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Open Access September 09, 2025

Biopsy-Negative Giant Cell Arteritis Presenting as Stroke Mimic with Vision Loss and Complex Vascular Disease

Abstract A man in his 60s with multiple vascular comorbidities presented with sudden, painless vision loss in one eye. Although he had a high risk for atherosclerotic events, initial evaluation for stroke was negative for acute ischemia, but found to have markedly elevated inflammatory markers. Accordingly, giant cell arteritis was investigated and Ophthalmologic findings and fulfillment of the 2022 [...] Read more.
A man in his 60s with multiple vascular comorbidities presented with sudden, painless vision loss in one eye. Although he had a high risk for atherosclerotic events, initial evaluation for stroke was negative for acute ischemia, but found to have markedly elevated inflammatory markers. Accordingly, giant cell arteritis was investigated and Ophthalmologic findings and fulfillment of the 2022 American College of Rheumatology/European Alliance of Associations for Rheumatology classification criteria supported the diagnosis of giant cell arteritis, despite a negative temporal artery biopsy. Management included high-dose glucocorticoids and delayed tocilizumab initiation due to the need for multiple vascular surgeries. Vision loss was irreversible, but systemic symptoms resolved and vascular interventions were successful. This case highlights the diagnostic and management complexities of biopsy-negative giant cell arteritis in patients with severe atherosclerotic vascular disease, emphasizing the importance of clinical judgment and established classification criteria when imaging and biopsy results are inconclusive.
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Case Report
Open Access June 26, 2025

The Relationship Between Lymphocyte Count and Mortality in Patients with Dysphagia

Abstract Background: Dysphagia is a common functional impairment in elderly populations, often leading to severe complications such as malnutrition and aspiration pneumonia, significantly increasing healthcare burdens. Currently, effective prognostic assessment tools are lacking. The absolute lymphocyte count (ALC), a biomarker reflecting immune-nutritional status, has potential predictive value in this context, though its role in dysphagia prognosis remains unclear. Methods: This retrospective cohort study included 253 dysphagic patients who received percutaneous endoscopic gastrostomy (PEG) or total parenteral nutrition (TPN) between 2014 and 2017. Five patients with missing ALC were excluded. Cox regression models assessed the association between ALC and mortality. ALC was analyzed as both continuous variable (using restriocted cubic splines) and categorical tertiles, with additional threshold analyses to assess non-linearity. Kaplan–Meier survival curves and subgroup analyses were also performed. Results: Lower ALC was associated with poorer nutritional status, higher inflammatory markers, and greater comorbidity burden. Higher ALC was independently associated with reduced mortality (adjusted HR: 0.60; 95% CI: 0.44–0.83; p = 0.002). Patients in the highest tertile had significantly better survival than those in the lowest (HR: 0.37; 95% CI: 0.23–0.59; P < 0.001). A non-linear threshold effect was identified at ALC = 1.899×109/L (p for non-linearity = 0.009). Kaplan–Meier analysis confirmed improved survival with higher ALC (p [...] Read more.
Background: Dysphagia is a common functional impairment in elderly populations, often leading to severe complications such as malnutrition and aspiration pneumonia, significantly increasing healthcare burdens. Currently, effective prognostic assessment tools are lacking. The absolute lymphocyte count (ALC), a biomarker reflecting immune-nutritional status, has potential predictive value in this context, though its role in dysphagia prognosis remains unclear. Methods: This retrospective cohort study included 253 dysphagic patients who received percutaneous endoscopic gastrostomy (PEG) or total parenteral nutrition (TPN) between 2014 and 2017. Five patients with missing ALC were excluded. Cox regression models assessed the association between ALC and mortality. ALC was analyzed as both continuous variable (using restriocted cubic splines) and categorical tertiles, with additional threshold analyses to assess non-linearity. Kaplan–Meier survival curves and subgroup analyses were also performed. Results: Lower ALC was associated with poorer nutritional status, higher inflammatory markers, and greater comorbidity burden. Higher ALC was independently associated with reduced mortality (adjusted HR: 0.60; 95% CI: 0.44–0.83; p = 0.002). Patients in the highest tertile had significantly better survival than those in the lowest (HR: 0.37; 95% CI: 0.23–0.59; P < 0.001). A non-linear threshold effect was identified at ALC = 1.899×109/L (p for non-linearity = 0.009). Kaplan–Meier analysis confirmed improved survival with higher ALC (p < 0.0001). Subgroup analyses showed the protective effect of higher ALC was consistent across age, sex, BMI, PEG use, and comorbidity strata, with no significant interactions. Conclusions: ALC is an independent, non-linear predictor of mortality in older dysphagic patients and may aid clinical risk stratification across diverse patient subgroups.
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Open Access June 19, 2025

Current Status of Legionnaires' Disease and Environmental Factors in Japan

Abstract Legionnaires' disease became widely known following an outbreak of pneumonia in the United States in 1976. It is often caused by infection from artificial water sources such as cooling towers, water supply and heating systems, and recirculating hot tubs. To effectively implement infection prevention measures for Legionnaires' disease, collaboration among healthcare workers, water supply and [...] Read more.
Legionnaires' disease became widely known following an outbreak of pneumonia in the United States in 1976. It is often caused by infection from artificial water sources such as cooling towers, water supply and heating systems, and recirculating hot tubs. To effectively implement infection prevention measures for Legionnaires' disease, collaboration among healthcare workers, water supply and heating system managers, building hygiene personnel, and other relevant parties is essential. It is important to note that outbreaks of Legionnaires' disease continue to occur frequently both domestically and internationally. While the number of reported cases of Legionnaires' disease in Japan has increased, the mortality rate has decreased but has stabilized at a lower level. Caution is also required as reports have been made in association with disasters and travel, in addition to artificial environmental water.
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Review Article
Open Access June 02, 2025

Residual Sets and the Density of Binary Goldbach Representations

Abstract A residual-set framework is introduced for analyzing additive prime conjectures, with particular emphasis on the Strong Goldbach Conjecture (SGC). For each even integer En4, the residual set [...] Read more.
A residual-set framework is introduced for analyzing additive prime conjectures, with particular emphasis on the Strong Goldbach Conjecture (SGC). For each even integer En4, the residual set (En)={Enp p<En,p} is defined, and the universal residual set E=En(En) is constructed. It is shown that E contains infinitely many primes. A nontrivial constructive lower bound is derived, establishing that the number of Goldbach partitions satisfies G(E)2 for all E8, and that the cumulative partition count satisfies ENG(E)N2log4N. An optimized deterministic algorithm is implemented to verify the SGC for even integers up to 16,000 digits. Each computed partition En=p+q is validated using elliptic curve primality testing, and no exceptions are observed. Runtime variability observed in the empirical tests corresponds with known fluctuations in prime density and modular residue distribution. A recursive construction is formulated for generating Goldbach partitions, using residual descent and leveraging properties of the residual sets. The method extends naturally to Lemoine's Conjecture, asserting that every odd integer n7 can be expressed as n=p+2q, where p,q. A corresponding residual formulation is developed, and it is proven that at least two valid partitions exist for all n9. Comparative analysis with the Hardy-Littlewood and Chen estimates is provided to contextualize the cumulative growth rate. The residual-set methodology offers a deterministic, scalable, and structurally grounded approach to additive problems in prime number theory, supported by both theoretical results and large-scale computational evidence.
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Article
Open Access May 13, 2025

Geochemistry distributions and statistics analysis of REE in stream sediments from the watershed west of Mambaka (Adamawa Plateau, Cameroun)

Abstract The Mambaka watershed is extends between latitudes 1 3°45'E and 14°15'E and longitudes 7°16'N and 6°45'N. The geology, various tectonic and structural events that have affected the Adamawa Plateau in Cameroon make it rich in multi-substance mining. The objective of this study is to map rare earth (REE) geochemical anomalies in the sediments of the watershed streams west of Mambaka, and to trace [...] Read more.
The Mambaka watershed is extends between latitudes 1 3°45'E and 14°15'E and longitudes 7°16'N and 6°45'N. The geology, various tectonic and structural events that have affected the Adamawa Plateau in Cameroon make it rich in multi-substance mining. The objective of this study is to map rare earth (REE) geochemical anomalies in the sediments of the watershed streams west of Mambaka, and to trace their origins and geochemical processes. Predictive maps from inverse distance interpolations (IDW), factor analysis (F1) or principal component analysis (PCA) and hierarchical bottom-up classification maps provided a better understanding of the central tendency, distribution and dispersion of REE in the samples and in the study area, based on standard deviation and variance values that generated two factors F1 (Ho-Tm-Er-Yb-Lu-Dy-Tb-Gd-Eu-Sm) and F2 (Pr-Nd-Ce-La-Sm) representing 92.44% of the total cumulative variance. The ratios Ce/Ce* > 0.78 and Eu/Eu* > 1 demonstrate positive anomalies in Ce and Eu, and clear differentiation. The normalized concentrations used to calculate fractionation ratios show that the values for LaN/YbN (0.58 to 1.34), LaN/SmN (0.61 to 0.88) and LaN/LuN (0.62 to 1.43) suggest higher fractionation in SS09 and lower fractionation in SS01. Similarly, the ratios La/Lu (61.71 to 143.46), La/Yb (9.00 to 20.72), La/Sm (4.02 to 5.83) and La/ Lu (61.71 to 143.46) confirm these higher ratios in SS09 and lower in SS01. The REE in the study area comes from hydrothermal processes based on high lineament densities at sampling points in igneous rocks with a mean ∑REE value of between 174-219 ppm.
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Article
Open Access April 30, 2025

Psychological Flexibility and Cardiovascular Health Behaviors Among Filipino Outpatients: A Correlational Study

Abstract (1) Background: Psychological flexibility, the ability to adapt to changing demands while staying true to personal values, is linked to better health behaviors. However, its relationship with cardiovascular health behaviors, particularly in Filipino populations, remains underexplored. (2) Aim: This study aimed to examine the relationship between psychological flexibility and [...] Read more.
(1) Background: Psychological flexibility, the ability to adapt to changing demands while staying true to personal values, is linked to better health behaviors. However, its relationship with cardiovascular health behaviors, particularly in Filipino populations, remains underexplored. (2) Aim: This study aimed to examine the relationship between psychological flexibility and cardiovascular health behaviors among outpatients in Rizal, Philippines, focusing on BMI, smoking, physical activity, and dietary habits. (3) Methods: A cross-sectional, descriptive-correlational design was used with 100 outpatient participants from selected hospitals. Psychological flexibility was measured using the Acceptance and Action Questionnaire-II (AAQ-II), and cardiovascular health behaviors were assessed using a modified version of the American Heart Association’s Life Simple 7 tool. Descriptive statistics and Pearson’s correlation were applied. (4) Results: The findings showed that respondents had neutral levels of psychological flexibility. While most exhibited intermediate BMI and physical activity, dietary habits varied. A significant positive correlation was found between psychological flexibility and whole grain consumption. However, no significant associations were found with BMI, smoking, or physical activity. (5) Conclusions: Psychological flexibility appears to influence specific health behaviors, such as dietary choices, but does not strongly correlate with other cardiovascular health behaviors. Further research is needed to explore its broader role in cardiovascular disease prevention.
Article
Open Access April 10, 2025

Assessment of the Knowledge, Attitude, and Practice of Sokoine University Students Regarding Endocrine Disruptors Coming from Plastic Chemicals

Abstract Objective: The knowledge, attitudes, and practices of SUA students about the use of plastics containing endocrine disruptors were investigated in this study. Methodology: A study with 150 participants was conducted to assess individuals' knowledge about endocrine disruptors, attitudes, and plastic use practices. Results: The findings indicate that the participants possessed an [...] Read more.
Objective: The knowledge, attitudes, and practices of SUA students about the use of plastics containing endocrine disruptors were investigated in this study. Methodology: A study with 150 participants was conducted to assess individuals' knowledge about endocrine disruptors, attitudes, and plastic use practices. Results: The findings indicate that the participants possessed an average degree of knowledge 50.2 ± 3.85 with the main emphasis of awareness being generic concepts rather than specific substances. Regarding the potential health impacts of endocrine-disrupting chemicals present in plastics, respondents' attitudes ranged from fair to positive, with a mean score of 3.5 ±0.09 indicating a fair attitude overall. Conclusion: It is important to practice polite behavior and increase public awareness of safe plastic disposal methods. Surprising only 38.0% of the participants mentioned that they refrain from heating their food in plastic containers to reduce their exposure to plastics. Students' practices revealed a notable dependence on plastic products despite their awareness of the concerns surrounding endocrine disruptors, as most of them reported using plastic water bottles, plastic cups, and plastic bags almost always. Additionally, only 20.7% of the respondents consistently implemented strategies to prevent exposure to endocrine-disrupting chemicals. Recommendation: The study recommended increasing the use of cleaner plastic substitutes and improving educational programs to convert information into practical actions. Policies that encourage environmentally friendly behavior and raise public awareness of safe plastic disposal techniques should be put into practice.
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Open Access March 29, 2025

The Role of Type 3 Diabetes in Alzheimer’s Disease: A Review of Current Evidence

Abstract Background: Type 2 Diabetes Mellitus (T2DM) and Alzheimer’s Disease (AD) are increasingly linked through shared pathophysiological mechanisms, giving rise to the concept of Type 3 Diabetes Mellitus (T3DM). Brain insulin resistance, oxidative stress, and neuroinflammation are central to both conditions, contributing to cognitive decline and AD progression. Aim: This review aims to [...] Read more.
Background: Type 2 Diabetes Mellitus (T2DM) and Alzheimer’s Disease (AD) are increasingly linked through shared pathophysiological mechanisms, giving rise to the concept of Type 3 Diabetes Mellitus (T3DM). Brain insulin resistance, oxidative stress, and neuroinflammation are central to both conditions, contributing to cognitive decline and AD progression. Aim: This review aims to explore this emerging relationship and its implications for prevention and management. Methods: Using an integrative review, 21 studies were systematically analyzed. The review focused on identifying demographic, genetic, and lifestyle factors contributing to T2DM and AD and examined shared molecular pathways such as insulin dysregulation and amyloid-beta accumulation. Results: The findings reveal that T3DM shares key features with T2DM and AD, including insulin resistance and chronic inflammation. Lifestyle interventions, such as diet and exercise, alongside routine cognitive and metabolic screenings, are critical in mitigating progression. Conclusions: Further research into diagnostic biomarkers and targeted therapies is essential to manage T3DM and its impact on AD. The role of nursing professionals in early detection, education, and holistic management is emphasized as vital in addressing this dual disease burden. This review offers actionable insights into integrated strategies for addressing these interconnected conditions.
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Review Article
Open Access March 06, 2025

Impact of Food Security on Dietary Diversity and Nutritional Intake Among Pregnant Women in Low-Resource Settings

Abstract Background: Food security and dietary diversity are essential determinants of maternal health, particularly among pregnant women in refugee populations who face heightened vulnerabilities due to displacement and inadequate living conditions. This study examines the impact of food security on dietary diversity and nutritional intake among pregnant Rohingya women residing in the makeshift [...] Read more.
Background: Food security and dietary diversity are essential determinants of maternal health, particularly among pregnant women in refugee populations who face heightened vulnerabilities due to displacement and inadequate living conditions. This study examines the impact of food security on dietary diversity and nutritional intake among pregnant Rohingya women residing in the makeshift camps of Ukhiya, Cox’s Bazar. Methods: A descriptive cross-sectional study was conducted among 96 pregnant Rohingya women from June to September 2022. Data were collected using structured questionnaires assessing socio-demographic characteristics, food security, and dietary diversity. Food security was evaluated using the Household Food Insecurity Access Scale (HFIAS), while dietary diversity was assessed through a 24-hour dietary recall and a 7-day food frequency questionnaire. Data were analyzed using SPSS (Version 26) and Stata (Version 13), employing descriptive statistics and chi-square tests to examine associations. Results: Most participants (57.3%) were food secure, and 85.4% demonstrated high dietary diversity, consuming seven or more food groups. However, 21.9% of households experienced severe food insecurity, highlighting ongoing challenges in food access. The highest consumption was observed for starch, flesh foods, dark green leafy vegetables, and vitamin A-rich fruits and vegetables (99.0%), while dairy products (69.8%) and organ meat (34.4%) were consumed less frequently. Despite high dietary diversity, severe food insecurity persists, indicating gaps in food assistance programs. Conclusions: While food support programs appear to contribute to high dietary diversity among pregnant Rohingya women, severe food insecurity remains a significant concern. Strengthening food security interventions, improving access to diverse nutrient-rich foods, and integrating sustainable food assistance models are essential to addressing these challenges. Future research should explore long-term strategies to enhance food security and assess the impact of targeted nutritional interventions on maternal health outcomes in refugee settings.
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Open Access February 21, 2025

Diminished Returns of Educational Attainment on Unpaid and Paid Maternity Leave of Mothers Giving Birth in Poverty

Abstract Background: Maternity leave, whether paid or unpaid, is a critical resource that can significantly impact maternal well-being and newborn outcomes. However, its availability and utilization among mothers living in poverty remain understudied. Education is widely recognized as a key factor that increases access to both paid and unpaid leave. However, the theory of Minorities’ [...] Read more.
Background: Maternity leave, whether paid or unpaid, is a critical resource that can significantly impact maternal well-being and newborn outcomes. However, its availability and utilization among mothers living in poverty remain understudied. Education is widely recognized as a key factor that increases access to both paid and unpaid leave. However, the theory of Minorities’ Diminished Returns (MDRs) posits that structural racism, segregation, and labor market discrimination limit the benefits of socioeconomic resources, such as education, for Black and Latino individuals. This suggests that the effects of education on maternity leave may not be uniform across racial and ethnic groups. Objective: This study aimed to examine the MDRs of education on access to unpaid and paid maternity leave among Black and Latino mothers compared to White mothers giving birth while living in poverty. Methods: We utilized baseline data from the Baby’s First Years Study (BFY), a longitudinal investigation of the effects of poverty on child development. The sample consisted of 1,050 mothers living in poverty who had recently given birth. Maternity leave (paid and unpaid) was assessed via self-report, and educational attainment was measured in years of schooling. Structural equation modeling (SEM) and interaction terms were employed to analyze racial and ethnic differences in the relationship between education and access to maternity leave. Results: Educational attainment was positively associated with access to unpaid maternity leave for the overall sample of mothers giving birth in poverty, but this association was weaker for Black and Latino mothers compared to non-Latino White mothers. Education did not significantly increase the likelihood of paid maternity leave, and there were no group differences for this association. Conclusion: This study highlights the urgent needs to address structural racism, labor market discrimination, and residential segregation that diminish the impact of education on living conditions for Black and Latino mothers, compared to non-Latino White mothers, even for those living under poverty. Policymakers and practitioners should develop targeted interventions to reduce racial and ethnic disparities in access to paid and unpaid maternity leave and other critical resources, particularly for new mothers living in poverty. Addressing these inequities is essential for improving maternal and newborn health outcomes and promoting social justice.
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Open Access February 15, 2025

Knowledge related to umbilical cord care among mothers of neonates attending outpatient departments in Sherpur district, Bangladesh

Abstract Background: Proper umbilical cord care prevents neonatal infections and reduces neonatal mortality. Despite global recommendations for evidence-based cord care practices, traditional beliefs, and inadequate maternal knowledge often lead to unsafe practices, particularly in low-resource settings like Bangladesh. This study aimed to assess the understanding of umbilical cord care among [...] Read more.
Background: Proper umbilical cord care prevents neonatal infections and reduces neonatal mortality. Despite global recommendations for evidence-based cord care practices, traditional beliefs, and inadequate maternal knowledge often lead to unsafe practices, particularly in low-resource settings like Bangladesh. This study aimed to assess the understanding of umbilical cord care among mothers of neonates in Sherpur District, Bangladesh, and identify factors associated with knowledge levels. Methods: A descriptive cross-sectional study was conducted from July to October 2020 at Sherpur Sadar Hospital. A total of 193 mothers of neonates were recruited using a non-randomized purposive sampling method. Data was collected through a pre-tested, semi-structured, interviewer-administered questionnaire. Knowledge levels were categorized as "Good" (>6) or "Poor" (≤6) based on responses to 10 structured questions. Statistical analyses, including chi-square tests and crude odds ratios (COR), were performed to identify socio-demographic factors associated with knowledge levels. Results: Of the 193 participants, 48.7% demonstrated "Good" knowledge, while 51.3% had "Poor" knowledge. Education level (p = 0.01), occupation (p = 0.02), family type (p < 0.001), and family size (p = 0.04) were significantly associated with knowledge levels. Mothers with higher education and those from joint families exhibited better knowledge. However, 28.5% of respondents were unaware of the typical umbilical cord-shedding timeframe, and 44% could not identify signs of infection. Unsafe practices, such as using medications (14.5%) or hot compression (7.2%) for drying the cord, were reported. Conclusion: The study reveals significant gaps in maternal knowledge regarding umbilical cord care in Sherpur District, driven by socio-demographic disparities and cultural practices. Targeted health education programs, emphasizing evidence-based cord care practices and leveraging local social structures, are urgently needed to improve neonatal health outcomes in similar resource-limited settings. Future research should evaluate the effectiveness of these interventions to inform policy and practice.
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Open Access February 07, 2025

Factors Affecting Pain Scale Preferences among Populations in Indonesia: Comparison Study between Suburban and Rural Areas

Abstract Introduction: Pain is considered as the fifth vital sign that should be considered in assessing patients. For clinicians to evaluate and determine the right pain interventions, there should be parameters such as pain scale. Our objective in this study is to determine factors affecting pain scale preferences in suburban and rural populations. The pain scales used in this study are FPS-R [...] Read more.
Introduction: Pain is considered as the fifth vital sign that should be considered in assessing patients. For clinicians to evaluate and determine the right pain interventions, there should be parameters such as pain scale. Our objective in this study is to determine factors affecting pain scale preferences in suburban and rural populations. The pain scales used in this study are FPS-R (Faces Pain Scale-Revised), VRS (Verbal Rating Scale), VAS (Visual Analogue Scale), and NRS (Numering Rating Scale). Method: This study uses observational design with an interview approach and a cross-sectional study. Areas covered are within Indonesia, which are marginal areas of Tangerang district border, and two rural areas in Serukam, West Kalimantan, and Soe, East Nusa Tenggara. Data collected will be analyzed using SPSS 25 software. Result: Populations within the suburban areas prefer NRS (52.08%) as their pain scale, and populations in rural areas prefer FPS-R 76.92%). Factors affecting pain scale preferences are location areas, as well as last education, with statistical significance of p<0.05. Discussion: Our study showed that the choice of several pain scales is not appropriate for specific demographics due to the complexity of these scales. Factors that should be considered are the location areas and education level, as some population in remote areas have better understanding of simpler pain scales. Conclusion: Complexity or simpler components may be an underlying reason for the preference of score selection to assess pain scales in some population. Therefore, the selection of pain scales should be adjusted to specific demographics so that clinicians can provide appropriate management with appropriate pain scales.
Article
Open Access February 04, 2025

The Use of Differentiated Instruction to Achieve Culturally Responsive Teaching

Abstract With an increasing diversity of learners in today’s educational set-ups, there is an insurmountable need to cater for individual differences including the cultural variations among learners. It is therefore necessary for educators to develop culturally responsive teaching that enhances intercultural competencies of learners. As educators strive to provide inclusive learning environments in which [...] Read more.
With an increasing diversity of learners in today’s educational set-ups, there is an insurmountable need to cater for individual differences including the cultural variations among learners. It is therefore necessary for educators to develop culturally responsive teaching that enhances intercultural competencies of learners. As educators strive to provide inclusive learning environments in which learners from diverse cultural backgrounds learn equitably, differentiated instruction becomes a practical tool. This paper explores how differentiated instruction can support and enhance culturally responsive teaching by examining how tailored instructional approaches can bridge cultural gaps and enhance educational outcomes. The aim is to provide a comprehensive understanding of how educators can effectively integrate differentiated instructional methodologies to achieve the goals of Culturally Responsive Teaching. The study used a descriptive survey design to determine the use of differentiated instruction by junior school teachers in Kenya and a systematic review of literature, practical examples, and studies on teachers’ practices in culturally responsive teaching. The study outcomes indicated that teachers used various differentiated instructional strategies with flexible grouping being the most commonly used strategy. However, there arises a concern, that teachers were not very familiar with cultural variations of learners in their classrooms even as they developed their differentiated instructional strategies. Literature provided the principles and practices of culturally responsive teaching. The combination of these results were used to formulate a conceptual framework for Culturally Responsive Differentiated Instruction (CRDI) that provides insights for practitioners to develop and implement culturally responsive differentiated instructional strategies. The study recommends that a framework to support teachers in the implementation of inclusive and equitable curriculum through CRDI be developed, CRDI be integrated into the teaching processes and the teachers be trained on providing for learner differences through CRDI.
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Open Access January 15, 2025

Prevalence and determinants of mental health stress among nursing students in Bangladesh: A cross-sectional study

Abstract Background: Nursing students are exposed to significant stress due to academic and clinical demands, which can adversely affect their mental health, academic performance, and future clinical competence. Despite the global acknowledgment of this issue, limited research has been conducted to explore the prevalence and determinants of stress among nursing students in Bangladesh. [...] Read more.
Background: Nursing students are exposed to significant stress due to academic and clinical demands, which can adversely affect their mental health, academic performance, and future clinical competence. Despite the global acknowledgment of this issue, limited research has been conducted to explore the prevalence and determinants of stress among nursing students in Bangladesh. Methods: This cross-sectional study was conducted from December 2023 to February 2024 among 372 nursing students enrolled in selected nursing colleges in Bangladesh. A purposive sampling technique was used, and data was collected using a semi-structured questionnaire. The questionnaire assessed socio-demographic characteristics, academic challenges, and psychological symptoms, with mental health stress measured using a Likert scale. Descriptive statistics and Chi-square tests were used to analyze the data, with a 95% confidence interval applied to all analyses. Results: The findings revealed that 31.7% of nursing students experienced severe stress, 23.9% reported moderate stress, and 16.7% had mild stress. Age, academic semester, and course load difficulties were significantly associated with stress levels (p < 0.05). Psychological symptoms such as anxiety, difficulty concentrating, and loss of interest in activities were also significantly linked to higher stress levels. Notably, students in their first semester and those reporting harder course loads were more likely to experience stress. However, gender was not significantly associated with stress levels. Conclusions: This study underscores the high prevalence of stress among nursing students in Bangladesh, driven by academic and clinical challenges and psychological symptoms. The findings highlight the need for targeted interventions, such as stress management training, enhanced mental health support, and policies to alleviate academic pressures. Future research should explore longitudinal trends in stress and evaluate the effectiveness of interventions to support a resilient nursing workforce.
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Open Access January 10, 2025

Artificial Immune Systems: A Bio-Inspired Paradigm for Computational Intelligence

Abstract Artificial Immune Systems (AIS) are bio-inspired computational frameworks that emulate the adaptive mechanisms of the human immune system, such as self/non-self discrimination, clonal selection, and immune memory. These systems have demonstrated significant potential in addressing complex challenges across optimization, anomaly detection, and adaptive system control. This paper provides a [...] Read more.
Artificial Immune Systems (AIS) are bio-inspired computational frameworks that emulate the adaptive mechanisms of the human immune system, such as self/non-self discrimination, clonal selection, and immune memory. These systems have demonstrated significant potential in addressing complex challenges across optimization, anomaly detection, and adaptive system control. This paper provides a comprehensive exploration of AIS applications in domains such as cybersecurity, resource allocation, and autonomous systems, highlighting the growing importance of hybrid AIS models. Recent advancements, including integrations with machine learning, quantum computing, and bioinformatics, are discussed as solutions to scalability, high-dimensional data processing, and efficiency challenges. Core algorithms, such as the Negative Selection Algorithm (NSA) and Clonal Selection Algorithm (CSA), are examined, along with limitations in interpretability and compatibility with emerging AI paradigms. The paper concludes by proposing future research directions, emphasizing scalable hybrid frameworks, quantum-inspired approaches, and real-time adaptive systems, underscoring AIS's transformative potential across diverse computational fields.
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Open Access January 04, 2025

Knowledge Level of Street Fruit Vendors on Food Hygiene in the Tamale Metropolis

Abstract This study aimed to assess the knowledge level of street food vendors on hygiene in the Tamale metropolis in the Northern Region of Ghana. The study employed the health belief model as the theoretical basis. Quantitatively, the study employed a descriptive cross-sectional study design to examine the microbial load of street-cut fruits and assess the knowledge and practice of vendors of cut fruits [...] Read more.
This study aimed to assess the knowledge level of street food vendors on hygiene in the Tamale metropolis in the Northern Region of Ghana. The study employed the health belief model as the theoretical basis. Quantitatively, the study employed a descriptive cross-sectional study design to examine the microbial load of street-cut fruits and assess the knowledge and practice of vendors of cut fruits on personal and food hygiene in the study setting. The population consists of cut and vented pawpaw, watermelon, and street fruit vendors registered with the health directorate in the Tamale Metropolis. A convenient sampling technique was used to select 113 respondents for the study. The Yamane formula was used to determine the sample size to select one hundred and thirteen participants (113) out of one hundred and fifty-eight street fruit vendors in the Tamale Metropolis. The main instrument for data collection was a questionnaire. A questionnaire had close-ended questions which were developed using a 'Yes' and 'No' response, and a four-point Likert-type scale ranging from 1=Strongly Disagree (SD), 2=Disagree (D), 3=Agree (A) and 4= Strongly Agree (SA). The data were analysed using descriptive statistics (frequency, percentages, means and standard deviation). The findings revealed that the overall knowledge level of respondents is low. The findings also indicate that vendors do not control the rate at which their customers touch their vended fruits. It is recommended that Street fruit vendors and handlers be educated on fruit hygiene practices through engagement by the Health Directorate Unit of Tamale Metropolis and the Ministry of Health. To keep consumers safe, the Tamale Metropolitan Assembly must strictly enforce compliance with regulations on operation permits and health clearance certificates. Metropolitan sanitation officers must regularly monitor fruit vendors to ensure compliance with goods.
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Open Access January 02, 2025

Ambient Air Quality and Human Health Risk Assessment of Heavy Metals in a Potentially Toxic Silver-Polluted Environment

Abstract Silver nanoparticles (Ag+NPs) contamination in the environment is a serious concern. This study investigated selected heavy metal (Ag+, Cd2+, Cr2+ and Pb2+) concentrations at different sampling points to assess the risk to human health (infants, children, and adults). To do this, an enclosed area (laboratory) of 12.6 m X 8.5 m (107.1 [...] Read more.
Silver nanoparticles (Ag+NPs) contamination in the environment is a serious concern. This study investigated selected heavy metal (Ag+, Cd2+, Cr2+ and Pb2+) concentrations at different sampling points to assess the risk to human health (infants, children, and adults). To do this, an enclosed area (laboratory) of 12.6 m X 8.5 m (107.1 m2) was clearly marked at different coded distances of S1, S2, S3, and S4 representing 2, 4, 6, and 8 m, while unpolluted atmosphere at 50 m away without Ag+NPs served as the control (S5). The silver fireworks were allowed to burn for an approximate 00h03m30s at each sampling points using a high-volume air sampler mounted at the Environmental Engineering Departmental Laboratory, Rivers State University, with windows and doors closed to simulate indoor conditions. Samples were digested using a mixture of analytical-grade nitric acid, analytical-grade hydrochloric acid and analyzed to evaluate the levels of heavy metals by atomic absorption spectrophotometry. The Ag+ result at S1 shows 30,000 µg/cm3, S2 was 29,000 µg/cm3, while S3 was 28000 µg/cm3 and then S4 was 13,000 µg/cm3. These results exceeded the permissible values of the United States National Ambient Air Concentration for rural, urban and industrial areas (0.0005, 0.004 and 0.6 µg/cm3, respectively). The result for the control (S5) (0.037 µg/cm3) was within the maximum allowable value. Results from other heavy metals such as Cd were 1000, 743, 401, 153, 0.001 µg/cm3, Cr was 5000, 4000, 3729, 2960, 0.002 µg/cm3, Pb was 0.048, 0.041, 0.035, 0.034 and 0.01, µg/cm3, respectively. However, higher values of Ag+, Cd, and Cr indicated a higher propensity for the metals to be toxic (bioavailable). In addition, the assessment of the potential health risk posed by these metals proved contaminated and harmful. Visitors recorded high values in exposure concentration (EC) and low values in average daily dose (ADD).
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Open Access December 10, 2024

Psychological Corollaries, Self-Care and Coping Behaviors of Healthcare Workers During COVID-19 Pandemic: An Integrative Review

Abstract Background: The COVID-19 pandemic posed significant psychological challenges to frontline healthcare workers (HCWs), including anxiety, stress, and emotional strain. Aim: This study investigates the psychological impact on HCWs during the pandemic and explores coping strategies employed to manage distress. Methods: An integrative review was conducted using 24 studies published [...] Read more.
Background: The COVID-19 pandemic posed significant psychological challenges to frontline healthcare workers (HCWs), including anxiety, stress, and emotional strain. Aim: This study investigates the psychological impact on HCWs during the pandemic and explores coping strategies employed to manage distress. Methods: An integrative review was conducted using 24 studies published between January and December 2020. These studies were analyzed to identify common psychological outcomes and coping mechanisms among HCWs. Results: Healthcare workers experienced significant psychological distress during the COVID-19 pandemic, including anxiety, stress, insomnia, and depression. Anxiety was the most commonly reported issue, particularly among women, younger healthcare workers, and frontline staff. Stress levels were heightened by high workloads, exposure to COVID-19 patients, and inadequate protective measures. Coping strategies and self-care behaviors, such as seeking social support and utilizing institutional resources, varied in effectiveness across populations. Conclusion: The findings highlight the urgent need for targeted mental health support and resilience programs for HCWs, ensuring they are better equipped to face future health crises.
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Integrative Review
Open Access December 03, 2024

Diabetes Nursing Education Its Implication Towards an Improved Quality of Life of Persons with Diabetes: A Systematic Review

Abstract Background: Diabetes is a chronic global health issue that requires effective management to improve patient outcomes and quality of life. Nursing education plays a critical role in empowering diabetic patients with self-management skills. Aim This systematic review evaluates the impact of diabetes-focused nursing education on patient outcomes and quality of life. Methods: This study [...] Read more.
Background: Diabetes is a chronic global health issue that requires effective management to improve patient outcomes and quality of life. Nursing education plays a critical role in empowering diabetic patients with self-management skills. Aim This systematic review evaluates the impact of diabetes-focused nursing education on patient outcomes and quality of life. Methods: This study uses PRISMA guidelines and a systematic approach to identify and evaluate relevant literature. Results and Discussion: Among the 14 studies reviewed, eight emphasized self-management education, while four incorporated multidisciplinary approaches. Findings consistently demonstrated that structured nursing education programs significantly improved self-management behaviors, glycemic control, and patient knowledge. For instance, nurse-led self-management programs resulted in substantial enhancements in self-care skills and diabetes-related knowledge. Moreover, interventions that combined health education with psychological support were particularly effective, leading to better blood glucose control and increased adherence to treatment. Studies that examined quality of life reported reductions in anxiety, improved lifestyle habits, and better overall self-management. These findings highlight the multifaceted benefits of nursing education, suggesting that structured, supportive programs positively impact both clinical and psychological aspects of diabetes care. Conclusion: The review emphasizes the value of comprehensive nursing education that integrates both clinical guidance and psychological support for holistic diabetes management. Implications: Ongoing professional development and culturally sensitive education programs are recommended to address the diverse needs of diabetic patients. Future research should investigate the long-term effects of nursing education and explore innovative strategies to enhance diabetes management outcomes.
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Systematic Review
Open Access November 26, 2024

Impact of Classroom from the Primary Level of the Acquisition of English as a Second Language in Bangladesh

Abstract This paper examines the impact of primary level classroom environments on the acquisition of English as a second language (L2) in Bangladesh, comparing English-medium and Bangla-medium schools. The study investigates how different instructional approaches and early exposure to English influence language proficiency among students. Through a mixed-methods approach, including surveys, interviews, [...] Read more.
This paper examines the impact of primary level classroom environments on the acquisition of English as a second language (L2) in Bangladesh, comparing English-medium and Bangla-medium schools. The study investigates how different instructional approaches and early exposure to English influence language proficiency among students. Through a mixed-methods approach, including surveys, interviews, and proficiency tests, the research reveals significant differences in language acquisition outcomes between the two educational settings. Findings indicate that students in English-medium schools, who are exposed to Natural approach methods of language learning and immersive English-speaking environments, demonstrate higher proficiency in speaking and listening skills compared to their Bangla-medium counterparts, who primarily receive grammar-focused instruction. The study highlights the critical role of early exposure to English, with students who begin learning the language at a younger age showing better phonological and syntactic development. Additionally, the integration of technology in language teaching emerges as a valuable tool for enhancing language learning, particularly in contexts with limited classroom exposure. The research suggests that Bangla-medium schools could benefit from adopting more interactive, student-centered teaching methods and integrating digital tools to support practical language use. The study's findings have significant implications for educational policy, advocating for a shift towards more immersive and communicative teaching practices to improve English language acquisition in Bangladesh. This research contributes to the broader understanding of SLA and offers practical recommendations for enhancing language education in similar contexts.
Article
Open Access November 16, 2024

Electrocution Cervical Myelopathy Presenting with Partial Brown Sequard Syndrome: A Case Report and Review of Literature

Abstract Background: Electrical injuries are underreported in literature, but they can affect the peripheral and central nervous system causing permanent disability. Aims and objectives: This case report aims to highlight cervical spinal cord injury secondary to electrocution, a rare cause of spinal cord injury. Case report: We report the case of a 54-year-old housewife who presented [...] Read more.
Background: Electrical injuries are underreported in literature, but they can affect the peripheral and central nervous system causing permanent disability. Aims and objectives: This case report aims to highlight cervical spinal cord injury secondary to electrocution, a rare cause of spinal cord injury. Case report: We report the case of a 54-year-old housewife who presented with transient loss of consciousness and right sided hemiparesis following electrocution, while at home. Results: The patient met clinical critera for partial Brown- Sequard syndrome, which to our knowledge, has not been previously reported. She showed significant improvement over a month and is currently under monitoring. Conclusions: Electrical injury is a rare cause of normal MRI myelopathy and the potential for immediate, delayed, and long- term neurological disability.
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Case Report
Open Access November 15, 2024

Education Does Not Equally Increase Financial Well-being for All

Abstract Background: Financial well-being is a key domain of overall well-being, encompassing an individual's ability to meet financial obligations, secure their financial future, and maintain a sense of financial freedom. Education is often viewed as a critical pathway to enhancing financial well-being. However, the returns of education on financial well-being are not uniform across racial, ethnic, [...] Read more.
Background: Financial well-being is a key domain of overall well-being, encompassing an individual's ability to meet financial obligations, secure their financial future, and maintain a sense of financial freedom. Education is often viewed as a critical pathway to enhancing financial well-being. However, the returns of education on financial well-being are not uniform across racial, ethnic, and nativity groups. The theory of Minorities’ Diminished Returns (MDRs) suggests that the positive effects of education on outcomes such as income and financial security are weaker for marginalized groups, including Black individuals, Latinos, and immigrants. Objective: This study examines the diminished returns of education on financial well-being among Black, Latino, and immigrant populations in the United States. We aim to investigate how structural inequalities contribute to weaker financial returns on education for these groups compared to their White and native-born counterparts. Methods: We utilized data from the Understanding America Study (UAS 2014) to conduct a cross-sectional analysis of adult respondents. The study assessed financial well-being outcomes (e.g., income, savings, and financial security) and their association with educational attainment across racial, ethnic, and nativity groups. Regression models were employed to test for interaction effects between education and race/ethnicity/nativity, adjusting for sociodemographic factors such as age, gender, employment, and family structure. Results: Our analysis included 8,121 individuals. The mean age of the respondents was 48 years (SD = 16). High education was associated with higher financial well-being (B = 1.284, 95% CI: 1.157, 1.410). The interaction terms between education and immigrant status (B = -0.507, 95% CI: -0.930, -0.084), race (Black) (B = -0.770, 95% CI: -1.208, -0.331), and ethnicity (Hispanic) (B = -0.589, 95% CI: -0.969, -0.210) were all significant, suggesting that immigrant, Black, and Hispanic individuals experience diminished returns on education in terms of financial well-being, relative to US-born non-Hispanic White individuals. The significant negative interactions between education and minority statuses (Black, Hispanic, and immigrant) indicate that while education generally improves financial well-being, the magnitude of this improvement is substantially smaller for these marginalized groups. Conclusion: Understanding how education translates to financial well-being across different racial, ethnic, and nativity groups is critical for addressing persistent financial disparities.
Article
Open Access November 05, 2024

Effect of Different Processing Methods on Total Phenolic and Total Flavonoid Content of Selected Indigenous Vegetables

Abstract Foods rich in phytochemicals are well recognized for their role in the prevention of chronic disease development, in addition to fulfilling the nutrient requirements. However, different processing methods employed during preparation may affect their levels and functionality as they are sensitive to different processing parameters such as temperature and light. This study aimed to evaluate the effects of three common processing methods; boiling, fermentation, and drying (sun and solar drying, with and without blanching), on total phenolic content and total flavonoid content in cassava (Manhot esculenta Crantz), black jack (Bidens pilosa) and bitter lettuce leaves (Launaea cornuta [...] Read more.
Foods rich in phytochemicals are well recognized for their role in the prevention of chronic disease development, in addition to fulfilling the nutrient requirements. However, different processing methods employed during preparation may affect their levels and functionality as they are sensitive to different processing parameters such as temperature and light. This study aimed to evaluate the effects of three common processing methods; boiling, fermentation, and drying (sun and solar drying, with and without blanching), on total phenolic content and total flavonoid content in cassava (Manhot esculenta Crantz), black jack (Bidens pilosa) and bitter lettuce leaves (Launaea cornuta) grown in Mkuranga District in the Eastern part of Tanzania. Total phenolic content and total flavonoid content were analyzed by using the spectrophotometric method with the use of Folin-Ciocalteu and Aluminum Chloride reagents, respectively. Total phenolic content ranged from 0.9±0.14 to 85.7 ± 0.56 mg Gallic Acid Equivalent (GAE)/100g and flavonoids ranged from 0.03±0.00 to 3.9±0.03 mg/100g across the treatments. Both parameters were adversely affected by fermentation and boiling, while solar and sun drying only reduced the flavonoid content. Results showed that direct solar and sun drying appear to be effective processing methods, for the retention and maintenance of total phenolic content in all samples while, none proved to be effective for flavonoid content.
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Article
Open Access October 27, 2024

Learners' Initial Conceptions in Science and School Performance

Abstract The theme of the study that catches our attention is the initial conceptions of learners in Science and school performance; this theme is based on the competency-based approach in force in Cameroon, which is implemented in several African countries. Insofar as learning is not the accumulation of new knowledge but a cognitive reorganization of old knowledge experienced, it is therefore a question [...] Read more.
The theme of the study that catches our attention is the initial conceptions of learners in Science and school performance; this theme is based on the competency-based approach in force in Cameroon, which is implemented in several African countries. Insofar as learning is not the accumulation of new knowledge but a cognitive reorganization of old knowledge experienced, it is therefore a question of knowing what is the influence of initial conceptions on the academic performance of learners in science. The objective of this research was to show that taking into account the initial conceptions of learners, Biology “SVT” has a lasting influence on learning and thus on the academic performance of learners. To achieve this objective, the study uses the mixed and quasi-experimental method, where two groups of learners were used: a control group and an experimental group. The experimental group was subjected to the teaching-learning system designed for this purpose, and in which the initial conceptions of the learners were taken into account according to do with or go against. In the light of the different hypotheses adopted and the different results of this study, it can be observed that the didactic consideration of the learners' initial conceptions improves their academic performance through the data of the experimental group. In relation to the field of education, this study shows that in order to enable learners to learn and build knowledge in the long term, their initial conceptions must be taken into account in concrete didactics; Otherwise, learning will be sporadic, learners' conceptions will be significant, which will lead to a learning defect perceptible by school failure.
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Open Access April 29, 2024

Floristic composition of vascular epiphytes in a disturbed forest of the Douala- Edea National Park (Cameroon)

Abstract The Douala-Edea National Park is a coastal protected area that opens to the Atlantic Ocean, and contains an abundant wildlife which finds a privilege habitat there, and certain taxa such as epiphytes, which are of particular interest for conservation. In many tropical forests, vascular epiphytes are one of the richest taxa, with major impacts on the nutrient and hydrological cycles. The aim of this research was to study the effect of the disturbance of habitat on the floristic composition of vascular epiphytes in the Douala-Edea National Park. This study was carried out between January - April 2021 in three types of disturbed habitats at the northern part of the park. Three plots of 100 m × 100 m dimensions were laid out across three ecosystems along the Sanaga river. The sampling method consisted in the direct observation of five adjacent transects of 100 m x 20 m dimensions inside each plot. Epiphytes species were evaluated on all trees of DBH ≥10 cm. Epiphytes' life-forms and the position on the host trees occupied by the epiphytes were also recorded. A total of 18 species belonging to 16 genera and 13 families were identified. Culcasia sp. was the most common species with a relative frequency of 30.27%. Biological indicators were represented by Ferns, with four species, and Orchidaceae, with one species. [...] Read more.
The Douala-Edea National Park is a coastal protected area that opens to the Atlantic Ocean, and contains an abundant wildlife which finds a privilege habitat there, and certain taxa such as epiphytes, which are of particular interest for conservation. In many tropical forests, vascular epiphytes are one of the richest taxa, with major impacts on the nutrient and hydrological cycles. The aim of this research was to study the effect of the disturbance of habitat on the floristic composition of vascular epiphytes in the Douala-Edea National Park. This study was carried out between January - April 2021 in three types of disturbed habitats at the northern part of the park. Three plots of 100 m × 100 m dimensions were laid out across three ecosystems along the Sanaga river. The sampling method consisted in the direct observation of five adjacent transects of 100 m x 20 m dimensions inside each plot. Epiphytes species were evaluated on all trees of DBH ≥10 cm. Epiphytes' life-forms and the position on the host trees occupied by the epiphytes were also recorded. A total of 18 species belonging to 16 genera and 13 families were identified. Culcasia sp. was the most common species with a relative frequency of 30.27%. Biological indicators were represented by Ferns, with four species, and Orchidaceae, with one species. The epiphytes species richness was highest in the low disturbed habitat (13 species), and lowest in the highly disturbed habitat (8 species). Strict epiphytes were highly recorded in the low disturbed habitat (6 species), and were absent in the highly disturbed habitat. Hemi-epiphytes were the commonest life-form (12 species) in the highly disturbed habitat, and have been defined as indicators of the perturbation of the habitat. Canopy was mostly sollicitated by epiphytes in the low disturbed habitat (66.25%) than the moderate disturbed habitat (49.85%), and highly disturbed habitat (30.66%). It has been found that the different forest sites have an influence on the typology of epiphytic species, and therefore, epiphytic flora should be managed for the conservation of the biodiversity in tropical forests.
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Open Access April 29, 2024

Predictors of Patient Outcomes Associated with Transfer Status to Definitive Care Hospitals: A Study of Admitted Road Traffic Injured Patients in Two Major Trauma Hospitals in The Gambia

Abstract The Gambia uses the Primary Health Care model with no trauma response system. Trauma patients are transferred through multiple levels of health care facilities before definitive care hospitals. This study was conducted to identify predictors of injury factors associated with transfer. In this study, we examined characteristics of transferred patients compared to those directly admitted in [...] Read more.
The Gambia uses the Primary Health Care model with no trauma response system. Trauma patients are transferred through multiple levels of health care facilities before definitive care hospitals. This study was conducted to identify predictors of injury factors associated with transfer. In this study, we examined characteristics of transferred patients compared to those directly admitted in definitive care hospitals. The study was conducted in two major trauma hospitals in The Gambia. 251 road traffic injury (RTI) patients were either transferred (84%) from lower-level health centers or directly admitted (16%) to one of the study hospitals. Transferred patients were more likely to have been pedestrian/bicyclists (aOR = 1.81; 95% CI = 0.86 – 3.80). Administration of antibiotics was significantly associated with direct admit than transferred patients (aOR = 6.84; 95% CI = 2.38 – 19.68). Transferred patients were more likely to receive intravenous fluid compared to direct admits (aOR = 0.03; 95% CI = 0.01 – 0.08). The study results have implications for policies and planning in the healthcare setting in The Gambia and other LMICs with similar settings. Based on the findings of this study, it is essential that hospital management teams adapt to increasing reliance of RTI patients on lower-level healthcare facilities. The study results suggest increased burden on lower-level health care facilities. Efforts and resources should focus more on supporting lower-level facilities.
Article
Open Access March 05, 2024

Risk Factors of Vitamin D Insufficiency/Deficiency among a sample of Egyptian Females in Child Bearing Period

Abstract Background: Vitamin D plays an important role in the development of bone health and possibly non-communicable diseases. Arab countries had made their own national studies to assess serum vitamin D level among women, yet in Egypt there is no national survey done. The aim of the current study was to identify risk factors affecting vitamin D level among Egyptian females during the [...] Read more.
Background: Vitamin D plays an important role in the development of bone health and possibly non-communicable diseases. Arab countries had made their own national studies to assess serum vitamin D level among women, yet in Egypt there is no national survey done. The aim of the current study was to identify risk factors affecting vitamin D level among Egyptian females during the child-bearing period. Subjects and methods: A total of 100 healthy adult females in their childbearing period who were attending a Family Medicine Center were included in our study. The age of the included women ranged from 19 to 49 years old with a mean age of 34 (SD 8.47) years. The majority of participants had deficiency (43%) and insufficiency (13%) of vitamin D level. Results: Unemployed women were more likely to have vitamin D deficiency than employed women (P<0.05). Participants who were exposed to sun ˃30 minutes/day were more likely to have sufficient vitamin D level (P<0.05). All participants who consume fish ≥3 times/week had sufficient vitamin D level. Therefore, there was a statistically significance association between a number of consuming fish/week and vitamin D3 level groups. Also, there was statistically significant association between number of consumed milk cups/day and vitamin D3 level groups. All participants who drink 2 cups of milk have sufficient vitamin D level. No statistically significance association was found between using multivitamins and vitamin D3 level groups. Conclusion: Unemployment, low fish consumption and infrequent sun exposure were significant risk factors for vitamin D deficiency. Future research on the role of multivitamins supplements in improving vitamin D nutrition is warranted.
Article
Open Access March 05, 2024

Culture Shock in Nursing: A Concept Analysis

Abstract 1) Background: Culture shock is a common experience by internationally educated nurses (IENs) working in foreign countries, characterized by disorientation and discomfort due to distinct norms, values, and rituals. 2) Aim: this study explores culture shock in IENs and explores mitigation techniques to enhance understanding of challenges faced in foreign cultural contexts. [...] Read more.
1) Background: Culture shock is a common experience by internationally educated nurses (IENs) working in foreign countries, characterized by disorientation and discomfort due to distinct norms, values, and rituals. 2) Aim: this study explores culture shock in IENs and explores mitigation techniques to enhance understanding of challenges faced in foreign cultural contexts. 3) Method: Using Concept Analysis by Walker and Avant (2019). 4) Results: A total of 20 articles were reviewed. Four major attributes were identified: psychological and emotional impact, communication barriers, acculturation and quality of life, and organizational challenges. 5) Conclusion: This paper explores the challenges faced by nurses from foreign countries due to cultural adjustment and proposes solutions to minimize its effects. It is beneficial for nurses, healthcare organizations, and policymakers, aiming to improve patient care and health outcomes. 6) Implication for Practice: Addressing culture shock can promote a smooth transition, enhance nurses' experience, and improve their cultural competence. Providing tailored orientation and mentorship programs can help IENs feel supported and empowered, leading to increased job satisfaction, retention rates, and better patient outcomes.
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Open Access February 26, 2024

A Case of Early Initiation of Veno-venous Extracorporeal Membrane Oxygen in Morbid Obesity with Severe Legionella Pneumonia

Abstract We present a case of a critically ill patient with severe Legionella pneumonia complicated by morbid obesity (BMI ≥ 40 kg/m2) who was successfully treated with early initiation of veno-venous ECMO (V-V-ECMO) without any sequelae. The patient, a 48-year-old male, initially presented with symptoms of a sore throat, fever, significant fatigue, and decreased appetite. Upon diagnosis of [...] Read more.
We present a case of a critically ill patient with severe Legionella pneumonia complicated by morbid obesity (BMI ≥ 40 kg/m2) who was successfully treated with early initiation of veno-venous ECMO (V-V-ECMO) without any sequelae. The patient, a 48-year-old male, initially presented with symptoms of a sore throat, fever, significant fatigue, and decreased appetite. Upon diagnosis of severe pneumonia complicated by morbid obesity, he was transferred to our hospital for further management. Upon admission, he was promptly intubated and placed on mechanical ventilation. Due to a positive urinary Legionella antigen test indicating a risk of deterioration, V-V ECMO was initiated immediately after intubation. During ECMO support, the patient received Levofloxacin Hydrate at 500 mg/day and Prednisolone Sodium Succinate at 100 mg/day. He was successfully weaned off ECMO after 12 days and transferred back to the referring hospital on day 20. While ECMO therapy for morbidly obese patients was traditionally considered relatively contraindicated, this case suggest that obesity alone is not a contraindication to initiating ECMO.
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Case Report
Open Access February 17, 2024

An Overview of Short- and Long-Term Adverse Outcomes and Complications of Perinatal Depression on Mother and Offspring

Abstract Antenatal and postpartum major depressive episode (MDE) according to Diagnostic and Statistical Manual of Mental Disorders 5th Edition (DSM-V) is defined as either daily sustained sad mood or lack of enjoyment or desire for a minimum two weeks plus four associated manifestations (only three if the two major symptoms are present) that start throughout pregnancy or during the first 4 weeks [...] Read more.
Antenatal and postpartum major depressive episode (MDE) according to Diagnostic and Statistical Manual of Mental Disorders 5th Edition (DSM-V) is defined as either daily sustained sad mood or lack of enjoyment or desire for a minimum two weeks plus four associated manifestations (only three if the two major symptoms are present) that start throughout pregnancy or during the first 4 weeks postpartum respectively: 1) Unintentional notable slimming up or down; 2) Sleepiness or sleeplessness; 3) Tiredness sensation; 4) Guilty or futility sensation; 5) Declined concentration capacity; 6) Frequent suicidal thoughts; 7) Psychomotor excitation or delay. Perinatal depression carries vital and adverse consequences on mother’s psychosocial aspects of life, pregnancy and delivery outcomes, her interrelations specifically with the new born with poorer overall health and influences negatively on offspring from the intrauterine life passing by complicated delivery experiencing hard unstable childhood reaching unhealthy adolescence and adulthood. These negative consequences necessitate a great attention for prevention, screening and prompt treatment for antenatal and postnatal depression to prevent such disastrous effects.
Brief Review
Open Access January 04, 2024

Cap-dependent endonuclease inhibitors for adult patients with influenza: the use of baloxavir marboxil

Abstract Baloxavir marboxil (BXM) is a novel anti-influenza agent that developed in Japan and inhibit the cap endonuclease specifically, and suggested the more clinical effectiveness in influenza. BXM reduces viral shedding more than do neuraminidase inhibitors (NAIs), and its clinical efficacy is equivalent to that of NAIs but is superior to that of NAIs in the case of type B influenza. BXM does not [...] Read more.
Baloxavir marboxil (BXM) is a novel anti-influenza agent that developed in Japan and inhibit the cap endonuclease specifically, and suggested the more clinical effectiveness in influenza. BXM reduces viral shedding more than do neuraminidase inhibitors (NAIs), and its clinical efficacy is equivalent to that of NAIs but is superior to that of NAIs in the case of type B influenza. BXM does not demonstrate any issues with safety, and treatment with BXM reduces the incidences of complicating sinusitis and bronchitis. Prophylactic administration of BXM inhibits intrafamilial transmission of influenza although low susceptible viruses with a PA/I38X substitution are isolated with a certain frequency following administration of BXM. Finally, In influenza treatment for patients aged 12−19 years and for adult outpatients, BXM can be used with the same recommendation level as oseltamivir.
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Mini Review
Open Access January 03, 2024

Inflammatory Bowel Disease associated with Intestinal Malrotation

Abstract Intestinal malrotation is an embryological abnormality modifying the classic anatomy of the small and large bowels, particularly the topographical one. Inflammatory bowel disease (IBD) is characterised by anatomical lesions with preferential intestinal tropism. These two conditions are rarely associated. They represent a real diagnostic and therapeutic challenge due to the overlap of non-specific [...] Read more.
Intestinal malrotation is an embryological abnormality modifying the classic anatomy of the small and large bowels, particularly the topographical one. Inflammatory bowel disease (IBD) is characterised by anatomical lesions with preferential intestinal tropism. These two conditions are rarely associated. They represent a real diagnostic and therapeutic challenge due to the overlap of non-specific symptoms and the complexity of the clinical management. We report the case of a young woman presenting with a flare-up of her IBD and a partial common mesentery syndrome. Clinicians should be aware of the potential pitfalls of the two entities to propose the adequate therapeutic strategy regarding the full understanding of the anatomy, notably when surgery is needed.
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Case Report
Open Access December 25, 2023

An Appraisal of International Students Retention and Graduation at Northern Arizona University

Abstract The Internationalization of higher education has plummeted since the 2010 tightening of migration policies. This study aims to examine the retention and graduation rates of international students at Northern Arizona University (NAU). Using a quantitative analysis approach, the study utilized secondary data from the Center for International Admission and Recruitment Office at NAU to examine the [...] Read more.
The Internationalization of higher education has plummeted since the 2010 tightening of migration policies. This study aims to examine the retention and graduation rates of international students at Northern Arizona University (NAU). Using a quantitative analysis approach, the study utilized secondary data from the Center for International Admission and Recruitment Office at NAU to examine the university’s recruitment, graduation, and retention strategies. The aim was to evaluate the impact of internationalization strategies on application and enrolment numbers. The study sample consisted over 2000 international students from fourteen countries, including China, India, Vietnam, Kuwait, Nepal, Ghana, Nigeria, United Kingdom, Spain, Germany, Canada, Mexico, France, and Iran in four cultural groups (Asia, Europe, Africa, and North America). A random sampling technique was used to select these countries partly because of their highest applications, enrolment numbers, as well as their adoption of recruitment strategies like those used by higher education institutions in the United States. A descriptive graphic representation, focusing on full-time undergraduate students during fall semesters, specifically freshmen international students, is illustrated. To facilitate a cross-country comparison of international students, this study presents an analysis of retention and graduation data across different countries spanning the past five years, from 2016 to 2020.
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Open Access December 19, 2023

Conservation of Cuabal from Community Environmental Education: Results of an Implemented Proposal

Abstract The spiny xeromorphic shrublands on serpentine (cuabales) constitute outstanding plant formations for the conservation of Cuban biodiversity, due to their floristic richness, high number of endemic species and local endemism, as well as their economic, social, cultural value and functions environmental. In the Callejón de Los Patos of Santa Clara, there are relicts of cuabal, although they show a [...] Read more.
The spiny xeromorphic shrublands on serpentine (cuabales) constitute outstanding plant formations for the conservation of Cuban biodiversity, due to their floristic richness, high number of endemic species and local endemism, as well as their economic, social, cultural value and functions environmental. In the Callejón de Los Patos of Santa Clara, there are relicts of cuabal, although they show a high level of deterioration due to human activity. This article presents the main results of an investigation, which focused on implementing actions for the development of Community Environmental Education, with emphasis on the conservation of cuabal, in Callejón de Los Patos. For the intervention process, the Community Self-Development Methodology was used, which is qualitative par excellence, and the investigative methods: document analysis, participant observation, in-depth, group and structured interviews, drawing directed, the reflective group, techniques group and triangulation of data. The main results of the research are: the diagnosis and implementation of actions, designed from the process of Community Environmental Education, which was developed at the Carlos Manuel de Céspedes National Rural School, of said settlement. During the intervention process, the development of cognitive, procedural and attitudinal knowledge for the conservation of cuabal was verified in the schoolchildren, contributing to the strengthening of the school as the most important cultural center of the community, as aspired in the Cuban National Education System.
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Open Access December 13, 2023

Is a Mexico-China Competition Emerging in US Supply Chains? A Comparative Perspective

Abstract With the current sources of US supply chains being more diversified than before, China’s share in US goods imports is declining while Mexico becomes the largest exporter to the US market in 2023. However, can Mexico use this trade diversion to successfully outweigh China in US supply chains? This paper thus investigates whether the Mexico manufacturing sector is competitive enough to completely [...] Read more.
With the current sources of US supply chains being more diversified than before, China’s share in US goods imports is declining while Mexico becomes the largest exporter to the US market in 2023. However, can Mexico use this trade diversion to successfully outweigh China in US supply chains? This paper thus investigates whether the Mexico manufacturing sector is competitive enough to completely replace its Chinese counterparts and rise to a strategically vital supplier for the US economy. Based on multiple empirical evidence, we find that although US supply chain sources are shifting from China to Mexico, the major part of the value added of Mexican exports to the US market is generated in China. Moreover, our evidence shows that Mexico’s exports to the US concentrate on low-skill sectors, while China’s mainly consists of high-skill goods. Further discussion shows that the current US trade shift is highly likely due to China’s FDI inflows to Mexico’s traditionally strong export sector, motor vehicles. However, this shift is not significant enough for Mexico to become a capable substitute for China in the US supply chains. We conclude that the "trade diversion" strategy alone cannot support Mexico’s role in reducing the US supply chain dependence on China. Therefore, the US should better consider how to establish a sustainable trade framework that fosters stable cooperation with China.
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Brief Report
Open Access December 12, 2023

Threatened Wildlife for an Instructional Approach about Biodiversity Conservation

Abstract Biodiversity is related to a global problem: its destruction, a fact supported by scientific authorities. It is not trivial that educational dimension has been contemplated as one of the strategies for its conservation. Since 1992 global initiatives such as the Convention on Biological Diversity postulates concepts that linked education and nature conservation. The main objective of this research work is to test the level of assimilation of extracurricular scientific knowledge by primary school pupils. The method chosen for the content was, on the one hand, a master class intervention with an interactive presentation on a digital whiteboard. Third cases were chosen. Each case consisted of a presentation of the current status of a species of fauna present in Spain. On the second part, students were asked to write an essay and to illustrate the experience during the presentation. Regarding the essays, students showed that they were more attracted to the first species that was presented (Iberian lynx) in a proportion of over 45% of cases. The “Endangered species” concept appeared in more than 77% of the texts reviewed. In terms of drawings, almost 55% of the responses seem to devote more attention to the second species described (Testudo graeca [...] Read more.
Biodiversity is related to a global problem: its destruction, a fact supported by scientific authorities. It is not trivial that educational dimension has been contemplated as one of the strategies for its conservation. Since 1992 global initiatives such as the Convention on Biological Diversity postulates concepts that linked education and nature conservation. The main objective of this research work is to test the level of assimilation of extracurricular scientific knowledge by primary school pupils. The method chosen for the content was, on the one hand, a master class intervention with an interactive presentation on a digital whiteboard. Third cases were chosen. Each case consisted of a presentation of the current status of a species of fauna present in Spain. On the second part, students were asked to write an essay and to illustrate the experience during the presentation. Regarding the essays, students showed that they were more attracted to the first species that was presented (Iberian lynx) in a proportion of over 45% of cases. The “Endangered species” concept appeared in more than 77% of the texts reviewed. In terms of drawings, almost 55% of the responses seem to devote more attention to the second species described (Testudo graeca). An attempt was made to offer rigorous, structured information related to different aspects of natural reality in order to contemplate the broadest possible vision. The example of an instructional intervention presented here aims to be an alternative to other transmissive teaching models. Likewise, the linking of abstract concepts with socio-cultural reality proved to be a successful strategy to reinforce knowledge about natural biodiversity, endangered species or threat factors.
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Open Access November 27, 2023

Physico-chemical and sensory characterization of bread based on green banana (Musa spp.) flour

Abstract The banana (Musa spp. [...] Read more.
The banana (Musa spp.) is a tropical fruit with excellent sensory characteristics in terms of aroma, flavor and texture, consumed worldwide and exploited in most tropical countries. Green banana flour is rich in flavonoids, which protect the gastric mucosa, has a high content of resistant starch, which acts in the body as a dietary fiber and thus has health benefits, and is an alternative option for bakery products, reducing waste of both the peel and the pulp. The aim of this study was to develop bread formulations with partial substitution of wheat flour with green banana flour (FBV), thus increasing the nutritional, technological and sensory value. 4 formulations, (A), standard sample; (B), bread with 10% FBV; (C), bread with 15% FBV and (D), bread with 20% FBV. Physico-chemical quality was assessed in terms of moisture content by drying at 105ºC, ash by incineration, fat by the Soxhlet method, protein by the biuret method, carbohydrates by difference calculation and calorific value by sum calculation and sensory analysis by affective methods. The data was evaluated using the RStudio 4.2.1 DCC statistical package. There were no significant differences in moisture content, lipids and calorific value. Differences were evident in the ash and protein content. Sensory acceptance of the standard formulation was 82.22%. The results obtained show that green banana flour can be used as a partial substitute for wheat flour to produce breads with functional properties.
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Open Access November 10, 2023

Bioremediation of Heavy Metals in Crude Oil-Contaminated Utisol, Using Nutrient Formulate Produced from Jatropha tanjorensis Leaf Extract

Abstract This work evaluated the bioremediation potential of Jatropha tanjorensis leaf extract at different masses (250g, 500g and 750g) over a 40-day period. To achieve this, crude oil contamination of sandy loam soil was stimulated in twelve plastic reactors containing fixed masses of soil (4kg each) of topsoil homogenized with 500g of Bonny light crude oil. The Jatropha tanjorensis leaves were cultivated, rinsed with distilled water, blended, and purified by filtration. The leaf extract was applied at the stated concentrations including a control reactor (without leaf extract). The plastics reactors were kept in an open air shielded away from rainfall. The physicochemical characteristics determined were particle size distribution (PSD), potential of hydrogen (pH), electrical conductivity (EC), organic matter (OM), organic carbon (OC), selected heavy metals (Cr, Cd, Zn, Pb) and sample management were all in line with standard procedure. After 40 days of treatment, results obtained showed that plastic reactor with 750g of leaf extract produced the highest amount of cadmium reduction of 97% (from an initial of and there was significant difference among treatment (P < 0.05). The sequence of reduction among treatment was 750g > 500g > 250g of the leaf extract. Chromium, Lead and zinc followed similar trend. Thus, the Jatropha tanjorensis [...] Read more.
This work evaluated the bioremediation potential of Jatropha tanjorensis leaf extract at different masses (250g, 500g and 750g) over a 40-day period. To achieve this, crude oil contamination of sandy loam soil was stimulated in twelve plastic reactors containing fixed masses of soil (4kg each) of topsoil homogenized with 500g of Bonny light crude oil. The Jatropha tanjorensis leaves were cultivated, rinsed with distilled water, blended, and purified by filtration. The leaf extract was applied at the stated concentrations including a control reactor (without leaf extract). The plastics reactors were kept in an open air shielded away from rainfall. The physicochemical characteristics determined were particle size distribution (PSD), potential of hydrogen (pH), electrical conductivity (EC), organic matter (OM), organic carbon (OC), selected heavy metals (Cr, Cd, Zn, Pb) and sample management were all in line with standard procedure. After 40 days of treatment, results obtained showed that plastic reactor with 750g of leaf extract produced the highest amount of cadmium reduction of 97% (from an initial of and there was significant difference among treatment (P < 0.05). The sequence of reduction among treatment was 750g > 500g > 250g of the leaf extract. Chromium, Lead and zinc followed similar trend. Thus, the Jatropha tanjorensis leaf extract has the potential to ameliorate crude oil-contaminated soil.
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Open Access November 03, 2023

Mathematical Modeling of the Price Volatility of Maize and Sorghum between 1960 and 2022

Abstract The price of grains like maize and sorghum is subject to significant fluctuations, which can have a significant impact on a country's economy and food security. The aim of the study is to model sorghum and maize price volatility in Nigeria. The data utilized in the study was extracted from World Bank Commodity Price Data (WBCPD), 2022. The data consists of monthly prices in nominal US dollars for [...] Read more.
The price of grains like maize and sorghum is subject to significant fluctuations, which can have a significant impact on a country's economy and food security. The aim of the study is to model sorghum and maize price volatility in Nigeria. The data utilized in the study was extracted from World Bank Commodity Price Data (WBCPD), 2022. The data consists of monthly prices in nominal US dollars for maize and sorghum from January 1960 – August 2022. The Autoregressive Conditional Heteroskedasticity (ARCH) and Generalized Autoregressive Conditional Heteroskedasticity (GARCH) models were utilized for capturing the two-grain price volatility. Two types of conditional heteroscedastic models exist, the first group uses exact functions to control the evolution of , while the second group describes with stochastic equations. It is inferred from the result that inherent uncertainties and fluctuations existed in the prices of maize and sorghum in Nigeria which implies that the price volatility is positive and statistically significant suggesting that historical information and past shocks play a crucial role in determining the volatility observed in the grains. It is recommended that the ARCH, GARCH, EGARCH, TGARCH, PARCH, CGARCH, and IGARCH models should be employed for modeling and managing the volatility of maize and sorghum prices in Nigeria. These models have shown effectiveness in capturing different aspects of volatility, including the impact of past shocks, conditional volatility, asymmetry, and other relevant factors.
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Open Access November 03, 2023

Quality of Communication between Healthcare Providers and Pregnant Women: Impact on Maternal Satisfaction, Health Outcomes, and Shared Decision-Making

Abstract The quality of communication between healthcare providers and pregnant women is a topic of paramount importance within the realm of maternal healthcare. It is not merely an aspect of medical interaction; rather, it is the prerequisite that influences various critical dimensions of maternal care, including maternal satisfaction, health outcomes, and shared decision-making. Effective communication [...] Read more.
The quality of communication between healthcare providers and pregnant women is a topic of paramount importance within the realm of maternal healthcare. It is not merely an aspect of medical interaction; rather, it is the prerequisite that influences various critical dimensions of maternal care, including maternal satisfaction, health outcomes, and shared decision-making. Effective communication between healthcare providers and pregnant women is essential for optimal maternal care during pregnancy and childbirth. Maternal satisfaction is a fundamental metric of patient-centered care, and improved communication, characterized by empathy, information sharing, and active listening, cultivates trust and enhances women's contentment with their care experiences. Positive provider-patient interactions are associated with improved emotional well-being, reduced stress levels, and increased adherence to prenatal recommendations, contributing to positive health outcomes for both mother and fetus. Shared decision-making is impacted by open and transparent dialogue between healthcare providers and pregnant women. Inclusive discussions about available interventions, risks, and benefits empower women to make informed choices aligned with their preferences and values. This shared decision-making promotes autonomy, self-efficacy, and a collaborative care partnership, potentially influencing the birthing experience and postpartum adaptation. However, challenges persist in communication quality, such as variability in healthcare provider communication styles, cultural considerations, and system-level factors. Addressing these challenges through targeted interventions, training, and policy implementation can further enhance the overall maternal care experience. Further research is needed to explore innovative strategies that optimize communication and promote positive outcomes throughout the continuum of maternal care.
Review Article
Open Access November 01, 2023

Individual Wave Component Signal Modeling, Parameters Extraction, and Analysis

Abstract The accurate estimation of Individual Wave Components (IWC) is crucial for automated diagnosis of the human digestive system in a clinical setting. However, this process can be challenging due to signal contamination by other signal sources in the body, such as the lungs and heart, as well as environmental noise. To address this issue, various denoising techniques are commonly employed in bowel [...] Read more.
The accurate estimation of Individual Wave Components (IWC) is crucial for automated diagnosis of the human digestive system in a clinical setting. However, this process can be challenging due to signal contamination by other signal sources in the body, such as the lungs and heart, as well as environmental noise. To address this issue, various denoising techniques are commonly employed in bowel sound signal processing. While denoising is important, it can increase computational complexity, making it challenging for portable devices. Therefore, signal processing algorithms often require a trade-off between fidelity and computational complexity. This study aims to evaluate an IWC parameter extraction algorithm that was previously developed and reconstruct the IWC without denoising using synthetic and clinical data. To that end, the role of a reliable model in creating synthetic data is paramount. The rigorous testing of the algorithm is limited by the availability of quality and quantity recorded data. To overcome this challenge, a mathematical model has been proposed to generate synthetic bowel sound data that can be used to test new algorithms. The proposed algorithm’s robust performance is evaluated using both synthetic and clinically recorded data. We perform time-frequency analysis of original and reconstructed bowel sound signals in various digestive system states and characterize the performance using Monte Carlo simulation when denoising is not applied. Overall, our study presents a promising algorithm for accurate IWC estimation that can be useful for predicting anomalies in the digestive system.
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Article
Open Access November 01, 2023

Efficacy and Safety of Long-Term Anticoagulation Therapy with Direct Oral Anticoagulants versus Vitamin K Antagonist in Patients with Cerebral Venous Thrombosis

Abstract Introduction: Cerebral venous thrombosis is a rare type of stroke caused by partial or complete occlusion of cerebral venous sinuses. Current guidelines recommend the administration of Low Molecular Weight Heparin (LMWH) during the acute phase and oral Vitamin K antagonists (VKAs) such as warfarin for 3-12 months. Direct Oral Anticoagulants (DOACs) are an attractive alternative to VKAs as [...] Read more.
Introduction: Cerebral venous thrombosis is a rare type of stroke caused by partial or complete occlusion of cerebral venous sinuses. Current guidelines recommend the administration of Low Molecular Weight Heparin (LMWH) during the acute phase and oral Vitamin K antagonists (VKAs) such as warfarin for 3-12 months. Direct Oral Anticoagulants (DOACs) are an attractive alternative to VKAs as therapy for CVT, for its safety and efficacy as anticoagulation therapy for deep venous thrombosis or pulmonary embolism. Method: This systematic review is written based on PRISMA guidelines with electronic search performed on various databases for journals published from June 1, 2018 to June 1, 2023. Results: We found four studies fulfilling the inclusion criteria, with four randomized controlled studies presenting 179 CVT patients treated with DOAC and 150 patients treated with standard therapy. DOACs used in reviewed studies are Dabigatran and Rivaroxaban. Discussion: Administration of DOACs as anticoagulation therapy in patients with CVT presents better recanalization rate with no significant differences in efficacy compared with VKAs, along with a better safety profile through similar mortality rate across two groups. Conclusion: DOACs as long-term anticoagulation therapy in patients with CVT has better efficacy along with a similar safety profile compared to VKA.
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Systematic Review
Open Access October 31, 2023

Effectiveness of Probiotics for Treatment of COVID-19: A Systematic Review and Meta-analysis

Abstract Background: Recently specific interactions and crosslinks between the gut microbiota and the lungs have been recognized, particularly with regard to respiratory immune and anti-microbial reactions. This is often known as the “gut-lung axis” or “a common mucosal immunological system”. Objective: The aim of the current systematic review was to evaluate evidence, from published clinical trials and cohort studies, if probiotics may have an effect in improving and managing COVID-19 symptoms. Materials and methods: The available studies were searched through a comprehensive search of electronic databases that included PubMed, Science Direct, Scirus, ISI Web of Knowledge, Google Scholar and CENTRAL (Cochrane Central Register of Controlled Trials), using a combination of the following keywords: “COVID-19" OR [...] Read more.
Background: Recently specific interactions and crosslinks between the gut microbiota and the lungs have been recognized, particularly with regard to respiratory immune and anti-microbial reactions. This is often known as the “gut-lung axis” or “a common mucosal immunological system”. Objective: The aim of the current systematic review was to evaluate evidence, from published clinical trials and cohort studies, if probiotics may have an effect in improving and managing COVID-19 symptoms. Materials and methods: The available studies were searched through a comprehensive search of electronic databases that included PubMed, Science Direct, Scirus, ISI Web of Knowledge, Google Scholar and CENTRAL (Cochrane Central Register of Controlled Trials), using a combination of the following keywords: “COVID-19" OR "SARS-CoV-2" AND "Microbiota" OR "Probiotics” OR “Gut Lung Axis”. The literature was reviewed until August 31, 2022. Results: Only 3 studies were included. One of them evaluated the efficacy of probiotics in COVID-19 patients to obtain complete remission of all signs and symptoms. The clinical trial proves that probiotics have a significant effect on complete remission of all signs and symptoms of COVID-19 patients with statistical significant difference. Only one clinical trial out of the 3 included studies had evaluated the need for O2 therapy during the study between the probiotics and control groups, but without statistical significant difference. No statistical significant difference between the probiotics group and placebo group was observed regarding fatal prognosis during the only clinical trial that measured death as an outcome. Conclusion: We couldn’t judge on these results as they are insufficient data for pooling and meta-analysis. However, what we can say is “Most probably Probiotics have no role in treatment of COVID-19 infection”.
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Meta-Analysis
Open Access October 27, 2023

Key Factor to Prevent Aortic Root and Descending Thoracic Aorta Enlargement after Aortic Valve and Ascending Aorta Combined Surgery

Abstract Objective: aortic root enlargement (ARE) and descending thoracic aorta dilatation (DTAD) in combined aortic valve and ascending aorta replacement surgery (AV+AAR) are postoperative concerning issues. This retrospective observational analysis studies surgical factors which could determine those complications. Methods: 236 patients underwent AV+AAR. Mean-time follow-up by [...] Read more.
Objective: aortic root enlargement (ARE) and descending thoracic aorta dilatation (DTAD) in combined aortic valve and ascending aorta replacement surgery (AV+AAR) are postoperative concerning issues. This retrospective observational analysis studies surgical factors which could determine those complications. Methods: 236 patients underwent AV+AAR. Mean-time follow-up by trans-thoracic echocardiography (TTE) and computer tomography (CT) was 44.7 ± 21.2 and 38.2 ± 18.4 months respectively. In long-term follow-up, outcome variables are: ARE equal/more than 10% of the preoperative TTE data and DTAD equal more than 5% of preoperative CT measurement at the same thoracic vertebrae axial slice. Results: ARE and DTAD appear strictly related to the discrepancy between prosthetic valve and straight vascular prosthesis diameters (p = 0.024), while there is not significant difference (log-rank = 0.917) related to aortic valve surgery type (replacement or repair). Considering diameter difference (DD) between vascular and aortic valve prosthesis, patients were subsequently grouped into two sections: L5 group, in which DD was less/equal than 5 mm, and M5, in which DD was more/equal than 5 mm. ARE was found in 30.8 % of L5 patients and only in 14.7 % among M5 patients (log-rank = 0.026). We have also observed descending thoracic aorta dilatation in 34.2 % of L5 and in 12.1 % of M5 (log-rank = 0.023). Conclusions: According with our data, difference between vascular prosthesis and aortic valve prosthesis equal/more than 5 mm is a protective factor against ARE and DATD.
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Article
Open Access October 16, 2023

Clinical Characteristics and Imaging Findings of Adult COVID-19 and Influenza-related Pulmonary Complications due to Methicillin-susceptible Staphylococcus aureus

Abstract The pulmonary characteristics of Staphylococcus aureus (S. aureus) co-infection with respiratory viruses, such as SARS-CoV-2 and influenza virus, are still unclear. Case series: Two patients with methicillin-susceptible S. aureus [...] Read more.
The pulmonary characteristics of Staphylococcus aureus (S. aureus) co-infection with respiratory viruses, such as SARS-CoV-2 and influenza virus, are still unclear. Case series: Two patients with methicillin-susceptible S. aureus (MSSA) infection in the lungs co-infected with either SARS-CoV-2 or influenza virus are reported. Case 1 was a 66-year-old woman who was admitted with SARS-CoV-2 infection. Her chest X-ray and computed tomography (CT) showed multiple cavity formations with infiltration shadows, and MSSA was detected from her sputum and blood, suggesting COVID-19-related bacterial pneumonia and pulmonary embolism. No catheters had been used, but she had skin eruptions and a history of SARS-CoV-2 vaccination. Ampicillin/sulbactam (ABPC/SBT) was administered, and she finally improved. Case 2 was an 87-year-old man with a history of atopic dermatitis who was admitted with moderate pneumonia, and influenza virus co-infection was found. He showed multiple cavitary shadows, and MSSA was isolated from both his sputum and blood. He was diagnosed with influenza-related bacterial pulmonary embolism. No catheters had been used, but he had a history of influenza vaccination. He was also treated by ABPC/SBT and finally improved. Conclusions: These cases suggest that MSSA showed affinity to the lungs when co-infected with either SARS-CoV-2 or influenza virus, and it presented as septic emboli without catheter use. We should consider MSSA infection when patients have SARS-CoV-2 or influenza virus co-infection, and multiple cavity formation and skin disorders are seen, even though they were vaccinated and no catheters were used.
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Case Series
Open Access October 13, 2023

A Report of Three Cases with Moderate Psoriasis Treated with New Topical Treatment

Abstract Practice guidelines recommend fixed combinations of calcipotriol, a topical vitamin D analogue, and betamethasone dipropionate, a high potency corticosteroid, as first line topical treatment for mild to moderate plaque psoriasis of the body and scalp. A new foaming lotion for treatment of Psoriasis was developed and patented by the Spanish Ministry of Industry, Trade and Tourism (Invention patent [...] Read more.
Practice guidelines recommend fixed combinations of calcipotriol, a topical vitamin D analogue, and betamethasone dipropionate, a high potency corticosteroid, as first line topical treatment for mild to moderate plaque psoriasis of the body and scalp. A new foaming lotion for treatment of Psoriasis was developed and patented by the Spanish Ministry of Industry, Trade and Tourism (Invention patent reference number 202030824). The foaming lotion is composed of clobetasol, papaverine hydrochloride, spironolactone, milk-peptide-complex and propylene glycol. Three cases with moderate Psoriasis aged 34, 36 and 66 years old were treated with our new foaming lotion for 7-8 days. The three patients reported important improvement in the itching sensations and remission of the scaled lesions. Before and after application of the new foaming lotion, Psoriasis Area Severity Index (PASI) scores improved in the first patient from 24.3 to 1.8, in the second patient from 26.1 to 1.8, and in the third patient from 27 to 1.8. Our results show the short-term effectiveness of the new foaming lotion in treating moderate and extensive Psoriasis. Long follow-up is needed to evaluate the remission period of Psoriasis and possible side effects of the new topical treatment.
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Case Report
Open Access October 11, 2023

Quality of Life Assessment of Health Record Professionals Working in a Tertiary Health Facility, during the COVID 19 Pandemic in South Western Nigeria

Abstract Background: There is paucity of data on health-related quality of life (HRQoL) among Health Information Managers/Health Record Officers (HROs) in the Nigeria health system. Hence, this study investigated the impact of the COVID-19 pandemic on health-related quality of life (QoL) among HROs in Obafemi Awolowo University Teaching Hospital Complex (OAUTHC), Ile-Ife, Nigeria. Methods: A [...] Read more.
Background: There is paucity of data on health-related quality of life (HRQoL) among Health Information Managers/Health Record Officers (HROs) in the Nigeria health system. Hence, this study investigated the impact of the COVID-19 pandemic on health-related quality of life (QoL) among HROs in Obafemi Awolowo University Teaching Hospital Complex (OAUTHC), Ile-Ife, Nigeria. Methods: A cross-sectional study was conducted in the University Hospital, where a total of 52 health record officers were purposively sampled. Relevant data were collected using the Short Form survey (SF-36v2) questionnaire. One-way ANOVA was used to determine mean group differences across the nine and the two QoL (physical and mental) summary domains based on respondents’ socio-demographics, while level of significance was set at 0.05. Results: All the QoL sections of the instrument used yielded an α-Cronbach’s score of > 0.70. Analysis of some QoL physical component dimensions showed that; Bodily pain (BP) was found to be significantly (P=0.032) associated with marital status, Physical functioning (PF) with gender (P=0.023), and general health (GH) with age group (P=00.025) and highest level of education (P=0.023). On the other hand, mental health component analysis revealed that Social Functioning (SF) was associated with age group (P=014), Role limitation (RE) with marital status (P=0.048), highest level of education (P=0.048) and years of service (P=0.015) etc. Conclusion: The QoL among HROs studied was generally above average, and demographic characteristics such as age, gender and marital status significantly influence QoL. Health managers and stakeholders should consider some of the factors identified in managing HROs.
Article
Open Access October 08, 2023

Correlation of Thyroid Gland Functions with Menstrual Patterns amongst Infertile and Fertile Women Attending a Tertiary Care Hospital in North-Central Nigeria

Abstract A regular menstrual cycle is important to maintain a woman’s fertility. This cycle has been linked to optimal function of the thyroid gland in the production of its hormones. Disturbance of thyroid gland functions could result to female infertility due to changes in menstrual patterns. Aim of this research was to determine the correlation between thyroid gland functions and menstrual patterns amongst infertile and fertile women attending a tertiary care hospital in North-Central Nigeria. This comparative, cross-sectional study recruited 106 women who visited the hospital's Gynecology Clinic and Family Planning Clinic. 53 of the 106 patients were women with a history suggestive of either primary or secondary infertility and the remaining 53 women with no history of infertility served as the control. A well-structured questionnaire was used to obtain data on the patients’ menstrual patterns. Anthropometric data were measured and obtained. Collected blood samples were analyzed using Enzyme-Linked Immunosorbent Assay (ELISA) technique to determine the serum levels of thyroid hormones. All obtained data was analyzed, and the level of significance was set at p<0.05, at a 95% confidence interval. 33 patients had menstrual anomalies (78.8% infertile women; 21.2% fertile women who served as control, p=0.012). The incidence of menstrual anomalies in the infertile women group and control group was 7.5% versus 0.0% for amenorrhea; 20.8% versus 5.7% for menorrhagia; 9.4% versus 7.5% for oligomenorrhea; 7.5% versus 0.0% for hypomenorrhea; nil polymenorrhea for both groups; and 50.9% versus 86.8% for normal menstrual patterns. Ten (9.43%) patients were diagnosed with thyroid dysfunctions (80% in infertile group; 20% in control group, p [...] Read more.
A regular menstrual cycle is important to maintain a woman’s fertility. This cycle has been linked to optimal function of the thyroid gland in the production of its hormones. Disturbance of thyroid gland functions could result to female infertility due to changes in menstrual patterns. Aim of this research was to determine the correlation between thyroid gland functions and menstrual patterns amongst infertile and fertile women attending a tertiary care hospital in North-Central Nigeria. This comparative, cross-sectional study recruited 106 women who visited the hospital's Gynecology Clinic and Family Planning Clinic. 53 of the 106 patients were women with a history suggestive of either primary or secondary infertility and the remaining 53 women with no history of infertility served as the control. A well-structured questionnaire was used to obtain data on the patients’ menstrual patterns. Anthropometric data were measured and obtained. Collected blood samples were analyzed using Enzyme-Linked Immunosorbent Assay (ELISA) technique to determine the serum levels of thyroid hormones. All obtained data was analyzed, and the level of significance was set at p<0.05, at a 95% confidence interval. 33 patients had menstrual anomalies (78.8% infertile women; 21.2% fertile women who served as control, p=0.012). The incidence of menstrual anomalies in the infertile women group and control group was 7.5% versus 0.0% for amenorrhea; 20.8% versus 5.7% for menorrhagia; 9.4% versus 7.5% for oligomenorrhea; 7.5% versus 0.0% for hypomenorrhea; nil polymenorrhea for both groups; and 50.9% versus 86.8% for normal menstrual patterns. Ten (9.43%) patients were diagnosed with thyroid dysfunctions (80% in infertile group; 20% in control group, p=0.046). Six (18.2%) out of 33 women with menstrual anomalies were diagnosed with thyroid dysfunction. Five (83.3%) out of these 6 women with both menstrual anomalies and diagnosed thyroid dysfunction were infertile while only one (16.7%) was fertile. Thyroid gland dysfunction correlates strongly with abnormal menstrual patterns, which implies that it is vital to evaluate thyroid hormone levels in blood serum in the course of treating menstrual irregularities and female infertility. Early detection of thyroid dysfunction is important in achieving a positive treatment outcome for female infertility.
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Article
Open Access October 07, 2023

A Systematic Review of Observational Studies Focusing on Impact of Telehealth Consultation in Osteoporosis Management during the Pandemic

Abstract Background: The COVID-19 pandemic disrupted routine osteoporosis care due to clinic closures and limited in-person consultations. Telehealth emerged as an alternative model enabling remote care delivery and monitoring. However, previous reviews on telehealth either did not include the pandemic period or had a limited focus in scope. Evidence synthesized specifically for osteoporosis care [...] Read more.
Background: The COVID-19 pandemic disrupted routine osteoporosis care due to clinic closures and limited in-person consultations. Telehealth emerged as an alternative model enabling remote care delivery and monitoring. However, previous reviews on telehealth either did not include the pandemic period or had a limited focus in scope. Evidence synthesized specifically for osteoporosis care during the pandemic is needed but lacking. Methods: We systematically searched PubMed, MEDLINE, EMBASE, PsycINFO, Web of Science, and CINAHL for studies on telehealth for osteoporosis published between January 2021 and March 2023. Five studies met the inclusion criteria of: osteoporosis population, telehealth intervention, and COVID-19 pandemic timeframe. Data was extracted on study characteristics, COVID-19 outcomes, osteoporosis status, telehealth purpose, patient satisfaction, and clinical outcomes. Result: The five studies showed telehealth was used for monitoring data, delivering test results, adjusting medications, and assessments. Osteoporosis prevalence among telehealth users ranged 30-100%. High patient satisfaction was reported with telehealth versus in-person care. No major differences occurred in medication delays or fractures between telehealth and in-person groups. Conclusion: This review found telehealth enables effective osteoporosis care and monitoring during the pandemic, with high patient and provider satisfaction. However, more robust randomized controlled trials are needed to establish stronger evidence around telehealth's impacts on clinical osteoporosis outcomes. Implications: Though promising, further high-quality studies will help clarify telehealth's role in improving osteoporosis care and outcomes. Findings inform guidelines on integrating telehealth into routine management. Evidence on user perspectives optimizes telehealth implementation policies.
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Systematic Review
Open Access October 03, 2023

Pharmaceutical Drug Serialization: A Comprehensive Review

Abstract A persistent problem in the pharmaceutical industry that has existed for centuries is the prevalence of counterfeit drugs, and the World Health Organization (WHO) estimates that millions of people are affected by this issue each year. In particular, 4 out of 10 drugs in poor or underdeveloped countries may be adulterated, which can lead to severe adverse events. To address this problem, many [...] Read more.
A persistent problem in the pharmaceutical industry that has existed for centuries is the prevalence of counterfeit drugs, and the World Health Organization (WHO) estimates that millions of people are affected by this issue each year. In particular, 4 out of 10 drugs in poor or underdeveloped countries may be adulterated, which can lead to severe adverse events. To address this problem, many countries have implemented regulatory compliance measures such as pharmaceutical drug serialization, which requires the unique identification of every drug package manufactured. This enables tracking and tracing of individual packages throughout the supply chain and helps to prevent counterfeit drugs from entering the market. In this paper, we conduct a systematic review of the serialization process evaluation and its impact on the pharmaceutical industry. We discuss the benefits of pharmaceutical drug serialization, including its ability to improve drug security and reduce adverse events and investigations. We also examine the challenges associated with implementing serialization processes and the regulatory requirements necessary for compliance. Finally, we explore the various tracking and tracing technologies used in serialization processes and their effectiveness in preventing the distribution of counterfeit drugs. Overall, this paper highlights the importance of pharmaceutical drug serialization in ensuring the safety and efficacy of drugs in the healthcare industry, particularly in poor or underdeveloped countries where the problem of adulterated drugs is especially prevalent.
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Review Article
Open Access September 26, 2023

Drug-Receptor Interaction of Peptidic HIV-1 Protease: Intermolecular Interaction-III

Abstract Recently, we have studied drug-receptor interaction of the peptidic HIV-1 protease inhibitors based on polar and hydrophobic interactions. We have also studied pharmacokinetics of these inhibitors based on Lipinski’s rule of five and its extended form. After that there was a need to study intermolecular interactions. From literatures, drug-receptor interaction involves hydrogen bonds between [...] Read more.
Recently, we have studied drug-receptor interaction of the peptidic HIV-1 protease inhibitors based on polar and hydrophobic interactions. We have also studied pharmacokinetics of these inhibitors based on Lipinski’s rule of five and its extended form. After that there was a need to study intermolecular interactions. From literatures, drug-receptor interaction involves hydrogen bonds between acceptor and donor sites of drug and its receptor. These donor acceptor sites must be more than four to be dominant. As single intermolecular H-bond is relatively weak and unlikely to support this type of interaction. It is also clear from literature that this interaction contribute to the alignment of reacting species in proper three-dimensional space in such a position that strong and effective polar or hydrophobic or both interaction occurs to form drug-receptor adduct or enzyme inhibitor complex as appropriate. The strength of H-bonds formed between drug and receptor was judged by bond lengths, bond angles and bond orders. As well as, its nature (strong, moderate or weak) and its number, too. Along with H-bonding, we have also studied Van der Walls i.e. non-bonding type interaction. These non-bonding interactions were studied using charge transfer from donor to acceptor and this results transfer of electron flux from donor molecule (drug/receptor) towards acceptor (receptor/ drug). Thus, lowering of energy of the system under investigation will occur. For this resulted interaction energy was also studied that very clearly explain feasibility of interactions. As we know that all above phenomena are molecular properties and do not cover involvement of orbitals. To cover this we have also studied drug-receptor interaction involving molecular orbital. It was HOMO of one reacting molecule (B) that donates electron pair, electron cloud or electron density to LUMO of another reacting molecule (A) that accepts or accommodates this electron pair, electron cloud or electron density. The quantity of the electron flux from HOMO to LUMO was judged by the value of ∆ELH. A lower value of this will support strong and effective drug-receptor interaction. Results of orbital based study have also been found to supports the results as abstracted from interaction energy.
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Article
Open Access September 20, 2023

Group-specific Differences in Blood Lead Levels among Occupationally Exposed Workers in Greater Banjul Area, The Gambia

Abstract Occupational lead (Pb) exposure continues to be an important public health problem globally, yet data is lacking on the associated risks and resources available for the prevention of Pb related diseases in low middle income countries (LMICs) like The Gambia. In this study, we used a case-control design to compare blood lead levels (BLLs) between the exposed (auto repair workers) and unexposed [...] Read more.
Occupational lead (Pb) exposure continues to be an important public health problem globally, yet data is lacking on the associated risks and resources available for the prevention of Pb related diseases in low middle income countries (LMICs) like The Gambia. In this study, we used a case-control design to compare blood lead levels (BLLs) between the exposed (auto repair workers) and unexposed (healthcare workers) populations in The Greater Banjul Area. The data was analyzed using Chi square test of independence to determine the characteristic factors associated with BLL. Multivariate logistic regression was used to test the relationship between BLLs for auto repair and healthcare workers and their experiences. The results of this study indicated 82.1% of cases had higher BLLs compared to 52.9% of controls. Also, the proportion of workers with elevated BLLs was higher for certain factors including more than 80% of those with greater than 10 of years job experience, more than 70% of those who worked greater than 5 days a week, worked more than 8 hours per day, did not use personal protective equipment (PPE), were illiterate or had no formal education, and smoked or ate at work. The study results have implications for policies and practice in the auto repair industry and related workplaces in The Gambia and other LMICs with similar settings. Based on the findings of this study, it is essential to initiate discussions to establish national occupational health policies in The Gambia aimed at protecting workers and the general population.
Article
Open Access September 19, 2023

Differential Complete Blood Count for Diagnosis of COVID-19?

Abstract Background: The World Health Organization (WHO) has declared COVID-19 a public health emergency of international concern. In this context, effective and affordable diagnostic procedures are essential for identifying and managing cases. Complete blood counts (CBC) are among the most common and readily available diagnostic tests. The current study aimed to evaluate the efficacy of CBC in [...] Read more.
Background: The World Health Organization (WHO) has declared COVID-19 a public health emergency of international concern. In this context, effective and affordable diagnostic procedures are essential for identifying and managing cases. Complete blood counts (CBC) are among the most common and readily available diagnostic tests. The current study aimed to evaluate the efficacy of CBC in diagnosing COVID-19 and identifying cases. Patients and Methods: A case-control study was conducted on 173 patients at Ain Shams University Hospitals over a period of three months. Patients were allocated into two groups according to COVID-19 PCR results: Group 1 included patients with COVID-19 positive PCR, and Group 2 included patients with COVID-19 negative PCR. Results: The study found that differential CBC had significant value in diagnosing COVID-19 disease. Many COVID-19 patients had lymphopenia and leucopenia compared to non-COVID-19 suspected patients. The low values of leukocytes, neutrophils, lymphocytes, and eosinophils with a CBC test were found to be valuable in the initial diagnosis of COVID-19. Conclusion: The definitive diagnosis of COVID-19 requires RT-PCR analysis, which is time-consuming and less accessible. Thus, the initial diagnosis and treatment of patients may be delayed. This study suggests that CBC, which is easily available and affordable, can be valuable in the early identification of COVID-19 cases, allowing for prompt treatment and management.
Article
Open Access September 19, 2023

Lonely No More: Investigating the Connection between Family Health, Social Support, and Well-being in Chinese “Empty Nest Youth”

Abstract Background: The phenomenon of "empty nest youth" is becoming increasingly ubiquitous, capturing the attention of society at large. However, few studies have been conducted in recent years on this group, especially focusing on their family and mental health. As such, this study investigates the correlation between family health and well-being among "empty nest youth," as well as the function of social support and loneliness in this relationship. Methods: A cross-sectional survey was conducted from June to August 2022 across 32 provinces, municipalities, and autonomous regions in China, utilizing a multi-stage sampling technique. And we screened individuals who were unmarried, living alone, and between 22-44 years old, resulting in a valid sample size of 908 cases; multiple regression analysis, mediation effect testing, and moderation effect testing are used to examine research hypotheses. Results: The regression analysis results show that family health not only has a direct impact on well-being (β = 0.36, p < 0.001) but also indirectly affects well-being through social support [β = 0.23, 95% CI: 0.19 0.28]. Additionally, the loneliness moderates the predictive impact of not only family health on social support (β = -0.13, p < 0.001) but also social support on well-being (β = -0.06, p [...] Read more.
Background: The phenomenon of "empty nest youth" is becoming increasingly ubiquitous, capturing the attention of society at large. However, few studies have been conducted in recent years on this group, especially focusing on their family and mental health. As such, this study investigates the correlation between family health and well-being among "empty nest youth," as well as the function of social support and loneliness in this relationship. Methods: A cross-sectional survey was conducted from June to August 2022 across 32 provinces, municipalities, and autonomous regions in China, utilizing a multi-stage sampling technique. And we screened individuals who were unmarried, living alone, and between 22-44 years old, resulting in a valid sample size of 908 cases; multiple regression analysis, mediation effect testing, and moderation effect testing are used to examine research hypotheses. Results: The regression analysis results show that family health not only has a direct impact on well-being (β = 0.36, p < 0.001) but also indirectly affects well-being through social support [β = 0.23, 95% CI: 0.19 0.28]. Additionally, the loneliness moderates the predictive impact of not only family health on social support (β = -0.13, p < 0.001) but also social support on well-being (β = -0.06, p < 0.001). Conclusions: These findings underscore the significance of directing policymakers and healthcare professionals towards the "empty nest youth's" familial and social support systems. It underscores the need for the development of policies aimed at addressing their emotional and material requirements by leveraging these familial and social networks. This approach ultimately contributes to the enhancement of their overall psychological well-being, promoting a more coherent and logical pathway for intervention and support.
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Open Access September 17, 2023

Knowledge and practice of diabetic foot prevention among diabetic patients attending Edward Francis Small Teaching Hospital, Banjul, The Gambia: an institutional-based cross-sectional study

Abstract Background: The increasing prevalence of Diabetes Mellitus (DM) is closely tied to complications, particularly diabetic foot ulcers, which significantly raise the risk of lower extremity amputations due to infected, non-healing ulcers. This study aimed to assess diabetic foot prevention knowledge, practices and associated factors among patients at the Edward Francis Small Teaching Hospital [...] Read more.
Background: The increasing prevalence of Diabetes Mellitus (DM) is closely tied to complications, particularly diabetic foot ulcers, which significantly raise the risk of lower extremity amputations due to infected, non-healing ulcers. This study aimed to assess diabetic foot prevention knowledge, practices and associated factors among patients at the Edward Francis Small Teaching Hospital (EFSTH), Banjul. Methods: In this cross-sectional study, we employed a convenience sampling technique to enroll 357 diabetic patients, both inpatients and outpatients, who were under the care of EFSTH. Data on diabetic foot prevention were collected through semi-structured interviews conducted by trained interviewers. Statistical analyses were carried out using SPSS, encompassing descriptive analysis, chi-square, Fisher exact tests, and logistic regression. Statistical significance was set at p<0.05, with a 95% confidence interval. Results: The mean age of the respondents was 47.3 years (±10.5), with women comprising 55.2% of the study population and 94.4% were married. About 73% demonstrated good knowledge of diabetic foot care and prevention, while 25.8% exhibited fair knowledge. A significant association was observed in bivariate analysis with patients’ educational level (P = 0.032). Specifically, patients with Madarasa (Arabic) education had a 68% lower likelihood 【aOR: 0.320, 95% CI: (0.103, 0.992), p = 0.048】 of practicing diabetic foot care and prevention compared to those with tertiary education. Conclusion: The study revealed that participants’ knowledge of preventing diabetic foot was high. However, the practice was poor. Therefore, there is a need for more health education on the practices that would emphasize diabetes management among diabetes patients.
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Open Access September 13, 2023

A Comparative Study of Attention-Based Transformer Networks and Traditional Machine Learning Methods for Toxic Comments Classification

Abstract With the rapid growth of online communication platforms, the identification and management of toxic comments have become crucial in maintaining a healthy online environment. Various machine learning approaches have been employed to tackle this problem, ranging from traditional models to more recent attention-based transformer networks. This paper aims to compare the performance of attention-based [...] Read more.
With the rapid growth of online communication platforms, the identification and management of toxic comments have become crucial in maintaining a healthy online environment. Various machine learning approaches have been employed to tackle this problem, ranging from traditional models to more recent attention-based transformer networks. This paper aims to compare the performance of attention-based transformer networks with several traditional machine learning methods for toxic comments classification. We present an in-depth analysis and evaluation of these methods using a common benchmark dataset. The experimental results demonstrate the strengths and limitations of each approach, shedding light on the suitability and efficacy of attention-based transformers in this domain.
Article
Open Access September 04, 2023

Management of Severe Acute Respiratory Syndrome-Corona Virus-2 infection in the Principality of Monaco

Abstract Background: This work is a report of the present situation and management of Corona Virus (CoV) infection in the Principality of Monaco. Methods: To comply with the practices adopted by the World Health Organization (WHO) and neighboring Countries in this area, residents infected by CoV are the object of this health report. The Prince’s Government also communicates the data relating to [...] Read more.
Background: This work is a report of the present situation and management of Corona Virus (CoV) infection in the Principality of Monaco. Methods: To comply with the practices adopted by the World Health Organization (WHO) and neighboring Countries in this area, residents infected by CoV are the object of this health report. The Prince’s Government also communicates the data relating to screening. These are stopped at Sunday January 1st included. Results: The results of this survey point out how this infection is still active in Monaco, although not at the emergency levels of 2020. Conclusions: These results call for not leaving prevention measures, both primary (vaccine) and secondary (personal protective equipment [PPE], social distancing, etc.) adopted until now and which gave so good results.
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Open Access August 18, 2023

ETCS as an Effective Tool to enable HRM to fulfill the Requirements of CSR in the Field of Employee Training: An Innovative Design and Specific Requirements

Abstract Purpose: There are specific requirements to fulfill CSR in the field of the training function, which can be deduced through a deep understanding of the meaning of CSRs (specifically, economic and ethical responsibilities). Those requirements must be included in the Electronic Training Card System (ETCS) to enable HRM in large organizations to adhere to its social responsibilities in the [...] Read more.
Purpose: There are specific requirements to fulfill CSR in the field of the training function, which can be deduced through a deep understanding of the meaning of CSRs (specifically, economic and ethical responsibilities). Those requirements must be included in the Electronic Training Card System (ETCS) to enable HRM in large organizations to adhere to its social responsibilities in the field of the employee training function. Therefore, this study aims to identify the needs of CSR in the field of training function and indicate how to include them in ETCS, in addition to identifying the necessary requirements for adopting of ETCS in business establishments. Method: The researcher adopted the following two concepts: 1) The concept of optimal use of economic resources (corporate economic responsibility); 2) The concept of fair opportunities for all (corporate ethical responsibility) in describing and specifying the items of criteria for measuring the effectiveness and efficiency of HRM in performing its job duties in the field of training. To design ETCS and include those requirements ″ items″ in it, the researcher relied on his diligence and skill in the field of designing electronic systems. Results: The study identified items of criteria for measuring the effectiveness and efficiency of HRM in performing its job duties in the field of training in a manner consistent with the requirements of CSR. The study was also able to design ETCS that will enable HRM to fulfill the requirements of CSR in employee training and determine the requirements for its application in institutions. Originality/Value: According to the researcher's vision, ETCS proposed in this study will enable HRMs in business institutions to adhere to their CSRs in the field of employee training- especially economic and ethical, because of its harmonious design with CSRs requirements.
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Article
Open Access July 28, 2023

Should not we vaccinate the public against seasonal influenza all over the year in COVID-19 era?

Abstract The pandemic of the SARS-CoV2 (COVID-19) that was declared by the World Health Organization (WHO) on 11 March 2020 is still ongoing. One of the early recommendations from CDC and other international agencies is the seasonal influenza vaccination to decrease the effects and burden of COVID-19 pandemic. This review suggests that during COVID-19 pandemic vaccination against seasonal influenza should [...] Read more.
The pandemic of the SARS-CoV2 (COVID-19) that was declared by the World Health Organization (WHO) on 11 March 2020 is still ongoing. One of the early recommendations from CDC and other international agencies is the seasonal influenza vaccination to decrease the effects and burden of COVID-19 pandemic. This review suggests that during COVID-19 pandemic vaccination against seasonal influenza should be conducted all over the year, even for young age groups, because of several reasons. First, the complications of seasonal influenza, especially pneumonia, could increase the burden on the saturated healthcare systems worldwide. Second, the resemblance of symptoms and signs of both seasonal influenza and COVID-19 will difficult diagnosing and isolation of COVID-19 patients. Third, it has been postulated that there is a cross immunity between seasonal influenza and COVID-19.
Mini Review
Open Access July 24, 2023

Role of Oncology Nurse Navigators: An Integrative Review

Abstract Background: Oncology nurse navigators (ONNs) are becoming even more vital as healthcare continues to develop into a more complicated, confusing maze for patients. When many specialists on the treatment team have divergent points of view due to the nature of their respective professions or other factors, the patient may experience feelings of confusion. In the end, this can cause delays in [...] Read more.
Background: Oncology nurse navigators (ONNs) are becoming even more vital as healthcare continues to develop into a more complicated, confusing maze for patients. When many specialists on the treatment team have divergent points of view due to the nature of their respective professions or other factors, the patient may experience feelings of confusion. In the end, this can cause delays in treatment, pose a threat to the established standard of care, and lead to a decrease in patient satisfaction. Aim: To enumerate various ways in which ONNs may help improve the quality of life of cancer patients. Design: An integrative review. Results: A total of 19 studies related to the topic are evaluated. Four main themes namely: provider of psychological support, facilitator of timely care, oncology nurse navigators perception of their role and patient’s perception of oncology nurse navigators and 3 sub themes which are: information giver, source of emotional support and coordinator, were identified to be the roles of the ONNs. The findings showed that oncology nurse navigators help reduce patients anxiety and distress, increase patient satisfaction, shorten the time from diagnosis to treatment, provide necessary information, support them emotionally and coordinate their care with the different members of the healthcare team and resources. Conclusion: The main function of the ONNs is to address any barrier that may hinder the patient’s cancer treatment, survivorship and even palliative care. ONNs make sure that each patient has individualized nursing care according to the patients and their families' needs. Implications for Practice: ONNs have the potential to significantly contribute not only to the quality of life of cancer patients but also to the process of achieving better service integration. The result of this integrative review contributes to the growth of the healthcare system by improving accessibility, fairness, efficiency, effectiveness, and the ability to maintain health services throughout time brought about by ONNs.
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Review Article
Open Access July 06, 2023

Health condition of palm trees of Mexico City, with an emphasis on “crowns”

Abstract The government of Mexico City carried out the introduction of palm trees in the 50s to increase the visual appearance of the main avenues. As a result of introduction of these exotic species, phytosanitary problems appeared. Currently there is scarce information on how to evaluate the health of these majestic monocots, in this sense, it is necessary to implement assessment scales to determine the [...] Read more.
The government of Mexico City carried out the introduction of palm trees in the 50s to increase the visual appearance of the main avenues. As a result of introduction of these exotic species, phytosanitary problems appeared. Currently there is scarce information on how to evaluate the health of these majestic monocots, in this sense, it is necessary to implement assessment scales to determine the health condition of the most frequently found species to advance on their care and management. The present study had the following objectives: 1) To determine the current state of health of palm trees by means of a scale of visual evaluation of the crown; 2) To know the diversity and structural characteristics of palm trees and 3) To determine the influence of composite variables on the ecosystem services such as the amount of shade provided. Health of palm trees were evaluated two times (dry and rainy seasons in 2022) on 35 transects of 200 m length. An imaginary circle divided into twelfths was overlapped on palm tree “crowns”, and through it, two absolute variables, Live Crown Ratio (LCR) and Crown Quality (CQ) were evaluated. Composite variables were also calculated. The 12/12 health scale adapted in the present study was useful. Four health categories were obtained for the Live crown ratio (LCR): 7.62% of the palm trees were in critical condition, 7.80% were in intermediate condition, 80.36% were in normal condition, and 4.20% were in excellent condition. Meanwhile, for crown quality (CQ), the percentages were 13.50%, 20.00%, 56.96% and 0.43%, respectively. The total height and “crown” diameter showed a positive correlation with the volume composite variables. The shadow area projected as an important ecosystem service increased as the health of the palm trees improved. This is the first study on palm trees health assessment in Mexico City.
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Article
Open Access May 10, 2023

Knowledge of Obstetric Warning Signs and Associated Risks among Saudi Pregnant Women

Abstract Women must be aware of the risk factors of pregnancy complications and the negative maternal and fetal health consequences to take preventative measures and management strategies that will result in a successful pregnancy. This study aimed to assess the Level of Knowledge about obstetric warning signs and the associated factors among pregnant Saudi women attending antenatal care in a tertiary care [...] Read more.
Women must be aware of the risk factors of pregnancy complications and the negative maternal and fetal health consequences to take preventative measures and management strategies that will result in a successful pregnancy. This study aimed to assess the Level of Knowledge about obstetric warning signs and the associated factors among pregnant Saudi women attending antenatal care in a tertiary care maternity set-up in Riyadh City. Data for this cross-sectional study were obtained using a structured questionnaire from eligible pregnant women admitted to King Saud Medical City (KSMC) between August 2020 and March 2021. Data were analyzed using descriptive and inferential statistics. Out of a minimum estimated sample size of 170, researchers recruited 362 participants. As observed, only 92 people, or 25.4%, had enough knowledge about various educational levels. The majority (91.2%) lived in villages, had no history of chronic disease (74.0%), and said that it took them at least 30 minutes to commute from their home to the hospital (69.3%). Two hundred two (55.7%) lacked appropriate knowledge, although most women (76.2%) had one to four pregnancies. Poor psychological health resulted from 37 people's (10.2%) inadequate Awareness. Even though 139 (38.4%) had spent more than 15 minutes receiving education from medical staff and 200 (61.5%) had attended the prenatal care clinic more than four times, most lacked adequate knowledge. The variables education level (P=0.000), working status (P=0.022), and place of residence (P=0.044) showed a statistically significant association with the knowledge level, also only education level statistically significantly affected the likelihood of knowledge gaps. In conclusion, early identification of obstetric warning signs and associated risk factors of pregnancy complications is integral to prevention.
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Open Access April 27, 2023

Evaluation of the Critical risk factors in PPP - procured Mass Housing Projects in Abuja Nigeria - A fuzzy synthetic evaluation (FSE) approach

Abstract The study accessed the critical risk factors in public-private partnership (PPP)-procured mass housing project (MHP) delivery in Nigeria. The research design adopts a quantitative approach, using well-structured questionnaires distributed to stakeholders involved in PPP-MHPs i.e. consultants, in-house professionals, contractors, and the organized private sector (OPS) registered with PPP [...] Read more.
The study accessed the critical risk factors in public-private partnership (PPP)-procured mass housing project (MHP) delivery in Nigeria. The research design adopts a quantitative approach, using well-structured questionnaires distributed to stakeholders involved in PPP-MHPs i.e. consultants, in-house professionals, contractors, and the organized private sector (OPS) registered with PPP departments in the Federal Capital Territory Development Authority (FCDA) Abuja, Nigeria. The instrument relates to the background information of respondents and the risk peculiar to PPP-MHP. Sixty-three (63) risk factors were submitted for the respondents to rank using Mean Item score (MIS) for risk occurrence and its severity, while risk significance index (RI) was used to determine the risk impact. Fuzzy Synthetic Evaluation (FSE) method was subsequently applied to determine the risk criticality groups and the overall risk level in the sector. The fuzzy set theory deals with ambiguous, subjective and imprecise judgments peculiar to decision making in construction project risk assessment. It aims to provide a synthetic evaluation of an object relative to a fuzzy decision environment with multiple criteria that requires qualitative linguistic terms. The findings show that thirty-one (31) risk factors were critical in the sector while financial and micro-economic risk group is contributing most significantly to the overall risk level in PPP-MHPs in Nigeria. The top 10 risk factors in the sector include availability of finance, high finance cost, the unstable value of the local currency, lack of creditworthiness, influential economic events (boom/recession), high bidding cost, poor financial market, financial attraction to project investors, interest rate volatility, inflation rate volatility, corruption and lack of respect for the law, non-involvement of the host community and poor execution of housing policies. The implication for practice is that having known the risk group contributing most significantly to the overall risk level in PPP-MHPs, adequate financial and budgetary allocation should be made available before embarking on such venture so as to sustain the scheme in the country. The study is one of the recent researches conducted on housing, since the procurement option is novel in the sector. The study is of immense value to PPP actors in providing necessary information required to formulate risk response methods in minimize the identified risk impact sector.
Article
Open Access April 27, 2023

Adolescent Students’ Knowledge of Sexually Transmitted Infections in Eastern Region Schools for the Deaf, Ghana

Abstract This study investigated adolescent students‟ knowledge of sexually transmitted infections (STIs) in eastern region schools for the deaf in Ghana. A descriptive survey design was used for the study. The researchers used HIV- The knowledge Questionnaire to assess the knowledge of respondents on STIs. Stratified sampling and simple random sampling techniques were employed. Proportional representation [...] Read more.
This study investigated adolescent students‟ knowledge of sexually transmitted infections (STIs) in eastern region schools for the deaf in Ghana. A descriptive survey design was used for the study. The researchers used HIV- The knowledge Questionnaire to assess the knowledge of respondents on STIs. Stratified sampling and simple random sampling techniques were employed. Proportional representation was used to select a sample of ninety-five (95) adolescent students with deafness from JHS2 and JHS3 between the ages of 13 and 24 years. Data were analyzed descriptively into frequencies and percentages. The results of the study indicated that the students knew of some of the types of STIs such as Gonorrhea, Syphilis, and HIV/AIDS. They, however, had inadequate knowledge of STIs such as Hepatitis B and Chlamydia.
Article
Open Access March 30, 2023

Pulsatile Blood Flow Simulation for Subject-Specific Geometry of a Human Aortic Arch

Abstract Pulsatile blood flow in a subject-specific human aortic arch and its major branches is studied computationally for a peak Reynolds number of 1553 and a Womersley number of 22.74. The aortic geometry is constructed from the CT-scan images of a subject. The aorta has out-of-plane curvature and significant area variation along the flow direction. A physiologically representative pulsatile velocity [...] Read more.
Pulsatile blood flow in a subject-specific human aortic arch and its major branches is studied computationally for a peak Reynolds number of 1553 and a Womersley number of 22.74. The aortic geometry is constructed from the CT-scan images of a subject. The aorta has out-of-plane curvature and significant area variation along the flow direction. A physiologically representative pulsatile velocity waveform is applied as boundary condition at the inlet of the aorta. The primary velocity profiles are skewed towards the inner wall of the ascending aorta during the entire cardiac cycle. In the decelerating phase, reverse flow is noted along the inner wall and the magnitude of maximum velocity is about 50 % of the peak flow condition. Flow separation is observed in the inner wall of the ascending aorta during the decelerating and reverse flow phases of the cardiac cycle. In the accelerating phase, however, flow separation does not occur. The major observation of the present work is the existence of complex and asymmetrical vortical flow structures which are not observed either in simple curved pipes or in idealized aortic arch computational studies. The relative strength of the secondary flow with respect to the primary flow is quantified by means of Relative Secondary Kinetic Energy whose highest value is evaluated to be 1.202 occurring near the entrance of the right carotid artery during the maximum reverse flow condition. High values of wall shear stress is observed at distal of the left and right subclavian arteries, the bifurcation of brachiocephalic artery between right subclavian artery and right carotid artery, and proximal inner wall of descending aorta during the cardiac cycle. The wall shear stress at the bifurcations of the branches are low and oscillatory and generally correlates with the preferential sites for atherosclerosis. The flow structures on the aorta wall are explicitly highlighted by the limiting streamlines. The application of limiting streamlines to clearly elucidate the complex on-wall flow structures is one of the key contributions of the present study. During the decelerating and reverse flow phases several critical points are observed on the aortic wall. These complex flow structures vanish during the accelerating phase. The observations made in the present study will be helpful in creating accurate and clinically useful computational models.
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Open Access March 18, 2023

The Efficiency of the Proposed Smoothing Method over the Classical Cubic Smoothing Spline Regression Model with Autocorrelated Residual

Abstract Spline smoothing is a technique used to filter out noise in time series observations when predicting nonparametric regression models. Its performance depends on the choice of the smoothing parameter. Most of the existing smoothing methods applied to time series data tend to over fit in the presence of autocorrelated errors. This study aims to determine the optimum performance value, goodness of [...] Read more.
Spline smoothing is a technique used to filter out noise in time series observations when predicting nonparametric regression models. Its performance depends on the choice of the smoothing parameter. Most of the existing smoothing methods applied to time series data tend to over fit in the presence of autocorrelated errors. This study aims to determine the optimum performance value, goodness of fit and model overfitting properties of the proposed Smoothing Method (PSM), Generalized Maximum Likelihood (GML), Generalized Cross-Validation (GCV), and Unbiased Risk (UBR) smoothing parameter selection methods. A Monte Carlo experiment of 1,000 trials was carried out at three different sample sizes (20, 60, and 100) and three levels of autocorrelation (0.2, 05, and 0.8). The four smoothing methods' performances were estimated and compared using the Predictive Mean Squared Error (PMSE) criterion. The findings of the study revealed that: for a time series observation with autocorrelated errors, provides the best-fit smoothing method for the model, the PSM does not over-fit data at all the autocorrelation levels considered ( the optimum value of the PSM was at the weighted value of 0.04 when there is autocorrelation in the error term, PSM performed better than the GCV, GML, and UBR smoothing methods were considered at all-time series sizes (T = 20, 60 and 100). For the real-life data employed in the study, PSM proved to be the most efficient among the GCV, GML, PSM, and UBR smoothing methods compared. The study concluded that the PSM method provides the best fit as a smoothing method, works well at autocorrelation levels (ρ=0.2, 0.5, and 0.8), and does not over fit time-series observations. The study recommended that the proposed smoothing is appropriate for time series observations with autocorrelation in the error term and econometrics real-life data. This study can be applied to; non – parametric regression, non – parametric forecasting, spatial, survival, and econometrics observations.
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Open Access March 02, 2023

Traumatic Pneumothorax Secondary to Acupuncture Procedure: A Case Report

Abstract Acupuncture is an alternative medicine, actually it has had a greater acceptance in our continent being use for multiple therapeutic purposes. Although it is a minimally invasive procedure it is not exempt from complications, most common minor complications such as infections or local pain have been described, as well as less frequently but potentially fatal complications such as subarachnoid [...] Read more.
Acupuncture is an alternative medicine, actually it has had a greater acceptance in our continent being use for multiple therapeutic purposes. Although it is a minimally invasive procedure it is not exempt from complications, most common minor complications such as infections or local pain have been described, as well as less frequently but potentially fatal complications such as subarachnoid hemorrhage and tension pneumothorax. We report a case of pneumothorax secondary to acupuncture in a patient who was treated for carpal tunnel syndrome.
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Case Report
Open Access February 21, 2023

Clinicians’ Perception of Spirituality in Oncology Care: A Qualitative Synthesis

Abstract Background: By rediscovering the medical field spiritual foundation, clinicians sought to balance their care and realize that spirituality is frequently associated with healthcare, thus one’s spiritual beliefs influence patients' decisions between aggressive care and complementary therapies in oncology care. Aim: This study investigates clinicians’ experiences and perceptions of [...] Read more.
Background: By rediscovering the medical field spiritual foundation, clinicians sought to balance their care and realize that spirituality is frequently associated with healthcare, thus one’s spiritual beliefs influence patients' decisions between aggressive care and complementary therapies in oncology care. Aim: This study investigates clinicians’ experiences and perceptions of spirituality in oncology care that clinicians can utilize to improve cancer and spiritual care provision. Methods: A thematic, qualitative synthesis. Results: Four main themes emerged from the synthesis of the 11 included studies that can steer future framework and policies to make clinicians more inept in providing care to address spiritual well-being of the patients and their family from a clinician's point of view of spirituality: “Maintaining Hope and Spiritual Wellness, Clinician’s Sensitivity to Cancer Patients, Provision of Culturally Respectful Spiritual Care, and Education in Providing Spiritual Care”. Conclusion: Cancer patients, cancer survivors, and clinicians’ quality of life is correlated with measures of spirituality and spiritual well-being. Spirituality also fulfill these oncologic patients has been linked to improved emotional and spiritual adjustment. Implications: Clinicians with different proficiencies, novice or expert, develop a strong spiritual belief can also be a strength when it comes to caring for those terminally ill patients, to be able to aid them in their sufferings. Amidst the challenges of spiritual care, these clinicians provide a patient strategy approach that is holistic to the care.
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Review Article
Open Access February 09, 2023

Adolescents' Psychosomatic Symptoms and Family Affluence in the Czech Republic: Based on National Evidence

Abstract Family affluence associates with adolescents' psychosomatic symptoms. However, the strength of the association varies across countries. As there was no related national evidence in the Czech Republic, this study aimed to investigate the relationship between family affluence and adolescents' psychosomatic symptoms. The current research adopted the data from a national survey Health Behaviours of [...] Read more.
Family affluence associates with adolescents' psychosomatic symptoms. However, the strength of the association varies across countries. As there was no related national evidence in the Czech Republic, this study aimed to investigate the relationship between family affluence and adolescents' psychosomatic symptoms. The current research adopted the data from a national survey Health Behaviours of School-Aged Children (HBSC). 12166 observations were included in the binary-choice analysis. It was found that low family affluence background was a risk factor for adolescents' psychosomatic health. Compared to boys, girls were more likely to demonstrate psychosomatic symptoms. Furthermore, parent-adolescent communications might mediate the relationship between family affluence and psychosomatic complaints. The results suggest health inequity for adolescents from low-income families. Moreover, I also advocate related interventions aiming to improve parent-adolescent communication quality to decrease poor adolescents' psychosomatic health risks.
Article
Open Access February 08, 2023

Entangled Photon Generation from a Three-Level Laser with a Parametric Amplifier and Coupled to a Thermal Reservoir

Abstract In this article the investigation of squeezing and statistical properties of light resulting by a non-degenerate three-level laser with the parametric amplifier and coupled to a thermal reservoir have been occurred. With the aid of master equation, stochastic differential equations were obtained. Applying solutions of resulting differential equations, quadrature variance, the mean and variance of [...] Read more.
In this article the investigation of squeezing and statistical properties of light resulting by a non-degenerate three-level laser with the parametric amplifier and coupled to a thermal reservoir have been occurred. With the aid of master equation, stochastic differential equations were obtained. Applying solutions of resulting differential equations, quadrature variance, the mean and variance of photon number, the photon number correlation are calculated. However, the two-mode driving light has no effect on the squeezing properties of the cavity modes. On the other hand, parametric amplifier and thermal reservoir increase the mean and variance of photon number. Furthermore, employing the same solutions, we also obtain anti normally ordered characteristic function defined in the Heisenberg picture. For a linear gain coefficient of (A = 100), for a cavity damping constant of K= 0:8, µ = 0 and for thermal reservoir th = 0, the maximum intra cavity photon entanglement is found at steady state and at threshold to be 60%.
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Review Article
Open Access February 07, 2023

Prevalence of Anemia and Variations of Hematological Parameters among Anemic Hemodialysis Patients in the Tripoli Region

Abstract Background: Prolonged decline in the ability of the kidney to regulate acid–base balance, eliminate waste products, and manage water homeostasis and entered chronic phase, toxic metabolic accumulates and erythropoietin secretion by the kidney is decreasing and causes hematological changes including decrease of HCT, MCV, RBCs and platelet counts. Hemodialysis became a practical treatment for kidney failure and is the most common method used to treat advanced and permanent kidney failure. Anemia is one of the most common complications in hemodialysis patients. Objectives: The study aimed to evaluate the prevalence of anemia among hemodialysis patients and investigate the variations of hematological parameters among anemic hemodialysis patients in the Tripoli region. Materials and Methods: The present study was conducted on 250 renal failure patients, attending Tripoli Center for dialysis and 100 normal healthy subjects. The study Ethical Committee of the medical centers and the Libyan Academy of graduate studies reviewed and approved the study design and patient consent statements were taken from each patient. Information's about the patients were recorded in a questionnaire. A blood sample of 5 ml was drawn by venous puncture from each normal healthy individual and hemodialysis patient. 2.5 ml of the blood sample was collected in K-EDTA tubes for the hematological examinations and another 2.5 ml of the blood sample was collected in a plain tubes for biochemical tests (serum urea, creatinine, and uric acid concentrations). The hematological parameters (RBCs count, Hb, HCT, MCV, MCH, MCHC, WBCs count, differential count of WBCs, and Platelets count) were determined using an automated hematology analyzer Sysmex (K- 4500) machine. The data were compared using GraphPad Prism version.9. The statistical significance of differences between groups was evaluated with the independent t-test. A P-value of <0.05 was considered significant for all statistical tests. Results: The results showed that the prevalence of anemia among hemodialysis patients was 89.8%. The degrees of anemia were 17% severe, 71.66% moderate, and 11.34% mild anemia. The types of anemia were 13.36% microcytic hypochromic, 82.59% normocytic hypochromic, and 4.05% macrocytic hypochromic anemia. RBCs, WBCs & platelets counts, Hct, MCHC, and Lymphocytes % showed a significant (P<0.01) decrease, and MCV was a significant (P<0.01) increase in the anemic hemodialysis patients compared with the healthy individuals. But, a significant (P<0.05) decrease in MCH was observed in the anemic hemodialysis patients when compared with the healthy individuals. A significant correlation was observed between RBCs and their indices with most of the hematological parameters. A significant (P<0.01) negative correlation was observed between serum urea with Hb, and RBCs count and Hct. While, a significant (P<0.01) positive correlation was recorded between uric acid with platelets count. A significant (P<0.05) positive correlation was observed between gender with platelets count, while, a significant negative correlation was recorded between gender with serum urea (P<0.01), creatinine, and uric acid, and Hb (P<0.05). A significant (P<0.01) negative correlation was observed between blood groups with serum uric acid. A significant (P<0.01) positive correlation was observed between durations of hemodialysis with RBCs count and Hb, while, a significant (P<0.05 [...] Read more.
Background: Prolonged decline in the ability of the kidney to regulate acid–base balance, eliminate waste products, and manage water homeostasis and entered chronic phase, toxic metabolic accumulates and erythropoietin secretion by the kidney is decreasing and causes hematological changes including decrease of HCT, MCV, RBCs and platelet counts. Hemodialysis became a practical treatment for kidney failure and is the most common method used to treat advanced and permanent kidney failure. Anemia is one of the most common complications in hemodialysis patients. Objectives: The study aimed to evaluate the prevalence of anemia among hemodialysis patients and investigate the variations of hematological parameters among anemic hemodialysis patients in the Tripoli region. Materials and Methods: The present study was conducted on 250 renal failure patients, attending Tripoli Center for dialysis and 100 normal healthy subjects. The study Ethical Committee of the medical centers and the Libyan Academy of graduate studies reviewed and approved the study design and patient consent statements were taken from each patient. Information's about the patients were recorded in a questionnaire. A blood sample of 5 ml was drawn by venous puncture from each normal healthy individual and hemodialysis patient. 2.5 ml of the blood sample was collected in K-EDTA tubes for the hematological examinations and another 2.5 ml of the blood sample was collected in a plain tubes for biochemical tests (serum urea, creatinine, and uric acid concentrations). The hematological parameters (RBCs count, Hb, HCT, MCV, MCH, MCHC, WBCs count, differential count of WBCs, and Platelets count) were determined using an automated hematology analyzer Sysmex (K- 4500) machine. The data were compared using GraphPad Prism version.9. The statistical significance of differences between groups was evaluated with the independent t-test. A P-value of <0.05 was considered significant for all statistical tests. Results: The results showed that the prevalence of anemia among hemodialysis patients was 89.8%. The degrees of anemia were 17% severe, 71.66% moderate, and 11.34% mild anemia. The types of anemia were 13.36% microcytic hypochromic, 82.59% normocytic hypochromic, and 4.05% macrocytic hypochromic anemia. RBCs, WBCs & platelets counts, Hct, MCHC, and Lymphocytes % showed a significant (P<0.01) decrease, and MCV was a significant (P<0.01) increase in the anemic hemodialysis patients compared with the healthy individuals. But, a significant (P<0.05) decrease in MCH was observed in the anemic hemodialysis patients when compared with the healthy individuals. A significant correlation was observed between RBCs and their indices with most of the hematological parameters. A significant (P<0.01) negative correlation was observed between serum urea with Hb, and RBCs count and Hct. While, a significant (P<0.01) positive correlation was recorded between uric acid with platelets count. A significant (P<0.05) positive correlation was observed between gender with platelets count, while, a significant negative correlation was recorded between gender with serum urea (P<0.01), creatinine, and uric acid, and Hb (P<0.05). A significant (P<0.01) negative correlation was observed between blood groups with serum uric acid. A significant (P<0.01) positive correlation was observed between durations of hemodialysis with RBCs count and Hb, while, a significant (P<0.05) negative correlation was recorded between durations of hemodialysis with body weight, and MCHC. Conclusion: It can be concluded that a higher prevalence of moderate, normocytic hypochromic anemia among hemodialysis patients. Also, results showed a significant variation in hematological parameters among the anemic hemodialysis patients. So, hemodialysis patients advice to examine the hematological parameters and treated from anemia if detected.
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Open Access January 28, 2023

A framework for the evaluation of the decision between onsite and offsite construction using life cycle analysis (LCA) concepts and system dynamics modeling

Abstract The decision to choose between onsite and offsite construction is important in the effort toward sustainable construction. Offsite construction is often promoted as an environmentally friendly approach to construction operations. However, previous studies have shown that there is a lack of clarity on the environmental trade-offs between onsite and offsite construction. Factors that can affect the [...] Read more.
The decision to choose between onsite and offsite construction is important in the effort toward sustainable construction. Offsite construction is often promoted as an environmentally friendly approach to construction operations. However, previous studies have shown that there is a lack of clarity on the environmental trade-offs between onsite and offsite construction. Factors that can affect the decision to build onsite or offsite include the availability of a local offsite manufacturing facility, the distance of the offsite factory to the final place of use, the proximity of the site to the local supply of material and labor, etc. This study provides a framework to apply the system dynamic modeling technique to evaluate how various factors can affect the environmental impact of the building construction phase (for onsite or offsite construction methods). The system dynamic model (using Vensim software) that was developed provides a platform that allows users to input variables such as the distance that is expected for transportation of labor, material, and equipment to both the onsite facility and the offsite construction location, factors associated with the use of equipment for construction, the distance needed for transportation of building panels or modules from the offsite facility to the final site, etc. Among other things, the model showed that an increase in the distance from the offsite yard to the final construction site increases the total impacts of transportation of completed modules. An increase in the number of trips for the transportation of material to the onsite construction location increases the total impact of onsite construction. In terms of the environmental impact of construction, none of the two methods of construction gives an absolute superiority over the other. The environmental performance of offsite and onsite depends on various associated factors. It is recommended that building practitioners review various factors that are peculiar to their projects to make an informed decision on the best construction methods.
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Open Access January 14, 2023

Searching for What You Can’t See - Evaluation of Pesticide Residues in Grain Sold at Selected Markets of Southwest Nigeria

Abstract Studies on the use of pesticides in southwest Nigeria have revealed a substantial rise in a variety of pesticide-related illnesses, including mental impairment and reproductive problems. Those who work in agriculture and are regularly exposed to pesticides are the most impacted. The World Health Organization (WHO) predicts that three million severe pesticide poisoning episodes occur globally each [...] Read more.
Studies on the use of pesticides in southwest Nigeria have revealed a substantial rise in a variety of pesticide-related illnesses, including mental impairment and reproductive problems. Those who work in agriculture and are regularly exposed to pesticides are the most impacted. The World Health Organization (WHO) predicts that three million severe pesticide poisoning episodes occur globally each year, with at least 300.000 deaths and 99% of cases occurring in low- and middle-income nations. The effects of longer-term exposure to pesticides on health are not yet precisely estimated. Objectives: To this end, the objective of this study is to assess the knowledge of pesticide residues and common pesticides in grain-based food (brown and white beans, yellow and white maize, brown millet and rice) about pesticide use in selected markets of Southwest Nigeria. Methods: A total of 240 respondents were selected from four states (Ado-Ekiti, Ibadan, Osun and Ondo) with the aid of structured questionnaire and interview guide using purposive sampling technique. The markets were Oja-titun (market) Ile-Ife, Osun; Alesinloye Market Ibadan, Oyo; Oja Oba, Ado-Ekiti, Ekiti; and Oja Oba, Akure Ondo State. The identification and quantification of pesticide residues was done using a Varian 3800/4000 gas chromatograph mass spectrometer while 60 structured questionnaires were administered to respondents including food merchants, buyers/consumers as well as food vendors. Data were analysed using descriptive statistics. Results: The experiment was conducted from November 2020 to November 2021. Up to 50.4% never read instructions on pesticide application while a shared 24.8% read them always and occasionally. The number of respondents who never read the instructions were particularly high in Ekiti and Ondo, up to 52.5% of the respondents in Ekiti do not know whether or not they are exposed to pesticides during application. Also, majority of the respondents never attended any professional training on pesticide application, this amounted to 79.3%. Most people were not aware that unsafe pesticide application is harmful to human health. Similarly, a wide variety of symptoms were reported by respondents following pesticide application or consumption of grains, these included headaches and dizziness, itching and redness of the eyes, skin allergy, diarrhea, and stomach disorder, vomiting and loss of appetite, weakness of the body, asthma, permanent skin patches, shortness of breath, excessive sweating. Millet recorded the highest number of OCP residues while maize had the lowest. On the contrary, maize had the highest number of OPP and carbamate residues while millet had the lowest number of OPP residues. Meanwhile, maize, rice and beans had only one carbamate pesticide residue. Conclusions: According to the study's conclusions, farmers who can only get information from agricultural extension officials should receive urgent and immediate attention for raising awareness. Additionally, extensive IPM training programs must be created with the intention of disseminating precautions for protecting human health and a healthy agro-ecosystem. In order to find more effective pest management methods that utilize less pesticides, it is crucial to reevaluate the pesticide residues and common pesticides found in grains in the targeted markets. To reduce farmers' exposure to pesticides, it is also required to establish personal protective measures, special educational initiatives, and legislation promoting the use of safer pesticides. Significance and novelty: This study gives policymakers a comprehensive understanding of the ways that may be utilized to close the significant knowledge gap on pesticide residues in grains and provides an insight into the knowledge of pesticide residues and common pesticides in grains.
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Open Access January 06, 2023

False Beliefs about Contracting Avian (Bird) Flu from Processed Poultry Products

Abstract Avian influenza (bird flu) occurs sporadically in American poultry flocks, decimating these flocks and causing substantial economic losses. Avian influenza also impacts the beliefs of food handlers and preparers in the home (home cooks). Although those who properly handle and prepare processed poultry products cannot succumb to avian influenza, there is a widespread belief that one can contract [...] Read more.
Avian influenza (bird flu) occurs sporadically in American poultry flocks, decimating these flocks and causing substantial economic losses. Avian influenza also impacts the beliefs of food handlers and preparers in the home (home cooks). Although those who properly handle and prepare processed poultry products cannot succumb to avian influenza, there is a widespread belief that one can contract the bird flu from these foods. Beliefs about getting avian influenza from poultry products and intentions to avoid consuming poultry products are the focus of this study of 285 home cooks. False beliefs about getting avian influenza from handling, preparing, and consuming poultry products are apparent in this sample. Correlational analysis also shows that those holding the false beliefs intend to act upon those beliefs by planning not to consume poultry products. Moreover, the false beliefs about contracting avian influenza from poultry products are correlated with a bias to see oneself as less likely to produce food that contains foodborne diseases. These findings are consistent with, and contribute to, the research literatures on belief formation and change, behavioral intentions, and with research showing how guilt by association thought processes underlie false beliefs related to food safety. This research has important implications for poultry and other food processing industries, and for campaigns to persuade the public about real and imaginary risks associated with particular food products.
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Open Access December 16, 2022

A Framework for the Application of Optimization Techniques in the Achievement of Global Emission Targets in the Housing Sector

Abstract The building construction industry holds a crucial role in the reduction of greenhouse gas emissions globally. The targets for greenhouse gas emissions may not be achieved without a defined strategic plan to meet up with the set targets from various sectors of the economy. Recognizing the enormous potential that the building industry holds in contributing to global greenhouse gas GHG emission [...] Read more.
The building construction industry holds a crucial role in the reduction of greenhouse gas emissions globally. The targets for greenhouse gas emissions may not be achieved without a defined strategic plan to meet up with the set targets from various sectors of the economy. Recognizing the enormous potential that the building industry holds in contributing to global greenhouse gas GHG emission reduction, this study describes a framework on how optimization techniques can be used as a guide for emission reduction targets for the housing sector using illustrations of the onsite and offsite building construction industry. Given that some of the GHG gases are also sources of air pollution, this study includes a discussion on how the effort to address air pollution can be used to find a consensus towards addressing the concern about GHG emissions. This study presents procedures for simplified methods of estimation of GHG emissions that various municipalities around the globe can use to estimate and report the emissions from the building construction industry. The study presents a unifying strategy for emission management. The study also demonstrates how programming methods can be applied to GHG emissions management. The approach used in this study is transferable to other industries. The study recommends a unifying strategy for the management and control of emissions in the building construction industry. The study also recommends a coordinated effort in sharing best practices for emission control and management from all jurisdictions globally. In the effort to reduce global emission targets, further studies like this and its expansion is recommended for all sectors of the global economy. It is recommended that these studies should be followed by a concrete effort to achieve good implementation of sustainable emission reduction targets globally.
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Open Access December 02, 2022

Effect of Industrial Effluent on Irrigation Water Quality of Choba River in the Niger Delta Region of Nigeria

Abstract Poor irrigation water quality due to oil spillage on surface water can result in food insecurity, health and economic challenges. This paper investigated the effect of total petroleum hydrocarbon (TPHC) and lead (Pb) on irrigation water quality in the oil spill prone area of the Niger Delta region of Nigeria. Water samples were taken from five different sections labelled A, B, C, D, and E along [...] Read more.
Poor irrigation water quality due to oil spillage on surface water can result in food insecurity, health and economic challenges. This paper investigated the effect of total petroleum hydrocarbon (TPHC) and lead (Pb) on irrigation water quality in the oil spill prone area of the Niger Delta region of Nigeria. Water samples were taken from five different sections labelled A, B, C, D, and E along the Choba River, in Rivers State, Nigeria. Sections B, C, D and E were direct industrial effluent discharge points while section A was without direct industrial effluent discharge. Standard methods were employed in the water sampling and analysis. Suitability of Choba river water for irrigation was assessed by comprehensive pollution index (CPI) that incorporated salinity, sodicity, and permeability hazard potentials as well as the specific toxicity hazard potentials of TPHC and Pb. Results showed that all primary water parameters except pH were within the Food and Agriculture Organization (FAO) guidelines. The pH was low, ranging between 4.48 and 5.6. TPHC values for four out of the five samples were greater than the 10mg/l guideline as recommended by the Directorate of Petroleum Resources for surface water. TPHC for the four samples ranged between 14.52 and 174.32mg/l. The parameters with the most impact on CPI include EC, PI and TPHC with TPHC having the most impact. Water samples from sections A, B and E with CPI values 0.14, 0.37, and 0.8 respectively were classified in the clean, sub clean and slightly polluted categories respectively, while water samples from sections C and D with CPI values greater than 1 range from moderately to heavily polluted and not suitable for agricultural irrigation. Only water sample A was found suitable for irrigation.
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Open Access November 29, 2022

The Application of Machine Learning in the Corona Era, With an Emphasis on Economic Concepts and Sustainable Development Goals

Abstract The aim of this article is to examine the impacts of Coronavirus Disease -19 (Covid-19) vaccines on economic condition and sustainable development goals. In other words, we are going to study the economic condition during Covid19. We have studied the economic costs of pandemic, benefits in terms of gross domestic product (GDP), public finances and employment, investment on vaccines around the [...] Read more.
The aim of this article is to examine the impacts of Coronavirus Disease -19 (Covid-19) vaccines on economic condition and sustainable development goals. In other words, we are going to study the economic condition during Covid19. We have studied the economic costs of pandemic, benefits in terms of gross domestic product (GDP), public finances and employment, investment on vaccines around the world, progress and totally the economic impacts of vaccines and the impacts of emerging markets (EM) on achieving sustainable development goals (SDGs), including no poverty, good health and well-being, zero hunger, reduced inequality etc. The importance of emerging economies in reducing the harmful effects of the Corona has also been noted. We have tried to do experimental results and forecast daily new death cases from Feb-2020 to Aug-2021 in Iran using Artificial Neural Network (ANN) and Beetle Antennae Search (BAS) algorithm as a case study with econometric models and regression analysis. The findings show that Covid19 has had devastating economic and health effects on the world, and the vaccine can be very helpful in eliminating these effects specially in long-term. We observed that there is inequality in the distribution of Corona vaccines in rich countries compared to poor which EM can decrease the gap between them. The results show that both models (i.e., Artificial intelligence (AI) and econometric models) almost have the same results but AI optimization models can robust the model and prediction. The main contribution of this article is that we have surveyed the impacts of vaccination from socio-economic viewpoint not just report some facts and truth. We have surveyed the impacts of vaccines on sustainable development goals and the role of EM in achieving SDGs. In addition to using the theoretical framework, we have also used quantitative and empirical results that have rarely been seen in other articles.
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Open Access November 08, 2022

The c-equivalence principle and its implications for physics

Abstract The c-equivalence principle, commonly accepted as true by most physicists, is the unstated assumption that equals the kinematic speed of light. Should someone prove the principle false, it would render the composition of two Lorentz transformations meaningless. The second hypothesis of the Special Theory of Relativity in its strong form would also be invalidated. This paper examined some of the [...] Read more.
The c-equivalence principle, commonly accepted as true by most physicists, is the unstated assumption that equals the kinematic speed of light. Should someone prove the principle false, it would render the composition of two Lorentz transformations meaningless. The second hypothesis of the Special Theory of Relativity in its strong form would also be invalidated. This paper examined some of the consequences for physics, should this principle be proven false and outline some experiments to determine light speed, which could falsify the principle and provide evidence for the ether.
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Review Article
Open Access October 29, 2022

Patient Perspectives on Factors Influencing Initiation of Gynecologic Care

Abstract Addressing adolescent and sexual reproductive healthcare is essential to providing young patients with the resources they need to navigate and empower themselves with. However, there is limited data about how often this occurs. Several studies have previously indicated that there is a large gap in accessing this gap in low-income neighborhoods. Our study aims to identify the establishment of [...] Read more.
Addressing adolescent and sexual reproductive healthcare is essential to providing young patients with the resources they need to navigate and empower themselves with. However, there is limited data about how often this occurs. Several studies have previously indicated that there is a large gap in accessing this gap in low-income neighborhoods. Our study aims to identify the establishment of gynecologic care among adolescent cisgender women and elucidate potential reasons for seeking or not seeking out care. We approached women in the pediatric emergency room that matched the inclusion criteria set out. Qualitative surveys were conducted until thematic saturation was reached and a cross-section study design was employed. Interviews were analyzed through modified ground theory. The study was conducted at the pediatric emergency department at University Hospital located in Newark, NJ. In 2018 estimates, the Newark population consists of 47.0% Black and 39.2% Hispanic or Latinos. Semi-structured interviews were conducted with 27 cisgendered, English-speaking females between ages 18 to 25 presenting to the pediatric emergency room who may or may not have previously established primary care with a gynecologist. Transcriptions were analyzed using modified grounded theory and themes were identified using inductive coding of patient interviews.
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Open Access October 26, 2022

Asymptotic Properties of the Semigroup Generated by a Continuous Interval Map

Abstract The article's purpose is twofold. First, we wish to draw attention to the insufficiently known field of continuous-time difference equations. These equations are paradigmatic for modeling complexity and chaos. Even the simplest equation , easily leads to complex dynamics, its solutions are perfectly suited to simulate strong nonlinear phenomena such as large-to-small cascades of structures, [...] Read more.
The article's purpose is twofold. First, we wish to draw attention to the insufficiently known field of continuous-time difference equations. These equations are paradigmatic for modeling complexity and chaos. Even the simplest equation , easily leads to complex dynamics, its solutions are perfectly suited to simulate strong nonlinear phenomena such as large-to-small cascades of structures, intermixing, formation of fractals, etc. Second, in the main body of the article we present a small but very important part of the theory behind the above equation marked by . Just as the discrete-time analog of this equation induces the one-dimensional dynamical system on some interval , so the equation induces the infinite-dimensional dynamical system on the space of functions . In the latter case, not only are the long-term behaviours of solutions critically dependent on the limit behaviour of the sequence (as in the discrete case) but also on the internal structure of as . Assuming to be continuous, we consider the iterations of as the semigroup generated by on the space of continuous maps, and introduce the notion of a limit semigroup for in a wider map space in order to investigate asymptotic properties of . We construct a limit semigroup in the space of upper semicontinuous maps. This enables us to describe both of the aforementioned aspects of our interest around the iterations of.
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Open Access October 26, 2022

Notes about Winning Strategies for Some Combinatorial Games

Abstract We study the theory of combinatorial games and find winning strategies for players. The algorithmic implementation of the winning strategies for the game TacTix is presented and the software implementation for this game in Python programming language is implemented. The program has a console interface and allows one to check the winning strategies in practice.
We study the theory of combinatorial games and find winning strategies for players. The algorithmic implementation of the winning strategies for the game TacTix is presented and the software implementation for this game in Python programming language is implemented. The program has a console interface and allows one to check the winning strategies in practice.
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Open Access October 12, 2022

Effects of Illicit Financial Flows on Economic Growth and Development in Sub-Saharan Africa

Abstract Using a desktop review of literature, the effect of illegal capital flows on the economic performance of Sub-Saharan Africa is examined. The review focus on articles with attention to illegal capital flows and their effects on the economic performance of Sub-Saharan Africa as a whole. By way of sampling method, purposive sampling was used, and so the desktop review focused purposively on articles [...] Read more.
Using a desktop review of literature, the effect of illegal capital flows on the economic performance of Sub-Saharan Africa is examined. The review focus on articles with attention to illegal capital flows and their effects on the economic performance of Sub-Saharan Africa as a whole. By way of sampling method, purposive sampling was used, and so the desktop review focused purposively on articles published on issues of illicit financial flows and their effects on the economic performance of Ghana and Sub-Saharan Africa as a whole. The review found a high propensity of trade mis-invoicing and thus high illicit financial flows, transactions across boarders from developing countries and for that matter Sub-Saharan Africa to the developed economies. Therefore, the research recommends that customs divisions in sub-Saharan Africa should have up-to-date commodity-level world pricing information to make relatively better comparisons to detect mis-pricing and avoid such falsification and manipulation in trade. Given the high propensity of trade mis-invoicing resulting in high illicit financial flows, we recommend that cross-border transactions from developing sub-Saharan African countries be subjected to heightened scrutiny to curtail any potential traces of falsification in trade for tax evasion.
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Open Access October 09, 2022

New Approach to Statistical Analysis of Election Results

Abstract In this paper, a new method of detection of election fraud is proposed. This method is based on the calculation of the ratio of two standard normal random variables; estimation of parameters of obtained sample and comparison of these estimates with known theoretical values of parameters. Also in the paper, there is an example of the application of the described method.
In this paper, a new method of detection of election fraud is proposed. This method is based on the calculation of the ratio of two standard normal random variables; estimation of parameters of obtained sample and comparison of these estimates with known theoretical values of parameters. Also in the paper, there is an example of the application of the described method.
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Open Access September 29, 2022

Anthyllis hermanniae L. subsp. brutia Brullo & Giusso (Fabaceae): population survey and conservation tasks

Abstract Anthyllis hermanniae subsp. brutia, is an Italian endemic shrub occurring just in one locality by the Calabrian Ionian coast in southern Italy. Objective of this study is to provide data on population numbers, demography and ecology, as well as to identify the main threats on the long term conservation of the target taxon. The survey has been carried out through field census work, sampling biometric and dendrometric data, and applying simple statistics. The population, counting totally 962 individuals, is divided in two stands concentrated in the central part of the distribution area. It is restricted to a narrow belt on the inland part of the dune slope encompassed between an artificial pine forest at the dune top, and the dune-specialized vegetation on the slope. Some biometric insights, such as stem diameter, plant height and number of annual rings, suggest the role of micro-ecology in individual shaping. The most relevant threating factor for the long term conservation of this rare taxon is the rapidly spreading Pinus halepensis subsp. halepensis. Local population of this invasive alien species, deriving from planted individuals, is now invading the A. hermanniae subsp. brutia [...] Read more.
Anthyllis hermanniae subsp. brutia, is an Italian endemic shrub occurring just in one locality by the Calabrian Ionian coast in southern Italy. Objective of this study is to provide data on population numbers, demography and ecology, as well as to identify the main threats on the long term conservation of the target taxon. The survey has been carried out through field census work, sampling biometric and dendrometric data, and applying simple statistics. The population, counting totally 962 individuals, is divided in two stands concentrated in the central part of the distribution area. It is restricted to a narrow belt on the inland part of the dune slope encompassed between an artificial pine forest at the dune top, and the dune-specialized vegetation on the slope. Some biometric insights, such as stem diameter, plant height and number of annual rings, suggest the role of micro-ecology in individual shaping. The most relevant threating factor for the long term conservation of this rare taxon is the rapidly spreading Pinus halepensis subsp. halepensis. Local population of this invasive alien species, deriving from planted individuals, is now invading the A. hermanniae subsp. brutia habitat. Chorological and ecological data here provided should hopefully steer further population dynamics investigation as well as any urgent environment management actions.
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Open Access September 20, 2022

Drug-Receptor Interaction of Peptidic HIV-1 Protease: Polar Effect-II

Abstract Klopman described the chemical reaction of metal ions and base ions in term of softness, En and Em, respectively. By simple modification of known methods, Singh et al. made it applicable for neutral Lewis acids (transition metal salts) and bases (organic molecules) and also extended its application to biological systems for site selectivity [...] Read more.
Klopman described the chemical reaction of metal ions and base ions in term of softness, En and Em, respectively. By simple modification of known methods, Singh et al. made it applicable for neutral Lewis acids (transition metal salts) and bases (organic molecules) and also extended its application to biological systems for site selectivity and to explain reaction mechanism (markovnikov and anti-markovnikov rule), ligand-receptor interaction of testosterones, estrogens and tetrahydroimidazobenzodiazepinone. In this study effective atomic softness En(eff) and Em(eff), and their change ΔEnm have been used for site selectivity and polar interaction between 51 peptidic HIV-1 protease inhibitors and receptor amino acids. ΔEnm values derived from drug-receptor interaction show that when one moiety on receptor behaves as nucleophile (O of valine amino acid) at the same time maximum electrophilic site of the drug (C-atom of the maximum En(eff) value) orient itself to come close the respective site and make maximum interaction, while when another moiety on receptor behaves as electrophilic site (C of isoleucine amino acid), at the same time maximum nucleophilic site of the drug (O-atom of the maximum Em(eff) value) also orient itself to come close the respective site and make maximum interaction.
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Open Access September 18, 2022

Check if a Graph is Bipartite or not & Bipartite Graph Coloring using Java

Abstract Nowadays, graphs including bigraphs are mostly used in various real-world applications such as search engines and social networks. The bigraph or bipartite graph is a graph whose vertex set is split into two disjoint vertex sets such that there is no edge between the same vertex set. The bipartite graphs are colored using only two colors. This article checks if a given graph is bipartite or not [...] Read more.
Nowadays, graphs including bigraphs are mostly used in various real-world applications such as search engines and social networks. The bigraph or bipartite graph is a graph whose vertex set is split into two disjoint vertex sets such that there is no edge between the same vertex set. The bipartite graphs are colored using only two colors. This article checks if a given graph is bipartite or not and finds the color assignments of the bipartite graph using Java implementation.
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Short Communications & Source Code
Open Access September 05, 2022

Comparison of Concept about Good Death and View of Life and Death among Japanese, Korean, and American at COVID-19

Abstract From 2020 to 2022 the Covid-19 was spread and many people died. Death is near to everyone. The aim of the study was to investigate differences of concept of good death and view of life and death cross cultural. Participants were 92 Japanese, 110 Korean and 100 American who were ordinary people. We used the Good Death questionnaire to measure desirable death and the Death Attitude Inventory to [...] Read more.
From 2020 to 2022 the Covid-19 was spread and many people died. Death is near to everyone. The aim of the study was to investigate differences of concept of good death and view of life and death cross cultural. Participants were 92 Japanese, 110 Korean and 100 American who were ordinary people. We used the Good Death questionnaire to measure desirable death and the Death Attitude Inventory to measure view of life and death. Participants completed both questionnaires. As for Good Death, Japanese and Korean regarded “not being burden to others” as important the most, and American regarded “feeling that one’s life is worth living” as important. The scores of “unawareness of death” and “religious and spiritual comfort” of Korean were the highest, following American, and Japan. As for the Death Attitude Inventory, the score of American was higher than Japanese and Korean totally. The scores of “Death as release” or “Death Avoidance” of American were the highest. These results suggest that although Japanese and Korean regard “Not being burden to others” as important in common, Korean regard religious and spiritual comfort as important. American may avoid to think of death and regard it as release. We can make use of these cultural differences in clinical situation.
Article
Open Access September 01, 2022

Public Perspective on the Negative Impacts of Substance Use-Related Social Media Content on Adolescents: A Survey

Abstract Despite the pervasive nature of internet use among adolescents and young adults, there is not enough knowledge about whether and how involvement in social media influences substance use patterns and the risk of drug use-related problems. This study was conducted to examine the complex relationship between substance use-related social media engagement (viewing, liking, commenting, and posting the [...] Read more.
Despite the pervasive nature of internet use among adolescents and young adults, there is not enough knowledge about whether and how involvement in social media influences substance use patterns and the risk of drug use-related problems. This study was conducted to examine the complex relationship between substance use-related social media engagement (viewing, liking, commenting, and posting the substance use-related social media content) and the drug use-related problem in adolescents from public perception. We surveyed to determine the perception of social media users regarding the association between substance use-related social media content and substance/drug abuse problems. An anonymous online questionnaire was conducted to collect the response from each participant. The response was generated after collecting the data from 126 users of mixed ages. The data was stringently analyzed, and the response was displayed in the form of bar charts. The primary findings indicated a significant relationship between drug/alcohol-related social media engagement and drug/alcohol-related problems. From public perception, a positive correlation was found between the engagement in the drug use-related content and drug use associated problems. However, further research is needed to determine the right direction of these associations that can provide substantiative solutions for numerous interventions aiming to prevent drug use-related adverse consequences.
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Discussion
Open Access August 20, 2022

Nursing Student Engagement with Their Learning: A Mixed Methods Study

Abstract Student engagement in educational activities is essential for achieving desired learning outcomes. Despite this, little is known about the engagement patterns of nursing students from diverse or disadvantaged backgrounds. A mixed method study was conducted to explore engagement patterns within and outside the classroom but not during clinical placements. Students were asked what engagement means [...] Read more.
Student engagement in educational activities is essential for achieving desired learning outcomes. Despite this, little is known about the engagement patterns of nursing students from diverse or disadvantaged backgrounds. A mixed method study was conducted to explore engagement patterns within and outside the classroom but not during clinical placements. Students were asked what engagement means to them and what influences their engagement. Students were also asked how many hours they engaged in each of their undergraduate subjects and the reasons for this. The study was conducted at an Australian education provider. All students (n = 240) enrolled in the Bachelor of Nursing course were invited to participate. Lecture attendance was high at the start of the semester, fluctuated weekly and declined as the semester progressed. Students averaged between 3.5 and 4.4 hours of engagement per subject per week. They defined engagement as actually coming to class and a commitment to learning. Students were engaged by new, interesting content and disengaged by repetitive or complex content and poor tutoring. Most students want to engage but are distracted by intrinsic and extrinsic factors. Research should explore how to best assess students without the concurrent academic workload interfering with their studies.
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Article
Open Access June 30, 2022

Weekly Quizzes Reinforce Student Learning Outcomes and Performance in Biomedical Sciences in-course Assessments

Abstract Studies have highlighted the benefits of frequent quizzing in class. Frequent quizzing can promote more student attendance, engagement, practice and review, and achievement. Conversely, the opponents of frequent quizzing suggest that too frequent testing might hinder learning by frustrating anxious students and inhibiting larger units of instructional material. Notably, most studies have used [...] Read more.
Studies have highlighted the benefits of frequent quizzing in class. Frequent quizzing can promote more student attendance, engagement, practice and review, and achievement. Conversely, the opponents of frequent quizzing suggest that too frequent testing might hinder learning by frustrating anxious students and inhibiting larger units of instructional material. Notably, most studies have used degree examinations to evaluate the impact of quizzes on student learning and performance, yet little is known about whether quizzes can reinforce student performance in the in-course assessments (ICAs) despite ICA importance in student learning. The present study aimed to test the hypothesis that administration of weekly MCQ quizzes can enhance the leaning outcomes and performance of biomedical science students in assessment methods such as essay and oral presentation that can directly measure and provide information about student learning. It was therefore limited to in-course assessments. We found that the performance of the weekly quiz student group is remarkably better than that of the control student group in both the essay and oral presentation ICAs, which are two measures and indicators of student learning, suggesting improved student learning outcomes and performance after administrating weekly MCQ quizzes that also promoted student attendance in classrooms. The findings of this research study have implications for students, teachers, and curriculum designers in higher education.
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Article
Open Access May 06, 2022

Drivers of Acute Diarrhea in Mothers of Children between 6 and 59 Months old in Kinshasa Households, Democratic Republic of the Congo

Abstract Acute diarrhea is a common affection, among children under 59 months old in Sub-saharan Africa and Asia known to be a global public health concern. It is responsible for significant mortality in developing countries. The main purpose of this study was to identify drivers of acute diarrhea in mothers of children aged 6-59 months in Kinshasa households. This study was conducted in two health areas [...] Read more.
Acute diarrhea is a common affection, among children under 59 months old in Sub-saharan Africa and Asia known to be a global public health concern. It is responsible for significant mortality in developing countries. The main purpose of this study was to identify drivers of acute diarrhea in mothers of children aged 6-59 months in Kinshasa households. This study was conducted in two health areas in Kinshasa namely Centre Supérieur Militaire Mobikisi and Hopital Militaire Central. It is a cross-sectional study of analytical type having a correlational design. In fact, 114 mothers having children aged 6 to 59 months old who had experienced at least three diarrheal episodes were selected and this research was carried out in January 2020. Independent variables were socio-economic factors and dependent variables were biological factors. Descriptive statistical analyses of which frequency and percentage were performed to describe the sampling profile. To measure the strength of association between different variables, the Pearson's Chi-Square (X2) test was used. The findings showed that 57% live in a high socio-economic environment compared to 43% who have a low socio-economic environment responsible for the occurrence of acute diarrhea. It was observed that 67.7% of participants knew the importance of access to health care services, compared to 32.3% who did not know. Meanwhile, 50.8% lived in a healthy environment versus 49.2% who had an unhealthy environment. Furthermore, 53.8% were in an acceptable demographic and biological situation, compared to 46.2% who were in a precarious demographic and biological situation. Acute diarrhea in children aged 6-59 months is one of the causes of morbidity and mortality in Kinshasa city. Obstacles to effective care are related to the lack of quality service provision. Policy makers must therefore put in place interventions to address these challenges in order to reduce infant morbidity and mortality in this area.
Article
Open Access April 06, 2022

Geobotanical field activities for learning landscape interpretation concepts and methods for university students

Abstract The objective of this work is to materialize the learning of geobotanical concepts, and a methodology for the interpretation of the landscape, which allows the student to acquire practical knowledge, to obtain sufficient autonomy that allows him to join the labor market. Regarding the methodology, 100 field samples are taken for 3 years, and the participation of 60 students. The evaluation is [...] Read more.
The objective of this work is to materialize the learning of geobotanical concepts, and a methodology for the interpretation of the landscape, which allows the student to acquire practical knowledge, to obtain sufficient autonomy that allows him to join the labor market. Regarding the methodology, 100 field samples are taken for 3 years, and the participation of 60 students. The evaluation is carried out through reports on the field study. The landscapes of various areas of southern Spain are studied. For this we rely on the methodology previously established by other researchers, through which a complete diagnosis of a territory is reached, since the series and geoseries of vegetation are revealed. Being a study of natural reality, the abstract character presented by concepts such as sigmetum, sinassociation, series, geoseries, climatophilous, edaphoxerophilous, chain; it is perfectly clarified to the student, which makes the student progress efficiently, coming to the fore the acquisition of practical knowledge compared to theoretical ones. For this reason, practical teaching acquires preponderance, since it not only provides knowledge, but also development of cognitive and psychomotor skills, which are essential in the acquisition of skills and development of the individual's personality.
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Innovation Article
Open Access February 22, 2022

Untreated Anderson Type II Odontoid Fracture with Severe Delayed Atlanto-Axial Dislocation, Lateral Mass Misleading Signs of Fusion, and Posterior Surgical Approach: A Case Report

Abstract We present a case of untreated type II odontoid fracture, which evolved in severe dislocation 18 months later. Delayed dislocations in untreated type II odontoid fractures are already reported in literature. The singularity of our case is that CT-scan showed signs of fusion in the right C1-C2 articulation, which could have required a more complex surgical procedure to realign the upper cervical [...] Read more.
We present a case of untreated type II odontoid fracture, which evolved in severe dislocation 18 months later. Delayed dislocations in untreated type II odontoid fractures are already reported in literature. The singularity of our case is that CT-scan showed signs of fusion in the right C1-C2 articulation, which could have required a more complex surgical procedure to realign the upper cervical spine. Surprisingly, a CT scan performed in the extension position showed complete mobility of C1 and allowed us to perform a one stage posterior fixation. We want to highline both the importance of treating an Anderson type II fracture to prevent dislocation (acute or delayed), and the possibility to perform a flexion-extension CT scan to project a better surgical plan.
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Case Report
Open Access December 15, 2021

Dissemination and Exploitation of Regional Meteo-Hydrological Datasets through Web-based Interactive Applications: The SOL System Case Study

Abstract The effects of climate change are already being felt in several parts of the World. Variability of changing rainfall intensity, drought and weather patterns contribute to determining the vulnerability of many human activities such as agriculture. In the next future, climate change considerations will depend on having appropriate strategies such as strengthen implementation agencies working in a [...] Read more.
The effects of climate change are already being felt in several parts of the World. Variability of changing rainfall intensity, drought and weather patterns contribute to determining the vulnerability of many human activities such as agriculture. In the next future, climate change considerations will depend on having appropriate strategies such as strengthen implementation agencies working in a coordinated manner and with a data-driven approach in order to ensure monitoring, reporting and data verification. In this context, national and regional meteorological Services are facing with high demand for timely and quality information, services and products. A web-based interactive application with the aim of disseminating meteo-hydrological information at regional scale is described in this paper. The web application is built on a relational database and client-side programming has been used for implementing the user interface and controlling the web page behavior. The combination of PHP (Hypertext Preprocessor, a general-purpose scripting language, especially suited to server-side web development) and JavaScript (high-level object-oriented scripting language, nowadays the dominant client-side scripting language of the Web) has been chosen for this reason, since such software is free to use for everyone. The SOL system, developed on behalf of Marche region, Italy, was chosen as a case study, due to its multi-source data framework and because of the processing and public dissemination of several ad-hoc data elaborations.
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Case Study
Open Access June 21, 2021

The rising role of age stratification in sleep and CPAP therapy adherence in elderly population

Abstract Proper and effective management of obstructive sleep apnea (OSA) in elderly patients represents an important yet under-researched therapeutic target. Therefore, the main purpose of our research was to employ age stratification to analyse sleep quality and sleep fragmentation, the daily sleepiness, OSA severity and CPAP compliance in elderly. Conforming to the inclusion criteria of minimum 70 years [...] Read more.
Proper and effective management of obstructive sleep apnea (OSA) in elderly patients represents an important yet under-researched therapeutic target. Therefore, the main purpose of our research was to employ age stratification to analyse sleep quality and sleep fragmentation, the daily sleepiness, OSA severity and CPAP compliance in elderly. Conforming to the inclusion criteria of minimum 70 years of age at the time of polysomnography and CPAP titration night a total number of 162 elderly patients was included, median age 73,00±4 (MED±IQR). The comparison group consisted of 448 adult subjects under the age of 70 years old, median age 54,00±14,00 (MED±IQR). Sleep fragmentation in elderly was promoted to suboptimal CPAP adherence, as the probability of CPAP use ≥ 4 hours per day was less than 20%. Overall CPAP compliance hours in the elderly group achieved 3,991±3,804 hours/day with bigger variation in between the subjects versus 5,547±3,465 hours/day for the controls, (MED±IQR, p<0,001). Despite naturally occurring sleep fragmentation worsened by OSA, less than 30% of elderly patients would score ≥ 10 points on Epworth sleepiness scale. The study emphasizes acute need for standardized age-specific diagnostic tools to address different perception of daily drowsiness and sleepiness by older people. Further, it underlines the importance of early recognition of possible comorbid OSA and insomnia and suggest paying more attention to “non-obese phenotype” in the subgroup of elderly patients with suspected OSA. Elderly patients might also need development of more flexible CPAP compliance criteria; however, those must be standardized and objective.
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Article
Open Access June 22, 2021

Effect of Vibration to Fatigued Plantar Flexor Muscles on Postural Stability in Healthy Young Adults

Abstract Objective: The effects of muscle fatigue appear to elicit a transient means of postural instability; however, the recovery of postural stability after fatiguing exercise has not been extensively studied. This study aimed to determine the immediate effect of local vibration applied to fatigued plantar flexor muscles on postural stability in healthy young adults. Design: True [...] Read more.
Objective: The effects of muscle fatigue appear to elicit a transient means of postural instability; however, the recovery of postural stability after fatiguing exercise has not been extensively studied. This study aimed to determine the immediate effect of local vibration applied to fatigued plantar flexor muscles on postural stability in healthy young adults. Design: True Experimental (pre-test - post test design with a control group). Setting: A tertiary care centre. Participations: 42 healthy young adults. Intervention: Fatigue of plantar flexors muscles was induced by repeated dynamic contractions performed to maximum exhaustion. Experimental group (n= 21) received local vibration to fatigued muscles with a handheld vibrator whereas the control group (n = 21) received no intervention (rest). Postural stability was assessed using one leg stance test (OLST) under three different conditions viz. pre-fatigue, post-fatigue and post rest/vibration. Results: Comparative analysis of postural stability within the group was done pre-fatigue, post-fatigue and post rest/vibration condition using Kruskal-Wallis test. A significant decrease from pre-fatigue to post-fatigue condition (p-value < 0.001); and a significant increase from post-fatigue to post rest/vibration condition (p-value < 0.001) was observed in OLST in both - control group and experimental group. However, further comparison of OLST between the groups (using unpaired t test) showed a significant difference in post-fatigue condition versus post rest/vibration condition in favour of the experimental group. Conclusion: Plantar flexors fatigue significantly affects one leg stance time in healthy young adults. Results of this study show that there is an immediate effect of vibration to fatigued muscles on recovery of postural stability in healthy young adults. Recovery of postural stability achieved quickly with such a simple tool may help increase the degree of participation in sports and other similar activities which can cause muscles to fatigue. However, more studies are required to determine this effect using other clinical measures.
Article
Open Access June 16, 2021

Evaluation of the Effect of Azospirillum brasilense and Mycorrhizal Fungi of the Soil in Yacón Grown in a Greenhouse

Abstract In order to evaluate the effect of Azospirillum brasilense and mycorrhizal fungi in the soil on the nutrition of the yacon crop (Smallanthus sonchifolius [(Poeppig & Endlicher) H. Robinson]), determinations of agronomic parameters and the health status of the plants were carried out, under greenhouse conditions. The tests were carried out at the time of the implantation of the culture: the propagules were inoculated with A. brasilense and with native mycorrhizal fungi, generating four treatments, including the control and the co-inoculation of the consortium of the microorganisms under study (T0: control or control without inoculation; T1: inoculation with native A. brasilense; T2: inoculation with native mycorrhizal fungi and T3: joint inoculation with A. brasilense and native mycorrhizal fungi. The results indicate that co-inoculation with A. brasilense [...] Read more.
In order to evaluate the effect of Azospirillum brasilense and mycorrhizal fungi in the soil on the nutrition of the yacon crop (Smallanthus sonchifolius [(Poeppig & Endlicher) H. Robinson]), determinations of agronomic parameters and the health status of the plants were carried out, under greenhouse conditions. The tests were carried out at the time of the implantation of the culture: the propagules were inoculated with A. brasilense and with native mycorrhizal fungi, generating four treatments, including the control and the co-inoculation of the consortium of the microorganisms under study (T0: control or control without inoculation; T1: inoculation with native A. brasilense; T2: inoculation with native mycorrhizal fungi and T3: joint inoculation with A. brasilense and native mycorrhizal fungi. The results indicate that co-inoculation with A. brasilense and native mycorrhizal fungi increased plant growth in height, leaf area, biomass, dry matter and yields significantly in greenhouse production. It was determined that the application of the selected microorganisms has a plant growth promoting effect, increasing growth and productivity, greenhouse grown yacón.
Article
Open Access June 16, 2021

Impact of Pandemic Covid-19 on Higher Education-Indian Context

Abstract Education stratum of India as well as world are worst-hit by Covid-19 and has imposed lockdown originating deleterious effect on academic life. A sheer number of learners ceased moving educational institutions and all pedagogies halted in India. Catastrophe has behaved as a stimulant for the educational institutions to cultivate and choose for platforms with technologies which were previously [...] Read more.
Education stratum of India as well as world are worst-hit by Covid-19 and has imposed lockdown originating deleterious effect on academic life. A sheer number of learners ceased moving educational institutions and all pedagogies halted in India. Catastrophe has behaved as a stimulant for the educational institutions to cultivate and choose for platforms with technologies which were previously noviced. Education sector has been challenging to weather the crux with alternative strategy and digitizing the challenges to hoover the menaces of the pandemic. Hypothesis of digital study has prognosis to impact the ventures of higher education for eon. Findings evince that despite digital learning is a nice adventure for little skills, varying illiberalities partake. Learners are crunched and academy also exclusively in unstable job. It has yet to be established the scope whereupon digital study would climactically cover for conventional study. Covid-19 conundrum has divulged prefacing dilemma and disparities clamoring synergetic attempt to contemplate even so pandemic’s approach. This deliberate paper illuminates sparse impeccable education in India and has discussed the positive and negative impacts of Covid-19. The paper also contributes a methodical substantiation of the experience and lessons digested from the impact of the pandemic on the transitional education panorama, and the dissemination and acceptance of e-learning in education. To end, few suggestions along with policy recommendations have been made to meet didactics during the pandemic contingency.
Article
Open Access June 08, 2021

The Influence of Emotional Intelligence on Leadership Style at Integrated Service Unit (UPT) Regional Revenue Management in Pematangsiantar

Abstract The purpose of this research is: 1. To determine the description of emotional intelligent and leadership style in the Integrated Service Unit (UPT) Regional Revenue Management in Pematangsiantar. 2. To determine the influence of emotional intelligent to leadeship style in the Integrated Service Unit (UPT) Regional Revenue Management in Pematangsiantar. The research uses literature research design [...] Read more.
The purpose of this research is: 1. To determine the description of emotional intelligent and leadership style in the Integrated Service Unit (UPT) Regional Revenue Management in Pematangsiantar. 2. To determine the influence of emotional intelligent to leadeship style in the Integrated Service Unit (UPT) Regional Revenue Management in Pematangsiantar. The research uses literature research design and field research. The population in this study were all administrative employee at in the Integrated Service Unit (UPT) Regional Revenue Management in Pematangsiantar, emounted to 42 employees. The type of data used are qualitative data and quantitative data. Sources of data used are primary and secondary. The data were collected through questionnaries, interviews and documentation. Test of instrument used with validity test and reliability test. The analysis technique used are normality test, qualitative descriptive analysis and quantitative descriptive analysis. The result of this study can be summarized as follows: 1. Emotional intelligent and leadership style are good. 2. Emotional intelligent have positive effect on leadership style. 3. Emotional intelligent heve moderately corelation with leadership style then the level of leadership style can be explained by emotional intelligent. 4. H0 is rejected, meaning that emotional intelligent has positive and significantly to leadership style. The suggestions of this research are: 1. To make leadership style, the leaders should be provided opportunities for employee to be more independently in making decisions both individually or in grups. 2. To enhance emotional intelligent, the leaders should record data of employee to know their skill, knowledge or work experience
Article
Open Access May 31, 2021

Design of a Movement Therapy in the form of Taekwondo and its Effectiveness on Easement of Clinical Symptoms in Boys Suffering from Deficit Attention and Hyper Activity Disorder

Abstract This research deals with Design of a Movement Therapy in the form of Taekwondo and its Effectiveness on Easement of Clinical Symptoms in boys suffering from Deficit Attention and Hyper Activity Disorder [ADHD]. In terms of objective, it is a practical research and in terms of how it gathered data it is a half-pilot research of pre & post-test encompassing test and control groups. Samples were [...] Read more.
This research deals with Design of a Movement Therapy in the form of Taekwondo and its Effectiveness on Easement of Clinical Symptoms in boys suffering from Deficit Attention and Hyper Activity Disorder [ADHD]. In terms of objective, it is a practical research and in terms of how it gathered data it is a half-pilot research of pre & post-test encompassing test and control groups. Samples were 32 children of 6-12 years of age who were ensured to have been suffering from ADHD as diagnosed by psychiatric clinics in Tehran. Sampling was made through easy method and test/control groups were formed randomly from among samples (each group containing16 members). ADHD was evaluated in samples using Conner’s teaching questionnaire pre & post-test questionnaire. To test group a 12-session long practice of movement therapy was prescribed in the form of Taekwondo. Findings were then analyzed using covariance analysis system. Results revealed that there is a meaningful relationship between movement therapy in the form of Taekwondo and easement of ADHD clinical symptoms in reliability of P<0.01). Therefore, difference of averages can persuade us that movement therapy in the form of Taekwondo is effective on easement of clinical symptoms of ADHD.
Article
Open Access January 16, 2026

Evaluating the Effectiveness of Occupational Health and Safety Management Practices in Improving Workplace Safety in Nigerian Construction Sites

Abstract The construction industry remains one of the most hazardous sectors globally, with Nigeria experiencing a high incidence of workplace accidents despite the adoption of Occupational Health and Safety Management (OHSM) frameworks. This study evaluated the effectiveness of OHSM practices in improving workplace safety across construction companies in Nigeria’s coastal cities. A cross-sectional design [...] Read more.
The construction industry remains one of the most hazardous sectors globally, with Nigeria experiencing a high incidence of workplace accidents despite the adoption of Occupational Health and Safety Management (OHSM) frameworks. This study evaluated the effectiveness of OHSM practices in improving workplace safety across construction companies in Nigeria’s coastal cities. A cross-sectional design was employed, combining quantitative surveys of construction workers (n = 1,400) with qualitative interviews of 35 managers and supervisors. Quantitative data were analyzed using SPSS version 28, while thematic analysis was applied to qualitative responses. Findings revealed a generally positive perception of OHSM, with 54.4% of workers rating OHS policy effectiveness as “Good” and 52.0% rating health outcomes as “Good.” However, accident frequency remained a concern, with 46.4% reporting accidents occurred “Occasionally” and 31.9% acknowledging them as “Frequent” or “Very Frequent.” Comparative analysis showed indigenous firms were rated higher in policy effectiveness and health outcomes but also reported slightly higher accident frequencies than international firms. Thematic analysis identified five key monitoring and evaluation strategies including routine inspections, regular training, audits, behavioural reinforcement, and access control, Also, five measures of OHSM effectiveness, including compliance observation, incident tracking, KPIs, employee feedback, and benchmarking. OHSM was found to positively influence project outcomes by reducing compensation costs, enhancing reputation, and improving supervision and quality of work. OHSM practices in Nigeria’s construction sector are perceived as effective in policy and health outcomes, yet accident rates remain a critical challenge. The study underscores the importance of continuous training, stricter enforcement, behavioural reinforcement, and systematic performance evaluation.
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Open Access February 13, 2026

Influence of Religious Literacy and Multicultural Teaching Competence on Religious and Moral Education Teachers’ Self-Efficacy: Empirical Evidence from Public Basic Schools in the Kumasi Metropolis

Abstract The focus of this study was to determine the influence of religious literacy and multicultural teaching competence on the teaching self-efficacy of Religious and Moral Education (RME) teachers in public basic schools within the Kumasi Metropolis. The research employed a cross-sectional survey design with a sample of 308 RME teachers selected through the stratified sampling technique from 165 basic [...] Read more.
The focus of this study was to determine the influence of religious literacy and multicultural teaching competence on the teaching self-efficacy of Religious and Moral Education (RME) teachers in public basic schools within the Kumasi Metropolis. The research employed a cross-sectional survey design with a sample of 308 RME teachers selected through the stratified sampling technique from 165 basic schools across 14 circuits. Data were collected using questionnaires and analysed using Partial Least Squares Structural Equation Modelling (PLS-SEM). The findings revealed that religious literacy significantly and positively influenced teachers’ self-efficacy (β = 0.487, p < 0.05), accounting for 23.7% of the variance. Similarly, multicultural teaching competence demonstrated a strong positive effect on teaching self-efficacy (β = 0.711, p < 0.05), explaining 50.6% of the variance. Finally, the study found that religious literacy and multicultural teaching competence together contributed 52.2% to RME teachers' teaching self-efficacy (SD = 0.692, p < 0.05, R² = 0.522). The study recommended that the Ghana Education Service (GES) and the National Council for Curriculum and Assessment (NaCCA) should design and mandate regular in-service training programmes focused specifically on religious literacy for RME teachers. Also, it was recommended that pre-service and in-service training should emphasise awareness of personal biases, deep knowledge of learners’ cultural and religious backgrounds, and practical skills for culturally responsive pedagogy.
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Open Access February 13, 2026

Integrated GIS and geotechnical assessment of the stability of the Oued Ayda dike (Kesra Siliana, Tunisia)

Abstract This study proposes an integrated approach combining geographic information systems (GIS) and geotechnical analyses to assess the stability of the Oued Ayda mountain lake dam, located in the Siliana Governorate, northwestern Tunisia. The mechanical properties of the embankment and foundation materials were integrated into a Mohr-Coulomb geomechanical model, while the pore water pressure [...] Read more.
This study proposes an integrated approach combining geographic information systems (GIS) and geotechnical analyses to assess the stability of the Oued Ayda mountain lake dam, located in the Siliana Governorate, northwestern Tunisia. The mechanical properties of the embankment and foundation materials were integrated into a Mohr-Coulomb geomechanical model, while the pore water pressure distribution was simulated for various representative hydromechanical scenarios: end of construction, normal operation, rapid drainage, and short- and long-term empty reservoir conditions. The stability analysis, performed using the Morgenstern-Price method with the SLOPE/W software (GeoStudio), reveals high safety factors on the upstream side (SF > 3 in the short term and SF ≥ 2 in the long term), indicating good resistance of this slope to hydraulic and mechanical stresses. Conversely, the results show that the downstream slope exhibits significantly lower safety factors, ranging from 1.335 to 1.338 under long-term conditions, particularly during normal operating and rapid drainage scenarios. These reduced values indicate a high vulnerability of this slope to persistent saturation and adverse hydraulic gradients. In conclusion, although the dam exhibits satisfactory overall stability, the downstream slope remains the most vulnerable area of the structure. The results underscore the need for rigorous management of water level fluctuations and suggest reinforcing the drainage system or implementing targeted stabilization measures to ensure the long-term safety and durability of the structure.
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Open Access January 31, 2026

Management of Placenta Accreta Spectrum Disorders: A Prospective Single-Centre Experience of 236 Cases in Riyadh, Saudi Arabia (2018–2024)

Abstract Objective: To evaluate maternal and neonatal outcomes of women with placenta accreta spectrum (PAS) disorders managed by a dedicated multidisciplinary team at a tertiary referral centre in Riyadh, Saudi Arabia. Methods: We conducted a prospective case series of all women with antenatally suspected and intraoperatively or histopathologically confirmed PAS managed at King Fahad Medical [...] Read more.
Objective: To evaluate maternal and neonatal outcomes of women with placenta accreta spectrum (PAS) disorders managed by a dedicated multidisciplinary team at a tertiary referral centre in Riyadh, Saudi Arabia. Methods: We conducted a prospective case series of all women with antenatally suspected and intraoperatively or histopathologically confirmed PAS managed at King Fahad Medical City between April 2018 and December 2024. Women with high suspicion of PAS were electively admitted at 31+6 weeks’ gestation for optimisation when feasible and delivered by midline laparotomy and fundal or classical caesarean incision with the placenta left in situ. Definitive management consisted of hand-assisted retrograde caesarean hysterectomy or segmental uterine resection with reconstruction. Outcomes included operative time, quantified blood loss, transfusion requirements, intra- and postoperative complications, intensive care unit (ICU) admission, hospital stay, and neonatal morbidity. Results: A total of 236 women with confirmed PAS were managed. Median maternal age was 36 years and placenta previa coexisted in 86.9%. Elective caesarean delivery at 34+0–35+6 weeks occurred in 72.0%, whereas 28.0% required emergency delivery for haemorrhage or labour. Caesarean hysterectomy was performed in 85.2% and conservative segmental uterine resection in 14.8%. Median operative time was 135 minutes and median blood loss 4.3 L; the median transfusion requirement was six units of packed red blood cells. Intraoperative complications occurred in 27.1%, most commonly bladder injury (14.8%). One woman (0.4%) died intraoperatively from disseminated intravascular coagulation with intracardiac thrombosis. ICU admission was required in 66.0%. Neonatal intensive care unit admission occurred in 53.0%, mainly because of prematurity; there were no neonatal deaths. Conclusion: Centralised multidisciplinary management of PAS with planned delivery at 34–35 weeks, avoidance of placental removal, and use of retrograde hysterectomy or segmental resection can minimise haemorrhage and maternal mortality while maintaining acceptable neonatal outcomes in a high-volume referral centre.
Article
Open Access January 25, 2026

Meigs’ syndrome presenting with pleuritic chest pain and dyspnea: rapid resolution after resection of an ovarian fibroma

Abstract Meigs’ syndrome is a rare triad of a benign ovarian fibroma (or fibroma‑like tumor), ascites, and pleural effusion that resolves after tumor resection. A 53‑year‑old multiparous woman presented with progressive exertional dyspnea and right‑sided pleuritic chest pain. Respiratory and cardiac evaluations were initially unrevealing. Bedside assessment identified mild right basal dullness, and [...] Read more.
Meigs’ syndrome is a rare triad of a benign ovarian fibroma (or fibroma‑like tumor), ascites, and pleural effusion that resolves after tumor resection. A 53‑year‑old multiparous woman presented with progressive exertional dyspnea and right‑sided pleuritic chest pain. Respiratory and cardiac evaluations were initially unrevealing. Bedside assessment identified mild right basal dullness, and point‑of‑care abdominal ultrasound demonstrated mild free fluid and a solid right adnexal mass. Chest radiography confirmed a small right pleural effusion. Without computed tomography and without diagnostic paracentesis or thoracentesis, Meigs’ syndrome was suspected. The patient underwent laparotomy with total abdominal hysterectomy and bilateral salpingo‑oophorectomy. Histopathology confirmed an ovarian fibroma. Postoperatively, symptoms resolved dramatically, and follow‑up imaging demonstrated complete resolution of the pleural effusion and ascites. This case highlights the importance of considering gynecologic etiologies in unexplained pleural effusion and dyspnea, especially when accompanied by abdominal distension or pelvic pressure.
Case Report
Open Access January 19, 2026

Mature Cataract, A Veil Concealing, A Pachychoroid Spectrum: About Two Cases

Abstract The pachychoroid spectrum is a new entity grouping pathologies with common choroidal features. First described in 2013 by American ophthalmologist Bailey Freund and his team [1]. It is defined by a diffuse or focal increase in choroidal thickness with dilatation of choroidal vessels adjacent to Bruch's membrane, associated with retinal pigment epithelial dysfunction, loss of the choriocapillaris [...] Read more.
The pachychoroid spectrum is a new entity grouping pathologies with common choroidal features. First described in 2013 by American ophthalmologist Bailey Freund and his team [1]. It is defined by a diffuse or focal increase in choroidal thickness with dilatation of choroidal vessels adjacent to Bruch's membrane, associated with retinal pigment epithelial dysfunction, loss of the choriocapillaris and thinning of Sattler's layer [1, 2]. At present, the pachychoroid spectrum includes well-known pathologies such as central serous chorioretinitis (CSCR) and polypoidal choroidal vasculopathy (PCV), as well as pathologies of more recent description such as epitheliopathy or type 1 neovessels secondary to pachychoroid, pachydrusen, choroidal excavation and peripapillary pachychoroid. The morphological changes of the lens which is a cataract can be unilateral or bilateral and occur symmetrically or not over variable durations. A cataract is said to be mature when the opacification occupies the entire lens, it induces a complete loss of vision. It makes the visualization of the fundus reflection impossible, which explains the impossibility of visualizing hemorrhages and other lesions of the eye with the possibility of concealing a pachychoroid spectrum during the ocular examination in patients. The aim of our study is to describe the symptomatology and therapeutic approach of SPC.
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Case Report
Open Access January 07, 2026

Pre-eclampsia’s Hidden Risk: Sudden Postpartum Bilateral Serous Retinal Detachment with Complete Visual Recovery

Abstract Introduction: Severe pre-eclampsia is a multisystem disorder associated with various ocular complications, however postpartum bilateral serous retinal detachment is uncommon and may threaten vision if not early recognized, thus requiring prompt management in order to prevent permanent visual loss. Clinical Description: A case of a 31-year-old woman, G3P0 with an in vitro [...] Read more.
Introduction: Severe pre-eclampsia is a multisystem disorder associated with various ocular complications, however postpartum bilateral serous retinal detachment is uncommon and may threaten vision if not early recognized, thus requiring prompt management in order to prevent permanent visual loss. Clinical Description: A case of a 31-year-old woman, G3P0 with an in vitro fertilization and previous miscarriages, developed severe pre-eclampsia at 34 weeks of gestation. She underwent an emergency cesarean section for maternal indication. On the second postoperative day, she develops sudden unilateral blindness and blurred vision in the contralateral eye. Ophthalmological examination showed normal optics discs while MRI revealed bilateral serous retinal detachment. She was managed conservatively with strict blood pressure control, magnesium sulphate therapy and anticoagulation with full recovery of vision over 3 weeks without need of surgical intervention. Discussion: Postpartum retinal detachment is uncommon, most often serous and reversible. This case highlights that conservative management focusing on strict blood pressure control and supportive care was sufficient to avoid surgical intervention. Timely diagnosis and coordinated multidisciplinary management ensured complete visual recovery. Conclusion: Bilateral serous retinal detachment is a rare but reversible postpartum complication of severe pre-eclampsia. With early recognition, close monitoring and conservative management can lead to complete restoration of vision.
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Case Report
Open Access December 28, 2025

Acute Right Ovarian Torsion with Six Twists: Successful Ovarian Preservation Following Detorsion

Abstract Introduction: Ovarian torsion is a rare gynecological emergency that can result in permanent ovarian loss if not promptly recognized and managed. Cases involving multiple rotations of the ovary are highly unusual and pose a significant risk for ovarian viability. Clinical Description: A 33-year-old P2 woman presented with sudden severe lower abdominal pain. Imaging showed a complex [...] Read more.
Introduction: Ovarian torsion is a rare gynecological emergency that can result in permanent ovarian loss if not promptly recognized and managed. Cases involving multiple rotations of the ovary are highly unusual and pose a significant risk for ovarian viability. Clinical Description: A 33-year-old P2 woman presented with sudden severe lower abdominal pain. Imaging showed a complex midline adnexal mass, more towards left and mild free fluid with suspected torsion. Emergency laparotomy showed a sixfold torsion of the right ovary with a dermoid cyst. Detorsion and cystectomy were performed with preservation of the ovary. Postoperative recovery was uneventful and histopathology further confirmed a benign dermoid cyst. Discussion: Ovarian torsion with multiple rotations is extremely rare so early recognition and timely surgical intervention enable ovarian salvage even in severe cases. Moreover, Dermoid cysts are the most common predisposing factor. Conclusion: This case highlights the importance of prompt diagnosis and immediate management of ovarian torsion to prevent complications, preserve ovarian integrity and fertility.
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Case Report
Open Access December 22, 2025

Reimagining Mathematical Modeling for a Responsive and Integrated Future in Infectious Disease Epidemiology

Abstract Mathematical modeling plays a central role in infectious disease epidemiology, shaping outbreak response strategies and informing public health policy. The COVID-19 pandemic demonstrated the value of these models but also exposed persistent limitations related to data fragility, lack of transparency, limited stakeholder engagement, and insufficient consideration of social and political contexts. [...] Read more.
Mathematical modeling plays a central role in infectious disease epidemiology, shaping outbreak response strategies and informing public health policy. The COVID-19 pandemic demonstrated the value of these models but also exposed persistent limitations related to data fragility, lack of transparency, limited stakeholder engagement, and insufficient consideration of social and political contexts. Rather than critiquing modeling as a discipline, this perspective argues for a reorientation of infectious disease modeling toward a more responsive, equity-centered, and participatory paradigm. We propose a conceptual framework built on three interrelated principles: adaptability through real-time data integration, transparency via open-source and reproducible practices, and relevance through interdisciplinary and co-produced model design. Drawing on illustrative examples from COVID-19 and dengue control efforts, we highlight how integrating behavioral dynamics, local knowledge, and policy feedback can improve model usefulness and public trust. Reconceptualizing models as dynamic systems of inquiry rather than static forecasting tools can enhance decision-making and promote more equitable and effective responses to future public health emergencies.
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Brief Review
Open Access December 09, 2025

Hidden Malignancy in Pregnancy: Metastatic Adenocarcinoma of Colon Disguised as Liver Hemangioma Leading to Maternal Mortality

Abstract Introduction: Colorectal cancer during pregnancy is a complex and rare condition often presenting with benign gastrointestinal symptoms that overlap with normal pregnancy related changes, leading to delayed or misdiagnosis. Further, hepatic metastases may complicate recognition, especially when initially interpreted as benign lesions such as hemangiomas. So, early identification and [...] Read more.
Introduction: Colorectal cancer during pregnancy is a complex and rare condition often presenting with benign gastrointestinal symptoms that overlap with normal pregnancy related changes, leading to delayed or misdiagnosis. Further, hepatic metastases may complicate recognition, especially when initially interpreted as benign lesions such as hemangiomas. So, early identification and management are crucial and remain challenging for optimizing maternal and fetal outcomes. Clinical Description: A case of 39-year-old gravida 5 para 4 at 24 weeks+1 day with chronic hypothyroidism, longstanding anemia and a one year history of epigastric + right upper quadrant pain with suspected hemorrhage from a known liver hemangioma. Further imaging suggested a malignant hepatic lesion where colonoscopy and biopsy confirmed stage IV metastatic colon adenocarcinoma with liver and adrenal metastases. Her condition deteriorated and delivered a stillborn infant at 26 weeks of 780 grams following placental abruption. She continued to decline despite supportive care and died. Conclusion: This case illustrates the diagnostic challenges of colorectal cancer in pregnancy where nonspecific symptoms and inaccurate imaging results contributed to delayed diagnosis. The aggressive nature of the disease emphasizes the importance of prompt diagnosis and integrated care approach to improve both maternal and fetal outcome.
Case Report
Open Access November 20, 2025

The Renaissance Man of Kyekyeku: In Celebration of Opanyin David Kwadwo Boadu's Life of Multiplicity and Benevolence

Abstract In contemporary society, a marked decline in humanity's intrinsic values has become a point of lamentation for many observers. This is particularly evident when one considers the recognition often bestowed upon individuals of dubious character, while those who embody exemplary virtues are frequently overlooked or forgotten. In this context, this paper seeks to pay rightful tribute to David Kwadwo [...] Read more.
In contemporary society, a marked decline in humanity's intrinsic values has become a point of lamentation for many observers. This is particularly evident when one considers the recognition often bestowed upon individuals of dubious character, while those who embody exemplary virtues are frequently overlooked or forgotten. In this context, this paper seeks to pay rightful tribute to David Kwadwo Boadu—the Renaissance Man of Kyekyeku—a figure whose remarkable life reflects a profound dedication to multiplicity and benevolence. This study delves deeply into his multifaceted contributions spanning various domains, including his roles as a husband, father, farmer, herbalist, midwife, hunter, catechist, musician, builder, arbitrator, counsellor, and cacao merchant. Each of these roles highlights essential themes of generosity and diversity, serving to illustrate how such attributes shape both an individual's identity and their contributions to the broader society. Utilising qualitative approach that involved interviews and employing the Streamwrite methodology—an innovative art-based approach designed to engage with the complexities of human experiences—this study underscores the critical importance of recognising individuals who exemplify these virtues as key to restoring the eroding humaneness in our communities.
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Article
Open Access November 12, 2025

Effect of Sleep Deprivation on Executive Functioning Among Young Adults: Meta-Analysis

Abstract Background: Sleep deprivation is increasingly prevalent among young adults due to academic, occupational, and social demands, making them susceptible to circadian disruption. Executive functioning—encompassing working memory, inhibitory control, and cognitive flexibility is essential for academic and professional success. This meta-analysis quantifies the effect of sleep deprivation on [...] Read more.
Background: Sleep deprivation is increasingly prevalent among young adults due to academic, occupational, and social demands, making them susceptible to circadian disruption. Executive functioning—encompassing working memory, inhibitory control, and cognitive flexibility is essential for academic and professional success. This meta-analysis quantifies the effect of sleep deprivation on executive functioning in healthy young adults. Practical Implications: These findings highlight the need for evidence-based interventions such as university-level sleep education programs, flexible academic scheduling, and workplace policies promoting adequate sleep to optimize cognitive performance and productivity among young adults. Methods: Following PRISMA 2020 guidelines, PubMed, Scopus, PsycINFO, and Web of Science were searched (January 2000–March 2024) for studies assessing acute (<6 hours sleep or ≥24 hours total deprivation) or chronic (<6 hours/night over multiple days) sleep deprivation in young adults. Outcomes included validated executive function tests (e.g., Stroop, N-Back). Random-effects meta-analysis (Hedges’ g) was conducted using R (version 4.3.2) with metafor/meta packages. Heterogeneity (I², Q-test), sensitivity (leave-one-out), and publication bias (funnel plot, Egger’s test) were evaluated. Results: Out of 2,478 screened studies, 39 met inclusion criteria (n=4,578). Sleep deprivation had a moderate-to-large detrimental effect on executive functioning (Hedges’ g = -0.62, 95% CI [-0.78, -0.45], p<0.001). Subdomain analysis revealed greatest impairment in working memory (g = -0.71), followed by inhibitory control (g = -0.59) and cognitive flexibility (g = -0.49) (all p<0.001). Moderate heterogeneity was present (I² = 58%), with results robust to sensitivity analysis. Egger’s test indicated no significant publication bias (p=0.22). Interpretation: Sleep deprivation significantly impairs executive functioning in young adults, especially working memory. Interventions improve sleep may enhance cognitive performance and should be integrated into public health strategies and educational policies. Future research should assess chronic restriction and individual vulnerability factors.
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Meta-Analysis
Open Access November 10, 2025

Teaching in a Diverse Society: Influence of Religious Literacy and Multicultural Teaching Competence on the Self-Efficacy of Religious and Moral Education Teachers in the Accra Metropolis, Ghana

Abstract The ultimate goal of this study was to determine the influence of religious literacy and multicultural teaching competence of RME teachers on their teaching self-efficacy in the Accra Metropolis. Grounded in culturally responsive teaching and self-efficacy theory, this study employed a cross-sectional survey design. All 441 RME teachers in the eight (8) circuits in the Metropolis which has [...] Read more.
The ultimate goal of this study was to determine the influence of religious literacy and multicultural teaching competence of RME teachers on their teaching self-efficacy in the Accra Metropolis. Grounded in culturally responsive teaching and self-efficacy theory, this study employed a cross-sectional survey design. All 441 RME teachers in the eight (8) circuits in the Metropolis which has seventy-two (72) basic schools were involved in the study through the census method. Data were collected using a questionnaire and analyzed using descriptive statistics and partial least squares structural equation modeling (PLS-SEM). Findings revealed that RME teachers reported high levels of RL, MTC, and TSE. Religious literacy and multicultural teaching competence jointly explained 44.2% of the variance in TSE, with a statistically significant positive effect (p < 0.05). It was recommended that, the curriculum for training RME teachers should include in them topics on RL and MTC.
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Article
Open Access November 09, 2025

Application of Building Information Modelling (BIM) for Enhancing Safety and Environmental Performance on Construction Sites in Nigeria

Abstract Background: Building Information Modelling (BIM) improves safety planning in construction by enabling visualization and simulation to identify and reduce risks. However, its adoption in Nigeria is limited. This study examines the application of BIM in enhancing safety and environmental performance on construction sites in Nigeria. Methodology: A quantitative cross-sectional survey [...] Read more.
Background: Building Information Modelling (BIM) improves safety planning in construction by enabling visualization and simulation to identify and reduce risks. However, its adoption in Nigeria is limited. This study examines the application of BIM in enhancing safety and environmental performance on construction sites in Nigeria. Methodology: A quantitative cross-sectional survey was conducted using a structured online questionnaire distributed to professionals in Nigeria’s construction industry. A purposive sampling method was employed to target respondents with relevant BIM experience. Data were analysed using SPSS version 28, applying descriptive statistics, chi-square tests, and logistic regression at a 5% significance level. Result: Findings show that BIM was fully adopted by 7.0% of organizations, with only 19.8% of respondents using it to identify safety hazards during planning. While 76.8% reported no notable safety benefit, 19.5% identified improved risk management as the key benefit. Most respondents (80.2%) reported no noticeable environmental benefits. Among those who did, improved energy efficiency was the most cited benefit (16.4%). Respondents with 10 or more years of experience were significantly more likely to report enhanced safety and environmental outcomes (AOR = 4.555; p = 0.003) and adequate BIM utilization (AOR = 3.255; p = 0.023). Those with intermediate BIM experience were also more likely to report high enhancement (AOR = 2.857; p = 0.039) and effective tool use (AOR = 2.881; p = 0.050). Conclusion: This study revealed that BIM has the potential to improve construction outcomes in Nigeria if supported by training, experience, and structured implementation.
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Article
Open Access November 06, 2025

Ventral Attention Network Resting State Functional Connectivity: Psychosocial Correlates among US Adolescents

Abstract Background: Resting-state functional MRI (rsfMRI) provides insights into large-scale brain network organization associated with cognitive control, emotion regulation, and attentional processes. The ventral attention network (VAN) is a key salience-driven network that supports attentional re-orienting to behaviorally relevant stimuli. However, little is known about how VAN [...] Read more.
Background: Resting-state functional MRI (rsfMRI) provides insights into large-scale brain network organization associated with cognitive control, emotion regulation, and attentional processes. The ventral attention network (VAN) is a key salience-driven network that supports attentional re-orienting to behaviorally relevant stimuli. However, little is known about how VAN resting state functional connectivity varies by demographic, socioeconomic, psychosocial, and behavioral factors during early adolescence. Objective: To examine associations between VAN rsfMRI connectivity and multiple demographic, socioeconomic, psychosocial, and behavioral characteristics. Methods: Data came from the baseline and early follow-up waves of the Adolescent Brain Cognitive Development (ABCD) Study. The analytic sample included youth with high-quality baseline rsfMRI data and complete socioeconomic and psychosocial measures. The primary outcome was mean resting-state functional connectivity within the VAN across subcortical and cortical regions of interest (ROIs). Bivariate correlations were computed between VAN connectivity and demographic (age, sex, puberty, race/ethnicity), socioeconomic (income, parental education, marital status, neighborhood income), psychosocial (trauma, discrimination, financial difficulty), trait (impulsivity), and behavioral variables (body mass index, depression, suicide, prodromal symptoms, and substance use). Unadjusted bivariate correlations and adjusted logistic regressions were used for data analysis. Results: VAN connectivity showed small but significant correlations with multiple contextual factors. Higher household income, parental education, and neighborhood affluence were associated with greater connectivity, whereas Black race and Hispanic ethnicity were related to lower connectivity. Youth reporting higher discrimination and financial difficulty exhibited weaker VAN connectivity. Greater VAN connectivity was negatively associated with impulsive reward-driven trait (drive), prodromal symptoms, BMI, and marijuana and alcohol use. Associations between VAN connectivity and suicide, depression, marijuana use, and alcohol use remained significant in age and sex adjusted models. Conclusions: VAN connectivity reflects subtle neural correlates of socioeconomic and psychosocial context in early adolescence. Our results underscore the importance of integrating structural and contextual factors in interpreting brain-behavior associations across diverse populations. These findings are suggestive of stable socioeconomic and psychosocial correlates of network efficiency.
Article
Open Access October 29, 2025

Mean Diffusivity of the Left Caudal Anterior Cingulate Cortex and Past Major Depressive Disorder in Adolescents: Evidence from the ABCD Study

Abstract Background: Adolescence is a critical developmental stage for the emergence of major depressive disorder (MDD). Structural and diffusion neuroimaging studies have highlighted the anterior cingulate cortex (ACC) as a key region implicated in emotion regulation, stress reactivity, and mood processing. However, few studies have examined whether microstructural characteristics of the ACC, [...] Read more.
Background: Adolescence is a critical developmental stage for the emergence of major depressive disorder (MDD). Structural and diffusion neuroimaging studies have highlighted the anterior cingulate cortex (ACC) as a key region implicated in emotion regulation, stress reactivity, and mood processing. However, few studies have examined whether microstructural characteristics of the ACC, reflected by mean diffusivity (MD) within gray matter–white matter (GM–WM) contrast regions, are associated with depression in early adolescence. Objective: To examine whether mean diffusivity (MD) within the GM–WM contrast of the left caudal anterior cingulate cortex (ACC) is associated with a past diagnosis of MDD among adolescents in the Adolescent Brain Cognitive Development (ABCD) Study, after accounting for demographic, socioeconomic, and adversity-related factors. Methods: Data were drawn from adolescents with diffusion MRI–derived mean diffusivity measures and diagnostics. The independent variable was mean diffusivity (MD) of the GM–WM contrast in the left caudal ACC. The primary outcome was past MDD diagnosis based on structured psychiatric assessments. Covariates included age, sex, socioeconomic status (SES), and exposure to adverse childhood experiences (ACEs). Logistic regression models tested the association between ACC MD and past MDD. A secondary model evaluated the relationship between ACC MD and past suicide attempt. Results: Mean diffusivity of the left caudal ACC was associated with the odds of past MDD, independent of age, sex, SES, and adversity exposure. In contrast, ACC mean diffusivity was not associated with a history of suicide attempt. Conclusions: Increased mean diffusivity in the caudal ACC may indicate microstructural alterations associated with depressive vulnerability in adolescence. ACC tissue integrity may serve as a sensitive neural correlate of early-onset depression.
Article
Open Access October 27, 2025

Electronic Cigarette Perception in Baltimore High Schools

Abstract Background: Electronic cigarette (e-cigarette) use among adolescents is a growing public health concern, particularly in low-income and Black communities. However, little is known about how social determinants of health shape e-cigarette perceptions in this population. Aims: This study examined social determinants associated with perceptions of e-cigarette safety among Baltimore high [...] Read more.
Background: Electronic cigarette (e-cigarette) use among adolescents is a growing public health concern, particularly in low-income and Black communities. However, little is known about how social determinants of health shape e-cigarette perceptions in this population. Aims: This study examined social determinants associated with perceptions of e-cigarette safety among Baltimore high school students. Methods: A cross-sectional survey (CEASE Youth: School Survey) was conducted with 604 Baltimore high school students aged 14–20. Participants completed a questionnaire assessing perceptions of e-cigarette safety, as well as parental education, race/ethnicity, parental employment, household composition, and community tobacco use. Results: Higher parental education was associated with lower perceived e-cigarette safety among students. Students in higher grades also reported lower perceived e-cigarette safety. In contrast, male students—particularly those in upper grades—were more likely to perceive e-cigarettes as safe. Race/ethnicity, household composition, parental employment, and community tobacco exposure were not associated with perceived e-cigarette safety. Conclusion: Higher parental education, female gender, and being in higher grades were associated with perceiving e-cigarettes as unsafe. These findings highlight the need for targeted interventions to address vaping perceptions among youth in urban settings.
Article
Open Access October 21, 2025

Trends in Smoking and Flavored Tobacco Use in California: Black–White Disparities, 2003–2023

Abstract Background: Tobacco control policies nationwide have contributed to a substantial decline in cigarette and tobacco use, with particularly sharp reductions observed in states such as California that have implemented restrictive bans, strong prevention measures, and high excise taxes. While these policies have led to overall decreases in tobacco use, progress has not necessarily been [...] Read more.
Background: Tobacco control policies nationwide have contributed to a substantial decline in cigarette and tobacco use, with particularly sharp reductions observed in states such as California that have implemented restrictive bans, strong prevention measures, and high excise taxes. While these policies have led to overall decreases in tobacco use, progress has not necessarily been distributed equally across racial groups. Understanding long-term trends by race is critical for addressing equity gaps in tobacco prevention and control. Evidence suggests that some racialized groups may experience slower or delayed declines, raising concerns about equity in public health gains. Methods: We analyzed data from the California Health Interview Survey (CHIS) spanning 2003–2023. Trends in current smoking were examined separately for non-Latino Black and non-Latino White adults. We also assessed current use of flavored tobacco products, given California’s statewide ban enacted in 2021. Changes were evaluated in both absolute terms (percentage point declines) and relative terms (percent reduction from baseline). Results: Smoking prevalence declined from 17.2% in 2003 to 5.2% in 2023 among White adults and from 19.9% to 9.0% among Black adults. This represents a 12.0 percentage point (69.8%) decline for Whites compared with a 10.9 percentage point (54.8%) decline for Blacks. For flavored tobacco use, prevalence decreased from 8.0% to 4.7% among White adults but only from 11.9% to 10.8% among Black adults. This corresponds to a 3.3 percentage point (41.3%) decline for Whites compared with a 1.1 percentage point (9.2%) decline for Blacks. Conclusions: Although both Black and White adults in California experienced reductions in smoking over the past two decades, White adults showed larger declines in both absolute and relative terms. Disparities were even more pronounced for flavored tobacco use, where declines were minimal among Black adults despite the statewide ban. These findings suggest that Black populations in California may have been left behind by tobacco control progress, especially regarding flavored products. Given the history of targeted marketing by the tobacco industry, the role of flavors in increasing dependence, and reduced access to cessation resources in Black communities, targeted policies and culturally tailored interventions are needed to ensure equitable reductions in tobacco use. Greater attention to flavored tobacco in Black communities may help narrow these disparities and advance California’s tobacco endgame goals.
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Article
Open Access October 09, 2025

Simulation-Based Learning in Nursing Education: Perspectives of Student Nurses in the Philippines

Abstract Simulation-based learning (SBL) is widely recognized as an effective educational approach that bridges theory and practice in nursing education. Despite its global adoption, limited research has examined the experiences of Filipino nursing students with SBL, particularly in resource-constrained settings. This study explored the perspectives of Bachelor of Science in Nursing students from a [...] Read more.
Simulation-based learning (SBL) is widely recognized as an effective educational approach that bridges theory and practice in nursing education. Despite its global adoption, limited research has examined the experiences of Filipino nursing students with SBL, particularly in resource-constrained settings. This study explored the perspectives of Bachelor of Science in Nursing students from a university in Metro Manila, Philippines, on the impact of SBL on their skills, emotional responses, and challenges encountered. A descriptive qualitative design was employed using purposive sampling of ten students who had participated in at least one SBL activity. Data were collected through semi-structured interviews and short written reflections and analyzed thematically following Braun and Clarke’s framework to capture nuanced experiences. Three major themes emerged from the analysis. First, students reported initial anxiety, nervousness, and stress during their early SBL experiences, which gradually transformed into confidence, adaptability, and resilience as they gained familiarity and competence. Second, SBL enhanced technical and cognitive skills such as clinical judgment, decision-making, teamwork, and patient-centered care, supporting students’ readiness for real-world practice. Third, students identified resource limitations, insufficient equipment, and time constraints as significant barriers to optimal learning, though these challenges also fostered creativity and perseverance. The findings demonstrate that SBL fosters technical competence, critical thinking, and professional growth but requires institutional support to address resource constraints and faculty development needs. This study underscores the importance of expanding SBL in Philippine nursing curricula to align with international best practices and to contribute to Sustainable Development Goals 3 (good health and well-being), 4 (quality education), and 5 (gender equality).
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Article
Open Access October 04, 2025

Unequal Burden of Loss of a Loved One in Non-Hispanic Black and White Californians

Abstract Purpose: Although the effect of loss of a loved one on depression is well established, very limited knowledge exists on racial differences in this effect. Aim: In the current study we compared Non-Hispanic White (NHW) and Non-Hispanic Black (NHB) Californians for the effects of loss of a loved one on depression in a representative sample of adults in California. Methods: This cross-sectional study used data from the Survey of California Adults on Serious Illness and End-of-Life 2019. Overall, 1603 people entered our study. We compared 901 (56.2%) NHB and 702 (43.8%) NHW adults (age 18 and older). Race/ethnicity, demographics (age and gender), socio-economic factors (education, income, employment, and marital status), religiosity, and health (self-rated health and number of chronic medical conditions), and depression were measured. To perform data analysis, we used logistic regression models. Results: In the pooled sample, loss of a loved one was not associated with self-reported depression, net of all covariates. Race, however, interacted with loss of a loved one on depression, suggesting a larger association for NHBs compared to NHWs. In race-specific models, loss of a loved one predicted depression for NHBs (OR = 1.54) but not NHWs (OR [...] Read more.
Purpose: Although the effect of loss of a loved one on depression is well established, very limited knowledge exists on racial differences in this effect. Aim: In the current study we compared Non-Hispanic White (NHW) and Non-Hispanic Black (NHB) Californians for the effects of loss of a loved one on depression in a representative sample of adults in California. Methods: This cross-sectional study used data from the Survey of California Adults on Serious Illness and End-of-Life 2019. Overall, 1603 people entered our study. We compared 901 (56.2%) NHB and 702 (43.8%) NHW adults (age 18 and older). Race/ethnicity, demographics (age and gender), socio-economic factors (education, income, employment, and marital status), religiosity, and health (self-rated health and number of chronic medical conditions), and depression were measured. To perform data analysis, we used logistic regression models. Results: In the pooled sample, loss of a loved one was not associated with self-reported depression, net of all covariates. Race, however, interacted with loss of a loved one on depression, suggesting a larger association for NHBs compared to NHWs. In race-specific models, loss of a loved one predicted depression for NHBs (OR = 1.54) but not NHWs (OR = 0.99). Conclusion: There are differences between NHBs and NHWs in the effect of loss of a loved one on depression. NHBs show a stronger association between loss of a loved one and depression than NHWs. This result is not in line with the NHB mental health paradox or with NHB resilience but is consistent with the notion that social relations may be more salient for NHBs than for NHWs.
Article
Open Access September 28, 2025

Mitochondrial Dysfunction and Oxidative Stress in Early-Onset Neurodegenerative Diseases: A Bibliometric and Data-Driven Analysis

Abstract Early-onset neurodegenerative diseases (EO-NDs), such as early-onset Alzheimer’s disease (EOAD), Parkinson’s disease (EOPD), and familial amyotrophic lateral sclerosis (fALS), often stem from monogenic causes and manifest before typical age thresholds. These disorders frequently feature disrupted mitochondrial function and heightened oxidative stress, which together accelerate neuronal damage and [...] Read more.
Early-onset neurodegenerative diseases (EO-NDs), such as early-onset Alzheimer’s disease (EOAD), Parkinson’s disease (EOPD), and familial amyotrophic lateral sclerosis (fALS), often stem from monogenic causes and manifest before typical age thresholds. These disorders frequently feature disrupted mitochondrial function and heightened oxidative stress, which together accelerate neuronal damage and degeneration. In this work, the author performs a comprehensive analysis of the literature and data related to mitochondrial dysfunction and redox imbalance in EO-NDs. Bibliometric trends were assessed using R-based tools on PubMed datasets, highlighting keyword networks and publication surges in recent years. Publicly available RNA-seq datasets from GEO and SRA were examined, with example DESeq2 analysis illustrating altered mitochondrial gene expression in EO-ND patient-derived samples. Network modeling of redox pathways using Python’s networkx demonstrates how oxidative stress can propagate through metabolic networks. Together, these computational approaches reinforce that mitochondrial DNA mutations, impaired electron transport chain (ETC) function, and reactive oxygen species (ROS) accumulation play central roles in EO-ND pathogenesis. The discussion further evaluates why antioxidant clinical trials have largely failed and how emerging therapies such as gene replacement, antisense oligonucleotides, and mitochondrial biogenesis modulators may provide more effective interventions.
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Brief Report
Open Access September 28, 2025

Gut-Brain Axis in Autism Spectrum Disorder: A Bibliometric and Microbial-Metabolite-Neural Pathway Analysis

Abstract The gut-brain axis (GBA) has emerged as a central focus in the study of neurodevelopmental disorders, particularly autism spectrum disorder (ASD). Research suggests that microbial composition and its metabolic byproducts influence neural development, synaptic plasticity, and behavior [1,2,3]. A structured bibliometric analysis of Scopus and Web of Science records was performed using Bibliometrix [...] Read more.
The gut-brain axis (GBA) has emerged as a central focus in the study of neurodevelopmental disorders, particularly autism spectrum disorder (ASD). Research suggests that microbial composition and its metabolic byproducts influence neural development, synaptic plasticity, and behavior [1,2,3]. A structured bibliometric analysis of Scopus and Web of Science records was performed using Bibliometrix and VOSviewer to trace trends and thematic evolution of GBA–ASD literature [7,8]. In parallel, a data-driven pathway modeling approach maps microbial metabolites (e.g., short-chain fatty acids, tryptophan catabolites) to host signaling pathways including vagal stimulation, immune cytokine modulation, and blood–brain barrier (BBB) permeability [4,5]. Simulations implemented in Python’s NetworkX illustrate how perturbations in metabolite flux may influence CNS outcomes. The findings reveal growing emphasis on butyrate, serotonin, microglial priming, and maternal immune activation in ASD-related GBA studies, and highlight the need for rigorous empirical validation of computational predictions [9,10,11].
Brief Report
Open Access September 24, 2025

A Convergence of the Muller’s Sequence

Abstract In this paper, we will examine a rather complex case of the paradoxical nature of certain conclusions that may arise when studying the numerical convergence of a specific nonlinear recursive sequence, known in the literature as Muller’s sequence. To analyze the peculiar computational behavior of this sequence, it is necessary to employ a powerful mathematical framework in order to understand the [...] Read more.
In this paper, we will examine a rather complex case of the paradoxical nature of certain conclusions that may arise when studying the numerical convergence of a specific nonlinear recursive sequence, known in the literature as Muller’s sequence. To analyze the peculiar computational behavior of this sequence, it is necessary to employ a powerful mathematical framework in order to understand the nontrivial issues that can arise when the software implementation of this seemingly simple mathematical problem. These challenges often stem from the limitations of numerical methods and the inherent errors in computer arithmetic, which can affect the accuracy and stability of the results, particularly when dealing with iterative methods like Muller's sequence.
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Article
Open Access September 19, 2025

Effectiveness of Subglottal Suctioning Could Prevent the Develop of VAP in the Patient on Mechanic Ventilator

Abstract VAP, or Ventilator Associated Pneumonia, is a type of pneumonia that arises in patients receiving mechanical ventilation. This condition is a serious complication and can lead to the patient's decline while on a mechanical ventilator, posing a significant risk for secondary complications if not addressed promptly. In particular, VAP is a prevalent issue in intensive care units, where the [...] Read more.
VAP, or Ventilator Associated Pneumonia, is a type of pneumonia that arises in patients receiving mechanical ventilation. This condition is a serious complication and can lead to the patient's decline while on a mechanical ventilator, posing a significant risk for secondary complications if not addressed promptly. In particular, VAP is a prevalent issue in intensive care units, where the healthcare team works to prevent further deterioration of the patient. VAP is associated with a notably high mortality rate, particularly in individuals with weakened immune systems, as well as in younger and older populations. Extended intubation and prolonged sedation can contribute to the onset of VAP. The previous study had found that incidence of VAP accounts for 9 % to 27 % endotracheal intubated patients, whereas VAP has a mortality rate ranging from 25 % to 50 % [1-3]. VAP increased ICU and hospital length of stay, antibiotic consumption, and healthcare cost (Zhi Mao et al, 2016) [4]. While using the subglottic suctioning could prevent and help the intubated patient to decreased the development of VAP. The study shown by Smith et al (2021) [5] SSD is a technique employed to reduce micro aspiration of oropharyngeal secretions in patients with cuffed endotracheal airways. Aspiration of oropharyngeal secretions is the accepted cause of the majority of ventilator-associated pneumonia (VAP), a complication of invasive ventilation with high associated mortality. Another study by Rahul Gujadhur et al (2005) [6], subglottic suction has also been shown to delay the onset of VAP but no benefits in terms of ventilation time, hospital stay or mortality benefit have ever been shown. This investigation into subglottic suctioning may assist the healthcare team, particularly in the intensive care unit, in preventing the development of VAP and shortening the duration of ventilation for patients. The advantages of subglottic suctioning are often debated, particularly regarding its impact on the duration of intubation. However, recent research indicates that implementing subglottic suctioning within a time frame of fewer than three days could help reduce intubation duration and lead to improved patient recovery.
Abstract
Open Access September 18, 2025

Does Stress Explain the Effects of Sexual/Gender Minority Status on Children’s Behavioral and Emotional Risk?

Abstract Background: Sexual and gender minority (SGM) youth are at elevated risk for adverse mental health and substance use outcomes. Stressors such as family conflict, discrimination, and trauma have been suggested as possible mediators of these disparities. Aims: This study examined whether family conflict, discrimination, and trauma mediate the associations between SGM identity and [...] Read more.
Background: Sexual and gender minority (SGM) youth are at elevated risk for adverse mental health and substance use outcomes. Stressors such as family conflict, discrimination, and trauma have been suggested as possible mediators of these disparities. Aims: This study examined whether family conflict, discrimination, and trauma mediate the associations between SGM identity and adverse outcomes, including suicide attempt, major depressive disorder (MDD), nicotine use, and marijuana use. Methods: Participants were children from the Adolescent Brain Cognitive Development (ABCD) study. SGM identity was reported at baseline, while outcomes included past MDD and suicide attempts as well as future nicotine and marijuana use. Structural equation modeling (SEM) was used to test both direct and indirect pathways linking SGM identity to mental health and behavioral outcomes. Results: No significant mediation was found through family conflict, discrimination, or trauma. Instead, effects of SGM identity were primarily direct: SGM youth had higher odds of past suicide attempts and MDD, as well as future marijuana use, but not future nicotine use. Stressor variables, however, were independently associated with outcomes. Discrimination predicted all outcomes; trauma was positively associated with suicide, nicotine, and marijuana use but not MDD; and family conflict predicted all outcomes except MDD. Conclusion: Family conflict, discrimination, and trauma did not mediate SGM disparities in mental health and substance use, but each emerged as an independent predictor of risk. These findings highlight the complexity of mechanisms underlying SGM-related disparities and suggest the need for future research to explore additional pathways and contextual influences.
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Open Access September 14, 2025

Lifecycle Management as a Roadmap to the Tobacco Endgame

Abstract Background: Tobacco endgame, defined as elimination of commercial tobacco sales The U.S. tobacco control landscape is a complex, adaptive system shaped by diverse stakeholders, evolving products and regulations, shifting social norms, and the strategic countermeasures of a powerful industry. Managing such complexity requires more than isolated interventions—it demands a coordinated, [...] Read more.
Background: Tobacco endgame, defined as elimination of commercial tobacco sales The U.S. tobacco control landscape is a complex, adaptive system shaped by diverse stakeholders, evolving products and regulations, shifting social norms, and the strategic countermeasures of a powerful industry. Managing such complexity requires more than isolated interventions—it demands a coordinated, enterprise-wide approach that accounts for dynamic interactions, feedback loops, and emergent risks. Objective: Drawing on complex systems thinking, Zachman enterprise architecture model, and public health best practices, we conceptualize tobacco control as an evolving enterprise progressing through six interconnected phases: (1) Conception & Initiation, (2) Policy & System Design, (3) Implementation & Operation, (4) Evaluation & Adaptation, (5) Consolidation & Endgame Transition, and (6) Sustainment or Sunset. Each phase incorporates governance structures, performance benchmarks, and transition criteria designed to manage interdependence and reduce systemic vulnerabilities. Results: The lifecycle framing emphasizes how tobacco control in the U.S. can evolve as a complex, adaptive enterprise—integrating public health objectives with legal, operational, and cultural change processes. This model supports strategic sequencing, cross-sector alignment, and risk mitigation against emergent industry tactics, enabling a resilient and measurable pathway to the endgame. Conclusions: Seeing tobacco control as a complex enterprise that operates under a lifecycle model may offer a roadmap for achieving and sustaining the tobacco endgame. Using this approach may enhance policy coherence, resource efficiency, and adaptability, ensuring tobacco endgame is achieved.
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Open Access September 04, 2025

Evidence-Based Protocols for the Prevention and Treatment of Prosthetic Joint Infection in Total Hip Arthroplasty: A Systematic Review

Abstract Objective: This systematic review aimed to identify, synthesize, and critically analyze the available evidence on clinical protocols used for the prevention and treatment of prosthetic joint infection (PJI) in total hip arthroplasty (THA), based on studies published between 2000 and 2025. Methods: The review was conducted according to PRISMA guidelines. Electronic searches were performed in PubMed (MEDLINE), Scopus, Web of Science, and Embase between January and April 2025. Eligible studies included clinical trials, cohort studies, case-control studies, systematic reviews, and meta-analyses published in English that addressed either preventive or therapeutic strategies for PJI in THA. Study selection, data extraction, and quality assessment were carried out independently by two reviewers. Due to the heterogeneity of the included studies, a qualitative synthesis was performed. Results: A total of 32 studies were included. Preventive measures identified in the literature comprised combined antibiotic prophylaxis (cefazolin and gentamicin), multimodal perioperative protocols such as ACERTO, nasal decolonization for Staphylococcus aureus [...] Read more.
Objective: This systematic review aimed to identify, synthesize, and critically analyze the available evidence on clinical protocols used for the prevention and treatment of prosthetic joint infection (PJI) in total hip arthroplasty (THA), based on studies published between 2000 and 2025. Methods: The review was conducted according to PRISMA guidelines. Electronic searches were performed in PubMed (MEDLINE), Scopus, Web of Science, and Embase between January and April 2025. Eligible studies included clinical trials, cohort studies, case-control studies, systematic reviews, and meta-analyses published in English that addressed either preventive or therapeutic strategies for PJI in THA. Study selection, data extraction, and quality assessment were carried out independently by two reviewers. Due to the heterogeneity of the included studies, a qualitative synthesis was performed. Results: A total of 32 studies were included. Preventive measures identified in the literature comprised combined antibiotic prophylaxis (cefazolin and gentamicin), multimodal perioperative protocols such as ACERTO, nasal decolonization for Staphylococcus aureus, silver-impregnated dressings, and structured post-discharge surveillance. Treatment strategies included DAIR (Debridement, Antibiotics, and Implant Retention), the DAPRI technique, one-stage and two-stage revision surgeries, muscle flap reconstructions, and protocols without spacers. These interventions were associated with significantly reduced infection rates and improved clinical outcomes when applied appropriately and in accordance with patient-specific factors. Conclusion: Effective prevention and treatment of PJI in total hip arthroplasty require a systematic and evidence-based approach. Integrated protocols—spanning preoperative optimization, meticulous intraoperative techniques, and rigorous postoperative monitoring—have proven effective in reducing infection incidence. In cases of established infection, surgical management must be tailored to the timing of infection, microbial profile, and host conditions. Two-stage revision remains the gold standard for complex infections, while one-stage revision and emerging techniques like DAPRI offer promising results in selected cases. This review contributes to the standardization of clinical practice and supports improved patient outcomes.
Systematic Review
Open Access July 24, 2025

Atypical Presentation of Lemierre’s Syndrome Masquerading as Gastroenteritis Lemierre’s Syndrome Mimicking Gastroenteritis

Abstract Lemierre’s syndrome (LS) is a rare clinical condition characterized by septic thrombophlebitis of the internal or external jugular vein, usually following an oropharyngeal infection. Here, we present a 20-year-old male patient who developed diarrhea, nausea, and vomiting after receiving clarithromycin for an upper respiratory tract infection. On admission, he had fever, hypotension, and elevation in acute phase reactants (WBC: 20,410/µL, CRP: 197 mg/L). Empirical treatment with ceftriaxone and metronidazole was initiated. Stool and throat cultures were negative. On the second day, abdominal tenderness developed; direct abdominal radiograph showed dilated bowel loops, but toxic megacolon was excluded during follow-up. Thoracic CT revealed septic emboli in the lungs. Due to persistent fever despite ceftriaxone and metronidazole therapy, treatment was escalated to meropenem on the fifth day. On the same day, blood cultures grew Fusobacterium necrophorum, raising suspicion of LS. Doppler ultrasound detected a thrombus in the left external jugular vein. Anticoagulant therapy with low-molecular-weight heparin and clopidogrel was initiated. The fever resolved by the seventh day of full antibiotherapy After three weeks of intravenous therapy, follow-up imaging showed regression of the thrombus. The patient completed a four-week course of antibiotics and anticoagulants and was discharged with full recovery. This case highlights the diagnostic challenge of LS presenting with gastrointestinal symptoms and emphasizes the importance of early blood cultures and imaging. External jugular vein involvement due to F. necrophorum [...] Read more.
Lemierre’s syndrome (LS) is a rare clinical condition characterized by septic thrombophlebitis of the internal or external jugular vein, usually following an oropharyngeal infection. Here, we present a 20-year-old male patient who developed diarrhea, nausea, and vomiting after receiving clarithromycin for an upper respiratory tract infection. On admission, he had fever, hypotension, and elevation in acute phase reactants (WBC: 20,410/µL, CRP: 197 mg/L). Empirical treatment with ceftriaxone and metronidazole was initiated. Stool and throat cultures were negative. On the second day, abdominal tenderness developed; direct abdominal radiograph showed dilated bowel loops, but toxic megacolon was excluded during follow-up. Thoracic CT revealed septic emboli in the lungs. Due to persistent fever despite ceftriaxone and metronidazole therapy, treatment was escalated to meropenem on the fifth day. On the same day, blood cultures grew Fusobacterium necrophorum, raising suspicion of LS. Doppler ultrasound detected a thrombus in the left external jugular vein. Anticoagulant therapy with low-molecular-weight heparin and clopidogrel was initiated. The fever resolved by the seventh day of full antibiotherapy After three weeks of intravenous therapy, follow-up imaging showed regression of the thrombus. The patient completed a four-week course of antibiotics and anticoagulants and was discharged with full recovery. This case highlights the diagnostic challenge of LS presenting with gastrointestinal symptoms and emphasizes the importance of early blood cultures and imaging. External jugular vein involvement due to F. necrophorum is rare and should be considered in patients presenting with septic emboli.
Case Report
Open Access July 12, 2025

Nodal Marginal Zone Lymphoma with IgG and IgM Secretion of Kappa Light Chain: Case Report

Abstract Nodal marginal zone lymphomas are indolent and rare non-Hodgkin lymphomas, most often diagnosed at an advanced stage. Their clinical presentations are typically insidious, which can lead to delayed diagnosis. The concomitant secretion of IgM and IgG immunoglobulins with kappa light chains constitutes an exceptional feature in this type of lymphoma, as illustrated by our case. We report the case of [...] Read more.
Nodal marginal zone lymphomas are indolent and rare non-Hodgkin lymphomas, most often diagnosed at an advanced stage. Their clinical presentations are typically insidious, which can lead to delayed diagnosis. The concomitant secretion of IgM and IgG immunoglobulins with kappa light chains constitutes an exceptional feature in this type of lymphoma, as illustrated by our case. We report the case of a 62-year-old man with a history of treated syphilis and inferior vena cava thrombosis managed with rivaroxaban, who presented with a left inguinal mass evolving over three months, accompanied by fever, night sweats, and weight loss. Clinical examination revealed non-inflammatory left inguinal lymphadenopathy without other abnormalities. Laboratory tests showed non-regenerative anemia, leukopenia, and elevated LDH levels. Protein electrophoresis revealed a monoclonal peak in the gamma region, confirmed by serum immunofixation showing two monoclonal bands of IgG kappa and IgM kappa types. Biopsy of the inguinal lymph node revealed histological and immunohistochemical features consistent with a small B-cell marginal zone lymphoma, staged as IV based on the extension workup. A chemotherapy regimen consisting of rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) was initiated, resulting in a partial response after four cycles. The coexpression of IgM and IgG kappa light chains in nodal marginal zone lymphomas, which are already rare, is an unusual finding. This particularity warrants multicenter studies to better assess its diagnostic, prognostic, and therapeutic implications.
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Case Report
Open Access June 28, 2025

Development of a Hemodialysis Data Collection and Clinical Information System and Establishment of an Intradialytic Blood Pressure/Pulse Rate Predictive Model

Abstract This research is a collaboration involving a university team, a partnering corporation, and a hemodialysis clinic, which is a cross-disciplinary research initiative in the field of Artificial Intelligence of Things (AIoT) within the medical informatics domain. The research has two objectives: (1) The development of an Internet of Things (IoT)-based Information System customized for the hemodialysis machines at the clinic, including transmission bridges, clinical personnel dedicated web/app, and a backend server. The system has been deployed at the clinic and is now officially operational; (2) The research also utilized de-identified, anonymous data (collected by the officially operational system) to train, evaluate, and compare Deep Learning-based Intradialytic Blood Pressure (BP)/Pulse Rate (PR) Predictive Models [...] Read more.
This research is a collaboration involving a university team, a partnering corporation, and a hemodialysis clinic, which is a cross-disciplinary research initiative in the field of Artificial Intelligence of Things (AIoT) within the medical informatics domain. The research has two objectives: (1) The development of an Internet of Things (IoT)-based Information System customized for the hemodialysis machines at the clinic, including transmission bridges, clinical personnel dedicated web/app, and a backend server. The system has been deployed at the clinic and is now officially operational; (2) The research also utilized de-identified, anonymous data (collected by the officially operational system) to train, evaluate, and compare Deep Learning-based Intradialytic Blood Pressure (BP)/Pulse Rate (PR) Predictive Models, with subsequent suggestions provided. Both objectives were executed under the supervision of the Institutional Review Board (IRB) at Mackay Memorial Hospital in Taiwan. The system completed for objective one has introduced three significant services to the clinic, including automated hemodialysis data collection, digitized data storage, and an information-rich human-machine interface as well as graphical data displays, which replaces traditional paper-based clinical administrative operations, thereby enhancing healthcare efficiency. The graphical data presented through web and app interfaces aids in real-time, intuitive comprehension of the patients’ conditions during hemodialysis. Moreover, the data stored in the backend database is available for physicians to conduct relevant analyses, unearth insights into medical practices, and provide precise medical care for individual patients. The training and evaluation of the predictive models for objective two, along with related comparisons, analyses, and recommendations, suggest that in situations with limited computational resources and data, an Artificial Neural Network (ANN) model with six hidden layers, SELU activation function, and a focus on artery-related features can be employed for hourly intradialytic BP/PR prediction tasks. It is believed that this contributes to the collaborating clinic and relevant research communities.
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Open Access June 26, 2025

The Intersection of Climate Change Adaptation and Smallholder Farmer Food Security: A Review of Strategies and Barriers

Abstract Smallholder farmers play a pivotal role in global food security; however, they remain exceptionally vulnerable to the impacts of climate change due to their reliance on natural resources and limited adaptive capacities. This narrative review synthesizes a wide range of global sources to explore the intersection of smallholder agriculture and climate adaptation strategies. The review examines [...] Read more.
Smallholder farmers play a pivotal role in global food security; however, they remain exceptionally vulnerable to the impacts of climate change due to their reliance on natural resources and limited adaptive capacities. This narrative review synthesizes a wide range of global sources to explore the intersection of smallholder agriculture and climate adaptation strategies. The review examines adaptation practices, agroecological methods, and the adoption of climate-resilient crop varieties. It reveals that the implementation of these strategies is frequently hindered by systemic barriers such as financial constraints, limited technological access, and institutional inefficiencies. Recognizing that previous studies have addressed isolated aspects of adaptation or relied on secondary data, this review highlights research gaps and offers a comprehensive synthesis of relevant literature. This review uses a narrative synthesis model suitable for integrating evidence from agronomy, economics, and social science to capture the complex challenges faced by smallholder farmers. The review emphasizes the importance of policy frameworks and participatory approaches that empower smallholder communities. This review synthesizes current evidence to inform potential directions for targeted interventions and future field-based studies, while recognizing the limitations of relying on secondary data. These recommendations aim to facilitate integrated policy reforms and drive research initiatives, ultimately strengthening the resilience and adaptability of smallholder agriculture in the face of ongoing climate change.
Review Article
Open Access June 25, 2025

Deconstructing Soccer Footwear: An Anatomical Review with Implications for Female Athlete-Specific Design

Abstract This review article provides a comprehensive anatomical analysis of soccer footwear, delving into the intricate structure and functional roles of its constituent components, including the upper, heel counter, tongue, toe box, outsole/sole plate, studs, and insole. Manufacturing processes influencing these structural elements are also discussed. Current market offerings and patented innovations in [...] Read more.
This review article provides a comprehensive anatomical analysis of soccer footwear, delving into the intricate structure and functional roles of its constituent components, including the upper, heel counter, tongue, toe box, outsole/sole plate, studs, and insole. Manufacturing processes influencing these structural elements are also discussed. Current market offerings and patented innovations in soccer cleat technology are examined through a biomechanical lens, highlighting their intended functions and limitations. A critical synthesis of existing knowledge underscores the anatomical and biomechanical distinctions between male and female athletes' feet, arguing for the necessity of sex-specific footwear design. This review culminates in emphasizing the imperative for specifically engineered soccer footwear for female athletes to optimize performance, enhance comfort, and mitigate the elevated risk of lower extremity injuries prevalent in the female game, thereby identifying crucial directions for future research in sports biomechanics and footwear engineering.
Commentary
Open Access June 18, 2025

The socio-economic influencers of school dropout amidst the implementation of the Free Senior High School policy in Ghana: A case study approach

Abstract The Free Senior High School (FSHS) policy implementation in Ghana has garnered significant attention in academic research, with various studies delving into its advantages and implementation obstacles. Nevertheless, there has been a rise in school dropout rates among secondary school students amidst the programme implementation. There is therefore the need for a more localized scientific inquiry [...] Read more.
The Free Senior High School (FSHS) policy implementation in Ghana has garnered significant attention in academic research, with various studies delving into its advantages and implementation obstacles. Nevertheless, there has been a rise in school dropout rates among secondary school students amidst the programme implementation. There is therefore the need for a more localized scientific inquiry into the socio-economic factors contributing to school dropout among Senior High School (SHS) students in the Abofour community. The study employed a qualitative approach, using the case study design to conduct interviews with 22 students who had dropped out of SHS, to explore their experiences and identify key socio-economic factors influencing their decisions to leave school. Thematic data analysis revealed six main themes, namely, lack of parental support, peer influence, early marriage and pregnancy, economic conditions, and unsupportive school environment, as among the causative factors. The findings suggest that while the Free SHS policy has removed some direct financial barriers, other social, economic, and institutional factors continue to spur up dropout rates. The study concludes that addressing these underlying issues requires a multi-faceted approach that includes strengthening family support systems, improving school environments, and providing targeted interventions for at-risk students. In this regard, policymakers and other educational stakeholders are required to provide targeted supports to enhance student retention and reduce dropout rates in the Abofour community.
Article
Open Access June 11, 2025

Biomechanical and Functional Performance of Hip Prosthesis Materials in Total Hip Arthroplasty: A Systematic Review

Abstract This systematic review aimed to evaluate the biomechanical properties, functional performance, and clinical outcomes of different hip prosthesis materials and designs used in total hip arthroplasty (THA). A comprehensive search strategy identified 34 peer-reviewed studies published between 2015 and 2024. The materials investigated included cobalt-chromium-molybdenum (CoCrMo), titanium alloys, [...] Read more.
This systematic review aimed to evaluate the biomechanical properties, functional performance, and clinical outcomes of different hip prosthesis materials and designs used in total hip arthroplasty (THA). A comprehensive search strategy identified 34 peer-reviewed studies published between 2015 and 2024. The materials investigated included cobalt-chromium-molybdenum (CoCrMo), titanium alloys, PEEK, ceramics, and advanced surface coatings such as polycrystalline diamond (PCD). In addition, dual mobility systems, lattice structures, and additively manufactured and patient-specific implants were assessed. The studies utilized clinical trials, finite element analysis, and biomechanical testing to compare outcomes such as wear resistance, stress distribution, osseointegration, and range of motion. The findings demonstrated that titanium alloys and porous lattice structures reduce stress shielding, while ceramics and CoCrMo provide superior wear resistance. Dual mobility implants improved joint stability and range of motion, particularly in high-risk patients. PEEK and PCD showed promising properties but lacked robust long-term data. The integration of advanced manufacturing technologies and material innovations has led to more personalized and biomechanically efficient solutions for THA. Further longitudinal studies are needed to validate these developments. This review provides a critical synthesis of the biomechanical, functional, and clinical implications of contemporary hip prosthetic systems.
Systematic Review
Open Access June 03, 2025

Complexity Leadership Theory Integration into Nursing Leadership and Development in Addressing COVID-19 and Future Pandemics

Abstract Complexity Leadership Theory (CLT) is a new and revolutionary concept in addressing healthcare crises worldwide. Its relevance and applications were tested during the COVID-19 pandemic. However, no definite and encompassing research was done to apply it to nursing leadership. Thus, this study examines CLT integration into nursing leadership to address the challenges posed by the pandemic. Through [...] Read more.
Complexity Leadership Theory (CLT) is a new and revolutionary concept in addressing healthcare crises worldwide. Its relevance and applications were tested during the COVID-19 pandemic. However, no definite and encompassing research was done to apply it to nursing leadership. Thus, this study examines CLT integration into nursing leadership to address the challenges posed by the pandemic. Through a systematic review of literature from PubMed, Scopus, and Web of Science, relevant studies were analyzed to determine how complexity leadership theory was defined, conceptualized, and operationalized within nursing leadership context. The findings reveal that traditional hierarchical leadership models are insufficient in a dynamic crisis environment like the pandemic. Instead, CLT’s framework which encompasses adaptive, administrative, and enabling leadership facilitates innovation, resilience, and effective interprofessional collaboration. Nurse leaders employing these strategies are better positioned to manage resources limitation, foster shared decision-making, and implement technological advancements in rapidly changing healthcare settings. Overall, this study underscores the potential of complexity leadership theory to transform nursing leadership practices by promoting continuous learning and empowerment, thereby enhancing crisis response and preparedness for future pandemics.
Systematic Review
Open Access May 24, 2025

Exploring Smartphone Use and Learning Behaviors among Senior High School Students: Insights from a Developing Region in Indonesia

Abstract Smartphone use among adolescents has surged globally, reshaping communication and learning patterns, especially in developing countries. However, the implications of such digital habits on students in rural or under-resourced areas remain underexplored. This study aims to examine the patterns of smartphone usage and its effects on learning among high school students in Tarutung, a developing [...] Read more.
Smartphone use among adolescents has surged globally, reshaping communication and learning patterns, especially in developing countries. However, the implications of such digital habits on students in rural or under-resourced areas remain underexplored. This study aims to examine the patterns of smartphone usage and its effects on learning among high school students in Tarutung, a developing region of North Sumatra, Indonesia. Utilizing a quantitative descriptive approach, data were collected from 358 students using structured questionnaires. The results show that 96.05% of students own personal smartphones regardless of socioeconomic background, with an average daily usage of 4 hours and 45 minutes. While 91.81% believe smartphones support their learning, 25.99% report declining academic performance. Alarmingly, 20.62% of students admitted involvement in cyberbullying activities, highlighting a critical digital risk impacting the school environment and student well-being. The study concludes that although smartphones offer educational benefits, their misuse can lead to negative academic, social, and psychological outcomes. This study recommends digital literacy curricula and structured cooperation between parents and educators to prevent risks while optimizing educational opportunities in smartphone use.
Article
Open Access May 20, 2025

Periprosthetic Joint Infections in Total Hip Arthroplasty: Diagnostic Advances, Treatment Algorithms, and Technological Innovations — A Comprehensive Review

Abstract Objective: This integrative review aims to critically examine the clinical management of periprosthetic joint infections (PJI) in total hip arthroplasty (THA), emphasizing decision-making strategies, diagnostic advancements, and therapeutic innovations. The study focuses on the complexity of infection control, microbial resistance, and individualized treatment planning. Methods: [...] Read more.
Objective: This integrative review aims to critically examine the clinical management of periprosthetic joint infections (PJI) in total hip arthroplasty (THA), emphasizing decision-making strategies, diagnostic advancements, and therapeutic innovations. The study focuses on the complexity of infection control, microbial resistance, and individualized treatment planning. Methods: A systematic review of the literature was conducted using PubMed, Scopus, Web of Science, and Google Scholar, targeting studies published between 2015 and 2025. Articles were selected based on their contribution to understanding the clinical, microbiological, and surgical aspects of PJI in THA. Fifty-five studies met the inclusion criteria and were analyzed descriptively. Results: PJI in THA is influenced by multifactorial risk profiles, including obesity, diabetes, and immunosuppression. Staphylococcus aureus, particularly MRSA, remains the most frequently isolated pathogen, followed by Gram-negative organisms and fungal species. Diagnostic innovations such as next-generation sequencing have enhanced pathogen detection, while two-stage revision remains the gold standard for chronic infections. Emerging strategies—such as antimicrobial coatings, tailored antibiotic protocols, and multidisciplinary care models—demonstrate promise in improving clinical outcomes. Conclusion: Managing PJI in THA necessitates a comprehensive and individualized approach, integrating early and accurate diagnosis, pathogen-specific treatment, and advanced preventive measures. The integration of emerging technologies and personalized care pathways is critical to optimizing outcomes and reducing the clinical and economic burden of PJI.
Review Article
Open Access May 15, 2025

Teaching Social Studies in an Integrated Manner: The Lived Experience of Out-Of-Field Social Studies Teachers

Abstract This study investigated the pedagogical implications of out-of-field teaching in Social Studies. The Out-of-field Social Studies teachers could encounter several challenges in their preparation and the implementation of the integrated Social Studies curriculum. This study sought the lived experiences of the out-of-field teachers concerning the causes of out-of-field teaching in social studies, [...] Read more.
This study investigated the pedagogical implications of out-of-field teaching in Social Studies. The Out-of-field Social Studies teachers could encounter several challenges in their preparation and the implementation of the integrated Social Studies curriculum. This study sought the lived experiences of the out-of-field teachers concerning the causes of out-of-field teaching in social studies, problems encountered by the out-of-field teachers and the mechanisms they employ to cope with the teaching of Social Studies. The study chose the qualitative phenomenological research design. Data were collected from all the 17 out-of-field Social Studies teachers through in-depth structured interview. Data were transcribed and analysed, through the inductive thematic analysis approach, unveiling of themes and concepts from the narratives of the research participants. The study revealed that out-of-field teaching in Social Studies occurs as a result of teacher shortage in integrated social studies programme. It is also caused by the perception that any teacher could teach Social Studies irrespective of the teachers’ qualification. Out-of-field teacher encounter problems such as inadequate content and pedagogical knowledge, lack of classroom managerial techniques and inability to deliver lessons through the integrated approach. Engaging in professional development courses, peer coaching, in-service training and workshops were some of the mechanisms employed by out-of-field teachers to cope with the teaching of Social Studies. The pedagogical implications of this phenomenon are that when teaching the Social Studies, the out-of-field teachers place more emphasis on aspects of the Social Studies curriculum where they have much knowledge and skip or put less emphasis on other aspects they lack in-depth knowledge, thus, the integrated approach to teaching Social Studies is not adopted effectively by out-of-field teachers. This waters down the content of Social Studies at the Senior High School level. Addressing the problem of out-of-field teaching in Social Studies requires training and recruiting more teachers who have background training and experience in the integrated approach to the teaching of Social Studies.
Review Article
Open Access May 09, 2025

Association Between Maternal Vitamin B12 Intake and Early Childhood Cognitive Development: Implications for Public Health

Abstract Background: Maternal nutrition plays a crucial role in fetal brain development, with vitamin B12 being essential for neuronal myelination and cognitive function. The paper by Hrezova et al. entitled “Vitamin B12 Intake During Pregnancy Linked to Child Speech Development and Intelligence Quotient”, examines the association between maternal B12 intake and early childhood neurodevelopment. [...] Read more.
Background: Maternal nutrition plays a crucial role in fetal brain development, with vitamin B12 being essential for neuronal myelination and cognitive function. The paper by Hrezova et al. entitled “Vitamin B12 Intake During Pregnancy Linked to Child Speech Development and Intelligence Quotient”, examines the association between maternal B12 intake and early childhood neurodevelopment. Methods: Using data from 5,151 mother-child pairs in the ELSPAC-CZ cohort, maternal B12 intake was assessed through dietary questionnaires, and child cognitive outcomes were evaluated at 18 months, 3 years, and 8 years. Multivariate adjustments were applied to control for potential confounders. Results: The research reports that higher maternal B12 intake was positively associated with improved language comprehension at 18 months (B=0.20,95% CI 0.06,0.34) and increased verbal IQ at 8 years (B=1.08,95% CI 0.09,2.08). However, no significant relationship was observed between maternal B12 intake and speech intelligibility at age 3 (OR=1.03,95% CI 0.99,1.07). Findings suggest B12’s role in early cognitive development but highlight gaps in its long-term effects. Conclusions: Ensuring adequate maternal B12 intake is vital for optimizing early neurodevelopment. Public health initiatives should promote B12 supplementation, especially for pregnant women at risk of deficiency. Further research with objective biomarkers is needed to clarify long-term effects.
Letter to Editor
Open Access May 05, 2025

Persistent Social Welfare Needs Among Educated Caribbean Black Individuals: Evidence of Minorities' Diminished Returns

Abstract Background: Educational attainment is strongly linked to increased employment opportunities, higher income, and greater financial security, making its inverse relationship with reliance on social welfare programs well-documented. However, consistent with the Minorities' Diminished Returns (MDRs) theory, the protective effects of education may be weaker for racial and ethnic minority [...] Read more.
Background: Educational attainment is strongly linked to increased employment opportunities, higher income, and greater financial security, making its inverse relationship with reliance on social welfare programs well-documented. However, consistent with the Minorities' Diminished Returns (MDRs) theory, the protective effects of education may be weaker for racial and ethnic minority groups compared to non-Latino Whites. This study examines whether the impact of educational attainment (measured as years of schooling) on social welfare use differs between Caribbean Black and White adults in the United States, focusing on outcomes since age 18 and in the past year. Objective: To investigate the relationship between years of schooling and the likelihood of using social welfare programs, while exploring whether this association varies between Caribbean Black and White adults, in alignment with the MDRs framework. Methods: Data were derived from the National Survey of American Life (NSAL), a nationally representative dataset with a robust sample of Black and White adults in the United States. The study focused on Caribbean Black and White participants aged 18 and older. Structural equation modeling (SEM) was employed to examine the relationship between years of schooling and social welfare use, adjusting for covariates including age, gender, employment status, and marital status. Interaction terms were used to assess potential differences in the returns of education across racial groups. Results: Higher educational attainment was associated with reduced likelihood of using social welfare programs overall. However, consistent with the MDRs framework, the protective effect of education was weaker for Caribbean Black individuals compared to their White counterparts. Caribbean Blacks with similar levels of education as Whites were more likely to report using social welfare programs since age 18 and in the past year, highlighting diminished returns on education for this population. Conclusion: This study extends the MDRs framework to Caribbean Black populations, a group rarely studied in the U.S., revealing significant disparities in the economic benefits of education. The findings underscore the need for policies that address systemic barriers limiting the economic returns of education for racial and ethnic minorities, including Caribbean Blacks, to promote greater equity in social and economic outcomes.
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Open Access May 05, 2025

Educated Yet Unhealthy? Diminished Returns of Education for Immigrants in the USA

Abstract Background: Minorities’ Diminished Returns (MDRs) theory posits that the health benefits of socioeconomic resources, such as education, are smaller for marginalized and minoritized populations, including immigrants. While MDRs have been extensively documented for racial and ethnic minorities, less is known about whether these diminished returns extend to immigrant populations. This study [...] Read more.
Background: Minorities’ Diminished Returns (MDRs) theory posits that the health benefits of socioeconomic resources, such as education, are smaller for marginalized and minoritized populations, including immigrants. While MDRs have been extensively documented for racial and ethnic minorities, less is known about whether these diminished returns extend to immigrant populations. This study tested MDRs of education on various health and cognitive outcomes, including self-rated health (SRH), cognitive function, numeracy, number of chronic medical conditions, and limitations in activities of daily living (ADLs) among immigrants compared to non-immigrants in the United States. Objective. To examine whether educational attainment confers weaker protective effects on SRH, cognitive function, numeracy, chronic medical conditions, and ADLs in immigrants compared to non-immigrants, confirming the presence of MDRs across these domains. Methods: We used data from the Understanding America Study (UAS), a nationally representative survey of U.S. adults. We tested the association between educational attainment and five outcomes—SRH, cognitive function, numeracy, number of chronic medical conditions, and limitations in ADLs—across immigrant and non-immigrant groups. Multivariate regression models were employed, adjusting for key sociodemographic covariates. Results: The protective effects of education on a range of health outcomes were significantly weaker for immigrants compared to non-immigrants. Education level showed weaker associations with SRH, cognitive function, numeracy, number of chronic conditions, and ADLs among immigrants. These findings suggest that even at higher levels of educational attainment, immigrants experience poorer health and cognitive functioning than their U.S.-born counterparts. Conclusion: This study offers strong evidence for the MDRs of education on multiple health outcomes among U.S. immigrants. One possible explanation is that, despite achieving higher levels of education, immigrants often face structural barriers—such as discrimination, limited access to resources, and economic inequities—that constrain the health-related benefits typically associated with educational attainment. Additionally, a portion of immigrant education may be acquired outside the United States, where credentials may not be fully recognized or rewarded within the U.S. labor market. These findings highlight the importance of policies aimed at addressing systemic inequities and improving access to healthcare, employment opportunities, and social support for immigrant communities. Future research should further explore the mechanisms underlying these diminished returns and identify policy solutions to reduce their impact. Keywords: Educational Attainment, Immigrants, Nativity, Self-Rated Health, Chronic Disease, Activities of Daily Living (ADL), Cognitive Function
Original Article
Open Access May 05, 2025

To Be Twice as Good to Get Half

Abstract “To Be Twice as Good to Get Half” is a common mindset among high aspiration and ambition Black individuals in the U.S., capturing the lived reality of Minorities’ Diminished Returns (MDRs). This paper explains that MDRs reflect how, even with high levels of ambition, self-efficacy, education, and income, Black individuals and other marginalized groups do not experience the same protective benefits [...] Read more.
“To Be Twice as Good to Get Half” is a common mindset among high aspiration and ambition Black individuals in the U.S., capturing the lived reality of Minorities’ Diminished Returns (MDRs). This paper explains that MDRs reflect how, even with high levels of ambition, self-efficacy, education, and income, Black individuals and other marginalized groups do not experience the same protective benefits for health and well-being as White populations. Systemic obstacles embedded within U.S. society weaken the expected returns on socioeconomic achievements for racialized individuals, creating a reality where “being twice as good” still results in lesser outcomes. High-SES Black individuals, for instance, continue to face significant risks for adverse outcomes, such as depression and chronic disease, due to structural inequities across domains like labor market discrimination, segregation, and accumulated disadvantage from childhood. Our analysis identifies key mechanisms—including interpersonal discrimination, lower-quality education, and structural racism in sectors like banking, policing, and real estate—that erode the protective effects of SES across racial lines. Mediating factors, such as chronic stress, allostatic load, and epigenetic changes over the life course, further compound these diminished returns, weakening the expected physical and mental health benefits. Drawing on extensive evidence from U.S. national and local datasets and corroborated by international studies, this paper underscores the necessity of policies that dismantle structural barriers rather than relying solely on SES improvements. Recommendations include implementing multi-sectoral policies, recognizing the unique challenges of middle-class non-White populations, and approaching policy with humility, acknowledging that achieving equity is a long-term endeavor. By challenging the “bootstraps” narrative, this paper advocates for structural interventions aimed at genuine health and economic equity for all racial and socioeconomic groups. While we provide an in-depth analysis of MDRs’ phenomena, mechanisms, mediators, and policy implications, the experience is often distilled as, “I have to be twice as good to get half.”
Article
Open Access May 04, 2025

Educational Attainment Better Protects Non-Latino than Latino People Against Diabetes Mellitus

Abstract Background: High educational attainment is a well-recognized protective factor against health problems such as diabetes. However, the theory of Minorities' Diminished Returns (MDRs) suggests that this protective effect is weaker for ethnic minorities compared to non-Latino Whites. This diminished effect is thought to result from structural inequalities, such as lower-quality [...] Read more.
Background: High educational attainment is a well-recognized protective factor against health problems such as diabetes. However, the theory of Minorities' Diminished Returns (MDRs) suggests that this protective effect is weaker for ethnic minorities compared to non-Latino Whites. This diminished effect is thought to result from structural inequalities, such as lower-quality education and fewer occupational opportunities, faced by ethnic minorities. Objective: This study examined the protective effect of years of schooling—used as a proxy for educational attainment—on diabetes mellitus (DM), overall and by ethnicity. Based on the MDRs framework, we hypothesized that the protective effect of education would be weaker for Latino individuals compared to non-Latinos. Methods: Data were drawn from the 2012 wave of the Understanding America Study (UAS), a nationally representative, internet-based panel. The outcome of interest was self-reported doctor diagnosis of DM. Logistic regression models were used to assess the association between educational attainment and DM, with an interaction term to explore differences between Latino and non-Latino individuals. Models were adjusted for age, sex, employment, immigration status, and marital status. Findings were presented as adjusted odds ratios (OR), p-values, and 95% confidence intervals (CIs). Results: Higher educational attainment was associated with lower odds of DM in both Latino and non-Latino individuals (p < 0.001). An interaction between education and ethnicity (p < 0.05) indicated that the protective effect of education was weaker for Latino individuals compared to non-Latinos. Conclusion: The findings align with the MDRs framework, which suggests that the health benefits of education are not equally distributed across ethnic groups. For Latino individuals, structural barriers such as lower educational quality and labor market discrimination may limit the protective effect of education against DM. While education is a key determinant of health, its unequal returns contribute to ethnic health disparities. Policymakers must address structural inequalities in education and employment that disproportionately affect ethnic minorities. Tackling these disparities through multi-sector policy interventions will require bipartisan political support.
Article
Open Access April 10, 2025

Advancements in Pharmaceutical IT: Transforming the Industry with ERP Systems

Abstract The pharmaceutical industry is undergoing a profound transformation driven by advancements in Information Technology (IT), with Enterprise Resource Planning (ERP) systems playing a pivotal role in reshaping operations. These systems offer integrated solutions that streamline key business processes, such as production, inventory management, supply chain optimization, regulatory compliance, and data [...] Read more.
The pharmaceutical industry is undergoing a profound transformation driven by advancements in Information Technology (IT), with Enterprise Resource Planning (ERP) systems playing a pivotal role in reshaping operations. These systems offer integrated solutions that streamline key business processes, such as production, inventory management, supply chain optimization, regulatory compliance, and data integration, contributing significantly to operational efficiency and organizational agility. This paper explores the evolution and impact of ERP systems within the pharmaceutical sector, highlighting their contributions to overcoming the industry’s inherent challenges, including complex regulatory requirements, the need for accurate and real-time data, and the demand for supply chain resilience. The integration of cloud-based ERP solutions, the incorporation of emerging technologies like Artificial Intelligence (AI), Machine Learning (ML), and the Internet of Things (IoT), and enhanced data analytics capabilities have revolutionized pharmaceutical IT. These advancements not only reduce operational costs, improve forecasting accuracy, and enhance collaboration but also ensure compliance with stringent global regulations, such as Good Manufacturing Practices (GMP) and FDA guidelines. Moreover, ERP systems have been instrumental in managing the pharmaceutical supply chain, ensuring product traceability, and improving inventory control and order fulfillment processes. This manuscript examines how ERP systems enable pharmaceutical companies to maintain high standards of product quality, improve decision-making, and ensure the safety and efficacy of drugs through robust tracking and auditing mechanisms. A case study of a pharmaceutical company that implemented an ERP system demonstrates the tangible benefits, including increased operational efficiency, improved compliance rates, and enhanced customer satisfaction. However, despite the clear advantages, challenges such as customization complexities, data integration issues, and resistance to change remain. As the pharmaceutical industry continues to evolve, ERP systems will remain a cornerstone of digital transformation, facilitating smarter decision-making, better resource management, and enhanced collaboration across global operations. This paper also identifies future trends, including the potential of AI and blockchain technologies in further strengthening ERP systems and transforming the pharmaceutical landscape.
Review Article
Open Access April 09, 2025

Color of Poverty Matters: Socioeconomic Resources and Health of Mothers Giving Birth to Children into Poverty

Abstract Background: Childhood poverty is a critical determinant of developmental, health, and behavioral outcomes. However, racial and ethnic differences in how families experience and navigate poverty suggest that a one-size-fits-all approach may not be an effective approach for alleviating disparities. Understanding baseline demographic, socioeconomic, health, and behavioral characteristics among [...] Read more.
Background: Childhood poverty is a critical determinant of developmental, health, and behavioral outcomes. However, racial and ethnic differences in how families experience and navigate poverty suggest that a one-size-fits-all approach may not be an effective approach for alleviating disparities. Understanding baseline demographic, socioeconomic, health, and behavioral characteristics among families in poverty is crucial to designing equitable interventions. Objective: To examine racial and ethnic differences in baseline demographic, socioeconomic, health, and behavioral characteristics among families living in poverty, using data from the Baby's First Years (BFY:2018-2019) Study. Methods: This analysis used baseline data from the BFY study, a randomized controlled trial (RCT) designed to evaluate the effects of monthly cash assistance on children’s developmental outcomes. The sample included 1,050 children and their families, consisting of mothers and, when available, fathers. Descriptive analyses were conducted to compare demographic, socioeconomic, health, and behavioral outcomes across racial and ethnic groups, focusing on Black, Hispanic, and other mothers. Results: Significant racial and ethnic differences were observed. Regarding demographic factors, Hispanic mothers were older than White mothers. In terms of socioeconomic factors, Hispanic mothers had fewer years of education compared to White mothers, while Black mothers were more likely to receive food stamps than mothers from other groups. Regarding health and behaviors, Black mothers reported worse self-rated health but were less likely to plan for breastfeeding compared to White mothers. In contrast, Hispanic mothers reported lower levels of depression and were more likely to plan for breastfeeding. Conclusion: These findings highlight the heterogeneity of experiences among families living in poverty, with significant differences across racial and ethnic groups. Such disparities underscore the importance of tailoring anti-poverty policies to the unique needs of diverse populations. Future research should explore how the effects of interventions, such as cash assistance or guaranteed income, may differ across racial and ethnic groups to inform equitable and effective policy development.
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Article
Open Access April 03, 2025

Depression, Subjective Health, Obesity, and Multimorbidity are Associated with Epigenetic Age Acceleration

Abstract Background: Epigenetic aging, measured through various DNA methylation-based clocks, may have implications for predicting disease risk. However, the sensitivity of different epigenetic clocks that have emerged as biomarkers for biological aging and in predicting physical and mental health outcomes remains uncertain. This study examines the age and sex-adjusted associations between [...] Read more.
Background: Epigenetic aging, measured through various DNA methylation-based clocks, may have implications for predicting disease risk. However, the sensitivity of different epigenetic clocks that have emerged as biomarkers for biological aging and in predicting physical and mental health outcomes remains uncertain. This study examines the age and sex-adjusted associations between multiple epigenetic age acceleration measures and three key health indicators, including self-rated health, depressive symptoms, and body mass index (BMI), in a nationally representative sample of U.S. middle-aged and older adults. Methods: We analyzed data from 4,018 adults in the 2016 wave of the Health and Retirement Study (HRS), which included several epigenetic age acceleration measures: HORVATH, HANNUM, LEVINE, HORVATHSKIN, LIN, WEIDNER, VIDALBRALO, YANG, ZHANG, BOCKLANDT, GARAGNANI, and GRIMAGE. Linear regression models were used to assess the associations between epigenetic age acceleration and self-rated health (poor health), depressive symptoms, and BMI, adjusting for age and sex. Results: We found significant positive associations between epigenetic age acceleration and worse self-rated health, higher depressive symptoms, and increased BMI. However, these associations varied across different epigenetic clocks, with some measures potentially having more consistent utility for specific health outcomes than others. Conclusion: Epigenetic age acceleration is linked to poorer self-rated health, greater depressive symptoms, and higher BMI, but choosing which epigenetic clock(s) to use is also important. These findings underscore the need to consider multiple epigenetic aging markers when assessing health risks and highlight the potential for particular clocks to serve as more sensitive indicators of physical and mental health outcomes.
Article
Open Access March 29, 2025

How Stigma Affects Patients Seeking Help for Drug Addiction

Abstract Stigma surrounding drug addiction remains a critical barrier to effective treatment, significantly influencing healthcare access, patient engagement, and recovery outcomes. This study explores the multifaceted impact of stigma on individuals seeking help for substance use disorders (SUDs), with a focus on healthcare-related discrimination, internalized stigma, and structural barriers. Research [...] Read more.
Stigma surrounding drug addiction remains a critical barrier to effective treatment, significantly influencing healthcare access, patient engagement, and recovery outcomes. This study explores the multifaceted impact of stigma on individuals seeking help for substance use disorders (SUDs), with a focus on healthcare-related discrimination, internalized stigma, and structural barriers. Research indicates that negative perceptions among healthcare providers contribute to delayed treatment-seeking behaviors, reduced adherence to medication-assisted treatment (MAT), and increased relapse rates. Additionally, patients internalizing these societal judgments experience heightened psychological distress, social isolation, and decreased self-efficacy, further hindering their recovery process. To address these challenges, evidence-based strategies such as addiction medicine education, trauma-informed care, harm reduction approaches, and peer support models have been shown to effectively reduce stigma and improve treatment outcomes. Hospital administrators and nursing leaders play a critical role in fostering a culture of empathy, advocating for the reframing of addiction as a neuro-psycho-biological disease rather than a moral failing. Future research should explore digital mental health interventions, motivational interviewing techniques, and interdisciplinary collaboration to further dismantle stigma and enhance the effectiveness of addiction treatment programs. This study highlights the urgent need for systemic policy changes, targeted educational programs, and a shift in clinical attitudes to create a more inclusive and stigma-free healthcare environment. Through implementing these approaches, healthcare providers can ensure equitable access to treatment and improve long-term health outcomes for individuals with opioid use disorder (OUD) and other substance-related conditions.
Essay
Open Access March 25, 2025

Resting-State Sensory-Motor Connectivity between Hand and Mouth as a Neural Marker of Socioeconomic Disadvantage, Psychosocial Stress, Cognitive Difficulties, Impulsivity, Depression, and Substance Use in Children

Abstract Background: The sensory-motor network is essential for integrating sensory input with motor function and higher-order cognition. Resting-state functional connectivity (rsFC) within this network undergoes significant developmental changes, and disruptions in these connections have been linked to behavioral and psychiatric outcomes. However, the relationship between sensory-motor [...] Read more.
Background: The sensory-motor network is essential for integrating sensory input with motor function and higher-order cognition. Resting-state functional connectivity (rsFC) within this network undergoes significant developmental changes, and disruptions in these connections have been linked to behavioral and psychiatric outcomes. However, the relationship between sensory-motor connectivity, early-life adversity, and later health behaviors remains understudied. Objective: This study examines the associations between rsFC within the sensory-motor network (mouth and hand regions) and key social, psychological, and behavioral factors, including baseline and past socioeconomic status (SES), trauma exposure, family conflict, impulsivity, major depressive disorder (MDD), and future substance use. Methods: Data were drawn from the Adolescent Brain Cognitive Development (ABCD) Study, a national sample of U.S. children. Resting-state fMRI data were used to assess functional connectivity within the sensory-motor network. Bivariate analyses examined associations between rsFC in the sensory-motor mouth and hand regions and baseline SES, past SES, childhood trauma exposure, family conflict, impulsivity, and MDD. Longitudinal analyses assessed whether baseline rsFC predicted future substance use. Results: Greater rsFC between the sensory-motor mouth and hand regions was significantly associated with lower SES, higher trauma exposure, and greater family conflict. Increased connectivity was also correlated with older age and more advanced puberty status. Higher rsFC between the sensory-motor mouth and hand regions was linked to greater impulsivity, lower cognitive function, an increased likelihood of MDD, and future marijuana use. Conclusion: These findings suggest that sensory-motor connectivity is sensitive to socioeconomic and psychosocial stressors, with potential long-term implications for mental health and substance use risk. The results highlight the importance of early-life environmental factors in shaping neurodevelopmental trajectories and emphasize the need for targeted interventions to mitigate the effects of adversity on brain function and behavior. Future research should further explore the role of sensory-motor network alterations in behavioral health outcomes as a function of environmental stressors.
Original Article
Open Access March 11, 2025

Why High Income Fails to Reduce E-Cigarette Use: The Knowledge-Attitude Paradox in the SMOKES Study

Abstract Background: Electronic cigarette (e-cigarette) use and vaping tobacco have increased rapidly worldwide, raising concerns about their health effects, social acceptability, and regulatory challenges. In many countries, e-cigarettes are more commonly used by individuals from higher socioeconomic status (SES) backgrounds, who, in theory, should have greater knowledge about e-cigarettes and [...] Read more.
Background: Electronic cigarette (e-cigarette) use and vaping tobacco have increased rapidly worldwide, raising concerns about their health effects, social acceptability, and regulatory challenges. In many countries, e-cigarettes are more commonly used by individuals from higher socioeconomic status (SES) backgrounds, who, in theory, should have greater knowledge about e-cigarettes and their associated risks. However, it remains unclear why a group with more knowledge about e-cigarette risks would also hold more positive attitudes toward vaping and exhibit higher usage rates — a phenomenon that may represent a knowledge-behavior paradox. Understanding this paradox, along with the complex relationships between e-cigarette knowledge, attitudes, and behaviors, is critical for informing effective public health interventions, campaigns, social media messaging, and regulatory policies. Objectives: This study aimed to evaluate the complex relationship between SES, e-cigarette knowledge, pro-vaping attitudes, and e-cigarette use. Methods: The SMOKES Study (Study of Measurement of Knowledge and Examination of Support for Tobacco Control Policies) used a multi-center, cross-sectional design, collecting data from 2,403 college and university students across 15 provinces in Iran (covering nearly half of the country's provinces). The survey measured family income, age, sex, ethnicity, e-cigarette use, knowledge, and attitudes. Structural Equation Modeling (SEM) was employed to examine the interrelations between SES, knowledge, attitudes, and behavior, while adjusting for age, sex, and ethnic minority status. Results: SEM analysis confirmed the hypothesized paradox. Although greater knowledge about e-cigarettes was linked to less favorable attitudes toward vaping and lower use, pro-vaping attitudes emerged as the strongest predictor of vaping behavior, while knowledge played a weaker protective role. Notably, individuals with higher SES simultaneously showed higher knowledge and, paradoxically, more pro-e-cigarette attitudes and greater usage. Female students and ethnic minority students reported higher correct knowledge and lower pro-vaping attitudes and use. Although age and higher family income were associated with more favorable attitudes, they did not directly predict vaping behavior. These results suggest that for higher SES individuals, poor knowledge is not the main driver of e-cigarette use; rather, their pro-e-cigarette attitudes, which seem to outweigh the influence of knowledge, play a key role. Conclusions: Although individuals from higher SES backgrounds report greater correct knowledge about e-cigarettes, this knowledge does not necessarily translate into reduced positive attitudes or lower usage. This study highlights the complexity of these paradoxical effects and suggests that public health strategies need to go beyond simple education and knowledge-based interventions. Targeted approaches should address industry messaging, challenge misconceptions, and strengthen regulatory efforts to reduce e-cigarette use among young adults, including those from higher SES backgrounds.
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Original Article
Open Access March 09, 2025

Place-Based Diminished Returns of Parental Education on Adolescents’ Inhalant Use in Rural Areas

Abstract Background Adolescent substance use is often influenced by socioeconomic and geographical factors. While higher parental education is typically associated with lower substance use, these protective effects may be weaker for marginalized groups facing structural disadvantages that limit the utility and returns of their economic and social resources. Rural areas, characterized by fewer [...] Read more.
Background Adolescent substance use is often influenced by socioeconomic and geographical factors. While higher parental education is typically associated with lower substance use, these protective effects may be weaker for marginalized groups facing structural disadvantages that limit the utility and returns of their economic and social resources. Rural areas, characterized by fewer employment opportunities and limited recreational activities, may contribute to marginalization-related diminished returns (MDRs) of parental education on adolescent substance use, including inhalant use. Objectives This study applies the MDRs framework to examine whether the protective effect of higher parental education on current inhalant use (past 30 days) among 12th-grade American adolescents varies by geographic location. Specifically, we assess whether youth from highly educated families in rural areas are at a disproportionate risk of inhalant use compared to their urban and suburban peers. Methods Using data from the 2024 Monitoring the Future (MTF) study, a nationally representative survey of 12th-grade adolescents in the U.S., we tested main effects and statistical interactions between parental education and residence (rural vs. urban/suburban) in predicting the odds of inhalant use over the past 30 days. Logistic regression models, both with and without interaction terms, were applied to evaluate whether the protective effects of parental education varied by residence location, controlling for relevant demographic and socioeconomic factors. Results Findings indicate a significant interaction between parental education and rural residence. While higher parental education was associated with lower odds of inhalant use in urban and suburban areas, this protective effect was substantially weaker in rural settings. Adolescents from highly educated families in rural areas exhibited a higher-than-expected risk of inhalant use, suggesting that geographic marginalization attenuates the benefits of parental socioeconomic resources. Conclusions These results highlight the role of place-based marginalization in shaping adolescent substance use disparities, demonstrating that MDRs extend beyond race and ethnicity to location-based disadvantages. Rural youths from highly educated families may face unique structural and social challenges that counteract the protective effects of parental education. Public health efforts should consider place-based interventions that address the economic, recreational, and social limitations of rural environments to reduce substance use risk among high-SES adolescents residing in rural areas.
Article
Open Access March 06, 2025

Tobacco-control policy support and tobacco use: SMOKES study

Abstract Background: Tobacco control policies are implemented globally to reduce tobacco-related morbidity and mortality. Emerging evidence suggests that individual tobacco use may influence the level of support for these policies. However, the extent to which personal use affects policy endorsement remains underexplored, particularly among young adults in academic settings. Aims: This study [...] Read more.
Background: Tobacco control policies are implemented globally to reduce tobacco-related morbidity and mortality. Emerging evidence suggests that individual tobacco use may influence the level of support for these policies. However, the extent to which personal use affects policy endorsement remains underexplored, particularly among young adults in academic settings. Aims: This study aimed to examine whether college students who use tobacco exhibit lower support for tobacco control policies compared to their non-user counterparts. Methods: We conducted a multi-center, cross-sectional study involving 2403 college students from various provinces in Iran. Tobacco use was ascertained based on self-reported consumption of cigarettes, electronic cigarettes, and hookah. Attitudes toward tobacco control policies were evaluated using a structured survey instrument, and comparative analyses were performed to assess differences in policy support between tobacco users and non-users. Results: The analysis revealed that tobacco users demonstrated significantly lower support for tobacco control policies compared to non-users. This association was consistently observed across users of cigarettes, electronic cigarettes, and hookah, suggesting a systematic pattern irrespective of the type of tobacco product used. Conclusion: These findings indicated a clear association between tobacco use and reduced endorsement of tobacco control policies among Iranian college students. These results have potential implications for public health policy, emphasizing the importance of addressing individual tobacco use behaviors in the development and implementation of tobacco control strategies. Further research is needed to elucidate the underlying mechanisms of this relationship.
Article
Open Access March 04, 2025

SMOKES: Study of Measurement of Knowledge and Examination of Support for tobacco control policies

Abstract Background: Tobacco use remains a major global health concern, and understanding the factors that influence tobacco-related knowledge and support for tobacco control policies is critical for effective development of tobacco control policies that are accepted by the public. Objectives: This study introduces the rationale, design, methodology, and participants of the SMOKES Study [...] Read more.
Background: Tobacco use remains a major global health concern, and understanding the factors that influence tobacco-related knowledge and support for tobacco control policies is critical for effective development of tobacco control policies that are accepted by the public. Objectives: This study introduces the rationale, design, methodology, and participants of the SMOKES Study (Study of Measurement of Knowledge and Examination of Support for tobacco control policies), which is conducted to evaluate tobacco use, tobacco-related knowledge and attitude, as well as support for tobacco control policies among college and university students. Methods: The SMOKES Study was designed to address significant gaps in literature by focusing on college and university students in a non-Western context. A multi-center, cross-sectional design was employed to collect data from a diverse sample of college and university students across different geographical provinces in Iran. The survey instrument incorporated a range of measures covering socio-demographic characteristics, university-related variables, family tobacco use status, personal tobacco consumption behaviors (including detailed assessments of cigarette, hookah, and electronic cigarette use), and attitudinal as well as knowledge-based assessments related to vaping. Support for tobacco control policies is also measured. Data were collected using an online survey that included self-administered questionnaires, enabling access to a large diverse sample. This study may be used to determine the prevalence of ever and current use of cigarettes, electronic cigarettes, and hookah, as well as examining the correlates of single, dual, and poly-tobacco use. The study also aims to assess the role of social determinants, attitudes, and ethnic/geographic differences in shaping these outcomes. Results: The study sample consisted of 2403 college and university students, including undergraduates enrolled in different academic programs from all faculties and disciplines. Participants were drawn from universities across 15 provinces, and 11 ethnic groups, ensuring a heterogeneous sample with respect to socio-demographic background, ethnicity, and institutional affiliation. This diversity enhances the generalizability of the findings and allows for the exploration of subgroup differences in tobacco use patterns and policy support. Conclusions: The SMOKES Study offers a framework for examining tobacco-related knowledge and the acceptability of tobacco control policies among a key part of the population, being college and university students. By providing detailed insights into the prevalence and correlates of tobacco knowledge, attitude, use, as well as the tobacco control policy support, the study lays the groundwork for tailored public health interventions and more effective tobacco regulation strategies particularly for college campuses in a non-Western setting.
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Article
Open Access December 22, 2023

Cloud Based Payment Processing and Merchant Services: A Scalable and Secure Framework for Digital Transactions in a Globalized Economy

Abstract In today’s world of a globalized economy and ubiquitous digital transactions, businesses are hungry for ways to increase transaction efficiency and security. In the real economy, solutions that scale to fit transaction volume or velocity are equally valuable. This is true for clearing and settlement and for the day-to-day needs of buyers and sellers alike. Clever observers of both cash and digital [...] Read more.
In today’s world of a globalized economy and ubiquitous digital transactions, businesses are hungry for ways to increase transaction efficiency and security. In the real economy, solutions that scale to fit transaction volume or velocity are equally valuable. This is true for clearing and settlement and for the day-to-day needs of buyers and sellers alike. Clever observers of both cash and digital transactions can spot cases where technology that supports transaction security or safety can strengthen consumer-borrower ties, mitigate default risks, and reduce recidivism. In general, a cloud solution for payment processing and merchant services solves two major barriers to optimum business technology: lack of scalability and lack of security [1]. The extension of current practice has its advantages, but new solutions unlock significant opportunities for both consumers and financial institutions [2]. The focus of this work is on the provisioning of cloud-based payment processing and merchant services to financial institutions and established global organizations, although the options available with these services mean they are potentially applicable to a wide range of group entities, including non-trading organizations, pension administrators, and group treasurers. With the increased attention to cybersecurity, a mass of data is available to assist the IT departments of the major payment processors, merchants, and acquirers to get cybersecurity on the radar of C-level executives [3]. The case is put forward for the increased targeting of and reporting to the Board’s Audit, Risk, and Liability Committees of publicly held payment processors and merchants to reduce fraud losses and mitigate the reputation and class action lawsuit risk due to data breaches. The progress of technology in the payment sector requires all stakeholders to have a collective approach in order to mitigate fraud and cybersecurity-related risks in new products and services to enhance consumer confidence and the proportion of retail cashless transactions [4].
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Review Article
Open Access February 27, 2025

Hopelessness and Smoking among Black Adults

Abstract Background: While the link between depression and smoking is known, less is known about the relationship between hopelessness and smoking in large national community-based sample of Black people. Aims: This study investigates the association between hopelessness and smoking status, using data from the National Survey of American Life (NSAL), which is the only ethnically [...] Read more.
Background: While the link between depression and smoking is known, less is known about the relationship between hopelessness and smoking in large national community-based sample of Black people. Aims: This study investigates the association between hopelessness and smoking status, using data from the National Survey of American Life (NSAL), which is the only ethnically diverse nationally representative sample of Black adults. Methods: Data from the NSAL were analyzed. Hopelessness and smoking status were assessed using structured interviews. Logistic regression was employed to assess the link between hopelessness and smoking status, controlling for potential confounders such as demographic factors and socioeconomic indicators as well as depression. Results: 4,939 participants entered our analysis. Hopelessness was significantly associated with higher odds of smoking status. This association remained robust after adjusting for confounders such as demographic factors, socioeconomic status, and depression. Conclusions: Hopelessness may be a critical risk factor for smoking in Black adults. Promoting hope as a component of targeted tobacco cessation programs may help reduce tobacco use of Black populations.
Article
Open Access February 26, 2025

Lower Successful Quit Rate of Menthol Tobacco Users in a Tobacco Cessation Program: An Explanatory Analysis in Search of Potential Mechanisms

Abstract Background: Menthol-flavored tobacco products are disproportionately used in low-income African American communities, a result of decades of targeted marketing and systemic inequities. Menthol use has been associated with lower quit rates, often compounded by factors such as lower trust in healthcare systems, reduced access to cessation programs, and other structural barriers. [...] Read more.
Background: Menthol-flavored tobacco products are disproportionately used in low-income African American communities, a result of decades of targeted marketing and systemic inequities. Menthol use has been associated with lower quit rates, often compounded by factors such as lower trust in healthcare systems, reduced access to cessation programs, and other structural barriers. Despite this, few studies have systematically examined the explanatory mechanisms that might clarify why menthol-flavored tobacco is linked to poorer cessation outcomes among participants in tobacco cessation programs. Aims: This study aimed to investigate the potential mechanisms by which menthol tobacco use is associated with lower quit rates across three types of smoking cessation interventions. Methods: Participants were randomized into one of three smoking cessation interventions: in-person (CEASE), self-help, or online/hybrid programs. Smoking abstinence was assessed three months post-intervention as the primary outcome. Secondary analyses explored whether demographic, socioeconomic, or behavioral factors mediated the association between menthol use and quit rates across the intervention arms. Results: Menthol tobacco use was significantly associated with lower quit rates (p < 0.01). This association was not explained by demographic, socioeconomic, health, or addiction-related factors. While menthol use was associated with lower education and employment levels, demographic characteristics, physical or mental health, or addiction did not explain the effect of menthol on tobacco cessation. These findings suggest that the lower quit rates observed among menthol users cannot be attributed to any third factors assessed in this study. Conclusions: Menthol tobacco use independently predicts lower quit rates, and the mechanisms behind this disparity remain unclear. The consistent findings across different intervention types highlight the need for further research to uncover the underlying pathways and to design targeted strategies to improve cessation outcomes for menthol users.
Article
Open Access February 26, 2025

Innovations and Challenges in Pharmaceutical Supply Chain, Serialization and Regulatory Landscape

Abstract The pharmaceutical supply chain has become increasingly complex and vulnerable to various risks, including counterfeit drugs, diversion, and fraud. As these challenges threaten patient safety and the integrity of global healthcare systems, serialization has emerged as a pivotal innovation in pharmaceutical logistics and regulatory compliance. Serialization involves assigning unique identifiers to [...] Read more.
The pharmaceutical supply chain has become increasingly complex and vulnerable to various risks, including counterfeit drugs, diversion, and fraud. As these challenges threaten patient safety and the integrity of global healthcare systems, serialization has emerged as a pivotal innovation in pharmaceutical logistics and regulatory compliance. Serialization involves assigning unique identifiers to individual drug packages, enabling precise tracking and authentication at every stage of the supply chain. This process provides unprecedented transparency, enhances product security, and facilitates real-time monitoring of pharmaceutical products as they move from manufacturers to end consumers. Despite its potential to revolutionize pharmaceutical traceability, the integration of serialization technologies faces numerous obstacles. These include high implementation costs, regulatory inconsistencies across regions, and the technological challenges of managing vast amounts of data. Moreover, the complex, multi-tiered nature of the global supply chain introduces additional risks related to data integrity, cybersecurity, and interoperability between systems. As pharmaceutical companies seek to navigate these challenges, innovations in serialization technology—such as blockchain, artificial intelligence (AI), the Internet of Things (IoT), and radio frequency identification (RFID)—are providing promising solutions to enhance efficiency, reduce fraud, and increase visibility. This manuscript explores both the innovative advancements and the key challenges associated with the integration of serialization in the pharmaceutical supply chain. It delves into the evolving regulatory landscape, highlighting the need for global harmonization of serialization standards, and examines the impact of serialization on securing pharmaceutical distribution networks. Additionally, the paper emphasizes the importance of collaboration among manufacturers, technology providers, and regulatory bodies in overcoming implementation barriers and realizing the full potential of serialization. As the pharmaceutical industry moves towards a more interconnected and data-driven future, serialization promises to play a central role in shaping the next generation of drug safety and supply chain management. By addressing the hurdles to adoption and leveraging emerging technologies, the pharmaceutical sector can create a more secure, transparent, and efficient supply chain that better serves public health and fosters greater trust among consumers and healthcare professionals alike.
Review Article
Open Access February 25, 2025

Nucleus Accumbens Resting State Functional Connectivity is Linked to Family Income, Reward Salience, and Substance Use

Abstract Background: As a central component of the brain's reward system, nucleus accumbens (NAcc) plays a crucial role in reward salience and substance use behaviors. Changes in the NAcc are also relevant to higher rates of substance use of youth and adults from low-income backgrounds. Although resting-state functional connectivity (rsFC) of the NAcc provides valuable insights into the neural [...] Read more.
Background: As a central component of the brain's reward system, nucleus accumbens (NAcc) plays a crucial role in reward salience and substance use behaviors. Changes in the NAcc are also relevant to higher rates of substance use of youth and adults from low-income backgrounds. Although resting-state functional connectivity (rsFC) of the NAcc provides valuable insights into the neural mechanisms underlying reward processing and the propensity for self-reported reward salience and substance use, research exploring the association between NAcc rsFC and brain networks beyond the default mode network (DMN) and prefrontal cortex (PFC) is limited. Objective: To investigate the role of the resting-state functional connectivity of the NAcc with the cingulo-opercular network, sensorimotor mouth network, and sensorimotor hand network in the association between socioeconomic status, self-reported reward salience, and future substance use. Methods: Data were obtained from the Adolescent Brain Cognitive Development (ABCD) study. NAcc rsFC with the cingulo-opercular network, sensorimotor mouth network, and sensorimotor hand network was assessed at baseline. Socioeconomic status was measured using family income. Self-reported reward salience was assessed using validated psychometric scales. Substance use outcomes were tracked longitudinally over the study period. Structural Equation Modeling was employed to examine the covariances between family income, NAcc rsFC, reward salience, and subsequent substance use. Results: Higher baseline family income was positively associated with baseline NAcc rsFC (B = 0.092, p < 0.001) and negatively associated with baseline reward salience (B = -0.040, p = 0.036) and future substance use (B = -0.081, p < 0.001). Baseline NAcc rsFC was strongly and positively associated with reward salience (B = 0.734, p < 0.001) and future substance use up to age 13 (B = 0.124, p < 0.001). Additionally, baseline reward salience was positively associated with future substance use (Covariance = 0.176, p < 0.001). Conclusion: The findings suggest that NAcc rsFC with brain networks beyond the DMN or PFC may contribute to the links between low parental socioeconomic status, reward salience, and substance use risk. Expanding the understanding of NAcc rsFC provides new insights into the neural mechanisms underlying these associations. These results have important implications for developing targeted interventions aimed at preventing substance use, particularly among low-income youth with heightened reward salience. Further research is needed to explore causal pathways and moderating factors influencing these relationships.
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Open Access February 25, 2025

Resting-State Functional Connectivity Between the Cingulo-Opercular and Default Mode Networks May Explain Socioeconomic Inequalities in Cognitive Development

Abstract Background: The Cingulo-Opercular Network (CON) is a crucial executive control network involved in regulating actions and facilitating higher-order cognitive processes. Resting-state functional connectivity between the CON and the Default Mode Network (DMN) plays a vital role in cognitive regulation, enabling the transition between internally focused and externally directed tasks. This [...] Read more.
Background: The Cingulo-Opercular Network (CON) is a crucial executive control network involved in regulating actions and facilitating higher-order cognitive processes. Resting-state functional connectivity between the CON and the Default Mode Network (DMN) plays a vital role in cognitive regulation, enabling the transition between internally focused and externally directed tasks. This study investigates whether resting-state functional connectivity between the CON and DMN mediates the effects of social determinants, such as educational opportunities and family structure, on cognitive outcomes in youth. Aims: This study aims to explore how CON-DMN connectivity influences the relationship between social gradients and cognition in youth. Specifically, it examines whether resting-state functional connectivity between these networks mediates the effects of educational opportunities and family structure on cognitive outcomes and seeks to uncover the neural mechanisms underlying these social gradients. Methods: Data were derived from the Adolescent Brain Cognitive Development (ABCD) study, a large longitudinal dataset of over 11,000 children aged 9–10 years. Cognitive outcomes were assessed using standardized NIH toolbox measures: Total Composite, Fluid Reasoning, Picture Vocabulary, Pattern Recognition, and Card Sorting. Social determinants were operationalized using indicators such as parental education, family composition, and neighborhood educational opportunities (COI). Resting-state functional connectivity (rsFC) between the CON and DMN was measured using functional magnetic resonance imaging (fMRI). Structural equation modeling (SEM) was employed to test whether CON-DMN rsFC mediated the relationship between social determinants and cognitive outcomes, adjusting for potential confounders such as age, sex, and race/ethnicity. Results: Stable family structure and greater educational opportunities were significantly associated with improved cognitive performance. These relationships were mediated by reduced functional connectivity between the CON and DMN. Conclusion: Reduced functional connectivity between the CON and DMN serves as a neural mechanism linking social gradients, such as educational opportunities and family structure, to better cognitive outcomes in youth.
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Open Access February 19, 2025

The CEASE Tobacco Cessation Controlled Trial for Low-Income Racial and Ethnic Minority Participants: Key Predictors of Success

Abstract Background: Tobacco use remains disproportionately high among low-income and racial-ethnic minority populations. The CEASE program, with its self-help, hybrid/online, and in-person modalities, has demonstrated efficacy in promoting tobacco cessation. However, predictors of successful cessation among participants in these groups remain unclear. Objective: To identify baseline predictors of successful tobacco cessation among low-income and racial-ethnic minority participants in the CEASE program, with a focus on demographic, socioeconomic, behavioral, and psychosocial factors. Methods: Participants were allocated into three intervention arms: self-help, CEASE hybrid/online, and CEASE in-person. Baseline characteristics, including demographics (e.g., age, gender), socioeconomic status (e.g., education, employment), substance use profiles (e.g., cigarette packs per week, use of other tobacco products, menthol tobacco use), physical health (e.g., general health, number of cardiometabolic risk conditions), mental health (e.g., depressive symptoms, perceived stress), perceived social support, and nicotine dependence, were analyzed as potential predictors of cessation success. Multivariable logistic regression models were used to identify factors associated with successful quitting, controlling for the study arm. Results: In addition to the study arm, gender, baseline depression, cardiometabolic conditions, tobacco flavor, and the use of other tobacco products were significant predictors of quit success. Individuals receiving in-person interventions had significantly higher odds of quitting (AOR = 3.79, p < 0.05). Women were significantly less likely to quit compared to men (AOR = 0.24, p < 0.01). Participants with a greater number of cardiometabolic risk conditions were more likely to quit (AOR = 1.93, p < 0.05), while those with higher levels of depression had lower odds of quitting (AOR = 0.61, p < 0.05). Menthol tobacco users were also less likely to quit (AOR = 0.10, p < 0.05). Interestingly, individuals who used other forms of tobacco in addition to cigarettes had increased odds of quitting (AOR = 2.86, p [...] Read more.
Background: Tobacco use remains disproportionately high among low-income and racial-ethnic minority populations. The CEASE program, with its self-help, hybrid/online, and in-person modalities, has demonstrated efficacy in promoting tobacco cessation. However, predictors of successful cessation among participants in these groups remain unclear. Objective: To identify baseline predictors of successful tobacco cessation among low-income and racial-ethnic minority participants in the CEASE program, with a focus on demographic, socioeconomic, behavioral, and psychosocial factors. Methods: Participants were allocated into three intervention arms: self-help, CEASE hybrid/online, and CEASE in-person. Baseline characteristics, including demographics (e.g., age, gender), socioeconomic status (e.g., education, employment), substance use profiles (e.g., cigarette packs per week, use of other tobacco products, menthol tobacco use), physical health (e.g., general health, number of cardiometabolic risk conditions), mental health (e.g., depressive symptoms, perceived stress), perceived social support, and nicotine dependence, were analyzed as potential predictors of cessation success. Multivariable logistic regression models were used to identify factors associated with successful quitting, controlling for the study arm. Results: In addition to the study arm, gender, baseline depression, cardiometabolic conditions, tobacco flavor, and the use of other tobacco products were significant predictors of quit success. Individuals receiving in-person interventions had significantly higher odds of quitting (AOR = 3.79, p < 0.05). Women were significantly less likely to quit compared to men (AOR = 0.24, p < 0.01). Participants with a greater number of cardiometabolic risk conditions were more likely to quit (AOR = 1.93, p < 0.05), while those with higher levels of depression had lower odds of quitting (AOR = 0.61, p < 0.05). Menthol tobacco users were also less likely to quit (AOR = 0.10, p < 0.05). Interestingly, individuals who used other forms of tobacco in addition to cigarettes had increased odds of quitting (AOR = 2.86, p < 0.05). No other factors, including demographic variables (e.g., age), socioeconomic status (e.g., education, marital status), substance use profiles (e.g., cigarette packs per week, NRT use), or nicotine dependence, were significant predictors of cessation success. Conclusion: Baseline self-reported anxiety/depression and depressive symptoms play a critical role in reducing the likelihood of successful tobacco cessation among low-income and racial-ethnic minority participants in the CEASE program. These findings underscore the importance of addressing mental health challenges as part of tobacco cessation interventions to enhance their efficacy. Future research should explore targeted strategies for integrating mental health support into cessation programs to improve outcomes for underserved populations.
Article
Open Access February 17, 2025

Gender Differences in the Association Between Socioeconomic Status and Cardiometabolic Health: National Health and Nutrition Examination Survey

Abstract Background: Socioeconomic status (SES) is a well-established determinant of health, often associated with lower risk of cardiometabolic diseases (CMD). However, the extent to which SES influences CMD may vary by gender due to differences in social roles, health behaviors, and biological susceptibilities. This study examined the relationship between SES, measured by the [...] Read more.
Background: Socioeconomic status (SES) is a well-established determinant of health, often associated with lower risk of cardiometabolic diseases (CMD). However, the extent to which SES influences CMD may vary by gender due to differences in social roles, health behaviors, and biological susceptibilities. This study examined the relationship between SES, measured by the poverty-to-income ratio (PIR), and CMD indicators—including obesity, diabetes, and cardiovascular disease (CVD)—among men and women using data from the National Health and Nutrition Examination Survey (NHANES). Methods: This cross-sectional study utilized NHANES data (1999-2018), adjusting for race/ethnicity and age. SES was operationalized using PIR, with CMD outcomes (obesity, diabetes, and CVD) as dependent variables. Generalized linear models (GLM) were employed to evaluate the main effects of SES on CMD, with gender included as a moderator. Results: Higher SES was associated with lower overall CMD risk. However, the protective effects of SES were more pronounced in women than in men for all outcomes. These findings suggest that gender-specific pathways may mediate the relationship between SES and CMD. Women may derive greater health benefits from higher SES due to factors such as reduced stress exposure, healthier behaviors, and increased healthcare utilization. Conversely, the weaker association observed in men may reflect differences in social hierarchy sensitivity, responses to unemployment, or other contextual factors. Conclusion: The findings highlight the importance of gender-specific considerations when addressing SES-related disparities in CMD outcomes. Policies and interventions aimed at reducing CMD burden should account for these gender differences to promote equitable improvements in cardiometabolic health. Further research is needed to unravel the mechanisms driving these differences and to inform targeted strategies.
Article
Open Access February 14, 2025

Trauma Erodes Financial Returns of Educational Attainment

Abstract Background: Educational attainment is often regarded as a pathway to economic stability and social mobility. However, the Minorities’ Diminished Returns (MDRs) framework has demonstrated that the effects of educational attainment on various economic, behavioral, and health outcomes are weaker for marginalized populations, including racial/ethnic minorities, immigrants, LGBTQ+ individuals, [...] Read more.
Background: Educational attainment is often regarded as a pathway to economic stability and social mobility. However, the Minorities’ Diminished Returns (MDRs) framework has demonstrated that the effects of educational attainment on various economic, behavioral, and health outcomes are weaker for marginalized populations, including racial/ethnic minorities, immigrants, LGBTQ+ individuals, and those living in disadvantaged areas. While MDRs have been documented for various marginalized demographic groups, the role of trauma in moderating socioeconomic outcomes remains underexplored. Objective: This study examines whether lifetime trauma exposure diminishes the positive association between educational attainment and poverty-to-income ratio (PIR), a key indicator of economic well-being. Methods: Using data from the National Survey of American Life (NSAL), we analyzed a nationally representative sample of 6,008 adults, including Black, White, Latino, and Other racial/ethnic groups. We employed linear regression models to evaluate the association between the independent variable educational attainment and the outcome PIR. We then tested lifetime trauma as a moderator of this association. Models controlled for age, gender, employment, and race/ethnicity. Results: Educational attainment was positively associated with PIR across all groups, but the strength of this association was significantly attenuated for individuals with a history of lifetime trauma. These effects were independent of covariates. Conclusions: These findings extend the MDRs framework by highlighting trauma as a potential contributor to diminished returns of education on socioeconomic wellbeing. Structural inequities that increase trauma exposure in minoritized populations may also limit the economic benefits of education, particularly for groups with multiple trauma exposures. Policies aimed at addressing economic inequality must integrate social policies that reduce trauma and stress.
Article
Open Access February 13, 2025

Psychosocial Correlates of Childhood Body Mass Index: Racial and Ethnic Differences

Abstract Objective: To examine racial/ethnic differences in the associations of family socioeconomic status (SES), neighborhood SES, and inhibitory control with body mass index (BMI) in 9-10-year-old children using data from the Adolescent Brain Cognitive Development (ABCD) study. Methods: This cross-sectional study included a diverse sample of children aged 9-10 years, representing [...] Read more.
Objective: To examine racial/ethnic differences in the associations of family socioeconomic status (SES), neighborhood SES, and inhibitory control with body mass index (BMI) in 9-10-year-old children using data from the Adolescent Brain Cognitive Development (ABCD) study. Methods: This cross-sectional study included a diverse sample of children aged 9-10 years, representing non-Latino White, Black, Latino, Asian, and Other racial/ethnic groups. BMI was the primary outcome. Key predictors were family SES, neighborhood SES, and inhibitory control. Multivariable regression models were stratified by race/ethnicity to identify group-specific associations. Results: Race/ethnic groups differed in psychosocial correlates of childhood BMI at age 9 and 10. Among non-Latino White children, higher family income (B = -0.086, p < 0.001), higher parental education (B = -0.069, p < 0.001), and living in a married household (B = -0.079, p < 0.001) were associated with lower BMI. Additionally, the presence of healthy food options in the zip code (B = -0.030, p = 0.032) was linked to lower BMI, while lack of planning (B = 0.032, p = 0.030) was associated with higher BMI. For non-Latino Black children, positive urgency (B = -0.068, p = 0.022) was negatively associated with BMI, while other factors such as family SES and neighborhood SES did not show significant associations. For Latino children, higher family income (B = -0.093, p = 0.001) and parental education (B = -0.099, p < 0.001) were associated with lower BMI. In this group, male gender (B = 0.043, p = 0.033) was associated with higher BMI. Among Asian children, higher family income (B = -0.199, p = 0.006) and parental education (B = -0.144, p = 0.037) were significantly associated with lower BMI. For children in the "Other" racial/ethnic category, higher family income (B = -0.101, p = 0.023), living in a married household (B = -0.076, p = 0.026), and higher median income in the zip code (B = -0.083, p = 0.013) were associated with lower BMI. In this group, male children had lower BMI compared to females (B = -0.089, p = 0.001). Conclusion: The findings highlight substantial racial/ethnic differences in the psychosocial and socioeconomic correlates of BMI in children. There is a need for tailored interventions that target social determinants of childhood high BMI. One size does not fit all.
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Open Access February 12, 2025

Unequal Benefits: How Parental Education Falls Short for Black and Latino Youth

Abstract Background: Parental education is a key determinant of academic performance, yet its protective effects may differ by race and ethnicity. The concept of Minorities’ Diminished Returns (MDRs) highlights the weaker association between socioeconomic resources and outcomes for marginalized populations, including Black and Latino youth. Objective: To investigate whether the [...] Read more.
Background: Parental education is a key determinant of academic performance, yet its protective effects may differ by race and ethnicity. The concept of Minorities’ Diminished Returns (MDRs) highlights the weaker association between socioeconomic resources and outcomes for marginalized populations, including Black and Latino youth. Objective: To investigate whether the positive association between parental education and school performance (letter grades) is weaker for Black and Latino youth compared to non-Latino White youth. Methods: Data were drawn from the Monitoring the Future (MTF) 2023 study. The sample included Black, Latino, and non-Latino White youth. The outcome was a nine-level continuous measure of academic performance based on self-reported letter grades, with higher scores indicating better performance. Multivariate regression models tested interactions between parental education and race/ethnicity in predicting grades, adjusting for confounders such as family income, gender, and school characteristics. Results: A total number of 7584 12th graders entered the study. Parental education was positively associated with school performance across all groups, but the magnitude of this association was significantly smaller for Black and Latino youth compared to non-Latino White youth. Even after controlling for socioeconomic and contextual factors, the racial and ethnic differences in the strength of this association persisted. Conclusions: Our findings provide evidence of Minorities’ Diminished Returns (MDRs) in the academic domain, with Black and Latino youth experiencing weaker benefits of parental education on school performance. These disparities suggest that structural barriers and systemic inequities undermine the translation of parental educational attainment into academic success for marginalized groups. Policy interventions must address these structural barriers to promote equity in educational outcomes.
Article
Open Access February 11, 2025

Childhood Depression, Hopelessness, and Suicidal Attempt Predict Earlier Tobacco and Marijuana Use Initiation During Adolescence

Abstract Background: Emotional problems have been associated with substance use, yet longitudinal research examining this relationship during childhood and adolescence in large, diverse, community-based samples remains limited. Aims: This study investigates the prospective associations between three emotional problems—hopelessness, depression, and suicide attempts—before ages 9–10 and [...] Read more.
Background: Emotional problems have been associated with substance use, yet longitudinal research examining this relationship during childhood and adolescence in large, diverse, community-based samples remains limited. Aims: This study investigates the prospective associations between three emotional problems—hopelessness, depression, and suicide attempts—before ages 9–10 and the subsequent initiation of tobacco and marijuana use before ages 14–15, using data from the Adolescent Brain Cognitive Development (ABCD) study. Methods: Data from the ABCD study were analyzed. Baseline emotional problems, including hopelessness, depression, and suicide attempts, were assessed at ages 9–10 through structured parent interviews. Substance use outcomes (tobacco and marijuana initiation) were tracked from baseline to follow-up at ages 14–15 using structured self-report measures. Structural Equation Modeling (SEM) was employed to assess the predictive roles of these early-life emotional problems, controlling for potential confounders such as demographic factors and family and neighborhood socioeconomic status. Results: Baseline hopelessness, depression, and suicide attempts at ages 9–10 were significant predictors of tobacco and marijuana use initiation at ages 14–15. These associations remained robust after adjusting for confounders, indicating the independent effects of early emotional problems on adolescent substance use initiation. Conclusions: Emotional problems in early childhood, including hopelessness, depression, and suicidal behavior, are critical predictors of substance use initiation during adolescence. These findings underscore the importance of early identification and targeted mental health interventions to reduce the risk of substance use among vulnerable youth.
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Open Access January 10, 2025

Extreme Heat Exposure is Associated with Lower Learning, General Cognitive Ability, and Memory among US Children

Abstract Background: The increasing frequency and intensity of extreme heat exposure is a significant consequence of climate change, with broad public health implications. While many health risks associated with heat exposure are well-documented, less research has focused on its impact on children’s cognitive function. Objectives: This study examines the [...] Read more.
Background: The increasing frequency and intensity of extreme heat exposure is a significant consequence of climate change, with broad public health implications. While many health risks associated with heat exposure are well-documented, less research has focused on its impact on children’s cognitive function. Objectives: This study examines the relationship between extreme heat exposure and various domains of cognitive function in children. Methods: Data were drawn from the Adolescent Brain Cognitive Development (ABCD) study. Key variables included race/ethnicity, age, gender, family socioeconomic status (SES), heatwave exposure, and multiple cognitive domains: total composite score, fluid composite score, crystallized intelligence, reading ability, picture vocabulary, pattern recognition, card sorting, and list recall. Structural equation modeling (SEM) was used for data analysis. Results: A total of 11,878 children were included in the analysis. Findings revealed significant associations between extreme heat exposure and lower cognitive performance across multiple domains. The strongest adjusted effects were observed in pattern recognition (B = −0.064, p < 0.001) and reading ability (B = −0.050, p < 0.001), both within the learning domain, as well as total composite cognitive ability (B = −0.067, p < 0.001), fluid composite (B = −0.053, p < 0.001), and crystallized intelligence (B = −0.061, p < 0.001), all within general cognitive ability. Weaker but still significant associations were found for list recall (B = −0.025, p = 0.006) and card sorting (B = −0.043, p < 0.001) within the memory domain, as well as picture vocabulary (B = −0.025, p = 0.008) within general cognitive ability. These associations remained significant after controlling for demographic factors, race/ethnicity, family SES, and neighborhood SES. Conclusions: This study underscores the impact of climate change on cognitive function disparities, particularly in learning and general cognitive ability among children exposed to extreme heat. Findings highlight the need for targeted interventions to mitigate the cognitive risks associated with heat exposure in vulnerable populations.
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Open Access February 10, 2025

Higher-than Expected Social Security Reliance Among Educated Black Americans: Minorities' Diminished Returns in National Health Interview Survey (NHIS) 2023

Abstract Background: While educational attainment is generally associated with reduced reliance on Social Security and disability benefits, Minorities' Diminished Returns (MDRs) theory suggests that the socioeconomic benefits of educational attainment are not equally distributed across racial groups and are weaker for minoritized populations. This study explores the association between educational [...] Read more.
Background: While educational attainment is generally associated with reduced reliance on Social Security and disability benefits, Minorities' Diminished Returns (MDRs) theory suggests that the socioeconomic benefits of educational attainment are not equally distributed across racial groups and are weaker for minoritized populations. This study explores the association between educational attainment and reliance on Social Security and disability benefits among Black and White adults in the United States. Objective: Building on the MDRs framework, we analyzed data from the National Health Interview Survey (NHIS) 2023 to examine how educational attainment impacts reliance on Social Security disability income, disability benefits, and public assistance for Black and White adults. Methods: We used a nationally representative sample of Black and White adults from the NHIS 2023 dataset. The outcomes assessed were reliance on three income sources: (1) Social Security disability income, (2) disability benefit income, and (3) public assistance disability income. Educational attainment was classified into three levels: less than high school (reference), high school diploma to some college, and college graduate or more. Logistic regression models assessed the relationship between educational attainment and reliance on each income source, with separate analyses for Black and White adults to evaluate differential effects. Results: Higher levels of educational attainment (high school diploma to some college and college graduate or more) were associated with lower odds of relying on Social Security disability, disability benefits, and public assistance. However, the protective effects of educational attainment were notably stronger for White adults than for Black adults. Among Black adults, even high educational attainment showed limited effectiveness in reducing reliance on these income sources, underscoring the Minorities' Diminished Returns (MDRs) phenomenon. Conclusions: Although educational attainment reduces reliance on Social Security and disability-related income sources, these protective effects are less pronounced for Black adults compared to White adults. The findings reveal persistent racial disparities in the economic returns of education, suggesting that structural factors may undermine the socioeconomic and health benefits of educational achievement for Black Americans. Targeted policy interventions may be needed to improve economic stability for Black adults, including those with higher educational credentials.
Article
Open Access February 10, 2025

Diminished Returns of Educational Attainment on Welfare Receipt of American Indian/Alaska Native People: National Health Interview Survey (NHIS) 2023

Abstract Background: Educational attainment is generally associated with reduced reliance on Social Security and disability benefits; however, the Minorities' Diminished Returns (MDRs) theory suggests that the socioeconomic benefits of education are weaker for minoritized populations. This study investigates the relationship between educational attainment and welfare receipt among American [...] Read more.
Background: Educational attainment is generally associated with reduced reliance on Social Security and disability benefits; however, the Minorities' Diminished Returns (MDRs) theory suggests that the socioeconomic benefits of education are weaker for minoritized populations. This study investigates the relationship between educational attainment and welfare receipt among American Indian/Alaska Native (AIAN) and White adults in the United States. Objective: Using the MDRs framework, we analyzed data from the National Health Interview Survey (NHIS) 2023 to examine how educational attainment impacts welfare receipt among AIAN and White adults. Methods: We analyzed a nationally representative sample of AIAN and White adults from the NHIS 2023 dataset. Welfare receipt was assessed as the receipt of any public assistance or welfare payments from state or local welfare offices. Educational attainment was categorized into three levels: less than high school (reference), high school diploma to some college, and college degree or higher. Logistic regression models were used to assess the relationship between educational attainment and welfare receipt, with separate analyses for AIAN and White adults to evaluate differential effects. Results: Higher educational attainment (high school diploma to some college and college degree or higher) was associated with lower odds of welfare receipt across both groups. However, the protective effect of a college degree was significantly weaker for AIAN adults compared to White adults. Consequently, AIAN adults remain at a higher risk of welfare reliance even with higher education, consistent with the Minorities' Diminished Returns (MDRs) framework. Conclusions: Although educational attainment generally reduces welfare reliance, this protection is less pronounced for AIAN adults than for White adults. This discrepancy suggests that structural factors, segregation, and social stratification may undermine the economic and health benefits of education for racialized groups in the U.S. Addressing these disparities requires policy interventions that extend beyond education, emphasizing quality job opportunities, healthcare access, and reduced labor market discrimination for individuals with advanced educational credentials, regardless of race.
Article
Open Access February 07, 2025

CEASE Tobacco Cessation Program: Validation of Self-Rated Quit with Fagerstrom Test for Nicotine Dependence

Abstract Background: Despite advancements in smoking cessation interventions, few programs have demonstrated sustained effectiveness among low-income, underserved populations. The Communities Engaged and Advocating for a Smoke-free Environment (CEASE) program was developed to address this gap and support tobacco cessation in these communities. However, it remains unclear whether self-reported [...] Read more.
Background: Despite advancements in smoking cessation interventions, few programs have demonstrated sustained effectiveness among low-income, underserved populations. The Communities Engaged and Advocating for a Smoke-free Environment (CEASE) program was developed to address this gap and support tobacco cessation in these communities. However, it remains unclear whether self-reported outcome measures in this context are in line with more objective outcome measures. Aims: This study aimed to validate self-reported quit rates using the Fagerström Test for Nicotine Dependence (FTND) as a gold standard outcome measure for evaluation of the effectiveness of the CEASE smoking cessation intervention compared to a self-help approach among low-income, underserved adult smokers. Methods: A quasi-experimental design was employed to evaluate this community-based intervention. Although participants were initially assigned to three groups, this report focuses on two arms that show the major difference in the efficacy of the program: (1) the self-help group (reference; Arm 1) and (2) the in-person CEASE group (Arm 2). Outcomes included successful quitting, assessed through self-reports, and changes in FTND scores. To examine the concordance between these measures, we tested whether changes in FTND scores fully explained the relationship between the intervention and self-reported quitting. Potential confounders included demographic, socioeconomic, and health-related variables. Data were analyzed using regression and structural equation modeling (SEM). Results: The majority of participants were Black Americans, followed by White individuals and those of other racial backgrounds. The CEASE intervention (Arm 2) demonstrated effectiveness in reducing nicotine dependence (measured by FTND) and increasing self-reported quit rates compared to the self-help group. Importantly, changes in FTND scores fully explained the effect of the CEASE intervention on self-reported quitting, highlighting the program’s impact on addiction severity. Conclusion: Successful quitting measured using self-report is in line with the decline in nicotine addiction severity among low-income racial minority populations. CEASE holds promise as a scalable solution to address smoking disparities in underserved communities.
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Open Access January 24, 2025

High Socioeconomic Status Black Adolescents Attend Worse Schools than Whites

Abstract Background: School characteristics — including poverty levels, teacher experience, graduation rates, and college enrollment — are essential determinants of students’ academic outcomes and long-term success. Families often use their socioeconomic resources, such as parental education and household income, to secure access to high-quality schools with favorable attributes. However, [...] Read more.
Background: School characteristics — including poverty levels, teacher experience, graduation rates, and college enrollment — are essential determinants of students’ academic outcomes and long-term success. Families often use their socioeconomic resources, such as parental education and household income, to secure access to high-quality schools with favorable attributes. However, Minorities’ Diminished Returns (MDRs) theory suggests that Black families may not experience the same benefits of high family SES due to structural barriers. This study examines the association between family SES and school characteristics, focusing on racial disparities in access to high-quality educational environments. Objective: To investigate the relationship between family SES (parental education and household income) and multiple school characteristics (poverty, teacher experience, graduation rates, and college enrollment), and to assess racial differences in these associations. Methods: Data from the Adolescent Brain Cognitive Development (ABCD) study, a national sample of US adolescents, was analyzed. We used multivariate regression models to examine associations between family SES and school characteristics and to test for interactions by race, specifically comparing Black and White adolescents. Results: Higher family SES was associated with positive school characteristics overall, including lower school poverty, greater teacher experience, and increased graduation and college enrollment rates. However, these positive effects of high family SES on school characteristics were significantly weaker for Black adolescents than for White adolescents. Black adolescents from high-income families were more likely than White adolescents from similar backgrounds to attend schools with higher poverty rates, less experienced teachers, and reduced graduation and college enrollment rates. Conclusion: Our findings highlight persistent racial inequities in access to educational opportunities, even among families with comparable socioeconomic resources. The diminished returns of family SES for Black adolescents underscore the role of structural barriers in limiting access to high-quality schools. These findings emphasize the need for policy interventions to address systemic inequalities that hinder Black families from fully leveraging their SES to access favorable educational environments.
Article
Open Access January 24, 2025

Neurocognitive, Emotional, and Behavioral Costs for Adolescents Due to Diminished Returns of Parental Employment on Trauma

Abstract Background: Parental employment is a significant social determinant of children's developmental outcomes, shaping their cognitive and behavioral trajectories. However, the effects of parental employment may not be equally protective across racial groups. The Minority Diminished Returns (MDRs) framework suggests that socioeconomic status (SES) factors, such as employment, yield fewer [...] Read more.
Background: Parental employment is a significant social determinant of children's developmental outcomes, shaping their cognitive and behavioral trajectories. However, the effects of parental employment may not be equally protective across racial groups. The Minority Diminished Returns (MDRs) framework suggests that socioeconomic status (SES) factors, such as employment, yield fewer protective benefits for Black families compared to White families. Objective: This study investigates the diminished returns of parental employment on trauma and associated neurocognitive and behavioral outcomes in children, with a focus on racial variation in these effects. Methods: Using data from the Adolescent Brain Cognitive Development (ABCD) study, a large and diverse sample of children was analyzed. We applied MDRs theory and social determinants of health frameworks to examine the association between parental employment, trauma, and children's cognitive and behavioral outcomes. The analysis controlled for family SES, neighborhood factors, and racial group differences. Results: Preliminary findings suggest that while parental employment is generally protective against trauma, the strength of this association is diminished for Black children. Black families with employed parents experience higher levels of trauma and stress compared to their White counterparts, which may contribute to racial disparities in cognitive and behavioral outcomes. Conclusion: Parental employment may not equally buffer against trauma-related risks for Black children, reflecting the broader pattern of diminished returns for racially disadvantaged groups. These findings highlight the need for policies addressing the unequal benefits of SES across racial groups.
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Open Access January 24, 2025

Pallidum Functional Hypoconnectivity and Inhibitory Control as Partial Mediators of Environmental Influences on Tobacco and Marijuana Initiation

Abstract Background: Low socioeconomic status (SES) has been linked to higher rates of tobacco and marijuana use initiation; however, the contributions of environmental and neurocognitive factors remain underexplored. This study investigates a potential pathway connecting low SES, fine particulate matter (PM2.5) exposure, brain functional connectivity, and inhibitory control to increased [...] Read more.
Background: Low socioeconomic status (SES) has been linked to higher rates of tobacco and marijuana use initiation; however, the contributions of environmental and neurocognitive factors remain underexplored. This study investigates a potential pathway connecting low SES, fine particulate matter (PM2.5) exposure, brain functional connectivity, and inhibitory control to increased tobacco and marijuana use initiation among adolescents. Objectives: To examine the mediating roles of PM2.5 exposure, resting-state functional connectivity between the right pallidum and the ventral attention network (P-VAN rsFC), and inhibitory control in the relationship between low SES and tobacco and marijuana use initiation. Methods: Data were drawn from the Adolescent Brain Cognitive Development (ABCD) study to assess associations between baseline SES, baseline PM2.5 exposure (based on zip code), baseline P-VAN rsFC, baseline inhibitory control, and subsequent tobacco and marijuana use initiation. Mediation models were used to determine whether PM2.5 exposure and changes in P-VAN rsFC act as pathways linking low SES to diminished inhibitory control and subsequent substance use initiation. Results: Low SES was associated with higher PM2.5 exposure, which, in turn, was linked to alterations in P-VAN rsFC. These alterations were correlated with lower inhibitory control, which significantly predicted tobacco and marijuana use initiation over time. Inhibitory control partially mediated the relationship between low SES and substance use initiation, indicating a complex pathway influenced by environmental and neurocognitive factors. Conclusions: This study identifies a potential mechanism linking low SES to tobacco and marijuana use initiation through environmental and neurobiological pathways. Understanding how PM2.5 exposure and neurofunctional connectivity impact inhibitory control can provide valuable insights for developing targeted interventions to reduce substance use among adolescents in low SES environments.
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Open Access January 23, 2025

Weaker Effects of Educational Attainment on Chronic Medical Conditions in American Indian Alaska Native, Black, and Latino Adults: National Health Interview Survey 2023

Abstract Background: Chronic medical conditions are major drivers of healthcare spending, morbidity, and mortality in the United States, as well as critical indicators of health disparities. The disproportionately high rates of chronic medical conditions among Black, Latino, and American Indian and Alaska Native adults compared to non-Latino Whites highlight the urgent need to examine the factors [...] Read more.
Background: Chronic medical conditions are major drivers of healthcare spending, morbidity, and mortality in the United States, as well as critical indicators of health disparities. The disproportionately high rates of chronic medical conditions among Black, Latino, and American Indian and Alaska Native adults compared to non-Latino Whites highlight the urgent need to examine the factors contributing to these disparities. While higher socioeconomic status is generally associated with better health outcomes, this benefit may be diminished for racialized and minoritized populations. Objective: This study investigates the protective effects of educational attainment and income-to-poverty ratio on the prevalence of chronic medical conditions and examines whether these effects vary across racial and ethnic groups, specifically among Black, Latino, and American Indian and Alaska Native adults compared to non-Latino White adults. Methods: Using data from the 2023 National Health Interview Survey (NHIS), this cross-sectional study analyzed the association between educational attainment and chronic medical conditions across racial and ethnic groups. Logistic regression models were employed to assess whether the strength of the relationship between education and chronic medical conditions differed by racial/ethnic group, controlling for key demographic and socioeconomic covariates. Sample size was 29,373 which was reflective of 256,566,689 US population. Results: Consistent with the theory of Minorities' Diminished Returns, findings showed that the protective effects of higher educational attainment on chronic medical conditions were significantly weaker for Black, Latino, and American Indian and Alaska Native adults than for their non-Latino White counterparts. Even among individuals with higher education, Black, Latino, and American Indian and Alaska Native adults faced elevated risks of chronic medical conditions. Conclusion: While educational attainment generally reduces the prevalence of chronic medical conditions, this protective effect is moderated by racial and ethnic background. Structural barriers limit the health benefits of educational attainment. This underscores the need for policies that address structural inequities—such as low-quality education and occupational segregation—that constrain the protective health effects of educational attainment for minoritized groups.
Article
Open Access January 23, 2025

Diminished Returns of Educational Attainment on Hypertension Prevalence among American Indian and Alaska Native Adults: National Health Interview Survey 2023

Abstract Background: Research on Minorities’ Diminished Returns (MDRs) consistently reveals that social determinants of health, especially educational attainment, do not yield equal health benefits across racial and ethnic groups in the United States. MDRs suggest that social stratification, segregation, lower education quality, and labor market discrimination contribute to diminished health returns [...] Read more.
Background: Research on Minorities’ Diminished Returns (MDRs) consistently reveals that social determinants of health, especially educational attainment, do not yield equal health benefits across racial and ethnic groups in the United States. MDRs suggest that social stratification, segregation, lower education quality, and labor market discrimination contribute to diminished health returns of education among minoritized groups. However, few studies have tested the relevance of MDRs in American Indian and Alaska Native (AIAN) populations compared to non-Hispanic White adults. Objectives: This study aimed to examine the strength of the inverse association between educational attainment and hypertension prevalence, hypothesizing that the protective effect of education on hypertension risk is reduced among AIAN adults relative to non-Hispanic Whites. Methods: Using data from the 2023 National Health Interview Survey (NHIS), we analyzed a nationally representative sample of adults aged 18 and older. Logistic regression models examined the association between educational attainment and self-reported hypertension diagnosis, stratified by racial/ethnic group (AIAN vs. non-Hispanic White). Models were adjusted for key covariates, including age, gender, income, and insurance status. Results: Higher educational attainment was associated with a lower prevalence of hypertension in the combined sample of AIAN and non-Hispanic White adults. However, this protective association was significantly weaker among AIAN adults compared to non-Hispanic White adults, as evidenced by a significant interaction between race and education. Conclusion: AIAN adults exhibit a higher prevalence of hypertension even at higher levels of educational attainment compared to non-Hispanic White adults, supporting the relevance of MDRs for AIAN populations. This finding underscores the need for public health interventions that address structural barriers and contextual factors unique to AIAN populations. Policies focused solely on educational access may be insufficient to reduce hypertension risk among AIAN adults without addressing broader social and structural inequities.
Article
Open Access January 23, 2025

Trauma and Early Puberty May Be Stronger Predictors of Early Tobacco Initiation in Girls Compared to Boys

Abstract Objective: This study investigates the pathways linking socioeconomic status (SES), trauma, early puberty, and tobacco use, with a focus on how these relationships differ by sex. Using data from the Adolescent Brain Cognitive Development (ABCD) study, we explore how SES and race contribute to trauma exposure, which in turn may influence early puberty and tobacco use. The study also examines [...] Read more.
Objective: This study investigates the pathways linking socioeconomic status (SES), trauma, early puberty, and tobacco use, with a focus on how these relationships differ by sex. Using data from the Adolescent Brain Cognitive Development (ABCD) study, we explore how SES and race contribute to trauma exposure, which in turn may influence early puberty and tobacco use. The study also examines potential mediating effects of trauma and early puberty on the association between SES and tobacco use, while comparing these pathways for males and females. Methods: Data were drawn from the ABCD study, and structural equation modeling (SEM) was employed to test direct and indirect pathways between SES, trauma, early puberty, and tobacco use. The sample was stratified by sex to assess differences in these relationships for males and females. Key predictors included SES, race, and age, while outcomes were trauma, early puberty, and tobacco use. The model assessed mediating effects of trauma and early puberty on tobacco use. Results: Trauma was a significant predictor of early puberty for females (B = 0.032, SE = 0.015, p = 0.039) but not males. Early puberty was significantly linked to tobacco use for females (B = 0.048, SE = 0.015, p = 0.001) but not for males. Additionally, trauma had an effect on tobacco use among females (B = 0.048, SE = 0.014, p < 0.001) but not males. Lower SES was significantly associated with higher trauma exposure for both males (B = -0.109, SE = 0.014, p < 0.001) and females (B = -0.110, SE = 0.015, p < 0.001). Conclusions: The findings suggest that trauma and early puberty play more significant roles in the pathways from SES to tobacco use for females than for males. While trauma and early puberty are crucial mediators for females, these factors are less predictive for males. These results highlight the importance of sex-specific interventions targeting trauma and early puberty as pathways to early tobacco use.
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Open Access January 22, 2025

Tech Transformations: Modern Solutions for Obstructive Sleep Apnea

Abstract Recent advancements in the screening, diagnosis, and management of obstructive sleep apnea (OSA) have significantly improved patient outcomes. For screening, the use of home sleep apnea testing (HSAT) has become more prevalent, offering a convenient and cost-effective alternative to traditional in-lab polysomnography. HSAT devices have shown good specificity and sensitivity, particularly in [...] Read more.
Recent advancements in the screening, diagnosis, and management of obstructive sleep apnea (OSA) have significantly improved patient outcomes. For screening, the use of home sleep apnea testing (HSAT) has become more prevalent, offering a convenient and cost-effective alternative to traditional in-lab polysomnography. HSAT devices have shown good specificity and sensitivity, particularly in patients with a high pre-test probability of OSA. In terms of diagnosis, advancements in wearable technology and mobile health applications have enabled continuous monitoring of sleep patterns and respiratory parameters. These tools provide valuable data that can be used to identify OSA more accurately and promptly. Additionally, machine learning algorithms are being integrated into diagnostic processes to enhance the accuracy of OSA detection by analyzing large datasets and identifying patterns indicative of the condition. Management of OSA has also seen significant progress. Continuous positive airway pressure (CPAP) therapy remains the gold standard, but new developments include auto-adjusting CPAP devices that optimize pressure settings based on real-time feedback. Mandibular advancement devices and hypoglossal nerve stimulation are emerging as effective alternatives for patients who are CPAP-intolerant. Furthermore, lifestyle interventions such as weight management, positional therapy, and exercise have been shown to complement medical treatments, leading to better overall outcomes. This review article highlights these advancements that collectively contribute to improved patient adherence, reduced symptoms, and enhanced quality of life for individuals with OSA.
Review Article
Open Access January 21, 2025

A Disaster Management Contingency and Training Plan for Nursing Service Personnel

Abstract Background: Disasters such as typhoons, floods, and earthquakes frequently impact the Philippines, placing nurses at the forefront of response and care. Given these recurring threats, ensuring that nurses possess adequate awareness, knowledge, and skills is crucial to mitigate risks, enhance preparedness, and promote effective disaster management. Aim/Objectives: This study sought to [...] Read more.
Background: Disasters such as typhoons, floods, and earthquakes frequently impact the Philippines, placing nurses at the forefront of response and care. Given these recurring threats, ensuring that nurses possess adequate awareness, knowledge, and skills is crucial to mitigate risks, enhance preparedness, and promote effective disaster management. Aim/Objectives: This study sought to (1) assess the current levels of awareness, knowledge, skills, and involvement of private hospital nurses in Rizal Province across four phases of disaster management—mitigation and prevention, preparedness, response, and rehabilitation and recovery; and (2) propose a contingency and training plan based on identified gaps. Methods: A descriptive correlational design was employed. A total of 350 nurses from Level 1, 2, and 3 hospitals participated by completing a validated questionnaire. Data were analyzed using descriptive statistics, analysis of variance, and correlation tests to identify differences and relationships among variables. Results: Overall, the nurses reported very high levels of awareness and skills, coupled with a high level of knowledge and significant involvement in disaster-related activities. Nurses in larger (Level 3) hospitals exhibited higher practical readiness and engagement, while those in Level 1 and 2 facilities had comparatively lower scores. Positive correlations emerged between higher levels of awareness, knowledge, and skills and increased engagement in disaster initiatives. Conclusion: Building on these findings, a targeted contingency and training plan was designed using Pucel’s Performance-based Instructional Design, emphasizing hands-on simulations, structured policy briefings, and collaborative efforts with local disaster risk reduction offices. Addressing these specific gaps can bolster hospital preparedness, strengthen community resilience, and ensure more effective disaster response and patient care.
Article
Open Access January 20, 2025

Deep Learning-Based Sentiment Analysis: Enhancing IMDb Review Classification with LSTM Models

Abstract Sentiment analysis, a vital aspect of natural language processing, involves the application of machine learning models to discern the emotional tone conveyed in textual data. The use case for this type of problem is where businesses can make informed decisions based on customer feedback, identify the sentiments of their employees, and make decisions on hiring or retention, or for that matter, [...] Read more.
Sentiment analysis, a vital aspect of natural language processing, involves the application of machine learning models to discern the emotional tone conveyed in textual data. The use case for this type of problem is where businesses can make informed decisions based on customer feedback, identify the sentiments of their employees, and make decisions on hiring or retention, or for that matter, classify a text based on its topic like whether it is about a particular subject like physics or chemistry as is useful in search engines. The model leverages a sequential architecture, transforms words into dense vectors using an Embedding layer, and captures intricate sequential patterns with two Long Short-Term Memory (LSTM) layers. This model aims to effectively classify sentiments in text data using a 50-dimensional embedding dimension and 20 % dropout layers. The use of rectified linear unit (ReLU) activations enhances non-linearity, while the SoftMax activation in the output layer aligns with the multi-class nature of sentiment analysis. Both training and test accuracy were well over 80%.
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Open Access January 16, 2025

Extreme Heat Exposure and Adolescent Cognitive Function

Abstract Background: Extreme heat exposure is an increasing public health concern, particularly in the context of climate change. Limited research has explored its impact on children's cognitive outcomes. This study investigates the association between extreme heat exposure and cognitive function in 9–10-year-old children, using data from the Adolescent Brain Cognitive Development (ABCD) study. [...] Read more.
Background: Extreme heat exposure is an increasing public health concern, particularly in the context of climate change. Limited research has explored its impact on children's cognitive outcomes. This study investigates the association between extreme heat exposure and cognitive function in 9–10-year-old children, using data from the Adolescent Brain Cognitive Development (ABCD) study. Additionally, we assess whether this effect is independent of socio-demographic factors such as race, family socioeconomic status (SES), and neighborhood SES. Methods: Data were drawn from the ABCD study, comprising over 10,000 children aged 9–10 years. Cognitive function was assessed through standardized cognitive tests, while extreme heat exposure was estimated using geographic and climate data. Structural equation modeling (SEM) was employed to examine the direct effects of heat exposure on cognitive outcomes and to account for potential confounding variables, including race, family SES, and neighborhood SES. Results: Black families, low SES households, and children from low SES neighborhoods were disproportionately exposed to extreme heat. Extreme heat exposure was significantly associated with lower cognitive function in children, and this association remained robust even after adjusting for socio-demographic factors. Conclusions: Extreme heat exposure is linked to diminished cognitive function in children, particularly among socio-economically disadvantaged and marginalized populations. Given the increasing frequency of extreme heat events due to climate change, future research should further explore these implications for children’s cognitive outcomes. Policy interventions that improve access to cooling infrastructure, expand green spaces, and prioritize at-risk populations are critical to mitigating the adverse cognitive effects of extreme heat in low SES communities.
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Open Access January 16, 2025

Heat Exposure Predicts Earlier Childhood Pubertal Initiation, Behavioral Problems, and Tobacco Use

Abstract Background: Climate change has raised significant concerns about its impact on health, particularly for vulnerable populations such as children and adolescents. While extensive research has examined physical health effects, limited attention has been given to the influence of extreme heat on developmental and behavioral outcomes. Objectives: This study investigates the association [...] Read more.
Background: Climate change has raised significant concerns about its impact on health, particularly for vulnerable populations such as children and adolescents. While extensive research has examined physical health effects, limited attention has been given to the influence of extreme heat on developmental and behavioral outcomes. Objectives: This study investigates the association between extreme heat exposure and early puberty initiation (ages 9-10), using data from the Adolescent Brain Cognitive Development (ABCD) study. It further explores how early puberty correlates with behavioral problems and tobacco use initiation. Methods: Data from 11,878 participants in the ABCD study were analyzed to examine the relationship between extreme heat exposure (independent variable) and puberty initiation (outcome). Behavioral problems and tobacco use initiation were evaluated as downstream outcomes of early puberty. Covariates included age, sex, and race/ethnicity, and behavioral problems were assessed using the Child Behavior Checklist (CBCL). Structural equation modeling (SEM) was employed for analysis. Results: Extreme heat exposure was significantly associated with earlier puberty initiation at ages 9-10. Early puberty, in turn, correlated with higher levels of behavioral problems and an increased likelihood of tobacco use initiation. Conclusions: These findings underscore the importance of addressing environmental factors such as extreme heat to reduce risks associated with early maturation, including behavioral and substance use challenges. Targeted interventions and policies are needed to mitigate the impact of extreme heat on child development, and longitudinal studies are essential to confirm these results and inform effective prevention strategies.
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Open Access January 09, 2025

Advances in the Synthesis and Optimization of Pharmaceutical APIs: Trends and Techniques

Abstract The synthesis and optimization of Active Pharmaceutical Ingredients (APIs) is fundamental to pharmaceutical drug development, directly influencing drug efficacy, safety, and cost-effectiveness. Over recent years, significant advancements in synthetic methodologies and manufacturing technologies have transformed API production. This manuscript provides an overview of the latest innovations in API [...] Read more.
The synthesis and optimization of Active Pharmaceutical Ingredients (APIs) is fundamental to pharmaceutical drug development, directly influencing drug efficacy, safety, and cost-effectiveness. Over recent years, significant advancements in synthetic methodologies and manufacturing technologies have transformed API production. This manuscript provides an overview of the latest innovations in API synthesis, focusing on key techniques such as green chemistry, continuous flow chemistry, biocatalysis, and automation. Green chemistry principles, including solvent substitution and catalytic reactions, have enhanced sustainability by reducing waste and energy consumption. Continuous flow chemistry offers improved reaction control, scalability, and safety, while biocatalysis provides an eco-friendly alternative for synthesizing complex and chiral APIs. Additionally, the integration of automation and advanced process control using machine learning and real-time monitoring has optimized production efficiency and consistency. The manuscript also discusses the challenges associated with regulatory compliance and quality assurance, highlighting the role of advanced analytical techniques such as HPLC, NMR, and mass spectrometry in ensuring API purity. Looking ahead, personalized medicine and smart manufacturing technologies, including blockchain for traceability, are expected to drive further innovation in API production. This review concludes by emphasizing the need for continued advancements in sustainability, efficiency, and scalability to meet the evolving demands of the pharmaceutical industry, ultimately enabling the development of safer, more effective, and environmentally responsible medicines.
Review Article
Open Access December 06, 2024

An Appraisal of Availability and Use of Protective Clothing for Workers in Ghana

Abstract The study aimed to examine the availability of protective clothing and its usage among workers at the University of Cape Coast in the central region of Ghana. It used the Accident-Proneness Theory and the Theory of Reasoned Action to achieve the study's objectives. The study adopted the positivist research paradigm. The study used a descriptive design with mixed methods. The study population [...] Read more.
The study aimed to examine the availability of protective clothing and its usage among workers at the University of Cape Coast in the central region of Ghana. It used the Accident-Proneness Theory and the Theory of Reasoned Action to achieve the study's objectives. The study adopted the positivist research paradigm. The study used a descriptive design with mixed methods. The study population comprised all workers and supervisors whose work demands the use of protective clothing at the University of Cape Coast. The study used multistage sampling techniques (stratified, purposive, proportional and Systematic random sampling techniques) to select one hundred and ninety-six departmental workers and five (5) supervisors in the University. The main instruments for data collection were a Semi-structured questionnaire and an unstructured interview guide. Mean and standard deviation, frequency count, and percentages were used to analyse the quantitative data. The qualitative data was analysed through the development of data categories and themes. The study concluded that “not all the protective clothing for the various departments were available. The University ensured that workers used what was in stock at the department. The protective clothing supplied to the various departments was insufficient, so their continuous use of the existing ones got them defaced, bringing about shortages. The study also revealed that workers used protective clothing most often, but not all used it because safety laws were relaxed. The study recommended that the University ensure a regular and adequate supply of PPC, insist on its usage, and enforce the use of PPC by all workers whose work demands it.
Article
Open Access November 27, 2024

Bead Jewellery Industry in Ghana: Problems and Solutions

Abstract Bead jewellery is common in all Ghanaian communities. Bead jewellers are well-known for their important bead jewellery production and have advanced to the Master craft level. The industry can be utilized if the industry's difficulties are discovered and remedied. The study area for the research includes Ghana's Eastern, Ashanti, and Greater Accra Regions. The study's population included bead [...] Read more.
Bead jewellery is common in all Ghanaian communities. Bead jewellers are well-known for their important bead jewellery production and have advanced to the Master craft level. The industry can be utilized if the industry's difficulties are discovered and remedied. The study area for the research includes Ghana's Eastern, Ashanti, and Greater Accra Regions. The study's population included bead jewellers, bead jewellery firms, bead dealers, bead aficionados, clients, and bead makers. With a sample size of 30, data was gathered mostly through direct observations, interviews, and document reviews. The study went over the procedure for securing land for a bead jewellery workshop. According to a survey conducted by the Ghanaian Chamber of Commerce and Industry (GCCII), Ghanaian bead jewellers should use qualified designers. Cost pooling in legal services, accounting, and consulting is likely to save money.
Case Study
Open Access November 23, 2024

Digital Design as a Tool for Assessing Attitudes

Abstract This study investigated the use of digital design as a tool for assessing attitudes among male sex offenders by exploring how artistic expression can reveal complex emotional landscapes related to their crimes. The study utilized digital paintings, a type of digital design that involves creating artwork using digital tools and software. Digital painting tools allowed the researcher to simulate [...] Read more.
This study investigated the use of digital design as a tool for assessing attitudes among male sex offenders by exploring how artistic expression can reveal complex emotional landscapes related to their crimes. The study utilized digital paintings, a type of digital design that involves creating artwork using digital tools and software. Digital painting tools allowed the researcher to simulate traditional painting techniques, while benefiting from the flexibility and versatility of digital media. It is essential to comprehend and address offenders’ attitudes towards sexual crimes to create prevention and rehabilitation plans that work. The effectiveness of digital paintings that illustrate the consequences of sexual crimes on offender, victim and the offender’s family was examined in this study. The study examined whether exposure to these visual representations could result in a quantifiable decrease in supporting attitudes toward sexual crimes by comparing participants' pre-test and post-test attitudes using the Crime Pics II tool. There is little research on how visual cues can change offenders' attitudes and perceptions, despite the urgent need for creative evaluation techniques in this delicate field. This study adds to the continuing conversation on crime prevention and offender rehabilitation by demonstrating how well digital design can change perceptions of sexual crimes. A total of 61 male convicts of defilement and rape were purposively sampled for the study. The study utilized an art exhibition and Rapid Serial Visual Presentation format to repeatedly display digital paintings to participants aged 18-45. The artwork produced in both monochrome and polychrome schemes and in realist and surrealist styles was designed to elicit immediate emotional and cognitive responses. Qualitative and quantitative analyses of the participants' responses and reflections provided important insights into their attitudes, including sentiments of regret and guilt as well as a sophisticated awareness of the wider effects of their behaviour. Monochrome paintings tended to portray darker emotions, whereas polychrome paintings showed a wider range of emotions, including hope and recognition of the harm done. The findings demonstrate that digital design can effectively support offenders' emotional processing and self-reflection, demonstrating its potential as a helpful tool in rehabilitative and assessment contexts.
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Open Access November 21, 2024

Financial Strain Partially Explains Diminished Returns of Parental Education in the ABCD Study

Abstract Background: Previous research shows that socioeconomic status (SES) positively impacts children's development, yet the benefits are not equally distributed across racial groups. According to the Minorities’ Diminished Returns (MDRs) framework, Black children tend to experience smaller gains from parental education compared to White children. Objective: Building on the MDRs framework, [...] Read more.
Background: Previous research shows that socioeconomic status (SES) positively impacts children's development, yet the benefits are not equally distributed across racial groups. According to the Minorities’ Diminished Returns (MDRs) framework, Black children tend to experience smaller gains from parental education compared to White children. Objective: Building on the MDRs framework, this study examines whether high financial strain contributes to the diminished returns of parental education for Black children, using data from the Adolescent Brain Cognitive Development (ABCD) Study. We hypothesized that: (1) there would be a positive effect of parental education on total cortical volume, (2) this effect would be weaker for Black than White children, and (3) higher household financial strain in Black families would mediate the diminished returns of parental education on total cortical volume for Black children. Methods: Data were drawn from the baseline ABCD Study, focusing on 7,936 9- and 10-year-old children identified as either Black (n = 1,775) or White (n = 6,161). Parental education was the key independent variable, covariates included age, sex, household income, and marital status, race was the moderator, financial strain was the mediator, and total cortical volume was the outcome. Structural Equation Models (SEMs) were employed to examine the associations between parental education and cortical volume, with financial strain as a mediator and race as a moderator. Results: Higher parental education was associated with greater cortical volume in the pooled sample. However, this effect was significantly weaker for Black children. Financial strain partially mediated the observed diminished returns of parental education. Conclusion: High financial strain experienced by middle-class Black families partially explains why the association between parental education and child development is weaker in Black than White families. Interventions aimed at enhancing educational quality, increasing employability, expanding access to higher-paying jobs, and reducing labor market discrimination against Black individuals may help address racial inequities in child development in the U.S. Efforts to reduce financial strain should extend beyond low-income populations to also support higher-educated minority families.
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Open Access November 21, 2024

Unequal Returns: Education Fails to Fully Prepare Black and Latino Americans for Retirement

Abstract Background: Retirement is a universal life stage, marking the culmination of an individual's working years. However, many people face financial challenges during retirement due to insufficient financial planning. Retirement preparedness is essential for ensuring economic security and maintaining a high quality of life in later years. Education is often viewed as a key driver of retirement [...] Read more.
Background: Retirement is a universal life stage, marking the culmination of an individual's working years. However, many people face financial challenges during retirement due to insufficient financial planning. Retirement preparedness is essential for ensuring economic security and maintaining a high quality of life in later years. Education is often viewed as a key driver of retirement preparedness, as it is linked to higher earnings, better financial literacy, and improved decision-making. However, the Minorities' Diminished Returns (MDRs) theory suggests that the economic, cognitive, and behavioral benefits of education are weaker for racial and ethnic minorities compared to non-Latino Whites. Objective: This study aims to examine the relationship between educational attainment and retirement preparedness, focusing on whether this association differs among Black, Latino, and non-Latino White individuals, using data from the Understanding America Study (UAS). Methods: Data were drawn from the UAS, a nationally representative internet-based panel survey. The sample included participants from diverse racial and ethnic backgrounds. Linear regression models were used to evaluate the association between educational attainment, measured in years of schooling, and retirement preparedness. Interaction terms were included to test whether the association varied by race and ethnicity. Models were adjusted for potential confounders, including age, sex, marital status, employment status, and immigration. Results: In the overall sample, higher educational attainment was significantly and positively associated with better retirement preparedness (p < 0.001). However, consistent with the MDRs framework, the strength of this association was significantly weaker for Black and Latino participants compared to non-Latino White participants (p < 0.05). Non-Latino Whites with higher education levels reported substantially better retirement preparedness, while the same level of education yielded smaller gains in retirement preparedness for Black and Latino individuals. Conclusion: The findings support the Minorities' Diminished Returns theory, showing that although educational attainment enhances retirement preparedness for all groups, Black and Latino individuals derive fewer benefits compared to their non-Latino White counterparts. These disparities point to persistent structural inequalities and systemic barriers within the education system and labor market, as well as the effects of segregation and discrimination, which undermine the economic benefits of education for marginalized populations. Addressing these disparities requires targeted policy interventions aimed at eliminating racial and ethnic inequalities in retirement outcomes and ensuring equitable benefits from educational attainment for all groups.
Article
Open Access November 19, 2024

Influence of Physical Features of Housing Environment on Students Halls of Residence

Abstract The purpose of the study was to examine the Influence of Physical Features of the Housing Environment on Students' Halls of Residence at the University of Cape Coast in the central region of Ghana. Quantitatively, a descriptive survey research design was adopted for the study. Housing Deficit Theory underpins the study. The study population comprised three hundred and eight one (381) level 100 [...] Read more.
The purpose of the study was to examine the Influence of Physical Features of the Housing Environment on Students' Halls of Residence at the University of Cape Coast in the central region of Ghana. Quantitatively, a descriptive survey research design was adopted for the study. Housing Deficit Theory underpins the study. The study population comprised three hundred and eight one (381) level 100 students in the Halls of Residence at the University of Cape Coast. Stratified proportionate random and simple random sampling techniques were used to select the eight (8) halls of residence and three hundred and eight one (381) level 100 students. The main instrument for data collection was a questionnaire. Cronbach's alpha was used in the study to assess the reliability of the variables. Descriptive statistics were used to analyse the data and show the direction of the responses. The study revealed that the students were satisfied with the physical features of the halls of residence, which influenced their contentment. Features such as recreational facilities, fire service systems, and relaxation facilities were vital in reaching such satisfaction. The study also indicated that the students were satisfied with how much their housing environment influenced their contentment. Students' relationship with their colleagues, the proximity of their halls of residence to the lecture halls and the serenity of the environment of the halls of residence all proved helpful in aligning the students' contentment to such an extent. It is recommended that the hall management should maintain the present physical features and facilities in the halls of residence for students' satisfaction. It is also recommended that the university management take into consideration the proximity of the halls of residence to the lecture theatres and the serenity of the environment of halls of residence in any future halls of residence construction.
Article
Open Access November 19, 2024

The Cost of Opportunity: Anti-Black Discrimination in High Resource Settings

Abstract Objective: Inequalities exist in children’s educational outcomes—including reading proficiency, school discrimination, and school disciplinary actions—across zip codes with different levels of educational childhood opportunity index (COI). This study examines the interaction between race and educational environment on children’s educational outcomes. We hypothesize that race, parental [...] Read more.
Objective: Inequalities exist in children’s educational outcomes—including reading proficiency, school discrimination, and school disciplinary actions—across zip codes with different levels of educational childhood opportunity index (COI). This study examines the interaction between race and educational environment on children’s educational outcomes. We hypothesize that race, parental education, and their interaction are associated with perceived school discrimination, which in turn reduces their cognitive, academic, and emotional wellbeing. We also hypothesize that Black children with high socioeconomic status (SES) report high perceived school discrimination in high-COI settings. Methods: Data were drawn from the Adolescent Brain Cognitive Development (ABCD) study, which measures a wide range of educational, cognitive, and emotional outcomes. At the same time, the ABCD children are sampled across areas with vast differences in COI rankings, that can be classified into these five categories: very high, high, average, low, and very low educational COIs. Our structural equation models (SEM) tested the additive and interactive effects of race and educational attainment on perceived school discrimination, and the effects of school discrimination on various cognitive abilities (reading proficiency, picture vocabulary, and list sorting working memory), school suspension, as well as depressed mood. Our multi-group SEM assessed how these relationships vary across educational COI levels. Results: Our findings showed that high SES Black children report highest school discrimination in residential areas with highest COIs. This is based on the observation that the interaction between race and parental education on experiences of school discrimination were only significant in areas with highest COI. Across residential areas with different COI levels, students who experienced higher school discrimination had higher suspension, worse depression, and worse cognitive performance. Conclusion: While higher COIs are associated with better academic outcomes, Black-White gaps exist in the role of increased COI through increased racial bias that children perceive. These findings underscore the complexity of educational equity, suggesting that improving COI alone is insufficient for eliminating racial disparities in school experiences. Policies should be in place to reduce school-based discrimination against Black students in high COI settings.
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Open Access November 19, 2024

High Education, Low Returns: Financial Literacy Challenges for African Americans and Hispanics

Abstract Background: Education is widely regarded as a key driver of financial literacy, yet racial and ethnic disparities persist. Even among highly educated individuals, African American and Hispanic populations may face challenges in financial literacy, likely due to structural racism and socioeconomic inequalities that diminish the benefits of education. This study examines the relationship [...] Read more.
Background: Education is widely regarded as a key driver of financial literacy, yet racial and ethnic disparities persist. Even among highly educated individuals, African American and Hispanic populations may face challenges in financial literacy, likely due to structural racism and socioeconomic inequalities that diminish the benefits of education. This study examines the relationship between education and financial literacy among African American and Hispanic individuals compared to their White counterparts, focusing on how structural factors contribute to these disparities. Objective: To determine whether highly educated African American and Hispanic individuals exhibit lower financial literacy compared to similarly educated White individuals and to explore the role of structural factors in explaining these disparities. Methods: Data from the 2016 Understanding America Study (UAS) were used to evaluate financial literacy among U.S. adults. The sample was stratified by race/ethnicity (African American, Hispanic, and White) and educational attainment. Financial literacy was assessed using standardized financial knowledge tests. Multivariate regression models were employed to investigate the relationship between race/ethnicity, education, and financial literacy, adjusting for socioeconomic factors such as income, employment, and household wealth. Results: African American and Hispanic individuals with higher levels of education demonstrated significantly lower financial literacy scores than their White peers (p < 0.001). The positive association between education and financial literacy was notably stronger for White individuals than for African American and Hispanic individuals. Further analyses suggest that structural barriers, including systemic discrimination in access to financial resources and disparities in educational quality, contribute to these diminished returns on education for racial and ethnic minorities. Conclusion: This study highlights persistent financial literacy disparities among highly educated African American and Hispanic individuals, underscoring the limitations of education alone in overcoming structural inequalities. The findings emphasize the need for targeted policies to address systemic barriers that restrict the financial knowledge and opportunities typically associated with higher education for racial and ethnic minority groups.
Article
Open Access November 18, 2024

Technological Caring Competence for Nursing Education (TCCNE) in Filipino Nurse Educators: Toward the Development of Basis for a Training Plan

Abstract Background: Nowadays, integrating online and remote instruction into education presents unique challenges, particularly in nursing education, where combining technology with the core value of caring is essential. Nurse educators must address students’ holistic needs, as their circumstances can influence overall learning development. Objectives: This study aims to ascertain the [...] Read more.
Background: Nowadays, integrating online and remote instruction into education presents unique challenges, particularly in nursing education, where combining technology with the core value of caring is essential. Nurse educators must address students’ holistic needs, as their circumstances can influence overall learning development. Objectives: This study aims to ascertain the technological caring competence of nurse educators Methodology: A descriptive design using an adapted tool on technological caring competence for nursing education (TCCNE) Results: A total of 243 Filipino nursing educators participated in this study. Overall, the participants’ perceived level of TCCNE was quite high. This sample representative of nursing educators holds strong perceptions of their TCCNE with the values of being considerate, supportive, and respectful to their students as the highest rated competency. This result implies that the educators keep the essence of what nursing is about as they model the importance of caring even in an academic setting considering that these teachers are using remote instruction. Conclusion: The study opens up a discussion on assessing the TCCNE of nursing education in an academic setting. Thus, its advocacy could start from implementing the research training plan. Further, the nurse educators should strengthen in balancing care with appropriate technology is viewed as a necessary step to maintain the essence of nursing, which is on caring that can be modeled out not just in clinical practice alone, but in nursing education.
Article
Open Access November 14, 2024

When Common Becomes Normal: Weaker Association Between Neighborhood Stress and Body Mass Index Among Black Adolescents Compared to White Adolescents

Abstract Objective: This study explores the relationship between neighborhood stress and Body Mass Index (BMI) in adolescents, while also examining whether this association differs between Black and White adolescents. Methods: Data from the Adolescent Brain Cognitive Development (ABCD) Study were analyzed using linear regression models to examine the association between neighborhood stress [...] Read more.
Objective: This study explores the relationship between neighborhood stress and Body Mass Index (BMI) in adolescents, while also examining whether this association differs between Black and White adolescents. Methods: Data from the Adolescent Brain Cognitive Development (ABCD) Study were analyzed using linear regression models to examine the association between neighborhood stress (defined as a composite score based on three items measuring perceived safety and neighborhood fear) and BMI in adolescents, controlling for demographic and socioeconomic variables. We tested models both with and without interaction terms to assess whether race moderated the association. Stratified analyses were conducted to further explore potential differences between Black and White adolescents. Results: A positive association was observed between neighborhood stress and BMI across the overall sample. However, this association was weaker for Black adolescents compared to White adolescents, even after adjusting for potential confounders. Conclusions: The contribution of neighborhood stress to higher BMI in adolescents may vary by race. Our findings suggest that while neighborhood stress is associated with increased BMI, Black adolescents appear to be less affected by these stressors than their White peers. This weaker association could be due to the normalization of stress in environments where it is pervasive (what is common becomes normal) or the presence of other significant risk factors affecting BMI in Black youth, such as poverty, limited food access, food culture, and food deserts. Future research should explore processes of habituation, inoculation, or even sensitization to stress among Black populations, who are often exposed to a wide range of stressors throughout the life course.
Article
Open Access November 09, 2024

Educated but Unhealthy? Examining Minorities' Diminished Returns

Abstract Background: Educational attainment is known to improve self-rated health; however, research suggests that these benefits may be less pronounced for racial and ethnic minority groups. The Minorities' Diminished Returns (MDRs) theory posits that the protective effects of resources such as education are weaker for marginalized populations, such as Black and Latino individuals, compared to [...] Read more.
Background: Educational attainment is known to improve self-rated health; however, research suggests that these benefits may be less pronounced for racial and ethnic minority groups. The Minorities' Diminished Returns (MDRs) theory posits that the protective effects of resources such as education are weaker for marginalized populations, such as Black and Latino individuals, compared to their White counterparts. Objective: This study aims to investigate racial and ethnic disparities in the association between years of schooling and self-rated health among U.S. adults, with a focus on understanding the reduced health benefits of education for Black and Latino individuals. Methods: Using data from the Understanding America Study (UAS; 2014), we conducted a cross-sectional analysis of adults aged 18 and older (N = 6,785). Self-rated health was the outcome, and years of schooling was the primary independent variable. We controlled for sociodemographic factors including age, gender, employment status, immigration status, and marital status. Stratified analyses were conducted by race/ethnicity (Non-Latino White, Non-Latino Black, and Latino). Linear regression models were used to examine the association between years of schooling and self-rated health, and interaction terms were included to assess variation in this relationship across racial/ethnic groups. Results: While years of schooling was positively associated with better self-rated health overall, the magnitude of this effect was weaker for Black and Latino individuals compared to White individuals. After adjusting for sociodemographic factors, Black and Latino adults reported worse self-rated health for each additional year of schooling, compared to their White counterparts, supporting the MDRs hypothesis. Conclusion: The findings suggest that while higher educational attainment is protective against worse self-rated health, this protection is not equally distributed across racial and ethnic groups. Black and Latino individuals experience diminished returns from their years of schooling in terms of self-rated health, likely due to structural barriers and social inequalities. Policies addressing health disparities must consider these diminished returns and aim to reduce structural racism and discrimination that undermine the benefits of education for minoritized populations.
Article
Open Access November 09, 2024

Educated but on Social Security Disability Insurance: Minorities’ Diminished Returns

Abstract Background: Educational attainment is widely regarded as a key predictor of economic and social outcomes in later life, including the likelihood of receiving Social Security Disability Insurance (SSDI). According to the Minorities' Diminished Returns (MDRs) theory, however, the benefits of education may be less pronounced for racial and ethnic minorities compared to non-Latino [...] Read more.
Background: Educational attainment is widely regarded as a key predictor of economic and social outcomes in later life, including the likelihood of receiving Social Security Disability Insurance (SSDI). According to the Minorities' Diminished Returns (MDRs) theory, however, the benefits of education may be less pronounced for racial and ethnic minorities compared to non-Latino Whites. This study investigates whether the effects of education on the likelihood of receiving SSDI differ by race and ethnicity, focusing on Black and Latino Americans. Objective: The primary aim of this study was to examine the relationship between educational attainment (measured in years of schooling) and the likelihood of receiving SSDI, with a specific focus on exploring how this relationship varies by race and ethnicity, in line with the MDRs framework. Methods: Data were drawn from the Understanding America Study (UAS), a nationally representative, internet-based panel survey. The sample included Black, Latino, and non-Latino White U.S. adults. Our sample size was 12,975 adults over the age of 18. Logistic regression models were used to assess the association between educational attainment and receiving SSDI, adjusting for demographic variables such as age, sex, employment status, and marital status. Interaction terms between race/ethnicity and educational attainment were included to explore whether the returns on education varied across racial and ethnic groups. Results: Higher educational attainment was significantly associated with a lower likelihood of receiving SSDI in the overall sample. However, consistent with the MDRs framework, the protective effect of education was significantly weaker for both Black and Latino individuals compared to non-Latino Whites. Black and Latino participants with similar levels of education as their non-Latino White counterparts were more likely to receive SSDI, reflecting diminished returns on educational attainment for these groups. Conclusion: This study provides strong evidence supporting the MDRs theory, demonstrating that the protective effects of education on the likelihood of receiving SSDI are not equally distributed across racial and ethnic groups. Black and Latino Americans experience weaker returns on their education when it comes to avoiding SSDI, likely due to structural inequalities and systemic barriers. These findings highlight the need for policies that address not only educational disparities but also the broader societal factors that limit the benefits of education for racial and ethnic minorities.
Article
Open Access November 07, 2024

Optimizing Pharmaceutical Supply Chain: Key Challenges and Strategic Solutions

Abstract Pharmaceutical supply chains are critical to ensuring the availability of safe and effective medications, yet they face numerous challenges that can jeopardize public health. This article provides a comprehensive analysis of the key issues impacting pharmaceutical supply chains, including regulatory compliance, demand forecasting, supply chain visibility, quality assurance, and geopolitical risks. [...] Read more.
Pharmaceutical supply chains are critical to ensuring the availability of safe and effective medications, yet they face numerous challenges that can jeopardize public health. This article provides a comprehensive analysis of the key issues impacting pharmaceutical supply chains, including regulatory compliance, demand forecasting, supply chain visibility, quality assurance, and geopolitical risks. Regulatory compliance remains a significant concern due to the stringent guidelines imposed by authorities such as the FDA and EMA, which can lead to increased operational costs and time delays. Additionally, traditional demand forecasting methods often fail to accurately predict fluctuations in drug demand, resulting in stockouts or excess inventory. Limited supply chain visibility further complicates these challenges, hindering timely decision-making and operational efficiency. Quality assurance is paramount, as maintaining the integrity of pharmaceutical products throughout the supply chain is crucial to preventing costly recalls and ensuring patient safety. Moreover, the globalization of supply chains introduces vulnerabilities to geopolitical risks, trade disputes, and natural disasters. In response to these issues, this article outlines strategic recommendations for optimizing pharmaceutical supply chains. These include leveraging advanced analytics and IoT technologies to enhance demand forecasting and visibility, strengthening compliance through automated systems and training, fostering collaboration among stakeholders, implementing robust risk management frameworks, and investing in quality management systems. By adopting these strategies, pharmaceutical companies can enhance the efficiency and resilience of their supply chains, ultimately ensuring the continuous availability of essential medications for patients worldwide. This analysis serves as a critical resource for industry professionals seeking to navigate the complexities of pharmaceutical supply chains in an increasingly dynamic global environment.
Review Article
Open Access August 07, 2024

Revolutionizing Active Pharmaceutical Ingredients: From Concept to Compliance

Abstract Active Pharmaceutical Ingredients (APIs) serve as the cornerstone of pharmaceutical development, driving therapeutic efficacy and safety in drug formulations. This article provides a comprehensive overview of the lifecycle of APIs, starting from their discovery and development, through to manufacturing processes and regulatory oversight. The development of APIs begins with intensive research and [...] Read more.
Active Pharmaceutical Ingredients (APIs) serve as the cornerstone of pharmaceutical development, driving therapeutic efficacy and safety in drug formulations. This article provides a comprehensive overview of the lifecycle of APIs, starting from their discovery and development, through to manufacturing processes and regulatory oversight. The development of APIs begins with intensive research and discovery efforts, where medicinal chemists and pharmacologists identify and optimize potential compounds through computational modelling, high-throughput screening, and structure-activity relationship studies. Promising candidates undergo rigorous preclinical testing to assess pharmacological properties, safety profiles, and potential adverse effects in animal models. Upon successful preclinical outcomes, APIs progress to clinical trials, involving phases of testing in human subjects to evaluate efficacy, dosage regimens, and safety profiles under controlled conditions. Clinical trial data are meticulously analyzed to support regulatory submissions, demonstrating the API's therapeutic benefits and safety for eventual patient use. Manufacturing APIs involves complex chemical synthesis or biotechnological methods, ensuring precise control over reaction conditions, purity, and yield. The scale-up from laboratory synthesis to industrial production demands adherence to Good Manufacturing Practices (GMP), where stringent quality control measures verify consistency, potency, and stability throughout production batches. Regulatory oversight by authorities such as the Food and Drug Administration (FDA) in the United States and the European Medicines Agency (EMA) in Europe ensures that APIs meet stringent standards of safety, efficacy, and quality before market approval. Manufacturers must submit comprehensive Chemistry, Manufacturing, and Controls (CMC) data, detailing manufacturing processes, analytical methods, and stability studies to support regulatory filings.
Review Article
Open Access November 05, 2024

Diminished Returns of Educational Attainment on Numeracy Score of Latino Populations: Insights from UAS Data

Abstract Background: Educational attainment is a well-established social determinant of various domains of cognitive function across the lifespan. However, the theory of Minorities' Diminished Returns (MDRs) suggests that the health benefits of educational attainment tend to be weaker for ethnic minorities compared to non-Latino Whites. This phenomenon may reflect the impact of structural [...] Read more.
Background: Educational attainment is a well-established social determinant of various domains of cognitive function across the lifespan. However, the theory of Minorities' Diminished Returns (MDRs) suggests that the health benefits of educational attainment tend to be weaker for ethnic minorities compared to non-Latino Whites. This phenomenon may reflect the impact of structural inequalities, social stratification, and historical disadvantage. Objective: This study examines whether the association between educational attainment and numeracy score, one domain of cognitive function, is weaker in Latino individuals compared to non-Latino individuals, as predicted by the MDRs framework. Methods: Data were drawn from the 2014 wave of the Understanding America Study (UAS), a national internet-based panel. Numeracy score, a domain of the cognitive function was measured using an 8-item measure. Linear regression models were used to analyze the association between educational attainment and numeracy score, with an interaction term for ethnicity x educational attainment to explore differences between Latino and non-Latino participants. Models were adjusted for age, gender, marital status, immigration, and employment, and results were presented as beta coefficients, p-values, and 95% confidence intervals (CIs). Results: Overall, 5,659 participants entered our analysis. Higher educational attainment was positively associated with higher numeracy score for both Latino and non-Latino participants (p < 0.001). However, the interaction between education and ethnicity was significant (p < 0.05), indicating that Latino individuals experienced smaller numeracy benefits from education compared to non-Latino individuals. These results support the MDRs framework, suggesting that structural barriers may reduce the numeracy returns of education for Latino individuals. Conclusion: This study provides evidence of diminished returns of educational attainment in terms of numeracy scores among Latino individuals. While education is a key determinant of cognitive abilities such as numeracy, its benefits are not equitably distributed across ethnic groups. Structural inequalities particularly in educational opportunities likely contribute to this disparity. Addressing these underlying factors through targeted policy interventions is necessary to promote cognitive equity for Latino populations.
Article
Open Access November 05, 2024

Black-White Gap Across Levels of Educational Childhood Opportunities: Findings from the ABCD Study

Abstract Objective: This study examines racial disparities in educational outcomes—including reading proficiency, grade point average (GPA), school discrimination, and school disciplinary actions—across regions with different levels of educational childhood opportunity index (COI). Our aim is to explore how these racial gaps between Black and White students vary in areas with differing educational [...] Read more.
Objective: This study examines racial disparities in educational outcomes—including reading proficiency, grade point average (GPA), school discrimination, and school disciplinary actions—across regions with different levels of educational childhood opportunity index (COI). Our aim is to explore how these racial gaps between Black and White students vary in areas with differing educational opportunities. We hypothesize that higher COI is associated with smaller academic achievement gaps but may also correspond with greater racial bias in unfair school treatment. Methods: Data were drawn from the Adolescent Brain Cognitive Development (ABCD) study, which provides comprehensive measures of educational outcomes, cognitive performance, and COI. National COI rankings were used to classify regions into five categories: very high, high, average, low, and very low educational opportunity. We analyzed racial gaps in reading proficiency, and experiences of discrimination and suspension across these COI categories. Multi-group Structural Equation Models (SEM) were used to assess how the relationship between race and educational outcomes varies across COI levels. Results: Our findings confirmed that Black-White gaps in reading proficiency and cognitive test performance (Flanker task) were less pronounced in regions with higher COI. However, racial disparities in school disciplinary actions and experiences of discrimination were more pronounced in higher-opportunity areas. Specifically, the effect of Black race was stronger in regions with the highest COI, where Black students experienced a disproportionately higher rate of unfair school treatment, including both school discrimination and suspensions, compared to their White peers. Conclusion: This exploratory study supports that while higher educational opportunities are associated with smaller academic achievement gaps between Black and White students, they might be linked to increased racial bias in school disciplinary actions and discriminatory treatment. These findings underscore the complexity of educational equity, suggesting that improving access to quality education alone is insufficient to eliminate racial disparities in school experiences. Addressing school-based bias and discrimination must accompany efforts to enhance educational opportunities.
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Open Access November 03, 2024

Students' Perceptions of the Usefulness of Formative Feedback in Mathematics Lessons

Abstract This study aimed to examine students' perceptions of the usefulness of formative feedback in mathematics lessons at Sagnerigu Municipality in the Northern Region of Ghana. Quantitatively, this study employed a descriptive non-experimental survey design. The population comprises all pupils of public Junior High Schools in the Sagnerigu Municipality. A purposive sampling technique was used to [...] Read more.
This study aimed to examine students' perceptions of the usefulness of formative feedback in mathematics lessons at Sagnerigu Municipality in the Northern Region of Ghana. Quantitatively, this study employed a descriptive non-experimental survey design. The population comprises all pupils of public Junior High Schools in the Sagnerigu Municipality. A purposive sampling technique was used to select the Junior High School students for the study. The criterion purposive sampling technique was used to select 518 final-year students for the 2022 Basic education certificate examination from 14 schools in Sagnerigu Municipality. The chosen schools comprised 291 students from high-performing schools and 227 students from low-performing schools. The primary tool for the study was the Student Feedback Perception Questionnaire (SFPQ), administered to the student participants. The Descriptive statistical tool was used to analyse the mean and standard deviation of the data. The study's examination of students' perceptions of feedback revealed a moderate level of perceived usefulness. This emphasises the importance of feedback as a tool for student growth and development. However, the findings also suggest the need for further support and guidance to optimise the impact of feedback on student learning outcomes. The findings also suggest that students value feedback that helps them improve their skills and strategies in Mathematics and keeps them on track to succeed. It also highlights the importance of providing different types of feedback to cater to the diverse learning needs of students. Educators can create a conducive environment that promotes student engagement and achievement by equipping teachers with effective feedback techniques, emphasising constructive comments and avoiding grades.
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Open Access November 01, 2024

Impacts of Drug Shortages in the Pharmaceutical Supply Chain

Abstract Drug shortages represent a significant and growing challenge within the pharmaceutical supply chain, with profound implications for patient care, public health, and healthcare costs. This manuscript provides a comprehensive examination of the causes and impacts of drug shortages, highlighting the multifaceted nature of this issue. Key factors contributing to shortages include manufacturing [...] Read more.
Drug shortages represent a significant and growing challenge within the pharmaceutical supply chain, with profound implications for patient care, public health, and healthcare costs. This manuscript provides a comprehensive examination of the causes and impacts of drug shortages, highlighting the multifaceted nature of this issue. Key factors contributing to shortages include manufacturing complications, limited availability of active pharmaceutical ingredients (APIs), market dynamics that discourage the production of less profitable medications, and regulatory challenges that slow down the approval process for new manufacturing capacities. The consequences of these shortages are far-reaching. Patients often face treatment delays, which can lead to adverse health outcomes, increased hospitalization rates, and even mortality. Healthcare providers experience heightened operational costs as they seek alternative therapies and manage complications resulting from inadequate treatment. Furthermore, the frequent occurrence of drug shortages erodes public trust in both the healthcare system and the pharmaceutical industry, leading to decreased patient adherence to prescribed therapies. To mitigate the impacts of drug shortages, this manuscript proposes several strategic solutions, including enhanced communication among stakeholders, diversification of supply sources, increased regulatory flexibility, and collaborative approaches between public and private sectors. Additionally, raising awareness among healthcare providers and patients regarding the causes and potential alternatives can empower stakeholders to navigate shortages effectively. Ultimately, addressing drug shortages necessitates a proactive and coordinated effort from all participants in the pharmaceutical supply chain. By implementing these strategies, stakeholders can enhance the resilience of the supply chain, ensuring that essential medications remain accessible and that patient care is not compromised. The findings of this manuscript underscore the urgent need for ongoing vigilance and collaborative action to tackle the challenges posed by drug shortages, safeguarding public health and improving healthcare outcomes globally.
Review Article
Open Access October 31, 2024

The Long Shadow of Early Poverty: Poverty at Birth, Epigenetic Changes at Age 15, And Youth Outcomes at Age 22

Abstract Background: Early life socioeconomic conditions and race/ethnicity are critical determinants of long-term health and behavioral outcomes. Epigenetic changes, particularly those measured by the GrimAge biomarker, may mediate the impact of these early adversities on later life outcomes. This study investigates the relationships between race/ethnicity, poverty at birth, epigenetic aging at age [...] Read more.
Background: Early life socioeconomic conditions and race/ethnicity are critical determinants of long-term health and behavioral outcomes. Epigenetic changes, particularly those measured by the GrimAge biomarker, may mediate the impact of these early adversities on later life outcomes. This study investigates the relationships between race/ethnicity, poverty at birth, epigenetic aging at age 15, and subsequent self-rated health, school discipline, depression, and school dropout at age 22. We explored sex differences in these paths. Methods: Data were drawn from the Fragile Families and Child Wellbeing Study (FFCWS), which included 733 youth with comprehensive follow-up data up to age 22. Structural Equation Modeling (SEM) was employed to assess the pathways from race/ethnicity and poverty at birth to epigenetic aging (GrimAge) at age 15, and subsequently to self-rated health and school discipline at age 22. The model controlled for potential confounders including sex, family structure, and parental education. Results: Race/ethnicity and poverty at birth were significantly associated with higher GrimAge scores at age 15 (p < 0.05). Higher GrimAge scores were predictive of poorer self-rated health (β = -0.08, p < 0.05) and increased instances of school discipline (β = 0.13, p < 0.01) at age 22. The indirect effects of race/ethnicity and poverty at birth on self-rated health and school discipline through GrimAge were also significant (p < 0.05), suggesting that epigenetic aging partially mediates these relationships. Sex differences were also observed. Poverty at birth predicted faster epigenetic aging at age 15 for males not females. We also observed that faster epigenetic aging at age 15 was predictive of school discipline of male not female participants at age 22. In contrast, faster epigenetic aging at age 15 was predictive of self-rated health (SRH) of female not male participants at age 22. Conclusions: This study provides evidence that with some sex differences, race/ethnicity and poverty at birth contribute to accelerated epigenetic aging (GrimAge) by age 15, which in turn predicts poorer self-rated health and increased school discipline issues by age 22. These findings emphasize the importance of early interventions targeting social determinants to mitigate long-term health and behavioral disparities. Addressing these early life conditions is crucial for improving health equity and outcomes in young adulthood.
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