PLOS ONE

In this study, the critical gap in understanding how fonio responds to contrasting pedoclimatic conditions, both within and outside its traditional production areas was addressed. A multi-environment trial was carried out to identify high-yielding genotypes with either broad stability or specific adaptation, thereby enabling targeted varietal recommendations to support the expansion of fonio cultivation into new areas. Randomized complete block design was used in six environments with eleven genotypes to evaluate flowering and maturity times, and grain yield. The Additive Main effect and Multiplicative Interaction and the Genotype main effect and Genotype x Environment interaction biplots revealed a significant effect of the genotype-by-environment interactions on traits, with genotypes B12 and G31 identified as high-yielding, while genotypes M5 and M14 were revealed as early-flowering and maturing. Genotypes M14 and M15 were adapted to all environments and early maturing. Boukoumbe, known as the fonio production area in Benin, was the most desirable for earliness, while Ina was the most ideal for grain yield, proving that fonio could be cultivated in Sudanian and Sudano-Guinean areas. Factor analysis revealed precipitation, C:N ratio, soil pH and texture as the main environmental variables influencing the grain yield in fonio. Our findings contributed to selecting stable, adapted genotypes.

Background: Refractive errors are the leading cause of preventable visual impairment worldwide, yet data from isolated Indigenous populations remain virtually absent from the global literature. The Yanomami, one of the largest Indigenous peoples in the Americas with recent and limited contact with non-Indigenous society, have no prior epidemiological data on refractive errors. Methods: A cross-sectional observational study was conducted in 2024 at the Yanomami Indigenous Health House, Boa Vista, Roraima, Brazil. A total of 158 self-identified Yanomami individuals aged 5 years or older were examined by an ophthalmologist. Refractive status was classified according to International Myopia Institute criteria. Results: Emmetropia was observed in 67.7% of participants, with a marked age-related decline from 100% in children aged 5 to 9 years to 38.6% in those aged 40 to 59 years. Myopia was present in 16.5% of participants, all low myopia; it was absent in children under 10 years and no high myopia was identified. Astigmatism affected 24.1% of participants and hyperopia 13.3%. Presbyopia was identified in 25.9%. Overall, 25.3% of participants presented with reduced visual acuity attributable to uncorrected refractive error, of whom 67.5% improved to normal or near-normal acuity (p < 0.001). Conclusions: This is the first characterisation of the Yanomami refractive profile, revealing a distinct myopia pattern shaped by high outdoor exposure and minimal near-work demands. Despite this, refractive correction remains effectively inaccessible to this population, leaving preventable visual impairment unaddressed and reflecting a profound health inequity. Corrective lens provision represents a high-impact, scalable intervention for this underserved community.

This report presents findings from a baseline cross sectional survey of autistic adults and adults with intellectual and developmental disabilities (IDD) connected to Our Stomping Ground (OSG), a nonprofit organization in northern Virginia committed to supported independent living. The survey was administered in 2022 and 2023 as the first wave of a planned longitudinal study, with the primary goal of establishing a comparable starting point between two groups: adults who were living, or preparing to live, independently in an OSG apartment building, and adults with disabilities who were continuing to live at home with family. A total of 76 adults completed the survey out of 98 potential participants. The two groups were well-matched at baseline across a wide range of characteristics, which is exactly what a sound longitudinal design requires. This comparability means that when follow up data are collected, any observed differences between the groups can be more confidently attributed to the experience of independent living rather than to pre-existing differences. These findings provide the empirical foundation for the longitudinal phase of this study and offer a meaningful snapshot of the health, well-being, and support needs of autistic adults and adults with IDD at a pivotal life stage.

Understanding how anthropogenic disturbance and vegetation structure influence bird abundance is important for biodiversity conservation in rapidly changing tropical landscapes. This study evaluated the effects of anthropogenic and vegetation-related variables on the abundance of the Red-cheeked Cordon-bleu (Uraeginthus bengalus) in human settlements and surrounding farmlands in Laminga Village, Jos-East Local Government Area, Plateau State, Nigeria. Bird surveys were conducted using line transects and quadrat-based vegetation assessments during November 2024. Poisson Generalized Linear Models (GLMs) were used to examine the influence of anthropogenic and vegetation predictors on abundance. Among anthropogenic variables, building density significantly reduced abundance ({beta} = -0.141, SE = 0.060, z = -2.333, p = 0.020), whereas human presence ({beta} = -0.073, p = 0.141) and noise level ({beta} = 0.009, p = 0.592) did not significantly influence abundance. Average grass height showed a marginal positive relationship with abundance ({beta} = 2.008, SE = 1.051, z = 1.910, p = 0.056), while hedgerow presence, hedgerow height, grass cover, and bare ground cover were not significant predictors. The vegetation model produced the lowest residual deviance (91.19) and AIC value (297.66), indicating comparatively stronger explanatory performance. The results suggest that structural habitat characteristics and building density may play more important roles in shaping Red-cheeked Cordon-bleu abundance than human activity or noise levels alone. These findings provide insight into species responses to environmental disturbance in human-modified savanna ecosystems.

Introduction: Early hospital presentation after stroke onset is necessary for rapid assessment and access to time-dependent acute management. This study examined the correlates of late presentation for stroke care among patients recorded at a tertiary hospital in Ondo State, Nigeria. Methods: A retrospective records review was conducted using secondary data from the Stroke Registry of the University of Medical Sciences Teaching Hospital, radiology department records, referral notes, and ambulance records. Records of stroke cases documented within the preceding 24 months were reviewed. Late presentation was defined as hospital presentation more than four hours after symptom onset. Frequencies, chi-square tests, and modified Poisson regression with robust standard errors were used to estimate adjusted prevalence ratios. Results: The analysis included 371 stroke cases. Of these, 317 (85.4%) presented after four hours, and the median time to presentation was 24 hours (interquartile range: 9-72 hours). Late presentation differed significantly by employment status, first-contact route, and pathway complexity at bivariate analysis. After adjustment, non-hospital first contact remained strongly associated with late presentation: patients whose first documented contact was non-hospital-based had almost 3 times the prevalence of delay compared with those whose first contact was hospital-based (adjusted prevalence ratio = 2.89; 95% confidence interval: 2.15-3.90; p < 0.001). Conclusion: Late presentation was pervasive in this tertiary hospital record cohort and was primarily associated with the initial direction of care-seeking. Stroke response interventions should emphasise immediate hospital presentation and strengthen urgent referral from non-hospital first-contact points.

Habitat modification is a major driver of avian population change in tropical savanna ecosystems. This study investigated habitat-related variation in the abundance of the Red-cheeked Cordon-bleu (Uraeginthus bengalus) across human settlements and surrounding farmlands in Laminga Village, Jos-East Local Government Area, Plateau State, Nigeria. Field surveys were conducted over a three-week period in November 2024 using 21 line transects sampled during peak bird activity periods. Bird abundance data were analysed using a Poisson Generalized Linear Model (GLM). Results showed that habitat type significantly influenced abundance, with significantly lower abundance recorded in human settlements compared to farmlands ({beta} = -0.836, SE = 0.192, z = -4.359, p < 0.001). Transect length positively influenced abundance ({beta} = 0.028, SE = 0.008, z = 3.600, p < 0.001). Model performance improved substantially from the null deviance (159.88) to the residual deviance (125.85), with an Akaike Information Criterion (AIC) value of 306.32. The findings suggest that farmlands provide more favourable habitat conditions for the species, likely due to greater vegetation availability and reduced structural disturbance relative to settlement areas. The study highlights the ecological importance of low-intensity agricultural landscapes in supporting avian persistence within human-modified savanna environments.

Abstract Purpose:Comparison of ocular parameters (ACD, AL, LT, VL, CCT, ASD, LC, LT/ACD) in preterm infants with retinopathy after treatment, those with spontaneous regression, and those without retinopathy, at postmenstrual (ages of 0 (40 weeks), 3 , and 6 months. Methods: Cross-sectional study. This research involved 297 premature infants assigned to three groups based on fundus results and intravitreal injection therapy: an ROP post-injection group, an ROP spontaneous regression group, and a non-ROP group. Axial length (AL), anterior chamber depth (ACD), l e n s t h i c kn e s s (LT), and vitreous length (VL) were assessed in all three groups using a corneal thickness meter at po st menstrual age s (PMA) of 0, 3, and 6 months. Derived parameters--ASD ((ACD + LT), LC ((ACD + LT/2), and LT/ACD--were subsequently calculated. A one-way ANOVA analysis revealed statistically significant differences in these ocular parameters among the groups (P < 0.05). Results: Significant differences e m e r g e d in anterior chamber depth (ACD) and l e n st h i c k n e s s ( LT) between the ROP post-injection group, ROP spontaneous regression group, and non-ROP group at 0, 3, and 6 (months postmenstrual age (PMA). At 0 months PMA: ACD(F=4.33, P=0.014), LT (F=5.45, P=0.005). At 3 months PMA: ACD (F=17.20, P<0.01), LT(F=15.23, P<0.01). At 6 months PMA: ACD (F=17.89, P<0.01), LT (F=17.21, P<0.01). Central corneal thickness (CCT) also differed significantly among the three groups at 0 months PMA(P <0 .0 1 ). All ocular parameters correlated significantly with Postmenstrual Age, with CCT and LT showing a negative correlation. Before 6 months PMA, axial length (AL) and vitreous length (VL) increased significantly, and ACD deepened significantly across all groups (P <0 .05 ). However , LT exhibited no significant change within the ROP group (post-injection group P=0.4; spontaneous regression group P=0 .33). No significant differences existed in any ocular parameters between the ROP post-injection group and the ROP spontaneous regression group (P>0.05). Conclusions: Before 6 months of postmenstrual age (PMA), axial length (AL), vitreous length (VL), and anterior chamber depth (ACD) were increased between the ROP group and non-ROP group; lens thickness (LT) remained unchanged in the ROP group but increased in the non-ROP group. The injection group and the spontaneous regression group showed no significant differences. The primary factors influencing anterior segment development were birth weight (BW), gestational age (GA), and postmenstrual age (PMA).

Seaweed cultivation has recently gained increased attention in North-West Europe as a sustainable source of biomass for biobased products. However, yields need to increase to make the seaweed sector economically viable. To achieve this, higher yielding varieties can be bred but this requires variation for yield and yield-related traits among genotypes. To reliably select high-yielding genotypes, an understanding is required of how both within-farm and between-farm environmental differences affect phenotypes and how to identify simple and reliable proxies for yield. In this study we evaluated growth of nine Saccharina latissima genotypes on two farms, 12 km apart, within the same season. We observed a threefold difference in yield among genotypes, demonstrating the potential for improvement through selection and breeding. Blade thickness and blade size-related traits were strongly correlated with yield, highlighting their potential to serve as rapid and non-destructive proxies for yield, thereby accelerating selection. Furthermore, we demonstrated the importance of adequate replication in farm trials to improve genotype performance estimation by correcting for within-farm spatial variation. Moreover, phenotypic variation was most explained by the genotype and environment, highlighting the importance of both genotype and site selection. Although genotype by environment interactions (GxE) were significant, its contributions were small, indicating stable genotype ranking across farms. Overall, these results are promising for breeding improved S. latissima as it indicates that genotype performance is consistent across close by locations and that local S. latissima populations harbour substantial phenotypic variation that can be used to breed for increased yield. Highlights- Local genetic resources harbour substantial variation in yield and morphology for breeding. - Minor GxE allows for breeding across farms. - Blade thickness and blade size related traits are good predictors of yield. - Correction for on-farm spatial variation improves genotype performance estimation.

Background Physical activity (PA) is essential for childrens physical, cognitive, and psychosocial development; however, many children do not meet recommended PA levels, particularly in low- and middle-income settings. Parents play a critical role in shaping childrens PA behaviours, yet limited empirical evidence exists regarding parental perceptions of PA participation, satisfaction, barriers, and improvement strategies within the Nigerian context. Methods A qualitative study was conducted in Enugu City, Nigeria, using in-depth semi-structured interviews with 20 parents of children enrolled in nursery, primary, and secondary schools. Participants were recruited purposively from community settings. Interviews were audio-recorded, transcribed verbatim, and analysed using reflexive thematic analysis following Braun and Clarkes framework. Reporting adhered to the Consolidated Criteria for Reporting Qualitative Research (COREQ). Results Five themes were identified: (1) parents perceptions of childrens PA participation as context-dependent and variable; (2) satisfaction with PA opportunities existing along a continuum from high satisfaction to dissatisfaction; (3) perceived enablers, including accessible spaces, social support, parental involvement, and safety; (4) perceived barriers, notably time constraints, academic prioritisation, limited facilities, safety concerns, and parental availability; and (5) strategies for improvement, emphasising school-based reforms, parental engagement, community collaboration, and policy-level support. Conclusions Parental satisfaction with childrens PA opportunities was mixed and frequently conditional, with many participants expressing dissatisfaction related to academic prioritisation, limited time for physical education, and inadequate recreational facilities. The findings suggest that improving both satisfaction and participation may require strengthened school-based physical activity provision, greater parental engagement, and enhanced community infrastructure to support balanced child development.

Abstract Objective. To determine the incidence and identify independent clinical predictors of emergence delirium (ED) in children aged 2-12 years. Material and methods. A prospective observational study included 56 children aged 2-12 years undergoing elective surgery under general anaesthesia. Preoperative anxiety (m-YPAS), induction behaviour (4 point scale), anaesthesia duration, opioid use, and postoperative pain (FLACC) were assessed. ED was diagnosed when the maximum PAED score was [&ge;]12. Results. The incidence of ED was 55.4% (31/56). Univariate analysis with false discovery rate (FDR) correction identified significant associations with ED for anaesthesia duration (q=0.002), induction behaviour (q=0.007), and surgery type (q=0.027). Multivariable logistic regression revealed three independent predictors: induction behaviour (category 3 vs 1) - odds ratio (OR) 14.2 (95% CI 2.6-78.1); anaesthesia duration (per minute) - OR 1.07 (95% CI 1.02-1.13); opioid use - OR 12.1 (95% CI 1.3-113.0). The model showed good discriminatory ability: area under the ROC curve (AUC) = 0.83 (95% CI 0.72-0.94). Conclusion. Emergence delirium in children aged 2-12 years without pharmacological premedication occurs in 55.4% of cases. The strongest independent predictors are adverse induction behaviour, longer anaesthesia duration, and intraoperative opioid use. The derived model can be used for personalised risk stratification of ED. Keywords: emergence delirium; children; risk factors; PAED; prediction model.

Objective To assess serum 25-hydroxyvitamin D [25(OH)D] levels in a health examination population in Guiyang, a low-latitude, high-altitude, and cloudy city in southwestern China, and to identify key determinants using machine learning. Methods This retrospective study included 10,931 adults (>20 years) who underwent health checkups at Guiyang First People's Hospital between February 2019 and April 2025. Beyond conventional statistical comparisons, a two-stage machine learning approach was applied: LASSO regression for feature selection, followed by an optimized Random Forest regression model (mtry = 2). SHapley Additive exPlanations (SHAP) were used to quantify variable importance. Results The median serum 25(OH)D level was 36.63 (IQR 24.77,53.17) nmol/L. Vitamin D deficiency (<50 nmol/L) was present in 70.98% of participants, while sufficiency (>75 nmol/L) was only 7.35%. Significantly lower levels were observed in females, in adults aged <30 years (deficiency rate 85.6%), and during spring. The optimized Random Forest model achieved a cross-validated RMSE of 21.427. SHAP analysis revealed a clear hierarchy of importance: age (mean SHAP = 5.604) > season (4.104) > sex (1.533) {approx} BMI (1.501). Conclusion Vitamin D deficiency is highly prevalent in the Guiyang health examination population. Age and season are the dominant determinants, far outweighing sex and BMI. Targeted interventions should focus on young adults, females, and the spring season, especially in regions with similar cloudy highland climates.

Background: Childhood and adolescent hearing loss affects not only communication and cognitive development but also motor skills and school participation. Consequently, it generates inequalities in learning and educational inclusion. Nevertheless, no systematic review has yet analyzed these differences from an inclusive education perspective. Methods: A systematic review with meta-analysis was conducted following PRISMA guidelines and registered in PROSPERO. Observational studies comparing physical fitness between children and adolescents with hearing loss and their hearing peers were included. Methodological quality was assessed using the Newcastle--Ottawa Scale, and standardized effect sizes were calculated with a random-effects model. Results: Five studies (n=404) were analyzed. Findings revealed significant differences in strength, agility, speed, and balance. Moreover, the meta-analysis showed a large standardized effect favoring hearing children (ES=-2.35; 95% CI: -3.34 to -1.37). Conclusions: Children and adolescents with hearing loss present significantly lower physical fitness, which may affect the planning of physical education activities if their capacities are misinterpreted. Implementing inclusive and adapted strategies within the school curriculum is essential to ensure equal opportunities, improve physical fitness, and promote educational equity.

Background: The Colour Blind Quality of Life Scale (CBQoL) is a questionnaire developed to assess the quality of life of individuals with congenital colour vision deficiency (CVD). This study aimed to translate the English version of the CBQoL into Vietnamese and evaluate the validity and reliability of the Vietnamese version (CBQoL-VN). Methods: A forward-backward translation method was performed to produce the Vietnamese text. Content validity was assessed by six experts in vision care. Reliability testing involved 30 participants with congenital CVD, while discriminant validity was evaluated by comparing this group against 30 participants with normal colour vision. Results: Following expert consensus, two items were removed and one transportation-related item was added. The content validation index (CVI) values of 1.0 for relevance, clarity, and understandability indicated excellent content validity. Internal consistency was high, with a Cronbach's alpha of 0.95 for the full scale. Discriminant validity analysis showed that participants with congenital CVD scored significantly lower across all CBQoL-VN domains compared to those with normal colour vision. Conclusions: The modified CBQoL-VN is a valid and reliable instrument for assessing the quality of life of individuals with congenital CVD in the Vietnamese population.

Introduction: Stroke care is time-sensitive, yet patients in low-resource settings may reach tertiary services only after passing through multiple formal and informal care options. This study examined documented care-seeking pathways and time to presentation among stroke cases recorded at the University of Medical Sciences Teaching Hospital (UNIMEDTH), Ondo State, Nigeria. Methods: A retrospective hospital record review was conducted using secondary data from the Stroke Registry, radiology department records, referral notes, and ambulance records at UNIMEDTH. The analysis included 371 stroke cases with documented time from symptom onset to UNIMEDTH presentation and reconstructable care pathways. First-contact routes were classified as hospital/biomedical, self/informal or traditional/faith-based care, and the number of documented steps defined pathway complexity before and including tertiary presentation. Frequencies and percentages described pathway patterns; median presentation times were compared using Mann-Whitney U and Kruskal-Wallis tests. Results: The median time to tertiary presentation was 24 hours (interquartile range [IQR] 9-72), and 317 patients (85.4%) presented after four hours. Only 30 patients (8.1%) presented directly to UNIMEDTH; 44 distinct care-pathway sequences were recorded. Hospital-facility first contact was documented for 81 patients (21.8%). It was associated with a median presentation time of 3 hours (IQR 2-6), compared with 48 hours (IQR 24-72) among patients whose initial contact was outside a hospital facility (U = 699.50, p < 0.001). The median time also differed across grouped first-contact categories and pathway complexity levels (both p < 0.001). Conclusion: Non-hospital or multi-step care-seeking pathways commonly preceded tertiary stroke presentations in this setting. The findings indicate that delayed tertiary arrival is partly embedded in the pathway followed after symptom onset. Interventions should combine public recognition of stroke warning signs with urgent referral linkages involving hospitals, patent medicine vendors, traditional and faith-based providers, and emergency transport systems.

ObjectiveTo 1) determine the expression and distribution of all PDE4 isozymes (A-D) along the length of the anterior urethra, 2) culture fibroblasts and epithelial cells from healthy and strictured urethras, 3) investigate an in vitro model of anterior urethral stricture disease (aUSD), and 4) assess the therapeutic potential of phosphodiesterase-4 (PDE4) inhibitors and testosterone compared to paclitaxel. MethodsThe presence and relative abundance of PDE4 isozymes (A-D) was confirmed using immunohistochemistry on 5 male cadaveric urethras. Human urethral fibroblasts (FBs) were cultured from healthy control urethras of patients undergoing vaginoplasty (n=3) and from idiopathic bulbar urethral strictures (L2S1E2) of patients undergoing urethroplasty (n=3). Epithelial cells (ECs) were cultured from a healthy control urethra and two urethral strictures. To investigate a model of aUSD, Control FBs were stimulated with TGF{beta}1 and compared to Stricture FBs on assays of cell proliferation and expression of genes relevant to aUSD pathophysiology. To test therapeutics, Stricture FBs were treated with the PDE4 inhibitor, roflumilast, testosterone (T), or paclitaxel and compared to Control FBs on the previously mentioned assays and cell viability. ResultsPDE4- A, B, and D were detected along the length of the urethra. Expression levels did not differ between urethral regions. TGF{beta}1 altered proliferation and gene expression in a dose-dependent manner. Roflumilast and T preserved cell viability and proliferation and decreased expression of genes positively associated with auSD. ConclusionUrethral FBs and ECs can be cultured from healthy and strictured surgical specimens, enabling in vitro research. PDE4 inhibitors and T may be non-cytotoxic alternatives or additions to paclitaxel for aUSD. HighlightsO_LIPDE4 isozymes A, B, and D are expressed in adult anterior urethras C_LIO_LIPDE4 is expressed equally from proximal bulbar to meatal urethra C_LIO_LIEpithelial cells and fibroblasts can be cultured from healthy and stricture urethra C_LIO_LITGF{beta}1 may not be an optimal method to model aUSD in vitro C_LIO_LIUnlike paclitaxel, roflumilast and testosterone are not toxic to urethral cells C_LI

Respectful maternity care [RMC] comprises the primary components of high-quality maternal health services. Evidence on RMC levels and determinants in Ethiopia is still inadequate. This study aimed to examine the reception and its determinants among postnatal women in government hospitals in the East Wallaga Zone, West Oromia. An institution-based cross-sectional study was conducted from June to October 2025, within seven days post-delivery. A structured questionnaire based on the WHO RMC tools was used. The total RMC score proved robust reliability [Cronbachs = 0.808] and was organized using the 75th-percentile threshold. Factor analysis revealed basic RMC dimensions, while logistic regression was used to identify predictors of a promising RMC experience. This study presented that only 46.8% of postpartum mothers received adequate RMC, with significant gaps in care. The main deficiencies comprised poor provider self-introduction, failure to call women by name, and infrequent communication and consent practices. Three key RMC dimensions were identified: privacy and consent, explanation and permission, and respectful communication. Using multivariate analysis, interpersonal caring practices were robust predictors of positive RMC experiences. Explaining procedures with possible events, maintaining privacy, obtaining consent, prompt responsiveness, provider self-introduction, and calling mothers by name were significantly associated factors. Sociodemographic and maternal reproductive factors were not significantly associated after adjusting for confounders. Finally, fewer than half [46.6%] of mothers experienced adequate RMC, which indicated major gaps in woman-centered care. Improving respectful interpersonal communication, informed consent, and maintaining privacy should be prioritized to boost the quality of maternal healthcare in the study area.

Depression remains a major public health concern globally, particularly in low resource settings where access to quality mental health care is limited and treatment outcomes are often suboptimal. In this context, the quality of the clinician patient relationship has been increasingly recognised as a critical determinant of therapeutic success. This study examined the influence of clinician patient therapeutic alliance and relational factors on treatment outcomes among patients with depression in Benue State, Nigeria. A crosssectional correlational design was adopted, involving patients diagnosed with depression and receiving care in selected health facilities. Data were analysed using Structural Equation Modelling to test hypothesised relationships among therapeutic alliance, relational factors, and treatment outcomes. The measurement model demonstrated strong psychometric properties, with all factor loadings exceeding 0.60, composite reliability above 0.90, and adequate convergent and discriminant validity. Results revealed that therapeutic alliance significantly predicted treatment outcomes, while relational factors also had a significant positive effect. Therapeutic alliance further significantly predicted relational factors. The model explained 61 percent of the variance in treatment outcomes. Mediation analysis indicated that relational factors partially mediated the relationship between therapeutic alliance and treatment outcomes, accounting for 29 percent of the total effect. The study concludes that therapeutic alliance, strengthened through trust, empathy, and collaboration, plays a central role in improving depression outcomes. Strengthening relational competencies in clinical practice is therefore essential for enhancing mental health care delivery in Nigeria.

Resuscitation in the oldest old at the end of life is associated with potential harm, raising concerns about misalignment with patients goals of care. This study aimed to elucidate changes in the use of resuscitation among the oldest old in Japan following the revision of the national guideline on end-of-life care which explicitly incorporates the concept of advance care planning. We conducted a repeated cross-sectional study using the National Database of Health Insurance Claims Open Data, including adults aged [&ge;]85 years, from April 2014 to March 2024. The annual number of resuscitation procedures per 100,000 individuals aged [&ge;]85 years was used as the measure of frequency. Resuscitation included closed-chest cardiopulmonary resuscitation (CPR) and endotracheal intubation. Interrupted time series analysis was used to examine changes following the 2018 revision of the national end-of-life care guideline. The frequencies of CPR and endotracheal intubation declined before 2018 (CPR: age 85-89, -68.4 [-87.9 to -48.8]; age [&ge;]90, -106.7 [-131.5 to -82.0]; intubation: age 85-89, -57.5 [-71.8 to -43.2]; age [&ge;]90, -69.5 [-80.7 to -58.3]), but the decline attenuated thereafter (CPR: age 85-89, +56.2 [28.0 to 84.5]; age [&ge;]90, +84.1 [50.7 to 117.6]; intubation: age 85-89, +36.6 [8.5 to 64.7]; age [&ge;]90, +38.3 [23.8 to 52.8]). These findings provide insight into the changes in resuscitation trends following policy interventions supporting end-of-life decision-making. Further studies are needed to better understand the mechanisms underlying this change.

Background Studies show 53 to 74% of women living with HIV experience postpartum ART adherence challenges. Viral load testing is a delayed indicator, highlighting the need for culturally appropriate screening tools to identify at-risk women early. This study examined the association between non-viral suppression and constructs within the AIDS Clinical Trials Group (ACTG) adherence questionnaire among women in Uganda to inform timely, targeted interventions to improve adherence. Methods The ACTG was adapted, and postpartum participants completed ACASI or Provider-Assisted Interviews (PAIs). Self-efficacy, social support, anxiety, depression, viral load, and clinical factors were analysed using mixed-effects logistic models over a 1-year period. Results Of 166 women, 21 completed ACASI and 145 PAIs. 4.2% (7/166) were not virally suppressed at baseline, and their non-suppression status was consistent throughout one year of follow-up. High self-efficacy scores were associated with 27% lower odds of viral non-suppression (Odds Ratio [OR], 0.73; 95% CI, 0.54, 0.98). High depression scores were associated with 22% higher odds of non-suppression (OR 1.22;95% (1.01,1.49). Other variables, including age, Body Mass Index, duration on ART, marital status, employment, education level, tap water, and travel time from home to clinic, were not associated with viral suppression in the covariate-adjusted analyses. Median self-efficacy and depression scores were 8 (IQR 1,9) and 1.2 (IQR 0,16), respectively. Focused group discussion data showed high acceptability and feasibility of using the ACTG adherence questionnaire in Uganda. Conclusion Lower self-efficacy and higher depression scores on the ACTG adherence questionnaire can help identify Ugandan women at risk of viral non-suppression in HIV programs. Keywords WLHIV, Antiretroviral Therapy, Adherence, Audio Computer Assisted Self Interview, Viral load

Background/Objectives People living with HIV face overlapping hardship through medical, behavioral, and social needs that require an integrated and coordinated approach. Harlem United multiservice model provides healthcare, food assistance, housing support, harm reduction services, behavioral health counseling, case management, and much more to support their clients. This study is an examination on how the participation in the Harlem United multiservice model is associated with changes over time in client health, behavioral health, and social outcomes. Methods This study performed a longitudinal program evaluation examining Harlem United clients enrolled between January 2020 and January 2025 who remained engaged in services for a minimum of one year. Client outcomes were assessed across three time points: Baseline, Year 1, and Year 2. The sample included 154 clients at baseline (N=154) with a total of 428 observations (N=428). Quantitative measures that were assessed included program involvement, housing stability, PHQ4 scores, food insecurity, medication adherence, and viral suppression. Data was analyzed using IBM SPSS Statistics through descriptive statistics, frequency tables, and generalized estimating equation models (GEE) to account for repeated observation over time. Results Medication adherence and viral suppression remained consistently high across all time points in the longitudinal study suggesting that most clients were virally suppressed or undetectable at baseline. Housing stability was statistically significant Wald X2 (2) = 156.073, p < 0.001 with improvements noted in Year 1 and Year 2 compared to baseline. Program level was significantly associated with PHQ4 scores, Wald X2 (1) = 7.902, p = 0.005. Food insecurity was also associated with PHQ4 scores, Wald X2 (1) = 5.462, p = 0.019. Findings suggest that clients with higher PHQ4 scores were involved in more programs compared to clients only enrolled in 1-2 programs. Additionally, clients with higher PHQ4 scores were more food insecure highlighting the relationship between social needs and mental health. Conclusion: Findings suggest that the Harlem United multiservice model played a supportive role in the maintenance of health and social outcomes through medication adherence and viral suppression. Although, significant improvement was not reflected across several outcomes, the association between PHQ4 scores, food insecurity, and an increase in program involvement suggest that the multiservice is reaching more clients with complex behavioral and social needs. Continued integration of these services is important for sustaining client stability while addressing social determinants of health.