The rapid evolution of digital finance has led to an unprecedented accumulation of financial data, necessitating the adoption of big data analytics to extract meaningful insights. Big data analytics in digital finance enables financial institutions to enhance customer profiling, optimize risk management, and develop data-driven market strategies. This paper explores the role of big data analytics in digital finance, focusing on how financial organizations leverage advanced analytical tools to gain deeper customer insights, predict market trends, and personalize financial services. Additionally, the study highlights the challenges, including data security, privacy concerns, and regulatory constraints, associated with big data implementation in the financial sector. By integrating artificial intelligence (AI) and machine learning (ML) with big data analytics, financial firms can create more robust strategies for improving customer engagement and operational efficiency. The paper concludes that big data analytics is a transformative force in digital finance, reshaping the way institutions interact with customers and navigate competitive markets.

Digital finance has emerged as a transformative force in emerging markets, significantly altering economic structures, financial accessibility, and social dynamics. This paper explores the socioeconomic impact of digital finance, focusing on financial inclusion, economic growth, employment, and poverty alleviation. Digital payment systems, mobile banking, and fintech innovations have expanded financial services to unbanked populations, fostering economic participation and entrepreneurship. However, digital finance also presents challenges such as cybersecurity risks, financial literacy gaps, and regulatory complexities. By analyzing case studies from various emerging economies, this research highlights the benefits and risks associated with digital finance adoption. The findings suggest that while digital finance accelerates economic development, proactive policy measures and robust financial literacy programs are essential to ensure equitable growth.

Mast cells play a crucial role not only in allergic responses but also in innate and adaptive immune responses. They release extracellular vesicles (EVs) containing proteins, lipids, and genetic material that facilitate intercellular communication. Mast cell-derived EVs (MC-EVs) have different characteristics depending on the state of the mast cells, and they are involved in various processes such as dendritic cell maturation, antigen presentation, T lymphocyte activation, macrophage polarization, and the modulation of epithelial cell permeability and epithelial-melancholy transition. EVs released by mast cells can interact with tumor cells and have dual roles in immune responses and disease pathogenesis. The RNA cargo in these EVs holds potential as diagnostic biomarkers and therapeutic targets in diseases including cancers, such as mastocytosis. Overall, these findings provide new insights into the role of EVs in mast cell function and inter-cellular communication.

In June 2023, the United Nations adopted the High Seas Treaty. Two years later, signatories are poised to ratify this treaty and create a legal instrument to implement marine protected areas (MPAs) in our greatest global commons, ocean areas beyond national jurisdiction. Protection of the open and deep ocean is timely: we stand at the precipice of an industrial revolution in Earth’s largest remaining wilderness. Deciding where to strategically implement high seas MPAs under this treaty requires robust biodiversity information, yet publicly accessible data is sparse, particularly at depth. There is now an opportunity for collective science action to support this collective policy action. Realizing this opportunity necessitates swift solutions to 1) support and incentivize standardized public sharing of existing biodiversity data; 2) broaden the scope of participatory science to process ocean observations into biodiversity data; and 3) equitably implement new data collection with research partners across our global community.

Climate change alters species interactions via asymmetric thermal tolerance, mediated by endosymbionts. The phenomenon was investigated here using the emerald ash borer (EAB) and its larval endoparasitoid Tetrastichus planipennisi - a compelling system where the southern range in host insect exceeds distribution of its parasitoid, coinciding with a striking endosymbiont contrast, i.e., while EAB naturally lacks Wolbachia and Rickettsia, its parasitoid maintains both endosymbionts. The study of four T. planipennisi populations (Jilin, Liaoning, Xinjiang, Beijing) revealed the Jilin population exhibited exceptional heat tolerance with 100% endosymbiont infestation. At 40°C, endosymbiont-negative (E-) wasps showed 3-hour shorter survival than endosymbiont-positive (E+) counterparts, with weaker antioxidant capacity. Crucially, rising temperatures impaired endosymbiont transmission to offspring. While beneficial, endosymbionts’ thermal sensitivity creates a trade-off that may disadvantage parasitoids versus E- host insects under climate warming. These findings advance understanding of endosymbiont-mediated climate adaptation and have important implications for biological control strategies in warming environments.

As climate change intensifies, forest ecosystems face increasing destabilization and biodiversity loss. While the role of tree species richness in maintaining ecosystem stability is well-established, the influence of shrub diversity—particularly under varying tree species richness—remains insufficiently understood. Here, we investigate the intricate interplay between shrub species richness, soil microbial communities, and environmental factors in driving ecosystem stability, defined as the temporal stability of tree community productivity. Using a large-scale, controlled experimental platform (BEF-China), we examined these dynamics across a gradient of tree species richness: monocultures, two-species mixtures, and four-species mixtures. Our findings reveal that shrub species richness exerts context-dependent effects on ecosystem stability, strengthening stability at higher levels of tree species richness. These effects are mediated primarily by shifts in microbial diversity and community-aggregated genomic traits. In monocultures, stability was predominantly governed by abiotic factors such as soil pH and slope, with minimal contributions from shrub species richness. In contrast, in two-species mixtures, increased shrub species richness significantly enhanced stability by promoting bacterial diversity and restructuring fungal communities. In four-species mixtures, bacterial and fungal genomic traits differentially modulated stability, highlighting the pivotal yet distinct roles of microbial communities in mediating biodiversity-stability relationships. Additionally, we identified key microbial taxa whose contributions to stability varied with tree species richness, further emphasizing the complexity of these interactions. Together, our results underscore the dynamic and context-specific roles of shrub diversity and microbial mediators in shaping ecosystem stability, providing novel insights into the mechanisms underpinning forest resilience in an era of rapid environmental change.

The Western diet, characterized by high consumption of processed foods, sugars, unhealthy fats, and low fiber intake, has been linked to numerous adverse health conditions, including metabolic syndrome, obesity, type 2 diabetes, and gut dysbiosis. Emerging research suggests that probiotics, live microorganisms that confer health benefits to the host, can play a crucial role in mitigating the negative effects of such diets. This paper explores the protective effects of probiotics on gut and metabolic health in the context of a Western diet. Through a comprehensive review of existing literature and experimental studies, this paper examines how probiotics influence gut microbiota composition, reduce inflammation, improve insulin sensitivity, and enhance overall metabolic health. Additionally, an experimental study investigating the effects of probiotic supplementation in individuals consuming a Western diet is analyzed to assess measurable health improvements. The results indicate that probiotics exert significant protective effects, demonstrating potential as a viable intervention for individuals exposed to unhealthy dietary patterns.

With the advancement of genetic sequencing technologies and the increase in the volume of biological data, deep learning (DL) has been adopted as one of the advanced data analysis methods in computational biology and genomic data analyzing. This review studied the articles published between 2020 and 2025 in which deep learning models were used to analyze genomic data. The results of this study show that convolutional neural networks (CNN) have been most widely used in genomic data analysis, while RNN, LSTM, and GNN methods have also been used in some applications such as time series data analysis, gene expression prediction, and molecular interaction discovery. The average accuracy of deep learning models in 2020 was about 88%, which increased to more than 93% in 2025. This improvement has been driven by advances in deep learning architectures, increased quality and volume of genomic data, and the use of hybrid models such as CNN+LSTM and GNN+CNN. In addition, most of the research has focused on cancer diagnosis, genetic diseases, and multi-omics data analysis. However, challenges remain, including multi-omics integration, explainable AI, fusion of genomic and image data, and transfer learning, which require further research. The results of this study indicate that deep learning in genomics data analysis can play an important role in discovering genetic patterns, improving the accuracy of disease diagnosis, and developing personalized therapeutic approaches. In the future, the development of multimodal deep learning models, interpretable methods (XAI), and the use of GNN for the analysis of gene networks and chromosomal interactions could lead to significant advances in this field.

The Curious Case of Carotidynia: Diagnosing TIPIC Syndrome

A document by Negarin AKBARİ. Click on the document to view its contents.

Title: Catheter Misplacement During Chemoport Insertion Reveals Persistent Left Superior Vena CavaAuthors: Chin-Hu Tsai, MDAffiliation: Division of General Surgery, E-Da Hospital, Kaohsiung, TaiwanCorresponding Author: Jian-Han Chen, MDDivision of General Surgery, E-Da Hospital, Kaohsiung, Taiwan.Director of Bariatric and Metabolism International Surgery Center, E-Da Hospital, Kaohsiung, TaiwanEmail: tigertsai0705@gmail.comKey Clinical Message: Persistent left superior vena cava may lead to unexpected catheter malposition and hemodynamic instability during central venous access. Awareness of this vascular anomaly is crucial to avoid misinterpretation.Ethical Statement: Written informed consent was obtained from the patient for publication of this case report and the accompanying images.Funding: The authors received no specific funding for this work.Acknowledgement: NoneAuthor Contributions: Dr. Chin-Hu Tsai contributed to literature review, image interpretation and writing article. Dr. Chung-Yen Chen contributed to conception of case and clinical management. Dr. Jian-Han Chen contributed to literature review and revising the article. All three authors approved the final version of the manuscript.A 57-year-old man with newly diagnosed esophageal squamous cell carcinoma was scheduled to undergo chemoport implantation via the left subclavian vein. During the procedure, the patient developed acute tachycardia (>130 bpm) and hypotension, with a systolic blood pressure decreasing to 80 mmHg. Portable chest radiography demonstrated that the chemoport catheter failed to cross the midline and was positioned within the left mediastinum (Figure 1 ), raising suspicion of inadvertent arterial cannulation during the puncture. However, arterial blood gas analysis revealed venous characteristics, and the patient’s hemodynamic instability resolved following intravenous fluid resuscitation and administration of antiarrhythmic agents.A retrospective review of preoperative contrast-enhanced computed tomography identified a persistent left superior vena cava (PLSVC), a congenital venous anomaly with an estimated prevalence of 0.3% to 0.5% in the general population [1,2], as demonstrated in Figure 2 . The PLSVC was found to drain into the coronary sinus, accounting for the abnormal catheter trajectory. Although often asymptomatic, PLSVC can pose challenges during procedures requiring central venous access, such as pacemaker lead placement or chemoport implantation [2,3]. Recognition of this anatomical variation prior to device placement is essential to optimizing procedural success and minimizing the risk of complications [1].

In order to solve the problem of safety accidents, such as the overturning of the traction walking plate and the jumping of subconductors, during the construction process of transmission line tension framing, because the construction personnel cannot fully monitor the key state quantities of the traction walking plate, a multi-parameter intelligent monitoring system for the traction walking plate based on the digital twin technology is developed. In the selection of twin data, based on the analysis of the risk points of the traction walking plate, the subconductor tension, tilt angle and spatial position of the traction walking plate are selected as the twin data. For the mapping of the twin data, the grid information model (GIM) and building information model (BIM) are used as the basis to establish a refined engineering structure model, which accurately reflects the geometry and mechanical properties of the traction slab. Finally, the connection design of twin data, hardware design, equipment data layer design and twin service type are designed in 3 parts, and the improved isolated forest algorithm is adopted as the twin service layer of the monitoring system.

Background : Diarrhoea is a significant cause of morbidity and mortality in foals. However, further research is needed to understand the occurrence of pathogens in both single and coinfections among extensively raised foals, with and without diarrhoea. Hypothesis/Objectives : Our hypothesis is that foals with diarrhoea have a greater prevalence of organisms detected in coinfections. Therefore, this study investigated the major microorganisms associated with diarrhoea in foals with and without diarrhoea. Study design : A total of 200 foals (100 diarrhoeic and 100 nondiarrhoeic), up to 1 year of age, were included in this study. Methods : Faecal samples were analysed for the detection of Clostridioides difficile (bacterial culture and toxin A/B detection), Clostridium perfringens (bacterial culture and genotyping) and Salmonella spp., Rhodococcus equi, Lawsonia intracellularis, Neorickettsia risticii, Enterococcus durans, Giardia duodenalis, Cryptosporidium spp. , rotavirus A and coronavirus (real-time PCR). Results : At least one enteric agent was detected in 85% and 70% of diarrhoeic and nondiarrhoeic foals, respectively. Codetection was significantly more frequent in the diarrhoeic group (27 singly detected organisms vs. 58 codetected organisms) than in the nondiarrhoeic group (37 singly detected organisms vs. 33 codetected organisms) (P = 0.0079). Salmonella spp., C. difficile (and A/B toxin gene detection) and Cryptosporidium spp. were significantly associated with foal diarrhoea. Conclusions and clinical relevance : The detection of multiple agents in foals with diarrhoea highlights the complexity of diagnosis and the potential interaction between agents in the multifactorial aetiology of this condition.

A 3-year-old Arabian mare was referred for evaluation of swelling beneath the tongue, unilateral facial swelling, mandibular abscess drainage, severe oral cavity wounds, anorexia, and depression. Radiographic imaging revealed a metallic foreign body located near the caudal molars, adjacent to the laryngeal region. Due to significant trauma-induced temporomandibular joint (TMJ) ankylosis and severe limitation in mouth opening, surgical access was extremely challenging. After extensive planning, the mare was anesthetized and after 90 minutes of delicate manipulation, the foreign object, identified as a hypodermic needle embedded within the daily forage, was successfully retrieved. Postoperative wound management and medical therapy led to complete recovery over two weeks. This case emphasizes the importance of considering intraoral foreign bodies in horses presenting with unexplained facial swelling and oral trauma.

The PXD has been shown to be an effective pharmaceutical treatment for epilepsy in children; however, the precise mechanism by which PXD exerts its antiepileptic effects remains to be elucidated. The objective of this study was to investigate the role of the ferroptosis pathway in the epilepsy model and to determine whether PXD interferes with this process to inhibit epileptogenesis. Behavioral changes in animals were assessed using the seven-point scoring method. The alterations in ferroptosis-related indicators were detected using H&E staining, TEM, immunofluorescence, ELISA, and WB analysis. Compared to the model group, both the sodium valproate and PXD groups demonstrated attenuated seizure severity. H&E staining indicated reduced inflammatory infiltration in the hippocampal tissues of the PXD and sodium valproate groups. TEM analysis revealed ameliorated mitochondrial swelling in these two treatment groups. Immunofluorescence showed diminished ROS levels in the PXD and sodium valproate groups. Specifically, the PXD group exhibited upregulated hippocampal expression of GSH, GPX4, HO-1, and SLC7A11, accompanied by downregulated MDA and ACSL4 expression. However, neither serum iron levels nor Nrf2 protein expression displayed significant alterations in the PXD or sodium valproate groups. In conclusion, PXD ameliorates seizure scores in PTZ-induced epileptic rat models by modulating the ferroptosis pathway.

Introduction: Neuroblastoma (NB) with central nervous system (CNS) metastases is rare at diagnosis but occurs more often during relapse/progression. Patients with CNS metastases face a dismal prognosis, with no standardized curative treatment available. Novel therapeutic approaches, such as intraventricular radio-immunotherapy with 131I-Omburtamab (Omb), have been developed. In this study, we report a retrospective, single tertiary center analysis of a 23-year cohort of NB patients with CNS metastases, highlighting current treatment strategies. Patients and Methods: Retrospective data analysis of all NB patients with CNS metastases treated at Hospital Sant Joan de Déu, Barcelona, from January 2000 to January 2023. Patient characteristics at diagnosis, first-line treatment, relapse patterns, and CNS metastasis management were analyzed in search of risk variables and survival outcomes. Results: CNS metastases at relapse were identified in 39/185 (21.1%) patients. Median age at diagnosis was 2.7 years, and 24/39 male. Stage 4 NB with multisite metastases accounted for most cases (92.2%). CNS events occurred predominantly at first relapse (29/39, 74.4%) and with neurological symptoms (23/38, 60.5%). MCYN amplification and concomitant extra-CNS metastases at CNS relapse were associated with poorer overall survival (OS) ( p=0.018 and p=0.0059, respectively). Neurological symptoms upon relapse significantly increased the risk for subsequent CNS events ( p=0.028). Curative-intent of treatment was attempted in 34/39 (87.2%) patients. After adjusting for immortal time bias, RT plus Omb significantly improved OS ( p<0.0001). Conclusions: In our experience, MYCN amplification and concomitant extra-CNS metastases at CNS relapse significantly decrease OS. Multimodal treatment including Omburtamab radioimmunotherapy significantly improves survival outcomes.

Background: There is a paucity of information regarding community acquired pulmonary embolism in children, and only one study directly compared community to hospital acquired pulmonary embolism in children. This study gathered data on children with community versus hospital acquired pulmonary embolism at a single institution over a 13-year period. Procedures: Children with pulmonary embolism were identified by a query of the hospital’s information system using diagnostic codes. Gathered data included demographics, presenting signs and symptoms, origin of the event, risk factors, treatment received, and outcomes. Results: Sixty-five children were identified as having a pulmonary embolism. Of these, 53 were community acquired. Female sex, adolescents, contraceptive use, and an elevated body mass index were identified as potential risk factors for community acquired pulmonary embolism. A deep vein thrombosis was found in a minority (30%) of patients who were imaged. Conclusions: As with other studies, the majority of children with pulmonary embolism at our institution were community acquired. Risk factors for venous thromboembolism in children are often derived by comparing children admitted with venous thromboembolism to other inpatients. Since community acquired pulmonary embolism seems to be more prevalent, comparisons to inpatients without a pulmonary embolism may not be valid. The combination of female sex, adolescents, elevated body mass index, community acquired pulmonary embolism in the absence of a deep vein thrombosis was present in 23% of our patients. This combination serves as potential risk factors for future investigations.

Title PageTitle: Comment on: Rationale for irradiation of persisting oligo-skeletal metastases to improve survival of metastatic neuroblastoma patients with a poor response to chemotherapy: A retrospective studyArticle type: Letter to the EditorCorrespondence: 1. Miriam Farooq BabaEmail: miriambaba1@gmail.comInstitute: Foundation University Medical CollegeAddress: Rawalpindi, PakistanORCID: 0009-0008-0519-4373Word count: 398Conflict of interest: NoneDeclaration: NoneAcknowledgments: NoneFunding: NoneAI Acknowledgment: This manuscript employs AI tools to refine wording and enhance clarity for better comprehension. While AI-assisted tools were used to rephrase certain sections, all core ideas, data, and substantive content remain the original work of the authors. No portion of this manuscript is fully AI-generated, and human oversight has ensured the integrity and accuracy of the scientific content.

Background: Neurological diseases of infectious origin affecting the central nervous system of horses are of great importance in equine’s health. Vaccination is considered the most effective approach to protect the animals against viral encephalomyelitis, rabies, herpesvirus myeloencephalitis and tetanus. Objectives: The aim of this study is to estimate vaccination coverage against rabies, encephalomyelitis, tetanus and herpesvirus type I myeloencephalopathy in horses from the Vale do Paraíba region (São Paulo, Brazil), determining the sampling profile, frequency of vaccination, and adherence to recommendations. Study Design: A data survey about vaccination against neurological diseases of horses residing in the area of Vale do Paraiba, in the State of São Paulo, Brazil, was conducted. Questionnaires and face-to-face interviews were performed in individuals responsible for the animals. Methods: Sampling was designed based on the 30 by 7 Method (adapted from the World Health Organization, WHO). To explore the association between vaccine types and the relative percentage of animals (clustered categories) vaccinated for each of the diseases, a principal component analysis was performed followed by a multiple correspondence analysis to identify interdependencies among sub-regions, functions, types and breeds, scores and vaccines for each animal group. Results: A total of 1,140 animals from 30 properties were surveyed. Vaccination rates for each disease were: 95% (1,087) for rabies; 84% (956) for encephalomyelitis and tetanus, 14% (165) for equine herpesvirus myeloencephalopathy. Moreover, animals intended for sports had the highest vaccination coverage rates, while working horses presented lower rates. Main limitations: Lack of a local/regional demographic census and a centralised data registry limits an accurate assessment of vaccination coverage. Conclusions: Although some properties present high rates of vaccinations for some of the diseases, low coverage rates as well as no vaccination were observed. These results could be considered for the implementation of equine vaccination programs in the region and abroad.

We systematically reviewed published studies to assess reproducibility in miRNA expression profiles from extracellular vesicles (EVs) isolated from mouse serum. Our search specifically targeted mouse studies employing precipitation methods for EV isolation from blood and small RNA sequencing of EV-miRNAs in control groups. Out of 48 identified studies, approximately half lacked publicly available raw data, leaving six eligible studies containing sequencing data from a total of 14 mice. miRNA expression counts were standardized using z-scores for comparability. Within individual studies, miRNA profiles showed reasonable consistency; however, significant variability was observed across different studies. Principal component analysis (PCA), t-distributed stochastic neighbor embedding (t-SNE), and Spearman correlation consistently demonstrated study-specific clustering rather than biological similarity. Methodological discrepancies in EV isolation, RNA extraction protocols, and unreported confounders such as platelet contamination or blood-handling procedures likely contributed to this variability. Our findings emphasize substantial reproducibility challenges in EV-miRNA research across murine studies, highlighting an urgent need for standardized methodologies and transparent reporting to improve reliability of miRNA biomarker discovery and facilitate meta-analytic integration in preclinical research.

The consensus that Autism is from an intrauterine infection has been growing, bolstered by Patterson’s and Fatemi’s studies. However, the question remains: which infection? In this review, a prime, conceivable candidate is presented, supported by scientific literature, old and new. Until 1980 autism is still called “childhood schizophrenia” and in some parts of the world, it still is. But there is an extensive body of literature which ties schizophrenia to the infectious focus of this paper. This was only brought more sharply into focus when Rzhetsky, in 2007, used a proof-of-concept biostatistical analysis of 1.5 million patient records, finding significant genetic overlap in humans with autism, schizophrenia……..and tuberculosis. And in March of 2017, Ahmedabad-based Dr. Ketan Patel, who has more than 20 years’ experience in treating and researching autism in children, said that as many as 45% of the autistic children in the world are found, upon proper scrutiny, to have a history of tuberculosis on either their family’s maternal or paternal side. Ever since Nadya Markova’s study, also in 2017, it can no longer be questioned that the all too common Cell-Wall-Deficient [CWD] forms of mycobacteria such as TB can easily penetrate the umbilical cord and infect the fetus from the maternal blood stream, even in the case of seemingly normal healthy deliveries. Tracing the history of autism from John Langdon Down’s children, a subset of which were autistic, to the present, this paper also explains how these stealth pathogen hypothesized to be behind Autism have evaded modern diagnostics.

Introduction: Dermatofibrosarcoma protuberans is an extremely rare subtype of soft tissue neoplasm.Although DFSP typically manifests in the trunk and extremities, it rarely occurs in the breast, and is often misdiagnosed as benign or malignant breast lesions. Data regarding DFSP in the breast is scarce in existing literature. Only 13 cases in men have been documented. Here, we present a case diagnosed with breast DFSP in a young male patient who underwent surgical excision at our facility. In addition to presenting this unique case, we also conducted a literature review to draw attention to breast DFSP. Currently, there is a lack of reported studies exploring the cause of breast DSFP, the clinical, and radiological features, and the response to surgical treatment.

Purpose: A standardized set of clinical practice guidelines from the Musculoskeletal Tumor Society (MSTS) was released in 2018 to aid non-specialist physicians in diagnosing bone and soft-tissue lesions. Artificial intelligence (AI) models like ChatGPT are increasingly prevalent. Our objectives were to determine how closely ChatGPT recommendations align with MSTS guidelines for imaging bone and soft tissue lesions. Methods: We developed questions to assess ChatGPT’s alignment with MSTS guidelines. Answers from ChatGPT were double-blinded and evaluated for concordance. Answers were scored using four categories: accuracy, overconclusiveness, supplementary information, and incompleteness. Chi-square test was used with a statistically significant p-value of less than 0.05. Results: A total of 14 questions were generated from the 12 guidelines. Results showed alignment between the accuracy of ChatGPT’s responses and the guidelines. Of the 14 questions posed to ChatGPT, 10 were deemed accurate. However, responses to 13 questions were deemed overconclusive or contained supplementary information (p<0.05). Additionally, 9 responses were deemed incomplete when compared to guidelines (p<0.05). Conclusions: Imaging methods recommended by MSTS to front-line practitioners are generally aligned with AI-based modeling recommendations. However, ChatGPT is not yet sufficient as a standalone modality, often providing supplementary or incomplete information. The value of AI-based predictions in healthcare are an evolving modality.

The COVID-19 pandemic significantly disrupted healthcare access worldwide, including in Kazakhstan, where healthcare disparities may have worsened. This study examines barriers to healthcare access during the pandemic and factors associated with failed access. A cross-sectional survey of 1021 adults was conducted in Kazakhstan between June and July 2021 using a multistage stratified sampling approach. Weighted analyses accounted for selection biases and non-response. Participants reported barriers to COVID-19-related care, access to healthcare services, and the mode of care received (in person, telemedicine, or not accessed). Fear of contracting COVID-19 (38.9%), hospitalization (24.7%), and isolation-related job or income loss (23.9%) were the most common barriers. Among those needing healthcare (n=753), 21.7 % failed to access services, particularly health products (31.7%), emergency care (21.6%), and inpatient medical care (20.2%). Failed access was significantly associated with chronic conditions (ARR 1.54, 95% CI 1.13–2.11), unemployment (ARR 1.70, 95% CI 1.12–2.57), and food insecurity (ARR 1.34, 95% CI 1.02–1.77). These findings highlight the need for targeted policies to ensure equitable healthcare access during public health crises, particularly for vulnerable populations.