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Ocean conditions drive interannual variability in juvenile albacore tuna (Thunnus alalunga) muscle energy content in the California Current System

Juvenile albacore tuna (Thunnus alalunga) undertake long migrations across the North Pacific that they fuel by feeding in the California Current System (CCS) during the summer. The CCS is a highly dynamic system, which can lead to differences in foraging success that may be indicated by differences in body condition. Assessed through stomach content analysis, albacore diet composition by mean proportional weight showed high interannual variability including some years characterized by large increases in consumption of anchovy (2011 = 81%, 2017, 2022) and sardine (Sardinops sagax, 2022). We used a generalized additive model (GAM) to investigate the impact of albacore length, month of collection, diet composition, and environmental conditions on albacore muscle energy content. Two proxies for muscle energy content, the carbon to nitrogen ratio (C:N) and ash free dry weight (AFDW), were positively but weakly correlated. Albacore C:N increased with month, body size, and upwelling in the first half of the year, and decreased with increasing sea surface temperature. The mean energy density of prey and chlorophyll-a concentration were not important predictors of muscle energy content, indicating that albacore may be resilient to changes in prey composition and productivity. Sea surface temperature was the most important predictor of muscle energy content, which suggests that marine heat waves and projected future warming in the CCS may have detrimental effects on albacore body condition or the value of the CCS as a foraging habitat.

Exploring Dolichos lablab compounds as potential inhibitors for fusion (F) protein of human metapneumovirus (HMPV): A systematic computational approach

One of the most crucial respiratory pathogens in the world, namely human metapneumovirus (HMPV), causes acute upper and lower respiratory tract infection. The HMPV Fusion (F) protein is a vital element for viral entry and is the sole target of neutralizing antibodies, making it a prime target for drug and vaccine development. Targeting the Fusion (F) protein of HMPV for inhibition has emerged as a potential therapeutic strategy, particularly in respiratory infection treatment. We aimed to identify potential inhibitors against HMPV F protein by molecular docking and molecular dynamics study. Through molecular docking, we were able to identify 16 lead compounds derived from Dolichos lablab (DL). These compounds exhibited robust binding affinities with the HMPV F protein, with better docking scores compared to the ribavirin inhibitor as a control with a −6.7 kcal/mol docking score. Among these top-ranked compounds, Brassinolide (CID_115196), Quercetin (CID_5280343), and 2’-Hydroxygenistein (CID_5282074) demonstrated favorable molecular, pharmacokinetics, and drug-like properties, promising biological activities, and acceptable toxicity profiles. Furthermore, Brassinolide, Quercetin, and 2’-Hydroxygenistein were found to be promising drug inhibitors with the greatest binding stability against the HMPV F protein compared to the ribavirin inhibitor, which is validated by the highest protein-ligand interactions and lowest Root Mean Square Deviation (RMSD), Root Mean Square Fluctuation (RMSF), and Radius of Gyration (Rg) values using 100 ns molecular dynamic simulation. Our study provides valuable insights into the therapeutic potential of DL compounds as potential or hypothetical inhibitors for HMPV F protein having three promising candidates- Brassinolide, Quercetin, and 2’-Hydroxygenistein. These results warrant further validation through detailed in vitro and in vivo investigations.

Boosting health provider performance with non-financial incentives: A cluster-randomized controlled trial in Tanzania

Background Non-financial incentives are frequently used to improve performance among healthcare providers, capitalizing on mission-driven intrinsic pro-social motivation. However, the effectiveness of incentives varies across settings and may depend on whether they are provided privately or publicly. Using a cluster-randomized controlled trial (ClinicalTrials.gov: NCT05525533) among drug shopkeepers in Tanzania, we designed and evaluated the effectiveness of non-financial incentives in boosting provider performance. Methods We developed a non-financial incentive that involved providing shopkeepers with monthly reports of aggregated customer feedback compiled from anonymous surveys from young women (15–24) to appeal to shopkeepers’ pro-social motivation for helping these customers. We randomized whether the feedback was provided privately (via a report) or publicly (displaying certificates of the customer feedback ratings). We estimated linear regression models on provider performance as measured by sales across different categories to young women from administrative point-of sales data over 12 months and estimated whether performance measures were correlated with shopkeepers’ pro-social motivation and concern for social image measured by surveys at Baseline. Results Young women customers completed 9,108 anonymous surveys across 99 shops. Shops receiving non-financial incentives privately did not increase performance. However, shops receiving non-financial incentives publicly reported an increase in sales to young women customers (58%, 95% CI: 20%, 97%), most notably for sexual and reproductive health products (96%, 95% CI: 4%, 187%), specifically oral contraception (154%, 95% CI: 9%, 306%) and pregnancy tests (75%, 95% CI: 8%, 143%). Performance measures were correlated with concern for social image but not pro-social motivation at baseline. Conclusions Publicly provided non-financial incentives increased performance among drug shopkeepers in Tanzania serving young women. Performance was strongest among those with higher concern for their social image at baseline, rather than those with stronger pro-social motivation. Future interventions using non-financial incentives to motivate healthcare providers should consider leveraging providers’ social image concerns to amplify the effectiveness of incentives.

Learnable edge detectors can make deep convolutional neural networks more robust

Deep convolutional neural networks (DCNNs) are vulnerable to examples with small perturbations. Improving DCNNs’ robustness is of great significance to the safety-critical applications, such as autonomous driving and industry automation. Inspired by the principal way that human eyes recognize objects, i.e., largely relying on the shape features, this paper first designs four learnable edge detectors as layer kernels and proposes a binary edge feature branch (BEFB) to learn the binary edge features, which can be easily integrated into any popular backbone. The four edge detectors can learn the horizontal, vertical, positive diagonal, and negative diagonal edge features, respectively, and the branch is stacked by multiple Sobel layers (using learnable edge detectors as kernels) and one threshold layer. The binary edge features learned by the branch, concatenated with the texture features learned by the backbone, are fed into the fully connected layers for classification. We integrate the proposed branch into VGG16 and ResNet34, respectively, and conduct experiments on multiple datasets. Experimental results demonstrate the BEFB is lightweight and has no side effects on training. And the accuracy of the BEFB-integrated models is better than the original ones when facing white-box attacks and black-box attack. Besides, BEFB-integrated models equipped with the robustness enhancement techniques can achieve better classification accuracy compared to the original models. The work in this paper for the first time shows it is feasible to enhance the robustness of DCNNs through combining both shape-like features and texture features.

Spatial disparities in zero-dose vaccination coverage for children aged 12–23 months in Ethiopia: A geographically weighted regression analysis

Background Though Ethiopia has made significant progress in childhood vaccination, many children remain unvaccinated, making it the third largest contributor to the global burden of zero-dose children. Zero-dose children are those who doesn’t receive the first dose of diphtheria, tetanus and pertussis containing vaccine. Identifying geographic inequities of zero-dose prevalence and the factors influencing it could help to effectively reach and identify at-risk children and to design tailored intervention. Objectives This study aimed to assess the geographical inequities and predicting factors of zero-dose children aged 12–23 month in Ethiopia. Methods We used a population-based survey data. A total of 6,212 children aged 12–23 were included. The spatial autocorrelation was employed to examine geographic variations in zero-dose children. Getis-Ord Gi* statistics was used for hotspot analyses. A Kriging interpolation technique used to estimate values of zero-dose at unmeasured locations based on known values of zero-dose at observed locations. The Geographic Weighted Regression (GWR) analysis was used to elicit determinants of geographic difference in zero-dose children. Adjusted R2 and Akaike Information Criteria (AICc) were used to compare the models. Results The prevalence of zero-dose children was 24.8% [CI: 23.7%−25.8%] ranged from 0.9% in Addis Ababa to 40.7% in Somali region. The zero-dose prevalence varied across the study area (Moran’s I = 0.193; P-value<0.0001). Significantly higher proportions of zero doses (hotspot areas) were identified in the north and south Somali, northwest Afar, East Amhara, and southern Oromia regions. GWR analysis showed that no ANC utilization, no TT/Td vaccination, poor perceptions on immunization, and far distance to healthcare facilities contributed to these geographic variations. Conclusion This study revealed that the prevalence of Zero-dose is unacceptably high, with geographic inequities varying across the country. Factors such as ANC utilization, TT/Td vaccination, perceptions of immunization, and distance to healthcare facilities contributed to these geographic differences. This underscores the importance of designing and implementing tailored interventions to identify and reach zero-dose children. Such an approach could help achieve the national and global immunization goal of leaving no one behind by providing equitable access to immunization.

Performance analysis of mouldboard plough body with raised elements and frame based on numerical simulation

This paper designed a mouldboard plough device, and performs performance analysis on the share-type plow body and frame based on numerical simulation methods. Firstly, the effects of forward speed, lugs angle, and the radius of the raised structure on the mouldboard plough’s performance were investigated, utilizing the discrete element method. The effects of these variables are analyzed through the response surface method. Furthermore, the significance of each factor is examined, and optimal parameter combinations are identified. The degree of influence on soil penetration resistance, ranked from largest to smallest, is as follows: forward speed, lugs angle, and mouldboard plough surface convex radius. Specifically, resistance to soil penetration increases with an increase in forward speed, lugs angle, and the radius of the convex structure. The degree of influence on the number of soil disturbance particles is ranked as follows: forward speed, the radius of the convex structure, and lugs angle. The number of soil disturbance particles decreases with an increase in forward speed, increases with a larger radius of the convex structure, and slightly decreases with an increase in the lugs angle. By establishing a regression model, the optimal parameter combination for the mouldboard plough was determined to be a forward speed of 0.8 m/s, a lugs angle of 45°, and a convex structure radius of 9 mm. Then, based on finite element analysis, both static and modal analyses were conducted on the frame of the plow device. The results indicated that, during stable operation of the mouldboard plough, the maximum stress occurs at the hinge joint between the frame and the tractor. The maximum stress value recorded is 24.7 MPa, with a corresponding maximum deformation of 0.02 mm, demonstrating that the designed frame satisfies the static requirements. Furthermore, the first-order natural frequency of the frame is 92 Hz, which is significantly higher than the external excitation frequency, thereby preventing the occurrence of resonance. Finally, the harmonic response analysis was performed on the frame, and the results showed that under the excitation conditions of 90 Hz and 500 Hz, the maximum displacement of the rack was 16.5 mm, and the results showed that it would not affect the working performance of the machine.

Structural damage identification using single-point vibration data processing

Structural health monitoring and damage identification are essential for ensuring the safety and performance of engineering systems. Cracks introduce nonlinear dynamic behavior due to intermittent contact from the opening and closing of crack surfaces, which limits the effectiveness of conventional linear identification methods. Moreover, many existing approaches rely on multiple distributed sensors, which may be impractical in real-world applications. To address these limitations, this study investigates the feasibility of identifying both crack depth and location using single-point vibration measurements. A recently developed nonlinear analysis framework is employed to simulate the dynamic response of a cracked beam, and spectrograms of the tip response under various crack conditions are generated using the short-time Fourier transform. These spectrograms are then used to train a convolutional neural network for damage identification. Numerical results demonstrate that the proposed method achieves high coefficients of determination (R²=0.82–0.97) between the true and identified values for both crack depth and location, provided the training data sufficiently cover damage conditions within the defined parameter ranges. Furthermore, data augmentation is shown to enhance identification accuracy, underscoring the method’s potential for implementation with limited vibration measurements.

Exploring the roles of male partners in the transmission, prevention and control of cervical cancer in Central Kenya: A qualitative study

Background Cervical cancer (CC), primarily caused by persistent infection with high-risk human papillomavirus (HPV) types, remains a major global public health issue. While it primarily affects women, male partners significantly influence HPV transmission, as well as women’s access to prevention and treatment through decision-making and social support. However, their role in prevention and treatment engagement remains underexplored. Aim The study aimed to explore the perceptions of couples’, healthcare workers’, and policymakers’ regarding the role of male partners in the transmission, prevention, and control of cervical cancer. Setting The study was carried out in three public county hospitals and community settings in Nyeri, Murang’a and Kirinyaga counties in Central Kenya. Methods We used qualitative research approaches for a comprehensive exploration of the roles of male partners in CC transmission, prevention and control. We conducted in-depth interviews and focus group discussions with 73 participants including 20 couples, 20 Nurses, 2 Clinical officers 2 Gynecologists, 6 Community health workers and 3 County directors of health. All the participants were purposefully sampled. We analyzed data thematically using inductive qualitative analysis approaches. Results Overall, we found key organizing themes including financial and logistical support, moral and emotional support, HPV transmission and prevention, gender norms and beliefs and practices. First male partners were perceived to offer financial support to facilitate cervical cancer treatment services as well as logistical support escorting their partners to the clinic or arranging for transport services. Additionally, men’s role in HPV prevention and transmission included supporting their children in vaccination as well as prevention by limiting number of sexual partners. However, Key barriers to male involvement in cervical cancer prevention and treatment reported by participants included limited knowledge about the disease, prevailing cultural beliefs and practices that favor traditional medicine over conventional healthcare, and entrenched gender norms that restrict male participation in reproductive health matters. Conclusion Cervical cancer awareness is limited, and male partners support is shaped by financial, cultural, social, and health system factors. Addressing these issues is key to improving prevention and control efforts. Contribution Identifying the potential barriers and male partners influence in access, screening and treatment of cervical cancer services.

Oral health profiles in the population of older adults in Ecuador: An analysis of latent classes

Background Ecuador’s aging population highlights the importance of addressing oral health issues among older adults because of the potential negative impact on their quality of life, nutrition, and overall well-being. Understanding the oral health profiles and specific needs of this population is crucial for the development of effective prevention and dental care strategies. This study aimed to identify and characterize the oral health profiles of older adults in Ecuador. Methods Data from the SABE 2009 survey were analyzed, encompassing responses from 5235 older adults from Ecuador. Oral health profiles were identified using oral health-related variables such as level of edentulism, the use of dentures, frequency of dental problems such as the change of food, among others. Additionally, a logistic regression analysis was conducted, in which sociodemographic and behavioral factors were assessed as predictors of the oral health profile membership of individuals. Results The analysis revealed 8 distinct oral health profiles among older Ecuadorian adults, varying in oral health status, prevalence of dental problems, and oral hygiene levels. Among these profiles, the three latent classes with the highest marginal probabilities were: (1) individuals with no original teeth, possessing complete dentures, minimal dental problems, and high satisfaction (0.22); (2) individuals with many missing teeth, dentures, minimal problems, and high satisfaction (0.19); and (3) individuals with all teeth missing, wearing dentures, with significant problems and high satisfaction (0.12). The significant factors influencing oral health status included age, education level, income, and access to dental services. Conclusion This study provides valuable insights into the diverse oral health profiles of older adults living in Ecuador. These findings can inform targeted prevention strategies and personalized dental care interventions to improve quality of life and overall well-being.

Behavioural risk factors for cardiovascular diseases among adolescents of secondary school in Tulsipur Sub-Metropolitan City, Nepal: A cross-sectional study

Background Cardiovascular diseases (CVDs) are a leading cause of global death and disability, affecting one-third of adult population. Often overlooked in school-going adolescents, behavioural risk factors are crucial contributors to CVD risk which begin early and accelerate during adolescent period. This study aims to assess the behavioural risk factors and their associated determinants among adolescents of Tulsipur Sub-Metropolitan City, Nepal. Methods A school-based cross-sectional study was conducted among 361 adolescents aged 16–19 years studying in grade 11 and 12 from public and private schools. Schools were selected using a stratified proportionate sampling method. Data were collected through a self-administered, structured, and validated questionnaire covering socio-demographic characteristics, behavioural risk factors of CVDs, and parental information. Descriptive and analytical statistics were used to analyse the data. Results The most prevalent behavioural risk factor was the consumption of calorie drinks (99%), followed by sedentary behaviour (60%), insufficient fruit and vegetable intake (57%), physical inactivity (35%), and consumption of processed food high in salt (33%). The prevalence of current smoking, alcohol consumption, and smokeless tobacco use was 12%, 10%, and 9% respectively. Key factors associated with the behavioural risk include maternal education, ethnicity, and education system. Parental tobacco and alcohol use were also associated with adolescent smoking and alcohol consumption. Conclusions The high prevalence of CVD risk factors among adolescents in Nepal highlights the urgent need for targeted interventions in both household and school settings. These interventions should aim to reduce behavioural risk factors to prevent the future burden of CVDs in resource-limited areas like Nepal.

Changing tides ushered in the world’s first civilization

Effectiveness and safety of an absorbable modified polymer starch powder hemostat versus usual care in gynecology procedures: A prospective, multi-center, and randomized study

Objective To evaluate the safety and effectiveness of an absorbable modified polymer starch powder hemostat (AMP-SPH) compared with standard care to control hemostasis when used in adult subjects during open or laparoscopic gynecological procedures for both benign and malignant diseases. Methods: Prospective, multi-center, randomized, and interventional phase IV study conducted on consecutive patients, aged ≥18 years, who underwent an open or laparoscopic gynecological procedure between November 2015 and July 2017 in a third-level Hospital. Study participants were randomly assigned (1:1) to receive either treatment with an AMP-SPH (AMP group) or usual standard care (SC group). The hemostatic treatment administered to the SC group was at the investigator’s discretion. The primary effectiveness endpoint of the study was the achievement of hemostasis (yes/no) within 10 minutes. Results: Ninety patients, 44 (48.9%) in the AMP group and 46 (51.1%) in the SC group were included in the analysis. the AMP group, 97.7% (43/44) of patients achieved hemostasis as compared to the 93.5% (43/46) of subjects in the SC group (mean difference: 4.2%; 95%CI: −4.1% to 12.6%; p = .337). The time required to achieve hemostasis was lower in the AMP group (1.91 ± 1.15 minutes) than in the SC group (2.28 ± 2.09 minutes), although not significant (p = .309). A higher proportion of patients in the SC group (17.9%) was observed to require blood products compared to those in the AMP group (4.8%).A total of 29 adverse events (AEs) (24 non-serious and 5 serious AEs) were reported, 12 AEs in the AMP group and 17 in the SC group. Conclusions According to the results of this study, AMP-SPH was not inferior to standard care in the control of bleeding for patients undergoing gynecology procedures and the cessation of bleeding was trending to be faster with the use of AMP-SPH than with standard methods. Trial registration ClinicalTrials.gov NCT02835391.

Will a child survive? Older siblings have a powerful influence

Evaluating the effects of multimodal EEG-fNIRS neurofeedback for motor imagery: An experimental platform and study protocol

Background Neurofeedback (NF) enables the self-regulation of brain activity through real-time feedback extracted from brain measures. Recently, the combination of several neuroimaging methods to characterize brain activity has led to growing interest in NF. The integration of various portable recording techniques, such as electroencephalography (EEG) and functional near-infrared spectroscopy (fNIRS), respectively based on electrical and hemodynamic activity, could enhance the characterization of brain responses and subsequently improve NF performance. Such multimodal NF used with motor imagery (MI) could benefit post-stroke motor rehabilitation to stimulate neuroplasticity of the lesioned motor areas. Nevertheless, their concomitant use in NF to identify brain activity features during upper-limb MI-based NF has not been studied to our knowledge. The objective of this paper is to present our fully operational experimental platform and the study protocol we propose to assess the benefits of combining EEG and fNIRS for NF in the context of MI. Methods We developed a custom experimental platform, including a cap integrating EEG and fNIRS sensors, along with software for real-time signal processing, NF score calculation and visual feedback presentation. To evaluate the effect of EEG-fNIRS NF in the context of MI, thirty right-handed participants will undergo three randomized NF conditions: EEG-only, fNIRS-only and EEG-fNIRS based NF. EEG electrodes and fNIRS channels will be positioned above the sensorimotor cortices. Participants will be presented with a visual representation of a ball along a one-dimensional gauge moving upwards according to their brain activity level as they perform a MI task of their left-hand. An NF score will be computed from the right primary motor cortex activity along the three different experimental conditions (EEG-only, fNIRS-only, EEG-fNIRS). The association between the NF score, the neuroimaging modality and the motor imagery strategy will then be analyzed. Discussion The designed experimental platform allows combined EEG-fNIRS NF. The presented study protocol will be the first investigation of the effects of multimodal neurofeedback using EEG and fNIRS during upper-limb MI tasks. We hypothesize that presenting the participants with a visual NF representing a score based on both EEG and fNIRS signals will result in more specific task-related brain activity in the sensorimotor cortices. With potentially increased neuroplasticity, such a system could find applications in clinical contexts, particularly in motor rehabilitation, for example in post-stroke units.

The impact of evolving maternal antiretroviral therapy guidelines on vertical transmission of HIV in the Western Cape, South Africa

Introduction Despite universal HIV test-and-treat policy in South Africa, vertical transmission continues to occur. We evaluated the temporal effectiveness of vertical transmission prevention (VTP) over three maternal antiretroviral therapy (ART) policy periods (three-drug ART accessible to those with CD4 counts <200 cells/µl (January 2010 – March 2010); < 350 cells/µl (April 2010 – April 2013); and lifelong ART regardless of CD4 count (May 2013 – December 2020)) in Western Cape, South Africa using public sector routine individuated data. Methods We conducted a retrospective cohort study with child HIV infection as the primary outcome. The cohort of 842 641 pregnancies from 2010–2020, inclusive of child HIV exposure, maternal ART, and child outcomes, was enumerated using administrative, laboratory and pharmacy data. Multivariable logistic regression was used to explore associations with vertical transmission. Results The proportion of pregnant women living with HIV (WLWH) initiating ART prior to pregnancy increased from 20.9% in 2010 to 71.1% in 2020. Of all pregnancies 17.1% (143 987/842 641) were HIV exposed and 16.3% (137 572/842 641) had a record of a child HIV outcome, of whom 3966 (2.9%) were HIV positive by 24 months. Among children with known maternal HIV exposure (143 987), 32.0% had unknown HIV status and 2.1% were diagnosed with HIV by study closure. In 2020, HIV status was ascertained in 87.2% (16 908/19 382) of children exposed to HIV. Children born in policy period 3 were less likely to have HIV than children born in policy period 2 (aOR 0.66; 95% CI 0.60–0.72), mediated through expanded ART access. Between 2017 and 2020, 16.5% of child HIV diagnoses were from pregnancies without maternal HIV exposure records. Young maternal age, no antenatal ART, previous tuberculosis and no records of antenatal visits were associated with vertical transmission in all periods. Conclusions Using routine data, we report an increase in WLWH initiating ART prior to pregnancy, and a decline in vertical transmission of HIV over three policy periods. Although HIV diagnosis amongst children exposed to HIV has reduced over time, the proportion of infections in children without established exposure emphasises the need to optimise VTP opportunities.

Genotype-phenotype correlations of germline mutations in exon 10 of the RET proto-oncogene from 14 MEN2A families of Ethnic Han Chinese

Objective To investigate the genotype-phenotype correlations of multiple endocrine neoplasia type 2A (MEN2A) caused by mutations in exon 10 of the RET gene in Ethnic Han Chinese. Methods A retrospective analysis was conducted on the family history and genetic characteristics of 14 independent MEN2A pedigrees, all carrying exon 10 mutations of the RET gene, from July 2003 to August 2023. Results A total of 74 out of 133 participants carried germline mutations in exon 10 of the RET gene. The cohort included 26 males and 48 females, with nine types of mutations observed: p.C609R, p.C611F/Y, p.C618G/R/S/Y and p.C620R/S. Of these, the C618 mutation was the most prevalent (71.6%), followed by p.C611 (22.9%), p.C620 (4.1%), and p.C609 (1.4%). The penetrance rates for medullary thyroid carcinoma (MTC), pheochromocytoma, hyperparathyroidism, hirschsprung disease, and cutaneous lichen amyloidosis were 90.3%, 6.9%, 2.8%, 1.4% and 1.4%, respectively. Among the 72 patients with available clinical information, 41 (56.9%) exhibited symptoms of MTC. Comparison of the age at diagnosis, size of MTC, and the positive rate of cervical lymph node metastasis (N1) revealed significant differences between patients with symptomatic and asymptomatic MTC (all P < 0.05). There was a significant difference in the positivity rate of N1 between patients with the p.C618/C620 mutations and those with the p.C609/C611 mutations. Additionally, there was a significant difference in the initial serum calcitonin levels between N1 and N0 patients (P < 0.05). Conclusion Exon 10 mutations of the RET gene are frequently located in codon 618 and contribute to the familial MTC phenotype. To improve the recognition of MEN2A, integrating family history, testing for RET mutations, and monitoring serum calcitonin levels are essential for early diagnosis and personalised treatment.

The role of community pharmacists in medicines optimisation for housebound people: A scoping review

Background An increasingly ageing population presents many challenges for healthcare systems, including how to support older adults who are more likely to be both housebound and have complex medication needs. Community pharmacists may play a key role in medicines optimisation for this vulnerable population, however, the extent of literature exploring this topic is unclear. Objective To map existing literature on the role of community pharmacists in medicines optimisation for housebound older adults in the United Kingdom (UK). Methods A scoping review was conducted following PRISMA-ScR guidelines. Peer-reviewed primary research and grey literature published since 2000 were searched using relevant databases and websites. Data was charted using a standardised form based on TIDieR guidelines and EPOC taxonomies. A narrative synthesis was conducted to summarise and interpret the findings from included studies. Results Seven sources were included in the review – five peer-reviewed articles and two grey literature reports. Interventions consisted of domiciliary medication reviews conducted by pharmacists. Key medicines optimisation strategies addressed were medication review, deprescribing, addressing polypharmacy and facilitating communication between providers. Reported outcomes included identification of widespread issues with polypharmacy and medication-related problems, reduced hospital admissions, cost savings and improved patient care. Gaps identified were limited generalisability, lack of comparisons to standard care, and under-representation of minority groups. Conclusions The literature indicates promise for the role of community pharmacists in medicines optimisation for housebound older adults through domiciliary services. However, more research is needed to evaluate the effectiveness and feasibility of pharmacist-led interventions in this setting. Addressing identified gaps will help inform pharmacists’ roles in supporting medication needs of housebound patients.

Prevalence and risk factors of intestinal protozoal infections among patients in Malaysia: A systematic review and meta-analysis

Backgrounds Intestinal protozoan infections (IPI), including Entamoeba spp., Giardia lamblia and Cryptosporidium spp., are common in diarrhoea patients in Malaysia. These parasites are primarily transmitted through contaminated food and water sources and pose a significant public health concern. Entamoeba spp., causes amoebiasis, which is characterised by severe diarrhoea with bloody stools, while Giardia spp., causes giardiasis, which is characterised by watery diarrhoea, abdominal pain and flatulence. Cryptosporidium spp. causes cryptosporidiosis, which is particularly severe in immunocompromised individuals. Despite efforts to improve water quality, sanitation, hygiene, and surveillance, limited epidemiological data prevent a clear understanding of the prevalence of intestinal protozoa and response to treatment. This systematic review and meta-analysis aimed to estimate prevalence, identify risk factors, and evaluate detection methods. Methods A comprehensive literature search was carried out in the following databases: Scopus, Google Scholar, Web of Science, PubMed and Cochrane Library. The review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidance. Based on the random effects model, results were reported as proportions with 95% confidence intervals (CI). Subgroup analyses were performed based on detection methods, target populations and regions. Results A total of 103 articles were found on the prevalence and risk factors of IPI in Malaysia. After removing duplicates and screening for eligibility, 49 studies were included in this meta-analysis. The overall pooled prevalence of IPI in Malaysia was 24% (95% CI: 0.17.0, 0.29). with I2 = 98.94%, (P < 0.001). Among the identified protozoa, Entamoeba spp. had the highest prevalence at 18% (95% CI: 0.12, 0.24), followed by G. lamblia at 11% (95% CI: 0.08, 0.14) and Cryptosporidium spp. at 9% (95% CI: 0.03, 0.14). A subgroup analysis revealed that Kelantan and Perak state have the highest prevalence of 39% and 29% while Selangor and Kuala Lumpur reported the lowest (13.6%). The highest prevalence was observed in the indigenous communities (27%), followed by the local communities that mainly comes from rural area (23%). According to a meta-analysis of ten risk factors, the pooled prevalence of protozoal intestinal infections was significantly higher (between 38% and 52%) in children under 15 years of age, in males, in those with low income or no formal education, and in those exposed to untreated water, poor sanitation or unhygienic practises. A high level of heterogeneity was observed (I2 > 98%), reflecting substantial variability across the included studies. Conclusion This review provides valuable insights into the epidemiology of protozoal intestinal infections in Malaysia. The high pooled prevalence of 24% underscores a substantial and ongoing burden of intestinal protozoal infections in Malaysia. The pooled prevalence should be interpreted with caution due to high heterogeneity, as the findings may not be generalizable to all settings. These findings support the development of evidence-based interventions to reduce the impact of these infections. Targeted screening, improved diagnostics, better access to clean water and sanitation, and health education for vulnerable groups are essential to reduce the burden of intestinal protozoa and strengthen national control measures.

Hippocampal representations drift in stable multisensory environments

Associations of high-risk drug patterns with mortality among community-dwelling older adults: A 23-year prospective cohort study

Background Data on drug safety in multimorbid older-adults are limited, as clinical trials often apply upper age limits and focus on individual drugs or specific combinations. We aimed to explore high-risk drug patterns in community-dwelling older-adults, and their associations with long-term mortality. Methods We included 1,048 participants from a longitudinal population-based cohort, all taking at least one medication. Participants were examined in 1999–2007 and followed for mortality through March 2022. Individuals with similar profiles of high-risk drugs, identified using Beers criteria as potentially inappropriate for most older adults or requiring caution, were grouped using agglomerative hierarchical clustering. Cox and competing-risk regressions were used to examine the associations of the high-risk drug patterns with all-cause and non-cancer mortality. Results The most prevalent morbidities among participants (mean age 73.3 ± 7.3 years, 55.9% women) were hypertension (55.3%) and cardiovascular diseases (45.5%), and 77.7% took at least one high-risk drug. Five distinct patterns were identified: ‘None’ cluster (no dominant high-risk drug); ‘Calcium channel blockers’ (CCBs) cluster, with high nonsteroidal anti-inflammatory drug (NSAID) prevalence; ‘Renin-angiotensin-aldosterone system (RAAS) inhibitors’ cluster, with a high concomitant use of sulfonylureas compared to other clusters; ’Diuretics’ cluster, with a relatively high prevalence of antithrombotics and proton pump inhibitors; and ’Benzodiazepines’ cluster, with a relatively high antidepressant prevalence. Clusters differed by age, sex, ethnicity, and health characteristics. In multivariable analysis, the ‘Diuretics’ cluster was associated with increased all-cause (HR = 1.33, 95%CI: 1.03–1.72) and non-cancer (HR = 1.41, 95%CI: 1.03–1.93) mortality compared to the ‘None’ cluster. The ‘CCBs’ cluster was associated with a greater risk for non-cancer mortality. Several drug combinations were identified as potential contributors to the increased risk observed in these clusters, including the concomitant use of NSAIDs and antihypertensives and a possible CCB-diuretic prescribing cascade. Conclusions Examining high-risk drug patterns offers a patient-centered approach to improving evidence-based medication guidelines and facilitating early interventions for vulnerable older-adults.