: Suicide is a serious public health problem, with a global mortality rate of 1.4% of all deaths worldwide, and the leading cause of unnatural death in Spain. The use of clinical simulation has proven to be a beneficial tool in the training of nursing students. Such experiences allow them to develop cognitive and affective skills that are fundamental for the detection of warning signs and use of interventions in cases of people who want to take their own lives. Working in a mental health environment can be difficult for nursing students; therefore, the purpose of this study was to explore the perceptions of nursing students on the approach, management and intervention of suicidal crisis through clinical mental health simulation. Methods: qualitative descriptive phenomenological study through focus groups and reflective narratives in a sample of 45 students. A thematic analysis was performed using ATLAS-ti. Results: After the analysis, three themes were obtained: (a) management and handling of emotions (b) identification of suicide motives (c) intervention in suicidal crisis. Discussion: Clinical simulation in mental health allows students to exercise clinical judgment reasoning, detect warning signs for a better treatment approach, and provide tools for effective intervention and management of patient care. The results of this study indicate that nursing students face challenges in approaching mental health clinical simulation due to lack of prior exposure.

Objectives: Aim to assess the perceptions of virtual learning among dental residents and faculty and employ Regulatory Focus Theory (RFT) to understand the impact of motivational orientations on virtual learning during COVID pandemic. Methods: 46 dental residents and 10 faculty in Upstate New York participated in the study (June -August 2021). Questionnaires were used to collect demographics, perceptions of virtual learning, burnout, and RFT types (promotion and prevention focus). Multiple regression analyses were used to examine factors associated with perceptions of virtual learning and burnout. Results: Overall, 70% of residents and 44% of faculty found virtual learning effective. Younger residents with less experience preferred virtual learning more than their older, experienced peers. Residents trained outside the U.S. and Canada favored in-person learning more than those trained within. Furthermore, residents with a higher promotion focus score found virtual learning more interactive for didactic courses. Additionally, 52% of residents experienced burnout, with a higher incidence among females (p=0.044). Conclusions: Virtual learning is well-received by dental residents and faculty, with potential for continued use post-pandemic. Future efforts should focus on creating an inclusive and supportive educational environment that meets the motivational and well-being needs of dental residents and faculty.

Comprehending the replication kinetics of SARS-CoV-2 variants helps explain why certain var-iants spread more easily and are more contagious, and pose significant health menaces to the global populations. The replication kinetics of Malaysian isolates of the Alpha, Beta, Delta, and Omicron variants were studied in the Vero E6 cell line. Their replication kinetics were deter-mined using the plaque assay, quantitative real-time PCR (qRT-PCR), and viral growth curve. The Beta variant exhibited the highest replication rate at 24 hours post-infection (h.p.i), as evi-denced by the highest viral titers and lowest viral RNA multiplication threshold. The plaque phenotypes also varied among the variants, in which the Beta and Omicron variants formed the largest and smallest plaques, respectively. All studied variants showed strong cytopathic effects after 48 h.p.i. The whole-genome sequencing highlighted cell-culture adaptation, where the Beta, Delta and Omicron variants acquired mutations at the multibasic cleavage site after three cycles of passaging. The findings suggest a strong link between the replication rates and their respec-tive transmissibility and pathogenicity. This is essential in predicting the impacts of the upcom-ing variants on the local and global populations and is useful in designing preventive measures to curb the virus outbreaks.

Marijuana is the most used illicit drug among youths in the United States. The objectives of the study were to identify the association between marijuana use and other risk behaviors including suicidality among high school students. The 2021 Mississippi Youth Risk Behavior Survey data sets were combined for this study. Crude odds ratio (OR) and adjusted odds ratio (AOR) with a 95% confidence interval were generated using the survey packages in R to account for weights and the complex sampling design of YRBS data. Tobacco products and alcohol use were significantly associated with marijuana use. Students who responded “Yes” to questions “currently used an electronic vapor product?”, “currently smoked cigarettes or cigars?” or “currently drank alcohol?” were more likely to use marijuana compared to students who responded “No”, after adjusting for other risk factors. Marijuana use is also significantly associated with students who had sex, compared to those who never had sex. The adjusted odds ratio is nearly doubled in those who had sex with the same sex or both sexes, compared to those who had heterosexual sex only. After adjusting for other health risk factors, the association between current marijuana use and attempted suicide was not statistically significant. The impact of students’ not sleeping in their parent's or guardian's home on current marijuana use was not significant after adjusting for other risk factors. Marijuana use is evenly burdened between males and females and between all race categories among Mississippi high school students. The identified associations seem to indicate that electronic vapor, tobacco products, and alcohol use could be the forerunners for drug use and should be treated accordingly in drug use prevention programs.

The ongoing COVID-19 pandemic is shaking the foundations of public health governance all over the world. Researchers are challenged by informing and supporting authorities on acquired knowledge and practical implications. This commentary applies established theories of risk perception research to COVID-19 and reflects on the role of risk perceptions in these unprecedented times. Moreover, it calls for utilizing the knowledge on risk perception to improve health risk communication, build trust and contribute to a collaborating governance.

Background This study aimed to identify the prominent risk factors that may trigger danger signals of early onset of vascular deregulation in T1D. The risk factors we have identified may serve as dual-purpose biomarkers of rapid diagnosis that offer prospective tailor-made resolution therapeutics. Methods The healthy control (HC) was compared with individuals diagnosed with T1D for the risk factors of vascular deregulation in published research studies from year 2013 to 2023. The PubMed, Web of Science and Google Scholar databases were searched from 1/1/2013 to 1/9/2023. The risk of bias was assessed with the Cochrane (ROBINS-I ) tool, which is relevant to clinical subjects. A random effect model for continuous data was followed and analysed by RevMan 5.4 and GraphPad Prism software. Results 80 relevant case-control studies having 5293 HC and 7492 T1D patients were included. The age and sex-matched HC consisted of persons free of disease and not under any medication while clinical subjects of all age groups were included. 28 risk factors were grouped into six primary outcome models, all of which favoured the T1D synonymous with a high risk of CVD. Conclusions Our findings have strong implications for improving the quality of life and health economics related to vascular disease in T1D. HbA1c% is the most effective biomarker, followed by FBG, LDL-C, and AI% which the clinicians could evaluate using a simple blood test or non-invasive techniques. (Protocol registered at https://www.crd.york.ac.uk/prospero/ CRD42022384636).

Lyme disease, the leading vector-borne ailment in the U.S., annually affects an estimated 476,000 individuals, predominantly in the Northeast and Upper Midwest. Despite its increasing incidence, the evaluation of risk within U.S. cities, including natural public lands, remains inadequate. This study focuses on blacklegged tick occurrences and Borrelia burgdorferi infection prevalence in 24 Staten Island parks, aiming to assess Lyme disease exposure risk. Monthly acarological risk index (ARI) calculations from 2019 to 2022 revealed elevated values (0.16-0.53) in specific parks, notably Wolfe’s Pond Park, High Rock Park, Clay Pit Pond Park, Clove Lake Park, and Fair View Park. June (0.36) and November (0.21) consistently exhibited heightened ARIs, aligning with peak tick collection months. Despite stable yearly infection rates at 28.97%, tick densities varied significantly between parks and years. Identifying a high transmission risk in specific parks in Staten Island, a highly urbanized part of New York City, emphasizes the continuous necessity for Lyme disease risk management, even within the greenspaces of large cities.

Polycystic ovary syndrome (PCOS) is a common condition in reproductive-age women. Women with PCOS are at higher risk of pregnancy complications including gestational diabetes (GDM). The prevalence of PCOS and GDM varies according to the diagnostic criteria used. The mechanism for the occurrence of GDM in women with PCOS is still unclear. Materials & Methods- A systematic search of the electronic database was done using keywords like PCOS, and GDM to include studies between April 2008 and March 2023 where uniform diagnostic criteria were used. Studies were excluded with high-risk of bias after the assessment of bias, and meta-analysis was done with relative risks and confidence intervals. Results & Discussion-Out of 1896 search results, 95 were selected for full-text. The quality of the studies was scrutinized and a total of 28 studies were included as they fulfilled the inclusion criteria. The incidence of GDM in women with PCOS was found to be 10.55 % (2.9- 54.9%) from pooled data involving 1,280,245. The prevalence of PCOS in women diagnosed with GDM was found from pooled data of 36,351 women in retrospective studies to be 2.47% (1.5- 50.1%). Selection predominantly included cohort studies, most commonly from China. The meta-analysis reported the risk of GDM is higher in women with PCOS than in those without PCOS (HR: 1.59, 95% CI: 1.27–1.91, p < 0.001). Family history of diabetes, ethnicity, pre-pregnancy BMI, insulin resistance, gestational weight gain, use of assisted reproductive techniques, and multifetal gestation were the risk factors for GDM in women with PCOS. Conclusion- The prevalence of GDM in patients with PCOS is high, but the causality is complex. The newer predictive models are promising in clarifying the causative relationships, yet use various parameters at different cut-offs. There is a need for the development of universally acceptable parameters for the early prediction of GDM in women with PCOS.

This study addresses a gap in the literature by conducting a comparative analysis of statistical and artificial intelligence techniques for predicting bankruptcy in small and medium-sized enterprises (SMEs). Using a comprehensive database of 7,104 Belgian SMEs, our findings demonstrate that intelligent techniques offer superior predictive accuracy for bankruptcy. Notably, our results indicate that a firm's position in the global value chain significantly affects prediction accuracy, with lower performance for firms operating upstream in the production process. This suggests that bankruptcy risk may spread upward along the value chain. This insight is particularly valuable for practitioners, as it highlights the importance of focusing on specific performance factors based on the type of firms they manage, advise, or collaborate with.

The origin of a product, consumer familiarity, and purchasing identity are factors that affect perception of cheese consumption. The present study aims at identifying consumers’ conceptualizations and attitudes towards local Greek cheeses of the North-Aegean Sea islands, such as Ladotyri, Graviera, Kasseri, Kaskavali, Melichloro, and Kalathaki, some of which have a Protected Designation of Origin (PDO) status, as opposed to cheeses of non-Greek origin, such as Cheddar, Regatto, and Gouda. Sensory and emotional attributes of local, local PDO, and imported cheeses, and drivers associated with consumers’ choice and acceptance above and beyond their sensory attributes were studied, using three methods: a) Flash Profile to gain insight into the sensory positioning of products and description of samples, b) qualitative analysis of focus groups to pinpoint consumer knowledge, preference, and consumption criteria, and c) a new methodology for natural language processing and sentiment analysis of social media posts to determine consumer conceptualizations. Social media posts have proven to be a valuable source of linguistic and cultural data for cheeses. Local cheeses, including PDO products, were found to be linked to village life and family gatherings, home, tradition, and childhood memories, with saltiness and hardness being their main sensory attributes. Imported cheeses were linked to fast food, pizza, and snacking, with elasticity and gumminess as prominent sensory qualities. The main criterion of purchase was intended usage and versatility, taste and texture, price, and familiarity. The findings provide key sensory attributes, information about consumer purchasing criteria, and relevant vocabulary for the promotion of cheeses as agri-food and gastronomic identity key products.

National heatwave plans are aimed at reducing the avoidable human health consequences due to heatwaves, by providing warnings to and improving communication between relevant stakeholders. The aim of this study was to assess the perceptions of key stakeholders within plans in Belgium and the Netherlands on their responsibilities, the partnerships, and the effectiveness of the local implementation in Brussels and Amsterdam. Key informant interviews were held with stakeholders that had an important role in development of the heatwave plan in these countries, or its implementation in Brussels or Amsterdam. Care organisations, including hospitals and elderly care organisations, had a lack of familiarity with the national heatwave plan in both cities, and prioritised heat the lowest. Some groups of individuals, specifically socially isolated individuals, are not sufficiently addressed by the current national heatwave plans and most local plans. Stakeholders reported that responsibilities were not clearly described and that the national plan does not describe tasks on a local level. We recommend to urgently increase awareness on the impact of heat on health among care organisations. More emphasis needs to be given to the variety of heat risk groups. Stakeholders should be involved in the development of updates of the plans.

Occupational accidents, despite continuous safety updates, are still a scourge in the occupational and forensic spheres, constituting, among other things, the subject of a large share of litigation. Demographic data can help to understand the areas where the application of health surveillance is lacking. This meta-analysis sets out to analyze data from studies on accidents at work, focusing on the correlation between the areas in which accidents occur and whether or not personal safety equipment is used, about the different regulations in force. For the selection of the data, a systematic review was carried out according to the PRISMA guidelines, with the primary objective of identifying the trend of occupational accidents in specific geographical areas, which differ in terms of the attention paid to preventive aspects. The data we highlighted showed, regarding the type of accident, substantial differences between low-income countries and industrialized countries (stratified according to the Human Development Index) and, an overall indifference as to whether or not individual safety devices were used, revealing that, despite the continuous normative evolution in the field of safety at work, even today, the investigative data on the actual application of the regulations, during accidents at work, is underestimated and little researched.

One of the major concerns in structural health management (SHM) is the early detection of a growing crack. Using this, future damage due to crack propagation can be mitigated or eliminated by implementing proper repair and maintenance. Acoustic Emission (AE) is a non-destructive testing (NDT) method with potential applications for locating and monitoring fatigue cracks. The research presented in this paper focuses on SHM using AE. A novel AE signal analysis approach was proposed in order to detect crack initiation and assess small crack lengths. Experimental investigation indicated that initiation of a crack could be identified through the statistical analysis of the resulting features of the AE signals. A probabilistic AE-based model for small fatigue crack sizing was developed and the uncertainties of the model were estimated. In addition, a probabilistic model validation approach was implemented to confirm accurate estimation of the results. The outcome of this research can be used to evaluate the integrity of structures under fatigue loading. The proposed approach can also be applied as an approach to manage health and assess prognosis of structures.

We estimated the risk of blood clots after COVID-19 vaccination accounting for the roles of vaccination in reducing the infection rate, and indirectly lowering the risk of blood clots caused by infection. A self-controlled case series method was used to examine the association between blood clots and COVID-19 vaccination. To deal with the bias due to under-reported infection among non-hospitalized subjects, a case-control study was used to compare the risk of blood clots in infected subjects to control subjects who were hospitalized due to physical injury. We found increased risks of blood clots after vaccination (incidence rate ratio is 1.13, 95% confidence interval (CI): [1.03, 1.24] after the first dose and 1.23, 95% CI: [1.13,1.34] after the second dose). Furthermore, vaccination attenuated the increased risk of blood clots associated with infection (odds ratio (OR) = 2.16, 95% CI: [1.93, 2.42] in unvaccinated versus OR=1.46, 95% CI: [1.25, 1.70] in vaccinated). A causal model was used to explain and weigh up possible risk factors for blood clots after COVID-19 vaccination. After accounting for vaccine efficacy against infection and the protection against infection-associated blood clots, receiving the COVID-19 vaccines decreases the risk of blood clots, especially during high infection rate period.

Understanding tourist behaviour during and after major tourism crises is essential to help destinations recover. The COVID-19 pandemic, a period of uncertainty and risk, makes it relevant to assess factors that influence travel intentions. There has been little research on tourist behaviour during health crises and, in particular, on perceived health risk and uncertainty effects on travel intentions. This study was carried out during the first months of the pandemic in Brazil and aims to investigate the role of health risk perception and intolerance of uncertainty on travel intentions for 2020 and 2021. We applied an online survey to 1,150 Brazilian participants from March to May of 2020. Our findings indicate that perceived COVID-19 severity, perceived probability of contracting it, and expected pandemic duration are significant predictors of travel intentions for both years. This paper sheds new light on tourist behaviour in the context of global health crises.

Severe early childhood caries remains the most common chronic disease affecting children. Its multifactorial etiology has established a controversy about which risk factors were more significant to its development. Therefore our study aimed through meticulous statistical analysis to arrange the “well agreed upon” common risk factors in order of significance, to aid the clinician in tailoring an adequate preventive program for this affected age group. The study reshuffled the risk factors contributing to severe early childhood caries and placed them in the order of their significance as follows: snacking of sugary food several times a day, increased number of siblings to 3 or more, night feeding, child self-employed brushing, mother caries experience, 2 siblings, on demand feeding, once/day sugary food, sharing utensils, 1 Sibling, male gender, father’s education, late first child dental visit, brushing time, mother’s education, no dental visit, decreased brushing frequency & no night brushing.

Stroke constitutes a significant public health concern due to its impact on mortality and morbidity. This study investigates the utility of machine learning algorithms in predicting stroke and identifying key risk factors using data from the Suita study, comprising 7,389 participants and 53 variables. Initially, unsupervised K-prototype clustering categorized participants into risk clusters, while five supervised models including Logistic Regression (LR), Random Forest (RF), Support Vector Machine (SVM), eXtreme Gradient Boosting (XGBoost), and Light Gradient Boosted Machine (Light-GBM) were employed to predict stroke outcomes. Stroke incidence disparities among identified risk clusters using the unsupervised K-prototype clustering method are substantial, according to the findings. Supervised learning, particularly RF was a preferable option because of the higher levels of performance metrics. The Shapley Additive Explanations (SHAP) method identified age, systolic blood pressure, hypertension, estimated glomerular filtration rate, metabolic syndrome, and blood glucose level as key predictors of stroke, aligning with findings from the unsupervised clustering approach in high-risk groups. Additionally, previously unidentified risk factors such as elbow joint thickness, fructosamine, hemoglobin, and calcium level demonstrate potential for stroke prediction. In conclusion, machine learning facilitated accurate stroke risk predictions and highlighted potential biomarkers, offering a data-driven framework for risk assessment and biomarker discovery.

Coxsackievirus A6 (CV-A6) has emerged as the predominant causative agent of hand, foot, and mouth disease (HFMD) in young children. Since the declaration of coronavirus disease 2019 (COVID-19) as a global pandemic, the incidence of infectious diseases, including HFMD, has decreased markedly. When social mitigation was relaxed during the COVID-19 pandemic in 2022, re-emergence of HFMD was observed in Gwangju, South Korea, and seasonal characteristics of the disease appeared to have changed. To investigate the molecular characteristics of enterovirus (EV) associated with HFMD during 2022, 277 specimens were collected. Children aged under 5 years accounted for the majority of affected individuals. EV detection and genotyping were performed using real-time RT-PCR and nested RT-PCR followed by sequence analysis. EV detection rate was found to be 82.3%, and the main genotype identified was CV-A6. Sixteen CV-A6 samples were selected for whole genome sequencing. According to phylogenetic analysis, all CV-A6 strains from this study belonged to the sub-genotype D3 clade based on VP1 sequences. Analysis of 3D polymerase phylogeny showed that only the recombinant RF-A group was identified. In conclusion, circulating EV types should be continuously monitored to understand pathogen emergence and evolution during the post-pandemic era.

The application of antimicrobials in aquaculture primarily aims to prevent and treat bacterial infections in fish. Inappropriate use of antimicrobials in fish farming may result in the emergence of zoonotic antibiotic-resistant bacteria and subsequent transmission of resistant strains to humans via food consumption. From recently, AMR emerged as a significant public health concern in the aquaculture ecosystem and fisheries. The aquatic environment serves as a potential reservoir for resistant bacteria, with aquaculture practices providing an ideal breeding ground for AMR due to the excessive use of antimicrobials to prevent and treat diseases. The mutual inter-connection of intensive fish farming systems with terrestrial environments, food processing industry and human population creates pathways for the transmission of resistant bacteria, exacerbating the problem further. One Health concept, which recognizes the interconnectedness of human, animal and environmental health, enables a holistic approach to address the challenges posed by AMR. By understanding the evolution of such approach, the future of aquaculture, being the important source of a global animal protein supply, can be safeguarded. Risk mitigation strategies for AMR should be based on One Health concept to contribute to sustainable aquaculture practices that protect human and animal health, ensure food safety and protection of environment.

The concept of vulnerable carotid plaques is pivotal in understanding the pathophysiology of is-chemic stroke secondary to large-artery atherosclerosis. At the macroscopic evaluation, vulnera-ble plaques are characterized by one or more of the following features: microcalcification, neo-vascularization, lipid-rich necrotic core (LRNC), intraplaque hemorrhage (IPH), thin fibrous caps, plaque surface ulceration, huge dimension determining stenosis, and plaque rupture. Recognizing these macroscopic characteristics is crucial to estimating the risk of cerebrovascular events, also in case of non-significant (less than 50%) stenosis. Inflammatory biomarkers, such as cytokines and adhesion molecules, lipid-related markers like oxidized low-density lipoprotein (LDL), and proteolytic enzymes capable of degrading extracellular matrix components are among the key molecules that will be scrutinized for their associative roles in plaque instability. Through their quantification and evaluation, these biomarkers reveal intricate molecular cross-talking govern-ing plaque inflammation, rupture potential, and thrombogenicity. Current evidence demonstrates that plaque vulnerability phenotypes are multiple and heterogeneous and are associated with as many highly complex molecular pathways that determine the activation of an immune-mediated cascade that culminates in thromboinflammation. This narrative review provides a comprehen-sive analysis of current knowledge on molecular biomarkers expressed by symptomatic carotid plaques. It explores the association of these biomarkers with the structural and compositional at-tributes that characterize vulnerable plaques

In the past two decades, several floods have affected people and their properties in Burkina Faso, with the unprecedented flooding occurring in Ouagadougou in September 2009. So far, most studies have focused on Ouagadougou and surrounding localities and have paid little attention to other flood-prone regions in Burkina Faso. Specifically, there is a data and knowledge gap about the flood risk in the Haut-Bassins region, which in turn hampers the development of mitigation strategies and risk reduction measures in communities. This study demonstrates how data collected at the household level can be used to understand flood risk and its components at the village level in this data-scarce region. Using an indicator-based method, we analyze both flood risk and flood risk perception at the village level. Moreover, we determine the factors influencing flood risk perception at the household level using an ordered logit model. We find that 12 out of the 14 villages considered, experience high levels of flood risk. The management of runoff from the nearest urban areas and poorly designed civil engineering infrastructures, such as roads, were highlighted by the households as significant factors that increase their vulnerability. Hence, dependencies in space and between urban and rural areas may play a substantial role in modifying risk. The perceived flood risk consistently exceeds the estimated flood risk, with an insignificant positive correlation between both risk indices. Regression results indicate that flood risk perception is mainly influenced by informational and behavioral factors of the households. The findings of this study can provide valuable information to municipal and regional authorities involved in disaster risk management in the study area. Moreover, the method is transferable to other data-scarce regions

This paper presents quantitative research results regarding the influence of demographic factors on the earthquake risk perception of the citizens of Belgrade. This research aims to determine how much the citizens of Belgrade are aware of the risk and prepared to react in the event of an earthquake. The relationship between gender, age, level of education, and facility ownership with risk perception was examined. T-test, One-way ANOVA, and Pearson correlation coefficient were used to examine the relationship between the variables and the earthquake risk perception. The survey was conducted using a questionnaire that was given and then collected online among 235 Belgrade respondents during September 2020. The questions were divided into three categories. The first part of the questionnaire was consisted of general questions about the demographic characteristics of the respondents, then the questions that would determine the level of awareness of the respondents about earthquakes, and finally, the questions for determining the respondents' preparedness. The results of the research show that women have a higher perception of risk. It has been proven that the youngest respondents from the age category of 18-30 have the lowest risk perception. The influence of education level in no case showed a statistically significant correlation with risk perception.

Pragmatic trials aim to assess intervention efficacy in usual patient care settings, contrasting with explanatory trials conducted under controlled conditions. In aging research, pragmatic trials are important designs for obtaining real-world evidence in elderly populations, which are often underrepresented in trials. In this review, we discuss statistical considerations from a frequentist approach for the design and analysis of pragmatic trials. When choosing the dependent variable, it is essential to use an outcome that is highly relevant to usual medical care while also providing sufficient statistical power. Besides traditionally used binary outcomes, ordinal outcomes can provide pragmatic answers with gains in statistical power. Cluster randomization requires careful consideration of sample size calculation and analysis methods, especially regarding missing data and outcome variables. Mixed effects models and generalized estimating equations (GEEs) are recommended for analysis to account for center effects, with tools available for sample size estimation. Multi-arm studies pose challenges in sample size calculation, requiring adjustment for design effects and consideration of multiple comparison correction methods. Secondary analyses are common but require caution due to the risk of reduced statistical power and false-discovery rates. Safety data collection methods should balance pragmatism and data quality. Overall, understanding statistical considerations is crucial for designing rigorous pragmatic trials that evaluate interventions in elderly populations under real-world conditions. In conclusion, this review focuses on various statistical topics of interest to those designing a pragmatic clinical trial, with consideration of aspects of relevance in the aging research field.

Background and Objectives. Prevalence of GERD is increased among individuals with obesity and RYGB is considered as the most effective procedure to control GERD and obesity. However, some patients continue to have GERD after RYGB. The aim of the study was to investigate the prevalence and the risk factors of GERD after RYGB. Material and Methods. This prospective study included 180 patients operated with RYGB and followed for on average of 12.2 (0.6) years. 126 (70%) patients agreed to participate in online consultations and provided data on weight, GERD symptoms, filled GERD-HRQL, TFEQ-18 and GSRS questionnaires. Results. The average age before surgery was 42.7 (10.5) years and BMI was 45.2 (6.4) kg/m2. 128 (71.1%) were females and preoperative GERD was diagnosed in 74 (41.1%) patients. At 12 years follow-up the mean %EBMIL and %TWL were 60.37 and 25.73, respectively. The median %WR was 18.0 (39.0). The GERD was present in 30 (23.8%) patients, of whom 12 (40%) continued to have GERD symptoms and 18 (60%) developed de novo GERD. The GERD-HRQL score significantly decreased from 3.0 (8.0) at baseline to 2.0 (5.0) (p=0.028) at 12 years. GSRS Diarrhea and Indigestion median scores increased significantly, from 1.33 (0.67) to 1.5 (2.42) (p 3.2.

Mississippi youth are demographically unique compared to that of the nation. The purpose of this study was to determine the trend of drug use among adolescents of the United States and Mississippi, and to estimate the differences of drug use prevalence as a whole, and by gender and by race. National and Mississippi YRBSS data from 2001 to 2021 were obtained for analysis. Summary statistics, prevalence ratio, and survey Chi-squared tests of independence statistics were generated for the comparison for all students, and by gender and race separately. Trend analysis was conducted using logistic regression combined with joinpoint regression. Six survey questions being studied were: have you ever used marijuana, inhalant, heroin, methamphetamines, injected drugs, and were you offered, sold, or given an illegal drug on school property during the last 12 months. Survey packages in R were used to account for the complex sampling design of YRBSS data. On the national level, all six drug related risk behaviors being studied showed significant decrease from 2001 to 2021. In Mississippi however, only “ever used marijuana” showed a trend of decrease, while three remain unchanged, and two increased. 2021 YRBSS data shows that Mississippi adolescents exhibited significantly higher prevalence of drug use, and are more likely to be offered, sold or given an illegal drug on school property. Our study suggests an urgent need for drug use intervention among Mississippi adolescents. More concerted actions at the community, school and government level are needed for reducing youth drug use and controlling the drug traffic on school property.

Herein, we examined the effects of weather parameters and individual clinicodemographic risk factors on hemorrhagic stroke (HS) incidence, severity on admission, and disability at discharge in a harsh desert climate. In a retrospective design we studied patients admitted to a stroke unit in Arab Emirates in 2016-2019. With a distributed lag nonlinear model we explored immediate and delayed effects of weather on stroke incidence. Supervised machine learning was used to build models predictive of scores in NIHSS and mRS scales. We assessed model performance by calculating ROC AUC, F1 scores, specificity, and sensitivity. HS risk increased after a significant change in any weather parameter. The risk was reduced below baseline after 1-week adjustment to environmental changes. Climate input from the previous 3 days yielded reliable classification models. Humidex was a better predictor of severity than air temperature, whereas body mass index, age, and time of day at stroke onset were the strongest clinical predictors. Weather parameters before admission were stronger predictors of disease severity than individual clinical factors. We addressed limitations of previous studies by analyzing a full set of climate parameters: ambient temperature, relative humidity, humidex, atmospheric pressure, and wind speed. Predictive models may help to optimize patient management and develop preventative strategies.

Background. The Stanford Health Assessment Questionnaire-Disability Index (HAQ) is widely used to measure functional ability in persons with Rheumatoid Arthritis (RA). The instrument was developed with limited involvement from persons with RA, and their perception of the instrument has not been studied in depth. The aim of this study was to explore how persons with RA experience the use of the HAQ in care. Methods. Forty persons with RA were purposefully recruited to participate in semi-structured interviews. The interviews were then analyzed qualitatively using thematic analysis. Results. The participants questioned the relevance of the HAQ but nevertheless experienced that the instrument had a profound effect on their understanding of health and how care is delivered. The analysis resulted in three themes: Problems with individual items, meaning of the summative score, and effects on care and health perceptions. Conclusions. To make the HAQ relevant to persons with RA, it needs to be revised or to include an option to select items most meaningful to the respondent. To ensure relevance, the HAQ update should preferably be co-created by researchers, clinicians and persons with RA.

The COVID-19 pandemic over the past years has shown a great need for rapid, low-cost and on-site detection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). In this paper, an aptamer-based colloidal gold nanoparticle lateral flow test strip was well developed to realize the visual detection of wild type SARS-CoV-2 spike protein (SP) and multiple variants. Under the optimal reaction conditions, a low detection limit of SARS-CoV-2 S protein of 0.68 nM was acquired, and the actual detection recovery was 83.3% to 108.8% for real world samples. This suggests a potential tool for the prompt detection of SARS-CoV-2 with good sensitivity and accuracy, and a new method for the development of alternative antibody test strips for the detection of other viral targets.

With the rapid developments that have been made in computer vision and computer technology, semantic segmentation of high-resolution images has emerged as a mainstream and challenging task. The, segmentation of water areas remains a complex task due to the similar features between water areas or between water areas and other land objects. Meanwhile, since coastlines and riverbanks are typically presented in irregular shapes, it is difficult to obtain the categories of pixels at boundaries. This paper proposed the use of a Water-Land Boundary Attention Network (WLBANet) to improve the accuracy of pixels at boundaries between water and land. This network also reinforced the performance of contextual information extraction into distinguishing between water areas and other land objects. To prove the validity of this proposed network, WLBANet was performed on the Water Land Dataset (WLD), which is also by this paper, and which contains water areas and other land objects categories. The results demonstrates that the proposed method has significant effectiveness.

In public health literature the risk of death or disease associated with a dietary, environmental of behavioral factor is most commonly denoted by odds ratio (OR), hazard ratio (HR) or risk ratio (RR). The ratio indices have several desirable statistical properties. However, the most important question is whether there are some evolved innate norms of perception of risk that people use and what they are. We conducted a simple one question survey of 98 individuals with different age, sex, educational and professional backgrounds. The respondents were asked to judge the relative perceived risk of four different hypothetical habits for which data on the percentage of people affected by the disease with and without the habit was given. They were asked to rank the risks for the four habits. Results showed that the habits that had the highest difference between probability of acquiring the disease were ranked high on risk perception. The probability ratios did not affect risk perception significantly. Further age, sex, profession or formal training in statistics did not affect the response significantly. Even individuals that were formally trained to use OR and HR as risk indicators, preferred using probability differences over ratios for judging their own risk in the perceived context. This preliminary inquiry into intuitive statistical perception suggests that designing statistical indices based on people’s innate perception may be a better strategy than trying to train people to understand the indices designed by expert statisticians.

A review of quantitative risk assessment (QRA) models of L. monocytogenes in produce was carried out, with the objective of appraising and contrasting the effectiveness of the control strategies placed along the food chains. Despite nine of the thirteen QRA models recovered focused on fresh or RTE leafy greens, none of them represented important factors or sources of contamination in the primary production, such as type of cultivation, water, fertilisers or irrigation method/practices. Cross-contamination at processing and during consumer’s handling was modelled using transfer rates, which were shown to moderately drive the final risk of listeriosis; highlighting therefore the importance of accurately representing the transfer coefficient parameters. Many QRA models coincided in the fact that temperature fluctuations at retail or temperature abuse at home were key factors contributing to increasing the risk of listeriosis. In addition to a primary module that could help assess current on-farm practices and potential control measures, future QRA models for minimally-processed produce should also contain a refined sanitisation module able to estimate the effectiveness of various sanitisers as a function of type, concentration and exposure time. Finally, L. monocytogenes growth in the products down the supply chain should be estimated by using realistic time-temperature trajectories, and validated microbial kinetic parameters, both of them currently available in the literature.

Childhood overweight/obesity (OV/OB) is a major public health problem, of greater concern when accompanied with comorbidities such as hypertension and insulin resistance leading to metabolically unhealthy obesity (MUO). Aetiologic associations between meal patterns, OV/OB risk and MUO are limited. The aim of this systematic review was to explore associations between meal patterns and the risk of childhood OV/OB and MUO. Longitudinal studies and randomised controlled trials from PUBMED and Scopus published between January 2013 - April 2024 were retrieved. Twenty-eight studies were included, all of which reported on OV/OB risk; none on MUO risk. Regular consumption of breakfast and family meals and avoiding dining while watching TV may be protective factors against childhood OV/OB, whereas meal skipping (primarily breakfast) may be a detrimental factor. Mixed effects of meal frequency on OV/OB risk were observed; no effects of frequency of lunch or of fast-food consumption and of meals served at school were found. There was insufficient evidence to support the role of other patterns (meal timing, eating in other social contexts). Meals were mainly participant-identified, leading to increased heterogeneity. Research focusing on childhood MUO and improved methodological approach (e.g. harmonised definitions) regarding the assessment of meal patterns are highly warranted.

This paper presents the work done to transition the lab scale synthesis (1 g) to a large scale (400 g) synthesis of the 3-5-diamino-1H-Pyrazole Disperazol; a new pharmaceutical for treatment of antibiotic resistant Pseudomonas aeruginosa biofilm infections. The potentially hazardous diazotisation step in the lab scale synthesis was transformed to a safe and easy to handle flow chemistry step. Additionally, the paper presents an OSHA recommended safety assessment of the active compound E, performed by Fauske and Associates, LLC.

The aim of this study was to estimate the association between fear of COVID-19 and risk perception with preventive behavior in health professionals from three Latin American countries. An analytical cross-sectional study was conducted. Health professionals with on-site care in Colombia, Ecuador, Guatemala, and Peru were surveyed. Information was collected through an online self-report questionnaire. The main variables were preventive behavior as the dependent variable and fear of COVID-19 and risk perception as independent variables. Linear regression was used, and Beta coefficients and p-values were calculated. 435 health professionals were included, the majority were aged 42 years or older (45.29%, 95%CI: 40.65%-50.01%) and female (67.82%, 95%CI: 63.27%-72.05%). It was shown that the greater the fear of COVID-19, the greater the preventive behavior of COVID-19 infection (B=2.21, p=0.002 for total behavior; B=1.12, p=0.037 for additional protection at work; B=1.11, p<0.010 for hand washing). The risk perception of COVID-19 infection had a slight direct relationship with preventive behaviors (B=0.28, p=0.021 for total behavior; B=0.13, p=0.015 for hand washing), with the exception of the preventive behavior of using additional protection at work (p=0.339). We found that fear and risk perception are associated with increased practice of hand washing and use of additional protection at work. Further studies are required on the influence of working conditions, job performance and the occurrence of mental health problems in frontline personnel with regard to COVID-19.

Background: The study aimed to investigate the association between environmental tobacco smoke exposure and the risk of wheezing among rural and urban preschool children in Mpumalanga province, South Africa, an area associated with poor air quality. Methods: In this study, parents/caregivers of preschool children (n=3145) completed a modified International Study of Asthma and Allergies in Childhood (ISAAC) questionnaire. Data were analysed using multiple logistic regression models. Results: The overall prevalence of Wheeze ever was 15.14%, with a higher prevalence in urban pre-schoolers than rural pre-schoolers (20.71% vs 13.30 %, P<0.000). Moreover, the total prevalence of asthma ever was 2.34%. The prevalence was greater in urban pre-schoolers than in rural pre-schoolers (3.92% vs 1.81%, P<0.001). In the final adjusted model, both urban and rural area children who lived with one or more people who smoked in the same household (WE: OR 1.44, 95% CI 1.11-1.86) (CW: OR 2.09, 95% CI 1.38-3.16) and (AE: OR 2.49, 95% CI 1.12-5.54) were found to have an increased likelihood of having Wheeze Ever, Current Wheeze and Asthma Ever as compared to those who lived with non-smokers. Conclusions: The implementation of smoking limits and prohibition is crucial in areas that are frequented or utilized by children. Hence, it is imperative for healthcare providers to actively champion the rights of those who do not smoke within the society, while also endorsing legislative measures aimed at curtailing the extent of tobacco smoke exposure.

A number of sustainable and environmental issues are caused by consumer's behavior. Consumers' consumption pattern plays an increasingly important role in environmental conservation and adopting to a more sustainable community. This study used planned behavior theory and structural equation model to quantifies individual purchasing behavior of electronic vehicles based on perceived health risk cased by air pollution in Kunming, China. The findings showed that (1)for residents in Kunming, the perceived air pollution risk, the willingness to purchase new energy vehicles, and actual purchase behavior are low; (2) perception of health risks has a significant positive impact on purchase willingness, behavioral attitude and subjective norms play a significant positive mediating role between perception of health risks and purchase willingness, and perception of behavioral control plays a significant negative role, purchase willingness has significant positive impact on purchase behavior, the direct effect of perceived behavioral control on purchase behavior is insignificant; (3) for highly educated groups, risk controllability has a significant impact on the perception of health risk, subjective norms and behavioral attitude have significant impacts on purchase willingness, while for low-income gourp, risk controllability has significant impacts on the perception of health risk.

This article aims to provide a comprehensive understanding of vaping from various perspectives that contributes to the origin, development, achievement, and consequences of the greed of e-cigarette manufacturers. In our analysis, multiple elements of the social landscape, including economic, cultural, moral, psychological, and philosophical dimensions, contributed to the origin and development of the vaping greed and shaped people’s behaviors. Further discussion was made on how the specific characteristics of e-cigarette products and the marketing strategies of the companies, especially social media marketing, fostered the growth of such greed. Through interviews, we have also discussed the unfolding of this greed within the community of teenage vapers. The growth of the vaping greed was manifested in the large market share taken by the companies, but these all significantly harm people’s health and the communities. Nicotine and other chemicals in e-liquids promote each other’s negative effects in the mechanism leading to pulmonary symptoms and addiction, which are not limited to the physical level. We described that addiction could be transgenerational and can induce trauma both at an individual level and a community level. Overall, the greed of the vaping industry is a very complex system. The treatment of the greed shall be complicated as well: Besides the public health measures taken to treat the symptoms of the greed, we should educate individuals to be aware of their unfulfilled needs to regain authenticity and establish an infallible authority to enforce universal morality, which eradicates the complications of addiction and the root of the capitalists’ greed, respectively.

Managing a portfolio whose value closely tracks an index by trading only in a subset of the index constituents involves an NP-hard optimisation problem. In the prior literature, it has been suggested to solve this problem using sequential Monte Carlo (SMC, a.k.a. particle filter) methods. However, this literature does not take transaction costs into account, although transaction costs are the primary motivation for attempting to replicate the index by trading in a subset, rather than the full set of index constituents. This paper extends the SMC approach to index tracking to allow for proportional transaction costs and implements this extended method on empirical data for a variety stock indices. In addition to providing a more practically useful tracking strategy by allowing for transaction costs, we find that including a penalty for transaction costs in the optimisation objective can actually lead to better tracking performance.

This study employed a deductive research approach and a survey strategy to assess risk perception and its influencing factors among construction workers in Malawi. Three specific construction hazards and their associated risks were selected. The hazards were ‘working at height (WAH) ‘manual handling of loads (MHL)’ and ‘heavy workload or intense pressure to be more productive (HWP)’. The study engaged multistage sampling of 376 subjects. Univariate analysis, factor analysis and multiple linear regressions were performed in order to determine the main influencing factors among the independent variables. The study established that workers were aware of risks posed by their work. They perceived the risk associated with WAH, MHL and HWP as very high (62.7%, = 8.80 ± 1.95); (48.5%, = 8.10 ± 2.38); (57.9%, = 8.49 ± 2.22) respectively. The study identified six factors as variables that showed significant effect on workers’ perception of risk (p < 0.05). These factors were “dreaded factor”, “avoidability and controllability”, “expert knowledge”, “personal knowledge”, education level and age. It is concluded that contractors in the Malawian construction industry should integrate analysis of behaviors and risk perception of the workers and other players to guide the identification of better health and safety interventions at their worksites.

Pancreatic cancer is one of the most fatal common cancers affecting both men and women, representing about 3 percent of all new cancer cases in the United States. In this study, we aimed to investigate the association of pancreatic cancer risk with alcohol consumption as well as folate intake. We performed a case-control study of 384 patients diagnosed with pancreatic cancer from May 2004 to December 2009 and 983 primary care healthy controls. Our findings showed no significant association between risk of pancreatic cancer and either overall alcohol consumption or type of alcohol consumed (drinks/day). Our study showed dietary folate intake was modestly but significantly inversely associated with pancreatic cancer (OR=0.99, P <.0001). The current study supports the hypothesis that pancreatic cancer risk is reduced with higher food-based folate intake.

Even though Greece is considered a vulnerable region in terms of climate hazards, public perception and attitude do not always identify climate change as an important environmental area of concern, especially when compared to socio-economic issues. The key issue of this paper is to investigate and analyse public perception in Greece as regards to climate change risk. Through a questionnaire survey this paper analyses trends that exist, peoples’ opinion and awareness with regards to climate risk and how willing they are to change current lifestyle, to pay or to act to minimize or to prevent the risk. Conventional wisdom of this paper is to highlight factors that influence individual perception and point out drivers of behavior change that can support efficiently future adaptation plans.

Abstract: Global ecological concern regarding the transfer of fouling organisms to ship hulls is increasing. This study investigated the species composition, dominant species, distribution patterns, community structure, and life-cycle differences of hull-fouling macroinvertebrates on five research vessels (R/Vs: Isabu, Onnuri, Eardo, Jangmok 1, and Jangmok 2) operated by the Korea Institute of Ocean Science and Technology (KIOST). Hull-fouling macroinvertebrates were collected three to five times on quadrats from the upper and middle sectors of the hull sides, bottom, and niche areas (the propellers and shafts and the thrusters). A total of 47 macroinvertebrate species were identified, represented by 8,519 individuals(ind.)/m2 and a biomass of 1,967 gWWt/m2 on the five vessels. The number of species, density, and biomass were greater on the coastal vessels the Eardo, Jangmok 1, and Jangmok 2 than on the ocean-going vessels the Isabu and Onnuri. Among the coastal vessels, barnacles were the most abundant and had the greatest density, while mollusks had the highest biomass. Differences between hull sectors showed that the highest species abundance and density appeared on all hulls in ports and bays where the Jangmok 1 operated, while the highest species abundance, density, and biomass were identified in the niche areas of the Eardo, which operated farther from the coast. The hull-fouling macroinvertebrates that exceeded 1% of all organisms were the barnacles Amphibalanus amphitrite, Balanus trigonus, and Amphibalanus improvisus; the polychaete Hydroides ezoensis; the bivalves Magallana gigas and Mytilus galloprovincialis; and the amphipod Jassa slatteryi. The dominant species were cosmopolitan and globally distributed, and many of them were cryptogenic. Six native species were identified: M. gigas, H. ezoensis, the amphipod Melita koreana, the isopod Cirolana ko-reana, and the barnacle B. trigonus and F. kondakovi. Eight non-indigenous species (NIS) were de-tected: barnacles A. amphitrite and A. improvisus, the bivalve M. galloprovincialis, the polychaete Perinereis nuntia, amphipods J. slatteryi and Caprella californica, and bryozoans Bugulina californica and Bugula neritina. Of the fouling macroinvertebrates found on the vessel hulls, 13% were native and 17% were NIS. The nMDS ordination analysis of the five vessels showed four clusters of fouling macroinvertebrate communities: two ocean clusters (the Isabu and Onnuri), one coastal cluster (the Eardo and Jangmok 2), and one local cluster (the Jangmok 1). More diverse communities developed on the hulls of vessels that operated locally rather than globally or in deep oceans. Spearman rank correlation showed that biological indices such as number of species, density, and biomass correlated highly and positively with the numbers of days on coastal operations and negatively with the number days on ocean operations. The species diversity index correlated positively with the total number of anchoring days and coastal operation days and negatively with the total number of operation days and ocean operation days. The macroinvertebrates differed by the area of operation, the port of anchorage, the number of days in operation and at anchor, and the hull sectors. There is no previous research data on hull-fouling macroinvertebrates in the Republic of Korea, and this study provides a basis for future studies to identify introduced species and their differences based on operation area.

Forestry workers play a crucial role in implementing forest management programs, but their outdoor work exposes them to rising temperatures caused by global climate change, which poses potential health risks related to heat. This study focuses on Indonesian forestry workers and examines the relationship between their knowledge of heat-related issues, risk perception, and precautionary behavior in dealing with increasing workplace heat exposure. Developing effective precautionary behavior is essential for preventing heat-related health disorders and promoting health protection programs. To facilitate a comprehensive comparison of the three variables, interviews were conducted with two groups of outdoor workers, comprising 210 forestry workers and 215 paddy farmers. The findings indicate that increasing knowledge about heat-related issues promotes precautionary behavior, and risk perception acts as a mediator between knowledge and behavior. Additionally, the study highlights that the emotion of "dread" intensifies perceived risk and predicts positive behavior change. To enhance heat-related knowledge, exploring the potential use of a "fear" tone is important. In conclusion, comprehensive strategies need to be implemented to promote precautionary behavior among vulnerable forestry workers, particularly manual laborers.

This paper introduces a novel decision-making approach grounded in insights into human visual perception of change. Modern technologies such as internet of things (IoT) provide us with large amounts of sensor data that need to be processed in real time and decisions made with a high degree of accuracy and reliability. Artificial intelligence (AI) methods are welcome in this context and need to be upgraded to meet actual challenges. While modern computing capabilities facilitate rapid data processing, the real-time demands of vast sensor data necessitate swift responses across the cyber chain, often leading to compromises in solution quality to circumvent combinatorial search complexities. Determining the adequacy of a solution entails varied approaches, often relying on heuristic methodologies. We illustrate our original approach with an example of a selected detail of a differential evolution algorithm, where we have to make a decision to adopt the best solution so far. We propose an approach inspired by human perceptual features that exploits the Weber-Fechner law to emulate human judgements, and offers a promising way to improve decision making in AI applications and real-time requirements fulfillment. Our proposed methodology demonstrates applicability across diverse AI scenarios involving numerical data, effectively mirroring human perception abilities.

Background: Despite their generally favorable prognosis, hepatic fibrosis remains a possible complication for hepatitis B virus (HBV) inactive carriers. This study aimed to estimate the prevalence of significant fibrosis and associated risk factors among Omani HBV inactive carriers. Methods: A retrospective study was conducted of 200 Omani HBV inactive carriers visiting a tertiary hospital in Muscat, Oman, between January 2017 and December 2018. Significant fibrosis (stage F2 or higher) was identified using two-dimensional shear-wave elastography. Baseline clinical, laboratory, and radiological data were analyzed to determine associations. Results: Of the total sample, 106 patients (53%) were male, and the mean age was 44.6 ± 9.3 years. The prevalence of significant fibrosis was 20% (n = 40). Male gender (p = 0.007), age ≥60 years (p = 0.024), and fatty changes in liver ultrasound (p = 0.044) were found to be independent factors for significant fibrosis. Conclusion: the prevalence of significant fibrosis was relatively high among a sample of Omani HBV inactive carriers, with several sociodemographic and clinical risk factors identified. Periodic assessment of liver function is needed for patients with these risk factors; moreover, routine biochemical parameters could be useful predictors of disease prognosis. Further research is recommended to substantiate these findings.

Reducing under-five mortality is a key indicator of a country's overall development, yet in Angola, understanding the factors contributing to hospital deaths in this vulnerable demographic remains incomplete despite improvements in healthcare infrastructure and public health policies. With one of the highest under-five mortality rates in Sub-Saharan Africa, Angola grapples with significant challenges, including malaria, malnutrition, pneumonia, neonatal conditions, and intestinal infectious diseases, as leading causes of death among children. This study aimed to identify factors associated with these hospital deaths in children aged 28 days to five years admitted to DBPH in Luanda between May 2022 and June 2023. Utilizing a hospital-based case-control design, a total of 1020 children were studied, with 340 cases of hospital deaths. Notably, distal and intermediate determinants emerged as primary predictors of hospital mortality, revealing significant associations with maternal education status, maternal alcohol consumption during pregnancy, short hospital stays (≤24h), poor nutritional status, short interbirth intervals, maternal age ≤19 years, and maternal age ≥35 years. These findings underscore the preventable nature of most under-five hospital deaths and emphasize the urgent need to address social inequities and enhance the quality of primary healthcare services to effectively mitigate child mortality.

The purpose of this study is to establish whether digital literacy and insurtech adoption influence insurance inclusion in Uganda. Principally, we sought to determine whether insurtech adoption mediates the nexus between digital literacy and insurance inclusion. This study adopted a cross-sectional and quantitative correlational approach. The study’s sample was 391 individuals who had used digital platforms such as mobile phones and computers to access insurance products and services in Uganda. Data were collected using structured survey questionnaires. Partial Least Squares Structural Equation Modelling (PLSEM) was employed to test the hypothesised relationships. The results demonstrate that both digital literacy and insurtech adoption significantly and positively influence insurance inclusion. We also found digital literacy to be a significant and positive determinant of insurtech adoption. Markedly, it was found that insurtech adoption mediates the association between digital literacy and insurance inclusion in Uganda. However, this study was conducted in a developing country with an underdeveloped insurance market and with low technological advancement. This may affect generalisation of the study findings. This study’s novelty lies in establishing how digital literacy and insurtech adoption interplay to influence insurance inclusion in Uganda. This is the first study to examine the effect of digital literacy and insurtech adoption on insurance inclusion.

Background/Objectives: Concurrent opioid (OPI) and benzodiazepine (BZD) use may exacerbate falls/fractures risk compared to no use or use alone. Yet, patients may need concurrent OPI-BZD use for co-occurring conditions (e.g., pain and anxiety). Therefore, we examined the association between longitudinal OPI-BZD dosing patterns and subsequent injurious falls risk. Methods: We conducted a retrospective cohort study including non-cancer fee-for-service Medicare beneficiaries initiating OPI and/or BZD in 2016-2018. We identified OPI-BZD use patterns during the 3 months following OPI and/or BZD initiation (i.e., trajectory period) using group-based multi-trajectory models. We estimated time to first injurious fall within 3 months post-trajectory period using inverse-probability-of-treatment-weighted Cox proportional hazards models. Results: Among 622,588 beneficiaries (age≥65=84.6%, female=58.1%, White=82.7%; having injurious falls=0.45%), we identified 13 distinct OPI-BZD trajectories: Group(A):Very-low OPI-only (early discontinuation)(44.9% of the cohort); (B):Low OPI-only (rapid decline)(15.1%); (C):Very-low OPI-only (late discontinuation)(7.7%); (D):Low OPI-only (gradual decline)(4.0%); (E):Moderate OPI-only (rapid decline)(2.3%); (F):Very-low BZD-only (late discontinuation)(11.5%); (G):Low BZD-only (rapid decline)(4.5%); (H):Low BZD-only (stable) (3.1%); (I):Moderate BZD-only (gradual decline)(2.1%); (J):Very-low OPI (rapid decline)/Very-low BZD (late discontinuation)(2.9%); (K):Very-low OPI (rapid decline)/Very-low BZD (increasing)(0.9%); (L):Very-low OPI (stable)/Low BZD (stable)(0.6%); and (M):Low OPI (gradual decline)/Low BZD (gradual decline)(0.6%). Compared with Group(A), 6 trajectories had increased 3-month injurious fall risks: (C): HR, 95%CI=1.78, 1.58-2.01; (D): 2.24, 1.93-2.59; (E): 2.60, 2.18-3.09; (H): 2.02, 1.70-2.40; (L): 2.73, 1.98-3.76; and (M): 1.96, 1.32-2.91. Conclusions: Our findings suggest that 3-month injurious fall risk varied across OPI-BZD trajectories, highlighting the importance of considering both dose and duration when assessing fall risks of OPI-BZD use among older adults.

Cervical cancer is one of the ailments that endangers the health of women all over the world and causes infertility. Fortunately, this disease can be avoided. Both the results and participation rates of the current preventative strategy remain poor. Hence, preventative or early detection methods remain challenging and open. In gynecology and computer science fields, few studies on identifying cervical cancer are based on behavior risk factor and machine learning. Moreover, various social and behavioral aspects might often make it more difficult to detect cervical cancer especially in low‑ and middle‑income countries (LMICs). Accordingly, focus on predicting the presence of cervical cancer through behavioral risk factors is the basic structure of this research. We proposed an approach to classify cervical cancer from a social-behavioral perspective using logistic regression to predict cervical cancer. We got significantly improved outcomes than the existing methods. Moreover, we used feature engineering to formulate less dimensionality as a pre-processing step and optimized parameters to be prepared for classification phase. The results proved that using the logistic regression with regularization type L1 had a promising performance. The accuracy of Logistic Regression (LR) L1 was 97.2%. Such results support the proposed work as a reliable classification predictive tool.

Background: Colorectal cancer (CRC) can significantly impact mental health, increasing suicide risk. Variables such as pain and threat perception may be crucial. This study aims to identify predictors of suicide risk in individuals with CRC. Methods: A total of 71 participants (76.06% men) aged 27 to 88 years (M = 65.18, SD = 12.02) were assessed using the SF-36 for pain, the Brief Illness Perception Questionnaire (B-IPQ) for threat perception, the Hospital Anxiety and Depression Scale (HADS) for emotional distress, and the Plutchik suicide risk scale for suicide risk. Descriptive, comparative, and correlational analyses were performed, followed by a linear regression analysis. Results: Nearly 20% of participants exhibited high suicide risk. There was a moderate to high association between suicide risk and the perception of threat, pain, and emotional distress. The linear regression model explained 39% of the variance in suicide risk, with threat perception, pain, and emotional distress as significant predictors. Conclusions: These results indicate the need for multidisciplinary care for individuals with CRC, including emotional support from health psychologists, and holistic, human-centered care from nursing and medical professionals. Future research is necessary to further explore these relationships and improve patient care strategies.

Background: In recent years, whole blood parameters and derivatives have been used as prognostic criteria in the course of the disease in various diseases. The prognostic nutritional index (PNI), the systemic immune-inflammation index (SII), the neutrophil-lymphocyte ratio (NLR) have been adapted as an indicator of inflammation and have been widely studied to define the severity of inflammation in some diseases. The aim of this study was to evaluate the relationship between parameters such as NLR, SII, PNI, controlling nutritional status (CONUT) score, nutritional risk index (NRI) and with immunonutrition status and disease activity in patients with ischemic stroke of small vessel, large vessel and other etiologies. Methods: We retrospectively evaluated the records of 1454 consecutive ischemic stroke patients hospitalized in the emergency department of Gaziosmanpasa Education and Research Hospital from 2019 to 2023. Results: Of the 1350 SVO patients included in the study, 58.8% had small vessel, 29.3% had large vessel and 11.9% had other etiologies. There was a significant difference between the 3 etiology groups for PNI and CONUT. The median PNI was 47.03 (41.33-52.85) in the other etiology group, 35.29 (33.69-37.25) in the small vessel group, and 34.11 (30.23-36.87) in the large vessel group. The CONUT median was 5(5-6) in the small vessel group, 5(4-6) in the large vessel group and 4(4-4) in the other etiology group. In addition, CONUT and PNI were also found to be independent risk factors for death. A negative significant correlation was observed between PNI and NLR (r:-0.692), SII (r:-0.591), CONUT (r:-0.685). Significant correlations were observed between CONUT and NLR (r:0.402), SII (r:0.312). Conclusion: PNI and SII were significantly associated with disease activity. PNI, CONUT and NRI as a more accurate prognostic indicator of nutritional status in patients with ischemic stroke of small vessel, large vessel and other etiologies. NLR and SII may be important predictive markers in the course and prognosis of stroke.

Background: Historically, in the United States and globally, women have supported other women before, during, and after childbirth. Birth doulas are considered an important component to eliminating racial disparities in maternal morbidity and mortality. To address disparities in birth outcomes, Healthy Women Healthy Futures (HWHF) provides free birth and postpartum doula services to low-income women and communities of color in New York City. Methods: Secondary analysis of program data (n=364) collected between 2020 and 2021 was conducted. Univariate and multivariable analyses focused on: method of delivery, preterm birth, low-birthweight birth, breastfeeding, maternal-infant skin contact. The key exposure variable was total doula hours. Results: Clients who received prenatal doula support had low rates of preterm birth (8.8%) and low birthweight (7.1%), and high rates of vaginal delivery (69.1%), breastfeeding in the hospital (90.9%), and maternal-infant skin contact (78.2%). Multivariable analysis did not identify an association between number of doula hours and any of the five outcomes examined. Conclusion: While descriptive results point to positive birth outcomes, these effects did not persist in multivariable analyses. Data quality concerns from this intervention likely hindered the ability to detect a program impact, emphasizing the importance of funding to support data collection and management activities.

The Solvency II regulatory framework specifies procedures and parameters for determining solvency capital requirements (SCRs) for insurance companies. The proposed standard SCR calculations involve two steps. The Value–at–Risk (VaR) of each risk driver is measured and, in a second step, all components are aggregated to the company’s overall SCR, using the Standard Formula. This formula has two inputs: the VaRs of the individual risk drivers and their correlations. The appropriate calibration of these input parameters has been the purpose of various Quantitative Impact Studies that have been conducted during recent years. This paper demonstrates that the parameter calibration for the equity–risk module—overall, with about 25%, the most significant risk component—is seriously flawed, giving rise to spurious and highly erratic parameter values. As a consequence, an implementation of the Standard Formula with the currently proposed calibration settings for equity–risk is likely to produce inaccurate, biased and, over time, highly erratic capital requirements.

The diagnosis and management of cow's milk allergy (CMA) is a topic of debate and controversy. We aimed to compare the opinions of expert groups from the Middle East (n=14) and the European Society of Pediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) (n=13). These Expert groups voted on statements developed by the ESPGHAN group and published in a recent position paper. The voting outcome was compared. Overall, there was consensus amongst both groups of experts. Most experts agreed that symptoms of crying, irritability and colic, as single manifestations, do not suggest CMA. They agreed that amino-acid-based formula (AAF) should be reserved for severe cases (e.g. malnutrition and anaphylaxis) and that there is insufficient evidence to recommend a step-down approach. There was no consensus on the statement that a cow’s milk-based extensively hydrolysed formula (eHF) should be the first choice as a diagnostic elimination diet in mild/moderate cases. Although the statements regarding the role of hydrolysed rice formula as a diagnostic and therapeutic elimination diet were accepted, 3/27 disagreed. The votes regarding soy formula highlight the differences in opinion in the role of soy protein in CMA dietary treatment. Generally, soy-based formula is seldom available in the Middle East region. All ESPGHAN experts agreed that there was no added value of probiotics, prebiotics, and synbiotics to the efficacy of elimination diets, whereas 3/14 of the Middle East group thought there was sufficient evidence. Therefore, there is not a consensus on the optimal diagnostic and therapeutic elimination diet for CMA, but the first-choice elimination diet and the stepwise management approach reveal some differences.

Lung cancer is the leading cause of cancer death worldwide therefore studies about the etiological factors and carcinogenesis are important.The aim of the study is to detect the presence and types of Human papilloma virus (HPV) in lung cancer and non-tumoral lung and Epidermal Growth Factor Receptor (EGFR) mutation prevalance in lung cancer with Polymerase Chain Reaction (PCR) method.Fifty patients who were histopathologically diagnosed lung cancer and 7 patients with non-neoplastic lung disease were enrolled in the study. HPV positivity was detected in 75.4% of the patients. The rate of high-risk HPV positivity was 100% in adenocarcinomas, 64.5% in squamous cell carcinomas, and 57% in non-neoplastic lung. HPV 51 was the most frequent type followed by HPV 16 (43.9%). There was no statistically significant relationship between HPV infection and age, gender and smoking history and EGFR mutation. The prevalence of HPV positivity is variable in lung cancer in different studies and this may be due to many factors including HPV detection methods, number of patients, geographic regions. New studies about the role of HPV infection need to be performed in order to obtain information about the use of prophylactic and theurepatic agents in lung cancer.

Background: Only few studies have studied the link between risk perception and sleep in the context of the COVID-19 pandemic. This study investigates the effect of two distinct risk appraisals—risk perception and perception of collective coordinated defense (PCCD) on Chinese adults’ sleep quality during the COVID-19 pandemic, and tested COVID-19-related fear and rumination as potential mediators of the relationships. Methods: Data were collected using a self-report online questionnaire from a sample of 224 Chinese adults during the fourth wave of the COVID-19 pandemic in Hong Kong. Results: COVID-19 risk perception and PCCD were related to poor sleep quality. Mediation analysis showed that both fear and rumination mediated the relationship between risk perception and sleep quality, whereas only fear mediated the relationship between PCCD and sleep quality. The model showed an excellent fit to the data and accounted for 44% of the variance in sleep quality in Chinese adults. Conclusions: This study demonstrates the distinct perceptual processes—risk appraisals in particular—contributed to poor sleep quality in Chinese adults during the COVID-19 public emergencies. These findings would be helpful for policy makers to address the sleep problems induced by psychological consequences of the pandemic.

: Fluoride toxicity has become a global public health concern, and its significant source of exposure is drinking water. This study aimed to determine groundwater fluoride level and assess its related human health risks. Its level was measured from groundwater samples using an ion-selective electrode. The total hazard index was assessed based on the chronic daily oral intake and dermal absorbed dose of groundwater fluoride. Analyses were conducted using ArcGIS and SPSS. This study reported groundwater fluoride ranged from 0.3 mg/L to 38 mg/L, with a mean annual level of 15 mg/L. Groundwater fluoride level above 5 mg/L was reported in 60 % of the water samples. Total hazard index values among sampled locations varied from 0.18 to 22.56. Half (51.5 %) of infants, 85.5 % of children, 82.5 % of adolescents, and 67.5 % of adults had a risk of developing a non-carcinogenic health effect. This study demonstrated that the fluoride level of the groundwater sources was high, and the water was not suitable for drinking, a result that is of special importance for children and adults since they are a hypersensitive subgroup of the population.

Global coverage and scale up of interventions to reduce newborn mortality remains low, though progress has been achieved in improving newborn survival in many low-income settings. An important factor in the success of newborn health interventions, and moving to scale, is appropriate design of community-based programs and strategies for local implementation. We report the results of formative research undertaken to inform the design of a newborn health intervention in Cambodia. Information was gathered on newborn care practices over a period of three months using multiple qualitative methods of data collection in the primary health facility and home setting. Analysis of the data indicated important gaps, both at home and facility level, between recommended newborn care practices and those typical in the study area. The results of this formative research have informed strategies for behavior change and improving referral of sick infants in the subsequent implementation study. Collection and dissemination of data on newborn care practices from settings such as these can contribute to efforts to advance survival, growth and development of newborns for intervention research, and for future newborn health programming.

This analysis examines the wide range of occupational and environmental health risks that affect people in diverse settings. This article emphasizes the importance of conducting exposure and risk assessments to safeguard public health by analyzing various hazards, including arsenic, oil accidents, lead, welding fumes, and mycotoxins. Various methodologies are utilized in these research articles to conduct the study, emphasizing hazard identification, exposure assessment, and risk characterization. The results uncover harmful substances, vulnerable demographics, and occupational duties linked to increased hazards. The report suggests various mitigation strategies, such as targeted interventions, enhanced community efforts, and improved exposure estimates. Notwithstanding the constraints identified in certain studies, the review emphasizes the necessity for continuous investigation to improve assessments of exposure, comprehend the cumulative effects, and examine the wider societal consequences. The significance of sector-specific risk assessments, protective measures, and ongoing monitoring is underscored to ensure mental and physical health protection.

Background: Patients with Inflammatory Bowel Disease (IBD) believe that diet is a key factor in the pathogenesis of their disease and in worsening their symptoms; they often follow restrictive diets that can lead to malnutrition, anxiety, and stress. Recent studies have found an association between eating disorders and IBD, particularly anorexia nervosa and ARFID (Avoidant Restrictive Food Intake Disorder). None of these studies report the association with orthorexia nervosa, that is the obsession with healthy and natural foods. Aim: to assess the risk of orthorexia nervosa in patients with IBD. Methods: 158 consecutive subjects were recruited, including 113 patients diagnosed with IBD and 45 controls. The Donini standardized questionnaire ORTO-15 was administered to assess the risk of orthorexia; clinical and demographic data were also collected. Results: patients with IBD have a prevalence of orthorexia of 77%, significantly higher than the 47% observed in the control group. In patients with IBD, the risk of orthorexia is associated with lower BMI and history of previous surgery. Conclusion: Many patients with IBD develop orthorexia nervosa that impacts the patient's psychological and social sphere, exposes them to a high risk of nutritional deficiencies, and affects quality of life. Further high quality studies are warranted to evaluate the clinical impact of orthorexia and its correlation with clinical features and frank eating disorders.

Beta thalassemia is an inherited blood disorder that results in inefficient erythropoiesis due to genetic mutation that leads to reduction or absence of the hemoglobin beta-globulin protein. Approximately 8.5% of UAE residents suffer from β-thalassemia, a significant health and financial problem. The treatment options available for β-Thalassemia major are limited and associated with a wide range of complications. β-thalassemia gene therapy is emerging as a potential novel treatment option that eliminates the complications caused by the current long-term treatment modalities and the associated economic burden. This paper reviews the scientific literature related to emerging gene-therapy for β-Thalassemia by analyzing all the articles published from January 2010 to December 2023 in the English language on Databases like PubMed, Scopus, ProQuest, and CINAHL. The use of gene therapy has demonstrated promising outcomes for a permanent cure of β-Thalassemia. ZYNTEGLO (Betibeglogene autotemcel) is the only cell-based gene therapy which was approved by the FDA on 19th August, 2018. To conclude, Gene therapy is an innovative solution. It demonstrates a promising future, but does come with its own set-backs and is something that must be tackled in-order to revolutionize it in the medical world. FDA approved ZYNTEGLO is a potentially one-time curative treatment for β-Thalassemia. Although cutting-edge, its use is limited because of the high cost; a price of $2.8million per patient.

To decrease oral pathogens and increase the number of beneficial bacteria, probiotics and bioactive compounds made via microbial bioconversion are recently used. In addition, the interest regarding probiotics-mediated bioconversion with popular medicinal plants is increasing. These compounds produced during the process exhibit synergistic effect and enhance a variety of biological activities including pathogen inhibition in host. Therefore, we developed bioconverted milk with high inhibitory activity against oral pathogens and α-glucosidase. Lactiplantibacillus plantarum SMFM2016-RK was chosen as the probiotic due to its beneficial characteristics such as high acid and bile tolerance, antioxidant activity, and α-glucosidase inhibition. Based on the minimal bactericidal concentration against three oral pathogens, the following appropriate concentrations of Artemisia herba-alba extract were added to milk: 5 mg/mL of A. herba-alba ethanol extract and 25 mg/mL of A. herba-alba hot-water extract. Four bioconverted milks (BM), BM1, BM2, BM3, and BM4, were produced by combining L. plantarum SMFM2016-RK alone, L. plantarum SMFM2016-RK and ethanol extract, L. plantarum SMFM2016-RK and hot-water extract, and L. plantarum SMFM2016-RK with both extracts. As a result of antimicrobial activity, BM3 inhibited the growth of Aggregatibacter actinomycetemcomitans and Porphyromonas gingivalis the most, and BM4 suppressed the growth of Fusobacterium nucleatum the most. In addition, bioconverted milk containing A. herba-alba (BM2, BM3, and BM4) inhibited α-glucosidase more effectively than BM1. In conclusion, A. herba-alba-added milk bioconverted by L. plantarum SMFM2016-RK displayed the growth inhibitory effect on oral pathogens and the α-glucosidase inhibitory activity, thus it necessitates to evaluate the effects on the alleviation of oral diseases and glycemic control through future animal experiments.

BACKGROUND Detecting total cholesterol in dried blood spots could aid in identifying individuals with a high likelihood of familial hypercholesterolemia and could be used as a screening measure. This study aims to assess the diagnostic accuracy of dried blood spots on Whatman 903 paper cards using a manual enzymatic technique. METHODS A total of 394 samples collected as serum and dried blood spots were compared. Cholesterol was determined in serum using the automated reference method, while cholesterol on paper was measured using a manual enzymatic method. Within- and between-day diagnostic variability were analyzed. The correlation between both methods was assessed using Passing-Bablok regression and Bland-Altman plot. Internal validation of our correlation formula was performed on 149 samples, along with external validation of the formula proposed by Corso et al. RESULTS The within- and between-day coefficient of variation was found to be lower than 10.14% and 14.09%, respectively. Method comparison yielded an area under the curve of 0.976, with a standard error of 0.009. Passing-Bablok regression indicated a precision of 0.803 and an accuracy of 0.96. Internal validation precision was measured at 0.716. Regarding internal validation, calculated cholesterol with our regression line did not differ from serum cholesterol analysis, while significant differences were observed in calculated cholesterol levels using the external formula. CONCLUSIONS Total cholesterol analysis in dot blood spots demonstrates high precision and reproducibility. This method reliably enables the incorporation of this biological marker into neonatal screening for familial hypercholesterolemia detection.

The fulfillment of rights to maternal healthcare is a key factor for wellbeing of woman. However, there is a lack of instrument to know the experience of women during maternity to bind the monitoring. The aim of this study was to validate an instrument to measure the woman’s perception of the fulfillment of rights during healthcare in pregnancy, childbirth and immediate postpartum. The instrument consist in 50 items was screening by an exploratory factor analysis. Additionally, the final version of the instrument consists in 29 items which was validate by confirmatory factor analysis and know-group validity. The instrument was applied in 185 Spanish women. The global Aiken’s V of initial instrument proposal was 0.89. Process resolves an instrument with 5 factors (information, privacy, consent, support, and participation) that explained the 60% of the total variance. The score of the instrument was correlated with resilience, maternity beliefs, and positive and negative affect. External validation showed relations with age, gravida, and number of labors. Additionally, the reliability Cronbach´s was 0.93 [0.91; 0.94]. In conclusion, the instrument developed is consistent and has appropriate psychometric properties for assess the fulfillment rights maternity healthcare.

Social biases may concentrate attention of researchers on a small number of well-known molecules/mechanisms leaving others underexplored. In accordance with this view, central to mechanistic toxicology is a narrow range of molecular pathways that are assumed to be involved in significant part of responses to toxicity. It is unclear, however, if there are other molecular mechanisms which play important role in toxicity events but are overlooked by toxicology. To identify overlooked genes sensitive to chemical exposures we used publicly available databases. First, we used data on published chemical-gene interactions for 17,338 genes to estimate their sensitivity to chemical exposures. Next, we extracted data on publication numbers per gene for 19,243 human genes from Find My Understudied Genes database. Threshold were applied to both datasets using our algorithm to identify chemically sensitive and chemically insensitive genes and well-studied and underexplored genes. 1,110 underexplored genes highly sensitive to chemical exposures were used in GSEA and Shiny GO analyses to identify enriched biological categories. Metabolism of fatty acids, amino acids, and glucose were identified as underexplored molecular mechanisms sensitive to chemical exposures. These findings suggest that future effort is needed to uncover the role of xenobiotics in the current epidemics of metabolic diseases.

Brown rice is a familiar whole grain in Japan. We examined national trends in brown rice consumption among Japanese adults aged ≥ 20 years old, using individual-level data from the National Health and Nutrition Surveys conducted between 2012 and 2019. We employed multivariable logistic regression to identify factors associated with brown rice consumption. The 95th percentile of daily brown rice intake remained at 0.0 grams throughout the study period. The percentage of brown rice consumers increased from 1.8% (95% confidence interval: 1.6–2.1) in 2012 to 2.3% (95% confidence interval: 1.8–3.0) in 2019. Compared with individuals who consumed only white rice, brown rice consumers had significantly higher mean intake levels of macronutrients, legumes, vegetables, fruits, and nuts. Brown rice consumption was positively associated with certain sociodemographic characteristics (being female, older age, residing in a major city, living without very young children, and having higher education levels) and health behaviors (lower body mass index, engaging in regular exercise, and being a former or never smoker). Despite its potential nutritional benefits in balanced diets, only a small fraction of adults in Japan consume brown rice, indicating a need for further promotion, particularly among individuals with characteristics associated with brown rice consumption.

The relationship between antitumor response and tumor marker changes was evaluated in patients with advanced hepatocellular carcinoma treated with durvalumab plus tremelimumab (Dur/Tre). Thirty-two patients were enrolled in this retrospective evaluation of treatment outcomes. According to Response Evaluation Criteria for Solid Tumors at 8 weeks, the objective response rate (OR) was 25% and the disease control rate (DC) was 56.3%. Median alpha-fetoprotein (AFP) ratio at 4 weeks was 0.310 in patients who achieved OR at 8 weeks (8W-OR group), significantly lower than the 1.105 in the non-8W-OR group (p=0.0020), but was 1.210 in patients who did not achieve DC at 8 weeks (non-8W-DC group), significantly higher than the 0.470 in the 8W-DC group (p=0.0006). Similarly, median des-γ-carboxy-prothrombin (DCP) ratio at 4 weeks was 0.125 in the 8W-OR group, significantly lower than the 1.225 in the non-8W-OR group (p=0.0001), but was 1.120 in the non-8W-DC group, significantly higher than the 0.480 in the 8W-DC group (p=0.0255). Early changes in tumor markers after Dur/Tre initiation were associated with antitumor response. In particular, changes in AFP and DCP at 4 weeks may offer useful biomarkers for early prediction of both response and progressive disease following Dur/Tre.

The literature study delves into novel therapeutic strategies in transplantation medicine, highlighting unique approaches that could revolutionize current practices. It emphasizes novel patterns that have the potential to transform the current landscape. Commencing with a thorough examination of the historical environment, it traces crucial advances and changes in transplantation. The focus is on traditional techniques, emphasizing their limitations and challenges. An extensive examination of contemporary transplantation therapies offers valuable insights into the most recent progress in organ, cellular, and tissue transplantation. This analysis examines the immunological obstacles and outlines the current advancements and constraints. The exploration further navigates into novel models and concepts such as immunomodulation, developments in organ preservation techniques, gene editing, biomaterials, scaffold-based solutions, and the integration of precision medicine, artificial intelligence, and machine learning applications. Each section analyzes the potential for change and current progress in various areas, backed by relevant scientific sources up to 2023. The subsequent sections delve into innovative cellular therapies, biotechnological progress, current clinical trials, and case studies demonstrating effective applications. This examination delves into the ethical and regulatory considerations of innovative therapeutic procedures, emphasizing ethical implications, regulatory frameworks, and the importance of balancing innovation with patient welfare. The literature review concludes by offering a forward-looking perspective, emphasizing potential progress, anticipated challenges, and advocating for collaboration and interdisciplinary approaches to overcome limitations in the field of transplantation medicine.

Deploying search and rescue (SAR) dogs in disaster situations is crucial for effective rescue missions. This study delves into the challenges and obstacles encountered during the use of SAR dogs, particularly focusing on the earthquake that hit Turkey in February 2023. By employing a case study approach, the research explores various factors that impact the efficiency and safety of SAR dog operations, such as environmental conditions, equipment needs, cultural perceptions, and logistical hurdles. Environmental conditions such as extreme weather, hazardous materials, and unstable structures present significant risks to both the dogs and their handlers. The adequacy of equipment, including protective gear and medical supplies, is critical for ensuring the safety and efficiency of rescue operations. Logistical challenges, including the transportation and care of dogs in disaster zones, further complicate their deployment. Cultural barriers also play a crucial role, as perceptions of dogs vary widely across different communities, potentially affecting the acceptance and integration of canine units in rescue efforts. The case study of the earthquake in Turkey highlights these issues, showcasing the successes and setbacks experienced by international rescue teams. The findings indicate that although SAR dogs are invaluable in locating survivors, they face significant dangers, including hazardous materials, extreme weather, and physical injuries. Additionally, cultural differences and logistical issues complicate their deployment. This paper highlights the necessity for improved training, protective measures, and international standards to ensure SAR dogs' well-being and effectiveness in disaster response efforts. The study's implications suggest that addressing these challenges can markedly enhance the preparedness and resilience of SAR teams, leading to more efficient and safer rescue operations in future disaster scenarios.

Legionella bacteria can proliferate in poorly maintained water systems, posing risks to users. All Legionella species are potentially pathogenic but Legionella pneumophila (L. pneumophila) is usually the primary focus of testing. However, Legionella anisa (L. anisa) also colonises water distribution systems, is frequently found with L. pneumophila and could be a good indicator for increased risk of nosocomial infection. Anonymized data from three commercial Legionella testing laboratories afforded analysis of 565,750 water samples. Data covered July 2019 to August 2021, including the COVID-19 pandemic. Results confirmed L. anisa commonly colonises water distribution systems, being the most frequently identified non-L. pneumophila species. Proportions of L. anisa and L. pneumophila generally remained similar but increases in L. pneumophila during COVID-19 lockdown suggests static water supplies might favour its growth. Disinfection of hospital water systems was effective but re-colonization did occur, appearing to favour L. pneumophila, although L. anisa colony numbers also increased as a proportion of the total. While L. pneumophila remains the main species of concern as a risk to human health, L. anisa’s role should not be under-estimated, either as a potential infection risk or as an indicator of the need to intervene to control Legionella colonization of water supplies.

The study assessed the trapping efficacy of locally-modified 1) Gravid Aedes Trap(GAT) lined with insecticide-treated net (ITN) as a killing agent, 2) Autocidal Gravid Ovitrap(AGO) with sticky board in the semi-field system (SFS) and field setting. Fully-balanced Latin square experiments were conducted to compare GAT lined with ITN vs AGO, both with either yeast or grass infusion. Biogents-Sentinel (BGS) with BG-Lure and no CO2 was used as standard trap for Aedes mosquitoes. In the SFS, GAT outperformed AGO in collecting both nulliparous (65% vs 49%,OR=2.22,[95%CI:1.89-2.60],p

(1) Background: Second Victims are health care workers negatively affected by adverse events and are prone to developing dysfunctional coping strategies compromising not only their own, but also patient safety. An effective way to address this issue is the implementation of peer support programs. This paper reports on the effectiveness of a peer support program at the Austrian Hietzing Clinic (KHI). (2) Methods: Telephone interviews were carried out after peer support sessions using a questionnaire. Descriptive analysis was carried out reporting frequencies and proportions for nominal variables, means with standard deviations for ordinal and interval-scaled variables. (3) Results: So far, 45 peer supporters have completed telephone interviews after a peer support session. The main reasons for the session were bad news from the private sphere and death of a patient. The peer supporters rated the helpfulness of the sessions for their colleagues as very high while not feeling very burdened themselves afterwards. (4) Conclusions: Underutilization of the program is probable. However, the high rating of helpfulness of the carried-out sessions by the peer supporters in combination with them not feeling very burdened, shows that the program is safe for the peer supporters and an upscaling is warranted.

Diarrhoea is a serious cause of mortality worldwide that can lead to dehydration, gut barrier function impairment, nutrient malabsorption, and alterations of the gut microbiota (dysbiosis). Current solutions for its management, such as oral rehydration salts (ORS), inhibitors of the gut motility, antibiotics, and living probiotics only partially counteract the mechanisms of the disease and do not provide a full coverage of the problem. Potential risks of the use of living probiotic strains, particularly in immunocompromised patients, can be eliminated with the use of tyndallized (heat-killed) postbiotic bacteria and yeast. ABB C22® is a postbiotic combination of three tyndallized yeasts, namely Saccharomyces boulardii, Saccharomyces cerevisiae, and Kluyveromyces marxianus. To assess the action of the postbiotic combination on diarrhoea, immune and gut epithelial cell signaling assays, gut barrier formation assay and rotavirus gene expression assay were performed. ABB C22® showed a strong anti-inflammatory effect, an induction of the build-up of the gut epithelium, and a degree of protection against rotavirus infection. These experimental studies support the use of the postbiotic ABB C22® as a solution for the management of diarrhoea and gastrointestinal conditions, alone or in combination with existing but incomplete treatments.

Safe water is a global public health concern amid increasing scarcity and pollution. Bottled water production and consumption contribute to these problems. This study examines tap water consumption in Italy, assessing associated sociodemographic factors and related health outcomes such as obesity and self-perceived health status. Data from the Italian National Statistics Institute's "Aspects of daily life" survey (N=45,597) were analyzed. Covariates included education, age, gender, economic status, region, concerns about waste and climate change, consumption of carbonated drinks excluding water, alcohol consumption, consumption of vegetables, consumption of snacks, body mass index, and self-perceived health status. Bivariate analyses and mixed-effect logistic regression models explored the associations. People who drink tap water were 19,674 with a higher prevalence in people aged 45 to 59 old, people with a graduate/post-graduate degree diploma, with optimal economic resources, and concerned about waste production and climate change, coming from the North-East regions of Italy. Underweight people showed a higher prevalence of TW assumption as well as those who drink less than occasionally carbonated drinks, drink alcohol, consume vegetables more than once a day, and snacks less than once a week with a satisfying level perceived health status. Regressions showed that all age classes are less likely to drink tap water than people younger than 20 years old. The category with “inadequate” economic resources is more likely to consume tap water. Low educational classes show a low likelihood of consuming tap water as well as Islands. A concern about waste production and climate change is associated with an increased likelihood of assuming tap water. Tap water consumption was negatively associate with obesity but not with a satisfactory Self-perceived health status. Insights from this study can inform public health strategies.

Background: Surveys conducted in different regions of the world showed that the prevalence rates of health risk behaviors (HRBs) in university students are sometimes higher than those found in non-university populations. This study aims to identify the prevalence rates and demographic and academic environment correlates associated with HRBs among Brazilian university students. Methods: In a cross-sectional epidemiological study, a random sample of 5,310 university students answered an online questionnaire with demographic (sex, age, skin color, marital status, and paid work) and academic setting information (housing type, size of campus, year and shift of study), as well as items clustered in four HRB domains: personal safety and violence, sexual behavior and contraception, addictive substance use, and eating habits, physical activity, and sleep. The data were analyzed statistically using bivariate analysis and hierarchical multiple regression. Results: The highest prevalence rates occurred in HRBs clustered in the domain of eating habits, physical activity, and sleep (> 60%), while HRBs for personal security and violence were less prevalent (

Objective: Mechanical bowel preparation is essential for the visualisation of the colon during colonoscopy, and previous studies have identified changes in gut microbiota composition after bowel preparation and colonoscopy. Considering the gut microbiota is increasingly implicated in mood, we aimed to explore the potential impact of this intervention on mood and the microbiota-gut-brain axis. Methods: We conducted a pre-post intervention study, with timepoints of one week before and one month after bowel preparation and colonoscopy, in community-dwelling adults referred for colonoscopy. Our primary outcome was change in average Hospital Anxiety and Depression Scale depression sub-scores using generalised estimating equations. We also examined changes in average anxiety, stress, and quality of life scores, and faecal microbiota composition and potential function using 16S rRNA sequencing. We further explored associations between changes in depressive symptoms and the gut microbiota and conducted post-hoc analyses to explore potential effect modifiers. Key Results: 59 participants were included in the analyses. Depressive symptoms decreased one-month post-procedure compared to baseline (adjusted β=−0.64; 95%CI: −1.18, −0.11). Irritable bowel syndrome (IBS) appeared to moderate this relationship (1.78; 0.292, 3.26); depressive symptoms increased in those with, and decreased in those without, IBS. Changes in gut microbiome composition included reduced alpha diversity, modest effects on beta-diversity, and increases in genera associated with potential health benefits, one-month post-procedure compared to baseline. Increases in the CLR-transformed abundance of Ruminococcaceae UCG-009 were associated with improvements in depressive symptoms. Conclusions: There is preliminary evidence of a potential mental health effect of bowel preparation and colonoscopy, which may be associated with changes to the gut microbiota. There may also be a differential mental health impact of this procedure for those with and without IBS. Considering the limitations of our study, further research is required to confirm these findings and their clinical relevance.

Background: Alarming data indicates that low back pain (LBP) affected around 619 million people globally in 2020, that presenting significant health and economic burden. Importantly, the chronic LBP (cLBP) strongly impairs quality of life and leads to disability and premature retirement thus emphasizing the urgent need for providing deeper insight into the factors that affect treatment outcomes and offer thorough guidance for the assessment and management of this disease. Taking into consideration the rising prevalence of cLBP and knowledge gap referring to the overall health benefits of balneotherapy (BT), the aim of this study was to assess the effects of BT on functional status, quality of life and psychological symptoms in patients with cLBP. Methods: A total 210 patients were recruited and divided into two groups: patients receiving conventional pharmacological therapy (CT) and receiving BT. The effectiveness of the treatment was assessed on the basis of Visual Analog Scale for pain intensity, EuroQol (EQ-5D) for the patient’s self-rated health and Work Ability Index Questionnaire to evaluate functional ability. In order to provide deeper insight into the quality of life and also factors associated with the functional status and mental health affected by BT, we also used the Short Form Health Survey Questionnaire and Center of Epidemiologic Studies Depression Scale. Results: Our findings suggest that BT significantly contributed to reduction of pain, better functionality and disability perception status. Conclusions: Understanding the association between individual perceptions of functionality, emotional and social elements provides basis for providing comprehensive guidelines and recommendations for cLBP management.

Stress is a natural yet potentially harmful aspect of human life, necessitating effective management, particularly during overwhelming experiences. This paper presents a scoping review of personalized stress detection models using wearable technology. Employing the PRISMA-ScR framework for rigorous methodological structuring, we systematically analyzed literature from key databases including Scopus, IEEE Xplore, and PubMed. Our focus was on biosignals, AI methodologies, datasets, wearable devices, and real-world implementation challenges. The review presents an overview of stress and its biological mechanisms, details the methodology for the literature search, and synthesizes the findings. It shows that biosignals, especially EDA and PPG, are frequently utilized for stress detection and demonstrate potential reliability in multimodal settings. Evidence for a trend towards deep learning models was found, although the limited comparison with traditional methods calls for further research. Concerns arise regarding the representativeness of datasets and practical challenges in deploying wearable technologies, which include issues related to data quality and privacy. Future research should aim to develop comprehensive datasets and explore AI techniques that are not only accurate but also computationally efficient and user-centric, thereby closing the gap between theoretical models and practical applications to improve the effectiveness of stress detection systems in real scenarios.

Understanding the dynamics of teamwork and communication among healthcare professionals is crucial in the face of evolving healthcare challenges. This study assessed relational coordination among healthcare professionals in the South Tyrolean healthcare system in Italy, focusing on communication and teamwork dynamics in a cross-sectional survey. Using the validated Relational Coordination Survey (RCS) instrument and 525 completed online responses, the questionnaire aimed to understand the implications of different levels of relational coordination ratings by general practitioners, hospital physicians, nurses, and administrative personnel (response rate 26%). The demographics of the participants revealed a predominance of female professionals (64%), with an average age of 50 and 18 years of service. The resulting RCS scores varied significantly across professional groups, with nurses reporting the highest within-group scores, indicating moderate coordination, and administrators reporting the lowest scores, reflecting areas of weak coordination. Between-group relational coordination was generally perceived as weak across professional groups, with the least weakness observed between general practitioners and nurses. German or Italian language and health district affiliation emerged as significant factors influencing relational coordination ratings, highlighting the need for differentiated understanding and strategies in multilingual and diverse regional settings. Assessments of interdisciplinary feedback and referral practices highlight the variation in teamwork and communication weaknesses and underscore the need for targeted interventions to improve relational coordination. This study provides insights into the complexity of relational dynamics in health care settings. It suggests that improving relational coordination through tailored strategies could significantly improve team effectiveness, quality of patient care, and overall system efficiency.

Non-Vitamin K Oral Anticoagulants (NOACs) have revolutionized anticoagulant therapy, offering improved safety and efficacy over traditional agents like warfarin. This review comprehensively examines the dual roles of NOACs—Apixaban, Rivaroxaban, Edoxaban, and Dabigatran—not only as anticoagulants but also as modulators of inflammation via Protease-Activated Receptor (PAR) signaling. We highlight the unique pharmacotherapeutic properties of each NOAC, supported by key clinical trials demonstrating their effectiveness in preventing thromboembolic events. Beyond their established anticoagulant roles, emerging research suggests that NOACs influence inflammation through PAR signaling pathways, implicating factors such as FXa and Thrombin in the modulation of inflammatory responses. This review synthesizes current evidence on the anti-inflammatory potential of NOACs, exploring their impact on inflammatory markers and conditions like atherosclerosis and diabetes. By delineating the mechanisms by which NOACs mediate anti-inflammatory effects, this work aims to expand their therapeutic utility, offering new perspectives for managing inflammatory diseases. Our findings underscore the broader clinical implications of NOACs, advocating for their consideration in therapeutic strategies aimed at addressing inflammation-related pathologies. This comprehensive synthesis not only enhances understanding of NOACs' multifaceted roles but also paves the way for future research and clinical applications in inflammation and cardiovascular health

Diabetic foot ulcers (DFUs) significantly affect the lives of patients and increase the risk of hospital stay and amputation. We suggest a remote-monitoring platform for better DFU care. This system uses digital health metrics (scaled from 0 to 10, where higher scores indicate a greater risk of slow healing) to provide a comprehensive overview through a visual interface. The platform features smart offloading devices that capture behavioral metrics such as offloading adherence, daily steps, and cadence. Coupled with remotely measurable frailty and phenotypic metrics, it offers an in-depth patient profile. Additional demographic data, wound characteristics, and clinical parameters, such as cognitive function, were integrated, contributing to a comprehensive risk factor profile. We evaluated the feasibility of this platform with 124 DFU patients over 12 weeks; 39% experienced unfavorable outcomes such as dropout, adverse events, or non-healing. Digital biomarkers were benchmarked (0-10), categorized into low, medium, and high risk for unfavorable outcomes, and visually represented using color-coded radar plots. The initial results of case reports illustrate the value of this holistic visualization to pinpoint the underlying risk factors for unfavorable outcomes, including a high number of steps, poor adherence, and cognitive impairment. Although future studies are needed to validate the effectiveness of this visualization in personalizing care and improving wound outcomes, early results in identifying risk factors for unfavorable outcomes are promising.

Background: The effectiveness of the anti-COVID-19 vaccine remains a matter to be clarified. Methods: The humoral and cellular immunity after the administration of three doses of the Pfizer–BioNTech and Oxford AstraZeneca vaccines against SARS-CoV-2 over one year and the appearance of post-vaccination COVID-19 have been studied. Results: Anti-SARS-CoV-2 IgG and IgA antibodies showed a progressive increase throughout the vaccination period. This increase was greatest after the third dose. The highest levels were observed in subjects who had anti-SARS-CoV-2 antibodies prior to vaccination. There was an increase in CD4+ αβ, CD8+ γδ and TEM CD8+ γδ T cells, and a decrease in apoptosis in CD4+CD8+ and CD56+ αβ and γδ T cells. Post-vaccination SARS-CoV-2 infection was greater than 60%. The symptoms of COVID-19 were very mild and were related to γδ T cell deficit, specifically CD8+ TEMRA and CD56+ γδ TEM, as well as lower pre-vaccine apoptosis levels. Conclusions: Those results demonstrate the important role that γδ T cells play in SARS-CoV-2 vaccine immunization.

Although the positive relationship between religion and environmental behavior is well-argued, empirical research about the relationship between religion and public pro-environmental behavior is relatively lacking. This paper aims to explore the group differences in the influence of religion on public pro-environmental behavior and the mediating role of environmental risk perception in religion and public pro-environmental behavior. Using the Chinese General Social Survey data in 2013 for empirical analysis, this study’s results show that there are group differences in the impact of religion on public pro-environmental behavior. Women with religious beliefs are more willing to engage in public pro-environmental behavior than those without religious beliefs. Religious believers over the age of 45 are more willing to participate in public pro-environmental behavior than those without religious beliefs. Political participants with religious beliefs are more willing to practice public pro-environmental behavior than those without religious beliefs. In addition, we found that environmental risk perception can act as partial mediation in religious and public pro-environmental behavior. In other words, religious beliefs are deeply embedded in local political and social culture. In order to correctly understand the relationship between religion and public pro-environmental behavior, it is necessary to consider religion in a specific cultural background.

Gestational trophoblastic diseases (GTDs) encompass a spectrum of conditions characterized by abnormal trophoblastic cell growth, ranging from benign molar pregnancies to malignant trophoblastic neoplasms. This systematic review explores the molecular underpinnings of GTDs, focusing on genetic and epigenetic factors that influence disease progression and clinical outcomes. Based on 65 studies identified through systematic search and selection criteria, key findings include dysregulations in tumor suppressor genes such as p53, aberrant apoptotic pathways involving BCL-2, and altered expression of growth factor receptors and microRNAs. These molecular alterations not only differentiate molar pregnancies from normal placental development but also contribute to their clinical behavior, from benign moles to potentially malignant forms. The review synthesizes insights from immunohistochemical studies and molecular analyses to provide a comprehensive understanding of GTD pathogenesis and implications for personalized care strategies.

Contamination in coastal regions attributed to fluoride and nitrate cannot be disregarded, given the substantial environmental and public health issues they present worldwide. Maintaining water quality is crucial for environmental well-being. This comprehensive study was performed to assess the spatial as well as indexical water quality, identify contamination sources, and evaluate associated health risks pertaining to nitrate and flouride in AlHassa region, KSA. The physiochemical results revealed a pervasive pollution of the overall groundwater. The dominant water type was Na-Cl, indicating saltwater intrusion and reverse ion exchange impact. Spatiotemporal variations in physicochemical properties suggest diverse hydrochemical mechanisms, with geogenic factors primarily influencing groundwater chemistry. The groundwater pollution index varied between 0.8426 and 4.7172, classifying samples as moderately to very highly polluted. Similarly, the synthetic pollution index (in the range of 0.5021-4.0715) revealed that none of the samples had excellent water quality, with various degrees of pollution categories. Nitrate Health Quotient (HQ) values indicated chronic human health risks ranging from low to severe, with newborns being the most vulnerable. Household use of nitrate-rich groundwater for showering and cleaning did not pose significant health risks. Fluoride HQ decreased with age, and children faced the highest risk of fluorosis. The Hazard Index (HI) yielded moderate to high-risk values. Nitrate risks were 1.21 times higher than fluoride risks, as per average HI assessment. All samples fell into the vulnerable category based on the Total Hazard Index (THI), with 88.89% classified as very high risk. This research provides valuable insights into groundwater quality, guiding water authorities, inhabitants, and researchers in identifying safe water sources and vulnerable human populations. The results highlight the need for appropriate treatment techniques and long-term coastal groundwater management plans.

Keywords: knowledge; behaviour; ergonomics; posture; musculoskeletal; pain; university; students; survey.

This study critically explores the legislative frameworks and national regulations of Serbia, Croatia, and Slovenia concerning the engagement, training, and responsibilities of search and rescue dogs and their handlers. The goal is to offer a thorough understanding of how these dogs and their handlers are engaged, trained, and managed in each country. By carefully analyzing the legal foundations, the study aims to clarify the rights, duties, and responsibilities of all parties involved, ensuring that search and rescue dog deployments are conducted within a structured and lawful framework. Such an understanding is crucial for improving disaster management and ensuring a coordinated response to various emergencies. The findings reveal that although each country has strong legal provisions for deploying search and rescue dogs, there are significant differences in the detail and scope of these regulations. Slovenia is notable for its detailed guidelines, regular evaluations, and licensing processes, setting a high standard. Croatia benefits from strong institutional support and active international collaboration, which greatly enhances its disaster response capabilities. On the other hand, Serbia, despite having a solid foundational framework, could improve by better coordinating with non-governmental organizations and aligning more closely with international standards. Key areas for improvement include harmonizing standards, enhancing training programs, increasing public awareness, better resource allocation, and adopting new technologies. By addressing these issues, Serbia, Croatia, and Slovenia can further strengthen their legal and institutional frameworks, ensuring their search and rescue teams are better prepared for disasters. This study emphasizes the need for continuous improvement through collaboration, standardization, and innovation to maximize the effectiveness of search and rescue operations involving dogs.

The North China Plain is among the regions most afflicted by ground fissure disasters in China. Recent urbanization has accelerated ground fissure activity in the three counties of the northern North China Plain, posing significant threats to both the natural environment and socioeconomic sustainability. Despite the increased attention, a lack of comprehensive understanding persists due to delayed recognition and limited research. This study conducted field visits and geological surveys across 43 villages and 80 sites to elucidate the spatial distribution patterns of ground fissures in the aforementioned counties. By integrating these findings with regional geological data, we formulated a causative model to explain ground fissure formation. Our analysis reveals a concentration of ground fissures near the Niuxi and Rongxi faults, with the former exhibiting the most extensive distribution. The primary manifestations of ground fissures include linear cracks and patch-shaped collapse pits, predominantly oriented in east-west and north-south directions, indicating tensile failure with minimal vertical displacement. Various factors contribute to ground fissure development, including fault activity, ancient river channel distribution, bedrock undulations, rainfall, and ground settlement. Fault activity establishes a concealed fracture system in shallow geotechnical layers, laying the groundwork for ground fissure formation. Additionally, the distribution of ancient river channels and bedrock undulations modifies regional stress fields, further facilitating ground fissure emergence. Rainfall and differential ground settlement serve as triggering mechanisms, exposing ground fissures at the surface. This research offers novel insights into the causative mechanisms of ground fissures in the northern North China Plain, providing valuable scientific evidence for mitigating ground fissure disasters during the urbanization process in the region.

Effective management of the medicine supply chain is crucial for ensuring the availability of essential medicines and supplies in public health facilities. This study aimed to determine the utilization of the electronic logistic management information system (e-LMIS) in public health facilities and its implications for the medicine supply chain. A mixed-methods approach, combining both quantitative and qualitative data collection methods was used. The study was conducted in 106 healthcare providers from 35 public health facilities in Singida District. Six key informants were interviewed in a qualitative method. Of 106 participants, (62.3%) said they were somehow competent in e-LMIS utilization. In in-depth interviews, respondents underscored the system's utility for tracking stock levels, procurements, and managing orders. Staff shortage and lack of customized training were mentioned as major challenges, hindering efficiency in managing drug supplies. This study highlighted the positive impact of e-LMIS on various aspects of the medicine supply chain, including the timely submission of orders and enhanced inventory management. Sustained management support and regular utilization of the e-LMIS system are crucial for building and maintaining competence among healthcare providers, thereby optimizing the medicine supply chain and ultimately improving healthcare delivery.

The evaluation of crowdfunding campaigns varies from person to person; some investors are more interested in the creativity of the project, and others are more concerned with the profiles of entrepreneurs. The study investigated how entrepreneurs’ face disclosure influenced the success of crowdfunding. Secondary data was collected from multiple crowdfunding platforms for projects in Africa, that is, cross-country data from 54 African countries, to overcome data limitations from a single country. Econometrics analysis revealed that the facial disclosure of entrepreneurs increases the probability of crowdfunding success. Images, videos, and backers had a positive influence on the success of crowdfunding. On the contrary, the duration of the crowdfunding campaign was negatively associated with its success. To reduce the knowledge asymmetry between creators and backers, those prepared to start a crowdfunding project must provide as much information as possible to show their abilities. This study contributes to understanding the role of disclosing an entrepreneur’s profile on economic exchanges in the success of online crowdfunding. The signalling and agency theories support the finding. The findings were limited to crowdfunding projects on the African continent and are not necessarily applicable to some developed countries.

Diarrhoea is a serious cause of mortality worldwide that can lead to dehydration, gut barrier function impairment, nutrient malabsorption, and alterations of the gut microbiota (dysbiosis). Current solutions for its management, such as oral rehydration salts (ORS), inhibitors of the gut motility, antibiotics, and living probiotics only partially counteract the mechanisms of the disease and do not provide a full coverage of the problem. Potential risks of the use of living probiotic strains, particularly in immunocompromised patients, can be eliminated with the use of tyndallized (heat-killed) postbiotic bacteria and yeast. ABB C22® is a postbiotic combination of three tyndallized yeasts, namely Saccharomyces boulardii, Saccharomyces cerevisiae, and Kluyveromyces marxianus. To assess the action of the postbiotic combination on diarrhoea, immune and gut epithelial cell signaling assays, gut barrier formation assay and rotavirus gene expression assay were performed. ABB C22® showed a strong anti-inflammatory effect, an induction of the build-up of the gut epithelium, and a degree of protection against rotavirus infection. These experimental studies support the use of the postbiotic ABB C22® as a solution for the management of diarrhoea and gastrointestinal conditions, alone or in combination with existing but incomplete treatments.

Background Lower respiratory tract infections (LRTIs), particularly pneumonia, are a leading cause of morbidity and mortality among children worldwide, especially in low-resource settings. The World Health Organization (WHO) Integrated Management of Childhood Illness (IMCI) guidelines currently recommend antibiotic treatment for all case of with pneumonia based on clinical signs along, which can lead to over-prescription of antibiotics and contribute to antimicrobial resistance (AMR). Point of care Lung Ultrasound (LUS) has emerged as a promising diagnostic tool in this context and has demonstrated potential in distinguishing between bacterial and viral pneumonia, thus enabling more targeted antibiotic use. This study aims to explore whether integrating LUS into the IMCI-based management of clinical pneumonia will better identify those who would benefit from antibiotic treatment, reducing antibiotic overuse without compromising health outcomes. Methods An open label randomized controlled trial will enrol 3500 children aged 60 days to 12 years presenting with IMCI-defined pneumonia. Participants will be enrolled in Senegal, Tanzania, and South Africa. Participants will be randomly assigned in a ratio of 1:1, stratified by site and age group (<5years, 5-12years) to either an intervention group, where LUS will guide antibiotic prescriptions utilising a predefined interpretation framework, or a control group receiving routine IMCI-based care. The co-primary outcomes of this study are the reduction in antibiotic use on the day of enrolment (Day 1) and rate of clinical failure by Day 8, using an acceptable clinical difference of 1.5x as a non-inferiority margin (delta of 2.5%). Secondary outcomes will include adverse drug reactions, cure rates, hospital admissions including in-patient duration, and cost-effectiveness. Data will be collected at baseline (Day 1), Day 8, and Day 29 post-enrolment. Discussion This study seeks to provide evidence on the clinical and public health benefits of using LUS to improve the diagnosis and management of paediatric pneumonia in low-resource settings. If this intervention proves effective it could contribute significantly toward reducing unnecessary antibiotic prescriptions, thereby addressing AMR. The potential for LUS to be integrated into routine clinical practice could revolutionize pneumonia management, especially in areas with limited access to advanced diagnostic tools. Trial Registration This trial will be registered on ClinicalTrials.gov and The South African National Clinical Trials Register (SANCTR) prior to participant enrolment.

A new quinazolinone alkaloid, named peniquinazolinone A (1), as well as eleven known com-pounds, 2-(2-hydroxy-3-phenylpropionamido)-N-methylbenzamide (2), viridicatin (3), viridicatol (4), (±)-cyclopeptin (5a/5b), dehydrocyclopeptin (6), cyclopenin (7), cyclopenol (8), methyl-indole-3-carboxylate (9), 2,5-dihydroxyphenyl acetate (10), methyl m-hydroxyphenylacetate (11), conidiogenone B (12), was isolated from the endophytic Penicillium sp. HJT-A-6. The chemical structures of all compounds were elucidated by comprehensive spectroscopic analysis, including 1D, 2D NMR, and HRESIMS. The absolute configuration at C-13 of peniquinazolinone A (1) was established by applying the modified Mosher’s method. Compounds 2, 3, and 7 exhibited an op-timal promoting effect on the seed germination of Rhodiola tibetica at a concentration of 0.01 mg/mL, while the optimal concentration for compounds 4 and 9 to promote Rhodiola tibetica seed germination was 0.001 mg/mL. Compound 12 showed optimal seed-germination-promoting activity at a concentration of 0.1 mg/mL. Compared with the positive drug 6-benzyladenine (6-BA), compounds 2, 3, 4, 7, 9, and 12 could extend the seed-germination period of Rhodiola tibetica up to the 11th day.

Background: Tuberculosis (TB) continues to be a serious public health threat that affects the most vulnerable population. Patients who are LTFU after TB diagnosis still represent one of the biggest challenges to TB control. Method: In this prospective observational study, we aimed to identify and analyse the risk factors associated with LTFU among TB patients who started first-line TB treatment in the Sanatorium Hospital in Luanda. Result: A total of 113 patients with TB were included between August 2018 and September 2019. Seventy-six (67.3%) patients were cured, 27 (23.9%) were LTFU, 5 (4.4%) died, 4 (3.5%) were transferred and 1 (0.9%) presented a treatment failure. After excluding those dead, transferred or who failed to treatment, we observed that severe TB at the time of diagnosis (OR 9.24, 95% CI 2.18-39.04) and food insecurity were significantly associated with LTFU (OR 5.96, 95% CI 1.66-21.41). Conclusion: The findings of our study are of enormous value to understand the reasons for the LTFU of patients with TB and can guide polices and facilitate designing measures to allow better adherence, and therefore, greater treatment success

Considering characteristics of high river density, special underlying surface in plain river network region, and municipal drainage system function, river network drainage unit model is proposed, which is defined as a region surrounded by main river or embankment. Flood storage variety and control projects regulation of small rivers in each unit is simulated. With drainage catchment as an object, according to its drainage capacity, simplified municipal drainage model was developed. Coupling river network drainage unit model, simplified municipal drainage model and 2D flood routing model, urban flood analysis model for plain tidal river network region was developed, which could be applied to analyzing flood from upstream river, storm surge and local rainfall. Demonstration research was carried out in Puxi flood protected area in Shanghai.

Few studies have examined the dietary protein intake and sources in combination with the longitudinal changes in brain structure markers. Our study aimed to examine the association between dietary protein intake and different sources of dietary protein with the longitudinal rate of change in brain structural markers. A total of 2723 and 2679 participants from the UK Biobank were included in the analysis. The relative and absolute amounts of dietary protein intake were calculated through a 24-hour dietary recall questionnaire. The longitudinal change rates of brain structural biomarkers were computed using two waves of brain imaging data. We utilized multiple linear regression to examine the association between dietary protein and different sources and the longitudinal changes in brain structural biomarkers. Restrictive cubic splines were used to explore nonlinear relationships, and stratified and sensitivity analyses were conducted. Increasing the proportion of animal protein in dietary protein intake is associated with a slower reduction in the total hippocampus volume (THV, β: -0.02524, P&lt;0.05), left hippocampus volume (LHV, β: -0.02435, P&lt;0.01) and right hippocampus volume (RHV, β: -0.02544, P&lt;0.05).Higher intake of animal protein relative to plant protein is linked to a lower atrophy rate in THV (β: -0.01249, P&lt;0.05) and LHV (β: -0.01173, P&lt;0.05) and RHV (β: -0.01193, P&lt;0.05). Individuals with higher intake of seafood exhibit lower longitudinal rate of change in HV compared to those with no consume (THV, β: -0.004514; P&lt;0.05; RHV, β: -0.005527, P&lt;0.05). In subgroup and sensitivity analyses, there was not a significantly alteration. A moderate increase in the intake and proportion of animal protein in the diet, especially from seafood, is associated with a lower longitudinal change rate in hippocampus volume.

Patients from regions without stem cell transplant (SCT) facilities often seek treatment abroad and return home for post-transplant care. While extensive data exists on GVHD and its risk factors, the prevalence of GVHD in international SCT patients returning to countries without transplant facilities, where multiple factors compromise post-transplant care, is not well documented. We screened 149 transplant recipients and analyzed data from 91 who received transplants abroad and were followed at our center from January 2019 to December 2022. This observational study used data from electronic medical records (EMR) and employed descriptive statistics, inferential tests, and relative risk calculations with forest plots to analyze GVHD prevalence and key risk factors. Of the recipients, 31.8% were residents from nine countries living in the UAE, and 67.2% were UAE citizens. Adults comprised 48.3% of the recipients, and 51.7% were pediatric. Hematological malignancies were the most common indication (49%), primarily in adults. Siblings were the majority of donors (52.6%), followed by related donors (23.09%), and unrelated donors (8.9%). Most (69.2%) received HLA-identical transplants followed by 21.9% who received haploidentical. Among adults, 62.2% developed GVHD, compared to 26% of pediatric patients. Recipients with related HLA-identical donors had a 50% GVHD prevalence, while those with unrelated identical donors had 71%. The overall GVHD prevalence was 50% among the 87.9% who received allogeneic SCTs. Despite favorable factors, GVHD prevalence remains high. Larger multicenter studies are needed to identify and assess the impact of contributing factors.

1) Background: Several studies have shown the benefit of drawing when learning anatomy. Virtual Reality (VR) also appears to be useful to increase the understanding of the location of anatomical structures. This study aims to describe how students in an Operating Room Nursing (OR nursing) master study program perceive the benefit of active learning methods, including drawing and the use of VR. 2) Methods: We combined these two methods in a class of 29 students. 38 half-finished drawings of anatomical structures were made. The students were to complete these during lectures with guidance from the teacher. The students also attended a two-hour VR session where they were to find various anatomical structures. A paper questionnaire was applied to evaluate the teaching program. Data were analyzed statistically. 3) Results: The students highly appreciated these learning methods. They reported that drawing made them work more actively during lectures and increased their learning outcome. They also perceived that the use of VR technology increased their understanding of the location of anatomical structures. 4) Conclusion: The combination of drawing and VR technology may be of benefit to OR Nursing students when learning anatomy by both increasing student activity and learning outcomes.

Background: Our previous study highlighted important healthcare access and utilization concerns among new immigrants. Hence, in this study, we aimed to explore the role of public and patient involvement (PPI) may have in enhancing the accessibility and their contribution to migration health studies. Method: An open and in-depth interactive consecutive virtual discussion was conducted among volunteer asylum seekers and refugees from Eritrea and Syria in Switzerland. The novel PPI establishment had three phases; inception, training phase, and contribution phase. Result: At the beginning, the concept of PPI was apprehensive to grasp, as it was a new approach. After training and consecutive discussions, volunteers were ardent to engage actively. Hence, among the prime findings were the PPI's role and effect in raising awareness, PPI's role in exploring and communicating the healthcare system accessibilities and utilization among their community, the impact of PPI in echoing the healthcare needs of their fellow migrants, and PPI's contribution in enhancing and strengthening migration health researches. Conclusion: The PPI volunteers in the study were keen to raise their community's awareness through their networks, and bridge the research gap between researchers and the public.

In this paper, we introduce a specialized, fully automated experimental arrangement designed for assessing the effectiveness of augmented and virtual reality technologies in healthcare setting and explore its design principles focusing on depth sensor characterization. The main goal of this project is to establish a robust benchtop platform for the quantitative evaluation of extended reality technologies in a controlled environment, emphasizing the practical assessment of augmented reality head-mounted devices. We outline a design concept and considerations for an experimental configuration aimed at creating a realistic testing environment. This apparatus comprises an observation platform mounted on a three-degree-of-freedom motorized system and a test phantom stage. Focusing on real-case scenarios, we utilized a range of sensors, including readily available range-sensing cameras and commercial augmented reality headsets, such as the Intel RealSense L515 LiDAR camera, mounted on the motion control system. The setup enabled automated data collection and facilitates controlled assessments and validation of various facets of augmented reality technologies, including object, hand, and head tracking, as well as static and dynamic image registration. This paper describes the system architecture, the process of automated data collection, and presents several evaluation studies conducted with this setup, providing insights into the quality and temporal noise associated with static or moving objects or observers in augmented reality applications.