The emergence of drug-resistant tuberculosis (DR-TB) is becoming a challenge to the national TB control programs including Ethiopia. Different risk factors are associated with the emergence of DR-TB. Identifying these risk factors in a local setting is important to strengthen the effort to prevent and control DR-TB. Thus, this study aimed to assess the risk factors associated with drug-resistant TB in Ethiopia. The Preferred Reporting Items for Systematic Reviews and Meta-analysis checklist was followed to conduct this study. We systematically searched the articles from electronic databases and gray literature sources. We used the Joanna Briggs Institute Critical Appraisal tools to assess the quality of studies. Data were analyzed using STATA version 15. We estimated the pooled OR along with 95%CI for each risk factor. The heterogeneity of the studies was assessed using the forest plot and I 2 heterogeneity test. Besides, we explored the presence of publication bias through visual inspection of the funnel plot and Egger’s regression test. After intense searching, we found 2238 articles, and 27 eligible studies were included in the final analysis. Based on the pooled analysis of the odds ratio, unemployment (OR; 2.71, 95% CI; 1.64, 3.78), having a history of the previous TB (OR; 4.83, 95% CI; 3.02, 6.64), having contact with a known TB patient (OR; 1.72, 95% CI; 1.05, 2.40), having contact with a known MDR-TB patient (OR; 2.54, 95% CI; 1.46, 3.63), and having pulmonary TB (OR; 1.80, 95% CI; 1.14, 2.45) were found to be the risk factors of drug-resistant TB. While older age TB patients (OR; 0.77, 95% CI; 0.60, 0.95) including age above 45 years OR; (0.76, 95% CI; 0.55, 0.97), and males (OR; 0.86, 95% CI; 0.76, 0.97) were found to had lower risk of DR-TB compared to their counterparts. A previous history of TB treatment is a major risk factor for acquiring DR-TB in Ethiopia that might be due to poor adherence during the first-line anti TB treatment. Besides, having contact with a known TB patient, having contact with a known MDR-TB patient, having pulmonary TB, and being unemployed were the risk factors of DR-TB in Ethiopia. Thus, active screening of TB contacts for DR-TB might help to detect DR-TB cases as early as possible and could help to mitigate its further transmission across the community.

Objectives: Our primary objective to determine the cumulative retention of Ob/Gyns since the inception of the program, to determine the demographic and practice characteristics of all Ob/Gyns who have been trained by the Ghana postgraduate Ob/Gyn programs, and to compare the geographic distribution of Ob/Gyns throughout Ghana between 2010 when a prior study was conducted and the current practice locations of all graduates in 2017. Design: Cross-sectional, Quantitative Investigation Setting: Fieldwork for this study was conducted in Ghana between June 21, 2017, and August 20, 2017. Methods: A roster of certified Ob/Gyns, year certified, and email contact information was obtained from the Ghana College of Physicians and Surgeons, a roster of practice locations was obtained from Ghana Medical Board. Main Outcome Measures: retention of Ob/Gyns, geographic distribution of providers, fand comparisons between 2010 and 2017 Results: Significant geographic spread and increase in in-country medical programs have occurred over the seven-year period. In recent years, the Ghana College of Physicians and Surgeons surpassed that of the West African College of Surgeons. Conclusion: Establishing an Ob/gyn training program with national certification provides a cadre of certified Ob/Gyns that can be trained and retained in low-income settings. Moreover, this allows for long term commitment in multiple relevant sectors that may serve to establish a comprehensive obstetric and gynecology capacity beyond urban centers.

Sexual Function the First Year Postpartum: A Mini-CommentaryRachel Pope MD, MPHUrology Insitute, Division of Female Sexual HealthUniversity Hospitals, Cleveland Medical Center11100 Euclid Avenue, Cleveland, OH [email protected] Title: Postpartum Sexual FunctionIn the first year postpartum, women tend to be burdened by physical exhaustion due to interrupted and lack of sleep, breastfeeding and the potential challenges therein, and chemically-induced anxiety and depression. Literature in the field of behavioral health has long-since described the high prevalence of postpartum mental health disturbances of 20% of all women, and the impact of mental health on quality of life documented world-wide (O’Hara MW et al. Perinatal mental illness: definition, description and aetiology. Best Pract Res Clin Obstet Gynaecol. 2014 Jan;28(1):3-12). Sexual dysfunction, however, is a lesser-known challenge and one that is notably under-reported and addressed in the medical literature, likely due to other dominating discomforts and an overall stigmatization of female sexual health. Furthermore, scheduled visits with medical providers rarely extend beyond six weeks postpartum and most women have not resumed sexual activity at this time.Sexual function is an important aspect of quality of life. There is straight-forward treatment for dysfunction and dyspareunia that may be caused by hypo-oestrogenized tissues and pelvic floor injuries. Cattani et al. highlight the experiences of women around the world through a comprehensive systematic review. It is not surprising then, that obstetric anal sphincter injuries (OASIS), episiotomies, and instrumental vaginal birth are all associated with sexual dysfunction and/or dyspareunia. While anal sphincter injuries affect approximately 6% of women (Jha S et al. Risk factors for recurrent obstetric anal sphincter injury (rOASI): a systematic review and meta-analysis. Int Urogynecol J. 2016 Jun;27(6):849-57.) and episiotomies continue to be on the decline, the paper by Cattani et al does show less dyspareunia among women who deliver by cesarean compared to spontaneous vaginal birth. One might assume this is related to the pelvic floor injuries. However, mode of delivery is not associated with overall sexual dysfunction. Strikingly, OASIS was associated with an odds ratio of 3 (1.28-7.03) for sexual dysfunction and 1.92 (1.47-2.52) for dyspareunia. While these injuries are not easily preventable, these data inform and strengthen the need for specialized clinics, follow-up care and increased attention to individuals who have sustained them (Madsen A, Hickman L, and Propst K. Recognition and Management of Pelvic Floor Disorders in Pregnancy and the Postpartum Period, Obstetrics and Gynecology Clinics of North America. 2021. 48; (3):571-584). For example, if an individual with a third or fourth degree laceration is identified as having increased risk for pain and dysfunction sexually, she should be counseled on this as to empower her to seek care should the concern arise. Lubricants, vaginal estrogens and DHEA can all be appropriately prescribed even if breastfeeding and could greatly improve her experience (Donders GGG, et al. Pharmacotherapy for the treatment of vaginal atrophy. Expert Opin Pharmacother. 2019 May;20(7):821-835.). Furthermore, this information underscores the need for women who have sustained a higher order laceration to present for pelvic floor physical therapy and rehabilitate as a preventive and therapeutic measure. Specialized clinics can help patients navigate this.Vaginal dryness from lactation is extremely common. This review only identified one study on vaginal dryness and sexual concerns. This does not indicate that vaginal dryness is not a problem, but rather that more research is indicated. Another unexplored variable is urinary incontinence. A large proportion of women experience urinary incontinence in the first year postpartum. It would be worth exploring the connection between UI and sexual dysfunction.Therefore, while this review represents progress in understanding the mechanism of sexual dysfunction and dyspareunia the first year postpartum, there is still more to be learned in the form of empiric evidence, especially regarding vaginal dryness and urinary incontinence.

Since the start of the COVID‐19 vaccinations, many dermatological manifestations have been described .There are certain safety-related events that, due to rarity, might be detected only during the mass vaccination programs. Here we report a potentially serious adverse effect of Covid vaccines that have been rarely reported before

Dolichols (Dols), ubiquitous components of living organisms, are indispensable for cell survival. In plants, as well as other eukaryotes, Dols are crucial for posttranslational protein glycosylation, aberration of which leads to fatal metabolic disorders in humans and male sterility in plants. Until now, the mechanisms underlying Dol accumulation remain elusive. In this report, we have analyzed the natural variation of the accumulation of Dols and six other isoprenoids between more than 120 Arabidopsis thaliana accessions. Subsequently, by combining QTL and GWAS approaches, we have identified several candidate genes involved in the accumulation of Dols, polyprenols, plastoquinone, and phytosterols. The role of two genes implicated in the accumulation of major Dols in Arabidopsis – the AT2G17570 gene encoding a long searched for cis-prenyltransferase (CPT3) and the AT1G52460 gene encoding an alpha-beta hydrolase (ABH) – is experimentally confirmed. These data will help to generate Dol-enriched plants which might serve as a remedy for Dol-deficiency in humans.

Background Solid organ transplantation (SOT) has become commonly used in children and is associated with excellent survival rates into adulthood. Data regarding long-term respiratory outcomes following pediatric transplantation are lacking. We aimed to describe the prevalence and nature of respiratory pathology following pediatric heart, kidney, and liver transplant, and identify potential risk factors for respiratory complications. Methods Retrospective review involving all children under active follow-up at the provincial transplant service in British Columbia, Canada, following SOT. Results Of 118 children, 33% experienced respiratory complications, increasing to 54% in heart transplant recipients. Chronic or recurrent cough with persistent chest x-ray changes was the most common clinical picture, and most infections were with non-opportunistic organisms typically found in otherwise healthy children. A history of respiratory illness prior to transplant was significantly associated with risk of post-transplant respiratory complications. 8% were diagnosed with bronchiectasis, which was more common in recipients of heart and kidney transplant. Bronchiectasis was associated with recurrent hospital admissions with lower respiratory tract infections, treatment of acute rejection episodes, and treatment with sirolimus. Interpretation Respiratory morbidity is common after pediatric SOT, and bronchiectasis rates were disproportionately high in this patient group. We hypothesise that this relates to recurrent infections resulting from iatrogenic immunosuppression. Direct pulmonary toxicity from immunosuppression drugs may also be contributory. A high index of suspicion for respiratory complications is needed following childhood SOT, particularly in those with a history of respiratory disease prior to transplant, experiencing recurrent or severe respiratory tract infections, or exposed to intensified immunosuppression.

Rapidly and effectively assessing environmental degradation is essential for promoting regional sustainable development in the transnational area of Changbai Mountain (TACM). However, comprehensively understanding environmental degradation in the TACM is still inadequate. In this study, we developed an environmental degradation index (EDI) by using multiple remote sensing data, including enhanced vegetation index (EVI), gross primary productivity (GPP), land surface temperature (LST), and MODIS surface reflectance products. We then evaluated its performance comparing with the remote sensing ecological index (RSEI), and assessed the environmental degradation across the whole TACM, in the subregions of China, the Democratic People’s Republic of Korea (DPRK), and Russia during 2000-2019. The results indicated that the EDI had the advantages of simplicity and rapidity, which can assess the environmental degradation in the TACM across long-time scales and large spatial extent. The TACM experienced a downward trend of environmental changes from 2000 to 2019. Degraded environment areas (49,329.50 km2) accounted for 30.09% of the entire TACM. The largest area of the degraded environment was on the DPRK’s side (i.e., 25,395.00 km2), which was 5.6 times larger than that on the Russian side and 1.3 times larger than that on the Chinese side. Hotspot areas that experienced significant environmental degradation just covered 17.69% of the land area of the TACM, the area of environmental degradation in them accounted for 33.89% of the total degraded environment across the whole TACM. We suggest that international cooperation policies and measures ought to be enacted to promote regional sustainable development.

Aaron Smith1, Doerthe Tetzlaff1,2,3, Marco Maneta4,Chris Soulsby3,21IGB Leibniz Institute of Freshwater Ecology and Inland Fisheries Berlin, Berlin, Germany2Humboldt University Berlin, Berlin, Germany3Northern Rivers Institute, School of Geosciences, University of Aberdeen, UK4Department of Geosciences, University of Montana, Missoula, Montana, USACorrespondence to: Aaron Smith ([email protected])

In land plants, heteroblasty broadly refers to a drastic change in morphology during growth through ontogeny. Juniperus flaccida and Pinus cembroides are conifers of independent lineages known to exhibit leaf heteroblasty between the juvenile and adult life stage of development. Juvenile leaves of P. cembroides develop spirally on the main stem and appear decurrent, flattened and needle-like; whereas adult photosynthetic leaves are triangular or semi-circular needle-like, and grow in whorls on secondary or tertiary compact dwarf shoots. By comparison, J. flaccida juvenile leaves are decurrent and needle-like, and adult leaves are compact, short, and scale-like. Comparative analyses were performed to evaluate differences in anatomy and gene expression patterns between developmental phases in both species. RNA from twelve samples was sequenced and analyzed with available software. They were assembled de novo from the RNA-Seq reads. Following assembly, 63,741 high quality transcripts were functionally annotated in P. cembroides and 69,448 in J. flaccida. Evaluation of the orthologous groups yielded 4,140 shared gene families among the four references (adult and juvenile from each species). Activities related to cell division and development were more abundant in juveniles than adults in P. cembroides, and more abundant in adults than juveniles in J. flaccida. Overall, there were 509 up-regulated and 81 down-regulated genes in the juvenile condition of P. cembroides and 14 up-regulated and 22 down-regulated in J. flaccida. Gene interaction network analysis showed evidence of co-expression and co-localization of up-regulated genes involved in cell wall and cuticle formation, development, and phenylpropanoid pathway, in juvenile P. cembroides leaves. Whereas in J. flaccida, differential expression and gene interaction patterns were detected in genes involved in photosynthesis and chloroplast biogenesis. Although J. flaccida and P. cembroides both exhibit leaf heteroblastic development, little overlap was detected, and unique genes and pathways were highlighted in this study.Keywords : Heteroblasty, RNA-seq analysis, cell wall and cutin biosynthesis, conifer leaf development, Juniperus flaccida, Pinus cembroides. 

Water quality dynamics depend strongly on hydrologic flow paths and transit time within catchments. In this paper we use a travel time tracking method to simulate stream salinity (as measured by electrical conductivity) in the Duck River catchment, NW Tasmania, Australia. The approach couples the StorAge transit time modelling approach with two different approaches to model electrical conductivity. The first assumes the catchment has a cyclic salt balance (rainfall source, stream flow sink) that is in dynamic equilibrium and evapoconcentration of salt is the only process changing concentration. The second assumes that the salinity of water in catchment storages is a function of water age in those stores, without explicitly simulating salt mass balance processes. The paper compares these alternate approaches in terms of salinity simulation, simulated stream water age distributions, and simulated storage age distributions. Both salinity simulation approaches reproduce stream salinity with high fidelity under calibration and perform well under validation. The simulations using the age-related solute concentration approach produce less biased results and thus high model efficiencies for validation periods. This approach also produces more consistent model parameter estimates between periods. There are systematic differences in the resultant age distributions between models, particularly for the solute balance based simulations where parameters (catchment storage size) changed more between calibration periods. The effect of time varying versus static storage selection functions are compared, with clear evidence that time varying storage selection functions with parameters linked to catchment conditions (flow) are essential for adequate simulation of event concentration dynamics.

We combine physics-based groundwater reactive transport modeling with machine learning techniques to quantify hydrogeologic model and solute transport predictive uncertainties. We train an artificial neural network (ANN) on a dataset of groundwater hydraulic heads and 3H concentrations generated using a high-fidelity groundwater reactive transport model. Using the trained ANN as a surrogate model to reproduce the input-output response of the high-fidelity reactive transport model, we quantify the posterior distributions of hydrogeologic parameters and hydraulic forcing conditions using Markov-chain Monte Carlo (MCMC) calibration against field observations of groundwater hydraulic heads and 3H concentrations. We demonstrate the methodology with a model application that predicts Chlorofluorocarbon-12 (CFC-12) solute transport at a contaminated site in Wyoming, USA. Our results show that including 3H observations in the calibration dataset reduced the uncertainty in the estimated permeability field and infiltration rates, compared to calibration against hydraulic heads alone. However, predictive uncertainty quantification shows that CFC-12 transport predictions conditioned to the parameter posterior distributions cannot reproduce the field measurements. We found that calibrating the model to hydraulic head and 3H observations results in groundwater mean ages that are too large to explain the observed CFC-12 concentrations. The coupling of the physics-based reactive transport model with the machine learning surrogate model allows us to efficiently quantify model parameter and predictive uncertainties, which is typically computationally intractable using reactive transport models alone.

Midwestern cities require forecasts of surface nitrate loads to bring additional treatment processes online or activate alternative water supplies. Concurrently, networks of nitrate monitoring stations are being deployed in river basins, co-locating water quality observations with established stream gauges. Here, we construct a synthetic data set of stream discharge and nitrate for the Wabash River Basin - one of the U.S.’s most nutrient polluted basins - using the established Agro-IBIS model. While real-world observations are limited in space and time, particularly for nitrate, the synthetic data set allows for sufficiently long periods to train machine learning models and assess their performance. Using the synthetic data, we established baseline 1-day forecasts for surface water nitrate at 12 cities in the basin using support vector machine regression (SVMR; RMSE 0.48-3.3 mg/L). Next, we used the SVMRs to evaluate the improvement in forecast performance associated with deployment of additional sensors. Synthetic data enable us to quantitatively assess the expected value of an additional nitrate sensor being deployed, which is, of course, not possible if we are limited to the present observational network. We identified the optimal sensor placement to improve forecasts at each city, and the relative value of sensors at all possible locations. Finally, we assessed the co-benefit realized by other cities when a sensor is deployed to optimize a forecast at one city, finding significant positive externalities in all cases. Ultimately, our study explores the potential for AI to make short-term predictions and provide an unbiased assessment of the marginal benefit and co-benefits to an expanded sensor network. While we use water quantity in the Wabash River Basin as a case study, this approach could be readily applied to any problem where the future value of sensors and network design are being evaluated.

With global warming and rapid urbanization, urban agglomerations over the Loess Plateau (LP) are suffering from various urban disasters. Urbanization has aggravated the decreasing trends of extreme precipitation in Taiyuan and Xi’an urban agglomerations (UAs) and enhanced the increasing trends of extreme precipitation in Luoyang, Hohhot and Xining UAs during 1979–2018. Meanwhile, the number of light rain days decreases in almost all the cities, indicating the sensitivity of light rain days to urbanization. The climate change is a primary contributor to the change of urban precipitation during 1980–2000. However, the urbanization contribution has been increasing gradually since 2000, and the urbanization further amplifies the trend of extreme precipitation caused by the climate change. In terms of the physical mechanisms, the rapid increasing surface temperature and aerosol particles are closely related to the urban precipitation. Our findings provide a systematic understanding of the urbanization effects on the extreme precipitation over the LP and may play an important role in the mitigation of urban disasters.

The hydraulic properties of coastal aquifer systems are relevant to various hydrogeological, hydro-ecological and engineering problems. This study presents an analytical solution for predicting groundwater head fluctuations induced by dual-tide in multilayered island aquifer systems, consisting of an unconfined aquifer on the top and any number of leaky aquifers below. The solution was derived via the methods of matrix differential calculus and separation of variables. It is more general than any existing analytical solutions for the tidal pressure propagation since the new solution can consider multilayered aquifer systems along with the effects of leakage and aquifer length. Using this solution, we illustrated potential errors that may occur due to neglecting one or more vital factors affecting groundwater fluctuations. Besides, we articulated the groundwater response to the dual-tide in complex coastal aquifers. Considering that some thin semipermeable layers may be ignored in practical field investigation, we also demonstrated the effects due to simplification of aquifer layers. The results showed that with the increase in the number of overlapped leaky layers, the tidal propagation in the bottom part of multilayered aquifer system approaches that in a single confined aquifer with the same transmissivity and storage.

This paper presents a taxonomy (hierarchical organization) of hydrological processes; specifically, runoff generation processes in natural watersheds. Over 120 process names were extracted from a literature review of papers describing experimental watersheds, perceptual models, and runoff processes in a range of hydro-climatic environments. Processes were arranged into a hierarchical structure, and presented as a spreadsheet and interactive diagram. For each process, additional information was provided: a list of alternative names for the same process, a classification into hydrological function (e.g. partitioning, flux, storage, release) and a unique identifier similar to a hashtag. The taxonomy provides a method to label and search hydrological knowledge, thereby facilitating synthesis and comparison of processes across watersheds.

Chorioamnionitis, a common complication of pregnancy is associated with significant maternal, perinatal, and long-term adverse outcomes. This case of placental infection leading to preterm delivery, severe neonatal sepsis, maternal wound infection, postnatal readmission, and prolonged hospital stay was caused by multi-drug resistant Extended Spectrum Beta Lactamase (ESBL)-producing Escherichia Coli

The MC4R is involved in the leptin-melanocortin pathway which mutations can lead to severe forms of obesity. We report one rare mutation p.Met215Ile in a woman with morbid obesity. This mutation leads to changes in protein structure through the loss of hydrophobic interactions and it is predicted to be disease-causing.

In the Sahel, exacerbated soils degradation is an ecological indicator of ecosystem vulnerability. This study examines the effects of restoration of degraded lands on soils physicochemical properties and adaptability of planted woody species over a period of 4-6 years. It is based on: 1) Physicochemical analyses of soils (granulometry, calcimetry, and organic matter) carried out on 102 samples taken in the upper 10 centimeters of the soil profile of the rehabilitated and control sites, 2) measures carried out for the dimensioning of anti-erosion structures, 3) dendrometric measurements on woody species planting in 20 plots each with a rectangular shape 60 m × 30 m as well as characterization of the structure of their root systems. Physicochemical analyses show an improvement in soil quality and structure thanks to the erosion control measures. The degradation of anti-erosion structures, inferred from the rate of siltation of micro-basins, the subsidence of the bulges, the formation, and extension of the breaches, is strongly influenced by the topography, precipitation, and sandy texture of the soils. The restoration activities have led to the reconstitution of vegetation cover on degraded soils. Based on dendrometric characteristics, height class structure, and root systems architecture, significant differences were observed between woody species planted in anti-erosive structures. Eucalyptus camaldulensis groups of with a tracer root system and high density, have the highest structural parameters resulting from the adaptation of this species on Sahelian degraded lands.