Community Level Research Articles

Koolangka Infant Life Saving: Culturally responsive infant CPR education for Aboriginal Australian parents

Objectives: Among Aboriginal children, the year between birth and 1 year of age has the highest mortality rate compared with any other age. Prompt administration of cardiopulmonary resuscitation (CPR) leads to better outcomes and a lower likelihood of ongoing sequalae. Current education on infant CPR is not provided to parents except in certain circumstances in a neonatal intensive care unit. Currently, there are no identified CPR education courses specifically available for Aboriginal or Torres Strait Islander people, meaning that current infant CPR education courses are not culturally responsive. Design: Partnering with an Aboriginal community from the Bindjareb region of the Western Australian Noongar nation, the researchers used a co-design approach and an Aboriginal Participatory Action Research (APAR) design to explore how to deliver culturally safe and responsive infant CPR community education. This resulted in the development of the Koolangka Infant Life Saving Education Framework (KILSEF), which can be used to guide future planning and delivery of culturally safe and responsive community level infant CPR education. Results: The study findings identified that members of the Aboriginal community were very interested in receiving infant CPR education, but the barriers identified from mainstream CPR course delivery need to be removed for the community to benefit from culturally responsive ways of learning. Culturally responsive community CPR education should be provided in culturally safe places and the focus of learning should be on the practical applications of CPR and less on the academic pre-reading and written requirements. Explanations should be provided in lay terms and patience is required to communicate ideas in ways that facilitate understanding, and the course may need to be delivered over several days to accommodate community participant availability. Conclusion: Addressing Aboriginal community concerns and barriers allowed for the implementation of culturally responsive infant resuscitation education which was highly valued by community members and led to increased community confidence and participation in CPR education.

From Politics of Islam to Terrorism: Discovering the Roots of Islamophobia in Indonesia

Islamophobia is an issue that has affected both minority and majority Muslim communities in many countries, including Indonesia. To gain a deeper understanding of Islamophobia in Indonesia, this study focuses on two of eight components of Islamophobia identified by Sabri Ciftci (2012), namely, Islam is perceived as a political ideology and is associated with violence. Through a combination of qualitative and quantitative methods, including historical-comparative and survey, the authors explore how the Indonesian government has dealt with Islamophobia since the Old and New Order periods. This research also delves into how Islamophobia has impacted minority Christians and moderate Muslims during the Reform Era, where Islam is often associated with religious intolerance and terrorism. The results indicate that Islamophobia in Indonesia has three primary root causes linked to certain Islamic societal behaviour: political tensions between Islamic fundamentalists and nationalists regarding the state ideology, religious tensions between radical Muslims and Christians resulting in intolerance, and acts of terrorism using Islamic symbols. This research concludes Islamophobia in Indonesia has switched from the government to the community level, requiring the government policy to eliminate Islamophobia in a pluralistic society.

The associations of food environment with gastrointestinal cancer outcomes in the United States.

Social conditions and dietary behaviors have been implicated in the rising burden of gastrointestinal cancers (GIC). The "food environment" reflects influences on a community level relative to food availability, nutritional assistance, and social determinants of health. Using the US Department of Agriculture-Food Environment Atlas (FEA), we sought to characterize the association of food environment on GIC presenting stage and long-term survival. Patients diagnosed with GIC between 2013 and 2017 were identified using the SEER database. FEA-scores were based on 282 county-level food security variables, store-restaurant availability, SNAP/WIC enrollment, pricing/taxes, and producer vicinity adjusted-for factors of socioeconomic status, race-ethnicity, transportation access, and comorbidities. Relative FEA rankings across US counties were averaged into a composite score and assigned to patients by county-of-residence. The association of FEA, cancer stage, and survival were analyzed using multiple logistic regression and cox-proportional hazard models relative to White/non-White race/ethnicity. Among 287,148 patients, the most common GIC-sites were colon (n = 97,942, 34%), pancreas (n = 49,785, 17.3%), liver (n = 31,098, 11.0%) and esophagus (n = 16,271, 5.7%). A worse food environment was independently associated with increased odds of late-stage diagnosis (esophageal odds ratio [OR]: 1.03, 95% confidence interval [CI]: 1.01-1.05; hepatic OR: 1.06, 95% CI: 1.03-1.08; pancreatic OR: 1.04, 95% CI: 1.01-1.06) among all patients; in contrast, food environment was associated with colorectal cancer stage among non-White patients only (OR: 1.04, 95% CI: 1.03-1.06). Worse food environment was associated with worse 3-year survival (colon OR: 1.03, 95% CI: 1.01-1.04; hepatic OR: 1.12, 95% CI: 1.08-1.17; gastric OR: 1.07, 95% CI: 1.01-1.13). Similar associations were noted relative to overall survival among the entire cohort (biliary tract hazard ratio [HR]: 1.03, 95% CI: 1.01-1.05; esophageal HR: 1.02, 95% CI: 1.01-1.04; hepatic HR: 1.07, 95% CI: 1.06-1.09; pancreatic HR: 1.04, 95% CI: 1.02-1.05; rectum HR: 1.03, 95% CI: 1.01-1.04; gastric HR: 1.05, 95% CI: 1.03-1.07), as well as among non-White patients (biliary HR: 1.04, 95% CI: 1.01-1.07; colon HR: 1.03, 95% CI: 1.01-1.05; esophageal HR: 1.05, 95% CI: 1.02-1.08; hepatic HR: 1.08, 95% CI: 1.06-1.10) (all p < 0.003). Food environment was independently associated with late-stage tumor presentation and worse 3-year and overall survival among GIC patients. Interventions to address inequities across communities relative to food environments are needed to alleviate disparities in cancer care.

Predicting the distribution of megabenthic communities on deep-water seamounts with cobalt-rich crusts in the Magellan Seamount Chain in the northwestern Pacific ocean

Deep-water seamount ecosystems are sensitive to human activities and have a slow recovery rate after being disturbed. Bottom trawling and potential deep-sea mineral extraction could severely damage benthic communities on seamounts and seriously impact deep-sea ecosystems. Inadequate knowledge of the distribution of megabenthos on seamounts or their community structure hinders deep-sea conservation and management. In this study, based on a multidisciplinary dataset generated from recordings taken by human-occupied vehicle (HOV) and remotely operated vehicles (ROVs) along transects and environmental variables, a range of megabenthic morphotaxa were observed on two adjacent deep-water seamounts and predicted using species distribution models (SDMs). Accordingly, based on the predicted distribution of each morphotaxon, five distinct communities were identified through cluster analysis. The results of SDMs showed that environmental variables varyingly impacted the distribution of different morphotaxa, among which the average velocity and eastness direction of near-bottom currents, bathymetric position index (BPI), and backscatter intensity exerted the most significant influence on megabenthic distribution patterns. The distribution of five distinct communities showed a similarity of community composition on the two deep-water seamounts, suggesting a potential connectivity between the two seamounts. The distribution of communities revealed the spatial characteristics of vulnerability of deep-water seamounts at the community level, which could provide a direct basis for marine spatial planning of deep-sea ecosystems.

Resilience among Caregivers of the Pediatric Cancer Patients

Abstract Backgound: Studies portray that one in every nine Indians develops cancer during their lifetime. Admissions to the Pediatric Oncology departments are increasing like any other department. Cancer affects not only the patients but also their caregivers both physically and psychologically. Aims and Objectives: In this scenario, the study aims to understand the caregivers’ level of resilience and the associated risk and protective factors. Materials and Methods: This descriptive study was conducted in Kerala. Sixty caregivers of the children in the age group between 1-17 years, diagnosed with cancer were selected for the study. Mexican Resilience Scale and self-prepared interview schedule were used to collect the quantitative data. Qualitative data were collected using an in-depth interview guide. Results: The study found that the majority of the respondents are moderately resilient, with men exhibiting higher resilience than women. The prime factors contributing to resilience were identified as strength and self-confidence, social competence, family support, social support, and structure. The study further identified individual factors (flexibility, emotional stability, etc.), familial factors (positive family environment), and community factors (support from NGOs and support groups, etc.) as protective factors contributing to resilience. Additionally, the study revealed how individual (lack of emotional stability, introverted nature, etc.), familial (relationship issues), and community (social perceptions about the disease) levels of risk factors impact resilience. Conclusion: The importance of strengthening the support systems around the caregivers and importance of oncology social worker to deal with the psychosocial issues of patients and caregivers are also discussed in this paper.

Performance characteristics of INDICAID antigen rapid diagnostic test on SARS-CoV-2 samples during the omicron wave in Cameroon

BackgroundWHO recommends the use of COVID-19 antigen rapid diagnostic tests (Ag-RDT) with at least 80 % sensitivity and 97 % specificity. In the era of Omicron variants, we sought to ascertain the performance of the INDICAID™ Ag-RDT compared to real-time PCR (RT-PCR) as the gold standard. MethodsA laboratory-based study was conducted among consenting individuals tested for COVID-19 at the virology laboratory of the Chantal BIYA International Reference Centre, Yaoundé-Cameron. The samples were processed by INDICAID™ Ag-RDT and DaAn Gene real-time PCR according to the manufacturer's instructions, and PCR-results were interpreted as per cycle thresholds (CT). The sensitivity, specificity, positive and negative predictive values (PPV and NVP) of INDICAID™ Ag-RDT were evaluated according to PCR CT-values. ResultsA total of 565 nasopharyngeal swabs were collected from participants (median age [IQR]: 40 [31–75]; M/F sex-ratio was 1.2 and 380 were vaccinated). Following PCR, overall COVID-19 positivity was 5.66 %. For CT < 37, INDICAID™ Ag-RDT sensitivity was 21.9 % (95%CI: [8.3–39.9]), specificity 100 % (95%CI: [99.3–100]); PPV 100 % (95%CI: [59.0–100]), NPV 95.5 % (95%CI: [93.4–97.1]) and kappa = 0.34 (95%CI: [0.19–0.35]). For CT < 25, sensitivity was 100 % (95%CI: [47.8–100.0]), specificity 99.6 % (95%CI: [98.7–99.9]); PPV 94.4 % (95%CI: [51.7–100]), NPV 100 % (95%CI: [99.3–100]) and kappa = 0.83 (95%CI: [0.6–1.0]). COVID-19 sequences generated were all Omicron BA.1 subvariants. ConclusionFor patients infected with high viral loads (CT < 25), INDICAID™ Ag-RDT has high intrinsic (sensitivity and specificity) and extrinsic (predictive values) performances for COVID-19 diagnosis. Due to its simplicity and short turnaround time, INDICAID™ Ag-RDT is, therefore a reliable tool to prevent the spread of COVID-19 at community level in the current era of Omicron subvariants.

Wildlife ecotoxicology of plant protection products: knowns and unknowns about the impacts of currently used pesticides on terrestrial vertebrate biodiversity.

Agricultural practices are a major cause of the current loss of biodiversity. Among postwar agricultural intensification practices, the use of plant protection products (PPPs) might be one of the prominent drivers of the loss of wildlife diversity in agroecosystems. A collective scientific assessment was performed upon the request of the French Ministries responsible for the Environment, for Agriculture and for Research to review the impacts of PPPs on biodiversity and ecosystem services based on the scientific literature. While the effects of legacy banned PPPs on ecosystems and the underlying mechanisms are well documented, the impacts of current use pesticides (CUPs) on biodiversity have rarely been reviewed. Here, we provide an overview of the available knowledge related to the impacts of PPPs, including biopesticides, on terrestrial vertebrates (i.e. herptiles, birds including raptors, bats and small and large mammals). We focused essentially on CUPs and on endpoints at the subindividual, individual, population and community levels, which ultimately linked with effects on biodiversity. We address both direct toxic effects and indirect effects related to ecological processes and review the existing knowledge about wildlife exposure to PPPs. The effects of PPPs on ecological functions and ecosystem services are discussed, as are the aggravating or mitigating factors. Finally, a synthesis of knowns and unknowns is provided, and we identify priorities to fill gaps in knowledge and perspectives for research and wildlife conservation.

Multi-sector stakeholder consensus on tackling the complex health and social needs of the growing population of people leaving prison in older age

BackgroundAs populations age globally, cooperation across multi-sector stakeholders is increasingly important to service older persons, particularly those with high and complex health and social needs. One such population is older people entering society after a period of incarceration in prison. The ‘ageing epidemic’ in prisons worldwide has caught the attention of researchers, governments and community organisations, who identify challenges in servicing this group as they re-enter the community. Challenges lie across multiple sectors, with inadequate support leading to dire consequences for public health, social welfare and recidivism. This is the first study to bring together multi-sector stakeholders from Australia to form recommendations for improving health and social outcomes for older people re-entering community after imprisonment.ResultsA modified nominal group technique was used to produce recommendations from N = 15 key stakeholders across prison health, corrections, research, advocacy, aged care, community services, via online workshops. The importance and priority of these recommendations was validated by a broader sample of N = 44 stakeholders, using an online survey. Thirty-six recommendations for improving outcomes for this population were strongly supported. The key issues underlying the recommendations included: improved multi-stakeholder systems and services, targeted release preparation and practices that ensure continuity of care, advocacy-focused initiatives in the community, and extended funding for effective programs.ConclusionsThere is consensus across stakeholders on ways forward, with intervention and policy updates required at the individual, systems and community levels. These recommendations entail two important findings about this population: (1) They are a high-needs, unique, and underserved group at risk of significant health and social inequity in the community, (2) Multi-sector stakeholder cooperation will be crucial to service this growing group.

Every loaf of bread is political – Reflections on collective care responses to Covid-19 in Cape Town

Feminist perspectives on care have demonstrated how capitalism undervalues care work. The Covid-19 pandemic highlighted this further, as systems of production and social reproduction became destabilized globally. In many countries, the formal pandemic response fell short of attending to the daily, fundamental care needs of people living through the crisis, especially those compromised by the socio-economic effects of the pandemic. These needs were often attended to at the community level. This article explores a community-led network of care, known as CANs, that emerged in response to the pandemic in Cape Town. It makes three overarching observations. The first is that community-led responses were characterised by a push towards the collectivisation of care work. The second is that this enabled emergent strategies and relational practices of care, centring notions of solidarity, inter-dependence and horizontal exchange of resources and knowledge. Finally, we observed that, although the devaluation of care work limited the recognition and material support extended to CANs, opportunities to re-politicise care work as resistance work emerged. These represent a prefigurative moment in which alternative logics and strategies can transform the vision of our health and care systems, and the notion of community participation in and ownership of those systems.

Assessing the Status of Flood Hazard on the Bank of Mohana River in Kailari Rural Municipality

Purpose: Kailali holds number of rivers originating from Mahabharat range and Chure range which get flooded every year, causing high losses of agricultural land and the flooding at community level. In order to identify and understand the probable risks in the study area and the methodologies followed to get rid of the flood risk or to protect the land and community from the effect of flood. Design/Methodology/Approach: The study was conducted during the period from March 2022 to May 2023. Field observation, in-depth interview, focus group discussion and questionnaire survey were the major tool applied for the investigation. Findings/Results: The study found that the flood is the major hazard, and the earthquake is the minor one. River encroachment is the major one problem of the river training works and inadequate people’s awareness is the minor one. The river down to Chure carries lots of sediment and thus increasing the bed loads. Thus, Chure protection programs must be effectively executed so that the lower plain will be sediment less and the inundation of land will be reduced. Originality/Value: The paper contributes on the effective ways to protect community from flood hazards

Quantifying the impact of hospital catchment area definitions on hospital admissions forecasts: COVID-19 in England, September 2020–April 2021

BackgroundDefining healthcare facility catchment areas is a key step in predicting future healthcare demand in epidemic settings. Forecasts of hospitalisations can be informed by leading indicators measured at the community level. However, this relies on the definition of so-called catchment areas or the geographies whose populations make up the patients admitted to a given hospital, which are often not well-defined. Little work has been done to quantify the impact of hospital catchment area definitions on healthcare demand forecasting.MethodsWe made forecasts of local-level hospital admissions using a scaled convolution of local cases (as defined by the hospital catchment area) and delay distribution. Hospital catchment area definitions were derived from either simple heuristics (in which people are admitted to their nearest hospital or any nearby hospital) or historical admissions data (all emergency or elective admissions in 2019, or COVID-19 admissions), plus a marginal baseline definition based on the distribution of all hospital admissions. We evaluated predictive performance using each hospital catchment area definition using the weighted interval score and considered how this changed by the length of the predictive horizon, the date on which the forecast was made, and by location. We also considered the change, if any, in the relative performance of each definition in retrospective vs. real-time settings, or at different spatial scales.ResultsThe choice of hospital catchment area definition affected the accuracy of hospital admission forecasts. The definition based on COVID-19 admissions data resulted in the most accurate forecasts at both a 7- and 14-day horizon and was one of the top two best-performing definitions across forecast dates and locations. The “nearby” heuristic also performed well, but less consistently than the COVID-19 data definition. The marginal distribution baseline, which did not include any spatial information, was the lowest-ranked definition. The relative performance of the definitions was larger when using case forecasts compared to future observed cases. All results were consistent across spatial scales of the catchment area definitions.ConclusionsUsing catchment area definitions derived from context-specific data can improve local-level hospital admission forecasts. Where context-specific data is not available, using catchment areas defined by carefully chosen heuristics is a sufficiently good substitute. There is clear value in understanding what drives local admissions patterns, and further research is needed to understand the impact of different catchment area definitions on forecast performance where case trends are more heterogeneous.

'Two heads are better than one.' - exploring the experiences of Ghanaian communities on the role and effect of Patient-Public Engagement in Health System Improvement.

Patient and Public Participation (PPP) is key to improving health systems. Yet, studies have shown that PPP implementations across many countries have been largely tokenistic. Particularly, in Ghana, whilst PPP is prioritised in national health policies and legislation, there appears to be little research focused on understanding PPP's role in health system improvement. The aim of this study, therefore, is to examine how PPP is working across the Ghanaian health system levels, as well as to understand the perspectives and experiences of participants on how PPP contributes to health system improvement. The qualitative study was undertaken in six communities in three districts in the Ashanti region of Ghana. Data were collected from semi-structured individual interviews. The selection of participants was purposive, based on their PPP-related roles. As a result, findings of this study may not reflect the experiences of others who are not directly involved in PPP initiatives. Thirty-five participants, mainly health service users and health professionals, were interviewed. Data were transcribed and analysed descriptively using Braun and Clarke's 2006 thematic analysis approach. Overall, participants noted PPP implementation was largely limited at higher health system levels (i.e. national, regional and district levels), but was functioning at the community level. PPP also improved access to health services, responsiveness to patient needs, community-health worker relationships, health-seeking behaviours, empowered healthcare users, and improved health outcomes. The study, therefore, recommended the need to undertake PPP across all levels of the health system to maximise PPP's role in health system improvement. Finally, the study suggested prioritising PPP, especially for resource-poor countries to complement government's efforts in improving accessibility of healthcare services to many communities and also provide a more patient-centred healthcare system responsive to patients' and public needs.

Colorectal Cancer: Epidemiology, Risk Factors, and Prevention.

Colorectal cancer (CRC) is the third most common cancer and the second most common cause of cancer mortality worldwide. There are disparities in the epidemiology of CRC across different populations, most probably due to differences in exposure to lifestyle and environmental factors related to CRC. Prevention is the most effective method for controlling CRC. Primary prevention includes determining and avoiding modifiable risk factors (e.g., alcohol consumption, smoking, and dietary factors) as well as increasing protective factors (e.g., physical activity, aspirin). Further studies, especially randomized, controlled trials, are needed to clarify the association between CRC incidence and exposure to different risk factors or protective factors. Detection and removal of precancerous colorectal lesions is also an effective strategy for controlling CRC. Multiple factors, both at the individual and community levels (e.g., patient preferences, availability of screening modalities, costs, benefits, and adverse events), should be taken into account in designing and implementing CRC screening programs. Health policymakers should consider the best decision in identifying the starting age and selection of the most effective screening strategies for the target population. This review aims to present updated evidence on the epidemiology, risk factors, and prevention of CRC.

Factors associated with help-seeking by women facing intimate partner violence in India: findings from National Family Health Survey-5 (2019–2021)

BackgroundIntimate partner violence (IPV) against women has harmful effects on their psychological and physical health. However, help-seeking for IPV is significantly low among women in the Indian context. This study examines the different factors that influence help-seeking behaviour among women in India. It also studies associations of the type of IPV with the source of help.MethodsThe study analyses data from the fifth round of the National Family Health Survey that was conducted in India (2019–2021). Independent variables were categorized at individual, relationship-household and community levels. The Stata 14.2 software was used to calculate the prevalence ratios and their corresponding 95% confidence intervals. Variables with p-values less than 0.05 were considered statistically significant. Poisson regression helped identify factors associated with help-seeking.ResultsResults indicate that among 72,320 women aged 18–49 years, 17,765 women ever-faced IPV. Of them, 14.2% of women who faced either physical and/or sexual IPV sought any help. Husband’s consumption of alcohol almost doubled the likelihood of help-seeking among women (19.91%), compared to women whose husbands did not drink alcohol (10.19%). Witnessing parental IPV also increased the odds (17.26%) of help-seeking. Women who were not empowered were more likely to seek help (14.11%) compared to women who were empowered (12.56%). The police were the predominant source where women went for formal help (6.94 to 8.43%), followed by doctors (1.84 to 2.71%). Close to 1 in 4 women (22.5%) sought help for sexual IPV, while 14.4% of women sought help for physical IPV. Around 95% of all women who faced IPV sought informal help, with 3 in 5 of them approaching their own families, and 3 in 10 approaching their in-laws or marital families.ConclusionsTwo significant factors that associate positively with help-seeking by women facing IPV are husbands’ alcohol consumption and witnessing parental IPV. Most women preferred informal help from the natal family, while among formal providers, the police were the foremost choice. Programmes and initiatives to build capacities of communities, and of police to respond to women seeking help for IPV, would enable more women to reach out for help.

Genomic and Epigenomic Influences on Resilience Across Scales: lessons from the responses of fishes to environmental stressors.

Understanding the factors that influence the resilience of biological systems to environmental change is an increasingly critical concern in the face of increasing human impacts on ecosystems and the organisms that inhabit them. However, most considerations of biological resilience have focused at the community and ecosystem levels, whereas here we discuss how including consideration of processes occurring at lower levels of biological organization may provide insights into factors that influence resilience at higher levels of biological organization. Specifically, we explore how processes at the genomic and epigenomic levels may cascade up to influence resilience at higher levels and ask how the concepts of 'resistance', or the capacity of a system to minimize change in response to a disturbance, and 'recovery', or the ability of a system to return to its original state following a disturbance and avoid tipping points and resulting regime shifts map to these lower levels of biological organization. Overall, we argue that substantial changes at these lower levels may be required to support resilience at higher levels, using selected examples of genomic and epigenomic responses of fish to climate-change relevant stressors such as high temperature and hypoxia at the levels of the genome, epigenome and organism.

A retrospective audit of adult and paediatric anaphylaxis management from two Australian metropolitan mixed emergency departments

BackgroundAnaphylaxis is a potentially life-threatening allergic reaction, with presentations to emergency departments (EDs) increasing across Australia. Understanding the features of those presenting with anaphylaxis and aspects related to its optimal clinical management across the admission, treatment and discharge settings is needed to minimise its impact. We aimed to evaluate the nature and management of presentations related to anaphylaxis across two Australian EDs.MethodsRetrospective audit of paediatric and adult patients presenting to a community or tertiary level ED with anaphylaxis from 1 May 2018 to 30 April 2019. Data extracted from medical records included demographic characteristics, causative agents, clinical features, treatments administered across community, ambulance or ED settings, as well as post-discharge care arrangements including provision of Adrenaline Auto-Injector (AAI) and Allergy/Anaphylaxis Action Plan (AAP).ResultsA total of 369 (107 paediatric and 262 adult) ED presentations were identified. A total of 94 (36%) adult and 46 (43%) paediatric patients received pre-hospital adrenaline, with a further 91 (35%) adult and 29 (27%) paediatric patients receiving a dose of adrenaline in the ED. The most commonly administered treatment in ED were corticosteroids, given to 157 (60%) adult and 55 (51%) paediatric patients. Among those requiring an AAI for discharge, 123/210 (59%) adult and 57/91 (63%) of paediatric patients left hospital with an AAI. In contrast, among those requiring an allergy/anaphylaxis action plan (AAP) on discharge, 61/206 (30%) adult and 30/90 (33%) of paediatric patients left hospital with one. Factors associated with an increased likelihood of receiving AAI on discharge in paediatric and adult patients included receipt of any adrenaline, receipt of two or more doses of adrenaline, and longer duration of hospital stay. Adults presenting within business hours were more likely to be discharged with AAI, but no such difference was observed for paediatric patients. Similar findings were evident for provision of AAP on discharge.ConclusionThese findings demonstrate the need to improve assessment and treatment in the ED. In particular, the observed large variability in provision of AAI and AAP on discharge presents opportunities to explore strategies to improve awareness and provision of these critical components of post-discharge care.

Mind the gaps: horizontal canopy structure affects the relationship between taxonomic and spectral diversity

ABSTRACT Spectral diversity (SD) in reflectance can be used to estimate plant taxonomic diversity (TD) according to the Spectral Variation Hypothesis (SVH). However, contrasting relationships between SD and TD have been reported by different studies. Indeed, multiple factors may affect SD, including spatial and spectral scales, vegetation characteristics and the adopted SD computational method. Here, we tested the SVH over 171 plots within a large and heterogeneous forest area in North-Eastern Italy using Sentinel-2 data, aiming at identifying possible factors affecting the strength and direction of SD-TD relationship. SD was determined using ‘biodivMapR’ (BD) and ‘rasterdiv’ (RD) R packages and 38 possible combinations of SD indices, at both α (within a community) and β (among communities) levels, and computational parameters accounting for spatial and spectral scales. Information on vegetation structure was either retrieved from ground-based or LiDAR data. A Random Forest approach was used to disentangle the relationships between SD, TD and vegetation structure, and to identify the best combination of SD computational parameters. At the α-level, we found negative relationship between TD and RD SD indices, which was mainly driven by the presence of gaps within the forest canopy. As regards BD, we found that this algorithm reduced background contribution on SD and was able to differentiate major forest types (broadleaves vs conifers), but derived α-SD indices were marginally correlated with α-TD. At the β-level, we observed a statistically significant positive correlation between BD SD indices and TD (maximum r = 0.24). Finally, we found stronger correlations and R2 when SD indices were calculated using smaller computation windows and over a larger pixels extraction area. Our findings suggest that vegetation cover and structure play a major role, with respect to inter-species spectral differences, in determining α-SD, and that SD might better capture differences in species composition at the landscape-level rather than the richness of individual communities.

Analysis of High Levels of Urine Proteins as a Sign of Impaired Kidney Function in Communities Around a Nickel Mining Industry in Morosi District, Southeast Sulawesi

The study is proposed to analyse the influence of individual and environmental factors on protein urine levels as a parameter for impaired kidney function in the community around Nickel mining industry in Morosi Sub-District, Southeast Sulawesi Indonesia. This quantitative study used a cross sectional study design. The population was people in 3 villages around the nickel mining industry aged 20-59 years. The sample size was 61 people using simple random sampling technique. Independent variable was age as representation of individual factor and environmental factors including house condition, water quality, waste management and household liquid waste. Protein urine as a parameter for impaired kidney function as the dependent variable. Data was collected by questionnaire and taking urine samples. Data were analysed using the multinomial logistic regression test with a significance level of 95%. The results show that the determinant of proteinuria levels in communities around the Morosi nickel mining industry was age (p=0.038&lt;0.05), the water source quality (p=0.002&lt;0.05). Solid waste management (p=0.05) and waste water management (p-value=0.045&lt; 0.05). Meanwhile, the house condition had no effect on high proteinuria levels (p value&gt; 0.05). In conclusion, impaired kidney function in communities around the Morosi nickel mining industry due to age, poor quality of water sources and poor management of solid waste and household liquid waste.

MetageNN: a memory-efficient neural network taxonomic classifier robust to sequencing errors and missing genomes.

With the rapid increase in throughput of long-read sequencing technologies, recent studies have explored their potential for taxonomic classification by using alignment-based approaches to reduce the impact of higher sequencing error rates. While alignment-based methods are generally slower, k-mer-based taxonomic classifiers can overcome this limitation, potentially at the expense of lower sensitivity for strains and species that are not in the database. We present MetageNN, a memory-efficient long-read taxonomic classifier that is robust to sequencing errors and missing genomes. MetageNN is a neural network model that uses short k-mer profiles of sequences to reduce the impact of distribution shifts on error-prone long reads. Benchmarking MetageNN against other machine learning approaches for taxonomic classification (GeNet) showed substantial improvements with long-read data (20% improvement in F1 score). By utilizing nanopore sequencing data, MetageNN exhibits improved sensitivity in situations where the reference database is incomplete. It surpasses the alignment-based MetaMaps and MEGAN-LR, as well as the k-mer-based Kraken2 tools, with improvements of 100%, 36%, and 23% respectively at the read-level analysis. Notably, at the community level, MetageNN consistently demonstrated higher sensitivities than the previously mentioned tools. Furthermore, MetageNN requires < 1/4th of the database storage used by Kraken2, MEGAN-LR and MMseqs2 and is > 7× faster than MetaMaps and GeNet and > 2× faster than MEGAN-LR and MMseqs2. This proof of concept work demonstrates the utility of machine-learning-based methods for taxonomic classification using long reads. MetageNN can be used on sequences not classified by conventional methods and offers an alternative approach for memory-efficient classifiers that can be optimized further.

Screening of voluntary blood donors for beta-thalassemia trait in an endemic area in Northwest India for 15 years: Results and future directions after screening more than 300 thousand donors

Abstract: BACKGROUND: North-West India has a high prevalence of the Thalassemia, and the Beta Thalassemia Trait often remains undetected in the population. Recognizing the need to address this public health issue, we initiated “Blood the Lifeline” project in 2006 with the aim to eradicate Thalassemia through proactive measures, including screening of voluntary blood donors. AIM: The primary aim of this study was to screen voluntary blood donors in an endemic area in northwestern India for Thalassemia trait. The study aimed to determine its prevalence, identify gender and ethnic group-wise distributions, and assess the implications for future interventions. METHODS: The screening program was conducted from January 2006 till December 2022. Voluntary blood donors were recruited from the target area and underwent Thalassemia trait screening. The screening process involved High Performance Liquid Chromatography using VARIANT II fully automated HPLC system to identify Thalassemia trait. Data regarding the total number of cases screened, gender distribution, ethnic group-wise distribution, and positive and negative cases were collected and analyzed. Screening Process: EDTA Pilot tube from each donor was collected and analyzed within 24 hrs of collection. RBC Counts, Hb Concentration, MCV, MCH, RDW-SD were noted to differentiate between Iron Deficiency Anaemia &amp; thalassemia trait &amp; following Criteria’s were taken into account: Total RBC Count: &gt; 5.0 x 106 / micro-liter, Hb: &lt; 11.7 g/dl, MCV: &lt; 77 fl, MCH: &lt; 28 pg &amp; RDW-SD: &lt; 45 fl. A combination of Formulas like Mentzer’s index= MCV/RBC &lt;13; Shine and Lal Index (S&amp;L) = MCV × (MCH/100) &lt; 1530; Green &amp; King (MCV2) × RDW]/ (Hb × 100) &lt; 65 were used for screening. All the above formulas were introduced into the Blood Bank Software to exclude out the blood units requiring screening &amp; confirmation. If any of the samples were positive on initial screening, then confirmatory test was done by demonstrating the elevation of concentration of HbA2 by HPLC VARIANT II fully automated analyser. RESULTS: A total of 377,503 voluntary blood donors for a 16 year period were screened and data was analysed .The Mean Hemoglobin of positive donors was 12.1 gm/dl; Mean RBC Count was 6.24 m/cu mm, MCV 67.79 fl, MCH 21.04 pg, RDW-SD 42.11fl &amp; HbA2 was 7.48%. The majority of positive cases were found in the Sindhi (16.68%), Punjabi (10.32%), and Muslim (9.81%) ethnic groups. The Rajasthani population accounted for 6.01% of positive cases. CONCLUSION: This comprehensive screening program revealed a relatively high prevalence of Thalassemia trait in 2.29% of the screened population. The communities with higher prevalence (Sindhi, Punjabi, and Muslim) were educated about the disease and a targeted screening program will be further carried out in these ethnic groups. The data helped in planning genetic counseling, carrier screening, and pre-marital screening programs to reduce the transmission of Thalassemia in these populations. By focusing efforts on specific groups and locations with higher prevalence, a community based approach to prevent the birth of children with Thalassemia major is being implemented. It is also being used for analyzing the implications of different local policies pertaining to Thalassemia trait in the region. Collaborative efforts between healthcare organizations, community leaders, and governmental agencies are crucial to address the burden of Thalassemia and work towards its eradication. The results of this study serve as a foundation for future initiatives aimed at minimizing the impact of Thalassemia at a community level.