Years Of Delay Research Articles

Profound primary prevention of liver cancer following a natural experiment in China: A 50‐year perspective and public health implications

AbstractLiver cancer causes upwards of 1 million cancer deaths annually and is projected to rise by at least 55% over the next 15 years. Two of the major risk factors contributing to liver cancer have been well documented by multiple epidemiologic studies and the hepatitis B virus (HBV) and aflatoxin show a synergy that increases by more than 8‐fold the risk of liver cancer relative to HBV alone. Using the population‐based cancer registry established by the Qidong Liver Cancer Institute in 1972 and aflatoxin‐specific biomarkers, we document that reduction of aflatoxin exposure has likely contributed to a nearly 70% decline in age‐standardized liver cancer incidence over the past 30 years despite an unchanging prevalence of HBV infection in cases. A natural experiment of economic reform in the 1980s drove a rapid switch from consumption of heavily contaminated corn to minimally, if any, contaminated rice and subsequent dietary diversity. Aflatoxin consumption appears to accelerate the time to liver cancer diagnosis; lowering exposure to this carcinogen adds years of life before a cancer diagnosis. Thus, in 1990 the median age of diagnosis was 48 years, while increasing to 67 years by 2021. These findings have important translational public health implications since up to 5 billion people worldwide might be routinely exposed to dietary aflatoxin, especially in societies using corn as the staple food. Interventions against aflatoxin are an achievable outcome leading to a reduction in liver cancer incidence and years of delay of its nearly always fatal diagnosis.

(266) Miconazole Vaginal Cream-Induced Acquired Neuroproliferative Vestibulodynia

Abstract Introduction The endodermal vestibule lies between the ectodermal vulva and the mesodermal vagina. Unlike the vulvar skin, the vestibular epithelium is thin, non-keratinized, and its submucosal immune cells are more susceptible to activation. Topical pharmaceutical agents that are applied to the genitals for various medical indications are likely to contact the vestibular epithelium. For example, miconazole vaginal cream (MVC) is approved for treatment of vaginal yeast infections and the irritation associated with the yeast infection. Active and inactive ingredients in MVC include miconazole nitrate, benzoic acid, cetyl alcohol, isopropyl myristate, polysorbate 60, potassium hydroxide, propylene glycol, purified water and stearyl alcohol. We have observed cases where individuals, previously without vestibular pain, have applied MVC to their genitals and immediately experienced excruciating burning that resulted in persistent unrelenting severe pain throughout the vestibule, which is a symptom of acquired neuroproliferative vestibulodynia (ANPV). Objective Our objective is to report cases of patients who used MVC and were diagnosed with ANPV in order to provide awareness of this condition. Methods We performed a retrospective chart review of persons with vulvas presenting to a single sexual medicine clinic between 6/2019-6/2023 who were clinically suspected to have ANPV after experiencing an allergic reaction following use of MVC. Patients were included who failed conservative treatments for provoked vestibular pain, underwent vestibulectomy and were histopathlogically diagnosed with ANPV (>8 CD117 stained immunopositive cells per high-power field (HPF), consistent with mast cells, and excess PGP117 stained immunopositive cells, consistent with nerves). Demographic data, prior diagnoses and treatments, and results from validated questionnaires were collected. Results Our patient cohort included 7 individuals who met the criteria for MVC-induced ANPV. Mean age at time of MVC-induced vestibular pain was 23 (range 18-29) years. Mean age of presentation to our sexual medicine facility was 28 (range 22-33) years. Mean years of delay in diagnosis of MVC-induced ANPV was 5 (range 1-12) years. 71% and 29% were previously diagnosed and unsuccessfully managed as hormone-mediated vestibulodynia and interstitial cystitis, respectively. The mean pain score and overall score for the Female Sexual Function Index (FSFI) was 1.2/6 (range 0-3.2/6) and 11.7/36 (range 4.2-18.1/36), respectively. All total FSFI scores were <26 and indicative of sexual dysfunction. The mean Female Sexual Distress Scale-Revised score was 32.2/52 (21-39/52), consistent with significant distress. Conclusions Our cohort of patients with MVC-induced ANPV experienced several years of misdiagnoses, unsuccessful treatments, and significant pain and distress. It is hypothesized that MVC induces ANPV in genetically susceptible individuals possibly due to activation of the innate submucosal immune cells from an allergic reaction to active or inactive ingredients in the MVC. This allergic reaction results in accumulation of mast cells in the subepithelial stroma that release cytokines and growth factors leading to proliferation of nerves with subsequent symptoms of allodynia and hyperalgesia. Avoidance of topical medications and use of systemic antifungal strategies in individuals with yeast infections may be advisable. Disclosure No.

Rapid Decision-Making Tool for Electric Powertrain Sizing for Motorcycles during New Product Development

As part of the intergovernmental and public interventions to reduce carbon dioxide emissions, there are no existing regulations to ban the sale of petrol motorcycles (PM), but it is expected that motorcycle regulations will follow car regulations with several years of delay. There is an emerging trend in motorcycle uptake, which will lead to new development projects with existing brands, and new brands, and will clearly increase the need for development tools that satisfies design challenges specific to electric motorcycles (EM) and electric powertrains. There is significant importance in motorcycle design to quantify the vehicle-level performance indicators and specifications, which are not limited to total vehicle mass, range, acceleration performance, and top speed. Those performance indicators should be quantified for different powertrain configurations and component selections to identify the most suitable configuration for the specific motorcycle development. In this paper, an innovative powertrain sizing approach is proposed to provide solutions for EMs against the design challenges specific to electric motorcycles. The innovative approach is to apply the practice of design space exploration (DSE) in resilient system design (RSD) to EM development. As a proof of concept, a case study of battery sizing is presented, in which a powertrain sizing tool is used to identify battery pack sizing requirements using requirement-based design (RBD), sensitivity analysis and DSE. The case study shows that the RBD approach allows EM product developers to identify a single solution, while DSE clearly demonstrates the trade-off between different configurations, taking multiple design variables into account. The tool prioritises high accessibility and high confidence with limited information at the early phases of electric motorcycle powertrain component sizing and selection.

Modeling delay of age at natural menopause with planned tissue cryopreservation and autologous transplantation

Ovarian tissue cryopreservation has been proven to preserve fertility against gonadotoxic treatments. It has not been clear how this procedure would perform if planned for slowing ovarian aging. This study aimed to determine the feasibility of cryopreserving ovarian tissue to extend reproductive life span and delay menopause by autotransplantation near menopause. Based on the existing biological data on follicle loss rates, a stochastic model of primordial follicle wastage was developed to determine the years of delay in menopause (denoted by D) by ovarian tissue cryopreservation and transplantation near menopause. Our model accounted for (1) age at ovarian tissue harvest (21-40 years), (2) the amount of ovarian cortex harvested, (3) transplantation of harvested tissues in single vs multiple procedures (fractionation), and (4) posttransplant follicle survival (40% [conservative] vs 80% [improved] vs 100% [ideal or hypothetical]). Our model predicted that, for most women aged <40 years, ovarian tissue cryopreservation and transplantation would result in a significant delay in menopause. The advantage is greater if the follicle loss after transplant can be minimized. As an example, the delay in menopause (D) for a woman with a median ovarian reserve who cryopreserves 25% of her ovarian cortex at the age of 25 years and for whom 40% of follicles survive after transplantation would be approximately 11.8 years, but this extends to 15.5 years if the survival is 80%. As another novel finding, spreading the same amount of tissue to repetitive transplants significantly extends the benefit. For example, for the same 25-year-old woman with a median ovarian reserve, 25% cortex removal, and 40% follicle survival, fractionating the transplants to 3 or 6 procedures would result in the corresponding delay in menopause (D) of 23 or 31 years. The same conditions (3 or 6 procedures) would delay menopause as much as 47 years if posttransplant follicle survival is improved to 80% with modern approaches. An interactive Web tool was created to test all variables and the feasibility of ovarian tissue freezing and transplantation to delay ovarian aging (here). Our model predicts that with harvesting at earlier adult ages and better transplant techniques, a significant menopause postponement and, potentially, fertile life span extension can be achieved by ovarian tissue cryopreservation and transplantation in healthy women.

The Kunming-Montreal Global Biodiversity Framework: what it does and does not do, and how to improve it

The Kunming-Montreal Global Biodiversity Framework (GBF) marks one of the most ambitious environmental agreements of the 21st century. Yet despite the ambition, and the considerable change in approach since negotiating its predecessor (the 2025 Vision and Aichi targets), the many pressures, including working through a global pandemic mean that the final agreement, despite several years of delay, is weaker than might have been hoped for. The GBF provides a set of four goals, composed of 23 targets (and a series of supporting annexes) which explore the options for conservation, restoration and sustainable use of biodiversity, and the mobilisation of necessary resources to maintain life on Earth. In this perspective we systematically examine the composition of the GBF, exploring what the targets lack and what weaknesses exist in text. We also detail the link between the targets and the key indicators which can be used to track success toward fulfilling the targets. We offer key recommendations which could help strengthen the application of various targets, and show where the indicators could be improved to provide more detailed information to monitor progress. Furthermore, we discuss the association between targets and their indicators, and detail where indicators may lack the necessary temporal resolution or other elements. Finally, we discuss how various actors might better prepare for the successor to the GBF in 2030 and what has been learnt about the negotiating process, including lessons to help ensure that future agreements can circumnavigate issues which may have weakened the agreement.

Review and New Perspectives on Non-Layered Manganese Compounds as Electrode Material for Sodium-Ion Batteries.

After more than 30 years of delay compared to lithium-ion batteries, sodium analogs are now emerging in the market. This is a result of the concerns regarding sustainability and production costs of the former, as well as issues related to safety and toxicity. Electrode materials for the new sodium-ion batteries may contain available and sustainable elements such as sodium itself, as well as iron or manganese, while eliminating the common cobalt cathode compounds and copper anode current collectors for lithium-ion batteries. The multiple oxidation states, abundance, and availability of manganese favor its use, as it was shown early on for primary batteries. Regarding structural considerations, an extraordinarily successful group of cathode materials are layered oxides of sodium, and transition metals, with manganese being the major component. However, other technologies point towards Prussian blue analogs, NASICON-related phosphates, and fluorophosphates. The role of manganese in these structural families and other oxide or halide compounds has until now not been fully explored. In this direction, the present review paper deals with the different Mn-containing solids with a non-layered structure already evaluated. The study aims to systematize the current knowledge on this topic and highlight new possibilities for further study, such as the concept of entatic state applied to electrodes.

The EU Directive on Women on Boards

After 10 years of delay, in November 2022 the EU passed the Directive on improving the gender balance among non-executive directors of companies listed on stock exchanges. This Directive imposes a 40% quota in respect of the underrepresented gender for listed company boards in the EU. The aim is to diversify corporate boardrooms and thereby boost economic growth and gender equality (among other objectives). In this paper I look at the mechanisms of the Directive and consider their practical effect and potential impact. I also ask whether the Directive has missed an opportunity to make a more tangible difference to gender equality by failing to effectively consider executive director diversity. I reach the conclusion that the Directive, as drafted, might have been suitable 10 years ago but is not necessarily today. The changes of the last 10 years threaten to mean the Directive becomes obsolete before its pre-destined end date in 2038. boardroom diversity, gender equality, quota, directors, company law, corporate governance, European Union

Energy Sources of Mobile Robot Power Systems: A Systematic Review and Comparison of Efficiency

Mobile robots can perform tasks on the move, including exploring terrain, discovering landmark features, or moving a load from one place to another. This group of robots is characterized by a certain level of intelligence, allowing the making of decisions and responding to stimuli received from the environment. As part of Industry 5.0, such mobile robots and humans are expected to co-exist and work together in a shared environment to make human work less tiring, quicker, and safer. This can only be realized when clean, dense, and economical energy sources are available. The aim of the study is to analyze the state of the art and to identify the most important directions for future developments in energy sources of robotic power systems based mainly on batteries. The efficiency and performance of the battery depends on the design using different materials. Work environments and performance requirements are considered in this systematic review to classify solutions that help developers choose the best-suited power system for specific application. Indirectly, the aim of the work is to generate discussion within the scientific and engineering community. A narrative review of publications from six major bibliographic databases according to preset inclusion criteria is combined with a critical analysis of current and future technologies. The main findings of the review allow answering the question of what is the role of modern power source technologies, artificial intelligence, and ground-breaking research work in global policies related to energy saving, green policies, and sustainable development. The main opportunities and threats are discussed, and a brief feasibility analysis is carried out. The novelty of the article relates not only to the analysis of technologies, but also to approaches and their use under conditions of limited resource availability, when resource usage must be minimized. The article provides an overview of batteries, their specifications, classifications, and their advantages and disadvantages. In addition, we propose (1) an algorithm for selecting the main energy source for robot application, and (2) an algorithm for selecting an electrical system power supply. Current mobile robot batteries are, in most cases, the robot’s biggest limitation. Progress in battery development is currently too slow to catch up with the demand for robot autonomy and range requirements, limiting the development of mobile robots. Further intensive research and implementation work is needed to avoid years of delay in this area.

Peaceful and Innovative Election in the 48th Congress of Muhammadiyah in Solo, Indonesia

After two years of delay, Muhammadiyah successfully organized its 48th Muktamar or Congress in Surakarta, Central Java, on 18-20 November 2022. Muktamar is actually a five-yearly event and the previous congress, the 47th congress, was held in Makassar in 2015. Due to the Covid-19 pandemic that has made gathering of large number of people impossible, Muhammadiyah decided to extend the mandate of the chairmen and all its structure, at first, until 2021 and then extended again until 2022. Muhammadiyah had tried to have a virtual congress or hybrid and had developed technological device for that, but at the end the congress was organized fully offline.In this Congress, Haedar Nashir and Abdul Mu’ti were reelected again as chairman and secretary for 2022 to 2027, the second term for both of them at the helm of Muhammadiyah. They received the highest number of votes, number one and two, from 2519 representatives from all provinces and districts in Indonesia: 2203 for Nashir and 2159 for Mu’ti. It is actually not something automatic or mandatory that those who received the highest votes would be elected as the chairman. During the congress, this organization elected 13 leaders and they would have deliberation to decide the chairman, general secretary, and other position in the central leadership. If needed, they have also the right to add or appoint people outside the 13 elect to have certain position in the central leadership.

Civilized Congress: Election and Organization of the 48th Muktamar of Muhammadiyah in Solo, Indonesia

The theme of this 48th Congress of Muhammadiyah is “Memajukan Indonesia, Mencerahkan Semesta” (Advancing Indonesia, Enlightening the Universe). What was happening there accurately reflected and implemented this theme. From the process of election, side events of the congress, to the activities of participants correctly called “penggembira” (cheerful and happy supporters).After three times rescheduling and two years of delay, Muhammadiyah successfully organized its Muktamar or Congress in Surakarta, Central Java, on 18-20 November 2022. Muktamar is actually a five-yearly event and the previous congress, the 47th congress, was held in Makassar in 2015. Due to the Covid-19 pandemic that has made gathering of large number of people impossible, Muhammadiyah decided to extend the mandate of the chairmen and all its structure, at first, until 2021 and then extended again until 2022. Muhammadiyah had tried to have a virtual congress or hybrid and had developed technological device for that, but at the end the congress was organized fully offline.

Adherence to ahealthy lifestyle and brain structural imaging markers.

Previous research has linked specific modifiable lifestyle factors to age-related cognitive decline in adults. Little is known about the potential role of an overall healthy lifestyle in brain structure. We examined the association of adherence to a healthy lifestyle with a panel of brain structural markers among 2,413 participants in PolyvasculaR Evaluation for Cognitive Impairment and vaScular Events (PRECISE) study in China and 19,822 participants in UK Biobank (UKB). A healthy lifestyle score (0-5) was constructed based on five modifiable lifestyle factors: diet, physical activity, smoking, alcohol consumption, and body mass index. Validated multimodal neuroimaging markers were derived from brain magnetic resonance imaging. In the cross-sectional analysis of PRECISE, participants who adopted four or five low-risk lifestyle factors had larger total brain volume (TBV; β = 0.12, 95% CI: - 0.02, 0.26; p-trend = 0.05) and gray matter volume (GMV; β = 0.16, 95% CI: 0.01, 0.30; p-trend = 0.05), smaller white matter hyperintensity volume (WMHV; β = - 0.35, 95% CI: - 0.50, - 0.20; p-trend < 0.001) and lower odds of lacune (Odds Ratio [OR] = 0.48, 95% CI: 0.22, 1.08; p-trend = 0.03), compared to those with zero or one low-risk factors. Meanwhile, in the prospective analysis in UKB (with a median of 7.7years' follow-up), similar associations were observed between the number of low-risk lifestyle factors (4-5 vs. 0-1) and TBV (β = 0.22, 95% CI: 0.16, 0.28; p-trend < 0.001), GMV (β = 0.26, 95% CI: 0.21, 0.32; p-trend < 0.001), white matter volume (WMV; β = 0.08, 95% CI: 0.01, 0.15; p-trend = 0.001), hippocampus volume (β = 0.15, 95% CI: 0.08, 0.22; p-trend < 0.001), and WMHV burden (β = - 0.23, 95% CI: - 0.29, - 0.17; p-trend < 0.001). Those with four or five low-risk lifestyle factors showed approximately 2.0-5.8years of delay in aging of brain structure. Adherence to a healthier lifestyle was associated with a lower degree of neurodegeneration-related brain structural markers in middle-aged and older adults.

Counterpoint: Preprints and the Future of Scientific Publishing-In Favor of Relevance.

Peer-reviewed journals provide an invaluable but inadequate vehicle for scientific communication. Preprints are now an essential complement to peer-reviewed publications. Eschewing preprints will slow scientific progress and reduce the public health impact of epidemiologic research. The coronavirus disease 2019 (COVID-19) pandemic highlighted long-standing limitations of the peer-review process. Preprint servers, such as bioRxiv and medRxiv, served as crucial venues to rapidly disseminate research and provide detailed backup to sound-bite science that is often communicated through the popular press or social media. The major criticisms of preprints arise from an unjustified optimism about peer review. Peer review provides highly imperfect sorting and curation of research and only modest improvements in research conduct or presentation for most individual papers. The advantages of peer review come at the expense of months to years of delay in sharing research methods or results. For time-sensitive evidence, these delays can lead to important missteps and ill-advised policies. Even with research that is not intrinsically urgent, preprints expedite debate, expand engagement, and accelerate progress. The risk that poor-quality papers will have undue influence because they are posted on a preprint server is low. If epidemiology aims to deliver evidence relevant for public health, we need to embrace strategic uses of preprint servers.

Capabilities and limitations of preschoolers with autism spectrum disorder in terms of mastering numeracy skills

The first part of the article briefly reviews studies on the mathematical abilities of children with autism spectrum disorder (ASD). Inconsistencies in the image of the mathematical aptitudes of this group of children have been revealed. One of the studies found that children with ASD with an average IQ score show higher math skills compared to children with the same IQ without ASD. The other study shows that there were no significant differences in the early numeracy skills among preschoolers. The differences reappeared after a year, when the children were re-examined when they were already first graders. Children with ASD in all examined areas scored lower than typically developing children. However, despite the generally lower scores obtained by the children with autism compared to the control group, the scores of children with ASD were within the average range. Therefore, the main purpose of the presented research was to find out the level of the mathematical skills in preschoolers diagnosed with ASD. The research used diagnostic experiments created by Edyta Gruszczyk-Kolczyńska (Gruszczyk-Kolczyńska, Zielińska, 2013). 36 children aged 3 to 6 were examined, including 18 children with ASD and 18 children in the broadly understood intellectual norm. It has been shown that out of 18 children diagnosed with ASD, every fourth preschooler shows the level of the numeracy and calculation skills well above their age (four examined children – one five-year-old and 3 six-year-olds). At the same time, in some of the examined children, significantly lower level of mathematical abilities was observed compared to children in the broadly understood intellectual norm (even 2–3 years of delay in the level of numeracy and calculation skills). The results of the presented studies can help to adapt the learning process to the intellectual potential of the surveyed children and to plan corrective or supportive actions.

A Survey of Diagnostic Delay in Axial Spondyloarthritis Across Two National Health Service (NHS) Rheumatology Services.

IntroductionDiagnostic delay is an ongoing challenge in axial spondyloarthritis (axial SpA). A recent, comprehensive literature review has found a mean average of 8.7 years of delay between symptom onset and formal diagnosis in the United Kingdom (UK). The primary aim of this study was to identify delays to diagnosis experienced by patients with axial SpA under the ongoing care of two urban National Health Service (NHS) rheumatology services. The secondary aims were (a) to count healthcare professional (HCP) interactions after symptom onset but prior to the diagnosis, (b) to compare our data to published delay to diagnosis research and (c) to explore contributing factors locally and the variation between the two UK rheumatology services.MethodsA 14-question survey was created to identify the delay to diagnosis and contributing factors across two urban NHS axial SpA services, from the onset of symptoms to diagnosis and commencement of treatment. Participants were recruited from clinic visits between August and November 2021 and completed the survey either on paper or via online survey software, both with HCP support.ResultsThose completing the survey formed a cohort of 106 participants with an established diagnosis of axial SpA who attended the axial SpA services at either Royal Free NHS Foundation Trust or Salford Care Organisation, Northern Care Alliance NHS Foundation Trust. The mean time from the onset of symptoms to the diagnosis of axial SpA was similar across centres despite the differences in demographics, with Royal Free at 5.72 years and Salford Royal at 5.96 years. When reviewing via median diagnostic delay, there was a notable difference with Royal Free at 6.09 years and Salford Royal at 4.27 years.Across the two sites, between the onset of symptoms and the diagnosis of axial SpA, 90% of the participants saw a general practitioner (GP), of which 63% of the patients saw a GP 1-5 times, 23% saw 5-10 times and 14% saw more than 10 times. Many participants also saw other HCPs, including physiotherapists, other manual therapists and hospital specialists prior to diagnosis. In addition, 32% saw one other HCP, 18% two other HCPs, 9% three, 7% four and 2.7% five other HCPs prior to diagnosis. Close to 80% of the patients stated that they had received adequate axial SpA education at diagnosis, and 76% of the patients were aware of who to contact in the event of a flare.ConclusionsThese data highlight that the mean average time to diagnosis for both trusts was between five and six years, somewhat lower than the 8.7-year national UK average. However, despite being specialist centres, these data are a long way from the National Axial Spondyloarthritis Society (NASS) “Gold Standard” of one year time to diagnosis. The contributors to this include lack of HCP and community awareness about axial SpA, its recognition and appropriate onwards referral. There is a need for concerted ways of working for the development of patient pathways and public and HCP education to reduce this delay to allow the ambitious NASS Gold Standard of one year time to diagnosis to be achieved.

Bilingualism and Language Education to Improve the Cognitive Health of Older Persons

This article explores whether lifelong bilingualism can be associated with delayed age-related cognitive decline, with cognitive (or brain) reserve as the mechanism that compensates by positively increasing the functional capacity of the brain for older persons. A structural review of recent psychoneurolinguistic studies shows that older bilinguals display several years of delay in dementia symptoms as compared to monolinguals, as well as that positive effects exist in bilingual brain networks, also related to other neurodegenerative disorders. The field is clearly missing an established methodology, nevertheless, lifelong bilingualism can be considered to induce cognitive reserve. Drawing from these implications, we hypothesize that successful ageing could be facilitated by the active use of multiple languages, and in this light, we discuss language education for older persons, the role of Third Age Universities, the implementation of crucial aspects in such courses, and the proper assessment of the effectiveness of language proficiency and cognition.

Satellite-based estimates of nitrogen oxide and methane emissions from gas flaring and oil production activities in Sakha Republic, Russia

Crude oil production activities and associated petroleum gas (APG) flaring are responsible for significant air polluting and greenhouse gas (GHG) emissions and have negative effects on the environment and climate. In Russia, one of the world's major oil producers, APG flaring remains a routine practice despite regulatory policies. We present the first analysis of nitrogen oxide and methane emissions over Tas-Yuryakh and Talakan oil fields in Sakha Republic (Eastern Siberia, Russia) using multi-satellite observations. Satellite-based TROPOMI (TROPOspheric Monitoring Instrument) nitrogen dioxide (NO2) mean fields show local NO2 enhancements corresponding to the locations of gas flares detected from Sentinel 2 imagery and VIIRS (Visible Infrared Imaging Radiometer Suite) fire data. We derive the annual nitrogen oxide (NOx = NO2+NO) emissions from TROPOMI NO2 observations using an exponentially-modified Gaussian model. We obtain NOx emissions up to 1.34 mol/s (in 2019) in Tas-Yuryakh, where persistent production APG flaring is detected, and about 0.6 mol/s in Talakan, where oil production is three times larger than in Tas-Yuryakh but gas flaring is employed only occasionally. In 2019 we observe a new flaring site in Tas-Yuryakh from the NO2 mean fields, corresponding to an increase in the environmental fees paid by the companies to the local budgets. Assuming that all NOx emissions are associated with APG flaring, the volume of gas flared for 2019 is estimated at 1.25 ± 0.48 billion cubic metres (bcm) in Tas-Yuryakh and 0.5 ± 0.2 bcm in Talakan. Furthermore, we find a clear methane (CH4) anomaly of about 30 ppb from the TROPOMI XCH4 mean fields near Talakan oil field. We estimate CH4 emissions of about 28–63 tons/h from individual TROPOMI XCH4 plumes using the cross-sectional flux method. The estimated satellite-based NOx and CH4 emissions are higher than the inventories, which are expected to underestimate the contribution from the oil and gas industry and are generally available with several years of delay. TROPOMI NO2 and CH4 observations demonstrate their capability in identifying emission sources from space with unprecedented detail. The results show how satellite observations can support environmental authorities in monitoring the emissions from the oil and gas industry and the commitment of oil companies in reducing APG flaring.

Role of Individual Motivations and Privacy Concerns in the Adoption of German Electronic Patient Record Apps-A Mixed-Methods Study.

Germany’s electronic patient record (“ePA”) launched in 2021 with several attempts and years of delay. The development of such a large-scale project is a complex task, and so is its adoption. Individual attitudes towards an electronic health record are crucial, as individuals can reject opting-in to it and making any national efforts unachievable. Although the integration of an electronic health record serves potential benefits, it also constitutes risks for an individual’s privacy. With a mixed-methods study design, this work provides evidence that different types of motivations and contextual privacy antecedents affect usage intentions towards the ePA. Most significantly, individual motivations stemming from feelings of volition or external mandates positively affect ePA adoption, although internal incentives are more powerful.

Evaluation of Undiagnosed HIV Estimates Computed from the CD4 Depletion Model in a Rural, Medium-low HIV Prevalence State.

The CD4 depletion model estimates diagnosis delays by approximating infection date from CD4 T-cell count at diagnosis, and back-calculation can compute the proportion of undiagnosed PLWHA. The model assumes the immigration of PLWHA to the U.S. is negligible and counts as a transmission event, which may be impractical outside high prevalence states. Duration of U.S. residency among foreign-born PLWHA and diagnosis delays were compared. The impact on estimates of undiagnosed PLWHA was tested through simulation with different proportions of foreign-born people assumed to have acquired HIV abroad. In 67% of foreign-born people, the mean (SD) years of delay (9.9 (6.3)) exceeded the duration of U.S. residency (2.0 (1.9)). Additionally, inaccuracies in the estimates for proportions of undiagnosed PLWHA were pronounced when foreign-born people who acquired HIV abroad comprised 30% of diagnoses. The CD4 model inadvertently misclassified some diagnoses as in-state transmission events. Consequently, simulated results demonstrated inaccuracies and unstable calculations.

Clubfoot management in the Middle East: a survey-based review.

Clubfoot is the most frequent congenital deformity involving the foot. Little is known about the management of this disease in the Middle East as sparse data is available in the literature. Through the last 5 decades, congenital clubfoot management in the Middle East went from manipulation through Kite’s technique in the late seventies, to early primary surgical intervention in the late eighties and early nineties of the previous century, and then back to manipulation with Ponseti’s technique and the French functional technique in the late nineties, with the latter falling out of favor with time. This is comparable to the evolution of management witnessed in the United States and in Europe, with 10 to 15 years of delay. The delay is getting shorter with time due to the easier access to published scientific data and the increasing number of fellows from Middle East travelling to referral centers in Europe and the USA. A survey was performed among pediatric orthopedic surgeons in the Middle East to assess their approach to clubfoot management. This is the first survey of its kind in the region. It showed a wide adoption (97.1%) of the Ponseti’s technique with serial manipulation and casting, Achilles tenotomy followed by abduction bracing. Divergent practices were found concerning the upper age limit for Ponseti treatment and the setting of the Achilles tenotomy. Nevertheless, these subjects are still a matter of debate in the literature and international conferences. All in all, pediatric orthopedic surgeons in the Middle East are offering their patients the gold standard of care. However, lot of work is to be done in raising awareness for this disease in the community, and among our colleagues as prenatal screening for clubfoot in the Middle East is practically nonexistent.

N12 A decade of waiting to know is not good enough! Experiences of women with vulval Crohn’s disease

Abstract Background Vulval Crohn’s disease is a rare extra manifestation of inflammatory bowel disease, and there is no treatment consensus for it. Current evidence is mainly from case studies and includes only about 250 participants globally. We explored how vulval Crohn’s disease affects women’s sexual well-being, and aimed to understand what might be the specific experiences of sexuality in this group Methods Three participants from a phenomenological study exploring sexuality in inflammatory bowel disease have self-reported as diagnosed with vulval Crohn’s disease. Data collected from telephone interviews were analysed using thematic analysis. Results Women with vulval Crohn’s disease reported a severe disease course with devastating consequences on their sexuality, and suffered years of delay in their diagnosis. Their experiences were summarised in four main themes: Scarred by Crohn’s, Striving for normality, Waiting too long, and Who’s going to help? Sex posed extreme challenges imposed by the condition, and participants waited almost a decade to get a diagnosis, which negatively affected their trust in clinicians. In their effort to continue to enjoy a sexual life as normal as possible, they had feared for the future, as they felt healthcare professionals were unsure of who should help those living with vulval Crohn’s disease. Conclusion In spite of specialists having knowledge of vulval Crohn’s disease, participants experienced lengthy periods to get a diagnosis, with damaging consequences for their lives. Discussing sexual well-being in clinical settings may increase chances of early detection and avoid worsening symptoms.