training and support strategies to enhance program delivery. Recommended implementation strategies include building strong program-school partnerships, creating a shared vision to improve access to care, and building engagement in families and communities while supporting nurse leaders and family involvement with training and resources. These results can help guide future telehealth interventions.Healthy aging is the prime goal of aging research and interventions. Healthy aging or not can be quantified by biological aging rates estimated by aging clocks. Generation and accumulation of large scale high-dimensional biological data together with maturation of artificial intelligence among other machine learning techniques, have enabled and spurred the rapid development of various aging rate estimators (aging clocks). Here we review the data sources and compare the algorithms of recent human aging clocks, and the applications of these clocks in both researches and daily life. We envision that not only more and multiscale data on cross-sectional data will add momentum to the aging clock development, new longitudinal and interventional data will further raise the aging clock development to the next level to be trained by true biological age such as morbidity and mortality age.Central ray amputation results severe esthetic blemish and functional and psychological sequelae. Three main reconstruction procedures have been reported in adults digital translocation, intracarpal osteotomy, and metacarpal resection; none of these, however, have been studied in children. The aim of this study was to report medium-term results for treatment of central ray amputation by proximal metacarpal resection following failure of digit replantation in children (i.e., skeletally immature patients). All children consecutively operated on by metacarpal resection after failure of digit replantation for complete central ray amputation between 2012 and December 2017 were retrospectively included. The surgical procedure consisted in metacarpal resection through a palmar approach, with deep transverse metacarpal ligament reconstruction. At last follow-up, adjacent finger range of motion, pain, rotational deformity and grip strength were evaluated, as well as metacarpal laxity. Metacarpal migration index and metacarpal divergence were measured on standard X-ray. Eleven children with a mean age of 11 ± 8 years were included. At mean 18 ± 3 months’ follow-up, range of motion in adjacent digits was conserved in all cases, with no intermetacarpal laxity. Grip strength was 28% lower than for the contralateral side. Two patients showed rotational malalignment in extension, without functional impairment. In 4th ray amputation (n = 8), metacarpal migration index was decreased by 65% due to radial migration of the 5th metacarpal, but metacarpal divergence was conserved in all cases. Isolated metacarpal resection of the central ray for replantation failure is a reliable and safe procedure with good radiological and functional results in skeletally immature children.

Surgical disease in Low Income Countries (LIC) is common, and overall provision of surgical care is poor. A key component of surgical health systems as part of universal health coverage (UHC) is financial risk protection (FRP) – the need to protect individuals from financial hardship due to accessing healthcare. We performed a systematic review to amalgamate current understanding of the economic impact of surgery on the individual and household. Our study was registered on Research registry (www.researchregistry.com).

We searched Pubmed and Medline for articles addressing economic aspects of surgical disease/care in low income countries. Data analysis was descriptive in light of a wide range of methodologies and reporting measures. Quality assessment and risk of bias analysis was performed using study design specific Joanna-Briggs Institute checklists. This study has been reported in line with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) and AMSTAR (Assessing the methodologiCs. Policies directed at strengthening surgical health systems must seek ways to reduce financial hardship on individuals and households from both direct and indirect costs and these should be monitored and measured using defined instruments from the patient perspective.The southern Pacific Ocean, off the New Zealand coast, has been reported as one sympatric area of the two parasite species Anisakis pegreffii and A. berlandi. Here, a multilocus genotyping approach, based on a panel of eleven DNA microsatellite (SSR) loci plus the sequences analysis of the nuclear nas10 nDNA and the mitochondrial mtDNA cox2 gene loci, was applied to a total of N = 344 adults and larvae of Anisakis spp. from cetacean and fish species, respectively. Akt inhibitor Out of the newly scored SSR loci, Anisl 15 and Anisl 2 showed fixed alternative alleles between A. pegreffii and A. berlandi resulting as 100% diagnostic loci. Out of SSRs Anisl 00314 and Anisl 7 previously disclosed, two additional loci, i.e., Anisl 4 and Anisl 22, were found to be sex-linked. The Bayesian genotypes clustering approach (STRUCTURE) allowed identification, with a 100% of probability value, N = 208 specimens to the “pure parental” A. pegreffii, N = 133 to the “pure parental” A. berlandi, while one adult and two larval stages showed mixed ancestry between the two groups having, in all cases, a Q-value = 0.50. NEWHYBRIDS analysis assigned (100% of probability) those specimens to their F1 hybrid category. This represents the first evidence of contemporary hybridization between the two parasite species in a sympatric area. The pairwise FST values estimated at intraspecific and interspecific level, inferred from both SSR loci and mitochondrial mtDNA cox2 sequences, have also demonstrated the existence of two distinct panmictic units in this study area, corresponding respectively to A. pegreffii and A. berlandi. The results obtained support the useful application of a multilocus approach in the identification of sibling species and their hybrid categories in sympatric areas. The possible use of sex-linked SSR loci of the two species of the A. simplex (s. l.), for sex determination of their larval stages, is also suggested.