Attendant Increase Research Articles

Substrate stiffness modulates cardiac fibroblast activation, senescence, and proinflammatory secretory phenotype.

In vitro cultures of primary cardiac fibroblasts (CFs), the major extracellular matrix (ECM)-producing cells of the heart, are used to determine molecular mechanisms of cardiac fibrosis. However, the supraphysiologic stiffness of tissue culture polystyrene (TCPS) triggers the conversion of CFs into an activated myofibroblast-like state, and serial passage of the cells results in the induction of replicative senescence. These phenotypic switches confound the interpretation of experimental data obtained with cultured CFs. In an attempt to circumvent TCPS-induced activation and senescence of CFs, we used poly(ethylene glycol) (PEG) hydrogels as cell culture platforms with low and high stiffness formulations to mimic healthy and fibrotic hearts, respectively. Low hydrogel stiffness converted activated CFs into a quiescent state with a reduced abundance of α-smooth muscle actin (α-SMA)-containing stress fibers. Unexpectedly, lower substrate stiffness concomitantly augmented CF senescence, marked by elevated senescence-associated β-galactosidase (SA-β-Gal) activity and increased expression of p16 and p21, which are antiproliferative markers of senescence. Using dynamically stiffening hydrogels with phototunable cross-linking capabilities, we demonstrate that premature, substrate-induced CF senescence is partially reversible. RNA-sequencing analysis revealed widespread transcriptional reprogramming of CFs cultured on low-stiffness hydrogels, with a reduction in the expression of profibrotic genes encoding ECM proteins, and an attendant increase in expression of NF-κB-responsive inflammatory genes that typify the senescence-associated secretory phenotype (SASP). Our findings demonstrate that alterations in matrix stiffness profoundly impact CF cell state transitions, and suggest mechanisms by which CFs change phenotype in vivo depending on the stiffness of the myocardial microenvironment in which they reside.NEW & NOTEWORTHY Our findings highlight the advantages and pitfalls associated with culturing cardiac fibroblasts on hydrogels of varying stiffness. The findings also define stiffness-dependent signaling and transcriptional networks in cardiac fibroblasts.

Access and utilization of health services improved by trained posyandu cadres in rural Indonesia

Abstract Posyandu stands for ‘Pos Pelayanan Terpadu’ in Bahasa, meaning ‘Integrated Service Post,’ a community-based health center to provide a range of services for mothers and under five children in Indonesia. Each Posyandu center s served by five posyandu cadres who are community-based health workers and responsible to deliver essential health services and counseling to their communities. In Central Lombok district, Indonesia, we facilitated building capacity and skill of posyandu cadres for counseling and health education and to encourage the community to attend Posyandu center as well as to seek care from nearby Puskesmas and Polindes (other community based static health facilities). During January - August 2022, we trained 1100 posyandu cadres and equipped them with pictorial cards with health education and counseling messages. We retrieved monthly attendance and care seeking data from Puskesmas, Polindes and Posyandu centers through routine health management information system for January 2022 to February 2023 and we compared pre-training (January-August 2022) and post-training (September 2022-February 2023) data. Monthly average number of pregnant women and sick children who were brought to nearby Puskesmas and Polindes for care during pre-training period was 1553 which was significantly increased to 1844 during post-training period (p < 0.001). We also observed statistically significant ((p < 0.001) increase in average monthly attendance of mothers and children at Posyandu centres (from 12,751 in pre-training period to 14,677 in post-training period). This incremental attendance at Posyandu centers and increased care seeking from Puskesmas and Polindes can potentially be attributable to counseling-education session by trained and skilled posyandu cadres and it reconfirms the worthiness of additional investment for capacity and skill building of posyandu cadres to improve community health in rural Indonesia. Key messages • Posyandu cadres have potential strength to make significant improvement in community health care service delivery by educating and counseling communities in rural Indonesia. • Investment on capacity building and training of posyandu cadres can pay off by improving access and utilization of health care services by pregnant women and children.

Enhancing Lecture Attendance: A Novel Approach Utilizing Clinical Case-Based Learning

There has been an observable trend indicating a decline in students' attendance in the lectures. Several reasons for this have been proposed, and various measures to mitigate this have been suggested in the past. We implemented a novel approach in our instructional strategy to address this. Real-life clinical problems relevant to the topic were integrated into the lectures, and they were deliberately excluded from the pre-lecture handouts. During the lectures, students were motivated to post questions and actively engage in peer-peer and peer-tutor discussions. To evaluate the impact of this intervention, student attendance before and after was monitored, calculated and statistically analyzed to get the average attendance. The results revealed a significant increase in the average attendance, demonstrating a statistically meaningful difference (p<0.001). Commencing classes with pertinent patient problems or real case scenarios and stimulating student participation through open-ended discussions and interactions significantly enhanced the appeal of the lectures. This intervention holds great significance in alignment with the forthcoming clerkship training of the students in the undergraduate program since it prepares them for direct patient and real clinical problem encounters. Upon analyzing the class attendance average pre- and post-implementation of the intervention, a substantial improvement in overall attendance was observed.

Migrants and Healthcare during COVID-19, the Case of Kanchanaburi Province in Thailand.

Since the outbreak of COVID-19, as reported by the WHO in December 2019 and subsequently declared a public health emergency of international concern, a distinct set of risk factors and vulnerabilities faced by migrants are affecting their exposure to the pandemic and its associated outcomes. This study aims to analyze the social determinants of health among migrants and their associated factors and compare the socio-demographic characteristics, patterns of COVID-19, and healthcare attendance and utilization among migrant workers and non-migrants. A descriptive study design was used to analyze COVID-19 morbidity among migrant workers. There were a total of 73,762 migrants living in the province by December 2021, with varied statuses and nationalities. Most of the migrants were from Myanmar, constituting about 80.1%. A total of 24,837 COVID-19 cases in Kanchanaburi province were recorded in 2020-2021. COVID-19 cases among migrant workers accounted for 22.3% during the period under review. Half, 2914 (52.7%) of the migrant female workers were victims of COVID-19 infections. Persons under the age of 18 accounted for about one-fifth of all the COVID-19 cases. Older, over 60 years old, Thais had about twice (10.1%) the COVID-19 cases compared with the older migrants (5.5%). There was a significant increase in healthcare attendance and utilization by non-migrants and migrants during the year under review. Migrants are at high risk of COVID-19 infection. Therefore, public health guidance for the prevention of COVID-19 should prioritize safeguarding the health of migrants by considering their individual characteristics and actions. Enhancing health insurance schemes for migrants, particularly vulnerable migrant groups, is critical for inclusive and expanded healthcare access. Physical, social, and economic environments that impact the health and well-being of migrants should be integral to pandemic prevention, preparedness, response, and recovery.

Histopathologic Diagnosis of Diffuse Placental Chorangiosis in a Patient WHO Presented with Preeclampsia and Inevitable Abortion

Reported cases of chorangiosis in the literature are few and its etiopathogenesis is not still not completely understood [1]. However, most cases are caused by prolonged placental under-perfusion and chronic hypoxia [1]. Chorangiosis is also referred to as “extreme villous hyper-vascularity”; it is diagnosed by “the presence of more than 10 capillaries in more than 10 terminal chorionic villi in several areas of the placenta”, usually in three or more microscopic high power fields [1]. Cases of chorangiosis are reportedly seen in up to 5–7% of examined placentas from infants admitted to newborn intensive care units for various reasons, with an attendant increase in neonatal morbidity and mortality [1]. One of the well-documented causes of chorangiosis is Preeclampsia [1], which is a known cause of placental hypoxia and hypoperfusion as seen in this index case.

Impacts of unconditional cash transfers on health care utilisation in informal sector households in Togo.

Most Togolese population earns their income from informal sector, and they are very often exposed to health outcomes. Cash transfers impact healthcare utilization by improving household's social capital, socio-economic status, lifestyle choice, and physical health. The aim of this paper was to analyse the impact of unconditional cash transfers on health care utilisation in informal sector households. We used the propensity-score method to compare health care utilisation by households that received cash transfers from nonbeneficiary households and simulated a potential confounder to assess the robustness of the impacts of the estimated treatment (i.e., cash transfer). Data were obtained from a national survey that covered 1405 households. The results show that women benefited the most from cash transfers (73.1%). Our estimates indicate that health care utilisation increased by 28.3% among workers in the informal sectors who benefited from unconditional cash transfers compared to nonbeneficiaries. The greatest impact was found on agriculture households with an increase by 31.3% in the health care utilisation. In general, cash transfer beneficiaries are more likely to use public health centres; there was an increase in public health facility attendance of 21.3%. Cash transfers are a valuable social protection instrument that improve health care utilisation of populations in the informal sector. Policymakers could use cash transfer as the infusion of income and/or assets that may impact health outcomes. Cash transfers are an opportunity to alleviate barriers of access to health care by older people. Future research must examine impact of cash transfer on health of vulnerable groups such as older people, children, and people with disabilities.

Effects of Increased Transparency on Political Divides and MP Behavior: Evidence from Televised Question Hours in the Finnish Parliament

We study the effects of increasing the transparency of parliamentary speeches on polarization and other types of MP behavior. We utilize the 1989 introduction of TV broadcasting to the Finnish government's parliamentary question hours held on the first Thursday of every month. By contrast, the question hours held on other Thursdays of the month were not televised until 2007, allowing us to use difference‐in‐differences design. We find a positive effect on government–opposition divides, but no evidence that the TV broadcasting of question hours would affect left–right polarization, differences between individual parties, or within‐party group differences. We also observe an increase in attendance and a negative effect on the number of speeches, but no effects on topics discussed, speech length nor interruptions. Our results suggest there is no trade‐off between increased transparency and left–right polarization. However, the presence of TV cameras can fuel other political divides and increase politicians’ effort.

Are Text Pages an Effective Nudge to Increase Attendance at Internal Medicine Morning Report Conferences? A Cluster Randomized Controlled Trial.

Despite the importance of medical educational conferences, low attendance remains an issue. The utility of reminder text pages as a behavioral nudge to increase attendance is unknown. Our objective was to determine whether reminder text pages increase daily morning report attendance. We conducted a multiple-crossover cluster randomized controlled trial among medical students and internal medicine interns and residents (learners) at the Veteran Affairs Boston Healthcare System during the 2019 to 2020 academic year. During intervention periods, all residents and interns received a text page reminder 5 minutes before the upcoming 8:00 am morning report conference; no page was sent during control periods. The primary outcome was conference attendance 10 minutes after the start of the conference. The study period included 85 morning report conferences, which 211 unique learners were eligible to attend; outcome data were available for 100% of eligible learners. On days when no page was sent, 44.4% of eligible learners attended the conference by 8:10 am ; on days when a reminder page was sent, 49.5% of eligible learners attended (P = .007). Accounting for clustering within individuals and controlling for date and team, the adjusted risk difference in morning report attendance associated with a reminder page was 4.0% (95% CI, 0.5%-7.6%) compared with no reminder page. No effect modification by overnight admissions was detected. Our results suggest that daily reminder pages may result in a small increase in conference attendance. Whether this small increase is educationally significant will vary across training programs that apply this strategy.

Football migration in the Czech Republic: A multi-level analysis of football migration in a semi-peripheral European Nation

ABSTRACT Football migration, including flows and effects, is measured over the first 27 years of the independent Czech Football League. Hierarchical multi-level analysis is used to test previous sport migration effects. Particular attention is paid to the economic and sport position of both sending and receiving nations by examining results through the world-systems theory. Though the number of football migrants continues to rapidly increase, the statistical results of this study indicate that receiving football migrants into the semi-periphery nation of Czech, where football is a primary sport, may increase winning percentage in the short term, but it does not lead to increases in fan attendance or improve the nation’s FIFA rankings. Longer term deliberation needs to be taken by individual club teams, as well as national federations, in order maximize the benefits of migration flows in the future.

Influence of state bus services on school attendance in under-privileged remote areas: reflections from a case analysis in estate areas of Haputale, Sri Lanka

Free education for all in Sri Lanka has enabled significant improvements in educational performance and living standards. However, there are still some issues unresolved; one being the difficulties in accessing education facilities in the townships, owing to mobility constraints. Students residing in plantation areas, for instance, become inconvenienced when public bus services are absent or unreliable.The present research quantitatively examined the significance of SLTB bus service availability, inter-alia, in determining the school attendance rate of students residing in remote estate areas. The Haputale Education Division was examined as a case study. Results indicated that, among factors that could significantly affect the level of school attendance of estate children, the availability of SLTB service on estate routes would be very crucial; a significant increase in attendance being realisable if SLTB’s scheduled school bus trips operated with greater reliability. The importance of affordable mobility services for school attendance in remote areas, is thus examined.The study enabled inference that the policy priority should be assigned to further strengthen and expand bus services. This intervention is likely to be more beneficial than focusing on other apparently influential determinants. However, the generalisability of these findings to other estate areas and geographically remote localities of the country needs to be confirmed through further research.

Effects of non-isotropic blockage on a tidal turbine modeled with the Actuator-Line method

Blockage effects are a consequence of the interaction between a body and the surrounding boundaries in a constrained flow. For the case of tidal rotors, global blockage (β) is usually defined bythe ratio between the swept area of the rotor and the cross-sectional area of a channel. Increasingblockage tends to increase the limits of power extraction (Garrett and Cummins, 2007), as well asthrust on a rotor through an attendant increase of through-rotor mass flow. While these observations have been studied and demonstrated for isotropic blockage effects (e.g., Zilic de Arcos et al.2020, Bahaj 2007 , Mikkelsen 2002), questions remain regarding the validity of such assumptionsfor non-isotropic blockage in channels with, e.g., rectangular cross-sections with varying aspectratios.
 In this work, we will use CFD simulations to analyze the effect of non-isotropic blockage on atidal rotor. The study aims to explore these effects using an Actuator-Line representation of anaxial-flow rotor, simulated under different blockage ratios (1 %, 5 %, 10%, and 19.7 %), aspectratios (0.25, 0.5, 0.75, and 1), and tip speed ratios (4, 5, 6, and 7). A total of 64 cases will beconsidered. For each simulated case, the power, thrust, and spanwise force distributions will beextracted as functions of time, and used to understand the effect of blockage on the performanceof tidal rotors.
 Our preliminary results, in agreement with existing literature, indicate that blockage affectswake development, as seen in Figure , along with power and thrust. These results, for a constantaspect ratio, show power increases up to 26 % for a blockage of 20 %. The bulk of the simulationmatrix, including the different aspect ratios, is currently under production and is expected to beready before the paper submission deadline.
 
 ReferencesGarrett, C., Cummins, P. (2007). The efficiency of a turbine in a tidal channel. Journal of fluidmechanics, 588, 243-251.Zilic de Arcos, F., Tampier, G., Vogel, C. R. (2020). Numerical analysis of blockage correctionmethods for tidal turbines. Journal of Ocean Engineering and Marine Energy, 6, 183-197Bahaj, A. S., Molland, A. F., Chaplin, J. R., Batten, W. M. J. (2007). Power and thrust measurements of marine current turbines under various hydrodynamic flow conditions in a cavitationtunnel and a towing tank. Renewable energy, 32(3), 407-426.Mikkelsen, R., Sørensen, J. N. (2002). Modelling of wind turbine blockage. In 15th IEAsymposium on the aerodynamics of wind turbines, FOI Swedish Defence Research Agency.
 

1035 Puppy Pandemic: A Review of Injuries Sustained from Dogs Before and After the UK Lockdowns in a Major Trauma Centre

Abstract Aim The COVID-19 pandemic saw a boom in UK pet ownership, dogs in particular, with 3.2 million households acquiring a pet during the lockdown period. While dog bites are well-documented, there is little research on other injuries sustained from dogs. This study aimed to identify and describe the various dog-associated injuries and their management, as well as determine if there was an increase in hospital attendance with dog-associated injuries during the lockdown period. Method A retrospective review of all patients seen by the orthopaedic team at a major trauma centre with dog-related injuries was conducted, comparing attendances between June and September 2019 (‘pre-panemic’) and the same period in 2021 (‘post-pandemic’). Demographics, injuries sustained, mechanism of injury, length of stay and operative management required were among the data analysed. Results There was a 32.7% increase in dog-related injuries between 2019 (n = 49) and 2021 (n = 65), the majority being fractures and lacerations. The most common mechanism of injury was tripping over a dog, followed by falls while walking and bites/scratches. Most injuries occurred in the home, with 71% of patients being the dog owner. Operative management was required in 51% of cases in the 2019 group and 29% in 2021. Conclusions To our knowledge, this is a novel research area, describing all dog-related injuries versus only bites. Fractures were the most common dog-related injury in both groups. This mechanism of injury presents a burden to healthcare in terms of resources. Fragility fractures need to be considered for this mechanism of injury.

The Impact of Blood Glucose Test Strips Reimbursement Limits on Utilization, Costs, and Health-care Utilization in British Columbia

ObjectivePeople living with diabetes and not using insulin may not derive clinically significant benefit from routine glucose self-monitoring. As a result, in 2015, British Columbia (BC) introduced quantity restrictions for blood glucose test strips (BGTS) coverage in public plans. We studied the impact of this policy on utilization, costs, and health-care utilization. MethodsWe identified a cohort of adults (≥18 years old) with diabetes between 2013 and 2019. Using BC’s administrative data, we studied utilization and costs among individuals with at least one PharmaCare-eligible BGTS claim. Using interrupted time-series analysis, we studied cost savings and determined the level of policy adherence. In addition, we investigated longitudinal changes in all-cause and diabetes-specific physician visits, all-cause hospitalizations, and health-care spending in the 3 to 5 years after policy implementation. ResultsOver the study period, 279.7 million BGTS were eligible for PharmaCare coverage, on which the government spent $124.3 million. After policy implementation, we observed an immediate decline in average utilization and PharmaCare expenditure on BGTS, leading to an estimated $44.6 million in savings between 2015 and 2019 (95% confidence interval $16.9 to $72.3 million). We found no association between the policy’s implementation and health services utilization or overall health-care spending over the long term. ConclusionsRestricting reimbursement for BGTS in BC resulted in significant cost savings without any attendant increase in health services utilization over the subsequent 5 years. This disinvestment freed up resources that could be channeled toward other interventions.

Cost-effectiveness analysis of phone reminders for outpatient magnetic resonance imaging (MRI) appointments in Singapore

IntroductionDue to long wait times, rising demand and limited resources for Magnetic Resonance Imaging (MRI) services, phone call reminders were implemented as an intervention to increase scanner utilisation and improve non-attendance at the radiology department in Changi General Hospital, Singapore. AimThis study aims to evaluate the impact of phone reminders on outpatient MRI non-attendance rate as well as the operational efficiency and savings of this intervention through cost-effectiveness analysis. MethodsMRI outpatient records from January to December 2020 (pre-intervention period) and January to December 2021 (post-intervention period) were retrospectively obtained from the hospital systems. Non-attendance rates, costs and savings following the intervention were compared. ResultsOutpatient appointment non-attendance rates reduced from 12.85% to 8.93% after intervention. Following the phone reminders, 2,953 patients (21.69%) decided to cancel or reschedule their appointments. Based on the 91.07% attendance rate (100% - 8.93%), another 2689 slots were recovered from the cancellation of these appointments and were given to other patients. The reduction in non-attendance rates (3.92%) after the intervention translates to an increase in attendance of 533 patients while the net revenue generation with the phone reminder intervention was $387,179. ConclusionCost analysis indicates that phone reminders provide an inexpensive, easily implemented and personalised method to help increase adherence and improve appointment attendance. Reminding patients by phone calls two day before their appointments also leads to better optimization of appointment slots from cancelations and re-scheduling that can be used to allocate these appointments to other patients.

Inferring Hillslope Groundwater Recharge Ratios From the Storage‐Discharge Relation

AbstractAccurate observation of hillslope groundwater storage and instantaneous recharge remains difficult due to limited monitoring and the complexity of mountainous landscapes. We introduce a novel storage‐discharge method to estimate hillslope recharge and the recharge ratio—the fraction of precipitation that recharges groundwater. The method, which relies on streamflow data, is corroborated by independent measurements of water storage dynamics inside the Rivendell experimental hillslope at the Eel River Critical Zone Observatory, California, USA. We find that along‐hillslope patterns in bedrock weathering and plant‐driven storage dynamics govern the seasonal evolution of recharge ratios. Thinner weathering profiles and smaller root‐zone storage deficits near‐channel are replenished before larger ridge‐top deficits. Consequently, precipitation progressively activates groundwater from channel to divide, with an attendant increase in recharge ratios throughout the wet season. Our novel approach and process observations offer valuable insights into controls on groundwater recharge, enhancing our understanding of a critical flux in the hydrologic cycle.

Strategies for Engineering Pedagogy to Improve Peer-based & Autonomous-learning through Technical Student Clubs

Abstract— As the pace of technology development and its applications for industry increases, the knowledge gap between academic curriculum and industry-readiness of technical school graduates also increases. Since a professor can only focus on a limited number of topics in a classroom environment, peer learning can significantly increase the knowledge covered. We have identified several shortcomings in the traditional paradigm of teaching methodology and propose in this paper a cyclical autonomous learning-based methodology that aims to overcome these shortcomings. Autonomous learning in the context of our research refers to a situation where learners take charge of their learning and are responsible for all the decision-making for the progression of the skill they want to acquire. The proposed methodology is a feedback-based student-industry led model that reviews and rectifies itself based on the present needs and requirements. This study explores this methodology which identifies the vital points required to develop student-based technical clubs and leveraging industry-based student initiatives to boost autonomous learning, which will help its members prepare for their careers and gain industryrelevant knowledge.Upon implementing the same vital points, we found a statistically significant increase of 800% in the gained industry-relevant knowledge of the club members, characterized by the dramatic increase in scholarships given by industry leaders, achieved by the club members. The study also found that the proposed methodology is also more effective and cogent than the traditional methods in engaging the students, which was clearly evinced by an 88.89% increase in average attendance. We also found a marked increase in overall ratings, from 8.6 to 9.2, using the proposed methodology. The study thus offers promising results in decreasing the knowledge gap, based on which institutions may be exhorted to adopt the proposed methodology for preparing industry-ready graduates. Keywords - Peer Learning, Autonomous Learning, Flipped Classroom, Holistic Education

Survey of knowledge and awareness of breast density amongst Maltese Women undergoing mammography screening

IntroductionThe ratio of breast glandular tissue to fatty tissue is known as breast density. This study assessed the knowledge and awareness of breast density of Maltese women undergoing mammography screening at the National Screening Unit. Increased breast density knowledge may lead to an increase in supplementary imaging attendance. In Europe, there are very limited studies assessing the knowledge and awareness of breast density, providing a solid rationale for this study to be done locally. MethodsWomen aged 50 to 69 who were eligible for breast cancer screening at the National Screening Unit were given a validated closed-ended questionnaire as part of a quantitative, prospective, cross-sectional, and descriptive study. The questionnaire was designed to achieve the aims of the study. Using IBM-SPSS (v28) software, the data was analysed using the Friedman and Kruskal Wallis tests. ResultsA total of 127 surveys were gathered, with a maximum margin of error of 8.66% based on a 95% confidence range. Breast density and the risks associated with it were not well known or understood (average scores ranging from 2.80 to 3.34 out of 5), but supplemental screening was more widely known (3.65). Participants' knowledge and awareness were correlated with their age, profession, and degree of education. Leaflets (40%) and medical experts (40%) were respondents' favourite sources of information. ConclusionThe population under study lacks knowledge and awareness of breast density and the risks it entails. It's important to provide women more details about breast density. With this information, women will be empowered to seek the finest care. Implications for practiceAlthough some socio-demographic parameters were linked to women's knowledge and awareness, it is advised that more research be done using a bigger sample size through interviews and other studies. Moreover, more information regarding breast density must be provided to women undergoing breast cancer screening in Malta to increase their knowledge and awareness.

Trends and factors associated with adolescent pregnancies in Tanzania from 2004-2016: Evidence from Tanzania Demographic and Health Surveys.

Adolescent pregnancy increases the risk of maternal and child morbidity and mortality. We aimed to determine trends and factors associated with adolescent pregnancy in Tanzania from 2004 to 2016 using the Tanzania Demographic and Health surveys (TDHS). We carried out an analytical cross-sectional study using the TDHS data for the years 2004 to 2005, 2010 and 2015 to 2016 among adolescent girls aged 15 to 19 years. Data analysis was performed using STATA version 15. Data analysis considered the complex survey design inherent in the demographic and health survey (DHS) data. The Poisson regression model was used to estimate Prevalence Ratios (PR) and 95% confidence intervals for factors associated with adolescent pregnancy. We analysed data for a total of 10,972 adolescents for the three TDHS rounds. The proportion of adolescent pregnancy significantly decreased from 26% to 22.8% from the year 2004/05 to 2010 and then increased again to 26.7% in 2015/16. Adolescents who were aged 18 to 19 years (APR 1.52; 95% CI, 1.38 to 1.68) married or cohabiting with their partners (APR 2.15; 95% CI, 1.93 to 2.40; P<.001), widowed/divorced/separated (APR 2.32; 95% CI, 2.03 to 2.66; P<.001), and among those who started sexual activity before 15 years of age (APR 1.20; 95% CI, 1.11 to 1.31; P<.001) were more likely to become pregnant during adolescence. In contrast, adolescents with secondary school education level and above were the least likely to become pregnant (APR 0.62; 95% CI, 0.51 to 0.75; P<.001) compared to those with no formal education. One in four adolescent girls aged 15 to 19 in Tanzania have already started childbearing and despite fluctuation, high rate of adolescent pregnancy persists. Preventive interventions should focus on adolescents with low education level, married/cohabiting with their partners, and who have started sex before 15 years of age. We advocate for the increase of school attendance until high school level to reduce the risk of early pregnancy in adolescents. Furthermore, qualitative studies are crucial to explore reasons for the rising trend of adolescent pregnancy in most zones of Tanzania, particularly between 2010 and 2015/16.

Preheating Influence on the Precipitation Microstructure, Mechanical and Corrosive Properties of Additively Built Al-Cu-Li Alloy Contrasted with Conventional (T83) Alloy.

In this paper, the high strength and lightweight Al-Cu-Li alloy (AA2099) is considered in as-built and preheated conditions (440 °C, 460 °C, 480 °C, 500 °C, and 520 °C). The purpose of this study is to investigate the influence of laser powder bed fusion (LPBF) in situ preheating on precipitation microstructure, mechanical and corrosive properties of LPBF-printed AA2099 alloy compared to the conventionally processed and heat-treated (T83) alloy. It is shown that precipitations evolve with increasing preheating temperatures from predominantly globular Cu-rich phases at lower temperatures (as-built, 440 °C) to more plate and rod-like precipitates (460 °C, 480 °C, 500 °C and 520 °C). Attendant increase with increasing preheating temperatures are the amount of low melting Cu-rich phases and precipitation-free zones (PFZ). Hardness of preheated LPBF samples peaks at 480 °C (93.6 HV0.1), and declines afterwards, although inferior to the T83 alloy (168.6 HV0.1). Preheated sample (500 °C) shows superior elongation (14.1%) compared to the T83 (11.3%) but falls short in tensile and yield strength properties. Potentiodynamic polarization results also show that increasing preheating temperature increases the corrosion current density (Icorr) and corrosion rate. Indicated by the lower oxide resistance (Rox), the Cu-rich phases compromise the integrity of the oxide layer.

How informal mentoring by teachers, counselors, and coaches supports students' long-run academic success

We document a largely unrecognized pathway through which schools promote human capital development – by fostering informal mentoring relationships between students and their teachers, counselors, and coaches. Using longitudinal data from a nationally representative sample of adolescents, we explore the nature and consequences of natural mentoring relationships by leveraging within-student variation in the timing of mentorship formation as well as differences in exposure among pairs of twins, best friends, and romantic partners. Results across difference-in-differences and pair fixed-effect specifications show consistent and meaningful positive effects on student attainment, with a conservative estimate of a 9.4 percentage point increase in college attendance. Effects are largest for students of lower socioeconomic status and robust to controls for individual characteristics and bounding exercises for selection on unobservables. Smaller class sizes and a school culture where students have a strong sense of belonging are important school-level predictors of having a K-12 natural mentor.