Artificial neural networks and inclusive growth: A customized measurement approach and empirical analysis for the MENA region

Longitudinal associations between depressive symptoms and exposure to intimate partner sexual violence in men: findings from a nationally representative sample.

The Tigray War (November 2020-November 2022) caused catastrophic health system collapse in northern Ethiopia, with substantial excess mortality and near-total destruction of health infrastructure. The impact on HIV care services remains poorly documented. We comprehensively assessed HIV care continuum recovery across prevention of mother-to-child transmission (PMTCT), HIV-exposed infant care and cervical cancer screening among women living with HIV during the postconflict period. We conducted a retrospective multidomain cohort study across seven health facilities in Mekelle City, Tigray, from November 2022 to May 2025. We assessed: (1) mother-to-child transmission (MTCT) rates among 405 HIV-exposed infants using Firth's penalised logistic regression; (2) feeding practices, growth outcomes, cotrimoxazole prophylaxis coverage and retention among 2482 follow-up visits using generalised estimating equations and (3) cervical cancer screening cascade completion among 2515 women living with HIV using mixed-effects logistic regression. Among 405 HIV-exposed infants, 11 were diagnosed HIV-positive, an MTCT rate of 2.72% (95% CI 1.36% to 4.81%). MTCT declined significantly from 5.56% in 2022 to 0% by early 2025 (p=0.0015). All transmissions occurred in primary-level facilities (8.27%), with none in secondary-level facilities (0%). Exclusive breastfeeding occurred in 90.9% of visits (95% CI 89.3 to 92.4%). Growth failure was rare among exclusively breastfed infants (0.48%) but markedly higher among replacement-fed infants (26.2%). Programme retention was 99.8%, mortality 0.2%, and no infants were lost to follow-up. Cervical cancer screening coverage was high (98.6% offered, 98.3% accepted), though only 76.9% completed screening. Despite catastrophic health system disruption, facility-based HIV services in post-war Tigray achieved near-elimination of MTCT by 2025, with exceptional retention, prophylaxis coverage and breastfeeding outcomes. Concentration of PMTCT services at secondary-level facilities was strongly associated with reduced transmission. However, these findings represent a selected population successfully accessing services; true population-level outcomes are likely substantially worse. Sustained investment in facility-based services and community outreach is essential for comprehensive HIV care recovery.

Doubts and disconnection: Police reflections on drug decriminalization in British Columbia in the first year of implementation.

Disparities in diagnosis, treatment, and outcomes of early-onset breast cancer: A global perspective.

Introduction The rising cost of targeted breast cancer therapies challenges financial sustainability and equitable access in dual-tier health systems. In Malaysia, public cancer care is highly subsidized but budget constrained, shifting patients toward private services that are typically financed through out-of-pocket payments, private health insurance or employer-sponsored insurance. Rakan KKM (MOH’s Friend) is a fee-for service initiative in selected public hospitals designed to provide lower-cost private care, with revenues reinvested into the public system. However, its financial implications for breast cancer pharmacotherapy remain uncertain. This manuscript presents a methodological protocol for a system dynamics (SD) model developed to evaluate the financial implications of Rakan KKM for breast cancer pharmacotherapy in Malaysia. Methodology A system dynamics model has been developed to model breast cancer disease progression across stages and patient movement between public, private and Rakan KKM care settings, integrating associated healthcare expenditures and revenue flows from the perspective of the Ministry of Health. An influence diagram was constructed through stakeholder engagement to identify key feedback mechanisms influencing access, affordability and system sustainability. Model parameterisation is complete, using national epidemiological data, published registries data, national drug acquisition cost estimates and expert elicitation from oncology clinicians and pharmacists. This protocol details the simulation framework where a status quo scenario is compared against intervention scenarios over a 10-year horizon. One-way sensitivity analysis and monte-carlo simulations address parameter and clinical uncertainties, while scenario analyses guided by the Diffusion of Innovation framework examine alternative uptake rates and capacity constraints. Conclusion This protocol describes a transparent and adaptable SD modelling approach to assess the fiscal sustainability of financing high-cost breast cancer therapies in mixed public-private systems by projecting how patient switching influences pharmacotherapy expenditure and the net resources potentially available to support public service investment through Rakan KKM.

Nigeria continues to face a persistent reproductive health (RH) financing gap despite decades of policy commitments. This rapid fiscal space analysis evaluates how the country can expand investment in RH services while maintaining macro-fiscal stability. Six domains were examined at the federal level: budget reprioritization, improvements in health sector efficiency, revenue enhancement, official development assistance, debt restructuring, and innovative financing mechanisms. The findings indicate that reallocating public expenditures, reducing inefficiencies, and introducing modest tax reforms could mobilise significant additional resources for RH by 2030. Strategic borrowing and blended finance instruments could further complement domestic funding. Realising these opportunities will depend on sustained political leadership, transparent and accountable budget execution, and stronger coordination across government and development partners. Implemented collectively, these measures provide a credible pathway to closing Nigeria's RH financing gap and advancing the country's demographic dividend.

Recent progressions within the FinTech space are advancing the way that people receive their financial services globally. Digital finance has improved access, efficiency, and personalization of financial services related to banking, payment, and investment services. However, not all segments of the population have reaped the benefits of these advancements. Older adults are one of the most underserved and at-risk user groups as their usage of digital resources continues to grow within increasingly digitized financial sectors. Older adults face several opt-in barriers attributed to their age, including cognitive decline, low digital literacy and tech anxiety, and trust-related concerns with using a digital service. AI-enabled FinTech solutions such as conversational chatbots, voice-activated applications, biometric users-authentication systems, individually tailored financial recommendations, fraud-detection systems, and adaptable user interfaces represent a significant opportunity to improve the likelihood that seniors will be financially included. The implementation of these types of technological resources can lessen physical, cognitive, and emotional barriers to financial engagement, thus promoting financial independence and confidence. Limited research has been conducted on AI-enabled FinTech from the perspective of older adults; the primary focus has been on consumers in general, and limited attention has been paid to the unique needs and interests of senior citizens. This study will perform a systematic literature review (SLR) of academic, policy, and industry literature on the impacts of AI technology in changing access and increasing confidence in the FinTech sector for senior citizens. The literature reviewed will be categorized into five major areas: accessibility, usability, trust and security, anxiety related to technology, and engagement of consumers in the FinTech marketplace. Overall, findings suggest AI-based tools have the potential to improve both access to and confidence in financial services for seniors, but there continues to be significant gaps related to ethics and design frameworks specific to seniors, long-term trends in adoption of technology, and regulation. Using perspectives from marketing, consumer behaviour, financial inclusion, and information systems, this study will identify critical research gaps and propose pathways for building inclusive, age-friendly, and sustainable AI-based financial ecosystems.

Abstract Rangelands cover over 50% of the land surface area in the western United States, providing important economic, social, and environmental benefits. The resilience of western rangelands, however, is increasingly threatened by climate change impacts. Although climate skepticism among agricultural producers is often cited as a barrier to adaptation, emerging evidence suggests that producers adapt regardless of climate beliefs. This raises critical questions about the relationship between climate beliefs and adaptive behavior. To investigate this relationship, we conducted semistructured interviews with 23 ranchers in Idaho, Montana, and Oregon to examine how they perceive, experience, and adapt to climate change. We found that ranchers’ understanding of climate change is more complex than a binary belief in or rejection of climate change. Most ranchers doubted anthropogenic climate change yet described detailed observations of a changing climate. Ranchers adopted a range of adaptation strategies but did not attribute these behaviors to climate change. We identified recurring themes, including climate politicization, regulatory fear and perceived powerlessness, and reframing of responsibility, that illustrate the sociopolitical context shaping these seemingly contradictory positions. Climate skepticism may function as a mechanism for managing dissonance, allowing ranchers to reconcile personal observations of environmental change with dominant community beliefs while preserving their personal identity. Our findings challenge binary framings of belief and behavior and highlight the need for culturally grounded climate communication strategies. We recommend investments in localized climate services, coproduced policies, and outreach that emphasize the cobenefits of adaptation and risk management while aligning with ranchers’ values and identities. Significance Statement Ranchers steward much of the working lands in the American West, making their decisions central to rangeland resilience under climate change. Our study examines how climate beliefs relate to adaptation and which social factors shape responses. Interviews conducted in Idaho, Montana, and Oregon show that while many ranchers doubt human-caused climate change, they describe shifting seasons and adapt in multiple ways. In practice, climate change adaptation often occurs independent of beliefs and is filtered through politicization, regulatory fear, and moral obligations of land stewardship; risk management is rarely ascribed to climate change. Our findings demonstrate that climate skepticism does not preclude action but instead reflects cultural and political pressures shaping how ranchers engage with climate change. Future research should examine which communication strategies and codesigned climate adaptation policies—aligned with ranchers’ values and identities—can effectively sustain adaptation.

Global investments to combat HIV, tuberculosis, and malaria (HTM) have delivered substantial health gains and may have reduced the burden placed by these diseases on the routine health system. We estimated the reduction in primary healthcare (PHC) utilization resulting from the scale-up of HTM services over 2000-2023 in 108 low- and middle-income countries. For each disease, we applied established mathematical models to quantify PHC utilization (outpatient visits and inpatient bed-days provided outside of HTM programs) by individuals with symptomatic HIV, tuberculosis, or malaria unable to access HTM-specific services. For each country, we estimated averted PHC utilization by comparing a scenario describing the actual scale-up of HTM services to a counterfactual scenario holding HTM service coverage constant at year 2000 levels. We applied published unit costs to estimate the averted costs resulting from reduced PHC utilization. Over 2000-2023, scale-up of HTM services averted an estimated 6.9 (95% uncertainty interval (UI) [4.4, 10.5]) billion outpatient PHC visits and 3.9 (95% UI [2.5, 5.9]) billion inpatient bed-days, representing US$135 (95% UI [71, 250]) billion in averted costs. These reductions were greatest in sub-Saharan Africa and East Asia and Pacific regions. Across study countries, these reductions represented a median of 4.4% of hospital bed capacity and 1.6% of government health spending in 2023. These percentages were 22.9% and 5.1%, respectively, for low-income countries. Our analysis did not consider changes in PHC services beyond utilization. Also, several inputs were missing in some countries, with missing values estimated using regression imputation. Over recent decades, sustained investments in HTM services in high-burden settings have averted substantial PHC utilization and associated costs. These benefits should be considered when assessing investment impact.

Cryptocurrency is a peer-to-peer and decentralised network-based currency. After the introduction in 2009, it faced criticism and favouritism and is still developing and reshaping. So far, it is being evaluated from many aspects like financial, economic, social, political and legal. The legal aspect plays a significant role in implementing any new technology. In the context of the regulation of cryptocurrency, its market is under constant flux, and regulatory authorities engage in monitoring its trade across borders. Fintech services are ironically bridging the gaps in cryptocurrency-related financial and investment services offered by blockchain. This study highlights the cryptocurrency movement across the world, acceptance, analysing the factors that affect its transaction. Scenarios have been explained in brief under the shadow, understanding the regulatory possibilities in Pakistan and the reasons creating hurdles for cryptocurrency regulation.

Climate finance as a catalyst for peace

ABSTRACT The post-pandemic hospitality industry presents intensified challenges, including leadership gaps in crisis management, heightened competition for sustainability-driven travelers, and an increasing reliance on multidimensional consumer experience signals. Traditional performance evaluation methods are inadequate as they fail to capture spatial heterogeneity in amenity valuations and decode nuanced emotional dynamics in user reviews. To address these limitations, we propose the Spatial-Sentiment Machine Learning (SSML) framework, which integrates Natural Language Processing (NLP) for sentiment decoding, Random Forests (RF) for nonlinear modeling, and Geographically Weighted Regression (GWR) for spatial modulation. SSML enables simultaneous analysis of sentiment thresholds, amenity optimization intervals, and location-specific amenity returns. Experimental evaluation on a dataset of 127 urban hotels in Los Angeles shows that SSML achieves superior predictive accuracy (MAE 0.37, R2 = 0.76) compared to baseline models. Furthermore, the framework validates six key hypotheses, including the nonlinear sentiment threshold effect (β = 0.73 at polarity = 0.1), optimal amenity portfolio interval (12–18 amenities, β = 0.45), and spatial heterogeneity where coastal regions exhibit 60% stronger facility-index impacts than inland areas. These results demonstrate that SSML not only enhances predictive performance but also generates actionable spatial resource allocation strategies, offering a systematic tool for aligning service investment with guest experience perceptions in competitive urban markets.

ABSTRACT Purpose Amid rising environmental expectations, green supply chains must balance profitability, sustainability, and fairness. This study examines how government subsidies, retailer green service investment, and fairness preferences jointly influence optimal pricing, product greenness, service effort, and profit allocation. Design/methodology/approach A Stackelberg game-theoretic model with a manufacturer and a retailer is developed. Four scenarios are analyzed: no intervention, subsidy only, service only, and combined subsidy–service. The model further incorporates fairness concerns of either party using an asymmetric Nash bargaining framework. Findings The results show that government subsidies improve product greenness and supply chain profitability, particularly when aligned with retailer-led green service investments. Service investments enhance demand but may reduce profits without policy support. Fairness preferences also reshape decision outcomes: manufacturer fairness raises prices but reduces efficiency, whereas retailer fairness promotes equity but may weaken upstream sustainability. A fairness sensitivity threshold enables profit coordination with minimal efficiency loss. Practical implications Aligning public subsidies with retailer green service initiatives can improve both environmental performance and supply chain profitability. Originality/value This study integrates economic incentives and behavioral fairness considerations into a unified framework for analyzing sustainable supply chain strategies.

In the Global South, a disproportionate number of young married women who experience unwanted and mistimed pregnancies undergo unsafe abortion practices, leading to a heightened burden of maternal and infant deaths in developing countries. The present qualitative study attempts to examine the practice of induced abortion at the village as well as assess the socio-structural barriers leading to poor sexual and reproductive health in rural Uttar Pradesh, India. The study underlines the lived experience and process of decision-making related to induced abortion, and the intertwined family, social, and healthcare-associated challenges faced by young married women. Evidence from the study suggests that the inability to use safe contraception methods, unsupportive behaviour of the spouse towards childcare, financial hardship, lack of accessibility and affordability of contraception methods, lesser decision-making power, and social norms and customs appeared to pose critical barriers to safe abortion practices among young married women. Findings from the study highlight an abysmal dearth of access to safe, affordable, and quality abortion care services in the study area. This calls for policymakers to increase investments in high-quality, comprehensive sexual and reproductive health services to ensure safe pregnancy and child health experiences in the Indian context.

Abstract Marketing campaigns are widely used by banks to promote financial products such as term deposits, loans, and investment services. However, traditional marketing approaches often involve contacting a large number of customers without accurately identifying potential subscribers, leading to low response rates and increased operational costs. With the rapid growth of data availability and advancements in machine learning, financial institutions can utilize predictive analytics to improve customer targeting and marketing efficiency. This study develops a predictive modelling framework using machine learning techniques for bank marketing campaign optimization. The research utilizes the Bank Marketing dataset containing 41,188 customer records with demographic attributes, campaign interaction history, and macroeconomic indicators. The modelling process includes exploratory data analysis, domain-driven feature engineering, statistical feature selection, and a structured preprocessing pipeline using scaling and one-hot encoding. Several machine learning algorithms including Logistic Regression, Random Forest, XGBoost, LightGBM, and K-Nearest Neighbors were evaluated using performance metrics such as F1-score, ROC-AUC, Average Precision, and cross-validation performance. To address class imbalance in the dataset, class-weight balancing techniques were incorporated into the modelling process. Experimental results indicate that the Balanced LightGBM model achieved the best overall performance, providing the highest composite evaluation across F1-score, ROC-AUC, and Average Precision metrics. The proposed framework demonstrates how machine learning-based predictive analytics can significantly improve marketing efficiency, reduce campaign costs, and enhance customer targeting strategies for banking institutions. Key Words: Machine Learning, Predictive Analytics, Bank Marketing, Business Analytics.

ABSTRACT The unmet mental health needs within Immigration Removal Centres in the United Kingdom present critical challenges. This study examines barriers to safeguarding and accessing mental health care through content analysis of nine His Majesty’s Inspectorate of Prisons inspection reports. Key challenges were identified in two categories: institutional impacts and service provision. Institutional barriers include inadequate reception screening, inconsistent use of interpreting services, staff shortages, and limited awareness of vulnerability safeguards such as Rule 35 and ACDT processes. Service provision issues encompass significant staff vacancies, uneven access to psychological therapies, and unsuitable facilities. Although some centres exhibit promising practices, most struggle to meet detainees’ needs effectively. Detention practices, including indefinite durations and prison-like regimes, exacerbate mental health deterioration among detainees, many of whom have pre-existing trauma. Findings call for improved staff training, better interagency communication, and increased investment in mental health services. This study highlights the need for systemic reform to address mental health disparities and promote humane, effective immigration management. Further research should explore scalable, rights-based approaches to care and detention alternatives.

Abstract Solar irrigation pumps (SIPs) are central to Nepal’s strategy for sustainable irrigation and reducing reliance on diesel pumps. The Alternative Energy Promotion Centre (AEPC) officially provides a 60% subsidy for SIPs under a demand-driven program. This study assesses (i) SIP subsidy delivery and adoption processes, and (ii) utilization patterns and their drivers, using a household survey of 630 farmers and a phone survey of 404 SIP owners. In practice, farmers contributed only 4% of total SIP costs on average, as local governments frequently topped up AEPC’s subsidy, making SIPs nearly free. While this boosted affordability, the scheme is only weakly progressive: large farmers also benefit from near-complete subsidization, raising equity and fiscal concerns. The applicant pool is dominated by educated, wealthier, and socially advantaged groups, while marginalized farmers are often excluded due to weak information and institutional gatekeeping. Utilization is moderate, with SIPs operating around 745 h annually—well below their technical potential. Breakdowns, long repair delays (averaging 110 d), and missing after-sales services reduce use. Training in operation and maintenance increases utilization by 38%, while cultivation of water-intensive crops also drives higher use. Transparent communication of the full subsidy package, progressive cost-sharing to prioritize smallholders, and stronger investment in training and rapid-repair services are essential. Without such reforms, the program risks under-utilization and elite capture of subsidies, undermining SIPs’ transformative potential for agricultural resilience and low-carbon growth.

Understanding the economic cost of self-harm is essential for evaluating intervention cost-effectiveness and guiding funding allocation and service planning. To estimate the cost associated with self-harm presentations to hospital emergency departments and investigate key predictors of cost. Data on presentations to hospital for self-harm in all Irish emergency departments were analysed for 2018 and 2019. Costs of hospital treatment following self-harm were identified (in 2019 euros) using top-down and bottom-up approaches. The perspective taken was that of the health service. Factors associated with costs were investigated using generalised linear models. There were 25 053 self-harm presentations from 2018 to 2019. The average annual cost of self-harm was approximately €26.5 million; almost half of the total cost was due to repeat self-harm presentations (47.3%). The mean cost per presentation was €2117 (s.d. €1845), which incorporates acute hospital costs (mean €2067, s.d. €2127) and those of initial aftercare (mean €50, s.d. €69). Psychiatric and medical admissions were associated with highest costs, three times that of presentations resulting in emergency department discharge (incidence rate ratio (IRR) 3.01, 95% CI 2.72-3.36 and IRR 2.88, 95% CI 2.72-3.36, respectively). Other factors associated with higher costs included older age, emergency department medical assessment unit admission, receiving a psychosocial assessment and self-harm involving a firearm. Demographic and clinical predictors of cost varied according to care pathway. Significant costs associated with repeat attendances and hospital admission provide evidence for investment in emergency department services providing comprehensive care for those presenting with self-harm, as well as in community-based mental health services.

Cataract is the leading cause of blindness worldwide despite treatment being very cost-effective. To stimulate efforts to address the large unmet need for affordable, good-quality cataract services, member states at the 74th World Health Assembly endorsed a global target of a 30 percentage-point increase in effective cataract surgical coverage (eCSC) by 2030. In this Article, we report on progress towards that target. We did a secondary analysis of 233 participant-level population-based survey datasets (Rapid Assessment of Avoidable Blindness [RAAB] surveys and other population-based cross-sectional surveys) from 68 countries (2003-24) to estimate eCSC with a cataract surgical threshold of worse than 6/18 pinhole visual acuity and a threshold of 6/18 or better for postoperative presenting visual acuity (eCSC6/18) for each country. Eligible studies included people aged 50 years and older, without any further age restrictions. eCSC was calculated as the number of people who had received surgery and had a good visual outcome as a proportion of all people who had received or were still to receive surgery. For countries with only one survey estimate available, we reported the survey as the country estimate; for each country with two or more surveys, we used more recent and nationally representative survey to generate estimates. We included 228 of 233 datasets (excluding five datasets from the European region) in a mixed-effects logistic regression to estimate global and WHO regional temporal trends in eCSC6/18 from 2000 to 2030. For global estimates, we used eCSC in the Americas region as a proxy for the European region. We used 120 RAAB surveys that measured visual acuity at the 6/12 threshold to analyse causes of non-good outcomes (postoperative presenting visual acuity worse than 6/12) and estimated potential gains in eCSC (with a cataract surgical threshold of worse than 6/12 pinhole visual acuity and a 6/12 or better threshold for postoperative presenting visual acuity [eCSC6/12]) from correcting residual postoperative refractive errors. Potential gains were estimated by comparing eCSC6/12 calculated using postoperative presenting visual acuity with eCSC6/12 calculated using pinhole visual acuity (a proxy for visual acuity with optical correction of refractive error). We used 130 studies to report 68 country estimates of eCSC6/18. Country estimates for eCSC6/18 from surveys ranged from 2·1% (95% CI 0·9-3·4) in Burundi (2024) to 77·7% (72·9-82·5) in Qatar (2023). Globally, we predicted eCSC6/18 of 48·2% (39·7-57·2) in 2025, increasing by 8·4 percentage points (8·1-8·6) between 2020 and 2030 (from 43·9% [36·6-51·2] to 52·3% [41·4-62·7]). Uncorrected refractive error accounted for a median 26·4% of non-good outcomes per survey; we estimated that treating this condition could yield a median 3·7 percentage-point gain in eCSC6/12 globally. Global efforts are not on track to meet the target of a 30 percentage-point increase in eCSC between 2020 and 2030-immediate and substantial investment in cataract services is, therefore, required. Survey data indicated which elements of the cataract care pathway could be targeted for quality-improvement initiatives. A suite of cataract surgery quality indicators should be collected to better inform service providers. Indigo Trust, The Fred Hollows Foundation, and Wellcome Trust.