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Preliminary feasibility and clinical utility of the Unified Protocol for the transdiagnostic treatment of emotional disorders in people with long COVID-19 condition: A single case pilot study

Purpose The implementation of psychological interventions in long COVID-19 patients is still very limited. This study aims to analyze the feasibility and preliminary utility of the Unified Protocol (UP), for the psychological treatment of emotional disorders in long COVID-19 patients. Methods 12 long COVID-19 patients (mean age = 47.92; SD = 13.18) presenting emotional disorders/symptoms received the UP through 8 online sessions. Results All participants completed the UP psychological program, attending all eight sessions and the 6-month follow-up appointment. However, adherence to the assessment protocol was lower, with a 33% dropout rate at the 6-month follow-up. High satisfaction was reported with both the UP program (mean = 9.75) and the online format. Satisfaction with individual UP modules ranged from 7.17 to 9 points (from 0 = any satisfaction to 10 = highest satisfaction). Qualitative feedback emphasized the usefulness of the UP program, with some participants suggesting additional contents (i.e., training in assertive communication skills), more personalized modules (i.e., providing just some UP modules) or increasing the number of sessions. In terms of the UP clinical utility, 25 mental clinical diagnoses were established at pre-assessment; 50% of participants no longer met criteria for a mental clinical diagnosis at post-assessment, increasing to 67% at follow-up. Most therapeutic objectives were achieved or initiated over the course of the intervention (78% at post-assessment; 86% at follow-up). At post-assessment significant improvements were observed in anxiety (8 participants), depression (9 participants), emotion dysregulation (4 participants) and quality of life scores (7 participants), although 2 participants did not maintain these gains in emotion regulation and quality of life at follow-up. Conclusion The promising results of the UP in terms of high participant satisfaction and clinical improvements in anxiety and depression scores suggest that the UP could be a valuable psychological intervention for individuals with long COVID-19 and comorbid emotional disorders. The modest improvements found in other outcomes highlighted the need to better adapt the psychological interventions for long COVID-19 patients.

Potential effect of non-nitrogen fixing cyanobacteria Spirulina platensis on growth promotion of wheat (Triticum aestivum L.) under salt stress

Abstract Numerous microalgae have been used as modern eco-friendly biostimulants under abiotic stress conditions; however, the application of non-nitrogen fixing cyanobacteria, such as Spirulina (Arthrospira platensis) has not been extensively investigated. In this study, the effects of A. platensis (60 mg/L) applied twice as a foliar application on the growth, photosynthetic pigments, and oxidative metabolism of Triticum aestivum seedlings grown under salt stress (150 mM) were evaluated. Under salt stress conditions, growth attributes such as shoot and roots fresh weights, lengths, and photosynthetic pigments were significantly inhibited compared to the control group. Treatment with A. platensis effectively improved all growth parameters. Under salt stress conditions, shoot fresh weight and length increased by 49% and 44%, respectively, while root fresh weight and length were enhanced by 105% and 223%. The contents of chlorophyll a, b, and carotenoids in wheat were significantly reduced by 57%, 35%, and 43%, respectively. Additionally, seedlings exposed to salinity showed improved accumulation of hydrogen peroxide (H2O2) and malondialdehyde (MDA), along with decreased peroxidase (POD) enzyme activity. Spirulina extract (SPE) mitigated salt and induced oxidative stress by enhancing the activities of antioxidant enzymes. Furthermore, SPE protected wheat seedlings from the detrimental effects of H2O2 by promoting secondary metabolite biosynthesis. Additionally, SPE increased the proline content by 25%, aiding in the regulation of osmotic stress. Taken together, the results of this study support the application of A. platensis as an effective biostimulant for improving wheat growth and food security by reducing the harmful impacts of salt stress in semi-arid regions.

Spatial epidemiology of tuberculosis diagnostic delays, healthcare access disparities, and socioeconomic inequities in Nairobi County, Kenya

Introduction Kenya ranks among the top 30 countries with a high tuberculosis (TB) burden globally. With a TB prevalence of 558 per 100,000, only 46% of TB cases are diagnosed and treated, leaving 54% undiagnosed and at risk of spreading the disease. This study analyzed the spatial distribution of tuberculosis diagnostic delays and their association with health care accessibility and socioeconomic inequalities in Nairobi County, Kenya. Materials and methods The cross-sectional study included 222 newly diagnosed bacteriologically confirmed Mycobacterium tuberculosis (Mtb) patients from Mbagathi County Hospital (MCH), Mama Lucy Kibaki Hospital (MLKH), and Rhodes Chest Clinic (RCC) in Nairobi County, Kenya. Patients were recruited consecutively through census sampling and categorized into two groups: delayed diagnosis (≥21 days from symptom onset) and non-delayed (<21 days) as defined by the WHO cutoff point. Patients’ residential locations were georeferenced using handheld GPS devices and captured digitally via Kobo Collect. Spatial analyses were performed using ArcGIS Pro, version, where Global Moran’s I statistic was used to assess spatial autocorrelation in the distribution of TB cases. Result Spatial analyses identified 28 statistically significant clusters of delayed TB diagnoses within Nairobi County. Spatial autocorrelation analysis using Moran’s I revealed a significant clustered distribution (Moran’s Index = 0.471, z-score = 3.370, p < 0.001). Hotspot analysis with the Getis-Ord Gi* statistic detected high-delay clusters (z > 2.58, p < 0.001) in informal settlements. Discussion and conclusion The study revealed significant spatial clustering of delayed TB diagnoses in Nairobi County, particularly in informal settlements. In contrast, timely diagnoses were predominantly clustered in high-income areas like Lang’ata and Karen. These clusters were significantly associated with lower household income and increased travel time to health facilities which underscored the need for targeted implementation of TB diagnostic services and control measures in the wards with the highest delays.

Advanced dynamic ensemble framework with explainability driven insights for precision brain tumor classification across datasets

Relationship between stress hyperglycemia ratio of one-year mortality in patients with heart failure: Analysis of the MIMIC-IV database

Background Stress Hyperglycemia Ratio (SHR) has been confirmed to be a predictor for adverse outcomes in cardiovascular diseases in recent years. However, the impact of SHR on one-year mortality in patients diagnosed with heart failure (HF) is still unclear. This study aims to explore the relationship between SHR and one-year mortality in HF patients, both complicated with and without diabetes mellitus (DM). Methods This study enrolled 3747 patients with HF from the Medical Information Mart for Intensive Care (MIMIC-IV) database. 1865 patients were set into the group of lower SHR (SHR < 0.964) and 1882 patients were in the higher group (SHR ≥ 0.964). The primary endpoint was one-year mortality. Results The mean age of the total study population was 69 ± 13, and 1530 (40.8%) of them were female. Finally, 188 (5.0%) patients died in the hospital and 766 (20.4%) patients died during a one-year follow-up. Patients in the higher SHR group had a longer hospital stay (2.7% vs. 2.4%, p < 0.001) and higher in-hospital mortality (8 vs. 7, p < 0.001) than those in the lower group. The Kaplan–Meier curves also show that higher SHR is associated with an elevated risk of one-year mortality in patients with HF, both in the DM and non-DM groups (all log-rank p < 0.0001). As a continuous variable, SHR was an independent predictor for one-year mortality [hazard ratio (HR), 2.893; 95% confidence interval (CI), 2.198–3.808]. Elevated SHR was significantly associated with higher risk of one-year mortality in patients with (HR, 1.499; 95% CI, 1.104–2.036) and without DM (HR, 1.300; 95% CI, 1.096–1.542), consistently. The RCS curve shows a gradual increase in the probability of one-year mortality as the value of SHR increases for HF patients. Conclusion Our findings indicated that a higher level of SHR was associated with elevated one-year mortality in HF patients both with and without DM, suggesting that SHR is a promising stratification indicator for predicting the risk of death in patients with HF.

Utilization of telemedicine in healthcare delivery to lesbian, gay, bisexual, transgender, queer, intersex, asexual, other sexual and gender minority (LGBTQIA+) populations: a scoping review

Frailty trajectory and its associated factors in older patients undergoing abdominal surgery involving the digestive system: A longitudinal study

Frailty is a common multifactorial clinical syndrome in older patients that seriously affects their prognosis. However, most studies to date have ignored the dynamics of frailty. Therefore, we employed a one-month observational longitudinal study to explore frailty trajectories using a latent class growth model. In total, 155 older patients who underwent abdominal surgery involving the digestive system were assessed preoperatively, at discharge, and at the one-month follow-up, and multiple logistic regression analysis was conducted to identify factors influencing frailty trajectories. Four frailty trajectory patterns were identified: no frailty (13.5%), frailty exacerbation (40.0%), frailty improvement (20.0%), and persistent frailty (26.5%). Logistic regression analysis revealed that body mass index, the Charlson comorbidity index score, the type of surgery, the intraoperative drainage tube retention time (drainage time), the first time the patient got out of bed after surgery, the time of the first oral feed after surgery, postoperative complications, mobility, nutritional risk, and anxiety were associated with frailty trajectories. We identified four frailty trajectories in older patients undergoing abdominal surgery involving the digestive system and found that these trajectories were influenced by multiple factors. Focusing on individual specificity is conducive to accurately addressing frailty-associated clinical problems and guiding relevant nursing decisions.

Accelerated wound healing through tannin-rich Jaft extract, concentration-dependent efficacy and mechanistic insights from Quercus brantii ointment formulations

Spatial distribution and factors associated with coexisting undernutrition among under-five children in Ethiopia: Evidence from the 2019 Mini-Demographic and Health Survey

Background Undernutrition remains a critical public health issue in Ethiopia, driving high under-five morbidity and mortality. Coexisting forms; stunting, wasting, and underweight magnify these risks but their spatial patterns and determinants remain poorly understood. This study investigates the geographic distribution and key factors of coexisting undernutrition among Ethiopian children under five to inform targeted, geographic-specific interventions. Methods We conducted a secondary data analysis of the 2019 Ethiopia Mini Demographic and Health Survey (EMDHS), including a weighted sample of 4,952 children under five years of age. Spatial analysis was employed to explore the geographic distribution of coexisting forms of undernutrition, and significant spatial clusters were identified using SaTScan version 10. To examine associated factors, a multilevel binary logistic regression model was fitted. Variables with a p-value < 0.2 in the bivariable analysis were included in the multivariable model. Effect measures were reported using Adjusted Odds Ratios (AORs) with 95% Confidence Intervals (CIs). Results The national prevalence of coexisting forms of undernutrition among children under five in Ethiopia was 19.6% (95% CI: 18.5,20.7), with marked regional disparities ranging from 5.2% in Addis Ababa to 30.7% in the Afar region. Spatial analysis identified a significant high-risk cluster spanning Afar, Amhara, Tigray, Benishangul-Gumuz, and northern Somali regions (Log-Likelihood Ratio [LLR] = 38.83, p < 0.001), indicating pronounced geographic heterogeneity. Maternal education at primary (AOR = 0.81, 95% CI: 0.68, 0.98), secondary (AOR = 0.53, 95% CI: 0.37, 0.77), and higher levels (AOR = 0.29, 95% CI: 0.17, 0.51), higher household wealth (richer: AOR = 0.68, 95% CI: 0.50, 0.92; richest: AOR = 0.53, 95% CI: 0.35, 0.80), and female sex (AOR = 0.80, 95% CI: 0.69, 0.92). Conversely, multiple births (AOR = 2.06, 95% CI: 1.33, 3.18) and residing in communities with high poverty levels (AOR = 1.44, 95% CI: 1.11, 1.87) significantly increased the risk of coexisting undernutrition. Conclusion Significant geographic disparities in coexisting undernutrition among Ethiopian children under five highlight urgent hotspots in Afar, Amhara, Tigray, Benishangul, and northern Somali regions. Protective factors such as maternal education, household wealth, and female sex, while multiple births and poverty were risk factors. These findings highlight the need for geographically targeted interventions focused on hotspot areas, with an emphasis on improving maternal education and alleviating poverty to reduce coexisting forms of undernutrition and enhance child survival.

A comparative analysis of the role of containment policies, vaccination strategies and virus variants in the COVID-19 pandemic across nine European countries

Abstract The COVID-19 pandemic disrupted public health, economies, and societies worldwide, with lasting effects still visible today. Containment policies were implemented to reduce viral transmission, but their effectiveness varied across geographic regions. Understanding the interplay between policies, epidemiological variables, vaccines, and variants is crucial for optimizing future epidemic responses. This study applies a vector autoregressive mixed-effect model to data from nine European countries over the entire pandemic duration, using weekly data to provide both global and country-specific analyses. Policy stringency was assessed using the Oxford Covid-19 Government Response Tracker. Our findings reveal that the relationship between epidemiological indicators and policy stringency evolved over time. Initially, hospitalizations were the primary driver of containment measures, but as vaccinations increased and new variants emerged, new case numbers became an important factor too. While all vaccine doses contributed to reducing cases and hospitalizations, only the second dose was associated with policy stringency. No significant association was found between virus variants and policy measures. Despite small country-specific differences, these insights highlight the complex interdependencies that shaped pandemic management. This framework can support future public health decision-making by balancing epidemiological trends with tailored policy responses at both national and international levels.

Work-related stress and sleep problems among small-scale miners in Ghana: The role of psychological factors

Objectives Sleep problems (SP) are prevalent among small-scale miners, yet little is known about their psychological and occupational determinants. We examined the association between work-related stress (WRS) and SP among small-scale miners in Ghana and explored the mediating roles of anxiety and depression in this association., Methods In this community-based cross-sectional study, data were collected from 664 miners in Obuasi,Ghana. WRS and SP were assessed using the Perceived Stress Scale (PSS-4) and the WHO Disability Assessment Schedule 2.0 (WHODAS 2.0), respectively, while anxiety and depression were measured using the GAD-7 and PHQ-9. Adjusted multivariate regressions and bootstrapped serial mediation models (Hayes’ PROCESS Model 6) evaluated the hypothesized pathways. Results The mean (SD) age was 28.8 (8.2) years, and 84.3% were males. WRS was significantly associated with SP (B = 0.2964, 95% CI = 0.2398–0.3530), with both direct (42.5%) and indirect (57.5%) effects. Anxiety mediated 38.0% of the total effect, depression 11.4%, and the anxiety–depression pathway 8.1%. Conclusions The study findings suggest that anxiety and depression serially mediate the WRS–SP link. These results underscore the need to address occupational stressors and incorporate mental health support into workplace policies to improve sleep quality and overall well-being in this vulnerable workforce.

Network dynamics reveal drought synchronization hubs in the Po River Basin

Abstract The intensifying climate crisis has exacerbated the frequency and severity of prolonged droughts, particularly in environmentally and socio-economically vulnerable climate change hot-spot regions. Despite advancements in monitoring, the spatiotemporal propagation and interdependencies of drought events remain poorly understood. This study analyzes drought synchronization within the Po River Basin, a critical hydrological system contributing approximately 40% of Italy’s GDP. Using the 12-month Standardized Precipitation Index (SPI-12) and complex network methods, we reveal the spatiotemporal dynamics of drought propagation, identifying key hubs and hot-spot regions. Our analysis identifies spatial hubs where droughts originate and terminal zones where impacts converge. This process follows a diffusive propagation mechanism, whereby local events spread through preferential pathways until they are interrupted by seasonal climatic conditions that restore precipitation regime. These findings enhance understanding of drought dynamics in interconnected systems, advancing the application of complex network theory to hydro-climatology. They also provide a foundation for research on societal resilience to climate change and the development of adaptive strategies for sustainable hydrological systems.

RETRACTED: Perennial plants and traditional medicine: Assessing the socio-demographic impacts on traditional remedies

This study assessed the curative uses of wild medicinal plants and investigated the socio-demographic aspects influencing traditional medicinal knowledge in Tehsil Hasilpur, Punjab. Using snowball sampling, data were collected from 300 respondents through interviews and field surveys. Analysis included plant life span, plant parts used, preparation methods, and quantitative indices such as Informant Consensus Factor (ICF), Use Value (UV), and Fidelity Level (FL). The findings revealed that males comprised 85.6% of respondents, reflecting cultural constraints on women’s participation. Traditional knowledge was more prevalent among individuals with primary education (53%) and the illiterate (24%). Perennial species dominated (98.6%), leaves are the most commonly utilized plant part (65.33%), and decoctions are the most popular preparation method (24%). High ICF values indicated strong consensus on plant efficacy, with Eucalyptus globulus exhibiting significant use value. These findings emphasize the impact of gender, education, and occupation on knowledge transfer, as well as the ecological significance of local flora. The study recommends integrating traditional medicinal knowledge into healthcare strategies and promoting collaborative conservation efforts to ensure sustainable use of ethnomedicinal resources.

Experimental characterization of silica gel adsorption and desorption isotherms under varying temperature and relative humidity in a fixed bed reactor

Federated hierarchical MARL for zero-shot cyber defense

Cyber defense systems face increasingly sophisticated threats that rapidly evolve and exploit vulnerabilities in complex environments. Traditional approaches which often rely on centralized monitoring and static rule-based detection, struggle to adapt to new, crafted, and novel attack patterns. This paper presents the Adaptive Zero-Shot Hierarchical Multi-Agent Reinforcement Learning (AZH-MARL) framework, a novel approach that integrates hierarchical reinforcement learning, zero-shot learning capabilities, and federated knowledge sharing to build resilient cyber defense systems. The hierarchical structure decomposes complex defense tasks into specialized sub-tasks managed by agents, reducing the learning problem’s complexity and enabling more efficient coordination. The zero-shot learning component allows the framework to recognize and response to previously unseen attack patterns through semantic mapping. Furthermore, the federated learning learning component facilitates for knowledge sharing across network domains while preserving data privacy, enabling collaborative defense without exposing sensitive information. The detailed evaluation demonstrates that our approach significantly outperforms existing methods across a range of scenarios. It achieves a high detection rate of 94.2% for known attacks and 82.7% for zero-day exploits, while maintaining a low false positive rate of 3.8%. This robust performance extends to the most sophisticated threats, achieving an 87.3% containment rate against Advanced Persistent Threats (APTs). The framework’s zero-shot capability is underpinned by a semantic mapping accuracy of 89.3%, which enables rapid adaptation to novel threats. Consequently, the mean response time is reduced by 35% for known attacks and 42% for zero-day exploits compared to the best-performing baseline. Finally, the federated learning architecture proves highly efficient, reducing communication overhead by 45% while preserving privacy. These results collectively demonstrate our framework’s potential to set a new standard for resilient and adaptive cyber defense in complex, distributed environments.

The significance of glycemic variability in conjunction with lactate metabolism levels in the clinical assessment of neonatal hypoxic-ischemic encephalopathy

Impact of ventilation and ambient temperature on COVID-19 transmission in clinic waiting rooms: A computational fluid dynamics approach

The ongoing COVID-19 pandemic underscores the necessity of understanding the transmission dynamics in enclosed, high-risk environments, such as clinic waiting rooms. This study used computational fluid dynamics (CFD) to investigate the behavior of virus-laden aerosols in clinic waiting rooms under six different scenarios with various temperatures and ventilation setups, offering insights into practical strategies for enhancing safety in healthcare environments. Key findings demonstrated that effective ventilation, through open windows and mechanical systems, can reduce virus-laden aerosol concentrations by up to 99.3% under optimal conditions (e.g., from 5.80 kg/m3 to 0.04 kg/m3By contrast, poorly ventilated scenarios exhibit significantly higher viral concentrations, which can rise as high as 5.80 kg/m3. A novel aspect of this research lies in the comprehensive modeling of human anatomy and aerosol interactions, which enhances the accuracy of viral-trajectory predictions. The practical implications include strategic recommendations for ventilation system design to mitigate transmission risks in clinical settings. These insights provide guidelines for healthcare facility design and emphasize the critical role of environmental control in reducing exposure to airborne pathogens.

Effects of normal stress on shear properties and acoustic emission characteristics of bonded rock-concrete interfaces

Development and validation of an adolescent health literacy scale in Ethiopia: A mixed methods approach

Background Adolescent health literacy (HL) is a significant public health concern, especially in developing countries with predominantly young populations like Ethiopia, as it impacts both their immediate and long-term health outcomes, and consequently, the overall wellbeing of their societies. Since HL is influenced by socio-cultural contexts, a locally developed and validated HL scale is essential for generating quality data and designing effective interventions. However, such a context-specific, validated HL scale for this age group is currently lacking in Ethiopia. This study, therefore, aims to develop and validate an adolescent HL scale tailored to the socio-cultural context of Ethiopia, to support measurement and intervention efforts. Methods This study employed a mixed methods approach, conducted in three stages between March 09, 2023 and January 25, 2024. In the first stage, concepts, categories/dimensions, and items were generated, using in-depth interviews and focus group discussions as data collection methods, to inform scale design, and the scale was subsequently developed based on these elements. The second stage comprised evaluating the scale’s content, cognitive, and usability standards through expert reviews/evaluations, cognitive interviews, and a pilot survey, followed by modifications based on these evaluations. The third stage involved further evaluation of the validity and reliability of the scale on a larger random sample, using confirmatory factor analysis and reliability tests, respectively. Purposive, convenience, and random sampling techniques were employed to select participants. The study was conducted in Afaan Oromo and Amharic languages as per the participants’ preferences. Data analysis was conducted using Atlas.ti (version 7.5.18) and SPSS with AMOS (version 23.0). Results In the first stage of the study, an initial pool of 88 items was generated and then reduced to 40 items following a rigorous review of their coverage and uniqueness. In the second stage, evaluations for content, cognitive, and usability standards further refined the items to 33 covering five dimensions: health information competency, communication, health awareness and knowledge, decision-making and behavior, and citizenship and responsibility. Finally, in the third stage, validity and reliability testing of the 33-item scale yielded strong results. For instance, confirmatory factor analysis produced CFI, TLI, and RMSEA values of 0.976, 0.974, and 0.034, respectively, and reliability testing provided a Cronbach’s alpha of 0.973 for the full scale and 0.850–0.937 for the subscales in the Afaan Oromo version. For the Amharic version, the corresponding values were 0.965, 0.962, and 0.039, with Cronbach’s alpha values of 0.970 for the full scale and 0.783–0.937 for the subscales. Conclusion The study developed and validated an adolescent HL scale, using a mixed methods approach within the socio-cultural context of Ethiopia, addressing a critical gap in this area. This scale is multidimensional, encompassing HL knowledge, skills, abilities, and related attributes or qualities essential for adolescents today. The scale can be adapted and used with populations beyond adolescents and in other contexts in future studies. It is also vital for designing effective strategies aimed at improving HL in adolescents.

Crossover balloon occlusion technique for access closure during transcatheter aortic valve implantation: a multicenter observational study