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  • image/svg+xml art designer at PLoS, modified by Wikipedia users Nina, Beao, JakobVoss, and AnonMoos Open Access logo, converted into svg, designed by PLoS. This version with transparent background. http://commons.wikimedia.org/wiki/File:Open_Access_logo_PLoS_white.svg art designer at PLoS, modified by Wikipedia users Nina, Beao, JakobVoss, and AnonMoos http://www.plos.org/
    Authors: Meiling Bao; Cunrui Huang;

    Abstract Background China has a shortage of health workers in rural areas, but little research exists on policies that attract qualified medical and nursing students to rural locations. We conducted a discrete choice experiment to determine how specific incentives would be valued by final–year students in a medical university in Guizhou Province, China. Methods Attributes of potential jobs were developed through the literature review, semi–structured interviews, and a pilot survey. Forty choice sets were developed using a fractional factorial design. A mixed logit model was used to estimate the relative strength of the attributes. Willingness to pay and uptake rates for a defined job were also calculated based on the mixed logit estimates. Results The final sample comprised 787 medical and nursing students. The statistically significant results indicated “Bianzhi” (the number of personnel allocated to each employer by the government) and physical conflicts between doctors and patients were two of the most important non-monetary job characteristics that incentivized both medical and nursing students. Policy simulation suggested that respondents were most sensitive to a salary increase, and the effect of incentive packages was stronger for students with a rural family background. Conclusions Strategies for patient–doctor relationships, Bianzhi and salary should be considered to attract final–year medical and nursing students to work in rural China. In addition, specific recruitment policy designs tailored for students with different majors and backgrounds should be taken into account.

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    Authors: Siedliska, Anna; Baranowski, Piotr; Pastuszka-Woźniak, Joanna; Zubik, Monika; +1 Authors

    Abstract Background Modern agriculture strives to sustainably manage fertilizer for both economic and environmental reasons. The monitoring of any nutritional (phosphorus, nitrogen, potassium) deficiency in growing plants is a challenge for precision farming technology. A study was carried out on three species of popular crops, celery (Apium graveolens L., cv. Neon), sugar beet (Beta vulgaris L., cv. Tapir) and strawberry (Fragaria × ananassa Duchesne, cv. Honeoye), fertilized with four different doses of phosphorus (P) to deliver data for non-invasive detection of P content. Results Data obtained via biochemical analysis of the chlorophyll and carotenoid contents in plant material showed that the strongest effect of P availability for plants was in the diverse total chlorophyll content in sugar beet and celery compared to that in strawberry, in which P affects a variety of carotenoid contents in leaves. The measurements performed using hyperspectral imaging, obtained in several different stages of plant development, were applied in a supervised classification experiment. A machine learning algorithm (Backpropagation Neural Network, Random Forest, Naive Bayes and Support Vector Machine) was developed to classify plants from four variants of P fertilization. The lowest prediction accuracy was obtained for the earliest measured stage of plant development. Statistical analyses showed correlations between leaf biochemical constituents, phosphorus fertilization and the mass of the leaf/roots of the plants. Conclusions Obtained results demonstrate that hyperspectral imaging combined with artificial intelligence methods has potential for non-invasive detection of non-homogenous phosphorus fertilization on crop levels.

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  • image/svg+xml art designer at PLoS, modified by Wikipedia users Nina, Beao, JakobVoss, and AnonMoos Open Access logo, converted into svg, designed by PLoS. This version with transparent background. http://commons.wikimedia.org/wiki/File:Open_Access_logo_PLoS_white.svg art designer at PLoS, modified by Wikipedia users Nina, Beao, JakobVoss, and AnonMoos http://www.plos.org/
    Authors: Li, Kun; Han, Xu; Ruiqiang Ni; Shi, Ge; +5 Authors

    Abstract Background Robinia pseudoacacia is a widely planted pioneer tree species in reforestations on barren mountains in northern China. Because of its nitrogen-fixing ability, it can play a positive role in soil and forest restoration. After clear-cutting of planted stands, R. pseudoacacia stands become coppice plantations. The impacts of shifting from seedling to coppice stands on soil bacterial community and soil properties have not been well described. This study aims to quantify how soil properties and bacterial community composition vary between planted seedling versus coppice stands. Methods Nine 20 m × 20 m plots were randomly selected in seedling and coppice stands. The bulk soil and rhizosphere soil were sampled in summer 2017. Bulk soil was sampled at 10 cm from the soil surface using a soil auger. Rhizosphere soil samples were collected using a brush. The soil samples were transported to the laboratory for chemical analysis, and bacterial community composition and diversity was obtained through DNA extraction, 16S rRNA gene amplification and high-throughput sequencing. Results The results showed that, compared to seedling plantations, soil quality decreased significantly in coppice stands, but without affecting soil exchangeable Mg2+ and K+. Total carbon (C) and nitrogen (N) were lower in the rhizosphere than in bulk soil, whereas nutrient availability showed an opposite trend. The conversion from seedling to coppice plantations was also related to significant differences in soil bacterial community structure and to the reduction of soil bacterial α-diversity. Principal component analysis (PCA) showed that bacterial community composition was similar in both bulk and rhizosphere soils in second-generation coppice plantations. Specially, the conversion from seedling to coppice stands increased the relative abundance of Proteobacteria and Rhizobium, but reduced that of Actinobacteria, which may result in a decline of soil nutrient availability. Mantel tests revealed that C, N, soil organic matter (SOM), nitrate nitrogen (NO3−-N) and available phosphorus positively correlated with bacterial community composition, while a variation partition analysis (VPA) showed that NO3−-N explained a relatively greater proportion of bacterial distribution (15.12%), compared with C and SOM. Surprisingly, N showed no relationship with bacterial community composition, which may be related to nitrogen transportation. Conclusions The conversion from seedling to coppice stands reduced soil quality and led to spatial-temporal homogenization of the soil bacterial community structure in both the rhizosphere and bulk soils. Such imbalance in microbial structure can accelerate the decline of R. pseudoacacia. This may affect the role of R. pseudoacacia coppice stands in soil and forest restoration of barren lands in mountain areas.

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  • image/svg+xml art designer at PLoS, modified by Wikipedia users Nina, Beao, JakobVoss, and AnonMoos Open Access logo, converted into svg, designed by PLoS. This version with transparent background. http://commons.wikimedia.org/wiki/File:Open_Access_logo_PLoS_white.svg art designer at PLoS, modified by Wikipedia users Nina, Beao, JakobVoss, and AnonMoos http://www.plos.org/
    Authors: Lutz, James A.; Struckman, Soren; Germain, Sara J.; Furniss, Tucker J.;

    Abstract Background Baseline levels of tree mortality can, over time, contribute to high snag densities and high levels of deadwood (down woody debris) if fire is infrequent and decomposition is slow. Deadwood can be important for tree recruitment, and it plays a major role in terrestrial carbon cycling, but deadwood is rarely examined in a spatially explicit context. Methods Between 2011 and 2019, we annually tracked all trees and snags ≥1 cm in diameter and mapped all pieces of deadwood ≥10 cm diameter and ≥1 m in length in 25.6 ha of Tsuga heterophylla / Pseudotsuga menziesii forest. We analyzed the amount, biomass, and spatial distribution of deadwood, and we assessed how various causes of mortality that contributed uniquely to deadwood creation. Results Compared to aboveground woody live biomass of 481 Mg ha−1 (from trees ≥10 cm diameter), snag biomass was 74 Mg ha−1 and deadwood biomass was 109 Mg ha−1 (from boles ≥10 cm diameter). Biomass from large-diameter trees (≥60 cm) accounted for 85%, 88%, and 58%, of trees, snags, and deadwood, respectively. Total aboveground woody live and dead biomass was 668 Mg ha−1. The annual production of downed wood (≥10 cm diameter) from tree boles averaged 4 Mg ha−1 yr−1. Woody debris was spatially heterogeneous, varying more than two orders of magnitude from 4 to 587 Mg ha−1 at the scale of 20 m × 20 m quadrats. Almost all causes of deadwood creation varied in importance between large-diameter trees and small-diameter trees. Biomass of standing stems and deadwood had weak inverse distributions, reflecting the long period of time required for trees to reach large diameters following antecedent tree mortalities and the centennial scale time required for deadwood decomposition. Conclusion Old-growth forests contain large stores of biomass in living trees, as well as in snag and deadwood biomass pools that are stable long after tree death. Ignoring biomass (or carbon) in deadwood pools can lead to substantial underestimations of sequestration and stability.

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  • image/svg+xml art designer at PLoS, modified by Wikipedia users Nina, Beao, JakobVoss, and AnonMoos Open Access logo, converted into svg, designed by PLoS. This version with transparent background. http://commons.wikimedia.org/wiki/File:Open_Access_logo_PLoS_white.svg art designer at PLoS, modified by Wikipedia users Nina, Beao, JakobVoss, and AnonMoos http://www.plos.org/
    Authors: Wu, Tian; Danyan Hu; Qingfen Wang;

    Abstract Background Noni (Morinda citrifolia Linn.) is a tropical tree that bears climacteric fruit. Previous observations and research have shown that the second day (2 d) after harvest is the most important demarcation point when the fruit has the same appearance as the freshly picked fruit (0 d); however, they are beginning to become water spot appearance. We performed a conjoint analysis of metabolome and transcriptome data for noni fruit of 0 d and 2 d to reveal what happened to the fruit at the molecular level. Genes and metabolites were annotated to KEGG pathways and the co-annotated KEGG pathways were used as a statistical analysis. Results We found 25 pathways that were significantly altered at both metabolic and transcriptional levels, including a total of 285 differentially expressed genes (DEGs) and 11 differential metabolites through an integrative analysis of transcriptomics and metabolomics. The energy metabolism and pathways originating from phenylalanine were disturbed the most. The upregulated resistance metabolites and genes implied the increase of resistance and energy consumption in the postharvest noni fruit. Most genes involved in glycolysis were downregulated, further limiting the available energy. This lack of energy led noni fruit to water spot appearance, a prelude to softening. The metabolites and genes related to the resistance and energy interacted and restricted each other to keep noni fruit seemingly hard within two days after harvest, but actually the softening was already unstoppable. Conclusions This study provides a new insight into the relationship between the metabolites and genes of noni fruit, as well as a foundation for further clarification of the post-ripening mechanism in noni fruit.

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  • Authors: Banerjee, Ankush; Paul, Bobby; Dobe, Madhumita; Bandyopadhyay, Lina; +2 Authors

    The multisectoral impact of the COVID-19 pandemic can impair treatment adherence of patients with noncommunicable diseases (NCDs). This mixed-method study, conducted from November 2020 to January 2021, assessed the quantum of their treatment adherence and its determinants in rural West Bengal. Quantitative data were collected from 213 NCD patients while qualitative exploration for barriers of treatment adherence was conducted as 6 in-depth Interviews. Treatment adherence was assessed by “Medication Compliance Questionnaire” and “Adherence to Healthy Lifestyle and Follow-up Advice” Questionnaire. A total of 39.4% were nonadherent to medications while 67.1% had nonadherence to healthy lifestyle and follow-up advice. Significant predictors associated with nonadherence were increasing age, female gender, lower socioeconomic status, decreasing patient empowerment, and decreasing trust in the medical profession. Economic crisis, fear of contagion, and nonavailability of investigation facilities were some new emerging barriers in addition to preexisting barriers of treatment adherence. Therefore, measures for improving patient empowerment and patient–provider relationship by motivation and counseling, taking proper care of vulnerable patients affected by the pandemic, and correcting deficiencies at the health-system level should be given utmost priority.

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    https://doi.org/10.25384/sage....
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  • Authors: Bonatti, Johannes; Crailsheim, Ingo; Grabenwöger, Martin; Winkler, Bernhard;

    In the mid- to late-1990s the cardiac surgery community began to apply limited incisions in mitral valve surgery. Ministernotomies and right-sided minithoracotomies were placed instead of the classic midline sternotomy. Adjunct technology such as videoscopy, advanced peripheral cannulation techniques, procedure specific long shafted surgical instruments, as well as surgical robots became available, and the procedures were refined in a stepwise fashion. In 2021, minimally invasive mitral valve repair is routine at many centers around the globe. We reviewed a total of 50 consecutive patient series published on the topic between 1999 and 2019. Three main versions of minimally invasive mitral valve surgery were applied in 20,539 patients. The surgical methods, their specific results, and the cumulative outcome of less invasive mitral valve surgery published over more than 20 years are reported and an integrated view on what less invasive mitral valve surgery can offer is presented.

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  • Land-use and land-cover analyses based on satellite image classification are used in most, if not all, sub-disciplines of physical geography. Data availability and increasingly simple image classification techniques ��� nowadays, even implemented in simple geographic information systems ��� increase the use of such analyses. To assess the quality of such land-use analyses, accuracy metrics are applied. The results are considered to have sufficient quality, exceeding thresholds published in the literature. A typical practice in many studies is to confuse accuracy in remote sensing with quality, as required by physical geography. However, notions such as quality are subject to normative considerations and performative practices, which differ between scientific domains. Recent calls for critical physical geography have stressed that scientific results cannot be understood separately from the values and practices underlying them. This article critically discusses the specific understanding of quality in remote sensing, outlining norms and practices shaping it and their relation to physical geography. It points out that, as a seeming paradox, results considered more accurate in remote sensing terms can be less informative ��� or meaningful ��� in geographical terms. Finally, a roadmap of how to apply remote sensing land-use analyses more constructively in physical geography is proposed.

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  • Authors: Roesler, Anna; Smithers, Lisa G.; Wangpakapattanawong, Prasit; Moore, Vivienne;

    Background:Nutrition-sensitive agriculture (NSA) interventions can contribute to improved food security and household dietary diversity. As well as undertaking trials, contextual factors that influence sustainability need to be scoped.Objective:To explore locals’ views of an NSA initiative, designed to improve food security and reduce malnutrition in children younger than 5 years, scoping future prospects 6 months after the conclusion of the trial.Methods:The initiative that was formally trialed over 6 months (November 2014 to April 2015) entailed keeping hens and home gardens. It occurred in the ethnic hill tribes of northern Thailand. In November 2015, 20 in-depth interviews were undertaken with villagers who had been involved in the initiative. Dialogue occurred in Thai with assistance of a translator and was recorded, transcribed, and translated to English. A detailed thematic analysis was undertaken.Results:Eggs produced by the hens were appreciated and fed to children, and the message of providing children with an egg a day was widely remembered. Subsequently, the hens ceased laying or died. The home gardens had seasonal scarcity of water. Less visible, but fundamental, women lacked time for these activities due to heavy burdens of farm labor.Conclusion:Keeping hens has potential to become a sustainable activity. Home gardens need water infrastructure to be viable. Women do not necessarily have spare capacity for such initiatives. The required labor needs deliberation by villagers.

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  • image/svg+xml art designer at PLoS, modified by Wikipedia users Nina, Beao, JakobVoss, and AnonMoos Open Access logo, converted into svg, designed by PLoS. This version with transparent background. http://commons.wikimedia.org/wiki/File:Open_Access_logo_PLoS_white.svg art designer at PLoS, modified by Wikipedia users Nina, Beao, JakobVoss, and AnonMoos http://www.plos.org/
    Authors: Unwin, H. Juliette T.; Mwandigha, Lazaro; Winskill, Peter; Ghani, Azra C.; +1 Authors

    Abstract Background The RTS,S/AS01 malaria vaccine is currently being evaluated in a cluster-randomized pilot implementation programme in three African countries. This study seeks to identify whether vaccination could reach additional children who are at risk from malaria but do not currently have access to, or use, core malaria interventions. Methods Using data from household surveys, the overlap between malaria intervention coverage and childhood vaccination (diphtheria-tetanus-pertussis dose 3, DTP3) uptake in 20 African countries with at least one first administrative level unit with Plasmodium falciparum parasite prevalence greater than 10% was calculated. Multilevel logistic regression was used to explore patterns of overlap by demographic and socioeconomic variables. The public health impact of delivering RTS,S/AS01 to those children who do not use an insecticide-treated net (ITN), but who received the DTP3 vaccine, was also estimated. Results Uptake of DTP3 was higher than malaria intervention coverage in most countries. Overall, 34% of children did not use ITNs and received DTP3, while 35% of children used ITNs and received DTP3, although this breakdown varied by country. It was estimated that there are 33 million children in these 20 countries who do not use an ITN. Of these, 23 million (70%) received the DTP3 vaccine. Vaccinating those 23 million children who receive DTP3 but do not use an ITN could avert up to an estimated 9.7 million (range 8.5���10.8 million) clinical malaria cases each year, assuming all children who receive DTP3 are administered all four RTS,S doses. An additional 10.8 million (9.5���12.0 million) cases could be averted by vaccinating those 24 million children who receive the DTP3 vaccine and use an ITN. Children who had access to or used an ITN were 9���13% more likely to reside in rural areas compared to those who had neither intervention regardless of vaccination status. Mothers��� education status was a strong predictor of intervention uptake and was positively associated with use of ITNs and vaccination uptake and negatively associated with having access to an ITN but not using it. Wealth was also a strong predictor of intervention coverage. Conclusions Childhood vaccination to prevent malaria has the potential to reduce inequity in access to existing malaria interventions and could substantially reduce the childhood malaria burden in sub-Saharan Africa, even in regions with lower existing DTP3 coverage.

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    Authors: Meiling Bao; Cunrui Huang;

    Abstract Background China has a shortage of health workers in rural areas, but little research exists on policies that attract qualified medical and nursing students to rural locations. We conducted a discrete choice experiment to determine how specific incentives would be valued by final–year students in a medical university in Guizhou Province, China. Methods Attributes of potential jobs were developed through the literature review, semi–structured interviews, and a pilot survey. Forty choice sets were developed using a fractional factorial design. A mixed logit model was used to estimate the relative strength of the attributes. Willingness to pay and uptake rates for a defined job were also calculated based on the mixed logit estimates. Results The final sample comprised 787 medical and nursing students. The statistically significant results indicated “Bianzhi” (the number of personnel allocated to each employer by the government) and physical conflicts between doctors and patients were two of the most important non-monetary job characteristics that incentivized both medical and nursing students. Policy simulation suggested that respondents were most sensitive to a salary increase, and the effect of incentive packages was stronger for students with a rural family background. Conclusions Strategies for patient–doctor relationships, Bianzhi and salary should be considered to attract final–year medical and nursing students to work in rural China. In addition, specific recruitment policy designs tailored for students with different majors and backgrounds should be taken into account.

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    Authors: Siedliska, Anna; Baranowski, Piotr; Pastuszka-Woźniak, Joanna; Zubik, Monika; +1 Authors

    Abstract Background Modern agriculture strives to sustainably manage fertilizer for both economic and environmental reasons. The monitoring of any nutritional (phosphorus, nitrogen, potassium) deficiency in growing plants is a challenge for precision farming technology. A study was carried out on three species of popular crops, celery (Apium graveolens L., cv. Neon), sugar beet (Beta vulgaris L., cv. Tapir) and strawberry (Fragaria × ananassa Duchesne, cv. Honeoye), fertilized with four different doses of phosphorus (P) to deliver data for non-invasive detection of P content. Results Data obtained via biochemical analysis of the chlorophyll and carotenoid contents in plant material showed that the strongest effect of P availability for plants was in the diverse total chlorophyll content in sugar beet and celery compared to that in strawberry, in which P affects a variety of carotenoid contents in leaves. The measurements performed using hyperspectral imaging, obtained in several different stages of plant development, were applied in a supervised classification experiment. A machine learning algorithm (Backpropagation Neural Network, Random Forest, Naive Bayes and Support Vector Machine) was developed to classify plants from four variants of P fertilization. The lowest prediction accuracy was obtained for the earliest measured stage of plant development. Statistical analyses showed correlations between leaf biochemical constituents, phosphorus fertilization and the mass of the leaf/roots of the plants. Conclusions Obtained results demonstrate that hyperspectral imaging combined with artificial intelligence methods has potential for non-invasive detection of non-homogenous phosphorus fertilization on crop levels.

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    Authors: Li, Kun; Han, Xu; Ruiqiang Ni; Shi, Ge; +5 Authors

    Abstract Background Robinia pseudoacacia is a widely planted pioneer tree species in reforestations on barren mountains in northern China. Because of its nitrogen-fixing ability, it can play a positive role in soil and forest restoration. After clear-cutting of planted stands, R. pseudoacacia stands become coppice plantations. The impacts of shifting from seedling to coppice stands on soil bacterial community and soil properties have not been well described. This study aims to quantify how soil properties and bacterial community composition vary between planted seedling versus coppice stands. Methods Nine 20 m × 20 m plots were randomly selected in seedling and coppice stands. The bulk soil and rhizosphere soil were sampled in summer 2017. Bulk soil was sampled at 10 cm from the soil surface using a soil auger. Rhizosphere soil samples were collected using a brush. The soil samples were transported to the laboratory for chemical analysis, and bacterial community composition and diversity was obtained through DNA extraction, 16S rRNA gene amplification and high-throughput sequencing. Results The results showed that, compared to seedling plantations, soil quality decreased significantly in coppice stands, but without affecting soil exchangeable Mg2+ and K+. Total carbon (C) and nitrogen (N) were lower in the rhizosphere than in bulk soil, whereas nutrient availability showed an opposite trend. The conversion from seedling to coppice plantations was also related to significant differences in soil bacterial community structure and to the reduction of soil bacterial α-diversity. Principal component analysis (PCA) showed that bacterial community composition was similar in both bulk and rhizosphere soils in second-generation coppice plantations. Specially, the conversion from seedling to coppice stands increased the relative abundance of Proteobacteria and Rhizobium, but reduced that of Actinobacteria, which may result in a decline of soil nutrient availability. Mantel tests revealed that C, N, soil organic matter (SOM), nitrate nitrogen (NO3−-N) and available phosphorus positively correlated with bacterial community composition, while a variation partition analysis (VPA) showed that NO3−-N explained a relatively greater proportion of bacterial distribution (15.12%), compared with C and SOM. Surprisingly, N showed no relationship with bacterial community composition, which may be related to nitrogen transportation. Conclusions The conversion from seedling to coppice stands reduced soil quality and led to spatial-temporal homogenization of the soil bacterial community structure in both the rhizosphere and bulk soils. Such imbalance in microbial structure can accelerate the decline of R. pseudoacacia. This may affect the role of R. pseudoacacia coppice stands in soil and forest restoration of barren lands in mountain areas.

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    Authors: Lutz, James A.; Struckman, Soren; Germain, Sara J.; Furniss, Tucker J.;

    Abstract Background Baseline levels of tree mortality can, over time, contribute to high snag densities and high levels of deadwood (down woody debris) if fire is infrequent and decomposition is slow. Deadwood can be important for tree recruitment, and it plays a major role in terrestrial carbon cycling, but deadwood is rarely examined in a spatially explicit context. Methods Between 2011 and 2019, we annually tracked all trees and snags ≥1 cm in diameter and mapped all pieces of deadwood ≥10 cm diameter and ≥1 m in length in 25.6 ha of Tsuga heterophylla / Pseudotsuga menziesii forest. We analyzed the amount, biomass, and spatial distribution of deadwood, and we assessed how various causes of mortality that contributed uniquely to deadwood creation. Results Compared to aboveground woody live biomass of 481 Mg ha−1 (from trees ≥10 cm diameter), snag biomass was 74 Mg ha−1 and deadwood biomass was 109 Mg ha−1 (from boles ≥10 cm diameter). Biomass from large-diameter trees (≥60 cm) accounted for 85%, 88%, and 58%, of trees, snags, and deadwood, respectively. Total aboveground woody live and dead biomass was 668 Mg ha−1. The annual production of downed wood (≥10 cm diameter) from tree boles averaged 4 Mg ha−1 yr−1. Woody debris was spatially heterogeneous, varying more than two orders of magnitude from 4 to 587 Mg ha−1 at the scale of 20 m × 20 m quadrats. Almost all causes of deadwood creation varied in importance between large-diameter trees and small-diameter trees. Biomass of standing stems and deadwood had weak inverse distributions, reflecting the long period of time required for trees to reach large diameters following antecedent tree mortalities and the centennial scale time required for deadwood decomposition. Conclusion Old-growth forests contain large stores of biomass in living trees, as well as in snag and deadwood biomass pools that are stable long after tree death. Ignoring biomass (or carbon) in deadwood pools can lead to substantial underestimations of sequestration and stability.

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  • image/svg+xml art designer at PLoS, modified by Wikipedia users Nina, Beao, JakobVoss, and AnonMoos Open Access logo, converted into svg, designed by PLoS. This version with transparent background. http://commons.wikimedia.org/wiki/File:Open_Access_logo_PLoS_white.svg art designer at PLoS, modified by Wikipedia users Nina, Beao, JakobVoss, and AnonMoos http://www.plos.org/
    Authors: Wu, Tian; Danyan Hu; Qingfen Wang;

    Abstract Background Noni (Morinda citrifolia Linn.) is a tropical tree that bears climacteric fruit. Previous observations and research have shown that the second day (2 d) after harvest is the most important demarcation point when the fruit has the same appearance as the freshly picked fruit (0 d); however, they are beginning to become water spot appearance. We performed a conjoint analysis of metabolome and transcriptome data for noni fruit of 0 d and 2 d to reveal what happened to the fruit at the molecular level. Genes and metabolites were annotated to KEGG pathways and the co-annotated KEGG pathways were used as a statistical analysis. Results We found 25 pathways that were significantly altered at both metabolic and transcriptional levels, including a total of 285 differentially expressed genes (DEGs) and 11 differential metabolites through an integrative analysis of transcriptomics and metabolomics. The energy metabolism and pathways originating from phenylalanine were disturbed the most. The upregulated resistance metabolites and genes implied the increase of resistance and energy consumption in the postharvest noni fruit. Most genes involved in glycolysis were downregulated, further limiting the available energy. This lack of energy led noni fruit to water spot appearance, a prelude to softening. The metabolites and genes related to the resistance and energy interacted and restricted each other to keep noni fruit seemingly hard within two days after harvest, but actually the softening was already unstoppable. Conclusions This study provides a new insight into the relationship between the metabolites and genes of noni fruit, as well as a foundation for further clarification of the post-ripening mechanism in noni fruit.

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  • Authors: Banerjee, Ankush; Paul, Bobby; Dobe, Madhumita; Bandyopadhyay, Lina; +2 Authors

    The multisectoral impact of the COVID-19 pandemic can impair treatment adherence of patients with noncommunicable diseases (NCDs). This mixed-method study, conducted from November 2020 to January 2021, assessed the quantum of their treatment adherence and its determinants in rural West Bengal. Quantitative data were collected from 213 NCD patients while qualitative exploration for barriers of treatment adherence was conducted as 6 in-depth Interviews. Treatment adherence was assessed by “Medication Compliance Questionnaire” and “Adherence to Healthy Lifestyle and Follow-up Advice” Questionnaire. A total of 39.4% were nonadherent to medications while 67.1% had nonadherence to healthy lifestyle and follow-up advice. Significant predictors associated with nonadherence were increasing age, female gender, lower socioeconomic status, decreasing patient empowerment, and decreasing trust in the medical profession. Economic crisis, fear of contagion, and nonavailability of investigation facilities were some new emerging barriers in addition to preexisting barriers of treatment adherence. Therefore, measures for improving patient empowerment and patient–provider relationship by motivation and counseling, taking proper care of vulnerable patients affected by the pandemic, and correcting deficiencies at the health-system level should be given utmost priority.

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  • Authors: Bonatti, Johannes; Crailsheim, Ingo; Grabenwöger, Martin; Winkler, Bernhard;

    In the mid- to late-1990s the cardiac surgery community began to apply limited incisions in mitral valve surgery. Ministernotomies and right-sided minithoracotomies were placed instead of the classic midline sternotomy. Adjunct technology such as videoscopy, advanced peripheral cannulation techniques, procedure specific long shafted surgical instruments, as well as surgical robots became available, and the procedures were refined in a stepwise fashion. In 2021, minimally invasive mitral valve repair is routine at many centers around the globe. We reviewed a total of 50 consecutive patient series published on the topic between 1999 and 2019. Three main versions of minimally invasive mitral valve surgery were applied in 20,539 patients. The surgical methods, their specific results, and the cumulative outcome of less invasive mitral valve surgery published over more than 20 years are reported and an integrated view on what less invasive mitral valve surgery can offer is presented.

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  • Land-use and land-cover analyses based on satellite image classification are used in most, if not all, sub-disciplines of physical geography. Data availability and increasingly simple image classification techniques ��� nowadays, even implemented in simple geographic information systems ��� increase the use of such analyses. To assess the quality of such land-use analyses, accuracy metrics are applied. The results are considered to have sufficient quality, exceeding thresholds published in the literature. A typical practice in many studies is to confuse accuracy in remote sensing with quality, as required by physical geography. However, notions such as quality are subject to normative considerations and performative practices, which differ between scientific domains. Recent calls for critical physical geography have stressed that scientific results cannot be understood separately from the values and practices underlying them. This article critically discusses the specific understanding of quality in remote sensing, outlining norms and practices shaping it and their relation to physical geography. It points out that, as a seeming paradox, results considered more accurate in remote sensing terms can be less informative ��� or meaningful ��� in geographical terms. Finally, a roadmap of how to apply remote sensing land-use analyses more constructively in physical geography is proposed.

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  • Authors: Roesler, Anna; Smithers, Lisa G.; Wangpakapattanawong, Prasit; Moore, Vivienne;

    Background:Nutrition-sensitive agriculture (NSA) interventions can contribute to improved food security and household dietary diversity. As well as undertaking trials, contextual factors that influence sustainability need to be scoped.Objective:To explore locals’ views of an NSA initiative, designed to improve food security and reduce malnutrition in children younger than 5 years, scoping future prospects 6 months after the conclusion of the trial.Methods:The initiative that was formally trialed over 6 months (November 2014 to April 2015) entailed keeping hens and home gardens. It occurred in the ethnic hill tribes of northern Thailand. In November 2015, 20 in-depth interviews were undertaken with villagers who had been involved in the initiative. Dialogue occurred in Thai with assistance of a translator and was recorded, transcribed, and translated to English. A detailed thematic analysis was undertaken.Results:Eggs produced by the hens were appreciated and fed to children, and the message of providing children with an egg a day was widely remembered. Subsequently, the hens ceased laying or died. The home gardens had seasonal scarcity of water. Less visible, but fundamental, women lacked time for these activities due to heavy burdens of farm labor.Conclusion:Keeping hens has potential to become a sustainable activity. Home gardens need water infrastructure to be viable. Women do not necessarily have spare capacity for such initiatives. The required labor needs deliberation by villagers.

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  • image/svg+xml art designer at PLoS, modified by Wikipedia users Nina, Beao, JakobVoss, and AnonMoos Open Access logo, converted into svg, designed by PLoS. This version with transparent background. http://commons.wikimedia.org/wiki/File:Open_Access_logo_PLoS_white.svg art designer at PLoS, modified by Wikipedia users Nina, Beao, JakobVoss, and AnonMoos http://www.plos.org/
    Authors: Unwin, H. Juliette T.; Mwandigha, Lazaro; Winskill, Peter; Ghani, Azra C.; +1 Authors

    Abstract Background The RTS,S/AS01 malaria vaccine is currently being evaluated in a cluster-randomized pilot implementation programme in three African countries. This study seeks to identify whether vaccination could reach additional children who are at risk from malaria but do not currently have access to, or use, core malaria interventions. Methods Using data from household surveys, the overlap between malaria intervention coverage and childhood vaccination (diphtheria-tetanus-pertussis dose 3, DTP3) uptake in 20 African countries with at least one first administrative level unit with Plasmodium falciparum parasite prevalence greater than 10% was calculated. Multilevel logistic regression was used to explore patterns of overlap by demographic and socioeconomic variables. The public health impact of delivering RTS,S/AS01 to those children who do not use an insecticide-treated net (ITN), but who received the DTP3 vaccine, was also estimated. Results Uptake of DTP3 was higher than malaria intervention coverage in most countries. Overall, 34% of children did not use ITNs and received DTP3, while 35% of children used ITNs and received DTP3, although this breakdown varied by country. It was estimated that there are 33 million children in these 20 countries who do not use an ITN. Of these, 23 million (70%) received the DTP3 vaccine. Vaccinating those 23 million children who receive DTP3 but do not use an ITN could avert up to an estimated 9.7 million (range 8.5���10.8 million) clinical malaria cases each year, assuming all children who receive DTP3 are administered all four RTS,S doses. An additional 10.8 million (9.5���12.0 million) cases could be averted by vaccinating those 24 million children who receive the DTP3 vaccine and use an ITN. Children who had access to or used an ITN were 9���13% more likely to reside in rural areas compared to those who had neither intervention regardless of vaccination status. Mothers��� education status was a strong predictor of intervention uptake and was positively associated with use of ITNs and vaccination uptake and negatively associated with having access to an ITN but not using it. Wealth was also a strong predictor of intervention coverage. Conclusions Childhood vaccination to prevent malaria has the potential to reduce inequity in access to existing malaria interventions and could substantially reduce the childhood malaria burden in sub-Saharan Africa, even in regions with lower existing DTP3 coverage.

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