Initiation Of Program Research Articles

Multisectoral approaches for sustainable food and nutrition security actions in Ethiopia

Ethiopia has demonstrated a commitment to tackling the high burden of Food and Nutrition Security (FNS) challenges by developing and implementing various policies, strategies, and programs. Despite the efforts, the current FNS situation is of significant public health concern observed by various nutrition indices. The narrative review aimed to appraise multisectoral policy, strategic and programmatic initiatives aimed at addressing FNS challenges and identify entry points for enhancing coherent and integrated FNS approaches. The review involved broad literature research using Preferred Reporting Items for Systematic Reviews and Meta Analyses (PRISMA) guidelines. A total of 1,086 articles and grey literature were identified. Out of this, 47 full-text articles and documents met the selection criteria and were included in this review. Evidence was synthesized in themes to characterize the successes and challenges of key FNS policies, strategies, and programs and identify potential areas of improvement to enhance multisectoral actions and address FNS challenges. Overall, Ethiopia has made considerable progress in enhancing FNS through the implementation of a range of FNS policies, strategies, and programs such as the National Nutrition Program (NNP), Productive Safety Net Program (PSNP), and Agricultural Growth Program (AGP) among others. These efforts have resulted in notable achievements, such as the reduction of the prevalence of undernourishment from 47.0% in 2000 to 24.9% in 2020 and the reduction of stunting among children under five years from 57.4% to 35.2% over the same period. Nonetheless, the pace of progress has been hindered by various contextual and programmatic challenges such as climatic shocks, poverty, high inflation, political instability, limited access to production resources, inadequate coverage of FNS interventions, inadequate financing, and inadequate multisectoral coherence and integration. A comprehensive and integrated multisectoral FNS approach focusing on enhancing commitment, planning, coordination, financing, capacity building, and accountability across sectors and levels is imperative. Strengthening coherence across various sectors, alongside the operationalization of robust multisectoral monitoring and evaluation systems highlighted in the National Food and Nutrition Strategy, constitutes the most suitable entry points for ensuring sustainable advancement in mitigating the prevailing FNS challenges in Ethiopia. Key words: Food and nutrition security, policy and program, multisectoral approaches, Integration, Ethiopia

#2014 Exercise safety and efficacy as a rehabilitation therapy for patients on hemodiafiltration: a 6-month controlled study

Abstract Background and Aims Individuals with chronic kidney disease (CKD) stage 5D face challenges due to the accumulation of uremic toxins. Hemodiafiltration (HDF) stands out for its efficacy in removing solutes of various molecular weights, offering mortality benefits. Although exercise rehabilitation is established as a beneficial adjunct therapy for patients on maintenance hemodialysis, its impact on maintenance HDF programs remains understudied. The primary aim was to evaluate the safety and efficacy of exercise as rehabilitation in patients undergoing HDF. The secondary aim was to compare the outcomes between intra- and inter-HDF exercise sessions. Method This study enrolled CKD 5D patients at Fenix Nephrology Group from 2021 to 2023. The assessment occurred at the initiation of the exercise program and after six months of exercise rehabilitation. Physical tests included the step-test, handgrip, and one-repetition maximum (1RM), and the Kidney Disease Quality of Life Short Form (KDQOL-SF), a patient-reported outcome measure. The urea reduction ratio (URR) reflected HDF adequacy. Patients engaged in twice-weekly aerobic exercises achieving 70% of maximum heart rate and resistance exercises (60% 1RM). Results Data from 234 patients were obtained, and 81 were not on the exercise program. From the remaining 153 patients, we excluded 64. Twelve patients were excluded because underwent kidney transplantation during their participation, 41 had incomplete data, and 11 patients carried out less than 80% of the scheduled exercise sessions. We included in our final analysis data from 89 patients (55 ± 15 years; 58.4% male). The mean dialysis vintage was 9 ± 7 years, including high-flux hemodialysis and HDF. Specifically, for HDF, the mean dialysis vintage was 5 ± 4 years. Mean exercise session adherence was 94 ± 4%, and the mean number of sessions was 39 ± 4. Concerning the performance outcomes, we observed significant improvements in the step-test (80 ± 22 to 93 ± 25 steps; p < 0.001) and handgrip measurement (28 ± 7 to 30 ± 7 kgf; p < 0.001), alongside an approximate 4% increase in lean body mass (13 ± 2 to 14 ± 2 kg; p < 0.001) during the 6 months. The KDQOL-SF improved in physical functioning (64 ± 22 to 72 ± 23; p < 0.001), general health (55 ± 23 to 61 ± 2; p = 0.01), social function (73 ± 26 to 80 ± 21; p = 0.004), physical (43 ± 9 to 47 ± 8; p < 0.001) and mental composite scores (46 ± 10 to 48 ± 9; p = 0.04), along with a reduction in fatigue (57 ± 17 to 60 ± 17; p = 0.03). A similar favorable trend was observed for the URR (68 ± 10% vs. 71 ± 8%; p < 0.05). We also analyzed the exercise rehabilitation program in two different groups. Thirty-five patients carried out intradialytic exercise (i.e., during the dialysis session). In this group, the mean dialysis vintage was 10 ± 7 years and specifically 5 ± 3 years on HDF. The other group included 54 patients performing interdialytic exercise (i.e., pre- or post-session). In this group, the mean dialysis vintage was 8 ± 6 years and specifically 4 ± 2 years on HDF. We did not observe complications during the exercise program, and no sessions were interrupted due to adverse events. Demographic and anthropometric data (age, sex, weight, and body mass index) were comparable between the groups. Furthermore, exercise performance was equivalent in both groups. Conclusion Our findings suggest that a supervised exercise program for maintenance dialysis patients performing HDF is safe and efficacious, yielding substantial improvements in patient-reported and performance outcomes. Notably, the positive effects of exercise persisted whether conducted during intradialytic or interdialytic periods.

Development of an enhanced recovery after surgery program for pediatric solid tumors.

Enhanced recovery after surgery (ERAS) is an evidence-based, multi-modal approach to decrease surgical stress, expedite recovery, and improve postoperative outcomes. ERAS is increasingly being utilized in pediatric surgery. Its applicability to pediatric patients undergoing abdominal tumor resections remains unknown. A group of key stakeholders adopted ERAS principles and developed a protocol suitable for the variable complexity of pediatric abdominal solid tumor resections. A multi-center, prospective, propensity-matched case control study was then developed to evaluate the feasibility of the protocol. A pilot-phase was utilized prior to enrollment of all patients older than one month of age undergoing any abdominal, retroperitoneal, or pelvic tumor resections. The primary outcome was 90-day complications per patient. Additional secondary outcomes included: ERAS protocol adherence, length of stay, time to administration of adjuvant chemotherapy, readmissions, reoperations, emergency room visits, pain scores, opioid usage, and differences in Quality of Recovery 9 scores. Institutional review board approval was obtained at all participating centers. Informed consent was obtained from each participating patient. The results of this study will be presented at pertinent society meetings and published in peer-reviewed journals. We expect the results will inform peri-operative care for pediatric surgical oncology patients and provide guidance on initiation of ERAS programs. We anticipate this study will take four years to meet accrual targets and complete follow-up. NCT04344899.

CAUSES AND EFFECTS OF POLITICAL THUGGERY ON THE SOCIO-ECONOMIC AND POLITICAL DEVELOPMENT OF OFU LOCAL GOVERNMENT AREA OF KOGI STATE, NIGERIA

Thuggery is a destructive force that erodes the fabric of society and breeds fear and distrust. It fosters a disregard for the rule of law and the principles of justice even as it erodes the values of empathy, compassion and respect for others, leading to a breakdown of social order. Societies afflicted by thuggery suffer from increased crime rates, reduced quality of life and a general sense of unrest and anarchy. Thuggery, especially its political variant, is a form of social violence which poses immense challenge to the security of lives and property of Nigerians and undermines the socio-economic and political development of the nation. This study interrogated the causes and effects of political thuggery on the socio-economic and political development of Ofu Local Government Area, Kogi State, Nigeria. Data for the study were collected from 384 respondents who were selected using the purposive and systematic random sampling techniques. Questionnaire, In-depth Interview (IDI) and Focus Group Discussion (FGD) were used to elicit data from respondents while the resultant quantitative data were analysed using the Statistical Package for Social Sciences (SPSS) Version 22.0. The Frustration Aggression Theory was adopted to provide theoretical pathway for the study. Findings from the study attributed political thuggery in Ofu Local Government Area Kogi State Nigeria, to a plethora of factors, among which are: unemployment, frustration, and bad governance. The study recommends the initiation of aggressive skill acquisition and job creation programmes by the Kogi State Government to effectively engage the army of unemployed youth in the study area to divert them from political thuggery while law enforcement should be strengthened to prosecute state and non-state actors found to be the sponsors of thugs whom they deploy to snatch ballot papers and engage in mayhem before, during and after elections in the study area, to serve as deterrent to others.

Developing evaluation measures for health departments sharing and linking HIV and STI surveillance data

Enhancing data sharing, quality, and use across siloed HIV and STI programs is critical for national and global initiatives to reduce new HIV infections and improve the health of people with HIV. As part of the Enhancing Linkage of STI and HIV Surveillance Data in the Ryan White HIV/AIDS Program initiative, four health departments (HDs) in the U.S. received technical assistance to better share and link their HIV and STI surveillance data. The process used to develop evaluation measures assessing implementation and outcomes of linking HIV and STI data systems involved six steps: 1) measure selection and development, 2) review and refinement, 3) testing, 4) implementation and data collection, 5) data quality review and feedback, and 6) dissemination. Findings from pilot testing warranted slight adaptations, including starting with a core set of measures and progressively scaling up. Early findings showed improvements in data quality over time. Lessons learned included identifying and engaging key stakeholders early; developing resources to assist HDs; and considering measure development as iterative processes requiring periodic review and reassessment to ensure continued utility. These findings can guide programs and evaluations, especially those linking data across multiple systems, in developing measures to track implementation and outcomes over time.

The Role of Human Resource Management in Conducting CSR at an IT Company in Indonesia

This study delves into the role of Human Resource (HR) department in corporate social responsibility (CSR) initiatives at PT Sigma Cipta Caraka (hereinafter: Telkomsigma). Through a qualitative analysis, the current practices of human resources concerning the corporate social responsibility programs at the company were scrutinized. The results indicate that the management of these programs predominantly falls under the purview of the Corporate Communications department, with minimal engagement from HR department. To enhance the efficacy of the program initiatives and cultivate a more cohesive approach to CSR within the organization, fostering collaboration between HR and Corporate Communications is imperative. By bridging these departments and aligning their efforts, Telkomsigma can optimize the impact of its CSR endeavors and reinforce its commitment to sustainable and socially responsible practices. This study underscores the significance of interdepartmental cooperation in driving meaningful the CSR outcomes and advancing the company's overarching goals of community engagement and environmental stewardship

Modern Illegal Drug Business in Ukraine: Multidisciplinary Study of the System of Prevention and Countermeasures Against the Legalization of Income (Money Laundering) Obtained by Criminal Means

Established that the modern illegal drug trade is an integral part of transnational organized crime, involving the laundering of proceeds obtained through criminal activities. A comprehensive multidisciplinary study was conducted to evaluate the effectiveness of Ukraine's efforts to combat the contemporary drug trade and to analyze the international system for preventing and countering the legalization of illicit income (money laundering). This study confirmed the connection between transnational organized crime and the laundering of money derived from the illegal trafficking of banned psychoactive substances. The research emphasized the critical need to enhance the criminal and legal frameworks, improve medical and pharmaceutical support, and expand social and economic assistance. By examining the global experience in combating organized crime and drug-related offenses, the study provided valuable insights into effective strategies. Particular attention was given to forensic pharmaceutical practices related to the detection of prohibited psychoactive substances and the legalization of income from their illicit trade. To address these challenges, the study recommends increasing the criminal liability for members of organized drug trafficking gangs and suggests specific amendments to articles 115, 305, and 307 of the Ukrainian Criminal Code. Furthermore, a detailed analysis of the European Union’s roadmap and international cooperation efforts in combating the illegal circulation of prohibited psychoactive substances and the laundering of illegal profits was conducted. Normative initiatives aimed at amending Article 209 of the Ukrainian Criminal Code were developed and proposed. The study indicated the importance of implementing the EU Roadmap measures in Ukraine to foster cooperation among various private and public institutions. This collaborative approach aims to coordinate joint actions, conduct research, and organize conferences and training sessions based on the EMCDDA European prevention program and UN initiatives. The study underscores the relevance, timeliness, and practical significance of engaging the international community, including scientists, medical professionals, pharmacists, students, the public, legal experts, law enforcement, and government authorities. Through this multidisciplinary approach, the study seeks to promote a more effective and coordinated response to the challenges posed by the modern drug trade and its associated criminal activities.

Assessment of the impact of COVID-19 and political instability on mental health of university students in Sudan.

The mental health of students plays a crucial role in their learning and performance. The COVID-19 pandemic, the political turmoil and a coup in Sudan has exacerbated stress and anxiety among university students in Sudan due to uncertainty about their academic activities. To assess post-traumatic stress disorder (PTSD) occurrence and coping strategies adopted by university students in Sudan. This cross-sectional survey was conducted from March to June 2022. It used the Coping Orientation to Problems Experienced (Brief-COPE) and Impact of Event Scale-Revised (IES-R) questionnaires to assess the occurrence of PTSD and coping strategies among 596 university students in Sudan. Descriptive statistics were used to determine the frequency and percentage, Student's t test was used to compare the means of 2 groups and one-way analysis of variance to compare the means of ≥ 3 groups. There was a high prevalence of PTSD among the students, with a score of 31.2 (SD 16.4). The total score of PTSD was higher among female students. Around 36% of the students had a PTSD score > 37, which is considered high enough to suppress immune function. The most widely adopted coping strategies were religion and acceptance of the situation, while substance use was the least. Students who had COVID-19 infection during the pandemic differed significantly from uninfected students in the application of coping strategies. In contrast, students whose family members or friends had COVID-19 were not significantly different from students with uninfected family members or friends in the application of the coping strategies, such as self-blame, denial, substance use, and behavioural disengagement. We recommend the initiation and implementation of psychological counselling programmes for university students in Sudan onsite or remotely. Further research should be carried out to assess the long-term effects of the pandemic and the political conflicts so as to design and implement appropriate and efficient interventions.

Knowledge, perception, attitude, and practice of complementary and alternative medicine by health care workers in Garki hospital Abuja, Nigeria

BackgroundHealthcare workers are currently making efforts to offer services that cater to the holistic care needs of their patients. Previous studies have shown that some healthcare workers encounter challenges when advising patients about Complementary and Alternative Medicine (CAM), even though its use is widespread. Many health care workers may not have received formal education or training in CAM and consequently are unable to address their patients’ questions about it. This study explored the knowledge, perception, attitude and practice of CAM by healthcare workers in Garki Hospital, Abuja, Nigeria.MethodsThis was an institution-based cross-sectional study, design and a convergent parallel, mixed methods design was used for data collection. Five (5) healthcare workers were purposively selected as participants for the key informant interviews, while two hundred and fifty (250) selected using a simple random sampling method completed the questionnaire. The data collection instruments used were a key informant interview guide and a 35-item self-administered questionnaire. Knowledge was assessed with a 4-item scale with a maximum score of 8. Perceptions and attitudes were assessed using Likert scales with a maximum score of 45 and 20, respectively. Practice was assessed with a 6-item scale with a maximum score of 18. Qualitative data was analysed using framework analysis. Quantitative data was analysed using descriptive and inferential statistics. Data acquired from both methods were integrated to form the findings.ResultsThe average age of respondents for the quantitative study was 34.0 ± 7.8 years, and they were predominantly females (61.2%) with one to ten years of work experience (68.8%). The mean knowledge, perception and attitude scores were 1.94 ± 1.39, 13.08 ± 2.34 and 32.68 ± 6.28, respectively. Multiple linear regression result showed that knowledge (t = 2.025, p = 0.044) and attitude (t = 5.961, p = 0.000) had statistically significant effects on the practice of CAM. Qualitative data revealed that the majority of the participants perceive CAM favourably, provided it is properly introduced into mainstream medicine with evidence of safety and research to prove its efficacy.ConclusionThe study has shown the gaps in knowledge and the practices of CAM by conventional medical practitioners. This has implications for their ability to counsel and refer patients who may require CAM therapies. Policy, research and programmatic initiatives that seek to enhance their knowledge of CAM, and improve collaboration with CAM practitioners are recommended.

Teaching self-criticism and peer-critique skills to engineering students through a temporal survey-based program

IntroductionEngineering students should develop critical-thinking skills and insist on appropriate performance levels both from themselves and from their colleagues during their training. In doing so, they will adopt critical attitudes toward their own and others’ work. This will help them to successfully perform their future professional work with the highest standards.MethodsIn this research, peer- and self-assessments of in-class presentations through a survey-based program were used to analyze the development of critical-thinking skills among engineering students. The program included two key features: firstly, formative assessments were repeatedly conducted over time; secondly, teachers’ ratings were provided to students as comparative benchmarks. This approach encouraged students to reflect on their ratings over time using the reference of the teacher.ResultsFrom a general perspective, the analysis of survey responses showed that students assigned lower ratings in assessments conducted at a later stage, despite receiving higher ratings from their teachers over time. Therefore, students became more demanding throughout the experience in spite of the increased quality of their work according to the teachers’ assessments. Moreover, students tended to closely attune their evaluations to their teachers’ ratings. Comparing peer- and self-assessments, it was noted that students were more demanding toward the work of their peers in the long term, and especially their ability to explain concepts, than they were toward their own work. Nevertheless, high temporary increases were observed in students’ own self-assessments of presentation-file quality. Finally, students did not conduct overall assessments with the same level of demand as their teachers at any time during the experience.DiscussionThe results demonstrate that this program and similar initiatives are useful to help engineering students to develop critical-thinking skills and to broaden their expectations with respect to their own and their colleagues’ work. However, other relevant aspects could be evaluated in lengthier programs, such as whether the students’ levels of critical thinking and expectations are maintained when the comparative reference of a teacher’s assessment is unavailable.

Can Robotic Arm-assisted Total Knee Arthroplasty Remain Cost-effective in Volume-based Procurement System in China? A Markov Model-based Study.

The volume based procurement (VBP) program in China was initiated in 2022. The cost-effectiveness of robotic arm assisted total knee arthroplasty is yet uncertain after the initiation of the program. The objective of the study was to investigate the cost-effectiveness of robotic arm-assisted total knee arthroplasty and the influence of the VBP program to its cost-effectiveness in China. The study was a Markov model-based cost-effectiveness study. Cases of primary total knee arthroplasty from January 2019 to December 2021 were included retrospectively. A Markov model was developed to simulate patients with advanced knee osteoarthritis. Manual and robotic arm-assisted total knee arthroplasties were compared for cost-effectiveness before and after the engagement of the VBP program in China. Probability and sensitivity analysis were conducted. Robotic arm-assisted total knee arthroplasty showed better recovery and lower revision rates before and after initiation of the VBP program. Robotic arm-based TKA was superior to manual total knee arthroplasty, with an increased effectiveness of 0.26 (16.87 vs 16.61) before and 0.52 (16.96 vs 16.43) after the application of Volume-based procurement, respectively. The procedure is more cost-effective in the new procurement system (17.13 vs 16.89). Costs of manual or robotic arm-assisted TKA were the most sensitive parameters in our model. Based on previous and current medical charging systems in China, robotic arm-assisted total knee arthroplasty is a more cost-effective procedure compared to traditional manual total knee arthroplasty. As the volume-based procurement VBP program shows, the procedure can be more cost-effective.

Assessing Patient Experiences With Patient-Centered and Inclusive Care in Academic Obstetrics and Gynecology Outpatient Clinics [ID 2683581

INTRODUCTION: Ensuring patient satisfaction remains an important objective for obstetrics and gynecology care. To address a research gap in this field, we aimed to assess patient satisfaction with culturally competent and respectful care in our obstetrics and gynecology clinics after initiation of diversity, equity, and inclusion programming. METHODS: From September 2021 to February 2022, we surveyed outpatient ob-gyn visitors about their experiences, using a 21-item survey that assessed cultural competency, treatment discussions, clinic accommodations, and comfort during sensitive exams, using a Likert scale. Participants also self-reported demographic information. RESULTS: Out of 246 returned surveys, participants generally reported positive interactions with clinic staff and health care providers, feeling heard (91%), respected (95%), and having their cultural/spiritual beliefs considered in treatment (95%). Most felt respected and comfortable during sensitive exams (96%) and were satisfied with treatment discussions (84%). However, those with a high-school education (79%) were less likely than college or graduate degree holders (93%) to feel administrative staff listened to them and their families (P<.05). Experiences with culturally competent care varied by race/ethnicity. Black/African American participants were less likely to feel staff understood their cultural experiences (55% versus 67–88%; P<.05) and that they recognized differences within their racial/ethnic group (50% versus 82–88%; P<.01). Black/African American individuals reported the highest incidence of race-based unfair treatment (20% versus 0–2%; P<.01). CONCLUSION: Lower satisfaction among Black/African American participants indicates care can be improved. Enhanced education for clinical teams can foster respectful, inclusive, and culturally competent care. Future qualitative research can offer further insights into inclusive practices in obstetrics and gynecology care.

Bridging vision gaps: a comprehensive study of the RAAHI programme for improving truckers' eye health in India

Bridging vision gaps: a comprehensive study of the RAAHI programme for improving truckers' eye health in India

What do Street Children Need in the Shelter Home: A Narrative Review Study?

Issues with street children, particularly in developing countries, seem to be alarming. Many countries reported increasing numbers. The aim of this research is to explore the experience support of street children in the shelter home, the question on how the experience of these street children when they are being placed in the shelter homes, and what the type of support is given to them? A comprehensive search of relevant databases from 2010 to August 2021 with critical key search focuses on the “street children's welfare" or "type support" and "experiences street children in various countries." Furthermore, the investigation of relevant databases yielded 313 hits, finally, 12 papers are suitable for the review with utilized the PRISMA review method in the process. This review has results support for street children, including theme; physiological support, phycological support, social support, and health care support. To conclude, street children have specific support needs; future program initiatives need to be developed that respond to street children's needs.

Multimodal approach utilising a weight management programme prior to bariatric surgery in patients with BMI ≥50 kg/m2: A propensity score matching retrospective cohort study.

We evaluated preoperative weight loss and days from initial consult to surgery in patients with BMI ≥50 kg/m2 who were and were not enrolled in medical weight management (MWM) prior to laparoscopic sleeve gastrectomy. We retrospectively identified patients with BMI ≥50 kg/m2 who had primary sleeve gastrectomy between 2014 and 2019 at two bariatric surgery centres in our healthcare system. Patients presenting after 2017 that received preoperative MWM (n = 28) were compared to a historical cohort of non-MWM patients (n = 118) presenting prior to programme initiation in 2017 on preoperative percent total body weight loss (%TBWL) and days from initial consult to surgery. A total of 151 patients (MWM, 33; non-MWM, 118) met inclusion criteria. BMI was significantly greater in MWM versus non-MWM (p = .018). After propensity score matching, median BMI at initial consult in non-MWM versus MWM no longer differed (p = .922) neither were differences observed on the basis of weight, age, sex, race or ethnicity. After PSM, MWM had significantly lower BMI at surgery (p = .018), lost significantly more weight from consult to surgery (p < .001) and achieved significantly greater median %TBWL from consult to surgery (p < .001). We noted no difference between groups on 6-month weight loss (p = .533). Days from initial consult to surgery did not differ between groups (p < .863). A preoperative MWM programme integrated into multimodal treatment for obesity in patients with a BMI ≥50 kg/m2 resulted in clinically significant weight loss without prolonging time to surgery.

Best Practices for Point of Care Ultrasound: An Interdisciplinary Expert Consensus.

Despite the growing use of point of care ultrasound (POCUS) in contemporary medical practice and the existence of clinical guidelines addressing its specific applications, there remains a lack of standardization and agreement on optimal practices for several areas of POCUS use. The Society of Point of Care Ultrasound (SPOCUS) formed a working group in 2022 to establish a set of recommended best practices for POCUS, applicable to clinicians regardless of their training, specialty, resource setting, or scope of practice. Using a three-round modified Delphi process, a multi-disciplinary panel of 22 POCUS experts based in the United States reached consensus on 57 statements in domains including: (1) The definition and clinical role of POCUS; (2) Training pathways; (3) Credentialing; (4) Cleaning and maintenance of POCUS devices; (5) Consent and education; (6) Security, storage, and sharing of POCUS studies; (7) Uploading, archiving, and reviewing POCUS studies; and (8) Documenting POCUS studies. The consensus statements are provided here. While not intended to establish a standard of care or supersede more targeted guidelines, this document may serve as a useful baseline to guide clinicians, leaders, and systems considering initiation or enhancement of POCUS programs.

Effect of an additional gonadotropin-releasing hormone 2 days after the initiation of a resynchronization program 25 days after artificial insemination on fertility of lactating dairy cows

We investigated the effect of an additional GnRH 2 d after initiation of resynchronization on d 25 post-AI on the proportion of cows without a corpus luteum (CL) at nonpregnancy diagnosis (NPD) and pregnancy per AI (P/AI) of cows with a CL at NPD that were reinseminated. Once per week, cows that were inseminated 25 d earlier were randomly assigned to receive either a GnRH treatment only (G25) or GnRH on this day and 2 d later (G25&27). Pregnancy diagnosis and CL presence were determined d 32 post-AI using ultrasonography. Nonpregnant cows with a CL were enrolled in different strategies for resynchronization of ovulation according to parity (primiparous or multiparous) and CL size. Primiparous and multiparous cows with a CL ≥20 mm in diameter continued Resynch-25 (PGF2α on d 32; PGF2α on d 33; GnRH on d 34; and AI on d 35). Multiparous cows with CL <20 mm restarted a modified Ovsynch at NPD (GnRH – 7 d – PGF2α – 1 d – PGF2α – 1 d – GnRH – 1 d – AI). Primiparous cows with CL diameter <20 mm started an Ovsynch+CIDR protocol on the day of NPD (GnRH + CIDR inserted – 7 d – PGF2α + CIDR removed – 1 d – PGF2α – 1 d – GnRH – 1 d – AI). Cows without a CL were not enrolled in any resynchronization program for a week and were excluded from fertility analyses. In multiparous cows only, the additional d 27 GnRH treatment was associated with a decreased P/AI 32 d and 102 d post-AI for the AI before treatment. The overall proportion of nonpregnant cows without CL did not differ between treatments. Yet, the GnRH treatment 27 d after AI tended to increase the proportion of overall nonpregnant cows with CL <20 mm at NPD. Treatment did not affect fertility parameters of primiparous cows with a CL ≥20 mm that continued Resynch-25 at NPD. Primiparous cows in G25&27 with CL <20 mm and submitted to Ovsynch+CIDR at NPD tended to have decreased P/AI 102 d after AI and calving/AI. When fertility parameters of primiparous cows with a CL independent of size at NPD were analyzed combined, no effect of treatment was observed. Treatment did not affect fertility of multiparous cows with CL <20 mm enrolled in Ovsynch at NPD. Multiparous cows in the G25&27 group that had a CL ≥20 mm and continued Resynch-25 at NPD tended to have a greater calving/AI due to a decreased total pregnancy loss. In summary, no treatment effect was observed on the overall fertility of primiparous cows with CL at NPD. In multiparous cows, G25&27 was associated with a decreased fertility of the previous AI, but it tended to increase calving/AI for multiparous cows with CL at NPD by decreasing the total pregnancy loss for the AI after treatment.

Initiating a Fetal Cardiac Program from Scratch in Low- and Middle-Income Countries: Structure, Challenges, and Hopes for Solutions.

Although fetal cardiac programs are well established in developed countries, establishing an efficient program in low- and middle-income countries (LMICs) is still considered a significant challenge. Substantial obstacles usually face the initiation of fetal cardiac service from scratch in LMICs. The primary structural frame of a successful fetal cardiac program is described in detail, emphasizing the required team members. The potential challenges for starting fetal cardiac services in LMICs include financial, awareness-related, prenatal obstetric screening, sociocultural, psychosocial, and social support factors. These challenges could be solved by addressing these barriers, such as collecting funds for financial support, raising awareness among families and health care providers, telemedicine, building international health partnerships, modifying training protocols for fetal cardiologists and sonographers, and initiating support groups and social services for families with confirmed fetal cardiac disease. Initiating a successful fetal cardiac program requires multi-aspect structural planning. The challenges for program initiation require diverse efforts, from modified training and promoting awareness of care providers and the community to governmental and nonprofit organizations' collaborations for proper building and utilization of program resources.

Recent development and fighting strategies for lincosamide antibiotic resistance.

SUMMARYLincosamides constitute an important class of antibiotics used against a wide range of pathogens, including methicillin-resistant Staphylococcus aureus. However, due to the misuse of lincosamide and co-selection pressure, the resistance to lincosamide has become a serious concern. It is urgently needed to carefully understand the phenomenon and mechanism of lincosamide resistance to effectively prevent and control lincosamide resistance. To date, six mobile lincosamide resistance classes, including lnu, cfr, erm, vga, lsa, and sal, have been identified. These lincosamide resistance genes are frequently found on mobile genetic elements (MGEs), such as plasmids, transposons, integrative and conjugative elements, genomic islands, and prophages. Additionally, MGEs harbor the genes that confer resistance not only to antimicrobial agents of other classes but also to metals and biocides. The ultimate purpose of discovering and summarizing bacterial resistance is to prevent, control, and combat resistance effectively. This review highlights four promising strategies, including chemical modification of antibiotics, the development of antimicrobial peptides, the initiation of bacterial self-destruct program, and antimicrobial stewardship, to fight against resistance and safeguard global health.

Residency Program Website Content May Not Meet Applicant Needs

Background: Residency program applicants use a variety of resources during the application cycle. Program websites can vary substantially, and it is unclear how the website information is used by applicants. We aimed to determine the most popular information source used by applicants. We also sought to identify specific online content that was deemed important in the decision-making process. Methods: A survey was distributed to fourth-year medical students at an academic institution. Demographic information was collected, and the importance of various online resources was gauged using a Likert scale. Subgroup analysis was performed for procedural versus non-procedural specialty applicants. Results: 91 of the 169 fourth-year medical students (54%) completed the survey. The most utilized sources for the students were residency program websites (41%), the Fellowship and Residency Electronic Interactive Database (FREIDA) website (36%), and the Doximity website (14%). The most valued (Likert scale of 4 and 5) website content for the students included information on resident wellness (86%), resident fellowship acquisition (85%), faculty data (84%), residency location and resident lifestyle (81%), and application point of contact (79%). There were significant differences between what procedural specialty applicants deemed important versus what those applying to non-procedural specialties deemed important. Conclusion: Residency program websites are commonly used among applicants during the residency match process. Content on resident wellness was highly valued irrespective of specialty choice; however, this information was often not present on residency websites. These findings may help guide website content development initiatives for residency programs to reflect applicant needs more adequately.