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Background Scientists have demonstrated the efficacy of vaccines against severe acute respiratory syndrome coronavirus 2 in randomized controlled trials. However, the extent to which reductions in COVID-19 case fatality ratio (CFR) are attributable to mass vaccination in the real world remains unclear. This study evaluated the association of COVID-19 vaccine coverage with CFR on a global scale. Methods The sample was a longitudinal data set of 90 countries over 25 weeks, from the first week of November 2020 to the third week of April 2021. CFR was measured in deaths per 100 COVID-19 confirmed cases; vaccine coverage was defined as the number of people who received at least one vaccine dose per 10 people in the total population. Data were retrieved from open-access databases, including Our World in Data and the Oxford COVID-19 Government Response Tracker. A country-level random effects model was used; a comprehensive set of variables for country characteristics and nonpharmaceutical interventions were included. Results A 10% increase in vaccine coverage was associated with a 7.6% reduction in the CFR (95% confidence interval (CI = -12.6 to -2.7%, P = 0.002). This association was stronger in countries with more effective governments (-8.3%; 95% CI = -13.6 to -3.1%, P = 0.002) and higher transport infrastructure quality (-8.1%; 95% CI = -13.3 to -2.9%, P = 0.002). Moreover, the vaccine coverage was associated with a reduced CFR in a dose-dependent manner. When vaccine coverage achieved 0.8 to 1.6, 1.6 to 3.2 and ≥3.2 per 10 people, the CFR reduced by 12.7% (95 CI = -21.8 to -3.6%, P = 0.006), 21.2% (95 CI = -33.9 to -8.5%, P = 0.001) and 31.3% (95 CI = -51.5 to -11.0%, P = 0.002), respectively as compared with no vaccination. Conclusions Our results provide supporting evidence that vaccination is critical to preventing deaths among infected people. Vaccination programmes have yielded significant health benefits in certain countries. However, globally, a large gap remains between observed and achievable fatality reductions. Continuous improvement in vaccine coverage will be critical to transforming efficacious vaccines into desired health outcomes.

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Standardized instruments are often used to assess the need for mental health services in a community. Such instruments are usually standardized on Caucasian samples and are generally assumed to be appropriate for different ethnocultural minorities. However, this assumption may be in error because cultural groups vary in their expression, manifestation, and reporting of symptoms. This article analyzes the responses to a standardized instrument, the Symptom Checklist (SCL), for four ethnic groups in Hawai'i: Caucasians, Filipinos, Japanese, and Native Hawaiians. Factor analysis using a procrustes rotation was used to force the data to fit into the five hypothesized factors of the SCL (somatization, obsessive‐compulsive, interpersonal sensitivity, depression, and anxiety). It showed that the scale item loadings generally did not correspond to the hypothesized factors. Among the ethnic groups, Caucasians appeared to have the best fit between the empirical and hypothesized factors whereas Native Hawaiians had the worst fit. Our results reinforce the importance of assessing established psychiatric symptom scales prior to their use on different ethnocultural minorities.

The population survey in Kin-Hu, Kinmen, had a high response rate of 79%. The crude prevalence rate of diabetes was 6.5%, and the age-adjusted prevalence rate was 4.9%. The low ratio of previously diagnosed to newly diagnosed diabetic cases may be due to lack of public awareness and medical services in this community.

The course of socio-cultural transition can neither be aimless nor arbitrary, instead it requires a clear direction. A common goal of social species' evolution is to move towards an advanced spiritual and conscious state. This study aims to develop a population-based algorithm on the basis of cultural transition goal. In this paper, the socio-cultural model based on a system thought framework could be used to develop a cultural evolution algorithm (CEA). CEA leverage four strategies, each consists of several search methods with similar thinking. Seven benchmark functions are utilized to validate the search performance of the proposed algorithm. The results show that all of the four strategies of cultural evolution algorithm have better performance when compared with relevant literatures.Finally, the CEA was then applied to optimize two different reliability engineering problems, a Serial-Parallel System design and a Bridge System design. For the Serial-Parallel System design, the CEA achieved the exact solution with ease, and for the Bridge System design, the solution obtained by the CEA is superior to those from other literatures.

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