Research Priorities Research Articles

Environmental public health research at the U.S. Environmental Protection Agency: A blueprint for exposure science in a connected world.

Exposure science plays an essential role in the U.S. Environmental Protection Agency's (U.S. EPA) mission to protect human health and the environment. The U.S. EPA's Center for Public Health and Environmental Assessment (CPHEA) within the Office of Research and Development (ORD) provides the exposure science needed to characterize the multifaceted relationships between people and their surroundings in support of national, regional, local and individual-level actions. Furthermore, exposure science research must position its enterprise to tackle the most pressing public health challenges in an ever-changing environment. These challenges include understanding and confronting complex human disease etiologies, disparities in the social environment, and system-level changes in the physical environment. Solutions will sustainably balance and optimize the health of people, animals, and ecosystems. Our objectives for this paper are to review the role of CPHEA exposure science research in various recent decision-making contexts, to present current challenges facing U.S. EPA and the larger exposure science field, and to provide illustrative case examples where CPHEA exposure science is demonstrating the latest methodologies at the intersection of these two motivations. This blueprint provides a foundation for applying exposomic tools and approaches to holistically understand real-world exposures so optimal environmental public health protective actions can be realized within the broader context of a One Health framework. IMPACT STATEMENT: The U.S. EPA's Center for Public Health and Environmental Assessment exposure research priorities reside at the intersection of environmental decision contexts and broad public health challenges. The blueprint provides a foundation for advancing the tools and approaches to holistically understand real-world exposures so optimal environmental protection actions can be realized. A One Health lens can help shape exposure research for maximum impact to support solutions that are transdisciplinary and must engage multiple sectors.

Addressing social norms for adolescent timing and spacing of pregnancy in low and middle-income countries: Developing a global research agenda.

Social norms shape adolescent sexual and reproductive health behaviours contributing to contraceptive and pregnancy outcomes. No global research agendas exist to guide research on adolescent social norms shifting in low- and middle-income countries (LMICs). We developed a social norms research agenda to improve adolescent healthy timing and spacing of pregnancy in LMICs. We adapted and applied the Child Health and Nutrition Research Initiative (CHNRI) method. A group of researchers guided the process, and consulted with diverse experts to develop a list of 21 research questions for global stakeholders to score via an online survey. Survey participants scored each research question according to four criteria (fills key gap, feasible, impactful, equitable). Research priority scores (RPS) and average expert agreement (AEA) statistics were calculated for each question and analysed overall and by stakeholder region and profession. We received 185 survey responses. Participants were, on average, 44 years old, 64% were women, 70% were from LMICs and 47% were implementers. The RPS ranged from 52 to 81% (74% median) and the AEA ranged from 49 to 70% (58% median). Nearly 70% of stakeholders gave the same score to each of the top five research questions. The top five research priorities focused on effective norm-shifting interventions (NSIs) strategies, processes and indicators to NSIs, and NSI adaptation and scale-up. Using a collaborative and rigorous process with diverse representation from LMICs and implementers, we reached consensus on five priority research questions to guide future adolescent social norms research to improve healthy timing and spacing of pregnancy in LMICs.

Diversity in Family Medicine Research.

In conjunction with the North American Primary Care Research Group (NAPCRG) Annual Conference in 2023, leaders in the field of family medicine came together to discuss and produce a Family Medicine Research Agenda. While multiple areas were discussed, diversity, equity, and inclusion did not rise to the top as research priorities. This article discusses the 3 areas family medicine leaders see as necessary to produce high-quality research. The authors present ideas on how diversity, equity, and inclusion can be prioritized in each area. In the first area, "Grow the family medicine research workforce by expanding pathways and strengthening mentorship," the authors present existing models, with an emphasis on those pathway programs proven to increase scholarship and research, such as the Leadership Through Scholarship Fellowship sponsored by the Society of Teachers of Family Medicine (STFM) and the Building Research Capacity Program sponsored by the Association of Departments of Family Medicine (ADFM). In the second area, "Increase funding for family medicine research and advocate for enhanced health policy and support," the authors present ideas on greater utilization of NIH diversity supplements as well as institutional advocacy by family medicine chairs to create seed grants and provide opportunities for diverse faculty to engage in research. Chairs can also increase the diversity of the researcher pool by recruiting among local full-time clinicians, a more diverse group than most faculties. For the final area, "Build a national infrastructure for organizing and optimizing family medicine research opportunities," the authors present solutions including following demographic data surrounding authorship and reviewing for journals; having dedicated committees or editors focused on diversity, equity, and inclusion; and using demographic data from conference submissions to encourage those from underrepresented backgrounds to translate their presentations into a manuscript. These strategies can help equity, diversity, and inclusion become central to our research and be used as a national model for other specialties attempting to do the same.

Evaluating Nuclear Forensic Signatures for Advanced Reactor Deployment: A Research Priority Assessment

The development and deployment of a new generation of nuclear reactors necessitates a thorough evaluation of techniques used to characterize nuclear materials for nuclear forensic applications. Advanced fuels proposed for use in these reactors present both challenges and opportunities for the nuclear forensic field. Many efforts in pre-detonation nuclear forensics are currently focused on the analysis of uranium oxides, uranium ore concentrates, and fuel pellets since these materials have historically been found outside of regulatory control. The increasing use of TRISO particles, metal fuels, molten fuel salts, and novel ceramic fuels will require an expansion of the current nuclear forensic suite of signatures to accommodate the different physical dimensions, chemical compositions, and material properties of these advanced fuel forms. In this work, a semi-quantitative priority scoring system is introduced to identify the order in which the nuclear forensics community should pursue research and development on material signatures for advanced reactor designs. This scoring system was applied to propose the following priority ranking of six major advanced reactor categories: (1) molten salt reactor (MSR), (2) liquid metal-cooled reactor (LMR), (3) very-high-temperature reactor (VHTR), (4) fluoride-salt-cooled high-temperature reactor (FHR), (5) gas-cooled fast reactor (GFR), and (6) supercritical water-cooled reactor (SWCR).

Bibliometric analysis of global research trends and prospects on circulating tumor DNA in colorectal cancer

BackgroundColorectal cancer (CRC) is one of the most commonly diagnosed advanced-stage malignancies worldwide and places a substantial burden on both the economic and social development of numerous countries.ObjectiveThis manuscript aims to synthesize the existing evidence and explore potential avenues for future scholarly research on ctDNA in CRC.MethodsBibliometric analyses were performed using the bibliometrix package in R, along with CiteSpace and VOSviewer software. The search was restricted to publications up to 31 March 2024, using the following terms: (“ctDNA” OR “circulating tumor DNA”) AND (“colorectal cancer” OR “colorectal tumor”) from the Web of Science Core Collection (WoSCC) database.ResultsUltimately, we identified 1,310 documents published in 353 journals authored by 7,683 researchers from 2,417 institutions across 66 countries. The USA was the most productive country. The Journal of Clinical Oncology was the most prolific, publishing 111 articles with 3,396 citations. The top five keywords were “colorectal cancer,” “circulating tumor DNA,” “acquired resistance,” “cell-free DNA,” and “plasma.” The top five cluster labels for references were “advanced cancer,” “metastatic colorectal cancer,” “liquid biopsy,” “colorectal cancer,” and “human colorectal cancer xenograft.”ConclusionsThe collaborative networks are primarily composed of highly productive authors, prestigious institutions, and leading countries. Additionally, the advancement of detection technologies, the development of standardized protocols, the exploration of circulating tumor DNA (ctDNA) dynamics in CRC, and the implementation of large-scale clinical trials for ctDNA-guided precision therapy in CRC are expected to become major research priorities in the future.

Decoding the Digital Pulse: Bibliometric Analysis of 25 Years in Digital Health Research Through the Journal of Medical Internet Research.

As the digital health landscape continues to evolve, analyzing the progress and direction of the field can yield valuable insights. The Journal of Medical Internet Research (JMIR) has been at the forefront of disseminating digital health research since 1999. A comprehensive network analysis of JMIR publications can help illuminate the evolution and trends in digital medicine over the past 25 years. This study aims to conduct a detailed network analysis of JMIR's publications to uncover the growth patterns, dominant themes, and potential future trajectories in digital health research. We retrieved 8068 JMIR papers from PubMed using the Biopython library. Keyword metrics were assessed using accuracy, recall, and F1-scores to evaluate the effectiveness of keyword identification from Claude 3 Opus and Gemini 1.5 Pro in addition to 2 conventional natural language processing methods using key bidirectional encoder representations from transformers. Future trends for 2024-2026 were predicted using Claude 3 Opus, Google's Time Series Foundation Model, autoregressive integrated moving average, exponential smoothing, and Prophet. Network visualization techniques were used to represent and analyze the complex relationships between collaborating countries, paper types, and keyword co-occurrence. JMIR's publication volume showed consistent growth, with a peak in 2020. The United States dominated country contributions, with China showing a notable increase in recent years. Keyword analysis from 1999 to 2023 showed significant thematic shifts, from an early internet and digital health focus to the dominance of COVID-19 and advanced technologies such as machine learning. Predictions for 2024-2026 suggest an increased focus on artificial intelligence, digital health, and mental health. Network analysis of JMIR publications provides a macroscopic view of the evolution of the digital health field. The journal's trajectory reflects broader technological advances and shifting research priorities, including the impact of the COVID-19 pandemic. The predicted trends underscore the growing importance of computational technology in future health care research and practice. The findings from JMIR provide a glimpse into the future of digital medicine, suggesting a robust integration of artificial intelligence and continued emphasis on mental health in the postpandemic era.

Cost‐efficiency and effectiveness of coral restoration pathways

Coral reefs play a crucial role in supporting over half a billion human livelihoods through their contributions to fisheries, tourism, and coastal protection. In light of substantial global declines in coral cover and the deterioration of reef habitats due to climate change and other human‐driven influences, the urgency of coral reef restoration has escalated to help preserve their vital ecosystem services. Comprehending the economic costs associated with existing and potential future coral restoration approaches has become time‐sensitive. The median cost of coral reef restoration is estimated to be 400,000 USD/ha (at base year 2010). This estimate comes with limitations due to its reliance on reported project costs associated with various techniques. Here we look to standardize expenses through uniform costing of reported efforts based on the time invested to estimate specific per‐unit costs for restoration methods. We complement literature‐extracted values with independent estimates based on real‐world operations. Using this approach, we decipher comparative costs of different nursery and outplanting approaches and identify incorporated dependencies. To gain insights into the impact of labor costs on global coral reef restoration expenditures, we examine variations in the costs of labor in two coral reef regions. Overall, our data‐based approach identifies limitations within the most commonly practiced restoration pathways, opportunities to reduce operational costs, and points toward priorities for future research and development.

Health inequalities and indoor environments: research challenges and priorities

Health inequalities and indoor environments: research challenges and priorities

Barriers to and Facilitators of Effective Behavioral Health Crisis Care Services.

Expanded funding to support care across the crisis continuum is intended to improve behavioral health outcomes. A greater understanding of how to effectively implement and integrate local crisis care systems has been identified as a research and policy priority. The aim of this study was to explore provider perceptions of the barriers and facilitators associated with implementing effective behavioral health crisis services. The authors conducted semistructured qualitative interviews with personnel from 15 behavioral health crisis care programs across California. Purposive sampling was used to ensure adequate representation of peer specialists, clinicians, mental health workers, and program leaders. Interview transcripts were analyzed via an inductive approach to thematic analysis. On the basis of patterns identified in the data, initial codes were developed, reviewed, and combined into overarching preliminary themes and subthemes. Twenty-nine crisis care personnel participated. Facilitators of effective crisis care included an optimal crisis service structure, a client-centered approach, engagement with clients' support systems, and collaboration with community partners to link clients to services and enable safe delivery of crisis care. Barriers at the client, program, and system levels were identified, with solutions proposed for each. The participants identified features of crisis care that could improve program implementation and effectiveness or could help mitigate identified barriers. As states and local municipalities work to implement an integrated system of care across the crisis care continuum, input from frontline providers can be used to support the development of new programs, refine existing services, and inform future directions for research.

QOL-20. NATIONAL BRAIN TUMOR SOCIETY BRAIN TUMOR QUALITY OF LIFE RESEARCH AGENDA

Abstract BACKGROUND QoL is a critical aspect of health care outcomes, particularly in the context of brain tumor treatment and survivorship. There are evidence gaps in optimal strategies for improving QoL among brain tumor patients and care partners. Understanding the multifaceted dimensions of QoL and identifying key areas for brain tumor QoL research can significantly enhance patient care and support. Engaging the brain tumor community in defining QoL outcomes and determining research priorities can help orient research resources to community needs and perspectives. OBJECTIVE To summarize the process and outcomes of an NBTS-led collaborative effort to co-design a comprehensive research agenda on QoL for brain tumor patients and care partners, as outlined in the “Brain Tumor QoL Research Agenda.” METHODS The agenda was developed through a collaborative effort involving experts in neuro-oncology, patients, care partners, patient advocacy groups, and healthcare professionals over a two-year period. A review of existing literature, patient experiences, and expert opinions informed the identification of key research priorities. A multistakeholder advisory group held monthly meetings where brain tumor QoL was defined. In 2023, we conducted two “Research Roundtables” for adults and pediatric/AYA. The World Cafe method captured data and a survey consensus process to validate findings. RESULTS The QoL research agenda delineates a multifaceted framework encompassing domains crucial for understanding and improving QoL in brain tumor patients. Key focus areas include symptom management, psychosocial support, care burden, treatment decision-making, survivorship issues, and health care delivery models. An RFP was released by NBTS with input from stakeholder advisors in April 2024. CONCLUSION The Brain Tumor QoL Research Agenda created a roadmap for advancing research efforts aimed at enhancing the QoL of individuals affected by brain tumors. By addressing the identified research priorities, healthcare stakeholders can work towards implementing effective interventions and policies to optimize patient outcomes and well-being. This program was funded through a Patient-Centered Outcomes Research Institute® (PCORI®) Eugene Washington PCORI Engagement Award (EACB-23261).

Advancing terrestrial ecology by improving cross-temporal research and collaboration

Abstract Ecology spans spatial and temporal scales and is inclusive of the history of life on Earth. However, research that occurs at millennial timescales or longer has historically been defined as paleoecology and has not always been well integrated with modern (neo-) ecology. This bifurcation has been previously highlighted, with calls for improved engagement among the subdisciplines, but their priority research areas have not been directly compared. To characterize the research agendas for terrestrial ecological research across different temporal scales, we compared two previous studies, Sutherland and colleagues (2013; neoecology) and Seddon and colleagues (2014; paleoecology), that outlined priority research questions. We identified several themes with potential for temporal integration and explored case studies that highlight cross-temporal collaboration. Finally, a path forward is outlined, focusing on education and training, research infrastructure, and collaboration. Our aim is to improve our understanding of biodiversity patterns and processes by promoting an inclusive and integrative approach that treats time as a foundational concept in ecology.

Can We Better Understand, Diagnose, and Treat Ketamine-Induced Uropathy, and Can It Be Reversed? ICI-RS 2024.

Ketamine, a versatile anesthetic, has seen increased recreational use, leading to significant health issues, including ketamine-induced uropathy (KIU). KIU manifests with lower urinary tract symptoms (LUTS) and can involve the upper urinary tract. This study aims to provide a comprehensive overview of KIU, addressing its pathophysiology, diagnostic strategies, and treatment options; and to define/identify future research priorities. During the 2024 meeting of the International Consultation on Incontinence Research Society (ICI-RS) in Bristol, a dedicated Proposal (P) convened to explore KIU. This initiative involved a thorough review of existing literature, expert presentations, and consensus-driven discussions. The methodology ensured a comprehensive exploration of KIU from both clinical and pre-clinical perspectives, leading to actionable research recommendations. Understanding the mechanisms of KIU is crucial for developing effective treatment options targeting specific pathophysiological pathways. Key findings include bladder fibrosis driven by transforming growth factor-β1 (TGF-β1), elevated purinergic responses and upregulated P2X1 purinoceptor expression, decreased barrier function due to increased expression of antiproliferative factor (APF), and functional loss of the bladder through Cav1.2 channel blockade. Research indicates that fibrosis, typically considered irreversible, may be mitigated. However, the exact timing and extent of fibrosis initiation and its impact on long-term outcomes require further research. LUTS typically improve after ketamine cessation but relapse upon resumption, indicating a hypersensitivity mechanism involving elevated serum IgE levels. Advanced stages of KIU do not always correlate with LUTS severity, shedding light on potential systemic effects and the need for evaluating liver enzymes. Furthermore, psychological dependency on ketamine, due to its positive perceptive and mood-altering effects, complicates cessation efforts. Long-term management requires a holistic approach, integrating medical treatments and supportive measures to help patients navigate life with potentially irreversible complications. This comprehensive review spans from fundamental pathology to practical clinical management, addressing both urological and systemic complications, and bridging insights from animal models to human applications. Developing effective treatment strategies necessitates addressing both the physical and psychological aspects of ketamine dependency.

Scientific landscape of oxidative stress in sarcopenia: from bibliometric analysis to hotspots review

ObjectiveSarcopenia is a significant healthcare challenge in the aging population. Oxidative stress (OS) is acknowledged to play a pivotal role in the pathological progression of sarcopenia. Numerous studies have demonstrated that mitigating or eliminating OS can ameliorate the pathological manifestations associated with sarcopenia. However, current clinical antioxidant therapies often fall short of anticipated outcomes. This bibliometric analysis aims to delineate prevailing research trends, thematic emphases, focal points, and developmental trajectories within the domain of OS in sarcopenia, while also endeavoring to explore prospective anti-oxidative stress strategies for future clinical interventions.MethodsRelevant publications were retrieved from the Web of Science (WOS) Core Collection database for the period 2000-2024. Citespace was employed for retrieving and analyzing trends and emerging topics.ResultsIn the field of OS in sarcopenia, the number of publications has significantly increased from 2000 to 2024. The United States and China are the primary contributors to global publication output. The most productive research institution is INRAE. The most prolific author is Holly Van Remmen from the United States, while the most frequently cited author is Cruz-Jentoft AJ from Spain. Experimental Gerontology is the journal with the highest volume of published articles, whereas the Journal of Gerontology Series A: Biological Sciences and Medical Sciences holds the record for the highest number of citations. The research keywords in this field can be categorized into eight domains: “Physiology and anatomy”, “Physiological mechanisms”, “Pathology associations”, “Experimental studies”, “Nutrition and metabolism”, “Sports and physical activities”, “Age” and “Oxidation and antioxidation”. Moreover, recent years have seen the emergence of “TNF-α,” “insulin resistance”, “mitochondrial autophagy”, “signal pathways”, and “mechanisms” as focal points in the realm of OS in sarcopenia, encompassing related fundamental research and clinical translation.ConclusionThis bibliometric and visualization provides a comprehensive analysis of the global research landscape in the field of OS in sarcopenia, identifies priorities, summarizes the current research status and suggests possible future research priorities. In addition, in order to benefit more sarcopenia patients, strengthening cooperation and communication between institutions and research teams is the key to the future development of this field. Given the expectation that research on OS in sarcopenia will remain a prominent area of interest in the future, this article could serve as a valuable resource for scholars seeking to shape future studies through an understanding of influential scholarly contributions and key research findings.Systematic review registrationhttps://www.crd.york.ac.uk, identifier CRD42024528628.

The LTAR Cropland Common Experiment at R. J. Cook Agronomy Farm.

Dryland agriculture in the Inland Pacific Northwest is challenged in part by rising input costs for seed, fertilizer, and agrichemicals; threats to water quality and soil health, including soil erosion, organic matter decline, acidification, compaction, and nutrient imbalances; lack of cropping system diversity; herbicide resistance; and air quality concerns from atmospheric emissions of particulate matter and greenhouse gases. Technological advances such as rapid data acquisition, artificial intelligence, cloud computing, and robotics have helped fuel innovation and discovery but have also further complicated agricultural decision-making and research. Meeting these challenges has promoted interest in (1) supporting long-term research that enables assessment of ecosystem service trade-offs and advances sustainable and regenerative approaches to agriculture, and (2) developing coproduction research approaches that actively engage decision-makers and accelerate innovation. The R. J. Cook Agronomy Farm (CAF) Long-Term Agroecosystem Research (LTAR) site established a cropping systems experiment in 2017 that contrasts prevailing (PRV) and alternative (ALT) practices at field scales over a proposed 30-year time frame. The experimental site is on the Washington State University CAF near Pullman, WA. Cropping practices include a wheat-based cropping system with wheat (Triticum aestivum L.), canola (Brassica napus, variety napus), chickpea (Cicer arietinum), and winter pea (Pisum sativum), with winter wheat produced every third year under the ALT practices of continuous no-tillage and precision applied N, compared to the PRV practice of reduced tillage (RT) and uniformly applied agrichemicals. Biophysical measurements are made at georeferenced locations that capture field-scale spatial variability at temporal intervals that follow approved methods for each agronomic and environmental metric. Research to date is assessing spatial and temporal variations in cropping system performance (e.g., crop yield, soil health, and water and air quality) for ALT versus PRV and associated tradeoffs. Future research will explore a coproduction approach with the intent of advancing discovery, innovation, and impact through collaborative stakeholder-researcher partnerships that direct and implement research priorities.

Research priorities: Establishing discipline-based education research in prosthetics and orthotics.

Education research, as a field of study, is relatively new to the health professions. Research and scholarship in prosthetics and orthotics education is limited, and the priority areas and needs of individuals interested in pursuing this area of research and scholarship are unknown. The objectives of this study were to collaboratively identify the areas in which education research in prosthetics and orthotics is needed, to prioritize these areas, and to evaluate the resources needed to support those interested in pursuing education research. Mixed methods. The researchers used a participatory action research approach. Focus group sessions were held at the 2022 International Society for Prosthetics and Orthotics (ISPO) Global Educators Meeting. Findings from the focus groups informed creation of a survey that was distributed internationally. The results of this survey were presented to attendees at the 2023 ISPO World Congress for review and ranking. Findings from focus group discussions were used to create a 20-item survey. High priority categories included providing feedback to students, program evaluation, and clinical education and internship. Protected time and funding, faculty development, and program resources were identified as items needed to support faculty in pursuing education research. At the ISPO World Congress, participants highly rated the categories of academic v. clinical practice, program resources, and program evaluation. Many categories were identified as priorities for orthotic and prosthetic education research, and ways to support faculty pursuing this work were highlighted. This study identified opportunities for education researchers to focus their efforts on directly impacting needs of education programs and the profession.

A Systematic Review of Isotopically Measured Iron Absorption in Infants and Children Under 2 Years

Background: Iron is an essential element for critical biological functions, with iron deficiency negatively affecting growth and brain development and iron excess associated with adverse effects. The goal of this review is to provide a comprehensive assessment of up-to-date evidence on iron absorption measured isotopically in children, preterm infants, and full-term infants, up to 24 months of age. Methods: Search databases included Pubmed, Cochrane, Web of Science, and Scopus from a date range of 1 January 1953 to 22 July 2024. The included articles were experimental studies with iron absorption outcomes measured by isotopic techniques. The risk of bias was assessed using the Cochrane Risk of Bias Tool. Results: A total of 1594 records were identified from databases, and 37 studies were included in the quality review with a total of 1531 participants. Article results were grouped by study commonality: absorption and red blood cell incorporation, type of milk feedings, additives to improve absorption, how and when to supplement with iron, and iron forms and complimentary foods. Conclusions: The results from this review support the current recommendations of oral iron supplementation. Iron from breast milk has high bioavailability, and unmodified cow’s milk reduces iron absorption. Supplemental iron is required at 4–6 months for healthy, full-term infants and sooner for preterm infants. Ascorbic acid increases iron absorption in full-term infants and children. Lactoferrin and prebiotics are promising candidates for enhancing iron absorption, but they require further investigation. Research evidence of iron absorption mechanisms and modulating factors in preterm infants is limited and should be a research priority.

Research on the impact and mechanism of digital economy on China’s food production capacity

Enhancing and strengthening food production capacity has always been a top priority in agricultural research, serving as a cornerstone for ensuring national food security and stable economic development. This study, based on panel data spanning from 2011 to 2021 across 30 provinces in China, delves into the mechanism through which the digital economy impacts food production capacity. Employing a double fixed effect model, a mediation effect model, and a panel threshold model, we uncover several key findings: The digital economy significantly boosts food production capacity, with robustness tests affirming the reliability of our results. Mechanism analysis reveals that the digital economy enhances food production capacity by elevating total factor productivity and bolstering agricultural resilience. The threshold effect underscores that urbanization levels exhibit a single-threshold impact, wherein the influence of the digital economy on food production capacity intensifies upon crossing this threshold. Heterogeneity analysis reveals that the digital economy significantly boosts food production capacity in central and primary grain-producing regions, while its impact is comparatively weaker in the eastern and western regions, as well as in non-primary grain-producing areas. In summary, this research sheds light on the pivotal role of the digital economy in augmenting food production capacity, offering valuable insights into regional variations and thresholds in its impact across China.

Paediatric palliative care in Aotearoa New Zealand-current state and future direction.

This paper seeks to explore the current state of paediatric palliative care in Aotearoa New Zealand. The low priority afforded to paediatric palliative care for more than two decades has had a significant impact on service provision, education and research within this specialty. As a result, provision of specialist paediatric palliative care to children with serious illness and their whānau (family, including extended family) is inequitable and vastly inadequate. This paper considers the consequences of having limited access to specialist palliative care for children and whānau, and outlines what is required for both service development and current priorities for research.

Early Viral Dynamics Predict HIV Post-Treatment Control After Analytic Treatment Interruption.

A key research priority for developing an HIV cure strategy is to define the viral dynamics and biomarkers associated with sustained post-treatment control. The ability to predict the likelihood of sustained post-treatment control or non-control could minimize the time off antiretroviral therapy (ART) for those destined to not control and anticipate longer periods off ART for those destined to control. Mathematical modeling and machine learning were used to characterize virologic predictors of long-term virologic control using viral kinetics data from several studies in which participants interrupted ART. Predictors of post-ART outcomes were characterized using data accumulated from the time of treatment interruption, replicating real-time data collection in a clinical study, and classifying outcomes as either post-treatment control (plasma viremia ≤400 copies/mL at 2 of 3 time points for ≥24 weeks) or non-control. Potential predictors of virologic control were the time to rebound, the rate of initial rebound, and the peak plasma viremia. We found that people destined to be non-controllers could be identified within 3 weeks of rebound (prediction scores: accuracy, 80%; sensitivity, 82%; specificity, 71%). Given the widespread use of analytic treatment interruption in cure-related trials, these predictors may be useful to increase the safety of analytic treatment interruption through the early identification of people who are unlikely to become post-treatment controllers.

Battling for food security in Africa: Is climate finance the missing bullet?

AbstractAs climate change increasingly threatens food production and distribution in Africa, understanding how climate finance programs can effectively improve food security in the region has become a critical research priority. In this light, the present study investigates the effect of climate finance on food security across 37 African countries from 2012 to 2021, utilizing secondary data and employing the system generalized method of moments. Our findings consistently demonstrate that climate finance plays a significant role in reducing food insecurity in Africa. This effect remains robust across various alternative food insecurity and climate finance metrics. Furthermore, through analyses of transmission channels, we confirm the indirect pathways through which climate finance contributes to improved food security outcomes in the region. Based on the findings, the study recommends strengthening and expanding climate finance initiatives focusing on enhancing accessibility, equity, and targeted support for farmers to reduce food insecurity.