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Deciphering the role of MFGE8 in lactation using CRISPR-CAS9 based gene editing in Buffalo mammary epithelial cells

Magnitude, distribution and determinants of non-utilization of antenatal care services among women in low- and middle-income countries: Insights for implementation of WHO recommendations

Introduction Pregnancy is a pivotal stage that fosters health and prepares women and their families for the transition to parenthood. Antenatal care (ANC) encompasses the services provided by skilled healthcare professionals to pregnant women and adolescent girls, ensuring optimal health outcomes for both mother and child throughout pregnancy. The majority of maternal and child deaths occur in low- and middle-income countries (LMICs), where access to essential healthcare services, including ANC, remains a significant challenge. This study was aimed to assess the magnitude, spatial distribution, and determinants of non-utilization of ANC services in LMICs. Methods This study analyzed data from the most recent Demographic and Health Surveys conducted between 2015 and 2024, encompassing a total of 47 LMICs. The analysis included a weighted sample of 480,068 women. We employed spatial analysis to illustrate the geographic distribution of non-utilization of antenatal care and hierarchical analysis to identify contributing factors. ArcGIS 10.8 and Stata 17 were utilized for spatial and hierarchical analysis, respectively. Adjusted odds ratios with 95% confidence intervals (CIs) were calculated, and factors were considered statistically significant at a p-value of less than 0.05. Results Pooled magnitude of non-utilization of ANC among women in LMICs was at 10.59%, ranging from 40.05% in Afghanistan to 0.76% in Burundi, with many regions in several countries identified as hotspots for ANC non-utilization. Factors significantly associated with higher odds of non-utilization included having no (AOR = 3.28; 95% CI: 3.02–3.55) or low (primary schooling: AOR = 1.81; 95% CI: 1.67–1.96, and secondary schooling: AOR = 1.28; 95% CI: 1.18–1.38) education, being unmarried (AOR = 1.35; 95% CI: 1.29–1.41), lower wealth index (poorest: AOR = 1.87; 95% CI: 1.77–1.98), poorer: AOR = 1.45; 95% CI: 1.38–1.54, middle: AOR = 1.17; 95% CI: 1.11–1.24, and richer: AOR = 1.09; 95% CI: 1.04–1.15), having no media exposure (AOR = 1.68; 95% CI: 1.64–1.73), residing in rural areas (AOR = 1.05; 95% CI: 1.02–1.09), facing distance issues to health facilities (AOR = 1.31; 95% CI: 1.28–1.34), and the low-income level of the countries (AOR = 2.27; 95% CI: 1.23–6.74). Conclusion A significant proportion of women in LMICs have not utilized antenatal care services. Factors at the individual, community, and country levels contribute to this non-utilization. Policymakers should focus on addressing these barriers to achieve the WHO recommendation of eight or more ANC contacts in LMICs.

Correction: Exploring the association between depression and telomere length: A systematic review and meta-analysis

Development and evaluation of an online HIV pre-exposure prophylaxis (PrEP) training program for community pharmacists to implement pharmacy-led PrEP services in Malaysia

Introduction Expanding HIV pre-exposure prophylaxis (PrEP) through pharmacies may improve access for key populations. As part of the preparation phase of the EPIS (Exploration-Preparation-Implementation-Sustainment) framework, we developed and evaluated an online, self-paced PrEP training program for community pharmacists to prepare for a pilot, pharmacy-led PrEP service in Malaysia. Materials and methods In May 2023, a PrEP training committee developed an online training program covering PrEP efficacy, safety, eligibility, baseline assessments, laboratory testing, prescribing, and special circumstances, and pre-/post-training knowledge tests. In June 2023, 18 community pharmacists asynchronously completed the training. Effectiveness was evaluated using a 20-question pre-/post-training knowledge test, with responses calculated into percentage scores, alongside participant feedback. Paired t-tests assessed knowledge score differences (p < 0.05). Results Participants (median age: 30.5 years [IQR: 5.8]; 78% female; 89% Chinese; median 6.5 years of experience [IQR: 4.5]; four with prior HIV-related experience) showed a mean increase in knowledge scores of 14.2% (95% CI: 8.2%–20.1%; p < 0.001), increasing from 64.7% to 78.9%. Scores for four mid-career participants (50% female, 5–10 years of experience, all with undergraduate degrees, including one with prior HIV-related training), however, did not improve, suggesting that tailored learning approaches may be needed, and that existing knowledge or prior experience do not necessarily predict learning outcomes. PrEP knowledge gaps remained primarily in counseling (−22%), identifying candidates (−12%), clinical contraindications (−6%), effectiveness (−6%), and management of missed doses for daily PrEP (−6%), highlighting potential challenges in clinical decision-making and patient communication. Most pharmacists agreed that the training was well-structured, easy to understand, of appropriate duration, and useful for their work. Satisfaction was high, as was willingness to recommend it. Conclusions The novel online self-paced training program improved pharmacists’ PrEP knowledge, though variability in knowledge gains suggests the need for enhancements. Incorporating case-based, problem-based, and simulation-based learning may improve comprehension, particularly in patient counseling, eligibility assessment, and PrEP contraindications.

Ecological safety evaluation method for plateau characteristic agribusinesses based on knowledge granularity

Effects of aromatherapy on sleep quality in patients: Protocol for an umbrella review

Introduction Poor sleep quality affects disease recovery and overall quality of life. Aromatherapy has been shown to improve sleep quality by alleviating anxiety, promoting relaxation, and enhancing blood circulation. Several meta-analyses have reported the effects of aromatherapy on sleep quality, however, the efficacy varies widely, with some studies showing that the effects are negligible or inconsistent. A comprehensive review synthesizing the available evidence on the impact of aromatherapy on sleep quality is still needed. Therefore, this study aims to provide an umbrella review summarizing all available systematic reviews and meta-analyses investigating the effects of aromatherapy on sleep quality. Methods and analysis A thorough literature search will be conducted across six English-language databases and four Chinese-language databases, following the Joanna Briggs Institute (JBI) methodology for umbrella reviews. Two reviewers will independently screen all articles to determine their eligibility based on pre-established inclusion criteria. Additionally, a manual search will be performed by reviewing the reference lists of the included studies. Data extraction will be conducted from all eligible studies, and the quality will be assessed using the Assessment of Multiple Systematic Reviews-2 (AMSTAR 2) tool. The study selection process will be presented using a PRISMA flow diagram. Statistical analyses will be performed using appropriate statistical methods to summarize and describe the findings. Results This study aims to provide comprehensive evidence by systematically evaluating the effects of aromatherapy on sleep quality in patients. It seeks to uncover the impact of aromatherapy on sleep quality across different patient populations and explore variations in its effectiveness based on disease type and the form of aromatherapy used. We will conduct a systematic evaluation of all eligible systematic reviews and meta-analyses. Subgroup analysis will also be performed, if applicable, to divide patients into groups according to how aromatherapy attributes (e.g., population type, dosage, route of administration) and disease types affect the effect size. PROSPERO registration number CRD42024580250.

Analytical approach for modelling of thread crimp in jacquard woven two-dimensional fabrics

Modeling and simulation of railway safety management with public supervision and dynamic incentives: A four-party evolutionary game and system dynamics approach

Railway accidents pose a significant threat to the industry, necessitating enhanced research into railway transportation safety. This study integrated a public oversight framework into the existing safety governance structure of railway transport operators, utilizing a four-party evolutionary game model and system dynamics for enhancement. Simulations conducted with Vensim software demonstrate that increased public supervision increases safety operation rates and improves the safety-related productivity of auxiliary enterprises. However, uncertainties in the evolutionary strategy process were identified. To address equilibrium fluctuations, a dynamic reward-punishment mechanism was developed. The optimized system achieved a safety operation rate of 99.7%, enhanced the safety-related productivity of the auxiliary enterprises to 93.2%, and increased the public supervision rate to 87.2%. These findings indicate that effective public participation and dynamic incentives can significantly improve safety management and prevent losses in railway sectors, offering valuable theoretical and practical insights for global railway enterprises.

A novel anoikis related gene prognostic model for colorectal cancer based on single cell sequencing and bulk transcriptome analyses

Factors influencing the success of targeted weight loss in healthcare providers with overweight and obesity after a six-month weight reduction intervention program

Obesity among healthcare providers (HCPs) affects their health and ability to provide care. In Terengganu, Malaysia, where 34% of adults are obese and over 50% of the workforce is overweight, targeted interventions are needed. Despite the importance of weight management in healthcare professionals, there is a lack of research focusing on effective strategies within this specific population. The study was conducted to identify factors associated with the success of targeted weight loss in HCPs with overweight and obesity following a six-month weight reduction intervention program. A cohort study involving HCPs with a body mass index (BMI) of 25 kg/m2 or higher was conducted in Terengganu, Malaysia, spanning from March to October 2023. All participants were required to undergo a six-month weight reduction intervention program. A participant who achieved a weight reduction of ≥ 5.0% during the follow-up period was considered successful in reaching the targeted weight reduction. Multiple logistic regression was applied to determine the factors associated with the success in achieving the targeted weight reduction. We found that the proportion of successfully achieved targeted weight reduction was 26.0%. The factors that were associated with the success of targeted weight reduction among HCPs with overweight and obesity were income (Adjusted Odds Ratio [AOR]: 0.94; 95% Confidence Interval [CI]: 0.88, 1.00, p-value 0.039), number of programs attended (AOR: 1.34; 95% CI: 1.02, 1.75, p-value 0.035), and the frequency of calorie intake recorded (AOR: 1.05; 95% CI: 1.02, 1.08, p-value 0.001). In conclusion, the proportion of successfully achieved targeted weight reduction was relatively low. To address this issue, future interventions need to concentrate on reinforcing participant self-monitoring and commitment levels. By emphasizing active progress tracking and cultivating strong dedication to the program’s objectives, there is a potential for significant improvements in weight management outcomes.

Application of nano-pico geotechnics and nano-pico heritage spray techniques for restoring and protecting historical brick buildings

Maternity care providers’ perspectives on late-term gestation management (LATE-study): A cross-sectional survey

Objective To examine the experiences, perspectives, and impact on daily work of maternity care providers regarding the updated Dutch national guideline on the management of late-term pregnancies. Design and setting This was a cross-sectional survey for maternity care providers in the Netherlands in 2024. Methods An online questionnaire was developed, improved on the basis of four semi-structured interviews, piloted, and distributed to primary care and hospital-based midwives, residents, and obstetricians. A 5-point Likert Scale was used for most questions. Descriptive analyses and data visualisation were performed. Linear regressions were performed to assess the association between characteristics and agreement with and adherence to the recommendations. The main outcome measures were awareness of the guideline, agreement with and adherence to the recommendations, opinions and perspectives on the impact of the guideline, and experiences of participants regarding the guideline. Results A total of 643 care providers were included, of whom 53% were primary care midwives, 29% obstetricians/residents and 19% hospital-based midwives. There was 72% agreement and 87% adherence to “offer induction of labour (IOL) at 41 weeks alongside expectant management”. Although 92% agreed with “discuss the advantages and disadvantages”, only 67% agreed with “specify perinatal outcomes” and 63% agreed with “specify outcomes for nulliparous versus multiparous women”. Adherence to these and to recommendations regarding monitoring were lower (43–59%). There was uncertainty among 45% about the benefits of the guideline, with only 17% believing in maternal and 20% believing in neonatal benefits. Conclusions Care providers widely agreed with and adhered to the recommendation to offer IOL at 41 weeks, but adherence to specific elements of shared decision-making was lower, and care providers expressed limited confidence on the benefits of the policy for mother and child.

Performance evaluation and multi-objective optimization of EDM parameters for Ti6Al4V using different tool electrodes

Abstract Ti6Al4V alloy is widely used in aerospace and biomedical applications due to its excellent mechanical and thermal properties, but its poor machinability makes it a difficult-to-cut material. Electrical Discharge Machining (EDM) offers an effective non-conventional machining approach for such materials, where tool electrode selection and process parameters critically influence performance. This study presents a comprehensive experimental investigation into the effect of three tool electrodes—graphite, copper, and brass—on the EDM performance of Ti6Al4V alloy. Key input parameters, including pulse-on time (Ton), pulse-off time (Toff), and current, were selected based on equipment limits and prior studies. Taguchi’s L9 orthogonal array was used for experimental design, and analysis of variance (ANOVA) was employed to determine the statistical significance of each factor. Output responses—material removal rate (MRR), tool wear rate (TWR), surface roughness (SR), and dimensional deviation (DD)—were measured and optimized using the Teaching–Learning-Based Optimization (TLBO) algorithm. Among the electrodes, graphite achieved the highest MRR (31.03 mm³/min), lowest TWR (0.4648 mm³/min), and minimal DD (101.76 μm), while brass produced the smoothest surface (SR = 3.19 μm). A collection of non-dominated responses was also found using Pareto optimal points. A minor adequate deviance was observed between the TLBO algorithm’s predicted and actual findings. Scanning electron microscopy (SEM) analysis was conducted to evaluate surface morphology. The qualitative SEM results confirmed fewer defects and better surface integrity for graphite electrodes. The findings validate TLBO as an effective tool for EDM process optimization and provide practical guidance for electrode selection in machining Ti6Al4V.

Association of healthcare fragmentation with three-year survival among kidney transplant recipients in Colombia

Objective Kidney transplantation requires a multidisciplinary approach to achieve optimal outcomes. Healthcare fragmentation, defined by inadequate communication and lack of integration among providers, disrupts the continuum of care, leading to adverse clinical outcomes. Latin American countries face significant challenges in delivering integrated healthcare. This fragmentation is further exacerbated in Colombia by the decentralized structure of the healthcare system, which disperses responsibilities across multiple actors, including public and private providers, insurers, and regional authorities. This study aimed to assess healthcare fragmentation in kidney transplant patients during their first post-transplant year and evaluate its association with three-year survival among patients enrolled in Colombia’s contributory healthcare scheme. Methods A retrospective cohort study was conducted using administrative data from Colombia’s contributory healthcare scheme. The cohort included kidney transplant recipients (2012–2016) who survived the first post-transplant year. Healthcare fragmentation was measured by the number of unique providers involved in the first year. Patients were categorised into high- and low-fragmentation groups based on the 75th percentile of provider distribution. The primary outcome was three-year survival, analysed using multivariate Cox regression to estimate hazard ratios (HRs), adjusted for age, sex, Charlson Comorbidity Index (CCI), insurer, region, and transplant year. Results The cohort comprised 2,028 kidney transplant patients, with a mean age of 47.7 years (SD: 13.4), 38.7% female, and 68.7% presenting a CCI ≤ 3. Healthcare fragmentation ranged from 1 to 34 providers, with a mean of 8.94 (SD: 6.77). High fragmentation (≥11 providers) was observed in 30.2% of patients. Three-year mortality was significantly higher in the high-fragmentation group (18%) compared to the low-fragmentation group (12%) (p = 0.04). High fragmentation was associated with a 49% increased mortality risk (adjusted HR: 1.49; 95% CI: 1.12–1.97; p = 0.01). Conclusion These findings underscore the importance of integrated care models and improved coordination among providers to enhance patient outcomes, particularly in resource-limited settings.

Integrated disease management, optimal effort allocation between prevention and control

Abstract Prevention and control are two complementary strategies for disease management. In the absence of disease, prevention could be viewed as wasteful. On the contrary, control requires efforts, only in the presence of the disease. But in some cases, control strategies are implemented a long time after the disease started, when irrevocable damages could be already observed. Deciding how much efforts are dedicated to prevention and control is a difficult problem in practice. In this work, we formulated a simple mathematical model to balance the trade-off between prevention and control efforts, with the expected loss due to disease. We derived an analytical form of the optimal prevention and control efforts and showed that the amount of control and prevention efforts depends on the relative values of the control and prevention efficacy, weighted by the probability of disease occurrence. We illustrated our framework for the management of gastro-intestinal nematodes in small-ruminants. In particular to discuss the use of different common management methods, such as systematic or targeted anthelmintic treatments, and mixed grazing. We proposed simple decision rules that could help designing future management practice and research efforts in this area. For examples, we computed the minimal anthelmintic efficacy for treatment to be economically viable. We also discussed the optimal cost and efficacy of a monitoring method for implementing targeted selective treatment, or the maximal cost of mixed grazing implementation. This framework is particularly useful to discuss the cost of new management strategy, and to ensure that new management designs are economically viable.

Clarification of fibrin generation and degradation reaction processes of clot-fibrinolysis waveform in hemorrhagic disorders

Clot-fibrinolysis waveform analysis (CFWA) is an assay used to simultaneously evaluate coagulation and fibrinolysis reactions. Although the assay detected the reaction via transmittance changes, there was no evidence that the transmittance changes indicated reactions. This study aimed to demonstrate that transmittance changes indicate coagulation and fibrinolysis reactions by detecting relative markers. CFWA was conducted using activated partial thromboplastin time (APTT) reagent and CaCl2 solution with tissue-plasminogen activator (tPA); transmittance changes were monitored, and the first derivative curve was analyzed in pooled normal plasma (PNP) and factors V, VIII, IX, X, and XI-deficient plasma samples. The samples during the coagulation and fibrinolysis reactions were prepared by adding the reaction stop solution, fibrin monomer complex (FMC), fibrin/fibrinogen degradation products (FDP), D-dimer and plasmin-α2 plasmin inhibitor complex (PAP) were measured to compare the waveform with the tendencies of these markers. The fibrinolysis markers FDP, D-dimer, and PAP increased in all samples as the reaction time increased. In FMC, the value increased during the coagulation phase, decreased at the end of the phase, and increased again during the fibrinolysis phase. FMC, FDP, and D-dimers were generated from fibrin/fibrinogen in the CFWA assay, indicating that the assay reflects coagulation and fibrinolysis reactions by monitoring transmittance.

The predictive value of neutrophil to high-density lipoprotein cholesterol ratio in early pregnancy for gestational diabetes based on nomogram

AI-ming backwards: Vanishing archaeological landscapes in Mesopotamia and automatic detection of sites on CORONA imagery

By upgrading an existing deep learning model with the knowledge provided by one of the oldest sets of grayscale satellite imagery, known as CORONA, we improved the AI model’s attitude towards the automatic identification of archaeological sites in an environment which has been completely transformed in the last five decades, including the complete destruction of many of those same sites. The initial Bing-based convolutional network model was re-trained using CORONA satellite imagery for the district of Abu Ghraib, west of Baghdad, central Mesopotamian floodplain. The results were twofold and surprising. First, the detection precision obtained on the area of interest increased sensibly: in particular, the Intersection-over-Union (IoU) values, at the image segmentation level, surpassed 85%, while the general accuracy in detecting archeological sites reached 90%. Second, our re-trained model allowed the identification of four new sites of archaeological interest (confirmed through field verification), previously not identified by archaeologists with traditional techniques. This has confirmed the efficacy of using AI techniques and the CORONA imagery from the 1960s to discover archaeological sites currently no longer visible, a concrete breakthrough with significant consequences for the study of landscapes with vanishing archaeological evidence induced by anthropization.

Spatial characterisation of social-ecological systems for ecological restoration along the coast cities of Zhejiang, China

Building critical thinking in pre-service teachers: Dispositions, skills, and standards

It is necessary for pre-service teachers to develop their critical thinking dispositions and skills in the pre-service period to develop similar skills in their future students. This research employed a one-group pretest-posttest design to investigate the effect of a 10-week critical thinking training on pre-service teachers’ critical thinking. The training had a significant effect on the development of critical thinking skills. While training led to a significant improvement in critical openness as a sub-dimension of critical thinking disposition, it did not affect critical skepticism. The results revealed significant differences in depth-breadth-adequacy and precision-accuracy dimensions of critical thinking standards.