Binomial Distribution Research Articles

Financial Stress and Tobacco Expenditure in Australian Households: A Cross-Sectional Analysis of Prevalence and Association Across Wealth and Income Levels.

Despite successful public health campaigns, tobacco use persists as a major cause of preventable illness and death. While tobacco taxation is recognized as an effective control strategy, concerns remain about potential financial strain on lower socioeconomic groups. This study investigates the relationship between household tobacco expenditure and financial stress in Australia, a country with high tobacco taxes and declining smoking rates. Household data from the 2015-16 Australian Household Expenditure Survey were analysed (N=10,036). Financial stress was measured using a scale based on nine self-reported indicators. Respondents were asked to report if their household had experienced any of these difficulties, e.g. inability to pay utility bills or going without meals. Negative binomial regression models assessed the association between tobacco expenditure share and financial stress, adjusting for sociodemographic factors, household wealth, and other expenditures. Financial stress was more prevalent among households that did (45.0%; (95% CI: 42.5, 47.5)) versus did not (25.4%) purchase tobacco. All levels of tobacco expenditure were significantly associated with higher financial stress bivariably, after controlling for covariates. For instance, households in the second-lowest tobacco expenditure share quintile had a higher mean financial stress score than non-purchasing households (RR=1.59, CI, 1.36, 1.85, p<0.001). In Australia, financial stress is prevalent among tobacco-purchasing households and household tobacco expenditure is significantly associated with increased financial stress even at modest levels of spending, i.e. the lower quintiles of tobacco expenditure. These findings underscore the need for targeted policies to mitigate financial strain and support smoking cessation among vulnerable populations. This study found that the prevalence of financial stress is higher in Australian households that purchase tobacco, regardless of their spending on tobacco. Although tobacco price increases reduce overall tobacco use, our study shows that increased prices exacerbate strain among financially disadvantaged smokers. Further research into associations between financial well-being and tobacco use is needed, both nationally and internationally. Longitudinal research should also examine the longer-term health and economic impacts mediated by financial stress.

Sales concentrations of digital brands

ABSTRACT This study compares the observed and theoretical sales concentration levels for over 200 digital brands in 18 diverse online categories and four countries. It applies the Pareto Share, ‘heavy half’ and Negative Binomial Distribution (NBD) to online brand purchase frequencies with a classic empirics-first approach. From the results, it emerged that, on average, the digital Pareto Share is 47% and the heavy half of a brand’s buyers contribute to 71% of its online sales. That is, the heaviest 20% of a brand’s online customers account for just under half its sales, and about seven in ten sales are from buyers who purchased the brand more often than the median frequency. These outcomes closely match the NBD’s theoretical expectations. Besides advancing empirical research on sales concentration for digital brands, this study provides valuable practical guidelines for effectively targeting (or ‘activating’) online buyers based on sales concentration levels.

The roles of L1 transfer, L2 exposure, and morphological salience in bilingual children's L2 English morphological development

IntroductionThe present study aims to advance our understanding of bilingual children's L2 morpheme acquisition variability by examining the child-internal factor of L1 transfer, child-external factor of L2 exposure, as well as the linguistic factor of morphological salience.MethodDrawing on naturalistic conversational data from a corpus of bilingual children's language samples, we analyzed the production accuracy of five English inflectional morphemes in 21 language samples from Spanish-English bilingual children and 25 language samples from Mandarin-English bilingual children. The two groups were age-matched and gender-balanced, with a mean age of 5 years and 1 month (range: 3; 8–7; 5). Binomial logistic mixed-effects models were employed to examine the accuracy of L2 morpheme production as influenced by L1 transfer, L2 input quantity (months of English exposure), input quality (morphological richness &amp;amp; lexical diversity), and the morphological salience of the target morphemes.ResultsThe results revealed a significant effect of L1 transfer, with Spanish-English bilinguals demonstrating higher accuracy than Mandarin-English bilinguals, particularly for English plural -s and articles. Besides, months of English exposure emerged as a significant positive predictor of L2 morpheme production accuracy. As regards input quality, while lexical diversity positively contributed to morpheme accuracy in both groups, morphological richness negatively affected morpheme production accuracy among Mandarin-English bilinguals. In addition, our descriptive analyses of morphological salience factors indicate that, across both groups of children, perceptual salience, morphophonological regularity, syntactic category and semantic complexity influence morpheme production accuracy to different degrees.DiscussionThe study suggests that L1 transfer plays a critical role in L2 English morpheme production accuracy and underscores the importance of L2 input quantity and quality, such as lexical diversity, in explaining variability in bilingual children's morpheme acquisition. Additionally, difficulties in producing English morphemes may be associated with factors related to morphological salience. Overall, the findings underlie the importance of L1 transfer, L2 exposure, morphological salience in bilingual children's L2 morpheme acquisition.

Inequalities in antenatal care service utilization in Nepal: evidence from nationally representative Nepal multiple indictor cluster surveys 2014 and 2019

IntroductionAntenatal care (ANC) is essential for improving maternal and neonatal health outcomes, and its utilization is influenced by socioeconomic factors. This study aims to assess disparities in ANC service utilization by wealth, caste/ethnicity, and province among Nepalese women, using data from the nationally representative Nepal Multiple Indicator Cluster Surveys (MICS) 2014 and 2019.MethodsWe assessed the association of ANC service utilization with the household wealth index quintiles, caste/ethnicity and province using multivariable logistic and negative binomial regression models. We also measured wealth-related inequality using concentration curves and concentration indices.ResultsThe proportion of women who received four or more ANC visits increased from 60.6% in 2014 to 77.8% in 2019. However, in both 2014 and 2019, women in the highest wealth quintile were over five times more likely to receive recommended ANC visits than those in the lowest quintiles. Similarly, the expected number of ANC visits was 70% higher in 2014 and 35% higher in 2019 for women in the highest wealth quintile compared to the lowest quintile. Concentration curves showed a decrease in pro-rich inequality in ANC utilization by 2019 relative to 2014, though notable inequality remained. Geographic disparities were evident: Karnali and Madhesh provinces had significantly lower utilization of recommended ANC visits and fewer ANC visits than Koshi Province. Ethnic disparities were also prominent, with women from Dalit, Disadvantaged Janajati, and Other Madheshi caste groups being significantly less likely to complete recommended ANC visits.ConclusionOur findings reveal persistent wealth-related inequality in ANC service utilization in Nepal, with women from wealthier households, advantaged caste/ethnic groups and better-off provinces having higher odds of receiving recommended ANC visits and a higher number of ANC visits. Concerted efforts are needed to address these equity gaps in ANC service utilization, particularly for women from low-income households, disadvantaged caste/ethnic groups, and underserved provinces.

Cyclist-Involved Crashes and Level of Traffic Stress: Evidence from Arizona

Confronted by growing environmental and health concerns, many transportation agencies are instituting new policies and programmatic interventions aimed at further motivating cycling as a mobility option. Yet, in most American metropolitan regions, cycling rates remain relatively low in comparison to other modes despite a suspected desire among many urban residents, workers, and visitors to expand their transportation portfolio. A primary reason for this stagnation in cycling relates to continued and mounting concerns about the personal safety and comfort of current and prospective cyclists using high-stress facilities to reach their destinations. To help understand the extent of this identified impediment to increased cycling adoption, this study examines the association between the level of traffic stress and traffic safety for cyclists measured by crash frequency at segment level and the severity of injury to cyclists at the incident level. By estimating a pair of negative binomial and binary logit models, respectively, this study adopts a two-pronged analytic framework to assess the significance of four different levels of traffic stress and their components (posted speed limit, number of travel lanes, annual average daily traffic) in predicting crash frequency and injury severity. Findings from this study of a 7-year crash data set collected across all metropolitan planning organization jurisdictional boundaries in Arizona show that an increase in the level of traffic stress of a segment is associated with an increase in the frequency of crashes involving cyclists and that cyclists are more likely to experience a more severe injury if involved in a crash with a motorist on a higher-stress facility.

Meteorological factors association with under-five children diarrhea incidence in central Gondar zone, Northwest Ethiopia. A time series study

BackgroundUnder 5 children diarrhea has been one of the major public health concerns in countries with limited resources such as Ethiopia. Understanding the association between under-5 diarrhea and meteorological factors will contribute to safeguarding children from adverse health effects through early warning mechanisms. Thus, this study aimed to explore the association between under-5 diarrhea and meteorological factors to reduce health risks.MethodsA time-series ecological study was used to explore the association between meteorological factors and under-5 diarrhea incidence. Spearman’s correlation was computed to test the correlation and a negative binomial regression model was fitted to determine the associations of meteorological factors with under-5 diarrhea incidence. The multicollinearity was checked using the variance inflation factor (VIF) before the multivariable regression analysis and the value was 5. aIRRs with 95% CIs and a significance level of 0.05 were used for all the statistical tests. Statistical analyses were conducted using STATA 14.2 software.ResultsThe highest under-5 diarrhea incidence morbidities was 180.9 per 1000 per year for under-five children. This study revealed a positive and negative correlation between the count of under-5 diarrhea and average monthly temperature and rainfall at 0 and 2 lag months with RRs of 1.0209 (95% CI: 1.0034–1.0387), RR 1.0202(95% CI:1.0022–1.0385), RR 0.999(95% CI:0.9985–0.9996), and RR 0.9992(95% CI:0.9987–0.9997) respectively.ConclusionThere was an association between under 5 diarrhea incidence and meteorological factors in the Central Gondar Zone. The mean monthly temperature and rainfall were positively and negatively related to the incidence of diarrhea in children under 5 years old. The results showed that the observed association between meteorological factors and under-5 diarrhea incidence could be used as evidence for the use of early warning systems for the prevention of childhood diarrhea.

A New Compound Family of Weibull Order Statistics and Left k-Truncated Power Series Distributions

This paper introduces a new family of distributions by compounding the left k-truncated power series distribution with the k-th order statistic of the Weibull distribution. The new family provides a flexible framework for modeling complex data, particularly in reliability engineering and survival analysis. We derive key functions, including the probability density function (PDF), cumulative distribution function (CDF), and hazard rate function (HRF). Several important special cases—such as the geometric, Poisson, binomial, and logarithmic power series distributions—are discussed. Fundamental properties of the family, including moments and quantiles, are explored. Parameter estimation is addressed using the maximum likelihood and the expectation-maximization methods. The paper concludes with potential applications and future research directions.

Characterising the effects of displacement on gender-based violence among women living with HIV in Ukraine: a cross-sectional study.

Women living with HIV (WLHIV) in conflict zones are at high risk of sexual and physical violence due to instability, stigma and proximity to military personnel. Given sustained ongoing conflict, this study evaluated the relationship between displacement and gender-based violence (GBV), including experiences of sexual violence, abuse by healthcare workers and reproductive coercion among WLHIV in Ukraine. These forms of violence are conceptualised as severe forms of enacted stigma that are downstream outcomes of social, cultural and political norms, as well as social and structural stigmas related to misogyny and HIV. Data were collected in Ukraine in 2020 as part of the People Living with HIV Stigma Index 2.0, led by 100% Life, the largest organisation for people living with HIV in Eastern Europe/Central Asia. WLHIV were recruited throughout Ukraine through limited chain referral and venue-based sampling. All participants completed a sociobehavioural questionnaire. Self-reported outcomes included sexual violence, violence in healthcare settings and reproductive coercion related to pregnancy, sterilisation and contraception. Displaced participants comprised WLHIV who were asylum seekers/refugees or internally displaced. Log binomial regression models estimated adjusted prevalence ratios (aPR) and 95% CIs for associations between displacement and GBV outcomes. A total of 1062 cisgender WLHIV completed the questionnaire, among whom 144 (13.6%) were displaced. Displaced WLHIV had higher proportions of lifetime experience using drugs (66.7% vs 22.0%, p=<0.01), selling sex (28.5% vs 12.2%, p=<0.01) and facing HIV-related stigma/discrimination (47.9% vs 34.4%, p=<0.01). Displaced WLHIV were significantly more likely to have experienced sexual violence (aPR: 2.74, 95% CI: 1.67 to 4.51), violence in healthcare (aPR: 2.57, 95% CI: 1.49 to 4.43), pregnancy coercion (aPR: 2.60, 95% CI: 1.41 to 4.78), sterilisation coercion (aPR: 4.26, 95% CI: 1.17 to 15.43) and contraception coercion (aPR: 2.48, 95% CI: 1.00 to 6.15) compared with non-displaced WLHIV. As the war in Ukraine continues, humanitarian and health systems can use these findings to guide integration of GBV referrals and scale-up of trauma-informed care and antiexploitation training into Ukrainian programming. Moreover, additional surveillance methods, including community-led monitoring, can support routine documentation of experiences of coercion and abuse in healthcare settings. Broadly, transformative approaches are needed to tackle structural causes of gender inequality, HIV and violence.

The impact of mass screening and treatment interventions on malaria incidence and prevalence: a retrospective analysis of a malaria elimination programme in eastern Myanmar, and systematic review and meta-analysis

BackgroundTargeted interventions are often needed to accelerate malaria elimination efforts. Mass screening and treatment (MSAT) involves testing all eligible and consenting individuals in an area for malaria and treating all positive individuals simultaneously. However, there are concerns regarding the impact of MSAT. This study evaluates the impact of MSAT on malaria incidence in Karen State, Myanmar, using routine surveillance data, and investigates the impact of MSAT in other settings through a systematic review and meta-analysis. MethodsTo investigate the impact of MSAT in Karen State, we retrospectively analysed routine malaria surveillance data collected in 10 villages where MSAT was done in 2018. Pre- and post-MSAT malaria incidences were compared, and a negative binomial mixed-effects model was used to estimate the relative change in monthly incidence for each additional year since MSAT.To investigate the impact of MSAT in other settings, we searched Scopus, Ovid MEDLINE, and Web of Science (end date 11th July 2022) for studies assessing the impact of MSAT interventions on the incidence or prevalence of malaria infections. Studies were summarized, and a random-effects meta-analysis was performed on studies grouped according to study design and the comparator used to assess the impact of MSAT.ResultsIn the 10 villages in Karen State, there was an overall reduction in P. falciparum incidence following MSAT (Incidence Rate Ratio 0.37; 95% CI: 0.19, 0.73). However, this is likely due to the ongoing impact of early diagnosis and treatment services offered in these communities, as shown by an overall reduction in incidence in the surrounding area. Results from nine studies identified in the systematic review demonstrate the variable impact of MSAT, which is likely influenced by a variety of factors, including intervention coverage and uptake, baseline malaria endemicity, and methods used for MSAT delivery. ConclusionsThis retrospective analysis and systemic review highlights the complexities behind the success of targeted interventions for malaria elimination. While these interventions are important drivers for achieving elimination goals, particularly in high-burden settings, it is important that various factors be considered when determining their suitability and how to optimize implementation.

Post-Discharge COVID-19 Symptoms Predict 1-Year Functional Decline, Falls, and Emergency Department Visits: A Cohort Study.

Hospitalization frequently results in persistent symptoms among older adults, raising concerns about the long-term impacts of acute events-a problem amplified by COVID-19. We investigated the effects of persistent symptoms on functional decline and unplanned events over 1 year in older patients recovering from COVID-19 hospitalization. This prospective cohort included patients aged ≥ 50 years who survived COVID-19 hospitalization between March and December 2020 as part of the CO-FRAIL study at Brazil's largest academic medical center. Persistent symptoms were defined as those reported at admission and continuously present at one-, three-, six-, nine-, and 12-month post-discharge, covering 16 symptoms. Outcomes included functional decline in basic activities of daily living (ADL), mobility activities, instrumental activities of daily living (IADL), number of falls, emergency department (ED) visits, and hospital readmissions. Associations between persistent symptoms and outcomes were examined using mixed-effects negative binomial regression models adjusted for sociodemographic, clinical, hospitalization-related factors, and post-discharge rehabilitation. Among 1019 patients (mean age = 65 ± 10 years; women = 45%; White = 62%), 324 (32%) experienced persistent symptoms throughout the year. Fatigue (28%), myalgia (19%), and dyspnea (13%) were the most common. Patients with ≥ 2 symptoms had an increased risk of functional decline in mobility activities (IRR = 2.11; 95% CI = 1.50-2.96), IADL (IRR = 2.00; 95% CI = 1.44-2.79), falls (IRR = 2.56; 95% CI = 1.14-5.75), and ED visits (IRR = 2.69; 95% CI = 1.27-5.70), but not readmissions. Among women, ≥ 1 persistent symptom was associated with a twofold increased risk of ADL decline. One year after discharge, patients with ≥ 2 persistent symptoms developed 1.27 more new disabilities (3.26 vs. 1.99 on a 15-point functional scale) and had 31 more unplanned events per 100 person-years (54.3 vs. 23.2) than those without symptoms. Persistent symptoms after hospitalization are common and contribute to functional decline, falls, and ED visits in older COVID-19 survivors. These findings suggest that greater attention to symptom burden may support risk identification and improve post-discharge care planning.

Health service use, health outcomes and treatment costs of adults with a cochlear implant: a retrospective cohort study

BackgroundData about the ongoing health service use, health outcomes and healthcare treatment costs of adult cochlear implant users are limited. This study examined health service use, health outcomes and treatment costs of adults who had a cochlear implant.MethodsThis was a retrospective cohort study of adults aged ≥ 18 years who received a cochlear implant during 2011–2021. Linked hospitalisation, non-admitted patient (NAP) services and mortality data in New South Wales (NSW), Australia were used. Health service use, health outcomes and treatment costs were compared for younger (18–64 years) and older (≥ 65 years) adults. A negative binomial regression model was used to examine factors associated with hospitalisation and health outcomes.ResultsThere were 3071 adults who had a cochlear implant; 47.6% aged 18–64 years and 52.4% aged ≥ 65 years. Older adults had a higher proportion of all-cause hospital admissions (34.1% vs. 18.4%, respectively), readmission within 28 days (7.8% vs. 4.7%, respectively), ≥ 13 NAP service contacts (33.9% vs. 24.9%, respectively) and mean treatment costs (AUD$44,101 vs. AUD$41,663, respectively) than younger adults. Charlson comorbidities and mental health disorders were key predictors of both hospitalisations and NAP service contacts for younger adults. Postoperative mechanical complications and prior hospital admissions were predictors of hospitalisation and NAP service contacts, respectively for younger adults. Having ≥13 NAP service contacts and a cochlear implant removed were predictors of hospitalisation and NAP service contacts, respectively for older adults. Having a longer hospital length of stay (LOS) was associated with cochlear implant removal, treatment cost, and other health conditions for both younger and older adults.ConclusionsAdults with multimorbidity used more hospital-based services or incurred large treatment costs. Early detection and treatment of comorbidities and long-term post-cochlear implant follow-up to identify any potential complications may reduce unplanned hospitalisations, adverse health outcomes, and associated hospital utilisation costs.

Assessing determinants of livestock predation by spotted hyenas in Nyang’hwale district and mitigation approaches adopted by the community

The study aimed to identify factors contributing to livestock attacks by spotted hyenas and evaluate the mitigation strategies employed in Nyang’hwale District, Geita Region, Tanzania, where such incidents are increasing. Data were collected through interviews with 384 households, focus group discussions, and key informant interviews. Negative binomial models were used to determine factors associated with livestock attacks by hyenas. The findings indicate that grazing livestock near forested areas significantly elevates the risk of spotted hyena attacks due to proximity to predator habitats. Additionally, attacks were more frequent during the rainy season, likely because dense vegetation including crops provides cover for predators. The most commonly employed strategies to mitigate livestock attacks were staying awake to watch over the animals at night and using guard dogs to alert villagers. Traditional livestock enclosures proved inadequate in preventing attacks, underscoring the need for improved structures. Cultural beliefs in the district associate spotted hyenas with witchcraft, which discourages community members from taking direct action against them, resulting in appeals for government or traditional healers to manage the spotted hyena population. To address these challenges, further research is recommended to assess the spotted hyena population size, prey availability, and ecological dynamics in the district. Integrating traditional knowledge and community beliefs with conservation strategies will be crucial for fostering coexistence and reducing human-hyena conflicts, ultimately ensuring livestock safety, preserving the spotted hyena population, and improving human livelihoods.

Factors Influencing Maize Value Addition in the Northwest Region of Cameroon

Aims: To determine the factors influencing maize value addition in the North West Region of Cameroon, and to identify the constraints associated with participation in maize value addition. Study Design: In this study, we used the Cross-sectional survey design. Place and Duration of Study: Five subdivisions in Mezam, North West Region of Cameroon, between 2023 and 2024. Methodology: Empirical data was collected from 500 maize entrepreneurs through purposive, stratified random and the snow ball sampling techniques and analysed using the binomial logistic regression model and descriptive statistics. Results: The binomial logistic regression analysis showed that income, and good storage facility had a significant positive effect on maize value addition while gender and access to extension services, had a significant negative effect on maize value addition in the Northwest region of Cameroon. However, lack of processing infrastructure and equipment, insufficient finances, Insufficient technical knowledge and skills were identified as the primary constraints impeding participation in maize value addition. Conclusion: The findings highlight important recommendations for enhancing maize value addition in the North West Region of Cameroon. First, it is important for the Government and NGOs to empower both men and women in maize value addition. Second, enhancing financial support for low and middle-income entrepreneurs is very crucial. Additionally, improving extension services to address the specific needs of maize processors is vital and lastly investing in better storage facilities will help minimize losses and facilitate timely processing, ultimately increasing participation in maize value addition for entrepreneurs.

Cosmology from LOFAR Two-metre Sky Survey Data Release 2: Counts-in-cells statistics

The second data release of the LOFAR Two-Metre Sky Survey (LoTSS-DR2) extends the first data release in terms of sky coverage and source density. It provides the largest radio source catalogue to date, including 4.4 million sources and covering 5,635 square degrees of the sky. Therefore, it provides an excellent opportunity for studies of the large-scale structure of the Universe. We investigated the statistical distribution of source counts in cells and we tested a computationally cheap method based on the counts in cells to estimate the two-point correlation function. We studied and compared three stochastic models for the counts in cells; these resulted in a Poisson distribution, a compound Poisson distribution, and a negative binomial distribution. By analysing the variance of counts in cells for various cell sizes, we fitted the reduced normalised variance to a single power-law model representing the angular two-point correlation function. Our analysis confirms that radio sources are not Poisson distributed, which is most likely due to multiple physical components of radio sources. Employing instead a Cox process, we show that there is strong evidence in favour of the negative binomial distribution above a flux-density threshold of 2 mJy. Additionally, the mean number of radio components derived from the negative binomial distribution is in good agreement with corresponding estimates based on the value-added catalogue of LoTSS-DR2. The scaling of the counts-in-cells normalised variance with cell size is in good agreement with a power-law model for the angular two-point correlation. At a flux-density threshold of 2 mJy and a signal-to-noise ratio of 7.5 for individual radio sources, we find that for a range of angular scales large enough to not be affected by the multi-component nature of radio sources, the value of the exponent of the power law ranges from -0.8 to -1.05. This closely aligns with findings from previous optical, infrared, and radio surveys of the large-scale structure. The multi-component nature of LoTSS radio sources is essential in order to understand the observed counts-in-cells statistics. The scaling of the counts-in-cells statistics with cell size provides a computationally efficient method for estimating the two-point correlation properties, offering a valuable tool for future large-scale structure studies.

Risk factors associated with zero-dose and under-immunized children, and the number of vaccination doses received by children in Ethiopia: a negative binomial regression analysis

IntroductionDespite the proven effectiveness of vaccination in improving child health and well-being, millions of children remain unvaccinated globally. Ethiopia has increased child vaccination coverage by threefold in the last decades. However, it is one of the top contributors to zero-dose and unimmunized children in Africa. Thus, we examined risk factors associated with zero-dose, under-immunization, and the number of vaccination doses received by children in Ethiopia.MethodsA cross-sectional household survey was conducted as part of the formative assessment for the Strengthening Service Delivery (SSD) project from July to August 2024. A stratified two-stage sampling was employed to recruit 1,368 mothers of children aged 12–23 months from agrarian and pastoral regions of Ethiopia. A multilevel negative binomial model was then fitted to estimate associations between individual- and community-level independent variables and the number of vaccine doses received. Adjusted incidence rate ratios (AIRR) with 95% CI were reported to declare the associations.ResultsAbout 14% of children did not receive any vaccinations, and 62% were under-immunized, with significant regional disparities: 9% of children in agrarian regions versus 69% in the pastoral areas received no vaccinations, while 60% of children in agrarian regions were under-immunized compared to 92% in the pastoral areas. Mothers attended higher education (AIRR = 1.20; 95% CI [1.01–1.42]), household wealth status of rich (AIRR = 1.39; 95% CI: [1.16–1.67]) and middle class (AIRR = 1.32; 95% CI: [1.09–1.61]), previous history of facility delivery (AIRR = 1.57; 95% CI: [1.35–1.83]) and home visit by community health workers (CHW) during pregnancy (AIRR = 1.32; 95% CI: [1.15–1.52]) and having any under 5 children with vaccination card (AIRR = 2.45; 95% CI: [2.08–2.90]) increased the likelihood of receiving vaccinations. However, children from the pastoral region (AIRR = 0.40; 95% CI: [0.29–0.54]) were less likely to receive higher vaccination doses.ConclusionOur study highlighted individual and community-level factors associated with the number of vaccination doses children received in Ethiopia. To address zero-dose and under-immunized children in Ethiopia, contextualized intervention focusing on the pastoral and vulnerable population is needed. Moreover, strengthening the health system and expanding healthcare access in the underserved population could help improve child vaccination.

Supplementation of Saccharomyces cerevisiae fermentation product to beef cows grazing fescue-based pastures and its impact on reproductive performance

Abstract The study aimed to evaluate the effects of Saccharomyces cerevisiae fermentation product (SCFP) supplementation during the breeding season on reproductive performance of beef cows grazing fescue-dominated pastures (Festuca arundinacea). A total of 883 multiparous suckled beef cows across eight locations were stratified by age and days postpartum (DPP) and randomly assigned to one of two treatments: 1) CON - mineral supplementation at 90 g/hd/d (n=439 cows; 13 experimental units), or 2) SCFP - mineral with 9 g SCFP (NaturSafe, Diamond V, Cedar Rapids, IA; n=444 cows; 13 experimental units). Supplementation began 21 days pre-breeding and continued through the breeding season (approx. 171 days). Cows grazed tall-fescue pastures and followed a fixed-time artificial insemination (TAI) protocol (7-day CO-Synch+CIDR) with natural service and clean-up bulls for a 70-day breeding season. Pregnancy diagnoses were performed by ultrasonography at 55 days post-TAI and 40 days after the breeding season. Cow body weight (BW) and body condition score (BCS) were recorded at TAI (day 0) and weaning (day 150). Mineral disappearance was measured weekly. Data were analyzed using GLIMMIX for binomial data and MIXED for continuous data. Cow age and DPP did not differ (P&amp;gt;0.10) between treatments (6.0 ± 1.0 yr and 79.7 ± 2.6 days, respectively). Mineral disappearance was similar (P=0.97) between treatments (99.2 and 99.8 ± 8.76 g/hd/d for CON and SCFP, respectively). No differences were observed (P&amp;gt;0.10) in BW and BCS between treatments on days 0 and 150. SCFP supplementation did not affect estrus expression (63.2% vs 63.7% ± 2.6% for CON and SCFP, respectively; P=0.91), but TAI pregnancy rates were higher (P=0.025) in SCFP (65.9 ± 2.5%) compared to CON (57.9 ± 2.5%). Final pregnancy rates tended to be higher (P=0.057) for SCFP (92.9 ± 1.4%) vs CON (89.0 ± 1.4%), with no effect on calf performance (P&amp;gt;0.10). In conclusion, SCFP supplementation during the breeding season did not influence BW or BCS but improved TAI pregnancy rates in beef cows grazing endophyte-infected tall fescue.

Pricing Chooser Option

With the rapid development of financial markets and the increasing diversification of investment instruments and choices, exotic derivatives like the Chooser option have emerged. This special type of option contract grants holders the right to choose whether the option is a put or a call at the selection date. This flexibility facilitates investors' hedging policies and diversification to spread risk and enhance returns. However, pricing it appropriately becomes a difficult task because of its complexity. This paper first aims to price the Chooser option in two ways: the N-period Binomial tree model and the Black-Scholes model combined with Monte Carlo simulations. Then, the results from both approaches are compared and it is found that the outcomes are approximately equivalent when the parameters are held constant. Building on this finding, the computational efficiency of both methods in Python is analyzed, with fixing N (period) at 100. The results indicate that the running time of the Black-Scholes model exceeds that of the N-period Binomial tree model.

National Survey on Attitudes of Brazilian Breast Surgeons Regarding Oncoplastic Surgery: Success of a Training Model.

Historically, breast reconstruction was performed by plastic surgeons. The Brazilian Society of Mastology (SBM) implemented initiatives to improve breast surgeons' training in oncoplastic techniques; however, the current proportion of surgeons performing these techniques remained unknown. This study aimed to determine the proportion of Brazilian breast surgeons performing oncoplastic surgery, their previous training, the complexity of procedures performed, and factors influencing adoption of techniques. In this survey, a structured questionnaire was sent to all SBM-affiliated breast surgeons between July and December 2023. Outcome proportions were estimated using binomial distribution. Adjusted proportion ratios (aPR) were calculated using robust Poisson regression. A 60.2% valid response rate was achieved (n = 1059/1759). Almost half of the respondents performed oncoplastic surgery, with most being young (< 40years) (aPR: 1.66; 1.31-1.10; p < 0.001), male (aPR: 1.39; 1.22-1.59; p < 0.001), southern residents (aPR: 1.39; 1.18-1.63; p < 0.001), with a specialist degree in breast disease (aPR: 1.19; 1.00-1.42; p < 0.004), primarily trained in general surgery (aPR: 1.32; 1.16-1.51; p < 0.001) and secondarily in breast surgery (aPR: 1.41; 1.08-1.85; p = 0.01), and performing > 100surgeries/year (aPR: 1.72; 1.49-1.99; p < 0.001). The techniques most commonly mastered were simple displacement (88.7%), therapeutic mammoplasty or contralateral symmetrization (96.4%), reconstruction with implants or tissue expanders (93.6%), extreme oncoplasty (81%), skin- and nipple-sparing (99%) or skin-reducing mastectomy (84.2%), and thoracoabdominal flaps (71.7%). A high proportion of Brazilian mastologists perform oncoplastic surgery. These findings provide key insights to further enhance training and improve outcomes.

Exploring the epidemiological characteristics of Mpox in the Arab Gulf countries

In May 2022, Mpox outbreaks emerged in regions where the virus is not traditionally prevalent. This study estimates the mean incubation period, serial interval and the extent of presymptomatic transmission in the Arab Gulf Countries (AGC). The effective reproduction number () is also calculated, as well as the degree of heterogeneity (), using the instant-individual heterogeneity transmission model. We analyze data from 41 confirmed cases for which we have complete information, estimating the mean incubation period using gamma, Weibull and lognormal distributions, with respective means of 8.52 (95% CI 7.26–9.98), 8.57 (95% CI 7.28–10.01), and 8.64 (95% CI 7.23–10.26) days. The mean serial interval, based on 31 case pairs, was 7.19 days (95% CI 4.11–12.95), 7.16 days (95% CI 5.80–8.90), and 10.0 days (95% CI 6.30–16.3) for the gamma, Weibull, and lognormal distributions, respectively. The Akaike Information Criterion (AIC) validated the best-fitting models. The serial intervals were shorter than the incubation periods, suggesting that pre-symptomatic transmission occurred in 60% of transmission events. We estimated to be 0.95 (95% highest posterior density [HPD]: 0.93–1.35) and to be 1.52 (95% HPD: 1.07–5.76), indicating supercritical Mpox transmission in the AGC with limited transmission heterogeneity. Using a Bayesian framework with non-informative priors and a negative binomial distribution, we projected to remain between 0.95 and 1.0 from August 2022 to January 2023, underscoring the need for continued efforts to reduce transmissibility. These findings provide valuable information for public health interventions, emphasizing a multifaceted approach to managing Mpox transmission.

Protocol for an observational study to assess the impact of pharmacogenetics on outcomes in vascular surgery (PROSPER).

Patients with chronic limb-threatening ischaemia (CLTI) are often prescribed clopidogrel in order to reduce their risk of major adverse limb and cardiovascular events. Clopidogrel is metabolised by the CYP2C19 enzyme and genetic variations in CYP2C19 are common. These variants can influence an individual's ability to metabolise clopidogrel to its active metabolite. Few studies have investigated the relationship between patient genotype and outcomes in vascular surgery. This work aims to establish the relationship between patient genotype and outcomes after revascularisation in patients with CLTI who are prescribed clopidogrel. It will consider whether pharmacogenetics can be used to ensure patients are prescribed effective medications to optimise their outcomes. This is an observational cohort study of patients undergoing lower limb surgical, endovascular or hybrid revascularisation for CLTI at Manchester University NHS Foundation Trust. Patients taking clopidogrel post-procedure, as well as those prescribed a non-clopidogrel based medication regimen, will be recruited prior to or shortly after revascularisation. Patients will undergo CYP2C19 genotyping and will be followed up using online records. The study has 90% power to detect 114 amputations with a target sample size of 483 participants. The primary outcomes are risk of amputation at 1 year and a composite endpoint for the risk of major adverse limb events (MALE) or death from any cause at 1 year. Secondary outcomes are risk of MALE at 1 year, risk of major adverse cardiovascular events (MACE) or death from any cause at 1 year, death within 30 days of revascularisation, minor re-interventions at 1 year, total number of re-interventions at 1 year and rate of systemic or gastrointestinal bleed at 1 year.Risk of amputation, MALE and MACE will be analysed using Cox models. All remaining outcomes will be analysed using negative binomial models. Potential competing events for the risk of amputation will be investigated as part of a sensitivity analysis. Patients given a non-clopidogrel-based medication will be compared as an additional analysis. Manchester University Research Ethics Committee approval obtained as part of the Implementing Pharmacogenetics to Improve Prescribing (IPTIP) trial process (IRAS 305751). The results of the study will be published in a peer-reviewed journal and presented at international conferences. This work is a sub-protocol for the IPTIP study which is registered as ISRCTN14050335.