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Determinants and barriers in early tuberculosis treatment in children at a primary health care facility in Kampala, Uganda; A mixed methods study
Background Tuberculosis (TB) remains a leading cause of mortality worldwide, with childhood TB posing unique diagnostic challenges due to its pauci bacillary nature. The World Health Organization emphasizes that these diagnostic difficulties hinder early detection, contributing to delays in treatment initiation, disease progression, and increased morbidity and mortality. Addressing these challenges is critical to achieving the global goal of ending TB as a public health threat by 2030. This study aimed to determine the median time to TB treatment initiation and explore the factors influencing early treatment among children under 15 years at Kisenyi Health Center IV. Methods We conducted a retrospective cohort mixed-methods study. Quantitative data were obtained through a retrospective review of medical records for 152 children under 15 years treated for TB at Kisenyi Health Center IV between February 1, 2021, and February 28, 2023. The median time to treatment initiation was estimated using Kaplan-Meier survival analysis, while Cox proportional hazards regression identified determinants of treatment initiation. Qualitative data were collected through key informant interviews with healthcare workers involved in childhood TB care. Thematic analysis, guided by the Capability, Opportunity, and Motivation Behavior (COM-B) model, was used to identify barriers to early TB treatment. Results A total of 152 children were included in the study. The median time to TB treatment initiation was 39.5 days (IQR: 30,80.9). Pulmonary bacteriologically confirmed TB was the only significant determinant of early treatment initiation (HR: 0.54, 95% CI: 0.31–0.88). Key barriers to timely TB treatment included caregivers’ poor knowledge of childhood TB, referral of children under five to the national referral hospital, inadequate diagnostic equipment and supplies, loss of community follow-up contacts, and high patient volumes. Conclusion Children with TB experience significant treatment delays, underscoring the urgent need for more accessible and rapid diagnostic tools to increase the proportion of bacteriologically confirmed cases and reduce treatment initiation time. Strengthening decentralized TB diagnostic capacity and enhancing caregiver awareness could improve early detection and treatment outcomes.
Evaluating the effects of volume censoring on fetal functional connectivity
Abstract Advances in neuroimaging have enabled non-invasive investigation of fetal brain development in vivo. Resting-state functional magnetic resonance imaging (rs-fMRI) has provided critical insights into emerging brain networks in fetuses. However, acquiring high-quality fetal rs-fMRI remains challenging due to the unpredictable and unconstrained motion of the fetal head. Nuisance regression, where the brain signal is regressed onto translational and rotational head motion parameters, has been widely and effectively used in adults to reduce the influence of motion. However, subsequent studies have revealed that associations between head motion and large-scale brain functional connectivity (FC) persisted even after regression. In ex utero groups (e.g., newborns, toddlers, and adults), censoring high-motion volumes has shown effectiveness in mitigating such lingering impacts of head motion. While censoring high motion volumes has been utilized in fetal rs-fMRI, a systematic assessment of the effectiveness of regression and censoring high motion volumes in fetuses has not been done. Establishing the effectiveness of censoring in fetal rs-fMRI is critical to avoid possible bias in findings resulting from head motion. To address this knowledge gap, we investigated the associations between head motion and fetal rs-fMRI at different analysis scales: blood oxygenation level dependent (BOLD) time series and whole-brain FC. We used a dataset of 120 fetal scans collected from 104 healthy fetuses. We found that nuisance regression reduced the association between head motion, defined by frame-by-frame displacement (FD) of head position, and BOLD time series data in all regions of interest (ROI) encompassing the whole brain. Nuisance regression, however, was not effective in reducing the impact of head motion on FC. Fetuses’ FC profiles significantly predicted average FD (r = 0.09 ± 0.08; p < 10–3) after regression, suggesting a lingering effect of motion on whole-brain patterns. To dissociate head motion and the FC, we used volume censoring and evaluated its efficacy in correcting motion at different thresholds. We demonstrated that censored data improved resting state data’s ability to predict neurobiological features, such as gestational age and sex (accuracy = 55.2 ± 2.9% with 1.5 mm vs. 44.6 ± 3.6% with no censoring). Collectively, our results highlight the importance of data censoring in reducing the lingering impact of head motion on fetal rs-fMRI, thus attenuating motion-related bias. Like older age groups such as neonates and adults, combining regression and censoring techniques is recommended for large-scale FC analysis, e.g., network-based analysis, for fetuses.
Seasonal dynamic of ticks infesting cattle (Bos indicus) farms in two provinces in Cambodia
Cattle tick infestations pose a significant threat to livestock health and productivity worldwide. These parasitic arthropods, feed on blood and may cause various diseases in cattle, such as anaplasmosis, babesiosis, ehrlichiosis, and theileriosis. The objective of this study is to understand the seasonal dynamic and distribution patterns of tick infesting cattle in Cambodia. A longitudinal tick survey was conducted from January to December 2023 in two cattle farms in the Takeo and Kampong Speu provinces. Ticks were collected directly from the animal hosts with fine-tip forceps or specialized tools such as tick twisters, and from the vegetation using a combination of dragging and flagging method. A total of 13,678 ticks were collected from 240 inspected cattle and 11,384 ticks were found from vegetation around the two farms. The most prevalent species was Rhipicephalus microplus complex (60.6%), while R. haemaphysaloides was recorded in small numbers (0.4%). Unidentified species represented 39% of the collected ticks, consisting of immature Rhipicephalus spp. In addition, one adult Rhipicephalus linnaei, 245 immatures of Haemaphysalis spp., and 11,138 larvae of Rhipicephalus spp. were collected using dragging and flagging methods. The results revealed significant seasonal differences in tick population dynamics across both provinces, with 60.24% in Kampong Speu and 57.09% in Takeo during the rainy season, compared to 39.76% and 42.91% during the dry season. Statistical analysis on questing activity showed no significant differences in tick density across different collection sites, times of the day and province. Our findings indicate a very high density of tick-borne pathogen vectors was observed on cattle in the two farms, which a poses potential risk to cattle productivity in Cambodia.
Impact of age, HIV1, sickle-cell genotypes, and interferon-gamma gene upstream variants on malaria disease outcomes in a longitudinal pediatric cohort
Physical and financial access challenges to seeking child healthcare in a rural district in Ghana
Introduction Timely access to available, and affordable essential child healthcare services is important to ensure the well-being of children under five years. However, healthcare systems in low- and middle-income countries like Ghana struggle to realise this goal because of the accessibility challenges that confront the system. Aim To explore the experiences of nurses and caregivers about the physical and financial challenges to accessing child healthcare services in a rural district in Ghana. Methods The study employed a qualitative approach using an exploratory descriptive design to collect data from nurses and caregivers of children under five years of age in the Nkwanta South Municipality, Ghana. Data collected through semi-structured interviews were analysed using qualitative techniques and the results presented in themes and sub-themes. Results The financial challenges to seeking child healthcare were the high costs of child healthcare services and challenges with health insurance ownership. Limited operational hours, long distances, and transportation difficulties to health facilities were the main health facility and physical access challenges to seeking child healthcare. Conclusions The physical and financial access challenges that confronted caregivers of children under-five years of age contributed to delays and non-utilisation of child healthcare services in various of ways. This situation largely contributed to the inadequate child health services utilisation experienced in rural areas. Addressing these challenges could enhance child healthcare access and improve the state of child health.
Dietary patterns and colorectal cancer: a multicenter case-control study in an Iranian population
The impact of spaced learning within physics lessons in secondary schools
Spaced learning (SL) involves distributed learning with timed distraction breaks unrelated to the learning input. These breaks are thought to facilitate consolidation of novel information in long-term memory by accommodating post-activation neural recovery and biochemical changes in potentiation. Applications of SL have become commonplace across UK teaching and feature in government guidance, although there have been few research trials, especially within secondary schools, and none addressing physics independently. However, past research with 14–16-year-old students in England found that interspersing a fast-paced video input with ten-minute distraction breaks in a standard hour-long biology lesson yielded exam performance equivalent to regular teaching across many months. The present study adapted this regime to learning a novel physics topic, atomic structure, including radioactive decay, part of pre-16 compulsory science education in England. An in-class video covered all of the subject content in a single one-hour lesson, with three learning inputs, of length 11 - 14 minutes, interspersed with ten-minute distraction breaks. As well as ‘business as usual’ controls, the research included groups that only experienced the SL lesson, and those who were exposed to it prior to traditional teaching. Impact on learning was assessed using tests similar to state examinations taken at the end of a two-year physics course. Six non-selective state (non-fee charging) schools with varying demography were invited to join the study to ensure the sample was representative of the 93% of students who attend such schools in England. In total, 336 students completed all pre- and post-intervention (immediate and delayed) tests. Students studying combined sciences and separate physics were divided into groups cutting across conditions, with the former taking a shorter test. SL led to immediate benefits for separate physics students, but the SL only group showed no further gain at delayed post-test, with performance then equal to controls, as in past work. However, the SL plus group exhibited additional gains, 50% to 90% greater than the other groups at delayed post-test, following traditional teaching. Among combined science students, the SL plus group showed gains at delayed post-test 60% greater than controls. These effects were consistent across different schools. The implication is that SL provides a foundation for subsequent learning, often doubling its efficiency regardless of context, and that it does so with minimal additional input.
Artificial intelligence-driven cybersecurity system for internet of things using self-attention deep learning and metaheuristic algorithms
Waiting times for outpatient visits during military conflict: An observational study
Background Environmental events, including military conflicts, may dramatically affect a hospital’s ability to provide routine treatments while maintaining reasonable waiting times. Objective To examine the impact of a military conflict (“Protective Edge”, PE) on the volume of activity and waiting times for outpatient clinics in a tertiary medical center. Methods Outpatient visits during PE (July-August 2014) were compared to outpatient visits during July-August 2013 (pre-conflict period) and 2015 (post-conflict period) with regards to the daily number of visits and waiting times. Clinics with at least 5,000 annual visits were included. Quantile regression adjusted for confounders was used for the multivariable models, in a stratified analysis by specialty. Results There were 87,495 outpatient visits during PE and 197,029 visits during the pre- and post-conflict periods. An 11% decrease in the daily number of visits was noted (ranging from 6% decrease in oncology and cardiology to 19–20% decrease in psychiatry and pediatrics). During PE, statistically significant longer waiting times were found for surgery (+1.0 day) and imaging (+1.1 days), while a 2.4 days decrease was noted in pediatrics, controlled for age, sex, ethnicity and the daily number of visits. Median waiting times were unchanged for cardiology, medicine, psychiatry and cardiology. Conclusions In the midst of a continuing military conflict, there was a notable increase in outpatient visit waiting times in some disciplines, but not all, despite a reduction in the overall volume of visits. Investigating whether similar impacts on patient care occur during other military conflicts or pandemics necessitates further research.
Magnetic properties of polymeric acrylic acid hydrogel dosimeter for radiotherapy applications
Linear infrastructure drives biotic homogenization among bird species of a tropical dry forest
Linear infrastructures (LIs) such as roads, railroads, and powerlines are expanding rapidly around the globe. While most future developments are projected to take place in tropical regions, available information on impacts of LIs is biased towards single species studies of solely road impacts in temperate regions. Therefore, we investigated impacts of three types of LIs (road, railroad, and powerline) on the bird community of a tropical dry forest. Point-count surveys to record avian richness and abundance were conducted at 80 plots that were spatially stratified to include sites proximate to all possible LI combinations. Five measures of vegetation structure were collected at each plot as well. We then assessed the relationship between the bird community (i.e., richness, abundance, composition) and distance to each LI type while accounting for variation in vegetation structure. Species richness and abundance both declined significantly (26% and 20%, respectively) from edge habitat next to railroad to interior forest plots, while community composition was significantly altered by the distance to all three LIs. Road and railroad (both forms of dynamic infrastructure with moving vehicles) had similar effects on the bird community that contrasted with those of powerline (a type of static infrastructure). The resulting ordination reveled that Sri Lankan endemics are significantly disfavored by LI proximity, while species that now have naturalized populations across the globe are most often found proximal to LI. Our results emphasize that LI drive biotic homogenization by favoring these increasingly widespread species at the expense of unique elements of the biota.
Group decision-making framework using generalized heronian mean operators in quasi rung orthopair fuzzy environment with applications
Socioeconomic inequalities in childhood and adolescent obesity in Australia: The role of behavioral and biological factors
Background Obesity among children and adolescents is a significant public health concern, influenced by a complex interplay of biological and behavioral factors. However, the extent to which these factors contribute to socioeconomic disparities in obesity remains inadequately understood. Therefore, this study aimed to elucidate the roles of behavioral factors —such as dietary habits, physical activity levels, and outdoor activities—alongside biological factors, including parental body weight, in shaping socioeconomic inequalities in obesity among Australian children and adolescents. Methods This study utilized data from the Birth Cohort (n=5101) and Kindergarten Cohort (n=4983) of the Longitudinal Study of Australian Children (LSAC). LSAC data have been collected biannually since 2004 for the B cohort and since 2000 for the K cohort. The study employed Concentration Index and Decomposition Index analyses to assess the magnitude and to identify the relative contributions of socioeconomic inequalities in obesity, focusing on the contributions of behavioral and biological factors. Results The analysis revealed that socioeconomic disparities in obesity among children and adolescents were significantly influenced by both biological and behavioral factors, as well as household income. Biological factors were found to account for 28.96% of these disparities, while household income contributed 49.17%, and behavioral factors explained 10.36% of the inequalities. Moreover, non-consumption of fatty foods and outdoor activities were found to be associated with a decrease in obesity by β:−0.317, β:−0.084, respectively. However, non-consumption of fruits and vegetables and maternal BMI were significantly correlated with an increased risk of obesity in children (β:0.406) and adolescents (β:0.117) respectively. Conclusion These findings provide critical insights into the distribution of obesity across different socioeconomic groups in Australia, highlighting the substantial role of household income and the combined impact of biological and behavioral factors. The results emphasize the importance of developing targeted public health interventions that support families from lower socioeconomic backgrounds to reduce obesity-related disparities.
Tuberculosis detection using few shot learning
Assessing the impact of global warming on the distributions of Allium stipitatum and Kelussia odoratissima in the Central Zagros using a MaxEnt model
Global warming is an undeniable fact occurring in different parts of the world. Climate changes can have irreversible effects on plant communities, particularly on endemic and endangered species. Therefore, it is important to predict the impact of climate change on the distribution of these species to help protect them. This study utilized the MaxEnt model to forecast the impact of climate change on the distributions of two medicinal, edible, and aromatic species, Kelussia odoratissima and Allium stipitatum, in Chaharmahal and Bakhtiari province. The study used the CCSM4 general circulation model along with two climate scenarios, RCP2.6 and RCP8.5, for the 2050s and 2070s to predict the potential impact of climate change on the distribution of the species studied. The research findings indicated that the model performed effectively for prediction (AUC≥0.9). The primary environmental variables influencing species distribution were found to be isothermality (Bio3), soil organic carbon, and pH for A. stipitatum, and soil organic carbon, precipitation seasonality (Bio15), and precipitation of the wettest month (Bio13) for K. odoratissima. The findings suggest that the distribution of the studied species is expected to decline in the 2050s and 2070s due to climate change, under both the RCP2.6 and RCP8.5 climate scenarios. The research indicates that climate change is likely to have a significantly negative effect on the habitats of these species, leading to important ecological and socio-economic impacts. Therefore, our study emphasizes the urgent need for conservation efforts to prevent their extinction and protect their habitats.
Improved YOLOv8n-based bridge crack detection algorithm under complex background conditions
Do pay-for-performance schemes improve quality in community pharmacy? A mixed-methods study exploring stakeholder perspectives on implementation of the nationwide Pharmacy Quality Scheme (PQS) in England?
Main study objectives To evaluate implementation and impact (at pharmacy and system level) of the pharmacy quality scheme (PQS), a pay-for-performance quality incentive scheme in community pharmacies in England since 2017. Methods Mixed-methods evaluation. Three linked datasets for 2021/22 (n = 10,135) were analysed for impact of pharmacy size, type (independent, chain, supermarket), location, prescription volume, and region on PQS participation, domains completion and payments. Forty-one qualitative interviews conducted with pharmacists, employers and representative bodies explored views and experiences of PQS implementation and impact. Harrington et al.‘s conceptual framework for evaluating community pharmacy pay-for-performance programmes guided qualitative data analysis. Results Nearly all community pharmacies in England participated in PQS, with differences identified between chains (99% participation) and independents (16.5%), with income via PQS being an important motivator. Interviewees agreed with policy-makers about the purpose of the PQS being patient safety, patient experience, and clinical effectiveness. Beyond these core dimensions, consistency of service provision, sustainability, and wider system integration were considered important. While PQS was largely viewed as positively impacting pharmacy teams, clinical practice, and patient care, interviewees felt that increasing workloads across the sector made it challenging to focus on quality. They felt that there was a lack of feedback, that impacts were not always visible, and indeed frontline pharmacists were often not aware of published evidence of PQS impacts. Multiple sources of guidance lead to duplication and confusion. Particularly independent pharmacies found PQS workload burdensome and complex. Conclusion The primary incentive for PQS engagement revolved around income stability for employers, with some positive impact achieved, but obstacles concerning resource implications and sustainability persist. Considering concerns about the viability of community pharmacy and the importance of increasing the scope of pharmaceutical services, these implementation challenges should lead policy-makers to question how best to incentivise quality.
Clinical and genetic analysis of oral and nasal staphylococcus aureus isolates in dental patients
EGF and IgA in maternal milk, donor milk, and milk fortifiers in the neonatal intensive care unit setting
Human milk contains a variety of factors that positively contribute to neonatal health, including epidermal growth factor (EGF) and immunoglobulin A (IgA). When maternal milk cannot be the primary diet, maternal milk alternatives like donor human milk or formula can be provided. Donor human milk is increasingly provided to infants born preterm or low birth weight with the aim to supply immunological factors at similar concentrations to maternal milk. We sought to assess the concentrations of human EGF and IgA in the diet and stool of neonates between exclusive maternal milk, donor human milk, or formula-based diets. Using a prospective cohort study, we collected samples of diet and stool weekly from premature and low birth weight neonates starting at 10 days postnatal through five weeks of life while admitted to a neonatal intensive care unit (NICU). Compared to formula, there was significantly more EGF in both the milk and the stool of the infants fed human milk. Donor milk pooled from multiple donors contained similar concentrations of EGF and IgA to maternal milk, which was also significantly more than formula diets. Maternal milk supplemented with a fortifier derived from human milk contained significantly more EGF and IgA compared to unfortified maternal milk or maternal milk supplemented with fortifier derived from bovine milk. Further analysis of human milk-derived fortifiers confirmed these fortifiers contained significant concentrations of EGF and IgA, contributing to an increased concentration of those factors that bovine milk-derived fortifiers do not confer. These findings illustrate how the choice of diet for a newborn, and even how that diet is modified through fortifiers or pasteurization before ingestion, impacts the beneficial biomolecules the infant receives from feeding.