Nowadays, controversy exists regarding the influence of comorbid depression on cognition in old age. Additionally, we still know little about the influence of depression in mixed dementia (MD), that is, in cases where there is the co-existence of Alzheimer’s disease and vascular dementia (VaD). Given that the assessment of financial capacity is pivotal for independent living as well as in the prevention of financial exploitation and abuse in old age, in this pilot study, we aimed to examine whether comorbid depression in MD patients can influence financial capacity performance. A total of 115 participants were recruited. They were divided into four groups: MD patients with and without depressive symptoms and healthy elderly without depression as well as older adults suffering from depression. Participants were examined with a number of neuropsychological tests, including the Mini-Mental State Examination (MMSE), Geriatric Depression Scale (GDS-15), and Legal Capacity for Property Law Transactions Assessment Scale (LCPLTAS). The results of this study suggested that financial capacity as measured with LCPLTAS in MD patients was severely impaired when depression co-existed compared to patients suffering only from depression and healthy controls. Deficits in financial capacity in MD and comorbid depression should be a point on which healthcare professionals should focus during neuropsychological assessment in order to prevent financial exploitation. Mixed/multifactorial dementia (MD) is a condition in which a person has more than one type of dementia, and for the present study, it is defined as the combination of the two most prevalent types of dementia (most frequent in the older population), namely Alzheimer’s Disease (AD) and Vascular Dementia (VaD) and seems to be more common than previously believed in the older adult population ,2,3. TheDue to the lack of consensus on the diagnostic criteria and the heterogeneous neuropathological characteristic of MD, this disorder has not been widely studied . Brain fThe fact that an older person may have a combination of two types of dementia means that symptomatology may vary. There is evidence supporting that MD is characterized by lower scores compared to AD patients . More spOne area of focus regarding Instrumental Activities of Daily Living (IADLs), which is of extreme importance for the older population, is financial capacity. Financial capacity is considered to be a broad and complex psychological construct that includes a variety of activities and specific skills  and judgment-decision-making skills. Deficits in financial capacity performance have been found in older patients with a diagnosis of VaD , AD 13]13], ParkIn addition to that, research has shown deficits in arithmetic and financial problems, which are included in instruments measuring financial capacity  per se iWhile the research on financial capacity and old age is still emerging, patients with a diagnosis of MD have been largely neglected. So far, only one study has shown that individuals with MD without depressive symptomatology demonstrate similar financial capacity performance with AD patients without depression and similar Mini-Mental State Examination (MMSE) scores .Biologically, brain areas such as the medial frontal and anterior temporal cortices’ decreased activity are related to impaired self-awareness in AD patients ,21, and Given all the above brain areas, which are not only affected in AD and MCI, but in many cases of MD patients, the aim of this research is to examine for the first time financial capacity performance in MD patients, and more specifically in MD patients with or without comorbid depressive symptomatology compared to healthy older adults with and without depression.GDS-15 = 1.70; SD = 1.51). A total of 25 participants had a diagnosis of moderate MD with depressive symptomatology  according to their self-reported depressive symptomatology . In the current study, 115 Greek older adults  were recruited from the Memory Clinic of Papanikolaou General Hospital and the Greek Alzheimer Association of Alzheimer’s Disease and Related Disorders (GAADRD), Thessaloniki, Greece. The diagnoses of the patients were supported by a consensus of specialized neurologists, geriatric psychiatrists, and neuropsychologists after neurological examination and neuropsychological assessment, medical history, neuroimaging (CT and/or MRI), and blood tests. Thirty participants had a diagnosis of MD  characterized as moderate cognitive impairment  scores), with no depressive symptomatology present based on a useful self-report tool used worldwide as well as in the Greek older population with a cutoff score of 6–7 points ; the 15-GDS-15 = 0.56, SD = 1.27), with no diagnosis related to cognitive deficits and with GDS-15 scores < 6, were approached following purposeful sampling  and were also tested as a control group. In addition to that, 30 older patients suffering only from depression  were also tested .A total of 30 community-dwelling older adults   = 0.356, p = 0.785], and gender   regarding age  see . Participants in all four groups were excluded as in similar studies ,13,14,15An extensive neuropsychological test battery was administered in order to assist in diagnosis by assessing basic cognitive abilities such as attention, working memory, abstraction, inhibition, fluency, verbal learning and memory, visual memory, visuospatial skills, and psychomotor speed. These tests were the Mini-Mental State Examination (MMSE), Test of Everyday Attention (ΤΕA), Trail Making Test (TMT)-Parts A and B, Rey-Osterrieth Complex Figure Test (ROCF)-copy condition and immediate and delayed recall conditions of the complex design, Rey Auditory Verbal Learning Test (RAVLT), Rivermead Behavioural Memory Test (RBMT), Verbal Fluency Task, Neuropsychiatric Inventory (NPI), Instrumental Activities of Daily Living (ΙADL), Clinical Dementia Rating (CDR), and Functional-Cognitive Assessment Scale (FUCAS). Financial capacity was assessed with the Legal Capacity for Property Law Transactions Assessment Scale (LCPLTAS), which consists of seven main domains: basic monetary skills, cash transactions, bank statement management, bill payment, financial conceptual knowledge, financial decision-making, and knowledge of personal assets . LCPLTASAll participants provided written informed consent prior to study participation and were not compensated for their participation in the study. They agreed to participate voluntarily and that they could withdraw their participation at any time without providing any reason and without any cost. The study protocol was approved by the Ethics Committee of the Aristotle University of Thessaloniki (as part of a larger study ) and folStatistical analysis was performed with the SPSS (IBM Corp 2016) IBM SPSS Statistics for Windows (Version 24)). Descriptive statistics and one-way analyses of variance (ANOVAs) were conducted to examine possible differences in demographic factors and cognitive test scores of the four groups . In addition, Pearson’s correlations between MMSE . This indicates that high MMSE scores (which reflect high cognitive ability) correlate in a statistically significant way with high scores on LCPTLAS, which depicts high financial ability. For the whole sample, no other statistically significant correlation was found between LCPTLAS and education (in years)  as well as for LCPTLAS and age (in years) .A strong positive correlation was found between the MMSE score and the LCPTLAS for the whole sample . Comparisons following one-way ANOVA for financial capacity as examined by LCPTLAS showed statistically significant differences with the healthy controls without depression performing best, followed by patients suffering only from depression, moderate MD patients without depression, and MD patients with depression  = 181.391, p < 0.001, η2 = 0.831)  significant differences and large effect sizes for the MMSE scores  = 140.398, 831) see .The above findings provide support for the first time for a significant impairment in financial capacity in cases of dual mixed pathology, such as MD (AD + vascular) with comorbid depression. The current study investigated performance in MD patients with and without comorbid depressive symptomatology and supports that both diagnostic groups are characterized by financial incapacity and that both groups clearly differentiate from non-depressed matched participants. Age (in years) and educational level (in years) of participants were not found to correlate with financial performance in LCPTLAS in this sample. This is in contrast to previous findings in healthy aging that support a negative influence of advancing age on financial capacity , as wellThis is an interesting point as both the MMSE as well as the specifically designed tool for financial capacity assessment (LCPTLAS) could both be used as neuropsychological indicators that are easy to administer and act as important sources of information for everyday functioning as well as sources to build personalized interventions against financial abuse in older adult populations ,34. Although the current study has several strengths, such as the exclusion of demographic influences that could play the role of confounders, this study also presents some limitations, which should be taken into consideration in future research endeavors, such as the small sample size, the slightly unequal size of the subgroups, and the fact that demented patients were not examined with post mortem autopsy (so the exact brain pathology could be documented in detail). Additionally, variables such as previous stressful life events or prior high levels of depression , the behThis is the first ever reported study of its kind to show that depression has a clearly differentiating power on financial capacity performance in the group of moderate MD patients. Although none of the participants was characterized as legally incapacitated, thus, officially, there was no legal decision depriving them of their right to make financial decisions, for both groups of MD and MD depressed patients, their family members responded that they unofficially made all relevant financial decisions on behalf of the older adults, something that corroborates the general tendency in Greece to consider as stigma the durable power of attorney for financial decisions, the valid wills as well as the living wills of older adults . Of cour


A quality improvement initiative for maternal and neonatal health care demonstrates that a responsive intervention design and implementation approach mitigates threats to clinical services during COVID-19. Responding to health workers’ and managers’ immediate needs related to coronavirus disease (COVID-19), followed by reprioritization and inclusion of a newly developed COVID-19 risk matrix, helped Mphatlalatsane staff to identify and mitigate disruptions to public sector maternal and neonatal health care (MNH) services in South Africa.Mphatlalatsane demonstrates that agile and context-specific responses to crises, such as the COVID-19 pandemic, can mitigate such threats and maintain interventions to improve MNH services.Multifaceted MNH intervention programs are challenging to design and implement, but if they are locally responsive they can benefit health care workers, managers, and patients in a systematic way.Program managers must remain alert to the continued disruptions by crises such as COVID-19 to routine MNH care services. A responsive approach requires attention to the immediate needs of health workers, such as emotional support, while balancing this with the ability of staff to identify and mitigatedisruptions to routine services caused by health crises. Despite global progress in reducing maternal and neonatal mortality and stillbirths, much work remains to be done to achieve the Sustainable Development Goals. Reports indicate that coronavirus disease (COVID-19) disrupts the provision and uptake of routine maternal and neonatal health care (MNH) services and negatively impacts cumulative pre-COVID-19 achievements. We describe a multipartnered MNH quality improvement (QI) initiative called Mphatlalatsane, which was implemented in South Africa before and during the COVID-19 pandemic. The initiative aimed to reduce the maternal mortality ratio, neonatal mortality rate, and stillbirth rate by 50% between 2018 and 2022. The multifaceted design comprises QI and other intervention activities across micro-, meso-, and macrolevels, and its area-based approach facilitates patients’ access to MNH services. The initiative commenced 6 months pre-COVID-19, with subsequent adaptation necessitated by COVID-19. The initial focus on a plan-do-study-act QI model shifted toward meeting the immediate needs of health care workers (HCWs), the health system, and health care managers arising from COVID-19. Examples include providing emotional support to staff and streamlining supply chain management for infection control and personal protection materials. As these needs were addressed, Mphatlalatsane gradually refocused HCWs’ and managers’ attention to recognize the disruptions caused by COVID-19 to routine MNH services. This gradual reprioritization included the development of a risk matrix to help staff and managers identify specific risks to service provision and uptake and develop mitigating measures. Through this approach, Mphatlalatsane led to an optimization case using existing resources rather than requesting new resources to build an investment case, with a responsive design and implementation approach as the cornerstone of the initiative. Further, Mphatlalatsane demonstrates that agile and context-specific responses to crises such as the COVID-19 pandemic can mitigate such threats and maintain interventions to improve MNH services. Successful interventions include birth preparedness and complication readiness programsIn SA, examples of successful microlevel MNH interventions include the Essential Steps in Managing Obstetric Emergencies, a skills-and-drills program for maternity staff, which reduced institutional MMR by 29%–,Measured against Sustainable Development Goal targets, the SA rate of adverse birth outcomes, such as stillbirths and preterm births,In this field action report, we describe and reflect on a QI initiative called Mphatlalatsane (meaning “the bright star before dawn”), which aimed to strengthen the MNH service package across all levels of care. We detail the goal, implementation context, key design features, and adaptations during the first 19 months of the COVID-19 pandemic, from March 2020 to October 2021.Mphatlalatsane aimed to strengthen the MNH service package across all levels of care to reduce maternal and neonatal mortality and stillbirths in South Africa.–Mphatlalatsane is implemented by the NDOH in 4 purposively selected health districts across the Eastern Cape, Limpopo, and Mpumalanga provinces . The goaRecommendations from NDOH ministerial committees such as the National Confidential Enquiry into Maternal Deaths Committee since 1997,The national primary health care reengineering strategy,Standardised Essential Steps in Managing Obstetric Emergencies drills,The Perinatal Problem Identification Programme and Child Healthcare Problem Identification Programme surveillance and response systems implemented since the 1990sSeveral health system strengthening workshops with managers and clinicians in the Mphatlalatsane districts over the past 10 yearsAligned with the SA Maternal, Perinatal and Neonatal Health Policy,In July 2018, at the commencement of Mphatlalatsane, the management team conducted site visits, engaged with senior managers in the 3 provincial governments (macrolevel), and held planning workshops with the district and subdistrict staff (mesolevel) and facility staff (microlevel). These consultations resulted in a proposal, codesigned with staff, that details implementation activities and partner roles and responsibilities . All MphConsultations resulted in a proposal, codesigned with staff, that details implementation activities and partner roles and responsibilities.The NDOH commissioned the South African Medical Research Council and University of the Western Cape to evaluate Mphatlalatsane. They received ethical approval (EC019-11/2019) from the South African Medical Research Council Ethics Committee.Implementation commenced in September 2019 when facility HCWs were trained as QI team leaders. Upon return, these leaders established a QI team in their respective facilities.Mphatlalatsane management appointed 3 QI advisors, 1 per province, to provide technical support and mentoring to the QI teams. To ensure sustainability, the advisors are required to identify and mentor a provincial official in each province over time. This will embed the QI system within the existing structures of the 3 provincial health departments. The first 2 COVID-19 waves and lockdowns severely disrupted QI team functioning and MNH services, with MNH staff either moved to other posts or too busy dealing with COVID-19–related functions. Staff attrition was a reality in most facilities, in some cases due to COVID-19 fatalities and illness, which required training of new team members. Additional district management support to engage with Mphatlalatsane activities was also needed. With the lifting of travel restrictions since July 2020, the advisors resumed in-person support visits. They were warmly welcomed back, and the teams readily reengaged with their QI activities, over time regaining much of their pre-COVID-19 momentum.Mphatlalatsane is multifaceted in several ways. First, it is a multipartnered initiative that seeks synergy between governmental and nongovernmental agencies to improve MNH services. A Program Management Committee (PMC) was established among the 5 partners to meet monthly and serve as a governance and implementation coordination platform.Second, it is multifaceted in its holistic health system strengthening focus. It recognizes that its microlevel intervention of QI for HCWs can only succeed if it is treated as part of the health system ecology: what happens at one level shapes and is shaped by what happens at the other levels. This holistic approach and acknowledgment of the interdependency are evident in its theory of change . The PMC,Third, this integrated approach translates into a portfolio of QI and other types of interventions. At the microlevel, the Mphatlalatsane philosophy advocates agency for HCWs through QI methodologies that upskill them to solve problems within their sphere of influence . SeveralBOXProblemThe clinic’s routine data showed only 63% of first antenatal care (ANC) visits occurred before 20 weeks of gestation, leading to late identification and management of pregnancy complications.AimTo improve first ANC visits before 20 weeks’ gestation to 70% within 2 months.Implementing a basket of change ideasIrrespective of the reason they visited the clinic, all women of childbearing age were tested for pregnancy; this does not require formal written consent from the patient as verbal explanation of the procedure is the standard of care.Community health care workers added pregnancy screening to their services.During routine health talks at the clinic, women were encouraged to visit the clinic as soon as a pregnancy was suspected.Family planning services were offered to schoolgirls. Girls could either visit the clinic before school, offered as a fast lane, or in the afternoons as part of the clinic’s adolescent and youth friendly services.Effectiveness of change ideaAfter 5 weeks of implementation, there were 12 newly diagnosed pregnancies of which 11 were earlier than 20 weeks’ gestation, resulting in 92% of first ANC visits done before 20 weeks’ gestation.The first ANC visits before 20 weeks’ gestation improved from 61% to 83% between February 24, 2020 and April 30, 2020.Mphatlalatsane advocates agency for HCWs through QI methodologies that upskill them to solve problems within their sphere of influence.Synergistic strengthening of all health system components is central to the intervention portfolio. As an example, the HCWs in Facility A identified improved ward infection control (microlevel) as their QI project. Since they lacked the supplies, the Clinton Health Access Initiative assisted them by streamlining the district-level (mesolevel) supply chain management of hygiene materials. Other examples include engaging with district and provincial (macrolevel) information management staff to strengthen the quality and use of routine data ; the developing and training staff on an instrument to monitor and evaluate the prevalence and management of hypertensive disorders in pregnancy, as well as ensuring that the necessary medical supplies are in stock; establishing an obstetrics response team to drive maternal and perinatal improvement in 1 of the provinces (coordinated by the University of Limpopo Trust Initiative for Newborn Care); and providing technical and logistical support from all partners to the NDOH in drafting a national integrated maternal, perinatal, and neonatal health policy.The NDOH identified an “implementation wedge” , comprisMphatlalatsane’s planning and implementation centers on innovation and responsiveness to local contexts and changing priorities. For example, the PMC adapted the classical QI methodology to an agile model that allows HCWs to choose how their team functions—short-circuiting plan-do-study-act cycles where there is a need to respond to other immediate challenges and allowing teams to have fewer, and more prolonged, plan-do-study-act cycles compared to the standard multiple, rapid cycles. The latter arrangement addressed the reality that the COVID-19 pandemic caused some QI team members to be redeployed to meet non-MNH COVID-19 emergencies. The PMC also implemented other measures in response to the pandemic . At the Supplement Table S1) offered practical suggestions to MNH managers at subdistrict and higher levels to sustain the delivery and uptake of routine MNH services, including ensuring effective communication with HCWs; using COVID-19 contact tracing activities to deliver the message that MNH services are essential services and thus always available; redefining the roles of HCW cadres, such as using lower-cadre nurses to monitor infection prevention and control compliance in the health facility; and maximizing the use of doulas  because family members were not allowed into facilities. The second matrix (Supplement Table S2) was developed to alert HCWs of COVID-19–imposed risks along the continuum of MNH services. The QI teams and QI advisors supported facility managers to develop context-specific solutions to deal with these risks, such as reconfiguring work spaces to minimize sharing of equipment. An online, self-paced, 14-module sexual and reproductive health training curriculum was developed to keep HCWs updated on new MNH guidelines. Finally, through the Clinton Health Access Initiative, Mphatlalatsane facilitated the supply of needed equipment through approved donations that abided by the Public Finance Management Act in SA.The PMC realized that dealing with COVID-19 at times came at the expense of MNH patients. This resulted in the development of 2 risk matrices. The first matrix (The PMC realized that dealing with COVID-19 at times came at the expense of MNH patients.Our preliminary reflections concern the 2 design characteristics considered key to the successful implementation of Mphatlalatsane, lessons learned during COVID-19, and thoughts on sustaining the initiative’s successes.–Mphatlalatsane focuses on providing support to all cadres of HCWs, including community health workers and managers, across all levels, to improve MNH services. The PMC takes an ecological view,,Mphatlalatsane is designed, implemented, and evaluated as implementation research. This confirms the importance of an ecological view of the systems in which Mphatlalatsane is implemented, as it focuses on exploring what works, for whom, and under which circumstances.Embedded in real-world settings, Mphatlalatsane promotes the integration of new effective practices into standard care.,The COVID-19 pandemic and its aftereffects on people’s health and the uptake and delivery of health care services will remain a reality for years to come. During similar crises in the future, the health system will need initiatives such as Mphatlalatsane to address the needs of health systems, HCWs, and managers while sustaining and improving MNH. Our implementation experience proves that an agile and responsive design approach makes this possible. Agile and responsive interventions require leadership attuned to HCW vulnerabilities at the point of service delivery, conscious of meso- and macrolevel management needs, with the ability to adapt health system arrangements to maintain its core function of quality care to mothers and neonates.Stable and robust leadership must balance the often conflicting demands of people and processes that constitute the health service ecology. Initiatives such as Mphatlalatsane must avoid turning into a collection of fragmented projects and instead forge true synergy between interventions and partners to ensure collective impact and sustainability. While recognizing the need for simultaneous action at multiple levels, our emerging experience is that absorptive capacity for sustainability is highly variable, especially in the context of chronic stresses and multiple, often unrelated, donor initiatives. Finally, public health services are hampered by cultures of compliance and risk aversion, undermining agency among managers and HCWs who then act as gatekeepers rather than gateways for change.,–Mphatlalatsane operates under the philosophy that quality care does not begin and end with more resources. It recognizes that known drivers of QI, such as shared decision making, accountability at all levels, and interpersonal relationshipsThe effectiveness of Mphatlalatsane to improve MNH services in a sustainable manner in South Africa is still to be evaluated. Our experiences to date demonstrate that inclusivity, embeddedness, responsivity, and agility in the context of crises such as the COVID-19 pandemic are key pillars of interventions aiming to improve MNH services. Data will be published as they emerge on QI team functioning and the measured effectiveness of Mphatlalatsane.


Transitions aims to understand the human immunodeficiency virus (HIV) risk at critical transition points in the sexual life course of adolescent girls and young women (AGYW) who engage in casual sex, transactional sex, and sex work. In this article, we present the Transitions study methods. The Transitions study has the following objectives: (1) to describe how the characteristics and length of the transition period and access gap vary across two epidemiological contexts ; (2) to understand how the risk of HIV varies by length and characteristics of the transition period and access gap across epidemiologic contexts; and (3) to assess the extent to which HIV infections acquired during the transition period and access gap could mitigate the population-level impact of focused interventions for female sex workers and explore the potential marginal benefit of expanding programs to reach AGYW during the transition period and access gap. Cross-sectional biobehavioral data were collected from young women aged 14 to 24 years who were recruited from locations in Mombasa County, Kenya, and Dnipro, Ukraine, where sex work took place. Data are available for 1,299 Kenyan and 1,818 Ukrainian participants. The survey addressed the following areas: timing of transition events ; sexual behaviors ; partnerships ; alcohol use; injection and non-injection illicit drug use; experience of violence; access to HIV prevention and treatment program; testing for sexually transmitted and blood-borne infections and HIV; and reproductive health . HIV and hepatitis C virus prevalence data were based on rapid test results. Mathematical modeling will be used to generate projections of onward HIV transmission at specific transition points in the sexual life course of AGYW. Taken together, these data form a novel data resource providing comprehensive behavioral, structural, and biological data on a high-risk group of AGYW in two distinct sociocultural and epidemiologic contexts. Across epidemic contexts, female sex workers (FSWs) and adolescent girls and young women (AGYW) experience a disproportionate burden of human immunodeficiency virus (HIV) 1. GlobalTraditional programs tailored for FSWs do not officially provide services for AGYW engaged in sex work (SW) since the legal status of some AGYW as minors impedes their access to health services without parental consent , 3. FurtTransitions study was designed to measure the prevalence and patterns of HIV risk, vulnerabilities, and infection and to generate model-based projections of onward HIV transmission at specific transition points in the sexual life course of AGYW, including young FSWs, in two epidemic contexts (Kenya and Ukraine) (transition period (from first sex until self-declared entry into SW) and during the access gap  among young women who enter SW (Transitions study methods.The Ukraine) , 7. Specenter SW  and to eTransitions is a cross-sectional biobehavioral survey with the following objectives:(1) to describe how the characteristics and length of the transition period and access gap vary across two epidemiological contexts ;(2) to understand how the risk of HIV varies by length and characteristics of the transition period and access gap across epidemiologic contexts; and(3) to assess the extent to which HIV infections acquired during the transition period and access gap could mitigate the population-level impact of focused interventions for FSWs and explore the potential marginal benefit of expanding programs to reach AGYW during the transition period and access gap.Transitions was implemented in Mombasa County, Kenya, and the city of Dnipro, Ukraine, in 2015. These two settings were chosen for their distinct sociocultural and epidemiological settings  and 127,750 AGYW (15–24 years) . The HIVDnipro is an industrial city in eastern Ukraine. In 2018, Dnipro had a population of 990,381, including 207,478 females of reproductive age (14–44 years) and 46,797AGYW (15–24 years) . The HIVcis-females who:The eligibility criteria for participation included 1) were 14 to 24 years of age;2) had ever had vaginal and/or anal sex; and3) were congregating at SW “hotspots” at the time of recruitment.A hotspot is an indoor or outdoor location where FSWs congregate to meet clients. The hotspot typology differs between Mombasa and Dnipro .Sex work (SW) is defined as an explicit exchange of money (or gifts or other resources) for sex between a sex worker and client with upfront negotiation of the price of sex before any exchange takes place. TS is a more nuanced exchange of money, gifts, or other resources for sex between individuals with no prenegotiation of the price of sex , and casual sex (CS). e of sex , 13. CS We modified the standard programmatic mapping method –21 for FBased on expected baseline values and odds ratios of HIV prevalence of the 3 study groups, with 80% statistical power and 95% confidence level, the sample sizes of the CS group, TS group, and SW group were 900, 450, and 450, respectively .The population sizes of three groups were estimated for each hotspot and used to develop a sampling frame for each group. The hotspots served as the primary sampling units. The number of primary sampling units for each group was determined based on the required sample size and the mean number of target group members per hotspot. The hotspots were selected after stratification by typology and geographic distribution to ensure a representative sample of hotspots. Therefore, we selected 170, 85, and 85 hotspots in Mombasa and 174, 116, and 136 hotspots in Dnipro from the sampling frame, respectively, for the CS, TS, and SW groups. In each selected hotspot, the required sample size was proportional to the size of the estimated target population in the hotspot. Within each hotspot, outreach workers or mobilizers would randomly select participants to approach based on an agreed upon sampling strategy. Briefly, the mobilizer would visit the hotspot during busy times to survey the size and shape of the venue and the number of potential participants who might be in the space. Starting at different corners of the venue, the mobilizer was asked to draw an imaginary diagonal line across the venue. Any woman standing or seated along the imaginary line was approached for an interview. Depending on the expected sampling frame for the spot, every second or third woman might be approached. The same strategy was applied to selecting tables to approach within a venue. For public spaces, such as beaches or parks, mobilizers walked along the beach/park and selected whoever was thought to fall within the study criteria.Transitions were conducted in partnership with the International Centre for Reproductive Health Kenya (ICRH) in Mombasa [a non-governmental organization (NGO) providing HIV prevention services for sex workers] and with research partners Ukrainian Institute for Social Research after Oleksandr Yaremenko (UISR) in Kiev and DEFgroup in Dnipro and Virtus (an NGO providing HIV prevention services for sex workers) in Dnipro. The recruitment and study procedures, as detailed below, were adapted to the local context and designed to be consistent with methods used in previous studies in both sites and therefore varied slightly between the two sites.Tool development, data collection and data cleaning for Peer educators (former or current FSWs) from the FSW network of ICRH visited selected hotspots and prescreened individuals who were congregating at the hotspot for eligibility until the preallocated sample size for that hotspot was achieved. Interested potential participants were given an invitation card to come to an interview site. At the interview site, trained research assistants screened and enrolled the participants. Following written informed consent, a structured questionnaire was administered. If the participant consented to take part in the biological component of the study, she was introduced to a clinical officer or nurse counselor who performed HIV rapid testing with pretest and posttest counseling and collected additional biological samples. Study procedures were conducted in Swahili or English in Mombasa County. Data collection took place between April and November 2015.Outreach workers (Virtus) and research assistants (DEFgroup) recruited participants and implemented the study under the direction of UISR. Virtus outreach workers visited and recruited participants from hotspots exclusively associated with SW such as brothels, apartments , and highways. If a potential participant met eligibility criteria and expressed interest in taking part in the study, she was escorted to a mobile clinic parked nearby where the Virtus outreach worker administered written informed consent and conducted the study procedures. Participants from hotspots not exclusive to SW were recruited by DEFgroup research assistants. For these participants, the written informed consent and interview were conducted on site or in a research van, and rapid HIV testing was conducted by a medical officer in an AIDS center outpatient clinic. Only participants who consented to the full study procedure  were enrolled. Study procedures were conducted in Russian in Dnipro. Data collection took place between July and November 2015.n = 1,299) of the target sample size because of unanticipated delays in study commencement and participant recruitment. Among participants, 714, 177, and 408 women were categorized into the CS, TS, and SW groups, respectively.In Mombasa County, screening information was available on 1,054 women . Of the In Dnipro, 3,038 women were screened, 2,489 eligible potential participants were invited to participate, and 1,818 (73.0%) were enrolled . Among wThe questionnaire collected information about participants' sociodemographic characteristics; timing of transition and access gap events ; sexual behaviors ; partnerships ; alcohol use; injection and non-injection illicit drug use; experience of violence; access to HIV prevention and treatment program; testing for sexually transmitted and blood-borne infections and HIV; and reproductive health . The questionnaires were pilot tested in both sites prior to implementation.Transitions participants by study group.Transitions Mombasa, 1,084 (83.4%) of 1,299 participants underwent HIV rapid testing.HIV testing followed the Kenya national testing algorithm using a series of 3 rapid tests on fingerprick blood samples . The firTransitions Mombasa, 1,193 (91.8%) of 1,299 participants provided DBS specimens.Dried blood spot (DBS) specimens were collected from consenting participants for HIV and hepatitis C serological confirmation performed by the National HIV and Retrovirology Laboratories of the Public Health Agency of Canada , using Avioq HIV-1 Microelisa System  and ORTHO® HCV Version 3.0 ELISA Test System . In Ureaplasma urealyticum, Ureaplasma parvum, Neisseria gonorrhoeae, Chlamydia trachomatis, Mycoplasma genitalium, Mycoplasma hominis, and Trichomonas vaginalis , herpes simplex virus , human papillomavirus , Treponema pallidum, and hepatitis B virus. Vaginal microbiome (via 16S rRNA sequencing) and cytokine profiles  were characterized in vaginal secretions. Phylogenetic analyses of HIV, hepatitis C virus, and human papillomavirus will be performed to understand viral genetic variation and evolution, geographic dispersal, and epidemic dynamics. These tests will be conducted in the University of Manitoba  and the National HIV and Retrovirology Laboratories.In addition, a self-collected urine sample, a self-collected vaginal secretion sample using a Softcup™  , and a blood sample collected via venipuncture by the clinical officer/nurse counselor were also obtained from consenting participants. These biological samples will be testing for a selection of sexually transmitted and blood-borne organisms including Transitions Dnipro, 1,818 (100%) of 1,818 participants underwent HIV rapid testing.A combination rapid test for HIV, syphilis, and hepatitis B and C [New Vision Diagnostics Profitest Rapid Multi-Infectious Disease Test Card (HIV/HBsAg/hepatitis C virus/TP) (whole blood/serum/plasma) ] was used. Participants who tested positive for HIV on the rapid test were referred to the Dnipropetrovsk Oblast AIDS Center or Dnipro City AIDS Center for confirmatory laboratory testing. If HIV confirmatory laboratory testing was also positive, participants were referred to the appropriate treatment services within the AIDS Center. In Descriptive analyses and multivariate logistics regression models using a proximate determinant framework  will be We will use a setting-specific, compartmental , determiWe will report and conduct the modeling in accordance with recommended best practices in use and justification of parameters based on the relevant research question  and as cThe key model assumption  is that the relative and absolute differences in sex acts, partnership types, condom use, etc., across subgroups of women aged 14 to 24 years are stable over time. Other key model assumptions include (a) instantaneous partnership formation and dissolution ; (b) partnerships and risks do not vary after age 24 years ; and (c) homogeneity in risks of transmission by health care states beyond on-treatment versus untreated. Finally, the model assumes that the trajectory of health care may vary between subgroups, but features such as reinitiation of HIV treatment are not dependent on how long one was on treatment .The data inputs (parameters) from the empirical study comprise subgroup population size, transition rates between compartments, sexual partnerships, and who has sex with whom patterns . Biological data inputs such as probability of transmission per sex act and by type of sex act will be drawn from the literature.In addition to the empirical data collected as part of the proposed study, the following individual-level data [previously collected by our team and securely stored at the Centre for Global Public Health] will be used for model parameterization: behavioral and biological data from serial cross-sectional and cohort studies of formal FSWs;–36 seriaEach site will be parameterized separately and fitted within a Bayesian framework , 29, 46 Once epidemic trajectories (“fits”) consistent with the observed epidemiological data are found, simulated counterfactuals will be developed, where all parameters are kept constant except for the variable of interest. In the case of objective 3, we will model increasing intervention access to women during the transition period and access gap. Using mathematical modeling and a simulated counterfactual, we will obtain a direct estimate of the marginal benefit of expanding tailored programs in this way over the subsequence 1, 5, and 10 years.A preliminary version of the dynamic model has been developed and has undergone model checks with preliminary analyses conducted under assumptions of an endemic equilibrium state . The modThe proximate determinants framework of HIV transmission provides a conceptual basis for examining underlying social, contextual, and demographic determinants, as well as individual proximate and biological determinants predicting risk of HIV infection . We willWe will use the mathematical model to perform the following specific analyses:Estimate the current and projected HIV incidence among women during the transition period and access gap for each study site.Estimate the potential impact of tailored interventions and baseline general population interventions on HIV incidence, HIV prevalence, and the fraction of HIV infections averted in FSWs and clients (and the wider community) under the following scenarios:Base-case scenario: existing tailored interventions reach FSWs after the transition period and access gap.a) Early tailored interventions scenario: existing tailored interventions reach women earlier in their formal SW career, i.e., shorten the access gap .b) Expanded tailored interventions scenario (“feasible”): expand tailored interventions to reach women during the transition period. This scenario will be informed by program implementers and knowledge users on our team to simulate “feasible” strategies and achievable levels of “coverage” of women during the transition period.c) Early and expanded tailored interventions (“optimistic”): expand tailored interventions to reach women during the transition period, at levels of coverage achieved by existing tailored interventions with self-identified FSWs.d) Intervention tools will include increased condom use and a simplified representation of combination antiretroviral treatment. For each specific analysis described above, the median and uncertainty bounds  will be reported, and an uncertainty analysis will be performed to determine which input parameters were most influential.Transitions data resource includes a unique study population and hotspot-based recruitment strategy that enables the examination of early HIV risk and vulnerabilities among AGYW who engaged in formal SW and other partnership types, including TS and CS. To date, there are only a few studies on young FSWs , the Ethical Review Committee Board at the Sociological Association of Ukraine, Committee on Medical Ethics of the L. Gromashevsky Institute of Epidemiology and Infectious Diseases at the National Academy of Medical Sciences of Ukraine; and the Kenyatta National Hospital/University of Nairobi Ethics and Research Committee (P497/10/2013), and the Research Permit Committee of the National Commission for Science, Technology and Innovation, in Kenya. Export of all collected biological samples from Kenya was granted by the Office of the Director of Medical Service of the Government of Kenya Ministry of Health. Written informed consent from the participants' legal guardian/next of kin was not required to participate in this study in accordance with the national legislation and the institutional requirements.MB and SMi conceptualized and designed the study. EC and MB prepared the first draft of the manuscript. HMa conducted the data cleaning and analyses with input from SMi and MB. JB was involved in the conceptualization of the study and study design. PB, HMu, and PG oversaw the field-work and data collection in Kenya. OB and DP oversaw the field-work and data collection in Ukraine. EC was the research coordinator for the study, supported tool development and was involved in mapping, enumeration, and data collection. SI led the mapping, enumeration, and was involved in data collection and analyses. SMo and RL provided input on study design and tool development and questionnaire items. MP and LL were involved in manuscript editing. PS oversaw the laboratory diagnostics. All authors were involved in interpretation of results, critically reviewed, and provided final approval for the manuscript.The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.


A simulated annealing search followed by optimization and characterization of the candidate structures afforded a total of 746 structurally different dimers held together via 80 different types of intermolecular contacts in 2894 individual non-covalent interactions as concluded from Natural Bond Orbitals (NBO), Quantum Theory of Atoms in Molecules (QTAIM) and Non-Covalent Interactions (NCI) analyses. This large pool of interaction possibilities includes the traditional primary hydrogen bonds and salt bridges which actually dictate the structures of the dimers, as well as the less common secondary hydrogen bonds, exotic X⋯Y  contacts, and H⋯H dihydrogen bonds. These interactions are not homogeneous but have rather complex distributions of strengths, interfragment distances and overall stabilities. Judging by their Gibbs bonding energies, most of the structures located here are suitable for experimental detection at room conditions.Neutral ( The nature of intermolecular bonding interactions was dissected using QTAIM, NCI, and NBO, three conceptually different methods, which for the present case afford consistent, complementary pictures. A total of 80 types of different intermolecular contacts were found in this complex and large universe of dimers. As a general rule, primary hydrogen bonds and salt bridges are the strongest of the interactions and determine the molecular geometry, conversely, secondary hydrogen bonds, exotic X⋯Y  and H⋯H dihydrogen contacts are weaker and most often a consequence of the structure. All interactions, even the highly ionic, may be described by the An intensive exploration of the potential energy surfaces for the interaction of neutral and charged cysteine monomers to form dimers in an aqueous environment represented by a continuum afforded a large number of isomers, amounting to 746 well characterized local minima. The isomers with the largest population are distributed within small energy differences of the putative global minima. Ten potential energy surfaces were explored in total for the contacts  as well contacts  in which


FMR1 gene and abnormal production and/or expression of the FMR1 gene products. Individuals with Fragile X syndrome (FXS), the most common heritable form of intellectual disability, have a full-mutation sequence (>200 CGG repeats) which brings about transcriptional silencing of FMR1 and loss of FMR protein (FMRP). Despite considerable progress in our understanding of FXS, safe, effective, and reliable treatments that either prevent or reduce the severity of the FXS phenotype have not been approved. While current FXS animal models contribute their own unique understanding to the molecular, cellular, physiological, and behavioral deficits associated with FXS, no single animal model is able to fully recreate the FXS phenotype. This review will describe the status and rationale in the development, validation, and utility of three emerging animal model systems for FXS, namely the nonhuman primate (NHP), Mongolian gerbil, and chicken. These developing animal models will provide a sophisticated resource in which the deficits in complex functions of perception, action, and cognition in the human disorder are accurately reflected and aid in the successful translation of novel therapeutics and interventions to the clinic setting.Fragile X encompasses a range of genetic conditions, all of which result as a function of changes within the  FMR1; also called fragile X messenger ribonucleoprotein 1 gene) on the X chromosome and the resultant absence of FMR protein (FMRP) ,9998,99]Meriones unguiculatus) belong to the Muridae family of rodentia [A gerbil model of FXS is expected to help fill this important gap. Along with mice and rats, Mongolian gerbils , another common pathological condition in FXS. Hyperactivity and seizures are common in FXS . ApproxiThe technical feasibility of developing gerbil models of FXS has been greatly enhanced with recent advancements in gerbil genome sequencing and genetic-editing tool development. CRISPR/Cas9-mediated zygote genome editing via assisted reproductive techniques enables highly efficient production of mammalian KO animals without establishing ESC lines and comprehensive genetic analyses ,180. ComIn conclusion, Mongolian gerbils have excellent sensitivity to low-frequency sounds that are used for speech perception, superior visual perception with a high level of cone composition in the retina, and complex social architecture and behaviors as compared to mice and rats. These more human-like characteristics render the use of gerbils for more closely recapitulating the sensory and communication deficits observed in FXS humans, particularly those associated with auditory and visual information processing and those mediating social-based behaviors. Gerbils are also suited to study epilepsy and metabolic deficits, common conditions associated with FXS. Experimentally, gerbils are diurnal, quickly bred, and are easy to handle in captivity. Upon the availability of FXS gerbils, auditory brain circuits could provide precise morphological and functional assessments of FMRP loss, and auditory deficits are relatively easy to assess behaviorally, a big advantage over more complex learning or cognitive tasks. With this advantage, therapeutic approaches can be rigorously tested. Therefore, a disease model of FXS in gerbils promises to bring new insight into understanding FXS pathology and can be easily adopted for basic research and preclinical therapeutic tests.Underappreciation of developmental mechanisms is another critical knowledge gap in the field of neurodevelopmental disorders. As the most frequent monogenetic form of autism and intellectual disability, FXS is at the frontier of efforts for drug development in treating neurodevelopmental disorders. In normal brains, FMRP is an RNA binding protein that provides spatiotemporal control of RNA trafficking and protein translation in dendrites and axons , an esseThe chicken is one of the most versatile experimental systems available for life sciences . SpecifiFMR1 gene was first cloned and characterized in 1996 [FMR1 gene is conserved between human and chicken [The chicken homolog of the  in 1996 . The nuc in 1996 ,191. Ind in 1996 , and the chicken . Recentl chicken , furtherStudies of chicken embryos following targeted FMRP misexpression have uncovered a number of novel FMRP functions in developing auditory neurons and circuits. It is well-established that auditory hindbrain assembly shares the same developmental framework between birds and mammals ,196. ChiThe journey for understanding FMRP function in the NM–NL circuit began with the identification of intensive FMRP expression in NM and NL neurons . ProteomWhile they are a newly established model for FMRP and FXS research, chicken embryos have a long-standing history for studying a wide variety of neurodevelopmental disorders. These include neural tube-related diseases , fetal aNew animal organisms have been adopted or are in development for FXS research and are expected to fill several important gaps that existing animal models have not filled. We anticipate that an NHP model of FXS will provide a unique series of molecular and phenotypic features and provide an exciting opportunity to address a range of neurological questions that link cellular, molecular and behavioral phenotypes in FXS and potentially other autism spectrum disorders. Modeling FXS in Mongolian gerbils is expected to more closely recapitulate the sensory and communication deficits observed in FXS, particularly those associated with auditory and visual information processing and those mediating social-based behaviors. Finally, advanced genetic and imaging approaches in chicken embryos allow in-depth characterization of FMRP functions during circuit assembly periods with high temporal and spatial resolutions and clinical relevance. These models, along with existing rodent and invertebrate models, are expected to contribute significantly to the next phase of FXS research and neurodevelopmental disorder studies.


This Special Issue examines the synthesis, characterization, and manufacturing of nanoparticles and their potential advantages and applications for the conservation of built cultural heritage materials.Machu Picchu, Petra, Angkor, Copán, Taj Mahal, and the Easter Island Moai are among many other monuments with irreplaceable cultural heritage significance, and all are currently eroding at a noticeable rate. This is leading to a constant loss of these structures’ cultural, artistic, and economic value. This rapid deterioration is being exacerbated by our lack of understanding of adequate remedial strategies to preserve these historical sites. Many attempts are currently being made by scientists worldwide toward the improvement of conservation actions, focusing mostly on the cleaning and consolidation of these substrates ,2. WithiThis Special Issue welcomes contributions that address research and practical advances in: (i) the novel synthesis and manufacturing process of nanoparticles; (ii) chemical, microstructural, and structural characterization of nanoparticles; (iii) evaluation of the cleaning or consolidation effectiveness; (iv) product application methods; (v) assessments of the long-term characteristics and durability of treated structures; and (vi) remarkable case studies.This Special Issue aims to answer some of those questions while presenting many considerable recent advances in nanolimes and other nanomaterials, as well as their applications for the conservation of our built heritage. All articles in this Special Issue will focus on papers with a broad interest to the built heritage community and their conservation practitioners, especially novel, high-quality studies with potential for real-world applicability.


While rice studies are abundant, they usually focus on macro-level rice production and yield data, genetic diversity, cultivar varieties, and agrotechnological innovations. Moreover, many of these studies are either region-wide or concentrated on countries in the Global North. Collecting, synthesizing, and analyzing the different themes and topic areas in rice research since the beginning of the 21st century, especially in the Global South, remain unaddressed areas. This study contributes to filling these research lacunae by systematically reviewing 2243 rice-related articles cumulatively written by more than 6000 authors and published in over 900 scientific journals. Using the PRISMA 2020 guidelines, this study screened and retrieved articles published from 2001 to 2021 on the various topics and questions surrounding rice research in Indonesia and the Philippines—two rice-producing and -consuming, as well as emerging economies in Southeast Asia. Using a combination of bibliometrics and quantitative content analysis, this paper discusses the productive, relevant, and influential rice scholars; key institutions, including affiliations, countries, and funders; important articles and journals; and knowledge hotspots in these two countries. It also discusses the contributions of the social sciences, highlights key gaps, and provides a research agenda across six interdisciplinary areas for future studies. This paper mainly argues that an interdisciplinary and comparative inquiry of potentially novel topic areas and research questions could deepen and widen scholarly interests beyond conventional natural science-informed rice research in Indonesia and the Philippines. Finally, this paper serves other researchers in their review of other crops in broader global agriculture. Rice feeds the majority of the world’s population and employs millions, especially in developing countries in the Global South  the most relevant and influential rice scholars and their collaboration networks; (2) the most rice research productive institutions, including author affiliations, their countries, and their research funders; and (3) the most significant articles and journals in rice research. This section also identifies 11 topic areas belonging to four major themes of importance for rice research in the two countries. Section “Contributions from and research agenda for the social sciences” provides a research agenda, where we identify and discuss the contributions of our review in terms of future work. Despite the preponderance of rice research in the last two decades and more in Indonesia and the Philippines, contributions from the social sciences remain marginal. Thus, in the section “Conclusion”, we conclude that emphasis is needed on expanding and maximizing the contributions of social scientists given the many opportunities available, especially for conducting interdisciplinary and comparative rice research in these Southeast Asian countries.We used bibliometric and quantitative content analyses to systematically categorize and analyze more than two decades of academic literature on rice in Indonesia and the Philippines. Bibliometric methods, also known as bibliometrics, have grown to be influential in evaluating various research fields and topic areas. Bibliometrics mushroomed because of the increasing availability of online databases and new or improved analysis software   productivity, (b) citations, and (c) H-indices. We acknowledge, however, that some Filipino and Indonesian scholars, whose papers may not be indexed in Scopus, could also be prolific based on different parameters, but we excluded them. We proceeded to map the collaboration networks of these authors to identify “who works with whom on what.” A collaboration network illustrates nodes (circle shape) as authors and links (connecting lines) as co-authorships  Government consisted country or state departments, bureaus, ministries, and other government regulatory bodies; (3) Interest groups and NGOs included intergovernmental bodies, such as the United Nations Food and Agriculture Office (FAO) and international organizations like the International Rice Research Institute (IRRI) and Oxfam; and (4) Banking and finance encompassed players from the finance sector, including multilateral development banks such as the Asian Development Bank (ADB), World Bank, and the International Fund for Agricultural Development (IFAD). After coding and categorizing, we analyzed the authors’ institutional collaboration networks.Following Sovacool , we cateWe identified the country’s productivity and coded them by global region based on their geographical location: (a) Asia, (b) Australia, New Zealand, and South Pacific, (c) Europe, (d) North America, (e) South America, and (f) Africa. We did this to show how various countries have been researching rice in Indonesia and the Philippines since the 21st century.We then constructed a country collaboration map as a visual macro-representation of countries working together on rice research using these data. Bibliometrix, however, measured the country’s productivity based on the corresponding authors’ affiliations. We, therefore, noted two critical points here. First, many corresponding authors may have multiple institutional affiliations. For example, one corresponding author may belong to more than two affiliations . Second, the corresponding authors may not necessarily be nationals of that country. Note that the unit of analysis is based on the corresponding authors’ institutional affiliations at the time of publication and not on their country/ies of citizenship or nationality. Despite these, our findings still provide insight into the macro-level productivity of countries conducting rice research in Indonesia and the Philippines.We analyzed the funders using Scopus’ in-house Analytics Tool and determined their relevance based on the number of articles mentioning them in the Funding source or Acknowledgment section in the paper. We categorized the funders into six: (1) government , (2) research , (3) foundations and non-government organizations (NGOs), (4) universities, (5) private companies and corporations, and (6) intergovernmental organizations/IGOs, including multilateral development banks.In terms of interdisciplinarity, we coded the articles as (a) interdisciplinary, (b) disciplinary, or (c) unidentified by using the authors’ department or division affiliation/s as a proxy to determine their disciplinary training. We coded an article as interdisciplinary if it belonged to any of the three criteria: (1) it had an author that had training or belonged to a department/division in at least two conventional disciplines ; (2) it had an author that had a self-identified interdisciplinary department ; or (3) it had at least two authors with different disciplinary training or expertise . We coded an article as disciplinary if its author/s had only belonged to one conventional department/division affiliation . On the other hand, we coded an article as undetermined when the authors had only indicated the name of their institutions or did not indicate their departmental or division affiliations .We examined the articles based on their local relevance and global influence. Bibliometrix measured the articles’ relevance based on their “local citations” or citations received from the 2243 articles of our sample dataset. We did this to determine which papers are considered relevant by authors studying various areas of rice research in Indonesia and the Philippines. Global influence is measured based on the articles’ citations from the global research community or other scientific works beyond our sample dataset. We also conducted a co-citation analysis of the cited references. Co-citation is the frequency by which articles cite together two or more articles relevant to the topic areas of inquiry  but unimportant external links, which could be interpreted as having limited importance for the field .Themes in the upper-left quadrant are the highly developed and isolated themes or Emerging or Declining Themes. They have low centrality and density, making them weakly developed and marginal.”Themes in the lower-left quadrant are known as Bibliometrix creates a thematic map that allows researchers to identify which study areas have been adequately explored and which areas need further investigation or re-investigation to identify knowledge hotspots and research gaps , followed by Bas Bouman and Grant Singleton—each with 20 articles. The top 10 authors with the highest number of publications have affiliations with the IRRI, the University of the Philippines, the University of Gadjah Mada, and the Philippine Rice Research Institute (PhilRice). For the full list of prolific scholars with at least 10 articles published, see Supplementary Table Of the 159 authors, one had a duplicate profile; thus, we identified 158 authors publishing on rice studies; the majority (66%) are men. The top 50 most prolific scholars produced a little over 25% (567 articles) of the total articles. Australian ecologist Finbarr Horgan topped this list (n = 36 citations) from the Universitas Padjadjaran, who studies rice genetic diversity, is the most cited. Local citations refer to the citations received by authors from our sample dataset of 2243 articles. Muhidin Muhidin from the Universitas Halu Oleo and Ruhyat Partasasmita from the Universitas Padjadjaran, followed him with 30 and 28 local citations, respectively. Common to these three authors are their Biology background/expertise and interest in rice genetic diversity. To check the top 20 most locally cited scholars, refer to Supplementary Table In terms of the authors with the most local citations, although Finbarr Horgan has the most documents, Johan Iskandar  in our dataset. The range of topics covers both regional and country studies. Some regional examples include the drivers of consumer demand for packaged rice and rice fragrance in South and Southeast Asia  on topics about rice pests and parasites , followed by Europe (13%) and North America (9%). At least 90% of rice scholars are in Indonesia, and more than 51% have affiliations in the Philippines, followed by Japan, the USA, and China. For the list of the top 20 most productive countries researching rice in Indonesia and the Philippines, see Supplementary Table Only around 47% 1050 studies) of our dataset acknowledged their funding sources, where most received financial support either from governments (45%), research (27%), or university funders (16%) Fig. . To see 0 studiesHalf of all articles in the dataset were borne out of interdisciplinary collaboration. More than a quarter of the articles, however, were unidentified, showing an apparent undercount of the total number of disciplinary collaborations. Most of these collaborative pieces of work (~61%) belong to the natural science subject areas of agricultural and biological sciences; biochemistry, genetics, and molecular biology; and environmental science      and green leafhoppers (Cicadella viridis) and their accompanying diseases, affect rice production. In Java, Indonesia, Triwidodo (Nilaparvata lugens) attack rates in rice fields. Brown planthopper attacks increased depending on the frequency of pesticide application, their varieties, and volume  temperature change and (b) organic rice production  as one of the inviolable customary laws of the Baduy Indigenous cultural community in Banten, Indonesia.Today, agriculture’s sociological, anthropological, and cultural research have gone beyond the classic technology adoption arena. In Indonesia, studies have explored farmers’ technical efficiency in rice production engagement and re-engagement of young people in rice farming; gender dynamics—including structures and systems of inclusion and/or exclusion—in rice production; the impacts of migration and return migration to farming households; community-based and policy-oriented case studies that provide examples of successfully engaging and retaining youth workers in farming; and social protection measures for aging farmers, to name a few.One of the biggest and most visible contemporary global challenges is the Covid-19 pandemic. Most pronounced is the pandemic’s impacts on the healthcare system and the economic toll it caused on the lives and livelihoods of people, including rice farmers. Only 0.18% (4 articles) of our dataset have investigated the impacts of Covid-19 on rice systems in Indonesia and the Philippines. Ling et al.  assessedRice prices did not change in the early months of the pandemic in Indonesia (Nasir et al., The ways and extent to which the pandemic negatively affected or exacerbated the vulnerabilities of rice farmers and other value chain actors remain an understudied area in the social studies of rice. Scholars could study the pandemic’s impacts in conjunction with other contemporary and emerging challenges like climate change, weather extremes, aging, conflict, and poverty. Scholars could also explore the medium- and longer-term impacts of the pandemic on rice production, unemployment risks, rice supply and nutrition security of farming households, and the potential and extent to which economic stimulus can benefit rice farmers, to name a few. Most importantly, the pandemic allows researchers and governments to assess the business-as-usual approach that resulted in the disastrous impacts of the pandemic on different sectors, including rice farmers, and hopefully devise strategies to learn from these experiences.From our review of 2243 articles, cumulatively written by 6893 authors using almost 80,000 references, we conclude that a voluminous amount of rice research has been conducted in Indonesia and the Philippines since 2001. As in other reviews, (e.g., on energy research by Sovacool, Supplementary Info


Citizen engagement, or partnering with interested members of the public in health research, is becoming more common. While ongoing assessment of citizen engagement practices is considered important to its success, there is little clarity around aspects of citizen engagement that are important to assess  and methods to assess  citizen engagement in health research.In this scoping review, we included peer-reviewed literature that focused primarily on method(s) to measure and/or evaluate citizen engagement in health research. Independently and in duplicate, we completed title and abstract screening and full-text screening and extracted data including document characteristics, citizen engagement definitions and goals, and methods to measure or evaluate citizen engagement (including characteristics of these methods).Our search yielded 16,762 records of which 33 records  met our inclusion criteria. Studies discussed engaging citizens  in research processes. Reported methods of citizen engagement measurement and evaluation included frameworks, discussion-based methods , survey-based methods , and other methods . Methods to measure and evaluate citizen engagement commonly focused on collecting perceptions of citizens and researchers on aspects of citizen engagement including empowerment, impact, respect, support, and value.We found that methods to measure and/or evaluate citizen engagement in health research vary widely but share some similarities in aspect of citizen engagement considered important to measure or evaluate. These aspects could be used to devise a more standardized, modifiable, and widely applicable framework for measuring and evaluating citizen engagement in research.Two citizen team members were involved as equal partners in study design and interpretation of its findings.Open Science Framework (10.17605/OSF.IO/HZCBR).The online version contains supplementary material available at 10.1186/s40900-022-00405-2. Involving members of the public (citizens) in health research is important. It helps make sure that research focuses on issues that are most important to citizens. It also helps ensure that the research done is respectful of citizen participation and most likely to provide benefit. However, the best way to engage citizens in research is unclear. In this scoping review, we examined existing studies that assessed citizen engagement in health research. We found that citizen engagement was often assessed by asking for feedback from both citizens and researchers. Feedback was collected in person (one on one interviews or group discussions) or in writing (using surveys or audits). Frameworks (organized ways of thinking about an issue) were also sometimes used to measure empowerment, impact, respect, support, and value of engaging citizens. It was clear from the frameworks that there is a need to develop clearer roles for citizens in research. The two citizen members of our research team who helped interpret our study findings felt that a set of guidelines for citizens to help them best participate in health research needs to be developed. We believe these observations could be used to create a more standard method for assessing citizen engagement in research.The online version contains supplementary material available at 10.1186/s40900-022-00405-2. Citizen engagement in health research is an increasingly common approach to conducting biomedical, clinical, health system and services, social, cultural, environmental, and population health research with citizens as collaborators rather than subjects , 2. OfteEngaging citizens in research has the potential to improve the relevance of study findings, minimize waste by facilitating stewardship over resources, create mutual learning and understanding, and build trust in research findings by improving relationships between communities and researchers , 7. AddiMethods to measure  citizen engagement in health research; andMethods to evaluate  citizen engagement in health research.Despite the push towards incorporating citizen engagement in research by funding bodies, citizen engagement is often tokenistic and lacks the clarity and guidance needed to facilitate it’s meaningful use –19. ExisWe designed and conducted a scoping review to map the existing literature on methods to measure and evaluate citizen engagement in health research according to the Arksey and O’Malley  and Levawhat is the state of knowledge on methods to measure and evaluate citizen engagement in health research?” to capture a broad range of potentially relevant literature. Our research question was developed to also shed light on the any relationship between measurement and evaluation of citizen engagement. We ensured that our research question defined the scope of inquiry with respect to population, concept, and outcomes of interest and would direct the subsequent steps  was piloted by two reviewers  with ten included studies, and revised as needed. Once the final data charting form was developed, all relevant articles were abstracted independently and in duplicate by two reviewers . Abstracted variables in the initial data charting form included study characteristics, participants, type and goals of citizen engagement, method(s) used to measure citizen engagement, method(s) used to evaluate citizen engagement, features of method(s) used, and observed benefits or risks of the measurement or evaluation method(s) used.We collated, summarized, and reported the results by (1) analyzing the data, (2) reporting results, (3) and evaluating their meaning and aimed to contextualize our findings within existing literature and research, practice, and policy , 27. We We present a descriptive summary of characteristics of the included documents, and the characteristics of the intended participants or audiences for these documents alongside a narrative synthesis of abstracted data variables.Involvement of citizens in literature synthesis is recommended by funding organizations such as the NIHR  and CIHROur search strategy returned 28,353 total results . Of these, studies were excluded because they: (1) reported aspects of citizen engagement other than methods of measurement or evaluation (n = 713), (2) reported outcomes or discussion on specific diseases/interventions  (n = 520), (3) had an ineligible study design  (n = 504), (4) included citizens as health research subjects only (n = 452), (5) engaged citizens, but in non-research  (n = 437), (6) were not health research related (n = 337), (7) focused on non-citizen stakeholders in health research  (n = 285), or (8) and/ or had inaccessible full-texts (n = 169). Thirty records met inclusion criteria and were included in our scoping review. Three additional records were found through searching reference lists and included for a total of 33 records. A study flow diagram including reasons for exclusion is shown in Fig. A majority of the included literature was published within the last 10 years . Literature included peer-reviewed journal articles , a report by a government organization , and a conferencing proceeding . Most literature reported work that was conducted in the United Kingdom , Canada , and other European nations  . Most included literature pertained to health services or health research , and clinical research  . Characteristics of the included literature are shown in Table Included records varied in type of citizens engaged, research engagement activities, and terminology used to describe the engagement process Table . Most stTerminology used to describe citizen engagement activities (in order of most common to least common) was: patient and public involvement , 61, 62,Of the 33 included studies, 20 (61.0%) presented method(s) to evaluate citizen engagement, five (15.2%) presented method(s) to measure citizen engagement, and eight (24.2%) presented method(s) to both measure and evaluate citizen engagement. Methods for the measurement and/or evaluation of citizen engagement included frameworks, discussion-based methods , survey-based methods , and other methods . Many studies utilized and reported on more than one method to measure and/or evaluate citizen engagement. A summary of these methods is presented in Table Five studies presented frameworks , 60, 67 Methods using discussion to measure and/or evaluate citizen engagement utilized focus groups (n = 7) , 49, 53,A number of studies used survey-based methods to measure and/or evaluate citizen engagement in health research. These methods included an audit , questiosupport and report rather than measure or evaluate citizen engagement, falling out of the scope of this review.A number of studies presented other methods to measure and/or evaluate citizen engagement. These included indicators of user involvement such as documentation of citizen roles in research and availability of training to citizens to facilitate their involvement in research , prioritOur scoping review produced two main findings. First, we found that multiple methods  have been used, often in combination, to measure and evaluate citizen engagement in health research. These methods collect perceptions of citizens, researchers, and/or research support personnel on many aspects of citizen engagement including reasons, type, and impact of engagement, any challenges encountered in engagement (including project-specific issues), and recommendations for improving future citizen engagement in health research. Secondly, we identified that existing frameworks to measure and evaluate citizen engagement commonly assess perceived empowerment, impact, respect, support, and value. Together, these findings summarize the nature of citizen engagement in health research and itemize citizen engagement aspects that are considered important to assess the degree and quality of citizen engagement in health research.In addition to our main findings, we identified that the terminology used to define citizen engagement and describe its activities varies widely. Citizen engagement is referred to as patient and public involvement (often in the United Kingdom), patient engagement, public engagement, consumer or service user-involved research, and community based participatory research depending on location and context. Varying terminology may pose a challenge for individual researchers to identify and utilize methods to appraise citizen engagement in research. Standardization of terminology could add to the accessibility and applicability of current and future methods to incorporate and evaluate citizen engagement in health research.In the process of screening literature for inclusion in this scoping review, we found that much of the current guidance on appraising citizen engagement in research exists in the form of editorials, letters to the editor, commentaries, and perspectives from experienced researchers in the field. We noted that this type of literature does not routinely discuss the merit of discussion-based methods that were used to evaluate citizen engagement in included studies. This could reflect a repeated dismissal of discussion-based qualitative research methods to measure and evaluate citizen engagement in research and warrants further investigation. Despite limited discussion-based methods to appraise citizen engagement, this literature emphasizes the context and process of engagement , clarityAs per recommendations by Levac and colleagues, we invited citizen team members  to help interpret the findings of this scoping review and provide insights beyond those in the literature . These cThis scoping review was designed to form an evidence basis for future work to advance and standardize appraisal of citizen engagement in health research. This study has strengths and limitations to consider. Strengths of our scoping review include: (1) co-development of the study protocol with a multidisciplinary team including researchers, health professionals, and health sciences librarians, and (2) citizen involvement in its design and interpretation. These elements helped to create a comprehensive synthesis and discussion of the existing literature on measuring and evaluating citizen engagement in health research.Our study also has limitations. A significant number of the methods we summarize in this scoping review are focus groups, interviews, and closed- and open-ended discussions and questions. These methods were often described in the literature with varying levels of detail, presenting difficulty in assessing the rigour of each method. While the level of detail available on included methods is variable, we do not perceive this as a limitation but rather an accurate snapshot of the currently utilized discussion-based methods to appraise citizen engagement in research. Another limitation to this study is possible unintended omittance of relevant literature due to (1) our definition of citizen engagement adapted from the CIHR , which mWhile there has been an increase in published methods to measure and evaluate citizen engagement over the past decade, there remains a need for standardized guidelines on appraising citizen engagement in research. Extensive variation in terminology used around citizen engagement contributes to a lack of unified principles or criteria that comprise effective citizen engagement and development of a single set of core principles that indicate degree  and quality  of citizen engagement is necessary. This set of principles could be impactful if further developed as guidelines to suit specific types of research  and varying audiences . Commitment to citizen engagement in research by funding bodies, research institutions, and scientific journals could create a shift in research culture promoting use of standardized practices, helping citizen engagement move away from tokenism into an efficient and unified process.We recommend standardization of terminology  used to describe participation of lay individuals in health research.We recommend development of a specific framework for the measurement and evaluation of citizen engagement in health research, built to foster empowerment, impact, respect, support, and value in citizen engagement.Additional file 1. Item S1. Medline (Ovid) search strategy.