key driver of habitat loss and fragmentation worldwide, yet many urban ecosystems contain vegetated habitat patches that support diverse wildlife communities. Managing urban systems to support robust wildlife communities requires us to understand the mechanisms that drive the response of species to the urban environment. Small mammals are key components of terrestrial ecosystems (e.g., seed predators, prey) and likely also carry out these roles in urban ecosystems; however, the effects of urbanization on small mammal communities are understudied. To identify how species-specific responses to urban environments shape community composition, we quantified both overall community and species-specific changes in small mammal abundance across an urbanization gradient in a Midwestern US metropolitan area. We combined small mammal trapping and land cover data to generate a hierarchical community abundance model. Species diversity increased with increasing proportional cover of human-modified land cover (i.e., impervious surfaces and turfgrass). This finding is driven by high species diversity on sites bordering streams in mowed parks and low diversity on sites with high tree canopy closure. Additionally, modeling results indicated that species responded differently to landscape attributes, leading to variation in small mammal community composition across the urbanization gradient: prairie-associated species tended to be more abundant in tall vegetation bordering mowed parks while habitat generalists tended to be more abundant on sites with greater canopy closure and shrub cover. Our results suggest that studies that focus on community-level responses (e.g., species richness) to urbanization may miss important species-specific responses. It may be particularly important to assess both species-specific and community-level responses in cities at ecotones (e.g., between forest and grassland) where species with different habitat requirements may replace one another in different types of green spaces, thereby changing community composition without affecting species diversity or richness. Our findings also indicate that vegetated urban patches, especially patches with tall vegetation cover and low canopy cover, are important habitat for prairie-associated small mammal communities, providing conservation options in heavily altered landscapes.

Complete genome sequence of Borrelia miyamotoi strain MN18-0001, an Am-East-2 strain type isolate derived from an Ixodes scapularis tick (Minnesota).

We report the genomic sequence of the hard tick relapsing fever spirochete Borrelia miyamotoi strain MN18-0001. B. miyamotoi causes human illness and is geographically widespread in Ixodes spp. (Acari: Ixodidae) ticks. This is a chromosome- and plasmid-resolved genome assembly of an Am-East-2 strain type isolate from the midwestern United States.

Barriers and facilitators to recovery among college students without access to a collegiate recovery program

Background Undergraduate students pursuing substance use recovery face multiple barriers, including widespread substance use on campus, stigma, and limited support. A small number of campuses have collegiate recovery programs to support students. Most students in recovery lack access to such programming, and little research has explored their experiences. Methods This study, framed by the recovery capital perspective, utilized thematic analysis to illuminate students’ experiences in recovery without a collegiate recovery program on a Midwestern US campus. Seventeen students participated in semi-structured interviews. We sought to understand the barriers to recovery these students faced and how students overcame them. Results Barriers exemplified limited or negative recovery capital. Students described substance use and mental health challenges, being overwhelmed with responsibilities, feeling isolated, and negative twelve-step group experiences. Students gained personal recovery capital by mobilizing personal strengths, coping, and self-care strategies. To build family/social capital, they engaged various supports (e.g. mutual aid or activist groups). Community capital was limited to campus counseling services or supportive professors. Notably, not all students chose abstinence. Conclusion This study augments the literature about how students in recovery overcome barriers without a collegiate recovery program. Universities should offer services to accommodate the range of recovery preferences and experiences.

Effects of Preferred Music on Older Adults with Dementia: An Observational Study

Dementia is becoming more prevalent as the population of adults over the age of 65 increases. With an increase in this disease comes a need for interventions, as dementia is incurable, nonpharmacological interventions are es-sential to reduce associated behaviors associated with de-mentia. This single subject A-B experimental design took place in the upper midwestern United States with indi-viduals diagnosed with dementia who had documented moderate-to-severe cognitive impairment and demon-strated dementia-related behaviors. Demographic and personalized treatment data were collected through chart reviews and interviews with staff and participants before starting baseline observations. The lead investigator con-ducted A-phase baseline behavioral observations using time sampling for five consecutive days followed by B-phase experimental behavioral observations using time sampling for five consecutive days. The data suggested that preferred music can impact dementia-related behaviors and has the potential to improve quality of life. Implications for recreational therapy practice are included.

Cultural-Environmental Systems and the Archaeology of Climate Change and Social Complexity: Midwest and Southeast United States

The investigation of dynamic fully integrated cultural-environmental systems is one grand challenge facing archaeologists in this century. In the Midwest and Southeast United States, archaeologists recently increased their study of Mississippian social systems (ca. AD 1000–1600) in relationship to paleoclimate and paleoenvironmental data. Significant differences in chronological control between archaeological chronologies and paleoenvironmental records pose challenges to the study of cultural-environmental systems in this region and often result in equifinal results. Three major lines of paleoenvironmental records are reviewed: bald cypress tree-ring records, the Living Blended Drought Atlas (LBDA), and lake-bottom sediment cores. The strongest approaches include local and regional multiproxy environmental records from the same location as a well-investigated archaeological site(s) or region(s). In the rare case where the cores also encode a regional population history, it may be possible to develop stronger inferences that consider variation within and between communities and their vulnerability to climate change and environmental catastrophes.

Demographic Variance in COVID‐19 Vaccine Hesitancy Among Reproductive‐Aged Females During the First Year of the Vaccine Rollout

ABSTRACTObjectiveInitial COVID‐19 vaccine trials excluded pregnant individuals, making eventual vaccine recommendations nongeneralizable. After noninferiority was established, the CDC, WHO, and ACOG supported vaccination of this group. However, only 31% of pregnant people accepted vaccination. This study aims to assess COVID‐19 vaccine hesitancy in a diverse cohort of reproductive‐aged females.MethodsWe used a validated WHO vaccine hesitancy survey tool, modified to address the COVID‐19 vaccine specifically. From August to November 2021, people capable of pregnancy aged 18–50 years were recruited from inpatient and outpatient OB/GYN services at a large, urban, academic centre in the Midwestern United States. The responses were collected anonymously and analysed using Kruskal–Wallis H and Mann–Whitney U tests.ResultsFifty‐one of sixty participants partially or fully completed the survey. Black individuals were more vaccine‐hesitant in general than Hispanic and White individuals (H[2] = 11.179, p &lt; 0.01), and they were more hesitant toward the COVID‐19 vaccine specifically (H[2] = 9.396, p &lt; 0.01). Pregnant people were less confident that the COVID‐19 vaccine was safe overall (H[2] = 11.473, p &lt; 0.005) compared to those recently pregnant or not pregnant. Individuals not using contraception reported being significantly less confident in the safety of the COVID‐19 vaccine (U = 96.500, p &lt; 0.05). Individuals who declined the flu vaccine were more likely to be COVID‐19 vaccine‐hesitant (U = 79.500, p &lt; 0.001). Participants' age and occupation were not associated with vaccine hesitancy.ConclusionVaccine hesitancy particularly among some demographic groups highlights the need to study the underlying factors contributing to a lack of confidence in the safety of the COVID‐19 vaccine.SynopsisOur validated survey‐based study found that Black participants capable of pregnancy were the most vaccine‐hesitant, highlighting a missed opportunity to care for these individuals.

Sibling socialization of alcohol use during adolescence: An integrated model of sibling influence processes.

Research demonstrates that siblings, especially older siblings, make unique contributions to adolescents' substance use above and beyond shared genetics and shared parenting. Older siblings' influences on younger adolescent siblings' alcohol use operate through both direct and indirect pathways. Using three waves of longitudinal data, the present study tested an integrated model of sibling influence processes focused on the linkages between older adolescent siblings' earlier alcohol use and younger adolescent siblings' later alcohol use. Longitudinal study using data collected from families on three occasions: Time 1 (March 2019-February 2020), Time 2 (July 2020-February 2021) and Time 3 (November 2021-February 2022) via online surveys. Families resided in five midwestern states in the US (Illinois, Indiana, Ohio, Pennsylvania and Wisconsin). Participants included two adolescent-aged siblings and one parent from 682 families (n = 2046 persons). Alcohol use by adolescents and parents was assessed at Time 1; younger siblings' social alcohol expectancies and perceptions of modeling were measured at Time 2; and younger siblings' alcohol use was measured at Time 3. Older siblings' earlier alcohol use predicted younger siblings' later drinking both directly [b = 0.15, standard error (SE) = 0.04, β = 0.17, P < 0.001] and indirectly through younger siblings' social alcohol expectancies [δ = 0.02, SE = 0.008, 95% confidence interval (CI) = 0.003, 0.03]. The direct (δ = -0.14, SE = 0.07, 95% CI = -0.27, -0.01) and indirect (δ = 0.03, SE = 0.02, 95% CI = 0.0001, 0.06) links were further moderated by younger siblings' reports of sibling modeling, but not by gender composition of the sibling dyad or the interaction of modeling and gender composition. Older siblings' alcohol use appears to influence younger siblings' later alcohol use directly, as well as indirectly through younger siblings' expectancies about alcohol. The global context of the sibling relationship, in this case sibling modeling, may further amplify or dampen these pathways of influence.

Teachers' and Principals' Familiarity with School Wellness Policy: A Health Promoting Schools Assessment.

The current study explored teacher and principal familiarity with school wellness polices in primary schools, including who serves on school wellness committees, and who should implement and enforce wellness policies in the school. An electronic survey guided by the Health Promoting Schools framework was administered from February to May 2020 to teachers and principals from one urban and one suburban school district in the Midwestern United States. There were 450 participants; response rates were 28% (urban), 33% (suburban), and 51% (school principals). Only 41.7% of the aggregate participant pool were familiar with their wellness policy. Participants were more familiar in the suburban compared to the urban district (χ2 = 68.2, p-value ≤ 0.001). Teachers/health teachers, nurses, and principals were most likely to be on wellness committees, and the most preferred wellness champions were teachers, nurses, and food service staff. Teachers and nurses are integral to school wellness and health education as part of multiple systems that can promote school health. The Health Promoting Schools framework is useful for guiding examinations to improve understanding of school wellness within school communities.

Impact of state tuition guarantee policy on enrollment in public universities

PurposeThis study estimates the effect of the Truth-in-Tuition policy on the enrollment of first-year students, minority students and all students (total enrollment) in Illinois universities.Design/methodology/approachEconometric models yield robust estimates using state- and time-fixed effects. This research uses the nonparametric Difference-in-Difference (DID) method. Variation in the starting of the Truth-in-Tuition policy across the Midwestern states is used as a natural experiment.FindingsResults demonstrate that the Truth-in-Tuition policy helped increase freshman enrollment but did not significantly impact minority enrollment. This policy, however, shows a much larger drop in total enrollment in Illinois universities.Originality/valueA comparison between regionally competing institutions under different policy regimes was not analyzed earlier.

Cutaneous Lesions in the Gular Region Caused by Feather Follicle Infestation with Harpirhynchidae sp. Mites in Great Crested Flycatchers (Myiarchus crinitus) in New York, USA, 2016-23.

Great Crested Flycatchers (Myiarchus crinitus), migratory passerines with a breeding range throughout the northeastern, midwestern, and southern US, are banded annually at the Braddock Bay Bird Observatory located on the southern shore of Lake Ontario, New York, USA. In 2016, a Great Crested Flycatcher was observed with distinct lesions in the gular and ventral neck region, which prompted evaluation for similar lesions in subsequently trapped flycatchers and other passerine species. From 2016 to 2023, 62/102 banded Great Crested Flycatchers had their gular region examined, and seven were found to have lesions (11.3% incidence). Similar lesions were not found in any other species. Lesions were localized to the gular region and included extensive feather loss with thickened, corrugated, pale-yellow skin. Grossly visible 1- to 2-mm-diameter, raised, white-to-yellow foci throughout the affected region corresponded microscopically to feather follicles that were massively dilated with mites. Morphologic analysis of mites obtained from skin scrapes revealed that this mite species belongs to the family Harpirhynchidae. Mites in this family have restricted avian host ranges and cause varying clinical presentations in passerines, though many species remain unidentified. PCR efforts were unsuccessful in yielding a species-level identification. Further monitoring of Great Crested Flycatchers and other avian species is warranted, as the fitness implications of this ectoparasitism at the individual and population levels are not known.

The LTAR Cropland Common Experiment at the Kellogg Biological Station.

The Kellogg Biological Station Long-term Agroecosystem Research site (KBS LTAR) joined the national LTAR Network in 2015 to represent a northeast portion of the North Central Region, extending across 76,000 km2 of southern Michigan and northern Indiana. Regional cropping systems are dominated by corn (Zea mays)-soybean (Glycine max) rotations managed with conventional tillage, industry-average rates of fertilizer and pesticide inputs uniformly applied, few cover crops, and little animal integration. In 2020, KBS LTAR initiated the Aspirational Cropping System Experiment as part of the LTAR Common Experiment, a co-production model wherein stakeholders and researchers collaborate to advance transformative change in agriculture. The Aspirational (ASP) cropping system treatment, designed by a team of agronomists, farmers, scientists, and other stakeholders, is a five-crop rotation of corn, soybean, winter wheat (Triticum aestivum), winter canola (Brassicus napus), and a diverse forage mix. All phases are managed with continuous no-till, variable rate fertilizer inputs, and integrated pest management to provide benefits related to economic returns, water quality, greenhouse gas mitigation, soil health, biodiversity, and social well-being. Cover crops follow corn and winter wheat, with fall-planted crops in the rotation providing winter cover in other years. The experiment is replicated with all rotation phases at both the plot and field scales and with perennial prairie strips in consistently low-producing areas of ASP fields. The prevailing practice (or Business as usual [BAU]) treatment mirrors regional prevailing practices as revealed by farmer surveys. Stakeholders and researchers evaluate the success of the ASP and BAU systems annually and implement management changes on a 5-year cycle.

Does every transgender person want gender affirming surgery? A survey of transgender individuals in the Midwestern United States.

Gender-affirming surgery (GAS) is a highly personalized decision for transgender and gender diverse (TGD) individuals. However, the proportion of TGD individuals who desire GAS is unknown. A questionnaire was created after identifying themes surrounding experiences with gender-affirming medical care by community focus groups. Respondents who reported medically transitioning and who had undergone GAS were compared to those without prior GAS. From 88 completed surveys, 18 (20.5%) individuals did not wish to undergo GAS. Of those medically transitioning and desiring GAS, 15.2% (9/59) desired GAS but had not received it yet, with 6.7% (6/9) identifying as non-binary. Individuals who had not had GAS were more likely to earn under $15,000 annually, compared to $25,000-49,000 in the GAS group (p = 0.01). There was no significant difference in educational level (p = 0.32) or insurance status (p = 0.33). Of TGD individuals who desire GAS, out-of-pocket expenses such as hair removal, opaque insurance policies, lack of social support, and access to gender-affirming providers can hinder the transition process. Understanding barriers and rationales for pursuing GAS can provide targets for improving healthcare delivery to this diverse population.

Impact of Recent Agricultural Ammonia Increases on Fine Particulate Matter Burden over the Midwestern United States

Impact of Recent Agricultural Ammonia Increases on Fine Particulate Matter Burden over the Midwestern United States

New Fermatean Fuzzy Distance Metric and Its Utilization in the Assessment of Security Crises Using the MCDM Technique

The problem of insecurity is a global phenomenon that has several forms like terrorism, banditry, kidnappings, etc. Insecurity has taken hold in the Sub-Saharan Region of West Africa, especially in Nigeria, for over two decades. Nigeria’s security crisis is more pronounced in the Northern Region, with a new wave in the North-Central Region of Nigeria. It is herculean to assess insecurity in the North-Central Region of Nigeria because of the region’s fuzzy or imprecise nature of insecurity. This constitutes the rationale for deploying the Fermatean fuzzy technique to assess insecurity due to the capacity of the Fermatean fuzzy scheme to handle imprecision. To this end, a new Fermatean fuzzy distance metric is presented to evaluate insecurity in the North-Central Region of Nigeria using a multi-criteria decision-making technique. To express the logic for creating the new Fermatean fuzzy distance metric, some existing Fermatean fuzzy distance metrics are discussed, along with their drawbacks. The mathematical properties of the new technique are discussed, and the new method is applied computationally to assess insecurity in the North-Central Region of Nigeria. The data for the security assessment are collected via Fermatean fuzzy linguistic variables using the opinions of security experts and analyzed using the technique for order of preference by similarity to ideal solution, which is a commonly used multi-criteria decision-making method. Finally, the numerical validity of the new technique is expressed with comparative results, and the finding shows the benefit of the new distance approach over the existing methodologies. The outcome of the work will provide reliable traveling advisories for safe voyages within the region.

Understanding Patient Portal Uses and Needs: Cross-Sectional Study in a State Fair Setting.

This study identified 22 features that are used and the needs for desired features/data in patient portals that enable online access to medical records. Data collected at a Midwestern state fair indicates that while most participants used patient portals, use and desirability of specific features varied widely. Identified needs for enhanced data access, portal functionality, and usability can be used to inform effective patient portal design.