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Health insurance enrollment and maternal health service utilization using Ghana Demographic and Health Survey, 2022

Background Maternal health services utilization is essential in the reduction of maternal mortality. Despite the implementation of a national health insurance scheme in 2003, Ghana still reports universal health coverage service index below the global average. This study investigates the association between health insurance coverage and maternal health service utilization. Methods This study utilized data from the Ghana Demographic and Health Survey (GDHS) conducted in 2022. The independent variable of the study was health insurance coverage, and the outcome variable was maternal health service utilization by assessing indicators including the timing of the first ANC visit, completing the recommended number of ANC visits, skilled birth attendance, facility-based delivery, and post-natal care. The data was analyzed for both descriptive statistics and logistic regression. Results The study sample consisted of 4303 women of reproductive age who had live births within the past 5 years of the survey. Health insurance coverage is associated with the likely odds of post-natal care (aOR 1.56; 1.15–2.12). Counterintuitively, women who were insured were less likely to give birth in a health facility (aOR 0.59; 0.45–0.78) in the presence of a skilled birth attendant (aOR 0.70; 0.57–0.86). Conclusion This study shows that while health insurance coverage can boost maternal health service utilization, the implementation mechanisms of these policies play a more critical role. Addressing challenges like out-of-pocket payments for insured individuals is essential to enhance service utilization under the policy.

Mysterious link between Earth’s magnetism and oxygen levels baffles scientists

Study on static and dynamic performance of aircraft maintenance hangar under multiple load combinations

To analyze the collaborative work performance of the roof structure and the lower support structure for the aircraft maintenance hangar, a numerical model of a single-span aircraft maintenance hangar is established to study the static and dynamic mechanical responses under various load combinations. Results show that the primary axial force and bending moment responses are concentrated in the main truss and the lower support column. The maximum compression occurs at the upper section of the two main trusses, while the maximum tension appears at the mid-span of the lower inner truss near the hangar gate. The displacement of the main truss exceeds that of the secondary truss, with the roof’s mid-span displacement being greater than that at the edges. The maximum support reactions occur at the main truss support column, the secondary truss column of the rear gable wall, and the lateral bracing between double-angle steel columns. The first three vibration modes and frequencies are highly susceptible to excitation and contribute significantly to the structure’s seismic response. This study provides critical theoretical support for the design of large-span aircraft maintenance hangars. The findings can guide optimized design strategies to enhance structural safety and efficiency, contributing to advancements in long-span hangar construction and maintenance practices.

Bioremediation of complex organic pollutants by engineered Vibrio natriegens

Informal employment, population health, and welfare policies: A global empirical analysis between 2011–2021

Despite informal employment being the most common type of employment globally, the empirical link between informality and health is underexplored. Using time-series, cross sectional data from the International Labor Organization (ILO) on informal employment for roughly 126 countries between 2011–2021, this study applies OLS regression to explore how informality associates with population health, measured as healthy life expectancy (HALE), maternal mortality, under-five mortality, equality of access to health care, and mortality due to communicable diseases and maternal and prenatal undernutrition. We also address whether this relationship is conditioned by the availability of higher quality welfare state. The results show that informality associates with a host of measures of poor health, controlling for important confounders, but it associates weakly positively with HALE. Contrary to expectations, an accessible welfare state does not condition informality in ways that lower the health burden. Our results are possibly not causal but subject to endogeneity bias since bad health conditions could lead to increased welfare policies. Longer time series of informal employment data is needed for further assessment. The basic results, however, point to a connection between the size of the informal workforce and diminished population health, controlling for important confounders.

Why pangolins are poached: they’re the tastiest animal around

Cyclodextrin glycosyltransferase immobilization on functionalized graphene nanoplatelets for enhanced cyclodextrin production

Immobilization of enzyme on functionalized nanomaterials offers a promising strategy for enhancing enzyme stability, reusability, and activity in a variety of industrial applications. In this study, graphene nanoplatelets (GNPs) were functionalized with ethanolamine, 3-aminopropyltrimethoxysilane (APTMS), and 3-mercaptopropyltrimethoxysilane (MPTMS) to provide an efficient support for cyclodextrin glycosyltransferase (CGTase) immobilization. Thermogravimetric analysis (TGA) verified the successful incorporation of functional groups, including amine and thiol groups, and ethanolamine-functionalized GNPs showing the highest grafting levels. The maximum starch conversions observed with the functionalized supports were 21% for APTMS-functionalized GNP, 11% for ethanolamine-functionalized GNP and 7% for MPTMS-functionalized GNP. After 16 hours of continuous operation, ethanolamine- and APTMS-functionalized GNP retained 94% of their initial activity, while MPTMS-functionalized GNP maintained 86% residual activity at the end of the operation. Production rate of cyclodextrin reached 171 mg/g/hr for GNP-Ethanolamine, 185 mg/g/hr for GNP-APTMS and 90 mg/g/hr for GNP-MPTMS per gram of immobilized CGTase. This study showed that functionalized GNP exhibited better catalytic performance and good stability during cyclodextrin synthesis, hence, they demonstrate strong potential for developing commercial biocatalyst, paving the way for further advancements in using GNP-based supports in CGTase immobilization.

Global, regional, and national burden of leukemia: Epidemiological trends analysis from 1990 to 2021

Background: Leukemia is a prevalent form of cancer that encompasses four primary subtypes, posing significant health risks. Gaining insights into the global epidemiology of leukemia and its subtypes is crucial for effective resource allocation, clinical guidance, and scientific inquiry. Methods: From 1990 to 2021, we analyzed age-standardized rates (ASR) trends across 204 countries and territories, utilizing the estimated annual percentage change (EAPC). Results: In 2021, there were approximately 460,000 leukemia cases, 320,000 deaths, and 10.98 million disability-adjusted life years (DALYs). Globally, age-standardized incidence rates (ASIR), mortality rates (ASMR), and DALY rates are on the decline, while age-standardized prevalence rates (ASPR) are rising in high social demographic index (SDI) regions. Men experience a higher leukemia burden compared to women. By subtype, acute myeloid leukemia (AML), chronic myeloid leukemia (CML), and chronic lymphocytic leukemia (CLL) predominantly impact older individuals, while acute lymphoblastic leukemia (ALL) primarily affects children. Notably, leukemia ASIR and ASDR reductions are observed in countries with high human development index (HDI). Conclusion: Although there has been a marked decrease in global leukemia incidence, mortality, and DALYs over the past 31 years, the rise in new cases due to population growth suggests an increasing overall disease burden by 2050. Furthermore, the impact of leukemia varies significantly by region and country, highlighting the urgent need for innovative and personalized prevention and treatment approaches to mitigate this global health issue.

Prevalence and incidence of primary autoimmune hemolytic anemia and cold agglutinin disease in the United States, 2016–2023

Background and aims Autoimmune hemolytic anemia (AIHA) and cold agglutinin disease (CAD) are debilitating conditions characterized by chronic hemolysis and severe anemia. The existing epidemiological estimates in the United States (US) remain limited because of the rarity of AIHA and CAD. This retrospective study aims to update the epidemiology of AIHA and CAD in the US from 2016 to 2023 by separately analyzing administrative claims data from Optum’s de-identified Clinformatics® Data Mart (Optum CDM), Inovalon’s Medical Outcomes Research for Effectiveness and Economics (MORE2) Registry, and Medicare Fee for Service (FFS). Methods The study consisted of patients aged ≥18 years with 180 days of continuous enrollment in their health plan. The index date was the first observed claim with AIHA or CAD ICD-9/10 diagnosis codes. The 2016–2021 US Census data were used to standardize incidence and prevalence estimates by age and sex. The results were presented by the US states. Results The AIHA incidence ranged from 1.4 to 6.6 per 100,000 persons across the databases. The CAD incidence ranged from 0.6 to 1.2 per 100,000 persons across the databases, with Medicare FFS estimates being the highest. Prevalence estimates also varied, with the AIHA 1-year prevalence ranging from 4.2 to 20.6 per 100,000 persons and CAD from 1.4 to 3.1 per 100,000 persons across the databases. Conclusion This multi-database analysis provides the updated epidemiological estimates of AIHA and CAD in the US, showing a higher incidence and prevalence in females than males, with both conditions increasing with age. However, no clear geographic pattern emerged across the US.

Tiny human hearts grown in pig embryos for the first time

Multi-site validation of an interpretable model to analyze breast masses

An external validation of IAIA-BL—a deep-learning based, inherently interpretable breast lesion malignancy prediction model—was performed on two patient populations: 207 women ages 31 to 96, (425 mammograms) from iCAD, and 58 women (104 mammograms) from Emory University. This is the first external validation of an inherently interpretable, deep learning-based lesion classification model. IAIA-BL and black-box baseline models had lower mass margin classification performance on the external datasets than the internal dataset as measured by AUC. These losses correlated with a smaller reduction in malignancy classification performance, though AUC 95% confidence intervals overlapped for all sites. However, interpretability, as measured by model activation on relevant portions of the lesion, was maintained across all populations. Together, these results show that model interpretability can generalize even when performance does not.

Barriers to referral uptake from primary to secondary eye care in the L V Prasad Eye Institute Network in South India

Purpose To investigate the barriers preventing referral uptake from primary care vision centres (VC) to higher level secondary centres (SC) in rural South India. Methodology This is a cross-sectional study conducted using data from 10 VCs surrounding an SC in Thoodukurthy village, Mahabubnagar district, Telangana, India. The study included 2,508 participants who received primary eye care at the VCs and referred to SC between July 1st to December 31st, 2019, and from July 1st to December 31st, 2020 respectively. Of these,1930 (76.9%) participants were available for the study. Participants were categorized as compliant if they visited the SC within one year of referral. Non-compliance was defined as failing to do so within that time. Interviews were conducted with non-compliant participants to understand their reasons for not seeking further care. Results Among the 1930 participants 1507 (78%) were interviewed; 938 (62.2%) were compliant, and 569 (37.8%) were non-compliant. The mean age was 54.64 years (SD:14.28 years) and 716 (47.5%) were female. Multivariable analysis showed participants not referred for teleophthalmology (OR:1.41,95%CI:1.00–1.99), unmarried participants (OR:1.32,95%CI:1.02–1.71) and participants without formal education (OR:1.44,95%CI:1.09–1.90) were more likely to be non-compliant. Participants living further from VCs (OR:0.98,95%CI: 0.98–0.99) had better compliance. The major barriers were attitudinal (60.5%), economic (12.1%) and other medical or Health-related barriers (9.3%). Conclusion The primary barriers to referral uptake were related to attitudes, economics, and medical. Participants not referred to teleophthalmology, unmarried, those without formal education, and those lived closer to VCs were more likely to be non-compliant. Addressing these barriers could improve the utilization of higher-level care services in this rural population.

Assessing the reliability of abdominal adiposity measurements by transabdominal ultrasound in first trimester pregnancies with sonographers of varying experience levels

Objective Given the growing evidence linking increased abdominal adiposity in early pregnancy to a higher risk of developing gestational diabetes mellitus (GDM), this study aims to evaluate the reliability of the sonographic measurements of abdominal adiposity during the first trimester of pregnancy, comparing the performance of sonographers with varying levels of experience. Methods A cross-sectional study was conducted on singleton Asian pregnant women with gestational ages between 11 and 14 weeks. Transabdominal ultrasound measurements of abdominal adiposity were performed by three sonographers with different experience levels, including measurements of subcutaneous fat thickness (SFT), visceral fat thickness (VFT), and preperitoneal fat thickness (PFT) using three techniques. Intra- and interobserver reliability were assessed using intraclass correlation coefficient (ICC) with a 95% confidence interval. Spearman pairwise correlation coefficients were used to analyze the correlation between maternal body composition and the sonographic measurements of abdominal adiposity. Result Ninety pregnant women participated. The overall ICCs indicated excellent intraobserver reliability for all parameters, with VFT measurement showing slightly lower reliability for less experienced operators. Interobserver reliability was excellent for all measurements except VFT, which showed good reliability between the most and least experienced operators. VFT correlated significantly with maternal waist-to-hip ratio (WHR). Conclusion Sonographic measurements of abdominal adiposity during the first trimester show high reliability, particularly when performed by experienced sonographers. Notably, VFT measurement displayed a significant positive correlation with maternal WHR, highlighting its potential as an indicator of central adiposity.

Trends of long-term opioid therapy and subsequent discontinuation among people with chronic non-cancer pain in UK primary care: A retrospective cohort study

Objectives To examine trends of opioid use, focusing on long-term opioid therapy (L-TOT) and its discontinuation among people with chronic non-cancer pain (CNCP). Design and setting Retrospective cohort study using UK Clinical Practice Research Datalink Aurum data. Population Incident opioid users (no opioid use in the prior year) with CNCP between 01/01/2009–31/12/2019. Among them, we identified L-TOT users (≥3 opioid prescriptions within 90 days, or total ≥90 supply days within the first year, excluding the initial 30 days) and L-TOT discontinuers (no opioid use for ≥180 days following a L-TOT). Main outcome measures Yearly rates of incident opioid users (over CPRD-registered patients), L-TOT users (over incident opioid users), and L-TOT discontinuers (over L-TOT users) were calculated. Annual counts of each group were fitted using segmented negative binomial regression models with an offset considering their corresponding denominators from 2009 to 2019, excluding 2014 due to policy changes in that year. Results Among 2,839,161 incident opioid users, 11.4% (n = 324,877) transitioned into L-TOT users within one year, of which 4.8% (n = 15,484) discontinued. Between 2009–2013, rates of L-TOT users significantly declined by 2.6% (incidence rate ratio: 0.974; 95% confidence interval: 0.971 to 0.978) per annum, followed by a significant step change in 2015 (1.026, 1.009 to1.044), and a significant annual increase of 2.4% (1.024, 1.019 to 1.029) from 2015 to 2019, compared to the 2009–2013 trend. The annual rates of L-TOT discontinuers remained stable from 2009 to 2013 (0.987, 0.971 to 1.002), followed by a non-significant step change (0.990, 0.916 to 1.070) in 2015, and a significant decrease in slope by 2.6% (0.974, 0.951 to 0.998) per annum during 2015–2019, relative to 2009–2013. Conclusions L-TOT has plateaued since 2015, accompanied with an accelerated decrease in discontinuation rates, suggesting ongoing reliance on opioids for CNCP management, despite increased awareness regarding L-TOT associated risks. This is likely due to the limited availability of other effective pharmacological options and non-pharmacological alternatives, and challenges in their accessibility.

Knowledge and stigma of autism spectrum disorders in Chinese university students in the context of inclusive education

This study investigated knowledge of autism spectrum disorder and associated stigma among Chinese university students, utilizing the cross-culturally validated Chinese version of the Autism Stigma and Knowledge Questionnaire. A total of 2,081 students from 25 provinces participated in an online survey. Independent-samples t -tests and one-way ANOVAs revealed that female students, upper-grade students, normal-education students, special education majors, and those who had completed inclusive education courses demonstrated significantly higher levels of ASD knowledge and lower levels of stigma. Prior interactions with autistic people were also associated with greater understanding of ASD and more accepting attitudes. These findings emphasize the significance of incorporating autism-related content into both general and special education curricula, fostering high-quality interactions with autistic communities, and critically considering the types of knowledge that most effectively mitigate stigma. As inclusive education reforms progress in China, enhancing professional training and awareness of neurodiversity will be crucial for preparing future educators to establish inclusive and supportive learning environments.

Sustained delivery of functional vascular endothelial growth factor from nanoporous silica nanoparticles into a fibrin gel

The unsolved major issue of large-scale tissue engineering scaffolds is insufficient initial vascularization. The lack of oxygen and nutrient supply for migrating cells inevitably leads to cell death and subsequently to implant failure. One approach to resolve this problem is the development of pre-vascularized tissue constructs. Following this idea, the installation of micro-vessels within a fibrin scaffold is a promising approach. To induce the formation of these micro-vessels a long-term release of vascular endothelial growth factor (VEGF), which is a key player in endothelial growth, is necessary. As drug carriers, nanoporous silica nanoparticles (NPSNPs) were chosen and loaded with VEGF by the interaction with grafted amino groups. Physicochemical characterization (TEM, XRD, N2 physisorption, zeta potential, and thermogravimetric analysis) revealed nanoparticles with approximately 44 nm in diameter, pore sizes of 3 nm, and a successful amino modification of the surface. The recorded release profiles showed a possible long-term release of up to 100 days. With adapted loading concentrations for in vitro testing, the released doses were applied within an in vitro 2D sandwich tube assay with endothelial cells and compared to repeatedly given doses of VEGF in solution. The VEGF released from the NPSNPs led to an equal tube formation, which qualifies them as an effective tool for VEGF delivery inside large-scale tissue constructs that cannot be reached from the outside.

Splinting in horizontal root fractures: A Bayesian network meta-analysis

Objective This study aims to evaluate which splinting method offers the most favorable prognosis in cases of dental trauma involving horizontal intra-alveolar root fractures. Materials and methods Search strategies were adapted for seven electronic databases and gray literature to identify studies evaluating the prognosis of horizontal intra-alveolar root fractures based on the type of splint used. The risk of bias in the included studies was assessed using the Joanna Briggs Institute Critical Appraisal tools. A Bayesian network meta-analysis was conducted. Results A total of 3,174 references were retrieved, of which six studies met the inclusion criteria. No significant differences were found between the types of splints used and the healing outcomes of horizontally fractured intra-alveolar roots, including comparisons to cases without fixation. Across all studies, the degree of fragment displacement was a key factor influencing healing: the less displacement, the better the prognosis. Other treatment-related variables analyzed by the authors also played a role in determining tooth prognosis. Conclusions There may be no difference regarding the type of splint used when considering the healing of horizontal intra-alveolar root fractures; however, other factors may have influenced this outcome. Clinical Relevance Understanding the fracture characteristics and the type of splinting intervention employed is essential for ensuring appropriate treatment in such cases.

Barriers to cataract surgeries as perceived by visually impaired 50 years and older cataract blind participants of Nepal survey for rapid assessment of avoidable blindness

Purpose To identify the main barriers and determinants to cataract surgery as perceived by 50 years and older Nepali people with severe visual impairment & blind due to cataracts. Methods This was part of the Rapid Assessment for Avoidable Blindness (RAAB), held in all provinces of Nepal from 2018 to 2021. Cataract blindness was defined as a person having the best-corrected vision, < 6/60 in the better eye, and an unoperated cataract, which was the principal cause of visual disability. The participants were interviewed using a pretested questionnaire with seven known barriers. The demographic information was correlated with the barrier score. Results We surveyed 718 cataract blind. Two-thirds of the participants were females. Four in ten were aged 50–59 years. The main barriers perceived were ’need is not felt’ (237; 33%), cost associated with surgery (218; 30%), lack of access (93; 13%), fear of surgery (88; 12%), nobody to accompany (40; 6%), unaware of surgery (18; 3%), and treatment denied (24; 3%). The barriers were not significantly different in females than in males. (P = 0.85). The provincial variations of barriers were significant. (P < 0.001). High cost was a perceived barrier in all provinces except Gandaki. Access to treatment was a barrier in the Gandaki province (38%). One in four participants in the Madhesh and Bagmati provinces feared surgery. Nearly half of the cataract blind in the Madhesh and Lumbini province did not feel ‘need for restoring vision’. Conclusions To improve cataract surgery uptake, identified barriers, like lack of awareness, low visual need, and high cost must be addressed. The strategies could be devised according to provincial barriers but similar to both genders and all 50 years and older cataract blind. Offering low-cost cataract surgery, financial assistance and health promotion to improve awareness and remove fear were recommended.

How you breathe is like a fingerprint that can identify you

Using computer-generated protein models to analyze mutations linked to Amelogenesis Imperfecta

Amelogenesis Imperfecta (AI) is a disorder of tooth development caused by mutations in genes involved in several stages of tooth enamel formation. Few proteins involved in tooth development or developmental anomalies are explored in detail. Knowledge of 3D protein structure is essential to studying protein function. However, crystallized complete protein structures related to teeth and oral development are rare in the Protein Data Bank. Computational approaches for automated protein structure prediction have become a popular alternative for generating protein 3D structures. In this study, we aimed to explore the potential of using computer-generated protein models to analyze mutations linked to AI. We took a systematic approach to identify, screen, and analyze AI-linked protein variants. Proteins with AI-linked mutations were identified from the NCBI and OMIM databases, followed by screening of sequences for intrinsically disordered regions (IDRs). The iterative threading assembly refinement (I-TASSER) server was used to generate homology models for the wildtype and mutant proteins. PyMOL was used to analyze and compare the 3D structures of the proteins. Nineteen human genes with AI-associated mutations were identified from NCBI and OMIM. We identified multiple AI-associated protein variants with structural differences compared to their wildtype form. The current evidence aligns with several of the structural alterations identified in our study. Our findings suggest the potential of utilizing computer-generated protein models to investigate disease-associated mutations. However, careful consideration of models, templates, and alignments over the regions of interest is necessary to predict any potential structural impact of a disease-causing protein variant.