Predator efficacy and attraction to herbivore- induced volatiles determine insect pest selection of inferior host plant

Unlike mammals, most invertebrates provide no direct parental care for their progeny, which makes a well-selected oviposition site crucial. However, little is known about the female evaluation of opportunities and threats during host selection. Leveraging the wide range of host plants used by the polyphagous pest, Spodoptera littoralis, we investigate oviposition choice between two plants of different nutritional quality. Females prefer to lay their eggs on the host plant, which has inferior larval development and more natural enemies but provides lower predation rates. On the superior host plant, a major predator shows more successful search behavior and is more attracted to herbivore-induced volatiles. Our findings show that predator efficacy and odor-guided attraction, rather than predator abundance, determine enemy free space. We postulate that predators’ behaviors contribute to the weak correlation between preference and performance during host plant selection in S. littoralis and in polyphagous insects in general

Plant-Induced Transgenerational Plasticity Affecting Performance but Not Preference in a Polyphagous Moth

Environmental variation experienced by a single genotype can induce phenotypic plasticity in various traits, such as behavioural, physiological and developmental characteristics. It can occur within the lifetime of an individual through within-generation phenotypic plasticity (WGP) or vertically across generations through transgenerational phenotypic plasticity (TGP). However, knowledge about TGP and the co-occurrence of WGP and TGP is still limited. In insect host-plant selection, the ability to alter phenotypic traits through WGP is well documented while the importance of TGP and the possible co-occurrence between the two is largely unknown. Host-plant selection of both larvae and adults of the polyphagous mothSpodoptera littoraliscan be modified by previous experience through WGP. Thus, the aim of this study was to investigate if parental host-plant experience can influence host-plant choice behaviour and performance ofS. littoralisoffspring through TGP. For this, we tested effects of rearing parents on different host plants on the offspring's first instar larval migration and host plant choice, larval development and adult oviposition. A transgenerational effect on larval development was found, with increased pupal weight on a matching host-plant diet to that of the parent, when larvae were reared on cotton (good larval host plant) while no such effect was found on maize (poor larval host plant). These findings indicate that TGP ofS. littoralisprogeny development traits may only occur under favourable conditions. Parental diet did not affect larval host plant choice or migration. Furthermore, no effect of parental diet was found on offspring oviposition behaviour, indicating that adult female host-plant selection is governed by innate preference hierarchy and WGP, rather than TGP. Thus, parental diet may influence offspring performance but not behaviour, indicating that WGP is most important for host-plant selection behaviours inS. littoralis, but TGP can affect progeny development. If so, the importance of different types of plasticity may vary among traits ofS. littoralisassociated with host plant utilisation

Herbivore-Induced Changes in Cotton Modulates Reproductive Behavior in the Moth Spodoptera littoralis

Plants produce chemical defense compounds to resist herbivore attack either by repelling the herbivores or attracting natural enemies of the herbivores. We have previously shown that volatile compounds from cotton released in response to herbivory by conspecifics reduce oviposition in cotton leafworm moth Spodoptera littoralis. It remained, however, unclear whether herbivore-induced changes also affect moth pre-mating and mating behaviors. In this study we examined the effect of herbivore-induced changes in cotton on reproductive behaviors i.e., female calling, male attraction and investment, and mating behavior in S. littoralis. We found a reduction in the number of females calling i.e., females releasing pheromone, in the presence of cotton plants damaged by larvae of S. littoralis compared to undamaged plants. Females also spent significantly less time calling and showed a delay in calling in the presence of damaged plants. Furthermore, males exhibited significantly delayed activation and reduced attraction toward female sex pheromone in the presence of damaged plants. We also found that mating success and the number of matings were significantly reduced in the presence of damaged plants whereas male investment i.e., spermatophore weight, was not affected. Thus, our study provides evidence that herbivory by conspecifics on host plants affect pre-mating and mating behaviors in an insect herbivore

10 A noninvasive approach for the early detection of diabetic retinopathy

This chapter introduces one of the most critical problems in ophthalmology, specifically the diagnosis and detection of diabetic retinopathy (DR). Developing a fast, accurate, and reliable method for the early detection of DR is of great clinical importance to prevent blindness in patients. For this reason, various methods for early detection of DR have been investigated and used such as a dilated eye examination, tonometry, fluorescein angiography, optical coherence tomography, and ultrawide-field retinal imaging. With the increased popularity of machine learning, researchers have formulated their own algorithms and methods to detect DR with various rates of success. This chapter overviews past and current diagnostic methods that have been developed for DR. In addition, this chapter addresses new methodologies being developed/researched and some challenges that researchers face in developing fast, accurate, and reliable diagnosis

Prevalence of Breast Tumors and Methods of Prevention: A Cross-sectional Study

Background: Breast cancer is one of the most prevalent forms of cancer in women and one of the most severe and significant public health concerns in developing nations. This study aimed to determine the prevalence of breast tumors and women’s preventive behavior. Methods: A descriptive, correlational cross-sectional design was employed for this study. The study was conducted at (jeddah). Participants were selected during the period from September to November 2022. Population of this study were adult women (Aged >18 years) at KSA. Study instruments consisted of the following domains sociodemographic data, anthropometric measurements, information related to menstrual cycle and pregnancy, obstetric history, family history, practices of breast self-examination, procedures of early detection and knowledge, attitude and practice assessment for methods of prevention. Results: The study included 420 women of different ages. Breast cancer was found among 82 women (19.5%). The mean age among all study participants was 33.96 + 14.79 years with median age of 28 years. More than half of study participants had normal BMI (n= 220, 52.4%) while third participants were overweight (n= 136, 32.4%). Among participants, 18.1% had a history of post-partum complications, 38.3% had undergone previous surgery, 1.4% had experienced vascular moles, 18.6% had a history of fibroid uterus, 6% had cervical polyps, and 5% had endometriosis. Table 3 presents obstetric history among study participants. More than half of study participants underwent previous hysteroscopy (n= 235, 56%). On the other hand, 81 women had a family history of breast cancer (19.3%). Most of women in this study perform self-examination of the breast (n= 300, 71.4%) and 102 women underwent fine needle aspiration procedure (FNA) (24.3%). The FNA result was positive among 81 women. Furthermore, 124 women underwent mammography (29.5%) and the result was positive among 67 participants. Breast cancer is found among 82 women (19.5%). Women in this study agreed that they should have clinical breast examination at any time (n= 191, 45.5%) while other women believed they should have this examination in certain circumstances such as mastodynia (n= 61, 14.5%), history of benign breast tumors (n= 38, 9%), obesity (n= 37, 8.8%) and family history of breast cancer (n= 32, 7.6%). Conclusion: Breast cancer prevalence was 19.5%. Urban residency was predominant, with varying educational levels. Marital status, income, family size, and work differed among participants. Chronic conditions and diverse anthropometric measurements were observed. Obstetric history showed early marriage and delivery ages, limited abortions, and varied complications. Family history indicated links to chronic diseases and cancers. Participants exhibited awareness about breast cancer risk factors and methods for early detection

Antimicrobial resistance among migrants in Europe: a systematic review and meta-analysis

BACKGROUND: Rates of antimicrobial resistance (AMR) are rising globally and there is concern that increased migration is contributing to the burden of antibiotic resistance in Europe. However, the effect of migration on the burden of AMR in Europe has not yet been comprehensively examined. Therefore, we did a systematic review and meta-analysis to identify and synthesise data for AMR carriage or infection in migrants to Europe to examine differences in patterns of AMR across migrant groups and in different settings. METHODS: For this systematic review and meta-analysis, we searched MEDLINE, Embase, PubMed, and Scopus with no language restrictions from Jan 1, 2000, to Jan 18, 2017, for primary data from observational studies reporting antibacterial resistance in common bacterial pathogens among migrants to 21 European Union-15 and European Economic Area countries. To be eligible for inclusion, studies had to report data on carriage or infection with laboratory-confirmed antibiotic-resistant organisms in migrant populations. We extracted data from eligible studies and assessed quality using piloted, standardised forms. We did not examine drug resistance in tuberculosis and excluded articles solely reporting on this parameter. We also excluded articles in which migrant status was determined by ethnicity, country of birth of participants' parents, or was not defined, and articles in which data were not disaggregated by migrant status. Outcomes were carriage of or infection with antibiotic-resistant organisms. We used random-effects models to calculate the pooled prevalence of each outcome. The study protocol is registered with PROSPERO, number CRD42016043681. FINDINGS: We identified 2274 articles, of which 23 observational studies reporting on antibiotic resistance in 2319 migrants were included. The pooled prevalence of any AMR carriage or AMR infection in migrants was 25·4% (95% CI 19·1-31·8; I2 =98%), including meticillin-resistant Staphylococcus aureus (7·8%, 4·8-10·7; I2 =92%) and antibiotic-resistant Gram-negative bacteria (27·2%, 17·6-36·8; I2 =94%). The pooled prevalence of any AMR carriage or infection was higher in refugees and asylum seekers (33·0%, 18·3-47·6; I2 =98%) than in other migrant groups (6·6%, 1·8-11·3; I2 =92%). The pooled prevalence of antibiotic-resistant organisms was slightly higher in high-migrant community settings (33·1%, 11·1-55·1; I2 =96%) than in migrants in hospitals (24·3%, 16·1-32·6; I2 =98%). We did not find evidence of high rates of transmission of AMR from migrant to host populations. INTERPRETATION: Migrants are exposed to conditions favouring the emergence of drug resistance during transit and in host countries in Europe. Increased antibiotic resistance among refugees and asylum seekers and in high-migrant community settings (such as refugee camps and detention facilities) highlights the need for improved living conditions, access to health care, and initiatives to facilitate detection of and appropriate high-quality treatment for antibiotic-resistant infections during transit and in host countries. Protocols for the prevention and control of infection and for antibiotic surveillance need to be integrated in all aspects of health care, which should be accessible for all migrant groups, and should target determinants of AMR before, during, and after migration. FUNDING: UK National Institute for Health Research Imperial Biomedical Research Centre, Imperial College Healthcare Charity, the Wellcome Trust, and UK National Institute for Health Research Health Protection Research Unit in Healthcare-associated Infections and Antimictobial Resistance at Imperial College London

Surgical site infection after gastrointestinal surgery in high-income, middle-income, and low-income countries: a prospective, international, multicentre cohort study

Background: Surgical site infection (SSI) is one of the most common infections associated with health care, but its importance as a global health priority is not fully understood. We quantified the burden of SSI after gastrointestinal surgery in countries in all parts of the world. Methods: This international, prospective, multicentre cohort study included consecutive patients undergoing elective or emergency gastrointestinal resection within 2-week time periods at any health-care facility in any country. Countries with participating centres were stratified into high-income, middle-income, and low-income groups according to the UN's Human Development Index (HDI). Data variables from the GlobalSurg 1 study and other studies that have been found to affect the likelihood of SSI were entered into risk adjustment models. The primary outcome measure was the 30-day SSI incidence (defined by US Centers for Disease Control and Prevention criteria for superficial and deep incisional SSI). Relationships with explanatory variables were examined using Bayesian multilevel logistic regression models. This trial is registered with ClinicalTrials.gov, number NCT02662231. Findings: Between Jan 4, 2016, and July 31, 2016, 13 265 records were submitted for analysis. 12 539 patients from 343 hospitals in 66 countries were included. 7339 (58·5%) patient were from high-HDI countries (193 hospitals in 30 countries), 3918 (31·2%) patients were from middle-HDI countries (82 hospitals in 18 countries), and 1282 (10·2%) patients were from low-HDI countries (68 hospitals in 18 countries). In total, 1538 (12·3%) patients had SSI within 30 days of surgery. The incidence of SSI varied between countries with high (691 [9·4%] of 7339 patients), middle (549 [14·0%] of 3918 patients), and low (298 [23·2%] of 1282) HDI (p < 0·001). The highest SSI incidence in each HDI group was after dirty surgery (102 [17·8%] of 574 patients in high-HDI countries; 74 [31·4%] of 236 patients in middle-HDI countries; 72 [39·8%] of 181 patients in low-HDI countries). Following risk factor adjustment, patients in low-HDI countries were at greatest risk of SSI (adjusted odds ratio 1·60, 95% credible interval 1·05–2·37; p=0·030). 132 (21·6%) of 610 patients with an SSI and a microbiology culture result had an infection that was resistant to the prophylactic antibiotic used. Resistant infections were detected in 49 (16·6%) of 295 patients in high-HDI countries, in 37 (19·8%) of 187 patients in middle-HDI countries, and in 46 (35·9%) of 128 patients in low-HDI countries (p < 0·001). Interpretation: Countries with a low HDI carry a disproportionately greater burden of SSI than countries with a middle or high HDI and might have higher rates of antibiotic resistance. In view of WHO recommendations on SSI prevention that highlight the absence of high-quality interventional research, urgent, pragmatic, randomised trials based in LMICs are needed to assess measures aiming to reduce this preventable complication

Global economic burden of unmet surgical need for appendicitis

Background: There is a substantial gap in provision of adequate surgical care in many low-and middle-income countries. This study aimed to identify the economic burden of unmet surgical need for the common condition of appendicitis. Methods: Data on the incidence of appendicitis from 170 countries and two different approaches were used to estimate numbers of patients who do not receive surgery: as a fixed proportion of the total unmet surgical need per country (approach 1); and based on country income status (approach 2). Indirect costs with current levels of access and local quality, and those if quality were at the standards of high-income countries, were estimated. A human capital approach was applied, focusing on the economic burden resulting from premature death and absenteeism. Results: Excess mortality was 4185 per 100 000 cases of appendicitis using approach 1 and 3448 per 100 000 using approach 2. The economic burden of continuing current levels of access and local quality was US $92 492 million using approach 1 and$73 141 million using approach 2. The economic burden of not providing surgical care to the standards of high-income countries was $95 004 million using approach 1 and$75 666 million using approach 2. The largest share of these costs resulted from premature death (97.7 per cent) and lack of access (97.0 per cent) in contrast to lack of quality. Conclusion: For a comparatively non-complex emergency condition such as appendicitis, increasing access to care should be prioritized. Although improving quality of care should not be neglected, increasing provision of care at current standards could reduce societal costs substantially

Pooled analysis of WHO Surgical Safety Checklist use and mortality after emergency laparotomy

Background The World Health Organization (WHO) Surgical Safety Checklist has fostered safe practice for 10 years, yet its place in emergency surgery has not been assessed on a global scale. The aim of this study was to evaluate reported checklist use in emergency settings and examine the relationship with perioperative mortality in patients who had emergency laparotomy. Methods In two multinational cohort studies, adults undergoing emergency laparotomy were compared with those having elective gastrointestinal surgery. Relationships between reported checklist use and mortality were determined using multivariable logistic regression and bootstrapped simulation. Results Of 12 296 patients included from 76 countries, 4843 underwent emergency laparotomy. After adjusting for patient and disease factors, checklist use before emergency laparotomy was more common in countries with a high Human Development Index (HDI) (2455 of 2741, 89.6 per cent) compared with that in countries with a middle (753 of 1242, 60.6 per cent; odds ratio (OR) 0.17, 95 per cent c.i. 0.14 to 0.21, P <0001) or low (363 of 860, 422 per cent; OR 008, 007 to 010, P <0.001) HDI. Checklist use was less common in elective surgery than for emergency laparotomy in high-HDI countries (risk difference -94 (95 per cent c.i. -11.9 to -6.9) per cent; P <0001), but the relationship was reversed in low-HDI countries (+121 (+7.0 to +173) per cent; P <0001). In multivariable models, checklist use was associated with a lower 30-day perioperative mortality (OR 0.60, 0.50 to 073; P <0.001). The greatest absolute benefit was seen for emergency surgery in low- and middle-HDI countries. Conclusion Checklist use in emergency laparotomy was associated with a significantly lower perioperative mortality rate. Checklist use in low-HDI countries was half that in high-HDI countries.Peer reviewe

Effects of hospital facilities on patient outcomes after cancer surgery: an international, prospective, observational study

Background Early death after cancer surgery is higher in low-income and middle-income countries (LMICs) compared with in high-income countries, yet the impact of facility characteristics on early postoperative outcomes is unknown. The aim of this study was to examine the association between hospital infrastructure, resource availability, and processes on early outcomes after cancer surgery worldwide.Methods A multimethods analysis was performed as part of the GlobalSurg 3 study-a multicentre, international, prospective cohort study of patients who had surgery for breast, colorectal, or gastric cancer. The primary outcomes were 30-day mortality and 30-day major complication rates. Potentially beneficial hospital facilities were identified by variable selection to select those associated with 30-day mortality. Adjusted outcomes were determined using generalised estimating equations to account for patient characteristics and country-income group, with population stratification by hospital.Findings Between April 1, 2018, and April 23, 2019, facility-level data were collected for 9685 patients across 238 hospitals in 66 countries (91 hospitals in 20 high-income countries; 57 hospitals in 19 upper-middle-income countries; and 90 hospitals in 27 low-income to lower-middle-income countries). The availability of five hospital facilities was inversely associated with mortality: ultrasound, CT scanner, critical care unit, opioid analgesia, and oncologist. After adjustment for case-mix and country income group, hospitals with three or fewer of these facilities (62 hospitals, 1294 patients) had higher mortality compared with those with four or five (adjusted odds ratio [OR] 3.85 [95% CI 2.58-5.75]; p&lt;0.0001), with excess mortality predominantly explained by a limited capacity to rescue following the development of major complications (63.0% vs 82.7%; OR 0.35 [0.23-0.53]; p&lt;0.0001). Across LMICs, improvements in hospital facilities would prevent one to three deaths for every 100 patients undergoing surgery for cancer.Interpretation Hospitals with higher levels of infrastructure and resources have better outcomes after cancer surgery, independent of country income. Without urgent strengthening of hospital infrastructure and resources, the reductions in cancer-associated mortality associated with improved access will not be realised