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Steinernema carpocapsae is an entomopathogenic nematode with established efficacy against various agricultural pests. However, its impact on key lepidopteran pests, including Ostrinia furnacalis, Mythimna separata, and Spodoptera litura, remains underexplored, particularly at the pupal stage. This study evaluates the efficacy of the nematode through a combination of choice-based attraction assays, non-choice infection performance bioassays involving direct application to specific pupal body parts, and assessments of sublethal effects on adult survival and oviposition following pupal-stage exposure. S. carpocapsae exhibited a clear preference for pupae of all three pests over blank controls and for previously infected pupae over healthy pupae. When presented with different pupal genders, S. carpocapsae preferred female M. separata over males but showed no gender preference for O. furnacalis and S. litura. Infection performance varied by body part, with a higher infection performance on the abdomen and thorax compared to the head for O. furnacalis and S. litura, and on the abdomen over the thorax and head for M. separata. Adult survival probability was significantly lower when pupae were infected, and female oviposition was reduced when either member of a mating pair had been infected. These findings highlight the efficacy of S. carpocapsae as a promising biological control agent against these lepidopteran pests, particularly when targeting the pupal stage.
Lagostonema ecasiense is a bursate nematode parasite of Lagostomus maximus in Argentina. New morphological data, geographical distribution, ecological data, molecular characterization and exploratory phylogenetic analysis are provided. The general morphology and measurements agree with the original description with minimal discrepancies. The geographical distribution of Lagostonema is expanded with 3 new provinces and 9 new departments in Argentina. The molecular characterization constitutes the first molecular contribution for the genus Lagostonema. The analysis of genetic distances and phylogenetic exploration allow considering L. ecasiense as a nominal species, confirming its nomenclatural taxonomic identity. Likewise, although morphological studies allow the identification of specimens from all populations as L. ecasiense, molecular studies show a major genetic distance in the population from Santiago del Estero Province concerning the rest of the populations. Consequently, the haplotypes are mentioned as Lagostonema sp. with the possibility that these specimens belong to a new species. This study is valuable because it contributes to the ratification of a nominal species described decades ago, adding new morphological aspects and providing an understanding of their value as a marker of host populations.
To describe the mitigation strategies for a Candida auris outbreak in a cardiothoracic transplant intensive care unit (CTICU) and its implications for infection prevention practices.
Design:
Retrospective cohort study from July 2023 to February 2024.
Setting:
A large academic medical center.
Methods:
A multidisciplinary team convened to conduct the outbreak investigation and develop mitigation strategies in the CTICU.
Results:
From July 2023 to February 2024, 34 possible hospital-onset cases of C. auris were identified in our CTICU. Whole-genome sequencing and phylogenetic analysis based on pairwise single nucleotide polymorphism (WG-SNP) distance revealed two distinct outbreak clusters. Of the 34 patients, 11 (32.3%) were solid organ transplant recipients and 12 (35.3%) had a mechanical circulatory support device. Of the cohort, only 11/34 (32.3%) had prior exposure to high-risk healthcare facilities within six months prior to admission, as follows: acute inpatient rehabilitation facilities (AIRs) (n = 5, 14.7%), skilled nursing facilities (SNFs) (n = 3, 8.8%), and long-term acute care hospitals (LTACHs) (n = 3, 8.8%). The cohort had a median of 22.0 antibiotic-days prior to their positive results. Five (14.7%) patients had C. auris candidemia, three of whom expired likely due to infection. Infection Prevention (IP) interventions addressed several modes of transmission, including healthcare personnel hands, shared patient equipment, and the environment.
Conclusion:
Our experience suggests that the epidemiology of C. auris may be changing, pointing towards a rising prevalence in acute care settings. IP interventions targeting hand hygiene behavior and promoting centralizing cleaning and disinfection of shared patient equipment may have contributed to outbreak resolution.
Ostrinia furnacalis Guenée (Lepidoptera: Crambidae) is a key lepidopteran pest affecting maize production across Asia. While its general biology has been well studied, the phenomenon of pupal ring formation remains poorly understood. This study examined the factors influencing pupal ring formation under controlled laboratory conditions. Results showed that pupal rings were formed exclusively when larvae were reared on an artificial diet, with no ring formation observed on corn-stalks. Females exhibited a significantly higher tendency to participate in ring formation than males. Additionally, male participation increased proportionally with the number of rings formed, a pattern not observed in females. The size of the rearing arena significantly influenced ring formation, with smaller arenas (6 cm diameter) promoting more frequent pairing, particularly among females. Temperature also played a significant role: lower participation rates were recorded at 22 °C compared to 25 °C and 28 °C, although the number of rings formed did not differ significantly across temperatures. Developmental stage and sex composition further influenced pairing behaviour; pupal rings formed only among individuals of similar maturity, and male participation was significantly reduced in all-male groups compared to mixed-sex groups. These findings suggest that pupal ring formation in O. furnacalis is modulated by dietary substrate, larval sex, environmental conditions, and developmental synchrony, offering new insights into the behavioural ecology of this pest.
Edited by
David Mabey, London School of Hygiene and Tropical Medicine,Martin W. Weber, World Health Organization,Moffat Nyirenda, London School of Hygiene and Tropical Medicine,Dorothy Yeboah-Manu, Noguchi Memorial Institute for Medical Research, University of Ghana,Jackson Orem, Uganda Cancer Institute, Kampala,Laura Benjamin, University College London,Michael Marks, London School of Hygiene and Tropical Medicine,Nicholas A. Feasey, Liverpool School of Tropical Medicine
In 1982, physicians in South-west Uganda noticed a new disease with prominent symptoms of weight loss and diarrhoea, known locally as slim disease, and in 1983 patients with opportunistic infections and Kaposi’s sarcoma (KS) were identified in hospitals in Rwanda and Zaire. These observations were made shortly after reports of clusters of unusual diseases associated with profound immunosuppression among men who had sex with men in the USA. These reports were the first to draw public attention to acquired immunodeficiency syndrome (AIDS), undoubtedly one of the greatest challenges to global public health of our times.
The function of aortic heart valves is to prevent regurgitant flow from the aorta into the left ventricle. A higher regurgitant flow is observed in bileaflet mechanical heart valves (BMHVs) compared with bioprosthetic heart valves (BHVs) because of their delayed closure. Here, we investigate this behaviour through fluid–structure interaction simulations of a BMHV compared with a trileaflet mechanical heart valve (TMHV) and a BHV under similar conditions. We find that the TMHV and BHV begin to close during the systolic deceleration, whereas BMHV only begins to close when the flow reverses. We found this to be related to hemodynamics as the TMHV and BHV, when fully opened, generate a central jet-dominant flow, whereas the BMHV generates triple jets with lateral jets being wider than its central jet. The flow deceleration of the central jet during late systole is higher than that of the sinuses, which results in a lower pressure in the central region than the sinuses to drive the leaflets of the TMHV and BHV towards the centre for closure. Conversely, the pressure on the sinus- and central flow-sides of the BMHV leaflets is nearly the same until the end of systole. We, contrary to what classically believed, did not find any evidence of sinus vortices generating high pressure or viscous stresses to initiate valve closure. Overall, the results suggest that the generation of a strong central jet and the direction of the leaflets’ closure towards the centre are the design principles to ensure an early valve closure and minimise regurgitation.
Suicidal and self-harming behaviours present a significant challenge for mental health services. Recent national guidelines advocate abandoning tools based on box-ticking and a move towards a personalised psychosocial assessment. This article examines evidence from theoretical and empirical research in this area and attempts to integrate it by introducing the source–problem–solution–motive (SPSM) model. The model, which builds on the contributions of other suicidologists, specially Jean Baechler, could be used as a framework for the assessment and management of these behaviours. The four stages of the model provide a comprehensive approach that enables an exploration of the internal logic of the behaviour. The model covers ‘because’ and ‘in-order-to’ motives. This allows a personalised approach, but also a structured one that can be taught and generalised.
[We present three articles on Iran in the crosshairs, examining the conflict over Iran in light of moves by the US, UN, Japan, EU and Israel. The central issue concerns the US effort to bring Iran before the UN Security Council for its refusal to terminate the development of its civilian nuclear power program. It is a course that many see as the essential step toward US-directed regime change.
Asian corn borer, Ostrinia furnacalis Guenée (Lepidoptera: Crambidae), is a major pest in corn production, and its management remains a significant challenge. Current control methods, which rely heavily on synthetic chemical pesticides, are environmentally detrimental and unsustainable, necessitating the development of eco-friendly alternatives. This study investigates the potential of the entomopathogenic nematode Steinernema carpocapsae as a biological control agent for O. furnacalis pupae, focusing on its infection efficacy and the factors influencing its performance. We conducted a series of laboratory experiments to evaluate the effects of distance, pupal developmental stage, soil depth, and light conditions on nematode attraction, pupal mortality and sublethal impacts on pupal longevity and oviposition. Results demonstrated that S. carpocapsae exhibited the highest attraction to pupae at a 3 cm distance, with infection declining significantly at greater distances. Younger pupae (<12 h old), were more attractive to nematodes than older pupae, and female pupae were preferred over males. Nematode infection was highest on the head and thorax of pupae, with a significant reduction in infection observed after 24 h. Infection caused 100% mortality in pupae within 2 cm soil depth, though efficacy was reduced under light conditions. Sublethal effects included a significant reduction in the longevity of infected adults and a decrease in the number of eggs laid by infected females compared to controls. These findings underscore the potential of S. carpocapsae as an effective biocontrol agent for sustainable pest management in corn production, offering a viable alternative to chemical pesticides.
The oriental armyworm, Mythimna separata (Walker), is a highly migratory pest known for its sudden larval outbreaks, which result in severe crop losses. These unpredictable surges pose significant challenges for timely and accurate monitoring, as conventional methods are labour-intensive and prone to errors. To address these limitations, this study investigates the use of machine learning for automated and precise identification of M. separata larval instars. A total of 1577 larval images representing different instar were analysed for geometric, colour, and texture features. Additionally, larval weight was predicted using 13 regression models. Instar identification was conducted using Support Vector Classifier (SVC), Random Forest, and Multi-Layer Perceptron. Key feature contributing to classification accuracy were subsequently identified through permutation feature importance analysis. The results demonstrated the potential of machine learning for automating instar identification with high efficiency and accuracy. Predicted larval weight emerged as a key feature, significantly enhancing the performance of all identification models. Among the tested approaches, BaggingRegressor exhibited the best performance for larval weight prediction (R2 = 98.20%, RMSE = 0.2313), while SVC achieved the highest instar identification accuracy (94%). Overall, the integration of larval weight with other image-derived features proved to be a highly effective strategy. This study demonstrates the efficacy of machine learning in enhancing pest monitoring systems by providing a scalable and reliable framework for precise pest management. The proposed methodology significantly improves larval instar identification accuracy and efficiency, offering actionable insights for implementing targeted biological and chemical control strategies.
Endovascular thrombectomy (EVT) is the gold standard treatment for acute ischemic stroke (AIS) patients with large vessel occlusion (LVO). Multiple factors can influence EVT outcomes, including procedural and patient-related variables. This meta-analysis investigated the impact of periprocedural hemoglobin (Hb) levels on EVT outcomes.
Methods:
We performed a comprehensive literature search across PubMed, Scopus, Web of Science and Cochrane CENTRAL. We analyzed the mean difference (MD) in Hb levels between good (modified Rankin Scale [mRS] 0–2) and poor (mRS 3–6) prognosis groups. We calculated pooled odds ratios (OR) for Hb levels as a predictor of prognosis and compared mortality and symptomatic intracranial hemorrhage (sICH) across different Hb levels.
Results:
The analysis included 921 patients from four studies. Patients in the good prognosis group had significantly higher Hb levels (MD: 0.48 g/dL, 95% CI: [0.2, 0.75], P = 0.0007). Each 1 g/dL increase in Hb was associated with a 22% increase in the odds of achieving a good three-month prognosis (OR: 1.22, 95% CI: [1.13, 1.33], P < 0.00001). Patients with Hb levels ≤13 g/dL in males and ≤12 g/dL in females were 1.69 times more likely to experience mortality (OR: 1.69, 95% CI: [1.1, 2.59], P = 0.02). No significant difference was observed in sICH occurrence between anemic and non-anemic patients.
Conclusion:
Higher Hb levels may be associated with improved prognosis, and lower Hb levels might increase mortality risk in AIS-LVO patients undergoing EVT. Further research is needed to validate these findings.
To assess the impact of treatment guidelines on the trends of outpatient antibiotic prescription among pediatric and adult patients at a cancer center in Pakistan.
Design:
Retrospective observational study conducted between July 1st 2018 and July 31st 2023.
Methods:
We determined the indication for antibiotics and the frequency of guideline-discordant prescriptions for upper respiratory tract infection (URTI), lower respiratory tract infection (LRTI), urinary tract infection (UTI), and diarrhea. The χ2 test was used to assess the impact of treatment guidelines on antibiotics prescribed for these indications.
Results:
The top indications for antibiotic prescription were skin and skin structure infection (SSSI) (n = 5159; 21.5%), URTI (n = 2760; 11.5%) and UTI (n = 2686; 11.2%). Amoxicillin-clavulanate (n = 7964; 33.3%), was the most frequently prescribed antibiotic. A large proportion of antibiotic prescriptions for URTI, diarrhea, UTI, and LRTI were either inappropriate (n = 6695; 86.5%) or unnecessary (n = 5534; 71.5%). Results revealed a statistically significant decline in the proportion of inappropriate antibiotics for UTI (91.3% vs 84.0%; P ≤ .001) and diarrhea (92.6% vs 87.0%; P = .031) and unnecessary antibiotics for diarrhea (90.2% vs 83.2%; P = .016) with the introduction of treatment guidelines. We noted a higher proportion of unnecessary prescriptions for LRTI (41.7% vs 31.7%; P = .003) and inappropriate antibiotics for UTI (95.1% vs 87.4%; P = .011) for pediatric patients.
Conclusion:
Misuse of outpatient antibiotics is common. Diarrhea, URTI, UTI, and LRTI are high-priority conditions for outpatient oncology-focused prescriber education and stewardship interventions.
Antimicrobial resistance is increased by antibiotic overuse, so it’s crucial for stewardship programs to monitor and control their use. Pneumonia, particularly prevalent among older adults in Japan, is requiring higher rates of medical treatment. This study aimed to develop an improved method for benchmarking broad-spectrum antibiotic use in the empiric treatment of pneumonia in older adult inpatients by applying the “smoothed” observed-to-expected (O/E) ratio which adjusts for hospital-level variations and minimizes the effect of extreme values.
Methods:
Using nationwide data from the Diagnosis Procedure Combination research group, pneumonia patients between April 1st 2018 and March 31st 2020 were analyzed. The primary outcome was the smoothed O/E ratio of the broad-spectrum antibiotic use for hospitals. It was calculated from the predicted values of broad-spectrum antibiotic use that were obtained through multilevel logistic regression using patient characteristics as predictors from data clustered by hospitals. The analysis investigated the risk-adjusted use of broad-spectrum antibiotics among hospitals.
Results:
A total of 244,747 patients from 958 hospitals were included, with a mean age of 81 (±8.30) years. The proportion of broad-spectrum antibiotic use was 35.3% (n = 86,316). The prediction model showed a C-statistic of 0.722. There was a noticeable variation in the O/E ratio among hospitals with values ranging from 0.13 (95% CI: 0.09–0.20) to 2.81 (95% CI: 2.64–2.97).
Conclusions:
Using a risk-adjusted smoothed O/E ratio, we assessed the use of broad-spectrum antibiotics across hospitals, identifying those with high O/E ratios that may indicate a need for improvement.
The Asian corn borer, Ostrinia furnacalis (Guenée), emerges as a significant threat to maize cultivation, inflicting substantial damage upon the crops. Particularly, its larval stage represents a critical point characterised by significant economic consequences on maize yield. To manage the infestation of this pest effectively, timely and precise identification of its larval stages is required. Currently, the absence of techniques capable of addressing this urgent need poses a formidable challenge to agricultural practitioners. To mitigate this issue, the current study aims to establish models conducive to the identification of larval stages. Furthermore, this study aims to devise predictive models for estimating larval weights, thereby enhancing the precision and efficacy of pest management strategies. For this, 9 classification and 11 regression models were established using four feature datasets based on the following features geometry, colour, and texture. Effectiveness of the models was determined by comparing metrics such as accuracy, precision, recall, F1-score, coefficient of determination, root mean squared error, mean absolute error, and mean absolute percentage error. Furthermore, Shapley Additive exPlanations analysis was employed to analyse the importance of features. Our results revealed that for instar identification, the DecisionTreeClassifier model exhibited the best performance with an accuracy of 84%. For larval weight, the SupportVectorRegressor model performed best with R2 of 0.9742. Overall, these findings present a novel and accurate approach to identify instar and predict the weight of O. furnacalis larvae, offering valuable insights for the implementation of management strategies against this key pest.
The Asian corn borer (ACB), Ostrinia furnacalis (Guenée, 1854), is a serious pest of several crops, particularly a destructive pest of maize and other cereals throughout most of Asia, including China, the Philippines, Indonesia, Malaysia, Thailand, Sri Lanka, India, Bangladesh, Japan, Korea, Vietnam, Laos, Myanmar, Afghanistan, Pakistan and Cambodia. It has long been known as a pest in South-east Asia and has invaded other parts of Asia, Solomon Islands, parts of Africa and certain regions of Australia and Russia. Consequently, worldwide efforts have been increased to ensure new control strategies for O. furnacalis management. In this article, we provide a comprehensive review of the ACB covering its (i) distribution (geographic range and seasonal variations), (ii) morphology and ecology (taxonomy, life-history, host plants and economic importance) and (iii) management strategies (which include agroecological approaches, mating disruption, integrated genetic approaches, chemical as well as biological control). Furthermore, we conclude this review with recommendations to provide some suggestions for improving eco-friendly pest management strategies to enhance the sustainable management of ACB in infested areas.
Culture is the unique customs, values, norms, and language of a society or community. It is constantly evolving to accommodate for changes in the social, political, economic, and environmental atmosphere. It also plays a critical role in how individuals interpret and respond to illness. Transcultural psychiatry has been developed to address the role of understanding and incorporating the role of culture in psychiatry. As the United States becomes more diverse, the application of transcultural psychiatry in clinical practice becomes even more important. There are several tools that clinicians can use to implement transcultural practices, including the Cultural Formulation Interview, CRASH model, HUMBLE model, and LEARN model. However, it is understood that barriers in implementation exist, such as language barriers, training, stereotypes, implicit discrimination, and time. To bridge these obstacles, clinicians should educate themselves about the different models of transcultural care and dedicate attention to adopting these in their personal practices and in their individual clinical teams.
A program for integral, transversal, and multidisciplinary management of aortic stenosis (MITMEVA) is being implemented at the Clinic Barcelona University Hospital (CBUH) to provide adequate treatment for patients with aortic stenosis (AS). Eleven actions at different care points were implemented (e.g., awareness raising for the general population, a single entry path for patient referral, prehabilitation and rehabilitation, and a risk-sharing agreement). Preliminary results are presented.
Methods
A before-and-after implementation study was conducted with 131 patients under MITMEVA and 131 matched (for treatment, New York Heart Association classification, sex, age, and referral place) historical controls. Data were collected on resources used and quality of life and to calculate several key performance indicators (KPIs) (e.g., knowledge improvement in citizens, time from diagnosis to treatment, and patient involvement and satisfaction) for each implemented action. A descriptive analysis of KPIs and a Markov model were performed to simulate clinical and economic outcomes for patient health states over time after the first year until the tenth year after intervention.
Results
The MITMEVA program increased quality-adjusted life-years by 1.78 (p=0.011) and reduced time from referral to first hospital visit by 24.7 percent (p=0.05), hospital complications by 19.7 percent (p=0.05), mean conventional ward stay from 12.8 to 8 days (p=0.01), and mean intensive care unit stay from 9.75 to 4.25 days, although the latter difference was not statistically significant (p=0.139). The mean cost per patient was reduced from EUR7,573.27 per patient to EUR6,024.61 per patient (p=0.01). The MITMEVA program was a dominant strategy. There was a 46 percent increase in correct AS symptom identification after delivering training on AS to the general population.
Conclusions
Integrated care approaches can potentially improve patient continuum of care if the strategies are deployed in a multidisciplinary and transversal way across healthcare actors. The MITMEVA program significantly improved clinical and economic outcomes and organization of care, benefiting patients and clinicians. Applying health technology assessment methods to such innovative projects can help prove the value of organizational innovations.
Economic evaluation using decision analytical models (DAMs) plays a limited role in shaping healthcare resource optimization and reimbursement decisions in the Middle East. This review aimed to systematically examine economic evaluation studies focusing on DAMs of medicines in the Middle East, defining methodological characteristics and appraising the quality of the identified models.
Methods
Six databases were searched (MEDLINE, Embase, EconLit, Web of Science, the Global Health Cost-Effectiveness Analysis Registry, and the Global Index Medicus) from 1998 to September 2023 to identify published DAMs of medicines in the Middle East. Studies meeting the inclusion criteria—full economic evaluations of medicines using a model-based method in the Middle East—were included. Data were extracted and tabulated to include study characteristics and methodological specifications. The results were analyzed narratively. The Philips checklist was used to assess the quality of the studies.
Results
Sixty-two DAM studies of medicines were identified from nine Middle Eastern countries, the majority of which (76%) were conducted in Iran, Turkey, and Saudi Arabia. The cost effectiveness of medications for non-communicable diseases was explored in 70 percent of the models. Cost-effectiveness thresholds based on gross domestic product were commonly used. International sources provided data on intervention effectiveness and health outcomes, while national sources were mainly used for the costs of resource use. Most models incorporated an assessment of parameter uncertainty, whereas other types of uncertainty were not explored. Studies from high-income countries were generally of higher quality than those from middle-income countries.
Conclusions
The number of published DAMs was low considering the available medicines and disease burden. Key aspects of high quality DAMs regarding model structure, input sources, and uncertainty assessment were not consistently fulfilled. Recommendations for future studies and policies included strengthening existing health economic capacities, establishing country-specific health technology assessment systems, and initiating collaborations to generate national cost and outcome data.
A program for integral, transversal, and multidisciplinary management of aortic stenosis (MITMEVA) was implemented at the Clinic Barcelona University Hospital to provide adequate and personalized treatment for patients with aortic stenosis (AS). MITMEVA includes 11 actions in the AS care pathway. This study aimed to test the scalability of MITMEVA by gathering the perspectives of relevant stakeholders in two other Catalan hospitals.
Methods
A mixed method study design was used to collect and analyze the views of relevant stakeholders on the scalability of the MITMEVA project. Qualitative and quantitative methods were used to answer the research question. All participants were interviewed individually using a semi-structured interview guide. The interviews were transcribed and analyzed by performing a content analysis with Atlas.ti software. Quantitative data were gathered and analyzed by adjusting the Intervention Scalability Assessment Tool (ISAT).
Results
Nine participants were interviewed from two tertiary hospitals in Catalonia and eight ISAT questionnaires were completed. From the content analysis, 11 of the 15 themes identified related to actions implemented in the MITMEVA program. The results pointed toward a positive view of implementation of the MITMEVA program in general, showing a good scalability for all the ISAT domains. On a scale of zero to three, most domains were scored two or above.
Conclusions
The qualitative and quantitative results indicated that the MITMEVA program has potential for scaling up to other Catalan hospitals to improve the management of AS. Generally, stakeholders from the two participating hospitals were positive about the project. However, small adjustments will be needed to account for the culture and organizational characteristics of the hospitals when scaling up the MITMEVA program.