Nevin Manimala

Chaos. 2024 Nov 1;34(11):113118. doi: 10.1063/5.0231126.

ABSTRACT

A deep understanding of non-smooth dynamics of vehicle systems, particularly with dry friction damping offer valuable insights into the design and optimization of railway vehicle systems, ultimately enhancing the safety and reliability of railway operations. In this paper, the two-parameter dynamics of a non-smooth railway wheelset system incorporating dry friction damping are investigated. The effect of the crucial parameters on the complexity of the evolution process is comprehensively exposed by identifying different dynamic responses in the two-parameter plane. In addition, the multistability and the various routes transition to chaos for the system are also discussed. It is found that dry friction induces highly complex dynamics in the system, encompassing a range of behaviors such as periodic, quasi-periodic, and chaotic motions. These intricate dynamics are a direct result of the interplay between multiple parameters, such as speed and damping coefficients, which are critical in determining the system’s stability and performance. The presence of multistability further complicates the system, resulting in unpredictable transitions between different motion states.

PMID:39504102 | DOI:10.1063/5.0231126

Chaos. 2024 Nov 1;34(11):113114. doi: 10.1063/5.0234573.

ABSTRACT

In this paper, we investigate the new generalized stochastic fractional potential-Korteweg-de Vries equation, which describes nonlinear optical solitons and photon propagation in circuits and multicomponent plasmas. Inspired by Kolmogorov-Arnold network and our earlier work, we enhance the improved bilinear neural network method by using a large number of activation functions instead of neurons. This method incorporates the concept of simulating more complicated activation functions with fewer parameters, with more diverse activation functions to generate more complex and rare analytical solutions. On this basis, constraints are introduced into the method, reducing a significant amount of computational workload. We also construct neural network architectures, such as “2-3-1,” “2-2-3-1,” “2-3-3-1,” and “2-3-2-1” using this method. Maple software is employed to obtain many exact analytical solutions by selecting appropriate parameters, such as the superposition of double-period lump solutions, lump-rogue wave solutions, and three interaction solutions. The results show that these solutions exhibit more complex waveforms than those obtained by conventional methods, which is of great significance for the electrical systems and multicomponent fluids to which the equation is applied. This novel method shows significant advantages when applied to fractional-order equations and is expected to be increasingly widely used in the study of nonlinear partial differential equations.

PMID:39504099 | DOI:10.1063/5.0234573

Epidemiol Serv Saude. 2024 Nov 1;33(spe2):e20231298. doi: 10.1590/S2237-96222024v33e20231298.especial2.en. eCollection 2024.

ABSTRACT

OBJECTIVE: To estimate vaccination coverage and analyze sociodemographic factors associated with non-vaccination in children born in 2017 and 2018 in the state capitals of Northeast Brazil.

METHODS: A household survey using cluster sampling was conducted from 2020-2022 to estimate vaccination coverage and hesitancy. Factors associated with non-vaccination were analyzed using logistic regression to calculate Odds Ratios (OR) and their Confidence Intervals (95%CI).

RESULTS: Natal was the capital with the lowest vaccination coverage, below 75.0% for most immunizers. Teresina had rates equal to or greater than 90.0% for all vaccines. Among those interviewed, 99.1% (95%CI 98.9;99.3) believe that vaccines are important for health; 95.4% (95%CI 95.0;95.8) trust immunobiologicals and 79.6% (95%CI% 78.8;80.3) are not afraid of reactions. Belonging to the highest socioeconomic stratum (adjusted OR: 1.34 – 95%CI 1.20;1.50) was as a factor associated with non-vaccination.

CONCLUSION: Low coverage highlights the need for a better understanding of regional specificities and social inequalities.

PMID:39504081 | DOI:10.1590/S2237-96222024v33e20231298.especial2.en

Epidemiol Serv Saude. 2024 Nov 1;33(spe2):e20231295. doi: 10.1590/S2237-96222024v33e20231295.especial2.en. eCollection 2024.

ABSTRACT

OBJECTIVE: To estimate vaccination coverage, identify barriers and hesitancy to vaccinating children up to 24 months, born between 2017-2018, living in the urban area of Rio Branco, Acre, Brazil.

METHODS: Population survey carried out from 2020 to 2021, which assessed sociodemographic characteristics and vaccination status among children.

RESULTS: Among 451 included children, vaccination coverage was below 80%. Meningococcal C vaccine had the lowest coverage for administered doses (76.3%; 95%CI 70.5;81.3) and doses on time (27.4%; 95%CI 23.1;32.1). The statements “vaccines cause serious adverse reactions” (26.4%; 95%CI 18.1;36.8) and “you don’t need vaccination for diseases that no longer exist” (22%; 95%CI 15.7;29.8) were the most frequent regarding vaccination hesitancy. Lack of vaccines was the main barrier to care (86.6%; 95%CI 71.8;94.3).

CONCLUSION: Vaccination coverage in children born in 2017-2018 was below the target recommended for the full schedule of administered doses, both valid and timely administered.

PMID:39504080 | DOI:10.1590/S2237-96222024v33e20231295.especial2.en

Epidemiol Serv Saude. 2024 Nov 1;33(spe2):e20231203. doi: 10.1590/S2237-96222024v33e20231203.especial2.en. eCollection 2024.

ABSTRACT

OBJECTIVE: To characterize the use of private services in infant vaccination and assess vaccination coverage according to the service used.

METHODS: : This was a national vaccination survey conducted in 2020 that estimated the use of private vaccination services and vaccination coverage among infants residing in state capitals and 12 inland municipalities.

RESULTS: : Of the 37,801 participants, 25.1% (95%CI 23.2;27.2) used private services at least once, with higher proportions in capitals, larger cities and in the South and Southeast regions. Socioeconomic and demographic differences were identified among families, based on the service used. The coverage for the set of vaccines administered up to 24 months was 60.3% (95%CI 58.6;62.0) in the public service and 59.5% (95%CI 55.9;63.0) in private services, and up-to-date vaccines, 10.3% (95%CI 9.1;11.6) and 9.4% (95%CI 7.4;11.8), respectively.

CONCLUSION: The use of private services was frequent, with low coverage for the set of vaccines, regardless of the type of service used, especially for up-to-date vaccines.

PMID:39504079 | DOI:10.1590/S2237-96222024v33e20231203.especial2.en

Epidemiol Serv Saude. 2024 Nov 1;33(spe2):e20231101. doi: 10.1590/S2237-96222024v33e20231101.especial2.en. eCollection 2024.

ABSTRACT

OBJECTIVE: To estimate vaccination coverage in children born between 2017-2018, living in urban areas of state capitals, the Federal District and 12 inland municipalities in Brazil, and to identify associated factors.

METHODS: This was a household survey conducted between 2020-2022, among children up to 24 months old. Vaccination coverage was estimated according to family, maternal and child characteristics.

RESULTS: Among the 37,801 children in the sample, complete coverage (doses administered) was 60.1% (95%CI 58.6;61.6) and 6.1% (95%CI 5.4;7.0) had not received any vaccines. Coverage was lower among children of mothers with lower level of education (OR = 0.70; 95%CI 0.54;0.90) and in those who experienced delays in receiving any vaccine by 6 months old (OR = 0.28; 95%CI 0.24;0.32).

CONCLUSION: Vaccination coverage is below the expected levels. Effective communication strategies are needed to reinforce the importance of routine vaccination, prevent delays and abandonment of the vaccination schedule, in order to recover the high coverage levels achieved in past decades.

PMID:39504078 | DOI:10.1590/S2237-96222024v33e20231101.especial2.en

Epidemiol Serv Saude. 2024 Nov 4;33(spe1):e2024371. doi: 10.1590/S2237-96222024v33e2024371.especial.en. eCollection 2024.

ABSTRACT

OBJECTIVE: To describe the distribution of nutritional status and food insecurity among the adult transgender population in the Baixada Santista region of the state of São Paulo and to identify associated factors.

METHODS: This was a cross-sectional study using data from the research project entitled Mapping the Transgender Population in Baixada Santista of the state of São Paulo, conducted through a structured questionnaire administered between August and December 2023. The outcomes were nutritional status and food and nutrition insecurity (FNI). The association analysis was performed using Fisher’s exact test.

RESULTS: A total of 237 people took part in the study. High prevalence of FNI was associated with an income of less than 2 minimum wages (p < 0.001), difficulty finding a job (p < 0.001) and lack of family support related to gender (p = 0.001). Difficulty reading/writing (p = 0.025) and proximity to an open-air market (p = 0.033) were negatively or positively associated with adequate nutritional status, respectively.

CONCLUSION: The high prevalence of FNI among the most vulnerable population and the adequate nutritional status associated with proximity to open-air markets indicate the need for policies aimed at reducing inequities and expand access to adequate food.

PMID:39504076 | DOI:10.1590/S2237-96222024v33e2024371.especial.en

Cad Saude Publica. 2024 Nov 4;40(10):e00088123. doi: 10.1590/0102-311XPT088123. eCollection 2024.

ABSTRACT

Hospitalization costs due to cardiovascular diseases are high. In 2019, for Bahia State, Brazil, alone, they exceeded BRL 153 million for the Brazilian Unified National Health System, surpassing the costs of cancer hospitalizations. This fact will show an upward trend with the increase in life expectancy in Brazil (7.3 years more by 2060). Introducing new technologies can mitigate the problem. This study analyzes the impact of telediagnostics in electrocardiogram on hospitalizations for cardiovascular diseases in 326 municipalities in Bahia from 2014 to 2020. Diff-in-diff estimator method was used for analysis of the periods before and after the implementation of telediagnostics in Bahia. Results show that the municipalities which introduced the new technology reduced cardiovascular diseases hospitalizations by 6 for each additional year. In the case of families benefiting from the Brazilian Income Transfer Program, the reduction was 3.26 hospitalizations, and 3.08 among municipalities with the specialized service. Hospitalization increase by 7.66 in the 30 to 59 age group and by 5.34 among men for each additional year. Results show a reduction of 1.15 hospitalizations for rheumatologic heart diseases and 1.39 among diabetic people. In terms of ethnicity/color, underreporting was identified in the conditions studied, resulting in more severe prognoses for blacks. Telediagnostics was effective in reducing this inequality by expanding access and reducing hospitalizations, playing a crucial role in public health and impacting mortality reduction. The theme, therefore, deserves further studies with different samples and sample periods.

PMID:39504059 | DOI:10.1590/0102-311XPT088123

JAMA Netw Open. 2024 Nov 4;7(11):e2443044. doi: 10.1001/jamanetworkopen.2024.43044.

ABSTRACT

IMPORTANCE: A single round of standard tobacco quitline treatment may not be sufficient to sustain abstinence, particularly among people experiencing socioeconomic disadvantage. Adaptive retreatment may help more individuals with socioeconomic disadvantage achieve abstinence and reduce disparities in smoking cessation outcomes.

OBJECTIVE: To evaluate 4 evidence-based strategies for adults with limited education, no insurance, or Medicaid eligibility who continued smoking after quitline treatment.

DESIGN, SETTING, AND PARTICIPANTS: A factorial randomized clinical trial with 4 factors adapting quitline strategies was conducted for participants enrolled from June 7, 2018, to January 25, 2023, with 6-month follow-up. Adults using the Wisconsin Tobacco Quit Line who were smoking cigarettes 3 to 6 months after prior quitline treatment who were uninsured, Medicaid insured, or had no more than a high school education were included.

INTERVENTIONS: Quitline retreatment strategies were (1) increased counseling intensity (4 calls vs 1 call), (2) increased nicotine replacement therapy intensity (4 weeks of combination nicotine patch plus nicotine lozenge vs 2 weeks of nicotine patch), (3) text-message support (National Cancer Institute SmokefreeTXT program vs none), and (4) financial incentives for engagement in counseling and SmokefreeTXT ($30/call and/or 6-week SmokefreeTXT retention vs no incentives).

MAIN OUTCOMES AND MEASURES: Primary outcome was 7-day point-prevalence biochemically confirmed abstinence 26 weeks after the target quit day. Intention-to-treat analysis was performed.

RESULTS: Of 6019 people assessed for eligibility, 1316 (21.9%) participants were randomized (mean [SD] age, 53.1 [11.9] years; 760 [57.8%] women), and 919 (69.8%) provided final follow-up. Intention-to-treat analyses showed 162 participants (12.3%) had biochemically confirmed abstinence at 26 weeks (368 [28.0% self-reported abstinence]). There were no significant main effects for the primary outcome: 1 call (11.6% [77 of 662]) vs 4 calls (13.0% [85 of 654]) (odds ratio [OR], 1.04; 95% CI, 0.88-1.24), 2-week patch (11.2% [73 of 654]) vs 4-week combination nicotine replacement therapy (13.4% [89 of 662]) (OR, 1.12; 95% CI, 0.94-1.34), no SmokefreeTXT (13.4% [88 of 657]) vs SmokefreeTXT (11.2% [74 of 659]) (OR, 0.88; 95% CI, 0.74-1.05), and no financial incentives (12.8% [85 of 662]) vs financial incentives (11.8% [77 of 654]) (OR, 0.94; 95% CI, 0.78-1.11).

CONCLUSIONS AND RELEVANCE: In this randomized clinical trial evaluating enhancements to tobacco quitlines for adults with socioeconomic disadvantage who were smoking after quitline treatment, none of the adaptive treatment strategies robustly improved long-term abstinence. Strategies are needed to enhance quitline retreatment effectiveness for adults with socioeconomic disadvantage.

TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT03538938.

PMID:39504025 | DOI:10.1001/jamanetworkopen.2024.43044

JAMA Netw Open. 2024 Nov 4;7(11):e2443097. doi: 10.1001/jamanetworkopen.2024.43097.

ABSTRACT

IMPORTANCE: Oral anticoagulation for adults with atrial fibrillation or atrial flutter (AFF) who are at elevated stroke risk reduces the incidence of ischemic stroke but remains underused. Efforts to increase anticoagulation initiation on emergency department (ED) discharge have yielded conflicting results.

OBJECTIVE: To evaluate the effectiveness of a multipronged intervention supporting anticoagulation initiation for eligible adult ED patients.

DESIGN, SETTING, AND PARTICIPANTS: The Clinical Decision Support to Optimize Care of Patients With Atrial Fibrillation or Flutter in the Emergency Department (O’CAFÉ) pragmatic, stepped-wedge cluster randomized clinical trial was conducted from July 1, 2021, through April 30, 2023, at 13 community medical centers (in 9 clusters) of an integrated health system in Northern California. The study included adult ED patients with primary AFF eligible for anticoagulation initiation when discharged home. Clusters were randomly assigned to staggered dates for 1-way crossover from the control phase (usual care) to the intervention phase.

INTERVENTION: Physician education, facility-specific audit and feedback, and access to decision support, which identified eligible patients and recommended shared decision-making, anticoagulation initiation (if suitable), and timely follow-up.

MAIN OUTCOMES AND MEASURES: The main outcome was a composite of anticoagulation on discharge or within 30 days. A primary intention-to-treat analysis (decision support access regardless of use) and a secondary per-protocol analysis (decision support use) were performed. Multivariable analyses adjusted for intervention and exposure months with random effects, accounting for clustering by facility and patient.

RESULTS: A total of 3388 eligible patients with atrial fibrillation were discharged home: 2185 (64.5%) were receiving pre-ED arrival anticoagulation and 1203 (35.5%) were eligible for anticoagulation. Among the 1203 patients with an initiation-eligible encounter, the median age was 74.0 (IQR, 68.0-82.0) years and approximately half (618 [51.4%]) were men. Among the 387 patients with an initiation-eligible control encounter, 244 (63.0%) received anticoagulation (190 [49.0%] at discharge and 54 [14.0%] within 30 days). Among the 816 patients with an initiation-eligible intervention encounter, 558 (68.4%) received anticoagulation (428 [52.5%] on discharge and 130 [15.9%] within 30 days). There was no statistically significant change in initiation of anticoagulation associated with the intervention (adjusted odds ratio, 1.33 [95% CI, 0.75-2.35]; P = .13). Decision support was used for 217 eligible case patients (26.6%) (per protocol) and was associated with a statistically significant change in anticoagulation initiation when compared with 599 patients for whom decision support was not used (164 [75.6%] vs 394 [65.8%]; P = .008).

CONCLUSIONS AND RELEVANCE: In this trial, a multipronged intervention to facilitate thromboprophylaxis among eligible ED patients with AFF did not significantly increase anticoagulation initiation. Opportunities exist to further improve stroke prevention among ED patients with primary AFF.

TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT05009225.

PMID:39504024 | DOI:10.1001/jamanetworkopen.2024.43097