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Abstract Immunopathology of human tuberculosis (TB) in a subgroup of patients is characterized by aberrantly high concentrations of inflammatory cytokines, for example Interleukin (IL)-6. Concomitant (co-)infections by parasites can affect host immunity, but the impact on immunopathology in TB patients is poorly defined. Here we characterized a group of patients with TB ( n = 76) from Ghana with different protozoan and helminth co-infections. Plasma cytokines were measured at the onset of disease and anti-mycobacterial treatment efficacy was monitored during disease course. A subgroup of TB patients had co-infections with protozoan (n = 19) or helminth (n = 16) parasites. Plasma analyses for candidate cytokines identified lower levels of IL-6 in parasite co-infected patients with TB. Moreover, it took less time for co-infected patients to become sputum-negative for Mycobacterium tuberculosis during treatment. These results indicated an influence of parasite co-infections on immunopathology in TB and suggested positive effects on treatment efficacy.

Background The Bethesda System for Reporting Thyroid Cytopathology (TBSRTC) aims to standardize the terminology and morphologic criteria associated with thyroid fine-needle aspiration cytology (FNAC) results while also providing corresponding risk assessments for malignancy. contributing to more consistent and standardized reporting of thyroid nodules and aiding clinicians in making informed decisions. Since then, it has been undergoing revisions and updates to further improve its utility and accuracy. Materials and Methods This is a retrospective study conducted at a tertiary care center. All patients with a history of thyroid gland swelling who had previously undergone FNA were included. The procedure included cytopathologists performing FNAC for all cases of midline neck swelling. Demographic and histopathology data were correlated with the cytological diagnosis. Results We included 288 cases. Of those, 234 (81.3%) were female and 54 (18.8%) were male. The presentation age range was 18–91 years. The most reported category was benign, which constituted 30.9% of the cases followed by malignancy (27.1%). As for thyroid lesions, papillary carcinoma was the most prevalent (43.6%). The correlation on cyto-histopathology was presented in every diagnostic category, showing high heterogeneity in diagnostic specificity and sensitivity. The overall diagnostic specificity and sensitivity were 56.05% (95% confidence interval [CI]: 47.92–63.95%) and 80.92% (95% CI: 73.13–87.25%), respectively. Positive and negative predictive values were 60.57% and 77.88%, respectively. Conclusion Our data suggests that the TBSRTC system promotes similar sensitivity and specificity to those reported elsewhere. It standardizes reporting and improves communication between cytopathologists and clinicians.

Abstract The removal of heavy metals, such as lead, from industrial wastewater is imperative due to their detrimental effects on both human health and the environment. This study delves into investigating the feasibility of employing a novel adsorbent, specifically a silica/klucel nanocomposite, for effectively extract lead from industrial effluents. The synthesis of this nanocomposite involved a simple and cost-effective method, combining silica nanoparticles with klucel. XRD, FTIR, E-SEM, Raman, and N2 gas adsorption at − 196 °C tools were employed to prospect the formation of silica/klucel nanocomposite. Outstandingly, treating 50 ml of 50 mg/l of lead with 10 mg of adsorbent exhibited rapid removal, which reached a maximum (95%) at 60 min contact time. The resulting composite demonstrated remarkable adsorption capabilities, primarily attributed to two factors: the expansive surface area of silica nanoparticles 139.1 m2/g and the porous structure provided by klucel. Through batch adsorption experiments, the nanocomposite’s proficiency in removing lead ions from aqueous solutions became evident. The kinetics of the adsorption process were found to adhere closely to a pseudo-second-order model, hinting at chemical adsorption as the rate-determining step. Langmuir isotherm model revealed that lead ions tend to form a monolayer on the surface of the nanocomposite and the maximum adsorption capacity (qm) was 63.938 mg/g. Additionally, the nanocomposite, exhibited notable stability and could be reused multiple times, where 65% removal efficiency was announced until the 7th cycle without significant degradation in performance. In summary, the silica/klucel nanocomposite emerges as a promising and eco-friendly adsorbent for removing lead from industrial effluents. Its efficient performance and sustainability offer a compelling solution to combat heavy metal contamination, thereby contributing to environmental preservation and human well-being.

Abstract This study proposes a new deep-learning approach incorporating a superfluity mechanism to categorize knee X-ray images into osteoporosis, osteopenia, and normal classes. The superfluity mechanism suggests the use of two distinct types of blocks. The rationale is that, unlike a conventional serially stacked layer, the superfluity concept involves concatenating multiple layers, enabling features to flow into two branches rather than a single branch. Two knee datasets have been utilized for training, validating, and testing the proposed model. We use transfer learning with two pre-trained models, AlexNet and ResNet50, comparing the results with those of the proposed model. The results indicate that the performance of the pre-trained models, namely AlexNet and ResNet50, was inferior to that of the proposed Superfluity DL architecture. The Superfluity DL model demonstrated the highest accuracy (85.42% for dataset1 and 79.39% for dataset2) among all the pre-trained models.

Abstract Background HIV clinical guidelines recommend hypertension detection and management to lower cardiovascular disease risk, but these have not been effectively implemented for people living with HIV (PWH). Addressing this implementation gap requires community-engaged implementation studies focused on addressing implementation barriers specific to the HIV care context. Methods This protocol describes a type 2 effectiveness-implementation hybrid study conducted in nine primary care clinics in Johannesburg. The study will evaluate the effect of implementation strategies on guideline-recommended blood pressure assessment and management in HIV clinics and the effects of assessment/management on patient blood pressure. A stepped-wedge, cluster randomized study design was used to randomize clinics to the time at which they receive the implementation strategies and patient intervention. The implementation strategies tested include identifying and preparing care champions, changing record systems, conducting ongoing training, providing audit and feedback, and changing the physical structure/equipment. The patient intervention tested includes detection of elevated blood pressure, educational materials, lifestyle modification advice, and medication where needed. Implementation outcomes include adoption, fidelity (co-primary outcome), cost, and maintenance of the blood pressure assessment protocol in participating clinics, while patient outcomes include reach, effectiveness (co-primary outcome), and long-term effects of the intervention on patient blood pressure. These will be assessed via direct observation, study records, staff logs, medical chart reviews, and patient and healthcare worker surveys. To examine effects on the implementation (intervention fidelity) and effectiveness (patient blood pressure changes) co-primary outcomes, we will use the standard Hussey and Hughes model for analysis of stepped-wedge designs which includes fixed effects for both interventions and time periods, and a random effect for sites. Finally, we will examine the costs for the implementation strategies, healthcare worker time, and patient-facing intervention materials, as well as the cost-effectiveness and cost-utility of the intervention using study records, patient surveys, and a time and motion assessment. Discussion This study will address knowledge gaps around implementation of cardiovascular disease preventive practices in HIV care in South Africa. In doing so, it will provide a dual opportunity to promote evidence-based care in the South African HIV care context and help refine implementation research methods to better serve HIV populations globally. Trial registration ClinicalTrials.gov: NCT05846503. Registered on May 6, 2023. https://classic.clinicaltrials.gov/ct2/show/NCT05846503 .

This paper introduces a novel non-homogeneous stochastic diffusion process, useful for modeling both decreasing and increasing trend data. The model is based on a generalized Gamma-like curve. We derive the probabilistic characteristics of the proposed process, including a closed-form unique solution to the stochastic differential equation, the transition probability density function, and both conditional and unconditional trend functions. The process parameters are estimated using the maximum likelihood (ML) method with discrete sampling paths. A small Monte Carlo experiment is conducted to evaluate the finite sample behavior of the trend function. The practical utility of the proposed process is demonstrated by fitting it to two real-world data sets, one exhibiting a decreasing trend and the other an increasing trend.

Abstract Glucagon-like peptide-1 (GLP-1) analogs are important therapeutics for type 2 diabetes and obesity. Ecnoglutide (XW003) is a novel, long-acting GLP-1 analog. We conducted a Phase 2, randomized, double-blind, placebo-controlled study enrolling 145 adults with T2DM. Participants were randomized to 0.4, 0.8, or 1.2 mg ecnoglutide or placebo as once-weekly injections for 20 weeks. The primary objective was to evaluate the efficacy of ecnoglutide, as measured by HbA1c change from baseline at Week 20. Secondary endpoints included body weight, glucose and lipid parameters, as well as safety. We show that, at end of treatment, the 0.4, 0.8, and 1.2 mg groups had statistically significant HbA1c reductions from baseline of −1.81%, −1.90%, and −2.39%, respectively, compared to −0.55% for placebo (P

Abstract Manufacturing ordinary Portland cement (OPC) poses significant challenges for sustainable construction practices. OPC manufacturing emits substantial greenhouse gases into the atmosphere and demands extensive raw materials. In pursuit of greener alternatives, researchers explore geopolymer concrete (GPC), a revolutionary material that entirely replaces OPC, comprising industrial wastes/by-products activated through an alkaline solution. The study aims to investigate the feasibility of incorporating quarry rock dust (QRD) into GPC production for environmentally sustainable structural applications. Circular columns (200 mm diameter, 1000 mm length) were formulated using GPC blends with fly ash, slag (SG), and QRD as a partial SG replacement. The structural performance of these columns, with and without steel fiber reinforcement, was evaluated under varied loading conditions. Results show that QRD is a valuable ingredient in GPC for structural concrete elements, offering performance comparable to traditional OPC concrete. Furthermore, the incorporation of steel fibers significantly enhances the peak axial loads, displacement response, and overall performance of GPC columns with or without QRD. Fiber-reinforced GPC columns demonstrated approximately 8–10% higher ultimate load capacity than equivalent OPC columns. Eccentricity was found to significantly reduce ductility, but fiber reinforcement offers substantial ductility improvements (25–55%).

Abstract Trifluoromethyl arenes (Ar–CF3) are amongst the commonly encountered fluorinated substructures in pharmaceutical, agrochemical, and material sciences. However, predominant methods to access Ar–CF3 possess several limitations, including harsh conditions, lack of availability of substrates, and poor regioselectivity, which combined restrict access to desirable highly functionalized Ar–CF3-containing compounds. To expand the scope of accessible Ar–CF3-based molecules, we present an orthogonal deoxyfluoroalkylation/aromatization approach that exploits readily accessible and programable cyclohexan(en)one substrates, which undergo a reliable 1,2-addition reaction with the Ruppert-Prakash reagent (TMSCF3) followed by aromatization to deliver highly functionalized Ar–CF3 compounds in a one/two-pot sequence. This general strategy enables access to highly substituted Ar–CF3-containing molecules that are difficult, expensive, and/or impossible to access by current synthetic methods.

Abstract Background Individuals with high blood pressure in India often miss essential follow-up visits. Missed visits contribute to gaps across the hypertension care continuum and preventable cardiovascular disease. Widespread misconceptions around hypertension care and treatment may contribute to low follow-up attendance rates, but to date, there is limited evidence of the effect of interventions to debunk such misconceptions on health-seeking behavior. We conducted a randomized controlled trial to measure whether combining information debunking commonly-held misconceptions with a standard reminder reduces missed follow-up visits among individuals with high blood pressure and investigated whether any observed effect was moderated through belief change. Methods We recruited 388 patients with uncontrolled blood pressure from the outpatient wards of two public sub-district hospitals in Punjab, India. Participants randomly assigned to the intervention arm received two WhatsApp messages, sent 3 and 1 days before their physician-requested follow-up visit. The WhatsApp message began with a standard reminder, reminding participants of their upcoming follow-up visit and its purpose. Following the standard reminder, we included brief debunking statements aimed at acknowledging and correcting common misconceptions and misbeliefs about hypertension care seeking and treatment. Participants in the control group received usual care and did not receive any messages. Results We did not find evidence that the enhanced WhatsApp reminders improved follow-up visit attendance (Main effect: 2.2 percentage points, p-value = 0.603), which remained low across both treatment (21.8%, 95% CI: 15.7%, 27.9%) and control groups (19.6%, 95% CI: 14.2%, 25.0%). Participants had widespread misconceptions about hypertension care but our debunking messages did not successfully correct these beliefs (p-value = 0.187). Conclusions This study re-affirms the challenge of continuity of care for chronic diseases in India and suggests that simple phone-based health communication methods may not suffice for changing prevalent misconceptions and improving health-seeking behavior. Trial registration The trial began on July 18th. We registered the trial on July 18th (before recruitment began), including the main outcomes, on the German Clinical Trial Register [Identifier: DRKS00029712] and published a pre-analysis plan in the Open Science Framework [osf.io/67g35].

Cinnamon is a plant with significant medicinal value and used extensively as a spice, flavoring, and fragrance ingredient. Phytochemical characterization via HPLC, antimicrobial activity against various microorganisms, anti-diabetic activity via α-amylase and α-glucosidase assessment, antioxidant activity via 2,2-diphenyl-1-picryl-hydrazyl-hydrate, total antioxidant capacity and Ferric reducing Antioxidant Power methods, besides anticancer activity against MCF-7 (human breast cancer cells) and WI-38 cells (human fetal lung fibroblast cells) of cinnamon bark extract were detected. A promising antimicrobial action towards Enterococcus faecalis, Staphylococcus aureus, Klebsiella pneumoniae, Salmonella typhi, Candida albicans, and Mucor circinelloides with inhibition zones of 25, 23, 18, 19, 29, and 16 mm, respectively was recorded. Cinnamon bark has IC50 of 5.01 and 2.58 µg/mL compared to standard acrobose with their IC50 values 4.32 and 1.99 µg/mL, for α-amylase and α-glucosidase inhibition, respectively. Cinnamon bark extract have IC50 of 77.39 ± 0.84 and 162.67 ± 0.28 μg/mL against MCF-7, and WI-38 cell lines, respectively. The protective effect of cinnamon in accelerating the apoptosis of MCF-7 cells has been verified by flow cytometric evaluation employing Annexin-V and cell cycle kits, besides increasing the amounts of malondialdehyde, hydrogen peroxide and nitric oxide with decreasing glutathione and catalase levels.

Abstract Background Non-communicable diseases (NCDs) pose a significant global health challenge, constituting over 80% of mortality and morbidity. This burden is particularly pronounced in low- and middle-income countries (LMICs), including Ethiopia. Despite this, there’s limited research on this issue in Africa. This study aims to investigate the prevalence, patterns, and outcomes of NCDs in hospitalized populations across three tertiary hospitals in Ethiopia. Methods A hospital-based cohort study (August 2022 - January 2023) included patients aged 14 and older diagnosed with cardiovascular diseases (CVDs), diabetes mellitus (DM), chronic obstructive pulmonary disease (COPD), asthma, or cancer at three Ethiopian hospitals. Data on demographics, socio-economic factors, clinical characteristics, and outcomes were collected through medical records and interviews. Logistic regression identified factors independently associated with in-hospital mortality, with p ≤ 0.05 considered statistically significant. Results In the study across three tertiary hospitals involving 2,237 patients, we uncovered the impact of NCDs. About 23.4% of patients struggled with NCDs, with cardiovascular diseases (53.3%), cancer (29.6%), diabetes (6.1%), and respiratory diseases (6.5%) being the most prevalent. Notably, among those affected, women comprised a slight majority (55.1%), with the average patient age being 47.2 years. Unfortunately, 15.3% of patients with NCDs faced in-hospital mortality. Our analysis revealed predictors of mortality, including cancer diagnosis (adjusted odds ratio [AOR]:1.6, 95% CI: 1.2–1.8, p = 0.01), medication adherence ( AOR: 0.36, 95% CI: 0.21–0.64, p

Abstract Background Co-occurring physical and mental health conditions are common, but effective and sustainable interventions are needed for primary care settings. Purpose Our paper analyzes the effectiveness of a Solution-Focused Brief Therapy (SFBT) intervention for treating depression and co-occurring health conditions in primary care. We hypothesized that individuals receiving the SFBT intervention would have statistically significant reductions in depressive and anxiety symptoms, systolic blood pressure (SBP), hemoglobin A1C (HbA1c), and body mass index (BMI) when compared to those in the control group. Additionally, we hypothesized that the SFBT group would have increased well-being scores compared to the control group. Methods A randomized clinical trial was conducted at a rural federally qualified health center. Eligible participants scored ≥ 10 on the Patient Health Questionnaire (PHQ-9) and met criteria for co-occurring health conditions (hypertension, obesity, diabetes) evidenced by chart review. SFBT participants (n = 40) received three SFBT interventions over three weeks in addition to treatment as usual (TAU). The control group (n = 40) received TAU over three weeks. Measures included depression (PHQ-9) and anxiety (GAD-7), well-being (Human Flourishing Index), and SFBT scores, along with physical health outcomes (blood pressure, body mass index, and hemoglobin A1c). Results Of 80 consented participants, 69 completed all measures and were included in the final analysis. 80% identified as female and the mean age was 38.1 years (SD = 14.5). Most participants were white (72%) followed by Hispanic (15%) and Black (13%). When compared to TAU, SFBT intervention participants had significantly greater reductions in depression (baseline: M = 18.17, SD = 3.97, outcome: M = 9.71, SD = 3.71) and anxiety (baseline: M = 14.69, SD = 4.9, outcome: M = 8.43, SD = 3.79). SFBT intervention participants also had significantly increased well-being scores (baseline: M = 58.37, SD = 16.36, outcome: M = 73.43, SD = 14.70) when compared to TAU. Changes in BMI and blood pressure were not statistically significant. Conclusion The SFBT intervention demonstrated efficacy in reducing depressive and anxiety symptoms and increasing well-being but did not affect cardio-metabolic parameters over a short period of intervention. Trial Registration The study was pre-registered at ClinicalTrials.gov Identifier: NCT05838222 on 4/20/2023. *M = Mean, SD = Standard deviation.

Abstract Introduction India grapples with a formidable health challenge, with an estimated 315 million adults afflicted with hypertension and 100 million living with diabetes mellitus. Alarming statistics reveal rates for poor treatment and control of hypertension and diabetes. In response to these pressing needs, the Community Control of Hypertension and Diabetes (CoCo-HD) program aims to implement structured lifestyle interventions at scale in the southern Indian states of Kerala and Tamil Nadu. Aims This research is designed to evaluate the implementation outcomes of peer support programs and community mobilisation strategies in overcoming barriers and maximising enablers for effective diabetes and hypertension prevention and control. Furthermore, it will identify contextual factors that influence intervention scalability and it will also evaluate the program’s value and return on investment through economic evaluation. Methods The CoCo-HD program is underpinned by a longstanding collaborative effort, engaging stakeholders to co-design comprehensive solutions that will be scalable in the two states. This entails equipping community health workers with tailored training and fostering community engagement, with a primary focus on leveraging peer supportat scale in these communities. The evaluation will undertake a hybrid type III trial in, Kerala and Tamil Nadu states, guided by the Institute for Health Improvement framework. The evaluation framework is underpinned by the application of three frameworks, RE-AIM, Normalisation Process Theory, and the Consolidated Framework for Implementation Research. Evaluation metrics include clinical outcomes: diabetes and hypertension control rates, as well as behavioural, physical, and biochemical measurements and treatment adherence. Discussion The anticipated outcomes of this study hold immense promise, offering important learnings into effective scaling up of lifestyle interventions for hypertension and diabetes control in low- and middle-income countries (LMICs). By identifying effective implementation strategies and contextual determinants, this research has the potential to lead to important changes in healthcare delivery systems. Conclusions The project will provide valuable evidence for the scaling-up of structured lifestyle interventions within the healthcare systems of Kerala and Tamil Nadu, thus facilitating their future adaptation to diverse settings in India and other LMICs.

Abstract Background Familial concordance of weight status is an emerging field of study that may guide the development of interventions that operate beyond the individual and within the family context. There is a dearth of published data for concordance of weight status within Pakistani households. Methods We assessed the associations between weight status of mothers and their children in a nationally representative sample of households in Pakistan using Demographic and Health Survey data from 2017–18. Our analysis included 3465 mother–child dyads, restricting to children under-five years of age with body mass index (BMI) information on their mothers. We used linear regression models to assess the associations between maternal BMI category (underweight, normal weight, overweight, obese) and child’s weight-for-height z-score (WHZ), accounting for socio-demographic characteristics of mothers and children. We assessed these relationships in all children under-five and also stratified by age of children (younger than 2 years and 2 to 5 years). Results In all children under-five and in children 2 to 5 years, maternal BMI was positively associated with child’s WHZ. For all children under-five, children of normal weight, overweight, and obese women had WHZ scores that were 0.21 [95% CI (confidence interval): 0.04, 0.37], 0.43 [95% CI: 0.25, 0.62], and 0.51 [95% CI: 0.30, 0.71] units higher than children of underweight women, respectively. For children ages 2 to 5, children of normal weight, overweight, and obese women had WHZ scores that were 0.26 [95% CI: 0.08, 0.44), 0.50 [95% CI: 0.30, 0.71), and 0.61 [95% CI: 0.37, 0.84] units higher than children of underweight women, respectively. There was no association between maternal BMI and child WHZ for children under-two. Conclusions The findings indicate that the weight status of mother’s is positively associated with that of their children, particularly after age 2. These associations further strengthen the call for research regarding interventions and policies aimed at healthy weight promotion among mothers and their children collectively, rather than focusing on individuals in isolation.

Abstract Background The associations of vegetarian diets with risks for site-specific cancers have not been estimated reliably due to the low number of vegetarians in previous studies. Therefore, the Cancer Risk in Vegetarians Consortium was established. The aim is to describe and compare the baseline characteristics between non-vegetarian and vegetarian diet groups and between the collaborating studies. Methods We harmonised individual-level data from 11 prospective cohort studies from Western Europe, North America, South Asia and East Asia. Comparisons of food intakes, sociodemographic and lifestyle factors were made between diet groups and between cohorts using descriptive statistics. Results 2.3 million participants were included; 66% women and 34% men, with mean ages at recruitment of 57 (SD: 7.8) and 57 (8.6) years, respectively. There were 2.1 million meat eaters, 60,903 poultry eaters, 44,780 pescatarians, 81,165 vegetarians, and 14,167 vegans. Food intake differences between the diet groups varied across the cohorts; for example, fruit and vegetable intakes were generally higher in vegetarians than in meat eaters in all the cohorts except in China. BMI was generally lower in vegetarians, particularly vegans, except for the cohorts in India and China. In general, but with some exceptions, vegetarians were also more likely to be highly educated and physically active and less likely to smoke. In the available resurveys, stability of diet groups was high in all the cohorts except in China. Conclusions Food intakes and lifestyle factors of both non-vegetarians and vegetarians varied markedly across the individual cohorts, which may be due to differences in both culture and socioeconomic status, as well as differences in questionnaire design. Therefore, care is needed in the interpretation of the impacts of vegetarian diets on cancer risk.

Abstract Background The burden of hypertension among people with HIV is high, particularly in low-and middle-income countries, yet gaps in hypertension screening and care in these settings persist. This study aimed to identify facilitators of and barriers to hypertension screening, treatment, and management among people with HIV in primary care clinics in Johannesburg, South Africa. Additionally, different stakeholder groups were included to identify discordant perceptions. Methods Using a cross-sectional study design, data were collected via interviews (n = 53) with people with HIV and hypertension and clinic managers and focus group discussions (n = 9) with clinic staff. A qualitative framework analysis approach guided by COM-B and the Theoretical Domains Framework were used to identify and compare determinants of hypertension care across stakeholder groups. Results Data from clinic staff and managers generated three themes characterizing facilitators of and barriers to the adoption and implementation of hypertension screening and treatment: 1) clinics have limited structural and operational capacity to support the implementation of integrated care models, 2) education and training on chronic care guidelines is inconsistent and often lacking across clinics, and 3) clinicians have the goal of enhancing chronic care within their clinics but first need to advocate for health system characteristics that will sustainably support integrated care. Patient data generated three themes characterizing existing facilitators of and barriers to clinic attendance and chronic disease self-management: 1) the threat of hypertension-related morbidity and mortality as a motivator for lifestyle change, 2) the emotional toll of clinic’s logistical, staff, and resource challenges, and 3) hypertension self-management as a patchwork of informational and support sources. The main barriers to hypertension screening, treatment, and management were related to environmental resources and context (i.e., lack of enabling resources and siloed flow of clinic operations) and patients’ knowledge and emotions (i.e., lack of awareness about hypertension risk, fear, and frustration). Clinical actors and patients differed in perceived need to prioritize HIV versus hypertension care. Conclusions The convergence of multi-stakeholder data highlight key areas for improvement, where tailored implementation strategies targeting motivations of clinic staff and capacity of patients may address challenges to hypertension screening, treatment, and management recognized across groups.

Plants represent a great source of medicines, and for their components to be discovered, extraction processes must be developed, especially methods based on green technology. Supercritical fluid extraction (SFE) was employed as a green method for Moringa oleifera extraction in the present investigation. The maximum yield of extraction was obtained at 25 MPa. Moreover, the extraction at 25 MPa induced the release of various phenols and flavonoids, as analyzed via high-performance liquid chromatography. The investigation revealed the concentrations of chlorogenic, gallic, rosmarinic, and coumaric acids to be 150.59, 89.90, 44.75, and 29.41 µg/mL, respectively at 25 MPa. However, their concentrations were 0.73, 1.53, 0.24, and 0.04 µg/mL, respectively at 15 MPa; vs. 4.73, 2.62, 1.06, and 0.50 at 35 MPa, respectively. Totals of saponin, flavonoid, phenolic, tannins, and alkaloid were recorded in maximum yield at 25 MPa. Moringa oleifera extracted at 35 MPa reflected highest inhibition zones of 27 ± 0.1, 30 ± 0.2, and 30 ± 0.1 mm against C. glabrata, C. tropicalis, and C. albicans, correspondingly. α-Amylase and α-glucosidase activities were greatly suppressed by the M. oleifera extract at 25 MPa with less IC50 (12.97 µg/mL and 6.0 µg/mL), than the IC50 (53.46 and 22.02 µg/mL) at 15 MPa, compared with acarbose IC50 (5.52 and 2.64 µg/mL), correspondingly.

Bacterial infections pose an ongoing challenge due to resistance developed by infectious bacteria. So much research targeting designing new antibacterials is published annually. Our goal is to synthesize compounds that have given antibacterial activity according to molecular docking against the chosen target protein and that have acceptable ADMET properties that can be synthesized and used in the future. New 2-(5-methoxy-1-(4-chlorobenzene)-2-methyl-1H-indol-3-yl)acetohydrazide derivatives’ antibacterial efficacy against two common strains of Gram-negative and Gram-positive microorganisms has been developed, produced, and investigated. Sophisticated, modern analytical methods, including ATR-FTIR and 1H NMR spectroscopy, were used to determine their spectral and physicochemical features. Compound YA3N is more effective than ciprofloxacin against K. pneumonia (MIC = 125 µg/mL) and shows good suppression of isolated tests of E. coli (MIC = 125 µg/mL). While compound YA4C demonstrated comparable suppression of S. pyogenes strains (MIC = 250 µg/mL), compounds YA3S and YA4B exhibit lesser activity towards the tested strain of bacteria.

Introduction: Type 1 diabetes mellitus (T1DM) is a chronic auto-immune disease in which loss of pancreatic islet β-cells leads to the deficiency of insulin in the body thus resulting in enhanced blood sugar levels. Effective blood glucose monitoring is crucial in T1DM management to prevent complications, particularly hypoglycemia. Method: The study adopted a cross-sectional survey to assess satisfaction and quality of life among T1DM patients using the freestyle libre continuous glucose monitoring (FSL-CGM), and a retrospective cohort study design to evaluate changes in HbA1c over a year. Result: The study involved 98 Saudi subjects, with 46.9% (n = 46) being male. The results indicated a high level of user satisfaction, with more than 85% of the participants responding positively, yielding a total satisfaction score of 30.86. User satisfaction with FSL-CGM was found to be significantly associated with the level of education. The use of FSL-CGM was also found to significantly improve the patients’ quality of life. However, the levels of HbA1c had an impact on both satisfaction and quality of life. Before using the FSL-CGM system, the mean HbA1c was 9.83%, which significantly decreased to 8.63% after using the system (P-value

The 2022 Monkeypox Disease (MPOX) outbreak was declared a pandemic after detecting multiple human-to-human monkeypox cases in ‘non-endemic’ nations. The index case of MPOX has been reported in Nepal. Also, the disease burden in neighboring countries and international travel and tourism could increase the MPOX burden in Nepal. This study recruited 443 study participants between August 25 and September 10, 2022, using the snowball technique and using descriptive statistics to assess the awareness and knowledge of MPOX. Approximately 82% (n=361) of the study participants were young adults aged between 18-29 years and were undergoing or holders of tertiary education degrees (72.2%, n=320). Our findings showed that 76.5% (n=339/443) of the respondents were aware of the 2022 MPOX outbreak and obtained information about the disease from their local radio and television stations (20.6%, n = 70), as well as from other sources such as social media platforms (70.5%, n=239), and other internet sources (61.6%, n=209). The mean knowledge score of the respondents was 3.95±1.26, with a range of 0.5 to 7. Approximately three-quarters (72.3%, n=245) of the study participants were graded to have a good knowledge of the MPOX. Of the listed symptoms, study participants correctly identified high fever (62.2%, n=339), rashes (51.0%, n=173), swollen lymph nodes (34.5%, n=117), and sores around the mouth, vagina, and anus (26.8%, n=91). A higher number of participants were aware that vaccination could confer protection against the disease (70.8%, n=240). However, less than one third of the participants (30%, n=102) were aware that safe sex practices can be a preventive strategy against the disease. Finally, none of the sociodemographic variables were associated with increased knowledge of MPOX among the study participants. The knowledge of MPOX among the study population was above average. We advocate that public enlightenment campaigns in Nepal should address wrong perceptions of MPOX.

A cross-sectional study was conducted to assess antibiotic usage, residues, resistance and drivers of their emergence in fish aquaculture in Northern Nigeria between 2019 and 2020. A structured questionnaire was administered to 151 randomly selected farmers. Fish, column and wastewater samples were analysed with enzyme link immunosorbent assay (ELISA) for residue detection and quantification. We performed descriptive and analytic statistical analyses. All selected farmers participated, 78.1% used antibiotics in ponds. Majority (77.1%) of the farmers did not know what antibiotic misuse entailed and 73.3% mentioned that antibiotic misuse and overuse cannot predispose to residues and resistance. The most frequently used antibiotics were tetracyclines (TCs) (99.2%). Significant risk routes for residue and resistance spread were: contaminated fish and its products ingestion, direct contact with fish and fomites contaminated as well as water and aerosols contaminated in the pond environment. Significant social and cultural that influenced residue and resistance development include antibiotics misuse/overuse (Odds Ratio [OR] = 3.8; 95% confidence interval [CI]: 1.62–8.74) as well as poor education and expertise of the farmers (OR = 2.9; 95% CI: 1.24–6.94). The mean TCs residues level in column and wastewater was 123.6 ± 18.2 μg/kg−1. Poor knowledge and attitudes regarding antibiotic usage were identified. Adequate antibiotic stewardship should be promoted through farmers’ education. Identified social and cultural factors can be mitigated through the ‘One Health’ approach.

ObjectivesWe present an adolescent in whom olfactory neuroblastoma (ONB) was detected on follow-up magnetic resonance imaging (MRI) 2.5 years after SIADH diagnosis. Our case contrasts prior pediatric reports in which ONB and SIADH were diagnosed concurrently.Case presentationA previously healthy 13-year-old girl was found to have SIADH during evaluation for restrictive eating. Work-up ruled out adrenal, thyroid and paraneoplastic causes, diuretic use, and vasopressin receptor and aquaporin channel mutations. Brain MRI was normal except for paranasal sinus (PNS) inflammatory changes to the left fronto-maxillary sinuses and frontoethmoidal recess. The sodium levels normalized with fluid restriction (800-900 ml/m2/day). Multiple repeated attempts to liberalize fluid intake resulted in recurrent hyponatremia. Follow-up brain MRIs 4 and 11 months after the initial presentation showed persistent PNS inflammatory changes. A subsequent brain MRI 31 months after initial presentation demonstrated a lesion in the left frontoethmoidal recess extending into the left nasal cavity and biopsy showed low grade ONB. The patient underwent surgery with normalization of serum sodium on liberalized fluid intake. Seven days after surgery, she had recurrence of SIADH, and brain MRI showed remnant of the ONB at the fovea ethmoidalis. She completed adjuvant radiotherapy though her SIADH persisted.ConclusionsOur case highlights the importance of considering ONB in the evaluation of children with SIADH. Idiopathic SIADH is rare in children and if no cause is identified, computed tomography of sinuses and nasal endoscopy should be considered earlier in the work-up of these patients, particularly in the absence of sinus symptoms.

Introduction: Region-specific data on individual factors associated with uptake of breast and cervical cancer screening or early testing in diverse Indian populations are limited. Aim: To assess the prevalence and individual determinants of uptake of breast and/or cervical cancer screening or testing among women aged 30–69 years in regionally representative populations of two large Indian cities: New Delhi and Chennai. Methods: We conducted an analysis of the cross-sectional data (2016–2017) nested within the Centre for Cardiometabolic Risk Reduction in South Asia cohort, established in 2010–2011 with 12,271 participants (5365 in New Delhi; 6906 in Chennai). Among 3310 women participants, we evaluated the associations of demographic, socioeconomic, lifestyle, medical, psychosocial, and reproductive factors with breast and/or cervical cancer screening or testing using multivariable logistic regression models with results expressed as adjusted odds ratios (OR) and 95% confidence intervals (CI). Results: At any point prior to 2016–2017, 193 women self-reported having undergone evaluations for breast and/or cervical cancer. The reasons for evaluation were ‘general examination’ or ‘physician’s advice’ (i.e., screening) or ‘being symptomatic’ (i.e., early testing). The overall prevalence was 5.8% for screening or testing and 2.5% for screening alone. Formal education (OR:1.88; 95% CI:1.12–3.15), high monthly household income (OR:2.27; 95% CI:1.59–3.25) and less ‘fear-of-judgement’ (OR:1.65; 95% CI:1.05–2.58) were positively associated with screening or testing uptake. When screening uptake was analysed separately, the results were generally similar. Conclusion: Our findings may have important implications for interventions at community-level (e.g., reducing ‘fear-of-judgement’, increasing awareness to screening programs and early symptoms) and health-system level (e.g., opportunistic screening).

Background: This study aims to enhance the biocompatibility of Nickel–Titanium (NiTi) alloy by developing a new coating using titanium dioxide (TiO2) and titanium pentoxide (Ta2O5) through direct current (DC) reactive sputtering technology. Materials and methods: Two distinct coating materials, namely, TiO2 and Ta2O5, were used to fabricate NiTi orthodontic archwires with improved surface properties. TiO2 nanoparticles, with thickness ranging from 21.90 nm to 31.93 nm, were deposited onto NiTi alloy substrates through DC reactive sputtering deposition under different power conditions. Results: X-ray diffraction and field emission scanning electron microscopy validated the uniformity and morphology of the coatings. Immersion tests in simulated body fluid (SBF) revealed significant hydroxyapatite layer growth on TiO2-coated NiTi, especially at a sputtering power of 240 W. Reduced nickel ion release was observed on TiO2 nanoparticles with a thickness of 21.90 nm at 50 W sputtering power compared with 31.93 nm-thick nanoparticles at 240 W. Ta2O5 thin films were deposited on NiTi substrates through DC magnetron reactive sputtering at ~100 °C with a deposition power of 50 W. Structural and morphological analyses through optical microscopy and X-ray diffraction, atomic force microscopy, and scanning electron microscopy revealed the homogeneity and low roughness of the coatings. Biocompatibility assessments in artificial saliva and SBF solutions established that Ta2O5-coated NiTi alloys exhibited superior electrochemical behavior, enhanced corrosion resistance, and diminished Ni ion release compared with uncoated specimens. Conclusion: TiO2 and Ta2O5 coatings not only improved the biocompatibility of NiTi orthodontic archwires but also presented a promising path for advanced biomedical applications. These coatings have potential in improving the cellular behavior and performance of NiTi-based orthodontic devices.

Abstract Importance A quarter of all 30-day readmissions involve fragmented care, where patients return to a different hospital than their original admission; these readmissions are associated with increased in-hospital mortality and longer lengths-of-stay (LOS). The stress on healthcare systems at the beginning of the COVID-19 pandemic could worsen care fragmentation and related outcomes. Objective To compare fragmented readmissions in 2020 versus 2018–2019 and assess whether mortality and LOS in fragmented readmissions differed in the two time periods. Design Observational study Setting National Readmissions Database (NRD), 2018–2020 Participants All adults (> 18 y/o) with 30-day readmissions Main outcomes and measures We examined the percentage of fragmented readmissions over 2018–2020. Using unadjusted and adjusted logistic and linear regressions, we estimated the associations between fragmented readmissions and in-hospital mortality and LOS. Results 24.0–25.7% of readmissions in 2018–2020 and 27.3%-31.0% of readmissions for COVID-19 were fragmented. 2018–2019 fragmented readmissions were associated with 18–20% higher odds of in-hospital mortality compared to nonfragmented readmissions. Fragmented readmissions for COVID-19 were associated with an 18% increase in in-hospital mortality (AOR 1.18, 95% CI 1.12, 1.24). The LOS of fragmented readmissions in March-November 2018–2019 were on average 0.81 days longer, while fragmented readmissions between March-November of 2020 were associated with a 0.88–1.03 day longer LOS. Conclusions and relevance A key limitation is that the NRD does not contain information on several patient/hospital-level factors that may be associated with the outcomes of interest. We observed increased fragmentation during COVID-19, but its impact on in-hospital mortality and LOS remained consistent with previous years.

Abstract Background Evaluation of students’ learning strategies can enhance academic support. Few studies have investigated differences in learning strategies between male and female students as well as their impact on United States Medical Licensing Examination® (USMLE) Step 1 and preclinical performance. Methods The Learning and Study Strategies Inventory (LASSI) was administered to the classes of 2019–2024 (female (n = 350) and male (n = 262)). Students’ performance on preclinical first-year (M1) courses, preclinical second-year (M2) courses, and USMLE Step 1 was recorded. An independent t-test evaluated differences between females and males on each LASSI scale. A Pearson product moment correlation determined which LASSI scales correlated with preclinical performance and USMLE Step 1 examinations. Results Of the 10 LASSI scales, Anxiety, Attention, Information Processing, Selecting Main Idea, Test Strategies and Using Academic Resources showed significant differences between genders. Females reported higher levels of Anxiety (p

Abstract Background Diabetes is a major global public health burden. Effective diabetes management is highly dependent on the availability of affordable and quality-assured essential medicines (EMs) which is a challenge especially in low-and-middle-income countries such as Ethiopia. This study aimed to assess the accessibility of EMs used for diabetes care in central Ethiopia’s public and private medicine outlets with respect to availability and affordability parameters. Methods A cross-sectional study was conducted in 60 selected public and private medicine outlets in central Ethiopia from January to February 2022 using the World Health Organization/Health Action International (WHO/HAI) standard tool to assess access to EMs. We included EMs that lower glucose, blood pressure, and cholesterol as these are all critical for diabetes care. Availability was determined as the percentage of surveyed outlets per sector in which the selected lowest-priced generic (LPG) and originator brand (OB) products were found. The number of days’ wages required by the lowest paid government worker (LPGW) to purchase a one month’s supply of medicines was used to measure affordability while median price was determined to assess patient price and price markup difference between public procurement and retail prices. Results Across all facilities, availability of LPG and OB medicines were 34.6% and 2.5% respectively. Only two glucose-lowering (glibenclamide 5 mg and metformin 500 mg) and two blood pressure-lowering medications (nifedipine 20 mg and hydrochlorothiazide 25 mg) surpassed the WHO’s target of 80% availability. The median price based on the least measurable unit of LPG diabetes EMs was 1.6 ETB (0.033 USD) in public and 4.65 ETB (0.095 USD) in private outlets. The cost of one month’s supply of diabetes EMs was equivalent to 0.3 to 3.1 days wages in public and 1.0 to 11.0 days wages in private outlets, respectively, for a typical LPGW. Thus, 58.8% and 84.6% of LPG diabetes EMs included in the price analysis were unaffordable in private and public outlets, respectively. Conclusions There are big gaps in availability and affordability of EMs used for diabetes in central Ethiopia. Policy makers should work to improve access to diabetes EMs. It is recommended to increase government attention to availing affordable EMs for diabetes care including at the primary healthcare levels which are more accessible to the majority of the population. Similar studies are also recommended to be conducted in different parts of Ethiopia.

Abstract Background Culicoides, also known as biting midges, carry pathogens which include Mansonella perstans. Mansonella perstans is a nematode parasite implicated in a number of disease outcomes. Even though a high prevalence of about 75% M. perstans infection has been recorded in some communities in the middle belt of Ghana, and a wide diversity of Culicoides species has been identified, the exact Culicoides species transmitting M. perstans in Ghana has not yet been deciphered. This study therefore aimed at assessing the species diversity of Culicoides and their role in the transmission of M. perstans in the middle belt of Ghana. Methods Culicoides species were sampled from 11 communities in the Asante-Akim North and Sene West districts in the middle belt of Ghana. Centre for Disease Control (CDC) UV light traps, as well as human bait (i.e. human landing catch and engorged catch) methods were used to assess the species abundance and diversity of Culicoides in the study communities in the wet and dry season. A colorimetric Loop-Mediated Isothermal Amplification (LAMP) assay was performed to assess the vector competence of the various Culicoides species. Results A total of 4810 Culicoides from 6 species were sampled. These included Culicoides inornatipennis, C. milnei, C. schultzei, C. grahamii, C. neavei, and C. imicola. Culicoides imicola was the most abundant species (56%) followed by C. grahamii (16%). Light traps sampled the most diverse species (6 species). Human landing catch and engorged catch methods identified three anthropophilic species, C. grahamii, C. milnei, and C. inornatipennis, with C. grahamii being the most anthropophilic with a peak biting time between the hours of 5 p.m. to 6 p.m. Generally, there was relatively higher species abundance in the wet than dry season. LAMP assay identified C. grahamii as the potential vector for M. perstans transmission in the middle belt of Ghana. Conclusions For the first time, we have demonstrated that C. grahamii is the potential competent vector for M. perstans transmission in the middle belt of Ghana. It is more abundant in the rainy season and has a peak biting time between the hours of 5 and 6 p.m. Graphical Abstract

Standard lifestyle interventions prove ineffective in preventing type 2 diabetes among individuals with isolated impaired fasting glucose, a highly prevalent prediabetes phenotype globally. Here, we propose low-calorie diets as a promising strategy for diabetes prevention in this high-risk population.

Introduction People with diabetes are at risk of developing chronic kidney disease. However, limited data are available to quantify their risk of kidney function decline in South Asia. This study evaluates the rate and predictors of kidney function decline among people with type 2 diabetes in South Asia.Research design and methods We analyzed data from the Centre for Cardiometabolic Risk Reduction in South Asia (CARRS) Trial to quantify the rate of decline in estimated glomerular filtration rate (eGFR) in people with type 2 diabetes (n=1146) over 2.5 years of follow-up. The CARRS Trial evaluated a multicomponent intervention of decision-supported electronic health records and non-physician care coordinator to improve diabetes management at 10 diabetes clinics in India and Pakistan. We used linear mixed models to estimate eGFR slope among all participants and tested the association of eGFR slope with demographic, disease-related, and self-care parameters, accounting for randomization and site.Results The mean age of participants was 54.2 years, with a median duration of diabetes of 7.0 years (IQR: 3.0 - 12.0) and median CKD-EPI (Chronic Kidney Disease Epidemiology Collaboration) eGFR of 83.6 (IQR: 67.7 to 97.9) mL/min/1.73 m2. The overall mean eGFR slope was −1.33/mL/min/1.73 m2/year. There were no differences in the eGFR slope by treatment assignment to intervention versus usual care. In the adjusted regression model, pre-existing diabetic retinopathy (slope difference: −2.11; 95% CI: −3.45 to –0.77), previous cardiovascular disease (−1.93; 95% CI: −3.45 to –0.40), and statins use (−0.87; 95% CI: −1.65 to –0.10) were associated with faster eGFR decline.Conclusions People with diabetes receiving care at urban diabetes clinics in South Asia experienced annual eGFR decline at two times higher rate than that reported from other contemporary international diabetes cohorts. Risk factors for faster decline were similar to those previously established, and thus care delivery models must put an additional emphasis on kidney protective therapies among subgroups with microvascular and macrovascular diabetes complications.Trial registration number NCT01212328.

Irrigation practices and sources can have significant impacts on water resources and the hydrologic fluxes that control these resources. To better manage water resources and future water supply, the influence of irrigation practices and management on these hydrologic fluxes should be quantified in time and space at varying scales, under potential irrigation management practices. To fulfill this objective, a surface-subsurface modeling approach was applied to simulate watershed-scale hydrologic processes in the Cache la Poudre River Basin, Colorado, USA (4824 km2), in which both surface water irrigation and groundwater irrigation are prevalent. The model chosen for this study is the watershed model SWAT+, using the spatially distributed, physically based groundwater module gwflow, in which unconfined groundwater storage, flows, and interaction with land surface features are simulated using a collection of grid cells that represent control volumes of the aquifer. Major groundwater inflows and outflows include pumping, recharge, groundwater-channel exchange, groundwater-lake exchange, and tile drainage outflow. To investigate the impact of irrigation practices, detailed surface and groundwater irrigation routines and canal-aquifer interactions were added to the SWAT+ source code, requiring information of irrigation sources and irrigation canal locations throughout the river basin. Model calibration and testing was performed using monthly stream discharge and groundwater head. The calibrated model is used to quantify the impact of surface water and groundwater irrigation scenarios on water availability and hydrologic fluxes within the river basin. A total of 22 scenarios were conducted and grouped into five main groups: irrigation source, irrigation amount, irrigation type, canal bed thickness, and partial or full sealing of earthen irrigation canals. Using groundwater as the only irrigation source decreases groundwater discharge to streams (by 14 %) due to lowering groundwater levels; converting flood irrigation to sprinkler irrigation throughout the basin decreases surface runoff by 22 %; and sealing earthen canals leads to a lowering of groundwater levels, which decreases groundwater discharge to streams by 9 %, leading to an overall decrease in streamflow in the Cache la Poudre River and changes to temporal patterns in streamflow. Overall, irrigation amount and type and canal sealing have a small impact on total groundwater storage, compared to changes in the percent of fields irrigated by groundwater pumping. Results are helpful for informed decision-making in agriculture water management and can lead to sustainable, efficient, and equitable use of water resources, helping to address the challenges posed by water scarcity and environmental conservation.

A novel thermal integration approach is introduced for a biomass-driven gas turbine power plant that generates electricity, coolant, and liquefied hydrogen. The designed scheme encompassed an organic flash cycle, a bi-evaporator ejector refrigeration unit, a high-temperature water electrolyzer for hydrogen production, a multi-effect desalination cycle for supplying water for electrolysis process, and a Claude cycle for hydrogen gas liquefaction. The designed system's importance comes back to using biomass feedstock as the input fuel and utilizing the hydrogen liquefaction method. In addition to the possibility of deploying the system in remote areas, it provides the opportunity for hydrogen storage in a smaller volume for more accessible storage and transportation. On the other hand, using a comparative method for selecting an environmentally friendly fluid for the heat recovery subsystem is another crucial aspect of the present study from the environmental aspect. It is found that R161 is the appropriate choice among the seven studied working fluids. Subsequently, a comprehensive evaluation of the entire system's thermodynamic and environmental aspects is performed using an intelligent process. By considering energy and exergy efficiencies along with CO2 emissions as the objective functions, a thorough sensitivity analysis and a triple-objective optimization are carried out. Hence, artificial neural networks for the objectives are developed and integrated into the NSGA-II optimization method. Employing LINMAP decision-making, the values of objective are attained, exhibiting 39.6 % for energy efficiency, 36.1 % for exergy efficiency, and 631.7 kg/MWh for CO2 emissions. Considering the optimum solution, the proposed system is capable of producing electricity, cooling, and liquefied hydrogen with capacities of 4526 kW, 1875 kW, and 21.22 m3/day, respectively. Additionally, the scenario yields an exergoenvironmental index of 0.579 and an exergetic stability index of 0.61. and a liquefied hydrogen generation rate of 21.22 m3/day.

IntroductionAn effective referral system is necessary to ensure quality and an optimum continuum of care. In the Kingdom of Saudi Arabia, an e-referral system known as the Saudi Medical Appointments and Referrals Centre (SMARC), has been fully functioning since 2019. This study aims to explore the rate of medical e-referral request acceptance in the KSA, and to study the factors associated with acceptance.MethodsThis period cross-sectional study utilised secondary collected data from the SMARC e-referral system. The data spans both 2020 and 2021 and covers the entirety of the KSA. Bivariate analyses and binary logistic regression analyses were performed to compute adjusted Odds Ratios (aORs) and 95% confidence intervals.ResultsOf the total 632,763 referral requests across the 2 years, 469,073 requests (74.13%) were accepted. Absence of available machinery was a significant predictor for referral acceptance compared to other reasons. Acceptance was highest for children under 14 with 28,956 (75.48%) and 63,979 (75.48%) accepted referrals, respectively. Patients requiring critical care from all age groups also had the highest acceptance including 6,237 referrals for paediatric intensive care unit (83.54%) and 34,126 referrals for intensive care unit (79.65%). All lifesaving referrals, 42,087 referrals, were accepted (100.00%). Psychiatric patients were observed to have the highest proportion for accepted referrals with 8,170 requests (82.50%) followed by organ transplantations with 1,005 requests (80.92%). Sex was seen to be a significant predictor for referrals, where the odds of acceptances for females increased by 2% compared to their male counterparts (95% CI = 1.01–1.04). Also, proportion of acceptance was highest for the Eastern business unit compared to all other units. External referrals were 32% less likely to be accepted than internal referrals (95% CI = 0.67–0.69).ConclusionThe current findings indicate that the e-referral system is mostly able to cater to the health services of the most vulnerable of patients. However, there remains areas for health policy improvement, especially in terms of resource allocation.

The study of natural convection and heat transfer in a trapezoidal cavity finds a wide range of technological applications including thermal energy storage systems, building ventilation/insulation, waste heat recovery, electronic device cooling, controlling PV panel temperature, energy conservation, exchangers, nuclear reactors, furnaces, glass production, food processing, and drying technologies. The purpose of the current study is to explore the entropy and natural convection of non-Newtonian nano-encapsulated phase change material (NEPCM) suspension in a saturated porous medium enshrouded in a trapezoid-shaped domain with three heated blocks fitted with the bottom surface. The novelty of the present work is the introduction of power-law (Ostwald-de Waele) model subject to NEPCM suspension in trapezoidal enclosure emplacing three heated fins at its bottom surface embedded in Brinkman-Forchheimer extended Darcy medium with variant porosity. The finite element method is implemented to solve the governing equations numerically. The important findings of the present study include streamlines, isotherms, velocities, and apparent viscosity enhance while entropy generation whittles down with rise in Darcy number. Entropy generation ameliorates by 519.16 % for low to high porosity of Brinkman-Forchheimer extended Darcy medium. The maximum apparent viscosity augments by 1441.24 % when power law index ameliorates.

In this study, Co-based catalysts supported over Ti-Al oxide and promoted with La, Ce, Mg, and K metals were assessed for CO2 reforming of methane reaction to produce syngas. Titania-alumina mixed oxide supports were prepared using the template-assisted-solvothermal method, and then Co and promotors were co-impregnated over the as-prepared support. Different characterizations of catalysts showed that variation in promotor metal impacts these catalysts' physical and chemical properties. The Ti-Al oxide support possessed the perfect hexagonal morphology. Potassium-promoted catalysts possessed the highest number of basic sites, whereas the La-promoted catalyst possessed the highest number of acidic sites. La promotion improved the Co dispersion, while Mg promotion enhanced the metal support integration. La-promoted catalysts are deactivated because of active metal oxidation and the generation of hard carbon. The carbon was deposited in all catalysts; however, the activity of the Mg-promoted catalyst was unaffected. The intermediate surface basicity and strong metal support interaction improved the Mg-promoted catalyst's stability. The La and Mg-promoted catalysts possessed lower apparent activation energies.

BackgroundDiabetes control is poor globally and leads to burdensome microvascular and macrovascular complications. We aimed to assess post hoc between-group differences in sustained risk factor control and macrovascular and microvascular endpoints at 6.5 years in the Center for cArdiovascular Risk Reduction in South Asia (CARRS) randomized trial.Methods and findingsThis parallel group individual randomized clinical trial was performed at 10 outpatient diabetes clinics in India and Pakistan from January 2011 through September 2019. A total of 1,146 patients with poorly controlled type 2 diabetes (HbA1c ≥8% and systolic BP ≥140 mm Hg and/or LDL-cholesterol ≥130 mg/dL) were randomized to a multicomponent quality improvement (QI) strategy (trained nonphysician care coordinator to facilitate care for patients and clinical decision support system for physicians) or usual care. At 2.5 years, compared to usual care, those receiving the QI strategy were significantly more likely to achieve multiple risk factor control. Six clinics continued, while 4 clinics discontinued implementing the QI strategy for an additional 4-year follow-up (overall median 6.5 years follow-up). In this post hoc analysis, using intention-to-treat, we examined between-group differences in multiple risk factor control (HbA1c ConclusionsIn urban South Asian clinics, a multicomponent QI strategy led to sustained multiple risk factor control and between-group differences in microvascular, but not macrovascular, endpoints. Between-group reductions in vascular outcomes at 6.5 years were observed only at sites that continued the QI intervention, suggesting that practice change needs to be maintained for better population health of people with diabetes.Trial registrationClinicalTrials.gov NCT01212328.

IntroductionReferrals are an integral part of any healthcare system. In the Kingdom of Saudi Arabia (KSA) an electronic referral (e-referral) system known as the Saudi Medical Appointments and Referrals Centre (SMARC) began formally functioning in 2019. This study aims to showcase the Saudi experience of the e-referral system and explore the epidemiology of referrals nationally.MethodsThis retrospective descriptive study utilised secondary collected data between 2020 and 2021 from the SMARC system. Cross tabulations with significance testing and colour-coded maps were used to highlight the patterns across all regions.ResultsThe study analysed over 600,000 referral requests. The mean age of patients was 40.70 ± 24.66 years. Males had a higher number of referrals (55.43%). Referrals in 2021 were higher than those in 2020 (56.21%). Both the Autumn and Winter seasons had the highest number of referrals (27.09% and 27.43%, respectively). The Surgical specialty followed by Medicine had the highest referrals (26.07% and 22.27%, respectively). Life-saving referrals in the Central region were more than double those in other regions (14.56%). Emergency referrals were also highest in the Southern regions (44.06%). The Central and Eastern regions had higher referrals due to unavailable sub-speciality (68.86% and 67.93%, respectively). The Southern regions had higher referrals due to both unavailable machine and unavailable beds (18.44% and 6.24%, respectively).ConclusionThis study shows a unique system in which referrals are between secondary, tertiary, and specialised care. It also highlights areas of improvement for equitable resource allocation and specialised care in slightly problematic areas as well as the use of population density in future planning.

Background Most adults with sickle cell disease will experience a silent cerebral infarction (SCI) or overt stroke. Identifying patient subgroups with increased stroke incidence is important for future clinical trials focused on stroke prevention. Our 3‐center prospective cohort study tested the primary hypothesis that adults with sickle cell disease and SCIs have a greater incidence of new stroke or SCI compared with those without SCI. A secondary aim focused on identifying additional risk factors for progressive infarcts, particularly traditional risk factors for stroke in adults. Methods and Results This observational study included adults with sickle cell disease and no history of stroke. Magnetic resonance imaging scans of the brain completed at baseline and >1 year later were reviewed by 3 radiologists for baseline SCIs and new or progressive infarcts on follow‐up magnetic resonance imaging. Stroke risk factors were abstracted from the medical chart. Time‐to‐event analysis was utilized for progressive infarcts. Median age was 24.1 years; 45.3% of 95 participants had SCIs on baseline magnetic resonance imaging. Progressive infarcts were present in 17 participants (17.9%), and the median follow‐up was 2.1 years. Incidence of new infarcts was 11.95 per 100 patient‐years (6.17–20.88) versus 3.74 per 100 patient‐years (1.21–8.73) in those with versus without prior SCI. Multivariable Cox regression showed that baseline SCI predicts progressive infarcts (hazard ratio, 3.46 [95% CI, 1.05–11.39]; P=0.041); baseline hypertension was also associated with progressive infarcts (hazard ratio, 3.23 [95% CI, 1.16–9.51]; P=0.025). Conclusions Selecting individuals with SCIs and hypertension for stroke prevention trials in sickle cell disease may enrich the study population with those at highest risk for infarct recurrence.

The present work deals with thermal aspect and entropy of ternary hybrid nanofluid (Graphene, Al2O3, and MWCNT as nanoparticles and water as base fluid) inside an inclined domain considering heat generation/absorption. The domain possesses triangle-shaped corrugated walls with variable height and a semi-circular heater located on its bottom wall. Finite element method (FEM) is employed to acquire a well-defined solution of the non-dimensional governing equations along with the boundary conditions. The influence of the pertinent parameters along with their ranges (0.2≤b≤0.3), (105≤Ra≤106), (0o≤η≤90o), (−1≤Hs≤1) has been studied. Some striking outcomes of the present investigation are that streamlines and entropy generation (EnT) peter out while local Nusselt number (Nuloc) and average Bejan number (Beave) ameliorate with rise in dimensionless height of the corrugated wall (b). The absolute maximum values of vertical and horizontal velocities of ternary hybrid nanofluid enhance by 96.47 % and 29.5 %, respectively, when inclination angle (η) increases from 45o to 90o. It is visualized that Nusselt number is maximum subject to heat sink while it attains a minimum value in response to heat source. Because of triangle shaped corrugated walls and ternary hybrid nanofluid, the present problem contributes superior cooling in thermal systems featured with such complex geometry in industries.

The security of stego-images is a crucial foundation for analyzing steganography algorithms. Recently, steganography has made significant strides in ongoing conflicts with steganalysis. In order to increase the security of stego-images, steganography must be able to evade detection using steganalysis methods. Secret information is typically hidden using traditional embedding-based steganography, which inevitably leaves traces of the modifications that can be found using more sophisticated machine-learning-based steganalysis techniques. Steganography without embedding (SWE) outperforms machine-learning-based steganalysis techniques because it does not require alteration of the data of the cover image. A novel image SWE method based on deep convolutional generative adversarial networks (GANs) is proposed to synthesize stego-images led by embedded text. The variational autoencoder (VAE) in the GAN model is utilized to synthesize the stego-image, based on interpolating the secret text in a continuous variable representation of the cover image. To further improve the framework’s performance and shorten processing times, the whale optimization algorithm (WOA) is used to identify the optimal VAE structure. When creating a stego-image, no embedding or modification procedures are required, and after training, a different convolutional neural network (CNN) known as the extractor can correctly extract the data from the image. The experimental results revealed that this approach has the advantages of evading detection using innovative deep learning (DL) steganalysis architecture and accurate information extraction.

Background: Atrial fibrillation (AF) stands as the most prevalent cardiac arrhythmia, with associated risks of stroke and systemic thromboembolism. While vitamin K antagonists, specifically warfarin, have historically been the mainstay for stroke prevention in AF, they come with inherent limitations. Aim: This review seeks to offer a comprehensive analysis of the efficacy, safety, and clinical advantages of novel oral anticoagulants (NOACs) compared to traditional warfarin in AF management. Method: A meticulous examination of pivotal clinical trials, meta-analyses, and recent research publications was conducted. Four NOACs, namely Dabigatran, Rivaroxaban, Apixaban, and Edoxaban, were compared against warfarin, focusing on parameters like stroke prevention, risk of bleeding, patient compliance, and drug interactions. Results: NOACs, as a collective group, demonstrated a comparable or superior efficacy profile in stroke prevention compared to warfarin. They also showcased a more predictable therapeutic range, fewer drug and food interactions, and, in certain cases, a better safety profile. The challenges associated with frequent monitoring and dose adjustments inherent to warfarin therapy were notably absent with NOACs. Conclusion: NOACs present a robust alternative to warfarin for AF management, demonstrating comparable efficacy and, in certain aspects, heightened safety and practicality. However, the choice of anticoagulant should remain individualized, taking into account patient-specific factors and clinician expertise.

Abstract Background Our research question is could follicular fluid (FF) leptin solely or contemporaneously with other clinical, biochemical, and sonographic adiposity measures predict the probability of having a live birth during ICSI cycles? This is a prospective cohort study that enrolled infertile women without polycystic ovary syndrome scheduled for ICSI. At baseline, women had an assessment of obesity using different metrics: clinical, serum biochemical, and sonographic. Clinical measures encompassed waist circumference and body mass index. Biochemical evaluation comprised an assessment of the homeostasis model for insulin resistance, visceral adiposity index, and lipid accumulation product. Preperitoneal and subcutaneous abdominal fat were measured using ultrasound and body fat index was calculated. On the day of oocyte retrieval, pooled FF was sampled to assess FF leptin. Our primary outcome was live birth after one fresh embryo transfer cycle. Results Out of 91 women analyzed in this study, 28 have a live birth (30.8%). No difference in FF leptin concentration was found between women with and without live birth (mean ± SD; 20336 ± 8006 vs 18493 ± 6655 pg/ml; P = 0.2). None of the assessed adiposity markers was a predictor for live birth. Substantially, follicular fluid leptin was positively correlated with insulin resistance in women with and without live birth (r = 0.21, P = 0.04). In logistic regression analysis, the outcome of the prior cycle, the ability to have cryopreserved embryos, and the oocyte maturation index were the predictors for live birth in our study. Conclusions The present work could not find evidence that follicular fluid leptin, preperitoneal fat, and other evaluated adiposity measures could impact live births after ICSI cycles.

Coronary artery calcium scoring (CACS), a non-invasive measure of coronary atherosclerosis, has significantly enhanced cardiovascular (CV) risk assessment and stratification in asymptomatic individuals. More recently, a higher score for CAC has been associated with an increased risk of non-CV diseases and all-cause mortality. This review consolidated evidence supporting the role of CAC in assessing non-CV diseases, emphasizing its potential in early diagnosis and prognosis. We observed a strong association between CACS and non-CV diseases, viz., chronic obstructive pulmonary disease, pulmonary embolism, pneumonia, diabetes, chronic kidney disease, osteoporosis, metabolic dysfunction-associated steatotic liver disease, nephrolithiasis, stroke, dementia, malignancies, and several autoimmune diseases. Also, CAC may aid in evaluating the risk of CV conditions developing secondary to the non-CV diseases mentioned earlier. Further evidence from prospective studies, intervention trials, and population-based behavioral studies is needed to establish CAC cutoff values and explore preventative care applications, facilitating their broader integration into healthcare practices.

By using piezoelectric materials, it is possible to convert clean and renewable energy sources into electrical energy. In this paper, the effect on the piezoelectro-elastic response of piezoelectric-fiber-reinforced nanocomposites by adding silica nanoparticles into the polyimide matrix is investigated by a micromechanical method. First, the Ji and Mori–Tanaka models are used to calculate the properties of the nanoscale silica-filled polymer. The nanoparticle agglomeration and silica–polymer interphase are considered in the micromechanical modeling. Then, considering the filled polymer as the matrix and the piezoelectric fiber as the reinforcement, the Mori–Tanaka model is used to estimate the elastic and piezoelectric constants of the piezoelectric fibrous nanocomposites. It was found that adding silica nanoparticles into the polymer improves the elastic and piezoelectric properties of the piezoelectric fibrous nanocomposites. When the fiber volume fraction is 60%, the nanocomposite with the 3% silica-filled polyimide exhibits 39%, 31.8%, and 37% improvements in the transverse Young’s modulus ET, transverse shear modulus GTL, and piezoelectric coefficient e31 in comparison with the composite without nanoparticles. Furthermore, the piezoelectro-elastic properties such as ET, GTL, and e31 can be improved as the nanoparticle diameter decreases. However, the elastic and piezoelectric constants of the piezoelectric fibrous nanocomposites decrease once the nanoparticles are agglomerated in the polymer matrix. A thick interphase with a high stiffness enhances the nanocomposite’s piezoelectro-elastic performance. Also, the influence of volume fractions of the silica nanoparticles and piezoelectric fibers on the nanocomposite properties is studied.

Background/Objectives: Intensive care unit (ICU) e-referrals are an important indicator for exploring potential deficiencies in critical care resources. This study aimed to examine the epidemiology and patterns of ICU e-referrals across all regions of Saudi Arabia during the COVID-19 pandemic using routinely collected data from April 2020 to December 2021. Methods: This descriptive epidemiological study analyzed data from the Saudi Medical Appointments and Referrals Centre (SMARC). This study reveals novel regional ICU e-referral patterns for critical cases using national unique digital health data, adding insights beyond the existing literature. Variables included age, sex, referral timing, reason, specialty, and region of origin. Descriptive statistics and mapping of administrative areas were performed based on e-referral request rates per 10,000 population. Results: During the study period, 36,619 patients had ICU e-referral requests. The mean age was 54.28 years, with males constituting 64.81% of requests. Out-of-scope e-referrals comprised 71.44% of requests. Referrals related to medical specialties, such as cardiology and pulmonology, were the most common (62.48%). Referral patterns showed peaks in July–August 2020 and May 2021. The Northern Border and Albaha areas had the highest request rates per population, potentially reflecting a higher proportion of severe cases requiring ICU-level care compared to other regions. Conclusions: The temporal pattern and geographic distribution of ICU e-referrals mirrored previously reported critical COVID-19 cases in Saudi Arabia. Preventive measures and vaccination programs contributed to a significant decline in ICU e-referral requests, suggesting a positive impact on controlling severe COVID-19 cases. Population-adjusted analysis revealed regional disparities, highlighting the importance of considering population size in healthcare resource management and policy.

Knee Osteoarthritis (OA) is one of the most common joint diseases that may cause physical disability associated with a significant personal and socioeconomic burden. X-ray imaging is the cheapest and most common method to detect Knee (OA). Accurate classification of knee OA can help physicians manage treatment efficiently and slow knee OA progression. This study aims to classify knee OA X-ray images according to anatomical types, such as uni or bicompartmental. The study proposes a deep learning model for classifying uni or bicompartmental knee OA based on redefined residual learning with CNN. The proposed model was trained, validated, and tested on a dataset containing 733 knee X-ray images (331 normal Knee images, 205 unicompartmental, and 197 bicompartmental knee images). The results show 61.81 % and 68.33 % for accuracy and specificity, respectively. Then, the performance of the proposed model was compared with different pre-trained CNNs. The proposed model achieved better results than all pre-trained CNNs.

BackgroundIn this study, we investigated the association between motivation, cognitive load, difficulty, and performance in a stroke education outreach program implemented for middle school students.MethodsVarious interactive instructional activities were developed to engage students throughout the program to assess cognitive and intrinsic load arising from learner implementation of various tasks in a stroke education program for middle school kids. Performance was measured using a post-test to assess knowledge gained by the 6th, 7th, and 8th-grade middle school students. A short questionnaire was also administered to collect data on students’ motivation using the ARCS model to asses attention, relevance, confidence, and satisfaction. In addition, we evaluated difficulty level and cognitive load. The relationship between performance and motivation was assessed using Pearson’s correlation.ResultsIn our results, there was no significant difference (p > 0.05) in performance between the 6th, 7th, and 8th-grade students. The difference in performance, cognitive load (mental effort and difficulty), or motivation between the 6th, 7th, and 8 t-grade students was not significant (p > 0.05). The correlation between motivation and performance was significant (r = 0.87, p = 0.001), while the correlation between mental effort and performance was not significant (r = 0.34, p = 0.270). Also, the correlation between difficulty and performance was not significant (r = 0.38, p = 0.361). In the ARCS motivation model, attention, and confidence received the lowest mean scores (3.9), while relevance received the highest score (4.3).ConclusionOur findings reveal the importance of implementing novel activities to enhance students’ motivation to improve performance in the implementation of stroke education outreach programs for middle school students.

Active components in medicinal plants provide unlimited useful and traditional medicines. Antimicrobial activities are found in secondary metabolites in plant extracts such as argan oil. This experimental investigation aims to determine argan oil’s volatile compounds and examine their in vitro antimicrobial properties. In silico simulations, molecular docking, pharmacokinetics, and drug-likeness prediction revealed the processes underlying the in vitro biological possessions. Gas chromatography–mass spectrometry (GC/MS) was used to screen argan oil’s primary components. In silico molecular docking studies were used to investigate the ability of the selected bioactive constituents of argan oil to act effectively against Pseudomonas aeruginosa and Staphylococcus aureus (S. aureus) isolated from infections. The goal was to study their ability to interact with both bacteria’s essential therapeutic target protein. The 21 chemicals in argan oil were identified by GC/MS. Docking results for all compounds with S. aureus and P. aeruginosa protease proteins ranged from −5 to −9.4 kcal/mol and −5.7 to −9.7 kcal/mol, respectively, compared to reference ligands. Our docking result indicates that the 10-octadecenoic acid, methyl ester was the most significant compound with affinity scores of −9.4 and −9.7 kcal/mol for S. aureus and P. aeruginosa proteins, respectively. The minimal bactericidal concentration (MBC) and minimal inhibitory concentration (MIC) of argan oil were 0.7 ± 0.03 and 0.5 ± 0.01 for S. aureus and 0.4 ± 0.01 and 0.3 ± 0.02 for P. aeruginosa, respectively. We confirmed the antimicrobial properties of argan oil that showed significant growth inhibition for S. aureus and P. aeruginosa.

Biosurfactants are surface-active molecules with unique qualities and various uses. Many microorganisms produce secondary metabolites with surface-active characteristics that serve various antiviral functions. The HIV and Zika viruses were chosen for this study because they can spread from mother to child and result in potentially fatal infections in infants. Halophilic bacteria from the Red Sea solar saltern in Egypt were screened using drop collapse, emulsification activity, and oil displacement assays to produce biosurfactants and emulsifiers. Halobacterium jilantaiense strain JBS1 was the most effective strain of the Halobacteriaceae family. It had the best oil displacement test and emulsification activity against kerosene and crude oil, respectively. Among the ten isolates, it produced the most promising biosurfactant, also recognized by the GC-MASS library. This study evaluated biosurfactants from halophilic bacteria as potential antiviral drugs. Some of the computer methods we use are molecular docking, ADMET, and molecular dynamics. We use model organisms like the HIV reverse transcriptase (PDB: 5VZ6) and the Zika virus RNA-dependent RNA polymerase (ZV-RdRP). Molecular docking and molecular dynamics make the best complexes with 5VZ6 HIV-RT and flavone (C25) and 5wz3 ZV-RdRP and ethyl cholate (C8). Testing for ADMET toxicity on the complex revealed that it is the safest medicine conceivable. The 5VZ6-C25 and 5wz3-C8 complexes also followed the Lipinski rule. They made five hydrogen bond donors and ten hydrogen bond acceptors with 500 Da MW and a 5:1 octanol/water partition coefficient. Finally, extreme settings require particular adaptations for stability, and extremophile biosurfactants may be more stable.