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Abstract Background Access to safe, financial affordable health care is a key factor in reducing health disparities. The malaria is a major public health issue, with significant economic implications in Guinea where the free malaria care services were introduced in 2010. This paper analyzes the costs associated with the care pathway for malaria patients in the Republic of Guinea. Methods An analysis of the costs associated with malaria disease was conducted using data from a cross-sectional survey on the determinants of malaria care pathway between December 2022 and March 2023. The data were collected in health facilities and at community health workers. According to the patient’s perspective, Time-Driven Activity-Based Costing (TDABC) and micro-costing approaches were used to assess the costs associated with care-seeking, cases management, and income loss. Results A total of 3300 patients were recruited in 60 health facilities. The majority were in urban areas (64.8%). One third of the patients were children under five years old. Over half of the patients or caregivers were without formal education, and most households were headed by husbands (78.5%). The median monthly income of the head of households was $116.0. Furthermore, after diagnosis, 25.5% of cases were uncomplicated malaria, 19.2% were complicated, and 52.2% were malaria associated with other diseases. Globally 41% of cases were on their first care pathway. The costs of care-seeking varied according to type of malaria, from $3.5 and $13.5 respectively for uncomplicated and complicated cases. The median direct costs of case management at health facilities were $7.3 (IQR: $4.1,13.3) for uncomplicated and $30.5 (IQR: 15.7, 51.4) for complicated cases. The total costs associated with the global care pathway differed across types of malaria and age groups, with median costs estimated at $17.4 (IQR: 6.7, 34.8) for uncomplicated cases and $43.5 (IQR: $ 19.7, 74.0) for complicated malaria. A delay in appropriate care-seeking accounted for 19% of the costs incurred by malaria patients in Guinea (p

Changes in the exchange rate affect many macroeconomic variables, where the depreciation of the exchange rate leads to the effects of economic activity through the rise in the prices of foreign goods, "imports" for domestic goods, which leads to the reluctance of the decimating Local yen for foreign goods, leading to increased international competitiveness of domestic goods, high export volume and reduced imports, all resulting in improved trade deficits. Among other things, the decline in local currency exchange rates can be accompanied by deflationary effects on the gross domestic product (GDP) through a decline in the purchase of export and import prices, which occurs in developing countries such as Algeria. This analysis, which delves into a crucial aspect of international trade, examined the impact of exchange rate fluctuations on imports in Algeria from 1990 to 2021. The methodology used was the self-slope technique, also known as Vector Autoregression (VAR), which relied on two crucial variables: the real exchange rate, which measures the amount of foreign goods needed to buy one unit of domestic goods. Similar to a market research analyst, it is important to consider the impact of imports at the local level. This includes goods and services sourced from foreign countries to meet domestic market and consumers' demands, especially during ongoing local protests. The analysis has found a negative and non-significant relationship between the real exchange rate and imports at a significance level of 5%, which means that the real exchange rate does not affect Algerian imports, as most Algerian imports are basic food commodities. These intermediate and productive goods cannot be dispensed without a local alternative. Hence, it indicates that fluctuations in exchange rates have no impact on Algerian imports.

Abstract Extranodal NK/T-cell lymphoma (ENKTCL) is an Epstein-Barr virus (EBV)-related neoplasm preferentially involving the upper aerodigestive tract. Here we show that NK-cell-specific Trp53 disruption in mice leads to the development of NK-cell lymphomas after long latency, which involve not only the hematopoietic system but also the salivary glands. Before tumor onset, Trp53 knockout causes extensive gene expression changes, resulting in immature NK-cell expansion, exclusively in the salivary glands. Both human and murine NK-cell lymphomas express tissue-resident markers, suggesting tissue-resident NK cells as their cell-of-origin. Murine NK-cell lymphomas show recurrent Myc amplifications and upregulation of MYC target gene signatures. EBV-encoded latent membrane protein 1 expression accelerates NK-cell lymphomagenesis and causes diverse microenvironmental changes, particularly myeloid propagation, through interferon-γ signaling. In turn, myeloid cells support tumor cells via CXCL16-CXCR6 signaling and its inhibition is effective against NK-cell tumors in vivo. Remarkably, KLRG1-expressing cells expand in the tumor and are capable of repopulating tumors in secondary recipients. Furthermore, targeting KLRG1 alone or combined with MYC inhibition using an eIF4 inhibitor is effective against NK-cell tumors. Therefore, our observations provide insights into the pathogenesis and highlight potential therapeutic targets, including CXCL16, KLRG1, and MYC, in ENKTCL, which can help improve its diagnostic and therapeutic strategies.

Objective This study investigates Saudi Arabian physiotherapists’ perspectives on direct access to physiotherapy (DAPT) services, focusing on perceived benefits, barriers and implementation in clinical practice.Methods A cross-sectional observational study design was used. Data collection occurred between December 2022 and June 2023 via an online structured questionnaire distributed through email and text messages. The DAPT section comprised items on awareness, endorsement, obstacles/barriers to implementation in Saudi Arabia, perceived benefits and expected benefits of various resources to guide evidence-based practice for physiotherapists. This section featured closed-ended questions using a 5-point Likert scale. The study included licensed physiotherapists currently working in Saudi Arabia.Results The study included 401 participants, with a nearly equal distribution of 203 males (50.6%) and 198 females (49.4%). The most common age group was 25–34 years, comprising 70.6% of the participants. A significant proportion (61.6%) were aware of DAPT, and 88% acknowledged its potential to reduce delays in care. However, 49.9% had not engaged with relevant literature. The primary barriers to DAPT identified were laws and regulations (mean=3.69, SD=1.21), physician support (mean=3.59, SD=0.99), entry-level education (mean=3.45, SD=1.17), patient beliefs (mean=3.38, SD=1.24), self-confidence (mean=3.35, SD=1.15) and professional autonomy (mean=3.34, SD=1.22).Conclusion Physiotherapists in Saudi Arabia demonstrate substantial awareness of direct access. Organisational initiatives and increased awareness are essential to promote direct access. This study highlights that direct patient access to physiotherapists offers significant benefits to patients, healthcare workers and the broader community.

Background: Infective endocarditis (IE) presents significant morbidity and mortality, with potential sex differences in clinical profile and outcomes. This is the first meta-analysis that aims to compare the clinical profile and outcomes of IE between males and females. Methods: We conducted a meta-analysis of nine studies evaluating the clinical profile and outcomes of IE in males versus females extracted from PubMed, EMBASE, SCOPUS, and Cochrane databases up to 1st of Jan 2024. Results: Our meta-analysis revealed notable sex differences in the incidence and complications of IE. Males exhibited a higher incidence of aortic valve IE (RR 1.57, 95 % CI [1.31, 1.88]), surgical indications for IE (RR 1.38, [1.12, 1.70]), Streptococci infection (RR 1.36, [1.04, 1.77]), intracardiac abscess (RR 1.22, [1.05, 1.42]), and Enterococci IE (RR 1.44, [1.28, 1.61]). In contrast, females had a higher incidence of mitral valve IE (RR 0.79, [0.67, 0.94]) and a higher in-hospital mortality rate (RR 0.84, [0.74, 0.96]). No significant sex differences were found in the incidence of valve vegetations, tricuspid valve IE, embolization, and Staphylococcus IE. In-hospital stay was longer in male patients, however, with borderline significance (RR 3.15, [-0.16, 6.45], p = 0.06). In patients who underwent surgery for IE, mortality rates were significantly lower in male patients (RR: 0.67 [0.59, 0.76], p

In today's rapidly evolving world, where technology is progressing swiftly, there is an increasing demand for facial recognition systems. Technologies are similar to digital forensics in that they can recognize people by scanning faces. However, one key problem they confront is dealing with covered or occluded faces, which might restrict recognition of faces in real-world situations. To overcome this issue, we created a system that is capable of identifying individuals even when their faces are veiled. We used the face detector algorithm called Multi-Task Cascaded Convolutional Neural Network (MTCNN) for face detection with 99.8% accuracy. Further we have conducted feature extraction and pre-processing on our self-created dataset. Our project utilizes the power of deep learning model: Residual Network (ResNet50), the form of deep neural network architectures well-suited for the job of features extraction. These features are matched by using Cosine similarity with accuracy of 92%. By leveraging the capabilities in the deep learning algorithms, this project provides a robust solution for automating the recognition of partially occluded faces.

Objective This study aimed to assess the prevalence and risk factors for neonatal sepsis among neonates admitted to selected health facilities in the Bamako district and Koulikoro region in Mali.Design This is a prospective cross-sectional study. Data were analyses using bivariate and multivariate logistic regression.Setting This facility-based study was conducted in four health facilities consisting of two hospitals and two reference health centres in Mali.Participants The study participants comprised 795 randomly selected neonates and their indexed mother.Outcome measures The primary outcome of the study was the prevalence of sepsis in the considered health facilities. The other variables of interest were risk factors for sepsis.Results The prevalence of neonatal sepsis among the study population was 21.00%. More than 74% of sepsis cases were early onset (

The relationship between bank performance and bank value is a crucial area of study, particularly in the context of emerging economies like Jordan. This study aims to investigate the moderating effect of bank performance on bank value, providing insight into how performance metrics influence overall valuation. The study employs a comprehensive methodological approach, utilizing panel data regression analysis to examine data from a sample of Jordanian banks over the period from 2014 to 2022. Key performance indicators such as Tobin’s Q, accounting conservatism, debt ratio, current ratio (CR), return on assets (ROA), and asset turnover are factors that influence bank value in the Jordanian market. The results reveal that bank performance significantly moderates the relationship between bank-specific factors and bank value. Specifically, the study finds that return on assets has a positive and statistically significant effect on bank value. The analysis reveals a significant positive correlation between bank value and profitability, as evidenced by a moderate positive correlation coefficient (0.26) between Tobin’s Q and ROA. However, weak or non-significant correlations are observed between bank value and accounting conservatism, debt ratio, and asset turnover.

Sheep farming represents a very important activity in the Algerian steppe, unfortunately it is in a critical situation following climate changes, decreases in rangelands and the rise in the prices of livestock feed, this has created conflicting situations between breeders. The competition for access to steppe spaces and the use of natural resources are at the origin of several conflicts between the actors of the steppe. In this article, we tried to present in a brief way the nature and rate of existing conflicts between pastoralists, and compliance with current legislation which aims to protect the plant cover and soil. The approach taken to carry out this analysis is based on a field survey whose target population is the holders of the herd. The sample size exceeds 364 surveyed spread across the 12 municipalities in our study area. Our work shows that one-fifth of respondents suffer from conflectual situations, either against a legal person or natural persons, while four-fifths endure no strife. In addition, the comparison between two periods (2010 - 2014 and 2015 – 2019) shows that the average number of established and trained offence report by forest administration concerning “illicit grazing” had doubled. The solution consists in cleaning up the steppe against illegal monopolies, accompanied by awareness-raising activities for a better awareness of residents to change their bad behavior. Finally, the competent authorities are required to find alternatives to enable farmers to carry out their activities properly.

Background:Wrong lifestyles such as smoking and drinking alcohol all lead to negative effects. Moreover, smoking is one of the most dangerous effects on people’s health, and it is considered one of the motives for slow suicide in humans, due to its consist deadly compounds and drinking alcohol has a dangerous effects too on people’s health. Objective:Is to estimate the variables at kidney function tests (uric acid, creatinine, and urea) and electrolytes like Na+, K+, and Cl−) in Iraqi male smokers. The major goal research is to check the variation on kidney function tests (uric acid, creatinine, and urea) and electrolytes like Na+, K+, and Cl−) in Iraqi alcoholic smokers males. Materials and Methods:This research carried out on 115 specimens of alcoholic smoker person’s sera bloods and nonalcoholic smoker persons from Iraqi males. Some kidney functions and electrolytes were determined included: uric acid, creatinine, and urea of kidney functions beside to sodium, potassium, and chloride of the electrolytes. Results:In this study, the results showed that affect smoking and alcohol consumption on kidney role was shown by the sera contents of urea, creatinine, uric acid, and urea values as it was observed that the sera contents of uric acid, creatinine, and urea were higher within alcoholic smokers persons compared with the blood specimens of the control group. The contents ranged of uric acid (5.99–9.25), creatinine (0.78–1.2), and urea contents were ranged between 26.3 and 30.03 of alcoholic smoker specimens. While the same markers in nonalcoholic smoker specimens (control group) were as following: uric acid (5.11), creatinine (0.69), and urea values (27.9) sequentially. Conclusion:There are a significant difference in serum Na+, K+, and Cl− in alcoholic smokers when compared to controls, also there are a significant difference in uric acid, urea, and creatinine levels.

Tomatoes are globally valued for their nutritional benefits and unique taste, playing a crucial role in agricultural productivity. Accurate diagnosis of tomato leaf diseases is vital to avoid ineffective treatments that can harm plants and ecosystems. While deep learning models excel in classifying these diseases, distinguishing subtle variations remains challenging. This study introduces XSE-TomatoNet, an enhanced version of EfficientNetB0, incorporating Squeeze-and-Excitation (SE) blocks and multi-scale feature fusion to boost classification performance. XSE-TomatoNet extracts multi-scale features, refines them with SE blocks, and merges them through Global Average Pooling, providing detailed and broad insights for precise disease classification. Our approach achieves an impressive accuracy of 99.11%, with 99% precision and recall, outperforming models like MobileNet and VGG19, especially when combined with data augmentation and ablation studies. The model achieved an average training accuracy of 99.41% and a validation accuracy of 98.88% in 10-fold cross-validation, showing strong generalization to unseen data. We also used LIME and SHAP for model interpretability, offering insights into the decision-making process, and employed Grad-CAM and Grad-CAM++ to visually highlight key areas in leaf images. Finally, the best model was integrated into a web-based system for practical use by tomato cultivators. • XSE-TomatoNet is an enhanced version of EfficientNetB0 which incorporates Squeeze-and-Excitation (SE) blocks and multi-scale feature fusion. • XSE-TomatoNet outperformed MobileNet (87.44%) and VGG-19 (95.50%), in terms of accuracy, achieving 99.41%. • Integration of interpretation using LIME and SHAP models gives higher level understanding of the diseases and employment of Grad-CAM and Grad-CAM++ shows visual representation of the diseased leaves.