China’s Law on Maternal and Infant Health Care are inadequate for the new context created by the three-child policy, leading to a delay in the provisions of maternal and newborn health (MNH) services. Several provinces have taken the initiative to develop local legislation to improve the local MNH environment. In response to the need for legal reform, Guangdong province in China has made revisions to its Guangdong Province Maternal and Newborn Healthcare Management Regulation (GPMNHMR) The amendments focus on three aspects: enhancing voluntary premarital screening, regulating assisted reproductive technology (ART) practices, and creating a supportive environment for mothers and newborns. Guangdong, having the highest birth rate in China, is one of the provinces with severe birth defects. Therefore, increasing premarital screening rates is essential. Guangdong boasts the highest number of authorized ART institutions in China, requiring effective management. Additionally, inadequate concentration on psychological well-being leads to a high rate of postpartum depression. Incorporating innovative measures into regulations necessitates a comprehensive assessment of their scientific validity and feasibility. Guangdong has advanced legislation through several approaches: integrating effective measures from pilot into regulations; co-decision making, promoting multiple stakeholders to participate in legislation; evidence-based legislation and committing to academic institutions for translation.

Individuals' traits affect their perceptions of events and their likelihood of marriage dissolution. However, the possible pathway in which those traits are influenced by traumatic life events has not been fully explored. In this study, we examined the effects of various traumatic life events on the likelihood of divorce, while controlling demographic and psychological factors. Our results showed that factors such as being cheated on, being emotionally or sexually abused, being disabled, and having divorced parents were positively associated with a higher likelihood of divorce. On the other hand, factors such as better subjective life conditions, older age, and previous divorce were negatively associated with the likelihood of divorce. The results also revealed some interaction effects between different factors, such as marital status and sense of loneliness before death. The results emphasize the importance of supporting those who have undergone traumatic life events, by helping them not only with the related traumas, but also preparing them for having a successful marriage. This is one of the earliest studies to consider the impact of traumatic life events on the likelihood of divorce.

The Ghana National Ambulance Service, established in 2004, has expanded its reach and improved emergency care across the country. Despite this progress, recent Auditor General reports highlight ongoing challenges, including operational inefficiencies, inadequate maintenance, and underutilized resources. These issues underscore the need for a comprehensive overhaul. This article explores effective strategies to address these challenges, focusing on technological advancements, improved management, and targeted training. By modernizing the ambulance fleet and enhancing operational practices, we can create a more efficient and responsive service to better meet the needs of the Ghanaian population.

Sarah Samson Jatau1https://orcid.org/0000-0002-8920-5058

The difficulty in establishing a reliable model for detecting and identifying boiler pipeline leakage with limited samples is addressed in this research. A support vector machine-based acoustic emission detection technology is proposed, which combines nonlinear and linear methods to classify signal parameters as feature vectors. This approach overcomes the limitations of traditional methods that require a large amount of training data for classification. It demonstrates outstanding advantages in small sample scenarios and binary classification. Firstly, the feature parameters of pipeline leak acoustic emission signals are extracted, and then put the extracted feature parameters into support vector machine classification and training as the input feature vector. Realizing the effective recognition of acoustic emission signals such as knocking, sandpaper friction and broken lead, the SVM can use the measured acoustic emission signals to judge the type of leakage signals, and the accuracy reaches 100% after training. The test results show that the method is effective and feasible in the pipeline leakage diagnosis ,verifying the acoustic emission technique is applied to the feasibility of pipeline leak detection.

Strong earthquakes often trigger large-scale secondary geological disasters, causing significant damage to local ecosystems. Among these, landslides represent one of the most severe types of disasters, leading to substantial vegetation loss. Consequently, post-disaster vegetation recovery (Vegetation Productive Capability, VPC) has received widespread attention. While some studies have assessed post-disaster vegetation recovery, they often lack predictions for landslides VPC and fail to fully explore the intricate nonlinear relationships between landslide vegetation recovery and environmental factors. To address these gaps, this study comprehensively evaluates post-disaster vegetation recovery and subsequently conducts modeling analyses on the evaluation results using data-driven techniques. Specifically, we employ Moderate Resolution Imaging Spectroradiometer (MODIS) Net Primary Productivity (NPP) data and a Generalized Additive Model (GAM) to assess and predict VPC for 25,945 landslides triggered by the 2008 Wenchuan earthquake. Experimental results demonstrate the GAM model’s effectiveness in predicting vegetation recovery in landslides, achieving a good fit (AUC=0.798). Random cross-validation (mean AUC=0.797) and spatial hold-out cross-validation (mean AUC=0.752) further validate its efficacy. Moreover, This study also explores complex nonlinear relationships between recovery and environmental factors, revealing significant impacts of population density, slope, temperature, precipitation, and residual vegetation. However, the impacts of terrain factors, specifically profile and plan curvature, show considerable uncertainty. This study marks a significant step towards developing robust methodologies for landslides VPC prediction, paving the way for enhanced post-disaster ecological restoration strategies.

Background: Due to the severe toxicity of carboplatin and cisplatin, nedaplatin and lobaplatin are increasingly used in advanced lung adenocarcinoma (LUAD). However, there are no studies comparing lobaplatin with nedaplatin in the treatment of advanced LUAD. In this study, patients with LUAD were treated with PN or PL, and the safety and efficacy of the two regimens were evaluated. Methods: A total of 344 locally advanced or advanced LUAD patients first-line treated with nedaplatin plus pemetrexed (PN) or lobaplatin plus pemetrexed (PL) were enrolled. There were 175 patients in PN group and 169 patients in PL group. The primary endpoint was leukopenia and thrombocytopenia (grade 3 and 4). Secondary endpoints included disease control rate (DCR), objective response rate (OCR), and progression-free survival (PFS). Results: In PN group, the incidence of myelosuppression among 3/4 grade adverse events were 7.4%, and 18.3% in the group that received PL (P < 0.01). Incidences of thrombocytopenia in PN group were 2.3% and in PL group were 10.1% (P < 0.01). The overall PFS of the PN group was 5.6 months (95% CI, 3.76-7.44) and PL group was 4.9 months (95% CI, 4.04-5.76) (P = 0.035). In mutation-negative patients, the median PFS was 5.0 months (95% CI, 3.84-6.17) in the PN group and 4.8 months (95% CI, 4.03-5.57) in the PL group (P = 0.05). There was no significant difference in DCR and ORR between the two groups (P > 0.05). Conclusions: The PL group is associated with a higher risk of hematologic toxicity than PN group. The PFS of PN group was better than that of PL group.

Analyzing the temporal dynamics of ecological communities can shed light on coexistence mechanisms and help understand how populations and communities will behave in the face of climate change. However, little is known about how frog communities respond to climate in urban ecosystems, especially in the Global South. Here, we analyzed how frog species richness and abundance are influenced by microclimate both intra- and inter-annually. We surveyed a peri-urban area in central Brazil, monthly for three years. To test the effect of microclimate on species richness and abundance, we used Generalized Additive Mixed-effects Models. We assessed seasonality using circular statistics. We also tested for differences in temporal beta diversity within and among years by estimating species disappearance and temporal rank shift, in addition to a multivariate model-based method to test the effect of year on species composition. Finally, we tested how taxonomic and phylogenetic alpha diversity changed through time using a novel approach based on Hill numbers. We found that species richness varied little among years and was affected only by photoperiod, while species abundance was more variable both between and within years, being mostly affected by humidity, temperature, and photoperiod. Species composition varied little between years, mostly between the first and subsequent years. Conversely, beta diversity was highest within years. Only the effective taxonomic richness changed significantly through time. Our results help not only understand temporal mechanisms that allow species coexistence, but also allow to make inferences about the impact of urbanization on biodiversity in recently urbanized landscapes, showing that species composition in peri-urban sites remains unaltered in a mid-timescale, especially when climate conditions changes little across years.

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Review of: The Pioneering Life of Mary Wortley Montagu, Scientist and Feminist. Biography by Jo Willett. Pen And Sword Books Ltd, Yorkshire-Philadelphia, 2021

Aquaporin 1 (Aqp1) is a transmembrane channel protein, present in various tissues including ocular tissues, carrying water and regulating the cations flow across membranes. Experimental laser photocoagulation in rat retina induces reproducible injuries mimicking some angiogenic features of ocular pathologies such as subretinal neovascularization, gliosis and possible repair mechanisms. Our study was designed to unravel the potential roles of Aqp1 in such processes. We performed immunohistochemical Aqp1 co-immunostainings with a typical marker of Muller cells and astrocytes: the glial acidic fibrillary protein (Gfap) known to be involved in gliosis, with the blood vessel marker called von Willebrand factor (vWf) and with Nestin, a progenitor/stem cell marker in certain contexts. We observed an Aqp1/Gfap co-immunolabeling principally in retinal radial Muller cells. The co-immunoreactivity Aqp1/vWf was partially distributed, mostly in the choroid (Ch) and retina. Aqp1/Nestin co-immunolabeling was not or rarely observed except in some blood vessels principally in the ganglion cell layer (GCL) and Ch. In conclusion, after laser impact in retina, we could not significantly detect the presence of Aqp1 in precursor cells; however we detected it in glial and endothelial cells similarly to what we observed in control retina. Thus, Aqp1 appears to be a protein present in posterior differentiated cells of the eye where it regulates the hydro-ionic flow that is distributed between cells, extracellular matrix and blood vessels.

Background: Household transmission of SARS-CoV-2 is a driver of the ongoing COVID-19 pandemic. Understanding factors that contribute to secondary infection rates (SIR) can define changing trends and inform public health policies. Methods: The ORegon CHild Absenteeism due to Respiratory Disease Study (ORCHARDS) prospectively monitors respiratory viruses within the Oregon School District (OSD) in southcentral Wisconsin. Households with students who had ≥2 respiratory symptoms were eligible and opted to participate in ORCHARDS. Between October 28, 2020, and May 16, 2022, all household members provided self-collected nasal specimens on days 0, 7, and 14 for SARS-CoV-2 detection using real-time reverse-transcription-polymerase chain reaction. We used logistic regression to investigate individual- and household-level characteristics associated with SARS-CoV-2 transmission. Results: Overall, 127 households comprising 572 individuals (48% female; 52% male; 0.4% non-binary; 77% >18 years) had at least one detection of SARS-CoV-2. The overall SIR was 47% and decreased over time (pre-Delta=72% [95%CI: 58%-83%]; Delta=51% [40%-63%]; and Omicron=41% [36%-47%]. Odds of household transmission were 63% lower during the Omicron period compared to the pre-Delta period (OR=0.36 [95%CI: 0.13-0.94] P=0.037). Greater household density (members/bedroom) was significantly associated with household transmission during the Omicron period (OR=6.8, [2.19-21.37] P=0.001). Index case age, illness severity, and individual symptoms were not significantly associated with odds of household transmission. Conclusions: Greater household density was associated with higher risk of SARS-CoV-2 transmission, but the risk declined over time with subsequent variants. Interplay between variants, prior infection, and individual/household factors may identify modifiable factors (e.g., behavior, vaccination) to reduce future transmission risk.

Objective: To compare between conservative management and appendectomy for acute appendicitis during pregnancy by trimester. Design: Retrospective cohort study. Setting: 632 acute-care hospitals in Japan. Population: Pregnant women diagnosed with acute appendicitis. Methods: We conducted a large nationwide study using a national inpatient database from July 2010 to March 2022. Comparisons were conducted using multivariable analysis with generalized estimating equations. Main Outcome Measures: Preterm labor, preterm delivery, or abortion, antepartum hemorrhage, duration of hospitalization, and duration of antibiotic use. Results: 3,158 individuals were eligible. Proportions of conservative management versus appendectomy by trimester were 507 (49.1%) vs. 525 (50.9%) in the first, 690 (44.6%) vs. 856 (55.4%) in the second, and 337 (58.1%) vs. 243 (41.9%) in the third. In the second trimester, appendectomy had a higher rate of preterm delivery, preterm labor, or abortion (OR 2.91; 95% CI 1.62–5.25). Antepartum hemorrhage occurred more frequently for appendectomy in the first (OR 2.12; 95% CI 1.31–3.43) and third (OR 2.43; 95% CI 1.79–3.31) trimesters. Appendectomy had longer duration of hospitalization in the second (2.15 days; 95% CI 1.14–3.17 days) and third (3.97 days; 95% CI 2.22–5.71 days) trimesters. Antibiotic use duration was shorter for appendectomy in the first (−1.20 days; 95% CI −1.51 to −0.90 days) and second (−0.61 days; 95% CI −0.90 to −0.32 days) trimesters. Conclusions: Clinical outcomes of acute appendicitis during pregnancy vary by trimester. Considering the appendectomy risks, conservative management may be viable depending on the clinical context and trimester.

Title: Exploration of Real-World Obstetric Data Regarding Cesarean Delivery Rate Since the ARRIVE Trial

A novel high-efficiency double LLC resonant dc-dc converter with zero input current ripple and low voltage stress is presented. The input current ripple and undesired harmonic components can be significantly reduced without adding a large input filter. Moreover, all main switches and rectifier diodes are softly switched in a wide input voltage range, reducing the switching loss. The voltage stress on each main switch is only half of the input voltage by using the improved three-level structure, which enables the use of low-voltage-rated power switches for high-voltage input applications. The operation principle is analyzed and experimental results of a prototype validate the performance of the proposed converter.

In this paper, we construct infinitely many self-similar solutions whose supports are contained in a cone { ( x , t ) : | x | < C t } . The construction is mainly based on the convex integration scheme. Under suitable change of variable and rescaling, we reformulate the Euler equation as a steady system with nontrivial source term. We construct the corresponding plane-wave solutions and show the non-uniqueness by Baire category argument.

Purpose: We aim to describe the characteristics of patients with childhood-onset craniopharyngioma and to analyze factors that impair quality of life (QoL) in this population. Methods: multicenter national study including patients treated between 2008-2022, from 2 to 25 years of age diagnosed with craniopharyngioma. QoL was assessed once during patient’s follow-up by age-adapted versions Pediatric Quality of Life Inventory (PedsQL TM) questionnaire. Results: Sixty-six patients were included. Median age at diagnosis was 5 years (IQR 3-8), while median follow-up was 7.4 years (IQR 2.8-9.7). Most craniopharyngioma were suprasellar (93.9%) and 59.7% had hypothalamic involvement (HI). All patients underwent surgery, 44.4% received radiotherapy and 23.6%, intra-cystic therapy. Most frequent long-term complications were visual deficit (72.7%) and endocrine impairment (94.5%). Patients exhibited hypothyroidism requiring hormone replacement (92.4%), hypocortisolism (80.3%), diabetes insipidus (86.4%) and/or growth hormone therapy (50%). When parents evaluated QoL, PedsQL TM median score was 53.8 points out of 100 (IQR 41-71.6). Higher scores were noted when patients assessed their own QoL [median-score 64.8 (IQR 57.3-81.8)], observing statistical-significant differences (p=0.019). QoL was impaired by repeated surgeries (r -0.44; p=0.014), HI [median-score 51.5 (IQR 39-63.8) vs 76.4 (59-84.8); p=0.001], radiotherapy [median-score 51.9 (IQR 38.1-61.3) vs 63.8 (IQR 49-82.5); p=0.02] and longer follow-up (r-0.3; p=0.01). Conclusion: In our study, most patients had significant comorbidities and low overall QoL scores, which was mainly affected by repeated surgery, radiation, and HI. The complex management of these patients requires multidisciplinary teams that can warrant the hypothalamic preservation and prompt intervention to prevent and identify sequelae.

With an annual cumulative occurrence of approximately 15,000 in North America, all childhood cancers are rare. Very rare cancers as defined by both the European Cooperative Study Group for Rare Pediatric Cancers (EXPeRT) and the Children’s Oncology Group (COG) fall into two principal categories: those so uncommon (fewer than 2 cases/million) that their study is challenging even through cooperative group efforts (e.g. pleuropulmonary blastoma, desmoplastic small round cell tumor) and those that are far more common in adults and therefore rarely studied in children (e.g. thyroid, melanoma, gastrointestinal stromal tumor). [1](#ref-0001) Treatment strategies for these latter tumors are typically based on adult guidelines, although the pediatric variants of these tumors may harbor different genetic signatures and demonstrate different behavior. If melanoma and differentiated thyroid cancer are excluded, other rare cancer types account for only 2% of the cancers in children aged 0 to 14.[1](#ref-0001) This article highlights several of the most common rare tumor types.

Purpose : Describe clinical characteristics and outcome of Li-Fraumeni-associated osteosarcomas. Methods : TP53 germline pathogenic/likely pathogenic variant carriers diagnosed with osteosarcoma in France between 1980 and 2019 were identified via the French Li-Fraumeni database at Rouen University Hospital. Sixty-five osteosarcomas in 52 patients with available clinical and histological data were included. The main clinical characteristics were compared with data from the SEER (National Cancer Institute’s Surveillance, Epidemiology, and End Results) for patients of the same age group. Results : Median age at first osteosarcoma diagnosis was 13.7 years (range:5.9-36.7). Compared to unselected osteosarcomas, LFS-associated osteosarcomas occurred more frequently in patients <10 years (23% versus 9%) and, when compared with osteosarcomas in patients <25 years were characterized by an excess of axial (16% versus 10%) and jaw sites (15% versus 3%) and histology with predominant chondroblastic component (35% versus 16%) and periosteal subtypes (17% versus 1%). Metastases incidence (25%) was as expected in unselected osteosarcomas. After the first osteosarcoma treatment, the rate of good histologic response (62%) and the 5-year progression-free survival (55%[95%CI:42.6−71.1]) were as expected in unselected series of osteosarcomas whereas the 5-year event-free survival was 36.5%[95%CI: 25.3−52.7] due to the high incidence of second malignancies reaching a 10-year cumulative risk of 55.3%[95%CI:34.3-69.5]. Conclusion : In osteosarcoma, young age at diagnosis, axial and jaw sites, histology with periosteal or chondroblastic subtype and synchronous multifocal tumors should prompt suspicion of a germline TP53 mutation. Standard treatments are effective, but multiple malignancies impair prognosis. Early recognition of these patients is crucial for tailored therapy and follow-up.

It appears as though the mechanisms of governance and societal order are faltering in our Republic. Each day, citizens rise early and engage in activities driven solely by personal whims, with little regard for the rule of law or the principles of common sense. This troubling trend, observed across many African nations, is degrading our richly endowed continent into a semblance of a banana republic. Such a spectacle is intolerable and demands immediate rectification. The responsibility to initiate change rests squarely on the shoulders of the intelligentsia, the educated elite, and all conscientious citizens of Ghana. It is imperative that we awaken from our silence and apathy to actively defend the rights and duties outlined in the 1992 Constitution of Ghana. Our collective voice and action are crucial in upholding these fundamental principles.

Since severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was first reported in Wuhan, China in December 2019, it has spread rapidly, and many coronavirus disease (COVID-19) cases have occurred in Gwangju, South Korea. Viral mutations following the COVID-19 epidemic have increased interest in the characteristics of epidemics in this region, and pathogen genetic analysis is required for infection control and prevention. In this study, SARS-CoV-2 whole-genome analysis was performed on samples from patients with COVID-19 in Gwangju from 2020 to 2022 to identify the trends in COVID-19 prevalence and to analyze the phylogenetic tree of dominant variants. B.41 and B.1.497 prevailed in 2020, the early stage of the COVID-19 outbreak; then, B.1.619.1 mainly occurred until June 2021. B.1.617.2, classified as sublineage AY.69 and AY.122, occurred continuously from July to December 2021. Since strict measures to strengthen national quarantine management had been implemented in South Korea until this time, mutations phylogenetic analysis was also able to infer the epidemiological relationship between infection transmission routes. Since the first identification of the Omicron variant in late December 2021, the spread of infection has been very rapid, and weekly whole-genome analysis of specimens has enabled us to monitor new Omicron sublineage occurring in Gwangju. Our study suggests that conducting reginal surveillance in addition to nation-level genomic surveillance will enable more rapid and detailed variant surveillance, which will be helpful in the overall prevention and management of infectious diseases.

This research compares decision-making techniques for diagnosing diabetes, including Bayesian decision theory, rough set theory, and fuzzy soft set theory. It discusses applying Bayesian decision theory and rough set theory, utilizing the latter to approximate three-way regions for patient classification. The study aims to provide effective medication plans by considering uncertainty. It concludes that the Bayesian rough set theory-based method identifies boundary regions for further investigation. It suggests decision-making based on minimum overall cost and provides a framework for more precise medical diagnoses for diabetic patients.

HIV-1 Tat (transactivator of transcription) protein is the main arsenal of HIV, playing numerous roles during viral infection. This protein is inherently disordered, lacking any secondary structures. This plasticity allows HIV-1 Tat to engage in interaction with multiple proteins and biological molecules, resulting in either collapse of the immune system or severe damage to tissues. Proteomic studies previously revealed p53, commonly cited as the guardian angel of the genome to interact with the Tat protein through its tetramerization domain. As p53 is crucial in terms of whether the cell dies or lives, its interaction with the Tat protein is of broad interest in the pathogenesis of HIV infection. For this reason, we investigated the complexation between the Tat protein and the tetramerization domain of p53 using molecular docking and molecular dynamics simulations. We believe that the results reported in this manuscript are of significance for developing novel therapeutic agents targeting the p53/Tat interaction.