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TBKIN: Threshold-based explicit selection for enhanced cross-modal semantic alignments

Vision-language models aim to seamlessly integrate visual and linguistic information for multi-modal tasks, demanding precise semantic alignments between image-text pairs while minimizing the influence of irrelevant data. While existing methods leverage intra-modal and cross-modal knowledge to enhance alignments, they often fall short in sufficiently reducing interference, which ultimately constrains model performance. To address this gap, we propose a novel vision-language model, the threshold-based knowledge integration network (TBKIN), designed to effectively capture intra-modal and cross-modal knowledge while systematically mitigating the impact of extraneous information. TBKIN employs unified scene graph structures and advanced masking strategies to strengthen semantic alignments and introduces a fine-tuning strategy based on threshold selection to eliminate noise. Comprehensive experimental evaluations demonstrate the efficacy of TBKIN, with our best model achieving state-of-the-art accuracy of 73.90% on the VQA 2.0 dataset and 84.60% on the RefCOCO dataset. Attention visualization and detailed result analysis further validate the robustness of TBKIN in tackling vision-language tasks. The model’s ability to reduce interference while enhancing semantic alignments underscores its potential for advancing multi-modal learning. Extensive experiments across four widely-used benchmark datasets confirm its superior performance on two typical vision-language tasks, offering a practical and effective solution for real-world applications.

Assessing mercury and lead pollution in the Ankobra estuary due to artisanal mining activities: Implications for water quality and aquatic life

Artisanal and small-scale gold mining, “Galamsey” as it is called in Ghana, within the Ankobra estuary has impacted the water quality, fish health and other aquatic organisms. This paper presents a study investigating the concentrations of mercury and lead in water, sediments, gills and liver of Chrysichthys nigrodigitatus of the Ankobra estuary. Bimonthly sampling between December 2020 and June 2021 was conducted at nine locations along the estuary. Physicochemical parameters such as temperature, dissolved oxygen, pH and turbidity were determined in situ using the EUTECH Multi-Parameter probe. A total of 36 water samples, 36 sediment samples and 120 fish samples were collected. Mercury (Hg) and lead (Pb) concentrations in the samples were measured using Atomic Absorption Spectrophotometry (AAS), employing appropriate techniques for each metal. Results showed that the physicochemical parameters of water, except for turbidity, were within the acceptable limits for aquatic life, based on the United States Environmental Protection Agency water quality criteria. Mercury and lead concentrations in water and fish samples exceeded United States Environmental Protection Agency guideline thresholds. In sediments, mercury levels surpassed both average shale values and ecological risk thresholds (ERM = 0.71 mg/kg), indicating high ecological risk, while lead remained below the ERL (46.7 mg/kg), suggesting low risk. Mercury and lead concentration in fish, water and sediments differ significantly (P < 0.05) across locations and between matrices (water, sediment, and fish organs). High bioaccumulation factors (BAFs) were recorded for both metals in fish. The BAF of mercury in fish-to-water samples was greater than in fish-to-sediment samples. In contrast, the bioaccumulation factor of lead was greater than in sediments compared to water. The study revealed that Ankobra estuary is polluted with mercury and lead and all necessary regulations should be enforced on the activities of artisanal miners to curb this menace.

Characterization of the genomic landscape of canine oral osteosarcoma reveals similarities with appendicular osteosarcoma

Osteosarcoma (OS) is the most common bone tumor in both dogs and humans. It predominantly occurs in the appendicular skeleton, with about 25% of cases occurring within the axial skeleton. Progression of local disease is often the life-limiting factor for patients with axial OS, in contrast to appendicular OS, where local disease is addressed surgically, and metastatic disease remains the primary obstacle. While OS is a rare human cancer, limiting the availability of samples, its higher incidence in dogs provides a valuable comparative model for study. Both canines and humans share commonalities in clinical presentation, but dogs have an accelerated progression. Similarly, complex structural genetic changes define appendicular OS in both dogs and people, but it is unclear whether the genomic landscape of axial OS exhibits different alterations that may separate it from appendicular OS. We performed pilot whole genome sequencing of canine primary oral (maxillary or mandibular) OS tumors (n = 8) and matched normal tissue. We found that the genetics of canine oral OS largely parallel the genetics of canine appendicular OS, including an overall low number of recurrent point mutations affecting the same gene (TP53 and SETD2, 3/8 samples). Structural variants dominated the landscape of mutational changes, with recurrent variants in DMD (4/8) and DLG2 (3/8) found at a similar incidence to appendicular OS. This pilot suggests genomic similarities between oral and appendicular OS.

Computational investigation unveils pathogenic LIG3 non-synonymous mutations and therapeutic targets in acute myeloid leukemia

Single nucleotide polymorphisms (SNPs) in DNA repair genes can impair protein structure and function, contributing to disease development, including cancer. Non-synonymous SNPs (nsSNPs) in the LIG3 gene are linked to genomic instability and increased cancer risk, particularly acute myeloid leukemia (AML). This study aims to identify the most deleterious nsSNPs in the LIG3 and potential therapeutic targets for DNA repair restoration in AML. We employed different computational approaches to analyze LIG3 nsSNPs and pathogenicity. Subsequently, molecular docking, molecular dynamics simulation (MDS), gene expression and clinical validation of LIG3 were performed to evaluate ligand-binding affinities, protein stability and to identify discriminatory gene signatures. Out of the 12,191 mapped SNPs, 132 were nsSNPs located in the coding region. Among these, 18 nsSNPs were identified as detrimental including 12 destabilizing and 6 stabilizing nsSNPs. Nine cancer-associated nsSNPs, including L381R and R528C, were predicted due to their structural and functional impacts. Further analysis revealed key phosphorylation and methylation sites, such as 529S and 224R. MDS highlighted stable interactions of compounds AHP-MPC and DM-BFC with wild-type and R528C mutant LIG3 proteins, while R671G and V781M mutants showed instability. Protein-protein interaction networks and functional enrichment linked LIG3 to DNA repair pathways. Kaplan-Meier analysis associated high LIG3 expression with improved survival in breast cancer and AML, suggesting its role as a prognostic biomarker. This study emphasizes the mutation-specific effects of LIG3 nsSNPs on protein stability and ligand interactions. We recommend identifying DM-BFC to advance personalized medicine approaches for targeting deleterious variants, following in-vitro and in-vivo validation for AML treatment.

Before hands disappear: Effect of early warning visual feedback method for hand tracking failures in virtual reality

Virtual hand representation in Head-Mounted Displays (HMDs) offers immersive and intuitive interactions in Virtual Reality (VR). However, current hand tracking algorithms are prone to errors, which can disrupt the user experience and hinder task performance. This paper presents a novel method for providing users with visual feedback when the quality of hand tracking decreases. Our approach employs a notification modal that warns users of potential failures. We identified three common hand tracking failure scenarios and evaluated the effectiveness of our method in two distinct VR tasks: object manipulation and complex assembly tasks. Results show that our early warning system reduces task completion time, lowers hand-tracking failures by up to 83%, decreases errors, improves system usability, and reduces cognitive load. This work contributes to the development of more robust and user-friendly VR HMD applications by enhancing hand tracking reliability, usability, and workload.

Association between non-high-density lipoprotein cholesterol to high-density lipoprotein cholesterol ratio (NHHR) and urinary albumin-creatinine ratio (ACR) in US adults: NHANES 2005–2018

Purpose The ratio of non-high-density lipoprotein cholesterol (NHDL-C) to high-density lipoprotein cholesterol (HDL-C), referred to as NHHR, is an emerging lipid parameter. The relationship between NHHR and the urinary albumin-creatinine ratio (ACR) remains unclear. Therefore, our aim is to explore the potential correlation between NHHR and ACR. Methods Data for this study were sourced from the 2005–2018 National Health and Nutrition Examination Survey (NHANES). Participants under 20 years, pregnant individuals, and those missing NHHR or ACR data were excluded. NHHR, calculated as the difference between total cholesterol (TC) and HDL-C divided by HDL-C, was assessed. Our analysis of the NHHR-ACR association involved multivariable linear regression, smoothed curve fitting, and subgroup analysis. Results A total of 34,734 participants were included, with a mean age of 49.81 ± 17.66 years. The prevalence of albuminuria was 12.66%. Multivariable regression analysis indicated a significant and independent positive association between NHHR and ACR after fully adjustment [β (95% CI): 7.19 (4.54, 9.85), p < 0.0001], particularly among female participants, individuals aged 60 or older, those of Mexican American or Non-Hispanic Black ethnicity, individuals with obesity, hypertension or diabetes. Conclusion Our findings demonstrate a positive correlation between NHHR and elevated ACR in US adults, implying that lowering NHHR may serve as a preventive and palliative strategy for albuminuria.

The relationship between N-terminal pro-brain natriuretic and coronary artery lesions in Kawasaki disease: A meta-analysis

Background Regarding the value of N-terminal brain natriuretic peptide precursors in evaluating coronary artery lesions (CAL) in Kawasaki disease. Objective To conduct a meta-analysis of relevant literature and explore the value of N-terminal brain natriuretic peptide NT ProBNP in evaluating coronary artery lesions (CAL) in Kawasaki disease. Method Retrieve publicly published literature on the relationship between serum NT ProBNP concentration and coronary artery disease in Kawasaki disease from CNKI, Wanfang, VIP, China Biomedical Database, Pubmed, Embase, Cochrane Library, Web of Science, and OVID databases, as well as manually search for other resource literature. Use state14 software to evaluate the quality of the included literature, calculate the combined sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, and diagnostic ratio ratio, and compile a comprehensive subject working characteristic curve (SROC) to calculate the area under the curve (AUC) and 95% confidence interval. Result A total of 25 articles were included using a random effects model, with a combined sensitivity of 0.80 [95% CI (0.74, 0.85)], specificity of 0.78 [95% CI (0.75, 0.82)], positive likelihood ratio of 3.94 [95% CI (3.32, 4.69)], negative likelihood ratio of 0.23 [95% CI (0.17, 0.30)], and diagnostic ratio of 17.24 [95% CI (12.0,24.77)]. The area under the SROC curve AUC is 0.87 (0.84–0.90). When the predicted value is 1000ng/L, the combined sensitivity is 0.87 [95% CI (0.80,0.92)], and the specificity is 0.78 [95% CI (0.71,0.84)]. Subgroup analysis revealed that the diagnostic value of NT ProBNP for Kawasaki disease complicated with CAL was higher in the over 3 year old group than in the under 3 year old group. NT ProBNP had higher diagnostic value for Chinese population, but its exclusion value was lower than that of Japanese population. The sensitivity and specificity of using chemiluminescence to detect NT-ProBNP were higher than those of enzyme-linked immunosorbent assay. Conclusion NT-ProBNP has high diagnostic value for coronary artery lesions in Kawasaki disease, and has greater diagnostic value for children over 3 years old, and the use of chemiluminescence.It demonstrates superior diagnostic efficacy for the Chinese population and enhanced exclusionary power for the Japanese population.

Correction: Assessing the potential of polygenic scores to strengthen medical risk prediction models of COVID-19

Acute effects of inspiratory muscle warm-up on muscle oxygenation, perceived exertion and prefrontal cortical activation

Objectives As rowing training loads intensify, the resulting high subjective exertion may force athletes to expand excessive neural impulses and cognitive resources. Given the finite nature of neural capacity, prolonged exposure to such demands could impair information processing, movement stability, and even causing non-contact injury. Therefore, this study aimed to investigate the effects of respiratory muscle warm-up intervention on prefrontal cortex and muscle oxygenation dynamics in athletes, thereby exploring its potential to mitigate cognitive-motor strain under rowing training conditions. Methods A total of 54 participants were recruited for the study, with an average age of 21.35 years. They were randomly assigned to one of three groups: Inspiratory muscles warm-up (IMW), placebo, or blank control. A portable muscle oximeter (Moxy, USA) was employed to monitor the muscle oxygen saturation level of the subjects throughout the training period. The degree of activation of the prefrontal cortex (PFC) was quantified by means of an oxygenation monitoring system (OctaMon). Concurrently, the CR10 scale was utilized to assess perceived exertion. Results Following the intervention, a significant difference in CR10 was observed between the various groups. A series of multiple comparisons demonstrated that the CR10 in the IMW group exhibited a significantly lower value than that observed in the placebo and control groups (p < 0.001). Once the baseline values from the pretest had been accounted for, a significant difference in oxygen saturation was observed between the different groups in the bilateral PFC. Post hoc analysis demonstrated significantly decreased HbO₂ in both the IMW (p = 0.019) and placebo (p = 0.035) groups relative to blank controls. Following the IMW intervention, the muscle oxygen saturation levels of the biceps brachii and vastus medialis in the subjects were significantly higher than those observed prior to training (p < 0.05). However, no significant difference was noted between the two tests in the control group, indicating that the IMW intervention can mitigate the decline in muscle oxygenation during training, alleviate discomfort in the lungs and motor muscles, and regulate subjective load. Conclusion The implementation of IMW intervention has the potential to mitigate the subjective burden experienced by athletes, thereby reducing discomfort during training. The combination of PFC activation level and muscle oxygen saturation index provides a superior explanation of the results. Nevertheless, further research is required to ascertain whether IMW can have a sustained positive impact.

Moderating role of mindfulness and social support in the relationship between fertility pressure and fertility quality of life in Chinese infertile men

Men with infertility are susceptible to fertility pressure, thus affecting their fertility quality of life. To develop fertility-pressure resilience interventions, we investigated whether mindfulness and social support could buffer the association between perceived fertility pressure and fertility quality of life in Chinese infertile men. In this cross-sectional study, Chinese men with infertility who visited the clinic for semen examination completed the Fertility Pressure Inventory, Mindful Attention Awareness Scale, Social Support Scale, and Fertility Quality of Life Scale online. In total, 469 Chinese infertile men (mean age: 32 years) were recruited, of whom 414 (88.3%) reported no childbearing history or high fertility stress. Analysis using generalised linear models revealed that social support had a moderating effect on the association between reproductive stress and reproductive quality of life (F = 11.006, P = 0.001), and between the core (F = 9.063, P = 0.003) and treatment (F = 9.383, P = 0.002) subdimensions of reproductive quality of life and reproductive stress. Among men with high social support scores, the association between reproductive stress and reproductive quality of life (t = −3.146, P = 0.002) and the core subdimension (t = −3.333, P = 0.001) was significant, whereas among men with low social support scores, the association between reproductive stress and reproductive quality of life (t = 0.906, P = 0.365) and the core subdimension (t = 0.266, P = 0.790) was not significant. Mindfulness did not significantly regulate fertility stress and reproductive quality of life(F = 1.528, P = 0.217), its core (F = 1.406, P = 0.236) and treatment (F = 1.026, P = 0.312) subdimensions. Higher social support levels attenuated the negative association between fertility stress and reproductive quality of life (including core dimensions) in infertile men. Experimental studies are needed to determine whether social support is a protective factor.

The effects of hydrotherapy on athletic ability in children with cerebral palsy: A systematic review and meta-analysis

Background Cerebral palsy (CP) is a disability caused by brain malformations or injuries occurring from conception to infancy. Hydrotherapy is a popular treatment for children with cerebral palsy and other neuromotor disorders. Despite evidence supporting the efficacy of hydrotherapy for treating children with cerebral palsy, there remains controversy regarding its effectiveness over different follow-up periods and in comparison with other physical therapy methods. Objective To compare the effects of hydrotherapy on gross motor abilities, fine motor functions, balance, and muscle tone in children and adolescents with cerebral palsy, and to assess evaluate efficacy across different age stages and treatment durations. Methods This meta-analysis was registered with PROSPERO (registration number CRD42024535838). Literature searches were conducted in databases including CNKI, VIP, WanFang, Web of Science, PubMed, Embase, and the Cochrane Library starting from June 2024. Randomized controlled trials (RCTs) that assessed the effects of hydrotherapy on gross motor functions, fine motor functions, balance, and muscle tone in children and adolescents with cerebral palsy were included. RCTs were evaluated for quality using the Cochrane risk of bias tool. Outcomes were analyzed by calculating mean difference (MD) or standardized mean difference (SMD) along with their 95% confidence intervals (CIs). Results Sixteen studies were included, assessing the impact of hydrotherapy compared to conventional care on gross motor functions in children and adolescents with cerebral palsy. The findings indicated that hydrotherapy significantly improved gross motor functions [SMD = 0.41, 95% CI = 0.15–0.68, I2 = 59.5%, p < 0.05], with consistent effects observed in children aged ≤6 years [SMD = 0.42, 95% CI = 0.16–0.68, I2 = 38.2%, p < 0.05] and those aged >6 years [SMD = 0.43, 95% CI = 0.22–0.63, I2 = 59.5%, p < 0.05]. Subgroup analysis based on intervention duration revealed that programs lasting more than 10 weeks were associated with significant improvements [SMD = 0.48, 95% CI = 0.31–0.66, I2 = 65.1%, p < 0.05], whereas no significant effects were found in interventions lasting 10 weeks or less [SMD = 0.14, 95% CI = –0.26–0.53, I2 = 35.6%, p > 0.05]. Hydrotherapy demonstrated a certain positive effect on fine motor functions [SMD = 0.78, 95% CI = 0.46–1.10, I2 = 46.4%, p > 0.05].In contrast, no statistically significant improvements were observed in balance [SMD = 0.64, 95% CI = –0.05–1.34, I2 = 80.7%, p > 0.05] or muscle tone [SMD = –0.45, 95% CI = –0.98–0.07, I2 = 58.2%, p > 0.05]. Conclusion The results indicate that hydrotherapy is more effective than conventional treatment in improving gross motor functions in children and adolescents with cerebral palsy, with consistent benefits observed across different age groups and in interventions of longer duration. Hydrotherapy also showed a positive trend in enhancing fine motor functions, although no significant improvements were observed in balance or muscle tone.

Research on APT groups malware classification based on TCN-GAN

Advanced Persistent Threat (APT) malware attacks, characterized by their stealth, persistence, and high destructiveness, have become a critical focus in cybersecurity defense for large organizations. Verifying and identifying the sources and affiliated groups of APT malware is one of the effective means to counter APT attacks. This paper addresses the issue of tracing and attributing APT malware groups. By improving and innovating the extraction methods for image features and disassembled instruction N-gram features of APT malware, and based on the Temporal Convolutional Network (TCN) model, the paper achieves high-accuracy classification and identification of APT malware. To mitigate the impact of insufficient APT malware samples and data imbalance on classification performance, the paper employs Generative Adversarial Networks (GAN) to expand the sample size. Validation on both public and self-constructed datasets shows that the proposed method achieves an accuracy and precision rate of 99.8%, significantly outperforming other methods. This work provides a foundation for subsequent countermeasures and accountability against related APT attack groups.

Exploring the barriers and facilities migrants face in accessing COVID-19 vaccines in Malaysia: A qualitative study

Background Malaysia provided COVID-19 vaccines for all residents, regardless of citizenship status. However, the extent of vaccine accessibility for migrant populations remains unclear, given the complex healthcare barriers they face. This study explored the barriers migrants faced in accessing COVID-19 vaccines and the measures taken to facilitate their access. Methods This qualitative study, conducted between April 2022 and February 2023, involved 32 purposively selected key informants from non-governmental organisations (7), international organisations (2), labour unions (2), healthcare providers (11) and migrant communities (10). Data were collected through in-depth, semi-structured, primarily individual interviews, and analysed using NVivo 12 Pro software following a six-phase thematic analysis: data familiarisation, code generation, theme identification, theme review, theme definition, and reporting. Results Thematic analysis identified barriers—including legal and administrative challenges, digital exclusion, vaccine hesitancy, and logistical issues—and facilitators, such as mandatory vaccination policies, innovative delivery approaches, communication support, and community engagement. Substantial challenges arose from pervasive distrust in healthcare services, compounded by identity document requirements, roadblocks, and fears of immigration arrests. Digital appointment systems excluded many migrants due to language and literacy barriers, data privacy concerns, and the need for identity documents. While vaccine hesitancy among migrants was generally low, concerns were primarily driven by fears of immigration enforcement rather than vaccine safety. Despite vaccination being voluntary, mandatory requirements for digital vaccination certificates or negative COVID-19 test results strongly incentivised uptake. Employer support, driven by economic interests, played a critical role in promoting compliance with workplace vaccination mandates. Collaboration with non-governmental organisations and community partners proved pivotal, offering tailored health communication and building trust. Flexible vaccine delivery strategies, including a shift from centralised to outreach models near residences and workplaces, enhanced access, particularly for hard-to-reach populations. Conclusion Despite numerous challenges, Malaysia’s vaccination efforts were largely successful due to innovative and collaborative delivery and communication strategies. To further improve health equity among marginalised populations, it is essential to enhance culturally sensitive training for frontline workers, strengthen employers’ business ethics, and increase the involvement of trusted stakeholders.

Comparative analysis of supervised learning models for effluent quality prediction in wastewater treatment plants

Effluent quality prediction is critical for optimizing Wastewater Treatment Plant (WWTP) operations, ensuring regulatory compliance, and promoting environmental sustainability. This study evaluates the performance of five supervised learning models—AdaBoost, Backpropagation Neural Networks (BP-NN), Support Vector Machine (SVR), XGBoost, and Gradient Boosting (GB)—using data from a WWTP in Zhuhai, China. The Effluent Quality Index (EQI), integrating multiple pollutant concentrations and environmental impacts, was used as the target variable. The models were trained and tested on 84 monthly datasets, with their performances compared using R2, Mean Absolute Percentage Error (MAPE), and Mean Bias Error (MBE). XGBoost achieved the best balance between accuracy and robustness, with the lowest MAPE(6.11%) and a high R2(0.813), while SVR excelled in fitting accuracy(R2 = 0.826) but showed limitations in error control. Although we employed GridSearchCV with cross-validation to optimize hyperparameters and ensure a fair model comparison, the study is limited by the reliance on data from a single WWTP and the relatively small dataset size (84 records). Nevertheless, the findings provide valuable insights into selecting effective machine learning models for effluent quality prediction, supporting data-driven decision-making in wastewater management and advancing intelligent process optimization in WWTP.

Climate-sensitive zoonotic diseases transmissible by companion animals: A scoping review protocol

Objective This joint protocol describes two scoping reviews that will identify and describe evidence for climate sensitivity of companion animal zoonotic diseases in cat, dog, and human populations worldwide. Introduction Climate change is a driver for emerging and re-emerging zoonotic diseases of global health concern. Companion animals can transmit over 70 zoonotic pathogens, some of which are sensitive to changes in meteorological factors. There is disparate evidence in our understanding of climate-sensitive companion animal zoonotic diseases. Inclusion criteria Primary research articles that describe 1) an association or effect between meteorological factors and the risk of zoonotic disease, 2) the presence of spatiotemporal variations in disease incidence or prevalence, or 3) the projected impacts of climate emission scenarios on disease trends will be included. Methods A comprehensive search strategy was developed using index terms and keywords for populations of interest, companion animal zoonotic diseases, and meteorological factors. Articles will be searched on MEDLINE (via Ovid), AGRICOLA (via ProQuest), and Web of Science. Additional articles will be identified using citation tracking. Independent reviewers will systematically apply a two-step study screening process based on defined eligibility criteria. Key study characteristics and findings will be collated and presented as a descriptive summary using graphical and tabular formats. Review registration Two separate protocols have been registered in Open Science Framework. The first review consolidates evidence in cat and dog populations (https://osf.io/ydgc2), while the second review is focused on human populations (https://osf.io/3cvx2).

Human Papillomavirus Vaccination uptake and associated factors among schools girls aged between 9–14 years in Ethiopia: Performance Monitoring for Action (PMA-ET) 2023, multilevel analysis

Background Human papillomavirus (HPV) is one of the sexually transmitted diseases infections that causes cervical cancer, and it is the second-leading cause of infection-related cancer globally. HPV infection causes around 604,000 cervical cancer cases (342,000 deaths) globally each year. Therefore, this study aimed to assess Human Papillomavirus Vaccination uptake and associated factors among schools girls in Ethiopia. Method Performance Monitoring for Action Ethiopia (PMA Ethiopia) is a survey project designed to generate data on various reproductive, maternal, and newborn health (RMNH) indicators that can inform national and regional governments. The prevalence of HPV vaccine uptake with a 95% Confidence Interval (CI) was reported and presented in a forest plot for East Africa Countries using STATA version 14.1. Intra-class Correlation Coefficient (ICC), Likelihood Ratio (LR) test, Median Odds Ratio (MOR), and deviance (−2LLR) values were used for model comparison and fitness. Adjusted Odds Ratios (AOR) with a 95% Confidence Interval (CI) and p-value ≤0.05 in the multilevel logistic model were used to declare significant factors associated with HPV vaccine uptake. Result In Ethiopia, the prevalence of HPV vaccine uptake among schools girls was 30.82% (95% CI: 29.21, 32.45). In the multilevel logistic regression model, girls in age groups of 12–14 years were 2.44 [AOR = 2.44, 95% CI: 1.86–3.16] times more likely to take HPV vaccine as compared to girls aged 9–11 years. Similarly, girls who had received any health service and received sexual and reproductive health services had 7.75 [AOR = 7.75, 95% CI: 5.65–10.62], and 3.24 [AOR = 3.24, 95% CI: 2.33–4.51] were more likely to take HPV vaccine compared to their counterparts respectively. Conclusion The study findings indicate that the proportion of girls reporting receipt of the HPV vaccine in this nationally representative survey is an alarmingly low 30.8%. The following critical factors have influenced this rate: age, access to sexual and reproductive health services, general health service utilization, and regional health disparity.

Strategies to enhance clinical teaching and learning in undergraduate nursing education: A scoping review

Background Nursing education comprises theory and practice as two complementary parts. Nursing is a practice-based profession, and students are expected to be practically competent in rendering quality care to the deserving population. Clinical training allows nursing students to gain the practical skills required in the nursing profession. In addition to the practical skills, clinical education helps students to learn skills such as problem-solving, decision-making and critical thinking. However, evidence exists that students cannot acquire clinical competence due to multiple factors. These factors are related to students, the clinical environment, and the nurse/faculty. There is a need to identify strategies to enhance clinical teaching and learning in undergraduate nursing education. Therefore, this scoping review aims to identify evidence-based strategies to support clinical teaching and learning in undergraduate nursing education. Methods A scoping review method underpinned by Peters et al. (2020) framework was employed. A search string developed from the title of the review was used to search online databases to identify peer-reviewed articles published between January 2011 and September 2023. Results Forty studies were included in the review, most originating from the United States. Seven themes were identified: scaffolding the curriculum, transformative teaching and learning approaches, integrating simulation-based education, dedicated education units for clinical placement, applying technology in clinical education, developing interprofessional teamwork and collaboration, and integrating inter-country clinical experience. Conclusion The current scoping review has unveiled strategies relevant to nursing students’ clinical teaching and learning. These strategies could guide curriculum developers, programme organisers, nursing teachers, nursing students, and clinical instructors at clinical learning sites in restructuring clinical teaching and learning in undergraduate nursing education to improve clinical education outcomes.

Mediation and moderation analysis of the association between physical capability and quality of life among stroke patients

To estimate the extent to which physical capability, depressive symptoms, balanced self-efficacy (BSE), and other risk factors, that are interrelated with stroke, influence the quality of life (QoL) in stroke survivors. A theoretical model based on Wilson and Cleary’s model tested the specific hypotheses: 1) physical capability has an indirect effect on QoL mediated by BSE; 2) physical capability has an indirect effect on QoL by depressive symptoms; 3) stroke risk factors (hypertension/diabetes/gender) moderate the above relationship. Six hundred and seventy stroke survivors were enrolled from ten different hospitals in Yunnan province from 2019 to 2021. Patients’ mental and physical function was assessed using the Brunnstrom recovery stage (BRS), mini-balance evaluation system test (Mini-BEST), Barthel index (BI), Activities-specific Balance Confidence scale (ABC), and Hamilton depression scale (HAM-D). The structural equation model (SEM) was used to test the moderated mediation model in Mplus 8.0 software. The model showed a good fit (RMSEA =  0.075, SRMR =  0.010). BSE significantly mediated the relationship between physical capability and QoL (β =  0.322, p =  0.002). Hypertension was found a significant moderator of all the direct paths from physical capability to QoL through depressive symptoms (В =  0.412, p =  0.015; В =  0.831, p =  0.020, respectively). This study provides a better insight into the relationship between physical capability and QoL via BSE in stroke survivors, which may help establish appropriate treatment for these individuals.

Leveraging molecular-QTL co-association to predict novel disease-associated genetic loci using a graph convolutional neural network

Genome-wide association studies (GWAS) have successfully uncovered numerous associations between genetic variants and disease traits to date. Yet, identifying significantly associated loci remains a considerable challenge due to the concomitant multiple-testing burden of performing such analyses genome-wide. Here, we leverage the genetic associations of molecular traits – DNA CpG-site methylation status and RNA expression – to mitigate this problem. We encode their co-association across the genome using PinSage, a graph convolutional neural network-based recommender system previously deployed at Pinterest. We demonstrate, using this framework, that a model trained only on methylation quantitative trait locus (QTL) data could recapitulate over half (554,209/1,021,052) of possible SNP-RNA associations identified in a large expression QTL meta-analysis. Taking advantage of a recent ‘saturated’ map of height associations, we then show that height-associated loci predicted by a model trained on molecular-QTL data replicated comparably, following Bonferroni correction, to those that were genome-wide significant in UK Biobank (88% compared to 91%). On a set of 64 disease outcomes in UK Biobank, the same model identified 143 independent novel disease associations, with at least one additional association for 64% (41/64) of the disease outcomes examined. Excluding associations involving the MHC region, we achieve a total uplift of over 8% (128/1,548). We successfully replicated 38% (39/103) of the novel disease associations in an independent sample, with suggestive evidence for six additional associations from GWAS Catalog. Replicated associations included for instance that between rs10774625 (nearest gene: SH2B3/ATXN2) and coeliac disease, and that between rs12350420 (nearest gene: MVB12B) and glaucoma. For many GWAS, attaining such an enhancement by simply increasing sample size may be prohibitively expensive, or impossible depending on disease prevalence.

Explainable one-class feature extraction by adaptive resonance for anomaly detection in quality assurance

In this study, we address the inherent challenges in radiotherapy (RT) plan quality assessment (QA). RT, a prevalent cancer treatment, utilizes high-energy beams to target tumors while sparing adjacent healthy tissues. Typically, an RT plan is refined through several QA cycles by experts to ensure it meets clinical and operational objectives before being considered safe for patient treatment. This iterative process tends to eliminate unacceptable plans, creating a significant class imbalance problem for machine learning efforts aimed at automating the classification of RT plans as either acceptable or not. The complexity of RT treatment plans, coupled with the aforementioned class imbalance issue, introduces a generalization problem that significantly hinders the efficacy of traditional binary classification approaches. We introduce a novel one-class classification framework, using an adaptive neural network architecture, that outperforms both traditional binary and standard one-class classification methods in this imbalanced and complex context, despite the inherent disadvantage of not learning from unacceptable plans. Unlike its predecessors, our method enhances anomaly detection for RT plan QA without compromising on interpretability—a critical feature in healthcare applications, where understanding and trust in automated decisions are paramount. By offering clear insights into decision-making processes, our method allows healthcare professionals to quickly identify and address specific deficiencies in RT plans deemed unacceptable, thereby streamlining the QA process and enhancing patient care efficiency and safety.