Geographic Diversity Research Articles

Executive and adaptive function impacts long-term outcomes for adults with maple syrup urine disease.

Successful transition to independent adulthood requires intact executive and adaptive function. These neurocognitive domains are frequently impaired in inherited metabolic disorders (IMD), despite optimal management. For many IMDs, the impact of executive and adaptive dysfunction on long-term outcomes remains undefined. Standardized assessments linking neurocognitive status with functional outcomes are needed to improve prognostication and tailor support for affected emerging adults. Maple syrup urine disease (MSUD), a relatively prevalent IMD, is primarily diagnosed in the first week of life through newborn screening. Despite early intervention, executive and adaptive dysfunction persist. We designed a remote, interactive battery of neurocognitive and functional assessments for adults (≥21 years) with MSUD to correlate neurocognition and long-term outcomes. Participants were selectively recruited for racial, ethnic, socio-economic, and geographic diversity. Assessments completed by 28 adults with MSUD (82% diagnosed after symptom onset, 25% from minority communities) show a wide range in educational attainment, employment, and residence. Executive and adaptive function were significantly impaired in adults with MSUD compared to controls. Executive and adaptive deficits correlated negatively with educational attainment, employment, and obtaining skills needed for adult-oriented healthcare or independent living. Clinical history did not predict functional outcomes, but neurocognitive assessments suggest the benefits of pre-symptomatic diagnosis. Independent adulthood is attainable for individuals with MSUD. Routine assessment of neurocognition and interventions targeting executive and adaptive function may improve long-term functional outcomes in IMD.

Modified Delphi Study to Establish Consensus About Child Neurology Residency Education: Next-Gen Training.

Rapid advances in diagnostics and treatments are shifting child neurology practice, but child neurology training requirements have been much slower to change. Previous literature confirms strong support for modernization, but no formal consensus exists regarding maintaining or changing training. We aimed to develop a holistic consensus regarding the optimal training pathway and requirements using a modified Delphi process. The authors invited 48 child neurologists as panelists, intentionally selecting to represent the diverse geography, practice type, subspecialties, and other demographics of child neurologists practicing in the United States. Panelists participated in an anonymized modified Delphi study with 4 rounds evaluating statements regarding current training requirements, core rotation durations, and mandatory subspecialty rotations with the option to agree or disagree. Statements were derived from current Accreditation Council of Graduate Medical Education, American Board of Psychiatry and Neurology, and American Board of Pediatrics requirements for child neurology training and recent literature. Statements that did not reach a predefined level of consensus (≥75% agreement or disagreement on a 7-point Likert scale) were re-queried or modified for subsequent rounds. Panelists had access to all previous anonymized results and comments. The final modifications were presented in round 4 as a comprehensive training proposal. Twenty-seven panelists agreed to participate, with most completing all 4 rounds. In round 1, consensus was reached on 45 of 118 (38%) items; round 2, 28 of 87 (32%); round 3, 16 of 25 (64%); and round 4, 1 of 1 (100%). There was consensus regarding the age scope of practice and certain subspecialties that should be required, but no initial consensus regarding time-based requirements. By round 4, consensus emerged for the following rotations-months: neonatal and pediatric intensive care-4, adolescent medicine-0.5, emergency medicine-1.5, inpatient pediatrics-3, outpatient pediatrics-3.5, inpatient child neurology-9.5, outpatient child neurology-6, inpatient adult neurology-3, outpatient adult neurology-2, genetics-2, EEG/neurophysiology-2, neuroimaging-1, child psychiatry-1, and electives-7.5. The consensus schedule consists of 46.5 total months of requirements. This study suggests that, despite diverging views prevalent among child neurologists, a diverse panel can, through a multiround Delphi process, arrive at consensus regarding many core features of the child neurology training structure and certification requirements.

Men as Midwifery Professionals: A Scoping Review.

Midwives provide skilled, primary, reproductive, and sexual health care to women, adolescent girls, and infants throughout the perinatal period, promoting health and safeguarding against obstetric emergencies and maternal and infant mortality. In many cultures, midwifery has been a predominantly female profession. However, in emerging research, the proportion of male midwives is growing to augment shortages of female midwives, prompting a need for further research that explores the contributions of male midwives in maternal and child health. The objective of this scoping review was to synthesize key findings from the literature regarding the growing, global workforce of male midwives. Specifically, we aimed to evaluate (1) the temporal nature of the publications, (2) the geographic distributions of the emerging literature, and (3) the key findings regarding male midwives' training and work experiences. We used Semantic Scholar and Google Scholar to identify relevant, peer-reviewed articles using the keywords "gender," "male," "men," "midwifery," and "nurse midwives," that met the inclusion criteria: (1) primary research papers, (2) published in the English language (for ease of understanding by the multinational, interdisciplinary authorship team), (3) explored male midwives' experiences during training/education and working, and (4) published between 2000 and 2023. Papers were excluded if they exclusively focused on females or nurses or other health professionals. Our initial search yielded 57 articles, with an additional nine obtained by reviewing the references. After excluding duplicates and reviewing based on inclusion criteria, 26 papers were included in the scoping review. All 26 articles were published between 2011 and 2023, with the majority (65%, n = 17) of articles focused on populations in the African region (Aims 1 and 2). Key findings (Aim 3) were as follows: 1. Training experiences of male midwives: Compared to other regions, male midwifery students in African, Middle Eastern, and Asian settings reported challenging training conditions, possibly influenced by sociocultural factors and gendered expectations of men in these settings. 2. Pregnant/birthing persons' delivery experiences and gendered preferences for their attending midwife: A significant number of birthing persons would choose female midwives over male midwives for their care, despite acknowledging similar skill sets. However, younger clients, urban residents, and non-traditional men expressed a need for gender equity and greater acceptance of men as midwifery professionals. 3. Professional work environment: Many of the male midwives faced professional challenges, often stemming from societal and professional prejudices, leading to feelings of alienation and marginalization within the midwifery profession. Despite these challenges, they remained dedicated to the profession and felt supported by their family, friends, and coworkers. Male midwives represent a growing proportion of the global obstetric workforce and provide an important contribution to addressing maternal morbidity and mortality. Further attention to providing equitable training opportunities, navigating caregiving within settings with strong cultural and religious influences, integrating cultural, geographic, and religious diversity into the midwifery curriculum, and providing male midwives with mentorship and role model support to grow and sustain their careers are urgently needed for improving maternal and infant health outcomes.

Gender and Geographic Equity in the International Association for Dental Research Awards.

To examine the gender and geographic distribution of the International Association for Dental, Oral, and Craniofacial Research (IADR) Distinguished Scientist Awards (DSA; data: 2019-2024), group awards (data: 1982-2024), and fellowships (data: 1987-2024). Publicly available data were obtained from the IADR awards website. Information on gender and location of the awardees was gathered from photographs and affiliations if available or otherwise from online profiles or using Genderize, an online gender allocation platform. Of the 99 DSA awardees in 2019 to 2024, 35% were women; 38% were from the United States, 12% were from the United Kingdom, and 11% were from Australia. Of the 35 DSA women awardees, 54% were from the United States and 11% from Finland. Of the 795 group awardees, 45% were women. Data on the location of awardees were readily available for 681 group awards; of these, 39% were from the United States and 87% were from high-income countries. Of the 113 fellowships awarded, 58% were to women. Of the 32 fellowships since 2018, 44% were for awardees from upper-middle income countries. Although women are overrepresented in the dental profession and the IADR has a global membership, women awardees remain underrepresented, and most awards are granted to researchers in high-income countries. These findings call attention to a deeper look at diversity, equity, and inclusion within the IADR. Gender diversity of IADR research awards is moving in the right direction, but geographic diversity lags, with most Distinguished Scientist Awards and group awards to members in high-income countries. There is an urgent need to consider performance relative to opportunities and applications. This change in process could provide a much-needed intersectionality lens for recognizing the research performance of IADR members while increasing diversity and inclusivity.

Panoramic view of the effects of active breaks in an educational context

In education, optimising academic achievement (AA) and promoting attention and concentration are essential elements. The main goal of this systematic review (SR) is to analyse and synthetise the scientific evidence to examine the impact that the different interventions with active breaks (AB) have on the AA, attention, and concentration of the students in educational contexts. To do this, the PRISMA protocol is followed (REG INPLASY: INPLASY202390082). The documents that comply with the inclusion criteria for this research are 29 scientific articles extracted from the databases Web of Science (WOS), SCOPUS and ERIC. The specific goals of this study are detailed through 13 research questions related to the characteristics of the works and their results, e.g. thematic and geographic diversity, variability in the research designs, inclusion of several educational levels and academic contents, as well as the presence of common intervention modalities and heterogeneous durations. The panoramic view suggested by the results presents AB as an interdisciplinary topic of international interest mainly focused on basic education, with measure instruments that are diverse and have variable duration, which might influence the comparability between studies. Even though some studies back up the positive effects of AB, the heterogeneity of approaches and results highlights the need of future research in order to unify criteria and allow a better understanding of the effects of AB and their applicability in several educational contexts.

Reddit for research recruitment? Social media as a novel clinical trial recruitment tool for adolescent and young adult (AYA) cancer survivors.

Adolescent and young adult cancer survivors (AYAs) have been considered a hard-to-reach population with low enrollment rates in cancer clinical trials. Race, ethnicity, socioeconomic status, and inaccessibility have been identified as barriers impacting research participation. Social media has the potential to overcome these barriers and increase AYA enrollment. This secondary analysis of a randomized controlled behavioral trial aims to (1) examine differences in participant characteristics and engagement as stratified by recruitment method and (2) offer considerations for using social media to recruit AYAs. Social media and traditional recruitment methods were employed to recruit 72 post-treatment AYAs (ages 16-29) for a virtual synchronous group-based resiliency intervention (Bounce Back). Screening surveys assessed sociodemographic, medical, and psychosocial characteristics. Feasibility was assessed via attendance and follow-up survey completion. Post-intervention program acceptability and treatment satisfaction ratings were collected. A total of 61% of AYAs were recruited via social media; with 40% from Reddit, 18% from Facebook, and 3% from Twitter. Participants recruited via social media had greater sociodemographic and geographic diversity, completed cancer treatment more recently, and reported increased anxiety and prospective worry compared to participants recruited via traditional channels. No significant between-group differences in retention, engagement, acceptability, or treatment satisfaction ratings were detected. Challenges encountered included bots, malingerers, and scheduling considerations. Recruiting via social media platforms, especially Reddit, enhanced participant diversity and intervention accessibility. Researchers should identify recruitment methods that promote inclusivity while preserving safety and research integrity. Social media recruitment was a successful and comparable recruitment strategy for engaging early post-treatment AYAs in a behavioral intervention trial.

The 100 Most Cited Publications in Lichen Planopilaris: A Bibliometric Analysis

Introduction: Lichen planopilaris (LPP) is a rare scarring alopecia with poorly understood etiology, leading to challenges in both diagnosis and management. With an increasing number of studies focused on its clinical presentation, histopathology, and trichoscopic features, a comprehensive bibliometric analysis of high-impact LPP research is necessary to assess current trends and identify gaps in the literature. Methods: To analyze trends in LPP research using the top 100 most-cited articles from Web of Science. Results: The average number of citations per article was 80.4 (range: 37-289), with publication dates ranging from 1990-2021. The most cited article was Kossard’s "Progressive Frontal Scarring Alopecia in Postmenopausal Women" with 289 citations. The United States (n=47) had the most publications, followed by England (n=18) and Spain (n=14). Most articles were LOE 3 (n=34) focusing on the "Clinical and Histopathological Presentation" (n=33). Key reported trichoscopic features included perifollicular erythema, perifollicular scaling, and loss of follicular ostia. Conclusion: This bibliometric analysis highlights foundational LPP studies, emphasizing key trichoscopic features while revealing gaps in high-level evidence. It underscores the need for more rigorous research and expanded geographic diversity to enhance diagnostic markers, refine trichoscopic criteria, and improve therapeutic approaches.

Clinical and demographic characteristics of frontal fibrosing alopecia in a dermatology referral center in Bogota, Colombia: a descriptive cross-sectional study.

Frontal fibrosing alopecia (FFA) is a type of scarring alopecia that is characterized by a symmetrical recession of the frontal/temporal hairline. Despite growing interest in this pathology, there is scarce data on its epidemiology in Latin American countries such as Colombia. To estimate the frequency and describe the clinical manifestations and factors associated with FFA. This descriptive cross-sectional study reviewed the electronic health records of adult patients diagnosed with FFA at a referral center in the city of Bogota, Colombia, between 2018 and 2021. Of the 1506 patients diagnosed with scarring alopecia, 213 fully met the selection criteria (14.14%). Patients had a median age at diagnosis of 60 years (Q1-Q3: 49-67 years) and were more frequently female (95.31%). Concurrent eyebrow alopecia was the most frequent clinical presentation (56.34%). Perifollicular desquamation was present in 114 patients (53.52%), perifollicular erythema in 56 (26.29%), and both features simultaneously in 35 (16.43%). Sunscreen use was reported by 116 (54.46%) and facial moisturizers by 38 (17.84%), both of which have been reported as risk factors. The small sample size and the lack of racial and geographical diversity in the subjects. This study provides baseline epidemiological data in a Colombian sample. Sex, location of alopecia, and symptoms were consistent with those reported in the literature, but age at presentation, tobacco use, use of wigs, and dyes differed from those reported in other countries.

Modeling the potential distribution and shift of an Algerian endangered endemic species (Cedrus atlantica) under climate change scenarios: Implications for conservation

Algeria is distinguished by its geographical and climatic diversity, which contains a varied flora and endemic species, being recognized as one of the biodiversity hot-spots of the Mediterranean region. Among its endemic species, the renowned Atlas cedar (Cedrus atlantica) is particularly notable as it exclusively grows in the Atlas Mountains. Classified as endangered species by the International Union for Conservation of Nature (IUCN) Red List, because of its endemism and also because dramatic declining populations over the past four decades. Forecasting the potential impact of climate change on the distribution of this species might help in devising effective conservation strategies. Under this backdrop, this study aimed to simulate the current distribution of suitable habitat for C. atlantica in Algeria and investigate the influence of climate change on its distribution range by the years 2050, 2070 and 2090. The distribution was modeled using Maximum Entropy (Maxent) based on locality information of 103 occurrence sites of the species and nine different environmental variables. The model showed that annual mean temperature and elevation were the most important environmental factors affecting the distribution of C. atlantica in Algeria. Currently, the total suitable habitats for this species, including both medium and high suitability habitats, cover a total area of 1,837 km2, yet its distribution is relatively narrow and fragmented. This area would obviously decrease under all future climate change scenarios, shifting northwestward and to higher elevations, where conditions conducive to the species’ expansion will exist. Our results showed that at lower elevations and latitudes the species is highly prone to the effects of climate change, and they are confronted with an augmented risk of extinction across diverse climatic scenarios. This research provides valuable information for the more effective conservation and sustainable management of C. atlantica in the face of climate change challenges.

Cognitive testing in 19 countries to refine WHO's Sexual Health Assessment of Practices and Experiences.

To refine a standard questionnaire on sexual practices, experiences and health-related outcomes to improve its cross-cultural applicability and interpretability. We aimed to explore participants' willingness and ability to answer the draft questionnaire items, and determine whether items were interpreted as intended across diverse geographic and cultural environments. We conducted cognitive interviews (n = 645) in three iterative waves of data collection across 19 countries during March 2022-March 2023, with participants of diverse sex, gender, age and geography. Interviewers used a semi-structured field guide to elicit narratives from participants about their questionnaire item interpretation and response processes. Local study teams completed data analysis frameworks, and we conducted joint analysis meetings between data collection waves to identify question failures. Overall, we observed that participants were willing to respond to even the most sensitive questionnaire items on sexual biography and practices. We identified issues with the original questionnaire that (i)affected the willingness (acceptability) and ability (knowledge barriers) of participants to respond fully; and/or (ii)prevented participants from interpreting the questions as intended, including poor wording (source question error), cultural portability and very rarely translation error. Our revisions included adjusting item order and wording, adding preambles and implementation guidance, and removing items with limited cultural portability. We have demonstrated that a questionnaire exploring sexual practices, experiences and health-related outcomes can be comprehensible and acceptable by the general population in diverse global contexts, and have highlighted the importance of rigorous processes for the translation and cognitive testing of such a questionnaire.

COVID-19 impacts on residential preferences for parks and green-blue spaces: A case study from Miami-Dade County, Florida

While the pandemic has enhanced positive perceptions of parks and green-blue spaces, there remains ongoing debate about whether this has translated into increased usage of these areas and a higher valuation of such proximities in the real estate market. Simply desiring more time in parks does not necessarily equate to a readiness to pay more for homes nearby. By analyzing housing transaction data, we investigated changes in residential preferences over a seven-year span, segmented into three phases: pre-pandemic (2015–2019), pandemic (2020−2021), and post-pandemic (2022). We focused particularly on the evolving attitudes toward parks, green-blue spaces, and their associated sports and social amenities during and after the pandemic, linking these shifts to trends in COVID-19 cases. Our findings revealed dynamic changes in homebuyer preferences toward parks, urban greenspaces, and coastal amenities. Notably, there was a decline in the willingness to pay for proximity to parks in 2021 and 2022, whereas the value assigned to homes near natural or designed walking trails significantly rose from 2020 to 2022. Coastal and beachfront properties continued to positively impact housing prices, a trend that the pandemic appears to have reinforced. These changes in preferences also showed significant geographical diversity, suggesting that the pandemic's influence on residential preferences is closely tied to local culture and urban landscapes. Our study suggests that while the pandemic may temporarily alter preferences not deeply rooted in a city's culture, only those preferences that are intrinsic to a locality are likely to persist.

Mass consciousness of Russian youth: image of the future

This is the second text within the all-Russian research on the image of the future in the mass consciousness using the methods of empirical sociology. In 2021-2024, researchers conducted 67 focus groups in 25 regions from Moscow to Kamchatka. In addition to diverse geography, the authors consider all types of localities as a research space: from supercities to small towns and villages. Two key methods are used: focus groups and psychography. Images of Russia in the present and in the future are described not only using words, but also presented in pictures by respondents. This text focuses on the study of mass consciousness of young people (age 18-30) and more local trends in geographical, generational, political and economic senses. The text highlights eight key trends in the mass consciousness of young people: socialization within Western culture, the highest level of paternalism (including the desired restoration of certain Soviet practices), weakening frustration due to cancel culture regarding Russia and its citizens from the West, demonstrative public depoliticization, permanent desire for a peaceful future with Russia's leading role in the international arena, etc. Despite the uneven attitude towards state institutions, the Fatherland is perceived by the mass consciousness of young people as a place to apply their own efforts to build a career and solve problems. The results of the study demonstrate the highest margin of safety of the Russian state, which has no alternatives regarding the construction of the image of the future.

Climate and Coffee Production in Ethiopia: A Review

Climate is a complex system involving the atmosphere, land surface, snow and ice, oceans, and other water bodies. It is measured by variations in temperature, humidity, atmospheric pressure, wind, precipitation, atmospheric particles, and other meteorological variables over a 30-year period. Climate change has gained momentum due to anthropogenic disturbances, which may negatively impact human health and the biosphere. The complex relationships between humans, microbes, and the biosphere are causing an increase in greenhouse gases (GHGs), causing global warming and other cascade effects. Climate change is a key environmental concern, posing challenges to ecosystems, food security, water resources, and economic stability. Historical climate records and projected patterns across global regions have confirmed this, with Ethiopia experiencing significant increases in annual mean temperature, hot days, and nights. Climate variability refers to the Spatio-temporal fluctuation of climatic conditions, focusing on the variability dimensions. The Intergovernmental Panel on Climate Change (IPCC) has declared climate change a key environmental concern. Climate in Ethiopia is characterized by significant geographic variance in rainfall and temperature data. The country has three seasons: bega (dry season) from October to January, belg (short rain season) from February to May, and kiremt (long rainy season) from June to September. The country's climate is influenced by the seasonal migration of the Intertropical Convergence Zone and its varied geography, affecting landforms, natural landscapes, and local people's living situations. Coffee is susceptible to drought, over-wetting, and wind damage because its production and quality are largely dependent on temperature and rainfall levels. In key coffee-growing regions around the world, the yield of coffee is at risk due to climate change and unpredictability. The production of coffee is expected to be severely impacted by high temperatures and unpredictable rainfall patterns in terms of yield, quality, pests, and illnesses.

Value and virtue in the extended reality (XR) industry

ABSTRACT It is increasingly common to see policymakers, industry, and regulators calling for governance of the ‘metaverse' – often envisioned as a technological stack supported by extended reality (XR) technology. This article focuses on the governance of XR by one major industrial stakeholder, Meta. We report on a thematic content analysis of partnership initiatives undertaken by Meta's Reality Labs division falling under the company's XR Programs and Research Fund (XPRF) – a US$50M scheme beginning in September 2021 (and ending September 2023), funding academic, industrial, and policy partnerships to ensure XR is 'developed responsibly'. We show that partnerships under the XRPRF are scoped predominantly around the prevention of social harm in XR (such as gender-based harassment and protecting children in VR) and promoting equity in XR software production, emphasizing diversity in geography and identity. These initiatives are framed as both socially and economically beneficial. We also examine the underlying political and economic interests guiding these partnership efforts – asking who really stands to benefit, and why. While we take a critical perspective to Meta's XRPRF, we believe things to be more complicated than beneficiaries of industry funding simply ‘selling out' or Meta exerting top-down power (by ‘buying’ research or policy influence aligned with their business interests). Rather, we argue that the XRPRF allows Meta to shape the contours of conversation and critique about where the harms in this emerging suite of technology are concentrated.

Systematic Review of Air Pollution in Ethiopia: Focusing on Indoor and Outdoor Sources, Health, Environment, Economy Impacts and Regulatory Frameworks

The varied geography (Bekele, 1996) and rapid economic growth of Ethiopia (World Bank, 2020) might have impact its air pollution patterns, with topography, elevation, and climate variability (Lemma Gonfa, 1996) playing significant roles. Environmental challenges, including deforestation and climate change, also affect air quality. This study offers a systematic review of air pollution research in Ethiopia, providing a thorough analysis of its health, environmental, and economic impacts, regional variations, and policy suggestions. It addresses both indoor and outdoor air pollution, assessing their wide-ranging effects. Data were gathered through an extensive search of peer-reviewed articles, policies, and guidelines using Google Scholar and reputable sources, following PRISMA guidelines. The review highlights critical sources of air pollution in Ethiopia, including indoor biomass fuel combustion and outdoor emissions from traffic and industries. Indoor air pollution, particularly from traditional biomass fuels like wood and dung, affects rural and peri-urban areas, leading to high levels of particulate matter and carbon monoxide. Outdoor pollution, driven by urbanization, industrial expansion, and vehicle emissions, worsens health issues and environmental damage. The study identifies severe health consequences, such as respiratory infections and cardiovascular diseases, with air pollution contributing to premature deaths and rising healthcare costs. Economic analysis highlights the significant costs related to healthcare, lost productivity, and infrastructure damage. Environmental impacts include harm to plant health, soil degradation, and contributions to climate change. Despite initiatives to improve air quality monitoring and regulation, challenges persist due to outdated policies, limited infrastructure, and insufficient data. The study emphasizes the need for more comprehensive research and regulations to tackle air pollution crisis.

Unified Assembly of Chloroplast Genomes: A Comparative Study of Grapes Representing Global Geographic Diversity

The genus Vitis, known for its economically important fruit—grape—is divided into three geographical groups, American, East Asian, and Eurasian, along with a hybrid group. However, previous studies on grape phylogeny using chloroplast genomes have been hindered by limited sample sizes and inconsistent methodologies, resulting in inaccuracies. In this study, we employed the GetOrganelle software with consistent parameters to assemble the chloroplast genomes of 21 grape cultivars, ensuring comprehensive representation across four distinct groups. A comparative analysis of the 21 grape cultivars revealed structural variation, showing chloroplast genome sizes ranging from 160,813 bp to 161,275 bp. In 21 Vitis cultivars, genome annotation revealed 134 to 136 genes, comprising 89 to 91 protein-coding genes (PCGs), 37 tRNAs, and 8 rRNAs. Our observations have pinpointed specific occurrences of contraction and expansion phenomena at the interfaces between inverted repeat (IR) regions and single-copy (SC) regions, particularly in the vicinity of the rpl2, ycf1, ndhF, and trnN genes. Meanwhile, a total of 193 to 198 SSRs were identified in chloroplast genomes. The diversification pattern of chloroplast genomes exhibited strong concordance with the phylogenetic relationships of the Euvitis subgenera. Phylogenetic analysis based on conserved chloroplast genome strongly clustered the grape varieties according to their geographical origins. In conclusion, these findings enhance our understanding of chloroplast genome variation in Vitis populations and have important implications for cultivar selection, breeding, and conservation efforts.

India's flood risk assessment and mapping with multi-criteria decision analysis and GIS integration

ABSTRACT India's diverse geography poses significant flood risks, addressed in this study through the geographic information system and multi-criteria decision analysis. This comprehensive flood risk assessment considers seven parameters: mean annual precipitation, elevation, slope, drainage density (DD), land use and land cover, proximity to roads, and distance to rivers. The findings indicate that flood vulnerability is primarily influenced by rainfall, elevation, and slope, with DD, land use, and proximity to roads and rivers also playing crucial roles. Experts weighed these factors to create a thorough flood risk map using the normalized rank index and normalized weight index, categorizing areas into five risk levels: very high, high, moderate, low, and very low. The study reveals that 3.40% of the area is at very high risk, 32.65% at high risk, 39.72% at moderate risk, 20.97% at low risk, and 3.25% at very low risk. These results highlight how human and natural factors interact to influence flood risk, with vulnerable areas characterized by low elevations, steep slopes, high drainage densities, and proximity to rivers or roads. The findings provide valuable insights for policymakers, scientists, and local authorities to develop strategies to mitigate flood losses across India's varied landscapes.

Concrete Infrastructure: Recent Advancements and Needs with a Focus on North America

This letter provides an overview of the continent’s diversity in geography and climatic exposure and the impact of chlorides on reinforced concrete structures in North America. Several research needs are identified, including those that arise as specifications begin to change from prescriptive to performance-based approaches. Further, the widespread changes in material compositions or chloride exposures, require important changes to specifications, design practices, or maintenance procedures. Related to reducing carbon emissions, there is a need to reduce clinker content in concrete mixtures, increase the use of novel cementitious and supplementary cementitious materials (SCM), and to understand the durability of such concretes. The following research efforts from a North American context are warranted: (i) investigating the long-term durability of novel cement and SCM systems, including non-Portland cement-based materials and those made with CO2 mineralization used to meet carbon emission targets; (ii) understanding climate change impacts of temperature and sea levels, including flood impact, on chloride exposure and chloride-induced corrosion; (iii) developing rapid and reliable tests to estimate durability in practice, particularly for scaling, freeze-thaw, salt damage, and chloride-induced corrosion; and (v) developing better understanding of the short and long-term implications of changes in constituent materials and exposure.

Abstract 4117454: PCSK9 Inhibitors for ASCVD Risk Reduction in Asian Populations — a meta-analysis of efficacy and safety profiles

Background: Dyslipidemia is increasingly prevalent in the Asia-Pacific region, correlating with higher mortality rates for ASCVD among this population. Statins, the cornerstone for dyslipidemia management, face higher intolerance in Asians compared to other races. PCSK9 inhibitors have emerged as a promising therapeutic additive to other lipid-lowering therapies. However, current trials predominantly involve caucasian populations, emphasizing the need for efficacy data across other ethnic groups. This meta-analysis aims to analyze the efficacy and safety profile of PCSK9i in Asian populations at high risk for ASCVD. Methods: We searched PubMed, Scopus, and Cochrane for RCTs from the past 10 years on PCSK9i vs. placebo in Asian populations at risk for ASCVD. Efficacy was measured by the mean difference in LDL levels from baseline. Safety parameters included ALT/AST, CK levels, and binding antibodies. Analysis was done with Review Manager, assessing heterogeneity with I^2 statistics. Results: Eleven studies in Singapore, Japan, the Philippines, India, South Korea, China, and Taiwan included 5443 patients (73% male, mean age 60.6, mean baseline LDL 114 mg/dL) with follow-up from 12 weeks to 16 months. Inclisiran was used in 3 studies, evolocumab in 5, alirocumab in 2, and tafolecimab in 1, alongside statins or ezetimibe. PCSK9i reduced LDL by -74.21 mg/dL and increased the likelihood of >50% LDL reduction compared to placebo (RR: 37.41, 95% CI: 16.31-85.82, P < 0.00001; I^2: 0%). PCSK9i significantly improve the achievement of LDL levels <70 mg/dL compared to placebo (RR: 15.77; 95% CI: 7.12 - 34.91, P < 0.00001; I^2: 82%) Adverse events showed a non-significant risk of >3x ULN increase in ALT/AST ( RR 0.58; 95% CI: 0.33-1.05; P = 0.78, I^2: 0%) and >5x ULN increase in creatine kinase (RR 0.32; 95% CI: 0.07-1.49; P = 0.97; I^2 = 0%). No significant difference in binding antibodies was observed (RR: 2.50, 95% CI: 0.13-49.47, P = 0.55; I^2 = 65%) Conclusion: In Asian populations, PCSK9 inhibitors effectively lower LDL levels without significant adverse events. The considerable heterogeneity in LDL reduction may result from variations in dosing, different agents used, baseline LDL levels, and geographical diversity. Future research should explore effects across more ethnicities to enhance generalizability.

Estimation of Human Epidermal Growth Factor Receptor 2 (HER2) Expression in Colorectal Adenocarcinoma for HER2 Targeted Therapy

Background: Colorectal carcinoma (CRC) ranks among the top cancers globally, with high mortality rates despite treatment advancements. Emerging therapeutic targets, including HER2, well-studied in breast and gastric cancers, are less explored in CRC literature. Objectives: To determine the frequency of HER2 expression in colorectal adenocarcinoma for HER2-targeted therapy and its association with various clinic-pathological variables.Materials and Methods: This cross-sectional study was conducted at the Department of Histopathology, Rehman Medical Institute (RMI), Peshawar, from November 15, 2022, to April 30, 2023. A total of 110 cases were included through consecutive sampling. The study included patients of both genders and all age groups who had undergone colectomy (right or left hemicolectomy, extended right hemicolectomy, abdominoperineal resection) and were previously diagnosed with CRC based on colonoscopic biopsies. Colonoscopic biopsy specimens and patients who had undergone neoadjuvant therapy were excluded. Immunohistochemistry assay for HER2 was performed, and the results were interpreted.Results: The mean age (SD) of study sample was 45 (6.12) years. There was a predominance of male patients. Out of the total 110 patients, HER2 expression was positive in 69 (62.73%) and negative in 41 (37.27%) patients. The lesions were predominantly located in the rectum and left colon in 77 (70.00%) of the patients. Histologically, 92 (83.64%) patients had non-mucinous tumor variants. Among the 69 positive cases, 32 (29.09%) were scored as 1+, 24 (21.82%) as 2+, and 13 (11.82%) as 3+. Tumor grade, tumor stage, HER2 expression, and score were statistically significantly associated with IHC staining intensity (p < 0.001). Similarly, tumor grade, tumor stage, and HER2 score were statistically significantly associated with positivity status (p < 0.001). Furthermore, statistically significant relationship between the degree of differentiation (tumor grade), tumor stage, IHC staining intensity and the score of HER2 overexpression was observed (p < 0.001).Conclusion: In our study, HER2 expression was observed in a significant number of patients. The findings indicate that HER2 expression correlates with specific tumor characteristics suggesting its potential as a biomarker in management for this disease. Further research with larger sample sizes and broader geographical diversity is recommended to better understand HER2's biological role in cancer.Keywords: Colorectal adenocarcinoma, Gastrointestinal system, HER2, Immunohistochemistry, Targeted therapy.