The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), that causes coronavirus disease 2019 (COVID-19) is a public health problem and may have co-infection with other pathogens such as influenza virus.This study aims to assess the co-infection of SARS-CoV-2 with influenza among COVID-19 cases.The all relevant studies were collected from international databases. For improving the quality of the present literature, the all studies were evaluated by two reviewers in order to confirm all of the studies have inclusion criteria. Finally, all articles with sufficient quality scores were included in meta-analysis. Assessment of heterogeneity among the studies of primary studies was performed using the statistic chi‐squared test (Cochran’s Q) and I2 index. In this results, random or fixed effect model were used for determination of heterogeneity test. All statistical analyses were performed using Comprehensive Meta-Analysis (CMA), V.2 software.This meta- analysis included 9 primary studies investigating the co-infection of SARS-CoV-2 with influenza among COVID-19 cases. Pooled prevalence (95% confidence interval) of co-infection is shown that the prevalence of influenza A is higher than influenza B. 2.3(0.5-9.3) vs 0.1 (0.4-3.3). Using the fixed effect model the frequency of fever was (80.6% [95% CI 76.1–84.40, p < 0.153]) and it is shown that fever is the most prevalent symptom in patients.Patients admitted to hospital with COVID-19 also infected with influenza virus. Thus, the current research provides a better understanding about the control and treatment of co-infection with SARS-CoV-2 and the influenza virus.

Introduction of antibiotics into agricultural fields via using reclaimed waste water or manure application causes toxic effects on environment and pose serious health risks to humans. This study investigated the uptake of antibiotics, their effect on metabolic pathways, and chloroplast structure of Allium tuberosum exposed to different antibiotics stresses. Disturbances in chloroplast structure and increase in number of mitochondria and plastoglobulli have been suggested defensive mechanism against antibiotic stress by extending variations in chlorophyll fluorescence variables resulted in alterations to metabolic activities. An untargeted metabolomic analysis was conducted to explore the comprehensive profiling of metabolites in response to the applied antibiotic stresses because metabolomic approach directly assesses the physiological status of plant. Simultaneously, metabolomic profiling demonstrated that NFL stress regulated more of its metabolic pathways than OTC and TC. Some of the metabolic pathways varied among the antibiotic treatments. Metabolic variations as a result of antibiotics stress highlighted pools of metabolites that affect the metabolic activities, chlorophyll fluorescence, and ultrastructural adjustments that stimulate defensive impact in A .tubersoum. These novel findings are useful in providing an insight of metabolic destabilization as well as metabolic changes in defensive mechanism and better understanding of stress response of A. tuberosum to different antibiotics.

Therapeutic strategies utilizing multi-functional and bispecific antibodies (BsAb) that engage multiple pathways are a promising way to improve and prolong efficacy of biologics in complex disease indications. In the early stages of discovery, BsAbs often exhibit a broad range of pharmacokinetic (PK) behavior. Optimization of the neonatal Fc receptor (FcRn) interactions and removal of undesirable physiochemical properties have been used to improve the ‘pharmacokinetic developability’ for various monoclonal antibody (mAb) therapeutics, yet there is a sparsity of such information for BsAbs. The present work evaluated the influence of FcRn interactions and inherent physiochemical properties on the pharmacokinetics of two related single chain variable fragment (scFv) based BsAbs. Despite their close relation, the two BsAbs exhibited disparate PK in cynomolgus monkeys with BsAb-1 having aberrant clearance of ~2 mL/hr/kg and BsAb-2 displaying a typical PK with a clearance of ~0.2 mL/hr/kg. Evaluation of the biophysical characteristics of the molecules, such as charge, non-specific binding, thermal stability, and hydrophobic properties, as well as FcRn interaction characterization showed some differences. In-depth drug disposition results revealed that poor physical stability and incomplete release from FcRn are the primary factors these contributed to the rapid clearance of the BsAb with aberrant PK.

Background and Aims: The DASH diet have been proven to be effective in lowering blood pressure (BP), but it is rarely used in people with type 2 diabetes (T2D), especially in the Chinese population. We aimed to evaluate the effects of 52% low- sodium salt applied to CM-DASH diet in patients with hypertension and T2D. Methods and Results: This trial is a single-blind, randomized controlled study conducted from December 2019 to November 2020 at Chongqing, China. 61 participants were randomly allocated to intervention group or control group for 8 weeks.2 participants were lost, and 59 patients were finally included in the analysis. The systolic blood pressure (SBP) and diastolic blood pressure (DBP) of intervention group and control group were significantly decreased compared with baseline, but there was no difference between groups. The 24-hour urine Na+ and Cl- of the two groups decreased significantly after intervention, but the increase of 24-hour urine K+ and the decrease of Na+/ K+ ratio were only observed in the intervention group. Furthermore,the urine urinary albumin creatinine ratio (UACR) and serum creatinine of two groups also decreased from baseline. Conclusions: Following the CM-DASH diet in hypertensive patients with T2D has beneficial effects in improving SBP and DBP. and the application of 52% low-sodium salt has a significant effect in reducing sodium intake and increasing potassium intake.

Human activities induce strong environmental changes that affect the quality of air, water and soil and increase the concentrations of polluting reactive compounds in the troposphere, such as ozone and nitrogen oxides. These changes can lead to a loss of biodiversity and alter plant physiology and plant-pollinator interactions, essential for pollination services, with potential consequences for agricultural production. Taking into account possible interactive effects with landscape quality and pesticide input, we investigated how air pollution (ozone and nitrogen oxides) and other sources of nitrogen is related to pollinator visitation rate and their contribution to agricultural production. We showed that ozone modulates the effect of pesticide exposure on crop pollinators, increasing the probability of negative impacts on crop pollination. Our results suggest that air pollution may have unexpected consequences for food safety and highlight the need for more sustainable transport and manufacturing policies to help safeguard biodiversity and related food production

Background: Anterior line ablation for peri-mitral atrial flutter (AFL) is associated with biatrial flutter due to disruption of the electrical conduction in the left atrial septum. Tachycardia cycle length (TCL) prolongation during anterior line ablation of peri-mitral AFL can be due to change of the AFL into a single loop biatrial flutter. Method: An AFL case with valvular disease, cardiac surgery and prior ablation was confirmed to be counterclockwise peri-mitral flutter with isthmus identified on the left atrial septum by LAT, bipolar voltage and propagation mapping. Ablation on the anterior and septum left atrium (LA) targeting the isthmus prolonged TCL from 266 ms to 286 ms. A second map was performed for both the left atrium (LA) and the right atrium (RA). Result: The activation in LA remained to be counterclockwise, but there was interruption of the LAT. The reentrant circuit was counterclockwise single loop biatrial, involving the whole LA and the RA septum with Bachmann bundle and the inferior posterior septum being the connection between RA and LA. The AFL was terminated by alation at the RA superior septum below SVC. Conclusion: Counterclockwise peri-mitral flutter can change into single loop biatrial flutter during anterior line ablation. RA mapping should be considered if there is prolonging of TCL without termination of the AFL and if there is interruption of LAT. The biatrial flutter can be terminated by ablation at the Bachmann bundle insertion in the RA.

Orphan legume crops play an important role in smallholder farmers’ food systems. Though less documented, they have the potential to contribute to adequate nutrition in vulnerable communities. Unfortunately, data are scarce about the potential of those crops to withstand current and future climate variations. Using Macrotyloma geocarpum as an example, we used genetically informed ecological niche models to explore the role of ecology on the current and future distributions of genetic populations of Kersting’s groundnut. Three main conclusions emerged: i) the models had good predictive power, indicating that M. geocarpum’s distribution was correlated with both climatic and soil layers; ii) identity and similarity tests revealed that the two genetic groups while overlapping, are each, locally adapted and display differences in climate suitability; iii) by integrating the genetic information in niche modeling, niches projections show divergence in the response of the species and genetic populations to ongoing climate change. This study highlights the importance of integrating genetic data into ecological niche modelling approaches to obtain finer scale information of species’ distribution, and explores the implications for agricultural adaptation, with a particular focus on identifying priority actions in orphan crops conservation and breeding.

Environmental DNA (eDNA) analysis is a promising tool for non-disruptive and cost-efficient estimation of species abundance. However, its practical applicability in natural environments is limited owing to a potential gap between eDNA concentration and species abundance in the field. Although the importance of accounting for eDNA dynamics, such as transport and degradation, has been discussed, the influence of eDNA characteristics, including production source and cellular/molecular state, on the accuracy of eDNA-based abundance estimation was entirely overlooked. We conducted meta-analyses using 44 of previous eDNA studies and investigated the relationships between the accuracy (R2) of eDNA-based abundance estimation and eDNA characteristics. First, we found that estimated R2 values were significantly lower for crustaceans and mussels than fish. This finding suggests that less frequent eDNA production of these taxa owing to their external morphology and physiology may impede accurate estimation of their abundance via eDNA. Moreover, linear mixed modeling showed that, despite high variances, R2 values were positively correlated with filter pore size, indicating that selective collection of larger-sized eDNA, which is typically fresher, could improve the estimation accuracy of species abundance. Although our collected dataset was somewhat biased to the studies targeting specific taxa, our findings shed a new light on the importance of what characteristics of eDNA should be targeted for more accurate estimation of species abundance. Further empirical studies are required to validate our findings and fully elucidate the relationship between eDNA characteristics and eDNA-based abundance estimation.

Aim of the Study: The low-carbohydrate ketogenic diet (KD) has been suggested as an adjunct therapy in cancer through its effect on modifying the metabolic milieu of the tumor. The present study was conducted to assess the feasibility of KD in patients with cancer. Materials and Methods: This study was conducted on 53 adult male patients with advanced, metastatic solid tumor cancer in Shafa Oncology Hospital Ahvaz, Iran in the years 2017-2019. The subject followed a low-carbohydrate KD comprised of 10 percent carbohydrates, 20 percent protein, and two-thirds fat. The total amount of carbohydrates per day was 70 grams. The subjects were monitored for possible adverse effects. The body weight, serum levels of glucose, blood urea nitrogen (BUN), and creatinine (Cr.) were measured and body mass index (BMI) was calculated on the 30th, 60th, and 90th day of study. In addition, at each round of measurement, these variables were measured in 21 other patients with advanced cancer following a normal diet Results: Of 53 patients, 10 passed away during the time of the study. Of 43 living patients, 22 (51.16%) dropped out of the study, and 21 (48.84%) continued to the end. No serious adverse effects were reported. No significant differences were detected between the patients following a low-carbohydrate diet and patients following a normal diet in terms of weight, BMI ,creatinine and BUN serum levels. The serum glucose level was 97.43±13.71, 95.81±14.93, and 107.76±37.73 mg/dL in the group of patients following the low-carbohydrate diet and 107.10±31.78, 106.67±34.74, and 99.38±27.48 mg/dL in patients following a normal diet on the 30th, 60th, and 90th day, respectively, with no significant difference between the two groups. Conclusion: Results of the present study support the feasibility of the use of this diet for patients with advanced cancer. Keywords: Cancer, Ketogenic diet, Low-carbohydrate diet, Feasibility

Covid-19 vaccines in pregnancy：weigh the pros and consRui-Hong Xue 1,2,3

In this piece of research, our aim is to investigate the novel solitons solutions of nonlinear (4+1)-dimensional Fokas equation (FE) and (2+1)-dimensional Breaking soliton equation (BSE) via new extended direct algebraic method. New acquired solutions are bright, singular, dark, periodic singular, combined-dark bright and combined-dark singular solitons solutions along with hyperbolic and trigonometric functions solutions. The achieved distinct types of solitons solutions contain key applications in engineering and physics. By taking the appropriate values of involved parameters, numerous novel structures are also plotted. These solutions define the wave performance of the governing models, actually.

Background and Purpose: PD-1 and PD-L1 antibodies have brought extraordinary clinical beneficial for cancer patients and their indications are expanding incessantly. Currently, most PD-1/PD-L1 products are delivered intravenously which may be inconvenient for some cancer patients. Here, we developed a novel oral delivered small molecular, YPD-29B, which targeted human PD-L1 specifically. Experimental Approach: HTRF and SPR assay were used to detect the binding affinity of YPD-29B and PD-L1. The PD-L1 dimerization were proved by native page and HTRF. PD-L1 cell based assay and PBMC cell activation assay were conducted to detect the T cell activation by YPD-29B in vitro. And human PD-1 humanized mice were used to test the antitumor activity and tolerance of YPD-29B in vivo. Key Results:: Our data suggested that YPD-29B could potently and selectively block the interaction between PD-L1 and PD-1, but did not inhibit any other immune checkpoints. Mechanistically, YPD-29B induced human PD-L1 dimerization and internalization, which subsequently activated T lymphocytes and therefore overcomes immunity tolerance in vitro. Moreover, YPD-29B exhibited great antitumor activity and was well tolerated in vivo. Conclusion and Implications: Our results indicated that YPD-29B serves as a promising therapeutic anti-human PD-L1 candidate for cancer immunotherapy.

In this paper, we consider an optimal control problem governed by linear parabolic differential equations with memory. Under the assumption that the corresponding linear parabolic differential equation without memory term is approximately controllable, it is shown that the set of approximate controls is nonempty. The problem is first viewed as a constrained optimal control problem, and then it is approximated by an unconstrained problem with a suitable penalty function. The optimal pair of the constrained problem is obtained as the limit of the optimal pair sequence of the unconstrained problem. The result is proved by using the theory of strongly continuous semigroups and the Banach fixed point theorem. The approximation theorems, which guarantee the convergence of the numerical scheme to the optimal pair sequence, are also proved. Finally, we also present a numerical example to validate our main theoretical results.

Host’s fitness can be affected by its genotype and gut microbiota, defined as the microbes living in the host’s intestinal tract. This study explored how the genetic diversity of the host influences its bacterial communities in the context of captive breeding programs, for the critically endangered European mink (Mustela lutreola). As stated by the ecosystem on a leash model, mechanisms such as inbreeding depression may lead to changes in immunomodulation and will therefore induce modifications of the gut microbiota. We investigated variation in the gut bacteria through 16S rRNA metabarcoding, related to the genetic diversity of European mink held in captivity in two breeding centers representing separate breeding stocks originating from the western and eastern populations. The genetic diversity of the host was assessed through diversity analysis of the adaptive MHC class I and II genes as well as neutral microsatellite markers. Results indicate lower diversity in neutral and MHC class I genes for the western population, and the opposite for MHC class II. A lower MHC class II gene variability led to an increase in microbial phylogenetic diversity and in abundance depending on the presence of specific MHC-II motifs. This shows the importance of integrating both neutral and adaptive markers when investigating genetic variation in the context of ex situ conservation, as well as gut microbial community assessment. We advocate for more natural mating systems in captive breeding program to foster genetic diversity as a whole to mitigate the effects of genetic drift on those small, isolated populations.

Background Recently, inflammation plays an essential role in the prognosis of atrial fibrillation (AF) patients. Systemic immune-inflammation index (SII), reflecting the inflammation status, which is measured by the formula: neutrophil count × platelet count/lymphocyte count, is a powerful prognostic marker in several types of cancer and cardiovascular disease. However, no information regarding the prognostic value of SII in patients with AF is available. Methods and results We retrospectively enrolled 1768 AF patients in our study. Demographic characteristics, laboratory data and echocardiography were measured and collected on admission. The primary endpoints were death from all causes and death from cardiovascular diseases. The secondary endpoints were major bleeding and stroke. During a mean follow-up of 22.35 months, 155 patients occurred death from all causes. For further analysis, patients were categorized into two groups according to the optimal cutoff value of SII level determined by using receiver operating characteristics curve analysis. The incidence of death from all causes and death from cardiovascular diseases in high SII group is significantly higher compared with that in low SII group. However, no significant differences were detected between two groups for the secondary endpoints (p>0.05). On multivariable Cox analysis with adjustment of potential confounders, the risk of death from all causes and death from cardiovascular diseases increased by 77.6% and 51.2%, respectively, in high SII group. Conclusion Systemic immune-inflammation index was significantly associated poor outcomes and was an independent predictor for mortality in atrial fibrillation patients.

Background: Circumcision is one of the most common operations and it causes serious postoperative pain, fear, and anxiety for children. This study aims to compare the effects of transversus abdominis plane (TAP) block and caudal epidural (CE) anesthesia on postoperative analgesia after circumcision in providing postoperative pain control. Methods: Eighty male children who underwent elective circumcision surgery under general anesthesia either with USG-guided TAP block or with CE block for postoperative analgesia were enrolled consecutively to this prospective observational study equally in each group. Postoperative pain scores and need for rescue analgesia were recorded and compared between the two groups. Results: There was no statistically significant difference between the groups in terms of mean age and Aldrete scores (p > 0.05). The BMI values of the caudal block group were found to be statistically significantly lower than the TAP group (p < 0.05). While there was no statistically significant difference between the groups in terms of 30th-minute VAS values (p> 0.05), but the CE block group’s 1st, 2nd, 4th 8th, 12th, 18th, and 24th hours VAS values were statistically significantly lower than the TAP block group (p <0.05). Conclusion: In this study, our data analysis showed us that; the USG-guided TAB block under general anesthesia is not associated with lower postoperative pain scores and delayed rescue analgesia need than the CE block in patients who underwent elective circumcision surgery. CE block provided superior analgesia than the USG-guided TAP block after male elective circumcision surgery in this study.

Introduction:There is increasing evidence that dyspnea and impaired exercise capacity are partially associated with respiratory muscle dysfunction,particularly diaphragmatic dysfunction,in patients with IPF.We aimed to assess the functions of the diaphragm, which is the main respiratory muscle,using both US and sEMG in patients with IPF,and to establish the correlation of these data with pulmonary function parameters,exercise capacity and radiological extent of fibrosis. Methods:We measured diaphragmatic mobility,diaphragmatic thickness and TF by US and the strength of diaphragmatic contraction on sEMG in IPF patients and compared with healthy individuals.We further assessed the correlation of these measurements with each other and with FVC,DLCO,6MWT,spO2 changes,mMRC score and TFS in patients with IPF. Results:41 IPF patients and 21 healthy individuals were included in the study.There was no difference in diaphragmatic mobility on US during quiet breathing between the patient and control groups(2.35 cm vs. 2.56 cm;p=0.29).Diaphragmatic mobility during deep breathing was lower in the patient group compared to the control group(5.02 cm vs. 7.66 cm;p<0.0001).IPF patients had greater diaphragmatic thickness during quiet and deep breathing than the control group(0.24 cm vs. 0.22 cm, 0.33 cm vs. 0.31 cm,respectively;p=0.045;p=0.043).There was no difference in TF between the two groups(39.37% vs. 44.16%;p=0.49).The strength of diaphragmatic contraction measured on sEMG was higher in IPF patients compared to healthy individuals(0.61 mV vs. 0.51 mV;p=0.03).In IPF patients,US and sEMG measurements had no significant relationship with FVC,DLCO,6MWT,spO2 change levels,mMRC scores and TFS(p>0.05).When the relationship between US and sEMG findings in IPF patients was evaluated,a positive correlation was found between the diaphragmatic thickness during quiet breathing and the strength of contraction(r=0.32;p=0.04). Conclusion:The functions of the diaphragm do not appear to be affected in IPF patients with mild-to-moderate restriction.However,the functions of the diaphragm may deteriorate as a result of inadequate compensatory response to the load on respiratory muscles in the later stages of the disease.

Objective: Oxytocin may cause dose-dependent ischaemic echocardiogram changes, prolongation of QT time and release of myocardial biomarkers. We have previously demonstrated comparable vasodilatory effects of oxytocin and carbetocin and are now undertaking a Phase 4 trial to investigate whether carbetocin causes changes to myocardial markers. Design: Randomized controlled trial. Setting: Obstetrics units at Oslo University Hospital or and Akershus University Hospital, Norway. Population or sample: Planned enrolment of 240 healthy, singleton pregnant women aged 18 to 50 years, who are undergoing planned caesarean delivery Methods: Based on pilot study data, each participant will receive a 1 -minute intravenous injection of either oxytocin 2.5 U or carbetocin 100 µg during caesarean section. Main outcome measures: The primary outcome is prespecified as the change from baseline in high-sensitive troponin I plasma concentrations at 6–10 hours after study drug administration. Secondary outcomes include uterine tone grade at 2.5 and 5 minutes after study drug administration, adverse events for up to 48 hours after study drug administration, estimated blood loss within 8 hours of delivery, need for rescue treatment and direct/indirect costs. Results: Enrolment and primary analysis is expected to be completed by the end of 2021. Conclusions: Any potential cardiotoxicity difference between oxytocin and carbetocin will help inform treatment decisions for pregnant women.

This paper is concerned with the study of decay rates of the energy associated to a semilinear wave equation with variable coefficients in a smooth domain, subject to acoustic boundary conditions and dissipative boundary memory feedback, where a general Borel measure is involved. Under quite weak assumptions on this measure, we show the decay rates of the semilinear system are described by solutions to a first order nonlinear, dissipative ODE, which recovering and extending some of the results from the literature. The method we used are energy multiplier methods, geometric analysis and a standard integral inequality.

The Yuanjiang dry-hot valley features hot and dry climate, low vegetation and soil degradation. It had lush vegetation in the past, but has become degraded in recent decades. Understanding the interrelationship between species and the habitat is necessary to explain this change. In this study, a link between fern and fern allies - a group that is hypersensitive to environmental factors and their circumstances is constructed. Intensive transects and plots were designed to be proxies for extant fern and fern allies, and their habitats. Fifty years of meteorological records of precipitation and temperature along altitude and river running direction (latitudinal) were employed. Alpha and beta diversity are used to access diversity. Species_estimated, Singletons, Uniques, ACE, ICE, and Chao2, which associate to abundance and rarity, are subscribed to the correlation between fern and fern allies, and their ecosystem. Eight species, Selaginella pseudopaleifera, Aleuritopteris squamosa, Adiantum malesianum, Pteris vittata, Davallia trichomanoides, Sinephropteris delavayi, Selaginella jugorum, and Lygodium japonicum are used as indicators of a typical xeric and sun-drying habitat. The results indicate (1) accompanied by dramatically shrinking habitats, fern and fern allies are in very low diversity and abundance, whereas the rarity is relatively high; (2) for fern and fern allies, environmental factors are positive when altitude goes up; and (3) eight indicator species are latitudinally correlated with fern and fern allies along the river running direction.

In this paper, we propose and analyse a predator-prey model with disease in prey. We assume that a portion of healthy prey takes refuge to avoid predation. We find the biologically feasible equilibrium points and their stability criteria by using linearization technique. We also perform Hopf bifurcation analysis around the coexisting equilibrium point. We carry out extensive numerical simulation to validate our theoretical results and also explore rich dynamics which cannot be attained analytically. We draw some one and two parameter bifurcation diagrams which demonstrate rich dynamics like, Hopf bifurcation, chaos, bistability, etc. We observe that invasion of disease in prey can produce chaos through period-doubling bifurcation, whereas refuge can control chaos via period-halving bifurcation. We also observe that refuge can control disease prevalence in the prey population.

The main target of this article is to prove the products, behaviors and simple zeros for the classes of the entire functions associated with the Weierstrass-Hadamard product and the Taylor series.

Metaevaluation is a systematic review of an evaluation for the purpose of determining the quality of the processes and findings of the evaluation. This research aims to make use of a metaevaluation process to assess and identify strengths and potential weaknesses associated with the Faculty of Medicine Curriculum Evaluation. Stufflebeams1 Program Evaluations Metaevaluation Checklist was used in the study. The Checklist consist of the attributes which are utility, feasibility, propriety, accuracy and evaluation accountability. A total of 30 standards quality distributions were determined as excellent (10%), very good (20%), good (23.33%), fair (36.67%), and poor (10%). The results were also analyzed in terms of attributes and utility, feasibility and accuracy standards are at a “good “level, but that the propriety and evaluation accountability are not at a sufficient level. Evaluation accountability is at very low level, which is poor. It can be said that the percentage of ratings of the standards rated as “good” and above was 53.33%. In medical education, education programs should be evaluated effectively and continuously as well as systematically. The overall findings in the metaevaluation of the undergraduate medical education program showed that the evaluation is successful in many ways. Key Words: Metaevaluation, Faculty, Medicine, Undergraduate, Medical Education

Rationale, aims and objectives: As part of Jordanian government’s healthcare strategy, Continuing Professional Development (CPD) has recently become mandatory as of 2018. The study aimed to draw the landscape of CPD for Jordanian Physiotherapist. The activities, attitudes, and workplace environment related to CPD were explored. Method: A quantitative web-based survey was used to collect data. The survey was open for potential participants for three months from 29/01/2020. Only physiotherapists practicing in Jordan; and involved in direct patient care were invited to take part. Results: Eighty-six Physiotherapists representing multiple cities in Jordan completed the survey. Around 13% held a post graduate qualification. The main activity in which participants engaged with was local workshops. Their main driver was to improve patients care. High financial burden and inability to travel were the main barriers. Conclusion(s): For the first time, the study provided evidence of the activities, motivators, and barriers to CPD in a sample of Jordanian physiotherapists. Findings are important in informing healthcare policy-making. In particular, it offers directions to maximise the impact of CPD.