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  • SL vs BAN highlights, 1st T20I: Sri Lanka beats Bangladesh by seven wickets

    SL vs BAN highlights, 1st T20I: Sri Lanka beats Bangladesh by seven wickets

    Hello and welcome to Sportstar’s highlights of the first T20I between Sri Lanka and Bangladesh, being held at Pallekele International Cricket Stadium in Pallekele.

    Playing XIs

    Bangladesh: Tanzid Hasan Tamim, Parvez Hossain Emon, Litton Das(w/c), Mohammad Naim, Towhid Hridoy, Shamim Hossain, Mehidy Hasan Miraz, Tanzim Hasan Sakib, Rishad Hossain, Taskin Ahmed, Mohammad Saifuddin

    Sri Lanka: Pathum Nissanka, Kusal Mendis(w), Kusal Perera, Avishka Fernando, Charith Asalanka(c), Dasun Shanaka, Chamika Karunaratne, Maheesh Theekshana, Jeffrey Vandersay, Binura Fernando, Nuwan Thushara

    TOSS

    Sri Lanka wins toss and opts to bowl.

    How to watch SL vs BAN 1st T20I Live

    The first T20I between Sri Lanka and Bangladesh will be televised live on the Sony Sports Network in India and streamed on SonyLIV and FanCode.

    The Squads

    Sri Lanka: Pathum Nissanka, Kusal Mendis (wk), Kusal Perera, Kamindu Mendis, Charith Asalanka (c), Dasun Shanaka, Dunith Wellalage, Maheesh Theekshana, Binura Fernando, Matheesha Pathirana, Nuwan Thushara, Jeffrey Vandersay, Dinesh Chandimal, Chamika Karunaratne, Eshan Malinga, Avishka Fernando.

    Bangladesh: Tanzid Hasan Tamim, Parvez Hossain Emon, Litton Das (wk) (c), Towhid Hridoy, Shamim Hossain, Jaker Ali, Mehidy Hasan Miraz, Tanzim Hasan Sakib, Rishad Hossain, Taskin Ahmed, Mustafizur Rahman, Nasum Ahmed, Mohammad Saifuddin, Mahedi Hasan, Mohammad Naim, Shoriful Islam.

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  • SGLT2 Inhibitor Offers Kidney Protection and Reduces Heart Failure Risk After Acute Myocardial Infarction

    SGLT2 Inhibitor Offers Kidney Protection and Reduces Heart Failure Risk After Acute Myocardial Infarction

    When initiated shortly after an acute myocardial infarction, empagliflozin (Jardiance; Boehringer Ingelheim, Eli Lilly) not only offers significant kidney-protective benefits by stabilizing kidney function but also effectively reduces the risk of heart failure, all while maintaining a strong safety profile across a broad range of baseline kidney function levels, according to recent findings from the EMPACT-MI trial (NCT04509674).1

    EMPACT-MI findings highlight empagliflozin’s significant cardiovascular and kidney benefits.

    Image Credit: MargJohnsonVA – stock.adobe.com.jpeg

    Previously, data on the cardiovascular-kidney effects and safety of empagliflozin, a sodium-glucose cotransporter 2 (SGLT2) inhibitor, in patients who recently experienced an acute myocardial infarction were limited. Pivotal EMPACT-MI data presented at last fall’s 2024 European Society of Cardiology Congress evaluated whether SGLT2 inhibitor treatment had an impact on kidney health in this patient population.2

    “That was the concern,” Deepak Bhatt, MD, MPH, MBA, director of Mount Sinai Heart, said in an interview with The American Journal of Managed Care® (AJMC®) at the conference. “What we found quite reassuringly, first of all, was that introducing SGLT2 inhibitors, specifically empagliflozin—though I think the results are generalizable to the class—that introduction of the SGLT2 inhibitor in this context was safe.”

    Now, findings from the secondary analysis of this pivotal trial shed new light on empagliflozin’s impact on kidney function and heart failure outcomes.1 The large-scale, double-blind, multicenter clinical trial randomized 6522 patients with acute myocardial infarction and an elevated risk for heart failure to either empagliflozin or placebo.

    Kidney-Protective Effects Observed

    The analysis revealed evidence of empagliflozin’s kidney-protective effects. At baseline, the mean (SD) estimated glomerular filtration rate (eGFR) was 76.1 (19.9) mL/min/1.73 m2. While an initial, transient decline in eGFR was observed with empagliflozin—a known hemodynamic effect of SGLT2 inhibitors and considered nonharmful in the long term—this decline fully recovered. By 24 months, eGFR remained stable in the empagliflozin group, whereas it continued to decline in the placebo group (P = .01).

    This finding is particularly significant as kidney function decline is common among patients with prior cardiovascular events, the authors emphasized. The stability in eGFR with empagliflozin in this vulnerable population further supports its use. The observed patterns in eGFR change were consistent across different baseline kidney function levels and the use of other common heart and kidney medications.

    Reduced Heart Failure Outcomes Across Kidney Function

    Beyond kidney protection, empagliflozin demonstrated a clear benefit in reducing the total adverse events of heart failure or all-cause mortality. Importantly, this reduction was consistent regardless of the patient’s baseline kidney function (Pinteraction ​= .30). This reinforces previous findings from EMPACT-MI, which was the first study to show a benefit in heart failure risk reduction specifically in patients with acute myocardial infarction. Given that patients with chronic kidney disease are at an especially high risk of heart failure, the authors highlighted that therapies that can mitigate this burden, like empagliflozin, hold substantial clinical importance.

    Safe for Early Initiation Post Myocardial Infarction

    A critical aspect of the findings relates to the safety of initiating empagliflozin therapy shortly after an acute myocardial infarction. The trial showed that 30-day adverse event rates were similar between the empagliflozin and placebo groups, and these rates remained consistent across various baseline kidney function levels, blood pressure readings, and the use of concomitant therapies.

    Physicians often express concerns about starting SGLT2 inhibitors in patients with acute myocardial infarction due to the potential for an initial eGFR decrease, the authors noted, especially given the vulnerability of this population to contrast exposure and acute kidney injury. However, this demonstrated that the acute treatment effect on eGFR with empagliflozin was similar to placebo and that overall safety was maintained. Notably, rates of acute renal failure were even numerically lower in the empagliflozin group, particularly in vulnerable subgroups with lower baseline eGFR or blood pressure.

    Clinical Implications and Future Directions

    These results have significant implications for clinical practice, suggesting that empagliflozin can be safely and effectively initiated during or early after hospitalization for acute myocardial infarction. SGLT2 inhibitors are underutilized, especially in primary care settings.3 The dual benefits of kidney protection and heart failure reduction exhibited by empagliflozin across a spectrum of kidney function levels indicate its value to post myocardial infarction care.1

    The study acknowledges certain limitations, including the availability of longitudinal eGFR data from only a subset of countries and the relatively small sample size for patients with very low (< 30 mL/min/1.73 m2). Additionally, EMPACT-MI was not specifically powered for kidney outcomes. Future research is needed to assess the benefits in patients with acute myocardial infarction who are not at an especially high risk for heart failure, as this remains an understudied group.

    “SGLT2 inhibitors are underused in clinical practice,” Bhatt said in a statement.4 “These data provide reassurance of the safety of using this class of drugs when indicated—even in patients after a recent heart attack and if the kidney function is impaired.”

    References

    1. Aggarwal R, Bhatt DL, Hernandez AF, et al. Secondary analysis of the EMPACT-MI trial reveals cardiovascular-kidney efficacy and safety of empagliflozin after acute myocardial infarction. Nat Cardiovasc Res. 2025;4(6):761-772. doi:10.1038/s44161-025-00657-7

    2. Grossi G. Dr Deepak Bhatt: empagliflozin shows no increased kidney risk after acute myocardial infarction. AJMC. September 2, 2024. Accessed July 9, 2025. https://www.ajmc.com/view/dr-deepak-bhatt-empagliflozin-shows-no-increased-kidney-risk-after-acute-myocardial-infarction

    3. Grossi G. SGLT2 inhibitors show renal benefits in HF and CKD as prescribers target uptake gaps. AJMC. April 15, 2025. Accessed July 9, 2025. https://www.ajmc.com/view/sglt2-inhibitors-show-renal-benefits-in-hf-and-ckd-as-prescribers-target-uptake-gaps

    4. SGLT2 inhibitor empagliflozin treatment stabilizes kidney function in patients who have had a heart attack. News release. Mount Sinai. June 13, 2025. Accessed July 9, 2025. https://www.mountsinai.org/about/newsroom/2025/sglt2-inhibitor-empagliflozin-treatment-stabilizes-kidney-function-in-patients-who-have-had-a-heart-attack

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  • Forget 3D printing—DNA and water now build tiny machines that assemble themselves

    Forget 3D printing—DNA and water now build tiny machines that assemble themselves

    When the Empire State Building was constructed, its 102 stories rose above midtown one piece at a time, with each individual element combining to become, for 40 years, the world’s tallest building. Uptown at Columbia, Oleg Gang and his chemical engineering lab aren’t building Art Deco architecture; their landmarks are incredibly small devices built from nanoscopic building blocks that arrange themselves.

    “We can build now the complexly prescribed 3D organizations from self-assembled nanocomponents, a kind of nanoscale version of the Empire State Building,” said Gang, professor of chemical engineering and of applied physics and materials science at Columbia Engineering and leader of the Center for Functional Nanomaterials’ Soft and Bio Nanomaterials Group at Brookhaven National Laboratory.

    “The capabilities to manufacture 3D nanoscale materials by design are critical for many emerging applications, ranging from light manipulation to neuromorphic computing, and from catalytic materials to biomolecular scaffolds and reactors,” said Gang.

    In two papers, one released on July 9 in Nature Materials and a second on April 11 in ACS Nano, Gang and his colleagues describe a new methodology for fabricating targeted 3D nanoscale structures via self-assembly that can find use in a variety of applications, and they provide a design algorithm for others to follow suit.

    And it’s all based on the most basic biomolecular building blocks: DNA.

    One pot stop for new materials

    When it comes to small-scale fabrication of microelectronics, conventional approaches are based on top-down strategies. One common approach is photolithography, which uses powerful light and intricate stencils to etch circuits. But mainstream lithographic techniques struggle with complex, three-dimensional structures, while additive manufacturing, better known as 3D printing, cannot yet fabricate features at the nanoscale. In terms of workflow, both methods fabricate each feature one by one, in serial. This is an intrinsically slow process for building 3D objects.

    Taking his cues from bio-systems, Gang builds 3D materials and devices from the bottom up via self-assembly processes that are directed by DNA. He has been refining his method through collaborations with other scientists to build, for example, extremely small electronics that they need for their work.

    Two months ago, he and his former student, Aaron Michelson, now a staff scientist at Brookhaven National Laboratory’s Center for Functional Nanomaterials,delivered a prototype for collaborators at the University of Minnesota interested in creating 3D light sensors integrated onto microchips. They built the sensors by growing DNA scaffolds on a chip and then coating them with light-sensitive material.

    That device was just the first of many. In their latest paper in Nature Materials, Gang and his team establish an inverse design strategy for creating the desired 3D structures from a set of nanoscale DNA components and nanoparticles. The study presents four additional applications of their “DNA origami” approach to material design: a crystal-like structure comprised of one-dimensional strings and two-dimensional layers; a mimic of the materials found commonly in solar panels; another crystal that spins in a helical swirl; and, for collaborator Nanfang Yu, professor of applied physics at Columbia Engineering, a structure that will reflect light in particular ways for his goal of one day creating an optical computer.

    Using advanced characterization techniques, such as synchrotron-based x-ray scattering and electron microscopy methods, at Columbia and Brookhaven National Laboratories, the team confirmed that the resulting structures matched their designs and revealed the designed considerations for improving structure fidelity. Each of these unique structures assembled itself in water wells in Gang’s lab. This type of material formation is parallel in its nature since the components come together during the assembly process, meaning significant time- and cost-savings for 3D fabrication compared with traditional methods. The fabrication process is also environmentally friendly as the assembly occurs in water.

    “This is a platform that is applicable to many materials with many different properties: biological, optical, electrical, magnetic,” said Gang. The end result simply depends on the design.

    DNA design, made easy

    DNA folds predictably, as the four nucleic acids that make it up can only pair in particular combinations. But when the desired structure contains millions, if not billions of pieces, how do you come up with the correct starting sequence?

    Gang and his colleagues solve this challenge with an inverse structural design approach. “If we know the big structure with the function that we want to create, we can dissect that into smaller components to create our building blocks with structural, binding, and functional attributes required to form the desired structure,” said Gang.

    The building blocks are strands of DNA that fold into a mechanically robust eight-sided octahedral shape, which Gang refers to as a voxel, with connectors at each corner that link each voxel together. Many voxels can be designed to link up into a particular repetitive 3D motif using DNA encoding, similar to how jigsaw puzzle pieces form a complex picture. The repetitive motifs, in turn, are also assembled in parallel to create the targeted hierarchically organized structure. Collaborator Sanat Kumar, the Michael Bykhovsky and Charo Gonzalez-Bykhovsky Professor of Chemical Engineering at Columbia, provided a computational verification of Gang’s inverse design approach.

    To enable the inverse design strategy, the researchers must figure out how to design these DNA-based nanoscale “jigsaw puzzle pieces” with the minimal number needed to form the desired structure. “You can think of it like compressing a file. We want to minimize the amount of information for the DNA self-assembly to be most efficient,” said first author Jason Kahn, a staff scientist at BNL and previously a postdoc at Gang’s group. Dubbed Mapping Of Structurally Encoded aSsembly, or MOSES, this algorithm is like nano-scale CAD software, Gang adds. “It will tell you what DNA voxel to use to make a particular, arbitrarily defined 3D hierarchically ordered lattice.”

    From there, you can add diverse types of nano-“cargo” inside the DNA voxels that will imbue the final structure with particular properties. For example, gold nanoparticles were embedded to give unique optical properties, as demonstrated in Yu’s experiments. But, as shown previously, both inorganic and bio-derived nanocomponents can be integrated into these DNA scaffolds. Once the device was assembled, the team also “mineralized” it. They coated scaffolds with silica and then exposed them to heat to decompose the DNA, effectively converting the original organic scaffolding into a highly robust inorganic form.

    Gang continues to collaborate with Kumar and Yu to uncover design principles that will allow for the engineering and assembly of complex structures, hoping to realize even more complicated designs, including a 3D circuit intended to mimic the complex connectivity of the human brain.

    “We are well on our way to establishing a bottom-up 3D nanomanufacturing platform. We see this as a ‘”next-generation 3D printing’” at the nanoscale, but now the power of DNA-based self-assembly allows us to establish massively parallel fabrication,” said Gang.

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  • Cartoon Cavalcade presenter Glen Michael dies aged 99

    Cartoon Cavalcade presenter Glen Michael dies aged 99

    Children’s TV presenter Glen Michael has died aged 99.

    His family said he passed away peacefully at his home in South Ayrshire after a short illness.

    He hosted Glen Michael’s Cartoon Cavalcade for nearly three decades on STV, beginning in 1966 and running until December 1992.

    STV described him as a “legend” and said he would be remembered as a “wonderful performer and personality.”

    Before the programme launched in 1966, Michael believed he had messed up his audition after smiling constantly due to nerves.

    But his approach was liked by programme bosses, who offered him a five-week contract at £14 a week.

    Over the decades the show became a hit as Michael introduced cartoons, read birthday greetings and chatted to on-screen companions – including Paladin the lamp and his dogs Rudi and Rusti.

    In 1975 Cavalcade won the Scottish ITV programme of the year award from the Radio Industries Club of Scotland.

    Bobby Hain, STV’s managing director for audiences, said: “We are deeply saddened to hear that Glen Michael has passed away.

    “Glen was a wonderful performer and personality and we know that many viewers will have very fond memories of him.

    “He was an STV legend, with Glen Michael’s Cavalcade a particular favourite for children across Scotland during its 26 year run.

    “Our thoughts are with his family at this time and we send them our deepest condolences.”

    Michael was also one of the original DJs when Radio Clyde launched in the 1970s.

    He was born in Devon and named Cecil Edward Buckland, later changing his name to Glen Michael when he decided to try for a career in showbusiness.

    As a teenager he went to London to try his luck as an entertainer, and later served in the RAF during World War II.

    During this time he met his wife Beryl, who he married in 1947 and who he also worked with in an onstage double act – Michael and Raye.

    His life changed when he moved to the Scotland in the early 1950s for a six week run with Scottish comedian Jack Milroy.

    The six week run stretched into 13 years of touring and performing in theatres across the country, along with TV appearances alongside Milroy and Rikki Fulton’s famed double act Francie and Josie.

    When Milroy moved to London, Michael, who had settled in Prestwick, was asked to audition for Cartoon Cavalcade.

    He continued to be busy until his death, recently recording a video as an ambassador for service veterans charity Erskine.

    He also supported Age UK with their charitable work.

    His wife died several years ago but he is survived by his children children Yonnie and Christopher and a number of grandchildren and great-grandchildren.

    His family said they were thankful to all the medical professionals and at home carers who helped look after him.

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  • OPEC+ Discussing Pause to Output Hikes After Next Increase – Bloomberg

    1. OPEC+ Discussing Pause to Output Hikes After Next Increase  Bloomberg
    2. Why OPEC Is Pumping Fast and Playing Hardball  Crude Oil Prices Today | OilPrice.com
    3. Kuwait committed to ensuring energy security – Minister of Oil  ZAWYA
    4. Oil prices slip after hitting two-week highs  Mettis Global
    5. OPEC+ supply increase necessary for global market, Middle East officials say  World Oil

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  • Retention in HIV pre-exposure prophylaxis and its predictors among men

    Retention in HIV pre-exposure prophylaxis and its predictors among men

    Introduction

    Human immunodeficiency virus (HIV) infection remains a global public health challenge, with an estimated 39.9 million people living with the virus worldwide by 2023. 1 The Joint United Nations Programme on HIV/AIDS (UNAIDS) global research reports a 39% decrease in new HIV cases in the general population; however, some populations, such as men who have sex with men and members of other key populations, are far behind this victory.1 Recent data by UNAIDS indicate that men who have sex with men account for approximately 20% of all HIV infections.1 In the majority of sub-Saharan African countries, same-sex practice is criminalized and stigmatized. 1,2 This has negative implications for accessing and using HIV prevention services in this population group. Due to this, the available limited data show that the magnitude of the problem is higher compared to other regions, and HIV prevalence among men who have sex with men is 4.9 times higher than that in the general population.2,3 In Tanzania, recent data show that HIV prevalence among men who have sex with men is more than twice that of the general population.4–6 Thus, to achieve the UN 2030 goals of ending HIV/AIDS as a public health threat, there is a need for innovative interventions for HIV prevention among men who have sex with men and other individuals at a higher risk of contracting HIV.

    In the battle against HIV, pre-exposure-prophylaxis (PrEP) was recommended by the World Health Organization (WHO) in 2015 as a biomedical prevention tool to be used in combination with other available methods among the populations at high risk.7 The WHO policy recommendations on HIV prevention using PrEP were adopted in Tanzania in 2017, and the roll-out started in 2021 following a demonstration trial.8 Evidence from clinical trials has shown that oral PrEP provides up to 99% protection against HIV when adhered to as prescribed.9–11

    Despite the proven efficacy of PrEP in preventing HIV transmission, most users are not retained in the service after initiation. Retention in PrEP care among men who have sex with men has been reported to be low globally.12–16 Factors that impact retention range from individual to social and structural levels. Individual factors such as poor knowledge about PrEP, fear of PrEP side effects, low self-efficacy, alcohol consumption, and drug use have explained the low retention rates.17,18 Social factors such as stigma, presence of supportive social connections, as well as healthcare-related factors like provider attitudes and infrastructure, access to peer support groups, psychological services, are also reported to affect retention.19–21 Generally, the presence of positive individual and social support factors is associated with improved retention in care. There is a growing body of literature on retention in PrEP care in sub-Saharan Africa; however, most studies have reported retention in an interventional setting.17,22,23 Therefore, this study aimed to investigate the extent and associated predictors of retention in PrEP care in real-world settings among men who have sex with men in Tanga, Tanzania.

    Materials and Methods

    Study Design and Setting

    This study draws on data collected from the control arm of a pragmatic quasi-experimental study for PrEP Roll-Out in Tanzania (PREPTA). PREPTA was a collaborative project between Muhimbili University of Health and Allied Sciences (MUHAS) and the University of Oslo (UiO) to study PrEP use and PrEP use promotion via a mobile health (“mHealth”) intervention among two key populations in Tanzania (men who have sex with men and Female sex workers). The project was implemented in Dar es Salaam (the mHealth intervention area) and Tanga (the mHealth control area). The project details are described elsewhere.24,25 This paper focuses on the analysis of data for men who have sex with men in the Tanga region, that is, men who joined the project and started PrEP but were not enrolled in the mHealth intervention. We focused our analysis on the control region, which allowed us to understand the extent of retention and its determinants in a real-world setting.

    Sample Size Estimation

    Sample size estimation was based on a standard statistical formula for cohort studies.26,27 The sample size was calculated using a 95% confidence level and 80% statistical power. Baseline adherence to PrEP was estimated at 30% based on the SEARCH study in Uganda and Kenya,22 with a minimum adherence threshold of 45% to detect a 15% difference. This resulted in the recruitment of 369 men who have sex with men in Tanga.

    Study Participants and Sampling Criteria

    The study participants were men who have sex with men aged ≥18 years. The inclusion criteria were being a resident of Tanga, defined as having lived in the region for at least six months, being HIV negative, having had same-sex within the past three months, and being ready to start PrEP. Participants were recruited through respondent-driven sampling.

    Data Collection Procedure

    Data were collected through structured face-to-face interviews conducted by trained research assistants. The research assistants underwent a three-day training covering data safety, the research process, and ethical considerations to ensure high-quality data collection. Responses were recorded using handheld tablets linked to the Services for Sensitive Data (TSD) platform, a highly secure server designed to store and process sensitive information with stringent access and data transfer controls.28 The structured questionnaire was pre-tested with 10 participants to assess clarity, flow, and contextual relevance. It included questions on sexual behaviors, HIV knowledge, PrEP-related stigma, self-efficacy, and social support.

    Study Variables

    Outcome Variables

    The outcome variable in this study was retention in PrEP care, measured one month after initiating PrEP. One-month retention is crucial for predicting long-term retention, as it marks the first reconnection between the client and healthcare providers.29 This reconnection enables them to discuss their initial experiences and obtain social support to identify and address various complications that could affect long-term retention. In line with Tanzania’s PrEP implementation framework, an HIV rapid test was conducted during the first visit to confirm eligibility for PrEP and provide a medication refill, both of which are essential for sustained retention. Studying retention at 1 month would enable the timely design of interventions to support long-term retention in care. Participants who attended their follow-up visit within 28 days of their scheduled appointment were considered retained, consistent with the definitions used by Mbotwa et al and Hovaguimian et al.25,29

    Independent Variables

    The independent variables included the socio-demographics that were age, marital status, gender identification, education level, having financial dependents, having children, and total monthly income; Sexual behavior predictors that included age at sexual debut, steady sex partner situation, type of sex at debut, preferred sexual positioning, condom use at last sex, multiple sex partners, lubricant use, and paid sex. Other factors included comprehensive HIV knowledge, perceived HIV risk, PrEP knowledge, perceived PrEP stigma, PrEP self-efficacy, access to condoms when required, and social support.

    Data Analysis

    Descriptive statistics were used to summarize the baseline characteristics (including sociodemographic and psychosocial characteristics), and the outcome (1-month retention). Continuous variables were summarized as means and standard deviations. Categorical variables were summarized as frequencies and percentages. To identify predictors of retention in PrEP care, we performed a Modified Poisson regression analysis. Variables meeting a significance threshold of p<0.2 in bivariate analysis were included in the multivariable logistic regression model. Data were analyzed using Stata version 18 (StataCorp, College Station, Texas, USA).

    Ethical Considerations

    The study was conducted in accordance with the Declaration of Helsinki. It was approved by the National Health Research Ethics Committee of Tanzania (protocol code: NIMR/HQ/R.8a/vol. IX/3454) and the Regional Ethical Committee (REK) in Norway (protocol code: 33675). The participants provided written informed consent prior to data collection. To protect their privacy, all data were stored in TSD, a highly secure server explicitly designed for handling sensitive information.28 De-identification was performed before the analysis, and personal identifiers were removed to safeguard the participants’ anonymity. Access to the TSD server is limited to authorized personnel to ensure that participant information remains secure.

    Results

    Participants Socio-Demographic Characteristics

    A total of 369 men who have sex with men, with a mean age of 24.7 ± 5.5 years, were included in the study. Over two-thirds (67.2%) had at least a secondary education level, more than one-third (34.5%) reported having children, and 87.5% had never been married (Table 1).

    Table 1 Comparison of Socio-Demographics and Other Socio-Behavioral Factors by Retention in PrEP Care Among Study Participants

    Participants Sexual Behaviors

    The majority of men, 287 (77.8%), assumed an insertive position in anal sex, while 47 (12.7%) were receptive, and 35 (9.5%) were versatile. Most participants (284 [77%]) reported that condoms were accessible each time they needed them. However, only 113 (30.6%) participants reported condom use during their last anal sex. Furthermore, 51.2% of the participants (189) reported having steady sexual partners; among these, 96 (51.2%) had more than one steady sexual partner, and 48.8% (93) had one steady sexual partner. Among the participants, 276 (74.8%) reported being paid for oral or anal sex. Of these, only 78 (28.3%) used a condom, whereas 194 (70.3%) did not use a condom during their last paid sex (Table 1).

    Retention in PrEP Care at 1-month Follow-up

    Of the 369 men in the study, 87 (23.6%) were retained in PrEP care 1-month after initiation. Higher retention was observed among men who reported anal, oral, or thigh sex as their first sexual experience (28.8%) than among those whose sexual debut type was vaginal (19.8%); p=0.027. Men with steady sex partners had higher retention rates (28%) than those without (18%), (p=0.038). Men who had used lubricants the last time they had anal sex with men were more often retained (27.8%) than those who had not (14.3%) (p=0.22). Furthermore, a larger proportion of men who reported adequate social support were retained at 1-month (32.2%) compared to those with inadequate social support (21%) (p=0.031).

    Factors Associated with Retention in PrEP at month 1

    Bivariate Analyses

    Bivariate analyses showed that PrEP retention was significantly associated with having a steady male partner, ever being married, having debuted with anal/oral or thigh sex, and having adequate social support. Retention was 1.5 times higher among men with a steady male partner compared to those without (PR 1.7, 95% CI: 1.0–2.2, p=0.041). In addition, the prevalence of retention was higher among men who had ever been married than among those who had never been married (PR 1.6, 95% CI: 1.0–2.5, p=0.044). Men whose type of sex debut was anal/oral or thighs sex had a higher prevalence of retention than those who had vaginal sex at the debut (PR 1.5, 95% CI:1.0–2.2, p = 0. 0.027). Furthermore, the prevalence of retention was 1.5 times higher for men who assumed a receptive position than those who assumed an insertive position during anal sex (PR 1.5, 95% CI: 1.0–2.2, p = 0.044). Finally, men who reported adequate social support had a higher prevalence of being retained in PrEP care than those who reported inadequate support (PR 1.5, 95% CI: 1.1–2.3, p = 0.027).

    Independent Predictors of Retention in PrEP Care

    In the multivariable regression analysis, independent predictors of retention in PrEP care were preferring the receptive position in anal sex, having had anal, oral, or thigh sex at sexual debut, and having adequate social support. Taking a receptive position in anal sex was associated with retention in PrEP care at month-1 (aPR 1.6, 95 CI: 1.0–2.6, p = 0.030). Furthermore, anal, oral, or thigh sex at sexual debut was also a significant predictor of 1-month retention (aPR 2.1, 95% CI: 1.2–3.8, p = 0.011), and adequate social support was a significant predictor of 1-month retention (aPR: 1.6, 95% CI: 1.0–2.6, p = 0.030). Table 2 lists the bivariate and multivariate correlates of the 1-month retention.

    Table 2 Factors Associated with 1-month Retention in PrEP

    Discussion

    Men who have sex with men bear a disproportionate burden of HIV, making it critical for them to utilize different preventive mechanisms, including PrEP. However, in our study, only 23.6% of men who have sex with men were retained in PrEP care 1-month after initiation. The challenge of low retention in PrEP care has also been observed in other PrEP programs, such as among female sex workers in Dar es Salaam, Tanzania, whereby the retention was only 27.7% at month 1.25 This could be due to the challenge of criminalization and stigmatization of the key population in the Tanzanian setting.24,25 Criminalization traces its roots from punitive laws that not only exist on paper but also manifest through stigmatization, harassment, and violence against men who have sex with men.30 This situation creates an environment in which seeking HIV prevention services, including PrEP, becomes risky and unwelcoming and therefore reduces retention.

    Unlike our study, studies in the US reported retention rates exceeding 70% at month one.12,31 This discrepancy could be attributed to contextual factors such as high levels of criminalization, stigmatization, and low social support for Men who have sex with men in the Tanzanian setting, which likely impact their willingness and ability to continue with PrEP. Surprisingly, in a recent study conducted in Kenya, with almost identical legal and health infrastructure settings to those in the current study, 96.8% of men were retained at three months.23 This difference may be due to the Kenyan study being intervention-based, whereby there was dedicated financial and administrative support for clients in PrEP as well as community-based organizations for AIDS prevention among gay men, bisexual men, and other men who have sex with men. Our findings highlight retention challenges among men who have sex with men in the real world, emphasizing the need for targeted interventions to improve retention in this population.

    Furthermore, this study revealed that preferring a receptive sex position during anal sex and having anal sex at sexual debut were associated with retention in PrEP care. This may be due to heightened perceived HIV susceptibility among men who engage in receptive anal sex compared to the ones engaging in insertive anal sex. There is a higher risk of HIV acquisition in receptive than in insertive condomless anal sex32,33 which could lead men engaging in receptive sex position to be more motivated to utilize PrEP than their counterparts. Additionally, in Tanzania, due to the stigma and legal repercussions around having same sex, the men preferring insertive anal sex with men are either still “in the closet” or generally assume a heterosexual role as “real men” while the ones preferring receptive anal sex with men are the only ones who are perceived as gay.34 Due to that, receptive ones easily access HIV prevention support and utilize it more than insertive ones, who have less risk perception and are not considered as members of the key population needing continuous PrEP care. Generally, our findings indicate that sexual roles and preferences determine retention in PrEP care among men who have sex with men, highlighting the need for further exploration of factors contributing to this difference to enable tailoring interventions accordingly to enhance retention.

    Adequate social support was a significant predictor of retention in PrEP care, consistent with findings from other studies.35,36 Since the clients who are expected to be retained in PrEP are “simply” at risk and not even living with the infection, attending follow-up visits regularly could be tiring and demotivating. Adequate support from family, partners, and healthcare workers could counteract these challenges, increase motivation, promote a sense of belonging, and improve retention in care.36 Furthermore, social support could counteract the effects of stigma around the men who have sex with men’s sexuality and PrEP, which is reported to be a huge barrier to retention in PrEP.36–38 Adequate social support helps develop a sense of belonging and worth among men who have sex with men37 which could strengthen their commitment to health protection and increase their chances of being retained in PrEP. Interestingly, no association was found between perceived PrEP stigma and retention in this study. This suggests that the more social support there is, the more resilient individuals become to the negative effects of stigma, and are better able to commit to ongoing PrEP care. Therefore, this study calls for the development of supportive social systems to promote retention in care and ultimately contribute to reduced HIV transmission among men who have sex with men and the general population.

    Study Strengths and Limitations

    This study was conducted in Tanzania, an African setting where PrEP use is a relatively new intervention, thereby contributing valuable evidence in a field with limited research. However, its quantitative nature does not offer an in-depth understanding of the factors that influence retention or the mechanisms through which they operate. Therefore, in-depth qualitative studies are recommended to explore factors that influence retention and their mechanisms of action.

    Conclusion

    Overall, our study reports low retention rates in PrEP care at one month among men who have sex with men in Tanzania. The fact that most men who have sex with men are not retained in PrEP care or use condoms increases the risk of HIV transmission within them and the general population. These findings suggest an urgent need to strengthen HIV prevention strategies beyond enrolment in PrEP to focus on retention. These strategies could include developing peer support initiatives, enhancing provider training to ensure supportive and nonjudgmental care, and integrating psychosocial support into PrEP programs. Collectively, these approaches may foster more supportive environments within societies and healthcare systems, improving PrEP retention among men who have sex with men, reducing HIV transmission risk, and contributing to ending HIV infection as a public health threat by 2030.

    Data Sharing Statement

    The data used in this analysis are available to the PREPTA project’s principal investigator (PI) upon reasonable request. Contact details: Prof. Elia J. Mmbaga Email: [email protected].

    Acknowledgments

    This study utilized the data collected during the PREPTA project. The Research Council of Norway funded this research through the Global Health and Vaccination Programme (GLOBVAC) (project number 285361). The project is also part of the European and Developing Countries Clinical Trials Partnership (EDCTP2) programme supported by the European Union. We sincerely thank the project team for their dedication in bringing the project to fruition. We are deeply grateful to the participants for their involvement in this study.

    Funding

    The corresponding author, FK, is sponsored by a project titled “Strengthening Doctoral Education for Health in Tanzania (DOCEHTA)”, project number 69940, funded by the Norwegian Programme for Capacity Development in Higher Education and Research for Development (NORAD).

    Disclosure

    The authors report no conflicts of interest in this work.

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  • Rights defenders denounce US sanctions on UN expert on Palestinians – Reuters

    1. Rights defenders denounce US sanctions on UN expert on Palestinians  Reuters
    2. US sanctions UN expert Francesca Albanese over Israel criticism  Al Jazeera
    3. US sanctions UN expert Francesca Albanese, critic of Israel’s Gaza offensive  BBC
    4. UN urges reversal of US sanctions on UN expert Albanese  Dawn
    5. US imposing sanctions on senior UN official focused on Palestinian human rights  CNN

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  • US government to invest in rare earths production

    US government to invest in rare earths production

    The US government is to become the biggest shareholder in the country’s only operational rare earths mine.

    It is also going to take a series of other steps to underpin the future of the operation in Mountain Pass, California.

    Rare earths are essential to huge amounts of modern technology, such as electric cars and wind turbines.

    Access to these metals has been at the heart of a US-China trade war, with Beijing controlling about 90% of global mining capacity.

    MP Materials, which owns the mine, has entered into an agreement with the US Department of Defense that is designed to reduce America’s dependency on imports of rare earths.

    The deal means that for the next 10 years the US government will commit to MP Materials receiving a minimum price of $110 per kg for its neodymium and praseodymium output.

    These are two of the most in-demand of the 17 different rare earths for the global economy. They are crucial for making permanent magnets, which are found in everything from smartphones to MRI scanners and electric motors.

    The move follows concerns that China has used its near total control of the industry to push prices down and force companies in other countries out of business.

    China is home to about 70% of the world’s rare earth mining and 90% of refining capacity as a result of years of government support for the industry.

    Under the agreement, MP Materials will build a new US facility to increase how much of the raw materials from the mine it can turn into useable products.

    The location is still to be decided, but the company says it will serve both defence and commercial customers.

    Much of this will be funded by the Department of Defense buying $400m of newly created shares.

    “This initiative marks a decisive action by the Trump administration to accelerate American supply chain independence,” said MP Materials founder and chief executive James Litinsky.

    Until now Shenghe Resources, a company partly owned by the Chinese government, has been one of MP Materials’ largest shareholders.

    Shenghe had been the sole customer for the output of the Californian mine, which meant that its rare earths were being sent to China for refining.

    Earlier this year, MP Materials said that it would stop doing this because of the huge 125% tariffs that China imposed on US goods, in response to the 145% tariffs President Trump had imposed on Chinese imports.

    It added that tariffs meant sending its output to China was neither commercially viable nor in alignment with America’s national interests.

    Rare earths have been at the heart of efforts to repair a US-China trade relationship that has deteriorated since Trump returned to the White House.

    Increased tariffs led Beijing to impose a new export licensing regime that severely limited how much of these materials was reaching American manufacturers.

    An agreement to improve that access, in exchange for lifting some of the US’s own export restrictions in other areas, was at the heart of recent trade talks between the world’s two biggest economies in London and Geneva.

    Despite that commitment the US complained that it has not been implemented fast enough.

    In the longer term, domestic supplies are the US’s best bet on increasing access to the rare earths which are crucial to the manufacturing that is at the heart of Trump’s economic vision for the country.

    China’s export controls have also led to criticism in Europe, with the European Parliament voting in favour of a resolution that called Beijing’s controls “unjustified” and “intended to be coercive”.

    They also urged the European Commission to speed up the implementation of the Critical Raw Materials Act, which came into force last year and is designed to reduce Europe’s reliance on imports.

    On a visit to Germany last week, China’s foreign minister downplayed these concerns, saying it was his country’s “sovereign right” as well as being “common practice” to control exports of goods that have both commercial as well as military uses.

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  • India doubling down on proxy war after clear defeat by Pakistan, says COAS Munir

    India doubling down on proxy war after clear defeat by Pakistan, says COAS Munir

    Chief of Army Staff Field Marshal Asim Munir said on Thursday that India was doubling down on its “nefarious agenda” against Pakistan through the use of proxies after facing a “manifest defeat” in the recent military conflict between the two countries.

    India blamed Pakistan for the April 22 Pahalgam attack without evidence, triggering a military escalation. On May 6–7, New Delhi launched air strikes that killed civilians, followed by a week-long missile exchange. A US-brokered ceasefire ended the war.

    A day earlier, Director General Inter-Services Public Relations (ISPR) Lt Gen Ahmed Sharif Chaudhry accused Indian National Security Adviser Ajit Doval of masterminding terrorism in Pakistan, alleging Indian support for terrorist groups.

    Echoing similar sentiments, Field Marshal Munir said, while chairing the 271st Corps Commanders’ Conference (CCC) at the General Headquarters (GHQ), said today: “Following its manifest defeat in direct aggression against Pakistan, post-Pahalgam incident, India is now doubling down to further its nefarious agenda through its proxies of Fitna-al-Khawarij and Fitna-al-Hindustan.”

    In July last year, the government designated the banned Tehreek-i-Taliban Pakistan as Fitna-al-Khawarij, while mandating all institutions to use the term khariji (outcast) when referring to the perpetrators of terrorist attacks on Pakistan.

    In May this year, the government designated all terrorist organisations in Balochistan as Fitna-al-Hindu­stan — a new phrase aimed at framing India’s alleged role in terrorism as a deliberate destabilisation strategy, potentially to galvanise domestic support.

    A statement from the ISPR said the CCC participants offered prayers for the martyrs of recent terrorist attacks by “Indian-sponsored proxies”.

    “Taking stock of recent successes against terrorist proxies, forum resolved that blood of our martyrs will not go waste and the safety and security of people of Pakistan remain topmost priority for the armed forces of Pakistan. Forum strongly asserted that it is imperative to take decisive and holistic actions at all levels against the Indian-backed and sponsored proxies.”

    The ISPR said the forum also noted the Indian military’s “baseless insinuations to offset its comprehensive defeat”, in an apparent reference to the deputy Indian army chief alleging last week that China gave Islamabad “live inputs” on key Indian positions during the conflict.

    “Invoking third parties in what is unmistakably a bilateral military confrontation reflects a disingenuous attempt at bloc politics aimed at falsely projecting India’s self-assigned role as a net security provider to accrue benefits in a region that is visibly growing disillusioned with Indian hegemonic ambitions and Hindutva-driven extremism,” the ISPR quoted Field Marshal Munir as saying on the matter.

    The army brass also conducted a holistic review of the prevailing internal and external security dynamics, with particular emphasis on the recent developments in the Middle East and Iran, noting the “growing propensity for ‘use of force’ as a preferred policy tool”, saying it warranted “persistent development of self-reliant capabilities as well as national unity and resolve”.

    The forum’s members were further briefed on the military’s ongoing drive with quick adaptation towards the “evolving threat spectrum and changing character of war”. The army chief also appreciated the leadership of the Pakistan Navy and the Pakistan Air Force for “further strengthening tri-services synergy”.

    Field Marshal Munir also shared details of the country’s “proactive and successful” diplomatic manoeuvres, including recent visits to Iran, Turkiye, Azerbaijan, Saudi Arabia and the United Arab Emirates, where he had accompanied Prime Minister Shehbaz Sharif.

    “Forum was also briefed on the historic and unique visit of the COAS to US, where meetings with top-tier leadership afforded an opportunity to share first hand Pakistan’s objective perspective on bilateral, regional and extra-regional developments.”

    The ISPR said that in his concluding remarks, the army chief expressed “full confidence in the operational readiness of Pakistan Army against complete threat spectrum”.

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  • Can chatbots really improve mental health?

    Can chatbots really improve mental health?

    Recently, I found myself pouring my heart out, not to a human, but to a chatbot named Wysa on my phone. It nodded – virtually – asked me how I was feeling and gently suggested trying breathing exercises.

    As a neuroscientist, I couldn’t help but wonder: Was I actually feeling better, or was I just being expertly redirected by a well-trained algorithm? Could a string of code really help calm a storm of emotions?

    Artificial intelligence-powered mental health tools are becoming increasingly popular – and increasingly persuasive. But beneath their soothing prompts lie important questions: How effective are these tools? What do we really know about how they work? And what are we giving up in exchange for convenience?

    Of course it’s an exciting moment for digital mental health. But understanding the trade-offs and limitations of AI-based care is crucial.

    Stand-in meditation and therapy apps and bots

    AI-based therapy is a relatively new player in the digital therapy field. But the U.S. mental health app market has been booming for the past few years, from apps with free tools that text you back to premium versions with an added feature that gives prompts for breathing exercises.

    Headspace and Calm are two of the most well-known meditation and mindfulness apps, offering guided meditations, bedtime stories and calming soundscapes to help users relax and sleep better. Talkspace and BetterHelp go a step further, offering actual licensed therapists via chat, video or voice. The apps Happify and Moodfit aim to boost mood and challenge negative thinking with game-based exercises.

    Somewhere in the middle are chatbot therapists like Wysa and Woebot, using AI to mimic real therapeutic conversations, often rooted in cognitive behavioral therapy. These apps typically offer free basic versions, with paid plans ranging from US$10 to $100 per month for more comprehensive features or access to licensed professionals.

    While not designed specifically for therapy, conversational tools like ChatGPT have sparked curiosity about AI’s emotional intelligence.

    Some users have turned to ChatGPT for mental health advice, with mixed outcomes, including a widely reported case in Belgium where a man died by suicide after months of conversations with a chatbot. Elsewhere, a father is seeking answers after his son was fatally shot by police, alleging that distressing conversations with an AI chatbot may have influenced his son’s mental state. These cases raise ethical questions about the role of AI in sensitive situations.

    Guided meditation apps were one of the first forms of digital therapy.
    IsiMS/E+ via Getty Images

    Where AI comes in

    Whether your brain is spiraling, sulking or just needs a nap, there’s a chatbot for that. But can AI really help your brain process complex emotions? Or are people just outsourcing stress to silicon-based support systems that sound empathetic?

    And how exactly does AI therapy work inside our brains?

    Most AI mental health apps promise some flavor of cognitive behavioral therapy, which is basically structured self-talk for your inner chaos. Think of it as Marie Kondo-ing, the Japanese tidying expert known for helping people keep only what “sparks joy.” You identify unhelpful thought patterns like “I’m a failure,” examine them, and decide whether they serve you or just create anxiety.

    But can a chatbot help you rewire your thoughts? Surprisingly, there’s science suggesting it’s possible. Studies have shown that digital forms of talk therapy can reduce symptoms of anxiety and depression, especially for mild to moderate cases. In fact, Woebot has published peer-reviewed research showing reduced depressive symptoms in young adults after just two weeks of chatting.

    These apps are designed to simulate therapeutic interaction, offering empathy, asking guided questions and walking you through evidence-based tools. The goal is to help with decision-making and self-control, and to help calm the nervous system.

    The neuroscience behind cognitive behavioral therapy is solid: It’s about activating the brain’s executive control centers, helping us shift our attention, challenge automatic thoughts and regulate our emotions.

    The question is whether a chatbot can reliably replicate that, and whether our brains actually believe it.

    A user’s experience, and what it might mean for the brain

    “I had a rough week,” a friend told me recently. I asked her to try out a mental health chatbot for a few days. She told me the bot replied with an encouraging emoji and a prompt generated by its algorithm to try a calming strategy tailored to her mood. Then, to her surprise, it helped her sleep better by week’s end.

    As a neuroscientist, I couldn’t help but ask: Which neurons in her brain were kicking in to help her feel calm?

    This isn’t a one-off story. A growing number of user surveys and clinical trials suggest that cognitive behavioral therapy-based chatbot interactions can lead to short-term improvements in mood, focus and even sleep. In randomized studies, users of mental health apps have reported reduced symptoms of depression and anxiety – outcomes that closely align with how in-person cognitive behavioral therapy influences the brain.

    Several studies show that therapy chatbots can actually help people feel better. In one clinical trial, a chatbot called “Therabot” helped reduce depression and anxiety symptoms by nearly half – similar to what people experience with human therapists. Other research, including a review of over 80 studies, found that AI chatbots are especially helpful for improving mood, reducing stress and even helping people sleep better. In one study, a chatbot outperformed a self-help book in boosting mental health after just two weeks.

    While people often report feeling better after using these chatbots, scientists haven’t yet confirmed exactly what’s happening in the brain during those interactions. In other words, we know they work for many people, but we’re still learning how and why.

    AI chatbots don’t cost what a human therapist costs – and they’re available 24/7.

    Red flags and risks

    Apps like Wysa have earned FDA Breakthrough Device designation, a status that fast-tracks promising technologies for serious conditions, suggesting they may offer real clinical benefit. Woebot, similarly, runs randomized clinical trials showing improved depression and anxiety symptoms in new moms and college students.

    While many mental health apps boast labels like “clinically validated” or “FDA approved,” those claims are often unverified. A review of top apps found that most made bold claims, but fewer than 22% cited actual scientific studies to back them up.

    In addition, chatbots collect sensitive information about your mood metrics, triggers and personal stories. What if that data winds up in third-party hands such as advertisers, employers or hackers, a scenario that has occurred with genetic data? In a 2023 breach, nearly 7 million users of the DNA testing company 23andMe had their DNA and personal details exposed after hackers used previously leaked passwords to break into their accounts. Regulators later fined the company more than $2 million for failing to protect user data.

    Unlike clinicians, bots aren’t bound by counseling ethics or privacy laws regarding medical information. You might be getting a form of cognitive behavioral therapy, but you’re also feeding a database.

    And sure, bots can guide you through breathing exercises or prompt cognitive reappraisal, but when faced with emotional complexity or crisis, they’re often out of their depth. Human therapists tap into nuance, past trauma, empathy and live feedback loops. Can an algorithm say “I hear you” with genuine understanding? Neuroscience suggests that supportive human connection activates social brain networks that AI can’t reach.

    So while in mild to moderate cases bot-delivered cognitive behavioral therapy may offer short-term symptom relief, it’s important to be aware of their limitations. For the time being, pairing bots with human care – rather than replacing it – is the safest move.

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