Background Accurate, non-invasive quantification of hepatic steatosis is crucial for clinical management. Recently developed ultrasound-guided attenuation techniques, such as Liver Steatosis Analysis (LiSA) and the Ultrasound-Guided Attenuation Parameter (UGAP), integrate real-time B-mode imaging with quantitative measurement, potentially overcoming the limitation of the lack of real-time guidance in the traditional Controlled Attenuation Parameter (CAP). However, direct comparative evidence for their performance in clinical practice remains insufficient. This study aimed to conduct a head-to-head comparison of the diagnostic performance of LiSA and UGAP, using the widely adopted CAP as a clinical reference standard. Methods This prospective study ultimately included 357 participants. All participants underwent LiSA, UGAP, and CAP examinations during a single visit. Operations followed standardized protocols with strict quality control (IQR <40 dB/m, IQR/M <30%). CAP-defined steatosis grades (S0-S3) served as the reference. Pearson correlation analysis was used to assess the associations of each parameter with CAP, Body mass index (BMI), etc. Diagnostic performance was evaluated using receiver operating characteristic (ROC) curve analysis, and the area under the ROC curves (AUROCs) of LiSA and UGAP were compared using the DeLong test. Results Both LiSA and UGAP demonstrated very high technical success rates (both 99.74%), significantly higher than that of CAP (96.84%, p = 0.002). Their measurements showed strong correlations with CAP values (LiSA: r = 0.83; UGAP: r = 0.81, both p < 0.001). For discriminating different steatosis grades (≥S1, ≥S2, =S3), LiSA achieved AUROCs of 0.96, 0.91, and 0.86, respectively, while UGAP achieved AUROCs of 0.96, 0.91, and 0.85, respectively. The DeLong test indicated no statistically significant difference in diagnostic performance between the two techniques across all grades (all p-values >0.62). This study provides, for the first time, CAP-referenced cut-off value suggestions for LiSA in diagnosing S2 and S3 steatosis (269.00 dB/m and 300.00 dB/m, respectively). Conclusion LiSA and UGAP show high agreement with CAP in diagnosing and grading hepatic steatosis, with comparable performance to each other. By virtue of their inherent integration with real-time B-mode imaging, they offer higher technical success rates and operational ease, demonstrating superior clinical feasibility compared to CAP. These findings support LiSA and UGAP as effective and practical alternatives or complements to CAP, enriching the toolkit for point-of-care steatosis assessment.

To evaluate the variability of P-score grading within the same eye during a single imaging session (P-Var) as a function of retinopathy of prematurity (ROP) severity. This study analyzed retinal images from 20 consecutive subjects selected from the Stanford University Network for Diagnosis of ROP (SUNDROP) database who were screened between January 2023 and December 2024 and subsequently received treatment. Nine masked graders evaluated the P-scores of 1597 images from 129 imaging sessions. Variability was measured through calculation of range, intergrader reliability, and agreement metrics. Probabilistic modeling was conducted to assess the impact of limited image sampling on disease classification. Significant P-score variability was observed within single eye visits, increasing with worsening vascular disease (maximum eye visit P-score: β = 0.222, P < 0.001) and overall disease severity as assessed with the Telemedicine ROP Severity Score (β = 0.0073, P < 0.001). Intergrader agreement for the nine graders was good (intraclass correlation coefficient [ICC] = 0.68; 95% confidence interval [CI], 0.65-0.71). Mean ± SD weighted kappa was 0.66 ± 0.10 between grader pairs. Exact P-score agreement was 28.5% ± 5.6%, improving to 72.5% ± 8.2% when allowing a ±1 P-score unit difference. The coefficient of variation of image-level P-scores between graders decreased with worsening disease. Probabilistic modeling demonstrated that limited image sampling with fewer than five views per eye can lead to significant misclassification, particularly in plus eyes. P-score variability exists within the same imaging session and increases with disease severity. These findings suggest that multiple images per session are necessary for accurate disease classification, particularly in eyes with more severe disease.

Rapid Access Neck Lump clinics are specialised clinics that focus on the evaluation, diagnosis and management of head and neck lumps in a timely manner. Internationally, these dedicated clinics are being utilised to improve outcomes of head and neck cancer patients. To date, there are only a few such clinics in the Australian public health system. The objective of this study was to demonstrate the benefits of a rapid access neck lump clinic, aiming to reduce waiting times for diagnosis and treatment commencement. A multidisciplinary consultant led rapid access neck lump clinic was established including a head and neck surgeon, radiologist, and pathologist. This allowed comprehensive evaluation of the patient with a neck lump in a single visit. Data were collected prospectively for all attendances at this clinic since its inception, over a five-year period from February 2018 to February 2023. The primary outcome was clinic efficiency including referral to assessment interval and time to diagnosis. Secondary outcomes included malignancy rate, diagnostic accuracy of fine needle aspiration cytology, and time to treatment initiation. The review included 437 consecutive patients seen in the clinic. The mean time from referral to first specialist assessment was 16.1 (+/-9.54 days). Ultrasound guided FNA was performed in 61% of patients and yielded a malignancy rate of 38.6%. The median number of days between specialist assessment and discussion at head and neck MDT was 5 days. The mean time between clinic review and treatment commencement was 39.3 days. This is the largest and first dataset of a rapid access neck lump clinic in Australia. The implementation of this clinic has reduced delays to assessment, diagnosis and consequentially treatment planning and treatment for patients with newly diagnosed head and neck cancer.

Aims: Marked elevation of serum total immunoglobulin E (IgE) levels (&amp;gt;1000 IU/ml) is most commonly associated with atopic diseases; however, its underlying etiology is highly heterogeneous. This study aimed to systematically evaluate the etiological factors associated with markedly elevated serum total IgE levels in patients attending an allergy and immunology outpatient clinic. Methods: Medical records of 1103 patients with serum total IgE levels &amp;gt;1000 IU/ml who presented to the allergy and immunology outpatient clinic between January 1 and September 1, 2023, were retrospectively reviewed. Patients with only a single outpatient visit and those who did not undergo adequate diagnostic evaluation to determine the cause of IgE elevation were excluded. A total of 643 patients who completed comprehensive clinical, laboratory, and diagnostic assessments were included in the final analysis. Etiological causes of IgE elevation were classified based on clinical and laboratory findings. Results: The mean age of the 643 patients was 47.55±17.00 years, and 52.9% were female. The median serum total IgE level was 1520 (1001–62,753) IU/ml. Atopic diseases were identified as the most common etiological factor (n:530, 82.4%). Other causes included infectious diseases (5.3%), inflammatory diseases (1.2%), neoplasms (0.5%), primary immunodeficiency disorders (0.2%), drug-related causes (0.2%), and other conditions (0.2%). Despite comprehensive evaluation, no underlying cause could be identified in 65 patients (10.1%), who were classified as having idiopathic total IgE elevation. Conclusion: Although markedly elevated serum total IgE levels are predominantly associated with atopic diseases, a substantial proportion of patients have alternative or unidentified etiologies. A systematic and multidisciplinary diagnostic approach is essential to accurately identify the underlying cause of IgE elevation and to guide appropriate clinical management.

Some Saxifraga species possess an intraindividual variation of flower symmetry and orientation: flowers with horizontally oriented corolla planes are radially symmetrical, whereas flowers with vertically oriented corolla planes are bilaterally symmetrical. Petal size, petal colouration, sequence of stamen movement, and interpetal angles are induced by gravity and thus correlate with symmetry and orientation. The flower visitors' responses to flower symmetry and orientation were tested in the field with fly-pollinated Saxifraga stellaris and S. cuneifolia. Video analysis of approach and landing behaviour showed that the landing site on the flowers was independent of flower symmetry and orientation. The flower visitors’ body axis, however, was aligned with the flowers’ vertical axis in most cases, since most flies land with their heads facing upwards. The flies' movement on the flower is more constrained in vertically oriented flowers: instead of walking around the protruding carpels, they walk over them. In a lab-based experiment, the deposition of pollen surrogate on stigmas of S. fortunei was tested using Episyrphus balteatus hoverflies that were dusted with pigment particles before a single flower visit. The hoverflies deposited more pigment particles on vertically oriented flowers, irrespective of flower symmetry. It is discussed whether vertically oriented bilaterally symmetrical Saxifraga flowers benefit from the avoidance of self-pollination and reduced pollen clogging. The role of differences in bilateral symmetry among Saxifraga species with regard to the display of floral guides in the upper petals, initiation of stamen movement in the lower stamens, petal length and interpetal angles is discussed in the context of pollination efficiency.

Abstract We study the properties of 56 massive (M⋆ &amp;gt; 1010 M⊙) galaxies at z &amp;lt; 1 that host AGN, detected via their broadband optical variability in the VST-COSMOS survey. VST-COSMOS provides a nearly-identical single visit depth (r ∼ 24.6 mag) and temporal baseline (eleven years) as the forthcoming Legacy Survey of Space and Time (LSST), albeit in a much smaller 1 deg2 footprint (four orders of magnitude smaller than that of the LSST). We compare the properties (morphologies, the presence of interactions, rest-frame colours and environment) of our AGN to galaxies in a control sample, which are drawn from the non-variable population and matched in redshift and stellar mass to their AGN counterparts. The fraction of AGN with early-type morphology (∼55percnt) and the fraction that is interacting (∼23percnt) are similar to what is observed in the controls, suggesting that these AGN are not primarily triggered by interactions. Similarly, the AGN and controls do not show strong differences in their rest-frame (u − z) colours or local environment, suggesting that neither the recent star formation histories nor the surroundings of the AGN are strongly atypical of the general galaxy population. This study provides a glimpse into forthcoming AGN science using the LSST. With vastly improved statistics, LSST will offer unprecedented insights into AGN demographics, host-galaxy evolution and the processes that fuel supermassive black holes, potentially reshaping our understanding of their place in the Universe.

To compare the consistency of choroidal hypertransmission (HT) and retinal pigment epithelium (RPE) loss area measurements among three commonly used spectral-domain optical coherence tomography (OCT) devices and assess their robustness for monitoring of geographic atrophy (GA). Patients with GA were imaged during a single visit using the three different OCT: (1) Heidelberg Spectralis; (2) Zeiss Cirrus; (3) Topcon Maestro2. Expert readers manually annotated a total of 120 OCT volumes for RPE loss and HT. Dice similarity coefficients (DSC) were calculated to quantify the spatial overlap between the lesions within each OCT device. Intraclass correlation coefficients (ICC) and Bland-Altman analyses were used to assess inter-device agreement. Spatial overlap between HT and RPE loss ranged from moderate to good, with HT lesions being significantly larger than RPE loss areas across all devices (p < 0.001). Overall agreement was good for HT and RPE loss. Systematic biases emerged, with Cirrus yielding consistently smaller measurements compared to Spectralis or Maestro2. Lesion measurements demonstrated good agreement across all three OCT devices, yet device-dependent differences require caution when comparing data. Accounting for inter-device variability is an essential step toward reliable clinical endpoints and successful integration of automated OCT algorithms into clinical trials and routine AMD care.

To compare post-operative pain following root canal treatment (RCT) in HIV-positive patients receiving highly active antiretroviral therapy (HAART) and HIV-negative patients and to assess the influence of systemic condition on endodontic pain. This investigation was designed as a prospective observational cohort study, following the PROBE 2023 guidance. A total of 60 patients (30 HIV-positive under HAART for at least three years with undetectable viral load, and 30 HIV-negative) with pulp necrosis and asymptomatic apical periodontitis were included. All teeth were treated in a single visit by an endodontic specialist using standardised chemo-mechanical preparation with reciprocating instruments, irrigation with 2.5% sodium hypochlorite and 17% EDTA, and single-cone obturation with AH Plus sealer. Patients without preoperative pain (VAS = 0) were included. Post-operative pain was assessed using a VAS, 0-10 at 6, 12, 24, 48 and 72 h and 7 days post-treatment. Statistical analysis was performed using the chi-square test, Kolmogorov-Smirnov test, and Mann-Whitney U test (95% confidence level). No significant differences were found between groups regarding sex, age or tooth location (p > 0.05). Both groups reported postoperative pain in the first 24 h, with no significant differences (p > 0.05). At 48 h, however, all HIV-positive patients reported complete pain relief, whereas the HIV-negative group still presented residual pain, showing a statistically significant difference (p = 0.021). At 72 h and 7 days, both groups reported no pain (VAS = 0). Overall, postoperative pain prevalence exceeded 45% in the first 24 h, regardless of systemic condition. Postoperative pain patterns were similar in HIV-positive patients under HAART and HIV-negative individuals, except for earlier pain resolution in the HIV-positive group at 48 h. These findings suggest that the systemic condition does not negatively affect the short-term management of endodontic pain.

BackgroundChronic obstructive pulmonary disease (COPD) is a chronic inflammatory disease characterized by airflow limitation and exertional dyspnea, leading to reduced exercise tolerance and physical inactivity. Nasal high-flow (NHF) therapy delivers heated and humidified gas at a high flow rate through a nasal cannula, washing out anatomical dead space, providing a small degree of positive airway pressure, improving ventilation efficiency, and reducing the work of breathing. In addition, adequate humidification may enhance ciliary clearance. The AIRVO3TM (Fisher & Paykel Healthcare, Auckland, New Zealand) is a novel portable NHF device that incorporates these features and can be used during ambulation. Using AIRVO3TM during exertion may improve exercise tolerance in patients with COPD; however, its safety and effectiveness in ambulatory patients have not yet been established.MethodsThis is a single-center, early-phase, open-label, randomized, two-period crossover pilot trial conducted at Nagasaki University Hospital, designed to evaluate the acute, within-day effects of AIRVO3TM on exercise tolerance during a single visit. Twenty patients with moderate to severe COPD will perform two 6-minute walk tests (6MWT) in a randomized order: one with AIRVO3TM and one without the device. The primary outcome is the 6-minute walk distance (6MWD). Secondary outcomes include percutaneous oxygen saturation (SpO2), transcutaneous partial pressure of carbon dioxide (PtcCO2), respiratory rate, pulse rate, Borg dyspnea scale score, time to desaturation (SpO2 ≤90%), time to PtcCO2 ≥45 mmHg, time to respiratory rate ≥22/min, walking distance to the first rest, patient-reported comfort, and subjective symptoms. Safety outcomes include the incidence of SpO2 <90%, adverse events (AEs), device-related discomfort, and withdrawal or dropout. Data will be analyzed primarily using paired t-tests and mixed-effects models that are appropriate for a crossover design.DiscussionThis trial will evaluate whether a portable NHF device increases exercise tolerance and is safe during ambulation in patients with COPD who do not require long-term oxygen therapy. By using room air [finspiratory oxygen fraction (FiO2) 21%] and focusing on high flow rather than high oxygen concentration, this study will clarify the pure effects of high-flow nasal therapy on exertional capacity. If the AIRVO3TM device is shown to be effective and acceptable, it may expand the options for pulmonary rehabilitation and daily physical activity in patients with COPD. Because all assessments are performed during a single study visit, this trial specifically evaluates short-term, acute responses to AIRVO3TM rather than long-term training effects of repeated use.Trial RegistrationThe study is registered in the Japan Registry of Clinical Trials (jRCT; trial ID jRCTs072240116; registered on February 20, 2025; https://jrct.mhlw.go.jp/latest-detail/jRCTs072240116). This article describes the protocol version 1.1 (March 11, 2025).

The Carbon Footprint of MRI Access: A Population-Based Study Evaluating Excess Patient Travel and CO2 Emissions in Nova Scotia.

We investigated the agreement between pulse wave velocity (PWV) and augmentation index (AIx%) obtained in a controlled fasted condition versus a non-fasted, uncontrolled, "real-world" condition. Thereafter, we assessed the reproducibility of PWV and AIx% over three repeated visits under controlled fasted conditions. PWV and AIx% were assessed in one uncontrolled visit, and three controlled fasted visits after a 10-min supine rest in 28 adolescents (61% girls) aged 12-14 years. Intraclass correlation coefficients (ICCs) between controlled visits were 0.5-0.6 (PWV) and -0.3-0.6 (AIx%) for PulsePen, and 0.5-0.6 (PWV) and 0.4-0.7 (AIx%) for Arteriograph. ICCs between a single uncontrolled visit and controlled visits were lower, especially for the Arteriograph (PWV: 0.0-0.1; AIx%: -0.4-0.0). Device agreement was poor (PWV ICC: -0.2-0.1; AIx% ICC: -0.5-0.3). Reproducibility using PulsePen was (PWV: 0.2-0.8; AIx%: -0.3-0.6) and Arteriograph (PWV: 0.0-0.1; AIx%: -0.4-0.0). The PulsePen had better reproducibility of PWV than the Arteriograph. Both devices had limited reliability and high variability in AIx% measurements. PWV from the PulsePen may be applicable in healthcare, while results from the Arteriograph should be interpreted with caution. Because of the poor agreement between the devices, the data from these devices should not be directly compared. These results may not be generalizable based on the modest sample size. In addition, the variability in real-world situations should not be overlooked.

Background/Objectives: Children and adolescents with intellectual disabilities (ID) have an elevated burden of obesity and cardiometabolic risk, yet factors associated with high blood pressure (BP) in this group remain insufficiently described. This study assessed the prevalence of hypertension (HTN) and isolated systolic hypertension (ISH) at a single visit and examined anthropometric and body composition correlates of elevated BP in children with ID. Methods: A cross-sectional study was conducted among 461 children and adolescents with ID aged 7-18 y attending special education schools in southeastern Poland. Anthropometric indicators (BMI, waist circumference [WC], hip circumference [HC], and waist-to-height ratio [WHtR]) and body composition parameters (BF%, MM%, FFM%, TBW%) were measured using standardized procedures. BP was assessed three times during one visit, and the average of the second and third readings was used. Receiver operating characteristic (ROC) analyses were used for exploratory assessment of discriminatory performance of anthropometric and body composition parameters, and multivariable logistic regression examined associations with elevated BP (HTN + ISH). Results: Overall, 13.9% of participants had HTN and 10.4% had ISH (combined prevalence: 24.3%). Abdominal obesity was present in 39.5% of participants, and elevated HC in 28.2%, both more common in girls. Higher BP categories were associated with greater WC, HC, BMI, and BF%, and lower MM%, FFM%, and TBW% (p < 0.0001). HC showed the highest discriminatory accuracy for HTN + ISH (AUC = 0.844), followed by MM%, BF%, and FFM%, whereas WHtR demonstrated limited discriminatory performance in ROC analyses. In multivariable models, WHtR ≥ 0.5 was associated with increased odds of elevated BP (OR = 4.25), whereas higher TBW% (≥55.38%) was inversely associated with elevated BP (OR = 0.17) in the total sample; similar patterns were observed in sex- and age-stratified analyses. Conclusions: Children with ID show a high prevalence of elevated BP at a single visit, including HTN-range and ISH-range values. Anthropometric indicators, particularly HC and WHtR, and BIA-derived body composition parameters reflecting higher fat mass and lower lean tissue proportion were associated with elevated BP. These exploratory findings suggest that simple anthropometric and body composition measures may help identify individuals who warrant further BP assessment, although longitudinal studies with repeated measurements are required before clinical application.

Medication-related osteonecrosis of the jaw (MRONJ) is a serious adverse drug reaction mostly associated to the use of bone-modifying agents. Preventive dental strategies aim to reduce its risk, but the comparative benefit of structured long-term interventions versus a single pre-treatment dental visit remains unclear. This study assessed the impact of a structured long-term, multidomain dental prevention protocol compared with a single baseline dental assessment in patients receiving an oncological-based, high dose (HD) regime of Zoledronic acid (ZA). Between 2012 and 2015, two Southern Italian university hospitals enrolled adult cancer and myeloma patients initiating ZA. Participants received either the Standard Protocol (SP), a single pre-treatment dental visit, or the Intensive Protocol (IP), which added scheduled follow-ups and periodontal care. MRONJ was diagnosed using SICMF-SIPMO clinical and radiological criteria. 202 patients (M/F = 83/119; mean age 63.3years), were stratified into a SP group (n = 115) and an IP group (n = 87). Eighteen patients developed MRONJ (8.9%). The MRONJ frequency was significantly higher in the SP group (13.9%) compared to the IP group (2.3%) (p = 0.004). MRONJ cases in the SP group showed poorer oral hygiene, a higher rate and severity of periodontitis alongside, and higher post-extraction onset rate. Multidomain dental prevention long-term protocol was found to be effective in reducing the incidence of MRONJ by ZA therapy, compared to a single pre-therapy dental intervention, with a potential change of case characteristics. These findings support integrating routine dental evaluation and periodontal maintenance into cancer and myeloma care pathways to improve patient safety and oral outcomes.

To evaluate the diagnostic performance of tin-filtered 150 kV ultra-low dose CT (ULDCT) for pulmonary nodule detection and size measurement compared with standard-dose CT (SDCT). This prospective study enrolled 261 patients who underwent both SDCT (120 kV) and ULDCT (150 kV with 0.6 mm tin filtration) during a single visit. Radiation dose parameters, subjective and objective image quality, and diagnostic performance were assessed using SDCT as the reference standard. Nodules were classified as solid, pure ground-glass (pGGNs), or mixed ground-glass nodules (mGGNs), and nodule diameters were compared between the two protocols. ULDCT reduced radiation dose by 83% compared to SDCT (1.10 ± 0.22 mSv vs 6.55 ± 1.51 mSv, P < 0.001) while maintaining excellent image quality. SDCT detected 856 nodules, with ULDCT identifying 779 true-positive nodules. Subtype analysis revealed sensitivities of 99.65% for solid nodules, 100% for mixed ground-glass nodules, and 70.12% for pure ground-glass nodules. No significant differences were observed in nodule diameter measurements between ULDCT and SDCT (P > 0.05). Tin-filtered 150 kV ULDCT achieves high sensitivity for pulmonary nodule detection with significantly reduced radiation dose and maintain clinically acceptable image quality. This study provides clinical validation of tin-filtered 150 kV ULDCT in a heterogeneous outpatient population, demonstrating its feasibility for accurate pulmonary nodule detection beyond screening settings and highlighting its subtype-specific performance.

Introduction: This randomized controlled clinical trial compared the radiographic periapical healing outcomes of single-visit versus multiple-visit root canal treatments for teeth with apical periodontitis. Materials and Methods: Thirty patients with single-rooted teeth diagnosed with primary apical periodontitis were randomly allocated to either a single-visit (n = 15) or a multiple-visit (n = 15) group. Periapical healing was radiographically evaluated using the Periapical Index (PAI) score at baseline and at 6 and 12-month follow-up appointments. Results: The results showed no statistically significant difference in the radiographic healing rates between the two groups at either follow-up period. The success rates (PAI score ≤2) were 93.3% for the single-visit group and 86.7% for the multiple-visit group at 12 months ( P &gt; 0.05). Conclusion: These findings suggest that both treatment protocols are equally effective in achieving periapical healing, challenging the necessity of an inter-appointment intracanal medicament.

Adherence to the Mediterranean diet, particularly olive oil intake, and metabolic health parameters are independently associated with SARS-CoV-2 vaccine-induced IgG responses

Our aim was to examine if a prepregnancy lifestyle intervention impacted early childhood weight gain. A 5-year longitudinal observational follow-up of children born to women aged 18-40 years with body mass index (BMI) ≥27 kg/m2 who participated in Prepare, a randomized clinical trial testing a prepregnancy lifestyle intervention vs. usual care control. Data were collected from birth through ages 36-60 months using electronic medical record (EMR) chart abstraction, a single in-person or virtual visit, and surveys. Of the 165 children born to Prepare participants, 133 (70 in intervention and 63 in usual care) contributed BMI data to the PrepareD observational follow-up study. Longitudinal BMI trajectories from birth to age 5 demonstrated no significant differences between study arms (p = 0.06). There were no significant differences in mean BMI (17.0 ± 1.7 vs. 16.7 ± 1.7; p = 0.44), BMI z-score (0.30 ± 1.12 vs. 0.02 ± 1.19; p = 0.40), BMI percentile (56.2 ± 29.8 vs. 50.2 ± 31.4; p = 0.56), or conditional weight gain (0.10 ± 1.07 vs. -0.17 ± 0.95; p = 0.19) between intervention and control arms, respectively, at age 12 months. There were also no significant differences in mean BMI (16.4 ± 1.7 vs. 16.2 ± 1.6; p = 0.61), BMI z-score (0.43 ± 1.07 vs. 0.23 ± 1.17; p = 0.44), BMI percentile (56.2 ± 29.8 vs. 57.1 ± 32.5; p = 0.39), or conditional weight gain (0.01 ± 1.08 vs. -0.09 ± 0.95; p = 0.51) at 36-60 months. A prepregnancy lifestyle intervention did not influence childhood weight trajectory. Focusing lifestyle interventions solely on prepregnancy maternal obesity may not be sufficient to influence childhood growth. Trials that examine lifestyle interventions that offer support before, during, and after pregnancy are needed to determine if intervening before conception can interrupt the intergenerational cycle of obesity.

Introduction: Multiple injection immunization is a service strategy that administers more than one vaccine in a single visit to improve immunization efficiency and coverage. Despite evidence of safety, parental concerns regarding adverse effects remain a major barrier to its acceptance. Maternal knowledge plays a critical role in decision-making related to childhood immunization. Objective: This study aimed to analyze the association between maternal knowledge of immunization and acceptance of multiple injection immunization at community health posts in an urban primary healthcare setting. Method: An analytical observational study with a cross-sectional design was conducted among 82 mothers with children aged 2–24 months, selected using purposive sampling. Data were collected using structured questionnaires and analyzed using the Chi-square test. Result and Discussion: More than half of respondents demonstrated a high level of immunization knowledge (57.3%), and the majority accepted multiple injection immunization (68.3%). Among mothers who accepted multiple injections, 67.9% had a high knowledge level. Statistical analysis showed a significant association between maternal knowledge level and acceptance of multiple injection immunization (p = 0.001). Conclusions: Maternal knowledge of immunization is significantly associated with acceptance of multiple injection immunization. Strengthening educational interventions targeting mothers and families is essential to improve acceptance and sustain optimal immunization coverage.

IntroductionWomen with HIV (WWH) have a higher risk of hypertension compared to women without HIV (WWoH). Exposure to adverse socioeconomic (e.g., area level deprivation) and psychosocial factors (e.g., stigma, inadequate social support) may contribute to inequities in hypertension through their influence on health behaviors (e.g., substance use, diet, physical activity) and psychophysiological (e.g., stress) responses.MethodsWe examined the association between socioeconomic and psychosocial factors, psychological distress, and current uncontrolled blood pressure among WWH (n=998) and WWoH (n=353) enrolled in the Women’s Interagency HIV Study (WIHS) at a single visit between April and September 2019.ResultsSocioeconomic and psychosocial factors were similar among WWH and WWoH. Among WWH and WWOH, 50.2% had current uncontrolled blood pressure, defined as a systolic blood pressure ≥130 mmHg or diastolic pressure ≥ 80 mmHg at the time of the study visit. Among WWH, socioeconomic, psychosocial, and behavioral factors explained 3% of the variance in blood pressure with self-reported health risk behaviors (r=0.15), and use of antihypertensive medication (r=0.09) had weak to moderate impact. Among WWoH, socioeconomic, psychosocial, and behavioral factors explained 10% of the variance in blood pressure, with self-reported health risk behaviors (r=0.19), use of antihypertensive medication (r=0.19), area-level social vulnerability (r=-0.17), and social support (r=0.16) demonstrating weak to moderate impacts.DiscussionTailored interventions that address socioeconomic and psychosocial stressors at the individual and societal levels may improve outcomes and reduce disparities in uncontrolled blood pressure.

The West Africa Ebola virus disease (EVD) outbreak resulted in over 28,000 individuals infected, primarily in Liberia, Guinea, and Sierra Leone. Data from previous outbreaks indicate lasting health problems in survivors. The long-term neurologic impact of EVD remains largely unknown. The aim of this study was to characterize the neurologic and neurocognitive sequelae of EVD in pediatric survivors of the 2015 outbreak in Liberia. In this cross-sectional observational study conducted in Monrovia, Liberia, pediatric survivors of acute EVD aged younger than 18 years at the time of infection and older than 2 years at the time of the visit, along with their asymptomatic close contacts as controls, were seen at a median of 18 months after EVD. The single clinic visit included a neurologic history and symptom questionnaire, neurologic examination, and neurocognitive testing. Seropositive survivors and seronegative controls were included in analyses, with the t test used for continuous variables and the χ2 or Fisher exact test used for categorical variables. The cohort included 31 EVD cases and 41 controls, with a median age of 11 years (44% female). Neurologic symptoms that were reported significantly more frequently in cases than in controls included arm/leg weakness (67.7% vs 4.9%, p < 0.0001); problems with sitting, standing, or walking (22.6% vs 4.9%, p = 0.031); difficulty seeing (38.7% vs 9.8%, p = 0.003); difficulty understanding speech (32.3% vs 0%, p < 0.0001); fecal incontinence (19.4% vs 0%, p = 0.0051); and lack of motivation (22.2% vs 0%, p = 0.0052). EVD cases more often demonstrated disability than controls on the modified Rankin Scale. EVD cases "either sometimes or often" faced consequences for poor behavior, became upset for unknown reasons, and had difficulty completing tasks independently more often than controls on executive function assessment. There was no significant difference between groups in individual neurologic examination components, frequency of uveitis, or cognitive test scores. Numerous neurologic symptoms were reported more commonly in EVD cases than in controls, suggesting that EVD may have a lasting effect on the nervous system. Limitations included small sample size and reliance on participant self-report. Our findings highlight the importance of long-term clinical monitoring of pediatric EVD survivors, given the potential impact on childhood development.