NIR responsive scaffold with multistep shape memory and photothermal-chemodynamic properties for complex tissue defects repair and antibacterial therapy.

Complex tissue damage accompanying with bacterial infection challenges healthcare systems globally. Conventional tissue engineering scaffolds normally generate secondary implantation trauma, mismatched regeneration and infection risks. Herein, we developed an easily implanted scaffold with multistep shape memory and photothermal-chemodynamic properties to exactly match repair requirements of each part from the tissue defect by adjusting its morphology as needed meanwhile inhibiting bacterial infection on demand. Specifically, a thermal-induced shape memory scaffold was prepared using hydroxyethyl methacrylate and polyethylene glycol diacrylate, which was further combined with the photothermal agent iron tannate (FeTA) to produce NIR light-induced shape memory property. By varying ingredients ratios in each segment, this scaffold could perform a stepwise recovery under different NIR periods. This process facilitated implantation after shape fixing to avoid trauma caused by conventional methods and gradually filled irregular defects under NIR to perform suitable tissue regeneration. Moreover, FeTA also catalyzed Fenton reaction at bacterial infections with abundant H2O2, which produced excess ROS for chemodynamic antibacterial therapy. As expected, bacteriostatic rate was further enhanced by additional photothermal therapy under NIR. The in vitro and vivo results showed that our scaffold was able to perform high efficacy in both antibiosis, inflammation reduction and wound healing acceleration, indicating a promising candidate for the regeneration of complex tissue damage with bacterial infection.

"Yin-Yang philosophy" for the design of anticancer drug delivery nanoparticles.

Understanding the in vivo transport process provides guidelines for designing ideal nanoparticles (NPs) with higher efficacy and fewer off-target effects. Many factors, such as particle size, morphology, surface potential, structural stability, and etc., may influence the delivering process of NPs due to the existence of various physiological barriers within the body. Herein, we summarise the distinct influences of NP physicochemical properties on the four consecutive in vivo transport steps: (1) navigating with bloodstream within blood vessels, (2) transport across vasculature walls into tumour tissues, (3) intratumoural transport through the interstitial space, and (4) cellular uptake & intracellular delivery by cancerous cells. We found that the philosophy behind the current consensus for NP design has certain similarities to the "Yin-Yang" theory in traditional Chinese culture. Almost all physicochemical properties, regardless of big or small sizes, long or short length, positive or negative zeta potentials, are double-edged swords. The balance of potential benefits and side effects, drug selectivity and accessibility should be fully considered when optimising particle design, similar to the "Yin-Yang harmony". This paper presents a comprehensive review of the advancements in NPs research, focusing on their distinct features in tumour targeting, drug delivery, and cell uptake. Additionally, it deliberates on future developmental trends and potential obstacles, thereby aiming to uncover the ways these characteristics influence the NPs' biological activity and provide theoretical guidance for the targeted delivery of NPs.

International comparison of hospitalizations and emergency department visits related to mental health conditions across high-income countries before and during the COVID-19 pandemic.

OBJECTIVE: To explore variation in rates of acute care utilization for mental health conditions, including hospitalizations and emergency department (ED) visits, across high-income countries before and during the COVID-19 pandemic. DATA SOURCES AND STUDY SETTING: Administrative patient-level data between 2017 and 2020 of eight high-income countries: Canada, England, Finland, France, New Zealand, Spain, Switzerland, and the United States (US). STUDY DESIGN: Multi-country retrospective observational study using a federated data approach that evaluated age-sex standardized rates of hospitalizations and ED visits for mental health conditions. PRINCIPAL FINDINGS: There was significant variation in rates of acute mental health care utilization across countries. Among the subset of four countries with both hospitalization and ED data, the US had the highest pre-COVID-19 combined average annual acute care rate of 1613 episodes/100,000 people (95% CI: 1428, 1797). Finland had the lowest rate of 776 (686, 866). When examining hospitalization rates only, France had the highest rate of inpatient hospitalizations of 988/100,000 (95% CI 858, 1118) while Spain had the lowest at 87/100,000 (95% CI 76, 99). For ED rates for mental health conditions, the US had the highest rate of 958/100,000 (95% CI 861, 1055) while France had the lowest rate with 241/100,000 (95% CI 216, 265). Notable shifts coinciding with the onset of the COVID-19 pandemic were observed including a substitution of care setting in the US from ED to inpatient care, and overall declines in acute care utilization in Canada and France. CONCLUSION: The study underscores the importance of understanding and addressing variation in acute care utilization for mental health conditions, including the differential effect of COVID-19, across different health care systems. Further research is needed to elucidate the extent to which factors such as workforce capacity, access barriers, financial incentives, COVID-19 preparedness, and community-based care may contribute to these variations. WHAT IS KNOWN ON THIS TOPIC: Approximately one billion people globally live with a mental health condition, with significant consequences for individuals and societies. Rates of mental health diagnoses vary across high-income countries, with substantial differences in access to effective care. The COVID-19 pandemic has exacerbated mental health challenges globally, with varying impacts across countries. WHAT THIS STUDY ADDS: This study provides a comprehensive international comparison of hospitalization and emergency department visit rates for mental health conditions across eight high-income countries. It highlights significant variations in acute care utilization patterns, particularly in countries that are more likely to care for people with mental health conditions in emergency departments rather than inpatient facilities The study identifies temporal and cross-country differences in acute care management of mental health conditions coinciding with the onset of the COVID-19 pandemic.

Robust distribution networks reconfiguration considering the improvement of network resilience considering renewable energy resources.

The integration of renewable energy sources into smart distribution grids poses substantial challenges in maintaining grid stability, efficiency, and reliability due to their inherent variability and intermittency. This study addresses these challenges by proposing a novel two-level optimization model aimed at enhancing operational efficiency and robustness in smart distribution grids. The model synergistically integrates renewable energy sources, energy storage systems, electric vehicles, and demand-side management through a dynamic reconfiguration approach. It employs a robust optimization framework combined with a two-stage second-order cone optimization model to manage real-time operations and strategic grid reconfiguration. Key findings from simulations on the IEEE 33 and 69-bus networks underscore the model's effectiveness. In the 33-bus system, implementing the demand response program led to a significant reduction in power losses, from 0.64 MW to 0.52 MW, and improved voltage stability, with the minimum voltage increasing from 0.970 to 0.980 p.u. Similarly, in the 69-bus system, power losses decreased from 0.85 MW to 0.79 MW, and voltage stability improved, with the minimum voltage rising from 0.962 to 0.972 p.u. The model also demonstrated reduced energy procurement needs, showcasing its impact on enhancing grid efficiency and reliability. These results highlight the model's potential for advancing smart grid management strategies, offering significant improvements in operational performance and stability under varying demand conditions.

Searching for effective strategies to reach boys and young men; a mixed-methods study protocol for youth clinics in Sweden.

BACKGROUND: Efforts to engage boys and young men in sexual and reproductive health (SRH) services in Sweden remain limited, with only a small proportion accessing youth clinics, the primary providers of such services. Existing initiatives are often ad-hoc and lack institutionalization within public policy and practice. This study aims to identify feasible and effective interventions to improve boys' and young men's access to youth clinics in Sweden. METHODS: Employing a mixed-methods approach, this study investigates interventions, strategies, and factors influencing access to SRH services for boys and young men in Sweden. Firstly, a systematic literature review will be conducted to identify evaluated interventions globally. Secondly, strategies to attracts boys and young men in youth clinics in Sweden will be mapped. Thirdly, case studies in two regions in Sweden - chosen for their demographic and geographic diversity - will be conducted interviewing healthcare providers, managers, policymakers, and boys and young men. Lastly, Q-methodology will be used to rank all identified strategies. Healthcare providers and managers will rank these strategies based on their perceived effectiveness and feasibility while boys and young men will rank the interventions based on perceived effectiveness. DISCUSSION: The added value of this project is generating robust evidence regarding boys and young men's involvement in SRH services, especially their access to youth clinics. This is crucial for (1) developing gender-sensitive services and service delivery models that effectively promote young men's SRH; (2) informing future young men's health policies ensuring that their unique SRH concerns are addressed; and (3) improving young men's participation in SRH provision. This will ultimately foster a culture of shared responsibilities and advance gender equality.

Benthic remineralization under future Arctic conditions and evaluating the potential for changes in carbon sequestration in warming sediments.

Benthic (seafloor) remineralization of organic material determines the fate of carbon in the ocean and its sequestration. Bottom water temperature and labile carbon supply to the seafloor are expected to increase in a warming Arctic and correspondingly, benthic remineralization rates. We provide some of the first experimental data on the response of sediment oxygen demand (SOD), an established proxy for benthic remineralization, to increased temperature and/or food supply across a range of Arctic conditions and regimes. Each factor significantly increased SOD rates (with different degrees of variability); however the largest increases were seen with both factors combined (50% to ten-fold increases), consistently across the four seasons and the spatial gradient covering shelf to deep basin included in our study. This ability of the Arctic benthos to process increased pulses of carbon suggests that increased sedimented carbon under warming conditions is likely to be utilized and processed, not accumulated, impacting carbon storage and decreasing the Arctic's role as a global carbon sink.

Incorporating sex and gender considerations in research on psychosocial work exposures and cardiovascular diseases: A systematic review of 55 prospective studies.

Cardiovascular diseases (CVDs) are a leading cause of morbidity and mortality, with disparities observed between males and females. Psychosocial work exposures (PWE), including workload, job control, reward and long working hours, are associated with CVD development. Despite higher prevalence among females, the association with CVD is consistently observed in males, with limited explanations for these differences. This study aimed to examine the consideration of sex and gender in prospective studies within systematic reviews on PWE - specifically, the demand-control model, the effort-reward imbalance model, and long working hours - and CVD. Conducting a systematic review, we assessed sex and gender considerations using criteria from the Sex and Gender Equity in Research (SAGER) guidelines. While most studies recognized potential sex and gender differences in the associations between PWE and CVD, only about half of the 28 studies that included both sexes (15 studies) analyzed females and males separately. Moreover, few studies included criteria for sex- and gender-based analyses. Less than half of the studies (23 studies) incorporated a sex and/or gender perspective to discuss observed differences and similarities between men and women. Although there is a rising trend in integrating sex and gender considerations, significant gaps persist in methodologies and reporting, highlighting the need for comprehensive incorporation of sex and gender considerations to bolster CVD prevention strategies and policies.

Self-reported Health Service Utilization and Barriers to Care Among US Adults with a History of Post COVID-19 Condition.

BACKGROUND: Millions of US adults continue to experience symptoms of post COVID-19 condition (PCC). More data on health service utilization patterns and barriers to care in this population are needed to understand how to care for people with PCC. OBJECTIVE: To evaluate health service utilization and barriers to medical care among individuals with a history of PCC compared with other US adults. DESIGN: Data were analyzed from the 2022 National Health Interview Survey (NHIS), a nationally representative, cross-sectional survey of the US population. PARTICIPANTS: US adults. MAIN MEASURES: Health service utilization and the presence of financial and nonfinancial barriers to care in the preceding 12 months. KEY RESULTS: There were 24,905 individuals included in the analysis, representing approximately 230 million US adults. The weighted prevalence of those with a history of PCC was 6.9% (95%CI, 6.5-7.3). Compared to other US adults, participants with a history of PCC were more likely to have had an urgent care visit (adjusted odds ratio (aOR) 1.52 [95%CI, 1.34-1.72]), emergency room visit (aOR 1.94 [95%CI 1.71-2.21]), hospitalization (aOR 1.48 [95%CI, 1.24-1.77]), rehabilitation services (aOR 1.35 [95%CI, 1.14-1.60]), home care (aOR 1.55 [95%CI, 1.66-2.26]), mental health counseling (aOR 1.39 [95%CI, 1.17-1.65]), and complementary and integrative medicine services (aOR 1.29 [95%CI, 1.13-1.49]). Furthermore, respondents with a history of PCC were more likely to report at least one financial barrier to care (aOR 1.71 [95%CI, 1.48-1.97]) and at least one nonfinancial barrier (aOR 1.77 [95%CI, 1.56-2.00]). A greater proportion of participants with a history of PCC reported a financial barrier and nonfinancial barrier than adults with most other chronic conditions captured by NHIS. CONCLUSIONS: Individuals with a history of PCC were more likely to use a variety of health services and report barriers to medical care. Health systems should consider developing accessible, multidisciplinary care pathways for this population.

Cement and zeolite stabilization/solidification of heavy metal-contaminated sediments: 841-Day leaching characteristics, mechanisms, and microstructure.

The long-term effectiveness of stabilized/solidified sediments (S/S sediments) is increasingly attracting attention. This study investigated the long-term leaching characteristics and mechanisms of S/S sediment through an 841-day tank leaching test, considering the influence of cement content, curing time, and zeolite. The results indicate significant correlations among pH, heavy metals, TN, NH3-N, and COD. The specimens with 6 % cement cured for 30 days (C6(30)) demonstrated considerable heavy metal stabilization, with stabilization rates for Cr, Ni, Cu, Zn, As, and Pb reaching 99.81 %, 99.06 %, 98.93 %, 99.61 %, 97.58 %, and 99.97 %, respectively. Compared to C6(30), partial replacement of cement with 10 % zeolite (C5 + Z0.5(30)) not only more effectively stabilized heavy metals except As, but also reduced the release of COD and NH3-N by 4.23 % and 10.04 %, respectively. However, there was a risk of TN, NH3-N, and COD exceeding permissible limits during long-term leaching. Microscopic analysis results suggested that hydration products and low porosity contributed to stabilization of heavy metals. Leaching mechanisms was revealed that surface wash-off controls the leaching of Cr and Pb, while diffusion controls the leaching of Ni, Cu, Zn, As, COD, TN, and NH3-N. Considering stabilization performance, cost and carbon emissions, C5 + Z0.5(30) is an effective strategy for reducing long-term environmental risks of S/S sediments.

Optimal energy management via day-ahead scheduling considering renewable energy and demand response in smart grids.

The energy optimization in smart power grids (SPGs) is crucial for ensuring efficient, sustainable, and cost-effective energy management. However, the uncertainty and stochastic nature of distributed generations (DGs) and loads pose significant challenges to optimization models. In this study, we propose a novel optimization model that addresses these challenges by employing a probabilistic method to model the uncertain behavior of DGs and loads. Our model utilizes the multi-objective wind-driven optimization (MOWDO) technique with fuzzy mechanism to simultaneously address economic, environmental, and comfort concerns in SPGs. Unlike existing models, our approach incorporates a hybrid demand response (HDR), combining price-based and incentive-based DR to mitigate rebound peaks and ensure stable and efficient energy usage. The model also introduces battery energy storage systems (BESS) as environmentally friendly backup sources, reducing reliance on fossil fuels and promoting sustainability. We assess the developed model across various distinct configurations: optimizing operational costs and pollution emissions independently with/without DR, optimizing both operational costs and pollution emissions concurrently with/without DR, and optimizing operational costs, user comfort, and pollution emissions simultaneously with/without DR. The experimental findings reveal that the developed model performs better than the multi-objective bird swarm optimization (MOBSO) algorithm across metrics, including operational cost, user comfort, and pollution emissions.

Distinct phenotyping of critical patients with demand-capacity imbalance initiating acute renal replacement therapy by consensus clustering.

BACKGROUND: Certain patient subpopulations requiring dialysis initiation show varied survival rates and chances of ending renal replacement therapy (RRT). Consensus clustering can help identify these subgroups and their dialysis outcomes. METHODS: The study included patients who were over 18 years old with urine output above 400 ml per day and an estimated glomerular filtration rate over 15 ml/min/1.73 m2. They underwent acute RRT because of systemic demand-capacity imbalance. Using consensus clustering with 33 clinical variables and urea:creatinine ratio (UCR) to the variables to investigate the catabolic demand. Endpoints were all-cause mortality and being dialysis-free at 180-day follow-up after RRT initiation. RESULTS: Of 946 patients (mean 63 ± 17 years and 649 men, 68.6 %) three distinct phenotypes were identified. 509 (53.8%) patients died and 364 (38.5%) patients were weaned off dialysis. Cluster 2 showed better survival (60.23% vs. 53.18% [cluster 1] vs. 45.85% [cluster 3], P < 0.01) and higher possibility to be weaned off RRT (45.24% vs. 38.44% [cluster 1] vs. 31.62% [cluster 3], P < 0.01). High UCR had increased mortality (59.16% vs. 47.75%, P < 0.01) and a lower weaning rates (33.27%; 45.72%, P < .01). UCR with the clustering phenotype improved risk stratification. CONCLUSIONS: Among critical patients undergoing RRT due to systemic demand-capacity imbalance, more than half of the patients died. We identified distinct phenotypes in demand-capacity imbalance in a heterogeneous cohort of patients initializing RRT. Additionally, we found that pre-dialysis UCR as a novel predictor for mortality and the likelihood of being dialysis-free.

Assessing the repeatability of expiratory flow limitation during incremental exercise in healthy adults.

We sought to determine the repeatability of EFL in healthy adults during incremental cycle exercise. We hypothesized that the repeatability of EFL would be "strong" when assessed as a binary variable (i.e., absent or present) but "poor" when assessed as a continuous variable (i.e., % tidal volume overlap). Thirty-two healthy adults performed spirometry and an incremental cycle exercise test to exhaustion on two occasions. Standard cardiorespiratory variables were measured at rest and throughout exercise, and EFL was assessed by overlaying tidal expiratory flow-volume and maximal expiratory flow-volume curves. The repeatability of EFL was determined using Cohen's κ for binary assessments of EFL and intraclass correlation (ICC) for continuous measures of EFL. During exercise, n = 12 participants (38%) experienced EFL. At peak exercise, the repeatability of EFL was "minimal" (κ = 0.337, p = 0.145) when assessed as a binary variable and "poor" when measured as a continuous variable (ICC = 0.338, p = 0.025). At matched levels of minute ventilation during high-intensity exercise (i.e., >75% of peak oxygen uptake), the repeatability of EFL was "weak" when measured as a binary variable (κ = 0.474, p = 0.001) and "moderate" when measured as a continuous variable (ICC = 0.603, p < 0.001). Our results highlight the day-to-day variability associated with assessing EFL during exercise in healthy adults.

Local governance of the 2014 ebola Epidemic: a PhD synthesis.

BACKGROUND: The doctoral dissertation examines how local response efforts were integrated into overall emergency management. OBJECTIVES: It seeks to understand the role and effectiveness of community-based actors in addressing collective action problems. METHODS: Sixty-seven semi-structured interviews were conducted from January to July 2017 in Liberia and Sierra Leone. Key informants include healthcare workers, traditional leaders, and community stakeholders, such as non-governmental organization representatives and volunteers. RESULTS: Findings show that traditional and community leaders responded to the public health emergency via rulemaking, quarantine, travel limitation, healthcare referrals, health sensitization, and door-to-door contact tracing. These actions by local leaders helped to change behaviors and improve cooperation. Sierra Leone had 32.3% more Ebola cases than Liberia but 18% fewer deaths. Sierra Leone had integrated traditional and community leaders before the scale up of international aid resources. CONCLUSION: This suggests that actions taken by traditional and community leaders improved overall efforts, and in some areas, before scaled-up humanitarian interventions. Bilateral engagement with local community actors should be integrated in every public health response to improve cooperation, and it should be done before an intervention is conceived and executed.

Main findings: Bottom-up legislation and community-led action were significant in containing the EVD spread in Liberia and Sierra Leone.Contribution to knowledge: Theoretical contribution centers on the governance patterns of Traditional Local Institutions. Evidence-based contribution was the observation of polycentric governance patterns of demand and supply-side barriers between traditional, state, and aid institutions.Global health impact for policy and action: Policymakers should contextualize soft factors such as trust, which can hamper technical advice. Any intervention should include bilateral engagement with local community leaders.

Navigating Nephrology's Decline Through a GPT-4 Analysis of Internal Medicine Specialties in the United States: Qualitative Study.

Background: The 2024 Nephrology fellowship match data show the declining interest in nephrology in the United States, with an 11% drop in candidates and a mere 66% (321/488) of positions filled. Objective: The study aims to discern the factors influencing this trend using ChatGPT, a leading chatbot model, for insights into the comparative appeal of nephrology versus other internal medicine specialties. Methods: Using the GPT-4 model, the study compared nephrology with 13 other internal medicine specialties, evaluating each on 7 criteria including intellectual complexity, work-life balance, procedural involvement, research opportunities, patient relationships, career demand, and financial compensation. Each criterion was assigned scores from 1 to 10, with the cumulative score determining the ranking. The approach included counteracting potential bias by instructing GPT-4 to favor other specialties over nephrology in reverse scenarios. Results: GPT-4 ranked nephrology only above sleep medicine. While nephrology scored higher than hospice and palliative medicine, it fell short in key criteria such as work-life balance, patient relationships, and career demand. When examining the percentage of filled positions in the 2024 appointment year match, nephrology's filled rate was 66%, only higher than the 45% (155/348) filled rate of geriatric medicine. Nephrology's score decreased by 4%-14% in 5 criteria including intellectual challenge and complexity, procedural involvement, career opportunity and demand, research and academic opportunities, and financial compensation. Conclusions: ChatGPT does not favor nephrology over most internal medicine specialties, highlighting its diminishing appeal as a career choice. This trend raises significant concerns, especially considering the overall physician shortage, and prompts a reevaluation of factors affecting specialty choice among medical residents.

Double Enzyme Active Hydrogel Program Regulates the Microenvironment of Staphylococcus aureus-Infected Pressure Ulcers.

The treatment of infected pressure ulcers (IUPs) requires addressing diverse microenvironments. A pressing challenge is to effectively enhance the regenerative microenvironment at different stages of the healing process, tailoring interventions as needed. Here, a dual enzyme mimetic and bacterial responsive self-activating antimicrobial hydrogel designed to enhance IPUs healing is introduced. This hydrogel incorporates pH-responsive dual enzyme-active nanoplatforms (HNTs-Fe-Ag) encapsulated within a methacrylate-modified silk fibroin (SFMA) and dopamine methacrylamide (DMA) matrix. This composite hydrogel exhibits adaptive microenvironment regulation capabilities. Under the low pH microenvironment of bacterial infection, it has excellent antimicrobial activity by self-activating the •OH generation in conjunction with photothermal effects. Under the neutral and alkaline microenvironment of chronic inflammation, it catalyzes the decomposition of hydrogen peroxide (H2O2) to produce oxygen (O2), thereby alleviating hypoxia and scavenging reactive oxygen species (ROS), which in turn remodulates the phenotype of macrophages. The composite hydrogel demonstrates on-demand therapeutic effects in the microenvironment of infected wounds, significantly enhancing the regenerative microenvironment of IUPs by promoting wound closure, inflammation regulation, and collagen deposition through self-activated antimicrobial action during infection and adaptive hypoxia relief during recovery. This approach offers a novel strategy for developing smart wound dressings.

Datasets on probability distributions of arrival and departure times of privately used electric vehicles.

This article presents the data used in the paper "Vehicle-to-home operation and multi-location charging of electric vehicles for energy cost optimisation of households with photovoltaic system and battery energy storage" [1]. The datasets reported in this paper include the probability distributions of arrival and departure times of privately used vehicles at both home and workplace. The datasets relate to two types of privately used vehicles, namely, those commuting to and from the workplace, and those used for all other activities except attending the workplace. These two vehicle types are referred to as work vehicles and casual vehicles respectively. The datasets consider different daily travel frequencies, where the term travel frequency refers to the number of times a vehicle arrives at home each day. The raw data of vehicle usage is sourced from the Victorian Integrated Survey of Travel & Activity (VISTA) [2], which is an ongoing survey that has collected data from 32,000 households and 82,000 people since 2012. This dataset is filtered to obtain the arrival-departure times of privately-used work vehicles. For the casual vehicles, the filtered data is categorised based on daily travel frequency to obtain the arrival-departure times. Using the filtered and categorised data, the probability distributions of the arrival-departure times for work and casual vehicles are extracted. Microsoft Excel and MATLAB software are used to perform the required processing. The experimental methods used to obtain the required data, from downloading the raw datasets to extracting the probability distributions, are described in this paper.

Solution for the External Contour Changes in Cone Beam Computed Tomography-Guided On-demand Online Adaptive Radiotherapy for a Patient With Very Advanced Head and Neck Cancer: A Technical Case Report.

This article presents a case of a patient with advanced head and neck cancer, characterized by a large and protruding tumor. The patient was treated with an innovative on-demand online adaptive radiotherapy (ART) technology, guided by cone beam computed tomography (CBCT), on the Ethos adaptive radiotherapy platform (version 1.0, Varian Medical Systems, Palo Alto, CA). A solution was provided for this special case to address the issue where part of the target volume could not participate in the optimization due to exceeding the external contour boundary during online adaptive radiotherapy. The treatment outcome was satisfactory in terms of tumor regression, while only grade 1 radiodermatitis and grade 2 oral mucositis at the end of radiotherapy. This article discusses the clinical diagnosis, treatment process, and follow-up of this case, aiming to provide clinical references for a broader application of this technology.

Estimating thresholds of nitrogen, phosphorus and potassium fertilizer rates for rice cropping systems in China.

Determining the fertilization rate plays a pivotal role in agronomic practices as they directly impact yield targets, soil fertility, and environmental risks. In this study, we proposed a method that utilizes allowed ranges of partial nutrient balance and yield to estimate the threshold of nitrogen (N), phosphorus (P), and potassium (K) fertilizer applied to rice (Oryza sativa L.) fields in China. Based on a dataset of 6792 observations from rice fields, we determined the minimum and maximum rates of N, P and K suggested for single (mono-season rice), middle (summer-season rice rotated with winter-season upland crop), early and late (double-season rice cropping system) rice, ranging between 114-146 and 220-292 kg N ha-1 per season, 56-74 and 112-149 kg P2O5 ha-1 per season, and 170-230 and 329-347 kg K2O ha-1 per season, respectively. These values serve as the lower and upper fertilization thresholds, guiding yield goals and environmental protection. Furthermore, if rice straw is returned to fields, the demand for K fertilizer can theoretically decrease by 183 kg K2O ha-1, with corresponding decreases of 50 kg N ha-1 and 26 kg P2O5 ha-1, respectively. A recommended fertilization approach, excluding returned straw nutrients from the upper fertilization thresholds, suggested average application rates of 194 kg N ha-1, 105 kg P2O5 ha-1, and 157 kg K2O ha-1, which align well with the nutrient requirements of rice. Additionally, substituting organic N for chemical N is an effective approach to conserve chemical fertilizer N, potentially reducing chemical N usage by 20%-40%. Utilizing slow-release N is also a favorable option to enhance N use efficiency and optimize N balance. This study offers valuable insights into the development of fertilization restriction indicators, aiming to achieve a delicate balance between environmental impact and agricultural productivity through the adoption of balanced fertilization rates and utilization of organic residues.

Barriers to Childhood Immunisation and Local Strategies in Four Districts in South Africa: A Qualitative Study.

Introduction: In South Africa over the past 20 years, immunisation has saved countless lives as well as prevented illnesses and disabilities. Despite this, vaccine-preventable illnesses remain a danger. The demand for and uptake of immunisation services are shaped by a variety of factors that can either act as barriers or facilitators to immunisation uptake. The aim of this project was to identify the supply and demand barriers and develop local strategies to improve childhood immunisation in four zero-dose districts in South Africa. Materials and Methods: This study used a mixed-method approach. In each of these four districts, 15 in-depth key informant interviews with health workers and local health managers and four focus group discussions (10 participants per focus group discussion) with community members and caregivers were held over a three-month period. Transcribed interviews were thematically analysed using qualitative analysis software (Nvivo®) into 10 factors as identified as important in influencing immunisation demand and uptake in previous studies. A further four were identified during the data analysis process. Results: Despite the varying role of factors affecting demand and uptake of immunisation services, three consistent findings stand out as major barriers across all districts. The first is interaction with healthcare staff. This clearly highlights the crucial role that the interactions between patients and staff play in shaping perceptions and behaviours related to immunisation services. The second is the overall experience of care at healthcare facilities. This emphasises the role that patient experience of services plays in perceptions and behaviours related to immunisation services. The third is family dynamics. This highlights the important role family dynamics play in shaping individuals' decisions regarding immunisation uptake as well as the impact it has on the ability of people to access health services. Discussion: The role played by the different factors in the demand and uptake of immunisation services varied across the four districts examined in this study. Each of the districts presents a unique landscape where different factors have varying degrees of importance in affecting the utilisation of immunisation services. In some districts, certain factors are major barriers, clearly hindering the demand and uptake of immunisation services, while in others, these same factors might be a relatively minor barrier. This discrepancy highlights the unique nature of healthcare challenges across the districts and the need for tailored strategy recommendations to address them effectively.

An Application of an Initial Full Value of Vaccine Assessment Methodology to Measles-Rubella MAPs for Use in Low- and Middle-Income Countries.

Measles and rubella micro-array patches (MR-MAPs) are a promising innovation to address limitations of the current needle and syringe (N&S) presentation due to their single-dose presentation, ease of use, and improved thermostability. To direct and accelerate further research and interventions, an initial full value vaccine assessment (iFVVA) was initiated prior to MR-MAPs entering phase I trials to quantify their value and identify key data gaps and challenges. The iFVVA utilized a mixed-methods approach with rapid assessment of literature, stakeholder interviews and surveys, and quantitative data analyses to (i) assess global need for improved MR vaccines and how MR-MAPs could address MR problem statements; (ii) estimate costs and benefits of MR-MAPs; (iii) identify the best pathway from development to delivery; and (iv) identify outstanding areas of need where stakeholder intervention can be helpful. These analyses found that if MR-MAPs are broadly deployed, they can potentially reach an additional 80 million children compared to the N&S presentation between 2030-2040. MR-MAPs can avert up to 37 million measles cases, 400,000 measles deaths, and 26 million disability-adjusted life years (DALYs). MR-MAPs with the most optimal product characteristics of low price, controlled temperature chain (CTC) properties, and small cold chain volumes were shown to be cost saving for routine immunization (RI) in low- and middle-income countries (LMICs) compared to N&S. Uncertainties about price and future vaccine coverage impact the potential cost-effectiveness of introducing MR-MAPs in LMICs, indicating that it could be cost-effective in 16-81% of LMICs. Furthermore, this iFVVA highlighted the importance of upfront donor investment in manufacturing set-up and clinical studies and the critical influence of an appropriate price to ensure country and manufacturer financial sustainability. To ensure that MR-MAPs achieve the greatest public health benefit, MAP developers, vaccine manufacturers, donors, financiers, and policy- and decision-makers will need close collaboration and open communications.