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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

In modern construction, nanomaterials can be added to concrete to improve its radiation shielding properties. A prediction model for the gamma-ray radiation shielding properties, such as linear attenuation coefficient (LAC) of nanomaterial-based concrete remains necessary. This study aims to develop prediction models for LAC of nano modified concrete (NMC) using nano alumina (NA) and carbon nano tubes (CNTs) subjected to high temperatures. These models are based on linear regression and three machine learning algorithms: M5 Prime (M5P), random forest (RF), and extreme gradient boosting (XGBoost). To build the models, results of 117 concrete cubic specimens (100 mm size) was utilized as a dataset with varying amounts of NA and CNTs. Relevant variables including temperature, exposure time, and NA and CNTs dosages were considered. To further validate the predicted results, various statistical metrics and K-fold cross-validation were employed to compare and validate the models' output. The results showed that the XGBoost model outperformed other models, with the highest R2 of 0.9975 and the lowest error of 0.4365 %. In addition, the impact of each parameter on LAC of NMC was assessed using Shapley Additive Explanations (SHAP) analysis. Sensitivity and SHAP analyses reveal that CNTs has the highest influence on the radiation shielding properties of NMC. In comparison with the previously developed ANN model, the XGBoost and ANN models showed approximately the same prediction power for predicting LAC of NMC.

The moment distribution method is considered one of the easiest and most reliable analysis methods. However, little attention has been given to modelling the stiffness of each member separately, as currently only one factor is being used to model all structural members without taking into account the loading conditions and curvature of the member. This can significantly influence the results when modelling columns, since unlike beams, which are usually bent in a single curvature configuration, columns can be bent in either a single or double curvature configuration. This paper presents a new set of stiffness factors to model each structural member separately depending on its boundary conditions and curvature. To validate this modification, an example concrete frame was modelled and analysed using the structural analysis software ETABS, and then the results were compared with that obtained from the standard moment distribution method and the modified moment distribution method. The results have revealed a significant enhancement in the accuracy of the obtained results when using the modified moment distribution method compared with the original moment distribution method, especially the values of the columns’ bending moments.

Background Neonates and children are more susceptible to a variety of infections, leading to frequent antibiotic prescriptions. However, the inappropriate use of antibiotics leads to antibiotic resistance and higher mortality rates. Therefore, this study aimed to determine the prevalence of antibiotic use, and current antibiotic prescribing practices among neonates and children admitted in the selected hospitals of Saudi Arabia.Methods A cross-sectional study was conducted from September to November 2023 to assess the prevalence of antibiotic use, and the current antibiotic prescribing practices across six hospitals of Saudi Arabia.Results The study included 499 children and neonates, with 94.6% receiving antibiotic prescriptions. The most frequently prescribed antibiotic class was third-generation cephalosporin (31.5%), with ceftriaxone being the most commonly prescribed antibiotic (15%). The majority of patients were prescribed one antibiotic (81.4%), and the intravenous route (96.4%) was the primary route for administration. The majority of patients were prescribed antibiotics empirically (69.7%), and community-acquired infections (64.2%) were the most common type of infection for antibiotic prescription. Similarly, sepsis (39.2%) was the most common indication for antibiotics, and the majority of prescribed antibiotics (61.7%) belonged to the ‘Watch’ category as per WHO AWaRe classification.Conclusion Our study revealed excessive antibiotic consumption in neonates and children, therefore quality improvement programmes including antimicrobial stewardship programmes are urgently needed to address ongoing issues.

ABSTRACTIntroduction Chronic kidney disease (CKD) is a major public health concern in Saudi Arabia. it is pertinent to mention that in the Southwestern region of Saudi Arabia. Hypertension and diabetes mellites are considered the major drivers of CKD. Research has documented worldwide the inappropriate dose adjustments in patients, ranging from 25% to 77%, of drugs requiring dose modifications. Pharmacists are pivotal members of the healthcare team, tasked with addressing issues pertaining to medications. This study aims to unveil pharmacist perspectives on renal dose adjustment in Saudi Arabia an important step in gauging their involvement in promoting healthy behaviours.Method A cross-sectional study design was conducted from December 2023 to January 2024 among pharmacists working in diverse healthcare settings, including clinical and hospital pharmacies, retail, and community pharmacies who had direct encounters with patients diagnosed with CKD. A validated questionnaire, the Renal Dose Adjustment-13 (RDQ-13) was used for this study. For comparing the knowledge, attitude, and perception scores of pharmacists statistical tests like One-Way ANOVA, and independent t-test; while for factors influencing the knowledge, attitude, and perception scores a multivariate linear regression was performed. The statistical significance level was set at 0.05.Results A total of 379 pharmacists completed the questionnaire, the knowledge score of pharmacists was 22.06 ± 2.81, while the attitude score was 8.56 ± 2.62 and the practice score was 5.75 ± 2.25. The findings of multivariate linear regression analysis indicated a statistically significant positive association between knowledge score and pharmacist’s age while for practice score the findings revealed a statistically negative association between working setting and designation of pharmacists.Conclusion The pharmacist in Saudi Arabia exhibited a proficient knowledge score of drug dosage adjustment pertinent to renal function while the attitude and practice score was less as compared to the knowledge score.

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

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

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

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

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

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

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

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

Abstract Background Structured lifestyle change education reduces the burden of cardiometabolic diseases such as diabetes. Delivery of these programs at worksites could overcome barriers to program adoption and improve program sustainability and reach; however, tailoring to the worksite setting is essential. Methods The Integrating Diabetes Prevention in Workplaces (INDIA-WORKS) study tested the implementation and effectiveness of a multi-level program for reducing cardiometabolic disease risk factors at 11 large and diverse worksites across India. Herein, we describe and classify program adaptations reported during in-depth interviews and focus group discussions with worksite managers, program staff, and peer educators involved in program delivery, and program participants and drop-outs. We used thematic analysis to identify key themes in the data and classified reported program adaptations using the FRAME classification system. Results Adaptations were led by worksite managers, peer educators, and program staff members. They occurred both pre- and during program implementation and were both planned (proactive) and unplanned (proactive and reactive). The most frequently reported adaptations to the individual-level intervention were curriculum changes to tailor lessons to the local context, make the program more appealing to the workers at the site, or add a wider variety of exercise options. Other content adaptations included improvements to the screening protocol, intervention scheduling, and outreach plans to tailor participant recruitment and retention to the sites. Environment-level content adaptations included expanding or leveraging healthy food and exercise options at the worksites. Challenges to adaptation included scheduling and worksite-level challenges. Participants discussed the need to continue adapting the program in the future to continue making it relevant for worksite settings and engaging for employees. Conclusion This study describes and classifies site-specific modifications to a structured lifestyle change education program with worksite-wide health improvements in India. This adds to the literature on implementation adaptation in general and worksite wellness in India, a country with a large and growing workforce with, or at risk of, serious cardiometabolic diseases. This information is key for program scale-up, dissemination, and implementation in other settings. Trial registration Clinicaltrials.gov NCT02813668. Registered June 27, 2016

Abstract With humans, animals and the environment being as interconnected as they are, the science describing their interactions needs to cut across disciplinary boundaries. Systems research at the interface between the three goes by several names, such as ‘Eco‐Health’ and ‘Planetary Health’, each with a varied focus, but the concept of ‘One Health’ (OH) has stood out as the most popular one. COVID‐19 has reiterated the importance of OH in response to health challenges. This review aimed to assess the OH approach integration and implementation level in Kerala state, India, in the context of emerging zoonotic diseases. A systematic literature review was conducted by searching for relevant articles with specific keywords across six electronic databases. This involved screening the initial hits for titles and abstracts, then systematic sorting to identify the ones that met the criteria, followed by more thorough scrutiny to finally shortlist the six studies to be included in the review. We found that OH in Kerala has made good progress, as evident from a few recent examples, but has a long way to go with significant challenges. In line with the study's aim, identifying and analysing what is already done, what is missing and what needs to be done can have wider implications for future OH implementation. Relevant threats and opportunities were identified, with lessons for Kerala and India and broader applications.

In this paper, the nonlinear space-time fractional extended Korteweg-de Vries (F-eKdV) equation involving the conformable fractional derivative (CFD) is considered. Bernoulli and Riccati equations as a simplest equation method together with applying modified traveling wave transformation are used to obtain the exact solution of F-eKdV equation. Also, by exp⁡(−Φ(ζ))-expansion method, different kind of exact traveling wave solutions are gained, including periodic-singular, dark-singular and plane-wave solutions. As a result, several soliton solutions of the proposed equation are revealed. These novel soliton waves are constructed using the software package Maple with some given parametric values and displayed graphically in 2-dimensional (2D) and 3-dimensional (3D) plots by using MATLAB. To illustrate how the fractional operator affects the results, some of the acquired solutions are presented for various values of the fractional order α and also compared to their exact solutions in classical case (i.e. α=1). In the given graphical representations, the physical meaning of the reported solutions is illustrated. From the obtained results, it is observed that the methods are effective and dependable to solve nonlinear fractional partial differential equations (NFPDEs).

Abstract Blockchain technology has gained significant attention in the most recent years due to its potential to address related issues to privacy, transparency, and security. In the healthcare industry, it is considered a promising solution to challenges related to data management, medical data privacy, and security. This paper proposes a novel framework for managing electronic medical healthcare records that uses Amazon Web Services (AWS) to create a secure and cost-effective solution. The proposed solution uses a serverless approach to reduce costs and only pay for the compute resources when needed. The framework focuses on improving the security of access to the blockchain network by implementing a multi-level security approach, starting from protecting the Hyperledger and implementing role-based access for end-users who require access to the stored data. The effectiveness of the proposed framework is demonstrated by creating a role-based access matrix for three different user types and performing multiple experiments to validate access for each user type.

The extension of the theory of generalized fractal–fractional calculus, named in this article as Martínez–Kaabar Fractal–Fractional (MKFF) calculus, is addressed to the field of integral equations. Based on the classic Adomian decomposition method, by incorporating the MKFF α,γ-integral operator, we establish the so-called extended Adomian decomposition method (EADM). The convergence of this proposed technique is also discussed. Finally, some interesting Volterra Integral equations of non-integer order which possess a fractal effect are solved via our proposed approach. The results in this work provide a novel approach that can be employed in solving various problems in science and engineering, which can overcome the challenges of solving various equations, formulated via other classical fractional operators.

In this work, some dynamical properties of Hill’s system are studied under the effect of continued fraction perturbation. The locations and kinds of equilibrium points are identified, and it is demonstrated that these points are saddle points and the general motion in their proximity is unstable. Furthermore, the curves of zero velocity and the regions of possible motion are defined at different Jacobian constant values. It is shown that the regions of forbidden motion increase with increasing Jacobian constant values and there is a noticeable decrease in the permissible regions of motion, leading to the possibility that the body takes a path far away from the primary body and escapes to take an unknown trajectory. Furthermore, the stability of perturbed motion is analyzed from the perspective of a linear sense, and it is observed that the linear motion is also unstable.

In this article, new results are investigated in the context of the recently introduced Abu-Shady–Kaabar fractional derivative. First, we solve the generalized Legendre fractional differential equation. As in the classical case, the generalized Legendre polynomials constitute notable solutions to the aforementioned fractional differential equation. In the sense of the fractional derivative of Abu-Shady–Kaabar, we establish important properties of the generalized Legendre polynomials such as Rodrigues formula and recurrence relations. Special attention is also devoted to another very important property of Legendre polynomials and their orthogonal character. Finally, the representation of a function f∈Lα2([−1,1]) in a series of generalized Legendre polynomials is addressed.

System-to-system communication via Application Programming Interfaces (APIs) plays a pivotal role in the seamless interaction among software applications and systems for efficient and automated service delivery. APIs facilitate the exchange of data and functionalities across diverse platforms, enhancing operational efficiency and user experience. However, this also introduces potential vulnerabilities that attackers can exploit to compromise system security, highlighting the importance of identifying and mitigating associated security risks. By examining the weaknesses inherent in these APIs using security open-intelligence catalogues like CWE and CAPEC and implementing controls from NIST SP 800-53, organizations can significantly enhance their security posture, safeguarding their data and systems against potential threats. However, this task is challenging due to evolving threats and vulnerabilities. Additionally, it is challenging to analyse threats given the large volume of traffic generated from API calls. This work contributes to tackling this challenge and makes a novel contribution to managing threats within system-to-system communication through API calls. It introduces an integrated architecture that combines deep-learning models, i.e., ANN and MLP, for effective threat detection from large API call datasets. The identified threats are analysed to determine suitable mitigations for improving overall resilience. Furthermore, this work introduces transparency obligation practices for the entire AI life cycle, from dataset preprocessing to model performance evaluation, including data and methodological transparency and SHapley Additive exPlanations (SHAP) analysis, so that AI models are understandable by all user groups. The proposed methodology was validated through an experiment using the Windows PE Malware API dataset, achieving an average detection accuracy of 88%. The outcomes from the experiments are summarized to provide a list of key features, such as FindResourceExA and NtClose, which are linked with potential weaknesses and related threats, in order to identify accurate control actions to manage the threats.

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

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