Increase In Coverage Research Articles

A mathematical model for the study of HIV/AIDS transmission with PrEP coverage increase and parameter estimation using MCMC with a Bayesian approach

In this article, we present a mathematical model for the study of HIV/AIDS considering the implementation of Pre-Exposure Prophylaxis (PrEP). As a novel element in the construction of the model, we consider the diagnosis of cases for attempting to enter the PrEP program, which allows us to study different forms of PrEP. The diagnosis of new infections helps to reduce transmission in the population because these patients are incorporated into the therapy and can achieve an undetectable viral load in blood which prevents them from infecting others. The model contains a compartment of infected persons with undetectable viral load in blood that is reached by adherence to treatment which is separated from those simply infected with the virus as they do not transmit it. Considering the structure of the model, we propose a method to study the effect of increased PrEP use and HIV incidence in a population. In the case of incidence, we took into account the stochasticity of the behavior. Besides, we find the basic reproduction number and present results that allow us to obtain the impact of the parameters associated with transmission, treatment and diagnosis on the basic reproduction number. We perform computational simulations, using demographic and HIV/AIDS data from Brazil, and utilize the Markov Chain Monte Carlo (MCMC) method with a Bayesian approach to estimate model parameters. We study two coverage increases at 25% and 35% that were selected according to the size of the Brazilian population and the daily use of PrEP. We compare the increases in coverage focused on HIV incidence, which is the number of new HIV cases infected and the number of HIV cases avoided, we conclude that by increasing PrEP coverage the incidence of HIV is reduced and the number of cases avoided increases.

RepeatsDB in 2025: expanding annotations of structured tandem repeats proteins on AlphaFoldDB.

RepeatsDB (URL: https://repeatsdb.org) stands as a key resource for the classification and annotation of Structured Tandem Repeat Proteins (STRPs), incorporating data from both the Protein Data Bank (PDB) and AlphaFoldDB. This latest release features substantial advancements, including annotations for over 34000 unique protein sequences from >2000 organisms, representing a fifteenfold increase in coverage. Leveraging state-of-the-art structural alignment tools, RepeatsDB now offers faster and more precise detection of STRPs across both experimental and predicted structures. Key improvements also include a redesigned user interface and enhanced web server, providing an intuitive browsing experience with improved data searchability and accessibility. A new statistics page allows users to explore database metrics based on repeat classifications, while API enhancements support scalability to manage the growing volume of data. These advancements not only refine the understanding of STRPs but also streamline annotation processes, further strengthening RepeatsDB's role in advancing our understanding of STRP functions.

Advancing Public Health Equity through Expanded Vaccination Services in prison: case studies from Italy and France

Abstract In Montpellier prison in France and San Vittore remand house in Italy, the provision of expanded, age-appropriate, coercion-free, and tailored vaccination services to PLP has emerged as a cornerstone in improving health outcomes within prison settings. The implementation of life course vaccination programs required the full integration of prison health into public health systems building on existing vaccination services covering HBV, flu and COVID-19. In San Vittore, a vaccination clinic aimed at people living in prison was set-up. Universal vaccination status assessment and vaccination catch-up was introduced targeting people admitted into prison. The vaccination clinic-related activities included information and awareness sessions on vaccination and health literacy offered regularly to PLP: increased vaccination knowledge is effective to enhance uptake. The vaccination clinic team consisted of infectious diseases physicians and a health assistant with an anthropological background, who ran the information and awareness sessions combining and adapting core content on vaccination with individual and community social and cultural contexts. Besides seasonal flu vaccination and anti-SARS-CoV-2 immunisation campaigns, vaccinations against pneumococcal pneumonia and herpes zoster were also offered to older and fragile individuals as per national immunization plan. One of the priority objectives of the vaccination clinic was the increase in vaccination coverage against HBV and HPV, not only as a tool for the prevention of infectious diseases, but as an innovative and effective tool of cancer prevention. As part of a more ambitious program to protect sexual health in prison and related to updated screening tools for the early diagnosis of lesions due to HPV infection, vaccination against HPV was also offered as part of a health empowerment project tailored to women in detention, with the aim of building self-awareness of their own health needs.

A CDSS based Integrated Pathway for Influenza Vaccination Across Primary and Secondary Care

Abstract Background In Italy, influenza vaccination coverage in people ≥ 65 years is unsatisfactory (56.7%), underlining the need to improve current vaccination strategies. The objectives of this study have been: to define a novel pathway to increase influenza vaccination adherence among ≥ 65 years population in the Lazio region; to provide a predictive estimate of the epidemiological and economic pathway’s potential impact. Methods A multidisciplinary working group (WG) featuring cross-sectoral expertise was created and WG periodic meetings were held to define the patient journey and its flow-chart representation. The pathway’s potential impact was assessed through epidemiological and economic indicators and scenario analyses. Results An integrated pathway across primary and secondary care was defined, based on the active patient in-Hospital recruitment and vaccination and enhanced by a Clinical Decision Support System relying on a digital algorithm to identify eligible patients. Assuming an increase of influenza vaccination coverage from the current rate of 60% (scenario 1) to 65% (scenario 2) in ≥ 65 years population in the Lazio region thanks to the pathway implementation, an increase of 8% in avoided influenza cases, influenza- or pneumonia-related hospitalizations and influenza-related outpatient visits was estimated with a relative increase in savings for hospitalizations and outpatients visits of up 2,367,310 euros. Setting the vaccination coverage at 70% (scenario 3), an increase of 16% in avoided influenza cases, hospitalizations and outpatient visits was estimated with a relative increase in savings for hospitalizations and outpatients’ visits of up to 4,833,259 euros. Conclusions Alongside offering a predictive estimate of the relevant pathway’s potential impact, both epidemiological and economic, this project, with its robust methodology, may serve as a scalable and transferable model for enhancing vaccination coverage at national and international level. Key messages • The proposed pathway, offering the option of receiving flu vaccination within the Hospital, supports the paradigm shift towards primary prevention pathways in secondary care settings. • Another relevant aspect of the integrated pathway is the adoption of an Artificial Intelligence tool to identify suitable patients and improve their recruitment and adherence to vaccination.

What if we could eradicate cervical cancer?

Abstract Introduction WHO wants to achieve the elimination of Cervical Cancer: all countries must achieve and maintain an incidence rate of less than 4 per 100,000 women. Three key pillars: 90% of girls fully vaccinated against HPV by 15 years of age; 70% of women aged 35-45 years screened; 90% of women with pre-tumour lesion and invasive tumour treated. Our study assessed the position of the Tuscany South East Local Health Authority(LHA TSE) with respect to these three pillars and how to improve it. Methods A retrospective observational study was conducted. The following were used: ISTAT data of incidence of cervical cancer standardised by age from 2013 to 2017;data from ISPRO on screening(PAP and HPV test)from 2013 to 2022;data of vaccination coverage taken from the Health Information System of Collective Prevention(SISPC) from 2012 to 2023 for children<12 years, Results The incidence rate of cervical cancer in LHA TSE is 9.4 per 100 thousand. About HPV vaccine coverage by age 12, for girls it has been rising from 80.5% in 2012 to a peak of 84.8% in 2019 and then progressively decreasing to 76.3% in 2023.Coverage for boys has also been progressively increasing from 0.8% in 2012 to a peak in 2019 of 74.9% and then decreasing to 69.8% in 2023. A total of 52 thousand children are vaccinated. As for the adjusted adherence to screening, we started from an average adherence of 51.8% in 2013 (75 thousand women invited with 102% coverage) to 53.2% in 2022 (54 thousand women invited with 107% coverage). In 2013, ASC-US+ lesions were found in 6.4 % of women by PAP Test and in 2022 in 6.3 % of women. In the examined period, more than 90% of women with pre-tumour lesion and more than 90% with invasive tumour were treated. Conclusions LHA TSE will have to implement actions to increase vaccination coverage and screening adherence rates through awareness campaigns and open days, also considering whether a change in the age range for starting screening is necessary as vaccination coverage increases. Key messages • Cervical cancer is one of the most preventable cancers, but too few young women are vaccinated against HPV infection, the main causative factor. • Prevention through adherence to screening enables early identification of lesions caused by HPV virus.

An assessment of adequate quality antenatal care and its determinants in India

BackgroundAntenatal care (ANC) is an important component in the continuum of care. Providing adequate quality ANC is necessary to prevent maternal and newborn mortality. The coverage of ANC has increased significantly in the last decade in India, but a mere increase in coverage is insufficient if the issue of quality is not simultaneously addressed. This study examines the change in each component of quality ANC between 2015-16 and 2019-21, highlights the factors associated with adequate quality ANC, and observes the state- and district-level distribution of adequate quality ANC during 2019-21.MethodsThis study is based on data from the two most recent rounds of the National Family Health Survey (NFHS), the Indian equivalent of the Demographic and Health Surveys (DHS). These rounds were conducted in 2015-16 and 2019-21 in selected households of India with a total of 190,797 and 176,843 sampled births, respectively. The dependent variable was quality antenatal care, a composite variable consisting of skilled healthcare providers, timeliness, sufficiency, and appropriateness of content. The independent variables were mother’s age, education, wealth quintile, birth order, mass media exposure, health insurance coverage, relationship with the head of household, facility exposure, intended pregnancy, history of adverse pregnancy outcomes, and other socio-demographic variables. Change in each component and dimension of quality antenatal care was assessed using data from both rounds of the survey. A multivariate multinomial logistic regression analysis was employed to identify the determinants of adequate quality ANC using the NFHS-5 data.ResultsThe findings revealed that 32 per cent of mothers received adequate quality antenatal care in 2019–2021, an increase of only 9% points compared to the 2015-16 period. Two significant barriers to achieving adequate quality antenatal care, in terms of appropriateness of content, were the provision of Iron and Folic Acid (IFA) tablets and counselling. The highest utilisation of adequate quality antenatal care was observed in the southern states. The utilisation of quality ANC increased with an increase in women’s education and wealth status; and was more prevalent among those with health insurance coverage and exposure to mass media.ConclusionDespite some improvements in the coverage of antenatal care, the quality of antenatal care continues to be very low and needs urgent attention. Achieving quality antenatal care in both content and experience requires addressing service gaps and developing better measures to capture and improve women’s care experiences.

39 Impact of the COVID-19 pandemic on routine immunization coverage in Canada: Results from a novel national surveillance system

Abstract Background The COVID-19 pandemic has posed unprecedented challenges to routine immunization programs globally. There is a growing body of evidence highlighting the impact of the pandemic on other routinely administered public health services. Understanding vaccination trends for routinely administered vaccinations during the pandemic is crucial for addressing potential gaps in protection and devising targeted strategies to enhance routine immunization programs. Objectives This study investigates the impact of the pandemic on routine immunization coverage in Canada, focusing on DTaP (Diphtheria, Tetanus, and Pertussis) with at least 4 doses and MMR (Measles, Mumps, and Rubella) with at least 1 dose, among children at age 2. Design/Methods Data were collected from the Routine Childhood Vaccination Coverage Surveillance system (RCVCSS) a novel national surveillance based on standardized detailed reports prepared by participating provinces and territories using data from their immunization registries. This analysis covers the years 2019 to 2022, capturing pre-pandemic, pandemic, and post-pandemic phases with data from 4 reporting provinces and territories (Alberta, Saskatchewan, New Brunswick and Yukon). The primary objective was to assess any changes in vaccination coverage at age 2 for routinely administered immunizations from 2019 to 2022, i.e., before, during and after the COVID-19 pandemic. Results Analysis reveals a decline in routine immunization coverage from 2019 to 2022. DTaP vaccination coverage at age 2 decreased from 82.0% in 2019 to 71.8% in 2022. Likewise, MMR vaccination coverage at two years showed a decline from 90.8% in 2019 to 81.7% in 2022. Similar downward trends in coverage were observed for other sets of antigens vaccinated against at age 2 including Varicella, Rotavirus, Polio, Pneumococcal and Hepatitis B. No major differences were observed when looking at vaccination coverage over time by sex. There were regional variations, with certain jurisdictions experiencing more pronounced declines than others and an increase in coverage in 2022 the post pandemic year. Conclusion There was a sustained decline in DTaP and MMR vaccination coverage at age 2 from 2019 to 2022. Further research is imperative to ascertain whether there has been a catch-up in vaccination coverage and to identify the root causes of the observed declines, so these can be addressed, and targeted interventions can be undertaken to allow coverage level to recover to their pre-pandemic levels.

New Linked Employee-Employer Data Show Workforce Composition Is Associated With Health Insurance Offers Among Small Employers.

Decades of research shows that small firms are much less likely to offer health insurance than large firms, but less is known about differences among small employers. We examine this issue using the Medical Expenditure Panel Survey-Insurance Component with Administrative Records (MEPS-ICAR), a unique employer-employee linked data set that is constructed by matching the Medical Expenditure Panel Survey-Insurance Component (MEPS-IC) to Internal Revenue Service administrative records and the Decennial Census. Multivariate analyses show that among firms with fewer than 50 workers, the probability that workers receive an insurance offer is positively associated with higher median workforce incomes, and conditional offers of dependent coverage increase when the majority of workers are married or from a family with at least three members. This first application of the MEPS-ICAR highlights the significance of workforce characteristics in shaping small employer insurance benefits and the data's usefulness for expanding analyses of policy changes, wage-benefit tradeoffs, and health insurance benefits.

The effects of Carpinus betulus expansion on soil properties under changing climatic conditions

Carpinus betulus (CB) is becoming increasingly important in the forests of Central Europe and is significantly increasing its proportion in various habitat types. We have analysed how the increase in CB affects soil properties. The study was conducted in the Białowieża Forest (BF). We monitored the changes in CB cover between 1962 and 2013 on 56 permanent plots and collected samples of the litter sub-horizons and the content of the underlying A horizons for laboratory analyses in 2014. During the study period, there was a significant increase in CB cover in the second tree layer by an average of 17.4 % (±1.8) and in the shrub layer by 3.8 % (±1.0), as well as an increase in species diversity from 41 % in the past to 59 % currently. The C/N ratio of the Oi sub-horizon was 32.0 (±0.9), and NH4+ compounds predominated over NO3-, with all nitrogen forms most closely associated with the C/N ratio. In the Oea sub-horizon, the C/N ratio was 23.4 (±0.4), and the sum of mineralised nitrogen reached 8%, with a clear predominance of NO3-. The characteristic most strongly associated with the increase in CB coverage was the NO3- content in the Oea sub-horizon. The MID analysis confirmed that the change in CB cover was not only significant, but also ecologically important. We suggest that there is a feedback loop in which the generally observed climate changes lead to trees occupying new habitats that supply the forest floor with high quality litter, which in turn affects the soil and promotes the persistence of changes in the species composition of the forest.

Investigating Gold Deposition with High-Power Impulse Magnetron Sputtering and Direct-Current Magnetron Sputtering on Polystyrene, Poly-4-vinylpyridine, and Polystyrene Sulfonic Acid.

Fabricating thin metal layers and particularly observing their formation process in situ is of fundamental interest to tailor the quality of such a layer on polymers for organic electronics. In particular, the process of high power impulse magnetron sputtering (HiPIMS) for establishing thin metal layers has sparsely been explored in situ. Hence, in this study, we investigate the growth of thin gold (Au) layers with HiPIMS and compare their growth with thin Au layers prepared by conventional direct current magnetron sputtering (dcMS). Au was chosen because it is an inert noble metal and has a high scattering length density. This allows us to track the growing nanostructures via grazing incidence scattering. In particular, Au deposition on the polymer polystyrene (PS) with the respective structural analogues poly-4-vinlypyridine (P4VP) and polystyrene sulfonic acid (PSS) is studied. Additionally, the nanostructured layers on these different polymer films are further probed by field emission scanning electron microscopy (FESEM), atomic force microscopy (AFM), X-ray reflectometry (XRR), and four-point probe measurements. We report that HiPIMS leads to smaller island-to-island distances throughout the whole sputter process. Moreover, an increased cluster density and an earlier percolation threshold are achieved compared to dcMS. Additionally, in the early stage, we observe a significant increase in coverage by HiPIMS, which is favorable for the improvement of the polymer-metal interface.

Effects of the continuous Medicaid coverage provision of the family first coronavirus response act on postpartum Medicaid coverage, depression symptoms, and birth control use.

The 2020 Family First Coronavirus Response Act (FFCRA) extended Medicaid coverage for enrollees without rechecking eligibility. Before that, women were eligible for Medicaid coverage up to 60 days postpartum. We examine the FFCRA's effect on Medicaid postpartum coverage, depression symptoms, and birth control use beyond 60 days after delivery. We use data from the 2016-2021 Pregnancy Risk Assessment Monitoring System (PRAMS). The primary sample includes 56,828 women who were income eligible up to 60 days postpartum or beyond in their state. We employ a difference-in-differences design comparing outcomes before and after the FFCRA between women who were not income eligible for Medicaid coverage beyond 60 days postpartum in their state and those who were income eligible. We estimate models without and with controlling for state-specific trends in outcomes over time. N/A. There is an 8.1 percentage-point increase in the likelihood of having Medicaid coverage without controlling for state-specific trends, and 5.4 percentage-points when controlling for state-specific trends (both p < 0.05). There is a decline in likelihood of being uninsured by 3 percentage-points (p < 0.05) without state-specific trends and a smaller and non-significant decline when including state-specific trends. Estimated effects on depression symptoms and birth control use are small and statistically non-significant. Following the FFCRA, there was an increase in Medicaid coverage beyond 60 days postpartum among women who would have been income ineligible for Medicaid after 60 days. However, there is a less pronounced effect on likelihood of being uninsured, which might be partly due to some switching from private to Medicaid coverage. There were no discernable effects on depression symptoms and birth control use. Examining additional health and health care utilization measures over a longer postpartum period is needed to further understand the FCCRA effects on these outcomes.

Impact of vegetation coverage and configuration on urban temperatures: a comparative study of 31 provincial capital cities in China

Urban vegetation plays a crucial role in regulating temperatures and heat waves in urban areas. However, the influence of vegetation coverage and its configuration on surface temperatures in different climate zones at a national scale is unclear. To address this, we utilized high-resolution data to detect spatial patterns for 31 provincial capital cities in China. We integrated day and night surface temperatures to determine the influence of vegetative coverage and configuration on urban temperatures across different climate zones and city sizes. Our study revealed that a subtropical monsoon climate and medium-sized cities had the highest vegetative coverage and shape complexity. The best connectivity and agglomeration of vegetation were found in a temperate monsoon climate and large cities. In contrast, small cities, especially those under a temperate continental climate, had low vegetation coverage, high fragmentation, and weak agglomeration and connectivity. In addition, vegetative coverage had a negative impact on daytime surface temperatures, especially in large cities in a subtropical monsoon climate. However, an increase in vegetation coverage could result in warming at night in small cities in temperate continental climates. Although urban vegetation configuration also contributed to moderating surface temperatures, especially at night, they did not surpass the influence of vegetation coverage. The effect on nighttime temperatures of the configuration of vegetation increased by 3–6% relative to that of daytime temperatures, especially in large cities in a temperate monsoon climate. The contribution vegetation coverage and configuration interaction to cooling efficiency decreased at night, especially in medium-sized cities in a temperate continental climate by 3–5%. In addition, this study identified several moderating effects of natural and social factors on the relationship between urban vegetation coverage and surface temperatures. High duration of sunshine, low humidity and high wind speed significantly enhanced the negative impact of vegetation coverage on surface temperatures. In addition, the moderating effect of vegetation coverage was more pronounced in low population density cities and high gross domestic product. This study enhances understanding of the ecological functions of urban vegetation and provides a valuable scientific basis and strategic recommendations for optimizing urban vegetation and improving urban environmental quality.

Spillover effects of Medicaid expansion on insurance coverage among low-income older individuals newly diagnosed with cancer.

168 Background: Medicaid expansion is associated with increased insurance coverage and improved health outcomes among patients diagnosed with cancer &lt; 65 years. Although not the target population, individuals ≥65 years may benefit from Medicaid expansion through “welcome mat” effects – the indirect increase in enrollment, particularly those with low income eligible for both Medicaid and Medicare (dual-eligible). This study aims to examine the associations of Medicaid expansion with Medicaid coverage, including both dual-eligible and Medicaid-only, among individuals diagnosed with cancer. Methods: Using the National Cancer Database, we identified patients ≥65 years newly diagnosed with cancer between 2010-2019 with income below 138% federal poverty level. We applied a quasi-experimental design, the difference-in-difference approach, with multivariable linear probability models to compare the changes in the percentage of dual-eligible or Medicaid-only coverage post (vs. pre) Medicaid expansion in expansion v. non-expansion states. Analyses were also stratified by key demographic characteristics. Results: A total of 256,997 patients with cancer were identified, with 136,373 patients from expansion states and 120,624 patients from non-expansion states. After adjusting for sociodemographic characteristics, the percentage of patients with dual or Medicaid-only coverage increased from 16.84 to 18.09 in expansion states and decreased from 14.14 to 12.62 in non-expansion states, resulting in a net increase of 2.11 percentage points (ppt, 95% confidence interval: 1.55, 2.67) associated with Medicaid expansion. Differences were more pronounced among patients diagnosed with stage III-IV cancers (DD: 2.53 ppt, 95%CI: 1.58, 3.48), racialized as non-Hispanic Black (DD: 3.71 ppt, 95%CI: 2.70, 4.73), residing in metropolitan areas (DD: 2.77 ppt, 95%CI: 2.08, 3.47), with two or more comorbidities (DD: 4.14 ppt, 95%CI: 2.47, 5.80), and treated in comprehensive (DD: 2.98 ppt, 95%CI: 2.02, 3.94) or academic cancer centers (DD: 3.31 ppt, 95%CI: 2.14, 4.49). Conclusions: Medicaid expansion was associated with an increase in Medicaid enrollment among patients diagnosed with cancer at 65 or older, suggesting spillover benefits of Medicaid expansion in supporting low-income elderly populations with cancer.

Cs/O, Cs/NF3, and Cs/Li/NF3 coadsorption on GaAs0.5P0.5 (001) β2(2×4) reconstruction surface: A first principle study

The activation process of p-type doped GaAs0.5P0.5 (001) β2(2 × 4) reconstruction surface is investigated based on first principle calculations. For Cs-only adsorption, the adsorption energy rises as the Cs coverage increases, and when the Cs coverage is at 0.75 ML, the work function hits its minimum. Cs/O and Cs/NF3 concurrent adsorption are conducive to increasing steadiness and lowering the work function of the reconstruction surface during the phase of high Cs coverage. The work function reaches its minimum when Cs coverage is 0.75 ML in Cs/O coadsorbed models while that occurs when Cs coverage is 1.00 ML in Cs/NF3 coadsorbed models. Results indicate that the Li atoms intercalation with low coverage in Cs/NF3 coadsorbed models is conducive to establishing dipole moments, strengthening stability, and lowering the work function. The optimal adsorption recipe is 6Cs/2Li/NF3, with which the surface owns the lowest work function and shows the most stable property.

HPV Vaccination Coverage in Brazil's State of Paraná: Spatial Distribution and Advances in Public Health.

Background/Objectives: To analyze the spatial distribution of HPV vaccination coverage in relation to sociodemographic variables in a state of Southern Brazil. Methods: This was an ecological, retrospective study with secondary data from the Department of Information Technology of the Unified Health System/Ministry of Health from 2015 to 2022. The cohort method was used to calculate vaccination coverage. Geographically weighted regression was used for the independent variables. Results: There was a 22.04% reduction in vaccination between the first and second doses. Coverage with the first dose of the vaccine reached 95.17% for the female population, 64.67% for the male population, and 79.57% for both sexes. In 50.62% of cities, coverage exceeded 90% for both sexes. In 80.45% of cities, the recommended coverage for females was achieved. The variable municipal performance was positively significant for the increase in vaccination coverage in 45.45% of the regions for girls, 18.18% for boys, and 36.36% for both sexes. The family health strategy variable was significant in 9.09% of the regions for girls and both sexes. The education variable showed an inverse significance for girls in 40.90%, for boys in 18.18%, and for both sexes in 36.36% of the regions. Conclusions: HPV vaccination declined between the first and second doses, with high first-dose coverage among females and moderate coverage among males. Municipal performance notably impacted coverage, particularly for girls. The family health strategy was relevant in specific regions, while educational factors had a variable effect. Addressing these variables may enhance vaccination coverage and minimize the gap between doses.

Short-Term Growth Dynamics of Spontaneous and Planted Vegetation on Subtropical Extensive Green Roof as Renaturalized Biotope

Spontaneous vegetation within a managed green space is often regarded as unwelcoming and insignificant weeds. This perception is still deep-rooted among green-space managers and the general public worldwide; they are generally uncertain about the management needs after allowing these groups of flora to take root. The short-term growth dynamics of both spontaneous and planted vegetation should be analyzed, and a widely acceptable, feasible management plan to balance aesthetic and ecological functions should be formulated with the backing of data and analysis for such fast-growing flora in tropical and subtropical regions. A manicured, extensive green roof with only seven (two native, five exotic) plant species was transformed into a renaturalized biotope by replacing 15 native ferns and forb species over 15 months. After planting, a baseline plant survey was conducted, with 54 plant species representing spontaneous growth and 14 planted species alive (7 planted native species survived, plus 7 species planted prior to renaturalization revived). Three quarterly plant surveys recorded the cover-abundance of each species, and the growth dynamics of the planted and spontaneous plant species were evaluated over the first year of study. During each quarterly survey, the number of planted and spontaneous plant species remained stable (ranging from 14 to 16 species and 51 to 54 species, respectively), with a constant turnover of 11 to 12 die-out species and 11 to 12 newly colonized or revived species. Plant coverage of different plant forms fluctuated slightly (within 7%) in the quarterly surveys according to seasonal changes, except for ferns, which outperformed (12% increase in coverage in a year) all the other plant forms. The height of the planted vegetation fluctuated in a year, being shorter during the summer, while the height of spontaneous vegetation remained stable throughout the year, exhibiting resilience to scouring heat. The seasonal growth tendencies of both planted and spontaneous plants were illustrated in relation to their species ranks, and further hierarchical cluster analysis was conducted for the clustering of spontaneous species. Their differential growth patterns provided comprehensive information or supported decisions regarding plant selection and maintenance, which is a scientific novelty within this unexplored topic. Management recommendations based on the findings were suggested to fulfill both aesthetic and ecological needs. Species with stable and less stable growth patterns could be useful to meet maintenance efficiency and biodiversity enhancement needs, respectively. These findings provide insights to form guiding principles for choosing plant species for renaturalization projects.

Simultaneous viscoelasticity and sprayability in antimicrobial acetic acid-alginate fluid gels

Acetic acid is a promising alternative to antibiotics for topical applications, particularly burn wounds, however its site specificity and retention are impaired by poor material properties. In this study, acetic acid was investigated as both the gelling agent and antimicrobial active in alginate fluid gels. The formed microstructure was found to be directly dependent on acetic acid concentration, leading to highly tuneable material properties. At clinically relevant concentrations of 2.5–5 % acetic acid, the fluid gels were elastically dominated at rest, with viscosities up to 7 orders of magnitude greater than acetic acid alone. These material properties imparted long term surface retention and microparticle barrier function, not seen with either acetic acid or alginate solutions. Most notably, sprayability was enhanced simultaneously with the increased viscosity and elasticity due to the introduction of a discretised microstructure, leading to a remarkable tenfold increase in spray coverage. Formulation was found not to inhibit antimicrobial activity, despite the less acidic pH, with common burn wound pathogens Staphylococcus aureus and Pseudomonas aeruginosa being equally susceptible to the fluid gels as to acetic acid solutions.

Explaining the Experiences of the Reasons for Non-Adherence to Treatment of Leukemia Cancer Patients in the Least Privileged Province of the Country: A Qualitative Study

Introduction: One of the most important challenges in cancer patients is the long treatment period, and as a result, non-compliance with the treatment, considering the cultural and indigenous context of Sistan and Baluchistan province, the importance of this position is felt more. Therefore, the present study was conducted with the aim of explaining the experiences of non-adherence to treatment in Leukemia cancer patients. Methods: This cross-sectional study was conducted qualitatively with a content analysis approach via a purpose-based sampling method on 34 leukemia cancer patients with a mean age of 46±7 in 2022. The data collection tool was a semi-structured interview guide. All interviews were recorded and implemented daily on paper. Finally, the data was coded using conventional content analysis method. Results: In this study, 17 women and 17 men were included in the study. 9 (26/5%) of them were more than 50 years old. After summarizing and coding the issues raised by the participants, 114 initial codes were obtained, five main themes (financial problems, lack of access to medical services, distrust of the health system and treatment, drug interactions and lack of motivation to continue treatment) and 10 sub-themes were extracted. Conclusion: It can be concluded that adherence to drug regimen in cancer patients is a complex issue that depends on many factors. The financial and spiritual support of the government, increasing insurance coverage, and developing infrastructure for better access of patients to medicines and medical centers are among the implementation suggestions of this study.

A relaxation‐based Voronoi diagram approach for equitable resource distribution

AbstractThis paper introduces a methodology designed to reduce cost, improve demand coverage, and ensure equitable vaccine distribution during the initial stages of the vaccination campaign when demand significantly exceeds supply. We formulate an enhanced maximum covering problem as a mixed integer linear program, aiming to minimize the total vaccine distribution cost while maximizing the allocation of vaccines to population blocks under equity constraints. Block‐level census data are employed to define demand locations, identifying gender, age, and racial groups within each block using population data. A Lagrangian relaxation technique integrated with a modified Voronoi diagram is proposed to solve the location–allocation problem efficiently. Empirical case studies in Pennsylvania, using real‐world data from the Centers for Disease Control and Prevention and health department websites, were conducted for the first 4 months of the COVID‐19 vaccination campaign. Preliminary results show that the proposed solution algorithm effectively solves the problem, achieving a 5.92% reduction in total transportation cost and a 28.15% increase in demand coverage. Moreover, our model can reduce the deviation from equity to 0.07 (∼50% improvement).

An integrated pathway for influenza vaccination across primary and secondary care using a clinical decision support system: model definition and predictive impact analysis.

Influenza is an important public health issue given its significant burden of disease. In Italy, the unsatisfactory coverage rate in people ≥65 years underlines the need to improve the current vaccination pathway. This study aims to define an integrated pathway across primary and secondary care, facilitated by a digital clinical decision support system (CDSS), to enhance vaccination coverage in people ≥65 years by actively recruiting patients in hospitals and administering vaccination. Moreover, the study seeks to gauge the potential epidemiological and economic impact of this approach. The methodology consisted of two main phases: definition of the integrated pathway and CDSS and estimation of the potential epidemiological and economic impact resulting from the implementation of the pathway in the whole Lazio region. Assuming an increase of influenza vaccination coverage from the current rate of 60% to 65% in ≥65 years old population in the Lazio region thanks to the pathway implementation, an increase of 8% in avoided influenza cases, avoided influenza- or pneumonia-related hospitalizations and avoided influenza-related outpatient visits was estimated with a relative increase in savings for hospitalizations and outpatient visits of up to 11.85%. Setting the vaccination coverage at 70%, the impact is doubled. Alongside offering a predictive estimate of the pathway's potential impact, both epidemiological and economic, this project, with its robust methodology, may serve as a scalable and transferable model for enhancing vaccination coverage at national and international level.