Browse Articles

A dynamic nonlinear flow algorithm to model patient flow

Abstract Hospitals are complex systems, and the flow of patients is dynamic and nonlinear in such systems. Network representation allows flow algorithms to observe bottlenecks as candidates for optimisation. To model the dynamic behaviour of the patient flow, we need to consider the variability in arrival rates and service times (length of stay). Previously proposed dynamic flow algorithms mainly focused on arrival and departure rates, inflow and outflow, edges’ and vertices’ capacity, and routing, with applications mainly in transportation and telecommunication. In hospitals, bottlenecks that emerge from the patients’ flow are a result of the vertices (wards) behaviour defined by capacity (beds), number of servers (staff), service time variability, and edges (care pathways) distribution probability. We offer a modified flow algorithm that takes a hospital network, iterates over the patients’ arrival rates, and measures the flow with respect to vertices’ capacities, servers, service time variability, edge capacity, and distribution probability. The result is a dynamic residual graph to measure the bottlenecks’ persistency and severity, identify the root causes of bottlenecks, and wards’ dynamic nonlinear behaviour. The algorithm provides a quick holistic view of hospital performance and the analysis of the edges and vertices’ behaviour over time.

Correction: Prevalence and association of musculoskeletal disorders with various risk factors among older Indian adults: Insights from a nationally representative survey

Microstructural and transcriptomic characterization of trabecular bone in idiopathic osteonecrosis of the femoral head

Retraction: HIF-1α and HIF-2α: Siblings in promoting angiogenesis of residual hepatocellular carcinoma after high-intensity focused ultrasound ablation

An adaptive hierarchical hybrid kernel ELM optimized by aquila optimizer algorithm for bearing fault diagnosis

Impact of health systems interventions in primary health settings on type 2 diabetes care and health outcomes among adults in West Africa: A systematic review

Type 2 diabetes is ambulatory care sensitive and adequate outpatient primary care supported by strong functional health systems can reduce avoidable complications and related mortality. A large body of published evidence exists on pharmacological agents and non- pharmacological interventions for the management of type 2 diabetes. However, the evidence on health systems’ ability to support patients’ primary care needs, especially in West Africa, where non-communicable disease (NCD) is an increasingly important part of the disease burden is uncertain. This systematic review explores the current published evidence on health systems interventions to support primary health facilities for type 2 diabetes care and impact on health outcomes, service access and quality in West Africa. The World Health Organization health systems building blocks and other post building blocks health systems frameworks guided our search and analysis. Only three pilot studies, including two randomized controlled trials and one pre-post study, met all our first inclusion criteria. However, we included 12 other studies which did not meet all the inclusion criteria but reported on a health system intervention for complete analysis: (The criteria were expanded to include studies conducted outside primary care settings. The rationale was that findings from such studies may influence primary care. Also, non-randomized control trials were later included). Our results showed that interventions with significant impact on glycemic control, treatment adherence, health literacy, and other associated outcomes addressed intersections between the individual health system blocks/areas. Thus, four cross-cutting themes related to the building blocks were found during analysis. The first theme was on interventions targeting the availability of trained health workers and the quality of their services; the second was on interventions targeting institutional infrastructure and resources for management; the third was on interventions targeting leadership and organizational culture and; the fourth was interventions targeting relationships among stakeholders. A fifth theme highlighting patients and family empowerment for type 2 diabetes control was also found in most of the interventions. Conclusion These findings confirm that the rising burden of non-communicable diseases in West Africa, particularly type 2 diabetes, can be tackled by strong functional primary healthcare systems.

Variation in defensive and exploratory behaviors across a rattlesnake (Crotalus scutulatus × viridis) hybrid zone in southwestern New Mexico

Abstract Studies on animal temperaments (consistent differences in behaviors across contexts) and behavioral syndromes (suites of correlated behaviors across contexts) have surged in recent decades. Accordingly, behavioral ecologists have gained greater appreciation for their evolutionary role and significance. Yet, despite their importance as potential evolutionary drivers, research focused on temperament and syndromes in shaping hybridization events is vastly understudied. Case studies have shown that hybridization has multiple effects on these phenomena, such as eliminating syndromes present in parental lineages and generating novel syndromes within hybrids. Here, we assessed temperament and syndromes in a naturally occurring rattlesnake hybrid zone (Crotalus scutulatus × viridis). We used laboratory behavioral assays to quantify defensive and explorative behaviors, and tested whether these traits were correlated with spatial and hunting behaviors of free-ranging individuals. C. viridis was more significantly more prone to rattle than C. scutulatus during handling tests. Similarly, hybrid individuals that had a greater proportion of their genome derived from C. viridis were also more prone to rattle. Parental and hybrid snakes exhibited varying syndromes in defensiveness and exploratory behaviors, yet further research is necessary to determine whether they impact hybrid fitness by creating mismatches between temperaments and predation pressures under natural conditions.

Physical activity and diet pattern do not mitigate C-reactive protein increases associated with oral contraceptive use

The purpose of this study was to examine the influence of body mass index (BMI), physical activity (PA) level, dietary inflammatory index (DII), and oral contractive (OC) use on C-reactive protein (CRP) levels, and to determine if elevated CRP values reflect systemic inflammation in OC users. Data were obtained from four cycles (1999-2006) of the U.S. National Health and Nutrition Examination Survey (NHANES) study, yielding a sample of 496 current OC users and a comparator group of 1,583 regularly menstruating women. A general linear model was used to test for interaction effects among BMI, PA level, and OC use, after adjusting for age and smoking status, with log-transformed CRP (lnCRP) identified as the outcome variable. Sequential general linear models with no interaction terms were then constructed to examine the impact of BMI, PA level, and OC use on circulating lnCRP after adjusting for age and smoking status. Follow-up analyses used general linear models to assess the relationship between lnCRP and other indices of systemic inflammation among OC users and nonusers, and to examine the predictors of lnCRP within each subgroup. The omnibus model including smoking status, age, PA level, OC use, and BMI did not identify any statistically significant two-way or three-way interaction effects (all p ≥ .259). The adjusted r2 value of the model modestly increased from 0.3789 to 0.3801 when all interaction terms were removed. After adjusting for smoking status and age, a sequentially built model indicated that PA level was inversely related to lnCRP values (p = .0019). When OC use was added to the model, it was positively associated with lnCRP values (p < .0001), with statistically and clinically significant lnCRP differences between OC users and nonusers. BMI was the last variable entered into the model, which was positively associated with lnCRP (p < .0001). Among OC nonusers, PA level (p = .0008) and BMI (p < .0001) were significantly predictive of lnCRP levels after adjusting for smoking status and age. In contrast, PA level was not significantly predictive of lnCRP values (p = .718) among OC users. All alternative indices of inflammation were positively correlated with lnCRP values (all p < .0001), but correlations were significantly stronger among OC users than nonusers (all p < .05). In a subset of OC nonusers with complete nutrition data, PA level (p = .021), BMI (p < .0001), and DII (p = .007) were significantly predictive of lnCRP after adjusting for smoking status and age. In contrast, PA level (p = .709) and DII (p = .690) were not significantly predictive of lnCRP values among OC users. In conclusion, OC-induced elevations in CRP appear to be reflective of a chronic, systemic inflammatory response. PA and low DII are associated with lower CRP among OC nonusers, but do not mitigate CRP elevations among OC users.

Alterations of static and dynamic changes in intrinsic brain activity and its relation to behavioral outcomes in subcortical ischemic stroke after one-month intervention

Disparity in school children’s reading skills in 11 African countries

To promote SDG Goal 4 and “education for all”, this study investigates children’s basic reading skills in 11 low-income and lower-middle-income African countries, using standardized reading tests from the Multiple Indicator Cluster Surveys (MICS). Research specifically examining children’s reading skills and disparities across socioeconomic groups in African contexts remains scarce. This study addresses a critical knowledge gap by providing comparative evidence on reading skills disparities across diverse social backgrounds, including children with disabilities. Our study provides new evidence on the “Learning Crisis in the Global South”, revealing alarmingly low levels of reading skills but with considerable variation across the 11 African countries studied. Substantial reading skills differences exist between children with disabilities or from disadvantaged backgrounds—those living in rural areas, and from poorer, less educated families—and their non-disabled and non-disadvantaged peers. Notably, these disparities are often more pronounced in countries with higher overall reading proficiency. Moreover, there are persistent gaps between children with and without disabilities across the countries and socioeconomic groups in this study. Encouragingly, strengthening education systems is a promising way of improving the reading skills of children with disabilities. These findings underscore the diverse challenges faced by children from different backgrounds in varying contexts.

Pattern synthesis of linear array antennas based on Chaos Triangular Pelican Optimization Algorithm

The impact of a low-carbohydrate nutrition education program on food preferences: The correspondence between self-report consumption and supermarket purchases

There is reasonable concern that self-reported nutrition assessments do not reflect actual food choices. Yet, a correspondence between both is imperative to evaluate any intervention on food preferences. This paper makes such a comparison. It provides evidence from a low-carbohydrate nutrition education program, which is assessed with both surveys and an incentivized behavioral measure of food choice. The main result is that there is a large correspondence between survey and behavioral measures for our sample of 95 women from two historically underprivileged communities in the Western Cape, South Africa. Compared to the control, the treatment group reported a 35% lower intake from the high-carbohydrate/ ultra-processed food Red List and 60% higher intake from the low-carbohydrate whole foods Green List. The treatment group was also 40% less likely to buy anything from the Red List with a supermarket voucher. In terms of the Green List, the treatment group was significantly more likely to buy eggs, organ meat, traditional fats, avocado and fish but there was no difference in red meat and chicken, non-starchy vegetables and full cream dairy. Low-cost incentivized measures of revealed preferences can be designed to validate subjective habits, increasing confidence in the quality of evidence from nutrition intervention studies.

Numerical study on the fragmentation of rock under single free face explosion of variable diameter decoupled charge

Workplace inequities and health outcomes among Black professionals in Canada

Background Anti-Black racism in Canada remains a significant barrier to the career advancement and overall well-being of Black professionals. Despite the existence of policies and legislation aimed at reducing workplace discrimination, Black Canadians continue to face systemic racism, microaggressions, and various forms of discrimination that hinder their professional growth and contribute to a hostile work environment. Objective This study explores the specific manifestations of anti-Black racism in Canadian workplaces, examines the physical and mental health impacts on Black professionals, and investigates the responses and coping mechanisms employed by these individuals in the face of racism. Methods A qualitative study was conducted involving semi-structured interviews with 24 Black professionals from diverse sectors, including healthcare, information technology, academia, and public service. Participants were selected based on their professional experience and self-identification as Black. Data were collected through in-depth interviews, which were transcribed and analyzed using LeximancerTM software to identify recurring themes and patterns. Results The study identified three primary themes: (1) Mechanisms of anti-Black racism, including microaggressions, overt bias, and tokenism; (2) Impacts of anti-Black racism, such as mental health trauma, career stagnation, and exacerbation of chronic health conditions; and (3) Responses of Black professionals, including code-switching, self-preservation behaviors, and early exit from the workplace. The findings reveal that despite high academic achievement and leadership positions, Black professionals face persistent discrimination that affects their career trajectories and personal lives. Conclusion Anti-Black racism in Canadian workplaces is deeply entrenched and continues to negatively impact the lives and careers of Black professionals. The study highlights the need for more effective diversity and inclusion initiatives that address the root causes of racism. Further research is recommended to explore the economic and psychological impacts of anti-Black racism and to develop strategies to mitigate its effects in the workplace.

An enhanced moth flame optimization extreme learning machines hybrid model for predicting CO2 emissions

Dental care trajectories among formerly incarcerated older adults in the United States

A growing body of research has documented an association between prior incarceration and lower dental care use, yet the longitudinal impact of prior incarceration on dental care patterns over time among older adults remains unexplored. This study aims to investigate whether prior incarceration is associated with differing trajectories of dental care use among older adults in the United States. Data were drawn from the 2012-2020 waves of the Health and Retirement Study (HRS), a nationally representative longitudinal survey of older adults in the United States (n =  5,893). Group-based trajectory modeling was used to estimate dental care use patterns over time. The findings revealed dental care patterns followed three trajectories: regular dental care use (48.1%), moderate-declining dental care use (27.3%), and low dental care use (24.6%). Multinomial logistic regression was used to examine the relationship between prior incarceration and membership in these trajectory groups. Bivariate analyses revealed that prior incarceration was significantly associated with higher relative risks of being in the moderate-declining (Relative Risk Ratio [RRR] =  2.75, 95% CI =  2.08-3.63) and low dental care use trajectories (RRR =  2.88, 95% CI =  2.10-3.94) compared to the regular dental care use group. After adjusting for sociodemographic, economic, and healthcare-related covariates, formerly incarcerated individuals had a 1.52 times higher relative risk of belonging to the moderate-declining dental care trajectory (RRR =  1.52, 95% CI =  1.16–1.98). The association between prior incarceration and membership in the low dental care trajectory group was not statistically significant. These findings underscore the need for targeted interventions to address dental care disparities among formerly incarcerated individuals, which could lead to improved oral and overall health outcomes for this vulnerable population.

Effects of field conditions on the degradation of cellulose-based and PLA nonwoven mulches

Abstract The impact of the field conditions on needle-punched mulches made of cellulose fibres and PLA biopolymer during the 300 days of exposure was investigated. The study observed the degradation of nonwoven mulches during specific exposure periods (30, 90, 180 and 300 days), evaluating their mechanical, morphological and chemical properties. The impact of nonwoven mulches on soil temperature and moisture, consequently on the number of microorganisms developed beneath mulches after 300 days of exposure, were analysed and associated with obtained results complementing comprehension of nonwoven mulch degradation. The findings show that nonwoven mulches made from jute, hemp, viscose and PLA fibres change when exposed to environmental conditions (soil, sunlight, rainfall, snow, ice accumulation, air and soil temperatures, wind). The changes include alterations in colour, structure shifts and modifications in properties. The results highlight the degradation pathways of cellulose and PLA mulches, revealing that cellulose-based fibres degrade through the removal of amorphous components, leading to increased crystallinity and eventual structural breakdown. WAXD findings demonstrated that microbial and environmental factors initially enhance crystalline regions in cellulose fibres but ultimately reduce tensile strength and flexibility due to amorphous phase loss. FTIR analysis confirmed the molecular changes in cellulose chains, particularly in pectin and lignin, while SEM provided direct evidence of surface damage and fibre disintegration. Furthermore, it was found that fibre types of nonwoven mulch influence soil moisture retention and soil microbial activity due to a complex interplay of fibre composition, environmental conditions and nonwoven fabric characteristics. Comprehensive mechanical, morphological and chemical results of different types of nonwoven mulch during the 300 days of exposure to the field conditions provide valuable insights into sustainable practices for using nonwoven mulches for growing crops.

Visual digital intermediaries and global climate communication: Is climate change still a distant problem on YouTube?

This article addresses the role of digital intermediaries in visual climate communication, and specifically their contribution to the persistence of a ‘green ghetto’ of traditional communicators and repertoires online. We argue for a comparative sensibility: global platforms convey global issues to global audiences, yet the same platform may distribute conditions of visibility for compelling communication unevenly around the world. The study analyses how a major global visual platform, YouTube (Search), articulates climate change in 232 countries in their official languages. It combines API research, channel coding and computational image analysis to assess the processing and presentation of top-ranked results with respect to their diversity and proximity to local context. The findings show that YouTube Search establishes visibility winners who typically sustain the classic visual repertoire of climate change as a distant problem, and that Global North sources dominate irrespective of region. However, there are notable exceptions to these patterns.

Intranasal administration of a panreactive influenza antibody reveals Fc-independent mode of protection

Agroforestry adoption and its influence on soil quality under smallholder maize production systems in western Kenya

Agroforestry, a sustainable land use practice, was introduced in western Kenya in the early 1990s as a soil fertility replenishment strategy. Since then, the effect of the practice on soil quality has seldom been evidenced. A study was conducted to assess the impact of agroforestry adoption on soil quality under smallholder maize systems in the region. Soil samples were collected from two land use practices: agroforestry adoption (90) and non-agroforestry adoption (30) at 0–30 cm depth from two locations (Busia and Kakamega counties). Results showed variations in soil characteristics between the study locations. Soils in Kakamega contained higher concentrations of soil organic carbon (SOC), exchangeable cations, and micronutrients. On average, agroforestry adoption significantly (P ≤ 0.05) improved soil physicochemical properties. Under agroforestry adoption, bulk density (BD) reduced by 21% (from 1.4 to1.1 g cm -3 ), while (SOC) increased by 75% (0.8–1.4%), P by 80% (3.0–5.4 mg kg -1 ), exchangeable K by 256% (0.3–8.0 cmol kg -1 ), Ca by 100% (1.0–2.0 cmol kg -1 ), S by 50% (0.2–0.3 mg kg -1 ), and Cu by 18% (2.8–3.3 mg kg -1 ). Agroforestry adoption significantly increased K and Cu levels above the critical thresholds of 0.4 cmol kg -1 and 1.0 mg kg -1 , respectively, at both locations. Sesbania sesban and Leucaena leucocephala influenced soil BD, pH and P (4.3.-7.0 mg kg -1 ), exchangeable K (0.4–0.7 cmol kg -1 ), Mg (0.1–0.2 cmol kg -1 ), and Mn (13.5–25.2 mg kg -1 ) at both locations, while Calliandra calothyrsus significantly increased SOC in Kakamega only. These findings highlight the significance of agroforestry in soil fertility management. Furthermore, Sesbania proved to be effective in enhancing the characteristics of soils at both sites, hence, the need for its inclusion in agroforestry extension messages. Further studies are needed to understand nutrient release mechanisms from agroforestry biomass and their influence on soil characteristics and maize yield in smallholder farming systems.