Water, Sanitation and Hygiene in Lower-Level Health Care Facilities of Dar es Salaam Region in Tanzania: Status towards Achieving the Sustainable Development Goals and Way Forward

Background: Improving Water, Sanitation and Hygiene in health care settings is a critical prerequisite for achieving national health goals and Sustainable Development Goals (SDGs). The World Health Organization (WHO) has set a target for each United Nations member state to reach by 2030. Each member state is required to reach by 2022, 2025 and 2030 at least 60%, 80% and 100%, respectively of basic level of service of the five elements which are water, sanitation, hygiene, waste management and environmental cleaning. Methods: This study aimed to evaluate and document the current state of basic water, sanitation, and hygiene services in all lower-level health care facilities in the Dar es Salaam region of Tanzania as of July 2022. A cross-sectional study was conducted in 99 public dispensaries in the Dar es Salaam region’s five councils: Ubungo, Kigamboni, Kinondoni and Temeke Municipalities, and Ilala City. The interviewee form and observational checklists were both digitalized using the Kobo tool software. The respondents were health care facility in-charges or nurse in-charges. Data were downloaded, validated, and imported to Stata version 15 for analysis. Results: The basic WASH level per JMP is far below the target in 2022. Each member state by 2022 is required to reach at least 60% of the basic level of service of each element. We found a low coverage of basic WASH in the 99 dispensaries included in this study. The basic WASH coverage was met in only 10 (10.1%) of the dispensaries, while the remaining 89 (89.9%) dispensaries fall on limited WASH services. Conclusion: This study revealed lower coverage of basic WASH services in dispensaries. An urgent need is required to improve the status of WASH in all the dispensaries and facilitate the provision of quality health care services, patient safety and reduce health care associated infections.

Dynamics of information diffusion and disease transmission in time-varying multiplex networks with asymmetric activity levels

While the interaction between information and disease in static networks has been extensively investigated,many studies have ignored the characteristics of network evolution.In this study,we construct a new two-layer coupling model to explore the interactions between information and disease.The upper layer describes the diffusion of disease-related information,and the lower layer represents the disease transmission.We then use power-law distributions to examine the influence of asymmetric activity levels on dynamic propagation,revealing a mapping relationship characterizing the interconnected propagation of information and diseases among partial nodes within the network.Subsequently,we derive the disease outbreak threshold by using the microscopic Markov-chain approach(MMCA).Finally,we perform extensive Monte Carlo(MC)numerical simulations to verify the accuracy of our theoretical results.Our findings indicate that the activity levels of individuals in the disease transmission layer have a more significant influence on disease transmission compared with the individual activity levels in the information diffusion layer.Moreover,reducing the damping factor can delay disease outbreaks and suppress disease transmission,while improving individual quarantine measures can contribute positively to disease control.This study provides valuable insights into policymakers for developing outbreak prevention and control strategies.

Monitoring absolute vertical land motions and absolute sea-level changes from GPS and tide gauges data over French Polynesia

In this study,we estimate the absolute vertical land motions at three tidal stations with collocated Global Navigation Satellite System(GNSS)receivers over French Polynesia during the period 2007-2020,and obtain,as ancillary results,estimates of the absolute changes in sea level at the same locations.To verify our processing approach to determining vertical motion,we first modeled vertical motion at the International GNSS Service(IGS)THTI station located in the capital island of Tahiti and compared our estimate with previous independent determinations,with a good agreement.We obtained the following estimates for the vertical land motions at the tide gauges:Tubuai island,Austral Archipelago-0.92±0.17 mm/yr,Vairao village,Tahiti Iti:-0.49±0.39 mm/yr,Rikitea,Gambier Archipelago-0.43±0.17 mm/yr.The absolute variations of the sea level are:Tubuai island,Austral Archipelago 5.25±0.60 mm/yr,Vairao village,Tahiti Iti:3.62±0.52 mm/yr,Rikitea,Gambier Archipelago 1.52±0.23 mm/yr.We discuss these absolute values in light of the values obtained from altimetric measurements and other means in French Polynesia.

Methodology for local correction of the heights of global geoid models to improve the accuracy of GNSS leveling

At present,one of the methods used to determine the height of points on the Earth’s surface is Global Navigation Satellite System(GNSS)leveling.It is possible to determine the orthometric or normal height by this method only if there is a geoid or quasi-geoid height model available.This paper proposes the methodology for local correction of the heights of high-order global geoid models such as EGM08,EIGEN-6C4,GECO,and XGM2019e_2159.This methodology was tested in different areas of the research field,covering various relief forms.The dependence of the change in corrected height accuracy on the input data was analyzed,and the correction was also conducted for model heights in three tidal systems:"tide free","mean tide",and"zero tide".The results show that the heights of EIGEN-6C4 model can be corrected with an accuracy of up to 1 cm for flat and foothill terrains with the dimensionality of 1°×1°,2°×2°,and 3°×3°.The EGM08 model presents an almost identical result.The EIGEN-6C4 model is best suited for mountainous relief and provides an accuracy of 1.5 cm on the 1°×1°area.The height correction accuracy of GECO and XGM2019e_2159 models is slightly poor,which has fuzziness in terms of numerical fluctuation.

Antibody Levels and Infection Status of Pertussis in the Population under Pertussis Resurgence in Guangxi in 2018:A Cross-Sectional Survey

Objective Pertussis cases have increased markedly since 2018 in Guangxi.The aim of this study was to evaluate antibody levels and the infection status of pertussis in the resident population.Method A total of 10,215 serum samples from residents were collected from August-November 2018 and tested for anti-pertussis IgG and toxin IgG using the enzyme-linked immunosorbent assay(ELISA).Results Of the collected samples,1,833(17.94%)tested positive for anti-pertussis IgG,with the median concentration of 16.06 IU/mL.Antibody level<10 IU/mL accounted for more than 60%in children under 4 years of age,but declined with age,whereas the percentages of the other three levels(10-40,40-50,and≥50 IU/mL)increased almost with age(P<0.001).Moreover,7,924 samples were selected for anti-pertussis toxin IgG,of which 653(8.24%)tested positive(≥40 IU/mL)with the median concentration of 5.89 IU/mL,and 204 participants(2.56%)had recent pertussis infection(≥100 IU/mL).Among the different age groups,the highest rates of positivity and recent infection were observed at 11-20 years of age,the lowest positivity rate at 5 years of age,and the lowest recent infection rate at 4 years of age(P<0.001,P=0.005,respectively).Conclusion The survey results showed that all age groups in Guangxi lacked immunity against pertussis,which was one of the main factors contributing to the resurgence of pertussis in 2018.In addition,the prevalence of pertussis is relatively high in Guangxi,and its incidence is seriously underestimated,especially in adolescents and adults.

Abnormal Thyroid Stimulating Hormone Level and Heavy Menstrual Bleeding

Heavy Menstrual Bleeding is one of the common Gynaecological issues. There are several causes. Some of the women presented with these issues found to have underling thyroid abnormality which was not discovered earlier. This research tries to find the prevalence of the Thyroid Disorder among the women present with Heavy menstrual bleeding in Sri Lankan women.

The Impact of Sea Level Rise on Roadway Design and Evacuation Routes in Delaware

As the global temperature continues to increase, the sea level continues to rise at a rapid rate that has never been seen before. This becomes an issue for many facets of life but one of the most impacted is the transportation infrastructure. Many people living in low elevation coastal areas can become trapped by flooding with no way in or out. With Delaware being a coastal state, this would affect a large portion of the population and will have detrimental effects over time if nothing is done to combat sea level rise. The issue with sea level rise in transportation is that once the roads become flooded, they become virtually unusable and detour routes would be needed. If all the roads in a coastal area were to be affected by sea level rise, the options for detours would become limited. This article looks at direct solutions to combat sea level rise and indirect solutions that would specifically help transportation infrastructure and evacuation routes in Delaware. There is not one solution that can fix every problem, so many solutions are laid out to see what is applicable to each affected area. Some solutions include defense structures that would be put close to the coast, raising the elevation of vulnerable roads throughout the state and including pumping stations to drain the water on the surface of the road. With an understanding of all these solutions around the world, the ultimate conclusion came in the form of a six-step plan that Delaware should take in order to best design against sea level rise in these coastal areas.

Buckling Optimization of Curved Grid Stiffeners through the Level Set Based Density Method

Stiffened structures have great potential for improvingmechanical performance,and the study of their stability is of great interest.In this paper,the optimization of the critical buckling load factor for curved grid stiffeners is solved by using the level set based density method,where the shape and cross section(including thickness and width)of the stiffeners can be optimized simultaneously.The grid stiffeners are a combination ofmany single stiffenerswhich are projected by the corresponding level set functions.The thickness and width of each stiffener are designed to be independent variables in the projection applied to each level set function.Besides,the path of each single stiffener is described by the zero iso-contour of the level set function.All the single stiffeners are combined together by using the p-norm method to obtain the stiffener grid.The proposed method is validated by several numerical examples to optimize the critical buckling load factor.

Core level excitation spectra of La and Mn ions in LaMnO3

Manganese-based perovskite is popular for research on ferromagnetic materials,and its spectroscopic studies are essential for understanding its electronic structure,dielectric,electrical,and magnetic properties.In this paper,the M-edge spectra of La ions and the M-edge,L-edge,and K-edge spectra of Mn ions in LaMnO3 are calculated by considering both the free-ion multiplet calculation and the crystal field effects.We analyze spectral shapes,identify peak origins,and estimate the oxidation states of La and Mn ions in LaMnO3 theoretically.It is concluded that La ions in LaMnO3 predominantly exist in the trivalent state,while Mn ions exist primarily in the trivalent state with a minor presence of tetravalent ions.Furthermore,the calculated spectra are in better conformity with the experimental spectra when the proportion of Mn3+is 90%and Mn4+is 10%.This article enhances our comprehension of the oxidation states of La and Mn within the crystal and also provides a valuable guidance for spectroscopic investigations of other manganates.

Emission and capture characteristics of deep hole trap in n-GaN by optical deep level transient spectroscopy

Emission and capture characteristics of a deep hole trap(H1)in n-GaN Schottky barrier diodes(SBDs)have been investigated by optical deep level transient spectroscopy(ODLTS).Activation energy(Eemi)and capture cross-section(σ_(p))of H1 are determined to be 0.75 eV and 4.67×10^(−15)cm^(2),respectively.Distribution of apparent trap concentration in space charge region is demonstrated.Temperature-enhanced emission process is revealed by decrease of emission time constant.Electricfield-boosted trap emission kinetics are analyzed by the Poole−Frenkel emission(PFE)model.In addition,H1 shows point defect capture properties and temperature-enhanced capture kinetics.Taking both hole capture and emission processes into account during laser beam incidence,H1 features a trap concentration of 2.67×10^(15)cm^(−3).The method and obtained results may facilitate understanding of minority carrier trap properties in wide bandgap semiconductor material and can be applied for device reliability assessment.

Levels of evidence and grades of recommendation supporting European society for medical oncology clinical practice guidelines

Background:The European Society for Medical Oncology(ESMO)guidelines are among the most comprehensive and widely used clinical practice guidelines(CPGs)globally.However,the level of scientific evidence supporting ESMO CPG recommendations has not been systematically investigated.This study assessed ESMO CPG levels of evidence(LOE)and grades of recommendations(GOR),as well as their trends over time across various cancer settings.Methods:We manually extracted every recommendation with the Infectious Diseases Society of America(IDSA)classification from each CPG.We examined the distribution of LOE and GOR in all available ESMO CPG guidelines across different topics and cancer types.Results:Among the 1,823 recommendations in the current CPG,30%were classified as LOEⅠ,and 43%were classified as GOR A.Overall,there was a slight decrease in LOEⅠ(−2%)and an increase in the proportion of GOR A(+1%)in the current CPG compared to previous versions.The proportion of GOR A recommendations based on higher levels of evidence such as randomized trials(LOEⅠ–Ⅱ)shows a decrease(71%vs.63%,p=0.009)while recommendations based on lower levels of evidence(LOEⅢ–Ⅴ)show an increase(29%vs.37%,p=0.01)between previous and current version.In the current versions,the highest proportion of LOEⅠ(42%)was found in recommendations related to pharmacotherapy,while the highest proportion of GOR A recommendations was found in the areas of pathology(50%)and diagnostic(50%)recommendations.Significant variability in LOEⅠand GOR A recommendations and their changes over time was observed across different cancer types.Conclusion:One-third of the current ESMO CPG recommendations are supported by the highest level of evidence.More well-designed randomized clinical trials are needed to increase the proportion of LOEⅠand GOR A recommendations,ultimately leading to improved outcomes for cancer patients.

A Hybrid Level Set Optimization Design Method of Functionally Graded Cellular Structures Considering Connectivity

With the continuous advancement in topology optimization and additive manufacturing(AM)technology,the capability to fabricate functionally graded materials and intricate cellular structures with spatially varying microstructures has grown significantly.However,a critical challenge is encountered in the design of these structures–the absence of robust interface connections between adjacent microstructures,potentially resulting in diminished efficiency or macroscopic failure.A Hybrid Level Set Method(HLSM)is proposed,specifically designed to enhance connectivity among non-uniform microstructures,contributing to the design of functionally graded cellular structures.The HLSM introduces a pioneering algorithm for effectively blending heterogeneous microstructure interfaces.Initially,an interpolation algorithm is presented to construct transition microstructures seamlessly connected on both sides.Subsequently,the algorithm enables the morphing of non-uniform unit cells to seamlessly adapt to interconnected adjacent microstructures.The method,seamlessly integrated into a multi-scale topology optimization framework using the level set method,exhibits its efficacy through numerical examples,showcasing its prowess in optimizing 2D and 3D functionally graded materials(FGM)and multi-scale topology optimization.In essence,the pressing issue of interface connections in complex structure design is not only addressed but also a robust methodology is introduced,substantiated by numerical evidence,advancing optimization capabilities in the realm of functionally graded materials and cellular structures.

A hybrid CNN-LSTM model for diagnosing rice nutrient levels at the rice panicle initiation stage

Nitrogen(N)and potassium(K)are two key mineral nutrient elements involved in rice growth.Accurate diagnosis of N and K status is very important for the rational application of fertilizers at a specific rice growth stage.Therefore,we propose a hybrid model for diagnosing rice nutrient levels at the early panicle initiation stage(EPIS),which combines a convolutional neural network(CNN)with an attention mechanism and a long short-term memory network(LSTM).The model was validated on a large set of sequential images collected by an unmanned aerial vehicle(UAV)from rice canopies at different growth stages during a two-year experiment.Compared with VGG16,AlexNet,GoogleNet,DenseNet,and inceptionV3,ResNet101 combined with LSTM obtained the highest average accuracy of 83.81%on the dataset of Huanghuazhan(HHZ,an indica cultivar).When tested on the datasets of HHZ and Xiushui 134(XS134,a japonica rice variety)in 2021,the ResNet101-LSTM model enhanced with the squeeze-and-excitation(SE)block achieved the highest accuracies of 85.38 and 88.38%,respectively.Through the cross-dataset method,the average accuracies on the HHZ and XS134 datasets tested in 2022 were 81.25 and 82.50%,respectively,showing a good generalization.Our proposed model works with the dynamic information of different rice growth stages and can efficiently diagnose different rice nutrient status levels at EPIS,which are helpful for making practical decisions regarding rational fertilization treatments at the panicle initiation stage.

Exploring Variability in Sea Level at a Tide Gauge Station through Control Charts

Monitoring temporal changes in sea level is important in assessing coastal risk.Sea level anomalies at a tide gauge station,if kinematically conceived,include systematic variations such as trend,acceleration,periodic oscillations,and random disturbances.Among them,the non-stationary nature of the random sea level variations of known or unknown origin at coastal regions has been long recognized by the sea level community.This study proposes the analyses of subgroups of random residual statistics of a rigorously formulated kinematic model solution of tide gauge variations using X-bar and S control charts.The approach is demonstrated using Key West,Florida tide gauge records.The mean and standard errors of 5-year-long subgroups of the residuals revealed that sea level changes at this location have been progressively intensifying from 1913 to the present.Increasing oscillations in sea level at this locality may be attributed partly to the thermal expansion of seawater with increasing temperatures causing larger buoyancy-related sea level fluctuations as well as the intensification of atmospheric events including wind patterns and the impact of changes in inverted barometer effects that will alter coastal risk assessments for the future.

Research on the Digital Economy's Impact on China's Economic Growth:Based on the Variations in Urbanization Levels Across China's Eastern,Central,and Western Regions and Sectoral Heterogeneity

This paper uses inter-provincial panel data from 2011 to 2017,a linear regression model,and a threshold model to conduct empirical analyses of the impact of the digital economy on China's overall economic growth and the three main sectors of industry.The paper then investigates the impact and effects the digital economy has had on the economic growth of the three main sectors of industry in China's eastern,central,and western regions.Finally,the paper investigates the most significant differences among the various regions and the threshold effects of urbanization levels on the relationship between the digital economy and economic growth.The findings indicate a significantly positive correlation between the digital economy and regional economic growth.Moreover,geographical factors notably influence this correlation.The digital economy exerts a positive effect on all sectors of industry.It may not substantially impact industrial development in regions with highly developed infrastructure.Regarding the other regions,the digital economy exhibits varying degrees of impact due to the differences in the specific indicators.The conclusion drawn by the threshold model is that the magnitude of the threshold effect correlates with geographic factors.No threshold effect was observed in the eastern region,while the threshold effect occurred in the central region when the urbanization levels for the provinces were below 0.6645.Similarly,the threshold effect was noted in the western region when the urbanization level was below 0.3931.Considering all of this,the study also offers policy recommendations that will help balance the regional development of digital economies,accelerate the digital transformation of traditional industries,enhance digital infrastructure construction,refine the formulation and implementation of data policy,and establish relevant incentive mechanisms.

Comprehensive Risk Assessment of Sea Level Rise and Tropical Cyclones in Dongzhaigang Mangroves,China

Mangroves play a pivotal role in tropical and subtropical coastal ecosystem,yet they are highly vulnerable to the effects of climate change,particularly the accelerated global sea level rise(SLR)and stronger tropical cyclones(TCs).However,there is a lack of research addressing future simultaneous combined impacts of the slow-onset of SLR and rapid-onset of TCs on China's mangroves.In order to develop a comprehensive risk assessment method considering the superimposed effects of these two factors and analyze risk for mangroves in Dongzhaigang,Hainan Island,China,we used observational and climate model data to assess the risks to mangroves under low,intermediate,and very high greenhouse gas(GHG)emission scenarios(such as SSP1-2.6,SSP2-4.5,and SSP5-8.5)in 2030,2050,and 2100,and compiled a risk assessment scheme for mangroves in Dongzhaigang,China.The results showed that the combined risks from SLR and TCs will continue to rise;however,SLRs will increase in intensity,and TCs will decrease.The comprehensive risk of the Dongzhaigang mangroves posed by climate change will remain low under SSP1-2.6 and SSP2-4.5 scenarios by 2030,but it will increase substantially by 2100.While under SSP5-8.5 scenario,the risks to mangroves in Dongzhaigang are projected to increase considerably by 2050,and approximately 68.8%of mangroves will be at very high risk by 2100.The risk to the Dongzhaigang mangroves is not only influenced by the hazards but also closely linked to their exposure and vulnerability.We therefore propose climate resilience developmental responses for mangroves to address the effects of climate change.This study for the combined impact of TCs and SLR on mangroves in Dongzhaigang,China can enrich the method system of mangrove risk assessment and provide references for scientific management.

Cumulative effects of excess high-normal alanine aminotransferase levels in relation to new-onset metabolic dysfunction-associated fatty liver disease in China

BACKGROUND Within the normal range,elevated alanine aminotransferase(ALT)levels are associated with an increased risk of metabolic dysfunction-associated fatty liver disease(MAFLD).AIM To investigate the associations between repeated high-normal ALT measurements and the risk of new-onset MAFLD prospectively.METHODS A cohort of 3553 participants followed for four consecutive health examinations over 4 years was selected.The incidence rate,cumulative times,and equally and unequally weighted cumulative effects of excess high-normal ALT levels(ehALT)were measured.Cox proportional hazards regression was used to analyse the association between the cumulative effects of ehALT and the risk of new-onset MAFLD.RESULTS A total of 83.13%of participants with MAFLD had normal ALT levels.The incidence rate of MAFLD showed a linear increasing trend in the cumulative ehALT group.Compared with those in the low-normal ALT group,the multivariate adjusted hazard ratios of the equally and unequally weighted cumulative effects of ehALT were 1.651[95%confidence interval(CI):1.199-2.273]and 1.535(95%CI:1.119-2.106)in the third quartile and 1.616(95%CI:1.162-2.246)and 1.580(95%CI:1.155-2.162)in the fourth quartile,respectively.CONCLUSION Most participants with MAFLD had normal ALT levels.Long-term high-normal ALT levels were associated with a cumulative increased risk of new-onset MAFLD.

Transforming growth factor-β1 and vascular endothelial growth factor levels in senile acute myeloid leukemia and correlation with prognosis

BACKGROUND Acute myeloid leukemia(AML)is a disease in which immature hematopoietic cells accumulate in the bone marrow and continuously expand,inhibiting hematopoiesis.The treatment and prognosis of this disease have always been unsatisfactory.AIM To investigate the correlation between vascular endothelial growth factor(VEGF)and transforming growth factor-β1(TGFβ1)expression and prognosis in older adults with AML.METHODS This study enrolled 80 patients with AML(AML group),including 36 with complete response(AML-CR),23 with partial response(AML-PR),and 21 with no response(AML-NR).The expression levels of VEGF and TGFβ1 were detected by reverse transcription polymerase chain reaction in bone marrow mononuclear cells isolated from 56 healthy controls.Kaplan-Meier analysis was performed to assess overall survival(OS)and progression-or disease-free survival(DFS).Prognostic risk factors were analyzed using a Cox proportional hazards model.RESULTS The AML group showed a VEGF level of 2.68±0.16.VEGF expression was lower in patients with AML-CR than those with AML-PR or AML-NR(P<0.05).TGFβ1 expression in the AML group was 0.33±0.05.Patients with AML-CR showed a higher TGFβ1 expression than those with AML-PR or AML-NR(P<0.05).VEGF and TGFβ1 expression in patients with AML was significantly correlated with the counts of leukocytes,platelets,hemoglobin,and peripheral blood immature cells(P<0.05);Kaplan-Meier survival analysis revealed that patients with high TGFβ1 expression had better OS and DFS than those with low TGFβ1 expression(P<0.05),whereas patients with low VEGF levels showed better OS and DFS than those with high VEGF levels(P<0.05).VEGF,TGFβ1,and platelet count were identified by the Cox proportional hazards model as independent risk factors for OS(P<0.05),while VEGF,TGFβ1,and white blood cell count were independent risk factors for DFS(P<0.05).CONCLUSION Decreased VEGF expression and increased TGFβ1 expression in patients with AML provide valuable references for determining and individualizing clinical treatment strategies.

Lightning in a Forest (Wild) Fire: Mechanism at the Molecular Level

The mechanism of lightning that ignites a forest fire and the lightning that occurs above a forest fire are explained at the molecular level. It is based on two phenomena, namely, internal charge separation inside the atmospheric cloud particles and the existence of a layer of positively charged hydrogen atoms sticking out of the surface of the liquid layer of water on the surface of rimers. Strong turbulence-driven collisions of the ice particles and water droplets with the rimers give rise to breakups of the ice particles and water droplets into positively and negatively charged fragments leading to charge separation. Hot weather in a forest contributes to the updraft of hot and humid air, which follows the same physical/chemical processes of normal lightning proposed and explained recently[1]. Lightning would have a high probability of lighting up and burning the dry biological materials in the ground of the forest, leading to a forest (wild) fire. The burning of trees and other plants would release a lot of heat and moisture together with a lot of smoke particles (aerosols) becoming a strong updraft. The condition for creating lightning is again satisfied which would result in further lightning high above the forest wild fire.

Nested Levels of Hybrid Cryptographical Technique for Secure Information Exchange

Data security is a very important part of data transmission over insecure channels connected through high-speed networks. Due to COVID-19, the use of data transmission over insecure channels has increased in an exponential manner. Hybrid cryptography provides a better solution than a single type of cryptographical technique. In this paper, nested levels of hybrid cryptographical techniques are investigated with the help of Deoxyribonucleic Acid (DNA) and Paillier cryptographical techniques. In the first level, information will be encrypted by DNA and at the second level, the ciphertext of DNA will be encrypted by Paillier cryptography. At the decryption time, firstly Paillier cryptography will be processed, and then DAN cryptography will be processed to get the original text. The proposed algorithm follows the concept of Last Encryption First Decryption (LEFD) at the time of decryption. The computed results are depicted in terms of tables and graphs.