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Competing Interests: The authors declare that they do not have any conflicts of interest.

Tobacco consumption is one of the major public health concerns worldwide. Moreover, alternative tobacco and nicotine products (ATNPs) are growing in popularity, especially among young adults in the past decade. The study aimed to determine the prevalence and associated sociodemographic factors of tobacco consumption among university students. A cross-sectional study was carried out among 338 university students of a private Malaysian university from March to April 2021. Data was collected using a self-administered online questionnaire with items including sociodemographic information, user status of tobacco consumption and types of tobacco product used. Descriptive statistics, Pearson's chi-square test, Fisher's exact test and simple and multiple logistic regression analyses were performed using the IBM SPSS version 26.0 to analyse the data. The prevalence of tobacco consumption in this study was 8.6% and the main tobacco product used was manufactured cigarettes. In Pearson's chi square test and Fisher's exact test, current use of tobacco was significantly associated with nationality, ethnicity, religion, school, current level of education and parents, siblings and friends use of tobacco ( p <0.05). In simple and multiple logistic regression analysis, being non-Malaysian, Indian, Muslim, year 4 student and having parents or siblings who used tobacco, all had statistically significant associations with the current use of tobacco ( p <0.05). Findings of this study showed that the use of tobacco among university students is concerning and warrants the need to develop and implement a strategic anti-tobacco program to limit this behaviour among university students., Competing Interests: The authors declared that they have no completing interest.

Background: Genetic-guided pharmacotherapy (PGx) is not recommended in clinical guidelines for coronary artery disease (CAD). We aimed to examine the extent and quality of evidence from economic evaluations of PGx in CAD and to identify variables influential in changing conclusions on cost-effectiveness., Methods and Results: From systematic searches across 6 databases, 2 independent reviewers screened, included, and rated the methodological quality of economic evaluations of PGx testing to guide pharmacotherapy for patients with CAD. Of 35 economic evaluations included, most were model-based cost-utility analyses alone, or alongside cost-effectiveness analyses of PGx testing to stratify patients into antiplatelets (25/35), statins (2/35), pain killers (1/35), or angiotensin-converting enzyme inhibitors (1/35) to predict CAD risk (8/35) or to determine the coumadin doses (1/35). To stratify patients into antiplatelets (96/151 comparisons with complete findings of PGx versus non-PGx), PGx was more effective and more costly than non-PGx clopidogrel (28/43) but less costly than non-PGx prasugrel (10/15) and less costly and less effective than non-PGx ticagrelor (22/25). To predict CAD risk (51/151 comparisons), PGx using genetic risk scores was more effective and less costly than clinical risk score (13/17) but more costly than no risk score (16/19) or no treatment (9/9). The remaining comparisons were too few to observe any trend. Mortality risk was the most common variable (47/294) changing conclusions., Conclusions: Economic evaluations to date found PGx to stratify patients with CAD into antiplatelets or to predict CAD risk to be cost-effective, but findings varied based on the non-PGx comparators, underscoring the importance of considering local practice in deciding whether to adopt PGx.

Support ector achine (SVM) is a newer machine learning algorithm for classification, while logistic regression (LR) is an older statistical classification method. Despite the numerous studies contrasting SVM and LR, new improvements such as bagging and ensemble have been applied to them since these comparisons were made. This study proposes a new hybrid model based on SVM and LR for predicting small events per variable (EPV). The performance of the hybrid, SVM, and LR models with different EPV values was evaluated using COVID-19 data from December 2019 to May 2020 provided by the WHO. The study found that the hybrid model had better classification performance than SVM and LR in terms of accuracy, mean squared error (MSE), and root mean squared error (RMSE) for different EPV values. This hybrid model is particularly important for medical authorities and practitioners working in the face of future pandemics.

Spray dryer had long been used to dry liquid materials and produce dry crystalline products. However, the drying of the bittern to produce quality salt crystals has not been widely published. Therefore, the purpose of this study was to examine the effect of drying conditions of the bittern using a spray dryer to produce salt with a high natrium chloride (NaCl) content. Drying was carried out in the hot air temperature (105-125 °C), drying air flow rate (25-45 ml/min), feed flow rate (20-30 ml/min), and concentration of maltodextrin (10-30%). The parameters were observed water content, NaCl content, yield, and mean particle diameter size (MPDS). The results showed that the inlet air temperature of 125 °C can significantly reduce the water content faster and produce higher NaCl levels than the inlet air temperature of 105 °C. The salt crystals produced at higher maltodextrin concentrations have lower water content and high NaCl content. The best-operating conditions are at a hot air temperature of 125 °C, a drying airflow rate of 45 m/s, and a maltodextrin concentration of 25% because it produces salt crystals with high NaCl content. Overall, these results indicate that the bittern can be dried using a spray dryer with potential NaCl content as a raw material for the pharmaceutical industry., Competing Interests: The authors declare no conflict of interest., (© 2022 The Authors.)

Objectives: This study aimed to examine the extent and quality of evidence from economic evaluations (EEs) of genetic-guided pharmacotherapy (PGx) for atrial fibrillation (AF) and to identify variables influential in changing base-case conclusions., Methods: From systematic searches, we included EEs of existing PGx testing to guide pharmacotherapy for AF, without restrictions on population characteristics or language. Articles excluded were genetic tests used to guide device-based therapy or focused on animals., Results: We found 18 EEs (46 comparisons), all model-based cost-utility analysis with or without cost-effectiveness analysis mostly from health system's perspectives, of PGx testing to determine coumadin/direct-acting anticoagulant (DOAC) dosing (14 of 18), to stratify patients into coumadin/DOACs (3 of 18), or to increase patients' adherence to coumadin (1 of 18) versus non-PGx. Most PGx to determine coumadin dosing found PGx more costly and more effective than standard or clinical coumadin dosing (19 of 24 comparisons) but less costly and less effective than standard DOAC dosing (14 of 14 comparisons). The remaining comparisons were too few to observe any trend. Of 61 variables influential in changing base-case conclusions, effectiveness of PGx testing was the most common (37%), accounted for in the models using time-based or medication-based approaches or relative risk. The cost of PGx testing has decreased and plateaued over time., Conclusions: EEs to date only partially inform decisions on selecting optimal PGx testing for AF, because most evidence focuses on PGx testing to determine coumadin dosing, but less on other purposes. Future EE may refer to the list of influential variables and the approaches used to account for the effect of PGx testing to inform data collection and study design., (Copyright © 2021 ISPOR–The Professional Society for Health Economics and Outcomes Research. Published by Elsevier Inc. All rights reserved.)

Pedestrian overflow causes queuing delay and in turn, is controlled by the capacity of a facility. Flow control or blocking control takes action to avoid queues from building up to extreme values. Thus, in this paper, the problem of pedestrian flow control in open outdoor walking facilities in equilibrium condition is investigated using M/M/c/K queuing models. State dependent service rate based on speed and density relationship is utilized. The effective rate of the Poisson arrival process to the facility is determined so as there is no overflow of pedestrians. In addition, the use of the state dependent queuing models to the design of the facilities and the effect of pedestrian personal capacity on the design and the traffic congestion are discussed. The study does not validate the sustainability of adaptation of Western design codes for the pedestrian facilities in the countries like Bangladesh.

Pedestrian movements are the consequence of several complex and stochastic facts. The modelling of pedestrian movements and the ability to predict the travel time are useful for evaluating the performance of a pedestrian facility. However, only a few studies can be found that incorporate the design of the facility, local pedestrian body dimensions, the delay experienced by the pedestrians, and level of service to the pedestrian movements. In this paper, a queuing based analytical model is developed as a function of relevant determinants and functional factors to predict the travel time on pedestrian facilities. The model can be used to assess the overall serving rate or performance of a facility layout and correlate it to the level of service that is possible to provide the pedestrians. It has also the ability to provide a clear suggestion on the designing and sizing of pedestrian facilities. The model is empirically validated and is found to be a robust tool to understand how well a particular walking facility makes possible comfort and convenient pedestrian movements. The sensitivity analysis is also performed to see the impact of some crucial parameters of the developed model on the performance of pedestrian facilities.

M/G/C/C state dependent queuing networks consider service rates as a function of the number of residing entities (e.g., pedestrians, vehicles, and products). However, modeling such dynamic rates is not supported in modern Discrete Simulation System (DES) software. We designed an approach to cater this limitation and used it to construct the M/G/C/C state-dependent queuing model in Arena software. Using the model, we have evaluated and analyzed the impacts of various arrival rates to the throughput, the blocking probability, the expected service time and the expected number of entities in a complex network topology. Results indicated that there is a range of arrival rates for each network where the simulation results fluctuate drastically across replications and this causes the simulation results and analytical results exhibit discrepancies. Detail results that show how tally the simulation results and the analytical results in both abstract and graphical forms and some scientific justifications for these have been documented and discussed.

The objective of this paper is to apply the Translog Stochastic Frontier production model (SFA) and Data Envelopment Analysis (DEA) to estimate efficiencies over time and the Total Factor Productivity (TFP) growth rate for Bangladeshi rice crops (Aus, Aman and Boro) throughout the most recent data available comprising the period 1989-2008. Results indicate that technical efficiency was observed as higher for Boro among the three types of rice, but the overall technical efficiency of rice production was found around 50%. Although positive changes exist in TFP for the sample analyzed, the average growth rate of TFP for rice production was estimated at almost the same levels for both Translog SFA with half normal distribution and DEA. Estimated TFP from SFA is forecasted with ARIMA (2, 0, 0) model. ARIMA (1, 0, 0) model is used to forecast TFP of Aman from DEA estimation.

Banking system plays an important role in the economic development of any country. Domestic banks, which are the main components of the banking system, have to be efficient; otherwise, they may create obstacle in the process of development in any economy. This study examines the technical efficiency of the Malaysian domestic banks listed in the Kuala Lumpur Stock Exchange (KLSE) market over the period 2005-2010. A parametric approach, Stochastic Frontier Approach (SFA), is used in this analysis. The findings show that Malaysian domestic banks have exhibited an average overall efficiency of 94 percent, implying that sample banks have wasted an average of 6 percent of their inputs. Among the banks, RHBCAP is found to be highly efficient with a score of 0.986 and PBBANK is noted to have the lowest efficiency with a score of 0.918. The results also show that the level of efficiency has increased during the period of study, and that the technical efficiency effect has fluctuated considerably over time.

The stock market is considered essential for economic growth and expected to contribute to improved productivity. An efficient pricing mechanism of the stock market can be a driving force for channeling savings into profitable investments and thus facilitating optimal allocation of capital. This study investigated the technical efficiency of selected groups of companies of Bangladesh Stock Market that is the Dhaka Stock Exchange (DSE) market, using the stochastic frontier production function approach. For this, the authors considered the Cobb-Douglas Stochastic frontier in which the technical inefficiency effects are defined by a model with two distributional assumptions. Truncated normal and half-normal distributions were used in the model and both time-variant and time-invariant inefficiency effects were estimated. The results reveal that technical efficiency decreased gradually over the reference period and that truncated normal distribution is preferable to half-normal distribution for technical inefficiency effects. The value of technical efficiency was high for the investment group and low for the bank group, as compared with other groups in the DSE market for both distributions in time-varying environment whereas it was high for the investment group but low for the ceramic group as compared with other groups in the DSE market for both distributions in time-invariant situation.

In a previous efficacy study, autoclaved Leishmania major (ALM) + bacille Calmette-Guérrin (BCG) vaccine was shown to be safe, but not superior to BCG alone, in protecting against visceral leishmaniasis. From June 1999 to June 2000, we studied the safety and immunogenicity of different doses of alum-precipitated ALM + BCG vaccine mixture administered intradermally to evaluate whether the addition of alum improved the immunogenicity of ALM. Twenty-four healthy adult volunteers were recruited and sequentially allocated to receive either 10 microg, 100 microg, 200 microg, or 400 microg of leishmanial protein in the alum-precipitated ALM + BCG vaccine mixture. Side effects were minimal for all doses and confined to the site of injection. All volunteers in the 10 microg, 100 microg, and 400 microg groups had a leishmanin skin test (LST) reaction of > or = 5 mm by day 42 and this response was maintained when tested after 90 d. Only 1 volunteer out of 5 in the 200 microg group had a LST reaction of > or = 5 mm by day 42 and the reasons for the different LST responses in this group are unclear. This is the first time that an alum adjuvant with ALM has been in used in humans and the vaccine mixture was safe and induced a strong delayed type hypersensitivity (DTH) reaction in the study volunteers. On the basis of this study we suggest that 100 1 microg of leishmanial protein in the vaccine mixture is a suitable dose for future efficacy studies, as it induced the strongest DTH reaction following vaccination.

Background: Assessment of patient satisfaction offers a way of optimizing health status and prevents waste of medical resources. The direct measurement of patient satisfaction is a new phenomenon in Kuwait., Objective: Assess patient satisfaction with respect to primary health care services and study any patterns of association of sociodemographic variables on the patient satisfaction level., Methods: The sample consisted of 301 patients selected systematically from five primary health care centers to represent various geographic areas in Kuwait City. Just over 56% of the sample were females, 59% were married, the great majority (70.4%) were government employees, more than 60% had a monthly income of less than 900 KD, more than 54% were intermediate and high secondary school graduates, and 37% were university graduates or had advanced degrees. The data was collected by personal interview using structured questionnaire., Results: The overall mean satisfaction was 3.1 points out of five (62%). The mean satisfaction scores were 3.64, 3.29, 3.08, 3.05, 2.21 for laboratory, pharmacy, radiology, dental and physician services, respectively. The highest mean score for physician services was obtained for communication skills (2.23); for pharmacy services, the availability of medicine (4.01); for laboratory services, the availability of lab materials (3.73); for radiology services, the waiting time for x-ray (3.60); and for dental services, the adequacy of dentists (3.27). The results indicated that gender, income, marital status and occupation were the most consistent demographic predictors of satisfaction, with females, those with lower income, lower education levels and the unemployed having higher mean satisfaction scores., Conclusion: There is a need for corrective intervention in some service areas and for an educational program to inform patients of the objectives and limitations of primary health services.

Background: Visceral leishmaniasis is a major cause of morbidity and mortality in the Sudan. Drug treatment is expensive, and drug resistance is becoming increasingly common. Safe, effective, and cheap vaccines are needed. We report the results of a vaccine trial against human visceral leishmaniasis., Methods: We undertook a double-blind randomised trial to test the safety and efficacy of an autoclaved Leishmania major (ALM) promastigote vaccine (1 mg per dose). Of 5093 volunteers screened, 2306 had negative leishmanin skin tests and reciprocal titres of less than 6400 in the direct agglutination test. They were randomly assigned two doses of ALM mixed with BCG or BCG alone. Volunteers were followed up for 2 years. The primary endpoint was clinical visceral leishmaniasis or post-kala-azar dermal leishmaniasis. Analyses were by intention to treat., Findings: Side-effects were confined to the injection site. The cumulative frequency of visceral leishmaniasis at 2 years did not differ significantly between the group assigned ALM plus BCG and that assigned BCG alone (133/1155 [11.5%] vs 141/1151 [12.3%], p=0.6). The vaccine efficacy was 6% (95% CI -18 to 25). The proportion of individuals showing leishmanin skin conversion was significantly higher in the ALM plus BCG group than in the BCG alone group throughout follow-up (303 [30%] vs 72 [7%] at 42 days). Individuals whose leishmanin test converted after vaccination (induration > or =5 mm) had a significantly lower frequency of visceral leishmaniasis than non-responders (27/375 [7.2%] vs 210/1660 [12.7%], p=0.003)., Interpretation: We found no evidence that two doses of ALM plus BCG offered significant protective immunity against visceral leishmaniasis compared with BCG alone. Leishmanin skin conversion with an induration of 5 mm or more in either group was associated with protection from the disease.