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Introduction: The h-index measures researchers' productivity by assessing simultaneously the number of publications and citations. We aimed to assess the factors that could influence h-index for hematologists practicing in academic institutions in Canada. Methods: We identified universities with a hematology residency training programs/fellowships using the Canadian Resident Matching Service (CaRMS) website. We obtained the listing of faculty, sex, and academic ranks by consulting faculty directories or by contacting respective departments/universities, when directories were unavailable or incomplete. For each faculty member, we obtained years since Royal College of Physicians' and Surgeons of Canada certification or equivalent, receipt of Canadian Institute of Health Research (CIHR) grants within the last 5 years, attainment of graduate degrees (M.Sc., Ph.D., other), and the h-index. Results: The data included information collected from 372 individuals (171 females) across Canada (Atlantic Provinces: 13; Quebec: 89; Ontario: 182; Prairie Provinces: 59; British Columbia: 29). Univariate analysis showed that male sex, practicing in British Columbia, longer duration since specialty certification, completion of an M.Sc. or a Ph.D. degree, attaining a higher academic rank and receiving CIHR funding were associated with higher h-index. The results of the univariate analysis were concordant with the multivariate analysis, except that practicing in Ontario was also associated with higher h-index. Conclusion: This study provides details on the h-index curve/parameters for academic productivity of hematologists in Canada. Importantly, based on multivariate analysis, higher h-index was associated with male sex, location of practice, years since certification, attainment of M.Sc. or Ph.D. degrees, academic rank, and recent CIHR funding.

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PURPOSE: The success of metabolic and bariatric surgery (MBS) is impacted by significant pre-surgical attrition rates and poor postoperative follow-up. This study focused on geographic variations in attrition rates and surgical outcomes for MBS practice for which the patient population is drawn from nine Chicago neighborhoods, to examine whether suboptimal weight loss or reduced adherence to the program varied across neighborhoods. METHODS: Patients who presented for their initial MBS consultation at the University of Illinois (UI) Health's program between January 2019 and December 2020 were identified from electronic medical records. Demographic and medical information was extracted, along with postoperative weight at 3, 6, and 12 months after surgery. The Chicago area was divided into nine geographic regions. The outcomes of interest were preoperative attrition rate, postoperative compliance to follow-up appointments, and postoperative weight loss for each group and by residential neighborhood. RESULTS: A total of 1202 patients were included in this analysis, of whom 423 (35%) underwent surgery and 780 did not, representing a pre-surgical attrition rate of 64.9%. Age, sex, and race/ethnic distribution varied markedly across geographic regions. Postoperative weight loss varied significantly in neighborhoods with higher proportions of residents from racial/ethnic minority backgrounds. Preoperative attrition and postoperative compliance did not differ across geographic regions. CONCLUSION: Patients' residential neighborhoods may influence weight loss after MBS. Preoperative and postoperative compliance did not vary by residential neighborhood.

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States of India like Bihar, Uttar Pradesh, and West Bengal along the Ganga River, endure natural disasters periodically, resulting in repeated trends of economic loss and damages. Especially, most of the districts of Bihar, India, are prone to floods. Based on this background, this study aims to assess the flood vulnerabilities across districts of Bihar, India, employing data from the Central Water Commission from 1953 to 2020. Further, we explore trends and patterns of loss and damage due to flood risks in Bihar. Using the flood vulnerability integrated method and the principal component analysis, the index is constructed by incorporating the three major indicators: exposure, sensitivity, and adaptive capacity. This study is unique, and advances from previous studies in using a greater number of variables in exposure indicator. The proxy variable for each indicator is identified through both inductive and deductive approaches, and the composite index is constructed using all three indicators. Also, we identify the districts with high level of education and per capita income are less likely to expose flood vulnerability. The comparison of the districts reflects wide range of variation in terms of flood vulnerability as per their adaptive capacity and sensitivity. Specifically, these findings align with Target Sustainable Development Goal 11.5. This study addresses the policy for disaster prevention, risk reduction, and mitigation measures, as well as the enhancement of the capability of adaptation to floods by the affected community.

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Attention deficit hyperactivity disorder (ADHD) is a neurodevelopmental disorder characterized by a reduced attention span, hyperactivity, and impulsive behaviors, which typically manifest during childhood. This study employs functional magnetic resonance imaging (fMRI) to use spontaneous brain activity for classifying individuals with ADHD, focusing on a 3D convolutional neural network (CNN) architecture to facilitate the design of decision support systems. We developed a novel deep learning model based on 3D CNNs using the ADHD-200 database, which comprises datasets from NeuroImage (NI), New York University (NYU), and Peking University (PU). We used fractional amplitude of low-frequency fluctuations (fALFF) and regional homogeneity (ReHo) data in three dimensions and performed a fivefold cross-validation to address the dataset imbalance. We aimed to verify the efficacy of our proposed 3D CNN by contrasting it with a fully connected neural network (FCNN) architecture. The 3D CNN achieved accuracy rates of 76.19% (NI), 69.92% (NYU), and 70.77% (PU) for fALFF data. The FCNN model yielded lower accuracy rates across all datasets. For generalizability, we trained on NI and NYU datasets and tested on PU. The 3D CNN achieved 69.48% accuracy on fALFF outperforming the FCNN. Our results demonstrate that using 3D CNNs for classifying fALFF data is an effective approach for diagnosing ADHD. Also, FCNN confirmed the efficiency of the designed model.

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Tropical cyclones (TCs) and their associated intense rainfall are among the most significant natural disasters. Exploring the characteristics of tropical cyclone precipitation (TCP) has always been a challenging issue in TC research. This study utilized the TC track data from the International Best Track Archive for Climate Stewardship and precipitation data from the multi-source weighted-ensemble precipitation covering the years 1980-2019, to examine shifts in precipitation rates and peak precipitation levels before and after TC landfall. The results highlight several key findings: (1) Precipitation during the TC landfall process is relatively stable beforehand but tends to decrease slightly after landfall. Generally, the maximum precipitation occurs during the landfall. (2) From 1980 to 2019, the rate of precipitation changes before landfall has significantly increased. Conversely, after the year 2000, the rate of precipitation changes after landfall has significantly decreased. (3) Over the past 40 years, while peak precipitation levels of landfalling TCs have remained relatively constant, the total precipitation has shown an increasing trend, particularly in regions like the main island of Hainan, southern Zhejiang, and Shanghai, which are characterized by high peak precipitation. The results help clarify the TC processes and provide reference points for parameter selection in regional TCP modeling.

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INTRODUCTION: Patients with moderate-to-severe atopic dermatitis (AD) who are most likely to respond to the Janus kinase (JAK) 1/2 inhibitor baricitinib (BARI) are known to have an impacted body surface area (BSA) ≤ 40% and severe itch (numerical rating scale [NRS] ≥ 7], collectively termed 'BARI itch-dominant' patients. Our objective is to build on our previous work by providing a body region-specific, clinical characterization of the BARI itch-dominant patient at baseline and their response to BARI 4 mg. METHODS: BREEZE-AD7 was a phase 3 trial in adults with moderate-to-severe AD receiving placebo or 2 mg or 4 mg BARI in combination with topical corticosteroids. Assessing only data from BARI itch-dominant patients, we summarized the baseline characteristics and conducted body region-specific analyses on Eczema Area and Severity Index (EASI) data in order to report the response to placebo versus BARI 4 mg within this patient subtype. RESULTS: BARI 4 mg was highly effective across all body regions; at week 16, 75% improvement was seen in EASI scores (EASI75), and response rates with BARI 4 mg (head/neck, 58.3%; trunk, 69.2%; upper extremities, 61.5%; lower extremities, 87.5%) all exceeded those with placebo (head/neck: 37.5%; trunk, 40.6%; upper extremities, 18.8%; lower extremities, 40.6%) as well as the overall EASI75 rates of the intent-to-treat (ITT) population (BARI, 48.0%; placebo, 23.0%). At baseline, most BARI itch-dominant patients presented with involvement of all regions (mean regional BSA 22.7%-40.3%), highest in the head and neck, mean EASI region scores of 15.7-24.0, and considerably severe sign ratings (mean EASI sub-scores: 1.4-2.3, out of 3), especially for erythema. CONCLUSION: BARI itch-dominant patients exhibit AD involvement across all body regions and considerable sign severity, especially erythema. In response to BARI 4 mg, EASI quickly improved across regions, substantially more so in this subtype than in the ITT population.

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BACKGROUND AND OBJECTIVES: Atrial fibrillation (AF) is a widespread cardiac arrhythmia that significantly impacts heart function. AF disrupts atrial mechanical contraction, leading to irregular, uncoordinated, and slow blood flow inside the atria which favors the formation of clots, primarily within the left atrium (LA). A standardized region-based analysis of the LA is missing, and there is not even any consensus about how to define the LA regions. In this study we propose an automatic approach for regionalizing the LA into segments to provide a comprehensive 3D region-based LA contraction assessment. LA global and regional contraction were quantified in control subjects and in AF patients to describe mechanical abnormalities associated with AF. METHODS: The proposed automatic approach for LA regionalization was tested in thirteen control subjects and seventeen AF patients. After dividing LA into standard regions, we evaluated the global and regional mechanical function by measuring LA contraction parameters, such as regional volume, global and regional strains, regional wall motion and regional shortening fraction. RESULTS: LA regionalization was successful in all study subjects. In the AF group compared with control subjects, results showed: a global impairment of LA contraction which appeared more pronounced along radial and circumferential direction; a regional impairment of radial strain which was more pronounced in septal, inferior, and lateral regions suggesting a greater reduction in mechanical efficiency in these regions in comparison to the posterior and anterior ones. CONCLUSION: An automatic approach for LA regionalization was proposed. The regionalization method was proved to be robust with several LA anatomical variations and able to characterize contraction changes associated with AF.

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Evidence of climate change is widespread and severe across all parts of the world. This poses a threat to humanity, and the entire environment. Appropriate policies are therefore required to help reduce greenhouse gas emission levels, limit the rate of global warming and its impact on climate change while pursuing national growth targets. This study employs the Tapio decoupling method to analyse the decoupling relationship (DR) between economic growth and carbon dioxide (CO2) emissions from 1998 to 2018. We also apply the Logarithmic Mean Divisia Index (LMDI) decomposition method on an extended Kaya identity to analyse CO2 emissions drivers in 145 countries. Last, the study examined the relative impacts of trade intensity and trade efficiency on the DR between economic growth and CO2 emissions. The results revealed that regions with relatively many developing and emerging countries (i.e., SSA, EAP, LAC, MENA, and SA) generally performed Weak Decoupling (WD), Expansive Negative Decoupling (END) and Expansive Coupling (EC), and the decoupling process was largely unstable. The ECA and NA regions on the other hand, which are typically composed of developed economies performed stable WD and Strong Decoupling (SD) statuses throughout the study period. The evidence further revealed that while trade intensity, activity, population, output per carbon emission and Carbon Intensity (CI) effects promote CO2 emissions, trade efficiency and energy intensity (EI) hinder emissions. We recommend that developing countries should enforce laws and cooperate with the developed economies to gain access to green technology to promote environmental sustainability.

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Medical waste (MW) is exploding due to the COVID-19 pandemic, posing a significant environmental threat, and leading to the urgent requirement for affordable and environmentally friendly MW disposal technologies. Prior research on individual MW disposal plants is region-specific, applying these results to other regions may introduce bias. In this study, major MW disposal technologies in China, i.e., incineration technologies (pyrolysis incineration and rotary kiln incineration), and sterilization technologies (steam sterilization, microwave sterilization, and chemical disinfection) with residue landfill or incineration were analyzed from an industry-level perspective via life cycle assessment (LCA), life cycle costing (LCC) and net present value (NPV) methods. Life cycle inventories and economic cost data for 4-5 typical companies were selected from 128 distinct enterprises and academic sources for each technology. LCA results show that microwave sterilization with residue incineration has the lowest environmental impact, emitting only 480 kg CO2 eq. LCC and NPV analyses indicate that steam sterilization with landfilling is the most economical, yielding revenues of 1,210 CNY/t and breaking even in the first year. Conversely, pyrolysis and rotary kiln incineration break even between the 4th and 5th years. Greenhouse gas emissions from the MW disposal in ten cities with the largest MW production in 2020 increased by 7% over 2019 to 43,800 tons and other pollutants increased by 6% to 12%. Economically, Shanghai exhibits the highest cost-effectiveness, while Nanjing delivers the lowest. It can be observed that the adoption of optimal environmental technologies has resulted in a diminution of greenhouse gas emissions by 279,000 tons and energy conservation of 1.76 billion MJ.

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BACKGROUND & AIMS: It is not yet known whether regional bioelectrical impedance (BIA) phase angle (PhA) may be informative of different types of strength performed by the lower and upper limbs, independently of lean soft tissue mass (LSTM). Using a sample of healthy adults, we aimed to examine the association and relevance of regional PhA relative to isometric and isokinetic strength of each limb. METHODS: A total of 57 participants (32.7 ± 12.9 years; 24.7 ± 3.5 kg/m2) were included in the present investigation. Regional raw BIA variables were determined using a phase-sensitive BIA device. Dual-energy X-ray absorptiometry was used to evaluate LSTM. Absolute isometric and isokinetic (i.e., 60°/s and 180°/s) strength of each limb (extension and flexion) was assessed using an isokinetic dynamometer and used to calculate relative strength. RESULTS: In absolute strength, only dominant leg PhA was associated with isometric extension strength (ß = 0.283) and isokinetic 180°/s flexion strength (ß = 0.354), regardless of LSTM (p < 0.05). In relative strength, a significant association of regional PhA was found for dominant arm flexion isometric strength (ß = 0.336), and non-dominant arm and dominant leg extension isometric strength (ß = 0.377, ß = 0.565, respectively; p < 0.05), independently of LSTM. Similarly, for isokinetic 180°/s strength, regional PhA significantly explained the variance in the relative strength of both arms and dominant leg (ß = 0.350 to 0.506), regardless of LSTM (p < 0.05). Relative isokinetic 60°/s strength was not consistently associated with regional PhA (p ≥ 0.05). CONCLUSIONS: Regional PhA significantly explained relative (isometric and 180°/s isokinetic strength of both arms and dominant leg), but not absolute muscle strength, independently of regional LSTM. Thus, after accounting for body size, regional PhA seems to have its own characteristics that explain relative strength independently of LSTM.

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BACKGROUND: Intra-aortic balloon pump (IABP) and Impella device utilization as a bridge to heart transplantation (HTx) have risen exponentially. We aimed to explore the influence of device selection on HTx outcomes, considering regional practice variation. METHODS: A retrospective longitudinal study was performed on a United Network for Organ Sharing (UNOS) registry dataset. We included adult patients listed for HTx between October 2018 and April 2022 as status 2, as justified by requiring IABP or Impella support. The primary end-point was successful bridging to HTx as status 2. RESULTS: Of 32,806 HTx during the study period, 4178 met inclusion criteria (Impella n = 650, IABP n = 3528). Waitlist mortality increased from a nadir of 16 (in 2019) to a peak of 36 (in 2022) per thousand status 2 listed patients. Impella annual use increased from 8% in 2019 to 19% in 2021. Compared to IABP, Impella patients demonstrated higher medical acuity and lower success rate of transplantation as status 2 (92.1% vs 88.9%, p < 0.001). The IABP:Impella utilization ratio varied widely between regions, ranging from 1.77 to 21.31, with high Impella use in Southern and Western states. However, this difference was not justified by medical acuity, regional transplant volume, or waitlist time and did not correlate with waitlist mortality. CONCLUSIONS: The shift in utilizing Impella as opposed to IABP did not improve waitlist outcomes. Our results suggest that clinical practice patterns beyond mere device selection determine successful bridging to HTx. There is a critical need for objective evidence to guide tMCS utilization and a paradigm shift in the UNOS allocation system to achieve equitable HTx practice across the United States.

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INTRODUCTION: Improved sinus rhythm (SR) maintenance rates have been achieved in patients with persistent atrial fibrillation (AF) undergoing pulmonary vein isolation plus additional ablation of low voltage substrate (LVS) during SR. However, voltage mapping during SR may be hindered in persistent and long-persistent AF patients by immediate AF recurrence after electrical cardioversion. We assess correlations between LVS extent and location during SR and AF, aiming to identify regional voltage thresholds for rhythm-independent delineation/detection of LVS areas. (1) Identification of voltage dissimilarities between mapping in SR and AF. (2) Identification of regional voltage thresholds that improve cross-rhythm substrate detection. (3) Comparison of LVS between SR and native versus induced AF. METHODS: Forty-one ablation-naive persistent AF patients underwent high-definition (1 mm electrodes; >1200 left atrial (LA) mapping sites per rhythm) voltage mapping in SR and AF. Global and regional voltage thresholds in AF were identified which best match LVS < 0.5 mV and <1.0 mV in SR. Additionally, the correlation between SR-LVS with induced versus native AF-LVS was assessed. RESULTS: Substantial voltage differences (median: 0.52, interquartile range: 0.33-0.69, maximum: 1.19 mV) with a predominance of the posterior/inferior LA wall exist between the rhythms. An AF threshold of 0.34 mV for the entire left atrium provides an accuracy, sensitivity and specificity of 69%, 67%, and 69% to identify SR-LVS < 0.5 mV, respectively. Lower thresholds for the posterior wall (0.27 mV) and inferior wall (0.3 mV) result in higher spatial concordance to SR-LVS (4% and 7% increase). Concordance with SR-LVS was higher for induced AF compared to native AF (area under the curve[AUC]: 0.80 vs. 0.73). AF-LVS < 0.5 mV corresponds to SR-LVS < 0.97 mV (AUC: 0.73). CONCLUSION: Although the proposed region-specific voltage thresholds during AF improve the consistency of LVS identification as determined during SR, the concordance in LVS between SR and AF remains moderate, with larger LVS detection during AF. Voltage-based substrate ablation should preferentially be performed during SR to limit the amount of ablated atrial myocardium.

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We investigate the effects of aging on regional productivity growth, the mechanisms and the strength of which are not well-understood. We focus on two different manifestations of population aging-workforce aging and an increasing share of retirees-and investigate channels through which aging may impact on regional productivity growth for a panel of German counties 2000-2019. We find that workforce aging is more negatively associated with productivity growth in urban than in nonurban regions. A likely reason is that aging is detrimental to innovative and knowledge-intensive activities, which are heavily concentrated in cities. We also find a negative association between the share of the retired population and productivity growth in regions with a small household services sector. A likely reason is that older people's disproportionate demand for local household services (including health care, recreation) requires a re-allocation of resources from more productive manufacturing or business services to less productive household services. Regions specialized more in highly productive industries have more to lose in this process.

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INTRODUCTION: Femoral head coverage in patients with hip dysplasia (DDH) is typically quantified using 2D measurements of the lateral center edge angle (LCEA) and anterior center edge angle (ACEA). However, as the morphology of DDH is complex and varies between patients, 2D measurements may not predict the true 3D femoral head coverage. Herein, 2D and 3D coverage were quantified before and after curved periacetabular osteotomy (CPO) and their relationships were assessed. MATERIALS AND METHODS: Forty-three hips that underwent CPO for DDH were analyzed. For 2D evaluation, LCEA was quantified from X-rays and CT images. The ACEA was measured from CT images (CT-ACEA) and digitally reconstructed radiographs generated from CT images (DRR-ACEA). Three-dimensional coverage was quantified from CT reconstructions of the hip and evaluated in the anterior, superior, posterior, and inferior regions of the femoral head. Two-dimensional measurements were correlated to 3D coverage to assess their relationships. RESULTS: The median preoperative 3D percent coverage was 17.7, 36.1, 56.1, and 14.6% for the anterior, superior, posterior, and inferior region, respectively. After CPO, all LCEAs and ACEAs increased significantly (all p < 0.001). For the 3D coverage, anterior and superior coverage significantly increased while the posterior and inferior coverage decreased (all p < 0.001). Moderate to strong correlations were detected between the two LCEAs and the 3D superior coverage in both the preoperative and postoperative period. For the correlation between 3D anterior coverage, no significant correlation was found between the CT-ACEA while a moderate correlation was found between the DRR-ACEA (rs = 0.41, p = 0.023). CONCLUSIONS: Our results indicate that the LCEA can be used to predict 3D coverage in the superior region of the femoral head. However, as the CT-ACEA or DRR-ACEA had no or only moderate correlation between the 3D anterior coverage, these measurements are not recommended for evaluating/estimating the 3D anterior coverage in patients with DDH.

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Stream macroinvertebrate assemblages are shaped by natural and human-related factors that operate through complex hierarchical pathways. Quantifying these relationships can provide additional insights into stream ecological assessment. We applied a structural equation modeling framework to evaluate hypothesized pathways by which watershed, riparian, and in-stream factors affect benthic macroinvertebrate condition in the Western Mountains (WMT) and Xeric (XER) ecoregions in the United States. We developed a conceptual model grounded in theory, empirical evidence, and expert opinion to evaluate the following hypotheses: (1) macroinvertebrate assemblages are primarily driven by proximal, in-stream factors (e.g., water quality and physical habitat); (2) anthropogenic land uses affect macroinvertebrates indirectly by altering in-stream characteristics; and (3) riparian vegetation cover attenuates land use effects. We tested our model separately on three measures of benthic macroinvertebrate assemblage condition: ratio of observed-to-expected taxonomic richness (O/E); a multimetric index (MMI); and richness of Ephemeroptera, Plecoptera, and Trichoptera taxa (EPT). In the WMT, site-level riparian cover, in-stream physical habitat (relative bed stability), and water chemistry (total nitrogen) were the top three predictors of macroinvertebrate assemblages, each having over two times the magnitude of effect on macroinvertebrates compared with watershed-level predictors. In the arid XER, annual precipitation and stream flow characteristics were top predictors of macroinvertebrate assemblages and had similar magnitudes of effect as in-stream water chemistry. Path analyses revealed that land use activities in the watershed and at the stream site degraded macroinvertebrate assemblages indirectly by altering relative bed stability, water quality, and riparian cover/complexity. Increased riparian cover was associated with greater macroinvertebrate condition by reducing land use impacts on stream flow, streambed substrate, and water quality, but the pathways differed among ecoregions. In the WMT, site-level riparian cover affected macroinvertebrate assemblages partly through indirect pathways associated with greater streambed stability and reduced total nitrogen concentrations. In contrast, in the XER, watershed-level riparian cover affected macroinvertebrate assemblages through greater specific stream power. Identifying the relative effects of and pathways by which natural and anthropogenic factors affect macroinvertebrates can serve as a framework for prioritizing management and conservation efforts.

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Purpose: Increased incidence of anterior cruciate ligament injuries has amplified the need for quantitative research in clinical and academic settings. We used a novel digital arthrometer to measure knee laxity in healthy people and patients with anterior cruciate ligament injuries. Changes in stiffness were also assessed to develop new indicators for detecting anterior cruciate ligament injury. The purpose of this study was to use arthrometer to measure the quantitative indicator of knee laxity, bringing clinicians a new perspective on how to identify injury to the ACL. Methods: In this cross-sectional study, anterior tibial displacement under continuous loading was measured using a novel digital arthrometer in 30 patients with unilateral anterior cruciate ligament injury and 30 healthy controls. Load-displacement curves were plotted, using real-time load and displacement changes. Stiffness was defined by the slope of the applied load to tibial displacement. Anterior tibial displacement and instantaneous stiffness values under different loads were compared. The restricting contribution of the anterior cruciate ligament transformed the displacement-stiffness curve from a sharp decrease to a stable increase, resulting in a minimum stiffness value. Using the minimum stiffness as the turning point, the load-displacement curve was divided into regions 1 and 2. The two regions' stiffness changes were compared. Based on the findings, receiver operating characteristic curves were plotted and the area under the curve was calculated to estimate the diagnostic accuracy. Results: Anterior tibial displacement was significantly greater in the anterior cruciate ligament injury group than in the controls under each 10-N increase load (p < 0.05). In the anterior cruciate ligament injury group, instantaneous stiffness was significantly lower on the injured side than on the healthy side (p < 0.05). In the two regions of the load-displacement curve, stiffness was significantly lower in the anterior cruciate ligament injury group than in the control group (all, p < 0.05). Receiver operating characteristic curves were plotted, using changes in stiffness under the two regions in both groups. Stiffness in region 2 had the largest area under the curve (0.94; 95% CI, 0.88-0.99). Using the cut-off value of 9.62 N/mm to detect ACL injury, the sensitivity and specificity were 93% and 82%, respectively. Conclusion: Our investigation of ligament stiffness provides novel insights into the properties of knee laxity. Stiffness in the later stages of increased loading <9.62 N/mm could be a valid indicator for identifying knee laxity.

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The aim of this study is to make a comparative study on the reproduction number R 0 computed at the beginning of each wave for African countries and to understand the reasons for the disparities between them. The study covers the two first years of the COVID-19 pandemic and for 30 African countries. It links pandemic variables, reproduction number R 0, demographic variable, median age of the population, economic variables, GDP and CHE per capita, and climatic variables, mean temperature at the beginning of each waves. The results show that the diffusion of COVID-19 in Africa was heterogeneous even between geographical proximal countries. The difference of the basic reproduction number R 0 values is very large between countries and is significantly correlated with economic and climatic variables GDP and temperature and to a less extent with the mean age of the population.

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Lake water levels are integral to lake function, but hydrologic changes from land and water management may alter lake fluctuations beyond natural ranges. We constructed a conceptual model of multifaceted drivers of lake water-levels and evaporation-to-inflow ratio (Evap:Inflow). Using a structural equation modeling framework, we tested our model on 1) a national subset of lakes in the conterminous United States with minimal water management to describe natural drivers of lake hydrology and 2) five ecoregional subsets of lakes to explore regional variation in water management effects. Our model fit the national and ecoregional datasets and explained up to 47% of variation in Evap:Inflow, 38% of vertical water-level decline, and 79% of horizontal water-level decline (littoral exposure). For lakes with minimal water management, Evap:Inflow was related to lake depth (ß = -0.31) and surface inflow (ß = -0.44); vertical decline was related to annual climate (e.g., precipitation ß = -0.18) and water management (ß = -0.21); and horizontal decline was largely related to vertical decline (ß = 0.73) and lake morphometry (e.g., depth ß = -0.18). Anthropogenic effects varied by ecoregion and likely reflect differences in regional water management and climate. In the West, water management indicators were related to greater vertical decline (ß = 0.38), whereas in the Midwest, these indicators were related to more stable and full lake levels (ß = -0.22) even during drought conditions. National analyses show how human water use interacts with regional climate resulting in contrasting impacts to lake hydrologic variation in the US.

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The construction industry has rapidly developed with continuous prosperity in Hong Kong and Mainland China, although accidents still occur with unacceptable frequency and severity. For promoting the safety issue of workers in construction industry, safety citizenship behavior (SCB) and safety consciousness (SC) were considered two influential constructs and further studied with integration of sociodemographic theories by scholars. However, no study has compared the SC and SCB of construction workers in terms of the demographic influence between Mainland China and Hong Kong. To fill this research gap, this study investigated the territorial difference between these two regions by conducting a cross-sectional questionnaire survey with recruitment of 253 Mainland construction workers and 256 Hong Kong construction workers. Significant similarities and differences of SC and SCB performance were revealed in terms of the workers with different genders, education levels, weekly working hours, and ages. This study provides insights into the comparison of demographic influence on SC and SCB of construction workers between Hong Kong and Mainland China, which is unique as it can yield useful managerial knowledge relevant to the personal safety of targeted groups of construction workers with particular demographic characteristics in both regions and contribute the implementation of safety interventions in line with the specific distinction in the territorial aspect.

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Background: In HIV clinical trials, proportions of Black and female participants achieving virologic suppression (VS) are often lower compared with White and male participants. As the antiretroviral therapy (ART) landscape continues to evolve, addressing existing challenges in clinical trial diversity will be critical to effectively translate results into clinical practice. Here, we pooled data to evaluate the efficacy and safety of dolutegravir (DTG)-containing regimens by race, sex, and regional subgroups. Methods: Three pooled analyses were conducted using 48-week results from phase 3/3b trials: DTG 3-drug vs non-DTG-containing 3- or 4-drug regimens in ART-naive participants (ARIA, FLAMINGO, SINGLE, SPRING-2), DTG-containing 2-drug vs 3-drug regimens in ART-naive participants (GEMINI-1, GEMINI-2), and DTG 3-drug vs non-DTG-containing 3- or 4-drug regimens in ART-experienced participants (SAILING, DAWNING). Proportions of participants with VS, safety, and change from baseline in CD4+ cell count were analyzed. Results: Proportions of participants achieving VS were high among those receiving DTG vs comparator regimens. Proportions of participants achieving VS were generally lower in Black (vs non-Black), female (vs male), and US (vs non-US) subgroups. No new safety signals emerged from any subgroup in pooled analyses. Conclusions: These analyses confirm that, across subgroups, DTG has robust efficacy and a good safety profile at week 48 relative to comparator regimens. Achieving VS may vary by participant characteristics, highlighting the urgent need for enrollment to reflect the demographics of global HIV populations more accurately. Future studies should strive to support participants throughout the trial to ensure optimal representation, inclusion, and retention.