Assessing the Predictive Accuracy of the aMAP Risk Score for Hepatocellular Carcinoma (HCC): Diagnostic Test Accuracy and Meta-analysis.

Purpose: We aimed to perform a meta-analysis with the intention of evaluating the reliability and test accuracy of the aMAP risk score in the identification of HCC. Methods: A systematic search was performed in PubMed, Scopus, Cochrane, Embase, and Web of Science databases from inception to September 2023, to identify studies measuring the aMAP score in patients for the purpose of predicting the occurrence or recurrence of HCC. The meta-analysis was performed using the meta package in R version 4.1.0. The diagnostic accuracy meta-analysis was conducted using Meta-DiSc software. Results: Thirty-five studies 102,959 participants were included in the review. The aMAP score was significantly higher in the HCC group than in the non-HCC group, with a mean difference of 6.15. When the aMAP score is at 50, the pooled sensitivity, specificity, negative likelihood ratio, and positive likelihood ratio with 95% CI was 0.961 (95% CI 0.936, 0.976), 0.344 (95% CI 0.227, 0.483), 0.114 (95% CI 0.087, 0.15), and 1.464 (95% CI 1.22, 1.756), respectively. At a cutoff value of 60, the pooled sensitivity, specificity, negative likelihood ratio, and positive likelihood ratio with 95% CI was 0.594 (95% CI 0.492, 0.689), 0.816 (95% CI 0.714, 0.888), 0.497 (95% CI 0.418, 0.591), and 3.235 (95% CI 2.284, 4.582), respectively. Conclusion: The aMAP score is a reliable, accurate, and easy-to-use tool for predicting HCC patients of all stages, including early-stage HCC. Therefore, the aMAP score can be a valuable tool for surveillance of HCC patients and can help to improve early detection and reduce mortality.

Development of Aczel-Alsina t-norm based linear Diophantine fuzzy aggregation operators and their applications in multi-criteria decision-making with unknown weight information.

Aczel-Alsina t-norm and t-conorm are intrinsically flexible and endow Aczel-Alsina aggregation operators with greater versatility and robustness in the aggregation process than operators rooted in other t-norms and t-conorm families. Moreover, the linear Diophantine fuzzy set (LD-FS) is one of the resilient extensions of the fuzzy sets (FSs), intuitionistic fuzzy sets (IFSs), Pythagorean fuzzy sets (PyFSs), and q-rung orthopair fuzzy sets (q-ROFSs), which has acquired prominence in decision analysis due to its exceptional efficacy in resolving ambiguous data. Keeping in view the advantages of both LD-FSs and Aczel-Alsina aggregation operators, this article aims to establish Aczel-Alsina operation rules for LD-FSs, such as Aczel-Alsina sum, Aczel-Alsina product, Aczel-Alsina scalar multiplication, and Aczel-Alsina exponentiation. Based on these operation rules, we expose the linear Diophantine fuzzy Aczel-Alsina weighted average (LDFAAWA) operator, and linear Diophantine fuzzy Aczel-Alsina weighted geometric (LDFAAWG) operator and scrutinize their distinctive characteristics and results. Additionally, based on these aggregation operators (AOs), a multi-criteria decision-making (MCDM) approach is designed and tested with a practical case study related to forecasting weather under an LD-FS setting. The developed model undergoes a comparative analysis with several prevailing approaches to demonstrate the superiority and accuracy of the proposed model. Besides, the influence of the parameter Λ on the ranking order is successfully highlighted.

Optimizing physicochemical properties, antioxidant potential, and antibacterial activity of dry ginger extract using sonication treatment.

This research paper focused on enhancing the physico-chemical attributes, antioxidant capacity, and antibacterial effectiveness of dry ginger extract through sonication as an assistant extraction treatment. Ginger, resulting from the rhizome of Zingiber officinale Roscoe, is known for its culinary and medicinal uses outstanding to its antioxidant and antimicrobial possessions from phenolic acids and flavonoids. The study explored the use of sonication as an assistant extraction method and found that it significantly augmented the total phenolic content of the ginger extract by 28 % compared to traditional extraction methods, reaching 10.55 ± 1.50 mg GAE/g, DW. The research assessed the physicochemical belongings, antioxidant action, and antibacterial possibility of the sonicated ginger extract. The sonicated extract exhibited scavenging activity against the DPPH radical of 56.0 %. Pearson correlation investigation revealed a strong confident correlation between the phenolic content and antioxidant activity (r = 0.92, p < 0.01), as well as volatile compounds exhibited a moderate confident correlation with antibacterial action (r = 0.67, p < 0.05). The sonicated ginger extract also demonstrated potent antibacterial action, preventing the growth of both Gram-positive and Gram-negative bacteria. These findings contribute to the development of more efficient methods for extracting phenolic from ginger and provide insights into the relationships between phenolic and bioactive properties.

Heavy metals in spices and herbs from worldwide markets: A systematic review and health risk assessment.

Culinary spices and herbs, renowned for their flavor, aroma, and medicinal properties, contain essential nutrients but also may pose health concerns due to heavy metal contamination. This systematic review, in accordance with PRISMA guidelines, investigates the global concentrations of heavy metals in culinary spices and herbs, and evaluates associated health risks. Fifty peer-reviewed studies from Scopus, PubMed, and Web of Science were examined and findings revealed variations in heavy metal content based on country of origin and spice type. In the MENA region, caraway and green cardamom from Bahrain had high levels of Pb (2.2 µg/g) and Cd (0.9 µg/g). Indian spices like cloves and Ajwain seeds exhibited high levels of iron (17.87 ± 8 mg/kg) and calcium (1353 ± 10 mg/kg). African and European spices showed regional disparities, with some exceeding permissible Pb and Cd limits. Non-carcinogenic human health risk assessments via oral exposure pathway conducted on reported Cd, Ni, and Cu concentrations throughout the reviewed global studies revealed no risks across all regions and for all spices and herbs under study except in Turkey for Cd levels found in chamomile with hazard quotients ranging between 1.26 and 1.47. On the other hand, carcinogenic risks varied based on reported Pb concentrations, ranging from 8.5 × 10-8 to a maximum of 4.96 × 10-3. These findings underscore the need for global vigilance in food safety practices and future research in countries with less stringent policies. Recommendations include improved agricultural practices, enhanced soil management, and stringent post-harvest procedures to mitigate contamination.

The association of social media with dietary behaviors among adults in the United Arab Emirates.

Background: Social media is an online community that offers a digital setting where people create, share, and access a wide range of information, knowledge, and viewpoints. This study assessed the association between social media use and eating behaviors and whether sociodemographic characteristics and lifestyle habits are correlated with this association. In addition, it assessed whether this effect is different according to changes in lifestyle habits due to the COVID-19 pandemic among adults in the United Arab Emirates (UAE). Methodology: A cross-sectional web-based study was conducted among 1056 adults living in the UAE. Information on sociodemographic characteristics, social media use, and dietary habits were collected. The Scale of Effects of Social Media on Eating Behavior (SESMEB) was used and a total score ranging from 18 to 90 was generated with higher scores corresponding to a greater effect. The general linear model analysis assessed associations of certain characteristics with the score. Independent T-test and one-way ANOVA test were used to investigate differences based on changes in lifestyle habits due to COVID-19. Results: Most participants (80.3 %) reported using social media >2 h/day. The mean score was 44.15 ± 12.68 (range 18-90). Increasing age, being a male, spending less time on social media, and not following influencers were associated with lower SESMEB scores. Not consuming breakfast and spending more time on screens for leisure were associated with higher scores (p < 0.05). Significantly higher scores were recorded for those previously infected with COVID-19 and who reported an increase in screen time, food intake, body weight, and meals/day (p < 0.05). Conclusion: Social media appears to have an association with adults' dietary habits in the UAE. Spending more time on social media, being a female, and having more screen time were associated with a higher impact. Targeted programs are needed to increase awareness and advocate for a positive lifestyle with social media use.

Valorization of sesame seed coat waste: phenolic composition, antibacterial efficacy, and nanoemulsion encapsulation for food preservation.

The study highlighted the potential of sesame seed coat (SSC), typically discarded during sesame paste processing, as a valuable resource for valorization through extracting bioactive compounds. It examined the phenolic composition and antioxidant activity of SSC, and evaluated its antibacterial properties against foodborne pathogens such as Listeria monocytogenes, Escherichia coli O157:H7, and Salmonella Typhimurium. Additionally, SSC underwent nanoemulsion coating, analyzed using dynamic light scattering and scanning electron microscopy, to enhance its application as a natural preservative. The research specifically focused on incorporating SSC nanoemulsion into milk to determine its effectiveness as a preservative. SSC demonstrated considerable antioxidant activity and phenolic content, with catechin identified as the predominant polyphenol. GC-MS analysis revealed seven major compounds, led by oleic acid. Notably, SSC effectively inhibited L. monocytogenes in broth at 100 mg/ml. The application of SSC and its nanoemulsion resulted in changes to bacterial morphology and a significant reduction in bacterial counts in milk, highlighting its potential as an effective natural antibacterial agent. The findings of this study highlight the potential use of SSC as a valuable by-product in the food industry, with significant implications for food preservation.

Mapping the Grounds for Mortalities in Acute Myeloid Leukemia Through Registry Analyses: A Retrospective Cohort Study of Children, Adolescents, and Young Adults Patients.

Background: Our objective was to identify non-malignant factors that contribute to mortality in children, adolescents and young adults, aiming to improve patient follow-up and reduce mortality rates to achieve better survival outcomes. Methods: We analyzed 8,239 acute myeloid leukemia (AML) cases diagnosed between 2000 and 2019 in the USA. Using version 8.4.0.1 of the Surveillance, Epidemiology, and End Results (SEER)*Stat software, we calculated the standardized mortality ratios (SMRs) and 95% confidence intervals (CIs) for each cause of death. Results: Out of the 3,165 deaths observed in the study population, the majority (2,245;70.9%) were attributed to AML itself, followed by non-AML cancers (573; 18.1%) and non-cancerous causes (347; 10.9%). Conclusions: Patients with AML are at a higher risk of developing other types of cancer and granulocyte deficiencies, which increases the risk of death from non-cancerous causes such as infections. Moreover, treatment for AML carries the risk of cardiac problems. AML is commoner in males than females.

EWSR1::ATF1 fusions characterize a group of extra-abdominal epithelioid and round cell mesenchymal neoplasms, phenotypically overlapping with sclerosing epithelioid fibrosarcomas, and intra-abdominal FET::CREB fusion neoplasms.

With the increasing use of next generation sequencing in soft tissue pathology, particularly in neoplasms not fitting any World Health Organization (WHO) category, the spectrum of EWSR1 fusion-associated soft tissue neoplasms has been expanding significantly. Although recurrent EWSR1::ATF1 fusions were initially limited to a triad of mesenchymal neoplasms including clear cell sarcoma of soft tissue, angiomatoid fibrous histiocytoma and malignant gastrointestinal neuroectodermal tumor (MGNET), this family has been expanding. We herein describe 4 unclassified extra-abdominal soft tissue (n = 3) and bone (n = 1) neoplasms displaying epithelioid and round cell morphology and carrying an EWSR1::ATF1 fusion. Affected were 3 males and 1 female aged 20-56 years. All primary tumors were extra-abdominal and deep-seated (chest wall, mediastinum, deltoid, and parapharyngeal soft tissue). Their size ranged 4.4-7.5 cm (median, 6.2). One patient presented with constitutional symptoms. Surgery with (2) or without (1) neo/adjuvant therapy was the treatment. At last follow-up (8-21 months), 2 patients developed progressive disease (1 recurrence; 1 distant metastasis). The immunophenotype of these tumors is potentially misleading with variable expression of EMA (2 of 3), pankeratin (2 of 4), synaptophysin (2 of 3), MUC4 (1 of 3), and ALK (1 of 3). All tumors were negative for S100 and SOX10. These observations point to the existence of heretofore under-recognized group of epithelioid and round cell neoplasms of soft tissue and bone, driven by EWSR1::ATF1 fusions, but distinct from established EWSR1::ATF1-associated soft tissue entities. Their overall morphology and immunophenotype recapitulate that of the emerging EWSR1/FUS::CREB fusion associated intra-abdominal epithelioid/round cell neoplasms. Our cases point to a potentially aggressive clinical behavior. Recognizing this tumor type is mandatory to delineate any inherent biological and/or therapeutic distinctness from other, better-known sarcomas in the differential diagnosis including sclerosing epithelioid fibrosarcoma.

Survival of Salmonella spp., Escherichia coli O157:H7, and Listeria monocytogenes in Ready-to-Eat "Guacamole": Role of Added Antimicrobials.

Ensuring the microbiological safety of food products is majorly important to regulatory agencies, producers, and consumers. This study aimed to examine the effects of three different antimicrobial agents, including chitosan (CH), mastic oil (M), and citric acid (CA), individually or as a combination, against Salmonella spp., Escherichia coli O157:H7, and Listeria monocytogenes (artificially inoculated) in Guacamole, a ready-to-eat (RTE) avocado-based salad. The Guacamole samples included untreated samples, designated as CNL, and samples treated as follows: CA 0.15% and CA 0.30% with citric acid added at 0.15% and 0.30% v/w; CH 0.5% and CH 1% with chitosan at 0.5 and 1% v/w; M 0.2% and M 0.4% with mastic essential oil (EO) at 0.2% and 0.4% v/w; CACH with CA 0.30% and CH 1% v/w; CAM with CA 0.30% and M 0.4% v/w; CHM with CH 1% and M 0.4% v/w; and CACHM with CA 0.30%, CH 1%, and M 0.4% v/w. Microbiological evaluation, monitoring of the pH values, and proximate analyses (moisture, fat, protein, ash, and water activity) were performed at different time intervals (days 0, 1, 3, 5, and 7) at two storage temperatures (4 and 10 °C). Antimicrobial treatments, particularly CH 1% and CACHM, effectively (p < 0.05) reduced Salmonella spp. and E. coli O157:H7 populations at 4 °C, while CACHM showed the most efficacy against L. monocytogenes. However, at 10 °C, antimicrobials had limited impact, and the bacterial counts exhibited an increasing trend during storage. The pH values in the avocado-based salad samples showed, in general, higher decreases at 10 compared to 4 °C, with the CHM combination showing the highest antimicrobial effect.

Impact of Privatization on Healthcare System: A Systematic Review.

Background: A notable shift in healthcare policy is healthcare privatization, which refers to the transfer of ownership, management, or provision of healthcare services from the public sector to private entities. Objectives: To provide a narrative examination of the impact of privatization on various dimensions of healthcare, including quality, equity, accessibility, and cost-effectiveness. Policymakers can utilize the findings of this study to make well-informed decisions regarding privatization strategies. Materials and Methods: A systematic review was implemented using the following databases: PubMed, Scopus, and Google Scholar. Studies conducted from January 2000 to January 2023 in developing or developed countries that assessed the impact of healthcare privatization on population health within public sector institutions were included. Results: Eleven studies were included. The findings revealed diverse perspectives on the impact of healthcare privatization, with four studies (36.4%) supporting privatization (two of these were conducted in Saudi Arabia), six studies (54.5%) opposing it (three of these were conducted in European countries), and one study (9.1%) taking a neutral stance. Two studies investigated the impact on healthcare quality, and both revealed that privatization negatively impacts uninsured patients and low-income populations. In addition, five studies investigated the healthcare access and equity dimensions following privatization: one was in favor, one was neutral, and three were opposing it. Four studies investigated the cost-effectiveness dimension, with three in favor and one study opposing it. Conclusion: This review highlights different perspectives on healthcare privatization. While studies, as those from Saudi Arabia, suggest benefits in terms of efficiency and innovation, others, particularly from European countries, emphasize negative consequences such as inequity and reduced quality. This emphasizes the need for more investigations to understand privatization's impact on healthcare.

Role of marination, natural antimicrobial compounds, and packaging on microbiota during storage of chicken tawook.

The aim of this study was to investigate the antimicrobial effect of marination, natural antimicrobials, and packaging on the microbial population of chicken tawook during storage at 4°C. Chicken meat was cut into 10 g cubes and marinated. The chicken was then mixed individually with 0.5% or 1% (w/v) vanillin (VA), ß-resorcylic acid (BR), or eugenol (EU), and stored under aerobic (AP) or vacuum (VP) packing at 4°C for 7 d. The marinade decreased microbial growth as monitored by total plate count, yeast and mold, lactic acid bacteria, and Pseudomonas spp. by about 1 log cfu/g under AP. The combination of marinade and antimicrobials under AP and VP decreased growth of spoilage-causing microorganisms by 1.5 to 4.8 and 2.3 to 4.6 log cfu/g, respectively. Change in pH in VP meat was less than 0.5 in all treated samples including the control. Marination decreased the lightness of the meat (L*) and significantly (p < 0.05) increased the redness (A*) and yellowness (B*). Overall acceptability was highest for marinated samples with 0.5% BR.

Adolescents' use of online food delivery applications and perceptions of healthy food options and food safety: a cross-sectional study in the United Arab Emirates.

Introduction: This cross-sectional study aimed to assess Online food delivery applications (OFDA) usage trends among adolescent users in the United Arab Emirates (UAE), focusing on their perceptions of healthy food options and food safety (n = 532). Methods: Sociodemographic information, frequency of OFDA use, factors affecting food choices, and perceptions of healthy food and food safety were investigated. A total perception score was calculated for each participant. Results: Most participants used OFDAs weekly (65.4%), favoring fast food (85.7%). Factors like appearance and price drove food choices (65.0%), while taste and cost hindered healthy food orders (29.7 and 28.2%). Younger and frequent users had lower scores for perceiving healthy food, while seeking healthy options was associated with higher scores (p < 0.05). Females and those seeking healthy food showed higher food safety scores (p < 0.05). Discussion: The study suggests tailored interventions to promote healthier choices and improve food safety perceptions among adolescents using OFDAs in the UAE.

Survival and growth behavior of common foodborne pathogens in falafel paste under different storage temperatures.

Falafel is a popular breakfast food in the Middle East that has been recently involved in several outbreaks of foodborne illnesses. The aim of the study was to explore the growth behavior of Salmonella enterica, Escherichia coli O157:H7, Shigella sonnie, Shigella flexneri, Listeria monocytogenes and Staphylococcus aureus in falafel paste (FP) under different storage temperatures (4, 10, or 24 °C) for 14 days. FP (pH = 6.2, aw = 0.96) was inoculated with 5.0 to 6.0 log CFU/g of each of the pathogens separately. Salmonella spp. significantly declined by 1.5 log at 4 °C but grew significantly by ca. 2 and 4 log at 10 and 24 °C, respectively after 14 days. E. coli O157:H7 significantly increased (4.5 log) in FP when stored under 24 °C and survived at a level of ~105 CFU/g at 10 °C. Comparatively, Sh. sonnie and Sh. flexneri showed a better survival pattern in FP stored under 4 °C and grew (˃ 3 log) after 5 days at 10 and 24 °C. L. monocytogenes was capable of growing by 1.9 and 4.3 log after 14 d days and by 3.9 log after 3 days at 4, 10, or 24 °C, respectively. No significant decline in S. aureus counts at 4 and 10 °C occurred, however, it increased significantly to ˃ 7 log CFU/g at 24 °C. Total mesophilic count and yeast and mold count reached to spoilage levels (˃107 CFU/g) in un-inoculated FP after 1 and 3 days of storage at 24 and 10 °C, respectively. FP could support the growth of common foodborne pathogens and hence it is recommended to utilize natural antimicrobials in FP and keep the product under refrigeration (4 °C) to preclude the growth of vegetative foodborne pathogens.

Antimicrobial activity of eugenol and carvacrol against Salmonella enterica and E. coli O157:H7 in falafel paste at different storage temperatures.

The objectives of the current study were: i) to investigate the antimicrobial activity of 0.125, 0.250 and 0.50 % (7.54, 15.08 and 30.17 mmol/Kg of eugenol) and (8.15, 16.31, and 33.61 mmol/Kg of carvacrol) against S. enterica and E. coli O157:H7 in falafel paste (FP) stored at 4, 10 or 25 °C for 10 d; and ii) to study the sensory properties of fried falafel treated with eugenol and carvacrol. S. enterica grew well in untreated falafel (control) samples at 10 and 25 °C, while E. coli O157:H7 grew only at 25 °C. However, numbers of S. enterica and E. coli O157:H7 in FP stored at 4 °C were reduced by 1.4-1.6 log CFU/g after 10 d. The antimicrobial agents were more effective at 25 °C against S. enterica, but were better at 4 and 10 °C against E. coli O157:H7. Addition of 0.125-0.5 % eugenol or carvacrol reduced the S. enterica numbers to undetectable level by direct plating (2 log CFU/g) by 2-10 d at 25 °C. FP samples treated with 0.5 % eugenol or 0.25-0.5 % carvacrol were negative for S. enterica cells by enrichment (1 CFU/5 g) by 10 d at 25 °C. In contrast, viable E. coli O157:H7 were not detected by direct plating when FP was treated with 0.25-0.5 % carvacrol or 0.5 % eugenol and stored at 4 °C by 2 d. Addition of eugenol or carvacrol did not affect the color, texture, and appearance of fried falafel but decreased the flavor and overall acceptability scores compared to untreated falafel. Using eugenol and carvacrol as natural antimicrobials have the potential to enhance the safety of FP by reducing the threat from foodborne pathogens.

Unraveling the potential nutritional benefits of fermented date syrup waste: Untargeted metabolomics and carbohydrate metabolites of in vitro digested fraction.

Valorization of fruit by-products is a crucial area of research for the development of innovative bio-based products. This study investigated the physicochemical properties and health-promoting benefits of date syrup waste, both fermented by Pichia cecembensis or Pichia kudriavzevii (FDSW), and unfermented (CDSW). Metabolomics profiles of these samples were identified post in vitro digestion. FDSW exhibited 42 volatile compounds, including 9 new ones, and contained (-)-epicatechin, tyrosol, and gallic acid. Bioaccessible fractions of FDSW demonstrated substantial α-amylase inhibition, with percentages of 40.7 % and 53.9 %, respectively. FDSW displayed superior cytotoxicity against Caco2 and MCF-7 cancer cell lines, with an average of âˆ¼75 % and 56 %, respectively. Untargeted metabolomics analysis revealed an increase in secondary metabolites, totaling 27 metabolites. LC-QTOF analysis of bioaccessible carbohydrate metabolites in FDSW identified two phytochemical groups, alkaloids, and terpenoids. This study underscores the potential of FDSW for producing value-added bio-based products with desirable characteristics and health benefits.

Preservative effect of pomegranate-based marination with ß-resorcylic acid and cinnamaldehyde on the microbial quality of chicken liver.

Chicken liver is considered a delicacy in the Middle East where pomegranate molass is commonly used as a salad dressing and in marinade recipes. Marinated chicken liver is a common entrée and represents a value-added product compared to the otherwise unmarinated liver which commands a lower price. The aim of this study was to investigate the inhibitory effects of a pomegranate-based marinade alone or following the addition of cinnamaldehyde or ß-resorcylic acid on the spoilage microorganisms present in chicken liver during storage for 14 d at 4°C or under mild temperature abuse conditions (10°C). The pH and microbial populations of total plate count (TPC), lactic acid bacteria (LAB), Pseudomonas spp. (PS), yeast and mold (YM), and Enterobacteriaceae (EN) were tested during the storage period and the shelf life was determined (defined as 107 log cfu/g). Sensory analysis was also conducted. The pH increased by a greater extent in unmarinated samples as compared to marinated samples (with or without antimicrobials) upon storage. The initial TPC, LAB, PS, YM, and EN microbial populations in the chicken liver were 3.85 ± 0.79, 3.73 ± 0.85, 3.85 ± 0.79, 3.73 ± 0.87, and 3.69 ± 0.23 log cfu/g, respectively. The marinade decreased the microbial populations by 2 to 4 log cfu/g. The marinade and antimicrobial mixture decreased the microbial populations by 3 to 4 log cfu/g. Except for 1 sample, none of the marinated chicken liver samples with or without antimicrobials reached the end of shelf life even up to 14 d of storage at both 4°C and 10°C. The overall sensory score was rated around 6/9 for the treated samples.

Caffeine intake and its association with nutrition, sleep, and physical activity among schoolchildren in the United Arab Emirates: a national cross-sectional study.

PURPOSE: Recent surveys indicate a significant increase in total caffeine intake among schoolchildren. Limited research has been published concerning the total intake of caffeine among schoolchildren in the Middle East and Gulf Cooperation Council (GCC) countries, including the UAE. METHODS: This cross-sectional survey estimated the total caffeine intake from foods and beverages among 10,275 schoolchildren in the UAE. Caffeine intakes were related to the European Food Safety Authority's level of no safety concern (3.0 mg/kg BW) and level of effects on sleep (1.4 mg/kg BW). RESULTS: More than half (56.2%) of the students consumed more than 100 mg (the upper limit allowed) of caffeine from dietary sources. High intake of caffeine (> 100 mg/day) was significantly associated (p = 0.001) with reduced sleep duration, difficulty falling asleep, infrequent exercising, using smart devices for more than 2 h a day, getting a lower GPA, skipping breakfast, eating fewer servings of vegetables than recommended, frequent consumption of fast food and more frequent snack consumption. CONCLUSION: Excessive intake of caffeine from different dietary sources coexists with unhealthy dietary and lifestyle behaviors and sleep problems. Tailoring educational programs and intervention strategies is warranted to correct the unhealthy intake of caffeine and the associated unhealthy dietary and lifestyle behaviors among schoolchildren in the UAE.

Correction: Healthy food and determinants of food choice on online food delivery applications.

[This corrects the article DOI: 10.1371/journal.pone.0293004.].

Etiology of Acute Lower Respiratory Illness Hospitalizations Among Infants in 4 Countries.

Background: Recent studies explored which pathogens drive the global burden of pneumonia hospitalizations among young children. However, the etiology of broader acute lower respiratory tract infections (ALRIs) remains unclear. Methods: Using a multicountry study (Albania, Jordan, Nicaragua, and the Philippines) of hospitalized infants and non-ill community controls between 2015 and 2017, we assessed the prevalence and severity of viral infections and coinfections. We also estimated the proportion of ALRI hospitalizations caused by 21 respiratory pathogens identified via multiplex real-time reverse transcription polymerase chain reaction with bayesian nested partially latent class models. Results: An overall 3632 hospitalized infants and 1068 non-ill community controls participated in the study and had specimens tested. Among hospitalized infants, 1743 (48.0%) met the ALRI case definition for the etiology analysis. After accounting for the prevalence in non-ill controls, respiratory syncytial virus (RSV) was responsible for the largest proportion of ALRI hospitalizations, although the magnitude varied across sites-ranging from 65.2% (95% credible interval, 46.3%-79.6%) in Albania to 34.9% (95% credible interval, 20.0%-49.0%) in the Philippines. While the fraction of ALRI hospitalizations caused by RSV decreased as age increased, it remained the greatest driver. After RSV, rhinovirus/enterovirus (range, 13.4%-27.1%) and human metapneumovirus (range, 6.3%-12.0%) were the next-highest contributors to ALRI hospitalizations. Conclusions: We observed substantial numbers of ALRI hospitalizations, with RSV as the largest source, particularly in infants aged <3 months. This underscores the potential for vaccines and long-lasting monoclonal antibodies on the horizon to reduce the burden of ALRI in infants worldwide.

Caffeinated energy drink consumption among Emirati adolescents is associated with a cluster of poor physical and mental health, and unhealthy dietary and lifestyle behaviors: a cross-sectional study.

Background: Consumption of caffeinated energy drinks (CED) has escalated during the last few years, especially among schoolchildren, with evident adverse health sequelae in this critical age group. Objective: This study examined the prevalence of CED consumption and its associations with sleep, physical and mental health, and dietary and lifestyle habits among schoolchildren in the United Arab Emirates (UAE). Method: A structured self-administered online questionnaire was developed and disseminated among schoolchildren aged 14-18 years, selected from schools of the seven emirates of the UAE. Results: More than 4,500 (N= 4,648) responses received. A relatively low prevalence of CED consumption (20%) was found among schoolchildren in the UAE. However, those who reported CED consumption were more likely to report unhealthy dietary (skipping breakfast, frequent snacking, and eating fast foods, low fruit, and vegetable intake) and lifestyle behaviors (long screen time, poor sleep health), in addition to poor self-reported mental and physical health than non-users. CED consumption was significantly and variably associated with multiple sociodemographic factors such as students' nationality, parental companionship, sex, school type, education level (children's and parents'), daily allowance, academic performance, screen time, sleep quality parameters, self-reported physical and mental health, and parents' employment. Sources of knowledge about CED were social media (55%), friends/schoolmates (52%), and family members (52%). Students believed that CED constitute sugar (87%), caffeine (69%), artificial flavors (67%) sweeteners (54%), and stimulating components (43%). The majority (70%) of students reported that CED consumption increases the risks for heart disease, diabetes, high blood sugar (65%), addiction (64%), high blood pressure (59%), and obesity (57%). Conclusion: These results offer important insights for health professionals, child health specialists, policymakers, and parents in the UAE regarding adolescents' attitudes, knowledge and behaviors toward CED consumption.