Monitoring Of Trends Research Articles

Monitoring the Risk of Corruption in the MENA Region: What Are the Most Reliable Data to Address the Sustainable Development Goals?

ABSTRACTCountering corruption is recognized by the United Nations Sustainable Development Goals (UN SDGs) as crucial for effective and sustainable governance. Sample surveys are often used as the primary tool for monitoring corruption, making the evaluation of their quality essential for building a reliable evidence base strategy and achieving the UN SDGs 16.5. However, there is a lack of studies assessing the quality of corruption surveys in the Middle East and North African (MENA) region. This gap can be attributed to various factors, including low prioritization, insufficient resources for anti‐corruption initiatives, the sensitivity of the topic, and language and cultural barriers. This article aims to assess the quality of corruption surveys in the MENA region by developing an ad‐hoc quality evaluation framework, MENA_QUEST_16.5. This framework includes criteria for assessing survey relevance, validity, accuracy, credibility, periodicity, and comparability to evaluate MENA surveys' effectiveness in capturing corruption events, in line with SDGs' requirement for measuring corruption. The framework is then applied to evaluate the quality of 19 national and cross‐national corruption surveys targeting countries in the MENA region. The study finds that the overall quality of MENA corruption surveys is good, but the number of national initiatives is low. Surveys often lack accuracy in depicting corruption issues, typically operationalizing corruption through only one or two questions. Details about corruption events (e.g., types of officials involved; types of benefits exchanged) are rarely investigated. Also, MENA surveys are not periodically conducted and suffer from a lack of transparency, with raw data generally unavailable or inaccessible. These results point to methodological shortcomings that should be addressed to obtain a reliable overview of corruption in the MENA region. Tackling these issues can improve the monitoring of corruption trends and inform anti‐corruption policy design and evaluation, to ultimately achieve the UN SDGs.

Cesarean section in Suriname using robson classification: a two-year nationwide cross-sectional study on rates, risk factors and perinatal outcomes of cesarean section

BackgroundOptimizing CS performance is a global health priority, given the maternal and perinatal morbidity and mortality associated with both underuse and overuse. This study aims to (1) determine the facility-based CS rate in Suriname and explore which women are most likely to undergo a CS and (2) classify all CS by the WHO Robson classification and analyze the perinatal outcomes.MethodsAn observational, cross-sectional study in Suriname, using nationwide birth registry data that included all hospital births in 2020 and 2021 (≥ 27 weeks of gestation). We used multivariate logistic regression analysis to assess maternal and perinatal characteristics associated with CS. We described cesarean births according to the Robson-10 classification and used descriptive statistics to analyze CS frequencies and perinatal outcomes.ResultsWe analyzed the 18,917 women who gave birth in Surinamese hospitals, with an overall 23.9% CS rate (n = 4522/18,917). The highest CS rates were seen among women with a previous CS (69.3%, aOR 16.2, 95% CI 14.4–18.2), BMI > 40 (47.0%, aOR 5.1, 95% CI 4.0–6.5), newborn with a birthweight from or above 4,000 g (37.3%, 2.2, 95% CI 1.6–3.0) and women giving birth at hospital IV (38.5%, aOR 1.8, 95% CI 1.6–2.0). Hindustani women were more likely to give birth by CS compared to Maroon women (aOR 1.6, 95% CI 1.4–2.0). The largest contribution to the overall CS rate was Robson group 5 (i.e. multiparous women with a previous CS and a singleton term pregnancy in cephalic presentation, 30.5%, n = 1,378). Robson group 2 and 4 (i.e. pre-labor CS, or CS after induction, among term women without previous CS and cephalic presentation) contributed to 21.8% (n = 985) of all CS performed. Robson group 1 and 3 (i.e. during spontaneous labor CS among term women without previous CS and cephalic presentation) accounted for 23.3% (n = 1,052) of all CS cases.ConclusionThe facility-based CS rate in Suriname is 24%, with substantial intra-country and inter-hospital variations. These disparities underscore the need for targeted interventions addressing both overuse and underuse of CS. Preventative measures should prioritize promoting safe VBAC, increasing assisted vaginal birth, preventing first-time CS and ongoing monitoring of trends and regular case audits.

Trends in anti-seizure medication spending by Medicare Part D and Medicaid from 2012 to 2022.

The rising cost of anti-seizure medications (ASMs) in the United States (US) is a major concern for patients, healthcare providers, insurance payors, and policymakers. We aim to describe and analyze the spending trends on ASMs in the Medicare Part D (MPD) and Medicaid population in the US. A retrospective study was conducted on the databases of MPD and Medicaid Spending by Drug from 2012 to 2022, which was published by the Centers for Medicare and Medicaid Services (CMS). The total expenditures (adjusted for inflation to 2022 dollars), number of claims, and cost-per-claim (CPC) for individual ASMs were summarized on an annual basis. Stratifications of ASMs were made by ASM generations and brand versus generic manufacturers. Expenditure on ASM by both MPD and Medicaid more than doubled between 2012 and 2022, soaring from $2.8 billion to $5.7 billion. The ASMs total annual claim number increased from 32.2 to 43.2 million. In 2012, second-generation ASMs comprised the largest percentage of total spending of MPD (51%) and Medicaid (57%), but third-generation ASMs took over the lead in 2022 (44% of MPD and 68% of Medicaid). The total spending by MPD and Medicaid on brand-name ASMs increased significantly from 2012 to 2022, likely contributed by almost tripling of CPC of brand-name ASMs in 2022. There was no significant change in CPC for generic ASMs from 2012 to 2022. The expenditure by MPD and Medicaid on ASMs has doubled in the past decade. The rise in spending was disproportionately comprised of newer third-generation and brand-name ASMs. Further monitoring of the spending trend and efforts on drug price negotiation may play a role curbing the rising cost of ASMs. The methods to control drug spending remain unclear and drug pricing negotiation and other policy reforms should be considered.

Antimicrobial Susceptibility Profiles of Commensal Staphylococcus spp. Isolates from Chickens in Hungarian Poultry Farms Between 2022 and 2023.

Antimicrobial resistance is one of the greatest challenges of our time, urging researchers in both veterinary and public health to engage in collaborative efforts, thereby fostering the One Health approach. Infections caused by Staphylococcus species can not only lead to significant diseases in poultry but also pose serious threats to human life, particularly in hospital (nosocomial) infections; therefore, it is crucial to identify their antimicrobial resistance. Our objective was to assess the susceptibility profile of commensal Staphylococcus aureus strains (n = 227) found in commercial chicken flocks in Hungary through the determination of minimum inhibitory concentration (MIC) values. Based on our findings, resistance to tiamulin (82.8%; 95% CI: 77.4-87.2%) and doxycycline (74.4%; 95% CI: 68.5-79.7%) is the most critical. The 55.1% (95% CI: 48.8-61.3%) resistance rate to enrofloxacin, a critically important antimicrobial, is also concerning. The fact that 58.6% (95% CI: 52.4-64.5%) of the strains were resistant to amoxicillin and 35.7% (95% CI: 29.7-42.1) were resistant to amoxicillin-clavulanic acid suggests that a proportion of the strains produce β-lactamase. Comparing our results with the available human hospital data, it was found that resistance to macrolide antibiotics is similarly high in both cases. Our findings highlight the necessity of conducting regular surveillance studies, which would allow the monitoring of future temporal trends. This information could benefit practitioners making clinical decisions to successfully treat infections. To uncover the underlying causes of multidrug resistance, next-generation sequencing can be employed to elucidate the genetic basis of phenotypic resistance.

Satellite monitoring of annual US landfill methane emissions and trends

Abstract We use satellite observations of atmospheric methane from the TROPOMI instrument to estimate total annual methane emissions for 2019–2023 from four large Southeast US landfills with gas collection and control systems. The emissions are on average 6× higher than the values reported by the landfills to the US Greenhouse Gas Reporting Program (GHGRP) which are used by the US Environmental Protection Agency for its national Greenhouse Gas Inventory (GHGI). We find increasing emissions over the 2019–2023 period whereas the GHGRP reports a decrease. The GHGRP requires gas-collecting landfills to estimate their annual emissions either with a recovery-first model (estimating emissions as a function of methane recovered) or a generation-first model (estimating emissions from a first-order decay applied to waste-in-place). All four landfills choose to use the recovery-first model, which yields emissions that are one-quarter of those from the generation-first model and decreasing over 2019–2023, in contrast with the TROPOMI observations. Our TROPOMI estimates for two of the landfills agree with the generation-first model, with increasing emissions over 2019–2023 due to increasing waste-in-place or decreasing methane recovery, and are still higher than the generation-first model for the other two landfills. Further examination of the GHGRP emissions from all reporting landfills in the US shows that the 19% decrease in landfill emissions reported by the GHGI over 2005–2022 reflects an increasing preference for the recovery-first model by the reporting landfills, rather than an actual emission decrease. The generation-first model would imply an increase in landfill emissions over 2013–2022, and this is more consistent with atmospheric observations.

Sulcus-Deepening Trochleoplasty and Medial Patellofemoral Ligament Reconstruction Provide Good Clinical Outcomes in Addressing Patellar Instability at Mid-Term Follow-Up: A Retrospective Case Series.

To update previously published clinical and radiographic outcomes of Dejour sulcus-deepening trochleoplasty and medial patellofemoral ligament reconstruction (MPFL-R), at mid-term follow-up, and monitor trends in patient reported outcome scores and satisfaction. Using the same cohort of patients from our previously published short-term series of 2-year follow up, interval follow-up was performed on 67 patients (76 knees) with severe trochlear dysplasia and recurrent patellar instability who were prospectively enrolled and underwent Dejour sulcus-deepening trochleoplasty and MPFL-R combined with other patellar-stabilization procedures. Patients with less than 2-year follow-up were excluded. Evaluation involved radiographic analysis, physical examination, clinical follow-up, and patient-reported outcome scores. 37 patients (45 knees) were included in the current study, with mean follow-up of 6.1 years postoperatively (Standard deviation [SD] 2.7 years). Two interval re-operations were performed (arthroscopic lysis of adhesions; hardware removal and arthroscopic shaving chondroplasty). There remained no occurrences of re-operation for recurrent patellar instability. Patient reported outcomes were largely stable from early (mean 3.6 years) to mid-term (mean 6.1 years) follow up with no statistically significant difference between early and mid-term International Knee Documentation Committee (IKDC) (P = 0.75), Kujala (P = 0.47) or VAS (Visual analog scale) pain (P = 0.06) scores. Compared to preoperative knee scores, there was a significant difference in IKDC (49.3 vs 82.0, P < 0.001, d = 1.85), Kujala (56.5 vs 89.3, P < 0.001, d = 2.03), and VAS pain (3.8 vs 1.9, P = 0.003, d = 0.33) scores at mid-term follow up (mean 6.1 years). Mean Kellgren-Lawrence grading of patellofemoral arthritis showed no statistically significant change from 0.56 to 0.52 (P = 0.511) on sunrise radiographs at the most recent follow-up. At mid-term follow-up, Dejour sulcus-deepening trochleoplasty and MPFL-R, combined with other patellar stabilization procedures, achieves durable resolution of patellar instability with maintained patient-reported outcome scores and satisfaction rates, and is without interval evidence of clinical or radiographic progression of patellofemoral arthritis. IV, Case Series.

A real-time hyperventilation trend monitoring algorithm in-flight

A real-time hyperventilation trend monitoring algorithm in-flight

Automated surveillance for surgical site infections (SSI) in hospitals and surveillance networks-expert perspectives for implementation.

This work aims at providing practical recommendations for implementing automated surveillance (AS) of surgical site infections (SSI) in hospitals and surveillance networks. It also provides an overview of the steps, choices, and obstacles that need to be taken into consideration when implementing such surveillance. Hands-on experience with existing automated surveillance systems of SSI (AS SSI systems) in Denmark, France, the Netherlands and Spain is described regarding trend monitoring, benchmarking, quality control, and research for surveillance purposes. Between April and October 2023, specific aspects/options of various surveillance purposes for AS SSI were identified during regular meetings of the SSI working group in the PRAISE (Providing a Roadmap for Automated Infection Surveillance in Europe) network. Expert discussions provided the basis for this perspective article. Decisions for implementation of AS SSI systems highly depend on the purpose of the surveillance. AS SSI systems presented here differ according to study population, setting, central or local implementation; the level of automation, design, and the data sources used. However, similarities were found for the rationales of automation, design principles and obstacles that were identified. There was consensus among all the experts that shortcomings in interoperability of databases, limited time, a want of commitment on the part of stakeholders, and a shortage of resources for information technology (IT) specialists represent the main obstacles for implementing AS SSI. To overcome obstacles, various solutions were reported, including training in the development of AS systems and the interpretation of AS SSI results, early consultation of end-users, and regular exchanges between management levels, IT departments, infection prevention and control (IPC) teams, and clinicians. Clarity on the intended application (e.g. purpose of surveillance) and information on the availability of electronic and structured data are crucial first steps necessary for guiding decisions on the design of AS systems. Adequate resources for IT specialists and regular communication between management, IT departments, IPC teams, and clinicians were identified as essential for successful implementation. This perspective article may be helpful for a wider implementation of more homogeneous AS SSI systems in Europe.

Challenges and opportunities of strategic communication in health and wellness tourism in Portugal

The growing focus on wellness and well-being has led to the consolidation of health and wellness tourism as a strategic part of the tourism economy in Portugal. This study analyses how regional tourism boards communicate these concepts and explores the challenges and opportunities presented by this rapidly changing market. The study examined the evolution of communication related to health and wellness in tourism between 2020 and 2022 based on a literature review, analysis of institutional websites and monitoring of digital trends. The results show a predominant focus on spa tourism and limited exploitation of the concept of well-being in a broader sense. The research highlights the need for more innovative and diversified communication strategies capable of attracting tourists seeking a holistic balance between physical, mental, and emotional health. Effectively communicating this distinctive value will be essential to strengthening Portugal’s competitiveness and resilience in a constantly evolving sector.

Prevalence of nasopharyngeal Streptococcus Pneumoniae carriage in infants: A systematic review and meta-analysis of cohort studies and randomized controlled trials.

This study aims to examine the prevalence of nasopharyngeal Streptococcus pneumoniae carriage (NSPC) in infants during their first two years of life and to compare the carriage rates among different vaccine groups and country income-levels. This will be achieved through a systematic review of the published literature, specifically focusing on data from cohort studies and randomized controlled trials. A comprehensive search was conducted in four electronic databases: PubMed, Web of Science, ScienceDirect, and Scopus, using a predefined search strategy. Forty-nine articles met the inclusion criteria for this systematic review. According to the results obtained from the random effects model, the pooled mean prevalence of NSPC was 1.68% at birth (95% CI [0.50; 5.47]), 24.38% at 1 to 4 months (95% CI [19.06; 30.62]), 48.38% at 4 to 6 months (95% CI [41.68; 55.13]), 59.14% at 7 to 9 months (95% CI [50.88; 66.91]), 48.41% at 10 to 12 months (95% CI [41.54; 55.35]), 42.00% at 13 to 18 months (95% CI [37.01; 47.16]), and 48.34% at 19 to 24 months (95% CI [38.50; 58.31]). The highest NSPC rates were observed among children aged 4 to 6 months and 7 to 9 months across all vaccine groups. Low-income countries consistently demonstrated the highest NSPC rates across all age categories studied. This systematic review and meta-analysis provide robust evidence of the high prevalence of NSPC in infants aged 4 to 6 months and 7 to 9 months in all vaccine groups, with persistent regional disparities, especially among low-income countries. The study highlights the need for continuous monitoring of NSPC trends, particularly the emergence of non-vaccine serotypes. Policymakers and healthcare providers should leverage these findings to enhance vaccination strategies, aiming to minimize the overall burden of pneumococcal diseases in infants.

Estimating the differences in police and hospital records of people injured in traffic crashes in Dire Dawa City administration, Ethiopia

The management of road safety relies on data from road traffic crashes to identify priorities, monitor trends and evaluate interventions. Both police and hospital records are important sources of information on crashes that result in injury; however, both are known to be incomplete, with the quality and completeness of data being lower in low- and middle-income countries. The aim of this study is to estimate the magnitude of the underreporting of crashes in Dire Dawa City, Ethiopia, as a case study that may be applicable elsewhere. In addition, it gives an opportunity to understand the discrepancies between police and hospital records in Dire Dawa City and how the data systems work in the city. This research compared data on traffic collisions resulting in injury from July 2014 to February 2019 across police and hospital databases and used the capture–recapture technique to estimate the actual numbers of crashes and the degree of under-recording in both sources. It was found that there was substantial under-recording in both sources, with the degree of under-recording varying by urban/rural area, gender, age, road user category and injury severity, as well as by source within these variables. The police figures were lower than the hospital figures, and in all cases but three (rural areas, passengers and serious injury crashes), both sources had more unmatched than matched cases. In addition, the analysis discovered undocumented deaths and injuries in both databases. To summarize, police capture more death instances, but hospitals capture more serious injury cases. The capture–recapture strategy predicted a greater number of instances than currently recorded by police and hospitals. This demonstrates a major under-reporting of crash data from both sources. This level of under-recording can lead to less effective road safety management and evaluation. Replication of this research in other parts of Ethiopia could provide information on local practices that are more or less successful in reducing the level of under-recording, and such results may have implications for other countries with similar problems.

Bacterial Infections, Trends, and Resistance Patterns in the Time of the COVID-19 Pandemic in Romania-A Systematic Review.

Background: The COVID-19 pandemic has intensified concerns over bacterial infections and antimicrobial resistance, particularly in Romania. This systematic review explores bacterial infection patterns and resistance during the pandemic to address critical gaps in knowledge. Methods: A systematic review, following PRISMA guidelines, was conducted using databases such as PubMed and Scopus, focusing on studies of bacterial infections from 2020 to 2022. Articles on bacterial infections in Romanian patients during the pandemic were analyzed for demographic data, bacterial trends, and resistance profiles. Results: A total of 87 studies were included, detailing over 20,000 cases of bacterial infections. The review found that Gram-negative bacteria, particularly Escherichia coli and Klebsiella pneumoniae, were the most frequently identified pathogens, alongside Gram-positive Staphylococcus aureus and Enterococcus spp. Multidrug resistance (MDR) was noted in 24% of the reported strains, with common resistance to carbapenems and cephalosporins. Conclusions: The pandemic has amplified the complexity of managing bacterial infections, particularly in critically ill patients. The rise in MDR bacteria underscores the need for stringent antimicrobial stewardship and infection control measures. Continuous monitoring of bacterial trends and resistance profiles will be essential to improve treatment strategies in post-pandemic healthcare settings.

The long-lasting impacts of the COVID-19 pandemic on population-based cancer survival: what are the implications for data analysis?

Monitoring trends of cancer incidence, mortality and survival is vital for the planning and delivery of health services, and the evaluation of diagnostics and treatment at the population level. Furthermore, comparisons are often made between population subgroups to explore inequalities in outcomes.During the COVID-19 pandemic routine delivery of health services were severely disrupted. Resources were redeployed to COVID-19 services and patient risk of COVID-19 infection required serious consideration. Cancer screening services were paused, the availability of healthcare providers was reduced and, in some cases, patients faced difficulty in accessing optimal treatment in a timely manner.Given these major disruptions, much care should be taken when interpreting changes in cancer survival estimates during this period. The impact on cancer incidence and mortality statistics that have already been reported in some jurisdictions should drive further thought on the corresponding impact on cancer survival, and whether any differences observed are real, artificial or a combination of the two.We discuss the likely impact on key cancer metrics, the likely implications for the analysis of cancer registration data impacted by the pandemic and the implications for comparative analyses between population groups and other risk factor groups when using data spanning the pandemic period.

Genetic diversity of the Khorat snail-eating turtle (Malayemys khoratensis) in Thailand.

Malayemys khoratensis is a freshwater turtle species endemic to northeastern Thailand and Lao PDR. While M. khoratensis is relatively common and widespread in Thailand, its population size and demographic trends remain largely unknown, as direct population estimates are lacking. This species faces significant threats from consumption, exploitation, and trade. Therefore, this study aims to investigate the genetic diversity, population structure, and demographic trends of M. khoratensis in northeastern Thailand, using two mitochondrial DNA genes, Cyt b and ND4. We grouped the turtles based on three major river basins in northeastern Thailand: Mun, Chi, and Northeast Mekong to assess population structure and test the isolation-by-basin hypothesis. The Cyt b and ND4 genes of 49 M. khoratensis individuals across 15 provinces in Thailand were sequenced, and 15 sequences from a previous study of Ihlow et al. (2016) were included into the analyses. We constructed a haplotype network from the concatenated sequences and analyzed the population structure with the analysis of molecular variance (AMOVA). Additionally, we used a Bayesian Skyline plot (BSP) analysis to estimate the effective female population size and explore the demographic history of this species. Our analysis identified 13 unique haplotypes defined by 26 polymorphic sites from 64 samples. The total haplotype diversity for M. khoratensis was 0.819, while nucleotide diversity was 0.0031. The haplotype network and AMOVA revealed no distinct population structure among the river basins, suggesting gene flow across these regions. The BSP estimated a stable effective female population size of approximately 130,000 individuals since around 100,000 years ago (late Pleistocene). Our findings indicated no significant population structure by river basin, which may be due to natural movement between basins or potential human-mediated translocations linked to the turtle trade. The demographic trend of M. khoratensis appears to have been stable over time. However, given the ongoing exploitation of this species, we recommend regular monitoring of population trends to support its long-term survival.

Fertility Trends in Bangladesh Employing Parity Progression Ratios

Fertility trends in Bangladesh have long been a subject of study due to the country's significant demographic transitions over the past few decades. This study investigated cohort fertility rates and trends using information from the Bangladesh Demographic and Health Surveys (BDHSs) (BDHS 2011, BDHS 2014, and BDHS 2017-2018). The study utilizes parity progression ratios (PPRs) to examine the fertility distribution among all women and currently married women. Fertility patterns are investigated across various birth cohorts of women spanning seven age groups (15-19, 20-24, 25-29, 30-34, 35-39, 40-44, and 45-49), including the entirety of the reproductive age range (15-49 years). In the BDHS 2011, the cohort total fertility rate (TFRc) was 2.62 for all women and 2.73 for currently married women. In the BDHS 2014, the TFRc for all women decreased to 2.40, and for currently married women, it declined to 2.56. Finally, in the BDHS 2017-18, the TFR for all women decreased to 2.30, while for currently married women, it reached 2.45. Notably, TFRc exhibited a declining trend over the three surveys, with the TFR remaining constant at 2.30 from BDHS 2011 to BDHS 2017-18. It is worth mentioning that while the TFR and TFRc values are identical, the TFRc for currently married women in BDHS-2017-18 is slightly higher by 0.15 compared to all women (BDHS 2014). This research highlights significant shifts in cohort fertility levels in Bangladesh over time, offering valuable insights into fertility patterns among women of varying age groups within the reproductive span. The observed declines in both TFRc underscore Bangladesh’s evolving fertility dynamics. Policymakers should sustain declining fertility rates while balancing population control with development and regularly monitor trends to adapt policies to changing reproductive patterns. International Journal of Statistical Sciences Vol. 24(2), November, 2024, pp 1-18

Long-Term Monitoring of Trends in Xerothermality and Vegetation Condition of a Northeast Mediterranean Island Using Meteorological and Remote Sensing Data

There is no doubt that global climate change is happening and affecting life on Earth in a variety of ways. It can be seen on the extreme events of natural disasters, prolonged periods of drought, and increased summer and annual temperatures. While climate change affects every place on Earth, the Mediterranean region is considered a hot spot of climate change. Temperature is expected to increase further, precipitation, especially during summer months, is expected to decrease, and extreme rainfall events are projected to increase. These projected changes will affect both continental and insular environments, with small islands being particularly vulnerable due to the lack of space for species to move into more favorable conditions. As a result, these environments need to be studied, the changes quantified, and the consequences monitored. The current study focuses on the island of Fournoi in the central eastern part of the Aegean Sea. We employed data from a local meteorological station, which operates for a limited period, the Climate Research Unit TS data, and remote sensing thermal data to monitor the trends in aridity over a period of almost 40 years. The results show that summer temperature has increased significantly over the last 40 years, and this is confirmed by both meteorological and remote sensing data. At the same time, precipitation seems to remain stable. Despite the increased aridity imposed by the increased temperature and stable precipitation, vegetation seems not to be experiencing extreme stress. On the contrary, it seems to be following a positive trend over the study period. This observation is explained by the extreme resilience of the plant species of the study area and the fact that vegetation has been recovering over the last 50 years after a period of human overexploitation, and this recovery overcomes the stress imposed by increased aridity.

Mpox Preparedness and Response 2024: Position Statement of The Disaster Management Experts Club

Statement of intent The worldwide re-emergence of mpox underlines the pressing necessity for a strengthened, coordinated, international strategy to manage and avert future outbreaks. The Disaster Management Experts Club promotes an approach that emphasises strong surveillance systems, healthcare readiness, and global cooperation to avert dissemination of thisvirus. Although mpox has demonstrated a comparatively mild clinical presentation in numerous instances, especially relative to its initial outbreaks, its capacity for rapid transmission, particularly among immunocompromised individuals, necessitates a proactive global response. The objective of this position is to reduce the current threats associated with mpox and prevent potential future pandemics. Through this, the Disaster Management Experts Club seeks to advocate: Augmented surveillance and proactive detection: Surveillance systems are crucial for identifying cases, monitoring transmission dynamics, and detecting potential mutations. The need to augment early warning systems encompasses not only case identification, but also indirect indicators such as absenteeism from employment or education. Enhancedresilience of healthcare systems: A resilient healthcare infrastructure that facilitates early case detection, isolation, and infection control is essential. The smooth transition of patients through primary healthcare, prehospital care, and hospital triage is vital for effectivempox Infection control measures, including the use of personal protective equipment (PPE) and rigorous environmental cleaning protocols, must be intensified to reduce nosocomial infections, as evidenced in previous outbreaks. International collaboration: A proactive coalition can limit the dissemination of mpox, especially considering its zoonotic origins and cross-border transmission. Cooperative initiatives among public health organisations, government entities, and healthcare providers are essential to the establishment of a comprehensive database to monitor and analyse mpox cases across various regions. Abstract The global emergence of mpox, previously known as monkeypox, traces back to the mid-19th century. The 2022 outbreak represented a significant escalation, prompting the World Health Organization (WHO) to declare a public health emergency. The imminent risk of a pandemic requires a proactive strategy for preparedness and mitigation. Despite human-to-human transmission, the clinical manifestations of mpox in the recent outbreak were notably milder, frequently presenting as subclinical prodromes and benign skin lesions resembling those of common sexually transmitted infections. Although complications were rare, they included severe outcomes such as pneumonia, sepsis, and neurological issues, particularly in immunocompromised individuals. Effective management of the outbreak required robust surveillance systems for early case detection, trend monitoring, and contact tracing. The smooth flow of patients through primary healthcare, prehospital care, and hospital triage was critical for early detection and isolation of suspected cases. Infection control measures, including the use of personal protective equipment (PPE) and environmental cleaning protocols, played a role in reducing nosocomial infection. This article highlights the importance of training healthcare providers, fostering collaboration across health sectors, and developing disaster preparedness plans to respond effectively to future outbreaks. It also explores the role of individual and mass vaccination, particularly among high-risk populations. This publication serves as a comprehensive resource for understanding the mpox pandemic and the collaborative efforts of the Disaster Management Experts Club in tackling this public health challenge.

A MALDI-TOF MS-based multiple detection panel of drug resistance-associated multiple single-nucleotide polymorphisms in Candida tropicalis.

Candida tropicalis is one of the main causes of invasive candidiasis. Rapid identification of antifungal resistance is crucial for selection of an appropriate antifungal to improve patient outcomes. Mutations at specific loci are strongly correlated with resistance to antifungal agents. In this study, we developed a multi-single-nucleotide polymorphism (SNP) panel to accurately identify 36 mutation sites across seven genes of C. tropicalis that are associated with resistance to azoles and/or echinocandins. Ten isolates were selected to test repeatability, and another 20 isolates of C. tropicalis were selected to validate consistency. Intra-assay and inter-assay repeatability of the panel was 100%, with the loci accuracy being 99.44% (716 of 720). Furthermore, 109 isolates were examined for clinical research, and the most commonly detected mutations were G751A and A866T of UPC2, A491T of TAC1, and A395T and C461T of ERG11. The G751A and A866T mutations of UPC2 as well as the A395T and C461T mutations of ERG11 co-existed. The SNP panel enables identification of specific mutations at critical sites of drug-resistant strains to facilitate the rapid selection of appropriate antifungal agents and efficient monitoring of the regional epidemiological trends of resistance of C. tropicalis.IMPORTANCEC. tropicalis infections pose a growing global public health challenge, with mortality rates approaching 40%. C. tropicalis is one of the top four Candida spp. responsible for candidiasis, particularly in the Asia-Pacific region and Latin America, notably affecting patients with neutropenia and malignancies. The azole resistance rate of C. tropicalis ranges from 0% to 30%. Between 2009 and 2018, the China Hospital Invasive Fungal Surveillance Network reported an increase in fluconazole and voriconazole resistance from 5.7% to ~30%. Although resistance to echinocandins and amphotericin B remains low, multi-resistance to echinocandins and azoles has been observed. Current methods for detecting drug resistance are limited by the long turnaround time of antifungal susceptibility testing, low throughput of Sanger sequence to target resistance mutations, complex data analysis, and high costs of second-generation sequencing. We developed and validated a rapid, high-throughput, and cost-effective panel to detect and monitor drug-resistance mutations of C. tropicalis.

The current state of data to estimate prevalence and severity of food allergies in the United States

Currently, in the United States, there is no comprehensive surveillance system to collect data on food allergies; however, prevalence and severity data are critical to quantify the burden of food allergies, develop evidence-based control measures, detect emerging issues, and monitor trends. To address this gap, we conducted a literature search, and expert interviews to identify surveillance systems and datasets that could be used to estimate the prevalence and severity of food allergies in the United States overall and for specific foods. Inclusion and exclusion criteria were developed and used to screen each data source. Selected articles were evaluated according to quality parameters to identify the most appropriate studies. Most studies estimated prevalence of food allergies in children, investigated multiple foods, and used surveys to collect self-reported data. Despite the high quality, robust study designs, and comprehensive survey instruments that currently exist, the studies identified do not provide sufficiently recent data to estimate the current burden of food allergies in the country. Studies lack consistencies across the years making the analysis of trends over time a challenge. National surveys conducted by Northwestern University in 2009/2010 and 2015/2016 represented the best available data; however, these data are likely outdated and are limited in assessing temporal food allergy trends. Data to accurately estimate the current prevalence and severity of food allergies and related trends is lacking. U.S. public health agencies should explore the development of a comprehensive surveillance program to address this gap and help inform evidence-based policies in food allergy management and prevention.

The spread of molecular markers of artemisinin partial resistance and diagnostic evasion in Eritrea: a retrospective molecular epidemiology study

Eritrea was the first African country to discontinue the use of histidine rich protein 2 (HRP2)-detecting rapid diagnostic tests (RDTs) for malaria diagnosis following reports of a high prevalence of pfhrp2/3-deleted Plasmodium falciparum parasites causing false-negative results in the country. Eritrea was also the first African country to report partial artemisinin resistance due to the Pfalciparum kelch13 (pfk13) Arg622Ile mutation. We aimed tocharacterise the spatial distribution of pfk13 mutants and their interactions with pfhrp2/3 deletions in Eritrea andto assess the role of the use of HRP2-detecting RDTs and antimalarial (artesunate-amodiaquine) therapy in the spread of the two variants. We conducted a retrospective molecular epidemiological analysis of pfk13 mutations and pfhrp2/3 deletions in existing Pfalciparum-infected blood samples collected as part of previous pfhrp2/3 deletion and severe malaria studies. Samples were collected in March, 2016and between September, 2018, and January, 2020, from symptomatic patients seeking care at 15health centres in four administration zones (Semenawi Keyih Bahri, Gash Barka, Anseba, and Debub) in Eritrea. Afragment spanning the propeller region of pfk13 was amplified from samples and sequenced using Sanger sequencing or targeted amplicon sequencing to identify genetic mutations. Deletions of pfhrp2/3 genes in samples were determined using multiplex quantitative PCR. Parasite haplotypes and genetic relatedness of parasite haplotypes were determined previously using microsatellite marker typing. The primary objective was to determine the prevalence of pfk13 mutations at health centres and administrative zones. The secondary objective was to investigate whether pfk13 mutants and pfhrp2/3 deleted parasites converge. We sequenced 50samples collected in March, 2016from the Semenawi Keyih Bahri zone and identified no pfk13 mutations. By contrast, in 587samples included in this study that were collected from health centres in GashBarka, Anseba, and Debub in 2018-20, we detected five different single non-synonymous mutations: Glu605Lys, Arg622Ile, Asn657Lys, Lys658Glu, and Ser679Leu. The most prevalent mutation was pfk13 Arg622Ile, which was detected in samples collected from all nine health centres where more than five samples were available across all three administration zones, with an overall prevalence of 11·9% (70 of 587samples; range 5·9-28·0%). Weidentified 22unique pfk13 Arg622Ile mutant haplotypes among 26samples tested, of which 13 (59·1%) were genetically related, whereas the remaining nine (40·9%) were not. The prevalence of pfk13 Arg622Ile was significantly higher in parasites with a single pfhrp3 deletion (46 [18·0%] of 255samples) than in parasites withoutpfhrp2/3 deletions (ten [6·2%] of 161samples; odds ratio 3·89 [95% CI 1·59-7·61]; p=0·0006) and with dual pfhrp2/3-deleted parasites (13 [9·0%] of 145; 2·23 [1·13-4·68]; p=0·018). The geographical spread of the pfk13 Arg622Ile mutation might have initially resulted from the clonal expansion and spread of pfhrp2/3 deletions under the test-and-treat policy using HRP2-detecting RDTs. Subsequently, selective pressure from artemisinin combination therapy could have further facilitated the spread of both pfk13 Arg622Ile and pfhrp2/3 deletions. Continuous monitoring of trends in pfk13 and pfhrp2/3 variants is needed to inform effective malaria control and elimination strategies in Eritrea and other African countries. US Department of Defense Armed Forces Health Surveillance Division, Global Emerging Infections Surveillance Branch (AFHSD/GEIS), and Wellcome Trust.