Uptake Levels Research Articles

Exploring the potential of pomegranate (Punica granatum) peel extract and punicalagin as novel anti-hypercholesterolemic agents

Background: Hypercholesterolemia, characterized by elevated low-density lipoprotein (LDL) cholesterol levels, is a significant risk factor for cardiovascular diseases. Familial and behavioral factors contribute to its onset, and while lifestyle changes offer some benefits, medical interventions are essential to manage this condition effectively. Statins, the primary medications used to lower LDL cholesterol, have limitations, including the unintended upregulation of proprotein convertase subtilisin/kexin type 9 (PCSK9). Therefore, exploring alternative approaches to enhance LDL receptor expression while targeting PCSK9 is crucial, with herbal medicine showing promise in this endeavor. Objective: This study investigates the potential of pomegranate peel extract and punicalagin, a key pomegranate component, in lowering LDL cholesterol in HepG2 cells. The research explores their effects on LDL receptor (LDLR) expression, LDL uptake, and proprotein convertase subtilisin/kexin type 9 (PCSK9) gene expression. Methods: HepG2 cells were treated with different concentrations of pomegranate peel extract (37.5, 75, 150, and 300 μg/ml) and punicalagin (12.5, 25, 50, and 100 μg/ml). Next, the viability of HepG2 cells, the protein levels of LDL receptors and LDL uptake, and the expression levels of PCSK9 were measured. Results: Pomegranate peel extract (37.5, 75, 150, and 300 μg/ml) and punicalagin (12.5, 25, 50, and 100 μg/ml) did not exhibit significant cytotoxicity and significantly increased LDLR protein levels (P-value= 0.00, after 24 hours) and LDL cholesterol uptake (P-value= 0.00, after 24 hours). Furthermore, they exhibited a dose-dependent reduction in the expression of PCSK9 (pomegranate: P-value= 0.01; punicalagin: P-value= 0.00). Conclusion: These findings suggest that pomegranate peel extract and punicalagin have the potential to serve as effective agents in managing hypercholesterolemia by enhancing LDL receptor expression and reducing PCSK9 expression in HepG2 cells. Further research is required to explore their effects on transcription factors and PCSK9 function. Keywords: Pomegranate; Punicalagin; HepG2 cell; LDL; Cardiovascular; Punica granatum

Influence of local potential plant biodiversity as green manure on soil total N, N uptake, and chlorophyll content of rice plants

Abstract. Suntoro S, Herdiansyah G, Widijanto H, Wardhana HR, Tjahjanto AD, Puspitasari C, Julianto EA, Maroeto. 2024. Influence of local potential plant biodiversity as green manure on soil total N, N uptake, and chlorophyll content of rice plants. Biodiversitas 25: 1655-1662. Continuous use of chemical fertilizers in the agricultural sector causes several problems. One of several solutions that can be offered is using green manure, which could restore soil fertility and be way more sustainable for the environment. A few criteria for plants to be made into green manure are having a fast decomposition process and a low C/N ratio. This research aims to discover local potential green manure based on nutrient content and response to rice plants' soil total N, N uptake, and chlorophyll content. This research used the experiment method with a single factor Randomized Completely Block Design. There were 10 treatments with 3 replications, namely P0: control; P1: NPK 200 kg/ha; P2: Rice straw 10 tons/ha; P3: Chromolaena 10 tons/ha; P4: Ipomoea 10 tons/ha; P5: Eichhornia 10 tons/ha; P6: NPK 100 kg/ha + Rice straw 5 tons/ha; P7: NPK 100 kg/ha + Chromolaena 5 tons/ha; P8: NPK 100 kg/ha + Ipomoea 5 tons/ha; P9: NPK 100 kg/ha + Eichhornia 5 tons/ha. The results showed that Chromolaena, Ipomoea, and Eichhornia have the potential to be developed as green manure because they have high N nutrient content and low C/N ratio. These three green manures can balance the NPK fertilizer and significantly increase soil total-N content, N uptake, and chlorophyll levels in rice plants. They also provide N nutrients, N uptake, and chlorophyll levels in rice plants.

A Systematic Review and Meta-Analysis on the Diagnostic and Prognostic Values of 18F-FDG PET in Uveal Melanoma and Its Hepatic Metastasis.

In this systematic review and meta-analysis (PRISMA-compliant), we tried to investigate diagnostic and prognostic values of 18F-FDG PET in uveal melanoma. A systematic search was conducted on the main medical literature databases to include studies that evaluated 18F-FDG PET as the imaging modality to evaluate patients with uveal melanoma. Overall, 27 studies were included. Twelve had data about the detection rate of 18F-FDG PET in primary intra-ocular tumours. The pooled sensitivity was 45% (95%CI: 41-50%). Furthermore, studies showed that the larger the primary tumour, the higher its uptake. Among the included studies, 13 assessed 18F-FDG PET in detecting metastasis. The pooled sensitivity and specificity were 96% (95%CI: 81-99%) and 100% (95%CI: 94-100%), respectively. Regarding liver metastasis, they were 95% (95%CI: 79-99%) and 100% (95%CI: 91-100%), respectively. Noteworthy, the level of 18F-FDG uptake was a strong predictor of patient survival. Lastly, 18F-FDG PET could characterise lesions from the histopathology perspective, distinguishing high-risk from low-risk diseases. Overall, although not reliable in detecting primary intra-ocular tumours, 18F-FDG PET is highly accurate for diagnosing metastatic uveal melanomas. It can also be a highly valuable modality in terms of patient prognostication. Thus, 18F-FDG PET can be recommended in patients diagnosed with uveal melanoma to enhance decision-making and patient management.

Gynecological health and uptake of gynecological care after domestic or sexual violence: a qualitative study in an emergency shelter

BackgroundDomestic and sexual violence have been linked to adverse gynecological and obstetric outcomes. Survivors often find it difficult to verbalize such violence due to feelings of shame and guilt. Vulnerable or socially excluded women are frequently excluded from research, particularly qualitative studies on violence. This study aimed to characterize the perceived impact of domestic or sexual violence on the gynecological health and follow-up among women with complex social situations.MethodsWe analyzed the data following inductive thematic analysis methods.ResultsBetween April 2022 and January 2023, we conducted 25 semi-structured interviews, lasting on average 90 min (range: 45–180), with women aged between 19 and 52, recruited in an emergency shelter in the Paris area. The women described physical and psychological violence mainly in the domestic sphere, their altered gynecological and mental health and their perception of gynecological care. The levels of uptake of gynecological care were related to the characteristics of the violence and their consequences. The description of gynecological examination was close to the description of coerced marital sexuality which was not considered to be sexual violence. Gynecological examination, likely to trigger embarrassment and discomfort, was always perceived to be necessary and justified, and consent was implied.ConclusionThis study can help question the appropriateness of professional practices related to the prevention of violence against women and gynecological examination practices. Any gynecological examination should be carried out within the framework of an equal relationship between caregiver and patient, for the general population and for women with a history of violence. It participates in preventing violence in the context of care, and more widely, in preventing violence against women.

Screening Strategies to Reduce COVID-19 Mortality in Nursing Homes

Nursing home residents continue to bear a disproportionate share of COVID-19 morbidity and mortality, accounting for 9% of all US COVID-19 deaths in 2023, despite comprising only 0.4% of the population. To evaluate the cost-effectiveness of screening strategies in reducing COVID-19 mortality in nursing homes. An agent-based model was developed to simulate SARS-CoV-2 transmission in the nursing home setting. Parameters were determined using SARS-CoV-2 virus data and COVID-19 data from the Centers for Medicare & Medicaid Services and US Centers for Disease Control and Prevention that were published between 2020 and 2023, as well as data on nursing homes published between 2010 and 2023. The model used in this study simulated interactions and SARS-CoV-2 transmission between residents, staff, and visitors in a nursing home setting. The population used in the simulation model was based on the size of the average US nursing home and recommended staffing levels, with 90 residents, 90 visitors (1 per resident), and 83 nursing staff members. Screening frequency (none, weekly, and twice weekly) was varied over 30 days against varying levels of COVID-19 community incidence, booster uptake, and antiviral use. The main outcomes were SARS-CoV-2 infections, detected cases per 1000 tests, and incremental cost of screening per life-year gained. Nursing home interactions were modeled between 90 residents, 90 visitors, and 83 nursing staff over 30 days, completing 4000 to 8000 simulations per parameter combination. The incremental cost-effectiveness ratios of weekly and twice-weekly screening were less than $150 000 per resident life-year with moderate (50 cases per 100 000) and high (100 cases per 100 000) COVID-19 community incidence across low-booster uptake and high-booster uptake levels. When COVID-19 antiviral use reached 100%, screening incremental cost-effectiveness ratios increased to more than $150 000 per life-year when booster uptake was low and community incidence was high. The results of this cost-effectiveness analysis suggest that screening may be effective for reducing COVID-19 mortality in nursing homes when COVID-19 community incidence is high and/or booster uptake is low. Nursing home administrators can use these findings to guide planning in the context of widely varying levels of SARS-CoV-2 transmission and intervention measures across the US.

Synthesis and evaluation of a 68Ga-labeled spermine derivative for tumor PET imaging

BackgroundThe polyamine transporter system (PTS), which renders it a promising target for tumor therapy and imaging applications, facilitates the transmembrane transport of polyamines. We reported a novel derivative of spermine labeled with gallium-68 ([68Ga]Ga-NOTA-Spermine) for the imaging of the PTS in mouse models of tumor. ResultsThe radiochemical yield of [68Ga]Ga-NOTA-Spermine was determined to be 64–69 %, demonstrating exceptional stability and radiochemical purity (>98 %). Cellular uptake experiments revealed that A549 cells exhibited peak uptake of [68Ga]Ga-NOTA-Spermine at 90 min (15.4 % ± 0.68 %). Biodistribution analysis demonstrated significant accumulation of [68Ga]Ga-NOTA-Spermine in kidneys and liver, while exhibiting low uptake levels in muscle, brain, and bones. Furthermore, Micro-PET/CT scans conducted on A549 tumor-bearing mouse models indicated substantial uptake of [68Ga]Ga-NOTA-Spermine, with maximum tumor/muscle (T/M) ratios reaching 3.71. ConclusionThese results suggest that [68Ga]Ga-NOTA-Spermine holds potential as a PET imaging agent for tumors with high levels of PTS.

Boosting Contraceptive Uptake in Urban Uganda: Older Women Benefit When Layering Adolescent and Youth Interventions Onto Existing Family Planning Programming.

Uganda has a large young population with a high unmet need for family planning (FP). Although there have been many efforts to improve access to and uptake of contraception, improvements have been slow. The Ministry of Health Uganda partnered with The Challenge Initiative (TCI) to implement a novel multipronged approach layering adolescent and youth sexual reproductive health (AYSRH) onto a functioning general FP program for women of reproductive age in 3 local governments of Buikwe, Mukono, and Iganga. We describe the approach and aim to determine whether layering AYSRH interventions onto an existing program resulted in increased contraceptive uptake among adolescents and youth aged 10-24 years and among women aged 25-49 years. We analyzed service statistics from the Uganda Health Management Information System to assess contraceptive uptake for adolescents and youth (aged 10-24 years) and older women (aged 25-49 years) before and after the implementation of the AYSRH approach in 3 areas (Buikwe, Iganga, and Mukono) compared to 11 areas where only the general FP program was implemented and the Uganda country total. This analysis showed that before the start of TCI's support, levels of contraceptive uptake were similar in all local governments. However, after implementation, there was an increase in uptake for general FP program only areas (1.7-point advantage over country total) and an even greater increase in general FP+AYSRH areas (2.4-point advantage over FP only programming). This was observed in both adolescents and youth aged 10-24 years and among women aged 25-49 years. The layering of TCI's AYSRH interventions onto a well-functioning FP platform not only increased contraceptive uptake among adolescents and youth aged 10-24 years but also boosted uptake among women older than age 25 years.

Cost-effectiveness of 4CMenB vaccination against gonorrhea: importance of dosing schedule, vaccine sentiment, targeting strategy, and duration of protection.

Observational evidence suggests the 4CMenB meningococcal vaccine may partially protect against gonorrhea, with one dose being two-thirds as protective as two. We examined the cost-effectiveness of vaccinating men-who-have-sex-with-men (MSM) in England, with one- or two-dose primary vaccination. Integrated transmission-dynamic health-economic modeling explored the effects of targeting strategy, first- and second-dose uptake levels, and duration of vaccine protection, using observational estimates of vaccine protection. Vaccination with one or two primary doses is always cost-saving, irrespective of uptake, although vaccine sentiment is an important determinant of impact and cost-effectiveness. The most impactful and cost-effective targeting is offering "Vaccination-according-to-Risk" (VaR), to all patients with gonorrhea plus those reporting high numbers of sexual partners. If VaR is not feasible to implement then the more-restrictive strategy of "Vaccination-on-Diagnosis" (VoD) with gonorrhea is cost-effective, but much less impactful. Under conservative assumptions, VaR(2-dose) saves £7.62M(95%CrI:1.15-17.52) and gains 81.41(28.67-164.23) QALYs over 10 years; VoD(2-dose) saves £3.40M(0.48-7.71) and gains 41.26(17.52-78.25) QALYs versus no vaccination. Optimistic versus pessimistic vaccine-sentiment assumptions increase net benefits by ∼30%(VoD) or ∼60%(VaR). At UK costs, targeted 4CMenB vaccination of MSM gains QALYs and is cost-saving at any uptake level. Promoting uptake maximizes benefits and is an important role for behavioral science.

Role of sociocultural beliefs/norms on level of access and uptake of contraceptives among unmarried adolescent girls in Nigeria: A systematic review study

Despite widespread awareness of the importance of contraceptive use in Nigeria, unintended pregnancies persist among adolescent girls, leading to events of unsafe abortion, sexually transmitted infections, maternal mortality, and disruptions to education and career, consequently resulting in economic hardships. Negative sociocultural beliefs and attitude serves as a deterrent for girls seeking contraceptives services in Nigeria. This study aimed to determine and describe how sociocultural beliefs and attitudes affect access and usage of contraceptive among unmarried adolescent Nigerian girls. This study employs a secondary research approach following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. PubMed, Scopus, PsycINFO, and CIHNAL were searched using relevant keywords to achieve and review studies that meet predefined criteria. Quality assessment of selected articles was done using the Critical Appraisal Skill Programme (CASP) and Mix Methods Appraisal Tools (MMAT) for qualitative and quantitative articles, respectively. Each selected article was synthesized thematically to identify patterns relevant to the research question. Thematic analysis revealed four sociocultural beliefs influencing contraceptive uptake among unmarried adolescent girls in Nigeria. Society's stigmatization of females for pregnancy prevention limits their freedom to access contraceptive services. Other factors include beliefs about sex and age, protective education, and societal intolerance for discussions about sex with adolescents. The study highlights the societal influence on contraceptive decisions for adolescent girls in Nigeria. Girls in need of contraceptives struggle with societal stigmatization perpetuated by beliefs that adolescent girls should abstain from sex until after marriage, which unfortunately does not align with current trends in sexual relationships among adolescents in Nigeria. it is therefore important to shift societal perspective about adolescent sexuality needs and promote the economic and lifelong benefits of preventing unplanned pregnancies through a multisectoral collaboration.

A liver-targeting magnetic iron oxide nanoparticle-based dual-modality probe for PET/MR imaging of liver tumor

Positron emission tomography/magnetic resonance (PET/MR) imaging combines the advantages of MR imaging with PET, provides more diagnostic information than single imaging modality. Asialoglycoprotein receptor (ASGPR) is abundantly expressed in the liver and has already been applied as a target for the hepatic imaging. Here we developed a Fe3O4 nanoparticle (NP)-based dual-modality probe targeting ASGPR for tumor PET/MR imaging. The dual-modality imaging probe was constructed by branched polyethyleneimine (PEI)-coated Fe3O4 NPs attached with N-acetylgalactosamine (GalNAc) derivatives and NOTA chelator, followed by radiolabeling with 68Ga. PET imaging results demonstrated that 68Ga-FPGN displayed high levels of uptake in the normal liver tissue and no or low uptake in tumors in situ. 68Ga-FPGN exhibited T2-weighted MRI, which reduced the T2 signal of normal liver tissue and enhance the visualization of tumor area. Our study proved the viability of 68Ga-FPGN as a novel PET/MR dual-modal probe for liver tumors imaging.

Chemokine Receptor 4-Targeted PET/CT With 68 Ga-Pentixather Detects More Lesions Than 68 Ga-Pentixafor PET/CT in Multiple Myeloma.

An 83-year-old woman with newly diagnosed multiple myeloma (MM) was enrolled in our 68 Ga-pentixather and 68 Ga-pentixafor PET/CT trial for evaluation of tumor burden. 68 Ga-pentixather PET/CT detected more focal bone lesions, and the uptake levels of focal bone lesions on 68 Ga-pentixather PET/CT were higher than those on 68 Ga-pentixafor PET/CT. This suggests that 68 Ga-pentixather PET/CT may be an alternative imaging modality and more sensitive in detecting MM lesions than 68 Ga-pentixafor PET/CT.

High uptake of COVID-19 vaccines among healthcare workers in urban Uganda.

The aim of the study was to describe the facilitators, barriers to and level of uptake of COVID-19 vaccines among healthcare workers in primary healthcare facilities in an urban setting in Uganda. We conducted a cross-sectional study among HCWs in private and public health facilities in Entebbe municipality between July 2021 and August 2021. Data was collected using a structured questionnaire that was shared, via an online link, to consented participants. Uptake of the vaccines among healthcare workers was analysed as proportions, and logistic regression was used to analyse barriers and facilitators to uptake of COVID-19 vaccines. The study enrolled 360 participants, with 61.7% (n = 222) females. A total of 236 (65.6%) healthcare workers had received at least one dose of COVID-19 vaccine, with higher uptake among females 64% (n = 151). Age above 40 years (OR 2.16), working in a government healthcare facility (OR 3.12), participating in COVID-19 vaccine related activities (OR 4.62), and having tested for SARS-COV-2 (OR 3.05) increased the odds of having been vaccinated. Working in small roadside clinics reduced the odds of being vaccinated by almost 70%, while HCWs in government health services were 3.1 times more likely to have been vaccinated. History of having cared for a COVID-19 patient and having a positive SARS-COV-2 test result did not influence the uptake of the vaccines in the study population. Vaccine uptake among HCWs was close to the World Health Organisation (WHO) recommended uptake of 70% by mid-2022.

Changes in access to viral load testing, incidence rates of viral load suppression and rebound following the introduction of the 'universal test and treat' guidelines in Cameroon: A retrospective follow-up analysis.

Cameroon adopted and started implementing in 2016, the 'universal test and treat' (UTT) guidelines to fast-track progress towards the 95-95-95 ambitious targets to end the HIV epidemic. Achieving the third 95 (viral load suppression) is the most desirable target in HIV care. We aimed to evaluate the effectiveness of this novel approach on access to viral load testing (VLT), viral suppression (VLS), and viral load rebound (VLR). A retrospective cohort study was conducted at The Nkongsamba Regional Hospital to compare VLT outcomes between the pre-UTT (2002 to 2015) and the post-UTT (2016 to 2020) periods. We used a data extraction form to collect routine data on adult patients living with HIV. We measured uptake levels of the first and serial VLT and compared the incidence rates of VLS (VL<1000 copies/ml) and viral load rebound (VLR) before and after introducing the UTT approach using Kaplan Meier plots and log-rank tests. Cox regression was used to screen for factors independently associated with VLS and VLR events between the guideline periods. Access to initial VLT increased significantly from 6.11% to 25.56% at 6 months and from 12.00% to 73.75% at 12 months before and after introducing the UTT guidelines respectively. After a total observation time at risk of 17001.63 person-months, the UTT group achieved an incidence rate of 90.36 VLS per 1000 person-months, four-fold higher than the 21.71 VLS per 1000 person-months observed in the pre-UTT group (p<0.0001). After adjusting for confounding, the VLS rate was about 6-fold higher in the UTT group than in the pre-UTT group (adjusted Hazard Rate (aHR) = 5.81 (95% confidence interval (95%CI): 4.43-7.60). The incidence of VLR increased from 12.60 (95%CI: 9.50-16.72) to 19.11 (95%CI: 14.22-25.67) per 1000 person-months before and after the introduction of UTT guidelines respectively. After adjusting, VLR was more than twice as high in the UTT group than in the pre-UTT group (aHR = 2.32, 95%CI: 1.30-4.13). Increased access to initial VLT and higher rates of VLS have been observed but there are concerns that the suppressed viral load may not be durable since the introduction of the UTT policy in this setting.

The Neuroprotective Flavonoids Sterubin and Fisetin Maintain Mitochondrial Health under Oxytotic/Ferroptotic Stress and Improve Bioenergetic Efficiency in HT22 Neuronal Cells.

The global increase in the aging population has led to a rise in many age-related diseases with continuing unmet therapeutic needs. Research into the molecular mechanisms underlying both aging and neurodegeneration has identified promising therapeutic targets, such as the oxytosis/ferroptosis cell death pathway, in which mitochondrial dysfunction plays a critical role. This study focused on sterubin and fisetin, two flavonoids from the natural pharmacopeia previously identified as strong inhibitors of the oxytosis/ferroptosis pathway. Here, we investigated the effects of the compounds on the mitochondrial physiology in HT22 hippocampal nerve cells under oxytotic/ferroptotic stress. We show that the compounds can restore mitochondrial homeostasis at the level of redox regulation, calcium uptake, biogenesis, fusion/fission dynamics, and modulation of respiration, leading to the enhancement of bioenergetic efficiency. However, mitochondria are not required for the neuroprotective effects of sterubin and fisetin, highlighting their diverse homeostatic impacts. Sterubin and fisetin, thus, provide opportunities to expand drug development strategies for anti-oxytotic/ferroptotic agents and offer new perspectives on the intricate interplay between mitochondrial function, cellular stress, and the pathophysiology of aging and age-related neurodegenerative disorders.

Polymorphism Dependent Cytotoxicity, Cellular Uptake, and Live Cell Imaging Studies on Napthalimide-Vinyl-Phenothiazine Conjugate.

Polymorphism-dependent cytotoxicity and cellular uptake of drug molecules have been studied for the past two decades. However, the visualization of polymorph-dependent cellular uptake and cytotoxicity using microscopy imaging techniques has not yet been reported. The luminescent polymorph is an ideal candidate to validate the above hypothesis. Herein, we report the polymorph-dependent cellular uptake, cytotoxicity, and bio-imaging functions of polymorphs 1Y and 1R of a naphthalimide-phenothiazine dyad. These polymorphs show different luminescence colors in the solid state and exhibit aggregation-induced enhanced emission (AIEE) in the DMSO-Water mixture. Bioimaging, cytotoxicity assay, and fluorescence-activated cell sorting (FACS) studies revealed that these polymorphs show different levels of cytotoxicity, cellular uptake, localization, and imaging potential. Detailed photophysical, morphological, and biological studies revealed that the difference in molecular conformation in these polymorphs enables them to form aggregates of different sizes and morphology, which leads to the differential uptake of these into the cells and consequently shows different cytotoxicity and imaging potentials.

Level of and factors associated with optimal uptake of intermittent preventive treatment for malaria in pregnancy at private-not-for-profit health facilities in Kasese district.

Malaria in pregnancy poses a high risk of poor maternal and neonatal outcomes and WHO recommends IPTp. However, its uptake has remained sub-optimal among mothers who attend antenatal care at private-not-for-profit health facilities. This study determined the level of and factors associated with uptake Intermittent preventive treatment of malaria for pregnant women (IPTp) at private-not-for-profit (PNFP) health facilities in Kasese District, Uganda. This was a cross-sectional study involving 396 postpartum mothers in the postnatal wards of 8 PNFP health facilities in Kasese district was conducted in September 2022. One hospital and 2 Health Centre IVs were purposively selected and 5 Health Centre IIIs selected randomly. Mothers were consecutively selected and interviewer administered semi-structured questionnaires were used to collect the data. Data were entered in epi-data version 3.1, cleaned and analyzed using STATA version 14. Data were adjusted for clustering & modified poison regression was used to determine associations of the factors and the outcome. From the analysis, level of optimal uptake of IPTp was 51.5% CI = (46.6-56.4). Being married (aPR = 1.35, 95% CI = 1.06-1.7, p = 0.014), attending ANC more than 4 Visits (aPR = 1.29, 95%CI = 1.09-1.54, p<0.001) positively influence optimal uptake while not taking IPTp at recommended time intervals (aPR = 0.49, 95%CI = 0.39-0.62 p<0.001) and mothers paying for IPTp drugs themselves (aPR = 0.74, 95%CI = 0.57-0.97, p = 0.031) negatively influence optimal uptake. This moderate uptake of IPTp among pregnant mothers suggests insufficient protection of pregnant mothers against malaria. Efforts to improve Antenatal care attendance, taking IPTp at recommended time intervals, not paying for ITPp drugs and encouraging marriages should be intensified.

Protocol for a trial-based economic evaluation analysis of a complex digital health intervention including a computerised decision support tool: the iFraP intervention

Background Digital health interventions (DHI) are associated with significant promise. In recent years, the need to assess the value of these healthcare technologies has motivated a debate regarding the suitability of existing economic evaluation methods in the context of DHI evaluation. Some have argued that robust economic evaluation methods may not be capable of capturing relevant DHI’s characteristics. Others consider that assessing the value of DHI might not be feasible. This protocol paper challenges that view. More specifically, it describes early Health Technology Assessments (HTA) methods to rigorously assess the value for money of a complex intervention including a digital decision support tool i.e., Improving uptake of Fracture Prevention drug treatments (iFraP) as a tracer intervention. iFraP is a complex intervention consisting of a computerised decision support tool, a clinician training package, and information resources to facilitate shared decision-making, increase informed medicine initiation and reduce levels of medicine discontinuation. iFraP’s development was motivated by a view that good quality shared decision-making conversations have the potential to improve levels of osteoporosis medicine uptake. Methods An early economic evaluation of the iFraP intervention was designed to identify, measure, and evaluate the costs and health benefits of iFraP compared to usual practice in Fracture Liaison Services (FLSs). A within-trial cost-effectiveness from the perspective of the National Health Service and Personal Social Service in England will be conducted using patient’s self-reported health related quality of life (HRQoL) and resource use from the iFraP randomised controlled trial. Microanalysis will be used to estimate iFraP’s intervention cost. Finally, Bayesian Value of Information analysis will allow us to estimate an upper bound for the potential health benefits gained from reducing uncertainty on the impact of the iFraP intervention to support uptake and adherence with osteoporosis medicines. Trial registration ISRCTN10606407 - https://doi.org/10.1186/ISRCTN10606407

Qualifications in home languages: opportunities, barriers and policy implications

ABSTRACT There is a recognised need for stronger language skills in the United Kingdom which could be partly addressed by valuing and harnessing the home language skills of its population. One way in which these skills could be supported is through formal accreditation, an opportunity which is not consistently being offered to pupils who speak a language at home which differs from the classroom language. This article draws on data from focus groups with multilingual pupils, interviews with mainstream and complementary school staff, and information from university admissions teams to explore the experiences of these stakeholders regarding home language qualifications, the perceived value of qualifications, as well as barriers and opportunities with regard to language qualification uptake. We discuss actions that could support higher levels of uptake and offer three short-term feasible policy interventions which could make a positive contribution to support for home language skills.

Attitude to cervical cancer screening and human papillomavirus testing experience in self-sampled Nigerian women.

Cervical cancer is a disease of major public health significance which can be prevented by adequate screening. This study assessed the level of cervical cancer knowledge, attitude to screening and human papillomavirus testing experience in women who self-sampled for cervical cancer screening. A descriptive cross-sectional study involving 790 women that had human papilloma virus (HPV) testing at the gynae-oncology unit of the Lagos State University Teaching Hospital. Participants were assessed of their cervical cancer screening knowledge, attitude and HPV testing experience. High risk HPV (hr-HPV) nucleic acid testing was funded by the Clinton Health Access Initiative. Majority (76.71%) of the respondents exhibited a high level of knowledge of cervical cancer, its causes, risk factors and prevention; and a positive experience with HPV self-sampling reported in 98.1%. hr-HPV positive rate was 13.4%. The most common reason (43%) for not having a cervical screening done was lack of a doctor's request. The most commonly known method of cervical screening by the respondents was Pap Smear test (55.31%). There is need for more education to improve the level of awareness and uptake of hr-HPV testing for cervical cancer in Lagos. Health care providers are not offering cervical cancer screening enough and this needs to be explored more in future studies.

Fractionation of metals in soil for strawberry cultivation: Effect on metal migration in food chain and application in risk assessment

Although trace metals in strawberry production system have attracted growing attention, little is known about metal fractionation in soil for strawberry cultivation. We hypothesized that the metal fractions in soil influenced by strawberry production had significant effect on food chain transport of metals and their risk in soil. Here, samples of strawberries and soil were gathered in the Yangtze River Delta, China to verify the hypothesis. Results showed that the acid-soluble Cr, Cd, and Ni in soil for strawberry cultivation were 21.5%–88.3% higher than those in open field soil, which enhanced uptake and bioaccessible levels of these metals in strawberries. Overall, the ecological, mobility, and health risks of Pb, Zn, Ni, and Cu in soil were at a low level. However, the ecological risk of bioavailable Cd, mobility risk of Cd, and cancer risk of bioavailable Cr in over 70% of the soil samples were at moderate, high, and acceptable levels, respectively. Since the increased acid-soluble Cr and Ni in soil were related to soil acidification induced by strawberry production, nitrogen fertilizer application should be optimized to prevent soil acidification and reduce transfer of Cr and Ni. Additionally, as Cd and organic matter accumulated in soil, the acid-soluble Cd and the ecological and mobility risks of Cd in soil were enhanced. To decrease transfer and risk of Cd in soil, organic fertilizer application should be optimized to mitigate Cd accumulation, alter organic matter composition, and subsequently promote the transformation of bioavailable Cd into residual Cd in soil.