UNASSIGNED: Leishmaniases are neglected diseases transmitted by sand flies. They disproportionately affect vulnerable groups globally. Understanding the relationship between climate and disease transmission allows the development of relevant decision-support tools for public health policy and surveillance. The aim of this modelling study was to develop an indicator that tracks climatic suitability for Leishmania infantum transmission in Europe at the subnational level.
UNASSIGNED: Historical records of sand fly vectors, human leishmaniasis, bioclimatic indicators, and environmental variables were integrated in a machine learning framework (XGBoost) to predict suitability in two past periods (2001-2010 and 2011-2020). We further assessed if predictions were associated with human and animal disease data from selected countries (France, Greece, Italy, Portugal, and Spain).
UNASSIGNED: An increase in the number of climatically suitable regions for leishmaniasis was detected, especially in southern and eastern countries, coupled with a northward expansion towards central Europe. The final model had excellent predictive ability (AUC = 0.970 [0.947-0.993]), and the suitability predictions were positively associated with human leishmaniasis incidence and canine seroprevalence for Leishmania.
UNASSIGNED: This study demonstrates how key epidemiological data can be combined with open-source climatic and environmental information to develop an indicator that effectively tracks spatiotemporal changes in climatic suitability and disease risk. The positive association between the model predictions and human disease incidence demonstrates that this indicator could help target leishmaniasis surveillance to transmission hotspots.
UNASSIGNED: European Union Horizon Europe Research and Innovation Programme (European Climate-Health Cluster), United Kingdom Research and Innovation.

The study covered a small, shallow lake, intensively used for recreation (sailing, tourist services and port infrastructure). This study aimed to determine the spatial differentiation of bottom sediments and the potential for phosphorus release in five zones, differing mainly in the type of recreation, depth, direct catchment management, shoreline management and macrophyte presence. The results were used to propose protective and restoration measures to improve the water quality of the studied lake. The innovation in the study was the detailed analysis of bottom sediments, which can be a significant source of pollution besides the external load from the catchment and tourist pressure, in the planned management of this ecosystem. Examination of the physicochemical properties of the bottom sediments showed a clear variation in both composition and potential for internal phosphorus loading. The sediments from the profundal zone, where the most boating activity was observed, together with the sediments from the shallow zone where the boats dock (mooring zone), had the highest potential to supply phosphorus to the bottom waters. This fact was demonstrated by the highest total phosphorus (TP) concentrations in sediments (up to 1.32 mgPg-1 DW) and the content of the most mobile fractions (up to 33%). The other zones associated with the marina, fuel zone, tributary and canal were not significant sources of phosphorus to the ecosystem. Based on the above results, a restoration method involving the removal of bottom sediments from the bottom zone was proposed, supported, of course, by protective measures in the catchment (maintaining a buffer zone around the lake and limiting the inflow of pollutants with tributary waters). The proposed measures with sustainable tourist pressure should improve water quality and thus contribute to protecting this valuable natural landscape.

BACKGROUND: Timely recognition of futile recanalization might enable a prompt response and an improved outcome in post-thrombectomy patients. This study aims to evaluate whether postoperative blood glucose increase (BGI) could act as an indicator of futile recanalization in patients receiving a successful thrombectomy.
METHODS: This is a single-center, retrospective analysis of patients with anterior circulation large-vessel occlusion and successful thrombectomy between February 2019 and June 2022. BGI was defined as a higher level of blood glucose at the first postoperative morning than at admission. Futile recanalization was defined as patients with a modified Rankin Scale score of 3-6 at 90 days after onset. Multivariable binary logistic regression was used to assess the association of BGI with futile recanalization.
RESULTS: A total of 276 patients were enrolled, amongst which 120 patients (43.5%) had BGI. Futile recanalization was more prevalent among patients with BGI compared to those without (70.0 vs. 49.4%, P = 0.001). After adjusting for potential confounders, BGI was associated with a higher likelihood of futile recanalization (adjusted OR: 2.97, 95%CI: 1.50-5.86, P = 0.002). This association was consistently observed regardless of diabetes history, occlusion site, time from symptom onset to groin puncture, or reperfusion status.
CONCLUSIONS: Our findings support BGI serving as an indicator of futile recanalization in patients with anterior circulation large-vessel occlusion and successful thrombectomy.

The displacement of the abomasum to the right (RDA) is a common condition regularly encountered in dairy cows, which requires urgent surgical correction. The survival of the patient primarily depends on early diagnosis and timely treatment, but other factors contributing to the outcome have been discussed in the literature. The objective of this study was to identify preoperative clinical, hematological, as well as intraoperative parameters that are associated with the prognosis of cows with RDA or abomasal volvulus (AV). This retrospective study included patients admitted to a veterinary teaching hospital over a period of 6 years with a diagnosis of RDA or AV. A total of 234 cows were included, of which 193 were discharged after treatment and thus classified as survivors. In contrast, 41 cases died or were euthanized during or after surgery and were categorized as non-survivors. Non-survivors showed more severe dehydration, higher heart rate, lower sodium, as well as higher L-lactate and phosphorus concentration in their blood prior to surgery compared with the survivors. During surgery, the abomasum of non-survivors was markedly dilated and twisted more frequently than in survivors. The results presented here can facilitate the early identification of animals with poor prognosis requiring more intensive peri- and postoperative care.

Pressure from expanding populations has resulted in a need for protection, reclamation, and restoration of damaged land to productive, beneficial health uses. The objective of this investigation was to 1) compare land cover on the Department of Energy (DOE) Oak Ridge Reservation (ORR) with the surrounding region, 2) select an indicator to evaluate ORR\'s protection of ecological resources, and 3) develop and implement a method to compare the amount of the indicator on ORR with the regions using National Land Cover Database (NLCD). Data demonstrated that ORR has a higher % of forests (deciduous, coniferous, mixed) than the 10 km and 30 km areas surrounding ORR, suggesting that obligations are being met to protect the ecology and environment. The findings also indicate that the interior forest at ORR is fragmented more than is the interior forest in the 30 km buffer zone, suggesting a need for DOE and managers of other lands to take into consideration the importance of intact interior forest when developing land or planning roads. The study describes the basis for specific ecological parameters such as interior forest that are important to consider when planning and executing remediation, restoration, and other management actions.

Phytoplankton is the essential primary producer in fresh surface water ecosystems. However, excessive phytoplankton growth due to eutrophication significantly threatens ecologic, economic, and public health. Therefore, phytoplankton identification and quantification are essential to understanding the productivity and health of freshwater ecosystems as well as the impacts of phytoplankton overgrowth (such as Cyanobacterial blooms) on public health. Microscopy is the gold standard for phytoplankton assessment but is time-consuming, has low throughput, and requires rich experience in phytoplankton morphology. Quantitative polymerase chain reaction (qPCR) is accurate and straightforward with high throughput. In addition, qPCR does not require expertise in phytoplankton morphology. Therefore, qPCR can be a useful alternative for molecular identification and enumeration of phytoplankton. Nonetheless, a comprehensive study is missing which evaluates and compares the feasibility of using qPCR and microscopy to assess phytoplankton in fresh water. This study 1) compared the performance of qPCR and microscopy in identifying and quantifying phytoplankton and 2) evaluated qPCR as a molecular tool to assess phytoplankton and indicate eutrophication. We assessed phytoplankton using both qPCR and microscopy in twelve large freshwater rivers across the United States from early summer to late fall in 2017, 2018, and 2019. qPCR- and microscope-based phytoplankton abundance had a significant positive linear correlation (adjusted R2 = 0.836, p-value < 0.001). Phytoplankton abundance had limited temporal variation within each sampling season and over the three years studied. The sampling sites in the midcontinent rivers had higher phytoplankton abundance than those in the eastern and western rivers. For instance, the concentration (geometric mean) of Bacillariophyta, Cyanobacteria, Chlorophyta, and Dinoflagellates at the sampling sites in the midcontinent rivers was approximately three times that at the sampling sites in the western rivers and approximately 18 times that at the sampling sites in the eastern rivers. Welch\'s analysis of variance indicates that phytoplankton abundance at the sampling sites in the midcontinent rivers was significantly higher than that at the sampling sites in the eastern rivers (p-value = 0.013) but was comparable to that at the sampling sites in the western rivers (p-value = 0.095). The higher phytoplankton abundance at the sampling sites in the midcontinent rivers was presumably because these rivers were more eutrophic. Indeed, low phytoplankton abundance occurred in oligotrophic or low trophic sites, whereas eutrophic sites had greater phytoplankton abundance. This study demonstrates that qPCR-based phytoplankton abundance can be a useful numerical indicator of the trophic conditions and water quality in freshwater rivers.

OBJECTIVE: To investigated whether endoscopic tympanoplasty and tympanomastoidectomy could present satisfying audiological outcomes for cholesteatoma patients.
METHODS: This was a retrospective study of 83 patients with cholesteatoma who underwent endoscopic tympanoplasty and tympanomastoidectomy between 2019 and 2021. The preoperative and postoperative audiological evaluations were performed. The evaluation methods included air conduction (AC), bone conduction (BC), and air-bone gap (ABG) procedures.
RESULTS: Eighty-three patients were included in the study, all of whom underwent endoscopic tympanoplasty and tympanomastoidectomy. Forty-seven patients presented postoperative ABG≤20 dB (59.49%). The frequencies tested included low-frequency (LF), middle-frequency (MF), high-frequency (HF), and pure-tone average (PTA). All three audiological parameters significantly decreased after surgery (P < 0.05) at every frequency, except for BC-LF (P > 0.05). There were also significant differences between the preoperative and postoperative proportions of degree of hearing (P < 0.05). Additionally, shifts in AC, BC, and ABG were linearly related to preoperative AC, BC, and ABG. Lastly, postoperative ABG-PTA presented differently depending on preoperative stapes superstructure conditions (present: 15.81 ± 11.23 dB, absent: 22.94 ± 12.20 dB, P = 0.009).
CONCLUSIONS: Our study of endoscopic tympanoplasty and tympanomastoidectomy presented complete audiological outcomes for cholesteatoma patients. It had a positive surgery success rate and improved AC, BC, and ABG at every frequency except BC-LF. Additionally, AC-LF and AC-MF improved to a greater degree than AC-HF due to these procedures. Moreover, the linear regression analyses demonstrated that preoperative ABG-PTA was the most efficient audiological indicator for surgery. Likewise, the preoperative condition of the stapes superstructure was proved to be the most efficient anatomical indicator for hearing outcomes.

Pancreatic resections are an important field of surgery worldwide to treat a variety of benign and malignant diseases. Postoperative pancreatic fistula (POPF) remains a frequent and critical complication after partial pancreatectomy and affects up to 50% of patients. POPF increases mortality, prolongs the postoperative hospital stay and is associated with a significant economic burden. Despite various scientific approaches and clinical strategies, it has not yet been possible to develop an effective preventive tool. The SmartPAN indicator is the first surgery-ready medical device for direct visualisation of pancreatic leakage already during the operation. Applied to the surface of pancreatic tissue, it detects sites of biochemical leak via colour reaction, thereby guiding effective closure and potentially mitigating POPF development.
The ViP trial is a prospective single-arm, single-centre first in human study to collect data on usability and confirm safety of SmartPAN. A total of 35 patients with planned partial pancreatectomy will be included in the trial with a follow-up of 30 days after the index surgery. Usability endpoints such as adherence to protocol and evaluation by the operating surgeon as well as safety parameters including major intraoperative and postoperative complications, especially POPF development, will be analysed.
Following the IDEAL-D (Idea, Development, Exploration, Assessment, and Long term study of Device development and surgical innovation) framework of medical device development preclinical in vitro, porcine in vivo, and human ex vivo studies have proven feasibility, efficacy and safety of SmartPAN. After market approval, the ViP trial is the IDEAL Stage I trial to investigate SmartPAN in a clinical setting. The study has been approved by the local ethics committee as the device is used exclusively within its intended purpose. Results will be published in a peer-reviewed journal. The study will provide a basis for a future randomised controlled interventional trial to confirm clinical efficacy of SmartPAN.
German Clinical Trial Register DRKS00027559, registered on 4 March 2022.

UNASSIGNED: The World Health Organization Office for the Eastern Mediterranean Region (WHO/EMRO), and the recently created palliative care experts network for the Eastern Mediterranean Region (EMR), decided to develop region-specific indicators for monitoring national palliative care development in the Region.
UNASSIGNED: To identify relevant and feasible macro-indicators for palliative care development for the EMR.
UNASSIGNED: Palliative care experts from the EMR were nominated and invited to complete a 2-round Delphi study to rate macro-indicators from previous studies and propose new ones based on the EMR regional characteristics. All indicators were assessed according to regional relevance (R) and feasibility (F). A content validity index (CVI) was calculated. Indicators with CVI ≥ 0.7/1, and scoring ≥ 7/9 for the R and F averages were selected.
UNASSIGNED: Twelve of the 22 countries in the Region were represented in the study. In the first round, 11 indicators were selected and 13 new ones proposed. In the second round, 15 indicators matched R, F and CVI criteria. Top-scored indicators were: existence of a current national palliative care strategy (R = 8, F = 8, CVI = 1); ratio of specialized services (for adults and children) in the country per population (R = 8, F = 7, CVI = 1); allocation of funds for palliative care in the national health budget by the Ministry of Health or equivalent government agency (R = 8, F = 6, CVI = 1); education for prequalification of doctors/nurses (R = 8, F = 8, CVI = 0.9); and availability of morphine and other strong opioids (R =8, F = 8, CVI= 0.9).
UNASSIGNED: A baseline set of 15 region-specific indicators for measuring the development of palliative care were validated by experts in the EMR.
مؤشرات كلية خاصة بإقليم شرق المتوسط لتطوير الرعاية الملطّفة في: دراسة بأسلوب دلفي.
ميجيل سانشيز كارديناس، إدواردو جارالدا، داني فان ستيجن، نسيم بورغازيان، سليم سلامة، ماري شارلوت بوسو، كارلوس سينتينو وشبكة خبراء الرعاية الملطِّفة لاقليم شرق المتوسط.
UNASSIGNED: إن مكتب منظمة الصحة العالمية لإقليم شرق المتوسط وشبكة خبراء الرعاية الملطِّفة لإقليم شرق المتوسط، التي أُنشئت مؤخرًا، قد قررا وضع مؤشرات خاصة بالإقليم لرصد تطوير الرعاية الملطِّفة في الإقليم.
UNASSIGNED: هدفت هذه الدراسة الى تحديد المؤشرات الكلية المهمة والمجدية لتطوير الرعاية الملطِّفة في إقليم شرق المتوسط.
UNASSIGNED: جرى ترشيح خبراء في الرعاية الملطِّفة من إقليم شرق المتوسط، ودعوتهم إلى استكمال دراسة بأسلوب دلفي مكونة من جولتين، لتقييم المؤشرات الكلية من الدراسات السابقة، واقتراح مؤشرات جديدة، استنادًا إلى الخصائص الإقليمية لإقليم شرق المتوسط. وجري تقييم جميع المؤشرات حسب الأهمية الإقليمية (R) والجدوى (F). كذلك جرى حساب مؤشر صحة المحتوى (CVI). ووقع الاختيار على مؤشرات ذات صحة محتوى (CVI) تبلغ ≥ 1/0.7، وتحقق ≥ 9/7 كمتوسط على مستوى الأهمية الإقليمية (R) والجدوى (F).
UNASSIGNED: شارك في هذه الدراسة اثنا عشر بلدًا من بلدان الإقليم البالغ عددها 22 بلدًا. وشهدت الجولة الأولى اختيار 11 مؤشرًا واقتراح 13 مؤشرًا جديدًا. أما في الجولة الثانية، فقد جرى الوقوف على 15 مؤشرًا مطابقًا لمعايير الأهمية الإقليمية (R) والجدوى (F) وصحة المحتوى (CVI). والمؤشرات التي حصلت على أعلى الدرجات هي ما يلي: وجود استراتيجية وطنية حالية للرعاية الملطِّفة (الأهمية الإقليمية (R) = 8، الجدوى (F) = 8، صحة المحتوى (CVI) = 1)؛ ونسبة الخدمات المتخصصة (للبالغين والأطفال) في البلد لكل مجموعة سكانية (الأهمية الإقليمية (R) = 8، الجدوى (7) = 8، صحة المحتوى (CVI) = 1)؛ وتخصيص أموال للرعاية الملطِّفة في ميزانية الصحة الوطنية التي تضعها وزارة الصحة أو وكالة حكومية مكافئة (الأهمية الإقليمية (R) = 8، الجدوى (F) = 6، صحة المحتوى (CVI) = 1)؛ تثقيف الأطباء/ الممرضات بشأن الاختبار المسبق للصلاحية (الأهمية الإقليمية (R) = 8، الجدوى (F) = 8، صحة المحتوى (CVI) = 0.9)؛ وتوفر المورفين والمواد الأفيونية القوية الأخرى (الأهمية الإقليمية (R) = 8، الجدوى (F) = 8، صحة المحتوى (CVI) = 0.9).
UNASSIGNED: تحقق الخبراء في إقليم شرق المتوسط من مجموعة أساسية تتألف من 15 مؤشرًا خاصًّا بالإقليم لتقدير تطوير الرعاية الملطِّفة.
Macro-indicateurs spécifiques à la Région pour la mise en place de soins palliatifs dans la Région de la Méditerranée orientale : étude Delphi.
UNASSIGNED: Le Bureau régional de l\'Organisation mondiale de la Santé (OMS) pour la Méditerranée orientale et le réseau d\'experts des soins palliatifs récemment créé dans la Région ont décidé de mettre au point des indicateurs spécifiques à la Région pour suivre les progrès qui y sont réalisés en matière de soins palliatifs au niveau des pays.
UNASSIGNED: Identifier des macro-indicateurs pertinents et réalisables pour la mise en place des soins palliatifs dans la Région de la Méditerranée orientale.
UNASSIGNED: Des experts en soins palliatifs de la Région de la Méditerranée orientale ont été désignés et invités à participer à une étude Delphi à deux tours pour évaluer les macro-indicateurs des études précédentes et en proposer de nouveaux en fonction des caractéristiques régionales pour la Méditerranée orientale. Tous les indicateurs ont été évalués en fonction de leur pertinence (P) et de leur faisabilité (F) au niveau régional. Un indice de validité du contenu (IVC) a été calculé. Les indicateurs ayant un indice de validité de contenu supérieur ou égal à 0,7/1, et un score supérieur ou égal à 7/9 pour les moyennes P et F ont été sélectionnés.
UNASSIGNED: Douze des 22 pays de la Région étaient représentés dans l\'étude. Lors du premier tour, 11 indicateurs ont été sélectionnés et 13 nouveaux indicateurs ont été proposés. Lors du second tour, 15 indicateurs correspondaient aux critères P, F et IVC. Les indicateurs les mieux notés étaient les suivants : existence d\'une stratégie nationale au moment de l\'étude pour les soins palliatifs (P = 8, F = 8, IVC = 1) ; ratio de services spécialisés (pour adultes et enfants) dans le pays par population (P = 8, F = 7, IVC = 1) ; allocation de fonds pour les soins palliatifs dans le budget national de la santé par le ministère de la Santé ou une institution gouvernementale équivalente (P = 8, F = 6, IVC = 1) ; formation pour la préqualification des médecins/infirmiers (P = 8, F = 8, IVC = 0,9) ; et disponibilité de morphine et d\'autres opioïdes puissants (P = 8, F = 8, IVC = 0,9).
UNASSIGNED: Un ensemble de référence de 15 indicateurs spécifiques à la Région pour mesurer la progression des soins palliatifs a été validé par des experts de la Région de la Méditerranée orientale.

Our aim was to develop a machine learning model, using real-world data captured from a connected auto-injector device and from early indicators from the first 3 months of treatment, to predict sub-optimal adherence to recombinant human growth hormone (r-hGH) in patients with growth disorders.
Adherence to r-hGH treatment was assessed in children (aged < 18 years) who started using a connected auto-injector device (easypod™), and transmitted injection data for ≥ 12 months. Adherence in the following 3, 6, or 9 months after treatment start was categorized as optimal (≥ 85%) versus sub-optimal (< 85%). Logistic regression and tree-based models were applied.
Data from 10,929 children showed that a random forest model with mean and standard deviation of adherence over the first 3 months, infrequent transmission of data, not changing certain comfort settings, and starting treatment at an older age was important in predicting the risk of sub-optimal adherence in the following 3, 6, or 9 months. Sensitivities ranged between 0.72 and 0.77, and specificities between 0.80 and 0.81.
To the authors\' knowledge, this is the first attempt to integrate a machine learning model into a digital health ecosystem to help healthcare providers to identify patients at risk of sub-optimal adherence to r-hGH in the following 3, 6, or 9 months. This information, together with patient-specific indicators of sub-optimal adherence, can be used to provide support to at-risk patients and their caregivers to achieve optimal adherence and, subsequently, improve clinical outcomes.