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Enhanced stability of simulated leukocytes for hematology internal quality control samples: A material improvement

Objectives This study aimed to develop and evaluate simulated leukocytes derived from porcine leukocytes as a stable alternative for internal quality control (IQC) in hematology laboratories. Addressing challenges related to material stability and availability, the research contributes to improving laboratory quality assurance in Vietnam. Methods Statistical methods including Shapiro-Wilk test, Levene’s test, t-tests, ANOVA, and the IQR method were applied to assess post-production quality and establish target values. Target values were established from data collected across 90 laboratories. The Interquartile Range (IQR) method was used to eliminate outliers, and target values were set for three analyzers (Sysmex XN-1000, Sysmex XN-550, and Horiba ABX Micros 60) per batch at three concentration levels. Sample stability was evaluated over a two-month shelf life using t-tests and monitored for 20 days post-opening with repeated measures ANOVA. Results Simulated leukocytes derived from goose erythrocytes exhibited instability at high concentration levels, whereas those derived from porcine leukocytes maintained stability over two months and demonstrated acceptable performance for up to 10 days post-opening. Conclusions The findings highlight the potential of porcine leukocytes as a reliable IQC material for hematology, meeting the stability and performance requirements of clinical laboratories.

Comparison of pregnancy outcomes after history-indicated and ultrasound-indicated cervical cerclage: A systematic review and meta-analysis

Objective To compare maternal and neonatal outcomes in women with a previous history of pregnancy loss and/or preterm delivery who underwent ultrasound-indicated cerclage (UIC) or history-indicated cerclage (HIC). Methods PubMed, Web of Science, Scopus, and Embase databases were searched for observational studies and randomized controlled trials (RCT) from inception to 30 April 2024. Eligible studies should have compared the outcomes of women with singleton pregnancies who underwent UIC or HIC. STATA version 15.0 was employed, and the analysis was done using a random effects model and unadjusted effect sizes from the included studies. Results Of 25 included studies (n = 3909), most (n = 18) were retrospective cohort studies. Compared to women who underwent HIC, UIC was associated with higher risk of having a preterm birth (<37 weeks of gestation) (OR 1.48, 95% CI: 1.17, 1.88; N = 15), low birth weight (<2500g) (OR 1.78, 95% CI: 1.32, 2.41; N = 6) and admission to neonatal intensive care unit (OR 1.70, 95% CI: 1.27, 2.27; N = 6,). Women with UIC also had a higher risk of chorioamnionitis (OR 2.34, 95% CI: 1.36, 4.04; N = 4). The risk of having a low APGAR score (5-minute score of less than 7), fetal death and preterm premature rupture of membrane (PPROM) was comparable among the two groups. Conclusion Our results demonstrate that UIC is associated with higher risks of adverse pregnancy outcomes compared to HIC. However, our evidence emanates from observational studies and is prone to biases, particularly because the findings were unadjusted for potential confounders. More clinical trials are needed to confirm our observations. Systematic review protocol registration PROSPERO CRD42024544181

Pharmaceutical expenditure changes under the volume-based procurement policy: Effects and influencing factors

Objectives To estimate the impact of China’s volume-based procurement (VBP) policy on the expenditure of both policy-covered and uncovered drugs, and to identify the elements that contribute to drug expenditure changes under VBP policy. Methods Using national drug procurement data of public medical institutions, this study included 25 policy-covered VBP drugs and 99 policy-uncovered alternative drugs as samples, seven “4+7” pilot cities and eight “4+7” expansion provinces as observation regions. Time-varying difference-in-difference (DID) model was applied to quantify policy impact on drug expenditures. The drug expenditure index decomposition method was employed to analyze the determinants of drug expenditure changes following VBP policy. Results The expenditure of VBP drugs significantly decreased by 42.19% after VBP policy (β = −0.55, p < 0.001), while alternative drugs increased by 11.52% (β = −0.11, p < 0.001), with a significant reduction in the overall expenditure of observed drugs (β = −0.05, p < 0.001). The decrease of VBP drug expenditures showed a trend of tertiary hospital (β = −0.64, p < 0.001) > secondary hospital (β = −0.57, p < 0.001) > primary healthcare centers (β = −0.39, p < 0.001). The index decomposition showed that manufacturer structure index (IM) decline was the primary driver for expenditure reduction of policy-covered drugs, with the IM decrease of 54.17% in pilot cities and 40.86% in expansion regions. The secondary driver was the price index (IP), with a decline of 31.68% in pilot cities and 36.08% in expansion regions. The restraining factor was the quantity index (IQ), increasing by 92.54% in pilot cities and 52.04% in expansion regions. IQ also drove the increase in alternative drug expenditures, increasing by 95.56% in pilot cities and 32.76% in expansion regions. Conclusion VBP policy effectively promoted the decline of total drug expenditures, primarily through manufacturer-level market displacement and the absolute price reduction. However, the “spillover effect” of alternative drugs weakened the overall effect on cost control. Strengthening holistic governance and improving the quality and intensiveness of drug use are important directions for future policy perfection.

Feasibility study for dose calculation with a radiation treatment planning system using a fixed-size electron cone applicator for small electron fields

Objective This study aims to evaluate the feasibility of radiation treatment planning using a commercial treatment planning system (TPS) for small fixed-size electron cone electron applicators not natively supported by the TPS. Methods Dosimetric characteristics, including beam profiles and output factors (OFs), were compared between a 6 MeV electron beam collimated by a small fixed-size electron cone applicator and a cerrobend cutout-based general applicator. Measurements were performed using a micro-diamond detector in a water phantom for field sizes of 2, 3, 4, and 5 cm. The monitor units (MUs) from the TPS were compared with direct measurements. To estimate the MU for the fixed-size electron cone applicator using the TPS, the relative OFs were defined as the ratio of the OFs for the fixed-size electron cone and general applicators. Dose distributions obtained from the TPS were validated against measurements using Gafchromic films, ensuring accuracy. Results Gamma analysis showed a passing rate >95% with 1%/1 mm criteria for depth dose comparisons and >99% with 2%/2 mm criteria for beam profiles. The general applicator’s OFs were consistently higher across all measured field sizes. The MU difference between the TPS and measurements was within 2.0%, while the difference between indirect TPS calculations and direct measurements for the fixed-size electron cone applicator remained within 1.0%. Dose distribution analysis showed >99% agreement (3%/3 mm) between the 2D dose distribution obtained using film in the fixed-size electron cone applicator and that calculated by the TPS of cerrobend cutout-based applicator. Conclusion The results demonstrate the feasibility of calculating monitor units and dose distributions for small fixed-size electron cone applicators using a commercial TPS combined with relative output factors. This approach offers a reliable method for dose calculation in specialized electron therapy applications.

Geospatial assessment of household water, sanitation and hygiene conditions and associated factors in Nigeria: A causal relationship model

Lack of adequate access to safe water, sanitation, and hygiene (WASH) has contributed to increased under-five mortality and morbidity of school-age children in low- and middle-income countries. Despite the global and national intervention programs, access to safe WASH remains a critical challenge in Nigeria. This study employed spatial and non-spatial statistics to establish causal relationships between WASH conditions and household factors in Nigeria. Results show that a large proportion of Nigerian households were still associated with unimproved hygiene (88%), sanitation (47%) and water (25%). Wealth status, literacy level and residency type exhibit significant causal relationships with households’ water sources (α = 0.000). Wealth status and the gender of household head exhibit significant causal relationships with sanitation condition (α = 0.000) and hygiene condition (α = 0.004 and α = 0.345, respectively). However, the computed parameter Degree of Dependence (DoD_j) shows that the choice of water sources mostly depends on residency type (DoD_j = 0.998) compared with the level of education and wealth status (DoD_j = 0.535 and 0.485, respectively). Statistical indices show that the implemented regression models are reliable (with models’ DoD of 0.714–0.996, Adjusted R2 of 0.184–0.762 and Akaike Information Criterion (AICc) of 68–103). The study concludes that a high risk of unimproved WASH is associated with rural residence, which is usually characterised by a low level of education, poverty and large household size. It further concludes that the high prevalence of unimproved hygiene, irrespective of the household wealth status and educational level, suggests the need for proper health and hygiene education. This study suggests the need for a more focused policy action towards empowering rural and vulnerable households in Nigeria with relevant preventive environmental and health information and appropriate social support for the communities.

The colonial response to the development of disease in Ghana and Côte d’Ivoire (ca. 1900-1955): A comparative analysis of British and French colonial health policies

Using a newly constructed dataset of official morbidity figures based on colonial medical reports, this article studies the British and French colonial response to the development of fourteen selected diseases in colonial health care facilities in Ghana and Côte d’Ivoire from circa 1900–1955. Yaws and malaria are shown to have received colonial attention due to their relatively high incidence in the facilities, while other diseases were deemed important for reasons other than the number of cases treated (sleeping sickness, yellow fever, smallpox). Despite similar forces surrounding colonial decision-making (such as the expansion of the colonial health care networks, population growth and the development of Western medicine), the British and French colonial response developed differently for part of the selected diseases (including sleeping sickness, measles and dysentery). For five commonly prevalent diseases (leprosy, dysentery, measles, gonorrhoea and syphilis) in Ghana and Côte d’Ivoire, the results in this article suggest that as of the 1930s, French colonial policymakers recognised their threat, while the British failed to do so sufficiently. A second new dataset of colonial vaccination campaigns (for ca. 1900–1955) formed the basis of an analysis of this aspect of the colonial response outside health care facilities. It finds that several diseases (including yellow fever) were addressed – more so in Côte d’Ivoire than in Ghana – but that smallpox vaccination campaigns trumped all others. The findings of this analysis indicate that extensive smallpox campaigns occurred earlier in both countries than previously suggested by the literature, and that the French colonial administration imposed a more elaborate programme.

Decentralised trials for hearing and tinnitus therapies: Lessons from the Digital thErapy For Improved tiNnitus carE (DEFINE) randomised controlled trial

Randomised Controlled Trials (RCTs) are the gold standard for evaluating the efficacy of interventions; yet, traditional methods involving multiple recruitment sites often involve significant logistical and financial challenges. The DEFINE trial demonstrates the feasibility of a decentralised approach to RCTs by comparing smartphone-delivered self-guided tinnitus therapy against one-to-one therapist-facilitated treatment for tinnitus. This trial was conducted entirely remotely, leveraging digital technologies for remote recruitment, data collection, and intervention delivery. A total of 210 participants were recruited through social media platforms over a five-month period. Participants were screened and enrolled by a central trial team remotely, who utilised hearing test smartphone applications and electronic consent forms. Baseline and follow-up assessments were conducted using electronic data capture (EDC) platforms, with high retention rates observed at each time point. The trial successfully recruited and retained participants, demonstrating the efficiency and cost-effectiveness of remotely managed trials. Key findings include a high engagement rate from social media ads, with 151,978 impressions leading to 4,997 clicks (3.3%), with a direct advertising spend of £880. 912 individuals self-screened for eligibility online. The median age of participants was 58.3 years, in line with comparable traditionally-recruiting tinnitus studies, with good geographical distribution across the UK. The trial’s adaptability allowed for protocol adjustments, and real-time monitoring of data quality and completeness. The DEFINE trial demonstrates that decentralised RCTs can offer a viable alternative to traditional RCTs for some hearing and tinnitus research, potentially increasing participant diversity and reducing the burden of research on participants, while maintaining rigorous standards of data collection and participant safety. Increasing clinical use of remote audiological assessment, and hearing implant programming provide increasing opportunities for the adoption of entirely remote or hybrid studies in hearing and tinnitus conditions.

Is it safe for women with a history of two cesarean deliveries to undergo a vaginal delivery attempt in comparison to patient with a history of one cesarean delivery?

Introduction Worldwide, numbers of repeat cesarean sections continue to rise. Although there is a multitude of evidence about the safety of a vaginal delivery attempt after one cesarean section, data is scarce regarding the risks of one compared to two prior procedures. This study aims to determine whether vaginal childbirth is less safe and successful for both mother and child in patients with a history of two cesarean sections compared to those with only one. Materials and methods This retrospective cohort study included all patients with a history of one or two prior cesarean deliveries who gave birth at term at Goethe University Frankfurt between 2014 and 2021. Maternal and neonatal morbidity, as well as rates of success for vaginal birth and uterine rupture, were compared between the groups. Results Of the 1967 women studied, 1697 gave birth after one previous cesarean section, while 270 had a history of two prior cesarean sections. There was no significant increase in maternal or fetal morbidity in women with two previous cesarean sections compared to one. However, the success rate of a vaginal delivery was lower in the group with two prior cesareans (27/79, 34.2%) than in the group with one (696/989, 70.3%). The rate of complete uterine rupture was higher in patients with two cesareans who underwent cesarean section after onset of labor (CSAOL-2: 3/89, 3.4%) compared to none in the CSAOL-1 group (0/492, 0.0%; p = 0.004). Maternal and fetal morbidity remained comparable across groups, with NICU admission rates of 11.2% (CSAOL-1) vs. 5.6% (CSAOL-2), and maternal transfusion rates of 0.86% (VBAC-1) vs. 6.45% (VBAC-2). Conclusion In the context of patient autonomy regarding the timing of delivery, offering the patient the choice of different delivery modes after two previous cesareans appears to be safe with respect to maternal and fetal risks. An individualized consultation and thorough counseling are essential, but the opportunity for different delivery options should be respected and supported.

A disproportionality analysis of FDA adverse event reporting system (FAERS) events for methimazole and propylthiouracil

Background Methimazole and propylthiouracil are the most common antithyroid drugs. We assessed the safety signals associated with methimazole and propylthiouracil by data mining the FDA pharmacovigilance database. Methods Data were retrieved from the FAERS database from the 1st quarter of 2004 through the 4th quarter of 2023. A disproportionate analysis of reporting advantage ratios was used to assess potential associations between adverse events and methimazole/propylthiouracil. Results A total of 17,379,609 reports were extracted, of which 5,317 cases of methimazole and 1,761 cases of propylthiouracil were classified as primary suspect reports. After combining the same primary ID, 1586 patients with methimazole and 446 patients with propylthiouracil were retained. We observed 8 categories of SOCs with a reported number ≥ 30 for methimazole and 12 categories of SOCs with a reported number ≥ 10 for propylthiouracil. The median time to adverse events in patients with methimazole was 31 days, with an interquartile range of 31–74 days. The median time to adverse events in patients with propylthiouracil was 90 days, with an interquartile range was 20–388.5 days. Conclusion Our study provided a more in-depth and extensive understanding of adverse events that may be associated with methimazole and propylthiouracil, which will help to reduce the risk of adverse events in the clinical treatment of methimazole and propylthiouracil.

Healthy minds index, Spanish version of core dimensions of wellbeing

Psychological wellbeing is a crucial aspect of human flourishing, yet validated assessment tools are needed across diverse linguistic and cultural contexts. This study aimed to adapt and validate the Healthy Minds Index (HMx) for Spanish-speaking populations (HMx-SV). The HMx-SV assesses four core dimensions of wellbeing: awareness, connection, insight, and purpose. We conducted exploratory and confirmatory factor analyses on data from two independent samples of university students (N = 362 and N = 1,594). The findings confirmed a four-factor structure, with strong internal consistency and convergent validity with established wellbeing measures. The HMx-SV demonstrated robust psychometric properties, making it a reliable and valid tool for assessing wellbeing in Spanish-speaking populations. By expanding access to a culturally adapted instrument, this study contributes to the broader understanding and promotion of psychological wellbeing in diverse communities.

Protocol to establish standards for the elements of infection prevention and control programs and practice and competency standards for infection control professionals in Australian hospitals

Healthcare-associated infections (HAI) are the most frequent hospital-acquired complication, resulting in significant mortality, disability, and system-level costs in Australian hospitals. Many HAIs can be prevented with appropriate infection prevention and control (IPC) measures, including IPC programs led by infection control professionals (ICPs). Despite recent improvements in hospital IPC practices in Australia, such as the introduction of National Safety and Quality Health Service (NSQHS) Standards for hospital accreditation, there are currently no evidence-based minimum standards for the content, composition, and governance of IPC programs, nor the identification of their core elements. Furthermore, there is a similar lack of evidence-based minimum standards guiding the practice requirements, skills, and competencies of hospital ICPs. This protocol outlines a sequential three-phase research design to establish the core requirements for the elements and governance of IPC programs, as well as minimum practice standards for ICPs in Australian hospitals. Phase 1 will involve two integrative reviews to synthesise the elements and governance systems of international IPC programs, and the competencies, education and practice standards for hospital ICPs globally. Phase 2 will use survey and interview methodologies to examine the current content and structure of IPC programs and governance systems in Australian hospitals, as well as the academic and professional content of IPC education and training courses for ICPs in Australia. In Phase 3, a modified electronic Delphi study will be conducted to generate expert consensus on the core requirements of Australian hospital IPC programs and systems of governance, and the professional practice, qualifications and competencies for Australian ICPs. The outcomes of Phase 3 will form the basis for the development of new standards that aim to equip the Australian acute care sector to deliver evidence-based IPC practices, education, resources, and governance.

Unpacking gender discrepancies in academic promotion across STEM fields in Mexico

Gender inequality in the sciences remains a persistent issue. Women are often unable to participate in the scientific process as easily as men. When they do, this is largely constricted to opportunities at the lower rather than higher ranks of academia. This gap not only sets back female scientists but also scientific and social progress, more generally. The objective of this study is to look at a prominent national program for researchers in Mexico – Sistema Nacional de Investigadores (SNI) – to assess additional productivity and promotion heterogeneity by gender across career trajectories and disciplinary boundaries. Tracing productivity and promotion activity for 18,799 researchers active in the SNI program from 1991 to 2011, the analysis uncovers the following: while female researchers are associated with more productivity than males at each stage of the program, they are less likely to attain higher levels of promotion as they progress through their career. Illustratively, our more conservative results indicate women are associated with 1.2 more publications than men the year prior to promotion to Level 2 from Level 1 in SNI. Yet, 13 percent of women are associated with Level 2 promotion compared to 22 percent of men. To contextualize our understanding of these patterns, we interviewed SNI participants and include empirical assessments to unpack what may explain these perplexing results. While significant female representation in the applicant pool is needed to improve the gender gap, only a marginal increase in the gender representation of the reviewer pool is needed to reduce it significantly. This result points to a novel underexplored mechanism to inform future studies and policy – that of evaluative salience . While this does not fully address gender bias in the sciences, a shift in salience from applicants to reviewers may be an important precursor to address more structural ills around gender inequality.

Genetic mutation predicts survival after immunotherapy for ovarian cancer

Delayed motherhood and its determinants among women of reproductive age in five Sub-Saharan African Countries: A multilevel analysis of recent demographic and health surveys (2021–2023)

Introduction In recent years, more women have delayed childbearing until their late twenties or early thirties, a time when reproductive potential declines, thereby making conception more challenging with advancing age. While delayed motherhood is widely reported, there is limited research on its underlying causes in Sub-Saharan Africa. Exploring these factors offers valuable insights for researchers, policymakers, and healthcare providers. Method This study used the most recent Demographic and Health Surveys (2021–2023) across five Sub-Saharan Africa countries. A weighted sample of 47,439 women of reproductive age were analyzed using Stata 14. The determinants of delayed motherhood were determined using a multilevel mixed-effects logistic regression model. Statistical significance was determined at p-values <0.05, and results were reported using adjusted odds ratio (AOR) with 95% confidence interval. Results A total of 47,439 study participants were enrolled in the study. The mean age was 31.9 years (±8.7 SD), with over half (54.54%) aged between 20 and 35 years. The prevalence of delayed motherhood among women of reproductive age in Sub-Saharan Africa was 61.94%. Individual factors such as did not have occupation (AOR = 1.65, 95% CI: 1.57, 1.73), whose husband did not have occupation (AOR = 1.55, 95% CI: 1.51, 1.78), and those with poor wealth status (AOR = 2.62, 95% CI: 1.58, 3.66) were more likely to delay motherhood. Moreover distance to a health facilities (AOR = 1.04, 95% CI: 1.09, 1.39), urban residence (AOR = 2.48, 95% CI: 1.67, 2.09), and high community illiteracy (AOR = 3.24, 95% CI: 1.55, 5.35) were also significant predictors of delayed motherhood. Conclusions This study reveals a significant prevalence of delayed motherhood among women of reproductive age in Sub-Saharan Africa. Major contributing factors include unemployment, poverty, urban residence, limited healthcare access, and community illiteracy. Addressing these disparities requires targeted policies and improved access to education and healthcare services.

Teacher acceptability of physically active learning in UK secondary schools – a mixed methods study

Background Roughly 70% of UK adolescents are insufficiently physically active, while secondary education reform is needed to improve adolescent wellbeing and 21 st -century skill-building. One potential strategy to help address these areas is physically active learning (PAL), where movement is integrated into curricular lessons. In the UK, studies have largely focussed on primary schools; little is known about PAL in UK secondary schools. This study aimed to explore, using mixed-methods, UK secondary school teachers’ acceptability of PAL, and their delivery preferences, perceived implementation barriers and facilitators. Methods Cross-sectional data were collected from UK secondary teachers via online survey (N = 75). In addition to descriptive statistics, Mann-Whitney U tests were conducted to examine differences by gender and school types (urban/rural, state-funded/independent), and Kruskal-Wallis tests for differences by subject. Qualitative data on teachers’ current teaching practice, PAL acceptability, and perceived barriers and facilitators, collected through open survey questions (N = 63), and online teacher interviews (N = 7), were analysed using the framework method. Results Using a scale of 1.0 (strong disagreement) to 5.0 (strong agreement), participants liked the concept of PAL (median 4.0, IQR 4.0,5.0) and would use PAL if it was school policy (median 4.0, IQR 3.5,5.0). Female participants were more certain that PAL should be implemented than male ( U  = 361.5, p  = 0.04). Languages teachers found PAL appropriate for their subject more than humanities and social science teachers ( U  = 6, p  = 0.01). Four main themes were generated: (1) ‘It’s time for a change’; (2) ‘PAL seems like common sense’; (3) ‘Is PAL realistic in secondary schools?’ and (4) ‘Recommendations for implementation’, highlighting a collaborative approach. Conclusions UK secondary teachers largely felt that PAL is a logical and enjoyable tool to contribute to education system improvement and can benefit pupils’ wellbeing and learning, if appropriately executed. The findings can inform future research working towards sustainable PAL implementation in UK schools.

Bioorthogonal Non-Canonical Amino Acid Tagging (BONCAT) to detect newly synthesized proteins in cells and their secretome

Background Cells respond to physiological or pathological stimuli by altering the composition of the proteins they produce. This adaptation includes changes to newly translated polypeptides that are destined for intracellular compartments or secretion. The secretome is relevant to cell physiology, as it promotes autocrine, paracrine, and endocrine signaling. These events control cell death, tissue repair, and other regenerative processes. Uncovering the changes in de novo protein synthesis under different growth conditions requires reliable methods to identify and quantify newly synthesized proteins. Bioorthogonal Noncanonical Amino Acid Tagging (BONCAT) can generate this information with high spatiotemporal resolution. Methods We developed a BONCAT-based protocol to characterize proteins synthesized de novo in mammalian cells. Cultured HeLa cells are used as a model system, as their cell physiology is particularly well understood. The current protocol employs L-azidohomoalanine as an L-methionine analog, which is incorporated into newly translated polypeptide chains. After the incubation period, cells and the growth medium, which contains the secretome, are processed separately. Specifically, proteins are alkylated, and L-azidohomoalanine is modified with a biotin affinity tag. Proteins are collected using a rapid precipitation method, which is compatible with the subsequent affinity purification of biotinylated polypeptides. The affinity-purified material can be used for diverse downstream applications, such as Western blotting. Our experiments illustrate the feasibility of different steps of the protocol. Moreover, we discuss potential bottlenecks of the procedure and provide solutions that address these obstacles. Discussion Our work demonstrates the power of a modified BONCAT protocol to study newly produced proteins in growing cells and their secretome. This method will be useful to examine the proteome and secretome changes that are linked to the altered performance of cells, tissues, and organs during aging, disease, or other challenging conditions.

Retraction: Suppression of uPA and uPAR Attenuates Angiogenin Mediated Angiogenesis in Endothelial and Glioblastoma Cell Lines

Omnipresent intercorrelations of metabolic syndrome markers in the general population

Background Besides the usual characterization of metabolic syndrome as a cluster of markers arbitrarily defined by thresholds, it is unclear to which extent these markers as continuous traits are correlated with each other in the general population. The present study aimed to explore these correlations across a wide array of biological, social and behavioral characteristics. Methods The cross-sectional analyses were performed in a large population-based French cohort (CONSTANCES) of 159,476 adults in whom blood glucose, low-density lipoproteins (LDL) and high-density lipoproteins (HDL), triglycerides, body mass index, waist and hip circumferences, systolic and diastolic blood pressures were measured at the time of recruitment between 2012 and 2021. Correlations between each pair of continuous marker distributions were assessed by calculating raw and partial correlation coefficients (r). Results The same pattern of partial correlations is observed with little variation in all groups of sex, age, individual and parental histories of cardiovascular disease, diagnosis of metabolic syndrome, social position, work environment, lifetime unemployment exposure, smoking, non-moderate alcohol consumption, leisure-time physical inactivity and diet quality. This pattern is composed of strong and expected intercorrelations between systolic and diastolic blood pressures (r ranging from 0.62 to 0.74), between body mass index and waist (r from 0.50 to 0.63) and hip (r from 0.58 to 0.70) circumferences and between waist and hip circumferences (r from 0.07 to 0.19). It also includes intercorrelations of systolic blood pressure with waist (r from 0.10 to 0.21) and hip (r from −0.07 to −0.12) circumferences and with blood glucose (r from 0.09 to 0.15), those of triglycerides with blood glucose (r from 0.07 to 0.16), LDL (r from 0.24 to 0.33), HDL (r from −0.20 to −0.29) and waist circumference (r from 0.07 to 0.15), and finally those of waist and hip circumferences with blood glucose (r from 0.09 to 0.17 and from −0.08 to −0.13) and HDL (r from −0.12 to −0.24 and from 0.08 to 0.18). Conclusions These results show that metabolic syndrome markers are correlated with each other whatever the biological, social or behavioral characteristics of individuals. They suggest that it makes sense to systematically consider these markers all together rather than separately in terms of etiology, prevention and treatment of metabolic diseases and cardiovascular risk in the general population.

Challenges and opportunities in monitoring the long-term well-being of people with HIV in Spain

Background Thanks to antiretroviral therapy, people living with HIV have an increased life expectancy, but face multimorbidity challenges while ageing. This study aimed to evaluate the monitoring capabilities of Spain’s subnational and national health information systems in addressing the multimorbidity needs of people with HIV (PHIV). Methods Employing 7 semi-structured focus groups discussions of 20 total participants through purposive sampling of relevant professional profiles recruited by the Spanish Interdisciplinary AIDS Society (SEISIDA), we thematically analysed the discussions using two theoretical frameworks: the World Health Organization health systems building blocks and the DeLone and McLean Information Systems Success Model. Content was validated via participant follow-up and triangulation with publicly available data. Results Participant feedback revealed ongoing challenges and capacities within the Spanish health information system for collecting, reporting, and using multimorbidity information among PHIV, including gaps in systematic monitoring of comorbidities, including mental health, technical and interoperability challenges in health data systems, and the need for improved data collection and coordination strategies. Conclusion Our findings underscore the importance of a comprehensive approach to health monitoring for chronic care management and the critical role of data standardization and systematization towards improved patient care and public health goal-setting.

An assessment of optimizing biofuel yield percentage using K-fold integrated machine learning models for a sustainable future

Accelerating population and modernization has triggered a steady rise in energy demand and a significant rise in household waste, particularly municipal solid waste. In this context, waste-to-energy conversion has emerged as a sustainable solution. This study aims to maximize biofuel production yield using biomass-based banana peel catalyst waste by optimizing process parameters through machine learning models integrated with k-fold cross-validation. The models employed include Polynomial Regression (PR), Decision Tree (DT), Random Forest (RF), and Linear Regression (LR). The three key input variables including reaction temperature (RT), catalyst concentration (CC), and methanol-to-oil molar ratio (MOR) were used to train and test the models, with biodiesel yield as the measured output. Among the models, PR emerged as the best-performing one for predicting biofuel yield, demonstrated by its high R² value of 0.956 and low error metrics (RMSE = 1.54 MSE = 2.39 MAE = 1.43). The best model was determined through balancing bias and variance across k-fold validation iterations, where PR exhibited the highest average R² value of 0.868. Furthermore, the optimized process parameters predicted by PR for maximum biofuel yield were a RT of 59°C, CC of 2.96%, and a MOR of 9.21, resulting in a yield of 95.38%. These findings contribute to advancing large-scale machine learning-driven biofuel optimization, supporting industrial waste-to-energy applications, and fostering sustainable energy development.