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LXNet: A lightweight CNN for lung disease classification from Chest X-ray with XAI-based interpretability
The diagnosis of lung diseases such as pneumonia and tuberculosis remains a major global health challenge, especially in resource-limited regions. Artificial Intelligence (AI) has shown strong potential in analyzing Chest X-Rays (CXR) for accurate and timely diagnosis, but most existing models are computationally heavy and lack interpretability, limiting their practical application. In this study, we present LXNet, a lightweight and explainable Convolutional Neural Network (CNN) for nine-class lung disease classification ( Normal , Pneumonia , Higher Density , Lower Density , Obstructive Pulmonary Diseases , Degenerative Infectious Diseases , Encapsulated Lesions , Mediastinal Changes and Chest Changes ). The model was evaluated on a diverse CXR dataset containing 6,743 images collected from a private imaging center (GRS Imagem, Brazil), enabling comprehensive multiclass assessment. LXNet contains only 0.35 million parameters and employs a no-pooling final block to preserve subtle diagnostic features while maintaining very low computational cost. Robustness was enhanced through adaptive Contrast Limited Adaptive Histogram Equalization (CLAHE), grayscale normalization and stratified class balancing. LXNet was benchmarked against pretrained CNNs (DenseNet201, ResNet50V2 and InceptionV3) under identical settings. Explainable AI (Grad-CAM, Score-CAM and LIME) provided meaningful visualizations. LXNet achieved 96.1% accuracy in 5-fold cross validation, outperforming the baselines (DenseNet201: 90.3%, InceptionV3: 88.9%) by 1–8%, with only 308 seconds of training on standard hardware. Statistical significance was confirmed using Wilcoxon signed-rank tests ( p = 0.03125). These results demonstrate LXNet’s promising performance and interpretability; however, reduced external performance indicates limited generalizability and its clinical applicability requires further validation.
Discharge after coronary artery bypass grafting: A qualitative study highlighting the need for individualised, person-centred care
Background This study explores patient preparedness and support during discharge following coronary artery bypass graft (CABG) surgery. Despite the importance of effective discharge planning, many patients feel unprepared and unsupported, which can hinder recovery and increase readmission risk. Aim To examine patient experiences of the discharge process post-CABG, focusing on education received and perceptions of person-centred discharge planning. Methods A qualitative study using constructivist grounded theory was conducted with eleven participants, interviewed 4–6 weeks post-surgery at a UK Northern NHS hospital. Semi-structured interviews were digitally recorded, transcribed, and analysed using a constant comparative method. Recruitment, data collection, and analysis occurred concurrently. Despite the modest sample size, the study achieved strong information power as the research aim was narrow and clearly focused on exploring the lived experiences of patients who had had a coronary artery bypass graft. This allowed for in-depth engagement with each participant, with relevant experience, enhancing the relevance and the richness of the data. Thematic saturation was observed early in the analysis, indicating that the data sufficiently addressed the research questions. The use of a rigorous analytical approach further ensured that the insights drawn were both meaningful and robust, supporting the adequacy of the sample size. The COREQ checklist guided reporting. Results Four key themes emerged: Patients avoided seeking support or “making a fuss.” Many felt unprepared for discharge. The information booklet was a valuable resource. Lack of post-discharge contact and continuity caused concern. Some participants reported insufficient pre-discharge information and unclear pathways for post-discharge support. The booklet was often the primary source of guidance. The participants’ reluctance to seek support could reflect a pattern of self-management shaped by uncertainty, low confidence, a desire not to burden healthcare professionals or a belief that doctors know best. Yet many felt unprepared for discharge perhaps highlighting gaps in communication and discharge planning. There also seems a reliance on written materials, such as the information booklet. Limited post- discharge contact, created further anxiety, where patients were unsure where to turn for advice. These findings point to the need for clearer, more person‑centred discharge processes. Better communication, improved pre‑discharge education, and clear pathways for follow‑up support could strengthen patient confidence and safety. Although booklets are helpful, they should supplement and not replace ongoing contact and personalised guidance. Ensuring continuity of care and enabling patients to seek help without hesitation is essential for effective person‑centred discharge practice. Conclusion Findings highlight the importance of person-centred approaches in discharge planning. Tailored education and support could improve patient confidence and symptom management during recovery, potentially reducing readmission rates.
Quality assessment of endotoxin contamination in consumables used for assisted reproductive technology
Commercially available disposable products such as cell culture utensils and catheters do not necessarily possess sufficient quality for in vitro fertilization (IVF), from the perspective of pyrogen contamination. We aimed to comprehensively analyze the pyrogen contamination status, including bacterial endotoxins, of the products used for IVF in assisted reproductive technology (ART) and improve their cleanliness using a new sterilization technology. Pyrogen contamination levels were evaluated using a direct human cell-based pyrogen test that is not affected by the recovery ratio, unlike bacterial endotoxin tests. Pyrogen inactivation tests were performed using low-temperature ozone/hydrogen peroxide gas treatment. The residual hydrogen peroxide was colorimetrically quantified, and the effectiveness of its removal by drying treatment was evaluated using germ cell viability as an indicator. Significant amounts of pyrogen, from 0.014 to 1.110 EU/product, were detected in seven of the twenty products. Pyrogen contamination levels were reduced below the detection limit by ozone/hydrogen peroxide gas sterilization. Hydrogen peroxide remained on the surface of the GPS dish but was reduced to a level that did not affect human sperm viability and embryo development after drying at 80°C for 24 h following sterilization. These products may carry a potential risk of reducing ART success rates, and pyrogen contamination levels may exceed the previously reported allowable level of 0.01–0.02 EU/mL in human IVF during actual use. Our study suggests that the manufacturing of products free from pyrogens and without adverse effects on germ cells is possible using ozone/hydrogen peroxide gas sterilization and subsequent drying technologies.
Diet quality determinants among manufacturing workers in Brazil: Socio-demographic factors, food choices, and ultra-processed foods
This study evaluated the association between diet quality and socio-demographic factors, anthropometric measures, food choices, and consumption of processed foods in a low-income Brazilian manufacturing worker population, addressing gaps in evidence from low- and middle-income countries (LMICs). A cross-sectional study was conducted with 921 workers from 33 industries in Rio Grande do Norte, Brazil, selected via stratified proportional and multi-stage sampling. Diet quality was assessed using the Diet Quality Index-International (DQI-I), which evaluates variety, adequacy, moderation, and balance. Dietary intake was measured via 24-hour recalls, and foods were classified by processing level (NOVA system). Socio-demographic, anthropometric, and food choice data (using the Food Choice Questionnaire) were collected. Associations were analyzed using multilevel linear regression. Higher diet quality was associated with being male (p = 0.001). Among women, diet quality improved with age (p = 0.018) and participation in a food assistance program (p < 0.001), whereas those variables showed no association among men. Prioritizing natural food content predicted higher DQI-I scores in both sexes (p < 0.05), while weight control was significant only for women (p = 0.034). Unprocessed food intake showed a positive association (p < 0.001) with diet quality, whereas ultra-processed food consumption was inversely associated (p < 0.001), most notably with diet variety and adequacy in both sexes, and with moderation in women. Food choices also influence diet quality, with people who value health benefits, natural content, weight control, and familiar products being more likely to consume diets with better variety and adequacy. No significant associations were found between diet quality and anthropometric measures. Socio-demographic factors, food choices, and levels of food processing significantly influence diet quality in this low-income Brazilian population. Public health strategies targeting reductions in ultra-processed food consumption and supporting food assistance programs may improve dietary patterns, particularly among women. These findings highlight the need for context-specific interventions to address nutrition transitions in LMICs.
Suicide mortality in eastern and western Germany, 1952–2022: Construction and validation of time series using joinpoint models with jump detection
Suicide mortality is a significant public health problem. Retrospective analyses can be helpful in better understanding temporal trends of suicide mortality and thus derive clues about causal and associated factors for the course. For this paper, we compiled suicide mortality rates for eastern and western Germany from 1952 to 2022 from various data sources, stratified by sex. The period encompasses events that could substantially alter the statistically recorded rates, such as the changes in versions of the International Classification of Diseases (ICD) in 1978 and 1997, but also the integration of the statistical system of the German Democratic Republic (GDR) into that of the Federal Republic of Germany (FRG) in 1990/91. These could cause methodologically induced breaks in the compiled time series. Using Joinpoint-Jump models, we tested whether at these defined points a jump, i.e., an abrupt change in the level of the time series, can be statistically detected or rejected. The empirical results show a high dynamism of suicide mortality in both parts of Germany, with very frequent increases and decreases of suicide mortality rates. However, the analyses do not point to systematic and substantial methodologically induced structural breaks resulting from ICD version changes or from transferring of the GDR statistical system to that of the FRG. The analysis results support the conclusion that the compiled long time series for eastern and western German women and men are largely consistent. It is unlikely that analyses of trends in suicide rates in Germany during that period are distorted by methodological artefacts examined. Some caution is warranted for women during periods of ICD code changes, although any methodological effects are likely small and within the range of typical annual fluctuations.
Unveiling the psychological network of work alienation among nursing interns: A resource conservation perspective and network analysis
Background Clinical internship is critical for nursing students, but heavy workload and emotional demands increase the risk of work alienation. Traditional linear models fail to capture complex interrelationships among psychological factors. Objective To apply psychological network analysis to explore the associative structure of work alienation in nursing interns, identifying central and bridge nodes to generate hypothesis‑generating intervention priorities. Methods A cross-sectional survey was employed. Nursing interns from four tertiary hospitals in the Guanzhong region of Shaanxi Province were recruited via convenience sampling from January to August 2025. Data were collected using the Nurse Work Alienation Scale, Compassion Fatigue Scale, Moral Distress Scale, Ethical Sensitivity Questionnaire for Nursing Students, and NASA Task Load Index. A total of 934 valid responses were obtained. A regularized partial correlation network model was estimated using the EBICglasso method (γ = 0.5). Node strength and bridge strength were calculated, and stability was assessed via bootstrap. Results Node strength analysis identified personal responsibility (1.19), burnout (1.18), and failure to maintain patient’s best interest (1.13) as the three most central nodes. Bridge strength analysis revealed secondary traumatic stress (STS) as the strongest bridge (0.43, 95% CI [0.31, 0.55]), followed by perceived workload (0.38) and self‑evaluation (0.38). Subgroup network comparisons showed no significant structural differences by gender, age, or education (all p > 0.05). Stability analysis confirmed good robustness for centrality estimates. Conclusion Psychological network analysis mapped the associative structure of work alienation, identifying personal responsibility, burnout, and STS as key hub and bridge nodes. These findings offer hypothesis‑generating targets for future interventions (e.g., trauma‑informed care, workload management, self‑efficacy enhancement), pending validation in longitudinal studies.
Prevalence and risk factors of adverse birth outcomes in Bangladesh: Insight from a nationwide survey
Background Adverse birth outcomes are significant public health concern in Bangladesh and can severely affect the health and wellbeing of children in later life. This study aimed to assess the prevalence of adverse birth outcomes (i.e., stillbirth, preterm birth, low birth weight (LBW), neonatal death) and identify the associated factors among the Bangladeshi population. Methods The study utilized nationally representative data from the Bangladesh Demographic and Health Survey (BDHS) to analyze index pregnancy outcomes for 10,254 ever-married women. The prevalence and associated factors of both composite and individual adverse outcomes were determined using appropriate statistical procedures. Results The findings indicate that 14.3% of pregnancies resulted in LBW, while 8.9% resulted in preterm birth, followed by stillbirths (1.3%) and neonatal deaths (1.3%). Overall, 14.2% of births were associated with at least one adverse outcome. Household wealth index, place of delivery, twin births, maternal desire, and regional factors were found to be associated with LBW. Factors affecting preterm birth included cesarean section delivery, wealth index, twin births and maternal desire to have children. Regarding stillbirths, associations were found with the cesarean section delivery, and twin births. For neonatal death, factors associated included cesarean section delivery, twin birth, and maternal desire. Lastly, the composite score of adverse birth outcomes was associated with wealth index, history of terminated pregnancies, place of delivery, decision-making autonomy, region, twin births, and maternal desire. Conclusion One in seven births in Bangladesh involved at least one adverse outcome, with LBW being the most prevalent. Socioeconomic disadvantage and limited women’s decision-making autonomy were consistently associated with adverse outcomes. Policies should prioritize equity-oriented maternal care, strengthen women’s autonomy, and ensure appropriate use of obstetric interventions.
Health system strategies and responses to the effects of Climate Change in Sub-Saharan Africa: A scoping review
Background Climate change is now regarded as a global health challenge of the 21st century, posing a negative health risk to the population. Sub-Saharan Africa is disproportionately affected more than any other region worldwide. Mapping strategies and responses in Sub-Saharan Africa to address the impact of climate change on health systems is a starting point for understanding evidence-based decision-making and informing best practices. Methods We conducted a scoping review to identify health systems strategies and responses to the effects of climate change in Sub-Saharan Africa. Electronic database searches were conducted on African Index Medicus, PubMed, CINAHL, and Scopus. Covidence software was used to remove duplicates, blind study selection, and data extraction. We included peer-reviewed articles (original quantitative and qualitative studies, mixed methods studies, reviews, editorials, and commentaries) published between 2011 and 2025. All book chapters and grey literature publications (dissertations, conference proceedings, abstracts, and reports) that primarily focus on climate change strategies and responses without effects on health systems were excluded. The results were analysed using descriptive thematic analysis. Results Out of 11459 articles, 8 studies met our inclusion criteria. Most studies provided strategies and responses centered on service delivery, health workforce, health information, leadership and governance, with few on health financing and medicinal products. No study was identified that had outlined strategies and responses across all of the six World Health Organisation building blocks for the health systems. Implementation challenges identified include inadequate funding, lack of knowledge among health workers on climate change and health, inadequate surveillance and reporting structures, and low prioritization of climate change activities among health workers. Conclusions This scoping review has identified some health system strategies and responses to the effects of climate change within the Sub-Saharan African region. The review has revealed that existing strategies and responses are fragmented and hindered by some implementation challenges. As climate change continues to pose health threats to the global population, urgent and effective interventions are required to minimize its impacts. It is essential to understand the unique vulnerabilities of the health systems, particularly those in the Sub-Saharan African region. The time is now to develop strategies and responses that can improve and strengthen health systems as it protects health of the population from the effects of climate change.
Factors influencing the participation of people with disabilities in digital skills training in Poland
The modern world is largely built around the use of digital technologies, which are present in life. The effective use of such technologies requires appropriate competences. People with disabilities, like everyone else, require access to digital technologies to fully participate in modern life. However, considering user diversity and the accessibility of digital technologies, digital competence training can play a key role. Therefore, the aim of this article is to present the determinants of participation in digital skills training among people with disabilities in Poland. To identify these factors, a questionnaire-based study was conducted with a group of 449 people with different disabilities. Logistic regression analysis revealed that perceived availability of accessible training significantly affects participation. When training is seen as inaccessible, the likelihood of participation decreases significantly by more than 70%. These findings highlight the need to improve the accessibility of digital skills training to ensure equal opportunities for all.
Shear strength characteristics of muddy interlayers with different water contents and particle size distributions
As a common weak structural plane, muddy interlayers often govern the stability of consequent bedding rock slopes (CBRSs). This study investigated the influence of water content (WC) and particle size distribution (PSD) on the shear strength characteristics of muddy interlayers in CBRSs. A series of CUTS tests was conducted to investigate the strength properties of remolded soil samples for muddy interlayers under WC and PSD conditions, and the maximum information coefficient (MIC) was used to evaluate the effects. The results revealed that under constant PSD, cohesion initially increased, subsequently decreased, and ultimately stabilized with increasing WC, whereas the internal friction angle (φ) consistently reduced. Under constant WC, increasing the proportion of soil particles (2–4 mm) from 0% to 40% reduced cohesion but increased φ. When the PSD changes, the coefficient of curvature ( C c ) positively affects cohesion but increases φ, whereas increasing the coefficient of uniformity ( C u ) has the opposite effect. MIC analysis revealed that changes in shear strength parameters due to variations in C c and C u were far greater than those caused by WC, highlighting the dominant role of PSD in controlling shear strength. These findings provide valuable insights for assessing the stability of rock slopes with muddy interlayers of similar compositions.
Mechanical properties and fire resistance of composite bamboo materials heat-treated with MOS gelling adhesive at different temperatures
Given the flammability and insufficient MPs of natural bamboo, this study uses Magnesium Oxysulfate (MOS)-Gelling Adhesive (MOS-GA) to prepare high-performance composite bamboo, and examines the effects of various temperature treatments on the MPs and fire resistance of MOS-GA composite bamboo. The results showed that MOS-GA had the best MPs after heat treatment at 400°C. After 7 days of curing, the CS of the specimen ranged from 90.02 MPa to 92.37 MPa, and the FS ranged from 9.52 MPa to 9.67 MPa. The MPs at 600°C decreased, the CS dropped to 10.17 MPa-18.24 MPa, and the FS dropped to 2.08 MPa-3.02 MPa. When treated with MOS-GA at 400°C, the composite bamboo material had a maximum along-grain CS of 79.36 MPa, and a TS and FS of 33.45 MPa and 72.12 MPa. The fire resistance limit of the specimen treated at 400°C reached 98 min, the charring depth was 35.2 mm at 100 min, the internal temperature distribution was reasonable, and it showed good thermal insulation performance and structural integrity. Research shows that moderate heat treatment temperature can effectively balance the MPs and fire resistance of MOS-based composite bamboo, providing a theoretical basis for its application in green fire-resistant buildings.
Factors affecting well-being among retired older adults: A protocol for an umbrella review
Background As global populations age, retirement has emerged as a critical life transition influencing well-being across physical, mental, social, financial, and spiritual domains. Although numerous systematic reviews have examined aspects of well-being in retirement, the evidence remains fragmented, with limited integration across domains. No umbrella review has comprehensively synthesized determinants and interventions influencing multidimensional well-being among retired older adults. Methods This protocol describes an umbrella review that will synthesize evidence from systematic reviews examining factors and policy, programmatic, community-based, or other supportive efforts associated with physical, mental, social, financial, and spiritual well-being among retired older adults. The review follows Joanna Briggs Institute (JBI) methodology for umbrella reviews and is reported in accordance with PRISMA-P guidance. The search strategy was developed in consultation with a knowledge synthesis librarian and peer reviewed using the PRESS guidelines. Database searches were conducted in MEDLINE (Ovid), CINAHL, PsycINFO, Scopus, and the Cochrane Database of Systematic Reviews for articles published from 2015 onward. Backward and forward citation searching will be undertaken. Two reviewers will independently screen records, extract data, and appraise methodological quality using the JBI Critical Appraisal Checklist for Systematic Reviews and Research Syntheses. Findings will be synthesized narratively. This protocol has been registered with PROSPERO (CRD420251158970). Discussion This umbrella review will provide an integrated, high-level synthesis of existing evidence on well-being in retirement, informing future research, policy, and practice aimed at supporting holistic and equitable aging.
Expression of Concern: Metabolic engineering of Bacillus subtilis with an endopolygalacturonase gene isolated from Pectobacterium. carotovorum; a plant pathogenic bacterial strain
Profiles of social-emotional competence in elementary students: A latent profile analysis
Objective This study aimed to classify profiles of elementary school students based on their levels of social-emotional competence and to examine the associations of demographic variables, including gender, grade, family structure on these latent profiles. Methods A stratified sampling method was employed to recruit 11,323 students from grades 3–6 across 42 schools in eastern, central, and western regions of China. Data were analyzed using Latent Profile Analysis (LPA) and Logistic regression. The four-profile solution was selected based on statistical indices (BIC = 1130587, Entropy = 0.912) and its interpretability. Results (1) elementary school students’ social-emotional competence could be classified into four categories: high level group (25.8%), medium to high level group (36.2%), low to medium level group (31.3%), and low level group (6.7%). (2) With the low level group as the reference category: compared with boys, girls were more likely to be classified into the high level group (OR = 15.701, P < 0.001); relative to Grade 3 students, Grade 4 students were more likely to be classified into the high level group (OR = 17.293, P < 0.001) and into the low to medium level group (OR = 4.061, P < 0.001); non-only children were more likely than only children to be classified into the high level group (OR = 15.679, P < 0.001) and into the low to medium level group (OR = 4.074, P < 0.001); students attending urban schools were more likely than rural students to be classified into the high level group (OR = 15.576, P < 0.001) and into the medium to high level group (OR = 4.084, P < 0.001); and non-left-behind children were more likely than left-behind children to be classified into the high level group (OR = 15.671, P < 0.001) and into the medium to high level group (OR = 4.094, P < 0.001). Conclusion Elementary school students exhibit distinct categorization patterns in social-emotional competence. These findings suggest that interventions should be tailored to address these profiles to enhance students’ social-emotional competence. It should be noted that these odds ratios are conditional on the low level group as the reference category. The low level group itself accounted for only 6.7% of the total sample, and within this already small category, the representation of certain demographic characteristics (e.g., girls, urban students) was extremely low. These two factors combined contribute to the large magnitudes of the reported odds ratios. Therefore, these values represent relative advantages compared to the low level group rather than overall population odds ratios, and should be interpreted cautiously.
Unmasking factors affecting sleep pattern disturbances among patients undergoing hemodialysis: A cross-sectional study
Background The number of patients on hemodialysis is steadily increasing in Gulf Arab countries, including Bahrain. Such treatment modality has a negative impact on the quality of life, particularly sleep quality. This study aimed to assess the factors affecting the sleep pattern disturbances of hemodialysis patients in Bahrain. Materials and Methods A cross-sectional design was employed. A convenience sample of 174 patients was recruited to the study from one of the main dialysis centers in Bahrain. Data was obtained via the Pittsburgh Sleep Quality Index questionnaire. Both univariate and multivariate analyses were used. A p value of less than 0.05 was considered statistically significant. Results Most of the patients had poor sleep patterns (91%). It would appear that the main contributing factors are older age (p=0.009), self-rated health (p=0.001), anemia (p=0.002), excessive weight gain, and pain symptoms after dialysis session (p=0.001, p=0.001 respectively) and taking medications for sleep (p=0.016). Conclusion There is an extremely high level of poor sleep quality among patients on hemodialysis. The contributing factors are multifactorial. There is an urgent need to include sleep assessment, mental health screening, and psychosocial support education into the routine nephrology care program.
Oriented Electric Field-Driven Cis-Azobenzene Selective Diborylation Reaction at the Single-Molecule Level
Attention problems statistically mediate the association between mobile phone addiction and mental health and procrastination in Chinese college students
Climate change adaptation strategies as a pathway to gender empowerment in East Shewa Zone, Ethiopia
Maternal awareness and practices regarding vitamin D and their impact on health outcomes in children under five years in Egypt
Abstract Vitamin D is essential for calcium absorption, bone mineralization, and immunological function; nonetheless, vitamin D deficiency (VDD) continues to be a significant health issue in children under five years. In Egypt, VDD is highly prevalent among preschool children, with maternal awareness and nursing practices playing significant roles in its occurrence. This study aimed to identify the relationship between maternal awareness and practices regarding vitamin D and their impact on health outcomes in children under five years. A cross-sectional, correlational, descriptive, and quantitative study was employed. Data collection occurred over eight months throughout three governorates in Egypt, involving 300 mothers and their children under five years of age. Children’s health status outcomes were assessed and linked with their mothers’ awareness and practice scores regarding vitamin D supplementation. It was found that two-thirds of mothers had satisfactory knowledge about vitamin D deficiency, but more than half showed unsatisfactory practice scores. A moderate positive correlation was found between maternal practices and children’s health outcomes as height (r = 0.301, p < 0.001), and weight (0.242, p < 0.001), as well as between mothers’ practices and knowledge scores ( r = 0.323, p < 0.001). Additionally, maternal practices were significantly influenced by both age and educational level. Maternal practices emerged as a more convincing and coherent associated with child health outcomes than awareness alone. The findings underscore revealed that although over two-thirds of mothers had satisfactory knowledge about VDD, more than half showed unsatisfactory practices. Mothers of children without VDD, and those whose primary teeth erupted before one year demonstrated significantly higher practice scores. A moderate positive correlation was found between maternal practices and children’s health outcomes (weight, and height), as well as between mothers’ practices and awareness scores. Additionally, maternal practices were significantly influenced by both age and educational level.