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Comparison of laboratory-based and non-laboratory-based WHO and GLOBORISK CVD risk scores: A cross-sectional analysis of the APCAPS cohort
Background and Aim Cardiovascular diseases (CVDs) represent a growing public-health challenge in India, where nearly one in four deaths is CVD-related. Accurate risk stratification underpins targeted prevention, yet laboratory-dependent tools are often impractical in resource-limited settings. The World Health Organization (WHO) and GLOBORISK initiatives both offer non-laboratory-based 10-year CVD risk algorithms alongside their laboratory-based counterparts. We aimed to compare laboratory- and non-laboratory-based WHO and GLOBORISK CVD risk scores, assess their concordance, and examine relationships with sub-clinical atherosclerosis in a rural Indian cohort. Materials and Methods We conducted a cross-sectional analysis of 2,465 adults (1,184 men, 1,281 women) aged 40−74 years from the third wave (2010−12) of the Andhra Pradesh Children and Parents Study (APCAPS). Participants with prior CVD were excluded. Ten-year CVD risk was calculated using sex-specific WHO (South Asia) and India-calibrated GLOBORISK models, both laboratory-based (age, sex, smoking, systolic blood pressure, diabetes, total cholesterol) and non-laboratory-based (age, sex, smoking, systolic blood pressure, BMI) algorithms. Categorical agreement was quantified via percentage agreement and quadratic weighted kappa (κ); continuous agreement by Bland-Altman analysis. We also evaluated linear associations between each risk score (categorical and continuous) and three sub-clinical atherosclerosis markers: carotid intima-media thickness (CIMT), pulse-wave velocity (PWV), and augmentation index (AIx), through sex-stratified multi-level linear regression with random intercept at the household level, adjusting for multiple testing (p < 0.01). Results Median WHO-CVD-risk was 6.0% (IQR 4% − 9%) in men and 3.0% (2% − 4%) in women for both lab and non-lab models; median GLOBORISK-CVD-risk was 12.0% (9% − 16%) for lab-model vs. 15.0% (10% − 16%) for non-lab-model in men and 5.0% (3% − 9%) for lab-model vs. 5.0% (3% − 9%) for non-lab-model in women. Categorical agreement was substantial to almost perfect: WHO κ = 0.82 (overall), GLOBORISK κ = 0.72. Bland-Altman analyses demonstrated mean differences <1% between lab- and non-lab-based scores, though non-lab models underestimated risk by 4.2% in diabetics and 1.2% in participants with total cholesterol ≥200 mg/dL. Both risk scores showed positive, dose-response relationships with CIMT, PWV, and AIx (p-trend<0.001), with each SD increase in CVD-scores associated with clinically meaningful increases in all three markers of sub-clinical atheroscerosis. Conclusion Non-laboratory-based WHO and GLOBORISK CVD risk scores exhibit high overall agreement with laboratory-based models and correlate strongly with subclinical atherosclerosis in rural India. However, modest underestimation in high-risk subgroups (diabetics, hypercholesterolemia) warrants cautious interpretation. These findings support the feasibility of non-lab risk assessment in resource-constrained settings, while underscoring the need for prospective validation against hard cardiovascular outcomes prior to large-scale implementation.
The mechanism and impact of digital transformation on supply chain resilience in the manufacturing industry
Influence of land-use history and ENSO on the flora of the Southern Line Islands
Remote tropical islands host unique ecosystems with rare species that have been historically affected by habitat degradation and species introductions, and now by climate change. However, we know little about the current ecological conditions of remote island ecosystems, particularly after the abandonment of commercial land uses. The Southern Line Islands, Kiribati, are among the least studied island groups in the Pacific. These islands have a history of land use, including guano extraction and coconut plantations (1800s to early 1900s), but have no current human uses or habitation. They have been exposed to El Niño Southern Oscillation (ENSO) events, particularly the strong 2015−2016 event. We studied the vegetation of Flint Island, Millennium Atoll, and Vostok Island to assess vegetation succession since the cessation of land-use, and whether they have been impacted by ENSO. Specifically, we drew on field surveys and satellite images from 2009 and 2021, and assessed changes in floristic characteristics between (i) current and historic surveys; (ii) islands with different land-use histories; and (iii) before and after the 2015−2016 ENSO. We found that extant species richness differed from the historic studies, due in large part to the disappearance of some non-native species on Millennium and Flint, and the emergence of some previously undocumented native species across the islands. Species composition differed across islands; Vostok Island has few species compared to Flint or Millennium due to its diminutive size, and remains dominated by Pisonia forest. There were few differences in plant species frequency and composition for the islands between 2009 and 2021, but normalized difference vegetation index (NDVI) values and land-use classification showed some evidence of dry conditions after the 2015−2015 ENSO. We conclude with recommendations for management of non-native species to support regeneration of the native ecosystems of the Southern Line Islands, with implications for other Pacific islands.
Development and content validation of an educational manual for promoting physical activity among older adults in India
Abstract To better address the increasing problem of physical inactivity among the elderly in India, we aimed to determine the attitudes of older adults toward physical activity and to create an educational resource that would encourage them to engage in physical activity. Thus, our goal was to develop an educational manual about physical activity tailored to the older adult population based upon their views about this topic. The manual was created over two separate stages. In the first stage, we evaluated the attitudes, facilitators, and barriers to physical activity among older adults through in-depth telephone interviews. Each of the 13 participants (five female and eight male), interviewed separately for 60 min, completed a semi-structured interview. Thematic analysis of the transcript of the interviews identified four superordinate themes: benefits of physical activity; perceived barriers; factors which motivate older adults to participate in physical activity; and domains of physical activity. These themes allowed us to tailor the manual to the specific needs of older adults, thereby providing us with valuable information from the perspective of older adults about physical activity. In the second stage of the study, we created a culturally congruent physical activity educational manual for use within the Indian population. We then performed content validation on the manual. For content validation, we used a panel of six experts and ten members of the target population to evaluate the relevance and effectiveness of the manual. All of the contents of the manual were ranked as relevant, with 100% relevance reported by the expert panel and 98% relevance reported by the target population. Independent I-CVIs > 0.79 (S-CVI/Ave = 79%) were calculated for each item, indicating that each item of the manual was relevant. An Flesch ease reading score of 80.9 was calculated for the manual, which indicates that it can be easily read by a sixth grade student. The current study provides a contribution to advances in science related to promoting health, by creating a validated, self-explaining, culturally-congruent physical activity educational manual for physically active older adults.
Vancomycin variable Enterococci in the Netherlands (2018–2023) and the mechanism of resistance induction
Enterococci are common human commensals but can cause severe infections in immunocompromised patients. Enterococcus faecium is a notable example, capable of acquiring resistance to multiple antibiotics, including the critically important drug vancomycin. Such strains, known as vancomycin-resistant E. faecium (VRE), are routinely detected in clinical laboratories using phenotypic assays. However, some isolates carry vancomycin resistance genes yet remain phenotypically susceptible; these are termed vancomycin variable enterococci (VVE). Because phenotypic assays may fail to identify VVE, patients treated with glycopeptides risk developing undetected VRE infections. VVE have been reported in Scandinavia and Japan, but their prevalence in the Netherlands remains largely unknown. To address this gap, two large Dutch clinical microbiology laboratories collaborated to screen enterococcal isolates for vancomycin resistance genes using molecular assays. Among 477 isolates tested, six carried van genes while remaining vancomycin-susceptible. Three of these subsequently developed vancomycin resistance in vitro . All three were Enterococcus faecium ST117 strains carrying a chromosomal vanB2 operon, likely linked to the same outbreak. Genomic analysis revealed three mutations in the van operon regulator proteins: vanR (T189K) and vanS (G253C, L282V). We conclude that: (1) VVE are present in the Dutch population and may spread between patients; (2) VVE can develop into VRE upon vancomycin exposure; (3) specific mutations in regulatory proteins may underlie this phenotype; and (4) diagnostic policies should balance the low prevalence of VVE against their potential to cause severe complications, using sensitive molecular tests when appropriate. Our findings emphasize the importance of surveillance in revealing hidden threats and guiding clinical microbiology strategies, particularly with respect to VVE as precursors of VRE.
Pharmacogenomic profiling of ABCB1 and CES1 in atrial fibrillation patients on dabigatran from a multiethnic Malaysian cohort
Isolation, molecular profiling, and antimicrobial sensitivity patterns of ESBL producing Acinetobacter baumannii in wastewater discharges from Goranchatbari sub-catchment area in Dhaka
The World Health Organization has recommended the development of new antimicrobials against Acinetobacter baumannii , one of the six highly significant pathogens. In this study, 28 wastewater samples were collected from the Goranchatbari sub-catchment area in Dhaka city over several periods. The samples were characterized for the presence of Acinetobacter spp. The isolates showing cream, opaque colonies on CHROMagar TM ESBL plates were considered positive for ESBL production. They were further characterized for major antibiotic resistance and pathogenic genes, biofilm production and antibiotic susceptibility testing. Furthermore, the isolates were phylogenetically clustered based on their Enterobacterial Repetitive Intergenic Consensus (ERIC) profiles and correlation matrix analysis was performed. Out of 28 samples, 27 were positive for Acinetobacter spp. and a total of 106/249 (42.6%) sample representative isolates were positive for ESBL production. Out of these 106 isolates, 97 (91.5%) were genotypically confirmed to belong to the Acinetobacter spp . and of which, 72 (74.2%) were genotypically confirmed as Acinetobacter baumannii . Among the distribution of β-lactamase genes, bla TEM was the most prevalent being present in 40/72 (55.6%) isolates, followed by bla SHV in 3/72 (4.2%) isolates. With respect to the pathogenic genes, pgaB and bfmS were the most prevalent being present in 80.6% and 69.4% of the isolates, respectively. The antibiotic susceptibility testing revealed a diverse range of resistance patterns with high levels of intermediate resistance being observed for cefotaxime and ceftriaxone. The biofilm formation screening revealed that 48.6% and 44.4% of isolates formed strong biofilms at 37°C and 25°C, respectively. The phylogenetic clustering of the A. baumannii isolates resulted in the formation of 10 clusters at 60% similarity index, and the correlation matrix helped reveal important associations between genotypic and phenotypic traits. These results demonstrate the continued prevalence of A. baumannii within these environmental reservoirs and its ability to persist despite seasonal variations, prioritizing changes in environmental health policies that aim to reduce the widespread prevalence of these pathogens.
CDK2 inhibition promotes neuronal differentiation in neuroblastoma
Abstract Neuroblastoma (NB) is a childhood tumor arising from neural crest-derived progenitor cells. Cyclin dependent kinase 2 (CDK2) has been suggested to be a promising therapeutic target in NB especially MYCN -amplified tumors. How CDK2 contributes to the development of NB is not fully understood. Here, we demonstrate that high CDK2 expression in NB correlates with advanced and high-risk disease, MYCN -amplification, poor prognosis, and undifferentiated tumors. We uncovered that CDK2 genetic or pharmacological inhibition induces neuronal differentiation in human NB cell lines, which effect is in general more prominent in the MYCN -amplified subtype. Further, we establish CDK2 as a MYCN target gene that modulate the MYC-pathway in MYCN -amplified NB. Notably, pharmacological inhibition of CDK2 in combination with MYCN inhibition or all- trans -retinoic acid (ATRA) differentiation therapy enhances neuronal differentiation in vitro. These results reveal an important function of CDK2 in NB and highlight CDK2 inhibition alone or in combination with MYC inhibitors and retinoids as a potential strategy for differentiation therapy in NB.
Stochastic virtual population in type 1 diabetes
Accurate, reliable, and efficient estimation of blood glucose dynamics from real-world data is challenging due to the time-varying nature, high uncertainty, and nonlinear interplay of complex processes. In this study, we propose and investigate a stochastic representation of a virtual population by fitting a hierarchical Bayesian model. In total, we use 500 24h-long sequences, 50 from each of the 10 patients with type 1 diabetes on multiple daily injection therapy. We model uncertainty on multiple levels, in physiology and in self-reported events, and take into account intra- and interday variability, and the effect of physical activity as well. The root-mean-square error between the glucose measurements and the mean of the posterior predictive distribution using the fitted low-rank multivariate normal guide is 12.44 mg/dL. We show that the posterior distributions can be used to simulate realistic intra-, and interday variability in terms of the investigated patient cohort.
Risk assessment of trihalomethanes in drinking water with seasonal variation considerations
Abstract This study evaluated the concentrations of trihalomethanes (THMs) in Alexandria’s drinking water across seven districts during summer and winter, and assessed the associated cancer risks. THMs, byproducts of water chlorination, are known for their potential carcinogenicity. A total of 35 drinking water samples were analyzed using gas chromatography with an electron capture detector (GC-ECD) to determine the concentrations of chloroform (CF), bromodichloromethane (BDCM), dibromochloromethane (DBCM), and bromoform (BF). The results revealed significant seasonal variations. Region-2 recorded the highest summer concentration (150 µg/L), while Region-7 had the highest winter concentration (196 µg/L). Hazard index (HI) calculations indicated that chloroform contributed the most to non-carcinogenic risks, with Region-7 recording an HI of 0.5698 in winter, while Region-2 showed a summer HI of 0.4843. Carcinogenic risk assessments using the USEPA methodology showed lifetime cancer risks significantly exceeding the acceptable threshold of 1 × 10 −6 , with an annual average total cancer risk of 67.027 × 10 −6 . These outcomes highlight the critical need for Alexandria to adopt advanced water treatment methods, such as ozonation and UV disinfection, optimize chlorine dosing, and strengthen routine monitoring to ensure compliance with safety standards and protect public health to safer drinking water and better health outcomes for Alexandria’s residents.
Latent profiles of spiritual care competence among Chinese nursing undergraduates: Correlations with spiritual care cognition and meaning of life
Background Spiritual care occupies a special position in overall care and improving the quality of services provided to patients. However, China’s higher nursing education is still in its infancy. The purpose of this research is to explore the heterogeneity of spiritual care competence of undergraduate nursing students in China. Methods A multicenter cross-sectional design was employed. From July 2024 to February 2025, a convenience sample of 1,224 undergraduate nursing students was recruited from four nursing colleges in the Guanzhong region of Shaanxi Province, China. Data were collected using the Chinese versions of the Spiritual Care Competence Scale, the Spiritual Care Cognition Scale, and the Meaning in Life Questionnaire. Descriptive and correlational analyses were performed using SPSS version 27.0, while latent profile analysis and ordinal logistic regression were conducted using Mplus version 8.0. Results The mean total score for spiritual care competence was 77.61 ± 14.61. Latent profile analysis identified three distinct profiles: a low-competence group (47.1%, 62.3 ± 8.2), a moderate-competence group (42.1%, 79.6 ± 6.7), and a high-competence group (10.8%, 95.1 ± 7.9). The model demonstrated high classification accuracy, with an entropy value of 0.948, and the Lo–Mendell–Rubin likelihood ratio test (LMRT) was significant (p = 0.006). Spiritual care competence was significantly positively correlated with spiritual care cognition (r = 0.540) and sense of meaning in life (r = 0.479) (both p < 0.01). Ordinal logistic regression indicated that lack of clinical internship experience, distant teacher–student relationships, absence of humanistic care education, lower levels of spiritual care cognition, and lower sense of meaning in life were key predictors of membership in lower competence profiles. Conclusion The spiritual care competence of undergraduate nursing students in China is underdeveloped and urgently needs to be improved. Their potential profiles can be divided into three categories, namely C1-low spiritual care competence, C2-medium spiritual care competence and C3-high spiritual care competence. Clinical internships, effective teacher–student mentoring, humanistic education, as well as individual spiritual cognition and sense of meaning in life, are key facilitators of competence development. It is recommended to integrate structured spiritual care training into undergraduate nursing curricula and to establish a systematic mentorship program.
The effects of pyrroloquinoline quinone and nicotinamide mononucleotide supplementation on interoception following acute exhaustive exercise: a randomised, double-blind, placebo-controlled study
Visual outcomes and quality of life after bilateral extended depth of field, bifocal, and mix-and-match IOL implantation
Purpose To evaluate the visual outcomes and vision-related quality of life among three intraocular lens (IOL) implantation strategies: bilateral extended depth of field (EDoF) IOL, bilateral bifocal IOL, and a mix-and-match approach. Methods In this prospective, non-randomized, observational study, patients with bilateral age-related cataracts selected their preferred IOL implantation type and were categorized into three groups accordingly. Three months after surgery, assessments of corrected and uncorrected binocular visual acuity at far, intermediate, and near distances were conducted, along with refraction, defocus curve, stereoacuity, vision-related quality of life, and photic symptoms. Results A total of 76 patients (152 eyes) were included. All patients achieved uncorrected distance visual acuity (UDVA) and best corrected distance visual acuity (BCDVA) of 20/32 or better in all groups. Binocular uncorrected intermediate visual acuity and distance-corrected intermediate visual acuity were superior in the mix-and-match and bilateral EDoF IOL groups (both P < 0.01). The bilateral bifocal IOL and mix-and-match groups demonstrated better distance-corrected intermediate visual acuity (both P < 0.05). No significant differences were observed among the three groups in UDVA, BCDVA, or uncorrected near visual acuity (UNVA) (P > 0.05). All groups reported similar outcomes for stereoacuity, vision-related quality of life, and photic symptoms (P > 0.05). Conclusions All three IOL strategies provided favorable vision-related quality of life, with the mix-and-match and bilateral EDoF IOL groups showing superior intermediate vision. The mix-and-match and bilateral bifocal IOL groups demonstrated better distance-corrected bilateral near vision performance, despite comparable UNVA among the three groups. These approaches remain valuable alternatives for providing optimal visual outcomes in regions where full vision range IOL are not yet accessible.
Knowledge-based optimization algorithm for feature selection in promoting circular economy through blockchain
Gut microbiome compositional clusters in association with cardiovascular risk: An observational cohort study
Aims The gut microbiome (GM) is increasingly recognized for its role in atherosclerosis development. However, its potential as a biomarker for risk-stratification in patients with atherosclerotic cardiovascular (CV) comorbidities remains under-explored. This study aimed to identify distinct GM clusters associated with elevated CV risk. Methods In this prospective observational cohort, patients with coronary artery disease, hypertension, hyperlipidemia, or diabetes mellitus referring to Mayo Clinic from 2013 to 2018 were enrolled. Bacterial DNA was analyzed in the V3-V5 region of 16S rDNA. Beta-diversity was plotted using Principal Coordinates Analysis. Unsupervised hierarchical clustering of the GM classified participants into two clusters. Cox regression evaluated the association between clusters and Major Adverse Cardiac Events (MACE), defined as a composite of cardiac events, heart failure, and all-cause mortality. Permutational Multivariate Analysis of Variance identified clinical factors contributing to cluster assignment. Linear Discriminant analysis identified GM taxa with differential abundance among clusters and their effect sizes. Results Among 211 participants (median age 60 [IQR: 50–70] years; 57.3% male), two distinct GM profiles emerged (Cluster H: N = 104; Cluster L: N = 107, P < 0.001). Cluster L participants were younger (P < 0.001), more likely female (P = 0.009), and had healthier CV profiles, including lower BMI (P = 0.007), hypertension (P = 0.010), hyperlipidemia (P = 0.005), and lower coronary artery disease prevalence (P = 0.003). Over a median follow-up of 7.4 years, Cluster L had a significantly lower incidence of MACE compared to Cluster H (HR = 0.48, 95% CI: 0.26–0.91, P = 0.024). Cluster L had higher operational taxonomic units (P < 0.001) and lower Bacillota-to-Bacteroidetes ratio (P < 0.001) compared to Cluster H. The predominant taxa in Cluster L included Bacteroides , Alistipes , and Parabacteroides , whereas Blautia , Agathobacter , and Clostridium sensu stricto-1 were more abundant in Cluster H. Conclusion Distinct GM profiles are associated with varying CV risk, highlighting the potential of unsupervised GM profiling as a novel tool for risk stratification and individualized therapy.
Effect of polyvinylpyrrolidone molecular weight and concentration on its dual role in the synthesis, stability and antimicrobial activity of silver nanoparticles
Research on the influence of virtual reality on muscle fatigue during rowing ergometer exercise – pilot study
The growing popularity of virtual reality (VR) applications has been reflected in numerous studies, particularly those examining the effects of VR on the human body, physical activity, and sports training. Comparative research suggests that simulated environments can influence physiological and psychological responses in distinct ways. The integration of VR with electromyographic (EMG) systems opens new opportunities to study biofeedback and muscle activation during exercise in real-time. However, only a limited number of studies have provided quantitative data on muscle fatigue. In the present research eight healthy male participants from previously described studies were examined using a VR environment to explore muscle fatigue. EMG signals were recorded from three muscle groups, and knee flexion angles were monitored. A VR simulation developed in Unreal Engine 5 was designed to reproduce a natural river scene for rowing training. The Discrete Wavelet Transform (DWT) was applied to both previously collected and VR-based data, calculating median frequency (MDF) distributions and linear regression for lower extremity muscles. Wilcoxon signed-rank tests comparing VR and non-VR conditions for the measured muscles: the Rectus Femoris, Biceps Femoris, and Gastrocnemius Lateralis, did not reveal statistically significant differences (all p > 0.05). Although no significant differences were observed, the proposed methodology introduces a valuable framework for quantitative fatigue assessment. By integrating VR with EMG analysis, this approach provides new perspectives for investigating muscle fatigue and its modulation in immersive environments.
Impact of iron chelation therapy on thyroid function in beta-thalassemia major patients from Pakistan
“Mother in the making”: Motherhood performativity of childless women in rural Pakistan
Motherhood is socially obligatory in rural Punjabi, Pakistan, leaving no room for voluntary childlessness. Women facing conception challenges strive to attain motherhood, combating the stigma of being labelled childless. Using Butler’s performativity theory, this study delves into the experiences of childless women striving to become mothers in the pronatalist society of Pakistan. In-depth interviews with childless women and focus group discussions with community members were conducted. The data were analysed using a thematic analysis. Results revealed that women must demonstrate mothering qualities alongside seeking treatment to validate their desire for motherhood. The study concludes that societal discourses shape childless women’s lives, influencing their conscious and unconscious adherence to gendered social norms of motherhood.