Reliable and accurate flood prediction in poorly gauged basins is challenging due to data scarcity, especially in developing countries where many rivers remain insufficiently monitored. This hinders the design and development of advanced flood prediction models and early warning systems. This paper introduces a multi-modal, sensor-based, near-real-time river monitoring system that produces a multi-feature data set for the Kikuletwa River in Northern Tanzania, an area frequently affected by floods. The system improves upon existing literature by collecting six parameters relevant to weather and river flood detection: current hour rainfall (mm), previous hour rainfall (mm/h), previous day rainfall (mm/day), river level (cm), wind speed (km/h), and wind direction. These data complement the existing local weather station functionalities and can be used for river monitoring and extreme weather prediction. Tanzanian river basins currently lack reliable mechanisms for accurately establishing river thresholds for anomaly detection, which is essential for flood prediction models. The proposed monitoring system addresses this issue by gathering information about river depth levels and weather conditions at multiple locations. This broadens the ground truth of river characteristics, ultimately improving the accuracy of flood predictions. We provide details on the monitoring system used to gather the data, as well as report on the methodology and the nature of the data. The discussion then focuses on the relevance of the data set in the context of flood prediction, the most suitable AI/ML-based forecasting approaches, and highlights potential applications beyond flood warning systems. Although natural disasters such as floods are inevitable, communities residing in flood-prone areas are often ill-equipped to mitigate their impacts. One straightforward strategy to reduce the adverse effects of floods is to improve existing flood warning mechanisms. Such measures would enable the prompt evacuation of vulnerable populations, the timely relocation of valuable assets, and ensure better preparedness to deal with the aftermath of the event. The significance of reliable and accurate flood warning mechanisms is paramount in saving lives, reducing property damage, and enhancing the overall resilience of communities facing such challenges [The lower Kikuletwa sub-catchment is an area of about 6657 kmjaro see . River Kallenges . Given aThe scarcity of data remains one of the critical challenges in improving the accuracy of flood warning systems, especially in areas with poorly gauged basins . Manual One of the foremost challenges associated with monitoring rivers in flood-prone areas, such as the Kikuletwa river, is the inability to obtain high flow readings during extreme flood events. This is often due to the dangerous conditions that arise during such events, preventing human intervention for data collection until safe conditions prevail. However, the high flow readings are critical for determining the threshold values that define the levels at which flood warnings will be issued. This emphasizes the significance of acquiring accurate and reliable data during these high flow events in order to improve the efficacy of flood warning systems. Failure to obtain such data can impede the development of effective flood warning models, and compromise the ability to mitigate the impact of flood events on vulnerable communities.In order to deal with these challenges, in this article we present a wireless sensor-based river monitoring system that enables robust, autonomous, and large-scale data gathering in a low-cost manner without the need for human intervention.The deployment of wireless sensors in poorly gauged rivers in developing countries is a significant contribution to flood monitoring and disaster response planning. This work proposes an efficient and cost-effective approach for collecting real-time, multi-feature data on river levels, which can facilitate the establishment of effective flood warning systems and aid with disaster response efforts. Additionally, the deployment and processes involved in this study can offer insights into designing superior sensors for similar environments.The continuous monitoring of river levels with wireless sensors enables the system to respond quickly to changes in water levels, providing timely and accurate information that can be used to issue flood warnings and make informed decisions regarding evacuation and relief efforts .Moreover, the deployment of wireless sensors in poorly gauged rivers can help bridge the gap in data on flood patterns and extreme events, providing a means to model floods based on extreme levels. This approach offers an alternative to traditional methods that relies on human monitoring and data collection, which may be impractical during flood events.The in-field deployed monitoring system proves to be successful in producing continuous data series of river water level and weather data , and is able to export the data in a standard format for storage and interpretation. Finally, we report and characterize the obtained data set and discuss its relevance for data-feeding of early warning and forecasting systems based on AI/ML models.https://floodlist.com/africa/burundi-tanzania-floods-late-february-2021) (accessed on 24 January 2023), , Tanzania—12 Killed in Dar Es Salaam Flash Floods. https://floodlist.com/africa/tanzania-daressalaam-floods-october-2020) (accessed on 24 January 2023). Worryingly, with the current climate change, such events are expected to be more frequent. The persistence of such events and their subsequent impacts are attributed mainly to the limited knowledge regarding their occurrence. This is partly due to data scarcity arising from poorly gauged or ungauged catchments. To effectively prepare for future hazards, it is imperative to have a better understanding of past and current events. Unfortunately, this is not the case in Tanzania as the current status quo is deficient in providing adequate data and knowledge on the subject. As such, there is a need to prioritize efforts towards addressing this knowledge gap to enhance preparedness and to mitigate the adverse effects of natural disasters such as river floods.The implementation of sensor-based river monitoring systems has gained prominence in recent years due to the increasing need for accurate and real-time data for effective water management and flood prediction . In the Kikuletwa River in Northern Tanzania is one of the many rivers that face challenges in terms of flash floods, which cause significant damage to infrastructure and agriculture, and cause loss of life. Implementing a sensor-based monitoring system is critical for mitigating the impact of floods and ensuring sustainable water management practices . The traFurther evidence from the literature shows that sensor-based monitoring systems are highly effective in providing real-time data for flood prediction and water management. This is the case, for example, of the water quality management project reported in , where dA multi-model implementation which supports the collection and aggregation of six weather parameters to complement existing local weather stations in building resilience to extreme weather events prediction.The development of a continuous data set on river characteristics which can be used in the context of improving flood resilience and water management.A mechanism to define river thresholds, which are a key input in anomaly detection ML models for floods.This work focuses on designing and deploying a multi-model wireless sensor system for near-real-time river monitoring. The system is intended to collect a multi-feature data set that is suitable for river anomaly detection and AI/ML prediction tasks. Six parameters—current hour rainfall (mm), previous hour rainfall (mm/h), previous day rainfall (mm/day), river level (cm), wind speed (km/h), and wind direction—are aggregated, summarized, and visualized. River level data, in particular, can be utilized to accurately establish thresholds for predicting river anomalies in poorly gauged basins. The main contributions are the following:To identify the optimal locations for installing sensors along the river, a preliminary study was conducted, with a special focus on the riverside villages. The study aimed to gather critical data for the research while also addressing the needs of the Pangani Water Board (PWB), the regulatory authority responsible for overseeing the management of ground and surface water in the region. The study was conducted in collaboration with the PWB, which required a permanent water monitoring system to produce satisfactory water flow and to control its behavior. Based on the feasibility study findings, two locations were identified as optimal for installing sensors: the bridge at Kikavu chini village, and the Kikuletwa bridge  situatedOur study employed the cutting-edge Waspmote Plug&Sense Smart Agriculture PRO, an Agriculture v30 Board, to attach our sensors , which proves to be beneficial in handling files within an application. By leveraging the power of this advanced technology, our research is able to collect and to transmit accurate data on critical environmental parameters.The devices are equipped with two types of batteries for the OEM line, a 6600 mAh, rechargeable lithium-ion battery (Li-Ion), with 3.7 V nominal voltage and a 52,000 mAh non-rechargeable battery with a 3.4 V nominal voltage. Waspmote is equipped with a control and safety circuit, through which the battery charge current is always made sure to be adequate. On the other hand, in the power sources for the devices, we have a solar panel. Waspmote comes with a rigid solar panel of 7 V, 500 mA which can allow up to 12 V, and the maximum charging current through the solar panel is 300 mA.https://education.nationalgeographic.org/resource/bathymetry) (accessed on 12 January 2023). Similar to topographic maps, bathymetric maps use lines to connect points of equal depth of the river. Echo sounding technology was employed (https://en.wikipedia.org/wiki/Echo_sounding) (accessed on 12 January 2023).To establish an initial reference for determining river levels, we conducted measurements of the river depth at both locations. The ultrasonic sensor utilized in our research measures the distance between its location and the water surface. This distance is subsequently transformed into river levels after determining the initial depth using the bathymetry technique. Bathymetry is a widely used technique for measuring water depth in oceans, rivers, or lakes. By applying this technique, we were able to accurately determine the initial depth of the river, which serves as a crucial reference point for subsequent measurements and data analysis (employed . Echo soThe sonar (echo sounder) depicted in The Kikavu bridge is situated at a latitude of −3.44 and a longitude of 37.30, representing the more upstream of the two locations we studied. On the other hand, the Kikuletwa bridge is situated at a latitude of −3.55 and a longitude of 37.31, representing the more downstream of the two locations. The ultrasonic sensor installed at the Kikavu bridge (kkv) was mounted at a height of 765 cm from the surface of water during installation, which coincided with normal flow (the flow during the dry season). In order to establish an initial reference point, we measured the initial river depth at Kikavu, which was found to be 94 cm. By accurately measuring the location and height of the ultrasonic sensor, we were able to collect reliable and precise data on river levels. The total distance from the sensor to the riverbed at Kikavu can now be written as:So, to obtain hourly river height from the incoming sensor data, we use the following formula:face see .The same procedure was was executed at Kikuletwa bridge with the sensors this time being mounted at a height of 400 cm from the surface of the water. The initial river depth at Kikuletwa was measured at 130.5 cm. The total distance from the sensor to the riverbed at Kikuletwa bridge can now be written as:So, to obtain the hourly river height from the incoming sensor data, we use the following formula:A programming cloud service provided by Libelium has a special application, P&S programmer, where each sensor node has been programmed to send data to Libelium cloud bridge . Basic cThe Smart Devices App was one of the most important tools during the process of installing programs to Waspmote Plug & Sense. Binary files generated from the P&S programmer, were uploaded to each of the devices though the Smart Devices App. The latest version of the Java Development Kit (JDK) is a requirement before using the Smart devices App; in our case, during the time of installation, we used Java SE 18. From the Smart Devices App, all the Plug & Sense devices that listed updates to programs were created from there after selecting a firmware that needed to be upgraded.Configure cloud connectors,Manage devices,Configure gateways.The data gathered by the sensor are sent to Libelium cloud bridge where they can be visualized in their raw state, and their status can be checked from time to time. The bridge is a service that allows users to send information from any IoT device to the main worldwide cloud platforms simultaneously, and without having to implement each specific cloud protocol or authentication methodology. In our case, we connected the bridge to Microsoft Azure. The Libelium cloud service has a buffer of limited size that is cleared after that data are sent to the final cloud service. The bridge has three main functionalities:All of these functionalities are oriented to send data from the sensor nodes to the final cloud service.The primary data sources are the sensor nodes, which send data to the cloud service through the Libelium cloud bridge. To facilitate effective data management and analysis, we implemented a comprehensive dashboard within the cloud service, which receives real-time data from the sensor nodes. Our cloud service is powered by Microsoft Azure, a state-of-the-art cloud computing platform, as illustrated in The sensor node must be registered in the Libelium Cloud (Services Cloud Manager) user account,A valid authentication API Key must be associated with the sensor node,The integrity of the Libelium Cloud Bridge service encryption layer is respected.Sensor nodes, through the 4G communication protocol, send data directly to the Libelium cloud bridge service. The Libelium Cloud bridge service listens to HTTPS requests to receive data from the sensor nodes. Valid requests must comply with the following requirements:At the data receiving end, we deployed a virtual machine with the necessary specifications to handle the high volume of incoming data streams from the sensor nodes. To facilitate efficient and effective data management and analysis, we leveraged the capabilities of InfluxDB, a high-performance time-series database designed for handling large volumes of time-stamped data. Additionally, we utilized Grafana, a powerful open-source visualization platform, to enable real-time data visualization, querying, and analysis see .The Libelium cloud bridge provided the necessary connectivity between the sensor nodes and the Microsoft Azure cloud connector, a scalable cloud-based service for storing and managing data. We implemented an Azure storage container to securely store the large amounts of unstructured data received from the sensor nodes.To enable seamless data integration and processing, we developed a custom Python script on the virtual machine that periodically checks for new data files every two hours and inserts them into InfluxDB. This script leverages InfluxDB’s APIs to provide automated and efficient data ingestion, while also enabling us to configure data retention policies to manage our data storage requirements.The data set consists of six variables, measured hourly. The variables are river level in centimeters (cm) measured using an Ultrasound sensor, current hour rainfall (mm), previous hour rainfall (mm/h), and last 24 h rainfall (mm/day), all measured using the pluviometer; wind speed in kilometers per hour (km/h) using the anemometer, and wind direction as the direction by the wind vane. The most important features of these are rainfall and river level, as they can directly state the condition of the river and if there will be any flood risks. Rainfall patterns are the main natural factor affecting water levels, with periods of wet conditions resulting in increasing water levels. On the other hand, wind speed and direction affect rainfall patterns; therefore, in this context, we have water level as a dependent variable, while the rest are independent.River water levels are measured hourly in centimeters by the ultrasonic sensor. The river level is then calculated based on the initial water level, recorded at a corresponding point by applying the formulas explained in The pluviometer gives three types of readings, rainfall for the current hour in millimeters (mm), previous hour (mm/h), and accumulated rainfall in the last 24 h (mm/day). The pluviometer has a small bucket of approximately 0.28 mm when full. During the measuring process, the switch is closed when the bucket is full, and then it is emptied afterwards. Some characteristics of rainfall data are shown in The anemometer used consists of a read switch that is normally open, and it closes only for a short time when the arms of the anemometer turn to complete a The wind vane measures the direction. To investigate some relationships among different variables, an exploratory data analysis was performed on a chunk of data collected from April to November 2022. The data came from one of the locations, Kikuletwa bridge. A correlation matrix was one of the tools used to show the correlation coefficients between the variables in the data set. A correlation coefficient ranges from −1 to 1, and indicates the strength and direction of the relationship between the variables.Looking at the matrix , we can There is also a weak negative correlation (−0.007) between the current hour rain and wind speed, meaning that as the current hour rain increases, the wind speed tends to slightly decrease. Similarly, there is a weak negative correlation (−0.069) between the wind speed and the river level, indicating that as the wind speed increases, the river level tend to slightly decrease.Overall, the correlations between these three variables are weak and suggest that there is no strong linear relationship between them. However, for the chunk of data selected, it is important to note that correlation does not necessarily imply causation, and further analysis would be needed to understand the underlying relationship between these variables. Histograms for the selected continues variable were also plotted to show the distribution of main variables.In the case of current rain, the histogram being concentrated at 0 and just above suggests that most of the time there is no rain, or very little rain. This is supported by the mean value being very close to 0, and the minimum value being 0, which of course, is the reality for Tanzania in 2022, with severely below-average rainfall . That waThe design and implementation of sensor-based river monitoring systems has gained considerable attention in recent years due to their potential to provide accurate and timely flood early warnings . This stAs emphasized in the paper, the accuracy and completeness of the data is paramount in determining the effectiveness of the warnings . Hence, Recent studies have shown that the integration of remote sensing data and machine learning algorithms can significantly enhance the accuracy and reliability of flood early warning systems ,30. In tHowever, onsite setup of the monitoring devices presents challenges in terms of the quality of data collected. Several sources of noise were identified that must be put into consideration during further analysis of the data set. For instance, the untimely recharging of the internet data can lead to gaps in the data, which can be easily identifiable in the data set since it mostly occurs in the last or first days of the month. In addition, the malfunctioning of the devices can result in out-of-range readings, which can be seen from ultrasonic distances that are beyond the possible distance that can be recorded.The solution presented in the paper aligns with the United Nations Sustainable Development Goal 6, which aims to ensure the availability and sustainable management of water and sanitation for all . The autFurthermore, the solution addresses the challenges of monitoring river floods in the Kikuletwa River. The proposed monitoring system has the potential to improve the quality of data collected and provide critical information for water management processes, while aligning with the United Nations Sustainable Development Goal 6. Future research can build upon the proposed solution by incorporating remote sensing data and machine learning algorithms to enhance the accuracy and reliability of flood early warning systems.The data generated from this experiment are hourly multivariate time series data, which contain multiple variables observed over a period of time. Machine learning algorithms such as AutoRegressive (AR), Autoregressive Integrated Moving Average (ARIMA), and deep learning algorithms such as Recurrent Neural Networks (RNN) in particular, are better suited for time-series data, such as river water levels and flow rates . A key aAnother approach is to use ensemble-based methods, such as random forests and gradient boosting, which combine the predictions of multiple models to produce a more accurate forecast. These methods are particularly useful when dealing with complex and nonlinear relationships between the input variables and the target variable ,36.Looking again at the simple exploratory data analysis explained in In this view, combining the power of AI/ML-based forecasting methods with the rich and diverse data set generated by the sensor-based river monitoring system, effective flood prediction models can be developed to help prevent or minimize the devastating effects of flooding.Firstly, the data set generated from the sensor-based river monitoring system for the Kikuletwa river floods can be used to improve water management and irrigation practices. By analyzing the data on water levels and flow rates, water managers can make informed decisions on when and how much water to release from reservoirs or dams for irrigation, and how to allocate water resources among different users . This caSecondly, the data set can be used to monitor the health and biodiversity of the river ecosystem. By analyzing the data on water quality, temperature, and other environmental parameters, scientists and conservationists can assess the impact of human activities on the ecosystem, identify areas of concern, and develop conservation strategies to protect and to restore the ecosystem. This can help to ensure the long-term sustainability of the river ecosystem, and it can help to promote environmental stewardship and awareness.Furthermore, the data set generated from the sensor-based river monitoring system can be used for research and educational purposes. Researchers can use the data to develop models and simulations of river systems, test hypotheses, and discover new insights into the workings of rivers. Educators can use the data to teach students about the importance of rivers and their role in the environment, and to promote environmental awareness and stewardship. This can help advance our understanding of river ecosystems and their importance, and can help educate future generations of environmental leaders and stewards.Moreover, the data set generated from the sensor-based river monitoring system can be used for early drought detection by continuously monitoring the water levels and flow rates in the river . When waFinally, the data set can be used to aid disaster response and recovery efforts in the event of a flood or other natural disaster. By providing real-time data on river conditions, the system can help emergency responders to identify areas of concern, allocate resources, and make informed decisions on how to respond to the disaster. After the disaster, the data set can be used to assess the extent of the damage, identify areas that need to be prioritized for recovery, and track the progress of recovery efforts over time. This can help to ensure that the disaster response and recovery efforts are efficient and effective, and it can help communities to recover more quickly from natural disasters.Overall, by leveraging the data set generated from the sensor-based river monitoring system for a range of purposes beyond flood warning systems, we can better understand, manage, and protect the complex systems that make up our natural environment.One potential limitation of the proposed solution of using wireless sensor networks for river level monitoring is that it relies on the availability of reliable and stable wireless connectivity. If there are disruptions in the wireless network, or if the sensors are located in areas with poor network coverage, data transmission and collection may be compromised.Another limitation is that the accuracy of the data collected by the sensors can be affected by various environmental factors, such as interference from other electronic devices, changes in water flow patterns, and changes in water temperature. Therefore, it is important to regularly calibrate and maintain the sensors to ensure that they are providing accurate and reliable data.Furthermore, the cost of implementing and maintaining a wireless sensor network can be relatively high, which may limit its scalability and adoption, particularly in under-resourced areas with limited funding and human capacity. Additionally, there may be challenges in terms of ensuring the security and privacy of the collected data, as well as the reliability of the sensor network over time.Overall, while wireless sensor networks hold great potential for improving river level monitoring and flood prediction, there are still some limitations and challenges that need to be addressed in order to fully realize their benefits.A multi-model implementation that supports the collection and aggregation of six weather parameters, complementing existing local weather stations and enhancing the region’s resilience to extreme weather event prediction.The development of a continuous data set on river characteristics, which can be used to improve flood resilience and water management strategies in the context of changing climate patterns.The introduction of a mechanism to define river thresholds, which are a key input in anomaly detection machine learning models for flood prediction and management.In conclusion, the implementation of a multi-model, sensor-based river monitoring system for the Kikuletwa river floods has demonstrated significant potential for providing accurate and timely data on river conditions, which is essential for disaster prevention and mitigation. The system combines sensors and traditional methods to capture real-time data on water levels, flow rates, and other key parameters, laying the groundwork for developing machine learning models for flood prediction in the future. The main benefits of this sensor-based system include its ability to provide continuous and reliable data on river conditions during extreme weather events, its scalability and flexibility for easy deployment and customization, and its potential for enhancing machine learning-based flood prediction accuracy. This study makes several important contributions to the field:By using advanced technologies such as sensors, cloud-based data storage and analysis, and machine learning algorithms, this study lays the foundation for future research and development in the field of machine learning for flood prediction. The successful implementation of the sensor-based river monitoring system for the Kikuletwa river floods, along with the significant contributions made in this study, can help water management officials to develop more effective and sustainable strategies for managing rivers and preventing floods, ultimately contributing to the broader goal of achieving sustainable development and resilience to climate change, as outlined in the United Nations’ Sustainable Development Goals (SDGs).Building upon the achievements of this study, future research should focus on the integration and optimization of machine learning algorithms to further improve flood prediction and management. Collaboration between researchers, local communities, and water management authorities will be critical to ensure that these advanced technologies are effectively applied and adapted to the specific needs and contexts of diverse regions. In addition, attention should be given to addressing potential challenges in scaling and customizing the system, such as limited resources, connectivity issues, and the need for localized adaptations, to ensure the sustainability and long-term successes of these efforts.Moreover, the successful implementation of this sensor-based river monitoring system can serve as a model for other regions facing similar challenges related to flood management and environmental monitoring. By sharing knowledge, experiences, and best practices gained from the Kikuletwa river case study, stakeholders can collaborate to develop and deploy contextually appropriate solutions in other vulnerable areas. This collaborative approach will not only help in addressing immediate flood risks, but it also contributes to the global effort of building resilience to climate change and fostering sustainable development.


Background: Adolescent Friendly Health Clinics (AFHCs) are one of the critical pillars of India’s Adolescent Health Programme-Rashtriya Kishor Swasthya Karyakram that seeks to enable all adolescents to realize their full potential by making informed decisions concerning their health and by accessing the services. Thus, a review was conceptualised to assess the compliance of AFHCs with the benchmark proposed by the Government under Rashtriya Kishor Swasthya Karyakram.Methods: Three databases  were searched for articles published between 2014 and December 2022. A snowball search strategy was also used to retrieve all published articles. Based on the search strategyeight studies were included.Results: AFHCs are not fully compliant with all the benchmarks proposed by the government of India. Evidence from the primary studies showed that the benchmarks need attention as privacy was lacking (six out of seven studies), unavailability of Information Education and Communication material (four out of five), signages (two out of four), referrals (one out of two), and judgemental attitude of health care providers (one out of 3).Conclusions: There is a pressing need to focus onthefulfilment of these gaps to make the clinics adolescent-friendly. This might increase the utilisation of available services in AFHCs by adolescents and will improve their health. The improved health will catalyse achieving the Sustainable Development Goals indicators that are associated with nutrition, reproductive health, sexual and intimate partner violence, child marriage, education, and employment. Investing intensively in adolescent health and development is not only crucial to improve their survival and well-being but also for India’s development and achievement of Sustainable Development Goals (SDGs) related to health, nutrition, education, gender equality, and food security. Investment in adolescent health and wellbeing yields triple benefits, as it benefits adolescents into their future adult life and the next generation. Health services and policies have largely ignored adolescence but, with the global HIV epidemic among adolescents, policymakers recognised the need to focus on adolescents’ sexual and reproductive health (SRH) needs. Simultaneously, numerous other adolescent health issues were spotlighted by the Lancet series on adolescent health in 2007, 2012, 2019 and 2022. The latest 2022 Lancet series highlights the global efforts to protect every child from before conception to adulthood.Adolescence (10-19 years) is a unique phase of life characterised by rapid changes in physical, biological, cognitive, social, and emotional development. and Reproductive, Maternal, Newborn, and Child Health + Adolescents (RMNCHA+A) launched in 2013. With these sustained efforts, adolescent health improved which is evident by comparing rounds of the National Family Health Surveys (NFHS) for the reduction in adolescent childbearing, contraceptive knowledge, use of contraceptive methods, mean age at first marriage, etc., While other health problems persisted such as tobacco use among adolescents, injuries and violence, mental health issues, weight gain, undernutrition, anaemia etc. For addressing these concerns, the Ministry of Health and Family Welfare (MOHFW), Government of India (GOI) in 2014 launched a flagship programme ‘Rashtriya Kishor Swasthya Karyakram’ (RKSK). The program aimed to reach out to 253 million adolescents - male and female, rural and urban, married and unmarried, in and out-of-school adolescents with a special focus on marginalised and underserved groups. The program under its ambit has expanded the scope from Sexual Reproductive Health (SRH) to nutrition, injuries, and violence (including gender-based violence), non-communicable diseases (NCDs), mental health and substance misuse, as a one-stop-shop. The strategies include community-based, facility-based interventions, and school-based interventions. The facility-based pillar of the programme focuses on providing adolescents with clinical and counselling services through Adolescent Friendly Health Clinics(AFHCs).In alignment with the international focus on adolescent health, there are various adolescent health programmes being implemented like the Reproductive and Child Health (RCH) program (I and II) Services in these clinics are being delivered through trained service providers- Medical officers (MO), Auxiliary Nurse Midwives (ANM), and Counsellors. These clinics have been integrated into medical colleges, district and sub-district hospitals, community health centres (CHCs), and primary health centres (PHCs) to bring services ‘closer to home’ for adolescents. At a different level of the health system, manpower and timings of services at the AFHCs vary. As per GOI, there are 7969 AFHCs as of 31st Dec 2019 in India; with the highest number of AFHC in Karnataka (2563) and lowest in Chandigarh (4) at various levels of health system catering to diversified health and counselling needs of adolescents. Since these clinics have been operational for several years; assessing compliance or alignment with the standards/indicators is critical for evaluation and considering further up-gradation if needed. With this background, a review was conceptualized to assess the compliance of the AFHCs with a benchmark proposed by MoHFW-GoI under RKSK focused on infrastructure, distance and convenient working hours, awareness about the clinic and range of services, competency of health service providers, privacy and confidentiality, awareness of the community members and referral linkage.AFHCs are one of the critical pillars of the RKSK that seeks to enable all adolescents to realize their full potential by making informed decisions concerning their health, by accessing the services and support to implement their decisions. we adopted a scoping review design by using Arksey and O’Malley’s five stage scoping review framework.To map the compliance of current adolescent healthcare facilities based on the RKSK benchmark set by GoI,Stage 1: Identify the research question Therefore, our scoping review addressed the following research question in an effort to synthesise the available knowledge in this field:Identifying the research question is the first step in carrying out a scoping review, according to Arksey & O’Malley.What is known about the compliance to the RKSK benchmark set by the GOI in various regions of India based on the available literature?Stage 2: identifying relevant studiesOur search strategy was established after conducting preliminary research to understand search terms and keywords. We looked up the terms “AFHC” AND “Adolescent Friendly Health Clinics,” “RKSK,” “compliance,” and “India” in PubMed, Scopus, and Google Scholar .Stage 3: Selection of literature: Inclusion criteria Our search approach identified twenty-four papers, which were then imported into Mendeley desktop 1.19.5. Ten duplicate items were deleted, leaving Fourteen articles to be screened. We screened titles, abstracts, and references using the criteria described below. The last search was carried out by two researchers from July 2022 to December 2022. Benchmark of AFHCs as per GOI’s guidelines was identified as the outcome of the studies.The systematic inclusion of the papers was done in accordance with the PRISMA  recommendations.3.1. Types and scope of studiesIn this review, studies using both quantitative and qualitative approaches were included from every research setting and region in India. We looked for papers that had been published in India between 2014 and December 2022 and had any information on the standard for AFHCs according to the Indian government. The studies conducted before 2014 were excluded, as that was the year the RKSK was launched. A priori, no language or publishing status restrictions were established.3.2. Key conceptsKey concepts pertaining to the AFHC benchmarks established by the GOI under RKSK were covered in this review.3.3. ParticipantsThis review focused on various level health facilities which provide AFHC services to adolescents aged 10-19 years.Following this, seven full-text papers were evaluated, and four papers were further omitted due to incorrect outcomes and full-text non-availability. Our review did not impose any geographic limitations in order to gather as many data as feasible and take diversity into account. We only considered articles that had undergone peer review. Papers without an English translation were not included in our analysis. However, a snowball search strategy was used to retrieve all maximum possible articles.3.4. Stage 4: Data extraction Two reviewers (SB and DB) looked over the full texts and abstracts of all the publications as well as their citations to determine each article's eligibility. Two authors independently evaluate the articles and extracted the data for this review based on the set benchmarks of GOI. Disagreements were resolved by discussion with the third author.Data related to the benchmarks was extracted on the excel sheet and before retrieving the data, the excel sheet was piloted by the researchers of the team. Information extraction included seven benchmarks set by MoHFW-GOI including Infrastructure, clean, bright and colourful, accessibility (distance and convenient working hours), awareness about the clinic and range of services it provides , non-judgmental and competent health service providers, privacy and confidentiality, awareness of the services to the community members, their need and referral from the periphery/community to the higher facilities and speciality clinics.3.5. Stage 5: Collating, Summarizing and Reporting the ResultsTo summarise our data, we used the author and year of publication, AFHC benchmarks, and clinic awareness. This study presents findings related to infrastructure, community awareness of the services provided, referral from the periphery/community and further referral linkages with higher facilities and specialty clinics, privacy and confidentiality, nonjudgmental and competent health service providers, and accessibility as AFHC benchmark parameters. However, clinic awareness also included the provision of Information, Education and Communication (IEC) and signage. A review synthesis was carried out, taking into account the differences between the various studies in terms of study aims, design, and conclusions.We found 24 papers from PubMed(n=0), Scopus(n=14), and Google scholar(n=10) in the initial database search. After removing the duplicates, 14 articles were screened, seven articles were excluded based on title and abstract screening. Only seven articles were eligible for full-text screening. While five articles were included during full-text screening by checking the references. Thus, a total of 12 articles were reviewed and finally, only eight articles were included in this review . Ladakh, Leh, Uttar Pradesh, Ahemdabad, Jharkhand,, Maharastra, Rajasthan,, Madhya Pradesh, Delhi, Haryana, Punjab, and Uttrakhand. They covered AFHC at various levels of establishment, for example, at CHC,, district hospital and sub-district hospital., These studies included, either ‘exit interviews’ of patients–, availing services at AFHCs or interviews of health care providers/counsellors/staff dealing with adolescents in AFHC and ‘Mystery clients’,, to gather information about AFHC.Eight studies from the year 2014 to 2022 were identified and included in the review. Of eight studies, six were cross-sectional, 1 cohort and 1 qualitative was included for review. The included studies had been conducted in different geographical locations of the country like Kashmir,Compliance of AFHCs with benchmarks enlisted under the RKSKPrivacy and confidentialityOut of the eight studies, seven studies evaluated the privacy and confidentiality aspect of AFHCs. Of the available seven studies, six studies reported that privacy and confidentiality in AFHCs were not maintained  and belo Similarly, interaction with mystery clients of Rajasthan reported disturbance from the staff and other patients visiting the clinic during their counselling sessions. In four out of 24 visits, these clients reported that someone was present (besides the practitioner/counsellor) during the sessions. In as frequent as half of the visits (12/24), the clients reported people coming in between the counselling sessions. This was mainly due to the location of the clinic which led to disturbance and visibility by others.Qualitative assessment emphasised seven of the fifteen clients from Jharkhand, Maharashtra and Rajasthan felt that their conversation with the MO or other staff could have been overheard by others. In addition, four of the nine clients who underwent a physical examination felt that others could have seen them while being examined by the MO. during their visits to AFHCs of Ahmedabad. During the clinic's observation, privacy and confidentiality were provided in only 63.6% of the facilities. Similarly, in RKSK facilities of Madhya Pradesh, curtains were not there (33%) and conversation could be heard from outside (40%). A six-state  evaluation of AFHCs showed that only 35% of them maintained privacy; with the least being in AFHCs of Himachal Pradesh (0%). Adolescents (69%) from Ahmedabad believed that there should be an opportunity for separate private discussions with doctors at AFHCs.Quantitative analysis in the identified studies also showed that confidentiality and privacy were breached. The majority of adolescents (90.91%) did not receive privacy during the consultation and curtains were available only during counselling of 42.42% of adolescent girlsOn the contrary, there was only one study from Kashmir and Ladakh that showed privacy was maintained. Results showed that 75% of AFHCs operational under RKSK had a dedicated space and the consultation room ensured the privacy of the clients.Infrastructure Four out of eight studies did not evaluate the AFHC infrastructure like cleanliness and brightness. The remaining four studies evaluated this benchmark and three studies reported that AFHC infrastructure was maintained well and in only one study the benchmark was not maintained, below is the evidence. Similar results were reported by all the adolescents (100%) accessing the AFHC in Ahmedabad. In another study 17 out of the 24 i.e., 70% of adolescents reported the clinic to be ‘overall clean from inside and outside highlighting cleanliness in these clinics. On other hand, a study conducted in 10 districts of Madhya Pradesh showed that only 60% of the clinics were clean.As per the qualitative results from a study conducted in three states, all the adolescents found the facility to be clean.Non-judgmental and competent health service providersAnother benchmark of the AFHC is to have non-judgemental and competent healthcare providers. Out of eight studies, only three studies have highlighted the finding around this benchmark. Out of three studies, one study did not meet the benchmark.One-third of the adolescents in a study reported some counsellors’ behavior was “judgemental and biased” as the counselor had a judgemental attitude towards unmarried adolescent girls engaging in premarital sexual activity. Similarly, in another study adolescents of Ahmedabad reported that 93.9% of health care providers were welcoming during their visits.Although, in one study almost all adolescent clients, regardless of their sex, or state of residence, reported that the healthcare provider had greeted them cordially when they entered the consultation room (21 of the 24 visits).Accessibility (distance and convenient working hours)The accessibility of these clinics is defined by the distance and the convenient working hours. Out of eight studies, three studies did not evaluate the accessibility of AFHCs. The remaining five studies evaluated this benchmark, and all (n=5) showed that the clinics were accessible to adolescents, below is the supportive evidence. and similarly 100% of adolescents reported that time was convenient. Similarly, when evaluating the AFHC of Kashmir and Madhya Pradesh it showed that they were functional on all days. Concerning the distance, AFHC was 5-10 kilometers away from the villages and also the respondents reported that these facilities were easily accessible.According to the result of the study conducted in Ahmedabad, 87.8% of adolescents reported that time and days are convenient to seek servicesAwareness about the clinic and range of services Another important variable is awareness of the clinic assessed through signboards and IEC material displayed in the AFHC. Out of eight studies, three studies did not evaluate this benchmark. Of the five studies, four studies showed that the IEC material benchmark was not fulfilled. In results derived through observations in another study, no IEC material was displayed in the AFHC. AFHC evaluation from six states of India showed that only 44% of clinics displayed material. Similarly, the adolescents reported that only limited IEC material on SRH was displayed in the waiting area of all the AFHCs.Evidence from the studies showed that reading material was available but was readable by only 56.5% of adolescents and less than half of adolescents (43.4%) reported that the material was interesting.On the contrary, only one evaluation from Kashmir and Ladakh regions showed a majority (83.3%) of the facilities had IEC material available. and another evaluation showed that 67% of AFHC from 10 districts of Madhya Pradesh had sign boards. On the contrary, evaluation of AFHCs from Ahmedabad showed signboards were available in 100% of the AFHCs and similar findings were seen when AFHCs from Jammu and Kashmir were observed.Regarding the availability of signages, only four studies evaluated the availability of signboards, and the findings gave a mixed picture (two studies met the benchmarks and the other two did not). In one evaluation, it showed that signboards were only seen in one-fourth of AFHCReferrals and community members awareness Similarly in another study, all counsellors reported referring cases of substance abuse, alcohol addiction, STIs, menstrual pain, unwanted pregnancy, and nocturnal emissions to more qualified healthcare providers but the adolescents reported only a few of them were referred to doctors by the counsellors for nocturnal emissions, STIs and teenage pregnancy.Community members’ awareness of the service provided has not been evaluated in the included studies. Another benchmark is the referral from the periphery/community to the higher facility. Out of eight studies, six studies have not evaluated the referral mechanism. The remaining two evaluated, out of which in one study mystery clients reported that they had been referred to a higher facility for SRH issues. The risk of child marriage in India has heightened as a result of the pandemic’s economic fallout, cybercrimes including cyberbullying due to excessive internet use, increased mental health issues due to information floated on social media, significant proportions of which were unverified or false. The screen time has also increased and physical activity has dwindled among adolescents. To overcome health and development issues, AFHCs can be a one-stop clinic as they are intended to be the first point of contact between an adolescent beneficiary and the formal healthcare system.This review sets out that existing AFHCs are not fully compliant with all the benchmarks proposed by MOHFW, GOI under the National Adolescent Health Programme. The benchmarks that need consideration include privacy in these clinics (six out of seven studies), availability of IEC material (four out of five studies), availability of signages (two out of four studies), referrals (one out of two studies), and non-judgemental attitude of health care providers (one out of three studies). It is important to fill these gaps in the existing AFHCs, especially during the current context of COVID-19 in India due to which the adolescents have become more vulnerable. As per the brief published in 2021, adolescents are vulnerable to a spectrum of issues due to restriction measures that have been put in place such as the closure of schools, restrictions on movement, physical distancing, mask-wearing, and restricted social gatherings. This method can be used across all Indian states to assess the functionality of AFHC at all facility levels and timely and tailor-made intervention can be given to fill the existing lacunae. United Nations agencies’ help can be sought in restructuring the AFHCs and this model has been used in other countries as well, like Tanzania. A study conducted in Tanzania described the challenges identified by the Ministry of Health and Social Welfare (MOHSW) and were then addressed with the support of WHO, UNFPA, and other partners in the country. Similar methodologies can be adopted in India to strengthen the health system.Thus, AFHCs strengthening is crucial for developing the trust of adolescents in availing the services at AFHCs as they are located in their vicinity. Multiple efforts such as a mechanism involving centre, state, block, and village level stakeholders for the constant AFHC evaluations and addressing the gaps identified in each evaluation are needed. In India, a study was previously conducted to evaluate the quality of Adolescent Reproductive Sexual Health services; it assessed if these services met the National Standards of care and utilized periodic program improvement recommendations through the WHO - quality assessment (QA) tools. Periodic interventions resulted in improving the average facility score from 27% to 83% and overall standards score from 28% to 81% at baseline and end line survey, respectively. Multiple studies have found associations between confidentiality practices and receipt of recommended services.– Additionally, privacy is particularly important for the issues like SRH, and substance misuse, given the possible sensitivity and stigma associated with them. IEC is a critical step toward a social behavior change communication approach that motivates people to adopt and sustain healthy behaviors in a short time. Training is effective and this was evident from the findings of the Tarunya project that provided cascading ARSH training to government staff at secondary care facilities and strengthened outreach activities to enhance community engagement. After 5 years of implementation, the project evaluation showed intervention efforts contributed to improvement in the quality and initial use of ARSH services. The performance of health facilities was appreciated by clients. Another aspect that needs attention is the non-judgemental attitude of the health providers. According to the World Health Organization, if an adolescent feels unwelcome, it is unlikely that they would utilize the services. Adolescents are an age group that needs to be treated with respect and dignity. The aforementioned characteristics determine the friendliness and acceptability of services provided to adolescents, and hence their propensity to utilise the available services. Capacity building of service providers in providing counselling services tailored to the age, life stage and health problem. Thus, there is a dire need for the booster training of the service providers at AFHCs to strengthen their skills to provide services in non-judgemental and sensitive manner. Another concern was the signboards and the IEC materials in the AFHCs. A marked signboard indicating if the facility has an AFHC and the timing as an important indicator as per the RKSK operational guidelines. With the presence of these signages, it is easy for adolescents to locate. The presence of this will help in adolescent knowledge enhancement. IEC materials can be Charts/Posters/Leaflets/Wall paintings, etc. on six thematic areas of RKSK and other adolescent health issues. The presence of IEC in all the clinics will be a valuable addition, as they are a means of imparting knowledge, disseminating health information, and positively modifying health attitudes and behaviours in a short period.There is also a need for regular booster training of healthcare workers on the importance of maintaining these benchmarks proposed by GOI. This training should give special emphasis on the maintenance of privacy, confidentiality, the importance of displaying the IEC material, signages, the non-judgemental attitude of health care providers, and the importance of referrals. Maintenance of privacy is a crucial aspect of adolescent healthcare as they encourage beneficiaries to seek care and disclose sensitive information that allows the service providers to deliver appropriate clinical services. Multi-point video conferencing was used to conduct virtual sessions with healthcare providers to improve their self-efficacy, further enhancing their interest and optimism in helping persons with addiction. This included case-based learning and didactic lecture by experts, also seeking clarification regarding standard management. Through this, 500 doctors from the district and PHC have been trained. These existing establishments can be used as an opportunity for organizing booster trainings.For the training of health care providers existing systems can be used. For instance, the Karnataka state involves mentoring network for the capacity building of health care providers for quality care. Across India, 900 health professionals were connected to NIMHANS ECHO.Though the robust methodology used in this review but there are some limitations including the less number of studies that were available across the different geographies of India which limited the generalizability of the study. Additionally, not all the studies included in this review have measured the benchmarks, making it challenging to replicate these findings and results must be used with caution.AFHC is one of the key pillars of the facility-based approach under RKSK and further strengthening the AFHC might increase the utilization of the available services by adolescents and will improve their health. The improved health of our young population will also help in achieving Sustainable Development Goals indicators that are associated with nutrition, reproductive health, sexual and intimate partner violence, child marriage, education, and employment.DB and SB conceptualized the idea. DB and SB conducted the screening and data extraction. DB and SM design the methodology. DB, SB and SM drafted the manuscript and MA critically reviewed the manuscript. All the authors approved the final version of the manuscript. A well written article as this is the need of the hour for adolescent health and AFHCS in India. The review addresses a clear focus on AFHC's compliance with bench marking. Its appreciable that the Arksey and O’Malley’s five stage scoping review framework is used for this writeup.  However few things like why quality of studies framework like CASP was not used could have been highlighted. This could have clarified regarding the rigor of studies included in the review. Limited studies are documented and hence generalisation of results is not possible.Are the rationale for, and objectives of, the Systematic Review clearly stated?YesIs the statistical analysis and its interpretation appropriate?I cannot comment. A qualified statistician is required.Are sufficient details of the methods and analysis provided to allow replication by others?YesAre the conclusions drawn adequately supported by the results presented in the review?YesReviewer Expertise:My PhD topic is closely related to the article. Health Promoting behaviour Among Adolescents Attending Adolescent friendly services was my area of research. This was an action research, where I started adolescent friendly services in a private school and this was welcomed by adolescents, parents and teachers. This was the first study of its kind in 2011.We confirm that we have read this submission and believe that we have an appropriate level of expertise to confirm that it is of an acceptable scientific standard. Some of the abbreviations are not explained by the author, and it will be helpful if they can be expanded upon. Example: GoI, IEC etc. IEC is expanded somewhere in the middle of the study; it will be better to explain when it is used for the first time in the manuscript.The authors utilize benchmarks proposed by the Government under Rashtriya Kishor Swasthya Karyakram. It will be helpful to know what the benchmarks are, how those benchmarks are measured (which indicators are used). Also, if there is a report or website which have those benchmarks listed, adding that will be helpful.This review has a limitation on the number of manuscripts available, and not all the studies have measured the benchmarks, which makes it hard to be replicated and results must be used with caution.It is a well-written document and is of great interest in public health in India. Some of my comments are:Are the rationale for, and objectives of, the Systematic Review clearly stated?YesIs the statistical analysis and its interpretation appropriate?I cannot comment. A qualified statistician is required.Are sufficient details of the methods and analysis provided to allow replication by others?YesAre the conclusions drawn adequately supported by the results presented in the review?YesReviewer Expertise:Public health, Nutrition, Hunger, food and nutrition insecurityI confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard. Comment 1: Some of the abbreviations are not explained by the author, and it will be helpful if they can be expanded upon. Example: GoI, IEC etc. IEC is expanded somewhere in the middle of the study; it will be better to explain when it is used for the first time in the manuscript.Response: The abbreviation of GOI added in the 10th line of the second para of Introduction. IEC expanded at the first place in method section and subsequently acronym IEC has been used.  Comment 2: The authors utilize benchmarks proposed by the Government under Rashtriya Kishor Swasthya Karyakram. It will be helpful to know what the benchmarks are, how those benchmarks are measured (which indicators are used). Also, if there is a report or website which have those benchmarks listed, adding that will be helpful.Response: Citation added in the 1st line of Design segment. All the details regarding benchmarks already exist in the data extraction segment of the manuscript. “Information extraction included seven benchmarks set by MoHFW-GOI including Infrastructure, clean, bright and colourful, accessibility (distance and convenient working hours), awareness about the clinic and range of services it provides , non-judgmental and competent health service providers, privacy and confidentiality, awareness of the services to the community members, their need and referral from the periphery/community to the higher facilities and speciality clinics”Comment 3: This review has a limitation on the number of manuscripts available, and not all the studies have measured the benchmarks, which makes it hard to be replicated and results must be used with caution. Response: Added to the limitation section of the manuscript.


This report details the outcome of the 1st International Earth Microbiome Project Conference. The 2-day conference was held at the Kingkey Palace Hotel, Shenzhen, China, on the 14th-15th June 2011, and was hosted by BGI . The conference was arranged as a formal launch for the Earth Microbiome Project, to highlight some of the exciting research projects, results of the preliminary pilot studies, and to provide a discussion forum for the types of technology and experimental approaches that will come to define the standard operating procedures of this project. The Earth Microbiome Project -3 is an The benefits of generating a comprehensive planet wide survey of comparable data are many fold, including an unprecedented knowledge resource that will allow fundamental advances in the study of microbial biodiversity, biogeography, ecology, global protein and gene diversity, evolution and community dynamics. Advances in sequencing technology, coupled with advances in computing and data analysis and the rise in massively-parallel researcher communication networks , makes it possible to now consider a distributed and scalable approach to the problem of sample collection, processing, sequencing and analysis for hundreds of thousands of environmental locations.The 1st International EMP Conference was designed to showcase the rationale, the tools, and design of the EMP, highlighting the technical challenges, and the potential. The EMP defines a suite of standard protocols and procedures for the processing and analysis of thousands of samples from disparate environments and locations. While the ‘no-size-fits-all’ paradigm is a fundamental problem for any global survey, the benefits of generating such survey outweigh these complications. Generating an integrated understanding of the role of microbes in the ecosystem turnover of each system on earth, and exploring the complexity of interaction between each system will help to define and build a new model of Earth’s biodiversity, which will help to define and refine our capability to manage the resources of this planet.30 microbial cells on Earth [The main goal of the EMP is a  systematic characterization of microbial life on Earth, which is exceptionally challenging and is comparable, if not exceeding, the challenge faced by astrophysicists and astronomers in exploring the universe. There are approximately 5 x 10on Earth ,5 which on Earth , and theThe 1st International EMP Conference was an open meeting with over 100 attendees. There were 8 invited guest speakers, including Rick Stevens  who gave the keynote on the morning of the first day. In addition, we had 22 offered talks with presenters from a range of nations . The meeting was loosely divided into two themes. The theme for Day 1 was microbial ecology, which focused on why we need the EMP, tools and models for the EMP, some preliminary data from the pilot study, and a number of exciting case studies from EMP collaborators. The theme for Day 2 was chiefly dedicated to standards and bioinformatic techniques, which included novel data analysis tools, standard data acquisition, and some considerations from previous or existing massive sequencing projects, including Terragenome, The Microbial Earth project, The Gordon and Betty Moore Foundations Virus Sequencing Project, and Meta-HIT.Professor Huanming Yang (Director of BGI) who gave a marvelous introduction to the reason for scientific meetings, which is expounded as ‘to make friends and drive collaboration’. He also reiterated BGI’s excitement at being involved with the EMP, and noted that this study was both ambitious and worthwhile. Professor Yang also Introduced Professor Rick Stevens  who gave the keynote for the conference. Professor Stevens discussed the origins, rationale and prospects for the EMP exploring the parallels with the Sloan Foundation’s Digital Sky Survey. He pointed out the EMP’s task was far more difficult, but with much more significant consequences for humankind.The 1st International EMP Conference  was opened by a welcome speech by George Kowalchuck  gave an exciting talk about why the EMP is important, and how the generation of comparable data from many ecosystems can help us to redefine our exploration of the microbial world. He argued that it was essential to combine large- and small-scale studies to build up a multidimensional picture of microbial life. Secondly, Jack A. Gilbert  gave a brief welcome and thank you note to the local committee for helping to organize the conference, he then outlined the EMPs fundamental goals, and provided some initial data from the main pilot study of the first 10,000 samples processed. The data were from 5,387 samples and comprised only of 16S rRNA sequences all generated using the same DNA extraction, amplification and sequencing protocol. The samples came from streamwater, soil, marine sediment, human skin, air, coal-beds, lake water, human guts and human oral cavities. The resulting alpha diversity was shown as well as a PCoA plot of all 5,387 samples comprising >210 million sequences of the 16S rRNA gene V4 region generated using Illumina GAIIx amplicon sequencing. Dr. Gilbert also presented results from the Western English Channel study, highlighting several new regional scale models derived from 16S rRNA and metagenomic data generated over a prolonged time series. These models highlighted the end-goal of the EMP, to generate taxonomic and metabolic turnover predictions across space and time. Two offered talks followed. The first was from Juan Imperial  who made a case for a global survey of legume-rhizobial symbionts. The second was from Guanghua Wang  who gave the first virus-based talk of the conference and highlighted the need for the EMP to explore viral biodiversity as well, specifically exploring T4-type bacteriophages.The first invited speaker was Jed Fuhrman  gave an excellent overview of the history and taxonomic profiling of marine microbial metagenome and as some of the most studied microbial ecosystems on Earth. He highlighted the absolute necessity for time series studies to determine the variability in any given system. Janet Jansson  provided an exciting overview of the work on the terrestrial microbiome, including the world’s largest metagenomic project, JGI’s Great Prairie Grand Challenge pilot study.Following a coffee break and group photograph, two further invited talks were given. Jun Wang  gave an excellent talk on the genome sequencing of the recent Escherichia coli strain from the outbreak in Germany (May/June 2011). He highlighted the importance of the EMP in helping to define the environmental reservoirs of human pathogens. John Stephen  followed with an introduction to a new initiative to generate a national terrestrial soils map for microbial life in Australia; this was an excellent example of an early stage adopter of the EMP protocols for generating comparable databases of large scale surveys. Torsten Thomas  made an excellent case for exploring the microbial world on physical surfaces, specifically sponges and corals, providing excellent examples of extant data and the lack of comparability among these data. Janet Seifert  gave a passionate argument for exploring the global diversity of marine stromatolites, which are considered among the oldest microbial ecosystems on Earth, and represent a valuable tool for exploring microbial evolution. Zhongjun Jia  then provided an excellent example of a country-wide survey of soil microbiota from China, with a focus on the need for collecting detailed and comprehensive environmental data records.Following lunch, S. Craig Cary  gave an excellent example of a sample collection from Antarctica, for which rich metadata is available, and gave a wonderful example of how to design a regional scale survey. Tong Zhang  discussed the microbiota of human engineered environments, suggesting the EMP should not overlook these. As an example, he discussed the microbiome of wastewater treatment plants. Haiyan Chu  gave an excellent example of a global-scale analysis of microbial life in soils, demonstrating that the communities in the arctic were fundamentally similar to communities from many different latitudes.Following the coffee break, This closed the official sessions for the first day. The attendees were then offered a tour of the facilities at BGI, Shenzhen, followed by a banquet for all attendees.Rob Knight , who discussed the lessons learned from the Human Microbiome Project and many of the other projects and datasets. Yangqing Peng  presented a new suite of bioinformatic tools for exploring genome reassembly from metagenomic data. Adina Howe  also discussed tools for sequence data assembly, including  the need to break-up the data into smaller portions prior to assembly. Hans-Joachim Ruscheweyh  followed with an excellent presentation of the MEGAN software package for metagenomic data analysis, and how the associated metadata can be used to group metagenomes by environmental parameters.The first talk on Day 2 was given by Yuzhen Ye  presented FragGeneScan as a tool for predicting genes in short and error-prone reads. Tom O. Delmont  provided some compelling data from the Terragenome Project exploring the soil microbiota from different ecosystems, and the implications of differences in DNA extraction techniques. In a departure from the original agenda, Hongwei Zhou  presented an interesting method for reducing the dominance of abundant members of the community so that a greater proportion of the rare community can be identified. Scott C. Edmunds  then presented examples of how to disseminate data following generation, including the idea of data DOIs and citation. Heshan Lin  discussed the use of graphic processing units (GPUs) for accelerating short-read mapping and local realignment for sequence data. Cheng-Cang Wu  concluded the session with an excellent talk on the use of long-insert clone libraries as another method for exploring the microbial dynamics in different ecosystems.Following the coffee break, Folker Meyer  explored the use of cloud computing and MG-RAST to exploit the vast data bonanza being generated by studies similar to the EMP. Nikos Kyrpides  then discussed the need for comprehensive coverage of genome sequences from cultured isolates to help ground truth observations in metagenomic data, highlighting the Microbial Earth Project (MEP). This project aims to sequence the genomes of all the type strains of Bacteria and Archaea, currently estimated to be around 9,000 taxa. Dr. Kyrpides also suggested that the EMP was so important as to be comparable to the moon race in the 1960s, and, as such, it demanded the need for a government agency  in each country to fund and facilitate the effort. This could be realized if the microbiology community would come together and form a distributed research center supporting EMP, which would eventually develop into a Microbial Environmental Genomics Agency (MEGA). K. Eric Wommack gave the second viral talk of the conference highlighting the efforts to sequence and survey viral life on Earth. He also introduced Virome as an annotation platform specifically designed for the annotation of viral metagenomic data. Jack A. Gilbert then gave a stand-in lecture for Suzanne Kennedy , which focused on the reproducibility of different DNA extraction methodologies, and introduced some products from MoBio designed at improving the quantity and quality of DNA extracted from different samples.Following lunch, Lanjuan Li  gave an excellent talk as the final presenter of the conference, discussing the implications of Hepatitis B infection on human gut microbiota.Following the coffee break, Jack A. Gilbert thanked all attendees and speakers, and gave special thanks to Hanqiao Kang and Zimin Zhu for all their assistance in making the conference such a success.To close the meeting, Following dinner, a panel discussion was held on the need for DNA extraction standards in the EMP. The premise of this working group was to explore the  concerns of the community regarding the adoption of a single DNA extraction methodology for all samples. As already highlighted by two of the talks in the core conference session, DNA extraction can vary from sample to sample, and different methods generate different profiles of the same samples. Importantly, it was evident immediately that no one technique would be an ideal solution. However, it was also made very clear that without a single extraction methodology there could be no absolute comparability between different samples and hence the idea of a systematic global survey would lose much of its value. The protocol adopted by the EMP for the first 10,000 samples pilot study was the MoBio PowerSoil DNA Isolation Kit . The manufacturer's protocol was amended with an initial 65 ºC heating step immediately after the addition of the bead solution, and before the shaking step. The outcome of this working group session was that sample and extraction bias will exist no matter which method is adopted, and the need for comparability should override primary concerns that different samples and different taxa will be differentially extracted in different systems. However, some recommendations were made, specifically that, following the initial pilot study, it was imperative that a more comprehensive assessment of the biases associated with different techniques be more thoroughly explored, and that this should be the basis of a second pilot study. Additionally, it was recommended that a robust DNA extraction protocol identified from this pilot study, defined as being able to extract the most DNA from the most environments, be adopted for future EMP studies. Importantly, a review of the DNA extraction protocol would be imperative annually for the continued development and refinement of the EMP. Finally, it was admitted that no one DNA extraction protocol would work for all samples, in that for some samples, the amount of DNA generated would be too low for any analysis. For the pilot study, it was recommended that these samples initially not be included so as to aid the generation of a massive, comparable dataset as quickly as possible. However, as EMP progresses it will be imperative that there be a focus on exploring the level of overlap between different techniques. An archive of these selected EMP sub-samples could be created where different extraction techniques were used that had a known variation to the core extraction protocol.It was agreed that another meeting be held in June 2012 to explore the evolution of the EMP, with the recommendation that the gathering convene in the Netherlands.


Adaptation to a chronic somatic disease depends on a variety of factors, including belief in health locus of control.Correlation between health locus of control and illness acceptance in patients with Graves-Basedow and Hashimoto diseases as well as correlation between health locus of control, illness acceptance, sex, and age.Three methods were applied: Multidimensional Health Locus of Control Scale by K.A. Wallston, B.S. Wallston and R. DeVellis; the Acceptance of Illness Scale by B.J. Felton, T.A. Revenson, and G.A. Hinrichsena; and a personal questionnaire. Two groups were subject to the research: 68 patients with Graves-Basedow disease and 54 patients with Hashimoto disease.Patients with Graves-Basedow disease, women above all, have their health locus of control in other persons  and are less inclined to accept their illness  when compared to patients with Hashimoto disease. A statistically significant correlation occurred between the age of patients and external  health locus of control.Beliefs in health locus of control and type of illness in female patient group are predictors of illness acceptance . Beliefs are cognitive elements of individual’s personality. They determine what we consider as true or false; owing to those beliefs we can answer the questions about other people, the world that surrounds us, or situations in which we can find ourselves. Each of us has different beliefs and accompanying emotions that lead to different conclusions. They are important elements of personality by which we are able to take our decisions, including decisions on our health .A chronic somatic disease makes an individual face with a number of new challenges, and in most cases patients approach their existing life by creating a subjective representation of the illness, the so-called illness representation. Illness representation and individual’s behaviour are affected, inter alia, by beliefs concerning locus of control (LOC), and in particular, health locus of control , 2.If an individual perceives an event subject to control of his/her actions or long-lasting features, then we refer to as internal locus of control. If the result is perceived by a person as an effect of luck, chance, destiny, or of being controlled by others, then we refer to as external locus of control .The concept of health locus of control, created by the Wallstons , 4, is bIndividuals with internal LOC are more responsible for their health, and for recovery and rehabilitation. In comparison to individuals with external LOC, they are more prone to undertaking efforts in order to feel well. Yet, this occurs only when an individual places health high in hierarchy of values . PersonsGenerally, external health locus of control is related to having chronic illnesses, with negative emotions such as depression, hostility, and anxiety, and with physical symptoms. Individuals with external locus of control apply passive avoidance ways of coping more frequently . ExternaAn emotional indicator to patient’s behaviour and his or her adaptation to an illness is the degree of illness acceptance reflected in minor intensification of negative reactions and emotions related to currently experienced illness, and in admission to illness related constraints. Illness acceptance refers to admission to such constraints and insight to resultant losses . PatientLatest researches, although not so explicit in all conclusions, reveal that illness acceptance by patients affects positively on quality of their general health and life conditions. In a group of patients with systemic lupus erythematosus, illness acceptance together with optimistic attitudes appeared to be a strong predictor of life quality . In patiPresent results of studies indicate that illness acceptance is not an expression of weakness and resignation, but rather it stems from self-confidence of the person thereby accepts and reconciles with everything that is out of his/her control; in consequence it helps him/her to live with and tolerate well the disease. Lack of illness acceptance may result in noncompliance, hence delay of healing process or emerge of complications may sometimes occur .Graves-Basedow and Hashimoto diseases are examples of chronic disorders requir systematic and regular control of patient’s own health and acceptance inevitable outcomes. They are categorised as autoimmune diseases caused by cell- and antibody mediated processes against specific thyroid cells in each disorder. The ethio-pathogenesis of these diseases is complex and not yet full recognised. The diseases usually develop rapidly and trigger factors like psychological or physical shocks, or a virus infection may frequently proceed the onset . ContempPatients with chronic endocrine diseases require to be consulted about their daily routine health related activities and warranted to reconcile with untreatable and inevitable conditions that may occur.As no studies in the past were performed on patients with autoimmune thyroid disein the context of illness acceptance and its correlation with health locus of control, our research were carried out. The following research questions were proposed:1. What is specificity of health locus of control and illness acceptance in patients with Graves-Basedow and Hashimoto diseases?2. What is the relationship between health locus of control and illness acceptance with patients’ age?3. What is the relationship between health locus of control and illness acceptance in patients with Graves-Basedow and Hashimoto diseases?The research was conducted individually among patients of Department and Clinic of Endocrinology. The consent of Commission of Ethics to perform the research was obtained. Participation in the research was voluntary; patients expressed their consents in writing and, filled up questionnaires.68 persons with Graves-Basedow disease (group G-B) and 54 patients with Hashimoto disease (group H) participated in the research. In both groups, number of participated women was more than participated men . This is because of higher incidence and prevalence of both diseases in women rather than in men. Due to substantial diversity in patients’ sex, all analyses could not be executed, thereby research results should be interpreted rather carefully.Mean values of age for group G-B and group H were 47.28  and 48.5 years , respectively. In regard to educational level, the largest groups consisted of patients with secondary  and vocational  education, and the smallest groups with primary  and university  education.Three research methods were applied: the Multidimensional Health Locus of Control (MHLC-B) by K.A. Wallston, et al , 20, theThe MHLC-B scale  consists of 18 statements on beliefs concerning generalised expectations in three dimensions of health locus of control, i.e.: internal (I), influence of other people (I), and influence of chance (P). The patient could express his or her attitude towards statements on a 6-point scale, where 1 denotes ‘strongly disagree’, and 6 ‘strongly agree’. The result range for each scale covers 6-36 points. The higher a scale results in, the stronger patient believes in a given dimension of health locus of control. This scale is accurate and reliable .The AIS  is applied to measure degree of acceptance of illness. It consists of 8 statements that describe negative consequences of undesirable health. The participants are asked to express their feeling by marking on each statement where 1 denotes ‘strongly agree’ and 5 ‘strongly disagree’. The higher a scale results in, the better patient accepts his/her illness and adapts more suitable to the illness with lower feeling of psychological discomfort. The AIS has satisfactory psychometric properties .Analyses were performed using the STATISTICA, 10th package. Correlation tests were used, including multiple regression analysis and tests of statistical significance of differences between mean results (Student’s t-test).Statistically, patients with Graves-Basedow disease differ significantly from those with Hashimoto disease in terms of health locus of control in other persons and increase in illness acceptance. However, there was no difference among the groups as to internal and external  health locus of control, . PatientWhile performing analysis for both sexes, statistically significant differences were observed only between female patients in terms of two variables: external health locus of control in other persons, and illness acceptance . Male paIn order to provide answer to research question No. 2 on relationship between health locus of control and illness acceptance with age, r-Pearson test was applied .Analysis of entire patient groups showed a positive significant correlation  between age and external health locus of control in other people. The elderly patients, irrespective of the type of illness, were more inclined to think that the control of their health depended on others.Analysis for each of the patient groups without age consideration did not reveal any statistically significant relationship between the age and beliefs in health locus of control and illness acceptance. Analysis for individual patient groups did not show, either, a statistically significant correlation between analyzed variables and the age. Yet, in analysis of patient groups when variable of their sex was taken into account, male patients with Graves-Basedow disease obtained a statistically significant result between the age and illness acceptance . The older they were, the more difficult it was for them to accept the disease. Other relationships were not statistically significant.As to the response to research question No. 3 on relationship between health locus of control with illness acceptance in patients with Graves-Basedow and Hashimoto diseases, analysis were conducted only in female patient groups. Results obtained so far have indicated that the importance of sex-variable is substantial; male patient groups were quantitatively insufficient to be included in the analysis. Multiple regression analysis was applied.2 = 0.143; F (4.95) = 5.116 P = 0.0009); influence of beliefs was located in chance and the disease – either Graves-Basedow or Hashimoto disease – is very important (Beliefs in health locus of control in the female patient group accounted for 14 % variability in illness acceptance (corrected Rmportant . When feCurrently, one can observe an explicit tendency to consider issues related to health and disease in a biopsychosocial context that takes into account the influence of psychological and social factors on the course of illness. The assessment of co-occurrence of these factors allows to explain health problems  more extIn case of suffering from a chronic illness of the thyroid gland it is essential to adapt to it and thus the patient can face with this new and difficult situation. The adaptation is reflected, inter alia, in the degree of illness acceptance that can be an emotional indicator of living and functioning with the illness , 13. A qThe first stage of analysis was concerned with the question about the specificity of beliefs and illness acceptance depending on the type of disease. Results obtained indicate that patients with Graves-Basedow disease substantially frequently have their health locus of control in other people and are less inclined to accept their illness than patients with Hashimoto disease. A question emerges as to the course of the illness, which results in evoking a belief in the necessity to trust others and in difficulties in accepting the currently experienced situation. Should we look for the causes of this situation in personality features, or rather in the specific nature of the disease? Do both these factors perform an essential role? Research conducted so far  corroborWhen we look at a chronic disease as a difficult situation  then posThe correlation between health locus of control and acceptance of the illness, and the age of patients occurred to be important. Elderly female patients, irrespective of the type of disease, were more inclined to have health locus of control in other people. This result is in concord with results obtained so far indicating that the elderly patients are more inclined to give the control over their health into the hands of other persons . The eldYet, the individual with age, even if s/he is not chronically ill, more frequently may experience his or her own weakness and acknowledges the fact that owing to the assistance of others, a variety of issues in his or her life may take an encouraging turn. Social experience shows that the individual needs help offered by others, and this feeling is even stronger when time goes by. Such persons also respond more favourably to therapeutic treatment. For instance, cancer patients were observably less depressive when they had their external health locus of control in other people . ResearcThe primary and basic question in the research presented was concerned with the role performed by beliefs in health locus of control in the acceptance of illness. The multiple regression analysis revealed that in the female patient group, these beliefs can be treated as indicators of the illness acceptance, since taken together they account for ca. 14 % of cases of the illness acceptance variability. The most important part of this variability can be contributed to beliefs with their locus in chance as well as the type of disease . When feThe results should be treated with some caution, since they have been obtained by examining a small group of patients and a small group of men.In summary we have Conclusions:1. Research patients with Graves-Basedow disease substantially frequently have their health locus of control in other people and are less inclined to accept their illness than patients with Hashimoto disease. This correlation refers to female, not male patients.2. A significant positive correlation between age and external health locus of control in other people was observed. The elderly patients, irrespective of the type of disease, were more inclined to think that controlling their own health depended on other people.3. Male patients with Graves-Basedow disease, while getting older, found it more difficult to accept their illness.4. Beliefs in health locus of control in the female patient group accounted for 14 % of variability of illness acceptance and could be treated as an indicator of illness acceptance. The most important contribution was made by beliefs in health locus of control in chance and the type of disease. When female patients suffered from Hashimoto disease and less frequently had their health locus of control in chance, they found it easier to accept their illness.