Non-pharmaceutical interventions (NPIs), including social distancing, wearing personal protective equipment, and lockdown measures, have been at the forefront of outbreak control in nursing homes. We used a mixed methodology to assess which NPIs nursing homes in the canton of Geneva, Switzerland, followed for their staff and residents during the first wave of the pandemic, between March 1, 2020 and June 1, 2020. For the qualitative component, we interviewed the attending physicians and/or director of each nursing home. Based on in-vivo codes, NPIs for nursing home workers and residents in each nursing home were thematically classified as: maximally restrictive, moderately restrictive, and minimally restrictive. In the quantitative component, we calculated incident rate ratios (IRR) for infection between the three levels of COVID-19-related measures taken in these nursing homes. We found an equal distribution of maximally (n=4), moderately (n=4), and minimally (n=4) restrictive NPIs. The extent of restriction did not show to be significantly associated with the cumulative incidence of COVID-19 cases among residents (maximally restrictive IRR = 3.90, 95%CI 0.82-45.54, p = 0.184; moderately restrictive IRR = 3.55, 95%CI 0.75-41.42, p = 0.212 ; minimally restrictive IRR = reference). Variabilities in NPIs adopted by nursing homes, and the number of COVID-19 cases appear to be randomly affected.

The COVID-19 pandemic has led to a substantial revolution in the incorporation of digital solutions in healthcare. This systematic review investigates the enduring physical and psychological consequences individuals experience up to two years post-recovery. Additionally, it focuses on examining the influence of mHealth interventions on these effects. Significantly, 41.7% of survivors experience lingering symptoms that have not been addressed, while 14.1% encounter difficulties in returning to work. The presence of anxiety, compromised respiratory functioning, and persistent symptoms highlight the immediate requirement for specific therapies. Telehealth, particularly telerehabilitation, presents itself as a possible way to address these difficulties. The study thoroughly examines 10 studies encompassing 749 COVID-19 patients, investigating the efficacy of telerehabilitation therapies in addressing various health markers. Telerehabilitation-based breathing exercises yield substantial enhancements in functional performance, dyspnea, and overall well-being. The results emphasize the potential of telerehabilitation to have a favorable effect on patient outcomes, however more research is needed to strengthen the existing evidence basis as one of the most important limitation is the limited number of trials and the evaluation of varied therapies. The analysis highlights the significance of digital solutions in post-COVID care and calls for ongoing research to improve comprehension and implementation of telehealth interventions in a swiftly changing healthcare environment.

Background and Aims: Late diagnosis of sepsis is associated with adverse consequences and high mortality rate. The aim of this study was to evaluate the diagnostic value of hematologic research parameters, that reflect the cell morphology of blood cells, available on the BC 6800 plus automated analyzer (Mindray) for the early detection of sepsis. Materials and Methods: A complete blood count (CBC) was performed by Mindray BC 6800 Plus Analyzer in 327 patients (223 with a confirmed diagnosis of sepsis following sepsis-3 criteria, 104 without sepsis), admitted at the Intensive Care Unit of the Novara’s Hospital (Italy) and in 56 patients with localized infection. Results: In univariate logistic regression, age, Hb, RDW, MO#, NMR, NeuX, NeuY, NeuZ, LymX, MonX, MonY, MonZ were associated with sepsis (p<0.005). In multivariate analysis, only RDW, NeuX, NeuY, NeuZ, MonX and MonZ were found to be independent predictors of sepsis (p<0.005). Morphological research parameters are confirmed to be predictors of sepsis even when analyzing the group with localized infection. Conclusions: In addition to already established biomarkers and basic CBC parameters, new morphological cell parameters can be a valuable aid in the early diagnosis of sepsis at no additional cost.

Quantification of erythrocytes and leukocytes is an essential aspect of hemogram diagno- 23 sis in Veterinary Medicine. Flow cytometry analysis, laser scattering, and impedance detection are 24 standard laboratory techniques, verified by manual microscopy counting. Although single-cell scat- 25 tering is already used as a standard technology for differentiating cell counts in flow cytometry, it 26 requires capillary cell separation. The current study investigates the scattering characteristics of 27 whole blood to identify correlations with erythrocytes and leukocytes counts. The scattering infor- 28 mation present in blood samples can be classified into three types: i) geometrical scattering, which 29 occurs when non-absorbed light is reflected and scattered, ii) Mie scattering, which happens when 30 light is scattered by particles of a similar size to the wavelength, and iii) Rayleigh scattering, which occurs when light is scattered by particles that are smaller than the incident light wavelength. In 32 this study, we investigate the scattering correction coefficients of dog blood absorption spectra in 33 the visible-near infrared range, to establish direct correlations with erythrocytes and leukocytes 34 counts, using multivariate linear regression. Our findings demonstrate the possibility of using the 35 scattering properties of dog blood, which is a step towards the existence of a portable and miniatur- 36 ized hemogram diagnosis in Veterinary Clinics worldwide.

Process mining offers significant services in the development of digital threads and digital twin applications for healthcare. One of the sub-emerging case studies is the use of patients’ location data in process mining analyses. While the streamlining of published works is focused on introducing process discovery algorithms, there is a necessity to address challenges beyond that. Literature analysis indicates that explainability, reasoning, and characterizing the root causes of process drifts in healthcare processes is an important but overlooked challenge. In addition, incorporating domain-specific knowledge into process discovery could be a significant contribution to process mining literature. To address this, we present the DIAG approach that consists of a meta-model and an algorithm that enables diagnosing in process mining through an ontology-driven approach. With DIAG, we modeled the healthcare semantics in a process mining application and diagnosed the causes of drifts in patients’ pathways. We performed an experiment in a hospital living lab to examine the effectiveness of the DIAG approach.

Accountable Care Organizations (ACOs) are healthcare delivery systems that aim to coordinate and improve the quality of care for patients while reducing costs. ACOs bring together doctors, hospitals, and other healthcare providers to work as a team to care for a defined population of patients. The idea behind ACOs is to shift the focus from paying for each individual service provided to patients, known as fee-for-service, to paying for the overall care and well-being of patients.ACOs typically operate under a shared savings model and also encourages providers to use data and technology to better coordinate care and improve patient outcomes.ACOs can be physician-led organizations, hospital-led organizations, and collaborations between healthcare providers. The success of ACOs depends on many factors, including the level of cooperation and collaboration among healthcare providers, the quality of care provided, and the ability to effectively manage costs.Despite their potential benefits, ACOs also face challenges, including the difficulty of coordinating care across multiple healthcare providers, the need to invest in technology and data management systems, and the challenge of changing provider behavior.This study assessed a number of systemic reviews and journals to assess the impact of ACO’s on population health. ACO’s have shifted away from costly care patterns and thus helped many countries.

Chest trauma is one of the most serious and difficult injuries, with various complications that can lead to ventilation - perfusion (V/Q) mismatch and systemic hypoxia. We are presenting a case of 53 – year - old male with no comorbidities or chronic therapy, who was admitted to the Intensive Care Unit due to severe respiratory failure after chest trauma. He developed right - sided pneumothorax and then thoracic drain was placed. On admission, the patient was hemodynamically unstable and tachypneic. The patient was intubated and mechanically ventilated, febrile (38.9°C) and unconscious. A lung CT showed massive non-ventilated areas predominantly in the right lung. He was ventilated with PEEP of 10 cmH2O with a FiO2 of 0.6 – 0.8. Empirical broad-spectrum antimicrobial therapy was immediately initiated. Both high FiO2 and moderate PEEP were maintained and adjusted according to the current blood gas values and oxygen saturation. After Stenotrophomonas maltophilia was identified and treated with sulfamethoxazole/trimethoprim his general condition gradually improved, and he was weaned from mechanical ventilation. In conclusion, both ventilatory and antibiotic therapy were needed to improve oxygenation and outcome of the patient with pneumonia due to the resistant S. maltophilia with V/Q mismatch.

Measles remains a highly contagious and potentially severe infectious disease, necessitating high vaccine coverage. However, misinformation and measles vaccine hesitancy/resistance posed significant challenges to achieving this goal. The COVID-19 pandemic further exacerbated these challenges, leading to a measles outbreak in Jordan in 2023. This study aimed to investigate the acceptance of the Measles-Rubella (MR) vaccine among parents in Jordan and identify its associated determinants. This cross-sectional questionnaire-based study was conducted using a previously Arabic-validated version of the Parental Attitudes towards Childhood Vaccines (PACV) survey instrument. Data collection took place in October 2023, and the final study sample comprised a total of 391 parents, with mothers representing 69.8% of the participants (n = 273). The majority of participating parents expressed either resistance (n = 169, 43.2%) or hesitancy (n = 168, 43.0%) towards MR vaccination, while only 54 participants (13.8%) expressed MR vaccine acceptance. Multivariate analysis revealed that trust in vaccine safety/efficacy, behavior, and having fewer offspring were significantly associated with MR vaccine acceptance. The current study revealed a concerning level of MR vaccine hesitancy/resistance among parents in Jordan. Urgent and targeted interventions are strongly recommended to address this issue, including mass campaigns aimed at building trust in the MR vaccine safety/efficacy. Additionally, there is an urgent need for effective public health initiatives to ensure sufficient measles vaccine coverage to prevent future outbreaks of this serious disease.

BACKGROUNDː The so-called Low Cardiac Output Syndrome (LCOS) is one of the most common complications in pediatric patients with congenital heart disease undergoing corrective surgery. LCOS requires high concentrations of inotropes to support cardiac contractility and improve cardiac output, allowing for a better systemic perfusion. To date, serum lactate concentrations and central venous oxygen saturation (ScVO2) are the most commonly used perfusion markers, but they are not completely reliable to identify a state of global tissue hypoxia. The study aims to evaluate whether the venoarterial carbon dioxide difference/arterial-venous oxygen difference ratio [P(v-a)CO2/C(a-v)O2] can be a good index to predict the development of LCOS in the aforemen-tioned patients, so as to treat it promptly. METHODSː This study followed a population of 98 children undergoing corrective cardiac surgery from June 2018 to October 2020 at the Department of Cardiac Surgery of University Hospital Inte-grated Trust and their subsequent admission at the Postoperative Cardiothoracic Surgery Intensive Care Unit. During the study, central arterial and venous blood gas analysis were carried out before and after cardiopulmonary bypass (CPB) (pre-CPB and post-CPB), at admission to intensive care unit, before and after extubation and at any time of instability or modification of the patient’s clinical and therapeutic conditions. RESULTSː The data analysis shows that 46.9% of the children developed a LCOS (in line with the current literature) but that there is no statistically significant association between the P(v-a)CO2/C(a-v)O2 ratio and LCOS onset. Despite the limits of statistical significance, however, a 31% increase in the ratio emerged from the pre-CPB phase to the post-CPB phase when LCOS is present. CONCLUSIONSː This study confirms a statistically significant association between the most used markers in adult patients (serum lactate concentration, ScVO2 and oxygen extraction ratio-ERO2) measured in the pre-CPB phase and the incidence of LCOS onset, especially in patients with he-modynamic instability before surgery.

We assessed the use of Evidence-Based Practice (EBP) among pharmacists working in community pharmacies in France, and the factors linked to this practice. During 3 months in 2018 an online survey was sent to over 7,000 active pharmacists, and posted on pharmacist social media sites. The 40-item questionnaire described four clinical cases reflecting typical situations (conventional med-icine and Complementary and Alternative Medicine) encountered daily by community pharma-cists. Multiple-choice responses were proposed and scored according to whether they reflected EBP. A high total score indicated behavior in line with EBP. Univariate and multivariate analyses were used to evaluate factors that might explain adherence to EPB (pharmacy’s characteristics, the pharmacist’s status, mode of continuing education and sources of information). 595 pharmacists completed the questionnaire. The majority relied on pharmaceutical industry and other biased and/or non-evidence-based sources, particularly concerning information on homeopathic products. The consultation of independent reviews, health agency recommendations, and peer-reviewed scientific journals, was associated with evidence-based decisions. In contrast, reliance on phar-maceutical industry documents, personal experience and informal handbooks was linked to lower EBP scores. The level of EBP use by French community pharmacists needs to be improved to ensure that good quality scientifically-based advice is given to customers.

The purpose of this work was to evaluate a novel methodology developed by Digital Blood Corporation (DBC) to calculate critical blood values using four non-invasive measured values as input. The values obtained using a point-of-care testing (POCT) device were utilized for comparison and reference. Radial arterial blood was collected for the POCT comparator analysis using the Abbott i-STAT^® device. The non-invasive methodology from DBC requires four parameters to be directly measured: temperature, hemoglobin, pO2, and pCO2. Subsequently, sodium, potassium, chloride, ionized calcium, total carbon dioxide, pH, bicarbonate, and oxygen saturation are calculated using an algorithm. The agreement between the POCT and DBC’s methodology was analyzed using Bland-Altman difference plots. For a second data set, pO2 and pCO2 values collected with the POCT were used as input for DBC’s algorithm to test its robustness. Data from 37 healthy ambulatory individuals, mean age: 42.4 + 13 years; range: 18-64 years, were included in the primary analysis. In the case of the non-invasive gained four input values the greatest variation between POCT and DBC’s approach was observed for pO2 and consequently for algorithm values that depend upon pO2 precision. Replacing transcutaneous pO2 and pCO2 with POCT values demonstrates the principal ability of DBC’s algorithm to predict the additional 8 blood values in sufficient agreement with a standard POCT device in healthy patients. The algorithm developed by DBC appears to be robust in the case of healthy patients but does need the four measured input values with preciseness comparable to a POCT device to give reliable and clinically relevant results. The present study thus serves as a proof of concept to facilitate future study and further development of this methodology into a non-invasive device.

Type 1 diabetes (T1D) has shown an increase in the incidence rate of about 3% per year over the last two decades. Continuous Insulin Subcutaneous Therapy (CSII) is widely used in the paediatric population with diabetes; however, it requires more preparation by the treating team and careful selection of potential users. Prescriptive provisions vary from Region to Region and the perspective of health workers still remains an unexplored area. The aim of the research project is to explore the representations of a group of diabetologists and psychologists working in pediatric diabetology on the national territory, regarding roles, functions and activities as part of a multidisciplinary team; their views on the potential benefits of CSII and the types of individuals applying for the use of technology. A socio-anagraphic data sheet was administered and two homogeneous focus groups were conducted by profession; they were audio recorded. The transcripts produced were analysed using the Emotional Text Mining (ETM) methodology. Each of the two corpus generated three clusters and two factors: for diabetologists, a focus on the patient in different levels of care emerged, collaborating both with other health professionals and with the territory, through the proposal of an intervention where the medical aspect is often represented by technology; also for psychologists there was a representation of interdisciplinary networking, with a greater focus on the processes inherent the management of pathology, from acceptance to the elaboration and integration of diabetes in the family narrative. The understanding of the representations of health professionals working in pediatric diabetes about new technologies can contribute to the consolidation of a network of professionals through a targeted work on possible critical issues emerged.

Semantic interoperability facilitates exchange and access of health data that is being documented in EHRs with various semantic features. In the EU, the regulation proposal of European health data space requires development of semantic interoperability. To achieve a fully integrated EHDS ecosystem leveraging the value of health data, stakeholders need to overcome challenges of implementing common standards and other semantic interoperability features. We aimed to research what scientific evidence is available on developing semantic interoperability. Our research questions focused specifically on key features and approaches for semantic interoperability and on possible benefits of these choices. For that purpose, we performed a systematic literature review by defining our study framework based on previous research. Our results consisted of 10 studies where data models, ontologies, terminologies, classifications, and standards were applied for building interoperability. Through increased access to interoperable patient information, a better quality and outcomes in care can be achieved. Better communication based on easily accessible data is facilitated between health professionals and between clinicians and the patients. When heading towards semantic harmonization as outlined in the EHDS proposal, more experiences and analyses are needed to assess how applicable the chosen solutions are for semantic interoperability of European health care data.

Smartphone-based point-of-care testing (POCT) is rapidly emerging as an alternative to traditional screening and laboratory testing, particularly in resource-limited settings. In this proof-of-concept study, we present a smartphone- and cloud-based artificial intelligence quantitative analysis system (SCAISY) for relative quantification of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-specific IgG antibody lateral flow assays that enables rapid and accurate evaluation of test strips. By capturing an image with a smartphone camera, SCAISY quantitatively analyzes antibody levels and provides results to the user. We analyzed changes in antibody levels over time in over 248 individuals, including vaccine type, number of doses, and infection status, with a standard deviation of less than 10%. We also tracked antibody levels in six participants before and after SARS-CoV-2 infection. Finally, we examined the effects of lighting conditions, camera angle, and smartphone type to ensure consistency and reproducibility. This study suggests that SCAISY is a simple and powerful tool for real-time public health surveillance, enabling the acceleration of quantifying SARS-CoV-2-specific antibodies generated by either vaccination or infection and tracking of personal immunity levels.

Abstract: Background: To determine the impact of a patient's ethnicity on the seeking preventive dental services at the Community Health Centers (CHCs) in South-Central Texas. Methods: Pri-mary electronic health records (HER) data were collected regarding each patient's medical and dental history, and comprehensive treatment planning. The researchers retrieved EHR from Jan-uary 2016 to 2022. Bivariate analysis was completed to test outcome with predicator and covariates using appropriate statistical tests. A multiple linear regression model was used to understand the association between the predictor and outcome variable while controlling for confounders. Results: The study findings revealed significantly higher dental visits (2.26 ± 2.88) for Hispanic patients. The results from the multiple regression model indicated that non-Hispanic patients had a 8% fewer chance of visiting the CHCs for preventive dental services compared to the Hispanic population (p-value<0.001) when all other variables are held constant. However, the study results were not significant as the effect size was small to conclude the effect of ethnicity on the patients visiting the dental clinic at the CHCs for preventive services. Conclusion: The study concluded that there is no difference in the preventive dental services completed by Hispanics and Non-Hispanics when all other variables are controlled.

The coronavirus disease of 2019, COVID-19, is caused by an infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). It was recognized in late 2019 and has since spread worldwide leading to a pandemic with unprecedented health and financial consequences. There remains an enormous demand for new diagnostic methods that can deliver fast, low-cost, and easy-to-use confirmation of a SARS-CoV-2 infection. We have developed an affordable electrochemical biosensor for the rapid detection of serological immunoglobulin (Ig) G antibody in sera against the Spike protein. Materials and Methods: A previously identified linear B-cell epitope (EP) specific to SARS-CoV-2 spike glycoprotein and recognized by IgG in patient sera was selected for the target molecule. After synthesis, the EP was immobilized onto the surface of the working electrode of a commercially available screen-printed electrode (SPE). The capture of SARS-CoV-2 specific IgGs allowed the formation of an immunocomples that was measured by square wave voltammetry from its generation of hydroquinone (HQ). Results: An evaluation of the performance of the EP-based biosensor presented a selectivity and specificity for COVID-19 of 93% and 100%, respectively. No cross-reaction was observed to antibodies against other diseases that included Chagas disease, Chikungunya, Leishmaniosis, and Dengue. Differentiation of infected and non-infected individuals was possible even at high dilution factor that decreased the required sample volumes to a few microliters. Conclusion: The final device proved suitable for diagnosing COVID-19 assaying actual serum samples and the results displayed good agreement with the molecular biology diagnoses. The flexibility to conjugate other EPs to SPEs suggests that this technology could be rapidly adapted to diagnose new variants of SARS-CoV-2 or other pathogens.

Methods to handle uncertainty in economic evaluation have gained much attention in the literature and the cost-effectiveness acceptability curve (CEAC) is the most widely used method to summarize and present uncertainty associated with program costs and effects in cost-effectiveness analysis. Some researchers have emphasized the limitations of the CEAC for informing decision and policy makers as the CEAC is insensitive to radial shifts of the joint distribution of incremental costs and effects in the North-East and South-West quadrants of the cost-effective plane (CEP). Furthermore, it has been pointed out that the CEAC does not incorporate risk-aversion in valuing uncertain costs and effects. In the present article we show that the cost-effectiveness affordability curve (CEAFC) captures both dimensions of the joint distribution of incremental costs and effects on the CEP and is therefore sensitive to radial shifts of the joint distribution on the CEP. Furthermore, the CEAFC also informs about the budget impact of a new intervention as it estimates the joint probability an intervention is both affordable and cost-effective. Moreover, we show that the cost-effectiveness risk-aversion curve (CERAC) allows to incorporate risk-aversion into the analysis and can therefore be used to inform decision-makers who are risk-averse. We use data from a published cost-effectiveness model of palbociclib in addition to letrozole versus letrozole alone for the treatment of oestrogen-receptor positive, HER-2 negative, advanced breast cancer to demonstrate the differences between CEAC, CEAFC and CERAC and show how these can jointly be used to inform decision and policy makers.

Biosensors have shown great potential in realizing rapid, low cost and portable on-site detection for diseases. This work reports the development of a new bioelectronic sensor called AC electrokinetics-based capacitive (ABC) biosensor, for the detection of genomic DNA (gDNA) of methicillin-resistant Staphylococcus aureus (MRSA). The ABC sensor is based on interdigitated microelectrodes biofunctionalized with oligonucleotide probes. It uses a special AC signal for direct capacitive monitoring of topological change on nanostructured sensor surface, which simultaneously induce dieletrophoretic enrichment of target gDNAs. As a result, rapid and specific detection of gDNA/probe hybridization can be realized with high sensitivity. It requires no signal amplification such as labelling, hybridization chain reaction, or nucleic acid sequence-based amplification. This method involves only simple sample preparation. After optimization of nano-structured sensor surface and signal processing, the ABC sensor demonstrated fast turnaround of results (~10 s detection), excellent sensitivity (a detection limit of 4.7 DNA copies /µL MRSA gDNA) and high specificity, suitable for point of care diagnosis. As a bioelectronic sensor, the developed ABC sensors can be easily adapted for detection of other infectious agents.

In recent years, Lassa fever has been announced as an infectious disease in the world, a few imported cases have been accounted for in various pieces of the world and there are developing worries of the possibilities of Lassa fever Virus as an organic weapon. Regardless of its assaulting impact, no substantial arrangement has been created to reduce the hazard of the ailment, about a large portion of 10 years after identifying it. A Review based on the documents from the literature search on PubMed, Scopus, Goggle Scholar and Science direct. Out of these, the final 16 articles that met the criteria were selected. Relevant information on epidemiology, the burden of management and control were obtained. Timely and effective containment of the Lassa fever disease in Lassa village four decades ago could have minimized the devastating effect and threats posed by this illness in the West African sub-region and indeed the entire globe. That was a hard lesson calling for much more proactive measures towards the eradication of the illness at primary, secondary, and tertiary levels of health care. Hence, the paper is aimed at appraising the threats associated with Lassa fever disease; its demands on curtailing the menace of the epidemic, and recommendations on important focal points.

The COVID-19 pandemic has created huge damage to society and brought panics around the world. Such panics can be ascribed to the seemingly deceptive features of the COVID-19: compared to other deadly viral outspreads, it has medium transmission and mortality rates. As a result, the severity of the causative coronavirus, SARS-CoV-2, was deeply underestimated by the society at the beginning of the COVID-19 outbreak. Based on this, in this review, we define the viruses with features similar to those of SARS-CoV-2 as the Panic Zone viruses. To contain those viruses, accurate and fast diagnosis followed by effective isolation and treatment of patients are pivotal at the early stage of virus breakouts. This is especially true when there is no cure or vaccine available for a transmissible disease, which is the case for current COVID-19 pandemic. As of January 2021, more than two hundred kits for the COVID-19 diagnosis on the market are surveyed in this review, while emerging sensing techniques for SARS-CoV-2 are also discussed. It is of critical importance to rationally use these kits for the efficient management and control of the Panic Zone viruses. Therefore, we discuss guidelines to select diagnostic kits at different outbreak stages of the Panic Zone viruses, SARS-CoV-2 in particular. While it is of utmost importance to use nucleic acid-based detection kits with low false negativity (high sensitivity) at the early stage of an outbreak, the low false positivity (high specificity) gains its importance at later stages of the outbreak. When a society is set to reopen from the lock-down stage of the COVID-19 pandemic, it becomes critical to have antibody based immunoassay kits with high specificity to identify people who can safely return to the society after their recovery of SARS-CoV-2 infections. Given that the emergence of mutant viruses at the beginning of 2021 has complicated current battle against the COVID-19, we also discussed approaches and guidelines to detect viral mutants in the middle of the second wave of the pandemic that started at the end of 2020. Finally, since a massive attack from a viral pandemic requires a massive defense from the whole society, we urge both government and private sectors to research and develop more affordable and reliable point-of-care testing (POCT) kits, which can be used massively by the general public (and therefore called as massive POCT) to contain Panic Zone viruses in future.

A significant part of the literature on innovative practice in medicine relates to seizing opportunities and curbing harms for patients in desperate situations. Unfortunately, the term innovation has multiple meanings and a rich rhetorical flourish that adds confusion and misunderstanding to an already difficult debate. This paper aims to enhance the current definition of innovative practice for medicine. First, we replace the term innovation with the more literal of new non-validated practice. To identify this meaning, we analyse the traditional research ethics’ distinction between research, validated practice, and innovation in the Belmont Report. Second, we propose the following explicit definition of new non-validated practice: the first or recent use of diagnostic, therapeutic or preventive interventions that introduce a significant change, with an insufficient level of evidence of safety or efficacy for regular healthcare, and with the main aim to benefit individual patients. This definition is a promising conceptual tool to inform empirical research, ethicists, and the harmonization of its regulation and legislation (e.g. right-to-try laws).

Background: Strengthening adherence to self-care behaviors in patients with periodontal disease (PD) and reducing plaque index is crucial for improving PD treatment. We evaluated the effectiveness of a theory of planned behavior (TPB)-based health education intervention involving planning strategy on self-care behaviors in patients with PD. Methods: A randomized controlled trial was conducted; 158 and 139 patients comprised the experimental group (EG) and control group (CG), respectively. Both groups received a leaflet, and the EG also received a planning intervention, which was a brief one-on-one counseling session with a planning sheet. Data were collected using a self-administered questionnaire. Results: Between-group comparisons of TPB measures revealed significant differences in all domains when controlling for baseline covariates. The EG exhibited significantly higher levels of action and coping planning than the CG at 2-week follow-up (effect size (ES) = 5.54 and 5.57, respectively) and 6-week follow-up (ES = 5.66 and 5.66, respectively). Between-group differences in changes of brushing behaviors increased significantly. More frequent use of dental floss was observed in the EG than in the CG at 2-week and 6-week follow-ups (24.7% and 22.8%, respectively). Conclusions: The intervention involving planning strategy effectively promoted adherence to self-care behaviors in patients with PD.

This paper proposes an innovative postulate based on experimental observations, namely, that the speed of light can vary between two inertial reference systems. This postulate is defined as the principle of relative change in the speed of light, which refreshes the concept of absolute speed of light in traditional physics. By integrating the principle of the invariance of the speed of light with the principle of relativity in relativity theory, several important conclusions are derived: space and time must be capable of and proportionally expand and contract. Between two inertial reference systems with different relative speeds of light, objects have an energy difference of k^2 times, which induces a natural tendency for objects to move towards a state of lower energy. The acceleration is only related to the relative change rate of the speed of light in vacuum space and is independent of the mass of the object. The kinetic energy obtained by the object comes from the reduction of internal energy of the object, emphasizing the key role of energy conversion in this process. The paper provides a new theoretical perspective for explaining the physical mechanisms of universal gravitation and dark energy.

In Brain-Computer Interface Motor Imagery (BCI-MI) systems, Convolutional Neural Networks (CNNs) have traditionally dominated as the deep learning method of choice, demonstrating significant advancements in state-of-the-art studies. Recently, Transformer models with attention mechanisms have emerged as a sophisticated technique, enhancing the capture of long-term dependencies and intricate feature relationships in BCI-MI. This research investigates the performance of EEG-TCNet and EEG-Conformer models, which are trained and validated using various hyperparameters and bandpass filters during preprocessing to assess improvements in model accuracy. Additionally, this study introduces the EEG-TCNTransformer, a novel model that integrates the convolutional architecture of EEG-TCNet with a series of self-attention blocks employing a multi-head structure. The EEG-TCNTransformer achieves an accuracy of 82.97% without the application of bandpass filtering. The source code of EEG-TCNTransformer is available on GitHub.

Biological systems have a unique ability inherited through their genome. It allows them to build, operate, and manage a society of cells with complex organizational structures where autonomous components execute specific tasks and collaborate in groups to fulfill systemic goals with shared knowledge. The system receives information from various senses, makes sense of what is being observed, and acts using its experience, while the observations are still in progress. We use the General Theory of Information (GTI) to implement a digital genome, specifying the operational processes that design, deploy, operate, and manage a cloud-agnostic distributed application that is independent of IaaS and PaaS infrastructure, which provides the resources required to execute the software components. The digital genome specifies the functional and non-functional requirements that define the goals and best-practice policies to evolve the system using associative memory and event-driven interaction history to maintain stability and safety while achieving the system’s objectives. We demonstrate a structural machine, cognizing oracles, and knowledge structures derived from GTI used for designing, deploying, operating, and managing a distributed video streaming application with autopoietic self-regulation that maintains structural stability and communication among distributed components with shared knowledge while maintaining expected behaviors dictated by functional requirements.

Edvard Munch, a founder of Expressionism was pre-occupied with depicting his subjective experience and the most prolific painter of self-portraits since Rembrandt. Based on evidence that faces and self-related images are more salient than other objects it is plausible that self-portraits, in which the subject and object are the same, reflect the artist’s state of mind. Although he suffered from a variety of physical and psychological illness Munch was not diagnosed with any specificity in his lifetime. Posthumous diagnoses include schizophrenia, anxiety, bipolar and other disorders. Recent research has revealed altered visual perception in such patients. The present study empirically analysed three stylistic elements of Munch’s painted self-portraits and portraits: contrast, colour and fractal dimension and his painted productivity, to determine if variations correlate with critical life events and if so whether they indicate states of mind. It found significant increases in contrast and colour brightness and persistent high complexity during critical periods supporting the conclusion that Munch is diagnostically best described as suffering from early onset schizophrenia and comorbid social anxiety disorder.

Glass and ceramics have a fundamental and crucial role in our lives due to their properties and aesthetic decoration. However, they create serious environmental problems, mainly due to their high occupation of landfills and harmful emissions. Both wastes could be utilized to reduce the natural resources' adverse environmental effects and exhaustion. With increasing environmental concerns to reduce solid waste as much as possible, the concrete industry has adopted several methods to achieve this goal. Hence this study examines the performance of self-compacted concrete (SCC) utilizing various percentages of recycled waste materials such as those deposited from glass and ceramic industries. The idea of utilizing recycled waste materials in concrete manufacturing has gained massive attention due to their impressive results in rheological and mechanical state. Recycled glass (RG) and ceramic waste powder (CWP) were utilized to replace fine aggregate and cement, respectively. Five mixes were designed, including the control mix, and the other four mixes with different dosages of RG and CWP as fine aggregate and cement replacement ranging between 5 to 25%. Mixes were tested for both rheological and mechanical properties to evaluate their compilment with SCC requirements as per codes and guidelines. The results revealed that 20%CWP or less as cement replacement and 10% or less of RG as fine aggregate replacement would provide suitable rheological properties along with mechanical ones. Utilizing recycled glass and ceramic waste powder provides strength like the mix designed with natural resources, which helps us structure economically and environmentally friendly.

Digital machine intelligence has evolved from its inception in the form of computation of numbers to AI, which is centered around performing cognitive tasks that humans can perform, such as predictive reasoning or complex calculations. The state of the art includes tasks that are easily described by a list of formal, mathematical rules or a sequence of event-driven actions such as modeling, simulation, business workflows, interaction with devices, etc., and also tasks that are easy to do “intuitively”, but are hard to describe formally or as a sequence of event-driven actions such as recognizing spoken words or faces. While these tasks are impressive, they fall short in applying common sense reasoning to new situations, filling in information gaps, or understanding and applying unspoken rules or norms. Human intelligence uses both associative memory and event-driven transaction history to make sense of what they are observing fast enough to do something about it while they are still observing it. In addition to this cognitive ability, all bio-logical systems exhibit autopoiesis and self-regulation. In this paper, we demonstrate how machine intelligence can be enhanced to include both associative memory and event-driven transaction history to create a new class of knowledge-based assistants to augment human intelligence. The digital assistants use global knowledge derived from the Large Language Models to bridge the knowledge gap between various participants interacting with each other. We use the general theory of information and schema-based knowledge representation to create the memory and history of various transactions involved in the interactions.

Chronic conditions like type 2 diabetes mellitus (T2DM), arterial hypertension (HTN), and obesity are major global health issues, causing significant morbidity and mortality. In Latin America, these conditions contribute to millions of premature deaths annually, posing challenges exacerbated by limited healthcare access and poor primary care quality, particularly in Mexico. Complementary medicine presents a potential solution, offering minimally invasive techniques to improve physical, mental, and spiritual well-being. Effective treatment adherence, crucial for positive outcomes, is influenced by self-efficacy, the ability to manage one's behavior in response to medical conditions. However, treatment adherence rates remain low, indicating a pressing public health concern. This study aimed to explore how perception of complementary medicine and treatment adherence predict self-efficacy among individuals with chronic conditions in Mexico. Analyzing data from 113 participants revealed significant correlations between variables, with treatment adherence positively associated with self-efficacy and perception of holistic medicine negatively correlated with self-efficacy. Regression analysis showed that incorporating perception of complementary medicine and treatment adherence significantly explained self-efficacy levels, suggesting the potential of complementary therapies in holistic healthcare approaches. However, collinearity between variables highlights the need for further research to better understand these relationships and their implications for improving healthcare outcomes in Mexico. Integrating complementary therapies with conventional treatments could enhance overall well-being and treatment adherence, offering promising avenues for addressing chronic conditions in the region. These findings underscore the importance of comprehensive healthcare approaches that integrate both conventional and complementary modalities to optimize health outcomes and quality of life for individuals with chronic conditions in Mexico and beyond.

This paper studies the flexural behavior of the bridge deck link slabs made with the Polyvinyl Alcohol-Strain Hardening Cementitious Composites (PVA-SHCC). Tensile and flexural properties of the PVA-SHCC with four volume fractions, i.e., 0%, 1%, 1.5%, and 2%, were evaluated first. Next, using the similarity theory, composite models with a geometric similarity ratio of 1: 5 were designed to represent the bridge deck with the link slabs. The models considered three materials for link slabs, including concrete, cement mortar and self-compacting PVA-SHCC; and two different curing ages at 7 and 56 days. Bending tests were performed to investigate the flexural behavior of the models. Based on the fractal theory, cracking characteristics of the models with different types of link slabs were compared, and the relationship between Df and the flexural behavior of the models were studied. Numerical models were built to correlate with the results from the bending tests. It is illustrated that the flexural behavior of the self-compacting PVA-SHCC link slab is better than that of concrete and cement mortar link slabs, where the crack initiation and propagation can be postponed.

Integrating a grid-connected battery into a Renewable Energy Community boosts Collective-Self-Consumption of photovoltaic produced energy and allow to perform Energy Arbitrage in the day-ahead and intraday electricity market. However, is it a cost-effective investment? The proposed analysis relay on Net Present Value assessment. Ageing affects are integrated and sensitivity analyses are conducted: considering community customers number, electricity mar-ket prices, battery cost, size and the decision to engage in energy arbitrage. Each scenario under-goes a 20-year hourly simulation using an ageing aware rolling-horizon 24-hours-looking-ahead scheduling, optimized with Mixed-integer linear Programming. Forecast errors, provid-ing of ancillary services, real time control and grid constrains are not taken into account. Simulations conducted on the Italian market indicates that a battery dedicated solely to collec-tive self-consumption is not economically appealing. However, integrating Energy Arbitrage, despite impact on battery lifespan, halves the payback period and enhances the attractiveness of larger battery investments. The Net Present Value is contingent upon battery size, customer number and market prices. However, if battery cost does not exceed 200 €/kWh the investment become cost-effective across all scenarios.

In order to improve real-time performance of gesture recognition by micro-Doppler map of mmWave Radar, the point cloud based gesture recognition for mmWave Radar is proposed in this paper.Two steps are carried out for mmWave Radar based gesture recognition. The first step is to estimate the point cloud of the gestures by 3D-FFT and the peak grouping. The second step is to train the TRANS-CNN model by combining the multi-head self-attention and the 1D-convolutional network, so as to extract the features in the point cloud data at a deeper level to categorize the gestures. In the experiments, TI mmWave Radar sensor IWR1642 is used as benchmark to evaluate the feasibility of the proposed approach. The results show that the accuracy of the gesture recognition reaches 98.5%. In order to prove the effectiveness of our approach, a simply 2Tx2Rx Radar sensor is developed in our lab and the accuracy of recognition reaches 97.1%. The results show that our proposed gesture recognition approach achieves the best performance in real-time with limited training data, in comparison with the existing methods.

(1) Background: Mindfulness-based interventions (MBIs) have shown interesting preliminary ef-fects over self-regulation processes in early adolescence. However, interventions usually integrate various types of practices with no clarity about the specific effect of each of them over attentional, emotional, and behavioral regulation. The objective of this research was to evaluate the effect of two MBIs, one focused on classic attentional practices and another one focused on the recognition and expression of emotions, over attentional, emotional, and behavioral self-regulation in early adolescents. (2) Method: An experimental method was carried out. A sample of 70 children be-tween 8 and 12 years old were randomized and assigned to three experimental conditions: 1) MBI with a focus on attentional practices, 2) MBI with a focus on recognition and expression of emotions, 3) control group, waiting list. The programs lasted 8 weeks, with a weekly 1-hour online synchronic session, plus home practices. Children were evaluated before starting the in-tervention and at the end of the 8-week program. The assessed variables were: 1) Mindfulness; 2) Emotional Regulation; 3) Attentional Regulation and 4) Behavioral regulation. (3) Results: Chil-dren that participated in both programs, increased their mindfulness and emotional and be-havioral regulation scores. Only children who participated in the program with a focus on at-tention showed significant changes in their ability to self-regulate attention. (4) Conclusions: online MBIs, with attention to external and internal stimuli practices, can be a good strategy to strengthen self-regulation skills of attention, emotions, and behavior in early adolescence.

This study investigated whether reciprocal collaborative pedagogy significantly impacts Indonesian electrical engineering polytechnic students in reducing reading anxiety and improving self-efficacy in ESP reading comprehension skills. Fifty Polytechnic students were equally assigned to two groups. Control groups learned in the traditional reciprocal teaching method individually. Experimental group engaged in reciprocal collaborative pedagogy. Each group received a 6-week reading strategy training. E-learning platforms were used in this study as a complementary tool to distribute ESP reading materials, announcements, and the experiment details being taught. The quantitative and qualitative results demonstrated that the tasks in reciprocal collaborative pedagogy positively affects Indonesian electrical engineering polytechnic students' learning experience and outcomes. This pedagogy promotes a productive learning environment through peer interaction, active engagement, and peer group discussions of the whole learning activities, reducing feelings of anxiety and building confidence in ESP-specialized text.

Printed circuit boards (PCBs) make up 3 to 5% of all electronic waste. The metal content of spent PCBs can reach 40%. They usually contain valuable metals - Ag, Au, Pd, as well as other metals such as Cu, Sn, Pb, Cd, Cr, Zn, Ni and Mn. However metallic part of whole PCB is 40-60% including Cu layers between the fiberglass-polymer layers. The paper describes economics of the the valuable metals (Ag, Au, Pd) containing concentrate preparation from raw PCB. Considered the influence of pre-treatment method of PCB before the extraction of valuable metals on the extraction self-cost change. The disintegration method is based on the high-energy impact of the particles of the material to be ground, thus causing the separation of the metallic components of the PCB. In the course of the work, single and double direct grinding by the method of disintegration was studied. For the calculation the test batch 10’000 kg of two types of PCB were taken for estimation of the self costs and potential profit in case of complete valuable metals (Ag, Au, Pd) plus Cu extraction. Is shown that from 10’000 kg of studied PCB is possible to obtain 1144 and 1644 kg of metal-rich concentrate, which further should be subjected to electro-hydrochlorination for metals leaching. The main findings shows, that despite of high content of Cu in studied PCB, the commercial value is insignificant in total income from the Ag, Au and Pd sale. Was established correlation of the self-cost decrease after separative disintegration of PCB by metal content increase (by specific metals such as Au, Ag, Pd and also Cu) with the metal potential yield after extraction.

The study aimed to investigate how distributed leadership influences adolescents' social and emotional competence, considering the roles of student-centered instructional practices and teacher self-efficacy. Utilizing survey data from 7,246 Suzhou adolescents enrolled in the SESS program, the study employed multilevel structural equation modeling for analysis. The findings indicated a positive correlation between distributed leadership and adolescents' social and emotional competence, as evaluated by teachers. Moreover, distributed leadership was observed to exert an indirect impact on adolescents' self-assessment and teacher-rated social and emotional competence. This influence operated through several mediators: student-centered instructional practices, teacher self-efficacy, and the sequential mediating pathway of student-centered instructional practices → teacher self-efficacy. This study underscores the significance of supportive elements in fostering students' social and emotional competence. It offers valuable insights into the everyday practices of teachers, principals, and administrators. Additionally, it sheds light on how distributed leadership contributes to enhancing adolescents' overall social and emotional development.

This study explores the interplay between web-based professional development, teachers' self-efficacy, resilience, and work values in the context of the Davao Region. The investigation reveals significant findings in three key areas: web-based professional development, teachers' resilience, and teachers' work values. The survey indicates that web-based professional development significantly impacts teachers' self-efficacy, with interaction self-efficacy registering the highest mean score. Moreover, teachers' resilience is manifested across emotional, motivational, and social dimensions, with emotional resilience scoring the highest mean. Teachers' work values, encompassing physical facilities, social environment, job security, new challenges, professional growth, personal growth, and interpersonal relationships, all demonstrate high descriptive equivalents. The study establishes a significant positive correlation between web-based professional development and teachers' self-efficacy, as well as a significant relationship between teachers' resilience and their work values. Furthermore, both web-based professional development and teachers' resilience exert a significant influence on teachers' work values.The conclusions drawn from the study highlight the prominence of web-based professional development, teachers' resilience, and work values in the educational landscape of the Davao Region. The findings underscore the interconnectedness of these factors and their crucial role in shaping the teaching profession. In light of these results, recommendations are made to inform policy decisions and enhance professional development programs for teachers in the region. The study encourages a holistic understanding of the relationships between web-based professional development, self-efficacy, resilience, and work values, aiming to contribute to the continuous improvement of education quality in the Davao Region. Additionally, future research is suggested to delve deeper into specific aspects of teachers' general self-efficacy, social resilience, and interpersonal relationships for a more comprehensive understanding.

Nucleobase-containing molecules are compounds essential in biology due to the fundamental role of nucleic acids, and in particular G-quadruplex DNA and RNA in life. Moreover, some molecules different from nucleic acids isolated from different vegetal sources or microorganisms show nucleobase moieties in their structure. Nucleoamino acids and peptidyl nucleosides belong to this molecular class. Closely related to the above, nucleopeptides also known as nucleobase-bearing peptides are chimeric derivatives of synthetic origin and more rarely isolated from plants. Herein the self-assembly properties of a vast number of structures, belonging to the nucleic acid and nucleo amino acid/nucleopeptide family, is explored in the light of the recent scientific literature. Moreover, several technologically relevant properties such as the hydrogelation ability of some of the nucleobase-containing derivatives are reviewed in order to open the door to future experimental investigations of newly-inspired nucleobase-driven hydrogels. Nucleobase-containing molecules, such as mononucleosides, DNA, RNA, quadruplex (G4)-forming oligonucleotides and nucleopeptides, are paramount in gel and hydrogel formation owing to their distinctive molecular attributes and ability to self-assemble in biomolecular nanosystems with the most diverse applications in different fields of biomedicine and nanotechnology. In fact, these molecules and their gels present numerous advantages, underscoring their significance and applicability in both material science and biomedicine. Their versatility, capability for molecular recognition, responsiveness to stimuli, biocompatibility, and biodegradability collectively contribute to their prominence in modern nanotechnology and biomedicine. In this review, we emphasize the critical role of nucleobase-containing molecules of different nature in pioneering novel materials with multifaceted applications highlighting their potential in therapy, diagnostics, and new nanomaterials fabrication as required in order to address the numerous current biomedical and nanotechnological challenges.

Self-consolidating concrete (SCC) is highly workable concrete that flows under minimal vibrations into congested reinforcement and sophisticated formworks. The properties of SCC are achieved by incorporating chemical admixtures. In this study, we analyzed if SCC could be designed with a cheap, easily accessible plant extract as a bio-admixture known as aloe vera mucilage (AVM). The main aim is to determine the effect of AVM on SCC prepared from ordinary Portland cement (OPC) and blended cement LC3, consisting of clinker (50%), calcined waste clay (30%), limestone (15%), and gypsum (5%). The AVM is applied in different dosages of up to 10%. The findings showed that the LC3 had a lower rate of consistency, lower slump values, and higher initial and final setting times compared to OPC. The V-funnel and L-box values were reduced with increased plasticizer dosing. Additionally, the OPC samples with both plasticizers achieved higher compressive strength than LC3 in the 7, 14, and 28 curing ages. However, the 2.5 % dosage of AVM showed some increase in compressive strength in both OPC and LC3 samples. Overall, AVM is comparable to the commercial plasticizer used as both influence the reduction of yield stress with an increase in slump flow.

Text annotation is an essential element of the natural language processing approaches. The manual annotation process performed by humans has several drawbacks, such as subjectivity, slowness, fatigue, and possibly carelessness. In addition, annotators may annotate ambiguous data. So, we developed the concept of automated annotation to get the best annotations using several machine-learning approaches. The proposed approach is based on an ensemble algorithm of meta-learners and meta-vectorizer techniques. The approach employs a semi-supervised learning technique for automated annotation, aimed at detecting hate speech. This involves leveraging various machine learning algorithms, including Support Vector Machine (SVM), Decision Tree (DT), K-Nearest Neighbors (KNN), and Naive Bayes (NB), in conjunction with Word2Vec and TF-IDF text extraction methods. The annotation process is performed using 13,169 Indonesian YouTube comments data. The proposed model used a Stemming approach using data from Sastrawi and also new data of 2,245 words. Semi-supervised learning uses 5%, 10%, and 20% of labeled data as compared to performing labeling based on 80% of the datasets. In semi-supervised learning, the model learns from the labeled data, which provides explicit information, and the unlabeled data, which offers implicit insights. This hybrid approach enables the model to generalize and make informed predictions even when limited labeled data is available, ultimately enhancing its ability to handle real-world scenarios with scarce annotated information. In addition, the proposed method uses a variety of thresholds for matching words labeled with hate speech ranging from 0.6, 0.7, 0.8, and 0.9. The experiment showed that the KNN-Word2ec model has the best accuracy value of 96.9% with a scenario of 5%:80%:0.9. However, several other methods have also accuracy above 90%, such as SVM and DT based on both text extraction methods in several test scenarios.

Eutrophication is a major environmental issue with many negative consequences, such as hypoxia and harmful cyanotoxins production. Monitoring coastal eutrophication is a crucial, especially for island countries like the Republic of Cyprus, which are economically dependent on the touristic sector. Additionally, the open-sea aquaculture industry in Cyprus has been exhibiting an increase in the last decades and environmental monitoring to identify possible signs of eutrophication is mandatory according to the legislation. Therefore, in this modelling study, two different types of Artificial Neural Networks (ANNs) are developed based on in situ-data collected from stations located in the coastal waters of Cyprus. Theses ANNs aim to model the eutrophication phenomenon based on two different data-driven modelling procedures. Firstly, the self-organizing map (SOM) ANN examines several water quality parameters (specifically water temperature, salinity, nitrogen species, ortho-phosphates, dissolved oxygen and electrical conductivity) interactions with the Chlorophyll-a parameter. The SOM model enables us to visualize the monitored parameters relationships and to comprehend complex biological mechanisms related to Chlorophyll-a production. A second feed-forward ANN model is also developed for predicting the Chlorophyll-a levels. Based on this ANN model, several scenarios associated to the eutrophication-related water quality parameters can be extracted. The combination of these two ANNs models is considered a holistic modelling approximation for the identification of eutrophication scenarios, since it enables not only the prediction of the Chlorophyll-a parameter levels, but also the “capturing” of hidden biological mechanisms associated with algal production.

"Finding fresh water in the ocean of data." is a challenge that all deep learning domains struggle with, especially in the area of hyperspectral image analysis. As hyperspectral remote sensing technology advances by leaps and bounds, there are increasing amounts of hyperspectral images(HSIs) can be available. Whereas in fact, these unlabeled HSIs are powerless to be used as material to driven a supervised learning task due to the extremely expensive labeling costs and some unknown regions. Although learning-based methods have achieved remarkable performance due to their superior ability to represent features, at the cost, these methods are complex, inflexible and tough to carry out transfer learning. In this paper, we propose the "Instructional Mask AutoEncoder"(IMAE), which is a simple and powerful self-supervised learner for HSI classification that uses a transformer-based mask autoencoder to extract the general features of HSIs through a self-reconstructing agent task. Moreover, we utilize the metric learning to perform an instructor which can direct the model focus on the human interested region of the input so that we can alleviate the defects of transformer-based model such as local attention distraction, lack of inductive bias and tremendous training data requirement. In downstream forward propagation, instead of global average pooling, we employ a learnable aggregation to put the tokens into fullplay. The obtained results illustrate that our method effectively accelerates the convergence rate and promotes the performance in downstream task.

Self-medication with natural products during disease outbreaks in developing countries poses significant public health challenges yet remains relatively unexplored in the published literature. This study aims to assess the implications of such practices, address the state and quality of evidence, identify gaps in the literature, explore determinants and contributing factors, elucidating the implications, and propose possible solutions. Using a modified systematic literature review methodology, 20 articles were selected from 1,683 reports after applying rigorous selection criteria and quality assessment using the AXIS critical evaluation tool. The findings revealed a dearth of literature concerning the implications of self-medication with natural products during disease outbreaks, highlighting the need for further investigation in this domain. Key determinants included gender, acquisition, and ideological factors, while common side effects comprised diarrhoea, stomach pain, sweating, headache, and nausea/vomiting. Notably, self-medication with natural products was associated with reduced communication with healthcare providers, leading to underreported side effects. It also creates a false sense of safety which may potentially exacerbate the spread of the prevailing disease. In conclusion, the rampant use of natural products for self-medication necessitates increased awareness among the population, encouraging individuals to seek professional medical care and support when faced with disease outbreaks.

This article presents a state-of-the-art literature review to understand people’s perceptions and opinions of Autonomous Vehicles (AVs) and the factors that influence AV adoption. A strategic literature search was conducted to select articles for this review. Most of the articles were published within the last five years and they used a household questionnaire survey to collect data. Mostly, they used statistical and econometric methods to evaluate the factors that affect people’s intentions to adopt AVs. The results show that psychological factors often appear as the most important internal factors of people’s willingness to adopt AVs. Additionally, other internal factors such as the socioeconomic profile of individuals and their household, and knowledge and familiarity with AV technologies would affect AV adoption tendencies. User attributes also indirectly affect AV adoption by influencing the psychological factors of users. We identify several critical external factors such as opportunities (e.g., safety and security, low congestion, energy use) and challenges (e.g., system failure, privacy breach, and legal issues), while another influential group includes transportation factors (e.g., travel mode, distance, and time), urban form (e.g., urban/rural, density, land use diversity), affinity to new technology, and the institutional regulatory environment. We discuss some recommendations for policy makers, auto industries, and private stakeholders to formulate policies and strategies to increase market share of AVs. Finally, we identify some limitations of previous studies and provide a blueprint for future research on AV adoption.

The impact of early maternal age on several outcomes (e.g. mental health issues, delinquency, aggression, impulsivity, victimization and interpersonal difficulties) has been studied since the late 1980s. Research has demonstrated links between exposure to adverse childhood experiences (ACEs) and trauma related outcomes such as substance abuse, interpersonal and self-directed violence, and sexual risk-taking, to name a few. The current study analyzed the incidence of ACE exposure and mental health outcomes (e.g. suicidal behaviors or self-harm, psychiatric hospitalizations, and substance use) as related to early maternal age in youth known to have experienced trafficking or sexual abuse. General demographics and incidence of various experiences and clinical presentations (e.g. ACE exposure, age of mother at birth of youth and age at first birth), and history of self-harm, substance use and psychiatric hospitalization were examined in a sample of 225 youth referred for services subsequent to experiences of sex trafficking or exploitation. Relationships between ACE exposure and maternal age related to mental health outcomes was also examined. Trafficked and exploited youth reported rates of ACE exposure and poor mental health outcomes at far greater rates than the general population. Significant findings were related to early maternal age and engaging in self-harm or suicidal behaviors. Previously anticipated mediational analyses were not conducted due to the sample size and lack of correlations. Findings highlight the significant ACE exposure and high needs of exploited, trafficked and abused youth and related mental health outcomes, emphasizing the need for early and comprehensive preventive and therapeutic interventions.

Recently, there is a growing need for sensors that can operate autonomously, without the need for an external power source. This is especially important in applications where conventional power sources, such as batteries, are impractical or difficult to replace. Self-powered sensors have emerged as a promising solution to this challenge, offering a range of benefits such as low cost, high stability, and environmental friendliness. One of the most promising self-powered sensor technologies is L-S TENG, which stands for the liquid-solid triboelectric nanogenerator. This technology works by harnessing the mechanical energy generated by external stimuli such as pressure, touch, or vibration, and converting it into electrical energy that can be used to power sensors and other electronic devices. Therefore, self-powered based on L-S TENG, which provides numerous benefits such as rapidly responding, portability, cost-effectiveness, and miniaturization, is critical for increasing living standards and optimizing industrial processes. In this review paper, the working principle with three basic modes has been briefly introduced firstly. After that, affecting parameters to L-S TENG are reviewed based on the properties of the liquid and solid phases. With different working principles, L-S TENG has designed a lot of structure that works as a self-powered sensor for pressure/force change, liquid flow motion, concentration, and chemical detection or biochemical sensing. Moreover, the continuous output signal of TENG plays an important role in a real-time sensor that is vital to the growth of the Internet of Things.

The research proposes a self-directed paradigm with self-design using the existing technology with LMS modules, discussions, and self-tests. The research establishes its criteria for assurance of teaching and learning known as 7x2C for the compliance of content, and appearance along with other criteria for the analysis. The above technology of web and LMS is tested for a business course that is technology-oriented in creating an experiential learning system for Covid-19 awareness. Similarly, among other ideas, an environment for educating learners about diabetes and obesity has been designed. The project is known as Sunchoke with its theme of Grow, Eat, and Heal. The educators can use their technology and apply self-directed pedagogy to transform this approach to their customized ways by using their content and rubrics.

(1) Background: The 2002 Budapest Open Access Initiative recommended on self-archiving of scientific articles in open repositories as the “green road” to open access. Twenty years later, only one part of the researchers deposits their publications in open repositories; moreover, one part of the repositories’ content is not based on self-archived deposits but on mediated nonfaculty contributions. The purpose of the paper is to provide more empirical evidence on this situation and to assess the impact on the future of the green road. (2) Methods: We analyzed the contributions on the French national HAL repository from more than 1,000 laboratories affiliated to the ten most important French research universities, with a focus on 2020, representing 14,023 contributor accounts and 166,939 deposits. (3) Results: We identified seven different types of contributor accounts, including deposits from nonfaculty staff and import flows from other platforms. Mediated nonfaculty contribution accounts for at least 48% of the deposits. We also identified difference between institutions and disciplines. (4) Conclusions: Our empirical results reveal a transformation of open repositories from self-archiving and direct scientific communication towards research information management. Repositories like HAL are somewhere in the middle of the process. The paper describes data quality as the main issue and major challenge of this transformation.

Supramolecular structures are of great interest due to their applicability in various scientific and industrial fields. These fields of scientific action include promising applications i biomedical areas, in sensing, and in conductive and electrical phases. The sensible definition of supramolecular molecules is being set by investigators, who, because of the different sensitivities of their methods and observational timescales, may have different views as to what constitute these supramolecular structures. Besides, diverse polymers can be found to offer unique avenues for multifunctional systems with properties in medicine industrial applications. Aspects of this review provide different conceptual strategies to address molecular design, properties, and potential applications of self-assembly materials and the use of metal coordination as a feasible and useful strategy for constructing complex supramolecular structures. In this order of appreciations and ideas order, it is that this review report involves classic topics such as hydrogels that range from their relationship with drug delivery systems, to metallo-supramolecular materials, through applications in ophthalmic systems, in applications that require adhesiveness and electrically conductive hydrogels. This review also addresses systems that are largely based on hydrogel chemistry and the enormous opportunities to design very specific structures for applications that demand enormous specificity.

User experience and user requirements are two independent approaches. User requirements address the customer's requirements and expectations for the solution, whereas user experience encompasses all aspects of how the user interacts with and uses the software. The software product should be easy to use and has usable features. Moreover, the additional value for the software is if the product has an attractive design or working environment that is in line with user behaviors, it can occur if integrate software requirements and user experience. Integration escalates developer productivity by focusing on features that meet the user's needs and expectations. That integration improves efficiency in software development by identifying and addressing problems that may arise during the development process, saving developer time and effort in developing software. The usage context of integration of user experience and user requirements in UX Journey contributes increase developer productivity and self-efficacy in developing software by focusing development on features that match the user needs, as well as increasing efficiency in overcoming problems that arise during the development process. UX Journey makes developers feel more confident in their ability to develop quality software.

Here I describe an overlooked form of non-biological paralife (i.e., near-life) that has been evolving on Earth for millions of years, and is currently in the final stages of transitioning into a new form of life. Any consideration of non-biological life or paralife is complicated by the fact that there is no consensus among biologists for the definition of life. This ambiguity has caused disagreement about whether subcellular reproduction systems like viruses are a form of life, despite having genomes, mutations, heritable phenotypes and system-improving evolution. To resolve this problem, I develop a definition of life that is entirely functional and independent of any of the structural idiosyncrasies of biological life on Earth: an order-generating system controlled by internally-encoded information that perpetuates itself by functioning to counteract its entropic decay. Using this definition, subcellular transposons, plasmids, and viruses are paralife because they match the definition of life in all ways except that they induce their order-generating functioning by a living host rather through their own self-sustaining production system. Using this functional definition of life, I show that utility- products (UPs) like fabricated hand tools are part of induced-reproduction systems that have features equivalent to biological genomes, mutations, heritable phenotypes, and a process of system-improving evolution. The perceived benefit of utility-products causes them to induce their reproduction by a biological life-form (humans). For these reasons, human utility products are functionally just as close to being a form of life as subcellular transposons, plasmids, and viruses, i.e., they are Utility-Product paralife (UP-parlife). I also show that some forms of UP-paralife are currently evolving into mechanical life that is capable of both self- sustaining reproduction and system-improving evolution without outside assistance. This transition requires the development of a high level of factory and/or UP automation and artificial intelligence (AI) that is capable of complex reasoning, imagination and creativity. Finally, I consider the influence of UP-life and UP-paralife on the development of the level of structural complexity in the universe, and I briefly speculate about how these non-biological forms of life and paralife will influence the expansion of scientific knowledge about the universe.

Refugee subject position is an evolving topic of contention in the world today with increased migrant and refugee mobilities. Urban refugee spaces are often segregated in the form of colonies, ethnic villages, even ghettos, embodying institutionalised discourses of apathy and violence. These spaces only occupy the cracks and margins of the normative, formal city, as appropriations of inhospitable natural terrains and urban systems. The paper discusses how refugees compete for resources for survival as “bio-political” subjects and are often held summarily responsible for causing ecological stress in host environments. After the 1947 Partition of the Indian subcontinent, millions of Hindu Bengali refugees from East Pakistan flooded the Eastern Indian states of West Bengal, Assam and Tripura. Kolkata particularly drew millions for better livelihood prospects. Facing government apathy and local violence, East-Bengali refugees appropriated the urban fringes of Kolkata and claimed their right to urban space through the political act of squatting or Jabar-Dakhal. The intent of this paper is to investigate and map the spatial distribution of East-Bengali refugee squatters and elaborate on how they transformed the terrain and distributed resources through self-management tactics. This spatial history case-study attempts to uncover locational data from archival government records, existing academic literature and fieldwork to visualise where the 145 pre-1950 and the 123 post-1950 Jabar-Dakhal colonies were located in the Kolkata Metropolitan Area. This case of successful refugee self-settlement is qualitatively read in relation to the major areas of ecological stress in Kolkata. One of the UN sustainable development goals is to make cities and human settlements ‘inclusive, safe, resilient and sustainable’. This paper hopes to encourage further studies of urban refugee self-settlement and local integration as a viable but complex socio-political-environmental process.

As a mediator variable, self-confidence is one of the most effective elements of the decision-making process of consumer behaviour. This research has studied the effects of different aspects of consuming fashion on the self-confidence and behaviour of consumers in Tehran’s clothing market. This study has considered the acceptance of new products, interest in mode and fashion, utilitarianism, and personal taste in its analysis. This research aims to understand the fashion buying behaviour amongst Iranian consumers in consideration of their attitude towards self-confidence and aspects of fashion consumption. The statistic sample is 400 consumers from Tehran’s clothing market who have been chosen based on the random availability procedure. The primary tool in this research was a questionary used to testify the assumptions and a model fit created by using structural equations and factor analysis. This research showed that the interest in mode and fashion, personal taste, utilitarianism, and new products positively impact self-confidence. In addition, the positive impact of self-confidence on fashion buying behaviour was confirmed.

Deep convolutional neural networks (CNNs) have been widely used in various medical imaging tasks. However, due to the intrinsic locality of convolution operation, CNNs generally cannot model long-range dependencies well, which are important for accurately identifying breast cancer from unregistered multi-view mammograms. This motivates us to leverage the architecture of Vision Transformers to capture long-range relationships of multiple mammograms from the same patient. For this purpose, we employ local Transformer blocks to separately learn patch relationships within a specific view (CC/MLO) of one side (right/left) of mammogram. The outputs from different views and sides are concatenated and fed into global Transformer blocks, to jointly learn patch relationships between two different views of the left and right breasts. To evaluate the proposed model, we retrospectively assembled a dataset involving 949 sets of CC and MLO view mammograms, which include 470 malignant cases and 479 normal or benign cases. We trained and evaluated the model using a five-fold cross-validation method. Without any arduous preprocessing steps (e.g., optimal window cropping, chest wall or pectoral muscle removal, two-view image registration, etc.), our two-view Transformer-based model achieves lesion classification accuracy of 77.0% and area under ROC curve (AUC = 0.814), outperforming state-of-the-art multi-view CNNs by 3.1% and 3%, respectively. Meanwhile, the new two-view model improves mammographic case classification accuracies of two single-view models by 7.4% (CC) and 4.5% (MLO), respectively. The promising results unveil the great potential of using Transformers to develop high-performing computer-aided diagnosis (CADx) schemes of mammography.

This work proposes a new theoretical approach for the next generation of extremely efficient motors, whose impact will be substantial for future sustainable technological development. Building on well-known physical concepts, this approach introduces the concept of equilibrium of mutual retention, upon which a device remains in an equilibrium state between movement and attraction-repulsion. This new theoretical approach showed promising results in computer simulation experiments, indicating that the equilibrium of mutual retention can allow for a new way of modeling an extremely efficient motor. Finally, a theoretical efficiency analysis showed the need to expand the limits of some physical concepts already established.

Universities have increasingly incorporated a third mission into their strategic planning. In addition to teaching and research, they have emphasised the training of entrepreneurs. However, there is still a lot of work to be done, as this process is facing resistance. The Entrepreneurial University covers all disciplines, including faculties of education. However, it has been shown that entrepreneurship tends to be more related to the faculties of economics and engineering, with a lesser presence in the faculties of education for various reasons: they consider entrepreneurship to be alien to their teaching role, there is a lack of entrepreneurial culture, and the objective of the Entrepreneurial University is unknown. The aim of this study is to analyse the level of entrepreneurship in Spanish faculties and schools of education. Forty deans and heads of education faculties in Spain took part in the survey. The results indicated a sufficient level of entrepreneurship; the dimensions related to active methodologies, and mission and strategy were the most developed, whereas entrepreneurship funding and entrepreneurship training for faculty employees were the least developed areas. Some deans noted that entrepreneurship was alien to their professional performance, although courses and good practices for the development of entrepreneurial initiative are gradually being implemented.

Teacher burnout has been revealed to be one of the most common negative consequence of the COVID-19 pandemic The purpose of this study was to identify distinct psychological resources and burnout risk profiles of teachers and to examine their association with Kolb’s Educator Roles and the professional experience. Methods: The survey data were collected from 330 preschool and primary school (84 males, Mage = 38.3, SD = 9.14) teachers using a convenience sampling method. Results: The two-step cluster analysis revealed two distinct profiles. The first profile, ‘High psychological resources, no burnout risk’, was characterised by absent symptoms of burnout and increased levels of well-being, self-control, and positive emotionality. The second profile, ‘Moderate psychological resources, mild burnout’, was associated with medium levels of well-being, self-control and positive emotionality accompanied by mild burnout. Our findings highlighted that cluster 1 had a significantly higher score for the Facilitator role and cluster 2 for the Expert and Coach roles. In addition, teachers with less professional experience were more likely to belong to cluster 1, taking into account their good skills on digital literacy. Conclusions: These findings help to provide new insights into the explanation of teacher burnout and the design of intervention programmes.

Alphaviruses, flaviviruses, measles viruses and rhabdoviruses are enveloped single-stranded RNA viruses, which have been engineered as expression vector systems for recombinant protein expression and vaccine development. Due to the presence of non-structural genes encoding the replicase complex, a 200,000-fold amplification of viral RNA occurs in the cytoplasm of infected cells providing extreme transgene expression levels, which is why they are named self-replicating RNA viruses. Expression of surface proteins of pathogens causing infectious disease and tumor antigens provide the basis for vaccine development against infectious diseases and cancer. The self-replicating RNA viral vectors can be administered as replicon RNA, recombinant viral particles, or layered DNA/RNA replicons. Self-replicating RNA viral vectors have been applied for vaccine development against influenza virus, HIV, hepatitis B virus, human papilloma virus, Ebola virus and recently coronaviruses, especially SARS-CoV-2 the causative agent of the COVID-19 pandemic. Measles virus and rhabdovirus vector-based SARS-CoV-2 vaccine candidates have been subjected to clinical trials. Moreover, RNA vaccine candidates based on self-amplifying alphaviruses have also been evaluated in clinical settings. Various cancers such as brain, breast, lung, ovarian, prostate cancer and melanoma have also been targeted for vaccine development. Robust immune responses and protection have been demonstrated in animal models. Clinical trials have shown good safety and target-specific immune responses. Ervebo, the VSV-based vaccine against Ebola virus disease has been approved for human use.

An introductory course of Arka Dhyana, also known as Intuitive Meditation (IM), consisting of five sessions, was offered to an international audience via Zoom technology. Participants were shown how to connect to their deeper self, essence or soul by bringing their I-ego-awareness from the thinking mind, often associated with the frontal part of the brain, to 19 energetic stations in the body including the heart centre. In this limited study, evaluation was both process and outcome orientated and included HeartMath (HM) Inner Balance or emWave2 electronic technology to measure mean coherence and achievement before and after each session. A highly significant increase in both coherence and achievement in six participants was found, which was also reflected in a reported increase in wellbeing related to feelings in qualitative statements indicating changes in levels of consciousness and individual transformative experiences as predicted by the Theory of the Six Main Levels of Consciousness.

The market for autonomous vehicles (AV) is expected to experience significant growth over the coming decades and to revolutionize the future of transportation and mobility. The AV is a vehicle that is capable of perceiving its environment and perform driving tasks safely and efficiently with little or no human intervention and is anticipated to eventually replace conventional vehicles. Self-driving vehicles employ various sensors to sense and perceive their surroundings and, also rely on advances in 5G communication technology to achieve this objective. Sensors are fundamental to the perception of surroundings and the development of sensor technologies associated with AVs has advanced at a significant pace in recent years. Despite remarkable advancements, sensors can still fail to operate as required, due to for example, hardware defects, noise and environment conditions. Hence, it is not desirable to rely on a single sensor for any autonomous driving task. The practical approaches shown in recent research is to incorporate multiple, complementary sensors to overcome the shortcomings of individual sensors operating independently. This article reviews the technical performance and capabilities of sensors applicable to autonomous vehicles, mainly focusing on vision cameras, LiDAR and Radar sensors. The review also considers the compatibility of sensors with various software systems enabling the multi-sensor fusion approach for obstacle detection. This review article concludes by highlighting some of the challenges and possible future research directions.

In this paper a novel and flexible solution for fault prediction based on data collected from Supervisory Control and Data Acquisition (SCADA) system is presented. Generic fault/status prediction is offered by means of a data driven approach based on a self-organizing map (SOM)and the definition of an original Key Performance Indicator (KPI). The model has been assessed on a park of three photovoltaic (PV) plants with installed capacity up to 10 MW, and on more than sixty inverter modules of three different technology brands. The results indicate that the proposed method is effective in predicting incipient generic faults in average up to 7 days in advance with true positives rate up to 95%. The model is easily deployable for on-line monitoring of anomalies on new PV plants and technologies, requiring only the availability of historical SCADA data, fault taxonomy and inverter electrical datasheet.

The increasingly used approach of combining different simulation software in testing of automated driving systems (ADS) increases the need for potential and convenient software designs. Recently developed co-simulation platforms (CSP) provide the possibility to cover the high demand on testing kilometers for ADS by combining vehicle simulation software (VSS) with traffic flow simulation software (TFSS) environments. The emphasis on the demand of testing kilometers is not enough to choose a suitable CSP. The complexity level of the used vehicle, object, sensors and environment models is essential for valid and representative simulation results. Choosing a suitable CSP raises the question of how the test procedures should be defined and constructed and what the relevant test scenarios are. Parameters of the ADS, the environments, objects, sensors in VSS as well as traffic parameters in TFSS can be used to define and generate test scenarios. In order to generate a large number of scenarios in a systematic and automated way, suitable and appropriate software designs are required. In this paper we present a software design for CSP based on the Model-View-Controller (MVC) design pattern and implementation of a complex CSP for virtual testing of ADS. Based on this design, an implementation of a CSP is presented using the VSS from IPG Automotive called CarMaker and the TFSS from PTV Group called Vissim. The results have shown that the presented CSP design and the implementation of the co-simulation can be used to generate relevant scenarios for testing of ADS.

We previously showed that, based on the frequency and distribution of specific cell types, rainbow trout (RT) intestinal mucosa is divided in two regions that form a complex nonlinear 3D pattern and have a different renewal rate. This work had two aims. First, to investigate whether the unusual distribution of cell populations reflects a similar distribution of functional activities. To this end, we determined the protein expression pattern of three well defined enterocytes functional markers: Peptide Transporter 1 (PepT1), Sodium-Glucose/Galactose Transporter 1 (SGLT-1) and fatty acid-binding protein 2 (Fabp2). Second, to characterize the structure of RT intestinal stem cells (ISC) niche and to determine whether the different proliferative rates correlate with a different organization and/or extension of the stem cells population. We studied the expression and localization of well-characterized mammal ISC markers: LGR5, HOPX, SOX9, NOTCH1, DLL1 and WNT3A. Our results indicate that morphological similarity is associated with similar function only between the first portion of the mid-intestine and the apical part of the complex folds in the second portion. Mammal ISC markers are all expressed in RT but their localization is completely different suggesting also substantial functional differences. Finally, higher renewal rates are supported by a more abundant ISC population.

We propose a novel transfer learning method for speech emotion recognition allowing us to obtain promising results when only few training data is available. With as low as 125 examples per emotion class, we were able to reach a higher accuracy than a strong baseline trained on 8 times more data. Our method leverages knowledge contained in pre-trained speech representations extracted from models trained on a more general self-supervised task which doesn’t require human annotations, such as the wav2vec model. We provide detailed insights on the benefits of our approach by varying the training data size, which can help labeling teams to work more efficiently. We compare performance with other popular methods on the IEMOCAP dataset, a well-benchmarked dataset among the Speech Emotion Recognition (SER) research community. Furthermore, we demonstrate that results can be greatly improved by combining acoustic and linguistic knowledge from transfer learning. We align acoustic pre-trained representations with semantic representations from the BERT model through an attention-based recurrent neural network. Performance improves significantly when combining both modalities and scales with the amount of data. When trained on the full IEMOCAP dataset, we reach a new state-of-the-art of 73.9% unweighted accuracy (UA).

Influence of particle size on the mechanical strength of alkali activated material from waste refractory monolithic was investigated in this study. Precursor was chemically and mineralogically analysed, separated on 4 fractions and alkali activated with Na-water glass. Alkali activated materials were thoroughly investigated under SEM and XRD to evaluate the not predicted differences in mechanical strength. Time dependence of curing temperature on mechanical strength was investigated in the sample prepared from a fraction that caused the highest compressive strength.

Within the task of replacing bronze journal bearings with aluminum the processes taking part on friction surface of high-alloyed aluminum alloys working with steel are investigated. The surface and subsurface layer of experimental aluminum bearings were studied before and after tribological tests by scanning electron microscopy including energy-dispersive analysis. Both structural and composition changes in surface layer are shown. It has been revealed that secondary structures are formed on the surface during friction process and include all the chemical elements of the tribosystem which is a consequence of its self-organization. The interaction behavior of some chemical elements of tribological system is discussed.

The increasing number of registered road crashes involving cyclists during the last decade, and the high proportion of road crashes resulting in severe injuries and fatalities among cyclists constitutes a global issue for community health, urban development, and sustainability. Nowadays, the incidence of many risk factors for road crashes of cyclists remains largely unexplained. Given the importance of this issue, the present study has been conducted with the aim of determining relationships between infrastructural, human factors and safety outcomes of cyclists. Objectives: This study aimed, first, to examine the relationship between key infrastructural and human factors present in cycling, bicycle-user characteristics, and their self-reported experience with road crashes. And second, to determine whether a set of key infrastructural and human factors may predict their self-reported road crashes. Methods: For this cross-sectional study, a total of 1064 cyclists (38.8% women, 61.2% men; M = 32.8 years of age) from 20 different countries across Europe, South America and North America, participated in an online survey composed of four sections: demographic data and cycling-related factors, human factors, perceptions on infrastructural factors, and road crashes suffered. Results: The results of this study showed significant associations between human factors, infrastructural conditions and self-reported road crashes. Also, a logistic regression model found that self-reported road crashes of cyclists could be predicted through variables such as age, riding intensity, risky behaviors, and problematic user/infrastructure interactions. Conclusions: The results of this study suggest that self-reported road crashes of cyclists are influenced by features related to the user and their interaction with infrastructural characteristics of the road.

Highly flexible manufacturing systems require continuous run-time (self-) optimization of processes with respect to various parameters, e.g. efficiency, availability, energy consumption etc. A promising approach for achieving (self-) optimization in manufacturing systems is the usage of the context sensitivity approach. Thereby the Cyber-Physical Systems play an important role as sources of information to achieve context sensitivity. In this paper it is demonstrated how context sensitivity can be used to realize a holistic solution for (self-) optimization of discrete flexible manufacturing systems, by making use of Cyber-Physical System integrated in manufacturing systems/processes. A generic approach for context sensitivity, based on self-learning algorithms, is proposed aiming at a various manufacturing systems. The new solution is propos encompassing run-time context extractor and optimizer. Based on the self-learning module both context extraction and optimizer are continuously learning and improving their performance. The solution is following Service Oriented Architecture principles. The generic solution is developed and then applied to two very different manufacturing processes. This paper proposes a holistic solution to achieve context sensitivity for Flexible Manufacturing Systems, whereby the knowledge created by applying the context sensitivity approach can be used for (self-) optimization of manufacturing processes.

Over 2.2 billion people across the globe face significant barriers to accessing essential ophthalmic care, with elderly, rural, and refugee populations being disproportionately affected. These obsta-cles deepen existing disparities in eye care. 3D printing is a novel technology that has the potential to transform the field and improve access through alleviating many patient-specific barriers. This article delves into the evolution of 3D printing within ophthalmology, highlighting its current ap-plications and future potential. It explores various 3D printing techniques and biomaterials, dis-cussing their effectiveness in creating advanced solutions such as bioengineered corneas, ocular prosthetics, and innovative treatments for dry eye syndrome. Additionally, 3D printing has rev-olutionized drug delivery systems for conditions like glaucoma, retinal diseases, and for ocular brachytherapy. Despite its promise, the integration of 3D printing into clinical practice presents challenges, which the article addresses alongside strategies for overcoming them. By mapping out the technological advancements and challenges, this review offers a roadmap for enhancing global eye care accessibility and improving patient outcomes on a global scale.

Background: The Second Victim Phenomenon (SVP) significantly impacts the well-being of healthcare professionals and patient safety. While SVP has been explored in various healthcare settings, there is limited data on its prevalence and associated factors among nurses in Austria. This study investigates the prevalence, symptomatology, and preferred support measures for SVP among Austrian nurses. Methods: A nationwide, cross-sectional, anonymous online survey was conducted using the SeViD questionnaire (Second Victims in German-speaking Countries), which includes the Big Five Inventory-10 (BFI-10). Statistical analyses included binary logistic regression and multiple linear regression using the bootstrapping, bias-corrected and accelerated (BCa) method based on 5000 bootstrap samples. Results: 928 participants responded to the questionnaire. Among the respondents, 81.58% (744/912) identified as Second Victims (SVs). The primary cause of becoming a SV was aggressive behavior from patients or relatives. Females reported a higher symptom load than males, and higher agreeableness was linked to increased symptom severity. Notably, 92.47% of SVs who sought help preferred support from colleagues, and the most pronounced desire among participants was to process the event for better understanding. Conclusions: The prevalence of SVP among Austrian nurses is alarmingly high, with aggressive behavior identified as a significant trigger. The findings emphasize the necessity for tailored support strategies, including peer support and systematic organizational interventions to mitigate the impact of SVP on nurses and to improve overall patient care. Further research should focus on developing and implementing effective prevention and intervention programs for healthcare professionals in similar settings.

Congenital heart disease (CHD) is a prevalent congenital disorder diagnosed with high frequency, affecting approximately 0.8% to 1.2% of all live births. Research has demonstrated that the use of pulse oximetry and clinical examination as a screening tool for CHD diagnosis has proven extremely valuable. We conducted a retrospective longitudinal study over a 3-year period that involved screening 1188 newborns admitted to the NICU during the first 72 hours of life within this timeframe. 201 newborns were diagnosed with CHD. Almost all (n=198) had a positive screening test during the 72-hour period, while 3 had a negative screening test, but were later diagnosed using echocardiography. The prevalence rate was 16.67%. A confusion matrix was constructed with 198 true positives (TP), 3 false negatives (FN), no false positives (FP), and 987 true negatives (TN). The sensitivity of the screening test was 98.51%, while the specificity 100%, with no false positives. In our study, a total of 9 deaths occurred. Using the Kaplan-Meier method, the survival probability appeared to be slightly above 0.9 (95.5%), indicating that almost all patients survived past 72 hours after being diagnosed with CHD. Pulse oximetry is an effective, low cost and easy-to-use method and a useful tool to assess and lead to the diagnosis of CHD.

Primary care pediatricians encounter a wide range of complex conditions in their daily clinical practice. It is not uncommon for their patients to get exposed to medical errors. Diagnostic errors, defined as missed, delayed, or wrong diagnosis, are of great importance as they may cause significant harm to the pediatric patient with severe disease. These errors often occur when the symptoms and signs of a disease are atypical or missing. Data on the most frequent misdiagnosed situations in pediatrics is scarce. One of these groups of conditions is that regarding cardiac diseases. The pediatric cardiology field has met rapid development over the past few decades. Primary care providers play a key role in diagnosis, management, and referral of children with heart disease, both congenital and acquired, because many common cardiac complaints are first addressed in the primary care setting. The scope of this review is to investigate the cardiac entities that are often missed by the general pediatricians. In particular, it aims to spot the most common of them, to describe their clinical presentation, their diagnostic options, red flags, and tips, and to provide the ways to avoid erroneous, delayed, or missed diagnosis.

Objective: To compare the incidence of skin abrasions caused by traditional straight edge flip flop straps versus rolled inner seam (RIS) designs in a controlled laboratory setting using preserved fetal pig skin as a proxy for human skin.Methods: This study utilized a custom-built apparatus to apply friction from two flip flop strap designs to preserved fetal pig skin samples. Three trials were conducted for each strap design to determine the time to initial abrasion onset. A paired t-test was employed for statistical analysis.Results: The RIS design demonstrated a statistically significant delay in abrasion onset compared to the standard design across all trials (p < 0.05), indicating a gentler interaction with the skin.Conclusion: The RIS strap design may offer a beneficial alternative to traditional straps by reducing the friction that can lead to skin abrasions, suggesting a potential to decrease the risk of dorsal foot ulcers. Further studies involving human subjects are warranted to validate these findings in a real-world context.Keywords: Flip flop strap design, skin abrasions, dorsal foot ulcers, footwear design, developing countries, diabetic foot care.

More than 13.5 billion COVID-19 vaccine doses have so far been delivered between 2021 and 2023 through a mix of delivery platforms, with mass vaccination campaigns being the main approach. In 2022, with the most likely scenario of continued circulation of SARS-CoV-2 and the need for periodic booster doses, there was a need for countries to plan for more sustainable approaches to provide COVID-19 vaccination. In this context of uncertainty, a global tool for integrating COVID-19 vaccines into immunization programmes and primary health care was published jointly by WHO and UNICEF to respond to country needs. The guidance leveraged existing health system frameworks, proposed four steps for the COVID-19 integration journey, and identified investment areas. The development process maximized robust global stakeholder and country engagement, and the timeframe was aligned with donor funding windows to support the integration of COVID-19 vaccination. The rapid dissemination of guidance allowed its use by countries to ascertain their readiness for integrating COVID-19 vaccination and inform the development of national plans and funding applications. While progress has been made in specific areas (e.g., optimizing cold chain and logistics leveraging COVID-19 vaccination), in the context of decreasing demand for COVID-19 vaccines, reaching adult COVID-19 vaccine high-priority-use groups and engaging and coordinating with other health programmes (beyond immunization) remains a challenge. We share the learning that despite the uncertainties of a pandemic, guidance documents can be developed and used within a short timeframe. Working in partnership with stakeholders beyond immunization towards a common objective is powerful and can allow progress to be made on integrating health services and preparing better for future pandemics.

Analytical chemistry applied to medical and diagnostic analysis, recently focused on the development of cost-effective biosensors able to monitor the health status or to assess the level of specific biomarkers that can be indicative for several diseases. The improvement of technologies relating to the possibility of non-invasive sampling of biological fluids, as well as sensors for the detection of analytical signals and the computational capabilities of the systems routinely employed in everyday life (e.g. smartphones, computers, etc.), make the complete integration of self-standing analytical devices more accessible. This review aims to discuss the biosensors that have been proposed in the last 5 years focusing on two principal detecting approaches, optical and electrochemical, which have been employed for quantifying different kind of target analytes reaching detection limits below the clinical sample levels required. These detection principles applied to Point-of-care (POC) devices, have been extensively reported in literature and even the limited examples found on the market are based on these strategies. This work will show the latest innovations considering the integration of optical and electrochemical detection with the most commonly reported analytical platforms for POC applications such as paper-based or wearable and implantable devices.

To ensure high-quality care, operationalize resilience and fill the knowledge gap regarding how to improve the prerequisites for resilient performance, it is necessary to understand how adaptive capacity unfolds in practice. Coronavirus 2019 stress-tested complex healthcare systems, and intensive care was driven to an unprecedented escalation. The main aim of this research was to explain the escalation process of intensive care from a microlevel perspective, including expressions of resilient performance, intervening conditions at the micro-meso-macrolevels and short- and long-term consequences. A secondary aim was to provide clinical recommendations regarding how to optimize the prerequisites for resilient performance in intensive care. A grounded theory methodology was used. First-person stories from different healthcare professionals (n70) in two Swedish regions were analyzed using the constant comparative method. A novel conceptual model of the escalation process of intensive care emerged, and 41 clinical recommendations concerning the optimal prerequisites for resilient performance were identified. Escalation was conceptualized as a transition from threatening chaos to temporary order through a complex process of adaptation. To prepare for the future, the components space, stuff, staff, system and science with associated continuity plans must be implemented, anchored and communicated to actors at all levels of the system.

Background: This study investigated the incidence, characteristics and functional outcomes associated with unplanned Acute Care Unit Readmissions (ACUR) during inpatient traumatic brain injury (TBI) rehabilitation in an Asian cohort. Methods: Retrospective review of electronic medical records from single rehabilitation unit was conducted from 1 Jan 2012 to 31 Dec 2014. Inclusion criteria were first TBI, aged &gt;18 years, admitted &lt; 6 months of TBI. ACUR were characterized into either of neurological, medical or neurosurgical subtypes. The main outcome measure was discharge Functional Independence Measure (FIM). Secondary outcomes included rehabilitation length of stay (RLOS). Results: Of 121 eligible TBI records, the incidence of ACUR was 14% (n=17), comprising neurologic (76.5%) and medical (23.5%) subtypes, occurring at median of 13 days (IQR 6, 28.5) after rehabilitation admission. Patients without ACUR had significantly higher admission mean (SD) FIM score compared to those with ACUR (FIM ACUR-negative 63.4 (21.1) vs FIM ACUR-positive 50.53(25.4), P =0.026). Significantly lower discharge FIM was noted in those with ACUR compared to those without. (FIM ACUR-positive 65.8(31.4) vs FIM ACUR-negative 85.4 (21.1), P = 0.023) Furthermore, a significant near-doubling of RLOS was noted in ACUR patients compared to non-ACUR counterparts [ACUR-positive median 55 days (IQR 34.50, 87.50) vs ACUR-negative median 28 days (IQR 16.25, 40.00), P = 0.002]. Conclusion: This study highlights the significant negative functional impact and lengthening of rehabilitation duration of ACUR on inpatient rehabilitation outcome for TBI.

Public Health Officers' (PHO) experiences in reaction to the COVID-19 pandemic can be based on whether the PHO is passive or active. Therefore, the study’s objectives are to identify the types of experiences and analyse the predictors of proactive practical experiences in solving COVID-19 among PHOs in the upper southern region of Thailand. Methods: An explanatory mixed-methods approach was used to collect data, through questionnaires and online in-depth interviews. The study was conducted from August 4, 2020, to August 3, 2021. Results: The results included 60 PHOs from 60 PCUs in 6 provinces, with 41 (68.3%) females and an average age of 35.57 years (SD = 11.61). The PHOs’ knowledge, understanding, and participation experience aspects were mostly proactive rather than passive. Factors that significantly predicted proactive practical experiences included sex (ORadj = 1.52, 95% CI = 1.04–2.21), age (ORadj = 1.69, 95% CI = 1.16-2.48), married status (ORadj = 1.69, 95% CI = 1.16-2.48), education level (ORadj = 1.50, 95% CI = 1.02–2.20), and position for work (ORadj = 1.69, 95% CI = 1.16-2.48). Conclusions: PHOs’ knowledge, understanding, opinion, and participation experiences were significant predictors of practical experience. Primary health care systems should promote proactive experiences in all four aspects to increase proactive practical experiences.

Older adults in low-and middle-income countries experience a disproportionate burden of non-communicable diseases (NCDs). Unintentional injuries are among the major NCDs, and falls are the second leading cause of these injuries and deaths worldwide, including in Thailand. We aimed to culturally adapt the CDC’s Stopping Elderly Accidents, Deaths, and Injuries (STEADI) for Thai older adults and explore the feasibility, appropriateness, and acceptability of using STEADI in primary care via trained community health workers (CHWs) and care managers (CMs). STEADI takes a coordinated care approach that consists of three steps: screening, assessing, and intervening. In Step a, CHWs screened fall risk in 20 community-dwelling older adults using three key questions and found that all of them had fall risk, then CHWs screened with a Stay Independent questionnaire (range 0-14) and found that 100% have high fall risk (total scores 9.7± 2.4). In Step b, CMs assessed balance, vision, footwear, postural hypotension, medications, and CHWs assessed home hazards. They found that 50% had poor balance, 70% took 4+ medications,75% fell on the walkway, and 70% had no bathroom modifications. In Step c, individual participants received fall prevention interventions to mitigate their specific fall risk factors. CHWs and CMs indicated high acceptability (19.20±.1.31 of 20 total), appropriateness (18.80± 1.79 of 20 total), and feasibility (18.60±1.67 of 20 total) of the Thai-STEADI intervention. Our study showed that the community-based multifactorial Thai-STEADI delivered by CHWs and CMs is feasible and acceptable to prevent falls in older adults with limited access to health care.

COVID-19 pandemic-related pressures on primary care may have driven inappropriate continuation of antibiotic prescriptions. Yet prescribing modality (repeat/non-repeat) has not previously been investigated in a pandemic context. Using the OpenSAFELY-TPP analytics platform, we analysed repeat/non-repeat prescribing frequency in monthly patient cohorts between Jan 2020–2022. In-depth analysis was conducted on Jan 2020 (“pre-pandemic”) and Jan 2021 (“pandemic”) cohorts. Per-patient prescribing and clinical conditions were determined by searching primary care record data using clinical code lists. Repeat prescribing was defined as >=3 prescriptions in a 6 month lookback period. Associations between demographics (e.g. age, sex, geography) and repeat/non-repeat prescribing were explored using unadjusted risk ratios. Antibiotic prescribing declined from May 2020; non-repeat prescribing declined more strongly than repeat prescribing (maximum declines -26% vs -11%, respectively). In the pandemic cohort, older patients were at higher risk of prescribing (especially repeat prescribing). The most common clinical conditions for repeat prescribing were COPD comorbidity and urinary tract infection. Comorbidities were more common among repeat vs non-repeat prescribed patients. In the pandemic cohort, vs pre-pandemic, repeat and non-repeat prescribing for comorbidities generally declined less compared with shorter-term conditions (infections, including COPD exacerbation/lower respiratory tract infection). Our findings inform ongoing development of stewardship interventions in England..

We sought to calculate the extra social costs resulting from child abuse in residential care facilities (RCFs) for children with disabilities (CWD) in Japan. We distributed a survey to 260 residential facilities for CWD in 2020 and obtained responses from 91 facilities. Among the children admitted to these facilities, 23–67% were affected by child abuse. We estimated the extra costs to be an average of USD 647.7 million. This study is meaningful in that there are no existing official statistics or research findings on the extra costs of residential care due to child abuse in Japan.

Background: Media coverage of Lyme disease (LD) has led to an increase in consultations for presumed LD in Europe. However, LD is confirmed in only 10-20% of patients, with a significant number remaining in a diagnostic dead-end. Objectives: To reach a deeper understanding of how patients themselves contribute to the diagnostic process. To describe the genesis of the LD hypothesis in care pathways. Methods: In 2019, 30 patients from a prospective cohort consulting in the infectious diseases department at University Hospital in Marseille for presumed LD were recruited for semi-structured interviews. The inclusion criteria were : suffering from subjective symptoms for 6 months, no clinical or paraclinical argument suggesting current LD. The patients’ medical trajectories were collected using a biographical approach. Results: The diagnosis of Lyme disease was primarily triggered by identification with personal testimonies found on the internet. Most of patients were leading their own diagnostic investigation. The majority of participants were convinced they had LD despite the lack of medical evidence and the scepticism of their referring GP. Conclusion: GPs should first systematically explore patients’ etiologic representations in order to improve adherence to the diagnosis especially in the management of medically unexplained symptoms. Long COVID-19 syndrome challenge offers an opportunity to promote active patient involvement in diagnosis.

Background and Objectives: Acute Heart Failure (AHF) is a common disease and a cause of high morbidity and mortality, constituting a major health problem. The main purpose of this study was to determine the impact of multiorgan ultrasound in identifying the pulmonary hypertension (PH) in patients admitted due to AHF, predict the evolution of the disease during hospitalization and identify areas of improvement in the care of patients with AHF. Materials and Methods: Patients were evaluated with a standard exam of lung ultrasound, echocardiography, inferior vena cava (IVC) and femoral, renal, hepatic, portal venous Doppler flow patterns at admission and on the day of discharge. Results: Thirty patients were enrolled during November 2021. The mean age was seventy-nine years (Standard Deviation – SD 13,4). Seven patients (23.3%) had a renal function worsening. Regarding ultrasound findings, venous excess ultrasonography score (VExUS) score was calculated at admission and at discharge, surprisingly remaining unchanged or even worsened in most of them (21 patients, 70.0%). The area under the curve for the Lung Score was 83.9% (p = 0.008), obtaining a cutoff value of 10 that showed a sensitivity of 82.6% and a specificity of 71.4% in the identification of intermediate and high PH. It was possible to monitor significant changes between both exams on the lung score (p &lt;0.001), hepatic vein Doppler (p &lt;0.001), portal vein Doppler (p = 0.030), intra-renal vein Doppler (p = 0.025) and VExUS score (p = 0.023), remaining similar the femoral vein Doppler (p = 0.177) and IVC (p = 0.132). Conclusions: Our study results suggest that performing serial multiorgan Point-of-Care ultrasound can help us to better identify high and intermediate probability of PH patients with AHF. Currently proposed multi-organ, venous Doppler scanning protocols, such as the VExUS score, should be further studied in different populations before expanding its use in AHF patients.

Glioblastoma (GBM) is one of the most aggressive solid tumors, particularly due to the presence of cancer stem cells (CSCs). Today the characterization of this type of cells with an efficient, fast and low-cost method remains an issue. Hence, we have developed a microfluidic lab-on-a-chip based on dielectrophoresis (DEP) single cell electro-manipulation to measure the two crossover frequencies: f_x01 in low frequency range (below 500 kHz) and f_x02 in Ultra High Frequency range (UHF, above 50 MHz). First, in vitro conditions were investigated. U87-MG cell lines were cultured in different conditions in order to induce an undifferentiated phenotype. Then, ex vivo GBM cells from patients’ primary cell culture, were passed through the developed microfluidic system and characterized in order to reflect clinical conditions. This article demonstrates that the usual exploitation of low frequency range DEP does not allow the discrimination of the undifferentiated from the differentiated phenotypes of GBM cells. However, the presented study highlights the use of UHF-DEP as a relevant discriminant parameter. The proposed microfluidic lab-on-a-chip is able to follow the kinetic of U87-MG phenotype transformation in a CSC enrichment medium and their cancer stem cells phenotype acquirement.

Maternal-child care is one of the foundations of primary health care. Nurses’ competency skills they have been taught. Community awareness is an important part of preventive healthcare, and nurses must be aware of the factors that impact the health of the community. This study examines the effectiveness of lecture-based instructions in maternal and child care and its implications to students' social competency skills and community awareness in Nursing Colleges in Nueva Ecija, Philippines. The researcher uses survey questionnaire and employed the descriptive design where fifteen (15) nursing students and five (5) teachers were purposively selected. The findings revealed that the weighted mean for the effectiveness of lecture based instruction in maternal and child care is 3.91 with verbal description of “Effective”, the effects of lecture based instruction in maternal and childcare to students’ social competency skills and community awareness got the weighted mean of 3.87 and interpreted as “very satisfactory” and the effectiveness of actual community-based instruction is very effective with weighted mean of 4.25 and is higher compare to lecture based instruction. The results also revealed that students and teachers were challenged in lecture-based instruction in maternal and chi8ldcare during distance learning. Recommendations for the enhancement of lecture-based instruction in maternal and childcare in social competency skills and community awareness were also made.

Background: Australia’s healthcare system is complex and fragmented which can create challenges in healthcare, particularly in rural and remote areas. Aboriginal people experience inequalities in healthcare treatment and outcomes. This study aimed to investigate barriers and enablers to accessing healthcare services for Aboriginal people living in rural and remote Australia. Methods: Semi-structured interviews were conducted with healthcare delivery staff and stakeholders recruited through snowball sampling. The communities were selected for their high proportion of Aboriginal people and geographical representation (coastal, rural, and border). Thematic analysis identified barriers and enablers. Results: Thirty-one interviews were conducted (n =5 coastal, n=13 remote, and n=13 border) and six themes identified: 1) Improved coordination of healthcare services; 2) Better communication between services and patients; 3) Trust in services and cultural safety; 4) Importance of prioritizing health services by Aboriginal people; 5) Importance of reliable, affordable and sustainable services; 6) Distance and transport availability. These themes were often present as both barriers and enablers to healthcare access for Aboriginal people. They were also present across the healthcare system and within all three communities. Conclusions: This study describes a pathway to better healthcare outcomes for Aboriginal Australians by providing insights into ways to improve access.

Smoking is a major risk factor for non-communicable diseases and remains a significant public health challenge in many lower- and middle-income countries (LMIC) including Namibia. The purpose of the study was to estimate the prevalence of smoking and its associated risk factors among HCWs and non-HCWs in Zambezi region. An exploratory cross-sectional survey was conducted between March and October 2020 among residents of the eight (8) constituencies of Zambezi region. Four hundred and sixty-one (461) respondents who had been residents of the selected constituencies for over five years and aged between 17-60 years were selected for the study. The main outcome measure was current cigarette smoking status. Descriptive statistics were used to summarize the socio-demographic characteristics of the respondents. We stratified data analysis by individual being health workers or non-health workers. A bivariate Pearson Chi-square test was used to determine the association between socio-demographic characteristics and the smoking status. Statistically significant variables in the bivariate analysis were used as predictors in the univariate and multivariate models. The response rate of potential participants was 95% (n=434). The mean (±SD) age of participant’s was 32.5 (± 11.34 years). Significant relationships were observed between smoking status and area of residency (constituency), gender, age category, level of education, age of onset of smoking and the daily smoking frequency. The majority of smokers (n=108) were none-HCWs with males being the majority (n=62). Age (p=0.001), education levels (p=0.001) and area of residency (p=0.022) were highly associated with smoking among none-HCW while marital status was associated with smoking among HCWs (p=0.013). In the final multivariate model, the odds of smoking among female non-HCWs were significantly lower (OR: 0.386; 95% CI: 0.228 – 0.655). Furthermore, the odds of smoking among this same group were lower among those who had secondary level education (OR: 0.178; 95% CI: 0.0659 – 0.483), post-secondary (OR: 0.117, 95% CI: 0.0412 – 0.330) and first stage tertiary (OR: 0.306: 95% CI: 0.106 – 0.881) compared to those who had primary school education. In conclusion, smoking prevalence among none HCWs and HCWs working in Zambezi included in the study was similar to that of the general Namibian population but higher than other neighboring countries within SADC. The results showed a need for the establishment of specific smoking related strategies that target HCWs to address smoking use parallel to the running of none HCWs which would ultimately decrease the smoking prevalence and improve health.

Objective: The private healthcare providers (PHCP) are believed to improve access to healthcare services in Public-Private Mix (PPM) projects, as they are considered first point of contact for healthcare. The purpose of this study was to know the satisfaction level of TB patients. Design: A questionnaire-based, cross-sectional study was carried out during November and December 2017 for 572 under-treatment patients registered with PHCPs in the PPM project. Lot quality assurance sampling technique was used to randomly select 19 districts from sample frame of 75 districts. In each selected district, data collector retrieved TB register of 8 months (Jan – Aug 2017) and systematically selected patients by fixed periodic interval. SPSS (version 24.0) was used to analyze the data. Results: Study included 53% (n=301) of males and 47% (n=271) of females, with mean age of 38 years (SD, ±18). Almost half of the participants were illiterate (51%, n=289) and 64% (n=365) were non-earning members of the family. In practice, most of the participants visit private providers (71%, n=407), including private hospital/clinic (44%) and traditional practitioners (27%; n=153). 55% of participants visited the current doctor because of clinic’s proximity to residence. 82% of the participants (n=469) were satisfied with the TB care services and 85% (n=488) said that they would recommend this clinic to others. Conclusion: PHCPs are preferred providers for individuals, which is consistent with findings of other studies. Though they are satisfied with TB care and services, interventions should be introduced to reduce the financial burden on the patient. Partnering PHCP is a way forward to ensure universal health coverage, health system strengthening and better health outcomes of the population.

Age-in-place can reduce the progress of dementia syndrome and improve the quality of life of the sufferers and their families. This work proposes an innovative information home support system to be established at the houses of people suffering from dementia. The main innovation of the system are its transparent character that overcomes the need for training of the sufferer, as well as the exploitation of a well-known technique for dementia, namely music therapy. It addresses the need of people suffering from dementia as well as their familiars to be recognized by them and have better interaction and collaboration. The system offers a ubiquitous recognition system, just by using smart devices like smart-phones or smart-wristbands. When a familiar person is detected in the house, then a sound file is reproduced on smart speakers placed in the house, in order to trigger the memory, based on the principles of music therapy. The system reproduced the appropriate time at 100% of the cases and the benefits of music therapy are evident daily. To the best of the authors' knowledge, this is the first system of its kind ever reported in the literature.

The role of vitamin D in the prevention and treatment of non-skeletal health issues has received significant media and research attention in recent years. Costs associated with clinical management of low vitamin D (LVD) have increased exponentially. However, no clear evidence supports vitamin D screening to improve health outcomes. Authoritative bodies and professional societies recommend against population-wide vitamin D screening in community-dwelling adults who are asymptomatic or at low risk of LVD. In order to assess patterns of physician management of LVD in this conflicting environment, we conducted a scoping review of three electronic databases and gray literature. Thirty-eight records met inclusion criteria and were summarized in an evidence table. Results from seven countries showed a consistent increase in vitamin D lab tests and related costs. Many vitamin D testing patterns reflected screening rather than targeted testing for individuals at high risk of vitamin D deficiency or insufficiency. Interventions aimed at managing inappropriate clinical practices related to LVD were effective in the short term. Variability and controversy were pervasive in many aspects of vitamin D management, shining light on physician practices in the face of uncertainty. Future research is needed is needed to inform better clinical guidelines and to assess implementation practices that encourage evidence-based management of LVD in adult populations.

This is the second of a series of two papers comparing the end of life issues in human and veterinary medicine. We outline the main differences between human and animal patients such as patient communication, finance and ‘conflicts of interest’ between animal, owner and veterinarian. We discuss striking similarities between human and veterinary issues such as assessing quality of life and the primary role of the attending veterinarian or doctor being the welfare and care of the patient. This paper takes the form of an ethical argument in favour of allowing euthanasia in human medicine, by providing insights into end of life issues for humans from an independent veterinary perspective. Veterinary surgeons are well trained in the ethics of euthanasia and put it to good use in the best interest of their animal patients. Doctors in the UK are limited and unwilling to put forward a case for the option of euthanasia for those patients who face a slow and agonizing death. With advances in medical science being able to significantly prolong the dying process, autonomy for the patient demands a review of the law regarding patient choice in the UK.

Crowd abnormal behavior recognition is one of the research hotspots in computer vision. Its goal is to use computer vision technology and abnormal behavior detection models to accurately perceive, predict, and intervene in potential abnormal behaviors of the crowd, and monitor the status of the crowd system in public places in real-time, to effectively prevent and deal with public security risks and ensure public life safety and social order. To this end, focusing on the crowd abnormal behavior recognition technology in the computer vision system, a systematic review study of its theory and cutting-edge technology is conducted. First, the crowd level and abnormal behaviors in public places are defined, and the challenges faced by crowd abnormal behavior recognition are expounded. Then, from the dimensions based on traditional methods and based on deep learning, the mainstream technologies of abnormal behavior recognition are discussed, and the design ideas, advantages, and limitations of various methods are analyzed. Next, the mainstream software tools are introduced to provide a comprehensive reference for the technical framework; Secondly, typical abnormal behavior datasets at home and abroad are sorted out, and the characteristics of these datasets are compared in detail from multiple perspectives such as scale, characteristics and uses, and the performance indicators of different algorithms on the datasets are compared and analyzed; Finally, the full text is summarized and the future development direction of crowd abnormal behavior recognition technology is prospected.

This research paper investigates the enhancement of strength and performance of self-compacting concrete (SCC) for integration in Department of Public Works and Highways (DPWH) projects using a value engineering approach. The study explores key elements of SCC's strength and performance, including mix design optimization, construction practices, and durability considerations. Strategies to optimize SCC's strength, durability, and workability are discussed, emphasizing the benefits of SCC in improving construction efficiency and quality control within DPW infrastructure. The study also identifies challenges and gaps in SCC utilization, such as standardized performance verification and cost considerations, and proposes future directions for advancing SCC technology in civil infrastructure development.

The significance of digital sustainability in donation-based crowdfunding platforms lies in its ability to encourage environmentally aware and socially responsible practices in the sphere of online philanthropy. Fundraising has been revolutionized by the emergence of donation-based crowdfunding platforms. This study explores the various factors influencing individuals' attitudes towards these platforms, particularly focusing on perceived usefulness, ease of use, credibility, and self-efficacy. The study examines how these factors affect donation intentions and electronic word-of-mouth intentions, utilizing data from 326 college students. The findings confirm that perceived usefulness, ease of use, credibility, and self-efficacy play crucial roles in shaping attitudes. Furthermore, these attitudes significantly impact both donation intentions and electronic word-of-mouth intentions. Adjustments to the structural model highlight the interconnectedness of these factors, improving the model's accuracy. The results provide practical guidance for platform administrators, campaign creators, and stakeholders involved in online philanthropy, emphasizing the need for user-friendly designs, trust-building, and fostering user confidence for successful crowdfunding efforts.

Such rapidly changing external conditions as the COVID-19 pandemic and the war in Ukraine, being pure crisis phenomena, not only determine the geopolitical and geoeconomic situation on the global markets, but also cause structural changes in individual countries. Under these conditions, the level of food self-sufficiency becomes particularly important, as it is one of the factors determining the food security of any country. The aim of the research is to assess Ukraine's food self-sufficiency compared to the European Union and Poland. The self-sufficiency ratio (SSR) index was used to assess food self-sufficiency. This is the ratio of the volume of production of the most important products of plant and animal origin to the volume of domestic consumption. Domestic consumption was defined as the volume of domestic production increased by the volume of imports, reduced by the volume of exports and also included changes in domestic stock levels. The surveyed time frame is 2019–2021. The analyzed data were taken from the State Statistics Service of Ukraine, FAOSTAT, USDA and Statistics Poland. A comparative analysis of self-sufficiency for the main agri-food sectors of Ukraine, the EU, and Poland showed significant differences. Taking into account the production potential and food self-sufficiency indicators of Ukraine, Ukraine's possible accession to the EU can be expected to have a major impact on the EU's supply and demand situation, as it may pose a threat to many EU agri-food sectors.

Quinacridone (QA) and 2,9-dimethylquinacridone (DQA) are synthetic substances suitable as a hard, abrasion-resistant, self-organizing gliding layer on ice, snow, and water. For sustainable use, a large number of parameters must be considered to demonstrate that these non-biogenic substances and their by-products and degradation products are harmless to humans and the environment in the quantities released. For this task, available experimental data are used and supplemented for all tautomers by numerous relevant physical, chemical, toxicological and ecotoxicological estimated values based on various Quantitative Structure Activity Relationship (QSAR) methods. On the one hand, the low solubility of QA and DQA leads to stable gliding layers and thus low abrasion and uptake by plants, animals, and humans. On the other hand, the four hydrogen bond forming functional groups per molecule allow nanoparticle decomposition and enzymatic degradation in natural environments. All available data justify a sustainable use of QA and DQA as a gliding layer. The assessment of the toxicological properties is complemented with an investigation of the size and morphology of DQA particles as well as field tests indicating an excellent performance as a gliding layer on snow.

Stroke causes disability and significantly affects patient quality of life. Post-stroke rehabilitation of upper limb function is crucial, as it affects daily activities and individual autonomy. Traditional rehabilitation methods often require frequent visits to specialized centers, which can be costly and challenging. This study investigated the effectiveness of a home-based self-training device, "Kenko Yusuri," in improving upper limb function in patients with chronic stroke. This multicenter prospective intervention study used a quasi-randomized controlled trial design. Ninety-three outpatients from five hospitals in Japan were enrolled and assigned to either the intervention group who used the "Kenko Yusuri" device or the control group who underwent conventional rehabilitation. All patients received botulinum toxin type A (BoNT-A) injections to treat upper limb spasticity. The primary outcome measure was the Fugl-Meyer Assessment (FMA) of upper-extremity motor function. Secondary outcomes included the modified Ashworth scale (MAS) score, range of motion (ROM), and chronic pain assessments. The intervention group demonstrated significantly greater improvements in FMA total scores than the control group. Patients with moderate paralysis experienced the greatest benefits from the intervention. There were no significant between-group differences in MAS scores or ROM measurements. Pain and wrist ROM showed improvement in the intervention group. Home-based training with a shaking device significantly improved upper limb function in patients with moderate chronic post-stroke paralysis. This approach aligns with the principles of use-dependent plasticity and offers a feasible and cost-effective alternative to traditional rehabilitation methods.

This study presents the chemical synthesis, purification, and characterization of a novel non-natural synthetic amino acid. The compound was synthesized in solution, purified, and characterized using NMR spectroscopy, polarimetry, and melting point determination. Dynamic Light 22 Scattering (DLS) analysis demonstrated its ability to form aggregates with an average size of 391 nm, extending to low micrometric sizes. Furthermore, cellular biological assays revealed its ability to enhance fibroblast cell growth, highlighting its potential for tissue regenerative applications. Circular dichroism (CD) spectroscopy showed the ability of the synthetic amino acid to bind serum albumins (using bovine serum albumin (BSA) as a model), and CD deconvolution provided insights into the changes in secondary structures of BSA upon interaction with the amino acid ligand. Additionally, molecular docking using HDOCK software elucidated the most likely binding mode of the ligand inside the BSA structure. We also performed in silico oligomerization of the synthetic compound in order to obtain a model of aggregate to investigate computationally. More in detail, in the dimer formation achieved by molecular self-docking, two distinct poses were observed, corresponding to the lowest and comparable energies, with one pose exhibiting a quasi-coplanar arrangement characterized by a close alignment of two aromatic rings from the synthetic amino acids within the dimer, suggesting the presence of π-π stacking interactions. In contrast, the second pose displayed a non-coplanar configuration, with the aromatic rings oriented in a staggered arrangement, indicating distinct modes of interaction. Both poses were further utilized in the self-docking procedure. Notably, iterative molecular docking of amino acid structures resulted in the formation of higher-order aggregates, with a model of a 512-mer aggregate obtained through self-docking procedures. This model of aggregate presented a cavity capable of hosting therapeutic cargoes and biomolecules, rendering it a potential scaffold for cell adhesion and growth in tissue regenerative applications. Overall, our findings highlight the potential of this synthetic amino acid for tissue regenerative therapeutics and provide valuable insights into its molecular interactions and aggregation behavior.

In the face of escalating climate concerns and the push for sustainable development, the global shift towards renewable and decentralized energy systems presents new challenges and opportunities. This study investigates integrating decentralized energy production, particularly photovoltaic (PV) systems, into national energy planning, aiming to optimize energy strategies that balance local production and consumption with national objectives. By analyzing the Swiss energy model, the research employs the EnergyScope and REHO models to assess the strategic implications of decentralized versus centralized energy systems. Results show that a decentralized approach can significantly reduce PV installation needs to 35 GW, about 23% of potential capacity, and decrease annual system costs by 10% to CHF 1230 per capita. This strategy emphasizes local consumption, minimizes grid reinforcement demands, and leverages economic advantages while addressing overproduction challenges through effective energy storage and grid management. Conclusions underline the strategic value of combining centralized and decentralized methods for resilient and sustainable energy planning. The study contributes to the discourse on energy policy and infrastructure planning, advocating for a hybrid model that accommodates both local conditions and broader energy objectives, urging further research into climate impacts and technology integration for a comprehensive energy future.

This study proposed to use wearable EEG to study the impact of vipassana mindfulness practice on beginner's physiological and neurological responses. Mindfulness meditation has been shown to have numerous benefits, including stress reduction, improved attention and cognitive function, and enhanced emotional regulation. The roots of mindfulness meditation in Buddhism emphasize cultivating present-moment awareness and insight. However, the neural mechanisms together with physiological mechanism and their interaction underlying these benefits remain poorly understood. Method: One middle age man (50 years old) participated in this longitudinal study using wearable EEG to investigate the neurophysiological change during a one-month consecutive vipassana mindfulness practice. Both EEG and heart rate responses were recorded each time, before (5 minutes), during (20 minutes), and after (5 minutes) meditation sessions. The EEG and HR data were analyzed by Matlab and EEGlab to examine changes in brainwave activity and heart rate. Results: alpha peak frequency (APF) is significantly lower after mindfulness meditation, as shown by comparison of APF before mindfulness (pre-5) and during mindfulness practice (med-20), and comparison between APF of pre-5 and after mindfulness practice (post-5). The same is with the beta peak power. While for theta peak frequency, it is significant lower during mindfulness meditation (med-20), when comparing to either pre-5 or post-5. See figure 1a. However, peak power index is not so sensitive, and it is more obvious in theta wave band. That is, the theta power peak is significantly lower after meditation, as can be observed in comparison between pre-5 and med-20, also between pre-5 and med-20. See figure 1b. STATE Heart-mean (bpm) Heart-std(bmp) pre-5 69.88 3.88 med-20 68.36 2.81 post-5 69.55 4.13 t-value test (pre-med) 0.0694 0.0003 t-value test (pre-post) 0.7934 0.3656 t-value test (post-med) 0.3193 0.0001 Table 1. The difference of Heart rate (mean and SD) in before (pre-5), during (med-20) and after (post-5)mindfulness meditation. We find significant change in standard deviation (SD) of heart rate between meditation and non-meditation mental states, as shown in table 1. The study provides insights into the underlying neurophysiological mechanisms of mindfulness meditation using wearable EEG devices. It demonstrates that in term of EEG measurement, spectrum frequency can be more sensitive than spectrum power; also heart rate variability as measured by SD is more sensitive to mean of HR. The proposed study contributes to the literature by using wearable EEG devices to collect data in a more accessible and convenient manner.