Background Psoriasis is a common chronic inflammatory skin disorder. Higher adiposity may increase the risk of psoriasis, but prospective data on this association are scarce. One prospective study showed that increased adiposity increased the risk of incident psoriasis in younger women, but no data are available in older women. Methods We prospectively examined the associations between body mass index (BMI), weight change, waist and hip circumference and risk of incident psoriasis in 67,300 women over a 12-year period (1996-2008) in the Nurses’ Health Study. The primary outcome was self-reported, physician-diagnosed psoriasis. Results During the 12 years of follow-up, there were a total of 809 incident psoriasis cases. There was a graded positive association between BMI (both baseline and updated) and the risk of psoriasis (both P values for trend <0.0001). Compared to women with updated BMI of <25, the multivariate RRs (relative risks) of incident psoriasis were 1.21 (95% CI, 1.03-1.43) for a BMI of 25.0 to 29.9, 1.63 (95% CI, 1.33-2.00) for a BMI of 30.0 to 34.9, and 2.03 (95% CI, 1.58-2.61) for a BMI of 35.0 or greater. Higher waist circumference, hip circumference, and waist-hip ratio were associated with a higher risk of incident psoriasis, but became non-significant after additionally adjusting for BMI. The BMI at age of 18 years was not associated with the risk of psoriasis. Weight gain since the age of 18 years was associated with an increased risk of psoriasis and RR of 10 lb gain was 1.08 (95% CI, 1.06-1.11; p<0.0001). Conclusion This large prospective study indicates that higher BMI and weight gain are risk factors for incident psoriasis in older US women.

Interactive Voice Response (IVR) platforms have been widely deployed in resource-limited settings. These systems tend to afford asynchronous push interactions, and within the context of health, provide medication reminders, descriptions of symptoms and tips on self-management. Here, we present the development of an IVR system for resource-limited settings that enables real-time, synchronous interaction. Inspired by community radio, and calls for health systems that are truly local, we developed 'Sehat ki Vaani'. Sehat ki Vaani is a real-time IVR platform that enables hosting and participation in radio chat shows on community-led topics. We deployed Sehat ki Vaani with two communities in North India on topics related to the management of Type 2 diabetes and maternal health. Our deployments highlight the potential for synchronous IVR systems to offer community connection and localised sharing of experience, while also highlighting the complexity of producing, hosting and participating in radio shows in real time through IVR. We discuss the relative strengths and weaknesses of synchronous IVR systems, and highlight lessons learnt for interaction design in this area.

 Epidemiologically-defined protocols for wastewater sample site selection are lacking  Demographically distinct catchment areas were selected with high spatial resolution  Sample collection for SARS-CoV-2 wastewater surveillance was conducted throughout the city  Our protocol may inform disease surveillance for geographically-targeted scales Accepted ArticleThis article has been accepted for publication and undergone full peer review but has not been through the copyediting, typesetting, pagination and proofreading process, which may lead to differences between this version and the Version of Record. Please cite this article as

Background: Treatment of spinal cord injury (SCI) induced neuropathic pain (NP) proves to be extremely clinically challenging as the mechanism behind SCINP is poorly understood. Matrix metalloproteinase (MMP) is largely responsible for the early disruption of the blood spinal cord barrier. This system initiates macrophage infiltration and degradation of myelin, which plays a pivotal role in how NP occurs. In a recent study, we demonstrated that folic acid (FA) treatment to cSCI rats reduced NP and improved functional recovery by repressing MMP-2 expression. We hypothesize that MMP-2 expression is suppressed because FA actively methylates the DNA sequence that encodes for the MMP-2 protein. However, modulation of MMP-2 expression for alleviation of NP is only pertinent to the mid-to late-phase of injury. Therefore, we need to explore alternate therapeutic methods to target the early-to mid-phase of injury to wholly alleviate NP. Purpose: Furthering our previous findings on inhibiting MMP-2 expression by FA in mid-and late-phase following cSCI in rats, we hypothesized that FA will methylate and suppress MMP-9 expression during the early-phase, day 1, 3, 7 post cSCI and mid-phase (day 18 post cSCI), in comparison with MMP-2 expression during mid-and the late-phase of cSCI. Methods: Adult male Sprague Dawley rats (250-270g) underwent cSCI, using a NYU impactor, with 12.5 gm/cm injury. The spinal cord-injured animals were treated intraperitoneally (i.p.) with a standardized dose of FA (80 μg/kg body weight) on day 1, 2, 3, prior to cSCI, followed by daily injection up to 14 or 17 days post-cSCI in different experiments. Animals were euthanized on day 1, 3, 7 post cSCI (early-phase), day 18 post cSCI (mid-phase), and day 42 post cSCI (latephase) and the epicenter region of injured spinal cord were harvested for MMP-9 and MMP-2 expression analysis by Western blots technique. Results: i) During early-phase on day 1, 3, and 7, the quantitation displayed no statistical significance in MMP-9 expression, between water-and FA-injected rats. ii) On day 18 post-cSCI, FA significantly modulates the expression of MMP-9 (p = 0.043) iii) Comparing results with MMP-2 expression and inhibition, FA significantly modulates the expression of MMP-2 on day 18 post cSCI (FA-and water-injected rats (p = 0.003). iv) In addition, FA significantly modulates the expression of MMP-2 on day 42 post-cSCI comparing FA-and water-injected rat groups (p = 0.034). Conclusion: We report that FA administration results in alleviating cSCI-induced NP by inhibiting MMP-9 in the proposed mid-phase of cSCI. However, FA administration resulted in MMP-2 decline during both mid-through late-phase following cSCI. Our study elucidates a new phase of cSCI, the mid-phase. We conclude that further investigation on discovering and quantifying the nature of the mid-phase of SCI injury is needed.