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Minimum Dietary Diversity for Children aged 6–23 months as a predictor of micronutrient adequacy in Ethiopia: Validation of the proxy indicator

Background The Minimum Dietary Diversity for Children aged 6–23 months (MDD-C) is a proxy indicator of micronutrient adequacy. There is a lack of evidence regarding the performance of this proxy indicator, including in Ethiopia, a country with diverse dietary habits. Therefore, this study aimed to validate the performance of MDD-C to predict micronutrient adequacy against the Mean Adequacy Ratio (MAR) among children aged 6–23 months in the North Mecha District, Northwest Ethiopia. Methods A community-based cross-sectional study was conducted among 457 randomly selected study participants from February 2–18, 2023. A single multiphasic interactive 24-hour dietary recall was used to collect dietary intake data. Spearman’s rank correlation test, Cohen’s kappa statistics, and Receiver Operating Characteristic Curve analysis were conducted. The optimal cutoff point for MDD-C was determined by selecting the points that maximized the Youden index. Statistical significance was determined with a p-value < 0.05 using a 95% confidence interval. Results The MDD-C had a moderate positive correlation (ρ = 0.62, p < 0.001) and a fair predictive ability (AUC = 0.78, 95% CI: 0.74, 0.83, p < 0.001) with the MAR to predict the micronutrient adequacy. The MDD score (≥5 food groups) had a sensitivity of 22.4% and a specificity of 91.4%, denoting slight agreement. The optimal cutoff point for MDD-C was found to be ≥ 3 food groups, with a sensitivity of 85.5% and a specificity of 62.9%. This optimal cutoff adjustment improved the agreement between the MDD-C indicator and micronutrient adequacy to a moderate level. Conclusions The MDD-C had a moderate positive correlation and a fair predictive ability with the MAR to accurately predict micronutrient intake adequacy at the optimal cutoff, despite poor sensitivity and high specificity at the standard cutoff. Countries need to adapt MDD-C cutoffs to local dietary patterns to improve accuracy. WHO and UNICEF should revisit the global application of a uniform cutoff and support the development of context-specific thresholds. This study in Ethiopia underscores the importance of further research to reassess the effectiveness of MDD-C as a proxy indicator for determining micronutrient adequacy across diverse populations and multiple countries.

Decomposing the gap in under-five mortality determinants between the low- and high-risk regions of Nigeria

Abstract Nigeria has the highest burden of under-five mortality (U5M) in the world and contributes 17% of the global childhood deaths. The high national average of U5M in Nigeria is driven by the rates in some regions of the country. This study quantifies the contributions of socioeconomic, bio-demographic, and health-related factors in explaining the gaps in U5M between the country’s low-risk regions (LRR) and high-risk regions (HRR). The study performed spatial analysis (using Local Moran’s I spatial analysis) and Blinder-Oaxaca decomposition analysis of the gap in U5M determinants between the LRR and HRR on a sample of children born five years before the 2018 Nigeria Demographic and Health Survey (n = 32,234). Spatial analysis shows that the North-west and parts of the North-east regions were hotspots for U5M, while the South-west and parts of the South-east were coldspots. Results from the decomposition analysis revealed a prevalence of 6.1% in LRR compared with 11.3% in HRR. This translates to 58.9% higher U5M in HRR relative to LRR. The study concludes that interventions aimed at enhancing factors like maternal education, access to economic resources, family planning uptake, and increasing birth intervals in HRR could be effective in reducing high U5M in Nigeria.

Antimicrobial stewardship programs and antibiotic use in Africa: A systematic review and meta-analysis protocol

Background Antimicrobial resistance (AMR) is a significant public health crisis, particularly in Africa where infectious disease burdens are high. While antimicrobial stewardship programs (ASPs) are a key intervention, a comprehensive synthesis of their impact on antibiotic use in this context is lacking. Objective This systematic review and meta-analysis aims to synthesize current evidence regarding the association between ASPs and antibiotic use in Africa. Methods MEDLINE (PubMed), Embase, CINAHL, Web of Science, and regional databases including african journals online and WHO global index medicus will be searched systematically. Original studies of the association of ASPs with antimicrobial consumption across healthcare settings will be included while Animal and environmental studies will be excluded. Two independent reviewers will screen articles, extract data, and assess quality using the Effective Public Health Practice Project (EPHPP) quality assessment tool. The main outcome measures will be proportion of patients receiving anantibiotic prescription and defined daily doses per 100 patient days. The pooled association of targeted ASPs with antimicrobial consumption will be be measured using multilevel random-effects models. Expected outcomes This systematic review and meta-analysis is expected to provide valuable, pooled evidence on the effectiveness of ASPs in reducing antimicrobial consumption in Africa. The findings will inform and call for evidence based interventions by governments and Non-Governmental Organizations (NGOs) to combat AMR in resource limited settings. Systematic review registration PROSPERO CRD420251003018.

Bisphenol A disrupts renal metabolism via MAPK-mediated steroid hormone dysregulation identified by transcriptomic and metabolomic analyses

Experimental investigation on the physical and mechanical properties enhancement of red clay modified with “RoadyesTM”

This study investigates the enhancement of the physical and mechanical properties of red clay from the Zhuzhou region using a nano polymer material (RoadyesTM), cement, and lime. The effects of varying dosages of RoadyesTM, cement, and lime on the properties of the modified red clay are examined. The indicate reveal that: (1) the addition of RoadyesTM alone results in a reduction in both the liquid limit and plasticity index, while simultaneously increasing cohesion and unconfined compressive strength; (2) Red clay treated with 0.25% RoadyesTM demonstrates the highest compression index, indicating optimal compressibility.; (3) The combination of RoadyesTM with cement and lime significantly enhances the mechanical properties of the red clay. Specifically, the combinations of 0.25% RoadyesTM with 6% cement and 0.25% RoadyesTM with 7% lime lead to the most significant improvements in both cohesion and compressive strength, with only minor changes in the internal friction angle. Additionally, it is found that the optimal dosage of cement decreases by 9% when RoadyesTM is incorporated.; (4) The effectiveness of the combination of 0.25% RoadyesTM and 6% cement is notably superior to that of the combination with 7% lime. Overall, the results of this provide offer valuable insights for the design and construction of roadbed engineering involving red clay.

A feasibility study evaluating the usability and acceptability of the personalised space technology exercise platform mobile application

Abstract The P-STEP (Personalised Space Technology Exercise Platform) app is designed to bring together tailored exercise guidance and up-to-date air quality information for individuals with long term health conditions. The app allows individuals to plan outdoor exercise walking routes while minimising their exposure to air pollution. Individuals with chronic long-term conditions, particularly respiratory and cardiovascular conditions, can use the app to minimise the risk of their symptoms being worsened by pollution while gaining the benefits of outdoor exercise. This study measured the usability and acceptability of the P-STEP app. The study was a single-arm 12-week pilot study based in Leicestershire, United Kingdom. We recruited 93 participants from an existing cohort study to use and evaluate the app for 12 weeks. Questionnaire data were collected at three timepoints; baseline, 6-weeks and 12-weeks. The primary outcome was the System Usability Scale at 12 weeks. Secondary outcomes included the User Engagement Scale Short Form, SF-12, Recent Physical Activity Questionnaire, bespoke app-specific usability questions and feasibility outcomes. Additional data collected include participant demographic information, technology self-efficacy, and adverse events. Weekly anonymised app usage data were collected and analysed separately to complement the questionnaire data. We assessed 342 individuals for eligibility, of whom 182 (53%) were eligible. Of the 182 eligible, 93 (51%) were enrolled and given access to the app for 12 weeks. Overall, 61 (66%) participants completed the study. At 12 weeks, the mean (sd) System Usability Score was 61.68 (22.9), bespoke usability score was 66.82 (14.75) and User Engagement Score was 3.08 (0.79). Completion rates across all questionnaires were high. Participants accepted the format of online questionnaires, with no participants requiring help to complete and no participants withdrawing from the study for this reason. This study helps to understand the feasibility and acceptability of administering the P-STEP app in a cohort of people with relevant long-term conditions. The results will help inform the design of a future randomised controlled trial. Trial registration The https://clinicaltrials.gov/ ID number is NCT05830318.

Treatment outcomes in lower limb lymphedema misdiagnosed as iliac vein compression syndrome: A retrospective analysis

Iliac vein compression is highly prevalent in the general population, which may lead to misdiagnosis of lower limb lymphedema as iliac vein compression syndrome and subsequent stent placement. This study retrospectively analyzed the treatment outcomes of 11 patients with secondary lymphedema who had previously been diagnosed with iliac vein compression by venography and underwent iliac vein stenting. Following iliac vein stent placement, six patients with Stage I and IIa lymphedema experienced partial relief of limb swelling; however, symptoms recurred and worsened within three months. The remaining patients showed no improvement in swelling after the stent was placed. Due to inadequate symptom relief following stent implantation, these patients underwent reevaluation and were subsequently diagnosed with lymphedema. Based on disease staging, they received appropriate interventions including complex decongestive therapy, lymphovenous anastomosis, or a combination of liposuction and lymphovenous anastomosis. Four patients with Stage I and IIa lymphedema underwent complex decongestive therapy, four patients with Stage I and IIa lymphedema received lymphovenous anastomosis, and the remaining three patients with Stage IIb lymphedema underwent liposuction combined with secondary lymphovenous anastomosis. Follow-up assessments were conducted at 3, 6, and 12 months post-treatment to evaluate limb morphology and functional outcomes using the Disability and Health Questionnaire for Lower Limb Lymphedema scores. Therapeutic outcomes analysis revealed that complex decongestive therapy, lymphovenous anastomosis, and liposuction demonstrated favorable efficacy in managing lymphedema cases with suboptimal response to prior iliac vein stenting.

Environmental hazards of wastewater disposal on groundwater at the West Sohag site, Egypt

Abstract Effluent infiltration from wastewater treatment plants into groundwater systems can be a source of contaminants of emerging concern that are not fully removed during the treatment processes. In the lowland desert area in Upper Egypt between the Eocene Limestone plateau and the new floodplain, wastewater disposal plants have been set up. Woody farmland will be irrigated with the treated wastewater. Some wastewater disposal sites, including the west Sohag site, have been operating since 1990. This site is considered a very hazardous source of soil and groundwater pollution. The current work aims to assess the environmental impact of the sewage water treatment plants (west Sohag site) in the Sohag Governorate, Egypt, using remote sensing and geochemical techniques. Monitoring the continuous extent of sewage water leakage and heavy metal mobility in the groundwater. The detailed visual interpretation of the different remote sensing data showed that the contaminated areas increased substantially. The area was classified into four classes, namely Urban centers, agricultural areas, water courses, and barren lands. The study showed that insufficient land is available to accommodate the projected quantities of wastewater. The hydraulic conductivity varies between 0.29 and 3.72 m/day with an average porosity of 38.9%. Excess raw wastewater accumulates on the ground surface at current operating sites, forming large, uncontrolled ponds. When soil, crops, and water supplies are contaminated chemically and bacteriologically, such ponds pose a risk to the ecosystem and could have catastrophic health consequences. Average heavy metal concentrations in the analyzed groundwater decreased from Zn > Cu > Pb > Cd, with mean values of 8.55 > 0.421 > 0.282 > 0.207 ppm, respectively. The correlations between heavy elements in the water are very high, with correlation coefficients greater than 0.8 between Pb & Cd, Pb & Cu, Pb & Zn, Cd & Cu, Cd & Zn, and Cu & Zn. According to speciation analysis, Zn, Cu, Pb, and Cd are highly mobile metals in the study area. Our findings confirmed the occurrence of sewage water leaking into the groundwater aquifer in the study area. These results offer useful data for examining the transport properties of heavy metal contaminants and developing practical remediation strategies.

Understanding social support during pregnancy: A qualitative study of women’s lived experiences in Nepal

This research study examines the experience and understanding of available social support in Nepal and its importance during pregnancy. The interviews, utilising twenty in-depth interviews with pregnant women in Nepal, were analysed inductively using a thematic analysis approach. The findings suggested that women consider their husband’s support the most important and desired support during pregnancy, while women also acknowledged support from relatives and neighbours. None of the women experienced any organised community support or NGO/INGO support, and the support from healthcare providers was limited. At the policy level, the maternity leave policy by the government of Nepal is seen as inadequate support in promoting working women in Nepal, and it lacks implementation in informal work sectors. The study concludes that appropriate social support can significantly enhance the well-being of pregnant women. Given the limited availability of formal support systems and the central role of spousal and informal community support, these findings highlight the need for context-specific interventions. Therefore, we recommend conducting interventional studies to design and evaluate targeted support mechanisms that address the diverse needs of pregnant women in Nepal, shaped by their socioeconomic and cultural contexts.

New potential morphologic features of the aorta associated with the occurrence of acute type B aortic dissection

Cause-and-effect relationships in a nonlinear model of Bitcoin’s energy use and price volatility effect

The environmental impact of Bitcoin (BTC) has been a source of concern due to its substantial energy consumption, which is a result of its proof-of-work mining algorithm and transaction processes. The global usage levels of Bitcoin are comparable to those of some affluent nations. This study examines the nonlinear causal relationship between the energy consumption of Bitcoin and its price volatility. In order to evaluate causality, we implement a nonlinear Granger causality test that is bolstered by artificial neural networks (ANNs). These networks are capable of recognizing intricate, nonlinear relationships that conventional linear models may be unable to identify. Our results indicate a substantial causal relationship between the price volatility of Bitcoin and fluctuations in its energy consumption, indicating that energy usage patterns can be used as indicators of market behavior. These findings have significant implications for regulators and investors, under-scoring the necessity of monitoring energy consumption trends to gain a more comprehensive understanding of the Bitcoin market dynamics and to inform policy decisions.

Bio-inspired neutrosophic-enzyme intelligence framework for pediatric dental disease detection using multi-modal clinical data

Abstract Pediatric oral diseases affect over 60% of children globally, yet current diagnostic approaches lack precision and speed necessary for early intervention. This study developed a novel bio-inspired neutrosophic-enzyme intelligence framework integrating biological principles with uncertainty quantification for enhanced pediatric dental diagnostics. We validated the framework across 18,432 pediatric patients aged 3–17 years from six international centers using multi-modal data, including clinical examinations, radiographic imaging, genetic biomarkers, and behavioral assessments. The framework incorporates neutrosophic deep learning for uncertainty modeling, enzyme-inspired feature extraction mimicking salivary enzyme dynamics, axolotl-regenerative healing prediction, and genetic-immunological optimization. Comprehensive validation employed stratified cross-validation, leave-one-center-out testing, and 18-month longitudinal tracking with mixed-effects statistical analysis. The framework achieved 97.3% diagnostic accuracy (95% CI: 95.8–98.2%), 94.7% sensitivity for incipient caries detection, and 96.2% specificity, significantly outperforming conventional methods (80.2% accuracy, p < 0.001) and state-of-art deep learning (89.4% accuracy, p < 0.001). Clinical efficiency improved with 37.5% diagnostic time reduction and 58.1% patient throughput increase. Cross-population validation showed consistent performance (89.7–93.8% accuracy) across ethnic groups with no demographic bias (p > 0.05). Economic analysis demonstrated 34.5% cost reduction with $12,450 per quality-adjusted life year and 8.7-month return on investment. The framework provides explicit uncertainty quantification enabling risk-stratified clinical decisions while maintaining robust safety profiles with zero serious adverse events. All algorithmic implementations and supplementary statistical validation reports are publicly provided to ensure transparency and reproducibility. This bio-inspired approach establishes new benchmarks for AI-assisted pediatric healthcare, demonstrating superior diagnostic performance, clinical efficiency, and global scalability for addressing pediatric oral health disparities.

Evaluation of a novel virtual reality training intervention to address implicit bias among healthcare workers, using an implementation science framework

Background There is a link between racial bias and poor health outcomes among Black, Indigenous, and People of Color (BIPOC). We aimed to design and evaluate a novel pilot virtual reality (VR) training program to reduce racial bias among healthcare providers in a university healthcare system. Methods CULTIVATE (Combatting Unequal Treatment in Healthcare Through Virtual Awareness in Empathy) is a mixed-methods study utilizing virtual reality (VR) training to enhance healthcare providers’ empathy towards racially and linguistically discordant patients. Participants included White-identifying clinical providers and graduate-level healthcare students, excluding those not engaged in direct patient care, BIPOC providers, and individuals unable to participate in VR training. Empathy was measured using a situational empathy scale and the Jefferson Empathy Scale (JSE) before and after the intervention, which comprised two VR modules, empathy assessments, and a qualitative interview. Quantitative and qualitative analyses were performed using the RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) framework to evaluate the program. The RE-AIM model will structure a framework for understanding virtual reality’s utility in future healthcare practice. Results Reach: 30 adults participated, mostly women (n = 21), 47% were physicians, and 8% had no prior implicit bias training. Eighteen participants completed pre- and post-VR empathy assessments and interviews. Effectiveness: There was no significant difference in mean JSE scores pre- (120.7) and post-intervention (122.2), but qualitative data indicated increased emotional responses. Adoption: Participants endorsed the intervention with a mean score of 8 (SD = 2) on a 10-point Likert scale for recommending it to others. Implementation: The program followed the pre-designed protocol. Maintenance: Participants reported improved clinical empathy towards BIPOC patients in qualitative analyses. Conclusions In this pilot study, participants found VR training to be acceptable and feasible. A larger sample needs to participate in the intervention to determine effectiveness. Qualitative results demonstrated that VR training enhanced empathy.

MOF-decorated track-etched membranes for the U(VI) ions sorption removal

Comparative physicochemical characterization and sensory profiling of Western Algerian and Polish honeys

Background An in-depth analysis was conducted on 37 honey samples from western Algeria representing diverse floral sources—lavender, rosemary, sweet white mustard, thyme, milk thistle, carob, orange, euphorbia, eucalyptus, camphor, jujube, sage, harmal, and multifloral blends. The objective was to evaluate their physicochemical properties and sensory characteristics, with Polish honeys serving as references. Methods Key physicochemical traits were measured, including moisture, pH, free acidity, electrical conductivity, hydroxymethylfurfural (HMF), proline, specific optical rotation, sugar profile (fructose, glucose, sucrose), and colour in CIELAB space (L*, a*, b*, Cab* and hab∘). Sensory evaluation was performed using a five-point hedonic scale (+2 = “like very much” to –2 = “dislike very much”) and an 11-descriptor Check-All-That-Apply (CATA) questionnaire. Results All values satisfied European quality limits (moisture 14.67–20.87%, pH 3.47–5.60, free acidity 8.00–40.33 meq/kg, conductivity 0.16–1.18 mS/cm, HMF 1.79–49.43 mg/kg, sucrose < 5 g/100 g, proline 265.95–1200.66 mg/kg). Polish samples scored higher for taste (+1.22 ± 0.42 vs + 0.18 ± 0.52; p = 0.009) and aroma (+0.72 ± 0.43 vs –0.26 ± 0.36; p = 0.016), whereas colour did not differ (p = 0.459). CATA indicated Algerian honeys were chiefly “mild” and “herbal”, contrasting with Polish “sweet” and “sharp” profiles. Principal-component analysis (PC1 + PC2 ≈ 65% variance) and hierarchical clustering defined three groups: (A) sweet aromatic (all Polish + four Algerian), (B) moderately mild, and (C) sharp–bitter–herbal. Selected Algerian varietals—rosemary (S29) and multifloral (S14)—matched Polish hedonic acceptance, highlighting their premium/exotic market potential. Conclusion Western Algerian honeys exhibit high compositional quality and distinctive sensory signatures, supporting competitiveness in food and health applications.

Eco-friendly bricks and tuff tiles from agricultural and industrial waste: advancing the United Nations (UN) sustainable development goals

Mitochondrial dysfunction-related metabolite methylmalonic acid is associated with decreased cognitive performance

Purpose Methylmalonic acid (MMA), a mitochondrial metabolite derived from propionate metabolism, has been implicated in fatal neurodegeneration in children with congenital methylmalonic acidemia. However, its clinical relevance in chronic cognitive decline remains poorly understood. This study aims to investigate the association between MMA levels, its metabolic coenzyme vitamin B12, and cognitive impairment in an elderly population. Patients and methods The cohort comprised 2,762 participants aged 60 and older, who underwent assessments using the Digit Symbol Substitution Test (DSST), Animal Fluency test (AFT), Consortium to Establish a Registry for Alzheimer’s disease (CERAD) Immediate Recall (CERAD-IR), CERAD Delayed Recall (CERAD-DR), with low cognitive performance defined as the bottom quartile. Generalized linear regression models were applied to explore potential associations. Additionally, differentially expressed genes (DEGs) in MMA-related propionate metabolic process were identified from the RNA expression profiles in frontal cortex from 56 Alzheimer’s disease and 44 non-dementia controls. Results Among the 2,762 participants, with a mean age of 69.2 years and 53.8% female, elevated MMA levels were significantly associated with an increased likelihood of low cognitive performance across multiple tests: DSST (OR = 1.95; 95% CI: 1.41–2.73), AFT (OR = 1.51; 95% CI: 1.01–2.25), CERAD-IR (OR = 1.58; 95% CI: 1.19–2.09), and CERAD-DR (OR = 1.56; 95% CI: 1.12–2.18). High serum vitamin B12 levels were associated with an increased likelihood of impaired CERAD-IR scores, although dietary B12 supplementation did not correlate with cognitive performance. Stratified analyses revealed a stronger relationship between MMA and cognitive decline in males, individuals over 75 years, and those with elevated serum and dietary vitamin B12 levels. DEG analysis identified genes related to MMA synthesis and mitochondrial function in cognitively impaired individuals, with significant enrichment in mitochondrial propionate metabolism pathways. Conclusion The findings indicate that elevated MMA levels are linked to cognitive decline in older adults, potentially through mitochondrial dysfunction. These results underscore the clinical importance of MMA in the context of chronic cognitive impairment.

A mutation detection method of discontinuous structures in rock strata based on drilling parameters

Metabolic dysfunction-associated steatotic liver disease (MASLD) can be a possible predictive factor of incident CKD: NAGALA cohort study

Background A decade-long follow-up study identified metabolic dysfunction-associated fatty liver disease (MAFLD) as an independent predictor for the onset of chronic kidney disease (CKD). In 2023, a Delphi consensus introduced the term metabolic dysfunction-associated steatotic liver disease (MASLD) as an updated nomenclature. This study aims to evaluate whether MASLD, as the newly defined concept of steatotic liver disease, functions as an independent risk factor for CKD development. Additionally, the study seeks to examine the association between MASLD and CKD, while identifying contributing risk factors. Methods This research involved a retrospective cohort study conducted on individuals participating in health checkups at Asahi University Hospital, Japan, from 1994 to 2023. Logistic regression analysis was employed to investigate the relationship between MASLD and the incidence of CKD over a five-year follow-up period. Results A total of 15,873 participants were included in this study. The incidence of CKD was highest among individuals with MASLD (9.5%). Multivariate analysis demonstrated that MASLD was significantly associated with an increased risk of CKD, with an odds ratio (OR) of 1.37 (95% CI 1.12–1.67, p = 0.002). Additional factors such as age (OR 1.04, 95% CI 1.03–1.05, p < 0.001) and estimated glomerular filtration rate (eGFR) (OR 0.88, 95% CI 0.87–0.89, p < 0.001) were also identified as significant predictors of CKD. These findings suggest a robust association between MASLD and an elevated risk of CKD compared to individuals without steatotic liver disease or cardiometabolic risk factors. Conclusions This study establishes MASLD as a significant risk factor for CKD onset. Effective identification and management of MASLD cases are essential to mitigate the incidence of CKD.

An energy saving perception method for industrial circulating cooling system