National University of Health Sciences

Introduction Social prescribing is an innovative approach to healthcare that involves referring patients to non-medical services and activities in the community to improve health and well-being. Pharmacists are well-positioned to contribute to social prescribing initiatives given their accessibility and expertise, but their involvement remains limited. Qualitative studies have explored pharmacists’ perspectives and experiences regarding social prescribing, but their findings have not been systematically synthesised. This protocol outlines a systematic review of qualitative studies to identify and synthesise the barriers and enablers influencing pharmacist involvement in social prescribing. Methods and analysis We will conduct a comprehensive search of electronic databases (PubMed, Web of Science, Embase, CINAHL, MEDLINE, The Cochrane Library, PsycINFO, Scopus) and grey literature sources for qualitative studies published in English from each database inception to January 2025 that explore barriers and facilitators to pharmacist involvement in social prescribing. Two reviewers will independently screen titles, abstracts and full texts for eligibility based on predefined criteria. Eligible studies will include those that use qualitative methods (eg, interviews, focus groups, observations) to explore the perspectives of pharmacists on factors influencing their involvement in social prescribing initiatives. Data will be extracted using a standardised form and synthesised using thematic analysis. The methodological quality of included studies will be appraised using the Critical Appraisal Skills Programme Qualitative Checklist. Confidence in the review findings will be assessed using the Grading of Recommendations Assessment, Development and Evaluation-Confidence in the Evidence from Reviews of Qualitative research approach. Ethics and dissemination Ethics approval is not required as this study will merely synthesise data from published studies. The results will be disseminated through peer-reviewed publications as well as conference presentations. PROSPERO registration number CRD42024600968.

Objective This scoping review aimed to map the volume (number of studies) and nature (topics and designs) of chiropractic education research and scholarly publications on chiropractic learners and programs worldwide. Introduction Despite the expansion of the chiropractic profession and its recognition by entities such as the World Health Organization, a gap exists in comprehending the international landscape of chiropractic education. No prior studies have systematically mapped the volume and nature of chiropractic education research and scholarly publications. A scoping review of chiropractic education research and scholarly publications is needed to guide future policy development, research agendas, and educational initiatives within the chiropractic profession. Inclusion criteria Publications in the indexed literature on chiropractic students, graduates, academics, and programs in any chiropractic education setting were included. Studies focused on chiropractic programs and education for chiropractic students or chiropractors worldwide. All research designs, literature reviews, descriptive studies, and commentaries were included. Methods This scoping review was conducted according to JBI methodology for scoping reviews and was reported according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR). The databases PubMed (NLM), Scopus, CINAHL via EBSCOhost, Index to Chiropractic Literature, Biblioteca Virtual em Saúde, and Educational Resources Information Center were searched from their inception to November 5 and 6, 2023, with no language limits. Data were extracted for primary topics, study designs, and regions of the included documents and entered in Covidence by paired independent reviewers. The findings were organized into figures and tables with a narrative description. Results The search identified 7494 documents. After deduplication, 5041 were screened for relevance, of which 667 were selected for full-text review. From these, 598 were selected for data extraction. The chiropractic education topics included values/ethical competence (n=3), personal/behavioral competence (n=34), knowledge and cognitive competence (n=49), functional and clinical competence (n=93), and program-relevant research (n=419). Most designs were quantitative (n=391), followed by descriptive reports (n=91), qualitative (n=43), mixed methods (n=40), commentaries (n=22), and literature reviews (n=11). Chiropractic education was most studied in the United States (n=359), Australia (n=116), and Canada (n=106). Conclusions This scoping review reports the volume and nature of indexed publications relating to chiropractic learners and programs worldwide. This body of literature contains learner competencies in knowledge, skills, and attitudes, as well as studies about chiropractic programs. The increasing number of publications and proportion of study designs over time show that chiropractic scholars and programs are engaged in collecting, analyzing, and distributing data relevant to education and training. The map of professional competencies in the chiropractic education literature shows that the profession possesses the fundamental traits needed to contribute to the global health care workforce. Review registration Open Science Framework https://osf.io/9b3ap

Background To estimate the additive associations of cardiometabolic multimorbidity (CMM) and depression on long‐term cognitive trajectory in multi‐regional cohorts and validate the generalizability of the findings in varying clinical settings. Method Data harmonization was performed across 14 longitudinal cohort studies within the Cohort Studies of Memory in an International Consortium (COSMIC) group, spanning North America, South America, Europe, Africa, Asia, and Australia. Three external validation studies with distinct settings were employed to assess generalizability. Cross‐sectional and longitudinal analyses were conducted. CMM was defined as: 1) CMM5: ≥ 2 among hypertension, hyperlipidemia, diabetes mellitus, stroke, and heart disease and 2) CMM3 (aligned with previous studies): ≥ 2 among diabetes mellitus, stroke, and heart disease. Depression was identified using the Geriatric Depression Scale, Center for Epidemiological Studies‐Depression scale, or medical history. A one‐step individual participant data meta‐analysis was utilized to investigate associations between the co‐occurrence of CMM and depression and cognitive outcomes in the COSMIC studies. Stratified analyses were conducted based on baseline dementia status, demographics, and APOE genotype. Repeated analyses were performed in external validation studies for generalization. Result Of the 32,450 older adults in the 14 COSMIC cohorts, we included 31,243 participants with complete data on CMM, depression, and cognitive assessment for cross‐sectional analyses. Among them, 23,242 who had at least 1 follow‐up cognitive assessment were included in the longitudinal analyses. From the three external studies we included 1964 participants, representing 3 multi‐ethnic Asian elderly cohorts (community cohort, memory clinic cohort, and stroke cohort). In the COSMIC studies analysis, the co‐occurrence of CMM and depression was associated with both cross‐sectional cognitive performance (β = ‐0.20, 95%CI = (‐0.25,‐0.16) for CMM5 and depression, β = ‐0.17, (95%CI = ‐0.044,‐0.031) for CMM3 and depression), and rate of cognitive decline (β = ‐0.038, 95%CI = (‐0.25,‐0.16) for CMM5 and depression, β = ‐0.023, (95%CI = ‐0.036, ‐0.009) for CMM3 and depression). This combined effect remained consistent across different subgroups particularly among participants without dementia. These findings were reproduced in the three external validation studies. Conclusion Our study demonstrated an additive effect between CMM and depression on cognitive decline. Targeting both cardiometabolic and psychological conditions could lead to greater effectiveness in delaying or preventing cognitive decline.

Climate change's effect on agriculture is a severe problem in every society, particularly in West Africa. The rising temperatures and extreme weather events have significant implications for food security. In this study, we examine the effects of CO2 emissions, agricultural advancements, and food availability on economic growth in West Africa from 1990 to 2020, using a panel ARDL approach with data from 14 countries. The analysis evaluates both long- and short-term effects, with the Dynamic Fixed Effects (DFE) estimator chosen as the most robust model. Results show no significant link between CO2 emissions and economic growth, while agriculture plays a key role, and food availability has mixed effects. The findings underscore the importance of sustainable agriculture and food security in promoting economic resilience in West Africa, offering insights for policymakers.

Introduction: Yeo’s index, the product of the mitral leaflet separation index and dimensionless index of mitral valve, was recently described to accurately identify severe rheumatic mitral stenosis (MS). We aimed to study the association between Yeo’s index and clinical outcomes in patients with rheumatic MS. Methods: We studied 297 patients with rheumatic MS. Clinical and echocardiographic data were obtained from the electronic medical record and Yeo’s index was measured in all cases. The outcome studied was a composite of all cause death, heart failure (HF) hospitalisation, mitral valve intervention and stroke or transient ischaemic attack. We also performed subgroup analysis of patients without pre-existing atrial fibrillation (AF) to assess for association with new onset AF. Results: After a median follow up of 6.3 years, 145 patients (48.8%) developed the composite outcome. Yeo’s index ( p <0.001), mitral valve area (MVA) by pressure half-time (PHT) ( p= 0.028) and planimetry ( p <0.001), age ( p =0.016), history of diabetes mellitus ( p =0.029), previous HF ( p =0.021), left ventricular ejection fraction ( p =0.022), and pulmonary artery systolic pressure ( p =0.007) were univariately associated with the composite outcome. Yeo’s index remained independently associated ( p <0.001, HR 0.094, 95% CI 0.260-0.340) with the composite outcome in multivariate analysis. In subgroup analysis of patients without pre-existing AF, Yeo’s index was independently associated ( p =0.024, HR 0.354, 95% CI 0.143-0.874) with new onset AF. MVA by PHT and planimetry were not associated with new onset AF. Conclusion: Yeo’s index was independently associated with clinical outcomes in patients with rheumatic MS.

We have developed maps of the predominant period of the ground and average S-wave velocity to depths of 10, 20 and 30 m (VS10, 20 and 30) as the fundamental data for seismic hazard assessment for Hue City, Central Vietnam. We conducted microtremor single-station measurements at 461 sites and microtremor array measurements at 157 sites in and around the city (i.e., within an area of about 15 km x 15 km). The peak period of horizontal-to-vertical spectral ratios (HVSR) obtained from three-component microtremor waveforms at a single station were regarded as a S-wave predominant period of the ground. Rayleigh-wave phase velocity at wavelengths of 13, 25 and 40 m obtained from vertical-component array measurements were regarded as VS10, 20 and 30, respectively. It revealed that the predominant periods range from 0.03 to 1.98 s (i.e., 0.5 to 33 Hz) in Hue City, which show a tendency to be longer in the northern part of the city than in the southern part. The analysis results of the average S-wave velocity indicate that soft sediments are very thick in the northern part of the city, where VS10, 20 and 30 ranges from 149 to 189 m/s. These analysis results are consistent with an existing geological map and quantify the geoenvironmental conditions in Hue City, indicating the effectiveness of the microtremor measurements for a seismic assessment.

Background Cardiometabolic multimorbidity (CMM) and depression are often co-occurring in older adults and associated with neurodegenerative outcomes. The present study aimed to estimate the independent and joint associations of CMM and depression on cognitive function in multi-regional cohorts, and to validate the generalizability of the findings in additional settings, including clinical. Methods Data harmonization was performed across 14 longitudinal cohort studies within the Cohort Studies of Memory in an International Consortium (COSMIC) group, spanning North America, South America, Europe, Africa, Asia, and Australia. Three external validation studies with distinct settings were employed for generalization. Participants were eligible for inclusion if they had data for CMM and were free of dementia at baseline. Baseline CMM was defined as: 1) CMM 5, ≥2 among hypertension, hyperlipidemia, diabetes, stroke, and heart disease and 2) CMM 3 (aligned with previous studies), ≥2 among diabetes, stroke, and heart disease. Baseline depression was primarily characterized by binary classification of depressive symptom measurements, employing the Geriatric Depression Scale and the Center for Epidemiological Studies-Depression scale. Global cognition was standardized as z-scores through harmonizing multiple cognitive measures. Longitudinal cognition was calculated as changes in global cognitive z-scores. A pooled individual participant data (IPD) analysis was utilized to estimate the independent and joint associations of CMM and depression on cognitive outcomes in COSMIC studies, both cross-sectionally and longitudinally. Repeated analyses were performed in three external validation studies. Findings Of the 32,931 older adults in the 14 COSMIC cohorts, we included 30,382 participants with complete data on baseline CMM, depression, and cognitive assessments for cross-sectional analyses. Among them, 22,599 who had at least 1 follow-up cognitive assessment were included in the longitudinal analyses. The three external studies for validation had 1964 participants from 3 multi-ethnic Asian older adult cohorts in different settings (community-based, memory clinic, and post-stroke study). In COSMIC studies, each of CMM and depression was independently associated with cross-sectional and longitudinal cognitive function, without significant interactions between them (Ps > 0.05). Participants with both CMM and depression had lower cross-sectional cognitive performance (e.g. β = −0.207, 95% CI = (−0.255, −0.159) for CMM5 (+)/depression (+)) and a faster rate of cognitive decline (e.g. β = −0.040, 95% CI = (−0.047, −0.034) for CMM5 (+)/depression (+)), compared with those without either condition. These associations remained consistent after additional adjustment for APOE genotype and were robust in two-step random-effects IPD analyses. The findings regarding the joint association of CMM and depression on cognitive function were reproduced in the three external validation studies. Interpretation Our findings highlighted the importance of investigating age-related co-morbidities in a multi-dimensional perspective. Targeting both cardiometabolic and psychological conditions to prevent cognitive decline could enhance effectiveness. Funding 10.13039/501100001809Natural Science Foundation of China and 10.13039/100000049National Institute on Aging/10.13039/100000002National Institutes of Health.

Purpose of review To systematically review costs associated with endourological procedures (ureteroscopy, URS; shockwave lithotripsy, SWL; and percutaneous nephrolithotomy, PCNL) for kidney stone disease (KSD), providing an overview of cost-effectiveness and health economics strategies. Recent findings A systematic review of the literature was performed, retrieving 83 English-written full-text studies for inclusion. Papers were labelled according to the respective area of interest: ‘costs of different procedures: SWL, URS, PCNL’, ‘costs of endourological devices and new technologies: reusable and disposable scopes, lasers, other devices’, ‘costs of KSD treatment in the emergency setting: emergency stenting versus primary URS’. Forty-three papers reported on associated cost for different procedures, revealing URS to be the most cost-effective. PCNL follows with higher hospitalization costs, while SWL appears to be least cost effective due to high need of additional procedures. The role of disposable and reusable scope is investigated by 15 articles, while other 16 reported on the role of different lasers, devices and techniques. The last nine studies included discussed the best and more cost-effective treatment for acute stone presentation, with promising results for primary URS versus emergency stenting and delayed URS. Summary Cost-effective and cost-conscious intervention is equally imperative to consider whilst weighing in clinical efficacy for endourological procedures. When a decision-making choice of SWL, URS or PCNL is offered to a patient, the outcomes must be balanced with a deeper understanding of additional cost burden of retreatment, reimbursement, repeated interventions, and recurrence. In todays’ practice, investing in endourological devices for KSD management must consider carefully the direct and hidden costs of using reusable and disposable technology. Cost control measures should not in any way compromise the quality of life or safety of the patient.

In this study, the propagation of ultrashort optical pulses in the context of long-distance optical fiber communications is numerically investigated. The method used is the finite difference scheme in the third order time domain and periodic boundary conditions. As a result, the obtained discrete system of ordinary differential equations is solved numerically by the fourth-order Runge–Kutta algorithm. The proposed algorithm was tested on various input pulses. Precise results of temporal mappings are presented.

Aims: To determine the roles of matrix metallopeptidase-9 (MMP9) on human coronary artery smooth muscle cells (HCASMCs) in vitro , early beginning of atherosclerosis in vivo in diabetic mice, and patients with diabetes. Methods: Active hMMP9 ( act-hMMP9) was added to HCASMCs and markers of inflammation were measured. Act-hMMP9 (n=16) or placebo (n=15) was administered to d i abetic KK.Cg- A y /J (KK) mice. Carotid artery inflammation and atherosclerosis measurements were made at 2 and 10 weeks after treatment. An observational study of newly diagnosed drug naïve patients with type 2 diabetes mellitus (T2DM n=234) and healthy matched controls (n=41) was performed and patients had ultrasound of carotid arteries and some had coronary computed tomography angiogram for the assessment of atherosclerosis. Serum MMP9 was measured and its correlation with carotid artery or coronary artery plaques were determined. Results: Act-hMMP9 induced inflammatory response in HCASMCs in vitro , including increased gene and protein expressions of MCP-1, ICAM-1, VCAM-1, and enhanced macrophage adhesion. Exogenous act-hMMP9 increased inflammation and initiated atherosclerosis in KK mice at 2 and 10 weeks: increased vessel wall thickness, lipid accumulation, and Galectin-3+ macrophage infiltration into the carotid arteries. In newly diagnosed T2DM patients, serum MMP9 correlated with carotid artery plaque size with a possible threshold cutoff point. In addition, serum MMP9 correlated with number of mixed plaques and grade of lumen stenosis in coronary arteries of patients with drug naïve T2DM. Conclusions: MMP9 contributes to the initiation of atherosclerosis and may be a potential biomarker for the early identification of atherosclerosis in patients with diabetes

We study the quantum characteristics of the Dirac oscillator within the framework of Heisenberg's generalized uncertainty principle. This principle leads to the appearance of a minimal length of the order of the Planck length. Hidden symmetries are identified to solve the model algebraically. The presence of the minimal length leads to a quadratic dependence of the energy spectrum on the quantum number n, implying the hard confinement property of the system. Thermodynamic properties are calculated using the canonical partition function. The latter is well determined by the method based on Epstein's zeta function. The results reveal that the minimal length has a significant effect on the thermodynamic properties.

Background The efficacy of endovascular treatment (EVT) in acute ischaemic stroke due to distal medium vessel occlusion (DMVO) remains uncertain. Our study aimed to evaluate the safety and efficacy of EVT compared with the best medical management (BMM) in DMVO. Methods In this prospectively collected, retrospectively reviewed, multicentre cohort study, we analysed data from the Multicentre Analysis of primary Distal medium vessel occlusions: effect of Mechanical Thrombectomy registry. Patients with acute ischaemic stroke due to DMVO in the M2, M3 and M4 segments who underwent EVT or received BMM were included. Primary outcome measures comprised 10 co-primary endpoints, including functional independence (mRS 0–2), excellent outcome (mRS 0–1), mortality (mRS 6) and haemorrhagic complications. Propensity score matching was employed to balance the cohorts. Results Among 2125 patients included in the primary analysis, 1713 received EVT and 412 received BMM. After propensity score matching, each group comprised 391 patients. At 90 days, no significant difference was observed in achieving mRS 0–2 between EVT and BMM (adjusted OR 1.00, 95% CI 0.67 to 1.50, p>0.99). However, EVT was associated with higher rates of symptomatic intracerebral haemorrhage (8.4% vs 3.0%, adjusted OR 3.56, 95% CI 1.69 to 7.48, p<0.001) and any intracranial haemorrhage (37% vs 19%, adjusted OR 2.61, 95% CI 1.81 to 3.78, p<0.001). Mortality rates were similar between groups (13% in both, adjusted OR 1.48, 95% CI 0.87 to 2.51, p=0.15). Conclusion Our findings suggest that while EVT does not significantly improve functional outcomes compared with BMM in DMVO, it is associated with higher risks of haemorrhagic complications. These results support a cautious approach to the use of EVT in DMVO and highlight the need for further prospective randomised trials to refine treatment strategies.

In this research, we introduce a groundbreaking distribution, termed the Modified Alpha Power Transformed Inverse Power Lomax Distribution (MAPT-IPLD), which offers a fresh perspective for modeling intricate datasets. By ingeniously amalgamating the modified alpha power transformation with the inverse power Lomax distribution, we have crafted a versatile and robust distribution family. We conduct a comprehensive examination of the theoretical characteristics of the MAPT-IPLD distribution, encompassing stochastic functions, quantile functions, measures, generic moments, probability-weighted moments, and Rényi entropy. .To showcase the practical utility of the MAPT-IPLD distribution, we apply it to diverse real-world datasets, demonstrating its efficacy in accurately capturing a wide array of phenomena. Through comparative analyses with existing models, we underscore its potential as a versatile tool for various statistical applications.In essence, the Modified Alpha Power Transformed Inverse Power Lomax Distribution represents a pioneering approach to statistical modeling, offering unparalleled flexibility and robust performance across a multitude of domains.

This study examined the connections between Benin's economic expansion, food production, agricultural productivity, and climate change. Using yearly statistics between 1961 and 2021, and R software version 4.2.2, we aim to: (1) Analyze how agricultural added value affects economic expansion; (2) analyze the effects of food production and temperature lagged values on economic growth; (3) investigate the different causality relationships between food production, temperature variation, agricultural added value and economic growth. To achieve these goals, statistical and econometric techniques such as Autoregressive Distributed Lags (ARDL) and the Toda-Yamamoto Granger causality framework were employed. The ARDL model verifies that there is a positive correlation between economic growth and the added value of agriculture based on empirical data. In addition, the Vector Autoregressive (VAR) model highlights the favorable impact of lagged food production values and the adverse effect of temperature fluctuations on economic growth. Granger causality analysis, employing the Toda-Yamamoto approach, unveils unidirectional links between food production and economic growth, as well as between temperature variation and agricultural added value. Interestingly, the study comes to the conclusion that there are no direct causal links between economic expansion and agricultural growth or between economic growth and temperature variance. Notably, bidirectional causality is established between livestock production and both economic growth and agricultural added value. These insights have significant implications for understanding climate change impacts on agriculture and suggest the need for adapted strategies to mitigate climate effects. Future research could focus on evaluating existing policies, exploring social and economic impacts, investigating market dynamics, and utilizing integrated assessment modeling to inform decision-making and foster sustainable economic growth in Benin's agricultural sector.

This article proposes and discusses a novel approach for generating trigonometric G-families using hybrid generalizers of distributions. The proposed generalizer is constructed by utilizing the tangent trigonometric function and distribution function of base model G(x). The newly proposed family of uni-variate continuous distributions is named the “Lomax Tangent Generalized Family of Distributions (LT-G)” and structural-mathematical-statistical properties are derived. Some special and sub-models of the proposed family are also presented. A Weibull-based model, ‘The Lomax Tangent Weibull (LT-W) Distribution,” is discussed and the plots of density (pdf) and hazard (hrf) functions are also explained. Model parameter estimates are estimated by employing the maximum likelihood estimation (MLE) procedure. The accuracy of the MLEs is evaluated through Monte Carlo simulation. Last but not least, to demonstrate the flexibility and potential of the proposed distribution, two actual hydrological and strength data sets are analyzed. The obtained results are compared with well-known, competitive, and related existing distributions.

In a context where sustainable construction and ecology are increasingly central, the construction industry is constantly seeking alternative materials that are both economical and eco-friendly. Concurrently, global rice production generates significant amounts of rice husks, often considered as low-value waste. This study deviates from traditional approaches that favor the use of rice husk ash (RHA) as a mineral additive, to explore the potential of rice husks themselves as a complete substitute for sand in concrete formulations. After meticulous characterization of the physicochemical properties of rice husks, several concrete formulations were designed and subjected to a battery of tests. The results are promising. They show that concrete based on rice husks exhibits satisfactory mechanical properties for a wide range of applications, from slabs to load-bearing walls. The compressive strength varies between 0.56 MPa and 5.41 MPa depending on the composition, while the thermal conductivity falls within a range of 0.070 W m⁻¹ K⁻¹ to 0.129 W m⁻¹ K⁻¹, which is comparable to other agro-concretes. This research highlights the promising potential of rice husks as a sand substitute material in concrete. It thus paves the way for more ecologically responsible and economically viable construction alternatives, while proposing a value-added solution for a widely available agricultural byproduct.

Purpose To assess management and outcomes of bladder neck stenosis (BNS) post-transurethral resection of the prostate (TURP) in 12 centers. Patients and Methods A retrospective analysis of patients who underwent transurethral BN incision for stenosis following TURP from January 2015 and January 2023 was performed. Inclusion criteria included endoscopic diagnosis of BNS associated with obstruction and/or lower urinary tract symptoms. Data are presented as median and interquartile range. Two distinct univariable logistic regression analyses were performed to identify factors associated with overall urinary incontinence and recurrent stenosis. Results Three hundred and seventy-two men were included. 95.2% of patients developed BNS following bipolar TURP. 21.0% of patients were on an indwelling catheter before BNS incision. Bipolar electrocautery was the most commonly employed energy for incision (66.5%). Collings knife was the most commonly employed (61.2%) instrument for incision, followed by end-firing holmium lasering (35.3%). Median operation time was 30 (25–45) minutes. The overall complication rate was 12.4%, with 19 (5.1%) patients suffering from acute urinary retention, 6 (1.6%) patients requiring prolonged irrigation due to persistent hematuria, and a surgical hemostasis was necessary in 8 cases (2.2%). Overall postoperative incontinence rate was 17.2%, with urge incontinence accounting for the most common type (45.3%). Incontinence lasted more than 3 months in 9/46 (14.3%) patients. Recurrent BNS occurred in 29 (7.8%) patients and was managed by re-endoscopic incision in 21 (5.6%) patients and dilatation only in 6 (1.6%) patients. Two (0.5%) patients underwent urethroplasty for recalcitrant stenosis. Logistic regression analysis showed that Collings knife was associated with higher odds of having postoperative incontinence (OR 3.93 95% CI 1.45–11.13, p=0.008) and BN recurrence (OR 3.589 95% CI 1.157–15.7, p=0.047). Conclusion Transurethral BN incision provides satisfactory short-term results with an acceptable rate of complications.