Boston University

Digital technologies can help support the health of migrants and refugees and facilitate research on their health issues. However, ethical concerns include security and confidentiality of information; informed consent; how to engage migrants in designing, implementing and researching digital tools; inequitable access to mobile devices and the internet; and access to health services for early intervention and follow-up. Digital technical solutions do not necessarily overcome problems that are political, social, or economic. There are major deficits with regard to (1) reliable data on the health needs of migrants and mobile populations and on how they can use digital tools to support their health; (2) evidence on effectiveness of solutions; and (3) a broad framework to guide future work. This article provides a wide socio-technical perspective, as a framework for analysis and developing coherent agendas across global-to-local spaces, with particular attention to the European region.

Stacked balloon actuators, constructed from heat- and pressure-bonded, stacked layers of sheet films have demonstrated their utility in soft robotics for performing intricate tasks and adapting to space-constrained environments. However, these actuators face limitations such as reduced force output at low displacement heights due to buckling and small retractive forces at high displacement heights due to radial collapse under vacuum. To mitigate these issues, we introduce a method for integrating fiber reinforcements: a nylon mesh fabric that increases the tensile strength of the actuator's structural layers without constraining the maximum inflated height, and a heat-sealable nylon taffeta fabric that provides radial support to the actuator's multi-chamber design. We demonstrate the advantages of this approach in a quadruped soft robot, showcasing improved force output, actuation speed, and the advantageous use of actuator's collapsibility for shape morphing.

This Viewpoint discusses supply and demand for glucagon-like peptide 1 (GLP-1) receptor agonists and concerns with using compounded drugs to fill this demand.

This article presents two authors’ duoethnographic exploration of meaningfulness in the do-it-yourself/do-it-with-others (DIY/DIWO) contexts of an independent rock band in the United Kingdom and a high school choir in the United States. The authors’ duoethnographic method also models a DIY/DIWO approach to scholarship, fostering a collaborative ethos founded in mutual trust and authentic connection. Meaningfulness is explored in relation to themes of fun, fulfillment, friendship and familiality, which are integral to the experiences and ethos of the musicians and scholars involved. This article concludes by suggesting ways in which the DIY/DIWO practices and contexts explored, might point to modes of engagement that can foster successful intimate, sustained relationships in arts, education and research.

We present multi‐platform observations of plasma cloak, O+ outflows, kinetic Alfven waves (KAWs), and auroral oval for the geomagnetic storm on 17 March 2015. During the storm's main phase, we observed a generally symmetric equatorward motion of the auroral oval in both hemispheres, corresponding to the plasmasphere erosion and inward motion of the plasma sheet. Consequently, Van Allen Probes became immersed within the plasma sheet for extended hours and repeatedly observed correlated KAWs and O+ outflows. The KAWs contain adequate energy flux toward the ionosphere to energize the observed outflow ions. Adiabatic particle tracing suggests that the O+ outflows are directly from the nightside auroral oval and that the energization is through a quasi‐static potential drop. The O+ outflows from the nightside auroral oval were adequate (108 $1{0}^{8}$‐109 $1{0}^{9}$ #/cm2 ${\mathrm{c}\mathrm{m}}^{2}$‐s) and prompt (several minutes) to explain the newly formed plasma cloak, suggesting that they were a dominant initial source of plasma cloak during this storm.

INTRODUCTION The aim of the study was to estimate the population‐based dementia incidence in Germany over a period of two decades. METHODS We analyzed data from 4814 participants of the population‐based Heinz Nixdorf Recall study (49.8% men, 45–75 years at baseline period 2000–2003), who have been monitored for the occurrence of cognitive decline and dementia. We calculated the cumulative incidence of dementia and its major subtypes and the incidence rate per 1000 person‐years over two decades. RESULTS During a median follow‐up of 18.2 (Q1–Q3: 11.3–20.6) years, a total of 298 participants (6.2%) developed dementia (22.1% Alzheimer´s disease, 23.5% vascular dementia, 15.1% mixed dementia, 9.1% other dementia, 30.2% unspecified). The overall incidence rate was 3.9 per 1000 person‐years. DISCUSSION Our study is the only current population‐based study in Germany that estimates the incidence of dementia. In order to reduce the high proportion of unspecific dementia diagnoses, diagnostics urgently need to be improved. Highlights New data on the incidence of dementia in Germany in participants ≥45 years of age. Participants have been monitored for dementia incidence over two decades. The overall incidence in our cohort was 3.9 per 1000 person‐years. Many patients had unspecific dementia diagnoses in their medical records. Further diagnostic evaluation should be available for all dementia patients.

Background We have previously studied biomarkers of tubular health (EGF), injury (KIM-1), dysfunction (alpha-1 microglobulin), and inflammation (TNFR-1, TNFR-2, MCP-1, YKL-40, suPAR), and demonstrated that plasma KIM-1, TNFR-1, TNFR-2 and urine KIM-1, EGF, MCP-1, urine alpha-1 microglobulin are each independently associated with CKD progression in children. In this study, we used bootstrapped survival trees to identify a combination of biomarkers to predict CKD progression in children. Methods The CKiD Cohort Study prospectively enrolled children 6 months to 16 years old with an eGFR of 30-90 ml/min/1.73m ² . We measured biomarkers in stored plasma and urine collected 5 months after study enrollment. The primary outcome of CKD progression was a composite of 50% eGFR decline or kidney failure. We constructed a regression tree-based model for predicting the time to the composite event, using a panel of clinically relevant biomarkers with empirically derived thresholds, in addition to conventional risk factors. Results Of the 599 children included, the median age was 12 years [IQR, 8 - 15], 371 (62%) were male, baseline urine protein to creatinine ratio was 0.33 [IQR: 0.12 - 0.95] mg/mg, and baseline eGFR was 53 [IQR, 40 - 66] ml/min/1.73m ² . Overall, 205 (34%) children reached the primary outcome of CKD. A single regression tree-based model using the most informative predictors with data driven biomarker thresholds suggested a final set of 4 prognosis groups. In the final model, urine albumin/creatinine was the variable with the highest importance, and along with urine EGF/creatinine identified the highest risk group of 24 children, 100% of whom developed CKD progression at a median time of 1.3 years [95% CI: 1.0, 1.7]. When the regression tree-derived risk group classifications were added to prediction models including the clinical risk factors, the C-statistic increased from 0.76 [95%CI: 0.71 - 0.80] to 0.85 [95%CI: 0.81 - 0.88]. Conclusions Using regression tree-based methods, we identified a biomarker panel of urine albumin/creatinine, urine EGF/creatinine, plasma KIM-1, and eGFR which significantly improved discrimination for CKD progression.

Super-resolution imaging of cell metabolism is hindered by the incompatibility of small metabolites with fluorescent dyes and the limited resolution of imaging mass spectrometry. We present ultrasensitive reweighted visible stimulated Raman scattering (URV-SRS), a label-free vibrational imaging technique for multiplexed nanoscopy of intracellular metabolites. We developed a visible SRS microscope with extensive pulse chirping to improve the detection limit to ~4,000 molecules and introduced a self-supervised multi-agent denoiser to suppress non-independent noise in SRS by over 7.2 dB, resulting in a 50-fold sensitivity enhancement over near-infrared SRS. Leveraging the enhanced sensitivity, we employed Fourier reweighting to amplify sub-100-nm spatial frequencies that were previously overwhelmed by noise. Validated by Fourier ring correlation, we achieved a lateral resolution of 86 nm in cell imaging. We visualized the reprogramming of metabolic nanostructures associated with virus replication in host cells and subcellular fatty acid synthesis in engineered bacteria, demonstrating its capability towards nanoscopic spatial metabolomics.

Background Although conventional pre-operative venography can accurately delineate venous anatomy as an alternative to ultrasound for hemodialysis access planning, it may carry a risk of contrast-induced acute kidney injury (AKI) and progression of renal failure in chronic kidney disease (CKD) patients not yet on dialysis. Therefore, the objective of this study was to evaluate the safety and efficacy of pre-operative venograms in pre-end-stage kidney disease (ESKD) patients. Methods We performed a retrospective cohort study (2018–2022) of consecutive pre-ESKD patients who underwent staged bilateral venograms for preoperative vein mapping prior to hemodialysis access creation at a tertiary care medical center. Patients were identified through an institutional database and data were extracted with chart review adjudication. The primary safety outcome was a composite of unplanned dialysis initiation within 7 days of venogram or development of contrast-induced AKI. Secondary outcomes included vascular access creation within 1 year of index venogram. Results A total of 142 pre-ESKD patients underwent 284 venograms. Mean (SD) age was 67 (14) years; 55% were female; and 65% of patients had stage 5 CKD, whereas 35% had stage 3 or 4 CKD. Rate of the primary safety outcome was 2.5%, which was driven by a 2.5% rate of contrast-induced AKI with no instances of unplanned dialysis initiation within 7 days of either venogram. Ultimately, 120 (85%) vascular accesses were created, of which 96% were autogenous fistulas. Forearm arteriovenous fistulas (AVFs) were the most common configuration (69%) followed by upper arm AVFs (27%); AV grafts were created in 4% of cases. Conclusion In a population of pre-ESKD patients, staged bilateral venograms led to few cases of reversible contrast-induced AKI with no instances of unplanned dialysis initiation. Furthermore, access creation was achieved in 85% of patients with the majority consisting of forearm AVFs. Therefore, preoperative venography for access planning appears safe in pre-ESKD patients.

Background Implementation fidelity measures are critical for understanding complex interventions. Though maternity waiting homes (MWHs) are recommended by the WHO and have been used to help pregnant women access health facilities for decades, a gap exists regarding fidelity studies on MWHs. To better understand intervention outcomes results, we assessed the fidelity of implementation of an improved Core MWH Model in 10 facilities in rural Zambia. Methods We analysed indicators for fidelity employing a widely used conceptual framework. We compared performance from October 2016 to July 2018 to goals set out during intervention design. The Core MWH Model consists of three pillars—infrastructure, policies and linkages to care—each designed to be culturally appropriate and responsive to community standards for safety and comfort. Results 70% of sites exhibited high adherence to the Core MWH Model components. User experience corroborated poorer performing elements: insufficient lighting, small cooking spaces, non-locking cabinets and few educational classes. Mission statements and governing documents were not always visible or available. The proportion of 3206 users who came from>10 km away was higher than the proportion of the surrounding population living at that distance except in two sites with low populations of remote-living women. Women stayed for just below the target of 14 nights. MWH occupancy rate overall was lower (52%) than the target (80%). MWH users reported high quality and satisfaction. Only three MWHs reached 50% female membership on their governance committees but met other key indicators for community ownership and engagement. Conclusions This fidelity evaluation of an MWH model in rural Zambia helps bridge the evidence–practice gap for the WHO’s recommendation on implementing MWHs and adds to the expanding body of literature on implementation fidelity studies in global health. Trial registration number NCT02620436.

Brazilians are a rapidly growing immigrant population in the United States (U.S.), yet little is known about their mental health and access to mental healthcare. Our goal was to access associations between the pursuit of– and access to—mental healthcare with mental health status and socio-demographic characteristics among Brazilian immigrant women. We conducted an online survey of Brazilian women aged 18 or older who reported being born in Brazil and currently residing in the U.S. We recruited respondents via Brazilian cultural media, community organizations serving Brazilian immigrants, and social media. We assessed respondents’ perceived access to mental healthcare, self-reported mental health (CES-D-10), and socio-demographic characteristics and conducted multivariable logistic regression. Our analysis included 351 participants. Half (52%) had CES-D-10 scores indicating high levels of depressive symptomatology. A third (33%) reported seeking care for their mental health in the past 12 months, 87% of whom reported obtaining care. Results of multivariable logistic regression determined that respondents who sought mental healthcare were more likely to have higher CES-D-10 scores (OR = 1.09, 95% CI 1.03–1.15), very low incomes (<$10,000 per year; OR = 0.34, 95% CI 0.12–0.96), and were marginally more likely to have a primary care provider (OR = 2.11, 95% CI 1.00, 4.46). We found that despite a high level of depressive symptomology, only one-third reported accessing care. While difficulty accessing care for mental issues is a widespread issue, our findings suggest that efforts are needed to ameliorate mental health issues for Brazilian women to reduce systemic, interpersonal, and individual barriers to seeking care among the 13% who sought healthcare but were unable to receive it.

Background Non-malignant tumors of the CNS contribute substantially to the morbidity and mortality from CNS tumors. It is critical to understand the epidemiology of non-malignant CNS tumors separately from CNS malignancies to inform resource allocation and policy since treatment and prognosis can differ. High quality international data on non-malignant CNS tumor burden are needed to accomplish this goal. Methods We assessed cancer registry and vital registration data available to the Global Burden of Disease study by its inclusion of non-malignant CNS tumors, reporting on the availability of data over time and by World Bank income group. We analyzed preliminary age-standardized incidence rates (ASIRs), age-standardized mortality rates (ASMRs), and proportions of CNS tumors by behavior for adults, children, and all ages. Results Non-malignant CNS tumors were reported separately in 17·2% (N=66) of registry reports and in aggregate with malignant CNS tumors in 18·0% (N=69) of reports. Only seven low- and middle-income countries (LMICs) had data reporting CNS tumors separately by behavior. Across all ages combined, the median ASIR of non-malignant CNS tumor data was 0·31 (interquartile range: 0·15-0·50) and ASMR was 0·24 (0·10-0·44) per 100,000 in LMICs compared to median ASIR of 3·62 (2·62-4·97) and ASMR of 0·32 (0·16-0·65) in high-income countries (HICs). A larger proportion of incident CNS tumors across were reported as non-malignant in HIC data than LMIC data (p<0.0001). Conclusions Our study alludes to current challenges in understanding global non-malignant CNS tumor burden and a need for increased international data collection. Further research is needed to comprehensively investigate opportunities for future data inclusion.

Coral persistence in the Anthropocene depends on interactions among holobiont partners (coral animals and microbial symbionts) and their environment. Cryptic coral lineages—genetically distinct yet morphologically similar groups—are critically important as they often exhibit functional diversity relevant to thermal tolerance. In addition, environmental parameters such as thermal variability may promote tolerance, but how variability interacts with holobiont partners to shape responses to thermal challenge remains unclear. Here, we identified three cryptic lineages of Siderastrea siderea in Bocas del Toro, Panamá that differ in distributions across inshore and offshore reefs, microbial associations, phenotypic traits of holobiont partners (i.e., phenomes), and skeleton morphologies. A thermal variability experiment failed to increase thermal tolerance, but subsequent thermal challenge and recovery revealed that one lineage maintained elevated energetic reserves, photochemical efficiency, and growth. Last, coral cores highlighted that this lineage also exhibited greater growth historically. Functional variation among cryptic lineages highlights their importance in predicting coral reef responses to climate change.