Endocervical brush cytology confirmed HSIL+ in the endocervical canal in 83% and ECC in 35% of cases (p < 0.0001). Conclusion: The DPT on three slides enables better detection of HSIL compared to PB/ECC, particularly for lesions localized in the endocervical canal sampled with a cytobrush. A high quality DPT could represent a surrogate for PB/ECC and open the possibility of direct access to therapeutic procedure.Objective: The aim of the study was to evaluate the accuracy of the diagnostic Pap test (DPT) on three slides and punch biopsy and endocervical curettage (PB/ECC) compared with the final biopsy material in the detection of high-grade squamous intraepithelial lesion (HSIL). Materials and methods: Patients treated with conization after previous DPT and PB/ECC were analyzed. The findings of the DPT and PB/ECC as well as of the endocervical brush cytology and ECC were compared with the final conus histology. Results: 150 patients were analyzed, and final histology verified 145 cases of HSIL and 3 cancers. The percentage of confirmed HSIL cytology was 97%, while for PB/ECC it was 79% with 30/145 false negative results. The correlation between Pap test and PB/ECC showed that the diagnostic accuracy of DPT is significantly higher ( Many countries are now moving toward high-risk human papilloma virus (HPV) screening as the primary test in cervical screening ,2. ThereThe expanded use of HPV testing has given a new significance to cytology, which has become more accurate and specialized. It is well known that simultaneous cytological evaluation and HPV analysis significantly increases the efficiency of cervical cancer screening and reduces the overall incidence of invasive cancer . In factAccording to Croatian national guidelines for the management of cervical intraepithelial lesions, colposcopy is recommended in patients with an abnormal Pap test detected in screening programs . AfterwaIn order to assess the role of Pap tests in the management of cervical lesions, especially in the era of primary HPV screening, the aim of this study was to compare the results of DPT and targeted PB/ECC with the final histological diagnosis of squamous high-grade cervical lesions. In addition, the results of the endocervical brush cytology and endocervical curettage were correlated separately with the final histological finding. These results may contribute to determine better the position of cytology as a valuable diagnostic tool in the diagnostic management of cervical dysplasia.The study population was patients referred for colposcopy at the Clinic of Gynaecology and Obstetrics of the Clinical Hospital Centre Rijeka between January 2019 and December 2020 because of an abnormal Pap smear. Inclusion criteria for the study were repeated DPT taken at the time of colposcopy, PB/ECC at the time of colposcopy or in the next visit and subsequent cone biopsy treatment. Patients received large loop excision of the transformation zone (LLETZ) or cold knife cone biopsy treatment for final HSIL+.® PLUS Cytology, Roche Diagnostics, Basel, Switzerland) was performed, and the cases were included in the positive group. The location of the dysplastic cells in the specimen was determined semi-quantitatively (ranging from zero to three) to be in posterior fornix, ectocervical or endocervical.Conventional DPT was taken at the time of colposcopy before histologic examination. The smear was placed on three separate slides representing the samples from the vagina, ectocervix and endocervix. Ayre ectocervical spatula and endocervical brush were used. The convex end of the Ayre spatula was used for the posterior vaginal fornix sampling with semicircular movement. The concave end was used for the ectocervix, and external orifice of the endocervical canal and sampling was done with complete circumference scraping. Endocervical brush cytology was performed by inserting a standard cytobrush to its full depth into the cervical canal. It was then rotated 90° to 180°. The material was transferred covering the whole glass slide. The slides were fixed in 95% ethanol and stained by routine Pap staining method. The resulting slides were reviewed and signed out by a cytopathologyst according to The Bethesda System for Reporting Cervical Cytology. HSIL cytological findings were classified positive, while no dysplastic changes or LSIL  were considered as negative for HSIL. In the group of ASC-H  additional testing with p16/Ki-67 dual-staining ; abnormal, grade 2 (G2); and suspect for invasive cancer. Single or multiple colposcopically directed PB were taken from the worst areas of abnormality together with ECC. ECC was performed by placing the Kevorkian metal curette inside the endocervical canal. Gentle pressure was applied at its tip and the curette moved along the length of the endocervix while being rotated in circular way to sample the entire circumference of the canal. Specimens from the endocervical curettage were reviewed microscopically and the amount of endocervical material was described as scant, moderate or abundant.Loop excision was performed following four-quadrant infiltration of local anaesthetic into the cervix. Specimens obtained by PB, ECC, LLETZ or cold knife cone procedure were immediately fixed in formalin and sent for histological examination. Histological examinations were performed by gynaecological pathologists following a standard protocol. Histological findings on cone specimens were used as the gold standard to measure the performance of the Pap test and colposcopically directed PB and ECC. In the case of HSIL+ diagnosis on PB and ECC with consecutive negative cone specimen, histology diagnosis made on PB and ECC was considered final. When multiple biopsies were taken, the highest-grade lesion was used for analysis. Similarly, if cone and LLETZ specimens showed different foci of varying grades of CIN, the worst grade was used as a final diagnosis. The location of the dysplastic process in the conization specimen was determined to be ectocervical or, if present within the endocervical canal, endocervical. Two patients reported as glandular atypia or with coexistence of both squamous and glandular pathology were excluded from the study since only squamous cell lesions were investigated.2) test was applied to compare proportions; p values < 0.05 were considered statistically significant. Analysis was done with the statistical software MedCalc .Categorical data was expressed as number and percentage. Chi-square . Furthermore, biopsies taken at the time of colposcopy often yielded false-negative reports. In fact, the false-negative results were significantly higher among PB/ECC when compared to DPT, thus suggesting a better agreement between cytology and final histology in cone biopsy.When the diagnostic accuracy of DPT and PB/ECC was compared, a statistically significant difference was noted. DPT had a significantly higher prediction rate of HSIL lesions when compared to PB/ECC  of the 88 patients had high-grade dysplasia in the endocervical sample confirmed on conization . HoweverDisagreement between ECC and final histology was also evident. In fact, 65% of the ECC findings resulted in false negatives when compared to results of cone biopsy . We werep < 0.0001). Therefore, the agreement between ECC and conization was only 35% since ECC detected only 29 HSIL cases out of 84 positive on conization (p < 0.0001).Although both DPT and ECC had a considerable level of false negative reports when compared, a significantly higher proportion of false negative results was noted in ECC (nization . EndocerIn the era of primary HPV screening, cytology has achieved a new role and changed its position from a primary screening tool of a large population to a secondary specialized triage and diagnostic test inevitable in the algorithm of cervical intraepithelial lesions management ,16. In fThe most frequent cause of misdiagnosis in cervical cancer screening is inadequate cervical sampling. The correct sampling of the cervix contributes significantly to the diagnostic value of the Pap test . As prevThere is a common perception that, because histology is the “gold standard” of diagnosis, non-correlating cytological results are always wrong. However, cytology offers certain advantages over histology in the assessment of cervical dysplasia. Applying the above-mentioned Pap test technique offers a diagnostically better quality sample by providing a greater amount of material and allowing the cytologist to correctly localize the lesion. In addition, previous authors claim that the morphology of intact cells in a cytological preparation is better to interpret subtle abnormalities in comparison to that of sectioned cells in histology that may not be visible in histologic preparations . FinallyWhen the results of the endocervical brush and ECC were evaluated, both DPT and ECC had a considerable level of false negative results, with 17% for endocervical brush and 65% for ECC. Previous studies have reported that ECC missed 45% of lesions in the endocervical canal identified on subsequent conization . AccordiThe lack of concordance between cytology, colposcopically directed PB and subsequent histopathological conization finding is common and remains an important clinical problem. False-negative biopsy or biopsy results that underestimate the grade of CIN may have serious implications if a subsequent conization is not performed . Accordi


The recovery of marine life from the end-Permian mass extinction event provides a test-case for biodiversification models in general, but few studies have addressed this episode in its full length and ecological context. This study analyses the recovery of marine level-bottom communities from the end-Permian mass extinction event over a period of 15 Ma, with a main focus on the previously neglected main phase during the Middle Triassic. Our analyses are based on faunas from 37 lithological units representing different environmental settings, ranging from lagoons to inner, mid- and outer ramps. Our dataset comprises 1562 species, which belong to 13 higher taxa and 12 ecological guilds. The diversification pattern of most taxa and guilds shows an initial Early Triassic lag phase that is followed by a hyperbolic diversity increase during the Bithynian (early middle Anisian) and became damped later in the Middle Triassic. The hyperbolic diversity increase is not predicted by models that suggest environmental causes for the initial lag phase. We therefore advocate a model in which diversification is primarily driven by the intensity of biotic interactions. Accordingly, the Early Triassic lag phase represents the time when the reduced species richness in the wake of the end-Permian mass extinction was insufficient for stimulating major diversifications, whereas the Anisian main diversification event started when self-accelerating processes became effective and stopped when niche-crowding prevented further diversification. Biotic interactions that might drive this pattern include interspecific competition but also habitat construction, ecosystem engineering and new options for trophic relationships. The latter factors are discussed in the context of the resurgence of large carbonate platforms, which occurred simultaneously with the diversification of benthic communities. These did not only provide new hardground habitats for a variety of epifaunal taxa, but also new options for grazing gastropods that supposedly fed from microalgae growing on dasycladaceans and other macroalgae. Whereas we do not claim that changing environmental conditions were generally unimportant for the recovery of marine level-bottom communities, we note that their actual role can only be assessed when tested against predictions of the biotic model. The end-Permian mass extinction was the most severe extinction event in Earth’s history and witnessed the extinction of 81%  to 96%  of marinThis study is based on data of macroinvertebrate occurrences compiled at the species level from palaeontological studies on Early and Middle Triassic lithological units . We prefWe did not include any species for which we haven’t studied the original description and figures. Taxa reported from thin sections or polished slabs were not considered because taxonomic assignments of these taxa were in most cases difficult to verify. The complete dataset includes 37 lithological units comprising 1562 species belonging to gastropods (695 species), bivalves (587 species), brachiopods (147 species), crinoids (33 species), echinoids (31 species), crustaceans (25 species), ophiuroids (12 species), scaphopods (nine species), serpulids (eight species), microconchids (six species), asteroids (four species), bryozoans (four species) and polyplacophores  diversified most quickly in the Middle Triassic. Shallow to moderately deep and deep infaunal, endobyssate, epibyssate, free-lying, cemented and pedunculate suspension-feeders as well as shallow infaunal deposit-feeders started diversifying at the same time  but theiBivalves, gastropods and brachiopods were the most diverse taxa in Early and Middle Triassic benthic communities . BivalveThe guild-species diversity of epifaunal herbivores and/or detritus-feeders  changed strongest among all ecological guilds during the studied time interval. During the Early Triassic they were the third most diverse guild but they started to diversify quickly during the Bithynian and became almost instantaneously the dominating guild in Middle Triassic benthic communities . The onlEpibyssate suspension-feeders  were the most diverse guild in the Induan and the Spathian (late Olenekian). During the Bithynian their absolute richness increased whereas their relative richness decreased ,  5C, 5DShallow to moderately deep infaunal suspension-feeders  were among the most diverse guilds during the Early Triassic but their relative richness decreased gradually after the Aegean  and 3. TAt the beginning of the Spathian, the relative richness of endobyssate suspension-feeders  started to increase, but after the Aegean, it decreased continuously . The samThe relative amount of pedunculate suspension-feeders (articulate brachiopods) fluctuated. They were relatively diverse during the Griesbachian (early Induan) and after the Bithynian but in between they were rather uncommon. After the early Illyrian they became gradually less diverse . In EarlOther guilds were rather uncommon during the Early and Middle Triassic or not represented in all time slices  and 3. DA remarkable aspect of the guild analysis is that the explosive Anisian diversity increase was not associated with the evolution of new benthic guilds, confirming previous observations by Our data indicate an explosive increase in benthic diversity at the beginning of the Middle Triassic that followed an extended Early Triassic lag phase . Can thiA preservation bias in Early Triassic strata has often been proposed as a possible reason for the generally low species richness at that time e.g., , but welTubiphytes-Limestone Member (Romania) and the Jena Formation (Germany), which corresponds to the strongest increase in diversity within the studied time interval. The described fauna from the Tubiphytes-Limestone Member comes from only 1.5 m3 of rock material , the history of research and the size of exposure influence our knowledge on species richness. In our data, the most extreme potential bias in this respect is between the stratigraphically adjacent data points from the Bithynian material , and rarmaterial . In contThe observation of an Early Triassic lag phase in the recovery from the end-Permian mass extinction is not new. Another class of explanations assumes that a breakdown of primary production in the Early Triassic caused a collapse of the food pyramid. According to these models, the low diversity in the Early Triassic corresponds to a time of reduced primary production e.g.,  and the In contrast to the idea of environmentally driven delay (EDD) models, the biotic interaction (BI) model does not only provide an explanation for the delayed recovery but it also makes a prediction for the diversification pattern that followed the initial lag phase. Mathematically, the BI model can be written as a differential equation that can be solved numerically. It contains a hyperbolic term that accounts for the positive feedback of species interactions on rates of diversification, which is usually combined with a damping term that limits the increase when the effects of niche pre-emption and ecological crowding become dominant ; 1984, tThe majority of the semilogarithmic plots presented in this study  and 7 isA conclusion from these observations is that they suggest a strong effect of biotic interactions on rates of diversification. This is the prime difference to the standard logistic model, which makes a neutral assumption with respect to biotic interactions. In the logistic model, the initially exponential increase is solely an effect of an increasing number of species that each have constant diversification rates. This assumption is clearly incompatible with the explosive diversification revealed in our dataset . NotablyImplicit in these finds is that we cannot expect an early rediversification if the feedback mechanism between richness and rates of diversification was ineffective after an extreme diversity crash, whether or not the environment was favourable. Does this conclusion refute the EDD model? It partly does, because it means that at least a portion of the lag phase is always attributed to BI. It is therefore incorrect to ascribe the full length of the lag phase to EDD. However, it is currently also uncertain whether the full length of the Early Triassic lag phase can be explained solely by the BI model. The length of the lag phase in this model depends upon two parameters, the starting diversity and the proportionality factor, which are not precisely known. It is therefore possible that adverse environmental conditions delayed or interrupted the early recovery whereas the BI model explains a subsequent extension of the lag phase. Clarifying the exact parameters in the BI model equation for different taxa is required for estimating the length of the intrinsic delay and thus the potential for EDD as an additional explanation for the Early Triassic lag phase.From an evolutionary viewpoint, the most relevant aspect is the nature of biotic interactions that cause positive feedbacks between species richness and rates of diversification. Tubiphytes-Limestone Member of the Caerace Formation in Romania. This Bithynian biostrome is dominated by the micro-encruster Tubiphytes and large volumes of synsedimentary cements , dasycladacean algae, corals, and in some cases also bivalves became important reef-builders , but it is strengthened by an indirect line of evidence. Middle Triassic gastropod diversity decreased towards deeper water settings  diversity increase at the beginning of the Middle Triassic cannot be explained by relaxation of environmental stress. Our data therefore support a model in which the intensity of biotic interactions determines the rate of diversification. Accordingly, the Early Triassic delay in rediversification represents the time in which the intensity of biotic interactions was too low for driving a major diversification because of the dramatic loss of species during the end-Permian mass extinction. Conversely, the hyperbolic Middle Triassic diversity increase occurred when self-accelerating processes became effective, and it stopped when niche-crowding prevented further diversification. This pattern is in agreement with a competition-driven diversification model that predicts a reversal in the effects of interspecific competition on diversification rates from accelerating to damping. Apart from interspecific competition, other ecological feedbacks might have stimulated the hyperbolic increase in diversity during the Anisian. Carbonate platforms, which reappeared simultaneously with the main stage of benthic rediversification, provided the ecological context for rich hardground communities. The coincidence of the resurgence of carbonate platforms and the evolution of reef-builders with the main diversification of benthic faunas suggests a positive loop effect, which is confirmed by several case studies. When reefs diversified, other reef-builders became abundant and acted as ecological engineers and niche constructers, providing new habitats for additional species. The quick diversification of gastropods in Middle Triassic carbonate platforms might be related to the proliferation of macroalgae, which provided much improved opportunities for grazing. A strength of the biotic interaction model is that it correctly predicts both an extended lag phase and a hyperbolic increase in diversity thereafter, whereas environmental scenarios fail to predict the second aspect.10.7717/peerj.11654/supp-1Supplemental Information 1(A) List of lithological units used for this study including information about their country, age and faunal content. (B) species list including information about their occurrences, ecological guild, taxon and references. (C) Reference list.Click here for additional data file.


The coronavirus disease (COVID-19) outbreak has resulted in the death of over four million people since late 2019. To reduce the human and economic costs of COVID-19, different vaccines have been developed and distributed across countries. There has been significant cross-country variation in the vaccination of people against COVID-19. In this study, we focus on public corruption to explain the significant cause of cross-country variation in immunization progress. We suggest that countries with a higher degree of public corruption have been less successful in the vaccination of their population, controlling for other important determinants of immunization progress. The only long-term response to the crisis is the immunization against the severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2).The end of 2019 saw the emergence of a novel and particularly infectious disease which had a sudden and profound global impact. The new coronavirus spread rapidly and soon took over the planet. There have been more than 213 million confirmed cases and close to 4.5 million deaths as of August 2021. To limit the spread of the virus, COVID-19 containment measures were implemented by countries. These measures, such as social distancing, entail economic and psychological costs . Such firms with access to subsidized rates on vaccines are incentivized to over-invoice their imports and sell the additional amounts in the black market for foreign exchange at a high premium16. In addition to the recent COVID-19 vaccine scandals, it is worth mentioning that some of the pharmaceutical companies manufacturing the COVID-19 vaccine  were sued over bribery prior to the pandemic15. These examples argue for the possible destructive effects of public corruption on the successful vaccination against COVID-19. However, a data-driven cross-country investigation on the role of corruption in vaccinations is lacking. In this study, using data on the share of the population who have been vaccinated against COVID-19, public corruption, healthcare capabilities and economic indicators from over 90 countries, we examine the association between corruption and COVID-19 vaccination coverage. We find strong evidence of the damaging effects of pre-pandemic corruption on immunization progress across countries.The supply shortage of COVID-19 vaccines creates opportunities for corruption throughout the world. In South America, Peruvian and Argentinian politicians and their families received vaccinations prior to being officially eligible for them17 defines corruption as “[…] the misuse of public power for private benefit.” Therefore, corruption occurs at the intersection of public spending and the private sector. Misuse is defined as a behavior that deviates from the formal and informal rules of a political society or “[…] more generally, where narrow interests are followed at the expense of the broader interests of the public at large”17. Corruption can take different forms such as extortion, fraud, embezzlement and bribery17.Lambsdorff18 identify, based on pre-pandemic research on corruption, at which stages of the vaccination process can public power be misused for private benefit. Goel et al. argue that the urgent political need for a vaccine creates an additional layer of government intervention compared to previous distribution processes of pharmaceutical goods. The accompanying increased number of involved bureaucrats could create opportunities for corrupt activities. Hastily negotiated contracts could give incentives for rent-extracting behavior. Goel et al. explain that at the vaccine development and approval stages, pharmaceutical companies might bribe regulatory institutions to expedite approvals of new vaccines. Finally, they suggest that in the distribution process, consumers might try to bribe bureaucrats for two reasons: to obtain vaccines before their official eligibility and to seek additional doses to subsequently sell on the grey market.But how can corruption affect the speed and scale of worldwide vaccination projects? In light of the extraordinary speed and global scale of COVID-19 vaccine distribution, Goel et al.19 state: “No other sector has the specific mix of uncertainty, asymmetric information and large numbers of dispersed actors that characterize the health sector. As a result, susceptibility to corruption is a systemic feature of health systems […].” The authors underscore the enormous amount of global government spending on health, which would make the health sector highly profitable and therefore especially vulnerable to corruption. Transparency International estimates that 7.5 trillion dollars every year are spent on public health globally, 500 billion dollars of which is misappropriated due to corruption20.Another channel for the effect of corruption on vaccination progress is the quality of health systems. The quality of the health sector essentially defines the speed and effectiveness of the COVID-19 vaccination process. However, the health sector is also prone to corruption. Savedoff and Hussmann21 argues that corruption in the health sector reduces the available capital for health, increases the costs for patients, inhibits service improvement, reduces the quality of care and generally hinders reform and improvement. Countries with health sectors that suffered from corruption prior to the crisis could be less effective during the COVID-19 pandemic. Farzanegan22, for example, has shown that the level of corruption is positively and significantly associated with COVID-19 fatality rates across countries. The “Nikkei COVID-19 Recovery Index,” ranks the vaccination progress, country-level infection management and social mobility for more than 120 countries. 14 out of 15 countries at the bottom of the ranking are the worst performing countries in the fight against the pandemic in September 2021 and are negative in the control of corruption index from the World Governance Indicators, showing higher degrees of corruption. Conversely, 13 out of the 15 top performing countries according to the index are in positive in the corruption index23. The nexus between corruption and governmental and health sector performance during the pandemic could also affect the speed and scale of vaccination projects worldwide.Sommer24 find a positive relationship between corruption and child mortality. The authors estimate that more than 140,000 deaths of children every year could be indirectly attributed to corruption. Sommer21 also focuses on child and infant mortality as the dependent variable and concludes that the interaction between corruption and health expenditures negatively affects child and infant mortality. Li et al.25 verify the negative effects of corruption on five different measures of health outcomes and conclude that corruption causes deaths. Habibov26 finds a negative relationship between corruption experienced in the healthcare sector and satisfaction with healthcare as subjective indicators. Achim et al.27 find that higher levels of corruption negatively affect physical  and mental health (expressed by happiness). Azfar and Gurgur28 find that in areas in the Philippines with widespread corruption, respondents reported longer wait times in public clinics and a higher frequency of being denied vaccines even prior to the COVID-19 crisis. Among other health outcomes, which were negatively associated with corruption, the authors find that corruption reduces immunization rates and delays the vaccination of newborns. Factor and Kang29 analyze the effects of corruption on different health indicators, including immunization. Their results show that higher corruption is associated with lower levels of health expenditures as a percentage of GDP per capita, and with poorer health outcomes in general. Higher levels of corruption show a negative effect particularly on Diphtheria and tetanus toxoids and pertussis (DPT) immunization rates.Moreover, there is empirical evidence for the substantial negative effects of corruption on the health sector. Hanf et al.32). Low levels of political trust may decrease the acceptance of vaccines against the COVID-19 virus. Empirical research finds a positive effect of trust on vaccine acceptance during previous immunization campaigns34. During COVID-19, trust in institutions and the health sector is especially crucial due to the shortened clinical trials and emergency approvals of the vaccines in many countries. Lazarus et al.35 report that higher levels of trust in information provided by the government are associated with higher COVID-19 vaccine acceptance.Another channel through which corruption may affect COVID-19 vaccination progress is social and political trust. Studies find that corruption negatively affects trust . Goel and Nelson44 explain the implications of COVID-19 vaccine rollouts on corruption in the case study of the US. For a robustness check, we also use the corruption perception index (CPI) from Transparency International in 2020. CPI is a composite index based on a combination of 13 surveys that shows how corrupt a country’s public sector is perceived to be by experts and business executives45. Theoretically, it is in the range of 0 (most corrupt) to 100 (least corrupt). We subtract the original scores from 100, thus higher values refer to more corruption in the public sector. There is a significant and positive correlation between the WGI and TI corruption indicators in our sample (r = 0.98).The primary independent variable is a measure of corruption. We use the control of corruption index from World Governance Indicators46 capture the pre-pandemic socio-economic conditions of countries. Earlier studies have shown a significant correlation between the level of economic development and corruption. A line of literature refers to the possible positive association (greasing the wheels hypothesis) when there is a high regulatory burden in an economy  while the most recent studies show a negative association between corruption and income of a nation (sanding the wheels hypothesis) . Corruption is also associated with pre-pandemic health infrastructure and resources. It is shown that corruption distorts the allocation of a government’s budget toward areas where bribes can be more easily obtained. In such economies, the areas such as public health and education are under-invested53. Obviously an equipped and efficient health care system can manage large-scale projects, such as vaccinations, more effectively. Corruption may hinder the successful implementation of vaccination through its distorting effect on the health sector. Finally, we have also controlled for the share of the urban population. It is also seen that higher levels of corruption may destabilize a political system in countries with higher levels of youth urban population54. An unstable political system will be less successful in efficiently and effectively implementing major vaccination projects.Progress in COVID-19 immunization is not just a function of administrative corruption. To check for other possible drivers of speed and coverage of vaccination projects, we consider a set of socio-economic, health and institutional indicators. The inclusion of such variables is important because they can be correlated with both corruption and vaccination coverage. These control variables are the logarithm (log) of GDP per capita, the log of physicians , the log of domestic general government health expenditure per capita, the log of nurses and midwives , and urban population . These variables are taken from the World Development Indicators by the World Bank55, and the government effectiveness index in 2020 from WGI43. Corruption is associated with the type of political regime, which is an important contributor toward successful vaccination projects. The government effectiveness measurement aims to capture perceptions of the quality of public services, the quality of the civil service and the degree of its independence from political pressures. In addition, it shows the quality of policy formulation and implementation and the credibility of the government's commitment to such policies. This dimension of governance is relevant in our analysis because vaccinations are an important public service and needs significant state capacity, coordination and commitment by government agencies. Government effectiveness has already been proven to be negatively associated with COVID-19 mortality56 and can be an important transmission channel for the effect of public corruption on vaccination progress. Moreover, countries with high ethnic fractionalization may suffer from a variety of socio-economic and policy distortions57. The risk of internal conflict and rent-seeking is higher in countries with higher degrees of ethnic fractionalization57. Thus, we also control for this issue using the fractionalization index from Drazanova58. Also, countries with more integration in the international markets and more economic openness may have faster access to suppliers of COVID-19 vaccines. Thus, we also control for globalization using the 2018 index (latest available year) from Gygli et al.59 The issue of international contacts was also examined by Farzanegan et al.60 during the COVID-19 outbreaks across countries. Finally, we control for continent dummy variables that consider other regional characteristics which may explain cross-country variations in the progress of vaccination against COVID-19.In addition, we control for the quality of political institutions by including the Polity2 index, which is taken from Marshall et al.Supplementary Information 1 provides detailed information on the variables and their sources. Table The baseline econometric model has the following form and we estimate it with ordinary least squares (OLS) and robust standard errors.i refers to country i. Corruption denotes the corruption index. In our baseline specification, we use the corruption index from 2020 and expect a negative influence of corruption on the percentage of the population who have been vaccinated against COVID-19. Z is a vector of control variables including continent dummy variables. We distinguish between six different continents: Africa, Asia, Europe, North America, South America, and Oceania (reference category). In addition, Z contains the political-socio-economic control variables .The subscript Table variance inflation factors larger than 10 . This process has no influence on our main results.Model 1 in Table Model 13 for both dependent variables show the net effect of the WGI corruption index on vaccination progress after considering the effects of socio-economic, health and institutional indicators. A robust negative association between cross-country vaccination progress and different levels of corruption according to both indexes can be observed in Tables In Table 18 argue that authoritarian regimes may be more efficient in vaccination projects due to “fewer time-consuming checks and balances.” In democratic regimes, different layers of administration could also decrease trust in vaccines. In spring 2021, many European countries suspended the use of Astra Zeneca due to the risk of blood clots61. After a few days of suspension, the vaccine was approved by the European Medicines Agency (EMA) and its usage was resumed. However, the suspension resulted in a sharp decrease in trust in the Astra Zeneca substance62. Among the top countries in the list of fully vaccinated nations in our sample, we refer to countries such as Bahrain, Qatar, and United Arab Emirates with Polity index values of or near − 10 (full autocracy).An increase in the (reversed) WGI corruption index measured in 2020 by 1.52 units of an interquartile change is associated with a decrease of 15.35 percentage points in the share of fully vaccinated people and can be observed in Table In Model 14 of Tables The goal of this study was to analyze the effects of public corruption on the global vaccination progress against COVID-19 across countries. We present the first cross country empirical evidence on the destructive effects of public corruption on vaccination progress. Our analysis of more than 90 countries shows that cross-country variation in corruption levels in 2020 alone explains approximately 50% of the variation in vaccination progress by the summer of 2021. An interquartile increase in the corruption index reduces the share of the vaccinated population by approximately 15 percentage points, controlling for other confounding variables. The negative effect of corruption is highly statistically significant as well. The findings also show that one of the relevant channels through which corruption negatively affected the vaccination distribution in a society is through government effectiveness. Corruption has a significant negative association with state capacity in formulating and implementing public policies and projects. The latter is a key factor for effective and efficient implementation of large-scale health projects, such as the vaccination of the greater population. Failing to control public corruption increases the vulnerability of a government’s administration and health sector in the case of pandemics like COVID-19. Corruption not only distorts economic growth but is also responsible for the lives of many people around the world by reducing the speed of vaccination and its coverage. Our empirical evidence using country-level data confirms the anecdotal evidence and reported observations in media on the destructive role of corruption in the management of the COVID-19 crisis.63. Our results may also hint at the possible increase in public awareness on the importance of addressing corruption. Citizens, under COVID-19, directly experience how costly public corruption can be and thus may be willing to support more anticorruption projects. Our results show that the level of economic development matters in the effective management of pandemics. Corruption, by reducing the level of economic development in the long term, may also continue to worsen health outcomes in society. One limitation of our study is that we explain cross-country variation in vaccination coverage by the summer of 2021. The pandemic is not yet resolved, and vaccinations are still on-going across the world. Therefore, future research is needed to see the full picture of the effect of corruption when the pandemic ends. Second, although we have tried to control for possible confounding variables besides our main variable of interest (corruption), one may not fully exclude the probability of missing other relevant factors. Nevertheless, we believe that this potential limitation should not be of major concern with the high explanatory power of our general specification (approximately 80%). Finally, while there are plausible arguments for the effect of corruption on the COVID-19 vaccination progress, one may also consider the possibility that these projects influence public corruption. We have tried to reduce the risk of reverse feedback by using a corruption index from 2020 and checking our results by using corruption scores from 2019. COVID-19 vaccinations intensified during 2021 across the world. It should be less likely that the COVID-19 pandemic and vaccinations programs of 2020/21 had a significant impact on corruption in 2019 or 2020. Future research may also further investigate the role of private corruption in COVID-19 vaccinations and the types of corruption practiced during the phases of vaccination development across countries.Our study has important policy implications. Delay in addressing corruption, especially in the global south countries, is not only a burden for long-term economic growth but can also impose significant human capital losses during pandemics. In other words, our results show that the overall costs of corruption can be much higher when we consider its health consequences for the whole population. Corruption in government administration, which negatively affects state vaccination projects, may reduce public trust in the government and intensifies the relative deprivation of the population. Income inequality, which is higher in corrupt economies, can extend to access to health care and an increase in the share of out-of-pocket spending on health by the population. As a result, we may even expect a higher risk of conflict and violence because of corruption during the pandemic. This risk of instability is higher if the government is less capable of intervening in the market and supporting the disadvantaged population during the pandemic. There is recent evidence for the effect of COVID-19 on conflict, which is higher in countries with poor governanceSupplementary Information.


The study concerns with the mechanical characteristics of heat and mass transfer flow of a second grade nanofluid as well as gyrotatic microorganism motion past a thin needle with dipole effect, entropy generation, thermal radiation, Arrhenius activation energy and binar chemical reaction. The governing equations and boundary conditions are simplified by the use of suitable similarity transformations. Homotopy analysis method is implemented to obtain the series solution of non-linear ordinary differential equations. Physical behaviors of heat and mass transfer flow with gyrotatic microorganisms and entropy generation are investigated through the embedded parameters. The nanofluid velocity is enhanced for higher values of the ferromagnetic parameter, local Grashof number, bioconvection Rayleigh number and radiation parameter. The Reynolds number, radiation parameter and Eckert number decrease the nanofluid temperature. The entropy generation is increased with the enhancement of radiation parameter, Eckert number, Lewis number, temperature difference parameter, dimensionless constant parameter, Curie temperature, Prandtl number and concentration difference parameter. Doranehgard et al.2 examined the simulation of natural gas in oil-saturated tight porous medium. Barnoon et al.3 explored the production of hydrogen through the propane steam reforming inside the reactor that consists of shell and tube heat exchanger. Moravej et al.4 detected the silver water nanofluid in a hemispherical three-dimensional solar collector operating system. Barnoon et al.5 explained the thermal management in biological tissue to prevent tissue destruction during a local heating process. Doranehgard and Dehghanpour6 described the numerical and analytical study for the quantification of diffusive and convective transport during the desolvation of 7 used the finite element method for the description of mathematical modeling of heat dispersion and eradication of tumor tissues in the liver utilizing microwaves. The influence of low to medium frequencies and low to medium power within the tissue is explored using a tiny antenna coupled to a power supply. Barnoon et al.8 scrutinized the behavior of heat transfer rate, MHD and porous medium over the mixed convection flow of ferrofluid through the rotating cylinder by using three distinct temperature cases with local thermal equilibrium and non-equilibrium. Barnoon et al.9 inspected the heat transfer and fluid flow by the existence of magnetic field along with the porous media and rotating circular obstacles. They identified that increasing the volume fraction improves the heat transfer rate. Barnoon et al.10 scrutinized the thermal performance, entropy generation and heat transfer of a two-phase nanofluid model embedded in a conical vane inside a circular porous channel and they observed that the heat transfer rate is enhanced with the drop of pressure. Shahsavar et al11 pointed out the investigations of heat transfer, hydrothermal and entropy generation features in a naturally cooled eccentric horizontal annulus from the perspective of first-law and second-law of thermodynamics. Shahsavar et al.12 employed the first and second law of thermodynamics to check the influence of water-silver biological nanofluid over the performance of newly designed heat sink in a porous media. Barnoon et al.13 discussed the heat transfer and nanofluid model in a permeable enclosure with thermal radiation and two-phase natural convection impacts toward a porous cavity. Barnoon and Toghraie14 analyzed the numerical investigations of heat transfer and laminar flow of non-Newtonian nanofluid toward the porous media. Various phenomena shown through the different differential equations have been existed and can be found in the references18.Many researchers and scientists have scrutinized the flow and heat transfer using a moving thin needle because of its importance in a variety of scientific and industrial applications. In this framework, several flow conditions have been considered. Heat transfer is utilized in a variety of specific applications, including metals, polymers, ceramics, anemometers, microscale cooling devices and hot wire for heat removal. Therefore, different researchers and scientists discussed the heat transfer in their research area. Song et al.21. Additionally, on the base of physical applications in industries and engineering a lot of researchers have broadly studied the non-Newtonian fluid. Bilal and Urva22 observed the presence of activation energy and variable viscosity in the non-Newtonian fluid toward the thin needle. In their study, they used MATLAB bvp4c built-in function for the solution of the ordinary differential equations and found that the fluid concentration becomes higher for activation energy. Khan et al.23 explained the non-Newtonian Odroyd-B fluid with activation energy and non-linear thermal radiation significance over the rotating disk and initiated that with the enhancement of radiation parameter, the transfer of heat becomes stronger. Gaffar et al.24 detected Jefferrey’s non-Newtonian fluid over the semi-infinite vertical plate with the effect of heat generation and noticed the different applications of their research in chemical and mechanical engineering such as nuclear waste simulation and polymeric manufacturing process. Waqas et al.25 studied the bioconvection non-Newtonian fluid with the motile microorganisms past a rotating disk. With the help of similarity transformations, they obtained the higher order ordinary differential equations of their model from the leading partial differential equations and also found some useful applications of rotating disks in engineerings such as crystal growth, lubrication, oceanography, computer storage devices and rotating machinery.Over the last few years, the scientists and researchers have considerable interest in non-Newtonian fluid because of their extensive applications in engineering and industries. Such type of fluid is used in oil store building, foods stuffs, material handling, synthetic processes, electronic packaging, enhanced oil recovery, polymer processing etc26 investigated the magnetic dipole effect on the flow of nanofluid along a stretched cylinder with gyrotactic microorganisms in a stratified medium. Zeeshan and Majeed27 established a Jeffery fluid flow mathematical model with the existence of magnetic dipole and heat transfer analysis due to the stretching surface through the applications of shooting method along with R-K method and obtained a series solution of the problem. Majeed et al.28 have investigated the magnetic dipole effect in a Maxwell ferrofluid in the presence of chemical reaction and they noticed that the thickness of the boundary layer and velocity of the fluid are reduced when the Maxwell parameter rises. Khan et al.29 calculated the thermal radiation behavior through the Williamson nanofluid with the manifestation of magnetic dipole effect and claimed that as the values of thermophoresis and Brownian motion parameters are changed, the fluid temperature falls. Hayat et al.30 discussed the dipole effect in a ferromagnetic second grade fluid toward the porous media and found some important results of skin friction, Nusselt number, velocity and temperature of the fluid in a graphical and tabular form.The magnetic dipole effect is an important phenomenon in engineering and industrial applications therefore, the researchers and scientists mostly use the magnetic dipole effect in their research work. Alshomrani32. Based on the importance of nanofluid many experimental and theoretical observations are being executed by different researchers. Waqas et al.33 analyzed the non-Newtonian nanofluid with the radiation and dipole impact. Most of the researchers use the nanofluid with zero mass flux conditions or convective heat conditions but according to the physical phenomena to make problem more optimistic and realistic they solved their model with both convective heat conditions and zero mass flux conditions and concluded that the boundary layer thickness is increased for the radiation effect. Akbari et al.34 evaluated the heat transfer effect in a non-Newtonian nanofluid and their results show that the heat transfer rate increases with the increase of nanoparticles of solid volume fraction. Naz et al.35 reported the behavior of activation energy in the numerical solution of the non-Newtonian nanofluid via shooting technique and scrutinized that the nanoparticles volume friction is improved for the enhancement of activation energy. Shafique et al.36 examined the influence of buoyancy impact through the bioconvection second-grade nanofluid in which they studied that the fluid concentration is affected by the increase of buoyancy. Ali et al.37 pointed out the study of heat source/sink and gyrotactic micro-organisms in a three-dimensional Maxwell nanofluid on a stretching surface and their numerical solution explained that the bioconvection Lewis number 38 introduced the mathematical model of Casson nanofluid between two stretching disks along with the influence of entropy generation. For the numerically investigation of the model, they applied the shooting technique. Ashraf et al.39 modeled a problem of non-Newtonian nanofluid with the combined occurrence of Brownian motion and thermophoresis impacts. The suspension of nanometer size particles in the base fluid is called nanofluid. Metals, their oxides, carbides, and carbon nanotubes are the main components of nanoparticles utilized in nanofluids. Nanofluids are beneficial in a variety of applications, including microelectronics, fuel cells, pharmaceutical procedures, heating systems, temperature controllers, gas vented from chimneys, dispersion of heat, machine for propelled cross breening and so on40 delivered the study of motile gyrotactic microorganisms in a non-Newtonian blood-based nanofluid by a cylindrical co-ordinate system and showed that throughout the whole flow channel, the behavior of the fluid flow remains same in non-tapered, converging and diverging arteries. Sohail et al.41 interpreted the non-Newtonian fluid flow with gyrotactic microorganisms in the presence of mass and heat transport behavior under the nonlinear stretching surface. For the physical formulation of the model, they employed the boundary layer theory in terms of partial differential equations and enhancement in reaction is noted in the profile of the motile density for Peclet number. Pal and Mondal42 presented the influence of gyrotactic microorganisms on a bioconvection nanofluid with thermal radiation and chemical reaction effects. In this article, they expressed that the chemical reaction shows the increasing effect over the nanoparticles concentration but decreasing behavior is observed for the thermal radiation. Haq et al.43 proposed the existence of gyrotactic microorganisms in a mathematical modelling of Williamson fluid in the prevalence of activation energy past a porous surface of cylinder. Gyrotactic microorganisms are used as controlling agents for the random movement of nanoparticles that are suspended. Khan et al.44 disclosed the Walter-B fluid subjected to gyrotactic microorganisms along with the heat transport phenomena by examining the graphical and tabular representation of the problem by built-in shooting technique. Nima et al.45 expressed another study of gyrotactic microorganisms in a non-Newtonian fluid over the vertical plate that are embedded in a porous medium where they determined that the non-Newtonian fluid temperature and velocity show the opposite trend for mixed convection parameter.In medical research, the bioconvection has been studied for over a couple of centuries. The typical upwardly swimming microorganisms, which are slightly denser than water in suspensions, cause this phenomenon. When the upper surface of the suspension becomes too thick due to microorganisms accumulation, the suspension becomes unstable, causing microorganisms to tumble and bio-convection currents to form. Despite the fact that comprehensive mathematical studies on bioconvection phenomena have been published, the importance of this phenomenon has attracted the attention of medical engineers in bio-diesel fuels, bio reactors and fuel cell technology. Bhatti et al.46 performed a study on a non-Newtonian fluid with the properties of entropy generation and heat transfer analysis through the parallel plates along with the slip conditions and discussed that by the existence of slip conditions, the entropy generation is reduced. Shahsavar et al.47 considered a two-phase ferrofluid model in a minichannel with the presence of entropy generation and magnetic dipole effect where the global total entropy generation rate is unaffected by the location of the dipole which is not exists in case of two and three dipoles. Khan et al.48 offered the aspect of activation energy and chemical reaction in a non-Newtonian nanofluid flow over the stretching surface and obtained results which described that the activation energy decreases the concentration of the fluid. By the implementation of shooting technique along with Runge-Kutta method, Kumar et al.49 made a debate on an entropy generation in a Williamson nanofluid in the presence of thermal radiation in which they discoursed that the fluid temperature becomes higher with the rising of radiation parameter and entropy generation shows the decreasing trend for concentration and temperature difference parameter.For the irreversible process, the entropy always increases. Heating and cooling are common occurrence in a variety of engineering and industrial processes, most notably in combustion engines, refrigerators, and air conditioners etc. Entropy generation is used to calculate the efficiency of such energy and electronic devices, and irreversibilities reduce the performance of such devices. Entropy generation and Bejan number can improve the efficiency of any system. Quantity and quality of energy are very essential components in the development and manufacturing of industrial products. To determine the degree and quality of dissipation of energy during a process, the second law of thermodynmics allocates the necessary tools. For assessing the energy quality, the most powerfull tool which is known as a entropy is used. The energy is lost during the transmisison of energy into the usefull work according to the second law of thermodynamics which affects the efficiency of energy conversion devices. It is noted form the definition that both enetropy generation and energy destruction are proportional to each other. As a result, the amount of available energy in a system decreases when the entropy is formed. Decreasing the amount of entropy generation improves the thermal system performance. That’s why during the thermodynamic process entropy generation is most significant tool. Several experimental and theoretical investigations for entropy generation are being conducted by different researchers. Shojaeian and KosarThe importance of numerous industrial and technological applications such as microscale cooling devices, hot wire anemometers and microstructure electronic devices prompted the researchers to investigate flow and heat transfer through a moving thin needle. The moving thin needle is being considered as a physical model of the present study. Additionally, a thin needle is identified as a parabolic rotation around its axis direction. In the present study, the non-Newtonian second grade nanofluid with gyrotactic microorganisms are discussed in heat and mass transfer flow. The magnetic dipole effect, activation energy, radiation effect and entropy analysis are also discussed through the use of homotopy analysis method. The influence of distinct quantities is discoursed in the graphical from.r is the radial coordinate and x is the axial coordinate as shown in Fig. Consider the steady, laminar and two-dimensional non-Newtonian flow of the second grade nanofluid toward the moving thin needle. The radius of the thin needle is mentclass2pt{minim26u, v are used for the velocity components, T is the nanofluid temperature and C is the nanofluid concentration, the motile gyrotactic microorganism density is N, K, n is the fitted rate constant such that (−1 < n < 1), 26The leading equations for the present model areNow, it is interesting to discourse some engineering physical quantities such as skin friction coefficient, local Nusselt number, local sherwood number and motile microorganisms asIn two-dimensional flow with the existence of thermal radiation, entropy generation per unit volume for incompressible non-Newtonian fluid in cylindrical coordinate system isIn Eq. , the firThe dimensionless form of the entropy generation is now achieved by using the specified similarity transformations in Eq.  as21\docThe present method is simulated for the accurate response without linearization and discretization of the nonlinear differential equations.This method can be used with systems that have smaller or larger natural parameters.Convergent solution to the model is gained with the help of this technique.This approach is linear and does not require any base functions.Homotopy analysis technique is employed for the analytical examination of the present study. For this investigation, computer-based programming software in Mathematics 10 is used. The HAM approach is adopted to address the problem because it provides the following advantages. The initial guesses and linear operators are taken asi = 1-9) are the arbitrary constants.p = 0 and p = 1, then the Eqs.  is used through MATHEMATICA. The various involved parameters are discussed for the different existing profiles like velocity, temperature, nanoparticles concentration, motile gyrotactic microorganisms concentration and entropy generation through the graphs in Figs. The variation of velocity profile for distinct values of different parameters are discussed in Figs. Figures In this section, nanoparticles concentration profile is sketched for various parameters. Figure Figures It is perceived that the dwindle in motile gyrotactic microorganism profile is reflected for growing values of bioconvection Lewis number Figure With the expansion of nanoparticles concentration difference parameter In the present analysis, the problem of two-dimensional non-Newtonian second grade nanofluid with magnetic dipole effect and gyrotactic microorganism past a thin needle is performed. The effects of Arrhenius activation energy and binary chemical reaction are also detected with the analysis of entropy generation. The solution of the model is obtained by using the most powerful analytical method called the homotopy analysis method (HAM) using MATHEMATICA. Over the heat and mass transfer second-grade nanofluid flow, the effects of different physical parameters are determined. The following results are summarised asThe velocity of the nanofluid increases when the ferromagnetic parameter Retardation in nanofluid velocity profile is noted for higher values of elasticity parameter The elasticity parameter Fluid temperature reduces for various values of Reynolds number Increasing behavior of nanoparticles concentrtaion profile is found for radiation parameter The influence of elasticity parameter The Lewis number The nanofluid entropy generation is enhanced with the increasing of radiation parameter Supplementary Information 1.


The design and evaluation of control programs for soil-transmitted helminths (STHs) is based on surveillance data recording measurements of egg counts in the stool of infected individuals, which underpin estimates of the prevalence and average intensity of infection. There is considerable uncertainty around these measurements and their interpretation. The uncertainty is composed of several sources of measurement error and the limit of detection of fecal smear tests on the one hand, and key assumptions on STH biology on the other hand, including assumptions on the aggregation of worms within hosts and on the impact of density-dependent influences on worm reproduction. Using 2 independently developed models of STH transmission we show how different aspects of STH biology and human behavior impact on STH surveillance and control programs and how accounting for uncertainty can help to develop optimal and sustainable control strategies to meet the World Health Organization (WHO) morbidity target for STHs. Ascaris lumbricoides), hookworm , and whipworm (Trichuris trichiura). STH infections cause considerable morbidity in vulnerable populations and are associated with malnutrition, anemia, adverse pregnancy outcomes, impaired cognitive and physical development in children and educational underachievement [Soil-transmitted helminths (STHs) are a group of parasites that affect an estimated 1.5 billion people world-wide, predominantly in low-income settings with lack of access to basic hygiene and sanitation facilities [ievement , 3. In 2ievement . The maiIn 2020, the World Health Organization (WHO) published new targets for STH control for 2030 . The tarThe WHO guidelines for STH control programs differentiate between low-, moderate- and high-prevalence settings, defined as <20%, 20–50%, and ≥50% prevalence of any STH infection in SAC, respectively . The preAs an increasing number of countries report they are approaching the morbidity target (<2% M&HI infections in SAC), appropriate strategies need to be developed, employing sensitive diagnostics, to evaluate whether the target has been reached and to regularly monitor the prevalence of STH infections to detect signs of resurgence early on. Previous studies have shown that the accuracy of currently recommended sampling schemes and diagnostics used to measure STH prevalence is insufficient to assess achievement of the morbidity target . The mosThe purpose of this article is to review how uncertainty in key assumptions on STH population biology can affect the planning and evaluation of STH control programs and how this uncertainty can be accounted for in program design to achieve sustainable STH morbidity control. To illustrate this, we use 2 simulation models independently developed at Erasmus MC (EMC) and Imperial College London (ICL). The models have been described in detail elsewhere. The parameters used for the simulations can be found in WHO guidelines for STH control programs recommend semi-annual PC treatment of pSAC and SAC in high-prevalence settings, annual PC treatment in moderate-prevalence settings, and no treatment in low-prevalence settings where M&HI infections are rare . After 5The frequency and duration of treatment required to reach the morbidity target does not only depend on local prevalence but also on the aggregation of worms among hosts. Aggregation here means that most infected individuals will have low to moderate worm burdens, but a few individuals will have very high worm burdens. The negative binomial distribution has been proven to be a good descriptor of the distribution of worms per host. Typically, heavily infected individuals are predisposed to this state by high exposure and potentially host suitability for infection. Variation in exposure among individuals is caused by local differences in environmental variables and human behavior, which is expected to vary by cultural and socioeconomic setting , 11. In Locations with the same pretreatment prevalence of STH infections may have different levels of worm aggregation and may therefore require different optimal treatment strategies. In areas with a high aggregation of worms among hosts, achieving the morbidity target may require more time or a higher treatment frequency . SimulatTo facilitate the achievement of control targets, it is desirable to reduce the level of aggregation of worms among hosts. Mathematical models predict that aggregation increases during treatment . The reaA. lumbricoides and T. trichiura infections lies in children, whereas hookworm infections affect adults equally or more than children [A. lumbricoides and T. trichiura are transmitted exclusively via the oral-fecal route, whereas hookworm larvae can infect humans directly via the skin [Exposure of different age groups to STH infection can vary geographically depending on STH species and cultural and socioeconomic differences in human behavior. Differences in exposure can lead to differences in infection intensities. For example, the main burden of children . The reathe skin . Models the skin , 22, andthe skin .Age-dependent contribution to the environmental reservoir of infectious material  can also impact on a program’s success. For example, in settings where adults contribute to environmental contamination similarly or more than children, PC treatment of adults is predicted to have greater additional benefits toward reaching the morbidity target than in settings where adult contamination of the environment is relatively low . ExtendiUncertainty about STH reproduction can affect program evaluation based on egg counts from fecal smear tests. Current WHO guidelines recommend evaluation of the impact of STH control programs after 5–6 years of PC treatment . SamplinThe ability of an evaluation strategy to accurately assess the impact of STH control programs does not only depend on the sampling scheme but also on the diagnostic. Comparative experimental studies concluded that the sensitivity of the Kato-Katz fecal smear test is superior to other diagnostic methods based on egg counts . HoweverIn addition to sampling and measurement uncertainty, there is an inherent uncertainty in the interpretation of diagnostic results for program evaluation because our understanding of how the number of eggs depends on the number of female worms within a host is incomplete.Programme evaluation is based on egg counts from human stool samples. The fecundity of female worms is affected by density-dependent competition for resources within the human host , 32. WheTwo different functions can accurately describe the density-dependent saturation of egg output per female worm. An exponential saturation function assumes that the total number of eggs produced by the worm population within a host first increases and then decreases as the number of female worms increases. A hyperbolic saturation function assumes that the total number of eggs produced within a host increases up to a threshold value as the number of female worms increases and stays stable thereafter.The choice of saturation function in mathematical models affects the predicted impact of PC treatment. For example, the impact of treatment on the prevalence of M&HI infections in high-prevalence settings is higher if the fecundity of female worms follows a hyperbolic saturation function. If the fecundity of female worms follows an exponential saturation function, the impact of treatment may be underestimated, because the number of worms within hosts may have been more reduced than the prevalence of M&HI infections measured by egg counts suggests . The reaIn moderate-prevalence settings, the impact of treatment on infection intensity depends less on the type of density-dependence and more on the slope of the egg production function. Consequently, the interpretation of evaluation data in moderate-prevalence settings is more straightforward than in high-prevalence settings.Ancylostoma caninum have higher egg outputs 6 days after deworming treatment than before, although the drug removed worms with 71% efficacy [Density-dependent fecundity of female STH can complicate the assessment of drug resistance using assays based on egg counts and may lead to an underestimation of drug efficacy. Veterinary studies in dogs have shown that dogs infected with high burdens of low-level resistant efficacy , 36. TheDuring program evaluation, a lower than expected reduction in STH prevalence and infection intensity in settings with a high baseline prevalence does not necessarily imply that the program was ineffective. However, efforts should be made to uphold high coverage and compliance until measurable progress has been achieved. More research is needed to establish the exact relationship between egg production and the number of female worms within a host. Data could be collected, for example, from worm expulsion studies from small cohorts at the beginning and end of STH control programs or from animal studies where model organisms are infected with known numbers of eggs/larvae.0 [Cessation of treatment or reduction in treatment frequency may lead to resurgence, unless elimination of transmission has been achieved or additional WASH interventions have been successfully implemented to reduce the value of the reproductive number R0 . Careful0 . The tim0 .Since the prevalence of STH infections and treatment coverage tend to be heterogeneous across a country, control targets are reached sooner in some implementation units than in others. To achieve targets and avoid resurgence in high-risk populations , targeted setting-specific intervention strategies will have to be implemented. Such strategies need to consider the potential re-importation of STH infections by individuals moving between implementation units or across country borders, for example, seasonal migrant laborers .The current treatment recommendations for STHs are general and differentiate only by settings defined by the prevalence of infection. Considering local variability in epidemiologically relevant human behavior and STH population biology can improve STH control. Such considerations will become especially relevant to implement sustainable STH morbidity control once the current targets have been reached. Uncertainty about program design caused by uncertainty on STH biology, ecology, and human behavior can be addressed by collecting setting-specific data before implementing the full program, for example, collecting infection intensity data to estimate the level of aggregation of worms among hosts, collecting worm expulsion data at the beginning and at the end of MDA programs, especially, in high-prevalence settings .Data that can inform the targeted design of STH control programs include the prevalence and intensity of STH infections by age group. To address uncertainty that cannot be reduced by collecting additional data prior to the implementation of STH control programs, contingency plans need to be made that account for local goals and resource availability and the consequences to future resource needs if program targets are not reached.Clinical Infectious Diseases online. Consisting of data provided by the authors to benefit the reader, the posted materials are not copyedited and are the sole responsibility of the authors, so questions or comments should be addressed to the corresponding author.Supplementary materials are available at ciab195_suppl_Supplementary-FiguresClick here for additional data file.ciab195_suppl_Supplementary-TableClick here for additional data file.


Current methods of burn estimation can lead to incorrect estimates of the total body surface area burned, especially among injured children. Inaccurate estimation of burn size can impact initial management, including unnecessary transfer to burn centers and fluid overload during resuscitation. To address these challenges, we developed a smartphone application that calculates the total body surface area of a burn using a body-part by body-part approach. The aims of this study were to assess the accuracy of the smartphone application and compare its performance to three established methods of burn size estimation .Twenty-four healthcare providers used each method to estimate burn sizes on moulaged manikins. The manikins represented different ages  with different total body surface area burns . We calculated the accuracy of each method as the difference between the user-estimated and actual total body surface area. We used multivariable modeling to control for manikin size and method.Among all age groups and burn sizes, the smartphone application had the greatest accuracy for burn size estimation  followed by the Rule of Palms , the Lund-Browder Chart , and the Rule of Nines .The smartphone application may improve the estimation of total body surface area burned compared to existing methods.


The recruitment and retention of health professionals in rural Australia is well documented. The COVID-19 pandemic has further exposed the precariousness of human healthcare resources within small rural communities. The external disaster of the COVID-19 outbreak described in this case analysis exacerbated the frail balance of sustaining adequate staffing levels and skill mix, which exposed behaviours of presenteeism within rural healthcare teams. An analysis of the complex of factors that led to the first nosocomial outbreak of COVID-19 within a healthcare environment in Australia demonstrates how rural healthcare environments are ill-equipped to meet the demands of unexpected external disasters. Using the Haddon Matrix to examine the factors that led to this outbreak provides us with the opportunity to learn from the case analysis. Health professional presenteeism contributed to the North West Tasmania COVID-19 outbreak and affected the hospital and health service provision within the region. Recommendations to mitigate risk for future disaster planning in rural healthcare environments include improved infection control strategies and a whole-community approach. The novel coronavirus COVID-19) is a highly contagious infectious disease that has become a pandemic, with a global impact similar to the H1N1 influenza (Spanish flu) pandemic in 1918 9 is a hi 2020), 020, 2]. Initially, the uncertainty regarding the transmission mechanisms of COVID-19, as well as the general unpreparedness and attitudes of the general populace and authorities . The conPerson-to-person transmission of the disease in communities has been obvious; however, there were unusual cross-infections from healthcare providers as virus “carriers” to patients for whom they cared, and vice versa. This transmission has been attributed to employees working while unwell, which is more formally known as ‘presenteeism’ . The behPresenteeism is a behaviour in which employees attend their place of employment while unwell, due to an acute illness, or other medical or psychological condition ,14. The Contextually, presenteeism not only adversely affects healthcare professionals, and the well-being of professional colleagues; it may also impact negatively on patient outcomes . ResearcRural health facilities face substantial challenges in the recruitment and retention of an appropriately and adequately skilled health professional workforce, due to a lack of sustainable infrastructure and declining funding . When exA case analysis was undertaken of the first nosocomial COVID-19 outbreak in North West Tasmania, Australia, which occurred in early April 2020. It occurred in both hospital and health service provision within the region. Data included details of the initial outbreak and progression incidence mortality, and organizational and government responses were predominantly sourced from two published reports—the interim report by the Tasmanian Department of Health  and an iThe Haddon matrix  was emplThe first Australian nosocomial outbreak of COVID-19 occurred at the North West Regional Hospital on the island state of Tasmania, Australia. The outbreak affected all health services in the North West of the island, including three hospitals and other health services [The timeline for the development of the outbreak begin with the first in-patient admitted to the North West Regional Hospital on 20 March 2020, followed by a second in-patient on 26 March 2020. On 3 April 2020, there were two positive COVID-19 tests of North West Regional Hospital healthcare professionals, a third staff member was reported as being COVID-19-positive on 4 April 2020 [The Haddon matrix describes which cofactors contributed to the onset and progress of the local outbreak in North West Regional Hospital, including host , resources, physical, and social environment on the horizontal axis and pre-, during and post-event on the vertical axis. . In thisThe findings from the interim report  indicateThe report also indicated there were a number of drivers for presenteeism among the health care workers employed at the North West Regional Hospital . It was While COVID-19 created unprecedented public health concerns globally , the repGiven that the nursing constitutes a large proportion of the health care workforce  and provThere are factors why nurses attend work while being physically or psychologically unwell. Fear of reprisal from employees for failing to attend designated shifts, feelings of letting colleagues down in an already understaffed situation, the necessity of earning an income, having a strong work ethic and not recognizing the severity of illness were identified . These fConsistent with the report, and as highlighted in the case study analysis, the threat of COVID-19 was initially poorly understood or not taken seriously . The traThe focus of the paper was presenteeism, and as such the exploration of other contributing factors that may have influenced the analysis process and the discussion may be skewed. The use of secondary data for the analysis process did not enable the seeking of further clarification of information and there is a reliance on information curated by outside parties.The COVID-19 outbreak in the North West of Tasmania provides opportunities to consider strategies and recommendations which can be employed to better prepare health care environments and the healthcare workforce for infectious disease disaster management planning. Recommendations include the provision for improved infection control measures, contact tracing technologies, enhanced communication strategies including health professional education, and support for a positive work culture . InvestmWith specific regard to presenteeism, the review noted:That the level of vigilance now required to reduce work presenteeism while suffering mild symptoms must be greatly increased to counter inadvertent transmission of COVID-19 in health care settings.”“ (p. 33).These recommendations can be equally applied across all health care environments and for any situation, including pandemics. Further research such as collecting primary research from future infectious disease outbreaks would contribute to the improvement of pandemic preparedness.The complexities surrounding the first nosocomial outbreak of COVID-19 in a rural region of Australia were multifactorial. Amongst other factors, staff presenteeism was found to be a major contributor to the spread of COVID-19 across multiple healthcare settings within the rural environment. Healthcare workforce factors, coupled with social and physical environments, as shown by the Haddon matrix, contributed to the COVID-19 outbreak. Lack of disaster management planning and precarious resourcing further enabled the rapid escalation of the outbreak across the North West region of Tasmania. Healthcare workforce presenteeism compounded the situation by health professionals continuing to attend work while unwell, which posed a credible risk to colleagues, patients, and members of the community external to place of employment. Transmission of disease via workforce presenteeism behaviours can also result in localized community outbreaks, potentiating major economic and social disruption, and heightening community anxiety. This case study analysis supports the need for co-created disaster preparedness to effectively manage current healthcare professional presenteeism in rural healthcare facilities and to mitigate risks of potential community transmission during future pandemics.


Now a day’s variety of nanomaterials is available, among these Aluminum Alloys AA7072 and AA705 are significant due to their thermal, physical and mechanical characteristics. These extensively used in manufacturing of spacecraft, aircraft parts and building testing. Keeping in view the significance of nanoliquids, the analysis of methanol suspended by AA7072 and AA7075 alloys under the multiple physical flow conditions is reported. The model is successfully treated by coupling of RK and shooting algorithm and examined the results for the flow regimes by altering the ingrained physical parameters. Then physical interpretation of the results discussed comprehensively. To validate the analysis, a comparison between the presented and existing is reported under certain assumptions on the flow parameters. It is found that the results are reliable inline with existing once. The two physical properties of a permeable plate known as suction and injection significantly affect the heat transport characteristics and shear stresses. In 2010, Ishak reported self-similar solutions for the thermal transport over a plate under the impacts of suction/injection and convective flow condition. He pointed that the self-similar solutions for steady and streamlined boundary layer flow over a permeable plate exist under the assumption that the permeable parameter and convective heat transport from the hot liquid alters with proportion of x-1/2 in which x denotes the distance from the leading edge of the surface2.Thermal transport properties in different colloidal suspensions over a permeable plate is significant and due to their variety of applications in engineering, nuclear reactors, bearings lubrication and cooling, electronics and in many other industrial zone2. On the basis of presented analysis, they detected that the hybrid colloidal suspension (Cu-Al2O3/H2O) is reliable for better thermal transport characteristics3. The flow of nanofluid over a chemically heated plate with suction characteristics by incorporating the Maxwell and Brinkmann correlations for thermal conductivity and density of the nanoliquid were described. Moreover, for novelty of the analysis, they retained the phenomena of viscous dissipation, radiative heat flux and chemical reaction in the constitutive model. They pointed that the heat transport rate drops for higher fraction factor and stronger Lorentz forces4.The study of thermal transport in hybrid colloidal suspension over a surface with uniform suction/injection by incorporating the impacts of magnetic field in the governing hybrid model is significant. They perceived that the heat transport upsurges for more magnetic colloidal suspension while decreasing behavior was reported by increasing the volumetric fraction ϕ5. They pointed the heat transfer characteristics in two different nanomaterials (Cu and TiO2) suspended in water. Further, the nanoliquids velocity, thermal transport and shear stresses prevailed for Cu-H2O in the analysis. They reported that prevailing effects of Cu-H2O were due to high thermal conductance of Cu nanomaterial. The heat transfer study by incorporating the effects of porosity is significant. Keeping in view the porosity effects, Maleki et al.6 reported the analysis of nanoliquid over a porous radiative plate. They captured the flow and heat transfer behavior in four different nanoliquids depending upon four nanomaterials  via graphical representation. The study of streamlined boundary layer flow by considering the suction/injection property captured by Sadri and Babaelahi7.Thermal and mass transportation in the nanoliquid by plugging the influences of absorption over a magnetized and radiative plate were examined by Prasad et al.8 pointed the heat transfer in silver based nanoliquid under the influence of heat generation/absorption with permeable effects over a porous surface. Furthermore, they examined the behavior of the nanoliquid velocity and temperature by altering the magnetic and Eckert parameters. In 2020, Shah et al.9 reported the effects of Hall current, viscous and ohmic dissipation in the nanoliquid squeezed inside porous sheet.The heat generation or absorption analysis in the flow regimes significantly alters the heat transport characteristics. Recently, Upreti et al.10. They detected that nanoliquid composed by AA7075 alloys is better for heat transport in comparison with AA7072 composed nanoliquid.The nanomaterials are significant due to high thermal and mechanical characteristics. These materials are significantly altering the properties of the nanoliquids composed by the respective nanomaterial. Among the nanomaterials, there is a material know as Aluminum alloys in which the role of aluminum is predominant. There are two major categories of aluminum alloys which further categorized as heat treatable and non-heat treatable alloys. Aluminum alloys are extensively used in the manufacturing of spacecraft, aircraft parts, building and testing. Due to better heat transport characteristics of AA7072 and AA7075 aluminum alloys, researchers analyzed various flow models composed by aluminum alloys and found fascinating behavior of the thermal transport. The heat transfer inspection in nanoliquids composed by AA7072 and AA7075 aluminum alloys by considering the effects of variable Lorentz forces reported Sandeep and Animasaun11. Three-dimensional heat transfer characteristic in the hybrid colloidal model AA7072-AA7075/Methanol with velocity condition examined were determined by Tlili et al.12. They treated the model numerically and discussed the results for the flow regimes. Further significant results for nanofluids examined in16. The impacts of aluminum nanomaterial with the addition of imposed magnetic field, heat transport due to Buoyancy effects over a paraboloid of revolution, 3D unsteady radiative flow characteristics of hybrid nanofluid and the investigation of heat transfer in CuO-GO/methanol was reported in the scientific literature20.The analysis of thermal transport in magnetized AA7075 alloys by considering the electric field strength was perceived KandasamyFrom the critical review the literature, it is perceived that the heat transport analysis in methanol suspended by AA7072 and AA7075 aluminum alloys is not reported over a permeable plate. For novelty of the analysis, radiative heat flux, phenomena of heat generation/absorption, suction/injection, thermal and velocity slip effects are ingrained in the governing colloidal model. Then, a numerical scheme based on shooting algorithm is adopted for mathematical treatment. Then results for the velocity, thermal transport and shear stresses for AA7072-Methanol and AA7075-Methanol are presented for suction/injection and heat generation/absorption separately. Finally, outcomes of the analysis concluded in the end.w while apart from the surface is The colloidal flow of AA7072-Methanol and AA7075-Methanol is taken over a permeable radiative plate in the presence of heat generation and absorption physical situation. The temperature at the surface is TFurther, it is assumed that the nanomaterials AA7072, AA705 and host liquid are thermally compatible and there is no slip between them. The flow configuration of AA7072-Methanol and AA7075-Methanol is painted in Fig. 6:Keeping in view the assumptions and various physical situations painted in the flow configuration, the governing colloidal model by plugging the influences of slip condition, permeability, radiative heat flux and heat generation/absorption described asThe associated flow conditions at the permeable surface and apart from it are described in the following way:The associated invertible transformations for under consideration colloidal model are described as:To improve the heat transfer efficiency of AA7072-Methanol and AA7075-Methanol, following effective models are adopted:12:Thermophysical properties for alloys AA7072, AA7075 and host liquid methanol described in Table 1By implementing the described invertible transformations and nanofluids characteristics in the governing colloidal model, the following version of the model along with flow conditions is attained:6 when For similarity solution of the system of ODEs governing the colloidal model, parameters embedded in Eq.  are indes in Eq. , we arriTherefore, when the parameters defined as in Eq.  then theThe local shear stresses and heat transfer rate expressed by the following formulas:After simplification following version is attained:22 is implemented. In ordered to apply the algorithm on under consideration colloidal models, first the transformations made for the velocity and temperature equations:The colloidal models AA7072-Methanol and AA7075-Methanol are nonlinear and tedious system of ODEs associated with multiple conditions based on imposed physical situations. So, it is tough or not even possible to solved the models for closed form solutions. Therefore, the models treated numerically. For said purpose, coupling of RK with shooting techniqueAfter plugging these transformations in model given in Eqs.  and 12)12) we atThe movement of AA702-Methanol and AA7075-Methanol against the velocity slip effects is decorated in Fig. Figure The alterations in the temperature The temperature alterations in radiative AA7072-Methanol and AA7075-Methanol nanoliquids under the influence of heat absorption are depicted in Fig. Figures This subsection deals with the influences of heat generation/absorption and velocity slip parameters on the temperature The temperature This subsection captured the trends in shear stresses and nusselt number for multiple under consideration flow parameters. From the analysis, more shear stresses on the surface are examined for suction of the fluid and stronger velocity slip effects. For injecting of the fluid, these trends become slow. Similarly, for higher velocity slip parameter more heat transfer trends at the surface are detected for suction case. These trends are painted in Fig. 6 for the particular value of the parameters. These results are incorporated in Table 6 that validate our analysis. The computation is perfomed by taking upper limit as This subsection conveys the comparative analysis of the present study with existing literature. The results for entclass1pt{minimaThe velocity of AA7072-Methanol and AA7075-Methanol abruptly increases for stronger velocity slip effects and momentum boundary layer thickness declines due to suction of the fluid.The temperature of the nanofluids enhances for stronger thermal radiations and heat energy inside the plate; while heat absorption opposes the fluid temperature.The temperature effects prevailed throughout the analysis for stronger heat generation in the plate.The shear stresses at the surface increases for suction of the fluid because more fluid particles transfer at the surface due to suction.The stronger thermal slip effects lead to drops in the local heat transfer rate for both AA7072-Methanol and AA7075-Methanol.The flow of AA7072-Methanol and AA7075-Methanol over a radiative permeable plate under the influence of different physical flow conditions is presented. From the comprehensive discussion of the results, it is concluded that: