Geographical Areas Research Articles

P-205 Exploring the influence of platelet rich plasma (PRP) versus PRP with hyaluronic acid on endometrial thickness (ET) and IVF outcome: a pilot study

Abstract Study question What is the impact of sub-endometrial instillation of PRP versus PRP with hyaluronic acid on ET and IVF outcome defined by positive and clinical pregnancy Summary answer PRP with hyaluronic acid group had more endometrial thickness with better vascularity and better pregnancy outcomes as compared to normal PRP What is known already Receptive endometrium is the end result of an interplay of a myriad of cytokines, adhesion molecules growth factors etc. Defect in these can result in thin endometrium. Sub endometrial PRP instillation has been attempted in such cases with promising results and acts by stimulating cell growth and angiogenesis These actions are enhanced by hyaluronic acid along with its antiadhesive effect. PRP with hyaluronic acid has been used previously in orthopedics, dermatology but not documented in thin endometrium. Most of previous studies have focused on endometrial thickness and no comparison has been done between PRP and PRP with hyaluronic acid. Study design, size, duration A retrospective observational study was conducted at Gunjan IVF WORLD Ghaziabad, from January 2022 to Dec 2023. Total 215 patients between the age group of 21-50 years with thin endometrium (ET < 7mm) with zone 2 or less vascularity with at least 1 good quality blastocyst for transfer were selected. They were subjected to hysteroscopic sub endometrial PRP instillation or instillation of PRP with hyaluronic acid Participants/materials, setting, methods Women with diverse reasons for infertility were divided into 2 groups - those receiving PRP (87 subjects) vs PRP with hyaluronic acid (128 subjects). PRP was activated by adding 0.1 ml of Calcium Chloride in 0.9 ml of PRP. Hyaluronic acid (80IU/ML) was added to PRP in the ratio of 1:5. The two groups were compared for positive pregnancy defined as βhCG >100 mIU/ml, clinical pregnancy defined as visualization of gestational sac and endometrial thickness Main results and the role of chance 112 of 215 (52.09%) women had positive pregnancy outcomes (βhCG >100 mIU/ml). Of the 112 subjects having positive outcomes, 40 (35.71%) belonged to normal PRP group and 72 (64.28%) belonged to PRP with hyaluronic acid group. Clinical pregnancy was seen in 37 (33.03%) in normal PRP group and 70(62.5%) in PRP with hyaluronic acid group. Mean βhCG was significantly higher in PRP with hyaluronic acid group (p = 0.013). Mean endometrial thickness was also higher in PRP with hyaluronic acid group (p = 0.05). The findings of the study suggest that PRP with hyaluronic acid has much better results in patients with thin endometrium in terms of not only the endometrial thickness but it also translates into better pregnancy rates. Limitations, reasons for caution 1. Patient pool from limited geographical area. 2. More Randomized controlled trials with larger sample size required to assess efficacy of Platelet rich plasma with hyaluronic acid. 3. The results were analyzed only up to clinical pregnancy and not ongoing pregnancy or live birth rates Wider implications of the findings 1. PRP with hyaluronic acid can be a boon to patients having thin endometrium who otherwise would have sub optimal IVF outcomes 2. Study can encourage larger randomized controlled trials in this direction especially in cases of intrauterine adhesions. Trial registration number not applicable

Wild yeast isolation by middle school students reveals features of North American oak populations of Saccharomyces cerevisiae and Kluyveromyces lactis.

Features of the natural life cycle of the budding yeast Saccharomyces cerevisiae were crucial to its domestication as a laboratory experimental model, especially the ability to maintain stable haploid clones and cross them at will to combine alleles via meiosis. Stable haploidy results from mutations in HO , which encodes an endonuclease required for haploid-specific mating-type switching. Previous studies found an unexpected diversity of HO alleles among natural isolates within a small geographic area. We developed a hands-on field and laboratory activity for middle school students in Denver, Colorado, USA to isolate wild yeast from oak bark, identify species via DNA sequencing, and sequence HO from S. cerevisiae isolates. We find limited HO diversity in North American oak isolates, pointing to efficient, continuous dispersal across the continent. By contrast, we isolated the "dairy yeast", Kluyveromyces lactis , from a tree <10 m away and found that it represents a new population distinct from an oak population in an adjacent state, pointing to high genetic diversity. The outreach activity partnered middle school, high school, and university students in making scientific discoveries and can be adapted to other locations and natural yeast habitats. Indeed, a pilot sampling activity in southeast Texas yielded S. cerevisiae oak isolates with a new allele of HO and, from a nearby prickly pear cactus, a heat-tolerant isolate of Saccharomyces paradoxus .

Food and beverage rituals at the period of birth, marriage, and death in Shamanist Turks and its modern reflections

It is known that the Turks have adopted many religions in history. Shamanism is also among the ancient beliefs of the Turks. Shamanism; Tengrism is also known by names such as the religion of the Sky God. This study examines the food and drink habits of Turks who believe in Shamanism during the mythological rituals they perform on the occasions of birth, marriage, and death. It also investigates how food and beverages were consumed during these occasions in Turkish mythology. The study emphasizes the reflections of the eating and drinking rituals in Turkish mythology to the present day. . In this context, a compilation article was made by using the literature review method, one of the qualitative research methods, by making use of secondary data sources. Various Turkic peoples and Turkic tribes were examined by scanning the relevant academic literature, and a conceptual framework was tried to be created. The research shows that Turks often use plant foods (barley, wheat, and oats) grown in their geographical area and horse meat in their rituals because it has an essential function in their lives. In addition, milk has an important place and is often consumed.

The Combined ICP-MS, ESEM-EDX, and HAADF-STEM-EDX Approach for the Assessment of Metal Sub-Micro- and Nanoparticles in Wheat Grain.

Metal sub-microparticles (SMPs) and nanoparticles (NPs) presence in food is attributable to increasing pollution from the environment in raw materials and finished products. In the present study, a multifaceted analytical strategy based on Environmental Scanning Electron Microscopy and High-Angle Annular Dark-Field-Scanning Transmission Electron Microscopy coupled with Energy-Dispersive X-ray Spectroscopy (ESEM-EDX, HAADF-STEM-EDX) and Inductively Coupled Plasma Mass Spectrometry (ICP-MS) was proposed for the detection and characterization of metal and metal-containing SMPs and NPs in durum wheat samples, covering a size measurement range from 1 nm to multiple µm. ESEM-EDX and ICP-MS techniques were applied for the assessment of SMP and NP contamination on the surface of wheat grains collected from seven geographical areas characterized by different natural and anthropic conditions, namely Italy, the USA, Australia, Slovakia, Mexico, Austria, and Russia. ICP-MS showed significant differences among the mean concentration levels of metals, with the USA and Italy having the highest level. ESEM-EDX analysis confirmed ICP-MS concentration measurements and measured the highest presence of particles < 0.8 µm in size in samples from Italy, followed by the USA. Less marked differences were observed when particles < 0.15 µm were considered. HAADF-STEM-EDX was applied to a selected number of samples for a preliminary assessment of internal contamination by metal SMPs and NPs, and to expand the measurable particle size range. The multifaceted approach provided similar results for Fe-containing SMPs and NPs. ICP-MS and ESEM-EDX also highlighted the presence of a significant abundance of Ti- and Al-containing particles, while for STEM-EDX, sample preparation artifacts complicated the interpretation. Finally, HAADF-STEM-EDX results provided relevant information about particles in the low nm range, since, by applying this technique, no particles smaller than 50 nm were observed in accordance with ESEM-EDX.

Awareness and use of improved livestock feed technologies among agro-pastoral households in the West African Sahel.

Seasonal scarcity of quality feed continues to be a bottleneck for agro-pastoralists and is the most important limitation to livestock production in agro-pastoral systems in the West African Sahel. In this regard, diverse promising technologies to increase the production and availability of quality feed have been introduced. Despite the introduction of various feed technologies in the region, the adoption rate by smallholder farmers is very low. The objective of this study was to identify factors affecting the likelihood of using improved livestock feed technologies among agro-pastoral households in two regions of Niger. A logit model was employed using data collected from randomly selected 218 agro-pastoral households between February and April 2023. The study revealed low awareness and use of improved livestock feed technologies among agro-pastoral households. The findings suggested the positive impact of education level, membership of farmer groups and ownership of small ruminant on enhancing the probability of using improved livestock feed technologies. Households' geographical area was one of the determinant factors in using improved livestock feed technologies. The use of improved livestock feed technologies was also influenced by family size. The study provides guidance to inform strategies by the decision-makers to enhance the utilization of improved livestock feed technologies among agro-pastoral households in the West African Sahel. Suggested strategies may in turn alleviate the current problem of low productivity of livestock, contribute to improving household food security and nutrition among agro-pastoral communities.

Distribution of catheterisation laboratories in Indonesia 2017–2022: a nationwide survey

BackgroundGeographical terrains of Indonesia pose a major hindrance to transportation. The difficulty of transportation affects the provision of acute time-dependent therapy such as percutaneous coronary intervention (PCI). Also, Indonesia’s aging population would have a significant impact on the prevalence of acute coronary syndrome in the next decade. Therefore, the analysis and enhancement of cardiovascular care are crucial. The catheterisation laboratory performs PCI procedures. In the current study, we mapped the number and distribution of catheterisation laboratories in Indonesia. MethodsA direct survey was used to collect data related to catheterisation laboratory locations in July 2022. The population data was sourced from the Ministry of Home Affairs. The recent growth of catheterisation laboratories was examined and evaluated based on geographical areas. The main instruments for comparing regions and changes throughout time are the ratio of catheterisation laboratories per 100,000 population and the Gini index (a measure of economic and healthcare inequality. Gini index ranges from 0 to 1, with greater values indicating more significant levels of inequality). Regression analysis was carried out to see how the number of catheterisation laboratories was affected by health demand (prevalence) and economic capacity (Gross Domestic Regional Product [GDRP] per Capita). FindingsThe number of catheterisation laboratories in Indonesia significantly increased from 181 to 310 during 2017-2022, with 44 of the 119 new labs built in an area that did not have one. Java has the most catheterisation laboratories (208, 67%). The catheterisation laboratory ratio in the provinces of Indonesia ranges from 0·0 in West Papua and Maluku to 4·46 in Jakarta; the median is 1·09. (IQR 0·71–1·18). The distribution remains a problem, as shown by the high catheterisation laboratory Gini index (0·48). Regression shows that distribution of catheterisation laboratories was significantly affected by GDRP and the prevalence of heart disease. InterpretationThe number of catheterisation laboratories in Indonesia has increased significantly recently, however, maldistribution remains a concern. To improve Indonesia's cardiovascular emergency services, future development of catheterisation laboratories must be better planned considering the facility's accessibility and density. FundingIndonesia Endowment Fund for Education – Lembaga Pengelola Dana Pendidikan (LPDP)

Imported schistosomiasis in travelers: experience from a referral Tropical Medicine Unit in Barcelona, Spain.

Acute schistosomiasis occurs most often in travelers to endemic regions. The aim of the study is to describe the epidemiological, clinical and parasitological characteristics of patients with schistosomiasis acquired during an international travel. Observational retrospective study including all travel-related schistosomiasis cases seen at the International Health Unit Vall d'Hebron-Drassanes (Barcelona, Spain) from 2009 to 2022. Diagnosis of schistosomiasis was defined by the presence of Schistosoma eggs in stools or urine or the positivity of a serological test. We collected demographic, epidemiological, clinical, parasitological, and therapeutic information. 917 cases of schistosomiasis were diagnosed, from whom 96 (10.5%) were travel-related. Mean age of the patients was 34.9 years, and 53.1% were women. Median duration of the travel was 72 days, and geographical areas where travelers had contact with fresh water were Africa (82.3%), Asia (12.5%), and South America (5.2%). Twenty (20.8%) patients reported having had some clinical symptom, being gastrointestinal symptoms the most frequent. Two patients developed the classical Katayama syndrome. In eleven (11.5%) cases eggs were observed in urine or feces samples, and 85 (88.5%) cases were diagnosed by a positive serology. Ninety-one (94.8%) patients received treatment with praziquantel with different therapeutic schemes. The two patients with Katayama syndrome received concomitant treatment with corticosteroids. Schistosomiasis in travelers represented 10% of the overall schistosomiasis cases in our center. Increasing the awareness in the pre-travel advice and implementing specific screening in those travelers at risk (long travelers, contact with fresh water) could reduce the incidence and associated morbidity in this group.

Pneumonectomy for non–small cell lung cancer. A National Cancer Database analysis of geographic and temporal trends, outcomes, and associated factors

BackgroundThe circumstances under which pneumonectomy should be performed are controversial. This study aims to investigate national trends in pneumonectomy use to determine which patients, in what geographic areas, and under what clinical circumstances pneumonectomy is performed in the United States. MethodsWe queried the National Cancer Database and included all patients undergoing anatomic surgical resection for non–small cell lung cancer (2015–2020). The association between demographic and clinical factors and the use of pneumonectomy were investigated. ResultsWho: A total of 128,421 patients were identified, of whom 738 (0.6%) underwent pneumonectomy. Those patients were younger (median 65 vs 68 years, P < .001), more often male (59.9% vs 44.9%, P < .001), more likely to be below median income level (44.2% vs 38.6%, P = .002), and more likely to have lower education indicators (53% vs 48.6%, P = .02) than those who underwent other anatomic resections. Notably, there was a decreasing trend in pneumonectomy use during the study period (0.9% down to 0.4%, P < .001). Where: Patients undergoing pneumonectomy were less likely to live in metropolitan areas (77.9% vs 81.7%, P = .008) and to live closer (<12 miles) to their treating facility (45% vs 49%, P = .02). Regional geographic differences also were identified (P < .001). Why: Patients who underwent pneumonectomy were more likely to have received neoadjuvant therapy (20.6% vs 5.3%, P < .001), to be clinically N (+) (39.3% vs 12.3%, P < .001), and to have more advanced tumors (cT3-4: 46.3% vs 11.3%, P < .001). ConclusionAlthough primarily driven by advanced oncologic features, socioeconomic and geographic factors also were associated independently with the use of pneumonectomy. Standardizing pneumonectomy indications nationwide is crucial to prevent widening outcome gaps for patients with lung cancer.

Mercury exposure and trophic ecology of urban nesting black-legged kittiwakes from France

Seabirds are increasingly used as bioindicators for assessing the chemical contamination of marine ecosystems, including mercury (Hg) worldwide. However, some geographical areas are still poorly documented, as Metropolitan France that is home to 28 seabird species including the black-legged kittiwake Rissa tridactyla, in the part of the southern limit of the North Atlantic range of the species. Here, we investigated Hg contamination and trophic ecology of black-legged kittiwakes breeding in the harbour of Boulogne-sur-Mer, Northern France. Mean blood Hg concentration was 4.81 ± 1.20 μg g-1 dw (dry weight), 3.66 ± 0.75 μg g-1 dw and 0.43 ± 0.07 μg g-1 dw for adult males, adult females, and chicks, respectively. According to Hg toxicity benchmarks for avian blood, 30% of the sampled adults were considered to be at moderate risk to Hg toxicity. Stable isotope and food analyses showed that highest δ15N values (reflecting a higher trophic position) were related to highest blood Hg concentrations in adult birds, and that Atlantic herring (Clupea harengus) and Atlantic mackerel (Scomber scombrus) were the main prey. Adult kittiwakes from Boulogne-sur-Mer showed Hg levels three times higher than those found in Arctic nesting kittiwakes, where sublethal effects have been documented. This study provides a first description of Hg contamination of black-legged kittiwakes breeding in France and calls for future ecotoxicological research to assess the vulnerability of this species in the southern part of its distribution range.

A One Health Approach to Level Up Ethnoveterinary Practises in Rural India: A Pilot Project among the Local Community of Doddaballapur (Karnataka)

Abstract The project aimed at introducing the local health practices attributed to animals for their health and production through immediate available resources among local communities in India. The traditional practices of nearly 20 clinical conditions of animal health were introduced to the farmers of the specified geographical area under Doddaballapur taluka name Shravanur and Koogonahalli of Doddaballapur, Karnataka, India. In these two villages nearly seventy–eight dairy farmers, who are depending on dairy for their livelihood, underwent intensive training on traditional animal health practices, which were documented and assessed by The University of Transdisciplinary Health Sciences and Technology (TDU). In order to effectively create change in the daily practises, we engage in a transdisciplinary process including all stakeholder from the milk sector (venetian, dairy milk farmer). Such transdisciplinary training and empowering programs helped the farmers in preventing the diseases and managing them in a more sustainable way and at the same time to meet the dairy milk federation needs both in term of quality and quantity. Information © The Authors 2024

Evaluation and validation of a PrintrLab-based LAMP assay to identify Trypanosoma cruzi in newborns in Bolivia: a proof-of-concept study

Vertical transmission of Trypanosoma cruzi represents approximately 20% of new Chagas disease cases. Early detection and treatment for women of childbearing age and newborns is a public health priority, but the lack of a simple and reliable diagnostic test remains a major barrier. We aimed to evaluate the performance of a point-of-care loop-mediated isothermal amplification (LAMP) assay for the detection of Tcruzi. In this proof-of-concept study, we coupled a low-cost 3D printer repurposed for sample preparation and amplification (PrintrLab) to the Eiken Tcruzi-LAMP prototype to detect vertically transmitted Tcruzi, which we compared with standardised PCR and with the gold-standard algorithm (microscopy at birth and 2months and serological study several months later). We screened pregnant women from two hospitals in the Bolivian Gran Chaco province, and those who were seropositive for Tcruzi were offered the opportunity for their newborns to be enrolled in the study. Newborns were tested by microscopy, LAMP, and PCR at birth and 2months, and by serology at 8months. Between April 23and Nov 17, 2018, 986mothers were screened, among whom 276were seropositive for Tcruzi (28·0% prevalence, 95% CI 25·6-31·2). In total, 224infants born to 221seropositive mothers completed 8months of follow-up. Congenital transmission was detected in nine of the 224newborns (4·0% prevalence, 1·9-7·5) by direct microscopy observation, and 14more cases were diagnosed serologically (6·3%, 3·6-10·3), accounting for an overall vertical transmission rate of 10·3% (6·6-15·0; 23of 224). All microscopy-positive newborns were positive by PrintrLab-LAMP and by PCR, while these techniques respectively detected four and five extra positive cases among the remaining 215 microscopy-negative newborns. The PrintrLab-LAMP yielded a higher sensitivity than microscopy-based analysis. Considering the simpler use and expected lower cost of LAMP compared with PCR, our findings encourage its evaluation in a larger study over a wider geographical area. Inter-American Development Bank.

Perinatal outcomes in grand multiparous women stratified by parity- A large multicenter study

ObjectiveTo assess the effect of each additional delivery among grand multiparous (GMP) women on maternal and neonatal outcomes. MethodsA multi-center retrospective cohort study that examined maternal and neonatal outcomes of GMP women (parity 5–10, analyzed separately for each parity level) compared to a reference group of multiparous women (parity 2–4). The study population included grand multiparous women with singleton gestation who delivered in one of four university-affiliated obstetrical centers in a single geographic area, between 2003 and 2021. We excluded nulliparous, those with parity > 10 (due to small sample sizes), women with previous cesarean deliveries (CDs), multifetal gestations, and out-of-hospital deliveries. The primary outcome of this study was postpartum hemorrhage (PPH, estimated blood loss exceeding 1000 ml, and/or requiring blood product transfusion, and/or a hemoglobin drop > 3 g/Dl). Secondary outcomes included unplanned cesarean deliveries, preterm delivery, along with other adverse maternal and neonatal outcomes. Univariate analysis was followed by multivariable logistic regression. ResultsDuring the study period, 251,786 deliveries of 120,793 patients met the inclusion and exclusion criteria. Of those, 173,113 (69%) were of parity 2–4 (reference group), 27,894 (11%) were of parity five, 19,146 (8%) were of parity six, 13,115 (5%) were of parity seven, 8903 (4%) were of parity eight, 5802 (2%) were of parity nine and 3813 (2%) were of parity ten.GMP women exhibited significantly higher rates of PPH starting from parity eight. The adjusted odds ratios (aOR) were 1.19 (95 % CI: 1.06–1.34) for parity 8, 1.17 (95 % CI: 1.01–1.36) for parity 9, and 1.39 (95 % CI: 1.18–1.65) for parity 10. Additionally, they showed elevated rates of several maternal and neonatal outcomes, including placental abruption, large-for-gestational age (LGA) neonates, neonatal hypoglycemia, and neonatal seizures. Conversely, they exhibited decreased risk for other adverse maternal outcomes, including preterm deliveries, unplanned cesarean deliveries (CDs), vacuum-assisted delivery, and third- or fourth-degree perineal tears and small-for-gestational age (SGA) neonates. The associations with neonatal hypoglycemia, and neonatal seizure were correlated with the number of deliveries in a dose-dependent manner, demonstrating that each additional delivery was associated with an additional, significant impact on obstetrical complications. ConclusionOur study demonstrates that parity 8–10 is associated with a significantly increased risk of PPH. Parity level > 5 correlated with increased odds of placental abruption, LGA neonates, neonatal hypoglycemia, and neonatal seizures. However, GMP women also demonstrated a reduced likelihood of certain adverse maternal outcomes, including unplanned cesarean, preterm deliveries, vacuum-assisted deliveries, SGA neonates, and severe perineal tears. These findings highlight the importance of tailored obstetrical care for GMP women to mitigate the elevated risks associated with higher parity.

Beyond ‘Community Craft Specialisation’ in Prehistoric Mainland Southeast Asian Metallurgy: Copper Smelting Behaviours at Khao Sai On, Nil Kham Haeng, Non Pa Wai, Phromthin Tai, and Tha Kae in Central Thailand

Archaeology in Lopburi Province has been under long-term development since the 1970s and has led to the discovery of Khao Wang Prachan Valley (KWPV) as one of three currently known primary copper production (mining and smelting) sites in Southeast Asia. However, since the 1980s, archaeometallurgical research has focused mainly on the two sites of Non Pa Wai (NPW) and Nil Kham Haeng (NKH), dated from the Neolithic (ca. 1800 B.C.) to Early Iron Age (ca. 2300 B.C.), that are known to have large sequences of archaeological material linked to copper production. Although other sites with evidence of copper production are known in this restricted geographical area, their assemblages have not previously been subjected to archaeometric study. This article discusses the results of archaeometallurgical analyses of slags from Khao Sai On (KSO), Tha Kae (TK), and Phromthin Tai (PTT) with sequences dated during the Middle-Late Iron Age. Slag analysis reveals that different smelting behaviours were occurring at these sites. One heterogenous smelting behaviour at Khao Sai On was probably linked to a smaller community practicing metallurgy among other activities, while Phromthin Tai shows more homogeneous production linked to a larger settlement. Although these three sites are located within 26 km of each other, smelters were probably exploiting different local copper deposits around KWPV. The results seem to support a community based type of production where production behaviours are linked to local geology, technical competence, and intensity of exploitation.

Effectiveness of integrating HIV prevention within sexual reproductive health services with or without peer support among adolescents and young adults in rural KwaZulu-Natal, South Africa (Isisekelo Sempilo): 2 × 2 factorial, open-label, randomised controlled trial

Approximately 200 000 South Africans acquired HIV in 2021 despite the availability of universal HIV test and treat and pre-exposure prophylaxis (PrEP). The aim of this study was to test the effectiveness of sexual and reproductive health services or peer support, or both, on the uptake of serostatus neutral HIV services or reduction of sexually transmissible HIV. We did an open-label, 2 × 2 randomised factorial trial among young people in a mostly rural area of KwaZulu-Natal, South Africa. Inclusion criteria included being aged 16-29 years, living in the mapped geographical areas that were accessible to the area-based peer navigators, being willing and able to provide informed consent, and being willing to provide a dried blood spot for anonymous HIV testing and HIV viral load measurement at 12 months. Participants were randomly allocated by computer-generated algorithm to one of four groups: those in the standard-of-care group were referred to youth-friendly services for differentiated HIV prevention (condoms, universal HIV test and treat with antiretroviral therapy, and PrEP if eligible); those in the sexual and reproductive health services group received baseline self-collected specimens for sexually transmitted infection (STI) testing and referral to integrated sexual and reproductive health and HIV prevention services; those in the peer support group were referred to peer navigators for health promotion, condom provision, and facilitation of attendance for differentiated HIV prevention services; and those in the final group received a combination of sexual and reproductive health services and peer support. Coprimary outcomes were linkage to clinical services within 60 days of enrolment, proportion of participants who had sexually transmissible HIV at 12 months after enrolment, and proportion of sampled individuals who consented to participation and gave a dried blood spot for HIV testing at 12 months. Logistic regression was used for analyses, and adjusted for age, sex, and rural or peri-urban area of residence. This study is registered with ClinicalTrials.gov (NCT04532307) and is closed. Between March 2, 2020, and July 7, 2022, 1743 (75·7%) of 2301 eligible individuals were enrolled and followed up. 12-month dried blood spots were collected from 1168 participants (67·0%). The median age of the participants was 21 years (IQR 18-25), 51·4% were female, and 51·1% had secondary level education. Baseline characteristics and 12-month outcome ascertainment were similar between groups. 755 (43·3%) linked to services by 60 days. 430 (49·8%) of 863 who were in the sexual reproductive health services group were linked to care compared with 325 (36·9%) of 880 who were not in the sexual and reproductive health services group (adjusted odds ratio [aOR] 1·68; 95% CI 1·39-2·04); peer support had no effect: 385 (43·5%) of 858 compared with 370 (43·1%) of 885 (1·02, 0·84-1·23). At 12 months, 227 (19%) tested ELISA-positive for HIV, of whom 41 (18%) had viral loads of 400 copies per mL; overall prevalence of transmissible HIV was 3·5%. 22 (3·7%) of 578 participants in the sexual and reproductive health services group had transmissible HIV compared with 19 (3·3%) of 590 not in the sexual and reproductive health services group (aOR 1·12; 95% CI 0·60-2·11). The findings were also non-significant for peer support: 21 (3·3%) of 565 compared with 20 (3·3%) of 603 (aOR 1·03; 95% CI 0·55-1·94). There were no serious adverse events or deaths during the study. This study provides evidence that STI testing and sexual and reproductive health services create demand for serostatus neutral HIV prevention in adolescents and young adults in Africa. STI testing and integration of HIV and sexual health has the potential to reach those at risk and tackle unmet sexual health needs. US National Institute of Health, Bill & Melinda Gates Foundation, and 3ie.

The tale of the rattle: Using rattle size to understand growth and sexual dimorphism in an insular population of rattlesnakes (Crotalus oreganus caliginis).

Islands have played a key role in our understanding of rapid evolution. A large body of literature has examined morphological changes in response to insularity and isolation, which has yielded useful generalizations about how animals can adapt to live in very small geographic areas. However, understanding the evolution of morphological variation in insular populations often requires detailed data sets on longitudinal patterns of growth and development, and such studies typically necessitate long-term mark-recapture on a large sample of individuals. Rattlesnakes provide a unique opportunity to address some of these difficulties because the addition of rattle segments to the rattle string occurs with regular periodicity and their size directly correlates with the body size of the snake at the time of the ecdysis cycle generating the segment. Here, we used a large database of rattle segment sizes recorded from island (Isla Coronado Sur, Baja California, Mexico) and mainland (Camp Pendleton, California, United States) populations of Western Rattlesnakes (Crotalus oreganus and C. o. caliginis) that separated approximately 10,000 years ago to compare body sizes at different ecdysis cycles, which allowed us to assess differences in growth rates and patterns of sexual size dimorphism. Our results show that rattlesnakes on Isla Coronado Sur appear to be born smaller and grow more slowly than their mainland counterparts, resulting in a "dwarfed" island population. However, despite significant differences in body size, both populations exhibited the same degree of sexual dimorphism. Our study demonstrates the potential to use rattle characteristics to recover detailed estimates of fundamental demographic parameters.

Tick-Borne Relapsing Fever Infection from a Bunker, a Case Report on a "One Health" Approach.

Background: Tick-borne relapsing fever (TBRF) caused by Borrelia persica is an endemic disease in Israel and highly prevalent in military personnel. Prevention among the Israel Defense Force soldiers is based on increased awareness mainly in hyperendemic areas and selective postexposure prophylaxis with doxycycline. In this study, we report the presence of a suspected outbreak of TBRF in four soldiers who spent 30 h inside a deserted bunker. Materials and Methods: Clinical data on TBRF suspected cases were retrieved from clinical records, soft ticks were collected using carbon dioxide (CO2) traps and their DNA was extracted and analysed by PCR and nucleotide sequencing. Environmental conditions such as relative humidity, air temperature, wind speed, and type of soil, as well as presence or absence of animal traces inside the bunkers were documented. Results: TBRF-like clinical symptoms in the patients included: tick bite scars, fever (37.5-39.2°C), rash, tachycardia, hypotension, myalgia, cough, headache, cervical lymphadenopathy and nausea. Microscopic search for B. persica in blood smears was performed in three patients and was negative. Out of the 255 Ornithodoros tholozani ticks collected from the bunker, 198 were analyzed and 2 (1%) were infected with B. persica. To determine if tick infestation in military bunkers is a common phenomenon, we surveyed nine additional military bunkers located in four different geographical areas for the presence of soft ticks. Only one additional bunker was infested with two O. tholozani ticks, both negative for B. persica. Presence of earth that probably helped sustain a relatively big tick population was observed on the floor in the highly infested bunker. Environmental treatment with lambda-cyhalothrin at 9.7% was performed and showed efficacy with no ticks recovered in the infested bunker 124 days after intervention. Conclusion: This study shows that military bunkers may harbor soft ticks infected with B. persica and entrance into bunkers should be considered as a risk for acquiring this infection like entrance into natural caves and archeological ruins.

Beyond ‘Community Craft Specialisation’ in Prehistoric Mainland Southeast Asian Metallurgy: Copper Smelting Behaviours at Khao Sai On, Nil Kham Haeng, Non Pa Wai, Phromthin Tai, and Tha Kae in Central Thailand

Archaeology in Lopburi Province has been under long-term development since the 1970s and has led to the discovery of Khao Wang Prachan Valley (KWPV) as one of three currently known primary copper production (mining and smelting) sites in Southeast Asia. However, since the 1980s, archaeometallurgical research has focused mainly on the two sites of Non Pa Wai (NPW) and Nil Kham Haeng (NKH), dated from the Neolithic (ca. 1800 B.C.) to Early Iron Age (ca. 2300 B.C.), that are known to have large sequences of archaeological material linked to copper production. Although other sites with evidence of copper production are known in this restricted geographical area, their assemblages have not previously been subjected to archaeometric study. This article discusses the results of archaeometallurgical analyses of slags from Khao Sai On (KSO), Tha Kae (TK), and Phromthin Tai (PTT) with sequences dated during the Middle-Late Iron Age. Slag analysis reveals that different smelting behaviours were occurring at these sites. One heterogenous smelting behaviour at Khao Sai On was probably linked to a smaller community practicing metallurgy among other activities, while Phromthin Tai shows more homogeneous production linked to a larger settlement. Although these three sites are located within 26 km of each other, smelters were probably exploiting different local copper deposits around KWPV. The results seem to support a community based type of production where production behaviours are linked to local geology, technical competence, and intensity of exploitation.

Therapeutic Options in Hydatid Hepatic Cyst Surgery: A Retrospective Analysis of Three Surgical Approaches.

Hydatid disease is endemic in certain geographical areas where animal breeding is common, frequently challenging the medical services in these regions. Hydatid cysts most often affect the liver, with damage to other organs accounting for around one-third of the total cases. The alternative to interventional or pharmacological approaches is surgical treatment, available in variants such as laparoscopy, laparoscopy with special instruments for hydatid disease, or open surgery. This article aims to analyze the outcomes of these three types of surgical approaches, considering preoperative indications, operative techniques and efficiency, and immediate and long-term postoperative results. A total of 149 patients from two different surgical units were analyzed over a period of seven years. It was observed that males were more affected by this pathology (53.02%), with the majority of patients coming from rural areas (62.42%). The distribution by surgical procedure type showed that 50.34% were operated on using open surgery, 33.56% by means of a laparoscopic approach with the usual instruments, and 16.11% by means of a laparoscopic approach with special instruments. The laparoscopic procedure with special instruments presented a lower rate of conversion to open surgery compared to the usual laparoscopic approach (p = 0.014). The analysis of the average operative duration revealed statistically significant differences between the three types of surgical techniques (p < 0.05), noting that interventions with specialized instruments had the shortest duration, while open surgery had the longest operative time (72.5 ± 27.23 min vs. 154 ± 52.04 min). In terms of intraoperative complications, they were documented in 8.34% of cases for the group operated on with special instruments, in 12.24% of cases for the standard laparoscopy group, and in 16% of cases for the open surgery group. Maximal cystectomy was the preferred method for resolving these cysts using minimally invasive surgery (p < 0.001), while Lagrot pericystectomy was preferred in the open approach (p < 0.001). The most frequent postoperative complication was biliary fistula (24.16%), encountered in varying percentages across each technique but without significant statistical difference (p > 0.05). Open surgery was associated with a longer length of hospitalization compared to minimally invasive procedures (p < 0.05), a higher number of late postoperative complications (p = 0.002), and a significantly higher number of recurrences (p < 0.001) compared to the other two techniques. The present study highlights the effectiveness of minimally invasive surgery for hydatid cysts as a safe alternative with fewer complications and superior results compared to open surgery. Additionally, it provides a comparative analysis of these surgical approaches (special instruments, standard laparoscopy, and open surgery) to hydatid disease for the first time. Under the circumstances where pharmacological treatment is recommended as a supportive measure before and after procedures, and using medication alone as the primary treatment option shows only modest efficacy, there is a necessity to consider invasive treatment methods. Percutaneous procedures represent the least invasive form of treatment, yielding results comparable to surgery in terms of efficacy. However, their effectiveness is influenced by factors such as the cyst's stage of development, its location, and the challenges in achieving complete intra-procedural isolation. Laparoscopy, particularly when using specialized instruments tailored to the tactical and technical demands of managing hydatid disease, serves to address the limitations of percutaneous methods. Open surgery's role is increasingly restricted, primarily serving as a fallback option in laparoscopic procedures or in cases complicated by hydatid disease. In conclusion, despite the rising popularity of percutaneous methods, surgery remains a viable therapeutic option for treating hydatid disease. Minimally invasive surgical interventions are increasingly versatile and yield comparable outcomes, further solidifying the role of surgery in its management.

PEMBUATAN SISTEM INFORMASI BRANDING DAN MARKETING KAWASAN USAHA MIKRO KECIL MENENGAH YANG BERSINERGI DENGAN KEGIATAN WISATA, PENDIDIKAN KELUARGA (DEWI PELAGA) DI CEMOROKANDANG MALANG

The geographical area of Cemorokandang village in Malang has a set of potential Small and Medium Enterprises (SMEs) that have been running for a long time but require technological support in branding and marketing. Currently, most SME groups in Cemorokandang village use the traditional method by entrusting the goods produced to shops around the area. The SMEs are in Dewi Pelaga (Desa Wisata Pendidikan Keluarga). Other potentials owned by Cemorokandang village that need to be managed are the potential for sports, tourism, and education potential. This potential needs to be promoted so that many people know it better. Therefore, it is necessary to have a branding and marketing information system that contains pages describing the potential of SMEs and other support such as sports, education, and tourism tracking places. The website that has been created has been tested, and results were obtained on the point that "The community services activities carried out really provide solutions to the problems faced by partners." Some 75% of partners gave a strongly agreed response, while the other 25% gave an agreeing response. From these results, it can be said that this information system is effective in branding and marketing products owned by SMEs in the Dewi Pelaga area.

A Geographical Study of General Land Use Pattern in Marathwada Region

In this study an effort to study the general land use pattern in Marathwada region. The term ‘Landuse’ means generally, the land utilization. The numerous factors are effects on general land use, like a physiography, climate, soil, irrigation and also some socio-economical elements. The present study is based on secondary data; data is obtained from governmental record. In the Marathwada region agriculture is dominant economic activity and their account is more in general land use. Out of the district geographical area 70.39 percent area under the net sown area followed by follow land, cultivable waste and the amount of forest cover share very less with 3.45 percent.