Treehouse

Abstract Adverse drug reactions (ADRs) remain a major barrier to successful tuberculosis (TB) treatment. They undermine adherence, prolong morbidity, and increase the risk of treatment failures and mortality. Yet, evidence on their incidence, duration, and management across diverse patient groups remains limited. We conducted a mixed-methods study to address this gap, using a representative sample of patients from six states in India. Specifically, we combined ethnographic observations and interviews with 40 patients and stakeholders across three districts with a quantitative survey of 2,000 randomly selected TB patients across eight districts. The ethnographic analysis revealed a novel taxonomy of ADRs, distinguishing active ADRs (acute, clinically urgent conditions), from passive ADRs (persistent, lower-intensity conditions) that quietly undermine adherence in later treatment phases. Passive ADRs such as skin darkening and fatigue typically warrant little clinical attention, yet their persistence makes them highly relevant for patient management strategies aimed at supporting adherence and achieving TB elimination. This finding was further contextualized and strengthened by quantitative analysis, which provided robust statistical insights into their incidence across diverse patient profiles. The quantitative analyses also reveal a near-universal burden of ADRs, with 86% of patients reporting at least one ADR (Mean = 3.1, SD 2.38). Women reported ADRs more frequently and for longer durations, particularly cutaneous ADRs, while elderly patients were more prone to gastrointestinal and musculoskeletal ADRs. Younger patients and women reported the highest prevalence of vomiting (41%), which emerged as the only independent predictor of unsuccessful treatment completion (OR = 0.39, 95% CI: 0.20–0.76). The overall number of ADRs was also strongly correlated with adverse treatment outcomes (OR = 0.88, 95% CI: 0.78–0.98). The active-passive taxonomy, along with risk-group profiling, offers a roadmap for differentiated counselling and pro-active patient-centric ADR management. We recommend embedding this approach into national TB protocols, with structured risk-based patient counselling at different stages of treatment, supported by adequate training for treatment coordinators and providers. While further research is warranted to assess scalability and cost-effectiveness, our findings demonstrate both the urgency and the feasibility of structured ADR management in high-burden TB settings. Author Summary Adverse drug reactions (ADRs) among drug-sensitive TB patients pose a significant challenge in TB treatment, particularly in resource-constrained settings. Yet, literature on their incidence, duration and resolutions pathways remains scarce - especially studies documenting these across socio-demographic profiles. Our study addresses this gap using a sequential mixed-methods design, combining qualitative and quantitative methodologies. The approach contributes two key advances to the literature. First, it introduces a novel taxonomy of ADRs, grounded in patients’ lived experiences and the support received. This taxonomy segregates ADRs into “active” ADRs, which are more severe and require urgent medical attention, and “passive” ADRs, which are less severe but persist for a longer time, and quietly undermine adherence. Second, it provides statistically validated evidence on the incidence, duration, and resolution of eleven ADRs, disaggregated across socio-demographic profiles. Together, these findings provide a roadmap for developing differentiated, risk-tailored protocols that emphasize gender- and age-responsive counselling. We recommend adapting these insights to inform dedicated ADR guidance within the National TB Elimination Frameworks (NTEP) for India, as well as other high-burden countries, clearly outlining the roles and responsibilities of healthcare providers - particularly treatment coordinators and physicians - and supporting them through targeted training led in collaboration with the NTEP.

Genotype-environment interaction is pervasive in forest genetics. Delineation of spatial breeding zones (BZs) is fundamental for accommodating genotype-environment interaction. Here we developed a BZ classification pipeline for the forest tree Eucalyptus globulus in 2 Australian regions based on phenotypic, genomic, and pedigree data, as well on a detailed environmental characterization (“envirotyping”) and spatial mapping of BZs. First, the factor analytic method was used to model additive genetic variance and site–site genetic correlations (rB) in stem volume across 48 trials of 126,467 full-sib progeny from 2 separate breeding programs. Thirty-three trials were envirotyped using 145 environmental variables (EVs), involving soil and landscape (71), climate (73), and management (1) EVs. Next, sparse partial least squares-discriminant analysis was used to identify EVs that were required to predict classification of sites into 5 non-exclusive BZ classes based on rB. Finally, these BZs were spatially mapped across the West Australian and “Green Triangle” commercial estates by enviromic prediction using EVs for 80 locations and 15 sets of observed climate data to represent temporal variation. The factor analytic model explained 85.9% of estimated additive variance. Our environmental classification system produced within-zone mean rB between 0.76 and 0.84, which improves upon the existing values of 0.62 for Western Australia and 0.67 for Green Triangle as regional BZs. The delineation of 5 BZ classes provides a powerful framework for increasing genetic gain by matching genotypes to current and predicted future environments.

To compare postenhancement visual acuity between patients who underwent postcataract laser in situ keratomileusis (LASIK) or photorefractive keratectomy (PRK). A private, tertiary referral practice in Sioux Falls, South Dakota. 3-year, retrospective chart review. Patients who underwent postcataract extraction excimer laser enhancement surgery targeted for emmetropia (±0.50 diopter). Postenhancement uncorrected distance visual acuity (UDVA) and manifest refraction spherical equivalent (MRSE) was recorded for all available follow-ups and compared for both groups. 822 postcataract enhanced eyes (491 LASIK; 331 PRK). For patients with at least 6-month follow-up, mean UDVA was 0.05 ± 0.13 logMAR in LASIK-enhanced patients and 0.15 ± 0.20 in PRK-enhanced patients ( P < .001). Mean absolute value MRSE was 0.22 ± 0.36 and 0.48 ± 0.62 for LASIK-enhanced and PRK-enhanced patients at or beyond 6 months, respectively ( P < .001). 330 (67%) LASIK-enhanced patients achieved 20/20 or better postenhancement UDVA, compared with 142 (43%) PRK-enhanced patients ( P < .001). Controlling for pre-enhancement UDVA, LASIK-enhanced patients showed significantly better postenhancement UDVA than PRK-enhanced patients, except in those with pre-enhancement vision of 20/20 or better, or those worse than 20/50. LASIK-enhanced virgin corneas had mean postenhancement of 0.05 ± 0.14 UDVA compared with 0.13 ± 0.19 UDVA in PRK-enhanced virgin cornea patients ( P < .001). LASIK provides better and more predictable outcomes in UDVA than PRK in postcataract enhancement patients, even when controlling for pre-enhancement visual acuity and prior ocular procedures.

Eucalyptus globulus Labill. is increasingly considered for supply of solid-wood products such as sawlogs, yet genetic studies of solid-wood traits have been lacking. We estimated genetic parameters of growth and form traits that affect log value in full-sib families from two advanced-generation breeding populations on eight sites in Western Australia. Mean single-site heritability was 0.11 ± 0.01 for diameter at breast height (DBH), 0.28 ± 0.05 for stem straightness, 0.09 ± 0.02 for branch thickness, and 0.05 ± 0.02 for forking incidence. Dominance effects were significant (p &lt; 0.05) at four sites for DBH and branch thickness and at three sites (one population) for straightness. Mean intersite additive genetic correlations were 0.76 ± 0.06 for DBH (n = 7), 0.75 ± 0.11 for stem straightness (n = 7), and 0.58 ± 0.07 for branch thickness (n = 4). Mean intersite dominance genetic correlations were 0.90 ± 0.04 for DBH (n = 7), 0.26 ± 0.27 (n = 4) for straightness, and 0.68 ± 0.11 for branch thickness (n = 3). Additive genetic correlations between DBH and straightness ranged from –0.71 ± 0.23 to 0.33 ± 0.19 with an average of –0.18 ± 0.12 (n = 8). Genetic correlations between DBH and branch thickness were mostly weak although straightness was generally associated with thinner branches (mean additive correlation 0.44 ± 0.15, n = 6). We conclude that prospects appear favourable for improving the solid-wood value of E. globulus by selection and breeding.

Electron microscopy and a commercial ELISA test for rotavirus antigen were used to diagnose rotavirus infection in diarrheic raccoons (Procyon lotor), striped skunks (Mephitis mephitis) and red foxes (Vulpes vulpes). Gross and histopathological changes in two raccoons and two red foxes were found to be very similar to those described previously in rotavirus mediated diarrhea in other animals. While an etiology for the diarrhea is not definitively established, it would appear to involve rotavirus alone or possibly in concert with enteropathogenic coliform bacteria, overfeeding of a commercial kitten milk replacer and the stresses of captivity.