In this work, we have studied the propagation of ultrasonic waves of lysozyme solutions characterized by different degrees of aggregation and networking. The experimental investigation has been performed by means of the Transient Grating (TG) spectroscopy as a function of temperature; this technique enables to measure the ultrasonic acoustic proprieties over a wide time window, ranging from nanoseconds to milliseconds. The fitting of the measured TG signal allows the extraction of several dynamic properties, here we focused on the speed and the damping rate of sound. The temperature variation induces in the lysozyme solutions a series of processes: protein folding-unfolding, aggregation and sol-gel transition. Our TG investigation shows how these self-assembling phenomena modulate the sound propagation, affecting both the velocity and the damping rate of the ultrasonic waves. In particular, the damping of ultrasonic acoustic waves proves to be a dynamic property very sensitive to the protein conformational rearrangements and aggregation processes.

The Voronoi entropy is a mathematical tool for quantitative characterization of the orderliness of points distributed on a surface. The tool is useful to study various surface self-assembly processes. We provide the historical background, from Kepler and Descartes to our days, and discuss topological properties of the Voronoi tessellation, upon which the entropy concept is based, and its scaling properties, known as the Lewis and Aboav-Weaire laws. The Voronoi entropy has been successfully applied to recently discovered self-assembled structures, such as patterned micro-porous polymer surfaces obtained by the breath figure method and levitating ordered water micro-droplet clusters.

This study shows the application of self-organizing maps (SOMs) to probabilistic forecasts of wind power generation and ramps in Japan. SOMs are applied to atmospheric variables obtained from atmospheric reanalysis over the region, thus deriving classified weather patterns (WPs). Probabilistic relationships are established between the synoptic-scale atmospheric variables over East Japan and the generation of regionally integrated wind power in East Japan. Medium-range probabilistic wind power predictions are derived by SOM, as analog ensembles based on the WPs of the multi-center ensemble forecasts. As this analog approach handles stochastic uncertainties effectively, probabilistic wind power forecasts are rapidly generated from a very large number of forecast ensembles. The use of a multi-model ensemble provides better results than a one-forecast model. The hybrid ensemble forecasts further improve the probabilistic predictability skill of wind power generation, as compared with non-hybrid methods. It is expected that long-term wind forecasts will provide better guidance to transmission grid operators. The advantage of this method is that it can include an interpretative analysis of meteorological factors for variations in renewable energy.

(RADA)4 nanoscaffolds are excellent candidates for use as peptide delivery vehicles: they are relatively easy to synthesize with custom bio-functionality, and assemble in situ to allow a focal point of release. This enables (RADA)4 to be utilized in multiple release strategies by embedding a variety of bioactive molecules in an all-in-one ‘construct’. One novel strategy focuses on the local, on-demand release of peptides triggered via proteolysis of tethered peptide sequences. However, the spatial-temporal morphology of self-assembling nanoscaffolds may greatly influence the ability for enzymes to both diffuse into as well as actively cleave substrates. Fine structure and its impact on overall affect on peptide release is poorly understood. In addition, fractal networks observed in nanoscaffolds are linked to the fractal nature of diffusion in these systems. Therefore, matrix morphology and fractal dimension of virgin (RADA)4 and mixtures of (RADA)4 and matrix metalloproteinase 2 (MMP-2) cleavable substrate modified (RADA)4 were characterized over time. Sites of high (GPQG+IASQ, CP1) and low (GPQG+PAGQ, CP2) cleavage activity were chosen. Fine structure was visualized using established according to established methods. After 2 hrs of incubation, nanofiber networks showed an established fractal nature, however nanofibers continued to bundle in all cases as incubation times increased. It was observed that despite extensive nanofiber bundling after 24 hrs of incubation time, the CP1 and CP2 nanoscaffolds were susceptible to MMP-2 cleavage. The properties of these engineered nanoscaffolds characterized herein illustrate that they are an excellent candidate as an enzymatically initiated peptide delivery platform.

Background: Even though a number of studies have verified the positive effect of physical activity (PA) on self-related health (SRH) no previous research has examined this association among pediatric patients with Type 1 diabetes mellitus (T1DM). Objective: The purpose of this study was to investigate the association between regular physical activity (PA) and self-rated health (SRH) in pediatric patients with Type 1 diabetes mellitus (T1DM) who lacked diabetes care. Methods: We conducted a retrospective study among pediatric patients with T1DM who lacked diabetes care and were enrolled in a diabetes education program between January 2011 to January 2015 at the endocrinology clinic of Seoul National University Children’s Hospital in South Korea. The eligible participants for this study were 37 pediatric patients with T1DM aged 9 to 17 years. PA was divided into regular PA and muscle strength exercise to analyze the relationship with SRH using binomial logistic regression analysis. Results: The results showed SRH of pediatric patients with T1DM who did not engage in regular PA was significantly lower than those who did (OR in regular PA = .199 [95% CI: .040, .995]; OR in regular muscle strength exercise = .097 [95% CI: .023, .825]). Conclusions: In conclusion, regular PA and muscle strength exercise in pediatric patients with T1DM who lacked diabetes care were effective in improving their SRH. A systematic plan is required to enhance regular PA for pediatric patients with T1DM.

Social media and other web 2.0 tools have provided users the platform to interact and also disclose personal information not only with their friends and acquaintances, but also with relative strangers with unprecedented ease. This has enhanced the ability of people to share more about themselves, their families, and their friends through a variety of media including text, photo, and video, thus developing and sustaining social and business relationships. The purpose of the paper is to identify the factors that predict self-disclosure on social networking sites within the Ghanaian context. Data was collected from 452 students in three leading universities in Ghana and analyzed with Partial Least Square-Structural Equation Modeling. Results from the study revealed that all variables in the proposed model with the exception of interaction and perceived control were significant predictors of self-disclosure with privacy risk being the most significant predictor. In all, the model accounted for 54.6 percent of the variance in self disclosure. The implications and limitations of the current study are discussed and directions for future research proposed.

Within the field of guilt and shame, two competing perspectives have been advanced. The first, the social-adaptive perspective, proposes that guilt is an inherently adaptive emotion and shame is an inherently maladaptive emotion; thus, those interested in moral character development and psychopathology should work to increase an individual’s guilt-proneness and decrease an individual’s shame-proneness. The functionalist perspective, in contrast, argues that both guilt and shame can serve a person adaptively or maladaptively—depending on the situational appropriateness, duration, intensity, and so forth. This paper reviews the research conducted supporting both positions, critiques some issues with the most widely used guilt- and shame-proneness measure in the social-adaptive research (the TOSCA), and discusses the differences in results found when assessing guilt and shame at the state versus trait level. The conclusion drawn is that although there is broad support for the functionalist perspective across a wide variety of state and trait guilt/shame studies, the functionalist perspective does not yet have the wealth of data supporting it that has been generated by the social-adaptive perspective using the TOSCA. Thus, before a dominant perspective can be identified, researchers need to (1) do more research assessing how the social-adaptive perspective compares to the functionalist perspective at the state level, and (2) do more trait research within the functionalist perspective to compare functionalist guilt- and shame-proneness measures with the TOSCA.

Abstract Background: Diabetes mellitus is dramatically increasing in the wide world. The managing of diabetes care emphasized the self-management education and support into patients’ care and family care. Objective: to review and synthesizes the effectiveness of DSME strategies involving family as a key person to provide social support for diabetes mellitus self-management of glycemic uncontrolled patients Method: Three databases through PubMed, CINAHL, and Scopus were reviewed to assess the relevant articles. The following search terms: “type 2 diabetes,” “self-management,” “family support,” and “glycemic uncontrolled.” We summarized details of family support on self-management among glycemic uncontrolled patients for 14 existing studies. Results: A total of 22 intervention studies were identified. Those studies have a heterogeneous of the education strategies, support perceived, follow-ups strategies and outcomes among type 2 DM. Family integration on diabetes self-management education (DSME) has a positive impact on several outcomes including, self-care behaviors, psychological outcomes, self-efficacy and clinical outcomes Conclusions: This systematic review found robust data related to the integration of family support on diabetes self-management among glycemic uncontrolled patients. Consequently, the improvement in outcomes was identified. Implications: The findings suggest model of family engagement is better and needed for sustaining the diabetes care in the long-term care

This article presents a self balanced multistage DC-DC step-up converter for photovoltaic applications. Proposed converter topology is designed for unidirectional power transfer and provides a doable solution for photovoltaic applications where voltage is required to be stepped up without magnetic components (Transformer-less and Inductor-less). The output voltage obtained from renewable sources will be low and must be stepped up by using a DC-DC converter for photovoltaic applications. K diodes and K capacitors along with two semiconductor control switch are used in the K-stage proposed converter to obtain an output voltage which is (K+1) times the input voltage. The conspicuous features of proposed topology are i) Magnetic components free (Transformer-less and Inductor-less). ii) Continuous input current iii) Low voltage rating semiconductor devices and capacitors iv) Modularity v) Easy to add a higher number of levels to increase voltage gain vi) Only two control switches with alternating operation and simple control. The proposed converter is compared with recent existing transformer-less and Inductor-less power converter in term of voltage gain, number of devices and cost. The application of proposed circuit is discussed in detail. The proposed converter has been designed with rated power of 60W, input voltage is 24V, output voltage is 100V and switching frequency is 100 kHz. The performance of the converter is verified through experimental and simulation results.

Using insights from cybernetics and an information-based understanding of biological systems, a precise, scientifically inspired, definition of free-will is offered and the essential requirements for an agent to possess it in principle are set out. These are: a) there must be a self to self-determine; b) there must be a non-zero probability of more than one option being enacted; c) there must be an internal means of choosing among options (which is not merely random, since randomness is not a choice). For (a) to be fulfilled, the agent of self-determination must be organisationally closed (a `Kantian whole'). For (c) to be fulfilled: d) options must be generated from an internal model of the self which can calculate future states contingent on possible responses; e) choosing among these options requires their evaluation using an internally generated goal defined on an objective function representing the overall `master function' of the agent and f) for `deep free-will', at least two nested levels of choice and goal (d-e) must be enacted by the agent. The agent must also be able to enact its choice in physical reality. The only systems known to meet all these criteria are living organisms, not just humans, but a wide range of organisms. The main impediment to free-will in present-day artificial robots, is their lack of being a Kantian whole. Consciousness does not seem to be a requirement and the minimum complexity for a free-will system may be quite low and include relatively simple life-forms that are at least able to learn.

Adolescence is a critical period for the development of self-perception, emotional well-being, and health-related behaviors. During this stage, adolescents undergo significant physical, emotional, and social changes that influence their overall health and interactions with their environment. This study analyzes the prevalence of behaviors related to self-perceived health, mood, and substance use among adolescents, identifies risk factors, and draws comparisons between different groups. It also examines how these factors interact with family and community dynamics to inform strategies for improving mental health care. Method: A descriptive cross-sectional study using questionnaires was conducted. Participants were adolescents aged 14 to 18 years from a school in the Baix Llobregat province of Catalonia. Descriptive and bivariate statistical analyses were performed using the chi-square test and p-value calculations with R Project software. Frequency and percentage analyses were employed to describe the health behaviors and emotional states of the participants. Results: The study reveals significant variations in adolescents' self-perceived health, emotional management, and substance use patterns. Adolescents with lower self-perceived health and negative mood states tend to exhibit higher rates of substance use, particularly alcohol and tobacco. Gender differences were observed, with girls generally reporting better health awareness and emotional regulation compared to boys. Conclusions: This study highlights the need for integrated approaches to family, community, and mental health care. Findings emphasize the importance of early intervention programs addressing emotional well-being and substance use in a holistic manner. Public health policies should prioritize comprehensive strategies involving schools, families, and communities to foster healthier behaviors and improve adolescent mental health outcomes.

This paper discusses the application of artificial intelligence in imaging omics, especially in cancer research. Imaging omics enables detailed analysis of spatial and temporal heterogeneity of tumours through high-throughput extraction of quantitative features from medical images such as MRI, PET, and CT. This paper focuses on applying PARKS systems to automate the recognition, segmentation, and extraction of image features, significantly enhancing the capabilities of clinical decision support systems (CDSS). The future direction is to establish a robust network infrastructure for radiology Medication-led Health care (RLHC) to facilitate the development and application of personalised treatment protocols, and to improve diagnostic accuracy, prognosis assessment, and treatment recommendations by uploading quantitative image features to a shared database and comparing them with historical images.

Liposomal amphotericin B (L-AmB) has become the cornerstone for the treatment of severe invasive fungal infections. However, renal toxicity may be an associated risk. Our aim was to evaluate the incidence of acute kidney injury (AKI) in critically ill patients receiving L-AmB for more than 48 hours. Clinical, demographic and laboratory variables were obtained retrospectively from electronic health record. Follow-up of the patients was for 7 days after L-AmB infusion. Patients were analyzed globally and differentiated between patients with "low" and "high" risk of developing AKI with machine learning techniques. Sixty-seven patients were included: 61 years, 67% male, with mean SOFA score of 4 (3-6.5) and a crude intensive care unit mortality of 34.3%. No significant variations in serum creatinine were observed during the observation period, except for the decrease in the high-risk subgroup. Overall, 26.8% of patients developed AKI-I, while 25% and 13% of patients at low and high risk of AKI developed AKI-I, respectively. The random forest models performed in overall and low-risk subgroup identified several major contributor’s factors to the development of AKI other than L-AmB administration. The development of AKI is multifactorial and the administration of L-AmB appears to be safe in this group of patients.

Glioblastoma (GBM) presents a significant public health challenge as the deadliest and most common malignant brain tumor in adults. Despite standard-of-care treatment, which includes surgery, radiation, and chemotherapy, mortality rates are high, underscoring the critical need for advancing GBM therapy. Over the past two decades, numerous clinical trials have been performed, yet only a small fraction demonstrated benefit, raising concerns about the predictability of current preclinical models. Traditionally, preclinical studies utilize treatment-naïve tumors, failing to model the clinical scenario where patients undergo standard-of-care treatment prior to recurrence. Recurrent GBM generally exhibits distinct molecular alterations influenced by treatment selection pressures. In this review, we discuss the impact of treatment - surgery, radiation, and chemotherapy - on GBM. We also provide a summary of treatments used in preclinical models, advocating for their integration to enhance the translation of novel strategies to improve therapeutic outcomes in GBM.

Introduction: Despite its high prevalence and impact on health, metabolic dysfunction-associated steatotic liver disease (MASLD) is inadequately addressed in European primary care (PC), with a large proportion of cases going undiagnosed or diagnosed too late. A multi-country European re-search consortium led a project to design and evaluate a patient-centered, integrated model for MASLD screening, diagnosis and linkage to specialty care for European PC settings. Aim: Based on the lessons from this project, the latest research evidence and existing guidelines for the management of MASLD, we sought to develop a set of practice recommendations for screening, referral and management of MASLD in PC. Methods: The Rand/UCLA modified Delphi panel method, with two rounds, was used to reach consensus on practice recommendations. The international panel consisted of experts from six countries, representing family medicine, gastroenterology, hepatology, cardiology and public health. Initially, fifteen statements were drafted based on a synthesis of evidence from the literature and earlier findings from our consortium. Prior to the consensus meeting, the statements were rated by the experts in a first round. Then, in a hybrid meeting, the experts discussed findings of round one, adjusted the statements and reassessed the updated recommendations in a second round. Results: In round one, there was already a high level of consensus on 10 out of 15 statements. After round 2, there were fourteen statements with a high agreement (>90%). One statement was not endorsed. The approved recommendations addressed the following practice areas: risk screening and diagnosis, management of MASLD – Lifestyle interventions, pharmacological treatment of MASLD/MASH, pharmacological treatment for co-morbidity, integrated care, surgical management and other referrals to specialists. Conclusion: The final set of 14 recommendations focuses on increasing comprehensive care for MASLD in PC. The recommendations provide practical evidence-based guidance tailored to PC practitioners. We expect that these recommendations will contribute to the ongoing discussion on systematic approaches to tackle MASLD and support European PC providers by integrating the latest evidence into practice.

Problem:Palestinian demographic landscape is undergoing an increase in the elderly population like many regions across the world. The elderly Palestinians face a unique challenges and problems of limited access to traditional care due to restricted movement, checkpoints, and also for limited healthcare resources. Therefore, the need arose to develop a sensitive and adaptable smart health monitoring system for Palestinian elderly to provide accurate and timely health data to improve well-being and prevent complications. Method: The proposed system (SHMS) leverages the Internet of Things (IoT) with appropriate sensors to track vital signs like heart rate, blood oximeter, body temperature and signal from a patient heart. Advanced algorithms analyze the data, generating alerts for potential health risks, triggering timely interventions, and enabling remote consultations. Results: This system has the potential to contributes to SDG 3 to significantly improve the health and well-being of elderly Palestinians by providing an accurate, low-power, and low-cost system for remote health monitoring. The system, being wearable, reads vital signs in real-time, overcoming geographical barriers and facilitating remote monitoring, especially in areas with limited healthcare centers and suffered from barriers along the way. The Doctor can suggest the patient’s prescription needed based on the momentary condition of the elderly and on previous readings of the sensors, if necessary. Which will also be notified via messages. Moreover, the doctor can take immediate intervention in case of an emergency. By implementing the system, it will be unnecessary for more than 50\% of the elderly to visit health care, thus reducing the cost to 50\%.}

In Taiwan, remote healthcare was initially limited to telemedicine services, and the systematic development of remote care was relatively delayed. It was not until 2007 that the Department of Health of the Executive Yuan first initiated the 'Remote Care Pilot Program,' followed by the 'Remote Care Service Improvement and Quality Enhancement Plan' in the subsequent year. In 2010, Taiwan officially launched the 'Remote Health Care Services Development Plan' and established a dedicated project office, marking the comprehensive start-up of remote care services. This stage saw significant contributions from artificial intelligence aids and ICT remote transmission technologies, greatly promoting the application of smart healthcare in home care. This study aims to explore the strategic gaps in the application of smart healthcare in home remote care. By analyzing gaps in 'legal regulations,' 'economic factors,' 'user behavior habits,' 'policy and culture,' and 'environment and technology,' this study employs a mixed-methods approach. Particularly, it uses the Analytic Hierarchy Process (AHP) to construct a weighted ranking of these strategic gaps. Through in-depth interviews with doctors and smart healthcare experts and the collection of 16 valid AHP questionnaire samples, which cover both industry and academia with a balanced distribution, the survey results are ensured to be representative and reliable. The findings indicate that 'legal regulations' are considered the most critical strategic gap that needs to be addressed first, followed by 'user behavior habits.' This suggests that when designing smart healthcare applications, greater consideration needs to be given to user acceptance and habits. By systematically analyzing and addressing these strategic gaps, this study not only provides solutions to issues in the application of smart healthcare in home remote care but also offers valuable references for future research and practice, aiming to make home remote care services more comprehensive and efficient.

Background/Objectives: The aim of this study was to investigate feasibility and safety of neuromuscular electrical stimulation (NMES) in patients on extracorporeal membrane oxygenation (ECMO) and assess thoroughly any potential adverse events. Methods: We conducted a safety and feasibility study including 16 ICU patients on ECMO support who were admitted to the cardiac surgery ICU from January 2022 to December 2023. Patients underwent a 45-minute NMES session, still on ECMO support, that included a warm up phase of 5 minutes, a main phase of 35 minutes and a recovery phase of 5 minutes. NMES was implemented on vastus lateralis, vastus medialis, gastrocnemius and peroneus longus muscle of both lower extremities. Two stimulators delivered biphasic, symmetric impulses of 75 Hz, with 400 μsec pulse duration, 5 sec on (1,6 sec ramp up and 0,8 sec ramp down) and 21 sec off. The intensity levels aimed to cause visible contractions and be well tolerated. Primary outcomes of the study were feasibility and safety, evaluated by whether the NMES sessions were successfully achieved, and by any adverse events and complications. Secondary outcomes included indices of rhabdomyolysis from biochemical blood test, 24 hours after the application of NMES. Results: All patients successfully completed their 45-minute NMES session, without presenting hemodynamic deterioration, adverse events or signs of rhabdomyolysis. The majority of patients achieved type 4 and 5 quality of muscle contraction. Conclusions: NMES is a safe and feasible exercise methodology in patients supported with ECMO.

.Bacground: Sepsis remains a major health challenge worldwide, characterized by a dysre-gulated host response to infection, leading to high mortality and morbidity in intensive care units (ICUs). The Fibrosis 4 (FIB-4) index, originally developed to assess liver fibrosis in hepatitis C patients, has recently been explored for its potential prognostic value in sepsis patients. Method: This study retrospectively analyzed 309 sepsis patients admitted to the Internal Me-dicine and Anaesthesia ICUs between December 12, 2021, and December 15, 2023, to inves-tigate the relationship between FIB-4 levels, Acute Physiology and Chronic Health Evaluation (APACHE), and Sequential Organ Failure Assessment (SOFA) and clinical outcomes. Results: The study found that higher FIB-4 measurements were statistically significantly asso-ciated with increased 28-day mortality, with a cut-off value of 4.9 providing a sensitivity of 54.92% and specificity of 74.25%. Logistic regression analysis indicated that elevated Conclusion:FIB-4 levels were a significant predictor of early mortality, suggesting that the FIB-4 index could serve as a valuable prognostic tool in assessing the severity and prognosis of sepsis patients.

Diabetic foot ulcers (DFUs) significantly affect the lives of patients and increase the risk of hospital stay and amputation. We suggest a remote-monitoring platform for better DFU care. This system uses digital health metrics (scaled from 0 to 10, where higher scores indicate a greater risk of slow healing) to provide a comprehensive overview through a visual interface. The platform features smart offloading devices that capture behavioral metrics such as offloading adherence, daily steps, and cadence. Coupled with remotely measurable frailty and phenotypic metrics, it offers an in-depth patient profile. Additional demographic data, wound characteristics, and clinical parameters, such as cognitive function, were integrated, contributing to a comprehensive risk factor profile. We evaluated the feasibility of this platform with 124 DFU patients over 12 weeks; 39% experienced unfavorable outcomes such as dropout, adverse events, or non-healing. Digital biomarkers were benchmarked (0-10), categorized into low, medium, and high risk for unfavorable outcomes, and visually represented using color-coded radar plots. The initial results of case reports illustrate the value of this holistic visualization to pinpoint the underlying risk factors for unfavorable outcomes, including a high number of steps, poor adherence, and cognitive impairment. Although future studies are needed to validate the effectiveness of this visualization in personalizing care and improving wound outcomes, early results in identifying risk factors for unfavorable outcomes are promising.

This study explores the multifaceted influence of litter size, maternal care, exercise, and aging on rats' neurobehavioral plasticity and dentate gyrus microglia dynamics. Body weight evolution revealed a progressive increase until maturity, followed by a decline during aging, with larger litters exhibiting lower weights initially. Notably, exercised rats from smaller litters displayed higher body weights during mature and aged stages. Dentate gyrus volumes showed no significant differences among groups, except for aged sedentary rats from smaller litters, which exhibited a reduction. Maternal care varied significantly based on litter size, with large litter dams showing lower frequencies of caregiving behaviors. Behavioral assays highlighted the detrimental impact of a sedentary lifestyle and reduced maternal care/large litters on spatial memory, mitigated by exercise in aged rats from smaller litters. Microglial dynamics in the layers of dentate gyrus revealed age-related changes modulated by litter size and exercise. Exercise interventions mitigated microgliosis associated with aging, particularly in aged rats. These findings underscore the complex interplay between early-life experiences, exercise, microglial dynamics, and neurobehavioral outcomes during aging.

This study aims to explore the associations between pediatric adverse events (PAEs) and hospital and patient characteristics within the inpatient hospital setting, focusing solely on the framework of pediatric quality indicators (PDIs) from the Agency for Healthcare Research and Quality (AHRQ). Specifically, the study focuses on NQI 03 Neonatal Blood Stream Infection (NBSI). The analysis utilizes discharge data from the Healthcare Cost and Utilization Project (HCUP) Kids’ Inpatient Databases (KID) for the year 2019. Through this analysis, the study seeks to answer research questions regarding associations between hospital characteristics and patient characteristics with NQI 03. The methodology employs bivariate and multivariate logistic regression models to analyze patient-level encounters of NBSI. The results indicate that smaller, rural, and non-teaching hospitals exhibit significantly lower odds of NQI 03 compared to large hospitals. Various individual factors such as gender, age, race, service lines, payment sources, and major operating room procedures also demonstrate differing levels of significance in relation to NQI 03, warranting further investigation. This study provides contextual expansion on the findings and offers valuable insights into PAEs in the inpatient hospital setting, specifically focusing on NBSI within the PDIs framework. It highlights areas for developing evidence-based interventions and guidelines for clinicians and policymakers. Ultimately, the findings contribute to the growing understanding of factors influencing NBSI and emphasize the importance of targeted strategies for improving pediatric patient safety.

Efficient triaging and referral assessment are critical in ensuring prompt medical intervention in the Community Health Care (CHC) system. However, the existing triaging systems in many Community Health Services are an intensive, time-consuming process and often lack accuracy, particularly for various symptoms that might represent heart failure or other health-threatening conditions. There is a noticeable limit of research papers describing AI technologies for triaging patients. This paper proposes a novel quantitative data-driven approach using machine learning (ML) modelling to improve the community clinical triaging process. Furthermore, this study aims to employ the feature selection process and machine learning power to reduce the triaging process’s waiting time and increase accuracy in clinical decision-making. The model was trained on medical records of “Heart Failure” patients’ dataset, which included demographics, past medical history, vital signs, medications, and clinical symptoms. A comparative study was conducted using the list of machine learning algorithms where XGBoost demonstrated the best performance among other ML models. The triage levels of 2,35,982 patients achieved an accuracy of 99.94%, precision of 0.9986, recall of 0.9958, and f1-score of 0.9972 within 0.059 seconds. The proposed diagnostic model can be implemented for the CHC decision system and be developed further for other medical conditions.

In this study, we propose an augmentation method for machine learning based on relabeling data in caregiving and nursing staff indoor localization with Bluetooth Low Energy (BLE) technology. Indoor localization is used to monitor staff to patient assistance in caregiving and to gain insights into workload management. However, improving accuracy is challenging when there is a limited amount of sensor data available for training. In this paper, we propose a data augmentation method to reuse the Received Signal Strength (RSS) from different sensors by relabeling to the sensors with less samples resolving data imbalance. Standard deviation and Kullback-Leibler divergence between minority and majority class are used to measure signal pattern to find matching sensors to relabel. By matching sensors between classes, two variation of relabeling are implemented specifically full and partial matching. The performance is evaluated using real world dataset we collected for five days in a nursing care facility installed with 25 BLE beacons. Random Forest model is utilized for location recognition, and performance is compared using the weighted F1-score to account for class imbalance. By increasing the sensor data with our proposed relabeling method for data augmentation, we achieved higher minority class F1-score as compared to augmentation with Random Sampling, Synthetic Minority Oversampling Technique (SMOTE) and Adaptive Synthetic Sampling (ADASYN). Our proposed method utilizes collected sensor data by leveraging majority class samples. Full matching demonstrated a 6 to 8% improvement from the original baseline overall weighted F1-score.

Background Acute kidney injury (AKI) is a common comorbidity in the intensive care unit (ICU), with higher mortality rate among those who receive continuous renal replacement therapy (CRRT). This study aimed to investigate the association of white blood cell (WBC) levels with all-cause mortality in AKI patients undergoing CRRT. Method We conducted a post hoc analysis of ICU patient data from multiple centers in Korea. First, the levels of WBCs were classified into four groups based on quartiles. Second, the relationship between different WBC levels and mortality was investigated with the Kaplan-Meier (K-M) survival curves, Cox proportional hazards model, and generalized additivity model (GAM). Finally, we used multiple imputation to avoid bias caused by non-randomized missing data. The endpoints were short-term (28 days) and long-term (90 days) mortality. Result In our analysis, a total of 1,100 ICU patients were included. Among them, 670 (60.90%) and 781 (71.00%) died within 28 and 90 days, respectively. K-M survival curves showed that patients with the lowest WBC levels had the highest risk of mortality for both outcomes. Adjusted multivariate Cox regression analysis confirmed that compared with the reference level (quartile 2), low WBC levels increased the risk of both 28-day mortality (quartile 1, HR = 1.43, 95% CI: 1.13–1.83, P = 0.004) and 90-day mortality (quartile 1: HR = 1.32; 95% CI: 1.05-1.66, P = 0.016). GAM analysis showed a non-linear, U-shaped relationship between pre-CRRT WBC levels and all-cause mortality (non-linear P < 0.05). Conclusion The baseline WBC level is an independent predictor of prognosis for ICU patients receiving CRRT. Patients in the lowest WBC quartile had the highest risk of all-cause mortality. These results provide further evidence that early observation and intervention may have a prognostic value for these high-risk patients.

Background: This study delves into the examination of racial and ethnic disparities in the distribution of the Monkeypox (MPOX) virus vaccine within the United States, offering a critical healthcare perspective on an emerging public health concern. It particularly focuses on the demographic patterns associated with MPOX transmission and the allocation of vaccines. Methods: A comprehensive analysis was conducted, drawing on a wide array of data sources to understand the vaccine distribution and demographic trends in the United States. The study scrutinized three main aspects: MPOX cases by race and ethnicity, vaccine administration across different racial and gender categories, and the potential disparities therein. Results: The findings reveal significant disparities in the distribution of vaccine doses, with males, particularly gay, bisexual, and other Men who have sex with men (MSM), receiving the majority of doses. Moreover, substantial variations in MPOX cases are observed among different racial and ethnic groups, emphasizing the need for culturally sensitive public health strategies. Conclusions: The study underscores the urgent need for targeted public health interventions to address disparities and safeguard the well-being of those at higher risk, particularly MSM. It highlights the importance of equity in vaccine distribution and culturally sensitive approaches, and serves as a foundation for shaping effective public health policies and strategies to mitigate the spread of MPOX. This research advances our understanding of healthcare disparities in the context of an emerging viral infection, providing valuable insights for future public health initiatives.

Machine learning (ML) techniques can help predict survival among cancer patients and might help with a timely integration in palliative care. We aim to explore the importance of subjective variables self-reported and collected via electronic patient reported outcome measure (ePROM) for survival prediction. A total of 256 advanced cancer patients met the eligible criteria. We analyzed objective variables collected from electronic health records, subjective variables collected via ePROM and all clinical variables combined. We used logistic regression (LR), decision trees, and random forests to predict 1-year mortality. Receiver operating characteristic (ROC) curve - area under the curve (AUC) and the ML models feature importance were analyzed. The performance of all variables for predictions (LR reaches 0.80 [ROC AUC] and 0.72 [F1 Score]) does not improve over the performance of only clinical non-patient reported outcome (non-PRO) variables (LR reaches 0.81 [ROC AUC] and 0.72 [F1 Score]). Our study indicates that patient-reported outcome (PRO) variables, which measure subjective burden, cannot be reliably used to predict survival. Further research in this area is needed to clarify the role of self-reported patient's burden and mortality prediction via ML.

A recently proposed single image parasite quantification (SIMPAQ) platform based on a Lab-On-a-Disc (LOD) device has been earlier successfully tested in field conditions demonstrating the efficiency in soil-transmitted helminths (STH) egg detection and analysis. A related study (Micromachines 2021, 12, 1032) revealed the effects that can limit the performance of a SIMPAQ method due to the action of the Euler and Coriolis forces, and the interaction of the moving eggs with the walls of the LOD chamber. Here we propose a new improved design that allows to overcome those limitations and enhance the yield of the SIMPAQ LOD device which is demonstrated in the experiments with synthetic particle model system and real parasite eggs.

The rapid progress in artificial intelligence, machine learning, and natural language processing has led to the emergence of increasingly sophisticated large language models (LLMs) enabling their use in healthcare. The study assesses the performance of two LLMs: the GPT-3.5 and GPT-4 models in passing the medical examination for access to medical specialist training in Spain MIR. Our objectives included gauging the model's overall performance, analyzing discrepancies across different medical specialties, discerning between theoretical and practical questions, estimating error proportions, and assessing the hypothetical severity of errors committed by a physician. We studied the 2022 Spanish MIR examination after excluding those questions requiring image evaluations or having acknowledged errors. The remaining 182 questions were presented to the LLM ChatGPT4 and GPT-3.5 in Spanish and English. Logistic regression models analyzed the relationships between question length and question sequence d performance. GPT-4 outperformed GPT -3.5, scoring 86.81% in Spanish (p<0.001). English translations had a slightly enhanced performance. Among medical specialties, GPT-4 achieved a 100% correct response rate in several areas, with specialties like Pharmacology, ICU, and Infectious Diseases showing lower performance. The error analysis revealed that while a 13.2% error rate existed, gravest categories like "error requiring intervention to sustain life" and "error resulting in death" had a 0% rate. Conclusions: GPT-4 performs robustly on the Spanish MIR examination, varying its capability to discriminate knoweldge across specialties. While the model's high success rate is commendable, understanding the error severity is critical, especially when considering AI's potential role in real-world medical practice and its implication on patient safety.

The Coronavirus Disease 2019 (COVID-19) pandemic has had a major impact on the mental and physical health of hospitalized patients. In our study we focused on the onset of symptoms correlated with Post-traumatic stress disorder (PTSD), depression and physical disabilities in patients admitted to the Intensive Care Unit (ICU) because of a severe respiratory distress related to COVID-19 (COVID Group) compared with patients admitted to the same ICU for trauma and other medical conditions than COVID-19 (No-COVID Group). The physical symptoms and the level of disability were evaluated with the Glasgow Outcome Scale-Extended (GOS-E), the Quality of Life after Brain Injury (QOLIBRI) and the 3 levels version of EQ-5D (EQ-5D-3L) questionnaire; psychiatric symptoms were investigated using the Impact of Event Scale-Revised 22-item (IES-R), the Patient Health Questionnaire, 9-Item Version (PHQ-9) and the Generalized Anxiety Disorder Assessment, 7-items version (GAD-7). These questionnaires were administered 6 months after discharge. Patients in the No-COVID Group showed statistically significant more severe scores in all the physical assessments while similar relevant PTSD and depressive symptoms were reported in both groups. The results of the present study underline the psychopathological impact of being hospitalized in ICU because of COVID-19 even after 6 months from discharge ,suggesting the importance of assessing the psychiatric effects of COVID-19 in the long term in order to create supportive measures.

Background: Skin and soft tissue infections (SSTI) are common presentations to the emergency department. However, this is less common after contact with contaminated water, both salt or fresh. This review presents the diagnosis and the management of water-related soft tissue sepsis in this vulnerable and difficult to treat subgroup of necrotizing soft tissue sepsis. Methods: A summative literature overview regarding bacterial and fungal SSTI after contact with contaminated water, with practical diagnostic and management aspects addressed. Results: The literature indicates that these remain difficult to treat wounds and organisms. An approach using appropriate diagnostic tools with both medical and surgical management strategies is provided. Conclusion: SSTI due to water contamination of wounds involve unusual organisms with unusual resistance patterns and require a nuanced and directed diagnostic approach with adaptation of the normal antibiotic or antifungal selection to achieve cure, along with aggressive debridement and wound care.

The objective of this study was to compare the pathogens and susceptibilities of the current automated rule-based technology (RBT) antibiogram with one manually collected through chart review with additional rules applied. This study was a 2-year, retrospective cohort study and included all bacterial cultures within the first 30 days from patients admitted to a single Burn Center. The current RBT antibiogram served as the control and new antibiogram versions were created using additional rules and compared to the control. Six-hundred fifty-seven patients were admitted (61% excluded for lack of cultures). Fifty-nine percent had at least one hospital acquired risk factor with over one-third having recent illicit drug use and one-third having a recent hospitalization. Of the 410 cultures included, 57% were Gram-negative and half were from wound infections. Sensitivities were significantly different when comparing manual and the RBT version after including factors, such as days since admission, presence of hospital acquired risk factors, or previous antibiotic courses. Recommended empiric Gram-negative antibiotics changed from double coverage to a single β-lactam with > 90% susceptibility. The susceptibilities between first and subsequent courses were dramatically different. Before developing an antibiogram or interpreting the output, it is important to consider which automated criteria are utilized, especially for units with extended lengths of stay.

: Background: Vaccine-related death is one of the leading causes of death among African Children. Vaccine coverage is a very important measure to decrease infant mortality. Covid-19 Pandemic has affected the healthcare system and may have disrupted vaccine coverage. Methods: DTP third doses (DTP3) Vaccine Coverage was extracted from UNICEF databases from 2012 to 2021( the last available date). Joinpoint regression was performed to detect the point where the trend changed. The annual percentage change (APC) with 95% confidence intervals (95% CI) was calculated for Africa and the regions. We compared DTP3 vaccination coverage in 2019 with 2021 in each country to verify compliance with WHO targets. Result: During the whole period, the vaccine coverage in Africa has increased with an Annual Percent change of 1.2% (IC 95% 0.9-1.5): We detected one Joint point in 2019. In 2019-2021, there was a decrease in DTP3 coverage with an APC of -3.5(95% -6.0;-0,9). (P< 0.001). Vaccination rates have decreased in many regions and countries during the last two years. Conclusions. COVID-19 has disrupted vaccine coverage, decreasing it all over Africa.

The COVID-19 pandemic has profoundly changed the world and human society in various ways. Infection-related figures are key indicators of the direct impact of the pandemic. In addition to the virus, many vulnerable populations (e.g. patients with complex health conditions) have suffered direct or indirect health impacts, such as delayed treatment or diagnosis of cancer and severe mental illness due to stay-at-home restrictions, or financial issues. Studying these kinds of impacts can provide the community with insights and understanding of how the pandemic has affected patients with health conditions and help inform decision-makers design policies that support various vulnerable populations. This paper surveys analytical work conducted on how COVID-19 has impacted patients with complex health conditions. We categorise vulnerable populations into three specific cohorts: patients with chronic disease, patients with cancer and patients with end-of-life care. We then investigate how each of these cohorts has been impacted by the pandemic. We also identify each cohort from an analytics perspective by leveraging various data collection strategies and analytical methods. The goals of this paper are to provide evidence on how to improve the quality of life for vulnerable populations and to inform a national response strategy for future pandemics, which seems inevitable in a highly globalised economy.

The past several decades have seen a shift in patient care towards digitalisation, which has ushered in a new era of health care delivery and improved sustainability and resilience of health systems, with positive impacts on both internal and external stakeholders. This study’s aim was to understand the role of digital virtual consultations in improving internal and external stakeholders’ health, as well as wellbeing among hospital doctors. A qualitative research approach was used with semi-structured online interviews administered to hospital doctors. The interviews showed that the doctors viewed digital virtual consultations as supplementary to in-person consultations, and as tools to reduce obstacles related to distance and time. If the necessary infrastructure and technology were in place, doctors would be willing to use these options. Implementing these technologies would improve the medical profession’s flexibility on the one hand; but it might affect doctors’ work–life balance if consultations extended beyond standard working hours.

The WHO European Region defined the role of a new central professional for primary care, the Family and Community Nurse (FCN). The introduction of FCN in the framework of health policies highlight a key role of nurses in addressing the families’ and communities’ needs. A scoping review was conducted in order to identify and describe the available tools which has been adopted for the assessment of the community health needs by FNC. A comprehensive literature review on Embase, Cochrane Library, PubMed, CINAHL, Scopus and PsycInfo databases was conducted including all studies up to May 2021. A total of 1563 studies were identified and 36 of them were included. The literature review had made possible to identify studies employing twelve different community assessment's tools or modalities. Referring the WHO framework proposed in 2001 some common themes have been identified with an uneven distribution, as profiling the population, deciding on priorities for action and public healthcare programmes, implementing the planned activities, evaluation of health outcomes, multidisciplinary activity, flexibility and involving the community. To the best of our knowledge, this work is the first attempt to provide an overview of community assessment tools, keeping the guidance provided by the WHO as a reference.

Systemic hypertension has been recognized as a modifiable traditional cardiovascular risk factor and influenced by many factors such as eating habits, physical activity, diabetes and obesity. The objective of this study was to identify cardiometabolic factors that predict changes in blood pressure induced by a one-year lifestyle intervention in primary care settings involving a collaboration between family physicians, dietitians, and exercise specialists. Patients with metabolic syndrome diagnosis were recruited by family physicians participating in primary care lifestyle intervention among several family care clinics across Canada. Participants for whom all cardiometabolic data at the beginning (T0) and the end (T12) of the intervention were available were included in the present analysis (n=101). Patients visited the dietitian and the exercise specialist weekly for the first three months and monthly for the last nine months. Diet quality, exercise capacity, anthropometric indicators, and cardiometabolic variables were evaluated at T0 and at T12. The intervention induced a significant decrease in waist circumference (WC), systolic (SBP) and diastolic (DBP) blood pressure, and plasma triglycerides and an increase in cardiorespiratory fitness (estimated VO2max). Body weight (p<0.001), body mass index (BMI) (p<0.001), and plasma glucose (p=0.006) reduction and VO2max increase (p=0.048) were all related to changes in SBP. WC was the only variable for which changes were significantly correlated with those in both SBP (p<0.0001) and DBP (p=0.0004). Variations in DBP were not associated with changes in other cardiometabolic variables to a statistically significant extent. Twelve participants were identified as adverse responders in both SBP and DBP and displayed less favorable changes in WC. The beneficial effects of a lifestyle intervention on blood pressure were significantly associated with cardiometabolic variables, especially WC. These findings suggest that a structured lifestyle intervention in primary care can help improve cardiometabolic risk factors in patients with metabolic syndrome.

Background: Although, negative repercussions of inadequate health service use on the health outcomes has been presumably exacerbated by COVID-19, the impact of the pandemic measures has been not evaluated properly yet. Objective: Our study aimed to quantify the COVID-19 pandemic measures’ effect on the general practitioner (GP) visit, specialist care, hospitalization and cost-related prescription nonredemption (CRPNR) among adults in Hungary, and to identify the social strata susceptible to the pandemic effect. Methods: This community-based cross-sectional study based on nationally representative data of 6,611 (Nprepandemic=5,603 and Npandemic=1,008) subjects aged 18 years and above. Data were obtained from the European Health Interview Survey 2019 (EHIS) and International Social Survey Program 2021 (ISSP) for prepandemic and pandemic, respectively. Multivariable logistic regression models were applied to determine the sociodemographic and clinical factors influencing the health care use by odds ratios (OR) along with the corresponding 95% confidence intervals (CI). To identify the social strata susceptible to pandemic effect, the interaction of the time of data collection with level of education, marital status, and ethnicity, was also tested. Results: While, the CRPNR did not changed, the frequency of GP visit, specialist care and hospitalization rate were remarkably reduced by 22.2%, 26.4%, and 6.7%, respectively, during the pandemic in Hungary. Roma proved to be not specifically affected by the pandemic in any studied respect. The pandemic restructuring of health care impacted the social subgroups evenly with respect to hospital care. However, the pandemic effect was weaker among primary educated adults (ORhigh-school vs primary-education =0.434; 95% CI 0.243-0.776, ORhigh-school vs primary-education =0.598; 95% CI 0.364-0.985), and among widows (ORwidowed vs married =2.284; 95% CI 1.043-4.998, ORwidowed vs married=1.915; 95% CI 1.157-3.168) on the frequency of GP visit and specialist visit; and the prepandemic CRPNR inequality by level of education was increased (ORhigh-school vs primary-education =0.236; 95% CI 0.075-0.743). Conclusion: Primary educated and widowed did not follow the general trend, and their prepandemic limited health care use was not reduced further during pandemic, resulting in an inequality reduction. The vulnerability of primary educated to CRPNR was the only gap widened in the pandemic period. This shows that although the management of pandemic health care use restrictions was implemented by increasing the social inequality in Hungary, the prevention of inequity in drug availability for primary educated individuals could require more support.

The study reports about a case of a lung cancer patient with increasing difficulties in falling asleep and frequent periods of wakefulness. Severe dyspnea related to pneumonitis caused as a side effect of immunotherapy worsened the situation. Eventually, fear of falling asleep developed, including panic attacks and anxiety of choking, which was shown to lead to nights of complete wakefulness. The patient did not only sleep poorly; he did not sleep at all at night for several days, as evidenced by the notes he made during the night. Polygraphy showed no evidence of sleep-disordered breathing, but frequent periods of wakefulness and reduced basal saturation around 90% during sleep due to lung changes such as extensive functional failure of the left upper lobe with position-dependent shunts. The authors hypothesized that the symptoms described were causally related to a drop in oxygen saturation in the patient's blood. Therefore, they pursued the goal of finding a measurement technique that is as inexpensive as possible and that the patient can operate without outside assistance and great effort. So the patient started using a low-cost wearable device that allows simultaneous measurements of blood oxygen content, pulse rate and movement intensity. It consists of a finger ring with pulse oximetry sensor and a wristband with the control unit containing a vibration motor. The described device reliably warned of disturbances in oxygen concentration in the blood during the night with its vibration alarm. By use of that device during the whole night at home, the events of reduced oxygen saturation and the anxiety symptoms were reduced. Sleep disturbances with sudden awakenings did not occur when using the device. The patient benefited from the security gained in this way and slept much more peacefully, and he could spend nights without waking up again. In conclusion, wearable oximeters with vibration alarm can be recommended for patients’ home care in lung cancer patients.

Titin is a giant protein that functions as a molecular spring in sarcomeres. Titin interplays the contraction of actin-containing thin filaments and myosin-containing thick filaments. The breakdown product of titin has been measurable in urine as urinary titin N-fragments. Urinary titin N-fragment was originally reported to be a useful biomarker in the diagnosis of muscle dystrophy. Recently, the urinary titin N-fragment has been increasingly gaining attention as a novel biomarker of muscle atrophy and intensive care unit-acquired weakness in critically ill patients, in whom titin loss is a possible pathophysiology. Furthermore, several studies reported that the urinary titin N-fragment also reflected muscle atrophy and weakness in patients with chronic illnesses. It may be used to predict the risk of post-intensive care syndrome or to monitor patients’ condition after hospital discharge for better nutritional and rehabilitation management. We provide several tips on the use of this promising biomarker in post-intensive care syndrome.

While nursing is an ethical profession, unethical behavior among nurses is increasing worldwide. This study examined the effects of an ethics seminar on nurses' moral sensitivity and ethical behavior. A total of 37 nurses (17 experimental, 20 control) were recruited. The ethics seminar was held over a 6-month period from May to October, 2018, and comprised six sessions held once a month for two hours. Moral sensitivity and unethical behavior were measured at the start and end of the seminar. Moral sensitivity and unethical behavior showed a negative correlation (r= -.455, p&lt;0.01). After the ethics seminar, the experimental group's moral sensitivity was significantly increased (t = -1.039, p = 0.314). The mean scores of unethical behavior at pre and post-test in the experimental group were 12.59 and 9.47, respectively. This was a statistically significant difference (t = 3.118, p = 0.004). There was no statistically significant difference in the mean score in both moral sensitivity and unethical behavior in the control group. We conclude that ethics seminars can enhance moral sensitivity and reduce the risk of unethical behavior among nurses. Regular ethics seminars and training must be provided to nurses as a matter of policy.

In recent years, the management of health systems is a main concern of governments and decision makers. Home health care is one of the newest methods of providing services to patients in developed societies that can respond to the individual lifestyle of modern age and the increase of life expectancy. The home health care routing and scheduling problem is a generalized version of the vehicle routing problem, which is extended to a complex problem by adding special features and constraints of health care problems. In this problem, there are multiple stakeholders such as nurses for which an increase of their satisfaction level is very important. In this study, a mathematical model is developed to expand traditional home health care routing and scheduling models to downgrading cost aspects by adding the objective of minimizing the difference between the actual and potential skills of the nurses. Downgrading can lead to a dissatisfaction of the nurses. In addition, skillful nurses have higher salaries and high-level services increase equipment costs and need more expensive trainings and nursing certificates. Therefore, downgrading can enforce hidden huge costs to the managers of a company. To solve the bi-objective model, an -constraint based approach is suggested and the model applicability and its ability to solve the problem in various sizes are discussed. A sensitivity analysis on the Epsilon parameter is conducted to analyze the effect of this parameter on the problem. Finally, some managerial insights are presented to help the managers in this field, and some directions for future studies are mentioned as well.

Purpose The gradual increase in geriatric issues and global imbalance of the ratio between patients and healthcare professionals has created a demand for intelligent systems with the least error-prone diagnosis results to be used by less medically trained persons and save clinical time. This paper aims at investigating the development of an image-based colourimetric analysis. The purpose of recognising such tests is to support wider users to begin a colourimetric test to be used at homecare settings, telepathology, etc. Design/methodology/approach The concept of an automatic colourimetric assay detection is delivered by utilising two cases. Training Deep Learning (DL) models on thousands of images of these tests using transfer learning, this paper i) classifies the type of the assay, and ii) classifies the colourimetric results. Findings This paper demonstrated that the assay type can be recognised using DL techniques with 100% accuracy within a fraction of a second. Some of the advantages of the pre-trained model over the calibration-based approach are robustness, readiness and suitability to deploy for similar applications within a shorter period of time. Originality/value To the best of our knowledge, this is the first attempt to provide Colourimetric Assay Type Classification (CATC) using DL. Humans are capable to learn thousands of visual classifications in their life. Object recognition may be a trivial task for humans, due to photometric and geometric variabilities along with the high degree of intra-class variabilities it can be a challenging task for machines. However, transforming visual knowledge into machines, as proposed, can support non-experts to better manage their health and reduce some of the burdens on experts.

Purpose: During the COVID-19 pandemic, the health care workers (HCWs) at the frontline have been largely exposed to infected patients, running an high risk of being infected by the SARS-CoV-2 virus. This study investigates the epidemiological, clinical and lifestyles characteristics that might play roles in the susceptibility of HCWs to COVID-19 in a hit Italian hospital. Methods:Demographic, lifestyle, work-related and comorbidities data of 1447 HCWs which underwent a nasopharyngeal swab for SARS-CoV-2 were retrospectively collected. For the 164 HCWs positive for SARS-CoV-2, data about safety in the workplace, symptoms and clinical course of COVID-19 were also collected. Cumulative incidence of SARS-CoV-2 infection was estimated. Risk factors for SARS-CoV-2 infection were assessed using a multivariable Poisson regression. Results: The cumulative incidence of SARS-CoV-2 infection among the screened HCWs was 11.33 (9.72-13.21). Working in a COVID-19 ward, being a former smoker (vs being a person who never smoked) and BMI were positively associated with SARS-CoV-2 infection, whereas being a current smoker was negatively associated with this variable. Conclusions: Assuming an equal accessibility and proper use of PPE of all the HCWs of our Hospital, the great and more prolonged contact with COVID-19 patients remains the crucial risk factor for SARS-CoV-2. Therefore, increased and particular care needs to be focused specifically on the most exposed HCWs groups, which should be safeguarded. Furthermore, in order to limit the risk of asymptomatic spread of SARS-CoV-2 infection, the HCWs mild symptoms of COVID-19 should be considered when evaluating the potential benefits of universal staff testing

Background: Given the increasing request for natural pharmacological molecules, this study assessed the antimicrobial capacity of Pistacia lentiscus L. essential oil (PLL-EO) obtained from the leaves of wild plants growing in North Sardinia (Italy), toward a wide range of periodontal bacteria and Candida including laboratory and clinical isolates sp., together with its anti-inflammatory activity and safety; Methods: PLL-EO was screened by gas chromatography / mass spectrometry. The minimal inhibitory concentration (MIC) was determined. The anti-inflammatory activity was measured by cyclooxygenase (COX 1/2) and lipoxygenase (LOX) inhibition while the antioxidant capacity was determined electro-chemically and by the MTT assay. The WST-1 assay was used to ascertain cytotoxicity toward four line of oral cells; Results: According to the concentrations of terpens, PLL-EO is a pharmacologically active phytocomplex. MICs against periodontal bacteria ranged between 3.13 and 12.5 µg/ml, while against Candida sp. were between 6.25 and 12.5 µg/ml. Oxidation by COX 1/2 and LOX was inhibited by 80% and 20% µg/mL of the oil respectively. Antioxidant activity seemed negligible, and no cytotoxicity arose; Conclusions: PLL-EO exhibits a broad-spectrum activity against periodontal bacteria and Candida, with an interesting dual inhibitory capacity toward COX2 and LOX inflammatory enzymes and without side effects against oral cells.

There is much discussion among clinicians, epidemiologists, and public health experts about why case fatality rate from COVID-19 in Italy (at 13.3% as of April 20, 2020, versus a global case fatality rate of 6.9%) is considerably higher than estimates from other countries (especially China, South Korea, and Germany). In this article, we propose several potential explanations for these differences. We suggest that Italy’s overall and relative case fatality rate, as reported by public health authorities, is likely to be inflated by such factors as heterogeneous reporting of coronavirus-related fatalities across countries and the iceberg effect of under-testing, yielding a distorted view of the global severity of the COVID-19 pandemic. We also acknowledge that deaths from COVID-19 in Italy are still likely to be higher than in other equally affected nations due to its unique demographic and socio-economic profile. Lastly, we discuss the important role of the stress imparted by the epidemic on the Italian healthcare system, which weakened its capacity to adequately respond to the sudden influx of COVID-19 patients in the most affected areas of the country, especially in the Lombardy region.

Aim: this scoping review was designed to identify studies that assess the adverse drug reactions (ADRs) for older people in Australian aged-care facilities. This review critically evaluated each published study to identify the risk of, or actual adverse drug events in older people. Inclusion criteria: This review considered any clinical studies that examined the adverse effects of medications in older people who were living in aged-care facilities. This review considered qualitative studies, analytical studies, RCTs, descriptive cross-sectional studies, and analytic observational studies that explored the use of medications and their adverse effects on older people in clinical settings (including aged care facilities). Methods: An initial search of the PubMed, OvidSP, EBSCOHost, MEDLINE, ScienceDirect, Wiley Online, SAGE, and SCOPUS databases, with full text was performed, followed by an analysis of the article’s title and abstract. Additionally, MeSH was used to describe the article. The initial round of the database search was based on inclusion criteria from studies that assessed tools or protocols aiming to identify the adverse effects of medications on the elderly population suffering chronic conditions or multiple co-morbidities. Two reviewers screened the retrieved papers for inclusion. The data presented in this review are in tabular forms and a narrative summary which aligns with the review’s objectives. Results: Seven studies were identified, and the extracted data from these studies were grouped according their characteristics and the auditing results of each study. Conclusion: There was no comprehensive or broadly adverse drug reaction assessment tool derived from Australian data that has been used on the elderly in an Australian healthcare setting.

This paper evaluates the effect of China’s New Rural Pension Scheme (NRPS) on the retirement sustainability in forms of both formal labor supply and informal labor supply, using data from China Health and Retirement Longitudinal Study (CHARLS). We explore the regional differences of the NRPS effect on labor supply between the Western regions and the other regions of China. Our analysis shows that western rural China has a more severe problem of “ceaseless toil” compared to the rest of the country. We find that NRPS improves the “ceaseless toil” situation of the Chinese rural elderly, and the results show a very different pattern between western China and other parts of the country.

The workforce crisis of primary care is reflected in the increasing number of general medical practices (GMP) with vacant general practitioner (GP) position, and the GPs’ ageing. Our study aimed to describe the association between this crisis and premature mortality. Age-sex-standardized mortality for 18-64 years old adults were calculated for all Hungarian GMPs annually in the period from 2006 to 2014. The relationship of premature mortality with GPs’ age and vacant GP position were evaluated by standardized linear regression controlled for list size, urbanization, geographical location, clients’ education, and type of the GMP. The clients’ education was the strongest protective factor (beta=-0175; p<0.001), followed by urban residence (beta=-0.149; p<0.001), and the bigger list size (beta1601-2000=-0.054; p<0.001; beta2001-X=-0.096; p<0.001). The geographical localization influenced significantly also the risk. Although, GMP with a GP aged older than 65 years (beta=0; p=0.995) did not affected the risk, GP vacancy was associated with higher risk (beta=0.010; p=0.033), but the corresponding number of attributable cases was 23.54 for 9 years. The vacant GP position is associated with significant but hardly detectable increased risk of premature mortality without considerable public health importance. Nevertheless, employment of GPs aged more than 65 does not impose premature mortality risk elevation.

Not a lot is known about either death or the dying process. Politicians and many in the medical profession in the UK tend to shy away from interfering with it by not allowing euthanasia as an end of life option for the patient. This is the first paper in a series of two, comparing the situation in human medicine and veterinary medicine, in which euthanasia is well practiced for relieving suffering at the end of an animal’s life. This first part takes the form of a literature review including best practice around end of life care, its deficiencies and the need for assisted dying. Veterinary surgeons are well trained in the ethics of euthanasia and put it to good use in the best interest of their animal patients. In countries which have legalized physician assisted suicide for the terminally ill reporting indicates that it works well, without increases in involuntary euthanasia and most importantly without intimidation of the vulnerable. However, there is still an ever increasing tendency to overuse sedation and opioids at the end of life, which merits further investigation. With advances in medical science able to significantly prolong the dying process, patient autonomy demands a review of the law in the UK.

Is there a qualitative difference between apes’ and human Theory-of-Mind (or ability to estimate others’ mental states)? After opting for the idea that expectations are empty profiles that recognize a particular content when it arrives, I apply the same description to ‘vicarious expectations’ –very probably present in apes. Thus, (empty) vicarious expectations and one’s own (full) contents are distinguished without need of meta-representation. Then, three proposals are made. First, vicarious expectations are enough to support apes’ Theory-of-Mind (including ‘spontaneous altruism’). Second, since vicarious expectations require a profile previously built in the subject that activates them, this subject cannot activate any vicarious expectation of mental states that are intrinsically impossible for him. Third, your mental states that think of me as a distal individual are intrinsically impossible states for me, and therefore, to estimate them, I must estimate your mental contents. This ability (the original nucleus of human Theory-of-Mind) is essential in human lifestyle. It is involved in unpleasant and pleasant self-conscious emotions, which respectively contribute to ‘social order’ and to cultural innovations. More basically, it makes possible the human (prelinguistic or linguistic) communication, since it originally made possible the understanding of others’ mental states as states that are addressed to me, and that are therefore impossible for me.

Background and Objectives: Fifty percent of individuals with borderline personality disorder (BPD) experience Non-Suicidal Self-Injury (NSSI). One of the crucial factors related to NSSI is the feeling of emptiness. Although some inner strengths, such as five precepts, meditation, and equanimity, have been identified as potential buffers against negative mental health outcomes in BPD, their role in mediating the relationship between emptiness and NSSI is not well-documented. This study aimed to explore how these inner strengths mediate the relationship between feelings of emptiness and NSSI in individuals with BPD symptoms. Materials and Methods: A total of 302 participants with BPD symptoms completed several assessments: the SCID-II Personality Disorder (Borderline PD) to assess feelings of emptiness and NSSI, the Inner-Strength-Based Inventory (i-SBI) to evaluate five precepts, meditation, and equanimity, and the Outcome Inventory Depression (OI-Dep) to assess depression. Mediation analysis was performed using IBM SPSS and AMOS, with NSSI as the outcome variable, feelings of emptiness as the predictor, and the inner strengths as mediators. Results: The participants had a mean age of 36.56, with 65.4% being female. The analysis showed that five precepts, meditation, and equanimity significantly mediated the relationship between feelings of emptiness and NSSI, with a standardized coefficient of β = 0.534 (95% CI = 0.417 to 0.647, p &lt; 0.001). The indirect effect of emptiness through these inner strengths was significant (β = 0.034, 95% CI = 0.009 to 0.075, p = 0.005). The mediation model explained 38% of the variance in NSSI with a 3% increase, albeit small but significant. Conclusions: The study highlights a negative mediating role of inner strengths in the relationship between feelings of emptiness and NSSI meaning that as these inner strengths increase, the direct impact of feelings of emptiness on NSSI decreases. This suggests that these inner strengths act as protective factors, reducing the likelihood that someone with feelings of emptiness will resort to NSSI as a coping mechanism. These findings suggest that targeting these inner strengths could be a valuable strategy in developing interventions aimed at reducing NSSI by addressing the underlying emotional challenges associated with BPD.

Since the beginning of the internet era, there has been an explosion of growth in structured data (such as numbers, symbols, and labels) as well as unstructured data (including images, videos, and text). Efficient and accurate mixed query of these two types of data is a key technology to achieve high-quality information retrieval, and it is also a major challenge that needs to be solved urgently in the industry. In this study, we employ an advanced Transformer model that combines strategies and fine-tuning techniques for multi-task learning. Specifically, the model is first pre-trained on a large-scale, general-purpose dataset to learn different types of data representations and basic language comprehension skills. After that, we fine-tuned the parameters of the model to better suit these specific data processing tasks for specific application scenarios, such as image annotation, video content analysis, and structured data query. At the heart of the model is the self-attention mechanism, which allows the model to automatically emphasize the important parts and ignore irrelevant information when processing the input data. In addition, we have introduced task-specific adaptation layers that are designed to add additional processing power to the original Transformer architecture, such as a semantic analysis layer for unstructured text data and a relational extraction layer for structured data. This combination of general pre-training and task-specific fine-tuning allows the model to flexibly process and integrate information from different data sources, improving processing efficiency and accuracy. Experimental results show that the model performs well in a variety of data processing tasks, significantly improves the accuracy and efficiency of information retrieval, and verifies the strong potential and adaptability of large language models in processing mixed data types.

Background: Atopic dermatitis is a chronic condition that significantly affects the daily life of those who suffer from it, requiring complex and personalized management with active participation of the patient in the management of their disease. Objective: to describe the design and development process of a mobile application, using the Design Thinking method, for the follow-up of patients with atopic dermatitis. Methods: User-centered design and prototype creation method, differentiating the phases of the empathize, define, idea, prototype, and test. A purposive snowball sampling was used to recruit patients with atopic dermatitis, family members, and health professionals. Three two-hour workshops were held, attended by 25 people. Results: the parameters to be monitored will include objective data (physical, behavioral, treatments, environmental, integration of daily routines) and subjective data (user experience). On the other hand, it will figure out behavior patterns, set up rewards, foster a feeling of community, and use notifications and a chatbot. Conclusion: The active integration of all stakeholders at each stage of the design and development of the digital solution has improved its relevance and acceptance, resulting in a tool that is expected to significantly improve the management of atopic dermatitis.

The study is based on information as the property of matter and its evolution from chemical to digital information. Consequences of these forms of information include molecular, modular, cel-lular, non-human, and human individual interactions, as well as human-machine interaction, and the formation of corresponding modules through self-organizing selective processes. The function of modular structures is decision-making and is analogous to the behavior of an intelligent agent. The evolutionary modular model is proposed based on the interaction of evolutionary factors (matter, energy, information, self-organization, natural selection, and heritability) among themselves and with the arrow of time. In conclusion, we realize that the essence of the evolution of living organ-isms is modular evolution. Modules through which the survival and reproduction of living organ-isms is ensured, are formed by two basic molecular processes, which are molecular recognition or information and modular self-organization.

Numerous investigations have suggested that seismic source parameters and properties of the surrounding medium harbor valuable information regarding alterations in stress fields and medium properties at the focal depth. Monitoring the spatial and temporal evolution of these parameters can yield insights into variations in stress fields or medium properties within the seismogenic zone, offering a critical avenue to overcome the Earth's inaccessible nature. In recent years, modern seismic parameters such as seismic moment, focal mechanism solution, source stress drop, corner frequency, radiated seismic energy, rupture radius, and apparent stress have been increasingly used to characterize source characteristics. The Sichuan region is situated on the southeastern edge of the Qinghai-Tibet Plateau and is known for its strong eastward extrusion and structural deformation. The main fault zones in the area include the Xianshuihe Fault, Anninghe Zemuhe Fault, and Longmenshan Fault. This paper estimates source parameters of small to medium-sized earthquakes (ML 1.5-5.2) in the main fault zones and adjacent areas in Sichuan. A total of 4,310 earthquake stress drop measurements from 2019 to 2023 were analyzed to create a stress distribution image along the fault. This earthquake parameters training catalog provides insight into how coseismic stresses change and their relationship with other geophysical factors, as well as their spatial and temporal evolution.

School bullying represents a widespread expression of violence in the peer context. Guided by the social-ecological model, this study investigated the longitudinal and transactional pathways linking domestic and neighborhood/community violence exposure (through direct victimization and witnessing), self-serving cognitive distortions (CDS), and school bullying perpetration. Furthermore, the cognitive desensitization hypothesis that the literature has supposed to develop in response to chronically violent contexts was examined. Two four‐wave cross-lagged panel mediation models were tested in a sample of 778 high school students (28.1% males; Mage [Time 1; T1] = 14.20, SD = 0.58). The results showed that both domestic and neighborhood/community violence exposure, as a victim and as a witness, respectively, were associated to self-serving CDs and bullying perpetration over time. Moreover, significant associations between CDs and bullying perpetration over time were found, with bidirectional effects for each of these longitudinal patterns. Finally, self-serving CDs were found to significantly mediate the relationships between both domestic violence victimization and community violence witnessing and school bullying perpetration. These findings highlight the need to consider school bullying as a social phenomenon stemming from a complex and bidirectional interplay between the individuals and the environments they inhabit confirming a basic postulate that “violence breeds violence”.

The aim of this investigation is focused on the effects of hooked-end steel fibers on both fresh and hardened properties of modified self-compacting concretes (SCC). For this purpose, the steel fibers are associated with other residues contents (i.e. marble, granite and rubber). This concatenated materials contents constitutes a novelty since no investigations are reported. It is found that the increase of rubber content, a better ability to absorb energy is observed. This indicates that a good alternative of structural material is provided. Fresh properties are evaluated by using flow, T500 time, V-funnel, J-ring methods. The mechanical behavior is evaluated in terms of compressive strength, tensile strength, static and dynamic modulus of elasticity, and damping ratio. Experimental results of the water absorption, porosity and density are also attained. It is also found that a SCC mixture containing steel fiber, marble/granite residue and rubber content is a potential mixture to be considered when in SCC designing associated with improved damping ratio. Although the rubber content decreases the mechanical behavior and slump flow, the concatenated utilization of MGR and steel fiber contents provide a slight improve in the damping result. An environmental benefit can also be associated since the cement consumption is decreased with marble additions.

This study investigates how customers’ technological readiness affects service quality and the adoption of self-service banking by developing an empirical model. The model was proposed to explore the relationships between technology readiness, self-service quality, and customer satisfaction. The hypotheses and stability of the model were tested using structural equation modeling. The findings revealed that technology readiness, including the optimism, innovation, and insecurity dimensions, had a significant positive impact on self-service quality. In addition, service quality fully mediated the relationship between technological readiness and customer satisfaction. These results suggest that when customers are ready to embrace and use new technology, their evaluation of service quality is high. Thus, bank managers should drive customer perceptions of the quality of self-service banking by improving their technological readiness through various measures. Furthermore, based on the mediating effect of self-service quality, banks must be aware that improving service quality can enhance customer satisfaction and maintain a competitive advantage.

This study explores how the covid-19 pandemic affected some psychological factors in people who got tattoos during or after the lockdown, the psychological factors assessed were self-esteem, risk taking behaviour, body image and locus of control. The study used a quantitative, between-subjects design to investigate the experiences of participants who acquired tattoos during the pandemic compared to those who did not. The results showed that participants who got a tattoo during the pandemic reported higher levels of self-esteem and body image satisfaction compared to those who did not get a tattoo. Furthermore, the findings suggest that individuals with tattoos may have a more external locus of control. Participants with tattoos exhibited higher levels of risk-taking behaviour compared to those without tattoos, furthermore sex affected risk-taking behaviour in tattooed individuals, and females with tattoos displayed a higher risk taking tendency than their tattooed male counterparts. Further research needs to be done while acknowledging the limitations of this study. Overall, this study is pivotal in establishing how the pandemic may have affected the aforementioned psychological factors in people with tattoos. It also adds to the growing body of literature in body modification and psychology.

Spiritual security should be a priority in our modern globalized society. Therefore, the study provides convincing evidence that it is important to develop a theoretical understanding of spiritual security. Several theoretical concerns regarding the establishment and maintenance of spiritual security are addressed in the article. He explores many ideas that are interrelated, including spiritual security, worldview, and spirituality. To ensure spiritual security, a practical analysis is carried out of the need to carry out various measures that strengthen the spiritual health of society.The article explains the methodology used in spiritual Security Investigations. According to the author, different levels of spiritual security can be analyzed using a structural-logical model and a dialectical method of cognition. Comparative analysis is also seen as a valuable tool. Spiritual intelligence is essential to overcome barriers, manage change, and ensure personal security and its impact on relationships. The process begins with introspection and evaluation, concluding with the ability to assess and understand the environment. By analyzing and understanding natural phenomena, it is possible to develop a sense of reality and a deeper appreciation of the nature of human existence. A person can feel spiritually safe if he adheres to his moral and spiritual beliefs and complies with the norms of society. It contains such things as worldview, social behavior, culture, research and social development. By expanding the spiritual point of view, the danger to the spiritual security of a person can be reduced.

This article delves into the complex tension between national self-rule and international involvement, in the context of global politics, examining the inherent challenges of upholding both principles when confronted with human rights abuses and the pursuit of global peace. The introduction presents the fundamental dilemma: self-governance versus moral obligations. The problem statement calls for a nuanced approach to address the intricate complexities of sovereignty and intervention, acknowledging the potential misuse by oppressive regimes and the ongoing challenges of determining when and how intervention is warranted. The article advocates for a more responsible and effective approach to global conflicts and human rights violations, balancing national sovereignty with judicious intervention when required. The methodology employs both literature review and case analysis to construct a framework for objectively assessing when international intervention is justified in instances of human rights abuses. The conclusion stresses the criticality of objective intervention criteria, transcending cultural, political, and economic biases, and advocates for a globally accepted approach that celebrates diversity while promoting global stability.

"Enhancing the Efficiency of Natural Gas Liquid (NGL) Extraction and Fractionation Trains: An Integrated Approach of Simulation Analysis, Advanced Modifications, and Technological Advancements. Through comprehensive research, innovative solutions such as the heat pump aided distillation (HPAD) system and self-heat recuperation technology (SHRT) have been developed to significantly reduce the energy consumption associated with conventional distillation systems. To identify a practical system for NGL fractionation trains, this study extensively examined and compared various HPAD and SHRT options to retrofit a single column. The objective was to find the most suitable and efficient solution for the fractionation process of natural gas liquids (NGLs). The retrofit options analyzed in this study encompassed a range of techniques, including vapor compression (VC), mechanical vapor re-compression (MVR), thermal vapor re-compression (TVR), bottom flashing (BF), side heat exchanger (SHE), intermediate heating and cooling (IHC), self-heat recuperative (SHR), and modified self-heat recuperative (MSHR) distillation. These methods were carefully examined to determine their suitability and effectiveness in improving the performance of NGL fractionation trains In this study, a depropanizer column, typically employed in conventional NGL plants, was selected as a case study. The simulation software Aspen HYSYS V7.3 was employed to model and analyze eight retrofit designs based on predefined criteria. The simulation data was carefully evaluated to identify the most efficient design for minimizing energy consumption. Among the retrofit options, the mechanical vapor re-compression (MVR) technique demonstrated the most significant energy cost reduction, with a remarkable 68.11 percent improvement compared to the base case conventional column. These findings highlight the potential of MVR as an effective solution for lowering energy costs in NGL fractionation trainsFollowing the MVR retrofit option, the study found that vapor compression (VC) achieved a considerable energy cost reduction of 66.65 percent, closely followed by modified self-heat recuperative (MSHR) at 64.02 percent, bottom flashing (BF) at 62.88 percent, self-heat recuperative (SHR) at 55.85 percent, side heat exchanger (SHE) at 54.23 percent, intermediate heating and cooling (IHC) at 39.54 percent, and thermal vapor re-compression (TVR) also at 39.54 percent. These findings highlight the significant potential for energy savings offered by these retrofit options, with VC being the most popular choice, closely followed by MSHR, BF, SHR, SHE, IHC, and TVR.

The perovskite solar cells (PSCs) have been significantly improved by utilizing inorganic hole transporting layer (HTL), such as nickel oxide. Despite the promising properties, there are still limitations due to defects. Recently, research on self-assembled monolayers (SAM) is being actively conducted, which show promise in reducing defects and enhancing device performance. In this study, we successfully engineered a p-i-n perovskite solar cell structure utilizing HC-A1 and HC-A4 molecules. These SAM molecules were found to enhance the grain morphology and uniformity of the perovskite film, which are critical factors in determining optical properties and device performance. Notably, HC-A4 demonstrated superior performance due to its distinct hydrophilic properties with a contact angle of 50.3°, attributable to its unique functional groups. Overall, the HC-A4 applied film exhibited efficient carrier extraction properties, attaining a carrier lifetime of 117.33 ns. Furthermore, HC-A4 contributed the superior device performance with its favorable band alignment, achieving the highest device efficiency of 20%.

Introduction: In an era of increasing public awareness regarding the pivotal role of nutrition in the onset and progression of chronic degenerative diseases, there is a growing demand for information and assistance pertaining to the intricate relationship between diet and disease. Nutritional practices, therefore, emerge as a fundamental element in the prevention and management of these maladies, necessitating a proactive response from healthcare professionals (HCP). This study sought to evaluate the impact of participation in a Culinary Medicine (CM) program on Mediterranean diet adherence, food management skills, culinary proficiency, and counseling confidence among HCP. Methods: A mixed-methods pilot implementation program (PIP) was meticulously designed and executed, engaging a cohort of 20 HCP recruited from Hospital Clinic Barcelona. The program unfolded at the Alícia Foundation kitchen-lab and encompassed a series of interactive, hands-on sessions that delved into the realms of gastronomy, food management, culinary skills, and culinary diet therapy, with a specific focus on prevalent diseases and their prevention, treatment, and care. Tailored questionnaires were administered to all participants both before and after the PIP. Results: Of the 20 participants, 14 successfully completed the study, comprising 86% women, 86% aged above 40, 71% nurses, and 7% medical doctors. Interestingly, 86% of the participants had previously received nutrition training, whereas only 14% had received culinary training. Following the completion of the program, there was a remarkable improvement in adherence to the Mediterranean diet (p < 0.01). However, no statistically significant improvements were observed in food management and culinary skills or counseling confidence (p > 0.5). Despite the absence of statistical significance, there was a noteworthy trend towards greater advocacy for dietary changes before resorting to medication, along with enhanced confidence in providing nutritional and culinary guidance to patients. Conclusion: The findings from this study underscore the potential of hands-on CM training as a vital component of nutrition education for HCP. While statistically significant improvements in certain domains were not observed, the program did demonstrate its ability to influence attitudes, knowledge, and behaviors related to healthy cooking and eating for both HCP themselves and their patients. Given these promising trends, future studies with a larger sample size must be performed to further elucidate the impact of CM training on HCP and its potential benefits for public health.

Gastric outlet obstruction (GOO) poses a common and challenging clinical scenario, characterized by mechanical blockage in the pylorus, distal stomach, or duodenum, resulting in symptoms such as nausea, vomiting, abdominal pain, and early satiety. Its diverse etiology encompasses both benign and malignant disorders. The spectrum of current treatment modalities extends from conservative approaches to more invasive interventions, incorporating procedures like surgical gastroenterostomy (SGE), self-expandable metallic stents (SEMS) placement, and the advanced technique of endoscopic ultrasound-guided gastroenterostomy (EUS-GE). While surgery is favored for longer life expectancy, stents are preferred in malignant gastric outlet stenosis. The novel EUS-GE technique, employing a lumen-apposing self-expandable metal stent (LAMS), combines the immediate efficacy of stents with the enduring benefits of gastroenterostomy. Despite its promising outcomes, EUS-GE is a technically demanding procedure requiring specialized expertise and facilities.

Contemporary diagnostic practice in psychiatry relies on the tick-box approach of diagnostic manuals. In light of the obvious limitations of diagnostic systems, narrative formulations, whether in the form of biological, psychodynamic or behavioural cognitive ones, have been proposed. Their approach, which can be caricatured as one of drawing arrows, enriches our clinical tools and practice but in their explicitly theoretical orientation, as well as expanding the field of discovery, they also constrain it. In two previous papers I summarized the resulting limitations, with specific reference to the patient’s experience and proposed further enriching clinical perspicacity by attending to images and parataxis. The specific intent of attending to the patient’s experiences through a process that explicitly eschews narrativization, but allows clinical phenomena to “hang loose”, is to facilitate a process of clinical discovery and healing through practices of co-production between patient and clinician. In the present paper, I expand the range of phenomena that may assist in this co-production through adding attention to dreams to that of images and parataxis. In particular, I turn to the work of the Italian novelist Guido Morselli. Morselli agrues that the self is created through bundling experiences together through acts of “will” in order to establish our personal narrative. In doing so, however, the “will” forbids access to phenomena that do not fit the dominant narrative. Experience is therefore impoverished. Dream consciousness is a type of consciousness not harnessed by the constraints of narrativity. It allows a slipping of the narrative vigilance which bundles phenomena together to create a coherent narrative and thus offers a richer menu of potential experiences, including “bizarre” images that can serve to challenge our usual self-narrative and offer a new perspective on ourselves.

Estimating the Remaining Useful Life (RUL) of aircraft engines holds a pivotal role in enhancing safety, optimizing operations, and promoting sustainability, thus being a crucial component of modern aviation management. Precise RUL predictions offer valuable insights into an engine’s condition, enabling informed decisions regarding maintenance and crew scheduling. In this context, we propose a novel RUL prediction approach in this paper, harnessing the power of Bi-directional LSTM and Transformer architectures, known for their success in sequence modeling, such as natural languages. We adopt the encoder part of the full Transformer as the backbone of our framework, integrating it with a self-supervised denoising autoencoder that utilizes Bidirectional LSTM for improved feature extraction. Within our framework, a sequence of multivariate time series sensor measurements serves as the input, initially processed by the Bidirectional LSTM autoencoder to extract essential features. Subsequently, these feature values are fed into our Transformer encoder backbone for RUL prediction. Notably, our approach simultaneously trains the autoencoder and Transformer encoder, different from the naive sequential training method. Through a series of numerical experiments carried out on the C-MAPSS datasets, we demonstrate that the efficacy of our proposed models either surpasses or stands on par with that of other existing methods.

Self-supervised learning is a method that learns general representation from unlabeled data. Masked image modeling (MIM), one of the generative self-supervised learning methods, has drawn attention showing state-of-the-art performance on various downstream tasks, though showing poor linear separability resulting from the token-level approach. In this paper, we propose a contrastive learning-based multi-view masked autoencoder for MIM, exploiting an image-level approach by learning common features from two different augmented views. We strengthen MIM by learning long-range global patterns from contrastive loss. Our framework adopts simple encoder-decoder architecture, learning rich and general representation by following a simple process: 1) two different views are generated from an input image with random masking and by contrastive loss, we can learn semantic distance of the representations generated by an encoder. By applying a high mask ratio, 80%, it works as strong augmentation and alleviates the representation collapse problem. 2) With reconstruction loss, decoder learns to reconstruct an original image from the masked image. We assess our framework by several experiments on benchmark datasets of image classification, object detection, and semantic segmentation. We achieve 84.3% fine-tuning accuracy on ImageNet-1K classification and 76.7% in linear probing, exceeding previous studies and show promising results on other downstream tasks. Experimental results demonstrate that our work can learn rich and general image representation by applying contrastive loss to masked image modeling.

This study proposes self-calibration of capacitor mismatch errors for high-resolution pipeline analog-to-digital converters (ADCs). The proposed calibration circuit recursively amplifies the capacitor mismatch error by re-utilizing a multiplying digital-to-analog converter in a pipeline stage without increasing the circuit complexity, and the amplified error voltage is converted into digital code by utilizing the remaining pipeline stages. Error correction is performed by subtracting the digital code from the ADC output during normal operation. A prototype of a 12-bit pipeline ADC is fabricated in a 0.18 µm standard CMOS process. The ADC comprises eight 1.5-bit stages, followed by a 4-bit flash ADC as the final stage; the capacitor mismatch errors in the first two pipeline stages are corrected by utilizing the proposed self-calibration technique. At a sampling rate of 30 MS/s, the measured differential and integral nonlinearities improve from +0.82/-0.75 and +1.12/-1.79 to +0.45/-0.41 and +0.47/-0.91 after calibration, respectively. Further, the measured dynamic performances improve significantly with calibration. For an input frequency of 2.09 MHz, the ADC achieves a spurious-free dynamic range (SFDR) and signal-to-noise and distortion ratios (SNDR) of 69.3dB and 63.9dB before calibration, respectively. After calibration, the SFDR and SNDR increase to 84.1dB and 68.9dB, respectively, and the effective number of bits is approximately 11.1bit. The power consumption of the ADC is 35mW under 1.8V supply, and the resulting figure of merit is 514fJ/conversion step.

Living organisms are active open systems far from thermodynamic equilibrium. The ability to behave actively corresponds to dynamical metastability: minor but supercritical internal or external effects may trigger major substantial actions such as gross mechanical motion, dissipating internally accumulated energy reserves. Gaining selective advantage from beneficial use of activity requires a consistent combination of sensual perception, memorised experience, statistical or causal prediction models, and resulting favourable decisions on actions. This information processing chain originated from mere physical interaction processes prior to life, here denoted as structural information exchange. From there, the self-organised transition to symbolic information processing marks the beginning of life, evolving by novel purposivity of trial-and-error feedback and accumulation of symbolic information. The emergence of symbols and prediction models can be described as a ritualisation transition, a symmetry-breaking kinetic phase transition of the 2^nd kind previously known from behavioural biology. The related new symmetry is the neutrally stable arbitrariness, conventionality or code invariance of symbols with respect to their meaning. The meaning of such symbols is given by the structural effect they ultimately unleash, directly or indirectly, by deciding on which actions to take. The early genetic code represents the first symbols. The genetically inherited symbolic information is the first prediction model for activities sufficient for survival under the condition of environmental continuity, sometimes understood as a “final causality” property of the model.

In the realm of mathematics education, self-explanation stands as a crucial learning mechanism, allowing learners to articulate their comprehension of intricate mathematical concepts and strategies. As digital learning platforms grow in prominence, there are mounting opportunities to collect and utilize mathematical self-explanations. However, these opportunities are met with challenges in automated evaluation. Automatic scoring of mathematical self-explanations is crucial for preprocessing tasks, including the categorization of learner responses, identification of common misconceptions, and the creation of tailored feedback and model solutions. Nevertheless, this task is hindered by the dearth of ample sample sets. Our research introduces a semi-supervised technique using the Language Learning Model (LLM), specifically its Japanese variant, to enrich datasets for the automated scoring of mathematical self-explanations. We rigorously evaluated the quality of self-explanations across five datasets, ranging from human-evaluated originals to ones devoid of original content. Our results show that combining LLM-based explanations with mathematical material significantly improves the model's accuracy. Interestingly, there's an optimal limit to how much synthetic self-explanation data can bene-fit the system. Exceeding this limit doesn't further improve outcomes. This study thus highlights the need for careful consideration when integrating synthetic data into solutions, especially within the mathematics discipline.

Acute myocardial infarction (AMI) is a leading cause of morbidity and mortality worldwide. This study aimed to test the efficacy of a newly-developed symptom self-management program on health outcomes among inpatients post-AMI. A pilot randomised, controlled trial was utilised. A convenience sample of 90 was recruited from a tertiary hospital in Singapore. Adult inpatients with post-AMI were randomly assigned to the three groups: IManage-HSet, IManage-FF or control group. Sample size was computed using power analysis. Data were collected through self-reported questionnaires and physiological instruments. Data analyses included univariate statistics, analysis of variance and repeated measure analysis of variance. Ninety participants were recruited with 30 in each group. Participants in the IManage-HSet and IManage-FF group had significantly greater relaxation (ηp2 = 0.11), lower objective stress (ηp2 =0.14), and greater knowledge (ηp2 = 0.62) than those of the control group. The two intervention groups had lower subjective stress (ηp2 = 0.04), depression (ηp2 = 0.01), and anxiety (ηp2 = 0.03) than the control but such differences did not achieve statistical significance. Furthermore, most participants reported that they were satisfied with the programs and they provided positive comments on the contents, educational materials and relaxation practice. This pilot study supports the potential benefits and feasibility of the IManage-VR and IManage-FF interventions on stress, perceived relaxation, knowledge and patient satisfaction. Contents of the symptom management interventions could be added into current cardiac rehabilitation programs. Future RCTs with multi-centered sites and larger sample size are required to further test the intervention. This study was prospectively registered with the International Standard Randomised Controlled Trial on the 5th August 2014 with registration number ISRCTN61027816.

Many researches have identified that adverse childhood experiences (ACEs) are associated with non-suicidal self-injury (NSSI) and suicidality. However, most studies have been restricted to a few types of ACEs. This study aims to investigate associations of 13 common types of ACEs with NSSI, suicidal ideation (SI) and suicide attempt (SA), as well as the mediation of depressive and anxiety symptoms therein. A total of 1771 students aged 11-16 years who participated in the baseline survey of the Chinese Adolescent Health Growth Cohort study were included for the analysis. ACEs, SI, SA, depressive and anxiety symptoms were recorded by standard questionnaire. Of included participants, 92.0% reported one or more category of ACEs. Smoking, parent-child separation, emotional abuse, physical abuse and being bullied were positively associated with NSSI, with the adjusted odds ratio (aOR) of 2.41(95%CI, 1.01-5.75), 1.80(1.28-2.54), 1.69(1.21-2.37), 2.08(1.44-3.01) and 1.87(1.35-2.59), respectively; smoking (4.03, 1.66-9.81), parent-child separation (1.42, 1.07-1.90), emotional abuse (1.91, 1.41-2.59), physical abuse (1.80, 1.27-2.57), emotional neglect (1.78, 1.28-2.49) and being bullied (2.08, 1.54-2.81) were positively associated with SI; smoking(4.30, 1.67-11.10), emotional abuse (2.42, 1.58-3.72) and being bullied (1.75, 1.17-2.60) were positively associated with SA. The associations of ACEs with NSSI, SI and SA were each partially or completely mediated through depressive and anxiety symptoms. Children and adolescents who had experiences of smoking, physical abuse and being bullied during childhood are consistently and independently associated with NSSI and suicidality, and these associations may be largely mediated through depressive and anxiety symptoms.

The self-organization properties of C70 fullerene molecules in a xylene/tetrahydrofuran binary mixture were studied for the first time by optical absorption, refractometry, and dynamic light scattering. A correlation has been established between the change in the refractive index of the C70/xylene/tetrahydrofuran solution and the degree of self-organization of C70 molecules in the medium at various concentrations and storage periods of the solution. It is shown that the features of the optical absorption spectrum of C70/xylene/tetrahydrofuran at a fixed low concentration of the fullerene are sensitive to its storage time. It was determined that the beginning time of the formation of C70 nanoclusters and their final size depend on the concentration of fullerene and the time of keeping the solution. The observed nature of the C70 fullerene solution in a binary mixture may help to elucidate the mechanism of self-organization in the future.

Since the emergence of convolutional neural networks (CNNs), and later vision transformers (ViTs), the standard paradigm for model development has been using a set of identical block types with varying parameters/hyper-parameters. To leverage the benefits of different architectural designs (e.g., CNNs and ViTs), we propose alternating structurally different types of blocks to generate a new architecture, mimicking how Lego blocks can be assembled. Using two CNN-based and one SwinViT-based blocks, we investigate three variations to the so-called LegoNet that apply the new block alternation concept for the segmentation task in medical imaging. We also study a new clinical problem that has not been investigated before – the right internal mammary artery (RIMA) and perivascular space segmentation from computed tomography angiography (CTA). It was proven to demonstrate a prognostic value to primary cardiovascular outcomes. We compare the model performance against popular CNN and ViT architectures using two large datasets (achieving 0.749 dice similarity coefficient (DSC) on the larger dataset). We also evaluate the model’s performance on three external testing cohorts, where an expert clinician corrected model-segmented results (DSC>0.90 for the three cohorts). To assess our proposed model for suitability in clinical use, we perform intra- and inter-observer variability analysis. Finally, we investigate a joint self-supervised learning approach to determine its impact on model performance.

The poor conductivity and instability of layered dihydroxides (LDHs) limit their widespread application in oxygen evolution reaction (OER). In this study, the composite electrode of NiMn-LDHs, reduced graphene oxide (rGO) and nickel foam (NF), i.e., NiMn-LDHs/rGO/NF, was prepared by a hydrothermal method. When subjected to oxygen evolution reaction (OER) catalytic performance in a solution of 1 M KOH, the NiMn-LDHs/rGO/NF composite catalyst exhibited an overpotential of only 140 mV at a current density of 10 mA cm-2 and a Tafel slope of 49 mV dec-1, which is not only better than the comparing RuO2/NF catalyst, but also better than most of the Mn-based and the Ni–Fe containing bimetallic OER catalysts reported in the literature. The excellent electrocatalytic performance is ascribed to the efficient integration of ultrathin NiMn-LDHs sheets, thin-layered rGO and NF, contributing a lot to the decrease in charge transfer resistance and the increase in electrochemically active surface area. Moreover, NF plays a role of current collector and a role of rigid support for the NiMn-LDHs/rGO composite, contributing extra conductivity and stability to the NiMn-LDHs/rGO/NF composite electrode.

This study analyses key aspects of the professional life of primary school teachers in a southern European context. In the social changes of last two decades profoundly impacted the well-being of teachers putting a strain on their ability to adapt to sometimes unfair working conditions. For this purpose twenty teachers (M = 38.85; DS = 9.17) were interviewed from different areas of Italy, data were analyzed using the Grounded Theory Method. Through data analysis were summa-rize and emphasize eight core themes. The results show the effects of a gradual impoverishment of the recognition of the role of teacher, highlighting the difficulty for teachers of renegotiating more flexible workload assessments and of reinforcing psycho-emotional skills for the development of a teaching methodology attentive to the psycho-emotional needs of pupils. Schools emerge as a rigid working context, in which a competent organizational function is often absent. Practical psychological implications are discussed.

The transition from undergraduate dental student to the actual practicing dentist is a crucial phase and ensuring the preparedness of graduates for the complexity and demands of contempo-rary dental practice is a challenging task. This study aimed to evaluate the self-perceived prepar-edness of undergraduate dental students and house officers in the dental colleges of Pakistan. Cross-sectional national study was planned to collect the information from dental students and new graduates in Pakistan. The pre-validated Dental Undergraduates Preparedness Assessment Scale (DU-PAS) was used. Purposive sampling technique was utilized to recruit house officers and undergraduate dental students from 27 dental schools in Pakistan. The data analysis was car-ried out using the R statistical environment for Windows (R Core Team, 2015). The total of 862 responses with 642 females and 219 males were analyzed in the study. Overall, clinical skills score was 30.56+9.08 and score for soft skills was 30.54+10.6. The mean age of the participants was 23.42+1.28. Deficiencies were reported in various soft skills and clinical skills attributes.The results highlighted the strengths and weaknesses of dental students and new graduates in Pakistani den-tal institutions. The findings may be used to further develop and strengthen teaching and training of dental students in Pakistan.

For any molecule, network, or process of interest, to keep up with new publications on these, is becoming increasingly difficult. For many cellular processes, molecules and their interactions that need to be considered can be very large. Automated mining of publications can support large scale molecular interaction maps and database curation. Text mining and Natural Language Processing (NLP)-based techniques are finding their applications in mining the biological literature, handling problems such as Named Entity Recognition (NER) and Relationship Extraction (RE). Both rule-based and machine learning (ML)-based NLP approaches have been popular in this context, with multiple research and review articles examining the scope of such models in Biological Literature Mining (BLM). In this review article, we explore self-attention based models, a special type of neural network (NN)-based architectures that have recently revitalized the field of NLP, applied to biological texts. We cover self-attention models operating either at a sentence level or an abstract level, in the context of molecular interaction extraction, published from 2019 onwards. We conduct a comparative study of the models in terms of their architecture. Moreover, we also discuss some limitations in the field of BLM that identifies opportunities for the extraction of molecular interactions from biological text.

The Amoebic Self Theory is a concept of the social psychology, which postulates that humans have a psychological boundary. As the authors of the concept propose [1], the function of the boundary is to allow psychological separation of one from the others. In this study, we examined how sen-sitivity to violation of the boundary, measured by an amoebic self scale, is connected with differ-ent types of procrastination sensu lato, measured by seven procrastination subscales. Only two of the seven procrastination aspects, i.e. the preference for pressure and outcome satisfaction, were negatively and significantly related to the spatial-symbolic domain of the amoebic self scale. The other purpose of this research was to examine the connection between the students’ grade point average (GPA) and scores obtained in the procrastination subscales. Only the non-adaptive aspect of procrastination predicted significantly the GPA. That is an important detail, because pointing out the gap between one’s self-opinion and the real, non dependent of the opinion, academic achievement. All these findings were considered in the academic context and consequences of these results were discussed.

Background: Adolescence is a developmental stage when there is a high risk of engaging in non-suicidal self-injury (NSSI). There is recent interest in the study of thwarted belongingness and perceived burdensome as variables associated with the frequency of NSSI in adolescents. Meaning in life (MIL) could be negatively associated with thwarted belongingness and perceived burdensome. To date, no studies have analyzed whether thwarted belongingness and perceived burdensomeness could be associated with the frequency of NSSI in adolescents. On the other hand, no studies have analyzed the buffering role of MIL in the association between thwarted belongingness and perceived burdensomeness and the frequency of NSSI. Aims: a) to test whether thwarted belongingness and perceived burdensomeness are associated with NSSI frequency; b) to test whether MIL moderates the association between thwarted belongingness and NSSI frequency; and c) to test whether MIL moderates the association between perceived burdensomeness and NSSI frequency. Method: The sample consisted of N = 1531 participants between 12 and 18 years old from Spain. The participants filled out the Inventory of Statements about Self-Injury, Purpose-In-Life Test-Adolescents Version, and Interpersonal Needs Questionnaire. Moderation analysis were performed. Results: Thwarted belongingness and perceived burdensomeness were positively associated with the frequency of NSSI in Spanish adolescents. MIL was a moderating variable between thwarted belongingness and the frequency of NSSI, and between perceived burdensomeness and the frequency of NSSI. Conclusion: Thwarted belongingness and perceived burdensomeness could be a risk factor for NSSI and MIL could be a protective factor against NSSI, and adding these variables to current descriptive theories of NSSI in adolescents would allow us to improve the assessment and treatment protocols for adolescents with NSSI.

Not only does this paper present a novel type-2 fuzzy system for identification and behavior prognostication of an experimental solar cell set and a wind turbine, but also it brings forward an exquisite technique to acquire an optimal number of membership functions and the corresponding rules. It proposes a seven-layered NCPRT2FS. For fuzzification in the first two layers, Gaussian type-2 fuzzy membership functions with uncertainty in the mean, are exploited. The third layer comprises rule definition and the forth one embeds fulfillment of type reduction. The three last remained layers are the ones in which resultant left–right firing points, two end-points and output all get assessed correspondingly. It should not be neglected off the nutshell that recurrent feedback at the fifth layer exerts delayed outputs ameliorating efficiency of the suggested NCPRT2FS. Later in the paper, a modern structural learning, established on type-2 fuzzy clustering, is held forth. An adaptively rated learning back-propagation algorithm is extended to adjust the parameters ensuring the convergence as well. Eventually, solar cell photo-voltaic and wind turbine are deemed as case studies. The experimental data are exploited and the consequent yields emerge so persuasive.

Due to the fact that negative energies have no existence in physical reality, the advanced mechanics of purely positive energies should describe gravitational interactions and collisions in monistic terms of extended kinetic energies and their local stresses. Such non-Newtonian mechanics of continuous inertial densities reinforces the Cartesian concept of matter-extension in the metric formalism of Einstein-Grossmann with a supplemental (dark, aether) fraction of bi-vertex mass-energy distributions. Local accelerations or decelerations of mono-vertex material densities in a multi-vertex distribution of complete kinetic energy arise under its constant integral due to nonlocal organization of continuous densities. Such integral conservation of the distributed mass-energy occurs instantaneously throughout the whole continuum of correlated densities and metric stresses despite the time-varying contributions of complementary mono-vertex and bi-vertex fractions. Under the nonlocal organization of purely kinetic (positive) mass-energy, geodesic self-heating and self-cooling of the pulsating space-matter conserve the integral energy in the two-fraction virial theorem for the averaged motion of visible mono-vertexes in the presence of invisible bi-vertex (interference, dark) mass-energy. Metric stresses of such material space are subordinate to nonlocal self-government of continuously distributed kinetic energy, including the relativistic rest-energy of General Relativity. These mutually consistent or correlated stresses in inertial space-time-energy create timelessly coordinated self-accelerations, observed for dense material volumes as distant gravitational pulls. In order to falsify/verify the nonlocal self-organization of adaptive kinetic energy, the monistic mechanics of self-consistent inertial densities and metric stresses can suggest moderate field changes in the temporal redshift, cycles of geodetic falls and takeoffs in pulsating kinetic organizations, and the calculated acceleration of the expanding Metagalaxy in its current phase of geodesic self-cooling.

Drought severity still remains a serious concern across sub-Saharan Africa (SSA) due to the destructive impact on multiple sectors of our society The interannual variability and trends in the changes of self-calibrated Palmer Drought Severity Index based on Penman–Monteith (scPDSIPM) and Thornthwaite (scPDSITH) methods for potential evapotranspiration (PET), precipitation (P) and normalized difference vegetation index (NDVI) anomalies, and sea surface temperature (SST) anomaly were investigated through statistical analysis of modelled and remote sensing data. It is shown that scPDSIPM and scPDSITH differed in the representation of drought characteristics over SSA. The scPDSI and remotely-sensed-based anomalies of P and NDVI showed wetting and drying trends over the period 1980-2012. The trend analysis showed increased drought events in the semi-arid and arid regions of SSA over the same period. A correlation analysis reveals a strong relationship between scPDSI variability and P, and NDVI anomalies for monsoon and pre-monsoon seasons. The correlation analysis of scPDSI variability with SST anomalies indicates significant positive and negative relationships, respectively. This study has demonstrated the applicability of multiple data sources for drought assessment and provides useful information for regional drought predictability and mitigation strategies.

The purpose of this study was to assess the extent to which self-esteem and depression mediated the influence of internalized stigma on life satisfaction among Korean out-of-school youths. Cross-sectional data on 318 youths provided information on perceived stigma, self-esteem, depression, life satisfaction, and personal characteristics. A multinomial logistic regression analysis was followed by structured path analysis to investigate the mediation effects. Internalized stigma was negatively associated with life satisfaction. Self-esteem significantly mediated the influence of stigma on depression and the influence of depression on life satisfaction. Further, stigma directly and significantly influenced depression. This study demonstrated that self-esteem and depression were important to the relationship between internalized stigma and life satisfaction. Implications for possible policies and programs with the aim of helping out-of-school youths to integrate and lead successful satisfying lives are discussed.

The use of cow bones for biomaterial is still limited; accordingly, the cow bones waste has low economic value. Basically, a human’s and a cow’s bones are the same in terms of their forming compound. Aluminum (Al) has the potential to combine with hydroxyapatite (HAp) to make metal matrix composites (MMC) that have the potential for biomaterials. Compatible elements to be combined with Al and HAp are magnesium (Mg), titanium (Ti), and Copper (Cu), used self-high propagating temperatures synthesis (SHS). MMC can be processed to be a useful, solid product. Applying pressure to the SHS reaction and heating process may result in biomaterial composite product consisting of some matrix materials such as Al come from cans materials used in the experiment was HAp that was processed from cow bones calcination, added by can that contained aluminum and wetting agent, namely magnesium. The exothermic temperature was 800-900°C. The compaction process was done to allow materials to be bound. Based on the ASTM F138 standard for element of biomaterials, the porosity value was below 30% and hardness level above 40 HV. Cow bones and can-based composite sample with the composition of HAp-Al-Mg: 85%-10%-5% met the standard since the hardness value was: 73.3 HV with a porosity value of 29.88%.

COVID-19 thromboembolic disease has brought all of us back to the drawing board. In COVID-19, pre-existing activated endothelium with increased Von Willebrand factor (VWF), low density lipoprotein (LDL) promoting “self-association” and “sticking” of long VWF strings to the vascular endothelial wall, suppressed ADAMTS13 cleavage of VWF, hypoxia induced upregulation and activation of VWF, fibrous network from neutrophil extracellular traps (NETs) with free DNA and histone, all appear to be initiating the thrombogenesis. Worsening complement activation, cytokine storm and resulting endothelial destruction, unregulated thrombogenesis leads to vascular occlusions and hypoxia. At this stage, the presence of abundant extracellular DNA, histone and -defensins appears worse than the SARS-CoV-2 itself. Previously observed in vitro mechanisms like histone “auto-activating” prothrombin, histone activated platelets generating thrombin without FXII, thrombin and plasmin cleaving complement C5 appears highly likely in COVID-19. Megakaryocytes are actively producing platelets in the lungs and appear to play a major role in thrombogenesis of COVID-19 raising suspicion of emperipolesis. This focused review is a compilation of my observations in relation to the pathophysiology of the intravascular environment, mainly in COVID-19 lungs. Pathophysiology based clinical trials are paramount in reducing morbidity and mortality in COVID-19.

Optimism and self-efficacy have been associated with psychological health. Empathy has also been found to promote positive functioning and to have a unique role in community health volunteering. This study investigated whether self-efficacy and optimism were associated with psychological and subjective well-being in a group of healthcare volunteers and whether empathy added incrementally to these associations. A sample of 160 Italian clown doctors volunteering in various hospitals completed self-report measures of self-efficacy, optimism, empathy, psychological well-being, and subjective well-being. Results indicated that self-efficacy and optimism were associated with both outcomes and that aspects of empathy, such as others’ perspective-taking and personal distress for others’ difficulties, incrementally added to these associations, although with opposite effects. The present study adds to previous research on the role of self-efficacy, optimism, and empathy for community health volunteers’ psychological health and offers suggestions regarding the training of this type of volunteer.

Owing to the time-varying characteristics and nonlinearities of industrial processes, control has higher difficulties and results in challenges for advanced technology. In this paper, a self-tuning controller that includes a nonlinear proportional-integral-derivative (NPID) control function as well as a self-tuning function is proposed for first-order plus time delay (FOPTD) process control. The NPID control function is implemented using the nonlinear PID controller whose optimum parameters are adapted by a neural network (NN). The self-tuning function is able to identify the process dynamics using a short period of process behavior and tune NPID parameters based on the identified parameters. The advantage of the proposed method is validated with a set of simulation works on three processes and the comparison results are presented.

Accurate prediction of the self-propulsion performance is one of the most important factors for energy-efficient design of a ship. In general, the hydrodynamic performance of a full-scale ship could be achieved by model-scale simulation or towing tank test with extrapolations. With the development of CFD methods and computing power, directly predict ship performance with full-scale CFD is an important approach. In this article, a numerical study on the full-scale self-propulsion performance with propeller operating behind ship at model- and full-scale is presented. The study includes numerical simulations using RANS method with double-model and VOF model respectively and scale effect analysis based on overall performance, local flow fields and detailed vortex identification. Verification study on grid convergence is also performed for full-scale simulation with global and local mesh refinements. And a series of sea trail tests were performed to collect reliable data for the validation of CFD predictions. The analysis of scale effect on hull-propeller interaction shows that the difference on hull boundary layer and flow separation is the main source of scale effect on ship wake. And the results of the fluctuations of propeller thrust and torque along with circulation distribution and local flow field show that propeller’s loading is significantly higher for model-scale ship. It is suggested that the difference on vortex evolution and interaction is more pronounced and have larger effects on ship’s powering performance at model-scale than full-scale according to the simulation results. From the study on self-propulsion prediction, it could be concluded that the simplification on free surface treatment does not only affect the wave-making resistance for bare hull but also the propeller performance and propeller induced ship resistance which can produced up to 5% uncertainty to the power prediction. Roughness is another important factor in full-scale simulation because it has up to approximately 7% effect on the delivery power. As a result of validation study, the numerical simulations of full-scale ship self-propulsion shows good agreement with the sea trail data especially for cases that have considered both roughness and free surface effects. This result will largely enhance our confidence to apply full-scale simulation in the prediction of ship’s self-propulsion performance in the future ship designs.

Opioids are highly addictive substances with a relapse rate of over 90%. While preclinical models of chronic opioid exposure exist for studying opioid dependence, none recapitulate the relapses observed in human opioid addiction. The mechanisms associated with opioid dependence, the accompanying withdrawal symptoms and the relapses that are often observed months or years after opioid dependence are poorly understood. Therefore, we developed a novel model of chronic opioid exposure whereby the level of administration is self-directed with periods of behavior acquisition, maintenance and then extinction alternating with reinstatement. This profile arguably mirrors that seen in humans, with initial opioid use followed by alternating periods of abstinence and relapse. Recent evidence suggests that dietary interventions that reduce inflammation, including omega-3 fatty acids such as docosahexaenoic acid (DHA), may reduce substance misuse liability. Using the self-directed intake model, we characterize the observed profile of opioid use and demonstrate that a diet enriched in polyunsaturated fat acids (PUFAs) ameliorates oxycodone-seeking behaviors in the absence of drug availability and reduces anxiety. Guided by the major role gut microbiota have on brain function, neuropathology, and anxiety, we profile the microbiome composition and the effects of chronic opioid exposure and DHA supplementation. We demonstrate that withdrawal of opioids led to a significant depletion in specific microbiota genera whereas DHA supplementation increased microbial richness, phylogenetic diversity, and evenness. Lastly, we examined the activation state of microglia in the striatum and found that DHA supplementation reduced the basal activation state of microglia. These preclinical data suggest that a diet enriched in PUFAs could be used as a treatment to alleviate anxiety induced opioid-seeking behavior and relapse in human opioid addiction.

The quantization error (QE) from Self-Organizing Map (SOM) output after learning is exploited in this studies. SOM learning is applied on time series of spatial contrast images with variable relative amount of white and dark pixel contents, as in monochromatic medical images or satellite images. It is proven that the QE from the SOM output after learning provides a reliable indicator of potentially critical changes in images across time. The QE increases linearly with the variability in spatial contrast contents of images across time when contrast intensity is kept constant. The hitherto unsuspected capacity of this metric to capture even the smallest changes in large bodies of image time series after using ultra-fast SOM learning is illustrated on examples from SOM learning studies on computer generated images, MRI image time series, and satellite image time series. Linear trend analysis of the changes in QE as a function of the time an image of a given series was taken gives proof of the statistical reliability of this metric as an indicator of local change. It is shown that the QE is correlated with significant clinical, demographic, and environmental data from the same reference time period during which test image series were recorded. The findings show that the QE from SOM, which is easily implemented and requires computation times no longer than a few minutes for a given image series of 20 to 25, is useful for a fast analysis of whole series of image data when the goal is to provide an instant statistical decision relative to change/no change between images.

Owing to the nondiffracting, self-accelerating, and self-healing properties, Airy beams of different nature have become a subject of immense interest in the past decade. Their interesting properties have opened doors to many diverse applications. Consequently, the questions of how to properly design spatial manipulation of Airy beams or how to implement them in different setups have become important and timely in the development of various optical devices. Here, based on our previous work, we present a short review on the spatial control of Airy beams, including the interactions of Airy beams in nonlinear media, beam propagation in harmonic potential, and the dynamics of abruptly autofocusing Airy beams in the presence of a dynamic linear potential. We demonstrate that under the guidance of nonlinearity and external potential, the trajectory, acceleration, structure, and even the basic properties of Airy beams can be adjusted to suit specific needs. We describe other fascinating phenomena observed with Airy beams, such as self-Fourier transformation, periodic inversion of Airy beams, and the appearance of spatial solitons in the presence of nonlinearity. These results have promoted the development of Airy beams, and have been utilized in various applications, including particle manipulation, self-trapping, and electronic matter waves.

In wireless sensor networks (WSNs), each sensor node can estimate the global parameter from the local data in distributed manner. This paper proposed a robust diffusion estimation algorithm based on minimum error entropy criterion with self-adjusting step-size, which are referred to as diffusion MEE-SAS (DMEE-SAS) algorithm. The DMEE-SAS algorithm has fast speed of convergence and is robust against non-Gaussian noise in the measurements. The detailed performance analysis of the DMEE-SAS algorithm is performed. By combining the DMEE-SAS with diffusion minimum error entropy (DMEE) algorithms, an Improving DMEE-SAS algorithm is proposed, in non-stationary environment where tracking is very important. The Improving DMEE-SAS algorithm can avoid insensitivity of the DMEE-SAS algorithm due to the small effective step-size near the optimal estimator, and obtain a fast convergence speed. Numerical simulations are given to verify the effectiveness and advantages of these proposed algorithms.

This study investigates job satisfaction, burnout, and well-being among first-generation migrant physicians in anesthesia and intensive care medicine in Germany, comparing them to their native German counterparts. Utilizing a cross-sectional survey design, the study collected data from 513 physicians, 110 of whom identified as having a migration background. Job satisfaction was measured using the German version of the Warr-Cook-Wall (WCW) Job Satisfaction Scale, burnout was assessed with the Copenhagen Burnout Inventory (CBI), and well-being was evaluated using the WHO-5 Well-Being Index. The job satisfaction ratings revealed no significant differences between migrant and German physicians in most dimensions, including physical workload, freedom to choose work methods, satisfaction with colleagues, responsibility, income, skill utilization, and variety in work tasks. However, migrant physicians reported significantly higher satisfaction with recognition received for their work and lower dissatisfaction with working hours. Burnout assessments showed that migrant physicians experienced higher psychological strain, perceiving every work hour as more exhausting and having significantly less energy for family and friends. Notably, migrant physicians reported higher difficulty and frustration in working with patients. Well-being ratings indicated that migrant physicians felt less energetic and active but found their daily life more filled with interesting activities. The findings underscore the unique challenges faced by migrant physicians, particularly in terms of recognition and patient-related burnout. These results highlight the need for targeted interventions to support migrant physicians, including cultural competence training and flexible working hours to enhance their job satisfaction and overall well-being. Addressing these issues is crucial for maintaining the quality of patient care and the occupational health of migrant physicians in Germany.

Background and objective: Iliopsoas abscess (IPA) is a rare condition with varied symptomology and etiology. Less than one-third of patients with IPA present on the emergency department (ED) admission with the traditional triad of fever, back pain, and restricted hip motion (or limp), leading to delays in diagnosis and management. This case report aims to bring awareness among healthcare professionals regarding the atypical presentation and introduce a potential differential diagnosis when evaluating patients with fever and back pain. The intention is to provide insights into the signs and symptoms that may indicate the presence of an iliopsoas abscess and prompt additional investigations. Case report: Here, we describe a case of primary iliopsoas abscess associated with drug-induced acute liver failure in our ED. The patient complained of pain in the left lumbar region and fatigue that started two weeks before this presentation, claiming that, during the previous night, the pain suddenly worsened. She had a fever, pain at palpation in the right hypochondriac and left lumbar regions, accompanied by fever and vomiting, jaundiced skin, and sclera at the examination in ED. On abdominal ultrasonography, the diagnosis of acute cholangitis was suspected. The laboratory test shows leukocytosis with neutrophilia, thrombocytosis, hepatocytolysis syndrome, and hyperbilirubinemia with the predominance of indirect bilirubin. We performed then abdominal and pelvic computed tomography, which confirmed the diagnosis of cholelithiasis observed with the diameter of the bile duct within normal limits but also showed an abscess-like collection fused to the interfibrillar level of the left iliopsoas muscle; a diagnosis we most likely would have been missed. After that, the patient was hospitalized in the General Surgery Department, and surgery drainage of the abscess was performed. The patient's evolution was excellent; she was discharged after 11 days. Conclusions: The case presented here exemplifies how iliopsoas abscess, a rare cause of back pain, can quickly go unrecognized, especially in the emergency department. Our experiences will raise awareness among doctors in emergency departments about this uncommon but essential diagnosis. With advancements in diagnostic tools and techniques, we aspire that more cases of iliopsoas abscess will be accurately diagnosed.

The COVID-19 pandemic profoundly impacted older people in residential aged care facilities (RACFs), especially those with dementia. This retrospective cohort study investigates the impact of the pandemic on agitation incidents within this population in 40 Australian RACFs. We compared pre-pandemic data (January-October 2019) with during-pandemic data (same months in 2020 and 2021) from electronic health records (EHRs) using Python to extract information from nursing notes. Various statistical analyses, including descriptive statistics to summarize the data, and a chi-square test to examine any significant association between the COVID-19 pandemic and the prevalence of dementia and agitation in dementia. Dementia prevalence dropped by 1.98% in 2021 compared to 2019, and by 4.09% compared to 2020 (p < 0.05). Overall agitation symptoms decreased by 20.1% from 2019 to 2021 (p < 0.05), but six specific symptoms increased: resisting (28.98%), wandering (11.78%), restlessness (3.19%), complaining (10.1%), arguing (2.36%), and outbursts (1.74%) (p < 0.05). Conversely, pacing decreased by 15.88% and speaking loudly de-creased by 10.9% (p < 0.05). Over half of the care recipients experienced agitation symptoms 2-5 times each year, increasing from 50.56% in 2019 to 58.28% in 2021 (p < 0.05). It is important to exercise caution regarding the accuracy of these findings due to the reduced opportunity for busy care staff to record behavioral changes caused by the isolation of individuals in their rooms during the pandemic.

(1) Context: Cancer triggers significant changes in family dynamics. It is noteworthy that coping and problem-solving skills, particularly in situations involving cancer in children and adolescents, have not been adequately explored in the context of family adaptation. This study aims to analyze the effectiveness of family interventions in coping to improve problem-solving skills in parents and/or caregivers of children and adolescents during and after oncological treatment. (2) Methods: This is a scoping review following the recommendations of the Joanna Briggs Institute and the Systematic Reviews and Meta-Analyses Extension for Scoping Review (PRISMA-ScR), from 2014 to 2024, in the databases LILACS, CINAHL, SCOPUS, Web of Science, and PUBMED. (3) Results: Forty-five studies were eligible. Coping strategies were categorized as follows: (1) positive attitudes (including a sense of courage and hope, family support to enhance resilience, and future planning), (2) caregiver empowerment (involving acceptance of diagnosis, emotional distancing, and coping through religiosity), and (3) communication skills (encompassing professional communication, horizontal dialogue with healthcare teams, and sincere communication with friends and family). (4) Conclusions: Over time, families develop coping and problem-solving strategies that influence changes in family functioning patterns, aiding them in accepting, reinterpreting, and reframing ideas and feelings associated with neoplasia.

We report the case of a 44-year-old woman who suffered gastric perforation after receiving bag-valve-mask (BVM) ventilation in the setting of alcohol intoxication. She had a markedly distended abdomen and cold, dusky lower extremities upon arrival to the emergency department. Imaging revealed a large volume intraabdominal accumulation of air with compression of the aorta. Needle decompression relieved symptoms of lower extremity arterial insufficiency. However, the patient quickly decompensated and subsequent exploratory laparotomy confirmed gastric rupture. A subtotal gastrectomy was performed but the patient ultimately passed on post-operative day two due to multi-organ dysfunction. Although BVM ventilation is commonplace in both the hospital and field, there is a lack of awareness of the serious complications of abdominal air accumulation due to their rareness in the adult population. Checking for abdominal distention during resuscitation ought to be routine in all patients. Signs of arterial insufficiency accompanying abdominal distention, once confirmed by diagnostic imaging that shows extensive pneumoperitoneum, are indicators of having reached a life-threatening level of air accumulation, calling for immediate needle decompression and exploratory laparotomy.