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Background Preprints are scientific manuscripts that are made available on open-access servers but are not yet peer-reviewed.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.

Background Physical activity plays a crucial role in the health and well-being of older adults, positively influencing various aspects of their quality of life. This study aims to explore the relationship between physical activity and body segments, as well as the risk indices of non-communicable chronic diseases in healthy elderly individuals. Methods The analyzed variables include weekly physical activity, the Postural Correction Index (PCI), measured using the system developed by Portland State University (PSU), and predictors of non-communicable chronic diseases assessed through body mass index (BMI) and waist-to-hip ratio. Results The results reveal a moderate positive relationship between physical activity and the PCI ( r=0.45; p≤0.05), with significant correlations in specific components of the PCI, such as thoracic depression ( r=0.51; pr=0.51; pr=0.53; p Conclusions It is concluded that physical activity has a significant positive impact on the posture of older adults, particularly in the trunk, contributing 40% to the improvement of PCI components. The PCI values obtained, exceeding 84.67 in men and 82.67 in women according to the PSU evaluation, underscore the effectiveness of physical activity in postural correction and the prevention of issues associated with chronic diseases.

Background We analysed the prevalence of depression under among pregnant women both in the immigrant and native populations in a Health Region of Spain, and evaluated the maternal factors associated with it. Methods We performed a retrospective observational cohort study in pregnant women in the Health Region of Lleida between 2012 and 2018. We analysed the following variables: age, body mass index (BMI), diabetes mellitus, hypertension, country of origin, and antidepressant drug prescribed. We performed a multivariate analysis and obtained the linear regression coefficients and their 95% confidence interval (CI). Results In a sample of 17177 pregnant women, 2.5% had a diagnosis of depression. The patients with depression had an average age of 32 years (SD 5.56) compared to the rest of the women who had an average age of 30 (SD 5.85) years of age. Obesity was present in 17.7% of patients with depression compared to 14.3% in the rest. A high percentage of women from Western Europe presented depression (2.9%); followed by women from Latin America (2.6%) and Eastern Europe (2.3%). The values for Africa, (0.8%) and Asia and the Middle East (0.5%) were significantly lower. We did not observe any relationship between depression and hypothyroidism, high blood pressure, and diabetes. Conclusions In our study, we found a prevalence of depression similar to the one found in other publications. As main risk factors, we identified age, weight, and geographical origin.

Background of the study This study intends to contribute to the continuing discussion about green economic growth by objectively investigating the consequences of clean energy generation, cutting-edge green practices, and ethical business on global sustainability. This study also examines how green finance laws effectively handle the financial limitations that companies face when pursuing green innovation. Green finance enables the development and implementation of sustainable business models, investments, trade, economic, environmental, and social projects through the effective utilization of financial resources. Methods This article offers a complete evaluation of the current state and advancements in green finance research using a mixed-methods approach, which includes bibliometric and qualitative analysis. We analysed a big dataset of research papers after entering the keywords into the Scopus database. Results This study found that green bank products include green securities, investments, climate financing, carbon finance, insurance, credit, and infrastructure bonds. Sustainability, sustainable development, investments, environmental economics, sustainable finance, green bonds, and the green economy dominate as a most prevalent theme. China has the strongest bibliometric linkages to other nations, followed by the US and UK. This study also examines whether green finance policies address firm financial restrictions while pursuing green innovation. VOS-viewer generates co-authorship-based keyword occurrence links and network maps. Conclusion Green finance strives to increase funding flows to sustainable development goals while mitigating environmental and social hazards. “Going green,” pricing, forecasting, modelling, picking the most efficient tool, and influencing investor behaviour toward environmentally friendly operations are all challenges. Environmental policies, interest rates, religion, risks, social inclusion, and banking laws all have an impact on bank green financing initiatives. The study’s main contribution is an overview of green finance breakthroughs for sustainability, which may help scholars and practitioners understand the trend and future research directions.

Background Surgeons are highly exposed to Work-related musculoskeletal disorders (WMSDs). Assessing the prevalence of these disorders, both overall and by body area, has become a focus of interest, and numerous articles have been published on the subject. Methods Journal articles and reviews focused on WMSDs published until today and referenced in PubMed/Medline, ScienceDirect, Science.gov, Mendeley and Google Scholar were analysed. VOSviewer version 1.6.20 and Microsoft Excel were used to perform a bibliometric and visualization analyses. Overall distribution of publications by year, sources with country and related indicators, research areas, authors with their affiliations, references and keywords were studied. Results Of the total 2338 items identified, 184 articles (174 articles and 10 reviews) published between 1991 and 2024 were included. Results showed an increase in the number of publications over the years, with a significant increase from 2016 onwards (R 2 = 0.8693). The United States is the leader in the field, with 89 publications (37.6%) and 2,631 citations. Hallbeck MS (USA) is the most prolific author (11 publications and 601 citations). World Neurosurgery and Work were the journals with the highest number of publications (n=7). Applied ergonomics has the highest number of citations. Medicine is the research area most present. Epstein’s work has the most citations worldwide, while Park et al’s work is the most cited of the 184 studies considered. “Ergonomics”, “musculoskeletal disorders”, “surgeons”, and “work-related musculoskeletal disorders” are the keywords most used by authors. Their use increased significantly since 2016, with an average year of publication around 2020. Conclusions The study of WMSDs in surgeons is a young research topic that is evolving significantly. North America, Europe and Asia have been the main contributors, with the USA in the lead. Subjective prevalence analysis based on questionnaires and ergonomic assessment using quantitative tools are the two main lines of research.

Background People need critical thinking skills to make well-informed health choices and avoid waste and unnecessary suffering. However, educational interventions can have adverse effects, which is often overlooked. We created a framework of potential harms of interventions to improve critical thinking about health choices. The objective was to identify potential effects and articulate potential mechanisms. We intended to use the framework to inform the development and evaluation of an intervention in Kenya, Rwanda, and Uganda. Methods We created an initial framework drawing on two earlier frameworks. We surveyed external experts using Likert-scale and open-ended items, including researchers, educators, and others, in a variety of relevant fields. We emailed the survey to an international advisory network, and all other experts recommended by respondents. We analyzed the quantitative data using descriptive statistics. We conducted a thematic analysis of the qualitative data. We revised the framework based on those results. To identify any effects missing from the revised framework, we individually interviewed a convenience sample of one teacher from each of Kenya, Rwanda, and Uganda. Results We received responses from 38 of 70 external experts (54%). The quantitative survey data suggested respondents agreed with the initial framework overall. However, the qualitative data led to substantial revisions. The revised framework consists of categories of adverse outcomes; outcomes within each category; sub-outcomes; individuals, groups, and populations that might experience each adverse outcome; beneficial outcomes corresponding with adverse outcomes; and potential mechanisms of adverse effects. There are six categories: decision-making harms, psychological harms, equity harms, group and social harms, waste, and other harms. In the interviews with teachers, we did not identify any effects missing from the revised framework. Conclusions As far as we know, the framework is the first tool of its kind for education research. It can be improved upon and adapted.

Delirium is a brain dysfunction characterized by attention and cognitive disturbances in a fluctuating manner. The international guidelines recommend daily screening for delirium. The Confusion Assessment Method for the Intensive Care Unit (CAM-ICU) and Intensive Care Delirium Screening Checklist (ICDSC) are the most commonly used methods for assessing delirium. This study aimed to identify barriers and gaps in knowledge and practice. This was a hospital-based Cross-Sectional study. Stratified random sampling was used in this study. 72 ICU doctors were randomly selected. Statistical analyses were performed using IBM SPSS version 23. Descriptive data were presented, and the chi-squared test was used to determine the associations among variables. Statistical significance was set at p < 0.05. More than 70% of the doctors were ≤ 30 years of age and female. A total of 69.4% of the participants had < 1year of experience. In total, 94.4% of the participants worked in medical ICUs. Less than 20% of the doctors used delirium assessment tools, with a statistically significant difference based on experience ( p=0.012). Delirium was not regularly assessed in 13.9% of the patients. Non-pharmacological management was applied by 76.4% of doctors, and communication with patients was the most frequent (75%). Haloperidol was the most commonly used drug (83.3%). A total of 40.3% of doctors did not stop delirium medication on ICU discharge. A regular delirium assessment was performed. However, the use of validated assessment tools is uncommon. Nonpharmacological management of delirium is important and is mostly performed. Our doctors prescribed antipsychotics for the treatment of both forms of delirium, and almost half of them did not stop the medications on ICU discharge. Medication reconciliation and contact with the next in-charge of the patients are important.

Background During pregnancy, the placenta is an extremely important organ as it secretes its own hormones, e.g. insulin-like growth factor 1 (IGF-1), to ensure proper intrauterine fetal growth and development. Ethanol, an addictive and widely used drug, has numerous adverse effects during pregnancy, including fetal growth restriction (FGR). To date, the molecular mechanisms by which ethanol triggers its toxic effects during pregnancy, particularly in the placenta, are not entirely known. For this reason, a murine model of partial IGF-1 deficiency was used to determine ethanol alterations in placental morphology and aspartyl/asparaginyl β-hydroxylase (AAH) expression. Methods Wild type (WT, Igf1 +/+) and heterozygous (HZ, Igf1 +/-) female mice were given 10% ethanol in water during 14 days as an acclimation period and throughout pregnancy. WT and HZ female mice given water were used as controls. At gestational day 19, pregnant dams were sacrificed, placentas were collected and genotyped for subsequent studies. Results IGF-1 deficiency and ethanol consumption during pregnancy altered placental morphology, and decreased placental efficiency and AAH expression in placentas from all genotypes. No differences were found in Igf1, Igf2, Igf1r and Igf2r mRNA expression in placentas from all groups. Conclusions IGF-1 deficiency and ethanol consumption throughout gestation altered placental development, suggesting the crucial role of IGF-1 in the establishment of an adequate intrauterine environment that allows fetal growth. However, more studies are needed to study the precise mechanism to stablish the relation between both insults.

Background Global environmental degradation is increasingly driving poor health outcomes worldwide. Healthcare systems and services are often not environmentally sustainable and compound the problem, while healthcare professionals are also recognised as key leaders in advancing sustainable healthcare. To adopt this leadership position, healthcare professionals’ knowledge, attitudes, and practices regarding environmental sustainability in healthcare must be established. This article reports the development and validation of a new instrument for this purpose that corresponds to the specificities of the Southern African context. Methods Questionnaire development followed a seven-stage process. Information was obtained from a 2021 study titled ‘South African Healthcare Professionals’ Knowledge, Attitudes, and Practices Regarding Environmental Sustainability in Healthcare: A Mixed-Methods Study’ to develop the instrument. Information was also sourced from the literature regarding environmental sustainability and healthcare to generate the first questionnaire with 29 items. The following stages included two rounds of expert input, separated by a pilot study with the target population to receive feedback regarding the instrument’s structure, relevance, and length. Content validity was determined through statistical analysis. Results Feedback was received from nine experts in stage two and 13 pilot-study participants in stage four and incorporated to improve the questionnaire. In stage six, the questionnaire was rated by seven experts. The content validity index of the questionnaire was calculated at two different stages, after which the indices were compared. Following a final edit, the questionnaire has 24 questionnaire items. The closing analysis calculated the scale content validity index average (S-CVI/Ave) of 0,922; this indicates that the final questionnaire has excellent content validity. Conclusion A questionnaire that assesses the knowledge, attitudes and practices of healthcare professionals regarding environmental sustainability in Southern Africa has been developed and validated. This questionnaire can now be used for further studies in Southern Africa.

Background This study examined the effect of thermocycling on the flexural strength properties of four CAD/CAM ceramic materials at different thicknesses. Methods Four CAD/CAM ceramics of different types: advanced lithium disilicate (ALD), zirconia-reinforced lithium silicate (ZLS) lithium disilicate (LD), and leucite reinforced (LE), and at three varying thicknesses 0.5, 1.0 and 1.5 mm were examined. After subjecting all specimens to 5000 thermomechanical cycles, flexural strength was determined using a universal testing apparatus. Scanning electron microscopy (SEM) was employed for analysis. Two factorial ANOVA models assessed the association of different factors (ceramic type and thickness) with flexural strength and elastic modulus. The 95% confidence intervals (CIs) and adjusted means were computed. A p-value < 0.05 was designated significant. Results ZLS exhibited the highest flexural strength at 1.5 mm thickness, while LD showed the highest Young’s modulus of elasticity. The lowest flexural strength was observed in the 0.5 mm thickness group. There were notable variations in flexural strength across all ceramic materials, with the highest adjusted mean strength in the ZLS group, ALD, LD, and LE, respectively. Additionally, significant differences were noted in ceramic thickness, with 1.5 mm thickness showing the highest strength and 0.5 mm thickness the lowest. Conclusions Ceramic material thickness significantly impacts flexural strength, with 1.5 mm thickness deemed suitable for posterior restorations. Ceramic materials with zirconia fillers or matrix demonstrated higher flexural strength than other ceramics.

Background The discoveries of Mulatu’s numbers, better known as Mulatu’s sequence, represent revolutionary contributions to the mathematical world. His best-known work is Mulatu’s sequence, in which each new number is the sum of the two preceding numbers. When various operations and manipulations are performed on the numbers in this sequence, beautiful and incredible patterns begin to emerge. This study aimed to identify novel characterizations of Mulatu’s numbers. Methods This study employed a multi-faceted approach to investigate characterizations of Mulatu’s numbers. Mathematical proof techniques such as principle of mathematical induction, proof by contradiction and direct proof were utilized to substantiate findings. GNU Octave (version 9, (1)) software was applied to verify the existence, classify, and conduct computational investigations of findings prior to formal proofs. Results In this study, we provided several characterizations of Mulatu’s numbers. We also investigated the properties and patterns of these fascinating numbers. Moreover, we have also shown that, similar to Fibonacci’s numbers, Mulatu’s numbers also give the so-called golden ratio, which is most applicable in numerical optimization. Furthermore, we formulated a relation among Mulatu’s numbers, Fibonacci numbers, and Lucas numbers. Finally, we provided a generating function for the Mulatu numbers. Conclusions In this study, we uncovered novel characterizations of Mulatu’s numbers and introduced a generating function for them. We investigated relationship between Mulatu’s numbers and the golden ratio. The results discussed offer valuable insights and enhance our understanding of their properties. Furthermore, these findings play a vital role in the boarder context of mathematical sequences, contributing significantly to the field.

Background Different usage scenarios and design guidelines were considered when planning a factory building and its ventilation system. Accordingly, it often makes sense to analyze the actual operating conditions again during subsequent operations in order to optimally adapt the air supply to the respective conditions in terms of demand-responsive ventilation. The aim is to ensure good indoor air quality and thermal comfort while significantly reducing energy consumption. Methods For this purpose, in addition to the sensors in the building management system, approximately 120 wireless sensors were installed in the occupied areas to measure the air temperature, operating temperature, humidity, and CO 2. In this way the spatial and temporal distributions of temperature, humidity, and CO 2 in the hall were visualized and evaluated to reduce the volume flows of the ventilation systems. The recorded data and findings were used to optimize ventilation systems by gaining a deeper understanding of indoor air flow. Results As part of the investigation, a considerable reduction in the air volume flows and thus the required energy consumption of the air handling units was achieved while maintaining the same thermal comfort. It was shown that the temperature field and indoor air quality were not negatively affected by the change in the air volume flow over a wide range. Conclusions This was made possible by the well-designed ventilation system, which achieves a low-pulse, slightly stratified indoor airflow, and a structural envelope with very good thermal insulation.

Background Concerns regarding academic efficiency at the postgraduate level in university programs require attention from those responsible for making university administrative decisions. This study aimed to determine the terminal efficiency of Peruvian university students enrolled in second specialty programs in a dental school over seven years. Methods This cross-sectional study considered all records of documents submitted for obtaining a title of second professional specialty in the programs offered by a dental school, published in its institutional repository between 2017 and 2023. The study variable was terminal efficiency (TE), considered both as a quantitative and qualitative variable. Additionally, some covariates were included, such as the year of formal document submission, the mode of document preparation, the second professional specialty in dentistry, and sex. Descriptive analysis was conducted to obtain absolute and relative frequencies. Bivariate analysis was performed using Chi-square, Mann-Whitney U, and Kruskal-Wallis tests. Results From the evaluation of TE between 2017 and 2023, it was observed that 72.09% (n=186) of students with a document submitted for obtaining a title of second professional specialty and published in the repository had a TE categorized of “Up to 1 year”. Likewise, the mean TE was 0.95 years (SD=1.25), with a statistically significant difference (p Conclusion The mean terminal efficiency of Peruvian university students in second specialty programs in a dental school over seven years was 0.95 years.

Background The emergence of antifungal resistance in fungal pathogens highlights the need for local epidemiological data to guide empirical therapy in clinical settings. Fungal research and anti-fungal drug resistance studies are limited in developing countries; hence, there is a need for burden estimation in low- and middle-income countries. This study aimed to determine the spectrum of fungal pathogens and the anti-fungal resistance profile of fungal pathogens isolated from the respiratory and urinary tracts of prison inmates in Nairobi, Kenya. Methods A cross-sectional study was conducted in which sputum and urine samples were obtained from inmates presenting with symptoms of respiratory and urogenital infections at a prison outpatient clinic. One hundred and sixty-two samples were collected and subjected to fungal investigation using standard protocols. Susceptibility to fluconazole, itraconazole, and voriconazole was assessed using standard broth microdilution. Clinical and sociodemographic data were obtained using a structured questionnaire. Results From the 162, 94 samples were positive for fungal pathogens, with an overall prevalence of 58%. Seventeen (18%) of the isolated fungi were Aspergillus fumigatus, Aspergillus flavus and Histoplasma. There was a statistically significant difference between fungal pathogens isolated from the respiratory and urogenital tracts in both sexes (pAspergillus flavus and A spergillus fumigatus were resistant. Conclusion Mycological agents are significant causes of respiratory and UTI infections among prison inmates, which could be attributed to prison conditions and misdiagnosis as bacterial infections. This highlights the need for specific control measures to reduce exposure to fungal infections in prisons and in the general population.

Background Faith and belief systems impact the emotional as well as immunological states of believers in ways that we are just beginning to understand. However, the clinical implications of prior studies are limited. The aim of the HEALING (Hospital-based Ecumenical and Linguistic Immuno-NeuroloGic) study is to examine immunological and neurological changes in hospitalized patients after meeting with a chaplain coupled with the study of biblical readings. Methods Hospitalized patients were pre-screened to identify those who were most in need of a spiritual intervention. A passage from the Bible was read to them during a meeting with the chaplain at bedside (n = 20) or in the chapel (n = 18). No meeting occurred in the randomized control group (n = 19). Blood samples were obtained 30 min prior and 60 min after the meeting to measure white blood cell (WBC) count, interferon-gamma (IFN-γ), immunoglobulin M (IgM), IgA, IgG, and complement 3 (C3). A subgroup of the visited patients was subjected to functional magnetic resonance imaging (fMRI), during which they listened to an audiotape of readings of the same biblical passage (n = 21). Results Immunological changes were not significant. Conversely, a significant (p fwe = 0.003) correlation was observed between lymphocyte changes and activation of the angular gyrus (left BA39) during fMRI, a brain area involved in word recognition. Conclusions This article contributes to the relevant literature by helping to create a realistic picture of the possibilities of neuroimmune modulation in clinical practice. Compared to healthy volunteers, the extent of short-term neuroimmunomodulation becomes narrower in a clinical setting. Although limited by the sample size and cohort study design, the findings suggest that the depth of psycho-immunological changes could depend on the degree to which the chaplain’s main message is understood.

Background Two-wheeled vehicles are the major mode of transportation in India. Such vehicles are exposed to excessive vibration on the road when compared to four-wheeled vehicles. However, the research on the reduction of whole body vibration in the case of two-wheelers is not explored in detail. The present study predicts rider comfort in the case of an electric two-wheeler as per ISO 2631-1, by obtaining the finding the weighted acceleration at the strategic locations of vibration at the test rig. Methods An electric two-wheeler test rig is used in the study. The values of acceleration from the test rig in running conditions are obtained by using NI LabVIEW 2019. The drive cycle of the electric vehicle (EV) test rig is controlled by Sync sols’ EV lab software. Obtaining the weighted root mean square (RMS) acceleration from running the test setup, it is compared with the ISO 2631-1 standard to obtain the rider comfort. Results Loading area, traction motor, base mount, and suspension were found to be the strategic points of vibration. Frequency weighted RMS acceleration of 0.3 to 0.4 m/s 2 obtained at these points are prone to cause discomfort for the rider. Vehicle speed, road profile, and duration of exposure were found to be important parameters affecting the rider’s comfort. A maximum of 4.6 m/s 2 amplitude was observed. The loading area, which corresponds to a rider’s seat in actual vehicle, is important and reduction of these vibrations make the ride comfortable for the rider. Suspension and base mount of the test rig are found to be uncomfortable observing the weighted RMS acceleration. Conclusions A suitable damping technique design is very much essential in reducing these vibrations and improve the rider comfort, as many more non-deterministic vibrations are prone to cause dis-comfort in case of actual on road riding conditions.

Background The EMPIRE (EMpirical Publication Impact and Reach Evaluation) Index is a value-based, multi-component metric framework to assess the impact of medical publications in terms of relevance to different stakeholders. It comprises three component scores (social, scholarly and societal impact), each incorporating related altmetrics that indicate a different aspect of engagement with the publication. Here, we present an exploratory investigation of whether publication types or disease indications influence EMPIRE Index scores. Methods Article-level metrics were extracted and EMPIRE Index scores were calculated for 5825 journal articles published from 1 May 2017 to 1 May 2018, representing 12 disease indications (chosen to reflect a wide variety of common and rare diseases with a variety of aetiologies) and five publication types. Results There were significant differences in scores between article types and disease indications. Median (95% CI) social and scholarly impact scores ranged from 1.2 (0.3–1.6) to 4.8 (3.1–6.6), respectively, for phase 3 clinical trials, and from 0.3 (0.3–0.4) to 2.3 (1.9–2.6), respectively, for observational studies. Social and scholarly impact scores were highest for multiple sclerosis publications and lowest for non-small cell lung cancer publications. Systematic reviews achieved greater impact than regular reviews. Median trends in the social impact of different disease areas matched the level of public interest as assessed through Google search interest. Although most articles did not register societal impact, mean societal impact scores were highest for migraine publications. Conclusions The EMPIRE Index successfully identified differences in impact by disease area and publication type, which supports the notion that the impact of each publication needs to be evaluated in the context of these factors, and potentially others. These findings should be considered when using the EMPIRE Index to assess publication impact.

Background of the study The systematic impact of macroeconomic variables on stock market returns makes it crucial to comprehend the link between macroeconomic variables and the stock market. Stock prices are closely linked to macroeconomic indicators, a crucial aspect for investors, policymakers, and researchers in emerging markets like India, influencing investment decisions and policy formulation. Methods The autoregressive distributed lag (ARDL) model was used in this study to examine the causal links between specific macroeconomic factors and Indian stock prices from April 2009 to March 2023. Results The outcomes of the research suggest that macroeconomic variables exert influence on the Indian stock market, across the short and long term. Moreover, the results of the paired Granger causality test suggest that the domestic macroeconomic variables possess predictive significance for stock prices in the Indian stock market. Conclusion The study reveals that macroeconomic variables significantly impact the Indian stock market, highlighting the need for investors and portfolio managers to monitor these conditions to optimize returns and mitigate risks. The Reserve Bank of India should maintain an optimal money supply to prevent inflation and exchange rate fluctuations, while bolstering the export sector and facilitating imports through initiatives like Atma-nirbhar Bharat Abhiyan and Make in India. Policies focusing on productivity, infrastructure, and a favourable business environment are also crucial. Therefore, it is crucial for investors and portfolio managers to consistently analyse the current macroeconomic conditions in order to maximize their profits and minimize risks. This research has extensive significance for comprehending the intricate connections between the stock market and macroeconomic issues.

The utilization of zein and gum arabic has grown in an attempt to formulate wall materials based on protein–polysaccharide complexes. This mixture provides a versatile delivery system for hydrophilic (guava leaf extract, GLE) or lipophilic (fish oil, FO) bioactive compounds, and it can be used as an edible film-forming polymer. This study was undertaken to characterize FO-containing edible films that were double-layered with a film containing GLE. Modified zein and gum arabic solutions (MG complex) were mixed at a ratio of 1:1.5 (v/v), adjusted to pH 5, added with glycerol (20% of the complex) and FO (5% of the complex), and finally adjusted to pH 5. This was prepared as the bottom/lower layer. The upper/active layer was prepared by mixing MG complex, glycerol, and GLE (1, 3, and 5% w/v of the complex). The total phenolic and flavonoid contents in GLE were 15.81 mg GAE/g extract and 6.99 mg QE/g extract, respectively. The IC50 of the DPPH radical scavenging activity of GLE was 26.86 ppm with antibacterial activity against Bacillus subtilis and Escherichia coli of 9.83 and 12.55 mm. The total plate counts of double-layered films containing GLE were retained below 3 log CFU/g during 28-day storage. The peroxide values of these films were dimmed for no more than 9.08 meq/kg sample on day 28 of storage. Thickness (872.00-971.67 μm), water vapor transmission rate (12.99-17.04 g/m 2/day), tensile strength (1.56-2.02 kPa), elongation at break (61.53-75.41%), glass transition (52.74-57.50°C), melting peak (131.59-142.35°C), inhibition against B. subtilis (33.67-40.58 mm), and inhibition against E. coli (2.05-9.04 mm) were obtained by double-layered films. GLE can be successfully incorporated into the active layer of a double-layer film to improve its characteristics while significantly slowing down the microbial contamination and oxidation rate. MG complex and FO can also contribute to the performance of the edible film.

Background As of July 2021, only 57% of Ecuador’s population had received the first vaccine dose against COVID-19. The national immunization campaign faced difficulties in reaching and providing vaccines to underserved population in remote areas. Methods The RISE project, funded by USAID and implemented by Jhpiego, aimed to develop an immunization strategy, that through the collaboration of an international non-profit organization, an academic institution and the public sector, could effectively support the national vaccination campaign of the Ecuadorian Ministry of Public Health. Results The program identified gaps in vaccination access and uptake, established specific strategies for targeted communities, analyzed official geographical information on vaccination coverage, ran micro-planning exercises at the local level, and adapted to new needs identified to ensure an effective vaccination uptake. From November 2021 up to May 2023, more than 1.8 million COVID-19 vaccine doses were administered to underserved populations living in geographically dispersed areas, in 18 provinces. Conclusions Employing data-targeted approaches and microplanning to identify underserved populations, strategic planning and collaboration between local governments, private sector, academic institution, and community leaders can substantially improve COVID-19 vaccines coverage and, thus, equity to vaccine access. The lessons learned might be useful to improve overall immunization service delivery.

Background Teaching professionalization aimed at the digital transformation of educational scenarios and training processes for students in contemporary higher education requires the mastery of digital competence by the teaching staff. The objectives of the study were to analyze the self-perceived level of digital teaching competence (DTC) of the faculty of the Technical University of Manabí (UTM), Ecuador, and to establish the relationship between age, sex, and academic profile variables with digital teaching competence. Methods A quantitative methodological approach was adopted to develop a descriptive-correlational field study with a non-experimental design. The participants were 277 professors, selected through non-probabilistic and voluntary sampling, who completed the DigCompEdu Check-In questionnaire sent by e-mail. Results The data revealed that the “integrator” and “expert” categories achieved high levels in all competencies. In particular, 48.74% of the participants were placed in the integrator category in the competence of facilitating skills, while 46.21% positioned themselves as integrators in the competence of evaluation and feedback. Additionally, a significant difference was found in the pedagogy variable in the interaction. Conclusions It is concluded that the competences self-perceived by the professors are within the intermediate categories such as integrator and expert. Likewise, the age, sex, and academic profile variables differ in the digital pedagogy level, which produces an inconsistent relationship, with the exception of the variable evaluates and provides feedback, where it was significant.

Background Sustainable supply chains are more competitive than conventional supply chains. Supply chain sustainability performance needs to be carried out to determine sustainability under current conditions and to design appropriate strategies to increase sustainability. This study aims to design a sustainability performance assessment model for the sago agro-industry supply chain and identify critical indicators for sustainability improvement. Methods The Fuzzy Inference System (FIS) evaluates sustainability on three levels: economic, social, and environmental. The Adaptive Neuro-Fuzzy Inference System (ANFIS) is then used to aggregate the overall sustainability performance. The cosine amplitude method (CAM) was used to analyze key indicators. This study assessed the sustainability performance on industrial- and small-medium-scale sago agro-industry. Results The results show that the supply chain sustainability performance on the industrial scale is 44.25, while it is 48.81 for the small-medium scale with the same status, almost sustainable. Key indicators for improving sago agro-industry supply chain sustainability performance include profit distribution among supply chain actors, institutional support for supply chains, waste utilization (reuse & recycle), and the availability of waste management facilities. The implication of this research for managers regards assessing the current status of sustainability performance and key indicators as a reference for formulating sustainability strategies and practices. Implication The sago agro-industry sustainability performance evaluation methodology uses industry-relevant metrics to assess supply chain sustainability, promoting collaboration among stakeholders and assisting in the creation of sustainable strategies. Conclusions The results of the study will enable supply chain actors to understand the key indicators for improving sustainability performance in the sago agro-industry supply chain, especially in Meranti Islands Regency, Riau Province. The proposed model can be applied to other agro-industries by adjusting the indicators used and assessing data availability and suitability for the research object.

Background Actions that are repetitive and being practiced automatically are called habits. Oral habits can be classified as normal or deleterious. Oral health education starts from footprints of awareness. Growing children require appropriate guidance for healthy growth and maintenance of their teeth, which makes the parent an active participant in the prevention and treatment of malocclusion and thus is majorly affected by their knowledge and attitude regarding various deleterious oral habits and habit breaking appliances. Aim To assess and compare awareness of deleterious oral habits and knowledge of habit breaking appliance, among parents at Alkharj Saudi Arabia. Methodology Study assessed awareness of deleterious oral habits and knowledge of habit breaking appliances among parents in Alkharj, Saudi Arabia. Results Conclusion Majority of the parents were aware of different deleterious oral habits but not aware of the dimensions of interventions like types of appliances, duration of use, etc. without knowing mentioned facts, in future which leads to development of malocclusion which probably requires orthodontic, surgical or prosthetic intervention correcting the outcomes of oral deleterious habits.

Background The selling of Jamu Gendong (an Indonesian traditional herbal medicine), is closely associated with the informal work of women who migrate to different regions. In Sukoharjo Regency and Wonogiri Regency, Central Java Province, the pressing need to meet household necessities in their places of origin compels women to assume the role of breadwinners. Therefore, this research aimed to identify the livelihood capital and resilience of migrant women selling jamu gendong. Methods The study was conducted in Ciamis Regency, West Java Province, Indonesia, in November 2022, using quantitative and qualitative methods. Primary data were collected through structured questionnaires and in-depth interviews. The sample comprised 51 women selected through snowball sampling and actively involved in selling Jamu Gendong, along with six key individuals from relevant agencies. Results The research findings indicate that the households of migrant women who sell jamu gendong can survive and adapt during their migration to prevent poverty by implementing diverse livelihood strategies. They are the only ones who move without their family members renting a place to live with them. This research has identified various capital sources, including productive age and skills in preparing jamu gendong; physical capital, including road infrastructure, markets, and access to health and education facilities; and natural, social, and financial capital. This research provides an in-depth understanding of women’s roles in family economic resilience, diversification of life strategies, the importance of social capital in migrant networks, economic empowerment through migration, and the influence of cultural values on livelihood strategies. Conclusions The findings contribute to a comprehensive understanding of the resilience demonstrated by migrant women selling jamu gendong. However, further research should be conducted in areas beyond the city center to obtain a holistic view of their resilience.

Background Hydatidosis of the thoracic wall differs from other hydatid localizations in its pathophysiology, diagnostic, and therapeutic management. It is a little-studied entity. The objectives of our work were to describe its surgical management and to analyze the factors that may influence recurrence and mortality. Methods A retrospective, descriptive, longitudinal, and multicenter study on four university hospital surgical centers of Tunis, from January 1995 to December 2022 including operated hydatid cysts of the thoracic wall. Overall survival (OS) and cumulative recurrence rates were calculated. Univariate and multivariable Cox regression analyses were performed to identify recurrence and mortality risk factors. Results Forty-nine patients were included. The mean age was 41 ± 17 years [8-76]. The main presenting sign was thoracic parietal swelling (n=22). Chest ultrasound and CT scan showed multivesicular formation in 17 and 33 cases, respectively. Muscle involvement was in the intercostal (n=4), paravertebral (n=13), and pectoralis major (n=3) muscles. Bone involvement was vertebral (n=11), costal (n=12), costo-vertebral (n=21) and sternal (n=2). A posterolateral thoracotomy was performed (n=20). Surgical excision at various levels of the chest wall with spinal stabilization (n=15) was performed. Sixty-three percent of the patients received antiparasitic medical treatment. Recurrence occurred in 37% of cases. Four patients died from hydatidosis-related complications. Factors could be independently associated with recurrence such as male gender, and vertebral involvement. The presence of a visceral hydatid cyst located at a distance from the parietal lesion at the time of diagnosis and the occurrence of postoperative infectious complications could increase mortality. Conclusions Chest wall hydatidosis represents a rare medical condition where surgery remains the preferred treatment modality. However, it carries a substantial burden of morbidity and mortality, influenced by various factors. Further large-scale studies are necessary to gain a deeper understanding of these factors and to optimize management strategies accordingly.

Background Heat polymerized acrylic (HPA) resins are known to have high porosity that contributes to increased surface roughness and microcrack formation in stress areas. This facilitates the attachment and growth of polymicrobial biofilms contributing to increased antimicrobial resistance. Many research had been carried out on avocado seeds, but no research that studies avocado seeds effect on denture-plaque microorganism biofilm on HPA resin has been found. Methods This study used 144 samples (n=144), namely HPA resin discs covered with mono-species and polymicrobial biofilms. The discs were soaked for 8 hours in the 5%, 10%, 15%, 20% avocado seed extract, positive control (alkaline peroxide), and negative control (aquadest). Each disc was shaken with a vortex mixer for 1 minute, and 100 μL was added into 96-well microplates with three times repetition and incubated for 24 hours. A microtiter plate biofilm formation assay was then conducted The inhibition values were determined from the percentage inhibition value formula which required absorption values from a microplate reader (595 nm). The research data were analyzed using a univariant test, and a one-way ANOVA test, accompanied by Welch ANOVA on non-homogenous data. Results In this research, it was found that the MBIC 50 of avocado seed extract against the mono-species of C. albicans (5%), C. glabrata (5%), A. odontolyticus (15%), S. gordonii (15%), S. aureus (10%), while against polymicrobial was 20%. There was a significant effect of soaking HPA resin in avocado seed extract on the inhibition of mono-species and polymicrobial biofilms with a value of p Conclusion The MBIC 50 of avocado seed extract in polymicrobial biofilm group was higher than that in the mono-species biofilm groups. Although alkaline peroxide showed higher inhibition value than that of the MBIC 50 in polymicrobial biofilm group, 20% avocado seed extract was concluded effective as it inhibited >50% polymicrobial biofilm.

Background Ethanol (EtOH) exposure throughout gestation and breastfeeding leads to multiple adverse outcomes in the hepatic system. Under oxidative stress, alterations in the liver are related to the inhibition of induced nitric oxide synthase activity in sinusoidal cells as a consequence of low expression of G-protein-coupled receptor (GPCR)-kinase interacting (GIT1). Here, we hypothesized that both glutathione peroxidase 1 (GPx1) and GIT1 could be altered by EtOH exposure during the third trimester of human equivalent development. Methods We exposed rats during the third trimester equivalent [postnatal days (PD) 2-8] to moderate levels of maternal EtOH (20%). GPx1 and GIT1 expression was detected by western blotting, and the antioxidant activity of glutathione peroxidase GPx and the concentration of hepatic carbonyl groups (CG were determined by spectrophotometry. Serum biochemistry parameters such as alanine aminotransferase (ALT), glucose (gluc), cholesterol (chol), and triglycerides (TG) were also measured. Results We found that ethanol decreased both GIT1 and GPx1 selenoprotein expression, affecting GPx antioxidant activity and increasing protein oxidation. Conclusions These results demonstrate for the first time that the GPx antioxidant system altered by EtOH exposure during the third trimester of development is related to a parallel decrease in GIT1 expression [1].

Background Antibiotic misuse and overuse have contributed to the emergence of multi-drug resistant (MDR) bacteria, posing a serious public health problem across the globe. Phage cocktails, which combine multiple phages, provide an efficient method to combat multidrug-resistant bacterial infections. This study integrated a computational pipeline to design a phage cocktail against the bacterial strains Acinetobacter baumannii AB0057 , Klebsiella pneumoniae subsp. pneumoniae HS11286, and Pseudomonas aeruginosa UCBPP-PA14 . Methods The whole genome sequences of selected multidrug-resistant bacteria were accessed. Prophage sequences were identified from them which could be expressed to produce viable lytic phages against MDR bacterial strains, thereby reducing the severity of infection. Prophages were annotated for open reading frames (ORFs), putative promoters, virulence factors, transcriptional terminators, ribosomal RNAs, and transfer RNAs. A dot plot was also generated to investigate similar phages and phylogenetic analysis was performed. Results A total of 11 prophages were predicted from the bacterial genomes. About 472 open reading frames were predicted along with 3 transfer RNAs. Additionally, the presence of 754 putative promoters and 281 transcription terminator sequences was also detected. Comparative genomic and phylogenetic analyses provided insight into the diversity, relatedness, and lytic potential of the phages. The final designed phage cocktail consisted of five selected prophages including Acinetobacter baumannii prophages (2759376-2809756) and (3311844-3364667), and Klebsiella pneumoniae prophages (1288317-1338719), (1778306-1808606), and (2280703-2325555). Conclusion The phage cocktail designed in this study might be useful against MDR Acinetobacter baumannii and Klebsiella pneumoniae infections, especially where conventional antibiotics fail. Sequence similarity analysis suggested that the phage cocktail may also be effective against other carbapenemase-producing K. pneumoniae strains.

Background Although the COVID-19 pandemic has diminished in intensity, the virus continues to circulate globally. The SARS-CoV-2 main protease (Mpro) is a key enzyme in the life cycle of the virus, making it important for the development of treatments against future variants of the virus. In this work, Peruvian natural compounds were evaluated against different mutations of the SARS-CoV-2 Mpro. Methods In silico techniques such as virtual screening, all-atom molecular dynamics simulations, and energy estimation analysis were applied. Results Of the tested compounds by virtual screening, rutin was identified as the best binding agent against the different proposed Mpro mutations. In addition, computational simulations and energy estimation analysis demonstrated the high structural and energetic stability between the Mpro-rutin systems. Conclusions Overall, our study identified rutin as the most promising compound with a strong affinity for various Mpro mutations, potentially playing a key role in the development of new treatments for emerging viral variants.

Background Physical activity trackers possess the potential to encourage increased physical activity. However, users often exhibit poor long-term adherence to these devices, which may stem from a lack of understanding of the factors influencing their use, as well as changes in health behavior. This study aims to provide new insights into the types of health-related apps and devices that young people discover, select, and utilize, along with the underlying reasons for their choices. Methods Young adults aged between 18-25 years reporting the use and nonuse of health apps and wearables were recruited and participated in focus group discussions about app choice, features, their perceptions towards the physical activity trackers, and reasons for continued use and for not using one. A total of Nine FGDS were conducted among users, nonusers, and former users of physical activity tracker usage. Data was recorded, transcribed, and analyzed for themes in an iterative approach. Results The physical activity tracker users group stated that they had a sense of achievement, validation, and other motivational feedback, which helped with adherence. All three groups (user, non-user, and former user) had similar concerns about cost, reliability, accuracy, and dependency. Former users also reported that the idea of accomplishing the goals would create anxiety and, in turn, harm the body. Former users and nonusers expressed their concerns regarding lack of time and loss of motivation to track their physical activity. Nonusers had issues with the functionality of the device (ease of use, battery, notifications, apps hang) and were also aware of all the health benefits of using wearables. Conclusion Physical activity users group, former users group, and nonusers group shared concerns about accuracy, cost, and battery.

Background The study analyzes the impact of public health spending on malnutrition among Peruvians, using data from the National Household Survey, the Central Reserve Bank of Peru, the National Institute of Statistics and Informatics and the Ministry of Economy and Finance from 2010. -2020. Previous studies have revealed the existing relationship of health spending with the reduction of malnutrition. Methods A quantitative approach is considered, with an explanatory type of research using panel data methodology considering the bidimensionality of the data, which allows quantifying this effect for the Peruvian case using the National Household Survey, data from the Central Reserve Bank of Peru, as well as information from the National Institute of Statistics and Informatics and the Transparency Portal of the Ministry of Economy and Finance in the period 2010-2020. Results The results show that public expenditure on health has a negative relationship with malnutrition; the rural sector has a positive relationship with malnutrition given the limitations present for access to adequate food. Similarly, the unemployment rate shows a positive relationship with malnutrition, given that being unemployed leads to a higher cause of malnutrition in the population, and the gross domestic product has a negative relationship with malnutrition, given that greater economic growth produces an impact on reducing malnutrition, with the greatest impact being on the rural population and the gross domestic product. Conclusions In the analysis period 2010-2020 in Peru, based on the panel data analysis, the impact of public health expenditure on reducing malnutrition is observed in 10 departments, achieving a reduction in malnutrition; while in 14 departments, this indicator has not been reduced.

Background In the 21 st century, the recognition of the rights and needs of victims of sexual violence has emerged as a fundamental discourse within international, regional, and local policy agendas. This has been influenced by the lasting psychological, emotional, and physical effects of sexual violence on the victims. These commentaries and agitation have spurred the need for alternative ways in which the Nigerian criminal justice system can be strengthened by incorporating criminal justice mechanisms and interventions that would enhance the needs and interests of victims in accessing justice despite its adversarial system of justice. Methods This study aims to appraise the different mechanisms of justice, needs, and interests of victims of sexual violence through a theoretical lens and drawing lessons from South Africa and Australia. To achieve this work, a doctrinal research methodology that utilized existing literature and secondary sources such as textbooks and online websites was adopted. Results The study found that there is a need for accountability for the protection of victims, implementation of legislation, and scaling up of resources for effective support services. In addition, the absence of resources, effective monitoring and compliance institutions, monitoring reports, specialized courts, and special regulations hampers the implementation of a victim-centered approach. Among others, the study recommends an all-inclusive criminal justice mechanism that would further incorporate a victim-centered approach towards advancing the rights and quality of justice for victims of Sexual Violence and the need for a victim impact statement to our criminal justice system for cases of sexual violence. Conclusion The study concludes that there is a need to make provisions for more effective alternative responses to incorporate the justice interests and needs of victims of sexual violence.

Background Over 500 million people worldwide rely on sorghum as a main food crop. About 10% of the daily caloric intake of households in Ethiopia’s northwest and eastern regions, including Benishangul Gumuz, comes from sorghum. A hemi-biotrophic fungal pathogen called Colletotrichum sublineolum caused anthracnose disease is among the biotic constraints of sorghum production. Methods Ten selected sorghum genotypes were assessed for sorghum anthracnose severity and its temporal and spatial dynamics on field plots in the districts of Assosa and Bambasi. The performance of the chosen sorghum genotypes was assessed using the following metrics: AUDPC, disease progress rate, yield-related trait, sorghum grain yield, and mean severity index. Anthracnose severity was evaluated using a 1–5 disease rating scale and assessments conducted at seven consecutive time points. Results Ten genotypes of sorghum were examined in the districts of Assosa and Bambasi, with mean anthracnose severity index ranging from 60-77 PSI and 53-82 PSI, respectively. AUDPC varied from 351 to 470 % days and 316 to 499 % days at Assosa and Bambasi districts, respectively. Bambasi district achieved a larger grain yield than the Assosa district. Assosa-1 demonstrated a significant level of disease pressure, yet the current investigation found that this genotype is the highest performing genotype in both locations. Conclusions There is a considerable positive link between the severity of anthracnose and the weekly total rainfall and relative humidity. At both trial sites, Mersa-1 continuously produced higher grain yields and reduced disease levels. Breeders might utilize the Baco Striga sorghum genotype as a check line in a breeding effort to resist anthracnose disease because it shown a high vulnerability to the disease at both locations.

Background Underwater gliders are widely used in marine applications for monitoring purposes. These gliders must withstand hydrodynamic forces and maintain its body stability. The underwater environments are highly unpredictable, and small changes in the environment can lead to significant instability in underwater vehicles. Methods This study uses different numerical techniques to investigate the hydrodynamic characteristics of a torpedo-shaped glider. A symmetric torpedo-shaped glider model was created and analyzed using a licensed version of ANSYS 20.1 Fluent tool. The behavior of the torpedo glider under various flow conditions was examined such as variation of grid test, change of turbulent models, the variation in the inflow boundary conditions involves varying the velocity from 10.16 m/s to 15.16 m/s in 1m/s increment and from 10.16 m/s to 7.66 m/s in 0.5 m/s, also six different models were analyzed. Results Research was also attempted with different turbulent models and the Spalart-Allmara model was producing least validation error of 1.28 % with a primary focus on nose optimization. By varying the nose length, the study aimed to identify the best-suited nose geometry to minimize drag force. The nose lengths were varied to 0.205 m and 0.19m, resulting in validation errors of 2.81% and 1.16%, respectively, the results are clearly explained in the sub sequent sections of this article. Conclusion In conclusion, this study has evaluated various modifications and their impact on drag force reduction. The application of Spallart-Allmara model resulted in an improvement of 1.28%. Decrease in velocity lead to a significant reduction in the drag force, with an improvement of 37.3%. The nose optimization also contributed to drag force; a nose length of 0.205m yielded a 3.37% improvement. While a 0.19m nose length resulted in a 1.67% reduction. This study helps researchers in hydrodynamics by optimizing geometry for drag reduction.

Background Artificial Intelligence (AI) has gained significant importance in dentistry, particularly in the field of cariology. The aim of this study was to perform a comprehensive bibliometric and altimetric analysis of research on the application of AI in cariology. Methods The Web of Science database was selected for the search conducted in February 2024, and selection and data extraction were performed independently by two researchers. Collaborative networks were generated using VOSviewer software, while altimetric data were analysed using Dimensions. The relationship between the bibliometric and altimetric data was examined using Spearman correlation. Results The search yielded 355 articles, of which 175 were included, published between 2008 and 2024. The most cited article reached 324 citations. Proof of concept was the most common study design (n=135), and the majority of studies used AI to detect and diagnose dental caries (n=122), with radiography being the most commonly used diagnostic method (n=99). The author with the highest number of articles was Schwendicke F (n=15), and the leading institution was Charite University, Berlin (n=13). China was the leading country in terms of research output (n=28) and Asia was the leading continent (n=54). The use of AI in cariology has been shown to improve diagnostic accuracy, reduce unnecessary interventions and optimise patient outcomes. Research interest in AI for cariology has increased significantly over the past five years, particularly in Asia. Conclusion These findings suggest significant clinical benefits and highlight the need for further research, particularly clinical trials, to validate these applications in practice.

Background Acinetobacter baumannii infection (ABI) is a concerning worldwide public health matter with high levels of morbidity and mortality, particularly in critically ill patients. This study aims to assess the prevalence, risk factors, and clinical outcomes of ABI in the pediatric intensive care unit (PICU) setting. Methods A retrospective review was performed on pediatric patients admitted to the PICU over an 8-year period. Demographic characteristics, infection risk factors, and clinical outcomes were compared and analyzed between patients with ABI, determined to be the case group, and patients without ABI, determined to be the control group. The study also assessed the prevalence of ABI and its antimicrobial resistance profile. Results Between June 2014 and May 2022, a total of 82 cases of ABI were identified, resulting in an overall prevalence of 5.02%. After applying the exclusion criteria, 12 cases were excluded. Consequently, 70 ABI cases in total and 140 cases in a control group were included in the study. Multivariable conditional logistic regression analysis identified chronic respiratory disease, mechanical ventilation lasting 3 days or more, and the use of piperacillin/tazobactam within the last 2 weeks as independent risk factors associated with ABI. The rate of carbapenem-resistant A. baumannii (CRAB) was notably high at 93.22%. Cases of ABI were associated with higher mortality rates and prolonged hospitalization compared to non-ABI cases. Conclusion ABI remains a critical pathogen in the PICU. The presence of chronic respiratory disease, use of mechanical ventilation for at least three days, and a history of receiving piperacillin/tazobactam within the last 2 weeks are significant risk factors for ABI. The high level of antibiotic resistance, especially to carbapenems, highlights the emphasis for more stringent infection control practices and the creation of novel antimicrobial therapies.

Background Triple-negative breast cancers are defined as tumors that lack the expression of the estrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor receptor 2 (HER2). It exhibits unique clinical and pathological features, is highly aggressive, and has a relatively poor prognosis and poor clinical outcome. Objective To identify a novel drug target protein against triple-negative breast cancer (TNBC) and potential phytochemical lead molecules against novel drug targets. Methods In this study, we retrieved TNBC samples from NGS and microarray datasets in the Gene Expression Omnibus database and employed a combination of differential gene expression studies, protein-protein interaction analysis, and network topology investigation to identify the target protein. Using molecular docking and molecular dynamics simulation studies, followed by Molecular Mechanics with Generalised Born Surface Area solvation, a potential lead molecule was identified. Result The androgen receptor (AR) was found to be the target protein, and 2-hydroxynaringenin was discovered to be a possible phytochemical lead molecule to combat TNBC. Upregulated genes with LogFC > 1.25 and P-value < 0.05 from the TNBC gene expression dataset were given to STRING tool to investigate the network topology, and androgen receptor (AR) was found to be an appropriate hub gene in the protein-protein interaction network. Phytochemicals that inhibit breast cancer were retrieved from the PubChem database and virtual screening was performed using PyRx against the AR protein. Based on Lipinski’s rule and ADMET properties, molecular interaction studies were analyzed using induced fit docking, wherein significant binding interactions were displayed by 2-hydroxynaringenin. Molecular dynamics studies and MM-GBSA of AR and the 2-hydroxynaringenin complex revealed strong and stable interactions. Conclusion AR was identified as a hub protein that is highly expressed in breast cancer and 2-hydroxynaringenin efficacy of counter TNBC needs to be investigated further in vitro and in vivo.

Background Nile tilapia ( Oreochromis niloticus) is predominant cultured species in aquaculture. However, there is a scarcity of literature regarding relationship between guava and star gooseberry leaf extract and the condition factor. Thus, the present study aims to investigate the effect of guava and star gooseberry leaf extract-supplemented diets on the specific growth rate, length-weight relationship, and condition factor of Nile tilapia. Methods Six hundred and thirty Nile tilapia (8.7±0.4 g) were randomly distributed among twenty-one tanks (30 fish per tank) within a recirculation system. Over a 60-day period, the fish were fed diets supplemented with 5g/Kg and 10g/Kg of guava leaf extract (GLE-5, GLE-10), star gooseberry leaf extract (SGLE-5, SGLE-10), and a mixture of both (MxLE-5, MXLE-10). Subsequently, specific growth rate, length-weight relationship, and condition factor were determined. Results After 60 days, the specific growth rate was significantly higher in all the GLE, SGLE, and MxLE groups compared to the control group. The final lengths and weights differed significantly both in the control group and all the GLE, SGLE, and MxLE groups. The analysis of the regression equation indicated a positive correlation (r = 0.970, 0.977, 0.976, 0.974, 0.974, 0.974, and 0.969) between the length and weight of Nile tilapia in the control group and in all the GLE, SGLE, and MxLE groups. The regression exponent “ b” values in all the GLE, SGLE, and MxLE groups were >3, indicating a positive allometric growth pattern in Nile tilapia compared to the control ( b=2.866), which exhibited a negative allometry. The final condition factor values did not differ significantly in either the control group or any of the plant extract groups. Conclusions Nile tilapia exhibited positive allometric growth patterns and maintained good health when fed with GLE, SGLE, and MxLE groups. Therefore, these plant extracts demonstrate suitability for commercial Nile tilapia production.

Introduction Diarrhea is a significant health problem in the Third World. Identification of the pathogen that causes diarrhea is vital for measures to prevent and control this disease. There are also very few reports of diarrhea in Sudan. Our study aimed to determine the Prevalence of specific protozoan pathogens ( Entamoeba histolytica, Cryptosporidium parvum., and Giardia spp) in children in Khartoum, Sudan. Methods We conducted a cross-sectional survey among children under five years of age hospitalized with acute diarrhea between April and December 2014. Diarrheal stool samples were collected, and E. histolytica, C. parvum, and Giardia spp were examined using multiplex real-time PCR. Results Four hundred and thirty-seven children with acute diarrhea were included in this study; the higher prevalence of diarrhea was in the age ≤ 2 years old (403, 92.2%), >2–≤4 years (32, 7.3%), and >4–Giardia spp (18.8%) and C. parvum (15.8%) were the most frequently identified parasites, followed by E. histolytica (0.9). The parasite infection rate was highest and lowest in the under 2-year-old group 143 (35.5%) and the 2–4-year-old group 12 (37.5%). The infection rate was higher in boys 104 (37.7%) than in girls 51 (31.7%). The number of positive cases was higher in the rainy season (August to December) 143 (37.4%), corresponding with that in the dry Season (April to June) 12 (21.8%). Discussion Our present study demonstrated the high prevalence of Giardia spp and C. parvum in children with diarrhea in the Khartoum region and the usefulness of the multiplex real-time method in disclosing pathogenic protozoal agents. Our result highlighted the necessity of developing intervention measurement and control strategies to deal with childhood parasitic diarrhea in this region.

Background This study delves into the intricate interplay among paradoxical leadership (PL), employees’ proactive work behaviour (PAB), and perceived psychological contract fulfilment (PPCF). PL, characterized by its simultaneous emphasis on apparently contradictory behaviours, has garnered attention due to its potential to foster innovation, adaptability, and creativity. The study’s main objective is to thoroughly explore the complexities of PL, its influence on PAB, and whether the PPCF serves as a mediator. Methods A survey was distributed to 338 hotel and travel agency employees to gather data. The data was analysed using structural equation modelling through a SmartPLS program. Results The results reveal a positive correlation between PL and PAB. Additionally, PPCF partially mediates this relationship, indicating its vital role in exploring the positive impact of PL on boosting proactive behaviours. Conclusions This research brings forth meaningful contributions to both theoretical and practical dimensions. Theoretically, it enhances our comprehension of how PL manifests in the distinctive landscape of the hospitality and tourism domain, substantiating its potential to drive proactive behaviours among employees. The mediation of PPCF enriches our grasp of the underlying mechanisms, accentuating the significance of maintaining harmonized and consistent leadership practices. From a practical vantage point, these findings offer valuable insights for hospitality and tourism establishments aspiring to optimize their leadership strategies for cultivating proactive work behaviour among their workforces.

The finite-volume theory has shown to be numerically efficient and stable for topology optimization of continuum elastic structures. The significant features of this numerical technique are the local satisfaction of equilibrium equations and the employment of compatibility conditions along edges in a surface-averaged sense. These are essential properties to adequately mitigate some numerical instabilities in the gradient version of topology optimization algorithms, such as checkerboard, mesh dependence, and local minima issues. Several computational tools have been proposed for topology optimization employing analysis domains discretized with essential features for finite-element approaches. However, this is the first contribution to offer a platform to generate optimized topologies by employing a Matlab code based on the finite-volume theory for compliance minimization problems. The Top2DFVT provides a platform to perform 2D topology optimization of structures in Matlab, from domain initialization for structured meshes to data post-processing. This contribution represents a significant advancement over earlier publications on topology optimization based on the finite-volume theory, which needed more efficient computational tools. Moreover, the Top2DFVT algorithm incorporates SIMP and RAMP material interpolation schemes alongside sensitivity and density filtering techniques, culminating in a notably enhanced optimization tool. The application of this algorithm to various illustrative cases confirms its efficacy and underscores its potential for advancing the field of structural optimization.

Background Hepatocellular carcinoma (HCC) is an aggressive malignancy with poor clinical outcomes. Hence cost-effective drugs with fewer side effects as a standard supportive therapy might yield substantial advantages in efficacy and safety. Kadukkai maathirai (KM) is being used as a supplement in hepatocellular carcinoma. We evaluated whether KM has any preventive action on cancer progression in diethyl nitrosamine (DEN) - induced HCC in rats. Methods DEN was injected to produce HCC in rats, which was confirmed after 16 weeks. All the rats were orally administered KM for 4 weeks. Hepatoprotective potential (serum AST, ALT, ALP, Bilirubin) and anticancer efficacy (body weight, nodule count, tumor progression by histopathology, expression of GSTM1 by Liquid chromatography-mass spectrometry (LC-MS), and In-silico analysis of phytoconstituents against β catenin and LRP analysis were evaluated. Results KM prevented cancer progression against DEN-induced HCC by an increase in GSTM1, a phase II detoxifying enzyme. It significantly reversed altered nodule count, relative liver weight, body weight, and histopathological features of HCC. In silico analysis of phytoconstituents of KM showed that they modulate the intracellular transcription process by inhibiting the armadillo repeat region of β catenin. Conclusions Our results elucidate the potential of KM as a supplement in HCC by reducing nodule count, protecting the liver from further damage, GSTM1 expression, and inhibiting armadillo repeat region of β catenin.

Background Prosthetic joint infection is a serious complication that can arise after total joint replacement surgery. When bacteria colonise an orthopaedic implant, they form biofilms that protect them from their environment, making them difficult to remove. Treatment is further complicated by a global rise of antimicrobial resistance. These protective mechanisms make treatment of prosthetic joint infection increasingly complex. Non-contact induction heating is an upcoming technology that uses heat to eradicate bacteria that are present on the surface of metallic implants. This study aims to provide insight into the feasibility of using non-contact induction heating on metallic implants that are in direct contact with other biomaterials, such as coatings composed of hydroxyapatite and bone cement composed of poly (methyl methacrylate) (PMMA). Methods Characterisation of hydroxyapatite coatings and adhesion strength tests were conducted according to standards set by the International Organisation for Standardisation (ISO 13779-2). The fixation strength of acrylic bone cement was tested according to an adapted method from ISO. Results It was found that non-contact induction heating did not significantly affect the adhesion strength of hydroxyapatite coatings. In contrast to hydroxyapatite coatings, acrylic bone cement softened temporarily as the temperature exceeded the glass transition temperature (83.38 ± 10.88°C). However, the induction heating temperature had no significant effect on the fixation strength after the cement was allowed to cool down. Conclusion This study shows the feasibility of using non-contact induction heating up to 80°C when bone cement or ceramic coatings are present in contact with infected metallic implants.

Background Misconduct in the academic community remains poorly understood among post-graduate dental students (PGDSs) in North Africa. Data on the knowledge of misconduct (KoM) level in this population is lacking. This study assessed KoM of Tunisian PGDSs’. Methods A cross-sectional study was conducted at the Faculty of Dental Medicine of Monastir, involving 147 PGDSs registered in 2022. Students were recruited via email invitations and convenience sampling at a medical congress. A French survey with 11 questions on KoM, offering three-choice answers (yes/no/maybe) was administered. Each correct answer received one point, and a total score below six indicated a low-level of KoM. Results The mean±SD KoM score of the 106 students who accepted to participate in the study was 4.4±1.8, indicating a low-level of KoM. The majority of PGDSs (85.85%) demonstrated a low-level of KoM. A comparison between subjective and objective assessments of KoM levels revealed that a significant percentage of PGDSs underestimated their knowledge (62.26% vs. 85.85%, respectively). The two groups of PGDSs with low (n=91) and acceptable or excellent (n=15) KoM levels showed comparable characteristics in terms of age, sex, discipline, post-graduate-level, experience-level, graduation-status, and survey-response modality. Conclusion This study identified a low-level of KoM among North-African PGDSs. This emphasizes the need for further efforts to enhance awareness and promote better KoM in this population.

Background Moldova strives for universal health coverage (UHC) and considers health technology assessment (HTA) an important policy instrument to inform the choice of services that should be covered to progressively realize UHC. It plays a key role in determining which technologies are coved, considering various dimensions often including cost-effectiveness, budget impact, and feasibility. This paper reports on work undertaken to develop a roadmap for HTA implementation, using evidence-informed deliberative processes (EDPs) as the guiding framework. Methods Between 2020 and 2022, we undertook several activities that informed the roadmap. We conducted a needs assessment and an assessment of European HTA best practices using a combination of desk research, interviews and surveys. We then conducted a document review of six selected HTA systems, complimented by expert interviews from three neighbouring countries. Results The roadmap provided a suggested HTA process, which included instructions on how to execute the different steps of the EDP framework to enhance the legitimacy of HTA-informed decision-making. The roadmap encompasses several aspects such as how to organize stakeholder involvement, how to identify and operationalize decision criteria, and how to make the decision process transparent. Guidance was given to the country on establishing a legal framework for HTA; a communication strategy; strengthening capacity and leveraging HTA expertise. The country was also given tailored advice on the positioning of the HTA-agency, first as an entity within the Ministry of Health or the National Agency of Public Health but with the long-term vision for it to be independent of any state institution. Conclusions Despite several challenges, including a partial disruption because of the Covid-19 pandemic, the development of the roadmap for HTA implementation was completed and agreed upon by the Ministry of Health in Moldova. This work has helped motivate and support the country in HTA institutionalization.

Background Prediabetes, a reversible condition before the onset of diabetes, is a significant concern in healthcare globally. The global prediabetes epidemic has emerged and has considerably impacted health expenditures. Various risk factors play important roles in the progression of prediabetes to diabetes. Intensive lifestyle and pharmacological interventions can significantly reduce the risk of diabetes progression. Objective This study aimed to determine the prevalence, characteristics, and risk factors of prediabetes state of Medan in August 2023. Methods The sample consisted of 89 participants. This was an analytical cross-sectional study in the community that met the inclusion and exclusion criteria. The determination of prediabetes is based on the results of blood tests, namely, the examination of fasting blood sugar levels (FBGL), 2-hour postprandial oral glucose tolerance test (OGTT), and hemoglobin A1c (HbA1C). Other examinations included lipid profiling (total cholesterol, HDL-C, LDL-C, and triglycerides). Data processing was performed using SPSS via univariate and bivariate analyses (chi-square test). Results Of the 89 participants, the prevalence of prediabetes based on HbA1c, FBGL and 2-hours OGTT levels was 28.1%, 50.6%, and 28.1%, respectively. 82% of the participants were female, and 53.9% were overweight or obese based on body mass index (BMI). The risk factors for prediabetes were age >64 years, female, physical inactivity, and diastolic blood pressure ≥90 mmHg ( pp>0.05). Conclusion This study found that the prevalence of prediabetes was 67.4% in Medan. Age >64 years, female, physical inactivity, and diastolic blood pressure ≥90 mmHg were the most important risk factors for prediabetes.

Introduction Calcium hydroxide (Ca(OH) 2) is the material of choice for pulp therapy. However, Ca(OH) 2 has drawbacks such as toxicity, poor sealing, and tunnel defect formation. Alternative materials have been developed to provide more biocompatible materials with better dentin formation ability. The objective of this study was to evaluate the effect of composites containing gelatin (G), chitosan (CH), tetraethyl orthosilicate (TEOS), and Ca(OH) 2, namely G-CH-TEOS-Ca(OH) 2 (Extended data) on inflammation of the dental pulp (expression of COX-2, PGP 9.5, TNF-α, and neutrophil number). Materials and methods A total of 16 Wistar rat models of acute pulp injury were prepared and divided into two groups, treatment and control, 8 with each. In the treatment group, we applied a pulp-capping material using G-CH-TEOS-Ca(OH) 2 and Ca(OH) 2. On the 1 st and 3 rd days, rats were sacrificed. Tissue samples from 4 rats in each group were processed for histological preparation. COX-2, PGP 9.5, and TNF-α were observed using immunohistochemical (IHC) staining, and neutrophil numbers were observed using hematoxylin-eosin staining. Image analysis of COX-2, PGP 9.5, and TNF-α expression was performed using ImageJ software. Results The results showed a decrease in COX-2 expression, but not significantly while PGP 9.5 and TNF-α expression were significantly higher than those in the control group. Neutrophil numbers were lower in the treatment group than in the control group, but the difference was not statistically significant. Conclusion The G-CH-TEOS-Ca(OH) 2 composite material may have potential as an exposed pulp medicament by reducing inflammation (COX-2 expression and number of neutrophils) and increasing the regeneration factor (TNF-α expression) and nerve (PGP 9.5 expression).

Background Several students use hostel facilities offered by their colleges and universities while pursuing higher education. A crucial change is witnessed in their food habits during their stay at the campus, which is vastly different from their home experience. Method The study employs the theory of planned behavior to conceptualize and understand the food choices of university students while following the qualitative research methodology and the phenomenological approach. The snowball sampling method is applied to select participants for the study. We selected twenty-six undergraduate and postgraduate students pursuing programs in technical and health science from a private university at Udupi with residence in the university campus for two to four years. Interviews with candidates were conducted online and audio-recorded with participants’ consent. Results The transcribed interviews were coded and categorized to obtain themes, which were then conceptualized to develop the model based on the theory of planned behaviour. The duration of their stay on campus allowed students to gain a perspective on the food events and the food they consumed at the university dining facility (UDF) guided by factors, such as taste, price, availability of time(during academic activity), accessibility to healthy food, academic stress and lack of knowledge on nutrition. Two factors emerged from the interviews, one, there was no display in the dining facility about the nutritional value of the food served; and, second, students preferred to dine out on unhealthy food rather than at the university because food from outside the campus, even though unhealthy, was easier on the pocket. Conclusion The study provides insights into the role of UDF in serving healthy and nutritional food to students for better health and improved academic performance. This work brings to light the relationship between students’ food choices and their impact on academic performance.

Introduction The first 28 days of life are considered the neonatal period, when pediatric health is most vulnerable. While crises can undoubtedly arise during this time, many ED or urgent care visits could be avoided with sufficient preventive hospital care during the newborn period and suitable follow-up with a primary care physician. The use of emergency rooms for non-urgent care could be the cause of rising healthcare costs and ineffective resource use. Purpose This study aimed to determine the presenting features, management, and disposition of neonatal attendance in the emergency department. Methods This was a retrospective observational cross-sectional study of medical records identified via the emergency department of neonatal visits (≤28 days) to King Fahd Hospital of the University (KFHU), Khobar, Saudi Arabia, over 12 months (2021–2022). The Chi-square test was performed to compare various etiologies, with a 5% significance level. Results A total of 649 neonate visited pediatric emergency department with a mean age of 15.5 ± 7.4 days and almost equal distribution of the gender. The most common presentation was upper respiratory tract infection (URTI) (26.8%), followed by physiological jaundice (20.2%), and colic (14%). A total of 205 (31.6%) neonates who visited the ED showed significant laboratory findings. Seventy-nine patients (12.2%) presenting with PED were admitted to the hospital. Conclusion Healthcare systems must devise strategies to address the growing number of non-urgent visits to emergency departments in a more efficient manner, while simultaneously reallocating scarce resources to higher-acuity cases. This emphasizes the necessity of health personnel educating caregivers. It’s also critical that medical professionals understand the common ailments that affect newborns and are skilled at correctly identifying ailments that could indicate a serious pathology.

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.