Search Results (209)

Background: We aimed to evaluate the impact of a Private Provider Engagement (PPE) model that integrated neighborhood private health providers into the immunization system to improve vaccine uptake and reduce coverage disparities among marginalized communities in Karachi, Pakistan, where health inequities and the risk of vaccine-preventable diseases remain high. Methods: Routine immunization service corners were established at nine private clinics in urban settlements of eight high-risk union councils (HRUCs) in Karachi. A quasi-experimental before-and-after study design was used with a baseline survey conducted in May–July 2022 and an end-line survey in April–June 2024. Households were selected using a multistage cluster sampling approach, and data were collected from parents or primary caregivers of children aged 4–11 months residing in the catchment areas for >3 months, using an adapted WHO immunization coverage questionnaire. The primary outcome was child immunization status for BCG, Polio, Pentavalent (DTP-3), Rotavirus, PCV, TCV, and MR vaccines, categorized as fully vaccinated, partially vaccinated, or unvaccinated, and verified through vaccination cards or caregiver recall. Multinomial and binary logistic regression were used to investigate factors associated with immunization coverage. Results: A total of 2167 children were surveyed (1141 children at baseline; 1026 children at end-line). The proportion of fully immunized children more than doubled across sexes, with significantly higher adjusted odds at endline (aOR: 6.34, 95%CI: 2.45–16.21). Age-appropriate uptake of all antigens improved, with over fourfold odds for receiving the Penta-3 vaccine (aOR 4.55, 95%CI: 3.55–5.82) and more than threefold odds for receiving the MR-1 Vaccine (aOR 3.67, 95%CI: 2.37–5.67). Parental education strongly predicted immunization, with the highest odds among children of fathers with secondary or higher education or skilled labor. Fully immunized Pashto-speaking children increased at endline but had the lowest odds compared to Urdu-speaking children. Conclusion: The PPE model increased vaccination coverage and reduced disparities in Karachi’s urban settlements, demonstrating potential for scale-up to strengthen routine immunization and reduce the number of zero-dose children. Full article

Background: Pancreatic Ductal Adenocarcinoma (PDAC) has a dismal five-year survival rate of 13% and is closely associated with cachexia. Cancer cachexia is a multifactorial syndrome characterized by irreversible wasting of skeletal muscles, fat loss and systemic inflammation. While cachexia is known to confer resistance to immune checkpoint inhibition in several cancers, the bidirectional relationship between cachexia and the immune system in PDAC remains unclear, necessitating the development of novel preclinical models. Our laboratory has characterized a novel pancreatic cancer cachexia model in C57BL/6J mice by utilizing the pancreatic cancer cell line called KPCL-4 derived from KPC-LSIY mice (Kras^LSL-G12D/+Tp53^LSL-R172H/+Pdx1-Cre/R26^LSL-LSIY). Methods: KPCL-4 cells were orthotopically injected into the pancreas of male and female C57BL/6J mice and hallmarks of cachexia were assessed at endpoint by measurement of tumor weight, terminal tumor-adjusted body weight, skeletal muscle, adipose tissue, liver and spleen masses, proteolytic markers and grip strength. Plasma cytokine and chemokine concentrations were quantified by Luminex assay and high-dimensional flow cytometry was used to investigate changes in tumor-infiltrating immune populations. Results: We observed a sex bias in cachexia presentation despite similar tumor weights in male and female mice, whereby males exhibited a >5% decrease in terminal tumor-adjusted body weight (p < 0.001), >50% fat loss (p < 0.001), upregulation of proteolytic markers in skeletal muscles (p < 0.01) and reduction in skeletal muscle mass (p < 0.05), function (p < 0.01) and cross-sectional area (p < 0.0001) whereas females demonstrated conserved skeletal muscle mass with 33% fat loss (p < 0.05), reduction in muscle cross-sectional area (p < 0.0001) and splenomegaly (p < 0.01). While intra-tumoral immune populations did not exhibit sex-specific differences, plasma cytokine concentrations were differentially upregulated in males and females, suggesting functional differences in immune cells as potent drivers of sex bias in KPCL-4-driven cachexia. Conclusions: The KPCL-4 orthotopic PDAC model exhibits prominent hallmarks of cachexia and serves as a novel platform for investigating the complex interplay between cancer cachexia and immunomodulation. Full article

Background: Women’s empowerment has been significantly associated with improved child health outcomes. Cambodia, amid a rapid socioeconomic transition, offers a critical setting to examine how advancements in women’s empowerment over the past decade have influenced child immunization completion within the first two years of life. Methods: Data from the Cambodia Demographic and Health Surveys conducted in 2010, 2014, and 2021–22, encompassing 9222 women with recent births, were analyzed. Empowerment was measured across literacy and information access, employment, and decision-making domains. Multinomial logistic regression assessed associations between empowerment factors and completion of oral polio (OPV), diphtheria–tetanus–pertussis (DTP), pneumococcal conjugate (PCV), and measles–rubella (MR) vaccines, adjusting for demographic and socioeconomic variables. Results: Between 2010 and 2022, women’s empowerment in Cambodia improved significantly, marked by higher literacy rates, nearly half of women completing primary education, and expanded digital access, with 82.4% owning mobile phones and approximately 50% using the internet daily. While non-working women slightly increased, agricultural employment declined by 20%, and cash earnings rose from 48.7% to 82.5%. Most women participated in major household decision-making, either independently or jointly. Completion rates for OPV, DTP, and PCV ranged from 79% to 83%, while just over half of children were fully vaccinated against measles. Higher maternal education and cash earnings were positively associated with OPV, DTP, and PCV completion but negatively associated with measles vaccination. Women in agricultural work were less likely to complete measles vaccination for their children than non-working women. Joint decision-making regarding the use of respondents’ income was associated with a higher likelihood of measles non-completion (OR = 2.26, 95% CI: 1.13–4.51), whereas joint decision-making about respondents’ health care was associated with a higher likelihood of measles completion (OR = 0.42, 95% CI: 0.21–0.83). Conclusions: Women’s empowerment remains a key determinant of vaccination outcomes in Cambodia. The distinct pattern observed for measles suggests that vaccines scheduled for older ages encounter greater structural and behavioral barriers. To overcome these challenges, strategies should focus on enhancing defaulter tracking, implementing reminder systems, expanding outreach and catch-up programs, and improving the convenience of vaccination services. Full article

The contemporary Digital Twinning Paradigm (DTP) emerges from the synergy of conceptual development and experiences gained through the digital transformation of real-world Cyber–Physical and Sociotechnical Systems. Balancing current practices and future trends of Digital Twinning concepts and technologies, framed by maturity and futureness evaluation and assessment, is an invariant. The intended mission of this research article is to perform the following: first, to establish and collect an open pool of digital twinning future trends and second, to specify the foundations for the development of a Digital Twinning Future Trends Evaluation Digital Twins-based framework. The proposed in-depth explainable (unleashed) systematic literature review methodology aided in fulfilling the first part of a mission, while the second one emerged from the transposition of characteristics of complementary maturity evaluation frameworks’ characteristics and digital twins referent architectures. The key research hypothesis is that the formation of a future trends persistence database precedes the backward-tracking analysis, enabling the isolation of the persistence rationale. These rationalities then drive the DTP model refinements to foster further prediction accuracy. The research outcomes suggest that, in general, a more rigorous justification of research suitability is necessary and highlight certain obstacles affecting the representativeness of review-based publishing. Through the continuous improvement of the future trends data layer, coupled with a comprehensive repertoire of cross-related research publications, the proposed framework enables the assessment of future trends in the DTP or other paradigms through the proposed Digital Twins Reference Architecture. Full article

Advancements in ship propulsion technologies are essential for improving the efficiency and reliability of maritime transportation. This study introduces a comprehensive approach that integrates motor design with sensorless control strategies, specifically focusing on Dual Three-Phase Permanent Magnet Vernier Motors (DTP-PMVM) for ship propulsion. The initial section of the paper explores the design of a 5-MW DTP-PMVM using finite element method (FEM) analysis in dual three-phase configurations. The subsequent section presents a novel sensorless control technique employing a Prescribed-time Sliding Mode Observer (PTSMO) for accurate speed and position estimation of the DTP-PMSM, eliminating the need for physical sensors. The proposed observer convergence time is entirely independent of the initial estimation guess and observer gains, allowing for pre-adjustment of the estimation error settling time. Initially, the observer is designed for a DTP-PMVM with fully known model parameters. It is then adapted to accommodate variations and unknown parameters over time, achieving prescribed-time observation. This is accomplished by using an adaptive observer to estimate the unknown parameters of the DTP-PMVM model and a Neural Network (NN) to compensate for the nonlinear effects caused by the model’s unknown terms. The adaptation laws are innovatively modified to ensure the prescribed time convergence of the entire adaptive observer. MATLAB (R2023b) Simulink simulations demonstrate the superior speed-tracking accuracy and robustness of the speed and position observer against model parameter variations, strongly supporting the application of these strategies in real-world maritime propulsion systems. By integrating these advancements, this research not only proposes a more efficient, reliable, and robust propulsion motor design but also demonstrates an effective control strategy that significantly enhances overall system performance, particularly for maritime propulsion applications. Full article

Atrium spaces are widely applied in university buildings. However, achieving effective energy reduction while maintaining adequate daylighting and indoor comfort remains a major challenge at the early design stage. This study identifies key building form design variables significantly influencing atrium daylighting, energy use, and thermal comfort, including building orientation, atrium width-to-depth ratio, atrium aspect ratio, atrium bottom area ratio, and skylight–roof ratio. A multi-objective optimization (MOO) framework is proposed to balance daylight performance, energy consumption, and thermal comfort under fixed envelope parameters. Using typical single- and double-atrium teaching buildings in cold regions as case studies, this research adopts Useful Daylight Illuminance (UDI), Energy Use Intensity (EUI), and Discomfort Time Percentage (DTP) as key indicators to evaluate the interactions between design parameters and building performance. Based on the Pareto-optimal results for the studied prototypes, a south-by-west orientation, moderately slender atrium proportions, relatively compact atrium bottom areas, and medium skylight–roof ratios together yield a balanced performance. Compared with the reference to the initial solution, the optimized solutions reduce EUI by up to 5.66% while also improving UDI and DTP. These results are intended as quantitative references and optimization for early-stage geometric forms design of atrium teaching buildings in cold regions. Full article

This study developed a rapid and real-time model for predicting total organic carbon (TOC), which is an alternative to the conventional biochemical oxygen demand (BOD) and chemical oxygen demand (COD) indicators. The influence of input variable selection methods and machine learning hyperparameter tuning on TOC prediction accuracy was compared using ten-year water quality monitoring data. The analysis showed that TOC exhibited strong correlations with COD, T-P, BOD, and ammonia nitrogen (NH₃-N). Principal component analysis confirmed that the primary factors driving TOC variation were associated with organic matter and nutrient pollution. Prediction models were developed using a multilayer perceptron (MLP) and random forest (RF). On average, the MLP model outperformed the RF model by approximately 20%, and COD consistently appeared as a critical predictor in all top-ranked feature sets. Finally, grid search-based hyperparameter tuning of the MLP model with the optimal variable set (DO, COD, T-P, DTP, PO₄-P) increased the coefficient of determination from 0.7496 to 0.7562. The findings demonstrate that precise exploration of variable combinations and stronger model regularization are essential for improving prediction performance in TOC modeling. This study provides a foundation for future development of predictive models that integrate external environmental factors such as nonpoint source pollution. Full article

In recent decades, there has been an upsurge in focus on the extraction of pyrite from sulfide ore deposits due to its vital role in the process of metal extraction and environmental management. This study explores the flotation behavior of pyrite in sulfide ores using mechanical-cell flotation. This study compared the performance of two commonly used flotation collectors, potassium butyl xanthate (KXT) and diethyl dithiophosphate (DTP), in the beneficiation of a sulfide ore from southwestern Spain. Statistical analysis performed using MiniTab 4.0 revealed that collector type, reagent dosage, and pulp pH were the principal factors affecting pyrite recovery. Under the tested conditions, KXT exhibited superior metallurgical performance and selectivity compared with DTP. The flotation kinetics demonstrate that the chemical was more efficacious throughout both the rougher and cleaner phases of the process. The findings robustly corroborate the notion that employing xanthate-based chemicals to enhance pyrite concentration facilitates metal extraction from the Sulfide Ore Deposit in southwestern Spain. The study sets out a basis for process growth, and it is proposed that further research be conducted under industrial water conditions to validate the findings. Full article

Sensor sampling errors and inverter dead-time effects introduce significant nonlinear disturbances into dual three-phase permanent magnet synchronous machine (DTP-PMSM) drive systems with sinusoidal excitation, leading to pronounced alternating current (AC) and direct current (DC) disturbances. These disturbances severely compromise the stability and reliability of the current control loop, ultimately degrading the overall driving accuracy of the system. To effectively address this issue, this paper proposes a novel interference suppression strategy based on bi-subspace predictive current control. Specifically, the proposed approach optimizes modulation through two-step virtual-vector-based predictive current control (VVPCC) operation to achieve disturbance decoupling. Building upon this foundation, a model-assisted discrete extended state observer (DESO) is incorporated into the fundamental subspace, whereas a discrete vector resonant controller (DVRC) with pre-distorted Tustin discretization is applied to the secondary subspace. Modeling analysis and experimental results demonstrate that, compared with the classical VVPCC method, the proposed bi-subspace VVPCC method has good steady-state performance and enhanced robustness in the presence of disturbances. Full article

Background: Despite remarkable progress in expanding access to childhood vaccines in the last two decades, global coverage with the third dose of the diphtheria–tetanus–pertussis-containing vaccine (DTP3) has recently plateaued, with many countries yet to meet the targets of the Immunization Agenda 2030 (IA2030). As countries cluster around the 80% coverage mark, further gains require targeted interventions for unreached populations. This analysis disaggregates children missing DTP3 into three groups—zero dose (ZD), missed DTP (MD), and drop-out (DO)—which, with DTP3, form four mutually exclusive groups, and examines which of these groups contributes most to coverage changes across countries. Methods: A total of 295 Demographic and Health Surveys from 1986 to 2023 were analyzed across 80 countries, comprising over 2.4 million children. Children were classified into mutually exclusive groups: DTP3, ZD, MD, and DO. We described trends over time and conducted decomposition analyses using a naïve approach and a structural model with isometric log-ratio transformations and causal mediation pathways. Results: Among the 2.4 million children across 80 countries, 63.8% had received DTP3, while 16.2% were DO, 8.8% were MD, and 11.2% were ZD. Countries showed important variations: some mainly reduced ZD, others reduced MD or DO, many achieved balanced progress, and a few experienced setbacks. The naïve model showed that coverage changes reflected different combinations of shifts across ZD, MD, and DO depending on context. The structural model indicated that DO had the strongest direct association with DTP3 coverage, followed by MD and ZD. Conclusions: This analysis highlights the differential contribution of intermediate groups to coverage variations over time. Understanding the association between coverage gains and shifts in ZD, MD, or DO can complement existing strategies to inform targeted planning and accelerate progress towards IA2030 equity goals. Full article

Therapeutic resistance remains a critical barrier in oncology, frequently leading to cancer relapse after initial treatment response. Growing evidence suggests the presence of drug-tolerant persisters (DTPs), a rare subpopulation of cancer cells that survives chemotherapy by entering a reversible specific adaptation. Unlike classical cell resistance, the DTP phenotype is independent of genetic changes and maintained through dynamic regulatory mechanisms. DTPs are phenotypically heterogeneous and can exhibit stem-like and quiescent cell phenotypes, non- or slow proliferation, and remarkable plasticity due to a di-pause-like state and executing epithelial–mesenchymal transition (EMT) or transdifferentiation processes. Despite advances in research, the molecular mechanisms underlying DTPs’ biology and their role in cancer relapse remain only partially understood. The review summarizes the current progress in processes that lead to the acquisition of cellular persistence status, which, in turn, constitute areas of vulnerability that can be exploited in cancer therapy. We highlight anti-DTP therapeutic strategies, including epigenetic modification, cell signaling and transcriptional regulation, metabolic reprogramming, and modification of cell interactions within the tumor microenvironment. Furthermore, we focus on the potential role of nanomaterials in the combat against DTPs. Nanoparticles not only act as part of the drug delivery process, enabling precise DTP targeting and enhancing intracellular drug accumulation, but their intrinsic properties can also be used to eradicate DTPs directly or by enhancing the effectiveness of other therapeutic strategies. The integrated approach offers strong potential to eliminate tumor persistence, prevent recurrence, and improve long-term patient outcomes beyond conventional therapies. Full article

Background/Objectives: Nigeria continues to face major challenges in achieving equitable immunisation coverage, with marked subnational disparities. This study aimed to assess trends in vaccine access and utilisation across Nigeria’s six geopolitical zones between 2018 and 2024, focusing on inequities in DTP coverage, dropout rates, and zero-dose prevalence. Methods: We conducted a comparative ecological analysis using secondary data from the Nigeria Demographic and Health Surveys (2018, 2024) and the 2021 Multiple Indicator Cluster Survey/National Immunisation Coverage Survey. Geometric mean coverage for penta 1 (DTP1) and penta 3 (DTP3), DTP1–DTP3 dropout rates, and zero-dose prevalence were calculated for each of the six geopolitical zones and analysed using WHO’s Health Equity Assessment Toolkit Plus. Absolute (difference, D) and relative (ratio, R) summary measures of inequality were also assessed. Results: Findings revealed statistically significant differences in indicators across the various regions during the period of study. While the South-East maintained >90% DTP1 coverage, the North-West declined from 37.3% (2018) to 33.4% (2024). In the same period, the absolute inequality (D) in DTP1 coverage increased from 55.3 to 58.4 percentage points. Zero-dose inequities worsened sharply: prevalence in the North-West rose from 25.7% (2021) to 47.4% (2024) compared to ~4% in the South-East, with a relative inequality (R) of 11.29 in 2024. In contrast, service utilisation improved, as dropout rates in the North-West fell from 38.7% (2018) to 14.3% (2024), reducing absolute inequality to 11.0 pp. Conclusions: Despite progress in reducing dropout, access to vaccination services remains highly inequitable, particularly in northern Nigeria. Declines since 2021 suggest systemic fragility compounded by COVID-19-related disruptions. Strengthening sustainable routine immunisation systems and investing in demand generation, especially through social and behaviour change communication, are essential to achieving equity. Full article

This study describes the design, implementation, and evaluation of a Competency-Based Pharmacy Education (CBPE) program for 120 direct-to-patient (DTP) pharmacists in China, aimed at improving pharmaceutical care and pharmacotherapy skills. The program, which integrated Case-Based Learning (CBL) and Objective Structured Clinical Examination (OSCE), included both online and in-person sessions. A cross-sectional analysis of participant performance and satisfaction showed a mean total OSCE score of 68.31. Participants demonstrated strengths in communication and documentation, with one-third of participants achieving high scores, while weaknesses were noted in patient education and care planning. Participant surveys revealed significant perceived improvements in communication and patient education skills among 62.5% of the participants. These findings suggest that CBPE is a promising approach for pharmacist training, advocating for its broader adoption to meet the evolving demands of healthcare and improve patient outcomes. Full article

In this paper, the effects of asymmetric interior permanent magnet (AIPM) rotors on the torque characteristics in dual three-phase (DTP) permanent magnet synchronous machines (PMSMs) are investigated. The electromagnetic performances of DTP PMSMs with symmetrical and asymmetric IPM rotors are compared, including air-gap flux density, back EMF, cogging torque, torque, loss, and efficiency. It is found that in DTP PMSMs, the AIPM rotor can achieve significant torque improvement under both healthy and single three-phase open-circuit conditions. It is also found that performance enhancement in AIPM DTP machines is more remarkable across the constant torque region, particularly at high-load conditions, than in the constant power region, compared with the symmetrical IPM counterpart. A prototype is fabricated and tested to verify theoretical analyses. Full article

A multivector direct model predictive control (DMPC) scheme is proposed for the dual three-phase permanent magnet synchronous machine (DTP-PMSM) drive system to achieve closed-loop control for both fundamental current tracking and harmonic current minimization. The proposed multivector DMPC scheme employs four active voltage vectors, including two large vectors and two basic vectors for implicit modulation. Moreover, the control optimization problem is formulated as a four-dimensional quadratic programming problem, which is suitable for real-time implementation. The proposed multivector DMPC scheme enables fast and accurate tracking of the fundamental current as well as effective suppression of harmonic currents in both the fundamental and harmonic subspaces. In addition, a Kalman filter observer is incorporated to enhance robustness against model uncertainties and disturbances. Experimental results on a DTP-PMSM test bench verify that the proposed multivector DMPC scheme effectively reduces torque ripple, improves current quality, and enhances both steady-state and transient performance of the system. Full article