Access Scheme Research Articles

Meal timing and risk of metabolic syndrome in the prospective French NutriNet-Santé biobank

Abstract Background Circadian rhythm disruption has been associated with higher risks of cardiometabolic diseases and several cancers. Mistimed eating patterns can desynchronize circadian rhythms, and could therefore influence metabolic health. However, long-term associations between meal timing and the metabolic syndrome remain unclear. The aim of this study was to evaluate the prospective associations between meal timing and the risk of developing metabolic syndrome. Methods We used measured biological and clinical data from 16 353 adults (51 years ± 13.72) in the NutriNet-Santé biobank (2011-2014), and examined the associations between meal timing, assessed with repeated 24-hour dietary records during the first two years of follow-up (starting 2009), and the risk of metabolic syndrome, using modified Poisson regression models, adjusted for main confounders. Results At the end of follow-up (mean 2.1 years (SD = 1.2)), a later timing of the first meal of the day was associated with a moderately higher risk of metabolic syndrome (1,788 cases; RR per 1-hour delay = 1.05; 95% CI: 1.00-1.10). However, after adjusting for overall diet quality, this association was attenuated (RR: 1.04; 95% CI: 0.99-1.09). Overall, we found no evidence of an association between the occurrence of metabolic syndrome and the time of the last meal (RR: 0.99; 95% CI: 0.95-1.05), the number of eating occasions (RR: 1.00; 95% CI: 0.98 - 1.03), or night-time fasting duration (RR: 1.03; 95% CI: 0.99 1.07). Conclusions In this large prospective study, timing of the first meal showed modest associations with metabolic syndrome. Further investigations using a longer follow-up are needed to elucidate how meal timing influences metabolic health. Key messages • Beyond the nutritional quality of meals, meal timing, particularly time of first meal, may be an accessible prevention strategy for metabolic health. • More largescale prospective and intervention studies are needed to better understand the links between meal timing and metabolic health.

Use of ChatGPT and Generative AI in Higher Education: Opportunities, Obstacles and Impact on Student Performance

A generative form of Artificial Intelligence now pervades all domains. Artificial intelligence technologies, especially ChatGPT, are increasingly prevalent in a multiplicity of fields, especially in education. This study investigated the impact of generative AI usage on student outcomes, analyzed usage patterns of ChatGPT and highlighted the challenges and advantages of integrating ChatGPT in higher education. Employing the descriptive survey method, the study's sample comprised graduate and post graduate students from Govt. Sadiq College Women University Bahawalpur, totaling (354) participants. Data collected through self-structured, closed-ended questionnaire was analyzed using SPSS software. Descriptive statistics along with correlation analyses and one-way ANOVA were used to analyze the data. The findings indicated ChatGPT is used by 51% students regularly and perceived as an effective way to rapidly complete academic tasks, provide personalized tutoring and provide 24/7 accessibility and alternative strategies, by most participant but they believe that over reliance on ChatGPT, limits student’s exploration capabilities, critical thinking and academic honesty.

Diagnostic and prognostic value of ECG-predicted hypertension mediated left ventricular hypertrophy using machine learning

Abstract Background Hypertension is the commonest cause of left ventricular hypertrophy (LVH). Using cardiac magnetic resonance (CMR) imaging, four distinct hypertension mediated LVH phenotypes have been reported: normal LV, LV remodelling, eccentric LVH and concentric LVH. Early detection of hypertensives with LVH can enable timely initiation of therapy however a CMR based screening strategy is costly, particularly in low resource settings. The electrocardiogram (ECG) is an inexpensive screening tool and can detect LVH but its capacity to discriminate between the 4 phenotypes is unknown. Purpose To classify hypertension mediated LVH phenotypes from the ECG using machine learning (ML) and test for associations of ECG predicted LVH phenotypes with incident cardiovascular outcomes. Methods ECG markers with a known physiological association with LVH (including QRS markers, Sokolow-Lyon, and Cornell) were extracted from the 12-lead ECG of 20,439 hypertensive participants in UK Biobank. Three classification models, logistic regression, support vector machine (SVM) and random forest, were trained in 80% of the participants using extracted ECG markers and clinical variables. The remaining 20% individuals were included in the test set for performance measurement. External validation was sought in 877 hypertensives from the Study of Health in Pomerania (SHIP). Subsequently, we tested for associations between the four ECG-predicted LVH phenotypes and incident major adverse cardiovascular events (MACE) and heart failure using Cox proportional hazard regression in the UK Biobank test set with median follow-up of 4.2 years. Results Among UK Biobank participants (mean age ± standard deviation 65 ± 7.4 years), 23,190 had normal LV, 894 LV remodelling, 218 eccentric and 103 concentric LVH. Classification performance of the three models was comparable, but SVM showed consistent results (accuracy 0.79, sensitivity 0.59, specificity 0.87, AUC 0.69) and superior prediction of eccentric LVH (AUC 0.86). In SHIP (55 ± 12.7 years), 704 had normal LV, 134 LV remodelling, 12 eccentric and 24 concentric LVH. In the external validation performed in SHIP, SVM had accuracy of 0.75 (sensitivity 0.51, specificity 0.85, AUC 0.65), with superior prediction of eccentric LVH (AUC 0.76), as shown in Figure 1. Ventricular rate and QRS amplitude (P<0.001) were the features most strongly associated with LVH. In the test set of UK Biobank, setting normal LV as the reference group, the ECG predicted eccentric LVH group was associated with heart failure (Hazard Ratio 3.42, confidence interval 1.06-9.86), there were no associations with MACE (Figure 2). Conclusions ECG-based ML classifiers were able to discriminate the four hypertension mediated LVH phenotypes with external validation demonstrating robustness. This automated approach enhances capabilities of non-specialists and potentially represents an accessible screening strategy for the early detection of hypertensives with LVH.

Review of the fluoropyrimidine antidote uridine triacetate.

In 2015, the United States Food and Drug Administration (FDA) approved uridine triacetate to treat overdose and severe toxicity of the fluoropyrimidine chemotherapy agents 5-fluorouracil (5-FU) and its oral prodrug capecitabine. Uridine triacetate is as an oral prodrug of uridine that competes with cytotoxic fluoropyrimidine metabolites for incorporation into nucleotides. Two million people worldwide start fluoropyrimidine chemotherapy each year, with 20-30% developing severe or life-threatening adverse effects, often attributable to a genetic predisposition such as dihydropyrimidine dehydrogenase deficiency. Whilst genetic prescreening is recommended prior to starting fluoropyrimidine agents, this only prevents 20-30% of early-onset life-threatening toxicity and so does not obviate the need for an antidote. Initial in-human studies established that uridine triacetate more than doubles the maximum tolerated weekly 5-FU bolus dose. A lack of clinical equipoise meant a placebo-controlled phase III trial was not ethical and so the phase III trials used historical controls. These found that uridine triacetate improved survival in those with fluoropyrimidine overdose and severe toxicity from 16% to 94%, with 34% able to resume chemotherapy within 30 days. Five case reports of delayed fluoropyrimidine toxicity demonstrate improvement following uridine triacetate treatment 120-504 h after last fluoropyrimidine administration, suggesting efficacy beyond the FDA licencing indications. Mechanistically uridine triacetate would be expected to be effective for overdose and severe toxicity of tegafur (a 5-FU prodrug), but there are no published case reports describing this. Uridine triacetate is available internationally through an expanded access scheme and has been available in the UK since 2019 on a named patient basis.

Significant reduction of complications applying an optimized vascular access and post-interventional groin-site management during electrophysiology procedures

Abstract Background Catheter ablation of cardiac arrhythmias is an established treatment strategy. However, the optimal femoral vascular access strategy and post-interventional management in the electrophysiology (EP) setting is still under debate. Purpose To assess the impact of ultrasound-guided versus conventional femoral vascular puncture and of a modified post-interventional groin-site management strategy on complication rates. Method Patients undergoing EP procedures at the our university heart and vascular center are included in an institutional prospective registry. Conventional vascular access as well as post-interventional groin site pressure-bandage and bed rest of 6 hours (group I) was compared to a new strategy including ultrasound-guided vascular access, venous closure by a Z-suture and groin site pressure-bandage for only 2 hours plus additional 4 hours bed rest (group II). Incidences of minor and major groin site complications for both groups were compared. Hematoma, bleeding, arteriovenous fistula or pseudoaneurysm of the femoral artery without need for intervention (e.g. transfusion, thrombin injection, surgery) were classified as minor complications. Complications requiring intervention or retroperitoneal hematoma were defined as major complications. Results A total of 1535 procedures in 1381 patients (779 (51 %) procedures in 705 (51%) patients in group I and 756 (49%) procedures in 676 (49%) patients in group II) were analyzed. In group I and group II, respectively, 39%/44% procedures were index pulmonary vein isolations, 30%/29% repeat atrial fibrillation, 16 %/15% supraventricular tachycardia, 12%/11% PVC or VT ablations, and 4%/2% left atrial appendage occlusions. The total groin site complication rate was 9% (70/779 procedures) for group I, and 5% (38/756 procedures) for group II (OR 0.54 [95%-CI 0.35-0.82], p=0.003). Major groin site complications occurred in 2% (19/779 procedures) in group I and were reduced to 1% (10/756 procedures) in group II (OR 0.53 [95%-CI 0.22-1.22], p=0.156). Conclusion The overall groin site complication rate in EP-procedures was significantly reduced by implementing a novel institutional standard for vascular access management including ultrasound-guided puncture and a modified post-interventional groin site management.

A case report on the choice of venous access after ectopic peripherally inserted central catheter in an upper limb of a patient with a second recurrence of right-side breast cancer.

Intravenous catheter placement in the healthy upper extremity is preferred for chemotherapy in patients with breast cancer. Common venous accesses are peripherally inserted central catheters (PICCs) and totally implantable intravenous port catheters (TIVPs). In this case, a patient with breast cancer had a history of infusion port placement through the left internal jugular vein, with ipsilateral innominate vein stenosis after placement. The patient was re-treated with a PICC placed ectopically through the left upper limb into the intrathoracic vein. After multidisciplinary consultation, a transfemoral PICC combined with intracavitary electrocardiography (IC-ECG) was performed to establish venous access. This case can assist PICC catheterization nurses in developing optimal venous access strategies tailored to the specific situations of patients in similar situations. Through adequate evaluations and optimal selection of venous access, the success rate of disposable catheterization can be improved, and the risk of complications reduced. A 53-year-old female with breast cancer had a history of infusion port, with ipsilateral innominate vein stenosis after placement. The patient was re-treated with a PICC placed ectopically through the left upper limb into the intrathoracic vein. An axial computed tomography (CT) image before totally implantable venous access port (TIVP) placement and An axial CT 103 days after TIVP placement shows diffuse stenosis of the left innominate vein, associated with infusion port placement through the left internal jugular vein. After multidisciplinary consultation, a transfemoral PICC combined with intracavitary electrocardiography (IC-ECG) was performed to establish venous access. The patient's lower limb PICC was left in place for 201 days with no complications, completing the full treatment cycle. This case presents a rare and insightful clinical scenario. For patients with a history of infusion port placement, particularly via the left internal jugular vein, careful analysis of the innominate vena cava and examination of chest wall vein exposure are essential to determining the optimal vascular access strategy.

Enhancing Conceptual Understanding of Electricity and Magnetism through VR Simulations

The study explores the efficacy of Virtual Reality (VR) simulations in enhancing students’ conceptual understanding of electricity and magnetism, using the Labster platform. Traditional teaching methods often need to adequately convey the complexities of these topics, leading to limited student engagement and poor comprehension. The research compares two groups: one receiving traditional instruction and another using VR-based simulations. The study found that students in the experimental group, who used VR simulations, showed a 35% improvement in post-test scores, compared to a 15% improvement in the control group. The VR group also reported higher levels of engagement and found abstract concepts such as electric fields and circuits easier to understand through interactive, immersive learning environments. Teachers noted that VR aided in visualizing difficult concepts, although challenges included a learning curve in technology usage and the need for proper integration into curriculum. The findings suggest that VR, when used as a supplemental tool, has the potential to significantly improve learning outcomes in physics education. However, the study highlights the need for further research into long-term impacts and accessibility issues and strategies to better integrate VR into traditional teaching methods.

A randomized clinical trial of emotional freedom techniques for chronic pain: Live versus self-paced delivery with 6-month follow-up.

Chronic pain represents a major global healthcare crisis, and current treatments are limited in effectiveness and safety. Emotional freedom techniques (EFTs) show promise as a potential psychological treatment. The current study investigated the effect of a randomized clinical trial of EFT for chronic pain in a sample of 147 adult chronic pain sufferers (89.9% female; mean 54.63 years). Participants engaged in a 6-week EFT programme (either online self-paced or in-person). The per-protocol analysis indicated pain severity and interference scores were significantly lower at the end of treatment for the EFT group compared to waitlist, and these were sustained at follow-up. There were no differences between the in-person or self-paced programmes at follow-up for pain severity and interference. Somatic symptoms were significantly lower after EFT, although no further differences at follow-up. Quality of life scores were significantly higher after EFT, which were sustained at follow-up, and no differences between two styles of programme. No significant effects were found for anxiety, depression, happiness or satisfaction with life across the 6-week programmes for either style of delivery or at follow-up. These are discussed in terms of clinical score meanings. Intent-to-treat analysis was consistent with the per-protocol analyses. Limitations of the study are identified and future directions are discussed. Findings offer early promise for EFT as a potentially effective pain management strategy, as well as support for online intervention without compromising treatment outcomes. An emerging body-based intervention for chronic pain may be a possible solution for remote clients who cannot attend in-person sessions. In this clinical trial Emotional Freedom Techniques (EFT) significantly reduced chronic pain severity and interference, and there were no differences between and online self-paced program toan online in-person EFT intervention. Both were equally effective, also enhancing quality of life without compromising outcomes. The results were significant at 6-month follow-up/. These findings highlight a body-based approach as a promising, accessible pain management strategy, and highlights that online programs may be part of the solution for chronic pain patients.

Navigating Information Equity, Access, and Literacy in the Context of Diversity, Equity, and Inclusion

In today's interconnected world, the ability to access and critically analyze information is essential for fostering diversity, equity, and inclusion. This proposal seeks to explore challenges and strategies related to information literacy amidst political and policy confrontations to continuously achieve fundamental principles. Objectives:•Highlight the importance of information literacy in promoting diverse perspectives and combating bias.•Discuss strategies for equitable access to accurate information, particularly for marginalized communities.•Explore the role of media and education in shaping inclusive narratives and fostering informed dialogue.•Address the impact of misinformation and polarization on efforts to promote diversity, equity, and inclusion. Panel Topics:Understanding Information Literacy: Define information literacy and its significance in empowering individuals to navigate complex information landscapes. Promoting Diverse Perspectives: Examine how access to diverse sources and viewpoints contributes to a more inclusive understanding of societal issues. Equitable Information Access: Discuss barriers to access reliable information, particularly in underserved communities, and propose solutions for greater equity. Expected Outcomes:•Increased awareness of the importance of information literacy in promoting diversity and inclusion.•Identification of actionable strategies for improving information access and combating bias in media.•Inspiration for collaborative initiatives aimed at fostering inclusive dialogues and empowering marginalized communities. Audience:Our target audience includes educators, media professionals, community organizers, policymakers, and individuals passionate about promoting diversity, equity, and inclusion through enhanced information literacy.

Estimation and Comparison of Deflouridation of Flouridated Ground Water Using Four Natural Adsorbents: Multani Mitti, Chalk Powder, Orange Peel Powder and Ragi Powder

This study highlights the global issue of fluoride contamination in drinking water, affecting approximately 260 million people in 30 countries, with India facing significant challenges as endemic fluorosis impacts around one million individuals across 17 states. The elevated fluoride levels are primarily attributed to fluoride-bearing minerals in local rocks and soils. The World Health Organization recommends maintaining fluoride concentrations near 1 mg/L to balance dental health benefits while preventing fluorosis. In response, various defluoridation methods—such as precipitation and adsorption—are implemented in India to adjust fluoride levels to optimal ranges. Given the essential role of water in physiological processes for humans, animals, and plants, understanding the variable quality of surface and groundwater is crucial. This variability is influenced by local geological factors and the presence of contaminants, necessitating effective management strategies for safe drinking water access.

MDM‐Incorporated Quad Donut Modes OCDMA‐FSO Scheme for Secure High‐Altitude Platforms‐To‐Satellite Scenarios

ABSTRACTThe next generation of communication networks is envisioned to be driven by high‐altitude platform (HAP)‐to‐satellite systems. License‐free narrow beam free space optics (FSO) can provide uninterrupted connectivity in satellite‐enabled Internet of Things scenarios. This work proposes a HAP‐to‐satellite hybrid mode division multiplexing–optical code division multiple access (MDM‐OCDMA) scheme employing zero cross‐correlation (ZCC) and multidiagonal (MD) codes. In high‐speed satellite communications, a 12 × 10‐Gbps hybrid MDM‐OCDMA scheme carrying four donut modes (0, 1, 2, and 3) enables high channel capacity, sufficient spectral efficiency, and data security under severe link conditions. Based on simulations, the hybrid MDM‐OCDMA scheme using the ZCC code achieves a greater FSO link distance of 420 m compared with when using the MD code at a 10e‐9 error correction limit under clear air and weak turbulent scenario. The reliable transmission distance of 250 m is achievable with the 120‐Gbps proposed system, assuming pointing errors of 2 mrad, 1‐dB receiver, and 2.5‐dB transmitter losses. The results also show that the system can sustain an additional loss of 1.5–2 dB over 250 m for all donut modes. Additionally, the system using ZCC code contributes to low power consumption over MD and variable weight ZCC code and thus requires a minimum received power of −4.02 dBm. It also offers high optical signal to noise of 42–52 dB, −11.58 to −22.20 dB of gain, 11.58–22.20 dB of noise figure, and −48.11 to −58.73 dBm of signal power at output over 200–700 m range up to 2 dB of additional loss. Comparative analysis indicates that the proposed system is more efficient, less complex, adequately distance‐friendly (=420 m), and capable of higher data rates (=120 Gbps) compared with other works. This makes it a promising solution for future high‐speed satellite communications considering the impact of link losses and atmospheric conditions.

Tree holes as a source of water for primate species in an Amazonian Forest fragment, northern Brazil

Abstract. Water is an essential nutrient for living beings and is fundamental to metabolic processes. Under free-living conditions, primate individuals can use different strategies, skills, and resources to access water. Here, we report on observations of water consumption in Ateles chamek and Sapajus apella; describe the environmental conditions in which such events were observed, as well as the behavior of the individuals; and compare these observations with similar records in neotropical primates. Water consumption was observed during primate surveys in a forest fragment of approximately 52 ha bordered by the Jaru River, located southwest of the Brazilian Amazon, Vale do Paraíso municipality, state of Rondônia, Brazil. To access water, individuals of A. chamek used their tails, whereas S. apella used a leaf as a tool. Our observations suggest that tree holes may be important water sources for primates in forest fragments and that individuals of different species use different strategies to collect water from tree holes. Access and consumption strategies are directly associated with different cognitive skills and behaviors, which may include using tools, as in the case of capuchins. As water consumption records are limited, these findings highlight the need for continuous reporting to better understand water acquisition. Such reports are especially needed in the context of fragmented and degraded habitats, where water availability is affected by edge effects and the reduction in both fleshy fruits and moisture, which are important for primate species.

Adolescent and young adult sleep and sleep-related behaviour change before and during the COVID-19 pandemic lockdown in Canada

ABSTRACT Background Sleep disturbance is common in adolescents and young adults (AYAs), impacted by stress and academic/scheduling demands that conflict with biological phase delay. COVID-19 lockdowns allowed us to study sleep in AYAs when there are lessened scheduling demands. Additionally, we could test whether a sleep self-management app was helpful during lockdowns. Method AYAs (ages 15–24 years) before (Pre-Lockdown; n = 65) and during lockdowns in Canada (Lockdown; n = 40) completed sleep diaries on the app; set goals based on generated feedback; and completed more sleep diaries pursuing whatever post-feedback goals they set. Results The Lockdown group reported later and less variable rise times (RT) and spent more time in bed (TIB), both awake and asleep. Pre-Lockdown set a goal to reduce RT variability whereas Lockdown set a goal to decrease TIB, and AYAs made behaviour changes to meet their goals. For both groups, sleep onset, duration of awakenings, sleep duration and efficiency, and insomnia severity significantly improved at endpoint. Conclusions AYAs slept differently during lockdowns, perhaps due to decreased scheduling. The pandemic revealed the need for accessible strategies to improve sleep health. Findings support the feasibility of using evidence-based apps, and that AYAs can effectively use self-management tools across variable global and social contexts to improve their sleep.

Understanding medicine access strategies for innovator medicines registered in South Africa

BackgroundSouth Africa is composed of a two-tier healthcare system. One tier is a private healthcare system that is funded through medical insurance, and comprised of people who can afford to make monthly payments towards their medical insurance. Second tier is a government-funded public healthcare system, which covers the majority of the population. This study explored the perceived barriers and current strategies being utilised by the pharmaceutical industry to increase access to innovator medicines.ObjectivesThe objectives of the study were to: (1) quantify and classify innovator medicines registered between 2010 and 2020 by the South African Health Products Regulatory Authority (SAHPRA); (2) identify barriers to accessing innovator medicines in South Africa through interviews with market access managers from innovator companies; and (3) explore the current market access strategies used by the pharmaceutical industry.DesignThis study employed a quantitative and qualitative methodology. Whereby the former involved the extraction of a list of innovator medicines from the regulator database, and the latter involved 9 semi structured interviews. Purposive sampling was conducted through pharmaceutical association member companies. The interviews included seven market access managers and two medicine managers from one of the payers in South Africa. Thematic analysis was used to interpret the data collected from the study.ResultsAccording to the regulator database during the review period, 238 innovator medicines were registered. Only 14.77% were available in the public sector in the form of tenders, whereas in the private sector (based on the products having a SEP), 76.92% were available. From the interviews six themes emerged: reimbursement of medicines, types of reimbursement, partnerships, technology, legislative challenges, and other factors (e.g., real-world evidence).ConclusionAccess to innovator medicines in South Africa is a challenge, as the price of these therapies is high. Therefore, various stakeholders in the health sector must collaborate to identify and implement solutions that are locally relevant. The government needs to proactively update policies that would allow for alternative reimbursement methods to be explored.

Navigating global horizons: a review of export promotion and foreign market entry strategies for small and medium enterprises (SMEs)

Purpose This study aims to conduct a systematic review of the existing literature on export promotion and foreign market entry strategies for small and medium enterprises (SMEs). Design/methodology/approach This study incorporates systematic literature review by using bibliometric technique and content analysis of 195 scholarly papers published between 2000 and 2024 obtained from Scopus database, using the PRISMA principles and a methodological framework. Findings The use of quantitative analysis has shown dynamic patterns in publication trends, characterized by notable increases in recent years. These trends align with the changing dynamics of the global economy and shifting priorities in international commerce. The study reveals thematic frameworks using author collaboration analysis, word cloud visualizations and a thematic map, providing insights into a significant motor, niche and developing issues that shape the discussion on the international growth of SMEs. Research limitations/implications It offers significant insights that can benefit academics, policymakers and practitioners who are interested in understanding and navigating the intricate terrain of export promotion and market access strategies specifically tailored for small firms. Originality/value To the best of the authors’ knowledge, the study is the first of a kind that presents a systematic examination of the existing body of knowledge on the internationalization of SMEs.

A novel superposition coding scheme based on polar code for multi‐user detection in underwater acoustic OFDM communication system

SummarySuperposition coding (SC) is a non‐orthogonal multiple access (NOMA) scheme for the downlink communication system, which allows signals of different users to be stacked and forwarded simultaneously in the same frequency band. The codeword for each user is assigned a different weight at the transmitter to avoid signal conflicts and interference after stacking, and successive interference cancellation (SIC) is adopted to decode. A novel SC scheme based on polar code, suitable for the downlink multi‐user underwater acoustic (UWA) communication system using orthogonal frequency division multiplexing (OFDM), is proposed in this paper. Polar code is utilized to create a nested code structure that is divided into several subsets. We exploit this feature of the polar codes and assign each subset to the corresponding user in the channel coding process. The information bits are placed on the independent subset for each user, and the random bits are placed on the subset of other users while all the users share the same set of frozen bits. Then, the codewords are stacked with different weights. The selection range of power factors can be expanded through the double superposition of the coding and the power domains, and higher system throughput and fairness can be achieved. The simulation and tank experiment results significantly verify the effectiveness of the proposed scheme, making it most suitable for the downlink UWA multi‐user communication systems.

Improved BCH-Polar Concatenated Scheme for Unsourced Random Access in Internet of Things

Improved BCH-Polar Concatenated Scheme for Unsourced Random Access in Internet of Things

Enhancing Accessibility in Archives of Developing Countries: Strategies for Inclusive Information Access in Pakistani Context

ABSTRACTThis study explores these challenges, focusing on language diversity, literacy levels, and technological infrastructure. Sindh's linguistic diversity, with Sindhi, Urdu, and English as primary languages, creates barriers for users not proficient in multiple languages. The need for translation services, limited by financial constraints, further complicates access. Additionally, literacy disparities between urban and rural areas hinder engagement with textual materials, necessitating educational outreach programs that require substantial investment. Technological barriers, including limited internet access and digital devices in rural areas, exacerbate these challenges. This research proposes strategies to enhance accessibility in Sindh Archives, such as multilingual cataloging, audiovisual resources, community outreach programs, mobile libraries, user‐friendly digital interfaces, collaborative partnerships, and capacity‐building initiatives. These strategies aim to promote equitable access to archival resources, enabling broader participation in research and education. By implementing these approaches, the rich cultural heritage of Sindh can be preserved and made accessible for future generations. The Sindh Archives in Karachi, with its extensive collection of historical documents, serves as a case study to illustrate the potential impact of these strategies.

Development of a novel light-sensitive PPG model using PPG scalograms and PPG-NET learning for non-invasive hypertension monitoring

Background and objectivePhotoplethysmography (PPG) signals provide a non-invasive method for monitoring cardiovascular health, including blood pressure levels, which are critical for the early detection and management of hypertension. This study leverages wavelet transformation and special purpose deep learning model, enhanced by signal processing and normalization, to classify blood pressure stages from PPG signals. The primary objective is to advance non-invasive hypertension monitoring, improving the accuracy and efficiency of these assessments. MethodsThe study employed continuous wavelet transform (CWT) to prepare PPG signals for analysis using a special purpose PPG-NET designed by applying advanced deep-learning models. PPG-NET was verified by applying several pre-trained models, including Inception, MobileNetV2, InceptionResNetV2, and others to the PPG data. Rigorously five-fold cross-validated models were conducted to obtain the models' performance to ensure robustness and repeatability of results. ResultsThe PPG-NET model demonstrated superior performance, achieving a perfect accuracy of 100 % in classifying the four stages of hypertension—normal, prehypertension, stage 1, and stage 2. The evaluation metrics reported include precision, sensitivity, and specificity, with the PPG-NET model achieving 100 % across all metrics. Other models showed varying levels of accuracy, with InceptionV3 also reaching 91.5 %, while some, like VGG-19, underperformed significantly. ConclusionsIntegrating CWT and PPG-NET offers a promising avenue for enhancing non-invasive blood pressure monitoring. The PPG-NET model, in particular, showed potential for clinical application due to its high accuracy and reliability. This study showed the effectiveness of combining advanced computational techniques with traditional PPG analysis, potentially leading to more personalized and accessible hypertension management strategies.

Factors Associated with Health-Seeking Behavior in Indonesia: Evidence from the Indonesian Family Life Survey 2014

Background and Objectives: Health-seeking behavior is a critical determinant of health outcomes, particularly in countries like Indonesia. Given the increasing burden of noncommunicable diseases, understanding the factors that influence health-seeking behavior in this context is essential for developing more accessible and effective public health strategies. This study aimed to identify various factors associated with health-seeking behavior among patients with chronic diseases across Indonesia, especially in formal facilities. Materials and Methods: This study used a cross-sectional research design, utilizing Indonesian Family Life Survey (IFLS)-5 data. The inclusion criteria included respondents aged 20–74 years old with at least one chronic disease based on self-reported data. Respondents who did not receive treatment, practiced self-medication, or provided incomplete data were excluded. We used multivariate logistic regression to identify factors associated with health-seeking behavior in formal facilities. Results: The results revealed that 80.7% (n = 1993) of the 2471 respondents sought treatment in formal facilities, whereas 19.3% (n = 478) opted for informal facilities. Respondents who were Bugis (OR 9.187, 95% CI 2.182–38.683; p = 0.002), retired (OR 2.966, 95% CI 1.233–7.135; p = 0.015), did not smoke (OR 1.604, 95% CI 1.126–2.285; p = 0.009), made less than IDR 1,500,000 a month (OR 1.466, 95% CI 1.174–1.831; p = 0.000), had to travel more than 3 km to reach a treatment facility (OR 1.847, 95% CI 1.41–2.42; p = 0.000), or had more than one comorbidity (OR 1.396, 95% CI; p = 0.01) were more likely to seek treatment at formal facilities. Conclusions: These findings are expected to provide recommendations for policymakers, healthcare providers, and researchers to contribute to the development of targeted interventions that can improve healthcare access and utilization, ultimately enhancing health outcomes and equity in Indonesia.