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If popular online platforms systematically expose their users to partisan and unreliable news, they could potentially contribute to societal issues such as rising political polarization 1 , 2 . This concern is central to the ‘echo chamber’ 3 – 5 and ‘filter bubble’ 6 , 7 debates, which critique the roles that user choice and algorithmic curation play in guiding users to different online information sources 8 – 10 . These roles can be measured as exposure, defined as the URLs shown to users by online platforms, and engagement, defined as the URLs selected by users. However, owing to the challenges of obtaining ecologically valid exposure data—what real users were shown during their typical platform use—research in this vein typically relies on engagement data 4 , 8 , 11 – 16 or estimates of hypothetical exposure 17 – 23 . Studies involving ecological exposure have therefore been rare, and largely limited to social media platforms 7 , 24 , leaving open questions about web search engines. To address these gaps, we conducted a two-wave study pairing surveys with ecologically valid measures of both exposure and engagement on Google Search during the 2018 and 2020 US elections. In both waves, we found more identity-congruent and unreliable news sources in participants’ engagement choices, both within Google Search and overall, than they were exposed to in their Google Search results. These results indicate that exposure to and engagement with partisan or unreliable news on Google Search are driven not primarily by algorithmic curation but by users’ own choices. Ecologically valid data collected during the 2018 and 2020 US elections show that exposure to and engagement with partisan or unreliable news on Google Search are driven not primarily by algorithmic curation but by users’ own choices.

Type 2 diabetes accounts for over 90% of all diabetes cases and is caused by a combination of behavioral risk factors. It is currently a serious health issue, particularly among women of reproductive age, as it is associated with reproductive disorders. Preventing it requires knowledge, but there is limited data on behavioral risk factors in Ethiopia. To assess knowledge of the behavioral risks of type 2 diabetes mellitus and its associated factors among women of reproductive age. A community-based cross-sectional study was conducted, with all women in the town serving as the source population. A multistage sampling method was utilized to recruit kebeles, and a systematic random technique was employed to select households at every 13th interval. We completed interview questionnaires for 623 samples. The crude odds ratio was calculated using a bivariate logistic model, and multivariate analysis was performed to control for confounding and identify associated factors among model-fitting variables using an adjusted odds ratio (AOR). The knowledge of behavioral risk factors (BRF) among women of reproductive age (WRA) is 47.0% [95% CI, 43.5-50.9], and significant associations were found with the following factors: average family income of between 3000 and 5000 Ethiopian Birr(ETH) 1.81 [95% CI, 1.03-3.18], > = 5001 ETH 1.93 [95% CI, 1.02-3.68], diabetes mellitus (DM) in the friend or relatives 4.03 [95% CI, 1.56-10.46], family history of DM 9.47 [95% CI, 4.74-18.90], source of information: health workers 1.87 [95% CI, 1.04-3.34] and friend or relatives 1.65 [95% CI, 1.04-2.62]. Knowledge of behavioral risk factors for type 2 diabetes was poor among study participants. Factors such as family income, diabetes mellitus (DM) in friends or relatives, family history of DM, and sources of information were strongly associated with good knowledge. It is essential to emphasize health education about behavioral risk factors for women.

Long-read sequencing and novel long-range assays have revolutionized de novo genome assembly by automating the reconstruction of reference-quality genomes. In particular, Hi-C sequencing is becoming an economical method for generating chromosome-scale scaffolds. Despite its increasing popularity, there are limited open-source tools available. Errors, particularly inversions and fusions across chromosomes, remain higher than alternate scaffolding technologies. We present a novel open-source Hi-C scaffolder that does not require an a priori estimate of chromosome number and minimizes errors by scaffolding with the assistance of an assembly graph. We demonstrate higher accuracy than the state-of-the-art methods across a variety of Hi-C library preparations and input assembly sizes. The Python and C++ code for our method is openly available at https://github.com/machinegun/SALSA.

Background Access to direct-to-consumer genetic testing services has increased in recent years. However, disparities in knowledge and awareness of these services are not well documented. We examined awareness of genetic testing services by rural/urban and racial/ethnic status. Methods Analyses were conducted using pooled cross-sectional data from 4 waves (2011–2014) of the Health Information National Trends Survey (HINTS). Descriptive statistics compared sample characteristics and information sources by rural/urban residence. Logistic regression was used to examine the relationship between geography, racial/ethnic status, and awareness of genetic testing, controlling for sociodemographic characteristics. Results Of 13,749 respondents, 16.7% resided in rural areas, 13.8% were Hispanic, and 10.1% were non-Hispanic black. Rural residents were less likely than urban residents to report awareness of genetic testing (OR = 0.74, 95% CI = 0.63–0.87). Compared with non-Hispanic whites, racial/ethnic minorities were less likely to be aware of genetic testing: Hispanic (OR = 0.68, 95% CI = 0.56–0.82); and non-Hispanic black (OR = 0.74, 95% CI = 0.61–0.90). Conclusions Rural-urban and racial-ethnic differences exist in awareness of direct-to-consumer genetic testing. These differences may translate into disparities in the uptake of genetic testing, health behavior change, and disease prevention through precision and personalized medicine.

AbstractObjectiveTo compare the effects of treatments for coronavirus disease 2019 (covid-19).DesignLiving systematic review and network meta-analysis.Data sourcesWHO covid-19 database, a comprehensive multilingual source of global covid-19 literature, up to 3 December 2021 and six additional Chinese databases up to 20 February 2021. Studies identified as of 1 December 2021 were included in the analysis.Study selectionRandomised clinical trials in which people with suspected, probable, or confirmed covid-19 were randomised to drug treatment or to standard care or placebo. Pairs of reviewers independently screened potentially eligible articles.MethodsAfter duplicate data abstraction, a bayesian network meta-analysis was conducted. Risk of bias of the included studies was assessed using a modification of the Cochrane risk of bias 2.0 tool, and the certainty of the evidence using the grading of recommendations assessment, development, and evaluation (GRADE) approach. For each outcome, interventions were classified in groups from the most to the least beneficial or harmful following GRADE guidance.Results463 trials enrolling 166 581 patients were included; 267 (57.7%) trials and 89 814 (53.9%) patients are new from the previous iteration; 265 (57.2%) trials evaluating treatments with at least 100 patients or 20 events met the threshold for inclusion in the analyses. Compared with standard care, three drugs reduced mortality in patients with mostly severe disease with at least moderate certainty: systemic corticosteroids (risk difference 23 fewer per 1000 patients, 95% credible interval 40 fewer to 7 fewer, moderate certainty), interleukin-6 receptor antagonists when given with corticosteroids (23 fewer per 1000, 36 fewer to 7 fewer, moderate certainty), and Janus kinase inhibitors (44 fewer per 1000, 64 fewer to 20 fewer, high certainty). Compared with standard care, two drugs probably reduce hospital admission in patients with non-severe disease: nirmatrelvir/ritonavir (36 fewer per 1000, 41 fewer to 26 fewer, moderate certainty) and molnupiravir (19 fewer per 1000, 29 fewer to 5 fewer, moderate certainty). Remdesivir may reduce hospital admission (29 fewer per 1000, 40 fewer to 6 fewer, low certainty). Only molnupiravir had at least moderate quality evidence of a reduction in time to symptom resolution (3.3 days fewer, 4.8 fewer to 1.6 fewer, moderate certainty); several others showed a possible benefit. Several drugs may increase the risk of adverse effects leading to drug discontinuation; hydroxychloroquine probably increases the risk of mechanical ventilation (moderate certainty).ConclusionCorticosteroids, interleukin-6 receptor antagonists, and Janus kinase inhibitors probably reduce mortality and confer other important benefits in patients with severe covid-19. Molnupiravir and nirmatrelvir/ritonavir probably reduce admission to hospital in patients with non-severe covid-19.Systematic review registrationThis review was not registered. The protocol is publicly available in the supplementary material.Readers’ noteThis article is a living systematic review that will be updated to reflect emerging evidence. Updates may occur for up to two years from the date of original publication. This is the fifth version of the original article published on 30 July 2020 (BMJ 2020;370:m2980), and previous versions can be found as data supplements. When citing this paper please consider adding the version number and date of access for clarity.

Existing health disparities based on race and ethnicity in the United States are contributing to disparities in morbidity and mortality during the coronavirus disease (COVID-19) pandemic. We conducted an online survey of American adults to assess similarities and differences by race and ethnicity with respect to COVID-19 symptoms, estimates of the extent of the pandemic, knowledge of control measures, and stigma. The aim of this study was to describe similarities and differences in COVID-19 symptoms, knowledge, and beliefs by race and ethnicity among adults in the United States. We conducted a cross-sectional survey from March 27, 2020 through April 1, 2020. Participants were recruited on social media platforms and completed the survey on a secure web-based survey platform. We used chi-square tests to compare characteristics related to COVID-19 by race and ethnicity. Statistical tests were corrected using the Holm Bonferroni correction to account for multiple comparisons. A total of 1435 participants completed the survey; 52 (3.6%) were Asian, 158 (11.0%) were non-Hispanic Black, 548 (38.2%) were Hispanic, 587 (40.9%) were non-Hispanic White, and 90 (6.3%) identified as other or multiple races. Only one symptom (sore throat) was found to be different based on race and ethnicity (P=.003); this symptom was less frequently reported by Asian (3/52, 5.8%), non-Hispanic Black (9/158, 5.7%), and other/multiple race (8/90, 8.9%) participants compared to those who were Hispanic (99/548, 18.1%) or non-Hispanic White (95/587, 16.2%). Non-Hispanic White and Asian participants were more likely to estimate that the number of current cases was at least 100,000 (P=.004) and were more likely to answer all 14 COVID-19 knowledge scale questions correctly (Asian participants, 13/52, 25.0%; non-Hispanic White participants, 180/587, 30.7%) compared to Hispanic (108/548, 19.7%) and non-Hispanic Black (25/158, 15.8%) participants. We observed differences with respect to knowledge of appropriate methods to prevent infection by the novel coronavirus that causes COVID-19. Deficits in knowledge of proper control methods may further exacerbate existing race/ethnicity disparities. Additional research is needed to identify trusted sources of information in Hispanic and non-Hispanic Black communities and create effective messaging to disseminate correct COVID-19 prevention and treatment information.

Background In today's post-revolution era, with demographic, cultural, and social changes, Tunisian society is witnessing several transformations: There's a rise in young single mothers and early sexual activity. A quarter of the population comprises young Tunisians who struggle with limited access to education and healthcare. Only 19.1% know how to prevent Sexually Transmitted Diseases (STDs), and 16% lack access to contraception. This insufficient sexual health knowledge exposes them to risks such as STDs, unintended teenage pregnancies, unsafe abortions, infertility, and even death. This study aims to assess young Tunisians' understanding of contraception, sexual behavior, information-seeking methods, and STD prevention. Methods A cross-sectional survey involving 100 high school students aged 15–18 was conducted from February to March 2022. It gathered information on their knowledge of contraceptives, sexual health, experiences, and access to services and products. The survey used hard-copy questionnaires. All statistical analyses were performed using SPSS (Statistical Package for the Social Sciences) software, version 26.0 IBM. Results A total of 100 participants were included, with a sex ratio of 0.92. most of them (35%) were 18 years old. Results showed that the majority (86%) of the students confirmed that they had not received any courses on contraception. Most students, 84%, said they obtained information about contraceptive methods from websites, while 63% mentioned friends as their source. The majority of participants, 62%, reported not using contraception, while 15% had used methods like condoms or withdrawal before. Both genders were mostly aware of the pill (89%) and male condom (85%) as common contraceptive methods. Over two-thirds of the participants stated that the male condom was the contraceptive method effective in preventing STD. Conclusion The majority of the adolescents displayed misconceptions regarding contraceptive methods and the prevention of STDs. The use of these methods remains significantly restricted. This study emphasizes the importance of increasing awareness of sexual health among adolescents. It recommends establishing accessible centers offering comprehensive services and guidance on contraception, sexuality, and pregnancy planning. Plain English Summary In today's Tunisia, societal changes post-revolution has led to an increase in young single mothers and early sexual activity. Many young Tunisians face challenges accessing education and healthcare. A significant portion lack knowledge about preventing sexually transmitted diseases (STDs), and some struggle to access contraception. This lack of sexual health knowledge puts them at risk of STDs, unintended pregnancies, unsafe abortions, infertility, and other health issues. This study aimed to understand young Tunisians' knowledge of contraception, sexual behavior, information-seeking habits, and STD prevention. It found that most students hadn't received formal education on contraception, and many relied on websites or friends for information. Despite awareness of contraceptive methods like the pill and condoms, many weren't using them. Both genders recognized male condoms as effective in preventing STDs. Overall, the study highlights misconceptions about contraception and STD prevention among adolescents, and the need for improved access to sexual health education and services.

The main objective of this study is to examine the linkage between CO 2 emissions, total factor productivity as a measure of income, information and communication technology (ICT), trade, financial development, and energy consumption in Tunisia from 1975 to 2014. To achieve this goal, the autoregressive distributed lag (ARDL) with the break point method is performed. The results demonstrate the rejection of the Kuznets environmental curve (EKC) hypothesis by obtaining a higher value of the long-term total factor productivity parameter compared to the short-term one. Moreover, our result shows an insignificant impact of ICT on CO 2 emissions as a measure of pollution. In addition, trade, financial development, and energy consumption affect negatively the environmental quality. As a result, Tunisian policymakers should enhance the total factor productivity, expand the information and communication technology, further develop the financial sector, enhance the share of renewable energy consumption, and reduce the energy consumption resulting in import and export goods. These goals will be achieved by improving Tunisia’s technological and innovation capacity, enhancing the use of ICT in transport, building, and industry sectors considered as the most pollutant ones, and creating renewable energy projects.

Objectives. Little is known about the use of social media as a tool for health communication. We used a mixed-methods design to examine communication about childhood obesity on Twitter. Methods. NodeXL was used to collect tweets sent in June 2013 containing the hashtag #childhoodobesity. Tweets were coded for content; tweeters were classified by sector and health focus. Data were also collected on the network of follower connections among the tweeters. We used descriptive statistics and exponential random graph modeling to examine tweet content, characteristics of tweeters, and the composition and structure of the network of connections facilitating communication among tweeters. Results. We collected 1110 tweets originating from 576 unique Twitter users. More individuals (65.6%) than organizations (32.9%) tweeted. More tweets focused on individual behavior than environment or policy. Few government and educational tweeters were in the network, but they were more likely than private individuals to be followed by others. Conclusions. There is an opportunity to better disseminate evidence-based information to a broad audience through Twitter by increasing the presence of credible sources in the #childhoodobesity conversation and focusing the content of tweets on scientific evidence.

The global Coronavirus disease (COVID-19) pandemic disrupted healthcare systems, reducing access to medical services. In Bangladesh, strict lockdowns, healthcare worker shortages, and resource diversion further strained the system. Despite these challenges, the impact on inpatient and outpatient service utilisation in Bangladesh remains unaddressed. This study explored the levels of inpatient admissions and outpatient visits in public healthcare facilities before and during COVID-19 pandemic in Bangladesh. We conducted a cross-sectional secondary analysis of inpatient and outpatient data from all public hospitals collected via District Health Information System, version 2 (DHIS2) from January 2017 to June 2021. Using 2017-2019 as the baseline, we analysed healthcare utilisation indicators (outpatient visits and inpatient admissions) with descriptive and segmented Poisson regression to assess the impact of COVID-19 in 2020 and 2021. In 2020, outpatient visits and inpatient admissions significantly declined to 34.1 million and 37.5 million, respectively, from 47.6 million and 56.2 million in 2019. Segmented regression analysis confirmed these drops, especially in Dhaka (IRR =  0.62, p < 0.001) and Barisal (IRR =  0.69, p < 0.002) for outpatient visits, and in Dhaka (IRR =  0.64, p < 0.000) and Khulna (IRR =  0.70, p < 0.000) for inpatient admissions. In 2021, most divisions saw an increase in outpatient visit and inpatient admission numbers, with the lowest rebound in Sylhet. The COVID-19 pandemic significantly reduced Outpatient Department (OPD) visits and Inpatient Department (IPD) admissions in Bangladesh in 2020, with partial recovery in 2021. To ensure sustained access to care, it is crucial to strengthen healthcare facilities and equip healthcare providers to be prepared for future pandemics or emergencies.