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BackgroundRandomized trials are the gold-standard for clinical evidence generation, but they can sometimes be limited by infeasibility and unclear generalizability to real-world practice. External control arm (ECA) studies may help address this evidence gaps by constructing retrospective cohorts that closely emulate prospective ones. Experience in constructing these outside the context of rare diseases or cancer is limited. We piloted an approach for developing an ECA in Crohn's disease using electronic health records (EHR) data.MethodsWe queried EHR databases and manually screened records at the University of California, San Francisco to identify patients meeting the eligibility criteria of TRIDENT, a recently completed interventional trial involving an ustekinumab reference arm. We defined timepoints to balance missing data and bias. We compared imputation models by their impacts on cohort membership and outcomes. We assessed the accuracy of algorithmic data curation against manual review. Lastly, we assessed disease activity following treatment with ustekinumab.ResultsScreening identified 183 patients. 30% of the cohort had missing baseline data. Nonetheless, cohort membership and outcomes were robust to the method of imputation. Algorithms for ascertaining non-symptom-based elements of disease activity using structured data were accurate against manual review. The cohort consisted of 56 patients, exceeding planned enrollment in TRIDENT. 34% of the cohort was in steroid-free remission at week 24.ConclusionWe piloted an approach for creating an ECA in Crohn's disease from EHR data by using a combination of informatics and manual methods. However, our study reveals significant missing data when standard-of-care clinical data are repurposed. More work will be needed to improve the alignment of trial design with typical patterns of clinical practice, and thereby enable a future of more robust ECAs in chronic diseases like Crohn's disease.

High conversion ratio dc-dc converters have received significant attention in renewable energy systems, primarily due to their necessary high-gain characteristics. This research proposes a high step-up ratio full-bridge resonant cascaded (FBRC) dc-dc converter designed for use in photovoltaics (PV), fuel cells (FC), electric vehicles (EV), and other low-voltage output energy sectors to achieve high voltage gain. This converter contains a full-bridge cell with a boost input inductor, a diode-capacitor cascaded stage that replaces the transformer as a voltage multiplier and an inductor-capacitor (LC) parallel-series resonant network across the FB terminal. One of the strategic features of the converter is its high voltage step-up characteristic combined with lower duty cycle operation that limits the maximum current through the active devices, making it particularly suitable for systems that generate low output voltage. In addition, zero-voltage switching (ZVS) is achieved during the turn-off and turn-on operation of the FB switches from 25% to full load, thereby lessening the switching losses. Moreover, the diminished necessity for passive components and the decreased voltage stress on both active and passive devices lead to the use of smaller and more cost-effective components. The theoretical analysis of the proposed converter is validated using a 500 W laboratory-scale prototype wherein high-performance SiC-based MOSFETs have been utilized as switching devices. It offers reduced ripples, with input current ripple at 5% and output voltage ripple at 0.76%. When the load is 400 W and 60 V as the input voltage, the maximum efficiency is found 95.8% at 400 V output voltage. The proposed dc-dc converter, with its high voltage gain and reduced component stress, shows significant promise for application in renewable energy systems.

With the rapid proliferation of portable and wearable electronics, energy autonomy through efficient energy harvesting has become paramount. Thermoelectric generators (TEGs) stand out as promising candidates due to their silent operation, high reliability, and maintenance-free nature. This paper presents the design, fabrication, and analysis of a micro-scale TEG for powering such devices. A planar configuration was employed for its inherent miniaturization advantages. Finite element analysis using ANSYS reveals that a double-layer device under a 50 K temperature gradient generates an impressive open-circuit voltage of 1417 mV and a power output of 2.4 μW, significantly exceeding its single-layer counterpart (226 mV, 0.12 μW). Validation against the analytical model results yields errors within 2.44% and 2.03% for voltage and power, respectively. Furthermore, a single-layer prototype fabricated using paper shadow masks and sputtering deposition exhibits a voltage of 131 mV for a 50 K temperature difference, thus confirming the feasibility of the proposed design. This work establishes a foundation for developing highly efficient micro-TEGs for powering next-generation portable and wearable electronics.

BackgroundDespite significant reductions in recent malaria cases and deaths globally, the persistence of this health concern necessitates a shift from traditional top-down approaches. Consequently, malaria control initiatives increasingly focus on empowering local communities through community-centred strategies. Therefore, this scoping review protocol systematically explores diverse community knowledge approaches adopted in malaria programmes worldwide and their associated outcomes.MethodsAdhering rigorously to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) guidelines, a comprehensive scoping review protocol was developed. Collaborating with a research librarian, a systematic search strategy targeted peer-reviewed literature from databases such as PubMed, Embase, Scopus, and Web of Science, complemented by a thorough grey literature search. Titles and abstracts will be screened, followed by extracting bibliographic details and outcome information using a standardized framework. Subsequently, the results will be systematically summarized and presented in a structured tabular format (S1 Checklist).DiscussionThis scoping review promises an in-depth understanding of current research regarding the impact of community knowledge in malaria programmes. The identification of knowledge gaps and intervention needs serves as a valuable resource for malaria-affected countries. The profound implications of community knowledge underscore its pivotal role in enhancing the effectiveness of prevention, control, and elimination efforts. Insights from this review will assist policymakers, empowering implementers and community leaders in designing effective interventions. This concerted effort aims to adeptly leverage community knowledge, thereby propelling progress toward the achievement of malaria elimination goals.

Mpox (formerly known as monkeypox) virus and some related poxviruses including smallpox virus pose a significant threat to public health, and effective prevention and treatment strategies are needed. This study utilized a reverse vaccinology approach to retrieve conserved epitopes for monkeypox virus and construct a vaccine that could provide cross-protection against related viruses with similar antigenic properties. The selected virulent proteins of monkeypox virus, MPXVgp165, and Virion core protein P4a, were subjected to epitope mapping for vaccine construction. Two vaccines were constructed using selected T cell epitopes and B cell epitopes with PADRE and human beta-defensins adjuvants conjugated in the vaccine sequence. Both constructs were found to be highly antigenic, non-allergenic, nontoxic, and soluble, suggesting their potential to generate an adequate immune response and be safe for humans. Vaccine construct 1 was selected for molecular dynamic simulation studies. The simulation studies revealed that the TLR8-vaccine complex was more stable than the TLR3-vaccine complex. The lower RMSD and RMSF values of the TLR8 bound vaccine compared to the TLR3 bound vaccine suggested better stability and consistency of hydrogen bonds. The Rg values of the vaccine chain bound to TLR8 indicated overall stability, whereas the vaccine chain bound to TLR3 showed deviations throughout the simulation. These results suggest that the constructed vaccine could be a potential preventive measure against monkeypox and related viruses however, further experimental validation is required to confirm these findings.

BackgroundChronic myocardial injury is a condition defined by stably elevated cardiac biomarkers without acute myocardial ischemia. Although studies from high-income countries have reported that chronic myocardial injury predicts adverse prognosis, there are no published data about the condition in sub-Saharan Africa.MethodsBetween November 2020 and January 2023, adult patients with chest pain or shortness of breath were recruited from an emergency department in Moshi, Tanzania. Medical history and point-of-care troponin T (cTnT) assays were obtained from participants; those whose initial and three-hour repeat cTnT values were abnormally elevated but within 11% of each other were defined as having chronic myocardial injury. Mortality was assessed thirty days following enrollment.ResultsOf 568 enrolled participants, 81 (14.3%) had chronic myocardial injury, 73 (12.9%) had acute myocardial injury, and 412 (72.5%) had undetectable cTnT values. Of participants with chronic myocardial injury, the mean (± sd) age was 61.5 (± 17.2) years, and the most common comorbidities were CKD (n = 65, 80%) and hypertension (n = 60, 74%). After adjusting for CKD, thirty-day mortality rates (38% vs. 36%, aOR 1.03, 95% CI: 0.52-2.03, p = 0.931) were similar between participants with chronic myocardial injury and those with acute myocardial injury, but significantly greater (38% vs. 13.6%, aOR 3.63, 95% CI: 1.98-6.65, pConclusionIn Tanzania, chronic myocardial injury is a poor prognostic indicator associated with high risk of short-term mortality. Clinicians practicing in this region should triage patients with stably elevated cTn levels in light of their increased risk.

BackgroundDengue is a mosquito-borne disease caused by four distinct, closely related dengue viruses (DENV). Global dengue incidence has markedly increased in the past decades. The World Health Organization reported that cases increased from 505,430 in 2000 to 5.2 million in 2019. Similarly, the total dengue cases in Malaysia increased from 7,103 in 2000 to a peak of 130,101 in 2019. Knowledge, attitude, and practice (KAP) remain the most effective dengue prevention and control tools. Furthermore, school-based health education is key to enhancing knowledge and raising awareness of the seriousness of dengue among schoolchildren and transferring knowledge and practice from classrooms to homes. Thus, it is necessary to plan an integrated module for the primary prevention of dengue infection, specifically among schoolchildren.AimsThe present study intends to develop, implement, and evaluate the effectiveness of a theory-based integrated dengue education and learning (iDEAL) module in improving the KAP, environmental cleanliness index, and dengue index among schoolchildren in Selangor and Kuala Lumpur.MethodsThis study is a single-blinded, cluster randomised controlled trial to be conducted from 1 September 2023 to 31 August 2025. The study will involve 20 primary and 20 secondary schools in Selangor and Kuala Lumpur. The 1600 participants will be randomly allocated to intervention and control groups based on selected clusters to avoid contamination. A cluster is a comparable school that fulfils the inclusion and exclusion criteria. The intervention group will receive the iDEAL module, while the control group will receive standard education. The iDEAL module will be developed following a systematic procedure and delivered in-person by trained researchers to the participants. The outcome will be measured using validated, self-administered questionnaires at baseline (T0), immediately (T1), one month (T2), and three months (T3) post-intervention to measure the intervention module effectiveness. The data will be analysed using IBM Statistical Package for Social Science (SPSS) version 28 and descriptive and inferential statistics. Within-group changes over time will be compared using one-way repeated measure analysis of variance for continuous and normally distributed variables. Within-group analysis of categorical data will use Cochran's Q test. The main effect and interaction between and within the intervention and control groups at T0, T1, T2, and T3 will be tested using the generalised linear mixed model (GLMM). Hypothetically, the KAP, environmental cleanliness index, and dengue index among the intervention group will be significantly improved compared to the control group. The hypothesis will be tested using a significance level with a p-value of 0.05 and a confidence interval of 95%.ConclusionsThe study protocol outlines developing and testing an iDEAL module for schoolchildren in Selangor and Kuala Lumpur, with no socio-demographic differences expected. The intervention aims to improve KAP, environmental cleanliness index, and dengue index, potentially reducing dengue risk. Results could inform public health policies, emphasizing school-based interventions' importance in combating diseases like dengue.

BackgroundPreconception health provides an opportunity to examine a woman's health status and address modifiable risk factors that can impact both a woman's and her child's health once pregnant. In this review, we aimed to investigate the preconception risk factors and interventions of early pregnancy and its impact on adverse maternal, perinatal and child health outcomes.MethodsWe conducted a scoping review following the PRISMA-ScR guidelines to include relevant literature identified from electronic databases. We included reviews that studied preconception risk factors and interventions among adolescents and young adults, and their impact on maternal, perinatal, and child health outcomes. All identified studies were screened for eligibility, followed by data extraction, and descriptive and thematic analysis.FindingsWe identified a total of 10 reviews. The findings suggest an increase in odds of maternal anaemia and maternal deaths among young mothers (up to 17 years) and low birth weight (LBW), preterm birth, stillbirths, and neonatal and perinatal mortality among babies born to mothers up to 17 years compared to those aged 19-25 years in high-income countries. It also suggested an increase in the odds of congenital anomalies among children born to mothers aged 20-24 years. Furthermore, cancer treatment during childhood or young adulthood was associated with an increased risk of preterm birth, LBW, and stillbirths. Interventions such as youth-friendly family planning services showed a significant decrease in abortion rates. Micronutrient supplementation contributed to reducing anaemia among adolescent mothers; however, human papillomavirus (HPV) and herpes simplex virus (HSV) vaccination had little to no impact on stillbirths, ectopic pregnancies, and congenital anomalies. However, one review reported an increased risk of miscarriages among young adults associated with these vaccinations.ConclusionThe scoping review identified a scarcity of evidence on preconception risk factors and interventions among adolescents and young adults. This underscores the crucial need for additional research on the subject.

The expanding urbanization of coastal areas has led to increased ocean sprawl, which has had both physical and chemical adverse effects on marine and coastal ecosystems. To maintain the health and functionality of these ecosystems, it is imperative to develop effective solutions. One such solution involves the use of biodegradable polymers as bioactive coatings to enhance the bioreceptivity of marine and coastal infrastructures. Our study aimed to explore two main objectives: (1) investigate PHA-degrading bacteria on polymer-coated surfaces and in surrounding seawater, and (2) comparing biofilm colonization between surfaces with and without the polymer coating. We applied poly(3-hydroxybutyrate) [P(3HB)) coatings on concrete surfaces at concentrations of 1% and 6% w/v, with varying numbers of coating cycles (1, 3, and 6). Our findings revealed that the addition of P(3HB) indeed promoted accelerated biofilm growth on the coated surfaces, resulting in an occupied area approximately 50% to 100% larger than that observed in the negative control. This indicates a remarkable enhancement, with the biofilm expanding at a rate roughly 1.5 to 2 times faster than the untreated surfaces. We observed noteworthy distinctions in biofilm growth patterns based on varying concentration and number of coating cycles. Interestingly, treatments with low concentration and high coating cycles exhibited comparable biofilm enhancements to those with high concentrations and low coating cycles. Further investigation into the bacterial communities responsible for the degradation of P(3HB) coatings identified mostly common and widespread strains but found no relation between the concentration and coating cycles. Nevertheless, this microbial degradation process was found to be highly efficient, manifesting noticeable effects within a single month. While these initial findings are promising, it's essential to conduct tests under natural conditions to validate the applicability of this approach. Nonetheless, our study represents a novel and bio-based ecological engineering strategy for enhancing the bioreceptivity of marine and coastal structures.

Herbal medicine is popularly used among patients who suffer from allergic rhinitis. This systematic review and meta-analysis was conducted to evaluate the efficacy and safety of single medicinal plants in the management of allergic rhinitis. We searched MEDLINE, CENTRAL, and Web of Science for randomised controlled trials which evaluated the use of single medicinal plant for allergic rhinitis among adults and children. Twenty-nine randomised controlled trials (n = 1879) were eligible while 27 (n = 1769) contributed data for meta-analyses. Most studies (studies = 20) compared medicinal plants against placebo and Petasites hybridus was most frequently investigated (studies = 5). Very-low-to-low-certainty evidence suggests that compared to placebo, single medicinal plants may improve overall total nasal symptoms (SMD -0.31, 95% CI -0.59 to -0.02; participants = 249; studies = 5; I2 = 21%) especially nasal congestion and sneezing; and rhinoconjunctivitis quality of life (RQLQ) scores (MD -0.46, 95% CI -0.84 to -0.07; participants = 148; studies = 3; I2 = 0%). Moderate-certainty evidence show no clear differences between single medicinal plants and antihistamine in overall symptoms (Total nasal symptoms: SMD -0.14, 95% CI -0.46 to 0.18; participants = 149; studies = 2; I2 = 0%). As adjunctive therapy, moderate-certainty evidence shows that medicinal plants improved SNOT-22 scores when given as intranasal treatment (MD -7.47, 95% CI -10.75 to -4.18; participants = 124; studies = 2; I2 = 21%). Risk of bias domains were low or not clearly reported in most studies while heterogeneity was substantial in most pooled outcomes. Route of administration and age were identified to be plausible source of heterogeneity for certain outcomes. Medicinal plants appear to be well tolerated up to 8 weeks of use. Clear beneficial evidence of medicinal plants for allergic rhinitis is still lacking. There is a need for improved reporting of herbal trials to allow for critical assessment of the effects of each individual medicinal plant preparation in well-designed future clinical studies.

The present study aims to investigate the influence of zeolite usage and stocking densities on various parameters, including ammonia removal from water, accumulation of heavy metals in fish organs, water quality, growth performance, feed efficiency, muscle composition, as well as hematological and biochemical parameters in European seabass (Dicentrarchus labrax) over a 90-day duration. A total of 2400 D. labrax with an initial weight of 9.83 ± 2.02 g and initial length of 9.37 ± 0.32 cm were distributed among 24 tanks. The research involved six distinct treatment groups, with two different zeolite levels (0 and 15 ppt) and three stocking density levels (50, 100, and 150 fish/m3), each replicated four times. The results of the research demonstrate a statistically significant improvement (p < 0.05) in water quality measures with the introduction of zeolite. The successful implementation of this amendment mitigated the adverse effects of fish density on water quality parameters. Higher stocking density negatively impacted European sea bass growth, feed utilization, and hemato-biochemical indicators. Zeolite use effectively alleviated these adverse effects, particularly on performance, feed utilization, hematological, and biochemical parameters. The study's results indicate that the utilization of zeolite has shown to be efficacious in mitigating the accumulation of heavy metals in both water and fish organs, while concurrently augmenting fish attributes. However, the increase in density led to a significant decrease in the accumulation of heavy metals in both water and fish organs. The present study highlights the capacity of natural zeolites to mitigate the negative consequences associated with water quality concerns. The efficiency of these zeolites in limiting the accessibility of heavy metals in polluted water is shown, hence minimizing their accumulation in fish organs. In addition, the improvement of fish performance has the capacity to have a beneficial influence on both the well-being and efficiency of fish in aquaculture. Additional research is essential to fully understand the complex molecular pathways involved in utilizing natural zeolite under different fish densities.

This study examines the influence of lag fertilization techniques on Pakistani wheat production, highlighting the need to understand and mitigate the environmental impacts of farming methods. The basic purpose of this study is to investigate the impact of CO2 emission from fertilization and other factors on wheat production in Pakistan, using a time series of data from 1990 to 2020. CO2 emission from fertilization (CO2EF) is estimated using the default values provided by the IPCC guidelines. The ARDL approach analyses the short-run and long-run effects of CO2EF, technology level, energy use, agricultural land, and agricultural labor on wheat production. The results show that all factors have significantly impacted wheat production in Pakistan at levels of 1% and 5% significance, both in the short and long run. These findings suggest that reducing CO2EF, technology level, energy use, agricultural land, and agricultural labor on wheat production can help to increase wheat production in Pakistan. The study also highlights the importance of adopting sustainable and efficient fertilization practices, exploring alternative fertilizers, and using crop rotation systems to mitigate the adverse effects of carbon emissions from nitrogen fertilization, energy use, and the use of technology. These measures can contribute to a more sustainable and climate-resilient agriculture sector in Pakistan.

BackgroundInduction of lactation occurs when breast milk is produced in a human (woman), without going through the process of pregnancy and delivery. Efforts to produce milk by women who had never been pregnant and give birth are not easy. According to the many who have attempted it, it is far more arduous a task than initiating postpartum lactation, but it is possible and worth the effort.Research aimThis study aimed to explore and understand the challenges for women during induced lactation in Malaysia.MethodsThis qualitative study was done in 2017 and utilized in-depth interview among women who induced lactation in five states based on five regions in Malaysia [Central Region (Selangor), Northern Region (Penang), Southern Region (Johor), East Coast Region (Kelantan), Malaysia Borneo (Sabah)]. All interviews were consented, audio-recorded then transcribed verbatim, followed by identification of main themes.ResultsData saturation was achieved after interviewing a total of 23 induced lactation women. Data synthesized using thematic analysis revealed six themes describing the main challenges during the induction process were (1) health condition, (2) work commitment, (3) overexertion, (4) not eligible to take leave, (5) inability to follow the treatment plan, and (6) difficulty attaching the adopted baby to initiate breastfeeding during induced lactation process.ConclusionsThe challenges faced by women during the process of induced lactation were complex and the induced lactation process requires considerable dedication and determination. The findings of this research will help other women and their spouses/partners comprehend the challenges, obstacles, and support that are needed along the induced lactation process. The Government and other stakeholders have roles in more efforts and programs to help these mothers breastfeed their adoptive child and make them feel more accomplished as women and mothers.

[This corrects the article DOI: 10.1371/journal.pone.0295212.].

Previous research has shown that natural medications pose health risks, especially in subjects with comorbidities. This study aimed to evaluate the safety of saffron ethanolic extract (SEE) administration in early and established atherosclerotic rabbits. Rabbits were given a high-cholesterol diet (HCD) for 4 and 8 weeks to induce early and established atherosclerosis respectively, and then they were treated with 50 and 100 mg/kg/day SEE. The body weight of the animals was recorded. Blood samples were collected at baseline, pre-treatment, and post-treatment for hematological studies, lipid profiles, and biochemical profiles. Tissue specimens of the vital organs were subjected to histological examination. The above parameters were significantly altered post-intervention with 4 and 8 weeks of HCD. No significant differences in body weight were observed in all the groups post-treatment with 50 and 100mg/kg of SEE compared to pre-treatment. However, low-density lipoprotein cholesterol, total cholesterol, serum urea, and glucose significantly decreased post-treatment with 50 and 100mg/kg/day SEE compared to pre-treatment in early and established atherosclerosis groups. Hematological parameters that were affected post-intervention with HCD returned to their baseline values post-treatment with 50 and 100mg/kg/day SEE. There was a significant improvement in the vital organs post-treatment with 50 and 100mg/kg SEE. SEE can safely be administered without causing harmful effects on the hematological, biochemical profiles, and vital organs. Notably, SEE exerts hypolipidemic and hypoglycemic effects on atherosclerotic conditions. Further clinical trials are warranted to ensure the safety of saffron administration in patients with atherosclerosis-related diseases.

BACKGROUND:Heatwaves have been linked to increased risk of mortality and morbidity and are projected to increase in frequency and intensity due to climate change. The current study uses emergency department (ED) data from Australia, Botswana, Netherlands, Pakistan, and the United States of America to evaluate the impact of heatwaves on ED attendances, admissions and mortality. METHODS:Routinely collected time series data were obtained from 18 hospitals. Two separate thresholds (≥4 and ≥7) of the acclimatisation excess heat index (EHIaccl) were used to define "hot days". Analyses included descriptive statistics, independent samples T-tests to determine differences in case mix between hot days and other days, and threshold regression to determine which temperature thresholds correspond to large increases in ED attendances. FINDINGS:In all regions, increases in temperature that did not coincide with time to acclimatise resulted in increases in ED attendances, and the EHIaccl performed in a similar manner. During hot days in California and The Netherlands, significantly more children ended up in the ED, while in Pakistan more elderly people attended. Hot days were associated with more patient admissions in the ages 5-11 in California, 65-74 in Karachi, and 75-84 in The Hague. During hot days in The Hague, patients with psychiatric symptoms were more likely to die. The current study did not identify a threshold temperature associated with particularly large increases in ED demand. INTERPRETATION:The association between heat and ED demand differs between regions. A limitation of the current study is that it does not consider delayed effects or influences of other environmental factors. Given the association between heat and ED use, hospitals and governmental authorities should recognise the demands that heat can place on local health care systems. These demands differ substantially between regions, with Pakistan being the most heavily affected within our study sample.

Children are susceptible to infections due to frequent participation in school group activities and their often-suboptimal hygiene practices. Frequent infections in children affect school attendance, academic performances, and general health. The effectiveness of school-based hygiene-related intervention programmes need to be informed by updated high-quality synthesised evidence. In this systematic review, we searched PubMed and Cochrane CENTRAL for randomised and non-randomised interventional studies that evaluated school-based hygiene-related interventions. We assessed risk-of-bias (Cochrane risk-of-bias 2 tool), performed random-effect meta-analysis (RevMan 5.4) and rated certainty-of-evidence (GRADE). Thirty-nine trials (41 reports), published from 2011 to 2024 from 22 countries were included. Twenty-three studies contributed data for meta-analysis. All school-based interventions were compared with standard curriculum and demonstrated very low to low certainty-of-evidence due to study methodological limitations and imprecision. Hand-body hygiene interventions may improve knowledge, attitudes and practices (SMD 2.30, 95%CI 1.17 to 3.44, 6 studies, 7301 participants), increase handwashing practices (RR 1.75, 95%CI 1.41 to 2.17, 5 studies, 5479 participants), and reduce infection-related absenteeism (RR 0.74, 95%CI 0.66 to 0.83, 5 studies, 1017852 observations). Genital hygiene interventions may improve attitude (SMD 6.53, 95%CI 2.40 to 10.66, 2 studies, 2644 participants) and practices (RR 2.44, 95%CI 1.28 to 4.68, 1 study, 1201 participants). However, intervention effects on oral hygiene appeared mixed, with worsening of the oral hygiene score (SMD 3.12, 95%CI 1.87 to 4.37, 2 studies, 652 participants) but improved dental hygiene (SMD -0.33, 95%CI -0.53 to -0.13, 3 studies, 4824 participants) and dental caries scores (SMD -0.34, 95%CI -0.52 to -0.16, 4 studies, 2352 participants). Limited evidence suggests that interventions targeting hand-body and genital hygiene practices may improve knowledge, practices, and infection-related absenteeism. However, the effects on oral hygiene intervention appeared mixed. Future research should strengthen randomisation and intervention documentation, and evaluate hygiene-related behaviour, academic performances and health outcomes. [ABSTRACT FROM AUTHOR]

Zymoseptoria tritici is the causal agent of Septoria tritici blotch (STB), one of the most economically destructive wheat foliar diseases. In this study, we explore the physiological and molecular changes elicited in two wheat cultivars with divergent responses (Taichung 29 = susceptible, and Shafir = resistant) upon infection by Z. tritici. Our aim is to uncover novel insights into the intricate mechanisms that govern wheat defense against Z. tritici infection. Our quantitative histopathological study showed that H2O2 accumulated in the resistant cultivar to a higher degree compared to the susceptible cultivar at the biotrophic and switching phase. Additionally, we combined qPCR with a targeted quantitative HPLC technique to evaluate the expression profiles of 13 defense-related genes and profile the polyphenolic compounds induced differentially in the STB susceptible and resistant cultivar. Our finding indicated that five out of 13 genes were strongly up-regulated in the resistant cultivar compared with that of the susceptible one at eight days post-inoculation (dpi), corresponding to the transition phase present in the infection process of Z. tritici. Finally, our targeted HPLC analysis demonstrated that the traced phenolic compounds were highly elevated in the susceptible cultivar infected by Z. tritici compared with that of the resistant cultivar. In conclusion, our comprehensive analysis unveils a robust defense response in the resistant wheat cultivar Shafir, characterized by heightened H2O2 accumulation, significant up-regulation of key defense-related genes during the transition phase, and a distinct profile of polyphenolic compounds, shedding light on the intricate mechanisms contributing to its resistance against Z. tritici, thereby providing valuable insights for the development of more resilient wheat varieties. [ABSTRACT FROM AUTHOR]

Background: The present study is a type of exploratory qualitative studies and applied research. The approach of this study is a prospective policy analysis in which we will formulate appropriate policy options to prevent and control iron deficiency anemia in Iran. Methods and materials: Current study is a multi-method research with an analysis for policy approach containing three phases. First, through a literature review study, policies, programs and interventions of different countries to control and prevent anemia caused by iron deficiency will be identified. Then, in the qualitative phase of the study, the challenges, barriers, facilitators of the policies and programs implemented and ongoing in Iran will be examined. The content and policy-making process, as well as the context and role of stakeholders and actors will be analyzed using the framework of the policy triangle and analysis of the policy process using the Kingdon's multiple streams model. Then, the proposed initial policy options will be developed. In the next phase, an expert panel contain experts, authorities and policymakers will be formed and the proposed options will be reviewed and categorized. In order to prioritize policy options and evaluate their feasibility in Iran, the Delphi technique and the policy options analysis framework of the Centers for Disease Control and Prevention (CDC) will be used. At the end, policy options will be selected based on the highest score and will be presented as appropriate policy options. Conclusion: Prospective policy analysis allows the selection of potentially practical and effective policy options to control iron deficiency anemia. The findings of current study will be presented as reports and research articles for policy makers. [ABSTRACT FROM AUTHOR]

High conversion ratio dc-dc converters have received significant attention in renewable energy systems, primarily due to their necessary high-gain characteristics. This research proposes a high step-up ratio full-bridge resonant cascaded (FBRC) dc-dc converter designed for use in photovoltaics (PV), fuel cells (FC), electric vehicles (EV), and other low-voltage output energy sectors to achieve high voltage gain. This converter contains a full-bridge cell with a boost input inductor, a diode-capacitor cascaded stage that replaces the transformer as a voltage multiplier and an inductor-capacitor (LC) parallel-series resonant network across the FB terminal. One of the strategic features of the converter is its high voltage step-up characteristic combined with lower duty cycle operation that limits the maximum current through the active devices, making it particularly suitable for systems that generate low output voltage. In addition, zero-voltage switching (ZVS) is achieved during the turn-off and turn-on operation of the FB switches from 25% to full load, thereby lessening the switching losses. Moreover, the diminished necessity for passive components and the decreased voltage stress on both active and passive devices lead to the use of smaller and more cost-effective components. The theoretical analysis of the proposed converter is validated using a 500 W laboratory-scale prototype wherein high-performance SiC-based MOSFETs have been utilized as switching devices. It offers reduced ripples, with input current ripple at 5% and output voltage ripple at 0.76%. When the load is 400 W and 60 V as the input voltage, the maximum efficiency is found 95.8% at 400 V output voltage. The proposed dc-dc converter, with its high voltage gain and reduced component stress, shows significant promise for application in renewable energy systems. [ABSTRACT FROM AUTHOR]

IntroductionThe vaccination against coronavirus disease 2019 (COVID-19) has been identified as a promising strategy to reduce the severity of the pandemic. Despite the safe and effective COVID-19 vaccines, bringing socioeconomically disadvantaged people under vaccination coverage has been challenging for developing countries like Bangladesh. Therefore, this study explored the determinants of vaccine acceptance among urban slum residents of Bangladesh using the Health Belief Model (HBM) and Theory of Planned Behavior (TPB).MethodsA face-to-face survey of 400 urban slum dwellers in two large cities in Bangladesh was conducted between July 5 to August 5, 2021. The questionnaire included vaccine acceptance, socio-demographics, health-related characteristics, trust in health authorities, reasons for vaccine hesitancy, and dimensions of HBM and TPB frameworks. Hierarchical logistic regression was performed to evaluate the association between these characteristics and vaccination acceptance.ResultsAround 82% (n = 327) of respondents were willing to accept the COVID-19 vaccine. In a fully adjusted model, respondents with secondary level education had higher intention (OR = 46.93, 95%CI = 1.21-1807.90, p < 0. 05) to accept COVID-19 vaccine. Respondents with bad (OR = 0.11, 95%CI = 0.01-0.35, pConclusionsThese findings offer valuable insights for policymakers in Bangladesh to design targeted interventions that address vaccine hesitancy and increase vaccination acceptability among socially disadvantaged individuals in urban areas. Strategies should focus on providing accurate and accessible information about the vaccine, communicating its positive impact effectively, engaging with religious leaders to address misconceptions, and tailoring vaccination campaigns to meet the unique needs of different demographic groups.

During the early days and months of the COVID-19 pandemic, healthcare facilities experienced a slump in non-COVID-related visits, and there was an increasing interest in telehealth to deliver healthcare services for adult and pediatric patients. The study investigated telehealth use variation by race/ethnicity and place of residence for the pediatric enrollees of the Alabama Medicaid program. This retrospective observational study examined Alabama Medicaid claims data from March to December 2020 for enrollees less than 19 years. There were 637,792 pediatric enrollees in the Alabama Medicaid program during the study period, and 16.9% of them had used telehealth to meet healthcare needs. This study employed a multivariate Poisson mixed-effects model with robust error variance to obtain differences in telehealth utilization and found that Non-Hispanic Black children were 80% as likely, Hispanic children were 55% as likely, and Asian Children were 46% as likely to have used telehealth compared to Non-Hispanic White children. Pediatric enrollees in large rural areas and isolated areas were significantly less likely (IRR: 0.90 for both, p

IntroductionMalaysia's gross domestic product is heavily influenced by the food and beverage sector and the contribution of the industry to the national economy is expected to increase in the coming years. Thus, the need for employees in the food industry will continue to rise as this sector grows. Nevertheless, employees in the food industry are exposed to various occupational hazards that can lead to occupational injuries, mainly related to kitchen work. Given the increasing number of employees in the food industry and the rising trend of occupational injuries, this study was conducted to determine the prevalence of recent occupational injuries and their associated factors and predictors among food industry workers.MethodsThis cross-sectional study was conducted in 2023 among food industry workers in Selangor, Malaysia. The respondents were sampled using a multistage random sampling method. Data were collected via online self-administered questionnaires and analysed using descriptive statistics and logistic regression models in the SPSS software, version 25.ResultsA total of 250 responses were received from 342 samples, with an overall response rate of 73.0%. The prevalence of recent occupational injuries among food industry workers was 44.8%. Statistically, significant associations were present between occupational injuries and alcohol consumption (p = 0.001), poor knowledge (p = 0.031), poor compliance (p = 0.021), poor safety management (p = 0.021), poor safety training (p = 0.002), poor safety culture (p = 0.003), physical exposure (p < 0.001), and ergonomic exposure (p = 0.009). The predictors for recent occupational injuries among food industry workers were Malay (adjusted Odds Ratio; aOR = 2.60, p = 0.027, 95% Confidence Interval; CI = 1.116, 6.035), alcohol consumption (aOR = 5.31, p = 0.001, 95% CI = 2.042, 13.779), poor knowledge (aOR = 1.98, p = 0.032, 95% CI = 1.059, 3.691), poor safety culture (aOR = 2.44, p = 0.002, 95% CI = 1.372, 4.342), and exposure to physical hazards (aOR = 8.88, p < 0.001, 95% CI = 3.031, 26.014).ConclusionThis study has found a high prevalence of occupational injuries among food industry workers, thereby highlighting the importance of addressing alcohol consumption, improving worker knowledge, enhancing work safety culture, and better control measures on exposure to physical hazards, especially among Malay workers. By prioritising these factors, employers can create safer work environments and minimise the risk of occupational injuries.

[This corrects the article DOI: 10.1371/journal.pone.0265487.].

In Pakistan, women outnumber men in medical colleges with 80 percent enrollment, yet many fail to practice medicine following graduation. Pakistan Medical Council (PMC) states 50 percent of graduated women doctors either did not practice or left employment in a short period. Thus, the non-servicing women doctors are assumed as the one of the major causes for the overall doctors' shortage in the country. Addressing this enduring matter, this study aims to explore and understand the factors that discourage women doctors from practicing medicine in Pakistani hospitals. The study employed qualitative exploratory inquiry with an interpretive paradigm to attain a deeper understanding of the problem. 59-semi structured interviews were conducted by non-working women doctors across the entirety of Pakistan. The narratives were then analyzed by thematic analysis using ATLAS.ti 22. The findings have resulted in the three major themes, i.e., workplace challenges, socio-cultural obstructions, and familial restrictions that possibly obstruct women from practicing medicine in hospitals. The findings suggested that accepting traditional cultural values, including entrenched gender roles in society, deters women from practicing medicine. The prevailing patriarchal societal system includes stereotypes against working women; early marriages hinder women from practicing medicine. The prevailing societal system upholds the influence of in-laws and a husband for women doctor professional employment. As a result, severe work-life conflict was reported where most women doctors ended up in their profession in the middle of struggling between socially rooted gender roles as homemakers and their professional careers-furthermore, the study found various workplace issues that posit an additional burden on already struggling women doctors. Issues include poor recruitment and selection process, transfer constraints, excessive workload with inadequate salary, harassment, gender discrimination, unsafe work environment, and little support from the administration highly contribute to the shortage of women doctors in Pakistan.

Informal human milk exchange is the practice of donating and receiving expressed human milk based on mutual consent between the donor and receiver in the need of human milk for infants below 2 years old. Main concerns related to informal human milk exchange is related to milk siblings and safety handling of the expressed breastmilk. Even though there are countries which have policies and procedures related to human milk bank, informal milk exchange has not been given much attention. Compared to human milk bank, informal human milk exchange is not regulated. This study aims to identify the system focused on personalized breastfeeding tracking and monitoring, online discussion forum, web-based consultation, and breastfeeding station locator. Review of current applications in supporting breastfeeding practices was conducted based on the PRISMA-ScR framework. A literature search was conducted in Scopus and Google Scholar databases to identify articles published in English or Malay and containing systems/applications related to breastfeeding, milk sharing, milk exchange, milk siblings/kinship within the societal context. According to the scoping review, current scientific publications mostly focused on breast milk, breastfeeding, and milk banking concerns, with recurring themes including social reasons, lactation insufficiency, and unsolved nursing problems. These themes highlight the complexities and complexities of informal human milk exchange practices. Two reviewers screened the articles, and the data were extracted and narratively synthesized. During the primary database search, 360 articles were found based on the related titles, abstracts, and keywords. Seventy eight met the inclusion criteria and were finalized in this review. We found that most scholarly works focused on breast milk, breastfeeding and milk banking challenges and issues with recurrent themes i.e., societies, lactation inadequacy and unresolved nursing problems. Based on our literature search and to the best of our knowledge, there is no recent scoping reviews which focuses on technology-based approaches on informal human milk exchange. Findings from this scoping review is important for advancing research and practice in this field, as well as improving outcomes for individuals and families affected by informal human milk exchange.

It has been estimated that in the next decade, IHD prevalence, DALYs and deaths will increase more significantly in EMR than in any other region of the world. This study aims to provide a comprehensive description of the trends in the burden of ischemic heart disease (IHD) across the countries of the Eastern Mediterranean Region (EMR) from 1990 to 2019. Data on IHD prevalence, disability-adjusted life years (DALYs), mortality, DALYs attributable to risk factors, healthcare access and quality index (HAQ), and universal health coverage (UHC) were extracted from the Global Burden of Disease (GBD) database for EMR countries. The data were stratified based on the social demographic index (SDI). Information on cardiac rehabilitation was obtained from publications by the International Council of Cardiovascular Prevention and Rehabilitation (ICCPR), and additional country-specific data were obtained through advanced search methods. Age standardization was performed using the direct method, applying the estimated age structure of the global population from 2019. Uncertainty intervals were calculated through 1000 iterations, and the 2.5th and 97.5th percentiles were derived from these calculations. The age-standardized prevalence of IHD in the EMR increased from 5.0% to 5.5% between 1990 and 2019, while it decreased at the global level. In the EMR, the age-standardized rates of IHD mortality and DALYs decreased by 11.4% and 15.4%, respectively, during the study period, although both rates remained higher than the global rates. The burden of IHD was found to be higher in males compared to females. Bahrain exhibited the highest decrease in age-standardized prevalence (-3.7%), mortality (-65.0%), and DALYs (-69.1%) rates among the EMR countries. Conversely, Oman experienced the highest increase in prevalence (14.5%), while Pakistan had the greatest increase in mortality (30.0%) and DALYs (32.0%) rates. The top three risk factors contributing to IHD DALYs in the EMR in 2019 were high systolic blood pressure, high low-density lipoprotein cholesterol, and particulate matter pollution. The trend analysis over the 29-year period (1990-2019) revealed that high fasting plasma glucose (64.0%) and high body mass index (23.4%) exhibited increasing trends as attributed risk factors for IHD DALYs in the EMR. Our findings indicate an increasing trend in the prevalence of IHD and a decrease in mortality and DALYs in the EMR. These results emphasize the need for well-planned prevention and treatment strategies to address the risk factors associated with IHD. It is crucial for the countries in this region to prioritize the development and implementation of programs focused on health promotion, education, prevention, and medical care.

Background Unintentional injury is a global burden that occurs everywhere, including in our homes. Young children are most vulnerable to home injuries because they still develop their physical and psychological skills and spend most of their time at home. Despite being largely preventable, three consecutive national surveys show no reduction in the rate of injury among children under five. More surprisingly, children from high-income families were found to have the highest incidence of injury, contradicting the findings from other countries. Objective This study aims to identify the determinants of non-adherence to unintentional home injury prevention practice among parents of under-five children in the North Seberang Perai district, Penang. Methods This sequential explanatory mixed-methods study consists of two phases consisting of a quantitative study which looks into respondents and their child’s sociodemographic status, their home injury prevention practice and the independent variables, followed by a qualitative study that interviews parents with non-adherence to home injury prevention practice and explore their barriers. In phase I, the parent or primary caregiver of a child age less than five years old who age 18 or older and is a Malaysian will be included in the study while being disabled or having a severe psychiatric disorder or having the index child diagnosed with chronic disease will make them not eligible to participate in the study. Derived using the two-group proportion formula, a sample size of 453 parents will be sampled among those with under-five children following up at the Maternal Child Health Department in the health clinics of North Seberang Perai using stratified systematic sampling. Chi-square/Fisher Exact test, simple logistic regression and multiple logistic regression will be used for data analysis. The sample will be stratified according to household income to look for associated factors and determinants of low prevention practice. In phase II, parents with a low score from the quantitative study will be selected to participate in the qualitative study using purposive sampling. A semi-structured interview using the help of an interview guide will be carried out and recorded with a voice recorder. The thematic analysis approach will be used to analyse the qualitative data. Results The study has been registered under the National Medical Research Registry. Conclusion It is hoped that findings from this study can shed light on the barriers faced by under-five parents in carrying out preventive measures at home.

BackgroundThe novel coronavirus disease (COVID-19) pandemic has impacted pregnant women, increasing maternal and neonatal morbidity. The placenta is a potential target for the pathophysiological processes due to the increased thrombotic inflammatory activation and inadequate uteroplacental perfusion and oxygenation, potentially causing intrauterine growth restriction. This study investigates the impact of gestational age at diagnosis of COVID-19 and the presence of symptoms on intrauterine fetal growth in pregnant women.MethodsA retrospective review of COVID-19 positive pregnant women in Qatar from March 2020 to March 2021 was conducted. They were divided based on trimester of pregnancy in which they were infected. The outcomes included birthweight, customised fetal birthweight centiles, small for gestational age (SGA) baby and daily growth increments, compared between the trimesters and between symptomatic and asymptomatic women.ResultsIn our cohort, 218 women (20.5%) were infected in the first trimester, 399 (37.5%) in the second and 446 (42%) in the third. Women in the second trimester were significantly younger and symptomatic. Women infected in the first trimester were least likely to have diabetes. The mean birthweight, risk of SGA (11.5% vs 10% vs 14.6%, p = 0.302), and median customized growth centiles (47.6% vs 45.9% vs 46.1%)were similar between the groups. Symptomatic women had significantly lower mean birthweight (3147 gms vs 3222 gms) and median birthweight centiles (43.9% vs 54.0%)compared to the asymptomatic (pConclusionThis study shows that women with symptomatic disease had lower birth centiles and birth weights. This was regardless of the gestational age at which they were infected. Early symptomatic disease seems to have an impact on fetal growth velocity; however, larger studies are needed to corroborate these findings.

IntroductionOccupational asthma (OA) is a type of Work-Related Asthma characterised by variable airflow limitation and/or inflammation due to causes and conditions attributable to a particular occupational environment, and not to stimuli encountered outside the workplace. There is an increasing need to extend the depth of knowledge of OA to better manage this condition, especially among food industry workers who are affected by it.ObjectiveThis systematic review aimed to determine the factors associated with occupational asthma among food industry workers by electronically collecting articles from two databases (Medline and Scopus).MethodsThis systematic review was prepared in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta Analyses) updated guideline. Two independent reviewers screened the titles and abstracts of the collected data, which were then stored in Endnote20 based on the inclusion and exclusion criteria. The included articles have been critically appraised to assess the quality of the studies using the Mixed Methods Appraisal Tool (MMAT).ResultThe search yielded 82 articles from Medline and 85 from SCOPUS, resulting in 167 unique hits. Only 22 articles have been included in the full-text assessment following a rigorous selection screening. Of the 22 articles identified, five were included in the final review. Several factors were found to have contributed to occupational asthma among food industry workers. They were classified into two categories: (1) work environment-related factors; and (2) individual factors.ConclusionSeveral work environment and individual-related factors were found to be associated with OA among food industry workers. A better understanding of the development of the disease and its potential risk factors is needed because it can affect worker's quality of life. Pre-employment and periodic medical surveillance should be conducted to assess and detect any possible risk of developing occupational asthma among workers.

BackgroundCOVID-19 has affected Healthcare workers in many ways. One of the important areas is the psychological impact. This study aims to examine the effects of the COVID-19 outbreak on the mental health of Healthcare Professionals (HCP) and associated factors.MethodsA cross-sectional study was conducted among healthcare providers in the Emirates of Abu Dhabi, United Arab Emirates, between April 11th, and July 23rd, 2020. The study was conducted by using an online anonymous Self-administered questionnaire through the survey monkey platform. A convenient sampling method was used to distribute the online survey link through the organization's email network admin list and smartphone messaging. Descriptive statistics, t-tests, and multivariant linear regression were used.ResultsAnxiety and depression risk scores were measured in a total of 1268 participants of healthcare providers. More than half of the participants reported symptoms of anxiety (51.5%). Depression symptoms were revealed in 38.3% of participating providers. A mild risk of anxiety was reported in 28.8% of the participants and 12.68% of the participants registered moderate anxiety risk scores and 9.95% reported a severe risk of anxiety. Among all participants, 4.3% and 2.7% reported moderately severe and severe risk of depression, respectively, while 22.5% and 8.8% of the participating healthcare providers documented mild and moderate depression risk. Anxiety and depression risk scores were significantly and negatively associated with age and working in primary health care.ConclusionsThe high prevalence of anxiety and depression recorded among HCP during the pandemic suggests that mental health intervention and support are necessary to ensure the psychological well-being of HCP.

ObjectiveTo determine whether more patients presented with Attention-deficit/hyperactivity disorder (ADHD)-related visits and/or sought care from family physicians more frequently during the COVID-19 pandemic.MethodsElectronic medical records from the University of Toronto Practice-Based Research Network were used to characterize changes in family physician visits and prescriptions for ADHD medications. Annual patient prevalence and visit rates pre-pandemic (2017-2019) were used to calculate the expected rates in 2020 and 2021. The expected and observed rates were compared to identify any pandemic-related changes.ResultsThe number of patients presenting for ADHD-related visits during the pandemic was consistent with pre-pandemic trends. However, observed ADHD-related visits in 2021 were 1.32 times higher than expected (95% CI: 1.05-1.75), suggesting that patients visited family physicians more frequently than before the pandemic.ConclusionDemand for primary care services related to ADHD has continued to increase during the pandemic, with increased health service use among those accessing care.

Background Randomized trials are the gold-standard for clinical evidence generation, but they can sometimes be limited by infeasibility and unclear generalizability to real-world practice. External control arm (ECA) studies may help address this evidence gaps by constructing retrospective cohorts that closely emulate prospective ones. Experience in constructing these outside the context of rare diseases or cancer is limited. We piloted an approach for developing an ECA in Crohn’s disease using electronic health records (EHR) data. Methods We queried EHR databases and manually screened records at the University of California, San Francisco to identify patients meeting the eligibility criteria of TRIDENT, a recently completed interventional trial involving an ustekinumab reference arm. We defined timepoints to balance missing data and bias. We compared imputation models by their impacts on cohort membership and outcomes. We assessed the accuracy of algorithmic data curation against manual review. Lastly, we assessed disease activity following treatment with ustekinumab. Results Screening identified 183 patients. 30% of the cohort had missing baseline data. Nonetheless, cohort membership and outcomes were robust to the method of imputation. Algorithms for ascertaining non-symptom-based elements of disease activity using structured data were accurate against manual review. The cohort consisted of 56 patients, exceeding planned enrollment in TRIDENT. 34% of the cohort was in steroid-free remission at week 24. Conclusion We piloted an approach for creating an ECA in Crohn’s disease from EHR data by using a combination of informatics and manual methods. However, our study reveals significant missing data when standard-of-care clinical data are repurposed. More work will be needed to improve the alignment of trial design with typical patterns of clinical practice, and thereby enable a future of more robust ECAs in chronic diseases like Crohn’s disease.

Background/Aim We investigated the association of noninvasive oxygenation support [high flow nasal cannula (HFNC) and BiPAP], timing of invasive mechanical ventilation (IMV), and inpatient mortality among patients hospitalized with COVID-19. Methods Retrospective chart review study of patients hospitalized with COVID-19 (ICD-10 code U07.1) and received IMV from March 2020-October 2021. Charlson comorbidity index (CCI) was calculated; Obesity defined as body mass index (BMI) ≥ 30 kg/m2; morbid obesity was BMI ≥ 40 kg/m2. Clinical parameters/vital signs recorded at time of admission. Results 709 COVID-19 patients underwent IMV, predominantly admitted from March-May 2020 (45%), average age 62±15 years, 67% male, 37% Hispanic, and 9% from group living settings. 44% had obesity, 11% had morbid obesity, 55% had type II diabetes, 75% had hypertension, and average CCI was 3.65 (SD = 3.11). Crude mortality rate was 56%. Close linear association of age with inpatient-mortality risk was found [OR (95% CI) = 1.35 (1.27–1.44) per 5 years, pConclusion Time spent on noninvasive oxygenation support [as defined by high flow nasal cannula (HFNC) and BiPAP] prior to IMV increased mortality risk. Research for the generalizability of our findings to other respiratory failure patient populations is needed.

With the rapid proliferation of portable and wearable electronics, energy autonomy through efficient energy harvesting has become paramount. Thermoelectric generators (TEGs) stand out as promising candidates due to their silent operation, high reliability, and maintenance-free nature. This paper presents the design, fabrication, and analysis of a micro-scale TEG for powering such devices. A planar configuration was employed for its inherent miniaturization advantages. Finite element analysis using ANSYS reveals that a double-layer device under a 50 K temperature gradient generates an impressive open-circuit voltage of 1417 mV and a power output of 2.4 μW, significantly exceeding its single-layer counterpart (226 mV, 0.12 μW). Validation against the analytical model results yields errors within 2.44% and 2.03% for voltage and power, respectively. Furthermore, a single-layer prototype fabricated using paper shadow masks and sputtering deposition exhibits a voltage of 131 mV for a 50 K temperature difference, thus confirming the feasibility of the proposed design. This work establishes a foundation for developing highly efficient micro-TEGs for powering next-generation portable and wearable electronics. [ABSTRACT FROM AUTHOR]

Background: Despite significant reductions in recent malaria cases and deaths globally, the persistence of this health concern necessitates a shift from traditional top-down approaches. Consequently, malaria control initiatives increasingly focus on empowering local communities through community-centred strategies. Therefore, this scoping review protocol systematically explores diverse community knowledge approaches adopted in malaria programmes worldwide and their associated outcomes. Methods: Adhering rigorously to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) guidelines, a comprehensive scoping review protocol was developed. Collaborating with a research librarian, a systematic search strategy targeted peer-reviewed literature from databases such as PubMed, Embase, Scopus, and Web of Science, complemented by a thorough grey literature search. Titles and abstracts will be screened, followed by extracting bibliographic details and outcome information using a standardized framework. Subsequently, the results will be systematically summarized and presented in a structured tabular format (S1 Checklist). Discussion: This scoping review promises an in-depth understanding of current research regarding the impact of community knowledge in malaria programmes. The identification of knowledge gaps and intervention needs serves as a valuable resource for malaria-affected countries. The profound implications of community knowledge underscore its pivotal role in enhancing the effectiveness of prevention, control, and elimination efforts. Insights from this review will assist policymakers, empowering implementers and community leaders in designing effective interventions. This concerted effort aims to adeptly leverage community knowledge, thereby propelling progress toward the achievement of malaria elimination goals. [ABSTRACT FROM AUTHOR]

Mpox (formerly known as monkeypox) virus and some related poxviruses including smallpox virus pose a significant threat to public health, and effective prevention and treatment strategies are needed. This study utilized a reverse vaccinology approach to retrieve conserved epitopes for monkeypox virus and construct a vaccine that could provide cross-protection against related viruses with similar antigenic properties. The selected virulent proteins of monkeypox virus, MPXVgp165, and Virion core protein P4a, were subjected to epitope mapping for vaccine construction. Two vaccines were constructed using selected T cell epitopes and B cell epitopes with PADRE and human beta-defensins adjuvants conjugated in the vaccine sequence. Both constructs were found to be highly antigenic, non-allergenic, nontoxic, and soluble, suggesting their potential to generate an adequate immune response and be safe for humans. Vaccine construct 1 was selected for molecular dynamic simulation studies. The simulation studies revealed that the TLR8-vaccine complex was more stable than the TLR3-vaccine complex. The lower RMSD and RMSF values of the TLR8 bound vaccine compared to the TLR3 bound vaccine suggested better stability and consistency of hydrogen bonds. The Rg values of the vaccine chain bound to TLR8 indicated overall stability, whereas the vaccine chain bound to TLR3 showed deviations throughout the simulation. These results suggest that the constructed vaccine could be a potential preventive measure against monkeypox and related viruses however, further experimental validation is required to confirm these findings. [ABSTRACT FROM AUTHOR]

Background: Chronic myocardial injury is a condition defined by stably elevated cardiac biomarkers without acute myocardial ischemia. Although studies from high-income countries have reported that chronic myocardial injury predicts adverse prognosis, there are no published data about the condition in sub-Saharan Africa. Methods: Between November 2020 and January 2023, adult patients with chest pain or shortness of breath were recruited from an emergency department in Moshi, Tanzania. Medical history and point-of-care troponin T (cTnT) assays were obtained from participants; those whose initial and three-hour repeat cTnT values were abnormally elevated but within 11% of each other were defined as having chronic myocardial injury. Mortality was assessed thirty days following enrollment. Results: Of 568 enrolled participants, 81 (14.3%) had chronic myocardial injury, 73 (12.9%) had acute myocardial injury, and 412 (72.5%) had undetectable cTnT values. Of participants with chronic myocardial injury, the mean (± sd) age was 61.5 (± 17.2) years, and the most common comorbidities were CKD (n = 65, 80%) and hypertension (n = 60, 74%). After adjusting for CKD, thirty-day mortality rates (38% vs. 36%, aOR 1.03, 95% CI: 0.52–2.03, p = 0.931) were similar between participants with chronic myocardial injury and those with acute myocardial injury, but significantly greater (38% vs. 13.6%, aOR 3.63, 95% CI: 1.98–6.65, p<0.001) among participants with chronic myocardial injury than those with undetectable cTnT values. Conclusion: In Tanzania, chronic myocardial injury is a poor prognostic indicator associated with high risk of short-term mortality. Clinicians practicing in this region should triage patients with stably elevated cTn levels in light of their increased risk. [ABSTRACT FROM AUTHOR]