Treatment abandonment in children with Wilms tumor at a national referral hospital in Uganda.

INTRODUCTION: The incidence of pediatric Wilms' tumor (WT) is high in Africa, though patients abandon treatment after initial diagnosis. We sought to identify factors associated with WT treatment abandonment in Uganda. METHODS: A cohort study of patients < 18 years with WT in a Ugandan national referral hospital examined clinical and treatment outcomes data, comparing children whose families adhered to and abandoned treatment. Abandonment was defined as the inability to complete neoadjuvant chemotherapy and surgery for patients with unilateral WT and definitive chemotherapy for patients with bilateral WT. Patient factors were assessed via bivariate logistic regression. RESULTS: 137 WT patients were included from 2012 to 2017. The mean age was 3.9 years, 71% (n = 98) were stage III or higher. After diagnosis, 86% (n = 118) started neoadjuvant chemotherapy, 59% (n = 82) completed neoadjuvant therapy, and 55% (n = 75) adhered to treatment through surgery. Treatment abandonment was associated with poor chemotherapy response (odds ratio [OR] 4.70, 95% confidence interval [CI] 1.30-17.0) and tumor size > 25 cm (OR 2.67, 95% CI 1.05-6.81). CONCLUSIONS: Children with WT in Uganda frequently abandon care during neoadjuvant therapy, particularly those with large tumors with poor response. Further investigation into the factors that influence treatment abandonment and a deeper understanding of tumor biology are needed to improve treatment adherence of children with WT in Uganda.

Association between the home-to-healthcare center distance and hearing aid abandonment among older adults.

Background: Access to audiology services for older adults residing in sparsely populated regions is often limited compared to those in central urban areas. The geographic accessibility to follow-up care, particularly the influence of distance, may contribute to an increased risk of hearing aid abandonment. Objective: To assess the association between the home-to-healthcare-calibration-center distance and hearing aid abandonment among older adults fitted in the Chilean public health system. Methods: 455 patients who received hearing aids from two public hospitals in two regions were considered. Univariate and multivariate Poisson regression models with robust variance estimation were used to analyze the association between the geographical distance and hearing aid abandonment, accounting for confounding effects. Results: Approximately 18% of the sample abandoned the hearing aid, and around 50% reported using the hearing aid every day. A twofold increase in distance between home and the hearing center yielded a 35% (RR = 1.35; 95% CI: 1.04-1.74; p = 0.022) increased risk of hearing aid abandonment. Also, those in the second quintile had a 2.17 times the risk of abandoning the hearing aid compared to the first quintile (up to 2.3 km). Under the assumption that patients reside within the first quintile of distance, a potential reduction of 45% in the incidence of hearing aid abandonment would be observed. The observed risk remained consistent across different statistical models to assess sensitivity. Conclusion: A higher distance between the residence and the healthcare center increases hearing aid abandonment risk. The association may be explained by barriers in purchasing supplies required to maintain the device (batteries, cleaning elements, potential repairs, or maintenance).

Understanding Professionals' Knowledge Regarding Factors Influencing Changes in Attitudes toward Female Genital Mutilation/Cutting in Post-Migration Communities in Geneva, Switzerland.

Female genital mutilation or cutting (FGM/C) is a practice involving the partial or complete removal of the external female genitalia for non-medical reasons. To facilitate attitude changes, the ecological model of behavior change considers multiple levels of influence and their relationships with environmental and behavioral factors. The combined effects of migration and cultural adaptation result in a transformative process that leads to decreased support for FGM/C. This qualitative study aimed to gain knowledge from FGM/C field professionals regarding the factors promoting behavioral changes in migrant communities in Geneva, Switzerland. Between September and October 2023, we conducted semi-structured interviews using a reflexive thematic analysis. Our qualitative research is reported in accordance with the COREQ criteria. A data analysis was performed using NVivo 14 software. Four influential dimensions were identified, each with associated factors. The first dimension, the social level, includes (1) the impact and implementation of anti-FGM/C laws. The second dimension, the community level, encompasses four factors such as (2) religion, (3) a multifaceted examination of social aspects, (4) navigating language barriers and raising awareness, and (5) cultural adaptation processes. The third dimension, the interpersonal level, includes factors such as (6) changing views on the marriage prerequisite. Finally, the fourth dimension, the personal level, is associated with (7) women's experiences and perspectives regarding FGM/C. The findings highlight seven environmental factors, both within and across dimensions of the ecological model, that interact with human behavior to enable an adaptive cultural process. This process influences changes in attitudes and behaviors regarding FGM/C.

An assessment of future rewilding potential in the United Kingdom.

Restoring ecosystems is an imperative for addressing biodiversity loss and climate change, and achieving the targets of the Kunming-Montreal Global Biodiversity Framework. One form of restoration, rewilding, may have particular promise but may also be precluded by requirements for other forms of land use now or in the future. This opportunity space is critical but challenging to assess. We explored the potential area available for rewilding in Great Britain until the year 2080 with a multisectoral land-use model with several distinct climatic and socioeconomic scenarios. By 2080, areas from 5000 to 7000 km2 were either unmanaged or managed in ways that could be consistent with rewilding across scenarios without conflicting with the provision of ecosystem services. Beyond these areas, another 24,000-42,000 km2 of extensive upland management could provide additional areas for rewilding if current patterns of implementation hold in the future. None of these areas, however, coincided reliably with ecosystems of priority for conservation: peatlands, ancient woodlands, or wetlands. Repeatedly, these ecosystems were found to be vulnerable to conversion. Our results are not based on an assumption of support for or benefits from rewilding and do not account for disadvantages, such as potential losses of cultural landscapes or traditional forms of management, that were beyond the modeled ecosystem services. Nevertheless, potential areas for rewilding emerge in a variety of ways, from intensification elsewhere having a substantial but inadvertent land-sparing effect, popular demand for environmental restoration, or a desire for exclusive recreation among the wealthy elite. Our findings therefore imply substantial opportunities for rewilding in the United Kingdom but also a need for interventions to shape the nature and extent of that rewilding to maintain priority conservation areas and societal objectives.

Una evaluación del potencial futuro de la resilvestración en el Reino Unido Resumen La restauración de ecosistemas es urgente para abordar la pérdida de biodiversidad y el cambio climático, así como para lograr los objetivos del Marco Mundial de Biodiversidad de Kunming­Montreal. Un método de restauración, la resilvestración, puede ser particularmente prometedor, aunque también puede ser excluido por los requerimientos para otras formas de uso de suelo actuales o en el futuro. Este espacio de oportunidad es crítico, pero también un reto para evaluar. Exploramos el área potencial disponible para el resilvestrado en Gran Bretaña hasta el año 2080 con un modelo multisectorial de uso de suelo con varios escenarios climáticos y socioeconómicos. Para este año, las áreas entre 5,000 y 7,000 km2 no estaban gestionadas o lo estaban, pero de manera que podían ser consistentes con el resilvestrado de los escenarios sin conflictuar el suministro de servicios ambientales. Más allá de estas áreas, otros 24,000­42,000 km2 de gestión extensiva tierra arriba podrían proporcionar áreas adicionales para el resilvestrado si los patrones actuales de implementación siguen en pie en el futuro. Sin embargo, ninguna de estas áreas coincidió de manera confiable con los ecosistemas de prioridad para la conservación: las turberas, bosques antiguos o humedales. Estos ecosistemas aparecieron varias veces como vulnerables a la conversión. Nuestros resultados no están basados en una suposición de apoyo para o los beneficios de la resilvestración y no consideran las desventajas, como la pérdida potencial de paisajes culturales o las maneras tradicionales de manejo, que estaban fuera del alcance de los servicios ambientales modelados. Sin embargo, las áreas potenciales para el resilvestrado emergen en una variedad de formas, desde la intensificación en otros lugares con un efecto de ahorro de tierras sustancial pero inadvertido, la demanda popular por la restauración ambiental o el deseo de una recreación exclusiva entre la elite acaudalada. Por lo tanto, nuestros descubrimientos implican una oportunidad sustancial para la resilvestración en el Reino Unido, aunque también una necesidad de intervenciones para moldear la naturaleza y la extensión de ese resilvestrado para mantener las áreas prioritarias de conservación y los objetivos sociales.

Opportunity abandonment: Why are entrepreneurs vulnerable to type I and II errors?

Opportunity actualization is a critical competency attributed to entrepreneurs, which has received widespread attention in the entrepreneurship literature. However, the knowledge of Entrepreneurial Opportunity Abandonment (EOA) decisions is limited. We, therefore, explore the relatively under-studied EOA, analyzing why entrepreneurs commit decision errors, abandon potentially viable opportunities (type I error) or pursue non-opportunity spaces (type II error), and ultimately forsake them later. Through a scoping literature review, we highlight more profound psychological variables that shape entrepreneurial opportunity behavior triggering EOA decisions. We discuss entrepreneurial cognitive limitations in articulating, concretizing, and communicating the opportunity. We argue that varying construal mindsets cause reification fallacies and create perceptual blocks in enunciating an opportunity idea. Further, subjective stakeholder feedback and biased information exchange largely shape EOA decisions, which are mediated through the information processing capacity of entrepreneurs. Finally, we propose four entrepreneurial decision-limiting hypotheses which require an empirical investigation.

Prevention of treatment abandonment remains an important challenge to increase survival of Wilms tumor in sub-Saharan Africa: A report from Wilms Africa-CANCaRe Africa.

BACKGROUND: The Wilms Africa studies implemented an adapted Wilm's tumor (WT) treatment protocol in sub-Saharan Africa in two phases. Phase I began with four sites and provided out-of-pocket costs. Phase II expanded the number of sites, but lost funding provision. Objective is to describe the outcomes of Phase II and compare with Phase I. METHODS: Wilms Africa Phase I (n = 4 sites; 2014-2018) and Phase II (n = 8 sites; 2021-2022) used adapted treatment protocols. Funding for families' out-of-pocket costs was provided during Phase I but not Phase II. Eligibility criteria were age less than 16 years and newly diagnosed unilateral WT. We documented patients' outcome at the end of planned first-line treatment categorized as treatment abandonment, death during treatment, and disease-related events (death before treatment, persistent disease, relapse, or progressive disease). Sensitivity analysis compared outcomes in the same four sites. RESULTS: We included 431 patients in Phase I (n = 201) and Phase II (n = 230). The proportion alive without evidence of disease decreased from 69% in Phase I to 54% in Phase II at all sites (p = .002) and 58% at the original four sites (p = .04). Treatment abandonment increased overall from 12% to 26% (p < .001), and was 20% (p = .04) at the original four sites. Disease-related events (5% vs. 6% vs. 6%) and deaths during treatment (14% vs. 14% vs. 17%) were similar. CONCLUSION: Provision of out-of-pocket costs was important to improve patient outcomes at the end of planned first-line treatment in WT. Prevention of treatment abandonment remains an important challenge.

The post-emergence period for denning Polar Bears: phenology and influence on cub survival.

Among polar bears (Ursus maritimus), only parturient females den for extended periods, emerging from maternal dens in spring after having substantially depleted their energy reserves during a fast that can exceed 8 months. Although den emergence coincides with a period of increasing prey availability, polar bears typically do not depart immediately to hunt, but instead remain at the den for up to a month. This delay suggests that there are likely adaptive advantages to remaining at the den between emergence and departure, but the influence of the timing and duration of this post-emergence period on cub survival has not been evaluated previously. We used temperature and location data from 70 denning bears collared within the Southern Beaufort Sea and Chukchi Sea subpopulations to estimate the phenology of the post-emergence period. We evaluated the influence of various spatial and temporal features on duration of the post-emergence period and evaluated the potential influence of post-emergence duration on litter survival early in the spring following denning. For dens that likely contained viable cubs at emergence (n = 56), mean den emergence occurred on 16 March (SE = 1.4 days) and mean departure on 24 March (SE = 1.6 days), with dates typically occurring later in the Chukchi Sea relative to Southern Beaufort Sea and on land relative to sea ice. Mean duration of the post-emergence period was 7.9 days (SE = 1.4) for bears that were observed with cubs later in the spring, which was over 4 times longer than duration of those observed without cubs (1.9 days). Litter survival in the spring following denning (n = 31 dens) increased from 0.5 to 0.9 when duration of the post-emergence period increased by ~4 days and other variables were held at mean values. Our limited sample size and inability to verify cub presence at emergence suggests that future research is merited to improve our understanding of this relationship. Nonetheless, our results highlight the importance of the post-emergence period in contributing to reproductive success and can assist managers in developing conservation and mitigation strategies in denning areas, which will be increasingly important as human activities expand in the Arctic.

Sustaining altitude pastures in mountain landscapes-a fuzzy cognitive model approach.

Similarly to other European mountain areas, in Serra da Estrela the grazing pressure has been reducing due to social and economic drivers that have pushed shepherds and sheep to the foothill, or plainly out of the sector. Shrub encroachment on commons and other previously grazed land is one of the most tangible effects of pastoral abandonment in Serra de Estrela. The impacts of the resulting increase in landscape continuity and biomass availability were made clear in the severe fires of 2017 and 2022. As fire risk is likely to increase with climate change, it becomes urgent to understand what strategies can be deployed to keep fragmentation in these landscapes. Key actors such as shepherds should be involved in this discussion to understand their perceptions, points of view and reasons for abandoning upland pastures. In this study, we use fuzzy cognitive mapping to identify the key variables and mechanisms affecting the pastoral system according to local shepherds. In our study, we developed with local stakeholders a framework outlining the local pastoral system. Based on that, we carried out the fuzzy cognitive mapping collecting 14 questionnaires. We found that shepherds' income is a central issue, but that it is highly dependent on many factors. Increasing the Common Agricultural Policy payments alone is not enough to incentivise the use of upland pastures. More targeted strategies, such as more support for shrub clearing, and direct payments conditional to transhumance are more impactful. Despite a contentious discourse between conservation and shepherding values in Serra da Estrela, we find that shepherd's values are aligned with biodiversity conservation and a potential nature-based solution for minimizing fire risk through woody fuel management. This opens up possibilities for new governance strategies, that put Serra da Estrela's social, environmental and cultural values at its core.

Investigating Factors Associated with Migration and Cultural Adaptation in Relation to Change in Attitudes and Behavior towards Female Genital Mutilation/Cutting (FGM/C) among Populations from FGM/C-Practicing Countries Living in Western Countries: A Scoping Review.

A growing body of evidence indicates a significant decrease in support for female genital mutilation/cutting (FGM/C) within post-migration communities in Western countries. Addressing knowledge gaps and comprehending the factors associated with FGM/C discontinuation in these communities is crucial. The objective of this scoping review is to describe the effects of migration and cultural change on factors supporting FGM/C cessation in migrant communities. The review, from 2012 to 2023, included the following databases: Embase, PubMed, Google Scholar, Swisscovery, CINAHL, APA PsycInfo, and gray literature. Applying the PRISMA-ScR framework, we identified 2819 studies, with 17 meeting the inclusion criteria. The results revealed seven key factors shaping attitudes and behavior toward FGM/C abandonment: (1) legislation against FGM/C, (2) knowing that FGM/C is not a religious requirement, (3) enhancing education about the practice, (4) migration and cultural change, (5) awareness of the harmful effects of FGM/C, (6) a positive view of uncut girls, and (7) a sense of self-agency. These findings highlight factors on a social, community, interpersonal, and personal level that enhance the abandonment of the practice. Further research in the FGM/C field will gain more accuracy in understanding and accounting for these multilevel factors in post-migration settings, offering valuable insights for targeted interventions to promote the cessation of the practice.

Exploring the Role of Complexity in Health Care Technology Bottom-Up Innovations: Multiple-Case Study Using the Nonadoption, Abandonment, Scale-Up, Spread, and Sustainability Complexity Assessment Tool.

BACKGROUND: New digital technology presents new challenges to health care on multiple levels. There are calls for further research that considers the complex factors related to digital innovations in complex health care settings to bridge the gap when moving from linear, logistic research to embracing and testing the concept of complexity. The nonadoption, abandonment, scale-up, spread, and sustainability (NASSS) framework was developed to help study complexity in digital innovations. OBJECTIVE: This study aims to investigate the role of complexity in the development and deployment of innovations by retrospectively assessing challenges to 4 digital health care innovations initiated from the bottom up. METHODS: A multicase retrospective, deductive, and explorative analysis using the NASSS complexity assessment tool LONG was conducted. In total, 4 bottom-up innovations developed in Region Västra Götaland in Sweden were explored and compared to identify unique and shared complexity-related challenges. RESULTS: The analysis resulted in joint insights and individual learning. Overall, the complexity was mostly found outside the actual innovation; more specifically, it related to the organization's readiness to integrate new innovations, how to manage and maintain innovations, and how to finance them. The NASSS framework sheds light on various perspectives that can either facilitate or hinder the adoption, scale-up, and spread of technological innovations. In the domain of condition or diagnosis, a well-informed understanding of the complexity related to the condition or illness (diabetes, cancer, bipolar disorders, and schizophrenia disorders) is of great importance for the innovation. The value proposition needs to be clearly described early to enable an understanding of costs and outcomes. The questions in the NASSS complexity assessment tool LONG were sometimes difficult to comprehend, not only from a language perspective but also due to a lack of understanding of the surrounding organization's system and its setting. CONCLUSIONS: Even when bottom-up innovations arise within the same support organization, the complexity can vary based on the developmental phase and the unique characteristics of each project. Identifying, defining, and understanding complexity may not solve the issues but substantially improves the prospects for successful deployment. Successful innovation within complex organizations necessitates an adaptive leadership and structures to surmount cultural resistance and organizational impediments. A rigid, linear, and stepwise approach risks disregarding interconnected variables and dependencies, leading to suboptimal outcomes. Success lies in embracing the complexity with its uncertainty, nurturing creativity, and adopting a nonlinear methodology that accommodates the iterative nature of innovation processes within complex organizations.

Ungulates mitigate the effects of drought and shrub encroachment on the fire hazard of Mediterranean oak woodlands.

Climate change is increasing the frequency of droughts and the risk of severe wildfires, which can interact with shrub encroachment and browsing by wild ungulates. Wild ungulate populations are expanding due, among other factors, to favorable habitat changes resulting from land abandonment or land-use changes. Understanding how ungulate browsing interacts with drought to affect woody plant mortality, plant flammability, and fire hazard is especially relevant in the context of climate change and increasing frequency of wildfires. The aim of this study is to explore the combined effects of cumulative drought, shrub encroachment, and ungulate browsing on the fire hazard of Mediterranean oak woodlands in Portugal. In a long-term (18 years) ungulate fencing exclusion experiment that simulated land abandonment and management neglect, we investigated the population dynamics of the native shrub Cistus ladanifer, which naturally dominates the understory of woodlands and is browsed by ungulates, comparing areas with (no fencing) and without (fencing) wild ungulate browsing. We also modeled fire behavior in browsed and unbrowsed plots considering drought and nondrought scenarios. Specifically, we estimated C. ladanifer population density, biomass, and fuel load characteristics, which were used to model fire behavior in drought and nondrought scenarios. Overall, drought increased the proportion of dead C. ladanifer shrub individuals, which was higher in the browsed plots. Drought decreased the ratio of live to dead shrub plant material, increased total fuel loading, shrub stand flammability, and the modeled fire parameters, that is, rate of surface fire spread, fireline intensity, and flame length. However, total fuel load and fire hazard were lower in browsed than unbrowsed plots, both in drought and nondrought scenarios. Browsing also decreased the population density of living shrubs, halting shrub encroachment. Our study provides long-term experimental evidence showing the role of wild ungulates in mitigating drought effects on fire hazard in shrub-encroached Mediterranean oak woodlands. Our results also emphasize that the long-term effects of land abandonment can interact with climate change drivers, affecting wildfire hazard. This is particularly relevant given the increasing incidence of land abandonment.

Implementation of Video-Based Care in Interdisciplinary Primary Care Settings at the Veterans Health Administration: Qualitative Study.

BACKGROUND: With the rapid shift to telehealth, there remains a knowledge gap in how video-based care is implemented in interdisciplinary primary care (PC) settings. OBJECTIVE: The objective of this study was to gain an in-depth understanding of how video telehealth services were implemented in PC from the perspectives of patients and interdisciplinary PC team members at the Veterans Health Administration (VHA) 2 years after the onset of the COVID-19 pandemic. METHODS: We applied a positive and negative deviance approach and selected the 6% highest (n=8) and the 6% lowest (n=8) video-using PC sites in 2022 from a total of 130 VHA medical centers nationally. A total of 12 VHA sites were included in the study, where 43 PC interdisciplinary team members (August-October 2022) and 25 patients (February-May 2023) were interviewed. The 5 domains from the diffusion of innovation theory and the nonadoption, abandonment, scale-up, spread, and sustainability (NASSS) framework guided the development of the 2 study interview guides (provider and patient). We identified themes that emerged across all interviews that were associated with the implementation of video-based care in interdisciplinary PC settings, using directed-content rapid analysis of the interview transcripts. The analysis was guided by 5 a priori NASSS domains: (1) patient condition or characteristic, (2) technology, (3) adopter system, (4) health care organization, and (5) adaptation over time. RESULTS: The study findings include the following common themes and factors, organized by the 5 NASSS domains: (1) patient condition or characteristic-visit type or purpose (eg, follow-up visits that do not require physical examination), health condition (eg, homebound or semihomebound patients), and sociodemographic characteristic (eg, patients who have a long commute time); (2) technology-key features (eg, access to video-enabled devices), knowledge (eg, how to use videoconferencing software), and technical support for patients and providers; (3) adopter system-changes in staff roles and clinical practice (eg, coordination of video-based care), provider and patient preference or comfort to use video-based care, and caregiver's role (eg, participation of caregivers during video visits); (4) health care organization-leadership support and access to resources, scheduling for video visits (eg, schedule or block off digital half or full days), and training and telehealth champions (eg, hands-on or on-site training for staff, patients, or caregivers); (5) adaptation over time-capacity to improve all aspects of video-based care and provide continued access to resources (eg, effective communication about updates). CONCLUSIONS: This study identified key factors associated with the implementation of video-based services in interdisciplinary PC settings at the VHA from the perspectives of PC team members and patients. The identified multifaceted factors may inform recommendations on how to sustain and improve the provision of video-based care in VHA PC settings as well as non-VHA patient-centered medical homes.

Female genital mutilation: trends, economic burden of delay and basis for public health interventions.

BACKGROUND: The practice of female genital mutilation (FGM) is a health and social problem. Millions of girls and women have undergone FGM or will soon, and more information is needed to effectively reduce the practice. The aim of this research is to provide an overview of the FGM trendlines, the inequality of its prevalence, and the economic burden. The findings shed light on 30-year trends and the impact of the pandemic on planned efforts to reduce FGM which helps with public health interventions. METHODS: Temporal trend analysis, and graphical analysis were used to assess the change and inequality over the last 30 years. We included 27 countries in which FGM is prevalent. We calculated the extra economic burden of delayed interventions to reduce FGM like COVID-19. RESULTS: For the 27 countries analyzed for temporal trendlines, 13 countries showed no change over time while 14 had decreasing trends. Among the 14, nine countries, Uganda, Togo, Ghana, Benin, Kenya, Nigeria, Central African Republic, Chad, and Ethiopia had high year-decrease (CAGR - 1.01 and - 10.26) while five, Côte d'Ivoire, Egypt, Gambia, Djibouti, and Mali had low year-decrease (CAGR>-1 and < 0). Among these five are the highest FGM prevalence similar distribution regardless the wealth quintiles or residence. There is an economic burden of delay or non-decline of FGM that could be averted. CONCLUSION: Findings indicate that some countries show a declining trend over time while others not. It can be observed that there is heterogeneity and homogeneity in the FGM prevalence within and between countries which may indicate inequality that deserves further investigation. There is considerable economic burden due to delays in the implementation of interventions to reduce or eliminate FGM. These insights can help in the preparation of public health interventions.

Corrigendum: Landscape of pediatric cancer treatment refusal and abandonment in the US: a qualitative study.

[This corrects the article DOI: 10.3389/fped.2022.1049661.].

Factors Influencing Duration of Breastfeeding: Insights from a Prospective Study of Maternal Health Literacy and Obstetric Practices.

Numerous factors concerning early breastfeeding abandonment have been described, including health literacy (HL). This study's objective was to analyze factors related to early breastfeeding abandonment (<6 months). This prospective multicentric study examined the duration of breastfeeding at 6 months postpartum and was conducted in four different regions of Spain from January 2021 to January 2023. A total of 275 women participated in this study, which focused on maternal HL and obstetric practices. A decrease in the breastfeeding rate was observed from hospital discharge (n = 224, 81.5%) to the sixth month postpartum (n = 117, 42.5%). A Cox regression analysis revealed that inadequate HL levels, lack of mobilization during labour, and induced labour were significantly associated with early breastfeeding cessation (p = 0.022, p = 0.019, and p = 0.010, respectively). The results highlight that women with adequate HL had a 32% lower risk of early breastfeeding abandonment. In comparison, mobilization during labour and induction of labour were linked to a 32.4% reduction and a 53.8% increase in this risk, respectively. These findings emphasize the importance of considering obstetric and HL factors when addressing the breastfeeding duration, indicating opportunities for educational and perinatal care interventions.

A spatial dataset about short-term land system dynamics (2005-2015) in the Mediterranean basin.

Mediterranean land systems are undergoing significant changes in terms of agricultural land use and practices. The location and nature of agricultural areas in the Mediterranean basin are changing following a set of tensions and opportunities taking place both locally and in the entire basin. This dataset presents the main short-term land system dynamics (2005-2015) and their location on the whole Mediterranean basin. The dataset is based on existing land use map and available data about agricultural surface distribution, and it is obtained through a classification process of the land systems on the two analyzed data (2005 and 2015) and a subsequent change detection between the two obtained maps. It covers all the Mediterranean bioclimatic area in pixels of 2 km spatial resolution, harmonizing information from the northern and southern side of the basin. We identified different types of changes, and the most relevant in terms of surfaces are: (1) from mixed agriculture to specialized fruit groves; (2) from agricultural areas to urban and/or periurban areas; (3) from agroforestry to arable systems, and (4) from predominantly bare soils to agricultural areas. This data can be used for further analysis to assess underlying trajectories, and the impact of the observed dynamics on biodiversity and the provision of ecosystem services, as well as on the organization of the food system.

Primary abandonment of the sac in the management of scrotal hernias: a dual-institution experience of short-term outcomes.

PURPOSE: Management of scrotal hernias presents as a common challenge, with operative interventions to address these hernias associated with higher rates of morbidity compared to those of less-complex pathology. Surgeons have advocated for the use of techniques such as primary abandonment of the distal sac as a potential means to reduce complications for operative intervention, with preliminary findings demonstrating feasibility. We sought to assess outcomes related to primary sac abandonment among patients undergoing minimally invasive (MIS) repair of scrotal hernias. METHODS: A review of prospectively maintained databases among two academic hernia centers was conducted to identify patients who underwent MIS inguinal hernia repairs with primary sac abandonment. Patient demographics, hernia risk factors, intraoperative factors, and postoperative outcomes were evaluated. Short-term outcomes related to patient-reported experiences and surgical-site occurrences requiring procedural intervention were queried. RESULTS: Sixty-seven male patients [median age: 51.6 years; interquartile range (IQR): 45-65 years] underwent inguinal hernia repair with primary sac abandonment. Anatomic polypropylene mesh was used in 98.5% cases. Rates of postoperative complications were low and included postoperative urinary retention (6%), clinically identified or patient-reported seromas/hematomas within a 30-day follow-up period (23.9%), deep venous thrombosis (1.5%), and pelvic hematoma (1.5%). No seromas or hematomas necessitated procedural interventions, with resolution of symptoms within three months of their operation date. CONCLUSION: We report a multi-center experience of patients managed with primary abandonment of the sac technique during repair of inguinoscrotal hernias. Utilization of this technique appears to be safe and reproducible with a low burden of short-term complications.

Ethical Concerns about Fashionable Dog Breeding.

The historical relationship between humans and dogs has involved selective breeding for various purposes, such as hunting, guarding, and service roles. However, over time, there has been a shift in preferences from functionality to aesthetics, which has influenced the diverse sizes, shapes, and coats of dog breeds. This review looks at fashionable dog breeding and questions the ethics of prioritising looks over health and behaviour. It aims to alert potential owners, breeders, and regulators to the importance of considering a dog's overall well-being, not just its appearance, which has resulted in fad breeding, leading to genetic disorders, health issues, and a loss of biodiversity. Ethical concerns arise from breeding brachycephalic breeds with respiratory conditions, inbreeding causing inherited disorders, and overbreeding popular breeds while shelter dogs remain unadopted. Additionally, the impact of cosmetic surgeries on popular dog breeds, as well as the neglect of behavioural traits in favour of physical characteristics and strict breeding practices are also considered. The current breeding model can have a negative impact on the emotional and cognitive well-being of dogs, resulting in issues such as aggression, anxiety, and other behavioural problems that can significantly reduce their overall quality of life. Unregulated breeding practices and the demand for rare breeds can lead to illegal breeding, compromising animal welfare. Prospective owners, veterinarians, kennel clubs, and legislators all need to play a responsible role in protecting animals.

Long-term outcomes with abandoning versus extracting sterile leads: A 10-year population-based study.

BACKGROUND: Long-term outcomes of sterile lead management strategies of lead abandonment (LA) or transvenous lead extraction (TLE) remain unclear. METHODS: We performed a retrospective study of a population residing in southeastern Minnesota with follow-up at the Mayo Clinic and its health systems. Patients who underwent LA or TLE of sterile leads from January 1, 2000, to January 1, 2011, and had follow-up for at least 10 years or until their death were included. RESULTS: A total of 172 patients were included in the study with 153 patients who underwent LA and 19 who underwent TLE for sterile leads. Indications for subsequent lead extraction arose in 9.1% (n = 14) of patients with initial LA and 5.3% (n = 1) in patients with initial TLE, after an average of 7 years. Moreover, 28.6% of patients in the LA cohort who required subsequent extraction did not proceed with the extraction, and among those who proceeded, 60% had clinical success and 40% had a clinical failure. Subsequent device upgrades or revisions were performed in 18.3% of patients in the LA group and 31.6% in the TLE group, with no significant differences in procedural challenges (5.2% vs. 5.3%). There was no difference in 10-year survival probability among the LA group and the TLE group (p = .64). CONCLUSION: An initial lead abandonment strategy was associated with more complicated subsequent extraction procedures compared to patients with an initial transvenous lead extraction strategy. However, there was no difference in 10-year survival probability between both lead management approaches.

Twelve-year conversion of rice paddy to wetland does not alter SOC content but decreases C decomposition and N mineralization in Japan.

Land-use change worldwide has been driven by anthropogenic activities, which profoundly regulates terrestrial C and N cycles. However, it remains unclear how the dynamics and decomposition of soil organic C (SOC) and N respond to long-term conversion of rice paddy to wetland. Here, soil samples from five soil depths (0-25 cm, 5 cm/depth) were collected from a continuous rice paddy and an adjacent wetland (a rice paddy abandoned for 12 years) on Shonai Plain in northeastern Japan. A four-week anaerobic incubation experiment was conducted to investigate soil C decomposition and N mineralization. Our results showed that SOC in the wetland and rice paddy decreased with soil depth, from 31.02 to 19.66 g kg-1 and from 30.26 to 18.86 g kg-1, respectively. There was no significant difference in SOC content between wetland and rice paddy at any depth. Soil total nitrogen (TN) content in the wetland (2.61-1.49 g kg-1) and rice paddy (2.91-1.78 g kg-1) showed decreasing trend with depth; TN was significantly greater in the rice paddy than in the wetland at all depths except 20-25 cm. Paddy soil had significantly lower C/N ratios but significantly larger decomposed C (Dec-C, CO2 and CH4 production) and mineralized N (Min-N, net NH4+-N production) than wetland soil across all depths. Moreover, the Dec-C/Min-N ratio was significantly larger in wetland than in rice paddy across all depths. Rice paddy had higher exponential correlation between Dec-C and SOC, Min-N and TN than wetland. Although SOC did not change, TN decreased by 14.1% after the land-use conversion. The Dec-C and Min-N were decreased by 32.7% and 42.2%, respectively, after the12-year abandonment of rice paddy. Conclusively, long-term conversion of rice paddy to wetland did not distinctly alter SOC content but increased C/N ratio, and decreased C decomposition and N mineralization in 0-25 cm soil depth.