June October Research Articles

Effectiveness of Positive Deviance, an Asset-Based Behavior Change Approach, to Improve Knowledge, Attitudes, and Practices Regarding Dengue in Low-Income Communities (Slums) of Islamabad, Pakistan: A Mixed-Method Study.

Simple SummaryDengue is a mosquito-borne infection caused by the Aedes mosquito, expanding at an alarming pace around the world. Recently, Pakistan has witnessed some major dengue outbreaks, affecting thousands of individuals across the country. As there is no specific cure or vaccine, prevention and vector control remain the key methods to avoid dengue infection. In Pakistan, dengue control activities are mainly focused on information-sharing through mass media and communication materials such as pamphlets and posters. The main challenge is a lack of community participation that can create an enabling environment for communities to follow the desired behaviors. There is a strong need to design and implement community-led behavior change approaches to ensure community participation and translate the knowledge into practices. This study was conducted to better understand the effectiveness of a community engagement approach, ‘positive deviance’, on dengue prevention and control. The study was carried out in two slums affected by the recent dengue outbreak in Islamabad, Pakistan. A total of 112 persons participated in the study, which was conducted from June–October 2020. The community discovered already-existing positive behaviors surrounding dengue prevention and control, which were shared with other participants through interactive activities. The study demonstrated positive changes in knowledge, attitudes, and practices, and could be a potential tool for dengue prevention and control programs worldwide.Dengue is a mosquito-borne, viral disease that has emerged as a global health concern in recent years. In the absence of specific antiviral treatment and vaccines, prevention remains the key strategy for dengue control. Therefore, innovative and community-driven approaches are required to improve the vector control practices. This study applied and evaluated the positive deviance (PD) approach on dengue prevention and control in selected slums of Islamabad during June–October 2020. The two most dengue-affected slums, the Faisal colony and France colony, were purposively selected as intervention and control groups, respectively. A total of 112 participants (56 for the intervention and 56 for the control group) participated in the study. The intervention group was exposed for two months to locally identified role model behaviors through weekly interactive sessions, dengue sketch competitions, and role plays. Another two months enabled the community to practice these behaviors without any external support in order to explore the intervention’s sustainability. Three surveys were conducted: before the intervention, after two months, and after four months, to assess any changes in the knowledge, attitudes, and practices of participating communities. Results found that the PD intervention had a significant positive impact on dengue knowledge, attitudes, and practices in the intervention group. PD could offer an empowering and efficient community engagement tool for future dengue prevention and control, both in Pakistan and more globally.

Seasonal and daily activity of non-native sambar deer in and around high-elevation peatlands, south-eastern Australia

Context Of the six species of non-native deer present in Australia, the sambar deer is the largest and has been identified as a major threat to high-elevation peatlands in south-eastern Australia. However, little is known about sambar deer activity in high-elevation peatlands. Aims The aims of this study were to quantify sambar deer activity (including wallowing) seasonally and daily in response to biotic and abiotic variables, and how activity was impacted by ground-based shooting. Methods To estimate sambar deer activity, camera traps were continuously deployed for 4 years in two ~4300-ha areas in Alpine National Park, Victoria, south-eastern Australia. One area was subject to management operations using ground-based shooting to target deer and the other was not. Monthly activity of sambar deer was modelled using biotic (woody vegetation cover), abiotic (snow depth, aspect, slope, distance to water, road and peatland) and management (treatment versus non-treatment) covariates. Additional camera traps were deployed to monitor sambar deer activity at wallows. Key results Sambar deer activity decreased when snow depth increased (between July and September), and was highest in easterly and northerly aspects with dense woody vegetation close to high-elevation peatlands and roads. During our 4-year study, sambar deer activity decreased in the treatment area but increased in the non-treatment area. Sambar deer exhibited a crepuscular diel cycle, with greatest activity around sunset. Only male sambar deer were observed to wallow, with most wallowing occurring in the afternoon during October–June. Conclusions Sambar deer utilised high-elevation peatlands during October–June. Daily activity was crepuscular and was greatest in dense tree cover close to roads. Ground-based shooting reduced sambar deer activity in and around high-elevation peatlands. Implications Control operations targeting sambar deer at high elevations in south-eastern Australia should be conducted during October–June. Outside this period sambar deer appear to use lower-elevation habitats. The effectiveness of ground-based shooting could be improved by focusing this control action around sunset (when sambar deer are most active) and in places with dense vegetation close to roads and high-elevation peatlands.

SARS-CoV-2 Seroprevalence, Cumulative Infections, and Immunity to Symptomatic Infection – A Multistage National Household Survey and Modeling Study, Dominican Republic, June–October 2021

SARS-CoV-2 Seroprevalence, Cumulative Infections, and Immunity to Symptomatic Infection – A Multistage National Household Survey and Modeling Study, Dominican Republic, June–October 2021

SARS-CoV-2 antibody prevalence and correlates of six ethnic groups living in Amsterdam, the Netherlands: a population-based cross-sectional study, June–October 2020

ObjectivesIt has been suggested that ethnic minorities have been disproportionally affected by the COVID-19. We aimed to determine whether prevalence and correlates of past SARS-CoV-2 exposure varied between six ethnic...

Gender differences in work-life balance of European neurosurgeons

IntroductionNeurosurgery is one of the most demanding medical specialties. For neurosurgeons, balancing professional activity with personal life can be challenging. Research questionTo evaluate gender differences in contribution of neurosurgeons in the household and child-rearing, as well as their impact on personal life and career. Material and methodsAn anonymous, electronic, 59-item web-based survey was administered to National Neurosurgical Societies of Europe, and European Member Societies of the European Association of Neurosurgical Societies (June–October 2021). ResultsA total of 205 European neurosurgeons (87 females and 118 males, mean age 40.7) are included in our survey. In neurosurgery, females are significantly more likely to be alone (37.9%), while males are significantly more likely to have children (66.9%). In terms of household efforts, females spend more time than males on the same tasks. Most participants (71.2%) view gender issues as a disadvantage in career pursuing. Women feel less accepted (54.3%) and having fewer opportunities (58.6%), while men believe that pregnancy/child-rearing (65.8%) and having many roles (51.3%) are the main obstacles. Both genders (77.6%) favor more convenient working conditions for young parents.Discussion and Conclusion. In our study we found that, women neurosurgeons take more responsibilities at home, especially in the child-rearing years. Female neurosurgeons are more likely to live alone or stay childless more often compared to their male colleagues. Supportive facilities, flexible programs, universal life policies and presumably curbing of the social stereotypes are of importance to overcome gender inequities that women are still facing in neurosurgery.

Do Cross-Latitude and Local Studies Give Similar Predictions of Phytoplankton Responses to Warming? An Analysis of Monitoring Data from 504 Danish Lakes

Cross-latitude studies on lakes have a potential to predict how global warming may cause major changes in phytoplankton biomass and composition, e.g., the development of favourable conditions for cyanobacteria dominance. However, results from these studies may be influenced by biogeographical factors, and the conclusions may, therefore, not hold when considering local response patterns. We used monthly monitoring data from 504 lakes in Denmark—a small and homogeneous geographical region—to establish empirical relationships between key phytoplankton groups and a set of explanatory variables including total phosphorus (TP), total nitrogen (TN), lake mean depth (DEP) and water temperature (TEMP). All variables had strong effects on phytoplankton biomass and composition, but their contributions varied over the seasons, with TEMP being particularly important in June–October. We found dominance of cyanobacteria in terms of biomass and also an increase in dinophytes biomass at higher TEMP, while diatoms and chlorophytes became less important. In May, however, the TEMP effect on total phytoplankton biomass was negative, likely reflecting intensified zooplankton grazing. Our results suggest that biogeographical effects are of minor importance for the response patterns of phytoplankton to temperature and that substantial concentration reductions of TN and TP are needed in eutrophic lakes to counteract the effect of the climate change-induced increase in TEMP.

Modeling the short-term fire effects on vegetation dynamics and surface energy in southern Africa using the improved SSiB4/TRIFFID-Fire model

Abstract. Fire causes abrupt changes in vegetation properties and modifies flux exchanges between land and atmosphere at subseasonal to seasonal scales. Yet these short-term fire effects on vegetation dynamics and surface energy balance have not been comprehensively investigated in the fire-coupled vegetation model. This study applies the SSiB4/TRIFFID-Fire (the Simplified Simple Biosphere Model coupled with the Top-down Representation of Interactive Foliage and Flora Including Dynamics with fire) model to study the short-term fire impact in southern Africa. Specifically, we aim to quantify how large impacts fire exerts on surface energy through disturbances on vegetation dynamics, how fire effects evolve during the fire season and the subsequent rainy season, and how surface-darkening effects play a role besides the vegetation change effects. We find fire causes an annual average reduction in grass cover by 4 %–8 % for widespread areas between 5–20∘ S and a tree cover reduction by 1 % at the southern periphery of tropical rainforests. The regional fire effects accumulate during June–October and peak in November, the beginning of the rainy season. After the fire season ends, the grass cover quickly returns to unburned conditions, while the tree fraction hardly recovers in one rainy season. The vegetation removal by fire has reduced the leaf area index (LAI) and gross primary productivity (GPP) by 3 %–5 % and 5 %–7 % annually. The exposure of bare soil enhances surface albedo and therefore decreases the absorption of shortwave radiation. Annual mean sensible heat has dropped by 1.4 W m−2, while the latent heat reduction is small (0.1 W m−2) due to the compensating effects between canopy transpiration and soil evaporation. Surface temperature is increased by as much as 0.33 K due to the decrease of sensible heat fluxes, and the warming would be enhanced when the surface-darkening effect is incorporated. Our results suggest that fire effects in grass-dominant areas diminish within 1 year due to the high resilience of grasses after fire. Yet fire effects in the periphery of tropical forests are irreversible within one growing season and can cause large-scale deforestation if accumulated for hundreds of years.

Decadal shift of the interannual relationship between western North Pacific tropical cyclone genesis frequency and South China Sea monsoon trough around 1980s

AbstractThe present study investigates the decadal shift of the interannual relationship between the South China Sea (SCS) monsoon trough (MT) and the genesis frequency of tropical cyclone (TC) over the western North Pacific during June–October 1949–2015. Significant change was found around the 1980s. The weak TC (categories 1–3) number has a decreasing relationship with the SCS MT. Their correlation coefficients are statistically remarkable during 1949–1978 but reduce to around 0.1. In contrast, the connection between strong TC (categories 4–5) number and SCS MT is strengthened after 1980s with correlation reaching up to 0.7. Such a shift can be explained by the changes in large‐scale environmental factors associated with MT movement. After 1980s, when the SCS MT extends southeastward, there exits enhanced cyclonic relative vorticity in lower level, increased moisture in middle level, reduced vertical wind shear and intensified divergence in upper level. These conditions are favourable for weak TC intensifying and developing into strong TC. In addition, more strong TC occurred in the southwest quadrant of WNP after 1980s; thus, the SCS MT would affect the TC for a longer time. Therefore, the genesis frequency of weak TCs has diminished, while more strong TCs are formed along with the SCS MT extending southeastward, leading to their strengthened interannual relationship.

17. Comparative Assessment of a Machine Learning Model and Rectal Swab Surveillance to Predict Hospital Onset Clostridioides difficile

BackgroundHospital onset Clostridioides difficile infection (HO-CDI) is associated with significant morbidity and mortality. Screening individuals at risk could help limit transmission, however swab-based surveillance for HO-CDI is resource intensive. Applied to electronic health records (EHR) data, machine learning (ML) models present an efficient approach to assess patient risk. We compare the effectiveness of swab surveillance against daily risk estimates produced by a ML model in detecting patients who will develop HO-CDI.MethodsPatients presenting to Michigan Medicine’s ICUs and oncology wards between June 6th and October 8th 2020 had rectal swabs collected on admission, weekly, and at discharge from the unit, as part of VRE surveillance. We performed anaerobic culture on the residual media followed by a custom, multiplex PCR on isolates to identify toxigenic C. difficile. Risk of HO-CDI was calculated daily for each patient using a previously validated EHR-based ML model. Swab results and model risk scores were aggregated for each admission and assessed as predictors of HO-CDI. Holding sensitivity equal, we evaluated both approaches in terms of accuracy, specificity, and positive predictive value (PPV).ResultsOf 2,044 admissions representing 1,859 patients, 39 (1.9%) developed HO-CDI. 23.1% (95% CI: 11.1–37.8%) of HO-CDI cases had at least one positive swab. At this sensitivity, model performance was significantly better than random but worse compared to swab surveillance—accuracy: 87.5% (86.0–88.9%) vs. 94.3% (93.3–95.3%), specificity: 88.7% (87.3–90.0%) vs. 95.7% (94.8–96.6%), PPV: 3.8% (1.6–6.4%) vs. 9.4% (4.3–16.1%). Combining swab AND model yielded lower sensitivity 2.6% (0.0–8.9%) compared to combining swab OR model at 43.6% (27.3–60.0%), and yielded PPV 7.1% (0.0–25.0%) vs. 43.6% (27.3–60.0%) respectively (Figure 1).Figure 1. Surveillance & risk score performance. Binary classification performance metrics of ML model (Model), toxigenic C. difficile rectal swab surveillance (Swab), and combination approaches (Model AND Swab and Model OR Swab), reported in terms of percentage points. Bold numbers highlight the best performing approach for a given performance metric. The combined approach of monitoring the Model AND Swab yielded the highest accuracy 97.5% (95% confidence interval: 96.8%, 98.1%), it also had the highest specificity 99.4% (99.0%, 99.7%). The combined approach of monitoring the Model OR Swab yielded the highest sensitivity 43.6% (27.3%, 60.0%) and negative predictive value (NPV) 98.7% (98.2, 99.2%). Using the Swab alone yielded the highest PPV 9.4% (4.3%, 16.1%) and F1 score 13.3% (6.2%, 21.8%). These results highlight the complementarity of the model and swab-based approaches.ConclusionCompared to swab surveillance using a ML model for predicting HO-CDI results in more false positives. The ML model provides daily risk scores and can be deployed using different thresholds. Thus, it can inform varied prevention strategies for different risk categories, without the need for resource intensive swabbing. Additionally, the approaches may be complimentary as the patients with HO-CDI identified by each approach differ.Disclosures Vincent B. Young, MD, PhD, American Society for Microbiology (Other Financial or Material Support, Senior Editor for mSphere)Vedanta Biosciences (Consultant) Krishna Rao, MD, MS, Bio-K+ International, Inc. (Consultant)Merck & Co., Inc. (Grant/Research Support)Roche Molecular Systems, Inc. (Consultant)Seres Therapeutics (Consultant)

Cycle of reproduction, oocyte atresia, and maturation size of the Manila clam Ruditapes philippinarum on a pebble beach in Mutsu Bay, Northern Japan

ABSTRACT This study investigated the seasonal cycle of reproduction and oocyte atresia (i.e. cell death and degeneration), and size at maturity of the Manila clam Ruditapes philippinarum (Mollusca: Bivalvia) in Mutsu Bay, Northern Japan. Monthly changes in condition factor and reproductive stage of gonads indicated that females and males spawned during July–September and June–October in 2014, respectively. The volume fraction of atretic oocytes reached a small peak at 9.3% in August (i.e. cell death of oocytes during their development in the spawning period) and the largest peak in October at 25.0% (i.e. residual oocytes in the recovery period). The atretic oocytes under resorption by macrophage-like cells comprised 2.5–14.3% and 100% of total atretic oocytes in the spawning and recovery/early gametogenesis periods, respectively. The shell length at 50% maturity was estimated to be 21.1 mm in females and 18.5 mm in males.

Climatology of transport and deposition of atmospheric substances of different intensity on the southern Primorye territory by using the meteorological reanalysis data and observations at EANET monitoring station

Abstract The article presents an analysis of air masses and precipitation transport to the area of EANET monitoring station in Russian Primorsky Krai (Primorskaya) during the warm seasons (June–October) for the period 2013–2018. The relative contributions of chemical compounds transfer from marine or continental regions were defined. The probability of sulfate and nitrate concentration values in precipitation was calculated separately in line with backward trajectory sectors. Obtained information is used for estimating contributions of marine and continental sources into wet deposition fluxes onto the Russian Far East areas.

Helicopter‐Based Chemical Immobilization of Mountain Goats in Coastal Alaska

ABSTRACTThe development, evaluation, and refinement of effective and humane capture methods for wildlife studies is important for increasing our capacity to understand and effectively manageand conserve wildlife populations. Carfentanil has been the primary agent used to chemically immobilize mountain goats (Oreamnos americanus) during the past 40 years. However, carfentanil is no longer commercially available for wildlife captures in North America. To investigate viable alternatives for mountain goat capture, we conducted field trials using thiafentanil to immobilize free‐ranging mountain goats via aerial darting methods; thiafentanil responses were then compared to a standard and widely used carfentanil dose. During June–October, 2005–2020, we immobilized mountain goats with either 2.4–3.0 mg carfentanil (n = 444) or 6.0–7.0 mg thiafentanil (n = 68) across a range of different field conditions at 6 different study sites in coastal Alaska. Induction and recovery times were more rapid (and subsequent immobilization times reduced) using thiafentanil compared to carfentanil. In most other respects, however, immobilization characteristics (i.e., body temperature, pulse rate, relative oxygen saturation) were virtually indistinguishable between individuals immobilized with carfentanil or thiafentanil. During typical immobilizations, mean rectal temperature increased 1.8° C, but increased as much as 3.0° C in some extreme cases. Administration of supplemental oxygen resulted in substantial, potentially clinically significant increases in peripheral capillary oxygen saturation, arterial oxygen, and pH in immobilized mountain goats. Our findings indicate that thiafentanil is an effective alternative to carfentanil for chemical immobilization of mountain goats and may offer some important advantages, particularly when immobilizing mountain goats and other species in difficult and potentially dangerous capture environments. © 2021 The Wildlife Society.

SARS-CoV-2 infection prevalence in people experiencing homelessness.

People experiencing homelessness have peculiar characteristics that make them more vulnerable to Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) transmission and to more serious forms of Coronavirus Disease 19 (COVID-19). The aim of this study was to evaluate the prevalence of SARS-CoV-2 infection in the homeless population assisted by the primary care services of the Eleemosynaria Apostolica, Vatican City. Persons experiencing homelessness and the volunteers assisting them were tested for COVID-19 through PCR and antigen rapid test between October 1st, 2020, and June 5th, 2021, in the clinical facilities of the Eleemosynaria Apostolica. A total of 1665 subjects from 96 different countries in five continents were included in the study; age range was 1-90 years. Overall, 2315 COVID-19 tests through nasopharyngeal swab were performed; 1052 Polymerase Chain Reaction (PCR) tests and 1263 antigen rapid tests. Nearly 40% of the subjects underwent both tests (n=650, 39.04%), 402 were tested with PCR test only (24.14%) and 613 with antigen test only (36.8%). PCR tests were negative in 966 cases and positive in 86 (8.17%), while antigen tests were negative in 1205 cases and positive in 58 (4.59%). The number of positive cases varied over time, with a drastic increase during the winter months of 2020 and a progressive decrease over 2021. Among positive cases, 24.41% were symptomatic; symptoms included fever, breathing difficulties, anosmia/hyposmia, cough, headache, and diarrhea. This study reported an overall prevalence of SARS-CoV-2 infection in our sample slightly above 8%. Additional data on viral genome through sequencing of SARS-CoV-2 in positive cases are of utmost importance to help identify variants and implement specific infection control measures.

Detection of Above-Ground Physiological Indices of an Apple Rootstock Superior Line 12-2 with Improved Apple Replant Disease (ARD) Resistance

(1) Background: The cultivation of resistant rootstocks is an effective way to prevent ARD. (2) Methods: 12-2 (self-named), T337, and M26 were planted in replanted and sterilized soil. The aboveground physiological indices were determined. (3) Results: The plant heights and the stem thicknesses of T337 and M26 were significantly affected by ARD. Relative chlorophyll content (June–October), Pn (August–September), and Gs (August) of T337 and relative chlorophyll content (June–July, September), Pn (September–October), and Ci (September) of M26 were significantly affected by ARD. ARD had a significant effect on Fv/Fm (June), qP (June–July), and NPQ of T337 (June–October, except August) and Fv/Fm (June) and NPQ (June-October, except July) of M26. Additionally, ARD affected Rfd of M26 and T337 during August. SOD (August and October), POD (August–September), and CAT (July-August, October) activities and MDA (September–October) content of T338 as well as SOD (July–October), POD (June–October), and CAT (July-October) activities and MDA (July, September–October) content of M26 were significantly affected by ARD. ARD significantly reduced nitrogen (October), phosphorus (September–October), and zinc (July) contents of M26 and potassium (June) content of T337. The above physiological indices were not affected by ARD in 12-2. (4) Conclusions: 12-2 could be useful as an important rootstock to relieve ARD due to strong resistance.

Drug use, harm-reduction practices and attitudes toward the utilisation of drug safety testing services in an Irish cohort of festival-goers

BackgroundFestival drug-related deaths are a growing public health concern.AimTo examine drug use and related harm-reduction practices and attitudes towards utilisation of drug safety testing services.MethodsData collection took place over the 2019 festival season (June–October). The questionnaire was self-reported. Data was gathered via the online survey, which was promoted through online and social media platforms and outlets. Social media communication methods were used to reach the targeted population more effectively.ResultsA total of 1193 Irish festival attendees over the age of 18 completed an anonymous online survey. Alcohol, MDMA powder/crystals, ecstasy pills and cocaine were the highest reported drugs used by Irish festival attendees. The vast majority of participants reported polysubstance use (86.8%/n = 1036). Forty percent of participants (39.98%/n = 477) reported having had sex following the use of a drug at a festival; of these, 66% (n = 316) said that the sex was unprotected. Most participants (84.0%/n = 1003) engaged in some form of harm reduction when taking drugs at festivals.Overwhelmingly, participants reported a willingness to engage with drug-checking services. The vast majority (96.3%; n = 1149) and would use drug checking services more than three-quarters (75.1%/n = 897) reported that they would use an ‘amnesty bin’ for drugs if it were part of an alert system to notify if dangerous drugs are in circulation. A chi-square test of Independence was conducted to examine whether age and utilisation of drug safety testing service a festival were independent. Moreover, when all cases are taken together, the difference between testing modalities (onsite, offsite and amnesty bin) shows a significant difference p < 001 between those who would use onsite and offsite drug testing facilities.ConclusionThe evidence from this survey indicates that those young people who use drugs at festivals would be prepared to utilise drug checking services and amnesty bins should help inform the public health response to this important area.

Projected changes in the near‐future mean climate and extreme climate events in northeast Thailand

AbstractThis study provides an assessment of changes in mean and extreme climate in northeast Thailand, focusing on the near‐future period (2021–2050). Spatiotemporal changes in climate extremes and return values are investigated compared to 1981–2010. Climate model‐related uncertainties are quantified using 14 models from the Coupled Model Intercomparison Project phase 5 (CMIP5) and 8 models from phase 6 (CMIP6). CMIP6 models have a higher sensitivity to external forcings as the CMIP6 ensemble suggests an increase in maximum and minimum temperatures by 1.45°C (0.8–1.9°C) and 1.54°C (1.1–1.9°C) under the high emission scenario, which is greater than by CMIP5 ensemble: 1.10°C (0.5–1.7°C) and 1.13°C (0.7–1.6°C), respectively. No significant changes in annual rainfall are projected, although it will be temporally more uneven with decreases (6–11%) during the pre‐rainy season (March–May) and increases (2–8%) during the rainy season (June–October). The bootstrap analysis technique shows the inter‐model uncertainties for rainfall projections in CMIP6 have reduced by 40% compared to CMIP5. The annual number of hot days will increase more than twofold and warm nights, more than threefold. Near‐future will experience an increase in the rainfall intensity, a decrease in the number of rainy days, and an increase in the 20‐year return values of annual maximum 1‐day rainfall and consecutive 5‐days rainfall (&gt;30%). In addition, the rainy season will be shortened in the future as onset and retreat are delayed, which may have implications in agricultural activities in the basin since cultivation is primarily rainfed. These findings suggest that anthropogenic activities will significantly amplify the climate extremes. The study results will be useful for managing climate‐related risks and developing adaptation measures to improve resilience towards potential climate hazards.

512Challenges and opportunities to appropriate antibiotic prescribing: a survey of clinicians’ perceptions in Australia

Abstract Background Emerging antibiotic resistance is significant threat to global public health. There is evidence on sub-optimal prescribing as a contributing factor to antibiotic resistance. This study aimed to identify behavioral determinants of antibiotic prescribing that may help design effective interventions. Methods A cross-sectional survey was undertaken with clinicians (hospital and primary care) in Australia from June–October 2019. Multivariate logistic regression was used to determine if clinicians’ characteristics, and guidelines’ use, are associated with barriers of appropriate antibiotic prescribing. Results Inappropriate prescribing behavior is not limited to clinicians’ practices, but also relate to patients’ expectation and clinical culture. Lack of data for evidence-based decision-making and diagnostic uncertainty contribute to sub-optimal antibiotic prescribing. Different care settings and clinicians’ experience influence perceptions of whether unavailability of information, delay in diagnostic results and patient expectations regarding treatment led to inappropriate prescribing behavior. Respondents in primary care and with less experience were more likely to consider that patient demands (primary care: OR 1.76, 95%CI 1.34–2.68 &amp; experience (1-10 years): OR 1.34, 95%CI 1.07–1.59) and lack of data required for decision-making (primary care: OR 1.59, 95%CI 1.09–2.10 &amp; experience (1-10 years): OR 1.63, 95%CI 1.13–1.87) are barriers to appropriate prescribing. Conclusions A complex network of social, contextual and clinical factors influence prescribing practices. A holistic approach addressing clinicians’ practices, setting requirements and patient expectations must be considered. Key messages For optimal antibiotic prescribing, there is a need to focus on contextual requirements, shared decision-making and availability of relevant information at point-of-care.

Biomass Quantity and Quality from Different Year-Round Cereal–Legume Cropping Systems as Forage or Fodder for Livestock

The quantity and quality of forage and fodder crops is the major drawback of the livestock sector in the country. There is a need to bridge the gap between the supply and demand of fodder through the adoption of specific sustainable fodder production strategies. The field experiments were conducted during kharif (rainy, June–October), rabi (post-rainy, October–February), and summer (March–May) seasons of 2018–19 and 2019–20 to identify a sustainable fodder cropping system module in randomized complete block design with fifteen fodder cropping systems in three replications. The main objective of this research was to identify the most productive cereal–legume cropping system, both in terms of quantity and quality of biomass, to reduce the gap between supply and demand of quality livestock feed around the year. Among cropping systems, Bajra–Napier hybrid intercropped with lucerne, cowpea, and sesbania recorded significantly higher green fodder (163.6, 155.2, and 144.0 t/ha/year, respectively) and dry matter yields (32.1, 30.8, and 31.3 t/ha/year, respectively). Similarly, the same perennial systems also recorded higher quality yield and ash content. However, higher crude protein content was noticed in monocrop legumes, with the highest in sesbania (22.32%), while higher ether extractable fat was found in monocrop sesbania (3.78%). The monocrop oats recorded higher non-fiber carbohydrates (36.90%) while a monocrop of pearl millet recorded higher total carbohydrates (80.75%), however they were on par with other monocrop cereal cropping systems. Cultivation of legumes as a monocrop, and their inclusion as an intercrop with cereals resulted in lower fiber fractions and improved crude protein in intercropping systems. Furthermore, this improved the dry matter intake and digestibility of fodder. With higher sustainable yield index values and land-use efficiency, perennial intercropping systems were also found to be sustainable. Thus, cultivation of the Bajra–Napier hybrid with either lucerne, cowpea, or sesbania as an intercrop will help livestock farmers to achieve higher productivity in terms of quantity and quality, and forms a viable option for overcoming livestock feed scarcity.

Vulnerability of personality disorder during COVID-19 crises: a multicenter survey of mental and social distress among patients referred to treatment

Background Relational and emotional problems, dysregulation, self-harming or substance abuse often characterize personality disorders (PD). In Norway, COVID-19 restrictions led to an abrupt shutdown of services from 12 March 2020 also including specialized PD treatments. Aims The objective of this study was to investigate social and mental distress among patients with PDs during the first COVID-19 wave. Design A survey was distributed after the first COVID-19 wave (June–October 2020) among 1120 patients from 12 PD treatment units. Results The response rate was 12% (N = 133). The survey reflected impairment of occupational activity (53% <50% activity last 6 months), life quality (EQ-5D-VAS: 56, SD 19), and personality functioning (LPFS-BF ≥12: 81%, 35% avoidant PD, 44% borderline PD) and high levels of depression and anxiety (PHQ-9 ≥ 10: 84%, GAD-7 ≥ 10: 68%), 49% with health-related anxiety. Problem increase was reported for anxiety (28%), depression (24%), aggression (23%), substance use (14%), and 70% of parents had more child-care difficulties. Self-destructive behaviors (26%) did not increase. The majority (78%) reported increased or unchanged social isolation and loneliness. Occupational activity declined with negative effects on part-time jobs/rehabilitation. Therapist contact was mainly telephone-based (63% ≥ weekly contact). More severe personality problems, current depressive symptoms, and self-harming before 12 March were associated with more frequent consultations. Conclusion The survey confirms severe, enhanced levels of mental distress among patients receiving telephone-based consultations as the main alternative to specialized PD treatment during the COVID-19 shutdown. The most vulnerable patients received more frequent consultations and self-destructive actions did not increase.

Consumption Patterns of a Generalist Omnivore: Eastern Box Turtle Diets in the Long Island Pine Barrens

Eastern Box Turtles (Terrapene carolina) are diet generalists and as such are predicted to have diverse diets in which familiar, low-quality foods are eaten consistently at low levels, and high-quality foods are rare but eaten whenever available. Previous work showed that they feed opportunistically on seasonally available plants (shoots, leaves, flowers, and fruit), invertebrates, mushrooms, and occasionally carrion. We used fecal samples to test optimal foraging predictions relevant to diet generalists and also whether the Eastern Box Turtle diets varied seasonally in a northeastern U.S. pine-oak habitat. We found that in-depth prey species consumption patterns of six different individuals were similar to those of the sampled population overall. Leaf and stem material was consumed by 100% of the turtles in all months despite being lower-quality than other prey available. Invertebrates were consumed by at least 80% of turtles in every study period; Coleopterans were found more commonly than other invertebrates. Snails were not eaten by more than 20% of the turtles in any study period, and mushroom consumption varied from 31–75% of samples in different study periods. Monthly diet overlap was measured using both Pianka’s Index of Overlap (PIO) and the Morisita–Horn Index (MH). The PIO method indicated that the prey consumption patterns were broadly similar from June–October, while the M–H method showed that only the July vs. August comparison was highly similar. The turtle diets changed only slightly between seasons, and they conform to predictions of diet generalist models usually applied to mammals.