Temporally-topological defect modes in photonic time crystals.

In this paper, we investigate the properties of temporally-topological defect modes (TTDMs) (or temporally-topological interface states) in the topological photonic time crystal (PTC) systems. The PTC systems are constructed by the cascade of multiple sub-PTCs that possess temporal inversion symmetries and different topologies. The cases of two-, three-, and multiple-sub-PTC for the topological PTC system are studied. By transfer matrix method, we find that the TTDMs appear when the topological signs of the corresponding gaps in the sub-PTCs are different. The positions of TTDMs can be adjusted by changing the modulation strength of the refractive index, the time duration, and the period of the sub-PTCs. Moreover, the number of TTDMs is one less than the number of sub-PTCs. In addition, the robustness of the systems is also studied. We find that the topological PTC systems have good robustness, especially on the random configuration of the refractive index and time duration for the temporal slabs in the systems. Such research may provide a new degree of freedom for PTC applications, such as novel PTC lasers, tunable band-stop or band-suppression PTC filters, and many others, in the field of integrated photonic circuits for optical communications.

CSM-CROPGRO model to simulate safflower phenological development and yield.

Crop simulation models are valuable tools for decision making regarding evaluation and crop improvement under different field conditions. CSM-CROPGRO model integrates genotype, environment and crop management portfolios to simulate growth, development and yield. Modeling the safflower response to varied climate regimes are needed to strengthen its productivity dynamics. The main objective of the study was to evaluate the performance of DSSAT-CSM-CROPGRO-Safflower (Version 4.8.2) under diverse climatic conditions. The model was calibrated using the field observations for phenology, biomass and safflower grain yield (SGY) of the year 2016-17. Estimation of genetic coefficients was performed using GLUE (Genetic Likelihood Uncertainty Estimation) program. Simulated results for days to flowering, maturity, biomass at flowering and maturity and SGY were predicted reasonably with good statistical indices. Model evaluation results elucidate phenological events with low root mean square error (6.32 and 6.52) and high d-index (0.95 and 0.96) for days to flowering and maturity respectively for all genotypes and climate conditions. Fair prediction of safflower biomass at flowering and maturity showed low RMSE (887.3 and 564.3 kg ha-1) and high d-index (0.67 and 0.93) for the studied genotypes across the environments. RMSE for validated safflower grain yield (101.8 kg ha-1) and d-index (0.95) depicted that model outperformed for all genotypes and growing conditions. Longer appropriate growing conditions at NARC-Islamabad took optimal duration to assimilate photosynthetic products lead to higher grain yield. Safflower resilience to different environments showed that it can be used as an alternate crop for different agroecological regions. Furthermore, CROPGRO-Safflower model can be used as tool to further evaluate inclusion of safflower in the existing cropping systems of studied regions.

Annual risk of hepatitis E virus infection and seroreversion: Insights from a serological cohort in Sitakunda, Bangladesh.

Hepatitis E virus (HEV) is a major cause of acute jaundice in South Asia. Gaps in our understanding of transmission are driven by non-specific symptoms and scarcity of diagnostics, impeding rational control strategies. In this context, serological data can provide important proxy measures of infection. We enrolled a population-representative serological cohort of 2,337 individuals in Sitakunda, Bangladesh. We estimated the annual risks of HEV infection and seroreversion both using serostatus changes between paired serum samples collected 9 months apart, and by fitting catalytic models to the age-stratified cross-sectional seroprevalence. At baseline, 15% (95 CI: 14-17%) of people were seropositive, with seroprevalence highest in the relatively urban south. During the study, 27 individuals seroreverted (annual seroreversion risk: 15%, 95 CI: 10-21%), and 38 seroconverted (annual infection risk: 3%, 95CI: 2-5%). Relying on cross-sectional seroprevalence data alone, and ignoring seroreversion, underestimated the annual infection risk five-fold (0.6%, 95 CrI: 0.5-0.6%). When we accounted for the observed seroreversion in a reversible catalytic model, infection risk was more consistent with measured seroincidence. Our results quantify HEV infection risk in Sitakunda and highlight the importance of accounting for seroreversion when estimating infection incidence from cross-sectional seroprevalence data.

Bone Health Impairment in Patients with Hemoglobinopathies: From Biological Bases to New Possible Therapeutic Strategies.

Hemoglobinopathies are monogenic disorders affecting hemoglobin synthesis. Thalassemia and sickle cell disease (SCD) are considered the two major hemoglobinopathies. Thalassemia is a genetic disorder and one of the major hemoglobinopathies determined by an impairment of globin chain production, which causes an alteration of erythropoiesis, an improvement in hemolysis, and an alteration of iron homoeostasis. In SCD, the mutations are on the ß-globin chain of hemoglobin which results in a substitution of glutamic acid by valine with consequent formation of Hemoglobin S (HbS). Several factors are involved in bone metabolism alteration in patients with hemoglobinopathies, among them hormonal deficiency, bone marrow hyperplasia, iron overload, inflammation, and increased bone turnover. Bone metabolism is the result of balance maintenance between bone deposition and bone resorption, by osteoblasts (OBs) and osteoclasts (OCs). An impairment of this balance is responsible for the onset of bone diseases, such as osteoporosis (OP). Therefore, here we will discuss the alteration of bone metabolism in patients with hemoglobinopathies and the possible therapeutic strategies to contain and/or counteract bone health impairment in these patients, taking into consideration not only the pharmacological treatments already used in the clinical armamentarium, but also the new possible therapeutic strategies.

Role of Nutraceuticals in Counteracting Inflammation in In Vitro Macrophages Obtained from Childhood Cancer Survivors.

The advancement of anti-cancer therapies has markedly improved the survival rate of children with cancer, making them long-term childhood cancer survivors (CCS). Nevertheless, these treatments cause a low-grade inflammatory state, determining inflamm-aging and, thus, favoring the early onset of chronic diseases normally associated with old age. Identification of novel and safer therapeutic strategies is needed to counteract and prevent inflamm-aging. Macrophages are cells involved in immune and inflammatory responses, with a pivotal role in iron metabolism, which is related to inflammation. We obtained macrophages from CCS patients and evaluated their phenotype markers, inflammatory states, and iron metabolism by Western blotting, ELISA, and iron assays. We observed a strong increase in classically activated phenotype markers (M1) and iron metabolism alteration in CCS, with an increase in intracellular iron concentration and inflammatory markers. These results suggest that the prevalence of M1 macrophages and alteration of iron metabolism could be involved in the worsening of inflammation in CCS. Therefore, we propose macrophages and iron metabolism as novel therapeutic targets to counteract inflamm-aging. To avoid toxic regimens, we tested some nutraceuticals (resveratrol, curcumin, and oil-enriched lycopene), which are already known to exert anti-inflammatory properties. After their administration, we observed a macrophage switch towards the anti-inflammatory phenotype M2, as well as reductions in pro-inflammatory cytokines and the intracellular iron concentration. Therefore, we suggest-for the first time-that nutraceuticals reduce inflammation in CCS macrophages through a novel anti-inflammatory mechanism of action, modulating iron metabolism.

Beyond breathing: Systematic review of global chronic obstructive pulmonary disease guidelines for pain management.

CONTEXT: Patients with chronic obstructive pulmonary disease (COPD) experience pain as both symptom and comorbidity. There has been no evaluation of the recommendations for pain management in updated clinical practice guidelines (CPGs). OBJECTIVES: Update the evidence on pain management, determine alignment of pain management recommendations with best-practice, and advocate for optimal pain management in patients with COPD. METHODS: PubMed, Guideline International Network, Guideline Portal, Agency for Healthcare Research and Quality, National Institute for Healthcare Excellence, Scottish International Guidelines Network, Institute of Medicine, grey literature, national websites, and bibliographies were searched. CPGs available online for stable COPD produced by organizations representing reputable knowledge of COPD management were included. CPGs unavailable online, not translatable into English, or not including techniques within the defined scope were excluded. Researchers performed frequency counts for the verbatim terms "pain," "physical activity," "exercise," "rehabilitation," "physical therap(ist)/(y), "physiotherap(ist)/(y)," recorded context, and collected recommendations for pain management/treatment when present. RESULTS: Of 32 CPGs, 24 included "pain" verbatim. Of these, 13 included recommendations for pain treatment/management. Common recommendations included opioids, pharmacological management, further medical assessment, and surgical intervention. Two CPGs referred to palliative care, one CPG discussed treating cough, and one discussed massage, relaxation, and breathing. CONCLUSIONS: Pain management recommendations vary and are not aligned with evidence. Pain should be addressed in patients with COPD, whether directly or indirectly related to the disease. Reduction of variability in pain management and the disease burden is necessary. Pain management should include referrals to providers who can maximize benefit of their services.

Clinical surveillance systems obscure the true cholera infection burden in an endemic region.

Our understanding of cholera transmission and burden largely relies on clinic-based surveillance, which can obscure trends, bias burden estimates and limit the impact of targeted cholera-prevention measures. Serological surveillance provides a complementary approach to monitoring infections, although the link between serologically derived infections and medically attended disease incidence-shaped by immunological, behavioral and clinical factors-remains poorly understood. We unravel this cascade in a cholera-endemic Bangladeshi community by integrating clinic-based surveillance, healthcare-seeking and longitudinal serological data through statistical modeling. Combining the serological trajectories with a reconstructed incidence timeline of symptomatic cholera, we estimated an annual Vibrio cholerae O1 infection incidence rate of 535 per 1,000 population (95% credible interval 514-556), with incidence increasing by age group. Clinic-based surveillance alone underestimated the number of infections and reported cases were not consistently correlated with infection timing. Of the infections, 4 in 3,280 resulted in symptoms, only 1 of which was reported through the surveillance system. These results impart insights into cholera transmission dynamics and burden in the epicenter of the seventh cholera pandemic, where >50% of our study population had an annual V. cholerae O1 infection, and emphasize the potential for a biased view of disease burden and infection risk when depending solely on clinical surveillance data.

Adjustment of model misspecification in estimation of population total under ranked set sampling through balancing.

In the model-based approach, researchers assume that the underlying structure, which generates the population of interest, is correctly specified. However, when the working model differs from the underlying true population model, the estimation process becomes quite unreliable due to misspecification bias. Selecting a sample by applying the balancing conditions on some functions of the covariates can reduce such bias. This study aims at suggesting an estimator of population total by applying the balancing conditions on the basis functions of the auxiliary character(s) for the situations where the working model is different from the underlying true model under a ranked set sampling without replacement scheme. Special cases of the misspecified basis function model, i.e. homogeneous, linear, and proportional, are considered and balancing conditions are introduced in each case. Both simulation and bootstrapped studies show that the total estimators under proposed sampling mechanism keep up the superiority over simple random sampling in terms of efficiency and maintaining robustness against model failure.

Stratum-specific health outcome estimation in Pakistan using double goal CART.

Post-stratification is applied when the subpopulation membership is observed only for sampled values and the goal is to estimate stratum-specific parameters which leads the survey statisticians towards primary goals i.e., classification of non-sampled units into different strata and prediction of the values of the study variables. Regression models, on one side, optimize the prediction of the study variable's non-sampled values while the classification algorithms, on the other side, look for the classification of non-sampled cases into different strata. Hence, it is crucial to deal with these two goals simultaneously for the estimation of stratum-specific parameters. This study introduces the idea of a double-objective classification and regression trees (CARTs) approach for estimating stratum-specific parameters. Theoretical properties of the total estimator are derived. An application on the estimation of health outcomes in different domains is given to delineate the practical significance as well as the efficiency of the proposed CART-based method. The proposed estimator of population total performs better than the existing stratum-specific estimator in terms of relative efficiency for all choices of parameters. As an ensemble model, the random forest CART outperforms the other competing tree-based models and homogenous population model without using any auxiliary variable.

A novel approach for estimating fertility rates in finite populations using count regression models.

Demographic health surveys (DHS) contain in-depth information about the demographic characteristics and the factors affecting them. However, fertility rates which are the important indicators of population growth have been estimated by utilizing the design-based approaches. Model-based approach, on the other hand, facilitates efficient predictive estimates for these rates by utilizing the demographic and other family planning related characters. In this article, we first attempt to observe the effect of various socio-demographic and family planing related factors on births counts by fitting different regression models to Pakistan Demographic Health Survey 2017-2018 data under classical as well as Bayesian frameworks. The births occurred during the time periods of 1-year, 3-years and 5-years are taken as the responses and modeled using different non-linear models. The model-based approach is then used for estimation of the fertility measures including age-specific fertility rates, total fertility rate, general fertility rate, and gross reproduction rate for ever-married women in Pakistan. The performance of the model-based estimators is examined using a bootstrapped sampling algorithm. While the age-specific fertility rates are over-estimated for some age groups and under-estimated for others. The model-based fertility estimates are recommended for estimating the demographic indicators at national and sub-national levels when survey data contains incomplete or missing responses.

An analytical framework combining online high-performance liquid chromatography methodologies and biological properties of different extracts of Leonurus cardiaca.

Little or no information is available concerning online high-performance liquid chromatography (HPLC) antioxidants and the antibiofilm effect of Leonurus cardiaca. Five distinct extractions of methanolic, ethyl acetate, dichloromethane, hexane, and water were obtained from L. cardiaca. In the online-HPLC-antioxidant analysis of all examined samples, rosmarinic acid emerged as the primary antioxidant, registering concentrations ranging from 6 to 15 ppm at wavelengths of 517 and 734 nm. Notably, the water extract exhibited robust antioxidant activity In vitro. Regarding acetylcholinesterase and butrylcholinesterase inhibition, the n-hexane extract exhibited superior inhibition with values of 3.08 and 5.83 galanthamine equivalent, respectively. Except for the water extract, all tested extracts (at a concentration of 20 µg/mL) exhibited substantial inhibitory activity against biofilm formation, in many cases superior to 80%, and reached even 94.52% against Escherichia coli. Although less vigorous, the extracts also acted against the mature biofilm (inhibition up 76.50% against Staphylococcus aureus). They could work against the metabolism inside an immature and mature biofilm, with inhibition percentages up to 93.18% (vs. Pseudomonas aeruginosa) and 76.50% (vs. Acinetobacter baumannii), respectively. Considering its significant antioxidants, enzyme inhibition, and antimicrobial activity, L. cardiaca emerges as a promising candidate for therapeutic potential.

Impact of Treviamet® & Treviamet XR® on quality of life besides glycemic control in type 2 DM patients.

BACKGROUND: Maintaining the quality of life is the main objective of managing type 2 diabetes (T2DM) (QoL). Since it is a key factor in patient motivation and adherence, treatment-related QoL has always been considered when choosing glucose-lowering medicines. The objective of the study was to evaluate the quality of life besides glycemic control among type 2 diabetes mellitus patients receiving Treviamet® & Treviamet XR® (Sitagliptin with Metformin) in routine care. METHODS: It was a prospective, open-label, non-randomized clinical trial including T2DM patients uncontrolled on Metformin therapy. All patients received Treviamet® & Treviamet XR® for six months. Sequential changes in QoL, fasting plasma glucose, HbA1c, body weight, and blood pressure were monitored from baseline to 3 consecutive follow-up visits. The frequency of adverse events (AEs) was also noted throughout the study. RESULTS: A total of 504 patients were screened; 188 completed all three follow-ups. The mean QoL score significantly declined from 57.09% at baseline to 33.64% at the 3rd follow-up visit (p < 0.01). Moreover, a significant decline in mean HbA1c and FPG levels was observed from baseline to 3rd follow-up visit (p < 0.01). Minor adverse events were observed, including abdominal discomfort, nausea, flatulence, and indigestion. Gender, HbA1c, diarrhea, and abdominal discomfort were significant predictors of a patient's QoL, as revealed by the Linear Regression Model (R2 = 0.265, F(16, 99) = 2.231). CONCLUSION: Treviamet® & Treviamet XR® significantly improved glycemic control (HbA1c levels) and QoL in T2DM patients without serious adverse events. TRIAL REGISTRATION: ClinicalTrials.gov identifier (NCT05167513), Date of registration: December 22, 2021.

Comparison Of Knowledge Among Millennials Studying In Non-Medical Universities Regarding Premarital And Prenatal Thalassemia Screening Policies In Pakistan.

Thalassemia awareness among the youth is vital for policy- making to reduce the disease burden in our country. A descriptive cross-sectional study was conducted via simple random sampling technique for which data was collected from May 2020 to May 2021 through Google forms. Results showed that out of a total of 394 non-medical university students, the majority, i.e. 265 (67.3%), were not aware of prenatal screening. Majority, i.e. 117 (29.7%), agreed that the couple should be screened before marriage, and 190 (48.2%) strongly agreed, while 46 (11.7%) had no knowledge. Students, however, believed premarital screening was either unavailable, not possible, or expensive. Other reasons included custom and culture of arranged marriages and religious reasons. The query that if both the parents are carriers and the foetus has thalassemia major should they have an abortion, showed mixed results. The key to controlling thalassemia is awareness of future parents.

Carboxymethyl cellulose based films enriched with polysaccharides from mulberry leaves (Morus alba L.) as new biodegradable packaging material.

The objective of this study was to determine the properties of a new active packaging film developed by the addition of mulberry leaves polysaccharides (MLP) into carboxymethyl cellulose (CMC). Biodegradable CMC-MLP films were fabricated by casting method with various concentrations of MLP (1, 5 and 10 % w/w). The addition of MLP into the CMC matrix resulted increased thickness (0.126 to 0.163 mm) and roughness of the films. Also, the decline in moisture content from 27.91 to 14.12 %, water vapor permeability from 8.95 to 5.21 × 10-10 g-1 s-1 Pa-1, and a swelling degree from 59.11 to 37.45 % were observed. With the increasing concentration of MLP, the mechanical properties of the films were improved and higher dispersion of UV light were noted. Fourier transform - infrared spectroscopy (FT-IR) and X-ray diffraction revealed good inter-molecular interaction between CMC matrix and MLP. The prepared films showed excellent thermal stability, antioxidant and antibacterial properties as well as susceptibility to biodegradation in the soil environment. Moreover, it was proved that the films have ability to retard oil oxidation. Overall, it was concluded that CMC-MLP films constitute a promising biomaterial that may be applied as active food packaging.

Exploring the Antibacterial Potential of Green-Synthesized MgO and ZnO Nanoparticles from Two Plant Root Extracts.

The green approach-based nanoparticle synthesis is considered a more cost-effective and ecologically responsible method of producing nanoparticles than other standard techniques. A major accomplishment in resolving these issues is the use of nanoparticles for environmental pollution remediation. This article describes a simple method for producing MgO and ZnO nanoparticles (NPs) using aqueous extracts of Zingiber officinale and Glycyrrhiza roots as the stabilizing and reducing agents, respectively. Fourier transform infrared spectroscopy (FTIR), X-ray diffraction (XRD), scanning electron microscopy (SEM), and energy-dispersed X-ray (EDX) spectroscopy methods were used to characterize the biologically synthesized metal oxide nanoparticles (MO NPs). The XRD results showed that the mean crystallite sizes of synthesized ZnO and MgO NPs, which have excellent purity, are 12.35 nm and 4.83 nm, respectively. The spherical or elliptical shape of the synthesized NPs was confirmed by the SEM analysis. The antibacterial activity of the synthesized NPs against both Gram-negative and Gram-positive bacteria was thoroughly investigated. With a medium zone of inhibition of 7 to 10 mm, the as-synthesized MgO NPs and ZnO NPs demonstrated moderate antibacterial activity towards various bacterial strains.

Polysaccharides and proteins based bionanocomposites as smart packaging materials: From fabrication to food packaging applications a review.

Food industry is the biggest and rapidly growing industries all over the world. This sector consumes around 40 % of the total plastic produced worldwide as packaging material. The conventional packaging material is mainly petrochemical based. However, these petrochemical based materials impose serious concerns towards environment after its disposal as they are nondegradable. Thus, in search of an appropriate replacement for conventional plastics, biopolymers such as polysaccharides (starch, cellulose, chitosan, natural gums, etc.), proteins (gelatin, collagen, soy protein, etc.), and fatty acids find as an option but again limited by its inherent properties. Attention on the initiatives towards the development of more sustainable, useful, and biodegradable packaging materials, leading the way towards a new and revolutionary green era in the food sector. Eco-friendly packaging materials are now growing dramatically, at a pace of about 10-20 % annually. The recombination of biopolymers and nanomaterials through intercalation composite technology at the nanoscale demonstrated some mesmerizing characteristics pertaining to both biopolymer and nanomaterials such as rigidity, thermal stability, sensing and bioactive property inherent to nanomaterials as well as biopolymers properties such as flexibility, processability and biodegradability. The dramatic increase of scientific research in the last one decade in the area of bionanocomposites in food packaging had reflected its potential as a much-required and important alternative to conventional petroleum-based material. This review presents a comprehensive overview on the importance and recent advances in the field of bionanocomposite and its application in food packaging. Different methods for the fabrication of bionanocomposite are also discussed briefly. Finally, a clear perspective and future prospects of bionanocomposites in food packaging were presented.

Estimating the gap between clinical cholera and true community infections: findings from an integrated surveillance study in an endemic region of Bangladesh.

Our understanding of cholera transmission and burden largely rely on clinic-based surveillance, which can obscure trends, bias burden estimates and limit the impact of targeted cholera-prevention measures. Serologic surveillance provides a complementary approach to monitoring infections, though the link between serologically-derived infections and medically-attended disease - shaped by immunological, behavioral, and clinical factors - remains poorly understood. We unravel this cascade in a cholera-endemic Bangladeshi community by integrating clinic-based surveillance, healthcare seeking, and longitudinal serological data through statistical modeling. We found >50% of the study population had a V. cholerae O1 infection annually, and infection timing was not consistently correlated with reported cases. Four in 2,340 infections resulted in symptoms, only one of which was reported through the surveillance system. These results provide new insights into cholera transmission dynamics and burden in the epicenter of the 7th cholera pandemic and provide a framework to synthesize serological and clinical surveillance data.

A Software Framework for Intelligent Security Measures Regarding Sensor Data in the Context of Ambient Assisted Technology.

Ambient assisted technology (AAT), which has the potential to enhance patient care and productivity and save costs, has emerged as a strategic goal for developing e-healthcare in the future. However, since the healthcare sensor must be interconnected with other systems at different network tiers, distant enemies have additional options to attack. Data and resources integrated into the AAT are vulnerable to security risks that might compromise privacy, integrity, and availability. The gadgets and network sensor devices are layered with clinical data since they save personal information such as patients' names, addresses, and medical histories. Considering the volume of data, it is difficult to ensure its confidentiality and security. As sensing devices are deployed over a wider region, protecting the privacy of the collected data becomes more difficult. The current study proposes a lightweight security mechanism to ensure the data's confidentiality and integrity of the data in ambient-assisted technology. In the current study, the data are encrypted by the master node with adequate residual energy, and the master node is responsible for encrypting the data using the data aggregation model using a node's key generated using an exclusive basis system and a Chinese remainder theorem. The integrity of the data is evaluated using the hash function at each intermediate node. The current study defines the design model's layered architecture and layer-wise services. The model is further analyzed using various evaluation metrics, such as energy consumption, network delay, network overhead, time in generating hash, tradeoff between encryption and decryption, and entropy metrics. The model is shown to adequately perform on all measures considered in the analysis.

Examining the Effectiveness of Financial Protection Schemes in Reducing Health Inequality.

Health protection schemes such as health insurance and financial assistance provide immense help and support to access health care services, especially to the poor and marginalized section of society. India is witness to low health-related expenditure, and the society's socioeconomic and demographic structure further drops health care access to the new bottom. Consequently, inequality in health care access is highly observed across many socioeconomic attributes. The condition of Bihar, the poorest state of India, is more alarming. The analysis suggests that financial support in terms of universal health insurance coverage considerably reduces out-of-pocket expenditure and thus health inequality. Further, the low health insurance coverage is not solely due to a lack of institutional commitment and implementation process; the cognitive behavior and attitude of people are equally responsible for low health care access. An intensive awareness program to show the benefit of the health insurance scheme and sensitization of people against the social stigma is important to provide better health care access and reduce health inequality.

The effect of the Dar es Salaam neurosurgery training course on self-reported neurosurgical knowledge and confidence.

Introduction: The Muhimbili Orthopaedic Institute in collaboration with Weill Cornell Medicine organises an annual neurosurgery training course in Dar es Salaam, Tanzania. The course teaches theory and practical skills in neurotrauma, neurosurgery, and neurointensive care to attendees from across Tanzania and East Africa. This is the only neurosurgical course in Tanzania, where there are few neurosurgeons and limited access to neurosurgical care and equipment. Research question: To investigate the change in self-reported knowledge and confidence in neurosurgical topics amongst the 2022 course attendees. Material and methods: Course participants completed pre and post course questionnaires about their background and self-rated their knowledge and confidence in neurosurgical topics on a five point scale from one (poor) to five (excellent). Responses after the course were compared with those before the course. Results: Four hundred and seventy participants registered for the course, of whom 395(84%) practiced in Tanzania. Experience ranged from students and newly qualified professionals to nurses with more than 10 years of experience and specialist doctors. Both doctors and nurses reported improved knowledge and confidence across all neurosurgical topics following the course. Topics with lower self-ratings prior to the course showed greater improvement. These included neurovascular, neuro-oncology, and minimally invasive spine surgery topics. Suggestions for improvement were mostly related to logistics and course delivery rather than content. Discussion and conclusion: The course reached a wide range of health care professionals in the region and improved neurosurgical knowledge, which should benefit patient care in this underserved region.