Retinoic acid breakdown is required for proximodistal positional identity during amphibian limb regeneration.

Regenerating limbs retain their proximodistal (PD) positional identity following amputation. This positional identity is genetically encoded by PD patterning genes that instruct blastema cells to regenerate the appropriate PD limb segment. Retinoic acid (RA) is known to specify proximal limb identity, but how RA signaling levels are established in the blastema is unknown. Here, we show that RA breakdown via CYP26B1 is essential for determining RA signaling levels within blastemas. CYP26B1 inhibition molecularly reprograms distal blastemas into a more proximal identity, phenocopying the effects of administering excess RA. We identify Shox as an RA-responsive gene that is differentially expressed between proximally and distally amputated limbs. Ablation of Shox results in shortened limbs with proximal skeletal elements that fail to initiate endochondral ossification. These results suggest that PD positional identity is determined by RA degradation and RA-responsive genes that regulate PD skeletal element formation during limb regeneration.

Improving experiences of neglected tropical diseases of the skin: Mixed methods formative research for development of a complex intervention in Atwima Mponua District, Ghana.

Integrated approaches to managing co-endemic neglected tropical diseases (NTDs) of the skin within primary healthcare services are complex and require tailoring to local contexts. We describe formative research in Atwima Mponua District in Ghana's Ashanti Region designed to inform the development of a sustainable intervention to improve access to skin NTD care. We employed a convergent, parallel, mixed-methods design, collecting data from February 2021 to February 2022. We quantitatively assessed service readiness using a standardised checklist and reviewed outpatient department registers and condition-specific case records in all government health facilities in the district. Alongside a review of policy documents, we conducted 49 interviews and 7 focus group discussions with purposively selected affected persons, caregivers, community members, health workers, and policy-makers to understand skin NTD care-seeking practices and the policy landscape. Outside the district hospital, skin NTD reporting rates in the surveyed facilities were low; supply chains for skin NTD diagnostics, consumables, and medicines had gaps; and health worker knowledge of skin NTDs was limited. Affected people described fragmented care, provided mostly by hospitals (often outside the district) or traditional healers, resulting in challenges obtaining timely diagnosis and treatment and high care-seeking costs. Affected people experienced stigma, although the extent to which stigma influenced care-seeking behaviour was unclear. National actors were more optimistic than district-level actors about local resource availability for skin NTD care and were sceptical of including traditional healers in interventions. Our findings indicate that improvement of the care cascade for affected individuals to reduce the clinical, economic, and psychosocial impact of skin NTDs is likely to require a complementary set of interventions. These findings have informed the design of a strategy to support high-quality, integrated, decentralised care for skin NTDs in Atwima Mponua, which will be assessed through a multidisciplinary evaluation.

Serological evidence of zoonotic filovirus exposure among bushmeat hunters in Guinea.

Human Ebola virus (EBOV) outbreaks caused by persistent EBOV infection raises questions on the role of zoonotic spillover in filovirus epidemiology. To characterise filovirus zoonotic exposure, we collected cross-sectional serum samples from bushmeat hunters (n = 498) in Macenta Prefecture Guinea, adjacent to the index site of the 2013 EBOV-Makona spillover event. We identified distinct immune signatures (20/498, 4.0%) to multiple EBOV antigens (GP, NP, VP40) using stepwise ELISA and Western blot analysis and, live EBOV neutralisation (5/20; 25%). Using comparative serological data from PCR-confirmed survivors of the 2013-2016 EBOV outbreak, we demonstrated that most signatures (15/20) were not plausibly explained by prior EBOV-Makona exposure. Subsequent data-driven modelling of EBOV immunological outcomes to remote-sensing environmental data also revealed consistent associations with intact closed canopy forest. Together our findings suggest exposure to other closely related filoviruses prior to the 2013-2016 West Africa epidemic and highlight future surveillance priorities.

Functional blindsight and its diagnosis.

Even when brain scans fail to detect a striate lesion, functional evidence for blindsight can be adduced. In the aftermath of an automobile accident, JK became blind. Results of ophthalmic exams indicated that the blindness must be cortical. Nevertheless, multiple MRI scans failed to detect structural damage to the striate cortex. Prior to the accident JK had been an athlete; after the accident he retained some athletic abilities, arousing suspicions that he might be engaged in fraud. His residual athletic abilities-e.g., hitting a handball or baseball, or catching a Frisbee-coupled with his experienced blindness, suggested blindsight. But due to the apparent absence of striate lesions, we designed a series of tasks for temporal and spatial dimensions in an attempt to detect functional evidence of his disability. Indeed, test results revealed compelling neural evidence that comport with his subjective reports. This spatiotemporal task-related method that includes contrasts with healthy controls, and detailed understanding of the patient's conscious experience, can be generalized for clinical, scientific and forensic investigations of blindsight.

A dataset on two decades of Japan's energy investments in Southeast Asian countries, 2000-2020.

Between 2000 and 2020, Japan played a crucial role in transforming Southeast Asia's energy sector, contributing significantly to local, national, and regional development. This period saw substantial Japanese investments in various energy sources, including renewable energy initiatives and continued use of fossil fuels, while emphasising capacity development. Our research involved an extensive and systematic inventory of secondary resources, with meticulous validation and fact-checking of critical project data. The resulting dataset provides funding amounts and details channelled through Japanese government-backed institutions and private corporations. This dataset could enhance our understanding of Japan-supported energy infrastructure and soft-skill capacity-building projects, allowing us to analyse further how these investments were aligned with the broader economic and sustainability objectives of Southeast Asian countries. Covering investment types, funding sources, and project locations, this valuable resource is useful for scholars across disciplines. Asian studies researchers can gain insights into Japan's strategic involvement in the region, while energy studies specialists can gain a nuanced understanding of the evolving energy finance landscape. Energy policy experts can also use this data to analyse the implications of Japan's contributions to Southeast Asia's energy transition.

Knowledge, attitudes, and practices in colorectal cancer screening in the Philippines

Background and Objective@#Colorectal cancer (CRC) has the third highest incidence in the Philippines. Currently, there is a paucity in literature that is focused on the knowledge, attitudes, and perceptions of Filipinos regarding CRC screening. This is the first study in the Philippines that describes this. @*Methods@#This is a cross-sectional study that validated a 52-item Filipino questionnaire on the knowledge on colorectal cancer, willingness to undergo CRC screening, and perceived benefits and barriers to fecal occult blood test (FOBT) and colonoscopy. The study enrolled household heads more than 20 years of age residing in both urban and rural communities in the Philippines. @*Results@#The UP-PGH CRC KAP (University of the Philippines – Philippine General Hospital Colorectal Cancer Knowledge, Attitudes, and Practices) and Rawl Questionnaire’s validity and internal consistency were established in a pilot study of 30 respondents. A total of 288 respondents were then enrolled to the main study group with a median age of 54.0. Knowledge scores for prognosis and utility of CRC screening were modest (6.3/12 and 8.4/20, respectively). Perceived benefit scores to FOBT and colonoscopy were high (9.9/12 and 13.9/16, respectively).Median scores to barriers to FOBT and colonoscopy were intermediate (22.5/36 and 35.8/60, respectively). Notably, a vast majority (86.1%) were willing to participate in CRC screening programs initiated by the government, and 46.9% agreed to undergo screening tests even as out-of-pocket expense. @*Conclusion@#The UP-PGH CRC KAP Questionnaire as well as the Filipino translation of the Rawl Questionnaire are reliable and valid tools in extensively assessing the knowledge of Filipinos on CRC and willingness to undergo screening, as well as the benefits of and barriers to FOBT and colonoscopy. Knowledge scores were modest suggesting that directed educational campaigns and awareness programs can aid in increasing awareness about CRC and its screening. Household income and highest educational attainment were significantly positively correlated with knowledge scores, and perceived benefits of and barriers to CRC screening. Scores were generally comparable between urban and rural communities.

Brazilian South-South Scientific Collaboration and The Sustainable Development Goals.

We look at Brazilian collaboration in Scientific papers based on SciVal and Incites regarding the Sustainable Development Goals (SDGs) of the United Nations. Data were collected from InCites® and SciVal® (2012-2021). Groups of Global South countries were formed (ASEAN, Asia, Africa, BRICS, Caribbean, Central and Latin America). Analyses included Cluster (Author position, impact/citations, open access, journal quartil), principal component, path and analysis of variance to see the effect of region and SDGs in Brazilian publishing. Scopus data were analysed in Vosviewer® for creating country networks through publication, citation and bibliographic coupling, as well as keyword analysis. SDG 3 (Good Health and Well-Being) dominates all Brazilian scientific collaborations with the various country groups. While gender equality shows greater importance in ASEAN and African countries, Life Below Water (SDG14), on Land (SDG15), and Climate Action (SDG13), are important in all regions. SDGs 1, 8, 10, 12, and 16 show less importance in this collaboration overall. Brazil is relatively more active in Zero Hunger (SDG2) and Life on Land (SDG15) than worldwide. Brazil South-South collaboration in published documents shows higher impact than North South in some areas. Collaboration priorities vary by region and triangulation with countries is high depending on language and region.

Experiences of Pain Management Nurses during the COVID-19 Pandemic: A Qualitative Study.

BACKGROUND: The knowledge and skills of pain management nurses positions them well to manage people's pain and provide critical services to patients with COVID-19. AIM: To understand the personal and professional experiences and the support pain management nurses received during the COVID-19 pandemic. METHODS: Between July 2020 and 2021, data were collected through semi-structured telephone interviews from members of the American Society for Pain Management Nursing. Content analysis was used. RESULTS: Eighteen pain management nurses who worked during the early stages of the pandemic were interviewed. Three main categories were identified: experiencing stress and burden, pain management strategies changed, learning to cope with support. Pain management nurses reported fear of exposure, difficulties with staff shortages, the complex social milieu, and how pain management took a backseat to other symptoms of COVID-19. They coped through support from their colleagues, organizational leaders, and community members. Pain management nurses provided recommendations for future care of patients' pain during a pandemic. CONCLUSIONS: Pain management nurses shared their professional and personal experiences and the support they received while managing patients' pain during the COVID-19 pandemic. Their experiences provided findings on the importance of pain management and to support nurses during personal and professional vulnerabilities during crises. Key recommendations on the care of patients' pain in future pandemics included developing expertise in pain management and health-related emergencies; engaging nurses in supportive mental health services, infectious disease testing, and vaccine efforts; and planning for surge capacity to reach out to underserved people living with pain.

Modelling mass drug administration strategies for reducing scabies burden in Monrovia, Liberia.

Scabies is a parasitic infestation with high global burden. Mass drug administrations (MDAs) are recommended for communities with a scabies prevalence of >10%. Quantitative analyses are needed to demonstrate the likely effectiveness of MDA recommendations. In this study, we developed an agent-based model of scabies transmission calibrated to demographic and epidemiological data from Monrovia. We used this model to compare the effectiveness of MDA scenarios for achieving scabies elimination and reducing scabies burden, as measured by time until recrudescence following delivery of an MDA and disability-adjusted-life-years (DALYs) averted. Our model showed that three rounds of MDA delivered at six-month intervals and reaching 80% of the population could reduce prevalence below 2% for three years following the final round, before recrudescence. When MDAs were followed by increased treatment uptake, prevalence was maintained below 2% indefinitely. Increasing the number of and coverage of MDA rounds increased the probability of achieving elimination and the number of DALYs averted. Our results suggest that acute reduction of scabies prevalence by MDA can support a transition to improved treatment access. This study demonstrates how modelling can be used to estimate the expected impact of MDAs by projecting future epidemiological dynamics and health gains under alternative scenarios.

Original Research: The Impact of COVID-19 on Pain Care Among Older Adults.

PURPOSE: In this qualitative descriptive study, we sought to understand the professional experiences and perceptions of pain management nurses who cared for older adults in the United States during the height of the COVID-19 pandemic. METHODS: Data were collected between July 2020 and July 2021 through individual, semistructured interviews with a nonprobability sample of 18 pain management nurses. An inductive content analysis approach, in which categories were derived from a coding process based on a close reading of data extracts from the interview transcripts, was used to reveal the major theme related to the study aim. RESULTS: Notwithstanding the variable consequences of COVID-19 on patients' health, a single overarching theme was pronounced: "Pain management for older adults remained unchanged during the pandemic despite unpredictable survival, restrictions on human interactions, and communication challenges." This theme was supported by four categories that emerged from the data: unpredictable survival, restriction-induced isolation, perceived continuity and equality of pain management, and communication challenges. CONCLUSIONS: During the COVID-19 pandemic, pain management nurses stepped in and joined interdisciplinary teams providing general and specialized pain care to ensure that older adults, whether inpatient or outpatient, continued to receive quality care. These study findings highlight the many challenges pain management nurses faced during this unprecedented public health crisis, as well as opportunities to improve the health system and enhance nursing practice to meet the needs of older patients.

Machine-supported decision-making to improve agricultural training participation and gender inclusivity.

Women comprise a significant portion of the agricultural workforce in developing countries but are often less likely to attend government sponsored training events. The objective of this study was to assess the feasibility of using machine-supported decision-making to increase overall training turnout while enhancing gender inclusivity. Using data obtained from 1,067 agricultural extension training events in Bangladesh (130,690 farmers), models were created to assess gender-based training patterns (e.g., preferences and availability for training). Using these models, simulations were performed to predict the top (most attended) training events for increasing total attendance (male and female combined) and female attendance, based on gender of the trainer, and when and where training took place. By selecting a mixture of the top training events for total attendance and female attendance, simulations indicate that total and female attendance can be concurrently increased. However, strongly emphasizing female participation can have negative consequences by reducing overall turnout, thus creating an ethical dilemma for policy makers. In addition to balancing the need for increasing overall training turnout with increased female representation, a balance between model performance and machine learning is needed. Model performance can be enhanced by reducing training variety to a few of the top training events. But given that models are early in development, more training variety is recommended to provide a larger solution space to find more optimal solutions that will lead to better future performance. Simulations show that selecting the top 25 training events for total attendance and the top 25 training events for female attendance can increase female participation by over 82% while at the same time increasing total turnout by 14%. In conclusion, this study supports the use of machine-supported decision-making when developing gender inclusivity policies in agriculture extension services and lays the foundation for future applications of machine learning in this area.

Pain Management and Substance Use Disorders: A Position Statement.

ABSTRACT: The American Society for Pain Management Nursing and the International Nurses Society on Addictions hold the position that persons with co-occurring pain and substance use disorder have the right to be treated with dignity and respect and receive evidence-based, high-quality assessment and management for both conditions using an integrated, holistic, multidimensional approach. Nonopioid and nonpharmacological approaches to pain management are recommended. Opioids should not be withheld from anyone if necessary to treat pain, and a team-based approach, including pain and addiction specialists, should be utilized when possible. Pain management should include interventions aimed at minimizing the risk for relapse or escalation of problematic substance use and actively involve the person and their support persons in the plan of care. Institutions should establish policies and procedures that support this position statement.

Eyes-Open and Eyes-Closed Resting State Network Connectivity Differences.

Resting state networks comprise several brain regions that exhibit complex patterns of interaction. Switching from eyes closed (EC) to eyes open (EO) during the resting state modifies these patterns of connectivity, but precisely how these change remains unclear. Here we use functional magnetic resonance imaging to scan healthy participants in two resting conditions (viz., EC and EO). Seven resting state networks were chosen for this study: salience network (SN), default mode network (DMN), central executive network (CEN), dorsal attention network (DAN), visual network (VN), motor network (MN) and auditory network (AN). We performed functional connectivity (FC) analysis for each network, comparing the FC maps for both EC and EO. Our results show increased connectivity between most networks during EC relative to EO, thereby suggesting enhanced integration during EC and greater modularity or specialization during EO. Among these networks, SN is distinctive: during the transition from EO to EC it evinces increased connectivity with DMN and decreased connectivity with VN. This change might imply that SN functions in a manner analogous to a circuit switch, modulating resting state relations with DMN and VN, when transitioning between EO and EC.

Pain Management and Substance Use Disorders.

The American Society for Pain Management Nursing and the International Nurses Society on Addictions hold the position that persons with co-occurring pain and substance use disorder have the right to be treated with dignity and respect, and receive evidence-based, high-quality assessment and management for both conditions using an integrated, holistic, multidimensional approach. Non-opioid and nonpharmacological approaches to pain management are recommended. Opioids should not be withheld from anyone if necessary to treat pain, and a team-based approach, including pain and addiction specialists, should be utilized when possible. Pain management should include interventions aimed at minimizing the risk for relapse or escalation of problematic substance use, and actively involve the person and their support persons in the plan of care. Institutions should establish policies and procedures that support this position statement.

Quantifying Population Burden and Effectiveness of Decentralized Surveillance Strategies for Skin-Presenting Neglected Tropical Diseases, Liberia.

We evaluated programmatic approaches for skin neglected tropical disease (NTD) surveillance and completed a robust estimation of the burden of skin NTDs endemic to West Africa (Buruli ulcer, leprosy, lymphatic filariasis morbidity, and yaws). In Maryland, Liberia, exhaustive case finding by community health workers of 56,285 persons across 92 clusters identified 3,241 suspected cases. A total of 236 skin NTDs (34.0 [95% CI 29.1-38.9]/10,000 persons) were confirmed by midlevel healthcare workers trained using a tailored program. Cases showed a focal and spatially heterogeneous distribution. This community health worker‒led approach showed a higher skin NTD burden than prevailing surveillance mechanisms, but also showed high (95.1%) and equitable population coverage. Specialized training and task-shifting of diagnoses to midlevel health workers led to reliable identification of skin NTDs, but reliability of individual diagnoses varied. This multifaceted evaluation of skin NTD surveillance strategies quantifies benefits and limitations of key approaches promoted by the 2030 NTD roadmap of the World Health Organization.

Intrinsic neural activity predisposes susceptibility to a body illusion.

Susceptibility to the rubber hand illusion (RHI) varies. To date, however, there is no consensus explanation of this variability. Previous studies, focused on the role of multisensory integration, have searched for neural correlates of the illusion. But those studies have failed to identify a sufficient set of functionally specific neural correlates. Because some evidence suggests that frontal α power is one means of tracking neural instantiations of self, we hypothesized that the higher the frontal α power during the eyes-closed resting state, the more stable the self. As a corollary, we infer that the more stable the self, the less susceptible are participants to a blurring of boundaries-to feeling that the rubber hand belongs to them. Indeed, we found that frontal α amplitude oscillations negatively correlate with susceptibility. Moreover, since lower frequencies often modulate higher frequencies, we explored the possibility that this might be the case for the RHI. Indeed, some evidence suggests that high frontal α power observed in low-RHI participants is modulated by δ frequency oscillations. We conclude that while neural correlates of multisensory integration might be necessary for the RHI, sufficient explanation involves variable intrinsic neural activity that modulates how the brain responds to incompatible sensory stimuli.

Work-Addiction Risk in Athletic Trainers and Its Relationship to Work-Family Conflict and Burnout.

CONTEXT: Individual factors can affect numerous work-life interface outcomes, including work-family conflict and burnout. Recently, the concept of work addiction has been investigated as an individual factor that could affect numerous outcomes. Despite the large body of literature investigating work-family conflict and burnout in athletic training, little is known about the incidence of work addiction or its potential effect on these outcomes. OBJECTIVE: To gather descriptive data on the work-addiction risk and examine the effect work addiction may have on work-life interface outcomes in athletic training. DESIGN: Cross-sectional study. SETTING: Online web-based survey. PATIENTS OR OTHER PARTICIPANTS: Athletic trainers (ATs) employed in all work settings were recruited to participate via social media and email distribution lists. Data from 226 (n = 65, 28.8% males; n = 161, 71.2% females) ATs, currently employed in more than 13 work settings, were included in data analysis. MAIN OUTCOME MEASURE(S): The online questionnaire consisted of 4 main sections: demographic questions, work-family conflict scale, Copenhagen Burnout Inventory, and the Work Addiction Risk Test. We calculated Mann-Whitney U and Kruskal-Wallis tests to determine if group differences existed. Simple linear regressions were used to assess if work-addiction risk scores predicted burnout and work-family conflict. RESULTS: The ATs experienced moderate levels of personal (55.0 ± 19.1) and work-related (50.0 ± 16.0) burnout and were at medium risk for work addiction (58.3 ± 11.2). No demographic differences were observed in burnout or work-family conflict scores, but these scores differed based on the work-addiction risk. Women were more at risk for compulsive tendencies than were men. Work-addiction risk scores predicted both burnout and work-family conflict, but only a relatively small percentage of the variability was explained. CONCLUSIONS: Those ATs at higher risk for work addiction reported higher levels of burnout. Because of the medium risk for work addiction among ATs, work-addiction mitigation strategies should be implemented by individuals and organizations.