Resource-poor Areas Research Articles

Exploring the motivations of female community health volunteers in primary healthcare provision in rural Nepal: A qualitative study.

Motivating Community Health Workers (CHWs)-many of whom are volunteers-is crucial for achieving Universal Healthcare Coverage (UHC) for Primary Healthcare (PHC) in resource-poor areas. In rural Nepal, PHC is mostly delivered by female CHWs, locally known as Female Community Health Volunteers (FCHVs), but little is known about them. This paper explores experiential factors influencing FCHVs' motivations, including how motivation intersects with women's livelihoods and consider what this means for achieving PHC in Nepal and globally. We conducted qualitative research in the hill and the Terai (flatland bordering India) areas of Nepal. Data were purposively collected through 31 semi-structured interviews (20 volunteers, 11 paid local health workers) and three focus group discussions with additional 15 volunteers. All interviews were audio-recorded, transcribed verbatim in Nepali and translated into English. Data were coded using NVivo10, analysed thematically at individual, organisational and community levels. FCHVs' motivations to volunteer was affected in several ways. At the individual level, participants wanted and were committed to voluntary work, yet the opportunity costs of volunteering, out-of-pocket expenditure and inadequate family support strained many of the women who were already overburdened. At the community level, perceived lack of appreciation of volunteer efforts by community members, who saw volunteers as paid health workers, undermined FCHVs motivation to volunteer. Finally, at the organizational level, a bureaucratic emphasis on recording and reporting, and lack of respect from local health workers undermined their motivation at work. Our paper illustrates how FCHVs from some of the poorest backgrounds can be highly motivated to volunteer, yet inadequate social and economic support across individual, organisational and community levels undermined this motivation, the security of their livelihoods, and thus wider efforts to achieve PHC. Financial investments are needed to compensate FCHVs, so that they remain motivated to deliver global health goals for PHC.

Novel methods for the rapid and sensitive detection of Nipah virus based on a CRISPR/Cas12a system.

Nipah virus (NiV), a bat-borne zoonotic viral pathogen with high infectivity and lethality to humans, has caused severe outbreaks in several countries of Asia during the past two decades. Because of the worldwide distribution of the NiV natural reservoir, fruit bats, and lack of effective treatments or vaccines for NiV, routine surveillance and early detection are the key measures for containing NiV outbreaks and reducing its influence. In this study, we developed two rapid, sensitive and easy-to-conduct methods, RAA-CRISPR/Cas12a-FQ and RAA-CRISPR/Cas12a-FB, for NiV detection based on a recombinase-aided amplification (RAA) assay and a CRISPR/Cas12a system by utilizing dual-labeled fluorophore-quencher or fluorophore-biotin ssDNA probes. These two methods can be completed in 45 min and 55 min and achieve a limit of detection of 10 copies per μL and 100 copies per μL of NiV N DNA, respectively. In addition, they do not cross-react with nontarget nucleic acids extracted from the pathogens causing similar symptoms to NiV, showing high specificity for NiV N DNA detection. Meanwhile, they show satisfactory performance in the detection of spiked samples from pigs and humans. Collectively, the RAA-CRISPR/Cas12a-FQ and RAA-CRISPR/Cas12a-FB methods developed by us would be promising candidates for the early detection and routine surveillance of NiV in resource-poor areas and outdoors.

Research on Problems and Countermeasures of Education Rights of Special Children Groups

This article explores the educational rights of children with special needs and the right to education for children with special needs is a crucial component of an inclusive society, advocating for inclusive education as a fundamental right, which delves into the unique psychological, physical, cognitive, and social needs of these children and emphasizes the importance of Individualized Education Programs (IEPs), assistive technologies, and community support. It delves into the unique characteristics and educational priorities of children with special needs, identifies the problems and barriers they face in accessing education, and proposes strategies and recommendations for improvement, it also highlights the progress made in policy and societal attitudes, along with the challenges that remain, particularly in resource-poor areas. Meanwhile, it discusses legal and policy barriers, societal attitudes, and infrastructure issues, proposing policy reform, innovative educational strategies, and increased community and family involvement as solutions. The article concludes by calling for ongoing research and advocacy to ensure that the right to education for children with special needs is fully realized.

Intercropping Options for Sustainable Minor Millet Production: A Review

High population pressure, climate change, stagnant crop productivity, changing food habit and declining natural resources compelled us to go for climate resilient resource conservation technologies to bring sustainability in our crop production. Crop diversification by replacing high input requiring cereals with “nutri- cereals” minor millets in our crop rotations and by following intercropping of minor millets with pulses or oilseeds may be economically profitable, environmentally safe and socially acceptable approach to ensure food and nutritional security of the burgeoning population. This is high time to include millets in our daily diets but millet availability in sufficient amount is big issue. Millets are crops of rainfed and dryland resource poor areas and moreover under the threat of global warming and changed climatic scenario sole planting of millets generally gives less economic returns. So, there is an urgent need for incorporation of the pulses/oilseeds as intercrop in millets production system to enhance the production to feed the increasing population on sustained basis besides restoring the soil nutritional status and to overcome the environmental stress. But performance of intercropping system depends on proper selections of suitable intercrop, appropriate row ratio combination and proper input management. Very limited research work has been conducted on intercropping in millets so far but noteworthy information was recorded by the researchers, which has been reviewed through a sincere effort here to give critical view about intercropping in minor millets for agricultural sustainability to the farmers, researchers and consumers.

Unlocking the Role of Social Norms: How They Shape Women's Public Toilet Usage in India.

Poor access to toilets has significant impacts on hygiene, health, safety, and well-being. Women in resource-poor areas may not use public toilets because of concerns about personal safety and the disapproval of others. This study examines social beliefs about women's use of public toilets in India, using data from 5,052 households in rural, semi-urban, and urban slum areas of Bihar and Tamil Nadu in 2018. We asked respondents about their beliefs regarding the prevalence of young women aged 16 to 30 years using public toilets alone and whether this behavior was approved of in their community. We also asked about their personal beliefs on this issue. We used hypothetical vignettes to assess perceptions of a young woman's behavior in different settings regarding public toilet usage by women. Our results show that people who believe many women in their community use public toilets alone and approve of it are more likely to have positive beliefs about this behavior. The experimental vignettes suggest a potential causal link between the prevalence and approval of public toilet usage among young women and their likelihood of using it. These findings are consistent across Bihar and Tamil Nadu and the three administrative regions, indicating that interventions aimed at changing social expectations about women's use of public toilets should focus on highlighting community members' usage and approval. Efforts to encourage woman's access to public toilets and services should target shifting beliefs about public toilet usage among women without disapproval from others.

Designing Anti-Viral Vaccines that Harness Intrastructural Help from Prior BCG Vaccination.

Vaccines are among the most effective tools for combatting the impact and spread of infectious diseases. However, the effectiveness of a vaccine can be diminished by vaccine inequality, particularly during severe outbreaks of infectious diseases in resource-poor areas. As seen in many developing countries that lack adequate healthcare infrastructure and economic resources, the acquisition and distribution of potentially life-saving vaccines may be limited, leading to prolonged suffering and increased deaths. To improve vaccine equity, vaccine design must take into consideration the logistics needed to implement a successful vaccination drive, particularly among the most vulnerable populations. In the manuscript titled "Exploiting Pre-Existing CD4+ T Cell Help from Bacille Calmette-Guérin Vaccination to Improve Antiviral Antibody Responses" published in the Journal of Immunology, the authors designed a recombinant subunit vaccine against the Ebola virus (EBOV) glycoprotein that can harness the pre-existing T helper cells from prior BCG vaccination. As a recombinant subunit vaccine adjuvanted with alum, this approach has many features that make it well suited for the design of vaccines for developing nations, such as relative ease of production, scalability, and distribution. In addition, the high prevalence of BCG immunization and natural immunity to mycobacteria in many regions of the world endow such vaccines with features that should increase potency and efficacy among populations residing in such regions. As a result of using the helper activity of pre-existing BCG-specific Th cells to drive antibody responses, a lower vaccine dose is needed, which is a major advantage for vaccine manufacture. Furthermore, the BCG-specific Th cells also stimulate immunoglobulin class switching to IgG isotypes that have strong affinities for activating Fc-gamma receptors (FcγRs). Taken together, we propose that the design of subunit vaccines with intrastructural help from BCG-specific Th cells can improve protection against viral infection and represents a vaccine design that can be generally adapted to other emerging viral pathogens for the control and prevention of infection in many developing countries.

B-247 Rapid and Field-deployable Microchip-based Real-time PCR for Hepatitis B Virus DNA Detection

Abstract Background Hepatitis B is one of the most common infectious diseases with global significance, seriously causing chronic liver complications and a heavy health burden in developing countries. There is no doubt that real-time polymerase chain reaction (RT-PCR) has been a golden standard for monitoring the Hepatitis B virus (HBV) level in clinical health management. However, the conventional PCR protocol cannot fulfill the field test requirement in some resource-poor areas due to its drawbacks, such as huge size, long turnaround time, and demand for professional laboratory facilities. For solving these problems, a portable microfluidic chip-based PCR detection system was developed to enable the nucleic acid test in a flexible, rapid, and economical way. With the efficient temperature control module and advanced optical path design, this novel panel can achieve fast thermal circulation with a 30°C/s heating rate and multiple fluorescent detection with a throughput of 6 samples at a time. Methods In this study, we assessed the detection performance of the system using a commercial HBV nucleic acid detection kit. The reproducibility, limit-of-detection (LoD), and linearity were validated by reference samples with gradient concentrations. We evaluated the clinical sensitivity and specificity of the microdevice by a total of 200 extracted serum samples (100 positive and 100 negative cases). The analytical results were compared with a traditional PCR device with FDA certification. Results The variation coefficients of the microdevice for reference samples with different concentrations are 1.78%, 1.98%, and 1.50% (n = 10), respectively. The field-deployable PCR system can provide the HBV DNA assay with a detection limit of 300 IU/ml, whose reaction time was approximately 67 mins rather than the 108 mins performed by the comparator. During the establishment of the standard curve, this fast PCR test shows a strong linear correlation (R2 = 0.9919) between targeted gene concentration and dilution factor. Additionally, among the 200 clinical samples, we used the microchip-based system to rapidly complete quantitative detection for each sample with high sensitivity of 100% (100/100) and specificity of 100% (100/100), which is critically consistent with the traditional PCR method. Conclusion Hence, the point-of-care microfluidic PCR system exhibits great feasibility in offering timely, accurate, and reliable molecular diagnosis for early epidemic disease screening and therapeutic guidance of chronic infections.

Boosting Electrochemiluminescence Immunoassay Sensitivity via Co-Pt Nanoparticles within a Ti3C2 MXene-Modified Single Electrode Electrochemical System on Raspberry Pi.

Point-of-care testing plays a crucial role in diagnostics within resource-poor areas, necessitating the utilization of portable and user-friendly devices. The adaptation of biosensors for point-of-care applications requires careful considerations, such as miniaturization, cost-effectiveness, and streamlined sample processing. In recent years, the electrochemiluminescence (ECL) immunoassay has gained significant attention due to its visual detection capabilities and ability to facilitate high-throughput analysis. However, the development of a practical and cost-effective ECL device remains a challenging task. This study presents the development of an integrated MXene-modified single-electrode electrochemical system (SEES) for visual and high-throughput ECL immunoassays incorporating a Raspberry Pi system. The SEES was designed by affixing a plastic sticker with multiple perforations onto a single carbon ink screen-printed electrode, which operates based on a resistance-induced potential difference. Leveraging the excellent adsorption and bioaffinity properties of the carbon ink screen-printed electrode, effective immobilization of antibodies was achieved. Furthermore, the incorporation of Co-Pt nanoparticles enhanced the ECL intensity and electron transfer kinetics, enabling the sensitive detection of SARS-CoV-2. The developed system comprised 18 individual reaction cells, allowing for simultaneous analysis while maintaining sample isolation. Impressively, the system achieved a remarkable minimum virus detection limit of 10-14 g mL-1, accompanied by a high R2 value of 0.9798. These findings highlight the promising potential of our developed system for efficient point-of-care testing in resource-limited settings.

Sustainable P-enriched biochar-compost production: harnessing the prospects of maize stover and groundnut husk in Ghana’s Guinea Savanna

Farmers in resource-poor areas of the Guinea Savanna zone of Ghana often face declining soil fertility due to the continuous removal of nutrient-rich harvested produce from their fields. This study focuses on the Lawra Municipality in the Guinea Savanna zone of Ghana, where low soil fertility, specifically, limits phosphorus (P) bioavailability and hinders crop production. The objective of this research is to formulate P-enhanced biochar-compost from maize stover (MS) and groundnut husk, which abound in the area, to close the nutrient loop. MS was co-composted with groundnut husk biochar at varying rates of 0, 10, 20, 30, and 40% by volume. To facilitate decomposition using the windrow system, the composting heaps were inoculated with decomposing cow dung, and the moisture content was kept at 60% throughout the monitoring period. The addition of biochar shortened the lag phase of composting. However, rates above 20% resulted in reduced degradation of MS. Biochar incorporation enriched the available phosphorus content in the final compost from 286.7 mg kg−1 in the non-biochar-compost to 320, 370, 546, and 840.0 mg kg−1 in the 10, 20, 30, and 40% biochar-compost, respectively.

Gramineae-legumes mixed planting effectively reduces soil and nutrient loss in orchards

Soil, water, and nutrients depletion may affect sustainable agriculture in some resource-poor areas. Implementing cover crops as a conservation management strategy mitigates the loss of water, soil, nitrogen (N), and phosphorus (P) by introducing vegetation during non-crop seasons or in the spaces between rows instead of leaving the land bare. This study aimed to compare water, soil, various carbon (C) forms, N, and P losses through leaching and surface runoff in orchard fields that were managed with either no-cover crop (NC) or cover crops, including natural grass (NG), Legume grass (LG), Gramineae grass (GG), and a mixture of Legume and Gramineae grass (MG). The findings indicate that cover crop fields exhibited a significant reduction in the runoff by 33–60 %, leaching amount by 33–51 %, soil loss by 30–53 %, and total C, N, and P by 30–48 %, 30–49 %, and 30–38 %, respectively compared to NC fields. Additionally, implementing artificial grass, particularly MG, demonstrated more significant efficacy in mitigating water and soil losses and associated N and P losses. Specifically, MG fields exhibited a 40 % and 18 % reduction in runoff and leaching as well as a reduction in total C, N, and P loss by 7 %, 12 %, and 7 %, respectively, compared to NG fields. The LG field experienced a 50 % more significant N loss than the MG field, whereas the GG runoff exhibited an increase of more than 70 %. Implementing MG coverage has significantly reduced soil erosion and consequent nutrient loss, establishing it as a viable and uncomplicated approach to conserving soil and water in orchards.

A pipette-smartphone portable on-site detection system for aflatoxin B1 detection in bread and peanut based on "Four-in-one" sea-urchin-like composite catalyst

The development of a low-cost, high-sensitivity, portable bioassay for detecting the highly toxic and thermally stable aflatoxin B1 (AFB1) is of significant importance to food safety and human health. A pipette–smartphone integrated biosensor based on a super “four-in-one” DNA sea-urchin-like composite catalyst (FSCC) was constructed for the efficient analysis of AFB1. Detection is possible via a self-made poly(methyl methacrylate) pipette, combined with a smartphone to further increase the biosensor’s portability. The combination of the two greatly simplifies experimental operations, reduces testing costs, and can minimize matrix interferences through sample pre-treatment operations. And the smartphone-APP signal readout strategy can avoid the need for a reading instrument, making it more suitable for field testing. The FSCC was developed by fully utilizing the properties of a Fe-Zr-metal–organic framework (Fe-Zr-MOF), which exhibits high catalytic activity and enables the encapsulation of abundant horseradish peroxidase in its pores, the in-situ reduction and enrichment of Pt nanoparticles on its surface, and the coordination of biotinylated DNA to achieve a high adsorption capacity of streptavidin-horseradish peroxidase. This ensured detection sensitivity, with a limit of detection = 1.57 pg/mL. The developed biosensor displays notable application potential, especially in resource-poor areas due to the advantages of low costs, simple operation, ultra-high sensitivity, portability, etc.

Performance of artificial intelligence for the detection of pathological myopia from colour fundus images: a systematic review and meta-analysis

BackgroundPathological myopia (PM) is a major cause of worldwide blindness and represents a serious threat to eye health globally. Artificial intelligence (AI)-based methods are gaining traction in ophthalmology as highly sensitive and specific tools for screening and diagnosis of many eye diseases. However, there is currently a lack of high-quality evidence for their use in the diagnosis of PM.MethodsA systematic review and meta-analysis of studies evaluating the diagnostic performance of AI-based tools in PM was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidance. Five electronic databases were searched, results were assessed against the inclusion criteria and a quality assessment was conducted for included studies. Model sensitivity and specificity were pooled using the DerSimonian and Laird (random-effects) model. Subgroup analysis and meta-regression were performed.ResultsOf 1021 citations identified, 17 studies were included in the systematic review and 11 studies, evaluating 165,787 eyes, were included in the meta-analysis. The area under the summary receiver operator curve (SROC) was 0.9905. The pooled sensitivity was 95.9% [95.5%-96.2%], and the overall pooled specificity was 96.5% [96.3%-96.6%]. The pooled diagnostic odds ratio (DOR) for detection of PM was 841.26 [418.37–1691.61].ConclusionsThis systematic review and meta-analysis provides robust early evidence that AI-based, particularly deep-learning based, diagnostic tools are a highly specific and sensitive modality for the detection of PM. There is potential for such tools to be incorporated into ophthalmic public health screening programmes, particularly in resource-poor areas with a substantial prevalence of high myopia.

Validation of a method for the dry preservation and rehydration of Anopheles gambiae sensu lato for parity analysis to assess the impact of vector control measures in the field

BackgroundAs the control of malaria remains heavily dependent on vector management interventions, it is important to understand the impact of these on mosquito populations. Age-grading is a valuable tool for this; however, logistical challenges in remote, resource-poor areas make current methodologies difficult to incorporate into clinical trials and routine surveillance. Our aim was to validate a methodology that could be easily implemented in such settings. Using dried mosquito specimens instead of freshly killed ones, we validated the commonly used ovarian tracheation technique for assessing population age structure.MethodsLaboratory-reared Anopheles coluzzii mosquitoes with known parity status were dry preserved in silica gel for up to 12 weeks and rehydrated prior to parity assessment. The results were compared to parity results for freshly killed mosquitoes from the same colony. Preserved, field-caught Anopheles gambiae sensu lato (s.l.) from Guinea-Bissau were assessed by three different assessors blinded to each other’s scores. An overall index of agreement was calculated using inter-rater reliability of all assessor pairings. The impact of preservation time was investigated using a one-way ANOVA to look for differences in assessor agreement over three time periods.ResultsThe parity status was correctly identified for 90% of dry preserved and rehydrated insectary-reared An. coluzzii and for 98% of freshly killed insectary-reared An. coluzzii. The inter-rater reliability was highest (0.94) for freshly killed An. coluzzii. The results for all time points showed excellent strength of agreement between assessors. For field-caught An. gambiae s.l., the overall index of agreement between all three assessors was 0.86 (95% confidence interval 0.78–0.93), indicating almost perfect agreement. There was no significant difference between assessor agreement between time frames.ConclusionsDry preserving and rehydrating Anopheles mosquitoes provides an alternative to using freshly killed mosquitoes to assess the efficacy of a control intervention in remote settings where it is logistically difficult to dissect fresh specimens. This method also provides the flexibility required for parity assessment to be done on larger scales over bigger areas.Graphical

Dupilumab as a Combination Therapy to Oral Systemic Immunomodulators for Moderate-to-Severe Atopic Dermatitis for Skin of Color Children in Resource-Limited Setting: A Case Series

Abstract Subcutaneous dupilumab, with or without topical therapy, is clinically proven to treat children with moderate-to-severe atopic dermatitis (AD). However, this well-researched biologic for AD in children is still among the most expensive medication in the world and not widely available in resource-poor areas. We share our experience managing four children with severe AD, aged 3 to 11, who poorly responded to oral systemic immunomodulators but successfully achieved rapid clinical remission when combined with subcutaneous dupilumab. No loading doses were administered to patients in this case series, and the maintenance dosages used were lower than the manufacturer’s recommendations. This case series illustrates that oral immunomodulators in combination with subcutaneous dupilumab therapy are efficacious, safe, tolerable, and cost-effective for children with moderate-to-severe AD. This treatment strategy can be considered an alternative for children with AD recalcitrant to other available treatment options, especially when AD management is challenging in limited resource settings.

Europium Nanoparticle-Based Lateral Flow Strip Biosensors Combined with Recombinase Polymerase Amplification for Simultaneous Detection of Five Zoonotic Foodborne Pathogens

The five recognized zoonotic foodborne pathogens, namely, Listeria monocytogenes, Staphylococcus aureus, Streptococcus suis, Salmonella enterica and Escherichia coli O157:H7, pose a major threat to global health and social–economic development. These pathogenic bacteria can cause human and animal diseases through foodborne transmission and environmental contamination. Rapid and sensitive detection for pathogens is particularly important for the effective prevention of zoonotic infections. In this study, rapid and visual europium nanoparticle (EuNP)-based lateral flow strip biosensors (LFSBs) combined with recombinase polymerase amplification (RPA) were developed for the simultaneous quantitative detection of five foodborne pathogenic bacteria. Multiple T lines were designed in a single test strip for increasing the detection throughput. After optimizing the key parameters, the single-tube amplified reaction was completed within 15 min at 37 °C. The fluorescent strip reader recorded the intensity signals from the lateral flow strip and converted the data into a T/C value for quantification measurement. The sensitivity of the quintuple RPA-EuNP-LFSBs reached a level of 101 CFU/mL. It also exhibited good specificity and there was no cross-reaction with 20 non-target pathogens. In artificial contamination experiments, the recovery rate of the quintuple RPA-EuNP-LFSBs was 90.6–101.6%, and the results were consistent with those of the culture method. In summary, the ultrasensitive bacterial LFSBs described in this study have the potential for widespread application in resource-poor areas. The study also provides insights in respect to multiple detection in the field.

Commentary: Impact of manual small-incision cataract surgery on outreach and training curriculum across the world.

Commentary: Impact of manual small-incision cataract surgery on outreach and training curriculum across the world.

Rapid Single-Step Immunochromatographic Assay for Angiostrongylus cantonensis Specific Antigen Detection.

Angiostrongylus cantonensis is the major etiological nematode parasite causing eosinophilic meningitis and/or eosinophilic meningoencephalitis in humans. The rapid global spread of Angiostrongylus cantonensis and the emerging occurrence of the infection have exposed the shortcomings of traditional/conventional diagnostics. This has spurred efforts to develop faster, simpler and more scalable platforms that can be decentralized for point-of-need laboratory testing. By far, the point-of-care immunoassays such as the lateral flow assay (LFA) are the best-placed. In this work, a LFA in the form of an immunochromatographic test device (designated AcAgQuickDx), based on the detection of a circulating Angiostrongylus cantonensis-derived antigen, was established using anti-31 kDa Angiostrongylus cantonensis antibody as the capture reagent and anti-Angiostrongylus cantonensis polyclonal antibody as the indicator reagent. The AcAgQuickDx was evaluated for its diagnostic potential with a total of 20 cerebrospinal fluids (CSF) and 105 serum samples from patients with angiostrongyliasis and other clinically related parasitic diseases, as well as serum samples from normal healthy subjects. Three of the ten CSF samples from serologically confirmed angiostrongyliasis cases and two of the five suspected cases with negative anti-Angiostrongylus cantonensis antibodies showed a positive AcAgQuickDx reaction. Likewise, the AcAgQuickDx was able to detect Angiostrongylus cantonensis specific antigens in four serum samples of the 27 serologically confirmed angiostrongyliasis cases. No positive reaction by AcAgQuickDx was observed in any of the CSF (n = 5) and serum (n = 43) samples with other parasitic infections, or the normal healthy controls (n = 35). The AcAgQuickDx enabled the rapid detection of active/acute Angiostrongylus cantonensis infection. It is easy to use, can be transported at room temperature and does not require refrigeration for long-term stability over a wide range of climate. It can supplement existing diagnostic tests for neuroangiostrongyliasis under clinical or field environments, particularly in remote and resource-poor areas.

Reconstructive Surgery for the Neglected Tropical Diseases: Global Gaps and Future Directions.

A review of the literature was conducted using the online database PubMed, from 2008 to 2021 with the specific diseases listed as NTDs either on the World Health Organization or the PLoS Neglected Tropical Disease websites. Reference lists of identified articles and reviews were also searched, as were databases from the World Health Organization's Weekly Epidemiological Record. Success in the surgical treatment and postoperative care of disfiguring NTDs would benefit from standardization and harmonization of surgical approaches and procedures. In some settings, reconstructive surgery should be used cautiously, emphasizing appropriate use of antibiotics, partnerships with global and local surgical teams, and local capacity building. Preventative hygiene approaches remain paramount in resource-poor areas. Surgery is a promising treatment for NTDs that result in disfigurement and disability. The expansion of local capacity building, with medical trips and surgical training of local health workers, together with the development of universal surgical protocols remain essential cornerstones for NTD reconstructive surgery. Antibiotics and drug management should comprise key first steps before turning to surgery.

China’s Inter-Provincial Energy Security Resilience Assessment over Space and Time: An Improved Gray Relational Projection Model

In recent years, with the increasing impact of extreme weather events on energy security, energy vulnerability has increased significantly, and more and more international institutions and departments have begun to incorporate resilience governance into energy security. This paper focuses on China’s inter-provincial energy security assessment. Compared with existing relevant research, the significant features of our work are (i) introducing the concept of energy resilience and presenting its evolution mechanism and evaluation criteria, (ii) developing a gray relational projection model by using the level difference maximization and optimization theory, (iii) measuring the energy resilience of 30 Chinese provinces over space and time. Our results show that the spatial–temporal patterns of energy resilience in China changed significantly from 2005 to 2018. High energy resilience moved from provinces with abundant nonrenewable energy before 2010 to provinces with high energy diversity. Energy endowment is a primary condition to ensure a region’s energy resilience. Renewable energy development, energy investment, economic development, and policy coordination play vital roles in ensuring regional energy resilience. Energy investment and economic development can effectively improve the energy resilience of resource-poor areas. This study’s results will serve as a reference for China and contribute to expanding knowledge in this field.

A Novel RT-LAMP for the Detection of Different Genotypes of Crimean-Congo Haemorrhagic Fever Virus in Patients from Spain.

Crimean-Congo haemorrhagic fever (CCHF) is a potentially lethal tick-borne viral disease with a wide distribution. In Spain, 12 human cases of CCHF have been confirmed, with four deaths. The diagnosis of CCHF is hampered by the nonspecific symptoms, the high genetic diversity of CCHFV, and the biosafety requirements to manage the virus. RT-qPCR and serological tests are used for diagnosis with limitations. Reverse-transcription loop-mediated isothermal amplification (RT-LAMP) could be an effective alternative in the diagnosis of the disease. However, none of the few RT-LAMP assays developed to date has detected different CCHFV genotypes. Here, we designed a RT-LAMP using a degenerate primer set to compensate for the variability of the CCHFV target sequence. RT-LAMP was performed in colorimetric and real-time tests on RT-qPCR-confirmed CCHF patient samples notified in Spain in 2020 and 2021. Urine from an inpatient was analysed by RT-LAMP for the first time and compared with RT-qPCR. The amplicons obtained by RT-qPCR were sequenced and African III and European V genotypes were identified. RT-LAMP amplified both genotypes and was more sensitive than RT-qPCR in urine samples. We have developed a novel, rapid, specific, and sensitive RT-LAMP test that allows the detection of different CCHFV genotypes in clinical samples. This pan-CCHFV RT-LAMP detected viral RNA for the first time in urine samples. It can be easily performed as a single-tube isothermal colorimetric method on a portable platform in real time and without the need for expensive equipment, thus bringing molecular diagnostics closer to rural or resource-poor areas, where CCHF usually occurs.