Browse Articles

Toward blockchain based electronic health record management with fine grained attribute based encryption and decentralized storage mechanisms

How did Ontario healthcare institutions implement and legitimize Covid-19 vaccine mandates? A qualitative multi‑method study protocol

Background Upon the WHO declaration of Covid-19 as a pandemic, healthcare workers (HCWs) – unvaccinated by necessity – were celebrated as “heroes” for their service under difficult conditions. Later, as some of them resisted vaccine mandates, they were reframed as “threats”, regardless of personal behaviour, workplace setting, or evidence of their harmfulness. This discursive shift and the institutional mechanisms supporting it remain underexamined. Goal This protocol outlines a qualitative multi‑method study investigating the implementation of Covid-19 vaccine mandates in medical establishments across Ontario, Canada. Methods This qualitative multi‑method planned study includes two phases. Phase 1 is an environmental scan of institutional vaccine mandate policies across a purposive sample of diverse Ontario medical establishments. It will track policy implementation timelines, mandates scope, exemptions eligibility criteria, and supporting scientific evidence presented. Phase 2 is a critical interpretive analysis of documents collected in Phase 1 that draws on Max Weber’s theory of bureaucracy and legitimacy, Carol Bacchi’s “What Is the Problem Represented to Be” (WPR) approach, and Brian Martin’s framework on suppression of dissent to identify patterns in the institutional framing and treatment of challenges to mandated vaccination. Expected outcomes The study outlined in this protocol is expected to yield descriptive and interpretive insights into how bureaucratic structures shaped mandate enforcement and dissent suppression. Results are expected to inform academic debates on institutional legitimacy, governance, and public health ethics.

Development of cognitive, motor, metabolic, and mutant huntingtin aggregation in the zQ175 mouse model of Huntington’s disease

Abstract Huntington’s disease (HD) is an inherited neurodegenerative disease. In humans, the clinical diagnosis is often dependent on the emergence of motor symptoms. However, cognitive impairments and metabolic changes can be early indicators. HD mouse models are a useful tool to understand disease progression, however, relatively few studies have monitored the timeline for the emergence of cognitive indices with motor and metabolic phenotypes in parallel. In this study, cognitive, motor, and metabolic phenotypes were investigated at different ages in the zQ175 knock-in mouse alongside immunohistochemical and long-term potentiation (LTP) studies. We demonstrated that zQ175 mice developed impaired hippocampal LTP at 3-months and cognitive deficits in visuospatial attention were evident by 4-months. Long-term and spatial memory impairments emerged by 12-months, alongside motor impairments. Additionally, an anxiolytic-like phenotype emerged at 6-months. Differences in body weight were also detected from 6-months onwards, primarily driven by a reduction in fat mass. Additionally, reduced brain weight and the presence of huntingtin aggregates in the hippocampus, striatum and hypothalamus were observed at 12-months. These data support the zQ175 mouse as a model of HD, which recapitulates many aspects of the disease progression in humans and can be used to understand mechanisms underlying the disease.

MHC-mismatched synovial mesenchymal stem cell injections delay knee osteoarthritis progression through hepatocyte growth factor secretion in rats

Background Knee osteoarthritis (OA) currently lacks disease-modifying treatments. While autologous mesenchymal stem cell (MSC) transplantation has shown promise, its limitations have led to growing interest in allogeneic MSC therapy. The aim of this study was to clarify the functional role of hepatocyte growth factor (HGF) in the chondroprotective effects of synovial MSCs transplanted under fully major histocompatibility complex (MHC)-mismatched allogeneic conditions in a rat model. Methods Synovial MSCs were isolated from the knees of ACI rats and transfected with either Hgf siRNA or control siRNA. HGF knockdown was confirmed at both the mRNA and protein levels. Chondrogenic capacity was assessed by evaluating the cartilage pellet size after in vitro differentiation. OA was surgically induced in Lewis rats by anterior cruciate ligament transection (ACLT). At one week post-surgery, the rats (n = 20 knees/group) received weekly intra-articular injections of one of the following for 7 weeks: (1) vehicle control (medium alone), (2) control siRNA-treated MSCs, or (3) Hgf siRNA-treated MSCs (1 × 10⁶ cells). At 8 weeks post-injection, cartilage degeneration was evaluated using macroscopic and histological Osteoarthritis Research Society International (OARSI) scoring. Results Transfection with Hgf siRNA reduced Hgf gene expression to 30% of the control levels and significantly decreased HGF protein secretion. HGF knockdown impaired in vitro chondrogenic differentiation, resulting in a reduced cartilage pellet size. In vivo, treatment with control siRNA-treated MSCs significantly delayed OA progression compared to the vehicle group, while Hgf siRNA-treated MSCs demonstrated diminished therapeutic efficacy, indicating reduced chondroprotective effects when HGF secretion was suppressed. Conclusions Synovial MSCs derived from ACI rats effectively delayed OA progression in Lewis rats despite the full MHC mismatch. HGF secretion played a critical role in mediating these chondroprotective effects. These findings highlight HGF as a key therapeutic effector in MSC-based treatment of OA under immunologically mismatched allogeneic conditions.

Optimized NCFET-based approximate multiplier for energy-aware image applications

Abstract Applications for multimedia at high speeds has driven the need for error-resilient circuits that trade-off with accuracy while enhancing performance. However, the challenges posed by CMOS scaling are significant, and they have steered VLSI engineers towards exploring beyond-CMOS technology, Negative Capacitance FETs (NCFETs) with a sense of urgency. Enhancing the performance of multipliers is essential, as they are key components in various applications, including image processing and advanced learning algorithms. With the benefits of approximate computing for reducing the energy consumption of applications where exactness is not a requirement while simplifying the design of the circuits. The work here develops highly efficient approximate 4:2 compressors and multiplier circuits, representing core elements in approximate computing systems. This study introduces an innovative 8*8 approximate multiplier based on a 45nm Verilog-A NCFET technology model. It features a cutting-edge 4:2 compressor engineered for exceptional energy efficiency. By operating at a remarkably low voltage of 0.5V, the multiplier significantly reduces power consumption and energy usage compared to existing architectures. Our simulation results are compelling: the 4:2 compressor consumes just 0.122aJ of energy with NCFET technology, far outperforming alternatives like 31.67aJ, 10.49aJ, 172.75aJ in 45nm CMOS technology at 1V, which the proposed work outperforms them despite operating at half the voltage. Moreover, we have successfully realised an 8*8 approximate multiplier incorporating these compressors for image multiplication using MATLAB. The proposed design shows substantial improvements in PSNR and MSSIM and surpasses leading approximate accuracy and energy efficiency multipliers.

Impact of circadian rhythm preference on performance in China’s standardized residency training: The mediating role of loneliness

Objective This study aimed to clarify how circadian rhythm preference influences academic performance within the evolving framework of standardized residency training in China, where research on residents’ psychological adaptation and social support remains limited. The main objective was to explore the relationship between individual chronotypes and standardized training performance, as well as the potential mediating effect of loneliness levels. Methods Basic information of residents who completed standardized training at the First Affiliated Hospital of Soochow University was retrospectively collected, including baseline information such as gender, place of study, and program type. Participants’ chronotypes and loneliness levels were evaluated using the Morningness-Eveningness Questionnaire-Self-Assessment and the University of California, Los Angeles Loneliness Scale. We then explored the relationships among chronotype, loneliness level, and academic performance using generalized linear modeling and mediation analysis. Results A total of 198 participants who had completed their residency training were included, among whom 93 (47.0%) achieved relatively higher final scores. After adjusting for confounding factors, the generalized linear models revealed significant associations between MEQ-SA scale (OR: 0.811, 95% CI: 0.770–0.855, p < 0.001), UCLA Loneliness scale (OR: 1.793, 95% CI: 1.076–1.323, p = 0.001), and the standardized training grades. Furthermore, mediation analysis indicated that loneliness level acted as a mediator in the association between chronotypes and training achievements (mediating role = 55.66%). Conclusion Unlike adolescents, residents in standardized training with an evening chronotype achieved higher final grades. Notably, loneliness significantly mediated this relationship, challenging conventional views on social isolation and learning. These findings underscore the need for further research to clarify underlying mechanisms and potential interventions in medical training.

A high isolated, high gain millimeter wave quad-port MIMO antenna array for wideband 5G new radio application

Special histological subtypes of breast cancer in a Hispanic Latino population

Introduction Special histologic subtypes of breast cancer have a unique biological behavior and outcomes. The literature has demonstrated that histologic and phenotype subclassification of breast cancer varies according to race and populations. Our aim was to describe the clinicopathological characteristics and outcomes of breast cancer with special histological subtypes in a Latin/Hispanic population. Methods A retrospective study was conducted. We reviewed the medical records of patients newly diagnosed with special histological subtypes of breast cancer at a single tertiary reference cancer center in Peru from 2014 to 2019. Results A total of 479 patients were included, the median age at diagnosis was 55 years (range 26–89). The majority of patients were from a metropolitan area (59.1%). The most common histological subtype was lobular (34.9%), followed by mucinous (12.7%), papillary (12.5%), apocrine (6.9%), metaplastic (5.4%), medullary (3.8%), cribriform (3.3%), neuroendocrine (0.8%), and 9.2% mixed histology. 61.6% had a moderately differentiated grade. The most common phenotype at diagnosis was HR + HER2- (57.7%), followed by triple-negative breast cancer (TNBC)(13.2%), showing a similar pattern after neoadjuvant therapy (NAT); HR + HER- (61.7%), and TNBC (16.3%). At diagnosis most patients were stage T2 (40.3%), N0 (61.0%) and stage II (40.7%); while after NAT, stage I (64.7%) was the most common. In regard to NAT, 45.9% received chemotherapy, 31.5% hormone therapy, 15.7% trastuzumab, and 5.8% radiotherapy. The majority underwent mastectomy (71.4%). In relation to adjuvant treatment, 72.7% received chemotherapy, 74.1% hormone therapy, 9.4% trastuzumab, and 76.4% radiotherapy. Loco-regional and distant recurrence occurred in 4.2% and 12.7%, respectively. With a median follow-up of 97 months (8 years), the overall survival (OS) at 5 years was 82%, with patients with cribriform histology presenting the best rate (100%) compared to the worst observed in patients with metaplastic histology (54%). Conclusions The most frequent special histologic subtypes of breast cancer in Latino-Hispanic patients were lobular, mucinous, papillary, metaplastic, and apocrine carcinomas. Patients were diagnosed at more advanced stages and more frequently presented a TNBC phenotype compared to the non-Hispanic White population. Certain histological subtypes in our population presented worse OS rates.

Exploring entropy measures in polymer graphs using logarithmic regression model

Abstract Graph Entropies, calculated from indices, quantify the structural information of chemical linkages and graphs using Shannon’s Entropy notion. This study investigates the chemical structures of polyester and polycarbonate polymers. Polyesters are synthetic polymers consisting of repeating chemical units linked by covalent bonds formed through ester groups. They are versatile materials found in a wide range of everyday products. In contrast, polycarbonates are thermoplastic polymers characterized by carbonate groups. Renowned for their strength and toughness, polycarbonates are widely used in engineering applications. In this study, we compute the Zagreb indices, redefined Zagreb indices, atom-bond connectivity index, and geometric-arithmetic index for polymer structures using edge partitioning based on degrees. Furthermore, we calculate Entropy measures for these structures using Shannon’s Entropy notion. Through numerical computations, we compare the topological indices with their corresponding Entropy measures. Finally, we employ a regression model to analyze the relationship between these topological indices and Entropy metrics.

Comparison of diagnostic algorithms used in guidelines on nutritional anaemias in adults

Background Anaemia is highly prevalent and commonly caused by nutritional deficiencies. Guidelines often include an algorithm to find the underlying cause. Here, we compared diagnostic algorithms and suggested laboratory tests for anaemia in clinical practice guidelines in countries with similar healthcare systems, focusing on iron, vitamin B12 and folate deficiency in the general adult population. Methods We searched for diagnostic guidelines on anaemia in the Trip, Guidelines International Network and country specific databases. To be selected, the guidelines had to include diagnostic criteria or algorithms to determine the cause of anaemia in the general adult population. Results In total, 14 records were included. For iron deficiency anaemia, guidelines varied in diagnostic criteria ranging from use of ferritin only, to ferritin in various combinations with a variety of other parameters, with different cut-off values. For vitamin B12 or folate deficiency, besides measurement of vitamin B12 or folate, some guidelines mentioned methylmalonic acid or homocysteine. Quality of evidence underlying cut-offs and parameters was variable, and laboratory aspects were underrepresented. Conclusions There was a lot of variation in the included diagnostic algorithms, especially for iron deficiency anaemia. Differences in cut-off values were seen, even when using similar diagnostic strategies. Furthermore, supporting evidence was variable. Further research is needed to determine optimal algorithms. Our findings highlight the need for inclusion of relevant laboratory aspects in guidelines, appropriate diagnostics and clinical decision limits.

Association between triglyceride-glucose index and myocardial injury in patients with heat stroke: an observational, retrospective study

Low systemic vascular resistance with normal blood pressure: Do we need vasopressors?

Background Vasoplegia is defined by systemic vascular resistance (SVR) < 800 dynes·s/cm5, cardiac index (CI) > 2.2 L/min/m2, and hypotension, and is associated with poor outcomes. Maintaining adequate blood pressure with vasopressors is considered essential in these cases. However, some patients exhibit low SVR and high CI while maintaining normal blood pressure, and the benefits of vasopressor use in this population have not been studied. Methods This study utilized the Medical Information Mart for Intensive Care-IV (MIMIC-IV) database and included intensive care unit (ICU) patients who met the criteria for vasoplegic status, defined as SVR < 800 dynes·s/cm5, CI > 2.2 L/min/m2, and mean arterial pressure (MAP) ≥ 60 mmHg. The primary outcome was kidney deterioration, and the secondary outcome was prolonged ICU stay (defined as > 3 days). Firth’s logistic regression was used to analyze associations. Subgroup analyses and interaction term p-values were also assessed to evaluate the modifying effects of relevant variables on the relationship between vasopressor use and the outcomes. Results Among 319 patients, 6.0% experienced kidney deterioration, and 24.1% had a prolonged ICU stay. Vasopressor use was not significantly associated with kidney deterioration (odds ratio [OR]: 2.96 [0.33–29.81], p = 0.321); however, it was significantly associated with prolonged ICU stay (OR: 4.71 [2.15–10.77], p < 0.001). Sensitivity analyses confirmed these findings across vasopressor types. Subgroup analysis showed that vasopressor use was associated with a higher risk of prolonged ICU stay in patients without congestive heart failure, without heart surgery, and without chronic kidney disease. Conclusions In patients with low SVR and normal blood pressure, vasopressor use was associated with longer ICU stays but not kidney protection.

Application of machine learning models for predicting depression among older adults with non-communicable diseases in India

Patterns and impacts of patient migration for primary knee arthroplasty in China: A national retrospective study

Objective The phenomenon of interregional patient migration for primary knee arthroplasty (KA) appeared due to unbalanced distribution of medical resources. However, there is a paucity of literature about migration among patients receiving primary KA and the possible influence of migration on postoperative outcomes and financial burden. This study was aimed to investigate the characteristics of patient migration for KA in China and evaluate the related impacts. Methods Primary KAs performed between 2013 and 2018 were retrieved from the Hospital Quality Monitoring System in China. Cross-province (i.e., 31 provinces of mainland China) attendance for KA was assessed. Propensity score-matched analysis was conducted to evaluate the effect of migration on postoperative outcomes and financial burden. Results A total of 168,693 primary KA patients were included during the study period. The migration rate decreased from 17.6% in 2013 to 7.6% in 2018 (P < 0.001). Migration occurred more frequently in patients with fewer comorbidities. Migrating patients tended to choose provincial hospitals and hospitals with high procedure volumes. Beijing and Shanghai were the most preferred destinations. After matching, there were no significant differences in in-hospital mortality, pulmonary embolism, deep vein thrombosis, wound infection, or 30-day readmission between two groups. The migration group had much higher total hospital charges. Conclusion A noticeable number of patients required cross-province migration to get access to KA. Migration didn’t make a big difference but caused a greater financial burden. It is imperative to take initiatives to reduce disparities in resource allocation instead of relying on cross-district access.

Interactive digital twins enabling responsible extended reality applications

Healthcare providers’ experiences and recommendations for antiretroviral therapy adherence in Ghana: A facility-based phenomenological study

Background In Ghana, poor treatment adherence among persons living with HIV (PLHIV) affects the effective treatment and management of HIV/AIDS. A key limitation in addressing the antiretroviral therapy (ART) adherence challenge is the skewed nature of the existing literature on the topic, as much of the research on ART adherence has focused on patient-reported experiences, failing to capture the perspectives of healthcare providers involved in ART delivery. Objective We ascertained healthcare providers’ perspectives on ART adherence among PLHIV and their proffered recommendations for improved ART retention in the Volta Region of Ghana. Methods A total of eighteen healthcare providers offering ART services to PLHIV in the Volta Region of Ghana were purposefully recruited from five HIV sentinel sites and interviewed. The data was thematically analyzed using ATLAS.ti. Results The health workers’ experiences were categorized under seven thematic areas. These included difficulties in accessing healthcare providers, improvements in adherence to treatment, people who have interrupted treatment often being new clients, general improvements in health outcomes, financial challenges, persistent stigmatization, and varied levels of family awareness about clients’ status. The reasons for treatment interruption were categorized into fifteen areas. These factors included appointment intervals, healthcare workers, medication shortages, long waiting times, clients’ distance from the facility, forgetfulness, drug characteristics, financial challenges, stigmatization, drug side effects, lack of donor support, alternative treatment choices, misconceptions about HIV cures, and the location of the ART clinic within the health facility. Participants recommended making health facilities/ART sites accessible to communities, increased advocacy on HIV by PLHIV, extended appointment intervals, continuous availability of antiretroviral drugs (ARVs), community support in the treatment of HIV, improved counseling, public education on HIV to reduce stigmatization, government support, home dispensing of ARVs, regulating the activities of traditional herbalists and faith-based healers, and the encouragement of religious bodies in ART adherence education for improved ART uptake. The ART-related challenges identified by the healthcare providers should be addressed by both the Ghana Health Service and the Ghana AIDS Commission to improve ART uptake and adherence in the Volta Region and across the country if Ghana is to end the HIV pandemic by 2030, as set by UNAIDS.

Bacterial nanocellulose-based hydrogel from Bacillus subtilis W7 for a sustainable adsorption of tetracycline from wastewater

Unveiling the full picture of malnutrition in Sub-Saharan Africa: The extended composite index of anthropometric failure among children under-5 in the SDG era

Introduction The burden of malnutrition among children under-5 in Sub-Saharan Africa (SSA) remains a significant public health concern. Traditional indices such as stunting, wasting, and underweight often failing to capture the overlapping and multifaceted nature of malnutrition. The Extended Composite Index of Anthropometric Failure (ECIAF) offers a comprehensive measure by integrating stunting, wasting, underweight and obese/overweight addressing the overlap and co-occurrence of different forms of malnutrition conditions, thus providing a more accurate depiction of nutritional deficiencies. Aligning with the Sustainable Development Goals, the ECIAF serves as a robust tool for health policymakers and public health practitioners to identify high-risk populations, allocate resources effectively, and improve health outcomes for young children in this region. This study aimed to determine the pooled prevalence of the Extended Composite Index of Anthropometric Failure and to identify its associated factors among children under-5 in SSA countries. Methods This study is a secondary data analysis of nationally representative community-based cross-sectional Demographic and Health Surveys (DHS) conducted in Sub-Saharan African countries, including a weighted sample of 176,141 children under-5 years. The recent demographic and health survey of 26 Sub-Saharan African countries were involved in this analysis. A multilevel binary logistic regression model was fitted to identify factors associated with ECIAF in children under-5 years old. The AOR with its 95% CI was estimated, and a level of significance of 0.05 was used to determine the significant factors of ECIAF. Results The pooled prevalence of ECIAF among children under-5 was 36% (95% CI: 33%, 40%) in Sub-Saharan Africa. Key factors associated with increased odds of ECIAF included: increasing child age (6–23 months [AOR = 1.56; 95% CI: 1.46, 1.66] & 24–59 months [AOR = 2.03; 95% CI: 1.88–2.19]), multiple births [AOR = 2.38; 95% CI: 2.05–2.76], reducing birth size (average [AOR = 1.20; 95% CI: 1.14, 1.26] & small [AOR = 1.80; 95% CI: 1.68–1.93]), having comorbidity [AOR = 1.12; 95% CI: 1.07, 1.16], reducing level of mother’s educational status (primary [AOR = 1.20; 95% CI: 1.12, 1.28] & no formal education [AOR = 1.36; 95% CI: 1.27, 1.45]), increasing number of children under-5 in the household (2 children [AOR = 1.17; 95% CI: 1.10, 1.23] & 3–5 children [AOR = 1.14; 95% CI: 1.06, 1.22]), reducing household wealth status (rich [AOR = 1.28; 95% CI: 1.17, 1.41], middle [AOR = 1.31; 95% CI: 1.19, 1.44], poor [AOR = 1.42; 95% CI: 1.28, 1.56] & poorest [AOR = 1.45; 95% CI: 1.31, 1.61]), living in rural area [AOR = 1.15; 95% CI: 1.09, 1.22]. Protective factors included female sex [AOR = 0.69; 95% CI: 0.66–0.72], birth interval >24 months [AOR = 0.86; 95% CI: 0.81, 0.91] health facility delivery [AOR = 0.79; 95% CI: 0.74–0.83], and antenatal care attendance [AOR = 0.83; 95% CI: 0.77–0.90]. Conclusions The pooled prevalence of ECIAF in children under-5 was high in Sub-Saharan Africa. Addressing this burden requires scaling up nutrition-sensitive interventions that tackle underlying determinants of child malnutrition, including poverty reduction, women’s education and empowerment, improved access to quality health services, safe water, sanitation, and hygiene programs. Such multisectoral strategies, alongside maternal and child health interventions, are essential to mitigate the identified risk factors and sustainably reduce ECIAF in the region.

Analysis of optic neuritis risk in patients with allergic diseases

Incidence and prevalence of neurodevelopmental disorders and disabilities among métis children in Alberta, Canada: A retrospective birth cohort study

Limited research has examined the neurodevelopmental health of Métis children from a functional perspective, which is essential for culturally sensitive service planning, and policy development. This population-based retrospective birth cohort study linked provincial administrative health data of Métis and non-Métis singleton live births (2006–2016) to follow them up to 10 years of age. A random 1:4 sample of non-Métis children served as a reference group. Neurodevelopmental disorders and disabilities (NDD/D) were examined across six functional NDD/D domains. Prevalence odds ratios (pOR) with 95% confidence intervals (CI) were calculated using logistic regression models, adjusted for maternal and neonatal characteristics. Incidence rates (IR) per 1,000 person-years were estimated, and age-specific IR was modeled using longitudinal Poisson regression, adjusting for covariates. Associations between maternal and neonatal characteristics and NDD/D incidence among Métis children were examined using multivariable longitudinal Poisson regression models, with adjusted incidence rate ratios (IRR) and 95% CI reported. A total of 38,958 singleton live births were included (7,853 Métis and 31,105 non-Métis). Overall NDD/D prevalence among Métis (3.3%) and non-Métis (2.8%) children did not differ significantly after adjustment (adjusted pOR: 1.1, 95% CI: 0.9, 1.3). Learning-cognition was the most prevalent NDD/D domain. Métis children had a higher IR of NDD/D at age 2 (5.5 vs. 2.8 cases per 1,000 person-years, rate difference: 2.7 [95% CI: 0.8, 4.6]). Among Métis children, higher NDD/D incidence was associated with maternal age younger than 20 or older than 35 years, high pre-pregnancy weight, male sex, preterm birth, and congenital anomalies. While overall NDD/D prevalence was similar between Métis and non-Métis children, Métis children were more likely to be diagnosed at age 2, suggesting potential differences in early diagnosis, access to care, or underlying risk factors. A functional classification approach of neurodevelopmental health supports culturally responsive early screening and intervention strategies to address these differences.