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HIV viral load suppression rates among adults and children living with HIV in the North West Region of Cameroon: A call for action!
Introduction HIV continues to be a major public health problem in Cameroon where 2.7% of the population aged 15 to 49 are living with HIV. The prevalence remains higher in females, 3.4% versus 1.9% in males. The North West region of Cameroon has a higher prevalence than the national average; 4% in the general population, 5.8% in females and 1.6% in males. Despite the availability of pediatric HIV treatment, gaps in outcomes of children living with HIV (CLHIV) persists. This study aimed to compare the HIV viral suppression rates among adults and children living with HIV receiving antiretroviral therapy (ART) in the North West Region of Cameroon. In this study we hypothesized that the virologic outcome of children living with HIV is unfavorable compared to adults. Methodology This study was a comparative cross-sectional analytical study with secondary analysis of Viral load laboratory database. Data was collected in June 2023. We systematically collected deidentified data on viral load test of all PLHIV with HIV viral load results in the Bamenda TB reference laboratory database for the period January 1, 2022 to December 31, 2022. Data was analyzed using Stata SE 14.2. Categorical variables were described using absolute and relative frequencies. These were compared using Pearson’s chi-squared test. Quantitative variables were described using mean as a characteristic of central tendency and standard deviation (SD) as a characteristic of dispersion. Results Analysis revealed that of the 23,814 PLHIV whose viral load test was done at the Bamenda TB reference laboratory during the year 2022, 17,364(73%) were female and 1436 (6%) were children. The level of HIV viral suppression (viral load<1000 copies/ml) in children was lower compared to that of adults (80% vs. 95%; p<0.001). Females had lower viral suppression than males (94% vs. 91%; p<0.001). Conclusion The results revealed a significant lower HIV viral suppression rate in children than in adults. Women also had a significantly higher HIV viral suppression than males. Findings indicated that HIV viral suppression rate is significantly higher for routine viral load testing than for targeted testing after enhanced adherence counselling, thus the need to systematically offer enhanced adherence counselling and other evidence-based support interventions in routine care to all PLHIV to avoid persistent high viral non-suppression. Action is needed to tackle all known factors contributing to high viral non-suppression in children living with HIV and to help achieve 95% viral suppression rate in CLHIV in the North West region of Cameron.
Tracking over 30 years of coral reef infrastructure degradation in Barbados
Overlap or breakthrough? exploration of the academic buoyancy structure in Chinese EFL learners
Academic buoyancy, recognized as a key component of positive personality traits in learning, has garnered significant attention. However, most research on buoyancy is limited to general educational contexts, lacking a comprehensive theoretical framework that poses challenges in evaluating buoyancy’s impact on learners within the domain of second language acquisition (SLA). This study seeks to bridge this gap by investigating academic buoyancy within the realm of foreign language learning, specifically among university students in mainland China studying English as a foreign language (EFL). The study comprises two phases, with a total of 632 EFL participants. In the initial phase, a 32-item scale was tailored to the present study, drawing on scales from previous buoyancy-related research. Item analysis and exploratory factor analysis were subsequently conducted with a sample of 209 students. The phase retained 21 measurements and identified three main components of buoyancy: sustainability (the ability to persist despite difficulties), goal-orientedness (the focus on achieving specific learning objectives), and controllability (the perception of managing learning challenges). In the second phase, the refined questionnaire was administered to an additional 423 students, and the data underwent confirmatory factor analysis. A reliable 12-item scale was obtained that accurately reflects the identified components of academic buoyancy. By elucidating the structure of buoyancy, this study offers valuable empirical insights that can guide pedagogical strategies and strengthen learner buoyancy in language learning contexts. The findings contribute to the broader discourse on positive personality traits in education, highlighting the importance of fostering buoyancy in language learners to support their academic success.
Chaotic gradient based optimization with fuzzy temporal optimized CNN for heart failure prediction
Evolutionary game on mutually influenceing double-layer network
In recent years, coupled double-layer networks have played an increasingly critical role in evolutionary game theory. Research indicates that these networks more accurately reflect real-world relationships between individuals. However, current studies mainly focus on unidirectional influence within double-layer networks. Based on this, we propose a strongly coupled double-layer network cooperation evolution model. Strength individuals are located in the upper network layer, influencing the strategy choices of ordinary individuals in the lower layer, and vice versa. Monte Carlo simulations show that strength individuals can effectively enhance overall group cooperation. Under low temptation to defect, the group maintains a high cooperation rate; under high temptation, the presence of strength individuals prevents the group from falling into total defection, helping ordinary individuals escape the defection dilemma and improve cooperation levels.
Predicting accrual success for better clinical trial resource allocation
Social contexts and black families’ engagement in early childhood programs
In the U.S., the federal government and dozens of cities have invested in home visiting programs intended to be universally available at scale to support caregivers of young children. Evaluations find that participation in these programs reduces maternal mortality, improves maternal mental health, and supports children’s healthy development. Yet, many parents of young children who are invited to participate in home visiting programs do not enroll. This study fills gaps in the literature by examining how the broader social context affects Black families’ engagement in home visiting programs. Via focus groups, survey data from a socioeconomically diverse sample of Black parents across the U.S., and a pre-registered field experiment, we capture views of and experiences with early childhood home visiting programs. We assess the responsiveness of these views to the broader social context and examine implications for interest and participation in home visiting programs. Focus group participants described benefits of home visiting while also expressing concerns about being unfairly judged about their parenting practices and the risk of a home visit resulting in child welfare system involvement. One out of four Black parents surveyed associated the term “home visit” with surveillance (i.e., government scrutiny of parenting), and associating “home visit” with surveillance was empirically correlated with lower participation in home visiting programs. Further, our pre-registered survey experiment showed a causal link between surveillance fears and home visit engagement. Reading a news article about a family’s experience with the child welfare system decreased interest in home visiting among Black parents, while labeling a program as “new baby wellness” rather than “home visit” increased interest. Collectively, the findings point to ways in which the broader social context of parenting/parental surveillance negatively affects Black parents’ participation in early childhood home visiting programs despite their interest.
Mathematical modeling of water sorption isotherms in specialty coffee beans processed by wet and semidry postharvest methods
Abstract This study investigates the experimental assessment and mathematical modeling of the water sorption isotherms in dried specialty coffee beans processed by wet and semidry postharvest methods. The wet and semidry sorption isotherms were experimentally obtained over a range of water activities between 0.1 and 0.85 at temperatures of 25, 35, and 45 °C using the dynamic dew point method (DDI). Mathematical modeling was conducted to describe the influence of water activity, temperature, and postharvest method on the equilibrium moisture content. Twelve conventional sorption equations and four machine learning techniques were employed for modeling, using 75% of the experimental data for training and 25% for validation. The selection of the best model was carried out via multifactor Analysis of Variance (ANOVA). Experimental results showed that wet and semidry coffee beans exhibited a type II S-shaped isotherm (Brunauer–Emmett–Teller classification) and a significant ( p < 0.05) influence of temperature on sorption curves. Additionally, the mucilaginous coating found in semidry coffee beans provided a protective role against water sorption. The Support Vector Machine (SVM) model provided the best fit for describing the sorption isotherms (mean relative error, MRE < 1% and adjusted coefficient of determination, R 2 adj > 99%), demonstrating its robustness in predicting the equilibrium moisture content as a function of water activity, temperature, and postharvest processing method. This mathematical model could serve as a virtual representation of the storage process, facilitating real-time decision-making to enhance coffee quality management during storage.
Effects of project-based learning on EFL learners’ writing performance
Connecting language classrooms with 21st-century skills could be the potential framework for enhancing EFL learners’ performance in writing classes. However, investigating whether project-based learning, as a new field within ELT with unique pedagogical affordances, can enhance learners’ writing skills still needs to be improved in the literature. Accordingly, this study aimed to investigate the impact of project-based learning on EFL learners’ writing performance. It sought to determine whether and to what extent project-based learning could enhance writing skills in an EFL context. The study employed a quasi-experimental design with an interrupted pre-test-post-test time series design with single group participants. Twenty-three third-year EFL undergraduate students enrolled in the Advanced Writing Skills I course were selected using a comprehensive sampling method. An essay writing test and interview were used to gather data. The participants of the study were given a series of three problem-solving essay writing tests before and after the intervention, which employed project-based essay writing instruction. In addition, to discover their attitudes toward the impacts of project-based learning and its applications on the ground, three randomly selected students were interviewed at the end of the intervention. The data collected through the tests were analyzed through a one-way repeated measure ANOVA; narration was also used to analyze the qualitative data gathered through interviews. Accordingly, the quantitative data suggested that project-based learning significantly enhances EFL learners’ writing performance. Moreover, interview data showed that students felt optimistic about the impact of project-based learning on their writing performance, idea generation, and cooperation among themselves. Therefore, project-based learning is suggested as another method in ELT writing classes because it enhances learners’ writing via idea generation, data collection, organization, cooperation, and general communication skills. As students work on worthwhile projects, its emphasis on real-world applicability and realistic activities can help them become better writers. Hence, teachers can reinforce the relationship between form and purpose by incorporating a variety of genres and collaborative writing to reflect real-world or professional situations.
A novel cyber threat intelligence platform for evaluating the risk associated with smart agriculture
The risk of malnutrition as a predictor of arrhythmia recurrence after catheter ablation in patients with paroxysmal non-valvular atrial Fibrillation and heart failure with preserved ejection fraction
Background Malnutrition presents a significant challenge in managing patients with atrial fibrillation (AF) and heart failure with preserved ejection fraction (HFpEF), yet its impact on AF recurrence after catheter ablation in this population remains unclear. Methods We conducted a retrospective analysis of 204 patients with paroxysmal non-valvular AF and HFpEF who underwent radiofrequency or cryoballoon ablation. Risk of malnutrition as assessed using three screening tools: the Controlling Nutritional Status (CONUT) score, Prognostic Nutritional Index (PNI), and Nutritional Risk Index (NRI)]. We examined the relationship between risk of malnutrition and AF recurrence post-ablation. Results After a mean follow-up period of 11.2 ± 1.8 months, 43 patients (21.1%) experienced AF recurrence. Despite being classified as overweight or obese based on body mass index, many patients were at risk of malnutrition according to the CONUT score, NRI, and PNI. Adjusted analyses showed that higher CONUT scores (HR: 10.132; 95% CI: 2.545–40.336; P = 0.001), lower NRI (HR: 22.734; 95% CI: 6.399–80.776; P < 0.001), or lower PNI (HR: 9.469; 95% CI: 3.232–27.739; P < 0.001) were significantly associated with increased risk of AF recurrence. Restricted cubic spline regression revealed an inverted U-shaped relationship between the CONUT score and AF recurrence, and L-shaped relationships for both NRI and PNI with AF recurrence. Conclusions Systematic nutritional assessment is crucial in patients with paroxysmal non-valvular AF and HFpEF. High CONUT scores, low NRI, or low PNI serve as independent predictors for AF recurrence. Further large-scale randomized controlled trials are required to validate these findings.
Similarity and quality metrics for MR image-to-image translation
Abstract Image-to-image translation can create large impact in medical imaging, as images can be synthetically transformed to other modalities, sequence types, higher resolutions or lower noise levels. To ensure patient safety, these methods should be validated by human readers, which requires a considerable amount of time and costs. Quantitative metrics can effectively complement such studies and provide reproducible and objective assessment of synthetic images. If a reference is available, the similarity of MR images is frequently evaluated by SSIM and PSNR metrics, even though these metrics are not or too sensitive regarding specific distortions. When reference images to compare with are not available, non-reference quality metrics can reliably detect specific distortions, such as blurriness. To provide an overview on distortion sensitivity, we quantitatively analyze 11 similarity (reference) and 12 quality (non-reference) metrics for assessing synthetic images. We additionally include a metric on a downstream segmentation task. We investigate the sensitivity regarding 11 kinds of distortions and typical MR artifacts, and analyze the influence of different normalization methods on each metric and distortion. Finally, we derive recommendations for effective usage of the analyzed similarity and quality metrics for evaluation of image-to-image translation models.
A data pipeline for secure extraction and sharing of social determinants of health
Objectives Linking neighborhood- and patient-level data provides valuable information about the influence of upstream social determinants of health (SDOH). However, sharing of these data across health systems presents challenges. We set out to develop a pipeline to acquire, deidentify, and share neighborhood-level SDOH data across multiple health systems. Methods We created a pipeline centered around Decentralized Geomarker Assessment for Multi-Site Studies (DeGAUSS) that utilizes containerization to geocode patient addresses and obtain neighborhood-level SDOH variables. We compared DeGAUSS to a third-party vendor geocoding tool available at Duke Health using a cohort of adult patients referred for abdominal transplant from January 1, 2016, to December 31, 2022. We calculated Cohen’s Kappa and percent disagreement at census block group and tract levels, and by Area Deprivation Index, urbanicity, and year. Results The pipeline successfully generated SDOH data for 97.8% of addresses. There was high concordance between DeGAUSS and the vendor tool at the census block group (0.93) and tract levels (0.95). At the block group level, disagreement proportion differed by year and urbanicity, with larger disagreement in the rural category than in micropolitan and metropolitan categories (13%, 7%, 6.2%, respectively). Discussion and conclusion We describe a novel pipeline that can facilitate the secure acquisition and sharing of neighborhood-level SDOH without sharing PHI. The pipeline can be scaled to include additional social, climate, and environmental variables, and can be extended to an unlimited number of health systems.
The effect of muscle energy technique on pain, kinesiophobia, and quality of life in patients with COPD with chronic pain
Development of a mental health-related structural stigma measurement framework in the healthcare system setting: A modified Delphi study
Introduction There is a worldwide dearth in literature on the nature, causes, and consequences of structural stigma in mental healthcare. This study aimed to address this gap by exploring key components for measuring structural stigma in healthcare system settings. Methods We used a modified Delphi method consisting of 3 rounds with global experts (stigma researchers, persons with lived experiences of mental health conditions (PWLEs), and policymakers). In the first round, indicators identified through a literature review (n = 39 studies) were appraised through expert consultation workshops with 22 panellists, including 54.5% women, 41% PWLEs, and 68.2% from low-and-middle income countries (LMICs). Round 2 (n = 53 panellists; 51% women, 8.3% PWLEs, and 56.6% from LMICs) involved ranking indicators through an online survey, and Round 3 (n = 58 panellists; 46% women, 21.7% PWLEs, and 60.4% from LMICs) involved re-ranking the results from Round 2. Smith’s salience index was calculated to measure consensus and Kendall’s coefficient of concordance to determine the degree of agreement. Narrative opinions and feedback from panellists during all three Delphi rounds were also sought. Results A list of indicators within five core measurement domains was identified in Round 1. Round 2 results were heterogeneous as indicated by the low to moderate salience of most indicators. Round 3 resulted in 4–5 indicators in each domain, that were ranked as highly salient by the expert panellists. Experts also provided narrative feedback on the definition of structural stigma, barriers to its measurement, domain-specific comments, and indicators-specific comments. Conclusion The framework aids in defining mental health-related structural stigma in healthcare and framing it in terms of inequities within healthcare system structures. These structures result in negative experiences of PWLEs and limit their access to quality healthcare. This conceptualization, informed by PWLE and stakeholders in LMICs, makes it easier to measure structural stigma and monitor changes in diverse healthcare settings around the world.
Assessing the association between household air pollution exposure and child heath in Mongolia: a birth-cohort study
Abstract Children in Mongolia are exposed to harmful levels of household air pollution (HAP) due to a high reliance on coal for indoor cooking and heating. This study aims to assess the association between HAP and child health outcomes, in a birth cohort from Ulaanbaatar, Mongolia. A composite HAP measure was created using information on cooking and heating fuels and behaviours collected as part of a randomised control trial assessing the impact of swaddling on child health. Child health outcomes (Bayley Scales of Infant Development scores [BSID-II], pneumonia, height and weight) were collected at 7, 13, and 36 months. Linear and Cox proportional hazard model were used to assess the association between HAP and child health outcomes at each time point, adjusting for child, maternal and environmental confounding factors. An increased risk of pneumonia was observed with an increasing HAP score (adjusted hazard ratio: 1.02 [1.01, 1.04]) at 7 months). An increase in HAP exposure was associated with a decrease in the BSID mental score at 13 months (β: − 0.09 [− 0.17, − 0.01]), BSID psychomotor score at 36 months (β: − 0.12 [− 0.23, − 0.02]). A decrease in height-for-age z-score (HAZ) and weight-for-age z-score (WAZ) were associated with increased HAP exposure at 7 (HAZ β: − 0.019 [− 0.030, − 0.010] and 13 months (HAZ β: − 0.020 [− 0.030, − 0.011], and WAZ β: − 0.012 [− 0.019, − 0.005]), however only HAZ was associated with HAP at 36 months (β: − 0.011 [− 0.020, − 0.002]). An increasing HAP score was associated with an increase in the health outcome composite score at 7 months only (β: 0.019; 95% CI 0.003–0.035). HAP exposure was shown to negatively impact child health sustainably over 3 years. There are implications for development of appropriate public health policies to mitigate HAP exposure throughout Mongolia and similar Central Asia settings.
Combined effects of basalt fiber geometrical characteristics on pavement performance of asphalt mixtures
Fibers have been widely adopted in asphalt mixture to improve its pavement performance. Lignin fiber and polyester fiber are the most popular two choices. Lignin fiber is derived from wood, which is not aligned with the principles of sustainable development. The production process for polyester fiber is more complex and costly, presenting both environmental and economic challenges in engineering applications. In contrast, basalt fiber is cost-effective, exhibit excellent wear resistance and impact toughness, and possess high mechanical strength. It is an ideal choice to improve pavement performance of asphalt mixtures. However, most of the existing studies focused on analyzing a single characteristic index of basalt fiber. They neglected the composite effects of geometric characteristics of basalt fiber, such as fiber diameter and length, on the pavement performance of asphalt mixtures at varying fiber contents. Therefore, taking the SMA-13 as an example, the combined effect of basalt fiber geometrical characteristics (fiber diameter, fiber length, and fiber content) on pavement performance are elucidated. Additionally, a random forest algorithm is adopted to perform a weight analysis of fiber characteristics and their correlation with pavement performance.
Thermal performance of Falkner Skan model (FSM) for (GOMoS2)/(C2H6O2-H2O) 50:50% nanofluid under radiation heating source
Sleep problems were unrelated to social media use in the late COVID-19 pandemic phase: A cross-national study
Sleep problems are commonly related to stress and mental health problems. However, social media use has become widespread in the general population during recent years, and their addictive potential may influence people’s sleep routine. In addition, the COVID-19 pandemic gave rise to substantial mental health problems in the population, and restrictions in social life gave social media a unique position as means for both entertainment and interpersonal contact. The aim of the study was to examine sleep problems in relationship to social media use in a cross-national sample two years after the COVID-19 outbreak. Participants were 1405 adults from four countries who completed a cross-sectional online survey. The data were analyzed with independent samples t-tests, Chi Squared tests of independence, and single and multivariable logistic regression analyses. Of the 858 (61.1%) participants who reported sleep problems during the past weeks, a substantial proportion (n = 353, 41.1%) related their sleep problems to their experience with COVID-19. With adjustments for age, gender, employment, and psychological distress, more hours of daily social media use was not significantly associated with sleep problems. However, higher age (OR: 1.13, p = 0.01), female gender (OR: 1.69, p<0.001), having employment (OR: 1.34, p = 0.04), and higher levels of psychological distress (OR: 1.20, p<0.001) were independently associated with sleep problems. While the debate about the pros and cons of social media use continue, this study suggests that higher levels of social media use was not of great concern for people’s sleep quality in the late COVID-19 pandemic phase. However, other aspects of social media use (eg, time of the day, content of interactions, associated stress experience) may be more relevant for understanding sleep problems and may be taken into consideration for people who experience such problems.