Human papillomavirus, sexually transmitted infections, and antimicrobial resistance in West Africa: Estimating population burden and understanding exposures to accelerate vaccine impact and drive new interventions: The PHASE survey protocol

by Adedapo Olufemi Bashorun, Larry Kotei, Abdoulie F. Jallow, Ousubie Jawla, Emmanuel U. Richard-Ugwuadu, Muhammed Jagana, Lamin Bah, Amadou Tijan Bah, Karamo Conteh, Mamadou S.K. Jallow, Mehrab Karim, Bai Lamin Dondeh, Anne Segonds-Pichon, Gary M. Clifford, Iacopo Baussano, Bruno Pichon, David Jeffries, Ed Clarke

Human papillomavirus (HPV) infection is a primary cause of preventable deaths from cervical cancer, a condition of profound inequality with approximately 90% of deaths occurring in low- and middle-income countries, particularly in sub-Saharan Africa. In May 2018, the WHO Director-General declared a Joint Global Commitment to Cervical Cancer Elimination, highlighting the critical role of HPV vaccines in achieving this goal. However, there is a lack of systemically collected data on HPV prevalence in The Gambia, and impact data from high-income countries may not be reliably extrapolated to West African settings due to geographical variation in HPV types and distinct behavioural, biological, and sociodemographic exposures. The Gambia introduced a two-dose HPV vaccination schedule in 2019, but coverage has been very low, interrupted mainly by the COVID-19 pandemic. This presents a key opportunity to generate vital baseline data on HPV prevalence in the population before potential scale-up of vaccination efforts. The PHASE survey, a multi-stage cluster survey, aims to establish the baseline, population prevalence estimates of high-risk and low-risk, vaccine-type and non-vaccine-type HPV infection in 15- to 49-year-old females in The Gambia by measuring urinary HPV-DNA. The survey will also quantify the effects of various exposures on HPV prevalence, including sexual behaviour, the presence of other sexually-transmitted infections (STIs) - Neisseria gonorrhoea (NG), Chlamydia trachomatis (CT), Trichomonas vaginalis (TV), Mycoplasma genitalium (MG), syphilis, as well as blood borne viruses, human immunodeficiency virus (HIV), hepatitis B and hepatitis C; obstetric history, socio-demographic characteristics, and cervical cancer screening and/or treatment. Additionally, the study will provide important antimicrobial resistance (AMR) data for NG and MG in sub-Saharan Africa, a region poorly represented in global surveillance programs. This data is needed to guide regional treatment guidelines and advocate for new solutions, including gonococcal vaccines. The AMR data are expected to immediately influence recommendations regarding the appropriate choice of antibiotics for syndromic STI management in West Africa and hence to address an important driver of AMR in the sub-region. Leveraging on the Medical Research Council Unit The Gambia funded Health Demographic Surveillance system (HDSS) as its sampling frame, the survey will utilize validated diagnostic assays and culturally sensitive data collection methods, to ensure both scientific rigor and local relevance. Tools such as Audio Computer-Assisted Self-Interviewing (ACASI) technology, developed in consultation with local community advisory boards, are included to reduce social desirability bias in reporting sexual behaviour. This approach aims to maximize both the reliability and cultural appropriateness of the findings. This study directly addresses the critical need for baseline epidemiological data on HPV in a West African setting to accelerate vaccine impact and drive new interventions towards cervical cancer elimination. By understanding other factors that influence HPV (like other STIs, sexual behaviour, etc.), the study aims to ensure that, when the vaccine’s impact is measured later, changes in other confounding factors that may impact on HPV prevalence can be accounted for. The study will also establish the population prevalence of the measured STIs and their relationship to common symptoms and other adverse health outcomes related to STIs.

Illegal drugs sensor: Performance evaluation and identification based on terahertz photonic crystal fiber

by Kayab Khandakar, Jabin Tasnin Upoma, Taib Hasan, A. H. M. Iftekharul Ferdous, Diponkar Kundu, Md. Omar Faruk, Md. Feroz Ali, Md. Shahorin Islam Shaun

Excessive hormone release, the possibility of sleep disturbances, and a brief and quick improvement in the functioning of many organs, the physiological system, the nerves, etc. are all consequences of the abuse of incentive medications. Illegal narcotics have terrible long-term impacts on human health, including the possibility of death, in addition to their immediate effects. These consequences highlight the need for more obviousness and accuracy in the detection of illicit drugs, as well as for their detection to be done gently, effectively, and consistently. This work introduces an illicit drug sensor based on PCF, with an eye toward these as the primary targets. Three illegal drugs – ketamine, amphetamine, and cocaine – have been simulated for the sensor. Two types of circular air holes in cladding of varying sizes have been developed for a single core PCF. The cladding has three-layer chain and wind turbine-shaped air holes, and a circular air hole in the core region that will be used to field test drug samples, all included to achieve low confinement losses and high sensitivity. A maximum Relative Sensitivity (RS) of 99.92%, 99.12% and 98.83% at ketamine, amphetamine, and cocaine respectively is revealed by the recently established PCF analysis, which was presented out right away. Furthermore, we looked at the Confinement Loss (CL) associated with these illicit drugs, which was around 1.275 × 10⁻⁷ dB/m, 2.653 × 10⁻⁹ dB/m, and 4.106 × 10⁻¹⁰ dB/m, besides Effective Material Loss (EML) of 0.0042 cm^-1, 0.0044 cm^-1 and 0.0045 cm^-1. Refractive index changes in PCF are usually the cause of action for PCF-based biosensors. These modifications have an impact on how light travels within the fiber. Drug molecules interact with light as a result of changes in the optical properties of the core that occur during light propagation through it.

Stories that bridge us: A mixed methods study to understand the impact of a hospital-wide storytelling event

by Maria F. Nardell, Malini M. Gandhi, Barbara Sarnoff Lee, Amy Wasserman

Oral storytelling events for healthcare professionals are gaining in popularity, yet evaluation of these initiatives is scarce. We designed and assessed the impact of a hospital-wide storytelling event at an academic medical center in New England. This study was grounded in social constructivism, which posits that knowledge and collaborative meaning-making are socially constructed through interpersonal interactions and shared language. Stories were solicited from interdisciplinary staff on a theme, and six selected storytellers were paired with coaches. The hybrid in-person/virtual event was held in 2021. Attendees were invited to complete a post-event survey, as well as a semi-structured interview or written response. Storytellers were invited to reflect via a post-event focus group or written responses. Qualitative data were coded using a mixed inductive and deductive content analytic approach. Survey data were analyzed using descriptive statistics. The storytellers included representation from internal and emergency medicine, nursing, infrastructure project management, and research administration. The 155 attendees included 25 in-person/130 virtual. Qualitative data (nine participants) revealed that sharing stories fostered interpersonal connection and a sense of common humanity, enhanced by the storytellers’ vulnerability and diversity. Storytellers valued coaches’ emotional and creative support in co-creating stories with them. Lastly, the event was felt to strengthen the hospital community. These themes were echoed in the survey data (30 participants): > 75% of respondents indicated that the event helped them reflect on their values, connect with others, and access a sense of purpose. A multidisciplinary hospital-wide oral storytelling event is one way to enhance self-reflection, interpersonal connection, and a sense of community among healthcare professionals.

Knowledge and attitudes of medical students towards the health impact of climate change: A study from Jordan

by Mohammed O. Khabour, Owais Omar Tarabsheh, Bilal M. Al-zu’bi, Omar F. Khabour, Rami Saadeh

Studies have reported a strong relationship between climate change and human health. Medical students’ knowledge and attitudes toward the impact of climate change on health are crucial to fostering their environmental stewardship. Therefore, the aim of this study was to examine the awareness and attitudes of medical students in Jordan toward climate change and human health. The study was cross-sectional in design, anonymous, self-reported, and used a closed-ended questionnaire. The study included 837 students from various medical specialties, including medicine, dentistry, applied medical sciences, pharmacy, and nursing. Statistical analysis involved cross-tabulations and regression analysis. About 46.3% of students reported good awareness of the health impacts of climate change, while 44.8% reported somewhat awareness. This awareness was found to be associated with female gender (P = 0.003) and university level (P 

Therapeutic application of nano-encapsulated pomegranate peel extract attenuated DSS-induced colitis: Antioxidant and anti-inflammatory role and reduction of exaggerated response of endoplasmic reticulum stress

by Abdallah Tageldein Mansour, Safaa I. Khater, Hemmat M. Eissa, Helal F. Al-Harthi, Areej A. Eskandrani, Mohammed Ageeli Hakami, Wafa S. Alansari, Amirah Albaqami, Hanan M. Alharbi, Tarek Khamis, Doaa Ibrahim

The medicinal application of pomegranate peel extract enriched with polyphenols (PPE) as a therapeutic strategy for managing inflammatory bowel diseases (IBD) is still limited. Integrating pomegranate peel extract (PPE) into an effective nanocarrier system could enhance its mechanistic actions, potentially aiding in the remission of colitis. Therefore, this approach aimed to enhance PPE’s stability and bioavailability and investigate mitigating impact of pomegranate peel extract-loaded nanoparticles (PPE-NPs) in a colitis model. Colonic injury was induced by 5% dextran sulfate sodium (DSS) and efficacy of disease progression after oral administration of PPE-NPs for 14 days was assessed by evaluating clinical signs severity, antioxidant and inflammatory markers, expressions of endoplasmic reticulum associated genes and histopathological and immunostaining analysis in colonic tissues. Clinical signs and disease activity index were effectively reduced, and the levels of fecal calprotectin were decreased in groups treated with PPE-NPs compared to DSS group. The colitic group showed a significant increase (P IL-17, TNF-α, and IL-1β (increased up to 2.99, 4.36 and 4.90 respectively unlike PPE-NPsIII that recorded reduced levels of CRP, MPO and NO (8,96, 78.30 and 123 nmol/g tissue respectively) and much lower (P CHOP, JUNK, ATF6, BIP, and Elf-2) and immunostaining expression regulation of key markers regulating autophagy (Beclin-2) in this group. The histopathological changes in the colon were less severe in the PPE-NPs received groups (especially at the level of 150 mg/kg) compared to DSS group. Collectively, these findings suggest that the nanoencapsulation of PPE enhances its effectiveness in promoting recovery of colonic tissue damage and achieving remission of colitis.

The assessment of physiotherapy practice is a robust measure of entry-level physiotherapy standards: Reliability and validity evidence from a large, representative sample

by Alan Reubenson, Leo Ng, Vidya Lawton, Irmina Nahon, Rebecca Terry, Claire Baldwin, Julia Blackford, Alex Bond, Rosemary Corrigan, Megan Dalton, Amabile Borges Dario, Michael Donovan, Ruth Dunwoodie, Genevieve M. Dwyer, Roma Forbes, Alison Francis-Cracknell, Janelle Gill, Andrea Hams, Anne Jones, Taryn Jones, Belinda Judd, Ewan Kennedy, Prue Morgan, Tanya Palmer, Casey Peiris, Carolyn Taylor, Debra Virtue, Cherie Zischke, Daniel F. Gucciardi, on behalf of the Physiotherapy Clinical Education Research Collaborative (PCERC)

The Assessment of Physiotherapy Practice (APP) is a 20-item assessment instrument used to assess entry-level physiotherapy practice in Australia, New Zealand and other international locations. Initial APP reliability and validity evidence supported a unidimensional or single latent factor as the best representation of entry-level physiotherapy practice performance. However, there remains inconsistency in how the APP is interpreted and operationalised across Australian and New Zealand universities offering entry-level physiotherapy programs. In essence, the presumption that the psychometric integrity of the APP generalises across people, time, and contexts remains largely untested. This multi-site, archival replication study utilised APP assessment data from 8,979 clinical placement assessments, across 19 Australian and New Zealand universities, graduating entry-level physiotherapy students (n=1865) in 2019. Structural representation of APP scores were examined via confirmatory factor analysis and penalised structural equation models. Factor analyses indicated a 2-factor representation, with four items (1–4) for the professional dimension and 16 items (5–20) for the clinical dimension, is the best approximation of entry-level physiotherapy performance. Measurement invariance analyses supported the robustness of this 2-factor representation over time and across diverse practice areas in both penultimate and final years of study. The findings provide strong evidence for the psychometric integrity of the APP, and the 2-factor alternative interpretation and operationalisation is recommended. To meet entry-level standards students should be assessed as competent across both professional and clinical dimensions of physiotherapy practice.

Benzothiazinone analogs as Anti-<i>Mycobacterium tuberculosis</i> DprE1 irreversible inhibitors: Covalent docking, validation, and molecular dynamics simulations

by Mahmoud A. A. Ibrahim, Doaa G. M. Mahmoud, Alaa H. M. Abdelrahman, Khlood A. A. Abdeljawaad, Gamal A. H. Mekhemer, Tamer Shoeib, Mohamed A. El-Tayeb, Peter A. Sidhom, Paul W. Paré, Mohamed-Elamir F. Hegazy

Mycobacterium tuberculosis is a lethal human pathogen, with the key flavoenzyme for catalyzing bacterial cell-wall biosynthesis, decaprenylphosphoryl-D-ribose oxidase (DprE1), considered an Achilles heal for tuberculosis (TB) progression. Inhibition of DprE1 blocks cell wall biosynthesis and is a highly promising antitubercular target. Macozinone (PBTZ169, a benzothiazinone (BTZ) derivative) is an irreversible DprE1 inhibitor that has attracted considerable attention because it exhibits an additive activity when combined with other anti-TB drugs. Herein, 754 BTZ analogs were assembled in a virtual library and evaluated against the DprE1 target using a covalent docking approach. After validation of the employed covalent docking approach, BTZ analogs were screened. Analogs with a docking score less than –9.0 kcal/mol were advanced for molecular dynamics (MD) simulations, followed by binding energy evaluations utilizing the MM-GBSA approach. Three BTZ analogs–namely, PubChem-155-924-621, PubChem-127-032-794, and PubChem-155-923-972– exhibited higher binding affinities against DprE1 compared to PBTZ169 with ΔG_binding values of –77.2, –74.3, and –65.4 kcal/mol, versus –49.8 kcal/mol, respectively. Structural and energetical analyses were performed for the identified analogs against DprE1 throughout the 100 ns MD simulations, and the results demonstrated the great stability of the identified BTZ analogs. Physicochemical and ADMET characteristics indicated the oral bioavailability of the identified BTZ analogs. The obtained in-silico results provide promising anti-TB inhibitors that are worth being subjected to in-vitro and in-vivo investigations.

Multi-session adaptation to audiovisual and sensorimotor biofeedback is heterogeneous among adolescents with cerebral palsy

by Alyssa M. Spomer, Benjamin C. Conner, Michael H. Schwartz, Zachary F. Lerner, Katherine M. Steele

Background

There is growing interest in the use of biofeedback-augmented gait training in cerebral palsy (CP). Audiovisual, sensorimotor, and immersive biofeedback paradigms are commonly used to elicit short-term gait improvements; however, outcomes remain variable. Because biofeedback training requires that individuals have the capacity to both adapt their gait in response to feedback and retain improvements across sessions, changes in either capacity may affect outcomes. Yet, neither has been explored extensively in CP.

Methods

In this study, we evaluated the extent to which adolescents with CP (7M/1F; 14 years (12.5,15.26)) could adapt gait and retain improvements across four, 20-minute sessions using combined audiovisual and sensorimotor biofeedback. Both systems were designed to target plantarflexor activity. Audiovisual biofeedback displayed real-time soleus activity and sensorimotor biofeedback was provided using a bilateral resistive ankle exoskeleton. We quantified the time-course of change in muscle activity within and across sessions and overground walking function before and after the four sessions.

Results

All individuals were able to significantly increase soleus activity from baseline using multimodal biofeedback (p 0.11).

Conclusions

This work suggests that individuals with CP have the capacity to adapt their gait using biofeedback, but responses are highly variable. Characterizing the factors driving adaptation to biofeedback may be a promising avenue to understand the heterogeneity of existing biofeedback training outcomes and inform future system optimization for integration into clinical care.