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A possible cost-effective way of meeting the demand of poultry products is through reduction of cost of production by introducing affordable unconventional sources of protein, particularly from plant products such as seeds and leaves. The objective of this study was to determine the feed intake, performance, carcass and digesta characteristics of broilers fed broiler finisher diet supplemented with Moringa oleifera leaf meal (MOLM), oak nuts (acorn meal) and crushed maize. The best growth performance, feed intake and tenderer and yellower meat were observed in birds fed 20% inclusion of crushed maize. Various inclusion levels of acorn, MOLM and crushed maize had no significant (P > 0.05) influence on feed conversion ratio. Feed intake was reduced by 20% inclusion of acorn meal. Dressing percentage, liver weight and abdominal fat were not significantly (P > 0.05) affected by dietary treatment. However, there was a significant (P ≤ 0.05) increase in gizzard weight with 20% inclusion of crushed maize. The breast muscle from birds fed 20% acorn had lowest ultimate pH and were less yellow. Low dry matter of digesta in the small intestine and caeca were observed with 20% inclusion of crushed maize and 20% inclusion of acorn, while 15% inclusion of crushed maize, together with 5% MOLM increased the dry matter of digesta and lowered pH in the caeca. It was concluded that 20% of crushed maize can be included in the first and the last finisher phases without negatively influencing performance. Furthermore, the significant positive synergistic effect of 15% acorn and MOLM on performance was prominent at the post-finisher phase (day 45 - 56), suggesting that the birds had adapted to the diet. [ABSTRACT FROM AUTHOR]

Domestic and international crops and livestock trade remain fragile among Zimbabwean smallholder farmers. Commercial crop-livestock integration in climate change vulnerable areas is low and sparsely documented. Practice, knowledge, and attitude indicators influencing participation of smallholder farmers in crop-livestock integrated platforms as a hedge against climate change-induced risks and uncertainties were assessed. A survey with 240 farmers in Insiza district, Matabeleland province, Zimbabwe was conducted. A modified knowledge, attitude, and perception framework was used to analyze data from six wards supported by World Vision through supplementary livelihood programs on crop-livestock integration. Conventional crop-livestock (63%), mixed crops-livestock (25%), and traditional grains-livestock (12%) options were dominant. There was a thin presence of stakeholders with a limited number of local buyers, contracting companies, and agro-dealers who participate on these platforms. Farmers have the knowledge, positive attitude, and motivated perceptions about the potential of traditional grains-livestock mechanisms to reduce climate change welfare compromising factors. Unbalanced policies, limited financing, and uncompetitive marketing channels limit the uptake of this option. Traditional grains-livestock alternatives should be supported in semi-arid environments to reduce food, income, and nutrition insecurity. Public-private partnerships should establish value addition systems to increase the market size of traditional grains-livestock products and enhance commercialization.

The fourth industrial revolution witnessed significant advancements in automating numerous aircraft inspection tasks. Still, certain critical procedures continue to rely on manual execution, including the aero-engine blade weighing process. This task is of paramount importance for blade mass inspection and engine dynamic balancing. Yet, automation of aero-engine blade weighing remains a challenge due to the intricate geometry of engine blades, and the stringent requirements on precision. To address this gap, this paper introduces, for the first time, a vision-guided robotic system for autonomous aero-engine blade weighing. The proposed system presents a novel end-effector design incorporating a high-precision load cell for accurate and rapid weighing coupled with an imaging sensor for autonomous robotic perception capabilities. The system is tested in industrial settings, and the results show a high weighing precision and accuracy of 0.0404 g and of 0.0252 g, respectively. Our system offers the advantage of seamless integration into existing industrial setups without the need for facility reconfiguration. Video Link., Competing Interests: Declarations. Competing interests: The authors declare no competing interests., (© 2024. The Author(s).)

Objective: To examine underlying political economy factors that enable or impede the integration of nutrition considerations into food system governance., Design: Comparative political economy analysis of data collected through (1) value chain analyses of selected healthy and unhealthy commodities and (2) food system policy analyses, using a theoretical framework focused on power, politics, interests and ideas., Setting: Ghana and South Africa., Participants: Value chain actors relevant to healthy and unhealthy foods (Ghana n 121; South Africa n 72) and policy stakeholders from government (Health, Agriculture, Trade and Industry, Finance), academia, civil society, development partners, Civil Society Organization (CSO) and private sector (Ghana n 28; South Africa n 48)., Results: Nutrition was a stated policy priority in both countries; however, policy responsibility was located within the health sector, with limited integration of nutrition into food system sectors (including Agriculture, Trade and Industry). Contributing factors included a conceptions of policy responsibilities for nutrition and food systems, dominant ideas and narratives regarding the economic role of the food industry and the purpose of food system policy, the influence of large food industry actors, and limited institutional structures for cross-sectoral engagement and coordination., Conclusions: Integrating nutrition into multi-sectoral food policy to achieve multiple food system policy goals will require strategic action across jurisdictions and regional levels. Opportunities included increasing investment in healthy traditional foods, strengthening urban/rural linkages and informal food systems, and strengthening institutional structures for policy coherence and coordination related to nutrition.

(1) Background: HIV drug resistance (HIVDR) poses a significant challenge to the effectiveness of antiretroviral therapy and the overall management of HIVand AIDS. Understanding the predictors of HIVDR is critical for developing strategies to mitigate its impact. The objectives of this study were to identify the predictors of HIVDR among Zimbabwe Population-Based HIV Impact Assessment (ZIMPHIA 2020) study participants, a national population-based survey. (2) Methods: Data from people living with HIV who participated in the ZIMPHIA 2020 were used to determine the predictors of HIVDR. (3) Results: The prevalence of HIVDR was 44.9%. Acquired HIVDR was present in 76.1% of people with a virological failure and transmitted resistance is 22.6% in naïve individuals. Factors associated with HIVDR in adjusted analysis were the number of lifetime sexual partners (aOR = 1.03, 95% CI: 1.01-1.06, p = 0.017), each additional year since the first HIV positive result (aOR = 1.17, 95% CI: 1.09-1.25, p < 0.01), each additional year on ART (aOR = 1.14, 95% CI: 1.06-1.23, p = 0.001), initiating ART before 2014 (aOR = 3.08, 95% CI: 1.72-5.49, p = 0.020), ever had switched antiretrovirals (aOR = 2.47, 95% CI: 1.15-5.29, p = 0.020) or had ever had a viral load test (aOR = 2.54, 95% CI: 1.54-4.17, p < 0.001) and a CD4 count < 350 (aOR = 2.04, 95% CI: 1.48-2.83, p < 0.01), while age ≥ 50 (aOR = 0.56, 95% CI: 0.32-0.98, 32 p = 0.04), condom use at last encounter (OR: 0.49, 95%CI: 0.33-0.73, p < 0.001), and not being on ART (aOR = 0.09, 95% CI: 0.06-0.13, p < 0.01) were associated with reduced odds of HIVDR. Conclusions: HIVDR was high among the participants. There is a need to address HIVDR and enhance the mechanisms already in place. This study introduces more information that would help in developing targeted interventions to prevent HIVDR and improve patient outcomes.

Background: Men who have sex with men (MSM) are disproportionately impacted by HIV in sub-Saharan Africa (SSA), where condomless anal intercourse (CAI) is a major driver of HIV transmission among this hidden subpopulation., Objectives: To determine CAI drivers and prevalence among HIV-positive and HIV-negative MSM., Method: Data from 1538 MSM who participated in a biobehavioural survey in Zimbabwe were used. Secondary statistical data analysis methods were used to determine prevalences and drivers of CAI., Results: A high prevalence of CAI, of at least 30%, among HIV-positive and HIV-negative MSM was found. Factors that led to a statistically significant higher CAI among HIV-positives compared to HIV-negatives included drunkenness (35% vs. 25%, P = 0.01), fear of partner (13% vs. 9%, P = 0.017), trusting the partner (10% vs. 6%, P = 0.008), and being offered more money (10% vs. 6%, P = 0.003)., Conclusion: Our findings indicate that economic, socio-behavioural and perceptual dimensions increase men's likelihood to engage in risky sexual behaviour, suggesting the need for HIV prevention efforts that provide tailored education regarding HIV risk among MSM in SSA. This is the first large biobehavioural survey that generated valuable information useful for analysing condomless anal sex among MSM in Zimbabwe., Competing Interests: The authors declare that they have no financial or personal relationships that may have inappropriately influenced them in writing this article., (© 2024. The Authors.)

Introduction: Multiple HIV Prevention Cascades (HPC) formulations have been proposed to assist advocacy, monitoring of progress of HIV prevention implementation and research to identify ways to increase use of HIV prevention methods. Schaefer and colleagues proposed a unifying formulation suitable for widespread use across different populations which could be used for routine monitoring or advocacy. Robust methods for defining and interpreting this HPC formulation using real world data is required., Methods: Data collected as part of the Manicaland Pilot HIV Prevention Cascades Study, east Zimbabwe, in 2018-19, was used to validate the HPC framework for PrEP, VMMC, male condom and combination prevention method use. Validation measures included feasibility of populating the HPC, contrasting simple vs complex measures of the HPC (using 2-sample proportion test), and testing ability of main bars to predict prevention use and testing whether sub-bars explained why people were lost from the HPC using logistic regression., Results: It was possible to populate the HPC for both individual and combined prevention methods using pilot survey data. Most steps were associated with prevention method usage outcomes, except for VMMC. There were significant overlaps between individuals reporting positive responses for the main bar and those citing barriers to motivation. To refine the HPC's access bar definition, it is suggested to also consider individuals who report access barriers. While the HPC framework identifies barriers to individual prevention methods, challenges arise in identifying those for combined prevention., Discussion: Our study successfully utilised questionnaires from the Manicaland HPC pilot survey to measure the HPC for individual and combined prevention methods. This demonstrates the feasibility of populating this framework using general population survey data and designated questionnaire modules. We propose a final formulation of the HPC, questionnaire modules and methods to create it. With proper evaluation and promotion, the HPC can enhance prevention services, aiding in the crucial reduction of HIV incidence., Competing Interests: This work was supported by the Bill and Melinda Gates Foundation (BMGF) (INV-09999) and the National Institute of Mental Health (NIMH) (R01MH114562-01). LM, SG, JI-E and CN acknowledge funding from the MRC Centre for Global Infectious Disease Analysis (reference MR/X020258/1), funded by the UK Medical Research Council (MRC). This UK funded award is carried out in the frame of the Global Health EDCTP3 Joint Undertaking. SG declares shareholdings in pharmaceutical companies GlaxoSmithKline and Astra Zeneca. All other authors have no conflicts of interest to declare.

Introduction: suboptimal use of donor funds and poor health systems performance is rife across most developing countries; to address this, results-based financing (RBF) models were developed. However, it is imperative to explore the emic and context specific influence of results-based financing in health systems performance. This study therefore sought to explore the influence of results-based financing on health worker motivation and governance, temporal perspective, distributional principle, and policy coherence. Finally, the influence of results-based financing on interrelations across donors, technical partners, and health workers was explored., Methods: the study adopted a qualitative, exploratory, descriptive, phenomenological design using audio-recorded face-to-face semi-structured interviews to capture diverse perspectives from the remaining and available two health financing experts, two technical partner organization representatives, and six health workers who have been implementing results-based financing from 2011 to 2022 in the Marondera district of Zimbabwe. Data was transcribed and collectively analyzed using NVIVO software., Results: improved staff motivation, better governance, health system development, equity, and policy consistency were attributable to results-based financing, notwithstanding several challenges including understaffing, increased workload, procurement red tape, financial rigidity, and delays in subsidy payments, which eroded gains of better performance. Additionally, a lack of continuum of care due to user fees faced by the poor at higher levels of care, and limited engagement between donors and healthcare facility workers were also observed. Conclusion: reinforcing pinpointed positives is vital for sustaining realized health gains; however, urgent attention is required to address the challenges to safeguard the milestones achieved thus far., Competing Interests: The authors declare no conflicts of interest., (Copyright: Prosper Nyabani et al.)

Objectives: Access to safe drinking water, sanitation, and hygiene, collectively called WASH, is a fundamental human right and a cornerstone of public health. However, inadequate WASH practices and environments significantly contribute to the global burden of diarrheal diseases, particularly, in children aged under 5 years. Inadequate WASH conditions are the primary drivers of various infectious diseases, including cholera, dysentery, hepatitis A, typhoid, and polio., Methods: We conducted secondary data analysis using the 2019 Zimbabwe Multiple Indicator Cluster Survey to investigate the specific WASH risk factors associated with recent diarrheal episodes in children aged under 5 years., Results: A total of 853 (14%) of 6092 children were reported to have experienced an episode of diarrhea in the last 2 weeks preceding the survey. Having insufficient water in the household was associated with 17.0% diarrhea episodes compared with 13.6% in those who did not face this problem. The availability of soap or detergents to wash hands was associated with a risk of diarrhea, with an odds ratio and 95% confidence interval of 1.19 (1.01-1.40), P = 0.033. The use of surface water, including rivers, dams, lakes, ponds, streams, canals, and irrigation channels, was associated with differences in diarrheal episodes, although this was of borderline significance, P = 0.082. Of the children who had a recent episode of diarrhea, 41.0% had their parents or caregivers seeking medical attention., Conclusions: There is need for an improvement in safe water supply to households and an improvement in health education on the importance of using soap after using the toilet to avoid contamination of food and water., Competing Interests: The authors have no competing interests to declare., (© 2024 The Author(s).)

Migration, a prevalent global phenomenon, significantly impacts health, particularly in low- to middle-income countries. This article presents a rapid review aimed at mapping projects, lessons and policies concerning sexual and reproductive health (SRH), HIV and migration in southern Africa. Utilising a population-concept-context framework, the review focuses on understanding the scope, nature and extent of interventions, identifying lessons learnt, and assessing existing policies and strategies. A comprehensive search strategy and screening process resulted in 19 studies and reports for inclusion. The review highlighted diverse projects across southern Africa, addressing SRH and HIV among migrants, refugees and asylum seekers. Projects ranged from peer-education interventions to community-based referral systems, aiming to improve knowledge, access and outcomes related to SRH and HIV. The lessons learnt emphasised the importance of community involvement, healthcare worker (HCW) training and inclusive policies to address migrants' diverse needs effectively. Additionally, projects facilitated cross-border collaborations and policy integration, enhancing access to SRH-HIV services and migrant health rights. Despite these efforts, challenges persist, including gender-based violence, financial barriers and xenophobic attitudes among HCWs. Limited access to comprehensive sexuality education and social protection for migrants underscores the need for further policy development and implementation. Nevertheless, existing policies, such as Botswana's inclusive HIV treatment policy and South Africa's National Strategic Plan for HIV, TB and STIs, demonstrate steps towards ensuring migrants' rights to healthcare.

Service providers find it difficult to implement Physical Exercise (PE) strategies in routine care within inpatient mental health settings even though they perceive it to be an effective therapy, with a robust evidence base. Identifying barriers that exist can assist with the development of future interventions and support PE services being introduced into mental health inpatient settings. The aim of this systematic review was to synthesise the evidence on the barriers or perceived barriers that exist amongst service users and providers when incorporating PE as an intervention within inpatient mental health settings. Using a narrative synthesis approach, four main themes were identified: (i) Barriers relating to service users' mental and physical health, (ii) Factors relating to service providers, (iii) Environmental factors and (iv) Cultural factors. Both service users and providers need more knowledge on implementing PE in inpatient mental health settings. Tailored programmes for service users are warranted, with specialist roles for staff developed., (© 2024 The Authors. International Journal of Mental Health Nursing published by John Wiley & Sons Australia, Ltd.)

The Covid-19 pandemic and associated restrictions have the potential to alter sexual risk behaviours for HIV acquisition with important implications for HIV prevention programmes in sub-Saharan Africa. To date, no large-scale data have been published to substantiate hypothesised changes in sexual risk behaviours. We used longitudinal survey data to assess the impact of Covid-19 on sexual risk behaviours in east Zimbabwe. Data on sexual behaviours in HIV-negative adults aged 15-54 years were collected in two rounds of a general population open-cohort survey conducted in Manicaland, Zimbabwe shortly before (July 2018 to December 2019; N = 7316) and several months into the Covid-19 epidemic (February to July 2021; N = 6356). Descriptive statistics and logistic regression models of serial cross-sectional and prospective cohort data were used to assess changes in sexual risk behaviours. The proportion of females aged 15-19 years reporting sexual debut declined from 29.7% before Covid-19 to 20.3% during Covid-19 (adjusted odds ratio (AOR) = 0.49, 95% confidence interval (95% CI), 0.38-0.63). Fewer sexually-active females reported multiple sexual partners during Covid-19 (3.35% versus 6.07%; AOR = 0.55, 95% CI, 0.43-0.72). No population-level changes in male behaviour between survey rounds were recorded but the cohort analysis revealed a complex pattern of behaviour change with HIV risk behaviours increasing for some individuals and decreasing for others. Overall HIV risk behaviours remained high in a sub-Saharan African population with a generalised HIV epidemic over a period of Covid-19 lockdowns when movements and social contacts were restricted., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Morris et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Background: Chronic lung disease (CLD) is common among children with HIV (CWH) including in those taking antiretroviral therapy (ART). Azithromycin has both antimicrobial and anti-inflammatory effects and has been effective in improving lung function in a variety of lung diseases. We investigated lung function trajectories among CWH with CLD on ART enrolled in a randomized controlled trial of adjuvant azithromycin. We also investigated factors that modified the effect of azithromycin on lung function., Methods: The study used data from a double-blinded placebo-controlled trial conducted in Malawi and Zimbabwe of 48 weeks on azithromycin (BREATHE: ClinicalTrials.gov NCT02426112) among CWH aged 6 to 19 years taking ART for at least six months who had a forced expiratory volume in one second (FEV 1 ) z-score <-1.0. Participants had a further follow-up period of 24 weeks after intervention cessation. FEV 1 , forced vital capacity (FVC) and FEV 1 /FVC were measured at baseline, 24, 48 and 72-weeks and z-scores values calculated. Generalized estimating equations (GEE) models were used to determine the mean effect of azithromycin on lung-function z-scores at each follow-up time point., Results: Overall, 347 adolescents (51% male, median age 15 years) were randomized to azithromycin or placebo. The median duration on ART was 6.2 (interquartile range: 3.8-8.6) years and 56.2% had an HIV viral load < 1000copies/ml at baseline. At baseline, the mean FEV 1 z-score was - 2.0 (0.7) with 44.7% (n = 155) having an FEV 1 z-score <-2, and 10.1% had microbiological evidence of azithromycin resistance. In both trial arms, FEV 1 and FVC z-scores improved by 24 weeks but appeared to decline thereafter. The adjusted overall mean difference in FEV 1 z-score between the azithromycin and placebo arms was 0.004 [-0.08, 0.09] suggesting no azithromycin effect and this was similar for other lung function parameters. There was no evidence of interaction between azithromycin effect and baseline age, lung function, azithromycin resistance or HIV viral load., Conclusion: There was no observed azithromycin effect on lung function z-scores at any time point suggesting no therapeutic effect on lung function., Trial Registration: ClinicalTrials.gov NCT02426112. First registered on 24/04/2015., (© 2024. The Author(s).)

There is a substantial increase in sexually transmitted infections (STIs) among men who have sex with men (MSM) globally. Unprotected sexual practices, multiple sex partners, criminalization, stigmatisation, fear of discrimination, substance use, poor access to care, and lack of early STI screening tools are among the contributing factors. Therefore, this study applied multilayer perceptron (MLP), extremely randomized trees (ExtraTrees) and XGBoost machine learning models to predict STIs among MSM using bio-behavioural survey (BBS) data in Zimbabwe. Data were collected from 1538 MSM in Zimbabwe. The dataset was split into training and testing sets using the ratio of 80% and 20%, respectively. The synthetic minority oversampling technique (SMOTE) was applied to address class imbalance. Using a stepwise logistic regression model, the study revealed several predictors of STIs among MSM such as age, cohabitation with sex partners, education status and employment status. The results show that MLP performed better than STI predictive models (XGBoost and ExtraTrees) and achieved accuracy of 87.54%, recall of 97.29%, precision of 89.64%, F1-Score of 93.31% and AUC of 66.78%. XGBoost also achieved an accuracy of 86.51%, recall of 96.51%, precision of 89.25%, F1-Score of 92.74% and AUC of 54.83%. ExtraTrees recorded an accuracy of 85.47%, recall of 95.35%, precision of 89.13%, F1-Score of 92.13% and AUC of 60.21%. These models can be effectively used to identify highly at-risk MSM, for STI surveillance and to further develop STI infection screening tools to improve health outcomes of MSM., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Mugurungi et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

We conducted secondary data analysis using a biobehavioral survey dataset of 1538 MSM from Zimbabwe. Survey participants were screened for the four symptoms suggestive of tuberculosis infection using the WHO TB screening algorithm. Results: All participants experienced at least one symptom suggestive of tuberculosis. 40% of HIV-positive MSM reported having had a cough in the last month and 13% of them experienced unexpected weight loss. The prevalence of experiencing any of the four TB symptoms amongst HIV-positive MSM was 23%. Contribution There is an urgent need for active TB case finding and treatment amongst HIV-positive MSM in Zimbabwe. Clinicians will need to ensure that MSM who need TB testing receive it timeously., (© 2024. The Author(s).)

Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Objectives: To measure HIV and Hepatitis B virus (HBV) prevalence and associated risk behaviors among men who have sex with men (MSM) and transgender women/genderqueer individuals (TGW/GQ) in Zimbabwe., Methods: We conducted a biobehavioral survey using respondent-driven sampling (RDS) among adult MSM and TGW/GQ in Harare and Bulawayo, Zimbabwe in 2019. Participants completed a questionnaire and underwent testing for HIV and HBV., Results: Overall, 1,510 (Harare: 694, Bulawayo 816) participants were enrolled and consented to testing; 3.8 % (58) tested positive for HBV, 22.5 % (339) tested positive for HIV, and 2.2 % (33) tested positive for both HIV and HBV. HBV prevalence was higher among participants with HIV compared to HIV-negative participants (9.7 % vs. 2.1 %, p < 0.0001). Overall, HBV prevalence was not statistically different between MSM and TGW/GQ (3.7 % vs 4.5 %, p = 0.49) nor between Harare and Bulawayo (3.3 % vs 4.3 %, p = 0.33)., Conclusions: Our survey demonstrates the prevalence of HBV among MSM and TGW/GQ is lower than other estimates of HBV among MSM in Africa but remains high among our survey population living with HIV highlighting the need to expand HBV testing and treatment services, especially among people with HIV in Zimbabwe., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2024 Published by Elsevier Ltd.)

Metals have been used for many years in medicine, particularly for the treatment of cancer. Cisplatin is one of the most used drugs in the treatment of cancer. Although platinum-containing therapeutics have unparalleled efficacy in cancer treatment, they are coupled with adverse effects and the development of tumour resistance. This has led to the exploration of other metal-based modalities including ruthenium-based compounds. Thus, in our previous study, we synthesized and characterized a novel ruthenium (II) complex (referred to herein as GA113) containing a bis-amino-phosphine ligand. The complex was subsequently screened for its anti-cancerous potential against a human malignant melanoma A375 cell line and findings revealed favourable cytotoxicity. In the current study, a nuclear magnetic resonance (NMR)-based cellular metabolomics approach was applied to probe the possible mechanism of GA113 in A375 cells. In addition, other biological assays including light microscopy, Hoechst-33258 and MitoTracker Orange CM-H 2 TMRos stain were used to assess cellular viability and apoptosis in GA113-treated cells. Consequently, multivariate statistical data analysis was applied to the metabolomic data to identify potential biomarkers. Six signatory metabolites were altered after treatment. Changes in these metabolites were linked to two metabolic pathways, which include the alanine, aspartate, and glutamate metabolic pathway as well as the glycine, serine, and threonine pathway. By means of an NMR-based metabolomic approach, we identified the potential mechanism of action of complex GA113 in A375 cancer cells thus providing new insights into the metabolic pathways affected by complex GA113 and establishing a foundation for further development, research, and eventual application in cancer., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 Elsevier Inc. All rights reserved.)