Human papillomavirus vaccination coverage among young women in the three sub-Saharan African countries using Demographic and Health Surveys data.

Cervical cancer is the fourth most common cancer, with 99% of cases linked to human papillomavirus (HPV) infection. It reflects global inequity as its burden is highest in low- and middle-income countries. The aim of this study was to determine the HPV vaccination coverage and its determinant factors among young women in the three sub-Saharan African countries. Data from the Demographic and Health Surveys among three sub-Saharan African countries were used for analysis. A total of 4,952 women were included in the study. Stata 14 was used to analyze the data. The determinants of the outcome variable were identified using a multilevel mixed-effects logistic regression model. Factors with p-values < 0.05 at 95% confidence interval were declared statistically significant. About 7.5% young women were vaccinated for HPV vaccine against cervical cancer in the current study. Younger age, use of internet, rich economic class, and individual-level media exposure were found to be favorable conditions, whereas being employed was negatively associated with HPV vaccination. Only few segments of young women in these three countries got HPV vaccination. The authors recommend that increasing internet use, media exposure, and economic level of young women will increase the HPV vaccination rates. Furthermore, creating awareness among employed women will also increase the possibility of HPV vaccination.

Quantitative comparison of bile acid glucuronides sub-metabolome between intrahepatic cholestasis and healthy pregnant women.

Because of the pathological indication and the physiological functions, bile acids (BAs) have occupied the research hotspot in recent decades. Although extensive efforts have been paid onto BAs sub-metabolome characterization, as the subfamily, BA glucuronides (gluA-BAs) profile is seldom concerned. Here, we made efforts to develop a LC-MS/MS program enabling quantitative gluA-BAs sub-metabolome characterization and to explore the differential species in serum between intrahepatic cholestasis of pregnancy (ICP) patients and healthy subjects. To gain as many authentic gluA-BAs as possible, liver microsomes from humans, rats, and mice were deployed to conjugate glucuronyl group to authentic BAs through in vitro incubation. Eighty gluA-BAs were captured and subsequently served as authentic compounds to correlate MS/MS spectral behaviors to structural features using squared energy-resolved MS program. Optimal collision energy (OCE) of [M-H]->[M-H-176.1]- was jointly administrated by [M-H]- mass and glucuronidation site, and identical exciting energies corresponding to 50% survival rate of 1st-generation fragment ion (EE50) were observed merely when the aglycone of a gluA-BA was consistent with the suspected structure. Through integrating high-resolution m/z, OCE, and EE50 information to identify gluA-BAs in a BAs pool, 97 ones were found and identified, and further, quantitative program was built for all annotated gluA-BAs by assigning OCEs to [M-H]->[M-H-176.1]- ion transitions. Quantitative gluA-BAs sub-metabolome of ICP was different from that of the healthy group. More GCDCA-3-G, GDCA-3-G, TCDCA-7-G, TDCA-3-G, and T-ß-MCA-3-G were distributed in the ICP group. Above all, this study not only offered a promising analytical tool for in-depth gluA-BAs sub-metabolome characterization, but also clarified gluA-BAs allowing the differentiation of ICP and healthy subjects.

SARS-CoV-2 seroprevalence among Beninese pregnant women in the third year of the pandemic.

BACKGROUND: Pregnant women are a vulnerable population to COVID-19 given an increased susceptibility to severe SARS-CoV-2 infection and pregnancy complications. However, few SARS-CoV-2 serological surveys have been performed among this population to assess the extent of the infection in sub-Saharan countries. The objectives of this study were to determine SARS-CoV-2 seroprevalence among Beninese pregnant women, to identify spatial seropositivity clusters and to analyse factors associated with the infection. METHODS: A cross-sectional study including women in their third trimester of pregnancy attending the antenatal care (ANC) clinics at Allada (south Benin) and Natitingou (north Benin) was conducted. Rapid diagnostic tests (RDT) for detection of IgG/IgM against the SARS-CoV-2 spike protein were performed using capillary blood. Seroprevalence of SARS-CoV-2 antibodies and associations between SARS-CoV-2 serostatus and maternal characteristics were analyzed by multivariate logistic regression. Spatial analyses were performed using the spatial scan statistics to identify spatial clusters of SARS-CoV-2 infection. RESULTS: A total of 861 pregnant women were enrolled between May 4 and June 29, 2022. 58/861 (6.7%) participants reported having received COVID-19 vaccine. None of the participants had been diagnosed with COVID-19 during their pregnancy. SARS-CoV-2 antibodies were detected in 607/802 (75.7%; 95% CI 72.56%-78.62%) of unvaccinated participants. Several urban and rural spatial clusters of SARS-CoV-2 cases were identified in Allada and one urban spatial cluster was identified in Natitingou. Unvaccinated participants from Allada with at least one previous morbidity were at a three-times higher risk of presenting SARS-CoV-2 antibodies (OR = 2.89; 95%CI 1.19%-7.00%). CONCLUSION: Three out of four pregnant women had SARS-CoV-2 antibodies, suggesting a high virus circulation among pregnant women in Benin, while COVID-19 vaccination coverage was low. Pregnant women with comorbidities may be at increased risk of SARS-CoV-2 infection. This population should be prioritized for COVID-19 diagnosis and vaccination in order to prevent its deleterious effects. TRIAL REGISTRATION: NCT06170320 (retrospectively registered on December 21, 2023).

Current status data with two competing risks and time-dependent missing failure types.

In competing risks data, in practice, there may be lack of information or uncertainty about the true failure type, termed as 'missing failure type', for some subjects. We consider a general pattern of missing failure type in which we observe, if not the true failure type, a set of possible failure types containing the true one. In this work, we focus on both parametric and non-parametric estimation based on current status data with two competing risks and the above-mentioned missing failure type. Here, the missing probabilities are assumed to be time-dependent, that is, dependent on both failure and monitoring time points, in addition to being dependent on the true failure type. This makes the missing mechanism non-ignorable. We carry out maximum likelihood estimation and obtain the asymptotic properties of the estimators. Simulation studies are conducted to investigate the finite sample properties of the estimators. Finally, the methods are illustrated through a data set on hearing loss.

Prediction of frequency response of sub-frame bushing and study of high-order fractional derivative viscoelastic model.

This paper presents experimental and dynamic modeling research on the rubber bushings of the rear sub-frame. The Particle Swarm Optimization algorithm was utilized to optimize a Backpropagation (BP) neural network, which was separately trained and tested across two frequency ranges: 1-40 Hz and 41-50 Hz, using wideband frequency sweep dynamic stiffness test data. The testing errors at amplitudes of 0.2 mm, 0.3 mm, and 0.5 mm were found to be 1.03%, 3.05%, and 1.96%, respectively. Subsequently, the trained neural network was employed to predict data within the frequency range of 51-70 Hz. To incorporate the predicted data into simulation software, a dynamic model of the rubber bushing was established, encompassing elastic, friction, and viscoelastic elements. Additionally, a novel model, integrating high-order fractional derivatives, was proposed based on the frequency-dependent model for the viscoelastic element. An enhanced Particle Swarm Optimization algorithm was introduced to identify the model's parameters using the predicted data. In comparison to the frequency-dependent model, the new model exhibited lower fitting errors at various amplitudes, with reductions of 3.84%, 3.61%, and 5.49%, respectively. This research establishes a solid foundation for subsequent vehicle dynamic modeling and simulation.

Hydroxychloroquine-azithromycin, doubase C, and QTc prolongation in congolese patients with COVID-19: Myth or reality?

BACKGROUND: QTc interval prolongation with an increased risk of torsade de pointes (Tsd) has been described in coronavirus disease 2019 (COVID-19) patients treated with hydroxychloroquine (HCQ) and azithromycin (AZI) in Western countries. In the DR Congo, few studies have evaluated the safety of this association or proposed new molecules. AIM: To determine the incidence of QTc prolongation and Tsd in COVID-19 patients treated with HCQ-AZIs vs doubase C (new molecule). METHODS: In present randomized clinical trial, we have included patients with mild or moderate COVID-19 treated with either HCQ-AZI or doubase C. Electrocardiogram (ECG) changes on day 14 of randomization were determined based on pretreatment tracing. Prolonged QTc was defined as ≥ 500 ms on day 14 or an increase of ≥ 80 ms compared to pretreatment tracing. Patients with cardiac disease, those undergoing other treatments likely to prolong QTc, and those with disturbed ECG tracings were excluded from the study. RESULTS: The study included 258 patients (mean age 41 ± 15 years; 52% men; 3.4% diabetics, 11.1% hypertensive). Mild and moderate COVID-19 were found in 93.5% and 6.5% of patients, respectively. At baseline, all patients had normal sinus rhythm, a mean heart rate 78 ± 13/min, mean PR space 170 ± 28 ms, mean QRS 76 ± 13 ms, and mean QTc 405 ± 30 ms. No complaints suggesting cardiac involvement were reported during or after treatment. Only four patients (1.5%) experienced QTc interval prolongation beyond 500 ms. Similarly, only five patients (1.9%) had an increase in the QTc interval of more than 80 ms. QTc prolongation was more significant in younger patients, those with high viral load at baseline, and those receiving HCQ-AZI (P < 0.05). None of the patients developed Tsd. CONCLUSION: QTc prolongation without Tsd was observed at a lower frequency in patients treated with HCQ-AZI vs doubase C. The absence of comorbidities and concurrent use of other products that are likely to cause arrhythmia may explain our results.

Evaluation of Doctors' Knowledge, Attitudes, Behaviors, Awareness and Practices on Rational Antimicrobial Stewardship in a Training and Research Hospital in Mogadishu-Somalia.

Introduction: Historically, antimicrobials have been used to treat microbial illnesses in humans and animals. But throughout this time, antibiotics that had been successful against particular microorganisms started to lose their effectiveness due to rising inappropriate use brought on by ignorance, negligent attitudes, and improper methods. Our goal in conducting this study was to ascertain the knowledge, attitudes, and practices of doctors with relation to the use of antibiotics in light of the growing global and Sub-Saharan African problem of antimicrobial resistance. Methods: In a tertiary hospital in Mogadishu, Somalia, a cross-sectional survey study was carried out to assess experts' and research assistants' knowledge, attitudes, behavior, awareness, and practices regarding the use of antibiotics and antibiotic resistance. A questionnaire consisting of 2 sections and 22 questions was applied to the participants on a voluntary basis. Results: Among the 202 doctors that participated in the study, 49 (24.3%) were specialists, and 153 (75.7%) were assistants. Prescriptions for one to ten antibiotic boxes per week on average were reported by 146 respondents (72.3%). Of the physicians, just 27 (13.4%) did not require assistance when prescribing an antibiotic. The most often accessed sources of support were experts in infectious diseases (43.1%) and national/international antimicrobial guidelines (32.2%). The top three factors contributing to antibiotic resistance in Somalia include misuse of antibiotics (61.4%), unnecessary prescriptions written by doctors (44.6%), and an absence of infectious disease specialists in most institutions (44.1%). Conclusion: As an alarming level of antimicrobial resistance has been observed globally in recent years, the results of our survey will help educate our doctors by gauging their perceptions, attitudes, and knowledge about rational antibiotic use in Sub-Saharan Africa. This will provide better patient outcomes.

Male-biased recombination at chromosome ends in a songbird revealed by precisely mapping crossover positions.

Recombination plays a crucial role in evolution by generating novel haplotypes and disrupting linkage between genes, thereby enhancing the efficiency of selection. Here, we analyse the genomes of twelve great reed warblers (Acrocephalus arundinaceus) in a three-generation pedigree to identify precise crossover positions along the chromosomes. We located more than 200 crossovers and found that these were highly concentrated towards the telomeric ends of the chromosomes. Apart from this major pattern in the recombination landscape, we found significantly higher frequencies of crossovers in genic compared to intergenic regions, and in exons compared to introns. Moreover, while the number of recombination events was similar between the sexes, the crossovers were located significantly closer to the ends of paternal compared to maternal chromosomes. In conclusion, our study of the great reed warbler revealed substantial variation in crossover frequencies within chromosomes, with a distinct bias towards the sub-telomeric regions, particularly on the paternal side. These findings emphasise the importance of thoroughly screening the entire length of chromosomes to characterise the recombination landscape and uncover potential sex-biases in recombination.

Cervical cancer prevention and care in HIV clinics across sub-Saharan Africa: results of a facility-based survey.

INTRODUCTION: To eliminate cervical cancer (CC), access to and quality of prevention and care services must be monitored, particularly for women living with HIV (WLHIV). We assessed implementation practices in HIV clinics across sub-Saharan Africa (SSA) to identify gaps in the care cascade and used aggregated patient data to populate cascades for WLHIV attending HIV clinics. METHODS: Our facility-based survey was administered between November 2020 and July 2021 in 30 HIV clinics across SSA that participate in the International epidemiology Databases to Evaluate AIDS (IeDEA) consortium. We performed a qualitative site-level assessment of CC prevention and care services and analysed data from routine care of WLHIV in SSA. RESULTS: Human papillomavirus (HPV) vaccination was offered in 33% of sites. Referral for CC diagnosis (42%) and treatment (70%) was common, but not free at about 50% of sites. Most sites had electronic health information systems (90%), but data to inform indicators to monitor global targets for CC elimination in WLHIV were not routinely collected in these sites. Data were collected routinely in only 36% of sites that offered HPV vaccination, 33% of sites that offered cervical screening and 20% of sites that offered pre-cancer and CC treatment. CONCLUSIONS: Though CC prevention and care services have long been available in some HIV clinics across SSA, patient and programme monitoring need to be improved. Countries should consider leveraging their existing health information systems and use monitoring tools provided by the World Health Organization to improve CC prevention programmes and access, and to track their progress towards the goal of eliminating CC.

Type 2 Myocardial Infarction in a Sub-Saharan Africa Population: Challenging the Current Concepts-Data From REACTIV.

BACKGROUND: From a large observational acute coronary syndrome registry in Côte d'Ivoire, we aimed to assess incidence, clinical presentation, management, and in-hospital outcomes for type 2 myocardial infarction (T2MI) compared with type 1 MI. METHODS AND RESULTS: We conducted a cross-sectional monocentric study using data from REACTIV (Registre des Infarctus de Côte d'Ivoire) at the Abidjan Heart Institute. All patients hospitalized with MI between 2018 and 2022 who underwent coronary angiography were included. For each patient, sociodemographic data, cardiovascular risk factors and history, and clinical and paraclinical presentation were collected at admission. In-hospital outcomes, including major adverse cardiovascular events and mortality, were reported. Among 541 consecutive patients hospitalized with MI, 441 met the definition of type 1 MI or T2MI. T2MI accounted for 14.1% of cases. Patients with T2MI showed a trend toward slightly younger age (54 versus 58 years, P=0.09). Patients with T2MI seemed to have less severe coronary artery disease, with less frequent multivessel disease (P<0.001). Main triggering factors for T2MI were coronary embolism (24.2%), severe hypertension with or without left ventricular hypertrophy (22.6%), and tachyarrhythmia (16.1%). In-hospital event rates were low in both MI types. Although the difference was nonsignificant, death rates for patients with type 1 MI tended to be higher than for patients with T2MI, as well as occurrence of major adverse cardiovascular events. CONCLUSIONS: Our study revealed disparities in clinical characteristics, angiographic features, cause, and in-hospital outcomes in T2MI in our population compared with Western populations. These results suggest the heterogeneity of T2MI and the potential causative and demographic variability depending on geographical area.

Prevalence and correlates of female genital mutilation among young women in selected sub-Saharan African countries: A pooled analysis.

A deeper understanding of the factors associated with female genital mutilation remains important in the fight against this practice, particularly in developing countries. This study focused on young women (15-35 years) and pooled analysis using DHS data (2015-2019) for selected sub-Saharan African countries was done. The weighted study sample was 26289 and the data were analysed using univariate, bivariate and multivariate regression analysis. The results are based on information at the time of the survey. The overall prevalence of FGM among young women from the selected countries was 71.5%. Sierra Leone had the highest prevalence (83.7%), followed by Tanzania (80.8%), Ethiopia (73.0%), and Gambia (72.4%). The prevalence in Senegal and Guinea were both below 60%. We found that age, level of education, age at first marriage, parity, employment status, media exposure, and type of place of residence were statistically associated with FGM. This calls for targeted interventions focusing on increasing awareness, education, and empowerment for young women with low socio-economic status.

Une compréhension plus approfondie des facteurs associés aux mutilations génitales féminines reste importante dans la lutte contre cette pratique, en particulier dans les pays en développement. Cette étude s'est concentrée sur les jeunes femmes (15-35 ans) et une analyse groupée utilisant les données DHS (2015-2019) pour certains pays d'Afrique subsaharienne a été réalisée. L'échantillon pondéré de l'étude était de 26 289 et les données ont été analysées à l'aide d'une analyse de régression univariée, bivariée et multivariée. Les résultats sont basés sur les informations disponibles au moment de l'enquête. La prévalence globale des MGF parmi les jeunes femmes des pays sélectionnés était de 71,5 %. La Sierra Leone avait la prévalence la plus élevée (83,7 %), suivie par la Tanzanie (80,8 %), l'Éthiopie (73,0 %) et la Gambie (72,4 %). La prévalence au Sénégal et en Guinée était inférieure à 60 %. Nous avons constaté que l'âge, le niveau d'éducation, l'âge au premier mariage, la parité, la situation professionnelle, l'exposition aux médias et le type de lieu de résidence étaient statistiquement associés aux MGF. Cela nécessite des interventions ciblées axées sur la sensibilisation, l'éducation et l'autonomisation des jeunes femmes ayant un statut socio-économique faible.

The Value of Radiomics Features Based on HRCT in Predicting whether the Lung Sub-Centimeter Pure Ground Glass Nodule is Benign or Malignant.

OBJECTIVE: In this study, a radiomics model was created based on High-Resolution Computed Tomography (HRCT) images to noninvasively predict whether the sub-centimeter pure Ground Glass Nodule (pGGN) is benign or malignant. METHODS: A total of 235 patients (251 sub-centimeter pGGNs) who underwent preoperative HRCT scans and had postoperative pathology results were retrospectively evaluated. The nodules were randomized in a 7:3 ratio to the training (n=175) and the validation cohort (n=76). The volume of interest was delineated in the thin-slice lung window, from which 1316 radiomics features were extracted. The Least Absolute Shrinkage and Selection Operator (LASSO) was used to select the radiomics features. Univariate and multivariable logistic regression were used to evaluate the independent risk variables. The performance was assessed by obtaining Receiver Operating Characteristic (ROC) curves for the clinical, radiomics, and combined models, and then the Decision Curve Analysis (DCA) assessed the clinical applicability of each model. RESULTS: Sex, volume, shape, and intensity mean were chosen by univariate analysis to establish the clinical model. Two radiomics features were retained by LASSO regression to build the radiomics model. In the training cohort, the Area Under the Curve (AUC) of the radiomics (AUC=0.844) and combined model (AUC=0.871) was higher than the clinical model (AUC=0.773). In evaluating whether or not the sub-centimeter pGGN is benign, the DCA demonstrated that the radiomics and combined model had a greater overall net benefit than the clinical model. CONCLUSION: The radiomics model may be useful in predicting the benign and malignant sub-centimeter pGGN before surgery.

Healthcare system barriers and facilitators to hypertension management in Ghana.

Background: Hypertension continues to pose a significant burden on the health systems in Sub-Saharan Africa (SSA). Multiple challenges at the health systems level could impact patients' blood pressure outcomes. There is a need to understand the gaps in health systems to improve their readiness to manage the rising burden of hypertension Objective: To explore health system barriers and opportunities for improved management of hypertension in Ghana, West Africa. Methods: We conducted 5 focus group discussions involving 9 health facility leaders and 24 clinicians involved in hypertension treatment at 15 primary-level health facilities in Kumasi, Ghana. We held discussions remotely over Zoom and used thematic analysis methods. Results: Four themes emerged from the focus group discussions: (1) financial and geographic inaccessibility of hypertension services; (2) facilities' struggle to maintain the supply of antihypertensive medications and providers' perceptions of suboptimal quality of insured medications; (3) shortage of healthcare providers, especially physicians; and (4) patients' negative self-management practices. Facilitators identified included presence of wellness and hypertension clinics for screening and management of hypertension at some health facilities, nurses' request for additional roles in hypertension management, and the rising positive practice of patient home blood pressure monitoring. Conclusion: Our findings highlight critical barriers to hypertension service delivery and providers' abilities to provide quality services. Health facilities should build on ongoing innovations in hypertension screening, task-shifting strategies, and patient self-management to improve hypertension control. In Ghana and other countries, policies to equip healthcare systems with the resources needed for hypertension management could lead to a high improvement in hypertension outcomes among patients.

Mixed influence of COVID-19 on primary maternal and child health services in sub-Saharan Africa: a scoping review.

Introduction: The COVID-19 pandemic profoundly affected the provision of and demand for routine health services in the world. The objective of this scoping review was to synthesize the influence of the COVID-19 pandemic on primary maternal and child health (MCH) services in sub-Saharan Africa. Methods: The studies searched original studies reporting on the influence of the COVID-19 pandemic on primary MCH services. Four scientific databases (Pubmed, AJOL, CAIRN, CINAHL) and one gray literature database (Google Scholar) were used for this search. We also searched through the snowball citation approach and study reference lists. Results: The influence of the COVID-19 pandemic on primary MCH services has been mixed in sub-Saharan Africa. Attendance at some health centers declined for antenatal care, deliveries, immunization, and pneumonia cases. Other health centers did not experience a significant influence of the pandemic on some of these services. In fact, antenatal care increased in a number of health centers. MCH service indicators which declined during COVID-19 were linked on the demand side to regulatory measures against COVID-19, the perceived unavailability of resources for routine services, the perceived negative attitude of staff in these facilities, the perceived transmission risk in primary health care facilities and the perceived anticipated stigma. On the supply side, factors included the lack of equipment in primary facilities, the lack of guidelines for providing care in the pandemic context, the regulatory measures against COVID-19 taken in these facilities, and the lack of motivation of providers working in these facilities. Conclusion: This study recommends prioritizing the improvement of infection prevention measures in primary health care facilities for resilience of MCH indicators to epidemic crises. Improvement efforts should be tailored to the disparities in preventive measures between health centers. The identification of best practices from more resilient health centers could better guide these efforts.

Cardiovascular disease in Sub-Saharan African prisons: a scoping review.

PURPOSE: The dual epidemic of non-communicable diseases (NCDs) and human immuno-deficiency virus (HIV) in Sub-Saharan Africa has increased substantially in recent years, with cardiovascular disease representing a significant contributor to the regional burden of disease. Very little is known about the cardiovascular health of people deprived of their liberty in the region. The purpose of this study was to collate extant literature on the topic. DESIGN/METHODOLOGY/APPROACH: A scoping review mapped and described what is known about cardiovascular disease in prison populations in Sub-Saharan Africa. A systematic search of empirical literature with no date limitation was conducted in English. Sixteen studies representing six Sub-Saharan African countries (Cameroon, Nigeria, Guinea, Burkina Faso, Ghana and Ethiopia) were charted, categorised and thematically analysed. FINDINGS: Seven key themes were identified: custodial deaths and autopsy; cardiorespiratory fitness and exercise; cardiovascular disease and elderly people in prison; cardiovascular disease and women in prison; dietary deficiencies; influence of sleep patterns on cardiovascular disease; and other associated risk factors. Most natural deaths at autopsy of custodial deaths were due to cardiovascular disease. Cardiorespiratory fitness was low in prisons, and poor sleep patterns and dietary deficiencies are likely contributors to the burden of cardiovascular disease in prisons. The needs of elderly and female prison populations are ill-considered. ORIGINALITY/VALUE: To the best of the authors' knowledge, this is the first known attempt to scope extant literature on cardiovascular disease in Sub-Saharan African prisons. A strategic focus on the cardiovascular health of people in prison is warranted. Routine monitoring and expansion of existing prison health-care services and integration of NCD services with infectious disease (HIV and tuberculosis) programmes in prisons are required.

Hyperbaric oxygen (HBO2) therapy in thermal burn injury revisited. Pressure does matter. Review.

For over five decades, many experimental and clinical studies have shown predominantly positive but controversial results on the efficacy of hyperbaric oxygen (HBO2) therapy in burns. The study aimed to define a common denominator or constellations, respectively, linked to the effects of HBO2 in burns with a special focus on dosage parameters. Based on original work since 1965, species, number of individuals, type of study, percentage of total body surface area (TBSA), region, depth of burn, causative agent, interval between burn and first HBO2 session, pressure, duration of individual session, number of HBO2 sessions per day, cumulative number of HBO2 sessions and type of chamber were assessed. Out of 47 publications included, 32 were animal trials, four were trials in human volunteers, and 11 were clinical studies. They contained 94 experiments whose features were processed for statistical evaluation. 64 (67.4%) showed a positive outcome, 16 (17.9%) an ambiguous one, and 14 (14.7%) a negative outcome. The only factor independently influencing the results was pressure with ATA (atmospheres absolute) lower than 3 ATA being significantly associated with better outcomes (p=0.0005). There is a dire need for well-designed clinical studies in burn centers equipped with hyperbaric facilities to establish dedicated treatment protocols.

Trends in Medicare Costs of Hyperbaric Oxygen Therapy, 2013 through 2022.

Objective: To analyze Hyperbaric Oxygen Therapy Registry (HBOTR) data to estimate the Medicare costs of hyperbaric oxygen therapy (HBO2) based on standard treatment protocols and the annual mean number of treatments per patient reported by the registry. Methods: We performed a secondary analysis of deidentified data for all payers from 53 centers registered in the HBOTR from 2013 to 2022. We estimated the mean annual per-patient costs of HBO2 based on Medicare (outpatient facility + physician) reimbursement fees adjusted to 2022 inflation using the Medicare Economic Index. Costs were calculated for the annual average number of treatments patients received each year and for a standard 40-treatment series. We estimated the 2022 costs of standard treatment protocols for HBO2 indications treated in the outpatient setting. Results: Generally, all costs decreased from 2013 to 2022. The facility cost per patient per 40 HBO2 treatments decreased by 10.7% from $21,568.58 in 2013 to $19,488.00 in 2022. The physician cost per patient per 40 treatments substantially decreased by -37.8%, from $5,993.16 to $4,346.40. The total cost per patient per 40 treatments decreased by 15.6% from $27,561.74 to $23,834.40. In 2022, a single HBO2 session cost $595.86. For different indications, estimated costs ranged from $2,383.4-$8,342.04 for crush injuries to $17,875.80-$35,751.60 for diabetic foot ulcers and delayed radiation injuries. Conclusions: This real-world analysis of registry data demonstrates that the actual cost of HBO2 is not nearly as costly as the literature has insinuated, and the per-patient cost to Medicare is decreasing, largely due to decreased physician costs.

Compositional Effects of Hybrid MoS2-GO Active Layer on the performance of Unipolar, Low-Power and Multistate RRAM Device.

Currently, 2D nanomaterials-based RRAMs are explored on account of their tunable material properties enabling fabrication of low power and flexible RRAM devices. In this work, hybrid MoS2-GO based active layer RRAM devices are investigated. A facile hydrothermal co-synthesis approach is used to obtain the hybrid materials and a cost-effective spin coating method adopted for the fabrication of Ag/MoS2-GO/ITO RRAM devices. The performance of the fabricated hybrid active layer RRAM device is analysed with respect to change in material properties of the synthesized hybrid material. The progressive addition of 0.5, 1.5, 2.5 and 4.5 weight % of GO to MoS2, results in a hybrid active layer with higher intermolecular interaction, in the case of Ag/MoS2-GO4.5/ITO RRAM device, resulting in a unipolar resistive switching RRAM behavior with low SET voltage of 1.37 V and high Ion/Ioffof 200 with multilevel resistance states. A space charge limited conduction (SCLC) mechanism is obtained during switching, which may be attributed to the trap states present due to functional groups of GO. The increased number of conduction pathways on account of both Ag+ions and oxygen vacancies (Vo2+), participating in the formation of conducting filament, results in higher Ion/Ioff. This is the first report of unipolar Ag/MoS2-GO/ITO RRAM devices, which are particularly important in realizing high density crossbar memories for neuromorphic and in-memory computing as well as enabling flexible 2D nanomaterials-based memristor applications.

Low-Cost Hourly Ambient Black Carbon Measurements at Multiple Cities in Africa.

There is a notable lack of continuous monitoring of air pollutants in the Global South, especially for measuring chemical composition, due to the high cost of regulatory monitors. Using our previously developed low-cost method to quantify black carbon (BC) in fine particulate matter (PM2.5) by analyzing reflected red light from ambient particle deposits on glass fiber filters, we estimated hourly ambient BC concentrations with filter tapes from beta attenuation monitors (BAMs). BC measurements obtained through this method were validated against a reference aethalometer between August 2 and 23, 2023 in Addis Ababa, Ethiopia, demonstrating a very strong agreement (R2 = 0.95 and slope = 0.97). We present hourly BC for three cities in sub-Saharan Africa (SSA) and one in North America: Abidjan (Côte d'Ivoire), Accra (Ghana), Addis Ababa (Ethiopia), and Pittsburgh (USA). The average BC concentrations for the measurement period at the Abidjan, Accra, Addis Ababa Central summer, Addis Ababa Central winter, Addis Ababa Jacros winter, and Pittsburgh sites were 3.85 µg/m3, 5.33 µg/m3, 5.63 µg/m3, 3.89 µg/m3, 9.14 µg/m3, and 0.52 µg/m3, respectively. BC made up 14-20% of PM2.5 mass in the SSA cities compared to only 5.6% in Pittsburgh. The hourly BC data at all sites (SSA and North America) show a pronounced diurnal pattern with prominent peaks during the morning and evening rush hours on workdays. A comparison between our measurements and the Goddard Earth Observing System Composition Forecast (GEOS-CF) estimates shows that the model performs well in predicting PM2.5 for most sites but struggles to predict BC at an hourly resolution. Adding more ground measurements could help evaluate and improve the performance of chemical transport models. Our method can potentially use existing BAM networks, such as BAMs at U.S. Embassies around the globe, to measure hourly BC concentrations. The PM2.5 composition data, thus acquired, can be crucial in identifying emission sources and help in effective policymaking in SSA.