Emission characteristics of biogenic volatile organic compounds in a subtropical pristine forest of southern China.

Emission characteristics of biogenic volatile organic compounds (BVOCs) from dominant tree species in the subtropical pristine forests of China are extremely limited. Here we conducted in situ field measurements of BVOCs emissions from representative mature evergreen trees by using dynamic branch enclosures at four altitude gradients (600-1690 m a.s.l.) in the Nanling Mountains of southern China. Composition characteristics as well as seasonal and altitudinal variations were analyzed. Standardized emission rates and canopy-scale emission factors were then calculated. Results showed that BVOCs emission intensities in the wet season were generally higher than those in the dry season. Monoterpenes were the dominant BVOCs emitted from most broad-leaved trees, accounting for over 70% of the total. Schima superba, Yushania basihirsuta and Altingia chinensis had relatively high emission intensities and secondary pollutant formation potentials. The localized emission factors of isoprene were comparable to the defaults in the Model of Emissions of Gases and Aerosols from Nature (MEGAN), while emission factors of monoterpenes and sesquiterpenes were 2 to 58 times of those in the model. Our results can be used to update the current BVOCs emission inventory in MEGAN, thereby reducing the uncertainties of BVOCs emission estimations in forested regions of southern China.

Intramolecular energy transfer and its influence on the overall quantum yields of Eu3+ and Tb3+ chelates with dimethyl(phenylsulfonyl)amidophosphate ligands.

Lanthanide chelates with dimethyl(phenylsulfonyl)amidophosphate (labeled as HSP) and Lewis base ligands (bpy = 2,2;-bipyridine and phen = 1,10-phenanthroline) of formula Na[Ln(SP)4] (1Ln), [Ln(SP)3bpy] (2Ln); [Ln(SP)3phen] (3Ln) (Ln = Eu3+, Gd3+, Tb3+ and Lu3+) were obtained and characterized by the X-ray, photoluminescence spectroscopy at 293 and 77 K as well as by intrinsic (QLnLn) and overall (QLnL) luminescence quantum yields. These phosphors manifest a very strong emission after excitation in the UV range of the molecular singlet states (S1) and two of them have very high QLnL values (Eu3+ and Tb3+ chelates of the type 2Ln and 3Ln). The dynamics of the excited states are discussed based on the intramolecular energy transfer theory, considering the dipole-dipole, the dipole-multipole and the exchange mechanisms. From the calculated energy transfer rates, a rate equation model was constructed and, thus, the theoretical QLnL can be obtained. A good correlation between the experimentally determined and theoretically calculated QLnL values was achieved, with the triplet state (T1) playing a predominant role in the energy transfer process for Eu3+ compounds, while the sensitization for Tb3+ compounds is dominated by the energy transfer rates from the singlet state (S1).

NMR-Based Analysis of Cellular Central Energy Metabolism and Exchange Rates.

Cell cultures are widely used in studies to gain mechanistic insights of metabolic processes. The foundation of these studies lies on the quantification of intracellular and extracellular metabolites, and nuclear magnetic resonance (NMR) is one of the key analytical platforms used to this aim. Among the factors influencing the quality of the produced data are the sampling procedures as well as the acquisition and processing of spectroscopic data. Here we provide our workflow for obtaining quantitative metabolic data from adherent mammalian cells using NMR spectroscopy. The described protocol is compatible with other analytical methods like LC- or GC-MS-based lipidomics and untargeted metabolomics from the same sample. We also show how the collected extracellular data can be used to extract exchange flux rates, particularly useful for flux analysis studies and metabolic engineering of human-induced pluripotent stem cells.

Advancements in Surgical Approaches for Sacrococcygeal Pilonidal Sinus: A Comprehensive Review.

Sacrococcygeal pilonidal sinus (SPS) is a condition involving the formation of a cavity in the lower back region. It is more common among young adults and is influenced by factors such as sitting for long periods, body hair, and certain lifestyle habits. Surgical treatment is often necessary for recurring or severe cases, and various surgical techniques available, ranging from traditional surgical methods to newer, less invasive approaches. This comprehensive review examines the progress in surgical techniques for managing SPS, emphasizing the effectiveness, safety, and patient outcomes associated with different methods. It provides an overview of traditional procedures, such as excision with primary closure, and contrasts these with recent innovations like endoscopic and laser-assisted techniques. The review also considers advanced technologies, including the potential of robotic surgery and the use of specialized materials. By assessing clinical outcomes, recurrence rates, complications, and patient satisfaction, this review seeks to identify the most effective surgical strategies for SPS. Additionally, it discusses recent technological advancements and highlights areas needing further research to improve the management and treatment of this condition.

A critical review of health and financial implications of obesity during the COVID-19 pandemic.

The COVID-19 was reported in Wuhan, China, in December 2019. There is a link between increased mortality and obese individuals with the disease. The disease has been claimed to have disproportionately affected non-Hispanic blacks and Hispanics. The rise in food accessibility and the drop in the relative cost of junk food items are the two most significant changes in dietary patterns. Around the world, 2.8 million people die from being overweight or obese, and those with more body fat also have a higher risk of diabetes (44%) and heart disease (23%). Obesity weakens the immune system because adipose cells infiltrate the bone marrow, spleen, and thymus. Obesity was substantially more common among COVID-19 patients who were hospitalized than those who were not hospitalized. Over 900 000 adults in the United States are hospitalized due to a COVID-19 infection. Hospitalizations in 271 700 (30.2%) cases have been attributed to obesity. Obese patients may be experiencing reduced thoracic expansion following bariatric surgery. Less tracheal collapse and air-trapping at end-expiration chest computed tomography (CT) were observed post-surgery, and patients reported reduced dyspnea. COVID-19 is estimated to cost the European Union €13.9 billion in secondary care, with 76% of that cost attributed to treatment for overweight and obese individuals. The average price per hospitalized patient also increased with increasing BMI. Screening for obesity, preventive measures, and recommendations for healthy lifestyle changes should be of the utmost importance to decrease both the health and financial implications of COVID-19.

Advancing life: innovative approaches to enhance survival in sickle cell anemia patients.

Sickle cell anemia (SCA) is a severe genetic disorder characterized by the production of abnormal hemoglobin S, leading to the formation of sickle-shaped red blood cells that cause chronic anemia, pain, and organ damage. This review explores recent innovative strategies aimed at improving survival rates and quality of life for SCA patients. Genetic therapies, particularly gene editing with CRISPR-Cas9 and gene therapy using lentiviral vectors, have shown significant potential in correcting the genetic defects responsible for SCA. Clinical trials demonstrate that these approaches can reduce sickle cell crises and minimize the need for blood transfusions by enabling the production of healthy red blood cells. Novel pharmacological treatments such as voxelotor, crizanlizumab, and L-glutamine provide additional mechanisms to prevent hemoglobin polymerization, reduce vaso-occlusive episodes, and decrease oxidative stress, respectively. These therapies offer new hope for patients, particularly those who do not respond adequately to existing treatments. Improved blood transfusion protocols, including automated red cell exchange and advanced donor-matching techniques, have enhanced the safety and efficacy of transfusions, reducing complications like alloimmunization. Comprehensive care models, integrating multidisciplinary care teams, patient education, and telemedicine, have further contributed to better disease management. By providing holistic care that addresses both medical and psychosocial needs, these models improve patient adherence to treatment and overall health outcomes. This review highlights the importance of these innovative strategies and calls for continued research and development to sustain and expand these advancements in SCA care.

Impact of COVID-19 on referrals to paediatric liaison psychiatry at Children's Health Ireland at Crumlin as the pandemic moved to endemic status.

BACKGROUND: Rates of acute mental health presentations in youth were increasing pre-pandemic internationally. Longitudinal studies following COVID-19 attest to ongoing deterioration in youth mental health, recognising adverse unintended consequences following public health restrictions. AIMS: To examine whether the initial post-COVID-19 increase in mental health presentations persisted following the reclassification of COVID-19 to endemic status, accompanied by the removal of most restrictions. METHOD: All referrals to paediatric liaison psychiatry (PLP) between January 2018 and December 2022 in a Dublin tertiary children's hospital were included in the study. An interrupted time series analysis with autoregressive integrated moving average models was conducted, examining referrals with respect to different phases of COVID-19 and application of public health restrictions. RESULTS: Some 1385 referrals to PLP were received over the 5-year study. There was a significant decrease in PLP referrals immediately post-COVID-19, followed by a significant and sustained increase as the pandemic progressed and moved to endemic status. Public health restriction phases had a unique effect on those presenting with suicidal ideation, with a significant increase in the number of referrals. There was no effect of restrictions on other clinical profiles. CONCLUSIONS: Increased referrals for youth with mental health difficulties, reported during the COVID-19 pandemic, persisted into the early endemic stage, after COVID-19 public health restrictions ceased. Specific impacts of restrictions on suicidal ideation referrals require further study. Investment in child and adolescent mental health services remains a priority, and future pandemic response strategies need to examine unintended consequences of any enforced public health measure.

Optimizing Microfluidic Channel Design with High-Performance Materials for Safe Neonatal Drug Delivery.

INTRODUCTION: Designing the microfluidic channel for neonatal drug delivery requires proper considerations to enhance the efficiency and safety of drug substances when used in neonates. Thus, this research aims to evaluate high-performance materials and optimize the channel design by modeling and simulation using COMSOL multiphysics in order to deliver an optimum flow rate between 0. 3 and 1 mL/hr. METHOD: Some of the materials used in the study included PDMS, glass, COC, PMMA, PC, TPE, and hydrogels, and the evaluation criterion involved biocompatibility, mechanical properties, chemical resistance, and ease of fabrication. The simulation was carried out in the COMSOL multiphysics platform and demonstrated the fog fluid behavior in different channel geometries, including laminar flow and turbulence. The study then used systematic changes in design parameters with the aim of establishing the best implementation models that can improve the efficiency and reliability of the drug delivery system. The comparison was based mostly on each material and its appropriateness in microfluidic usage, primarily in neonatal drug delivery. The biocompatibility of the developed materials was verified using the literature analysis and adherence to the ISO 10993 standard, thus providing safety for the use of neonatal devices. Tensile strength was included to check the strength of each material to withstand its operation conditions. Chemical resistance was also tested in order to determine the compatibility of the materials with various drugs, and the possibility of fabrication was also taken into consideration to identify appropriate materials that could be used in the rapid manufacturing of the product. RESULTS: The results we obtained show that PDMS, due to its flexibility and simplicity in simulation coupled with more efficient channel designs which have been extracted from COMSOL, present a feasible solution to neonatal drug delivery. CONCLUSION: The present comparative study serves as a guide on the choice of materials and design of microfluidic devices to help achieve safer and enhanced drug delivery systems suitable for the delicate reception of fragile neonates.

Burden of oral cancer and associated risk factors at national and state levels: A systematic analysis from the global burden of disease in India, 1990-2021.

BACKGROUND: Oral cancer is the sixth most prevalent cancer globally, posing a significant health concern, especially in India, where it accounts for one-third of the global cases. Despite high incidence and mortality rates, comprehensive national and regional data on risk factors and trends are scarce. METHODS: This study analyzed data from the Global Burden of Disease (GBD) 2021 report, focusing on the age-standardized incidence rate (ASIR), mortality rate (ASMR), disability-adjusted life years (ASDR), and prevalence rate (ASPR) of oral cancer in India from 1990 to 2021. Joinpoint regression analysis was used to assess trends, and ARIMA models were applied to forecast future trends from 2022 to 2031. RESULTS: From 1990 to 2021, India experienced a moderate increase in oral cancer mortality, with ASMR rising from 5.32 to 5.92, reflecting an annual percentage change (APC) of 11.18 %. ASDR increased from 152.94 to 163.61 (APC of 6.98 %), and ASPR showed a marked rise from 15.71 to 25.46 (APC of 62.06 %). The burden varied significantly across states. Gender disparities were observed, with males consistently exhibiting higher incidence and mortality rates. ARIMA forecasts projected an upward trend in oral cancer metrics from 2022 to 2031, with ASIR expected to reach 10.15 per 100,000 and ASPR 29.38 per 100,000 by 2031. CONCLUSIONS: The study reveals a persistent and growing burden of oral cancer in India, highlighting the influence of lifestyle and socioeconomic factors. Targeted strategies to mitigate risk behaviors, improve early detection, and address disparities are urgently needed to reduce the disease's impact.

Safe Landing: Feasibility and Safety of Operating Room Extubation in Minimally Invasive Cardiac Valve Surgery.

OBJECTIVE: This study was designed to explore key safety outcomes after operating room (OR) extubation in minimally invasive cardiac valve surgery. DESIGN: Single-center retrospective chart review. SETTING: Academic medical center in the United States. PARTICIPANTS: Patients undergoing valvular surgery via thoracotomy (November 2017-October 2022) at a single institution. INTERVENTIONS: The OR extubation protocol was implemented on August 20, 2020. MEASUREMENTS AND MAIN RESULTS: Delirium rates, reintubation rates, and intubation duration were compared before and after OR extubation protocol implementation. Logistic regression identified patient perioperative characteristics associated with unsuccessful OR extubation. Among 312 patients, 254 were extubated in the intensive care unit (ICU) and 58 in the OR. Preoperative demographics were comparable except for the Charlson Comorbidity Index (median: 2.0 ICU extubation v 1.5 OR extubation). Interrupted time series analysis showed no change in postoperative delirium post-OR extubation implementation, with a trend toward decreasing delirium (risk ratio = 0.37, CI: 0.13-1.10, p = 0.07). The postimplementation era also had a lower median intubation duration (8 hours v 13 hours, p < 0.001) without increasing reintubation rates (1.7% v 7.9%, p = 0.159). Increased bypass length (odds ratio = 0.99, CI: 0.98-0.99, p < 0.001), intraoperative morphine milligram equivalents (odds ratio = 0.99, CI: 0.99-1.0, p = 0.009), and preoperative Charlson Comorbidity Index above 3 (odds ratio = 0.42, CI: 0.19-0.95, p = 0.037) were associated with decreased odds of OR extubation. CONCLUSIONS: OR extubation was not associated with increased postoperative delirium or reintubation rates but did decrease intubation duration. Successful OR extubation relies upon the consideration of various patient perioperative characteristics.

Association of Race With Referral Disparities for Patients With Diabetic Foot Ulcers at an Institution Serving Rural and Urban Populations.

Background: Racial minorities are more likely to develop type 2 diabetes and experience associated microvascular complications. Non-Hispanic Blacks and Hispanics initially present with more severe diabetic foot ulcers (DFUs) and peripheral artery disease (PAD), with an associated 10-fold increase in risk for lower extremity amputation within the first year after diagnosis. This study was designed to determine if race is associated with a failure to refer to specialists for DFU treatment, and the severity of DFU at the time of initial presentation. Methods: Patients were identified from the medical record based on a diagnosis related to diabetic foot complications between January 1, 2018, and June 1, 2023, in the family medicine, endocrinology, orthopaedic, or emergency clinics at a Midwest Academic Hospital serving rural and urban populations. Patients self-reported race, demographics, severity of ulcer based on Wagner ulcer scale at time of referral, eventual amputation status, and measures of social determinants of health including the national Area Deprivation Index (ADI) and Rural-Urban Commuting Area (RUCA) codes were manually extracted and analyzed for correlations with referral status. Results: A total of 597 patients were eligible for inclusion. Race was not associated with lower referral rates (P > .99) or source of referral (P = .58) to specialty clinic and ulcer severity at initial examination (P = .34). Patients who initially presented to the emergency department had more severe ulcers (P = .016), and higher severity was significantly associated with lower limb amputation vs mild ulcers (odds ratio = 38.8, P = .02). No significant differences in referral source or severity of ulcer at presentation were seen for sex, age, marital status, insurance type, rural status, ADI, time from referral to appointment, or eventual amputation. Conclusion: In this study, we found that patient race was not associated with severity of DFU at presentation or subsequent referral to a Midwest academic specialty orthopaedic clinic for care.Level of Evidence: Level III, retrospective review.

What is the best mode of delivery in nulliparous, singleton, term, vertex pregnancies of individuals ≥ 35 years old?: Short title: What is the best mode of delivery in nulliparous, singleton, term, vertex pregnancies?

With approximately 145 million births occurring worldwide each year - over 30 million by cesarean delivery, the need for evaluation of maternal and perinatal outcomes in different delivery scenarios is more pressing than ever. Recently, in a meta-analysis of the available randomized controlled trials (RCTs), planned cesarean delivery was associated with decreased rates of low umbilical artery pH, and neonatal complications such as birth trauma, tube feeding, and hypotonia when compared to planned vaginal delivery. Among singleton pregnancies, planned cesarean delivery was associated with a lower rate of perinatal death. For mothers, planned cesarean delivery was associated with significantly less chorioamnionitis, more wound infection, and less urinary incontinence at 1-2 years. Conversely, planned vaginal delivery has been associated with benefits such as a lower incidence of wound infection and quicker postpartum recovery compared to planned cesarean delivery. Nonetheless, several risk factors for cesarean delivery are increasing - such as older maternal age, obesity, diabetes, excessive gestational weight gain, and birth weight - while maternal pelvises are getting smaller. Concerns about the potential long-term risks of multiple cesarean deliveries, such as placenta accreta spectrum disorders, highlight the need for a balanced evaluation of both delivery modes. However, the total fertility rate is decreasing in the US and around the world, with many people wanting two or fewer babies, which decreases future risk of placenta accreta incurred by multiple cesarean deliveries in these individuals. Furthermore, one in four obstetricians-gynecologists has undergone a cesarean delivery on maternal request for their nulliparous, singleton, term, vertex (NSTV) pregnancy, and cesarean delivery rates less than about 19% have been associated with higher perinatal and maternal mortality. Thus, we propose that it is imperative that we prioritize conducting randomized trials to compare planned cesarean to planned vaginal delivery for NSTV pregnancies. Such trials would need to include 8,000 or more individuals; they would ideally follow each participant to the end of their reproductive life and study perinatal and maternal outcomes, including non-biologic outcomes such as patient satisfaction, postpartum depression, breastfeeding rates, mother-infant bonding, post-traumatic stress, and cost-effectiveness. The time for such a trial is now, as it holds the potential to inform and improve obstetrical care practices globally.

Did H.M. exhibit accelerated long-term forgetting? Measuring forgetting in amnesia.

The early investigations of patient H.M. inaugurated the modern era of memory research. During the 1970s and 1980s, a key debate over whether H.M. with bilateral medial temporal lobe lesions exhibited accelerated long-term forgetting attracted an increasing interest in forgetting research among amnestic patients. Huppert and Piercy (1979) examined H.M.'s performance in visual recognition at 10-minute, 1-day, and 7-day intervals and suggested that H.M. was subjected to rapid forgetting compared with Korsakoff patients and healthy participants reported in Huppert and Piercy (1978). In contrast, Freed et al. (1987) employed the same experimental paradigm and concluded that forgetting rates in H.M. did not differ from those in healthy controls. These incompatible findings highlighted a methodological challenge in measuring forgetting in the cross-group comparison design, where closely equalising the initial performance between patient and control groups is usually suggested. The re-analysis in this viewpoint, using both linear- and nonlinear-based modelling, reconciled the discrepancy between the aforementioned studies. Our results indicated that the rate of forgetting in H.M. did not differ from that in healthy controls, regardless of whether the initial performance was closely matched. Here, we suggest that the cross-group comparisons in forgetting studies do not necessarily seek a perfect match in initial performance unless the risks of confounding encoding and retrieval processes can be effectively controlled.

Antibiotic administration for open reduction internal fixation of closed ankle fractures: Is one preoperative dose enough?

Although preoperative antibiotics are used routinely in ankle fracture surgery, there is considerable variability in postoperative antibiotic dosing regimens amongst surgeons. The aim of this study is to compare the rate of surgical site infection (SSI) in patients receiving one dose of preoperative antibiotics to patients who received more than one dose of antibiotics. A single-center Level I Trauma Center retrospective review of patients with isolated closed ankle fractures who underwent open reduction internal fixation over a 10-year period was performed. Demographics data and risk factors were obtained from the electronic medical record. SSI was detected using a text-mining algorithm on all postoperative clinic notes. Factors associated with the development of SSI or increased antibiotic dosing were evaluated. Eight-hundred and twenty-six patients were included in the analysis. There was no correlation between infection rate and any of the potential risk factors evaluated. Two-hundred and ninety-two patients received only one dose of antibiotics preoperatively and 534 patients received more than one antibiotic dose. The rate of SSI was not significantly different between the single-dose cohort (5.8 %) and the multi-dose cohort (3.9 %) (p=0.215). Routine use of postoperative antibiotics in open reduction internal fixation of closed ankle fractures did not decrease the rate of SSI, regardless of associated comorbidities. LEVEL OF EVIDENCE: : Level III (therapeutic retrospective cohort study).

Detection rates and diel activity patterns of four understudied felids from Borneo.

Carnivore guilds are charismatic and have vital and irreplaceable roles in their native ecosystems, yet many of these species are threatened and remain understudied. Borneo is a biodiversity hotspot that hosts a rich diversity of endemic wildlife but is threatened by deforestation and habitat loss. Using cameras placed by the Smithsonian Institution in Sabah, Borneo, we assessed the detection rates and diel activity patterns of the native felid species. Across 51 camera trap sites between 2016 and 2019, felids were detected 55 times across a combined 9958 trap nights, including 20 independent detection events for Sunda leopard cats, 15 for Sunda clouded leopards, 12 for Borneo bay cats, and 5 for marbled cats, with no detections of flat-headed cats. Collectively, this demonstrates the challenge of sampling cryptic species that have declined due to habitat loss and conflict with humans. Despite this, we show that Borneo bay cats and marbled cats exhibited different diel activity patterns than Sunda cloud leopards, suggesting the smaller species use temporal displacement to avoid competition and predation. Sunda leopard cats exhibited broadly similar activity patterns to Sunda clouded leopard, potentially because the two species typically occupy different dietary and habitat niches. These results demonstrate the importance of devoting future research towards monitoring these species and understanding the mechanisms by which they co-exist.

A new methodology for projecting the future degradation of rendered façades under the influence of a changing climate based on the gradual evolution of maximum temperatures.

The effect of climate change on the durability of buildings and external components is considered a relevant subject that requires research efforts. This study intends to contribute to the body of knowledge in this field through a practical-based, innovative quantitative methodology. This methodology is created to model the degradation evolution of rendered façades and project it based on the influence of the climate change signal for individual variables, considering their gradual impact. A sample of 26 rendered façades in residential buildings in Lisbon has been subjected to recent on-site visual inspections, to evaluate each case study's degradation condition. Previous inspections had been performed more than a decade ago in the context of a background methodology. This research highlights the influence of (i) maximum temperatures (TX) on global mean triennial degradation rates (∆Sw,mt), for a period of 30 years (1990-2020), and (ii) TX projections on degradation evolution from the date of the recent inspections until the last triennium of the reference degradation projections period (ΔSwFR and ΔSwFRN) (2020-2044). The correlation between TX and ΔSw,mt is significant, which indicates that the increase in maximum temperatures considerably explains the decrease in degradation rates from 1990 to 2020. The future global degradation of rendered façades based on TX scenarios is expected to (i) be lower than the one based on a historical observed trend and (ii) be the lowest when the temperature rise is the highest. Temperature warming, even though detrimental to some degradation phenomena, is expected to decelerate the overall degradation evolution of rendered façades in Portugal and possibly in analogous areas of the Mediterranean.

Surveillance of antimicrobial utilization in Africa: a systematic review and meta-analysis of prescription rates, indications, and quality of use from point prevalence surveys.

BACKGROUND: Antimicrobial resistance (AMR) is a global public health concern that is fueled by the overuse of antimicrobial agents. Low- and middle-income countries, including those in Africa,. Point prevalence surveys (PPS) have been recognized as valuable tools for assessing antimicrobial utilization and guiding quality improvement initiatives. This systematic review and meta-analysis aimed to evaluate the prescription rates, indications, and quality of antimicrobial use in African health facilities. METHODS: A comprehensive search was conducted in multiple databases, including PubMed, Scopus, Embase, Hinari (Research4Life) and Google Scholar. Studies reporting the point prevalence of antimicrobial prescription or use in healthcare settings using validated PPS tools were included. The quality of the studies was assessed using the Joanna Briggs Institute (JBI) critical appraisal checklist. A random-effects meta-analysis was conducted to combine the estimates. Heterogeneity was evaluated using Q statistics, I² statistics, meta-regression, and sensitivity analysis. Publication bias was assessed using a funnel plot and Egger's regression test, with a p-value of < 0.05 indicating the presence of bias. RESULTS: Out of 1790 potential studies identified, 32 articles were included in the meta-analysis. The pooled prescription rate in acute care hospitals was 60%, with significant heterogeneity (I2 = 99%, p < 0.001). Therapeutic prescriptions constituted 62% of all the prescribed antimicrobials. Prescription quality varied: documentation of reasons in notes was 64%, targeted therapy was 10%, and parenteral prescriptions were 65%, with guideline compliance at 48%. Hospital-acquired infections comprised 20% of all prescriptions. Subgroup analyses revealed regional disparities in antimicrobial prescription prevalence, with Western Africa showing a prevalence of 65% and 44% in Southern Africa. Publication bias adjustment estimated the prescription rate at 54.8%, with sensitivity analysis confirming minor variances among studies. CONCLUSION: This systematic review and meta-analysis provide valuable insights into antimicrobial utilization in African health facilities. The findings highlight the need for improved antimicrobial stewardship and infection control programs to address the high prevalence of irrational antimicrobial prescribing. The study emphasizes the importance of conducting regular surveillance through PPS to gather reliable data on antimicrobial usage, inform policy development, and monitor the effectiveness of interventions aimed at mitigating AMR.

Digital Gamification Tool (Let's Control Flu) to Increase Vaccination Coverage Rates: Proposal for Algorithm Development.

BACKGROUND: Influenza represents a critical public health challenge, disproportionately affecting at-risk populations, including older adults and those with chronic conditions, often compounded by socioeconomic factors. Innovative strategies, such as gamification, are essential for augmenting risk communication and community engagement efforts to address this threat. OBJECTIVE: This study aims to introduce the "Let's Control Flu" (LCF) tool, a gamified, interactive platform aimed at simulating the impact of various public health policies (PHPs) on influenza vaccination coverage rates and health outcomes. The tool aligns with the World Health Organization's goal of achieving a 75% influenza vaccination rate by 2030, facilitating strategic decision-making to enhance vaccination uptake. METHODS: The LCF tool integrates a selection of 13 PHPs from an initial set proposed in another study, targeting specific population groups to evaluate 7 key health outcomes. A prioritization mechanism accounts for societal resistance and the synergistic effects of PHPs, projecting the potential policy impacts from 2022 to 2031. This methodology enables users to assess how PHPs could influence public health strategies within distinct target groups. RESULTS: The LCF project began in February 2021 and is scheduled to end in December 2024. The model creation phase and its application to the pilot country, Sweden, took place between May 2021 and May 2023, with subsequent application to other European countries. The pilot phase demonstrated the tool's potential, indicating a promising increase in the national influenza vaccination coverage rate, with uniform improvements across all targeted demographic groups. These initial findings highlight the tool's capacity to model the effects of PHPs on improving vaccination rates and mitigating the health impact of influenza. CONCLUSIONS: By incorporating gamification into the analysis of PHPs, the LCF tool offers an innovative and accessible approach to supporting health decision makers and patient advocacy groups. It enhances the comprehension of policy impacts, promoting more effective influenza prevention and control strategies. This paper underscores the critical need for adaptable and engaging tools in PHP planning and implementation. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR1-10.2196/55613.

The Diagnostic Ability of GPT-3.5 and GPT-4.0 in Surgery: Comparative Analysis.

BACKGROUND: ChatGPT (OpenAI) has shown great potential in clinical diagnosis and could become an excellent auxiliary tool in clinical practice. This study investigates and evaluates ChatGPT in diagnostic capabilities by comparing the performance of GPT-3.5 and GPT-4.0 across model iterations. OBJECTIVE: This study aims to evaluate the precise diagnostic ability of GPT-3.5 and GPT-4.0 for colon cancer and its potential as an auxiliary diagnostic tool for surgeons and compare the diagnostic accuracy rates between GTP-3.5 and GPT-4.0. We precisely assess the accuracy of primary and secondary diagnoses and analyze the causes of misdiagnoses in GPT-3.5 and GPT-4.0 according to 7 categories: patient histories, symptoms, physical signs, laboratory examinations, imaging examinations, pathological examinations, and intraoperative findings. METHODS: We retrieved 316 case reports for intestinal cancer from the Chinese Medical Association Publishing House database, of which 286 cases were deemed valid after data cleansing. The cases were translated from Mandarin to English and then input into GPT-3.5 and GPT-4.0 using a simple, direct prompt to elicit primary and secondary diagnoses. We conducted a comparative study to evaluate the diagnostic accuracy of GPT-4.0 and GPT-3.5. Three senior surgeons from the General Surgery Department, specializing in Colorectal Surgery, assessed the diagnostic information at the Chinese PLA (People's Liberation Army) General Hospital. The accuracy of primary and secondary diagnoses was scored based on predefined criteria. Additionally, we analyzed and compared the causes of misdiagnoses in both models according to 7 categories: patient histories, symptoms, physical signs, laboratory examinations, imaging examinations, pathological examinations, and intraoperative findings. RESULTS: Out of 286 cases, GPT-4.0 and GPT-3.5 both demonstrated high diagnostic accuracy for primary diagnoses, but the accuracy rates of GPT-4.0 were significantly higher than GPT-3.5 (mean 0.972, SD 0.137 vs mean 0.855, SD 0.335; t285=5.753; P<.001). For secondary diagnoses, the accuracy rates of GPT-4.0 were also significantly higher than GPT-3.5 (mean 0.908, SD 0.159 vs mean 0.617, SD 0.349; t285=-7.727; P<.001). GPT-3.5 showed limitations in processing patient history, symptom presentation, laboratory tests, and imaging data. While GPT-4.0 improved upon GPT-3.5, it still has limitations in identifying symptoms and laboratory test data. For both primary and secondary diagnoses, there was no significant difference in accuracy related to age, gender, or system group between GPT-4.0 and GPT-3.5. CONCLUSIONS: This study demonstrates that ChatGPT, particularly GPT-4.0, possesses significant diagnostic potential, with GPT-4.0 exhibiting higher accuracy than GPT-3.5. However, GPT-4.0 still has limitations, particularly in recognizing patient symptoms and laboratory data, indicating a need for more research in real-world clinical settings to enhance its diagnostic capabilities.