PLOS ONE

Introduction Decentralized COVID-19 testing with antigen rapid diagnostic tests (Ag-RDT) is recommended by the Nigerian Centre for Disease Control for community-level services. These services have been provided in Primary Healthcare Centers, Community Pharmacies, and licensed “Patent Medicine Stores” that serve the least affluent communities. To support quality assurance, we applied an adapted version of SPI-RT (Stepwise Process for Improving the Quality of HIV Rapid and Recency Testing) to sites providing COVID-19-RDTs in Federal Capital Territory of Nigeria. Methods Between September 2022 and February 2023 community healthcare facilities (48 Community Pharmacies, 21 Patent Medicine Stores, 79 Primary Health Centers) were evaluated using Stepwise Process for Improving the Quality of SARS-CoV-2 Antigen Rapid Diagnostic Testing (SPI-RT) Checklist, tailored to the local implementation context. Evaluated domains included service quality, documents and records, personnel training and certification, safety, physical infrastructure, pre-testing phase, testing phase, and post-testing phase. Each facility received an overall score, expressed as a percentage indicating their performance level. Results 41/79 (52%) of Primary Health Centers scored at least 90% for service quality, as did 19/48 (40%) of pharmacies, with only 1/21 (4.8%) Patent Medicine Store. Apart from personnel training and certification, Primary Health Centers scored highest across most domains of service quality, followed by Community Pharmacies. The lowest median score in any domain was in the Patent Medicine Stores on testing and safety at 60% for both post-testing phase and safety. Conclusion Primary Healthcare Centers and Community Pharmacies can provide quality decentralized testing for COVID-19. Patent Medicine Stores may need additional support including monitoring and quality improvement initiatives to ensure the provision of high-quality decentralized COVID-19 rapid testing services.

Enteroviruses and rhinoviruses are highly diverse, with over 300 identified types. Reverse transcription-polymerase chain reaction (RT-PCR) assays targeting their VP1, VP4, and partial VP2 (VP4-pVP2) genomic regions are used for detection and identification. The VP4-pVP2 region is particularly sensitive to RT-PCR detection, making it efficient for clinical specimen analysis. However, a standard type identification method using this region is lacking. This study aimed to establish such a method by examining the divergence of VP4-pVP2 amino acid sequences between enterovirus and rhinovirus prototypes. Pairwise analysis of 249 types indicated a 95% threshold for enterovirus intra-species identification but not for rhinovirus prototypes. Protein BLAST search analyses of representative enterovirus prototypes, including EV-A71, EV-D68, CVA6, CVA10, CVA16, and polioviruses (PVs), validated the 95% threshold for typing, with a few exceptions such as PV1-PV2 and CVA6-CVA10, as well as some EV-C types. This study proposes a criterion for typing based on VP4-pVP2 amino acids, which can aid in rapid enterovirus diagnosis during routine clinical or environmental surveillance and emergency outbreaks. Our research confirms the reliability of the suggested VP4-pVP2-based threshold for typing and its potential application in laboratory settings.

Background The prevalence and impact of obesity and overweight is one of the main concerns among researchers worldwide. There are several consequences of overweight and obesity among students in developing countries like Bangladesh. Therefore, this study aims to explore the prevalence and impact of overweight or obesity on individuals’ self-esteem and academic performance among university students in Bangladesh. Methods and materials This study is based on primary data that was collected from 600 students of Jahangirnagar University using a well-structured questionnaire. The questionnaire included demographic information, the Rosenberg Self-Esteem Scale (RSES), and the International Physical Activity Questionnaire (IPAQ-7). The summary statistics, the Fisher exact test, the Chi-square test, and the Pearson correlation matrix were computed. A logistic regression model assessed the relationship between low self-esteem and other variables such as demographic characteristics, BMI status, and physical activities. Results The findings indicate that 38.2% of the students are overweight or obese, and the prevalence rate is high among males. The lowest academic performance across all disciplines is observed among obese students. A negative correlation is observed between BMI and self-esteem (r = -0.41) and academic performance is negatively linked with overweight or obese (r = -0.26) Results depict that overweight/obese students are 7.11 times more likely to have low self-esteem (AOR: 7.11, 95% CI: 4.59–11.02) compared to normal students. Conclusions Overweight and obese students are more prone to lower academic performance and low self-esteem, considering physical inactivity and irregular dietary patterns. Therefore, university authorities ought to encourage students to engage in physical activities and should create awareness among students about the beneficial effects of nutritious foods and the importance of physical exercise.

Air pollution constitutes a significant worldwide environmental challenge, presenting threats to both our well-being and the purity of our food supply. This study suggests employing Recurrent Neural Network (RNN) models featuring Long Short-Term Memory (LSTM) units for forecasting PM10 particle levels in multiple locations in Skopje simultaneously over a time span of 1, 6, 12, and 24 hours. Historical air quality measurement data were gathered from various local sensors positioned at different sites in Skopje, along with data on meteorological conditions from publicly available APIs. Various implementations and hyperparameters of several deep learning models were compared. Additionally, an analysis was conducted to assess the influence of urban traffic on air and noise pollution, leveraging the COVID-19 lockdown periods when traffic was virtually non-existent. The outcomes suggest that the proposed models can effectively predict air pollution. From the urban traffic perspective, the findings indicate that car traffic is not the major contributing factor to air pollution.

Differentiating subjects through the comparison of their recorded speech is a common endeavor in speaker characterization. When using an acoustic-based approach, this task typically involves scrutinizing specific acoustic parameters and assessing their discriminatory capacity. This experimental study aimed to evaluate the speaker discriminatory power of vowel formants—resonance peaks in the vocal tract—in two different speaking styles: Dialogue and Interview. Different testing procedures were applied, specifically metrics compatible with the likelihood ratio paradigm. Only high-quality recordings were analyzed in this study. The participants were 20 male Brazilian Portuguese (BP) speakers from the same dialectal area. Two speaker-discriminatory power estimates were examined through Multivariate Kernel Density analysis: Log cost-likelihood ratios (Cllr) and equal error rates (EER). As expected, the discriminatory performance was stronger for style-matched analyses than for mismatched-style analyses. In order of relevance, F3, F4, and F1 performed the best in style-matched comparisons, as suggested by lower Cllr and EER values. F2 performed the worst intra-style in both Dialogue and Interview. The discriminatory power of all individual formants (F1-F4) appeared to be affected in the mismatched condition, demonstrating that discriminatory power is sensitive to style-driven changes in speech production. The combination of higher formants ‘F3 + F4’ outperformed the combination of lower formants ‘F1 + F2’. However, in mismatched-style analyses, the magnitude of improvement in Cllr and EER scores increased as more formants were incorporated into the model. The best discriminatory performance was achieved when most formants were combined. Applying multivariate analysis not only reduced average Cllr and EER scores but also influenced the overall probability distribution, shifting the probability density distribution towards lower Cllr and EER values. In general, front and central vowels were found more speaker discriminatory than back vowels as far as the ‘F1 + F2’ relation was concerned.

In the face of increasingly diverse demands from tourists, traditional methods for scenic route planning often struggle to meet these varied needs. To address this challenge and enhance the overall service quality of tourist destinations, as well as to better understand individualized preferences of visitors, this study proposes a novel approach to scenic route planning and itinerary customization based on multi-layered mixed hypernetwork optimization. Firstly, an adaptive multi-route feature extraction method is introduced to capture personalized demands of tourists. Subsequently, a personalized tourist inference method based on a multi-layered mixed network is presented, utilizing the extracted personalized features to infer the true intentions of the tourists. Lastly, we propose a hypernetwork optimized route planning method, incorporating the inference results and personalized features to tailor the optimal touring paths for visitors. The results of our experiments underscore the efficacy of our methodology, attaining an accuracy score of 0.877 and an mAP score of 0.881 and outperforming strong competitors and facilitating the design of optimal paths for tourists.

Tomato spotted wilt orthotospovirus (TSWV) is one of the most destructive pathogens and causes serious losses in agriculture worldwide. Biogenic pesticides application may be an effective approach for defending against TSWV. Tagitinin A (Tag A) extracted from Tithonia diversifolia (Hemsl.) A. Gray has a high protective effect against TSWV infection. Tag A can induce jasmonic acid to suppress gene expression in TSWV. In this study, the F-box protein (CPR30) was mediated by Tag A, the expression of the CPR30 gene in Tag A-treated leaves was significantly higher (2 times) than that of the negative control. Furthermore, the replication of TSWV-NSm/NSs genes and the expression of TSWV-NSm/NSs proteins significantly increased after silencing the CPR30 gene in protective assays; CPR30 overexpression showed the opposite tendency. The CPR30 protein only localized and interacted with the TSWV-NSm protein. Thus, this study reveals a new mechanism by which Tag A mediates ubiquitin–protein ligase E3 (CPR30) to interact with NSm inhibite NSm replication and expression, and defend against systemic TSWV infection.

RNA-modifying enzymes have recently garnered considerable attention due to their relevance in cancer biology, identifying them as potential targets for novel therapeutic intervention. THUMPD3 was recently identified as an RNA methyltransferase catalysing N²-methylguanosine (m²G) within certain tRNAs. In this study, we unveil a novel role for THUMPD3 in lung cancer cells. Depletion of the enzyme from lung cancer cells significantly impairs their fitness, negatively impacting key cellular processes such as proliferation and migration. Notably, exogenous expression of THUMPD3 in normal lung fibroblasts stimulates their proliferation rate. Additionally, transcriptome-wide analyses reveal that depletion of THUMPD3 from lung cancer cells induces substantial changes in the expression of cell surface proteins, including those comprising the extracellular matrix (ECM). We further demonstrate that THUMPD3 maintains expression of an extra-domain B (EDB) containing pro-tumour isoform of Fibronectin-1 mRNA, encoding FN1, an important ECM protein. Crucially, depletion of THUMPD3 promotes an alternative splicing event that removes the EDB-encoding exon from Fibronectin-1. This is consistent with THUMPD3 depletion reducing cellular proliferation and migration. Moreover, depletion of THUMPD3 selectively and preferentially affects the alternative splicing of ECM and cell adhesion molecule encoding transcripts, as well as those encoding neurodevelopmental proteins. Overall, these findings highlight THUMPD3 as an important player in regulating cancer-relevant alternative splicing and they provide a rationale for further investigations into THUMPD3 as a candidate target in anti-cancer therapy.

Background This systematic review evaluates occupational health within the Gulf Cooperation Council (GCC) countries, focusing on ergonomic, physical, chemical, and biological hazards. It identifies significant impacts of these hazards across various professions and underscores the highlights for region-specific strategies and further research. Methods A comprehensive search in Scopus, PubMed, and Web of Science databases until October 2023 targeted occupational health studies in the GCC, adhering to PRISMA guidelines and NIH Quality Assessment Tools. The protocol was registered on PROSPERO (CRD42023465909). Results From 2202 articles screened, 202 were included, with publications distributed as follows: Saudi Arabia (121), United Arab Emirates (26), Kuwait (20), Oman (15), Qatar (13), and Bahrain (7). Findings indicate that ergonomic hazards, characterized by musculoskeletal disorders, are influenced by job roles and work environments. Physical hazards, particularly needlestick injuries, eye safety concerns, and risks from extreme temperatures and radiation, were notable across the region. Chemical hazards, including exposure to pesticides, cement, and petrochemicals, were identified as significant health risks, necessitating better safety measures. Biological hazards, evidenced in studies from Oman, UAE, and Saudi Arabia, highlighted the risks from infectious agents and parasites, stressing the need for effective prevention and hygiene practices. Conclusion The review advocates for the urgent development of comprehensive health policies to mitigate occupational hazards in the GCC. It highlights the need for collaborative efforts to address ergonomic challenges, enhance protective measures, and respond to chemical and biological risks effectively. Region-specific strategies, ongoing research, and technological advancements are crucial for ensuring workforce safety in these evolving environments.

Salivary microRNAs (miRNAs) have been recently revealed as the next generation of non-invasive biomarkers for the diagnostics of diverse diseases. However, their short and highly homologous sequences make their quantification by RT-qPCR technique highly heterogeneous and study dependent, thus limiting their implementation for clinical applications. In this study, we evaluated the use of a widely used commercial RT-qPCR kit for quantification of salivary miRNAs for clinical diagnostics. Saliva from ten healthy volunteers were sampled four times within a three month time course and submitted for small RNA extraction followed by RT-qPCR analysed. Six miRNAs with different sequence homologies were analysed. Sensitivity and specificity of the tested miRNA assays were corroborated using synthetic miRNAs to evaluate the reliability of all tested assays. Significant variabilities in expression profiles of six miRNAs from ten healthy participants were revealed, yet the poor specificity of the assays offered insufficient performance to associate these differences to biological context. Indeed, as the limit of quantification (LOQ) concentrations are from 2–4 logs higher than that of the limit of detection (LOD) ones, the majority of the analysis for salivary miRNAs felt outside the quantification region. Most importantly, a remarkable number of crosstalk reactions exhibiting considerable OFF target signal intensities was detected, indicating their poor specificity and limited reliability. However, the spike-in of synthetic target miRNA increased the capacity to discriminate endogenous salivary miRNA at the LOQ concentrations from those that were significantly lower. Our results demonstrate that comparative analyses for salivary miRNA expression profiles by this commercial RT-qPCR kit are most likely associated to technical limitations rather than to biological differences. While further technological breakthroughs are still required to overcome discrepancies, standardization of rigorous sample handling and experimental design according to technical parameters of each assay plays a crucial role in reducing data inconsistencies across studies.

Cognitive Diagnostic Computerized Adaptive Testing (CD-CAT), in conjunction with nonparametric methodologies, is an adaptive assessment tool utilized for diagnosing students’ knowledge mastery within smaller educational contexts. Expanding upon this framework, this study introduces the blocked procedure previously used in the parametric CD-CAT, enhancing the flexibility of nonparametric CD-CAT by enabling within-block item review and answer modification. A simulation study was conducted to evaluate the performance of this blocked procedure within the context of nonparametric CD-CAT across varied conditions. With increasing block size, there was a marginal reduction in pattern correct classification rate; however, such differences diminished as item quality or test length augmented. Overall, under a majority of conditions, the blocked procedure, characterized by block sizes of 2 or 4 items, allows item review within-block while attaining satisfactory levels of classification accuracy. The integration of within-block item review and answer modification with nonparametric CD-CAT fosters a more adaptive and learner-centric testing environment.

The majority of migration moves globally are internal within national borders. This makes internal migration intensities an important component for understanding the dynamics of population change according to size, composition and across geographies. While incorporating migration into demography’s quantitative framework allows a description of population change across both time and space, and mathematical and conceptual frameworks for migration have been developed, researchers lack a public repository of historical age-origin-destination-specific migration probabilities that is in a common format and spans a range of countries. Addressing this requires a robust method for inferring migration probabilities from census and survey data when there are significant levels of uncertainty from small-sample noise and age aggregation. In this paper we extend the P-TOPALS and P-spline methods for smoothing migration probabilities to apply to grouped data by ages to develop a methods protocol for a harmonised, homogeneous format and multi-nation Human Internal Migration Database. We find our method out-performs a hybrid spline-parametric method in terms of both accuracy and plausibility. We illustrate the method by estimating complete age-origin-destination migration probabilities for more than 50 countries using microdata samples from IPUMS International. This work advances the stock of migration data from which demographers and others can draw from in the analysis and projection of population change.

Accurate disease spread modeling is crucial for identifying the severity of outbreaks and planning effective mitigation efforts. To be reliable when applied to new outbreaks, model calibration techniques must be robust. However, current methods frequently forgo calibration verification (a stand-alone process evaluating the calibration procedure) and instead use overall model validation (a process comparing calibrated model results to data) to check calibration processes, which may conceal errors in calibration. In this work, we develop a stochastic agent-based disease spread model to act as a testing environment as we test two calibration methods using simulation-based calibration, which is a synthetic data calibration verification method. The first calibration method is a Bayesian inference approach using an empirically-constructed likelihood and Markov chain Monte Carlo (MCMC) sampling, while the second method is a likelihood-free approach using approximate Bayesian computation (ABC). Simulation-based calibration suggests that there are challenges with the empirical likelihood calculation used in the first calibration method in this context. These issues are alleviated in the ABC approach. Despite these challenges, we note that the first calibration method performs well in a synthetic data model validation test similar to those common in disease spread modeling literature. We conclude that stand-alone calibration verification using synthetic data may benefit epidemiological researchers in identifying model calibration challenges that may be difficult to identify with other commonly used model validation techniques.

Aim The recent EMPA-KIDNEY trial showed evidence for preventing disease progression in adult patients with chronic kidney disease (CKD) treated with empagliflozin. It is however yet unknown if use of empagliflozin is cost effective in the Netherlands. We aimed to evaluate the cost effectiveness of empagliflozin in adult patients with CKD in the Netherlands. Methods A cost-effectiveness analysis was conducted using a Markov state microsimulation model, simulating kidney progression of CKD patients with eGFR <90 ml/min per 1.73 m2 comparing empagliflozin plus standard of care (SoC) and SoC alone. KDIGO classification was used to describe the risk of CKD progression. The input data were taken from the EMPA-KIDNEY trial (baseline characteristics, treatment effect, and utilities), and published data and national sources were used for general population mortality, treatment and event costs. The analyses were performed from a societal perspective with applying a lifetime horizon. Discounting was done according to the Dutch pharmacoeconomic guidelines. The incremental cost-effectiveness ratio (ICER) was compared to a willingness-to-pay threshold of €50,000/QALY. Deterministic and probabilistic sensitivity analyses were performed to explore the impact of uncertainty around the input parameters. Results The base-case results showed total discounted costs for empagliflozin plus SoC and SoC alone of €200,193 and €234,574 respectively, indicating total savings of €34,380. Empagliflozin plus SoC was associated with higher total discounted health benefits of 11.06 life years (LYs) and 9.01 quality-adjusted life years (QALYs), compared with 9.74 LYs and 7.79 QALYs for SoC alone, resulting in an additional 1.31 LYs and 1.22 QALYs for empagliflozin plus SoC. Empagliflozin plus SoC is a dominant alternative compared to SoC alone. Sensitivity analyses confirmed the robustness of the findings and conclusion. Conclusion Using empagliflozin in addition to SoC in adult patients with CKD is likely to be cost saving compared to the current SoC in the Netherlands, irrespective of diabetes status and albuminuria.

Background The World Health Organisation (WHO) estimates that about 3.2 billion people which is nearly half of the world’s population are at risk of malaria. Annually about 216 million cases and 445,000 deaths of malaria occur globally. Africa accounted for 90% and 91% of the malaria cases and deaths respectively. Zambia has earmarked malaria elimination on its path to Universal Health Coverage (UHC). This paper aims to determine the incidence of Out-of-Pocket Payments (OOP) and Catastrophic Health Expenditures (CHE) and impoverishment among households with malaria patients in Zambia. The paper focusses on the incidence of OOP and impoverishment for malaria in a setting without user fees for accessing primary malaria health care services and virtually no user fees at all levels of care if referred through the referral system. The results of this study will also serve as a baseline for tracking Zambia’s path towards achieving malaria financial access on its path towards UHC among patient with malaria. Methods The study uses a nationally representative cross-sectional survey of households in both rural and urban areas of Zambia. The study employed probability sampling procedures. A two-stage stratified cluster sample design was used. We analyse a total of 2,005 households that had at least one member suffering from malaria with a recall period of four weeks for out-patients and six months for the in-patient respectively. A logistic regression model was estimated with a Categorical Dependent variable being CHE (CHE = = 1, or otherwise = = 0). A household is considered impoverished if it fell below the poverty line due to OOP. All data was analyzed using Stata version 2013. Results and discussion The results show that although the country has a free malaria policy at primary care level and virtually at all levels if referred through the health system process, households are still incurring costs in accessing health care services. Incidence of CHE and impoverishment were reflected at all levels. In terms of CHE, the poorest contributed almost 30% while the wealthier quintile contributed about 10%. Similarly, impoverishment effects of OOPs are more pronounced in the poorest quintile. The OOP composed mainly of transport, followed by diagnosis and medicines and was lowest for Insecticide-treated bed nets (ITNs) payments. The high costs of transport that the households had to incur when accessing health services could be due to the long distance that the households have to face as they travel to the health facilities as most of the facilities in Zambia are still outside the 5 km radius. The drug expenditure could be explained by the drugs running out of stock. Low expenditure on ITNs could be due to the country’s strategy of mass distribution working to give the country’s universal financial protection on ITNs for malaria. Conclusion and policy implications This study sought to address gaps in OOP and the associated incidence of CHE and impoverishment for malaria, distribution of OOP among Social Economic Status (SES) setting and determinants of OOP in Country that has earmarked malaria elimination in the UHC agenda. Understanding household’s costs related to malaria will enable targeting intervention to accelerate Zambia’s path towards elimination of malaria and therefore contribute to attainment of the Sustainable Development Goals of household’s financial access to UHC. Thus, the study will also serve as a baseline for tracking UHC for household financial access to malaria care that the country has embarked on.

Although malaria is endemic in coastal Côte d’Ivoire, updated data on the resistance profile of the main vector, Anopheles gambiae sensu lato (s.l.), are still lacking, thus compromising decision-making for an effective vector control intervention. This study investigated the complex members and the insecticide resistance in the Anopheles gambiae s.l. populations in coastal Côte d’Ivoire. Between 2018 and 2020, cross sectional survey bioassays were conducted on female An. gambiae s.l. mosquitoes in three coastal health districts (Aboisso, Jacqueville and San Pedro) of Côte d’Ivoire. Pyrethroids deltamethrin, permethrin and alphacypermethrin (1X, 5X and 10X), clothianidin and synergist piperonyl butoxide (PBO) combined with pyrethroid 1X were tested using WHO tube bioassays. Chlorfenapyr was evaluated using CDC bottle bioassays. An. gambiae complex members and kdr 995F, kdr 995S and Ace-1 280S mutations were identified using polymerase chain reaction (PCR) technique. Overall, An. gambiae s.l. populations were primarily composed of Anopheles coluzzii (88.24%, n = 312), followed by Anopheles gambiae sensu stricto (7.56%) and hybrids (4.17%). These populations displayed strong resistance to pyrethroids at standard diagnostic doses, with mortality remaining below 98% even at 10X doses, except for alphacypermethrin in Aboisso. Pre-exposure to PBO significantly increased mortality but did not induce susceptibility, except for alphacypermethrin in Jacqueville. Clothianidin induced full susceptibility in Jacqueville and San Pedro, while chlorfenapyr induced susceptibility in Aboisso at 100 μg ai/bottle and all three districts at 200 μg ai/bottle. kdr 995F mutation dominated, with frequencies varying from 71.2% to 79.3%. kdr 995S had low, rates with frequencies ranging from 2.3% to 5.7%. Ace-1 280S prevalence varied between 4.2% and 42.9%. Coastal Côte d’Ivoire’s An. gambiae s.l. populations were mainly composed of An. coluzzii and showed high resistance to pyrethroids. Clothianidin, chlorfenapyr, and PBO with pyrethroids increased mortality, indicating their potential use as an alternative for malaria vector control.

This study aimed to investigate the impact of a lubricant derived from trimethylolpropane trioleate on power consumption and surface roughness during high-speed drilling of Al-6061, with the goal of developing an environmentally friendly cutting fluid. The study investigated the impact of additive concentration, spindle speed, and feed rate on energy consumption and surface roughness using a Taguchi L27 orthogonal array. Through analysis of the Taguchi experimental outcomes and single-to-noise ratios, the parameters were ranked accordingly. The results of the ANOVA analysis reveal that spindle speed has the greatest impact on Power (87.89%), followed by followed feed rate (6.96%) and additive concentration (2.98%). However, feed rate (43.51%) has the most significant influence on surface roughness, followed by speed (38.48%) and additive concentration (11.90%). Varying additive concentration affects more on surface quality rather than power consumption. Furthermore, a machine learning algorithm was developed to forecast and compare various key aspects of high-speed drilling machinability, including power and surface roughness. Three different measures of accuracy were used to evaluate the performance of the projected values: coefficient of determination (R2), mean absolute percentage error, and mean square error. The decision tree performed better than other models in accurately predicting power and surface roughness. This research introduces an innovative method for assessing the most effective biodegradable cutting fluid and forecasting power and surface quality by developing an optimal combination.

Background Caregivers of young children may have been particularly vulnerable to mental health challenges during the COVID-19 pandemic due to its negative impacts on their housing, finances, and childcare demands. This study explored the associations between COVID-19-related experiences and symptoms of depression and anxiety among Ugandan caregivers. Methods This cross-sectional study included 100 Ugandan caregivers of young children aged 6–59 months with uncomplicated malaria and iron deficiency (N = 85) and without malaria or anemia (N = 15) who were enrolled in the Optimizing Iron Status in Malaria-Endemic Areas (OptiM) study. Sociodemographic data and COVID-19 experiences were collected using an internally developed survey and symptoms of depression and anxiety were measured using the Hopkins Symptom Checklist (HSCL-25) and the Center for Epidemiologic Studies Depression (CESD-20) scale. Multiple linear regression models were used to assess the associations between COVID-19 survey scores with HSCL-25 or CESD-20 scores. Results Nearly half of caregivers reported clinically meaningful symptoms of depression (46%) and/or anxiety (49%). Caregivers had more severe symptoms of depression and/or anxiety if they experienced greater changes in living situations or decreases in physical activity (CESD-20: β = 3.35, 95% CI [1.00, 5.70], p = .01), food insecurity (HSCL-25: β = 3.25, 95% CI [0.41, 6.10], p = .03, CESD-25: β = 3.09, 95% CI [0.79, 5.39], p = .01), and domestic violence (HSCL-25: β = 3.82, 95% CI [0.94, 6.70], p = .01) during COVID-19. These associations did not vary depending on whether the caregivers had children with malaria. Conclusions Negative COVID-19 experiences were significantly associated with more severe depression and anxiety in Ugandan caregivers, regardless of their children’s malaria status. Urgent attention and action are needed to support the mental well-being of this vulnerable population. Further prospective studies should investigate the long-term impact of COVID-19 on caregivers and their children.

People who experience gambling harms commonly experience stigmatisation, which is detrimental to psychological wellbeing, and a significant barrier to help-seeking. While there have been efforts to challenge stigmatisation, there is little empirical evidence available to inform such initiatives. To address this gap in knowledge, we conducted a thematic analysis of naturalistic data in the form of posts made on online support forums by people with experience of gambling-related harm, in order to understand how they are stigmatised, and to identify barriers to help-seeking. Five main themes were identified: (a) beliefs about the nature and origin of gambling addiction, which related to participants’ beliefs about causes of gambling harm and cognitions about the nature of addiction; (b) self-stigma, which encompassed the frequent and substantial incidences of self-stigma; (c) anticipated stigma, which described the stigma and discrimination people expected to face because of their gambling harm; (d) stigmatising other people who experience gambling harm, which describes the ways in which some people who experienced gambling harms stigmatised other people who experienced gambling harms; and (e) experienced stigma and discrimination, which encompassed the experienced stigmatisation people encountered. Experiences discussed/described within the forums were developed into a timeline of gambling harms which was cyclical in nature and involved six stages: onset, concealment of problems, crisis point, disclosure of problems, recurrence of harms (sometimes termed ‘relapse’) and recovery. The study highlights the impact of societal stigma on individuals’ self-perception and interactions, particularly emphasising the challenges experienced during relapse periods, which heighten stigma and distress. The study also identifies potential avenues for stigma reduction, including targeted campaigns addressing societal, anticipated, and self-stigma.

Aim To investigate the clinical efficacy of population-based treatment of human papillomavirus (HPV) infections with Paiteling. Methods Between 1 June 2024 and 31 August 2024, 575 HPV-infected patients attending The First People’s Hospital of Jingzhou gynecology outpatient clinic from October 2020 to December 2023 were retrospectively collected, all of whom were analyzed for HPV subtype infection and the presence or absence of cytomorphological abnormality using HPV-DNA testing and TCT; they were divided into 319 cases in the Paiteling group and 256 cases in the Interferon group, and the patients of both groups were subjected to TCT 1 month after the end of the administration of the medication and HPV review. Results 1. The three most frequent subtypes of HPV in this data are HPV 16, HPV 52, and HPV 58, all of which are high-risk types; 2. The results of the post-treatment review of HPV infection showed that the overall effective rate of the Paiteling group was better than that of the Interferon group, and the difference in the cumulative effective rate between the two groups was statistically significant (P < 0.001); 3. Comparative analysis of patients with 14 high-risk types of human papillomavirus in a single infection showed that the overall conversion rate in the Paiteling group was 76.3%, higher than that of the Interferon group, which was 36.7%. The difference was statistically significant (P < 0.001). Conclusion The overall efficacy of Paiteling for cervical HPV infection is significantly better than that of Interferon, and it is worth promoting its use in the clinic.

Predictive models are often complex to produce and interpret, yet can offer valuable insights for management, conservation and policy-making. Here we introduce a new modelling tool (the R package ‘BBNet’), which is simple to use, and requires little mathematical or computer programming background. By using straightforward concepts to describe interactions between model components, predictive models can be effectively constructed using basic spreadsheet tools and loaded into the R package. These models can be analysed, visualised, and sensitivity tested to assess how information flows through the system’s components and provide predictions for future outcomes of the systems. This paper provides a theoretical background to the models, which are modified Bayesian belief networks (BBNs), and an overview of how the package can be used. The models are not fully quantitative, but outcomes between different modelled scenarios can be considered ordinally (i.e. ranked from ‘best’ to ‘worse’). Parameterisation of models can also be through data, literature, expert opinion, questionnaires and/or surveys of opinion, which are expressed as a simple ‘weak’ to ‘very strong’ or 1–4 integer value for interactions between model components. While we have focussed on the use of the models in environmental and ecological problems (including with links to management and social outcomes), their application does not need to be restricted to these disciplines, and use in financial systems, molecular biology, political sciences and many other disciplines are possible.

Bariatric surgery is another treatment options for patients with obesity, who cannot achieve weight controlled by conservative non-surgical therapy. Although bariatric surgery provides clinical benefits for these patients, it is costly. This study aims to evaluate the cost-effectiveness of bariatric surgery, as compared to nonbariatric surgery, in patients with body mass index (BMI) ≥32.5 kg/m² and type 2 diabetes mellitus (T2DM), and to estimate the budget impact of bariatric surgery in Thailand. Methods: A Markov model was developed to estimate and compare total costs incurred and quality-adjusted life years (QALYs) gained between bariatric surgery and nonbariatric surgery over lifetime horizontal. Analysis was conducted under payer and societal perspectives. Costs and outcomes were discounted at an annual rate of 3%. The outcomes were presented as incremental cost- effectiveness ratio (ICER). Results: Under payer’s perspective, bariatric surgery resulted in higher total lifetime cost (676,658.39 baht vs 574,683.38 baht) and QALYs gained (16.08 QALYs vs 14.78 QALYs), as compared to nonbariatric surgery, resulting in an ICER of 78,643.02 baht/QALY. Similarly, under the societal perspective, bariatric surgery resulted in higher total lifetime cost (1,451,923.83 baht vs 1,407,590.49 baht) and QALYs gained (16.08 QALYs vs 14.78 QALYs), as compared to nonbariatric surgery. Under societal perspective, ICER was estimated at 34,189.82 baht/QALY. A 5-year budget impact analysis indicated that bariatric surgery incurred the total budget of 223,821 million baht. Conclusions: At the cost-effectiveness threshold of 160,000 baht/QALY, bariatric surgery was a cost-effective strategy and should continue to be included in the benefit package for patients with obesity and T2DM.

Pain-o-metry provides biomarkers indicating connections between pain-related conditions and the health of various physiological systems, including the cardiovascular system. In this study, a non-linear data-driven analytical technique was employed to analyze second-by-second hemodynamic responses to recurrent clino-orthostatic challenges in 43 female fibromyalgia patients and 38 healthy women. The primary goal was to elucidate the systemic and systematic interaction of diverse hemodynamic and cardiovascular mechanisms across various timeframes and phases, precisely identifying their collective role as a unified bodily mechanism in managing regular gravity-induced blood redistribution challenges within the context of chronic pain. Findings suggest a connection between chronic disease and the equilibrium between cardiac preload and afterload in blood pressure regulation. Patients exhibit a shift towards afterload due to deficiencies in mechanisms governing initial transient reactions and later steady-state processes related to acutely induced blood redistributions. The imbalance is linked to reduced venous blood return, increasing cardiac strain—particularly in terms of contractility and heart rate—as the body compensates for heightened cardiac afterload and reduced effective blood volume. This makes individuals more susceptible to chronic peripheral tissue and cerebrovascular hypoperfusion, potentially leading to chronic ischemia and inflammation in various tissues and organs. The data-driven analytical technique enables the identification of combinations of gravity-induced hemodynamic and cardiovascular responses within specific timeframes for precise detection. This approach aims to facilitate potential diagnostic and monitoring applications in wearable devices, enhancing the ability to identify at-risk populations for preventive interventions.