Background: According to EWGSOP2, the diagnosis of sarcopenia is confirmed when in addition to low muscle strength, low muscle quantity or quality is present. Echo intensity (EI) determined by muscle ultrasound (US) has been proposed as an efficient method for the assessment of muscle quality. The effect of changing various US parameter settings on EI remains unclear. Therefore, the aim of this study was to assess the differences between EI values obtained by adjusting parameter settings over their entire range in a sample of middle-aged healthy subjects. Methods: Thirty-two repeated US scans of rectus femoris (RF) and rectus abdominis (RA) muscles were taken in eight men and three women with a portable Mindray M7 premium US machine, working in an Extended field-of-view, B-Mode setup, equipped with a linear 5.0-10.0 MHz transducer. The following US parameters and settings were fixed: gain 60dB, depth 6.5cm, and frequency 10 MHz. Readily adjustable parameters were dynamic range (DR), gray map (GM), line density, persistence, and IClear. A default setting DR65 was chosen as the reference setting. For each of the parameters, the settings of one single parameter of interest was changed over its entire range following a standardized protocol. The EI values were calculated using the open-source software ImageJ. Repeated measures analyses were performed to evaluate the effect of parameter settings on EI. Linear interpolation was used to determine non-significant ranges across a given parameter. Results: For the RF muscle, the EI values were significantly different across DR (p<0.001), GM (p<0.001), and IClear (p<0.001). Post hoc analysis confirmed the differences within these three settings. Echo intensity values within the range of DR55 to DR80 were not significantly different. For the RA muscle, the EI values were significantly different across DR (p=0.004) and GM (p=0.030). Post hoc pairwise comparisons revealed no significant difference with the default setting, except for DR150 (p=0.042). Conclusion: We showed that EI values differ across the DR and GM range, especially in the RF. We suggest using a DR setting within its midrange to minimize the effect of machine setting-dependent factors on EI values. These findings reconfirm the need for standardization of ultrasound echo intensity settings when applied for diagnostic purposes of muscle quality.

ChatGPT is gaining widespread acceptance for its ability to generate natural language sentences in response to various inputs and is expected to become a supplementary tool for diagnosing and determining treatment policies in clinical settings. ChatGPT was used to evaluate its ability to perform clinical inference and accuracy in answering questions on the 117th Japanese National Medical Licensing Examination held in February 2023. The exam questions were manually inputted into ChatGPT's window, and the accuracy of ChatGPT's responses was determined based on answers provided by a preparatory school. ChatGPT provided answers for 389 out of 400 questions, and its overall correct answer rate was 55.0%. The correct answer rate for 5-choice-1, 5-choice-2, and 5-choice-3 were 57.8%, 42.9%, and 41.2%, respectively. The highest correct answer rate was for the compulsory exam (67.0%), followed by the specific knowledge exam (54.1%) and the cross category exam (47.9%). The correct answer rate for non-image questions was 56.2% and for image questions, it was 51.5%. The study suggests that ChatGPT has potential to support healthcare professionals in clinical decision-making in Japanese clinical settings, but caution should be exercised in interpreting and using the answers generated by ChatGPT due to room for improvement in performance.

The primary focus of this review is to explore the application and significance of coping strategies within the domains of clinical psychology and neuropsychology. These strategies consist of a variety of techniques, behaviors, and cognitive interventions, and their critical role in reinforcing resilience and facilitating adaptive responses to stressors has been highlighted. At the core of this exploration, the intricate neuropsychological relationship between brain stress pathways and the application of coping mechanisms has been analyzed. The neural aspects of stress, and how they can be influenced by adaptive strategies, are detailed, illustrating the profound impact these coping mechanisms have at a neurobiological level. Delving into the neuropsychological underpinnings, this review will shed light on how stress response pathways in the brain interact with, and can be modulated by, various coping strategies. These mechanisms are particularly salient when addressing the multifaceted challenges faced by individuals with neuropsychological or mental health issues. While these strategies span a broad spectrum, from introspection and cognitive reframing to behavioral activation and social support seeking, their integration and application remain diverse within clinical contexts. This review endeavors to elucidate the theoretical underpinnings of these strategies, their empirical support, and their practical implications within therapeutic interventions. Furthermore, the intricate interplay between individualized coping techniques and structured therapeutic methodologies will be examined, emphasizing the potential for a holistic treatment paradigm, thereby enhancing therapeutic outcomes and fostering individual resilience.

Direct assessments of executive function (EF) are increasingly used in research and clinical settings, with a central assumption that they assess “universal” underlying skills. Their use is spreading globally, raising questions about the cultural appropriateness of assessments devised in Western, industrialized countries. We reviewed multidisciplinary evidence and theory to identify sets of cultural preferences that may be at odds with the implicit assumptions of EF assessments. These preferences relate to motivation and compliance; cultural expectations for interpersonal engagement; contextualized vs. academic thinking; cultural notions of speed and time; the willingness to be silly, be incorrect, or do the opposite; and subject-matter familiarity. In each case, we discuss how the cultural preference may be incompatible with the assumptions of assessments, and how future research and practice can address the issue. Many of the cultural preferences discussed differ between interdependent and independent cultures and between schooled and unschooled populations. Adapting testing protocols to these cultural preferences in different contexts will be important for expanding our scientific understanding of EF from the narrow slice of the human population that has participated in the research to date.

Background: Cervical cancer is the fourth most common cancer in women globally despite being a largely treatable and preventable malignancy. Developing countries account for over 80% of all new cases of cervical cancer. Women residing in low-resource settings such as those residing in slums have a higher risk of cervical cancer, and lower uptake of cervical cancer screening. Diverse barriers influence the uptake of cervical cancer screening among women in low-resource settings. Objectives: This qualitative study was carried out prior to a cervical cancer screening program and explored women’s knowledge about cervical cancer, and their perceived barriers and recommendations for the program.Method: Four focus group discussions (FGD) were conducted among 35 women between the ages of 21 – 65 years residing in two urban slums in Lagos, Nigeria. Each FGD was limited to 8-10 participants of women of similar ages. Voice recordings were transcribed verbatim and analysis was done using thematic analysis.Results: Most of the women were not aware of cervical cancer and none knew the symptoms or risk factors of cervical cancer. The participants felt that the cervical cancer screening program would be well accepted in the community, however, they expressed concerns about the cost of the screening test and the sex of the person performing the test. The recommendations proffered for a successful cervical cancer screening program include; reducing the cost of the test or providing the test free of charge, having people that speak the local language as part of the team, using female health care providers, using a private location within the community or nearby PHC, and publicizing the program with the use of SMS, phone calls, town crier, and health talks. It was recommended that organizing health education sessions would help improve women’s poorly perceived susceptibility to cervical cancer.Conclusion: Interventions to increase uptake of cervical cancer screening among women in low resource settings need to improve knowledge and understanding of cervical cancer and address the barriers to cervical cancer screening such as cost, distance, and as much as possible, sex of the healthcare provider should be considered.

The prevalence of Noncommunicable Diseases (NCDs) in South Africa is increasing annually, with the burden projected to escalate by 2030. Devastatingly, factors such as lifestyle changes, urbani- sation, and an aging population significantly contribute to a rising burden of Cardiovascular disease (CVDs), diabetes, and cancer which directly impact the mortality and morbidity rates seen in South Africa. Recognising this, the South African government has seen the need for emphasis on developing policies and interventions tar- geting physical inactivity to prevent and manage NCD, particularly cost-free and easy to administer training protocols. However, phys- ical inactivity remains a significant issue, leading to various health concerns in rural communities, including injuries and Fetal Alcohol Spectrum Disorders (FASD). Despite effort to promote physical ac- tivity, the prevalence of NCDs continues to rise, necessitating target- ed interventions to ensure equitable healthcare among South African citizens. On the Contrast, preservation and promotion of traditional games is vital as they offer indigenous populations accessible and culturally relevant means to maintain health and wellness. In this regard, it is important to recognize the importance of preserving and promoting traditional games as they potentially serve as a method for indigenous people to maintain their health and wellness in a way that is accessible and culturally relevant to them. These games have gained popularity in South Africa, with initiatives underway to show- case them globally fostering cultural exchange. Further, revitalizing and conserving these games can cultivate a culture of health and wellbeing in South Africa.

The extent of access to energy of displaced populations in settlements and camps in Africa is largely unknown, given 94% of displaced persons without access to electricity and 81% with a reliance on biomass for cooking. A multitude of contextual factors, such as the location and the characteristics of housing, the legal status, the socio-cultural background and the availability of humanitarian and public services impact the living conditions and the needed energy services. Limitations in accessing energy services have direct, multilayered, and far-reaching implications, including impacts on health, nutrition, education, protection, and livelihood. The objective of this article is to contribute to a more comprehensive understanding of the current state of energy ac-cess in displacement contexts on the African continent by identifying and utilizing existing data. After a screening of the vast and various available information, setting up of a database, consoli-dating the gathered data as well as assessing the quality through a quality assessment method, the currently available information is visualized and discussed. Remarkable differences in the access to electricity for displaced persons across the countries are found. For both electricity and clean cooking, the availability for displaced persons ranges from nearly no access at all up to an access rate of 100%. More strikingly, the results also show that besides South Africa, and the se-lected countries in the Maghreb region, the access to both clean cooking and electricity for dis-placed persons is remarkably low. At the same time, the poor data quality does not allow to draw solid conclusions nor impactful implementation activities. Novel conceptual frameworks and indicators are needed. Future research needs to focus on a more comprehensive understand-ing of how energy is interwoven in the lives of displaced persons, before a set of energy indicators can be derived. It is essential that the concerned persons, the displaced persons themselves are in-cluded in the research in a meaningful way.

In developing countries, noise exposure and its negative health effects have been little explored. The present study aimed to assess the noise exposure situation in adults living in informal settings in the Western Cape Province, South Africa. We conducted continuous one-week outdoor noise measurements at 134 homes in four different areas. These data were used to develop a land use regression (LUR) model to predict A-weighted day-evening-night equivalent sound level (Lden) from geographic information system (GIS) variables. Mean noise exposure during day (6:00-18:00) was 60.0 A-weighted decibels (dB(A)) (interquartile range 56.9-62.9 dB(A)), during night (22:00-6:00) 52.9 dB(A) (49.3-55.8 dB(A)) and average Lden was 63.0 dB(A) (60.1-66.5 dB(A)). Main predictors of the LUR model were related to road traffic and household density. Model performance was low (adjusted R²=0.130) suggesting that other influences than represented in the geographic predictors are relevant for noise exposure. This is one of the few studies on the noise exposure situation in low- and middle-income countries. It demonstrates that noise exposure levels are high in these settings.

The targeting-Her-2/neu therapy by passive application with trastuzumab is associated with acquired resistance and subsequent metastasis development, attributed to upregulation of tumoral PD-L1 expression and downregulation of Her-2/neu. We aimed to investigate this association, following active immunization with our recently constructed B cell–peptide based Her-2/neu vaccines in both preclinical and clinical settings. Immunohistochemistry (IHC), fluorescence in situ hybridization (FISH), and combined positive score (CPS), were applied to evaluate Her-2/neu and PD-L1 expression using a murine syngeneic tumor model for Her-2/neu lung metastases, and tumor biopsies from a gastric cancer patient with disease progression. A significant and concomitant reduction of Her-2/neu and upregulation of PD-L1 expression was observed in the vaccinated mice, after 7 but not after 4 weeks of metastases development. A significant increase of tumor-infiltrating B lymphocytes was observed at both time points. Downregulation of Her-2/neu and upregulation of PD-L1 were observed in a patient’s primary tumor at the disease progression time point but not prior to vaccination (Her-2/neu IHC: 3 to 0, FISH: 4.98 to 1.63; PD-L1 CPS: 0% to 5%). Our results further underline the need for combination therapy by targeting PD-L1 to prevent metastasis formation and immune evasion of Her-2/neu positive and PD-L1 negative tumor cells.

New technologies such as "connected" and "autonomous" vehicles are going to change the future of traffic signal control and management and possibly will introduce new traffic signal systems that will be based on floating car data (FCD). The use of floating car data to regulate, in real-time, traffic signal systems has the potential for an increased sustainability of transportation in terms of energy efficiency, traffic safety and environmental issues. However, research has never explored how not "connected" vehicles would benefit by the implementation of such systems. This paper explores the use of floating car data to regulate in real-time traffic signal systems in terms of cooperative-competitive paradigm between "connected" vehicles and conventional vehicles. In a dedicated laboratory, developed for testing regulation algorithms, results show that "invisible vehicles" for the system (which are not "connected") in most simulated cases also benefit when real time traffic signal settings based on floating car data are introduced. Moreover, the study estimates the energy and air quality impacts of signal regulation by evaluating fuel consumption and pollutant emissions. Specifically, the study demonstrates that significant improvements in air quality are possible with the introduction of FCD regulated traffic signals.

Agriculture is the backbone of Kenya’s economy, supporting up to 80% of the rural livelihoods. Kenya’s export horticulture is currently the leading Agriculture subsector in Kenya has evolved from small-holder farming to agro-industrial large-scale export farming dominated by multinational companies. It is regarded as an agro-industrial food system based on the economies of scale producing for mass markets outside of the production area. Much of the food consumed from this food system has undergone multiple transformations and been subject to a host of formal and informal insitutions (rules, regulations, standards, norms and values). An Anthropological study of export horticulture in Northwest Mount Kenya was carried out utilizing qualitative data collection methods in Northwest Mount Kenya region. Data was coded and analysed thematically based on grounded theory approach. The study described the institutional settings of export horticulture from an emic perspective as changing and defining the operations of the food system access and management of common pool resources, namely water and land. With the agro-industrial food system competing for these scarce resources in a semi-arid zone, there is potential for conflict and also reduced production and overall benefits to the different actors in the study area.

As in every workplace, human sustainability in dental enterprises is connected to air and water quality, eco-friendly and naturally designed working spaces and 4R’s culture. Purpose of this study is to access the preferences and knowledge on circular economy and green building construction in a sample of students and dentists in Greece. Students (N1=93) and dentists (N2= 126) filled in e-questionnaires from April to December 2022. The response rate was 17,88% for N1 and 1.94% for N2. Data revealed that both students and dentists lack knowledge on circular economy (N1=67.7%, N2=68,25%), EU regulations on amalgam disposal (N1=64.5%, N2=58.73%) and plastic recycling (N1=76.34%, N2=76,98) while they do recycle at home (N1= 80.6%, N2=82.54%) and have participated in voluntary environmental actions (N1=58.1%, N2=66.67%). Gender influences the importance of factors related to green dental practices, with women students being more prone to answer positively as important for increase costs for network changes (p=0.02), lack of environmental awareness of manufacturers (p=0.057), and poor wastewater management (p=0.01). Students from urban areas are more prone to answer positively for lack of state financial support (p=0.02), low level of green design in the building (p=0.03), low direct financial benefit of a green dental office (p=0.04), low benefit to the reputation of the green dental office (p=0.02), lack of continuing education training seminars on green dentistry (p=0.05). For dentists, no significant relationships were observed except of a weak positive relationship in increase in costs for changes related to utility networks (p=0.08) while increased wasteful energy (p=0.12) and waste of dental materials (p=0.19) seemed important only for dentists in urban areas. Women dentists were more prone to answer positively on wasting energy (p=0.024) and use of unapproved disinfection products (p=0.036). The findings contribute ideas and solutions on green dental office buildings and sustainable behaviors through educational activities and social perspective of factors such as age, experience in dentistry, gender, and urbanism. It also inspires future multi-disciplinary research on dental quality assurance, psychology of environmentalism, economics, and behavioral science in dentistry.

Diagnostics is believed to drive about 70% of medical interventions, but this may not be true for all demographics. With more than 30% of the African population living in extreme poverty ($1.9 per day - 2022); and healthcare costs competing unfavorably against unbridled access to antibiotics and herbal concoctions, especially in Sub-Saharan Africa, how do you convince such a people to choose diagnostics first? More importantly, how do you design a medical device targeted at meeting the diagnostic needs of this demographic? In developing diagnostic devices for such a market, what is worth sacrificing? How dire is the need for advanced technologies in devices developed for such a demographic? These are questions that remain unaddressed by the technological breakthroughs and current research in medical device development, especially for infectious disease diagnostics. The objective of this paper is to underscore critical concerns which must be considered in the bid to successfully design medical diagnostic devices for Africa and perhaps, other limited-resource settings. It is also written as a suggestive guidance document for researchers whose interest is in the development of infectious disease diagnostic platforms for rural Africa and similar limited-resource environments.