World Academy of Science, Engineering and Technology

Authors: Hagos Tesfay Medhin, Carlos F. O. Graeff, Teketel Yohannes Anshebo, Negussie Megersa, Erika Soares Bronze-uhle, Augusto Batagin-neto

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Dye/polymer based dosimeters are developed by various researchers for medical, industrial and environmental applications. Most of these radiochromic dosimeters are focused on applications related to detection of high dose ionizing radiation. Development of dosimeters from different materials such as polymers, dyes, semiconductors, metal oxides and other materials is an active research area. The development of a radiochromic dosimeter from cheap materials such as polymers and dyes for low dose radiation dosimetry is also getting much attention.Some polymethine cyanine dyes were studied for their dosimetric characteristics. The results of the studies show that these dyes could be promising materials for developing radiation dosimeters for the measurement of low dose radiation in medicine and environment. A traditional turmeric dye called curcumin was also studied in film form for high dose dosimetry. However, heptamethine dyes and curcumin have not been profoundly investigated for low dose dosimetry.Dosimetric studies were carried out on the heptamethine cyanine dyes, curcumin dye solutions and polyvinyl alcohol (PVA) films using UV-Vis spectrophotometry, spectrofluorometry, mass spectrometry (MS), optical densitometry and Fourier transform infra-red spectroscopy (FT-IR) methods. The heptemethine cyanine dyes and curcumin showed promising dosimetric characteristics for low dose applications in the dose range from 0 to 30 Gy. The dose response could be caused by the loss of conjugation due to attack by Cl and other radicals as well as stable molecules such as HCl generated from the radiolysis of chloroform. The response curve of emission amplitude versus absorbed radiation dose shows linear relation. The FTIR and MS results corroborates with the absorption and emission spectra showing degradation of conjugation bonds in the dyes via radicals generated from radiolysis of chloroform.This shows that heptamethine and curcumin dye solution in chloroform are promising materials for low dose radiation dosimetry application in medicine as well as environment.

Keywords: dosimetery, radiochromic, dye, radiation

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Authors: Cheng Cao, Jay Pillai, Sina Ghadermarzi, Sara Daraei

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Linking patient records across disparate healthcare systems is essential for creating comprehensive views of patient health, yet this task is complicated by inconsistent identifiers, data quality issues, and privacy constraints. Although traditional deterministic and probabilistic methods have been widely used for record linkage, their performance is often limited in the presence of noisy or incomplete personally identifiable information (PII), and privacy-preserving variants frequently restrict matching to exact token equality. This work presents a hybrid record linkage approach, TruPPRL, which integrates a deep embedding model with deterministic rules to address challenges related to accuracy, robustness, and privacy. Leveraging a large-scale real-world dataset, a BERT-based Siamese network is fine-tuned with contrastive loss to encode PII fields as numeric vectors. These embeddings capture semantic similarity, enabling fuzzy matching while preserving anonymity. By combining the flexibility of learned representations with the reliability of matching based on high-confidence rules, the proposed system demonstrates substantial improvements in linkage performance, validating its effectiveness in privacy-sensitive, real-world healthcare settings.

Keywords: contrastive learning, BERT, privacy preserving record linkage, rule-based

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Authors: Nixon Anthony, Wen Chun Chan, Che Hsien Huang, Jie Han Li, Hsin Hui Chiu, Li Ya Hung, Kuan Chieh Chen

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Fungal contamination on industrial surfaces is an often-overlooked concern in occupational hygiene, particularly within the footwear manufacturing sector. In tropical regions, elevated humidity and temperature further exacerbate microbial proliferation, potentially increasing workers’ exposure risks. This study investigates the extent and variability of fungal contamination across common surface materials in Indonesian footwear factories, with a focus on how key environmental parameters influence contamination levels and fungal diversity, factors essential to exposure control and workplace sanitation strategies.Surface samples were collected using dry cotton swabs from operational materials including fabric, wood, leather, rubber, and plastic. Simultaneously, environmental conditions were recorded: air temperature, relative humidity, carbon dioxide (CO₂) concentration, and PM₁₀ levels. Fungal cultures were incubated on Potato Dextrose Agar for 72 hours at 32 °C and 75% RH, followed by visual colony enumeration. Representative isolates underwent external sequencing, with ITS2 regions extracted using Chromas and ITSx. Fungal community composition was analyzed through phylogenetic trees constructed in MEGA software.Statistical analysis revealed surface-specific relationships between CO₂ concentration and fungal contamination. CO₂ levels showed a positive correlation with contamination on wood surfaces (β = 0.01, p = 0.0043), but a negative correlation on leather surfaces (β = –0.01, p = 0.01), suggesting that material properties interact with indoor air quality to shape microbial dynamics. These trends may be influenced by human activity patterns and surface microenvironments. Fungal diversity analyses showed no significant differences between surface types, indicating relatively uniform species composition across work zones.This study highlights the need for integrated environmental monitoring and surface-specific hygiene interventions within occupational settings. By addressing material- and air-quality-related contamination risks, these findings provide practical guidance for improving contamination control and safeguarding worker health in tropical manufacturing environments.

Keywords: fungal contamination, surface susceptibility, footwear manufacturing, mold risk

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Authors: Stephen J. Nicholls, Adam J. Nelson, Marc Ditmarsch, John Jp Kastelein, Christie M. Ballantyne, Kausik K. Ray, Ann Marie Navar, Steven E. Nissen, Mariko Harada-Shiba, Danielle L. Curcio, Annie Neild, Douglas Kling, Andrew Hsieh, Julie Butters, Brian A. Ference, Ulrich Laufs, Maciej Banach, Roxana Mehran, Alberico L. Catapano, Yong Huo, Michael Szarek, Violeta Balinskaite, Michael H. Davidson

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Background/Synopsis: Obicetrapib is a highly selective cholesteryl ester transfer protein inhibitor that lowers low-density lipoprotein (LDL) cholesterol levels. Purpose: The efficacy and safety of obicetrapib has not been fully characterized in patients at high risk of cardiovascular events. Methods: BROADWAY enrolled 2530 patients with familial hypercholesterolemia (FH) or a history of atherosclerotic cardiovascular disease (ASCVD), treated with maximally tolerated lipid lowering therapy. Patients with either LDL cholesterol 100 mg/deciliter and/or non-high-density lipoprotein (non-HDL) cholesterol 130 mg/deciliter or LDL cholesterol 55-100 mg/deciliter and/or non-HDL cholesterol 85-130 mg/deciliter with at least one additional cardiovascular risk factor were randomized (2:1) to obicetrapib 10 mg or matching placebo daily for 365 days. The primary endpoint was the percent change from baseline to Day 84 in LDL cholesterol. Results: Patients (mean age 65 years, female 33%, White race 74%, ASCVD 89%, FH 16%, statin use 90%) had a mean baseline LDL cholesterol level of 98 mg/deciliter. The difference between placebo and obicetrapib for the change in LDL cholesterol was -32.7% (95% confidence interval [CI] -35.8, -29.5), P<0.0001. The percent change from baseline in LDL cholesterol at day 84 was +2.7% (95% CI -0.4, 5.8) with placebo and -29.9% (95% CI -32.1, -27.8) with obicetrapib. The incidence of adverse events was similar across treatment groups. Conclusion: Obicetrapib was well tolerated and produced placebo-adjusted LDL cholesterol reductions of 32.7% in patients at high risk of cardiovascular events with elevated lipid levels despite treatment with maximally tolerated lipid lowering therapy.

Keywords: CETPi, obicetrapib, dyslipidemia, LDL-C, ASCVD

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Authors: Ashish Sarraju, Danielle Brennan, Kierstyn Hayden, Amanda Stronczek, Anne Goldberg, Erin Michos, Darren Mcguire, Denise Mason, Grace Tercek, Stephen Nicholls, Douglas Kline, Annie Nield, John Jp Kastelein, Michael Davidson, Marc Ditmarsch, Steven Nissen

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Reducinglow-density lipoprotein cholesterol (LDL-C) levels is a primary strategy to reduce the risk of adverse atherosclerotic cardiovascular disease (ASCVD) events. Obicetrapib is an orally administered, highly selective cholesteryl ester transfer protein inhibitor with limited data on efficacy andsafetywhenadministeredinafixed-dosecombinationwithezetimibe.it conducted a multicenter randomized clinical trial in patients with preexisting or high risk for ASVCD with LDL-C levels greater than 70 mg/dL while receiving maximally tolerated lipid-loweringtherapy excluding ezetimibe to evaluate the effects of a fixed-dose combination (FDC) of obicetrapib and ezetimibe onLDL-C levels..Participants were randomized in 1:1:1:1 fashion to the FDC of obicetrapib 10 mg and ezetimibe 10 mg (n=102), obicetrapib 10 mg monotherapy (n=102), ezetimibe 10 mg (n=101) monotherapy, or matching placebo (n=102) administered daily for 84 days.The co-primary endpoints were percent LDL-C changes in the FDC group compared with placebo,ezetimibe monotherapy, obicetrapib monotherapy, and the placebo-adjusted change in the obicetrapib monotherapy group.Among407randomizedparticipants,themeanagewas66.9(SD,9.3)years,177(43.5%)were female,baselineLDL-Clevelswere91.0,98.2,100.0,and96.5mg/dLintheplacebo,ezetimibe monotherapy, obicetrapib monotherapy, and FDC groups, respectively. Changes in LDL-C at day 84forobicetrapib-ezetimibeFDCwere-48.6%(95%confidenceintervals[CI],-58.3to-38.9%) comparedwithplacebo,-27.9%(95%CI,-37.5to-18.4%)comparedwithezetimibemonotherapy,and-16.8%(95%CI,-26.4to-7.1%)comparedwithobicetrapibmonotherapy.Obicetrapib monotherapy reduced LDL-C levels by 31.9% (95% CI, 22.1 to 41.6%). Adverse events were broadlysimilar across treatment groups.Among participants with preexisting or high risk for ASCVD, orally administered obicetrapib ezetimibeFDCtherapyreducedLDL-Clevelsbynearly50%during84daysoftreatment.

Keywords: CEPT inhibitor, ASCVD, dyslipidemia, LDL-C

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Authors: Oyibode Gabriel Chukwuma Etaoghenevwegba, Erunke Canice Esidene

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The main objective of this investigation is to unravel the nexus between governance deficits, ravaging insecurity and endemic poverty and how these challenges have impinged on Sustainable Development Goals (SDGs) in Nigeria. Recent investigations by scholars and public analysts point to the singular fact that insecurity has been on the rise. Of particular interest to this study is the attendant bourgeoning effects these trends have had on the nation and its people, and particularly the vulnerable groups. Thus the unfortunate incidences of insecurity in Nigeria, namely, terrorism, kidnapping, cannibalism, ethnic conflicts, sectional political agitations, rising inflation and all forms of misdemeanors are rife. The multiplier effects of all this is that not only are the poorest of the poor, as well as the vulnerable groups not being able to cope with the increasing hardship; life generally has become brutish, nasty and short for the average Nigerian, and indeed many households. This development, no doubt, runs contrary to the dictates and mandates of the SDG agenda which is supposed to eliminate poverty and hunger by the year 2030.This paper is a theoretical exploration of works of experts in the broader field of security and poverty studies. The study adopts secondary method for data collection and evaluation. The paper has observed that realizing the intents of SDGs might be a huge challenge in the expected base year if no meaningful strategies are put in place to forestall the menace of insecurity and excruciating poverty in Nigeria in the current covid-19 dispensation. The work sums up with policy recommendations for overall achievement and realization of the core mandates of the SDGs both now and in the foreseeable future.

Keywords: governance, insecurity, Covid-19, SDG

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Authors: Ritika Sarda, Shraddha Deo

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This paper reflects on how social determinants like childhood experiences, marriage, domestic violence (physical, verbal, emotional, and financial), social support, and intervention strategies shape resilience outcomes. Comparing A and B’s trajectories underscores that access to support alone is insufficient economic inclusion, sustained intervention, and culturally sensitive outreach are crucial. The findings contribute to policy recommendations that integrate mental health interventions, financial literacy, and gender-sensitive frameworks, ensuring that community-led approaches empower women beyond survival toward long-term autonomy. Additionally, resilience-building should be embedded into educational systems, with structured training, awareness programs, and exercises in schools to help young women develop emotional regulation, problem-solving skills, and self-efficacy from an early age. These initiatives will reinforce preparedness, ensuring resilience is not just reactive but proactively nurtured throughout life.

Keywords: resilience, social determinants, community mental health, economic inclusion, education

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Authors: Aishwarya Kapoor, Samia Dilarus Syeda, Huma Zille

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Background: Prompt diagnosis of deep vein thrombosis (DVT) is essential to prevent serious complications such as pulmonary embolism. NICE guidelines recommend that patients suspected of having DVT receive a Doppler ultrasound scan within 4 hours of clinical suspicion. If this is not achievable, anticoagulation treatment should be started and imaging must be completed within 24 hours. This audit was performed at a district general hospital in the UK to evaluate adherence to these guidelines and identify opportunities for improvement. Methods: A two-cycle retrospective audit was conducted. The first cycle involved analysis of 51 Doppler ultrasound scans requested for suspected DVT. Data collected included time from request to scan and compliance with the 4-hour and 24-hour targets. After recognizing delay patterns, an intervention was introduced involving educational posters across clinical and radiology areas and enhanced communication between the medical and radiology teams. A second audit cycle was performed one month later, reviewing 66 scans. Results: During the initial cycle, 21 scans (41%) were performed within 4 hours, while 30 (59%) were delayed beyond this timeframe. Additionally, 15 scans (29%) were completed after 24 hours, indicating non-compliance with NICE standards. Delays were primarily clustered between 6–8 PM. Following the intervention, the second cycle revealed that 25 scans (38%) met the 4-hour deadline, with 41 scans (62%) exceeding it. The number of scans completed within 24 hours improved slightly (48 in the first cycle vs. 54 in the second), though 18 scans (27%) still breached the 24-hour timeframe. Peak delays persisted between 6–8 PM, with Mondays showing the greatest frequency of late scans, possibly due to backlog from the weekend, while Fridays experienced the fewest delays. Conclusion: This audit highlighted ongoing difficulties in meeting recommended timeframes for Doppler ultrasound in suspected DVT cases. Although the awareness campaign modestly improved compliance with the 24-hour standard, significant delays remain, especially during evening hours and early weekdays. These findings emphasize the need for better resource allocation, workflow adjustments, and stronger collaboration between clinical and radiology teams to ensure timely diagnosis and enhance patient safety. Ongoing review and quality improvement efforts are necessary to achieve sustained progress.

Keywords: doppler ultrasound, deep vein thrombosis (DVT), NICE guidelines, audit, quality improvement, 4-hour target, 24-hour target, diagnostic delays, interdepartmental communication, radiology workflow, patient safety, clinical governance, imaging compliance, NHS audit, service evaluation

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Authors: Yung-Feng Yen

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Background and Aims: Alcohol dependence may induce angiotensin-converting enzyme 2 (ACE2) overexpression, potentially increasing vulnerability to severe acute respiratory syndrome coronavirus-2 infection. However, the relationship between alcohol dependence and the risk of coronavirus disease 2019 (COVID-19) infection remains unclear. The aim of this nationwide population-based cohort study was to investigate the association between alcohol dependence and the incidence of COVID-19 infection in Taiwan. Design, Setting, Participants: We identified 247,000 individuals with alcohol dependence between 2001–2019 from the Taiwan National Health Insurance Research Database. Another 2,470,000 age- and sex-matched controls without alcohol dependence were randomly selected for comparison. All study participants were followed up until the occurrence of new-onset COVID-19 infection, death, or December 31, 2021. Measurements: A diagnosis of COVID-19 was determined by a positive real-time reverse transcriptase–polymerase chain reaction test. We employed a Cox regression model, considering death as a competing risk, to assess the impact of alcohol dependence on the risk of COVID-19 infection. Findings: Among 2,717,000 participants, 2,374 (0.092%) developed incident COVID-19 during an average follow-up of 1.98 years, including 415 (0.17%) individuals with alcohol dependence and 1,959 (0.08%) controls. After adjusting for age, sex, urbanization, the Charlson Comorbidity Index, and COVID-19 vaccination status, alcohol dependence was significantly associated with a higher risk of incident COVID-19 infection (adjusted hazard ratio [AHR]: 1.26; 95% confidence interval [CI]: 1.11–1.43). Subgroup analyses, stratified by age, sex, and COVID-19 vaccination status, revealed that alcohol dependence was linked to increased risk of incident COVID-19 infection across all subgroups, except for individuals aged 18–49 years and those who had received only a single dose of the COVID-19 vaccine. Conclusions: Alcohol dependence was identified as an independent risk factor for incident COVID-19 infection. These findings highlight the importance of prioritizing individuals with alcohol dependence as a key target population for COVID-19 prevention efforts.

Keywords: alcohol dependence, COVID-19, cohort study, Taiwan

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Authors: Navtej Singh Chhibber, Julian Hanson

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Background: This study aimed to identify factors associated with adverse outcomes following percutaneous drainage of diverticular abscesses within CCLHD regional hospitals (in particular: need for repeat drainage procedure, need for additional surgery, prolonged hospitalisation > 11 days, and mortality) and provide data for comparison with existing literature. Methods: A single-center retrospective analysis identified 38 diverticular abscess drainage procedures performed from May 2021 to November 2025 from a preliminary pool of 371 abscess cases. Patient demographics, abscess characteristics, procedural details, and clinical outcomes were analysed to identify predictors of adverse outcomes. Results: Of 37 patients, 11 (28.9%) required surgery within 6 months, 7 (18.4%) required repeat drainage, 19 (50%) experienced prolonged hospitalisation (>11 days), and 2 (5.3%) died during admission. Left iliac fossa (36.8%) and central pelvic (28.9%) were the predominant collection locations. Presence of gas within the collection significantly predicted subsequent surgery (OR=5.34, 95% CI: 1.04-27.41, p<0.05). Advanced age (OR=1.05 per year, 95% CI: 1.00-1.10, p<0.05) and need for surgery (OR=6.26, 95% CI: 1.09-36.00, p<0.05) were significant predictors of prolonged hospitalisation. Maximum collection size was associated with repeat drainage requirement (OR=1.45 per 10mm increase, 95% CI: 0.99-2.12, p=0.05). Conclusion: Gas containing diverticular abscesses, larger collections, advanced patient age, and involvement of adjacent anatomical structures were adverse prognostic indicators for percutaneous drainage. These findings align with existing literature and help inform risk stratification to optimise patient outcomes.

Keywords: diverticular abscess, percutaneous drainage, diverticulitis complications, risk factors, clinical outcomes

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Authors: Asraa Hafeez, Nadir Ibrahim

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Delirium is a critical phenomenon observed amongst 31% of patients in intensive care units (ICUs), associated with prolonged mechanical ventilation, increased duration of ICU stays, and higher mortality rates. Sleep optimisation has increasingly been recommended to reduce delirium in ICU patients; however, many nocturnal care activities remain unaddressed. This retrospective quality improvement study was conducted to evaluate the frequency, preventability, and clinical impact of nocturnal care activities among ICU patients at Salford Royal Hospital over a seven-month period. Patients who developed delirium were identified based on a positive CAM-ICU (Confusion Assessment Method- ICU) outcome, with random sampling used to obtain the sample of patients for the study. Data on night-time care activities performed in the 72 hours prior to the onset of delirium were retrieved from patient records and used to calculate mean frequencies of disruptions per night. The indications for patient disruption were also recorded. Patients were organised into high (≥ 7 mean disruptions per night) and low (< 7 mean disruptions per night) disturbance groups to facilitate correlation with delirium outcomes. The results demonstrated nocturnal disruption to be a significant issue, with patients experiencing 7.5 (±2.98) mean disruptions per night. Administration of non-urgent medications, routine venepuncture, and repositioning assessments were identified as predominant avoidable causes of disturbance. Other sources of nocturnal disruption included arterial blood gas sampling, administration of unscheduled/ PRN medications and endotracheal tube cuff monitoring/ suctioning. High levels of nocturnal disturbance were associated with a 2.4-fold increase in the incidence of prolonged delirium (lasting more than 24 hours) (24% vs 10%) and a 2.3-fold increase in the requirement for antipsychotic therapy (34% vs 15%), when comparing to patients with low levels of disturbance. These findings emphasise the need to optimise night-time care to preserve sleep quality and mitigate delirium risk. Recommendations for improvement include rescheduling non-urgent tasks to daytime hours and grouping together essential care activities during the night to minimise patient disruption. At the same time, patient risk must be considered in order to maintain patient safety. Implementing these strategies can help to achieve improved patient outcomes and satisfaction, better time management, and reduced clinical overall.

Keywords: critical care, delirium, nocturnal care practices, sleep optimisation

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Authors: Sarah Fahad Bin Sultan, Shahad Abdulrahman Al-Doss, Shahad Abdullah Al-Saud, Fajr Ahmed Bin Khulayf, Shaden Fahad Al-Mejhed, Rana Abdulaziz Al-Jameel

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This study investigates the absorbed dose distribution of 150 MeV protons in water, utilizing both semi-empirical models and Monte Carlo N-Particle (MCNP) simulations. The analysis considers factors such as Gaussian dispersion, neutron interactions, and secondary particle contributions to provide a comprehensive dose profile. Results from MCNP simulations demonstrate strong agreement with semi-empirical calculations and SRIM/TRIM data, validating their use in predicting dose distributions, particularly around the Bragg peak. The study also examines ionization energy loss and atomic displacement profiles, crucial for assessing tumor damage and material defect formation.

Keywords: bragg peak, brain tumors, dose distribution, gaussian dispersion, ionization energy loss, linear energy transfer, MCNP, monte carlo simulation, proton range, proton therapy, relative biological effectiveness, secondary radiation, srim/trim, water phantom

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Authors: Ahmed Kassem, Mohammed Ahmed, Ahmed Alwetaidy, Sherif Farahat, Mohamed Albendary, Ashish Kelkar

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Aim: This retrospective analysis aimed at evaluating appendicectomy outcomes in view of in-hospital delay and identifying predictive factors for complicated appendicitis. Methods: Data collection of consecutive appendicectomies over eight months period was executed. The primary outcome was the impact of in-hospital (decision to incision) delay on severity of operative findings, operative time, length of hospital stays (LOS), and morbidity. Secondary outcomes included possible predictors for complicated operative findings. Patients were categorised into 3 groups: <8 hours, 8-24 hours, and >24 hours. Widespread peritoneal pus, gangrene, and perforation of the appendix were considered complicated findings. Results: 198 patients were included, with 74% diagnosed by CT, 5% by USS/MRI, and 21% by clinical examination. Appendicectomy was delayed for <8 hours in 38% of patients, 8-12 hours in 52%, and >24 hours in 9%. There was no statistically significant difference between the 3 groups in operative findings, escalated CT to operative findings, operative time, or early complications. Similarly, no notable difference was found in 30-day readmission or complication rates. Despite the evident increased LOS with longer delay (2, 2.57, 2.61 in respective groups), this impact was statistically non-significant (P=0.077). The presence of fever and raised CRP above 100 was significantly correlated with complicated operative findings (P<0.0001). Isolated hyperbilirubinemia (P=0.004) and imaging confirmed complicated findings (P<0.0001) were also strong predictors. Conclusion: Appendicectomy can be delayed safely to facilitate effective theatre prioritisation, bearing in mind the clinical context and WSES 2020 recommended safe 24-hour delay. Patients with positive predictor criteria should be prioritised for surgery.

Keywords: postoperative complications, Appendicitis severity, appendectomy delay, outcomes of delay

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Authors: Farhad Alipour

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Diabetes mellitus is a complex metabolic disorder marked by chronic hyperglycemia. Beta cell apoptosis has been triggered by various factors, including high glucose levels, cytokines, free fatty acids, leptin, and sulfonylureas. These stimuli activate metabolic pathways such as the polyol, hexosamine, and DAG/PKC pathways, which contribute to oxidative and nitrosative stress and lead to cytokine release. These cytokines, in turn, activate transcription factors like NF-κB and STAT1 in beta cells, inducing the expression of pro-apoptotic markers such as Fas and TNF-α and promoting apoptosis via the extrinsic pathway. Additionally, intrinsic apoptotic signaling is stimulated by cytokines within beta cells. Several genes implicated in apoptotic signaling and diabetes pathogenesis include Fas, FasL, Akt, caspases, calpain-10, and PTEN. Other associated gene products include NOS2, SUMO, ApoCIII, FOXO1, and GLIS3. Anti-apoptotic regulators such as Bcl-2 and Bcl-XL also play a key role in modulating beta cell survival. Epigenetic mechanisms are increasingly recognized as important contributors in both type 1 and type 2 diabetes. Continued research on apoptosis-related genes and their products may support advancements in pharmacogenomics and personalized therapies, particularly those involving antioxidants that target apoptotic pathways in diabetes.

Keywords: beta cell apoptosis, diabetes mellitus, cytokines, oxidative stress, fas/fasl, bcl-2 family

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Authors: Sisay Mulugeta Alemu, Ezgi Baltaci, Marcel Reinmuth, Ingolf Bayer, Volker Wrinkler, Katrin Schaller, Till Baernighausen, Alexander Zipf, Sven Lautenbach, Connie Hoe

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Introduction: Cigarette vending machines (CVMs) are widely available in Germany. Currently, the country's Protection of Young Persons Act only states that these CVMs must to be either installed in locations inaccessible to minors or employ technical measures or permanent supervision to prevent minors from accessing tobacco products. The industry itself has a self-regulation of a minimum distance of 100 meters between CVMs and educational institutions such as schools and kindergartens. This study aimed to examine the spatial distribution of CVMs in relation to educational institutions and to evaluate the usefulness of OpenStreetMap (OSM) as data source for tobacco control research. Methods: Location data on schools, kindergartens, and CVMs in Heidelberg, Germany, were obtained from OpenStreetMap and supplemented by comprehensive ground-truthing, whereby all streets in Heidelberg were observed through systematic bicycle rides by a research assistant across the city. Missing CVMs were mapped using the OSMAND app. We first mapped the distribution of CVMs relative to educational institutions and calculated both Euclidean and real-world walking distances using OpenRouteService. Spatial point pattern analysis was conducted to assess the randomness of CVM distribution. We also explored the association between CVM density and neighborhood unemployment rates. Furthermore, a co-location analysis was performed to determine whether CVMs were spatially clustered near specific points of interest (POIs), such as bars and restaurants, more frequently than expected by chance. Finally, we modeled a prioritization scheme for CVM removal based on proximity to educational institutions using location allocation analysis. Results: A total of 170 CVMs were identified in Heidelberg. While the average CVM density was 1.6 per km², some districts exhibited densities as high as 13.8 CVMs per km². Spatial analysis revealed a non-random distribution, with significant clustering. CVMs were generally located at increasing distances from educational institutions, particularly beyond 100 and 150 meters; however, 50 CVMs were found within 100 meters of a school or kindergarten. The shortest recorded distances were 6 meters from a kindergarten and 63 meters from a school. A significant association was observed between the average distance from CVMs to the nearest school and district-level unemployment rates (p = 0.005). Vending machines were significantly co-located with hospitality and food venues such as bars and restaurants. Conclusions: CVMs are frequently located near environments frequented by children and youth, highlighting the urgent need for Germany to strengthen its tobacco control regulations and consider banning CVMs as per the World Health Organization Framework Convention on Tobacco Control (WHO FCTC). Moreover, this study demonstrates the potential of OpenStreetMap as a valuable tool for tobacco control research.

Keywords: smoking, cigarette vending machines, spatial analysis, OpenStreetMap, Germany

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Authors: Abdulrahman Almalki, Deemah Rashed Alqahtani, Rawabi Mohammed Alotaibi, Nora Mohamed Al-Jerasy, Weam Bander Almutairi, Saad Alrashidi, Kholoud Saad Almogren

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Glioblastoma multiforme (GBM) is one of the most aggressive and treatment-resistant primary brain tumors, characterized by rapid proliferation, diffuse infiltration, and poor prognosis. Despite current standards of care—surgical resection followed by radiotherapy and chemotherapy with temozolomide—median survival remains below 15 months. A major obstacle to treatment success is the presence of hypoxic tumor niches that harbor cells with metastatic phenotypes and intrinsic resistance to conventional radiation. These regions are poorly oxygenated, genetically unstable, and less responsive to DNA-damaging therapies, highlighting the urgent need for new strategies that overcome radio resistance and engage anti-tumor immunity. In this project, we investigated proton therapy as a precision modality capable of delivering high linear energy transfer (LET) radiation with minimal damage to surrounding healthy tissue. Unlike conventional X-rays, proton beams deposit most of their energy at the Bragg peak, enabling spatially localized dose delivery. Beyond this physical advantage, we hypothesized that proton therapy could stimulate immune responses through activation of the cGAS–STING pathway, which detects cytosolic double-stranded DNA and initiates the production of interferon-beta (IFNβ), a key cytokine in anti-tumor immunity. Using dose–response data from the U251 GBM cell line, we incorporated IFN-β dose response into the FLUKA Monte Carlo simulation framework. Simulations showed that a dose of approximately 17 Gy optimized IFN-β induction without triggering TREX1, a DNA exonuclease known to suppress immune signaling at higher doses. The biological dose was modulated to selectively cover a virtual subregion within the GTV, suggesting the potential to stimulate localized immune responses in treatment-resistant tumor microenvironment. These findings support the dual role of proton therapy in delivering precise radiation while also enhancing immunogenicity, offering a promising foundation for future biologically guided radiotherapy strategies in GBM. Further validation through in vitro experiments and integration with immunotherapy could help translate this approach into clinical protocols and expand its relevance beyond GBM to other poorly immunogenic tumors.

Keywords: IFN-β, proton beam, Monte Carlo simulation, FLUKA software

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Authors: Mohamed Ismail Abdi

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Background: Microbial diseases continue to be major threats to the world regardless of efforts and progress in developing modern medicine. Therefore, this study aimed to evaluate the antibacterial activity of some selected experimental herbs against major selected bacterial species. Methods: This research was conducted at the Microbiology laboratory of Mekelle University, College of Veterinary Medicine (MU-CVM), from August to November 2017. An experimental study was conducted using Nerium oleander, Solanum linnaeanum, and Nicotiana glauca as the experimental herbs to evaluate them against major bacterial species, namely, Escherichia coli, Salmonella typhimurium, Staphylococcus aureus, and Streptococcus agalactiae. The herbal plants were purposively selected because of their availability and ethnomedicinal uses to check them for their antibacterial activity. Data was analyzed using STATA version 12 software. Statistical analysis was also undertaken using variance (one-way ANOVA) coupled with Bonferroni to compare results between plants and concentrations. Results: Maceration of the herbal materials with methanol 99.8% was found to give a high yield percentage of the extract compared to distilled water. The zone of inhibition caused by the methanol extract of Nerium oleander against the test bacteria was larger than the zone of inhibition due to the distilled water extract of Nerium oleander. Furthermore, the methanolic extracts of Solanum linnaeanum and Nicotiana glauca had higher zones of inhibition than distilled water extracts. The result indicated a statistically significant difference (P < 0.05) among the herbal extract concentrations in their efficacy in inhibiting the growth of the test bacteria. All the experimental bacterial species were found resistant to the herbal extracts at 100 mg/ml concentrations but susceptible at the concentration of 200mg/ml. The lowest amount of Nerium oleander extract that stopped the growth of both Staphylococcus aureus and Streptococcus agalactiae was 2 µg/ml. Conclusion: All three experimental herbal extracts were found to have antibacterial activity against the test bacterial species. Generally, we should conduct further studies on plant fractions and isolates for their antibacterial activity. The herbal extracts should undergo in-vivo evaluation to determine their systemic curative effect on diseases caused by the tested bacterial species.

Keywords: invitro evaluation, antibacterial activity, herbal extracts, zone of inhibition

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Authors: Chang Liu, Hao Li

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Background: Myocardial injury after non-cardiac surgery (MINS) is an easily overlooked complication but closely related to postoperative cardiovascular adverse outcomes, so early diagnosis and prediction are particularly important. Objective: The aim of the study is to develop and validate an explainable machine learning model for predicting MINS among older patients undergoing non-cardiac surgery. Methods: The retrospective cohort study included non-cardiac surgical older patients from one northern center and one southern center in China. The datasets from January 2017 to August 2019 in Center 1 were as the training set, and from July 2020 to July 2021 in Center 1 as the internal validation set. The dataset from January 2021 to October 2021 in Center 2 was used as an external validation set. Before modeling, two methods, including the least absolute shrinkage and selection operator (LASSO) and recursive feature elimination (RFE), were used to reduce the dimensions of data and select key features from all collected variables. Models were developed based on the extracted features using several machine learning algorithms, including Category Boosting (CatBoost), Random Forest (RF), Logistic Regression (LR), Naïve Bayes, Light Gradient Boosting Machine (LightGBM), eXtreme Gradient Boosting (XGBoost), Support Vector Machine (SVM), Decision Tree (DT). Prediction performance was assessed by the area under the receiver operating characteristic curve (AUROC) as the main evaluation metric to select the best algorithms. The validation of the model was performed using internal and external validation datasets with the best algorithm. The model performance was also compared with the classical Revised Cardiac Risk Index (RCRI). The SHapley Additive exPlanations (SHAP) method was applied to calculate values for each feature, representing the contribution to the predicted risk of complication, and generate personalized explanations. Results: A total of 19463 patients were included, among those 12464 patients in Center 1 were included as the training set, 4754 patients in Center 1 as the internal validation set, 2245 in Center 2 as the external validation set. The best-performing model for prediction was the CatBoost algorithm, achieving an AUROC of 0.805 (95% confidence interval, 0.778–0.831) in the training set, and validating with an AUROC of 0.780 in the internal validation set, 0.70 in the external validation set, also with superior performance compared to RCRI (AUROC:0.636, P<0.01). The SHAP values indicated the ranking of the level of importance of each variable, and preoperative serum creatinine concentration, red blood cell distribution width, and age accounted for the top three. The results from the SHAP method can make predictions about the events with a positive value or non-events with a negative value and an explicit explanation of individualized risk prediction. Conclusions: The machine learning models can provide a personalized and fairly accurate risk prediction of myocardial injury after non-cardiac surgery, and the explainable perspective can help identification of potentially modifiable sources of risk on the patient level.

Keywords: machine learning, myocardial injury, SHAP method, individualized risk prediction

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Authors: Hao Li, Chang Liu

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Background: Effective approaches for fusing intraoperative blood pressure measurements and perioperative variables to predict the risk of major adverse cardiovascular events more accurately and in real-time are lacking; we intended to examine the performance of advanced multimodal deep learning utilizing real-time blood pressure and perioperative variables to predict the risk of postoperative major adverse cardiovascular events. Methods: Datasets of older patients who underwent noncardiac surgery with eligible blood pressure monitoring records were reviewed and divided into training and test datasets. Perioperative structured variables and unstructured blood pressure data were used as input independently or combined with distinct models: the classical Revised Cardiac Risk Index with only preoperative variables, machine-learning models with preoperative and intraoperative structured variables, a deep-learning Transformer model with only real-time blood pressure data, and a multimodal deep-learning model with perioperative structured variables and unstructured blood pressure data. Major adverse cardiovascular events within the postoperative 30 days were the primary outcome. The multimodal deep-learning model with structured variants and continuous blood pressure exhibited the best predictive performance, compared with the Transformer model, the Revised Cardiac Risk Index model and machine learning models. Results: Among the 14345 patients included in our analysis (median [IQR] age, 70 [69–74] years; 7556 [52.7%] males), 655 (4.6%) experienced major adverse cardiovascular events within postoperative 30 days. The multimodal deep-learning model with structured variants and continuous blood pressure exhibited the best predictive performance, with an AUROC of 0.840. With only continuous blood pressure, the Transformer model showed a prediction performance with an AUROC of 0.790. The two models established by deep learning performed better than the existing Revised Cardiac Risk Index model, whose AUROC was 0.608, as well as machine learning models, whose highest AUROC was 0.736 with combining variables. Conclusion: Based on multimodal deep-learning techniques, intraoperative continuous blood pressure data can be integrated with perioperative biostatistical variants, providing an accurate risk prediction for major adverse cardiovascular events and aiding real-time risk predictions and intervention during surgery.

Keywords: major adverse cardiac events, real-time blood pressure, multimodal, deep learning

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Authors: Becky King

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The increasing adoption of digital healthcare solutions presents an opportunity to enhance sustainability in healthcare administration. One such innovation, electronic consent (eConsent), replaces traditional paper-based consent processes, thereby reducing paper waste, carbon footprint, and administrative inefficiencies. Despite its technological advantages, little research quantifies the environmental benefits of eConsent adoption. This study employs a lifecycle assessment (LCA) to compare the environmental impact of paper-based vs. digital consent workflows. Key metrics include paper waste reduction, carbon emissions from document processing, and energy consumption of digital storage. A case study conducted in clinical research institutions demonstrated a 65% reduction in paper usage, significantly decreasing emissions associated with printing, storage, and document handling. The findings also highlight operational benefits such as faster patient onboarding and improved workflow efficiency. These results support the argument that eConsent is a viable sustainability strategy in digital healthcare. The study emphasizes the need for policy-driven implementation of paperless technologies to promote eco-friendly, cost-effective medical systems. This study will include a visual comparison of eConsent’s environmental impact versus traditional methods.

Keywords: digital healthcare, eConsent, lifecycle assessment, paper waste reduction, sustainability in healthcare

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Authors: Kieran Green, Sheena Asthana, Martha Lee

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According to the World Health Organization, loneliness has reached epidemic levels, posing a pervasive public health challenge among older adults in the United Kingdom. Loneliness is linked with numerous negative health outcomes, including depression, cognitive decline, poorer cardiovascular health, frailty, and decreased self-management. Loneliness also contributes to high rates of unscheduled urgent care among older people and overcrowding in emergency departments and inpatient beds. Digital technologies increasingly appear feasible and necessary for combatting loneliness and increasing social connectivity for older adults. However, the success of these innovations depends on addressing issues like poor access, low digital literacy, computer anxiety and individual beliefs. Codesign, which involves the end-user in developing these technologies, can help to overcome these barriers, ensuring usability, acceptability, and motivation. Still, there remains a deficit of codesign methodologies that empower, encourage mutual learning, and achieve active involvement for older adults. This paper outlines and shares the outcomes of a multi-stage codesign process led by Plymouth Living Labs' to create a teleconferencing application that connects residents with local activities (e.g., museums, arts and crafts and exercise). Collaborating with a university, industry partners, a housing association, and a health provider, the approach combined contextual inquiry, online Q&A sessions, and five in-person mind-mapping and cognitive walkthrough workshops. Participants include technology developers (n=2), activity representatives (n=15) and residents (n=105). We reflect on this codesign process's methodological and ethical successes, challenges, and opportunities. Recommendations include sculpting communications around the journey where users make a real difference, establishing strong relationships with a housing association, and building workshops combining multiple, yet simplified, key codesign components. These elements can ensure breadth, which sustains interest and reduces the overall travel demand for older participants. Finally, the paper recognises that the methodology would be improved by a more iterative approach to the multi-component sessions.

Keywords: loneliness, older adults, digital technology, co-design, teleconferencing, social connectivity

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Authors: Sheena Asthana, Kieran Green, John Downey, Rachael Fox, Martha Lee

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In the NHS, as in other health systems, it is generally agreed that difficulties in achieving digital transformation lie less in problems with the technical (hardware and software) aspects of digital solutions than the ‘soft’ system issues relating to institutional context, organisational complexity and what are broadly described as ‘human factors’. A range of approaches have been explored within digital health research to better understand and address the complex series of factors that have given rise to the implementation gap. Focusing on the need to deploy digital health technologies to support the ‘shift left’ (preventative) agenda, this paper explores how a systems engineering approach could provide the cross-disciplinary, holistic framework that is required to address what could be described as a very messy problem. Our framework combines methods such as Digital Twins to simulate complex care pathways with Living Labs that enable interdisciplinary collaboration, co-design, and iterative pilot testing. When combined, these methods could help align interests, integrate end-user needs, embed design for successful implementation and iteratively adapt and improve digital health technologies, as well as offering an evaluation strategy that emphasizes safety, effectiveness and cost-efficiency.

Keywords: systems engineering, complexity science, digital acceleration, living labs, preventative health, social care, NHS

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Authors: Pankaj Goel

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Excessive consumption of sugar is a primary factor for dental caries, and dietary guidelines have been developed to reduce them, especially in children. However, there is a paucity of literature regarding barriers and facilitators faced by parents in promoting healthier dietary habits in the prevention of early childhood carriers (ECC). A study was conducted in the Department of Dentistry of a tertiary care hospital in Bhopal, India, on either or both parents of children with ECC. Interviews were conducted to identify the challenges faced and modifications made in children’s cariogenic diet to prevent ECC. Interviews were transcribed, translated, coded, and organized into themes. Analysis was done using NVivo 15 software. Three Focus Group Discussions (FGDs) were conducted on 21 participants (11 males and 10 females) aged 31-45 years. Seven themes emerged, demonstrating that the majority of primary caregivers were aware of the etiology of tooth decay but lacked knowledge of a healthy diet. Counseling resulted in positive feedback with the shift from a sugary diet to more nutritious alternatives, improved oral health, reduced parental stress, and enhanced confidence in diet management. Facilitators included support from public health dentists, whereas time and cultural norms were notable barriers. Recommendations include reminders and periodic follow-ups to sustain the healthy change in diet.

Keywords: diet counseling, early childhood caries, primary caregivers, qualitative study

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Authors: Debra Carroll-Beight

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This paper critiques current healthcare practices for intersex and transgender or gender-diverse populations. These practices are often grounded in “normalization” paradigms that frame nonconforming bodies as problems requiring correction. Intersex individuals frequently undergo early, non-consensual interventions to conform to binary sex norms, while transgender individuals face legal and clinical gatekeeping restricting access to gender-affirming care. These practices illustrate how healthcare institutions contribute to what Rosemarie Garland-Thompson terms “misfits”—individuals whose bodies and identities are misaligned with societal and medical expectations. This analysis challenges normalization practices, advocating for a more pluralistic understanding of embodiment. Embracing this perspective can transform healthcare systems to value bodily integrity and consent, shifting the focus from correcting deviations to creating spaces where diverse bodies and identities genuinely belong. Using a theoretical-normative methodology grounded in materialist feminist ethics, this paper interrogates the systemic oppression perpetuated by normalization practices. Garland-Thompson’s materialist feminism emphasizes the interplay of social power and embodiment, reframing the issue from individual deviance to structural oppression. Drawing on the concept of misfits, the analysis positions the restrictive frameworks of healthcare institutions and societal norms—not the bodies themselves—as the root problem. The analysis highlights the need to reorient healthcare practices toward bodily sovereignty, a concept centered on autonomy, self-determination, and consent. For intersex individuals, this is a non-interventionist model, deferring or forgoing non-emergency medical decisions. For transgender individuals, this shifts to a facilitative model that prioritizes reducing barriers and ensuring access to care without gatekeeping. This inclusive framework recognizes transgender experiences, including those who seek no medical intervention or prefer partial interventions. By respecting bodily diversity and reducing institutional obstacles, healthcare systems can foster more supportive and ethically sound environments. These approaches challenge the authority of medical gatekeeping and affirm intersex and transgender individuals as moral agents whose bodies and identities are respected and valued.

Keywords: intersex, disability, embodiement, feminist ethics

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Authors: Milan Singh, Kailash Pandey, D. P. Singh

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Nuclear medicine is a rapidly growing field that plays a crucial role in healthcare by using radioactive materials to diagnose and treat conditions such as cancer, heart disease, and neurological disorders. With 1.8 million cancer cases reported last year, nuclear medicine has become indispensable for early detection and monitoring of disease progression. India operates around 442 nuclear medicine centers, including 24 medical cyclotron facilities jointly operated by government and private institutes, for radiopharmaceutical production. However, India still relies heavily on pharmaceutical imports from countries such as Canada and Japan. Currently, leading companies in the production of radiopharmaceuticals contribute significantly to the advancement of Nuclear Medicine, but the country still has a considerable distance to cover in this field. With government support, India aims to cultivate its domestic market to meet its own demand instead of depending on exports. This study focuses on the evaluation and optimization of the production pathways for some crucial positron emitter radioisotopes significant in PET, such as ¹¹C (half-life - 20.38 min), ¹³N (9.97 minutes), ¹⁵O (2.04 minutes), ¹⁸F (109.77 minutes) and ⁶⁴Cu (762 minutes) using the EMPIRE-3.2 statistical model code. The evaluated cross-sections are well validated with the experimental as well as evaluated nuclear data libraries (i.e., EXFOR and TENDL), provide reliable cross-section values over a wide energy range, including regions where experimental data is unavailable, enabling the identification of viable production routes for these isotopes. Eight nuclear reactions are found ideal for the isotope production: ¹⁴N(p,a)¹¹C, ¹⁶O(p,a)¹³N, ¹⁴N(d,n)¹⁵O, ¹⁵N(p,n)¹⁵O, ¹⁸O(p,n)¹⁸F, ²⁰Ne(d,a)¹⁸F, ⁶⁴Zn(n,p)⁶⁴Cu and ⁶⁴Ni(p,n)⁶⁴Cu. The calculated excitation function peaks for these reactions lie within the energy range of 5–15 MeV, making them ideal for isotope production using in-house cyclotrons. This allows nuclear medicine facilities to independently produce isotopes without relying on external distributors, improving the availability of these isotopes for treatment purposes.

Keywords: positron emitter, production routes, radiation utilization, radiotracers

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Authors: Eychmueller Steffen, Felber Sibylle

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Background: Patient’s complaints in regard to insufficient competencies of physicians in communication remained stable over the last two decades. This is surprising because of the widespread integration of communication training in medical curricula. A potential explanation is the lack of a more comprehensive understanding of interactive competencies in this field. Methods: Based on a literature scoping review, we developed a framework for interactive competencies. The framework was then exposed to a consensus process following a shortened version of the COMET-outcome methodology within various target groups (medical students, clinicians, patient representatives, and experts) organized by a Swiss medical school. Results: A framework of seven areas with potentially interdependent competencies was defined: self-compassion, self reflexion, basic interpersonal communication skills including cultural sensitivity, skills for online-conversation, serious illness conversation, interprofessional/-hierarchical exchange, and patient education/ empowerment. Conclusion: A more comprehensive understanding of and training in various aspects of interaction, such as self-compassion, interprofessional interaction, and communication via digital tools, may help to overcome potential shortcomings in current communication training focussing on the direct physician-patient scenario only.

Keywords: communication skills, interactive competencies, medical education, self compassion

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Authors: Giulia di Prima, Elena Belfiore, Cecilia la Mantia, Serena Indelicato, Giuseppe Avellone, Viviana de Caro

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Oxidative stress is the key factor leading to both physiological processes (e.g., aging) and pathological mechanisms affecting the skin and the mucosae (e.g., oral lichen planus, oral mucositis). These naturally occurring events or altered conditions are characterized by an imbalance between the oxidative species and the physiological antioxidant defenses. In this view, the daily use of an antioxidant device could be a preventive strategy aimed at restoring any occurring imbalance. Nowadays, the employ of natural and safe antioxidants is preferable, and among them polyphenols are under the spotlight. Additionally, as polyphenols suffer from low bioavailability after oral intake, they could take advantage of a direct buccal administration. A further actual trend is related to sustainability and circular economy. Particularly, at present, sustainable efforts focus on the extraction of natural antioxidants from agri-food wastes, and recently, the waste black bentonite (BB), an inorganic waste coming from must clarification, emerged as a rich source of polyphenols. Based on these considerations, the aims of this work were to develop and characterize an antioxidant secondary raw material starting from the waste BB as well as to employ this excipient to produce a buccal thermosensitive spray intended for oral cavity wellness. To stay in a sustainability point of view, maceration with eco-friendly and unconventional extraction solvents was established as a method to recover polyphenols. Specifically, according to a waste-to-market approach, PEG200, a well-known safe and eco-friendly pharmaceutic liquid excipient, was selected to obtain a high-value-added secondary raw material directly useful to produce cosmetics, pharmaceuticals, and medical devices. The extract has been extensively characterized by HPLC-DAD and HPLC-MS analyses, DPPH, Bradford, and Folin–Ciocalteu assays as well as validated as a safe raw material through OECD-compliant in vitro tests. Then, it was directly inserted into a liquid formulation intended for daily oral care. The goal of the design process was to develop a user-friendly device that could be easily integrated into daily routines. To achieve this, a fluid formulation was designed using Pluronic F-127 which led to a fluid, sprayable, and easily administrable formulation at room temperature, but that transforms into a viscous gel once at body temperature, enhancing retention time and allowing polyphenols to effectively accumulate in tissues. The formulation incorporated a high concentration of extract (30% w/w), xylitol as a sweetener, preservatives, and penetration enhancers. The temperature-dependent gelation behavior has then been assessed by both in vitro and ex vivo tests. The extensibility assay revealed that a drop of formulation spreads until it occupies a surface up to 64 times or less than 5 times the initial one at room and body temperatures respectively. The DPPH test proved that the antioxidant properties of the final formulation are the sum of the preservatives and the extract, but the latter had a predominant role. Finally, the formulation was proved through ex vivo test to be able to allow rapid polyphenol tissue accumulation as both the buccal and sublingual tissues were saturated after just 15 min of application, highlighting an ideal candidate for further in vivo evaluations.

Keywords: antioxidant, in situ gelling, oromucosal spray, polyphenols, waste recovery

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Authors: Vanadana Gopal K., Archana Har, Harshalata Suryavanshi

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Background: Awake fibreoptic intubation is a challenging procedure that requires effective sedation. Dexmedetomidine and propofol are two commonly used sedatives, but their comparative efficacy and safety in this setting are unclear. Methods: This retrospective case series compared the sedation quality, hemodynamic stability, and recovery profiles of 6 patients, three who received dexmedetomidine and three patients who received propofol for awake fibreoptic intubation. Results: Dexmedetomidine provided better sedation quality, hemodynamic stability, and faster recovery times compared to propofol. Additionally, dexmedetomidine resulted in a lower incidence of post-operative nausea and vomiting. Conclusion: Dexmedetomidine appears to be a suitable alternative to propofol for awake fibreoptic intubation, offering better sedation quality, hemodynamic stability, and recovery profiles. Further prospective studies are needed to confirm these findings.

Keywords: dexmedetomidine, propofol, hemodynamic stability, efficacy

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Authors: Helen Owino, Sharifa Hussein

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Background: Kenya has made significant strides in improving access to PHC services. However, challenges relating to equitable distribution of services, resource allocation, and financial sustainability must be addressed. Targeted policy interventions strengthened collaboration between public and private sectors, and innovative financing mechanisms are needed to bridge existing gaps and enhance the delivery of PHC services. A holistic and collaborative approach is essential to ensure PHC remains accessible, affordable, and of high quality for all its citizens. By addressing the identified issues and building on the existing strengths, Kenya can move towards a more resilient and inclusive health system. Study objectives: Inform scale-up of promising primary health care (PHC) approaches/models, Inform the development of PHC advocacy materials, and Contribute to country, regional, and global discourse on PHC financing. The methodology involved conducting a desk review of background literature and statistics on the current state of PHC and key informant interviews guided by a questionnaire based on the pillars or building blocks of Health Systems Strengthening (HSS). Summary of Key Findings: Strong support from leadership is key for the successful implementation of Primary Care Networks (PCNs), as seen in Kisumu and Nakuru, where County Health Management Teams (CHMTs) showed commitment to the success of PCNs even without partner support. Using already existing governance and human resources for health (HRH) mechanisms to implement PCNs is useful, especially where there are resource constraints and improve performance: An appointed PHC focal person/office is key to ensuring the planning and implementation of PCNs, e.g., Kisumu, Nakuru, and Garissa. Embracing joint planning and distribution of resources within PHC leads to more efficient use of resources coordination outcomes, for example, in Kisumu and Garissa. Subsequent prioritization and county funding have led to successful PCN implementation in Nakuru and Kisumu. Partner funding in Garissa has facilitated PCN functionality in Garissa and Nakuru. Intersectoral collaboration and public participation in the health sector lead to greater utilization of PHC services, e.g., in Kisumu, working with other ministries to improve infrastructure like road networks to facilities has improved access to PHC facilities.

Keywords: PHC policy and programming, innovations and adaptations, scale up, UHC

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Authors: Cheng Hong YEO

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Introduction: Objective: To evaluate the effectiveness of Spectral Dual Layer CT (DECT) in diagnosing choledocholithiasis, specifically focusing on its accuracy in detecting small biliary stones compared to other imaging modalities. Background: DECT has shown promise in improving the detection and characterization of gallstones in the common bile duct, offering potential advantages over traditional imaging methods like standard CT and ultrasonography. Methodology: Study Design: Single-blinded retrospective study conducted at a teaching hospital. Patient Selection: Reviewed records of patients who underwent DECT for suspected choledocholithiasis and had follow-up MRCP, ERCP, or IOC within 8 weeks. 23 patients with proven choledocholithiasis and 23 controls without biliary filling defects were included. DECT Protocol: Used a Philips IQ 256-slice dual-energy CT scanner with standard protocols including 120 kVp and 40 keV mono-E images. Assessment: Four radiologists, blinded to the study question, evaluated images for the presence of choledocholithiasis. Sensitivity, specificity, PPV, and NPV were calculated based on consensus diagnoses. Results: Diagnostic Performance: DECT showed an overall sensitivity of 47.8% and specificity of 78.3% for detecting choledocholithiasis. The accuracy of the diagnosis ranged from 54% to 63% among observers. Stone Detection: Of the identified stones, 6 were calcified and 17 non-calcified. Detection of calcified stones was more accurate (83.3%) compared to non-calcified stones (35.3%). Differences in signal between stones and bile were noted in certain imaging parameters. Interobserver Agreement: The agreement among radiologists was fair, with a Fleiss Kappa coefficient of 0.30. Conclusion: This is the first study to specifically analyse the performance of spectral CT in choledocholithiasis detection using a control group and blinding of reviewers. Our modest results demonstrating lower overall sensitivity than had been reported previously at 47.8% overall while identifying 40% of non-calcified stones <9 mm. We believe further research and development on advancements in spectral CT technology or newer techniques such as photon counting CT is warranted.

Keywords: dual energy CT, choledocholithiasis, gallstones, body imaging

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