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The mathematical interpretation of interventions for the mitigation of epidemics in the literature often involves finding the optimal time to initiate an intervention and/or the use of the number of infections to manage impact. Whilst these methods may work in theory, in order to implement effectively they may require information which is not likely to be available in the midst of an epidemic, or they may require impeccable data about infection levels in the community. In reality, testing and cases data can only be as good as the policy of implementation and the compliance of the individuals, which implies that accurately estimating the levels of infections becomes difficult or complicated from the data that is provided. In this paper, we demonstrate a different approach to the mathematical modelling of interventions, not based on optimality or cases, but based on demand and capacity of hospitals who have to deal with the epidemic on a day to day basis. In particular, we use data-driven modelling to calibrate a susceptible-exposed-infectious-recovered-died type model to infer parameters that depict the dynamics of the epidemic in several regions of the UK. We use the calibrated parameters for forecasting scenarios and understand, given a maximum capacity of hospital healthcare services, how the timing of interventions, severity of interventions, and conditions for the releasing of interventions affect the overall epidemic-picture. We provide an optimisation method to capture when, in terms of healthcare demand, an intervention should be put into place given a maximum capacity on the service. By using an equivalent agent-based approach, we demonstrate uncertainty quantification on the likelihood that capacity is not breached, by how much if it does, and the limit on demand that almost guarantees capacity is not breached.

The prevalence of mental health conditions and national suicide rates are increasing in many countries. Lithium is widely and effectively used in pharmacological doses for the treatment and prevention of manic/depressive episodes, stabilising mood and reducing the risk of suicide. Since the 1990s, several ecological studies have tested the hypothesis that trace doses of naturally occurring lithium in drinking water may have a protective effect against suicide in the general population. To synthesise the global evidence on the association between lithium levels in drinking water and suicide mortality rates. The MEDLINE, Embase, Web of Science and PsycINFO databases were searched to identify eligible ecological studies published between 1 January 1946 and 10 September 2018. Standardised regression coefficients for total (i.e. both genders combined), male and female suicide mortality rates were extracted and pooled using random-effects meta-analysis. The study was registered with PROSPERO (CRD42016041375). The literature search identified 415 articles; of these, 15 ecological studies were included in the synthesis. The random-effects meta-analysis showed a consistent protective (or inverse) association between lithium levels/concentration in publicly available drinking water and total (pooled β = -0.27, 95% CI -0.47 to -0.08; P = 0.006, I2 = 83.3%), male (pooled β = -0.26, 95% CI -0.56 to 0.03; P = 0.08, I2 = 91.9%) and female (pooled β = -0.13, 95% CI -0.24 to -0.02; P = 0.03, I2 = 28.5%) suicide mortality rates. A similar protective association was observed in the six studies included in the narrative synthesis, and subgroup meta-analyses based on the higher/lower suicide mortality rates and lithium levels/concentration. This synthesis of ecological studies, which are subject to the ecological fallacy/bias, supports the hypothesis that there is a protective (or inverse) association between lithium intakes from public drinking water and suicide mortality at the population level. Naturally occurring lithium in drinking water may have the potential to reduce the risk of suicide and may possibly help in mood stabilisation, particularly in populations with relatively high suicide rates and geographical areas with a greater range of lithium concentration in the drinking water. All the available evidence suggests that randomised community trials of lithium supplementation of the water supply might be a means of testing the hypothesis, particularly in communities (or settings) with demonstrated high prevalence of mental health conditions, violent criminal behaviour, chronic substance misuse and risk of suicide.

Lithium can be found naturally in drinking water. In clinical practice, it is widely used in pharmacological doses for the treatment of bipolar disorder; and may also prevent suicidal behaviour in people with mood disorders. In two studies, lithium levels in tap water have been significantly and negatively correlated with suicide. We measured lithium levels in tap water in the 47 subdivisions of the East of England and correlated these with the respective suicide standardised mortality ratio in each subdivision. We found no association between lithium in drinking water and suicide rates across the East of England from 2006 to 2008.

Background The incidence of kidney cancer, which is 34% attributable to obesity and smoking, has been steadily increasing over the past few decades in many countries in Europe, North America and Oceania. In recent years, there have been several reports of increasing incidence of early-onset cancer in young adults aged <50 years. We conducted a retrospective population-based cohort study to examine whether there have been changes in the incidence of kidney cancer in England during the past four decades. Methods Individual-level, national (population-based) cancer registration data for patients diagnosed with kidney cancer (ICD-10 code, C64) in England from 1985–2020 were obtained from the Office for National Statistics/Public Health England. Average annual incidence rates (AAIR) were calculated by two age categories (<50, 50+ years) and gender during the six five-year time periods (1985–89 to 2010–14) and the recent six-year period (2015–20). The percentage change in the incidence rates in each age group and gender was calculated as the change in the AAIR from the first (1985–89) to the last time period (2015–20). The Average Annual Percentage Change (AAPC, year-on-year increase in incidence rates during 1985–2000) was estimated using the slope of the linear trend line fitted to the incidence rates by year of diagnosis. Results During the 36-year study period (1985–2020), a total of 206,816 cases (62.4% males, 37.6% females) of kidney cancer were registered in England. In young adults aged <50 years, the AAIRs (per 100,000 population) increased by 157% in males and 133% in females (from 1.4 in 1985–89 to 3.6 in 2015–20 in males and from 0.9 in 1985–89 to 2.1 in 2015–20 in females). In older adults aged 50+ years, the AAIRs increased by 127% in males and 144% in females (from 24.5 in 1985–89 to 55.5 in 2015–20 in males and from 11.9 in 1985–89 to 29.0 in 2015–20 in females). The AAPC during the 36-year period was 5.0% in people aged <50 years compared to 4.7% in those aged 50+ years. Conclusion There has been a steady and substantial increase in the incidence of kidney cancer in England over the past four decades. This was partly driven by the largest and unexpected increase in the incidence of early-onset kidney cancer in young adults aged <50 years, which was steepest in males. Some of this increase is in analogy with the increasing prevalence of obesity; nevertheless, other causes driving this increase in early-onset kidney cancer in young adults remain elusive and need further investigation.

The Doubly-Fed Induction Generator (DFIG) is preferred for wind turbines (WTs) due to their variable speed capability, reinforcing energy capture efficiency. Despite its advantages, researchers continually face challenges in managing the DFIG, including overshooting, rising time, and stability under fault conditions. The faults in WTs may stem from the grid or different operational disturbances. The crowbar protection mechanism is an efficient strategy to reduce fault impacts on DFIGs. However, the traditional hysteresis-based methods to detect faults and crowbar activation are prone to false triggering, and to address the challenges posed, this paper presents a novel control strategy that increases the low-voltage ride-through (LVRT) capability of the grid-connected DFIG systems by incorporating Fuzzy Logic Control (FLC) to enhance accuracy in fault detection and employs the Salp Swarm Optimization Algorithm (SSA) to refine controller parameters. The SSA algorithm shows a superior dynamic response and stabilizes the DFIG system efficiently. Besides, the SSA algorithm precisely calibrates the proportional-integral (PI) controller gains and DC-link capacitance values to achieve the optimal transient response between Distributed Generation (DG) integration and fluctuating loads. It is evident by the results that the power quality is improved, and the active power overshoot value is decreased from 10.12 × 10 6 to 3.78 × 10 6 . Moreover, by implementing the SSA algorithm in which the overshoot value is also decreased from 15.01 × 10 6 to 6.10 × 10 6 , the best results are achieved. The proposed method is validated by comparative analyses with recent studies that showcase its superiority in refining machine dynamics and decreasing overshoots and transients. Henceforth, the obtained results validate the proposed method’s ability to compete against other conventional methods.

Background This cross-sectional cohort study assessed the inequalities in oesophageal carcinoma risk by age, sex and nativity in Kuwait: 1980–2019. Methods Using oesophageal cancer incidence data from the Kuwait National Cancer Registry, relevant Kuwaiti population data and World Standard Population as a reference, age-standardized incidence rates (ASIR) (per 100,000 person-years) overall and by subcohorts were computed. The incident oesophageal cancer cases count was overdispersed with excessive structural zeros, therefore, it was analyzed using multivariable zero-inflated negative binomial (ZINB) model. Results Overall ASIR of oesophageal cancer was 10.51 (95% CI:  6.62-14.41). The multivariable ZINB model showed that compared with the younger age category (< 30 years), the individuals in higher age groups showed a significant ( p  < 0.001) increasing tendency to develop the oesophageal cancer.  Furthermore, compared with the non-Kuwaiti residents, the Kuwaiti nationals were significantly ( p  < 0.001) more likely to develop oesophageal cancer during the study period. Moreover, compared with 1980-84 period, ASIRs steadily and significantly  ( p  < 0.005) declined in subsequent periods till 2015-19. Conclusions A high incidence of oesophageal cancer was recorded in Kuwait, which consistently declined from 1980 to 2019. Older adults (aged ≥ 60 years) and, Kuwaiti nationals were at high risk of oesophageal cancer. Focused educational intervention may minimize oesophageal cancer incidence in high-risk groups in this and other similar settings. Future studies may contemplate to evaluate such an intervention.

The installation of Distributed Generation (DG) units in the Radial Distribution Networks (RDNs) has significant potential to minimize active power losses in distribution networks. However, inaccurate size(s) and location(s) of DG units increase power losses and associated Annual Financial Losses (AFL). A comprehensive review of the literature reveals that existing analytical, metaheuristic and hybrid algorithms employed on DG allocation problems trap in local or global optima resulting in higher power losses. To address these limitations, this article develops a parallel hybrid Arithmetic Optimization Algorithm and Salp Swarm Algorithm (AOASSA) for the optimal sizing and placement of DGs in the RDNs. The proposed parallel hybrid AOASSA enables the mutual benefit of both algorithms, i.e., the exploration capability of the SSA and the exploitation capability of the AOA. The performance of the proposed algorithm has been analyzed against the hybrid Arithmetic Optimization Algorithm Particle Swarm Optimization (AOAPSO), Salp Swarm Algorithm Particle Swarm Optimization (SSAPSO), standard AOA, SSA, and Particle Swarm Optimization (PSO) algorithms. The results obtained reveals that the proposed algorithm produces quality solutions and minimum power losses in RDNs. The Power Loss Reduction (PLR) obtained with the proposed algorithm has also been validated against recent analytical, metaheuristic and hybrid optimization algorithms with the help of three cases based on the number of DG units allocated. Using the proposed algorithm, the PLR and associated AFL reduction of the 33-bus and 69-bus RDNs improved to 65.51% and 69.14%, respectively. This study will help the local distribution companies to minimize power losses and associated AFL in the long-term planning paradigm.

Alcohol education must ensure that young people have appropriate information, motivation and skills. This article describes the fifth phase in a program of intervention development based on principles of social marketing and intervention mapping. The aim was to enhance drink refusal self-efficacy (DRSE) and help develop skills for non-drinking or moderate drinking. We conducted a mixed-methods feasibility trial that measured intervention effects among 277 UK secondary school students aged 14–16, and used qualitative methods to explore four teachers’ experiences of delivering the intervention. The intervention did not produce the desired changes in DRSE or alcohol use, but nor did it increase alcohol use. In the qualitative process evaluation, time constraints, pressure to prioritize other topics, awkwardness and embarrassment were identified as barriers to fidelitous delivery. A more intense and/or more prolonged intervention delivered with greater fidelity may have produced the desired changes in DRSE and alcohol use. This study illustrates how principles of social marketing and intervention mapping can aid development of resilience-based education designed to help students develop skills to drink moderately, or not drink. It also highlights the need to consider the constraints of micro-social (school) and macro-social (societal) cultures when designing alcohol education.

ObjectiveThis study aimed to coproduce a culturally adaptive storytelling video intervention to support the psychosocial well-being of Nepalese migrant workers.DesignA multimethods participatory study was conducted involving three different but interconnected phases: (1) formative research involving a systematic review, pilot survey and stakeholder consultations; (2) exploration and analysis of Nepalese literature relevant to contemporary migration; and (3) coproduction of a storytelling video intervention, using participatory workshops.Participants and settingsConvenience sample of outgoing and returnee migrant workers from the Gulf Cooperation Council (GCC) countries, their families and other relevant stakeholders in Dhading District of Bagmati Province, Nepal.ResultsThe systematic review of 33 included studies identified five key health issues: mental health; occupational hazards; sexual health; healthcare access; and infectious diseases. In the survey (n=60), workers reported various health problems including fever/common cold (42%); mental health problems (25%); and verbal abuse (35%). Twenty interviewees identified issues related to physical health (eg, pneumonia, kidney disease) as well as mental health (eg, anxiety, depression). Nepalese literary resources primarily portrayed themes of: separation; hopelessness and helplessness; and poor workplace environments. Drawing on these findings and iterative workshops with stakeholders, a culturally sensitive storytelling video intervention was coproduced to support the psychosocial well-being of Nepalese migrant workers in GCC countries. The intervention used an animated video format with audio narration and subtitles, presenting a story centred around the struggles of an archetypal male migrant worker and their use of coping strategies for dealing with adversities.ConclusionsThis is a feasibility study conducted in a single district of Nepal; as such, the findings should be generalised cautiously. Despite these limitations, the project is testament to the value of participatory methods in the development of culturally sensitive public health interventions for marginalised groups, and points to the utility of coproduced storytelling formats in migrant health contexts. Future research is needed to evaluate feasibility and acceptability of the intervention as well as the outcomes and experiences of migrant workers who engaged with the video.

[This corrects the article DOI: 10.1371/journal.pone.0264958.].[This corrects the article DOI: 10.1371/journal.pone.0264958.].