The chest bone, or sternum, protects the heart and lungs and aids in breathing motion. It is included on chest radiographs of dogs and cats, but little information is available for veterinarians on what abnormalities or diseases affect the chest bone in companion animals. We reassessed chest radiographs of dogs and cats taken in our hospital over a 2 year period to describe these changes. We found that abnormalities of the chest bone were visible in 24% of dogs and 29% of cats, with the most common abnormality being age-related degeneration. Most of the abnormalities noted were of minor clinical importance, but in some animals, conditions that could be painful or otherwise affect well-being were seen.Evaluation of the sternum is part of the routine examination of small animal thoracic radiographs. However, descriptions on frequency and type of abnormalities are lacking. This retrospective observational study aimed to describe abnormal radiographic findings of the sternum in a cross-section of client-owned dogs and cats undergoing thoracic radiography between 1 January 2019 and 1 January 2021 for reasons unrelated to diseases of the sternum. The study population consisted of 777 dogs  and 183 cats . Sternal abnormalities were observed in 189/777 (24%) dogs and 53/183 (29%) cats, mostly around the intersternebral cartilages, accounting for 32/80 (40%) dogs and 20/35 (57%) cats. This was followed by an abnormal number of sternal segments . Pectus excavatum was observed in 6/777 (0.8%) dogs and 6/183 (3%) cats, and pectus carinatum in 18/777 (2%) dogs and 2/183 (1%) cats. Post-traumatic changes, such as subluxation, were observed in nine dogs (1.1%) and three cats (1.6%). Presumed prostatic carcinoma metastasis and malignant lymphoma were observed in two dogs (0.2%). Incidental radiographic sternal abnormalities are common in cats and dogs but mostly of unknown clinical relevance. An evaluation of the sternum is part of the routine examination of small animal thoracic radiographs, as it forms the ventral contour of the thoracic cavity. The sternum contributes to the bony protection of the intra-thoracic cardiopulmonary structures, as well as to the stability and breathing motion of the thorax.manubrium sterni), is wider and longer than the other sternal segments. The manubrium of the sternum is the point of insertion of the sternocephalicus muscle and has lateral shelves of bone accommodating the attachment of the costal cartilages of the first pair of ribs. The body of the sternum (corpus sterni) consists of six rectangular to cylindrical-shaped sternebrae. The most caudal last sternebra, or xiphoid process (processus xiphoideus), is flat and long, occasionally with a foramen in its caudal half. The xiphoid process is prolonged caudally by the xiphoid cartilage (cartilago xiphoidea), which supports the cranial part of the ventral abdominal wall and from which the linea alba extends caudally to the symphysis pelvis. The individual sternebrae are connected by intersternebral cartilages, forming cartilaginous joints , and the sternum is covered on the ventral and dorsal surface by thickened periosteum, forming the sternal membrane (membrana sterni). Whilst the costal cartilages of the first pair of ribs articulate directly with the manubrium of the sternum, the costal cartilages of the second to seventh ribs articulate with the consecutive intersternebral cartilages between the individual sternal segments, and both the costal cartilages of the eighth and ninth rib pairs articulate with the intersternebral cartilage between the seventh sternebra and the xiphoid process. The first eight paired sternocostal joints are synovial joints, but no synovial joint was found at the ninth sternocostal articulation The costal cartilages of the last four pairs of ribs do not directly articulate with the sternum but connect via the costal arch or are floating ribs, and these ribs are therefore considered asternal ribs ) if normally distributed or as median (range) if the distribution was skewed. Data were analyzed using IBM SPSS Statistics (Version 28). Independent samples n = 145), Labrador Retriever (n = 62), Chihuahua (n = 28), Bernese Mountain Dog (n = 26), Golden Retriever (n = 23), French Bulldog (n = 23), Labradoodle (n = 22), and German Shepherd (n = 21). One hundred and fourteen dogs were of brachycephalic breed. The three most common indications for thoracic radiography in dogs were metastasis screening (n = 252), cough (n = 94), and dysphagia (n = 57). An example of a thoracic radiographs of a dog on which the sternum was considered unremarkable is provided in The study population consisted of 777 dogs. The group of dogs had a mean age of 7.3  years and consisted of 400 males (188 neutered) and 377 females (252 neutered) of various breeds, the most common being mixed breed (n = 8), post-traumatic changes (n = 5) or shape deformity of the sternum (n = 1), and an abnormal number of sternebrae in combination with shape deformity (n = 4) or post-traumatic changes (n = 1).Sternal abnormalities were observed in 189/777 (24%) dogs . Nineteen = 108; 14%), most of which were considered degenerative type changes such as mineralisation of the sternal cartilages or formation of bony spurs . Marked degenerative changes, such as narrowing of the intersternebral cartilage space (n = 13), vacuum phenomenon (n = 13), and subluxation (n = 5), were mainly observed in the mid-section of the sternum, between the 3rd and 4th and 4th and 5th sternebrae (n = 16). The mean age of dogs with degenerative changes  was significantly higher than the mean age of dogs without these changes .Abnormalities were most frequently observed in the area of the intersternebral cartilages in dogs . Less than eight sternal segments were observed 46 dogs (6%): seven sternebrae were visible in 40 dogs, six sternebrae in four dogs, and three and four sternebrae in one dog each. The latter resulted in morphologically abnormal short sternum (n = 5) or four (n = 2) sternebrae. Three dogs with lower number of sternebrae showed border effacement of the ventral thoracic diaphragmatic surface and the caudal ventral cardiac silhouette due to cranial excursion of the diaphragm, but none of these animals had evidence of peritoneopericardial herniation. Supernumerary sternal segments  were observed in 16 dogs (2%), affecting predominantly medium and large breed dogs. The most common breed affected was Labrador Retriever (n = 7).An abnormal number of sternal segments was the second most seen abnormality in dogs ( sternum . The lown = 8) and Chihuahua (n = 5) were overrepresented.Pectus excavatum was observed in six dogs (0.8%), and the severity was considered mild in five dogs and moderate in one dog based on vertebral indices . Pectus excavatum involved the caudal sternum in five cases and the mid-sternum in one mixed breed dog. One case was considered likely to have a traumatic instead of congenital origin based on clinical history. Four of the five dogs with suspect congenital pectus excavatum were brachycephalic breeds, including two out of seven Pugs . Mild pen = 9, of which five were in combination with other degenerative changes) (Presumed post-traumatic changes were observed in 12 dogs (1.5%), although none of these dogs were presented for thoracic radiography because of a history of trauma or suspect traumatic lesions of the sternum; the indication in eight of these dogs was metastasis screening. The presumed post-traumatic changes mainly consisted of dislocation (changes) . These cOne Chihuahua with malignant lymphoma had multiple pathological fractures associated with osteopenia . An aggrn = 112), Maine Coon (n = 16), mixed breed (n = 11), and British Shorthair (n = 10). The most common indications for thoracic radiography in cats were dyspnea (n = 40), metastasis screening (n = 37), and post-accident trauma (n = 18). An example of a thoracic radiographs of a cat on which the sternum was considered unremarkable is provided in The study population consisted of 183 cats. The group of cats had a mean age of 7.3  years and consisted of 105 males (89 neutered) and 78 females (66 neutered) of various breeds, most commonly Domestic Shorthair (n = 3) or degenerative changes (n = 3).Sternal abnormalities were observed in 53/183 (29%) cats . Six catp = 0.002). Concurrent gas opacity in the intersternebral cartilage space or associated subluxation of sternebrae was not observed in any of the cats with signs of degenerative changes of the intersternebral cartilages.Degenerative changes, consistent of mineralization of the sternal cartilages or formation of bony spurs, were observed in 15 cats (8%). Cats with degenerative changes were significantly older than those without  or sixth and seventh sternebrae (n = 5). The other nine cats with seven sternebrae had an absence of one sternal segment. One Domestic Shorthair had six individual sternebrae, caused by complete fusion of the fourth and fifth sternebrae and the absence of one sternal segment , of which seven cats had nine sternebrae. Nineteen cats had seven individual sternal segments, which, in ten cats was caused by complete fusion of the first and second sternebrae ( segment .Pectus excavatum was observed in six cats (3%), and the severity was considered mild in four cats and moderate and severe in one cat each  . The typn = 2), partial fusion of sternebrae (n = 3), and narrowing of the intersternebral cartilage space without signs of degeneration (n = 1).Signs of traumatic luxation were observed in three cats (1%). One cat had undergone recent cardiopulmonary resuscitation, and the other two cases showed more chronic changes with malformed fusion of the dislocated sternebrae. One of these cats had a history of sternal fracture 10 years prior and the other cat had no known history of trauma . Other aThe sternum develops from the fusion of bilateral mesodermal bars which unite from day 25 of gestation in dogs and day 28 of gestation in cats, starting cranially at the manubrium of the sternum and ending caudally at the xiphoid process ,24. OssiAs in previous reports, pectus excavatum mostly affected the caudal sternum in dogs in our study population, which is the typical form of pectus excavatum . Komsta In agreement with a previous publication by Hassan and colleagues (2018), we observed pectus carinatum predominantly in small breed dogs, except for in one English Springer Spaniel . In thatAlthough neoplastic disease was the most common indication for thoracic radiography in dogs, only two cases presented with radiographic aggressive bone lesions affecting the sternum. One dog diagnosed with malignant lymphoma presented with pathological fractures of multiple sternebrae, the other dog was diagnosed with prostatic carcinoma and had an aggressive bone lesion affecting the second and third sternebrae. However, the sternal lesions were not biopsied in these dogs and therefore it remains unknown if these aggressive bone lesions indeed were caused by neoplastic disease. Skeletal involvement affecting the spine has been described in canine multicentric lymphoma ,30, but synchondroses sternales, mostly consistent of mineralization of the sternal cartilages or formation of bony spurs, was the most common finding in our study, with a prevalence of 14% in dogs and 8% in cats. In 13 of the dogs affected, gas opacity was observed in between the sternebrae on the left lateral view radiograph. Gas accumulation within synovial joints and intervertebral disc spaces is termed vacuum phenomenon. This gas consists of 90–92% nitrogen and its presence has been associated with intervertebral disc degeneration in dogs [synchondrosis sternalis in dogs, similar to the above-mentioned association between vacuum phenomenon in the intervertebral disc space and intervertebral disc degeneration in dogs [Age-related degeneration of the  in dogs ,36,37. T in dogs  and, in  in dogs . In our Sternal dislocation is infrequently reported in veterinary literature and is most often considered to be of traumatic origin ,16,17. BOur study had several limitations. First, the retrospective design prohibits adequate correlation between radiographic findings and clinical signs. For example, it cannot be reliably determined if sternal dislocation in dogs with severe intersternebral cartilage degeneration was associated with pain or other clinical signs, because no specific history and physical examination addressing these findings were performed in these cases. Secondly, the large variety in breeds in combination with the relatively low number of cases for each disorder impedes drawing firm conclusions on any breed predispositions. Thirdly, the use of radiography instead of a cross-sectional technique such as computed tomography results in a lower sensitivity for detection of abnormalities because of the inferior contrast resolution and problems of superimposition inherent to radiography. Moreover, computed tomography would allow a better representation of the anatomy. For instance, computed tomography was reported to be useful for evaluation of thoracic asymmetry and sternal torsion in cats with pectus excavatum, which cannot be done with radiography . In addiSternal abnormalities are common incidental findings on thoracic radiographs of companion animals and were observed on thoracic radiographs of 24% of dogs and of 29% of cats in our study population. Clinically relevant abnormalities, such as severe degeneration of the intersternebral cartilage space, dislocation, or aggressive bone lesions, were only recognized in few cases, whilst most animals showed abnormalities that were unlikely to cause clinical complaints.


To determine the extent to which primary care physicians have been willing to incorporate computerized protocols and clinical information systems into their practices.A survey was fielded to both primary care and non hospital-based specialty group practices of five physicians or more.The types of these technologies in use and the degree to which the physicians themselves were active users.Findings (n=197 or a 38% response rate) are presented grouped by three stages of software application adoption: (1) transaction; (2) decision support; and (3) expert systems or simulation of human thought. Transaction systems, particularly applications that support practice administration such as registration, billing, and scheduling, have the highest percentage of adoption (82% to 97%). Expert systems are uncommon (3% to 6%), with slightly higher penetration of telephone triage (such as "ask-a-nurse") and prevention reminders applications . Within group practices, physician "hands-on" use of systems is low for viewing (28%), and even lower for entering patient information (6% to 8%).Emerging knowledge technologies such as medical decision support or expert systems are not widely accepted and may even threaten traditional physician domains of expertise. Explicit consideration of potential physician opposition should be included in planning pharmaceutical management strategies that depend on "hands-on" physician computer use to be successful.


Rheumatoid pulmonary nodule can be detected in up to 32% of rheumatoid arthritis (RA) patients and approximately one-third of nodules may cavitate. We aimed to evaluate characteristics of patients with RA developing cavitary pulmonary nodular (CPN) lesions under disease-modifying antirheumatic drugs (DMARDs), follow-up of both cavitary and solid nodules, and their outcome with the treatment.RA patients who presented with CPN lesions during follow-up were recruited retrospectively in this case series analysis. Total numbers and mean diameters of cavitary and solid nodules in each thorax computed tomography (CT) have been determined and followed up by two experienced pulmonary physicians. Moreover, changes in treatment after the development of the CPN lesions and characteristics of cavitary nodules were collected.Eleven patients with CPN lesions were reported. At the time of CPN diagnosis, more patients were taking leflunomide than methotrexate (81% vs 19%). Half of the patients were receiving biologic therapy and only 18% were taking anti-TNF drugs. After a median of 24 (3–65) months of follow-up, the regression of CPN lesions was determined in 45% (5/11) of patients. Four of these 5 (80%) patients were switched to a treatment regimen without leflunomide and three of them to nonanti-TNF biologic treatment or targeted synthetic DMARDs .CPN lesions seen in RA patients are often pulmonary manifestations of the underlying disease; however, one must rule out malignancies or infections. If lesions progress under DMARDs, it is advised to discontinue synthetic DMARDs (LEF/MTX) and switch to another biological DMARD with different modes of action Rheumatoid arthritis (RA) is a chronic inflammatory disease typically involving small joints. Pulmonary involvement is the most common extraarticular manifestation of the disease. Pulmonary disease, which is a major source of morbidity and mortality in RA, manifests most commonly as interstitial lung disease (ILD), airways disease, rheumatoid nodules (RN), and pleural effusions .The prevalence of rheumatoid pulmonary nodules, also called necrobiotic nodules, ranges from less than 0.4% in radiological studies to 32% in lung biopsies of patients with RA [Nodules usually present a diagnostic challenge rather than therapeutic. Nodules in RA patients should be evaluated similarly to those in any other patient presenting with solitary or multiple pulmonary nodules, as nodules may reflect the presence of infection, malignancy, or other inflammatory diseases. Biologic drugs are now widely used for treating RA. Various side effects, mainly infection, have been described with these drugs. The efficacy of these agents for the treatment of pulmonary involvement of disease has not been specifically evaluated in large placebo-controlled randomized trials.We report characteristics of 11 patients with RA developing cavitary pulmonary nodular (CPN) lesions under disease-modifying antirheumatic drugs (DMARDs) and follow-up of cavitary nodules and their outcome with the treatment were reported.RA patients who presented with CPN lesions during follow-up between September 2009 and April 2019 in rheumatology outpatient clinic were recruited retrospectively in this case series analysis. Diagnosis of the CPN lesions was made with computed tomography (CT) scan and indication for imaging of these patients were constitutional/respiratory symptoms or any abnormality at routine annual conventional radiography during biological treatment. Characteristics of the patients, positron emission tomography (PET), and biopsy (if available) findings were collected from patient reports. Patients without biopsy were the ones who did not accept biopsy or who had contraindication for biopsy (with cardiac failure and arrhythmia treated by the cardiac pacemaker). In addition to these, changes in treatment after development of the CPN lesion and characteristic of cavitary nodules were collected. Outcome assessment focused mainly on the number and characteristics of all nodules  with the modification of treatments, but we also evaluated cavitary nodules separately. Total numbers and mean diameters of cavitary and solid nodules in each CT have been determined with the agreed decision of two experienced pulmonary physicians, who were aware of the clinical data of the patients. An increase in total nodule count or new cavitation of a solid nodule at CT was accepted as a progression of the lesion. It is also accepted as a progression of the lesion if there is a 20% or more increase of mean nodule size even though total and cavitary nodule count is stable. A decrease in total or cavitary nodule count and a 30% or more decrease in mean nodule size is accepted as regression of the lesion.The study was approved by the local clinical research ethics committee (reference number: 09.2019.592)Before initiation of biologic drugs (except rituximab), each patient was screened for tuberculosis and underwent conventional radiography, clinical pulmonary examination, and ppd/QuantiFERON test, and tuberculosis prophylaxis (9 months of isoniazid) was given to 5 of them as the results of these tests.Two patients received antituberculosis treatment after the detection of CPN; the negative QuantiFERON test turned positive during abatacept treatment in 1 patient (case 4) and biopsy of the nodule was necrotizing granuloma for the other one although tuberculosis bacilli were not detected (case 8). After antituberculosis treatment, there was no regression at the cavitary nodules.Respiratory symptoms were reported by 2 patients and constitutional symptoms by 2 patients while the others were asymptomatic during the diagnosis of CPN. All patients were seropositive, 2 patients had p ANCA (antinuclear cytoplasmic antibody)-positive, but the ELISA test for anti-MPO (myeloperoxidase) and PR3 (proteinase) were negative. Extensive examinations for microbial organisms (mycobacteria and opportunistic infections) were all negative .A total of 48 CTs were evaluated by two experienced pulmonary physicians. We are presenting CT findings showing cavitary and solid nodules of our patients in Fluorodeoxyglucose (FDG) PET/CT scan examination of nodules was performed to exclude malign conditions in 7 patients. We determined that both mediastinal lymphadenopathy (LAP) and cavitary-solitary nodules had increased uptake with a standardized uptake value (SUV) of 1.6–7.9 FDG. Salivary gland adenocarcinoma was detected in one of the patients with 12 FDG uptake value at the submandibular area, but biopsy from mediastinal lymph node (11 FDG) showed tuberculosis-negative necrotizing granuloma.We evaluated CTs of patients for the total (solid/cavitary) nodules at the end of 28 (3–65) months follow-up and 4 (36.3%) patients were diagnosed with regressed lesions while 7 (63.7%%) patients had progressive lesions compared to previous CTs  and switch to biological DMARDs with different modes of action. In addition, improvement of the CPN lesions might be seen with non-TNF biologic treatment or targeted synthetic DMARDs .


Scientific Reports 10.1038/s41598-021-03609-w, published online 10 January 2022Correction to: The Acknowledgements section in the original version of this Article was incomplete, where the grant number of one of the funding agencies was omitted.“SP would like to acknowledge support of the National Science Centre of Poland within the OPUS programme.”now reads:“SP would like to acknowledge support of the National Science Centre of Poland within the OPUS programme (2020/39/B/ST2/01524).”The original Article has been corrected.


In India, unsafe sex has been documented among truck drivers. This study explores the factors influencing their attitude of trucker towards condom use.A cross-sectional study design was adapted for this study in which 25 factors were chosen to assess attitude toward condom use on 7 point validated Likert scale UCLA Multidimensional Condom Attitude Scale on 5 subcomponents -Reliability, Pleasure, Stigma associated with condom use, embarrassment about negotiation and use of condom and about purchasing condom. Hundred truck drivers were recruited using convenient sampling and Mann-Whitney U and Kruskall Wallis Test were used to validate the subcomponents among those practicing unsafe sex.Positive attitudes regarding reliability and effectiveness of condom were significantly higher among adult entrants and those resting more than 10 hours during journey whereas positive attitude regarding pleasure associated with condoms and stigma towards it is significantly higher among truck drivers travelled long distances and resting more than 10 hours.Adolescent entrants, those who have not travelled long distances and not rested more than 10 hrs requires improvement in the attitude towards condom use. WHO reports globally 36.9 million people are living with HIV. 1In South-east Asia, 1.7 million people are living with HIV and number of people living with HIV in India is 2100000.2Sexual promiscuous lifestyle is common among truck drivers and therefore susceptible of acquiring HIV infection. 12There seems to be few studies highlighting the attitude toward condom use among truck drivers. This study was undertaken with an objective to assess the attitude towards condom use and its predictors among truck drivers at transhipment location in Meerut district, IndiaThis cross-sectional study was conducted at Trans-shipment area in Meerut district, India which is home to over two hundred transporters and over 500 trucks are available at any given point of time. Furthermore, a typical halt can range from thirty minutes to two days and work hours of most transporters are eleven hours.Hundred truck drivers were recruited who were having a valid driver's license from the trans-shipment area using convenient sampling procedure.A pre-tested validated questionnaire comprising closed ended questions was used to document socio-demographic-occupational profile and for assessment of attitude towards condom use University of California Los Angeles Multidimensional Condom Attitude Scale (UCLA MCAS) was used.13The truck drivers were briefed about the purpose of the study, importance of their participation, its consequential benefit to truck drivers and assurance of their confidentiality. After briefing them, the informed consent was taken from truck driver agreeing to participate and regardless of the participation, the truck drivers were given condoms and advices related to health issues. Truck drivers having wrong perception about condom were educated about the benefit of condom The pilot study, modification of questionnaire, recruitment of participants for main study and data analysis was done from a period of August 2014 to September 2015.Occupation profile: Type of truck drivers (based on distance traversed), average number of days away from home, average resting time during trip and type of entrant (adolescent or adult)Unsafe sex: Our criterion for unsafe sex was operationally defined as inconsistent use of condom with high risky sexual partners like CSW and MSM irrespective type of intercourse-vaginal, anal or oral (Fellatio) and practicing either Cunnilingus or Analingus or both.Attitude towards Condom Use: The 25 item UCLA MCAS 7-point Likert scale was used to assess the attitude towards condom use. The UCLA MCAS has 5 subscales (or domains) - Reliability and Effectiveness of Condoms, Pleasure associated with Condom, Stigma associated with condom use, Embarrassment about negotiation and use of condom and Embarrassment about purchasing condoms. 13Reliability and effectiveness subscale included 1) Condoms are an effective method of preventing the spread of Aids and other sexually transmitted diseases 2) Condoms are unreliable (reverse scored) 3) I think condoms are an excellent means of contraception 4) Condoms do not offer reliable protection (reversed score) 5) Condoms are an effective method of birth control. Pleasure associated with condoms included 1) Use of condom is an interruption of foreplay (reversed score) 2) Condoms ruin the sexual act (reversed the score) 3) Condoms are a lot of fun 4) The use of condom can make sex more stimulating 5) Condoms are uncomfortable for both parties (reversed score)Stigma associated with Condom use included 1)Women think men who use condoms are jerk (reversed score) 2)If a couple is about to have sex and the man suggests using a condom, it is less likely that they will have sex (reversed score) 3) People who suggest condom use are a little bit geeky (reversed score) 4) Men who suggest using a condom are really boring (reversed score) 5) A woman who suggests using a condom does not trust her partner (reversed score). Embarrassment about negotiation and use of condom include 1) It is really hard to bring up the issue of using condoms to my partners (reversed score) 2) When I suggest using a condom I am almost always embarrassed (reversed score) 3) It is easy to suggest my partner that we use a condom 4) I never know what to say when my partner and I need to talk about condoms or other protection (reversed score) 5) I am comfortable talking about condoms with my partner. Embarrassment about purchasing condoms include 1) I always feel really uncomfortable when I buy condoms (reversed score) 2) I don't think that buying condoms is awkward 3) It is very embarrassing to buy condoms (reversed score) 4) It would be embarrassing to be seen buying condoms in a store (reversed score) 5) It would be embarrassing to be seen buying condoms in a store (reversed score)The analysis was done in SPSS 21.The total score for each item = +  +  +  +  +  +  / Total Response (100)Mean score% for each subscale = (mean score – 1)/Minimum value = 1 and maximum value = 7The mean score for individual participant in different subscales was computed and non-parametric test [Kruskall Wallis and Mann-Whitney U Test] were applied to find the predictors of attitude regarding condom use.The study was a component of a dissertation and Subharti Medical College  Institutional Committee approved the dissertation (SMC/PG-13/2013).Of the 100 participants, most were married (72%), literate (90%), adult entrant (69%), travelled long distance (77%) average time away from home less than 10 days (71%) and resting during journey less than 10 hours (65%).The attitude among truck driver regarding reliability and effectiveness of condom is 88.3% , pleasure associated with condom is 70.3% , stigma associated with condom is 73.7% , embarrassment about negotiation and condom use is 76% and purchasing condoms is 75.8%.The mean score for attitude regarding reliability and effectiveness of condoms is significantly higher among adult entrants than adolescent entrants and those resting more than 10 hours during journey whereas mean score for regarding pleasure associated with condoms is significantly higher among truck drivers travelled long distances and resting more than 10 hours. Furthermore, the mean score for attitude regarding stigma associated with condom use is significantly higher among truck drivers travelled long distance and attitude regarding embarrassment about negotiation and use of condom was significantly higher among truck drivers resting more than 10 hours. However, mean score for attitude regarding embarrassment about purchasing condom use was significantly higher among adult entrants and those who have travelled long distance. This seems to be the first study for elaborative assessment of attitude toward condom use among truck driver population in India using UCLA Multidimensional Condom Attitude Scale. The findings of the study indicate in almost all domains the attitude of truck driver was far from satisfactory.This scale was used among 20 recruited community members assessing difference in attitude towards condom use between those consuming alcohol and does not consuming it.18The study is subjected to limitation because of small sample size recruited using convenience sample and social desirability bias may have influence on the response of the participants. Hence it is recommended the study be conducted on a large sample size using probability sampling.The age of the entrant, travelling long distances and resting time more than 10 hours were predictors significantly affecting attitude of truck drivers regarding condom use.


C) to the neurotoxic pathogenic form (PrPTSE) via a yet undefined but profoundly complex mechanism. Despite several decades of research on PrD, the basic understanding of where and how PrPC is transformed to the misfolded, aggregation-prone and pathogenic PrPTSE remains elusive. The primary clinical hallmarks of PrD include vacuolation-associated spongiform changes and PrPTSE accumulation in neural tissue together with astrogliosis. The difficulty in unravelling the disease mechanisms has been related to the rare occurrence and long incubation period (over decades) followed by a very short clinical phase (few months). Additional challenge in unravelling the disease is implicated to the unique nature of the agent, its complexity and strain diversity, resulting in the heterogeneity of the clinical manifestations and potentially diverse disease mechanisms. Recent advances in tissue isolation and processing techniques have identified novel means of intercellular communication through extracellular vesicles (EVs) that contribute to PrPTSE transmission in PrD. This review will comprehensively discuss PrPTSE transmission and neurotoxicity, focusing on the role of EVs in disease progression, biomarker discovery and potential therapeutic agents for the treatment of PrD.Prion diseases (PrD) or transmissible spongiform encephalopathies (TSE) are invariably fatal and pathogenic neurodegenerative disorders caused by the self-propagated misfolding of cellular prion protein (PrP TSE) of normal cellular prion protein (PrPC) (Prusiner Prion diseases (PrD) or transmissible spongiform encephalopathies (TSE) are progressively rapid and fatal neurodegenerative diseases (NDs) with a defining hallmark of vacuolation in the brain tissue , Gerstmann–Stäussler–Scheinker (GSS) and fatal familial insomnia (FFI) while sporadic CJD (sCJD) presents with disease aetiology from unknown origins. PrD with acquired aetiologies from exposure to pathogenic prions includes iatrogenic CJD (iCJD), vCJD, and kuru. To date, various human-to-human iCJD transmissions occurred due to incomplete decontamination of surgical equipment, corneal grafting, dura mater grafting, cadaveric pituitary-derived growth hormone or gonadotrophin, and blood transfusions  denaturation, proteinase K (PK) treatment and high-performance liquid chromatography (HPLC) purification yielded the significant component of a single protein ranging 27–30 kDa in size (PrP 27–30) TSE isofoC has high endogenous expression in neurons and is encoded by only one exon out of three exons in the PrPC gene at chromosome 20  anchor at the C terminus (residue 230) and two N-linked glycans at residues 181 and 197. Nuclear magnetic resonance (NMR) examination of PrPC structure revealed an intrinsically disordered N-terminal tail (residues 23–128), three α-helical regions (two of them linked by a disulphide bridge) and a short anti-parallel β-sheet , where it is packaged in extracellular vesicles  and released into the extracellular environment  was developed  model –based structure  isolation of infectious prions from different prions strains for dynamic and multi-angle light scattering (DLS/MALS) analysis showed quaternary structure difference resulting in PrPTSE strain heterogeneity  polymorphism   fragment on SDS-PAGE gels, three different PrPres subtypes have been identified, which include type 1 (21 kDa), type 2 (19 kDa) and type intermediate   is a technique that converts normal brain homogenate PrPTSE deposition are the characteristic features of prion-infected brains, the mechanism of neurotoxicity has remained elusive. However, several studies have investigated the synergistic effect generated by the interaction of PrPC and PrPTSE, providing some explanation on the neurotoxic effects of PrPTSE. Grafting neural tissue overexpressing PrPC into PrPC null mice brains and intracerebrally injecting scrapie prions produced severe histopathological changes exclusively in the grafted tissue  starvation followed by ATP depletion    and exosomes classified based on biogenetic pathway and size. Apoptotic bodies (500–5000 nm) arise from the cell fragmentation during apoptosis, microvesicles (200–1000 nm) from outward budding and shedding from the plasma membrane, and exosomes 40–200 nm) which are released intercellularly following production via the endosomal pathway and fusion of the MVB to the plasma membrane , and many have predicted targets in crucial neuronal signalling pathways. This suggests that EVs could carry brain-associated miRNAs and into the blood  play key roles in gene regulation either by inducing mRNA degradation or repression of mRNA translation. A plethora of miRNAs are present in the brain, indicating that complex physiological and neuronal development functions of miRNAs are more enriched in the brain regions, which shows the complex physiological functions of the brain , a regulator of ceramide biosynthesis, reduced exosomes as well as miRNA secretion, an effect that was reversed following overexpression –infected N2a cells overexpressing murine prion protein demonstrated upregulation in the redox chaperone, protein disulphide isomerase (PDI)  and ATPase (complex V). A more recent study validated mitochondrial respiratory chain deficiency in human sCJD brain temporal cortex with immunohistochemistry, demonstrating a loss of all mitochondrial complexes (I–V)  and Alzheimer’s disease (AD). An early study of scrapie-infected hamster brain cerebral cortex transmission electron microscopy images depicted alterations in mitochondrial morphology and depletion of mitochondrial matrix and cristae –derived EVs from human placenta intravenously delivered to multiple sclerosis mice demonstrated increased motor abilities, reduced DNA damage and increased myelination  –derived EVs injected into the bloodstream ameliorated neuroinflammation and increased cognitive function in immunocompetent mice (Leavitt et al. EV research is a burgeoning field elucidating the dynamic nature of intercellular communication in the local and distal areas of the body, and has opened a new horizon to decipher the fundamental biological processes in health and disease. Studies exploiting EVs as the biomarker source and their subsequent role in pathogenic and neurotoxic processes aid a better understanding of the complexity of PrD. The gaps in the study of proteomics and lipidomic cargo from the infectious EVs of several prion strains would help to reveal common neurotoxicity-related pathways. Moreover, the functional study of infectious prion EVs in communication with the glial cells can reveal these EVs’ immunomodulatory and inflammatory effects. While secondary lymphoid organs, including the spleen, are indicated as an early accumulation site for prion replication following peripheral prion infection, isolating EVs from these organs for infectivity and cargo assessment would result in better understanding of EVs’ associated roles. Future studies utilising emerging technologies to examine the nanoscale world of EVs will shed more light on this growing field, promoting strain-specific biomarker discovery for disease diagnosis and enabling the engineering of EVs for disease treatment.


This study aimed to use data analytics to retrospectively identify the prevalence of inpatients across a system of hospitals with a BAAL who received and tolerated the culprit or related beta-lactam (BL) without proper documentation in the allergy profile of the electronic medical record (EMR). Findings from this study could prioritize direct non-invasive delabeling opportunities as a feasible process measure for resource limited antimicrobial and diagnostic stewardship programs (ADSP).> 18 years of age, 2) inpatients at a NM System Hospital (NMSH) with > 1 overnight stay between 8/1/2020 and 8/1/2022, 3) a BAAL in the allergy profile of the EMR, and 4) received > 1 dose of a BL during the study period. Patients who only received aztreonam were excluded. The primary objective of this study was to determine the prevalence of inpatients with a BAAL who received and tolerated the culprit BL antibiotic during the study period without proper documentation in the allergy profile of the EMR. The secondary objectives were 1) to determine the prevalence of inpatients with a BAAL who received and tolerated a related BL antibiotic during the study period without proper documentation in the allergy profile of the EMR and 2) to determine the prevalence of reported BL allergy reactions and severity risk.Eligible patients were generated by a data analyst using the Northwestern Medicine (NM) Enterprise Data Warehouse. Patients eligible for inclusion: 1) adults Results of our study identified up to 751 inpatient BAALs (9.7%), including 87 BAALs of high priority, as valuable targets for early direct non-invasive delabeling, requiring minimal effort and resources from ADSP.Using data analytics to empirically assess digital allergy information could streamline the antimicrobial stewardship process, proactively identifying and prioritizing BAALs to cast a wider net and efficiently achieve process measure outcomes related to allergies compared to conventional methods of delabeling.Anju T. Peters, MD MSCI, Astra Zeneca: Advisor/Consultant|Astra Zeneca: Grant/Research Support|Merck: Advisor/Consultant|Merck: Grant/Research Support|Optinose: Advisor/Consultant|Sanofi Regeneron: Advisor/Consultant|Sanofi Regeneron: Grant/Research Support


In the published article, there was an error in the legend for (A) Immunization and challenge schedule with prime and boost (day 0 and 21), intranasal challenge (day 42), and bleeds . On day 45 mice were euthanized for the harvesting of lungs and nasal turbinates. (B) Viral levels in the nasal turbinates of mice as measured by tissue culture infectious dose 50 (TCID50). (C) Viral levels in the left lung of mice as measured by TCID50. P-values are indicated for the significance of differences and NS denotes no statistical difference. Vaccines were Fluad (T) (blue) and Fluzone (T) (red) with saline (black) and non-infected controls (white). Yamagata-lineage challenge virus was mouse-adapted B/Florida/04/2006.”“Measuring viral titers in the nasal turbinates and lungs of mice following vaccinations and subsequent challenge with Yamagata-lineage influenza B virus. The authors apologize for this error and state that this does not change the scientific conclusions of the article in any way. The original article has been updated.


Existing data on adverse effects (AEs) of COVID-19 vaccines among people living with human immunodeficiency virus (PLHIV) are currently limited.A cohort study was conducted among PLHIV receiving care at two clinics during COVID-19 epidemics in Thailand (2021-2022). The PLHIV received various types and regimens of COVID-19 vaccines based on vaccine availability and the national policies. Data on vaccine types and AEs were collected and assessed using the online survey system.Of the 398 vaccinated PLHIV, 365 (92%) had CD4 count at enrollment ≥ 200 cells/µL, 382 (96%) were virologic suppressed, 153 received two doses and 245 received three doses of COVID-19 vaccines. Inactivated and viral vector were the most common vaccine types received by the PLHIV as the first and second doses , while mRNA vaccine was the most commonly used as a booster dose (57%). For the first and second vaccine doses, the most common AEs were fever (15% and 11%) and injection site pain (11% and 11%). The mRNA vaccine significantly caused more overall AEs, injection pain, fatigue, and rashes than the other two types, while the mRNA and viral vector vaccines significantly caused more fever than the inactivated vaccine. For a booster dose, viral vector vaccine significantly caused more injection site pain and headache than the other two types. Most of the PLHIV reported that the AE intensity was similar between the first and second doses (49%) and was more for a booster dose compared to the first dose (50%). The majority of all AEs of the first, second and booster doses spontaneously recovered without treatment  or required symptomatic treatment without hospitalization . By multivariable analysis, receipt of viral vector or mRNA vaccine and age less than 40 years were independently associated with any AEs of the primary series vaccines, while having AEs from the previous dose and female sex were factors associated with any AEs of a booster vaccine.The three types of COVID-19 vaccines were generally safe among PLHIV. Most of the AEs were non-severe and did not require hospitalization. PLHIV who were elderly, female or had AEs from the previous vaccine dose should be closely monitored for AEs of the vaccines.All Authors: No reported disclosures


Mental disorders, musculoskeletal diseases (MSDs) and their comorbidities are major threats to work and functional ability. The relationship between mental health and the common MSDs has not received enough attentionTo study the socio-professional characteristics of workers suffering from work related MSDTo evaluate the association of work related MSDs with anxiety and depression disordersA descriptive cross-sectional study conducted among workers with work-related MSDs who consulted the occupational medicine department of the Charles Nicolle Hospital between January 2022 and September 2022. A remote survey was conducted among these workers to screen for anxiety and depressive disorders using the Hospital anxiety and Depressive ScaleThe study population consisted of 54 workers with MSDs with a sex ratio (M/F) of 0.74. The average age was 44.4 [27-61 years]. The average professional seniority was 14.9 years±7 years and the sectors with the highest prevalence of MSDs were the health sector (22%), the food industry (13%) and the textile industry (11%). The workers reported MSDs of the lumbar spine in 61%, gonarthrosis in 31%, followed by MSDs of the upper limb in 25%. The prevalence of anxiety and depressive disorders were respectively 46% and 38%. There was no significant association between socio-demographic factors and anxiety depressive disorders. The anxiety disorder was associated with MSDs of the lumbar spine .Anxiety and depressive disorders were common among workers with MSDs related to work. Interventions targeting psychological distress and work-related psychosocial characteristics may reduce their musculoskeletal pain.None Declared


Toxoplasma encephalitis (TE) is the most frequent cause of expansive brain lesions among acquired immunodeficiency syndrome (AIDS) patients; however, the optimal timing of antiretroviral therapy (ART) initiation in these patients remains controversial.This was a multicenter prospective observational study, and eligible patients were recruited from eleven treatment centers in China.In total, 87 patients were included, and 38 of them were assigned to the Early ART group (initiating ART within 2 weeks after anti-Toxoplasma treatment initiation), while the remaining 49 patients were allocated to receive deferred ART (initiating ART at least 2 weeks after anti-Toxoplasma treatment initiation). Our results indicated that the incidence of immune reconstitution inflammatory syndrome (IRIS)  and the number of death events  were not significantly different between the two groups at Week 48. The timing of ART initiation was also found to not significantly contribute to human immunodeficiency virus (HIV) viral load control. The difference in the number of patients who maintained an undetectable HIV viral load of <50 copies/mL in each of the two groups of patients was calculated to not be statistically significant at Week 24  and Week 48 . Meanwhile, median CD4+ T-cell counts were also observed not to reach statistical significance between the two groups, both at Week 24  and Week 48 .In our study, early ART initiation was observed to not confer statistically significant differences in the incidence of IRIS, mortality, and HIV virological and immunological outcomes, when compared to deferred ART initiation.All Authors: No reported disclosures


In recent decades, vagus nerve stimulation (VNS) therapy has become widely used for clinical applications including epilepsy, depression, and enhancing the effects of rehabilitation. However, several questions remain regarding optimization of this therapy to maximize clinical outcomes. Although stimulation parameters such as pulse width, amplitude, and frequency are well studied, the timing of stimulation delivery both acutely (with respect to disease events) and chronically (over the timeline of a disease’s progression) has generally received less attention. Leveraging such information would provide a framework for the implementation of next generation closed-loop VNS therapies. In this mini-review, we summarize a number of VNS therapies and discuss (1) general timing considerations for these applications and (2) open questions that could lead to further therapy optimization. What VNS implementation strategies have worked best ?Moving forward, what open questions and strategies can be assessed for further optimizing VNS therapy and timing?Implanted vagus nerve stimulation (VNS) is utilized for a number of applications, including improving cardiovascular function  the reactive neurostimulator (RNS) by NeuroPace and 2) VNS with AutoStim Mode by LivaNova. The former uses neural recordings for early seizure detection, while the latter uses relative increases in heart rate (characteristic of seizure activity) for a similar purpose  uses brief bursts of closed-loop VNS paired with events to promote neural plasticity and recovery following disease or dysfunction . Overall, the ultimate role of closed-loop VNS for treating cardiovascular disease will be affected by a number of exciting innovations, including neurogram decoding of cardiovascular information Zanos  and machWhile therapeutic intervention for disease states that are symptomatic  but not perceivable is important, such disease progression is usually preceded by a series of interconnected subclinical states  detect disease events and better time VNS and (2) intervene earlier in disease progression to maximize the clinical benefits of VNS (Fig.  detect d


Sorghum bicolor (L.) Moench] utilizes the cytoplasmic-nuclear male sterility (CMS) system for seed production and subsequently harnesses heterosis. Since the cost of developing and evaluating inbred and hybrid lines in the CMS system is costly and time-consuming, genomic prediction of parental lines and hybrids is based on genetic data genotype. We generated 602 hybrids by crossing two female (A) lines with 301 diverse and elite male (R) lines from the sorghum association panel and collected phenotypic data for agronomic traits over two years. We genotyped the inbred parents using whole genome resequencing and used 2,687,342 high quality  single nucleotide polymorphisms for genomic prediction. For grain yield, the experimental hybrids exhibited an average mid-parent heterosis of 40%. Genomic best linear unbiased prediction (GBLUP) for hybrid performance yielded an average prediction accuracy of 0.76–0.93 under the prediction scenario where both parental lines in validation sets were included in the training sets (T2). However, when only female tester was shared between training and validation sets (T1F), prediction accuracies declined by 12–90%, with plant height showing the greatest decline. Mean accuracies for predicting the general combining ability of male parents ranged from 0.33 to 0.62 for all traits. Our results showed hybrid performance for agronomic traits can be predicted with high accuracy, and optimizing genomic relationship is essential for optimal training population design for genomic selection in sorghum breeding.Hybrid breeding in sorghum [ Heterosis is the phenomenon by which the interest . Mid-parc values . The genulations . IMPH ar1 hybrid . Therefo1 hybrid .Sorghum bicolor (L.) Moench] is one of the self-pollinated crops that is bred as a hybrid crop, particularly in the United States (US) and Australia. Beginning in the 1950s, sorghum breeding in the US started utilizing the cytoplasmic-nuclear male sterility (CMS) system to produce hybrid cultivars  of R lines crossed to two female testers. The male lines used for generating single crosses are accessions included within the US sorghum association panel (SAP) that represent the genetic and phenotypic diversity of sorghum across the globe and could be used in allele mining and prebreeding (A sorghum hybrid diversity panel (SHDP) of 602 hybrids was generated by crossing 301 diverse male restorer (R) lines to two CMS female (A) testers: ATx642 (PI656029) and ATx2928 (PI629059) . The malHelicoverpa zea) and fall armyworm (Spodoptera frugiperda) infestation. Fields were watered using overhead irrigation only as needed to prevent drought stress.The hybrids and parental lines from the SHDP were planted along with the commercial check in a modified randomized complete block design with two replications in May 2019 and May 2020 at the Clemson University Pee Dee Research and Education Center  in Florence, SC. The modification was done by blocking each complete replication into smaller blocks based on previously observed maturity and height phenotypes for the male parent of the hybrids to avoid shading effect of taller lines on neighboring plants. There were a total of 40 blocks per replication and each block consisted of 30 individual plots. Each plot had two rows with a row length of 6.096 m and a row spacing of 0.762 m. The experimental hybrids, their parental lines and check hybrid variety (83P17) were randomized completely for each small block nested within each replication. Preplant fertilizer was blended based on soil sample results and per field recommendations for cereal grain production. In 2019, the fertilizer blend consisted of granular muriate of potash  at 300 kg haPhenotypic data were collected for days to anthesis (DTA) when about 50% of the primary panicles in the plot were at mid-anthesis. Plant height (PH) was measured from the base of the plant to the top of the representative panicle within the plot after physiological maturity. Plants were harvested when the majority of the plants in the plot reached post-physiological maturity (grain moisture below 18%) using a Wintersteiger Delta two row combine plot harvester. Harvest dates ranged from 16 to 18 September in 2019 and 17 to 25 September in 2020. Total harvest weight of the grain from each plot and the average moisture content of the harvested grain was used to calculate grain yield (GY) in bushels/acre and subsequently converted to ton per hectare  lines of the female parents were used to evaluate female parent performance. The following model was used to adjust for spatial variability within each experimental year:whereThe adjusted means (BLUPs) of wherewherevcftools   8) by redist function in R ..8). Suppd by GNP .For genomic GCA and genomic GCAe shared . For thee shared . Mean prGCAs of male lines were estimated from the genomic GCA model  using alThe ability to predict testcross performance in hybrids was evaluated for male general combining abilities (mGCA) using the GCA and GCAo models , Fig. 5.Hybrid sorghum breeding is based on a CMS system where male sterile females (A lines or seed parents) are crossed to restorer males (R lines or pollinator parents) to produce seed of commercial Following the wide range of diversity in the parental genotypes, the  to 20%) . The comSince the possible hybrid combinations even in a medium sized breeding program far exceeds the capacity to test them in actual hybrid crosses, one of the main motivation for the use of GP in hybrid breeding is to be able to estimate hybrid genetic value of those untested hybrid crosses  or only female parent (T1F) were shared between training and validation sets to understand the effect of parent testing on the accuracy of single cross predictions. While single-cross performance was predicted with high accuracy in T2 scenario, a strong decline (12–90%) in prediction accuracy was observed in T1F compared to T2. This is expected because the predictions from the model in T2 rely not only on kinship between male parents , as in the case of T1F, but also on information from other crosses in the training set that involves the male parent of predicted hybrid with the other female tester. Plant height showed the greatest decline in prediction accuracy in T1F, which could be due to very limited phenotypic variability among female lines for PH, and as a result, accuracy for PH could have been driven primarily by male parent. GP of sorghum hybrids using GBLUP model and cross-validation involving leave one parent out strategy (similar to our T1F) showed mean prediction accuracies (0.31–0.54) for grain yield that was similar to accuracy from our T1F prediction scenario (Prediction of testcross performance of inbred lines in hybrid combinations has been studied across multiple crop species ( studied . PredictThe phenotypic distribution of agronomic traits and consistent heterotic advantage of experimental Studies exploring the role of genetic diversity and genomic relationship on GP for trait phenotypic values as well as trait heterotic values are essential for optimization of training population for predicting hybrid performance. In silico simulation studies have highlighted strategies for application of rapid recurrent genomic selection combined with progeny testing to facilitate separation of heterotic groups, reduction in breeding cycle, and ultimately increase in long term genetic gain (jkac311_Supplementary_DataClick here for additional data file.


To examine the federal government's current health care initiatives in the Centers for Medicare and Medicaid Services (CMS) to improve quality of care and cost-effectiveness around the prescription drug benefit.The government has a unique perspective on quality and outcome. Pharmacists need a working knowledge of 3 areas: (1) Medicare Part D, (2) medication therapy management efforts, and (3) demonstration projects. All of these will make demands on health care providers but should result in better outcomes data and patient care. All of these areas also have value components, and all have strategic implications as 2006 moves into 2007.CMS does not consider managing cost and providing value to be mutually exclusive and is attempting to move America's health care toward a value based program.


Suicide rates in Azerbaijan rank among the top 3 highest of all Muslim majority countries. Further, approximately 40% of women in Azerbaijan report being physically or sexually abused. Women experiencing interpersonal violence report higher rates of suicide ideation and attempts (34%) than women in the general population. No prior studies have specifically explored protective factors against suicide and interpersonal violence in Azerbaijan.This study aims to address this gap and to identify culturally relevant protective factors against suicide and violence against women in Azerbaijan.A total of 51 women with lived experience and mental health providers participated in either in-depth qualitative interviews or focus groups. The interview guide for the focus groups and one-on-one interviews were developed by the study PI. A list of questions served as the basis for the discussions and was revised and expanded as the groups progressed. For the qualitative analyses, conventional content analysis following a systematic process of coding and classification was utilized.Three main protective factors against suicide were identified: 1) psychological support (33%); 2) psychoeducation to raise awareness of suicide and reduce stigma (28%); and 3) providing financial opportunities/supports (10%) and for violence against women 1) advocacy (28%); 2) psychological support (28%); and 3) changing cultural values (17%).This study fills a much-needed gap in our understanding of suicide and violence against women in Muslim populations. Our findings suggest that for intervention to be relevant and effective, prevention programming needs to span micro, mezzo, and macro levels.None Declared


There is a modest but consistent association between violent behavior and schizophrenia. Persons with schizophrenia are at a modestly increased risk of committing violence ,with approximately half of victims being relativesOur study examined the factors attributed to violent behaviour within the relationship patient-caregiver in schizophrenia according to caregivers.This is a cross-sectional study among caregivers of patients with schizophrenia during the period from June to August 2022.Patients who attended our department of psychiatry at the Razi.The questionnaire was divided into three sections. The first section contained items regarding patient- and caregiver-related information.In the second section, caregivers were asked questions about their experience of violence perpetration and victimization involving their relative with schizophrenia in the past 12 months.Beyond frequency, caregivers were also asked to specify, the causes of the violence perpetrated and sufferedThe third section contained two measures, i.e. the Depression Anxiety and Stress Scales (DASS-21) and the abridged version of the Zarit Burden Interview (ZBI), assessing psychological distress and caregiving burden, respectively. The protocol of the study was approved by the ethics committee of the Razi Psychiatric Hospital.The majority of caregivers were females (63.6%), and consisted of patients’ parents (50.9%).The most endorsed causes of violence victimization were symptoms of illness (57.3%), followed by refusal to adhere to treatment (49.1%), drug reaction (23.6%), and negative events; while the most reported causes of violence perpetration were refusal to adhere to treatment (42.7%), Symptoms of illness (37.3%), and limitation of patients’ activities and/or liberty (32.7%).Bivariate analysis showed that lower patients’ economic status (p=.042), tobacco (p=.015) and alcohol use (p=.014) as well as taking Trihexyphenidyl (p=.001) were significantly and positively associated with violence perpetration by caregivers against their relatives with schizophrenia.Multivariable analysis (Logistic regression) revealed that caregivers’ levels of burden remained significantly associated with violence victimization occurrence , while only having other person in charge of caring represented a significant factor associated with perpetration of any form of violence against patients .It is important for medical staffs to provide caregivers with professional knowledge about patients’ real motivation for violence in order to improve their skills of problem-solving.None Declared


Clostridioides difficile infection (CDI) is a priority. Infection control measures to prevent CDI target symptomatic (infected) patients. These patients are placed on contact precautions (CP), requiring hand hygiene and use of gloves and gowns. However, asymptomatic (colonized) patients may be a reservoir for cross contamination, and evidence is scarce regarding prevention measures with this population. To address this gap, our study evaluates the effect of universal gloving (UG) for all patient contact to prevent transmission from these patients. However, the gloving intervention involves complex behavioral practices with wide variations in compliance; thus, data on intervention implementation provides critical context. Here we provide a preliminary analysis of intervention fidelity.Prevention of A cluster randomized trial (CRT) is being conducted in ten VA hospital patient units; 5 units randomized to standard of care (CP) and 5 units to the intervention (UG plus CP). A secondary outcome of the study is intervention fidelity (gloving compliance). This analysis includes monthly observation data on hand hygiene (HH) and gloving compliance for UG and HH, gloving, gowning for CP in both groups using a standardized observation tool. Compliance was calculated using the total number of compliant observations divided by the total number of observations.Table 1). Gloving compliance with UG was lower than expected and significantly lower than gloving compliance for CP in the intervention group (Table 2). Table 3 compares HH and gloving between UG (intervention group) and CP (both groups). Gloving compliance was significantly higher with CP than with UG.1012 Observations were conducted between May 2022 and April 2023. HH, gloves and gown compliance for CP did not differ between groups (Results TablesTable 1 - 3Intervention fidelity is critical to support rigor of the CRT, but our results showed lower than expected compliance for both gloving and HH despite the UG intervention. A pilot interview identified the healthcare worker requirement for practicing both HH and gloving as a barrier. Additional investigation into barriers to gloving and HH compliance within the context of a UG intervention is ongoing.All Authors: No reported disclosures


Scientific Reports 10.1038/s41598-022-24353-9, published online 28 November 2022Correction to: The original version of this Article contained an error in the Funding section.“This work was supported by the funds from the National Natural Science Foundation of China (No. 81971842 to Lianbo Zhang) (grant numbers 81973120 to Liu) and National Key R&D Program of China (grant numbers #2018YFC1311600 to Liu).”now reads:“This work was supported by the funds from the National Natural Science Foundation of China (No. 81971842 to Lianbo Zhang).”The original Article has been corrected.


During 2013, the 11 countries of the World Health Organization (WHO) South-East Asia RegionRubella is the leading cause of vaccine-preventable birth defects ; 3 develRCV1 was introduced in five SEAR countries  before 2013 and in the remaining six SEAR countries  for measles and rubella elimination was established during 2016 and developed an updated framework for verification of measles and rubella elimination during 2020  obtain the highest level of national commitment from SEAR countries and support from partners; 2) strengthen routine immunization and achieve ≥95% coverage with RCV1; 3) conduct high-quality SIAs; 4) enhance surveillance sensitivity and increase collection of specimens for rubella virus detection and genotyping; and 5) leverage elimination activities to enhance measures to restore routine immunization services and reduce immunity gaps for all vaccine-preventable diseases. With the regional birth cohort representing 24% of the world’s infants surviving beyond age 1 year, progress toward rubella elimination in SEAR represents an important opportunity to decrease rubella-related death, disability, and illness worldwide.During 2013, coverage with the first dose of rubella-containing vaccine (RCV1) in the World Health Organization South-East Asia Region was 12%, and only five countries in the region had introduced RCV into their routine immunization programs.By 2021, all 11 SEAR countries had introduced RCV1, and estimated regional RCV1 coverage increased from 12% to 86%; rubella incidence declined by 80%. Maldives and Sri Lanka achieved rubella elimination; Bhutan, North Korea, and Timor-Leste have halted endemic transmission of rubella virus for >36 months.SEAR has made substantial progress toward rubella elimination. To achieve regional rubella elimination by 2023, optimal and accelerated measures to implement all elimination strategies are needed.


Cryptomeria japonica (Cj) and Chamaecyparis obtusa (Co) at three environmentally different sites. Based on molecular and morphological analyses, we characterized their associated AMF communities. Cj was more densely colonized than Co and that root colonization intensity was significantly correlated with soil AMF diversity. The communities comprised 15 AMF genera dominated by Glomus and Paraglomus and 1443 operational taxonomic units (OTUs) of which 1067 and 1170 were in roots and soil, respectively. AMF communities were significantly different among sites, and the root AMF communities were significantly different from those of soil at each site. The root and soil AMF communities responded differently to soil pH. At the genus level, Glomus and Acaulospora were abundant in roots while Paraglomus and Redeckera were abundant in soil. Our findings suggest that AMF colonizing roots are protected from environmental stresses in soil. However, the root-soil-abundant taxa have adapted to both environments and represent a model AMF symbiont. This evidence of strategic exploitation of the rhizosphere by AMF supports prior hypotheses and provides insights into community ecology.Arbuscular mycorrhizal fungi (AMF) in the roots and soil surrounding their hosts are typically independently investigated and little is known of the relationships between the communities of the two compartments. We simultaneously collected root and surrounding soil samples from The online version contains supplementary material available at 10.1007/s00248-023-02223-9. Arbuscular mycorrhizal fungi (AMF) are ubiquitous symbiotic microorganisms that live in both the soil and in roots of their hosts upon which they bestow diverse benefits , 2. AMF AMF communities and species richness may be similar or dissimilar between the roots and surrounding soil . DiffereCamellia japonica ), and vesicles (vesicular colonization [VC]) following McGonigle et al. [Five ethanol-conserved root systems were selected randomly for the assessment of mycorrhization frequency (MF) and intensity in Cj and Co. The roots were stained with Trypan blue in lactoglycerol . Under ae et al. , except We performed statistical analysis using R v. 4.2.2  softwareWe used a permutation-based multivariate analysis of variance (PERMANOVA) in the vegan R package to examine the effects of site, host species, and compartment on the AMF community. Similar and dissimilar communities were detected by analysis of similarity (ANOSIM) based on Bray-Curtis model in the vegan R package. The AMF community was ordinated and visualized using the ggplot2 R package v. 3.4.0. Next, we applied the multinomial species classification method (CLAM) in the vegan R package to identify the AMF OTUs and genera in each compartment of the rhizosphere (root or soil) and those significantly associated with a host (Cj or Co) . We alsoParaglomus occultum AJ276082 served as the outgroup in the phylogenetic tree for which we relied on the clade only when its SH-aLRT ≥ 80% and UFBoot ≥ 95%. The tree was annotated and displayed using Interactive Tree of Life  [The sequences of the top 10 most abundant OTUs (dominant) of each group of samples were aligned using MEGA11 and their maximum-likelihood phylogenetic positions were determined using an automatic model finder, tested with PhyML (SH-aLRT) and ultrafast (UFBoot) bootstraps over 1000 randomizations, all implemented in IQ-TREE 2 . ParagloL, v. 5) .The soil pH was significantly different between sites and host species but the interaction between the two factors was not significant Table . It wentrbcL for Cj and Co (ON156682–ON156726) in BankIt (2569115).After excluding unconfirmed samples, for the remaining 94 samples, Illumina MiSeq amplicon sequencing produced 1,114,607 amplicon sequences clustered into 108,048 OTUs. After quality filtering and sequence annotation, we obtained 555,657 Glomeromycota amplicon sequences of excellent quality that clustered into 1445 AMF OTUs. After being rarefied, the normalized AMF community data comprised 226,634  Glomeromycota amplicon sequences in 94 (100.00%) samples and clustered into 1443 AMF OTUs. We deposited the sequence read archives in the National Center for Biotechnology Information (PRJNA714473), the representative nucleotide sequences of the AMF OTUs generated (MZ479751–MZ481498) in GenBank (SUB9891895), and the partial nucleotide sequences of Site, host species, and compartment significantly affected the composition and structure of the AMF community at the OTU level Table S. In UTCBOTU richness of the root AMF community was less than that of the surrounding soil , two unknown clades, and some unknown Glomeraceae . Arbuscles, hypha, and vesicles were observed in Cj and Co , the soil explorers (more abundant in soil than in roots), and the explorers of both, thereby validating the hypothesis of strategic taxon-based colonization in the AMF community  and Chamaecyparis obtusa (Co), collected from three sites in Japan. Normalized community data was used to build these curves, 2411 Glomeromycotan amplicon sequences per sample. Despite the differences in the number of samples per group, it is noticeable that OTU richness of the arbuscular mycorrhizal fungi (AMF) community was higher in soil than rootsESM 2Online Resource 2 Venn diagrams of shared operational taxonomic units (OTUs) in roots and soil communities of arbuscular mycorrhizal fungi (AMF) associated with Cryptomeria japonica (Cj) and Chamaecyparis obtusa (Co), collected from three sites in Japan. Notice that the number of OTUs exclusively in roots of Cj (Cj Root) or Co (Co Root) has reduced considerably when data from all sites were consideredESM 3Online Resource 3 Phylogenetic tree for the placement of the dominant (top 10 most abundant) operational taxonomic units (OTUs) in the intra- and extraradical communities of arbuscular mycorrhizal fungi (AMF) associated with Cryptomeria japonica (Cj) and Chamaecyparis obtusa (Co) collected from three sites in Japan. Maximum likelihood tree was built using the representative sequences of the dominant OTUs (29 nucleotide sequences) and 53 reference nucleotide sequences downloaded from NCBI GenBank and MaarjAM databases. Best model and parameters were selected with automatic model finder in IQ-TREE 2. SH-aLRT test and ultrafast bootstrap (UFBoot) over 1000 randomizations were performed and UFboot ≥ 95% are shown at the nodes where SH-aLRT ≥ 80%. Accessions of the dominant OTUs (in bold) and scientific names of reference sequences followed by their accessions were used for labeling. All sequences contained an average of 550 bp of the small subunit ribosomal DNA between the primer pairs NS31 and AM1 (EPS 1595 kb)ESM 4Online Resource 4 Classification of AMF OTUs in two habitats using multinomial species classification method (CLAM) for the host (Cryptomeria japonica and Chamaecyparis obtusa) and the compartment (root and soil). Only root samples were used for the host-related classification while root and soil samples were used for the compartment-related classification. Generalist, similarly abundant in both habitats; x specialist, more abundant in the habitat x than the other; Too rare, the OTUs is too rare to be classified with confidenceESM 5Online Resource 5 Anatomical structures of arbuscular mycorrhizal fungi (AMF) in stained roots of Cryptomeria japonica  and Chamaecyparis obtusa . a and d show vesicles and hyphae, respectively while others show different morphologies of arbusculesESM 6Cryptomeria japonica; Co, Chamaecyparis obtusa. b) The UTCBF and UTCF are mixed plantations of Cj and Co. The UTTF site is an adjacent Cj plantation and Co plantation. Table S2 Understory plant community composition of the study sites. a) + refers to the presence at the corresponding site. Table S3 Analyses of variance on soil pH, soil electrical conductivity, and host diameter at breast height a) Variables are soil pH, soil electrical conductivity (EC), and diameter at breast height (DBH) of the host tree. Factors are Site and Host. Sites are Chiba (UTCBF), Chichibu (UTCF), and Tanashi (UTTF). Hosts are Cryptomeria japonica (Cj) and Chamaecyparis obtusa (Co). Table S4 Permanova on the arbuscular mycorrhizal fungi (AMF) community at the OTU level. a) Sites are Chiba (UTCBF), Chichibu (UTCF), and Tanashi (UTTF). Hosts are Cryptomeria japonica (Cj) and Chamaecyparis obtusa (Co). Compartments are root and surrounding soil. Table S5 Mantel test showing the biotic and abiotic effects on the root and soil AMF communities associated with Cryptomeria japonica (Cj) and Chamaecyparis obtusa (Co). Significant effects  are in bold. a) Sites are Chiba (UTCBF), Chichibu (UTCF), and Tanashi (UTTF). Factors are Host and Compartment. Hosts are Cryptomeria japonica (Cj) and Chamaecyparis obtusa (Co). Compartments are root and surrounding soil. Table S6 Analysis of root and soil AMF communities similarities between Cryptomeria japonica (Cj) and Chamaecyparis obtusa (Co). ANOSIM p-value < 0.05 (in bold) refers to significantly different communities. Table S7 Analyses of variance on the alpha diversity indices of arbuscular mycorrhizal fungi (AMF) community. a) Variables are number of operational taxonomic units (NOTUs) and Shannon index. Factors are Site, Host, and Compartment. Sites are Chiba (UTCBF), Chichibu (UTCF), and Tanashi (UTTF). Hosts are Cryptomeria japonica (Cj) and Chamaecyparis obtusa (Co). Compartments are root and surrounding soil. Table S8 Association of arbuscular mycorrhizal fungi (AMF) with host species  or compartments of the rhizosphere (Root and Soil) based on the multinomial species classification method (CLAM). Table S9 Mantel test showing the biotic and abiotic effects on the root and soil AMF communities associated with Cryptomeria japonica (Cj) and Chamaecyparis obtusa (Co). Significant effects  are in bold. Table S10 Permanova on the arbuscular mycorrhizal fungi (AMF) community at the genus level. Table S11 Analyses of variance on root colonization by type of arbuscular mycorrhizal fungi (AMF) morphotypes. Table S12 Pearson correlations showing the association of root and soil conditions with the root colonization of Cryptomeria japonica (Cj) and Chamaecyparis obtusa (Co). Correlation values are followed by the significance probability in parentheses. Significant correlations  are in boldTable S1 Summary of the study sites a) UTCBF, Chiba; UTCF, Chichibu; UTTF, Tanashi; MAP, mean annual precipitation; MAT, mean annual temperature; Cj,


This reParticipants of child‐bearing potential in HPTN 084, the trial that enrolled individuals assigned female at birth, were required to use long‐acting reversible contraceptives (LARCs) with a failure rate of <1%. This stringent requirement was in response to a safety signal associated with peri‐conception dolutegravir (DTG) use in women living with HIV . CAB injGood participatory practice (GPP) recommends that community stakeholders contribute to protocol development to ensure locally appropriate and acceptable trial procedures . FollowiN = 101) stakeholders from HPTN 084 countries (n = 82) and the United States (n = 19) attended the consultation, with most representing community (86%), global (7%) and other (7%) stakeholder groups as defined by GPP guidelines [n = 50) (range 43–52) stakeholders from sub‐Saharan Africa responded to polling questions , National Institutes of Health (NIH), Eunice Kennedy Shriver National Institute of Child Health & Human Development (NICHD), National Institute on Drug Abuse (NIDA), and the National Institute of Mental Health (NIMH), under award numbers UM1AI068619 (HPTN Leadership and Operations Center), UM1AI068617 , and UM1AI068613 (HPTN Laboratory Center). The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH. Additional funding was provided by the Bill & Melinda Gates Foundation (OPP1154174) and ViiV Healthcare. Pharmaceutical support was provided by ViiV Healthcare and Gilead Sciences.The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.


Objectives: Based on Sardjito Hospital surveillance data in 2020, the incidence of SSI in orthopedic implant surgery was 46 cases (4.7%), mostly in the outpatient clinic. We evaluated some of the potential risks and proposed redesign of infection prevention and control measures in April 2021 to improve the overall clean care at the orthopedic outpatient clinic. Methods: We conducted an operational study to redesign various components of clean care using a before-and-after evaluation of infection risk. The study was led by an IPC nurse and was supported by all levels of stakeholders at Sardjito Hospital, a referral and academic hospital in Yogyakarta, Indonesia, during May–September 2021. Results: The redesigned components covered continuing professional development (CPD) through a workshop on clean care and wound care for doctors and nurses. The workshop also encouraged high-level management to make several important changes: (1) to redistribute medical staff schedules, (2) to start online patient registration to better distribute and decrease patient loads, (3) to set up the waiting room as well as the dressing room with strictly separate between dirty and clean areas, (4) to schedule daily general disinfection at noon during service hours, and (5) to perform routine air disinfection after daily clinic services as well as placing an additional portable HEPA filter for continuous air disinfection. After the these changes, during 2021, 7 SSIs occurred among postoperative orthopedic implant patients, a decrease of 85%. We observed more clean and neat rooms without patient overcrowding as well as easy and comfortable flow of patients and staff. Environmental pathogen germ counts decreased significantly. Conclusions: A redesign project at the orthopedic outpatient clinic reduced the incidence of postoperative SSIs and reduced the number of environmental pathogens. Overall clean care is a basic strategy in IPC for improving patient safety.


In April, May, and June 2003, we conducted market research with decision makers from 3 payer segments to determine their perspectives on the potential introduction of statins to the U.S. over-the-counter (OTC) market.We selected a convenience sample of survey participants based upon prominence in the market, membership size, and by willingness to participate in our study. The 12 participating managed care organizations (MCOs) cover approximately 100 million lives. The 4 pharmacy benefit managers (PBMs) cover approximately 200 million lives. The 3 large employers (one employer withheld quantitative results) provide medical coverage to nearly 1.4 million employees, both actives and retirees. Each survey participant received a verbal description of an OTC statin and a proposed patient self-management system. We asked each participant a series of questions to obtain opinions on a number of issues related to the potential introduction of an OTC statin.Our research findings can be summarized in the following key(1) MCO representatives generally view OTC statins as a low-risk and beneficial addition to drug therapy options; (2) payer policies will continue to support access to prescription statins with no change in policy following introduction of an OTC option; (3) several of the MCOs and 75% of the PBMs anticipate a sharp, short-term increase in plan costs as a consequence of OTC statin availability; (4) survey participants believe that consumer or member reaction will be mixed and that consumer advertising and physician education will be important; (5) MCOs and PBMs are eager for involvement but cautious about partnerships with pharmaceutical companies; and (6) the details of any OTC statin offering will lay the foundation for its success.Based upon interviews conducted from April through June 2003, key decision makers from 4 PBMs, 12 MCOs, and 3 large employers generally considered the introduction of an OTC statin as a low risk and a beneficial addition to drug therapy. Most believed that increased awareness would result in an initial increase in plan costs, but long-term savings would accrue through improved care and availability of lower-cost OTC options for low-to-moderate-risk patients. The key concern is how to help patients gain enough knowledge and comfort to manage their own cholesterol therapy safely and successfully.


Invasive cervical cancer (ICC) is an HIV-associated cancer that is preventable and precancerous stages including early ICC stages could be detected through screening offering opportunities for treatment and cure. The high incidence in women living with HIV and late presentation often at advanced stages of ICC with limited treatment facilities often result in early mortality. We sought to compare the epidemiologic characteristics and survival differences in HIV status of ICC patients in Nigeria.We conducted a cohort study at two federal academic hospital-based research sites in Jos University Teaching Hospital, and Lagos University Teaching Hospital Nigeria, between March 2018 and September 2022. We enrolled women with histologically confirmed ICC with known HIV status, and FIGO staging as part of the United States of America’s National Institutes of Health/National Cancer Institute funded project titled ‘Epigenomic Biomarkers of HIV-Associated Cancers in Nigeria’. The primary outcome was all-cause mortality with assessment of overall survival (OS) and time to death after ICC diagnosis. OS distribution was estimated using the method of Kaplan-Meier and compared between groups using the log-rank test.A total of 239 women with confirmed ICC were enrolled and included in this analysis, of whom 192 (80.3%) were HIV-negative (HIV-/ICC+), and 47 (19.7%) were HIV-positive (HIV+/ICC+). The HIV+/ICC) patients were younger with median age 46 (IQR: 40–51) years compared to 57 (IQR: 45–66) among HIV-/ICC+) , with 12-month OS 84.1% (95%CI: 75% - 90%) and 67.6% (95%CI: 42%−84%) respectively.ICC is diagnosed at a relatively young age in women living with HIV, with a significantly lower overall survival probability compared to women without HIV. The trend of presentation and diagnosis at advanced stages in women living with HIV could partly explain the differences in overall survival. The World Health Organization (WHO) global estimates showed that 604,127 new cases of invasive cervical cancer (ICC) and 341,831 deaths occurred in 2020.Late presentation and diagnosis, lack of access to care, low resources, and ineffective treatment of ICC have contributed to the high mortality and poor survival for cases of ICC in Nigeria and most low- and middle-income countries (LMICs). –8 The dePrevious epidemiologic studies have focused on the survival outcomes of patients with cervical cancer based on stage at diagnosis, access to treatment by surgery or chemoradiation, but few have compared survival outcomes by HIV status., 11, 12 We conducted a cohort study at two academic hospital-based research sites in Jos  and Lagos , Nigeria. We enrolled women with histologically confirmed invasive cervical cancer, with and without HIV, as part of the United States of America’s National Institutes of Health/National Cancer Institute funded project titled ‘Epigenomic Biomarkers of HIV-Associated Cancers in Nigeria’ (U54CA221205) (see inclusion below).Eligible study participants were approached for enrollment at the two research sites between March 2018 and September 2022. Trained research staff screened and enrolled women aged 18 or older who were not pregnant, no history of hysterectomy, and were not undergoing cancer treatment at the time of recruitment. Participants were classified into two cohorts based on histopathological confirmation of ICC and HIV diagnosis: 1) HIV-positive women with ICC (study group: HIV+/ICC+), 2) HIV-negative women with ICC (control group): HIV-/ICC+). Participants’ clinical and demographic information were obtained by interviewer-administered questionnaires at the time of enrollment into the study. The intent and procedures of the study were disclosed to the study participants and informed consent was obtained. The study protocol was reviewed and approved by the Institutional Review Boards (IRB) at UniJos (JUTH/DCS/ADM/127/XXVII/630) and UniLag (CMUL/HREC/02/22/327/V4) in Nigeria, and Northwestern University (NU) in the USA (STU00207051).The HIV status of study participants receiving care and treatment at the Presidential Emergency Plan for AIDS Relief (PEPFAR) program of the two participating institutions was extracted from the adult HIV treatment and care database. Women with unknown HIV status had rapid HIV diagnostic testing according to the national HIV testing serial algorithm, which involved the use of the Rapid Determine Test, Unigold, and STAT Pack rapid HIV diagnostic test kits. All HIV-infected women receiving care in the PEPFAR program at both study sites were on antiretroviral therapy (ART) at the time of study enrollment. Those whose HIV infection was diagnosed at enrollment were provided appropriate HIV counseling and linked to care and commencement of ART in the PEPFAR program of the participating institutions in accordance with the Nigerian National ART Guidelines.Suspected ICC cases were evaluated by the gynecologic oncology team at the Jos University Teaching Hospital (UniJos) and Lagos University Teaching Hospital (UniLag). Diagnostic evaluation of ICC included examination under anesthesia (EUA), and clinical staging according to the international federation of gynecology and obstetrics (FIGO 2009).  During tAs previously reported, the pauThe primary clinical outcome analyzed in this study was all-cause mortality with assessment of overall survival and time to death after invasive cervical cancer diagnosis. Overall survival (OS) is defined as time from ICC diagnosis to death with censoring at the date of last available follow up as obtained from clinic visits or telephone contact up to September 30th, 2022. The use of telephone for cancer follow up has been documented in a prior study in Jos Nigeria and in other studies in Africa., 20Study data were collected and managed using REDCap electronic data capture tools, 22 withDescriptive statistics were used to summarize baseline subject characteristics for ICC+/HIV+ and ICC+/HIV- groups, and overall. Continuous variables were summarized using median and interquartile range (IQR) and compared between groups using the Wilcoxon rank sum test. For categorical variables, frequencies and percentages were reported, and proportions were compared using Fisher’s exact test. Frequencies of missing observations were tabulated, and missing observations were not included in these descriptive analyses.Primary objective was to determine the association between HIV status and overall survival (OS) among ICC+ patients. OS distribution was estimated using the method of Kaplan-Meier, and survival estimates are reported with the corresponding 95% confidence bands, 25th, median, and 75th percentiles survival times are presented. Overall survival was compared between groups using the log-rank test. Overall survival was estimated for HIV+ and HIV- groups, and by study site.Statistical analyses were performed using R v. 4.2.2 statistical software, and usiBetween March 18th, 2018, and September 30th, 2022, a total of 239 women with confirmed invasive cervical cancer were enrolled and are included in this analysis, of whom 192 (80.3%) were HIV-negative (HIV-/ICC+), and 47 (19.7%) were HIV-positive (HIV+/ICC+).The median age at study enrollment was 53 years (IQR: 44–65) among the ICC+ participants overall. HIV-positive patients were younger with median age 46 (IQR: 40–51) years compared to 57 (IQR: 45–66) among HIV-negative ; had a higher level of education with only 10.6% having no formal education as compared to 32.6% in the HIV- groups (p<.001); and a higher number of lifetime sexual partners with median of 3 (IQR: 1–4) partners among HIV+ patients vs. 1 (IQR: 1–2) in the HIV- group (p<0.001). Women without HIV had a higher number of childbirths  but comparable age at first childbirth (median 20 years old in both groups) and BMI (median 25 in both groups) to women with HIV. The most common histopathologic variant of ICC was squamous cell carcinoma in 80.4% of all cases and was similar among HIV+ and HIV- women . The majority of patients (68.1%) had moderately differentiated tumor grade , and the histopathologic variants and tumor grading were comparable in both groups. HIV+ women tended to be diagnosed with advanced stage more frequently (64.9%) than HIV- women (47.9%) although the difference was not statistically significant (p=0.10). Other descriptive statistics of the participants with ICC by HIV status have been summarized in Following diagnosis and enrollment of participants with ICC, types of treatments received were not significantly different for women with HIV and without HIV as shown in We also compared the survival outcomes by HIV status  and founThis manuscript discusses the descriptive epidemiologic characteristics and survival outcomes of women with and without HIV diagnosed with invasive cervical cancer enrolled in two large tertiary academic medical centers in Nigeria. We found that women with HIV were 11 years younger at diagnosis of ICC compared to women without HIV. Although there were no significant differences in baseline BMI, FIGO staging at diagnosis, histopathologic variants, tumor grading and types of treatment received, we found that overall survival was significantly better in ICC participants without HIV compared to those living with HIV. Our findings were similar with a larger Zambian cohort of ICC patients that showed women with HIV were 10 years younger at diagnosis with a poorer prognosis compared to those without HIV.The relatively low survival rates in our primary analyses likely reflect the fact that treatment options for cervical cancer are greatly limited in most LMIC settings including Nigeria, with a paucity of trained gynecologic oncology specialists and limited cancer centers with chemoradiation facilities. A recent review has corroborated the poor treatment facilities, particularly the lack of radiotherapy centers to compensate the poor surgical services for gynecological cancers in sub-Saharan African settings.These chaThe paucity of trained gynecologic oncologists and limited compliance to treatment guidelines is widespread in LMICs. This has been reported in a related study in Botswana in southern Africa that showed comparable findings of women with HIV being diagnosed with ICC at a much younger age compared to women without HIV, and the hazards of early mortality were significantly higher in women with HIV. The effeThe above findings have implications given the evidence of high incidence of cervical cancer in women living with HIV. It is imOur data showed comparable histologic types of ICC and tumor grading irrespective of HIV status. As in most literature, the most common histologic variant found in both HIV positive, and HIV negative cervical cancer tumors is squamous cell carcinoma variants. A previous study report of a retrospective cervical cancer cohort found that women living with HIV were significantly more likely to be diagnosed at advanced stages of cancer compared to HIV negative women. Our dataA previous histopathologic study of ICC showed that the commonest variant in both HIV positive and negative patients is the squamous cell type, and as in our study cohort is diagnosed at younger age in HIV-infected patients compared to HIV-negative patients. The studOur study findings are unique and are based on the strength of the enrollment protocol jointly developed by investigators from both participating sites in two distinct geographic zones in Nigeria in collaboration with Northwestern University. The histologic diagnoses and tumor grading were further subjected to peer review and quality improvement through a telepathology scanning and video conferencing platform involving the two participating sites and Northwestern pathology core. To the bCervical cancer remains a significant public health concern, diagnosed at a relatively young age in women living with HIV, with a significantly lower overall survival probability compared to women without HIV. The trend of presentation and diagnosis of this cancer at advanced stages in women living with HIV could partly explain the differences in overall survival. Strategies that strengthen access to primary prevention, early detection through screening, and early provision of effective treatment should be prioritized for all women- particularly those infected with HIV.Supplement 1


Frontotemporal dementia (FTD) encompasses a group of clinically, genetically and pathologically heterogeneous neurodegenerative disorders that mainly affect people under the age of 64 years. However, around 25% of those affected have a later age of onset. FTD represents 10–20% of all dementia cases [The clinical hallmarks of FTD include gradual yet progressive deficits in behaviour and/or language with the relative preservation of memory. Subtypes of FTD are identified clinically according to the symptoms that appear prominently at presentation. Clinical diagnoses include behavioral variant FTD (bVFTD), which accounts for nearly 60% of cases; primary progressive aphasia (PPA), which affects language; and the movement disorders progressive supranuclear palsy (PSP) and corticobasal syndrome (CBS) . With diC9orf72, progranulin (GRN) and MAPT, with C9orf72 repeat expansions being the most common. Neuropathologically, TAR DNA binding protein-43 (TDP-43), fused in sarcoma (FUS) and tau are three major proteins that cause pathological deposits in FTD post-mortem brains [C9orf72 expansions also have an additional pathology where di-peptide repeat proteins are also found deposited in patients. It is thought that disease pathogenesis is caused either by a gain of toxic function or a loss of nuclear function associated with protein dislocation from the nucleus, which in turn may lead to neuronal degeneration. FUS regulates the transcription of multiple genes, including the MAPT gene [A third of FTD cases are genetically linked with mutations occurring in