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The associations of cardiovascular health and all-cause mortality among individuals with depression

SIX1 aggravates the progression of spinal cord injury in mice by promoting M1 polarization of microglia

Paternal family history of premature atherosclerotic disease and perinatal death: A population-based cohort study

Background Studies have reported that pregnancies conceived by fathers with modifiable cardiovascular risk factors are at higher risk of ending in losses compared to those without such risk factors. Our objective was to examine the association between paternal family history _a non-modifiable risk factor_ of premature atherosclerotic disease and perinatal death. Methods This is a population-based cohort study. Information on fathers, aged 18–50 years who participated in three population-based health surveys conducted in Norway during 1974–2003 was linked to their singleton births registered in the Medical Birth Registry of Norway. We used multilevel mixed effect logistic regression analyses with random intercepts by father’s identification number. The birth was the observation unit in all analyses. Results A total of 220,386 fathers who had 512,111 births with information on family history of CHD (12.3% with positive family history) and 203,257 births with information on family history of stroke (9.2% with positive family history) were analysed. There were 782 (1.3%) and 195 (1%) perinatal deaths in births to fathers with family history of CHD and stroke while 5,922 (1.3%) and 1,858 (1%) in those without family histories. We found no association between family history of CHD and stillbirth (OR 1.01, 95% CI 0.92; 1.12), neonatal death (OR 0.98, 95%CI 0.86, 1.11) or perinatal death (OR 1.00, 95% CI 0.92, 1.08). Similarly, we found no associations between family history of stroke and stillbirth (OR 1.00, 95% CI 0.82, 1.21), neonatal death (OR 1.09, 95%CI 0.84, 1.41) or perinatal death (OR 1.02, 95% CI 0.88, 1.20). Limitations Socioeconomic background of fathers was captured using imperfect proxy. Potential misclassification of family history and selection bias should be considered. Conclusion Results of this large, cohort study including half-a million births, do not indicate an association between paternal family history of premature atherosclerotic disease and perinatal death.

Shared governance increases marine protected area effectiveness

Marine protected areas (MPAs) are widely used to conserve and manage coastal resources. Protected areas are governed by a variety of institutional arrangements, yet little is known concerning the relative performance of different governance approaches. This research draws upon a unique dataset that combines details on the reported International Union for Conservation of Nature (IUCN) governance categories of 217 global MPAs and their ecological outcomes to compare the performance of alternative governance arrangements. We find that MPAs with shared governance arrangements, where management authority is shared among multiple government and non-government actors, are 98% more likely to have higher fish biomass than MPAs governed by state agencies (i.e., primarily government) alone (mean effect size and 95% C.I = 0.32 ± 0.31). We also find higher biomass in older MPAs, those in countries with higher gross domestic product (GDP), and those with a higher proportion of no-take area. With targets to protect 30% of our oceans driving new commitments to expand MPA coverage globally, our results suggest that multi-stakeholder participation and collaboration facilitated by shared and decentralized governance arrangements can play an important role in achieving conservation outcomes.

Characterizing the services provided by family physicians in Ontario, Canada: A retrospective study using administrative billing data

Family physicians in Ontario provide most of the primary care to the healthcare system. However, given their broad scope of practice, they often provide additional services including emergency medicine, hospital medicine, and palliative care. Understanding the spectrum of services provided by family physicians across different regions is important for health human resource planning (HHRP). We investigated the services provided by family physicians in Ontario, Canada using a provincial physician database and administrative physician billing data from 2017. Billing codes were used to define 18 general services that family physicians may provide. We then evaluated variation in the services provided by different physicians based on the physicians’ geographic location (north-urban, north-rural, south-urban, and south-rural) and career stage (i.e., years in practice). Ontario had 14,443 family physicians in 2017, with most practicing in urban communities in southern Ontario and only 6.5% practicing in any setting in northern Ontario. In general, rural physicians provided a greater range of services than their urban colleagues. Their practices most often included clinic medicine, mental health services, emergency medicine, palliative care, and hospital medicine. Physicians in urban southern Ontario and those at a more advanced career stage were more likely to provide a narrower range of services. Overall, our findings have the potential to shape HHRP, medical education curriculum development, and clinical services planning in Ontario and elsewhere. Moreover, our results provide policy- and decision-makers with a basis for integrating knowledge of the specific clinical services delivered by family physicians into their future planning, with the goal of ensuring a fit-for-purpose workforce able to meet community healthcare needs.

In vitro and in vivo evaluation of Ulva lactuca for wound healing

Ulva lactuca (U. lactuca) is an important seaweed species. Some ingredients in this species are thought to accelerate wound healing. However, limited data on the use of seaweed for wound healing exists. This study examined whether ethanol or aqueous extracts of U. lactuca promote antioxidant and anti-inflammatory properties in vitro and wound healing in vitro and in vivo. Cell proliferation, antioxidation, and migration were observed in NIH3T3 cells treated with U. lactuca extract in vitro. Both U. lactuca extracts were examined for their ability to inhibit inflammatory cytokine synthesis in lipopolysaccharide (LPS)-stimulated RAW 264.7 cells. In vivo experiments involved four groups of albino mice (BALB/c; 10 mice per group). One 1.0 cm2 wound was created via excision of full-thickness skin on the back of all mice. Group I mice were treated topically with the ethanol extract of U. lactuca (25 mg/mL) for 10 d. Group II mice were treated topically with an aqueous extract of U. lactuca (12.5 mg/mL) for 10 d. Group III mice received topical application of phosphate-buffered saline solution. Group IV mice wounds were maintained without treatment. Both extracts considerably increased fibroblast proliferation. The antioxidant activity of the U. lactuca extract was determined using a total antioxidant capacity assay. Both extracts inhibited the release of tumor necrosis factor-α (TNF-α) and interferon-γ (IFN-γ) from LPS-mediated inflammation in RAW 264.7 cells. These extracts also upregulated the expression of Th2 cytokines such as transforming growth factor beta 1 (TGF-β1) and interleukin 10 (IL-10) in RAW 264.7 cells under pro-inflammatory conditions. Both extracts enhanced the migratory ability of NIH3T3 cells. U. lactuca ethanol extract enhances wound healing properties in vivo. These results suggest that bioactive compounds derived from U. lactuca extract are beneficial for wound healing and anti-inflammatory therapies.

Depression among people living in rural and urban areas of Thailand: A cross-sectional study

Background Depression has a growing trend in the population worldwide. In this cross-sectional study, we investigated the prevalence and associated factors of depression among individuals residing in rural (Ban Luang district, Nan Province) and urban (Lak Si, Bangkok) areas of Thailand. Understanding the differences in depression between these two settings can provide insights for specific targeted interventions and mental health policies. Methods The multistage stratified random sampling was applied to select the study participants. We recruited participants from rural and urban communities in Thailand using a structured survey questionnaire through either face-to-face interviews or in paper or electronic form. We collected data on depression using the Patient Health Questionnaire-9 (PHQ-9) tool and sociodemographic characteristics and conducted descriptive statistics and logistic regression analysis. Results Of 867 survey participants, 420 were from rural areas (Nan) and 447 were from urban areas (Bangkok). Participants’ mean age was 55.9±9.5 years in rural areas and 56.0±12.0 years in urban areas. Most participants in urban areas were women, married, and had lower education levels (71.1%, 50.3%, 58.8%, respectively). The overall prevalence of depression across both settings was 18.6%. We found a higher prevalence of depression in the urban (31.8%) than the rural (4.5%) setting. In multiple logistic regression analysis, urban residence was significantly associated with higher rates of depression compared with rural residence (adjusted odds ratio [AOR] 9.43, 95% confidence interval [CI] 5.08–17.52). Nuclear family and using social media were associated with lower levels of depression in urban areas (AOR 0.50 and 0.43, 95% CI 0.27–0.93 and 0.22–0.84, respectively). Higher education level was significantly associated with higher levels of depression in rural areas (AOR 3.84, 95% CI 1.19–12.42). Conclusion This study emphasized the difference in depression and related factors between rural and urban areas of Thailand, highlighting a greater prevalence in urban areas. To help prevent depression, it is important to address specific challenges in each setting, such as those faced by highly educated individuals living in rural areas with high depression rates, exploring social media use patterns in urban populations, and understanding dynamics of the nuclear family. Our findings can inform the development of public health policies aimed at effectively mitigating the burden of depression and improving overall mental well-being in specific settings.

Mesothelial cell responses to acute appendicitis or small bowel obstruction reactive ascites: Insights into immunoregulation of abdominal adhesion

Previous abdominal surgery (PAS) increases risk of small bowel obstruction (SBO) due to adhesions, and appendectomy (appy) is an independent risk factor for abdominal adhesion-related complications. Peritoneal inflammation, e.g., acute appendicitis (AA), causes formation of reactive ascitic fluid (rA) that activates peritoneum surface mesothelial cells (MCs) to form adhesions. Pathologic adhesions may arise if restoration of MC-regulated fibrinolysis and secretion of glycocalyx (GCX) are disrupted. Proteins affecting these processes may originate from peritoneal rA. This is a prospective observational IRB-approved study at three Level 1 trauma centers where rA is collected prior to surgical intervention for non-perforated AA or adhesiolysis for SBO. Samples from 48 appy and 15 SBO patients were used to treat human MCs and subjected to quantification of 85 inflammatory mediators. Results were compared between patients with surgically naïve abdomens (naïve) and patients with >1 PAS. Select rA caused MCs to form clusters of fibroblastic cells, extracellular matrix fibers (FIB), and secretion of GCX. PAS and naïve patient rA fluids were clustered into “fiber-GCX” (FIB-GCX) groups: highFIB-highGCX, highFIB-lowGCX, noFIB-highGCX, noFIB-lowGCX, and noFIB-noGCX. Between groups, 26 analytes were differentially abundant including innate immune response, wound healing, and mucosal defense proteins. Factors that contributed to the differences between groups were rA-induced highFIB and history of PAS. Overall, PAS patient rA showed a muted immune response compared to rA from naïve patients. Our data suggest that abdominal surgery may negatively impact future immune responses in the abdomen. Further, quantifying immunomodulators in peritoneal rA may lead to the development a personalized approach to post-surgical adhesion treatment and prevention.

Global, regional, and national survey on burden and Quality of Care Index (QCI) of orofacial clefts: Global burden of disease systematic analysis 1990–2019

Background Orofacial clefts are the most common craniofacial anomalies that include a variety of conditions affecting the lips and oral cavity. They remain a significant global public health challenge. Despite this, the quality of care for orofacial clefts has not been investigated at global and country levels. Objective We aimed to measure the quality-of-care index (QCI) for orofacial clefts worldwide. Methods We used the 2019 Global Burden of Disease data to create a multifactorial index (QCI) to assess orofacial clefts globally and nationally. By utilizing data on incidence, prevalence, years of life lost, and years lived with disability, we defined four ratios to indirectly reflect the quality of healthcare. Subsequently, we conducted a principal component analysis to identify the most critical variables that could account for the observed variability. The outcome of this analysis was defined as the QCI for orofacial clefts. Following this, we tracked the QCI trends among males and females worldwide across various regions and countries, considering factors such as the socio-demographic index and World Bank classifications. Results Globally, the QCI for orofacial clefts exhibited a consistent upward trend from 1990 to 2019 (66.4 to 90.2) overall and for females (82.9 to 94.3) and males (72.8 to 93.6). In the year 2019, the top five countries with the highest QCI scores were as follows: Norway (QCI = 99.9), Ireland (99.4), France (99.4), Germany (99.3), the Netherlands (99.3), and Malta (99.3). Conversely, the five countries with the lowest QCI scores on a global scale in 2019 were Somalia (59.1), Niger (67.6), Burkina Faso (72.6), Ethiopia (73.0), and Mali (74.4). Gender difference showed a converging trend from 1990 to 2019 (optimal gender disparity ratio (GDR): 123 vs. 163 countries), and the GDR showed a move toward optimization (between 0.95 and 1.05) in the better and worse parts of the world. Conclusion Despite the positive results regarding the QCI for orofacial clefts worldwide, some countries showed a slight negative trend.

Five year mortality in an RCT of a lung cancer biomarker to select people for low dose CT screening

The role of biomarkers in risk-based early detection of lung cancer may enable screening to become cost effective and widely accessible. EarlyCDT-Lung is an example of such a blood-based autoantibody biomarker which may improve accessibility to Low dose Computed Tomography (LDCT) screening for those at highest risk. We randomized 12 208 individuals aged 50–75 at high risk of developing lung cancer to either the test or to standard clinical care. Outcomes were ascertained from Register of Deaths and Cancer Registry. Cox proportional hazards models were used to estimate the hazard ratio of the rate of deaths from all causes and lung cancer. Additional analyses were performed for cases of lung cancer diagnosed within two years of the initial test. After 5 years 326 lung cancers were detected (2.7% of those enrolled). The total number of deaths reported from all causes in the intervention group was 344 compared to 388 in the control group. There were 73 lung cancer deaths in the intervention arm and 90 in the controls (Adjusted HR 0.789 (0.636, 0.978). An analysis of cases of lung cancer detected within 2 years of randomization in the intervention group showed that there were 34 deaths from all causes and 29 from lung cancer. In the control group there were 56 deaths with 49 from lung cancer. In those diagnosed with lung cancer within 2 years of randomization the hazard ratio for all cause mortality was 0.615 (0.401,0.942) and for lung cancer 0.598 (0.378, 0.946). Further large-scale studies of the role of biomarkers to target lung cancer screening, in addition to LDCT, are likely to provide additional value.

An implementation trial to mAnage siCkle CELl disEase through incReased AdopTion of hydroxyurEa in Nigeria (ACCELERATE): Study protocol

Background Despite the proven efficacy of evidence-based healthcare interventions in reducing adverse outcomes and mortality associated with Sickle Cell Disease (SCD), a vast majority of affected individuals in Africa remain deprived of such care. Hydroxyurea (HU) utilization among SCD patients in Sub-Saharan Africa (SSA) stands at less than 1%, while in Nigeria, approximately 13% of patients benefit from HU therapy. To enhance HU utilization, targeted implementation strategies addressing provider-level barriers are imperative. Existing evidence underscores the significance of addressing barriers such as inadequate healthcare worker training to improve HU adoption. The ACCELERATE study aims to evaluate the adoption of HU among providers through the Screen, Initiate, and Maintain (SIM) intervention, facilitated by healthcare worker training, clinical reminders, and task-sharing strategies, thereby enhancing patient-level SCD management in Nigeria. Methods This study will implement the SIM intervention, encompassing patient screening, initiation of HU treatment, and maintenance of dosage, which will be implemented via the TAsk-Strengthening Strategy for Hemoglobinopathies (TASSH TCP), derived from our team’s TAsk-Strengthening Strategy for Hypertension control (TASSH) trials. Employing a sequential exploratory mixed-methods approach within the Exploration, Preparation, Implementation, and Sustainment (EPIS) framework, this study will assess SIM adoption by providers in Nigeria. The primary outcome is the rate of SIM adoption at clinical sites at 12 months, with secondary outcomes including sustainability/maintenance of SIM intervention and implementation fidelity. Discussion This study’s findings will offer crucial insights into effective SCD management strategies, leveraging existing SCD clinical networks and resources in Nigeria to enhance HU adoption among providers in a scalable and sustainable manner. Additionally, the study will inform best practices for implementing HU therapy in resource-constrained settings, benefiting healthcare providers, policymakers, and stakeholders invested in improving SCD care delivery. Trial registration NCT06318143.

SPEED (SPlEnic Embolisation Decisions) study—Decision to treat acute traumatic splenic artery injury in the context of trauma protocol

Background The spleen is commonly injured in trauma and this may be managed with a conservative approach, embolisation or splenectomy. There is uncertainty how splenic embolisation fits into the treatment paradigm and the delivery of IR services remains variable. Aims and objectives The primary objectives are to determine if service design significantly affects splenic embolisation (SE) rates in AAST grade 2–5 acute traumatic splenic injuries (ATSI) across the Major Trauma Centres (MTCs) in England and to determine if variation in treatment affects SE outcomes in ATSI. Methods We will include 5 years of data from traumatic splenic injury patients in the MTCs from 01/01/2016 to 31/12/2020 available from the Trauma Audit and Research Network (TARN) database. Inclusion Criteria will be all patients with ATSI registered with TARN. Those without a CT available to grade radiologically will be excluded. Data available from the TARN database and then correlated with data that will be collected at each MTC, where detail as to the embolisation technique, specific injury pattern, imaging based follow up and patient survival will be available. A short service-based questionnaire will be sent to each centre to establish centre-specific details such as on call rota, IR response activation, reporting practices and capture data around routine decision-making at that site. Data will be collected on an anonymised (REDCap) database. This project will evaluate the impact of service design on embolisation rates and outcomes, as well as evaluating the impact of the variation upon treatment selection and outcomes. Logistic regression will be used to identify factors associated with treatment selection and mortality at 30 days.

Views and opinions of the general public about the reimbursement of expensive medicines in the Netherlands

Objectives Solidarity-based healthcare systems are being challenged by the incremental costs of new and expensive medicines for cancer and rare diseases. To regulate reimbursement of such drugs, the Dutch government introduced a policy instrument known as the Coverage Lock (CL) in 2015. Little is known about the public opinion regarding such policy instruments and their consequences, i.e., reimbursement of some, but not all, expensive medicines. We aimed to identify the preferences of Dutch citizens regarding the reimbursement of expensive medicines, and to investigate the views of the public on the use of the CL as a healthcare policy instrument and their input for improvement. Methods Web-based survey of a representative sample of 1999 Dutch citizens aged 18 years and older (panel of research company Kantar Public). Potential respondents were approached via e-mail. Several policy measures, real-life cases and statements related to the CL were presented in the survey to respondents. Their responses were analysed by tabulating descriptive statistics (proportions and percentages). Results 1179 individuals (response rate 59%) filled in the questionnaire. Although a majority considered the CL policy unjustified, they preferred it to the alternative policy measures that were presented. In four real-life case descriptions of patients in need of expensive medicines, respondents most often indicated effectiveness, lack of availability of alternative treatment and improved quality of life due to treatment as reasons for a positive reimbursement decision. An unfavourable cost-benefit ratio was their main reason to be against reimbursement. Some argued that withholding reimbursement was a way of informing manufacturers that extremely high prices are unacceptable. Conclusion There is public support for patients in need of expensive medicine. Many respondents supported the CL as a reimbursement policy. However, there is a wish to optimize the interpretation of the assessment criteria and the weight these are attributed in decision making about reimbursement of expensive innovative medicine for patients.

Men’s gender role and attitude toward sexual autonomy of women in India

Objective Sexual autonomy is essential to women’s empowerment and crucial to human rights. Measurement of women’s sexual autonomy from men’s perspective is rare in India, though critical for achieving the sexual and reproductive rights of women who continue to exhibit poor sexual and reproductive health (SRH) outcomes. The study assesses Indian men’s attitudes toward women’s sexual autonomy and associated factors using a nationally representative sample of men. Methods This study involved a total sample of 101,839 men aged 15–54 covered in the fifth round of the National Family Health Survey (2019–21). Descriptive statistics, bivariate analysis, and binary logistic regression were used to determine predictors of men’s favorable attitudes toward the sexual autonomy of women. All the statistical analyses were performed using Stata with a 5% significance level. Results Sixty-three percent of men hold a favorable attitude toward women’s sexual autonomy. Men’s support for women’s sexual autonomy was positively correlated with their egalitarian views on household decision-making (AOR: 1.45; CI: 1.41–1.49), higher educational attainment (AOR: 1.34; CI:1.20–1.50), currently married status, media exposure (AOR: 1.17; CI: 1.12–1.21), currently working status, and wealthier household strata (AOR: 1.17; CI: 1.11–1.23). Conclusion Results suggest promoting gender egalitarian norms through educational campaigns, community workshops held by local leaders, grassroots healthcare professionals, and non-governmental organizations, and broadening existing SRH strategies by including younger, non-literates, unmarried, unemployed, and rural men.

Optimization of the green synthesis of gold nanorods using aqueous extract of peeled sour guava as a source of antioxidants

Obtaining gold nanorods (AuNRs) through biosynthesis is an alternative that replaces the traditional use of ascorbic acid with chemical compounds such as polyphenols, owing to their notable antioxidant properties. Therefore, we developed an AuNR biosynthesis method using an aqueous extract of sour guava (Psidium araca). Initially, a study was conducted to determine the antioxidant capacity of different parts of the fruit (pulp and peel) over 14 days. Four colorimetric techniques were used: total phenol, ABTS (2,2-azino-bis-3-ethylbenzothiazoline-6-sulphonic acid), FRAP (ferric reducing antioxidant power (FRAP), and DPPH (1,1-diphenyl-2-picrylhydrazyl). Subsequently, in stage 2, the selected aqueous extract was used, and two response surface designs were performed. The objective of this study was to find a model equation that would indicate the optimal parameters for obtaining AuNRs with a surface plasmon band at 808 nm, with possible applications in the health field. The results of the antioxidant capacity experiments were analyzed in Minitab® using a multilevel factorial design, and the peel exhibited the highest antioxidant capacity. Subsequently, the biosynthesis of AuNRs proceeded using a 5-factor response surface experimental design as input variables (concentration in mM of gold, silver, extract, NaBH4, and reaction time in hours) and longitudinal plasmon (LSPR) as output variables. The AuNRs were approximately 30 nm in size with an LSPR between 700 and 800 nm. Statistical model evaluation revealed a dependence between gold and time and gold–silver factors. Finally, antioxidant capacity was used to select the part (peel or pulp) of sour guava that could be used as a weak reducing agent. Moreover, the utility of surface-response methodology was explored to optimize the synthesis of AuNRs using green agents.

Evaluation of keratometric and total corneal astigmatism measurements from optical biometers and anterior segment tomographers and mapping to reconstructed corneal astigmatism vector components

Purpose To investigate different measures for corneal astigmatism in the context of reconstructed corneal astigmatism (recCP) as required to correct the pseudophakic eye, and to derive prediction models to map measured corneal astigmatism to recCP. Methods Retrospective single centre study of 509 eyes of 509 cataract patients with monofocal (MX60P) IOL. Corneal power measured with the IOLMaster 700 keratometry (IOLMK), and Galilei G4 keratometry (GK), total corneal power (TCP2), and Alpin’s integrated front (CorT) and total corneal power (CorTTP). Feedforward shallow neural network (NET) and linear regression (REG) prediction models were derived to map the measured C0 and C45 power vector components to the respective recCP components. Results Both the NET and REG models showed superior performance compared to a constant model correcting the centroid error. The mean squared prediction errors for the NET/REG models were: 0.21/0.33 dpt for IOLMK, 0.23/0.36 dpt for GK, 0.24/0.35 for TCP2, 0.23/0.39 dpt for CorT and 0.22/0.36 dpt for CorTTP respectively (training data) and 0.27/0.37 dpt for IOLMK, 0.26/0.37 dpt for GK, 0.38/0.42 dpt for TCP2, 0.35/0.36 dpt for CorT, and 0.44/0.45 dpt for CorTTP respectively on the test data. Crossvalidation with model optimisation on the training (and validation) data and performance check on the test data showed a slight overfitting especially with the NET models. Conclusions Measurement modalities for corneal astigmatism do not yield consistent results. On training data the NET models performed systematically better, but on the test data REG showed similar performance to NET with the advantage of easier implementation.

Factors associated with chronic kidney disease knowledge and preventive practices: An analytical cross-sectional study among patients with hypertension at Amana Regional Referral Hospital in Dar es Salaam, Tanzania

Background Globally, Chronic kidney Disease (CKD) has become a significant public health concern, with sub-Saharan Africa being among the populations experiencing the highest rates. Managing CKD poses a significant challenge due to its health complications and associated high cost of care. Hypertension is one of the leading causes of CKD, responsible for the decline in kidney function in patients. Knowledge and lifestyle modifications are pivotal to the prevention and progression of CKD. In Tanzania, little is known regarding CKD knowledge and preventive practices among patients with hypertension. Therefore, this study aimed to assess context-specific factors associated with CKD knowledge and preventive practices among patients with hypertension at Amana Regional Referral Hospital in Dar es Salaam. Methods An analytical cross-sectional study involving 184 patients was conducted at Amana Regional Referral Hospital. Patient were recruited at the outpatient hypertension clinic using simple random sampling in June and July 2022. Data analysis was conducted using IBM-SPSS Statistics version 25. Bivariate and multiple logistic regression analyses were performed to identify factors associated with knowledge and preventive practices related to CKD, with statistical significance set at a p-value < 0.05. Results The median CKD knowledge score was 13 (IQR: 9–16). Of the 184 respondents, 104 (56.5%) demonstrated high CKD knowledge. None of the sociodemographic factors were significantly associated with CKD knowledge. The median score for CKD preventive practices was 9 (IQR: 8–9), and 111 respondents (60.3%) had good practices. High CKD knowledge was significantly associated with good CKD preventive practices (AOR: 1.98; 95% CI: 1.08, 3.62; p = 0.027). Conclusion A significant proportion of hypertensive patients in this study exhibited both high CKD knowledge and good preventive practices. The positive correlation between CKD knowledge and improved preventive practices highlights the importance of educational interventions to further enhance CKD knowledge among patients with hypertension.

Applying fractional calculus to malware spread: A fractal-based approach to threat analysis

Malware is a common word in modern era. Everyone using computer is aware of it. Some users have to face the problem known as Cyber crimes. Nobody can survive without use of modern technologies based on computer networking. To avoid threat of malware, different companies provide antivirus strategies on a high cost. To prevent the data and keep privacy, companies using computers have to buy these antivirus programs (software). Software varies due to types of malware and is developed on structure of malware with a deep insight on behavior of nodes. We selected a mathematical malware propagation model having variable infection rate. We were interested in examining the impact of memory effects in this dynamical system in the sense of fractal fractional (FF) derivatives. In this paper, theoretical analysis is performed by concepts of fixed point theory. Existence, uniqueness and stability conditions are investigated for FF model. Numerical algorithm based on Lagrange two points interpolation polynomial is formed and simulation is done using Matlab R2016a on the deterministic model. We see the impact of different FF orders using power law kernel. Sensitivity analysis of different parameters such as initial infection rate, variable adjustment to sensitivity of infected nodes, immune rate of antivirus strategies and loss rate of immunity of removed nodes is investigated under FF model and is compared with classical. On investigation, we find that FF model describes the effects of memory on nodes in detail. Antivirus software can be developed considering the effect of FF orders and parameters to reduce persistence and eradication of infection. Small changes cause significant perturbation in infected nodes and malware can be driven into passive mode by understanding its propagation by FF derivatives and may take necessary actions to prevent the disaster caused by cyber crimes.

Does a priming warm-up influence the incidence of V˙O2pl during a ramp test and verification phase?

Objective This study compared the effects of two different warm-up protocols (normal vs. priming) on the oxygen plateau (V˙O2pl) incidence rate during a ramp test. It also compared the cardiopulmonary responses during the ramp test and subsequent verification phase. Methods Eleven recreational cyclists performed two experimental visits. The first visit required a normal warm-up (cycling at 50 W for 10 min) followed by the ramp test (30 W.min-1) and supramaximal verification phase with 30 min rest between tests. The second visit required a priming warm-up (cycling at 50 W for 4 min increasing to 70% difference between the gas exchange threshold [GET] and maximum work rate [WRmax] for 6 min) followed by the same protocol as in the first visit. Physiological responses were collected during the exercise and compared. Oxygen kinetics (V˙O2 Kinetics) and V˙O2pl incidence rate were determined during the ramp tests for both visits. Results As planned, following the warm-up the priming visit experienced greater physiological response. However, the incidence rate of V˙O2pl during the ramp test was the same between visits (73%), and maximal oxygen uptake was not different between visits after the ramp test (normal, 4.0 ± 0.8; primed, 4.0 ± 0.7 L·min−1, p = 0.230) and verification phase (normal, 3.8 ± 0.6; primed, 3.8 ± 0.7 L·min−1, p = 0.924) using a Holm-Bonferroni correction for controlling family-wise error rate. V˙O2 Kinetics were not different between visits during the ramp test (normal, 10.8 ± 1.1; primed, 10.8 ± 1.2 mL·min−1·W-1, p = 0.407). The verification phase confirmed V˙O2max in 100% for both the normal and priming visits. Conclusion Our hypothesis that a priming warm-up facilitates the incidence rate of V˙O2pl during a ramp test is not supported by the results. The verification phase remains a prudent option when determining a ‘true’ V˙O2max is required.

Anti-nucleocapsid SARS-CoV-2 antibody seroprevalence in previously infected persons with immunocompromising conditions—United States, 2020–2022

People with immunocompromising conditions (IC) are at increased risk of severe COVID-19 and death. These individuals show weaker immunogenicity following vaccination than individuals without IC, yet immunogenicity after SARS-CoV-2 infection is poorly understood. To address this gap, the presence of infection-induced antibodies in sera following a positive COVID-19 test result was compared between patients with and without IC. A commercial laboratory provided patient data gathered during July 2020–February 2022 on COVID-19 viral test results and antibody assay results, which included infection-induced (anti-N) antibody presence. Participants were categorized into having or not having IC based on if there was an indicative diagnostic code on their health record for a five-year period prior to the study period. Anti-N presence in sera from people with a positive COVID-19 test result was compared by IC status for four post-infection periods: 14–90, 91–180, 181–365, and 365+ days. A longitudinal, logistic regression produced adjusted odds ratios comparing anti-N prevalence among specimens with and without associated IC, adjusted for age, sex, residence in a metro area, and social vulnerability index (SVI) tertile. Data included 17,025 anti-N test results from 14,690 patients, 1,424 (9.7%) of which had at least one IC on record. In an adjusted comparison to patients without IC, patients with any IC were 0.61 times as likely to have infection-induced antibodies (99% CI: 0.40–0.93), during the 14–90 days following infection. Similar patterns were found when comparing people with two specific types of IC to people without any IC: (1) solid malignancies and (2) other intrinsic immune conditions. These findings stress the importance of prevention measures for people with IC, such as additional vaccination doses and consistent mask use before and after a documented infection.