Browse Articles

Unintended coastal transformation from small-scale infrastructure and land use change

Abstract This study investigates the impact of small-scale coastal development on beach material changes along the Ban Khlong Wan (BKW) coastline in the Mid-Gulf of Thailand, a site of legal disputes between local communities and government agencies over environmental impacts. We applied shoreline change analysis, high-resolution LiDAR observations, beach material characterization, and land use change assessment to understand the causes of beach transformation. Contrary to prior reports attributing the transition from sandy to muddy conditions to coastal protection structures, our findings reveal the coastline remained predominantly sandy until 2002, with shoreline shifts averaging less than ± 1 m/year. The construction of a fishery pier and hard structures (2004–2008) disrupted longshore sediment transport, leading to sand accumulation updrift and sediment deficits downdrift. This, combined with increased muddy inputs from upstream land use change, particularly the conversion of 100 ha of natural wetland into aquaculture ponds, contributed to mudflat formation. While detached breakwaters and seawalls aided in shoreline stabilization, they were not the primary cause of the transformation. Rather, the shift from alongshore sandy to riverine muddy sediment supply was the key driver. These findings highlight the need for integrated coastal management that considers the interactions between infrastructure, sediment processes, and land use change to mitigate degradation and support sustainable development of small-scale coastal projects.

Global burden of NAFLD 1990–2021 and projections to 2035: Results from the Global Burden of Disease study 2021

Background Non-alcoholic fatty liver disease (NAFLD) is the most common chronic liver disease. The global burden of NAFLD is increasing. This study used the Global Burden of Disease (GBD) 2021 study data to assess the burden and development trends of NAFLD from 1990 to 2021. Methods The incidence, prevalence, death and disability-adjusted life years (DALYs) rates of NAFLD in geographic populations worldwide from 1990 to 2021 were extracted from the GBD 2021 study data. The global temporal trend of NAFLD from 1990 to 2021 was evaluated using estimated annual percentage change and age-standardized rate. The Bayesian age-period-cohort model was used to predict NAFLD burden future trends to 2035. Results The global age standardized incidence rate (ASIR) of NAFLD among the all-age population increased by 25% and the age standardized prevalence rate (ASPR) increased by 24%. The age standardized mortality rate (ASMR) and age standardized DALYs rate (ASDR) were relatively stable. Countries with middle socio-demographic index (SDI) had the highest ASIR and ASPR from 1990 to 2021, high-middle SDI and high SDI had the lowest ASMR and ASDR. North Africa and Middle East had the highest ASIR and ASPR in 2021, ASIR increased at the greatest rate in East Asia and Western Europe, ASPR increased at the greatest rate in Western Europe. In 2021, the highest number of incidence cases and incidence rates were in 20–24 years group, reflecting a tendency towards a younger onset of NAFLD. Conclusions The global burden of NAFLD has risen steadily from 1990 to 2021, and projections to 2035, placing enormous pressure on society. It is necessary to implement measures targeting risk factors such as high fasting plasma glucose and tobacco, including improving lifestyle, adjusting diet, and applying drug intervention.

Enhancing formation resistivity factor estimation in carbonate reservoirs using electrical zone indicator and multi-resolution graph-based clustering methods

Association of COVID-19 stimulus receipt and spending with family health

In this study, we aimed to determine the impact of U.S. government stimulus payments on family health during the COVID-19 pandemic. We hypothesized that receiving stimulus checks is associated with better family health and the effect of stimulus check receipt differs by income level. Additionally, we hypothesized that spending on immediate needs and paying off loans is associated with worse family health, and the effects of this spending differ by income level. Participants included 456 registered Amazon Mechanical Turk (mTurk) users, stratified by income, marital status, and parental status. We used the Family Health Scale – Long Form to measure family health constructs: social-emotional health, healthy lifestyle, health resources, and social support. For all statistical analyses, we used SAS Studio 3.8. We performed an exploratory factor analysis to determine six spending profiles: loans, savings, housing, household supplies, durable goods, and medical costs. After adjustment, our multiple linear regression model found that mean family health and social-emotional health scores were higher among individuals who received all three checks, but this did not differ by income category. Mean family health and social-emotional health were lower among individuals who spent more significant portions of their stimulus checks on housing, household supplies, and medical costs. Spending greater portions of checks on medical costs was associated with lower scores among every family health construct except family healthy lifestyle. Among mid-to-high-income participants, family health scores were significantly lower, with more spending on housing, household supplies, durable goods, and medical costs, with similar results in the subscale scores. The reduction of family health scores with spending on medical costs and durable goods were more pronounced among the mid-to-high-income group than the low-income group. Stimulus payments may be a promising family policy method for improving overall family health; however, more research should address the differences between income groups and government assistance.

Idiopathic intracranial hypertension without papilledema in chronic migraineurs and revisiting of friedman’s diagnostic criteria

Abstract The application of Friedman’s criteria to diagnose suggested IIH WOP will prevent many chronic patients with migraine (CM) from proper diagnosis and treatment. Our prospective study aimed to compare the prevalence of suggested IIH WOP in case of following Friedman’s criteria and in case of novel proposed criteria (OP > 200 mmH2O and radiological finding ≥ two), also reporting the predictive radiological signs for IIH WOP. Refractory chronic patients with migraine underwent ophthalmologic, neurological evaluation, MRI, and a lumbar puncture (LP) with opening pressure (OP) measurement. CSF withdrawal was performed in patients with CSF OP > 200 mmH20. Suggested IIHWOP was defined according to Friedman’s criteria and our novel criteria. Regression analysis was performed to detect the strongest predictor of suggested IIHWOP. The effect of CSF withdrawal was evaluated clinically after two months. One hundred and two consecutive CM were enrolled (95 F, age 32.34 ± 9.45, and BMI 29.04 ± 5.89) without papilledema. Eighteen patients (17.65%) had OP greater than 250 mmH2O, and 20 patients (19.61%) with OP ≥ 200 mmH2O and ≤ 250 mH2O. Prevalence of suggested IIH WOP, according to Friedman’s diagnostic criteria, was three patients (2.9%) only. In case of our novel diagnostic criteria (Absent 6th nerve palsy, ICP > 200 mmH2O, and ≥ two radiological signs), eight patients (7.8%) were discovered. After CSF withdrawal, 85% of patients with migraine with OP > 200 mm H2O improved, specially CM with bilateral Transverse sinus stenosis (TSS). The prevalence of suggested IIH WOP in CM was 7.8%. Bilateral TSS was the only predictor of IIHWOP.

Multiplex nodal modularity: A novel network metric for the regional analysis of amnestic mild cognitive impairment during a working memory binding task

Modularity is a well-established concept for assessing community structures in various single and multi-layer networks, including those in biological and social domains. Brain networks are known to exhibit community structure at a variety of scales—local, meso, and global scale. However, modularity, while useful in describing mesoscale brain organization, is limited as a metric to a global scale describing the overall strength of community structure. This approach, while valuable, overlooks important variations in community structure at node level. To address this limitation, we extended modularity to individual nodes. This novel measure of nodal modularity (nQ) captures both mesoscale and local-scale changes in modularity. We hypothesized that nQ would illuminate granular changes in the brain due to diseases such as Alzheimer’s disease (AD), which are known to disrupt the brain’s modular structure. We explored nQ in multiplex networks of a visual short-term memory binding task in fMRI and DTI data in the early stages of AD. While limited by sample size, changes in nQ for individual regions of interest (ROIs) in our fMRI networks were predominantly observed in visual, limbic, and paralimbic systems in the brain, aligning with known AD trajectories and linked to amyloid-β and tau deposition. Furthermore, observed changes in white-matter microstructure in our DTI networks in parietal and frontal regions may compliment studies of white-matter integrity in poor memory binders. Additionally, nQ clearly differentiated MCI from MCI converters indicating that nQ may be sensitive to this key turning point of AD. Our findings demonstrate the utility of nQ as a measure of localized group structure, providing novel insights into task and disease-related variability at the node level. Given the widespread application of modularity as a global measure, nQ represents a significant advancement, providing a granular measure of network organization applicable to a wide range of disciplines.

Genome-wide identification of the cytochrome P450 superfamily in Trichoplusia ni and in-silico expression of resistance against HDAC inhibitors

Downhill running regulates cardiac immune response through GCN2

Downhill running (DR) has recently emerged as a promising exercise modality for cardiac rehabilitation, but the effect and mechanism of DR on myocardium remains unclear. General control nonderepressible 2 (GCN2), an eukaryotic initiation factor 2α (eIF2α) kinase, is beneficial to the heart when it is deficiency. The current study aimed to explore whether the GCN2 is associated with cardioprotective effects in downhill running. Eight-week-old male wild type (WT) mice and GCN2 knock out (KO) mice were randomly divided into WT control (n = 6), WT exercise(n = 5), GCN2 KO control(n = 5), and GCN2 KO exercise(n = 5) groups. Mice in the exercise groups were subjected to a single session of downhill running treadmill exercise training. In WT mice, DR increased the proportion of basophils, decreased the percentage of lymphocytes in the blood, and decreased the expression of GCN2, Ifn-γ, Tgf-βr1 and immune cell markers in the myocardium. Compared with WT mice, GCN2 KO mice decreased the proportion of monocytes and neutrophils in the blood, decreased expression of Ifn-γ, Tgf-βr1 and immune cell markers, and increased expression of Il-12α in the myocardium. In GCN2 KO mice, DR increased the expression of immune cell markers in the myocardium. DR and GCN2 KO both reduced TGF-β1 expression, and elevated p-eif2a expression in the myocardium. This finding demonstrated that downhill running alters inflammation and immune response in the myocardium, which is associated with GCN2.

RSM optimization and morphological investigation of bismuth ferrite for photodegradation of organic pollutant under visible light

Relationship between baseline platelet-to-red blood cell distribution width ratio and all-cause mortality in non-traumatic subarachnoid hemorrhage: A retrospective analysis of the MIMIC-IV database

Objective The study aimed to evaluate the relationship between baseline platelet-to-red blood cell distribution width ratio (PRR) and mortality in critically ill patients with non-traumatic subarachnoid hemorrhage (SAH). Methods This cohort study of adults with non-traumatic SAH used Medical Information Mart for Intensive Care (MIMIC-IV) data from 2008–2022 admissions at the Intensive Care Unit (ICU). We collected the PRR levels at admission and determined the all-cause death rates for the ICU and hospital. Cox proportional hazards models were utilized to analyze the association between baseline PRR level and all-cause mortality. Kaplan–Meier survival curve analysis was used to examine the consistency of these correlations. Restricted Cubic Splines (RCS) analysis was used to determine the relationship curve between all-cause mortality and PRR level and examine the threshold saturation effect. To evaluate the consistency of correlations, interaction and subgroup analyses were also conducted. Results A total of 1056 patients with non-traumatic SAH were included in this study. All-cause mortalities in the ICU and hospital were 14.8% (156/1056) and 18.6% (196/1056), respectively. Compared to individuals with lower PRR Q1(≤12.67), the adjusted HR values in Q2 (12.68–15.99), Q3 (16.00–19.41), and Q4 (≥19.42) were 0.61 (95%CI:0.40–0.92, p = 0.017), 0.60 (95%CI: 0.39–0.92, p = 0.020), and 0.60 (95% CI:0.39–0.93, p = 0.019), respectively. Kaplan–Meier analysis showed that patients with low PRR levels had significantly higher ICU and in-hospital mortality (p < 0.001). The association between the PRR level and ICU and in-hospital mortality exhibited a non-linear relationship (p < 0.05). The threshold breakpoint value of 22.6 was calculated using RCS analysis. When the PRR level was lower than 22.6, the risk of ICU and in-hospital mortality rates decreased with an HR of 0.91 (95%CI: 0.88–0.94, p < 0.001) and 0.94 (95%CI: 0.92–0.96, p < 0.001), respectively. When the PRR level was higher than 22.6, the risk of ICU mortality (HR = 1.03, 95% CI: 0.97–1.10, p = 0.312) and in-hospital mortality (HR = 1.01, 95%CI: 0.95–1.08, p = 0.693) almost hardly increased with the increase in the PRR level. The interaction between the PRR and all subgroup factors was analyzed, and significant interactions were not observed. Conclusion There was a non-linear connection between the baseline PRR level and in-hospital mortality. A low level of PRR could increase the risk of death in participants with non-traumatic SAH.

Cross-lingual effects of AI-generated content on human work

Abstract Artificial intelligence (AI) technologies, especially large language models (LLMs), have permeated human work around the globe, but how effective is workers’ usage and application of AI-generated content across language settings? This research examines the quality of (1) AI-generated business recommendations in English, Arabic, and Chinese and (2) business emails written by human participants in those languages. In Study 1, trained evaluators rated the quality of AI-generated content. Study 2 is a randomized experiment in which 480 human participants (160 in each language setting) wrote emails to address business issues, with or without the help of AI-generated content. Trained evaluators then rated the quality of those emails. This research finds that the AI-generated responses were of lower quality in Arabic and Chinese than in English. Importantly, human participants’ usage of AI-generated contentin email-writing was associated with less actionable and less creative work output in Arabic and Chinese than in English. Non-English participants were particularly disadvantaged when dealing with more technical work tasks (e.g., tasks related to scientific discovery or product design). These findings underscore the need for more language-inclusive LLMs to support workers worldwide, as current technologies may inadvertently widen the productivity gap between English and non-English speakers, particularly in more technical domains.

A multi-criteria decision-making framework for managing the safety of marine recreational powered platforms: Integration with the SHELL model

The rise of marine recreational activities has led to a growing use of marine recreational powered platforms, raising safety concerns related to navigation. In Taiwan, the current regulatory system for such platforms remains fragmented and under debate. This study aims to support policy development by identifying key safety management priorities. This study utilized the four core components of the SHELL model, which include Software, Hardware, Environment, and Liveware, as the analytical foundation and identified 20 preliminary safety criteria through an extensive review of relevant literature. A Modified Delphi Method and DEMATEL analysis were applied to gather expert insights and prioritize 10 representative indicators. The resulting Influence Network Relation Map revealed that “Comprehensive Management Regulations” had the highest causal influence across all dimensions. Additionally, “Basic Navigation Concepts” and “Emergency Response and Safety Knowledge” were found to be the most central elements. Based on these findings, the study recommends targeted measures including enhanced regulation, improved training, radar monitoring, and spatial planning to reduce navigation risks and promote safer marine recreation. Building on the above findings, this study confirms the effectiveness of an innovative integration of the SHELL model and the DEMATEL method, which provides a structured and adaptive framework capable of systematically identifying systemic navigational risks in marine recreational activities.

Domain general noise reduction for time series signals with Noisereduce

Structural disorder and distinctive motifs in the C-terminal region of the MADS-domain transcription factors are conserved across diverse taxa

Plants have acquired the ability to adapt and respond to varying environmental conditions through modifications in their developmental programs. This adaptability relies on the plant’s capacity to sense environmental cues and respond via diverse signal transduction pathways and transcriptional regulation. Transcription factors are central in these processes, orchestrating specific gene expression in both developmental and stress responses. In Arabidopsis thaliana, 91% of transcription factors contain large intrinsically disordered regions (IDRs). The structural flexibility in these regions is critical in protein-protein interactions and contributes to functional versatility across different cell types. MADS-domain transcription factors constitute an eukaryotic protein family involved in a diversity of developmental processes and stress responses. Using bioinformatic tools, we found that most Arabidopsis MADS-domain proteins contain IDRs (≥30 residues) in their C-terminal region, with a higher proportion of global disorder in Type II compared to Type I MADS-domain proteins. Remarkably orthologous proteins from non-plant species in the Eukarya domain (Drosophila melanogaster, Saccharomyces cerevisiae, and Homo sapiens) also present disordered C-terminal regions, containing longer IDRs than those found in Arabidopsis, or other analyzed plant species. Additionally, conserved motifs were identified within the C-terminal IDRs of Arabidopsis Type I and Type II MADS-domain proteins, suggesting interactions with co-regulatory partners. We also identified putative activation domains in the C-terminal region of Type I and Type II MADS-domain proteins. The involvement of IDRs in selecting co-regulators is further supported by the identification of Molecular Recognition Features (MoRFs) in Type II MADS-domain proteins. The conserved structural disorder in the C-terminal region of MADS-domain proteins, which includes specific motifs, across diverse domains of life provides valuable insights into their structural properties and mechanisms of action as transcriptional regulators.

Overburden structure fracture evolution and ground pressure behavior under oblique residual coal pillars in thick seam mining

Abstract This study investigates the complex overburden fracture movements and mining pressure evolution induced by obliquely arranged lower-slice extraction passing through residual upper-slice coal pillars in split-level fully mechanized top coal caving of extremely thick coal seams. Through integrated physical simulation, FLAC3D numerical analysis, and field monitoring, the instability mechanisms of residual pillars and their impact on strata behavior were elucidated. The internal and external fields and the evolution characteristics of the overlying strata and structure in the inclined and lower-slice working faces, respectively, were determined. Key findings include: (1) lower-slice extraction induced large-scale overburden collapse through residual pillar instability, with progressive roof structure evolution. (2) When the working face was within 15 m of the section pillar, the maximum vertical stress reached 46.7 MPa (9.9% increase), with significant pillar deformation. When the working face was below the section pillar, a crescent-shaped stress-distribution pattern was observed. (3) Varying obliquely intersecting position between the lower-slice face and the overlying pillar generated a quasi-symmetric trapezoidal fracture pattern. Structural dynamic instability induced an evolutionary sequence of asymmetric double-arch, symmetric double-arch, and single-arch internal-collapse configurations. These findings help extract extremely thick coal seams safely using the split-level fully mechanised top coal caving method.

Development of a consensus-based core outcome set for post-treatment recovery in adults with epilepsy and comorbid depression or anxiety: A Delphi and ICF-guided protocol

Introduction Up to 50% of adult patients with epilepsy experience comorbid depression or anxiety, complicating post-treatment recovery and requiring tailored outcome assessment. No core outcome set (COS) exists for this dual-diagnosis population, unlike broader epilepsy COSs or quality-of-life COSs for drug-resistant epilepsy, which do not prioritize mental health comorbidities. This protocol outlines the development of a standardized COS to evaluate post-treatment recovery in adults with epilepsy and comorbid depression or anxiety, using the International Classification of Functioning, Disability, and Health (ICF) framework to ensure a biopsychosocial perspective. This COS aims to enhance cross-study comparability and inform personalized care for this underserved group. Methods and analysis This study will employ a three-phase process: (1) A systematic review of outcomes in epilepsy with comorbid depression or anxiety in adult patients, searching PubMed, Embase, and Cochrane Library per Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, including outcomes such as seizure control, mood stability, cognitive function, social reintegration, and suicide-related outcomes; (2) Mapping outcomes to ICF domains (body functions, activities, participation) for comprehensive coverage; and (3) A three-round Delphi survey using a 9-point Likert scale to achieve consensus among an international panel of ≥60 stakeholders, including neurologists, psychiatrists, psychologists, patients, and caregivers, with ≥20% from low- and middle-income countries. Consensus requires ≥70% agreement on scores of 7–9 (critically important) and ≤15% on 1–3 (low importance). The COS will capture domains like seizure control, mood stability, cognitive function, and social reintegration. Discussion This COS will address a critical gap by standardizing outcome measurement for adults with epilepsy and mental health comorbidities, complementing broader COSs, such as the Epilepsy Outcome Set for Effectiveness Trials (EPSET), by focusing on mental health recovery, including suicide-related outcomes, and extending quality-of-life-focused sets, such as those using the Quality of Life in Epilepsy (QOLIE) scales, to include neurological and functional outcomes. The ICF-guided, patient-inclusive approach ensures global relevance. Potential limitations, including stakeholder bias, will be mitigated through diverse recruitment and robust consensus methods. Conclusion This protocol leverages Delphi methodology and ICF principles to develop a novel COS for a complex dual-diagnosis population. By prioritizing mental health recovery in adults, including critical outcomes like suicide prevention, it offers a distinct tool to enhance research and clinical practice, with future validation planned to ensure applicability across settings. PROSPERO registration number CRD42024576141

How big data analytics improves hospital environmental performance through supply chain innovation, decision quality, and risk taking

A 6-month, prospective randomized controlled trial of the TargetEd MAnageMent (TEAM) intervention vs. enhanced treatment as usual among Ugandans at risk for stroke

Background Among low and middle-income countries, especially in Sub-Saharan Africa, the stroke burden is severe, with increasing trends in stroke incidence, prevalence, and mortality. Aims This 6-month, prospective randomized controlled trial (RCT) compared a novel stroke risk reduction approach (TargetEd manAgeMent Intervention (TEAM)) vs. Enhanced Treatment as Usual (ETAU) in 247 Ugandans at risk for stroke. Methods Participants, enrolled across 3 Ugandan sites, were adults with high stroke risk. The primary outcome was a change in systolic blood pressure (SBP) from baseline to 6-month follow-up. Secondary outcomes included changes from baseline to 6 months on diastolic BP (DBP), serum lipids, glycosylated hemoglobin (HbA1c), self-efficacy and stress. Results The mean sample age was 55.4 (±SD = 12.0) with majority being women (n = 168, 68%). In addition to hypertension, the most common risk factors were hyperlipidemia (n = 199, 80.6%) and obesity (n = 98, 39.7%). Overall mean SBP and DBP at baseline were 143.0 (SD = 19.8, range 94.5–206) and 89.3 (SD = 14.0, range 61–136) respectively. In TEAM, SBP significantly improved from 145.7 (±21.5) at baseline to137.4 (±18.1) at 6-months vs. change from 141.9 (±18.4) to 141.1 (±21.9) for ETAU (p = 0.031). There were similar reductions in DBP favoring TEAM (p = .012). Compared to ETAU, TEAM showed improved physical activity (p = .017), self-efficacy (p < .001) and stress (p = .014). Conclusions There is a need for effective and practical approaches to reduce stroke burden in Sub-Saharan Africa. Inclusion of the TEAM approach in primary care seems to be a pragmatic and effective way to potentially reduce stroke burden in Uganda. Trial registration ClinicalTrials.gov identifier: NCT04685408, registered on 28 December 2020.

Influence of selected cognitive performances on musculoskeletal injury occurrence in adult male professional Slovenian PrvaLiga football players in a prospective cohort study

Abstract Evidence suggests athletes with lower baseline cognitive performance are at higher risk of musculoskeletal injuries. This prospective cohort study investigates basic and executive cognitive functions in predicting injuries in 78 professional male football (soccer) players from four Slovenian first league teams. Data were collected during the 2018/2019 winter break, and injuries recorded in the second half of that and the 2019/2020 season. Cognitive functions assessed by computerized tests (PsyToolkit) included psychomotor vigilance (simple, choice reaction time) and visuospatial memory (Corsi-block-tapping-test), while pen-and-paper tests assessed motor speed, visual scanning, and executive functions (TMT; Delis-Kaplan-Executive-Function-System). Forty-two players sustained at least one musculoskeletal injury (9 contact injuries), 36 remained injury-free. Logistic regression analyses indicated that none of the cognitive measures significantly influenced injury occurrence (p > 0.05). However, non-significant trends were observed for the TMT ratio score (p = 0.065, OR = 1.64), reflecting cognitive flexibility, and for TMT-A (p = 0.05, OR = 0.60), reflecting visual scanning. Specifically, players with lower cognitive flexibility showed a 64% increase in the odds of sustaining an injury, while better visual scanning performance was associated with a 40% reduction in injury odds. No significant association was found between basic or executive cognitive functions and musculoskeletal injuries in professional male football players. However, a non-significant trend suggested that lower cognitive flexibility may be associated with increased injury risk. These findings underscore the need for larger studies to better clarify the role of executive functions in assessing injury risk in football.

Assessing ITN textile preferences: A comparative study of polyethylene and polyester nets across different settings in Burkina Faso

Insecticide-treated nets (ITNs) are crucial for preventing malaria and other vector-borne diseases, effectively reducing transmission and mortality rates. However, their uptake remains low, influenced by textile preferences, with polyester nets being favored for comfort, despite their shorter lifespan compared to other materials. A study in Burkina Faso aimed to understand community preferences for ITN fabrics across different environmental contexts to improve malaria control strategies. Using a mixed-methods approach, the study surveyed and interviewed urban and rural communities in three climatic zones of Burkina Faso to identify socio-economic, environmental, and cultural factors shaping ITN material preferences. The study found that 95.2% (95% CI: 94.6–95.7) of participants had a preference for a specific ITN fabric, with 93% (95% CI: 92.3-93.6) favoring polyester over polyethylene, citing superior comfort, breathability, and protection. Regional differences emerged, with rural areas and the Humid savannah-Sahelian zone showing a stronger preference for polyester nets, especially in larger sizes. The study recommended that malaria control programs prioritize polyester-based nets, offer larger sizes for rural populations, use smaller mesh sizes, and adopt rectangular designs to improve coverage and comfort. Urban populations emphasized comfort and efficacy, while rural areas focused more on durability and size. Factors like ease of maintenance, comfort, and local climate were significant in shaping preferences. The study concluded that tailoring ITN distribution strategies to regional needs such as adjusting net size and mesh could improve malaria control efforts. These insights can guide the optimization of malaria prevention programs, enhancing their effectiveness and long-term sustainability in diverse settings.