Toll plaza optimization is essential for improving traffic flow and easing congestion on road networks. This study aims to suggest and assess potential optimization solutions for the Peshawar toll plaza, considering variables like traffic volume, toll-collecting effectiveness, and customer facilitation. Different resources are used for data collection, like the National Highway Authority of Pakistan. Physical data is collected from the established Toll Plaza of Peshawar, along with the development of each line. The goal of this study is to suggest and assess potential optimization solutions for the Peshawar toll plaza, considering variables like traffic volume, toll-collecting effectiveness, and customer happiness. The analysis of present traffic patterns, the detection of bottlenecks, and the creation of plans to ease congestion and enhance overall traffic flow are all part of the optimization process. The approaches used in this study include data analysis, simulation, and traffic modeling. PTV VISSIM is software for transportation planning, design, and analysis. The simulations consider various conditions, such as variable traffic volumes, toll collection methods, and lane configurations. When comparing the different optimization strategies, performance indicators like trip time, latency, and queue length are utilized to determine which approach is practical. Waiting time Vs. Existing each lane, etc, is explained. In the end, comparing queue lengths and throughput across different lane scenarios shows that maximizing throughput with existing lanes yields up to 45% improvement with E-tag lanes, 40% with existing E-tag lanes, 38% with E-tag plus additional toll and cash lanes, 32% with three cash lanes, and 28% with two E-tag lanes. Failure to regularly monitor and adjust the existing lane pattern scenario based on traffic patterns can lead to queues being 20% longer. Without proactive evaluation and optimization, there is a potential 63% opportunity for queue length improvement

The direct radiative effect of aerosols is taken into account in many limited area numerical weather prediction models using wavelength-dependent aerosol optical depths of a range of aerosol species. We study the impact of aerosol distribution and optical properties on radiative transfer, based on climatological and more realistic near real-time aerosol data. Sensitivity tests were carried out using the single column version of the ALADIN-HIRLAM numerical weather prediction system, set up to use the HLRADIA broadband radiation scheme. The tests were restricted to clear-sky cases to avoid the complication of cloud-radiation-aerosol interactions. The largest differences in radiative fluxes and heating rates were found to be due to different aerosol loads. When the loads are large, the radiative fluxes and heating rates are sensitive to the aerosol inherent optical properties and vertical distribution of the aerosol species. Impacts of aerosols on shortwave radiation dominate longwave impacts. Sensitivity experiments indicated the important effects of highly absorbing black carbon aerosols and strongly scattering desert dust.

Different toll collection types of vehicles and different distribution of tollbooths lead to the toll plaza diverging area becoming a typical vehicle weaving area with frequent crossing behaviors and conflicts on highways. This study aims to identify contributing factors to conflict risks of four vehicle-following patterns in a toll plaza diverging area by developing random parameters ordered logit models with heterogeneity in means and variances. The model can flexibly capture the unobserved heterogeneity of the contributing factors in different vehicle-following patterns. Real-world vehicle trajectory data obtained from the toll plaza diverging area in Nanjing, China, are used for model estimation. The results show that vehicle-following patterns with the same toll collection types have higher percentage of severe conflict risks. The average acceleration of the following vehicles, lane marking indicator, the initial lanes and lane-changes of vehicles are significantly associated with the collision risk levels. The standard deviation of surrogate safety measures of all vehicles in sub-segments are found differ significantly between vehicle-following patterns. Furthermore, a series of likelihood ratio tests are adopted to test the spatial dependence in sub-segments of the diverging area. The findings of this study could provide valuable information for safety improvement in toll plazas.

Aflatoxin being a serious threat to public health and international trade, necessi-tates a comprehensive understanding and calculated response with effective inter-vention strategies. This review methodically looks at several aspects of aflatoxin, starting with how it affects international trade laws through feed and feed ingre-dient regulations. Aflatoxin contamination poses serious challenges to world health and the economy, especially in areas that are already at risk. Examining the varia-bles affecting aflatoxin toxicity, the paper clarifies aflatoxin toxicity's complex me-tabolism and the resulting health effects of exposure. The serious repercussions of aflatoxicosis outbreaks and their connections to illnesses like Aspergillosis and cancer are highlighted by a detailed exploration of prospective decontamination techniques as well as strategies for detecting and capturing aflatoxin. A thorough knowledge of the factors that contribute to aflatoxin contamination demonstrates the intricate interactions between environmental variables, farming methods, stor-age circumstances, and different physical, biological, and nutritional components. Strong detection strategies are required due to aflatoxins’ significant effects on an-imal and human health. The paper describes complete preventative tactics that en-compass manipulation in management strategies. global trade and public health from this pervasive threat.

Current sampling methods for detecting the presence of the invasive freshwater hydrozoan Craspedacusta sowerbii rely mainly on visual confirmation of the medusa stage. Confirming the presence of the polyp stage is equally important to observing medusae since typical late summer/early fall occurrences or observations of medusae are sporadic though becoming more frequent. The polyp stage is important as it is the organism’s primary stage and is present throughout the year depending on water temperatures. Therefore, sampling methods for the polyp stage are commonly the collection of substrates such as rocks, plants or pieces of wood in a given body of water and can be cumbersome to examine. Based on preliminary culturing of the polyp stage on glass and plastic microscope slides in the lab, we designed a novel sampling methodology based on submerging 4 substrate types (small glass petri dishes, Hester-Dendy plates, plastic and glass microscope slides) to confirm the presence of C. sowerbii polyps in the field. We tested this method in various lakes in the Illinois-Indiana region (USA). The sampling method we designed was effective in that C. sowerbii polyps (and sometimes colonies) were found on both plastic and glass slides. While this method can be sufficient for detection of the polyp stage, it also shows significant potential for improvement; we highlight water flow and competition and predation from other organisms as significant factors influencing the collection of C. sowerbii polyps for future methodologies.

Having effective and efficient financing is one of the most important steps in accelerating the development of public infrastructure, including toll roads. This study aims to identify Critical Success Factors (CSFs) for the implementation of toll infrastructure financing in Indonesia. Thirty-three CSFs have been identified from literature review. A Delphi survey involving a panel of experts working in the infrastructure industry was conducted. Based on the survey, it is known that internal rate of return, affordability, investment decision, commercial banks, financing costs, interest rate risk, control of cash flow, contract scope, and principles of risk transfer are important factors for the implementation of toll infrastructure financing in Indonesia. This study fills research gaps by developing a CSF model for successful toll road infrastructure financing in Indonesian PPPs, considering private perspectives and aiming to provide insights for investors and enhance understanding of country profiles in developing countries. The focus on toll road implementation in Indonesia contributes to a comprehensive understanding of CSFs for PPPs in the country.

Over the last few years, Earth Observation (EO) data has shifted towards increased use to produce official statistics, particularly in the agriculture sector. National statistics offices worldwide, including in Asia and the Pacific, are expanding their use of EO data to produce agricultural statistics such as crop classification, yield estimation, irrigation mapping, and crop loss estimation. The advances in image classification, such as pixel-based and phenology-based classifications, and machine learning create new opportunities for researchers to analyze EO data applied to agriculture statistics. However, it requires the ground truth (GT) data because classification result mainly depends on the quality of GT. Therefore, in this study, we introduced a random sampling approach to design and collect GT data using EO imagery and ancillary data. As a result of data collection, GT data improve the algorithms and validates classification results. Nevertheless, despite the importance of GT data, they are rarely disseminated as a data product in themselves. Thus, this results in an untapped opportunity to share GT data as a global public good, and improved use of survey and census data as a source of GT data.

Toll-like receptors (TLRs) are a class of pattern recognition receptors (PRRs) family that identify pathogen-associated molecular patterns derived from microbes and activate immune cell response. Following TLRs ligation, different adaptor and transcription molecules such as myeloid differentiation primary response gene 88 (MyD88) and nuclear factor kappa B (NF-kB) are recruited that initiate inflammatory signaling pathways. The human Toll-like receptor 10 (hTLR10) is a novel member of the PRRs family with a regulatory function of immune responses because of unique cytoplasmic domains which lead to induction of both inflammatory and anti-inflammatory properties. Recent studies have reported the association of TLR10 polymorphisms with many inflammatory diseases and human cancer. Engagement of TLR10 on the surface of the epithelium and macrophages leads to the production of proinflammatory cytokines and chemokines, while other studies have proven an anti-inflammatory role of TLR10. Accordingly, TLR10 suppresses proinflammatory cytokine production via negative regulation of MyD88 and the Akt (protein kinase B) and MAPK (mitogen-activated protein kinase) signaling pathways. This review aimed to provide answers for these conflicting findings (Inflammatory and anti-inflammatory properties of TLR10) to further identify distinct biological functions of TLR10.

Toll-like receptor 4 (TLR4) is a member of the TLR family. Members of the TLR family play an important role in innate immune responses and are induced by recognition of pathogen-associated molecular patterns. They are also involved in cell proliferation and apoptosis in cancer. We investigated the role of TLR4 in apoptotic cell death in gynecological cancer cells; gynecological cancer is associated with infertility and spontaneous abortion. To examine the effect of TLR4 activation on apoptotic signaling in cancer cells, cultured primary cancer cells were treated with the TLR4 agonist lipopolysaccharide (LPS). The morphology of cancer cells was compared with normal myometrial cells. Enhanced growth rate and loss of contact inhibition with cellular overlap was observed in the cancer cells. The molecular mechanism analysis revealed differential expression of tumor suppressor genes in LPS-treated cancer cells. The expression of apoptosis-related caspase-3 was increased significantly in cancer cells with TLR4 activation after exposure to LPS. Taken together, these results suggest the pro-apoptotic activity of TLR4 as a potential therapeutic target for the treatment of gynecological cancers.

Tobacco use is bad for your health in many ways, not just your lungs. It affects many other parts of your body, including your nervous system. This abstract looks at the link between smoking and the nervous system and shows how smoking affects the nerve system in specific ways. There are a lot of different diseases and risks that can come from smoking. By weakening blood vessels and making it easier for blood clots to form, smoking makes the chance of having a stroke much higher. Using tobacco is also linked to a drop in brain function and memory problems, as well as a higher chance of neurodegenerative diseases like Alzheimer's disease and dementia. Also, people who smoke have a higher chance of getting multiple sclerosis, which is a long-term autoimmune disease that affects the central nervous system. It can also cause peripheral neuropathy, which can damage nerves and cause tingling, pain, and stiffness in the limbs. Nicotine, the substance that makes tobacco addicting, changes the brain's reward circuits. This makes it hard to stop smoking because it leads to addiction. In addition to these effects on the body, smoking also has effects on the mind. It makes mood disorders like sadness and anxiety more likely, making the symptoms worse and hurting general health. Understanding the effects of smoking on the brain is important for improving overall health and getting people to stop smoking. Public health efforts, education, and targeted interventions are needed to make people aware of these risks and help them make choices about smoking that are based on accurate information. By looking at how smoking affects the brain, we can try to make people's lives better and protect their and their communities' well-being.

Nowadays the relationship between planning land use and actual land use is not so clear in general. A lot of efforts have been put in the failures of regulation for the expansion of construction land. However, it still lacks an integrated approach to study the effectiveness of land use regulation in terms of different land use types. Furthermore, the existing evaluation of land use plan mainly focuses on a general level, a detailed research on the regulation effectiveness of each construction land use type is absent. Therefore, this research tries to evaluate regulation effectiveness of land use plan, which takes Cangwu country, Guangxi Province as an example. The finding by analysis is that the total area of construction land expansion was about 3494.73 ha, nearly 1.1 times of the plan quota. Moreover, the effectiveness differs greatly in various construction land use types. Town, industrial/mining sites can be well regulated through the quota of land use plan. While, the quota regulation system is not as effective for other type of construction land. Thus, we suggest to improve the regulation effectiveness of construction land through different plan instruments.

Objective: To determine the effect of sandblasting before and after sintering on the surface roughness of zirconia and the micro-tensile bond strength of a pressable veneering ceramic to zirconia. Methods: Pre-sintered zirconia blocks (IPS e.max ZirCAD, Ivoclar Vivadent) were divided into a control group (CTR, no surface treatment) and four test groups of three specimens each: Pre-S-30, Pre-S-50, Pre-S-110 were sandblasted with 30µm SiO2, 50µm Al2O3 and 110µm Al2O3 particles respectively, before sintering, Post-S-30 was sandblasted with 30µm SiO2 after sintering. For each treatment, the surface roughness was measured (Ra, Perthometer M4P, Mahr Perthen). After sintering the zirconia blocks, a liner and a pressable ceramic (IPS e.max ZirPress, Ivoclar Vivadent) were fired. Sixteen micro-bars were obtained from each block and submitted to the micro-tensile bond strength (µTBS) test. Data were analyzed with one-way ANOVA. Any correlation between Ra and µTBS was evaluated (Sperman test). Results: Sandblasting before sintering with 110µm Al2O3 (Ra=3.44±0.44µm), 50µm Al2O3 (Ra=2.32±0.46µm), and 30µm SiO2 (Ra=1.22±0.22µm) resulted in significantly higher roughness than sandblasting after sintering with 30µm SiO2 (Ra=0.46±0.11µm). The highest µTBS was measured when the sintered zirconia was sandblasted with 30μm SiO2 (26.79±14.80 MPa), which was significantly different from that of specimens that were sandblasted before sintering (Pre-S-30=20.90±11.70; Pre-S-50=21.27±15.19; Pre-S-110=23.99±16.83) or were not treated (CTR=17.44±14.03). Conclusions: Sandblasting zirconia before sintering enhances the surface roughness proportionally to the particle size of the sand used. Sandblasting with 30µm SiO2 after sintering appeared to improve bonding between the veneering ceramic and zirconia. Clinical Significance: Sandblasting with 30µm SiO2 after sintering may improve bonding between veneering ceramics and zirconia, thus reducing ceramic fractures/chippings.

There have been several cases of large-scale wind generators (WGs) tripping off caused by untimely fault removing in recent years. Currently, the discoordination between the box-type transformer fuse protection (BTFP) and two-section collecting line current protection (CLCP) brings a security risk to wind farm. In order to ensure the selectivity, the first section (Sec-I) CLCP should be set a enough interval that is longer than the fuse melting time, and another interval is set for the Sec-II CLCP, which weakens the speed of the CLCP. When a fault occurs on the collecting line, there is no doubt that WGs cannot work too long in abnormal operation, which may cause WGs to be placed off the grid. For a power system with high penetration of wind power, large-scale WGs tripping off will cause a great power shortage, and affect the stability of the power system. The selectivity and sensitivity of the CLCP is analyzed in detail to make the CLCP speed better. Considering the fault ride-through ability of WGs, the fault clear time is an important factor to lead to large-scale WGs tripping off. Two main works are done in this paper. The first is to accelerate the speed of the Sec-I CLCP though reducing the protection zone. Another one is introduce the risk assessment module into the CLCP, which not only improve the speed of the CLCP but also ensure the safety of the wind farm during faults. According to the deference in trip-off causes of WGs, the matching functions are created to assess the trip-off risk of WGs on the spot. In the case of fault, the trip-off risk indicators of WGs are timely updated to data sharing center and open to the CLCPs. The set of risk indicators is divided into several subsets according to the risk range. The dynamic changes of the subsets during fault help to improved CLCP scheme. This scheme can accelerate protection speed based on the increasing risk of large-scale WGs tripping off in wind farms. Compared with traditional CLCP, this approach can make the CLCP combines selectivity and speed better based on the analysis of the ride- through ability of WGs.

Abstract. The remarks by the Supreme Leader of the Islamic Revolution on the toll of the famines that afflicted occupied Iran in World War I and World War II indicate a desire to incorporate these calamities in Iran’s national narrative and collective memory. His criticism of famine historiography and stated toll numbers, and the unfolding catastrophic famine in Gaza, justify and necessitate a fresh look at each famine’s historiography and toll. This article re-estimates the toll of each famine by including many overlooked and neglected primary sources and in ways not previously done. It builds a trajectory of Iran’s demographic development from 1810 to 1944, and derives the toll of each famine. The World War II famine and typhus epidemics had claimed 5.5 million. World War I famine was also more deadly, though the 1869-73 famine was not far behind. At least 15.5 million Iranians died in the two world wars, a fact nowhere reflected in the history of the conflicts. Iran’s 1944 population of 12 million was unchanged from that of 1850 and a century of population growth obliterated

On using a 3D model to teach students a topic in astronomy, feedback was evaluated via a questionnaire. Analysis of students' responses to the questions revealed that user interface had a significant impact on their attitudes, which in turn could increase users' willingness to use immersive technology in e-learning. The results also showed that improving visual features through immersive technology and augmented reality tools were effective. The results confirm all hypotheses about positive relationships between facilitating conditions and usability of metaverse technology for students' attention and study motivation.

The work aims to develop an electromagnetic shielding measurement methodology and design an electromagnetic shielding effectiveness test setup for thin sheet material testing. In brief, multiple shielding effectiveness standards are described and analyzed in the thin sheet material testing framework. Two types of the developed shielding effectiveness test probe in high and low-frequency ranges are validated comprehensively. Extensive descriptions and data of developed testing methodology are also reported.

Background: Pediatric obesity treatment is based on high-intensity lifestyle counseling. However, high dropout rates and low effectiveness have been reported even in specialized centers. Mobile health technologies have been used in research settings to overcome these limits with contrasting results. This study aims to evaluate the effectiveness of a six-month intervention with a mobile app for the treatment of pediatric obesity at 6 and 12 months of follow-up. Methods: Patients were randomly assigned to standard care or standard care plus mobile app (2:1). The mobile app delivered high-intensity lifestyle counseling for diet and physical activity. Results: Seventy-five subjects were prospectively enrolled. At six months of follow-up, the m-app group showed significantly lower dropout rates compared to standard care(p=0.01). The risk of dropout was significantly higher in controls compared to the intervention group (OR 3.86,95%C.I. 1.39-10.42,p=0.01). After one year of follow-up, we observed lower albeit non statistically significant dropout rates in the m-app compared to the standard care group(p=0.24). No differences were observed in terms of z-score BMI and percentage of BMI reduction between the two groups. Conclusion: our findings suggest that mobile app might help in the clinical management of children and adolescents with obesity in terms of dropout reduction.

The hand-net is the standard method for capturing mosquitoes with sylvatic diurnal activity in disease outbreaks in Brazil. However, occupational risks and biases related to the collectors´ abilities and attractiveness are important limitations. In this study, we compared hand-nets with automatic traps (CDC) associated to CO2 and BG-Lure®, in the Vassununga State Park, a Brazilian Savanna protection area. The collections carried out over 27 days, on the ground and the forest canopy. A total of 1,555 mosquitoes were obtained in 20 taxa. The diversity index ranged between 1.12 and 1.79 and the dominance index, from 0.22 to 0.40. The dominant species in the ground was Aedes scapularis (46.0%) and in the canopy, Hg. janthinomys/capricornii (31.9%). Haemagogus leucocelaenus was rare (n=2). The hand-net resulted in the greatest diversity and abundance of species in both strata, followed by traps associated with CO2. A low degree of similarity was observed between the hand-net on the ground compared to the other capture methods. The use of BG-Lure® alone resulted in a low number of specimens. In conclusion, the hand-net is still the method of choice for collecting arbovirus vectors in the diurnal period, especially yellow fever vectors.

Pyrolyzed organic matter – commonly referred to as biochar – generally has positive effects on plant growth and can enhance early seedling development. Biochar-based seed coatings may thus be beneficial, specifically under adverse soil conditions such as high soil salinity. We evaluated germination and early plant development in radish (Raphinus sativa) seeds coated with conifer-feedstock slow-pyrolysis biochar; following the precedent of prior studies, polyvinyl acetate (PVAc) was used as the binding agent. Biochar-based seed coatings reduced germination rates and radicle extension in Petri dish trials; however, leaching of coated seeds largely eliminated this effect. PVAc applied in solution inhibited seed germination to a similar extent, suggesting that toxicity of PVAc or chemical products derived from it is the main mechanism for germination inhibition; a meta-analysis of published literature also indicates negative effects of biochar-based seed coatings using PVAc. In greenhouse trials the same biochar seed coatings improved aspects of plant growth and physiological status relative to controls, specifically enhancing root development. We conclude that biochar-based seed coatings have promise in promoting early seedling growth, and in combating salinity stress in agronomic and restoration applications. However, our findings contraindicate PVAc use as a binding agent. Further research is needed to test non-phytotoxic, readily biodegradable binding agents and to optimize biochars and seed coating processes for specific applications in agronomy and ecological restoration.

Background: Bioaerosol can represent a danger to the health. During SARS-CoV-2 pandemic, portable devices were used in different environments and considered a valuable prevention tool. This study has evaluated the effectiveness of the air treatment device “AEROK 1.0” in reducing microbial, particulate and pollen airborne contamination indoors, during normal activity. Methods: In an administrative room, airborne microbial contamination was measured using active (DUOSAS 360 and MD8) and passive sampling; a particle counter was used to evaluate particle concentrations; a Hirst-type pollen trap was used to assess airborne pollen and Alternaria spores. Statistical analysis was performed using SPSS 26.0; p values <0.05 were considered statistically significant. Results: The airborne bacterial contamination assessed by the two different samplers decreased by 55.54% and 69.13%, respectively. The airborne bacterial contamination assessed by passive sampling decreased by 44.16%. For fungi, the reduction was 38.7% by active sampling. Airborne particles (diameters ≥ 1.0, 2.0 μm) and the ratio of indoor/outdoor concentrations of total pollen and Alternaria spp spores significantly decreased. Conclusions: The results highlight the effectiveness of AEROK 1.0 in reducing airborne contamination. The approach carried out represents a contribution to the definition of a standardized model for evaluating the effectiveness of this type of devices.

Glial cells provide physical and chemical support and protection for neurons. Secreted neurotrophic factors, scaffolds and vesicles regulate in addition to normal homeostasis, repair following neural tissue injury or degeneration. We previously demonstrated that human CNS glia have revascularization capacity by inducing endothelial cell sprouting and microchanneling driven by glial cell secreted components. The clinical potential of using secreted factors and vesicles generated by glial cells in conditioned media was shown by their re-normalization of pathological blood vessels and 3D tissue wound healing and remodeling capacity. To identify secreted components of glial cells and how CNS and PNS glial cells differentially regulate neural tissue homeostasis, disease and injury response, we developed a novel culture method for various types of glial cells that allow for isolating and characterizing secreted glial components, free of animal factors and contaminants normally associated with serum-based culture conditions. Our culture method will enable to identify secreted components using ultrasensitive RNA, glycoconjugate and protein analysis technologies. The characterization of glial secreted factors involved microchanneling may help in development of new clinical therapies for glial and neural cells or axons to migrate and reform connections.

This work discusses seismic isolation technologies and analyses the concept of geotechnical seismic isolation (GSI) system, which is characterized by new principles of operation, using geomaterial with modified properties to reduce inertial seismic loads on buildings and structures. The aim of the study is to develop a geotechnical seismic isolation system in the form of vertical barriers, with different geometrical characteristics, using rubber-soil mixture (RSM). The novelty of the work consists in determination of effective constructive and technical solutions of vertical seismic barriers from RSM, which are characterized by reliability in providing seismic isolation of construction objects. Soil and superstructure interactions are modeled in Plaxis software, using the Northridge earthquake accelerogram. The results confirm the positive impact of using RSM as an effective material for GSI vertical barriers. The present numerical and experimental results show that the GSI system using RSM can significantly reduce the seismic hazard. The results of computational-experimental modeling will become a research, analytical and design basis for the development of new ways to ensure earthquake resistance of construction objects.

Introductory courses regarding radar technologies are very popular in undergraduate curriculum of many electrical and electronics engineering departments. Hands-on experience is an essential part for understanding the theoretical concepts given in lectures. In most cases, it is not affordable for universities to acquire experimental radar systems, especially those in developing countries. This paper presents a detailed description of a cost-effective easy-to-deploy radar system laboratory sessions and measures the educational effectiveness of the proposed material. The provided radar models can be used in teaching undergraduate students the working principles of frequency modulated continuous wave (FMCW) radar systems, as well as assisting graduate students in their research activities. The effectiveness of the laboratory sessions is measured thoroughly via qualitative and quantitative methods based on the proposed learning process and students’ success. The results show that the lab sessions have increased the students' understanding of the topics covered within the course, and the students' general perception is positive.

As a vital component of the terrestrial ecosystem, grassland accounts for one-third of the global vegetation system. Grassland degradation has been exacerbated due to extreme overgrazing in China's Inner Mongolia Autonomous Region (IMAR). While conservation was carried out as the Ecological Subsidy and Award Program (ESAP) to mitigate grassland degradation, little is known about its effectiveness in improving the biophysical conditions of grassland. This paper integrates the conceptual frameworks of total socio-environmental systems to assess how ecological systems respond to ESAP, investigate spatial heterogeneity of ESAP, and explore the meddling effects of socio-environmental interactions on ESAP. We integrate ecological, climate, and socioeconomic data and developed several hierarchical linear mixed models (HLMM) to investigate how these factors interact with ESAP in IMAR. Our findings prove that the above-ground biomass between 2011 and 2015 responds significantly to variations in socioeconomic conditions and ecological communities. Available land resources, hospital and medical facilities, and net farmer and herdsman income are the most critical factors contributing to grassland productivity. Primary industries like mining, total consumer retail value, farming, forestry, animal husbandry, fishery productions, and GDP are the most damaging factors affecting biomass. Our study recommends a regionally or locally tailored ecological recovery policy, instead of a generalized one, in the future effort to conserve grassland.

This study aimed at testing the effectiveness of novel combinations of chemical and physical methods to control Prosopis juliflora, an invasive weed in the Moshi and Simanjiro districts of Nothern Tan-zania. Six different treatments including manual uprooting, glyphosate, bark chop with chemical application, two separate chemical mixtures and control were tested in a total of 32 plots, which represented two land use types (grazing land and farmland) found in the two districts. Each plot covered 20m×30m plot area. Two response variables (stem count and tree volume) were recorded to compare weed population density before and after treatment six months later. An analysis of the untreated control plots, showed that the inherent growth potential of P. juliflora was higher in Moshi than in Simanjiro district. The number of stems increased during the experiment for all six treatments showing that the P. juliflora population had not yet reached the local carrying capacity. For the manual control treatment, the increase was reduced compared to the untreated control. For all other treatments, the increase in stem count was on par with that in the untreated control or even higher. Thus, we conclude that only manual uprooting had a controlling effect but not to the extent that it eradicated P. juliflora. Thus, it is for P. juliflora as for weed control in general: weed control must be an ongoing effort.

AI-driven tools can identify nursing students' strengths and weaknesses, thus enabling the development of customized learning plans that target specific areas for improvement. This targeted approach can enhance knowledge retention and skill development, resulting in better prepared healthcare professionals. Nursing students are required to overcome their own psychological stress during their internship in order to understand sick children’s emotional reactions, as well as to be able to interact and communicate with such children. The application of AI picture-based teaching e-books helps nursing students to understand how to use therapeutic games to improve communication with sick children. A comparison of the differences between nursing teachers’ self-efficacy scores and nursing students’ application of AI picture-based teaching e-books (experimental group) and narrative handouts (control group) was achieved via therapeutic games to deal with sick children’s fear of medical examinations and treatments. In addition, a comparison was also conducted on the differences between the impact of the self-efficacy of the experimental group and that of the control group in dealing with sick children’s behavioral responses with respect to fears of medical examinations and treatments. This study is a quasi-experimental study, in which the self-efficacy scores of 30 nursing students were collected and analyzed in both the experimental group and the control group before and after intervention in dealing with sick children’s behavioral responses to fears of medical examinations and treatments. It was found that the self-efficacy score of the experimental group was higher than that of the control group (β coefficient is 0.356) when assessing the self-efficacy scores and behavior of the experimental and control groups in dealing with sick children’s fears of medical examinations and treatments through one-way analysis of covariance (one-way ANCOVA), moreover, a statistically significant difference (p < 0.05) was observed. The experimental group’s score of behavioral responses to the fears of sick children to examinations and treatments was lower than that of the control group (β coefficient was -1.540), wherein a statistically significant difference (p < 0.05) was shown. The self-efficacy of the experimental group in dealing with sick children’s fears of medical examinations and treatments had a statistically significant impact on the sick children’s behavioral responses to the fear of medical examinations and treatments (p < 0.05). In addition, the higher the self-efficacy scores of the experimental group in dealing with sick children’s fear of medical examinations and treatments, the lower the sick children’s behavioral responses to fears of medical examinations and treatments (the β coefficient was -0.914), the control group’s self-efficacy scores in dealing with sick children’s fears of medical examinations and treatments did not have a statistically significant impact on the sick children’s behavioral responses to fears of medical examinations and treatments (p > 0.05). This study proves that the application of AI picture-based teaching e-books by nursing teachers is more effective than narrative handouts in improving nursing students’ self-efficacy when using therapeutic games to deal with, as well as reduce, sick children’s fears of medical examinations and treatments.

Seventy-seven percent of Irish primary school children do not meet recommended physical activity (PA) guidelines [1]. The Daily Mile (TDM) is a primary school initiative designed to increase children’s PA output. This study evaluates TDM’s perceived effect on Irish primary school children’s health-related metrics. A mixed-methods study, comprising two data collection phases, used the RE-AIM framework to evaluate TDM [2]. Phase one involved teachers, principals and classroom assistants (n = 191) from TDM-registered schools completing a questionnaire. Two TDM-registered schools participated in phase two where, (i) interviews were conducted with each principal, (ii) a teacher sub-sample (n = 4) participated in a focus group and (iii) a child sub-sample (n = 14) participated in separate focus groups. TDM was perceived to positively impact markers of children’s health, including their PA behaviour, physical fitness and social wellbeing. Inclement weather (66.5%) and a lack of time (56.5%) were reported as the top-ranked implementation barriers. Moreover, TDM’s repetitive nature often left children feeling disinterested and resulted in some teachers modifying the initiative to maintain engagement levels. Maintaining the long-term implementation of TDM and its health benefits in primary schools may require bespoke amendments to the original format to preserve children’s engagement.

Background Gingivitis can develop without mechanical cleaning within three weeks. The first clinical sign is bleeding on positive probing. The accumulation of dental biofilm generates an inflammatory gingival response. In the past decade, attention has focused mainly on the interproximal areas and the use of customsized interproximal toothbrushes.The aim of the study was to evaluate the effectiveness of individualized oral hygiene education and its role in dental prevention among patients with dental problems. Methods Before treatment, patients were clinically and radiologically examined, full mouth plaque score (FMPS), full mouth bleeding score (FMBS), and bleeding on brushing (BOB) were recorded, and matrix-metalloproteinase-8 (MMP-8) was measured by using a chair-side MMP-8 measuring system. Patients in group A had gingivitis, but no periodontal damage and patients in group B had periodontal damage. Patients in both groups A and B were identified in to four subgroups based on their toothbrushing habits and the oral health education they received. The three months after initial examination, each patient was examined three more times (2, 4 and 12 weeks later). Results It was concluded that subjects in groups A1 and B1 showed significant reduction in BOB, MMP-8, FMBS and FMPS levels after two weeks. Solo Prophylaxis (A1and B1) remained as a well-constructed protocol with hte complete resolution of interdental inflammation after two weeks. Other subgroups achieved significant reductions only after 12 weeks. Conclusions BOB and MMP-8 are valuable complements in preventive dentistry, and are able to detect potential pathological processes in interproximal spaces. The clinical relevance of BOB, in addition to FMBS, FMPS and gingival inflammation can be demonstrated to patients, which may increase compliance.

Long-term safety of a nutraceutical combination based on agnus castus and magnolia extracts combined with soy isoflavones (SI) and lactobacilli, and effectiveness on vasomotor symptoms and sleep disorders in postmenopausal women, were assessed. A controlled study was carried-out in menopausal women comparing this nutraceutical combination (ESP group) with formulation containing isoflavones alone (C group), at the dosage recommended. Kuppermann index, PSQI, and SF-36 were determined at baseline, 3, 6 and 12 months. Endometrial thickness, mammary density and liver function were evaluated at baseline and after 12 months. 180 women (100 in ESP group and 80 in C group, mean age 55.5 years, in menopause for about 36 months) were enrolled in the study. At the treatment end, mammary density, endometrial thickness, and hepatic function did not show substantial differences between groups. Kuppermann index, and particularly hot flushes, were progressively and significantly decreased in frequency and severity during ESP versus C treatment. No adverse events were observed. Agnus castus and magnolia, combined with SI + lactobacilli, can effectively and safely be used in symptomatic postmenopausal women, mainly when quality of sleep is the most disturbing complaint. Endometrium, mammary glands and liver function, were unaffected after 12 months treatment.

In recent years, the focus of disease resistance and susceptibility studies in cattle have been on determining patterns in the innate immune response of key proteins, such as Toll-like receptors (TLR). In the bovine genome, there are 10 TLR family members and, of these, TLR2, TLR4 and TLR6 are specialized in recognition of bacterial ligands. Indigenous cattle breeds of Anatolia have been reported to show fewer signs of clinical bacterial infections, such as bovine tuberculosis and mastitis, and it is hypothesized that this might be due to a less stringent genetic selection during breeding. In contrast, Holstein-Friesian cattle have been under strong selection for milk production, which may have resulted in greater susceptibility to diseases. To test this hypothesis, we have compared the TLR2, TLR4 and TLR6 genes of Anatolian Black (AB), East Anatolian Red (EAR), South Anatolian Red (SAR), Turkish Grey (TG), and Holstein (HOL) cattle using Next Generation Sequencing. The SAR breed had the most variations overall, followed by EAR, AB, TG and HOL. TG had the most variations for TLR2 whereas SAR had the most variations in TLR4 and TLR6. We compared these variants with those associated with disease and susceptibility traits. We used exon variants to construct haplotypes, investigated shared haplotypes within breeds and determined candidate haplotypes for disease resistance phenotype in Anatolian cattle breeds.

Purpose: The study aimed to investigate if there were any links between liver function biomarkers and immunoglobulins levels in serum, and Toll-like receptors (TLRs) and neuropilin-1 (NRP1) in COVID-19 patients. The study also aimed to assess the accuracy—sensitivity, specificity, and area under the curve (AUC) by the receiver operator curve (ROC) analysis for immunoglobulins levels and TLRs expressions. Patients and Methods: This study included 150 patients (100 patients with confirmed COVID-19 and 50 healthy volunteers as a control group). Patients with COVID-19 were subdivided into two groups according to the severity of symptoms (moderate and severe, with 50 patients each). Serum C-reactive protein (CRP), alanine aminotransaminase (ALT), aspartate aminotransaminase (AST), albumin, lactate dehydrogenase (LDH), immunoglobulin (Ig) G, and IgM levels were estimated. TLRs (TLR2 and TLR4) and NRP1 gene expression in blood samples were investigated using quantitative real-time polymerase chain reaction (qRT-PCR). ROC analysis was also applied to determine the accuracy of various detected parameters in predicting the possibility of COVID-19 infection. Results: In COVID-19 patients, serum parameters related to liver function, except serum albumin, CRP, IgG, IgM, and TLR2, TLR4, and NRP1 mRNA expression levels, significantly elevated compared to controls. Severe COVID-19 patients exhibited significantly higher liver enzymes (ALT, AST and LDH), CRP, and TLR2 mRNA expression levels and lower albumin levels than the moderate group. In the moderate and severe groups, ALT, CRP, TLR2, and TLR4 had a significant positive correlation with IgM levels. ALT, AST, LDH, CRP, TLR2, and TLR4 showed a significant positive correlation with IgG levels in both groups. In both the moderate and severe groups, NRP1 expression was found to be significantly correlated with CRP, IgG, IgM, TLR2, and TLR4. In contrast, serum albumin levels exhibited a significant negative correlation with IgG and IgM levels only in the severe group, but they showed a significant negative correlation with TLR2, TLR4, and NRP1 expression in both moderate and severe groups. Serum ALT and AST activities were positively correlated with NRP1 expression in the moderate group but not in the severe group and as well as TLR2 and TLR4 expression in both the moderate and severe groups. ROC analysis indicated that AUC was higher than 0.800 for serum IgM level and TLR4 gene expression in moderate COVID-19 group. Conclusions: The increased liver function biomarkers in serum and NRP1 expression are closely correlated with sustained activations in humoral and innate immune responses during COVID-19 infection. As a result, TLR2, TLR4, and NRP1 could be targets for limiting COVID-19 infection and impairment effects on liver function. Moreover, detection of IgM level in serum and TLR4 expression in blood have a good accuracy in predicting the possibility of infection with COVID-19 in moderate cases.

Toll-like receptors (TLRs) play a key role in the innate immune response to numerous pathogens, including Acanthamoeba sp. The aim of this study was to determine the expression of TLR2 and TLR4 in the eyes of mice following intranasal infection with Acanthamoeba sp. Amoebae used in this study were isolated from the bronchial aspirate of a patient with acute myeloid leukemia (AML) and atypical symptoms of pneumonia. We found statistically significant differences in the expression of TLR2 and TLR4 in the eyes of immunocompetent mice at 8, 16, and 24 days post Acanthamoeba sp. infection (dpi) compared to control. Immunosuppressed mice showed significant differences in the expression of TLR2 at 16 and 24 dpi compared to uninfected animals. Our results indicate that TLR2 and TLR4 are upregulated in the eyes of mice in response to Acanthamoeba sp. We suggest that it is possible for trophozoites to migrate through the optic nerve from the brain to the eyes.

Schistosomiasis, a crippling ailment that afflicts over 220 million people worldwide. Yet or up till now, there is no vaccine for schistosomiasis, and chemotherapy relies heavily on a single drug, the praziquantel. The present study was undertaken to investigate the therapeutic effect of Monophosphoryl Lipid A (MPLA) as an adjuvant in soluble egg antigen (SEA) vaccinated mice against the deleterious pathological impacts induced in hepatic tissues of mice by Schistosoma mansoni infection. In addition, to study the associated parasitological, immunological and biochemical parameters. Parasitological parameters showed that intraperitoneal injection of MPLA into SEA-vaccinated and S. mansoni-infected mice was effective to a significant degree in reducing the worm and egg burden, granuloma count and diameter as well as the total area of infection in their livers versus SEA-untreated but infected ones. In addition, MPLA showed ameliorative action on the elevated liver oxidative stress marker, including malondialdehyde (MDA) and decrease in the level of the antioxidant enzymes, reduced glutathione (GSH) and catalase (CAT) which may have a role in the liver damage and fibrosis due to S. mansoni infection. In conclusion, treatment with MPLA has multi-functions in attenuating the deleterious impacts of S. mansoni infection in mice livers. Its effects are mediated through a reduction of ova count, worm burden, granuloma diameter and amelioration of antioxidant defense systems, and liver function biomarkers.

Weight loss solutions are on the rise, and there is growing interest in natural alternatives to the pharmaceuticals in the market, which are not devoid of relevant side effects. To this end, the objective of the current study is to assess the effects of a botanical-based blend comprised of lemon verbena and hibiscus extracts in weight management, body fat, appetite, lipid, and glucose profiles, in an overweight population, for 90 days. As a result, the volunteers presented significant weight loss in absence of diet, which coincided with decreased body fat. Body fat was assessed by anthropometry, electrical bioimpedance and DEXA scan. Cholesterol levels were also significantly decreased. Satiety assessment revealed that the product contributed to increased feeling of fullness and satisfaction after a meal, compared to the placebo group, which could contribute to the weight loss observed. Blood glucose and blood pressure levels remained unchanged, which was expected as the volunteers were normoglycemic and their blood pressure was in the healthy range. In conclusion, daily supplementation of a botanical-based blend contributes to weight loss in overweight individuals, in absence of diet, while not affecting other parameters that are in the healthy range. This product could be a candidate alternative or add-on to other weight loss products, as part of a healthy lifestyle.

Understanding the dynamics of land use and land cover (LULC) change in today's context of rapid urbanization is critical for sustainable urban planning and environmental conservation. Therefore, the research aim is to understand the LULC changes in Chattogram Metropolitan Area and to assess the policy implications of these changes for sustainable urban development. Through a comparative analysis of LULC maps for two periods (1997–2007; 2007–2017), we investigated the transformation of a detailed planning zone before and after detailed area plan (DAP) approval. Using a mixed-method approach integrating quantitative data with policy analysis, we elucidated the impacts of urbanization trends on local ecosystems—specifically the conversion of forest cover and waterscape use. The findings reveal a significant conversion of forested and waterscape areas to urban and peri-urban landscapes, highlighting the urgent need for sustainable planning interventions that focus on these peri-urban areas. The study further critiques the DAP's effectiveness, revealing a disconnect between regional policy implementation and local outcomes. This research proposes a validated, scalable framework for urban master plans that adapts to the complex socio-ecological contexts of rapidly urbanizing regions.

Onychomycosis is a common fungal nail infection for which new antibiotics are needed to overcome antifungal resistance and other limitations of conventional treatments. This study reports the development of antifungal nail lacquers containing oregano essential oil (OEO), rosemary essential oil (REO), and/or biogenic silver nanoparticles (bioAgNP). The formulations (F) were tested against dermatophytes by agar diffusion, ex vivo nail infection, and scanning electron microscopy techniques. They were evaluated pharmacotechnically and by FTIR-PAS to access permeation across the nail plate. F-OEO and F-OEO/Ag were promising for the final nail lacquer formulation, they permeated through the nail plate and showed antifungal efficacy against dermatophytes-contaminated nails after 5 days of treatment. The treated nails had decreased hyphae and spores compared to untreated control; the hyphae were atypically flattened which indicates loss of cytoplasmic content due to damage to cytoplasmic membrane. Formulations were stable after centrifugation and thermal stress, maintaining organoleptic and physicochemical characteristics. F-OEO and F-OEO/Ag had pH compatible with the nail, and drying time (59-90 s) within the reference for nail lacquer. For the first time, OEO and bioAgNP were incorporated in a nail lacquer, resulting in a natural and nanotechnological antifungal product for onychomycosis that may combat microbial resistance.

Background. A direct clinical and morphological comparison of non-COVID myocarditis than was diagnosed before the SARS-CoV-2 pandemic and post-COVID myocarditis has not been performed so far. Purpose: to compare morphological activity, toll-like receptors expression and response to the immunosuppressive therapy in patients with non-COVID and post-COVID myocarditis. Metodhs. Seventy-seven patients (52 male and 25 female, 48.7±11.7 y.o.) with biopsy proven myocarditis, NYHA class 2 or more heart failure, ejection fraction (EF) <45% were included. A history of myocardial infarction, verified cardiomyopathies, systemic autoimmune diseases, viral DNA in the myocardium, except parvovirus B19, were exclusion criteria. The right ventricular endomyocardial biopsy with hematoxylin and eosin, Van Gieson stains, PCR for virus (herpes viruses, parvovirus B19, adeno-, enteroviruses and SARS-CoV-2), immunohistochemical study for CD3, CD45, CD68, CD20, nucleocapsid / spike proteins of SARS-CoV-2 and in addition toll-like receptors (TLR) type 4 and 9 expression (in 38 patients) were performed. The steroids (methylprednisolone 24-40 mg per day), azathioprine, mycophenolate mofetil were prescribed. The mean follow-up was 16 [6; 30] month. Results. In 45 patients, myocarditis was diagnosed before the SARS-CoV-2 pandemic (giant-cell in one case and lymphocytic in the others). Other 32 patients had post-COVID myocarditis positive for RNA or/and proteins of SARS-CoV-2 (giant-cell in one case, eosinophilic in three cases and lymphocytic in the others). There were no differences in age, NYHA class, CRP and anti-heart antibodies level, echocardiographic parameters (mean EF 30.2±7.8 vs 28.7±6.7%), parvovirus B19 positivity (22 vs 34%), doses of methylprednisolone (24-40 mg/day) and death / transplantation rate (11.1 vs 9.4%). Differences between non-COVID vs post-COVID myocarditis focused on higher CD3, CD 45*, TLR 4 (4+ vs 6+), TLR 9 (0 vs 2+) expression and better response to therapy [10% or more increase in EF in 53 vs 86%* of patients, mean EF (43.9±12.3 vs 49.8±7.6%*) by the end of follow-up], *p<0.05. Conclusion. Post-COVID myocarditis is characterised by different morphological types, higher morphological activity, tendency to higher TLR expression and the best response to the immunosupressive therapy in comparison with non-COVID myocarditis.

In the chronic phase of chikungunya virus (CHIKV) infection, excessive inflammation manifests as incapacitating joint pain and prolonged arthritis. Arthritis resulted from a large influx of infiltrating immune cells driven by pro-inflammatory cytokines and chemokines originating from the toll-like receptor (TLR)-mediated innate antiviral response. This study investigated fisetin's ability to modulate TLR-mediated antiviral responses against CHIKV in Huh7 cells. The CHIKV inhibitory potential of fisetin was assessed by plaque-forming unit assay, virus yield reduction assay, and bright-field microscopy (cytopathic effect, immunofluorescence). Fisetin’s modulatory potential on TLR-mediated antiviral response was evaluated by immunofluorescence assay (expression of TLR proteins), qRT-PCR (mRNA level of antiviral genes), human cytokine array, and immunoblotting of key transcription factors. The present study showed fisetin induced the expression of the antiviral genes at an early time-point by promoting the phosphorylation of IRF3 and IRF7. Fisetin reduced excessive inflammatory cytokine responses in CHIKV-infected Huh7 cells by impeding the over-phosphorylation of NF-κB. Fisetin also reduced CHIKV-induced cytopathic effects in CHIKV-infected Huh7 cells. Altogether, our study suggests that fisetin modulates TLR-mediated antiviral responses by affecting the CHIKV-induced inflammatory responses.

We analyze a time-delayed SIQR model that considers the transportation-related infections and entry-exit screening. This model aims to determine the measures for preventing and controlling major emergent infectious diseases and the associated costs. We calculate the basic reproduction number (R0), apply the linearization method, and construct an appropriate Lyapunov function to determine the stability of the disease-free equilibrium in the local and global. We collect COVID-19 infection data from two regions in the United States in 2020 for data fitting, obtain a set of optimal parameter values, and show that the model is suitable for simulating the outbreak and spread of emerging infectious diseases. We find that transportation-related infections increase the basic reproduction number, enhancing the impact on disease spread. Entry-exit screening effectively suppress the spread of disease by reducing the basic reproduction number. Furthermore, we investigate the influence of the incubation period on disease and find that a shorter incubation period results in a shorter duration but a larger scale of infection, and the peaks are reduced. We conduct a sensitivity analysis of the R0 and propose three measures to prevent the spread of new infectious diseases based on the most sensitive parameters: wearing masks, implementing urban closures, and administering medication to sick but not yet hospitalized patients promptly. In the case of COVID-19, we use Pontryagin’s minimum principle to get time-varying control measures to control the spread of the outbreak. Optimal control effectively controls the development and deterioration of the disease. Finally, several control measures are compared through cost-effectiveness analysis, and the results show that wearing masks is the most cost-effective measure. Our study provides some practical guidance for controlling the spread of major emerging infectious diseases.

The opportunities and potential of Artificial Intelligence (AI) in Environmental Assessment (EA) are often mentioned. However, do we in the EA field understand the implications of what is happening in other biological sciences, and are we preparing for the changes that are coming? This interdisciplinary letter focuses on AI-driven developments in biodiversity data and analysis as a starting point for stimulating discussion about what AI means in practice for the field of EA. We highlight implications for training, transformation of practice and decision making as first steps in a research agenda.

While the majority of previous studies assessing pain-related variables in psychopaths used electric shocks, little is known about the effectiveness of alternative pain-inducing methods to increase emotional responses such as fear and anxiety. A small sample of healthy undergraduate men (N = 15) was recruited to assess the effectiveness of a heat stimulus to induce pain in an immediate versus delayed punishment paradigm. Although pain catastrophizing, anxiety, and threat of pain did not increase throughout the experiment, participants experienced a significant increase of fear of pain and pain intensity, indicating that the heat stimulus was effective in inducing pain. Furthermore, subjects were slower in initiating the pain stimulus during the first five trials, but no time difference was found during the 15 remaining trials. No correlation was found between psychopathic traits and pain-related variables, with the exception of inconsistent results within the Fearless Dominance factor. Findings are discussed in terms of improvement for a larger scale study involving psychopathic individuals.

Concrete cracks and local damage can affect the bond performance between concrete and steel bars, thereby reducing the durability of reinforced concrete structures. Compared with general concrete crack repair methods, biomineralization repair not only has effective bonding capabilities but is also particularly environmentally friendly. In view of this, this study aimed to apply biomineralization technology to repair damaged fiber-reinforced lightweight aggregate concrete (LWAC). Two groups of LWAC specimens were prepared. The control group used lightweight aggregates (LWAs) without bacterial spores and nutrient sources, and the experimental group used LWAs containing bacterial spores and nutrient sources. These specimens were first subjected to compression tests and pull-out tests, respectively, and thus were damaged. After the damaged specimen healed itself in different ways for 28 days, secondary compression and pull-out tests were conducted. The self-healing method of the control group involved placing the specimens in an incubator. The experimental group was further divided into experimental group I and experimental group II. The self-healing method of experimental group I was the same as that of the control group. The self-healing method of experimental group II involved soaking the specimen in a mixed solution of urea and calcium acetate for two days, and then taking it out and placing it in an incubator for two days, with a cycle of four days. The test results showed that, compared with the control group specimens, the relative bond strength ratio of the experimental group II specimens increased by 17.9%. Moreover, the EDS and XRD analysis results confirmed that the precipitate formed at the crack was calcium carbonate, which improved the compressive strength and bond strength after self-healing. This indicates that the biomineralization maintenance method used in experimental group II is more effective.

Background: Health insurance (HI) run by government is providing health care service to large population. Due to poor accountability, participation and sustainability, cooperative health insurance is becoming more popular and effective in low and middle income and some high-income countries too. In Nepal, there are public and cooperative HI is in practice. The aim of this study is to compare the effectiveness of public (government) and cooperative HI in relation to benefit packages, population coverage, inclusiveness, health care utilization, and promptness for treatment in these two health insurance models in Nepal. Method: This is an institution based concurrent mixed study consists of qualitative and quantitative variables from public and cooperative groups. We included all public HI operated by government hospitals and cooperatives groups those purchased hospital service in contract. Two separate study tools were applied to access the effectiveness of insurance models. The key questions were asked for the representatives of government and private health insurance. The numeric information consisted of in quantitative data and subjective response was included in qualitative approach. Descriptive statistics and Mean Whitney U test was applied in numeric data and qualitative information were analyzed by inductive approach Results: The study revealed that new enrolment was not increased, health care utilization rate was increased and the benefit package was almost same in both groups. The overall inclusiveness was higher for the government HI, but enrolment from the religious minority, proportion of negotiated amount during treatment were significantly higher (p<0.05). During illness, the response time to reach hospital was significantly faster in cooperative health insurance than government health insurance. Qualitative findings showed that level of participation, accountability, transparency and recording system was better in cooperative health insurance than public. Conclusion: Cooperative HI could be more sustainable and accountable to the community for all; low, middle and high-income countries.

Fibromyalgia (FM) is a complex, chronic, widespread pain syndrome that can cause significant health and economic burden. Emerging evidence has shown that neuroinflammation is an underlying pathological mechanism in fibromyalgia. Toll-like receptors (TLRs) are key mediators of the immune system. TLR4 is expressed primarily in microglia and regulates downstream signaling pathways, such as MyD88/NF-κB and TRIF/IRF3. It remains unknown whether electroacupuncture (EA) has therapeutic benefit in attenuating fibromyalgia pain and what role the TLR4 pathway may play in this effect. We compared EA with sham EA to eliminate the placebo effect due to acupuncture. We demonstrated that intermittent cold stress significantly induced an increase in mechanical and thermal FM pain in mice (mechanical: 2.48 ± 0.53 g; thermal: 5.64 ± 0.32 s). EA but not sham EA has analgesic effect on FM mice. TLR4 and inflammatory mediators-related molecules were increased in FM mice’s thalamus, medial prefrontal cortex, somatosensory cortex, and amygdala, indicating neuroinflammation and microglial activation. These molecules were reduced by EA but not sham EA. Furthermore, a new chemogenetics method was used to precisely inhibit SSC activity displayed an anti-nociceptive effect through TLR4 pathway. Our results imply that the analgesic effect of EA is associated with TLR4 downregulation. We provide novel evidence that EA can modulate the TLR4 signaling pathway, revealing potential therapeutic targets for FM pain.

Background: Front-of-pack-labels (FOPLs) on packaged foods provide consumers with essential information about the nutritional content of food products, enabling them to make informed choices and align their dietary habits with their health goals. However, evidence on the comprehensibility, use, and effectiveness of FOPLs remains limited, particularly in low- and middle-income countries like Kenya. Objective: In this study, we assessed the effectiveness of three FOPLs in helping consumers identify excess nutrients of concern in packaged food products and their potential influence on food purchases in Kenya. Methods: A total of 2198 shoppers with diverse backgrounds were recruited from selected supermarkets in three Kenyan main cities (Nairobi, Mombasa, Kisumu) and a small town (Garissa). Participants were randomized to three FOPLs: Red and green Octagon label (RG), Red and Green Octagon with icons (RGI) and a black Octagon Warning label (WL). In the control phase, participants were shown unlabeled images of packaged food products and they responded to a set of questions. In the experimental phase, the same product images were presented with one of the three front-of-pack labels they were randomized to, and participants answered the same questions again. Differences in the proportions of participants correctly identifying the nutrients of concern and the changes in intention to purchase unhealthy foods before and after exposure to FOPLs were analyzed using frequency tables and Chi-Square tests. The effectiveness of the three FOPLs was further assessed using a modified Poisson regression. Results: Results showed that exposure to FOPLs significantly improvement participants' ability to correctly identify nutrients of concern across various food categories. Additionally, FOPLs reduced consumers’ intentions to purchase unhealthy foods, with the Warning Labels (WL) emerging as particularly effective in enhancing consumers' understanding of product healthiness and reducing the intention to purchase unhealthy foods compared to the other two FOPLs. Conclusion: These findings underscore the potential role of FOPLs, particularly the WL as an effective regulatory tool for promoting healthier food choices in Kenya.

Human Papillomavirus (HPV) self-sampling has the potential to increase cervical cancer screening (CCS) and reduce the cervical cancer burden in Medically Underserved Women (MUW). However, interventions promoting self-sampling are limited. We examined the effectiveness of an intervention study in increasing CCS among MUW. We conducted a quasi-experimental intervention study. Face-to-face verbal approach was to recruit MUW (n=85, mean age 48.57±11.02) living in a small city in the US. Behavioral intervention based on reframing, reprioritizing, and reforming (3R model) was used to educate the women about CCS in a group format. The women completed pre-and post-intervention assessments and followed-up interviews. The primary outcome was CCS uptake. Mixed methods analyses were conducted using a t-test for the primary outcome, PROCESS for mediation analysis, and NVivo for interview data. Majority of women (75%) completed self-testing. High-risk HPV prevalent among the women was 11%, and of those, 57% followed-up with physicians for care. We found that the significant increase in the women’s post-intervention screening behaviors was mediated by the increase in knowledge (Indirect Effect [IE] = .1314; 95% CI, .0104, .4079) and attitude (IE = .2167; 95% CI, .0291, .6050) scores, (p&lt;0.001). Interview analyses offered further explanations (see the explanations in parenthesis) why MUW found the intervention messages acceptable (encourages proactive behavior), feasible (simple and easy to understand), and appropriate (helpful and informative). Barriers including lack of trust and fear of results were identified. The findings suggest that an intervention that combines the 3R model and self-sampling may increase CCS among MUW.

Immortal-time bias (ITB) is known to be common in cohort studies and distorts the association estimates between treated and untreated groups. We used data from the last of two large studies in an Italian province on COVID-19 vaccines safety and effectiveness incurred this bias, and aligned the entire population on a single index date, to correct the ITB. We considered the "all-cause deaths" outcome to compare the survival curves between the unvaccinated group and the various vaccination statuses. The all-cause deaths Hazard Ratios in univariate analysis for unvaccinated (reference) versus vaccinated with 1, 2, 3/4 doses were 0.88 (CI95: 0.78 –1.00; p-value 0.044), 1.23 (1.16–1.32; p-value ≤0.001) and 1.21 (1.14–1.29; p-value ≤0.001), respectively. The multivariate values were 2.40 (2.00–2.88; p-value <0.0001), 1.98 (1.75–2.24; p-value <0.0001), 0.99 (0.90–1.09; ns). The possible explanations of the trend of the Hazard Ratios as vaccinations increase could be a harvesting effect; a calendar-time bias, accounting for seasonality and pandemic waves; a case-counting windows bias; a healthy-vaccinee bias; or some their combination. With two and even with 3/4 doses the calculated Restricted Mean Survival Time and Restricted Mean Time Lost have shown a small but significant downside for the vaccinated populations.

Multidrug resistant organisms (MDROs) outbreaks have been steadilyincreasing in Intensive care units (ICUs). Still, healthcare institutions and workers (HCW) reached no unanimity on how and when implementing infection prevention and control (IPC) strategies. We aimed to provide a pragmatic, physician practice-oriented, resume of strategies towards different MRDOs outbreaks in ICU. We performed a narrative review on IPC in ICUs, investigating patient-to-staff ratios, education, isolation, decolonization, screening and hygiene practices, outbreak reporting, cost-effectiveness, reproduction-number(R0), and future perspectives. The most effective IPC strategy remains unknown. Most studies focus on a specific pathogen or disease, making the clinician losing the big picture. IPC strategies proved their cost-effectiveness regardless typology, country, or pathogen. A standardized, universal, pragmatic protocol for HCW education should be elaborated. Likewise, a rapid outbreak recognition tool elaboration (i.e., an easy-to-use mathematical model) would improve early diagnosis and spreading prevention. Further studies are needed to express in favor or against MDROs decolonization. New promising strategies are emerging and need to be tested in the field. The lack of IPC strategies application has made, and still makes ICUs a major MDROs reservoir into the community. In a not-too-distant future genetic engineering and phage therapies could represent a plot-twist in MDROs IPC strategies.

This qualitative research explores the transformative impact of technological innovations on retail marketing effectiveness. Through thematic analysis of interviews with industry professionals, the study identifies key themes including enhanced customer engagement, personalized marketing strategies driven by AI and machine learning, data-driven decision-making leveraging big data and analytics, the rise of e-commerce platforms, integration of mobile technologies, adoption of augmented reality (AR) and virtual reality (VR), development of omnichannel strategies, and implementation of loyalty programs. These themes illustrate how technology has reshaped retail marketing by enabling real-time customer interactions, personalized shopping experiences, and targeted marketing campaigns that enhance customer satisfaction and loyalty. The findings highlight the critical role of digital platforms like social media in fostering community engagement and brand loyalty. AI and machine learning facilitate personalized marketing efforts, tailoring product recommendations and enhancing customer experiences. Data-driven strategies optimize marketing ROI by providing insights into consumer behavior and market trends. E-commerce platforms expand market reach and streamline transactions, while mobile technologies and AR/VR innovations create immersive shopping experiences that captivate consumers. Omnichannel strategies integrate physical and digital channels, delivering seamless brand experiences and enhancing customer retention through CRM systems and loyalty programs. Looking ahead, retailers must navigate challenges such as rapid technological change, the need for continuous adaptation, and concerns about data privacy. By embracing technological advancements strategically and maintaining ethical standards, retailers can sustain competitive advantage, meet evolving consumer expectations, and drive growth in the digital era.

This research focuses on developing a Student Performance Evaluation System to enhance effectiveness and oversight in higher education. The system aims to address challenges faced by instructors in evaluating student performance using a distributed system approach. Agile methodology is employed in development, and database replication techniques are applied for data synchronization. System features include registration, assessment form creation, assessment submission, statistical visualization, and access to assessment history. The system is designed to improve efficiency and transparency in the assessment process. Key features of the system include registration process, assessment form creation, assessment submission, statistical visualization, and access to assessment history. Its goal is to enhance efficiency and transparency throughout the assessment process. The article details the system workflow and the roles played by Admins, Instructors, and students in system usage. Additionally, it discusses the back-end development model and pathways, as well as the performance testing results. Performance testing indicates that the system achieves high throughput of up to 21.55 requests per second, with an average response time of only 34 milliseconds and an error rate of zero percent. These results affirm that the system efficiently handles user loads and nearly instantaneously responds to requests, providing an optimal user experience in the context of student performance evaluation in higher education.

Rapid haemostasis during surgery is essential when one wants to reduce the duration of opera-tions, reduce the need for transfusions, and above all when one wants to achieve better patient management. The use of haemostatic agents, sealants and adhesives improves the haemostatic process by offering several advantages, especially in vascular surgery. These agents vary widely in their mechanism of action, composition, ease of application, adhesion to wet or dry tissue, im-munogenicity and cost. The most used are cyanoacrylate-based glues (Glubran 2) or polysaccharide hydrogel-microsphere powder (AristaTMAH). This work is based on a retrospective study carried out on a sample of patients with different vascular diseases (FAV, pseudoaneurysm and PICC application) in which two different haemostatic sealants were used. The aim was to assess the safety, the advantages and the ability of both sealants to activate the haemostatic process at the affected site, also in relation to their chemical-physical characteristics. The obtained results showed that the application of Glubran 2 and AristaTMAH as surgical wound closure systems is effective and safe as the success achieved was ≥94% on anastomoses of FAV; 100% on stabilization of Picc catheters; ≤95% on pseudoaneurysms.

The effectiveness of combining strength-specific training with endurance training to enhance the performance of endurance runners remains uncertain. This study aimed to analyze effect of practising maximum-strength (MAX), explosive strength (EXP) or both combined (COMB) on seven runners’ performance-indicators: vertical jump (VJ), one-repetition-maximum-squat (1RM), peak-velocity/peak-running-speed (PV), lactate-threshold (over incremental-test-protocols, LT), middle-distance-time-trial (TT), maximum-oxygen-consumption (VO2max), running-economy (RE). Systematic-review (Scopus, Wed of Science, Sports Discuss, PubMed) with meta-analysis was conducted following PRISMA standards. Inclusion-criteria (PICOS) were: recreational or well-trained athletes aged 18-45 performing concurrent-training ≥five-week. Used search-terms were related to different types of strength/endurance, participants’ age, sport-modality. 20 manuscripts were selected, quality-assessed with PEDro. MAX training is more effective than EXP, COMB in improving VJ, 1RM, PV, while COMB is more effective than MAX, EXP to enhance TT. MAX is more effective than EXP in improving LT. Concurrent-workouts do not provide additional benefits to VO2max. It is unknown which strength-modality (MAX, EXP or COMB) is more effective in improving RE. Concurrent-training is more effective than single-mode-endurance-training for enhancing specific performance-variables in adult-endurance-runners. Middle-, long-distance-runners may consider incorporating MAX-training to target specific goals, e.g., improving VJ, 1RM, LT, PV while utilizing COMB-training to enhance TT. Certain variables may benefit from EXP. New randomized-controlled-trials are required to confirm these findings.

Abstract: Background: The optimal strategy for the microelimination of HCV within community settings remains ambiguous. We evaluated the percentage of participants who achieved linkage to care (LTC) following the conclusion of the screening campaign, and examined the diverse factors influencing LTC among these individuals. The effectiveness of recall intervention for the non-LTC population and its barriers were analyzed. Methods: We initiated an HCV patients recall program to identify the HCV participants who might not be treated after the HCV screening campaign. A program staff recalled HCV participants who lost to follow-up through the telephone from March 2019 to June 2019. They were informed of HCV treatment's importance, efficacy, availability, and safety. Result: Among 185 HCV-infected participants, 109 (58.9%) HCV-infected participants had obtained LTC. Compared with those who had LTC, those without LTC were older, lower education levels, were less aware of their HCV infection, less frequently lived in urban areas, and had less health insurance. At the end of the recall program, 125 (67.6 %) persons had liked to care. The proportion of LTC increased by 8.7 %. 119 persons had an HCV RNA test, and 82 (68.9%) had viremia. Of 82 patients with viremia, 78 (95.1%) received antiviral therapy. 76 (97.4 %) of them achieved a sustained virological response. Conclusion: After a community screening campaign, 59 % of participants with anti-HCV positive had LTC. The recall program can increase by 9 %. However, there were still 32% of HCV participants who couldn't be linked to care. Outreach care for non-LTC patients is a way worth trying to achieve micro-elimination of HCV in the rural community.

Deep inhalation breath hold (DIBH) has become a valuable technique in left breast cancer radiotherapy, offering the possibility to reduce radiation exposure to organs at risk (OARs) and minimize the risk of cardiac complications. The treatment method involves patients stopping breathing during irradiation to temporarily distance the heart from the radiation field, reducing potential cardiac and other complications. Research shows that DIBH reduces the radiation dose to the heart and lungs. However, the effectiveness of DIBH is determined by a variety of factors, including the patient's training, cooperation, anatomical features, age and choice of radiotherapy technique. Additionally, cardiovascular risk factors: diabetes, smoking, hypertension can affect the effectiveness and potential complications of DIBH. Moreover, lack of consent, fear, anxiety, depression and comorbid psychiatric disorders disqualify some patients from the DIBH treatment method. Careful patient selection, comprehensive training and optimization of treatment parameters are essential to maximize the benefits of DIBH while minimizing potential side effects. DIBH enhancement techniques, such as IMRT or VMAT, also have an important role to play. The purpose of this review article is to summarize the factors affecting the efficacy and side effects of DIBH in radiation therapy for left breast cancer, with the aim of optimizing its clinical application while minimizing side effects.

Colonoscopy, essential for diagnosing and treating colorectal cancer, relies on effective bowel preparation to inspect the colonic mucosa fully. Traditional education methods include printed instructions and verbal explanations, but these may not ensure clear patient understanding. Poor bowel preparation can obscure mucosal visibility, delaying cancer diagnosis and treatment. Using the outpatient’s Android mobile device, the mobile health care model is provided as a nursing guide to assist in bowel preparation for colonoscopy. This single-blinded, randomized trial en-rolled patients for colonoscopy at a Northern Taiwan gastroenterology center. Eligible patients were physically and mentally healthy and could communicate in Chinese. The study tested the ColonClean app during bowel preparation. After the procedure, endoscopists rated the prepara-tion quality using the Aronchick Scale. Data analysis with SPSS software (version 25.0) evaluated if the app significantly improved bowel preparation compared to those who did not use it. Forty patients were recruited for both the control (conventional method) and experimental (conven-tional method plus ColonClean app) groups. In the experimental group, endoscopists assessed bowel preparation quality; all achieved at least "Fair," with 75% receiving "Excellent" or "Good" ratings. The ColonClean App enhanced bowel preparation quality more effectively than tradi-tional nursing guidance.

Algorithmic systems used in healthcare contexts are primarily developed for the benefit of the public. It is therefore essential that these systems are trusted by the individuals for whose benefit they are deployed. Drawing inspiration from the principles embedded in the testing of the safety, efficacy and effectiveness of new medicinal products, concurrent design engineering and pro-fessional certification requirements, the authors propose, for the first time, a preliminary com-petency-based ‘Algorithmic Ethics’ Effectiveness Impact Assessment’ framework for developers of AI systems used in healthcare contexts. They concluded that this set of principles should en-compass the algorithmic systems ‘production lifecycle’, to guarantee the optimized use of the AI technologies, avoiding biases and discrimination while ensuring the best possible outcomes, simultaneously increasing decision-making capacity and the accuracy of the results. As AI is as good as those who program it and the system in which it operates, the robustness and trustworthiness of their ‘creators’ and ‘deployers’, should be fostered by a certification system guaranteeing the latter’s knowledge and understanding of ethical aspects as well as their com-petencies in integrating these aspects in trustworthy AI systems when used in healthcare con-texts.

A key step in the study of tree pathology is the identification of appropriate method for inoculating pathogens of diseases in branch and trunk. Pathogens of diseases in branch and trunk are commonly inoculated through punching, burning, and toothpick inoculation. However, there is a lack of comparative analysis of the inoculation outcomes of these three methods. In this work, Six‐year‐old P. alba var. pyramidalis were inoculated with V. sordida, using punching, burning, and toothpick techniques, respectively, to investigate the differences in the effectiveness of these inoculation methods. Results reveal that the incidence rate was 93.55% in the toothpick inoculation group, significantly higher than 80.65% in the burning inoculation group (p = 0.007), while punching inoculation exhibited significant pathological responses in the early stages, with spontaneous healing in the later stage. Addi-tionally, toothpick inoculation was more efficient in inducing Valsa canker when inoculating the pathogen at the bottom of the tree, with lower intra‐ and inter‐row spacing (stand density) providing better outcomes than higher intra‐ and inter‐row spacing. The results of this study demonstrate that toothpick inoculation is an optimal option for studying the artificial inoculation of V. sordida in six‐year‐old P. alba var. pyramidalis, providing technical support for research on poplar diseases and offering a theoretical basis for the inoculation of other diseases in branch and trunk.

Background: Large-cell neuroendocrine carcinoma presents significant treatment challenges owing to its rarity and limited therapeutic options. The LANCE study was designed to explore the survival benefits of incorporating atezolizumab in chemotherapy for metastatic LCNEC. Methods: In this non-randomized study, patients with metastatic LCNEC were treated with ei-ther standard chemotherapy plus atezolizumab or standard chemotherapy alone. The primary outcomes measured were progression-free survival (PFS) and overall survival (OS), with an ex-ploratory analysis of miR375 in plasma as a potential biomarker. Results: Of the 22 screened patients, 17 met the inclusion criteria and were stratified into the atezolizumab and chemotherapy (n=10) or chemotherapy alone(n=7) groups. After a median follow-up of 23.3 months, the 12-month survival rate for the atezolizumab group was 57.1% (95% CI: 32.6%-100%) and 45.7% at 24 months (95% CI: 22.4%-93.2%). In contrast, the chemotherapy group had a 14.3% survival rate at both 12 and 24 months (95% CI: 2.33%-87.7%). The log-rank test for survival showed a statistically significant difference in the atezolizumab-treated group (chi-squared = 4, df = 1, p = 0.04). A non-significant correlation was found between disease pro-gression and elevated levels of miR375. Conclusions: This pilot study suggests that atezolizumab combined with chemotherapy may be effective in treating metastatic LCNEC. The non-significant correlation between plasma miR375 levels and disease progression suggests its biomarker potential, warranting further validation research.

The advent of artificial intelligence (AI) has revolutionized digital marketing, offering unprecedented levels of personalization. AI-driven personalization leverages machine learning algorithms and data analytics to tailor content, advertisements, and recommendations to individual consumers based on their behavior, preferences, and demographics. This paper explores the effectiveness of AI-driven personalization in enhancing customer engagement, increasing conversion rates, and improving overall marketing efficiency. It also examines the ethical considerations associated with these technologies, including data privacy, consent, and the potential for manipulation or bias. While AI-driven personalization can lead to more relevant and engaging consumer experiences, it raises critical ethical questions that must be addressed to ensure responsible and fair use. The study concludes with recommendations for marketers and policymakers to balance the benefits of AI personalization with the need for ethical standards and consumer protection.

Knee osteoarthritis is the most popular type of osteoarthritis that causes extreme pain in elderly. Currently there is no cure for osteoarthritis. To lessen clinical symptoms, glucosamine was suggested. The primary goal of our study is to evaluate the efficacy and safety of glucosamine from recent studies. Electronic databases such as PubMed, Scopus, Cochrane were used to assess RCT. From the beginning through March 2023, the papers were checked, and if they fulfilled the inclusion criteria, they were then examined. WOMAC and VAS scales were considered as main outcome measure. A total of 15 studies were selected. Global pain was significantly decreased in comparison to placebo, as measured by the VAS index, with an overall effect size SMD of -7.41 ([95% CI] 14.31, 0.51). The WOMAC scale confirmed that pain, stiffness, and physical function had improved, however the effects were insufficient. A statistical update also revealed that there were no reports of serious medication interactions or significant adverse events. To summarize, glucosamine is more effective than a placebo at reducing pain in knee osteoarthritis patients. In long-term treatment, oral glucosamine sulfate 1500 mg/day is believed to be well tolerated.

The natural hosts regarding Orthohantaviruses are rodents, soricomorphs and bats, and it is well known they may cause serious or even fatal diseases among humans worldwide. The virus is persistent among animals and it is shed via urine, saliva and feces, throughout the entirety of their lives. We aim to identify the effectiveness regarding hantavirus detection from rodent tissue samples and urine originating from naturally infected rodents. Initially, animals were trapped at five distinct locations throughout the Transdanubian region in Hungary. Lung, liver, kidney and urine samples were obtained from 163 perished animals. All organs and urine were tested using nested reverse transcriptase-polymerase chain reaction (nRT-PCR). Furthermore, sera were examined for IgG antibodies against DOBV and PUUV viruses by Western Blot assay. IgG antibodies against hantaviruses and/or nucleic acid were detected in 25 (15.3%) cases. Among Apodemus, Myodes, and Microtus rodent species, DOBV, PUUV, TULV were all clearly identified. The virus nucleic acid was detected most effectively from the kidney (100%), while only 55% of screened lung tissues were positive. Interestingly, only 3 out of 20 rodent urine samples were positive regarding nRT-PCR. Moreover, five rodents were seropositive without detectable virus nucleic acid from any of the tested organs.

This study focuses on evaluating and improving the effectiveness of village fund management in Merauke Regency, South Papua. Village fund management faces unique challenges due to the region's geographical and socio-economic conditions. Organizational behavior transformation is critical, particularly in addressing weaknesses in organizational structure, communication, work culture, and monitoring systems, to achieve sustainable development outcomes. A qualitative case study approach was employed, with data collected through in-depth interviews, participant observation, and document analysis between May and August 2024. Merauke Regency was selected for its diversity in management practices. Thematic analysis and triangulation techniques were used to ensure the reliability and validity of findings. The findings reveal that transforming the organizational structure from hierarchical to flexible team-based models, improving communication, and fostering a positive work culture significantly enhanced village fund management. These changes led to better coordination, responsiveness, efficiency, and transparency. Increased community participation and strengthened monitoring and evaluation also contributed to more effective development outcomes.This study provides practical recommendations for policymakers to design more sustainable and inclusive village fund management strategies. Data-driven and participatory approaches are crucial for maximizing development impacts and ensuring socio-economic benefits at the village level.

Background: Signaling by toll like receptors (TLRs) initiates important immune responses against viral infection. The role of TLRs in severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections is not well elucidated. Thus, we investigated the interaction of TLRs agonists and SARS-COV-2 antigens with immune cells in vitro. Material & methods: 30 coronavirus disease 2019 (COVID-19) patients (15 severe and 15 moderate) and 10 age and sex matched control (HC) were enrolled. Peripheral blood mononuclear cells (PBMCs) were isolated and activated with TLR3, 7, 8 and 9 agonists, the spike protein (SP) of SARS-CoV-2 and the Receptor Binding Domain (RBD) unit of SP. Frequencies of CD3⁺IFN-β⁺ T cells, and CD3⁺IFN-g⁺ T cells was evaluated by flow cytometry. Interferon (IFN)-b gene expression was assessed by qRT-PCR. Results: The frequency of CD3+IFN-β+ T cells was higher in moderate and severe patients at baseline in comparison with HCs. Stimulation of PBMCs from moderate patients with SP and TLR8 agonist significantly upregulated the frequency of CD3+IFN-β+ T cells (P=0.0005 and 0.0024, respectively) when compared to non-stimulated (NS) samples. The greatest increase in CD3⁺IFN-b⁺ T cell frequency in PBMCs from severe patients was seen with TLR8 and TLR7 agonists when compared to NS (P= 0.003 and 0.0167, respectively). TLR stimulation did not significantly enhance the frequency of CD3+IFN-g+ T cells generated from PBMCs from moderate and severe patients compared with unstimulated controls. However, the frequency of CD3+IFN-ɣ+ T cells in PBMCs from moderate patients was upregulated by agonists of TLR3, 8 and 9, SP and RBD when compared with NS samples from HCs. The expression of the IFN-β gene after stimulation of CD3⁺T cells with the TLR8 agonist was also up-regulated in moderate than severe patients (moderate vs. severe: p=0.0006). In addition, stimulation of CD3⁺ T cells with SP, up-regulated the expression of IFN-β gene expression in cells from patients with moderate disease (moderate vs. severe: p=0.01). Conclusion: Stimulation of PBMCs from COVID-19 patients with a TLR8 agonist and with SP enhanced IFN-b protein and gene levels. This may potentiate immune responses against SARS-CoV-2 infection and prevent viral replication and spread.

As traditional cultural heritage education gradually reduces students' exposure to the physical environment, it is more difficult to stimulate students' awareness of and interest in local culture. The concepts of cultural preservation and sustainable development have not yet been effectively integrated into teaching. Therefore, this study developed an alternative reality game (ARG) combined with a learning scaffold to enable students to gain a deeper understanding of the history and cultural heritage of Taiwan during the Japanese rule period through an immersive learning experience, and to explore and solve real-world problems in an interactive environment, which helped students understand the concepts of cultural preservation and sustainable development. The results of the study showed that the experimental group of students using the ARG integrated learning scaffold significantly outperformed the control group in terms of learning effectiveness and engagement. Students in the experimental group not only had a deeper understanding of the curriculum content, but also showed higher behavioral and emotional engagement. In addition, students' awareness of cultural preservation and sustainable development increased, which indicates that the materials developed in this study are effective in promoting their deeper understanding of local educational development and cultural identity. This study confirms that the combination of innovative technology and gamified instruction not only enhances students' learning effectiveness, but also promotes their understanding of cultural heritage. Future research should further optimize the use of technology to reduce the impact of operational difficulties on students' learning experience and explore how alternative reality game (ARG) technology can be used in more subject areas.

Antiviral therapy such as Oseltamivir has been recommended for hospitalized children with suspected and confirmed influenza for almost 20 years. The therapy is officially authorized for newborns two weeks of age or older, however, questions about its safety and effectiveness still surround it. Our goal was to assess the epidemiological features of two consecutive seasonal in-fluenza cases in children following the COVID-19 pandemic and also to observe the clinical ef-fectiveness and tolerability of oseltamivir in hospitalized children who were not vaccinated against influenza and who had different influenza subtypes, including A (H1N1), A (H3N2), and influenza B, and to identify specific comorbidities associated with influenza in children. We performed an observational study on 1300 children, enrolled between 1st October 2022 and 30th May 2023 and 1st October 2023-4th of May 2024, to the IX Pediatric Infectious Diseases Clinical Section of the National Institute of Infectious Diseases "Prof. Dr. Matei Balș". During the 2022-2023 influenza sea-son, 791 pediatric patients tested positive for influenza and received Oseltamivir. Of these, 89% (704/791) had influenza A, with 86.4% subtypes A(H1N1) and 13.6% of cases had A(H3N2), and influ-enza B 11%(87/791) pediatric patients. Of the total group, 59% were male, and the median age was 2,4 years (1.02-9.28). For the 2023-2024 influenza season, 509 pediatric patients tested positive for influen-za, 56.9% were male gender and were treated with Oseltamivir. 81.6 % had Influenza A, and 18.4% had influenza B. Treatment with neuraminidase inhibitors like Oseltamivir, 2mg/kg/dose twice daily for 5 days, was well tolerated by the children, and we recorded no deaths. The duration of fever hospitaliza-tion after the Oseltamivir administration was significantly longer for patients with A(H1N1) infection than A(H3N2), during both seasons. We identified more complications in the 2022-2023 season and a decreasing number of Influenza B for the 2023-2024 season. Among children with comorbidities, the most common were asthma, gastrointestinal disorders, and metabolic and endocrine diseases. In terms of effectiveness, oseltamivir significantly reduced the intensity of influenza symptoms, thus reducing the number of days of hospitalization (p=0.001) as well as post-infection complications (p=0.005) in both groups. Oseltamivir was less effective in Influenza A (H1N1) than A(H3N2), (p=0.0035). In this study, we evaluated the clinical effectiveness of oseltamivir therapy for all influenza types/subtypes in children, and the length of hospitalization. We identified comorbidities associated with prolonged dura-tion of hospitalisation. Influenza vaccination should be the main tool in the prevention of influenza and its complications in children, especially with comorbidities.

The rodent collecting duct (CD) expresses a 24p3/NGAL/lipocalin-2 (Lcn2) receptor (Slc22a17) apically to possibly mediate high-affinity reabsorption of filtered proteins by endocytosis, yet its functions remain uncertain. Recently, we showed that hyperosmolarity/-tonicity upregulates Slc22a17 in cultured mouse inner medullary CD cells, whereas activation of toll-like receptor 4 (TLR4) via bacterial lipopolysaccharides (LPS) downregulates Slc22a17. This is similar to the upregulation of Aqp2 by hyperosmolarity/-tonicity and arginine vasopressin (AVP) and downregulation by TLR4 signaling that occur via the transcription factors Nfat5 (TonEBP or OREBP), cAMP-responsive element binding protein (CREB), and nuclear factor-kappa B, respectively. The aim of the study was to determine the effects of osmolarity/tonicity via Nfat5, AVP via CREB and TLR4 signaling on the expression of Slc22a17 and its ligand Lcn2 in the mouse (m) cortical collecting duct cell line mCCD(cl.1). Normosmolarity/-tonicity was 300 mosmol/l whereas addition of 50-100 mmol/l NaCl for up to 72 h induced hyperosmolarity/-tonicity (400-500 mosmol/l). RT-PCR, qPCR, immunoblotting and immunofluorescence microscopy detected Slc22a17 and Lcn2 expression. RNAi silenced Nfat5, and the pharmacological agent 666-15 blocked CREB. Activation of TLR4 occurred with LPS. Similar to Aqp2, hyperosmotic/-tonic media and AVP upregulated Slc22a17 via activation of Nfat5 and CREB, respectively, and LPS/TLR4 signaling downregulated Slc22a17. Conversely, though Nfat5 mediated hyperosmolarity/-tonicity induced downregulation of Lcn2 expression, AVP reduced Lcn2 expression and predominantly apical Lcn2 secretion evoked by LPS, but through a posttranslational mode of action that was independent of cAMP signaling. In conclusion, the hyperosmotic/-tonic upregulation of Slc22a17 in mCCD(cl.1) cells via Nfat5 and by AVP via CREB suggests a contribution of Slc22a17 to adaptive osmotolerance, whereas Lcn2 downregulation could counteract increased proliferation and permanent damage of osmotically stressed cells.

Context: As software industries, adopted different frameworks where Scrum is play a vital role in different software industries. Scrum basis the three main stakeholders i.e. Product Owner, Scrum Master and Development. Where Scrum Master is a very crucial role for any agile project. However, in the past Scrum Master Faces different challenges, which discovered in several studies. However, we need to measure the effectiveness of the Scrum master in Agile Projects, how presently Scrum Master are performing in Pakistani software industries. Objective: The main objective of this research to identify the effectiveness of the Scrum Master in agile projects in Pakistani software industries. Method: Research Method (Qualitative Research) For this purpose, we gathered the facts from Pakistani software industries by using the qualitative method. We conducted a survey from different software industries; almost 12 participants responded the survey as per their best knowledge as well as they agreed for face- to-face interviews. Results: The results indicated that, mostly organization compliance with the Scrum ceremonies. In addition, 65% Scrum Masters has a great effectiveness in any agile project. 21% of Scrum Master generates negative impact in agile project. Conclusion: The main highlights of this research, we have presented the compliance of the Scrum in different software organization. Further, we explore the both positive and negative impact of the Scrum master in Pakistani software organizations.

Dealing with randomness is a crucial aspect that cost-effectiveness analysis (CEA) tools need to address, but existing stochastic CEA tools have rarely examined risk and return from the perspective of global benefits. This paper proposes a stochastic CEA tool that supports medical decision-making from the perspective of global benefits of risk and return, the risk-adjusted incremental cost-effectiveness ratio (ICER). The tool has a traditional form of ICER but uses the risk-adjusted expected cost. Theoretically, we prove that the tool can provide marginal medical decisions that promote the risk-return level on global benefits within any intervention structure and can also serve as a discriminating condition for the optimal intervention structure. Numerical simulations within a framework of mean-variance support the conclusions in this paper.

Severe Acute Respiratory Syndrome Coronavirus 2(SARS-CoV-2) is the virus that caused COVID-19 around the world. The disease starts off as a flu-like symptom and then eventually spreads in the human body.Infections are easily transmitted from human to human which makes it more severe among individuals. SARS-CoV-2 virus is in the same family of viruses SARS and MERS.As of today, there is no approved vaccine that can cure COVID-19. However, potential treatments showing promising improvement results among affected COVID-19 patients. In this review, the effectiveness of the current treatments for COVID-19 has been explored.

The pollution of the bays in Abidjan is a major concern for the Ivorian policy makers. In fact, the pollution of the bays induce high costs to the society while impacting population health dramatically. As a result, pollution reduction management of production activities has been undertaken in the Cocody Bay area. To our knowledge, no study has yet proposed a model to evaluate the cost-effectiveness of these pollution management strategies. A cost-effectiveness model, based on Monte Carlo simulation, was developed to assess the economic and environmental impacts of various scenarios characterized by a set of production practices, both in the short term and in the long term. The authors discuss the steps and input parameters of the model presented. The proposed model may serve as the basis for identifying an optimal production scenario defined as the scenario with the best incremental cost-effectiveness ratio considering a willingness to pay (WTP) threshold. The WTP, to be estimated based on the gross domestic product of Côte d’Ivoire, represents the opportunity costs associated with selecting the optimal scenario. The current framework can also be applied to other settings facing similar challenge.

Our study aimed to identify predictors for the effectiveness of tumor regression in lung cancer patients undergoing neoadjuvant treatment and cancer resections. Patients admitted between 2016 and 2022 were included in the study. Based on the histology of the tumor, patients were categorized into lung adenocarcinoma group (LUAD), and squamous cell carcinoma group (SQCA). Ninety-five patients with non-small cell lung cancer were included in the study. Fifty-eight (61.1%) and 37 (38.9%) patients were included in the LUAD and SQCA groups, respectively. Nine (9.5%), 56 (58.9%), and 30 (31.6%) patients were categorized with a tumor regression score of I, II, and III respectively. In multivariable analyses, histology of the primary tumor (SQCA), lymph node size in the preoperative CT scan (>1.7cm) and absolute tumor size reduction after neoadjuvant treatment (>2.6 cm) independently predict effectiveness of tumor regression (OR, [95% Confidence interval, p-value] of 6.88 [2.40-19.77, p70 years, extended resection >one lobe, and tumor recurrence or metastasis were identified as significant independent predictors of reduced overall survival. Assessment of tumor size before and after neoadjuvant treatment might help to identify high-risk patients with decreased survival and to improve patient management and care.

Digital transformation is revolutionizing supply chain management, profoundly influencing marketing effectiveness across industries. This qualitative study explores the impact of digital transformation on supply chains and its implications for marketing strategies. Through in-depth interviews, case studies, and document analysis, the research elucidates how digital technologies such as IoT, blockchain, AI, and advanced analytics are reshaping supply chain dynamics. Key findings highlight enhanced supply chain visibility, improved decision-making capabilities, and strengthened collaboration among supply chain partners. These technological advancements empower organizations to optimize inventory management, anticipate market trends, and deliver personalized customer experiences, thereby enhancing operational efficiency and customer satisfaction. Furthermore, the study underscores the role of digital transformation in promoting sustainability and ethical practices within supply chains. Technologies like blockchain facilitate transparent and traceable supply chains, supporting initiatives for responsible sourcing and environmental stewardship. Despite the transformative benefits, the study identifies challenges including significant investment requirements, integration complexities, and data security concerns. Strategic approaches to technology adoption, robust cybersecurity measures, and employee training are essential for overcoming these challenges and maximizing the benefits of digital transformation. Overall, this study contributes to understanding how digital transformation drives innovation in supply chain management and enhances marketing effectiveness. By embracing digital technologies and aligning supply chain strategies with marketing objectives, organizations can navigate competitive landscapes, meet evolving consumer expectations, and achieve sustainable growth in the digital era.

Background: Advances in additive manufacturing and the development of antimicrobial biopolymers facilitate the production of critical medical devices with strong and safe biocidal properties. The purpose of this study was to assess the antimicrobial efficacy, safety, and longevity of a polylactic acid-based biopolymer supplemented with a copper-based composite additive. Methods: An antimicrobial polylactic acid-based biopolymer was tested against several inoculants including Staphylococcus Aureus, MRSA, E. coli, Listeria, HCoV-229E (a SARS-CoV-2 surrogate), and HIV-1. Material safety was evaluated according to international testing standards for in vitro cytotoxicity. Results: The main findings of the present investigation showed a strong and long-lasting biocidal effect of a polylactic acid-based biopolymer embedded with a copper-based composite additive against Staphylococcus Aureus, MRSA, E. coli, Listeria, HCoV-229E (a SARS-CoV-2 surrogate), and HIV-1. Furthermore, the cytotoxicity and safety assessment of the antimicrobial biopolymer was found to be “non-toxic” and safe for human skin contact. Conclusions: The present investigation showed that the antimicrobial biopolymer exhibits strong and long-lasting biocidal properties against an array of viral and bacterial inoculants.

Background: Narcolepsy is characterized by excessive daytime sleepiness (EDS) and episodes of cataplexy, frequently triggered by psychological stress, significant disturbances in sleep-wake cycles, pregnancy, or trauma. Modafinil is widely used as the preferred treatment due to its effectiveness in alleviating EDS, improving disease outcomes, and enhancing overall quality of life. Nonetheless, long-term safety and efficacy data are still lacking, underscoring the importance of future research to advance treatment options for narcolepsy. Aim: In our systematic review and meta-analysis, we aim to assess the effectiveness of Modafinil in the treatment of Narcolepsy. Methods: We searched in electronic databases (PubMed, Embase, Google Scholar, Scopus, Science Direct, Web of Science) was performed to identify cohort studies and randomized controlled trials (RCTs) up to 8th July 2024. Data extraction focused on baseline characteristics of the included studies and efficacy outcomes, including scores on the Maintenance of Wakefulness Test (MWT) and Epworth Sleepiness Scale (ESS) . We performed the meta-analysis utilizing the Review Manager software, version 5.4. To assess the outcomes, we compared the Modafinil-treated group with the placebo group, employing the mean difference (MD) and a 95% confidence interval (CI) for statistical analysis. Result: In total, 3833 articles were identified for screening, with nine studies included in the systematic review and five in the meta-analysis. These studies involved 997 adult patients with Narcolepsy treated with Modafinil. MWT revealed a significant increase in total scores (MD= 3.56, 95% CI [2.25 to 4.86], p < 0.00001) and ESS revealed a significant decrease in scores (MD= -3.34, 95% CI [-4.13 to -2.56], p < 0.00001). Conclusion: The research emphasizes the potential of Modafinil in alleviating EDS associated with Narcolepsy. While the results are promising, they are based on short term scale studies. It is crucial to undertake larger-scale, extended-duration, placebo-controlled studies that include a broad range of demographic populations. These trials are essential to confirm the efficacy, verify the safety profile, and fine-tune dosing strategies to maximize the long-term therapeutic benefits.

Background: Although confirmed cases of infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) have been declining since late 2020 due to general vaccination, little research has been done regarding the impact of vaccines against SARS-CoV-2 in Spain in terms of hospitalizations and deaths. Objective: Our aim was to identify the reduction in severity and mortality of coronavirus disease 2019 (COVID-19) at a nationwide level due to vaccination. Methods: We designed a retrospective, population-based study to define waves of infection and to describe the characteristics of the hospitalized population. We also studied the rollout of vaccination and its relationship with the decline in hospitalizations and deaths. Finally, we developed two mathematical models to estimate non-vaccination scenarios using machine learning modeling (with the ElasticNet and RandomForest algorithms). The vaccination and non-vaccination scenarios were eventually compared to estimate the number of averted hospitalizations and deaths. Results: In total, 498,789 patients were included, with a global mortality of 14.3%. We identified six waves or epidemic outbreaks during the observed period. We established a strong relationship between the beginning of vaccination and the decline in both hospitalizations and deaths due to COVID-19 in all age groups. We also estimated that vaccination prevented 170,959 hospitalizations (CI 95% 77,844–264,075) and 24,546 deaths (CI 95% 2,548–46,543) in Spain between March 2021 and December 2021. We estimated a global reduction of 9.19% in total deaths during the first year of COVID-19 vaccination. Conclusions: Demographic and clinical profiles changed over the first months of the pandemic. Patients over 80 years old and other age groups obtained clinical benefit from early vaccination. The severity of COVID-19, in terms of hospitalizations and deaths, decreased due to vaccination.

Hyperbaric oxygen (HBO) treatment has been proven to attenuate neuroinflammation in rats. This study aimed to determine the potential mechanism underlying the anti-inflammatory effects of HBO treatment on burn-induced neuroinflammation in rats. Thirty-six adult male Sprague–Dawley (SD) rats were randomly assigned to the following six groups (n = 6 per group): (1) sham burn with sham HBO treatment, (2) sham burn with HBO treatment, (3) burn with 1-week sham HBO treatment, (4) burn with 2-week sham HBO treatment, (5) burn with 1-week HBO treatment, and (6) burn with 2-week HBO treatment. SD rats that received third-degree burn injury were used as a full-thickness burn injury model. Subsequently, we analyzed the expression of proteins involved in the galectin-3 (Gal-3)-dependent Toll-like receptor-4 (TLR-4) pathway through enzyme-linked immunosorbent assay (ELISA), immunohistochemistry (IHC) analysis, and Western blotting, and a behavior test was also conducted. The behavior test revealed that HBO treatment significantly suppressed mechanical hypersensitivity in the burn with HBO treatment group compared with the burn with sham HBO treatment group (p < 0.05). ELISA results showed that tumor necrosis factor alpha (TNF-α) and interleukin 1 beta (IL-1β) levels in the dorsal horn of the spinal cord and the skin were significantly decreased in the burn with HBO treatment group compared with the burn with sham HBO treatment group (p < 0.05). Western blotting results demonstrated that HBO treatment significantly reduced the expression of Gal-3 and TLR-4 in the dorsal horn of the spinal cord in the burn with HBO treatment group compared with the burn with sham HBO treatment group (p < 0.05). IHC analysis results showed that the expression of Gal-3, TLR-4, CD68, and CD45 in the dorsal horn of the spinal cord was significantly lower in the burn with HBO treatment group than in the burn with sham HBO treatment group (p < 0.05), and the expression of CD68 and macrophage migration inhibitory factor (MIF) in the right hind paw skin was significantly lower. The expression of vimentin and fibroblast growth factor (FGF) in the right hind paw skin was significantly higher after HBO treatment (p < 0.05). This study proved that early HBO treatment relieves neuropathic pain, inhibits the Gal-3-dependent TLR-4 pathway, and suppresses microglia/macrophage activation in a rat model.

We aimed to directly compare the cost-effectiveness of the NELSON and NLST screening protocols, two trials influencing lung cancer screening implementation internationally. A decision-analytic model analyzing the cost-effectiveness of the NELSON protocols was manipulated to reflect the protocols of the NLST, while maintaining features specific to the Hungarian healthcare setting. In the NELSON protocol, there are three possible outcomes to the initial round of screening: positive, negative, or indeterminate, indicating an uncertain degree of suspicion for lung cancer. This pro-tocol differs from the NLST protocol, in which the only possible screening outcomes are positive or negative, with no indeterminate option. The NLST pathway for smokers aged 55-74 resulted in a 43 € increase in total average lifetime costs compared to the Hungarian screening pathway and re-sulted in a lifetime gain of 0.006 QALYs. The incremental costs and QALYs yield an ICER of 7875 €/QALY. Our results demonstrate that assigning any suspicious LDCT screen as a positive result (NLST protocol) rather than indeterminate (NELSON protocol) can yield a slight QALY gain that is worth the additional use of resources according to Hungary’s willingness to pay threshold. Our study provides insight on the cost-effectiveness, advantages, and disadvantages of various LDCT screening protocols for lung cancer and can assist other countries as they implement their screening programs.

A mathematical model that incorporates human attacks on dogs is presented to explore the dynamics of rabies transmission. The model divided the infection rate into two categories: dog-to-dog transmission rates during the prodromal phase (βdP) and the furious phase (βdF). It has been determined that the model is well-posed and that all of the solutions are positive, as well as the feasibility and positivity of the model's solutions. Both the basic reproduction number (R0) and the effective reproductive number (Re) are computed, and it is demonstrated that the model has a unique disease-free equilibrium that is globally asymptotically stable whenever Re < 1. To identify the model's most sensitive parameters and the ones that intervention efforts should focus on, sensitivity analysis of the effective reproduction number is carried out. We can construct an optimal control system using the state equations, the adjoint equations, and the optimality condition that determines the controls by applying Pontryagin's Maximum/Minimum principle. To help decision-makers in allocating funds for rabies interventions, cost-effectiveness analyses are conducted. To determine the degree to which the intervention strategies are advantageous and cost-effective, this study performs a cost-effective analysis of one or all possible combinations of the optimal rabies control strategies (pre-exposed and post-exposed vaccination for both dog and human populations) for the four different transmission settings. After arranging the techniques to increase effectiveness (total infections prevented), a cost-effective analysis using the Incremental Cost Effectiveness Ratio (ICER) was conducted. The result supports the function that the four intervention options are performing to either completely eradicate or significantly reduce rabies disease among the populations. The dynamical behavior of the system is studied through simulations using the ode45 numerical technique from MATLAB.

In the Emergency Department (ED), pain is one of the symptoms that is most frequently reported, making it one of the most significant issues for the emergency physician, but is frequently under treated. Intravenous (IV), oral (PO), and intramuscular (IM) delivery are the standard methods for administering acute pain relief. Firstly, we compared the safety and efficacy of IN analgesia to other conventional routes of analgesia to assess if IN analgesia may be an alternative for the management of acute pain in ED. Secondary, we analyzed the incidence and severity of adverse events (AEs) and rescue analgesia required. We performed a systematic review-based keywords in Pubmed/Medline, Scopus, EMBASE, the Cochrane Library and Controlled Trials Register finding only twenty randomized Clinical trials eligible in the timeline 1992-2022. A total of 2098 patients were analyzed and compared to intravenous analgesia showing no statistical difference in adverse effects. In addition, intranasal analgesia also has a rapid onset and quick absorption. Fentanyl and ketamine are two intranasal drugs that appear promising and may be taken simply and safely while providing effective pain relief. IN is simple to administer, non-invasive, rapid onset and quick absorption; it might be a viable choice in a variety of situations to reduce patient suffering or delays in pain management. Analgesia needs to be tailored to each patient's features and type of pain: IN Fentanyl and Ketamine look promising and may be administered easily and safely while providing effective pain relief.

Stormwater management is a key urban issue in the world, in line with the global issues of urban sprawl and climate change. It is urgent to investigate the effectiveness in managing stormwater with different strategies for maintain urban resilience. A method based on a storm water management model (SWMM) was developed for assessing the control of stormwater runoff volume and the percentage removal of suspended solids by implementing a Sponge City strategy. An interdisciplinary approach was adopted incorporating Low Impact Development (LID) with urban Green Infrastructure and Gray Infrastructure paradigms in a typical old residential community in Suzhou, China. Four types of sponge facilities for reducing stormwater runoff were bio-retention cells, permeable pavements, grassed pitches, and stormwater gardens. The simulation results indicate that the stormwater pipe system can meet the management standard for storms with a five-year recurrence interval. The volume capture ratio of annual runoff is 91% and the reduction rate of suspended solids is 56%. This study demonstrates that Sponge City strategy is an effective approach for managing stormwater, particularly in old and densely populated urban areas. Implementing spongy facilities with a LID strategy for stormwater management can significantly enhance urban water resilience and increase ecosystem services.

Varicella (chickenpox) is one of the most common infectious diseases in preschool children and can be prevented by immunization. While immunization program promotes higher vaccine coverage, there are still challenges with implementing vaccination programs particularly in low-income countries. Economic barriers can increase inequality in vaccination, which highlights the importance of distributing cost-effective varicella vaccines. Varicella vaccines have been developed with two main Varicella-Zoster Virus (VZV) strains globally: MAV/06 and Oka strains. Most of the vaccines are based on the Oka strain, while MAV/06 strain vaccines were exclusively developed by GC Biopharma. Although more than 30 million doses of MAV/06 vaccines as cost-effective vaccines have been distributed internationally, there is no comprehensive review on safety, immunogenicity, and effectiveness of MAV/06 vaccines in the literature. This paper aims to summarize and present more than 30 years of accumulated evidence from research on safety, immunogenicity, and effectiveness of MAV/06 vaccines. We expect that MAV/06 vaccines as cost-effective varicella vaccines make a significant contribution to improving global public health and health equality in children.

Background/Objectives: Population aging is rapidly increasing, and the importance of preventive medicine has been stressed. Health checkup, diet, and exercise are of paramount importance. This study aimed to evaluate the effectiveness of a personalized dual-task intervention that combined exercise with cognitive tasks in improving physical and cognitive functions among independently living elderly individuals. Methods: Participants were aged &gt;65 years who were mostly independent in their activities of daily living, divided into 2 groups. The group receiving the 20-min robot-assisted session was compared to the group receiving traditional functional restoration training. This randomized trial assessed the impact of this intervention on the 30-s chair stand test score and Montreal Cognitive Assessment-Japanese version score of the participants. Results: Both scores significantly improved in the intervention group, indicating enhanced lower-limb function and cognitive capabilities. Conclusions: These findings suggest that integrating cognitive tasks with physical exercise can be a potent strategy to improve overall well-being in the elderly, offering valuable insights for designing comprehensive preventive health programs tailored to this demographic.

Abstract: Using adjuvants to optimize and increase the efficacy of herbicides is an acceptable manner to reduce herbicides undesirable impact on the environment in sustainable agriculture. In this study, it was demonstrated that the application of 0.1% of the non-ionic surfactant (NIS, Contact) and 0.5 L ha-1 of a crop oil concentrate (COC, Renol) did not improve the efficacy of rimsulfuron on Amaranthus retroflexus. In contrast, the same treatments enhanced performance and rainfastnes of rimsulfuron in Chenopodium album in pot expriments. Increasing non-ionic surfactant concentration to 1 L ha-1 increased rimsulfuron performance around 11-fold for Amaranthus retroflexus compared to around 3-fold for Chenopodium album. The same treatment, also reduced the rainfastness of rimsulfuron on Amaranthus retroflexus while improving the rainfastness of rimsulfuron on Chenopodium album. Measured ED50 and ED90 values of rimsulfuron indicated that the addition of the 0.2 L ha-1 of NIS improved the recommended (60 g ai. ha-1) and the reduced (30 g ai. ha-1) of rimsulfurom in field. The highest potato yield measured (60 tons per ha) when 60 g ai. ha-1 rimsulfuron was applied at three stages (S1, S4, and S7) without using a NIS; not significant differences were measured when the same dose of rimsulfuron was applied at the three (S1, S4, and S7) and two (S1, S4) stages with NIS.

Background: In long-term care facilities, there are many residents who do not have the ability to seek shelter by themselves in the case of an emergency. Thus, it is extremely important that the staff of nursing homes are equipped with correct disaster prevention concepts, emergency survival responses, and hazard mitigation measures. Purpose: Discuss the intervention effectiveness of different fire prevention and emergency response trainings at nursing homes and the relationship and predictivity of awareness to self-efficacy. Method: Recruit staff from two nursing homes through purposive sampling, using a two-team pre-and post-test design to collect results from 41 individuals in the experiment group and 40 individuals in the control group. The research tool is the “Nursing Home Fire Prevention and Emergency Response Awareness and Self-Efficacy Scale,” to compare the effectiveness of advanced and general fire safety trainings. Result: After receiving improved advanced fire safety training, the total score and the result of the experiment group on fire prevention and emergency response awareness and self-efficacy had both performed better than the control group who received general fire safety training (p < .001); fire prevention and emergency response awareness has significant and positive correlation with self-efficacy (r=.601, p < .001), and awareness is a significant predictor variable to self-efficacy (p < .001). Conclusion/Practical Application: This study finds that the key to improving learning effectiveness includes adding fire science concept chapter when creating fire safety training material in order to strengthen basic awareness; fire safety training should comprehensively introduce all related duty responsibilities of staff fire defense formation, in turn enabling mutual responsive support for the needs of the site; also, to become familiarized with the knowledge requires appropriate frequency of training and enhancing the staff’s awareness to fire prevention and emergency response, which is the most important key of learning effectiveness.

Purpose: Melanoma’s incidence is increasing, and elderly people could be significantly impacted since the majority occurs in people over 65 years of age. Combined targeted therapies (TT) are current standard regimen for BRAF mutated metastatic melanoma (MM). Except for subgroups of pivotal trials, little data are available for TT in this population. Materials and Methods: Outcomes were explored in real life patients from MelBase, a French multicentric biobank dedicated to the prospective follow-up of unresectable stage III or IV melanoma. Patients treated by BRAF TT and/or MEK TT combined or not, were included from 2013 to 2017 in 2 groups: group 1 <65-year-old (yo), group 2 >65 yo, analyzed for tolerance and efficacy. Results: 353 patients were included: 231 in group 1, 122 in group 2. Median follow-up was 12 months (M). Median time of treatment was 6.9 M. A total of 80% had at least one Adverse Effect (AE). Most frequent AE (all grades) were mainly skin and subcutaneous, general, and gastrointestinal disorders. A total of 31% of AE were grade 3–4: 28% in group 1 and 39% in group 2 (p = 0.05). No differences were observed in all AE grades proportion, dose modifications, interruptions, and discontinuations. For each group, median overall survival was 20.3 M (CI 95%: 15.5–27.9) and 16.3 M (CI: 14.5–26.9), respectively (p = 0.8). Median progression free survival was 7.8 M (6.4–9.9) and 7.7 M (CI: 5.8–11.3) (p = 0.4). Objective response rate was 59% and 50% (p = 0.6). Conclusion: This study on a large multicentric cohort is the first to assess that TT is well tolerated in elderly BRAF-mutated patients such as in patients younger than 65. Efficacy was similar between groups with outcomes reaching those from pivotal studies. There is thus no argument against using TT in elderly people, although an onco-geriatric opinion is welcome for the most vulnerable.

Anthropogenic lead pollution is an environmental problem that threatens the quality of soils and waters and endangers living organisms in numerous surface and subsurface habitats. Lead coprecipitation on mineral surfaces through dissolution-recrystallization processes has long term effects on lead bioavailability. Gypsum and calcite are among the most abundant and reactive rock forming minerals present in numerous geological settings. In this work, we study the interaction of slightly acidic (pHi = 5.5) Pb-bearing aqueous solutions ([Pb]i = 1 mM and 10 mM) with crystals of gypsum and /or calcite under atmospheric conditions. This interaction results in a reduction of the concentration of lead in the liquid phase due to the precipitation of newly formed Pb-bearing solid phases. The extent of this Pb removal mainly depends on the nature of the primary mineral phase involved in the interaction. Thus, when gypsum is the only solid phase initially present in the system the Pb-bearing liquid-gypsum interaction results in Pb removals in the 98-99.8 % range, regardless of [Pb]i. In contrast, when the interaction takes place with calcite, Pb removal strongly depends on [Pb]i. It reaches 99% when [Pb]i = 1 mM while it is much more modest (⁓13%) when [Pb]i = 10 mM. Interestingly, Pb-removal is maximized for both [Pb]i (99.9 % for solutions with [Pb]i = 10 mM and 99.7% for solutions with [Pb]i = 1 mM) when Pb-polluted solutions simultaneously interact with gypsum and calcite crystals. Despite the large Pb removals found in most of the cases studied, the final Pb concentration ([Pb]f) in the liquid phase always is well above the maximum permitted in drinking water (0.1 ppm), with the minimum ([Pb]f = 0.7 ppm) being obtained for solutions with [Pb]i =1 mM after their interaction with mixtures of gypsum and calcite crystals. This result suggests that integrating the use of mixtures of gypsum-calcite crystals might help to develop more efficient strategies for in-situ decontaminating Pb-polluted waters through mineral coprecipitation processes.

On the eve of the Brexit process, in the context of a rising Euroscepticism that fuels the modest confidence of European citizens in their national and European institutions, the article assesses the efficiency and effectiveness of the European Parliament within the framework of the ordinary legislative procedure (co-decision). After defining and formulating the main indicators, the paper analyses the micro- and macro-performance of the European Parliament within the decision-making process from a quantitative-qualitative and a qualitative-quantitative perspective, highlighting the relativizing factors and the responsiveness of the European decision-making process to the Europeans’ needs.

Medication non-adherence remains a substantial obstacle in asthma care, prompting the exploration of novel therapeutic modalities that prioritize rapid symptom relief, anti-inflammatory activity and facilitate patients’ compliance. This task is well served by a new form of therapy - inhaled triple-combination medications ICS/LABA/LAMA (inhaled glucocorticosteroid/long-acting beta2-agonist/long-acting muscarinic antagonist). The integration of three medications within a singular inhalation device culminates in the reduction of the effective dose of the principal therapeutic agent for asthma management, namely, ICS. This consolidation yields a dual benefit of minimizing the likelihood of adverse effects typically linked with ICS while concurrently optimizing bronchodilator efficacy. The accumulated evidence suggests that adding LAMA to a medium- or high-dose ICS/LABA results in a decrease of asthma exacerbations compared to medium- or high-dose ICS/LABA alone, accompanied by sustained enhancements in lung function parameters. We propose in adult patients experiencing suboptimal asthma control despite medium/high-dose ICS/LABA treatment - regardless of adherence to GINA-recommended strategies, such as MART therapy as a first-line approach or alternative second-line strategies - the preferred course for intensifying asthma therapy involves the addition of a LAMA, ideally in the form of SITT.

Background/Objectives: High-intensity anaerobic physical training frequently results in muscle damage among boxers and kickboxers, which can impede performance and recovery. Vibrational therapy (VT) and passive rest (PR) have been employed as methods to enhance muscular recovery and performance. This study evaluates the effectiveness of these two recovery methods on upper limb muscle strength and lactate levels in plasma after high-intensity exertion. Methods: Eighteen elite boxers and kickboxers, aged 19-32 years, underwent tests employing VT and PR as recovery methods in a controlled, crossover study. Muscle performance was assessed via isokinetic dynamometry, and lactate levels were measured pre-exercise, post-exercise, and post-recovery. The study adhered to the Declaration of Helsinki guidelines and was approved by the relevant bioethics committee. Results: The results showed that VT led to a faster recruitment of muscle fibers and improved muscle endurance as indicated by decreased fatigue work indices compared to PR. However, no significant differences were observed in peak torque or lactate levels between the two recovery methods. The VT group exhibited quicker recovery times in torque generation and better performance in fatigue resistance. Conclusions: VT appears to provide superior muscular recovery compared to PR following intense anaerobic effort, particularly in terms of muscle strength endurance and activation speed. These findings support the potential of VT in sports recovery protocols, although similar lactate response suggests that metabolic recovery rates are not significantly affected.

Consumer trust in supply chain certifications plays a pivotal role in shaping contemporary consumer behavior and marketing effectiveness. This qualitative research investigates consumer perceptions of supply chain certifications and their impact on purchasing decisions and brand loyalty. Through semi-structured interviews and focus group discussions with 30 participants, the study explores themes such as credibility, transparency, perceived value, and the influence of certifications on consumer trust. Findings reveal that consumers value certifications that signal ethical sourcing practices and sustainability commitments, viewing them as assurances of product quality and social responsibility. Credibility and transparency in certification processes emerged as critical factors influencing consumer trust, while perceived benefits such as environmental sustainability and fair labor practices positively influenced purchase intentions. Moreover, certifications were found to enhance brand loyalty by aligning with consumers' ethical values and beliefs. However, the study identifies challenges including high certification costs, complexity in compliance, and consumer skepticism, which hinder broader adoption and effectiveness of certifications. The implications of these findings suggest that businesses can enhance consumer trust and market competitiveness by investing in rigorous certification standards, clear communication strategies, and sustainable practices. Addressing barriers through improved transparency and consumer education is crucial for maximizing the impact of certifications on ethical consumption. Future research directions include longitudinal studies on certification impacts and comparative analyses across industries and global markets to further enrich understanding of consumer behavior and certification influences.

(1) Background: Aim was to investigate real-world effectiveness (hypothesizing non-inferiority) and safety profile of risdiplam in paediatric and adult nusinersen-risdiplam spinal muscular atrophy (SMA) switch cohort. (2) Methods: A retrospective and anonymous collection of relevant demographic and clinical data for all Croatian SMA patients switched from nusinersen to risdiplam up to September 2023 (reimbursed by Croatian Health Insurance Fund – CHIF) was performed using CHIF database and associated reimbursement documentation. Patients were included in effectiveness and safety analysis if they met the following inclusion criteria: i) risdiplam reimbursed by CHIF; ii) patient received at least 6 doses of nusinersen before switch to risdiplam; iii) no relevant pause between the latter disease modifying drugs (DMDs); iv) availability of all prespecified studied data and parameters. (3) Results: 17 patients met inclusion criteria [58.9% female; median age 12.75 (3.0-44.5) yr.]. In our ‘switch’ cohort, we have demonstrated a non-inferiority of risdiplam to nusinersen, in SMA 1 (+1.0 in CHOP INTEND; p=0.067), SMA 3p (+0.7 in HFMSE; p=0.897) and SMA 3a (+0.8 in RHS; p=0.463) subpopulations, during a one-year follow-up period. There were no reports on respiratory function worsening, feeding worsening, and no lethal events. No new safety concerns were identified, except of the weight gain that arose as a new potential adverse drug reaction ‘signal’ in two patients. (4) Conclusions: We have reported a pivotal real-world findings on switching SMA patients from nusinersen to risdiplam and demonstrated its effectiveness (non-inferiority), safety and tolerability in a heterogenous paediatric and adult ‘switch’ cohort, which will further increase the quality and standards of care as well as safety of a notable portion of SMA patients; especially for those who demand switch from nusinersen to other DMDs from clinical or personal reasons.

Background. False memories tend to increase in healthy and pathological aging, and their reduction could be useful in improving cognitive functioning. The objective was to use an active-placebo method to verify whether the application of tDCS in improving true recognition and reducing false memories in healthy older people. Method. Participants were 29 healthy older adults (65-78 years old) assigned to active or placebo group; active group received anodal stimulation at 2mA for 20 min over F7. An experimental task was used to estimate true and false recognition. The procedure took place in two sessions on two consecutive days. Results. A mixed ANOVA of true recognition showed a significant main effect of session (p = .004), indicating an increase from before treatment to after it. False recognition showed a significant main effect (p = .004), indicating a decrease from before treatment to after it and a significant session x group interaction (p < .0001). Conclusions. Overall, our results show that tDCS is an effective tool for increasing true recognition and reducing false recognition in healthy older people, and suggest that stimulation improves recall by increasing the number of items a participant can recall and reducing the number of memory errors.

Evaluation of the effectiveness of protected areas is critical for forest conservation policies and priorities. To evaluate their effectiveness, we used 30-m resolution forest cover change data between 1990 and 2010 for ~4,000 protected areas and analyzed the relationships of the effectiveness of protected areas with socio-economic variables. Our results show that protected areas in the Tropics avoided 83,500 ± 21,200 km2 of deforestation during the 2000s. Brazil’s protected areas have the largest amount of avoided deforestation of 50,000 km2. We also show the amount of international aid received by tropical countries compared to the effectiveness of protected areas. International aid had major benefits in Latin America led by Brazil while tropical Asian countries used the resource ineffectively. Our results demonstrate that protected areas have been relatively more efficient in countries where deforestation pressures were increasing, and governance and forest change monitoring capacity are important factors for enhancing the efficacy of international aid.

After an earthquake, assessing the seismic vulnerability of buildings is essential for prioritizing emergency response, guiding reconstruction, and ensuring public safety. Accurate and timely evaluation of structural damage plays a vital role in mitigating further risks and facilitating in-formed decision-making during disaster recovery. This study investigates the performance of various Generative Artificial Intelligence (GAI) models, developed by different companies with diverse model sizes and context windows, in analysing post-earthquake images. The primary objective was to evaluate the models' effectiveness in classifying structural damage according to the EMS-98 scale (with 5 levels of damage), which ranges from minor damage to total destruction. For masonry buildings, the correct classification rates varied widely across models, from 28.6% to 64.3%, with mean damage grade errors ranging from 0.50 to 0.79. In the case of reinforced concrete buildings, correct classification rates ranged from 37.5% to 75.0%, with mean damage grade errors between 0.50 and 0.88. The use of fine-tuning could probably improve the results substantially. Improving the accuracy of GAI models could significantly reduce the time and resources needed to assess post-earthquake damage, namely when comparing with more traditional approaches. The results achieved thus far demonstrate the promise of GAI models for rapid, automated, and ac-curate damage evaluation, which is critical for expediting decision-making in disaster response scenarios.

This academic article examines the effectiveness of international humanitarian intervention in conflict zones. Humanitarian intervention refers to the use of military, diplomatic, or economic measures by external actors to protect civilians, promote human rights, and alleviate suffering in areas affected by armed conflict. The research employs a comprehensive approach, incorporating content analysis, case study, and historical analysis in its methodology. It explores the key challenges faced by international actors in implementing humanitarian interventions and evaluates their impact on conflict resolution and post-conflict reconstruction. Through this thorough analysis of case studies and scholarly literature, this article contributes to the ongoing debate surrounding the efficacy of international humanitarian intervention.

This paper aims to provide a systematic review of the literature on school effectiveness, with a focus on identifying the main factors that contribute to successful educational outcomes. The research question that this paper aims to address is: What are the main factors of school effectiveness? The research was interested in several descriptors such as school, effectiveness/efficiency theories, effectiveness/efficiency research, and factors. Studies were reviewed through two databases: JSTOR and ERIC (published within the 2016-2022 period). The paper defines several categories that are exposed within school effectiveness research. Within these categories, various factors that affect the students’ outcomes and the defined effectiveness at school are listed. As the results show, the issue of school effectiveness is a multifaced challenge as the effectiveness of schools is a complex concept that can be measured through various indicators such as academic achievement, student engagement and teacher satisfaction. The review of school effectiveness has revealed that several factors contribute to effective schools, such as strong leadership, effective teaching practices, a positive school culture and parental involvement. Additionally, school resources, such as funding and facilities, can impact school effectiveness, particularly in under-resourced communities.

Across the global construction industry, fatalities continue to occur from high-risk activities where the risk controls have been defined, however were unreliable. In the mining industry, Critical Control Risk Management has provided positive results in reducing major accidents, which raises the question, could the Critical Control approach reduce the fatality rate in the construction industry? This study analysed 10 years of serious and fatal incident investigation reports from four international construction companies to i) assess the reliability of their Critical Controls (CCs) and ii) assess the factors which affect the reliability of CCs. The results show the reliability of CCs, measured by implementation and effectiveness, averaged just 42%. Human performance factors including risk identification, decision-making and competency together with supervision, job planning, communication organisational factors were identified as affecting the reliability of CCs. The study used bow-tie diagrams with real event data to find the actual CC effectiveness. This gave actionable findings directly related to individual CCs enabling the participating organization to focus resources on improving specific verification processes. The results confirm the applicability of CCs for the Major Accident Event hazards analyzed and highlights further review is required of the factors which need to be considered when implementing a CC program. This paper details our methodology and results, to assist others apply CCs as a risk management tool.

(1) Background: Obstetric work requires good communication, which can be trained in interventions targeting health care providers and pregnant women/ patients. This systematic review aims to aggregate the current state of research on communication interventions in obstetrics. (2) Methods: Using the PICOS scheme, studies published in peer-reviewed journals in English or German between 2000 and 2020 were searched. Out of 7,018 results, 71 studies were included in this synthesis and evaluated using the Oxford Level of Evidence Scale. (3) Results: 63 studies, including a communication component, revealed a positive effect on different proximal outcomes (i.e., communication skills). Three studies evaluating the effect of communication training on distal performance indicators (i.e., patient safety) proved to be beneficial to some extent. Most studies included different groups at the same time; those addressing health care providers were more common than those with students (61 vs. 12). Expectant mothers were targeted only in 9 studies. Overall, the evidence level of studies was low (only 11 RCTs), with 24 studies evidence level of I-II, 35 of III, and 10 of IV. (4) Conclusions: Communication training should be applied more often to improve communication of staff, students, and pregnant women, and thereby improve patient safety.

Three-temperature heating systems consist of a heat engine and a heat pump, enabling thus maximum usage of the primary thermal source for the heating of buildings. This analysis has revealed obvious advantages and disadvantages that the combining of thermodynamic systems has in future development, also with respect to environmental and economic issues. It appears that the combination of a Stirling engine or a similar heat drive with a heat pump is especially suitable. In order to analyze the effectiveness of such a system, a comprehensive calculation procedure is used: its basis lies in accounting for all types of energy and their relationship to the original natural resource. The present paper aims to point out that the combination of Stirling engine and a heat pump is a useful solution thanks to the most favorable resultant economic impact if compared to the usage of a diesel, four-stroke gas, or, most commonly used, electric drive.

Light sources tend to affect images captured in any automatic optical inspection (AOI) system. In this study, the effectiveness of metal-halide lamps, quartz-halogen lamps, and LEDs as the light sources in AOI systems for the detection of the 3rd and 4th layers electrodes of thin-film-transistor liquid crystal displays (TFT-LCDs) is examined experimentally. The results show that the performance of LEDs is generally comparable or better than that of metal-halide and quartz-halogen lamps. The best optical performance is by the blue LED due to its spectrum compatibility with the time-delay-integration charged-coupled device (TDI CCD) sensor and its better spatial resolution. The images revealed by the blue LED are sharper and more distinctive. Since current LEDs are more energy efficient and environmentally friendly, using LEDs as the light source for AOI is very beneficial. As the blue LED performs the best, it should be adopted for AOI using TDI CCD sensors.