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Background The demand for online education promotion platforms has increased. In addition, the digital library system is one of the many systems that support teaching and learning. However, most digital library systems store books in the form of libraries that were developed or purchased exclusively by the library, without connecting data with different agencies in the same system. Methods A hybrid recommender system model for digital libraries, developed from multiple online publishers, has created a prototype digital library system that connects various important knowledge sources from multiple digital libraries and online publishers to create an index and recommend e-books. The developed system utilizes an API-based linking process to connect various important sources of knowledge from multiple data sources such as e-books on education from educational institutions, e-books from government agencies, and e-books from religious organizations are stored separately. Then, a hybrid recommender system suitable for users was developed using Collaborative Filtering (CF) model together with Content-Based Filtering. This research proposed the hybrid recommender system model, which took into account the factors of book category, reading habits of users, and sources of information. The evaluation of the experiments involved soliciting feedback from system users and comparing the results with conventional recommendation methods. Results A comparison of NDCG scores, and Precision scores were conducted for Hybrid Score 50:50, Hybrid Score 20:80, Hybrid Score 80:20, CF-score and CB-score. The experimental result was found that the Hybrid Score 80:20 method had the highest average NDCG score. Conclusions Using a hybrid recommender system model that combines 80% Collaborative Filtering, and 20% Content-Based Filtering can improve the recommender method, leading to better referral efficiency and greater overall efficiency compared to traditional approaches.

Background of the study This research examines how psychological and social biases affect individual investors’ investing decisions. Investor sentiment significantly influences financial markets, frequently causing stock prices to deviate from their intrinsic values. In rising economies such as India, where retail investors are significantly affected by psychological factors, comprehending these attitudes is crucial. Methods This study analyses data from a comprehensive questionnaire that was conducted throughout the nation and included 552 retail investors. The investigation employed structural equation modelling (SEM) to identify the elements that influence the decision-making of individuals who invest in the Indian stock market. Findings The research offers insight on the influence that investor attitude has on investment decision-making as well as the factors that precede it. The study demonstrates that investors make financial decisions based on sentiment. In addition to assessing the efficacy of the Indian financial market, this study sought to ascertain the rationality of investors’ choices by exploring the factors that influence their decision-making process. Conclusion The outcome of the study shows that information seeking, anchoring, herding, representativeness, and overconfidence all have a big impact on investors. Moreover, the study has proven investors’ irrationality and stock market inefficiency. The findings may be employed to further examine the trading practices of international investors and encourage further study in the field of behavioural finance.

Background Various problems, such as a shortage of teachers, especially in certain outlying and underdeveloped provinces, unequal distribution of teachers, low teacher competency, and mismatch between educational qualifications and scientific fields, as well as the demands of increasingly dynamic developments in science and technology, resulting in the need for professional development for elementary school teachers to improve teacher professionalism in Indonesia. These background as a basis for the government to create teacher professional education program for elementary school teachers continuously. It is hoped that it will be able to answer the educational problems facing the Indonesian nation. This research explores the opinions of elementary school teachers who have participated in teacher professional development activities through the in-service teacher professional education program. Methods We collected data through a written survey of 24 elementary school teachers, as well as article documents relevant to the research topic. Data were analyzed using thematic analysis. Result The research produced two main themes: increasing teacher competencies and sustainable teacher development programs. Increasing teacher competency related to social competence, pedagogical competence and professional competence. The sustainable teacher development program is related to the guaranteeing the instructional quality of post-program and multi-sectoral collaboration Conclusion Developing teacher professionalism through teacher professional education program in elementary schools in Indonesia positively impacts teachers’ becoming professional teachers. Teacher professional education program is an indication of improving teacher professionalism, especially in developing teaching skills, improving the quality of instruction, teacher motivation and individual development in dealing with various problems in instruction in the classroom, especially in elementary schools, so that the instructional objectives that have been set can be achieved. The professionalism of elementary school teachers will improve if there are sustainable programs such as mentoring programs from the government, universities and parties that focus on improving the quality of education in Indonesia

Background Multiple medical conditions arising from reduced physical and physiological functioning, including cognitive decline, manifest in older persons. This study aims to examine the relationship between cognitive function and associated risk factors in older persons living in long-term care facilities in Indonesia. Methods This study involved 350 elderly individuals residing in long-term care institutions. A cross-sectional design utilizing an analytical survey methodology was implemented. Data were gathered via interviews employing a demographic questionnaire and the Montreal Cognitive Assessment (MoCA). Statistical analysis was conducted using SPSS (version 23). Results Univariate analysis demonstrated significant correlations between cognitive performance and gender, ethnicity, level of education, medical history, subjective memory issues, smoking habits, alcohol consumption, dietary intake of fruits and vegetables, and employment history (p < 0.05). Higher education (OR = 0.69, 95% CI: 0.56–0.84) and reduced subjective memory complaints (OR = 0.29, 95% CI: 0.20–0.44) correlated positively with enhanced cognitive function, but alcohol intake (OR = 6.79, 95% CI: 2.42–19.1) correlated with impaired cognitive function. Conclusions the level of education, subjective memory complaints, and alcohol intake are substantially correlated with cognitive performance in older persons residing in long-term care facilities. Evaluating demographic characteristics in elderly individuals can assist healthcare professionals in the early detection of cognitive impairment, facilitating prompt interventions in long-term care environments.

Background COVID-19 disease has spread rapidly worldwide, causing high mortality. Accessible biomarkers capable of early identification of patients at risk of severe form are needed in clinical practice. The aim of the study was to determine the biological markers that predict a critical condition. Methods Retrospective study including patients with confirmed COVID-19 hospitalized between September 2020 and June 2021. The primary endpoint was progression to critical status within 7 days from admission. We defined two groups: Critical group: Patients who developed a critical condition or died or transferred to the ICU before or at 7 th day. Non-critical group: Patients who remained in non-critical respiratory status until 7 th day or discharged before or at 7 th day. Results Our study included 456 patients, with a sex ratio of 1.32 and an average age of 62 years. At the 7 th day of hospitalization, 115 (25.2%) patients were in the critical group and 341 (74.8%) patients were in the non-critical group. The univariate logistic regression indicated that laboratory findings between non-critical and critical groups showed that C-reactive protein (CRP) (p=0.047), D-Dimer (p=0.011), creatinine (0.026), creatine kinase (p=0.039), lactate dehydrogenase (p=0.04), and troponin (p=0.001) were all higher among patients in critical group. However, lymphocyte (p71.5 (OR=1.598, 95% CI=1.042-2.45, p=0.032) were associated to critical group. Conclusions Our results show the predictive value of lymphopenia, thrombocytopenia, high NLR and CRP levels to evaluate the prognosis of COVID-19 pneumonia. A prognostic score could be proposed for guiding clinical care and improving patient outcomes.

Background Low Back Pain (LBP) is the most common musculoskeletal disorder in the world. Medical students, particularly those who use computers for study purposes, are more vulnerable to LBP due to prolonged sitting times and improper sitting posture during lectures. However, prior research showed that the prevalence of LBP among medical students appeared lower when they were enrolled during online pandemic learning. Hence, this research is performed to determine the correlation between the duration of sitting and sitting posture on the incidence of LBP among medical students in Universitas Sumatera Utara, Indonesia. Methods A cross-sectional study with an analytical descriptive design was conducted in September 2023 among randomly selected 147 medical students at Universitas Sumatera Utara, Indonesia. The inclusion criteria of the research sample are students with BMI< 23 kg/m2 while the exclusion criteria are students who have abnormalities and a history of trauma or spinal fractures. Data was obtained from filling out questionnaires of The Pain and Distress Scale (PAD) and Body Awareness of Postural Habit in Young People (BAPHY). A Chi-square test and logistic regression were used to analyze data with a p-value < 0.05 was regarded as statistically significant. Results The study’s findings revealed that 40.1% of students reported having LBP problems, 72.1% reported sitting for more than seven hours each day, and 33.3% reported having a bad sitting posture. Chi-square analysis revealed a significant correlation between sitting duration and posture on complaints of lower back pain (RR = 1.69, p = 0.041 and RR = 1.69, p = 0.009). At a risk of 2,438 times, sitting posture is the main factor contributing to LBP among medical students at Universitas Sumatera Utara, Indonesia. Conclusions This research showed a significant correlation between duration and sitting posture on the incidence of low back pain.

Background Third molar extraction is one of the most common oral surgical procedures globally. This study assessed patients’ knowledge of third molar extraction procedures. Methods A self-administered questionnaire was administered to patients (N=384) of the dental hospital at Imam Abdulrahman bin Faisal University in the eastern province. The questionnaire covered demographic data, knowledge of third molar extraction, and patients’ perception questions. SPSS Version 24 was used for statistical analysis. Chi-square and Fisher’s Exact test were used. P-values less than or equal to 0.05 were considered statistically significant . Results According to the demographical characteristics of the patient who received 3rd molar removal surgery. As per the history of the extraction, 45% had previous 3rd molar extraction experience, whereas 55% had no previous dental surgical experience. There was no significant difference between the groups with the knowledge about the extraction (p-0.187). Patients with no previous history were more aware of the correct time for 3rd molar extraction at 27% vs 19%, respectively (P=0.046*). Patients with a previous history of third molar extraction showed significant results of knowledge in terms of taking medication prior to 3rd molar surgical procedure. Conclusion The patient with previous experience with third molar extraction showed low misconceptions. However, further studies should consider increasing the knowledge and correcting the patients’ perceptions.

In this paper, we apply the concept of bipolar fuzzy sets to pseudo-UP ideals in pseudo-UP algebras. We prove that the intersection of two bipolar fuzzy pseudo-UP ideals is also a bipolar fuzzy pseudo-UP ideal, while the union of two such ideals does not always result in a bipolar fuzzy pseudo-UP ideal. Additionally, we discuss the concepts of bipolar fuzzy pseudo-UP ideals under homomorphism and explore several related properties. The homomorphic image and inverse image of bipolar fuzzy pseudo-UP ideals in a pseudo-UP algebra are also examined in detail. Furthermore, we study the notion of a bipolar fuzzy pseudo-UP ideal under the Cartesian product of pseudo-UP algebra. The Cartesian product of any two bipolar fuzzy pseudo-UP ideals is also the bipolar fuzzy pseudo-UP ideal of pseudo-UP algebra, and then some related results are obtained. MSC: 03G25, 06D30.

Background This paper examines the impact of financial inclusion on bank stability within Ethiopian context, using panel data from 17 commercial banks over the period 2015-2023. Given the scarcity of research focused on the relationship between financial inclusion and bank stability in Ethiopia, this paper seeks to address a crucial gap by analyzing both conventional and digital aspects of financial inclusion in relation with bank stability. Methods A two-stage principal component analysis (PCA) was conducted to construct a composite financial inclusion index, integrating 10 conventional and 5 digital indicators. The study applied a two-step robust system generalized method of moments (GMM) to examine the effects of financial inclusion on bank stability, complemented by Granger causality testing to examine the directionality of this relationship. Results The result reveals a significant positive effect of financial inclusion on bank stability and Granger causality tests confirms a bi-directional relationship between financial inclusion and stability, indicating that improvements in financial inclusion foster greater stability and vice versa. Our results also highlight that while bank efficiency and GDP growth rate positively effect stability, total assets and income diversification exhibit detrimental effects. Conclusions It is essential to capitalize policy synergies to promote bank stability and to enhance financial inclusion through conventional and digital channels, while carefully managing the implications of risks associated with income diversification and asset distribution. Ensuring inclusive financial system is vital for maintaining bank stability, thus positioning it as a key priority for financial institutions.

Background/Objective Weight stigma has significant psychological and social implications, yet studies on perspective-taking as an intervention strategy remain scarce. This study aimed to investigate the effect of perspective-taking on weight stigma among Chinese university students and examine the potential mediating role of common ingroup identity. Methods A randomized controlled experiment with 202 Chinese university students (experimental group, perspective-taking group: n = 102; control group: n = 100) was conducted. Weight stigma was measured pre- and post-intervention using the Anti-Fat Attitudes Test. The study employed a 2 × 2 mixed design with ANCOVA and mediation analysis. Results The experimental group showed significantly lower post-test weight stigma when controlling for pre-test scores ( F(1, 199) = 25.69, p < .001). Perspective-taking engagement was significantly higher in the experimental group ( t = 3.13, p = .002). Common ingroup identity negatively correlated with post-test weight stigma ( r = -.28, p < .001) but did not significantly mediate the perspective-taking and weight stigma reduction relationship. Conclusion Perspective-taking effectively reduces weight stigma among Chinese university students, contributing to stigma reduction strategies in university settings. Further research on underlying mechanisms is warranted.

Background Central serous chorioretinopathy (CSCR) is a common retinal condition with an increased risk of recurrence. Traditional approaches have made choroidal visualization challenging, but recent advances in optical coherence tomography (OCT) innovation have permitted the collection of more accurate choroidal visualizations. This study aimed to measure choroidal thickness in eyes with active CSCR as well as in the unaffected opposite eyes of these same individuals. Methods This research was conducted at the ophthalmology division in Ghazi Al-Hariri Hospital from the 1 st of October 2019 until the 31 st of March 2020. A total of 49 people, corresponding to 65 eyes, were included in the study. Among these participants, 16 individuals presented with central serous chorioretinopathy (CSCR), affecting a total of 32 eyes. The CSCR individuals were further split into two groups: “Group A” consisted of 20 eyes with active CSCR, and “Group B” encompassed the remaining 12 unaffected opposite eyes. Additionally, the right eyes of 33 individuals who were age and gender-matched served as controls assigned as “Group C”. Results The choroid exhibited a substantial rise in thickness across each of the nine sectors in group A as compared to group C. Similarly, group B showed a significant increase in choroidal thickness in relation to group C. The mean subfoveal choroidal thickness (SFCT) was measured as follows: 474.55μm, 437.5μm, and 292.03μm among groups A, B, and C, correspondingly. These differences were identified as clinically significant for both A vs. C and B vs. C. Conclusions This study’s findings indicate a thickening of the choroid in both eyes exhibiting active CSCR, as well as in the unaffected opposite eyes of those with the disease.

Introduction Low and middle-income countries account for the largest proportion of women’s deaths as a result of pregnancy or childbirth-related complications. The sub-Saharan region is the most affected with approximately 70% (202 000) of maternal deaths between 2000 and 2020. These deaths could have been prevented if expectant mothers were prepared for childbirth. Birth preparedness is perceived as a better strategy that helps attain a substantial reduction in maternal mortality. This is achieved by attending early antenatal classes, receiving skilled care during childbirth, and care and support right after birth. The latest survey on antenatal class attendance conducted in South Africa provides an estimated 30.8% of expectant mothers in public healthcare facilities. Methods This study employed a qualitative approach to collect data, as a result, one focus group discussion with five (N=5) participants and two others with six (N=6) participants each (n=6X2=12) and twenty individual interviews were conducted. The study sought to explore and describe the knowledge and attitudes of healthcare professionals regarding the birth preparedness of women in labour at selected hospitals in Durban KwaZulu-Natal. Results Expectant mothers were unprepared for both labour and postnatal care. The unprepared expectant mothers were uncooperative and made the task of midwives difficult to the extent of endangering the life of their expected newborn babies and their own. Factors such as finance, heterogeneity, staff shortage, language barrier, lack of family support, lack of interest, cultural beliefs, and confusion caused by various sources of information were responsible for birth unpreparedness. Conclusion The synergy between expectant mothers and midwives appears to be an important factor in achieving better birth preparedness.

Background Atopic dermatitis (AD) is a chronic inflammatory skin condition characterized by pruritus and skin barrier dysfunction. This study aims to evaluate the therapeutic potential of Pelargonium graveolens (Geraniaceae) in managing AD symptoms through its essential oil. Methods The chemical composition of Pelargonium graveolens flower essential oil (PFEO) was analyzed using gas chromatography-mass spectrometry (GC-MS). Its antimicrobial, antioxidant, and anti-inflammatory properties were assessed, along with the inhibitory effects of PFEO on key enzymes involved in skin repair: tyrosinase, elastase, and collagenase. An in vivo evaluation of a gel formulation containing PFEO was also conducted to assess its anti-inflammatory and analgesic efficacy. Results GC-MS analysis identified major compounds in PFEO, including Geraniol (22.83%), beta-citronellol (19.51%), naphthalenemethanol (15.36%), and Geranyl tiglate (9.38%), with minor constituents such as linalool (3.81%) and neryl formate (1.31%). PFEO exhibited bacteriostatic activity against various bacterial and fungal strains, including Pseudomonas aeruginosa, Staphylococcus aureus, Methicillin-Resistant Staphylococcus aureus (MRSA), Bacillus anthracis, Streptococcus pyogenes, Staphylococcus epidermidis, Candida albicans, and Malassezia spp. The essential oil also demonstrated significant antioxidant properties and inhibited key enzymes linked to skin alterations in AD. Conclusions PFEO shows promising therapeutic potential for managing symptoms of atopic dermatitis due to its antimicrobial, antioxidant, and anti-inflammatory properties, as well as its analgesic effects. The findings support further exploration of PFEO as a natural alternative in the treatment of AD.

Background This study aims to contribute to a better understanding of the impact of the financial technologies (fintech) era on the performance in the banking sector, measured through non-performing loans (NPL) and their coverage by provisions for NPL. It is a question of knowing whether banking investment in fintech makes it possible to better evaluate the granting of credits, and therefore makes it possible to reduce overdue credits. Methods To this end, the method used consists of using a regression analysis and a Pearson correlation applied to the financial data of Moroccan banks observed during two distinct periods, namely 2007-2014, considered pre-fintech, and the period 2015-2022, considered as the fintech period. Results With the emergence of the fintech era, the Moroccan banking situation improved slightly compared to the pre-fintech period: bad debts did not increase despite the significant increase in net banking income and the size of banking assets during the fintech era. Conclusions The implementation of fintech has improved customer relationship management, credit risk analysis and loan monitoring services, which ultimately reduces non-performing loans and improves the coverage of non-performing loans by provisions. The main implication of the results allows us to deduce that the implementation of fintech makes it possible to have a positive impact on overdue credits, and they are also likely to serve as a lever for the inclusion of those excluded from banking services.

Background Understanding the demographics, tumor characteristics, genetic mutations, and immune scores in colorectal cancer (CRC) patients may aid in tailoring treatment and predicting survival. Methods This retrospective cohort study assessed clinical parameters, immune scores, and their relationship with survival in patients with CRC. Results The study included 74 patients, mean age 53.7 years, mostly male (53.3%) and aged 41-70 (77.3%). Common comorbidities included cardiovascular diseases (29.3%) and hypertension (21.3%). Adenocarcinoma (74%) primarily affects the colon (73%). KRAS mutations and Microsatellite instability-High (MSI-H)/deficient mismatch repair (dMMR) were found in 1.3% and 16% of patients, respectively. Stage IV (77.3%) and liver metastases (52.7%) were prevalent. Immune score was influenced by cancer stage (p = 0.04) and metastasis (p=0.05). The immune score was not associated with survival (p = 0.181). Patients with comorbidities had lower one- (p = 0.027) and two-year survival rates (p = 0.037) survival rates. Cardiovascular comorbidities negatively impacted one-year survival (p = 0.047) and two-year survival (p = 0.037). The mean survival time was shorter for males (2.047±0.288 vs. 2.781±0.195 years, p = 0.041), patients with comorbidities (1.772±0.371 vs. 2.702±0.188 years, p = 0.017), and cardiovascular comorbidities (1.558±0.316 vs. 2.685±0.207 years, p = 0.038). Comorbidities (unadjusted hazard ratio [HR] 2.948, p = 0.023) and cardiovascular comorbidities (unadjusted HR 2.695, p = 0.046) were initially associated with survival but lost significance after adjusting for confounding variables. Conclusions This study provides insights into CRC patient demographics and their interplay with the immune score and survival.

Background Sustaining a ‘fit-for-purpose’ health workforce requires a better understanding of the health care worker cadres that are affected during pandemics and their outcomes. In hospitalized health care workers with confirmed COVID-19 between March 2020 and May 2023 in Liberia, we determined the hospitalization and case fatality rates, type of health care worker cadres affected, their demographic and clinical characteristics and hospital exit outcomes. Methods This was a cohort study using routine data extracted from hospitalization forms for health care workers in 24 designated COVID-19 treatment facilities. Results Of the 424 health care workers with COVID-19, hospitalization rates progressively declined between 2020 and 2023, (P Conclusions The hospitalized health care workers for COVID-19 were predominantly clinical and laboratory personnel who were mostly unvaccinated, and health facilities were hot-spots for contracting infections. The triage and referral system was weak with unnecessary hospitalization of mild infections. This study provides useful insights for outbreak preparedness including priority vaccination and improving health care worker safety in Liberia.

Background Table tennis presented a unique and accessible sport for people of all ages, particularly seniors compared to other sports. Methods This study utilized a quantitative with 136 Table tennis players those who registered for attending in the Thailand Master Table tennis Championships 2024 which hosted in January 2024 at Chiangmai. The questionnaire based on the measurement quality of life, WHOQOL Thai version, and analyzed using Descriptive statistics, Pearson Correlation. Results Pearson correlation coefficients between the scores of the quality of life in four dimensions and the overall score revealed significant correlations (p < 0.01) with all dimensions, including physical health, psychological health, social relationships, and environmental health. Conclusions Playing Table tennis for senior in the tournament level helped to improve the quality of life in all domains.

Background Studies have shown that perceived self-efficacy can influence teachers’ emotional state, thoughts and behaviours, and students’ learning. It’s also an important referential of professional satisfaction. In turn, teaching methodologies influence motor learning, as well as psychological, cognitive and social learning, with different impacts on human development and learning retention, levels of intrinsic motivation and continuity of practice in order to support a healthy lifestyle. Research on aquatic educators and teaching methodologies is scarce and at the same time necessary according to the view that aquatic literacy is an integral part of physical literacy and the only possibility of being more able to interact with this environment. Methods In this study we used an online questionnaire, aimed at aquatic professionals, which was answered voluntarily and anonymously to measure the prevalence of the use of different teaching methodologies, the comprehensive aquatic method and the perception of teacher self-efficacy. It has been deposited and can be consulted at https://doi.org/10.6084/m9.figshare.27316242.v1. Results All methods can generate a feeling of self-efficacy in teachers despite having different results, with the methodologies that involve students more actively (cognitivist and constructivist) being those that generate a greater feeling of self-efficacy in teachers. MAC is a method that is more closely related to methodologies focused on active student participation and, consequently, it is a method that generates a high perception of self-efficacy in teachers. Conclusions Levels of self-efficacy influence professional satisfaction, teacher physical, mental and emotional health, as well as student learning. Is recommended that aquatic professionals give prevalence to the cognitivist and constructivist teaching methodologies being MAC a privileged methodological approach for promoting active lifestyle habits throughout life.

Background Breast cancer has become the most prevalent disease and its incidence has almost doubled in the Indian population. This increased burden demands new targeted therapies with novel compounds either synthetically produced or derived from indigenous plants, which could be a promising approach for the development of drugs. Euphorbia thymifolia L is a widely growing tropical herb that has been reported to have various ethnopharmacological properties. Although Euphorbia genus is reported to have anticancer properties, E. thymifolia is not reported to have anticancer properties to date. Therefore, the aim of the present study was to screen the phytoconstituents and identify the active compounds present in the methanolic extract of E. thymifolia (ME.ET) as ligands to inhibit human cancer cell lines with special reference to potential protein targets implicated in breast cancer using an In-silico approach. Methods ME.ET was subjected to GC-MS analysis to screen the phytoconstituents, and the identified compounds were docked with protein targets such as extracellular signal-regulated kinases (ERK1), a serine/threonine kinase-1(AKT1), human epidermal growth factor 2 (HER2), estrogen receptor (ER), maternal embryonic leucine zipper kinase (MELK), polo-like kinase-1(PLK1), and protein tyrosine kinase (PTK6). Compounds with good docking scores were further subjected to dynamic studies to understand the protein ligand binding stability, ligand pathway calculation, and molecular mechanics energies combined with Poisson-Boltzmann (MM/PBSA) calculations using the Schrodinger suite. Results GC-MS analysis revealed the presence of 245 phytoconstituents, 219 of which were unique. When subjected to docking, these phytocompounds, namely 3,6,9,12-tetraoxatetradecane-1,14-diyl dibenzoate (TTDB) and succinic acid, 2-(dimethylamino) ethyl 4-isopropylphenyl ester (SADPE), showed good docking scores. Molecular dynamics studies showed a high affinity and low binding energy for TTDB with HER2, ERK1, and SADPE with ER. Conclusions Hence, in this study, we identified two lead compounds in E.thymifolia linn. Further invitro and invivo anticancer studies can be performed to confirm these results and to understand the molecular mechanism by which they exhibit anticancer activity against breast cancer.

Background This study examines the growing trend of ethnicized leadership in Ethiopian higher education institutions and advocates for a shift toward merit-based governance to improve institutional integrity and performance. Since 1991, with the introduction of ethnic federalism, leadership appointments in Ethiopian universities have increasingly been based on ethnic identity rather than qualifications. This has led to governance challenges, weakened academic standards, and reduced institutional efficiency. The study highlights the need for governance reforms prioritizing meritocracy to enhance the quality and sustainability of Ethiopia’s ethnically diverse higher education system. Methods The study utilizes a qualitative research approach, combining both primary and secondary data. Primary data were collected through semi-structured interviews with university administrators, faculty, and governance experts, while secondary data were gathered from institutional reports, government policies, and academic literature. Institutional theory, principal-agent theory, and meritocratic theory frame the analysis, providing insights into how ethnic-based leadership appointments affect university governance and performance. Results The findings reveal that ethnicized leadership has eroded governance structures, lowered academic quality, and compromised institutional efficiency. Leadership appointments based on ethnicity rather than merit have led to poor decision-making, weakened accountability, and reduced transparency. In contrast, merit-based governance improves accountability, decision-making, and institutional performance. The study emphasizes that transitioning to a meritocratic leadership model is vital for restoring institutional integrity and academic excellence in Ethiopian universities. Conclusions Ethnic federalism, while initially designed to empower regions, has politicized federal institutions, including universities, reducing them to regional entities rather than national institutions. This system of ethnicized leadership has fostered a culture of favoritism, rampant corruption, and ineffective governance, ultimately weakening Ethiopia’s higher education system. Recommendations Governance reforms that prioritize merit-based appointments are urgently needed. Legal reforms, transparent leadership selection processes, depoliticization efforts, and capacity-building initiatives are recommended to foster a meritocratic culture and improve institutional performance in Ethiopian universities.

Background Glioma is the second most common type of brain tumor, accounting for 24% of all brain tumor cases. The current diagnostic procedure is through an invasive tissue sampling to obtain histopathological analysis, however, not all patients are able to undergo a high-risk procedure. Circulating microRNAs (miRNAs) are considered as promising biomarkers for glioma due to their sensitivity, specificity, and non-invasive properties. There is currently no defined miRNA profile that contributes to determining the grade of glioma. This study aims to find the answer for “Is there any significant miRNA that able to distinguish different grades of glioma?”. Methods This study was conducted to compare the expression of miRNAs between low-grade glioma (LGG) and high-grade glioma (HGG). Eighteen blood plasma samples from glioma patients and 6 healthy controls were analyzed for 798 human miRNA profiles using NanoString nCounter Human v3 miRNA Expression Assay. The differential expressions of miRNAs were then analyzed to identify the differences in miRNA expression between LGG and HGG. Results Analyses showed significant expressions in 12 miRNAs between LGG and HGG, where all of them were downregulated. Out of these significant miRNAs, miR-518b, miR-1271-3p, and miR-598-3p showed the highest potential for distinguishing HGG from LGG, with area under curve (AUC) values of 0.912, 0.889, and 0.991, respectively. Conclusion miR-518b, miR-1271-3p, and miR-598-3p demonstrate significant potentials in distinguishing LGG and HGG.

Introduction Dengue fever poses a significant public health threat, particularly in tropical regions like Malaysia. The rising incidence of dengue outbreaks challenges healthcare systems and highlights the urgent need for effective preventive measures. Climate change, with rising temperatures and shifting rainfall patterns, is expected to worsen the dengue situation in the coming years. Methods . This is a cross-sectional study conducted among adult residents of low-cost housing apartments in an urban poor community in Kuala Lumpur, Malaysia involving approximately 16,000 residents. A representative sample of 1,636 residents was calculated using the Krejcie and Morgan formula, and stratified random sampling was used to ensure proportional representation across the various floors of each PPR community apartment block. Data were collected using a structured questionnaire adapted from a validated Malay version. The questionnaire assessed respondents’ knowledge, attitudes, and practices (KAP) related to dengue prevention, categorising KAP scores as “Good” (≥80%) or “Poor” ( Results In this community, 76.7% of participants exhibited poor knowledge and 83.1% had a negative attitude towards dengue, despite 66.7% demonstrating good preventive practices. The PPR location significantly predicts dengue knowledge, attitudes, and preventive practices, with p-values of less than 0.001 for all domains. Marital status also predicts dengue knowledge (p = 0.007) and preventive practices (p = 0.023), while prior infection with dengue is a predictor of preventive practices (p = 0.047). Conclusion Despite the community’s good dengue prevention practices, likely influenced by environmental expectations, there remains a critical need for education to sustain and strengthen these efforts, as climate change continues to worsen in the coming years. It is crucial to help residents grasp the relevance of these practices, so they can apply them more effectively as climate-driven risks intensify. Targeted interventions should de designed differently for each of the four PPR communities as their levels of knowledge, attitude and practices vary significantly, taking into account independent factors like marital status and prior dengue infection, which shape preventive behaviors.

Background Polypharmacy is common among hospitalized patients with infectious infections owing to comorbidities or concomitant illnesses. This raises the likelihood of drug-drug interactions and creates uncertainty for healthcare providers. This study aimed to assess the potential drug-drug interactions (pDDIs) among hospitalized patients with infectious diseases in a secondary care hospital. Methods A prospective observational study was conducted in the internal medicine ward for six months after the ethics committee’s approval. Data were collected from patient case records, and prescriptions were screened for pDDIs from a portable electronic physician information database (PEPID) resource analyzed using SPSS, version 27.0. Results In total, 148 patient case records were analyzed, and 549 pDDIs were identified, with 66.8% having at least one or more DDIs. The mean number of drug interactions was 3.70 ± 4.58 per prescription. The most frequently encountered drug interactions were drug combinations such as bisoprolol with atorvastatin and aspirin with tazobactam/piperacillin. Bivariate analysis showed that age, comorbidities, length of hospital stay, and the number of drugs prescribed were risk factors associated with DDIs (p Conclusions This study observed the prevalence of DDIs in hospitalized patients with infectious diseases of ‘moderate’ severity. Prescription screening using a drug information database assists in early identification and prevention of DDIs, enhancing drug safety and quality of patient-centered care.

Background COVID-19 pandemics increases venous thromboembolism (VTE) risk during hospitalization, despite prophylactic anticoagulation. Limited radiological diagnosis in pandemic requires a guided protocol for anticoagulant adjustment. Methods This retrospective cohort study was conducted at a single center as part of a quality improvement program evaluating the efficacy and safety of anticoagulation protocols. The study focused on implementing a guideline for anticoagulant dosing protocol based on dynamic changes in D-dimer levels in COVID-19 hospitalized patients. The dosing guideline allowed for dose escalation from standard prophylactic levels to escalated prophylactic or therapeutic levels, depending on the patient's risk profile for VTE. The primary endpoints included in-hospital survival comparing between fix and dynamic adjustment treatment groups. Secondary endpoints encompassed major and clinically relevant non-major bleeding (CRNMB) events, incidence of breakthrough thrombosis, length of hospitalization and ICU stay, days of mechanical ventilator use, and survival duration. Findings Among the 260 COVID-19-infected patients hospitalized between March 15th and June 15th, 2020. The patients received fixed anticoagulant dosage in 188, 72.3%) patients, while 72 (27.7%) were up-titrated according to the protocol. In-hospital survival at 30 days demonstrated superiority among patients whose anticoagulation was up-titrated to either escalated prophylactic or therapeutic (80.2%) compared to receiving fixed anticoagulant dosage (51.3%) (p=0.01). Bleeding events were significantly higher in up-titrate group (12.5%) compared to fixed anticoagulant dosage group (2.13%). Most of them are CRNMB. Conclusion A dynamic, D-dimer-based dose escalation of anticoagulation for hospitalized patients with COVID-19 holds promise in improving in-hospital mortality rates without a significant increase in fatal bleeding events.

Background The COVID-19 pandemic has profoundly affected global health systems and daily life, exacerbating vulnerabilities, particularly in Indonesia. This study investigates the impact of anxiety and education level on mental health, with spiritual intelligence as an intervening variable among post-COVID-19 patients in Indonesia. Methods Utilizing a cross-sectional design, data were collected from 390 post-COVID-19 patients in Indonesia. Structured questionnaires assessed anxiety, education level, spiritual intelligence, and mental health. Structural Equation Modeling (SEM) was used to analyze the relationships among these variables. Results The findings indicate that anxiety significantly affects both spiritual intelligence and mental health, with spiritual intelligence acting as a mediating factor. Additionally, higher educational attainment is positively associated with enhanced spiritual intelligence and improved mental health outcomes. Conclusions The study underscores the importance of incorporating spiritual development practices into mental health interventions and educational programs to boost resilience and overall well-being in the post-pandemic era. While these findings are promising, the cross-sectional design limits causal inferences, and future research should consider longitudinal studies to examine these relationships over time. These practices can help mitigate the adverse effects of anxiety and educational disparities on mental health.

Background Current health recommender systems lack interactivity that relates to the current situation. Methods We designed and implemented an intervention study for obese patients that incorporates context information obtained from smartphone and smartwatch sensors, gamification, as well as joint goal management of patients and health coaches. We developed a health behaviour recommendation system comprising of a smartphone application, cloud platform for data management, and a data dashboard for coaches. Results We conducted a three months long study and analysed data from eight patients, focusing on system function, patient adherence, satisfaction and overall impact of the proposed system on changing health-related habits. Along with data analysis, we also provide patient feedback collected during interview round after the end of the study. Conclusion Patients could successfully implement the goals using the EghiFit app. Challenges regarding the data collection, recommendation synthesis, and patient engagement persist. Furthermore, reliable sensor data processing on current smartphone platforms is difficult due to system restrictions. Future research should further integrate sensor data, gaming, and health behaviour intervention design using smart devices.

Background Technology enhances teaching and learning quality, yet when educators lack tech proficiency, it hinders effective education and leads to frustration, lower confidence, and self-doubt. This study aims to investigate the experiences of university faculty members in relation to the impact of technology on their mental well-being. Methods Using a qualitative approach (grounded theory), ten university faculty members were selected for in-depth interviews based on criteria such as teaching experience, tenure, specific courses or subjects taught, and active engagement during the research period. The guiding research question, “What are the experiences and perceptions of university faculty members concerning techno-stress?” directed the study’s focus. The instrument (interview guide) that measured techno-stress consisted of 12 items and was administered virtually. Data were analyzed thematically to uncover common stressors, adaptive strategies, and institutional challenges faced by faculty in adapting to technology’s demands and work overload. Additionally, the study identified four subcategories: work overload, social and emotional interaction, adaption to new technologies, and expectations and teaching quality. Results Techno-stress is a composite of emotional and physical reactions triggered by the improper use of technology. Faculty members’ encounters with techno-stress have substantial implications for their quality of life. Conclusions This research highlights technology’s positive impact on higher education but notes faculty struggles with techno-stress, emphasizing the need for training, support, and boundaries to maintain work-life balance and enhance educational quality.

Background Selfies have been defined as “a photograph that one has taken of oneself, and are a continuing growing trend among Millennials and Gen Z”. Narcissism refers to a personality trait of an extraordinary self-awareness and adoration. Studies have shown a close relationship between selfie-taking behavior, narcissism and oral health. Hence, a study was conducted with aim of assessing correlations between perceived health, perceived oral health, selfie-taking behavior, narcissism and oral health behavior in an adolescent population. Methods An analytical cross-sectional questionnaire study was designed using relevant literature for collating information on sociodemographic characteristics, frequency of dental visits, selfie-taking behavior and perceived oral health. Oral health examination was performed to assess decay and plaque using DMFT index and Plaque index. Narcissism was assessed using The Five-Factor Narcissism Inventory Short Form. Results The study included a sample of 163 participants. The associations between selfies taken per day and perceived oral health was statistically significant (p value 0.047*). Binary logistic regression models were constructed, which were significant for perceived oral health and grandiose fantasy. Plaque Scores showed significant corelations between indifference, manipulativeness, thrill seeking and age. Step forward binary regression demonstrated a significant odds ratio for grandiose narcissism followed by selfie-taking behavior Conclusion This study revealed a correlation between perceived oral health and selfie-taking behaviour. Further studies are required to assess selfie-taking behaviour and oral health.

Background Trade openness shows a positive impact on economic growth, supported by economic theory, and export diversification and economic complexity show a positive dynamic in trade openness in the world; however, a specificity is generated in South American countries. Therefore, the objective of the research is to analyse the macroeconomic determinants of trade openness in Latin American countries. Methods The research approach was quantitative and explanatory using panel data methodology from the databases of the World Bank, Harvard University and the Economic Commission for Latin America and the Caribbean for the period 2000-2020. Results The fixed effects panel data model showed that the variables that had a negative impact on trade openness were GDP, the economic complexity index and the logistic performance index, while the variables that had a positive impact were exports of high-tech products (a proxy for innovation), exports, imports, research and development expenditure and interregional trade in goods. Conclusions Therefore, during the analysis period of 2000-2020 in South America, based on the panel data analysis under fixed effects, a total of 8 countries had a negative impact on trade openness, and only the economies of Chile, French Guiana, and Brazil had a positive impact on trade openness; these economies are characterized by their better performance in the economic complexity index, their higher percentage of budget for research and development expenses, and their trade policies oriented towards the industrialization of their value-added products.

Background Fenugreek, or Trigonella foenum-graecum L, is an edible and medicinal plant of the Fabaceae family. Fenugreek seeds contain a variety of phytochemicals, including proteins, lipids, amino acids, vitamins, flavonoids, steroidal saponins, coumarin, and alkaloids. Trigonelline TG is a bioactive plant alkaloid initially extracted from fenugreek seeds. A substantial portion of fenugreek’s health benefits may rely on the presence of TG. This study addresses the research gap for a fast, green, and economical method for quantifying trigonelline (TG) in fenugreek. Methods Fenugreek seeds from various origins were extracted using three green solvents: acetone (ACt), ethanol (EtOH), and water (H 2O). The UPLCMSMS method was developed and validated using a green mobile phase of H 2O: EtOH, and an r2-value of 0.999 in the linearity range of 0.1-500 ppb was adopted. The method was validated with an accuracy of 98.6% for trace analysis of TG using a small amount (10 mg) of fenugreek samples from five different origins. Results The average extract yield (±SD) was 5.36±6.3, with the highest extract yield observed in H 2O. The ESI (+ve) of the UPLCMSMS resulted in the fragmentation pattern ( m/z) 138→94.10→92.05→78.20. The TG quantification revealed an average TG concentration of 181.4, with the highest amount of TG in H2O extract (392.7±132.4 ppb), followed by EtOH (91.9±83.3 ppb) and ACt (59.5±30.9 ppb). The TG amount observed in the validation step substantiated the efficiency and reproducibility of the developed method. Conclusions The method may be used as an effective tool for a green, rapid, economical, and eco-friendly extraction and quantification of TG in diverse matrices of pharmaceutical, cosmeceutical, herbal, and food products.

Introduction The social media landscape has undergone radical changes and has revolutionized consumer perspectives, purchasing habits, and behaviors. Amidst this emerging trend is the rise of influencer marketing and its impact on the purchase intentions of followers. The objective is to explore the characteristics of influencers that contribute to their credibility. This research aims to explore the role of consumers’ attitude toward brands on their intention to adopt brands endorsed by influencers. Methods This cross-sectional research was undertaken among GenZ in the urban landscape of India. Data collected was analyzed using SmartPLS4 software. Findings Trust, expertise, and similarity were the significant antecedents of the formation of influencer credibility. Attractiveness did not have a significant influence on influencer credibility. A complementary partial mediation of Attitude towards a brand is observed in the association between influencer credibility and the purchase intention of followers. Attitude towards the video also had a significant positive influence on purchase intention. Conclusion The study found that Gen Z places little importance on an influencer’s attractiveness, as it has no significant impact on credibility. However, attitude toward the brand strongly influenced purchase intention and partially mediated the relationship between influencer credibility and purchase intention.

Background This study aimed to determine the relationships between hematological parameters- hemoglobin, Total Leucocyte Counts (TLC), platelet counts, Absolute Neutrophil Counts (ANC), Absolute Lymphocyte Counts (ALC), Neutrophil Lymphocyte Ratio (NLR), Systemic Immune Inflammatory Index (SII), Neutrophil Monocyte Ratio (NMR), Platelet Lymphocyte Ratio (PLR) and the severity of COVID-19 disease and their use in predicting severity of COVID-19 disease. Methods and Material This was a prospective, observational, single-center study of 573 symptomatic adult inpatients of COVID 19 admitted to our tertiary care center. Statistical analysis used The above-mentioned hematological parameter levels were noted and compared between the two categories of COVID-19 disease, namely non-severe and severe COVID-19 using logistic regression methods. Their cut-off values were detected using the ROC curve. Results The median TLC, ANC, NLR, SII, NMR, PLR were notably higher in patients with severe COVID-19 than in those with non-severe COVID-19. Logistic regression analysis showed that NMR (OR=1.029, p=0.006) and ALC (OR=0.999, p=0.002) were statistically significant independent predictors of COVID-19 severity. Conclusions The hematological parameters mentioned, can be used for predicting severe COVID-19 disease at admission. ALC and NMR levels could be used as hematological markers to predict severity of COVID-19 in adult patients with their cut off values being < 1105 cells/cubic millimeter and > 10.434 respectively.

Objective The shift to online learning during COVID-19 led to increased musculoskeletal discomforts and impacted students’ quality of life. Neck pain (NP), once a minor issue, has become more prevalent due to prolonged electronic device use in new learning methods. This study aims to measure the prevalence of NP among University of Sharjah (UOS) students during the COVID-19 online learning period and to investigate the factors that provoked it. Methods This study focused on young adult students aged 17-26 and did not consider gender or athletic status due to the university’s demographics and pandemic restrictions. Demographic data, Neck Disability Index (NDI) assessments, and pain management information were gathered and analyzed using SPSS 24 through univariate and bivariate methods. Results The prevalence of NP during COVID-19, among 325 UOS students was found to be 62.7%, 64.41% of which had NP at the time of doing the survey. NDI scores were found to be skewed. The median was 16% which indicates mild NP while the interquartile range was 19.11. Most participants reported experiencing posterior neck pain (38.77%), primarily attributed to prolonged sitting (81.23%). Factors such as lifting, personal care, and emotional well-being were found to have a significant impact on NDI. Participants who did not seek medical attention exhibited significantly higher levels of neck pain disability, as measured by the NDI. The median NDI score for this group was 20, with an interquartile range of 16.89 while, those who sought medical attention had a higher median NDI score of 34 with interquartile range of 22. Conclusion This study highlights the prevalence of neck pain among UOS students, emphasizing the need for postural improvements and further research on prevention strategies in the UAE.

Background Projects enable the resolution of problems and alter societal realities, assuming they represent the optimal choices to modify living conditions positively. If projects are deemed intelligent solutions to problems, why do they fail? This question will be addressed in this article through bibliometric analysis. Methods A bibliometric analysis was conducted on the success or failure factors influencing social investment projects, through a descriptive study with search equations, utilizing a comparative matrix to analyze 32 articles from Scopus and 22 from Web of Science. Results As a result, the number of publications, the themes addressed, and their origins between 2018 and 2023 were identified. The VOSviewer software allowed for identifying keywords and their relationships; with this input, a review of scientific production was conducted to subsequently identify the factors influencing projects and how they have been addressed within their contexts. Conclusions In conclusion, it was found that both the factors influencing success or failure in projects are permeated by the environment and the impact of political, social, and economic factors, in addition to the interaction of elements related to soft and hard skills.

Background Humanity faces dual existential crises of biodiversity loss and global warming. Acknowledging the environmental impact of sports, the United Nations is calling on the sports sector to take the lead in fighting climate change and adopting climate-neutral practices. Research on the greenhouse gas emissions of amateur league play is evolving but to date there are few studies that have described the travel patterns for large samples of teams and explored ways to reduce travel. Methods Travel distances for the 2022/23 season were calculated for 339 amateur football and handball teams playing in different leagues in Bavaria. The program Gurobi was utilised to optimise the grouping of teams in order to reduce travel by car. Results The study showed that playing in a higher amateur league most often resulted in longer travel distances for both women’s and men’s sports. Some amateur teams had to travel up to 2,958 kilometres for one season of play. All 339 teams combined travelled a total of 474,231 km (1398.9 per team in average) for away matches in the 2022/23 season of play. Optimising the groups in which teams play can reduce total travel distances by up to 19.7% while keeping the number of games played constant. Conclusions Our findings indicate that travel distances in amateur football and handball, despite being shorter than those of professional teams, contribute significantly to carbon emissions. Due to the greater number of amateur teams and the necessity to reduce greenhouse gas emissions, it is crucial to explore ways of reducing travel in amateur sports. This touches on ethical issues regarding how much travel that causes greenhouse gas emissions is justified in amateur play. Algorithm based optimisation of which teams play against each other appears to be a straightforward, cost-effective, and scalable method for reducing travel emissions in amateur sports.

Introduction and aim Periodontal disease, initiated by dental biofilm and influenced by various local and systemic factors, includes stress as a potential contributor to its progression. Despite associations with severe forms like acute necrotizing ulcerative gingivitis, a comprehensive large-sample study linking stress to periodontal disease is lacking. This study aims to investigate the relationship between mental health and periodontal disease. Materials and Methods Leveraging data (secondary dataset) from the National Health and Nutrition Examination Survey (NHANES) from 2011–2012 and NHANES 2013–2014 cycles, relevant information was extracted. Mental health was the exposure variable, and periodontal disease, assessed through indices following Eke et al.’s definition, served as the outcome. Covariates (demographical characteristics) impacting periodontal disease were considered, and disease status analyses employed the Rao-Scott chi-squared test. A logistic regression model assessed mental health’s impact on periodontal disease. Results Among the 2764 Participants, more than a quarter (29.1%) were aged over 60 years, 52% were females. Logistic regression indicated higher odds of periodontal disease among individuals feeling bad about themselves for more than half of the day (OR 1.170, 95% CI 0.533-2.474), though statistical significance was not reached. Periodontitis prevalence significantly varied based on marital status, with 6.6% of married and 10.8% of unmarried Participants affected. Notably, a statistically significant difference in periodontitis prevalence existed between Participants with health insurance (8.3%) and those without (16.5%). Conclusion Our findings suggest trends in periodontal disease prevalence linked to mental health, marital status, and access to health insurance. However, the absence of statistically significant findings calls for caution in interpreting these relationships. We recommend that future studies further investigate these potential associations to provide a clearer understanding.

Introduction Health systems worldwide are struggling to ensure the affordability of medicines. Prescription, dispensing, and pharmaceutical expenditures are key variables that highlight the need to understand how global scientific evidence is generated against factors (implicit and non-explicit) that influence these variables. Objectives To provide a panorama of scientific production on drug prescription and dispensing, and its relationship with pharmaceutical expenditure in health systems worldwide. Methods A five-stage scientometric mapping was performed based on a systematic search of 8 databases. The five stages are: i) retrieval, ii) migration, iii) analysis, iv) visualization and v) interpretation. Results A corpus of evidence from 103 systematic literature reviews was obtained, screened and sifted, visualizing the countries, authors, databases, journals, institutions and time periods that contributed most to evidence generation. Central research themes are identified and phenomena related to article publication are discussed. Conclusions The analysis reveals a clear leadership of the United Kingdom and the United States in scientific production on prescribing, dispensing and pharmaceutical expenditure in health systems worldwide. This scientific production is mainly focused on financing policies, pharmaceutical incentives and interventions, and rational use of medicines. There is also evidence of the scarcity of scientific production in Latin American publications and authors, which could generate interest for future research.

Background F-keratin forms an evolutionary conserved nanocomposite which allows birds to fly. Structural models for F-keratin are all based on the pioneering X-ray diffraction studies on seagull F-keratin, first published in 1932, confirmed for other species and refined over the years. There is, however, no experimental proof because native F-keratin does not form a perfect molecular crystal as required for structure determination. Methods Peacock’s tail feathers were systematically re-investigated by taking diffraction patterns at different rotation angles. Using the recently developed AlphaFold algorithm, a collection of 3D models of arbitrarily truncated and multiplied Pavo cristatus F-keratin sequences was created. The shape, dimensions, density and interfacial exposure of functionally relevant amino acid side chains of the calculated 3D building blocks were used as the initial selection criteria for filamentous F-keratin precursors. Full reproducibility of in silico folding and agreement with previous results from mechanical testing, biochemical analyses and SAXS experiments was mandatory for suggesting the tentative structure for the novel F-keratin repeating unit. Results The filament of the F-keratin polymer is an alternating arrangement of two units called 'N-block' and 'C-block': Four strands AA 1–52 form a disulfide-stabilized twisted parallelepiped, with 89° internal rotation within eight levels of β-sandwiches. Four strands AA 81–100 form a two-level “ β-sandwich” in which aromatic residues provide resilience, like vertebral discs in a spinal column. The pitch of an N+C-block octamer is 10 nm. Solidification may involve 'C-blocks' to temporarily mold into 'C-wedges' of 18° tilt, which align F-keratin into laterally amorphous fiber-reinforced composites of 9.5 nm axial periodicity. This experimentally significant distance corresponds to the fully stretched AA 53–80 matrix segment. The deformed “spinal column” unwinds under compression when F-keratin filaments perfectly align horizontally into stacked sheets in the solid state. Conclusions At present, the tentative structure presented here is without alternatives.

Background Globally, neonatal deaths are significantly attributed to hypothermia. This is mostly because of its co-morbidity with asphyxia, premature birth and severe neonatal infections. Worldwide, neonatal hypothermia case fatality rates (CFRs) range from 8.5% to 52%. This study aimed to assess how well a video-based training intervention on mothers’ knowledge and practices in preventing neonatal hypothermia worked. Methods The knowledge and practices of two groups of primi-para mothers—one control group and one intervention group—were compared in order to achieve this. A total of 124 primipara mothers took part in the research. Using a video based tool, the intervention group was educated about preventing hypothermia in newborns. Both control and intervention group mothers were interviewed to compare the knowledge and practices. Results Sixty-one of the sixty-two mothers in the control group were unsure of which body area to cover in order to preserve the baby’s body heat. Following the intervention, 61 out of 62 mothers in the group recognised which body part to cover to protect the baby’s body heat. In the post-intervention group, 98.4% of moms wore a cap over their baby’s head, compared to just 35.5% in the control group. Conclusion The results of this study demonstrate the significant improvement in mothers’ knowledge and actions about the prevention of neonatal hypothermia resulting from the use of a video-based training tool.

Background One of the most popular tools that is used to evaluate education quality is the Student Evaluation of Education Quality (SEEQ). This local data study examined the SEEQ’s psychometric properties in Omani education, specifically its validity and reliability. Methods This was quantitative research to assess educational quality from the students’ viewpoint. The study was conducted at Muscat College from January to March 2024.Simple randomization implemented at the course level helped to choose the participants. All students registered in the specified courses were asked to take part after a random sample of the courses Muscat College offers throughout the study term was chosen. Five hundred fifty students completed the survey. AMOS was used to conduct confirmatory factor analysis (CFA), and PSS was used to evaluate the internal consistency (IBM Corp., 2024a, 2024b). Results CFA of the SEEQ indicated that the eight -factor solution best fit the data. Results also showed that the SEEQ has overall good-to-excellent reliability. The adapted scale was psychometrically sound, proving SEEQ’s applicability Conclusions This study proposes using SEEQ to measure Oman’s education quality.

Background Cone Beam Computed Tomography (CBCT) has improved diagnosis and treatment planning in paediatric dentistry, but no bibliometric studies have examined the research landscape. This study provides an overview of CBCT in paediatric dentistry. Methods A bibliometric review was conducted using articles from the Web of Science database up to February 2024. Conference papers and editorials were excluded. Data extracted included citation counts, publication dates, journals, impact factors, study designs, topics, geographical and institutional affiliations, authors, and keywords. Collaborative networks were visualised using VOSviewer, and Spearman’s correlation assessed the relationship between citation counts and other variables. Results The review analysed 517 articles, with the most cited receiving 557 citations. Publication dates ranged from 2005 to 2024, with a peak in 2023. Observational studies were the most common, particularly on maxillary expansion. The American Journal of Orthodontics and Dentofacial Orthopedics was the most cited journal, and the USA was a major contributor. Jacobs R authored the most articles (n=19), and the University of Alberta led in institutional output. Spearman’s correlation showed a weak positive correlation between citation count and journal impact factor (rho=0.272, p Conclusions This bibliometric review provides an overview of the use of CBCT in paediatric dentistry, particularly in maxillary expansion. The findings suggest that more specific imaging protocols may improve safety and clinical outcomes, and that further investigation of long-term outcomes may provide valuable insights.

A monitoring program enabled the evaluation of water quality and the simulation of the pollution dynamics of the rivers in the Joya de los Sachas and Francisco de Orellana cantons in Ecuador. For this assessment one used the WQI (water quality index) and the pollution indices ICOMO (organics contamination), ICOSUS (suspended solids), ICOMI (mineralization), ICOTRO (trophy system), and ICOpH (pH Index). The mathematical model operates with several input parameters, including dissolved oxygen, fecal coliforms, the biochemical oxygen demand (BOD 5), turbidity, total solids, total phosphorus, pH, total nitrogen, suspended solids, alkalinity, conductivity, temperature, and the concentrations of nitrates, nitrites, and phosphates. WQI values were obtained from ICO pollution indices. The pollution of the Sacha area is significant, WQI = 0.292, which represents an advanced degree of pollution, since increased BOD values correspond to a high load of organic pollutants. They can originate from household, agricultural, industrial, and soil erosion waste. Likewise, the Sacha River has an ICOSUS = 0.16, which renders water treatment difficult, without impacting human health. Calculated WQI values reveal that the water quality of the Sacha, Basura and Coca rivers is low, being highly contaminated. In contrast, the Huamayacu, Jivino Rojo, Jivino Negro, and Jivino Blanco rivers are commonly polluted.

Background The association between anemia and severity of infection as well as mortality rates among patients infected with COVID-19 has scarcely been studied. This is the first study from the UAE aimed to assess the influence of anemia on COVID-19 severity, ICU admission, and mortality rate. Methods A retrospective chart review of hospitalized COVID-19 patients was conducted in a large COVID-19 referral hospital in UAE. The study included adult patients with confirmed COVID-19. Clinical and laboratory data, severity of the disease, ICU admissions, and mortality rates were analyzed and correlated to the presence of anemia among the patients. Results A total of 3092 patients were included. 362 patients (11.7%) were anemic and most of the cases were between asymptomatic and mild COVID-19 (77.4%, n=2393). Among patients with anemia, 30.1% (n=109) had moderate to severe COVID-19. Statistically, anemia was associated significantly with a higher risk for severe COVID-19 outcome compared to nonanemic patients (AOR:1.59, 95% CI:1.24-2.04, p Conclusion Anemia was a major risk factor for severe COVID-19, ICU admission and mortality among hospitalized COVID-19 patients. Thus, healthcare providers should be aware of monitoring the hematological parameters among hospitalized patients with COVID-19 and anemia to reduce the risk of disease complications and mortality. This association should also be considered in other infectious diseases.

Background The Environmental Nutrition Program (ENP) as an environmental intervention offers voluntary involvement with students, but persists in exposure. This study aimed to investigate the effect of ENP on students’ dietary intake and nutritional knowledge. Methods A quasi-experimental study was conducted with a control school. ENP comprises four activities: the use of uniform food serving tools, nutrition fact displays, food and nutrition information displays, and body weighing awareness. The ENP emphasized voluntary involvement with students but persisted in exposure for over 8-weeks. Multiple passes of 24-hour food recall and validated questionnaires were used in the assessments by a nutritionist. Multiple linear regressions were performed to analyze the effectiveness of ENP. Results A total of 113 female high school students, with a median age of 16 years, were recruited. At baseline, all students had a lower dietary intake than the national recommendation. Except for the stipend, no differences in the characteristics were found among the students. The students’ carbohydrate intake and nutritional knowledge significantly increased after the ENP in the intervention school ( p < 0.001). Total energy, protein, and fat intake also improved after ENP. Conclusion ENP activities effectively increased students’ daily carbohydrate intake and nutritional knowledge. Thus, ENP may be appropriate for enhancing nutrition literacy among female students. Future studies with a longer time frame are encouraged to yield sustained, favorable dietary practices.

Background of the study Child marriage is linked with multiple maternal and child health issues. However, there is insufficient information regarding the factors influencing child marriage among rural women. Objective To identify the determinants of child marriage among rural women of reproductive age women in the West Guji Zone, Southern Ethiopia, 2024. Methods A community-based cross-sectional study was conducted from April 1 to May 5, 2024. A multistage sampling procedure was used to select 711 participants. The SPSS version 25 was used for data analysis. A multivariable logistic regression model was fitted to determine the determinants of child marriage. Adjusted odd ratio with a 95% confidence interval was used to assess the strength of the associations, and statistical significance was declared at p < 0.05. Results The prevalence of child marriage was 49.6% (95% CI: 0.472-0.524). Being Muslim (AOR=2.104, 95% CI =1.176-3.764), nonformal fathers’ education (AOR=2.633, 95% CI=1.135-6.109), primary level of fathers’ education (AOR=3.326, 95% CI=1.421-7.787); not exposed to media (AOR=1.56, 95% CI=1.033-2.356); living with a relative (AOR=1.592, 95% CI=1.012-2.504); not knowing the legal age of marriage (AOR=2.528, 95% CI=1.593-4.010); marital decision making by girls (AOR=.666, 95% CI=.463-.959), and poor parental wealth status (AOR=4.464, 95% CI=2.795-7.129) were associated with child marriage. Conclusion Almost one in every two women married before 18 in the study area. The determinant factors include religion, fathers’ level of education, exposure to media, living arrangements; awareness of the legal marital age, marriage decision making, and parents’ wealth status. Thus, intervention efforts should focus on these factors to increase the marital age and improve women’s prospects.

Background One of the most common strabismus types in children is intermittent exotropia, which masks the deviation of one eye outward, mostly in children aged 2-4 years. It may affect visual development and often coexists with refractive mistakes. Unlike esotropia, which usually links to hyperopia, intermittent exotropia might have a different relationship with refractive errors and thus lead to myopia. Methods In this cross-sectional study from August 2021 to December 2023, 179 patients diagnosed with intermittent exotropia were recruited via an outpatient clinic of Najah Al-Quraishi, Baghdad, Iraq. The refractive errors were compared by autorefractometry and retinoscopy after cycloplegic dilation. Data analysis was constructed under the use of IBM SPSS V.26 for the determination of emmetropia, myopia, and hyperopia prevalence. Results The most expected refractive error among the 179 patients was emmetropia, which occurred in 68 patients (38%). Low hyperopia and low myopia were also common, with 64 and 40, respectively. A limited number of patients had moderate/high myopia and moderate/high hyperopia; in detail, the prevalence was following: 5% of patients had moderate myopia, while 0.5% of patients suffered from high myopia; symmetrically, 5% were moderate to high hyperopia. From the data collected, a trend emerged for a low refractive error and symmetric refractive error in both eyes. Conclusion Contrasted to prior conventional wisdom about refractive error in strabismus, it established the greater incidence of emmetropia in patients with intermittent exotropia. The findings call for specific management strategies to be applied in this population.

Background Effective clinical laboratories are the need of the hour, they play a significant role in healthcare, providing tests for diagnosis, treatment monitoring. Having skilled and adequate staffing is crucial for clinical laboratories to operate efficiently, manage their workload effectively, and deliver test results in a timely manner. Despite being critical for healthcare delivery, ensuring adequate staffing levels in clinical laboratories remains a complex challenge for healthcare providers worldwide due to resource constraints and workforce shortages. Methods This study evaluates the effectiveness of clinical laboratory staff utilization by considering workload, work pressure, and staffing requirements. We utilized the Workload Indicators of Staffing Need (WISN) method to assess the staffing in the clinical laboratory of a tertiary care hospital. Annual hospital statistics were collected for two years from June 2021 to May 2023 to calculate the average number of days (234) worked annually, percentage of workload, distribution of activity time measurement units, and the ratio of needed, surplus, and existing staff. The findings aim to provide valuable insights for optimizing staffing levels and ensuring an efficient laboratory environment. Result The analysis found a significant workforce gap in the laboratory between the current staff numbers and the calculated staffing needs. The WISN ratios ranged from 0.2 to 0.7, indicating the existing 33 staff members face a high workload burden. The calculated ideal staffing level was 46.33 personnel. These results demonstrate staff shortage and excess workload pressure on the current laboratory employees. Conclusion The results highlight the importance of optimizing staffing levels in clinical laboratories to ensure quality service delivery. The WISN methodology can be a useful tool in healthcare facilities for making evidence -based decisions for staff allocation, maximizing the utilization of employee skill sets, and establishing standard staffing benchmarks tailored to the needs of clinical laboratories.

Background Hemodialysis patients are frequently colonized by Staphylococcus aureus, leading to severe infections with high mortality rates. However, little is known about transition from non-colonization to colonization or bacteremia over time. The aim was to analyze the behavior of S. aureus colonization, identifying the probability of transition from non-colonized to colonized state or bacteremia, and the influence of specific covariates. Methods The study was conducted in a dialysis unit associated with a tertiary care hospital in Medellín between October 2017 and October 2019. An initial measurement was taken to evaluate S. aureus colonization, and follow-up measurements were performed 2 and 6 months later. Bacteremia evolution was monitored for 12 months. A two-state recurrent continuous-time Markov model was constructed to model transition dynamics from non-colonization to S. aureus colonization in hemodialysis patients. Subsequently, the model was applied to a third state of bacteremia. Results Of 178 patients on hemodialysis, 30.3% were colonized by S. aureus. Transition intensity from non-colonization to colonization was three times higher (0.21; CI: 0.14-0.29) than from colonization to non-colonization (0.07; CI: 0.05-0.11). The colonization risk increased in patients with previous infections (HR: 2.28; CI: 0.78-6.68), hospitalization (HR: 1.29; CI: 0.56-2.99) and antibiotics consumption (HR: 1.17; CI: 0.53-2.58). Mean non-colonized state duration was 10.9 months, while in the colonized state was 5.2 months. In the 3-state model, it was found that patients colonized were more likely to develop S. aureus infection (13.9%). Conclusion A more likely transition from non-colonization to colonization was found, which increases with factors such as previous infection. In addition, the development of bacteremia was more likely in colonized than in non-colonized patients. These results underline the importance of surveillance and proper management of S. aureus colonization to prevent serious complications, such as bacteremia, and improve prognosis in this vulnerable population.

Background While a laminectomy is often mandated for spinal canal stenosis, foraminal stenosis may account for pain and functional limitations instead of central canal issues. Targeted treatment directed at this specific region may enhance patient outcomes. Methods Retrospective observational study of a total of 30 patients with previous decompression laminectomies for lumbar spinal canal stenosis were operated upon for foraminotomies from November 2012 to November 2018. The surgeries were clinically done, and EMG-confirmed nerve root compressions were treated with exact decompression techniques according to the anatomy and pathology in each case. Additionally, a systematic review followed PRISMA guidelines was conducted, utilizing Scopus and PubMed databases to identify studies on reoperation rates after decompression with or without fusion in lumbar spinal stenosis. Results The results were fearsome post-operatively, trying significant improvement in pain, functional status, and walking distance. Pain reduction was achieved in 80% of patients by an increase in the Carnovsky rating scale with evidence of improved pain reduction and walking endurance; this points to minimal resulting complications of one complete case of foot drop and three infective cases managed conservatively. It was shown in the systematic review that fusion surgeries lowered the rates of reoperations at the index level but increased those for adjacent segment reoperations, while decompression alone had higher index-level reoperation rates due to recurrent stenosis. Conclusion Most of the emphasis on foraminal stenosis, rather than traditional laminectomies, significantly reduces postoperative pain and improves functional outcomes. This strategy brings a promising alternative to the management of recurrent symptoms in patients with lumbar spinal canal stenosis.

Background Preprints are scientific manuscripts that are made available on open-access servers but are not yet peer-reviewed. Although preprints are becoming more prevalent, uptake is not optimal. Understanding researchers’ opinions and attitudes toward preprints is valuable to optimize their use. Understanding knowledge gaps and researchers’ attitudes toward preprinting can assist stakeholders, such as journals, funding agencies, and universities, to use preprints more effectively. Here, we aimed to collect perceptions and behaviours regarding preprints across an international sample of biomedical researchers. Methods Corresponding authors of articles published in biomedical research journals were identified from a random sample of journals from the MEDLINE database. Their names and email addresses were extracted to invite them to our anonymous, cross-sectional survey, which asked participants questions about their knowledge, attitudes, and opinions regarding preprinting. Results The survey was completed by 730 respondents providing a response rate of 3.20% and demonstrated a wide range of attitudes and opinions about preprints with authors from various disciplines and career stages worldwide. Most respondents were familiar with the concept of preprints but most had not previously posted one. The lead author of the project and journal policy had the greatest impact on decisions to post a preprint, whereas employers/research institutes had the least impact. Supporting open science practices was the highest ranked incentive, while increasing authors’ visibility was the highest ranked motivation for publishing preprints. Conclusions Although many biomedical researchers recognize the benefits of preprints, there is still hesitation among others to engage in this practice. This may be due to the general lack of peer review of preprints and little enthusiasm from external organizations such as journals, funding agencies, and universities. Future work is needed to determine optimal ways to improve researchers’ attitudes through modifications to current preprint systems and policies.