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The neutrophil-to-lymphocyte ratio as a predictor of all-cause mortality in individuals with anemia: A population-based study

Background This study investigates the association between the neutrophil-to-lymphocyte ratio (NLR) and all-cause mortality in individuals with anemia using the National Health and Nutrition Examination Survey (NHANES) 1999–2018 dataset. Methods We included 3,212 participants with anemia, categorized into three groups by NLR values. Baseline characteristics, comorbidities, and demographics were analyzed. We performed univariate logistic regression, multivariable Cox regression, non-linear regression, and breakpoint analysis to examine NLR-mortality relationships. Subgroup analysis assessed effect modification by clinical factors. Results The mean age of the cohort was 56.0 ± 18.3 years. Participants in the highest NLR tertile (T3) had significantly higher mortality risk, with an HR of 1.25 (95% CI:1.07–1.48, p = 0.007) in the fully adjusted model. Univariate logistic regression showed that NLR was independently associated with mortality (odds ratio [OR] = 1.44, 95% confidence interval [CI]: 1.35–1.52, p < 0.001), with higher mortality risk in the highest NLR tertile (OR = 2.9, 95% CI: 2.39–3.53, p < 0.001). Multivariable Cox regression analysis confirmed NLR as a significant predictor (hazard ratio [HR] = 1.11, 95% CI: 1.07–1.15, p < 0.001). A non-linear regression analysis identified a data-derived threshold at NLR = 1.475, with the risk of mortality increasing significantly above this threshold (HR = 1.134, 95% CI: 1.073–1.2, p < 0.001). Conclusion NLR is a significant predictor of all-cause mortality in individuals with anemia. Elevated NLR, particularly above 1.475, is associated with a 25.0% higher mortality risk, suggesting its potential utility as a prognostic biomarker in this context.

Engineering characteristics of agro-residue–based geopolymer concrete with fibre reinforcement

Comparison of chemo-mechanical and conventional caries removal methods in 6-to-12-year-old children: Randomized clinical trial

Background To address the discomfort associated with conventional drilling for caries removal in children, a minimally invasive approach such as chemo-mechanical caries removal was developed. This study aimed to compare the effectiveness of, and patient behavior associated with chemo-mechanical caries removal versus conventional drilling in children aged 6–12 years. Methods A split-mouth randomized clinical trial was conducted involving 66 molar teeth. The effectiveness of Papacarie Duo Gel and conventional drilling methods was assessed using colony-forming unit (CFU) counts before and after each treatment. Cavity preparation time and intraoperative patient behavior using the Frankl Behavior Rating Scale were also evaluated. Results Both methods resulted in a significant reduction in bacterial counts post-treatment. However, conventional drilling showed a greater percentage reduction in bacterial load (82.9 ± 13.9; t = −4.42, p  < 0.001) compared to the chemo-mechanical method (68.6 ± 16.6). The mean caries removal time was 692.4 ± 245.9 sec with the chemo-mechanical method, compared to 266.9 ± 101.6 sec with conventional drilling. In terms of behavior, 57.6% of the children exhibited a positive response during chemo-mechanical treatment whereas negative behavior was more commonly observed with conventional drilling. Conclusion While conventional drilling remains the better-established and time-efficient method of caries removal, the chemo-mechanical technique serves as a valuable alternative for managing children, reducing anxiety and promoting greater comfort and cooperation during treatment. Trial registration PanAfrican Clinical Trial Registry PACTR202310877678533

Hematological and clinical-chemistry parameters of kratom users: a comparative study of users and non-users in Southern Thailand

Engineering Cyanoarene Photocatalysts to Resolve Deactivation Challenges in Organocatalyzed ATRP

Abstract Cyanoarene‐based photocatalysts (PCs) have been widely utilized in organic transformations including photo‐mediated controlled radical polymerization (CRP). Despite favorable photophysical and electrochemical properties, these PCs have exhibited limited efficacy in photoinduced organocatalyzed ATRP (O‐ATRP). We identified that reduced performance arises from preferential formation of [PC •+… Br − ] complexes, which facilitates detrimental back electron transfer (BET), generating bromine radicals and side reactions. To address this, we developed a new cyanoarene‐based PC, 4DMDP‐IPN, incorporating strongly electron‐donating groups at donor moieties. This design effectively suppresses complex formation and alleviates BET, significantly improving O‐ATRP performance. With 4DMDP‐IPN, O‐ATRP of methacrylates with high monomer conversion, narrow dispersity, and excellent chain‐end fidelity, even at an ultra‐low PC loading of 5 ppm. This represents the lowest reported PC loading that still ensures polymerization control, eliminating the need for post‐polymerization catalyst removal. Moreover, we demonstrated successful O‐ATRP of poly(methyl acrylate), a particularly challenging monomer, with decent levels of control and chain‐end fidelity. This work not only overcomes intrinsic limitations of cyanoarene‐based PCs in O‐ATRP, but also establishes a new design strategy for next‐generation PCs. We anticipate that these findings will contribute significantly to the advancement of photo‐CRP and broaden the applicability of cyanoarene‐based PCs in a wide range of organic transformations.

Insights into the pathogenesis and differential diagnosis of clival lesions in an individual from a 16th-century-CE mass grave at Mohács (Southwestern Hungary)

The aim of our paper is to present and discuss in detail the pathological lesions suggestive of tuberculosis observed in a skeleton ( MMG3–75 ) that was excavated from the 16 th -century-CE mass grave No. 3 of the Mohács National Memorial Site (Sátorhely, southwestern Hungary). The differential diagnoses of the observed bony changes, with special attention to the clival alterations, are presented. During the macromorphological, radiological, and digital microscopic examination of MMG3–75 , the skull base showed mild cortical erosion and multiple, well-circumscribed osteolytic lesions at the clivus clearly evidenced by 3D imaging. In addition, endocranial granular impressions and abnormal blood vessel impressions were observed in multiple locations on the inner skull surface. Based on the differential diagnosis of the clival changes and their co-occurrence with endocranial alterations indicative of tuberculous meningitis (granular impressions and abnormal blood vessel impressions), they were most likely due to tuberculous involvement of the skull base. Additional aDNA analysis provided no evidence for the presence of Mycobacterium tuberculosis DNA in MMG3–75 . To the best of our knowledge, MMG3–75 is the first reported archaeological case of tuberculous clival osteomyelitis with associated meningitis, giving us a unique insight into the occurrence of an extremely rare manifestation of tuberculosis in mediaeval Hungary.

Temporal order of activations and interactions during arithmetic calculations measured by intracranial electrophysiological recordings in the human brain

Abstract Arithmetic requires complex and fast processes orchestrated within a large-scale network spanning multiple brain regions. However, reports on the network’s temporal dynamics are scarce. Here, we present data from intracranial EEG (iEEG) of 20 subjects (epilepsy surgery candidates) performing a sequential three-operand arithmetic task. Utilizing the high temporal and spatial resolution of iEEG, we analysed changes in high-gamma band (HGB; 52–120 Hz) activity and functional connectivity assessed by phase-locking value (PLV) in the delta (0.1–3 Hz) and theta (3–7 Hz) frequency bands. Strong and transient HGB activations peaked first in the ventral occipito-temporal cortex, followed by a more gradual increase in the lateral parietal, sensorimotor, and frontal cortices, accompanied by deactivations in default mode network areas. The connectivity patterns were more extensive during calculation than number recognition, with the theta PLV peaking ~ 150 ms earlier than the delta PLV. Earliest connectivity appeared, surprisingly, between ventral temporal and frontal regions at ~ 100–200 ms, evolving into a robust pattern among key network nodes at ~ 200–400 ms after the presentation of each operand. The presented results elucidate information flow within the putative arithmetic network during calculation in the human brain, offering high-temporal-resolution insights into its functional architecture.

The influence of lime type on the properties of traditional lime-soil materials

The conservation of historic earthen structures requires repair materials that are both high-performance and historically appropriate. While archaeological evidence indicates that the historical use of blocky quicklime to make lime-soil materials, modern research and conservation practice often focus on its powdered counterpart, creating a knowledge gap. Thus, this work systematically evaluated the physical properties, microstructure, and composition of lime-soil materials prepared with blocky quicklime, powdered quicklime, and hydrated lime (at 10–20% content). The results demonstrated that hydrated lime yielded inferior strength and durability. Although both types of quicklime enhanced performance, they functioned through distinct mechanisms. Powdered quicklime provided consistent, dosage-dependent improvement, making it reliable for high-performance requirements. In contrast, blocky quicklime exhibited a pronounced optimum at 15% content; beyond this, performance declined due to expansion stresses from excess, partially hydrated cores, as identified by FT-IR spectroscopy. This study concluded that the choice of lime form was critical: powdered quicklime was recommended for predictable, broad-spectrum enhancement, whereas blocky quicklime could be effective but required strict dosage control to harness its unique potential and avoid damage. These findings provided a scientific basis for selecting and applying lime materials in the repair of earthen architectural heritage.

Identification of hub genes and construction of a survival prediction model for patients with nasopharyngeal carcinoma

To what extent do people in malaria-endemic countries know asymptomatic malaria infections? A systematic review

Introduction Malaria is a parasitic disease caused by Plasmodium parasite and transmitted to humans by infected female Anopheles mosquito. Several studies have explored community knowledge of malaria. However, despite the remarkable proportions of asymptomatic malaria, its awareness remains relatively understudied among the affected communities. Hence, this study aimed to determine the proportion of people with knowledge of asymptomatic malaria in endemic countries and describe their perspective towards malaria control interventions. The findings from this study could contribute to developing tailored interventions in both low and high-transmission settings. Method The systematic review protocol was deposited in protocols.io and registered at PROSPERO (ID: CRD42024508104). A systematic literature review was conducted searching for peer-reviewed articles on knowledge of asymptomatic malaria published from 2010 to 2024. Three databases (PubMed (MEDLINE), Google Scholar, and Web of Science) were searched. The risk of bias in the included studies was assessed using the Joanna Briggs Institute (JBI) critical appraisal tool and the Mixed Methods Appraisal Tool (MMAT). A thematic analysis and a narrative synthesis were conducted to synthesise the results. The research followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Results In total, 483 articles were retrieved, and 11 relevant articles were included in the analysis. According to four studies conducted among the general public, the proportion of individuals knowledgeable of asymptomatic malaria ranged from 14.2% to 79.8%. The proportion among health personnel was 88% (one study). The qualitative studies showed varied and lacking knowledge of asymptomatic malaria among the participants, as well as refusal and reluctance to adhere to interventions targeting asymptomatic Plasmodium carriers. Conclusion This review showed a lack of knowledge of asymptomatic malaria among endemic communities and a remarkable shortage of studies on related topics. For better malaria control and to accelerate disease elimination, education on asymptomatic malaria would be necessary. Given the limited number of studies, further research on knowledge of asymptomatic malaria would be crucial in various malaria-endemic areas to provide evidence for tailored interventions.

Multiscale diffusion-enhanced attention network for steel surface defect detection in Polysilicon Production

Design, Synthesis, and Structural Evolution of Pseudo‐Natural Product IDO1 Inhibitors and Degraders

Abstract Terpenoid alkaloids are derived from the fusion of structurally diverse terpenoid‐ and alkaloid moieties. The biologically relevant chemical space defined by this unique natural product (NP) class may be explored beyond the limitations of biosynthetic pathways by means of the pseudo natural product (PNP) principle, i.e., by combination of NP fragments in different arrangements. We describe the design, synthesis and structural evolution of a monoterpene–pyrrolidine PNP collection obtained by functionalization and combination of bicyclic monoterpenes with pyrrolidine alkaloid‐derived fragments. Diverse fusion strategies led to the discovery of (‐)‐myrtenal‐pyrrolidine PNPs that are indoleamine‐2,3‐dioxygenase 1 (IDO1) inhibitors and degraders, termed iDegs. Structural fine‐tuning modulated both degradation and inhibition potencies. Co‐crystallization revealed that iDegs induce unprecedented changes in the C‐terminus of IDO1 which promote degradation. iDegs inhibited tumor growth in SKOV‐3 tumor‐bearing mice and led to prolonged survival, which promises to inspire novel medicinal chemistry programs aimed at IDO1 in different diseases.

Supporting mental well-being of healthcare workers using a mobile app: A mixed-methods feasibility study

Poor mental well-being is common among healthcare workers, affecting individual health, patient safety, and organisational performance. Mobile app-based self-care interventions are promising due to their accessibility, low cost, and ease of use. This study aimed to assess the feasibility of a self-monitoring mobile app called MYARKEO, to improve mental well-being among healthcare workers and healthcare trainees in the United Kingdom (UK). The study evaluated recruitment and retention rates, variability of key outcomes to inform a future randomised controlled trial (RCT), intervention engagement, barriers and facilitators to engagement, and potential refinements to the mobile app. A mixed-method feasibility RCT was conducted with two groups: an intervention group using MYARKEO to monitor mental well-being over 6 weeks, and a non-intervention control group. Data were collected at baseline and post-intervention and included the Warwick-Edinburgh Mental Well-being Scale (WEMWBS), the Depression Anxiety and Stress Scale (DASS-21), and the mHealth App Usability Questionnaire (MAUQ). Qualitative data were collected through semi-structured interviews (n = 13) and analysed using thematic analysis. Forty-nine participants (32 workers, 17 trainees; aged 18–60+) were included in the trial, with a 20.5% dropout rate. Daily app usage averaged 64.5%. Participants frequently monitored mood, sleep, food, and exercise. Interviews identified themes of “Usefulness,” “Enablers of engagement,” “Barriers to engagement,” and “Suggested intervention improvements.” This study demonstrates the feasibility of using a mobile app to monitor and promote mental well-being among healthcare workers and trainees. While app engagement was promising, challenges were identified, highlighting the need for refinements to the app’s content, interface, and design for future trials.

Estimation and spatial distribution of soil organic carbon content in farmland using unmanned aerial vehicle hyperspectral remote sensing technology

Copper‐Silver Bimetallic Metal‐Covalent Organic Frameworks with Unique Intermediate Interlayer Transfer Effects for Enhanced Electrocatalytic CO ₂ to Ethylene Conversion

Abstract The electrochemical reduction of CO 2 to ethylene (C 2 H 4 ) offers a promising approach to mitigating greenhouse gas emissions while generating high‐value chemical products. However, achieving both high C 2 H 4 selectivity and long‐term catalyst stability remains a significant challenge for single‐atom catalysts, primarily due to the absence of adjacent active sites required for the coupling of reaction intermediates. Herein, a bimetallic metal‐covalent organic framework (MCOF) with precisely tunable Cu‐Ag spatial configurations was developed to enhance CO 2 ‐to‐C 2 H 4 conversion through a synergistic catalytic mechanism. By optimizing the Cu/Ag molar ratio to 1:1 (Ag 0.5 Cu 0.5 ‐CTC‐TAPT), the catalyst achieves a Faradaic efficiency for C 2 H 4 (FE(C 2 H 4 )) of 51.5% ± 0.9% at a reduction potential of ‐1.774 V versus (vs.) RHE, along with a current density of 439.0 ± 7.3 mA cm −2 and excellent stability (FE(C 2 H 4 ) > 40% over 10 h), outperforming most single‐metal M/COFs and MOF‐based electrocatalysts that predominantly yield C1 products. In situ spectroscopic analysis and mechanistic studies indicate that Ag sites primarily facilitate CO generation, while neighboring Cu sites promote C─C bond formation. This work introduces a novel design strategy for constructing COF‐based materials with adjacent heterogeneous metal active sites, highlighting their significant potential for the electrochemical conversion of CO 2 into valuable C2+ chemicals.

To see or not to see the vet: A vignette-based study of decision-making by UK dog owners regarding seeking veterinary care for commonly presenting conditions

Barriers to accessing veterinary-care for dog-owners are diverse and dynamic, and widely accepted as major canine welfare threats because of potential non-, under- or delayed treatment. Owner knowledge and perceptions are recognised as key influences on decisions to seek veterinary-care but are currently understudied. This study aimed to explore decision-making by UK dog-owners around seeking veterinary-care for common conditions in dogs and identify influences upon these decisions prior to the introduction of Artificial Intelligence technologies. An online vignette-based survey collected responses from UK dog-owners regarding disorder vignettes ( n  = 3) randomly selected from a bank of n  = 30, that were developed from anonymised VetCompass clinical histories to describe common canine conditions in general practice. Framed as being the dog-owner for each vignette, participants suggested (i) the condition they believed the dog was affected by, (ii) their perceived urgency for seeking veterinary-care and (iii) information-sources used to influence their decisions. Post-vignette questions explored participants’ real-world dog-health information-sourcing behaviours for their own dog(s). Outcomes modelled included (1) accuracy of condition identification, and (2) appropriateness of urgency assessments compared to consensus from a panel of veterinary surgeons. Analyses included n  = 5316 vignette responses from n  = 1772 participants. Epilepsy, kennel cough, flea infestation and osteoarthritis were the most accurately identified disorders whereas mast cell tumour, glaucoma and gastrointestinal foreign body were the least accurately identified. Owners using internet-searching for health-information to aid vignette responses scored higher on accuracy than those who did not. Owners perceived conditions to require veterinary-care less urgently than veterinary surgeons in 28.4% of vignette responses; however, using online dog-health groups for information-sourcing reduced the risk of under-urgency. Owners were most accurate at identifying conditions with external clinical signs but often underestimated urgency of seeking veterinary care. Improved accessibility and utilisation of veterinary triage services, telemedicine and information-prescriptions for owners could improve canine welfare by supporting better dog-owner decision-making and optimising veterinary professional workload.

Widespread macrolide resistance among rapidly growing mycobacteria due to plasmids containing erm(55)

“It’s a last straw situation”; Overdose response and preferences for seeking support from emergency services during overdose in rural Ohio

Objectives We assessed how people who use drugs in rural Ohio communities affected by the opioid epidemic respond to overdose, their preferences for seeking support from first responders, and factors contributing to their willingness or hesitancy to call 9-1-1 during an overdose. Methodology Semi-structured interviews were conducted in select rural Ohio counties from 2021–2022 as part of the Ohio Opioid Project, one of eight sites in the Rural Opioid Initiative focused on overdose in the rural United States. Forty-four interviews with people who use drugs were coded using thematic analysis. Results Most participants had suffered an overdose (23/43) or witnessed (33/43) an overdose. Most participants preferred not to seek first responder support during an overdose if the victim was able to be revived. As a result, first responder support was not sought in most overdoses experienced or witnessed by participants. When first responders were called, outcomes varied: some participants felt the overdose victim’s lives were saved, others felt stigmatized by first responders, and one was arrested by law enforcement at the scene. Among participants who preferred not to seek support from first responders, fear of arrest, hospitalization, and stigmatization were the main reasons. Significance/Contribution This study details intervenable factors that could prevent overdoses from escalating to fatalities in rural Ohio, including: increasing awareness and knowledge for Good Samaritan Laws to encourage calls to 9-1-1 during overdose, ensuring unlawful arrests are not made at the scene of an overdose, and de-stigmatizing substance use among first responders and health care professionals. Findings may not be generalizable to the entire United States, but may have applicability in other rural, Appalachian areas.

In silico design of a multi-epitope vaccine targeting DENV-1 and DENV-3

Abstract The co-infection of DENV-1 and DENV-3 during endemic outbreaks can be potentially fatal and complicate the diagnostic process. In our study, we have focused on the development of a multiepitope vaccine against DENV-1 and DENV-3 co-infection, utilizing non-structural protein 1 (NS1) and envelope protein (E) as key antigens. B cell and T cell epitopes were predicted for their immunogenicity, antigenicity, and ability to elicit an IFN-γ response. The final construct showed predicted stability (Instability Index: 30.63), antigenicity (0.5509), non-allergenicity, and hydrophilic character (GRAVY: −0.226) based on computational assessments. Tertiary structural validation revealed 90.1% of residues in a favoured region. Molecular docking revealed a stronger binding of the DENV-TLR3 complex. The receptor and vaccine have stable interactions, according to molecular dynamics simulations and free energy estimations (-90 kJ/mol). Strong B and T cell memory responses were demonstrated by immune simulations, accompanied by increased levels of IgG, IFN-γ, and TGF-β. The codon-optimized sequence was successfully cloned into the pcDNA™3.1/V5-His-TOPO ® expression vector for potential experimental validation. As a result of this in silico approach, a targeted vaccine for DENV-1 and DENV-3 co-infections is possible, which merits further experimental evaluation.

The role of sex education in withdrawal use: Prevalence and correlates among a nationally representative sample of adolescents and young adults

Objectives Instances of withdrawal, the practice of removing a penis from a vagina before ejaculation to prevent pregnancy, have increased in some US populations over the past two decades. There is a paucity of research, however, on the prevalence and correlates of withdrawal among adolescents and young adults (AYAs). This study sought to determine the prevalence and correlates of withdrawal use in a representative sample of AYAs in the US, highlighting the association between receipt of informal sexuality education and withdrawal use. Study design We analyzed cross-sectional National Survey of Family Growth data from AYAs surveyed between 2011 and 2019 (15–24 years; N = 14,262). Prevalence of withdrawal was determined using different sexual activity time-points (at first sex and ever) and reference periods (past 3 and 12 months). Logistic regression models were used to identify correlates of withdrawal alone and combined with at least one other method. Results Across all waves and reference periods, the prevalence of withdrawal was higher among AYAs who combined it with at least one other method (ever [overall]=15.15, SE = 0.58) compared with those who used it as the only method (ever [overall]=8.32, SE = 0.38). Compared to the 2011–2013 wave, those in the 2015–2017 wave had greater odds of reporting using only withdrawal in the past 3 months (AOR: 1.50; 95% CI: 1.02, 2.21). The same trend was seen in those who used withdrawal with another method at last sex in the past 3 and 12 months. Withdrawal alone or combined with another method varied by receipt of informal sexuality education topics (e.g., methods of birth control vs STIs). Conclusion Variations in use of withdrawal based on type of informal sexuality education received suggests that different motivations might inform interventions in promoting effective reproductive health practices.