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Healthcare systems barriers and strategies for pre-exposure prophylaxis utilization amongst young females in Gauteng province: Registered nurse’s perspectives

Background Healthcare system present several barriers impacting on Pre-Exposure Prophylaxis (PrEP) utilization amongst young females. To overcome these barriers, there are strategies that could be employed to improve PrEP performance. Within healthcare system, registered nurses play critical role on PrEP utilization, however their perceptions on barriers and strategies have not been explored and described in this setting. Therefore, this paper aimed at exploring, describing and contextualizing registered nurse’s perceptions on health systems barriers and strategies regarding PrEP utilization amongst young females. Methods Qualitative, explorative, descriptive and contextual method was used to explore and describing registered nurse’s perceptions on healthcare systems barriers and strategies regarding PrEP utilization. Purposively sampled participants for focus group discussions and data was analysed using reflexive thematic analysis. Results Barriers and strategies regarding PrEP utilization were reported as themes which emerged with eight sub-themes. Which included; healthcare system structure, healthcare providers, health promotion and medication barriers and strategies. Healthcare system structural barriers included limited PrEP access, healthcare workers related comprised training, competency and staffing while health promotion included poor awareness, inaccurate PrEP information, HIV-ART related stigma. Pill related barriers were side effects, contraindication and monitoring burden crucial to be addressed to enhance PrEP usage. Moreover, strategies such as increased access, PrEP integration to existing HIV, FP services, Department of Education and training of nurses on PrEP would assist to overcome these barriers. Proactively managing side-effects, increased awareness, using media platforms to disseminate information, quality counselling and three-monthly injectable PrEP for the success of desired utilization amongst young females. Conclusion Findings reported healthcare system structure, healthcare providers, health promotion and medication barriers and strategies affecting utilization of PrEP voiced by registered nurses within focus group discussions.

TIR domains produce histidine-ADPR as an immune signal in bacteria

An improved robust algorithms for fisher discriminant model with high dimensional data

This paper presents an improved robust Fisher discriminant method designed to handle high-dimensional data, particularly in the presence of outliers. Traditional Fisher discriminant methods are sensitive to outliers, which can significantly degrade their performance. To address this issue, we integrate the Minimum Regularized Covariance Determinant (MRCD) algorithm into the Fisher discriminant framework, resulting in the MRCD-Fisher discriminant model. The MRCD algorithm enhances robustness by regularizing the covariance matrix, making it suitable for high-dimensional data where the number of variables exceeds the number of observations. We conduct comparative experiments with other robust discriminant methods, the results demonstrate that the MRCD-Fisher discriminant outperforms these methods in terms of robustness and accuracy, especially when dealing with data contaminated by outliers. The MRCD-Fisher discriminant maintains high data cleanliness and computational stability, making it a reliable choice for high-dimensional data analysis. This study provides a valuable contribution to the field of robust statistical analysis, offering a practical solution for handling complex, outlier-prone datasets.

Ru and W isotope systematics in ocean island basalts reveals core leakage

Abstract The isotopic composition of lavas associated with mantle plumes has previously been interpreted in the light of core–mantle interaction, suggesting that mantle plumes may transport core material to Earth’s surface1–5. However, a definitive fingerprint of Earth’s core in the mantle remains unconfirmed. Precious metals, such as ruthenium (Ru), are highly concentrated in the metallic core but extremely depleted in the silicate mantle. Recently discovered mass-independent Ru isotope variations (ε 100Ru) in ancient rocks show that the Ru isotope composition of accreted material changed during later stages of Earth’s growth6, indicating that the core and mantle must have different Ru isotope compositions. This illustrates the potential of Ru isotopes as a new tracer for core–mantle interaction. Here we report Ru isotope anomalies for ocean island basalts. Basalts from Hawaii have higher ε 100Ru than the ambient mantle. Combined with unradiogenic tungsten (W) isotope ratios, this is diagnostic of a core contribution to their mantle sources. The combined Ru and W isotope systematics of Hawaiian basalts are best explained by simple core entrainment but addition of core-derived oxide minerals at the core–mantle boundary is a possibility.

Making “inclusion” more than a buzzword: A critical interpretive synthesis of literature about recruiting seldom-heard groups in health research

Introduction Seldom-heard’ groups do not experience equitable access, engagement, or benefits from health services and are often underrepresented in research. Methods This paper presents a critical interpretive synthesis (CIS) of the literature. The included articles were those published between 2000 and 2024 in PubMed and Web of Science that focused on the recruitment and engagement of ‘seldom-heard’, ‘hard-to-reach’, or ‘disadvantaged’ groups in Europe. Purposive samples of articles followed a flexible and iterative review. Analysis and synthesis focused on identifying “synthetic constructs” or overarching themes, which informed the development of a “synthesizing argument” regarding recruitment and engagement strategies for seldom-heard groups. The presented paper focuses on the “synthetic constructs”, whereas the “synthetic argument” will be described in a subsequent paper. Results Of the 7601 articles identified, 23 were included. The analysis revealed four synthetic constructs: 1) the complexity of labels and identity, 2) the impact of labels on recruitment, 3) strategies to address recruitment challenges, and 4) the broader effects of these strategies on research and researchers. Conclusion Effective recruitment of seldom heard groups requires lengthy, careful planning, relationship-building, and an understanding of their unique perspectives. In doing so, researchers can contribute to reducing health inequalities and amplifying the voices of underrepresented populations.

A complementary two-dimensional material-based one instruction set computer

Correction: Vitamin B12 deficiency and neuropsychiatric symptoms in Lebanon: A cross-sectional study of vegans, vegetarians, and omnivores

The optimal warming strategy to reduce perioperative hypothermia: A prospective randomized non-blinded clinical trial

Background To mitigate perioperative hypothermia, patients can be warmed preoperatively and intraoperatively with forced-air warming (FAW) and conductive warming (CW) methods. We examined the association of four combinations of pre- and intraoperative CW and FAW with the magnitude of intraoperative hypothermia. Methods We conducted a prospective randomized trial at a tertiary healthcare center in the United States (trial registration number ISRCTN23065394). Patients were randomized to 4 arms based on the following pre/intraoperative warming combinations: (1) CW/CW, (2) FAW/FAW, (3) no active prewarming (NAPW)/CW, (4) NAPW/FAW. Body temperature was measured using an esophageal probe. The area under the temperature curve (AUC) below 36°C was calculated according to the trapezoidal rule and quantified intraoperative hypothermia. A mixed model was used to estimate differences in AUC between the 4 arms. Results 182 patients were analyzed. Patients in the NAPW/FAW arm had the highest AUC values while those in the CW/CW arm had the lowest. AUC values [median (Q1, Q3] were as follows: CW/CW = 4.7 (0, 26.6); FAW/FAW = 8.0 (0, 30.8); NAPW/CW = 7.4 (0, 27.1); NAPW/FAW = 19.9 (5.0, 44.3). Mixed model results showed significant lower AUC values in CW/CW and NAPW/CW when compared to NAPW/FAW. The ratio of mean AUC [95% CI] between CW/CW vs NAPW/FAW was 0.49 [0.24, 0.98], 51% lower, and between NAPW/CW and NAPW/FAW, 0.46 [0.23, 0.91], 54% lower. When the AUC was normalized to the duration of surgery (AUC/case duration in°C, or “relative AUC”), significant lower relative AUC values were observed between FAW/FAW vs NAPW/FAW (48% lower, p = 0.0419) and NAPW/CW vs NAPW/FAW (48% lower, p = 0.0407). Conclusions CW is more effective than FAW at reducing intraoperative hypothermia when FAW is used without prewarming. When patients are actively prewarmed, CW and FAW show no difference in their ability to maintain patient temperature.

Subyearling Chinook salmon diets in Lower Columbia River estuarine habitats

The Lower Columbia River and Estuary is critical rearing habitat for juvenile Pacific salmon. Extending from the river mouth to Bonneville Dam 235 river kilometers upstream, the Estuary has been altered by dams, dikes, and habitat loss due to deforestation and wetland removal. Since 2008, five sites have been monitored to identify the long-term status and trends in Lower Columbia River and Estuary juvenile salmon rearing habitat. Here, we address predominantly natural origin juvenile Chinook Oncorhynchus tshawytscha diets and identify spatial and temporal trends in prey consumption, stomach fullness, energy consumption, and the metabolic costs associated with fish size and water temperatures. Juvenile Chinook diets consisted mainly of corophiid amphipods, chironomid dipterans, and cladocerans, with other insects filling in most of the remainder of their diets. Juvenile Chinook salmon diets were stable over time, and stomach fullness and caloric intake was comparable among the sites where most salmon were collected. Juvenile Chinook salmon were frequently in water temperatures above fitness thresholds and higher water temperatures and metabolic rates will require increased foraging as water temperatures rise. Reduced growth, earlier migration, and mismatches between prey production and foraging are near term possibilities. Juvenile salmon rearing resiliency in the estuary can be aided by maintaining sufficient river discharge levels for salmon, and by restoring habitat and habitat connectivity to the mainstem channel.

A mobile robot safe planner for multiple tasks in human-shared environments

Various approaches have been studied to solve the path planning problem of a mobile robot designing with multiple tasks. However, safe operation for a mobile robot in dynamic environments remains a challenging problem. This paper focuses on safe path planning for a mobile robot executing multiple tasks in an environment with randomly moving humans. To plan a safe path and achieve high task success rate, a safe planner is developed where a double-layer finite state automaton (FSA)-based risk search (FSARS) method considering environmental risks is proposed. The low-level of FSARS is a novel safe approach to prioritize a safe path rather than merely seeking the shortest path in dynamic environments. Meanwhile, the high-level implements a safety-first search structure utilizing FSA transitions. This structure aims to generating optimal paths while multitasking, avoiding collisions with humans moving completely randomly at the planning level instead of aiming at real-time collision avoidance. FSARS is verified through a series of comparative simulations involving seven types of environmental settings, each with distinct task number, grid size, and human number. We evaluate FSARS based on several metrics, including conflict number, conflict distribution, task success rate, reward, and computational time. Compared with the reinforcement learning method, FSARS reduces the average conflict by 65.4% and improves the task success rate by 34.4%. Simulation results demonstrate the effectiveness of FSARS with the lowest collisions and the highest success rate compared with classic approaches.

Health symptoms and post-COVID-19: Comparing symptomatic groups based on self-reported and primary care data

Introduction Health symptoms are common in the general population. Relatively little research has focused on health symptoms in context of the COVID-19 pandemic between people with different manifestations of COVID-19. Aim of this study was to assess symptom differences between individuals suffering from post-COVID-19, individuals infected with COVID-19 but not suffering from lasting symptoms (‘ex-covid’), and non-infected individuals. Methods A 2022 nation-wide cross-sectional health survey was combined with routine primary care data. The response rate for the survey was 32%. The questionnaire data consisted of 315,586 respondents, and the electronic health record (EHR) data included 29,797 patients with merged questionnaire data. Prevalence of individual symptoms and number, duration, and severity of symptoms were analyzed. Results Individuals with post-COVID-19 reported more (IRR 1.48 [CI 1.46–1.49]), longer lasting (1.92 [CI 1.88–1.96]), and more severe symptoms (2.00 [CI 1.96–2.05]) than the ex-covid group. Post-COVID-19 also reported more (1.55 [CI 1.52–1.57]), longer lasting (1.87 [CI 1.82–1.92]), and more severe symptoms (1.95 [CI 1.89–2.01]) compared to non-infected. Ex-covid reported more symptoms than the non-infected, but on average, their symptoms lasted a shorter duration and were experienced as less severe. In EHRs, symptoms between groups showed generally the same pattern. Conclusion & discussion This study points at variation in symptomatology after COVID-19 infection. Individuals with post-COVID-19 experienced more, longer-lasting, and more severe symptoms compared to the other two groups. This study was one of the first to assess group differences between groups with different types of COVID-19 infections.

Preparation of a neutral nitrogen allotrope hexanitrogen C2h-N6 

Abstract Compounds consisting only of the element nitrogen (polynitrogens or nitrogen allotropes) are considered promising clean energy-storage materials owing to their immense energy content that is much higher than hydrogen, ammonia or hydrazine, which are in common use, and because they release only harmless nitrogen on decomposition 1 . However, their extreme instability poses a substantial synthetic challenge and no neutral molecular nitrogen allotrope beyond N 2 has been isolated 2,3 . Here we present the room-temperature preparation of molecular N 6 (hexanitrogen) through the gas-phase reaction of chlorine or bromine with silver azide, followed by trapping in argon matrices at 10 K. We also prepared neat N 6 as a film at liquid nitrogen temperature (77 K), further indicating its stability. Infrared and ultraviolet–visible (UV-Vis) spectroscopy, 15 N-isotope labelling and ab initio computations firmly support our findings. The preparation of a metastable molecular nitrogen allotrope beyond N 2 contributes to our fundamental scientific knowledge and possibly opens new opportunities for future energy-storage concepts. 

Causes and risk factors for an acute kidney injury outbreak among children in The Gambia, June – September 2022: A case-cohort study

Introduction Between June and September 2022, an outbreak of acute kidney injury (AKI) occurred in The Gambia among children, with 82 cases and 66 deaths recorded. Medicines taken by children with AKI were found to contain unacceptable amounts of diethylene glycol (DEG) and ethylene glycol (EG). The objective of the study was to establish the likely cause of the AKI outbreak and associated risk factors. Materials and methods A case-cohort study was conducted in six of the seven regions of The Gambia. Cases were children eight years or younger, residing within the six regions in the study period and diagnosed with AKI within that period. Controls were children in the same age range as cases and residing within the same neighborhood as cases but without a diagnosis of AKI. Three hundred twenty-one children were recruited for the sub-cohort from which controls were selected. Data were analyzed using Marginal Structural Models for a point treatment with the inverse probability of treatment weights estimator. Multivariable logistic regression was used to identify risk factors for AKI using a 5% level of significance in the final model. Results Sixty-three cases and 258 controls were enrolled into the study. Of the 63 cases, 58 were confirmed and five were suspected cases. AKI among the children was causally associated with ingestion of adulterated medicine(s) (OR = 1.76 (1.60–1.92); p < 0.0001). Risk factors of AKI were the ingestion of adulterated medicine(s), concomitant medicines, and being of a younger age. Conclusion The acute kidney injury outbreak that occurred among children in The Gambia in the period June through September 2022 was causally associated with the ingestion of adulterated medicines. The risk was increased by consumption of concomitant medicines and being of a younger age. DEG adulteration of paediatric medicines has been an all-too -common event in multiple countries.

Meet the engineer using deep learning to restore Renaissance art

Assessment of potential land suitability for rainfed wheat production using GIS and multi criteria decision analysis in the Southwestern parts of Ethiopia

Wheat production in Ethiopia is vital for improving food security, boosting the national economy, and achieving self-sufficiency in food consumption. The present study aims to assess the potential land suitability for rainfed wheat (Triticum aestivum L.) production by using Geographic Information System and multi criteria decision analysis in southwestern parts of Ethiopia. Biophysical data, including land use and land cover (LULC), soil drainage, soil texture, soil depth, proximity to markets and roads, land surface temperature, slope, rainfall, and elevation, were used. In addition, different software tools, such as ArcGIS 10.3, ERDAS Imagine 2015, IDRISI Selva 17, and ArcSWAT were applied. The results revealed that approximately 177.1 km² (1.3%) of the study area was classified as highly suitable, 5375.2 km² (38.2%) as moderately suitable, 7,246.0 km² (51.5%) as marginally suitable, and 1235.1 km² (8.8%) as currently not suitable for rainfed wheat cultivation. Furthermore, out of the 23 districts analyzed, Sayo Nole and Bedelle Zuriya were identified as highly suitable for wheat production, with an area of 32.7km2 and 23.3km2 respectively. Therefore, the study recommends that future study research investigate additional other ecological parameters, such as soil PH, lime, gypsum, salinity, alkalinity and socio-economic data, which were not included in the present study.

Federated k-means based on clusters backbone

Federated clustering is a distributed clustering algorithm that does not require the transmission of raw data and is widely used. However, it struggles to handle Non-IID data effectively because it is difficult to obtain accurate global consistency measures under Non-Independent and Identically Distributed (Non-IID) conditions. To address this issue, we propose a federated k-means clustering algorithm based on a cluster backbone called FKmeansCB. First, we add Laplace noise to all the local data, and run k-means clustering on the client side to obtain cluster centers, which faithfully represent the cluster backbone (i.e., the data structures of the clusters). The cluster backbone represents the client’s features and can approximatively capture the features of different labeled data points in Non-IID situations. We then upload these cluster centers to the server. Subsequently, the server aggregates all cluster centers and runs the k-means clustering algorithm to obtain global cluster centers, which are then sent back to the client. Finally, the client assigns all data points to the nearest global cluster center to produce the final clustering results. We have validated the performance of our proposed algorithm using six datasets, including the large-scale MNIST dataset. Compared with the leading non-federated and federated clustering algorithms, FKmeansCB offers significant advantages in both clustering accuracy and running time.

Investigating the physical and chemical factors affecting the microbial status of water in the water distribution network of Babol City with an emphasis on the HPC index

Background and purpose Safe and hygienic drinking water is crucial for public health. Secondary bacterial contamination, often caused by improper transport and distribution conditions, poses a significant threat. This study aimed to investigate the physical and chemical factors influencing the microbial status of drinking water in Babol’s distribution network, focusing on the heterotrophic plate count (HPC) index. Methods Thirty-two water samples were collected randomly from Babol’s rural areas and analyzed for HPC, residual free chlorine, turbidity, pH, and temperature. HPC was measured using the plate spreading technique on R2A agar. Descriptive statistics and regression analysis were employed to analyze the data. Findings Heterotrophic bacteria were detected in 61.4% of the samples, with 9.6% exceeding 500 CFU/ml. The average HPC was 140 CFU/ml, while residual free chlorine averaged 0.33 mg/l. In 21.4% of samples, residual chlorine was below 0.2 mg/l, and 19% had no detectable chlorine. Turbidity ranged from 0.05 to 3 NTU. Statistical analysis revealed significant positive correlations between HPC and pH, MPN, turbidity, and temperature (α < 0.05). Conclusion Regular HPC monitoring in Babol’s drinking water distribution network is essential to identify contaminated areas and ensure adequate residual free chlorine levels (0.2–0.8 mg/l) for maintaining bacteriological water quality.

The structure of liquid carbon elucidated by in situ X-ray diffraction

Abstract Carbon has a central role in biology and organic chemistry, and its solid allotropes provide the basis of much of our modern technology1. However, the liquid form of carbon remains nearly uncharted2, and the structure of liquid carbon and most of its physical properties are essentially unknown3. But liquid carbon is relevant for modelling planetary interiors4,5 and the atmospheres of white dwarfs6, as an intermediate state for the synthesis of advanced carbon materials7,8, inertial confinement fusion implosions9, hypervelocity impact events on carbon materials10 and our general understanding of structured fluids at extreme conditions11. Here we present a precise structure measurement of liquid carbon at pressures of around 1 million atmospheres obtained by in situ X-ray diffraction at an X-ray free-electron laser. Our results show a complex fluid with transient bonding and approximately four nearest neighbours on average, in agreement with quantum molecular dynamics simulations. The obtained data substantiate the understanding of the liquid state of one of the most abundant elements in the universe and can test models of the melting line. The demonstrated experimental abilities open the path to performing similar studies of the structure of liquids composed of light elements at extreme conditions.

Estimation of cervicocephalic kinesthetic perception and its correlation with fall risk in adults with diabetes and without diabetes experiencing cervical pain: A comparative study

Aims This study aimed to evaluate the relationship between cervicocephalic kinesthesia sensation and the incidence of falls in adults with Type 2 Diabetes Mellitus (DM-2) experiencing cervical pain. Methods The research was conducted between January 1, 2022, and August 15, 2022. A total of 60 participants were included, with an average age of 26.03 ± 3.45 years and an average BMI of 21.4 ± 2.05 kg/m². Participants were divided into two groups: an experimental group of adults with DM-2 and cervical pain, and a control group without DM-2 but with cervical pain. Results Head repositioning errors were significantly higher in the experimental group for right-side and left-side lateral flexion (P = 0.002). Forward flexion also showed a significant difference between groups (P = 0.006). However, no significant differences were observed between the groups in extension (P = 0.589). No considerable differences were noted in the Berg Balance Scale (BBS) and Neck Disability Index (NDI) scores between the groups. Conclusions Individuals with DM-2 experiencing neck pain exhibited minimal errors in head repositioning tests, yet no substantial alterations were evident in NDI and BBS scores.

Artificial intelligence-assisted method of structural health monitoring of subway shield tunnel based on insulation degradation location

Stray current leakages inevitably arise to seriously threaten the reliability of the subway tunnel structure and third-party system through electrochemical corrosion. Location of stray current leakage provides novel approach to mitigate stray current corrosion and valid guidance for maintenance of subway tunnel. The present study is dedicated to develop an integrated network-based method for locating the insulation degradation in subway tunnel. In this work, a predictive model based on LWQPSO-SOM algorithm is designed to cluster the risk level of stray current leakage through data mining. Then, an evaluation index Phigh is proposed to calculate the probability of high-risk index in the clustering results. Identification results of leakage zone of stray current is effectively validated through the measurement of rail-to-earth conductance. Results showed that the distribution of Phigh is highly related with rail-to-earth conductance distribution, indicating that the proposed method is applicable for stray current leakage location in the subway tunnel and potentially applicable in engineering fields.